[Illness behavior and expectations on physician-patient relationships of medical students in the second and fifth year of education]. / Krankheitsverhalten und Arzt-Patient-Beziehungserwartungen bei Medizinstudenten. Ein Vergleich zwischen vorklinischem und klinischem Studium.

We investigated illness behaviour and treatment expectations of future physicians. 209 medical students in their second and 110 students in their fifth year of education were examined by means of a specific questionnaire and the Biographic Inventory for Diagnosis of Abnormal Behaviour (BIV). As to our questionnaire we found a six factors solution that could explain 44% of the variance. Students in the fifth year of education were more critical towards physicians, waited longer until they took advantage of professional help, tried more to influence both the diagnostic and therapeutic process and they adhered stronger to a psychosocial concept of illness than the second year students. Women desired more psychological support and fell back on household remedies more often than men. Students who had experienced a poor parent-child-relationship also were dissatisfied with their physician-patient-relationship. Introverted students were less demanding towards their physicians and more often searched for help in the lay system than extroverted students. With these factors, behaviour, experiences and attitudes of medical students with reference to a potential or actual patient role can be well described.

[Hospital data management at the Graz University Ophthalmology Clinic]. / Krankenhausdaten-Management der Universitäts-Augenklinik Graz.

In 1991, the eye hospital at the University of Graz initiated the development of a system for the documentation of patient data and services provided. The starting point of the hospital data management system was the surgical documentation system. This made it possible for the patient to be transferred to the ward accompanied by the completed and signed surgical report. In the subsequent steps we developed a complete client server system adapted to the different specific needs of all the various sections of the eye hospital. A further important feature is the fact that all the data are available for access at every part of the hospital. The current version has been in use since 1996, and will be discussed below. The main features of our hospital data management system are automated coding of medical services provided in the diagnostic, surgical and outpatient areas, and guaranteed authenticated data. Automatic generation of findings, reports, etc, allows the physician to concentrate fully on medical concerns. For a modern, service-oriented hospital, complete records of the services provided are indispensable. Complete recording of services is, however, possible only via automation. In our case, this means not only that the available data are always correct (up to date), but also that there is wide acceptance of and reliance on these data by the medical staff. Since the system is an in-house development, it is possible to react rapidly to suggestions for improvement and to eliminate possible errors immediately. The hospital data management system of the eye hospital at the University of Graz is a well-functioning example that makes it worthwhile discussing the greater use of subsystems.

[Interdisciplinary longitudinal curriculum "Medical Psychology, Psychotherapy and Psychosomatics." Experiences from the preclinical segment]. / Fachübergreifendes Längsschnittcurriculum "Medizinische Psychologie, Psychotherapie und Psychosomatik." Erfahrungen aus dem vorklinischen Abschnitt.

The departments of Medical Psychology, Psychosomatics and Psychotherapy developed an interdisciplinary longitudinal curriculum in order to coach medical students for the whole length of their medical education. Experiences from the first four undergraduate semesters are reported. 46 students (33 females, 13 males), mean age 22.3 +/- 2.6 years, attended 60 hours of interdisciplinary group sessions. Frequent motives to join the course were interest in psychosocial disciplines and relevant previous experience. The students expected to benefit from this project in their study, their future practice as a physician, and in their personal development. Important educational goals that could be attained were the adoption of a patient-centred view in medicine as well as strengthening of the students' critical capacities and sensitivity. The students especially appreciated the possibility of group discussions and the opportunity to participate actively in the course. Based on a critical review of the evaluation, the possibility of a transfer of our model is considered and perspectives for the future are developed.

Detection of antichlamydial antibodies in tears: a diagnostic aid?

OBJECTIVES: The antibody response in sera and tears of 167 patients with suspected chlamydial conjunctivitis was compared with the antibody response in sera and tears of 45 patients with symptoms of urogenital chlamydial infection to discover whether and which type of antichlamydial antibody detected in tears may be of diagnostic help in chlamydial conjunctivitis. METHODS: Diagnosis was based on chlamydial antigen detection from the conjunctiva and urogenital tract, done by a direct immunofluorescence assay, McCoy cell culture, and polymerase chain reaction. Additionally, antichlamydial immunoglobulin A (IgA) and immunoglobulin G (IgG) were determined in sera and tears of all patients by an immunoperoxidase assay. RESULTS: Two hundred twelve patients were examined--167 with conjunctivitis, 45 with symptoms of urogenital chlamydial infection. Cell culture, direct immunofluorescence assay, and polymerase chain reaction brought identical results. Conjunctival specimens taken from 33 (20%) of the patients with conjunctivitis were Chlamydia antigen positive; specimens taken from 134 (80%) were negative. Antichlamydial antibodies were found in tears of 29 (88%) of the patients with conjunctivitis whose specimens were Chlamydia antigen positive. Fifty-four (40%) of the patients with conjunctivitis whose specimens were Chlamydia antigen negative had antichlamydial antibodies in their tears. Twenty-five patients with urethritis (56%) were Chlamydia antigen positive in urethral swabs; 20 (44%) were negative. Antichlamydial antibodies were found in the tears of eight (32%) of the Chlamydia antigen-positive and two (10%) of the Chlamydia antigen-negative patients with urethritis. In contrast to patients with conjunctivitis, findings for patients with urethritis always were negative for antichlamydial IgG in the tears. CONCLUSION: Antichlamydial antibodies in tears were seen significantly more often in patients with conjunctivitis than in those with urethritis (P < or = 0.05). Antichlamydial IgG was found only in tears of patients with conjunctivitis. Therefore, the authors conclude that the detection of antichlamydial IgG in the tears might be helpful for diagnosis in patients with suspected chlamydial conjunctivitis who have antigen-negative conjunctival swabs.

Evaluation of two nonculture antigen tests and three serotests for detection of anti-chlamydial antibodies in the diagnosis of ocular chlamydial infections.

BACKGROUND: Diagnosis of chlamydial conjuctivitis is difficult in chronic diseases because chlamydial elementary bodies are mostly undetectable in conjunctival scrapings by cell culture. We therefore compared two nonculture antigen tests and three different serotests for anti-chlamydial antibodies with McCoy cell culture, the "gold standard" of chlamydial diagnosis. Conjunctival scrapings and serum samples of 93 patients attending the outpatient eye clinic in Graz because of chronic follicular conjunctivitis were tested. METHODS: A total of 558 conjunctival scrapings and 93 serum samples were investigated. Chlamydial antigen detection was done by McCoy cell culture, polymerase chain reaction (PCR; Amplicor, Roche), and direct immunofluorescence assay (DFA; Microtrak, Syva). Antichlamydial IgA and IgG antibodies in the sera were detected by an immunoperoxidase assay (IPAzyme, Savyon) and two different enzyme-linked immunosorbent assays (SeroELISA, Savyon and rELISA, medac). RESULTS: Cell culture and PCR yielded identical results. The positivity rate for chlamydial conjunctivitis was 8.6% (8 of 93 patients). PCR proved most sensitive and most specific. IPAzyme was 75% sensitive for IgA and 100% for IgG; SeroELISA and rELISA were less sensitive. IPAzyme was 81% specific for IgA and 47.3% for IgG. SeroELISA and rELISA were less specific for IgA, but more specific for IgG. Post-test likelihood of disease was greatest in IPAzyme. CONCLUSIONS: PCR proved to be a good alternative to cell culture; DFA is useful for quick diagnosis. Genus-specific serotests cannot compete with chlamydial antigen detection. They differ in sensitivity and specificity because of the antigen type they present. They are still of only supportive value in cases where chlamydial antigen detection is not possible. Recently introduced species-specific antibody tests should be of greater value.

[Computer-assisted multimedia interactive learning program "Primary Open-Angle Glaucoma"]. / Das computergestützte multimediale interaktive Lernprogramm "Primäres Offenwinkelglaukom".

INTRODUCTION: Advances in the area of information technology have opened up new possibilities for the use of interactive media in the training of medical students. Classical instructional technologies, such as video, slides, audio cassettes and computer programs with a textbook orientation, have been merged into one multimedia computer system. The medical profession has been increasingly integrating computer-based applications which can be used, for example, for record keeping within a medical practice. The goal of this development is to provide access to all modes of information storage and retrieval as well as documentation and training systems within a specific context. MATERIAL AND METHODS: Since the beginning of the winter semester 1995, the Department of Ophthalmology in Giessen has used the learning program "Primary Open Angle Glaucoma" in student instruction. One factor that contributed to the implementation of this project was that actual training using patients within the clinic is difficult to conduct. Media-supported training that can provide a simulation of actual practice offers a suitable substitute. The learning program has been installed on Power PCs (Apple MacIntosh), which make up the technical foundation of our system. The program was developed using Hypercard software, which provides userfriendly graphical work environment. This controls the input and retrieval of data, direct editing of documents, immediate simulation, the creation of on-screen documents and the integration of slides that have been scanned in as well as QuickTime films. All of this can be accomplished without any special knowledge of programming language or operating systems on the part of the user. RESULTS: The glaucoma learning program is structured along the lines of anatomy, including an explanation of the circulation of the aqueous humor, pathology, clinical symptoms and findings, diagnosis and treatment. This structure along with the possibility for creating a list of personal files for the user with a collection of illustrations and text allows for quick access to learning content. The program is designed in such a way that working with and through it is done in a manner conducive to learning. Student response to the learning program as an accompaniment to instruction has been positive. CONCLUSION: Independent, supplemental student learning by means of an interactive learning program has raised the quality of study within the sciences. The use of a pedagogically sound multimedia program, that is oriented toward problem solving and based on actual cases offers students the opportunity to actively work ophthalmological material. An additional benefit is the development of competence in working with computer-support information systems, something that is playing an ever-increasing role within the medical profession.

[Evaluating an interactive, multi-media learning system for the study of primary open angle glaucoma]. / Evaluierung des interaktiven, multimedialen Lernsystems zum Studium des Primären Offenwinkelglaukoms.

Using the interactive multimedia learning system for studying open-angle glaucoma [3] a prospective, randomized, case-controlled study was carried out to determine the value of this new form of learning in terms of acceptance and the imparting of knowledge. This article describes details of the study and presents their results. Results were established on the basis of targeted questions asked prior to and after the learning phase, followed by an analysis of frequencies and significance testing by the Chi squared method. It was shown that the imparting of knowledge is significantly improved when this learning system is employed. In addition, after its first use, acceptance of this new medium rose dramatically.

[Interactive, multimedia learning system for the study of primary open angle glaucoma--system description from the viewpoint of the computer scientist]. / Interaktives, multimediales Lernsystem zum Studium des Primären Offenwinkelglaukoms--Systembeschreibung aus der Sicht des Informatikers.

For use on an Apple Macintosh PC, a software packet was developed with the aid of which medical students can learn all about primary open-angle glaucoma; at the same time, it is also highly suitable for supplementing lectures. The subject is subdivided into the three sections anatomy, pathology and clinical picture. All the possibilities of computer technology, for example controllable animation, video sequences and special graphic effects are utilized. A special lexicon, a complex of questions and all the possible cross-references combine to make the learning system a very flexible and highly effective learning tool.

[Tonometry with a new non-contact tonometer]. / Zur Tonometrie mit einem neuen Non Contact-Tonometer.

We conducted comparative measurements with 100 healthy probands and patients suffering of glaucoma with both a Goldmann Applanation Tonometer (GAT) and the new Keeler Non Contact Tonometer (NCT). A noticeable conformity of mean values in the group I with values under 23 mm Hg and in group II with values greater or equal 23 mm Hg was obvious. The results of three NCT measurement values were compared with those of four measurements. The Keeler NCT nearly fulfills the needed criteria for the first group with pressure under 23 mm Hg except for a high standard deviation. In group II (pressure greater or equal 23 mm Hg) the demanded nominal values are exceeded.

Taste thresholds in man are differentially influenced by hydrocortisone and dexamethasone.

The present study focused on sensory processing (taste threshold) in healthy young men given different cortisol doses within the normal physiological range. It aimed to differentiate the effects of dexamethasone, a synthetic pure glucocorticoid, compared to hydrocortisone, which has both glucocorticoid and mineralocorticoid properties. In a double-blind, cross-over design, 18 male subjects participated in three sessions. Subjects were pretreated orally with hydrocortisone (50 mg), dexamethasone (2 mg) or placebo. Taste detection was tested by a forced-choice three stimulus drop technique to determine detection acuity and a signal detection procedure to determine the ability to detect differences in NaCl concentration. Cortisol concentrations were determined in blood and saliva. Hydrocortisone and dexamethasone had opposite effects on taste detection acuity. With the highest cortisol levels after intake of hydrocortisone, subjects made more errors in detection trials with respect to stimuli close to the absolute taste detection threshold than after intake of dexamethasone. Detection of differences was impaired by both glucocorticoids. This type of behavioral study in man may help clarify the roles of heterogeneous corticosteroid receptor systems within the human brain.

[Development of gas-driven pump intended for implantation for long-term administration of drugs]. / Entwicklung einer zur Implantation vorgesehenen, dampfdruckgetriebenen Pumpe für die Langzeitapplikation von Pharmaka.

A prototype is presented of a new, implantable therapeutic system for parenteral long-term administration of drugs. It consists of a casing with two chambers separated by a membrane. One of the chambers contains the dissolved substance and includes an interchangeable device to expel the substance. This chamber can be refilled transcutaneously through an opening which is then reclosed. The other chamber contains an isobarically expandable propulsive substance which exerts pressure upon the membrane to cause the solution to be expelled. The liberation time depends upon the particular expelling device used and the viscosity of the medicinal solution. The pharmaceutical and technological aspects of the applicability of this prototype in vitro are examined and discussed.