Needlestick and sharps injuries at a German university hospital: epidemiology, causes and preventive potential - a descriptive analysis.

OBJECTIVES: To analyze the number, epidemiology and circumstances of needlestick and sharps injuries (NSSI) and exposures to body fluids and to identify further preventive measures to improve the occupational safety of health care workers (HCW). MATERIAL AND METHODS: Setting: German university tertiary-care referral center. Retrospective study based on injury documentation sheets of the hospital's staff and faculty health service and, if given, on reports by continuity doctors and by the accident and emergency department in January 2014-June 2016. RESULTS: Altogether, 567 injuries were registered with a significant decrease of cases over the study period. The majority of accidents occurred in the operating theater (35%). Stress, time pressure, overstrain, carelessness and distraction were found to be the main reasons for injuries. At least 30% of the cases were preventable, mainly by wearing personal protective equipment (PPE), by proper disposal of an item and by early replacement of overfilled sharps containers (SC). In 20% of the cases involving an item, the injury was caused by a safety-engineered device (SED). Almost one-third of these injuries were attributable to an improper use of the SED. CONCLUSIONS: Despite many efforts made to reduce their number, NSSI still occur. Health care workers and students should be offered regular trainings to be sensitized to this topic and to learn the appropriate use of SED. Moreover, organizational measures must be taken, such as the provision of suitable PPE and safe SC. Strategies need to be established to improve the working conditions and reduce the stress level of HCW. Int J Occup Med Environ Health. 2022;35(5):497-507.

Academic emotions during an interprofessional learning episode in a clinical context: assessing within- and between-variation.

Emotional experiences in the context of learning play an important role in the handling of learning processes. The aim of this study was to track participants' self-reported academic emotions using a momentary assessment design with 14 measurement points to identify patterns and emotional states. In a 2-week course, 35 medical and nursing students were assigned to work together in small groups and assess real cardiac patients' histories, treatment, and care. Thirty-two students participated in the study. Within means, standard deviations, and intra-class correlation coefficients were assessed to consider the relative proportion of within- and between-individual variation. Type of activity, time of day and group effects were investigated by means of ANOVAs or Mann-Whitney U tests. Results show a heterogeneous pattern of positive moods and only marginal occurrence of negative moods. Within variation was bigger than between variation of most positive moods. The highest positive affect was reported during a reflective seminar. Negative affect was higher during a stressful task. Medical and nursing students only differed in terms of their nervousness. It was also revealed that the variation in moods differed to a great extent between the small groups. The findings support the importance of academic emotions in interprofessional learning. Designing IPE to foster positive emotions during the learning processes might help students to be able to apply their knowledge and insights on the benefits of interprofessional collaboration in future working environments.

Understanding Mental Burden and Factors Associated With Study Worries Among Undergraduate Medical Students During the COVID-19 Pandemic.

The Coronavirus disease 2019 (COVID-19) pandemic is affecting many areas of life and has led to major changes in undergraduate medical education. Even before the COVID-19 pandemic, high mental burden of medical students has frequently been reported in the literature. Additional pandemic-specific stressors could exacerbate this situation. This study aimed to assess mental health outcomes among medical students during the first semester after the COVID-19 outbreak and perception of the students on how the learning environment has changed. In May 2020, we conducted a cross-sectional survey among undergraduate medical students at a large medical school in Germany. The survey included validated mental health instruments (Distress Thermometer, Patient Health Questionnaire 4) and self-developed items to examine the perception of the study situation during the COVID-19 pandemic. Open-ended questions were analyzed by conventional content analyses. The response rate was 59.2% (914/1,545). Overall, 61.9% of the students reported distress levels above the cutoff. Year 1 students reported significantly higher levels of distress, anxiety and depression than students during their second to fourth year of studies. 48.3% of the students indicated a decrease in their study motivation since the beginning of the COVID-19 pandemic with significant differences between study years. The binary logistic regression model showed that male gender, being in study year 2, higher distress scores and higher symptoms of depression were significantly associated with a higher likelihood for experiencing serious worries. In the open-ended questions on current concerns related to the impact of the COVID-19 pandemic on their studies, students most frequently reported concerns about missing relevant practical learning experience, difficulties with self-regulated learning and self motivation as well as study-related worries. Year 4 students reported significantly more worries about the lack of practical training than students from study years 1 to 3. Analysis of gender differences showed that female students reported more frequently diverse worries. In contrast, female students shared more frequently helpful strategies in all the categories compared to male students. Our findings suggest that medical students experience significant levels of distress and mental burden during the COVID-19 pandemic and highlight the need for ongoing psychological and educational support for medical students during the COVID-19 pandemic and after.

Perception of the study situation and mental burden during the COVID-19 pandemic among undergraduate medical students with and without mentoring.

Objectives: The COVID-19 pandemic caused drastic changes in medical education and might affect students' mental health and perception of study conditions. Mentoring may have mediating effects by enhancing social support. The University Medical Center Hamburg-Eppendorf (UKE) offers a voluntary general mentoring program (g-mentoring) for all interested students and a mentoring program for students with excellent course results and scientific interest (e-mentoring) We aimed to investigate the mental burden and views of their study situation during COVID-19 among students who did or did not participate in one of the formal mentoring programs. Method: We conducted a cross-sectional online survey (May 2020) examining students' mental burden using the Patient Health Questionnaire (PHQ-4), and assessing their perception of study conditions and digital teaching using self-developed items. Results: Of 1193 invited students, 543 (45.5%) completed the survey. 35% of those participated in the g-mentoring and 7% in the e-mentoring. 59% did not participate in any program. More e-mentees than g-mentees and nonparticipants reported clinically unproblematic levels of anxiety and depression symptoms. The majority of students (55%) was somewhat worried about the impact of the pandemic on their study situation. Regarding digital teaching students did not feel overburdened by the lack of a fixed schedule and structure, e-mentees even less than g-mentees and nonparticipants. Both g-mentees and nonparticipants were significantly more appreciative of the possible repeated use of the digital teaching materials than e-mentees (both groups M=5.7 vs. M=5.4 in e-mentees, p=.045). Conclusion: The results indicate that while students feel substantially burdened by the situation and the majority worries about the impact of the pandemic on their studies, they also seem to cope well with the digital course format. Study motivation during COVID-19 decreased among the majority of students with and without mentoring. These aspects may be important to address by medical schools interested in developing effective interventions to support students during a pandemic and continuous online teaching.

Presentation and evaluation of the teaching concept "ENHANCE" for basic sciences in medical education.

A solid understanding of basic sciences is a prerequisite for successful completion of medical education. Therefore, it is essential to improve the quality of teaching and to ensure the applicability of basic sciences. Based on practical experiences and previous research, we developed an innovative step-by-step concept, called ENHANCE, for the implementation or revision of teaching units, especially for basic sciences. We used comparative self-assessment gains, a questionnaire to assess teaching quality as well as end-of-semester evaluations (students' satisfaction and open-ended questions) to evaluate the ENHANCE concept. It was found that ENHANCE-based teaching units were related to increased students' satisfaction, high attendance rates and that restructuring the course curriculum yielded in a positive assessment of teaching effectiveness. The revised courses were rated as the very best of all classes in several semesters. Qualitative data showed that students particularly appreciated the level of comprehension and how helpful the courses were for the understanding and preparation of the regular curriculum.

The Hamburg integrated medical degree program iMED.

The integrated medical degree program (iMED) was established in winter semester 2012/2013 at the Faculty of Medicine of Universität Hamburg with the aim of improving medical education. The main features of the iMED medical degree program include the close integration of theoretical knowledge and practical skills, scientific orientation and the teaching of psychosocial and communication skills. All these features are commonly found in the modular compulsory core curriculum and elective courses ("2nd Tracks"): The compulsory core curriculum comprises 19 modules which are arranged thematically in seven module groups and cover three stages of a "learning spiral". By comprehensively coordinating the teaching content and the learning objectives of the participating theoretical and clinical subjects, theoretical content is taught on the basis of real patient's medical histories from the first stage of the learning spiral. The elective courses enable students to learn and apply scientific work in a structured curriculum according to their own interests. Relevant practical skills for students future professional routines are taught in the longitudinal training course "Clinical Examination Methods plus Communication" (KUMplusKOM), which runs through the entire curriculum up to the final practical year. Accompanying, extra-curricular projects such as crash courses in the natural sciences or using the iMED Textbook as an online learning platform increase the attractiveness of the iMED degree program. Results of the evaluation show that the introduction and the accompanying optimization of iMED were very successful.

Genome-wide association study identifies inversion in the CTRB1-CTRB2 locus to modify risk for alcoholic and non-alcoholic chronic pancreatitis.

OBJECTIVE: Alcohol-related pancreatitis is associated with a disproportionately large number of hospitalisations among GI disorders. Despite its clinical importance, genetic susceptibility to alcoholic chronic pancreatitis (CP) is poorly characterised. To identify risk genes for alcoholic CP and to evaluate their relevance in non-alcoholic CP, we performed a genome-wide association study and functional characterisation of a new pancreatitis locus. DESIGN: 1959 European alcoholic CP patients and population-based controls from the KORA, LIFE and INCIPE studies (n=4708) as well as chronic alcoholics from the GESGA consortium (n=1332) were screened with Illumina technology. For replication, three European cohorts comprising 1650 patients with non-alcoholic CP and 6695 controls originating from the same countries were used. RESULTS: We replicated previously reported risk loci CLDN2-MORC4, CTRC, PRSS1-PRSS2 and SPINK1 in alcoholic CP patients. We identified CTRB1-CTRB2 (chymotrypsin B1 and B2) as a new risk locus with lead single-nucleotide polymorphism (SNP) rs8055167 (OR 1.35, 95% CI 1.23 to 1.6). We found that a 16.6 kb inversion in the CTRB1-CTRB2 locus was in linkage disequilibrium with the CP-associated SNPs and was best tagged by rs8048956. The association was replicated in three independent European non-alcoholic CP cohorts of 1650 patients and 6695 controls (OR 1.62, 95% CI 1.42 to 1.86). The inversion changes the expression ratio of the CTRB1 and CTRB2 isoforms and thereby affects protective trypsinogen degradation and ultimately pancreatitis risk. CONCLUSION: An inversion in the CTRB1-CTRB2 locus modifies risk for alcoholic and non-alcoholic CP indicating that common pathomechanisms are involved in these inflammatory disorders.