[Master trainer concept "structured specialist further education" : A joint project of the German Professional Associations of Internal Medicine, Surgeons and Orthopedic/Trauma Surgeons]. / Mastertrainerkonzept "Strukturierte Facharztweiterbildung" : Ein gemeinsames Projekt der Deutschen Berufsverbände der Internisten, Chirurgen und Orthopäden/Unfallchirurgen.

BACKGROUND: The quality requirements in the practice of postgradual medical further education below the normal level of the further education regulations is a barely developed scientific field in Germany. A systematic use of internationally accepted scientific evidence barely exists. AIM: This research and development project was initiated in 2001 in order to be able to implement a practical but evidence-based model compatible with the existing structure of postgradual medical education. This project has been supported since 2013 by the Professional Associations of Internal Medicine (BDI), Surgeons (BDC) and Orthopedic and Trauma surgeons (BVOU). METHODS: The development phase of this complex intervention was based on three stages involving stakeholder interviews from relevant groups, the identification of a theoretical model for the construction and systematic literature reviews to identify the relevant evidence. RESULTS: The basic model for structured specialist further education developed included the creation and implementation of a simple core curriculum for every department, a tool for systematic feedback within the framework of the annual further education interviews and a simple clinical assessment to evaluate the actual clinical performance of physicians in further education. A pilot test of this model was carried out in 150 specialist departments in Germany and continually developed. DISCUSSION: The project shows that such a program can be systematically developed and pilot studies can be carried out. The central problems in implementation involve the traditional informal further education culture, which as a rule does not implement a systematic elicitation of the state of learning continuously distributed over the whole period of further education and the practical testing of competence development.

[Implementation of a competency-based graduate medical education program in a neurology department]. / Einführung eines kompetenzbasierten Facharztweiterbildungsprogramms in einer neurologischen Abteilung.

BACKGROUND: Competency-based programs have long been the basis of graduate medical education in British and North America. Such formally defined program structures are lacking in German graduate medical education. METHODS: The methods and assessment tools used in a curriculum-based program of graduate education in medical specialties are presented. The feasibility of the program was tested in day-to-day use in a pilot study conducted within a neurology department. Experience of it during a 1-year period after implementation has also been collected. RESULTS: It was found that implementation of the program is feasible providing that both the trainers and the students are well motivated, that adequate resources are provided, and that a formal training system is provided for the trainers. This is confirmed by the 1-year experience of the program in routine clinical practice. CONCLUSIONS: The competency-based program presented, which is compatible with many quality management systems, offers management and assessment tools that will make for more satisfactory postgraduate medical education.

Relationship between amniotic fluid insulin and maternal blood glucose concentrations in patients with carbohydrate intolerance during pregnancy.

In contrast to maternal blood glucose, amniotic fluid insulin (AFI) directly reflects the functional state of the fetal pancreas. In a prospective study we evaluated the correlation of AFI with maternal metabolic control in 70 amniotic fluid specimens from 61 women having carbohydrate intolerance during pregnancy (White A n = 44, B0 n = 17). AFI was measured with the Insulin RIA 100 kit from Pharmacia (Freiburg). The normal range of AFI was established in 304 healthy pregnant women (16th-42nd gestational week). AFI concentrations increased by a factor of 1.5 to 2 during gestation reflecting the maturation of the fetal pancreas. Elevated AFI levels (> 97th centile) were found in 11% of normoglycemic diabetics and in 50% of women with insufficient metabolic control. Despite a high overall concordance (81%) no direct relationship could be found between fetal and maternal parameters. Patients with increased AFI values had a 5-fold higher rate of large-for-gestational age (LGA) infants than women with normal levels. This finding confirms the pathogenetic role of hyperinsulinism in the development of fetal macrosomia.

[Pregnancy outcome with intensified insulin therapy in manifest diabetes]. / Schwangerschaftsausgang unter intensivierter Insulintherapie bei manifestem Diabetes.

In 1981, the intensified insulin therapy for achievement of euglycaemia in pregnant diabetics was introduced at the University Department of Obstetrics and Gynaecology in Cologne. This study compares the results of 112 pregnancies in women with overt diabetes monitored before (1971-1980) or after (1981-1988) changing the therapeutic regimen. In the period from 1981 to 1988, the proportion of euglycaemic patients (preconceptionally 19%, before delivery 79%) was clearly higher than from 1971 to 1980 (n = 42; 7% and 9%, respectively). The tight blood glucose control resulted in a doubling of hypoglycaemic episodes during pregnancy. The proportion of preterm deliveries was reduced from 47% to 24%. The rate of caesarean sections was nearly constant (1971-1980: 38%, 1981-1988: 34%). The marked success of therapy was the decrease of perinatal mortality from 20.9% to 2.9%. The perinatal morbidity also diminished, as shown by the decreasing rates (30-90%) of foetopathy, macrosomy, respiratory distress syndrome, birth trauma, hypoglycaemia, hypocalcaemia and polycythaemia. The malformation rate, however, remained high (1971-1980 = 7%, 1981-1988 = 11%). The results demonstrate the necessity of a strict blood glucose control during pregnancy, beginning before the time of conception.

Epidemiology of HIV and hepatitis B virus (HBV) in selected African and Asian populations.

401 sera from patients of a rural hospital in Zimbabwe (1987), 211 South African sera (1982/83), as well as 460 sera from four Katmandu hospitals (1985) were tested for HIV-1 antibodies. The sera from Zimbabwe and Nepal were additionally tested for anti-HIV-2 using a panel of different tests, for hepatitis B markers, and partially for antibodies against other viral, bacterial, and protozoal antigens. Detailed clinical and sociodemographic data were taken from the Zimbabwe and Katmandu patients. The prevalence of HIV-1 antibodies in the Zimbabwe study population was 3.2%. All infections were found in the age group 17 to 30 years (n = 254). The epidemiological situation was entirely different from that of HBV (hepatitis B virus). No serum could be confirmed to be anti-HIV-2-positive, but a definite diagnosis is still difficult to establish. Regular town contacts may be considered a possible risk factor. Antibodies against HIV-1 could not be detected in the South African and Asian sera. The seropositivity for anti-HBc in Katmandu (14%) and the prevalence of HBsAg (1.1%) was much lower than reported from other Asian countries.

PIP: 401 sera from patients in a rural hospital in Zimbabwe (1987), 211 South African sera (1982-83), as well as 460 sera from 4 Kathmandu hospitals (1985) were tested for HIV-1 antibodies. The sera from Zimbabwe and Nepal were additionally tested for anti-HIV-2 using a panel of different tests for hepatitis B markers and partially for antibodies against other viral, bacterial, and protozoal antigens. Detailed clinical and sociodemographic data were taken from the patients in both groups. The prevalence of HIV-1 antibodies in the Zimbabwe study population was 3.2%. All infections were found in the 17-30 year age group (n=254). The epidemiological situation was entirely different from that of HBV (hepatitis B virus). No serum could be confirmed to be anti-HIV-2- positive, but a definite diagnosis is still difficult to establish. Regular town contracts may be considered a possible risk factor. Antibodies against HIV-1 could not be detected in the South African and Asian sera. The seropositivity for anti-HBc in Kathmandu (14%) and the prevalence of HBsAg (1.1%) was much lower than reported from other Asian countries. (author's modified)