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Objective: The amendment of the Medical Licensing Act (ÄAppO) in Germany in 2002 led to the introduction of graded assessments in the clinical part of medical studies. This, in turn, lent new weight to the importance of written tests, even though the minimum requirements for exam quality are sometimes difficult to reach. Introducing exam quality as a criterion for the award of performance-based allocation of funds is expected to steer the attention of faculty members towards more quality and perpetuate higher standards. However, at present there is a lack of suitable algorithms for calculating exam quality. Methods: In the spring of 2014, the students‘ dean commissioned the „core group“ for curricular improvement at the University Medical Center in Rostock to revise the criteria for the allocation of performance-based funds for teaching. In a first approach, we developed an algorithm that was based on the results of the most common type of exam in medical education, multiple choice tests. It included item difficulty and discrimination, reliability as well as the distribution of grades achieved. Results: This algorithm quantitatively describes exam quality of multiple choice exams. However, it can also be applied to exams involving short assay questions and the OSCE. It thus allows for the quantitation of exam quality in the various subjects and – in analogy to impact factors and third party grants – a ranking among faculty. Conclusion: Our algorithm can be applied to all test formats in which item difficulty, the discriminatory power of the individual items, reliability of the exam and the distribution of grades are measured. Even though the content validity of an exam is not considered here, we believe that our algorithm is suitable as a general basis for performance-based allocation of funds., Zielsetzung: Mit der Novellierung der ÄAppO im Jahr 2002 und der Einführung benoteter Leistungsnachweise hat die Bedeutung schriftlicher Prüfungen im klinischen Abschnitt des Medizinstudiums deutlich zugenommen. Allerdings werden die Mindestanforderungen an die Qualität von Prüfungen mitunter nur schwer erreicht. Mit der Aufnahme von Prüfungsqualität in den Kriterienkatalog zur Vergabe von LOM (Leistungsorientierter Mittelvergabe) könnte die Aufmerksamkeit der Lehrenden gelenkt und allein dadurch die Qualität der Prüfungen verbessert und verstetigt werden. Derzeit mangelt es jedoch an geeigneten Bemessungsgrundlagen. Methoden: Im Frühjahr 2014 wurde die „core group“ zur Verbesserung der Lehre an der Universitätsmedizin Rostock vom Studiendekan beauftragt, den der Verteilung von LOM Lehre zugrunde liegenden Kriterienkatalog zu überarbeiten. In diesem Zusammenhang wurde zunächst anhand von multiple choice-Klausurergebnissen ein Algorithmus entwickelt, der auf Aufgabenschwierigkeit, Trennschärfe, Reliabilität und Notenspiegel basiert und damit die Qualität der häufigsten Prüfungsform im Studium der Humanmedizin quantitativ abbildet. Ergebnisse: Dieser Algorithmus wurde anschließend auch auf Klausuren mit offenen Fragen sowie auf den OSCE übertragen. Mit seiner Hilfe lässt sich die Prüfungsqualität in den einzelnen Fächern berechnen und – vergleichbar mit Impaktpunkten und Drittmitteleinwerbungen - in eine intrafakultäre Rangfolge überführen. Schlussfolgerung: Dieser Algorithmus ist auf alle Prüfungsformate anwendbar, bei denen Aufgabenschwierigkeit, Trennschärfe, Reliabilität und Notenspiegel erfasst werden. Auch wenn eine weitere wichtige Kenngröße, nämlich die Validität einer Prüfung hier nicht berücksichtigt wird, so ist der vorgestellte Algorithmus als Bemessungsgrundlage für LOM durchaus geeignet., GMS Journal for Medical Education; 33(3):Doc44

Background and Goal of Study: Inadequate tissue oxygenation should be prevented during surgery as it might cause postoperative morbidity. In this observational study we looked at factors that might influence tissue oxygenation (StO2) such as blood pressure and use of vasoactive drugs. Materials and Methods: In 159 urological patients receiving balanced anaesthesia and mechanical ventilation, we measured StO2 intraoperatively on the thenar eminescence (InSpectra, Hutchinson Tech., USA) along with (non)invasive blood pressure and recorded the use of noradrenaline. We correlated StO2 and MAP as recorded at defined moments during surgery. In addition, we looked at the effects of low blood pressure (as defined by the areas under the curve (AUC) while MAP was < 65 mmHg) on StO2. Furthermore, we related StO2 to different noradrenaline (NA) dosages: none, low (

PURPOSE: Our primary objective is to detail the incidence, site, and timing of penile squamous cell carcinoma (pSCC) recurrence after inguinal lymph node dissection (ILND). MATERIALS AND METHODS: We performed a retrospective analysis of 551 patients who underwent ILND for pSCC from 2000 to 2017. The primary outcome was pSCC recurrence after ILND. Recurrences were identified and stratified by site. Timing of recurrence was determined. Multivariable logistic regression analysis determined associations with recurrence. Multivariable Cox regression analysis determined associations with overall survival (OS). Sub-group analysis of the distant recurrences analyzed timing and OS by site of distant recurrence. RESULTS: After ILND pSCC recurred in 176 (31.9%) patients. Median time to recurrence was 10 months for distant recurrences, 12 for inguinal, 10.5 for pelvic, and 44.5 for local. Greater than 95% of distant, inguinal, and pelvic recurrences occurred within 48 months of ILND, versus 127 months for local recurrences. Post-ILND recurrence was associated with pN2 (OR 1.99, 95% CI 1.0-4.1), and pN3 (OR 7.2, 95% CI 4.0-13.7). Patients who had local recurrence had similar OS to those without (HR 1.5, 95% CI 0.6-3.8), and worse OS was identified in patients with inguinal (HR 4.5, 95% CI 2.8-7.1), pelvic (HR 2.6, 95% CI 1.5-4.5), or distant (HR 4.0, 95% CI 2.7-5.8) recurrences. Patients with lung recurrences had worse OS than other sites (HR 2.2, 95% CI 1.1-4.3). CONCLUSIONS: Of the patients 31.9% had post-ILND recurrence associated with high pN staging. Greater than 95% of distant, inguinal, and pelvic recurrences occurred within 48 months, suggesting surveillance beyond this is low yield. Local recurrences occurred over a longer timeline, emphasizing necessity of long-term surveillance of the primary site. ispartof: JOURNAL OF UROLOGY vol:206 issue:4 pages:960-968 ispartof: location:United States status: published

Context. The impact of applying renal ischaemia during nephron-sparing surgery to avoid renal damage in the treated kidney has gained importance in different Surgical techniques. Objective: The main objective of the present study is to point Out the limit of renal ischaemia times for warm and cold ischaemia approaches. Important results of research on renal ischaemia and different surgical techniques as well as results of clinical studies concerning renal function after renal ischaemia in partial nephrectomy are highlighted. Evidence acquisition: A Medline literature research was performed, combining queries on the keywords nephron-sparing surgery, partial nephrectomy, and ischemia. Links to related articles and cross-reading of citations in related articles were surveyed, as were reviews, letters to editors, and information collected from urologic textbooks. The references formed the basis of this review article, with selection and deletion based on the relevance and importance of the content. In a final step, interactive peer review by the expert panel of coauthors completed the review. Evidence synthesis: Renal ischaemia research showed an increasing renal damage proportional to ischemic time. Current clinical data support safe ischaemia times, within 20 min of warm ischaemia and up to 2 h of cold ischaemia, to minimise renal ischemic damage. To date, no ischaemia dose-response curve or algorithm is available to predict the risk of acute kidney injury and chronic kidney disease in patients undergoing intraoperative ischaemia. in general, there seems to be a higher risk for comorbidity caused by renal damage in patients suffering from kidney turnout. Conclusions: If ischaemia is required, the turnout should be removed within 20 min of warm ischaemia, regardless of surgical approach. Efforts should be made to start immediately with cold ischaemia, if the feasibility within this span of time seems to be jeopardised. Thus, cold ischaemia times up to 2 h can be tolerated by the kidney, depending on the individual method. Nevertheless, cold ischaemia with ice slush should be kept as short as possible-at best within 35 min. In ischemic nephron-sparing surgery, one of the Surgeons main aims should be to avoid loss of renal function. Only after optimal preoperative appraisal and planning can the best postoperative outcomes for renal function be achieved. (C) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.