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Due to the further decrease in the number of habilitations in medicine since 2010, the general requirements for habilitation could have increased during the same period.The requirements for a medical habilitation at German universities in a comparison of 23 years are re-evaluated.An analysis of habilitation regulations for 12 target parameters and evaluation of these by a scoring system (range 0-34 points).Only the criterion of the requirement for a doctorate has remained the same in the 23-year comparison in the evaluation (1998-2021). All results of the other 11 criteria have changed compared to the previous study from 2010. The rating of habilitation achievements has increased from a total score in 1998 of 15.2 ± 5.1 points (95% confidence interval 13.6-16.9 points) to 25.1 ± 3.6 points in 2021 (95% confidence interval 23.9-26.2 points; p 0.001). The range of assigned scoring values is again more broadly spread in the 11-year comparison with values from 12 to 31 points. A striking new criterion was that 98% of the assessed habilitation regulations now require a didactic continuing education in, however, significantly different requirements from the faculties.The requirements for a medical habilitation continued to significantly increase over the 23-year period with, however, a wider dispersion of scores. The more detailed description can be seen as a direct indication of an improvement in transparency. In contrast, the broader dispersion shows that a uniform assessment standard for Germany has again receded into the distance.HINTERGRUND: Aufgrund der seit 2010 weiter gesunkenen Anzahl an Habilitationen in der Medizin könnten die generellen Anforderungen an die Habilitation im gleichen Zeitraum gestiegen sein.Die Anforderungen für eine medizinische Habilitation an deutschen Hochschulen im Vergleich von 23 Jahren werden reevaluiert.Es erfolgte eine Analyse der Habilitationsordnungen auf 12 Zielparameter und Bewertung dieser durch ein Scoringsystem (Range 0–34 Punkte).Lediglich das Kriterium der Promotionsvoraussetzung ist im 23-Jahres-Vergleich in der Bewertung gleichgeblieben (1998–2021). Alle Ergebnisse der anderen 11 Kriterien haben sich im Vergleich zur Voruntersuchung aus 2010 verändert. Die Bewertung der Habilitationsleistungen ist von einem Gesamtscore aus dem Jahr 1998 von 15,2 ± 5,1 (95 %-Konfidenzintervall 13,6–16,9) auf nun 25,1 ± 3,6 Punkte im Jahr 2021 gestiegen (95 %-Konfidenzintervall 23,9–26,2; p 0,001). Die Range der vergebenen Scoringwerte ist im 11-Jahres-Vergleich wieder breiter gestreut mit Werten von 12 bis 31 Punkten. Als auffällig neues Kriterium zeigte sich, dass bei 98 % der bewerteten Habilitationsordnungen nun eine didaktische Weiterbildung in jedoch erheblich unterschiedlicher Anforderung von den Fakultäten gefordert wird.Die Anforderungen an eine medizinische Habilitation sind im 23-Jahres-Vergleich weiter signifikant angestiegen mit jedoch breiterer Streuung der Scorings. Die detailliertere Beschreibung kann als direkter Hinweis auf eine Verbesserung der Transparenz angesehen werden. Die breitere Streuung zeigt hingegen, dass ein einheitlicher Bewertungsmaßstab für Deutschland wieder in die Ferne gerückt ist. more...

The diagnosis of a scaphoid fracture, especially in the differentiation of a fresh fracture, the nonunion or a possible anatomical norm variant, can be difficult. We report on two patients who presented with stress-related, radiocarpal pain in our department. In both cases, radiological abnormalities were observed in the scaphoideal area, with a scaphoideum bipartitum on both sides, as well as an approximately 25-year-old scaphoid pseudarthrosis. more...

Hintergrund Die Promotion stellt ein selbstandig bearbeitetes wissenschaftliches Projekt dar. Im Fachgebiet der Medizin ist diese jedoch seit Jahren Grundlage kontroverser Diskussionen. Ziel der hier vorgelegten Arbeit war es, eine Bestandsaufnahme der aktuell in Deutschland gultigen Promotionsordnungen medizinischer Fakultaten und Hochschulen vorzunehmen und eine solide Vergleichbarkeit auf Basis eines Scoring-Systems zu entwickeln. more...

This research presents an analysis of spatial access to both opioid use disorder treatment facilities and emergency medical services in New Hampshire during 2015-2016, a period during which there was a steep increase in unintentional overdoses involving fentanyl. For this research, spatial access was computed using the enhanced two-step floating catchment area model combined with the Huff model to assess access across New Hampshire and gives attention to supply-side parameters that can impact spatial access. The model is designed to measure access to healthcare services for opioid use disorder patients offered at treatment centers or from buprenorphine treatment practitioners, as well as from emergency medical services across New Hampshire. A composite index of accessibility is proposed to represent overall access to these different treatment services for opioid use disorder patients. Geospatial determinants of spatial access included street network distances, driving times and distance decay relationships, while other key factors were services availability and population demand. Among the towns with the highest composite access scores, approximately 40% were metropolitan locations while 16% were rural towns. The insights from this research showed that for this period, while the opioid crisis was impacting many towns in New Hampshire, high levels of access to treatment services were not uniform across the state. When comparing the access results with data on the towns of residence for individuals who died from unintentional overdoses involving fentanyl during 2015 and 2016, estimates found that approximately 40% of the towns were not estimated to be in the highest class of access to treatment services at the time. This research provides information for local public health officials to support planning strategies to address opioid use disorder treatment access in high-risk regions. more...

Die medizinische Habilitation stellt einen wesentlichen Erfolgsfaktor fur die Karriere eines Arztes dar. Ob sie jedoch noch eine akademische Befahigung oder doch eher ein Karriereinstrument beschreibt wird kontrovers diskutiert. In diesem Zusammenhang haben wir eine Umfrage bei Habilitierten in der Medizin durchgefuhrt, deren Ziel die Evaluation des Stellenwerts der Habilitation ist. Die Untersuchung wurde als Online-Umfrage mithilfe eines Fragebogens zu biographischen Merkmalen sowie zu subjektiven Einschatzungen habilitationsrelevanter Themen durchgefuhrt. Insgesamt konnten 628 Fragebogen ausgewertet werden. Der Stellenwert einer Habilitation wird von 68,6 % als hoch eingeschatzt und war bei 71,0 % fur ein berufliches Vorankommen notwendig. Die Chancen nach erfolgreicher Habilitation einen Lehrstuhl zu erhalten, werden nur mittelmasig bis niedrig eingestuft (68,1 %). Dennoch wurden 92,3 % erneut habilitieren und 86,5 % die Habilitation Fachkollegen empfehlen. Daher sprechen sich 78,8 % gegen die Abschaffung aus. Reformwunsche, wie eine bundeseinheitliche Habilitationsordnung, weniger Abhangigkeit von Ordinarien und mehr Transparenz wurden genannt. Die Habilitation hat einen hohen Stellenwert in der Medizin und deren Abschaffung wird mehrheitlich nicht gewunscht. Obwohl die Chancen auf einen Lehrstuhl nur gering eingeschatzt werden, scheint die Habilitation fur die Karriere forderlich. Jedoch besteht die Notwendigkeit zu wesentlichen inhaltlichen, strukturellen und internationalen Veranderungen. more...

BACKGROUND Cutaneous microcirculation has shown to play a key role in wound healing. Although healing disorders are still one of the most common complications in hand surgery, there still exists a lack of scientific research on possible age-related changes in cutaneous microcirculation at the dorsum of hand. HYPOTHESIS Cutaneous microcirculation at the dorsum of the hand differs significantly between different age groups. METHODS 53 healthy subjects were divided into 2 groups by age (Group A more...

Characteristics of diphenhydramine (DPH)-induced accidental overdose deaths were compared to deaths without DPH present. Data from 4702 drug-induced deaths during 2005 to 2011 in four states were reviewed, with 3884 of these certified as accidental. DPH was involved in 276 cases (5.9%), with the manner of death ruled accidental in 181 (DPH group). The remaining 3703 accidental deaths constituted the control group. Age, body mass index, and the cases with benzodiazepine or opioid co-intoxicants did not differ significantly between groups. In the DPH deaths, methadone was the most frequently identified additional co-intoxicant, particularly when only one or two other co-intoxicants were present. Significantly more females (57.5% vs. 31.5%, respectively) and co-intoxicants were present (55.8% vs. 20.1% with ≥ 3 other co-intoxicants present, respectively) in the DPH compared to the control group. Alcohol was identified significantly less often in DPH decedents. Antidepressants overall and the selective serotonin reuptake inhibitor (SSRI) and tricyclic antidepressant (TCA) classes appeared significantly more often as co-intoxicants in DPH decedents compared to controls. Female DPH decedents were also significantly more likely than control females to have antidepressants (32.7% vs. 16.8%, respectively), TCAs (16.4% vs. 7.1%), or SSRIs present (21.2% vs. 11.6%). DPH concentrations in the accidental deaths were usually lower compared to the suicides although overlap was present. In conclusion, the availability of over-the-counter DPH appears to pose significant potential for drug abuse and should be identified as contributory to death with other detected co-intoxicants such as antidepressants, benzodiazepines, opioids, and other central nervous system depressant drugs. more...

Diagnosing scurvy (vitamin C deficiency) in adult skeletal remains is difficult despite documentary evidence of its past prevalence. Analysis of 20 European colonists buried at Saint Croix Island in New France during the winter of 1604-1605, accompanied by their leader Samuel de Champlain's eyewitness account of their symptoms, provided the opportunity to document lesions of adult scurvy within a tightly dated historical context. Previous diagnoses of adult scurvy have relied predominantly on the presence of periosteal lesions of the lower limbs and excessive antemortem tooth loss. Our analysis suggests that, when observed together, reactive lesions of the oral cavity associated with palatal inflammation and bilateral lesions at the mastication muscle attachment sites support the differential diagnosis of adult scurvy. Antemortem loss of the anterior teeth, however, is not a reliable diagnostic indicator. Employing a biocultural interpretive approach, analysis of these early colonists' skeletal remains enhances current understanding of the methods that medical practitioners used to treat the disorder during the Age of Discovery, performing rudimentary oral surgery and autopsies. Although limited by a small sample and taphonomic effects, this analysis strongly supports the use of weighted paleopathological criteria to diagnose adult scurvy based on the co-occurrence of specific porotic lesions. more...

Differentiating traumatic injuries in bone from taphonomic damage in the postmortem period is a complex process requiring a systematic approach. Trauma by definition occurs while the individual is still living, but bone characteristics usually do not allow delineation of the moment of death. Thus, the anthropologist seeks characteristics that will associate a skeletal defect with the perimortem period, at or about the time of death. However, the anthropological designation of perimortem time period does not have precise boundaries. It refers to remains that lack any sign of remodeling or healing on the one hand, and which have not lost biomechanical elasticity and plasticity on the other hand, i.e., it refers to the condition of skeletal remains when they sustained the suspected injury. Fracture patterns that reflect biomechanical plasticity are lost gradually as the time since death increases, and this pace will depend on the environmental context. There are additional clues to identify postmortem status, including when the damaged feature fits a taphonomic pattern of scavenger modification or weathering, or physically overlies obvious postmortem modifications, or when the feature fits a known pattern of sharp force instruments or weapons. Damage due to recovery or the examination process must be ruled out. The timing of occurrence of a suspected perimortem injury can therefore extend for days or weeks into the time before the actual death, and it can extend for days to months after death. The anthropologist responds to the challenge of differentiating trauma and taphonomic modification by knowing the characteristics of healing bone, the features of biomechanical plasticity reflected in fracture morphology, the taphonomic patterns of scavenging and weathering, the environmental context of discovery and recovery, and the characteristics of the relevant regional taphonomy. more...

Sehnenverletzungen der Hand sind haufig und stellen hohe Anspruche an die chirurgische Versorgung. Eine genaue Kenntnis der Anatomie der Streck- und Beugesehnen im Bereich der Hand ist Voraussetzung, um eine detaillierte klinische Untersuchung durchfuhren und die richtige Diagnose stellen zu konnen. Abhangig von der vorliegenden Verletzung kommen verschiedene konservative oder operative Therapieoptionen in Betracht. Im Gesamtkonzept der Versorgung von Sehnenverletzungen der Hand spielt die Nachbehandlung eine wichtige Rolle, um ein optimales funktionelles Ergebnis zu erzielen. Es ist jedoch zu beachten, dass Ausmas, Mechanismus und exakte anatomische Lokalisation der Verletzung sowie Begleitverletzungen ebenso die Operationsergebnisse beeinflussen wie die Mitarbeit des einzelnen Patienten in der Nachbehandlung. more...

PURPOSE Soft tissue management is of paramount importance in ankle surgery. As such, full thickness necrosis of the soft tissue envelope represents a severe complication following total ankle joint arthroplasty (TAA) potentially leading to implant exposure, infection and thus, substantially compromised patient outcomes. One of the main factors leading to soft tissue complications is an undetermined arterial perfusion of the lower leg or ankle joint. We report on clinical cases suffering soft tissue complications following TAA with the respective plastic surgical therapy regimen and present a simple algorithm for preoperative perfusion evaluation. METHODS The medical records of 30 consecutive primary TAA patients were retrospectively reviewed after observing a higher than expected rate of severe soft tissue defects which have been referred to our plastic surgery department. RESULTS 3 patients (10%, all females, age 63 ± 5 years; BMI 27 ± 3 kg/m2) presented with a soft tissue defect leading to angiography revealing one case of severe arterial obstruction. Wound closure could be reached in one case by conservative therapy consisting of regular dressing changes. In the further patients definite soft tissue reconstruction could only be performed by surgical intervention. One could be covered by split-thickness skin grafting and one by a microsurgical transplantation of a free latissimus dorsi flap. On the basis of these complications we established an easy algorithm for the preoperative evaluation of the arterial perfusion in the ankle region. First, (I) the pulses of the dorsal foot artery and posterior tibial artery should be examined. In the case of not palpable pulses (II) the ankle-brachial index should be performed. Values of 1.2 recommend (III) to perform angiography. In the case of stenosis or complete obstruction (IV) the arterial blood flow should be reconstituted by interventional radiological stenting or vascular surgical procedures. CONCLUSION The identification of the arterial perfusion status of patients undergoing TAA using a straightforward clinical algorithm might overcome TAA-related soft tissue complications and improve patient-related outcome measures. more...

Pleiotrope Substanzen sind durch ihr ausgesprochen vielfaltiges und komplexes Wirkspektrum charakterisiert und dies macht sie fur die Therapie von Wunden attraktiv. Neben seinem bekannten Effekt der Steigerung der Hamatopoese konnte das Glykoproteinhormon Erythropoietin (EPO) in diversen anderen Organen eine deutliche Gewebeprotektion aufzeigen. Der Einsatz von EPO im Rahmen von Regenerationsprozessen der Haut basiert hier wahrscheinlich im Wesentlichen auf seiner zytoprotektiven, proangiogenen, antiapoptotischen sowie antiinflammatorischen Wirksamkeit. Hier kann EPO durch eine niedrigdosierte bzw. einmalige Applikation die strukturelle und koordinierte Interaktion verschiendener Zelltypen untereinander stimulieren. Diese Ubersichtsarbeit soll die Vor- und Nachteile einer EPO-Gabe im Rahmen verschiedener Heilungs- und Regenerationsvorgange der Haut aus der experimentellen Forschung beleuchten und mogliche klinische Anwendungen diskutieren. more...

We illustrate an interdisciplinary approach to identify a victim in a case with complex taphonomic and procedural issues. Burning, fragmentation, species commingling, and examination by multiple experts required anthropological preparation and analysis combined with radiographic adaptations to image and match trabecular patterns in unusually small, burned specimens. A missing person was last seen in the company of a reclusive female on a remote rural property. A warranted search found several burn sites containing human and animal bones. Fragment preparation, analysis, and development of a biological profile by anthropologists enabled examination by the odontologist, molecular biologist, and radiologist, and justified use of antemortem radiographs from one potential victim. Visual and radiological comparison resulted in a positive (later confirmed) identification of the victim by radiological matches of three carpal phalanges. Although some dimensional changes are expected with burning, morphological details were preserved, aided by selection of relatively intact, small bones for comparison. more...

The skin is the biggest organ of the human being and has many functions. Therefore, the healing of a skin wound displays an extraordinary mechanism of cascading cellular functions which is unique in nature. As healing and regeneration processes take place in all parts of the human body, this review focuses on the healing processes of the skin and highlights the classical wound healing phases. While regeneration describes the specific substitution of the tissue, i.e. the superficial epidermis, mucosa or fetal skin, skin repair displays an unspecific form of healing in which the wound heals by fibrosis and scar formation. The first stage of acute wound healing is dedicated to hemostasis and the formation of a provisional wound matrix, which occurs immediately after injury and is completed after some hours. Furthermore, this phase initiates the inflammatory process. The inflammatory phase of the wound healing cascade gets activated during the coagulation phase and can roughly be divided into an early phase with neutrophil recruitment and a late phase with the appearance and transformation of monocytes. In the phase of proliferation the main focus of the healing process lies in the recovering of the wound surface, the formation of granulation tissue and the restoration of the vascular network. Therefore, next to the immigration of local fibroblasts along the fibrin network and the beginning of reepithelialization from the wound edges, neovascularization and angiogenesis get activated by capillary sprouting. The formation of granulation tissue stops through apoptosis of the cells, characterizing a mature wound as avascular as well as acellular. During the maturation of the wound the components of the extracellular matrix undergo certain changes. The physiological endpoint of mammalian wound repair displays the formation of a scar, which is directly linked to the extent of the inflammatory process throughout wound healing. more...

In einer kontrollierten Studie wurde ein Kollagen-Gentamicin-Verbund bei 67 Patienten zur Behandlung von posttraumatischen wie postoperativen Osteomyelitiden sowie bei zementfreien Endoprothesen zur Blutstillung und lokalem Infektionsschutz des Implantatlagers eingesetzt. Durch die lokale Applikation des resorbierbaren Antibiotikaverbundes konnten auch bei relativ hoher Dosierung nur an der Nachweisgrenze mesbare Gentamicinspiegel beobachtel werden. In der Mehrzahl der Falle (n=63) ist die Infektberuhigung klinisch wie radiologisch gesichert. more...