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Biomedical subjects

F Eitel

Publications and source records attributed to F Eitel.

At least 19 recordsLinked to original sources
PubMed2003

[Operative or conservative treatment of anterior cruciate ligament rupture: a systematic review of the literature].

The aim of this paper was to examine all studies that compared operative and conservative treatment of anterior cruciate ligament (ACL) rupture. Covering a period of 22 years all relevant articles were retrieved from the medical databases Medline, Embase, and Cochrane. The results of these studies were judged on to the criteria of subjective stability (giving-way phenomenon), objective stability (pivot shift test), and return to the preinjury level of sports. There were 11 different studies published in 16 articles consisting of 2 randomized,2 prospective, and 7 retrospective trials. Except in one study the results in the operative groups were always better than in the conservative groups. The meta-analysis of both randomized studies showed significant advantages for the operative treatment. Although arthroscopic ligament plasty is an established standard method for the treatment of ACL rupture, there is almost no basis for this procedure in the literature.Thus,new clinically applicable studies are necessary to develop objective guidelines for the treatment of anterior cruciate ligament tears.

Anterior Cruciate Ligament↗
PubMed2002

[Evidence based trauma surgery].

It is wise for surgeons to critically analyze their decision making, to add evidence in addition to the normal approaches, i.e. expert opinion and pathophysiological rationale. What evidence, is how it works, how often it is used in orthopedic surgery are the main topics of this article, as well as problems and limits to evidence-based medicine (EbM). EbM operates in five steps: 1. formulate an answerable question with respect to the patient's problems; 2. search the relevant literature; 3. critically appraise the assembled information through evidence based standards; 4. implement these evidence supported findings in your daily practice; 5. evaluate your evidence-based practice. When one builds decisions upon evidence the following effects become apparent: rational choice of possible, alternative decisions, reduction of diagnostic and therapeutic risks, improvements in medical education and efficient delivery of health care. A literature search reveals few evidence-based investigations published in orthopedic surgery. Lastly, we discuss limitations of EbM, showing that both misunderstanding about EbM and technical problems contribute to mistrust in EbM. These may include problems with population heterogeneity, standardization of surgical procedures, conducting random studies, the lack of statistical power and often "publication bias". Overcoming present problems with EbM by further ("evidence-based") research should lead to better understanding of the evidence paradigm and eventually modify this approach. The literature already demonstrates that EbM attains its goal. A valid judgment of EbM will result if one evaluates one's own evidence-based practices. The implementation of EbM is also a matter of policy.

Decision Support Systems, Clinical↗
PubMed2000

Do we face a fourth paradigm shift in medicine--algorithms in education?

Medicine has evolved toward rationalization since the Enlightenment, favouring quantitative measures. Now, a paradigm shift toward control through formalization can be observed in health care whose structures and processes are subjected to increasing standardization. However, educational reforms and curricula do not yet adequately respond to this shift. The aim of this article is to describe innovative approaches in medical education for adapting to these changes. The study design is a descriptive case report relying on a literature review and on a reform project's evaluation. Concept mapping is used to graphically represent relationships among concepts, i.e. defined terms from educational literature. Definitions of 'concept map', 'guideline' and 'algorithm' are presented. A prototypical algorithm for organizational decision making in the project's instructional design is shown. Evaluation results of intrinsic learning motivation are demonstrated: intrinsic learning motivation depends upon students' perception of their competence exhibiting path coefficients varying from 0.42 to 0.51. Perception of competence varies with the type of learning environment. An innovative educational format, called 'evidence-based learning (EBL)' is deduced from these findings and described here. Effects of formalization consist of structuring decision making about implementation of different learning environments or about minimizing variance in teaching or learning. Unintended effects of formalization such as implementation problems and bureaucracy are discussed. Formalized tools for designing medical education are available. Specific instructional designs influence students' learning motivation. Concept maps are suitable for controlling educational quality, thus enabling the paradigm shift in medical education.

Algorithms↗
PubMed2000

[Computer-assisted instruction in medicine: a multicenter evaluation study in 7 German language media resource centers].

EVA, a multicentre study of seven computer resource centres (CRCs) in three German-speaking nations, was carried out over a period of six months to gather structural and process data regarding the use of computer-based instruction (CBI) applications in medicine, and to identify the factors contributing to a more successful integration of CBI into the medical curriculum. 618 machine-readable questionnaires from CRC users and seven questionnaires on structural data of the participating CRCs covering 51 computer stations were evaluated. For Macintosh workstations (n = 34), an additional digital log-protocol was analysed. In conclusion, it seems that so far less than 10% of medical students use CBI programs in German-speaking countries. The data show the presently still poor integration of CBI into the medical curriculum.

Computer-Assisted Instruction↗
PubMed2000

[Implementation of a quality management system for the curriculum in emergency medicine education].

Medical teaching, training and education in basic and advanced life support were improved by basic quality management procedures. 3rd year medical students (n = 276) of two consequent semesters were questionnaired about their acute emergency medicine curriculum. While Group A (n = 134) received a standard course, the new course for group B (n = 142) was reorganised on the basis of the results of group A. Interventive educational measures were an increased number of models provided for exercising the students skills, and an extension of megacode training possibilities. Participation of students in course design improved the overall performance in respect of knowledge, skills and decision-making (p < 0.05). Curriculum acceptance and intrinsic motivation of students however were not positively influenced by practical training compared to traditional knowledge transfer.

Curriculum↗
PubMed1997

Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials.

BACKGROUND: Homeopathy seems scientifically implausible, but has widespread use. We aimed to assess whether the clinical effect reported in randomised controlled trials of homeopathic remedies is equivalent to that reported for placebo. METHODS: We sought studies from computerised bibliographies and contracts with researchers, institutions, manufacturers, individual collectors, homeopathic conference proceedings, and books. We included all languages. Double-blind and/or randomised placebo-controlled trials of clinical conditions were considered. Our review of 185 trials identified 119 that met the inclusion criteria. 89 had adequate data for meta-analysis, and two sets of trial were used to assess reproducibility. Two reviewers assessed study quality with two scales and extracted data for information on clinical condition, homeopathy type, dilution, "remedy", population, and outcomes. FINDINGS: The combined odds ratio for the 89 studies entered into the main meta-analysis was 2.45 (95% CI 2.05, 2.93) in favour of homeopathy. The odds ratio for the 26 good-quality studies was 1.66 (1.33, 2.08), and that corrected for publication bias was 1.78 (1.03, 3.10). Four studies on the effects of a single remedy on seasonal allergies had a pooled odds ratio for ocular symptoms at 4 weeks of 2.03 (1.51, 2.74). Five studies on postoperative ileus had a pooled mean effect-size-difference of -0.22 standard deviations (95% CI -0.36, -0.09) for flatus, and -0.18 SDs (-0.33, -0.03) for stool (both p < 0.05). INTERPRETATION: The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo. However, we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition. Further research on homeopathy is warranted provided it is rigorous and systematic.

Double-Blind Method↗
PubMed1997

[Medical education in crisis].

BACKGROUND: The controversy about the value of current undergraduate medical education in Germany. PROBLEM: Are there empirical data about economic evaluation undertaken to investigate the value of medical education? METHOD: Case study. Literature review with MedLine. ENDPOINTS: Utility of the curriculum, indicated by (1) prevalence of vocational demands reflected in the curriculum content; (2) students' performance as MDs; (3) student's dissertation rate; (4) synthesis of basic sciences, clinical sciences and practical work; (5) mentoring provided by faculty; and (6) cost-benefit analyses. RESULTS: 1. Selection bias of clinical education: only 3% of the incidence of diseases are seen in university hospitals, the main educational experience in Germany. 2. No objective performance data available in Germany. 3.91% of the students wish wo write a dissertation, but only 38% of the graduates, by their third year, have attained that goal by receiving the title Dr. med. 4. Practical education in GP practice in the US and UK starts in the students' 1st year; in Germany, in the 4th year. 5. More mentoring is desired by 66% of the students. 6. No German cost-benefit analyses could be retrieved. CONCLUSION: We face a quantifiably severe crisis in medical education. An approach to quality management, of which economic evaluation is an integral part, would be suitable to improve teaching quality.

Cost-Benefit Analysis↗
PubMed1995

[Development of a practice-oriented curriculum. 9. Arthrology].

The background problem this article addresses is the need to reduce the quantity of medical information to a standard core of knowledge relative to the overwhelming amount of scientific information to be learned in the limited amount of time students have available. The article is part of a study the aim of which is to define a core students, independent of their further medical specialization. The design of this study is a survey of a representative sample of Swiss general practitioners who were asked to identify in the list of Nomina Anatomica the most prevalent anatomical entities (terms) occurring in their practice. To assure the representativeness of the sample the identified terms were compared to prevalent diagnoses of all Swiss general practitioners and to the incidence of cases in German hospitals. From the list of International Anatomical Nomenclature (IANC) 280 anatomical terms could be identified with respect to arthrology. Of these, 250 were judged uniformly by the physicians: 52 terms were considered relevant, while it was not though necessary for 198 terms to be relevant, while it is was not thought necessary for 198 terms to be learned, i.e. general practitioners agreed on 89.3% of the terms. Only 29.7% of the terms in the IANC list belong to anatomical core knowledge in arthrology. There is evidence for the representativeness of these findings when compared to the prevalence of diagnoses made by general practitioners and to the incidence of cases in German hospitals. The method of using criteria of prevalence in a survey to identify a core of knowledge in medicine is suited for the definition of learning content necessary for professional purposes.

Curriculum↗
PubMed1994

Critical review and meta-analysis of serial agitated dilutions in experimental toxicology.

1. We conducted an overview and quantitative meta-analysis of all experimental literature on the protective effects of serial agitated dilutions (SADs) of toxin preparations. 2. Articles were systematically collected and evaluated for scientific quality using pre-defined methodological criteria and then independently analysed for validity. 3. We found 105 publications exploring the effects of SAD preparations in toxicological systems. 4. The quality of evidence in these studies was low with only 43% achieving one half of the maximum possible quality score and only 31% reported in a fashion that permitted reevaluation of the data. 5. Very few studies were independently replicated using comparable models. 6. Among the high quality studies, positive effects were reported 50% more often than negative effects. 7. Four of 5 outcomes meeting quality and comparability criteria for meta-analysis showed positive effects from SAD preparations. 8. Average percent protection over controls in these preparations was 19.7 (95%Cl 6.2-33.2). 9. Further research with special attention to methodological detail and independent replication should be done.

Animals↗
PubMed1994

[Development of clinical algorithms for quality assurance in management of multiple trauma].

Resuscitation and management of high-risk multiple trauma patients require a systematic and coordinated approach to diagnostic and therapeutic interventions. Clinical algorithms with branch chain decision logic can provide a clear and organized transformation of clinical standards for trauma care. Owing to their capability in formalization and standardization, algorithms define precisely the process of care and serve as a central interface within the system of quality assurance and quality control. The standardized document symbols and conventions for information processing according to ANSI/ISO/CCITT regulations are generally applied to the flowchart design of clinical algorithms. Special starting and ending point symbols make it possible to break down complex processes in several single interrelated algorithms. Inclusion of optional criteria checklists reduces the number of decision nodes and loops and minimizes the extent of a comprehensive algorithm. Clinical algorithms are an excellent tool for converting highly complex concepts of multiple trauma management into a logical, prioritized and systematic process of care.

Algorithms↗
PubMed1991

[A new application of plastination in bone histology].

The plastination techniques originally developed for macroscopy can be modified for the preparation of plastinated sections for microscopy. Particularly good penetration of the specimen during preparation of the histological section is obtained, when the techniques described for freeze substitution, degreasing and forced impregnation with resin are employed. The different types of polymers are compared to determine the particular advantages and disadvantages of each. The sectioning technique and the use of histological stains are described for both undecalcified and decalcified bones. The modified Spalteholz technique with decalcification of sections and second plastination procedure for the preparation of transparent decalcified bone sections is described. This makes it possible to produce plane parallel standardized sections for morphometric examination of the vascular structure of the bone. The possible uses of the plastination for the histological examination procedures currently in use, such as fluorescence microscopy, microangiography and microradiography, are shown. The relative values of different microangiographic techniques have been determined for the first time by means of further developments of the Spalteholz and plastination techniques, because they have provided the possibility of standardizing sections. Thus, the plastination technique appears to be especially useful for the examination of microscopic specimens.

Animals↗
PubMed1990

[Bone response to unphysiological mechanical stress. A histomorphological study on modelling and remodelling of Martin's transformation zone in the ulna].

In this study the morphological changes in the shape and structure of the ulna were investigated following resection of a mid-shaft segment in the radius. These morphological alterations are called in German "Martin'sche Umbauzone" (MUZ; Martin's transformation zone). Various explanations for the MUZ can be found in the literature; Wolff's law, in particular, offers hints about the development of this phenomenon. The morphological changes in the ulna were investigated by microangiography, polarized light and fluorescence microscopy as well as by micro-radiography. The radius was operated on in 36 mongrel dogs. The development and localization of new bone formation at the endosteal and periosteal envelope of the ulna were studied. The woven bone formation of the envelopes (modelling) and the intracortical remodelling in the distal part of the ulnae were compared with the intact ulnae of the opposite extremities. It is concluded from these morphological alterations that the experimental design chosen provides a valuable, tissue-related model for the investigation of morphogenesis in bones. Further investigations will deal with the correlation between strain and new bone formation.

Animals↗
PubMed1990

[Use of an internal fixator in the femur and tibia. Clinical and roentgenological course in animals].

The applicability of a new internal fixator was tested in the femur and tibia of sheep. The device was primarily developed for the spinal column by the association for studies of internal fixation (ASIF). For this investigation 12 sheep were subjected to transverse osteotomy and the bones were then stabilized with a internal fixator: The clinical and radiological follow up shows a stable healing process of the osteotomy within 8 weeks despite full load-bearing on all extremities. During the entire study period the sheep had full freedom of movement. Clinical and radiological observations were confirmed by the results of histological examinations. The results allow the following conclusions: in view of the course of recovery the indications for application of a internal fixator can be extended to fractures of the lower extremities. Further studies pertaining to the suitability of the implant for various fracture types are in progress. The great advantage of this fixation technique is that the fixator is mounted without any damage to either the endosteal or the periosteal circulation.

Animals↗
PubMed1988

[Anastomoses of the large intestine in standardized diffuse peritonitis in the rat].

A standardized experimental diffuse peritonitis model was developed for the purpose of studying the mechanisms of impaired anastomotic healing in cases of peritonitis. Sham peritonitis or standardized diffuse peritonitis was induced to 42 animals, and anastomosis of the ascending colon was performed 24 hours later. Bursting pressures were measured at six different time intervals, following performance of anastomosis. Significant differences in bursting pressure between sham peritonitis and real peritonitis were restricted to the shortest time interval after performance of anastomosis. More studies will be necessary to investigate the high rates of insufficiency in peritonitis cases.

Anastomosis, Surgical↗
PubMed1988

[Wound healing and wound dressing].

This review article intends to discuss the clinical management of wounds in respect to a pathophysiological background. Recent results of research in the field of wound healing are demonstrated. Wound healing can be seen as aseptic inflammatory response to a traumatic stimulus. The activation of the clotting cascade by the trauma induces a sequence of humoral and cellular reactions. Platelets, granulocytes and macrophages are activated stepwisely. In the first phase of wound healing the wounded tissue area will be prepared for phagocytosis by enzymatic degradation of ground substance and depolymerisation of protein macromolecules (wound edema). Following the phagocytic microdebridement mesenchymal cells proliferate and produce matrix substance. Microcirculation within the traumatized area will be restored by angiogenesis, macroscopically observed as new formed granulation tissue. This leads to the wound healing phase of scar tissue formation. In this complexity of reactions naturally many possibilities of impairment are given. The most common complication during wound healing is the infection. It can be seen as self reinforcing process. The therapy of the impairment of wound healing consists in the disruption of the specific vicious circle, in the case of an osseus infection that would be a macrodebridement (that is necrectomy) and biomechanical stabilization. The surgical management of wounds principally consists in ensuring an undisturbed sequence of the healing process. This can be done by the wound excision that supports the phagocytic microdebridement. A further possibility is to avoid overwhelming formation of edema by eliminating the traumatic stimulus, by immobilization of the injured region and by ensuring a physiological microenvironment with a primary suture if possible. There are up to the present no drugs available to enhance cell proliferation and to regulate wound healing but it seems that experimental research is successful in characterizing substances as growth factors and mediators. A second way of managing is to prevent the wound healing from troubles by using preventive measures: unbroken aseptic chain, stopping bleeding exactly and introducing sufficient drainage, avoiding of ischaemia and last not least inserting foreign substances into the tissue as few as possible.

Animals↗