Biomedical subjects

Jana Jünger

Publications and source records attributed to Jana Jünger.

7 recordsLinked to original sources

PubMed2005

Depression increasingly predicts mortality in the course of congestive heart failure.

BACKGROUND: Congestive heart failure (CHF) is frequently associated with depression. However, the impact of depression on prognosis has not yet been sufficiently established. AIMS: To prospectively investigate the influence of depression on mortality in patients with CHF. METHODS: In 209 CHF patients depression was assessed by the Hospital Anxiety and Depression Scale (HADS-D). RESULTS: Compared to survivors (n=164), non-survivors (n=45) were characterized by a higher New York Heart Association (NYHA) functional class (2.8+/-0.7 vs. 2.5+/-0.6), and a lower left ventricular ejection fraction (LVEF) (18+/-8 vs. 23+/-10%) and peakVO(2) (13.1+/-4.5 vs. 15.4+/-5.2 ml/kg/min) at baseline. Furthermore, non-survivors had a higher depression score (7.5+/-4.0 vs. 6.1+/-4.3) (all P<0.05). After a mean follow-up of 24.8 months the depression score was identified as a significant indicator of mortality (P<0.01). In multivariate analysis the depression score predicted mortality independent from NYHA functional class, LVEF and peakVO(2). Combination of depression score, LVEF and peakVO(2) allowed for a better risk stratification than combination of LVEF and peakVO(2) alone. The risk ratio for mortality in patients with an elevated depression score (i.e. above the median) rose over time to 8.2 after 30 months (CI 2.62-25.84). CONCLUSIONS: The depression score predicts mortality independent of somatic parameters in CHF patients not treated for depression. Its prognostic power increases over time and should, thus, be accounted for in risk stratification and therapy.

Adult↗

PubMed2005

A modified electronic key feature examination for undergraduate medical students: validation threats and opportunities.

The purpose of our study was the development and validation of a modified electronic key feature exam of clinical decision-making skills for undergraduate medical students. Therefore, the reliability of the test (15 items), the item difficulty level, the item-total correlations and correlations to other measures of knowledge (40 item MC-test and 580 items of German MC-National Licensing Exam, Part II) were calculated. Based on the guidelines provided by the Medical Council of Canada, a modified electronic key feature exam for internal medicine consisting of 15 key features (KFs) was developed for fifth year German medical students. Long menu (LM) and short menu (SM) question formats were used. Acceptance was assessed through a questionnaire. Thirty-seven students from four medical schools voluntarily participated in the study. The reliability of the key feature exam was 0.65 (Cronbach's alpha). The items' difficulty level scores were between 0.3 and 0.8 and the item-total correlations between 0.0 and 0.4. Correlations between the results of the KF exam and the other measures of knowledge were intermediate (r between 0.44 and 0.47) as well as the learners' level of acceptance. The modified electronic KF examination is a feasible and reliable evaluation tool that may be implemented for the assessment of clinical undergraduate training.

Adult↗

PubMed2005

Effects of basic clinical skills training on objective structured clinical examination performance.

OBJECTIVES: The aim of curriculum reform in medical education is to improve students' clinical and communication skills. However, there are contradicting results regarding the effectiveness of such reforms. METHODS: A study of internal medicine students was carried out using a static group design. The experimental group consisted of 77 students participating in 7 sessions of communication training, 7 sessions of skills-laboratory training and 7 sessions of bedside-teaching, each lasting 1.5 hours. The control group of 66 students from the traditional curriculum participated in equally as many sessions but was offered only bedside teaching. Students' cognitive and practical skills performance was assessed using Multiple Choice Question (MCQ) testing and an objective structured clinical examination (OSCE), delivered by examiners blind to group membership. RESULTS: The experimental group performed significantly better on the OSCE than did the control group (P < 0.01), whereas the groups did not differ on the MCQ test (P < 0.15). This indicates that specific training in communication and basic clinical skills enabled students to perform better in an OSCE, whereas its effects on knowledge did not differ from those of the traditional curriculum. CONCLUSION: Curriculum reform promoting communication and basic clinical skills are effective and lead to an improved performance in history taking and physical examination skills.

Adult↗

PubMed2004

CAMPUS--a flexible, interactive system for web-based, problem-based learning in health care.

Care for patients is the best way to learn medicine and medical methods and skills. But the availability of real patients for learners is limited. Often the appropriate patient is missed or he can not be demonstrated to all students because of practical or ethical problems. A possible solution is the presentation of a clinical problem by a virtual patient using a simulative computer program. But such an approach means often a lot of work for the author of the case. We developed a flexible and realistic system, CAMPUS (www.medicase.de), which supports the case authors with appropriate vocabularies and a comfortable authoring tool. There are different kinds of case presentations to the users in accordance to the level of professionalism of the user and the scenario the program is used in. An evaluation within an internship has shown, that such pro-grams are judged as useful by medical students. But further studies are necessary to examine if the program will be used for the self-study and to develop further kinds of using scenarios within problem-based curricula.

Computer Simulation↗

PubMed2003

[Integration of a doctor/patient-communication-training into clinical teaching. Examples from the reform-curricula of Heidelberg and Dreden Universities].

It is an important demand of educational reforms to improve the skills of the communication with patients. To reach this goal neither interdisciplinary courses nor tutorials with paper-cases are sufficient. This is the reason why teaching modules including a training to improve doctor-patient-communication were integrated into the reform-curricula at the universities of Heidelberg (Heidelberger Curriculum Medicale, HEICUMED) and Dresden (Dresdner Integrated Patient-Oriented Learning, DIPOL). These modules were originated in cooperation of psychosomatic/psychotherapeutic clinics with representatives of other departments, which provides a chance to integrate psychosomatic issues into the teaching of other disciplines and to promote basic psychosomatic competences. The concept, the realization, and the results of the evaluation of these teaching modules will be described. The evaluation showed that the students rated them as mainly positive, as more effective than traditional learning and that the training improved their self-efficacy related to communicative competences.

Communication↗

PubMed2003

[Communication and interaction in psychosomatic education: use of standardized patients].

An amendment to the German medical curriculum in April 2002 will place communication and social skills at the centre of medical training. In addition to providing cognitive knowledge, psychosomatic courses offer the opportunity to integrate affective learning, with a focus on communication and interaction processes. In winter term 2001/2002 a training with standardised patients was implemented and evaluated as part of the psychosomatic internship of the Department of General Internal and Psychosomatic Medicine at the Medical Hospital of the University of Heidelberg. Quantitative and qualitative results showed that training with standardised patients is well accepted and that acceptance is independent of student gender, career choice, or interests. These training units are easy to integrate into psychosomatic practical courses. The results discussed here will focus on the role and importance of various elements of medical training.

Adult↗

PubMedDate not supplied

Effect of depressive symptoms on survival after heart transplantation.

OBJECTIVE: This study explored the value of preoperative self-reported assessment for depression and anxiety in patients who had undergone heart transplantation (HTx). The initial sample was divided into subgroups of patients with ischemic (ICMP) and dilated cardiomyopathy (DCMP). Patient depression and anxiety scores were measured in both subgroups and their impact on pre- and postoperative mortality investigated. METHOD: An initial sample of 152 patients with either ICMP (N = 57) or DCMP (N = 95) and end-stage heart disease awaiting heart transplantation were assessed in a multidimensional longitudinal study, including psychological and somatic variables. One hundred and three patients received a HTx and were followed up for a mean of 4.4 years. Proportional hazard models were computed to test for the influence of psychosocial and somatic factors on outcome. RESULTS: Preoperative depression and state anxiety scores were significantly higher in the ICMP group. In addition to donor and recipient age, ICMP patients in the preoperative high depression group also showed a significantly higher mortality after HTx. This result remained significant even after controlling for sociodemographic and somatic variables. CONCLUSIONS: Patient self-reported depression, but not anxiety, can contribute to the identification of subgroups of patients with an unfavorable outcome after HTx. It therefore may be helpful to screen for depression, particularly in patients with an ischemic cause of their end-stage heart disease. Specific intervention programs should be further developed and evaluated.

Anxiety↗