Chirurgie (Heidelberg, Germany)最新文献

The number of patients with fragility fractures will continue to increase in the future. The multimorbidity of these patients places high demands on the treatment. The treatment of this complex group of patients in specialized centers is therefore recommended. The collaborative treatment of patients by trauma surgeons and geriatricians improves the results. The treatment is carried out according to a standardized protocol and includes rapid surgical stabilization of the fracture and an interdisciplinary care of the patients. During hospitalization many patients develop delirium. Due to the high rate of complications endangered patients should already be identified in the emergency department to enable a timely initiation of preventive measures. Due to the high number of patients requiring treatment and the complexity of the patients, the legislation has established specific requirements for the treatment of proximal femoral fractures. The treatment of fragility fractures in trauma surgery goes beyond the surgical stabilization alone and incorporates the pharmaceutical treatment of the osteoporosis.

Fractures of the upper ankle joint are frequent injuries and part of routine clinical trauma surgery. In recent years, treatment strategies have changed in different ways due to advances in imaging diagnostics and a better understanding of the biomechanics. In addition, new implant systems are available. The goals of the reconstruction are anatomical reduction with restoration of the joint anatomy, reconstruction of the length, rotation and axial relationships as well as the restoration of stable joint guidance. In addition to the bony reconstruction, the focus is on restoring ligamentous instabilities. Keywords that are increasingly more in focus and controversial are: the posterior malleolar fragment, syndesmosis instability, the fourth malleolus and the importance of the deltoid ligament. For a good long-term result, anatomical reconstruction remains the basic requirement, regardless of the methods used.

Background: Traditional surgical training and further education has historically involved long working hours and hands-on experience within the framework of a teacher-apprentice relationship; however, changes in regulatory policy in the USA and subsequently in Switzerland and the European Union from 2003, led to restrictions in the working hours of medical residents. As a result the traditional method of surgical training "see one, do one, teach one" has come under scrutiny, prompting a search for alternative training methods beyond the confines of the operating theater.

Objective: This publication highlights the possibilities and limitations associated with the use of virtual reality (VR) and gamification in surgical training and further education. It examines the ability of these technological resources to enhance the effectiveness and engagement of medical residents and the feasibility of incorporating them into the surgical training curriculum.

Material and methods: The study was based on a literature search for current developments in surgical training, VR and gamification. Furthermore, various studies and projects that investigated the use of VR and gamification in medical training and further education were analyzed.

Results and discussion: In this investigation it could be shown that the use of VR reduces the perioperative risks and improves the training environment and learning. The use of gamification also increases the motivation and engagement of the medical residents. As a result the quality of medical education can be improved by the fusion of VR and gamification.

Background: The hospital plan for North-Rhine/Westphalia (NRW) aims to enhance and optimize the quality and efficiency of healthcare in Germany's largest federal state and could potentially serve as a blueprint for the entire country. The State Ministry of Labor, Health and Social Affairs (MAGS) has issued determination notices for the service groups (LG), which were sent to hospitals with final implementation scheduled for April 2025.

Method: A consensus-based questionnaire was distributed to 254 chief physicians of visceral surgery departments (CÄ). The survey queried information on age, number of beds, care levels, service groups, centralization, specialization, certification, changes in public perception, continuing education and threats to training authorization as well as the attractiveness of the discipline and concerns regarding junior staff.

Results: Out of 254 questionnaires 108 were returned (42.5%). Approximately 50% of the respondents believe the reform is necessary; however, 32% of clinics were denied allocation of an LG despite having certification. In 45 clinics (42%) no LG was allocated at all. One hospital received an LG without applying for it. Additionally, 80 hospital administrators (74%) reported not seeing any meaningful political strategy behind the hospital plan, 35% of CÄs did not anticipate improvements in treatment quality from centralization, 59 head physicians (55%) expressed concerns that their hospital's public image would deteriorate and 86 CÄs (80%) believed the current training regulations can no longer be guaranteed. Furthermore, 72% of respondents felt that visceral surgery is losing its appeal as a discipline and 48% were worried about their personal future career prospects.

Discussion: While the reform is generally supported by the respondents, the implementation method has received significant criticism. The certifications from the German Cancer Society (DKG) and the German Society for General and Visceral Surgery (DGAV) are not consistently recognized, raising doubts about the reliability of hospital services. Additionally, a detailed impact analysis and accompanying research are lacking (e.g., capacity bottlenecks, staff shortages, waiting times, hospital closures). The attractiveness of surgery as a discipline and advanced training in special visceral surgery are at risk.

Background: Cleft lip and palate is the most frequent malformation in humans that requires surgical correction but is not primarily life-threatening. That is why in many economically not very well developed countries, special surgical care, such as for cleft lip and palate, is not guaranteed at all or is not sufficiently guaranteed, so that numerous aid organizations have been founded for over 50 years to provide help by organizing surgical aid missions. Even if this help seems primarily ethically harmless and very laudable, the lack of rules and instructions unfortunately regularly leads to the fact that legal, ethical and even medical treatment standards are often not observed to the detriment of the affected children.

Method: The necessary principles and prerequisites for surgical aid missions are described in an overview article and from these conceptual and strategic recommendations for the actions of the involved service disciplines are derived. Ultimately, the goal must be not only to surgically help the individual fate but also firstly to treat the functional aspects of the malformation holistically and secondly, to also prioritize the goal of achieving sustainability by competently training the local staff in order to be able to perform such surgery alone in the near future to make such aid missions unnecessary.

Conclusion: Surgical aid missions in Third World countries are a model of success as many hundreds of thousands of children and adults with a cleft lip and palate have been successfully treated; however, unfortunately the sustainable further development of local structures and skills is often neglected. There is also an urgent need to establish general guidelines for surgical aid missions in Third World countries.