Large skull-base meningiomas are difficult to treat due to their proximity or adherence to critical structures. We analyzed the long-term results of patients with skull-base meningiomas treated by a ...new approach with high-precision fractionated stereotactic radiotherapy.
One hundred eighty-nine patients with benign meningiomas were treated with conformal fractionated stereotactic radiotherapy between 1985 and 1998. Patients were undergoing a course of radiotherapy either as primary treatment, following subtotal resection, or for recurrent disease. The median target volume was 52.5 mL (range, 5.2 to 370 mL). The mean radiation dose was 56.8 Gy (+/- 4.4 Gy). Follow-up examinations, including magnetic resonance imaging, were performed at 6-month intervals thereafter.
The median follow-up period was 35 months (range, 3 months to 12 years). Overall actuarial survival for patients with World Health Organization (WHO) grade I meningiomas was 97% after 5 years and 96% after 10 years. Local tumor failure was observed in three of 180 patients with WHO grade I tumors and was significantly higher in two of nine patients with WHO grade II tumors. A volume reduction of more than 50% was observed in 26 patients (14%). Preexisting cranial nerve symptoms resolved completely in 28% of the patients. Clinically significant treatment-induced toxicity was seen in 1.6% of the patients. No treatment-related deaths occurred.
The results of this study demonstrate that fractionated stereotactic radiotherapy is safe and effective in the therapy of subtotally resected or unresectable meningiomas. The overall morbidity and incidence subacute and late side effects of this conformal radiotherapy approach were low.
Aim: Empathy is a core element in the doctor-patient relationship. This study examined whether empathy in medical students can be improved by specific training.
Methods: 158 medical students were ...randomized into two groups. The intervention group participated in an empathy skills training with simulated patients (SPs). The control group participated in a history course. After the intervention, empathy was assessed by blinded SPs and experts in an Objective Structured Clinical Examination (OSCE). Students also filled out a self-assessment concerning their attitude on empathy (Jefferson Scale of Physician Empathy Student Version, JSPE-S-S).
Results and Conclusions: Participants of the intervention group showed significantly higher levels of empathy when rated by SPs and experts than the control group. In contrast to that, no significant group differences were observed in self-rated empathy. The results underpin the value of empathy skills trainings in medical school study programs.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Because of the new medical licensure act in Germany, much more bedside teaching than before is needed. For many of the relevant clinical pictures, few patients can be expected to undergo study ...lessons. That is why many universities use simulated patients (SP). In contrast to other disciplines such as internal medicine or surgery, there is not much literature about SP in psychiatry and psychotherapy. The objective of this pilot study was to evaluate if SP used for clinical teaching in addition to real patients are well accepted for simulation of psychiatric illnesses and clinical teaching. After randomization, one half of the 139 study medical students were taught using real patients and the other half using real patients and SP. The amounts of patient contact were equal in both groups. Using a questionnaire, pre- and postanalysis was carried out of answers about communication skills, the capability of addressing difficult subjects such as suicidality, and interest in psychiatry. The acceptance rate of SP was very high. Students' ratings of clinical teaching and their own performance, and their interest in future psychiatric work were significantly higher in the SP group. The results of this pilot study are very encouraging and indicate that the systematic use of SP in clinical psychiatric teaching is not only an appropriate alternative to real patients but also can lead to higher quality.
Zusammenfassung
Aufgrund der neuen Approbationsordnung für Ärzte wird deutlich mehr Unterricht am Krankenbett gefordert als bisher. Da Patienten nur in begrenztem Maße im Studentenunterricht ...eingesetzt werden können, werden inzwischen verstärkt Simulationspatienten (SP), auch standardisierte Patienten genannt, in der Lehre eingesetzt. Im Gegensatz zu anderen medizinischen Fächern liegen für den Einsatz von SP im Unterricht in Psychiatrie und Psychotherapie kaum Daten vor.
Im Rahmen eines Pilotprojekts sollte überprüft werden, ob SP in Ergänzung zu realen Patienten im praktischen Unterricht im Fach Psychiatrie und Psychotherapie von den Studierenden gut angenommen werden und ob psychische Erkrankungen von Laienschauspielern realitätsgetreu dargestellt werden können. Darüber hinaus sollte überprüft werden, ob der Einsatz von SP zu einer besseren Bewertung der Lehre führt.
Von 139 Studierenden eines Semesters erhielt eine Hälfte nach Randomisierung praktischen Unterricht mit realen Patienten, die andere Hälfte sowohl mit realen Patienten als auch mit SP bei gleicher Gesamtzahl der Patientenkontakte. Es erfolgte eine Prä-Post-Analyse mit einem Fragebogen, der die Items „Kenntnisse in Gesprächsführung“, „Zutrauen, schwierige Themen wie Suizidalität ansprechen“, „Freude am Unterricht“ und „Interesse am Fach“ beinhaltete.
Die SP wurden sehr gut von den Studierenden angenommen. Der Nutzen des Unterrichts und die Einschätzung der eigenen Kenntnisse im Fach Psychiatrie und Psychotherapie wurde in der Gruppe, die zusätzlich mit SP unterrichtet wurde, signifikant besser bewertet als in der Kontrollgruppe.
Die Ergebnisse dieser Pilotstudie sind sehr ermutigend und deuten darauf hin, dass der systematische Einsatz von SP im praktischen Unterricht im Fach Psychiatrie und Psychotherapie ein geeigneter Ersatz für reale Patienten sein und die Ausbildung in bestimmten Aspekten sogar verbessern kann.
Glacial Lake Outburst Floods (GLOFs) have become increasingly common over the past century in response to climate change, posing risks for human activities in many mountain regions. In this paper we ...document and reconstruct the sequence of events and impact of a large GLOF that took place in December 2015 in the Chileno Valley, Patagonia. Hydrograph data suggests that the flood continued for around eight days with an estimated total discharge of 105.6 × 106 m3 of water. The sequence of events was as follows: (1) A large debris flow entered the lake from two steep and largely non-vegetated mountain gullies located northeast of the Chileno Glacier terminus. (2) Water displaced in the lake by the debris flow increased the discharge through the Chileno Lake outflow. (3) Lake and moraine sediments were eroded by the flood. (4) Eroded sediments were redistributed downstream by the GLOF. The post-GLOF channel at the lake outlet widened in some places by >130 m and the surface elevation of the terrain lowered by a maximum of 38.8 ± 1.5 m. Farther downstream, large amounts of entrained sediment were deposited at the head of an alluvial plain and these sediments produced an ~340 m wide fan with an average increase in surface elevation over the pre-GLOF surface of 4.6 ± 1.5 m. We estimate that around 3.5 million m3 of material was eroded from the flood-affected area whilst over 0.5 million m3 of material was deposited in the downstream GLOF fan. The large debris flow that triggered the GLOF was probably a paraglacial response to glacier recession from its Little Ice Age limits. We suggest that GLOFs will continue to occur in these settings in the future as glaciers further recede in response to global warming and produce potentially unstable lakes. Detailed studies of GLOF events are currently limited in Patagonia and the information presented here will therefore help to inform future glacial hazard assessments in this region.
Glacier Benito is a temperate outlet glacier on the west side of the North Patagonian Icefield. Rates of thinning and ablation were obtained using data collected by the ritish Joint Services ...Expedition in 1972/73 and subsequent data collected in 2007 and 2011. Ice-front recession rates were based on dendrochronological dating for the terminal moraines and aerial and satellite imagery of the ice front in 1944, 1998 and 2002. Between the first Benito survey in 1973 and 2007, the lower glacier thinned by nearly 150 m at an average rate of 4.3 m yr
−1
with the rate increasing to 6.1 m yr
−1
between 2007 and 2011, a 28.7% increase during the latter period. Increases in ice movement and ablation were negligible: ice movement for 1973 and 2007 averaged 0.45 m day
−1
and ablation averaged 0.05 m day
−1
. Ice front recession along the glacier's centre line from 1886 to 2002 was approximately 1860 m. Retreat rates between 1886 and 1944 averaged 8.9 m yr
−1
. Thereafter glacier asymmetry makes measurement along the glacier centre line unrepresentative of areal change until 1998 when symmetry was restored; retreat between 1944 and 1998 was 15.4 m yr
−1
. From 1998 to 2002 the rate increased dramatically to 127.2 m yr
−1
. Recession from the southern end of Benito's terminal moraine in the 1850s supports an early date for initial retreat of the Icefield's glaciers.
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