HintergrundDer Nationale Kompetenzbasierte Lernzielkatalog Chirurgie (NKLC) wurde von allen chirurgischen Fachgesellschaften gemeinsam formuliert. Er bildet ein Verbindungsglied zwischen den ...chirurgischen Lehrstühlen und dem fachübergreifenden Nationalen Kompetenzbasierten Lernzielkatalog Medizin (NKLM), der künftig als Grundlage für die Inhalte der studentischen Lehre und letztlich der Staatsexamina dienen soll. Der NKLC enthält 230 chirurgische Lernziele. Die durchgeführte Analyse ermittelte den Anteil an herzchirurgisch relevanten Lernzielen im NKLC und vergleicht die Ergebnisse mit den tatsächlich bislang gestellten Prüfungsfragen im schriftlichen Teil des 2. Staatsexamens (M2).Material und MethodenDie Examensfragen vom Herbst 2009 bis Herbst 2014 (n = 11) wurden retrospektiv analysiert. Lernziele mit Bezug zur Herzchirurgie wurden durch Fachärzte für Herzchirurgie aus dem Katalog ausgewählt. Anschließend wurden in den Staatsexamina diejenigen Fragen identifiziert, die sich auf herzchirurgische Lernziele bezogen. Die Analyse umfasste die Gesamtzahl der Fragen, die Anzahl der Fragen pro Examen sowie pro Lernziel und Kompetenzebene.ErgebnisseSieben erfahrene Fachärzte für Herzchirurgie fungierten als Gutachter. Es wurden 46 chirurgische Lernziele (20 % aller Lernziele im NKLC) identifiziert, die in der Herzchirurgie abgebildet werden. Insgesamt wurden in den 11 untersuchten Examina 246 Fragen (7,1 % aller 3480 gestellten Fragen) mit Bezug zur Herzchirurgie gefunden. Die häufigsten Fragen mit reinem Organbezug „Herz“ betrafen Herzklappenerkrankungen und angeborene Herzfehler mit jeweils 21 Fragen (entspricht je 0,6 % aller 3480 Fragen). Elf herzchirurgische Lernziele (23,9 %) wurden bislang nie geprüft, davon befinden sich 3 auf der Kompetenzebene 3.SchlussfolgerungHerzchirurgisch relevante Lernziele nehmen mit etwa einem Fünftel einen breiten Raum im NKLC ein, was im M2 nicht entsprechend abgebildet wird. In Anbetracht ihrer immensen gesundheitspolitischen Bedeutung erscheinen die herzmedizinischen Inhalte in den bisherigen Prüfungen eindeutig unterrepräsentiert.
Spontaneous pneumothorax is an uncommon complication of COVID-19 viral pneumonia. The exact incidence and risk factors are still unknown. Herein we review the incidence and outcomes of pneumothorax ...in over 3000 patients admitted to our institution for suspected COVID-19 pneumonia.
We performed a retrospective review of COVID-19 cases admitted to our hospital. Patients who were diagnosed with a spontaneous pneumothorax were identified to calculate the incidence of this event. Their clinical characteristics were thoroughly documented. Data regarding their clinical outcomes were gathered. Each case was presented as a brief synopsis.
Three thousand three hundred sixty-eight patients were admitted to our institution between March 1st, 2020 and June 8th, 2020 for suspected COVID 19 pneumonia, 902 patients were nasopharyngeal swab positive. Six cases of COVID-19 patients who developed spontaneous pneumothorax were identified (0.66%). Their baseline imaging showed diffuse bilateral ground-glass opacities and consolidations, mostly in the posterior and peripheral lung regions. 4/6 cases were associated with mechanical ventilation. All patients required placement of a chest tube. In all cases, mortality (66.6%) was not directly related to the pneumothorax.
Spontaneous pneumothorax is a rare complication of COVID-19 viral pneumonia and may occur in the absence of mechanical ventilation. Clinicians should be vigilant about the diagnosis and treatment of this complication.
Introduction: The annual report for the National Audit of Cardiac Rhythm Management (CRM) Devices describes procedural activity and complication rates; it is reported through the National Institute ...of Cardiovascular Outcomes Research (NICOR). NICOR sets a cut off of 15 months following implant to attribute device related complications. However, device related revisions can occur after 15 months and we sought to investigate these and compare them with the NICOR group. Methods: Our devices database was searched for all device procedures during 2018, and all recorded complications. A comparison was made between patients within, and outside of the 15-month reporting period. Complications were classified as wound related, infection, pneumothorax, haematoma, lead displacement and ‘other’ lead complications such as parameter changes or integrity faults. The time from the first device implant to detection of complication was recorded, however some patients underwent further procedures within this period. Statistical analysis was performed with Chi-squared and t-test. Results: 2,393 CRM device procedures were performed at our centre over 2018. A total of 174 (7.28%) complications were recorded, involving 169 patients. 115 (4.81%) complications were recorded across 110 patients, within the 15-month NICOR period, and 59 (2.47%) occurred after 15 months. NICOR mean age was higher than the non-NICOR group (69.8 ± 16.5 versus 63.8 ± 19.0 years, p=0.04) but the proportion of males was similar (57.3 versus 64.4%, p=0.37). All-cause mortality was similar 5five (4.5%) versus 3 (5.1%), p=0.88. As the data was dichotomised by time from implant, mean time from first implant to recorded complication was shorter in the NICOR group compared with the non-NICOR group (1.48 ± 3.09 versus 9.89 ± 5.89 years, p<0.0001). Within the NICOR group (n=115), lead displacements made up the largest proportion, 45 (39.12%), followed by ‘other’ lead complications 16 (13.91%), wound revisions 16 (13.91%), infection 13 (11.30%), pneumothorax 5 (4.35%), haematoma 9 (7.83%) and pericardial effusion 6 (5.22%). By contrast, the non-NICOR complications (n=59) were dominated by ‘other’ lead complications, 37 (61.71%) which primarily related to integrity issues and parameter changes. There was 1 lead displacement beyond 15 months (1.69%), 8 (13.56%) wound revisions and 12 (20.34%) very late infections. There were no reported pneumothoraxes, haematomas or pericardial effusions after 15 months. Discussion: A considerable proportion of complications requiring intervention present many years after the initial implant, and certainly outside of the NICOR reporting window. Although reported locally, this may reflect a significant burden of morbidity related to CRM devices that goes unreported at a national level. Conclusion: Late device related complications falling outside of the NICOR reporting window are an important source of patient comorbidity and they deserve our attention and further investigation. Image Omitted
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