Drei Viertel aller Krankenhäuser in Deutschland haben mittlerweile Probleme, offene Arztstellen zu besetzen. Die ärztliche Stellenanzeige ist ein entscheidendes Instrument des Personalmarketing und zugleich Image-bildendes Medium mit hoher Außenwirkung. Die vorliegende Studie untersucht die Wichtigkeit von Angaben und Angeboten in ärztlichen Stellenanzeigen auf die potenielle Bewerbungsentscheidung von Medizinstudierenden. Insgesamt 184 zukünftige Ärztinnen und Ärzte klinischer Semester nahmen freiwillig im Rahmen einer Querschnittsstudie an einer anonymen Befragung teil. Mittels eines standardisierten Fragebogens wurde die Wichtigkeit von 49 Einzelitems aus Stellenanzeigen für Berufsanfänger mithilfe einer 4-stufigen LIKERT-Skala bewertet. Abschließend priorisierten die Studienteilnehmer ihre Gründen für eine Klinikbewerbung. Wesentlichen Einfluss auf die Bewerbungsentscheidung hatten Angebote/Informationen in Bezug auf Fort- und Weiterbildungsaspekte und die Vereinbarkeit von Beruf und Familie. Bezahlung nach Ärztetarif und Dienstbelastung spielten eine wichtige Rolle bei der Bewerbungsmotivation. Zusatzverdienste durch Notarzt- und gutachterliche Tätigkeit sowie Hilfe bei der Wohnungsvermittlung, dem Umzug und/oder die Übernahme von Vorstellungskosten durch den Arbeitgeber waren weniger von ausschlaggebender Bedeutung. In der Priorisierung entscheidender Gründen bei der Auswahl eines zukünftigen Arbeitgebers hatten „geregelte Arbeitszeiten“, ein „individuell festgelegtes Ausbildungskonzept“ und „familienattraktive Regelungen“ die höchste Priorität. Der „Möglichkeit zur wissenschaftlichen Arbeit“ wurde nur eine geringe Bedeutsamkeit zugemessen. Hohe Wichtigkeit für die Bewerbungsentscheidung von Medizinstudierenden auf eine ärztliche Stellenanzeige haben persönliche Entwicklungsmöglichkeiten und Aspekte, die zum Einklang zwischen Arbeit und Familie/Privatleben beitragen.
Background and purpose — In hip arthroplasty, acetabular inclination and anteversion—and also femoral stem torsion—are generally assessed by eye intraoperatively. We assessed whether visual estimation of cup and stem position is reliable.Patients and methods — In the course of a subgroup analysis of a prospective clinical trial, 65 patients underwent cementless hip arthroplasty using a minimally invasive anterolateral approach in lateral decubitus position. Altogether, 4 experienced surgeons assessed cup position intraoperatively according to the operative definition by Murray in the anterior pelvic plane and stem torsion in relation to the femoral condylar plane. Inclination, anteversion, and stem torsion were measured blind postoperatively on 3D-CT and compared to intraoperative results.Results — The mean difference between the 3D-CT results and intraoperative estimations by eye was −4.9° (−18 to 8.7) for inclination, 9.7° (−16 to 41) for anteversion, and −7.3° (−34 to 15) for stem torsion. We found an overestimation of > 5° for cup inclination in 32 hips, an overestimation of > 5° for stem torsion in 40 hips, and an underestimation < 5° for cup anteversion in 42 hips. The level of professional experience and patient characteristics had no clinically relevant effect on the accuracy of estimation by eye. Altogether, 46 stems were located outside the native norm of 10–20° as defined by Tönnis, measured on 3D-CT.Interpretation — Even an experienced surgeon's intraoperative estimation of cup and stem position by eye is not reliable compared to 3D-CT in minimally invasive THA. The use of mechanical insertion jigs, intraoperative fluoroscopy, or imageless navigation is recommended for correct implant insertion.
Mesenchymal stromal cells (MSCs) that are promising for cartilage tissue engineering secrete high amounts of prostaglandin E2 (PGE2), an immunoactive mediator involved in endochondral bone development. This study aimed to identify drivers of PGE2 and its role in the inadvertent MSC misdifferentiation into hypertrophic chondrocytes. PGE2 release, which rose in the first three weeks of MSC chondrogenesis, was jointly stimulated by endogenous BMP, WNT, and hedgehog activity that supported the exogenous stimulation by TGF-β1 and insulin to overcome the PGE2 inhibition by dexamethasone. Experiments with PGE2 treatment or the inhibitor celecoxib or specific receptor antagonists demonstrated that PGE2, although driven by prohypertrophic signals, exerted broad autocrine antihypertrophic effects. This chondroprotective effect makes PGE2 not only a promising option for future combinatorial approaches to direct MSC tissue engineering approaches into chondral instead of endochondral development but could potentially have implications for the use of COX-2-selective inhibitors in osteoarthritis pain management.
A rare catastrophic failure of modular component Total Hip Arthroplasty is dissociation between liner and cup, which has been associated with component malposition and/or impingement and seems to be more frequently associated with the Pinnacle system. The goal of this study was to evaluate the resistance of a polyethylene liner to lever-out-forces of the Pinnacle locking mechanism and the locking mechanisms of two other current cup/liner systems using a standardized testing method (ASTM).Five of each of the following cups were evaluated with their corresponding polyethylene liners: Pinnacle Multihole cup with and without intact anti-rotation tabs (ART's); Allofit-S-Alloclassic and Plasmafit Plus7 cups. The ASTM test set-up was used to evaluate the lever-out force resulting in liner dissociation for each construct.The Pinnacle construct with intact ARTs required the greatest force (F) to achieve dissociation (263.2 ± 79.2 N) followed by the Plasmafit Plus7 (185.8 ± 36.9 N) and the Allofit-S (101.4 ± 35.3 N) constructs, respectively. However, after removal of the ARTs, the Pinnacle system required the least force to achieve dissociation (75.1 ± 22.2 N) (p < 0.001).The intact Pinnacle system appeared the most stable in lever-out tests when compared to the other systems. However, after removal of the ARTs, the Pinnacle system required the least force for dissociation, consistent with locking mechanism failure, and suggesting that the ARTs are a critical component of the locking mechanism. Our findings are consistent with the clinical experience of dissociated Pinnacle constructs displaying damaged or missing ARTs, and that damage to these may increase risk of liner dissociation.
Football players have a high risk of leg muscle injuries, especially when exposed to mental stress. Injuries to muscles of the thigh are common in amateur and professional football, representing almost a third of all injuries. These injuries occur primarily in non-contact situations and from overuse. They can lead to a range of costs, including financial costs associated with treatment as well as those associated with long-term recovery, and absence from training and/or competition. Further, there is a high risk of injury recurrence and subsequent injury.
Selbst ein Vierteljahrhundert nach Einführung des Begriffs und der Prinzipien evidenzbasierter Medizin (EbM) sind einige Gesundheitsdienstleister(innen) noch davon überzeugt, dass diese im unvereinbaren Gegensatz zum medizinischen Erfahrungswissen stehen würden. Gerade in den operativen Disziplinen wird oft argumentiert, dass EbM die Bedeutung von Intuition und manuellem Geschick herabwürdigt. Diese Annahmen sind irreführend und zumeist geprägt durch ein falsches Verständnis von der Methodik der EbM. Die besten kontrollierten Studien lassen sich ohne klinische Expertise weder vernünftig interpretieren noch implementieren – Klinikerinnen und Kliniker müssen ihre Patientinnen und Patienten aber nach dem aktuellen Stand des medizinischen Wissens behandeln. In einer Ära umwälzender biomedizinischer Entwicklungen, wissenschaftlicher Informationsexplosion und Schrittinnovationen sollten sich alle Berufsgruppen im Gesundheitswesen mit praktikablen Werkzeugen vertraut machen, um die Validität und Relevanz klinischer Studienergebnisse rasch und systematisch beurteilen zu können und ihre Entscheidungen an diesen auszurichten. In diesem Beitrag wird anhand des aktuellen Beispiels eines neuen Medizinprodukts in der Behandlung von Rotatorenmanschettenrupturen und des Schulterdach-Engesyndroms (Impingement) illustriert, wie wichtig es ist, Daten im Kontext konkreter und präziser Fragestellungen zu deuten und klinische Erfahrung mit den methodischen Prinzipien der EbM zu kombinieren.
Training of young surgeons in total hip arthroplasty (THA) is crucial, but might affect operative time and outcome especially in minimally invasive (MIS) THA. We asked whether the learning curve of orthopaedic residents trained on MIS THA has an impact on (1) operative time (2) complication rates and (3) early postoperative outcome. In a retrospective analysis of over 1000 MIS THAs from our institutional joint registry, operative time, complication rates, patient reported outcome measures (Western Ontario and McMaster Universities Arthritis Index [WOMAC] and Euro-Qol 5D-5L [EQ-5D]) within the first year and responder rates for positive outcome as defined by the Outcome Measures in Rheumatology and Osteoarthritis Research Society International consensus responder (OMERACT-OARSI) criteria were compared between trainee and senior surgeons. Mean operative time was nine minutes longer for trainees compared to senior surgeons (78.1 ± 25.4 min versus 69.3 ± 23.8 min, p < 0.001). Dislocation (p = 0.21), intraoperative fracture (p = 0.84) and infection rates (p = 0.58) were comparably low in both groups. Both trainee and senior THAs showed excellent improvement of EQ-5D (0.34 ± 0.26 versus 0.32 ± 0.23, p = 0.40) and WOMAC (45.9 ± 22.1 versus 44.9 ± 20.0, p = 0.51) within the first year after surgery without clinical relevant differences. Similarly, responder rates for positive outcome were comparable between trainees with 92.9% and senior surgeons with 95.2% (p = 0.17). MIS THA seems to be a safe procedure during the learning curve of young orthopaedic specialists, but requires higher operative time.
Background and purpose — There is growing evidence that hypoproteinemia is an important risk factor for adverse events after surgery. Less is known about the impact of vitamin deficiency on postoperative outcome. Therefore we evaluated the prevalence and impact of malnutrition and vitamin deficiency in geriatric patients undergoing elective orthopedic surgery. Patients and methods — In a retrospective analysis of 599 geriatric patients who had undergone elective orthopedic surgery in 2018 and 2019, hypoproteinemia, and deficiency of vitamin D, vitamin B12, and folate were assessed. Reoperation rates, readmission rates, complication rates, and transfusion rates were compared between malnourished patients and patients with normal parameters. Multivariable logistic regression models were used to assess the relationship between malnutrition and postoperative adverse events, controlling for confounding factors such as age, sex, diabetes mellitus, and frailty. Results — Patients with malnutrition showed a higher rate of reoperation (13% vs. 5.5%; p = 0.01) and exhibited more wound-healing disorders (7.4% vs. 1.3%, p = 0.001) as well as Clavien–Dindo IV° complications (7.4% vs. 2.4%; p = 0.03). Deficiency of vitamin D led to a higher rate of falls (8.4% vs. 2.9%, p = 0.006). Deficiency of vitamin B12 and folate did not affect postoperative adverse events. Although correlated to frailty (p = 0.004), multivariable regression analysis identified malnutrition as independent risk factor for reoperation (OR 2.6, 95% CI 1.1–6.2) and wound healing disorders (OR 7.1, CI 1.9–26). Interpretation — Malnutrition is common among geriatric patients undergoing elective orthopedic surgery and represents an independent risk factor for postoperative adverse events.
