@article{HalfmannCastioniWetzeletal.2024,
  author    = {Halfmann, Marie and Castioni, Noah and Wetzel, Lea and Koopmann, Anne and K{\"o}nig, Sarah and Schmieder, Astrid},
  title     = {Effects of the COVID-19 pandemic on the mental health of medical students and young physicians in Germany: Gender-specific results of an online survey},
  series = {Heliyon},
  volume    = {10},
  journal   = {Heliyon},
  number    = {1},
  issn      = {2405-8440},
  doi       = {10.1016/j.heliyon.2023.e23727},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-350502},
  year      = {2024},
  abstract  = {Background Healthcare workers and medical students faced new challenges during the COVID-19 pandemic. Processes within many hospitals were completely disrupted. In addition, the face to face teaching of medical students was drastically reduced. Those at risk of developing mental health problems appear to be younger health care workers and women. Objective To investigate potential COVID-19 pandemic-related gender differences in psychological distress among medical students and physicians in their first years of practice. Design and setting An anonymous survey was carried out online between December 1, 2021, and March 31, 2022, at the Mannheim Medical Faculty and the W{\"u}rzburg Medical Faculty, Germany, after obtaining informed consent. Primary outcome measures were changes in anxiety and depression symptoms using the Hospital Anxiety and Depression Scale (HADS), and changes in participants' current quality of life using the WHO Quality of Life BREF. Results The results show wave-like courses for perceived anxiety and burden overlapping with the course of the COVID-19 incidence. In comparison to men, women showed a significant higher increase in HADS (p = 0.005) and a reduced life quality (p = 0.007) after COVID-19. Both sexes showed different frequencies of the factors influencing quality of life, with the presence of a previous mental illness and mean anxiety having a significant higher negative impact in women. Conclusion Future and young female physicians reported a disproportionate higher burden during COVID-19 compared to their male colleges. These observations suggest an increased need for support and prevention efforts especially in this vulnerable population.},
  language  = {en}
}
@article{WabnitzSchwienhorstStichAsbecketal.2023,
  author    = {Wabnitz, Katharina and Schwienhorst-Stich, Eva-Maria and Asbeck, Franziska and Fellmann, Cara Sophie and Gepp, Sophie and Leberl, Jana and Mezger, Nikolaus Christian Simon and Eichinger, Michael},
  title     = {National Planetary Health learning objectives for Germany: A steppingstone for medical education to promote transformative change},
  series = {Frontiers in Public Health},
  volume    = {10},
  journal   = {Frontiers in Public Health},
  issn      = {2296-2565},
  doi       = {10.3389/fpubh.2022.1093720},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-306027},
  year      = {2023},
  abstract  = {Physicians play an important role in adapting to and mitigating the adverse health effects of the unfolding climate and ecological crises. To fully harness this potential, future physicians need to acquire knowledge, values, skills, and leadership attributes to care for patients presenting with environmental change-related conditions and to initiate and propel transformative change in healthcare and other sectors of society including, but not limited to, the decarbonization of healthcare systems, the transition to renewable energies and the transformation of transport and food systems. Despite the potential of Planetary Health Education (PHE) to support medical students in becoming agents of change, best-practice examples of mainstreaming PHE in medical curricula remain scarce both in Germany and internationally. The process of revising and updating the Medical Licensing Regulations and the National Competency-based Catalog of Learning Objectives for Medical Education in Germany provided a window of opportunity to address this implementation challenge. In this article, we describe the development and content of national Planetary Health learning objectives for Germany. We anticipate that the learning objectives will stimulate the development and implementation of innovative Planetary Health teaching, learning and exam formats in medical schools and inform similar initiatives in other health professions. The availability of Planetary Health learning objectives in other countries will provide opportunities for cross-country and interdisciplinary exchange of experiences and validation of content, thus supporting the consolidation of Planetary Health learning objectives and the improvement of PHE for all health professionals globally.},
  language  = {en}
}
@article{SimonParisiWabnitzetal.2023,
  author    = {Simon, Johanna and Parisi, Sandra and Wabnitz, Katharina and Simmenroth, Anne and Schwienhorst-Stich, Eva-Maria},
  title     = {Ten characteristics of high-quality planetary health education},
  series = {Frontiers in Public Health},
  volume    = {11},
  journal   = {Frontiers in Public Health},
  issn      = {2296-2565},
  doi       = {10.3389/fpubh.2023.1143751},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-313856},
  year      = {2023},
  abstract  = {Aim: The climate and ecological crises are considered fundamental threats to human health. Healthcare workers in general and doctors in particular can contribute as change agents in mitigation and adaptation. Planetary health education (PHE) aims to harness this potential. This study explores perspectives among stakeholders involved in PHE at German medical schools on the characteristics of high-quality PHE and compares them to existing PHE frameworks. Methods: In 2021, we conducted a qualitative interview study with stakeholders from German medical schools involved in PHE. Three different groups were eligible: faculty members, medical students actively involved in PHE, and study deans of medical schools. Recruitment was performed through national PHE networks and snowball sampling. Thematic qualitative text analysis according to Kuckartz was used for the analysis. Results were systematically compared to three existing PHE frameworks. Results: A total of 20 participants (13 female) from 15 different medical schools were interviewed. Participants covered a wide range of professional backgrounds and experience in PHE education. The analysis revealed ten key themes: (1) Complexity and systems thinking, (2) inter- and transdisciplinarity, (3) ethical dimension, (4) responsibility of health professionals, (5) transformative competencies including practical skills, (6) space for reflection and resilience building, (7) special role of students, (8) need for curricular integration, (9) innovative and proven didactic methods, and (10) education as a driver of innovation. Six of our themes showed substantial overlap with existing PHE frameworks. Two of our themes were only mentioned in one of the frameworks, and two others were not explicitly mentioned. Few important elements of the frameworks did not emerge from our data. Conclusions: In the light of increased attention regarding the connections of the climate and ecological crises and health, our results can be useful for anyone working toward the integration of planetary health into medical schools' and any health professions' curricula and should be considered when designing and implementing new educational activities.},
  language  = {en}
}
@article{KollingBackhausHofmannetal.2022,
  author    = {Kolling, Markus and Backhaus, Joy and Hofmann, Norbert and Keß, Stefan and Krastl, Gabriel and Soliman, Sebastian and K{\"o}nig, Sarah},
  title     = {Students' perception of three-dimensionally printed teeth in endodontic training},
  series = {European Journal of Dental Education},
  volume    = {26},
  journal   = {European Journal of Dental Education},
  number    = {4},
  doi       = {10.1111/eje.12743},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-318676},
  pages     = {653 -- 661},
  year      = {2022},
  abstract  = {Introduction In endodontic education, there is a need for thorough training prior to students embarking on clinical treatment. The aim of this study was to use three-dimensional printing technology to create a new model and to compare its suitability for training purposes with resin blocks and extracted teeth. Materials and Methods Multi-jet-modelling (MJM) produced the 3D model replicating a common difficulty in root-canal morphology. An evaluation study comprising 88 students was run in the sixth semester (summer 2018 and winter 2018/2019). A new questionnaire assessed students' perception of training models and educational environment. Welch's t-test analysed significant differences. Results The most pronounced differences between models were noted when rating material hardness, radiopacity, root-canal configuration and suitability for practising. Students estimated their learning outcome as greater with 3D-printed teeth compared to resin blocks. Three-dimensionally printed teeth received significantly lower ratings with regard to enthusiasm, the learning of fine motor skills and spatial awareness, when compared to human teeth (p ≤ .001). However, 3D-printed teeth were appreciated for additional benefits, such as their cleanliness, availability and standardisation of training opportunities with complex root-canal configurations. Conclusion Students preferred extracted human teeth to 3D-printed teeth with respect to their physical characteristics and training experience. However, educational advantages may compensate for the shortcomings. The new questionnaire proved both adequate and accurate to assess the models and educational environment in endodontic training. The new 3D-printed teeth enhanced the learning opportunities.},
  language  = {en}
}
@article{WestphaleBackhausKoenig2022,
  author    = {Westphale, Silke and Backhaus, Joy and Koenig, Sarah},
  title     = {Quantifying teaching quality in medical education: The impact of learning gain calculation},
  series = {Medical Education},
  volume    = {56},
  journal   = {Medical Education},
  number    = {3},
  doi       = {10.1111/medu.14694},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-259576},
  pages     = {312-320},
  year      = {2022},
  abstract  = {Background Student performance is a mirror of teaching quality. The pre-/post-test design allows a pragmatic approach to comparing the effects of interventions. However, the calculation of current knowledge gain scores introduces varying degrees of distortion. Here we present a new metric employing a linear weighting coefficient to reduce skewness on outcome interpretation. Methods We compared and contrasted a number of common scores (raw and relative gain scores) with our new method on two datasets, one simulated and the other empirical from a previous intervention study (n = 180) employing a pre-/post-test design. Results The outcomes of the common scores were clearly different, demonstrating a significant dependency on pre-test scores. Only the new metric revealed a linear relationship to the knowledge baseline, was less skewed on the upper or lower extremes, and proved well suited to allow the calculation of negative learning gains. Employing the empirical dataset, the new method also confirmed the interaction effect of teaching formats with specific subgroups of learner characteristics. Conclusion This work introduces a new weighted metric enabling meaningful comparisons between interventions based on a linear transformation. This method will form the basis to intertwine the calculation of test performance closely with the outcome of learning as an important factor reflecting teaching quality and efficacy. Its regular use can improve the transparency of teaching activities and outcomes, contribute to forming rounded judgements of students' acquisition of knowledge and skills and enable valuable feedforward to develop and enhance curricular concepts.},
  language  = {en}
}
@article{KannBruennertHansenetal.2020,
  author    = {Kann, Simone and Bruennert, Daniela and Hansen, Jessica and Concha Mendoza, Gustavo Andr{\´e}s and Crespo Gonzalez, Jos{\´e} Jos{\´e} and Armenta Quintero, Cielo Leonor and Hanke, Miriam and Hagen, Ralf Matthias and Backhaus, Joy and Frickmann, Hagen},
  title     = {High prevalence of intestinal pathogens in Indigenous in Colombia},
  series = {Journal of Clinical Medicine},
  volume    = {9},
  journal   = {Journal of Clinical Medicine},
  number    = {9},
  issn      = {2077-0383},
  doi       = {10.3390/jcm9092786},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-211289},
  year      = {2020},
  abstract  = {Background: Intestinal infections remain a major public health burden in developing countries. Due to social, ecological, environmental, and cultural conditions, Indigenous peoples in Colombia are at particularly high risk. Materials: 137 stool samples were analyzed by microscopy and real-time-Polymerase Chain Reaction (RT-PCR), targeting protozoan parasites (Giardia intestinalis, Entamoeba histolytica, Cryptosporidium spp., and Cyclospora cayetanensis), bacteria (Campylobacter jejuni, Salmonella spp., Shigella ssp./enteroinvasive E. coli (EIEC), Yersinia spp., enterohemorrhagic E. coli (EHEC), enteropathogenic E. coli (EPEC), enterotoxin-producing E. coli (ETEC), enteroaggregative E. coli (EAEC), and Tropheryma whipplei), and helminths (Necator americanus, Strongyloides stercoralis, Ascaris lumbricoides, Ancylostoma spp., Trichuris. trichiura, Taenia spp., Hymenolepis nana, Enterobius vermicularis, and Schistosoma spp.). Microscopy found additional cases of helminth infections. Results: At least one pathogen was detected in 93\% of the samples. The overall results revealed protozoa in 79\%, helminths in 69\%, and bacteria in 41\%. G. intestinalis (48\%), Necator/hookworm (27\%), and EAEC (68\%) were the most common in each group. Noteworthy, T. whipplei was positive in 7\% and T. trichirua in 23\% of the samples. A significant association of one infection promoting the other was determined for G. intestinalis and C. jejuni, helminth infections, and EIEC. Conclusions: The results illustrate the high burden of gastrointestinal pathogens among Indigenous peoples compared to other developing countries. Countermeasures are urgently required.},
  language  = {en}
}
@article{BocukWolffKrauseetal.2017,
  author    = {Bocuk, Derya and Wolff, Alexander and Krause, Petra and Salinas, Gabriela and Bleckmann, Annalen and Hackl, Christina and Beissbarth, Tim and Koenig, Sarah},
  title     = {The adaptation of colorectal cancer cells when forming metastases in the liver: expression of associated genes and pathways in a mouse model},
  series = {BMC Cancer},
  volume    = {17},
  journal   = {BMC Cancer},
  number    = {342},
  doi       = {10.1186/s12885-017-3342-1},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-170853},
  year      = {2017},
  abstract  = {Background: Colorectal cancer (CRC) is the second leading cause of cancer-related death in men and women. Systemic disease with metastatic spread to distant sites such as the liver reduces the survival rate considerably. The aim of this study was to investigate the changes in gene expression that occur on invasion and expansion of CRC cells when forming metastases in the liver. Methods: The livers of syngeneic C57BL/6NCrl mice were inoculated with 1 million CRC cells (CMT-93) via the portal vein, leading to the stable formation of metastases within 4 weeks. RNA sequencing performed on the Illumina platform was employed to evaluate the expression profiles of more than 14,000 genes, utilizing the RNA of the cell line cells and liver metastases as well as from corresponding tumour-free liver. Results: A total of 3329 differentially expressed genes (DEGs) were identified when cultured CMT-93 cells propagated as metastases in the liver. Hierarchical clustering on heat maps demonstrated the clear changes in gene expression of CMT-93 cells on propagation in the liver. Gene ontology analysis determined inflammation, angiogenesis, and signal transduction as the top three relevant biological processes involved. Using a selection list, matrix metallopeptidases 2, 7, and 9, wnt inhibitory factor, and chemokine receptor 4 were the top five significantly dysregulated genes. Conclusion: Bioinformatics assists in elucidating the factors and processes involved in CRC liver metastasis. Our results support the notion of an invasion-metastasis cascade involving CRC cells forming metastases on successful invasion and expansion within the liver. Furthermore, we identified a gene expression signature correlating strongly with invasiveness and migration. Our findings may guide future research on novel therapeutic targets in the treatment of CRC liver metastasis.},
  language  = {en}
}
@article{EdelmannMusialBrightGelbrichetal.2016,
  author    = {Edelmann, Frank and Musial-Bright, Lindy and Gelbrich, Goetz and Trippel, Tobias and Radenovic, Sara and Wachter, Rolf and Inkrot, Simone and Loncar, Goran and Tahirovic, Elvis and Celic, Vera and Veskovic, Jovan and Zdravkovic, Marija and Lainscak, Mitja and Apostolović, Svetlana and Neskovic, Aleksandar N. and Pieske, Burkert and D{\"u}ngen, Hans-Dirk},
  title     = {Tolerability and feasibility of beta-blocker titration in HFpEF versus HFrEF: Insights from the CIBIS-ELD trial},
  series = {JACC: Heart Failure},
  volume    = {4},
  journal   = {JACC: Heart Failure},
  number    = {2},
  doi       = {10.1016/j.jchf.2015.10.008},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-191022},
  pages     = {140-149},
  year      = {2016},
  abstract  = {OBJECTIVES: This study evaluated the tolerability and feasibility of titration of 2 distinctly acting beta-blockers (BB) in elderly heart failure patients with preserved (HFpEF) and reduced (HFrEF) left ventricular ejection fraction. BACKGROUND: Broad evidence supports the use of BB in HFrEF, whereas the evidence for beta blockade in HFpEF is uncertain. METHODS: In the CIBIS-ELD (Cardiac Insufficiency Bisoprolol Study in Elderly) trial, patients >65 years of age with HFrEF (n = 626) or HFpEF (n = 250) were randomized to bisoprolol or carvedilol. Both BB were up-titrated to the target or maximum tolerated dose. Follow-up was performed after 12 weeks. HFrEF and HFpEF patients were compared regarding tolerability and clinical effects (heart rate, blood pressure, systolic and diastolic functions, New York Heart Association functional class, 6-minute-walk distance, quality of life, and N-terminal pro-B-type natriuretic peptide). RESULTS: For both of the BBs, tolerability and daily dose at 12 weeks were similar. HFpEF patients demonstrated higher rates of dose escalation delays and treatment-related side effects. Similar HR reductions were observed in both groups (HFpEF: 6.6 beats/min; HFrEF: 6.9 beats/min, p = NS), whereas greater improvement in NYHA functional class was observed in HFrEF (HFpEF: 23\% vs. HFrEF: 34\%, p < 0.001). Mean E/e' and left atrial volume index did not change in either group, although E/A increased in HFpEF. CONCLUSIONS: BB tolerability was comparable between HFrEF and HFpEF. Relevant reductions of HR and blood pressure occurred in both groups. However, only HFrEF patients experienced considerable improvements in clinical parameters and Left ventricular function. Interestingly, beta-blockade had no effect on established and prognostic markers of diastolic function in either group. Long-term studies using modern diagnostic criteria for HFpEF are urgently needed to establish whether BB therapy exerts significant clinical benefit in HFpEF. (Comparison of Bisoprolol and Carvedilol in Elderly Heart Failure HF] Patients: A Randomised, Double-Blind Multicentre Study CIBIS-ELD]; ISRCTN34827306).},
  language  = {en}
}
@article{WidderBackhausWierlemannetal.,
  author    = {Widder, A. and Backhaus, J. and Wierlemann, A. and Hering, I. and Flemming, S. and Hankir, M. and Germer, C.-T. and Wiegering, A. and Lock, J. F. and K{\"o}nig, S. and Seyfried, F.},
  title     = {Optimizing laparoscopic training efficacy by 'deconstruction into key steps': a randomized controlled trial with novice medical students},
  series = {Surgical Endoscopy},
  volume    = {36},
  journal   = {Surgical Endoscopy},
  number    = {12},
  doi       = {10.1007/s00464-022-09408-2},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-323969},
  pages     = {8726-8736},
  abstract  = {Background Simulator training is an effective way of acquiring laparoscopic skills but there remains a need to optimize teaching methods to accelerate learning. We evaluated the effect of the mental exercise 'deconstruction into key steps' (DIKS) on the time required to acquire laparoscopic skills. Methods A randomized controlled trial with undergraduate medical students was implemented into a structured curricular laparoscopic training course. The intervention group (IG) was trained using the DIKS approach, while the control group (CG) underwent the standard course. Laparoscopic performance of all participants was video-recorded at baseline (t0), after the first session (t1) and after the second session (t2) nine days later. Two double-blinded raters assessed the videos. The Impact of potential covariates on performance (gender, age, prior laparoscopic experience, self-assessed motivation and self-assessed dexterity) was evaluated with a self-report questionnaire. Results Both the IG (n = 58) and the CG (n = 68) improved their performance after each training session (p < 0.001) but with notable differences between sessions. Whereas the CG significantly improved their performance from t0 -t1 (p < 0.05), DIKS shortened practical exercise time by 58\% so that the IG outperformed the CG from t1 -t2, (p < 0.05). High self-assessed motivation and dexterity associated with significantly better performance (p < 0.05). Male participants demonstrated significantly higher overall performance (p < 0.05). Conclusion Mental exercises like DIKS can improve laparoscopic performance and shorten practice times. Given the limited exposure of surgical residents to simulator training, implementation of mental exercises like DIKS is highly recommended. Gender, self-assessed dexterity, and motivation all appreciably influence performance in laparoscopic training.},
  language  = {en}
}