Search

[english] Purpose: Mentoring plays an important role in students' performance and career. The authors of this study assessed the need for mentoring among medical students and established a novel large-scale mentoring program at Ludwig-Maximilians-University (LMU) Munich School of Medicine.Methods: Needs assessment was conducted using a survey distributed to all students at the medical school (n=578 of 4,109 students, return rate 14.1%). In addition, the authors held focus groups with selected medical students (n=24) and faculty physicians (n=22). All students signing up for the individual mentoring completed a survey addressing their expectations (n=534).Results: Needs assessment revealed that 83% of medical students expressed overall satisfaction with the teaching at LMU. In contrast, only 36.5% were satisfied with how the faculty supports their individual professional development and 86% of students voiced a desire for more personal and professional support. When asked to define the role of a mentor, 55.6% "very much" wanted their mentors to act as counselors, arrange contacts for them (36.4%), and provide ideas for professional development (28.1%). Topics that future mentees "very much" wished to discuss included research (56.6%), final year electives (55.8%) and experiences abroad (45.5%).Conclusions: Based on the strong desire for mentoring among medical students, the authors developed a novel two-tiered system that introduces one-to-one mentoring for students in their clinical years and offers society-based peer mentoring for pre-clinical students. One year after launching the program, more than 300 clinical students had experienced one-to-one mentoring and 1,503 students and physicians were involved in peer mentoring societies.[german] Hintergrund: Mentoring ist eine wichtige Stütze in der Karriere von Studierenden. In der vorliegenden Untersuchung dokumentieren wir den Mentoring-Bedarf der Medizinstudierenden an der Medizinischen Fakultät der Ludwig-Maximilians-Universität München (LMU) und beschreiben die Einführung eines innovativen, umfassenden Mentorenprogramms.Methoden: Die Bedarfsanalyse wurde durch eine an alle Medizinstudierenden der Medizinischen Fakultät gerichtete Online-Umfrage durchgeführt (n=578 von 4.109 Studenten, Rücklauf 14,1%). Außerdem führten wir Fokusgruppen mit Medizinstudenten (n=24) und ärztlichem Personal (n=22) durch. Schließlich wurden alle Studierenden, die sich für das individuelle Mentorenprogramm interessierten, zu ihren Erwartungen befragt (n=534).Ergebnisse: 83% der Medizinstudierenden äußerten Zufriedenheit mit dem aktuellen Münchener Curriculum. Im Gegensatz dazu fühlten sich nur 36.5% der Studierenden unserer großen Fakultät ausreichend im Studium betreut, und 86% der Studierenden äußerten den Wunsch nach mehr Betreuung. Die Rolle ihres Mentors wünschten sich 55.6% "sehr" als Berater, Kontaktvermittler (36.4%) und Ideenlieferant (28.1%). Die Themen, die angehende Mentees im Vorfeld "sehr" mit ihren Mentoren besprechen wollten, waren die Doktorarbeit (56.6%), das Praktische Jahr (55.8%) und Auslandsaufenthalte (45.5%).Schlussfolgerungen: Wir haben anhand der Erkenntnisse unserer Bedarfsanalyse ein innovatives, zweigleisiges Konzept entworfen, das aus einem beliebig skalierbaren individuellen Mentorenprogramm für Studierende in klinischen Semestern und einem Peer Mentoring-Programm für sämtliche Medizinstudierende unserer Fakultät besteht. Ein Jahr nach der Initiierung des Programms haben über 300 Studierende im klinischen Studienabschnitt einen individuellen Mentor aus der Fakultät ausgewählt und 1.503 Studierende und Ärzte nahmen am Peer Mentoring teil.

[english] Aims: The Medical Curriculum Munich (MeCuM) has been implemented since 2004 and was completely established in 2007. In this study the clinical part of MeCuM was evaluated with respect to retention of the knowledge in internal medicine (learning objectives of the 6th/7th semester). Methods: In summer of 2009 and winter of 2009/2010 1065 students participated in the Progress Test Medizin (PTM) from Charité Medical School Berlin. Additionally the students answered a questionnaire regarding the acceptance and rating of the progress test and basic demographic data. Results: The knowledge of internal medicine continuously increases during the clinical part of the medical curriculum in Munich. However, significant differences between the sub-disciplines of internal medicine could be observed. The overall acceptance of the PTM was high and increased further with the study progress. Interestingly, practical experiences like clinical clerkships positively influenced the test score. Conclusions: The PTM is a useful tool for the evaluation of knowledge retention in a specific curriculum. [german] Zielsetzung: Das Medizinische Curriculum München (MeCuM) wurde seit 2004 implementiert. Seit 2007 ist MeCuM im klinischen Studienabschnitt voll etabliert (Ende der Übergangsregelungen). Aktuell sollte MeCuM bezüglich der Nachhaltigkeit des im Modul 2 „Konservative Medizin“ (6./7. Semester) vermittelten Wissens evaluiert werden.Methodik: Im Sommersemester 2009 und Wintersemester 2009/2010 absolvierten 1065 Studierende den Progress Test Medizin (PTM). Zusätzlich beantworteten die Studierenden einen Fragebogen zur Akzeptanz und Bewertung des PTM sowie zu demographischen Basisdaten.Ergebnisse: Das Wissen „Konservative Medizin“ nimmt im klinischen Studienabschnitt kontinuierlich zu, wobei sich deutliche Unterschiede in den internistischen Subdisziplinen zeigen. Die Akzeptanz des PTM ist sehr hoch und nimmt im Studienverlauf zu. Praktische Erfahrungen (Famulatur) beeinflussen das Testergebnis signifikant.Schlussfolgerung: Mit dem PTM kann die Nachhaltigkeit erworbenen Wissens im Verlauf eines klinischen Curriculums evaluiert werden.

Since 2004 a commercial learning management system (LMS) was introduced at the Medical Faculty of LMU. During the following four years the platform was hardly used by staff members and students. Therefore, in 2009 it was replaced by the Open Sorce LMS Moodle. Reasons for this step were a better adaptability of the software and the possibility for teachers to upload their material themselves. Our aim was to enhance acceptance among both students and teachers. During the implementation special emphasis was laid on the integration of Moodle into the existing IT infrastructure of the faculty. After the introduction of Moodle the number of active users increased from 500 to 5,060 (students and teachers). The number of courses raised from 14 to 90 (summer term) and 125 (winter term). Mainly static documents such as scripts and lecture slides have been uploaded, but also a few interactive activities have been provided. The calculated costs for using Moodle added up to about 20 €/user/year. In comparison the commercial system cost about 100 €/user/year because of the low number of users. The high acceptance especially among teachers showed that decision to introduce Moodle was the right step at our faculty. Evaluation results show that despite many improvements users still rate Moodle as not very user friendly. At the end of the summer term we faced technical problems due to an unexpected peak of hits. An ongoing adaption of the platform is necessary to adress these issues. The aim for the coming terms are to support teachers to provide more high quality interactive learning activities.

Introduction Endogenous hypercortisolism presents with variable phenotypes. Etiological factors accounting for the level of hypercortisolism or varying severity of associated comorbidities are lacking. Recently, the adrenal ATP-binding cassette B1 (ABCB1) gene was identified as a modulator of glucocorticoid secretion. Objective To evaluate the effect of ABCB1 polymorphism rs2032582 on steroid metabolome and clinical phenotypes in patients with endogenous hypercortisolism. Methods In this cross-sectional cohort study, 137 patients prospectively enrolled in the German Cushing's registry were included (41 with ACTH-producing pituitary adenoma, 21 with cortisol-producing adrenal adenoma, and 75 with excluded hypercortisolism). In all patients, ABCB1 polymorphism was analyzed using a TaqMan genotyping assay, glucocorticoid metabolite excretion in 24-hour urine samples was analyzed by gas chromatography-mass spectrometry, and the clinical phenotype was assessed systematically. Results In patients with cortisol-producing adrenal adenomas, but not in patients with ACTH-producing pituitary adenomas, homozygous major allele GG of ABCB1 polymorphism rs2032582 was associated with higher overall cortisol metabolite secretion (median 13515 [IQR 10347; 25669] µg/24h vs. 9645 [6146; 10732] µg/24h in minor homo- and heterozygotes, p=0.036) and elevated major cortisol metabolites αTHF, THF and THE (9339 [6929; 17789] µg/24h vs. 6288 [4184; 7455] µg/24h, p=0.045). Moreover, these patients showed higher mean arterial pressure (116 [111; 131] mmHg in major homozygotes vs. 105 [96; 112] mmHg in minor homo- and heterozygotes, p=0.036). Conclusion The genotype of drug transporter gene ABCB1 rs2032582 polymorphism is associated with the degree of cortisol metabolite secretion in cortisol-producing adrenal adenomas and could, therefore, represent a modifier of disease severity in this context. [ABSTRACT FROM AUTHOR]

Context Treatment options for advanced neuroendocrine tumors (NETs), pheochromocytomas and paragangliomas (PPGLs) are still limited. In recent years, antitumor effects of cannabinoids have been reported; however, there are only very limited data available in NETs or PPGLs. Objective Investigation of the effects of cannabidiol (CBD) on patient-derived human NET/PPGL primary cultures and on NET/PPGL cell lines. Methods We established primary cultures derived from 46 different patients with PPGLs (n = 35) or NETs (n = 11) who underwent tumor resection at 2 centers. Treatment of patient primary cultures with clinically relevant doses (5 µM) and slightly higher doses (10 µM) of CBD was performed. Results We found opposing effects of 5 µM CBD: significant antitumor effects in 5/35 (14%) and significant tumor-promoting effects in 6/35 (17%) of PPGL primary cultures. In terms of antitumor effects, cluster 2-related PPGLs showed significantly stronger responsivity to CBD compared to cluster 1-related PPGLs (P =.042). Of the cluster 2-related tumors, NF1 PPGLs showed the strongest responsivity (4/5 PPGL primary cultures with a significant decrease in cell viability were NF1 -mutated). We also found opposing effects of 10 µM CBD in PPGLs and NETs: significant antitumor effects in 9/33 of PPGL (27%) and 3/11 of NET (27%) primary cultures and significant tumor-promoting effects in 6/33 of PPGL (18%) and 2/11 of NET (18%) primary cultures. Conclusion We suggest a potential novel treatment option for some NETs/PPGLs but also provide evidence for caution when applying cannabinoids as supportive therapy for pain or appetite management to cancer patients and possibly as health supplements. [ABSTRACT FROM AUTHOR]

BACKGROUND: Diagnosis of primary aldosteronism (PA) is complicated by the need to withdraw antihypertensive medications that interfere with test results, particularly renin. This study examined whether machine learning-based steroid-probability scores offer a renin measurement-independent approach for testing less prone to interference than the aldosterone-to-renin ratio (ARR). METHODS: This prospective multicenter cohort study involved the use of plasma steroidomics and the ARR in 839 patients tested for PA, including 190 with and 578 without PA (71 indeterminate). Receiver operating characteristic curves for steroid-probability scores and the ARR were examined with and without interfering medications. Impacts of individual medications on plasma aldosterone, 18-oxocortisol, 18-hydroxycortisol, steroid-probability scores, renin, and ARRs were examined by multivariable and paired analyses in patients with and without PA. RESULTS: Receiver operating characteristic curves indicated a significant impact of interfering antihypertensive medications on the diagnostic performance of the ARR and minimal impact on steroid-probability scores. Mineralocorticoid receptor antagonists increased plasma aldosterone, 18-oxocortisol, and 18-hydroxycortisol in patients without PA and resulted in false-positive test results for steroid-probability scores and false-negative results for the ARR. Diuretics increased aldosterone, 18-oxocortisol, and steroid-probability scores in patients without PA, whereas angiotensin-converting enzyme inhibitors decreased aldosterone, steroid-probability scores, and ARRs. Beta-adrenoceptor blockers, dihydropyridine calcium channel blockers, and angiotensin receptor blockers had negligible impact on mineralocorticoids and steroid-probability scores. CONCLUSIONS: Among antihypertensive drugs that impact plasma aldosterone, 18-oxocortisol, and 18-hydroxycortisol, mineralocorticoid receptor antagonists stood out as a cause of false-positive results for derived steroid-probability scores. Other antihypertensives have minimal or no impact, an advantage for use of steroid-probability scores over the ARR when those medications cannot be withdrawn. [ABSTRACT FROM AUTHOR]

Background Cushing's syndrome (CS) can be difficult to diagnose. A timely diagnosis, however, is the cornerstone for targeted treatment, to reduce morbidity and mortality. One reason for the difficulties to identify early on patients with CS might be the presence of a mild phenotype. The aim of the study was to classify the phenotypic landscape of CS. We studied patients with overt CS and mild autonomous cortisol secretion (MACS). Method The study was part of the German Cushing's registry. Patients were prospectively included at time of diagnosis and the number of comorbidities and clinical signs and symptoms were assessed in a standardized fashion. One hundred twenty-nine patients with CS (pituitary CS, n = 85, adrenal CS, n = 32, ectopic CS, n = 12, respectively) and 48 patients with MACS were included. Patients with clinical signs and/or comorbidities typical for CS and at least 2 pathological screening tests were classified as having CS. Patients with a 1 mg low-dose-dexamethasone-suppression test above 1.8 µg/dL without being clinically overt CS were classified as having MACS. Results On average, patients with CS had 2 comorbidities (range 1-3) at time of diagnosis (pituitary CS: 2 [1-3], adrenal CS: 3 [2-4], ectopic CS: 3 [2-4]). Patients with MACS, however, had 3 comorbidities (range 2-3). Hypertension was the most common comorbidity in all subtypes of CS (78%-92%) and in patients with MACS (87%). Of a total of 11 clinical signs, patients with CS had on average 5 with 28% of patients having between 0 and 3 clinical signs, 50% 4-7 signs, and 22% more than 7 clinical signs. Patients with MACS had on average 2 clinical signs (range 1-3) at time of diagnosis. Conclusion The phenotypic landscape of CS is quite variable. The frequency of comorbidities is similar between patients with CS and MACS. A relevant number of patients with overt CS have just a few clinical signs. There is also an overlap in frequency of symptoms and clinical signs between patients with CS and MACS. According to the current guidelines, 96% of our patients with MACS fall into the category "consideration of adrenalectomy". This should be kept in mind when making treatment decisions in the latter group of patients. [ABSTRACT FROM AUTHOR]

Context Patients with primary aldosteronism (PA) have higher cardiac comorbidities including more pronounced left ventricular hypertrophy than patients with essential hypertension. Objective Autonomous cortisol cosecretion (ACS) is a common subtype in PA associated with a worse metabolic profile. Hypothesis Autonomous cortisol cosecretion may affect myocardial parameters and result in a worse cardiac outcome compared to patients with PA and without ACS. Methods Three hundred and sixty-seven patients with PA undergoing 1 mg dexamethasone suppression test (DST) and echocardiography at baseline from 2 centers of the German Conn's Registry were included. Follow-up for up to 3.8 years was available in 192 patients. Results Patients with PA and ACS had higher NT-proBNP levels at baseline compared to patients with PA without ACS (114 vs 75.6 pg/mL, P =.02), but showed no difference in echocardiography values. NT-proBNP levels showed a significant positive correlation (r = 0.141, P =.011) with cortisol levels after DST at baseline. In response to therapy of PA, NT-proBNP levels decreased, but remained significantly higher in patients with ACS compared to patients without ACS. At follow-up, left ventricle end-diastolic dimension (LVEDD) decreased significantly only in patients without ACS. Left atrial diameter (LAD) decreased significantly in patients without ACS and in female patients with ACS but not in male patients. Left ventricular mass index (LVMI) significantly improved in female patients without ACS but remained unchanged in female patients with ACS as well as in male patients at follow-up. Conclusions In patients with PA, concomitant ACS is associated with a worse cardiac profile and only partial recovery even years after initiation of targeted PA therapy. [ABSTRACT FROM AUTHOR]