Sustained impact of a short small group course with systematic feedback in addition to regular clinical clerkship activities on musculoskeletal examination skills-a controlled study.

BACKGROUND The discrepancy between the extensive impact of musculoskeletal complaints and the common deficiencies in musculoskeletal examination skills lead to increased emphasis on structured teaching and assessment. However, studies of single interventions are scarce and little is known about the time-dependent effect of assisted learning in addition to a standard curriculum. We therefore evaluated the immediate and long-term impact of a small group course on musculoskeletal examination skills. METHODS All 48 Year 4 medical students of a 6 year curriculum, attending their 8 week clerkship of internal medicine at one University department in Berne, participated in this controlled study. Twenty-seven students were assigned to the intervention of a 6×1 h practical course (4-7 students, interactive hands-on examination of real patients; systematic, detailed feedback to each student by teacher, peers and patients). Twenty-one students took part in the regular clerkship activities only and served as controls. In all students clinical skills (CS, 9 items) were assessed in an Objective Structured Clinical Examination (OSCE) station, including specific musculoskeletal examination skills (MSES, 7 items) and interpersonal skills (IPS, 2 items). Two raters assessed the skills on a 4-point Likert scale at the beginning (T0), the end (T1) and 4-12 months after (T2) the clerkship. Statistical analyses included Friedman test, Wilcoxon rank sum test and Mann-Whitney U test. RESULTS At T0 there were no significant differences between the intervention and control group. At T1 and T2 the control group showed no significant changes of CS, MSES and IPS compared to T0. In contrast, the intervention group significantly improved CS, MSES and IPS at T1 (p < 0.001). This enhancement was sustained for CS and MSES (p < 0.05), but not for IPS at T2. CONCLUSIONS Year 4 medical students were incapable of improving their musculoskeletal examination skills during regular clinical clerkship activities. However, an additional small group, interactive clinical skills course with feedback from various sources, improved these essential examination skills immediately after the teaching and several months later. We conclude that supplementary specific teaching activities are needed. Even a single, short-lasting targeted module can have a long lasting effect and is worth the additional effort.

Systematisch benachteiligt? Bildungsbeteiligung und -erfolg von Jugendlichen mit Migrationshintergrund

Wie erklären sich die ungleichen Bildungschancen von Jugendlichen mit und ohne Migrationshintergrund? Der Artikel geht dieser Frage anhand von Daten aus den Städten Bern und Zürich nach. Während Jugendliche aus dem nichtdeutschsprachigen Ausland im Vergleich zu Schweizer Jugendlichen im Nachteil sind, haben Jugendliche aus Deutschland und Österreich sogar einen Vorteil. Dabei zeigt sich, dass diese Unterschiede weniger auf sprachliche Schwierigkeiten als vielmehr auf Effekte der sozialen Herkunft zurückzuführen sind

Trends of periodontal conditions in two different randomly selected Swiss (Bernese) cohorts 25 years apart

AIM To assess the periodontal conditions of two randomly selected Swiss cohorts 25 years apart. MATERIAL AND METHODS Standardized examinations were performed to assess the periodontal conditions of two randomly selected populations of the Canton of Bern; oral cleanliness was evaluated using the plaque index (PlI) and the retention index (RI). Gingival health was scored according to the gingival index (GI). Periodontal conditions were evaluated by pocket probing depth (PPD) and loss of attachment (LA). RESULTS At the first examination in 1985, 206 out of 350 subjects were evaluated, while in the second examination in 2010, 134 out of 490 subjects attended the examinations. In 1985, subjects showed a mean PlI of 1.16, and 0.77 in 2010. RI was 0.81 and 0.36 in 1985 and 2010 respectively. Mean GI was 1.34 and 0.6. The mean proportion of PPD ≤3 mm was 72% in 1985 and 97.3% in 2010. PPD ≥ 6 mm affected 2.0% in 1985 and 0.3% in 2010. In 1985, subjects had an average of 20.7 teeth, while in 2010, the average was 24.6. In 1985, 7.3% of the subjects were edentulous, while in 2010, 4.5% had no teeth. CONCLUSIONS Trends to improvements resulting in more teeth in function and better periodontal conditions were recognized.

Printed Narrative: The Festival Books for Archduke Ernest of Austria from Brussels and Antwerp 1594

Workshop „The Narrative in Eastern and Western Art“, Graduate School of Letters, Kyoto, 2-5 December 2013 Abstract by Ivo Raband, University of Berne Printed Narrative: The Festival Books for Ernest of Austria from Brussels and Antwerp 1594 During the early modern period the medium of the festival book became increasingly more important as an object of ‘political narration’ throughout Europe. Focusing on Netherlandish examples from the sixteenth and seventeenth centuries, my talk will focus on the festival books printed for the Joyous Entries of Archduke Ernest of Austria (1553–1595). Ernest was appointed Governor General of the Netherlands by King Philipp II in 1593, being the first Habsburg Prince to reside in Brussels since 30 years. In Brussels and Antwerp, the Archduke was greeted with the traditional Blijde Imkomst, Joyous Entry, which dates back to the fourteenth century and was a necessity to actually become the sovereign of Brabant and Antwerp and to uphold the privileges of the cities. Decorated with ephemeral triumphal arches, stages, and tableaux vivants, both cities welcomed Ernest and, at the same time, demonstrated their civic self-assurance and negotiated their statuses. In honor of these events of civic power, the city magistrates commissioned festival books. These books combine a Latin text with a description of the events and the ephemeral structures, including circa 30 engravings and etchings. Being the only visual manifestation of the Joyous Entries, the books became important representational objects. The prints featured in festival books will be my point of departure for discussing the importance of narrative political prints and the concept of the early modern festival book as a ‘political object’. By comparing the prints from Ernest’s entries with others from the period between 1549 and 1635, I will show how the prints became as important as the event itself. Thus, I want to pose the question of whether it would have been possible to substitute a printed version of the event for the actual ceremony.

Comparison of ovarian cancer markers in endometriosis favours HE4 over CA125

Endometriosis is a gynaecological condition with an associated chronic inflammatory response. The ectopic growth of 'lesions', consisting of endometrial cells outside the uterine cavity, stimulates an inflammatory response initiating the activation of macrophages, and resulting in increased cytokine and growth factor concentrations in the peritoneal fluid (PF). Endometriosis‑associated inflammation is chronic and long lasting. In patients with endometriosis, the risk of developing ovarian cancer within 10 years, particularly of the endometrioid or clear cell subtype, is increased 2.5‑4 times. Endometriosis creates a peritoneal environment that exposes the affected endometriotic and the normal ovarian surface epithelial cells to agents that have been suggested to be involved in the pathogenesis of cancer. Concentrations of several cytokines and growth factors were increased in the PF of patients with endometriosis. The ovarian cancer marker, CA125, was one such growth factor; however, this remains to be confirmed. Human epididymis protein 4 (HE4) was detected at high concentrations in patients with ovarian cancer and was identified as the best biomarker for the detection of ovarian cancer. The present study determined the levels of HE4 and CA125 in the peritoneal fluid of 258 patients with and 100 control individuals without endometriosis attending the Department of Obstetrics and Gynaecology, University of Berne (Berne, Switzerland) between 2007 and 2014. The cases were subdivided into groups without hormonal treatment (n=107), or treated with combined oral contraceptives (n=45), continuous gestagens (n=56) or GnRH agonists (n=50). Both of these markers were significantly increased in the non‑treated endometriosis samples compared with the control group. Hormone treatment with either of the three agents mentioned resulted in the concentration of CA125 returning to the control levels and the concentration of HE4 decreasing to below the control levels. CA125, however not HE4, significantly differed between the proliferative and secretory cycle phases. Since HE4 is sensitive to hormonal treatment and robust towards menstrual cycle variation, HE4 is potentially superior to CA125 as an endometriosis marker and therefore has greater potential as a marker for the identification of women at risk of developing ovarian cancer.

Perinatal mental health service provision in Switzerland and in the UK.

QUESTIONS UNDER STUDY The epidemiology of maternal perinatal-psychiatric disorders as well as their effect on the baby is well recognised. Increasingly well researched specialised treatment methods can reduce maternal morbidity, positively affect mother-baby bonding and empower women's confidence as a mother. Here, we aimed to compare guidelines and the structure of perinatal-psychiatric service delivery in the United Kingdom and in Switzerland from the government's perspective. METHODS Swiss cantons provided information regarding guidelines and structure of service delivery in 2000. A subsequent survey using the same questionnaire was carried out in 2007. In the UK, similar information was accessed through published reports from 2000-2012. RESULTS Guidelines for perinatal psychiatry exist in the UK, whereas in Switzerland in 2000 none of the 26 cantons had guidelines, and in 2007 only one canton did. Joint mother-baby admissions on general psychiatric wards were offered by 92% of the Swiss cantons. In the UK, pregnant women and joint mother-baby admissions are only advised onto specialised perinatal-psychiatric units. In Switzerland, in 2007, three specialised units (max. 24 beds) were in place corresponding to 1 unit per 2.5 million people, while in the UK there were 22 mother-baby units (168 beds) in 2012 (1 unit per 2.8 million). In the UK, less than 50% of trusts provided specialised perinatal-psychiatric health care. CONCLUSIONS The main difference between the UK and Switzerland was the absence of guidelines, regular assessment and plans for future development of perinatal psychiatry in Switzerland. There are still geographical differences in the provision of perinatal-psychiatric services in the UK.

Le voyage contemporain

Conférence donnée dans le cadre de l’UNAB, Berne, Naturhistorisches Museum, 15 mai 2014. Études de certaines formes contemporaines de l'écriture de voyage.

Lecture-débat avec l’écrivain haïtien Louis-Philippe Dalembert

Débat avec l'écrivain Louis-Philippe Dalembert, invité dans le cadre de la chaire de professeur invité pour la littérature mondiale Friedrich Dürrenmatt. Université de Berne et ONO – Das Kulturlokal, 12 mai 2015.

Days spent in acute care hospitals at the end of life of cancer patients in four Swiss cantons: a retrospective database study (SAKK 89/09).

Number of days spent in acute hospitals (DAH) at the end of life is regarded as an important care quality indicator for cancer patients. We analysed DAH during 90 days prior to death in patients from four Swiss cantons. Claims data from an insurance provider with about 20% market share and patient record review identified 2086 patients as dying of cancer. We calculated total DAH per patient. Multivariable generalised linear modelling served to evaluate potential explanatory variables. Mean DAH was 26 days. In the multivariable model, using complementary and alternative medicine (DAH = 33.9; +8.8 days compared to non-users) and canton of residence (for patient receiving anti-cancer therapy, Zürich DAH = 22.8 versus Basel DAH = 31.4; for other patients, Valais DAH = 22.7 versus Ticino DAH = 33.7) had the strongest influence. Age at death and days spent in other institutions were additional significant predictors. DAH during the last 90 days of life of cancer patients from four Swiss cantons is high compared to most other countries. Several factors influence DAH. Resulting differences are likely to have financial impact, as DAH is a major cost driver for end-of-life care. Whether they are supply- or demand-driven and whether patients would prefer fewer days in hospital remains to be established.

Training primary care physicians to offer their patients faecal occult blood testing and colonoscopy for colorectal cancer screening on an equal basis: a pilot intervention with before-after and parallel group surveys.

OBJECTIVES Primary care physicians (PCPs) should prescribe faecal immunochemical testing (FIT) or colonoscopy for colorectal cancer screening based on their patient's values and preferences. However, there are wide variations between PCPs in the screening method prescribed. The objective was to assess the impact of an educational intervention on PCPs' intent to offer FIT or colonoscopy on an equal basis. DESIGN Survey before and after training seminars, with a parallel comparison through a mailed survey to PCPs not attending the training seminars. SETTING All PCPs in the canton of Vaud, Switzerland. PARTICIPANTS Of 592 eligible PCPs, 133 (22%) attended a seminar and 106 (80%) filled both surveys. 109 (24%) PCPs who did not attend the seminars returned the mailed survey. INTERVENTION A 2 h-long interactive seminar targeting PCP knowledge, skills and attitudes regarding offering a choice of colorectal cancer (CRC) screening options. OUTCOME MEASURES The primary outcome was PCP intention of having their patients screened with FIT and colonoscopy in equal proportions (between 40% and 60% each). Secondary outcomes were the perceived role of PCPs in screening decisions (from paternalistic to informed decision-making) and correct answer to a clinical vignette. RESULTS Before the seminars, 8% of PCPs reported that they had equal proportions of their patients screened for CRC by FIT and colonoscopy; after the seminar, 33% foresaw having their patients screened in equal proportions (p<0.001). Among those not attending, there was no change (13% vs 14%, p=0.8). Of those attending, there was no change in their perceived role in screening decisions, while the proportion responding correctly to a clinical vignette increased (88-99%, p<0.001). CONCLUSIONS An interactive training seminar increased the proportion of physicians with the intention to prescribe FIT and colonoscopy in equal proportions.

Plattentektonik im Sandkasten

Der Prozess der Plattentektonik erklärt, wes­ halb die Oberfläche der Welt langsam, aber stetig in Bewegung ist. In Echtzeit lassen sich diese grossräumigen Veränderungen in der Erdkruste nicht untersuchen. Mithilfe eines Sandkastenmodells und eines Röntgentomographen ist es Geologen der Universität Bern jedoch gelungen, tekto­ nische Entwicklungen im Labor zu simulieren.

Mobilities, Entanglements, Transformations. Outline of a Research Project on Pottery Practices in Neolithic Wetland Sites of the Swiss Plateau

A large number of later Neolithic sites (3900–3500BC) in Switzerland, Southern Germany and Eastern France offer outstandingly well preserved archaeological materials from cultural layers. Due to the wide use of dendrochronology, settlement remains and artefact assemblages can now be placed into a precise and fixed chronological framework, thus presenting a unique case within prehistoric archaeology. In earlier research, chronological and regional units were constructed on the basis of pottery. These spacial and temporal units of typical pottery sets were understood as Neolithic cultures, as culturally more or less homogenous entities connected with (ethnic) identities. Today, with a larger data corpus of excavated settlements at hand, we can begin to understand that this period of the past was in fact characterised by a multitude of cultural entanglements and transformations. This is indicated by the occurrence of local and non-local pottery styles in one and the same settlement: for example typically local Cortaillod pottery is found together with NMB-styled pottery in settlements at Lake Neuchâtel or Michelsberg pottery is regularly occurring in settlements at Lake Constance where Pfyn pottery style is the typical local one. These and many more examples show that there must have been complex entanglements of social ties expanding between Eastern France, Southern Germany and the Swiss Plateau. Given these circumstances the former notions of Neolithic culture should be critically revised. Therefore, in late 2014, the Prehistoric Archaeology Department at the Archaeological Institute of University of Berne started a four-year research project funded by Swiss National Science Foundation in late 2014: ‘Mobilities, Entanglements and Transformations in Neolithic Societies of the Swiss Plateau (3900-3500 BC)’. It’s objective is to address the topic sketched above by adopting a mixed methods research (MMR)-design combining qualitative and quantitative approaches from archaeology and archaeometry. The approach is theoretically based on Pierre Bourdieu’s reflexive sociology and his concept of habitus but includes further concepts of practice theories. By shifting the focus to the movement of people, ideas and things – to pottery production practices in contexts of mobility – a deeper understanding of the transformative capacities of encounters can be achieved. This opens the path for new insights of Neolithic societies including social, cultural and economic dynamics that were underestimated in former research.

It's confusing when the Swiss go to the polls. Here are 6 surprising things about their elections

On Sunday, Switzerland votes on its federal parliament. The members of both chambers - 200 National Councillors and 46 Councillors of States - are directly elected, with the 26 Swiss cantons (or provinces) forming the districts. Seats in the National Council are distributed to the cantons based on their population size, while in the Council of States each full canton gets two seats and the six half-cantons get one each. Here are six things to look out for.