Alexander Göhler

Home Institution
Humboldt-Universität Berlin

Host Institution
Tufts University School of Medicine Boston, MA
Research Mentor: Dr. John B Wong
Clinical Rotations: I spent one term of my last year of medical training (PJ) in pediatrics at Boston Floating Children's Hospital, i.e. four rotations: Gastroenterology Consult Service, Ward Subinternship, PICU Subinternship, Endocrinology and Metabolism Consult Service.

E-Mail: alexgoehler@gmx.de

Research Topic
see Abstract
Personal Reactions to the U.S. Experience
I really enjoyed my time in Boston. The many universities in this city create a great attraction for post-docs and other researchers. Therefore, you will always meet people who also are staying on a temporary basis and are interested in "social events".
Being interested in a rather exotic field as medical informatics (MI), my experience was excellent. While MI has just started in Germany, the Boston Biomedical Program (combined Harvard-Tufts-MIT) has existed for over 20 years. The co-operation of the different institutions enabled me to learn about many different aspects in this field.
Clinical rotations: In general education is a business in the U.S. Students pay a lot of money for their educations and professors know this. Morning reports and noon conferences, as well as the formation of the ward team, i.e. attending-resident-medical student, are meant to be educational. And so they are! Nevertheless it still depends on the individual persons. Therefore, I would not say that medical training is always better in the U.S. than in Germany.
Greatest Difficulties Encountered
Finding a room for reasonable price within an acceptable distance is really difficult with a limited budget.
Most humorous incident
For Christmas I went to Florida. I never saw more Santa Clauses and decorated palm trees than on the Caribbean Key Islands.
Helpful Hints for Future Students
- Check out the WebPages mentioned in former yearbooks.
- Stop comparing life between the U.S. and Germany - just accept the differences for the time that you are there.

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Abstract on Research Topic
Post-CABG Cognitive Decline: A Meta-Analysis of Outcomes from One Week to Six Months

Authors
A. Göhler, S.N. Hoffman, M.P. Wolf, J.A. TenBrook, Jr., and J.B..Wong

Institution
Department of Clinical Decision Making, Informatics and Telemedicine, Tufts-New England Medical Center, Boston, MA
Purpose
To perform a meta-analysis of post-CABG cognitive decline following on- and off-pump surgical techniques. Introduction: Coronary artery bypass grafting (CABG) is performed in over one million patients annually worldwide for the treatment of coronary artery disease. CABG has been found to result in post-operative cognitive decline, but a quantitative pooled estimate of this outcome has not been reported.
Methods
MEDLINE search from 1966-2002 with the terms, coronary artery bypass, cognitive disorder, brain injury, and neuropsychological testing. We included prospective studies reporting CD between 1 week and 6 months post-CABG that complied with neuropsychologic reporting standards. Data were combined in a random-effects meta-analysis to provide summary outcome estimates.
Results
Our search yielded 8 prospective case series and 10 randomized trials with a total of 1798 patients. The mean age was 60 years (range 49-69) with 82% (%) 53-94 men. Comorbidities included hypertension in 39% (range 33-51%), diabetes in 12% (range 0-24%) and previous neurologic deficit in 4% (range 0-39%). Following on-pump CABG, cognitive dysfunction was evident in 51% at 1-2 weeks (CI: 48-57%, 5 studies, 596 patients), 29% at 2 months (CI: 20-40%, 9 studies, 760 patients), 25% at 3 months (CI: 12-45%, 5 studies, 465 patients), and 23% at 6 months (CI: 18-30%, 3 studies, 311 patients). Analysis of 3 RCTs (368 patients) comparing on- to off-pump CABG showed less cognitive dysfunction with off-pump CABG at 3 month (Risk Difference (RD): -13.7%, CL: -27.4% to -0.08%, p=0.049).
Conclusion
About one-half of patients develop cognitive dysfunction 1-2 weeks after CABG. Cognitive dysfunction appears to improve over 2-3 months without further change up to 6 months. Off-pump CABG has a lower risk of cognitive decline. Further studies in octogenarians and interventions to reduce cognitive dysfunction post-CABG should be performed.