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Vergleich der Effektivität des C-MAC® Miller und Glidescope® Core™ LoPro Videolaryngoskops sowie der direkten konventionellen Laryngoskopie beim Management des schwierigen kindlichen Atemwegs an einem Intubations- manikin mit Pierre-Robin-Sequenz
Get PDFBackground and goals: Videolaryngoscopy is effective in managing the difficult
pediatric airway. However, the evidence for selecting the most suitable video-
laryngoscope for the airway of pediatric patients with Pierre Robin sequence has
not been adequately investigated. Therefore, the aim of this study was to com-
pare the conventional Miller laryngoscope with two videolaryngoscopes: the C-
MAC® with a straight Miller blade and the Glidescope® Core™ LoPro with a hy-
perangulated blade. This comparison was conducted in pediatric anesthesia us-
ing an intubation manikin that is anatomically modeled on a 6-month-old infant
with Pierre Robin sequence.
Methods: As part of this randomized crossover study, 86 anesthesiologists intu-
bated the Pierre Robin intubation manikin using the conventional Miller laryngo-
scope, the Storz C-MAC® with a straight Miller blade, and the Glidescope®
Core™ LoPro with a hyperangulated blade. The following parameters were rec-
orded during intubation: “Time to intubation” was the primary outcome. Second-
ary endpoints included “time to vocal cord level,” “time to ventilation,” overall suc-
cess rate, number of intubation attempts and optimization maneuvers, the Cor-
mack-Lehane score, severity of dental trauma, and subjective impressions. In
addition to the total group of subjects, two subgroup analyses were conducted to
determine the influence of gender and previous experience of the subjects. For
this purpose 43 anesthesiologists with limited previous experience (assistant phy-
sicians) and 43 anesthesiologists with extensive previous experience (specialist
and senior physicians) in the field of pediatric anesthesia were compared with
regard to the above-mentioned parameters.
Results and observations: The Glidescope® Core™ LoPro showed a signifi-
cantly shorter “time to vocal cord level” compared to the C-MAC® Miller and direct
conventional laryngoscopy with a Miller spatula. However, both the C-MAC® with
a straight Miller blade and the direct conventional laryngoscopy with the Miller
blade showed a significantly shorter “time to intubation” and “time to ventilation”
compared to the Glidescope® Core™ LoPro. The intubation success rate was
98.8% when using the C-MAC® Miller, 94.2% when using direct conventional
laryngoscopy with a Miller blade and 87.2% when using the Glidescope® Core™
LoPro, with the difference between the two video laryngoscopes reaching the
significance level. In the two subgroup analyses on the influence of gender and
previous experience of the subjects, the Glidescope® Core™ LoPro also had the
lowest success rate of intubation results. The C-MAC® Miller was the only device
that did not result in oesophageal intubation.
Both video laryngoscopes were rated significantly better than direct conventional
laryngoscopy in terms of visibility, effort required for intubation and oral soft tissue
trauma.
Comparing all devices, 50% of the anesthesiologists would prefer the C-MAC®
Miller, 39.5% the Glidescope® Core™ LoPro and only 9.3% the conventional Mil-
ler laryngoscope for intubating an infant with a Pierre Robin sequence. Only one
of the participants (1.2%) could not decide on one of the laryngoscopes.
Conclusions and discussion: The C-MAC® video laryngoscope with a straight
Miller blade showed the highest rate of successful intubations in the present
study. The Glidescope® Core™ LoPro provided the fastest and best view of the
glottis and caused the least oral soft tissue trauma. However, this laryngoscope
also had the highest rate of unsuccessful intubations. Accordingly, good visibility
does not necessarily result in a high level of intubation success. The hyperangu-
lation of the LoPro blade allowed "seeing around the corner" on the one hand but
made intubation more difficult on the other. Our results suggest that in infants
with Pierre Robin sequence, the use of the C-MAC® video laryngoscope with a
straight Miller blade is advantageous over the Glidescope® Core™ LoPro and
direct conventional laryngoscopy and could help to further increase intubation
success and safety in airway management.Hintergrund und Ziele: Die Videolaryngoskopie ist effektiv beim Management
des schwierigen pädiatrischen Atemweges. Allerdings ist die Evidenz bei der
Auswahl des am besten geeigneten Videolaryngoskops für den Atemweg von
pädiatrischen Patient*innen mit Pierre-Robin-Sequenz bisher nicht ausreichend
untersucht worden. Daher war das Ziel dieser Studie das konventionelle Miller-
Laryngoskop mit zwei Videolaryngoskopen, dem C-MAC® mit einem geraden Mil-
ler-Spatel und dem Glidescope® Core™ LoPro mit einem hyperangulierten Spatel
beim Einsatz durch Anästhesist*innen an einem Intubations-Manikin, welches
anatomisch einem 6-monatigen Säugling mit Pierre-Robin-Sequenz nachemp-
funden ist, zu vergleichen.
Methoden: 86 Anästhesist*innen intubierten im Rahmen dieser randomisierten
crossover Studie das Pierre-Robin-Intubations-Manikin mit dem konventionellen
Laryngoskop mit Miller Spatel, dem Storz C-MAC® mit geradem Miller-Spatel und
dem Glidescope® Core™ LoPro mit hyperanguliertem Spatel. Folgende Parame-
ter wurden während der Intubation erfasst: „Zeit bis zur Intubation“ war die pri-
märe Zielgröße. Sekundäre Endpunkte waren die „Zeit bis zur Stimmband-
ebene“, die „Zeit bis zur Ventilation“, die Gesamterfolgsrate, die Anzahl der Intu-
bationsversuche und die der Optimierungsmanöver, der Cormack-Lehane Score,
die Schwere des dentalen Traumas und subjektive Eindrücke. Neben dem Ge-
samtprobandenkollektiv erfolgten noch zwei Subgruppenanalysen zum Einfluss
des Geschlechts und der Vorerfahrung der Proband*innen. Hierzu wurden 43
Anästhesist*innen mit eingeschränkter Vorerfahrung (Assistenzärzt*innen), so-
wie 43 Anästhesist*innen mit umfangreicher Vorerfahrung (Fach- und Ober-
ärzt*innen) im Bereich der Kinderanästhesie hinsichtlich der oben genannten Pa-
rameter verglichen.
Ergebnisse und Beobachtungen:
Das Glidescope® Core™ LoPro wies gegenüber dem C-MAC® Miller und der di-
rekten konventionellen Laryngoskopie mit einem Miller Spatel eine jeweils signi-
fikant kürzere „Zeit bis zur Stimmbandebene“ auf. Sowohl für das das C-MAC®
mit geradem Miller Spatel, als auch für die direkte konventionelle Laryngoskopie
mit dem Miller Spatel konnte allerdings im Vergleich zum Glidescope® Core™
LoPro eine signifikant kürzere „Zeit bis zur Intubation“ sowie „Zeit bis zur Ventila-
tion“ erfasst werden.
Der Intubationserfolg betrug beim Einsatz des C-MAC® Miller 98,8%, bei der di-
rekten konventionellen Laryngoskopie mit Miller Spatel 94,2% und beim Gli-
descope® Core™ LoPro 87,2%, wobei der Unterschied zwischen den beiden Vi-
deolaryngoskopen das Signifikanzniveau erreichte. Auch in den zwei Subgrup-
penanalysen zum Einfluss des Geschlechts und der Vorerfahrung der Pro-
band*innen wies das Glidescope® Core™ LoPro jeweils die geringsten Intuba-
tionserfolge auf. Nur mit dem C-MAC® Miller kam es zu keiner akzidentiellen öso-
phagealen Fehlintubation.
Beide Videolaryngoskope wurden im Vergleich zur direkten konventionellen La-
ryngoskopie hinsichtlich der Sicht, des Kraftaufwandes bei der Intubation und des
oralen Weichteiltraumas signifikant besser bewertet.
Im Vergleich würden 50% der Anästhesist*innen das C-MAC® Miller, 39,5% das
Glidescope® Core™ LoPro und nur 9,3% das konventionelle Miller Laryngoskop
zur Intubation eines Säuglings mit Pierre-Robin-Sequenz bevorzugen. Nur einer
der Teilnehmenden (1,2%) konnte sich nicht auf eines der Laryngoskope festle-
gen.
Schlussfolgerungen und Diskussion: Das Videolaryngoskop C-MAC® mit ge-
radem Miller Spatel wies in der vorliegenden Untersuchung die höchste Rate an
erfolgreichen Intubationen auf. Das Glidescope® Core™ LoPro ermöglichte die
schnellste und beste Sicht auf die Glottis und verursachte das geringste orale
Weichteiltrauma. Allerdings wies dieses Laryngoskop auch die höchste Rate an
nicht erfolgreichen Intubationen auf. Eine gute Sicht bedeutet dementsprechend
nicht zwangsläufig einen hohen Intubationserfolg. Die Hyperangulation des
LoPro Spatels ermöglichte zwar einerseits die Sicht „um die Ecke“, erschwerte
andererseits aber die Intubation. Unsere Ergebnisse legen nahe, dass bei Säug-
lingen mit Pierre-Robin-Sequenz der Einsatz des C-MAC® Videolaryngoskops
mit geradem Miller Spatel gegenüber dem Glidescope® Core™ LoPro und der
direkten konventionellen Laryngoskopie vorteilhaft ist und dazu beitragen könnte,
den Intubationserfolg und die Sicherheit im Atemwegsmanagement weiter zu
steigern
Nanoparticle Clustering in Supraparticles to Control Magnetic Long‐Range Interactions
Get PDFTo tailor superparamagnetic iron oxide nanoparticles (SPIONs) to the specific needs of diverse application fields, it is essential to understand not only their intrinsic properties but also their interactions with each other. Theoretical models predicting/explaining the magnetization behavior of macroscopic samples containing millions of SPIONs are intricate due to the complexity of the underlying relaxation mechanisms in alternating fields. This study introduces supraparticles (SPs) as model architectures to empirically investigate magnetic interactions within and between large SPION clusters (>100 nanoparticles (NPs)). For this purpose, NP dispersions containing SPIONs and silica (SiO2)NPs as non‐magnetic building blocks are spray‐dried to form binary SPs. Selective salt‐induced agglomeration of the two building block types before spray‐drying is utilized to tailor SP architectures, including control over SPION cluster size, shape, and proximity. Magnetic particle spectroscopy (MPS), operating under ambient conditions, reveals altered magnetization behavior for different cluster structures. Not only the nearest SPION neighbors, but the whole cluster structure up to several micrometers is decisive for the magnetization behavior. This highlights the importance of long‐range magnetic interactions. This work presents a versatile approach for designing model architectures to advance empirical interaction studies between SPIONs in macroscopic samples.Spray‐dried binary supraparticles serve as model systems to tailor the structure of micrometer‐sized clusters of superparamagnetic iron oxide nanoparticles (SPIONs). Magnetic particle spectroscopy reveals altered magnetization behavior of SPIONs in dependence on the cluster structure, which highlights the importance of magnetic long‐range interactions. imageStiftung Begabtenförderung Cusanuswerk http://dx.doi.org/10.13039/501100014401Bundesministerium für Bildung und Forschung http://dx.doi.org/10.13039/501100002347Deutsche Forschungsgemeinschaft http://dx.doi.org/10.13039/501100001659HORIZON EUROPE European Research Council http://dx.doi.org/10.13039/10001918
Reconfiguring gender, kinship, and spirituality: space‐ and place‐making in Muslim Malaysia
Get PDFIn the public and private spaces of Malaysia's capitalist cities, Malay women abide by a stricter Islamic dress code than they do in rural areas. Hence, in this local context, spatial public/private and ‘placial’ rural/urban order are of importance for gender identifications and practices. These orders imply influences on gendered forms of embodiment in the form of dress codes. This research examines the sociocultural constitutions of space and place in Malaysia regarding their relatedness to one another. The central argument states (1) that public space in Muslim contexts is defined as a social space in which men and women who are eligible to marry (non‐ mahram ) encounter each other; and (2) that these relations are perceived and practised differently in urban and rural public and private spaces. This implies that the public‐private divide is based significantly on gendered kinship relations: that is, concepts of family.Abstrait Reconfigurer le genre, la parenté et la spiritualité : création d'espaces et de lieux en Malaisie musulmane Résumé Dans les espaces publics et privés des grandes villes capitalistes de Malaisie, les femmes se plient à un code vestimentaire islamique plus strict que dans les régions rurales. Dans ce contexte local, l'ordre public/privé de l'espace et l'ordre rural/urbain du lieu sont importants pour l'identification et les pratiques genrées et influent sur les formes genrées d'incorporation, en l'occurrence les codes vestimentaires. L'autrice examine la constitution socioculturelle de l'espace et du lieu en Malaisie et les liens entre l'un et l'autre. Ses arguments principaux sont (1) que l'espace public dans les contextes islamiques se définit comme un espace social, dans lequel se rencontrent des hommes et des femmes à marier ( non‐mahram ), et (2) que ces relations sont perçues et mises en pratique différemment dans les espaces urbains et ruraux, qu'ils soient publics ou privés. Il en découle que la division entre public et privé se fonde, de façon significative, sur des liens de parenté genrée, autrement dit sur des concepts de famille.German Research Foundation http://dx.doi.org/10.13039/50110000165
Same Classroom, Different Reality: Secondary School Students’ Perceptions of STEM Lessons—A Pioneering Study
Get PDFOur study is the first exploration of students’ situational perceptions of STEM lessons based on the DIAMONDS approach. This approach postulates eight perceptual dimensions: Duty , Intellect , Adversity , Mating , pOsitivity , Negativity , Deception , and Sociality . Three research questions were investigated in a validation study involving 447 eighth graders, each based on a distinct validation strategy. (1) Convergent validation strategy: How do students perceive STEM lessons regarding the DIAMONDS dimensions? (2) Criterion-related validation strategy: Are these perceptions associated with STEM education outcomes? (3) Explanatory validation strategy: Do gender differences also appear in the perception of STEM lessons? Data were collected via an online questionnaire. The main results indicated that (1) students associate STEM lessons mainly with Duty and Intellect ; (2) their situational perception of STEM lessons was linked to STEM education outcomes; and (3) there were substantial variances in how students perceive STEM lessons. Male students perceived STEM lessons more positively ( pOsitivity ), while females associated them relatively more with negative attributes ( Adversity , Negativity , or Deception ). All three validation strategies produced results confirming the validity of the DIAMONDS approach. In this way, the results of our study offer a promising start for the DIAMONDS approach in STEM education research.The authors declare that the research was supported by the German Federal Ministry of Education and Research (BMBF) under project grant number 16MF1091B.German Federal Ministry of Education and Research (BMBF
Correction: contactless radar-based heart rate Estimation in palliative care– a feasibility study and possible use in symptom management
Get PDFModulation of Host Immunity by Microbiome‐Derived Indole‐3‐Propionic Acid and Other Bacterial Metabolites
Get PDFABSTRACT In recent years, we have witnessed a rapidly growing interest in the intricate communications between intestinal microorganisms and the host immune system. Research on the human microbiome is evolving from merely descriptive and correlative studies to a deeper mechanistic understanding of the bidirectional interactions between gut microbiota and the mucosal immune system. Despite numerous challenges, it has become increasingly evident that an imbalance in gut microbiota composition, known as dysbiosis, is associated with the development and progression of various metabolic, immune, cancer, and neurodegenerative disorders. A growing body of evidence highlights the importance of small molecules produced by intestinal commensal bacteria, collectively referred to as gut microbial metabolites. These metabolites serve as crucial diffusible messengers, translating the microbial language to host cells. This review aims to explore the complex and not yet fully understood molecular mechanisms through which microbiota‐derived metabolites influence the activity of the immune cells and shape immune reactions in the gut and other organs. Specifically, we will discuss recent research that reveals the close relationship between microbial indole‐3‐propionic acid (IPA) and mucosal immunity. Furthermore, we will emphasize the beneficial effects of IPA on intestinal inflammation and discuss its potential clinical implications.The gut commensal Clostridium sporogenes metabolizes dietary tryptophan into indole‐3‐propionic acid (IPA). In this review, we highlight recent findings suggesting that IPA acts as an effective signaling molecule, modulating the function of Th17 lymphocytes and resulting in protection against intestinal inflammation. imageDeutsche Forschungsgemeinschaft http://dx.doi.org/10.13039/50110000165
Ultra-Short-Pulse Laser Welding of Glass to Metal with a Shear Strength Above 50 MPa
Get PDFWe report an ultra-short-pulse laser welding process that allows one to consistently weld Borofloat ® 33 glass to aluminum with a shear strength above 50 MPa. We explored the morphology of the welding seam and quantified the quality of the bonding by statistically determining the shear strength with more than 30 samples. The results of the shear strength tests indicate that the intrinsic shear strength of the aluminum serves as the upper limit of the glass-to-metal bond.This research was funded by SCHOTT AG (Mainz, Germany).SCHOTT A
The Impact of Dietary Intake of Furocoumarins and Furocoumarin-Rich Foods on the Risk of Cutaneous Melanoma: A Systematic Review
Get PDFBackground/Objectives: Furocoumarins, chemical compounds found in many plant species, have a photosensitizing effect on the skin when applied topically and, by interacting with ultraviolet radiation (UVR), stimulate melanoma cells to proliferate. Whether dietary intake of furocoumarins acts as a melanoma risk factor has been investigated in several epidemiological studies, which are synthesized in our systematic review. Methods: The study protocol was registered with PROSPERO (registration number: CRD42023428596). We conducted an in-depth literature search in three databases coupled with forward and backward citation tracking and expert consultations to identify all epidemiological studies, irrespective of their design, addressing the association between a furocoumarin-containing diet and melanoma risk. We extracted information on the study details and results in a standardized manner and evaluated the risk of bias of the results using the Joanna Briggs Institute’s critical appraisal tools. Results: We identified 20 publications based on 19 different studies providing information on the association between dietary furocoumarin intake and melanoma risk. We refrained from a meta-analytical synthesis of the results because of the large heterogeneity in exposure assessment, operationalization of furocoumarin intake in the analyses, and analytical methods of the studies. In a qualitative synthesis, we found moderate evidence supporting the notion that dietary furocoumarin intake at higher levels acts as a risk factor for cutaneous melanoma. Conclusions: Our systematic review provides an overview of the current epidemiological evidence, but it could not clearly answer whether and to what extent dietary furocoumarin intake increases melanoma risk. Future epidemiological analyses focusing on this topic require more comprehensive dietary and UVR exposure data to better characterize the individual total furocoumarin intake and its interplay with UVR exposure patterns.This research received no external funding
Patienteneinstellungen zu klinischen BIG Data Anwendungen
Get PDF1 Abstract
1.1 Objectives
Big data has also become an integral part of the clinical context in the 21st century. It has been used increasingly for several years and has opened up new avenues in science and research, especially in the last 10 years through artificial intelligence. The aim of the following study was to capture the view of female patients on essential points of a sovereign handling of their health data in the context of modern data processing. The survey was conducted as part of the DABIGO project. DABIGO stands for Data Sovereignty in Clinical Big-Data Regimes. Ethical, Legal and Governance Challenges.
Furthermore, a differentiation should be made between patients with malignant and benign disease, especially with regard to the underlying disease.
1.2 Design & Methods
Paper questionnaires were distributed in the gynecological clinic of the University Hospital Erlangen from March to November 2019. Here 558 questionnaires could be completely evaluated. In addition, there were 54 online questionnaires that could be completed on a website of the foundation Young Adults with Cancer in the same period. Here, only people with cancer under the age of 40 were targeted. The content of the questions did not differ, except for one question: What is the reason for presentation at the clinic.
A survey of female patients with and without cancer was conducted. Due to the patient population of our clinic, it was found that the cohort of older female patients and the cohort of female cancer patients were over-represented. In addition, a few women (n=23) with unclear histology participated.
1.3 Observations & Results
The results of the survey showed a low level of knowledge among female patients about data processing in the healthcare sector. Despite the presence of data in the everyday life of the patients, the knowledge about their handling in the medical sector is low or not present at all, with 71% of the patients. Therefore, the trust in the doctor continues to be very high, 85% of the respondents continue to trust the doctor in case of a medical decision, only 2,7% trust the computer. The remaining patients were unsure about this.
Almost 84% of the patients are generally willing to make their data available, their motivation is mostly that the patients themselves or perhaps their relatives can be helped. More than half of the respondents express a need for protection concerning their own data, and it is noted that economic background information is more important to patients than, for example, diagnoses and therapies. Patients state a higher need of data protection for psychological diagnoses compared to non-psychological diagnoses. According to the majority of patients, their relatives should be allowed to decide on the use of the data and their ownership rights, in addition to the individual. Further the treating physicians and the hospital should also be authorized in approx. 70% to decide about the use of the data. Scientists are only authorized to make decisions about the data in the eyes of about 30% of the patients. If it was the ownership of the data, then the willingness is again significantly lower.
1.4 Conclusiones
In general, knowledge of Big Data in the medical context was almost non-existent. Although it is impossible to imagine research in modern oncology without machine data processing, this played a very subordinate role in the perception of those concerned. This assumption had to be included for further questions about data protection and data processing. Pleasing for the use of the data was a great willingness of the patients to make their data available. Their trust in their treating physicians was very high despite the flood of information provided by the new media.
With regard to data protection, it was surprisingly revealed that for patients, it is not health data that needs to be protected the most, or genetic data, as one might assume. Instead, a large majority of them consider economic background information to be the most sensitive. This is remarkable from several points of view. On the one hand, it opens up possibilities for relaxing the disclosure of health data, since this is probably viewed by a broad social consensus as less sensitive than has been considered in the legislation to date. Furthermore, the sociological aspect is also notable, considering that there is a broad coverage of health services by the statutory health insurance in Germany. The solidarity system enables patients to have access to the most modern therapy methods without their financial background playing a role. Especially this result can be considered further and had not been described to this extent before.
The goal, the digitalization of healthcare, requires a process with many interlocking steps. In addition to the adaptation of data protection laws and the provision of information to patients, good communication and cooperation between all parties involved is essential. The goal must be worked out; the potential of health data must be used for the benefit of all.Die Analyse von hochvolumigen Daten (Big Data) nimmt einen zunehmenden Stellenwert in der Gesellschaft und der Wissenschaft ein. Auf der anderen Seite sind Daten insbesondere in Deutschland durch spezielle Gesetze besonders geschützt. In diesem Kontext wurde eine Umfrage initiiert, die sich mit dem Wissen und der Einstellung von Frauen zu diesem Thema beschäftigt. Die Umfrage wurde als Teil des DABIGO Projektes durchgeführt. DABIGO steht für Datensouveränität in klinischen Big-Data Regimes. Ethische, rechtliche und Governance Herausforderungen.
Hierbei wurden Patientinnen der Frauenklinik und ein kleines Kollektiv der Stiftung „Junge Erwachsene mit Krebs“ zu ihrem Wissen und Meinung zu Datenanwendung und Datenschutz/Datenrecht im medizinischen Kontext befragt.
2.1 Hintergrund und Ziele
Big Data ist aus dem klinischen Kontext im 21. Jahrhundert nicht mehr wegzudenken. Es kommt seit einigen Jahren vermehrt zur Anwendung und hat vor allem in den letzten 10 Jahren durch künstliche Intelligenz neue Wege in der Wissenschaft und Forschung eröffnet. Ziel der folgenden Studie war, die Sicht von Patientinnen zu wesentlichen Punkten eines souveränen Umgangs mit ihren Gesundheitsdaten im Kontext der modernen Datenverarbeitung, Big-Data, zu erfassen. Weiter soll vor allem im Hinblick auf die Grunderkrankung zwischen PatientInnen mit maligner und benigner Erkrankung differenziert werden.
2.2 Methoden
Es wurden in der Frauenklinik des Universitätsklinikums Erlangen von März 2019 bis November 2019 in den verschiedenen Sprechstunden Papierfragebögen verteilt, die unter 9.3 zu finden sind. Hierbei konnten 558 vollständig ausgewertet werden. Dazu kamen 54 vollständige Online-Fragbögen, die im selben Zeitraum parallel auf der Homepage der Stiftung für „Junge Erwachsenen mit Krebs“ als Umfrage zu finden waren. Hier wurden gezielt nur Menschen mit einer Krebserkrankung unter 40 Jahren angesprochen. Der Inhalt der Fragen unterschied sich bis auf folgende Frage nicht: „Was ist der Vorstellungsgrund in der Klinik“. Daher ist eine Einbindung dieses Kollektivs möglich.
Es erfolgte eine Untersuchung von PatientInnen mit und ohne Krebserkrankung. Es hat sich aufgrund des Kollektivs unserer Klinik ergeben, dass ältere Patientinnen und Krebserkrankte stärker vertreten waren. Zudem haben einige wenige Frauen (n=23) mit Erkrankung unklarer Dignität teilgenommen.
2.3 Ergebnisse und Beobachtungen
Das Ergebnis der Umfrage zeigte zunächst ein geringes Wissen der PatientInnen über Datenverarbeitung im Gesundheitswesen. Trotz der ubiquitären Präsenz von Daten im Alltag der PatientInnen war das Wissen über deren Handhabe im medizinischen Sektor bei 71% der PatientInnen gering oder gar nicht vorhanden. Daher ist das Vertrauen in den Arzt weiter sehr groß, 85% der Befragten vertrauten im Fall einer medizinischen Entscheidung weiter auf den Arzt, nur 2,7 % dem Computer. Die übrigen PatientInnen waren sich diesbezüglich unsicher. Knapp 84% der PatientInnen waren bereit, ihre Gesundheitsdaten generell zur Verfügung zu stellen. Die Motivation ist meist, dass entweder den Patientinnen selbst oder möglicherweise künftig ihren Angehörigen damit geholfen werden kann. Über die Hälfte der Befragten fand die eigenen Daten besonders schützenswert, hier war zu beobachten, dass ökonomische Hintergrundinformationen für PatientInnen wichtiger waren wie beispielweise Diagnosen und Therapien. PatientInnen sahen zudem rein körperlichen Diagnosen als weniger schützenswert an, im Vergleich zu psychischen Diagnosen. Über die Verwendung der Daten und deren Eigentumsrechte sollte nach der Mehrheit der PatientInnen neben der Person selbst die Familie entscheiden dürfen. Bei 70 % der Befragten erhielten sowohl die behandelten ÄrztInnen als auch das Krankenhaus diese Befugnis. Die Wissenschaft spielte hier mit ca. 30% eine noch geringe Rolle. Wenn es sich um die Eigentumsrechte an den Daten handelte, dann ist die Freigiebigkeit nochmals deutlich geringer.
2.4 Schlussfolgerungen und Diskussion
Generell war das Wissen um Big Data im medizinischen Kontext kaum vorhanden. Obwohl in der modernen Onkologie maschinelle Datenverarbeitung aus der Forschung nicht wegzudenken ist, spielte dies in der Wahrnehmung der Betroffenen eine sehr untergeordnete Rolle. Diese Annahme musste für weitere Fragen zum Thema Datenschutz und Datenverarbeitung mit einbezogen werden. Erfreulich für die ausgedehnte Nutzung der Daten war eine große Bereitschaft der PatientInnen ihre Daten zur Verfügung zu stellen. Das Vertrauen in ihre behandelnden Ärztinnen und Ärzte war trotz der Informationsflut durch die neuen Medien sehr groß. Im Hinblick auf den Datenschutz zeigte sich erstaunlicherweise, dass für die PatientInnen nicht etwa Gesundheitsdaten am meisten zu schützen sind oder genetische Daten, wie man vielleicht annehmen möchte. Sondern die ökonomischen Hintergrundinformationen werden von einer großen Mehrheit als das Sensibelste angesehen. Dies ist aus vielerlei Gesichtspunkten spannend. Zum einen eröffnet das Möglichkeiten der Lockerung der Weitergabe von Gesundheitsdaten, da diese wohl in einem breiten gesellschaftlichen Konsens als weniger sensibel angesehen werden, wie bislang in der Gesetzgebung berücksichtigt. Weiter ist aber auch der soziologische Aspekt spannend, vor dem Hintergrund, dass es in Deutschland eine breite Abdeckung der Gesundheitsleistungen durch die gesetzliche Krankenkasse gibt. Das Solidarsystem ermöglicht den PatientInnen den Zugang zu modernsten Therapiemethoden, ohne dass der finanzielle Hintergrund eine Rolle spielt. Vor allem dieses Ergebnis kann weiterführend betrachtet werden und war in diesem Umfang bislang noch nicht beschrieben worden.
Das Ziel, die Digitalisierung des Gesundheitswesens bedarf eines Prozesses mit vielen Schritten, die ineinandergreifen. Neben der Anpassung der Datenschutz-Gesetze und der Information der PatientInnen kommt es auf eine gute Kommunikation und Zusammenarbeit aller Beteiligten an. Das Ziel muss erarbeitet werden, es gilt das Potential der Gesundheitsdaten zum Wohle aller zu nutzen
Global Health Ethics in der COVID-19-Pandemie. Komparative Studien zur guten Praxis im Gesundheitswesen
Get PDFObjectives:
The COVID-19 pandemic had a particular impact on older people, who are classified as vulnerable.
On the one hand, older people are at a high risk of suffering a severe course of the
disease, on the other hand, protection of well-being threatened by a COVID-19 infection is to
be ensured primarily by restricting social contacts. However, this has huge negative consequences,
such as social isolation and loneliness, which in turn also increase the risk of morbidity and mortality. Especially affected are older people in nursing homes or hospitals. Geriatric patients can often even be attributed the two most relevant COVID-19 risk factors: old age and comorbidities. In addition, long-term care facilities and hospitals combine a very high
risk of infection due to essential nursing and medical contacts and a high risk of social isolation and loneliness due to strict visiting restrictions. In the context of preventive measures fighting the global COVID-19 pandemic, contact regulations in nursing homes and hospitals as well as fast and equitable distribution of effective vaccines worldwide are challenges faced by global society that require in-depth scientific research in real time focusing on a medical ethics perspective.
Design & Methods:
The first article consists of a detailed comparison of the situation in care homes in five different
countries during the first year of the pandemic in 2020. It analyses current data published by the authorities and includes various international publications.
The second article discusses the legal provisions on visiting restrictions and bans within European
hospitals in 2021 and their impact on mental and physical health of older patients dealing with data of the Organisation for Economic Cooperation and Development (OECD), regulations of the respective authorities as well as current publications.
The third article presents a detailed analysis of the first year of COVAX’ global vaccine distribution in 2021, identifying problematic aspects of its allocation framework regarding the implementation of its fundamental ethical principles. Therefore, data out of the respective organizations as well as publications on alternative distribution models and criticism of the COVAX concept were gathered. Based on the analysis, we present the idea of an alternative allocation framework.
Observations & Results:
The comparative international perspective in real time helps us learn from the successful measures, concepts, etc. of other (federal) countries. A detailed analysis can also form the basis for concepts in future global health crises. Based on the analysis of the situation in nursing homes and hospitals the best practices for prevention have been identified and the importance of mitigating measures to avoid social isolation and loneliness has been highlighted. Nevertheless, a generally low spread of COVID-19 in a country, i.e., outside the facility, is crucial for low infection rates in nursing homes, which emphasises the importance of a societywide approach combatting COVID-19. The need for an international surveillance system as a tool for public health has been identified. Issues of global equity could also be addressed, as fair and rapid vaccine distribution could not be achieved through COVAX. Based on our analysis we developed the 'Prioritized Distribution of Equal Shares' allocation framework, which
combines the concepts of equality (proportional allocation) and equity (weighted allocation) right from the outset, in order to achieve both main principles: ethical and practical feasibility.
Conclusions:
Combining the expertise of all publications, a general lack of medical ethics in the scientific and political discourse during the pandemic was revealed. The severity of the encroachments on fundamental and human rights, which was unprecedented in Germany, requires intensive monitoring of the measures taken, which has so far been neglected