Psychiatrische Kriterien zur Beurteilung der Einwilligungsfähigkeit

Every day each physician has to assess a patient’s capability to consent to medical treatment. This paper illustrates the legal term “capability to informed consent” and proposes psychopathological criteria to assess this capability. It is not possible to make this conditional to certain psychiatric diagnoses, but to some relevant symptoms. These symptoms are qualified to indicate the inability to understand, to process and to value the crucial information or the inability to determine or to express his personal will.     

Gewahrsamstauglichkeit, Vernehmungsfähigkeit, Verhandlungsfähigkeit

Ability to undergo custody refers to the relatively short period of police custody, while ability to undergo detention refers to the ability to undergo pre-trial confinement or penal confinement. Ability to undergo custody indicates that the psychological and physical condition of the subject allows a relatively limited police confinement. Ability to undergo interrogation is considered to be the capacity to understand the sense of the questions posed during police investigations and at court, and to answer such questions meaningfully. In a civil court procedure, ability to undergo trial is the capacity to participate in legal proceedings. The capacity to undergo legal proceedings is bound to contractual capacity. Ability to undergo trial refers to the accused in criminal proceedings (principal proceedings). The German Federal High Court (BGH) defines ability to undergo trial as a state of mental clarity and freedom, so that it is possible to proceed against the accused according to criminal law. He must be in a position to represent his own interests reasonably, to maintain his rights, to conduct his defence in a reasoned and understandable manner and to deliver procedural declarations as well as to understand such. In addition, the carrying out of the principal proceedings may not endanger his life nor result in irreparable severe damage to his health.     

The inter-relationships of physical activity, physical fitness, and body measurements

While several measures of physical activity have been used in research, it is not clear how these measures relate to each other or to measures of fitness and fatness. The purpose of this study was to examine the relationships of three commonly used indicators of physical activity to determine how they relate to each other as well as to measures of physical fitness and anthropometric measurements related to body fatness. Data from white adult men working for U.S. railroad companies in 1957 to 1960, who were free of pre-existing cardiovascular disease (N = 2,356), were used to study these relationships cross-sectionally. Total and intense leisure time activity and occupational activity were directly related to caloric intake. Total leisure time activity was inversely related to exercise test heart rate and directly related to body mass index, but not related to resting heart rate or skinfold thickness. Intense leisure time activity was significantly related to all fitness measures and not significantly related to fatness. Caloric intake was directly related to measures of fitness and inversely related to fatness. Occupational activity was directly related to measures of fitness and body mass index, and inversely related to skinfold thickness. These results provide a better understanding of methods appropriate to ascertaining physical activity in epidemiologic research as well as assisting in the comparison of results from studies which have used different physical activity indicators.     

Restrictive covenants in professional employment contracts

For a court to sustain a restrictive covenant with anticompetition as its major thrust does violence to our individual rights. There is no duty for a former employee not to compete as an incident of employment. Employers who seek to enforce restrictive covenants to protect their practice areas are asking the court to place on one side of the scales of justice the birthright of a newcomer to engage in the competitive marketplace and to place on the other side the right of the established group to have a public market area reserved exclusively for their benefit by prior claim. The court is being asked to take valuable legal rights to pursue competitive opportunities from one person or business and give them to the other person or business. In a legal sense, this is not easy to justify. Without something specific and private to protect other than public competitive opportunities, a restrictive covenant may violate public policy by casting a chilling effect on competition, may be abusive to constitutional equal protection, does violence to the concept of free enterprise, and tends to deny communities the services of highly trained professionals that may otherwise be hard to replace. The law of restrictive covenants varies from one state to another. Some jurisdictions have strayed from the traditional position detailed here and often are inclined to protect the employer's right to a service area for a specified term. The services of a local attorney should be obtained when it is necessary to deal with a contractual restrictive covenant.     

Radiation doses to patients and personnel involved in embolization of intracerebral arteriovenous malformations.

Radiation doses to patients and personnel were measured during 5 embolization procedures in 5 different patients. Thermoluminescent dosimeters were used to measure the absorbed doses in different points of the skin of patients as well as personnel. A transmission ionization chamber was used to determine the energy imparted in the patients. The effective dose equivalent HE during the procedures was estimated to be in the range of 6 to 43 mSv to the patients, 10 to 26 microSv to the radiologist in charge of the embolizations, 3 to 24 microSv to the assisting radiographer and 13 to 86 microSv to the nurse anesthetist. Radiation doses to the patients were considerable but the estimated risks from radiation were low compared to the risks of the arteriovenous malformation itself and the hazards of the embolization. The annual radiation doses to the personnel were well below established dose limits.     

Supplemental oxygen effects on ventilation in acclimatized subjects exercising at 5700 m altitude

INTRODUCTION: This study examines the effect of supplemental oxygen on acclimatized mountaineers at high altitude during rest and submaximal exercise. METHODS: Three healthy, acclimatized participants undertook nine periods of data collection lasting 10 min each over 2 consecutive days at 5700 m. These occurred at rest and exercise (40 and 80 W), breathing ambient air or supplemental oxygen (2 and 4 L m min') through an open-circuit breathing system. RESULTS: As minute ventilation increased during exercise, the fraction of inspired oxygen (FIO2) fell from 0.31 at rest to 0.23 with 2 L x min(-1) of oxygen and from 0.36 to 0.26 with 4 L x min(-1). Oxygen at both flow rates resulted in a significant increase in the arterial blood saturation of oxygen (SaO2) (Rest: 79% to 96% to 97%; 40 W: 80% to 95% to 97%; 80 W: 76% to 94% to 98%) and reduction in respiratory rate (RR) (Rest: 28 to 22 to 24; 40 W: 36 to 25 to 25; 80 W: 41 to 26 to 26). Tidal volume (VT, ml x s(-1)) was found to increase with the addition of oxygen (Rest: 959 to 844 to 969; 40 W: 1393 to 1834 to 1851; 80 W: 1558 to 2105 to 2215) and resulted in a non-significant reduction in minute ventilation (VE, L) (Rest: 25 to 17 to 21; 40 W: 46 to 45 to 43; 80 W: 61 to 51 to 53). No significant changes in heart rate were observed when oxygen was used (Rest: 78 to 62 to 71; 40 W: 90 to 91 to 96; 80 W: 105 to 102 to 101). CONCLUSION: An open-circuit breathing system may increase SaO2 and reduce RR in acclimatized mountaineers during rest and sub-maximal exercise at 5700 m, though further research is needed to confirm this.     

Thermoregulatory and metabolic responses to jogging prior to and during pregnancy

Ten joggers were serially studied prior to and during pregnancy at their individual training intensity levels to estimate their thermal and metabolic response to exercise in the field. Prior to conception, a 20-min run at 74% of VO2max (range = 62 to 90%) increased the respiratory exchange ratio to 0.90 +/- 0.01 (range = 0.87 to 0.96) with a rise in whole blood glucose (5.19 +/- 0.14 to 6.63 +/- 0.23 mM X l-1), lactate (0.61 +/- 0.06 to 2.62 +/- 0.74 mM X l-1), and rectal temperature (37.5 +/- 0.1 to 39.0 +/- 0.1 degree C). Despite a spontaneous decrease in exercise intensity to 57 +/- 5% of VO2max (range = 34 to 79%) at 20 and to 47 +/- 2% of VO2max (range = 36 to 59%) at 32 wk gestation, the rise in respiratory exchange ratio with exercise was maintained at 0.92 +/- 0.02 (range = 0.88 to 0.97) and 0.93 +/- 0.01 (range = 0.88 to 0.97), respectively, suggesting a shift to the left in the relationship between exercise intensity and fractional carbohydrate utilization by muscle during exercise in pregnancy. The concomitant changes in whole blood glucose before and after exercise at 20 (4.46 +/- 0.16 to 4.45 +/- 0.08 mM X l-1) and 32 (5.30 +/- 0.19 to 4.55 +/- 0.15 mM X l-1) wk further strengthen this view. Post-exercise, whole blood lactate levels at 20 (0.53 +/- 0.06 to 1.59 +/- 0.30 mM X l-1) and 32 (0.77 +/- 0.07 to 0.89 +/- 0.11 mM X l-1) wk were lower than those observed prior to pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)     

规范产前超声检查诊断胎儿肢体畸形的价值

目的:探讨规范产前超声检查诊断胎儿肢体畸形的价值。材料和方法:应用彩色多普勒超声仪对2008-08～2010-08保定市妇幼保健院行产前检查的41800例孕妇按照该院胎儿超声筛查规范进行检查。筛查分四个阶段:11～14周、18～24周、25～32周和33～足月,将其中的18～24周、25～32周作为常规检查肢体的两个重要时期。使用连续顺序追踪超声法(SCSA)检测胎儿四肢,观察胎儿肢体的形态、结构、姿势、运动情况。结果:检测出肢体异常53例,胎儿肢体畸形9种(桡骨缺如5例、前臂缺失1例、四肢短小畸形11例、手缺失5例、肢体姿势异常6例、足内翻10例、双侧股骨不等长2例、下肢小腿缺如1例、多(或)并指(趾)12例,其中21例合并其他畸形。本组病例均经产后证实。结论:规范的产前超声检查是诊断胎儿肢体畸形重要的影像学诊断方法,是胎儿超声筛查质量控制体系中的重要组成部分。     

Ethical issues in medical imaging: implications for the curricula

The changing nature of healthcare delivery and the climate in which such work is undertaken, has brought new challenges and opportunities for all healthcare professionals. Consequently staff within medical imaging need to be able to respond to change, and also, in many cases, be able to lead and initiate debate if they are to remain in control of their profession. This paper examines a number of issues relating to the increasing attention given to ethical dilemmas within healthcare delivery. It is suggested that these matters will need to be addressed within medical imaging curricula if staff and students are to manage their changing work context. Due to the complexities of the current challenges, the focus is on the ethical dilemmas encountered within daily practice, and an exploration of how healthcare professionals can be best prepared to respond to the current Code of Professional Conduct and other related professional obligations.     

Law, psychiatry and rights.

This article deals with the effect of the shift in emphasis from the moral rights to the legal rights concept in psychiatry with reference to matters such as involuntary civil commitment, the right to treatment, the right to refuse treatment, the duty to warn or to protect, the duty to protect future patients from abusive colleagues and the duty to become politically active.     

The principles of tomographic positioning with particular reference to skull tomography.

Because the principles of tomography relating to positioning have not been clearly understood it has generally been the practice to employ only basic positions when undertaking tomographic studies. The purpose of this paper is to outline tomographic positioning principles, and to integrate them in a simple positioning system for common usage. This has given rise to the need for a completely new set of technical terms which pertain to positioning for skull tomography. It is hoped to establish an understanding which will enable the radiographer to devise methods of demonstrating structures for which there are no text book references to act as a guide, and to assist the radiologist in the recognition of pseudo-shadows.     

Radiation doses to the legs of radiologists performing interventional procedures: are they a cause for concern?

The purpose of this study was to ascertain the magnitude and distribution of doses to the legs of radiologists when performing interventional procedures. LiF:Mg,Ti TLD100 chips were used to measure simultaneously doses to the lower limbs and, for comparison, the hands during 100 interventional procedures. Results show leg dose was dependent upon type and complexity of procedure, equipment used and whether lead protection was available. Where no lead protection was used, the doses to the lower limbs were frequently similar to or higher than those received by the hands. The mean dose to the legs ranged from 0.19 mSv to 2.61 mSv per procedure, compared with 0.04 mSv to 1.25 mSv to the hands. During transjugular intrahepatic portosystemic shunt and embolisation procedures the leg dose could be as much as 2-3 times greater than that to the hands. When lead protection was used, the dose to the legs was reduced significantly to 0.02 mSv to 0.5 mSv per procedure. A clear linear relationship was shown between the dose-area product (DAP) reading and the dose to the feet of the radiologist. As a "rule of thumb", a DAP reading of 100 Gy cm(2) will give a dose of 1 mSv to the legs, if no lead protection was used, dropping to approximately 0.02 mSv if lead protection was present. This study demonstrates that the dose to the legs of radiologists can be higher than that to the hands when no lead protection is used. The inclusion of a lead screen to protect the legs is an effective method of dose reduction when performing interventional procedures.     

Using photoshop filters to create anatomic line-art medical images

There are multiple ways to obtain anatomic drawings suitable for publication or presentations. This article demonstrates how to use Photoshop to alter digital radiologic images to create line-art illustrations in a quick and easy way. We present two simple to use methods; however, not every image can adequately be transformed and personal preferences and specific changes need to be applied to each image to obtain the desired result. There are multiple ways to obtain anatomic drawings suitable for publication or to prepare presentations. Medical illustrators have always played a major role in the radiology and medical education process. Whether used to teach a complex surgical or radiologic procedure, to define typical or atypical patterns of the spread of disease, or to illustrate normal or aberrant anatomy, medical illustration significantly affects learning (). However, if you are not an accomplished illustrator, the alternatives can be expensive (contacting a professional medical illustrator or buying an already existing stock of digital images) or simply not necessarily applicable to what you are trying to communicate. The purpose of this article is to demonstrate how using Photoshop (Adobe Systems, San Jose, CA) to alter digital radiologic images we can create line-art illustrations in a quick, inexpensive, and easy way in preparation for electronic presentations and publication.     

Countershock: mobilizing resistance to electroshock weapons

Electroshock, stun and restraint technologies are often used for torture and as tools of repression. There is much information available exposing the problems with such technologies, but little about how to be effective in challenging their use. The concept of political ju-jitsu--the process by which an attack on a non-violent resister can backfire on the attackers--is introduced and adapted to examine challenges to electroshock weapons. In order to make these weapons backfire, it is important to emphasize the value of potential targets, to expose secret dealings, to reveal the harm caused by the weapons and to communicate clearly to a wide audience. A longer-term goal is policy change to deny access by torturing states to such repressive tools. Countershock strategies and methodologies are introduced here as potential tools to create ever-expanding torture-technology-free zones.     

The role of the artificial uterus in embryo adoption and neonatal intensive care

Embryo adoption is a way of having children for couples who wish to share a pregnancy experience but have neither eggs nor sperm to realise their dream. This type of situation could occur where the wife has had a hysterectomy, while her husband has an extremely low sperm count. The donors of embryos are usually couples who have completed their families. The artificial womb will duplicate the technology of a natural womb so as to enable the child to gestate and develop physically to maturity. This ability will enable the artificial womb to be used to rescue severely premature babies who would otherwise have died and allow them to develop normally to term. Legislation will be required to regulate situations where an entire pregnancy is sustained in an artificial uterus. Clarity as to parenthood in particular will need to be regulated.     

The staffing shortage: AHRA responds

The AHRA Board of Directors formed a Long-Term Staffing Task Force to study the question, "Should AHRA become involved in the resolution(s) of the current staffing crisis, and if so how?" Because the background information that could be gathered was extensive, the Task Force used the following four questions to guide its activity: SENSITIVITY TO MEMBERS' VIEWS: What do we know about the needs, wants and preferences of our members, prospective members and customers relevant to a decision to become involved in activities to resolve the staffing crisis? FORESIGHT ABOUT FUTURE ENVIRONMENT: What do we know about the current and evolving dynamics of our profession relevant to a decision to become involved in activities to resolve the staffing crisis? INSIGHT INTO THE ORGANIZATION: What do we know about the strategic position and internal capacity of our organization relevant to a decision to become involved in activities to resolve the staffing crisis? CONSIDERATION OF OUR CHOICES: What are the ethical implications of our choices relevant to a decision to become involved in activities to resolve the staffing crisis? After considerable investigation and discussion, the Task Force made the following recommendations to the Board: RAISE AWARENESS OF OUR PROFESSION: Expand the number of radiologic technologists in the workforce by increasing the diversity of our students and by changing the traditional method in which we educate students (i.e., full-time, day clinical education). Create a quality monitor useful to the majority of radiology leaders to begin to systematically document the shortage. Support limited licensure and/or create a defined position of "staff extender" for radiologic technology.     

Analysis of radiation scatter during angiographic procedures: evaluation of a phantom model and a modified radiation protection system

PURPOSE: To study the radiation scattering associated with the digital subtraction angiography (DSA) unit in angiographic procedures and to design an effective radiation protection shield based on these data. MATERIALS AND METHODS: The number of scattered photons was measured at three points relative to the operator's position. Anteroposterior abdominal and lateral cranial fluoroscopy were evaluated. As protective devices, a lead curtain, sliding shields, and a brim-shaped image intensifier (II) hood were designed. RESULTS: In abdominal fluoroscopy, radiation was found to scatter to the operator's lower limbs from the underside of the catheter table, to the abdomen from the side of the patient's body, and to the head and neck from the table surface adjacent to the patient. The use of protective devices reduced exposure from 2.89 to 0.058 mR/min for the operator's lower limbs, from 0.987 to 0.069 mR/min for the operator's abdomen, and from 0.696 to 0.139 mR/ min for the operator's head and neck area. With lateral cranial fluoroscopy, radiation was detected to scatter to the operator's lower limbs from the underside of the catheter table, to the abdomen from the patient's temporal area, and to the head and neck from the patient's face. The use of protective devices reduced exposure from 0.248 to 0.010 mR/min for the operator's lower limbs, from 0.129 to 0.010 mR/min for the operator's abdomen, and from 0.162 to 0.018 mR/min for the operator's head and neck area. CONCLUSIONS: The characteristic directions of scattering to the operator were identified. An effective modified radiation protection system was designed based on this information.     

The problem with medical research on tissue and organ samples taken in connection with forensic autopsies in France

Currently, in France, it is legally impossible to conduct scientific research on tissue and organ samples taken from forensic autopsies. In fact, the law schedules the destruction of such samples at the end of the judicial investigation, and the common law rules governing cadaver research cannot be applied to the forensic context.However, nothing seems in itself to stand in the way of such research since, despite their specific nature, these samples from forensic autopsies could be subject, following legislative amendments, to common law relating to medical research on samples taken from deceased persons. But an essential legislative amendment, firstly to allow the Biomedicine Agency to become authorized to issue a research permit and secondly, to change the research conditions in terms of the non-opposition of the deceased to said research.Such an amendment would be a true breakthrough because it would allow teams to continue to move forward calmly in research, and allow this research to be placed within a legal framework, which would promote international exchanges.     

Informatics in radiology: Measuring and improving quality in radiology: meeting the challenge with informatics

Quality is becoming a critical issue for radiology. Measuring and improving quality is essential not only to ensure optimum effectiveness of care and comply with increasing regulatory requirements, but also to combat current trends leading to commoditization of radiology services. A key challenge to implementing quality improvement programs is to develop methods to collect knowledge related to quality care and to deliver that knowledge to practitioners at the point of care. There are many dimensions to quality in radiology that need to be measured, monitored, and improved, including examination appropriateness, procedure protocol, accuracy of interpretation, communication of imaging results, and measuring and monitoring performance improvement in quality, safety, and efficiency. Informatics provides the key technologies that can enable radiologists to measure and improve quality. However, few institutions recognize the opportunities that informatics methods provide to improve safety and quality. The information technology infrastructure in most hospitals is limited, and they have suboptimal adoption of informatics techniques. Institutions can tackle the challenges of assessing and improving quality in radiology by means of informatics.     

Interpretive reproducibility of stress Tc-99m sestamibi tomographic myocardial perfusion imaging

BACKGROUND: Observer variability has been shown with interpretation of planar thallium-201 images. The interpretive reproducibility of technetium-99m sestamibi tomographic imaging is unknown. This study evaluated the interpretive reproducibility of interpretable Tc-99m sestamibi tomographic images among nuclear cardiologists with a wide range of training and experience. METHODS: Three experienced readers (EX) and 3 less-experienced readers (LEX) interpreted 138 exercise and rest Tc-99m sestamibi tomographic images (101 were abnormal in patients with coronary artery disease [CAD], 37 were normal in patients with <5% likelihood of CAD) twice in random sequence without clinical data. Images of good to excellent quality were randomly selected from a database at 2 nuclear cardiology laboratories. Intraobserver and interobserver agreement for global, left anterior descending (LAD) territory, non-LAD first (normal/abnormal) and second (normal/fixed/reversible) order, and defect extent (normal/single-vessel CAD/multi-vessel CAD) were assessed with percent agreement and Cohen's kappa (kappa) statistic. RESULTS: With regard to intraobserver agreement, first and second order ranged from 87% to 94% and 80% to 90% for global, 82% to 96% and 78% to 95% for LAD, and 88% to 91% and 80% to 90% for non-LAD, respectively. Defect extent ranged from 75% to 90%. There were no differences between EX and LEX for global and non-LAD first and second order, LAD first order, and defect extent. LAD second order was 93% for EX compared with 88% (P = .015) for LEX. With regard to interobserver agreement, first and second order ranged from 73% to 89% and 64% to 85% for global, 73% to 93% and 69% to 91% for LAD, and 76% to 88% and 68% to 84% for non-LAD, respectively. Defect extent ranged from 61% to 82%. Global first and second order ranged from 85% to 87% and 78% to 82% for EX compared with 73% to 84% and 64% to 79% for LEX. LAD first and second order ranged from 89% to 91% and 88% to 89% for EX compared with 73% to 91% and 69% to 70% for LEX. Non-LAD first and second order ranged from 82% to 86% and 76% to 77% for EX compared with 76% to 86% and 68% to 81% for LEX. Defect extent ranged from 69% to 75% for EX compared with 59% to 77% for LEX. CONCLUSIONS: There is moderate to excellent interpretive reproducibility with stress Tc-99m sestamibi SPECT imaging among nuclear cardiologists with a wide range of training and experience.