Moral competency of students at a german medical school - A longitudinal survey.

BACKGROUND: Medical students and doctors face various challenges in clinical practice. Some of these challenges are related to ethical issues. Therefore, teaching ethics respectively building moral competences has become an integral part of the medical curriculum in Germany and many other countries. To date, there is little evidence on moral competence of medical students. METHODS: Self-administered survey among medical students from one German medical school in the first (cohort 1) and fifth semester (cohort 2) in the winter term 2019/20 (T0). Both cohorts received the same questionnaire one year later in winter term 2020/21 (T1). Assessment was performed with Lind's Moral Competence Test. We performed convenience sampling. We analyzed the data with descriptive statistics and C-Scores as a measure of moral competence (higher scores = higher competence, ≥ 30 points = high competence). RESULTS: A total of 613 students participated in the study (response rate 67.5%, n = 288 with data on both time points). 69.6% of the participants were female, the mean age was 21.3 years. Mean C-Score for both cohorts for T0 (first and fifth semester) is 32.5 ± 18.0 and for T1 (third and seventh semester) is 30.4 ± 17.9. Overall, 6.6% (T0) and 6.7% (T1) of respondents showed some but very low moral competence. 3.3% (T0) and 3.0% (T1) showed no moral competence. Additionally, students without prior experience in the healthcare system scored 3.0 points higher. CONCLUSIONS: Improvement of assessment of moral competence as well effective interventions are particular needed for supporting those students which have been identified to demonstrate little moral competences.

Visualization of fibroblast activation using 68Ga-FAPI PET/CT after pulmonary vein isolation with pulsed field compared with cryoballoon ablation.

BACKGROUND: Pulsed-field ablation (PFA) is a novel ablation modality for atrial fibrillation (AF) ablating myocardium by electroporation without tissue-heating. With its different mechanism of tissue ablation, it is assumed that lesion creation is divergent to thermal energy sources. 68Ga-fibroblast-activation protein inhibitor (FAPI) PET/CT targets FAP-alpha expressed by activated fibroblasts. We aimed to assess 68Ga-FAPI uptake in pulmonary veins as surrogate for ablation damage after PFA and cryoballoon ablation (CBA). METHODS: 26 patients (15 PFA, 11 CBA) underwent 68Ga-FAPI-PET/CT after ablation. Standardized uptake values (SUV) and fibroblast-activation volumes of localized tracer uptake were assessed. RESULTS: Patient characteristics were comparable between groups. In PFA, focal FAPI uptake was only observed in 3/15 (20%) patients, whereas in the CBA cohort, 10/11 (90.9%) patients showed atrial visual uptake. We observed lower values of SUVmax (2.85 ± 0.56 vs 4.71 ± 2.06, P = 0.025) and FAV (1.13 ± 0.84 cm3 vs 3.91 ± 2.74 cm3, P = 0.014) along with a trend towards lower SUVpeak and SUVmean in PFA vs CBA patients, respectively. CONCLUSION: Tissue response with respect to fibroblast activation seems to be less pronounced in PFA compared to established thermal ablation systems. This functional assessment might contribute to a better understanding of lesion formation in thermal and PFA ablation potentially contributing to better safety outcomes.

[The 1960 poliomyelitis vaccination campaign in the GDR using the example of the city of Halle (Saale): historical experiences and problems]. / Die Impfaktion gegen Poliomyelitis in der DDR im Jahr 1960 am Beispiel der Stadt Halle (Saale): Historische Erfahrungen und Probleme.

In the 1950s, the epidemic occurrence of infantile paralysis (poliomyelitis) posed major challenges to health systems worldwide. Since there was no causal therapy for the viral disease, exposure prophylaxis was of particular importance. Ultimately, it was only through the development of vaccines that infantile paralysis could be permanently reduced. In 1960, the Sabin-Tschumakow oral vaccine was administered in the former German Democratic Republic GDR for the first time in Germany. Within one year, this vaccine succeeded in almost completely eradicating polio in the GDR. The article uses unpublished archival material to trace the systematic vaccination campaign using the example of the then district capital Halle (Saale). There alone, 63,328 children and adolescents were immunized within three days in May 1960. With 78,085 vaccinees recorded in advance, this corresponded to a rate within the polio-vulnerable population group of around 81%. The sources show that the GDR's government healthcare system and the principle of outreach vaccination contributed to the success of the vaccination campaign.

[From neurasthenic to bipolar: The German Emperor Wilhelm II. in the light of 19th and 20th century psychiatric interpretations]. / Vom Neurastheniker zum Bipolaren: Kaiser Wilhelm II. im Spiegel psychiatrischer Diagnosen des 19. und 20. Jahrhunderts.

Doubts about the sanity of the German Emperor Wilhelm II emerged soon after his accession to the throne in 1888. Chancellor Bismarck, after he was dismissed by the young monarch, was among the first to spread rumours about Wilhelm's alleged mental aberration. The emperor's erratic behaviour was a concern for many of his contemporaries and some drew comparisons to Ludwig II of Bavaria who had been declared insane and deposed in 1886. In 1894, the historian Ludwig Quidde published a study on Roman Caesarean madness that was obviously aimed at Wilhelm II and attracted great public attention. Members of his entourage depicted Wilhelm as a neurasthenic, and after his abdication in 1918 some psychiatrists made an armchair diagnosis of bipolar disorder. The degree to which these diagnoses were accurate may never be known. Wilhelm's adversaries used speculations about his mental state as a political tool to discredit him. This culminated after the First World War when the political dispute about the loss of the war reached the boiling point. Such psychopathological analyses of Wilhelm II demonstrate that, at the beginning of the 20th century, the interpretative authority and expertise of psychiatry was not limited to medicine but reached the political sphere as well. The case also points to the problematic nature of armchair diagnosing and the mingling of psychiatric and political judgement.

Bound states in the continuum for optomechanical light control with dielectric metasurfaces.

We investigate a reconfigurable dielectric metasurface merging optomechanical interaction and quasi-bound states in the continuum promising for all-optical light control light. The surface consists of a dimerized high-contrast grating with a compliant bilayer structure. The optical forces induced by a control light field lead to structural deformations changing the optical response. We discuss requirements for the geometry and optical force distribution to enable an efficient optomechanical coupling, which can be exploited to tune reflectivity, phase and polarization of a beam impinging on the metasurface. Numerical results explore some tunable devices as mirrors, saturable output couplers, phase modulators and retarder plates.

Lectures on Inhumanity: Teaching Medical Ethics in German Medical Schools Under Nazism.

Nazi medicine and its atrocities have been explored in depth over the past few decades, but scholars have started to examine medical ethics under Nazism only in recent years. Given the medical crimes and immoral conduct of physicians during the Third Reich, it is often assumed that Nazi medical authorities spurned ethics. However, in 1939, Germany introduced mandatory lectures on ethics as part of the medical curriculum. Course catalogs and archival sources show that lectures on ethics were an integral part of the medical curriculum in Germany between 1939 and 1945. Nazi officials established lecturer positions for the new subject area, named Medical Law and Professional Studies, at every medical school. The appointed lecturers were mostly early members of the Nazi Party and imparted Nazi political and moral values in their teaching. These values included the unequal worth of human beings, the moral imperative of preserving a pure Aryan people, the authoritarian role of the physician, the individual's obligation to stay healthy, and the priority of public health over individual-patient care. This article shows that there existed not only a Nazi version of medical ethics but also a systematic teaching of such ethics to students in Nazi Germany. The findings illustrate that, from a historical point of view, the notion of "eternal values" that are inherent to the medical profession is questionable. Rather, the prevailing medical ethos can be strongly determined by politics and the zeitgeist and therefore has to be repeatedly negotiated.

Clinical ethics and patient advocacy: the power of communication in health care.

In recent years, the rights of patients have assumed a more pivotal role in international discussion. Stricter laws on the protection of patients place greater priority on the perspective and the status of patients. The purpose of this study is to emphasize ethical aspects in communication, the role of patient advocates as contacts for the concerns and suggestions of patients, and how many problems of ethics disappear when communication is highlighted. We reviewed 680 documented cases of consultation in a 10-year period of patient advocates' activity at a big German university hospital with 1,300 beds. On the basis of this extensive material, the article will focus on the intersection of the advocate's work with the problems of patients in hospitals. Deficits in the level of communication between health care professionals and patients were frequently uncovered. Patients primarily complain about the lack of dialogue and empathy. Middle-aged patients consulted the patients' advocate disproportionately more often. Measured against this baseline, the group of 65 and older complained less frequently. Besides complaints the advocate was asked in more than one-third of all cases for information about medical matters, hospital regulations or administrative problems. Patients obviously see the advocate as a well-connected and ideally unbiased contact person for uncertainties concerning their malady or a potential stay in hospital. Those seeking help often set hope in the information given by the voluntary patient representative. It should be highly recommended for every German hospital to establish the position of a patient advocate. Furthermore, patients can profit from regular exchange between the advocate and the Ethics Committee, also, to help ensure that their rights are taken into account and implemented in an ethically desirable context.

[The historiography of medicine in postwar Germany: a self-examination]. / Medizingeschichte und Nachkriegszeit in Deutschland: Fragen an das eigene Fach.

The paper deals with the history of medical historiography in postwar Germany. The two decades after 1945 were crucial for the further development of the historiography of medicine in both parts of Germany. Among the issues that need to be investigated in more detail are the coming to terms with the Nazi past, the ideological rivalry between East and West Germany, and the role of individual scientists. The paper invites medical historians to become more deeply engaged with the recent history of their field.

[Between interdependence and separation: the history of medicine as an academic discipline in divided Germany (1945-1959)]. / Zwischen Verflechtung und Abgrenzung: Das Fach Medizingeschichte im geteilten Deutschland (1945-1959).

The article traces the development of the history of medicine as an academic discipline in divided Germany between 1945 and 1959. During this time period the core of the field--the German association for the history of medicine, the scientific journal and, as well, many scientists--shifted from East to West Germany. The fate of the formerly renowned chair of the history of medicine in what was now East Berlin and the difficulties to find a candidate willing to fill in the position indicate the problems in establishing a socialist historiography of medicine. The 1950s was a lost decade for the historiography of medicine in East Germany. In the meantime the historiography of medicine in West Germany, based on better starting conditions, consolidated institutionally.

In Vivo Cardiac Electrophysiology in Mice: Determination of Atrial and Ventricular Arrhythmic Substrates.

Cardiac arrhythmias are a common cardiac condition that might lead to fatal outcomes. A better understanding of the molecular and cellular basis of arrhythmia mechanisms is necessary for the development of better treatment modalities. To aid these efforts, various mouse models have been developed for studying cardiac arrhythmias. Both genetic and surgical mouse models are commonly used to assess the incidence and mechanisms of arrhythmias. Since spontaneous arrhythmias are uncommon in healthy young mice, intracardiac programmed electrical stimulation (PES) can be performed to assess the susceptibility to pacing-induced arrhythmias and uncover the possible presence of a proarrhythmogenic substrate. This procedure is performed by positioning an octopolar catheter inside the right atrium and ventricle of the heart through the right jugular vein. PES can provide insights into atrial and ventricular electrical activity and reveal whether atrial and/or ventricular arrhythmias are present or can be induced. Here, we explain detailed procedures used to perform this technique, possible troubleshooting scenarios, and methods to interpret the results obtained. © 2024 Wiley Periodicals LLC. Basic Protocol: Programmed electrical stimulation in mice.

General practice in the German Democratic Republic (1949-1990) : A discipline between threat and professionalization.

BACKGROUND: In the 1950s the socialist health policy in East Germany did not follow a clear-cut course with regard to outpatient medical care. Whilst state-run policlinics gradually took the place of doctors in private practice, the required qualifications of physicians working in outpatient care remained unclear. After preparatory lobbying by committed physicians from the outpatient sector, the 1960 Weimar Health Conference finally paved the way for the preservation and professionalization of general practice in East Germany. AIM: The article analyzes the formation of general practice as a specialty in East Germany between 1945 and 1990. We scrutinize the status of general practitioners and their field in the socialist health system as well as the foundation of their medical society. Our paper aims to contribute to a broader history of general practice in Germany. METHODS: We draw on literature from that time, unpublished archival material, and interviews with contemporary witnesses. RESULTS: After the establishment of standards for specialist training in the early 1960s, general practice was introduced as a field of specialty in 1967. By this, East Germany had a compulsory specialist training in general practice much earlier than West Germany. In 1971, a specialist society for general practice was founded in East Germany. However, institutionalization at the medical faculties was still lacking. Meanwhile, the nationalization of outpatient care continued. In the years that followed, primary medical care was increasingly provided in policlinics. In 1989, of 40,000 physicians in the GDR, only about 340 were still practicing in their own offices. CONCLUSION: Within the nationalized GDR health system a committed group of physicians, under difficult political circumstances, pushed for professionalization of general practice and its recognition as a field of specialty. When general medicine was recognized as a specialty in 1967, this happened earlier than in other countries and constituted an important milestone.

[Illness, conflicts, and medical supply problems: patients and their petitions in the last decade of the GDR]. / Krankheit, Konflikte und Versorgungsmängel: Patienten und ihre Eingaben im letzten Jahrzehnt der DDR.

This article contributes to historical research on medical care in the GDR by using patients' written petitions to the Central Committee of the Socialist Party submitted in the 1980s. It investigates how patients experienced everyday medical care in the GDR beyond the ideals of official health policy. What were their experiences with doctors and nurses and what possibilities for managing conflicts did sick and needy people have? Starting with a critical consideration of sources and some remarks about the culture of petitioning in GDR society, the article provides insight into the lives of patients in the late GDR. An analysis of medical petitions reveals individual ways of coping with disease and indicates that patients made particular demands of the socialist state and its health system. Patients articulated their expectations quite critically, using characteristic patterns of argumentation and, at times, successfully exerting pressure on the regime to answer their demands.

Ethics consultation and empathy : finding the balance in clinical settings.

There is no doubt that emotions have an important effect on practices of moral reasoning such as clinical ethics consultation. Empathy is not only a basic human emotion but also an important and learnable skill for health care professionals. A basic amount of empathy is essential both in patient care and in clinical ethics consultation. This article debates the "adequate dose" of empathy in ethics consultations in clinical settings and tries to identify possible situations within the process of consultation in which this crucial feeling is at risk.

[Life of a Century: Gottfried Bermann Fischer (1897-1995) - Surgeon and Publisher]. / Vom Chirurgen zum Verleger ­ Das Jahrhundertleben des Gottfried Bermann Fischer (1897­1995).

Gottfried Bermann Fischer was a German-Jewish physician and publisher who dedicated his life to the S. Fischer publishing company which ranks among the most significant German-language publishers in the 20th century. In 1925 Bermann left his position as a surgeon and married Brigitte Fischer, daughter of the company's founder Samuel Fischer. Now called Bermann Fischer he became a passionate publisher and steered the company through the Weimar Republic and Nazi years, publishing authors like Hermann Hesse, Thomas Mann, and Alfred Döblin. Fearing the Nazi terror Bermann-Fischer left Germany in 1936 with his family and parts of the company. From his exile in Austria, Sweden, and later in the United States Bermann Fischer carried on with publishing. In 1950 the S. Fischer publishing company was reestablished in Frankfurt, West Germany. Bermann Fischer and his wife brought out the works of Sigmund Freud and books like Alexander Mitscherlich's "Doctors of Infamy". Through these publishing activities Bermann Fischer had a significant impact on public debates about medicine and its past in Germany.