Introducing a machine learning algorithm for delirium prediction-the Supporting SURgery with GEriatric Co-Management and AI project (SURGE-Ahead).

INTRODUCTION: Post-operative delirium (POD) is a common complication in older patients, with an incidence of 14-56%. To implement preventative procedures, it is necessary to identify patients at risk for POD. In the present study, we aimed to develop a machine learning (ML) model for POD prediction in older patients, in close cooperation with the PAWEL (patient safety, cost-effectiveness and quality of life in elective surgery) project. METHODS: The model was trained on the PAWEL study's dataset of 878 patients (no intervention, age ≥ 70, 209 with POD). Presence of POD was determined by the Confusion Assessment Method and a chart review. We selected 15 features based on domain knowledge, ethical considerations and a recursive feature elimination. A logistic regression and a linear support vector machine (SVM) were trained, and evaluated using receiver operator characteristics (ROC). RESULTS: The selected features were American Society of Anesthesiologists score, multimorbidity, cut-to-suture time, estimated glomerular filtration rate, polypharmacy, use of cardio-pulmonary bypass, the Montreal cognitive assessment subscores 'memory', 'orientation' and 'verbal fluency', pre-existing dementia, clinical frailty scale, age, recent falls, post-operative isolation and pre-operative benzodiazepines. The linear SVM performed best, with an ROC area under the curve of 0.82 [95% CI 0.78-0.85] in the training set, 0.81 [95% CI 0.71-0.88] in the test set and 0.76 [95% CI 0.71-0.79] in a cross-centre validation. CONCLUSION: We present a clinically useful and explainable ML model for POD prediction. The model will be deployed in the Supporting SURgery with GEriatric Co-Management and AI project.

Why do transgender individuals experience discrimination in healthcare and thereby limited access to healthcare? An interview study exploring the perspective of German transgender individuals.

BACKGROUND: Transgender individuals experience limited access to healthcare. This results not least from experiences of discrimination to which they are exposed in the health system. These contribute to transgender individuals having poorer health than cis individuals, i.e. individuals whose sex assigned at birth is in line with their gender identity. It is an ethical duty to take effective measures to minimize inequalities in medical care. At best, such measures should also be assessed as appropriate from the perspective of those affected in order to be accepted and thus effective. It is therefore important to know whether measures touch on the subjectively assumed reasons for experiences of discrimination. Hence, to be able to take appropriate measures, it is important to identify the reasons that transgender individuals see as causal for their experiences of discrimination in healthcare. METHODS: We conducted semi-structured interviews with 14 German transgender individuals and asked them about their own experiences of discrimination in healthcare and their assumptions on the reasons for discrimination. We analyzed the responses using the method of structured qualitative content analysis. RESULTS: 13 transgender individuals reported experiences of discrimination in healthcare. These emanated from different professional groups and took place in trans-specific as well as general medical settings. We were able to identify a total of 12 reasons that transgender individuals see as causal for their experiences of discrimination: (1) internalized trans-hostility and "protection" of cis individuals, (2) lack of knowledge/uncertainties regarding transition, (3) "protection" of a binary worldview, (4) binary worldview in medicine, (5) structural deficits, (6) asymmetric interactions with specialists, (7) current political debate, (8) view of transgender individuals as a "burden for society", (9) objectification, (10) homophobia, (11) misogyny/androcentrism and (12) discrimination as reaction to discrimination. CONCLUSIONS: German transgender individuals have a very differentiated picture regarding their subjective reasons for experiencing discrimination in healthcare. Overall, disrespect regarding gender identity and a confrontation with foreignness seems to be seen as the decisive factor. Thus, it is not enough to focus only on measures that aim to remedy the information deficit on the part of medical providers. Measures must be taken that can create a granting and respectful attitude towards transgender individuals.

Women education in the Soviet prophylactoria and the care homes for sexually transmitted disease patients in the Soviet Occupation Zone of Germany.

OBJECTIVES: In the 1920s, so-called prophylactoria were established in the USSR. In these institutions, sex workers with sexually transmitted diseases (STDs) were treated. After the end of World War II, care homes for patients with STDs were established in the Soviet Occupation Zone of Germany (SOZ). These institutions were also intended to treat people suffering from STDs. This article compares these two types of medical institutions. METHODS: Sources from the State Archive of the Russian Federation in Moscow, the German Federal Archives in Berlin and the City Archive Zwickau were used. The analysed sources were evaluated by using the historical-critical method. RESULTS: The prophylactoria were novel institutions that combined education and medical treatment of people with STDs. Similar strategies were followed in the care homes for STD patients. In both institutions, the sick persons had to follow a regular daily routine and work every day. The political indoctrination served to educate 'socialist personalities'. Nevertheless, various differences can be found between the facilities: the length of stay was different. The women in Soviet prophylactoria were cared for there for up to 2 years. However, the standard duration of stay in the care homes for STD patients was 3-6 months. CONCLUSIONS: The prophylactoria had a long-term programme not only to treat sick women but also to reeducate them. The aim was to enlighten and integrate them into the new Soviet society. The care homes for STD patients had a short-term programme of combating venereal diseases. Their main goal was to treat patients with STDs as quickly as possible, while education was an additional measure. Whether both institutions were successful in educating and treating these patients can hardly be assessed from today's perspective.

User Perspectives of Geriatric German Patients on Smart Sensor Technology in Healthcare.

With consideration of the progressing aging of our societies, the introduction of smart sensor technology can contribute to the improvement of healthcare for older patients and to reductions of the costs of care. From the clinical and medico-ethical points of view, the advantages of smart sensor technology are copious. However, any ethical evaluation of an introduction of a new technology in medical practice requires an inclusion of patients' perspectives and their assessments. We have conducted qualitative, semi-structured, exploratory interviews with 11 older patients in order to gain their subjective opinions on the use of smart sensor devices for rehabilitation purposes. The interviews were analyzed using methods of qualitative content and thematic analyses. In our analysis, we have focused on ethical aspects of adoption of this technology in clinical practice. Most of the interviewees expressed their trust in this technology, foremost because of its accuracy. Several respondents stated apprehension that the use of smart sensors will lead to a change in the patient-healthcare professional relationship. Regarding costs of introduction of smart sensors into healthcare, interviewees were divided between health insurance bearing the costs and individual participation in corresponding costs. Most interviewees had no concerns about the protection of their privacy or personal information. Considering these results, improvement of users' technology literacy regarding possible threats connected with putting smart sensors into clinical practice is a precondition to any individual application of smart sensors. This should occur in the form of extended and well-designed patient information adapted to individual levels of understanding. Moreover, application of smart sensors needs to be accompanied with careful anamnesis of patient's needs, life goals, capabilities, and concerns.

[Enchiridion medicinae (1573)-a short pharmaceutical manual compiled by Georg Henisch]. / Das Enchiridion medicinae (1573) ­ ein pharmazeutisches Kurzhandbuch, zusammengestellt von Georg Henisch.

In 1573, Georg Henisch published a short pharmaceutical handbook, Enchiridion medicinae, which contains remedies for individual health problems, without making any further comments on the effects and method of use. However, this manual had a predecessor which was published in Paris in 1571 without mentioning the author. The text of both editions is practically identical, there are only minimal differences, but the second edition has been expanded to a foreword and final sections with some recipes. A comparison of the work with contemporary medical literature revealed that Enchiridion medicinae is a compilation of three works by other authors, De materia medicinali et compositione medicamentorum by G. Rondelet from 1556, a commentary by the French author Sebastien Coquillat Scipio on Galen's work Quos, quibus, quando purgare oporteat from 1553 and the book Lilium medicinae by Bernard de Gordon from 1550. Henisch probably acquired this compilation from 1571 as a young student in France, added some passages by Rendelet and passages from two others books, wrote a foreword which he signed with his name and published in Basel in 1573.

[O vos mendici medici. Criticism of medical doctors by Johannes Gregor Macer Szepsius (ca. 1530-after 1579)]. / O vos mendici medici. Ärztekritik des Johannes Gregor Macer Szepsius (ca. 1530­nach 1579).

A relationship between literature and medicine has existed since antiquity. A physician often appears in the literary genre of satire as the representative of medicine and is the object of the satire. The barely known humanistic author Johannes Gregor Macer Szepsius (ca. 1530-nach 1579) was a humanist who sharply criticized the work and behavior of physicians. We have read, translated and analyzed the satirical verses from his comprehensive poetical work De vera gloria, On the true glory, with respect to content, structure and sources. According to this, physicians are characterized by conceit, ignorance and laziness and therapeutic ineptitude. The comparison with other satirical works shows that much of that which he accuses physicians of is repeated in the history of medicine. Some places are similar to the proverbs from Walter's collection of proverbs from the Middle Ages and others are similar to the invectives of Petrarch. Macer also levels criticism against physicians in his poem about the family tree of his friend Anton Schneeberger that appears in Schneeberger's work De bona valetudine militum conservanda liber.

Hermann Rorschach's (1884-1922) Clinical and Scientific Work as a Psychiatrist in Russia.

ABSTRACT: This year marks the 100th anniversary of the death of the Swiss psychiatrist Hermann Rorschach, the famous creator of an inkblot projective test. This article examines an insufficiently studied period of Rorschach's work in Russia in 1913-1914 and aims to reconstruct his clinical and scientific activities at that time. Rorschach worked in the psychoneurological sanatorium in Kryukovo near Moscow where he treated his patients with psychotherapy. During that period, he came in contact with leading psychiatrists and became a part of the Russian psychoanalytic community. Case histories of Rorschach's patients did not reveal any original approaches in his psychotherapeutic methods. Despite his lack of time for scientific work, he still coedited one of the leading psychiatry journals in Russia, Issues of Psychiatry and Neuropathology , where he published an article on the organization of services for mental health in Switzerland. Moreover, he contributed to the transfer of knowledge by publishing reviews of his Russian colleagues' works in German journals.

Masturbation as a Cause of "Sexual Neurasthenia": Anton Chekhov's Medical Report (1883).

ABSTRACT: In the 18th and 19th centuries, in Europe and the United States, masturbation was seen not only as a deviant form of sexual activity but also as a cause of nervous diseases. Masturbation was originally thought to cause insanity, but with the introduction of George Miller Beard's concept of neurasthenia, it came to be considered a form of nervous exhaustion. In the current article, we analyzed the almost forgotten medical report of a "sexual neurasthenic," written by the famous Russian writer and physician Anton Chekhov (1860-1904). This report gives us detailed information about the treatment of a patient allegedly experiencing the effects of masturbation, and thus reflects the medical discourse on masturbation in Russia in the early 1880s. It shows that although the international debate on the causes of neurasthenia had just begun, the concept of neurasthenia toward masturbation had already been put into practice at the Moscow University Clinic in 1883.

Explicability of artificial intelligence in radiology: Is a fifth bioethical principle conceptually necessary?

Recent years have witnessed intensive efforts to specify which requirements ethical artificial intelligence (AI) must meet. General guidelines for ethical AI consider a varying number of principles important. A frequent novel element in these guidelines, that we have bundled together under the term explicability, aims to reduce the black-box character of machine learning algorithms. The centrality of this element invites reflection on the conceptual relation between explicability and the four bioethical principles. This is important because the application of general ethical frameworks to clinical decision-making entails conceptual questions: Is explicability a free-standing principle? Is it already covered by the well-established four bioethical principles? Or is it an independent value that needs to be recognized as such in medical practice? We discuss these questions in a conceptual-ethical analysis, which builds upon the findings of an empirical document analysis. On the example of the medical specialty of radiology, we analyze the position of radiological associations on the ethical use of medical AI. We address three questions: Are there references to explicability or a similar concept? What are the reasons for such inclusion? Which ethical concepts are referred to?

Equal access to healthcare in national legislations: how do Croatia, Germany, Poland, and Slovenia counteract discrimination in healthcare?

BACKGROUND: The aim of the study was a comparative analysis of legislative measures against discrimination in healthcare on the grounds of a) race and ethnicity, b) religion and belief, and c) gender identity and sexual orientation in Croatia, Germany, Poland and Slovenia. METHODS: We conducted a search for documents in national legal databases and reviewed legal commentaries, scientific literature and official reports of equality bodies. We integrated a comparative method with text analysis and the critical interpretive approach. The documents were examined in their original languages: Croatian, German, Polish, and Slovenian. RESULTS: All examined states prohibit discrimination and guarantee the right to healthcare on the constitutional level. However, there are significant differences among them on the statutory level, regarding both anti-discriminatory legal measures and other legislation affecting access to healthcare for groups of diverse race or ethnicity, religion or belief, sexual orientation or gender identity. Croatia and Slovenia show the most comprehensive legislation concerning non-discrimination in healthcare in comparison to Germany and even more Poland. Except for Slovenia, explicit provisions protecting equal access for members of the abovementioned groups are insufficiently represented in healthcare legislation. CONCLUSIONS: The study identified legislative barriers to access to healthcare for persons of diverse race or ethnicity, religion or belief, sexual orientation or gender identity in Croatia, Germany, Poland and Slovenia. The discrepancies in the level of implementation of anti-discriminatory measures among these states show that there is a need for comprehensive EU-wide regulations, which would implement the principle of equal treatment in the specific context of healthcare. General anti-discrimination regulations should be strengthened by inclusion of anti-discrimination provisions directly into national legislation relating specifically to the area of healthcare.

Cancer, the Media and Dealing with Knowledge.

Among the primary function of the media are conveying personal understanding and expanding the subjective knowledge of the recipient citizen. A particular challenge arising during this process is the mediation of medical knowledge. In addition to pure factual knowledge, it often involves subjective experiences, hopes and wishes. One example of this is media reports about cancer therapies. As a result of widespread media coverage since 2017, the public is under the impression that methadone is a promising treatment for cancer. This chapter analyzes the part played by the media and the ethical debate. The ethical issues that arise concern good scientific practice, patient autonomy and the media coverage of methadone. We conclude that, according to the current state of research, the promotion of methadone as a cure for cancer is ethically unacceptable. In this case the media are not fulfilling their task of imparting knowledge, because they are not communicating the current state of research or the associated ethical questions.

Accepting the Incomprehensible: What Samuel Beckett Can Tell Psychiatrists Today.

ABSTRACT: The aim of this article is to propose that reading Samuel Beckett's novels can improve compassionate acceptance of mental phenomena and human behavior deemed incomprehensible. In a narrative inquiry into all of Beckett's novels, we could discern nihilism and existential insecurity as themes both central to Beckett's prose and relevant in working with people with severe mental disorders. By deconstructing narrative structures and struggling to say the unsayable, Beckett can provide a perspective that goes beyond rational understanding. Beckett's prose can extend our imagination of mental and embodied phenomena by describing absurd and incomprehensible aspects of human experience and behavior. His unique sense of humor in dealing with bleak, meaningless situations and the acceptance and perseverance that his characters show in their struggles could help promote compassionate therapeutic relationships and improve clinical teaching in psychiatry. This can help psychiatrists and patients to face the existential aspects of mental illness, "limit situations" according to Jaspers, in a manner both respectful and open to subjective views.

Normative framework of informed consent in clinical research in Germany, Poland, and Russia.

BACKGROUND: Biomedical research nowadays is increasingly carried out in multinational and multicenter settings. Due to disparate national regulations on various ethical aspects, such as informed consent, there is the risk of ethical compromises when involving human subjects in research. Although the Declaration of Helsinki is the point of reference for ethical conduct of research on humans, national normative requirements may diverge from its provisions. The aim of this research is to examine requirements on informed consent in biomedical research in Germany, Poland, and Russia to determine how each national regulatory framework relates to the provisions of the Declaration of Helsinki. METHODS: For this analysis, we conducted a search of the legal databases "Gesetze im Internet" for Germany, "Internetowy System Aktow Prawnych" for Poland, and "ГAPAHT - Garant" for Russia. The search was complemented by a review of secondary literature contained in the databases Google Scholar, PubMed, Polish National Library, and eLibrary.ru. We have identified 21 normative regulations containing provisions on informed consent in clinical research in all three countries. The content of these documents was systematically categorized and analyzed. RESULTS: The normative framework in all three countries shows a strong commitment towards the core ethical principles of research envisaged in the Declaration of Helsinki. Nevertheless, provisions on informed consent vary between these three countries. The differences range from the method and language in which information should be provided, through the amount of information required to be disclosed, to the form of documenting consent or withdrawal. In the case of research on vulnerable groups, these differences are particularly visible. CONCLUSIONS: The identified differences can negatively impact the ethical conduct of international clinical studies. Attention needs to be paid that flexibilities within national regulations are not misused to undermine the protection of research subjects. Achieving global or regional legislative harmonization might prove impossible. Such lack of legal consensus reinforces the significance of the international ethical agreements. TRIAL REGISTRATION: Not applicable.

Aligning Patient's Ideas of a Good Life with Medically Indicated Therapies in Geriatric Rehabilitation Using Smart Sensors.

New technologies such as smart sensors improve rehabilitation processes and thereby increase older adults' capabilities to participate in social life, leading to direct physical and mental health benefits. Wearable smart sensors for home use have the additional advantage of monitoring day-to-day activities and thereby identifying rehabilitation progress and needs. However, identifying and selecting rehabilitation priorities is ethically challenging because physicians, therapists, and caregivers may impose their own personal values leading to paternalism. Therefore, we develop a discussion template consisting of a series of adaptable questions for the patient-physician encounter based on the capability approach. The goal is to improve geriatric rehabilitation and thereby increase participation in social life and well-being. To achieve this goal, we first analyzed what is considered important for participation on basis of the capability approach, human rights, and ethics of care. Second, we conducted an ethical analysis of each of the four identified dimensions of participation: political, economic, socio-cultural, and care. To improve compliance with rehabilitation measures, health professionals must align rehabilitation measures in an open dialogue with the patient's aspiration for participation in each dimension. A discussion template based on the capability approach allows for a proactive approach in patient information and stimulates a critical assessment of treatment alternatives while reducing the risk of imposing personal values.

[Men in Closed Venerological Wards of the GDR illustrated by Examples of Berlin, Dresden and Erfurt]. / Männer in geschlossenen Venerologischen Stationen der DDR am Beispiel von Berlin, Dresden und Erfurt.

OBJECTIVES: While numerous research results are available on the treatment of women in closed venereological wards in the GDR, hardly anything is known about the forced admissions of men to these wards. The aim of this study was to analyse construction of the wards, the admission and maintenance in the wards as well as the extent of the compulsory admissions of men. METHODS: Unprinted sources were researched in the Federal Archive and State Archive Berlin and in the municipal archives of Erfurt and Zwickau and analyzed using a historically critical method. In addition, printed sources found in databases were researched and evaluated. RESULTS: In the GDR, the closed venereological wards for men were part of closed venereological facilities, each of which included a ward for women. Men and women were accommodated separately. Reasons for the admission of men were sexually transmitted diseases to be treated, suspicion of frequently changing sexual partners (HwG-Verdacht) and disciplinary measures. The medical care of the men corresponded to the contemporary medical standard. Only a few men were committed. CONCLUSIONS: The number of beds and compulsory admissions was considerably lower in the wards for men than in those for women. The men were compulsory committed due to having a venereal disease or due to being a sexually promiscuous individual (HwG-Person), while more than 50% of women were committed because of drifting. In addition, men were regarded as reliable subjects in medical care, while women were regarded as defaulting and unreliable. In this respect, the situation of men differs fundamentally from that of women.

[Benefits from herb garden. Pharmaceutical works in translations by Georg Henisch]. / Der nutz auß den Krautgärten. Georg Henischs Übersetzungen pharmazeutischer Werke.

Georg Henisch (1549-1618), native of today´s Slovak city Bardejov (in German Bartfeld) translated four pharmaceutical texts from Latin into German, three works by the French author Antoine Mizauld and one by Sextus Placitus, an author of the late Classical period. All of them were published in quick succession in the years 1574-1575 and they appeared until 1615 in several unchanged editions. All four works have a similar theme: unusual curative substances which could be easily procured from plants, metals and animals and they are addressed to the layman. From the point of view of genre, they are different, it is a matter of Kräuterbücher, herbal books, so called Hausväterliteratur (house father literature) and medicine, art and wonder books as well. In his translations, Henisch does not adhere strictly to the original texts, leaving out some smaller parts, translating freely and adapting his version to suit his wider German audience.

Shame, dissociative seizures and their correlation among traumatised female Yazidi with experience of sexual violence.

BACKGROUND: Survivors of Islamic State of Iraq and Syria (ISIS) captivity are at high risk of developing mental disorders such as post-traumatic stress disorder (PTSD). AIMS: This study looks at the correlation between sexual abuse, shame, somatoform or bodily distress disorders, and dissociative seizures (psychogenic non-epileptic seizures). METHOD: The psychological effects of traumatic events and dissociative seizure were assessed in Yazidi women who were held captive by ISIS in Northern Iraq between 2014 and 2018. These effects were examined comparing 64 women who were held captive and sexually abused by ISIS with 60 women suffering from PTSD who were not held captive and sexually abused by ISIS. Structured clinical-psychological interviews and established psychometric questionnaires were used to assess mental disorders especially dissociative seizures and somatoform disorders, and shame related to trauma. RESULTS: Women who were held captive by ISIS showed a significantly higher prevalence of dissociative seizures (43.7%; P = 0.02) and somatisation disorder (38.7%; P = 0.02), as well as depressive (75.0%; P = 0.42) and anxiety disorders (62.5%; P = 0.44), than women who were not held captive and sexually abused by ISIS. Dissociative disorders were identified in 40.6% (P = 0.36) of those female Yazidi who experienced sexual violence while being held captive. CONCLUSIONS: Shame in connection with sexual violence seems to play an important role in negative self-perception after rape. Dissociation not only plays an important role in unprocessed childhood trauma with feelings of shame, but also in more recent trauma experiences with shame.

Psychosocial Reactions to Plagues in the Cultural History of Medicine: A Medical Humanities Approach.

The aim of this work is to elucidate psychosocial reactions to plagues by analyzing three landmark descriptions from different eras: Thucydides' description of the plague of Athens (430 BC) in The History of the Peloponnesian War, Giovanni Boccaccio's description of the plague in Florence (1348) in The Decameron, and Albert Camus' description in The Plague (1947). Using a narrative inquiry, we found psychosocial reactions to be complex and ambivalent and could discern several coping strategies. We propose that this knowledge can help psychiatrists and other healthcare professionals during the ongoing COVID-19 pandemic.

Social diversity and access to healthcare in Europe: how does European Union's legislation prevent from discrimination in healthcare?

BACKGROUND: Social diversity can affect healthcare outcomes in situations when access to healthcare is limited for specific groups. Although the principle of equality is one of the central topics on the agenda of the European Union (EU), its scope in the field of healthcare, however, is relatively unexplored. The aim of this study is to identify and systematically analyze primary and secondary legislation of the EU Institutions that concern the issue of access to healthcare for various minority groups. In our research, we have concentrated on three features of diversity: a) gender identity and sexual orientation, b) race and ethnicity, and c) religion or belief. METHOD AND MATERIALS: For the purpose of this analysis, we conducted a search of database Eur-Lex, the official website of European Union law and other public documents of the European Union, based on specific keywords accompanied by review of secondary literature. Relevant documents were examined with regard to the research topic. Our search covered documents that were in force between 13 December 2007 and 31 July 2019. RESULTS: Generally, the EU legal system prohibits discrimination on grounds of religion or belief, racial or ethnic origin, sex, and sexual orientation. However, with regard to the issue of non-discrimination in access to healthcare EU secondary law provides protection against discrimination only on the grounds of racial or ethnic origin and sex. The issue of discrimination in healthcare on the grounds of religion or belief, gender identity and sexual orientation is not specifically addressed under EU secondary law. DISCUSSION: The absence of regulations regarding non-discrimination in the EU secondary law in the area of healthcare may result from the division of competences between the European Union and the Member States. Reluctance of the Member States to adopt comprehensive antidiscrimination regulations leads to a situation, in which protection in access to healthcare primarily depends on national regulations. CONCLUSIONS: Our study shows that EU antidiscriminatory law with regard to access to healthcare is fragmentary. Prohibition of discrimination of the level of European binding law does not fully encompass all aspects of social diversity.

Medical care or clinical research on humans? Contaminated anti-D immunoglobulin in the GDR and its consequences.

BACKGROUND: In 1978 and 1979, contaminated anti-D immunoglobulin was used in the German Democratic Republic (GDR). As a result, several thousand women were, in the end, infected with hepatitis C. These women received medical attention, part of which was research on hepatitis C. Up to now, results of the research and data are being published in international journals. It remains unclear whether the affected women were asked to be subjects of the clinical research. METHODS: The authors analyzed historical sources and conducted interviews with contemporary witnesses. RESULTS: In the GDR, these women were compulsorily treated by physicians without sufficient information about the disease, diagnostics, and therapy. If the women refused medical care, they were coerced into it by the physicians. Medical care and research were inseparable. Without the knowledge of the women and without their consent, research was carried out on the blood samples and liver biopsies acquired from them.After the German reunification, the same physicians continued to conduct research on the same group of patients. Beginning in 1990, interferon therapy was offered to the women. Parallel to the medication with interferon, studies on the effects of the therapy were carried out. In this case as well, the women were not informed about the use of collected data, nor did they agree to it. CONCLUSIONS: Physicians should clearly define the border between medical care and scientific interest. Exclusively, data obtained from studies performed correctly under ethical point of view should be accepted for publication.