Digital Online Patient Informed Consent for Anesthesia before Elective Surgery-Recent Practice in Europe.

BACKGROUND: Digitalization in the health system is a topic that is rapidly gaining popularity, and not only because of the current pandemic. As in many areas of daily life, digitalization is becoming increasingly important in the medical field amid the exponential rise in the use of computers and smartphones. This opens up new possibilities for optimizing patient education in the context of anesthesia. The main aim of this study was to assess the implementation of remote consent in Europe. METHODS: An online survey entitled "Digital online Patient Informed Consent for Anesthesia before Elective Surgery. Recent practice in Europe," with a total of 27 questions, was sent by the European Society of Anesthesiology and Intensive Care (ESAIC) to their members in 47 European countries. To assess the effect of the economy on digitalization and legal status with regard to anesthesia consent, data were stratified based on gross domestic product per capita (GDPPC). RESULTS: In total, 23.1% and 37.2% of the 930 participants indicated that it was possible to obtain consent online or via telephone, respectively. This observation was more often reported in countries with high GDPPC levels than in countries with low GDPPC levels. Furthermore, 27.3% of the responses for simple anesthesia, 18.7% of the responses for complex anesthesia, and 32.2% of the responses for repeated anesthesia indicated that remote consent was in accordance with the law, and this was especially prevalent in countries with high GDPPC. Concerning the timing of consent, patients were informed at least one day before in 67.1% of cases for simple procedures and in 85.2% of cases for complex procedures. CONCLUSION: Even European countries with high GDPPC use remote informed consent only in a minority of cases, and most of the time for repeated anesthetic procedures. This might reflect the inconsistent legal situation and inhomogeneous medical technical structures across Europe.

Schema generation in recurrent neural nets for intercepting a moving target.

The grasping of a moving object requires the development of a motor strategy to anticipate the trajectory of the target and to compute an optimal course of interception. During the performance of perception-action cycles, a preprogrammed prototypical movement trajectory, a motor schema, may highly reduce the control load. Subjects were asked to hit a target that was moving along a circular path by means of a cursor. Randomized initial target positions and velocities were detected in the periphery of the eyes, resulting in a saccade toward the target. Even when the target disappeared, the eyes followed the target's anticipated course. The Gestalt of the trajectories was dependent on target velocity. The prediction capability of the motor schema was investigated by varying the visibility range of cursor and target. Motor schemata were determined to be of limited precision, and therefore visual feedback was continuously required to intercept the moving target. To intercept a target, the motor schema caused the hand to aim ahead and to adapt to the target trajectory. The control of cursor velocity determined the point of interception. From a modeling point of view, a neural network was developed that allowed the implementation of a motor schema interacting with feedback control in an iterative manner. The neural net of the Wilson type consists of an excitation-diffusion layer allowing the generation of a moving bubble. This activation bubble runs down an eye-centered motor schema and causes a planar arm model to move toward the target. A bubble provides local integration and straightening of the trajectory during repetitive moves. The schema adapts to task demands by learning and serves as forward controller. On the basis of these model considerations the principal problem of embedding motor schemata in generalized control strategies is discussed.

Effects of prehospital hypothermia on transfusion requirements and outcomes: a retrospective observatory trial.

OBJECTIVES: Prehospital hypothermia is defined as a core temperature <36.0 °C and has been shown to be an independent risk factor for early death in patients with trauma. In a retrospective study, a possible correlation between the body temperature at the time of admission to the emergency room and subsequent in-hospital transfusion requirements and the in-hospital mortality rate was explored. SETTING: This is a retrospective single-centre study at a primary care hospital in Germany. PARTICIPANTS: 15,895 patients were included in this study. Patients were classified by admission temperature and transfusion rate. Excluded were ambulant patients and patients with missing data. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome values were length of stay (LOS) in days, in-hospital mortality, the transferred amount of packed red blood cells (PRBCs), and admission to an intensive care unit. Secondary influencing variables were the patient's age and the Glasgow Coma Scale. RESULTS: In 22.85% of the patients, hypothermia was documented. Hypothermic patients died earlier in the course of their hospital stay than non-hypothermic patients (p<0.001). The administration of 1-3 PRBC increased the LOS significantly (p<0.001) and transfused patients had an increased risk of death (p<0.001). Prehospital hypothermia could be an independent risk factor for mortality (adjusted OR 8.521; p=0.001) and increases the relative risk for transfusion by factor 2.0 (OR 2.007; p=0.002). CONCLUSIONS: Low body temperature at hospital admission is associated with a higher risk of transfusion and death. Hence, a greater awareness of prehospital temperature management should be established.

Physical load exposure at construction sites.

OBJECTIVES: This field study analyzed work-related causes of musculoskeletal disorders to investigate the structure of physical workload in different occupations in the construction industry and rank different tasks with respect to the load on the lumber spine. METHODS: An observation instrument (Arbeitswissenschaftliches Erhebungsverfahren für Bauarbeiten) and a specially devised data retrieval system (Allgemeines Datenerfassungs- und Analysesystem für Bauarbeit) provided material for a large database which allowed a differentiated analysis of load exposures. The study was comprised of data from 340 construction workers (bricklayers, scaffolders, carpenters, plumbers, and painters). On the basis of a regular daily worktime of 8 hours, specific statistical aspects were studied concerning manual materials handling, biomechanical pressure on lumbar disc L5/S1, and posture constraints during kneeling, squatting, bending and overhead positions. RESULTS: The scaffolders (13.7% of the regular daily worktime), bricklayers using bricks requiring two hands (7.1%), and carpenters (6.7%) handled weights of > 10 kg. With respect to lumbar disc L5/S1, the scaffolders and bricklayers often showed pressures in excess of 3.4 kN. Bricklaying required bent postures for 20.7-35.6% of the daily worktime. The painters (23.8%), plumbers (16.7%), and carpenters (7.2%) often worked in kneeling postures. The painters often used overhead positions (18.3%). The bricklayers and scaffolders had high frequencies of materials handling. The recovery time for this repetitive work was longer than threefold the load time. CONCLUSIONS: This study showed that it is possible to rank different construction tasks with respect to load exposure. In addition it was shown that preventive measures such as improved ergonomic design, organizational structure, training, and medical health care are needed.