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.

Establishing a student-run free clinic in a major city in Northern Europe: a 1-year experience from Hamburg, Germany.

BACKGROUND: Student-Run Free Clinics (SRFCs) have been an integral part of US medical schools since the 1960s and provide health care to underserved populations. In 2018, we established an SRFC in Hamburg, Germany, a major city in Northern Europe. The aim of this study was to describe the central problems and to investigate the usefulness of an SRFC in a country with free access to medical care, such as Germany. METHODS: All consecutive patients treated at the SRFC Hamburg between February 2018 and March 2019 that consented to this study were analyzed regarding clinical characteristics, diagnosis, readmission rate and country of origin. RESULTS: Between February 2018 and March 2019, 229 patients were treated at the SRFC in Hamburg. The patients came from 33 different countries with a majority (n = 206, 90%) from countries inside the European Union. The most common reasons for visiting the SRFC were infections (23.2%), acute or chronic wounds (13.5%) and fractures (6.3%). CONCLUSION: Our multicultural patients suffer mainly from infections and traumatological and dermatological diseases. We find similarities to published Canadian SRFC patient cohorts but differences in diseases and treatment modalities compared to US SRFCs. Importantly, we demonstrate the relevance and necessity of the SRFC in a major city in Northern Europe.

Conflicting Aims and Values in the Application of Smart Sensors in Geriatric Rehabilitation: Ethical Analysis.

BACKGROUND: Smart sensors have been developed as diagnostic tools for rehabilitation to cover an increasing number of geriatric patients. They promise to enable an objective assessment of complex movement patterns. OBJECTIVE: This research aimed to identify and analyze the conflicting ethical values associated with smart sensors in geriatric rehabilitation and provide ethical guidance on the best use of smart sensors to all stakeholders, including technology developers, health professionals, patients, and health authorities. METHODS: On the basis of a systematic literature search of the scientific databases PubMed and ScienceDirect, we conducted a qualitative document analysis to identify evidence-based practical implications of ethical relevance. We included 33 articles in the analysis. The practical implications were extracted inductively. Finally, we carried out an ethical analysis based on the 4 principles of biomedical ethics: autonomy, beneficence, nonmaleficence, and justice. The results are reported in categories based on these 4 principles. RESULTS: We identified 8 conflicting aims for using smart sensors. Gains in autonomy come at the cost of patient privacy. Smart sensors at home increase the independence of patients but may reduce social interactions. Independent measurements performed by patients may result in lower diagnostic accuracy. Although smart sensors could provide cost-effective and high-quality diagnostics for most patients, minorities could end up with suboptimal treatment owing to their underrepresentation in training data and studies. This could lead to algorithmic biases that would not be recognized by medical professionals when treating patients. CONCLUSIONS: The application of smart sensors has the potential to improve the rehabilitation of geriatric patients in several ways. It is important that patients do not have to choose between autonomy and privacy and are well informed about the insights that can be gained from the data. Smart sensors should support and not replace interactions with medical professionals. Patients and medical professionals should be educated about the correct application and the limitations of smart sensors. Smart sensors should include an adequate representation of minorities in their training data and should be covered by health insurance to guarantee fair access.

Ethical Challenges With Smartwatch-Based Screening for Atrial Fibrillation: Putting Users at Risk for Marketing Purposes?

Background: Atrial fibrillation is the most common persistent arrhythmia. It is associated with increased mortality and morbidity such as stroke. The early detection of atrial fibrillation can significantly reduce the risk of stroke through preventive anticoagulation. Smartwatches offer the opportunity to screen for atrial fibrillation in the general population. This paper aims to analyze the ethical challenges associated with screening for atrial fibrillation using smartwatches. Methods: This is an ethical analysis. The methodology is based on the principle-orientated approach of Beauchamp and Childress. The principles of beneficence, non-maleficence, justice, and autonomy have to be guaranteed given the influence of private companies, privacy protection, liability and doctor-patient-relationship. The work is based on a systematic literature research. Results: There is currently no evidence that screening for atrial fibrillation with smartwatches improves the outcome and reduces the number of adverse events. The high number of false-positive results can lead to harm. The principle of non-maleficence is violated. The over-reliance on and the lack of adequate education by smartwatches can worsen the doctor-patient relationship. However, the relationship can also be improved by the proactive participation of the patient, which leads to greater autonomy, compliance and in the end beneficence. Since smartwatches are consumer goods, there is a risk for greater disparities in the poor and rich population. There is also a risk of discrimination against ethnic minorities due to underrepresentation in training data and study cohorts. The principle of justice is violated. The storage of sensitive medical data by private companies also raises many ethical and legal concerns. Conclusion: This analysis has shown that the use of smartwatches to detect atrial fibrillation is currently in an ethical perspective problematic. The lack of evidence and the high number of false-positive results can lead to harm. As smartwatches provide only little information about the possible consequences, informed consent cannot be assumed. Ethical implementation could be archived if doctors provide smartwatches to patients who have been shown to benefit from them. The implementation and education should be managed by the doctor.