Dark Patterns - nur für manche dunkel? : Untersuchung digitaler Kompetenz als Einflussfaktor auf die Wirkung von Dark Patterns

Onlinedienste arbeiten kontinuierlich daran, ihre Leistungskennzahlen zu verbessern. Dabei ist der Einsatz von manipulativen Praktiken weit verbreitet. Vermehrt werden Dark Patterns - eine Form der Manipulation, bei der Erkenntnisse aus der Psychologie im Design von Nutzeroberflächen einsetzt werden, mit dem Ziel die Nutzenden zu einem Verhalten zu verleiten, das deren eigenen Interessen entgegenstrebt - angewendet. Dark Patterns sind grossteils mit negativen Konsequenzen für die Konsument_innen verbunden und erste Erkenntnisse aus der Forschung weisen darauf hin, das nutzergruppenspezifische Faktoren wie der Bildungsstand und das Alter die Wirkung von Dark Patterns beeinflussen. Die Identifikation von Faktoren, die zur Vulnerabilität der Konsument_innen beitragen, ist insbesondere im Rahmen des Konsumentenschutzes von Relevanz und bedarf weiterführender empirischer Forschung. Diese Arbeit nimmt sich dieser Forschungslücke an und untersucht Einflüsse auf die Wirkung von Dark Patterns anhand der Anwendung von Dark Patterns auf Cookie- Zustimmungshinweisen. Aufbauend auf bestehender Forschung wird untersucht, ob die Digitale Kompetenz der Nutzenden einen Einfluss auf die Erkennung von Dark Patterns, sowie deren Wirkung hat und ob die Wirkung von Dark Patterns durch deren Erkennung abgeschwächt wird. Dazu wurde ein Laborexperiment durchgeführt, in dessen Rahmen die Digitale Kompetenz der Proband_innen erhoben wurde. Einleitend zur Befragung wurde ein Cookie-Zustimmungshinweis präsentiert, welcher experimentell manipuliert wurde. Im Cookie-Zustimmungshinweis der Experimentalgruppe wurde ein Set an Dark Patterns eingesetzt, während der Hinweis der Kontrollgruppe frei von manipulativen Elementen gestaltet wurde. Die Analyse des Zusammenhangs zwischen dem Einsatz von Dark Patterns zur Manipulation hinsichtlich der Zustimmung zu den Cookies, ergab keine signifikanten Effekte. Die Hinweise wurden bereits ohne den Einsatz von Dark Patterns mit 82.1 Prozent mehrheitlich akzeptiert, wobei die Zustimmung unter Einsatz von Dark Patterns um 9.0 Prozent höher lag. Weiter wurden keine Effekte der Digitalen Kompetenz auf die Zustimmung zu den Cookies oder auf die Wirkung der Dark Patterns festgestellt. Das Messkonstrukt der Erkennung von Dark Patterns wies Schwächen im Bereich der Inhaltsvalidität auf und stand in keinem Zusammenhang zur Wirkung der Dark Patterns. Die in dieser Arbeit aufgestellten Hypothesen wurden somit allesamt abgelehnt. Das Ausbleiben des direkten Effekts von Dark Patterns auf die Zustimmung zu den Cookies könnte damit begründet werden, dass aufgrund der Allgegenwärtigkeit von manipulativen Praktiken auf Cookie-Hinweisen eine Konditionierung der Konsument_innen erfolgte, wodurch unabhängig von deren Ausgestaltung, diese akzeptiert werden. Weiter wird darauf hingewiesen, dass die Untersuchung anhand des Anwendungsfalls der Cookie-Zustimmungshinweise einige anwendungsspezifische Besonderheiten aufweist, welche die Generalisierbarkeit einschränken. Aus diesem Grund wird eine Wiederholung der Untersuchung des Einflusses der Digitalen Kompetenz auf die Wirkung von Dark Patterns anhand eines anderen Einsatzgebietes von Dark Patterns, empfohlen

Risk Factors of Intraoperative Dysglycemia in Elderly Surgical Patients

BACKGROUNDː Dysglycemia is associated with adverse outcome including increased morbidity and mortality in surgical patients. Acute insulin resistance due to the surgical stress response is seen as a major cause of so-called stress hyperglycemia. However, understanding of factors determining blood glucose (BG) during surgery is limited. Therefore, we investigated risk factors contributing to intraoperative dysglycemia. METHODSː In this subgroup investigation of the BIOCOG study, we analyzed 87 patients of ≥ 65 years with tight intraoperative BG measurement every 20 min during elective surgery. Dysglycemia was defined as at least one intraoperative BG measurement outside the recommended target range of 80-150 mg/dL. Additionally, all postoperative BG measurements in the ICU were obtained. Multivariable logistic regression analysis adjusted for age, sex, American Society of Anesthesiologists (ASA) status, diabetes, type and duration of surgery, minimum Hemoglobin (Hb) and mean intraoperative norepinephrine use was performed to identify risk factors of intraoperative dysglycemia. RESULTSː 46 (52.9%) out of 87 patients developed intraoperative dysglycemia. 31.8% of all intraoperative BG measurements were detected outside the target range. Diabetes [OR 9.263 (95% CI 2.492, 34.433); p=0.001] and duration of surgery [OR 1.005 (1.000, 1.010); p=0.036] were independently associated with the development of intraoperative dysglycemia. Patients who experienced intraoperative dysglycemia had significantly elevated postoperative mean (p<0.001) and maximum BG levels (p=0.001). Length of ICU (p=0.007) as well as hospital stay (p=0.012) were longer in patients with dysglycemia. CONCLUSIONSː Diabetes and duration of surgery were confirmed as independent risk factors for intraoperative dysglycemia, which was associated with adverse outcome. These patients, therefore, might require intensified glycemic control. Increased awareness and management of intraoperative dysglycemia is warranted

Lernen am Artefakt: Pädagogisch-didaktische Grundlagen für das dialogisch ästhetisch-forschende Lernen

Wie sprechen Schüler*innen über ihre eigenen Handlungen und Lernprozesse, wenn die Lehrperson nicht ins Geschehen involviert ist? Und inwiefern führt das ästhetisch-forschende In-Beziehung-Treten mit dem Artefakt zu neuen Erfahrungen, die sich für das konzeptuelle Denken der Schüler*innen als leitend erweisen? Mithilfe prozess- und handlungsorientierter Konzepte leistet Claudia Mörgeli dazu Grundlagenforschung im Fach "Textiles und Technisches Gestalten". Ihre Erkenntnisse nutzt sie für Handlungshinweise an Lehrpersonen, die auch außerhalb der Kunstpädagogik lernförderlich angewendet werden können

Telemedicine in Intensive Care Units: Scoping Review

Background: The role of telemedicine in intensive care has been increasing steadily. Tele-intensive care unit (ICU) interventions are varied and can be used in different levels of treatment, often with direct implications for the intensive care processes. Although a substantial body of primary and secondary literature has been published on the topic, there is a need for broadening the understanding of the organizational factors influencing the effectiveness of telemedical interventions in the ICU. Objective: This scoping review aims to provide a map of existing evidence on tele-ICU interventions, focusing on the analysis of the implementation context and identifying areas for further technological research. Methods: A research protocol outlining the method has been published in JMIR Research Protocols. This review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A core research team was assembled to provide feedback and discuss findings. Results: A total of 3019 results were retrieved. After screening, 25 studies were included in the final analysis. We were able to characterize the context of tele-ICU studies and identify three use cases for tele-ICU interventions. The first use case is extending coverage, which describes interventions aimed at extending the availability of intensive care capabilities. The second use case is improving compliance, which includes interventions targeted at improving patient safety, intensive care best practices, and quality of care. The third use case, facilitating transfer, describes telemedicine interventions targeted toward the management of patient transfers to or from the ICU. Conclusions: The benefits of tele-ICU interventions have been well documented for centralized systems aimed at extending critical care capabilities in a community setting and improving care compliance in tertiary hospitals. No strong evidence has been found on the reduction of patient transfers following tele-ICU intervention

Quantitative detection of Porphyromonas gingivalis fimA genotypes in dental plaque

We developed quantitative fimA genotype assays and applied them in a pilot study investigating the fimbrial genotype distribution of Porphyromonas gingivalis in European subjects with or without chronic periodontitis. P. gingivalis was found in 71% and 9% of the samples from patients and healthy subjects, respectively. Enumeration of total P. gingivalis cell numbers by polymerase chain reaction and immunofluorescence showed excellent correspondence (r=0.964). 73% of positive samples contained multiple fimA genotypes, but generally one genotype predominated by one to three orders of magnitude. Genotype II predominated in 60% of the samples. Genotype IV occurred with similar prevalence (73%) as genotype II but predominated in only 20% of the samples. Genotypes I, III and V were of much lower prevalence and cell densities of the latter two remained sparse. Our results suggest marked differences among the fimA genotypes' ability to colonize host sites with high cell number

Tackling the frailty burden with an integrative value-based approach: results from a mixed-methods study

Aim The purpose of this paper is to investigate the implementation of value-based care principles in the context of frailty in the perioperative process, highlighting the importance of an integrative perspective considering medical and patient-centric outcomes as well as costs. Subject and methods This mixed-methods study employs a sequential design. Qualitative observational data were used to identify needs and barriers for implementing value-based principles, and quantitative methods were subsequently used to demonstrate the value of employing such an approach using data gathered from n = 952 patients. Propensity score matching was applied to identify the frailty-associated costs of the inpatient setting for n = 381 non-frail and n = 381 (pre-)frail patients, in particular considering patient-centric outcomes. Results The qualitative analysis identified three main challenges when implementing value-based principles in the context of perioperative care and frailty, namely challenges related to the cost, patient-centric, and integrative perspectives. In addressing these shortcomings, a quantitative analysis of a propensity score-matched sample of patients undergoing surgery shows additional frailty-associated costs of 3583.01 [1654.92; 5511.04] EUR for (pre-)frail patients and the influence of individual patient-centric attributes. Effect size Cohen’s d was 0.26. Conclusion The results demonstrate that frailty should be considered from an integrative perspective, taking cost, patient-centered outcomes, and medical outcomes into account simultaneously. The results also show the value of a research design which uses qualitative data for the identification of needs and barriers, as well as quantitative data for demonstrating the usefulness of the conceived value-based approach to perioperative care delivery

Sharing Frailty-related information in perioperative care: an analysis from a temporal perspective

BACKGROUND: Especially patients older than 65 years undergoing surgery are prone to develop frailty-related complications that may go far beyond the index hospitalization (e.g., cognitive impairment following postoperative delirium). However, aging-relevant information are currently not fully integrated into hospitals' perioperative processes. METHODS: We introduce a temporal perspective, which focuses on the social construction of time, to better understand existing barriers to the exchange of frailty-related data, targeting complexity research. Our chosen context is perioperative care provided by a tertiary hospital in Germany that has implemented a special track for patients over 65 years old undergoing elective surgery. The research followed a participatory modelling approach between domain and modelling experts with the goal of creating a feedback loop model of the relevant system relationships and dynamics. RESULTS: The results of the study show how disparate temporal regimes, understood as frameworks for organizing actions in the light of time constraints, time pressure, and deadlines, across different clinical, ambulant, and geriatric care sectors create disincentives to cooperate in frailty-related data exchanges. Moreover, we find that shifting baselines, meaning continuous increases in cost and time pressure in individual sectors, may unintentionally reinforce - rather than discourage - disparate temporal regimes. CONCLUSIONS: Together, these results may (1) help to increase awareness of the importance of frailty-related data exchanges, and (2) impel efforts aiming to transform treatment processes to go beyond sectoral boundaries, taking into account the potential benefits for frail patients arising from integrated care processes using information technology

Routine frailty assessment predicts postoperative complications in elderly patients across surgical disciplines – a retrospective observational study

BACKGROUND: Frailty is a frequent and underdiagnosed functional syndrome involving reduced physiological reserves and an increased vulnerability against stressors, with severe individual and socioeconomic consequences. A routine frailty assessment was implemented at our preoperative anaesthesia clinic to identify patients at risk. OBJECTIVE: This study examines the relationship between frailty status and the incidence of in-hospital postoperative complications in elderly surgical patients across several surgical disciplines. DESIGN: Retrospective observational analysis. SETTING: Single center, major tertiary care university hospital. Data collection took place between June 2016 and March 2017. PATIENTS: Patients 65 years old or older were evaluated for frailty using Fried's 5-point frailty assessment prior to elective non-cardiac surgery. Patients were classified into non-frail (0 criteria, reference group), pre-frail (1-2 positive criteria) and frail (3-5 positive criteria) groups. MAIN OUTCOME MEASURES: The incidence of postoperative complications was assessed until discharge from the hospital, using the roster from the National VA Surgical Quality Improvement Program. Propensity score matching and logistic regression analysis were performed. RESULTS: From 1186 elderly patients, 46.9% were classified as pre-frail (n = 556), and 11.4% as frail (n = 135). The rate of complications were significantly higher in the pre-frail (34.7%) and frail groups (47.4%), as compared to the non-frail group (27.5%). Similarly, length of stay (non-frail: 5.0 [3.0;7.0], pre-frail: 7.0 [3.0;9.0], frail 8.0 [4.5;12.0]; p < 0.001) and discharges to care facilities (non-frail:1.6%, pre-frail: 7.4%, frail: 17.8%); p < 0.001) were significantly associated with frailty status. After propensity score matching and logistic regression analysis, the risk for developing postoperative complications was approximately two-fold for pre-frail (OR 1.78; 95% CI 1.04-3.05) and frail (OR 2.08; 95% CI 1.21-3.60) patients. CONCLUSIONS: The preoperative frailty assessment of elderly patients identified pre-frail and frail subgroups to have the highest rate of postoperative complications, regardless of age, surgical discipline, and surgical risk. Significantly increased length of hospitalisation and discharges to care facilities were also observed. Implementation of routine frailty assessments appear to be an effective tool in identifying patients with increased risk. Now future studies are needed to investigate whether patients benefit from optimization of patient counselling, process planning, and risk reduction protocols based on the application of risk stratification

Prehabilitation of elderly frail or pre-frail patients prior to elective surgery (PRAEP-GO): study protocol for a randomized, controlled, outcome assessor-blinded trial

BACKGROUND: Frailty is expressed by a reduction in physical capacity, mobility, muscle strength, and endurance. (Pre-)frailty is present in up to 42% of the older surgical population, with an increased risk for peri- and postoperative complications. Consequently, these patients often suffer from a delayed or limited recovery, loss of autonomy and quality of life, and a decrease in functional and cognitive capacities. Since frailty is modifiable, prehabilitation may improve the physiological reserves of patients and reduce the care dependency 12 months after surgery. METHODS: Patients ≥ 70 years old scheduled for elective surgery or intervention will be recruited in this multicenter, randomized controlled study, with a target of 1400 participants with an allocation ratio of 1:1. The intervention consists of (1) a shared decision-making process with the patient, relatives, and an interdisciplinary and interprofessional team and (2) a 3-week multimodal, individualized prehabilitation program including exercise therapy, nutritional intervention, mobility or balance training, and psychosocial interventions and medical assessment. The frequency of the supervised prehabilitation is 5 times/week for 3 weeks. The primary endpoint is defined as the level of care dependency 12 months after surgery or intervention. DISCUSSION: Prehabilitation has been proven to be effective for different populations, including colorectal, transplant, and cardiac surgery patients. In contrast, evidence for prehabilitation in older, frail patients has not been clearly established. To the best of our knowledge, this is currently the largest prehabilitation study on older people with frailty undergoing general elective surgery. TRIAL REGISTRATION: ClinicalTrials.gov NCT04418271. Registered on 5 June 2020. Universal Trial Number (UTN): U1111-1253-4820 SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13063-022-06401-x

A comparison of first-attempt cannulation success of peripheral venous catheter systems with and without wings and injection ports in surgical patients—a randomized trial

Background: A peripheral venous catheter (PVC) is the most widely used device for obtaining vascular access, allowing the administration of fluids and medication. Up to 25% of adult patients, and 50% of pediatric patients experience a first-attempt cannulation failure. In addition to patient and clinician characteristics, device features might affect the handling and success rates. The objective of the study was to compare the first-attempt cannulation success rate between PVCs with wings and a port access (Vasofix (R) Safety, B. Braun, abbreviated hereon in as VS) with those without (Introcan (R) Safety, B. Braun, abbreviated hereon in as IS) in an anesthesiological cohort. Methods: An open label, multi-center, randomized trial was performed. First-attempt cannulation success rates were examined, along with relevant patient, clinician, and device characteristics with univariate and multivariate analyses. Information on handling and adherence to use instructions was gathered, and available catheters were assessed for damage. Results: Two thousand three hundred four patients were included in the intention to treat analysis. First-attempt success rate was significantly higher with winged and ported catheters (VS) than with the non-winged, non-ported design (IS) (87.5% with VS vs. 78.2% with IS; P-Chi < .001). Operators rated the handling of VS as superior (rating of"good" or"very good: 86.1% VS vs. 20.8% IS, P-Chi <.001). Reinsertion of the needle into the catheter after partial withdrawal-prior or during the catheterization attempt-was associated with an increased risk of cannulation failure (7.909, CI 5.989-10.443, P < .001 and 23.023, CI 10.372-51.105, P < .001, respectively) and a twofold risk of catheter damage (OR 1.999, CI 1.347-2.967, P = .001). Conclusions: First-attempt cannulation success of peripheral, ported, winged catheters was higher compared to non-ported, non-winged devices. The handling of the winged and ported design was better rated by the clinicians. Needle reinsertions are related to an increase in rates of catheter damage and cannulation failure