CONCEPTUALIZING PASSIVE TRUST: THE CASE OF SMART GLASSES IN HEALTHCARE

In recent years the digitisation of healthcare has been moving forward. Emerging technologies, such as smart glasses, are being tested for allowing healthcare workers information access at the point of care, while being able to work hands-free. Yet it remains unclear how the use of smart glasses will affect the trust relationship between patients and caregivers. The patient is not an active user of the smart glasses but is nevertheless dependent on outcomes influenced by the smart glasses. The patient, therefore, becomes a passive trustor of this technology. Building up-on existing trust research literature, we present a research model and extend it by interviewing 20 patients about their experiences with caregivers and their perceptions regarding the use of smart glasses in healthcare. We find that communication with patients is a key driver of passive trust in technology and trust in caregivers. This research contributes to a better understanding of the trust relationship between patients and caregivers and provides insights into the construct of passive trust in technology. In order to extend the qualitative data analysis, future research should investigate the extent of the acceptance of smart glasses by patients within healthcare facilities

Influence of tree hollow characteristics and forest structure on saproxylic beetle diversity in tree hollows in managed forests in a regional comparison

Tree hollows are among the rarest habitats in today's Central European managed forests but are considered key structures for high biodiversity in forests. To analyze and compare the effects of tree hollow characteristics and forest structure on diversity of saproxylic beetles in tree hollows in differently structured managed forests, we examined between 41 and 50 tree hollows in beech trees in each of three state forest management districts in Germany. During the two‐year study, we collected 283 saproxylic beetle species (5880 individuals; 22% threatened species), using emergence traps. At small spatial scales, the size of hollow entrance and the number of surrounding microhabitat structures positively influenced beetle diversity, while the stage of wood mould decomposition had a negative influence, across all three forest districts. We utilized forest inventory data to analyze the effects of forest structure in radii of 50–500 m around tree hollows on saproxylic beetle diversity in the hollows. At these larger spatial scales, the three forest management districts differed remarkably regarding the parameters that influenced saproxylic beetle diversity in tree hollows. In Ebrach, characterized by mostly deciduous trees, the amount of dead wood positively influenced beetle diversity. In the mostly coniferous Fichtelberg forest district, with highly isolated tree hollows, in contrast, only the proportion of beech trees around the focal tree hollows showed a positive influence on beetle diversity. In Kelheim, characterized by mixed forest stands, there were no significant relationships between forest structure and beetle diversity in tree hollows. In this study, the same local tree hollow parameters influenced saproxylic beetle diversity in all three study regions, while parameters of forest structure at larger spatial scales differed in their importance, depending on tree‐species composition

The Paleolithic rock art of El Mirón (Ramales de la Victoria, Cantabria, Spain): a proposal for its stratigraphic dating

RESUMEN: Este artículo describe el arte parietal descubierto en la Cueva de El Mirón (Cantabria, España) en el curso de las excavaciones dirigidas en el yacimiento por MGM y LGS desde 1996. El arte consiste en grabados, la mayoría de ellos aparentemente no fi gurativos en su estado actual, pero hay una imagen de un caballo y otra de un posible bisonte. Todos los grabados se localizan en el fondo del gran vestíbulo, a plena luz, en íntima relación con los depósitos de origen humano. El caballo y los grabados lineales asociados a él en las paredes de la cueva pueden atribuirse al Magdaleniense inferior o medio sobre la base de su estilo y de la altura practicable sobre las superfi cies de ocupación de estos períodos. Datables con mayor precisión son dos grupos de grabados lineales sobre un gran bloque que pueden asignarse al Magdaleniense inferior cantábrico, un período bien caracterizado por sus obras de arte mueble, como los omóplatos grabados, en El Mirón y en otros varios yacimientos regionales. El bloque cayó de la pared de la cueva, con su cara exterior yaciendo sobre el nivel 110, datado por radiocarbono en 16.130 ± 250 y 16.520 ± 40 BP. A partir de entonces se grabó su cara originalmente interior. A continuación, el bloque y sus grabados fueron progresivamente recubiertos por sedimentos del Magdaleniense medio, superior y fi nal datados entre ca. 14.500- 12.000 BP. En suma, el arte descubierto y estudiado hasta la fecha en El Mirón puede atribuirse al Magdaleniense inferior y medio, aunque el yacimiento estuvo habitado por los humanos al menos desde el Paleolítico medio hasta época medieval. El artículo concluye situando el arte parietal de El Mirón en el contexto de las otras numerosas (pero peor datadas) manifestaciones de arte rupestre de la cuenca del río Asón, en la Cantabria Oriental, que incluyen sitios tan notables como Venta de la Perra, Covalanas, La Haza y Cullalvera.ABSTRACT: This article describes the rock art discovered in El Mirón Cave (Cantabria, Spain) during the course of excavations directed by LGS and MGM since 1996. The art consists of engravings: most are apparently non-representational in their currest condition, but there is one image of a horse and another of a possible bison. The engravings are all located at the rear of the large, sunlit vestibule of the cave, in intimate relationship with human habitation deposits. The horse and associated linear engravings on the cave wall can be attributed to the earlymiddle Magdalenian on the basis of style and practicable height above occupation surfaces of those periods. More precisely datable, two series of linear engravings on a large block can be assigned to the Lower Cantabrian Magdalenian, a period well-endowed with works of portable art, such as engraved scapulae, both at El Mirón and in many other regional sites. The block fell from the cave wall, its outer surface landing on Level 110, which is 14C-dated to 16,130 ± 250 and 16,520 ± 40 BP. Then the fl at inner surface of the block was engraved. Next, the block and the engravings were progressively covered over by sediments pertaining to Middle, Upper and Terminal Magdalenian levels 14C-dated between ca. 14,500- 12,000 BP. In sum, the art discovered to date in El Mirón can be attributed to the early and middle Magdalenian period, although the site itself was inhabited by humans from at least late Middle Paleolithic through Medieval times. This article concludes by placing the Mirón parietal art within the context of the numerous other (but less-well dated) cave art manifestations in the river Asón basin of eastern Cantabria, including such notable sites as Venta de la Perra, Covalanas, La Haza and Cullalvera

Stellenwert von Kardiokompressionssystemen in der außer- und innerklinischen Reanimation : eine retrospektive Registeranalyse und prospektive Metaanalyse

Der Kreislaufstillstand ist ein dramatisches notfallmedizinisches Ereignis, dessen ernüchternde Prognose sich seit der Erstbeschreibung der Kardiopulmonalen Reanimation (CPR) im Jahr 1960 nicht grundlegend verändert hat. Ein vielversprechender neuartiger Therapieansatz sind mechanische Kardiokompressionssysteme. Fragestellung: Welchen Einfluss hat der Einsatz von Kardiokompressionssystemen im Vergleich mit manueller CPR mittels Herzdruckmassage auf das Outcome von Erwachsenen mit Kreislaufstillstand? Primärer Zielparameter ist die Rückkehr eines Spontankreislaufs (ROSC). Unter den sekundären Zielgrößen befinden sich Krankenhausaufnahme und -entlassung, neurologisches Outome, sowie eine Vielzahl an Surrogatparametern für die Durchführung und Qualität der CPR, die im Text ausgeführt werden. Material und Methoden: Zunächst sollen in einer retrospektiven Analyse alle außerklinischen Kreislaufstillstände ausgewertet werden, die in den Jahren 2007 bis 2012 im Deutschen Reanimationsregister dokumentiert wurden. Die in diesem Zeitraum angewendeten Systeme, AutoPulse® und LUCAS® (Interventionsgruppen) werden mit manueller CPR (Kontrollgruppe) verglichen. Anhand außerklinischer Risikofaktoren kann der ROSC-After-Cardiac-Arrest (RACA) Score errechnet und mit der beobachteten Rate an ROSC verglichen werden. Eine multivariate Analyse adjustiert den Einfluss der mechanischen CPR auf die Rate an ROSC nach epidemiologischen Faktoren und Therapiemaßnahmen. Die statistische Auswertung erfolgt mit SPSS Statistics® 21.0, IBM, ARMONK/USA. In einem zweiten Schritt soll schließlich in einer Metaanalyse der Einfluss von Kardiokompressionssystemen auf das primäre und sekundäre Outcome anhand der aktuell verfügbaren Literatur geklärt werden. Hierzu werden die gängigen Literaturdatenbanken nach Studien durchsucht, die Kardiokompressionssysteme mit manueller CPR vergleichen. Diese Publikationen werden mit Hilfe von Review Manager® 5.3, The Nordic COCHRANE Centre, KOPENHAGEN/Dänemark, analysiert und bewertet. Ergebnisse: In die Analyse des Deutschen Reanimationsregisters können 11.217 Patienten eingeschlossen werden (167 AutoPulse®, 156 LUCAS®, 10.894 manuell). ROSC wird in 57,1% bei AutoPulse® erreicht (95%-Konfidenzintervall 49,5%-64,8%; RACA-Score 46,6%). Bei LUCAS® wurde ROSC in 46,5% erreicht (38,4%-54,7%; RACA 43,4%) und bei manueller CPR in 40,1% (39,2%-41,1%; RACA 39,9%). Adjustiert nach Einflussfaktoren beträgt die odds ratio für ROSC unter Berücksichtigung der CPR-Dauer 1,70 (1,12-2,57) für AutoPulse® und 1,66 (1,09-2,51) für LUCAS®. Ohne Berücksichtigung der CPR-Dauer beträgt sie 1,39 (0,98-1,97) für AutoPulse® und 0,99 (0,68-1,43) für LUCAS®. Die Metaanalyse zeigt signifikant mehr ROSC bei Systemen mit semizirkumferentiell konstringierenden Bändern, während dies für Systeme mit mechanischen Stempeln nicht gezeigt werden kann. Je länger das Outcome der Patienten nachbeobachtet wird, desto geringer zeigt sich die Überlegenheit der Kardiokompressionssysteme, so dass sich bis zur Klinikentlassung und dem Langzeitüberleben keine signifikanten Unterschiede zwischen Interventions- und Kontrollgruppen mehr nachweisen lassen. Nach mechanischer CPR zeigen die Patienten signifikant seltener ein günstiges neurologisches Outcome. Hinsichtlich weiterer Zielparameter zeigt sich eine sehr inkonsistente Studienlage. Diskussion: Während AutoPulse® die Rate an ROSC signifikant erhöht, erfüllen LUCAS® und manuelle CPR das erwartete Outcome (RACA). Diese Beobachtung wird auch durch die Metaanalyse gestützt. Adjustiert nach Risikofaktoren zeigen beide Systeme eine Überlegenheit gegenüber manueller CPR; diese Beobachtung ist hauptsächlich der Berücksichtigung der Reanimationsdauer in der multivariaten Analyse zuzuschreiben. Diesem Effekt stehen in der Metaanalyse erfasste Schwierigkeiten bei der Anwendung und ein verzögerter Ablauf der Reanimation entgegen. Grundsätzlich ist zu beachten, dass die Frage, welche Technik die bessere ist, auch stark von der Qualität der manuellen CPR in der Kontrollgruppe abhängt. Die Metaanalyse zeigt einige Hinweise für mögliche Anwendungsbereiche und Indikationen für Kardiokompressionssysteme auf. Auch in diesem Zusammenhang besitzen Zeitpunkt und Dauer der CPR einen zentralen Stellenwert. Schlussfolgerung: Mit Hilfe von Kardiokompressionssystemen lassen sich sicher und effektiv Thoraxkompressionen durchführen. Allerdings kann deren Anwendung die Prognose der Patienten beeinträchtigen, insbesondere wenn sie lebensrettende therapeutische Maßnahmen verzögen. Unter definierten Bedingungen, insbesondere wenn Transport, Umgebungsbedingungen oder Therapie eine prolongierte Reanimation erwarten lassen, wenn es die Sicherheit des Teams oder der Ablauf der Reanimation erfordern, oder aber als Überbrückung bis zu einer definitiven Therapie, kann die mechanische CPR Vorteile bieten. Grundsätzlich sollten Kardiokompressionssysteme nur in definierten Situationen nach ärztlicher Indikationsstellung und mit klaren therapeutischen Konzepten eingesetzt werden

Sepsis in der prähospitalen Notfallmedizin

Background!#!Sepsis is a challenge in emergency medicine, as this life-threatening organ dysfunction, caused by a dysregulated host response to an infection, presents manifold and therefore is often recognized too late.!##!Objectives!#!Recently published surviving sepsis campaign and German S3 guidelines provide recommendations for diagnosis and therapy of sepsis in an in-hospital or intensive care setting, but do not particularly address out-of-hospital emergency medical care. We aim to work out the evidence base with regard to the out-of-hospital care of patients with suspected sepsis and to derive treatment recommendations for emergency medical services.!##!Conclusions!#!Therapy of sepsis and septic shock is summarized in bundles, whereby the first bundle should ideally be completed within the first hour-in analogy to 'golden hour' concepts in other emergency medical entities, such as trauma care. In the out-of-hospital setting, therapy focuses on securing vital parameters, according to the ABCDE scheme, with a particular focus on volume therapy. Further procedures within the 1 h bundle, such as lactate measurement, obtaining microbiological samples, and starting an anti-infective therapy, are broadly available in hospital only. The aim is to control the site of infection as soon as possible. Therefore, an appropriate designated hospital should be chosen carefully and informed in advance, in order to initiate and pave the way for further clinical diagnostic and treatment paths. Moreover, structured and target-oriented handovers, as well as regular training, are required

Advanced and Invasive Cardiopulmonary Resuscitation (CPR) Techniques as an Adjunct to Advanced Cardiac Life Support

Background: Despite numerous promising innovations, the chance of survival from sudden cardiac arrest has remained virtually unchanged for decades. Recently, technological advances have been made, user-friendly portable devices have been developed, and advanced invasive procedures have been described that could improve this unsatisfactory situation. Methods: A selective literature search in the core databases with a focus on randomized controlled trials and guidelines. Results: Technical aids, such as feedback systems or automated mechanical cardiopulmonary resuscitation (CPR) devices, can improve chest compression quality. The latter, as well as extracorporeal CPR, might serve as a bridge to treatment (with extracorporeal CPR even as a bridge to recovery). Sonography may be used to improve thoracic compressions on the one hand and to rule out potentially reversible causes of cardiac arrest on the other. Resuscitative endovascular balloon occlusion of the aorta might enhance myocardial and cerebral perfusion. Minithoracostomy, pericardiocentesis, or clamshell thoracotomy might resolve reversible causes of cardiac arrest. Conclusions: It is crucial to identify those patients who may benefit from an advanced or invasive procedure and make the decision to implement the intervention in a timely manner. As with all infrequently performed procedures, sound education and regular training are paramount

Application of mechanical cardiopulmonary resuscitation devices and their value in out-of-hospital cardiac arrest: A retrospective analysis of the German Resuscitation Registry

Background Cardiac arrest is an event with a limited prognosis which has not substantially changed since the first description of cardiopulmonary resuscitation (CPR) in 1960. A promising new treatment approach may be mechanical CPR devices (mechanical CPR). Methods In a retrospective analysis of the German Resuscitation Registry between 2007-2014, we examined the outcome after using mechanical CPR on return of spontaneous circulation (ROSC) in adults with out-of-hospital cardiac arrest (OHCA). We compared mechanical CPR to manual CPR. According to preclinical risk factors, we calculated the predicted ROSC-after-cardiac-arrest (RACA) score for each group and compared it to the rate of ROSC observed. Using multivariate analysis, we adjusted the influence of the devices' application on ROSC for epidemiological factors and therapeutic measures. Results We included 19,609 patients in the study. ROSC was achieved in 51.5% of the mechanical CPR group (95%-CI 48.2-54.8%, ROSC expected 42.5%) and in 41.2% in the manual CPR group (95%-CI 40.4-41.9%, ROSC expected 39.2%). After multivariate adjustment, mechanical CPR was found to be an independent predictor of ROSC (OR 1.77; 95%-CI 1.48-2.12). Duration of CPR is a key determinant for achieving ROSC. Conclusions Mechanical CPR was associated with an increased rate of ROSC and when adjusted for risk factors appeared advantageous over manual CPR. Mechanical CPR devices may increase survival and should be considered in particular circumstances according to a physicians' decision, especially during prolonged resuscitation

Automated mechanical cardiopulmonary resuscitation devices versus manual chest compressions in the treatment of cardiac arrest: protocol of a systematic review and meta-analysis comparing machine to human

Introduction Cardiac arrest is a leading cause of death in industrialised countries. Cardiopulmonary resuscitation (CPR) guidelines follow the principles of closed chest compression as described for the first time in 1960. Mechanical CPR devices are designed to improve chest compression quality, thus considering the improvement of resuscitation outcomes. This protocol outlines a systematic review and meta-analysis methodology to assess trials investigating the therapeutic effect of automated mechanical CPR devices at the rate of return of spontaneous circulation, neurological state and secondary endpoints (including short-term and long-term survival, injuries and surrogate parameters for CPR quality) in comparison with manual chest compressions in adults with cardiac arrest.Methods and analysis A sensitive search strategy will be employed in established bibliographic databases from inception until the date of search, followed by forward and backward reference searching. We will include randomised and quasi-randomised trials in qualitative analysis thus comparing mechanical to manual CPR. Studies reporting survival outcomes will be included in quantitative analysis. Two reviewers will assess independently publications using a predefined data collection form. Standardised tools will be used for data extraction, risks of bias and quality of evidence. If enough studies are identified for meta-analysis, the measures of association will be calculated by dint of bivariate random-effects models. Statistical heterogeneity will be evaluated by I2-statistics and explored through sensitivity analysis. By comprehensive subgroup analysis we intend to identify subpopulations who may benefit from mechanical or manual CPR techniques. The reporting follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Ethics and dissemination No ethical approval will be needed because data from previous studies will be retrieved and analysed. Most resuscitation studies are conducted under an emergency exception for informed consent. This publication contains data deriving from a dissertation project. We will disseminate the results through publication in a peer-reviewed journal and at scientific conferences.PROSPERO registration number CRD42017051633