Informed Consent - Balance zwischen Patientenschutz und Forschungsinteressen

Forschungsethische Debatten haben sich in den letzten Jahren häufig der Frage gewidmet, ob Ausnahmen bei der strikten Forderung nach individueller Einwilligung des Patienten zulässig oder gar geboten sind. Einige Studiendesigns mit solchen Ausnahmeregelungen werden im Folgenden zur Diskussion vorgestellt

The reception and implementation of ethical guidelines of the Swiss Academy of Medical Sciences in medical and nursing practice

Questions under study: We conducted a survey among Swiss health care professionals on the reception and implementation of a number of selected ethical guidelines of the Swiss Academy of Medical Sciences (SAMS). The following guidelines were chosen for evaluation: “Care of patients in the end of life”, “Palliative care”, “Borderline questions in intensive-care medicine” and “The determination of death in the context of organ transplantation”. Methods: Anonymous questionnaires were sent to 1933 physicians (general practitioners and internists) and nurses, randomly chosen from address lists of the relevant professional associations. We conducted a statistical analysis using SPSS 16.0. Results: The response rate was 43.1%. 16.3% of the responding physicians had never heard of the guidelines “Care of patients in the end of life”, 30.5% had already heard of them, 34.1% knew some of their contents and 19.1% were familiar with the complete content of the guidelines. 60.5% of those physicians and 56.0% of those nurses who had at least heard of these guidelines utilised them in clinical practice. The guidelines “Palliative care” and “Borderline questions in intensive- care medicine” yielded similar results. By contrast, only 0.5% of responding physicians reported never having heard of the guidelines “The determination of death in the context of organ transplantation”, 2.9% had already heard of them, 24.4% knew some of their contents and the vast majority of respondents (72.2%) considered themselves to be completely familiar with the guidelines. Conclusion: Knowledge of the evaluated guidelines is fairly widespread among Swiss GPs, internists and nurses. The guidelines are utilised in clinical practice by the majority of those care providers who are aware of their existence. The guidelines “The determination of death in the context of organ transplantation”, as a legally binding document, are even better known and routinely implemented in medical practice

Confusion and Slurred Speech in a 34-Year-Old Woman from India

A 34-year-old woman from India, presented with episodes of confusion and progressive speech deterioration. She also had a painless neck “lump”, which persisted despite antibiotics. She was diagnosed to have a space occupying lesion in the left parietal lobe, which was subsequently biopsied

On the origin of planets at very wide orbits from the re-capture of free floating planets

In recent years several planets have been discovered at wide orbits (>100 AU) around their host stars. Theoretical studies encounter difficulties in explaining their formation and origin. Here we propose a novel scenario for the production of planetary systems at such orbits, through the dynamical recapture of free floating planets (FFPs) in dispersing stellar clusters. This process is a natural extension of the recently suggested scenario for the formation of wide stellar binaries. We use N-body simulations of dispersing clusters with 10-1000 stars and comparable numbers of FFPs to study this process. We find that planets are captured into wide orbits in the typical range ~100-10^6 AU, and have a wide range of eccentricities (thermal distribution). Typically, 3-6 x (f_FFP/1) % of all stars capture a planetary companion with such properties (where f_FFP is the number of FFP per star). The planetary capture efficiency is comparable to that of capture-formed stellar-binaries, and shows a similar dependence on the cluster size and structure. It is almost independent of the specific planetary mass; planets as well as sub-stellar companions of any mass can be captured. The capture efficiency decreases with increasing cluster size, and for a given cluster size the it increases with the host/primary mass. More than one planet can be captured around the same host and planets can be captured into binary systems. Planets can also be captured into pre-existing planetary and into orbits around black holes and massive white dwarfs, if these formed early enough before the cluster dispersal. In particular, stellar black holes have a high capture efficiency (>50 % and 5-10 x (f_FFP/1) % for capture of stars and planetary companions, respectively) due to their large mass. Finally, although rare, two FFPs or brown dwarfs can become bound and form a FFP-binary system with no stellar host.Comment: ApJ, in press. Added two figure