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Biomedical subjects

C Dierks

Publications and source records attributed to C Dierks.

17 recordsLinked to original sources
PubMed2003

Nutritional deficiencies in German middle-class male alcohol consumers: relation to dietary intake and severity of liver disease.

OBJECTIVE: The purpose of the present study was to compare the nutrient intake and the nutritional status between German middle-class alcohol consumers and non-drinkers. DESIGN: Cross-sectional study using patients with different stages of alcoholic liver disease (ALD) and healthy volunteers. SETTING: Southern Germany. SUBJECTS: Seventy-six hospitalized German middle-class alcohol consumers with different stages of alcoholic liver disease (ALD) and 22 healthy control subjects. METHODS: Subjects and controls were nutritionally assessed and mineral and vitamin content was measured in blood and urine. RESULTS: When compared with controls, alcohol consumers had significantly higher intakes of total calories, but intake of non-alcoholic calories did not differ between groups (P<0.05). Among drinkers, there was a decrease in percentage of energy derived from protein and fat and a significant increase in carbohydrates (P<0.05). With the exception of vitamin E, micronutrient intake of alcoholics was equal to that of controls; however, blood vitamin (vitamin C, retinol, lycopene, alpha- and gamma-carotene) and trace element (selenium, zinc) concentrations of alcohol-drinking patients were lower than those of non-drinkers. CONCLUSION: From the results of this study it is concluded that in German middle-class male alcohol consumers the status of several micronutrients is disturbed, although dietary intake hardly differs from that in non-alcoholic controls.

Adult↗
PubMed2001

[Legal adjustment in a European frame].

The legal and practical problems discussed concerning telemedicine within the western world seem quite similar: quality, litigation, professional law, data protection and financing are the main tasks that any health system within the EU is facing now. The working group T 6 of the European Health Telematics Association establishes a good basis for analyzing and developing a legal framework. However, in addition to the ongoing discussion about the necessary legal adjustments the engagement of Germany concerning these European aspects needs enforcement.

Developed Countries↗
PubMed2000

Legal aspects of telepathology.

In some legal surroundings telepathology is considered a breach of registrational barriers. The recommendation of the G 8 states in Europe for required legislation in telemedicine suggests to recognise that the localization of the remote health care professional defines the site not only of licensure but also of liability. This approach must be considered helpful, since it can solve many problems brought about by the doubtful results of private international law and conventions like the European Union (EU) and Lugano Convention. Under today's conditions in private international law it must be considered essential to agree upon a choice of law and stipulate a court of jurisdiction when doing telepathology. However, the opposing aims of insuring the patients claims and avoiding jurisdictions that exceed the local expectations of the medical professional must be reconciled. Data protection and data security are other crucial topics that require attention. Generally speaking, the principles of minimum data exchange, anonymity, pseudonymity and cryptography must be established as a basis for all telepathology procedures. Only when personal data is needed, its use can be legitimated. Written consent of the patient is advised. To guarantee a cross-border security level the regulations of the EU-Data Protection Directive need to be transformed into national law. In practise, cross-border dataflow shall only take place where the security level can be maintained even within the other country. Finally, reimbursement questions must be answered to establish a sound economical basis for telepathology. The spatial distance between the participants may yield the question, whether the service has been rendered to an extent necessary and sufficient for reimbursement. If reimbursement takes place on a cross-border or cross-regional level, severe disturbances of the health systems can occur. Regulation schemes or treaties need therefore to be developed to avoid such disturbances and encompass mutual standards of care as well as methods to balance reimbursement.

Europe↗
PubMed2000

[Malpractice considerations and the legal social reality].

According to German civil law the physician's services rendered to the patient must be in accordance with the medical state of art, which must regularly be adapted to successfully evaluated innovations. In the German statutory health insurance most of the services are financed under budgets. Budgets do not satisfactorily reflect the growing needs of an innovative medical system. Hence, the legislative organs have to take action in order to carry out a reform of the statutory health system that enables free enterprise, competition and the patient's free choice of services.

Budgets↗
PubMed1999

[Data protection in telemedicine--legal aspects].

Recent developments in telemedicine have resulted in an increased flow of personalized medicinal data and therefore caused new in calculable risks and dangers to the right of privacy. This article discusses the particular problems of this issue: The patient's consent must be based on sufficient information about the intended data processing and data flow. Transmitting data into countries outside the European Community should prevail sufficient data protection according to the EC-Guideline. Particular attention mus be paid to the regulations of the new German Multimedia Legislature.

Confidentiality↗
PubMed1998

[Withholding medical care as physical injury--refusal to treat from the viewpoint of the lawyer. Special aspects of therapy in children].

Medical treatment as well as refusal of treatment may be a source for tortious liability. Omitting treatment is generally accepted if the patient refuses consent. Special problems arise however, if the patient is not capable of consenting to therapeutic procedures. Assessing the patient's capability to consent is then the primary obligation. In absence of a respective capability the parents' will has to be accepted as the basis of therapeutic decision, as long as the objective medical needs of the patient remain in consideration. Omitting medically necessary treatment may not be justified with the opposing will of the parents.

Child↗
PubMed1997

Remote memory in Parkinson's disease and senile dementia.

Remote memory for public events was investigated in 14 demented patients with Parkinson's disease (PD), 14 non-demented PD patients, and 14 controls. These groups were compared with 16 demented patients with dementia that was due to Alzheimer or was of vascular origin (SDAVT), and with a group of elderly controls. The two demented groups were of a different age but displayed a comparable degree of dementia. Remote memory was assessed using a 'famous events' questionnaire with items both of comparable salience and difficulty. Results showed severely impaired retrograde memory functions in the two demented groups for both recall and recognition with non-demented PD patients performing similar to the controls. Remote memory impairments extended 30-40 years without any temporal graded memory losses. Non-demented PD patients and controls showed an inferior free recall performance, especially for the remote past. The two PD groups benefited from recognition to the same extent as the controls, whereas the improvement for SDAVT patients was inferior when compared to their elderly controls. In contrast to SDAVT patients, anterograde memory was associated with remote memory for specific decades in demented PD patients. The results are interpreted with respect to an underlying retrieval deficit with a superimposed anterograde impairment common to both types of dementia and an additional loss of storage sites in SDAVT patients.

Aged↗
PubMed1997

[Prerequisites in prescribing practice: physician decision processes].

Selecting a drug for proper treatment of the patient is still primarily the physicians choice. The selection is usually not influenced beforehand but subject to control in a case of malpractice. It must be taken into consideration, however, that about half of the practising doctors in Germany are working in their own practice. The vast majority of these are participating in the statutory health insurance system. Their therapeutic measures have to be in accordance with the social code, it's by-laws, regulations and guidelines. Drugs may only be prescribed if a curable decrease has been determined and the range of potential prescriptions has been scrutinised. Two "negative lists" have to be observed. In addition to this, the prescription must be effective, sufficient and may not exceed the necessities. If there are therapeutic alternatives the drugs efficacy must be taken into evaluation. Since the beginning of 1993 the doctor's choice is also influenced by the overall budgeting of drug expenses and the fear of personal liability for a budget excess.

Cost-Benefit Analysis↗
PubMed1996

[Medical expert assessment in civil and criminal law--medical expert assessment from the viewpoint of the attorney].

Dealing with a medical expert assessment requires experience and perseverance of the lawyer. Exact knowledge about the expert opinion itself and the procedural options is of greatest importance due to the decisive impact of the medical expert assessment on the outcome of the lawsuit. The lawyer has to consider at any time of the process whether he can initiate an expert assessment, whether he has to evaluate, criticize or question obtained expert assessments, whether he has to challenge the expert or possibly has to introduce another expert into the lawsuit. The expert witness has to have professional knowledge and the lawyer as well as the court have to absorb this knowledge and use it accordingly.

Criminal Law↗
PubMed1993

Medical confidentiality and data protection as influenced by modern technology.

Confidentiality has been considered to be a basic element of the doctor-patient relationship worldwide since the time of Hippocrates. On the verge of entering a society in which communication plays a leading role, confidentiality alone can no longer protect the patient's rights. Increasing diagnostic activity multiplies the amount of data available for processing in health systems. On the other hand, the use of electronic medical records allows practically unlimited amounts of data to be saved. The compilation of any personal data, however, requires a legal basis such as the consent of the individual concerned, which is generally given within the doctor-patient relationship. Compiled medical data can be assigned to four main sectors: therapy, financing, administration and research. This division into four sectors is based on the need to reconcile the conflicting needs of the patient's right to informational self-determination and third-party interests. Data can be processed for one or more of these purposes insofar as a legal basis therefore (law or consent) exists. Using the data for purposes outside the sector for which they were compiled interferes with the individual's right to informational self-determination. Thus most data compiled in the course of therapy may not be processed for research purposes, unless made anonymous, thereby losing the chance of retracing the source of the data. However, new informational techniques can procure secure anonymized and retraceable data flow. The legislature has to consider these technologies in order to enable the enormous opportunities presented by new methods of data processing to be fully exploited in research.

Computer Security↗
PubMedDate not supplied

[Results of cryptorchism therapy. A study of 232 patients].

232 patients had been treated for cryptorchidism. The disorder was unilateral in 126, bilateral in 106 patients. Therapy was performed either with human chorionic gonadotropin in 102 cases (hCG total dose of 18.000 I.U.) or surgery in 129 cases. Testicular descent was achieved in 51.5% by hormonal therapy and in 51.9% by surgery. Unilateral cases were subject to successful treatment in 53.2%, bilateral cases in 50%. The influence of initial finding (inguinal vs. abdominal retention) and age of the patients on results were analysed. Inguinal retention (n = 240) was successfully treated in 50.8%, abdominal retention (n = 94) in 54.3%. Testicular descent after therapy was found in 52.9% for patients 2-9 years of age (n = 119), in 50% for patients 10-13 yrs. of age (n = 88) and in 48% for patients older than 13 (n = 25). Regular findings after therapy was noted in 51.7% of all 232 patients. Method of therapy, initial finding and patients age, however, could not be shown to influence results significantly.

Adolescent↗