Ethical, Legal, and Practical Concerns Surrounding the Implemention of New Forms of Consent for Health Data Research: Qualitative Interview Study.

Background: In Europe, within the scope of the General Data Protection Regulation, more and more digital infrastructures are created to allow for large-scale access to patients' health data and their use for research. When the research is performed on the basis of patient consent, traditional study-specific consent appears too cumbersome for many researchers. Alternative models of consent are currently being discussed and introduced in different contexts.

Evaluating models of consent in changing health research environments.

While Specific Informed Consent has been the established standard for obtaining consent for medical research for many years, it does not appear suitable for large-scale biobank and health data research. Thus, alternative forms of consent have been suggested, based on a variety of ethical background assumptions. This article identifies five main ethical perspectives at stake.

Allocating scarce intensive care resources during the COVID-19 pandemic: practical challenges to theoretical frameworks.

The COVID-19 pandemic strained health-care systems throughout the world. For some, available medical resources could not meet the increased demand and rationing was ultimately required. Hospitals and governments often sought to establish triage committees to assist with allocation decisions.

The concept of vulnerability in medical ethics and philosophy.

Background: Healthcare is permeated by phenomena of vulnerability and their ethical significance. Nonetheless, application of this concept in healthcare ethics today is largely confined to clinical research. Approaches that further elaborate the concept in order to make it suitable for healthcare as a whole thus deserve renewed attention.

Machine metaphors and ethics in synthetic biology.

The extent to which machine metaphors are used in synthetic biology is striking. These metaphors contain a specific perspective on organisms as well as on scientific and technological progress. Expressions such as "genetically engineered machine", "genetic circuit", and "platform organism", taken from the realms of electronic engineering, car manufacturing, and information technology, highlight specific aspects of the functioning of living beings while at the same time hiding others, such as evolutionary change and interdependencies in ecosystems.

Are older people a vulnerable group? Philosophical and bioethical perspectives on ageing and vulnerability.

The elderly are often considered a vulnerable group in public and academic bioethical debates and regulations. In this paper, we examine and challenge this assumption and its ethical implications. We begin by systematically delineating the different concepts of vulnerability commonly used in bioethics, before then examining whether these concepts can be applied to old age.

Do we have a moral obligation to synthesize organisms to increase biodiversity? On kinship, awe, and the value of life's diversity.

Synthetic biology can be understood as expanding the abilities and aspirations of genetic engineering. Nonetheless, whereas genetic engineering has been subject to criticism due to its endangering biodiversity, synthetic biology may actually appear to prove advantageous for biodiversity. After all, one might claim, synthesizing novel forms of life increases the numbers of species present in nature and thus ought to be ethically recommended.

Development and feasibility of a scale to assess postoperative recovery: the post-operative quality recovery scale.

Background: Good postoperative recovery is increasingly recognized as an important outcome after surgery. The authors created a new Post-operative Quality Recovery Scale (PQRS) that tracks multiple domains of recovery from immediate to long-term time periods in patients of varying ages, languages, and cultures.

Methods: The parameters of importance to both clinicians and patients were identified.

Volume replacement with a balanced hydroxyethyl starch (HES) preparation in cardiac surgery patients.

Objective: Balanced fluids appear to be have advantages over unbalanced fluids for correcting hypovolemia. The effects of a new balanced hydroxyethyl starch (HES) were studied in cardiac surgery patients.

Design: Prospective, randomized, unblinded study.

The impact of fluid therapy on microcirculation and tissue oxygenation in hypovolemic patients: a review.

Purpose: An optimal volume replacement strategy aims to restore systemic hemodynamics with the ultimate goals of improving organ perfusion and microcirculation for sustaining adequate tissue oxygenation. This review presents the (patho)physiological basis of hypovolemia, microcirculation, and tissue oxygenation and presents a literature review on the effects of plasma substitutes on microperfusion and oxygenation in the clinical setting.

Methods: Literature review of the effects of fluid therapy on microcirculation and tissue oxygenation using PubMed search including original papers in English from 1988 to 2009.

Usefulness of monitoring platelet function by multiple electrode aggregometry in primary coronary artery bypass surgery.

Objectives: Antiplatelet therapy commonly is used for the prevention of cardiovascular complications but increases the risk of perioperative bleeding. Multiple-electrode aggregometry (MEA) was investigated for monitoring platelet inhibition by acetylsalicylic acid (ASA) and clopidogrel in patients undergoing elective coronary artery bypass graft (CABG) surgery with regard to clinical outcome as measured by postoperative blood loss and transfusion requirements.

Design: A prospective observational study.

Safety of nonblood plasma substitutes: less frequently discussed issues.

A variety of different fluids are promoted to correct hypovolaemia. Apart from the crystalloid versus colloid debate, there exists also a colloid versus colloid discussion as different protein (albumin) and nonprotein colloids (dextrans, gelatins, hydroxyethyl starch preparations) are available for this purpose. The different plasma substitutes largely differ with regard to their composition and their physicochemical properties.

Goal-directed intraoperative therapy based on autocalibrated arterial pressure waveform analysis reduces hospital stay in high-risk surgical patients: a randomized, controlled trial.

Introduction: Several studies have shown that goal-directed hemodynamic and fluid optimization may result in improved outcome. However, the methods used were either invasive or had other limitations. The aim of this study was to perform intraoperative goal-directed therapy with a minimally invasive, easy to use device (FloTrac/Vigileo), and to evaluate possible improvements in patient outcome determined by the duration of hospital stay and the incidence of complications compared to a standard management protocol.

A new plasma-adapted hydroxyethyl starch preparation: in vitro coagulation studies.

Objective: Preparing hydroxyethyl starch (HES) in a plasma-adapted solution is supposed to improve safety with regard to coagulation. The influence of a new plasma-adapted HES preparation on coagulation was studied.

Design: Operator-blinded, randomized study.

Cardiopulmonary bypass priming using a high dose of a balanced hydroxyethyl starch versus an albumin-based priming strategy.

Background: The optimal priming solution for cardiopulmonary bypass (CPB) is unclear. In this study, we evaluated the influence of high-volume priming with a modern balanced hydroxyethyl starch (HES) preparation on coagulation, inflammation, and organ function compared with an albumin-based CPB priming regimen.

Methods: In 50 patients undergoing coronary artery bypass grafting, the CPB circuit was prospectively and randomly primed with either 1500 mL of 6% HES 130/0.

Hepatocellular integrity after parenteral nutrition: comparison of a fish-oil-containing lipid emulsion with an olive-soybean oil-based lipid emulsion.

Background And Objective: Parenteral nutrition including lipids might be associated with liver disease. The cause leading to parenteral nutrition-related liver dysfunction remains largely unknown but is likely to be multifactorial. The study was performed to assess the effects of a lipid emulsion based on soybean oil, medium-chain triglycerides, olive and fish oil (SMOFlipid20%) compared with a lipid emulsion based on olive and soybean oil on hepatic integrity.