Ethical issues in dental education-A cross-sectional study with pre-clinical and clinical dental students

INTRODUCTION

Although ethics is an indispensable part of dental education, it has not yet played a relevant role in the dental curriculum in Germany. The study aimed at assessing their prior knowledge of ethical aspects, and their expectations of and wishes for ethics course of dental students, preclinical vs. clinical, at the dental school Kiel, Germany by means of a validated questionnaire.

METHODS

A descriptive cross-sectional study design was used. The study population consisted of dental students, from pre-clinical (n = 105) and clinical semesters (n = 110). In January 2019, each student completed a validated questionnaire to identify semester-specific ethical teaching content. Besides descriptive analyses, Mann-Whitney U test was used to compare pre-clinical and clinical students.

RESULTS

A total of 215 dental students, with a mean age of 25.3 (SD 4.1), participated in the study, of which 150 were female (69.8%) and 65 were male students (30.2%). The results in the areas of 'previous knowledge of ethical issues' and 'expectations and desires in terms of teaching medical ethics' showed similarities and differences between pre-clinical and clinical students. Both groups stated that they need training in ethics. Moreover, especially clinical students recognize that more ethical competence is needed if the first patient contact will start.

CONCLUSION

The study indicates that there is a clear need for ethics education. Student awareness of the relevance of ethical competences and the perception of ethical problems increased progressively during the course of their studies. Overall, the study provides good support for the development of specific ethics courses.

[From Nazi to Hitler Analyst: The Autobiographical Reinterpretations of the Psychiatrist Johann Recktenwald (1882-1964)]

AIM OF THE STUDY

The focus of this article is the psychiatrist Johann Recktenwald (1882-1964) who has so far received little attention: acquitted of the charge of "crimes against humanity", he went public in post-war Germany with a neuropsychiatric treatise on Hitler. But is this appearance as a Hitler-critical psychiatrist consistent with the available historical sources? What was Recktenwald's relationship with the Nazi regime, and how did he behave in the "Third Reich" towards the patients entrusted to his care?

METHODS

The paper is largely based on documents from various archives, some of which have been evaluated for the first time, and on court records. The latter are supplemented and compared with the writings of Recktenwald and the available secondary literature.

RESULTS

During the "Third Reich", Recktenwald served the Nazi regime in many ways, was jointly responsible for numerous patient murders and thus moved into the role of a Nazi perpetrator. After his acquittal in post-war Germany, he endeavored to construct a personal distance to National Socialism by critically examining Hitler's psychopathology, which at the same time served his own exculpation.

CONCLUSION

Recktenwald is a particularly impressive example of the efforts of Nazi perpetrators to retrospectively rewrite their own role in the "Third Reich" - and at the same time a reflection of a post-war society that was willing to accept such biographical reinterpretations in order to avoid coming to terms with the Nazi past.

Nazi persecutee and opponent of racial hygiene: The extraordinary life of the "ethnopathologist" Max Kuczynski (1890-1967)

The pathologist Max Kuczynski (1890-1967) gained recognition for his bacteriological research but is also considered the founder of the so-called ethnopathology. As a "non-Aryan," Kuczynski emigrated from Nazi Germany to Peru, where his elder son was later even to become president. However, the circumstances surrounding the end of Kuczynski's career in Germany are hardly known. This article takes this research gap as an opportunity to reconstruct his life, the circumstances of his emigration, and his work in South America. Numerous archival documents serve as sources. In the mid-1920s, Kuczynski developed "ethnic pathology," a new interdisciplinary approach that offered a counter-concept to the increasingly popular racial hygiene in Germany. But his career in Germany ended even before the Nazis came to power in 1933. He was dismissed from the Charité Pathological Institute in October 1932 at the instigation of its new director, Robert Rössle (1876-1956). Personal and financial reasons played a role, but Kuczynski's rejection of racial hygiene may also have been a decisive factor: Rössle himself turned increasingly to questions of racial hygiene in the Third Reich and used the corpses of Nazi victims for his research. It can be shown that the circumstances of Kuczynski's dismissal were already catalyzed by anti-Semitic and eugenic tendencies, which were to unleash themselves radically in Germany only a few months later - and even caught up with him in Peruvian exile.

The recent ethics boom in dentistry-moral fig leaf, fleeting trend or professional awakening?

OBJECTIVES

"Ethics in dentistry" seems to be gaining importance as more and more dental institutions, professional associations and dental schools are addressing ethical issues. The aim of this paper is to highlight this ongoing development and to analyze and evaluate its relevance for future dentistry and the dental profession.

MATERIALS AND METHODS

A qualitative analysis of literature and Internet sources served as the methodological basis. Recent trends were first illustrated using striking examples and then compared with the status quo in medicine and the medical profession, where ethics have a long professional tradition. It is discussed to what extent it seems worthwhile to transfer existing structures and initiatives in medicine to dentistry.

RESULTS

There is a broad variety of ethical announcements and initiatives in international dentistry (e.g., dental codes of ethics, adjustments to dental licensure regulations, professional publications, textbooks, awards, podcasts). It should be noted that ethical issues arise not only in life-threatening situations, but also in everyday dental practice. Existing ethical structures in medicine can be adapted or provide guidance for education, clinical practice and research.

CONCLUSIONS

Teaching ethical competence in dental education, clinical practice and research can make an important contribution to the professionalization of dentists-quite similar to medicine. Furthermore, a broad integration of ethics in dentistry strengthens the public image of dentists.

CLINICAL RELEVANCE

Dealing confidently with ethical issues is a key competence for successful work as a dentist-both in practice and in science.

A shift in psychiatry through AI? Ethical challenges

The digital transformation has made its way into many areas of society, including medicine. While AI-based systems are widespread in medical disciplines, their use in psychiatry is progressing more slowly. However, they promise to revolutionize psychiatric practice in terms of prevention options, diagnostics, or even therapy. Psychiatry is in the midst of this digital transformation, so the question is no longer "whether" to use technology, but "how" we can use it to achieve goals of progress or improvement. The aim of this article is to argue that this revolution brings not only new opportunities but also new ethical challenges for psychiatry, especially with regard to safety, responsibility, autonomy, or transparency. As an example, the relationship between doctor and patient in psychiatry will be addressed, in which digitization is also leading to ethically relevant changes. Ethical reflection on the use of AI systems offers the opportunity to accompany these changes carefully in order to take advantage of the benefits that this change brings. The focus should therefore always be on balancing what is technically possible with what is ethically necessary.

Persecutee in the Third Reich, full professor in the GDR: The communist physician Carl Coutelle (1908-1993) and his post-war career as pathologist

As an avowed communist, Carl Coutelle was one of the few (future) pathologists persecuted for purely political reasons in the Third Reich. Despite this peculiarity, his life has received little attention. The present article takes the existing research desideratum as an opportunity to elaborate on Coutelle's fate during the Nazi era, but also on his academic rise to the position of full professor at the University of Halle (GDR). The analysis is based on extensive files from various German archives. The article pursues a twofold question: On the one hand, it seems necessary to clarify how Coutelle's life between 1933 and 1945 can be characterized and classified, and on the other hand, it is of interest whether he owed his career in the GDR primarily to scientific merit or to state support. It can be shown that Coutelle's career path reflects the prevailing political power relations: With the beginning of the Third Reich, Coutelle was completely disenfranchised because of his political views; he was forced to emigrate, interrupted his nascent scientific career, and became actively involved in the international anti-fascist resistance. After the war, Coutelle became one of the protagonists of the socialist transformation and denazification of the health care system in the Soviet Occupation Zone. Now his career took the opposite course: Although his research performance was below average compared to other pathologists from the GDR, the avowed communist was appointed full professor - due to state intervention and against the declared will of the faculty in Halle.

The ideological roots of Nazi eugenics in pathology and its pioneers Martin Staemmler, Ludwig Aschoff, Robert Rössle, and Georg B. Gruber

This study examines the ideological roots of Nazi eugenics and racial hygiene in the medical field of pathology and its key figures Martin Staemmler (1890-1974), Ludwig Aschoff (1886-1942), Robert Rössle (1876-1956), and Georg B. Gruber (1884-1977). The focus is on their specific approaches to racial hygiene and its legitimization by pathology and its representatives. The study is based primarily on the scientific works and statements of these four pathologists on the content of racial hygiene and the impact of these contributions on Nazi eugenics and its practical implementation in the Third Reich. The paper provides three key findings: (1) Staemmler, Aschoff, Rössle, and Gruber each had a significant impact on the implementation of Nazi eugenics and the legitimization of the Third Reich's health and population policies. (2) They all proclaimed the superiority of the Volksgemeinschaft ('people's community') over the individual and pursued the major objective of ensuring Volksgesundheit ('national health') by preventing the spread of hereditary diseases through sterilizations. (3) The specific relationship to racial hygiene was different for each of the four pathologists: Staemmler had a direct vision of racial hygiene in a national socialist context, Aschoff was committed to the subject long before 1933 and used the Nazi rise to power to reaffirm and expand his position, Rössle and Gruber adopted racial hygiene ideas not until the mid-1930 s, but later radicalized their views and lent additional legitimacy to Nazi eugenics in theory and practice. (4) Albeit to varying degrees, all four pathologists bear some responsibility for the medical crimes that resulted from Nazi eugenics and the related policies. It can be concluded that Staemmler, Aschoff, Rössle, and Gruber made considerable contributions to the theory of Nazi eugenics and provided the much-needed scientific legitimization for the Third Reich's health and population policies.

From Germany to Venezuela: The two careers of the Jewish-born pathologist Rudolf Jaffé (1885–1975)

The pathologist Rudolf Jaffé (1885-1975) is considered one of the most important specialists of his time - even though he had to flee from the Nazis and attempt a professional restart in South America. The article examines the concrete background of his emigration to South America and the factors that enabled Jaffé to establish pathology as a scientific discipline in Venezuela. Various archival documents and materials from the private archives of Jaffé's descendants serve as sources. These documents are supplemented by relevant secondary literature. Jaffé's career can be divided into four phases: (1) Jaffé's broad education, which qualified him for his later work in Venezuela. (2) Jaffé's professional activity at the Senckenberg Institute of Pathology in Frankfurt. (3) His career peak in Germany as head of the Institute of Pathology in Berlin-Moabit, and finally (4) his forced emigration to Venezuela, where he became the doyen of the field of pathology. It can be shown that Jaffé's great scientific success, even after his emigration, was based on three factors: his exceptional personality, his broad, multifaceted training, and the special conditions in Venezuela.

Telemedicine in nursing homes: Insights on the social acceptance and ethical acceptability of telemedical consultations

Introduction

The increasing number of older adults in need of care, the resulting rise in demand for care services and the shortage of nursing staff are major challenges for society. In these situations, the use of telemedicine seems promising - especially in nursing homes when the focus is on rapid support in acute medical cases. However, in addition to the medical and technical potential, the acceptability and usability of the use of telemedical consultations are crucial for a sustainable implementation and acceptance. Our research aims at a holistic identification of socially and ethically relevant parameters for the evaluation of telemedical consultations in nursing homes.

Methods

Presentation of the empirical approach of an interdisciplinary cooperation that combines social and ethical research perspectives during an entire research project. Qualitative analysis of social and ethical aspects based on an interview study with care personnel (N = 14) who have experiences with telemedical consultations in nursing homes, as an example of this interdisciplinary collaboration and to show first insights.

Results

The results of the interview study show a slightly positive evaluation of the use of telemedical consultations in nursing homes. Six main categories were identified to capture and differentiate ethically and socially relevant perceived benefits and barriers (contact with physicians, general, personnel-related, residents-related, technical, and organizational aspects).

Conclusion

The study results allow initial recommendations for the implementation of telemedicine consultations in nursing homes considering socially and ethically relevant aspects. These recommendations can be used to inform medical and technical experts in the field of telemedicine. In addition, the presentation of the interdisciplinary collaboration shows that the close integration of social and ethical aspects in research enables a holistic dimension of the use of telemedicine.

Chore or desire? Students' response to online lessons in scientific integrity

One of the main responsibilities of universities for their students, researchers, and society is to teach scientific integrity. Over the years, many universities-including RWTH Aachen University-have developed modules to impart the rules of good scientific practice. The current case study outlines the "Scientific Integrity" online course of RWTH Aachen University that has been offered to all master's students starting in October 2020; it explains to what extent the topic of scientific integrity meets genuine interest among students. Based on the online questionnaires that students were asked to fill out before starting the course (Q1) and after completing the course (Q2), it was verified that the implemented course achieved a satisfactory, but expandable acceptance. 57% of study participants initially (Q1) strongly affirmed to be interested in the topic; said percentage increased to 65.3% at the end of the course (Q2). While at the time of Q1 most students admitted that they would not take the course if it were voluntary, the majority of study participants came to the opposite conclusion after the course (Q2). The results suggest that the assessment of the relevance of the course may be dependent on familiarity with its contents.

Searching for motives: Suicides of doctors and dentists in the Third Reich and the postwar period, 1933-1949

The criminal practices of National Socialism not only led to millions of murders, but also to increased suicide rates. The present study examines a specific aspect of this phenomenon: the suicides and corresponding motives of 275 German doctors and dentists in the period from 1933 to 1949. The analysis is based on a wide variety of primary and secondary sources. Most suicides were due to National Socialist repression, with peaks in 1938 and 1942. One fifth of the cases were among National Socialist perpetrators, with a peak of those suicides occurring in 1945. The motives for suicide ranged from despair to a lack of career prospects to a final act of self-determination and political opposition; many of the doctors experienced or expected a social downfall before attempting suicide.

[Perpetrator or victim? The orthodontist Gustav Korkhaus (1895-1978) and his actual role in the Third Reich]

PURPOSES

Gustav Korkhaus is widely regarded as the most important German orthodontist of the post-war period; in contrast, his relationship to National Socialism is much less well defined. Against this background, this article sheds light on the concrete scientific and (professional) political significance of Korkhaus; special attention is paid to his role in the Third Reich.

METHODS

The study is based on primary sources from the Federal Archives Berlin, the State Archives North Rhine-Westphalia (Department Rhineland), and the University Archives Bonn. Contemporary publications were also included, as well as secondary literature on Korkhaus.

RESULTS

Korkhaus was an international pioneer of orthodontics in many respects-as a scientist, expert politician, and developer of orthodontic innovations. During the Third Reich, he joined numerous Nazi organizations and enjoyed the backing of the "Reichszahnärzteführer" (Reich dentist leader) Ernst Stuck. After 1945, however, he portrayed himself as a political victim.

CONCLUSION

Korkhaus did not commit Nazi crimes, but contrary to his claims, he was not a victim of the Nazi regime either. Rather, he served the Nazi state for career reasons and contributed to the omnipotence of the regime. He thus belongs to the group of political opportunists.

[The pathologist Hans Klein (1912-1984) : Autopsy of his role in the "Third Reich"]

The role of pathologist Hans Klein during the National Socialist era and his career in post-war Germany have hardly received systematic attention. During World War II, Hans Klein worked in two medical institutions, where he collaborated with individuals who were significantly involved in Nazi crimes. Klein's participation initially extended mainly to his work as an employed pathologist at the Rudolf Virchow Hospital in Berlin. There he was introduced to autopsy practices in the context of the children's euthanasia programme and autopsies of victims of medical experiments. Later, a shift in his activities is noticeable at the Hohenlychen Sanatorium. Klein's activities there increasingly involved independent research or voluntary collaboration in the projects of other scientists that were closely connected to the SS and experiments on human beings in concentration camps. He never had to face justice. His role was not further investigated by the Allies - probably due to his non-existent Nazi party and SS membership.

Is there a need for a clear advice? A retrospective comparative analysis of ethics consultations with and without recommendations in a maximum-care university hospital

Background

The theory and practice of ethics consultations (ECs) in health care are still characterized by many controversies, including, for example, the practice of giving recommendations. These controversies are complicated by an astonishing lack of evidence in the whole field. It is not clear how often a recommendation is issued in ethics consultations and when and why this step is taken. Especially in a facilitation model in which giving recommendations is optional, more data would be helpful to evaluate daily practice, ensure that this practice is in line with the overarching goals of this approach and support the development of standards.

Methods

We analyzed all consultations requested from an EC service working under a facilitation approach at a maximum-care university hospital in Germany over a period of more than 10 years. Our aim was to better understand why—and under what circumstances—some consultation requests result in a recommendation, whereas others can be sufficiently addressed solely by facilitated meetings. We especially wanted to know when and why clients felt the need for clear advice from the EC service while in other cases they did not. We compared ethics consultations in terms of the differences between cases with and without recommendations issued by the ethics consultants using χ² difference tests and Welch’s t-test.

Results

A total of 243 ECs were carried out between September 2008 and December 2019. In approximately half of the cases, a recommendation was given. All recommendations were issued upon the request of clients. When physicians asked for an EC, the consultation was significantly more likely to result in a recommendation than when the EC was requested by any other party. ECs in cases on wards with ethics rounds resulted in comparably fewer recommendations than those in wards without ethics rounds. When interpersonal conflicts were part of the problem or relatives were present in the meeting, clients less frequently asked for a recommendation.

Conclusion

From the client’s point of view, there does not seem to be only one “right” way to provide ethics consultations, but rather several. While facilitated meetings are obviously appreciated by clients, there also seem to be situations in which a recommendation is desired (especially by physicians). Further empirical and theoretical research is needed to validate our single-center results and re-evaluate the role of recommendations in ethics consultations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12910-021-00590-x.

Identification of semester-specific teaching contents for dental ethics: development, testing and validation of a questionnaire

BACKGROUND

Although medical ethics is an indispensable part of dental education, it has not played a relevant role in the dental curriculum thus far. This study is aimed at developing and validating a questionnaire that identifies semester-specific ethical issues, in order to develop longitudinal ethic modules.

METHODS

March 2018 a workshop on item generation was coordinated, using Delphi method; followed by a cognitive testing with students (2nd, 4th, 10th semesters, n = 12). A pilot test was carried out with students from different semesters (n = 60). The distribution of response frequencies and missing values were determined. The questionnaire used for validation consisted of three dimensions: ethical knowledge, dealing with ethical issues, expectations in terms of teaching. The psychometric examination was carried out by preclinical students (n = 105) and clinical semesters (n = 110) January 2019.

RESULTS

After cognitive testing and piloting, some items were reformulated, so that a questionnaire with 127 items was used for validation. The individual dimensions were assigned to various factors with excellent to acceptable internal consistency (Cronbach's α 0.72-0.96).

CONCLUSION

The questionnaire has an acceptable to excellent consistency and suggests that the different dimensions are conclusive. With this questionnaire, ethical issues in dentistry can be mapped and teaching contents identified.

[Walter Büngeler (1900-1987) : Nazi victim or political influencer in Brazil?]

Walter Büngeler is one of the best known German pathologists of the 20th century. He became internationally known for his basic research on leukaemia and the pathology of tumours. In 1936 he left Europe for Brazil but returned in 1942. After 1945, he staged himself as a political victim who had been expelled first by the National Socialists and later from Brazil. In fact, with this portrayal he succeeded in passing the denazification procedure without any damage and in continuing and considerably expanding his university career. Until the recent past, Büngeler was described in the relevant literature as a Nazi critic or victim. But does the presentation handed down by Büngeler stand up to a critical examination of the facts?On the basis of contemporary sources, the article reveals serious differences between Büngeler's statements and historical facts. It can be shown that Büngeler's allegations in denazification were incorrect in all relevant aspects.

Success or failure? Pathologists persecuted under National Socialism and their careers after emigrating to the United States

This study examines the biographies of pathologists persecuted by the National Socialists after their emigration from the German Reich to the USA. The work is based on primary sources from various archives and a systematic evaluation of secondary literature on the persons concerned. The study yields five central results: (1) Out of 118 identified persecuted pathologists, a total of 91 persons left the German Reich, 60 of them demonstrably to the USA. (2) The majority of the pathologists immigrated to the USA between 1938 and 1941. (3) A good two thirds of the pathologists were (again) employed in the USA as university teachers, the majority in the leading position of Full Professor. (4) The preferred area of employment was the East Coast of the USA. (5) The labor market situation was particularly favorable for specialized pathologists. It can be concluded that the majority of the emigrated pathologists studied succeeded in continuing or even expanding their professional careers in the USA, with existing academic networks playing a noticeable role. Pathology thus occupies a special position in the context of the migration history of persecuted physicians under National Socialism.

Alfred Gysi (1865-1957) - More than a Pioneer of Dental Prosthetics and Articulation

Alfred Gysi was one of the most influential dental scientists of the last century. He is primarily considered a pioneer of modern articulation and occlusion theory, and several of his technical developments still bear his name. But what milieu did this dentist come from, what characterized his academic career and what research contributions did he make beyond the theory of articulation? How was he perceived by contemporary experts – as a researcher and as a colleague – and how can his scientific contributions be classified from today's perspective? These are precisely the questions that this article examines. The study is based on contemporary primary sources and on Gysi's own publications. In addition, a systematic re-analysis of the available secondary literature on the life and work of Alfred Gysi and on the history of the Zurich Dental Institute was carried out. The analysis shows that Gysi had a strong influence on contemporary dental prosthodontics and contributed considerably to its scientific character, especially due to the development of articulators and face bows, which received worldwide attention. But Gysi's scientific influence was by no means limited to prosthetics. Rather, he also provided important studies on caries and the dental pulp. Moreover, he published fundamental work on dental histopathology and microphotography. The current image of Gysi therefore needs to be revised. In view of the thematic breadth of his scientific contributions, Gysi is not only the most important prosthodontist of his time, but also one of the most versatile and innovative representatives in the history of Swiss dentistry.

[Political follower or loyal National Socialist? : On the role of former DGP President Herbert Siegmund (1892-1954) in the Third Reich. German version]

BACKGROUND

Herbert Siegmund (1892-1954) was undoubtedly one of the most influential German pathologists of the 20th century. He received numerous high honors both during the Third Reich and after 1945. He was, among other things, rector of the University of Münster (1943-1945), holder of the Goethe Medal awarded by Hitler (1944), honorary doctor of the University of Cologne (1949), recipient of the Paracelsus Medal (1953), and president of the German Society for Pathology (DGP, 1954). The almost seamless post-war career was possible above all because Siegmund was counted among the politically uninvolved university physicians after 1945. It was not until after the turn of the millennium that this picture cracked.

MATERIAL AND METHODS

The article is based on primary sources from the state archives of Schleswig-Holstein and North Rhine-Westphalia, the University Archives of Münster, the Federal Archives of Berlin, the University Archives of Cologne, and the City Archives of Stuttgart, some of which were evaluated for the first time. Two questions are at the center of this article: (1) To what extent can it be proven that Siegmund benefited from the Nazi state in terms of his career after 1933? (2) Are there indications that he served the Nazi regime and its networks? In addition, we will discuss how Siegmund himself described his role in the Third Reich and whether his statements stand up to critical scrutiny.

RESULTS

The paper concludes that Siegmund contributed to valorizing the Nazi system. After 1945, he did not position himself at a critical distance from his activities in the Third Reich; rather, he drew of himself - largely unopposed - the image of a politically blameless scholar.

[Virchow medallists and honorary members of the German Society for Pathology and their relationship with National Socialism : A cross-sectional study. German version]

The present study focuses on the group of pathologists who (1) were appointed honorary members or bearers of the Rudolf Virchow Medal by the German Society for Pathology (DGP) and (2) experienced the "Third Reich" as a citizen of the "Third Reich". In particular, it examines the relationship between those distinguished persons and National Socialism, and, at the same time, the criteria of the professional society when awarding such honours. Specifically, it is important to clarify what role the DGP officials ascribed to the political stance or experience of the candidates in the Nazi dictatorship during the selection process: were there victims of the Nazis among the honourees whose repressive experiences and personal fates were intended to be acknowledged in this way? Of equal interest is the counter-question: were pathologists honoured who had made (party)political commitments to National Socialism during the "Third Reich"?A total of 9 Virchow medallists and 3 honorary members met the inclusion criteria. None of those affected belonged to the group of pathologists who suffered injustice during the "Third Reich" or who could be described as victims of the Nazis. On the other hand, 4 of the 9 German Virchow medal winners and 1 of the 3 honorary members had joined the National Socialist Party and to some extent other Nazi organisations. Obviously, previous closeness to National Socialism was not a decisive factor in the selection of honorary members and Virchow medallists and, in particular, was not an exclusion criterion.The aforementioned results correspond to the findings of a parallel study, in which the political past of the German DGP chairmen appointed up to 1986 was examined. This showed that two thirds of them had joined the National Socialist Party during the "Third Reich".

Current Practice of Neurosurgical Teleconsultation in Germany

OBJECTIVE

 As neurosurgery is a demanding specialty with services in larger medical centers only, consultation over larger distances plays an important role in health care. In times of digitalization, teleconsultation for medical images and cases plays an increasing role in neurosurgical services. However, no standards and demands have been established for its execution in the subfield of neurosurgery, so far. Therefore, as a first step, we performed a survey about the current state of teleconsultation in neurosurgery in Germany.

METHODS

 A standardized questionnaire consisting of 20 items was used to investigate the frequency of use and the operating conditions of teleconsultation in the field of neurosurgery. The survey was performed during the annual national German Society of Neurosurgery conference in 2017. Participation in the written survey was on voluntary and anonymous basis.

RESULTS

 In total, 296 individuals took part in the survey (140 specialists in neurosurgery, 77 residents). Among them, 71% were male and 121 worked at a university medical center. In total, 87.5% of all participants indicated that teleconsultation was used in their institutions (n = 113 in university medical centers and n = 76 in hospitals), and a vast majority stated to have had personal experience with it (88.6% of specialists, 85.5% of residents). The most frequent initial request for a consultation was done by phone call (80.3%). Images or data were then primarily transmitted via an electronic system (77.3%), followed by transmissions via CD or by post. The reply to a consultation was also mainly done by phone call (91.3%), followed by fax, or by e-mail. No standard protocol was followed by 78.6% of the respondents, and they stated not to know about the statutory and legal rules. However, it was stated that the protection of patient data was not endangered by using teleconsultation. The usefulness of teleconsultation and its future relevance were rated highly by the participants. The risk of misinterpretation of image data, especially without having direct access to other patient data, seemed to be a critical and unequivocal challenge.

CONCLUSION

 The results of the survey demonstrate that teleconsultation for medical images and cases is a frequently used and well-accepted tool in neurosurgical health care. However, a standardized neurosurgical procedure is still lacking and the statutory rules for this field of digital medicine are generally not known in our community. Potential misinterpretation and resulting misjudgment seem to be realistic drawbacks. Thus, we see a necessity for elaboration of guidelines for teleconsultation in neurosurgery on national and European basis.

Political follower or loyal National Socialist? : On the role of former DGP President Herbert Siegmund (1892-1954) in the Third Reich

BACKGROUND

Herbert Siegmund (1892-1954) was undoubtedly one of the most influential German pathologists of the 20th century. He received numerous high honors both during the Third Reich and after 1945. He was, among other things, rector of the University of Münster (1943-1945), holder of the Goethe Medal awarded by Hitler (1944), honorary doctor of the University of Cologne (1949), recipient of the Paracelsus Medal (1953), and president of the German Society for Pathology (DGP, 1954). The almost seamless post-war career was possible above all because Siegmund was counted among the politically uninvolved university physicians after 1945. It was not until after the turn of the millennium that this picture cracked.

MATERIAL AND METHODS

The article is based on primary sources from the State Archives of Schleswig-Holstein and North Rhine-Westphalia, the University Archives of Münster, the Federal Archives of Berlin, the University Archives of Cologne, and the City Archives of Stuttgart, some of which were evaluated for the first time. Two questions are at the center of this article: (1) To what extent can it be proven that Siegmund benefited from the Nazi state in terms of his career after 1933? (2) Are there indications that he served the Nazi regime and its networks? In addition, we will discuss how Siegmund himself described his role in the Third Reich and whether his statements stand up to critical scrutiny.

RESULTS

The paper concludes that Siegmund contributed to valorizing the Nazi system. After 1945, he did not position himself at a critical distance from his activities in the Third Reich; rather, he drew of himself - largely unopposed - the image of a politically blameless scholar.

[The pathologist and "short-term rector" Albert Dietrich (1873-1961) and his ambivalent relationship with the Nazi regime : Not Nazi enough? German version]

Throughout his professional life, the pathologist Albert Dietrich devoted himself to researching and combating cancer. Due to his considerable reputation and success, he was one of the first doctors to be awarded the Paracelsus Medal for his scientific services in 1952.However, Dietrich's role in the Third Reich was - and still is - far less defined. In May 1933, he became rector of the Eberhard Karls University in Tübingen, which at that time was one of the most Nazi-oriented universities. However, his term of office was short - by the end of 1933 he had already been replaced by the protestant theologian Karl Fezer.This article sheds light on Dietrich's ambivalent relationship to National Socialism and analyzes and discusses the background to his dismissal, his later (also politically influenced) emeritus status (1938/39), and his entry into the NSDAP, which took place at retirement age (1941). The study is based on archival sources partly evaluated for the first time and on a reanalysis of the relevant research literature.The study shows that Dietrich was targeted by individual Nazi decision-makers primarily because he advocated a supposedly "liberalist" university policy. Dietrich thus ultimately stands for a type of university lecturer who renounced a decidedly Nazi stance in public without, however, placing himself in a critical relationship to Nazi ideology. Against this background, statements from the postwar period that saw him retrospectively near Nazi opposition are to be classified as the formation of legends.

The influence of clinical experience on dental students' ethical awareness

INTRODUCTION

There has been no structured integration of ethical issues into the dental curriculum and currently no data for certain ethics modules exists in Germany. The study aimed at evaluating the attitudes to ethical issues that affect students at the Dental School in Kiel during patient treatment.

MATERIAL AND METHODS

In the summer of 2017, students were recruited from the 6th and 10th semesters. A qualitative study design with interviews was chosen. The dimensions included, for example, experience with ethical issues, definitions and expectations of teaching content and methods. A qualitative content analysis was performed.

RESULTS

Twelve and eleven students from semesters (32% each) participated. No student was able to name an ethical question based on his own experience (private/study). The need to address ethical issues was justified solely by personal treatment experiences.

DISCUSSION

The study revealed a lack of basic ethical knowledge resulting in a lack of ability to deal with ethical issues. Instead, participants described experiences of psychological pressure, feelings of helplessness.

CONCLUSION

The results suggest that ethical-theoretical foundations should be taught before the beginning of patient treatment. A didactic combination with clinical facts and case vignettes is recommended.

Ethics rounds: affecting ethics quality at all organisational levels

Clinical ethics support (CES) services are experiencing a phase of flourishing and of growing recognition. At the same time, however, the expectations regarding the acceptance and the integration of traditional CES services into clinical processes are not met. Ethics rounds as an additional instrument or as an alternative to traditional clinical ethics support strategies might have the potential to address both deficits. By implementing ethics rounds, we were able to better address the needs of the clinical sections and to develop a more comprehensive account of ethics quality in our hospital, which covers the level of decisions and actions, and also the level of systems and processes and aspects of ethical leadership.

[History of the anatomical and clinical autopsy]

The history of the autopsy is naturally also a part of the history of anatomy and pathology and spans over about 2300 years. The first documented autopsies were conducted in about 300 B.C. Thereafter, due to the prohibition of dissections due to religious, social, or hygienic reasons, a long period of stagnation took place. With the onset of the Renaissance in the 15th and 16th century, interest in the ancient sciences such as anatomy began to rise and consequently an increasing number of dissections for anatomical studies were conducted. Nevertheless, it took nearly 200 years until clinical symptoms and/or causes of disease and death were correlated with anatomical findings. In the second half of the 19th century, the clinical autopsy based on the combination of macroscopic and microscopic findings became more and more important as a precondition for the systematic description of diseases. Based on autopsy findings and together with several new techniques, modern pathology could be established at the beginning of the 20th century as a source of scientific knowledge for the clinical medicine and as a theoretical discipline of its own.

Knowledge and attitudes on electroconvulsive therapy in Germany: A web based survey

OBJECTIVE

The aim of this article is to examine knowledge and attitudes on electroconvulsive therapy (ECT) among the German population.

METHOD

A web-based population survey based on a standardized questionnaire was used to examine knowledge and attitudes towards ECT as a treatment of severe depression among the general public (sample of 1000; representative in terms of age, gender and federal states of the German population).

RESULTS

ECT is not well known and negatively connoted among the German population. A higher level of awareness and knowledge about ECT correlates with higher agreement to treatment with it. The analysis of feedback from the open question underlines the complexity of ECT: on the one hand, negative attitudes, stereotypes, and associations, and on the other hand interest, willingness, and acceptance to deal with the method were shown.

CONCLUSION

The results suggest an urgent need for more information about the basic facts, psychiatric applications, and effectiveness of ECT in order to increase the level of awareness and knowledge, and thus the method's acceptance. An increase in acceptance would expand the therapeutic spectrum for the mentally ill. Correspondingly, persons affected and their relatives as well as physicians and healthcare professionals should be involved in awareness-raising measures.

[Safety of Hyaluronic Acid in Postoperative Treatment after Penetrating Keratoplasty]

BACKGROUND

The objective of this clinical trial was to confirm the safety of phosphate-free high molecular weight hyaluronate (HYLO®-GEL) as lubricant for postoperative care after penetrating keratoplasty.

PATIENTS AND METHODS

51 eyes were followed up 6 weeks after penetrating keratoplasty under therapy with phosphate-free high molecular weight hyaluronate. Visual acuity, intraocular pressure, conjunctival hyperaemia, conjunctival chemosis, corneal fluorescein staining, corneal infiltrates, corneal endothelial-epithelial decompensation, Descemet's folds, Tyndall effect, cells in the anterior chamber and subjective assessment of lacrimation, foreign body sensation, pressure sensation, burning, mucus and itching were recorded on the first, third and fifth postoperative days and six weeks postoperatively. Tolerance was rated by the patient and the attending ophthalmologist.

RESULTS

The following objective parameters improved significantly from day 1 to week 6 in patients treated with phosphate-free high molecular weight hyaluronate: visual acuity, conjunctival hyperaemia, conjunctival chemosis, corneal fluorescein-staining, corneal endothelial-epithelial decompensation, Descemet's folds, the maximum diameter of corneal erosion, Tyndall effect and cells in the anterior chamber. In addition, there was significant improvement in the course of the following subjective complaints: lacrimation, foreign body sensation, pressure sensation and itching. In total 63 % (32/47) of the study patients reported excellent local tolerance of phosphate-free high molecular weight hyaluronate on day one postoperatively. This proportion rose to 86 % (37/43) 6 weeks postoperatively. The safety of phosphate-free high molecular weight hyaluronate was rated by the ophthalmologists as "perfect" in 92 %, as "acceptable" in 6 % and as "unacceptable" in 2 % of eyes.

CONCLUSION

Therapy with phosphate-free high molecular weight hyaluronate results in significant improvements in objective findings and subjective symptoms after penetrating keratoplasty. Tolerance was rated as "excellent" by the ophthalmologist in 92 % of patients in the early postoperative follow-up.

The German Radiological Society and the Protagonists of Radiology during the Time of National Socialism--State of Research, Explanation Attempts, Desiderata and Research Prospects

The intention of the authors is the recognition and critical analysis of efforts to study the history of the German Radiological Society during the time of National Socialism from 1933 to 1945 with the goal of determining existing desiderata and identifying the resulting research prospects. There is a need to study concrete individual biographies of radiologists (members of the German Radiological Society, perpetrators, and victims) and their careers before and after 1945 as well as the importance of the interdisciplinarity of the discipline and the lack of institutional involvement during the "Third Reich". Moreover, the comparatively difficult starting situation of the study of the history of the German Radiological Society is discussed.

Information, consent and treatment of patients with Morgellons disease: an ethical perspective

Morgellons is a medically contested diagnosis with foremost dermatological symptoms. Patients experience fibers emerging from the skin, together with a range of other somatic, psychiatric, and neurological complaints. Within the medical community, it is generally held to be a variation of delusional parasitosis/delusional infestation, which is usually treated with antipsychotics. Little attention has been paid in the literature to the ethical aspects of treating patients with Morgellons disease. The communicative strategies suggested in the literature display significant ethical issues, primarily the use of therapeutic privilege, i.e. withholding information from the patient. Since this limits patient autonomy, that approach is ethically problematic. Instead, the physician has an ethical obligation to respect the patient's autonomy, provide full information, and seek consent before initiating a psychiatric referral.

Pilot project "Patient-Safety" in Medical Education

Since the summer term 2009 the study project "Patientensicherheit - Der klinische Umgang mit Patienten- und Eingriffsverwechslungen sowie Medikationsfehlern" (Patient Safety - the clinical handling of patients - and mistaking of procedures as well as medication errors) is offered within the Modellstudiengang Medizin. Seminars on patient safety in Germany so far mainly address trained doctors and health economists. In contrast, this study project on patient safety should at an early stage contribute to a "culture of discussing and preventing mistakes" - an aspect that is little established in clinical medicine, but also in medical training. For this purpose, a broad variety of courses was developed, which - relying on problem-oriented learning - enables the students to analyse so-called adverse events (AE) and develop adequate prevention measures on the basis of the insights gained by this analysis. Therefore, theoretical lessons are complemented by discussing prototypical clinical cases. These discussions are moderated by experienced clinicians. After completing the seminar, students showed a significant increase (comparison of means) in the self-assessed qualifications "Wissen zu Patientensicherheit" (Knowledge of Patient Safety) and "Wahrnehmung von Risikosituationen" (Appreciation of Risk Situations). All in all, the students rated their training success with a grade of 1.5 (good).