Professional Medical Associations Research Articles

Unravelling Low-Value Care Decision-Making: Residents' Perspectives on the Influence of Contextual Factors.

Several initiatives have been developed to target low-value care (i.e. waste) in decision-making with varying success. As such, decision-making is a complex process and context's influence on decisions concerning low-value care is limitedly explored. Hence, a more detailed understanding of residents' decision-making is needed to reduce future low-value care. This study explores which contextual factors residents experience to influence their decision-making concerning low-value care. Methods: We employed nominal group technique to select four low-value care vignettes. Prompted by these vignettes, we conducted individual interviews with residents. We analyzed the qualitative data thematically using an inductive-deductive approach, guided by Bronfenbrenner's social-ecological framework. This framework provided guidance to 'context' in terms of sociopolitical, environmental, organizational, interpersonal, and individual levels. In 2022, we interviewed 19 residents from a Dutch university medical center. We identified 33 contextual factors influencing residents' decision-making, either encouraging or discouraging low-value care. The contextual factors resided in the following levels with corresponding categories: (1) environmental and sociopolitical: society, professional medical association, and governance; (2) organizational: facility characteristics, social infrastructure, and work infrastructure; (3) interpersonal: resident-patient, resident-supervising physician, and resident-others; and (4) individual: personal attributes and work structure. This paper describes 33 contextual factors influencing residents' decision-making concerning low-value care. Residents are particularly influenced by factors related to interactions with patients and supervisors. Furthermore, organizational factors and the broader environment set margins within which residents make decisions. While acknowledging that a multi(faceted)-intervention approach targeting all contextual factors to discourage low-value care delivery may be warranted, improving communication skills in the resident-patient dynamics to recognize and explain low-value care seems a particular point of interest over which residents can exercise an influence themselves.

Gender Inequalities that Hinder the Professional Growth of Female Doctors and Trainees

Madam, Gender inequality is defined as inequality regarding sex or gender in which one sex or gender is consistently preferred or emphasised above other. Gender disparity is thought to have existed for countless years, with women supposed to be providers at home while men anticipated as leaders with professions outside the home. (1) 
 
 Implicit biases have an adverse effect on women's careers in medicine and contribute to imposter syndrome, exhaustion, underrepresentation in leadership roles, income inequality, poorer advancement, and less favourable reviews. Gender bias in the promotion process or in the ladder for progression may be a factor for the slower development of women in academic medicine, with fewer women at each succeeding level of career promotion. Men, for example, earn more honours from professional medical associations, whereas women obtain less opportunities to talk at large conferences. According to a 2014 poll of 1066 physicians who received career advancement awards, 66% of women and about 10% of men reported personal gender bias. (1)

Scaling up integrated care: a realist evaluation on the role of country-specific policy dialogues and scale-up roadmaps in Belgium, Slovenia, and Cambodia

Background: The ‘SCale-Up of diaBetes and hYpertension care’ (SCUBY) project aims to support the scale-up of integrated care for diabetes and hypertension in Cambodia, Slovenia, and Belgium through the co-creation, implementation, and evaluation of contextualized roadmaps. These roadmaps offer avenues for action and are built on evidence as well as stakeholder engagement in policy dialogues. These two implementation strategies – roadmaps and policy dialogues – are very much intertwined and considered to be key elements for successful stakeholder supported scale-up. Yet, little is known about how, why, and under which conditions a roadmap leads to successful implementation and scale-up of integrated care. Therefore, the resulting research question is: ‘How, why, and under which context conditions does a co-created scale-up roadmap lead to adoption, implementation, and scale-up of integrated care?’.
 Methods: A realist approach is used towards testing the initial programme theory (IPT) in the three countries. The IPT draws on political science theory of the multiple streams model (MSM) adapted by Howlett and includes five streams (problem, solution, politics, process and programme) that can emerge, converge and diverge across all policy stages. To test the IPT, information from different sources was collected. Firstly, qualitative interviews were conducted with the researchers in the SCUBY country teams as well as with key stakeholders (health facility managers, policy makers, civil servants, professional medical and patient associations, NGOs, and implementers). Secondly, a document review of grey literature, meeting reports, and official documents was performed. Finally, a workshop was organised with SCUBY researchers from all country teams to refine the IPT. We used the Intervention-Context-Actors-Mechanism-Outcome (ICAMO) configuration to synthesise information into a configurational map.
 Results: In each country case, the project partner’s mandate was key in the approach to scale-up, the design, and content, leading to different mechanisms, scale-up pathways, and outcomes. In Belgium, the (scientific) solutions stream was dominant with creating common understanding as a key mechanism; in Slovenia, the programme stream became the dominant focus whilst exemplifying good practices of patient empowerment; and in Cambodia, the political stream was dominant yet closely knit together with the solutions stream – with knowledge sharing and credibility as key mechanisms. A finding across all three countries was that a lack of political support can derail or slow down scale-up.
 Discussion: This study extends the knowledge base about the use of co-creation in policy dialogues to build a roadmap for scale-up. The roadmaps illustrate how the MSM theory can be used to theorize the policy process of roadmap and policy dialogues in different contexts, aligning the context-dominant stream with the context-specific scale-up strategy. By testing theories in real cases, the theories can be adapted, refuted and/or reconstructed to elicit a refined theory of how and why a roadmap co-created in policy dialogues for scale-up works.

The Doctor in Free Movement Law: Expertise, Duty, and Accountability

Abstract This Article provides an empirical analysis of all free movement of doctors cases decided by the CJEU. The aim of the Article is twofold: to provide a ‘characterisation’ of the type of doctors who rely on free movement law, and to make a link between their reliance on free movement law and the concept of medical professionalism. In what circumstances, and with what purpose, do doctors rely on free movement law? And does their reliance on free movement law pose a risk to medical professionalism? The analysis shows that most cases before the CJEU focussed on the expertise and qualifications of doctors. Many cases were brought by groups of doctors or medical professional associations. In most cases, the aim of the doctor's reliance on free movement law was to defend medical professionalism. Nevertheless, some recent cases show that doctors do rely on free movement law to restrict their accountability towards patients or national healthcare systems. Moreover, these cases show that arguments based on free movement law are relied on in a broader range of non-specialised courts or tribunals. This makes it important that national courts continue to engage in a dialogue with the CJEU.

Identifying therapeutic alternatives in Medicare drug price negotiation: The case of etanercept.

As the Centers for Medicare & Medicaid Services (CMS) navigates the process of negotiating drug prices, it plans to compare the cost, safety, and effectiveness of each drug with its therapeutic alternatives. How CMS selects therapeutic alternatives is a consequential decision, and there remains uncertainty about their methodology. To understand the challenges CMS will face in selecting therapeutic alternatives, we developed a methodology that leverages clinical guidelines by US medical professional associations to identify potential therapeutic alternatives for etanercept, one of the first 10 drugs selected for Medicare price negotiation. For each of etanercept's 5 US Food and Drug Administration-approved indications, we identified all drugs with the same mechanism of action as etanercept and considered drugs with different mechanisms if they were recommended in place of etanercept at the same treatment stage, or if there was no strong comparative safety or effectiveness evidence that the drug differed from etanercept. We identified 22 potential therapeutic alternatives to etanercept, including 4 drugs with the same mechanism, 10 biologics with different mechanisms, and 8 small-molecule drugs. We faced several challenges in selecting therapeutic alternatives using clinical guidelines, such as how to reconcile strong recommendations that were based on weak evidence and how to consider combination therapies. This exercise demonstrates the complex considerations that CMS will face as it negotiates drug prices based on therapies' cost, safety, and effectiveness relative to therapeutic alternatives.

A Clinical Audit: Assessing the Diagnostic Delay of Primary Brain Tumors, Glioblastoma IDH-Wild Type and Primary CNS Lymphoma; Exploring the Use of CSF Liquid Biopsy

Background: Diagnostic delay is a critical issue in healthcare, often leading to delayed treatment and poor patient outcomes. Diagnostic errors contribute to about 10% of patient deaths annually. Delays are very prevalent in Glioblastoma and Primary CNS Lymphoma. Both have an aggressive nature and a short survival rate, which urges for early diagnosis to ensue treatment as quick as possible. The delayed diagnosis can be attributed to tumor-specific factors such as challenging differential diagnoses, inadequate methods in achieving optimal outcomes, and the presence of confounding factors like steroid usage. Aims and Objectives: The objective of this clinical audit is to analyse patient records within an oncology unit. The primary goal is to assess the quality of practice by evaluating the standards of diagnosis and treatment. Additionally, the audit aims to pinpoint areas that require improvement at every stage of patient management, encompassing administration, symptom evaluation, and post-therapeutic measures. Based on these findings, a comprehensive plan of action will be proposed to address the identified issues effectively. Standards and Methods: In this Clinical Audit, we assessed the adherence of 10 Glioblastoma and PCNSL patients in a neuro oncology unit, to standards and guidelines set by professional medical associations. Which include World Health Organisation (WHO), National Health Service England (NHS), and European Association of Neuro-oncology (EANO). Results: Our cohort showed long diagnostic delays, minimum and maximum values of 30 and 1825 days. The sample did not show significantly longer delays compared to other PCNSL or HGG patients, all collected from the literature, with p values of 0.174 and 0.637, respectively. Conclusions: In Conclusion, Diagnostic Delay attributed to PCNSL and Glioblastoma can be pinpointed to the inadequacy of existing standards in relying solely on stereotactic biopsies for definite diagnosis when it may not be ideal for all patients at all tumor stages. A plan of action encouraging large clinical trials of CSF Liquid Biopsy is recommended with an employment of recent advances and focusing on detecting circular tumor DNA for the diagnostic insight it provides. As well as exploring its use during or post therapy to monitor the lesion and pathology. To also adhere strictly to the discouragement of steroid use for the negative prognostic factors it causes.

Menstrual health matters. Period

Menstrual health is composed of physical and psychosocial factors and fundamental to the well-being of menstruating individuals. Clinicians are urged to assess markers of menstruation as a vital sign, informing potential current and future health risks. Period poverty, or lack of access to menstrual hygiene products, sanitation, and clinical support, is a concern worldwide, particularly for vulnerable populations. As global health authorities and professional medical associations call for menstrual health as a priority, pharmacists are well-positioned to contribute solutions through access, education, advocacy, and research.

Pharmacy Benefit Managers in the Eye of the Storm: Growing Multipartite Scrutiny.

The high cost of prescription drugs in the U.S. remains an ongoing national challenge. A recurring focal point in discussions over this distressing steady state is the role(s) played by Pharmacy Benefit Managers (PBMs) who negotiate drug prices with pharmaceutical manufacturers, conduct drug utilization reviews, engage in disease management, and see to formulary creation. At their inception, the multiple newly established PBMs were arguably intent on constraining the rise of prescription drug prices. At the time of this writing, however, the lion share of a far less competitive PBM market is controlled by CVS Caremark, Express Scripts, and OptumRx. It is this evolving reality which could be interpreted to mean that the PBMs may have become part of the problem, rather than part of the solution. Expanded scrutiny of the PBMs by Federal and State authorities as well as by Professional Medical Associations must not be delayed with an eye toward affording the public with relief from the high cost of prescription drugs.

LEGALITAS ORGANISASI BARU DI LUAR WADAH TUNGGAL ORGANISASI PROFESI DOKTER DI INDONESIA DALAM TINJAUAN YURIDIS

The Association of Indonesian Doctors has been formed and declared in a Decree of the Ministry of Law and Human Rights, Number AHU-003638.AH.01.07.2022. The Indonesian Doctors Association is no longer the sole forum for medical organizations in Indonesia. The study of the legality of this new association and the study of the organization of the Indonesian Doctors' Association have violated the right to associate and human rights because it is the sole forum for the medical professional organization which is the focus of the problem raised by the author. The study uses a normative juridical approach to seek answers with certainty and legal certainty through existing legal theories, norms and legislation. The conclusions obtained are that in order to protect patients, improve service quality, and ensure legal and statutory certainty, the medical professional association or organization must be one. Determination of quality and service, competency standards, and professional ethics must come from a professional organization. With a noble purpose, a single professional organization does not violate the law on association and human rights. The presence of a new medical society organization will not interfere with the position of the Indonesian Doctors Association as a professional organization. The suggestion from this study is that new organizations such as the Association of Indonesian Doctors must synergize and become the task force for the Indonesian Doctors Association in controlling the running of the organization while simultaneously providing a driving force for services to the Indonesian people.
 
 Key words: Professional organizations; Constitution; Medical practice

Cruel and Unusual: Reforming Carceral Systems to Protect and Affirm Transgender and Gender-Diverse Communities.

Transgender and gender-diverse communities are disproportionately incarcerated in the USA. Incarcerated gender minority populations are detained within carceral systems constructed around a cisgender (gender identity matches sex assigned at birth) binary (only male and female identities recognized) understanding of gender. This leads to marginalizing experiences while perpetuating the extreme vulnerability individuals experience in the community. In order to address this cruel and unusual experience, carceral systems should undergo "whole-setting" reforms to protect and affirm transgender and gender-diverse populations. This includes ensuring access to gender-affirming clinical care that aligns with community health standards recommended by medical professional associations. Implementing gender-affirming reforms reduces security issues and will likely improve health outcomes providing mutual benefit for both correctional staff and gender minority populations. Given the current divisive political and social environment for gender minority populations in the USA, evidence-based person-centered reforms in corrections are needed now more than ever.

Training on Corrections and Health Within U.S. Academic Health Professions Education: A Scoping Review.

Despite the scale, inequity, and consequences of mass incarceration, health care provider knowledge and awareness on correctional health remain limited. Understanding the educational experiences of health professions learners and the studies used to evaluate them can provide useful information about current gaps to guide future curricular improvement. To address this need, we conducted a scoping review of peer-reviewed studies examining United States-based academic health professions educational programs on correctional health. Studies were coded based on study characteristics, learner outcomes, and degree to which they contained elements described in relevant position statements by two professional medical associations. Overall, 27 articles (1975-2021) were included. Learner outcomes were primarily documented at the "reactions" (93%) and "learning" (52%) levels of the Kirkpatrick model (1979), relative to "behaviors" (11%) and "long-term outcomes" (0%). Comparison of curricula to select position statements revealed multiple content gaps in the realms of prevalent conditions requiring expertise (e.g., violence and self-harm); ethical and medical-legal considerations (e.g., privatization of correctional health care); and correctional health care systems, structures, and administration. Taken together, findings highlight gaps in, and opportunities for, correctional health educational programs. Addressing health care workforce training needs is a necessary yet insufficient step to achieving health equity for populations affected by incarceration.

International EANM-SNMMI-ISMRM consensus recommendation for PET/MRI in oncology

PreambleThe Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and professional organization founded in 1954 to promote the science, technology, and practical application of nuclear medicine. The European Association of Nuclear Medicine (EANM) is a professional non-profit medical association that facilitates communication worldwide between individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985. The merged International Society for Magnetic Resonance in Medicine (ISMRM) is an international, nonprofit, scientific association whose purpose is to promote communication, research, development, and applications in the field of magnetic resonance in medicine and biology and other related topics and to develop and provide channels and facilities for continuing education in the field.The ISMRM was founded in 1994 through the merger of the Society of Magnetic Resonance in Medicine and the Society of Magnetic Resonance Imaging. SNMMI, ISMRM, and EANM members are physicians, technologists, and scientists specializing in the research and practice of nuclear medicine and/or magnetic resonance imaging.The SNMMI, ISMRM, and EANM will periodically define new guidelines for nuclear medicine practice to help advance the science of nuclear medicine and/or magnetic resonance imaging and to improve the quality of service to patients throughout the world. Existing practice guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each practice guideline, representing a policy statement by the SNMMI/EANM/ISMRM, has undergone a thorough consensus process in which it has been subjected to extensive review. The SNMMI, ISMRM, and EANM recognize that the safe and effective use of diagnostic nuclear medicine imaging and magnetic resonance imaging requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guideline by those entities not providing these services is not authorized.These guidelines are an educational tool designed to assist practitioners in providing appropriate care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, the SNMMI, the ISMRM, and the EANM caution against the use of these guidelines in litigation in which the clinical decisions of a practitioner are called into question.The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by the physician or medical physicist in light of all the circumstances presented. Thus, there is no implication that an approach differing from the guidelines, standing alone, is below the standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the guidelines when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology subsequent to publication of the guidelines.The practice of medicine includes both the art and the science of the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment.Therefore, it should be recognized that adherence to these guidelines will not ensure an accurate diagnosis or a successful outcome. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources, and the needs of the patient to deliver effective and safe medical care. The sole purpose of these guidelines is to assist practitioners in achieving this objective.

The Rule of Rescue in the Era of Precision Medicine, HLA Eplet Matching, and Organ Allocation

Precision medicine can put clinicians in a position where they must act more as resource allocators than their traditional role as patient advocates. In the allocation of transplantable organs and tissues, the use of eplet matching will enhance precision medicine but, in doing so, generate a tension with the present reliance on rule of rescue and justice-based factors for allocations. Matching donor and recipient human leukocyte antigens (HLA) is shown to benefit virtually all types of solid organ transplants yet, until recently, HLA-matching has not been practical and was shown to contribute to ethnic/racial disparities in organ allocation. Recent advances using eplets from the HLA molecule has renewed the promise of such matching for predicting patient outcomes. The rule of rescue in organ allocation reflects a combination of ethical, policy, and legal imperatives. However, the rule of rescue can impede the allocation strategies adopted by professional medical associations and the optimal use of scarce transplant resources. While eplet-matching seeks to improve outcomes, it may potentially frustrate current ethics-motivated initiatives, established patient-practitioner relationships, and functional conventions in the allocation of medical resources such as organ and tissue transplants. Eplet-matching allocation schemes need to be carefully and collaboratively designed with clear, fair and equitable guidelines that complement functional conventions and maintain public trust.

Искусственный интеллект и нейронные сети в урологии.

Introduction. The review is devoted to the analysis of the world experience in the use of artificial intelligence in medicine and urology. Materials and methods. The review was conducted on the basis of data published in the PubMed, Scientific Electronic Library eLibrary.ru databases and on the professional medical associations websites. The article contains 43 scientific publications. Results. In this literature review, the types of neural networks and the features of their application are considered in detail. Special attention is paid to the use of artificial intelligence in medical imaging, particularly in urology. Effectiveness and accuracy of developing the connectionism method application in artificial neural network (ANN) in recent publications are presented. Advantages and disadvantages of artificial intelligence for a predictive model are outlined. We also considered the main mistakes displayed in publications regarding unreliable or poorly created neural networks and studies in the use of ANNs for clinical practice. Conclusion. The use of neural networks as a tool in the daily clinical practice of a specialist is still limited. The main problems are still the unreliability of the created models and lack of easy-to-use algorithms.

Work Experience in Providing Psychological Assistance to Medical Facility Staff During the Covid-19 Pandemic

The text of the report presented at the Conference of the Professional Medical Association of Psychotherapists, Psychologists and Social Workers by Anastasia Borodkina, in which she talks about her experience of psychological support for medical workers who had undergone Covid-19.

SAGES perspective: professional medical associations, commercial interests, and conflicts of interest

Professional medical associations (PMAs) have an essential role in advancing medical care and health. PMAs promote skills training, clinical standards, and other important educational activities. Most often, PMAs are not-for-profit entities that rely upon funding from industry to help cover the costs of these valuable activities. Equally important, innovation and progress in surgery require physician collaboration with industry throughout the product development process. SAGES has opined that, with appropriate Conflict of Interest (COI) disclosure and management processes, PMA educational activities can be both scientifically and ethically sound. SAGES has developed and implemented comprehensive and stringent processes for managing potential COI within the organization, at the annual meeting, and in developing educational offerings. This document reviews the SAGES COI processes and results 2009-2021. Implementation of the SAGES COI disclosure and management processes reduced the reported perceived incidence of bias at the annual meeting from 4.4-6.2% (2008-2010) to 1.2-2.2% (2011-2013). Recent comparison of reported disclosures revealed a rise in number of speakers with financial relationships and an increase in reporting of disclosures in presentations without an associated increase in need for conflict resolution by the COI committee. Despite good overall adherence to COI policies, SAGES was recently cited for non-compliance with ACCME standards related to inclusion of faculty with ownership interest. This experience highlighted the potential for discordance in the interpretation of whether disclosures relate to specific CME content. SAGES COI processes have since been updated to reflect the more stringent 2020 ACCME Standards that exclude speakers and planners with ownership interest from any CME activity. The SAGES experience with disclosure and mitigation of financial relationships highlights the challenges of validating the accuracy of physician disclosures and establishing the relevance of financial relationships to the content of accredited educational activities. SAGES will continue to streamline its COI disclosure process with specific focus on aligning all financial disclosures among the various reporting platforms.

Veterinarians show resilience during COVID-19: challenges faced and successful coping strategies.

To identify challenges veterinarians faced during the COVID-19 pandemic, explore how they coped, identify coping strategies associated with greater resilience, and determine incentives and barriers to performing healthy coping behaviors. 266 surveys completed by veterinarians in the Potomac region. A cross-sectional survey was distributed electronically through veterinary medical boards and professional associations between June and September 2021. Most survey responses came from veterinarians working in Maryland (128/266 [48%]) and Virginia (63/266 [24%]) who were predominantly white (186/266 [70%]), female (162/266 [61%]), and working in small-animal clinical practice (185/266 [70%]). The greatest workplace challenges experienced were increased workloads (195/266 [73%]) and reevaluating existing workflows (189/266 [71%]). Separation from loved ones (161/266 [61%]) was the greatest personal challenge. Of the veterinarians who completed the 10-point Connor-Davidson Resilience Scale (n = 219), which measures resilience on a scale from 0 (no resilience) to 40 (greatest resilience), the mean score was 29.6 (SD, 6.9), with a median of 30 (IQR = 10). Intrinsic factors most strongly associated with greater resilience were increasing age (P = .01) and later career stage (P = .002). Job satisfaction, autonomy, good work-life balance, and approach-focused coping strategies were positively associated with resilience. Overwhelmingly, the primary reported barrier to performing healthy coping behaviors was limited time to devote to self-care (177/266 [67%]). A combination of individual approach-focused coping strategies and organizational interventions are crucial to support a resilient veterinary workforce.

Opportunities and barriers for prehospital emergency medical services research in the Netherlands; results of a mixed-methods consensus study

IntroductionQuality improvement in prehospital emergency medical services (EMS) can only be achieved by high-quality research and critical appraisal of current practices. This study examines current opportunities and barriers in EMS research in the Netherlands.MethodsThis mixed-methods consensus study consisted of three phases. The first phase consisted of semi-structured interviews with relevant stakeholders. Thematic analysis of qualitative data derived from these interviews was used to identify main themes, which were subsequently discussed in several online focus groups in the second phase. Output from these discussions was used to shape statements for an online Delphi consensus study among relevant stakeholders in EMS research. Consensus was met if 80% of respondents agreed or disagreed on a particular statement.ResultsForty-nine stakeholders participated in the study; qualitative thematic analysis of the interviews and focus group discussions identified four main themes: (1) data registration and data sharing, (2) laws and regulations, (3) financial aspects and funding, and (4) organization and culture. Qualitative data from the first two phases of the study were used to construct 33 statements for an online Delphi study. Consensus was reached on 21 (64%) statements. Eleven (52%) of these statements pertained to the storage and use of EMS patient data.ConclusionBarriers for prehospital EMS research in the Netherlands include issues regarding the use of patient data, privacy and legislation, funding and research culture in EMS organizations. Opportunities to increase scientific productivity in EMS research include the development of a national strategy for EMS data and the incorporation of EMS topics in research agendas of national medical professional associations.

Age-based triage and human rights

The article provides the first comprehensive assessment of age-based triage from the perspective of human rights. Triage, that is the sorting of patients into categories of priority of treatment, has been known for decades. It has however got larger prominence during the Covid-19 crisis. The crisis has exposed healthcare systems in many countries to a critical shortage of resources, forcing them to consider resorting to triage. The absence of legal rules has been compensated by non-binding triage guidelines, adopted by professional medical and ethical associations. This article analyses 11 guidelines, showing that none of them is truly age neutral. Some use allocation criteria that entail disparate treatment of older persons, consisting of their de-prioritization or exclusion from access to life-saving treatment on account of their age. Others rely on allocation criteria whose application has disparate effects on older persons. The article argues that whereas the latter approach could be compatible with human rights standards, the former entails violations of the principle of non-discrimination and of several other human rights (the right to life, the prohibition of inhuman and degrading treatment, the right to private life, and the right to health).

Handlungsempfehlungen für SARS-CoV-2-Testkonzepte für asymptomatische Beschäftigte im Gesundheitswesen

ZusammenfassungHintergrund und ZielsetzungBei der Umsetzung von SARS-CoV‑2-Testkonzepten in Einrichtungen des Gesundheitswesens kommen ranggleiche Gesetze und Verordnungen zur Anwendung. Vor dem Hintergrund erlebter Hindernisse bei einer adäquaten Umsetzung gesetzlicher Vorgaben in regelkonforme und rechtssichere Prozesse auf betrieblicher Ebene war das Ziel der vorliegenden Arbeit, dafür konkrete Handlungsempfehlungen zu entwickeln.MethodikIn einer Fokusgruppe mit Vertreter*innen aus Behörden, Fachschaften und Interessenvertretungen wurden auf Basis von Leitfragen aus zuvor identifizierten Handlungsfeldern in einem holistischen Ansatz kritische Aspekte der Umsetzung diskutiert. Die transkribierten Inhalte wurden anhand deduktiv-induktiver Kategorienbildung qualitativ analysiert.ErgebnisseAlle Diskussionsinhalte konnten den identifizierten Kategorien Gesetzliche Hintergründe von, Anforderungen an und Zielrichtungen für Testkonzepte in Gesundheitseinrichtungen, Zuständigkeiten für Umsetzung in betrieblichen Entscheidungsketten sowie Implementierung von SARS-CoV-2-Testkonzepten/Testprozessen zugeordnet werden.ImplikationenDie Umsetzung gesetzlicher Vorgaben in regelkonforme und rechtssichere SARS-CoV-2-Testkonzepte in Einrichtungen des Gesundheitswesens setzt bereits sowohl die Einbeziehung von Ministerien, Fachschaftsvertretungen, Berufsverbänden, Arbeitgeber(AG)- und Arbeitnehmer*innenvertretungen, Datenschutzexpert*innen, Vertretungen möglicher Kostenträger als auch eine integrative und vollzugstaugliche Formulierung von Gesetzen und Verordnungen voraus. Die Definition von Zielrichtungen für Testkonzepte ist maßgeblich für nachfolgend im Betrieb etablierte Prozessabläufe, bei denen Aspekte des Beschäftigtendatenschutzes genauso berücksichtigt werden müssen wie die Bereitstellung zusätzlicher personeller Ressourcen für die Bewältigung der Aufgaben. Zudem muss es in Zukunft ein zentrales Anliegen der Betriebe sein, IT-Schnittstellenlösungen für eine datenschutzkonforme Informationsweitergabe zu Beschäftigten zu finden.