„Symptomchecker“ und studentische „Checks“ Ergebnisevaluation von diagnostischen und Triage- Assessments medizinischer Diagnoseprogramme und Medizinstudierender

Hintergrund: Im digitalen Zeitalter suchen immer mehr Patienten medizinische Informationen im Internet. Neu sind in diesem Rahmen so genannte Symptomchecker, die nach der Angabe von Symptomen Verdachtsdiagnosen stellen und Dringlichkeitseinschätzungen abgeben. Sie richten sich an Patienten und übernehmen somit ärztliche Aufgaben. Durch ihre Funktionen ergeben sich mögliche Vorteile, wie das Einsparen von Ressourcen bei nicht behandlungsbedürftigen Beschwerden oder eine telemedizinische Versorgung in strukturschwachen Regionen. Fehleinschätzungen und Fehldiagnosen durch die Symptomchecker könnten jedoch auch zu einer Überbelastung von Notaufnahmen führen und bergen Risiken, wie das Nichterkennen ernster Krankheitszustände und Notfälle. Zielsetzung: Ziel der vorliegenden Studie war die Evaluation der Leistungsfähigkeit der Symptomchecker bezüglich Diagnose und Triage, um in der Folge ihren potenziellen Nutzen einschätzen und ihn mit der Fähigkeit von menschlichem Personal vergleichen zu können. Methode: Diese monozentrisch prospektive Studie wurde im Rahmen der AG Lehre der Abteilung Allgemein-, Viszeral- und Tumorchirurgie des Universitätsklinikums Köln durchgeführt. Im Rahmen dieser Untersuchung wurden 143 Medizinstudierende des klinischen Studienabschnitts sowie 16 Symptomchecker getestet. Deren Leistungsfähigkeit in Diagnosestellung und Triage wurde anhand standardisierter allgemeinmedizinischer Fallvignetten (n=49) unterschiedlicher Dringlichkeit ermittelt. Dazu wurden diese in die Benutzeroberflächen der Symptomchecker eingegeben. Im Falle der Studierenden wurde die Bearbeitung der Vignetten in Textform und mit Hilfe eines Chat-gestützten Anamnesegesprächs via der Nachrichtenfunktion des Messengers Skype durchgeführt. Ergebnisse: Die Symptomchecker nannten in durchschnittlich 38.02% der Fallbearbeitungen die richtige Diagnose an erster Stelle und in 56.44% innerhalb der ersten drei Verdachtsdiagnosen. Im Gegensatz dazu waren es bei den Studierenden (in Textfallbearbeitung) 64.10% präzise Diagnosen und 80.19% noch korrekte Differentialdiagnosen. Neben dieser signifikant besseren Leistung in der Diagnosestellung übertrafen die Studierenden die Symptomchecker auch in der Triage, wobei hier der Unterschied nur bei den Fällen höchster Dringlichkeit signifikant war. In der Untersuchung zeigte sich eine hohe Varianz der verschiedenen Symptomchecker, sodass einige Angebote in ihrer Leistung den Studierenden nahekamen. Schlussfolgerung: Symptomchecker erreichen zu diesem Zeitpunkt noch nicht die Leistung von Menschen mit medizinischem Basiswissen in Bezug auf Diagnosestellung und Triage, sodass nur einzelne Angebote potenzielle Vorteile in der Gesundheitsversorgung bringen könnten. Die Entwicklung der Symptomchecker sollte in der Zukunft durch interdisziplinäre Forschung kritisch begleitet werden

Cruel (im)mobilities and the nearly utopian intimacies of Italian migrants’ personal relationships

Most research on visits focuses on (semi)successful connections that equate valued intimacy to adaptation to transnational life and ethno-national kin obligations. In contrast, we highlight important migrant relationships where adaptation is minimal and contact diminishes, yet they also take on heightened affective intensity. Drawing from a multi-sited ethnography that includes migrants and friends and family, we examine the affective and ethical dimensions of visits and ICTs (information and communications technology) within the personal relationships of highly skilled Italian migrants in London. Deploying the concepts cruel optimism and polyrhythmia, the paper examines how contrasting rhythms of visits and ICTs provoke reflections and feelings on whether intimacies at a distance are ‘real’. Despite difficulties, informants suggest intimacies ‘feel normal’, imbuing relations with hope for their authenticity that grounds relations in a state of mobile impasse: where feelings of normalcy lead to less interest in recreating connections yet also constructs hope that sustains visits and digital connections

Rethinking Visiting Friends and Relatives Mobilities

The increasing number of people leading more mobile lives, with spatially dispersed families, raises questions over how they maintain their family life and friendships, and how this is shaped and shapes different forms of migration, and different patterns of Visiting Friends and Relatives (VFR). This paper develops an explanatory framework for conceptualizing and analyzing VFR mobilities, seeking to draw together threads from migration, mobilities and tourism studies. In unpacking the notion of VFR, this paper understands VFR mobilities as being constituted of diverse practices, and discusses five of the most important of these: social relationships, the provision of care, affirmations of identities and roots, maintenance of territorial rights, and leisure tourism. While these five types of practices are considered sequentially in this paper, they are in practice often blurred and overlapping. The interweaving of these practices changes over time, as does the meaning and content of individual practices, reflecting changes in the duration of migration, life cycle stage, individual goals and values, and the broader sets of relationships with and social obligations to different kin and friends

Mobility and Bounding the Traveling Imagination: A Cultural Analysis of Visiting Friends and Relatives Tourism

Tourism can be a difficult form of travel to define. In order to make working with tourism easier, the tourism industry often uses criteria and definitions that can limit understandings of tourism. An example is an often-common view in the tourism industry of visiting friends and relative (VFR) as unimportant. The purpose of this thesis is to offer research showing why VFR can be important to the tourism industry. This thesis presents a research project that uses ethnography and cultural analysis to study the visits of friends and family of foreign-born residents in the city Malmö. The focus is on how residents and visitors attempt to articulate questions such as, are visits tourism trips or family and friends get togethers? How does one present Malmö to friends and family so they feel welcome, and hopefully comeback? By focusing on mobility, the cultural processes that guide answers to these questions are revealed. The research demonstrates that during visits lines between tourism and migration and tourist and local are blurred. Residents and visitors, guided by rules of hospitality, switch between roles of host and guests as they co-create complex place experiences that draw on aspects of daily life and tourism and migration. These experiences are explained as residents and visitors attempting to construct a new sense of place based on mobility. The research also demonstrates insight into what consumers can value as tourists as well making the case that the tourism industry can benefit by working with different forms of mobility

Reimagining transnational relations: the embodied politics of visiting friends and relatives mobilities

Migrant populations are often viewed in terms of alterity despite being settled members of communities. The image of migrants in many western contexts is one of being poor or ethnically and religiously different. This image in turn often frames migrants as being non-local. However, in reality, the local is not perceived and constructed through predetermined or essentialist subjectivity but through processes of constructing and negotiating borders of identity and place that incite people to shift between subject positions of local/visitor, host/guest, or tourist/migrant. This paper problematises the rigidity of social positions that underpin images of migrant populations as the other by examining the visiting friends and relatives (or VFR) practices of migrant residents in Malmo, Sweden. Whereas many studies of VFR build on a tourism-migration dialectic and focus on migrants, this study uses mobility politics as an analytical lens to examine both migrant residents and their friends and family. This focus sheds light on how family and friend's mobility politics are connected to the perception and construction of the local, local selves, and others. The research findings demonstrate that migrant residents are not the other but are an embedded part of the city regularly attracting visitors to the area. Furthermore, during visits, lines between host and guest, migrant and tourist, and visitor and local are blurred. Residents and visitors, guided by the rules of hospitality, attribute new embodied meanings to tourist and migrant mobilities that strengthen and bound the imaginations of residents and visitors to transnational networks. The conclusions from the study also help shed light on migrant integration and potential avenues for working with integration in the future

Imaginations, desires and fantasies of togetherness : the negotiation of relationships through digital visiting friends and relatives mobilities.

While research into different forms of migrant co-presence has grown across mobilities, tourism and migration studies, conceptualization of the social relations underpinning co-presence has been underdeveloped. While the literature thus far has been significant, because analysis has been somewhat over-determined by binary thinking of tradition versus loss, and grounded in difference, conceptualization has been rather de-attached from the everyday lives of informants. Physical and digital VFR (visiting friends and relatives) have been viewed through a continuum – on one side there is a rosy, unshaken view of the social that has privileged ethnic norms and analytical separations of kinship and friendship and moral and market relations. On the other, more pessimistic side, the social is equated to high reflexivity, individualization and market influence, resulting in the dissolution of traditional kin and kith obligations and reinforcing analytical divisions of co-presence as divided between a consumer oriented affluent north and un-reflexive ethnic south. The middle ground, while highly adept, nonetheless offers a sort of cheery pessimism that tends to implicitly confirm individualization while also suggesting informants partly succumb to normative principles. This thesis moves away from the moral and instead focuses on the relational ethics of digital and physical co-presence within the trans-local personal communities of highly skilled Italian migrants in London. This thesis employs a multi-sited ethnography, drawing from 41 interviews carried out with migrants in London and with their friends and family abroad. The thesis finds informants are not necessarily guided by unconscious ethno-national normativity or seeking to destroy tradition but that migration and tourism are modes of care for the self used to re-imagine selves and socialites within intersecting life course moments that fosters situated forms of obligation. With some relationships, co-presence is driven by a fantasy of wholeness, a shared imagined and affective optimism for solid intimacy that drives the trans-local co-development of life-projects, leading to a common sense of belonging articulated through co-embodied rhythms of ICTs and VFR. With other relationships, the fantasy turns to cruel optimism - rhythms of ICTs and VFR simultaneously construct hope for solid intimacy while continually highlighting divergent life courses and developing a sense of un-belonging. Lastly, the thesis equates responsibility to temperature, as a by-product of friction, to help highlight how the production and management of friction is crucial to understanding the ontological politics and relational ethics that heats and sustains some relations while cooling others. The study demonstrates that globalization and mobility do not simply concern outside forces articulating various degrees of stability and loss to ethno-national tradition but that social and cultural change are also generated from the inter-subjective imaginations, fantasies and desires of individual migrant/non-migrant subjects attempting to re-envision togetherness within particular life course moments

Imaginations, desires and fantasies of togetherness : the negotiation of relationships through digital visiting friends and relatives mobilities.

While research into different forms of migrant co-presence has grown across mobilities, tourism and migration studies, conceptualization of the social relations underpinning co-presence has been underdeveloped. While the literature thus far has been significant, because analysis has been somewhat over-determined by binary thinking of tradition versus loss, and grounded in difference, conceptualization has been rather de-attached from the everyday lives of informants. Physical and digital VFR (visiting friends and relatives) have been viewed through a continuum – on one side there is a rosy, unshaken view of the social that has privileged ethnic norms and analytical separations of kinship and friendship and moral and market relations. On the other, more pessimistic side, the social is equated to high reflexivity, individualization and market influence, resulting in the dissolution of traditional kin and kith obligations and reinforcing analytical divisions of co-presence as divided between a consumer oriented affluent north and un-reflexive ethnic south. The middle ground, while highly adept, nonetheless offers a sort of cheery pessimism that tends to implicitly confirm individualization while also suggesting informants partly succumb to normative principles. This thesis moves away from the moral and instead focuses on the relational ethics of digital and physical co-presence within the trans-local personal communities of highly skilled Italian migrants in London. This thesis employs a multi-sited ethnography, drawing from 41 interviews carried out with migrants in London and with their friends and family abroad. The thesis finds informants are not necessarily guided by unconscious ethno-national normativity or seeking to destroy tradition but that migration and tourism are modes of care for the self used to re-imagine selves and socialites within intersecting life course moments that fosters situated forms of obligation. With some relationships, co-presence is driven by a fantasy of wholeness, a shared imagined and affective optimism for solid intimacy that drives the trans-local co-development of life-projects, leading to a common sense of belonging articulated through co-embodied rhythms of ICTs and VFR. With other relationships, the fantasy turns to cruel optimism - rhythms of ICTs and VFR simultaneously construct hope for solid intimacy while continually highlighting divergent life courses and developing a sense of un-belonging. Lastly, the thesis equates responsibility to temperature, as a by-product of friction, to help highlight how the production and management of friction is crucial to understanding the ontological politics and relational ethics that heats and sustains some relations while cooling others. The study demonstrates that globalization and mobility do not simply concern outside forces articulating various degrees of stability and loss to ethno-national tradition but that social and cultural change are also generated from the inter-subjective imaginations, fantasies and desires of individual migrant/non-migrant subjects attempting to re-envision togetherness within particular life course moments

Die höchste Zierde Teutsch-Landes und Vortrefflichkeit des Teutschen Adels : vorgestellt in der Reichs-Freyen Rheinischen Ritterschafft ... Stamm-Taffeln und Wapen ...

durch ... Georg Helwig ... zusammen getragen. Vermehrt und ... biß auff jetzige Zeit fortgeführt und in diese Stamm-Taffeln verfasset durch Johann Maximilian Humbracht, ...In Fraktur. - Vorlageform des Erscheinungsvermerks: Franckfurt am Mayn / In Verlag von Friedrich Knoch / Buchhändlern. Anno M. DCC. VII