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Bypass operation at the beating heart in comparison to the operation with support of the heart-lung machineThe coronary Bypass operation at the beating heart ("off-pump surgery") is a new procedure which promises advantages in comparison to the established procedure with uses a heart-lung machine ("on-pump-surgery"). In the presented HTA report cardiac surgery the question is investigated, whether there are advantages of the off-pump-surgery in comparison to the on-pump-surgery regarding medical effectiveness, safety as well as cost effectiveness.At the beginning a systematic literature search was done, the articles were classified according to the hierarchy of evidence. There are partly considerable different groups of patients included in the different studies as well as quite different outcome parameters. The quality of the studies in detail, where at least two groups are compared was generally very good. The studies results show more or less equivalent results in the comparison of the two operation techniques. Concluding neither a clinical superiority nor an inferiority on the basis of the present available studies can therefore be proven (off-pump Coronary Artery Bypass; OPCAB) or the conventional bypass operation with use of the heart-lung machine (Coronary Artery Bypass Graft; CABG can). The diagnostic criteria of a patient who is allocated to the one or other operating technique are important. Due to technical reasons the majority of patients with the necessity of a bypass operation con only be treated by CABG, (on-pump-surgery). These criteria for the allocation of operation techniques should be the important components of optimization considerations.
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Cold Heart, Warm Heart : On fiction, interaction, and emotion in medical educationFiction is used for educational purposes in various fields such as engineering, law and higher education. In medical education, the theories of medical humanities and narrative medicine propose that engaging with fictional works can provide opportunities for medical students and physicians to develop central professional skills such as emotional awareness and empathy, which can help mitigate the documented empathy decline which occurs during medical training. Despite extensive research about fiction inclusion in medical education, there is very limited research on the insitu processes of fiction use, and how emotional aspects of the medical profession can be conceptualized in fiction discussions. This thesis investigates the intersection of fiction, interaction and emotion in medical education. The purpose of the study is to contribute knowledge on the ways emotion can be constructed in medical education as affective stances and as professional emotions that medical students need to learn how to manage. Discursive psychology (DP) forms the theoretical and methodological framework to analyse 58 hours of videoand audiorecorded fiction seminars from two Swedish medical schools. Emotion from a DP perspective is understood not as a reflection of an inner experience, but as an interactionally achieved phenomenon, deployed in the formation of social action. Results show that reflection and reflective practices are imbedded in fiction seminars, and that affective stances are constructed as a student resource to manage intensity, control, assessment and accountability. Furthermore, the professional emotions of physicians are constructed as emotional labour which students need to prepare for, and the feeling rules of the medical profession are constructed as calibrations of emotions which are both fluid and changeable. The task of learning professional emotion is oriented to as troublesome by students as it might interfere with their focus on managing student identities.