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Covid-19 is severely impacting hospitality establishments, with consequences on consumers' decision-making. Yet, little is known about current factors influencing travelers' accommodation choice. This paper adopts a sequential mixed-methods design to examine the importance attributed to additional measures implemented in tourism accommodation during a pandemic, by interviewing sixteen potential travelers, and then profiling a convenience sample of 4,386 consumers accordingly. Findings suggest that accommodation key factors are sanitization and PPE use, physical distancing in restaurant service, room service delivery, reception automation, and social and environmental engagement. Consumers attribute different importance to accommodation services in three configurations: Sanitization and Physically Distancing Seekers, All-round Concerned, and Sustainability Supporters. Profiling of the segments revealed numerous distinctive characteristics. [ABSTRACT FROM AUTHOR]

Objectives It is difficult to obtain longitudinal 'real world' data from ambulatory medical care in Germany in a systematic way. Our vision is a large German research data repository featuring representative, anonymized patient and outpatient health care data, longitudinal, continuously updated and across different providers, offering a perspective of linking secondary care data or additional data obtained from research cohorts, for example patient reported data or biodata, and will be accessible for other researchers. Here we report specific methods and results from the RADAR project.Methods Survey of legislation, design of technical processes and organisational solutions, with a feasibility study to evaluate technical and content functionality, acceptability and performance fitness for health services research questions.Results In 2016, a multi-disciplinary scientific team initiated the development of a privacy protection and IT security concept for data exported from the electronic medical records (EMR) of physicians' practices in line with the European General Data Protection Regulation. Technical and organisational requirements for lawful research infrastructure were developed and executed for use in a specific case, namely ̒oral anticoagulation'. In 7 Lower Saxonian general practices, 100 patients were selected by their physician and their data - reduced to 40 essential data fields - extracted from EMR via a mandatory software interface after informed consent. Still in the practice, the data were split into identifying or medical data. These were encrypted and transferred either to a trusted third party (TTP) or to a data repository, respectively. 75 patients who met our inclusion criteria (minimum of one year of oral anticoagulation treatment) received a quality-of-life questionnaire via the TTP. Of the 66 returns, 63 responses were then linked to the EMR data in the repository.Conclusion Results from RADAR project proved the technical and organisational feasibility of lawful, pseudonymised data acquisition and the linkage of questionnaires to EMR data. The protecting concepts privacy by design and data minimization (Art. 25 GDPR with Recital 78) were implemented. Without informed consent, secondary use of routine data from ambulatory care which are sufficiently anonymized but still meaningful is all but impossible under current German law., Competing Interests: Die Autoren erklären, dass keine Interessenkonflikte bestehen., (Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany.)

Background: Medical data from family doctors are of great importance to health care researchers but seem to be locked in German practices and, thus, are underused in research. The RADAR project (Routine Anonymized Data for Advanced Health Services Research) aims at designing, implementing and piloting a generic research architecture, technical software solutions as well as procedures and workflows to unlock data from family doctor's practices. A long-term medical data repository for research taking legal requirements into account is established. Thereby, RADAR helps closing the gap between the European countries and to contribute data from primary care in Germany., Methods: The RADAR project comprises three phases: (1) analysis phase, (2) design phase, and (3) pilot. First, interdisciplinary workshops were held to list prerequisites and requirements. Second, an architecture diagram with building blocks and functions, and an ordered list of process steps (workflow) for data capture and storage were designed. Third, technical components and workflows were piloted. The pilot was extended by a data integration workflow using patient-reported outcomes (paper-based questionnaires)., Results: The analysis phase resulted in listing 17 essential prerequisites and guiding requirements for data management compliant with the General Data Protection Regulation (GDPR). Based on this list existing approaches to fulfil the RADAR tasks were evaluated-for example, re-using BDT interface for data exchange and Trusted Third Party-approach for consent management and record linkage. Consented data sets of 100 patients were successfully exported, separated into person-identifying and medical data, pseudonymised and saved. Record linkage and data integration workflows for patient-reported outcomes in the RADAR research database were successfully piloted for 63 responders., Conclusion: The RADAR project successfully developed a generic architecture together with a technical framework of tools, interfaces, and workflows for a complete infrastructure for practicable and secure processing of patient data from family doctors. All technical components and workflows can be reused for further research projects. Additionally, a Trusted Third Party-approach can be used as core element to implement data privacy protection in such heterogeneous family doctor's settings. Optimisations identified comprise a fully-electronic consent recording using tablet computers, which is part of the project's extension phase.

Objectives: Managing participants and their data are fundamental for the success of a clinical trial. Our review identifies and describes processes that deal with management of trial participants and highlights information technology (IT) assistance for clinical research in the context of participant management., Methods: A scoping literature review design, based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement, was used to identify literature on trial participant-related proceedings, work procedures, or workflows, and assisting electronic systems., Results: The literature search identified 1329 articles of which 111 were included for analysis. Participant-related procedures were categorized into 4 major trial processes: recruitment, obtaining informed consent, managing identities, and managing administrative data. Our results demonstrated that management of trial participants is considered in nearly every step of clinical trials, and that IT was successfully introduced to all participant-related areas of a clinical trial to facilitate processes., Discussion: There is no precise definition of participant management, so a broad search strategy was necessary, resulting in a high number of articles that had to be excluded. Nevertheless, this review provides a comprehensive overview of participant management-related components, which was lacking so far. The review contributes to a better understanding of how computer-assisted management of participants in clinical trials is possible., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

Background and Objectives: The use of primary care data gathered from electronic health records in local practices could be an important building block for the future of health services research. However, the risks and reservations associated with using this data for research purposes should not be underestimated. We show the data protection and privacy problems that may arise through secondary analysis of routine primary care data and describe the technical solutions that are available to address these concerns - as a trust-building measure., Methods: We screened 40 variables that are deemed important for documentation in the electronic health records of primary care physicians and rated the risk of patient re-identification when using these records from routine medical data for research purposes. The criteria used to rate the risk of re-identification were "expert perception" (inferences of a professional observer of phenotypical characteristics which are documented in the 40 variables), "researchable additional knowledge" (knowledge of characteristics of a person through publicly available information and social media networks), and "statistic frequency" according to diagnosis and medication statistics., Results: Diagnoses and reasons for contacting a general practitioner can contain particularly identifiable characteristics such as "obesity" (ICD-10 E66) and "nicotine dependence" (F17). About half of all ICD codes documented in primary care fall below a critical threshold value in their absolute frequency; this is all the more problematic if diagnoses allow for re-identification due to phenotypical characteristics. Medication information holds little potential risk of re-identification of a person. However, the application of medications could be a source of re-identification, e. g., self-injections of insulin or use of inhalators. Information about times and dates are especially sensitive for the re-identification of a person. Sex and age of a patient generally pose no problems, except in the case of very young or very old individuals when these age groups are seldom represented in the practice., Discussion: Routine health data are, in principle, sensitive data. Knowledge about the variables in primary care data gathered from electronic health records in local practices and the evaluation of this data allow us to more accurately estimate the risk of re-identification for the persons concerned. In particular, chronic diagnoses and/or diagnoses in long text, calendar dates for patient contacts and therapies bear a high risk of re-identification. Technical measures such as removing data, masking values and coding should make re-identification considerably more difficult. There will always be a remaining risk of re-identification which should be openly discussed to counteract concerns about a lack of data protection or a sweeping critique of digitization in healthcare., (Copyright © 2019.)

Single doses of cefazolin, 500 mg intramuscularly and 1 g intravenously, were administered to 16 patients having lung pathology who were scheduled for thoracic fluid aspiration. Pleural fluid and serum samples were taken at intervals of 30 to 240 min for determination of cefazolin levels. The levels obtained were variable; however, the levels of cefazolin in pleural fluid generally exceeded the reported minimal inhibitory concentration values for Staphylococcus pneumoniae and Staphylococcus, and group A beta-hemolytic streptococcus. In addition, the pleural fluid levels exceeded the minimal inhibitory concentration for cefazolin against most of the Klebsiella and Haemophilus influenzae strains. These data show that cefazolin, despite its comparative high protein binding, produces levels in the pleural fluid capable of inhibiting the organisms commonly found in respiratory tract infections.

These cases illustrate the potential effectiveness of a fractionated combination chemotherapy program in controlling invasive operable cancer of the bladder without side effects and with sustained normal bladder function. It should be emphasized that these patients had refused any other modality, including surgery, radiation therapy, and standard dosage chemotherapy. At this time all patients are free of clinical disease, living normal lives, and have suffered no side effects from the treatment protocol. The authors believe that by continuous monitoring and close observation, as was illustrated in case No. 2, X-ray therapy and/or surgery can still be utilized effectively if necessary, and if the patient accepts it at the time. This is only a case report study of three patients for a limited period of time. It is not suggested that this should be the treatment of choice in operable cancer of the bladder; however, it opens up a potential for those patients who refuse surgery and/or X-ray therapy and are not willing to accept the side effects of chemotherapy.

A case of myelofibrosis successfully treated by the use of splenectomy has been reported. The feeling of the authors is that splenectomy should be considered at a much earlier stage of the disease, when the patient is a better risk with a longer survival. We see no valid physiological reasoning for leaving a spleen in, which is valueless to the patient in addition to causing multiple side effects, directly and indirectly from its size and overactivity. This is especially true when attempts to reduce the size have potential hazards, none are completely effective and when the physiological necessity for this reticulo endothelial site seems to be unnecessary. Perhaps it would be of greatest value if all cases of myelofibrosis should be seen at the inception and throughout by the hematological and surgical service together.

This is an article reviewing the literature and our experience to date (six months) in the treatment of cancer using whole body hyperthermia in the first 60 patients. WBHT is an effective method of treating cancer. Patients were treated for a total of eight hours, 180 degrees F for two hours. WBHT was induced by means of two high-flow water filled blankets. Toxicity included fatigue, nausea, diarrhea and first degree burns. There was no evidence of visceral damage. There were no mortalities during the procedure. Objective responses were 50%, subjective responses were 65%. The literature demonstrates and our study confirms that under closely monitored conditions, WBHT is a feasible, safe and active anti-cancer therapy. WBHT may be safely used as an adjunct to other active cancer therapies including X-ray therapy and chemotherapy.