Was ist das eigentlich? Cyberrisiken verständlich erklärt

Es wird viel über Cyberrisiken gesprochen. Oftmals fehlt aber das grundsätzliche Verständnis, was Cyberrisiken überhaupt sind. Ohne diese zu verstehen, lässt sich aber auch kein Versicherungsschutz gestalten.

Beinahe alle Aktivitäten des täglichen Lebens können heute über das Internet abgewickelt werden. Online-Shopping und Online-Banking sind im Alltag angekommen. Diese Entwicklung trifft längst nicht nur auf Privatleute, sondern auch auf Firmen zu. Das Schlagwort Industrie 4.0 verheißt bereits eine zunehmende Vernetzung diverser geschäftlicher Vorgänge über das Internet.

Anbieter von Cyberversicherungen für kleinere und mittelständische Unternehmen (KMU) haben Versicherungen die Erfahrung gemacht, dass trotz dieser eindeutigen Entwicklung Cyberrisiken immer noch unterschätzt werden, da sie als etwas Abstraktes wahrgenommen werden. Für KMU kann dies ein gefährlicher Trugschluss sein, da gerade hier Cyberattacken existenzbedrohende Ausmaße annehmen können. So wird noch häufig gefragt, was Cyberrisiken eigentlich sind. Diese Frage ist mehr als verständlich, denn ohne (Cyber-)Risiken bestünde auch kein Bedarf für eine (Cyber-)Versicherung.

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ACNP exam Format | ACNP Course Contents | ACNP Course Outline | ACNP exam Syllabus | ACNP exam Objectives

The Adult-Gerontology Acute Care Nurse Practitioner (AG-ACNP) Post-Professional Certificate is designed for graduate prepared Nurse Practitioners (NP) or Clinical Nurse certified (CNS) who are seeking to expand their roles via nurse practitioner certification in Adult-Gerontology Acute Care. The curriculum prepares nurse practitioners to function as generalist, principal providers of care for adults and older adults with acute, critical and complex chronic health problems across the continuum of acute care services.

AG-ACNP students may choose a clinical emphasis in cardiopulmonary, critical care, oncology, trauma emergency preparedness or directed study. The directed study allows students to design clinical experiences around a particular area of interest (i.e. internal medicine, general surgery). The curriculum consists of NP and AG-ACNP specialty courses and clinical practice hours.

Graduates of the AG-ACNP Post-Professional Certificate are eligible to sit for the national certification examination in Adult-Gerontology Acute Care offered by the American Nurses Credentialing Center or American Association of Critical Care Nurses. Successful passing of the national certification examination entitles the graduate to apply for certification as a Certified Registered Nurse Practitioner (CRNP) in Adult-Gerontology Acute Care by the State Board of Nurse Examiners of the Commonwealth of Pennsylvania.

Course work may be completed in 3 terms

540 clinical hours

Online or onsite

Students are required to attend 2 onsite laboratory intensives - 2 days in the Summer term and 1 day in the Fall term. Each student will be responsible for the room and board cost during the lab intensives.

Online students will need to arrange for clinical placements and appropriate physician or nurse practitioner preceptors. An Affiliation Agreement between the University and the clinical site is required before clinical hours can begin.

Graduates of the AG-ACNP Post-Professional Certificate are prepared to accomplish the following:

Assume responsibility for promoting, maintaining and restoring health to acutely/critically or complex chronically ill adults and older adults

Identify health risks, promote wellness, and diagnosis and manage acute and chronic illness

Participate in multi-disciplinary research and provide leadership in mobilizing health services

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Medical Acute exam Questions


Kinesiophobia is negatively associated with physical activity: What factors influence this relationship?

In a accurate study posted to medRxiv*, researchers examined the association between physical activity and kinesiophobia.

Study: Kinesiophobia and Physical Activity: A Systematic Review and Meta-Analysis. Image Credit: GP PIXSTOCK/Shutterstock.com Study: Kinesiophobia and Physical Activity: A Systematic Review and Meta-Analysis. Image Credit: GP PIXSTOCK/Shutterstock.com

*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.


The health benefits of physical activity have been well documented in the literature, including lower risks of disease, disability, and death. In particular, increased physical activity reduces the risk of obesity, cardiovascular disease, cancer, hypertension, dementia, and depression.

Kinesiophobia is the irrational, debilitating, and excessive fear of movement and activity due to a sense of vulnerability to a medical condition, injury, or pain.

The perception of physical activity-related cues automatically activates the physical activity concept and associated pleasant or unpleasant affective memories, leading to an impulsive tendency to approach or avoid physical activity.

Likewise, aversive fear of injury, pain, or worsening of a medical condition associated with the concept of movement may lead to automatic avoidance behaviors contributing to this fear. It may result in a phobic state (kinesiophobia).

About the study

In the present study, researchers systematically reviewed and meta-analyzed the relationship between physical activity and kinesiophobia. Medline, Cumulative Index to Allied and Nursing Health Literature (CINAHL), and PsycINFO databases were searched for potential studies using relevant keywords.

Studies were eligible if they reported original data from human participants, included at least one measure of physical activity and kinesiophobia, and evaluated their association.

Conference abstracts, study protocols, book chapters, and studies incorporating physical fitness measures were excluded. Duplicates were removed, and titles/abstracts were reviewed.

The team extracted data on participant characteristics, body mass index, pain intensity, health status, type and level of kinesiophobia, type of physical activity measure, and statistical estimates.

The risk of bias was estimated using the appraisal tool for cross-sectional studies. In the meta-analysis, Pearson product-moment correlations were pooled from studies to analyze the relationship between physical activity and kinesiophobia.

The heterogeneity variance (Tau-squared) was calculated using the restricted maximum likelihood estimator. Besides, the I-squared statistic was used to quantify between-study heterogeneity.

Publication bias was assessed using Egger’s regression test and p-curve analysis. Several sub-group analyses were performed. In addition, a secondary meta-analysis was performed to assess the relationship between device-measured physical activity and kinesiophobia.

A sensitivity analysis examined whether the quality of studies influenced results.


The authors identified 395 potential hits from the primary search. After exclusions, 49 studies with 6,084 participants were selected for the systematic review. The studies evaluated healthy individuals and those with pain, arthritis, cancer, surgery, and cardiovascular, neurological, and pulmonary conditions. Most studies used the Tampa scale of kinesiophobia to assess kinesiophobia.

Studies reporting the highest kinesiophobia levels involved individuals with a cardiovascular condition, arthritis, chronic pain, or pulmonary condition. Kinesiophobia levels were lower in healthy individuals and those with neurological or surgical conditions.

Thirty-four studies assessed physical activity using self-reported questionnaires. Accelerometers and pedometers were used in others.

The meta-analysis, which included 41 studies, revealed a significant moderate negative correlation between physical activity and kinesiophobia. Nevertheless, there was substantial between-study heterogeneity and publication bias.

The association between physical activity and kinesiophobia was significant only in patients with arthritis or cardiovascular disease. Heterogeneity was higher in studies with arthritis populations than those comprising cardiovascular disease patients.

Moreover, only self-reported physical activity measures correlated with physical activity and kinesiophobia. The secondary meta-analysis revealed no evidence of an association between accelerometer-based physical activity measures and kinesiophobia. Finally, the sensitivity analysis revealed that the quality of studies did not impact the correlation.


The findings reveal a moderate negative correlation between physical activity and kinesiophobia, suggesting that the fear of movement induces an impulse to avoid physical activity. Moreover, arthritis or cardiovascular disease patients may be at an elevated risk than others.

Although there was no association between kinesiophobia and physical activity in other health conditions (cancer, surgery, acute pain, and neurological or pulmonary disorders), the effects of kinesiophobia cannot be ruled out.

Notably, the association was statistically significant only in studies incorporating self-reported measures of physical activity, with the secondary meta-analysis supporting this finding.

This raises the question of the robustness of the association, given the higher reliability and validity of device-based measures than self-reports. Thus, future studies using device-based measures of physical activity are required to corroborate the findings.

*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Crossed Wires: Ischemia Testing and Monomorphic VT Storm

Patients with a severe form of ventricular arrhythmia who may be referred for catheter ablation are often first tested for coronary artery disease (CAD) or ischemia. But such testing seldom makes a difference to downstream management or outcomes, researchers conclude, based on registry data.

The findings, they say, question such routine CAD/ischemia testing in patients like those studied, who had episodes of monomorphic ventricular tachycardia (VT) storm but not an acute coronary syndrome (ACS) and ultimately went to ablation.

Of 97 such patients, about 44% underwent CAD/ischemia testing by invasive angiography, myocardial functional imaging, or both. But the tests didn't predict important ablation outcomes, including pre- or postablation VT inducibility. Nor did they significantly affect the likelihood or outcomes of preablation revascularization or 2-year survival.

The findings "argue against performing routine evaluations to rule out coronary [disease] or myocardial ischemia as culprits in monomorphic VT storm" in patients without evidence of ACS, write Feras Alkhalaileh, MD, Heart and Vascular Institute, Cleveland Clinic, Ohio, and colleagues in their report published August 2 in JACC: Clinical Electrophysiology.

They suggest it's "reasonable" not to perform tests for CAD or ischemia in such patients, senior author Ayman A. Hussein, MD, from the same center, told theheart.org | Medscape Cardiology. Although such tests may be considered "case by case," performed routinely they "aren't going to add much to patient care, and as a matter of fact, may delay proper care and expose them to risks," Hussein said.

It's "reasonable" to test for CAD or ischemia in patients with polymorphic VT storm, which is likely ischemia-driven, he observed. In contrast, monomorphic VT storm is likely caused by myocardial scar, which revascularization cannot treat. "Because there's scar substrate, they find that ischemic evaluations are technically without much yield."

These issues are "not very controversial" among cardiac electrophysiologists, Hussein said, but it remains "common practice" for other certified to order angiography or ischemia testing for patients with monomorphic VT storm, typically in the cardiac care unit (CCU), before considering ablation.

"Sometimes, as electrophysiologists, they don't get to see them before an ischemic evaluation has already been done," he added.

It's "very hard to convince interventional cardiologists, CCU intensivists, or general cardiologists" that a VT may not be caused by ischemia, said electrophysiologist Roderick Tung, MD, University of Arizona College of Medicine, Phoenix, who was not involved in the current study.

In patients with monomorphic VT storm, "By the time we're consulted, they've already had a cath. And it's probably just not necessary," Tung said. "That's why this is such a great paper, because it has an immediate message" for nonelectrophysiologist clinicians and "the potential to change clinical practice."

The study included 97 patients with monomorphic VT storm from a prospective VT-ablation registry covering about 7 years at a major referral center. Their mean age was 64 years and 88% were men. Two-thirds were known to have ischemic cardiomyopathy and were in NYHA functional class II.

As reported, 10% of the cohort underwent coronary angiography after presentation with monomorphic VT storm, 26% had CT or PET myocardial functional imaging, and 9% had both tests.

Only four patients ultimately underwent coronary revascularization; no acute coronary occlusions were involved. Monomorphic VT recurred in all four cases, the report notes.

The 43 and 54 patients who did or did not get the CAD/ischemia tests, respectively, showed no significant procedural differences in extent of scar modification, prevalence of clinical or hemodynamically stable VT, or use of mechanical circulatory support; or in postablation, VT inducibility or overall mortality during follow-up averaging 24.3 months.

To address possible concerns about selection bias in the main cohort, all of whom underwent ablation, a secondary analysis was conducted with 91 patients with known asymptomatic coronary disease and monomorphic VT storm who were selected from the registry without regard to whether they underwent catheter ablation.

Of that cohort, 21 went to invasive angiography and 25 underwent stress testing; six of the latter went on to coronary angiography, the report states. Monomorphic VT later recurred in four of the five patients, who then underwent coronary revascularization.

Such patients with known coronary disease, Hussein said, are those "possibly more likely to get an ischemic evaluation." And yet, "regardless of whether they had ablation, the yield of ischemic evaluations in these patients was low."

By far most of the CAD/ischemia tests in the study's primary cohort were performed using noninvasive imaging, notes an editorial accompanying the new report. "This raises the possibility of false negatives with very proximal and multivessel CAD, and with balanced ischemia," write Saurabh Kumar, BSc (Med)/MBBS, PhD, and Ashwin Bhaskaran, MBBS, MSc, University of Sydney, New South Wales, Australia.

Ideally, the issues addressed by the study should be tested in large randomized, controlled trials, they state. "Achieving sufficient recruitment to address this clinical question may be difficult, leaving clinicians with the challenge of applying observational data to their patients."

J Am Coll Cardiol EP. Published online August 2, 2023. Full Text, Editorial

Alkhalaileh, Hussein, and their coauthors report no relevant financial relationships. Tung has previously disclosed receiving speaking fees from and serving on advisory boards for Abbott, Biotronik, Boston Scientific, and Medtronic, and receiving research grants from Abbott. Kumar has received research grants from Abbott Medical and Biotronik; and honoraria from Biosense Webster, Abbott Medical, Biotronik, and Sanofi. Bhaskaran declared no relevant financial disclosures.

Follow Steve Stiles on Twitter: @SteveStiles2. For more from theheart.org | Medscape Cardiology, follow us on Twitter and Facebook.


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Warum sind Cyberrisiken so schwer greifbar?

Als mehr oder weniger neuartiges Phänomen stellen Cyberrisiken Unternehmen und Versicherer vor besondere Herausforderungen. Nicht nur die neuen Schadenszenarien sind abstrakter oder noch nicht bekannt. Häufig sind immaterielle Werte durch Cyberrisiken in Gefahr. Diese wertvollen Vermögensgegenstände sind schwer bewertbar.

Obwohl die Gefahr durchaus wahrgenommen wird, unterschätzen viele Firmen ihr eigenes Risiko. Dies liegt unter anderem auch an den Veröffentlichungen zu Cyberrisiken. In der Presse finden sich unzählige Berichte von Cyberattacken auf namhafte und große Unternehmen. Den Weg in die Presse finden eben nur die spektakulären Fälle. Die dort genannten Schadenszenarien werden dann für das eigene Unternehmen als unrealistisch eingestuft. Die für die KMU nicht minder gefährlichen Cyber­attacken werden nur selten publiziert.

Aufgrund der fehlenden öffentlichen Meldungen von Sicherheitsvorfällen an Sicherheitsbehörden und wegen der fehlenden Presseberichte fällt es schwer, Fakten und Zahlen zur Risikolage zu erheben. Aber ohne diese Grundlage fällt es schwer, in entsprechende Sicherheitsmaßnahmen zu investieren.

Erklärungsleitfaden anhand eines Ursache-Wirkungs-Modells

Häufig nähert man sich dem Thema Cyberrisiko anlass- oder eventbezogen, also wenn sich neue Schaden­szenarien wie die weltweite WannaCry-Attacke entwickeln. Häufig wird auch akteursgebunden beleuchtet, wer Angreifer oder Opfer sein kann. Dadurch begrenzt man sich bei dem Thema häufig zu sehr nur auf die Cyberkriminalität. Um dem Thema Cyberrisiko jedoch gerecht zu werden, müssen auch weitere Ursachen hinzugezogen werden.

Mit einer Kategorisierung kann das Thema ganzheitlich und nachvollziehbar strukturiert werden. Ebenso hilft eine solche Kategorisierung dabei, eine Abgrenzung vorzunehmen, für welche Gefahren Versicherungsschutz über eine etwaige Cyberversicherung besteht und für welche nicht.

Die Ursachen sind dabei die Risiken, während finanzielle bzw. nicht finanzielle Verluste die Wirkungen sind. Cyberrisiken werden demnach in zwei Hauptursachen eingeteilt. Auf der einen Seite sind die nicht kriminellen Ursachen und auf der anderen Seite die kriminellen Ursachen zu nennen. Beide Ursachen können dabei in drei Untergruppen unterteilt werden.

Nicht kriminelle Ursachen

Höhere Gewalt

Häufig hat man bei dem Thema Cyberrisiko nur die kriminellen Ursachen vor Augen. Aber auch höhere Gewalt kann zu einem empfindlichen Datenverlust führen oder zumindest die Verfügbarkeit von Daten einschränken, indem Rechenzentren durch Naturkatastrophen wie beispielsweise Überschwemmungen oder Erdbeben zerstört werden. Ebenso sind Stromausfälle denkbar.

Menschliches Versagen/Fehlverhalten

Als Cyberrisiken sind auch unbeabsichtigtes und menschliches Fehlverhalten denkbar. Hierunter könnte das versehentliche Veröffentlichen von sensiblen Informationen fallen. Möglich sind eine falsche Adressierung, Wahl einer falschen Faxnummer oder das Hochladen sensibler Daten auf einen öffentlichen Bereich der Homepage.

Technisches Versagen

Auch Hardwaredefekte können zu einem herben Datenverlust führen. Neben einem Überhitzen von Rechnern sind Kurzschlüsse in Systemtechnik oder sogenannte Headcrashes von Festplatten denkbare Szenarien.

Kriminelle Ursachen


Hackerangriffe oder Cyberattacken sind in der Regel die Szenarien, die die Presse dominieren. Häufig wird von spektakulären Datendiebstählen auf große Firmen oder von weltweiten Angriffen mit sogenannten Kryptotrojanern berichtet. Opfer kann am Ende aber jeder werden. Ziele, Methoden und auch das Interesse sind vielfältig. Neben dem finanziellen Interesse können Hackerangriffe auch zur Spionage oder Sabotage eingesetzt werden. Mögliche Hackermethoden sind unter anderem: Social Engineering, Trojaner, DoS-Attacken oder Viren.

Physischer Angriff

Die Zielsetzung eines physischen Angriffs ist ähnlich dem eines Hacker­angriffs. Dabei wird nicht auf die Tools eines Hackerangriffs zurückgegriffen, sondern durch das physische Eindringen in Unternehmensgebäude das Ziel erreicht. Häufig sind es Mitarbeiter, die vertrauliche Informationen stehlen, da sie bereits den notwendigen Zugang zu den Daten besitzen.


Obwohl die Erpressung aufgrund der eingesetzten Methoden auch als Hacker­angriff gewertet werden könnte, ergibt eine Differenzierung Sinn. Erpressungsfälle durch Kryptotrojaner sind eines der häufigsten Schadenszenarien für kleinere und mittelständische Unternehmen. Außerdem sind auch Erpressungsfälle denkbar, bei denen sensible Daten gestohlen wurden und ein Lösegeld gefordert wird, damit sie nicht veröffentlicht oder weiterverkauft werden.

Ihre Cyberversicherung sollte zumindet folgende Schäden abdecken:


  • Soforthilfe und Forensik-Kosten (Kosten der Ursachenermittlung, Benachrichtigungskosten und Callcenter-Leistung)
  • Krisenkommunikation / PR-Maßnahmen
  • Systemverbesserungen nach einer Cyber-Attacke
  • Aufwendungen vor Eintritt des Versicherungsfalls

Cyber-Drittschäden (Haftpflicht):

  • Befriedigung oder Abwehr von Ansprüchen Dritter
  • Rechtswidrige elektronische Kommunikation
  • Ansprüche der E-Payment-Serviceprovider
  • Vertragsstrafe wegen der Verletzung von Geheimhaltungspflichten und Datenschutzvereinbarungen
  • Vertragliche Schadenersatzansprüche
  • Vertragliche Haftpflicht bei Datenverarbeitung durch Dritte
  • Rechtsverteidigungskosten


  • Betriebsunterbrechung
  • Betriebsunterbrechung durch Ausfall von Dienstleister (optional)
  • Mehrkosten
  • Wiederherstellung von Daten (auch Entfernen der Schadsoftware)
  • Cyber-Diebstahl: elektronischer Zahlungsverkehr, fehlerhafter Versand von Waren, Telefon-Mehrkosten/erhöhte Nutzungsentgelte
  • Cyber-Erpressung
  • Entschädigung mit Strafcharakter/Bußgeld
  • Ersatz-IT-Hardware
  • Cyber-Betrug