endoreg-db 0.8.5.1__py3-none-any.whl

endoreg_db/models/metadata/sensitive_meta_logic.py

@@ -0,0 +1,730 @@
+import logging
+import os
+import random
+import re  # Neu hinzugefügt für Regex-Pattern
+from datetime import date, datetime, timedelta
+from hashlib import sha256
+from typing import TYPE_CHECKING, Any, Dict, Optional, Type
+
+from django.db import transaction
+from django.utils import timezone
+
+from endoreg_db.utils import guess_name_gender
+
+# Assuming these utils are correctly located
+from endoreg_db.utils.hashs import get_patient_examination_hash, get_patient_hash
+
+# Import models needed for logic, use local imports inside functions if needed to break cycles
+from ..administration import Center, Examiner, FirstName, LastName, Patient
+from ..medical import PatientExamination
+from ..other import Gender
+from ..state import SensitiveMetaState
+
+if TYPE_CHECKING:
+    from .sensitive_meta import SensitiveMeta  # Import model for type hinting
+
+logger = logging.getLogger(__name__)
+SECRET_SALT = os.getenv("DJANGO_SALT", "default_salt")
+DEFAULT_UNKNOWN_NAME = "unknown"
+
+# Regex-Pattern für verschiedene Datumsformate
+ISO_RX = re.compile(r"^\d{4}-\d{2}-\d{2}$")
+DE_RX = re.compile(r"^\d{2}\.\d{2}\.\d{4}$")
+
+
+def parse_any_date(s: str) -> Optional[date]:
+    """
+    Parst Datumsstring mit Priorität auf deutsches Format (DD.MM.YYYY).
+
+    Unterstützte Formate:
+    1. DD.MM.YYYY (Priorität) - deutsches Format
+    2. YYYY-MM-DD (Fallback) - ISO-Format
+    3. Erweiterte Fallbacks über dateparser
+
+    Args:
+        s: Datumsstring zum Parsen
+
+    Returns:
+        date-Objekt oder None bei ungültigem/fehlendem Input
+    """
+    if not s:
+        return None
+
+    s = s.strip()
+
+    # 1. German dd.mm.yyyy (PRIORITÄT)
+    if DE_RX.match(s):
+        try:
+            dd, mm, yyyy = s.split(".")
+            return date(int(yyyy), int(mm), int(dd))
+        except ValueError as e:
+            logger.warning(f"Invalid German date format '{s}': {e}")
+            return None
+
+    # 2. ISO yyyy-mm-dd (Fallback für Rückwärtskompatibilität)
+    if ISO_RX.match(s):
+        try:
+            return date.fromisoformat(s)
+        except ValueError as e:
+            logger.warning(f"Invalid ISO date format '{s}': {e}")
+            return None
+
+    # 3. Extended fallbacks
+    try:
+        # Try standard datetime parsing
+        return datetime.fromisoformat(s).date()
+    except Exception:
+        pass
+
+    try:
+        # Try dateparser with German locale preference
+        import dateparser
+
+        dt = dateparser.parse(s, settings={"DATE_ORDER": "DMY", "PREFER_DAY_OF_MONTH": "first"})
+        return dt.date() if dt else None
+    except Exception as e:
+        logger.debug(f"Dateparser fallback failed for '{s}': {e}")
+        return None
+
+
+def format_date_german(d: Optional[date]) -> str:
+    """
+    Formatiert date-Objekt als deutsches Datumsformat (DD.MM.YYYY).
+
+    Args:
+        d: date-Objekt oder None
+
+    Returns:
+        Formatiertes Datum als String oder leerer String bei None
+    """
+    if not d:
+        return ""
+    return d.strftime("%d.%m.%Y")
+
+
+def format_date_iso(d: Optional[date]) -> str:
+    """
+    Formatiert date-Objekt als ISO-Format (YYYY-MM-DD).
+
+    Args:
+        d: date-Objekt oder None
+
+    Returns:
+        Formatiertes Datum als String oder leerer String bei None
+    """
+    if not d:
+        return ""
+    return d.isoformat()
+
+
+def generate_random_dob() -> datetime:
+    """Generates a random timezone-aware datetime between 1920-01-01 and 2000-12-31."""
+    start_date = date(1920, 1, 1)
+    end_date = date(2000, 12, 31)
+    time_between_dates = end_date - start_date
+    days_between_dates = time_between_dates.days
+    random_number_of_days = random.randrange(days_between_dates)
+    random_date = start_date + timedelta(days=random_number_of_days)
+    random_datetime = datetime.combine(random_date, datetime.min.time())
+    return timezone.make_aware(random_datetime)
+
+
+def generate_random_examination_date() -> date:
+    """Generates a random date within the last 20 years."""
+    today = date.today()
+    start_date = today - timedelta(days=20 * 365)  # Approximate 20 years back
+    time_between_dates = today - start_date
+    days_between_dates = time_between_dates.days
+    random_number_of_days = random.randrange(days_between_dates)
+    random_date = start_date + timedelta(days=random_number_of_days)
+    return random_date
+
+
+def update_name_db(first_name: Optional[str], last_name: Optional[str]):
+    """Adds first and last names to the respective lookup tables if they don't exist."""
+    if first_name:
+        FirstName.objects.get_or_create(name=first_name)
+    if last_name:
+        LastName.objects.get_or_create(name=last_name)
+
+
+def calculate_patient_hash(instance: "SensitiveMeta", salt: str = SECRET_SALT) -> str:
+    """Calculates the patient hash for the instance."""
+    dob = instance.patient_dob
+    first_name = instance.patient_first_name
+    last_name = instance.patient_last_name
+    center = instance.center
+
+    if not dob:
+        raise ValueError("Patient DOB is required to calculate patient hash.")
+    if not center:
+        raise ValueError("Center is required to calculate patient hash.")
+
+    assert first_name is not None, "First name is required to calculate patient hash."
+    assert last_name is not None, "Last name is required to calculate patient hash."
+    
+    hash_str = get_patient_hash(
+        first_name=first_name,
+        last_name=last_name,
+        dob=dob,
+        center=center.name,  # Use center name
+        salt=salt,
+    )
+    return sha256(hash_str.encode()).hexdigest()
+
+
+def calculate_examination_hash(instance: "SensitiveMeta", salt: str = SECRET_SALT) -> str:
+    """Calculates the examination hash for the instance."""
+    dob = instance.patient_dob
+    first_name = instance.patient_first_name
+    last_name = instance.patient_last_name
+    examination_date = instance.examination_date
+    center = instance.center
+
+    if not dob:
+        raise ValueError("Patient DOB is required to calculate examination hash.")
+    if not examination_date:
+        raise ValueError("Examination date is required to calculate examination hash.")
+    if not center:
+        raise ValueError("Center is required to calculate examination hash.")
+
+    hash_str = get_patient_examination_hash(
+        first_name=first_name,
+        last_name=last_name,
+        dob=dob,
+        examination_date=examination_date,
+        center=center.name,  # Use center name
+        salt=salt,
+    )
+    return sha256(hash_str.encode()).hexdigest()
+
+
+def create_pseudo_examiner_logic(instance: "SensitiveMeta") -> "Examiner":
+    """Creates or retrieves the pseudo examiner based on instance data."""
+    first_name = instance.examiner_first_name
+    last_name = instance.examiner_last_name
+    center = instance.center  # Should be set before calling save
+
+    if not first_name or not last_name or not center:
+        logger.warning(f"Incomplete examiner info for SensitiveMeta (pk={instance.pk or 'new'}). Using default examiner.")
+        # Ensure default center exists or handle appropriately
+        try:
+            default_center = Center.objects.get_by_natural_key("endoreg_db_demo")
+        except Center.DoesNotExist:
+            logger.error("Default center 'endoreg_db_demo' not found. Cannot create default examiner.")
+            raise ValueError("Default center 'endoreg_db_demo' not found.")
+
+        examiner, _created = Examiner.custom_get_or_create(first_name="Unknown", last_name="Unknown", center=default_center)
+    else:
+        examiner, _created = Examiner.custom_get_or_create(first_name=first_name, last_name=last_name, center=center)
+
+    return examiner
+
+
+def get_or_create_pseudo_patient_logic(instance: "SensitiveMeta") -> "Patient":
+    """Gets or creates the pseudo patient based on instance data."""
+    # Ensure necessary fields are set
+    if not instance.patient_hash:
+        instance.patient_hash = calculate_patient_hash(instance)
+    if not instance.center:
+        raise ValueError("Center must be set before creating pseudo patient.")
+    if not instance.patient_gender:
+        raise ValueError("Patient gender must be set before creating pseudo patient.")
+    if not instance.patient_dob:
+        raise ValueError("Patient DOB must be set before creating pseudo patient.")
+
+    dob = instance.patient_dob
+    year = dob.year
+    month = dob.month
+
+    patient, _created = Patient.get_or_create_pseudo_patient_by_hash(
+        patient_hash=instance.patient_hash,
+        center=instance.center,
+        gender=instance.patient_gender,
+        birth_year=year,
+        birth_month=month,
+    )
+    return patient
+
+
+def get_or_create_pseudo_patient_examination_logic(
+    instance: "SensitiveMeta",
+) -> "PatientExamination":
+    """Gets or creates the pseudo patient examination based on instance data."""
+    # Ensure necessary fields are set
+    if not instance.patient_hash:
+        instance.patient_hash = calculate_patient_hash(instance)
+    if not instance.examination_hash:
+        instance.examination_hash = calculate_examination_hash(instance)
+
+    # Ensure the pseudo patient exists first, as PatientExamination might depend on it
+    if not instance.pseudo_patient_id:
+        pseudo_patient = get_or_create_pseudo_patient_logic(instance)
+        instance.pseudo_patient_id = pseudo_patient.pk  # Assign FK directly
+
+    patient_examination, _created = PatientExamination.get_or_create_pseudo_patient_examination_by_hash(
+        patient_hash=instance.patient_hash,
+        examination_hash=instance.examination_hash,
+        # Optionally pass pseudo_patient if the method requires it
+        # pseudo_patient=instance.pseudo_patient
+    )
+    return patient_examination
+
+
+@transaction.atomic  # Ensure all operations within save succeed or fail together
+def perform_save_logic(instance: "SensitiveMeta") -> "Examiner":
+    """
+    Contains the core logic for preparing a SensitiveMeta instance for saving.
+    Handles data generation (dates), hash calculation, and linking pseudo-entities.
+    Returns the Examiner instance to be linked via M2M after the main save.
+    """
+
+    # --- Pre-Save Checks and Data Generation ---
+
+    # 1. Ensure DOB and Examination Date exist
+    if not instance.patient_dob:
+        logger.debug(f"SensitiveMeta (pk={instance.pk or 'new'}): Patient DOB missing, generating random.")
+        instance.patient_dob = generate_random_dob()
+    if not instance.examination_date:
+        logger.debug(f"SensitiveMeta (pk={instance.pk or 'new'}): Examination date missing, generating random.")
+        instance.examination_date = generate_random_examination_date()
+
+    # 2. Ensure Center exists (should be set before calling save)
+    if not instance.center:
+        raise ValueError("Center must be set before saving SensitiveMeta.")
+
+    # 3. Ensure Gender exists (should be set before calling save, e.g., during creation/update)
+    if not instance.patient_gender:
+        # Attempt to guess if names are available
+        first_name = instance.patient_first_name or DEFAULT_UNKNOWN_NAME
+        gender = guess_name_gender(first_name)
+        if not gender:
+            raise ValueError("Patient gender could not be determined and must be set before saving.")
+        instance.patient_gender = gender
+
+    # 4. Calculate Hashes (depends on DOB, Exam Date, Center, Names)
+    instance.patient_hash = calculate_patient_hash(instance)
+    instance.examination_hash = calculate_examination_hash(instance)
+
+    # 5. Get or Create Pseudo Patient (depends on hash, center, gender, dob)
+    # Assign directly to the FK field to avoid premature saving issues
+    pseudo_patient = get_or_create_pseudo_patient_logic(instance)
+    instance.pseudo_patient_id = pseudo_patient.pk
+
+    # 6. Get or Create Pseudo Examination (depends on hashes)
+    # Assign directly to the FK field
+    pseudo_examination = get_or_create_pseudo_patient_examination_logic(instance)
+    instance.pseudo_examination_id = pseudo_examination.pk
+
+    # 7. Get or Create Pseudo Examiner (depends on names, center)
+    # This needs to happen *after* the main instance has a PK for M2M linking.
+    # We create/get it here and return it to the main save method.
+    examiner_instance = create_pseudo_examiner_logic(instance)
+
+    # 8. Ensure SensitiveMetaState exists (will be checked/created *after* main save)
+
+    # Return the examiner instance so the model's save method can handle M2M linking
+    return examiner_instance
+
+
+def create_sensitive_meta_from_dict(cls: Type["SensitiveMeta"], data: Dict[str, Any]) -> "SensitiveMeta":
+    """Logic to create a SensitiveMeta instance from a dictionary."""
+
+    field_names = {f.name for f in cls._meta.get_fields() if not f.is_relation or f.one_to_one or (f.many_to_one and f.related_model)}
+    selected_data = {k: v for k, v in data.items() if k in field_names}
+
+    # --- Convert patient_dob if it's a date object ---
+    dob = selected_data.get("patient_dob")
+    if isinstance(dob, date) and not isinstance(dob, datetime):
+        # Convert date to datetime at the start of the day and make it timezone-aware
+        aware_dob = timezone.make_aware(datetime.combine(dob, datetime.min.time()))
+        selected_data["patient_dob"] = aware_dob
+        logger.debug("Converted patient_dob from date to aware datetime: %s", aware_dob)
+    elif isinstance(dob, str):
+        # Handle string DOB - check if it's a field name or actual date
+        if dob == "patient_dob" or dob in [
+            "patient_first_name",
+            "patient_last_name",
+            "examination_date",
+        ]:
+            logger.warning(
+                "Skipping invalid patient_dob value '%s' - appears to be field name",
+                dob,
+            )
+            selected_data.pop("patient_dob", None)  # Remove invalid value
+        else:
+            # Try to parse as date string
+            try:
+                import dateparser
+
+                parsed_dob = dateparser.parse(dob, languages=["de"], settings={"DATE_ORDER": "DMY"})
+                if parsed_dob:
+                    aware_dob = timezone.make_aware(parsed_dob.replace(hour=0, minute=0, second=0, microsecond=0))
+                    selected_data["patient_dob"] = aware_dob
+                    logger.debug(
+                        "Parsed string patient_dob '%s' to aware datetime: %s",
+                        dob,
+                        aware_dob,
+                    )
+                else:
+                    logger.warning(
+                        "Could not parse patient_dob string '%s', removing from data",
+                        dob,
+                    )
+                    selected_data.pop("patient_dob", None)
+            except Exception as e:
+                logger.warning(
+                    "Error parsing patient_dob string '%s': %s, removing from data",
+                    dob,
+                    e,
+                )
+                selected_data.pop("patient_dob", None)
+    # --- End Conversion ---
+
+    # Similar validation for examination_date
+    exam_date = selected_data.get("examination_date")
+    if isinstance(exam_date, str):
+        if exam_date == "examination_date" or exam_date in [
+            "patient_first_name",
+            "patient_last_name",
+            "patient_dob",
+        ]:
+            logger.warning(
+                "Skipping invalid examination_date value '%s' - appears to be field name",
+                exam_date,
+            )
+            selected_data.pop("examination_date", None)
+        else:
+            # Try to parse as date string
+            try:
+                # First try simple ISO format for YYYY-MM-DD
+                if len(exam_date) == 10 and exam_date.count("-") == 2:
+                    try:
+                        from datetime import datetime as dt
+
+                        parsed_date = dt.strptime(exam_date, "%Y-%m-%d").date()
+                        selected_data["examination_date"] = parsed_date
+                        logger.debug(
+                            "Parsed ISO examination_date '%s' to date: %s",
+                            exam_date,
+                            parsed_date,
+                        )
+                    except ValueError:
+                        # Fall back to dateparser for complex formats
+                        import dateparser
+
+                        parsed_date = dateparser.parse(exam_date, languages=["de"], settings={"DATE_ORDER": "DMY"})
+                        if parsed_date:
+                            selected_data["examination_date"] = parsed_date.date()
+                            logger.debug(
+                                "Parsed string examination_date '%s' to date: %s",
+                                exam_date,
+                                parsed_date.date(),
+                            )
+                        else:
+                            logger.warning(
+                                "Could not parse examination_date string '%s', removing from data",
+                                exam_date,
+                            )
+                            selected_data.pop("examination_date", None)
+                else:
+                    # Use dateparser for non-ISO formats
+                    import dateparser
+
+                    parsed_date = dateparser.parse(exam_date, languages=["de"], settings={"DATE_ORDER": "DMY"})
+                    if parsed_date:
+                        selected_data["examination_date"] = parsed_date.date()
+                        logger.debug(
+                            "Parsed string examination_date '%s' to date: %s",
+                            exam_date,
+                            parsed_date.date(),
+                        )
+                    else:
+                        logger.warning(
+                            "Could not parse examination_date string '%s', removing from data",
+                            exam_date,
+                        )
+                        selected_data.pop("examination_date", None)
+            except Exception as e:
+                logger.warning(
+                    "Error parsing examination_date string '%s': %s, removing from data",
+                    exam_date,
+                    e,
+                )
+                selected_data.pop("examination_date", None)
+
+    # Handle Center
+    center_name = data.get("center_name")
+    if not center_name:
+        raise ValueError("center_name is required in data dictionary.")
+    try:
+        center = Center.objects.get_by_natural_key(center_name)
+        selected_data["center"] = center
+    except Center.DoesNotExist as exc:
+        raise ValueError(f"Center with name '{center_name}' does not exist.") from exc
+
+    # Handle Names and Gender
+    first_name = selected_data.get("patient_first_name") or DEFAULT_UNKNOWN_NAME
+    last_name = selected_data.get("patient_last_name") or DEFAULT_UNKNOWN_NAME
+    selected_data["patient_first_name"] = first_name  # Ensure defaults are set
+    selected_data["patient_last_name"] = last_name
+
+    patient_gender_input = selected_data.get("patient_gender")
+
+    if isinstance(patient_gender_input, Gender):
+        # Already a Gender object, nothing to do
+        pass
+    elif isinstance(patient_gender_input, str):
+        # Input is a string (gender name)
+        try:
+            selected_data["patient_gender"] = Gender.objects.get(name=patient_gender_input)
+        except Gender.DoesNotExist:
+            logger.warning(f"Gender with name '{patient_gender_input}' provided but not found. Attempting to guess or use default.")
+            # Fall through to guessing logic if provided string name is invalid
+            patient_gender_input = None  # Reset to trigger guessing
+
+    if not isinstance(selected_data.get("patient_gender"), Gender):  # If not already a Gender object (e.g. was None, or string lookup failed)
+        gender_name_to_use = guess_name_gender(first_name)
+        if not gender_name_to_use:
+            logger.warning(f"Could not guess gender for name '{first_name}'. Setting Gender to unknown.")
+            gender_name_to_use = "unknown"
+        try:
+            selected_data["patient_gender"] = Gender.objects.get(name=gender_name_to_use)
+        except Gender.DoesNotExist:
+            # This should ideally not happen if "unknown" gender is guaranteed to exist
+            raise ValueError(f"Default or guessed gender '{gender_name_to_use}' does not exist in Gender table.")
+
+    # Update name DB
+    update_name_db(first_name, last_name)
+
+    # Instantiate without saving yet
+    sensitive_meta = cls(**selected_data)
+
+    # Call save once at the end. This triggers the custom save logic.
+    sensitive_meta.save()  # This will call perform_save_logic internally
+
+    return sensitive_meta
+
+
+def update_sensitive_meta_from_dict(instance: "SensitiveMeta", data: Dict[str, Any]) -> "SensitiveMeta":
+    """Logic to update a SensitiveMeta instance from a dictionary."""
+    field_names = {f.name for f in instance._meta.get_fields() if not f.is_relation or f.one_to_one or (f.many_to_one and f.related_model)}
+    # Exclude FKs that should not be updated directly from dict keys (handled separately or via save logic)
+    excluded_fields = {"pseudo_patient", "pseudo_examination"}
+    selected_data = {k: v for k, v in data.items() if k in field_names and k not in excluded_fields}
+
+    # Handle potential Center update
+    center_name = data.get("center_name")
+    if center_name:
+        try:
+            center = Center.objects.get_by_natural_key(center_name)
+            instance.center = center  # Update center directly
+        except Center.DoesNotExist as exc:
+            logger.warning(f"Center '{center_name}' not found during update. Keeping existing center.")
+            selected_data.pop("center", None)  # Remove from dict if not found
+
+    # Set examiner names if provided, before calling save
+    examiner_first_name = data.get("examiner_first_name")
+    examiner_last_name = data.get("examiner_last_name")
+    if examiner_first_name is not None:  # Allow setting empty strings
+        instance.examiner_first_name = examiner_first_name
+    if examiner_last_name is not None:
+        instance.examiner_last_name = examiner_last_name
+
+    # Handle patient_gender specially with graceful error handling
+    patient_gender_input = data.get("patient_gender")
+    if patient_gender_input is not None:
+        try:
+            if isinstance(patient_gender_input, Gender):
+                selected_data["patient_gender"] = patient_gender_input
+            elif isinstance(patient_gender_input, str):
+                gender_input_clean = patient_gender_input.strip()
+                # Try direct case-insensitive DB lookup first
+                gender_obj = Gender.objects.filter(name__iexact=gender_input_clean).first()
+                if gender_obj:
+                    selected_data["patient_gender"] = gender_obj
+                    logger.debug(f"Successfully matched gender string '{patient_gender_input}' to Gender object via iexact lookup")
+                else:
+                    # Use mapping helper for fallback
+                    mapped = _map_gender_string_to_standard(gender_input_clean)
+                    if mapped:
+                        gender_obj = Gender.objects.filter(name__iexact=mapped).first()
+                        if gender_obj:
+                            selected_data["patient_gender"] = gender_obj
+                            logger.info(f"Mapped gender '{patient_gender_input}' to '{mapped}' via fallback mapping")
+                        else:
+                            logger.warning(f"Mapped gender '{patient_gender_input}' to '{mapped}', but no such Gender in DB. Trying 'unknown'.")
+                            unknown_gender = Gender.objects.filter(name__iexact="unknown").first()
+                            if unknown_gender:
+                                selected_data["patient_gender"] = unknown_gender
+                                logger.warning(f"Using 'unknown' gender as fallback for '{patient_gender_input}'")
+                            else:
+                                logger.error(f"No 'unknown' gender found in database. Cannot handle gender '{patient_gender_input}'. Skipping gender update.")
+                                selected_data.pop("patient_gender", None)
+                    else:
+                        # Last resort: try to get 'unknown' gender
+                        unknown_gender = Gender.objects.filter(name__iexact="unknown").first()
+                        if unknown_gender:
+                            selected_data["patient_gender"] = unknown_gender
+                            logger.warning(f"Using 'unknown' gender as fallback for '{patient_gender_input}' (no mapping)")
+                        else:
+                            logger.error(f"No 'unknown' gender found in database. Cannot handle gender '{patient_gender_input}'. Skipping gender update.")
+                            selected_data.pop("patient_gender", None)
+            else:
+                logger.warning(f"Unexpected patient_gender type {type(patient_gender_input)}: {patient_gender_input}. Skipping gender update.")
+                selected_data.pop("patient_gender", None)
+        except Exception as e:
+            logger.exception(f"Error handling patient_gender '{patient_gender_input}': {e}. Skipping gender update.")
+            selected_data.pop("patient_gender", None)
+
+    # Update other attributes from selected_data
+    patient_name_changed = False
+    for k, v in selected_data.items():
+        # Avoid overwriting examiner names if they were just explicitly set
+        if (
+            k not in ["examiner_first_name", "examiner_last_name"]
+            or (k == "examiner_first_name" and examiner_first_name is None)
+            or (k == "examiner_last_name" and examiner_last_name is None)
+        ):
+            try:
+                # --- Convert patient_dob if it's a date object ---
+                value_to_set = v
+                if k == "patient_dob":
+                    if isinstance(v, date) and not isinstance(v, datetime):
+                        aware_dob = timezone.make_aware(datetime.combine(v, datetime.min.time()))
+                        value_to_set = aware_dob
+                        logger.debug(
+                            "Converted patient_dob from date to aware datetime during update: %s",
+                            aware_dob,
+                        )
+                    elif isinstance(v, str):
+                        # Handle string DOB - check if it's a field name or actual date
+                        if v == "patient_dob" or v in [
+                            "patient_first_name",
+                            "patient_last_name",
+                            "examination_date",
+                        ]:
+                            logger.warning(
+                                "Skipping invalid patient_dob value '%s' during update - appears to be field name",
+                                v,
+                            )
+                            continue  # Skip this field
+                        else:
+                            # Try to parse as date string
+                            try:
+                                import dateparser
+
+                                parsed_dob = dateparser.parse(v, languages=["de"], settings={"DATE_ORDER": "DMY"})
+                                if parsed_dob:
+                                    value_to_set = timezone.make_aware(parsed_dob.replace(hour=0, minute=0, second=0, microsecond=0))
+                                    logger.debug(
+                                        "Parsed string patient_dob '%s' during update to aware datetime: %s",
+                                        v,
+                                        value_to_set,
+                                    )
+                                else:
+                                    logger.warning(
+                                        "Could not parse patient_dob string '%s' during update, skipping",
+                                        v,
+                                    )
+                                    continue
+                            except Exception as e:
+                                logger.warning(
+                                    "Error parsing patient_dob string '%s' during update: %s, skipping",
+                                    v,
+                                    e,
+                                )
+                                continue
+                elif k == "examination_date" and isinstance(v, str):
+                    if v == "examination_date" or v in [
+                        "patient_first_name",
+                        "patient_last_name",
+                        "patient_dob",
+                    ]:
+                        logger.warning(
+                            "Skipping invalid examination_date value '%s' during update - appears to be field name",
+                            v,
+                        )
+                        continue
+                    else:
+                        # Try to parse as date string
+                        try:
+                            import dateparser
+
+                            parsed_date = dateparser.parse(v, languages=["de"], settings={"DATE_ORDER": "DMY"})
+                            if parsed_date:
+                                value_to_set = parsed_date.date()
+                                logger.debug(
+                                    "Parsed string examination_date '%s' during update to date: %s",
+                                    v,
+                                    value_to_set,
+                                )
+                            else:
+                                logger.warning(
+                                    "Could not parse examination_date string '%s' during update, skipping",
+                                    v,
+                                )
+                                continue
+                        except Exception as e:
+                            logger.warning(
+                                "Error parsing examination_date string '%s' during update: %s, skipping",
+                                v,
+                                e,
+                            )
+                            continue
+                # --- End Conversion ---
+
+                # Check if patient name is changing
+                if k in ["patient_first_name", "patient_last_name"] and getattr(instance, k) != value_to_set:
+                    patient_name_changed = True
+
+                setattr(instance, k, value_to_set)  # Use value_to_set
+
+            except Exception as e:
+                logger.error(f"Error setting attribute '{k}' to '{v}': {e}. Skipping this field.")
+                continue
+
+    # Update name DB if patient names changed
+    if patient_name_changed:
+        try:
+            update_name_db(instance.patient_first_name, instance.patient_last_name)
+        except Exception as e:
+            logger.warning(f"Error updating name database: {e}")
+
+    # Call save - this will trigger the full save logic including hash recalculation etc.
+    try:
+        instance.save()
+    except Exception as e:
+        logger.error(f"Error saving SensitiveMeta instance: {e}")
+        raise
+
+    return instance
+
+
+def update_or_create_sensitive_meta_from_dict(
+    cls: Type["SensitiveMeta"],
+    data: Dict[str, Any],
+    instance: Optional["SensitiveMeta"] = None,
+) -> "SensitiveMeta":
+    """Logic to update or create a SensitiveMeta instance from a dictionary."""
+    # Check if the instance already exists based on unique fields
+    if instance:
+        # Update the existing instance
+        return update_sensitive_meta_from_dict(instance, data), False
+    else:
+        # Create a new instance
+        return create_sensitive_meta_from_dict(cls, data), True
+
+
+def _map_gender_string_to_standard(gender_str: str) -> Optional[str]:
+    """Maps various gender string inputs to standard gender names used in the DB."""
+    mapping = {
+        "male": ["male", "m", "männlich", "man"],
+        "female": ["female", "f", "weiblich", "woman"],
+        "unknown": ["unknown", "unbekannt", "other", "diverse", ""],
+    }
+    gender_lower = gender_str.strip().lower()
+    for standard, variants in mapping.items():
+        if gender_lower in variants:
+            return standard
+    return None