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Die Anaesthesiologie Apr 2024The limitations and disadvantages of opioids in anesthesia are very well known but the advantages combined with a lack of effective alternatives even now still prevents... (Review)
Review
The limitations and disadvantages of opioids in anesthesia are very well known but the advantages combined with a lack of effective alternatives even now still prevents refraining from using opioids as part of an adequate pain therapy. For decades, pain research has had the declared goal of replacing opioids with new substances which have no serious side effects; however, currently this goal seems to be a long way off. Due to the media coverage of the "opioid crisis" in North America, the use of opioids for pain management is also increasingly being questioned by the patients. Measures to contain this crisis are only slowly taking effect in view of the increasing number of deaths, which is why the triggers are still being sought. The perioperative administration of opioids is not only a possible gateway to addiction and abuse but it can also cause outcome-relevant complications, such as respiratory depression, postoperative nausea and vomiting and an increase in postoperative pain. Therefore, these considerations gave rise to the idea of an opioid-free anesthesia (OFA), i.e., opioids are not administered as part of anesthesia to carry out surgical procedures. Although this idea may make sense at first glance, a rapid introduction of this concept appears to be risky as it entails significant changes for the entire anesthesiological management. Based on relatively robust data from clinical studies, this concept can now be evaluated and discussed not only emotionally but also objectively. This review article presents arguments for or against the complete avoidance of intraoperative or even perioperative opioids. The current conditions in Germany are primarily taken into account, so that the perioperative pain therapy is transferable to the established standards. The results from current clinical studies on the implementation of an opioid-free anesthesia are summarized and discussed.
Topics: Humans; Analgesics, Opioid; Anesthesia; Pain Management; Pain, Postoperative; Analgesia
PubMed: 38568253
DOI: 10.1007/s00101-024-01397-2 -
Zhurnal Voprosy Neirokhirurgii Imeni N.... 2024Primary brainstem gliomas are still poorly studied in neurooncology. This concept includes tumors with different histological and genetic features, as well as variable... (Review)
Review
Primary brainstem gliomas are still poorly studied in neurooncology. This concept includes tumors with different histological and genetic features, as well as variable clinical course and outcomes. Nevertheless, treatment implies radiotherapy without a clear idea of morphological substrate of disease in 80% of cases. Small number of studies and insufficient data on histological and genetic nature of brainstem tumors complicate clear diagnostic and treatment algorithms. This review provides current information regarding primary glial brainstem tumors. Appropriate problems and objectives are highlighted. The purpose of the review is to provide a comprehensive and updated understanding of the current state of brainstem glial tumors and to identify areas requiring further study for improvement of diagnosis and treatment of these diseases. Brainstem tumors are an understudied problem with small amount of data that complicates optimal treatment strategies. Further researches and histological verification are required to develop new methods of therapy, especially for diffuse forms of neoplasms.
Topics: Humans; Glioma; Brain Stem Neoplasms
PubMed: 38549416
DOI: 10.17116/neiro20248802198 -
Journal of Psycholinguistic Research Mar 2024The purpose of this study was to consider the core of the mental lexicon of the Kazakh language based on the analysis of associative dictionaries, to determine the basic...
The purpose of this study was to consider the core of the mental lexicon of the Kazakh language based on the analysis of associative dictionaries, to determine the basic lexico-semantic groups of words and to compare the basic lexical layer with value categories. This study uses the following methods of linguocultural, comparative, lexico-semantic, and conceptual analysis, as well as analytical and synthetic analysis, with the help of which the main conceptual values of the Kazakh people were studied: spiritual, mental and material. The lexico-semantic categories of words in the Kazakh language were identified: names of people; adjectives with an assessment of reality; basic action verbs; nouns with abstract meanings. An idea was formed about the differences between the conceptual cores of the mental lexicon of the Kazakhs, the British, and the Spaniards. The principles of intercultural communication and ways of its implementation were considered on the example of the study of the Kazakh language from the point of view of linguistic culture. The basic concepts and their semantic meanings were compared based on the analysis of the linguistic nature of lexemes in the Kazakh, English and Spanish languages. Tables with the results of the study were presented to illustrate the results obtained. This study can be used in further scientific practice, for example, in linguocultural, sociocultural, historical, lexicographic, and conceptual studies.
Topics: Humans; Language; Semantics; Communication; Linguistics; Central Asian People
PubMed: 38526840
DOI: 10.1007/s10936-024-10074-9 -
Recenti Progressi in Medicina Apr 2024Dissecting bodies is a common practice in many cultures. But in "big data medicine", the art of dissecting the human body has become an obsession. Indeed, modern...
Dissecting bodies is a common practice in many cultures. But in "big data medicine", the art of dissecting the human body has become an obsession. Indeed, modern biotechnology allows us to see and measure the molecular components of every single cell. But how can we put this immense number of bits and pieces back together again and see the patient as a whole? The first turning point is that proposed by René Descartes, who, inspired by dreams and visions, conceived the idea of unifying all scientific disciplines through the pervasive application of mathematics. Descartes formulates four basic rules, the second (top-down method) and third (bottom-up method) of which become crucial in modern data analysis. An instructive case study considered here is that of pulmonary tuberculosis, where the Cartesian approach of decomposing problems into smaller and smaller "pieces" - from organism to organ and from cellular lesion to the microscopic level - has led to the cure of the disease through antibiotics. This success story inspired Paul Ehrlich who, with the concept of the "magic bullet", defined modern pharmacology. However, this paradigm is being challenged today by multifactorial diseases and big data medicine, where the enormous availability of clinical and molecular data must be integrated to arrive at a therapeutic decision. The Cartesian approach shows its limitations today, as witnessed by the similar difficulty in fields other than medicine, illustrated here by the case of choosing to produce a successful television series based on user profiling. The take-home message is that the amount of data collected does not automatically guarantee success but that, instead of being data-driven, a collective "human" overview and assessment is inevitable. That is, close collaboration between clinicians and data analysts, integrating expertise, is needed to address challenges in the diagnosis and treatment of complex diseases through imagination and not mere extrapolation.
Topics: Humans; Patients; Medicine; Anti-Bacterial Agents; Big Data; Biotechnology
PubMed: 38526380
DOI: 10.1701/4246.42228 -
Giornale Italiano Di Cardiologia (2006) Apr 2024At the dawn of "metaclinical medicine" era, shared decision-making represents the overcoming of modern medicine guidelines and classical medicine experience. The...
At the dawn of "metaclinical medicine" era, shared decision-making represents the overcoming of modern medicine guidelines and classical medicine experience. The patient's life plan, the doctor's health plan, the scientist's evidence-based plan, the administrator's plan and the beliefs of the society for healthcare options should be integrated into the shared decision-making process to avoid patient's unrealistic expectations, doctor's self-referential and defensive medicine, the science without compassion of the scientist, the administered medicine of the politician, the herd mentality of artificial intelligence. For a doctor who must evaluate according to science and conscience, it becomes difficult to make decisions about a patient who thinks that there can be "no decisions about me without me". It risks being a pure declamatory statement in the absence of clinical knowledge and the associated concept of probability. The idea of moving from informed consent to shared probability is convenient for both the doctor and the patient but not for litigation professionals. Even in metaclinical medicine, clinical decision support systems, if well governed, would facilitate the choice of the best treatment according to the definition of absolute risk reduction and the number of patients to be treated to avoid an event, leaving it up to the doctor-patient relationship the narrative and the choice of the most appropriate treatment, which also requires taking care of the emotional and compassionate aspects.
Topics: Humans; Artificial Intelligence; Physician-Patient Relations; Informed Consent; Physicians; Probability
PubMed: 38526358
DOI: 10.1714/4244.42203 -
Therapeutic Advances in Ophthalmology 2024New developments in artificial intelligence, particularly with promising results in early detection and management of keratoconus, have favorably altered the natural... (Review)
Review
BACKGROUND
New developments in artificial intelligence, particularly with promising results in early detection and management of keratoconus, have favorably altered the natural history of the disease over the last few decades. Features of artificial intelligence in different machine such as anterior segment optical coherence tomography, and femtosecond laser technique have improved safety, precision, effectiveness, and predictability of treatment modalities of keratoconus (from contact lenses to keratoplasty techniques). These options ingrained in artificial intelligence are already underway and allow ophthalmologist to approach disease in the most non-invasive way.
OBJECTIVES
This study comprehensively describes all of the treatment modalities of keratoconus considering machine learning strategies.
DESIGN
A multidimensional comprehensive systematic narrative review.
DATA SOURCES AND METHODS
A comprehensive search was done in the five main electronic databases (PubMed, Scopus, Web of Science, Embase, and Cochrane), without language and time or type of study restrictions. Afterward, eligible articles were selected by screening the titles and abstracts based on main mesh keywords. For potentially eligible articles, the full text was also reviewed.
RESULTS
Artificial intelligence demonstrates promise in keratoconus diagnosis and clinical management, spanning early detection (especially in subclinical cases), preoperative screening, postoperative ectasia prediction after keratorefractive surgery, and guiding surgical decisions. The majority of studies employed a solitary machine learning algorithm, whereas minor studies assessed multiple algorithms that evaluated the association of various keratoconus staging and management strategies. Last but not least, AI has proven effective in guiding the implantation of intracorneal ring segments in keratoconus corneas and predicting surgical outcomes.
CONCLUSION
The efficient and widespread clinical translation of machine learning models in keratoconus management is a crucial goal of potential future approaches to better visual performance in keratoconus patients.
TRIAL REGISTRATION
The article has been registered through PROSPERO, an international database of prospectively registered systematic reviews, with the ID: CRD42022319338.
PubMed: 38516169
DOI: 10.1177/25158414241232258 -
La Tunisie Medicale Dec 2023Access to medication is a major public health issue worldwide and can be considered as an indicator of the quality of public health services in a country.
INTRODUCTION
Access to medication is a major public health issue worldwide and can be considered as an indicator of the quality of public health services in a country.
AIM
To evaluate patient satisfaction with the services provided by the external pharmacy in the drug distribution circuit in public healthcare facilities in Tunisia.
METHODS
To achieve this goal, a satisfaction survey was conducted on a sample of 200 patients at the external pharmacies of two university hospitals in Tunis, namely the La Rabta University Hospital and the Charles Nicolle University Hospital.
RESULTS
This survey revealed that despite the efforts made by the state and the importance of the drug market in Tunisia, 80% of patients reported difficulties in finding their medication in the healthcare facilities where they consult, and more than 60% are forced to obtain them from private pharmacies. The survey also highlighted a contrast between the quality of services provided by the external hospital pharmacy and those of private pharmacies. Indeed, only 25% of the surveyed patients were satisfied with the services provided by the external pharmacy. Although this satisfaction was conditioned by several factors, the main concern of the patients remained the availability of medication. In fact, with little difference in terms of care, 80.5% of the participants favored the idea of transferring the services provided by the external pharmacy to private pharmacies.
CONCLUSION
In summary, this study has highlighted the need to rethink the drug supply and distribution system and to explore alternative approaches to significantly improve access to medication and the quality of services provided by external pharmacies in Tunisian public hospitals.
Topics: Humans; Pharmacies; Tunisia; Pharmacy; Delivery of Health Care; Surveys and Questionnaires
PubMed: 38477198
DOI: No ID Found -
Zhonghua Yi Shi Za Zhi (Beijing, China... Jan 2024The Dictionary of Chinese Medicine,«») is the first comprehensive dictionary of traditional Chinese medicine in China. The dictionary, edited by Xie Guan()and compiled...
The Dictionary of Chinese Medicine,«») is the first comprehensive dictionary of traditional Chinese medicine in China. The dictionary, edited by Xie Guan()and compiled for several years by the teachers and students of Shanghai Special School of Traditional Chinese Medicine, was first published by The Commercial Press in 1921. In 1919, Lu Simian() joined The Commercial Press to assist Xie Guan who is his old friend in compiling the contents on medical books for the dictionary . In the same year, Lu Simian wrote a book called («»). Recently, some scholars believe that Xie Guan disassembled and compiled it into . Through a comparative study of these two, it can be seen that and do use homologous materials in the interpretation of some medical books, but as a whole is not compiled into , and the idea of there is a plagiarism relationship between them is incorrect.
Topics: Humans; China; Medicine, Chinese Traditional; Books; Writing
PubMed: 38475685
DOI: 10.3760/cma.j.cn112155-20230914-00027 -
Zhonghua Yi Shi Za Zhi (Beijing, China... Jan 2024"Wu shan qi e"(five symptoms with good prognosis and seven with poor prognosis)is a theory used to determine the prognosis of external diseases in traditional Chinese...
"Wu shan qi e"(five symptoms with good prognosis and seven with poor prognosis)is a theory used to determine the prognosis of external diseases in traditional Chinese medicine which have been mentioned in many ancient Chinese medicine books and have been valued by external doctors throughout history. However, it has been rarely discussed in modern literature. The theory were first seen in the , and the idea was originated from Ni Shun in "Wu shan qi e"have evolved into many variants through the exertion of medical practitioners throughout history. By reviewing medical books of previous dynasties, it was found that there are two main versions: the version and its derivative versions, and the version and its derivative versions.
Topics: Humans; Qi; Medicine, Chinese Traditional; Physicians; Books; China
PubMed: 38475679
DOI: 10.3760/cma.j.cn112155-20231108-00052 -
Die Anaesthesiologie Apr 2024Various professional groups are involved in the daily work of the central operating room with the aim of providing the best possible treatment for each individual using...
BACKGROUND
Various professional groups are involved in the daily work of the central operating room with the aim of providing the best possible treatment for each individual using modern medical technology (sociotechnical system) in a cost-effective manner. Ensuring perioperative patient safety is of particular importance. At the same time, the efficient use of the central operating room is essential for the economic success of a hospital. Preoperative preparation is a complex process with many substeps that are often difficult to manage. Historically, the focus has been on retrospective learning from errors and incidents. More recent approaches take a systemic view. A central idea is to consider the mostly positive course of treatment and the adjustments to daily work that are currently required by the people involved (Safety-II). By taking greater account of how the many components of the system interact, processes can be better understood and specific measures derived. This strengthens the system's ability to adapt to changes and disturbances, thus ensuring that goals are achieved. The functional resonance analysis method (FRAM) is an internationally recognized method for modelling work as done compared to work as imagined. This paper presents the application of FRAM to preoperative preparation in a major regional hospital.
OBJECTIVE
Is FRAM suitable for improving process understanding in preoperative preparation?
MATERIAL AND METHODS
An interdisciplinary project team identified relevant functions of preoperative preparation through document analysis and walkthroughs. Based on this, more than 30 guided interviews were conducted with functionaries. The results were presented graphically and specific information, such as safety-related statements or reasons for the variability of functions, were also presented textually. In the next phase, statements were evaluated and compared with the target model and the job descriptions.
RESULTS
The FRAM revealed the process as a complex network of relationships. During the modelling process, a varying degree of centrality and variability of certain functions became apparent. From the observations, the project team selected those with high relevance for patient safety and for the efficiency of the overall process in order to prioritize starting points for deriving measures to increase resilience. These starting points relate either to single functions, such as surgical site marking or to multiple functions that are variable in their execution, such as delays due to nonsynchronized duty times.
CONCLUSION
The FRAM conducted provides valuable new insights into the functioning of complex sociotechnical systems that go far beyond classical linear methods. The awareness of operational processes gained and the resulting dynamic view of interactions within the system enable specific measures to be derived that promote resilient behavior and reduce critical variability, thus contributing to increased patient safety and efficiency.
Topics: Humans; Operating Rooms; Retrospective Studies; Patient Safety; Efficiency; Hospitals
PubMed: 38459378
DOI: 10.1007/s00101-024-01390-9