Safeguarding Infant Brains: A Multidisciplinary Challenge—Results of a Survey, Update on Current Scientific Evidence, and Recommendations on How to Deal with Possible Anesthetic Drug Neurotoxicity

2017 ◽  
Vol 28 (05) ◽  
pp. 400-405
Author(s):  
John Vlot ◽  
Rene Wijnen ◽  
Frank Weber
Keyword(s):  
Pediatric Surgery ◽  
Scientific Evidence ◽  
Pediatric Anesthesia ◽  
Daily Practice ◽  
Scientific Data ◽  
Shared Responsibility ◽  
Neutral Position ◽  
Anesthetic Drug ◽  
Anesthetic Drugs ◽  
Prospective Longitudinal

Introduction Potential neurotoxicity of anesthetic drugs has been among the most intensively discussed issue in pediatric anesthesia for more than 10 years. It remains unclear how far this discussion has reached the European pediatric surgical community. Our aim was to investigate the thoughts of pediatric surgeons regarding this topic. In addition, we provide an update on the current scientific evidence regarding neurotoxicity together with recommendations for clinical practice. Materials and Methods A web-based survey to assess the thoughts of practicing European pediatric surgeons regarding neurotoxicity and how it may have influenced their daily practice of pediatric surgery was launched via the European Pediatric Surgeons' Association Web site. Results A total of 72 responses could be analyzed. A majority of the respondents were interested in the topic but felt a need to further explore it. Thirty-one respondents have changed their daily practice of pediatric surgery due to potential anesthetic drug toxicity. Eighteen respondents reported to be concerned about neurotoxicity, 29 held a neutral position, and 8 were not concerned. Twenty-seven respondents found it a shared responsibility of the surgeon and the anesthesiologist to deal with the neurotoxicity issue. The majority of respondents found a necessity for further research on anesthetic drug neurotoxicity, assigning the highest priority to prospective longitudinal human studies and the lowest to animal studies. Conclusion The neurotoxicity question has reached the pediatric surgical community. Currently available scientific data do not support the theory of anesthetic drug-induced neurotoxicity in young children. Recent interdisciplinary clinical research focuses on neurodevelopmental outcome after surgery in neonates and infants. The European Safe Anesthesia For Every Tot initiative suggests focusing on proper conduct of anesthesia in children rather than on possible anesthetic drug neurotoxicity.

scholarly journals POS1391 MEASURING SUBCLINICAL INFLAMMATION IN HAND AND FOREFOOT IN PATIENTS WITH ARTHRALGIA USING 1.5T OR 3.0T MRI: DOES FIELD STRENGTH MATTER?

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 978.1-978
Author(s):  
D. Krijbolder ◽  
M. Verstappen ◽  
F. Wouters ◽  
L. R. Lard ◽  
P. D. De Buck ◽  
...  
Keyword(s):  
Field Strength ◽  
Scientific Evidence ◽  
Correlation Coefficients ◽  
Daily Practice ◽  
Scientific Data ◽  
Imaging Features ◽  
Subclinical Inflammation ◽  
The Individual ◽  
3.0T Mri ◽  
Inflammation Score

Background:Magnetic resonance imaging (MRI) of small joints sensitively detects inflammation. MRI-detected subclinical inflammation, and tenosynovitis in particular, has been shown predictive for RA development in patients with arthralgia. These scientific data are mostly acquired on 1.0T-1.5T MRI scanners. However, 3.0T MRI is nowadays increasingly used in practice. Evidence on the comparability of these field strengths is scarce and it has never been studied in arthralgia where subclinical inflammation is subtle. Moreover, comparisons never included tenosynovitis, which is, of all imaging features, the strongest predictor for progression to RA.Objectives:To determine if there is a difference between 1.5T and 3.0T MRI in detecting subclinical inflammation in arthralgia patients.Methods:2968 locations (joints, bones or tendon sheaths) in hands and forefeet of 28 arthralgia patients were imaged on both 1.5T and 3.0T MRI. Two independent readers scored for erosions, osteitis, synovitis (according to RAMRIS) and tenosynovitis (as described by Haavaardsholm et al.). Scores were also summed as total inflammation (osteitis, synovitis and tenosynovitis) and total RAMRIS (erosions, osteitis, synovitis and tenosynovitis) scores. Interreader reliability (comparing both readers) and field strength agreement (comparing 1.5T and 3.0T) was assessed with interclass correlation coefficients (ICCs). Next, field strength agreement was assessed after dichotomization into presence or absence of inflammation. Analyses were performed on patient- and location-level.Results:ICCs between readers were excellent (>0.90). Comparing 1.5 and 3.0T revealed excellent ICCs of 0.90 (95% confidence interval 0.78-0.95) for the total inflammation score and 0.90 (0.78-0.95) for the total RAMRIS score. ICCs for individual inflammation features were: tenosynovitis: 0.87 (0.74-0.94), synovitis 0.65 (0.24-0.84) and osteitis 0.96 (0.91-0.98). The field strength agreement on dichotomized scores was 83% for the total inflammation score and 89% for the total RAMRIS score. Of the individual features, agreement for tenosynovitis was the highest (89%). Analyses on location- level showed similar results.Conclusion:Agreement of subclinical inflammation scores on 1.5T and 3.0T were good to excellent, in particular for tenosynovitis. This suggests that scientific evidence on predictive power of MRI in arthralgia patients, obtained on 1.5T, can be generalized to 3.0T when this field strength would be used for diagnostic purposes in daily practice.Disclosure of Interests:None declared

Treatment of varicose tributaries with sclerotherapy with polidocanol 0.5 % foam

VASA ◽  
2010 ◽  
Vol 39 (2) ◽  
pp. 169-174 ◽  
Author(s):  
Reich-Schupke ◽  
Weyer ◽  
Altmeyer ◽  
Stücker
Keyword(s):  
Scientific Evidence ◽  
Daily Practice ◽  
Severe Adverse Effect ◽  
Safe Procedure ◽  
Efficacy And Safety ◽  
Foam Sclerotherapy ◽  
History Of ◽  
One Year ◽  
Additional Therapy

Background: Although foam sclerotherapy of varicose tributaries is common in daily practice, scientific evidence for the optimal sclerosant-concentration and session-frequency is still low. This study aimed to increase the knowledge on foam sclerotherapy of varicose tributaries and to evaluate the efficacy and safety of foam sclerotherapy with 0.5 % polidocanol in tributaries with 3-6 mm in diameter. Patients and methods: Analysis of 110 legs in 76 patients. Injections were given every second or third day. A maximum of 1 injection / leg and a volume of 2ml / injection were administered per session. Controls were performed approximately 6 months and 12 months after the start of therapy. Results: 110 legs (CEAP C2-C4) were followed up for a period of 14.2 ± 4.2 months. Reflux was eliminated after 3.4 ± 2.7 injections per leg. Insufficient tributaries were detected in 23.2 % after 6.2 ± 0.9 months and in 48.2 % after 14.2 ± 4.2 months, respectively. Only 30.9 % (34 / 110) of the legs required additional therapy. In 6.4 % vein surgery was performed, in 24.5 % similar sclerotherapy was repeated. Significantly fewer sclerotherapy-sessions were required compared to the initial treatment (mean: 2.3 ± 1.4, p = 0.0054). During the whole study period thrombophlebitis (8.2 %), hyperpigmentation (14.5 %), induration in the treated region (9.1 %), pain in the treated leg (7.3 %) and migraine (0.9 %) occurred. One patient with a history of thrombosis developed thrombosis of a muscle vein (0.9 %). After one year there were just hyperpigmentation (8.2 %) and induration (1.8 %) left. No severe adverse effect occurred. Conclusions: Foam sclerotherapy with injections of 0.5 % polidocanol every 2nd or 3rd day, is a safe procedure for varicose tributaries. The evaluation of efficacy is difficult, as it can hardly be said whether the detected tributaries in the controls are recurrent veins or have recently developed in the follow-up period. The low number of retreated legs indicates a high efficacy and satisfaction of the patients.

scholarly journals Traditional Applications of Tannin Rich Extracts Supported by Scientific Data: Chemical Composition, Bioavailability and Bioaccessibility

Foods ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 251
Author(s):  
Maria Fraga-Corral ◽  
Paz Otero ◽  
Lucia Cassani ◽  
Javier Echave ◽  
Paula Garcia-Oliveira ◽  
...  
Keyword(s):  
Chemical Composition ◽  
Chemical Nature ◽  
Scientific Evidence ◽  
Scientific Data ◽  
Attractive Alternative ◽  
Chemical Profile ◽  
Traditional Use ◽  
Starting Point ◽  
Scientific Approach ◽  
Food Applications

Tannins are polyphenolic compounds historically utilized in textile and adhesive industries, but also in traditional human and animal medicines or foodstuffs. Since 20th-century, advances in analytical chemistry have allowed disclosure of the chemical nature of these molecules. The chemical profile of extracts obtained from previously selected species was investigated to try to establish a bridge between traditional background and scientific data. The study of the chemical composition of these extracts has permitted us to correlate the presence of tannins and other related molecules with the effectiveness of their apparent uses. The revision of traditional knowledge paired with scientific evidence may provide a supporting background on their use and the basis for developing innovative pharmacology and food applications based on formulations using natural sources of tannins. This traditional-scientific approach can result useful due to the raising consumers’ demand for natural products in markets, to which tannin-rich extracts may pose an attractive alternative. Therefore, it is of interest to back traditional applications with accurate data while meeting consumer’s acceptance. In this review, several species known to contain high amounts of tannins have been selected as a starting point to establish a correlation between their alleged traditional use, tannins content and composition and potential bioaccessibility.

Parental Presence during Induction of Anesthesia Improves Compliance of the Child and Reduces Emergence Delirium

2021 ◽  
Author(s):  
Diego Gil Mayo ◽  
Pascual Sanabria Carretero ◽  
Luis Gajate Martin ◽  
Jose Alonso Calderón ◽  
Francisco Hernández Oliveros ◽  
...  
Keyword(s):  
Pediatric Surgery ◽  
Pediatric Anesthesia ◽  
Preoperative Anxiety ◽  
Preoperative Preparation ◽  
Parental Presence ◽  
Emergence Delirium ◽  
Group 2 ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Preparation Strategy

Abstract Introduction Preoperative stress and anxiety in pediatric patients are associated with poor compliance during induction of anesthesia and a higher incidence of postoperative maladaptive behaviors. The aim of our study was to determine which preoperative preparation strategy improves compliance of the child during induction and decreases the incidence and intensity of emergence delirium (ED) in children undergoing ambulatory pediatric surgery. Materials and Methods This prospective observational study included 638 pediatric American Society of Anesthesiologists I–II patients who underwent ambulatory pediatric surgery, grouped into four preoperative preparation groups: NADA (not premedicated), MDZ (premedicated with midazolam), PPIA (parental presence during induction of anesthesia), and PPIA + MDZ. The results were subsequently analyzed in four age subgroups: Group 1 (0–12 months), Group 2 (13–60 months), Group 3 (61–96 months), and Group 4 (> 96 months). Preoperative anxiety (modified Yale Preoperative Anxiety Scale [m-YPAS]), compliance of the child during induction (Induction Compliance Checklist [ICC]), and ED (Pediatric Anesthesia Emergence Delirium scale) were analyzed in each group. Results Eighty-one percent of patients in the PPIA + MDZ preparation group presented a perfect compliance during the induction of anesthesia (ICC = 0), less preoperative anxiety (mean score m-YPAS = 26), less probability of ED (odds ratio: 10, 5 [3–37.5]; p < 0.05), and less ED intensity compared with the NADA group (1.2 vs. 5.8; p = 0.001). Conclusion PPIA associated with midazolam premedication improves compliance during induction and decreases the incidence and intensity of ED.

Scientific basis of the System for Analysis of Validity in Evaluation: The SAVE Metaprotocol.

2021 ◽  
Vol 2 (2) ◽  
pp. 3679-3684
Author(s):  
Antonio Domínguez-Muñoz
Keyword(s):  
Disability Pension ◽  
Scientific Evidence ◽  
Daily Practice ◽  
Scientific Basis ◽  
Third Party ◽  
Significant Advance ◽  
Fraud Triangle ◽  
Clinical Context ◽  
Academic Knowledge ◽  
Flexible Application

There are multiple situations, often related to the administrative or judicial field, in which it is necessary to use a healthy skepticism, to question the validity of an assertion, appealing to the evidence that can prove or disprove it. (Shermer, 2008). From a child custody issue to facing a harsh criminal conviction, to applying for a disability pension or obtaining an indemnity in an insurance context; in all of them, there is the opportunity to use deception for one's own benefit, harming a third party, through fraud. As we know, opportunity, together with prior motivation or incentive and subsequent justification, constitute the classic fraud triangle proposed by Cressey (1961).             This questioning of the validity of the case understood as its accuracy or correspondence with what it pretends to be and independently of its various types, is only possible from a method of analysis based on scientific evidence that benefits from using a system ordered by rules for the investigation - which we know as a protocol (Amezcua, 2000) - as well as a multiple approaches (Campbell and Fiske, 1959) that is proportionate to a conception of the detection and demonstration of deception from the approach of complexity (Cardozo, 2011). If, in addition, such a system was sufficiently flexible to be useful in the daily practice of the various fields in which it may be necessary to use it, it could represent a significant advance in this area.             These, together with those of Behavior Analysis in Ethology, Criminology, and Psychology, are the initial theoretical bases on which the System of Analysis of Validity in Evaluation (SAVE) is designed, establishing four phases in two domains of multiple and orderly but flexible application, to scientifically question the validity of a case and provide it with consistency and even legal value when appropriate. Although SAVE was born in a clinical context (Domínguez-Muñoz et al., 2014) its main area of knowledge is the study of lying and deception, an area in which there is a large bibliography, somewhat dispersed among various disciplines, which must be incorporated as a source of academic knowledge for its use in the applied field (Domínguez-Muñoz et al., 2017).    

scholarly journals How effective is dog culling in controlling zoonotic visceral leishmaniasis? a critical evaluation of the science, politics and ethics behind this public health policy

2011 ◽  
Vol 44 (2) ◽  
pp. 232-242 ◽  
Author(s):  
Carlos Henrique Nery Costa
Keyword(s):  
Visceral Leishmaniasis ◽  
Control Measure ◽  
Scientific Evidence ◽  
Critical Evaluation ◽  
Scientific Data ◽  
Ethical Considerations ◽  
Brazilian Government ◽  
Kala Azar ◽  
Scientific Results

INTRODUCTION: Zoonotic kala-azar, a lethal disease caused by protozoa of the genus Leishmania is considered out of control in parts of the world, particularly in Brazil, where transmission has spread to cities throughout most of the territory and mortality presents an increasing trend. Although a highly debatable measure, the Brazilian government regularly culls seropositive dogs to control the disease. Since control is failing, critical analysis concerning the actions focused on the canine reservoir was conducted. METHODS: In a review of the literature, a historical perspective focusing mainly on comparisons between the successful Chinese and Soviet strategies and the Brazilian approach is presented. In addition, analyses of the principal studies regarding the role of dogs as risk factors to humans and of the main intervention studies regarding the efficacy of the dog killing strategy were undertaken. Brazilian political reaction to a recently published systematic review that concluded that the dog culling program lacked efficiency and its effect on public policy were also reviewed. RESULTS: No firm evidence of the risk conferred by the presence of dogs to humans was verified; on the contrary, a lack of scientific support for the policy of killing dogs was confirmed. A bias for distorting scientific data towards maintaining the policy of culling animals was observed. CONCLUSIONS: Since there is no evidence that dog culling diminishes visceral leishmaniasis transmission, it should be abandoned as a control measure. Ethical considerations have been raised regarding distorting scientific results and the killing of animals despite minimal or absent scientific evidence

Pediatric Anesthesia

PEDIATRICS ◽  
1949 ◽  
Vol 4 (4) ◽  
pp. 539-539
Keyword(s):  
Pediatric Surgery ◽  
Reference Data ◽  
Pediatric Anesthesia ◽  
Infants And Children ◽  
Good Source ◽  
Extensive Experience ◽  
Present Volume ◽  
Young Subjects ◽  
Made In

For those who are interested in the advancement of pediatric surgery, it has long been obvious that improvements should be made in anesthesia for infants and children. Much credit should go to Drs. Leigh and Beltom for their important efforts in this direction. The present volume is based on an extensive experience with anesthesia technics in young subjects and hence bears a mark of authority. The book is a good source of reference data for those who are called upon to work in this field.

Do we trust scientific evidence? A multicentre retrospective analysis of first IVF/ICSI cycles before and after the OPTIMIST trial

2021 ◽  
Vol 36 (5) ◽  
pp. 1367-1375
Author(s):  
E Papaleo ◽  
A Revelli ◽  
M Costa ◽  
M Bertoli ◽  
S Zaffagnini ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Conflicts Of Interest ◽  
Controlled Trial ◽  
Scientific Evidence ◽  
Daily Practice ◽  
Vitro Fertilization ◽  
Starting Dose ◽  
Before And After ◽  
Competing Interest

Abstract STUDY QUESTION Has the practice of individualizing the recombinant-FSH starting dose been superseded after the largest randomized controlled trial (RCT) in assisted reproduction technology (ART), the OPTIMIST trial? SUMMARY ANSWER The OPTIMIST trial has influenced our ART daily practice to a limited degree, but adherence is still generally poor. WHAT IS KNOWN ALREADY Although the ‘one size fits all’ approach has been discouraged for decades by most authors, the OPTIMIST study group demonstrated in a large prospective RCT that, in general, dosage individualization does not improve the prospects for live birth, although it may decrease ovarian hyperstimulation syndrome (OHSS) risk in expected high responders. STUDY DESIGN, SIZE, DURATION Retrospective analysis of all first in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles from 1st January 2017 to 31st December 2018, before and after the OPTIMIST publication on November 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS Two thousand six hundred and seventy-seven patients, between 18 and 42 years old, undergoing their first IVF-ICSI cycle in seven Italian fertility centres, were included. Patients were allocated to three groups according to their ovarian reserve markers: predicted poor ovarian responders (POR), predicted normo-responders (NR) and expected hyper-responders (HRs). MAIN RESULTS AND THE ROLE OF CHANCE Between 2017 and 2018, there was an overall increase in prescription of the standard 150 IU dose proposed by the OPTIMIST trial and a reduction in the use of a starting dose &gt;300 IU. After subgroup analysis, the decrease in doses &gt;300 IU remained significant in the POR and NR sub-groups. LIMITATIONS, REASONS FOR CAUTION The retrospective nature of the study. Physicians need time to adapt to new scientific evidence and a comparison between 2017 and 2019 may have found a greater impact of the Optimist trial, although other changes over the longer time span might have increased confounding. We cannot be sure that the observed changes can be attributed to knowledge of the OPTIMIST trial. WIDER IMPLICATIONS OF THE FINDINGS Clinicians may be slow to adopt recommendations based on RCTs; more attention should be given to how these are disseminated and promoted. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this study. E.P. reports grants and personal fees from MSD, grants from Ferring, from IBSA, grants and personal fees from Merck, grants from TEVA, grants from Gedeon Richter, outside the submitted work. E.S. reports grants from Ferring, grants and personal fees from Merck-Serono, grants and personal fees from Theramex, outside the submitted work. All other authors do not have conflicts of interest to declare. TRIAL REGISTRATION NUMBER Not applicable.

Introduction

ESC CardioMed ◽  
2018 ◽  
pp. 1927-1928
Author(s):  
Giuseppe Boriani
Keyword(s):  
Clinical Skills ◽  
Care Delivery ◽  
Scientific Evidence ◽  
Healthcare Providers ◽  
Cardiac Pacing ◽  
Daily Practice ◽  
Specific Patient ◽  
Current Prevalence ◽  
History Of ◽  
The Impact

The history of pacing for bradycardia started more than 50 years ago and in these five decades the technologically driven evolution of devices and tools has been complemented by the acquisition of important scientific evidence of benefit in specific patient settings. The current prevalence of bradyarrhythmias requiring permanent cardiac pacing therapy is not precisely known, but the progressive ageing of the population makes it necessary to improve knowledge of the impact of bradycardia on patients’ health, as well as to improve the implementation in daily practice of the most appropriate and evidence-based device treatments, with an adequate reorganization of care. Moreover, the impressive technological evolution that occurred in this field, as a result of extensive cooperation between physicians, scientists, engineers, manufacturers, regulatory agencies, and healthcare providers, led to the appearance of new requirements such as improved clinical skills, the need for continuous education on rapidly evolving technology, the assessment of treatment costs, the need for consensus guidelines, and the need for reorganization of care delivery including telemedicine for device follow-up.

scholarly journals Deficiencies in Scientific Evidence for Medical Management of Gender Dysphoria

2019 ◽  
Vol 87 (1) ◽  
pp. 34-42 ◽  
Author(s):  
Paul W. Hruz
Keyword(s):  
Gender Identity ◽  
Gender Dysphoria ◽  
Small Sample Size ◽  
Scientific Evidence ◽  
Prospective Trial ◽  
Scientific Data ◽  
Small Sample ◽  
Sex Characteristics ◽  
Biological Sex

Individuals who experience a gender identity that is discordant with biological sex are increasingly presenting to physicians for assistance in alleviating associated psychological distress. In contrast to prior efforts to identify and primarily address underlying psychiatric contributors to gender dysphoria, interventions that include uncritical social affirmation, use of gonadotropin-releasing hormone agonists to suppress normally timed puberty, and administration of cross-sex steroid hormones to induce desired secondary sex characteristics are now advocated by an emerging cohort of transgender medicine specialists. For patients with persistent gender dysphoria, surgery is offered to alter the appearance of breasts and genital organs. Efforts to address ethical concerns regarding this contentious treatment paradigm are dependent upon reliable evidence on immediate and long-term risks and benefits. Although strong recommendations have been made for invasive and potentially irreversible interventions, high-quality scientific data on the effects of this approach are generally lacking. Limitations of the existing transgender literature include general lack of randomized prospective trial design, small sample size, recruitment bias, short study duration, high subject dropout rates, and reliance on “expert” opinion. Existing data reveal significant intervention-associated morbidity and raise serious concern that the primary goal of suicide prevention is not achieved. In addition to substantial moral questions, adherence to established principles of evidence-based medicine necessitates a high degree of caution in accepting gender-affirming medical interventions as a preferred treatment approach. Continued consideration and rigorous investigation of alternate approaches to alleviating suffering in people with gender dysphoria are warranted. Summary: This paper provides an overview of what is currently known about people who experience a gender identity that differs from their biological sex and the associated desire to engage the medical profession in alleviating associated discomfort and distress. The scientific evidence used to support current recommendations for affirming one’s preferred gender, halting normally timed puberty, administering cross-sex hormones, and surgically altering primary and secondary sexual traits are summarized and critically evaluated. Serious deficits in understanding the cause of this condition, the reasons for the marked increase in people presenting for medical care, together with immediate and long-term risks relative to benefit of medical intervention are exposed.

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