This presentation highlights core pharmacological aspects of opioid and non-opioid pain medications in the elderly patient. Specifically, it covers pharmakinetics, pharmacodynamics and drug-drug ...interactions of select pain medications. The presentation aims to promote safe use of pain medications in the elderly.
Disclosure
No significant relationships.
Transpedicular screw fixation has been accepted worldwide since Harrington et al. first placed pedicle screws through the isthmus. In vivo and in vitro studies indicated that pedicle screw insertion ...accuracy could be significantly improved with image-assisted systems compared with conventional approaches. The O-arm is a new generation intraoperative imaging system designed without compromise to address the needs of a modern OR like no other system currently available. The aim of our study was to check the accuracy of O-arm based and S7-navigated pedicle screw implants in comparison to free-hand technique described by Roy-Camille at the lumbar and sacral spine using CT scans. The material of this study was divided into two groups, free-hand group (group I) (30 patients; 152 screws) and O-arm group (37 patients; 187 screws). The patients were operated upon from January to September 2009. Screw implantation was performed during PLIF or TLIF mainly for spondylolisthesis, osteochondritis and post-laminectomy syndrome. The accuracy rate in our work was 94.1% in the free-hand group compared to 99% in the O-arm navigated group. Thus it was concluded that free-hand technique will only be safe and accurate when it is in the hands of an experienced surgeon and the accuracy of screw placement with O-arm can reach 100%.
Interactions between the pharmaceutical industry and physicians have recently received attention for their potential to create conflicts of interest in clinical practice, research and education. As a ...consequence, several medical and psychiatric associations including the EPA have published guidance papers to encourage best practice. In this context, the European Federation of Psychiatric Trainees (EFPT) performed a cross-sectional survey among European psychiatric trainees in order to ascertain the current level of interactions, as well as beliefs and attitudes towards interactions with the pharmaceutical industry. Responses from 1444 psychiatric trainees from 20 countries were obtained and reveal important differences in the level of interactions across Europe. Assigning a an educational role to the pharmaceutical industry and aid by senior psychiatrists in organizining industry-sponsored events were associated with a higher degree of interactions. Creating alternative, non-industry-sponsored educational opportunities and specific training dedicated to industry interactions may help to reduce the impact of the pharmaceutical industry on psychiatric training in the future.
Behavioural and psychological symptoms of dementia (BPSD) such as agitation, aggressive behaviour, repetitive vocalizations, apathy, etc. are a frequent challenge in the care for patients with ...dementia. BPSD are furthermore associated with individual suffering, reduced quality of life and caregiver burden. This talk will provide an update on current pharmacological and non-pharmacological treatment strategies for BPSD on the basis of the relevant guidelines and a review of the current literature. For pharmacological treatment, the focus has recently shifted from antipsychotics to antidepressants due to their more favourable risk/benefit profile. Treatment algorithms that include behavioural diagnostics and both pharmacological and non-pharmacological interventions will be presented as a tool to guide clinical practice.
Soil texture is important for many environmental processes. In this paper, we study the classification of soil texture based on hyperspectral data. We develop and implement three 1-dimensional (1D) ...convolutional neural networks (CNN): the LucasCNN, the LucasResNet which contains an identity block as residual network, and the LucasCoordConv with an additional coordinates layer. Furthermore, we modify two existing 1D CNN approaches for the presented classification task. The code of all five CNN approaches is available on GitHub (Riese, 2019). We evaluate the performance of the CNN approaches and compare them to a random forest classifier. Thereby, we rely on the freely available LUCAS topsoil dataset. The CNN approach with the least depth turns out to be the best performing classifier. The LucasCoordConv achieves the best performance regarding the average accuracy. In future work, we can further enhance the introduced LucasCNN, LucasResNet and LucasCoordConv and include additional variables of the rich LUCAS dataset.
Introduction
Although pedicle screw fixation is a well-established technique for the lumbar spine, screw placement in the thoracic spine is more challenging because of the smaller pedicle size and ...more complex 3D anatomy. The intraoperative use of image guidance devices may allow surgeons a safer, more accurate method for placing thoracic pedicle screws while limiting radiation exposure. This generic 3D imaging technique is a new generation intraoperative CT imaging system designed without compromise to address the needs of a modern OR.
Aim
The aim of our study was to check the accuracy of this generic 3D navigated pedicle screw implants in comparison to free hand technique described by Roy-Camille at the thoracic spine using CT scans.
Material and methods
The material of this study was divided into two groups: free hand group (group I) (18 patients; 108 screws) and 3D group (27 patients; 100 screws). The patients were operated upon from January 2009 to March 2010. Screw implantation was performed during internal fixation for fractures, tumors, and spondylodiscitis of the thoracic spine as well as for degenerative lumbar scoliosis.
Results
The accuracy rate in our work was 89.8 % in the free hand group compared to 98 % in the generic 3D navigated group.
Conclusion
In conclusion, 3D navigation-assisted pedicle screw placement is superior to free hand technique in the thoracic spine.
Empirical knowledge around palliative care provision and needs of people with intellectual disabilities is extremely limited, as is the availability of research resources, including expertise and ...funding. This paper describes a consultation process that sought to develop an agenda for research priorities for palliative care of people with intellectual disabilities in Europe.
A two-day workshop was convened, attended by 16 academics and clinicians in the field of palliative care and intellectual disability from six European countries. The first day consisted of round-table presentations and discussions about the current state of the art, research challenges and knowledge gaps. The second day was focused on developing consensus research priorities with 12 of the workshop participants using nominal group technique, a structured method which involved generating a list of research priorities and ranking them in order of importance.
A total of 40 research priorities were proposed and collapsed into eleven research themes. The four most important research themes were: investigating issues around end of life decision making; mapping the scale and scope of the issue; investigating the quality of palliative care for people with intellectual disabilities, including the challenges in achieving best practice; and developing outcome measures and instruments for palliative care of people with intellectual disabilities.
The proposal of four major priority areas and a range of minor themes for future research in intellectual disability, death, dying and palliative care will help researchers to focus limited resources and research expertise on areas where it is most needed and support the building of collaborations. The next steps are to cross-validate these research priorities with people with intellectual disabilities, carers, clinicians, researchers and other stakeholders across Europe; to validate them with local and national policy makers to determine how they could best be incorporated in policy and programmes; and to translate them into actual research studies by setting up European collaborations for specific studies that require such collaboration, develop research proposals and attract research funding.
Abstract
Transcatheter aortic valve implantation (TAVI) is currently considered an acceptable alternative for the treatment of patients with severe aortic stenosis and a high perioperative risk or a ...contraindication for open surgery. The benefit of TAVI significantly outweighs the risk of the procedure in patients requiring treatment that are not suitable for open surgery, and leads to a lower mortality in the one-year follow-up. The absence of a direct view of the aortic root and valve remains a challenge for the transcatheter approach. While direct inspection of the aortic valve during open surgery allows an adequate prosthesis choice, it is crucial for TAVI to know the individual anatomical details prior to the procedure in order to assure adequate planning of the procedure and proper prosthesis choice and patient selection. Among the imaging modalities available for the evaluation of patients prior to TAVI, computed tomography (CT) plays a central role in patient selection. CT reliably visualizes the dimensions of the aortic root and allows a proper choice of the prosthesis size. The morphology of the access path and relevant comorbidities can be assessed. The present review summarizes the current state of knowledge regarding the value of CT in the evaluation of patients prior to TAVI.
Key Points:
CT plays a central role in patient selection and planning prior to TAVI.
CT reliably detects the dimensions of the aortic root including the size of the aortic annulus, the degree of valve calcification and the morphology of the access routes.
CT provides a more accurate measurement of the aortic annulus than 2D TEE and CT is the only imaging modality that allows a risk assessment for paravalvular leakages based on the calcification of the aortic valve.
Citation Format:
Lehmkuhl L, Foldyna B, Haensig M et al. Role of Preprocedural Computed Tomography in Transcatheter Aortic Valve Implantation. Fortschr Röntgenstr 2013; 185: 941-949
Abstract Background Interactions between the pharmaceutical industry (PI) and psychiatrists have been under scrutiny recently, though there is little empirical evidence on the nature of the ...relationship and its intensity at psychiatry trainee level. We therefore studied the level of PI interactions and the underlying beliefs and attitudes in a large sample of European psychiatric trainees. Methods One thousand four hundred and forty-four psychiatric trainees in 20 European countries were assessed cross-sectionally, with a 62-item questionnaire. Results The total number of PI interactions in the preceding two months varied between countries, with least interactions in The Netherlands (M (Mean) = 0.92, SD = 1.44, range = 0–12) and most in Portugal (M = 19.06, SD = 17.44, range = 0–100). Trainees were more likely to believe that PI interactions have no impact on their own prescribing behaviour than that of other physicians (M = 3.30, SD = 1.26 vs. M = 2.39, SD = 1.06 on a 5-point Likert scale: 1 “completely disagree” to 5 “completely agree”). Assigning an educational role to the pharmaceutical industry was associated with more interactions and higher gift value (IRR (incidence rate ratio) = 1.21, 95%CI = 1.12–1.30 and OR = 1.18, 95%CI = 1.02–1.37). Conclusions There are frequent interactions between European psychiatric trainees and the PI, with significant variation between countries. We identified several factors affecting this interaction, including attribution of an educational role to the PI. Creating alternative educational opportunities and specific training dedicated to PI interactions may therefore help to reduce the impact of the PI on psychiatric training.
In this paper, we investigate the potential of estimating the soil-moisture content based on VNIR hyperspectral data combined with LWIR data. Measurements from a multi-sensor field campaign represent ...the benchmark dataset which contains measured hyperspectral, LWIR, and soil-moisture data conducted on grassland site. We introduce a regression framework with three steps consisting of feature selection, preprocessing, and well-chosen regression models. The latter are mainly supervised machine learning models. An exception are the self-organizing maps which combine unsupervised and supervised learning. We analyze the impact of the distinct preprocessing methods on the regression results. Of all regression models, the extremely randomized trees model without preprocessing provides the best estimation performance. Our results reveal the potential of the respective regression framework combined with the VNIR hyperspectral data to estimate soil moisture measured under real-world conditions. In conclusion, the results of this paper provide a basis for further improvements in different research directions.
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