[Refraining from futile medical treatment in clinical practice. Directives of the Polish pediatric society]. / L'astensione dall'accanimento terapeutico nella pratica clinica. Linee-guida della società polacca.

The continuous development of medicine increases the possibility of sustaining life functions, which frequently leads to prolonging the patient's agony or exposing him/her to unnecessary suffering. The application of some medical procedures, technical equipment and pharmacological measures that prolong the process of dying in terminally ill children may be a sign of therapeutic obstinacy. Such actions are not an outcome of concern for the welfare of young patients and violate their dignity. In the interest of incurable and terminally ill children and considering the needs of physicians who have to make difficult clinical decisions, the Polish Pediatric Society (PPS) ratified the guidelines concerning abandoning and withdrawal of overzealous therapy. The objective of this article was to present the Italian medical society, Polish rules for refraining from overzealous therapy in pediatrics. The commentary to the Directive include the remarks on the dubious concept of "therapeutic obstinacy". Following fragments of the article characterize Polish ideas on terminally ill children's rights, the current situation of these children in medical care, and the origins and character of the document approved by the PPS. The complementation of the commentary are remarks made by a team of experts that develop guidelines which apply to specific clinical problems associated with the care of terminally ill children. This article is yet another voice in the wide debate on the moral imperative of refraining from therapeutic obstinacy in medical practice.

Direct blood PCR in combination with nucleic acid lateral flow immunoassay for detection of Plasmodium species in settings where malaria is endemic.

Declining malaria transmission and known difficulties with current diagnostic tools for malaria, such as microscopy and rapid diagnostic tests (RDTs) in particular at low parasite densities, still warrant the search for sensitive diagnostic tests. Molecular tests need substantial simplification before implementation in clinical settings in countries where malaria is endemic. Direct blood PCR (db-PCR), circumventing DNA extraction, to detect Plasmodium was developed and adapted to be visualized by nucleic acid lateral flow immunoassay (NALFIA). The assay was evaluated in the laboratory against samples from confirmed Sudanese patients (n = 51), returning travelers (n = 214), samples from the Dutch Blood Bank (n = 100), and in the field in Burkina Faso (n = 283) and Thailand (n = 381) on suspected malaria cases and compared to RDT and microscopy. The sensitivity and specificity of db-PCR-NALFIA compared to the initial diagnosis in the laboratory were 94.4% (95% confidence interval [CI] = 0.909 to 0.969) and 97.4% (95% CI = 0.909 to 0.969), respectively. In Burkina Faso, the sensitivity was 94.8% (95% CI = 0.88.7 to 97.9%), and the specificity was 82.4% (95% CI = 75.4 to 87.7%) compared to microscopy and 93.3% (95% CI = 87.4 to 96.7%) and 91.4% (95% CI = 85.2 to 95.3%) compared to RDT. In Thailand, the sensitivity and specificity were 93.4% (CI = 86.4 to 97.1%) and 90.9 (95% CI = 86.7 to 93.9%), respectively, compared to microscopy and 95.6% (95% CI = 88.5 to 98.6%) and 87.1% (95% CI = 82.5 to 90.6) compared to RDT. db-PCR-NALFIA is highly sensitive and specific for easy and rapid detection of Plasmodium parasites and can be easily used in countries where malaria is endemic. The inability of the device to discriminate Plasmodium species requires further investigation.

Nuclear mapping in parathyroidectomy: the impact on operative time.

BACKGROUND: Precise intraoperative localization and identification of hyperactive parathyroid tissue remains one of the most challenging tasks for surgeons performing parathyroidectomies. Among a few adjuvant methods tested recently, a novel technique called nuclear mapping may become a real breakthrough in parathyroid surgery. It is based on intraoperative detection of radioactivity after previous intravenous administration of 99mTc Sestamibi, which is accumulated in hyperactive parathyroid tissue. The purpose of this study was to assess the impact of nuclear mapping on operative time in parathyroidectomy. METHODS: The study was conducted as a retrospective univariable and multivariable analysis of clinical factors potentially influencing the operative time in a group of 27 patients undergoing parathyroidectomy. RESULTS: Univariable analysis revealed that nuclear mapping was associated with significant reduction in operative time (79.4 +/- 62.2 min vs. 135.8 +/- 49.2 min; p = 0.0186); whereas, bilateral neck exploration, partial sternotomy and reoperative neck prolonged the procedure by mean 70.7 +/- 12.9 min (p = 0.0035); 100,9 +/- 50.36 min (p = 0.0154) and 73.3 +/- 22.8 min (p = 0.0081), respectively. Multivariable analysis using a multiple regression model identified nuclear mapping, sternotomy and reoperative neck as independent variables significantly influencing the duration of parathyroidectomy. CONCLUSIONS: Nuclear mapping is an efficient intraoperative adjuvant technique facilitating localization of hyperactive parathyroid tissues in vivo and instantly confirming their identity ex vivo. It guides the surgeon throughout the parathyroidectomy and is associated with significant reduction in operative time.

["Thinking styles" category in the study of the history of medical ideas]. / Kategoria "style myslenia" w badaniu historii idei medycznych.

The author substantiates the thesis that the "thinking style" category reveals-when applied to reflection on the history of medicine-its predominance over other categories covered by the study of the progress of human knowledge, including also the paradigm category. The said predominance lies mainly in synchronic explanation of both the justifying and revealing contents through the "thinking styles" category (using the traditional terminology of the philosophy of knowledge). It becomes also possible to study the aspects not only of "oriented perception" but also "models of culture" as the factors that support one another in the process of elucidating the genesis and evolution of medical ideas. Thus, "thinking styles" cover with its explanatory range a wide field of research, not confined to explaining only one concrete fact or even a unique scientific discovery, but also applied to the system of links between various and even-on the face of it-very remote thinking patterns. The "thinking styles" category opens a perspective and necessity for search in the area of the history of medical thought on a considerably larger scale than in the case of classical, positivistic depictions of the history of medicine. In the opinion of the author, the questions about numerous relations and correlation of the studied discovery with the surrounding social and cultural time and space are unavoidable. When applying the "thinking styles" category, which should provide answers to such questions, it is not possible to escape the need for the studying of an interference network, horizontally and vertically. This calls for interdisciplinary studies that employ philosophical, historical and medical, social and psychological knowledge, which is a strong basis for continuous cooperation between these lines of knowledge to capture and understand the sense of the past. The author exemplifies his views. A long-term process of the migrating of the "microscopic" vision of the world, including the image of a human body, to the "nucleus" (center) that generates pattern thinking in 17th and 18th centuries led to the emergence of historical style of thinking by the end of 18th and in 19th centuries. The aforementioned migration was in all likelihood affected by a tendency encountered in all cultures during the Enlightenment to the rationalistic, materialistic and strictly scientific perception of reality. Here, the "patterns of culture" also play a significant role as elements that have an impact on the creation of thinking styles. Cultural transformations could exert an influence on the emergence of certain medical specialties such as pediatrics. An analysis of the Renaissance views on "eye"-related diseases displays a slow, creeping migration of thinking characteristics from the space of humoral thinking style to the modern thinking areas. Such spreading of beliefs that support the thesis of the continual nature of scientific change in medicine is also visible in the medicine of the 17th century.