Advanced Medical Practice Research Articles

A survey of anesthesiologists aged 60 years and older in Korea: current status, challenges, and future strategies

Background: As the global population ages, medical professionals are also aging. This study investigates the status of Korean anesthesiologists over the age of 60.Methods: Anesthesiologists aged 60 and older, residing and working in Korea, were invited to participate in this study via e-mail from February to March 2021 and by mail from June to August 2021. The survey consisted of 40 questions covering 10 topics, including health status, residence, work style, and economic status. Depending on the type of question, answers were ranked on a scale of 1, 2, and 3, with the most preferred response being selected.Results: A total of 63 responses were received, resulting in a response rate of 26.5%. Among the respondents, 56 were currently practicing as anesthesiologists and reported satisfaction with their clinical practice and life status. On average, they treated 24 patients per day without experiencing significant discomfort or inconvenience in their roles as senior physicians. Twenty-four respondents acknowledged physical discomfort related to aging, and nine expressed cautions regarding age-related changes. Fifty-two respondents indicated that reeducation for advanced medical practice as anesthesiologists was necessary.Conclusions: Senior anesthesiologists in Korea are primarily working in secondary and tertiary hospitals and are satisfied with their current life status. A comprehensive evaluation of reeducation programs for advanced clinical practice and retirement strategies for senior anesthesiologists is needed to address the growing number of aging physicians in the workforce.

Panoramic review on polymeric microneedle arrays for clinical applications.

Transdermal drug delivery (TDD) has significantly advanced medical practice in recent years due to its ability to prevent the degradation of substances in the gastrointestinal tract and avoid hepatic metabolism. Among different available approaches, microneedle arrays (MNAs) technology represents a fascinating delivery tool for enhancing TDD by penetrating the stratum corneum painless and minimally invasive for delivering antibacterial, antifungal, and antiviral medications. Polymeric MNAs are extensively utilized among many available materials due to their biodegradability, biocompatibility, and low toxicity. Therefore, this review provides a comprehensive discussion of polymeric MNAs, starting with understanding stratum corneum and developing MNA technology. Furthermore, the engineering concepts, fundamental considerations, challenges, and future perspectives of polymeric MNAs in clinical applications are properly outlined, offering a comprehensive and unique overview of polymeric MNAs and their potential for a broad spectrum of clinical applications.

ІНТЕГРАЦІЯ БЛОКЧЕЙН-ТЕХНОЛОГІЙ У СИСТЕМУ УПРАВЛІННЯ КАДРОВИМ ПОТЕНЦІАЛОМ МЕДИЧНИХ ЗАКЛАДІВ

The article is devoted to the topical issue of applying blockchain technologies in managing the personnel potential of medical institutions. The authors emphasize the importance of using secure technologies that will prevent hacking communities from accessing confidential personal data, especially in the medical field, where comprehensive information about most citizens is concentrated.
 Despite the significant advantages of blockchain, this technology has been sporadically implemented in Ukraine, particularly in the medical sphere. Most scientific works focus on the advantages and disadvantages of using blockchain in other industries, while its applications in managing the personnel potential of medical institutions are insufficiently covered.
 The aim of the article is to reveal the peculiarities of using blockchain technology in the personnel management system of medical institutions. The article identifies several areas of blockchain application in personnel management of medical facilities: forming a database of patients assigned to specific medical professionals, creating databases of medical achievements, systematizing information about advanced medical practices, managing databases on the professional development of medical staff, optimizing internal communication systems, and improving decision-making algorithms. The advantages, disadvantages, opportunities, and threats of using blockchain in this area are discussed in detail. The risks of implementing the technology in wartime conditions are analyzed separately.
 The introduction of blockchain in managing the personnel potential of medical institutions is a promising direction, which will contribute to the consolidation of data on the professional career development of medical staff, optimization of internal communication systems, improvement of managerial decision-making, and more. The further prospect of using this technology requires the development of effective algorithms for its implementation, taking into account possible risks and challenges.

Technology in Advancing Medical Practice

The role of technology in advancing medical practice and improving patient outcomes is increasingly vital in today's healthcare landscape. In the past few decades, we have seen rapid advancements in medical technology, which have transformed how we diagnose, treat, and prevent diseases. Medical technology has brought about remarkable improvements in patient outcomes and quality of life, as well as reducing healthcare costs.
 One of the most significant advances in medical technology is the development of electronic health records (EHRs). EHRs allow healthcare providers to store patient information electronically, making it more accessible and easier to share between healthcare providers. With EHRs, healthcare providers can access patient records in real-time, enabling them to make informed decisions about patient care. EHRs also enable healthcare providers to track patient outcomes and improve the quality of care provided to patients.
 Medical imaging technology has also revolutionized medical practice. Medical imaging technology includes X-rays, CT scans, MRI, and PET scans. These technologies allow healthcare providers to visualize the inside of a patient's body, enabling them to diagnose and treat diseases more accurately and effectively. In addition, the development of 3D printing technology has allowed healthcare providers to create custom prosthetics and implants for patients, improving their quality of life.
 Telemedicine is another area where technology has advanced medical practice. Telemedicine allows healthcare providers to diagnose and treat patients remotely, reducing the need for in-person visits. This technology has been particularly useful in rural areas where patients have limited access to healthcare. Telemedicine also reduces healthcare costs by reducing the need for expensive in-person visits.
 In conclusion, technology has played a significant role in advancing medical practice and improving patient outcomes. From electronic health records to medical imaging technology and telemedicine, medical technology has transformed how we diagnose, treat, and prevent diseases. While there are still challenges to overcome, such as ensuring the security and privacy of patient information, it is clear that medical technology will continue to play a critical role in improving healthcare outcomes and reducing healthcare costs. As healthcare providers and technology companies work together to develop and implement new medical technologies, we can expect to see continued progress in the years to come.

Medical Culture of Volga Protestant Communities (Second Half of 18th – Early 20th Centuries): Religious and Ethical Aspects

Introduction. The authors proceed from the understanding that medical culture is a complex of factors contributing to the preservation of health, and these positions analyze the culture of the German Protestant communities (Lutherans, Hernguthers, Mennonites) inhabiting the Povolzhye (Volga region) in the second half of 18th – early 20th centuries. The study of cultural contexts of health, including religious ethical norms, is key to analyzing health and well-being of a population. Methods and materials. Materials for the study were statutes of Protestant communities, data of zemstvo medical statistics, publications in central and local periodicals, as well as eyewitness accounts of visitors of German colonies. The comparison of ethical standards contained in the statutes and recorded by witnesses with data on morbidity and mortality allow us to estimate the role of religious and ethical views in the medical culture of Volga Protestants. Analysis and results. The authors have found that the conditions for maintaining health in German colonies, including the availability of high-quality medical care, were directly related to the labour ethics of Protestantism and the high level of dwellers welfare. Labour ethics determined importance to keep fit, influenced nutritional culture and the perception of medical care. The total literacy of colonists contributed to the spread of advanced medical practices among them (for example, vaccination). Protestant virtues of diligence and order became the basis for the development of hygienic skills – an important factor in the prevention of infectious diseases. The ideals of marital fidelity and family values promoted health maintenance. Self-government characteristic of Protestant communities made it possible to quickly respond to the challenges posed by threats to health.

University of Florida College of Medicine.

University of Florida College of Medicine.

The Menace of Antimicrobial Resistance

The discovery of Penicillin in 1926 was followed by discovery and use of several groups of antimicrobials, which gave a major boost to modern medicine by significantly decreasing mortality and morbidity. Thus, antimicrobials were regarded as a major breakthrough as they not only cured infectious diseases but also played a key role in success of advanced medical practices viz organ transplant, immunosuppressive therapy, cancer chemotherapy, complicated surgeries specially in contaminated areas, implants etc. However these ‘miracle drugs’ are slowly losing their efficacy due to emergence and spread of antimicrobial resistance (AMR). [1-3]
 Emergence of AMR is a natural evolutionary phenomenon shown by microorganisms against widespread use of antimicrobials. Beta lactams were the first affected group (Table-1) and since then bacteria have gained resistance to other groups of -antibiotics too. None of the classes including even the recently discovered antibiotics have been able to escape this dynamic phenomenon. [3-6]

Are Today’s EHR Alerts Putting Clinicians, Patients at Risk?

Are Today’s EHR Alerts Putting Clinicians, Patients at Risk?

MULTIDRUG-RESISTANT AND EXTREMELY DRUG-RESISTANT BACTERIA: ARE WE FACING THE END OF THE ANTIBIOTIC ERA?

Antibiotics are one of the most significant advancements of modern medicine. They have changed the prognosis of several bacterial infections, and made possible advanced medical practices associated with a high risk of infectious complications. Unfortunately, antibiotics are affected by the phenomenon of antibiotic resistance, which jeopardizes their efficacy. In recent years, antibiotic discovery and development has been lagging, due to a lower appeal of this sector for the pharmaceutical industry, while antibiotic resistance has continued to evolve with the eventual emergence and dissemination of bacterial strains which are resistant to most available antibiotics and pose a major challenge to antimicrobial chemotherapy. This worrisome scenario, indicated as the “antibiotic resistance crisis”, has been acknowledged by Scientific Societies and Public Health Agencies, and is now gathering an increasing attention from the Media and Governments. This article reviews the antibiotic-resistant pathogens which currently pose major problems in terms of clinical and epidemiological impact, and briefly discuss future perspective in this field.

Bio-inactivation of human malignant cells through highly responsive diluted colloidal suspension of functionalized magnetic iron oxide nanoparticles

Magnetic fluids, more specifically aqueous colloidal suspensions containing certain magnetic nanoparticles (MNPs), have recently been gaining special interest due to their potential use in clinical treatments of cancerous formations in mammalians. The technological application arises mainly from their hyperthermic behavior, which means that the nanoparticles dissipate heat upon being exposed to an alternating magnetic field (AMF). If the temperature is raised to slightly above 43 °C, cancer cells are functionally inactivated or killed; however, normal cells tend to survive under those same conditions, entirely maintaining their bioactivity. Recent in vitro studies have revealed that under simultaneous exposure to an AMF and magnetic nanoparticles, certain lines of cancer cells are bio-inactivated even without experiencing a significant temperature increase. This non-thermal effect is cell specific, indicating that MNPs, under alternating magnetic fields, may effectively kill cancer cells under conditions that were previously thought to be implausible, considering that the temperature does not increase more than 5 °C, which is also true in cases for which the concentration of MNPs is too low. To experimentally test for this effect, this study focused on the feasibility of inducing K562 cell death using an AMF and aqueous suspensions containing very low concentrations of MNPs. The assay was designed for a ferrofluid containing magnetite nanoparticles, which were obtained through the co-precipitation method and were functionalized with citric acid; the particles had an average diameter of 10 ± 2 nm and a mean hydrodynamic diameter of approximately 40 nm. Experiments were first performed to test for the ability of the ferrofluid to release heat under an AMF. The results show that for concentrations ranging from 2.5 to 1.0 × 103 mg L−1, the maximum temperature increase was actually less than 2 °C. However, the in vitro test results from K562 cells and suspensions containing these MNPs at concentrations varying within a narrower range from 2.5 to 10 mg L−1, typically under an AMF of 15 kA m−1 at 356 kHz, indicate efficient cytotoxic activity against malignant cells and inhibition of cell growth, even at very low hyperthermally induced temperature increases. The IC50 value varied with time, reaching 3.5 mg L−1 after 10 min under the AMF. Our results effectively demonstrate new prospective uses for such nanoparticles in advanced medical practices in oncology.

Sutureless securement of central venous catheters and peripherally inserted central catheters with a novel securement system

The use of central venous catheters (CVC) represents a standard of care intrinsic to advanced medical practice worldwide. While the use of these catheters has transformed patient care for the good, adverse events can occur as a result of migration of the catheter and systemic infection. Central venous catheters share the common feature of ending near the atrium but commonly can enter the body through the subclavian and internal jugular veins or can enter through the veins of the arm (PICC). Securement has been shown to be an important factor in reducing the risk of infection. We describe the results of the development of a system of securement that does not require sutures.

Training to achieve coordination of rescue and ambulance and medical teams

Japanese emergency medical technicians are not allowed to perform some advanced medical practices such as a tracheal intubation, establishment of an intravenous line, administration of a drug to a patient who retains their own circulation. So medical staff have to be dispatched to the accident scene to give a patient such medical practices. In Japan, we have developed and dispersed the educational course of the Disaster Medical Assistance Team since 2005. But the role of medical teams at the scene is not widely known among rescue workers. It is also distant for medical staff to coordinate rescue teams, because most of them do not work with rescue workers in their daily work. We have felt a need for practical training to achieve the coordination of rescue and medical teams.

A practical approach to acromegaly management in Latin America.

IntroductionEvidence-based treatment guidelines have undoubtedly advanced medical practice and supported optimal management of acromegaly, but their application may be hampered by limited access to the latest treatment options.MethodsIn this retrospective, narrative review, the authors revisited existing treatment guidelines for acromegaly in Latin America. These were considered in conjunction with published evidence chosen at the authors’ discretion.FindingsIn a socially and economically diverse region, such as Latin America, any regional practice guidelines need to appreciate that recommended treatment options, such as surgery by expert pituitary surgical teams and drug therapies, especially somatostatin analogs, are often not available due to limited resources. In these instances, physicians may be obliged to apply less effective therapeutic options.ConclusionsThe current article looks at the practical aspects of acromegaly management in Latin America and discusses this in the context of existing guidelines. Furthermore, we consider potential strategies to make better use of resources through combination and multimodal approaches to treatment.

Dr. Joseph Warren: Leader in Medicine, Politics, and Revolution

Dr. Joseph Warren: Leader in Medicine, Politics, and Revolution