The Sleeping Beauty Problem -- A Real-World Solution

The Sleeping Beauty Problem remains a paradoxical problem that penetrates multiple disciplines that include probability theory, self-locating belief, decision theory, cognitive science, the philosophy of mathematics and science. It asks the credence of Sleeping Beauty on a coin toss being Heads in the experiment that incites two main stances, that of the Halfers and Thirders. Here a real-world empirical approach numerically highlights breakdown between these groups and considers the role of how a real-world application of such an experiment with sleep induction by anesthesia and pharmacological amnesia induction would affect the coin credence probability of Sleeping Beauty

Extracorporeal life support for severe drug-induced cardiotoxicity: a promising therapeutic choice

Drug-induced cardiovascular failure is an acute condition that is associated with significant healthcare consequences. Antidotes and supportive treatments are the initial measures to manage cardiotoxicity, but if severe drug-induced cardiotoxicity develops, usually as cardiovascular shock or cardiac arrest, then circulatory assistance may have an important role in the therapeutic algorithm. A number of circulatory assistance techniques have been increasingly employed to treat severe drug-induced cardiotoxicity. These include extracorporeal membrane oxygenation, intra-aortic balloon pumping and standard cardiopulmonary bypass. Recently, extracorporeal life support (ECLS) has been developed to provide percutaneous cardiopulmonary support peripherally without the need for sternotomy. ECLS can provide successful treatment of severe drug-induced cardiotoxicity in selected cases. This technique may be associated with complications of limb ischaemia, haemorrhage and embolism. An increased consideration of ECLS within the context of rigorous clinical studies and strong evidence can add to its future use for severe drug-induced cardiotoxicity

The Promising Connection Between Data Science and Evolutionary Theory in Oncology.

Theoretical and empirical work over the past several decades suggests that oncogenesis and disease progression represents an evolutionary story. Despite this knowledge, current anti-resistance strategies to drugs are often managed through treating cancers as independent biological agents divorced from human activity. Yet once drug resistance to cancer treatment is understood as a product of artificial or anthropogenic rather than unconscious selection, oncologists could improve outcomes for their patients by consulting evolutionary studies of oncology prior to clinical trial and treatment plan design. In the setting of multiple cancer types, for example, a machine learning algorithm can predict the genetic changes known to be related to drug resistance. In this way, a unity between technology and theory might have practical clinical implications-and may pave the way for a new paradigm shift in medicine

Emergency Prehospital On-scene Thoracotomy: A Novel Method

The necessity for prehospital thoracotomy is rare, but can be lifesaving. Occasionally an emergency practitioner or surgeon coincidentally arrives at a trauma scene before the arrival of emergency medical teams. In such a circumstance, even when thoracotomy may be indicated, it is not usually performed in view of the lack of equipment (e.g. dissecting tools or rib retractor). We present a novel technique of »L« shape thoracotomy, or Thoraco-sterno-costochondrotomy, whereby in a prehospital setting, and with minimal equipment (such as a penknife) a thoracotomy can be performed with adequate exposure of the heart and great vessels. The similarities of this pragmatic procedure are considered within the context of ancient Aztec and Mesoamerican thoracotomies

Breaking Bad News Training in the COVID-19 Era and Beyond.

COVID-19 has disrupted the status quo for healthcare education. As a result, redeployed doctors and nurses are caring for patients at the end of their lives and breaking bad news with little experience or training. This article aims to understand why redeployed doctors and nurses feel unprepared to break bad news through a content analysis of their training curricula. As digital learning has come to the forefront in health care education during this time, relevant digital resources for breaking bad news training are suggested

Evolution of Outcomes in Cardiothoracic Surgery

The measurement of outcomes is a fundamental component of modern surgery to provide the foundations of surgical improvement. The conventional emphasis of clinical outcomes such as morbidity and mortality has been augmented with a growing focus on quality of life, quality of care and patient satisfaction. Outcome measures can provide cardiothoracic surgeons the opportunity to assess their results in increased precision and transparency.  An initiative to increase patient awareness and education regarding their hospitals and their surgeons has meant a necessary move towards greater clarity and accountability of all surgical centres.  This has seen an adaptation towards a more patient-centered approach. Comprehensive quality measures and a framework for analyzing and interpreting these results is pivotal as is knowing what to measure and how to measure it. Innovative approaches whereby the patient measures and reports their own ‘outcome’ and experience are being piloted in all surgical specialties, including cardiothoracic surgery. Adopting the Donabedian model for quality measurement in three domains structure, process, and outcomes is a valid and reliable instrument for assessing patient’s satisfaction and quality of care as are the wide range of validated surveys of health related quality of life, which should be routinely implemented

Current Trends and Future Developments in Robotic Cardiac Surgery

Robotic Cardiac Surgery has revolutionised operating for surgeons to provide less operative pain, shorter hospital stays and improved quality of life. As surgeons are constantly trying new techniques, Robotic Cardiac Surgery now encompasses mitral valve surgery, coronary revascularisation, atrial fibrillation surgery, pacing lead implantation, congenital cardiac operations, cardiac tumours resection and diaphragmatic pacing. Robotic technology is gradually becoming more affordable and so more centres are investing in training surgeons in these techniques. As a result, robotic cardiac surgery has developed into a rapidly evolving speciality with exciting new possibilities... (excerpt