Η δημόσια τάξη ως λόγος περιορισμού των συνταγματικών δικαιωμάτων

Η δημόσια τάξη συνδέεται άρρηκτα με την κρατική κυριαρχία. Ως επί το πλείστον αφορά τις σχέσεις του ατόμου με το κράτος και με το κοινωνικό σύνολο (εσωτερική τάξη). Το περιεχόμενό της μεταβάλλεται ανάλογα με τον τόπο και το χρόνο και ο προσδιορισμός του εναπόκειται στο κράτος που αφορά. Στα πλαίσια της ελληνικής έννομης τάξης, η δημόσια τάξη αναγνωρίζεται στο Σύνταγμα ως αυτοτελώς προστατευόμενο έννομο αγαθό και σημαίνει την κατάσταση της κοινής ειρήνης. Υπό στενή έννοια ταυτίζεται με τη δημόσια ασφάλεια, ενώ υπό ευρεία έννοια περιλαμβάνει επιπλέον και την ομαλή κοινωνική - οικονομική ζωή της χώρας. Η δημόσια τάξη αποτελεί κατά το Σύνταγμα και την ΕΣΔΑ θεμιτό λόγο για την επιβολή ειδικών περιορισμών σε σειρά ατομικών δικαιωμάτων, οι οποίοι μάλιστα συνεπάγονται έντονη επέμβαση στην ιδιωτική σφαίρα, πολλές φορές με τη χρήση υλικής βίας. Επομένως, η ερμηνεία της αόριστης αυτής νομικής έννοιας οφείλει να σέβεται τον εγγυητικό χαρακτήρα των ατομικών ελευθεριών. Αντίστοιχα, οι περιορισμοί που επιβάλλονται χάριν της διαφύλαξής της, οφείλουν να είναι σύμφωνοι με την αρχή της αναλογικότητας ή, κατά την ΕΣΔΑ, με τη ρήτρα του «αναγκαίου μέτρου σε μια δημοκρατική κοινωνία». Τα παραπάνω αναπτύσσονται αναλυτικά στα Κεφάλαια Ι, ΙΙ και ΙΙΙ της παρούσας διπλωματικής εργασίας, ενώ στο Κεφάλαιο IV γίνεται αναλυτική παρουσίαση των επιμέρους δικαιωμάτων. Στο τέλος, αντί επιλόγου, αναπτύσσεται ένας ορισμένος προβληματισμός γύρω από τα παραπάνω ζητήματα. Η υποστήριξη πλαισιώνεται με την παρουσίαση των απόψεων της ελληνικής συνταγματικής θεωρίας, καθώς και της νομολογίας των εθνικών δικαστηρίων και του ΕΔΔΑ.Public order is inextricably linked to state sovereignty. It mostly concerns the relations of the individual with the state and with society (internal order). Its content varies according to place and time and its determination rests with the state concerned. In the context of the Greek legal order, public order is recognized in the Constitution as an independently protected legal good and means the state of common peace. In a narrow sense it is identified with public security, while in a broad sense it also includes the smooth social and economic life of the country. According to the Constitution and the ECHR, public order is a legitimate reason for the imposition of special restrictions on a series of individual rights, which in fact involve intense intervention in the private sphere, often with the use of material violence. Therefore, the interpretation of this vague legal concept must respect the guarantee character of individual freedoms. Accordingly, the restrictions imposed for its preservation must be in accordance with the principle of proportionality or, according to the ECHR, with the "necessary measure in a democratic society" clause. The above are developed in detail in Chapters I, II and III of this thesis, while in Chapter IV there is a detailed presentation of the individual rights. At the end, instead of an epilogue, a certain reflection is developed around the above issues. The support is framed by the presentation of the opinions of the Greek constitutional theory, as well as the jurisprudence of the national courts and the ECtHR

Research priorities in regional anaesthesia: an international Delphi study

Background: Regional anaesthesia use is growing worldwide, and there is an increasing emphasis on research in regional anaesthesia to improve patient outcomes. However, priorities for future study remain unclear. We therefore conducted an international research prioritisation exercise, setting the agenda for future investigators and funding bodies. Methods: We invited members of specialist regional anaesthesia societies from six continents to propose research questions that they felt were unanswered. These were consolidated into representative indicative questions, and a literature review was undertaken to determine if any indicative questions were already answered by published work. Unanswered indicative questions entered a three-round modified Delphi process, whereby 29 experts in regional anaesthesia (representing all participating specialist societies) rated each indicative question for inclusion on a final high priority shortlist. If ≥75% of participants rated an indicative question as ‘definitely’ include in any round, it was accepted. Indicative questions rated as ‘definitely’ or ‘probably’ by <50% of participants in any round were excluded. Retained indicative questions were further ranked based on the rating score in the final Delphi round. The final research priorities were ratified by the Delphi expert group. Results: There were 1318 responses from 516 people in the initial survey, from which 71 indicative questions were formed, of which 68 entered the modified Delphi process. Eleven ‘highest priority’ research questions were short listed, covering themes of pain management; training and assessment; clinical practice and efficacy; technology and equipment. Conclusions: We prioritised unanswered research questions in regional anaesthesia. These will inform a coordinated global research strategy for regional anaesthesia and direct investigators to address high-priority areas

Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project

Background and objectives: Documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia. Methods: Following the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live polling on items not yet excluded or accepted from previous rounds. Progression or exclusion of potential components through the rounds was based on the achievement of strong consensus. Strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement. Results: Seventy-seven collaborators participated in both rounds 1 and 2, while 50 collaborators took part in round 3. In total, experts voted on 83 items and achieved a strong consensus on 51 items, weak consensus on 3 and rejected 29. Conclusion: By means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia

Study of cerebral haemodynamics with the application of transcranial doppler ultrasonography - TCD in patients with chronic liver disease

BackgroundCerebral haemodynamic and metabolic derangement is well known and common in patients withchronic liver disease or / and cirrhosis. It is often manifested as hepatic encephalopathy, although itscause and pathogenesis are not clearly understood and poorly elucidated. Patients with cirrhosisusually show alterations of cerebral perfusion and oxygenation, as well as changes of systemichaemodynamics and are thus prone to develop arterial hypotension, which might result in brainhypoperfusion, if cerebral autoregulation is impaired. Transcranial Doppler and Cerebral Oximetryare non invasive methods of neurological monitoring and are broadly used in the evaluation of theintracranial circulation and cerebral oxygenation status.Study Aims and ObjectivesThe aim of this open, comparative, non randomized, cross – sectional and longitudinal,observational clinical study was to evaluate brain haemodynamics in patients with chronic liverdisease and to test the degree of impairment of their cerebral autoregulatory mechanism, by usingTranscranial Doppler Ultrasonography. In addition, one of our basic scopes was to compare theseresults with those from Cerebral Oximetry and correlate them with the levels of blood S100bprotein.Material and MethodsOur study consisted of 40 healthy volunteers (Group I) and 40 patients with chronic liver disease(Group II). From those with chronic hepatic disease, 33 had liver cirrhosis (Group IIa) and 7 justchronic liver disease without cirrhosis (Group IIb). Regarding cerebral haemodynamics the baselineparametres that were examined included cerebral blood flow velocities, Vsyst, Vdias, Vmean,Pulsatility and Resistive Indices (PI &RI), as well as rSO2 values from Cerebral Oximetry. All thesevalues were recorded and studied bilaterally. The evaluation of the cerebral autoregulatorymechanism was performed with the continuous monitoring of mean arterial blood pressure, as wellas of the cerebral blood flow velocities, in the middle cerebral artery, bilaterally, during passivemovements of Trendelenbourg and Reverse Trendelenbourg, at 45ο, sequentially. The cerebralability of altering its perfusion and metabolism status was checked, again bilaterally, with themeasurement of the parametres mentioned above, after 1 min of active and passive movement ofthe right and left elbow and hand, with one movement happening after the other. All themeasurements mentioned above, were also evaluated in the subgroups of cirrhotic patients, with orwithout hepatic encephalopathy, with or without portal hypertension and according to the Child –Pugh stage of the disease. In all the subjects that were tested basic cardiorespiratory parametreswere recorded, at predetermined checking time – points. Finally, blood samples were withdrawnfrom both patients and healthy volunteers for investigation of basic haematological and biochemicalparametres, analysis of arterial blood gases and determination of the S100b protein blood levels.ResultsDuring the cross – sectional phase of our study, the cerebral blood flow velocities were found to belower in patients with chronic liver disease, when compared to healthy volunteers, without anysignificant differences between patients with or without cirrhosis. In addition, regarding TCDvelocities, important deviations were noticed in between cirrhotic patients of various stages, withthe detection of the lowest values in those of Child – Pugh Stage C. Furthermore, we foundstatistically significant differences, bilaterally, in between cirrhotic patients with or without hepaticencephalopathy, but without any strong correlation to its stage. PI and RI were significantly higher inpatients with cirrhosis than in controls and non – cirrhotic patients with chronic hepatic disease.Hepatic Encephalopathy patients were characterized by higher cerebral vascular resistance, compared to cirrhotic patients without any cerebral derangement. Similar results wereextrapolated from the Cerebral Oximetry measurements, with the lowest values of rSO2 beingdetected in patients of Child – Pugh Stage C and in those with hepatic encephalopathy also of Stage3. PI and RI were significantly correlated with the severity of cirrhosis and the existence of hepaticencephalopathy. In addition, they were significantly correlated with blood ammonia levels, PT andserum levels of albumin and bilirubin. Both Vmean and rSO2, as well as PI and RI were stronglycorrelated with S100b blood levels. In subjects with the highest values of S100b, the lowest values ofVmean and rSO2 were measured, whereas the highest PI and RI were calculated.During the longitudinal phase of our study, which refers to the autoregulatory mechanism testing,the following were noticed. Head down or head up provoked an increase or drop in blood pressurerespectively in all the subjects that were examined. Healthy controls and non cirrhotic patients had aprompt recovery of Vmean and a progressive recovery of arterial pressure, so that, after 120 sec,both parametres had returned to baseline. At 20 sec the recovery of flow velocity was faster thanthat of blood pressure. By contrast, patients with cirrhosis had a delayed and incomplete recovery ofboth parametres. The recovery of mean velocity paralleled that of arterial pressure, indicating animpaired cerebral autoregulation. Regarding passive and active movements of elbows and hands,we noticed an ipsilateral and contralateral increase of blood flow velocities and cerebral Oximetryvalues, but without any statistically significant differences between control subjects and chronichepatic patients, or their subgroups.ConclusionsThe results of this cross sectional and longitudinal study indicate that cerebral blood flow velocitiesand cerebral oximetry values are decreased in patients with chronic liver disease, whereas PI and RIare elevated, in strong correlation with the liver failure stage, the cirrhosis stage and the presence ofhepatic encephalopathy. This conclusion becomes more powerful when we take into account thestrong correlation of the measured indices and the levels of S100b protein. Cerebral autoregulationmechanism is often impaired in chronic hepatic patients, especially those with decompensatedcirrhosis. These patients can easily develop cerebral hypoperfusion, if arterial pressure falls abruptly.TCD Ultrasonography and Near Infrared Spectroscopy (Cerebral Oximetry) provide real time anduseful indices to assess and monitor cirrhotic patients and subjects with chronic liver failure

Reimagining How We Treat Acute Pain: A Narrative Review

Acute pain may be influenced by biopsychosocial factors. Conditioned pain modulation, distraction, peripheral nerve stimulation, and cryoneurolysis may be helpful in its treatment. New developments in opioids, such as opioids with bifunctional targets and oliceridine, may be particularly suited for acute pain care. Allosteric modulators can enhance receptor subtype selectivity, offering analgesia with fewer and/or less severe side effects. Neuroinflammation in acute pain is caused by direct insult to the central nervous system and is distinct from neuroinflammation in degenerative disorders. Pharmacologic agents targeting the neuroinflammatory process are limited at this time. Postoperative pain is a prevalent form of acute pain and must be recognized as a global public health challenge. This type of pain may be severe, impede rehabilitation, and is often under-treated. A subset of surgical patients develops chronic postsurgical pain. Acute pain is not just temporally limited pain that often resolves on its own. It is an important subject for further research as acute pain may transition into more damaging and debilitating chronic pain. Reimagining how we treat acute pain will help us better address this urgent unmet medical need

Regional anesthesia practice in Greece: A census report

Background and Aims: Regional anesthesia (RA) techniques (central neuraxial and peripheral nerve blocks [CNBs and PNBs]) are well-established anesthesia/analgesia modalities. However, information on their nationwide use is sparse. The aim of the survey was to assess the utility of RA techniques in Greece, during 2011. Materials and Methods: A nationwide, cross-sectional descriptive survey was conducted (March to June, 2012), using a structured questionnaire that was sent to 128 Greek Anesthesia Departments. Results: Sixty-six completed questionnaires (response rate 51.56%) were analyzed. The data corresponded to 187,703 operations and represented all hospital categories and geographical regions of Greece. On the whole, RA was used in 45.5% of performed surgical procedures (85,386/187,703). Spinal anesthesia was the technique of choice (51.9% of all RA techniques), mostly preferred in orthopedics (44.8%). Epidural anesthesia/analgesia (application rate of 23.2%), was mostly used in obstetrics and gynecology (50.4%). Combined spinal-epidural and PNBs were less commonly instituted (11.24% and 13.64% of all RA techniques, respectively). Most PNBs (78.5%) were performed with a neurostimulator, while elicitation of paresthesia was used in 16% of the cases. Conversely, ultrasound guidance was quite limited (5%). The vast majority of consultant anesthesologists (94.49%) were familiar with CNBs, whereas only 46.4% were familiar with PNBs. The main reported limitations to RA application were lack of equipment (58.23%) and inadequate education/training (49.29%). Conclusion: Regional modalities were routinely used by Greek anesthesiologists during 2011. Neuraxial blocks, especially spinal anesthesia, were preferred over PNBs. The underutilization of certain RA techniques was attributed to lack of equipment and inadequate training

A Survey of Regional Anesthesia Use in Greece and the Impact of a Structured Regional Anesthesia Course on Regional Techniques Knowledge and Practice

Background: Due to the growing interest in regional anesthesia (RA) techniques and the realization of the need for formalized education in them, the Greek Chapter of the European Society of Regional Anesthesia and Pain Therapy (ESRA-Hellas) has established a structured hands-on training course held annually since 2009, which is quite popular in the community of Greek anesthesiologists. The aim of the current survey was twofold: first, to provide an overview of the current practice of RA in Greece; secondly, to evaluate the effect the aforementioned training course has on participants’ knowledge and attitude towards RA. Methods: An electronic questionnaire was uploaded on SurveyMonkey and a link giving access to the questionnaire was forwarded via email to a mailing list of 825 practicing Greek anesthesiologists held in the electronic database of ESRA Hellas. The survey was totally anonymous and no identifying information was collected throughout. It contained questions relating to the anesthesiologists’ demographic characteristics, their RA practice, and information pertaining to the RA training course. Results: A total of 424 fully completed questionnaires were received, representing an overall response rate of 51.4%. Attendants of the course are more familiar than non-attendants with the performance of peripheral nerve blocks with neurostimulation and/or ultrasound guidance (p < 0.001). Attendants are also less likely to practice exclusively general anesthesia, more likely to use peripheral blocks for lower limb surgery, and more likely to consider taking the European Diploma of RA in comparison to non-attendants (p < 0.001, p = 0.018 and p = 0.002, respectively). Both cohorts consider the course of value and agree that the main reason to use regional techniques is to ensure optimal postoperative analgesia, while the main hindrance to RA practice is the lack of relevant education in the techniques, especially those under ultrasound guidance. Regarding improvement of the course, most participants suggested devoting ampler time in hands-on ultrasound practice and application. Conclusion: Greek anesthesiologists seek educational activities in the field of RA and the course seems to fulfil the majority of attendants’ expectations. There will be further effort by the organizers to improve weaknesses of the current course and undertake further educational initiatives in the field of RA according to international recommendations