Intelligence-based medicine

Despite seven hundred thousand new medical references last year, the relationship between a given set of medical features and specific pathophysiology, treatment, and criteria of improvement is often weak. Moreover, the generalization of evidences obtained in specific settings may lead to under-treat or to over-treat a significant proportion of patients. We expose an application of the cybernetic loop, based on traditional medical steps: nosology, semeiology, pathophysiology, therapy and on the four transitions between these steps. This approach leads to formulate eight basic questions evaluating the steps in terms of reproducibility and the transitions in terms of predictivity. We detail two practical applications: 1) the evaluation of a medical decision (implantation of an internal cardioverter-defibrillator) and 2) the evaluation of a specific study (EPHESUS). Using this loop allows to determine clearly when evidence is lacking and/or to which extend an evidence really increases the medical knowledge or just creates a market

Metrology in medicine: from measurements to decision, with specific reference to anesthesia and intensive care.

Metrology is the science of measurements. Although of critical importance in medicine and especially in critical care, frequent confusion in terms and definitions impact either interphysician communications or understanding of manufacturers' and engineers' instructions and limitations when using devices. In this review, we first list the terms defined by the International Bureau of Weights and Measures regarding quantities and units, measurements, devices for measurement, properties of measuring devices, and measurement standards. The traditional tools for assessing the most important measurement quality criteria are also reviewed with clinical examples for diagnosis, alarm, and titration purposes, as well as for assessing the uncertainty of reference methods

A New Ratio for Protocol Categorization

The present review describes and validates a new ratio “S” created for matching predictability and balance between TP and TN. Validity of S was studied in a three-step process as follows: (i) S was applied to the data of a past study predicting cardiac output response to fluid bolus from response to passive leg raise (PLR); (ii) S was comparatively analyzed with traditional ratios by modeling different 2 * 2 contingency tables in 1000 hypothetical patients; (iii) precision of S was compared with other ratios by computing random fluctuations in the same patients. In comparison to other ratios, S performs better in predicting the cardiac response to fluid bolus and supports more directly the clinical conclusions. When the proportion of false responses is high, S is close to the coefficient correlation (CC). When the proportion of true responses is high, S is the unique ratio that identifies the categorization that balances the proportion of TP and TN. The precision of S is close to that of CC. In conclusion, S should be considered for creating categories from quantitative variables; especially when matching predictability with balance between TP and TN is a concern

Effect of inoculation with Lentilactobacillus buchneri and Lacticaseibacillus paracasei on the maize silage volatilome: the advantages of advanced 2d-chromatographic fingerprinting approaches

[Image: see text] In this study, the complex volatilome of maize silage samples conserved for 229 d, inoculated with Lentilactobacillus buchneri (Lbuc) and Lacticaseibacillus paracasei (Lpar), is explored by means of advanced fingerprinting methodologies based on comprehensive two-dimensional gas chromatography and time-of-flight mass spectrometry. The combined untargeted and targeted (UT) fingerprinting strategy covers 452 features, 269 of which were putatively identified and assigned within their characteristic classes. The high amounts of short-chain free fatty acids and alcohols were produced by fermentation and led to a large number of esters. The impact of Lbuc fermentation was not clearly distinguishable from the control samples; however, Lpar had a strong and distinctive signature that was dominated by propionic acid and 1-propanol characteristic volatiles. The approach provides a better understanding of silage stabilization mechanisms against the degradative action of yeasts and molds during the exposure of silage to air

Volume overload impact on 3D right ventricular shape and strain: comparative analysis of tetralogy of Fallot and atrial septal defect patients

International audienc