Bridging knowledge gaps: a bibliometric analysis of non-invasive ventilation in palliative care studies

BACKGROUND

Despite being a useful strategy for providing respiratory support to patients with advanced or terminal illnesses, non-invasive ventilation (NIV) requires in-depth investigation in several key aspects.

OBJECTIVES

This bibliometric analysis seeks to comprehensively examine the existing research on the subject. Its goal is to uncover valuable insights that can inform the prediction trajectory of studies, guide the implementation of corrective measures, and contribute to the improvement of research networks.

METHODS

A comprehensive review of literature on NIV in the context of palliative care was conducted using the Web of Science core collection online database. The search utilized the key terms "non-invasive ventilation" and "palliative care" to identify the most relevant articles. All data were gathered on November 7, 2023. Relevant information from documents meeting the specified criteria was extracted, and Journal Citation Reports™ 2022 (Clarivate Analytics) served as the data source. The analysis employed literature analysis and knowledge visualization tools, specifically CiteScope (version 6.2.R4) and VOSviewer (version 1.6.20).

RESULTS

A dataset with bibliometric findings from 192 items was analyzed. We found a consistent upward of the scientific output trend over time. Guidelines on amyotrophic lateral sclerosis management received the highest number of citations. Most documents were published in top-ranked journals. Less than one-third of the documents pertain to clinical studies, especially retrospective analyses (25%). Key topics such as "decision making", and "communication" were less addressed.

CONCLUSIONS

Given the substantial clinical implications, further high-quality studies on this subject are recommended. Encouraging international collaborations is needed. Despite the growing volume of documents in the field, this bibliometric analysis indicates a decline in collaborative networks.

Editorial to the Special Issue: "Recent Advances in the Management of Chronic Pain"

Chronic pain is a complex biopsychosocial phenomenon with far-reaching implications, not only in terms of clinical care but also in the realms of social and economic impact [...].

Ethical Considerations in the Use of Artificial Intelligence in Pain Medicine

Although the integration of artificial intelligence (AI) into medicine and healthcare holds transformative potential, significant challenges must be necessarily addressed. This technological innovation requires a commitment to ethical principles. Key issues concern autonomy, reliability, and bias. Furthermore, AI development must guarantee rigorous data privacy and security standards. Effective AI implementation demands thorough validation, transparency, and the involvement of multidisciplinary teams to oversee ethical considerations. These issues also concern pain medicine where careful assessment of subjective experiences and individualized care are crucial. Notably, in this rapidly evolving technological landscape, politics plays a pivotal role in establishing rules and regulations. Regulatory frameworks, such as the European Union's Artificial Intelligence Act and recent U.S. executive orders, provide essential guidelines for the responsible use of AI. This step is crucial for balancing innovation with rigorous ethical standards, ultimately leveraging the incredible AI's benefits. As the field evolves rapidly and concepts like algorethics and data ethics become more widespread, the scientific community is increasingly recognizing the need for specialists in this area, such as AI Ethics Specialists.

Non-invasive Mechanical Ventilation in Lung Cancer: Physiological Principles and Clinical Utilization in Surgical and Non-surgical Settings

Non-invasive mechanical ventilation (NIMV) has emerged as a pivotal intervention for the care of individuals with lung cancer. NIMV offers substantial advantages in enhancing oxygenation, optimizing respiratory function, elevating pulmonary capacities, and facilitating patient comfort. NIMV's utility extends to enhancing clinical conditions that range from chronic obstructive pulmonary disease and emphysematous lung ailments to aiding patients with lung cancer facing acute respiratory failure. Furthermore, NIVM includes perioperative pulmonary rehabilitation. This approach is particularly relevant for individuals with limited lung capacity. Since both non-invasive positive pressure ventilation modes, including BiLevel positive airway pressure and continuous positive airway pressure, address the underlying pathophysiological mechanisms that contribute to postoperative respiratory failure, the proactive and early integration of NIMV has the potential to significantly enhance gas exchange and overall respiratory performance in meticulously chosen patients within the perioperative phase. Although non-intubated video-assisted thoracic surgery represents an interesting field of application for NIMV strategies, further studies are needed to optimize operative modalities. Lastly, NIMV has a pivotal role in the settings of intensive care and palliative care units, thereby cementing its versatile utility across various medical contexts.

Opportunities and barriers for telemedicine in pain management: insights from a SIAARTI survey among Italian pain physicians

BACKGROUND

The integration of telemedicine in pain management represents a significant advancement in healthcare delivery, offering opportunities to enhance patient access to specialized care, improve satisfaction, and streamline chronic pain management. Despite its growing adoption, there remains a lack of comprehensive data on its utilization in pain therapy, necessitating a deeper understanding of physicians' perspectives, experiences, and challenges.

METHODS

A survey was conducted in Italy between January 2024 and May 2024. Specialist center members of the SIAARTI were sent an online questionnaire testing the state of the art of telemedicine for pain medicine.

RESULTS

One-hundred thirty-one centers across Italy reveal varied adoption rates, with 40% routinely using telemedicine. Regional disparities exist, with Northern Italy showing higher adoption rates. Barriers include the absence of protocols, resource constraints, and bureaucratic obstacles. Despite challenges, telemedicine has shown positive impacts on service delivery, with increased service volume reported. Technological capabilities, including image sharing and teleconsultation with specialists, indicate promising interdisciplinary potential.

CONCLUSIONS

The integration of advanced telemedicine software utilizing artificial intelligence holds promise for enhancing telemonitoring and alert systems, potentially leading to more proactive and personalized pain management strategies.

Artificial Intelligence-Driven Diagnostic Processes and Comprehensive Multimodal Models in Pain Medicine

Pain diagnosis remains a challenging task due to its subjective nature, the variability in pain expression among individuals, and the difficult assessment of the underlying biopsychosocial factors. In this complex scenario, artificial intelligence (AI) can offer the potential to enhance diagnostic accuracy, predict treatment outcomes, and personalize pain management strategies. This review aims to dissect the current literature on computer-aided diagnosis methods. It also discusses how AI-driven diagnostic strategies can be integrated into multimodal models that combine various data sources, such as facial expression analysis, neuroimaging, and physiological signals, with advanced AI techniques. Despite the significant advancements in AI technology, its widespread adoption in clinical settings faces crucial challenges. The main issues are ethical considerations related to patient privacy, biases, and the lack of reliability and generalizability. Furthermore, there is a need for high-quality real-world validation and the development of standardized protocols and policies to guide the implementation of these technologies in diverse clinical settings.

Towards artificial intelligence application in pain medicine

Pain is a complex, multidimensional experience involving significant challenges in both diagnosis and management. While acute pain serves as a critical warning mechanism, chronic pain encompasses intricate biological, psychological, and social components, complicating its assessment and treatment. Artificial intelligence (AI) technologies are revolutionizing medicine and healthcare. Here we present an overview of the recent advances in AI for pain medicine. For example, the emergence of automatic pain assessment (APA) methodologies offers promising avenues for more objective pain evaluation. For APA aims, AI technologies, including machine learning algorithms and deep learning architectures such as natural language processing systems, have shown potential in analyzing biosignals, facial expressions, and speech patterns related to pain. However, the integration of these objective measures with traditional self-reporting remains essential for a comprehensive approach to pain diagnosis. Notably, APA models can be implemented for pain diagnosis in newborn and non-communicative patients. Additionally, the application of AI extends beyond pain diagnosis to personalized treatment strategies, predict opioid use disorders, education and training, clinical trajectory definition, and telehealth and real-time. Despite the potential of these innovations, challenges such as validation, parameter selection, and ethical aspects of technical implementation must be addressed.

Implementation of a Hybrid Care Model for Telemedicine-based Cancer Pain Management at the Cancer Center of Naples, Italy: A Cohort Study

BACKGROUND/AIM

Telemedicine, the remote delivery of healthcare services, represents a great opportunity for cancer pain management. A care model of telemedicine that combines remote visits and hospital access could be an effective and safe strategy for pain management of cancer patients.

PATIENTS AND METHODS

A retrospective study was conducted using the dataset of the telemedicine program at the Istituto Nazionale Tumori of Naples, Italy for assessing the efficacy of a telehealth-based model of care. Demographic, clinical, and process variables were investigated.

RESULTS

A total of 226 cases and 489 visits were included in the analysis. The mean age of patients was 63.4 years (SD=12.4 years), and no sex differences were observed. Approximately 55% of patients were ECOG-PS ≤2 and 87% suffered from metastatic disease. More than half of the patients were treated with high doses of opioids. Each patient had a mean of 2 remote visits and half of the patients had more than 1 telehealth consultation. The dropout ratio was 5.3%. Most visits (n=472) were conducted on patients in the Campania Region, Italy. The maximum covered distance from the Cancer Center and the patients' location was 555.22 Km. A significant difference in the overall number of visits (p=0.006) and the number of pro-capita remote visits (p=0.010) was found, in favor of the group of patients treated before the end of the Covid-19 emergency in Italy, compared to those treated after the pandemic.

CONCLUSION

Despite various positive outcomes, the analysis highlights several weaknesses, such as the need to assist patients with advanced and non-advanced disease located outside the regional territory. Overall, the telehealth processes should be adapted to post-pandemic scenarios towards their implementation in routine clinical practice.

The controversial experiments on the intravenous administration of drugs (and air!) during the cholera epidemic of 1867 in Italy

Cholera ravaged many American and European cities in the nineteenth century. Likewise, Italy was struck by six epidemics since the morbus first appeared in 1835-1837. After the International Sanitary Conferences held in Paris in 1851, there was a decrease of the cases due to consolidation of the city in terms of public and private health. Nevertheless, due to the lack of alternative and innovative remedies, the mortality remained unchanged, affecting more than 60 percent of patients. The city of Brescia in Northern Italy was severely hit by the epidemic of 1867. Not being able to implement effective therapeutic strategies, the administration of drugs like quinine and strychnine was proposed to be done intravenously. The results of intravenous injections were ominous, and all the patients died of "‘sudden death"’. Although the academic authorities forbade further experiments, some physicians carried on a long trial using test animals and mental patients as ‘"guinea pigs"’.

Editorial for the Special Issue: "Advances in Postoperative Pain Management and Chronic Postoperative Pain"

Acute and chronic pain are two completely distinct universes [...].

Rise and decline of the barbiturate methitural for intravenous anesthesia: A systematic search and narrative synthesis

BACKGROUND

Within the history of intravenous anesthesia, barbiturates represent a chapter of considerable importance. Although the reference barbiturate thiopental had several limitations, it dominated the scene of the intravenous anesthesia until the mid-1980s, when propofol was introduced on the market. In the meantime, several barbiturate derivatives were placed on the market and abounded. This work is aimed at evaluating the clinical impact of the barbiturate derivatives methitural, analyzing the reasons for its rapid abandonment, in the late 1950s.

METHODS

A systematic methodology of the search was associated with a descriptive analysis of the bibliography found. A computer-operated search strategy using Medline and Google Scholar databases was implemented. The algorithm was composed by using the words "Diogenal" OR "Thiogenal" OR "Methitural" OR "Metigenal" OR "Neraval" including biochemical and marketed terms. A manual search of the sources was carried out, and precise inclusion and exclusion criteria were established. The narrative synthesis was conducted taken into account the historical context of anesthesia.

RESULTS

The database search yielded 3645 records. Nineteen records were identified through other sources. After duplicates removing (n = 238), and exclusion of not pertinent 3027 records, 314 full-text articles were assessed for eligibility. Of those, other 225 papers were excluded and 89 articles were included in the qualitative synthesis.

CONCLUSION

Although methitural could be useful in particular surgical settings such as short-acting surgery, and in patients with liver diseases, a limited advantage over thiopental, and its scarce market diffusion due to increased costs, have limited its use. Through a critical analysis of literature, the lack of high-quality studies does not allow us to draw definitive conclusions on the drug.

Pietro Manni (1778-1839) and the care of the apparently dead in the Age of Positivism

When can a man be declared 'really dead'? Being able to determine whether an individual's life has ended or not implies two important considerations, whether we can resuscitate him and avoid premature burial, the fear of which is termed 'taphophobia'. By the end of the 18th century, several scientists were involved in the study of apparent death and resuscitation. Pietro Manni was an obstetrician who, affected by his brother's death and his inability to help him, devoted himself to the study of apparent death, which became his aim in life. His Practical handbook for the care of the apparently dead is a detailed essay on resuscitation with a precise arrangement of topics - ventilation, tracheostomy, electricity and asphyxia in newborns - organised into chapters and paragraphs that resemble current texts on resuscitation.