Ethical, political, and social aspects of high-technology medicine: Eos and Care

Neuroscience and Greek mythology

This article highlights the major reflections of ancient Greek mythology in modern neuroscience. An analysis of ancient Greek texts and medical literature using the MeSH term mythology was performed to identify mythological references pertaining to neuroscience. The findings are discussed in relation to etymology, early conceptualization of the nervous system structure and function, incipient characterization of neuropsychiatric disease, and philosophical stance to the practice of medicine in ancient Greece. The search identified numerous observations in clinical neurology (e.g., stroke, epilepsy, cognitive and movement disorders, sleep, pain and neuromuscular medicine, neuroinfectious diseases, headache, neuroophthalmology, and neurourology), neurosurgery, and psychiatry, as well as basic neurosciences (e.g., anatomy, embryology, genetics, pathology, and pharmacology) concealed in ancient myths. Beyond mere etymological allure and imaginative reflections in science, these fables envisage philosophical concepts that still tantalize our protean medical practice today.

The burden of not-weighted factors - Nursing workload in a medical Intensive Care Unit

OBJECTIVES

Body weight and infection status affect nursing workload and are not accounted for in the Therapeutic Intervention Scoring System 28 (TISS-28) and Nine Equivalents of Nursing Manpower Use Score (NEMS). The objective of this study was to analyse the correlation between weight and infection status with TISS 28 and NEMS in a cohort of medical Intensive Care Unit patients.

RESEARCH METHODOLOGY

A retrospective observational trial was conducted on the nursing records of 26 randomly selected patients over a 12-month period. TISS-28 and NEMS were calculated for each day of ICU stay. Infectious status was determined based on positive cultures to multi-resistant organisms while overweight and obesity were based on Body Mass Index.

RESULTS

A total of 809 nursing shifts' activity records were analysed. There were 12 infected patients that required isolation, 14 overweight patients and 3 obese: 9 patients presented both conditions. Only the presence of both conditions was statistically associated with an increase in workload (TISS-28p-value = 0.041 and NEMS p-value = 0.011).

CONCLUSIONS

Although TISS-28 and NEMS do not specifically consider body weight and infection status, their integration into nursing workload scores may improve the accuracy as management tools, increasing the quality of the cares provided.

Bioethical aspects of end-of-life care

Managing end-of-life care can be difficult because of the particular nature of intensive care support, which can separate the biological and the biographical aspects of life. Artificial organ support can temporarily delay death but, at the same time, may fail to restore a quality of life that the patient judges acceptable. For this reason, two concepts must be considered: that the mission of the healthcare system should be to care for patients according to their interests and wishes and that quality of care is related above all to the careful commitment of healthcare workers to the patient's best interests. Keeping these concepts in mind, the rule of the five Cs (competence, collegiality, communication, continuity of care and compassion) might be helpful in the management of end-of-life care. Unfortunately, neither the rule of the five Cs nor the careful use of moral principles in order to promote the patients' dignity can assure a universally acceptable decision. A reasonable level of 'moral certainty', however, might be achieved using a deliberative approach, which provides for the inclusion of all the different subjects involved in the decision-making process (patient, family, doctors, nurses and other carers), in order to reach the best possible decision in a specific situation.