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1.
Anat Sci Educ ; 2024 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-38634610

RESUMO

The development of anatomy as a scientific undertaking appears to have left little room for religious and cultural input into the conduct of anatomical investigations. This has been brought to the fore by questionnaires regarding the willingness or otherwise of individuals to donate their bodies for dissection, with higher levels of willingness from those without religious affiliations. This has led to the assumption that there is inherent opposition to body donation by those with a religious stance, although there has been little exploration of this. This is increasingly important with growing awareness that anatomy is an international discipline, leading to increasing attention to the religious and cultural contexts within which it is practiced. There is a diversity of responses toward body donation within different countries, as well as by those influenced by Islam, Hinduism, and Buddhism. Additionally, there are diverse cultural attitudes within Confucianism in Asia, Zulu in Africa, and Maori in New Zealand. Even those within the Christian church are influenced by a variety of values, some of which are in tension, with emphasis on the sacredness of life and the significance of burial being negative toward body donation, with informed consent and altruism pointing in a positive direction. The challenge for anatomists is to understand those within their communities, seek to appreciate their perspectives, and also make known the potential of body donation and dissection for enhancing medical practice and improving the education of future health workers.

2.
Circ Cardiovasc Imaging ; 16(6): e015352, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37288553

RESUMO

BACKGROUND: Left atrial (LA) function following catheter or surgical ablation of de-novo long-standing persistent atrial fibrillation (AF) and its impact on AF recurrence was studied in patients participating in the CASA-AF trial (Catheter Ablation vs. Thoracoscopic Surgical Ablation in Long Standing Persistent Atrial Fibrillation). METHODS: All patients underwent echocardiography preablation, 3 and 12 months post-ablation. LA structure and function were assessed by 2-dimensional volume and speckle tracking strain measurements of LA reservoir, conduit, and contractile strain. Left ventricular diastolic function was measured using transmitral Doppler filling velocities and myocardial tissue Doppler velocities to derive the e', E/e', and E/A ratios. Continuous rhythm monitoring was achieved using an implantable loop recorder. RESULTS: Eighty-three patients had echocardiographic data suitable for analysis. Their mean age was 63.6±9.7 years, 73.5% were male, had AF for 22.8±11.6 months, and had a mean LA maximum volume of 48.8±13.8 mL/m2. Thirty patients maintained sinus rhythm, and 53 developed AF recurrence. Ablation led to similar reductions in LA volumes at follow-up in both rhythm groups. However, higher LA emptying fraction (36.3±10.6% versus 27.9±9.9%; P<0.001), reservoir strain (22.6±8.5% versus 16.7±5.7%; P=0.001), and contractile strain (9.2±3.4% versus 5.6±2.5%; P<0.001) were noted in the sinus rhythm compared with AF recurrence group following ablation at 3 months. Diastolic function was better in the sinus rhythm compared with the AF recurrence group with an E/A ratio of 1.5±0.5 versus 2.2±1.2 (P<0.001) and left ventricular E/e' ratio of 8.0±2.1 versus 10.3±4.1 (P<0.001), respectively. LA contractile strain at 3 months was the only independent predictor of AF recurrence. CONCLUSIONS: Following ablation for long-standing persistent AF, improvement in LA function was greater in those who maintained sinus rhythm. LA contractile strain at 3 months was the most important determinant of AF recurrence following ablation. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02755688.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Função do Átrio Esquerdo , Ablação por Cateter/métodos , Ecocardiografia/métodos , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/cirurgia , Recidiva , Resultado do Tratamento
3.
Anat Sci Educ ; 16(4): 610-617, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37039309

RESUMO

Concerns have recently been expressed about the continuing availability of human bones from India, obtained originally for educational purposes but lacking the requisite informed consent that would be expected today. More generally, a broader claim is being made, namely, that the practice of using any unconsented bones in educational settings is unethical and should cease. These calls, in turn, raise broader issues regarding the availability of anonymous archival collections in anatomy museums. Although this debate centers on undergraduate anatomy teaching, much anthropological research utilizes human remains of past populations for which there can have been no consent. A suggested alternative for undergraduate teaching is the use of 3D images of human bones, rather than the bones themselves. In addressing these issues, the background to the India bone trade is assessed, and the year 1985 is pinpointed as having significant ethical weight. The cultural and ethical interests inherent in studying archival anonymous skeletal material are weighed against indiscriminate reburial. Although any use of unconsented material represents ethical compromise, account should be taken of changing ethical expectations with time. It is concluded that: there is no justification for repatriation or disposal of all bones for which specific informed consent has not been obtained; continued use of anonymous archival human bones in a professional setting is acceptable, even in the absence of informed consent, with the proviso that there are no culturally relevant groups seeking repatriation; the continued existence of bones in long-standing private collections cannot be justified since it amounts to long-term storage with no identified goals; the notion that 3D images are an ethically superior alternative to actual human bones is unsustainable, since there is an intimate connection between the bones and the 3D images.


Assuntos
Anatomistas , Anatomia , Humanos , Anatomia/educação , Consentimento Livre e Esclarecido , Esqueleto , Índia
4.
Surg Radiol Anat ; 44(1): 83-92, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34994829

RESUMO

PURPOSE: The physicians say that the least anatomy is required for clinical practice. But the disease causes anatomical distortions or variations in structures impairing functions of organs and systems. So, the diagnosis and analysis of treatment of disease depend on interwoven inter-relationship among Anatomy, Physiology, Pathology, Radiology and clinical sciences. Consequently, the upcoming doctors are to be cultivated sufficient anatomy. Therefore, the objective of this study is to analyze viewpoints of medical students, faculties and practitioners regarding degree of need of Anatomy in clinical practice. METHODS: A feedback survey has been carried out among students and faculties to seek their views on the need of Anatomy in clinical practice using two hypotheses. Hypothesis 1 defines the degree of need of Anatomy ('most essential', 'essential' and 'least essential') in clinical practice based on answers of questionnaire by medical students and faculties, whereas hypothesis 2 assigns weights depending on knowledge and experience of the feedback providers. The means/weighted means of views have been statistically analyzed. Additionally, the literature survey was carried out on the demand, necessity, importance, usefulness and applicability of Anatomy in clinical practice. RESULTS: Our statistical analysis revealed that Anatomy is 'most essential' for clinical practice. In literature survey too, the inadequate knowledge of anatomy among medical students leads to poor comprehension of clinical practice. So, anatomy is most essential for clinical practice. CONCLUSION: Sound knowledge of Human Anatomy is most essential during medical practice for Physicians.


Assuntos
Anatomia , Educação de Graduação em Medicina , Médicos , Radiologia , Estudantes de Medicina , Anatomia/educação , Currículo , Docentes , Humanos , Inquéritos e Questionários
5.
Anat Sci Educ ; 14(2): 148-153, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33463041

RESUMO

In responding to Covid-19 anatomists have succeeded in adapting their teaching to online delivery. However, long-term reliance on this mode of teaching raises the prospect that transferring the whole of the learning environment to an impersonal digital world will lead to loss of anatomy's humanistic side. In looking to a future increasingly dependent upon digital input to teaching, a number of roadblocks are identified. These are: the peril of abandoning the ethos of anatomy; for the workload of staff and especially for female academic staff; by a lack of adequate resources; to the research nature of departments, including the quality of research; to the position of anatomy in the biomedical sciences; and from pressures to retreat from a dissection-based education. In tracing a future trajectory for anatomy, issues outlined are the inevitability of change, the need for anatomy to market itself to the world, and the opportunities presented for anatomy to view itself increasingly as a contributor to broad scholastic endeavors. Suggestions include exploring the possibilities presented by virtual anatomy museums, the use of online learning to reach those not normally in touch with anatomy teaching, and exploring the integrated courses with humanities disciplines. It is concluded that anatomy will flourish if there is a willingness to expand the traditional horizons and be prepared to integrate all that is best in the person-to-person and digital worlds.


Assuntos
Anatomia/educação , COVID-19/prevenção & controle , Instrução por Computador , Dissecação/educação , Educação a Distância , Ensino , COVID-19/transmissão , Cadáver , Currículo , Avaliação Educacional , Feminino , Humanos , Masculino , Modelos Educacionais , Mulheres Trabalhadoras , Carga de Trabalho
6.
Pacing Clin Electrophysiol ; 44(2): 318-326, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33377500

RESUMO

OBJECTIVES: To study how left atrial appendage electrical isolation (LAAEI) impacts atrial dominant frequency (DF) in patients with long-standing persistent atrial fibrillation (LSPAF). BACKGROUND: LAAEI is associated with a high probability of freedom from atrial fibrillation (AF) and spectral analysis may identify high-frequency sources. How LAAEI impacts the AF dynamics and the subgroup of LSPAF patients in whom LAAEI would be most beneficial, is unclear. METHODS: Twenty patients with LSPAF were included in the study. Fast Fourier transforms (FFT) were performed on atrial electrograms recorded from 13 sites in the LA and RA. The highest peak frequency was defined as DF. RESULTS: There was no significant difference in DF between atrial sites except for at the superior vena cava which had the lowest DF at baseline. Stepwise ablation consisting of circumferential pulmonary vein isolation and a linear ablation set of mitral isthmus and roof significantly reduced the DF within the coronary sinus (CS) (5.93 ± 0.98 Hz vs. 5.09 ± 0.72 Hz, p < .05) and the LA posterior wall (LApos) (6.26 ± 0.92 Hz vs. 5.43 ± 0.98 Hz, p < .01). LAAEI preferentially further decreased the DF at the LApos (p < .01), but not at the CS. In cases where there was < 13.6% reduction in the DF of the LApos following the stepwise ablation, the addition of LAAEI was associated with an increased restoration of sinus rhythm (55%, p < .05). CONCLUSION: LAAEI in addition to stepwise ablation results in further reduction of the DF in the LApos, which is associated with acute termination of AF and favorable ablation outcome.


Assuntos
Apêndice Atrial/cirurgia , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Idoso , Fibrilação Atrial/fisiopatologia , Procedimentos Cirúrgicos Cardíacos/métodos , Protocolos Clínicos , Técnicas Eletrofisiológicas Cardíacas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
7.
Front Cardiovasc Med ; 7: 596491, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33381527

RESUMO

Background: The efficacy of catheter ablation for atrial fibrillation (AF) in patients with functional mitral regurgitation (MR) and left ventricular (LV) systolic dysfunction (LVSD) is not known. The aim of the study is to determine the efficacy of catheter ablation for AF in patients with functional MR and LVSD, and to validate its effects on the severity of MR and cardiac reverse remodeling. Methods: We performed a retrospective study of 54 patients with functional MR who underwent AF ablation, including 21 (38.9%) with LVSD and 33 (61.1%) with normal LV systolic function (LVF). The primary outcomes evaluated were freedom from recurrent atrial tachyarrhythmia (ATa), severity of MR, and left atrial (LA) and LV remodeling. Results: During a mean follow-up of 20.7 ± 16.8 months, freedom from recurrent ATa was not significantly different between patients with LVSD and those with normal LVF after the first ablation (P = 0.301) and after multiple ablations (P = 0.728). Multivariable predictors of recurrent ATa were AF duration [hazard ratio (HR) 1.12, 95% confidence interval (CI) 1.01-1.25; P = 0.039), previous stroke (HR 5.28, 95% CI 1.46-19.14; P = 0.011), and estimated glomerular filtration rate (HR 0.97, 95% CI 0.95-0.99; P = 0.012). Compared with baseline, there was a significant reduction in severity of MR (P = 0.007), LA size (P < 0.001) and LV end-systolic dimension (P = 0.008), and improvement in the LV ejection fraction (P = 0.001) after restoring sinus rhythm in patients with LVSD. Conclusion: Catheter ablation is a valid option for the treatment of AF in patients with functional MR and LVSD, even though multiple procedures may be required.

8.
Eur Heart J ; 41(47): 4471-4480, 2020 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-32860414

RESUMO

AIMS: Long-standing persistent atrial fibrillation (LSPAF) is challenging to treat with suboptimal catheter ablation (CA) outcomes. Thoracoscopic surgical ablation (SA) has shown promising efficacy in atrial fibrillation (AF). This multicentre randomized controlled trial tested whether SA was superior to CA as the first interventional strategy in de novo LSPAF. METHODS AND RESULTS: We randomized 120 LSPAF patients to SA or CA. All patients underwent predetermined lesion sets and implantable loop recorder insertion. Primary outcome was single procedure freedom from AF/atrial tachycardia (AT) ≥30 s without anti-arrhythmic drugs at 12 months. Secondary outcomes included clinical success (≥75% reduction in AF/AT burden); procedure-related serious adverse events; changes in patients' symptoms and quality-of-life scores; and cost-effectiveness. At 12 months, freedom from AF/AT was recorded in 26% (14/54) of patients in SA vs. 28% (17/60) in the CA group [OR 1.128, 95% CI (0.46-2.83), P = 0.83]. Reduction in AF/AT burden ≥75% was recorded in 67% (36/54) vs. 77% (46/60) [OR 1.13, 95% CI (0.67-4.08), P = 0.3] in SA and CA groups, respectively. Procedure-related serious adverse events within 30 days of intervention were reported in 15% (8/55) of patients in SA vs. 10% (6/60) in CA, P = 0.46. One death was reported after SA. Improvements in AF symptoms were greater following CA. Over 12 months, SA was more expensive and provided fewer quality-adjusted life-years (QALYs) compared with CA (0.78 vs. 0.85, P = 0.02). CONCLUSION: Single procedure thoracoscopic SA is not superior to CA in treating LSPAF. Catheter ablation provided greater improvements in symptoms and accrued significantly more QALYs during follow-up than SA. CLINICAL TRIAL REGISTRATION: ISRCTN18250790 and ClinicalTrials.gov: NCT02755688.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Taquicardia Supraventricular , Fibrilação Atrial/cirurgia , Análise Custo-Benefício , Humanos , Anos de Vida Ajustados por Qualidade de Vida , Recidiva , Resultado do Tratamento
9.
Anat Sci Educ ; 13(5): 549-555, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32705774

RESUMO

The move of much anatomy teaching online in response to the Covid-19 pandemic has been successfully implemented within very short time frames. This has necessitated a high degree of dependence upon the use of digitized cadaveric resources, has entailed immense workload demands on staff, and has disrupted students' studies. These educational exigencies have been accompanied by ethical uncertainties for a discipline centered on study of the dead human body. An ethical framework for anatomy is suggested based on the principles of equal concern and respect, minimization of harm, fairness, and reciprocity, in which all staff and students are to be treated with respect and as moral equals. A series of ethical obligations are proposed as a means of maintaining the ethos of anatomy, coping with the suspension of body donation, providing adequate resources, and responding to increased dependence upon external providers. Good academic practice raises more general obligations stemming from the welfare of students, the increased workload of staff, and checking on online assessment and invigilation. As anatomists respond to the educational and ethical lessons prompted by this pandemic, they should plan for future disruptions to normal work patterns by adopting a sustainable and equitable course of action.


Assuntos
Anatomia/ética , Infecções por Coronavirus , Educação a Distância/ética , Pandemias , Pneumonia Viral , Anatomia/educação , COVID-19 , Humanos
10.
Anat Sci Educ ; 13(6): 721-731, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32077216

RESUMO

Cultural practices in the African continent have been thought to impact negatively on body donation. Thus, most African countries continue to rely on unclaimed bodies for dissection programs, or bequests from the white population. The latter situation is dominant in South African medical schools. Since South Africa is multi-cultural with nine main ethnic groups of the Black African population, it is important to seek the reasons behind lack of participation in body donation. This report represents a move in this direction with its qualitative study of the cultural practices of the Zulu ethnic group in the province of KwaZulu-Natal from the perspective of a variety of participants, with emphasis on their treatment of the human body after death. Four themes emerged from interviews: (1) Death is not the end; (2) Effect of belief in ancestors; (3) Significance of rituals and customs carried out on human tissue; and (4) Burial as the only method of body disposal. Each of these themes is discussed in relation to the likelihood of body donation being seen by Zulus as an acceptable practice. It is concluded that this is unlikely, on account of the need to preserve the linkage between the physical human body and the spirit of the deceased person, and the perceived ongoing relationship between the spirit of the dead and the living. In view of these conclusions, a number of options are canvassed about the manner in which anatomists in KwaZulu-Natal might obtain bodies for dissection. These possibilities have implications for anatomists working in comparable cultural contexts.


Assuntos
População Negra/etnologia , Sepultamento , Etnicidade , Doadores de Tecidos/psicologia , Obtenção de Tecidos e Órgãos , Adulto , Anatomistas , Anatomia/educação , Atitude Frente a Morte/etnologia , Cadáver , Dissecação , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Faculdades de Medicina/provisão & distribuição , África do Sul
11.
Anat Sci Educ ; 13(4): 504-511, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31696652

RESUMO

The increasing availability of physician-assisted death (PAD) has opened up a novel means of making donated bodies available for anatomical dissection. This practice has come to the fore in Canada, but is unlikely to be confined to that country as legislation changes in other countries. The ethical considerations raised by this development are placed within the framework of the ethical guidelines on body donation promulgated by the International Federation of Associations of Anatomists. The discussion centers on understanding the ethical dimensions of moral complicity, and whether it is accepted or rejected. If rejected it is possible to separate ethical concerns regarding PAD from subsequent use of donated bodies, as long as there is fully informed consent and complete ethical and procedural separation of the two. Openness about the origin of bodies for dissection is essential. Students should be instructed on the nuances of moral complicity, and consideration be given to those with moral doubts about PAD. Two issues are raised in considering whether these moves represent an ethical slippery slope: the attraction represented by obtaining relatively "high quality" bodies, and the manner in which organ donation following PAD has led to challenges to the dead donor rule. Although body donation raises fewer concerns, the ethical dimensions of the two are similar. The ethical constraints outlined here have the capacity to prevent an ethical slippery slope and constitute a sound basis for addressing an innovative opportunity for anatomists.


Assuntos
Anatomistas/ética , Anatomia/educação , Ética Profissional , Suicídio Assistido/ética , Obtenção de Tecidos e Órgãos/ética , Anatomistas/normas , Cadáver , Canadá , Dissecação/ética , Guias como Assunto , Humanos , Faculdades de Medicina , Sociedades/normas , Estudantes/psicologia , Suicídio Assistido/legislação & jurisprudência , Obtenção de Tecidos e Órgãos/normas
12.
Anat Sci Educ ; 12(4): 444-453, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30900810

RESUMO

In China as elsewhere in the world, human bodies and body parts have long been used for a wide range of medical and non-medical purposes. In recent decades, China has played a considerable role in some of the public exhibitions of plastinated bodies and body parts, and the commercial trade in organ donations. These contemporary developments have raised numerous challenging ethical and governance questions. In spite of the growing role of China in these, there have been few studies devoted to Chinese ethical thinking that might govern its policies on the use of human bodies and body parts, and in particular on the issue of commercialization. The present study is an attempt to bridge this gap, and concludes that Confucian thinking stresses the primacy of righteousness over profits and utilities. This conclusion is reached directly by drawing on Confucian ethical responses to the peculiar practice of using human body parts, such as placenta and flesh, as drugs in traditional Chinese medicine in imperial China and what has been called "yili zhibian," the major Confucian discourse on yi (righteousness or justice) and li (profit or interest) in its long history. The principle of prioritizing righteousness over profit leads to a general moral opposition to the commodification of human bodies and body parts. While Confucianism may not place an absolute prohibition on any such use, it does require that any commercial uses are made subject to the fundamental moral principles, such as righteousness, as well as adequate ethical governance procedures.


Assuntos
Comércio/ética , Confucionismo , Exposições como Assunto , Corpo Humano , Princípios Morais , Cadáver , China , Comércio/legislação & jurisprudência , Humanos , Políticas
13.
J Am Heart Assoc ; 8(4): e010535, 2019 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-30773973

RESUMO

Background Atrial tachycardia ( AT ) is common in patients with adult congenital heart disease and is challenging to map and ablate. We used ultra-high-density mapping to characterize the AT mechanism and investigate whether substrate characteristics are related to ablation outcomes. Methods and Results A total of 50 AT s were mapped with ultra-high-density mapping in 23 procedures. Patients were followed up for up to 12 months. Procedures were classified to group A if there was 1 single AT induced (n=12) and group B if there were ≥2 AT s induced (n=11 procedures). AT mechanism per procedure was macro re-entry (n=10) and localized re-entry (n=2) in group A and multiple focal (n=6) or multiple macro re-entry (n=5) in group B. Procedure duration, low voltage area (0.05-0.5 mV), and low voltage area indexed for volume were higher in group B (159 [147-180] versus 412 [352-420] minutes, P<0.001, 22.6 [12.2-29.8] versus 54.2 [51.1-61.6] cm2, P=0.014 and 0.17 [0.12-0.21] versus 0.26 [0.23-0.27] cm2/mL, P=0.024 accordingly). Dense scar (<0.05 mV) and atrial volume were similar between groups. Acute success and freedom from arrhythmia recurrence were worse in group B (100% versus 77% P=0.009 and 11.3, CI 9.8-12.7 versus 4.9, CI 2.2-7.6 months, log rank P=0.004). Indexed low voltage area ≥0.24 cm2/mL could predict recurrence with 100% sensitivity and 77% specificity (area under the curve 0.923, P=0.007). Conclusions Larger low voltage area but not dense scar is associated with the induction of multiple focal or re-entry AT s, which are subsequently associated with longer procedure duration and worse acute and midterm clinical outcomes.


Assuntos
Mapeamento Potencial de Superfície Corporal/métodos , Ablação por Cateter/métodos , Átrios do Coração/fisiopatologia , Cardiopatias Congênitas/complicações , Taquicardia Supraventricular/fisiopatologia , Adulto , Feminino , Seguimentos , Átrios do Coração/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Taquicardia Supraventricular/etiologia , Taquicardia Supraventricular/cirurgia , Fatores de Tempo , Resultado do Tratamento
14.
Anat Sci Educ ; 12(4): 435-443, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30554454

RESUMO

New technological developments have frequently had major consequences for anatomy education, and have raised ethical queries for anatomy educators. The advent of three-dimensional (3D) printing of human material is showing considerable promise as an educational tool that fits alongside cadaveric dissection, plastination, computer simulation, and anatomical models and images. At first glance its ethical implications appear minimal, and yet the more extensive ethical implications around clinical bioprinting suggest that a cautious approach to 3D printing in the dissecting room is in order. Following an overview of early groundbreaking studies into 3D printing of prosections, organs, and archived fetal material, it has become clear that their origin, using donated bodies or 3D files available on the Internet, has ethical overtones. The dynamic presented by digital technology raises questions about the nature of the consent provided by the body donor, reasons for 3D printing, the extent to which it will be commercialized, and its comparative advantages over other available teaching resources. In exploring questions like these, the place of 3D printing within a hierarchical sequence of value is outlined. Discussion centers on the significance of local usage of prints, the challenges created by regarding 3D prints as disposable property, the importance of retaining the human side to anatomy, and the unacceptability of obtaining 3D-printed material from unclaimed bodies. It is concluded that the scientific tenor of 3D processes represents a move away from the human person, so that efforts are required to prevent them accentuating depersonalization and commodification.


Assuntos
Anatomia/educação , Imageamento Tridimensional/ética , Modelos Anatômicos , Impressão Tridimensional/ética , Obtenção de Tecidos e Órgãos/ética , Anatomia/ética , Cadáver , Humanos , Consentimento Livre e Esclarecido , Princípios Morais , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/legislação & jurisprudência
15.
Trials ; 19(1): 117, 2018 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-29458408

RESUMO

BACKGROUND: Atrial fibrillation is the commonest arrhythmia which raises the risk of heart failure, thromboembolic stroke, morbidity and death. Pharmacological treatments of this condition are focused on heart rate control, rhythm control and reduction in risk of stroke. Selective ablation of cardiac tissues resulting in isolation of areas causing atrial fibrillation is another treatment strategy which can be delivered by two minimally invasive interventions: percutaneous catheter ablation and thoracoscopic surgical ablation. The main purpose of this trial is to compare the effectiveness and safety of these two interventions. METHODS/DESIGN: Catheter Ablation versus Thoracoscopic Surgical Ablation in Long Standing Persistent Atrial Fibrillation (CASA-AF) is a prospective, multi-centre, randomised controlled trial within three NHS tertiary cardiovascular centres specialising in treatment of atrial fibrillation. Eligible adults (n = 120) with symptomatic, long-standing, persistent atrial fibrillation will be randomly allocated to either catheter ablation or thoracoscopic ablation in a 1:1 ratio. Pre-determined lesion sets will be delivered in each treatment arm with confirmation of appropriate conduction block. All patients will have an implantable loop recorder (ILR) inserted subcutaneously immediately following ablation to enable continuous heart rhythm monitoring for at least 12 months. The devices will be programmed to detect episodes of atrial fibrillation and atrial tachycardia ≥ 30 s in duration. The patients will be followed for 12 months, completing appropriate clinical assessments and questionnaires every 3 months. The ILR data will be wirelessly transmitted daily and evaluated every month for the duration of the follow-up. The primary endpoint in the study is freedom from atrial fibrillation and atrial tachycardia at the end of the follow-up period. DISCUSSION: The CASA-AF Trial is a National Institute for Health Research-funded study that will provide first-class evidence on the comparative efficacy, safety and cost-effectiveness of thoracoscopic surgical ablation and conventional percutaneous catheter ablation for long-standing persistent atrial fibrillation. In addition, the results of the trial will provide information on the effects on patients' quality of life. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN18250790 . Registered on 24 April 2015.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Toracoscopia/métodos , Ablação por Cateter/efeitos adversos , Análise Custo-Benefício , Interpretação Estatística de Dados , Humanos , Estudos Multicêntricos como Assunto , Cuidados Pós-Operatórios , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Toracoscopia/efeitos adversos
16.
Clin Anat ; 29(1): 2-3, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26474945
17.
Clin Anat ; 29(1): 46-54, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26475081

RESUMO

Anatomy has been thrust into the public domain by the highly successful public displays of dissected and plastinated human bodies. This is anatomy in modern guise, anatomy as perceived by the general public. If this is the case, the message it is giving the public about the nature of anatomy is that it is an impersonal analysis of the human body of value within a medical and health care environment. While this is in part true, and while it reflects important aspects of anatomy's history, it fails to reflect the humanistic strands within an increasing swathe of contemporary anatomy. These are manifested in growing recognition of the centrality of informed consent in the practice of anatomy, awareness of the personal dimensions and relationships of those whose bodies are being dissected, and manifested in thanksgiving ceremonies involving staff and students. The notion that the bodies undergoing dissection can be students' first teachers and/or patients is gaining ground, another indication of the human dimensions of the anatomical enterprise. Exhibitions such as Body Worlds ignore these dimensions within anatomy by dislocating it from its clinical and relational base. The significance of this is that loss of these dimensions leads to a loss of the human face of anatomy by isolating it from the people whose body bequests made this knowledge possible. What is required is greater transparency and openness in the practices of all who deal with the dead human body, trends that owe much to the writings of scholars from within a range of humanities disciplines as they have responded to the public displays of dissected plastinated bodies. Anatomists have much to learn from these debates.


Assuntos
Anatomia Artística/educação , Cadáver , Corpo Humano , Consentimento Livre e Esclarecido/ética , Inclusão em Plástico , Humanos
18.
Clin Anat ; 29(1): 55-9, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26475228

RESUMO

Good practice recommendations for the donation of human bodies and tissues for anatomical examination have been produced by the International Federation of Associations of Anatomists (IFAA). Against the background of these recommendations, the ethical values underlying them were outlined. These were the centrality of informed consent, their non-commercial nature, and the respect due to all associated with donations including family members. The latter was exemplified in part by the institution of thanksgiving services and commemorations. A number of issues in the recommendations were discussed, including the movement of bodies across national borders, donor anonymity, taking images of bodies and body parts, and the length of time for which bodies can be kept. Outstanding questions in connection with body donation included the availability of bodies for research as well as teaching, allowing TV cameras into the dissecting room, and the display of archival material in anatomy museums. Future prospects included whether IFAA could be formulating a position on the public exhibition of plastinated human material, and in what ways IFAA could assist countries currently dependent upon the use of unclaimed bodies.


Assuntos
Anatomia/educação , Anatomia/ética , Cadáver , Diversidade Cultural , Guias como Assunto , Doadores de Tecidos/ética , Obtenção de Tecidos e Órgãos/normas , Humanos , Obtenção de Tecidos e Órgãos/ética
19.
New Bioeth ; 22(3): 237-252, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28219268

RESUMO

The public exhibitions of plastinated (preserved) and dissected human cadavers have proved exceedingly popular and also very contentious. However, there has been little in the way of sustained analysis of these exhibitions from a Christian angle. The technique of plastination enables whole bodies to be displayed as though standing and playing a variety of sports, and with 'life-like' facial expressions. In analyzing this phenomenon, the plastination procedure is outlined, and the degree of naturalness of the whole body plastinates assessed. In searching for theological directives the debate over burial and cremation is used as a means of exploring the respect we give the dead body, and the significance of the resurrection of the body for our views of the dead body. In particular, attention is paid to devaluation of the dead body in situations ranging from dissection of the body through to commercial public exhibitions. The centrality of notions of altruism and 'gift' is discussed. It is concluded that there are many disquieting features to these exhibitions, necessitating caution in approaching them. Nevertheless, in reminding visitors of their mortality and the wonders of the human body, they are not to be dismissed entirely.


Assuntos
Cadáver , Corpo Humano , Dissecação , Humanos , Inclusão em Plástico , Preservação Biológica
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