Philosophy and anaesthesiology are disciplines that are rarely associated despite their respective interests in human consciousness. In this paper, we consider the advantages of integrating anaesthesiology and philosophy in the endeavour of discovering the neural correlates of state consciousness. We venture the following twopart argument. First, we argue that philosophical debates about the correlation conditions for state consciousness can be improved by focusing on how anaesthesiologists actually measure and study consciousness in practice. We present Integrated Information Theory as (...) a promising framework for discriminating features hitherto considered relevant to the identification of the neural correlates of state consciousness. Second, we argue that an improved philosophical understanding of what comprises the correlation conditions for state consciousness can, in turn, advance anaesthesiological methodologies; not only can it improve how potential evidence is gathered and assessed, but it can aid in the prevention of intraoperative awareness, increasing patient safety and well-being. (shrink)

Since 2010, the European Journal of Anaesthesiology has required the reporting of five items concerning ethical approval in articles describing human research: ethics committee’s name and address, chairperson’s name, study’s protocol number and approval date. We aimed to assess whether this requirement has helped to identify and to contact the referenced ethics committees. In this cross-sectional study, we analysed articles requiring ethical approval, according to the Swiss federal law for human research and published in the European Journal of (...) class='Hi'>Anaesthesiology in 2011. Ethics committees were searched through our institutional Internet access based on information provided in the articles. The last search was performed in November 2015. Numbers of items reported, of ethics committees identified, and of those that confirmed having provided ethical approval are reported. Of 76 articles requiring ethical approval, 74 declared it. Ethics committees’ names and addresses were mentioned in 63/74, protocol numbers in 51/74, approval dates in 48/74, and chairpersons’ names in 45/74. We could identify 44/74 committees; 36/74 answered our inquiry and 24/74 confirmed their role. Thirty-four of 74 articles reported all five items; in 25/34, we were able to identify an ethics committee, 18/34 answered our inquiry, and 15/34 confirmed their role. Forty of 74 articles reported ≤4 items; in 19/40, we were able to identify an ethics committee, 18/40 answered our inquiry, and 9/40 confirmed their role. Reporting five items significantly increased identification of ethics committees and their confirmation of ethical approval. Twelve of 74 ethics committees were unable to confirm their role in approving the study. Even when details concerning ethical approval were reported in these studies of human research, we were unable to identify almost half of the ethics committees concerned. The reporting of five items, compared with reporting ≤4, was associated with facilitated identification of ethics committees, and increased the likelihood that they would be able to confirm the study’s approval. Future research should identify which information facilitates identification of, and contact with, ethics committees. (shrink)

In clinical practice, modern medicine, especially intensive medicine, has made outstanding technological progress that has changed diagnostic and therapeutic paradigms. Nowadays, some patients for whom there were no treatments in the past not only survive but return to active life thanks to intensive medicine. However, in some cases intensive care will not help patients in a critical condition and merely prolong death. In such situations, the treatment is terminated or not extended, and the patient is allowed to die in dignity. (...) In this specific situation all intensive procedures are terminated. Palliative care is the next stage. This is a sensitive issue that should be discussed with healthcare professionals and experts from other areas of life to ensure it is communicated appropriately to patients and their relatives. (shrink)

Statistical methods used by healthcare entities enable the collection of various information about the structure and characteristics of treated patients. They are an important source of knowledge, and form a database that plays an important role in entity management theory. In the presented study, we analysed the hospital stays of patients treated in all hospital wards of the 3rd City Hospital in Łodź during 2012. The following, in particular, were taken into account: admittance procedure, discharge procedure, age and sex of (...) hospitalised persons. Patients in over 55% of cases were admitted using the sud- den admittance procedure. At the same time, over 3/4 of the stays ended with a referral for further treatment in ambulatory conditions, and death occurred in approx. 5% of hospitalisations. By comparing the discharge procedures, the percentage of deaths in the Anaesthesiology and Intensive Care Wards can be seen clearly. Internal wards are next in turn. The biggest differences in the length of hospitalisation between the studied institution and the NFZ data concern the E77, A49, A48, A87, A33, D18, E16, E61 and G37 groups. (shrink)

BackgroundCurrently, intensive care medicine strives to define a generally accepted way of dealing with end-of-life decisions, therapy limitation and therapy discontinuation.In 2006 a new advance directive legislation was enacted in Austria. Patients may now document their personal views regarding extension of treatment. The aim of this survey was to explore Austrian intensive care physicians' experiences with and their acceptance of the new advance directive legislation two years after enactment (2008).MethodsUnder the aegis of the OEGARI (Austrian Society of Anaesthesiology, Resuscitation (...) and Intensive Care) an anonymised questionnaire was sent to the medical directors of all intensive care units in Austria. The questions focused on the physicians' experiences regarding advance directives and their level of knowledge about the underlying legislation.ResultsThere were 241 questionnaires sent and 139 were turned, which was a response rate of 58%. About one third of the responders reported having had no experience with advance directives and only 9 directors of intensive care units had dealt with more than 10 advance directives in the previous two years. Life-supporting measures, resuscitation, and mechanical ventilation were the predominantly refused therapies, wishes were mainly expressed concerning pain therapy.ConclusionA response rate of almost 60% proves the great interest of intensive care professionals in making patient-oriented end-of-life decisions. However, as long as patients do not make use of their right of co-determination, the enactment of the new law can be considered only a first important step forward. (shrink)

This paper reviews a theory on the physiological conditions of consciousness. The theory consists of four hypotheses: (1) The occurrence of states of consciousness depends on the formation of higher-order representations that represent the internal state of the brain itself. (2) Higher-order representations are instantiated by the spatio-temporal activity pattern of large-scale neuronal assemblies. (3) The N-methyl-D-aspartate (NMDA) synapse plays a crucial role in the generation of conscious states by implementing the binding mechanism that the brain uses to produce large-scale (...) assemblies. (4) The activation state of the NMDA receptor determines the rate at which representational structures can be built up. Unconsciousness or altered states of consciousness occur if, and only if, NMDA-dependent binding processes are inhibited. (shrink)