Modern medicine is one of humankind's greatest achievements.Yet today, frequent medical errors and irreproducibility in biomedical research suggest that tremendous challenges beset it. Understanding these challenges and trying to remedy them have driven considerable and thoughtful critical analyses, but the apparent intransigence of these problems suggests a different perspective is needed. Now more than ever, when we see options and opportunities for healthcare expanding while resources are diminishing, it is extremely important that healthcare professionals practice medicine wisely. In Medical Reasoning, neurologist Erwin B. Montgomery, Jr. offers a new and vital perspective. He begins with the idea that the need for certainty in medical decision-making has been the primary driving force in medical reasoning. Doctors must routinely confront countless manifestations of symptoms, diseases, or behaviors in their patients. Therefore, either there are as many different "diseases" as there are patients or some economical set of principles and facts can be combined to explain each patient's disease. The response to this epistemic conundrum has driven medicine throughout history: the challenge is to discover principles and facts and then to develop means to apply them to each unique patient in a manner that provides certainty. This book studies the nature of medical decision making systematically and rigorously in both an analytic and historical context, addressing medicine's unique need for certainty in the face of the enormous variety of diseases and in the manifestations of the same disease in different patients. The book also examines how the social, legal, and economic circumstances in which medical decision-making occurs greatly influence the nature of medical reasoning. Medical Reasoning is essential for those at the intersection of healthcare and philosophy.
Reproducibility in Biomedical Research: Epistemological and Statistical Problems, 2nd Ed. explores the ideas and conundrums inherent in scientific research. Reproducibility is one of the biggest challenges in biomedical research. It affects not only the ability to replicate results, but the very trust in the findings. Since published in 2019, Reproducibility of Biomedical Research: Epistemological and Statistical Problems established itself as a solid ethical reference in the area, leading to significant reflection on biomedical research. The second edition addresses new challenges to reproducibility in biosciences, namely reproducibility of machine learning Artificial Intelligence (AI), reproducibility of translation from research to medical care, and the fundamental challenges to reproducibility. All current chapters will be expanded to cover advances in the topics previously addressed. Reproducibility in Biomedical Research: Epistemological and Statistical Problems, 2nd Ed. provides biomedical researchers with a framework to better understand the reproducibility challenges in the area. Newly introduced interactive exercises and updated case studies help students understand the fundamental concepts involved in the area. - Includes four new chapters and updates across the book, covering recent developments of issues affecting reproducibility in biomedical research - Covers reproducibility of results from machine learning AI algorithms - Presents new case studies to illustrate challenges in related fields - Includes a companion website with interactive exercises and summary tables
Nonlinear Dynamics of Parkinson's Disease and the Basal Ganglia-Thalamic-Cortical System examines current research regarding the operations of the basal ganglia-thalamic-cortical system that causes neurological disorders like Parkinson's disease. While there have been remarkable advances in the understanding of the anatomy, physiology and chemistry of these systems, there remains a significant degree of inconsistency and incompleteness between facts and advancements. This book introduces the novel concepts of nonlinear complex systems and their connection to Parkinsonism as well as hyperkinetic disorders. The actual mechanisms underlying the motor disorders of Parkinson's disease at the level of the lower motor neuron are also discussed. - Outlines phenomenological selectivity of pallidotomy and Deep Brain Stimulation - Reviews the anatomical models of pathophysiology and physiology - Discusses the instrumental and analytical misrepresentations and the inferences that misrepresent the data in Nonmonotonic Nonlinear Dynamics
Ethics of Everyday Medicine: Explorations of Justice examines and analyses the relatively unexplored domain of ethics involved in the everyday practice of medicine. From the author's clinical experience, virtually every decision made in the day-to-day practice of medicine is fundamentally an ethical question, as virtually every decision hinge on some value judgment that goes beyond the medical facts of the matter. The first part of the book is devoted to medical decision cases in several areas of medicine. These cases highlight elements of the current healthcare ecosystem, involving players other than the physician and patient. Insurers (private, commercial, and governmental), administrators, and regulators' perspectives are surfaced in point of care case analysis. Part two contributes to the development of actionable tools to develop better ethical systems for the everyday practice of medicine by providing a critical analysis of Reflective Equilibrium and ethical induction from the perspective of logic and statistics. The chapter on Justice discusses the neurophysiological representations of just and unjust behaviours. The chapter on Ethical Theories follows, describing the epistemic conundrum, principlism, reproducibility, abstraction, chaos and complexity. The following chapter approaches ethical decisions from the logic and statistic perspectives. The following chapter, The Patient as Parenthetical, the author discusses patient-centric ethics, and the rise of business- and government-cetric ethics. The final chapter, A Framework to Frame the Questions for Explore Further, proposes a working framework to deal with current ethical issues. Ethics of everyday Medicine: Explorations of Justice acknowledges that there are no answers yet to the ethical dilemmas that confront the everyday practice of medicine, but proposes a framework for deeper analysis and action. This reading would be useful to all healthcare professionals. Regulators and policy makers could also benefit from understanding how the complex healthcare environment influences medical decisions at point of care. - Offers an overview of the current health care ecosystem and the ethical questions posed by divergent interests - Includes cases for ethical analysis of common medical practice - Proposes a framework for ethical decision making in the clinical setting - Provides critical analysis of Reflective Equilibrium and ethical induction from the perspective of logic and statistics
Deep brain stimulation programming (DBS) continues to grow as an effective therapy for a wide range of neurological and psychiatric disorders, helping patients reach optimal control of their disorder. With the technique finding so much success, the next question is how to make the complexities of post-operative programming cost-effective, especially when traditional medications and treatments can no longer do the job. The second edition of Deep Brain Stimulation Programming is fully revised and up-to-date with the latest technologies and focuses on post-operative programing, which no other text does. This book provides programmers with a foundation of the brain as an electrical device, focusing on the mechanisms by which neurons respond to electrical stimulation, how to control the stimulation and the regional anatomy, and the many variations that influence a patient's response to DBS. Dr. Montgomery explores new techniques of programming; including those based on stimulation frequency, closed-loop DBS, and the roles of oscillators in DBS; and new technological advances that make pre-existing theories of pathophysiology obsolete. Key Features of the Second Edition Include · Highlights post-operative deep brain stimulation; · Includes the most recent discoveries in deep brain stimulation programming; · Highly illustrated with figures for absorption of key programming and techniques; · Provides an appendix of additional resources available through the Greenville Neuromodulation Center.
Twenty Things to Know About Deep Brain Stimulation is an extensive and in-depth critical analysis of the field of Deep Brain Stimulation (DBS) from what many may consider a revolutionary perspective. This book demonstrates the unique nature and incredible promise of DBS and shows how it is unparalleled as a therapeutic intervention. Dr. Montgomery provides an epistemic analysis of the presuppositions, assumptions and fallacies underlying current clinical understanding of DBS as well as the physiology and pathophysiology affected by DBS. Reviews of the safety and efficacy for a number of conditions, patient selections and issues in the post-operative management are also included. Given the revolutionary potential and the complexity of DBS in an ever changing healthcare delivery context, the ethics of DBS are discussed in detail.
A thorough understanding of electricity, electronics, biophysics, neurophysiology, and neuroanatomy is important to render more tractable, and otherwise complex, electrophysiologically-based targeting in the brain during operative manipulations. Most importantly, electrophysiological monitoring requires controlling the movement of electrons in electronic circuits in order to prevent irreversible damage. This new textbook presents a fundamental discussion of electrons, the forces moving these electrons, and the electrical circuits controlling these forces. The forces that allow recording and analysis also permeate the environment producing interference, such as noise and artifacts. Intraoperative Neurophysiological Monitoring for Deep Brain Stimulation discusses how to avoid or suppress noise and artifacts for the most successful surgical outcome.
Deep Brain Stimulation (DBS) is a remarkable therapy for an expanding range of neurological and psychiatric disorders. In many cases it is better than best medical therapy and succeeds even when brain transplants fail. Yet despite the remarkable benefits, many physicians and healthcare professionals seem hesitant to embrace this therapy. Post-operative programming of the DBS systems seems unfamiliar, even mysterious, and is viewed as difficult and time consuming. However, DBS programming is rational and can be efficient and effective if one understands the basing underlying concepts of electronics, electrophysiology, and the relevant regional anatomy. Even these principles can be relatively easy to grasp. The book helps the reader to obtain an intuitive understanding of the basic principles of electronics, electrophysiology and the relevant regional anatomy through the use of readily understood metaphors and numerous illustrations. In addition a number of tools are provided including algorithms to ensure efficient and thorough programming. Forms are provided to help with documentation. In addition, DBS related research provides a remarkable tool to understand how the brain works and what happens in diseases such as Parkinson's disease. Already long cherished theories of the pathophysiology of Parkinson's disease must be abandoned. Indeed, these DBS derived insights suggest fundamental revisions of theories of brain function are in order. The book provides an introduction to where some of the new theories may lead particularly with the growing awareness of the importance of oscillations in the brain's activities. The brain has more in common with electrical devices, such as computers, than it does to a stew of chemicals. DBS operates at the electrical level in the brain, which is fundamental to how the brain creates, manipulates and conveys information and may indeed be fundamental to the misinformation the results in the dysfunction related to disorders of the brain. For downloadable forms and other relevant material, please visit: http://www.uab.edu/DBS_PrinciplesAndPractice
A thorough understanding of electricity, electronics, biophysics, neurophysiology, and neuroanatomy is important to render more tractable, and otherwise complex, electrophysiologically-based targeting in the brain during operative manipulations. Most importantly, electrophysiological monitoring requires controlling the movement of electrons in electronic circuits in order to prevent irreversible damage. This new textbook presents a fundamental discussion of electrons, the forces moving these electrons, and the electrical circuits controlling these forces. The forces that allow recording and analysis also permeate the environment producing interference, such as noise and artifacts. Intraoperative Neurophysiological Monitoring for Deep Brain Stimulation discusses how to avoid or suppress noise and artifacts for the most successful surgical outcome.
Twenty Things to Know About Deep Brain Stimulation is an extensive and in-depth critical analysis of the field of Deep Brain Stimulation (DBS) from what many may consider a revolutionary perspective. This book demonstrates the unique nature and incredible promise of DBS and shows how it is unparalleled as a therapeutic intervention. Dr. Montgomery provides an epistemic analysis of the presuppositions, assumptions and fallacies underlying current clinical understanding of DBS as well as the physiology and pathophysiology affected by DBS. Reviews of the safety and efficacy for a number of conditions, patient selections and issues in the post-operative management are also included. Given the revolutionary potential and the complexity of DBS in an ever changing healthcare delivery context, the ethics of DBS are discussed in detail.
This biography traces the career of Frenchman Jacques Coeur, royal official, merchant, and financier, amidst war and exploration in fifteenth-century Europe and invites readers to consider Coeur's career against a broad historical context.
Nonlinear Dynamics of Parkinson's Disease and the Basal Ganglia-Thalamic-Cortical System examines current research regarding the operations of the basal ganglia-thalamic-cortical system that causes neurological disorders like Parkinson's disease. While there have been remarkable advances in the understanding of the anatomy, physiology and chemistry of these systems, there remains a significant degree of inconsistency and incompleteness between facts and advancements. This book introduces the novel concepts of nonlinear complex systems and their connection to Parkinsonism as well as hyperkinetic disorders. The actual mechanisms underlying the motor disorders of Parkinson's disease at the level of the lower motor neuron are also discussed. - Outlines phenomenological selectivity of pallidotomy and Deep Brain Stimulation - Reviews the anatomical models of pathophysiology and physiology - Discusses the instrumental and analytical misrepresentations and the inferences that misrepresent the data in Nonmonotonic Nonlinear Dynamics
Deep brain stimulation programming (DBS) continues to grow as an effective therapy for a wide range of neurological and psychiatric disorders, helping patients reach optimal control of their disorder. With the technique finding so much success, the next question is how to make the complexities of post-operative programming cost-effective, especially when traditional medications and treatments can no longer do the job. The second edition of Deep Brain Stimulation Programming is fully revised and up-to-date with the latest technologies and focuses on post-operative programing, which no other text does. This book provides programmers with a foundation of the brain as an electrical device, focusing on the mechanisms by which neurons respond to electrical stimulation, how to control the stimulation and the regional anatomy, and the many variations that influence a patient's response to DBS. Dr. Montgomery explores new techniques of programming; including those based on stimulation frequency, closed-loop DBS, and the roles of oscillators in DBS; and new technological advances that make pre-existing theories of pathophysiology obsolete. Key Features of the Second Edition Include · Highlights post-operative deep brain stimulation; · Includes the most recent discoveries in deep brain stimulation programming; · Highly illustrated with figures for absorption of key programming and techniques; · Provides an appendix of additional resources available through the Greenville Neuromodulation Center.
Reproducibility in Biomedical Research: Epistemological and Statistical Problems, 2nd Ed. explores the ideas and conundrums inherent in scientific research. Reproducibility is one of the biggest challenges in biomedical research. It affects not only the ability to replicate results, but the very trust in the findings. Since published in 2019, Reproducibility of Biomedical Research: Epistemological and Statistical Problems established itself as a solid ethical reference in the area, leading to significant reflection on biomedical research. The second edition addresses new challenges to reproducibility in biosciences, namely reproducibility of machine learning Artificial Intelligence (AI), reproducibility of translation from research to medical care, and the fundamental challenges to reproducibility. All current chapters will be expanded to cover advances in the topics previously addressed. Reproducibility in Biomedical Research: Epistemological and Statistical Problems, 2nd Ed. provides biomedical researchers with a framework to better understand the reproducibility challenges in the area. Newly introduced interactive exercises and updated case studies help students understand the fundamental concepts involved in the area. - Includes four new chapters and updates across the book, covering recent developments of issues affecting reproducibility in biomedical research - Covers reproducibility of results from machine learning AI algorithms - Presents new case studies to illustrate challenges in related fields - Includes a companion website with interactive exercises and summary tables
The book is a guide to the principles of electronics, electrophysiology and regional neuroanatomy that allows the rational use of Deep Brain Stimulation. Practical issues are addressed and algorithms and tools are provided. Also, how DBS is leading to new and revolutionary theories of brain function and dysfunction are described.
Ethics of Everyday Medicine: Explorations of Justice examines and analyses the relatively unexplored domain of ethics involved in the everyday practice of medicine. From the author's clinical experience, virtually every decision made in the day-to-day practice of medicine is fundamentally an ethical question, as virtually every decision hinge on some value judgment that goes beyond the medical facts of the matter. The first part of the book is devoted to medical decision cases in several areas of medicine. These cases highlight elements of the current healthcare ecosystem, involving players other than the physician and patient. Insurers (private, commercial, and governmental), administrators, and regulators' perspectives are surfaced in point of care case analysis. Part two contributes to the development of actionable tools to develop better ethical systems for the everyday practice of medicine by providing a critical analysis of Reflective Equilibrium and ethical induction from the perspective of logic and statistics. The chapter on Justice discusses the neurophysiological representations of just and unjust behaviours. The chapter on Ethical Theories follows, describing the epistemic conundrum, principlism, reproducibility, abstraction, chaos and complexity. The following chapter approaches ethical decisions from the logic and statistic perspectives. The following chapter, The Patient as Parenthetical, the author discusses patient-centric ethics, and the rise of business- and government-cetric ethics. The final chapter, A Framework to Frame the Questions for Explore Further, proposes a working framework to deal with current ethical issues. Ethics of everyday Medicine: Explorations of Justice acknowledges that there are no answers yet to the ethical dilemmas that confront the everyday practice of medicine, but proposes a framework for deeper analysis and action. This reading would be useful to all healthcare professionals. Regulators and policy makers could also benefit from understanding how the complex healthcare environment influences medical decisions at point of care. - Offers an overview of the current health care ecosystem and the ethical questions posed by divergent interests - Includes cases for ethical analysis of common medical practice - Proposes a framework for ethical decision making in the clinical setting - Provides critical analysis of Reflective Equilibrium and ethical induction from the perspective of logic and statistics
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