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BackgroundThere is considerable public interest in whether Europe is facing an opioid crisis comparable to the one in the United States and the contribution of opioid prescriptions for pain to a potential opioid crisis.MethodsA task force of the European Pain Federation (EFIC) conducted a survey with its national chapter representatives on trends of opioid prescriptions and of drug-related emergency departments and substance use disorder treatment admissions and of deaths as proxies of opioid-related harms over the last 20 years.ResultsData from 25 European countries were received. In most European countries opioid prescriptions increased from 2004 to 2016. The levels of opioid consumption and their increase differed between countries. Some Eastern European countries still have a low opioid consumption. Opioids are mainly prescribed for acute pain and chronic noncancer pain in some Western and Northern European countries. There was a parallel increase in opioid prescriptions and some proxies of opioid-related harms in France, Finland and the Netherlands, but not in Germany, Spain and Norway. In United Kingdom, opioid overdose deaths, but not opioid prescriptions increased between 2016 and 2018. There are no robust data available on whether prescribed opioids for pain patients contributed to opioid-related harms.ConclusionsThere are marked differences between European countries in trends of opioid prescribing and of proxies for opioid-related harms. Europe as a whole is not facing an opioid crisis. Discussions on the potential harms of opioids should not obstruct their prescription for cancer pain and palliative care.SignificanceEurope as a whole is not facing an opioid crisis. Some Eastern European countries have limited access to opioid medicines. Discussions on the potential harms of opioid medicines for noncancer pain should not obstruct opioid therapy for cancer therapy and palliative care.

Context: Palliative care advocates argue that service implementation is feasible in all settings. Yet, services have developed patchily in low- and middle-income settings. Beyond Human Development Index indicators, there has been limited engagement with the broader development challenges facing nations tasked with implementing palliative care. Objective: The objective of this study was to describe how indicators of national development relate to levels of palliative care services in 207 countries around the world. Methods: We conducted a ecological study to identify relationships between potential predictor variables and the level of national palliative care development. A total of 28 predictor variables from the following six domains were selected using hypothesized relationships with levels of palliative care development: disease demographics, socioeconomics, health systems, politics, demographics, and economics. The outcome variable was level of national palliative care development on a six-point scale. Spearman's correlation was used to measure the strength of the association. Results: Twenty-six of 28 variables were statistically significantly associated with levels of palliative care development in 207 countries. Palliative care is more developed in countries with high—percentage of deaths from noncommunicable disease, population proportion aged 65+ years, gross national income, and tourism. Development is lower in countries with high levels of political corruption, infant mortality, deaths by infectious diseases, and weak democracy. Prevalence of undernourishment and levels of private health expenditure were not significantly associated with palliative care development. Conclusion: Palliative care development is highly consistent with broader national development indicators. It is less in countries where sudden deaths are more likely and benefits from palliative care provision are likely to be very limited. In such countries, resources may be prioritized toward life-prolonging therapies and key aspects of ...

Jeongsoo Kim,1 SuHwan Shin,2,3 YoungHyun Jeong,4 So Yoon Kim,5,6 Ho-Jin Lee4,7 1Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea; 2Department of Medical Law and Ethics, Graduate School, Yonsei University, Seoul, Republic of Korea; 3Blue Urology Clinic, Seoul, Republic of Korea; 4Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea; 5Division of Medical Law and Bioethics, Department of Medical Humanities and Social Sciences, Yonsei University College of Medicine, Seoul, Korea; 6Asian Institute for Bioethics and Health Law, Yonsei University, Seoul, Korea; 7Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of KoreaCorrespondence: Ho-Jin LeeDepartment of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of KoreaTel +82-2-2072-0039Fax +82-2-747-8363Email zenerdiode03@gmail.comPurpose: Although the use of opioids is increasing in South Korea, there have been no studies on the serious complications caused by the opioids. The aim of this study was to investigate the rare but serious complications through medicolegal analysis.Materials and Methods: From January 1994 to December 2019, we retrospectively reviewed the closed cases of lawsuits involving the complications of opioids using the database of judgments of the Supreme Court of Korea. General characteristics, opioid-induced complications, and judicial characteristics were analyzed.Results: Of the 46 cases, 31 cases of complications were finally included in the analysis. There were 28 (90.3%) cases of opioid administration for acute pain and 3 (9.7%) cases for chronic pain. The most commonly prescribed opioid was pethidine (n = 13, 41.9%), and the most common complication was respiratory depression (n = 17, 54.8%). All except two cases were associated with permanent injuries, including 18 (58%) deaths. Twelve (38.7%) cases were ruled in favor of the plaintiff in the claims for damages, with a median payment of United States dollar (USD) 126,346 (IQR: USD 77,275– 379,219). Of these cases, the most frequently admitted complaint by the court was the neglect of observation (n = 10, 32.3%), followed by the inappropriate drug choice (n = 4, 12.9%). Eleven (36.7%) cases were plaintiffs' claims for violating explanation obligations, of which 2 (6.7%) were recognized in the court.Conclusion: Our results suggest that physicians must be aware of the serious complications related to opioids and health policies to prevent such complications and malpractice should be adopted.Keywords: acute pain, adverse drug events, complications, legislation and jurisprudence, medical liability, opioids

Intro -- Preface -- Contents -- Contributors -- Chapter 1: Informed Consent: Pediatric Patients, Adolescents, and Emancipated Minors -- Introduction -- History of Medical Decision Making -- History of Informed Consent -- Informed Consent: General Concepts in Pediatrics -- Goals and Limitations in Pediatrics -- Consent by Proxy and Parental Permission -- Assent -- Assessing the Decision-Making Capacity of the Pediatric Patient -- Components of Informed Consent -- Informed Consent: Age-Based Approach in Pediatrics -- Infants/Toddlers -- School-Age Children -- Adolescents and the "Mature Minor" -- Emancipated Minors -- Informed Refusal and Dissent -- Unique Considerations -- Jehovah's Witnesses and Blood Consent -- Trainees -- Emergency Surgery -- Informed Consent and Language Barriers -- Informed Consent When Multiple Physicians Participate in the Case -- Elective and Cosmetic Surgery -- Surgical Innovation and Research -- Conclusions -- References -- Chapter 2: Preoperative Testing: Ethical Challenges, Evidence-Based Medicine and Informed Consent -- Introduction -- "Screening" Tests Versus "Targeted" Tests -- The Role of Evidence-Based Testing in Ethical Care of Patients: Addressing the Balance of Risks and Benefits -- What Is the Evidence for Performing Preoperative Screening Tests? -- Electrocardiogram -- Electrolytes -- Complete Blood Count -- Coagulation Screening -- Medical Tests with Special Ethical Significance -- HIV and Hepatitis -- Pregnancy Testing -- Informed Consent for Preoperative Testing -- What If the Patient Refuses Preoperative Testing? -- References -- Chapter 3: Informed Consent and the Disclosure of Surgeon Experience -- Introduction -- Informed Consent Principles: Disclosure and Understanding -- Disclosure of the Risks, Benefits, Alternatives -- Patient Understanding -- Informed Consent -- Informing the Patient.

This article is about subjectivity in experiences of pain. I argue that the body is a site of political intervention and interpretation that shapes `reality' as tangible, substantial categories of cultural experience, including experiences of pain. To the degree that subjectivity works within disciplines of the body (medicine and social work), experiences of pain are significant processes from which an understanding of forms of resistance can begin. I conclude that ultimately what is at stake in understanding the subject through a cultural analysis of pain practices is the very experience of illness, the experience of our bodies. I work with a narrative sketched from my everyday practice as a social worker in an Emergency and Trauma department in an acute care hospital in Toronto, Canada. In doing so, I forefront arts-based methods as a form of qualitative research.

Pain is the unpleasant sensation and emotional experience that leads to poor quality of life for millions of people worldwide. Considering the complexity in understanding the principles of pain and its significant impact on individuals and society, research focuses to deliver innovative pain relief methods and techniques. This review explores the clinical uses of machine learning (ML) for the ; This work has been partly supported by the project that has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 739578 (RISE – Call: H2020-WIDESPREAD-01-2016-2017-TeamingPhase2) and the Republic of Cyprus through the Deputy Ministry of Research, Innovation and Digital Policy.

Objective: This study examined whether anesthesia residents (physicians in training) performed clinical duties in the operating room differently during the day versus at night. Background: Fatigue from sleep deprivation and working through the night is common for physicians, particularly during residency training. Methods: Using a repeated-measures design, we studied 13 pairs of day-night matched anesthesia cases. Dependent measures included task times, workload ratings, response to an alarm light latency task, and mood. Results: Residents spent significantly less time on manual tasks and more time on monitoring tasks during the maintenance phase at night than during the day. Residents reported more negative mood at night than during the day, both pre- and postoperation. However, time of day had no effect on the mood change between pre- and postoperation. Workload ratings and the response time to an alarm light latency task were not significantly different between night and day cases. Conclusions: Because night shift residents had been awake and working for more than 16 hr, the observed differences in task performance and mood may be attributed to fatigue. The changes in task distribution during night shift work may represent compensatory strategies to maintain patient care quality while keeping perceived workload at a manageable level. Applications: Fatigue effects during night shifts should be considered when designing work-rest schedules for clinicians. This matched-case control scheme can also be applied to study other phenomena associated with patient safety in the actual clinical environment.

Objective: A novel vibrotactile display type was investigated to determine the potential benefits for supporting the attention and task management of anesthesiologists. Background: Recent research has shown physiological monitoring and multitasking performance can benefit from displaying patient data via alarm-like tactile notifications and via continuously informing auditory displays (e.g., sonifications). The current study investigated a novel combination of these two approaches: continuously informing tactile displays. Method: A tactile alarm and two continuously informing tactile display designs were evaluated in an anesthesia induction simulation with anesthesiologists as participants. Several performance measures were collected for two tasks: physiological monitoring and anesthesia induction. A multi-task performance score equivalently weighted components from each task, normalized across experimental scenarios. Subjective rankings of the displays were also collected. Results: Compared to the baseline (visual and auditory only) display configuration, each tactile display significantly improved performance in several objective measures, including multitask performance score. The continuously informing display that encoded the severity of patient health into the salience of its signals supported significantly better performance than the other two tactile displays. Contrasting the objective results, participants subjectively ranked the tactile alarm display highest. Conclusion: Continuously informing tactile displays with alarm-like properties (e.g., salience mapping) can better support anesthesiologists' physiological monitoring and multitasking performance under the high task demands of anesthesia induction. Adaptive display mechanisms may improve user acceptance. Application: This study can inform display design to support multitasking performance of anesthesiologists in the clinical setting and other supervisory control operators in work domains characterized by high demands for visual and auditory resources.

Misuse of pain medicine is a leading cause of accidental deaths in the USA—over 15 000 deaths annually. A system dynamics model was developed and used to study the impact of three types of policy interventions to reduce adverse outcomes. Besides medical usage, the model also includes the diversion of pain medicines and their nonmedical use. Model behavior compared favourably with historical data at multiple points in the system. A prescription drug monitoring program intervention reduced nonmedical overdoses through supply restriction, and an intervention to reduce popularity of nonmedical usage reduced nonmedical overdoses by curtailing demand. A tamper‐resistant drug formulation intervention resulted in decreased risk to individuals but increased overdose deaths. Key policy insights are that supply and demand must be carefully considered; that the feedback loops, which created the problem, can help to identify solutions; and that outcome metrics must be carefully chosen. Copyright © 2015 John Wiley & Sons, Ltd.