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Adiposity-based Chronic Disease a New Diagnostic Term
Published in James M. Rippe, Lifestyle Medicine, 2019
Michael G. Flynn, Krauss Jeffrey
Unfortunately, multiple and conflicting health messaging about the definition and the causes of obesity, best lifestyle practices, and unproven therapies only aggravate confusion within the scientific literature,6,7 lay press,8 and popular culture.9,10 Abnormal adiposity poses significant and irrefutable health risks, but sustainable lifestyle interventions, though logically sound and evidence based, are very difficult to implement. This incongruence commonly leads to therapeutic nihilism on the part of both healthcare professionals (HCP) and patients. To some degree, this follows from the widely held belief that obesity is a personal choice rather than a bona fide chronic disease state with hallmark biological and behavioral components.
First Half of the Nineteenth Century
Published in Arturo Castiglioni, A History of Medicine, 2019
Pathology and clinical medicine, by separating themselves from metaphysical concepts and doctrinal systems, at this time entered a period of investigative progress that created a new world in symptomatology, diagnosis, and the understanding of the nature of disease. The great French and English schools maintained the Hippocratic trend in clinical medicine. The Germanic schools turned toward a more analytical method that led to a purely materialistic concept of vital phenomena, to scepticism in treatment, and to the construction of a new dogmatism. [It is but fair to add that therapeutic scepticism had its deserved place at a time when the true knowledge of the nature of disease was still in its childhood; and, as has subsequently been shown, drugs were usually given uselessly or even harmfully. It is pleasant to observe that with a better knowledge of the nature of the disease and of the action of drugs, clinical investigation is now turning more and more toward therapeutic problems. “Therapeutic nihilism,” which should be considered more correctly as often an unwillingness to indulge in an unreasonable use of drugs, has now been replaced by a rational drug therapy. Ed.]
Realizing the benefits
Published in Mark Baker, Neal Maskrey, Simon Kirk, Allen Hutchinson, Clinical Effectiveness and Primary Care, 2018
Mark Baker, Neal Maskrey, Simon Kirk, Allen Hutchinson
As health care becomes more refined, and concern for the quality of life takes centre stage in the later stages of both life and disease, health professionals take seriously the balance of benefit between the side-effects of treatment and the clinical benefits which are likely. This is the legitimate case for therapeutic nihilism. There are still practitioners who do not treat or refer patients with treatable disorders for other reasons, including ignorance, oversight and social reasons. This is so for both routine secondary care procedures, such as adjuvant cancer therapy, and for complex tertiary interventions, such as for end-stage renal disease. There is evidence of institutional sexism and ageism in referral on to higher specialist care, especially in cardiology and oncology; these are other unjustified types of nihilism.
Moral Distress: The Context of Measurement
Published in The American Journal of Bioethics, 2023
Niek Kok, Marieke Zegers, Cornelia Hoedemaekers, Jelle van Gurp
ICU professionals in our sample consistently score high on the MDS-R item: “Initiate extensive lifesaving actions when I think they only prolong death” (e.g. Kok et al. 2021). By qualitative data, we know that ICU professionals differ in their assessment of the beneficiality of lifesaving actions based on their assessment of a patient’s prognosis and their tolerance for uncertainty. Some professionals tend toward what has been called “therapeutic nihilism”, while others are inclined toward therapeutic optimism or hopefulness (Mamede and Schmidt 2014). Moral distress arises in the first group of professionals if they provide care which they believe is futile, while the latter group experiences moral distress from abstaining treatment which they believe is effective. However, both groups often arrive at their beliefs about treatment in a context where knowledge is fragmented or dispersed.
Persistent spinal pain syndrome: a proposed replacement for failed back surgery syndrome
Published in British Journal of Neurosurgery, 2023
Brian Simpson, Nick Christelis, Marc Russo, Michael Stanton-Hicks, Giancarlo Barolat, Simon Thomson
FBSS (and FNSS: ‘failed neck surgery syndrome’) fails to indicate whether surgery caused or exacerbated the pain directly, or indirectly, or simply failed to relieve the pain, and it is unclear about recurrent pain. It identifies neither inappropriately-performed surgery, for example insufficient decompression and unjustified intervention, nor the effects of complications of surgery, such as neurological damage. There is no reference to pathophysiological mechanisms nor, even, to the particular operation(s) performed. Psychological and social factors are ignored, despite their frequent relevance, but the juxtaposition of ‘failed’ and ‘syndrome’ can imply that the patient is to blame. The therapeutic nihilism infers a poor prognosis. Finally, successful back surgery is not clearly defined, so there is no point of reference.
Insular glioblastoma: surgical challenges, survival outcomes and prognostic factors
Published in British Journal of Neurosurgery, 2023
Amanjot Singh, Kuntal Kanti Das, Deepak Khatri, Suyash Singh, Jaskaran Singh Gosal, Sushila Jaiswal, Prabhakar Mishra, Anant Mehrotra, Kamlesh Bhaisora, Jayesh Sardhara, Arun Kumar Srivastava, Awadhesh Jaiswal, Sanjay Behari
Insula is an anatomically and functionally complex area with well-documented surgical risks.1–3 Therefore, therapeutic nihilism have long characterised surgical endeavours in this region. However, a special microenvironment makes the insula prone to develop gliomas, the lion share of which are low grades pathologically.4,5 The earlier studies somehow underestimated the incidence of high grade gliomas in the insula (about 10% of all intracranial high-grade gliomas.4 A large number of recent publications have not only improved our understanding of insular gliomas in general but also have shown that high grade tumours are probably much more frequent than thought.4,6–8 However, we do not find many publications focusing on the high-grade insular gliomas. Interestingly, we have not encountered a single publication focusing on the insular glioblastomas (iGBM) in the literature. Most of the articles tend to combine the low- and the high-grade gliomas while deriving the results8,9. Contrasting findings have emanated from the previous studies. While Sanai et al8 noted the insular high-grade gliomas to be more indolent and to do well with extensive resections,Simon et al 9 have suggested only a palliative tumour decompression considering a generally poor outcome with these tumors.