17/02/2017Experimental evidence confirms what surveys have long suggested: Physicians are more likely to prescribe antibiotics when they believe there is a high expectation of it from their patients, even if they think the probability of bacterial infection is low and antibiotics would not be effective, according to a study published by the American Psychological Association.
16/02/2017Going into hospital, whether unexpectedly or planned, can be a very difficult time for patients and their families. Care and support from hospital staff can make a huge difference to their experiences, but when staff face increasing demands on their time, this is not always easy to deliver.
14/02/2017In the laboratories of Institute of Molecular Medicine Finland (FIMM), drug testing is done ex vivo. That is, various leukemia drugs are tested with patient samples instead of the patients themselves. This enables the researchers to test different drug combinations efficiently and without burdening the patient.
09/02/2017A substantial part of people, one in five, undergoing systemic treatment for psoriasis till have considerable problems with their disease. This is according to a study with 2,646 Swedish psoriasis patients conducted at Umeå University and the Swedish Institute for Health Economics, and recently published in the Journal of Dermatological Treatment.
08/02/2017The promise of information technology has been to improve quality, cut costs and increase patient satisfaction. By themselves, electronic health records, or EHRs, have failed to achieve those aims. Software that adds functionality to EHRs can assess patient risks, help physicians identify problems earlier and better document care quality.
01/02/2017Achromatopsia is a rare hereditary visual disorder. Along with total color blindness, patients most notably suffer from reduced visual acuity and increased sensitivity to light and glare.
01/02/2017Ophthalmology procedures and eye surgeries have been around since ancient times. Today we can hardly imagine the types of circumstances that surrounded any surgical procedures to our perhaps most important sense organ in those days and later eras. Meanwhile, the present and future of this medical specialty looks all the more promising.
01/02/2017Using stents to treat glaucoma is not a new procedure but they have not been implanted into patients on a regular basis until only recently. But this is about to change, which is why MEDICA.de asked what these glaucoma mini-stents are able to do and who may be a good candidate for them. Professor Norbert Pfeiffer answered our questions.
31/01/2017At MEDICA-tradefair.com, we have already commemorated World Cancer Day quite often. But why? Because cancer is an omnipresent topic. Most certainly, sooner or later, directly or indirectly, each and every one of us will get in touch with it – when we develop cancer ourselves or a person close to us does.
23/01/2017Treatment for certain diabetes cases involves constant monitoring of blood-glucose levels and daily insulin shots. But scientists are now developing a painless "smart" patch that monitors blood glucose and releases insulin when levels climb too high.
19/01/2017How do medical professionals determine whether or not a patient has experienced a post-operative complication? A team of Mayo Clinic physicians and researchers has published results of a three-year study examining mechanisms for measuring and reporting postoperative infection complications.
18/01/2017Using data from a national study, Johns Hopkins researchers determined that using heart CT scans can help personalize treatment in patients whose blood pressure falls in the gray zone of just above normal or mild high blood pressure. Previously, the appropriate blood pressure treatment for these patients used risk calculations and some guesswork.
09/01/2017A new pilot study led by McLean Hospital's Ipsit Vahia, MD, medical director of Geriatric Psychiatry Outpatient Services at McLean Hospital, suggests that the use of tablet computers is both a safe and a potentially effective approach to managing agitation among patients with dementia.
04/01/2017Gambling addiction activates the same brain pathways as drug and alcohol cravings, suggests new research. The study, by international scientists including researchers from Imperial College London, suggests targeting these brain pathways may lead to future treatments for the condition.
04/01/2017The University of Montreal Hospital Research Centre (CRCHUM) has been awarded a grant of 2 million dollar from the National Institutes of Health (NIH) to pilot the Canadian component of a study to determine the optimal amount of blood to transfuse in anemic patients who have suffered a myocardial infarction.
03/01/2017Until it burst onto the scene earlier this year, Zika was an obscure, little-known virus. As a result, scientists know little about how it works. Over the past year, they have learned that it can cause a range of dangerous health problems, including birth defects such as microcephaly and neurological problems such as Guillain-Barré syndrome.
03/01/2017A treatment billed as a potential breakthrough in the fight against disease, including cancer, could back-fire and make the disease fitter and more damaging, new research has found. Ground-breaking research has found that introducing 'friendlier' less-potent strains into a population of disease-causing microbes can lead to increased disease severity.
02/01/2017When children suffer from a critical or terminal illness, the first impulse of adults is often to not tell the children and sugarcoat the situation. Yet it is just this type of behavior that frequently causes children to emotionally withdraw.
02/01/2017Treatments for children need to be different from treatment for adults – this also applies in oncology. Having said that, children do not just need new and different treatment concepts that still necessitate research. They also require the support from their families, who need to be nearby during treatment.
02/01/2017Our topic title "pediatric (children’s) oncology" evoked strong emotional reactions from several mothers and fathers of our staff. "This hits too close to home for me, I couldn’t write about it", or "How do people manage to deal with this?". And we are only on the sidelines; physicians, caregivers and nurses at the hospital, hospice or families at home are the ones that have the real tough job.
22/12/2016Capsaicin, an active ingredient of pungent substances such as chilli or pepper, inhibits the growth of breast cancer cells. This was reported by a team headed by the Bochum-based scent researcher Prof. Hanns Hatt and Dr Lea Weber, following experiments in cultivated tumour cells.
14/12/2016FDA-approved artemisinins, since decades used to treat malaria, transform glucagon-producing alpha cells in the pancreas into insulin producing cells – thereby acquiring features of beta cells, the cell type damaged in type 1 diabetes.
13/12/2016Heart damage caused by chemotherapy is worse in cancer patients who also have diabetes, according to a study. "Cardiotoxicity induced by chemotherapy with anthracyclines is being increasingly reported, mainly because a smaller proportion of patients now die from cancer," said lead author Dr Ana Catarina Gomes, a cardiologist in training at the Hospital Garcia de Orta in Almada, Portugal.
12/12/2016The quality of life of elderly myocardial infarction patients can be significantly improved without extra costs by means of so-called case management following hospitalization. Health economists from the Helmholtz Zentrum München have reported these results in the journal Value in Health.
08/12/2016Watching millions of neurons in the brain interacting with each other – for a long time this was possible only to a limited extent. The current techniques can visualize only superficial layers or the imaging they use is too slow. But now, Prof Daniel Razansky and his team have found a new method to visualize the brain activity – by using optoacoustics.
08/12/2016The hip fracture risk factors are generally similar among those with and without Alzheimer's disease, according to a recent study from the University of Eastern Finland. However, the incidence of hip fracture is higher among those with Alzheimer's disease, regardless of other characteristics.
07/12/2016Patients with the same illness often receive the same treatment, even if the cause of the illness is different for each person. This represents a new step towards ultimately being able to offer every patient more personalised treatment.
01/12/2016A German proverb says, "Old age is like a hospital that accepts all diseases," and medicine confirms that older people are not only considerably more susceptible to infectious diseases than they were in middle age, but that body and mind are also less resilient and recover slower or not at all from adverse effects or injuries.
30/11/2016Massachusetts General Hospital (MGH) investigators have developed new methods for mapping and measuring solid stress - the force exerted by solid and elastic components - within tumors, an accomplishment that may lead to improved understanding of those forces and their consequences and to novel treatment strategies.
29/11/2016A new study led by researchers at Massachusetts Eye and Ear found that vestibular thresholds begin to double every 10 years above the age of 40, representing a decline in our ability to receive sensory information about motion, balance and spatial orientation. The report was published in "Frontiers in Neurology".
28/11/2016As Zika spreads throughout the world, the call for rapid development of therapeutics to treat Zika rings loud and clear. Taking a step further in identifying a possible therapeutic candidate, a team of researchers have discovered the mechanism by which C10, a human antibody previously identified to react with the Dengue virus, prevents Zika infection at a cellular level.
28/11/2016Researchers at Children's Hospital Los Angeles (CHLA) have conducted the first study of its kind, using proton magnetic resonance spectroscopy (MRS) to look at brain regions in both adults and children who stutter.
02/11/2016World Diabetes Day is on November 14 of this year. This is reason enough to get informed about the options available in medicine on the subject of "diabetes". One area is telediabetology, a combination of telemedicine and diabetology. It is still not widespread in Germany, but that is about to change because the benefits for patients, physicians and hospitals are obvious.
24/10/2016Preoperative rehabilitation is gaining importance in medicine. It helps to prepare patients for upcoming treatments and surgeries, thereby reducing risks and complications during surgery and making faster rehabilitation possible.
04/10/2016Chronic inflammatory bowel diseases like Crohn’s disease and ulcerative colitis increasingly develop at a younger age and affect patients for life. Regular check-ups need to occur every two to three months. Now, a specially designed app intends to provide relief.
01/09/2016Patients take center stage during surgery. Their treatment should be as gentle and effective as possible, which is why there is a trend towards minimally invasive surgery (MIS). But minimal procedures require better supporting technologies. The hybrid operating room combines surgery and imaging systems and increasingly replaces conventional open surgery approaches with MIS.
01/09/2016Monitoring individual results during surgery with an angiography system? This is already an option in approximately 200 hospitals in Germany. Thanks to intraoperative imaging, major medical procedures can be replaced by minimally invasive surgery because physicians are able to monitor the results immediately. This is gentler on patients and decreases the number of subsequent revision surgeries.
01/09/2016When it comes to the future of medicine, we often ponder how we would like to be treated. On the other hand, there is the issue of how physicians would like to treat their patients. The surgical procedures are determined by the technology that doctors are surrounded by. That’s why technology development also needs to be adapted to the needs of surgeons in the operating room of the future.
22/08/2016A beautiful field of flowers, a trip to the beach or a visit to the zoo. Children can experience all of these at the Clinical Center Dortmund in a 270- degree projection on the wall. The Center created a space that is designed to help its little patients overcome their fear of MRI scans.
22/07/2016Millions of people all over the world suffer from partial blindness – caused by glaucoma, a stroke or traumatic brain injury. For years, the loss of vision was deemed irreversible. But now a new treatment makes it possible to improve eyesight and vision.
01/07/2016Children instinctively know this – exercising is fun, makes you happy and keeps you fit. This begs the question of when and why this innate love for movement dwindles in many of us as we get older. After all, diseases like type 2 diabetes or high blood pressure can be considerably controlled with sufficient exercise.
22/06/2016Exercise makes you healthy – oftentimes even when you are sick. That’s why doctors hardly ever recommend taking a break from it. Even patients who are about to receive a heart transplant can benefit from sports. As is so often the case, the dose makes the poison. We asked sports medicine physician Prof. Martin Halle, what people need to consider.
22/05/2016The treatment for diabetes is very time-consuming for patients: they need to regularly monitor blood sugar levels, take medication and inject insulin. Poor self-management may result in a dangerous lapse in blood glucose levels. Yet external factors can also contribute to diabetes being out of control. An artificial pancreas system could offer relief.
08/05/2016The "Act on secure digital communication and applications in the health care system" (the e-Health Act in short) took effect on December 29 last year. By the end of 2018, hospitals and medical practices will be gradually introduced to the new features of the electronic health card and telemedicine.
01/05/2016In addition to patient counseling and clinical diagnostics, the lion’s share of a cardiologist’s work consists of collecting data to be able to better treat future cases based on the gathered information. Until now, this data was recorded in Excel spreadsheets or many other communication platforms. A software is designed to facilitate a cross-industry exchange.
09/02/2016Many people suffer from atherosclerosis, especially in developed countries. The buildup of fatty deposits inside the arterial blood vessels leads to strokes and heart attacks. Now, a new method is designed to get to the root of the problem, and with the help of nanoparticles inject new turbo replacement cells into the blood vessels which are intended to exert their curative effect.
22/01/2016It may fits, but somewhere it still tweaks. Although a suit off the rack serves its purpose, it is still far from being an ideal solution. With a custom made heart it is different. It is similar with implants. Often patients complain about the fact that those implants feel strange. 3D printing is on the best way to change this. Here, the implants are adapted to the carrier.
04/01/2016Most Europeans think it was a long time ago, but the residents of West Africa clearly feel the consequences of the Ebola epidemic that broke out in December 2013 and still continues today. So far, approximately 11,300 people have died as a result of the outbreak; more than 28,000 contracted the disease.
04/01/2016Infectious diseases are widespread in conflict areas. When basic medical care is lacking on location, people cannot be appropriately treated. Laboratory tests are limited in the field. Rapid diagnostic tests make it possible for medical personnel to quickly and accurately test patients for several infectious diseases, for instance for the presence of malaria or HIV infection.
01/12/2015If you could stimulate brain cells to grow in a specific direction, you would probably be able to achieve a significant improvement in the health of patients suffering from Parkinson’s disease. This is why the MAGNEURON project focuses on this approach. The EU is funding the project with approximately 3.5 million Euros.
01/12/2015Each year, approximately 250,000 Germans suffer a stroke. This makes stroke the third leading cause of death after heart disease and cancer. The circulatory disorder that occurs in the brain is normally treated using systemic thrombolysis, a procedure that bears various risks. Unlike mechanical thrombectomy, which offers clear advantages by comparison.
09/11/2015Interview with Professor Jürgen Weitz, Director of the Clinic and Polyclinic of Visceral, Thoracic, and Vascular Surgery, University Hospital Carl Gustav Carus at the Technical University Dresden
02/11/2015Performing surgery in a hybrid operating room is meant to be a relief for the staff and offer patients new options for treatment. What is actually so different about this hybrid operating room, what can you expect and what should you keep in mind during the planning process?
01/10/2015A proper diagnosis is a part of great therapy. However, it can also be beneficial to be able to quickly respond to changes during a treatment. One example of this is the treatment of uterine myomas. Female patients at the University Hospital Bonn are treated using so-called high-intensity focused ultrasound, HIFU in short. Prof. Holger Strunk explains this procedure.
01/10/2015It is a portmanteau, a mixture of two words. This way it saves us time and trouble while speaking because the human speech apparatus is lazy. And it describes a mixture of procedures: the combination of two procedures that would normally be separate in medicine. We are talking about theranostics.
01/09/2015They can be seen everywhere: at the wrists, in the ear, clipped to the belt. Wearables are small technical assistants who are built to collect and partially also to analyze data. Some of them collect measurable health data, others "only" count their user’s steps or measure the surrounding UV radiation. The fact is, however, that wearables are en vogue and are used for many different cases.
03/08/2015Endoradiotherapy can be very unpleasant for cancer patients, since it does not only harm tumor cells, but also healthy ones. Sometimes, patients even need to stop therapy because of the side effects. Physicians and researchers are thus continuously searching for ways to transport radiopharmaceuticals directly and exclusively to their target.
03/08/2015Malignant tumors can be fought with X-rays – usually with radiation therapy from outside the body. Nuclear medicine physicians can also accomplish this inside the body with radioactive materials, called radiopharmaceuticals. They also offer big benefits for clinical diagnostics as long as a specific target can be assigned to them.
01/07/2015In the case of cardiac arrhythmia, the normal heart rate gets out of balance due to various reasons. In some cases, it is necessary to implant a cardiac pacemaker. Just like with any intervention, this type of surgery also involves risks. In the worst-case scenario, this can lead to abnormal wound healing or obliteration of the vascular system.
22/06/2015Bladder tumors have different growth characteristics. In most cases, they are limited to the inner wall of the bladder and thus well resectable. Unlike carcinoma in situ, which becomes muscle invasive after a certain amount of time. To be able to completely remove the tumor during resection, photodynamic diagnostics (PDD) can make sense.
01/06/2015A tumor is as unique as the person who is affected by it. For a long time, it was assumed this would make treatment more difficult since cancer drugs are not able to be one hundred percent effective in targeting the affected cells. In this interview with MEDICA.de, Professor Ugur Sahin explains why it is precisely these individual mutations that make him hopeful for a new type of therapy.
01/06/2015When cancer is diagnosed, the terms tumor markers or biomarkers keep popping up. They describe characteristics that are not found in healthy persons. The classic tumor markers can be easily detected in blood samples or other body fluids. Other analysis methods require more effort. Yet they all share one thing in common: biomarkers indicate a potential tumor.
04/05/2015Whether it is a mammogram, colonoscopy or a skin cancer screening – after a certain age, we are subject to various early cancer detection screenings. Yet many of us don’t know that these screening tests are also associated with risks. This is something what Dr. Sylvia Sänger from the University Medical Center Hamburg-Eppendorf discovered in a study.
04/05/2015Since the end of April 2015, the long-awaited evaluation report on the skin cancer screening programs offered by German health insurance providers is now finally available. We spoke with Dr. Ralph von Kiedrowski, Board Member of the German Dermatologist Association (German: Berufsverband Deutscher Dermatologen) on what the screening can accomplish and his take on the G-BA report.
01/04/2015The doctor-patient relationship isn’t always easy. On the one hand is the physician, who is responsible for helping many patients. On the other hand is the patient, who visits the doctor in the hopes of his or her problem being treatable. Things always get difficult when one of them feels that they don’t see eye-to-eye. And this happens a lot.
01/04/2015Communication is the key to success when it comes to the patient-physician relationship. Compared to the past however, this relationship has changed somewhat: although physicians are still the experts, thanks to the internet and popular science, patients now also know more about health and diseases. An "informed patient" is not a problem for physicians, but rather a source of better understanding.
23/03/2015Does a patient benefit from treatment or not? How many patients are being treated as a result of damaged cartilage in the knee joint? What intervention is performed most frequently? These and other questions are meant to be answered in the future with the help of a new Cartilage Registry, which was created by the German Society for Orthopedics and Trauma Surgery.
23/02/2015An 80-year-old female patient needs a new aortic valve replacement. Since the old one is severally calcified, the leaflets no longer open properly. Due to various factors, the patient is considered inoperable. Nevertheless, to make surgery possible for her, specialists at the Heart and Diabetes Center NRW in Germany have prepared the intervention based on an exact 3D heart replica.
02/02/2015When children are sick, their parents take them to a pediatrician. A pediatric pathologist is needed when pathology exams need to be conducted. This branch of pathology requires specialized knowledge. The Society for Pediatric and Fetal Pathologists is championing the transfer and preservation of this knowledge.
05/01/2015It sounds strange: During fecal microbiota transplantation, the stool of a healthy donor is transferred into the intestines of a diseased patient to restore his or her damaged gut flora. This is an entirely normal process in the animal kingdom. Now the stool transplant has established itself as the standard for treating Clostridium difficile.
08/12/2014Comparative research models are indispensable in wound healing research to evaluate new treatments of chronic wounds. Consequently, studies need to exhibit equivalent basic prerequisites and be conducted on similar wounds. This is why a team of researchers is working on an automated process to place standardized wounds in skin models.
01/12/2014Several weeks ago on November 1, 2014, 29-year-old Brittany Maynard, who suffered from terminal brain cancer, took drugs to end her life surrounded by her family. This was preceded by months of despair and anguish, but also by love and a lust for life as the young woman describes in several videos she recorded to fight for the right to die with dignity.
01/12/2014How does a physician handle a patient, who wants to die and what rights do I actually have as a patient? Legal practitioners do not automatically answer these and other questions. We talked about this subject with MD-PhD Ralf Jox from the Institute of Ethics, History and Theory of Medicine at the Ludwig Maximilians University of Munich, Germany.
01/12/2014Modern medical technology shortens and makes care processes easier, while it ensures the safety of patients at the same time. However, monitoring or electronic sensors for remote surveillance keep being accompanied by ethical violations. Patients feel like they are being watched and in the worst-case scenario, robbed of their freedom and autonomy.
03/11/2014The treatment of chronic wounds is extremely problematic. Chronic wounds can take months or years to heal and some even never heal resulting in over 100.000 amputations taking place annually in the US alone. A new technology from Iceland, that is based on fish skin and is already used clinically, allows for improved healing of chronic and burn wounds.
08/10/2014The NanoKnife® therapy practiced at the Prostate Center in Offenbach am Main removes prostate tumors in a gentle manner im comparison to prostatectomy or radiation therapy. In this interview with MEDICA.de, Professor Michael K. Stehling explains the advantages of the focal therapy.
01/10/2014On November 10, 2014, astronaut Alexander Gerst will return to Earth from the International Space Station (ISS). He is not just anxiously expected by his family, but also by Dr. Anna-Maria Liphardt from the Institute of Biomechanics and Orthopedics at the German Sport University Cologne
01/09/2014When very young children already need to be in the operating room, it’s not just the parents that are concerned. This type of situation is a special challenge for the entire operating team, because children are always very special patients - especially since they are not just simply small grown-ups!
01/09/2014The rooms in German intensive care units are cold and dreary. Hectic movements determine the patient’s everyday life along with noisy surveillance systems. Artificial light often also promotes a disturbed circadian rhythm. Sleeping pills are meant to solve this problem, but they also increase the risk of delirium at the same time.
01/08/2014If neither the immune system nor antibiotics are able to control an infection, a sepsis can arise out of it - an infection that attacks several organs at the same time and causes the immune system to overreact. This is a life-threatening condition.
01/08/2014Detecting infections quickly and reliably with the naked eye: This is what many doctors in hospitals and in the doctor's surgeries wish for. To make this dream come true, Prof. Holger Schönherr, a scientist from Siegen, is researching a sensor that should show an infection by a color change.
22/07/2014Diabetes is a lifestyle disease that could result in dangerous consequences for the individual patient and the entire society. However, you can successfully stop this disease with targeted prevention methods.
01/07/2014Large burns require skin grafting. Surgeons remove split-thickness skin grafts and apply them to the injured areas. Now skin that has been made in a laboratory is meant to help in covering burns as well as chronic wounds and thus promote the healing process. Researchers in Zurich have been working on this for more than 13 years.
01/07/2014The not so popular “love handles“ could revolutionize medicine in the near future. In cooperation with the University of Rostock (Professor Hermann Seitz), the human med AG Company currently seeks to develop a device that is able to gently remove adipose tissue during surgery and subsequently isolate stem cells.
10/06/2014The German Technician Health Insurance (German: Techniker Krankenkasse) conducted a study on the Topic “Phone coaching helps seriously ill patients and saves money“. We spoke with Günter van Aalst about the interesting findings.
02/06/2014When are sports healthy, how often should you engage in sports and what effect do sports have on the body – over the past few decades, there were always different answers to these questions. Many studies that were conducted in the past however confirm the assumption that sports and exercise always support health, even if someone is already sick.
02/05/2014Successful communication is most important in medicine. The most modern channels have been utilized in this area for quite some time now. Medical apps need to meet several requirements at once. For their use to pay off, they need to be beneficial for prevention or therapy. And to ensure a safe application, they also need to be both technically and medically flawless.
02/05/2014Whether in remote areas or in a large city – people everywhere need good healthcare. Thanks to mobile health, more and more people can get medical help, even in poor regions of the world.
01/04/2014When the call comes in at the dispatch center, things need to happen fast: rescue workers sprint to the car, race onto the street and make their way to the patient within a few short minutes. No more than thirty minutes later, the patient arrives at the hospital from which he is hopefully soon released again with a clean bill of health. At least that's how it works in theory.
24/03/2014He is kind of a "Bones" McCoy, since he keeps astronauts fit: Dr. Simon Evetts leads the Medical Projects and Technology team within the Medical Support Office of the European Astronauts Centre in Cologne, Germany. MEDICA.de talked to him about sports in universe, space technology and the benefits for us earthlings.
03/02/2014Shortening a time-consuming procedure from four hours to five minutes and automate it at the same time sounds like a dream come true for employees in all fields and industry sectors. This dream could soon become a reality for radiologists. Software could take away the tedious processing of CT images, which is required before cancer radiation therapy.
03/02/2014Radiologists usually do their work after oncologists when it comes to cancer treatment. Yet modern radiology also provides treatments at this point. MEDICA.de spoke with Professor Stefan Schönberg, Director of the Institute of Clinical Radiology and Nuclear Medicine at the University Medical Center Mannheim, Germany, about the use of a new computer tomograph and its benefits for patients.
22/01/2014It guards the body but can become its enemy: the immune system defends us from intruding pathogens; it is also able to cause severe diseases if it falsely recognizes the body itself as a threat. Molecular receptors in the whole body enable the immune system to “sense” what happens within.
15/01/2014In Western civilization, equality of women and men has been a topic for many years and is already being successfully implemented in many areas, even if many obstacles still need to be overcome – the introduction of quotas for women in boardrooms, just to mention one of them.
08/01/2014Heart diseases can be triggered by special viruses that affect the cardiac muscle. Preventive drugs could definitely be developed – if the virus does not mutate.
06/01/2014Even medical risk products are not always tested as thoroughly as would be necessary – be it because of criminal energy, lack of know-how or financial reasons. A revision of clinical trial procedures could not only fix loop holes and methodological flaws. Products and methods could also be brought into general medical care more quickly under new rules.
06/01/2014Whether a surgical suture is better applied manually or with a surgical stapler can be determined through trial and error. Determining which method guarantees patient safety best should also not just be based on a surgeon’s experience. Controlled studies are the method of choice to assess both well-proven and new techniques in the operating room.