Recenti progressi in medicina
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Since several decades, peer review has become the standard to evaluate quality and priority of manuscripts submitted to scientific journals. During this process, manuscript is reviewed by scientists from the same field of the authors, with a competency on the topic of the manuscript (peer reviewers). Peer reviewers submit their comments to the journal editor, who then takes a decision on manuscript acceptance, need for revision of rejection. ⋯ In this article we overview the main options available for crediting peer reviewers for their efforts, focusing, in particular on the creation of a robust metrics able to attest the number and quality of peer reviews produced by this individual. This process implies the involvement of peer reviewers, journal editors and publishers and of a third, external, certification party. If implemented, this strategy could promote a virtuous circle, leading to an overall improvement of the process of peer review and ultimately of scientific publishing.
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Lemierre's syndrome is a dangerous potential sequela of pharyngitis that results in septic thrombophlebitis of the internal jugular vein. A high index of suspicion is needed to consider this diagnosis in the workup of pharyngitis and should be aggressively treated once. Gram-negative anaerobic bacteria, mainly Fusobacterium necrophorum are implicated. ⋯ But with the introduction of penicillin in the 1940s, the incidence of the syndrome dropped, and it eventually became known as the "forgotten disease". Since the 1990s, however, there has been a marked resurgence of Lemierre's syndrome. Although uncommon, clinicians need to be aware of this condition because patients with Lemierre's syndrome require prompt and appropriate antimicrobial therapy.
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Quantitative and qualitative approaches in scientific research should not be looked at as separate or even opposed fields of thinking and action, but could rather offer complementary perspectives in order to build appropriate answers to increasingly complex research questions. An open letter recently published by the BMJ and signed by 76 senior academics from 11 countries invite the editors to reconsider their policy of rejecting qualitative research on the grounds of low priority and challenge the journal to develop a proactive, scholarly and pluralistic approach to research that aligns with its stated mission. The contents of the letter, the many voices raised by almost fifty rapid responses and the severe but not closed responses of the editors outline a stimulating debate and hopefully prelude some "change in emphasis", ensuring that all types of research relevant to the mission of the BMJ (as well as other core journals) are considered for publication and providing an evolving landmark for scientific and educational purposes.
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The treatment of advanced melanoma underwent a complete revolution over the last years. Targeted therapy and immunotherapy marked the beginning of a new management model for cancer. Targeted therapies are drugs directed exclusively against specific molecules in order to modulate their action. ⋯ Since Food and Drug Administration (FDA) approval of ipilimumab in 2011, many other molecules have been investigated. Recently, anti-PD-1 (nivolumab and pembrolizumab) achieved promising results. The aim of this review is to trace the history of nivolumab, through major Phase I, II and III studies until FDA and European Medicines Agency approval.
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In the modern medicine a sound evidence is available today supporting the four fundamental principles representing the best scientific and ethical approach to end of life issues: shared decision making process in a doctor-patient relationship centered care; rejection of dying process marked by the suffering and disproportionate treatments; withholding/withdrawing these treatments and palliative sedation as main contributions to suppress the patients' suffering and pain at the end of life; clear-cut difference between these clinical and ethical options and euthanasia. In some European countries, such as Germany, France, UK, and Spain, these principles are included in a well set legislation regarding the end of life issue, but this is not the case of our country. Despite this failure, in Italy, doctors, patients, and their families, need a law aimed to deal with the complex issues of end of life care as a whole. ⋯ The fundamental principles of the regulation of the doctor-patient relationship centered care will rest on the contents of code of medical ethics, the safeguard of dignity, autonomy, and health of human beings. In conclusion, we hope to have supplied a useful contribution to draw up in the next future a law able to guarantee the autonomy of doctor-patient relationship, respecting different cultures and religious or non-religious approaches to life and death, as well as the different biography and biology of everyone. Our first goal was to comprehensively address the issue of end of life, understanding the concerns of patients and their families in a very problematic stage of their life, and offering to the doctors a valuable tool for dealing with the increasing complex connection between disease, death and modern medical practice on one hand, and related human fortunes on the other hand.