Recenti progressi in medicina
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Today the sepsis represents a very important clinical entity. The Surviving Sepsis Campaign assessed an incidence of sepsis equal to 3 cases/1,000 inhabitants. ⋯ The early diagnosis and therapy are very important elements for the outcome of the patients. The Authors present the results of the adoption in their hospital of a guidelines document for the management of the septic patient, that show a decrease of their mortality due to the early diagnosis and specific treatments.
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The respiratory allergies, including allergic rhinitis and allergic asthma, represent a substantial medical and economic burden worldwide. Despite their dimension and huge economic-social burden, no data are available on the costs associated with the management of respiratory allergic diseases in Italy. The objective of this study was to estimate the average annual cost incurred by the National Health Service (NHS), as well as society, due to respiratory allergies and their main co-morbidities in Italy. ⋯ To our knowledge, this is the first study in which direct costs (incurred by NHS) and indirect ones (incurred by the society) were taken into account to estimate the overall burden associated with respiratory allergies and their main co-morbidities in our Country. In conclusion, this work may be considered an efficient tool for public decision-makers to correctly understand the economic aspects involved by the management and treatment of respiratory allergies-induced diseases in Italy.
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Italy, as well as many other countries, is facing the problem to adapt medical education to the challenges of a rapidly changing, globalised world. One main concern is the mismatch of competencies to patient and population needs, which calls for an orientation to a competency-based medical education. Competency is defined as the ability to use knowledge, skills and attitudes in a professional context. ⋯ An overall picture of professional competencies allows also to design a continuum between pre- and post-graduate training, up to the continuous professional development. A second essential issue is the adoption of the point of view of complexity in considering the educational system, as well as to focus on reflective thinking as a meta-competency. The National Conference of the Directors of Medical Curricula is running a set of initiatives to support this process of change.
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GIST (gastrointestinal stromal tumor) are the most common mesenchymal tumors in gastrointestinal tract and are thought to derive from the cells of Cajal or their precursors that have a constitutional mutation in KIT and PDGFRA genes. There are KIT and PDGFRA genes mutations detected before the start of therapy that are believed to be related to GIST pathogenesis and some secondary mutations causing drug resistance and progression of disease. The most common KIT mutations are detected in exon 11 (66-71%), exon 9 (10-13%), exon 13,14,17 (1% each). ⋯ On the contrary, volume of the tumor, number of mitosis and site of GIST are strong prognostic and predictive factors. In conclusion mutational analysis in GIST is at present more useful in metastatic setting than in adjuvant therapy. The insurgence of primary and secondary mutations during therapy is a fundamental step for disease progression.
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In 2020 the percentage of patients with a diagnosis of cancer in people with more than 65 years will exceed 70% and 28% in ethnic minorities. The treatment of cancer in these populations is challenging for the oncologists due to socio-economic issues such as poverty, reduced access to the hospital care, level of education. The clinical pathway "diagnosis-treatment-cure", typical of the care of young patients has to be integrated in elderly patients with a more individualized treatment by means of comprehensive geriatric assessment (CGA). ⋯ Another important indicator is the disease specific survival (DSS). Concerning the design of clinical trials, a possible strategy is to enrol elderly patients without upper age limit and to plan stratification. An interesting trial design is the so called "extended trial" that allow to re-open the arm of a trial in which a too low number of older patients was enrolled.