Recenti progressi in medicina
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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.
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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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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.
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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.