Recenti progressi in medicina
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Cancer-related fatigue (CRF) is a very common and distressing symptom experienced by most cancer patients, during and after treatments and also at the end of life. There is no accepted definition of CRF, because it is a multifaceted symptom that involves multiple biopsychosocial aspects. Several scales for assessing CRF have been used, unidimensional or multidimensional, but there is no agreement regarding the best instrument to measure CRF. ⋯ Non-pharmacologic interventions (physical exercise, psychosocial interventions and other integrative interventions, such as yoga, ginseng, acupuncture) have been evaluated in several randomized and non-randomized studies, but with many methodological limitations. Therefore, the most effective non-pharmacological intervention remains unclear and the effect sizes are small. Further research is needed to delineate the optimal definition, measurement and treatment of CRF.
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The pharmaceutical and medical devices industry provides one of the main sources of scientific information for physicians. The impact of this kind of information on physicians' prescribing behavior has been extensively studied. Available evidence consistently shows that prescription habits are affected by industry-driven scientific research data. ⋯ Several American universities decided to prohibit any relationships between students and industry representatives. It would be desirable that such policies be adopted by other institutions. In addition, the practical guide published by the World Health Organization "Understanding and Responding to Pharmaceutical Promotion" should be better known and used.
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The management of chronic pain still represent a challenge for physicians. Opioids are the main stem in the treatment of chronic severe pain, not only for their potency, but as they act as central drugs. The main limit to their utilization in clinical practice is the prevalence of side effects, in particular in the gastrointestinal tract, whose constipation represents the most common. ⋯ In the case of TAP PR, instead, 0.31 QALYs were gained with additional savings due to the reduction of drug side effects, hospitalizations and emergency department access. Therefore, the use of TAP PR implies an average saving of € 31.6 per patient. These data are the results of a pharmacoeconomic model and require a further validation in clinical practice.
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The high state of anxiety about Ebola virus and its possible spread in the Western world has seemingly changed the route of the disease, for which effective vaccines and medicines do not exist. The rapid spread of the virus provides a paradigmatic narrative about the failure of today's governance for health, grounded on a series of global initiatives focussed on pathologies prioritized by the donors' community, at the detriment of health promotion and the strengthening of health systems in countries. ⋯ Today, the WHO is increasingly weak technically, politically and financially. While the virus remains out of control, the WHO's capacity to play a role in accompanying the development of the new essential vaccines and in brokering the conditions for accessibility and availability of the new medical tools remains to be questioned.
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Adverse drug reactions affecting the skin have particular relevance as they may cause significant mortality and a possible modification of the benefit/risk profile of the concerned drug. The following entities are of special importance: Stevens Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), acute generalized exanthematous pustulosis (AGEP) and drug rash with eosinophilia and systemic symptoms (DRESS). On the above mentioned reactions we focused our surveillance programme in the Lombardy region, the REACT-Lombardia project. ⋯ The risk for specific drug exposures was estimated by employing drug utilization data expressed as Defined Daily Doses (DDD). Mortality rate from SJS-TEN was 21%. Together with the registry, a "hub and spoke" clinical network for the management of severe cutaneous reactions was established with the Burn Unit of Niguarda Ca' Granda Hospital as the reference center for the most critical patients.