Recenti progressi in medicina
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For the past decade decision makers worldwide have endorsed the use of neuraminidase inhibitors. They spent billions of pounds stockpiling the two anti-influenza drugs oseltamivir and zanamivir from the mid-2000s as part of a global effort to be prepared for an influenza pandemic. When the H1N1 pandemic emerged in 2009 the drugs were rolled out around the globe for treatment and prevention of influenza and its complications. ⋯ What should have been a routine review got complicated as the validity of a key study that underpinned the evidence on efficacy was unclear. Our three and half year battle for data has resulted in the drug manufacturers providing us with full clinical study reports and unveiled a story in which no party has taken full responsibility for ensuring the validity of the evidence underlying its decisions. We hope that the publication of our systematic review of the trials, alongside all the source clinical study reports, will change the way such decisions are made.
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The approval of new antiviral agents and the wide-ranging costs of ophthalmic therapies with comparable efficacy have renewed the debate over the cost-effectiveness of novel drugs. In oncology, more expensive treatments do not always substantially change the outcome of the disease, but they merely prolong life expectancy by a few weeks even at the cost of significant side effects. ⋯ In addition, fund allocation for purchasing high cost medications results in limited investment in clinical research and human resources - doctors, nurses and other healthcare staff - that play a central role in patient care. Regulatory agencies should be more demanding, reimbursing pharmaceutical companies on the basis of treatment outcome.
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Pain is one of the most frequent symptom in elderly people with dementia and despite of this, it is still under-acknowledged and under-treated. The best approach to pain assessment is to evaluate it with the most appropriate scale. While in the elderly suffering mild-moderate cognitive impairment, it's possible to use self-report scales, in the elderly with severe cognitive impairment the use of observational scales is recommended. ⋯ All keywords were linked using AND and OR boolean operators. Altogether 5 self-report scales and 17 observational scales were retrieved, 7 of which available in Italian validated versions. The review analyzes potential and limitations of each assessment tool, in order to assist the clinician to make the most appropriate choice when using it in health care contexts.
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Comparative Study
[Role of intensive medical training on Law 38 to improve pain management in primary care].
The Italian Law no. 38/2010 requires that the physician reports in the medical record the type and the intensity of pain, analgesic therapies and clinical results. We developed a training model for 256 primary care physicians (GPs). After a period of intensive training on the content of the law no. 38, diagnostic and pharmacological approach of pain, we carried out a clinical audit by a web based clinical record to assess doctor's compliance to Law no. 38 and the use of opioids. 2631 patients were assessed (age 71,5±13,7 years; median 74). ⋯ Chronic non cancer pain remains one of the major clinical problems in the primary care setting, especially in the elderly. The standard measurement of parameters related to pain and the proper use of opioids depends on the scientific update and how this is delivered. GPs are crucial to implement the Law 38 and to increase the degree of complexity of the patient to be properly admitted to a SPOKE/HUB center.
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In Italy, the debate on the off-label use of intravitreal bevacizumab in patients with age-related macular degeneration (AMD) has attracted a very wide coverage by the media. Our national regulation on the off-label uses of pharmacological agents was initially issued in 1999 to handle the case of the so-called "Di Bella therapy" in patients with cancer. Some changes to this regulation have been made thereafter, and the most recent law currently prohibits the use of off-label agents in cases where approved medicines are available. ⋯ Therefore, a lively debate has been started and is still ongoing to establish how the present regulation in this area can be revised. In devising the new regulation on this issue, one point deserving consideration is that the case of bevacizumab vs ranibizumab in patients with AMD is very atypical in the current scenario of in-hospital drug treatments. Hence, the new regulation should be tailored to the therapeutic needs of all patients likely to receive an off-label treatment for any clinical indication rather than to the specific case of intravitreal treatments for patients with AMD.