Recenti progressi in medicina最新文献

HER2-positive breast cancer accounts for approximately 15-20% of all breast tumors and is characterized by a more aggressive biology compared with other subtypes. However, the introduction of anti-HER2 agents has made this disease increasingly manageable, even in advanced stages. Among the most recent therapeutic advances, trastuzumab deruxtecan (T-DXd) has emerged as a new standard of care, thanks to its remarkable efficacy, ability to induce deep and durable responses, and significant activity in challenging sites such as the central nervous system and bone. Clinicians play a crucial role in ensuring optimal patient management during T-DXd therapy, including the monitoring and prevention of major toxicities (such as interstitial lung disease, nausea and vomiting, and cardiotoxicity), as well as in evaluating potential combinations with locoregional treatments - within an increasingly integrated multidisciplinary team. Maintaining a good quality of life remains essential, particularly for patients achieving long-lasting responses. Finally, results from recent clinical trials suggest a potential role for T-DXd in earlier disease stages, underscoring the growing need for clinical expertise in managing this innovative therapy.

The debate over medical residents' commitment highlights the evolution of the healthcare profession. Moving beyond the rhetoric of "vocation" or initiatory suffering, a new professionalism is emerging. This must integrate scientific expertise with Medical Humanities, be supported by legal and organizational safeguards, and foster a therapeutic relationship built on trust and collaboration among colleagues.

Introduction: Globalization and increasing migration flows have profoundly reshaped demographic and health landscapes in Europe. Physicians are now required to integrate not only biomedical expertise but also cultural competence and knowledge of global disease patterns. Tropical Medicine (TropMed) and Migration Medicine (MigMed) represent two complementary domains bridging infectious disease expertise with social and intercultural dimensions of care. Despite their relevance, several studies highlight significant educational gaps in these fields across Europe.

Methods: We conducted an exploratory, observational study at the University of Udine (Italy) using a self-administered online questionnaire (EUSurvey platform) to assess awareness, knowledge, and educational exposure to TropMed and MigMed among medical students and residents. The survey was open from April to June 2024 and addressed 1,406 eligible participants. Only descriptive statistics were applied given the small and self-selected sample.

Results: A total of 48 participants completed the questionnaire (response rate: 3.4%). Awareness of MigMed was limited, with one quarter of respondents unfamiliar with the term, while TropMed was better known. Knowledge of infectious diseases linked to migration varied: tuberculosis and sexually transmitted infections were relatively well known, whereas diseases such as Chagas or Dengue were rarely identified. Educational exposure was scarce: only one third had attended vaccination courses, fewer than 20% had participated in training on migration health, and less than 10% had engaged with activities organized by the Italian Society of Migration Medicine (SIMM). Despite these gaps, a notable minority expressed career aspirations in international or NGO settings.

Conclusions: Although limited by an extremely low response rate, this study highlights a critical educational gap in TropMed and MigMed among future physicians. The lack of engagement itself is a meaningful finding, reflecting limited awareness and interest in topics of growing public health importance. These results call for urgent curricular reforms in Italian medical education, integrating global health, intercultural competence, and equity-oriented training as core components to prepare physicians for a healthcare system increasingly shaped by migration and cultural diversity.

Informed consent is today an essential element of clinical practice, grounded in the principle of patient self-determination. Its evolution, from the traditional paternalistic model to the recognition of the patient's right to make conscious choices, has been marked by key historical and legal milestones such as the Nuremberg trials, the Tuskegee Study, and, in Italy, the landmark "Massimo" ruling of 1990, later consolidated by Law 219/2017. In General Practice, consent takes on specific features: often implicit, dynamic, and closely linked to the doctor-patient relationship, it goes beyond the mere signing of a form and unfolds throughout the entire care process. Information plays a central role and must be tailored, clear, and proportionate to the patient's level of understanding, while avoiding the pitfalls of excessive "defensive information." In this perspective, informed consent becomes a tool for sharing therapeutic goals and building a decision-making alliance, thereby redefining the very aims of medicine.