Recenti progressi in medicina最新文献

Post-Normal Science (PNS) was introduced about 30 years ago to address the changing relation between science and governance when science is called upon to provide inputs to policy-related issued. Originally concerned mainly with environmental risks, in the last decades the PNS approach has been applied to a growing and diversified number of issues. It is considered particularly appropriate in situations characterized by: uncertain facts, a plurality of potentially conflicting values, high stakes, and urgent decisions. The objective of this paper is to present a survey that will test the opinions of practitioners and stakeholders on the usefulness of the PNS approach for addressing three emerging issues within the field of radiation oncology: the high and growing number of expected patients, the number of sessions per radiotherapy cycle, and treatment in old age. Respondents will also be asked to indicate which of the typical PNS intervention tools - such as extended and inclusive dialogue, the use of hybrid tools, adaptability and flexibility, and transparency in decision-making -are most suitable, and to what extent. Professionals and stakeholders from one radiotherapy center in northern Italy and two centers in southern Italy will be interviewed.

In the period between March 2021 and December 2023, our Casa della Salute in Borgaretto (Torino) organized a clinic dedicated to vaccination against Covid-19 in its local and with its staff (medical, nursing and administrative). To try to inform the majority of the population about this activity, we used the social networks of the Casa della Salute (Facebook and website), the social networks of the Municipality of Beinasco and some of the local newspapers. The list of eligible subjects was shared with the ASL TO 3 and the invitation to vaccination was made via SMS from a dedicated platform, indicating the day and time of the appointment. All the actors involved participated in multiple organizational meetings to share the logistical aspect and the management of any critical events. 10.167 vaccines were administered, the vaccination sessions lasted 6 hours each, the vaccination days were 112, with an average of 90 patients per session. This vaccination campaign, albeit in an emergency context, was made possible by the good organization of all the Casa della Salute staff, integrated with the ASL TO 3 and the Municipality of Beinasco. None of the three entities, alone, would probably have been able to obtain the same result: the ability to integrate and the will to cooperate were fundamental.

CAR-T therapies are a form of innovative and personalised immunotherapy in the field of onco-haematology. Diffuse large B-cell lymphoma (DLBCL) is a very aggressive form of non-Hodgkin's lymphoma (NHL) for which CAR-T therapies are approved as 3rd-line and more recently (from 11/11/2023), as 2nd-line for patients who relapse within 12 months after 1st-line chemo-immunotherapy. This study was conducted to estimate the eligible DLBCL population for CAR-T therapies in 2024 in Lazio region. Starting with a cohort of DLBCL patients from a previous work, a series of proportions were first obtained applying the eligibility criteria for CAR-T, and then applied to the annual incident cases of NHL in Lazio region. From 1,353 NHL cases, 392 (29%) were considered DLBCL of which 82% (322) received first line chemo-immunotherapy. They were then divided into two groups: with relapse ≤12 months (Group 1) and with relapse >12 months (Group 2). Fifty percent of Group 1 (46 cases) and part of those not eligible to ASCT (35%=16 cases) constitute the eligible population for CAR-T therapy as 2nd-line. From the 29 cases of Group 2, were calculated the proportions of CAR-T eligible patients among those not eligible for ASCT (35%=5 cases) and those who did not respond to salvage chemotherapy (65%=4 cases) and with post-transplant relapse (39%=3 cases). A total of 74 DLBCL patients were found to be eligible for CAR-T therapies. This study demonstrates that the use of Real World Data is a valuable tool in defining the target population for new therapeutic indications.

The objective of this study is to identify the essential hard and soft skills that healthcare professionals must develop when working in a low- and middle-income country (LMIC), where the socio-economic and cultural context differs significantly from that of Italy. The analysis was conducted following a period of observation conducted by a hospital pharmacy resident at a rural hospital in southern Tanzania. In order to ascertain the role and requisite competencies for hospital pharmacists (HPs) in LMICs, an investigation was conducted based on the 24 competencies identified by EAHP. The skills identified relate to patient care and clinical pharmacy, drug skills, management skills and professional skills. HPs in LMICs play a role in the final follow-up of hospital prescriptions, requiring in-depth knowledge of drugs. Communication, therapeutic education and follow-up are very important in a setting where primary care is lacking. Moreover, given the limited availability of resources, management and professional skills are crucial. The analysis has shown how, in different working contexts, health professionals are stimulated to develop and implement mainly specific skills, the sharing of which, through field experiences, can lead to a bilateral improvement of the services and health care offered.

The aim of the work was to create a survey related to health questions to be distributed to associations active for trans* people's rights. 165 answers were obtained: among these, 45.6% are from trans* people and 31.3% from cisgender women. Different gender identifications are reported by trans* people who answered to the survey. Finally, among all the answers obtained, 71.3% have never received information about a gender-personalized medicine and 79.4% have never received informations about different therapeutic choices. From the comments collected in the survey's open field, three macro-themes emerged: disinformation, pathologization, and lack of economic resources. It is then necessary to break all prejudices to respect the right to health of trans* people, who are still invisible within health systems today.

The clinical management of triple-negative breast cancer has been very difficult for a long time, being classical chemotherapy the only possible therapeutic approach given the absence of specific targets. However, the therapeutic armamentarium has recently been expanded thanks to the introduction of new molecules, in particular immunotherapy and antibody-drug conjugates (ADCs), which have made it possible to significantly improve the prognosis of this patient population both in the early and advanced settings. Since 2022, the ADC sacituzumab govitecan has been approved by the Italian Medicines Agency (Aifa) for the treatment of advanced/metastatic triple-negative breast cancer pretreated with at least two lines of systemic therapy, of which at least one for metastatic disease. In the collection of case reports, we delved into the available data on the efficacy profile and impact on quality of life of sacituzumab govitecan in several special populations of patients with triple-negative metastatic breast cancer.

The Asst Valcamonica faces significant challenges in providing continuity of care services due to a shortage of medical personnel, exacerbated by its location in a mountainous area and the seasonal variability of tourism. To address these needs, a temporary nursing-run clinic was developed, aimed at providing healthcare to tourists, particularly during August 2023. The Family and Community Nurse (IFeC) plays a crucial role in primary care, working in synergy with remote medical consultations to ensure an integrated care model; provide first-level healthcare during peak tourist periods. And experiment with a network organizational model with nursing management and teleconsultation between nurse and physician. The project was implemented from 7 to 25 August 2023, with an organizational network that included a nursing clinic managed by an IFeC at the Community House of Ponte di Legno, and the collaboration with the Integrated Medical Center of the Regional Emergency Agency for remote medical consultations. The service operated from Monday to Friday, from 10:00 to 17:00. During the activation period, there were 186 visits recorded. Of these, 87 were requests for information and 99 were requests for services. 86% of nursing management was deemed sufficient. Only 3% required a teleconsultation with the CMI physician, while 10% were directed to the Emergency Room. The nursing clinic model could be replicated in other Community Houses with high tourist influx. The implementation of a system based on nursing triage and teleconsultation could enhance assistance in both Tourist Continuity of Care and Primary Care.