Recenti progressi in medicina最新文献

The clinical case described concerns a 53-year-old patient with triple-negative disease, metastatic to the skin, fragile, not due to comorbidities, but due to toxicities from previous antiblastic treatments. The major toxicities reported, even previously, were inherent to bone marrow function, with prolonged neutropenia, despite the use of granulocyte growth factor (GCSF). The patient has no family history of breast cancer and does not have a mutation in the BRCA1/2 genes. In pathological history, only arterial hypertension under medical therapy with nebivolol.

Hospital logistics automation applied to the dispensing of medicines to patients in care transition (hospital discharge or outpatient visit) offers significant opportunities to improve risk management and ensure the quality of healthcare. The adoption of technological innovation in hospital requires organizational changes, development of new workflows, collaboration between different professionals and acquisition of new skills. The logistics automation system was analyzed using NOISE analysis, as a strategic planning tool, in order to assess the impact of this innovation. The analysis highlighted the consistency of the innovation with local health policies, the assessment of feasibility in the hospital context and the reorganization focused on process optimization. As a result, operational steps were initiated leading to the acquisition of the new technology in February 2023. The application of strategic planning techniques to healthcare processes is crucial to ensure technological advancement in healthcare, the maximization of public investments and the development of a new professional culture capable of optimising innovations.

Climate change has negative effects on mental health as shown by the World health organization (Who). Heatwaves can exacerbate some mental conditions such as schizophrenia and psychosis, both in the elderly and children as well as in young adults, and increase mortality for neurological and psychiatric diseases. Subjects facing climate events such as heavy rains and flooding may suffer from a psychological problem in the short, medium and long-term. Studies from the international and Italian context show that air pollution exposure may affect common mental problems such as depression and anxiety. Taking into account the growing trend in climate extremes, there is the need to deepen the knowledge on this topic to support the implementation of prevention and mitigation interventions.

Triple-negative breast cancer (TNBC) poses a challenge due to high metastatic potential and few care options. The successful management of relapsed disease is an unmet clinical need, to date. The antibody drug conjugate sacituzumab govitecan (SG) has been an actual breakthrough in the metastatic TNBC (mTNBC) algorithm. Herein, we report the case of a 45-year-old patient, who was referred to our centre for a hard-to-treat locoregional relapse from TNBC, thus receiving SG in third-line setting for 15 months. We also discuss clinical presentation, treatment patterns and outcomes along with a brief literature review. Our case study outlines the long-term efficacy of third-line SG in a TNBC patient with a refractory disease. Thanks to SG use within a multimodal patient journey, a sustained disease control along with a preserved quality of life was gained. Further real-world data is awaited to confirm these findings.

The aim of this scoping review is to shed light on the current state of the art regarding ChatGPT's potential applications in clinical decision support, as well as its accuracy, sensitivity, speed, and reliability in different clinical contexts (diagnosis, differential diagnosis, treatment, triage, surgical support). Most of the articles found were original research articles, with a few reviews and commentaries. A total of 225 articles were found, of which 50 were included based on retrieval and eligibility. ChatGPT performs well in diagnosis with complete data but struggles with incomplete or ambiguous information. Its differential diagnosis is inconsistent, especially in complex cases. It shows good sensitivity in treatment recommendations but lacks personalization and requires human oversight. In triage, ChatGPT is accurate, with high sensitivity for hospitalization decisions but lower specificity for safe discharges. For surgical support, it aids in planning but cannot adapt to intraoperative changes without human input. The results indicate that ChatGPT has potential in supporting clinical decisions but also highlights significant current limitations; that include the need for medical-specific adaptation, the risk of generating false (artificial hallucinations), incomplete, or misleading information, and ethical and legal issues that need to be addressed.

Scuole che promuovono salute (Sps) is a model promoted by the World Health Organization and recognized at the European and national levels for promoting health and well-being at school. Pause Attive is an effective and evidence-based intervention to promote physical activity and reduce sedentary behaviour of children in the school setting. In the 2023-2024 school year, 348 schools joined the "Rete Lazio Sps" of which 99 joined the intervention Pause Attive for a total of 1.200 classes, more than 21.200 children involved and 1.500 teachers trained by health professionals of Asl. Pause Attive is a sustainable intervention for local health authority and effective in increasing movement and promoting attention and learning of children in the school setting.

Purpose: Telepharmacy (TF) represents a tool to manage the complexity related to drug therapies and to guarantee continuity of patient empowerment in transitions of care. The aim of this work is to analyze the critical issues related to the implementation of the TF service, in order to enhance its application.

Results: Over 27 months, the TF service was offered to 60 patients. 48% of patients used the service (mean age=38 years; N=13 (45%) M). Although they accepted the service, 17% of patients (mean age=56 years; N=2 (20%) M) were unable to access the platform once they returned home. Poor digital skills and lack of a caregiver were barriers to service acceptance for 35% of patients (mean age=63 years; N=13 (62%) M). Overall, patients with a mean age ≥56 years did not use the service.

Conclusions: TF represents an opportunity in care transitions to identify early critical issues related to drug therapy and to contribute to the integration of different levels of care. The analysis highlights that only the youngest patients (with an average age of 38 years), being more skilled in IT, have actually had access to the TF service. It will be necessary in the near future to make health teleconsultations increasingly widespread and accessible.