Severe liver dysfunction after raltitrexed administration in an HCV-positive colorectal cancer patient.
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Adenocarcinoma↗
Biomedical subjects
P Binetti
Publications and source records attributed to P Binetti.
[Medical education centers: strategies and purpose].
The introduction of new didactic guidelines, for the graduate degrees in medicine and allied disciplines, is secondary to the new needs of the National Health Care System, and in part to the significant developments of science. It is not easy to meet this challenge. It is likewise not easy to channel coherently the required changes, with respect to the scientific, clinical and didactic goals. Paradoxically the same institutions that are in such great need of transformation, are also a significant part of the existing problem. In many countries, schools of medicine have developed centers for medical education that are geared toward the development and growth of students, teachers-tutors, and patients alike. Medical education has become more global, in an attempt to meet much needed communication needs, from both ends, teachers and students, as well as the recipients of care, patients. One major goal of such centers is the introduction of innovative didactic activities. There is indeed a new tendency toward the development of methodological tracks aiming at the acquisition and consolidation of a deeper and broader cultural knowledge. Amongst these initiatives there is the introduction of an evaluation of the teaching delivered, as well as the development of a multidisciplinary approach to didactics. The latter, is a prerequisite of an effective training directed toward the development of the concept of "team approach", whose ultimate goal is patient care. In Italy, at the Università Campus Biomedico, in Rome, one of the first of such centers of medical education has been developed. Its goal is to be both a learning organization, as well as a center for both research and clinical services.
Education, Medical↗
[Where is medical education going?].
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Curriculum↗
[The tutorial dimension of clinical training of students].
The tutorial dimension of students' clinical education represents a mandatory point of the educational system in Campus Bio-Medico University of Rome. In the area of tutorial system the clinical tutor is the key figure of the cultural and methodological innovation actuated by Italian Medical Faculties and represents the conjunction ring between clinical and educational settings. The clinical tutor is able to achieve a real communication with students and patients, too. The present work want to be a specific review of literature about the significance of the clinical tutor figure in the educational setting of medical faculties and describes the ongoing experience of the tutorial system in Campus Bio-Medico University.
Clinical Competence↗
[Priority objective of medical education].
PURPOSE: To analyze the Best Evidence Medical Education approach (BEME) in relation to the need of improving the quality of education in medical faculties through strictly controlled forms of experiments. MATERIALS AND METHOD: Starting from the analysis of several Medical Education Centers in different Faculties of Medicine, their objectives, activities and quality control systems have been extrapolated in order to point out how institutions identify and control introduced changes. More in detail, a comparison between two italian Centers for Medical Education has been carried out: the one of Bari, which has been the first one in Italy, and the most recent one, at the Campus Bio-Medico, in Rome. CONCLUSIONS: A tendency to apply the growing cultural acquisitions and the new criteria of economy and management to the medical field is developing, which asks for a particular attention to the quality control and to the cost-benefit analysis. Evidence based medicine tries therefore to validate the diagnostic and therapeutic decisions on the basis of experiments whose methodology belongs to the controlled clinical trials' model. These, despite some blind areas, are still a shared effort of the scientific community to objectify the analysis of a given problem and compare the results. Likewise, Evidence Based Medical Education is an attempt to maintain the need for experimenting effective educational forms without giving up their scientific validation. The Medical Education Centers in the different Faculties may have this research function which makes undergraduate medical education one of the three main aspects of the medical teacher's role: research, care and education.
Education, Medical↗
[A specialization course for clinical tutors: experience of the specialty course no. III at the University Campus of Biomedicine, Rome, Italy].
Clinical tutoring meant as guidance and support for the achievement of professional competency (which includes attitudes, knowledge, and skills) has proved itself as a critical opportunity for nursing students' clinical learning. The tutor's skill develops itself especially through the acquisition of clinical and psychopedagogical expertise unquestionably necessary to meet students' educational needs. For the third year the Università "Campus Bio-Medico" di Roma, has started a Specialisation course for Clinical Tutors. The course objective is to achieve psychopedagogical, clinical, ethical and managerial competency. Although the course always maintains the same cultural, methodological, and managerial setting, each year it develops different key aspect linked to the participants' interests and educational needs. In fact, the students as active participants of their learning and well aware of the tutors' role, determine themselves such objectives. This paper is based on the principal themes of this year's course as they have been discussed and developed in final papers by the students.
Education, Nursing↗
[Assessment of teaching quality: from normative aspects to the relapse of the formative project].
INTRODUCTION: To base the medical student's education on scientific evidence, we need to applied to medical education the same evidence-based methods characteristics of scientific research. Our goal is to change curricula, educational methods, teaching of clinical skills, in order to improve professional training of medical and nursing students. Our work highlights the student's point of view relative to changes of educational project, that is a constitutive aspect of best evidence medical education. DESIGN: Every year, an evaluation test is submitted to all medical, nursing and nutritionist students of Università "Campus Bio-Medico". This test worked out by both teachers and students, is designed to explore student's perception of all aspects, educational and relational, related to the university. Data are been processed using explorative analysis of principal elements, and then using factorial analysis with "Varimax", data orthogonal rotation. A specific database in Microsoft Access, is been used for data entry, while statistical analysis is been performed using didactic software STATA (Stata Corporation). RESULTS: According to data, we can claim that our students evaluate their teachers and tutors depending on two principal factors: on one hand educational skills, that include personal competence on teaching and getting in touch with the students; on the other hand managing and planning skills. These are very important to overcome the dangers related to integrated courses, composed by many different scientific matters and planned by many teachers: without a very good planning, students may not be allowed to achieve clear, synthetic and well-structured knowledge. CONCLUSIONS: Students want to be regarded as adult learners, they wish to achieve a well structured knowledge, both composed by theoretical and practical skills and personal relations, in order to think of every activity according to an organic knowledge.
Education, Medical↗
[In order to develop an innovative training it is necessary to bring the whole faculty].
Faculty development initiatives in the year 2001-2002 will need to respond to changes in medical education and health care delivery, to build on the achievement and accomplishments of the past, and to continue to adapt to the evolving roles of faculty members. The faculty development programs will need to broaden their focus, consider diverse training methods and formats, conduct more rigorous program evaluations and new collaborations. Setting standards for performance is a relatively new area of study. The goal is to familiarize the teacher with the framework, principles, key concepts and practical considerations of standard setting approaches and to enable the tutor to make educated choices in selecting the most appropriate standard setting approach for their testing needs. Best Evidence medical education (BEME) is an attempt to examine systematically the quality of the evidence available to address educational issues.
Education, Medical↗
[Blessed Josemaria Escrivà's view on pain. Meeting on pain, open to the entire Medical School of Rome: faculty, students, administrators, etc...].
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Humans↗
[Assessing professional training].
This article is intended as a contribution to the current debate on assessment of clinical competence during the clerkship phase of the undergraduate medical training programme. Assessment in clinical clerkship typically concerns the final stage of undergraduate medical training. When clinical competence is split up into numerous attributes and different methods are used for each attribute, an atomistic approach may be the result. At the end of a curriculum, such as with clerkship assessment in particular, we want to assess the integrated performance of clinical tasks, Splitting up tasks into different attributes and testing these separately will arm the authenticity of the assessment. The emphasis in clerkship assessment must be on the formative role of assessment. The popular objective structured clinical examination (OSCE) uses direct observation of students in simulated clinical situations under standardized conditions. The assessment, however, remains limited to the shows how. There is a wide gap between the educational objectives and the assessment of clerkship training. Finally, in modern undergraduate medical curricula increasing value is placed on teaching and teacher training. Supervision can be provided in a variety of styles and settings. The final assessment of the clerkship is determined by a combination of tests. These effects should be monitored continuously to ensure that students are given the opportunity and are being encouraged to achieve the educational objectives the clerkship is intended to provide. The clerkship as an educational environment is gradually receiving more attention. In light of the above findings and the importance of clerkship to medical education, improvements can and must be made.
Clinical Competence↗
[Ethical aspects in medical education and updating of medicine].
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Bioethics↗
[Teachers' education goes through students' evaluation as well].
OBJECTIVE: Students' opinion on the quality of the educational methods can represent an interesting factor useful to encourage teachers to reconsider their educational methodologies in view of the new planning required by changes in the study curricula. MATERIALS AND METHODS: The paper considers the evaluation expressed by medical students of the "Campus Bio-Medico" University during three consecutive years, in order to perceive the dynamic sense and the evolving prospective of the educational quality as a whole. From a methodological point of view the evaluation of each year and of each course are related to a general median line. This is a significant indicator of the variations of educational methodologies considered as a whole. The relation between the general median line and the course one allows taking into consideration the relative and the absolute variation of the quality. RESULTS: To be relevant the analysis of each course has to be put in relation with the progress of the previous year and with the overall state of the educational activities. While in the first case students evaluating the same course are not the same, in the second one the group of students is substantially stable and allows a better control of the evaluators' variable. CONCLUSIONS: Students' judgements on the educational quality have to be put always into a constructive frame. They have to be involved in the process of improving the educational methodologies by means of orienting teachers' education, pointing out possible critical aspects or stressing each time the results they expect. The dynamic aspect of evaluation allows constant confrontation of the results obtained during a course with the criteria of the expected quality growth. That is, a course apparently static or even dropping, can be considered as such only because the students expectations have grown.
Education, Medical↗
[An uncommon application of counseling in medicine: encountering death in education and in practice].
If scientific knowledge can be acquired through a series of learning strategies that are made easier by the tutorial system, personal and relational training is a more complex task. In fact, it means acquiring a particular mental structure that one only reaches with personal development. The emotional management of patients and of their relatives also requires a set of psychological and communicative abilities that are inborn predispositions, but have to be nurtured: learning from experience, sympathetic listening, self insight and understanding, attention towards transference and counter-transference, cannot be acquired from theory, but have to be experienced and verified hands-on. Living other people's emotional experience is not easy; sympathizing means being able to identify with them, but at the same time, to perceive oneself as separate. Moreover, the contact with suffering and sickness amplifies problems of the self, activating a set of emotions and defence mechanisms. One may get caught into other people's suffering, and be influenced by fear and anguish. Approaching illness, pain and death already represents a border-line experience. Students have to overcome the reassuring reality of theoretical study to carry out a strong and complex relational experience: that of a never-ending alternation of taking care and separation, of fulfilment and frustration, of continuous professional and personal testing. The emotional urge is varied and uninterrupted: managing patients cannot be reduced to a protocol of interventions technically defined.
Adult↗
[Counseling in Internal Medicine and Family Medicine: old and new needs of the patients].
INTRODUCTION: Present proliferation of so called Complementary and Alternative Medicine (CAM), reveals the patient's deep discomfort, as s/he does no longer perceive as satisfying the relation with his/her family doctor, thus wanting to seek for different solutions. The lack of a scientific basis of the majority of these medicines often causes an effective risk to health. OBJECTIVE: The survey highlights how the acquisition of expertise in Counselling, together with the more specific clinical ones, enables the physician to manage the many relational issues more adequately. This skill will allow physicians to meet patients' needs more effectively, and as a consequence, it will make them more satisfied of the relation which will loose its present anonymous and bureaucratic nature. The intrinsic dignity of the help relation will be restored and this will help to face the treatment processes even if these do not bring to recovery. CONCLUSIONS: The new expertise proposed to physicians, could be part of the new ECM programmes. It could also allow to verify, in Italy as well, if a medical class more prepared under this aspect, corresponds to a reduction of request for CAM, and consequently to a substantial improvement of the scientific dimension of personal professional vocation.
Complementary Therapies↗
[The physician-patient relation in the light of the attachment theory. Attachment counseling].
INTRODUCTION: The doctor-patient relationship has always played a key role in the patient's treatment and recovery process. However, it is still difficult to interpret its dynamic healing aspects. Above all, the mechanisms that enable the patient to improve and to change are not still sufficiently clear. WORKING THEORY: The attachment theory assumes an emotional support of the doctor towards the patient. According to this, the patient completely "invests" the doctor of his emotions as in the ancestral model of family relationship. The possibility of obtaining success seems to be strictly linked to the doctors' capacity of accepting this "mandate" offered by the patient who autonomously takes this decision. CURRENT SITUATION: Physicians deal with the complexity of pathologies every day and this shows an increasing necessity of a "doctor-patient relationship", enabling the physician to identify the patients symptoms in a more extended way which involves pain and suffering as well. As for the pharmacological intervention, the patient's attitude and expectations of recovery have a definite effect on the simple assumption of medicine. CONCLUSION: Today's physicians' scientific education would be extremely insufficient, if it were not encouraged by the awareness that his/her duty goes beyond the simple medical prescription. It has to reach the patient's heart as well as arouse the understanding of events related to him/her. This is not just a cultural factor but also a precise way of interacting with the patient according to one's own Counselling models.
Counseling↗
[New prospects in physician-patient communication: role of the animated model].
UNLABELLED: Today information technology and multimediality play a key role in the field of medicine and only recently have been used to improve the doctor-patient relationship. The authors propose the use of induction movies also in this field improving communication between doctor and patient especially when handling surgical operations and complex procedures. These movies give detailed information to patients showing images and explaining in a simple way surgery, therapy and innovative procedures helping the patients to cope with surgery and therapy reducing anxiety and worry. This innovative method was also used successfully for the training of students helping them to understand important issues. MATERIALS AND METHODS: An induction movie on CD regarding two different surgical techniques was shown to 20 patients (7 females and 13 males, average age 50.8), 20 doctors and 20 students. RESULTS: Doctors and patients appreciated this new communication method enabling doctors to better communicate with patients and patients to better understand operation procedures. Worry for operation was reduced and compliance before and after surgery was increased. As to the notion point of view students understood quicker and easier. CONCLUSIONS: This method is innovative and enables technical information to reach patients, doctors and students faster. Images are kept in mind easier and help patients to evaluate the pros and cons of surgery reducing worry. There was more communication between doctors and patients improving therefore their relationship and at the same time reducing communication barriers.
Communication↗
[Counseling for adolescents with eating disorders].
INTRODUCTION: The increase of disorders connected to eating behaviours arises serious problems in the social and health-care setting. These require long-term therapeutic interventions, which have to be strongly integrated on the pharmacological, psychotherapeutic, social and cultural aspects. At present the issues develops itself on three levels: a) increase of the number of subjects, especially adolescents, b) protraction of the illness, with frequent critical relapses, c) always less defined evolution of the pathology with a tendency to become chronic and develop other kinds of illnesses. OUTLINE OF THE SURVEY: The Clinical Psychology Service of the CBM University Hospital examined 300 records of adolescents with various forms of eating disorders. Some of these interventions were requested by various clinical departments while other cases were directly taken care of and offering pharmacological as well as therapeutic interventions. RESULTS: The analysis of adolescents' dynamics allows an interpretation of modern eating disorders as one of the issues characteristic of the always more difficult body-mind integration. For adolescents corporeality is a weight, some kind of foreign body they don't like, and it is not thought as the basic way to get in contact with others so to express one's own feelings and wishes. CONCLUSIONS: Eating disorders are very strong symptoms of personal and social malaise. For this reason they require an integrated intervention starting from the family environment, reaching the child in its uniqueness as well as the larger social context. Actually the latter sends messages to young people which are strongly destabilizing from an ethical point of view as well as for body aesthetics. A counseling service offered at first to parents becomes an effective way of preparing both sides to more complex and articulated types of treatment. These can be more expensive but can build up again a disturbed or not properly developed psychological balance in adolescents.
Adolescent↗
[The right to be born and the need to be born healthy... questions in medical ethics].
INTRODUCTION: Science, thanks to the commitment of huge amount of human capitals, in many cases supported even by enormous fund investment, gain continuously ground reaching new position and spreading out the borders on human chances in a sphere so delicate like birth. New genetic screening tests, new contraceptive drugs using even more sophisticated features, comply with the new law on assisted insemination, put up new challenges involving all the scientific-social environments and necessitate precise answers on ethical side, but even concrete commitment on vocational training. PROBLEM: In this case we take working examples distinguished only on perception, as the pre-implant diagnosis, the morning after pill, and certain about the recent legislation on assisted insemination, to highlight their common scientific and cultural milieu. These problems call for an unquestionable and unique response, to restore clarity about choices involving the need and ability on human being to look for and find answers about existential matter as the beginning of life. Human being value and its significance need to be relentlessly restated, just because they are endlessly debated by a synergy of the emotional point of view, even impressive, and new stand out techniques. PROPOSAL: in that sense vocational training is undeniable goal, even more, but not only, in a Faculty of Medicine. A student needs to learn to reflect on the relations between scientific forthcoming and their ethical and bioethical repercussion.
Contraceptives, Postcoital↗