1,720,979 research outputs found
La medicina centrata sul paziente
No full textThe dominant model in medical practice today has been defined as the "disease-centered" model. In the past few years, it has been attacked for oversimplifying the problems of illness because it assumes disease to be fully accounted for by deviations from the norm of measurable biological variables. This article describes a patient-centered model that integrates the traditional understanding of disease with each patient's experience of illness. The transformed clinical method involves three major changes: 1) new tasks for the consultation: the patient-centered method focuses on disease and on four principal dimensions of the patients, i.e., their ideas about the illness, their feelings and fears, the impact of their problems on their lives, their expectations about what should be done; 2) new strategies to obtain these objectives: new interviewing skills and communication techniques, e.g., attentive listening; open questions; 3) new modes of teaching and learning, e.g., the use of role-playing and videotaping. Research has shown that patient-centered medicine enables better clinical results to be obtained and is associated with increased patient and physician satisfaction
Modulation of brain tryptophan hydroxylase activity by brain tryptophan content
No full textNECKERS, L. M., G. BIGGI0, E. MOJA AND J. L. MEEK: Modulation of brain tryptophan hydroxylase activity by brain tryptophan content. J. Pharmacol. Exp. Ther. 201: 110-116, 1977. Although hydroxylation oftryptophan (TP) is considered to be the rate-limiting step in serotonin synthesis, the mechanism whereby tryptophan hydroxylase (TPH) partici-pates in the regulation of serotonin synthesis is still in question. Since the brain TP concentration is probably near the Km for tryptophan hydroxylase, changes in brain TP content could affect the rate of its hydroxylation. However, it has not been established whether in vivo the activity ofTPH changes with changes in TP concentra-tion. In this paper we have made use of high pressure liquid chromatography coupled with fluorescence detection to measure TPH and TP in several brain nuclei and other regions of rat brain after treatments known to lower brain TP levels. Chlorimipra-mine, loading with neutral amino acids and a TP-deficient diet decreased the TP content of some, but not all, brain regions studied. Whenever TP content was de
Etica e parole nelle consultazioni cliniche
No full textUna letteratura in continua espansione segnala l'importanza che ha all'interno delle consultazioni cliniche una comunicazione efficace. Ma cosa si intende per comunicazione efficace in medicina? Come nota Michael Parker (2004), comunicatori molto efficaci possono tuttavia essere cattivi dottori e una comunicazione efficace può essere usata per molti diversi scopi, sia buoni che cattivi. Buoni comunicatori sono spesso categorie diverse di soggetti quali gli artisti, i venditori, persino i dittatori. Queste considerazioni rendono opportuno parlare in medicina non di una comunicazione efficace, ma di una comunicazione efficace ed etica. Il nostro lavoro si propone come una breve e generalissima introduzione a queste tematiche. Per renderne più agevole la lettura, abbiamo diviso il processo continuo della comunicazione in una visita medica in due fasi: quella del Raccogliere informazioni, quella del Dare informazioni e Prendere decisioni ( sui vantaggi e sulle insidie di dividere il processo della comunicazione in medicina in differenti elementi, si veda, ad esempio, de Haes e Bensing, 2009). Discuteremo quindi il problema di una comunicazione efficace ed etica in ognuna delle due fasi citate
Difficult conversations in medicine: an experiential optional course with medical students
No full textIntroduction: Although the task of handling emotions during a medical consultation seems to be at least important as if not even more than managing communication (1), medical training rarely undertakes an organized approach to promoting personal awareness and to provide opportunities to explore student’s emotional and cognitive responses to patients (2). This could be useful especially in highly emotional situations, as the bad news communication. A 30 hrs optional course was realized at the Medical School of Milan, with the aim of undertaking the management of emotional aspects in a clinical consultation, starting from what students themselves consider as a difficult conversation in medicine. A pre-post test was used to assess the effects of the course. A satisfaction questionnaire was also used.
Methods: Photolangage (3) was used to explore participants’ representations of difficult situations through the use of standardized pictures and as a pre/post test to assess the possible changes in student’s perception. Issues of the course were decided and discussed with the students on the basis of the pre-test results. The course was realized through the use of peculiar teaching tools such as socio drama, family genogram, role-playing, movies and group discussions. At the end of the course the participants’ opinion was collected through 3 open-ended questions investigating strength and weakness points, and suggestions.
Results: 15 students, 8 males and 7 females, participated in the course: 5 of them were in their 1st/2nd years of the Medical School, 9 in 3rd/4th and 1in 5th/6th. The themes, chosen in accordance with students’ preferences, were: role of family; sexuality; communications of mistakes; death. Regarding the students’ satisfaction questionnaire and the pre/post photolangage results, a content analysis of the answers is ongoing.
Discussion: the study could suggest a new teaching method to improve the undergraduate medical students’ management of emotionally difficult conversation
Impariamo ad essere diabetici : primi passi di un corso psicoeducativo con pazienti affetti da diabete di tipo II
No full textDifficult encounters with a hemophilic patient : the inner perspective of physicians
No full textThis study aimed at exploring the hematologists' internal representation of a difficult encounter with a hemophilic patient, using a written open format. Narrations were analyzed with Interpretative Phenomenological Analysis. Three main issues were identified, each with sub-issues: (1) Inside the relationship: to tell or not to tell, the balance between a normal life and a deviant medical condition, the guilt; (2) The borders of the professional role: professional values, the "do-it-all" doctor; and (3) The existential confrontation. This study reveals the deep involvement of physicians with their patients, at a professional level and, strongly, at a personal level. The experience of being so deeply involved should be considered in the continuing medical programs for physicians dealing with hemophilia
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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