88 research outputs found
The concept of the mask and the doctor-patient relationship: insights from a (re)reading of Luigi Pirandello’s Six Characters in Search of an Author
No full textThe concept of the mask and the doctor-patient relationship: insights from a (re)reading of Luigi Pirandello's Six Characters in Search of an Author. The aim of this article is to explore the concept of the "mask" and its relevance within the doctor-patient relationship, as well as within the broader medical-scientific context. The primary reference for this analysis is Luigi Pirandello's work Six Characters in Search of an Author (1921), which embodies universal themes, supplemented by examples from figurative art. What emerges is the patient's necessity, utilizing artistic expression, to narrate their own experiences through a mask that serves as the vessel for their innermost emotions
Su alcuni effetti delle trasformazioni nella generazione umana
No full textLe odierne applicazioni della medicina hanno introdotto tali e tante trasformazioni nell’atto procreativo umano, da rendere plausibile l’idea che sia in corso una sorta di “rivoluzione riproduttiva”.
Tra le problematiche risultanti delle trasformazioni in atto vi è, per un verso, un effetto involutivo sulla generazione umana, nel senso che esse hanno ridotto o rischiano di ridurre l’“evento” rappresentato dalla nascita a mero “fatto biologico”, di “avvicinare” pericolosamente i meccanismi che la regalano a quelli della riproduzione animale e di rendere “superflua”, nel processo generativo, l’integrazione affettivo-morale tra due persone, che poi è quel che qualifica più specificatamente il riprodursi umano.
Per altro verso, vi sono una serie di mutamenti nella scena sociale concernenti l’atteggiamento che l’adulto ha nei confronti dei nuovi nati e lo “statuto simbolico” del figlio, la cui immagine è sempre meno associabile a nozioni quali “ospite”, “dono” “frutto”, “benedizione” e sempre associabile a quella di “desiderio” da soddisfare a tutti costi.
Il contributo tenta un approfondimento di queste criticità
Antropologia medica
No full textDopo una breve presentazione dell’antropologia e dell’antropologia culturale come
discipline, in questo capitolo verranno definiti i contenuti specifici dell’antropologia medica
come branca di studio dell’antropologia culturale. Nel proseguo, verrà esplorata
l’interpretazione di antropologica medica fornita dal neurobiologo e filosofo tedesco
Viktor von Weizsäcker, che l’ha intesa come «dottrina generale dell’uomo come scienza
fondamentale della medicina», e le cui intuizioni sono state molto feconde nel percorso
novecentesco di ricucitura tra scienza e humanities. Verrà inoltre approfondito il contesto
culturale dentro cui la proposta weizsäckeriana maturò, rappresentato dal Positivismo e
dal Neopositivismo, e i suoi collegamenti con l’emergere di un diverso modo di concepire
la salute e il rapporto tra medici e pazienti, verificatosi attorno alla metà del ‘900. Da
ultimo, verranno esplicitati i quattro modelli di relazione medico-paziente secondo la schematizzazione
proposta dagli studiosi americani Ezekiel J. Emanuel e Linda L. Emanuel
MaReD - Malattie Respiratorie da Droga e Interstitial Lung Disease (ILD) cocaina correlata
No full textWhich kind of ethical issues in HTA processes? Results and considerations from the application of ethics expertise in HTA processes in Italy
No full textBackground: The ethics domain is intrinsic to HTA processes even if the practical experiences are still limited.
Objectives: The contribution deals with the kinds of the ethical issues recognized within HTA processes where bioethicists of the Institute of Bioethics of the Università Cattolica (Rome, Italy) were involved.
Methods: The overall HTA processes performed from 2007 to 2011 are seven. The technologies assessed were the following: three pharmaceuticals (Lapatinib, Lucentis, Dabigatran etexilate), two antipneumococcal vaccines (Synflorix, Prevenar 13), one diagnostic procedures (PECT and SPECT scanning for early diagnosis of minimally cognitive impairment), one surgical tool (Ultrasound harmonic scalpel in surgery). EUnetHta Core models were utilized for research questions, and the “triangular model” as ethics approach.
Results: The ethical issues assessed regarded: 1. Effectiveness/safety of the technologies, particularly the need for patients’ strata to optimize the benefit from the utilization of new pharmaceuticals(often very expensive for a National Health Service); 2. respect for patient’s dignity, integrity, autonomy, values, as well healthcare professionals, and the benefit/harms for other stakeholders; 4. distributive justice issues, with reference to National/Regional Healthcare Service coverage for the technology, its Regional supply; the fairness of the availability of the technology.
Discussion: Today, the available HTA tools for ethics analysis (e.g.: EUnetHTA Core Model), can consent a good recognition of specific issues related to healthcare technologies assessment, even considering the different ethical approaches (e.g.: casuistry, utilitarianism, etc. Still, an important open space for further methodological implements/reflections about ethical domain integration and practical running in HTA processes remains.
Implications for the health system/professionals/patients/society: Because health technologies embody a variety of social and political aspects for individual and people, technologies cannot be assessed only through the (also necessary) narrow lens of costeffectiveness analysis. Health decision-making processes need to be informed by the values that prevail in a given society
Towards an integrated assessment of complex health interventions. Results of the European INTEGRATE-HTA project
No full textINTEGRATE-HTA, an innovative research project was co-funded by the European Union (EU) under the Seventh Frame¬work Programme from January 2013 until December 2015. This project developed concepts and methods that enable a patient-centred, comprehensive, and integrated assessment of complex health technologies which were applied in a palliative care case study. The practical guidances are available through the project website www.integrate-hta.eu.
Introduction: background and objectives:
In recent years there have been major advances in the development of health technology assessment (HTA). However, HTA still has certain limitations when assessing technologies which:
- are context-dependent, as current HTA focusses on the health technology, not on the (socio-cultural, healthcare) system within it is used;
- perform differently depending on the way they are implemented;
- may have different effects on different patients/consumers.
Furthermore, HTA usually assesses and appraises aspects side-by-side while decision-making needs an integrated perspective on the value of a health technology. In the EU-funded INTEGRATE-HTA project, we (a Consortium of seven partners from five different European countries: Germany, Italy, The Netherlands, Norway, United Kingdom) developed concepts and methods to deal with these challenges. As the rise in chronic diseases in ageing populations has led to the development of increasingly complex technologies, we used palliative care as a case study to test the concepts and methods.
Methods:Different approaches were used to develop guidances on how to conduct an integrated assessment of a complex health technology. These include building on existing concepts and methods for single assessment aspects, i.e. effectiveness, ethical, socio-cultural, economic, and legal issues; Logic models were used to conceptualize the intervention in its context; Feedback from stakeholder advisory panels in seven different European countries to ensure public and patient involvement; and Application in a case study on palliative care. The applicability and relevance of the draft guidances were reviewed by an external panel of 31 experts, representing 14 nationalities and a variety of professional backgrounds.
Results: INTEGRATE-HTA resulted in six guidances: “Assessing effectiveness, economic, ethical, socio-cultural and legal aspects in complex health technologies”; “Guidance on moderators, predictors and patient preferences for treatment outcomes, and their integration”; “Assessment of context and implementation in systematic reviews and HTAs of complex interventions”; “Use of logic models in systematic reviews and HTAs of complex interventions”; “Integrated assessment of complex health technologies – The INTEGRATE-HTA model”; and a case study report: “Integrated assessment of home based palliative care with and without reinforced caregiver support: ‘A Demonstration HTA”. At the meeting, we will present the added value of the guidances to HTA-doers and users.
Conclusion: The INTEGRATE-HTA guidances can help to unlock the value of health technology. It is not a matter of collecting the facts, but a matter of collecting facts that are considered relevant, plausible to stakeholders and which are amenable to scientific inquiry. The guidances therefore contribute to a transparent HTA process and a deeper understanding of complex health technologies. As already stated by Farrell et al.: “Assessment processes are embedded in different sorts of institutional settings, within which scientists, decision-makers, and advocates communicate to define relevant questions for analysis, mobilize certain kinds of experts and expertise, and interpret findings in particular ways.
The impact of mevastatin on HCV replication and autophagy of non-transformed HCV replicon hepatocytes is influenced by the extracellular lipid uptake
No full textStatins efficiently inhibit cholesterol synthesis by blocking 3-hydroxy-3-methylglutaryl (HMG)-CoA reductase in the mevalonate pathway. However, the effect of statins on intracellular cholesterol is partially counterbalanced by a consequent increased uptake of extracellular lipid sources. Hepatitis C virus (HCV) infection induces intracellular accumulation of cholesterol by promoting both new synthesis and uptake of circulating lipoproteins, which is required for HCV replication and release. Hepatocytes respond to the increase in intracellular cholesterol levels by inducing lipophagy, a selective type of autophagy mediating the degradation of lipid deposits within lysosomes. In a cellular system of HCV replication based on HuH7 hepatoma cells, statin treatment was shown to be sufficient to decrease intracellular cholesterol, which is accompanied by reduced HCV replication and decreased lipophagy, and has no apparent impact on endocytosis-mediated cholesterol uptake. To understand whether these results were influenced by an altered response of cholesterol influx in hepatoma cells, we analyzed the effect of statins in non-transformed murine hepatocytes (MMHD3) harboring subgenomic HCV replicons. Notably, we found that total amount of cholesterol is increased in MMHD3 cells upon mevastatin treatment, which is associated with increased HCV replication and lipophagy. Conversely, mevastatin is able to reduce cholesterol amounts only when cells are grown in the presence of delipidated serum to prevent extracellular lipid uptake. Under this condition, HCV replication is reduced and autophagy flux is severely impaired. Altogether, these results indicate that both de novo synthesis and extracellular uptake have to be targeted in non-transformed hepatocytes in order to decrease intracellular cholesterol levels and consequently limit HCV replication. Copyright © 2019 Vescovo, Refolo, Manuelli, Tisone, Piacentini and Fimia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms
Introduction to Ethics in Health Technology Assessment
No full textThe course has been specifically developed for international participants and is based on more recent international achievements in the field. It will emphasize adapting approaches in ethics for all types of health technologies and across international settings. Participants who attend this course will strengthen their understanding and facilitate their participation in ethical assessment in HTA, as well their ability to participate in broader discussions. Most importantly it provides a number of approaches for ‘how to’ incorporate ethics into an HTA.
After the preconference workshop participants will be able to:
• explain and acknowledge the role of ethical issues in HTA;
• recognize potential ethical issues in HTA and formulate appropriate research questions,
• know about and use methods for analysing ethical issues;
• know how to find and critically approach literature used when identifying ethical implications of health care technologies;
• describe different ways of synthesizing and communicating the results of an ethics analysis
. Il progetto del programma Erasmus+ “VALIDATE”: VAlues in Doing Assessments of healthcare Technologies
No full textGli odierni processi di HTA prevedono la valutazione di sicurezza, efficacia clinica e costo-efficacia relativi all’impiego di tecnologie sanitarie, e talvolta ad essi si aggiunge la valutazione degli aspetti organizzativi, etici, sociali e legali. Tali elementi di valutazione vengono, di norma, considerati singolarmente.
Il principale inconveniente di questo approccio è che esso non tiene in debito conto il fatto che la selezione degli aspetti che devono essere valutati nel processo di HTA dipende, fondamentalmente, dal framework valoriale, a parte dal quale la valutazione viene condotta. I differenti stakeholders ragionano e agiscono essi stessi a partire da framework valoriali differenti, cosa che ha un evidente impatto sul processo di HTA. Pertanto, piuttosto che considerare gli aspetti etici, sociali e legali come separati, occorrerebbe riconoscere che essi costituiscono il framework a partire dal quale è possibile determinare quali evidenze empiriche sono necessarie, al fine di valutare il valore di una determinata tecnologia sanitaria.
VALIDATE” (VAlues in Doing Assessments of healthcare Technologies) è un progetto finanziato dall’Unione Europea nell’ambito del programma Erasmus+. Il suo obiettivo consiste nel formare la prossima generazione di esperti nell’HTA ad utilizzare un approccio, dove la valutazione di sicurezza, efficacia e impatto economico risulti integrata a quella degli aspetti organizzativi, etici, sociali e legali.
Obiettivo dell’intervento sarà quello di illustrare contesto, obiettivi, contenuti e output del progetto VALIDATE
Integrating Empirical Analysis and Normative Inquiry in Health Technology Assessment: The Values in Doing Assessments of Health Technologies Approach
No full textHealth technology assessment (HTA) aims, through empirical analysis, to shed light on the value of health technologies (O'Rourke et al. [2020, International Journal of Technology Assessment in Health Care 36, 187-90]). HTA is, then, where facts and values meet. But how, where, and when do facts and values meet in HTA? Currently, HTA is usually portrayed as a sequential process, starting with empirical analysis (assessment), followed by a deliberation on the implications of the findings for a judgment of a health technology's value (appraisal). In this paper, we will argue that in HTA, empirical analysis and normative inquiry are much more closely entwined. In fact, as we hope to show, normative commitments act as an indispensable guide for the collection and interpretation of empirical evidence. Drawing on policy sciences, we will suggest a concrete methodology that can help HTA practitioners to integrate empirical analysis and normative inquiry in a transparent way. The proposed methodology can be conceived as a concrete means for conducting a scoping exercise in HTA. Moreover, it offers a distinct way of giving stakeholders a structural and constructive role in HTA. This paper outlines the approach developed by the values in doing assessments of health technologies project, a project funded by the Erasmus+ program (contract number 2018-1-NL01-KA203-038960), which is the European Union's program to support education, training, youth, and sport in Europe. The project has resulted in an E-learning course, an accompanying handbook, and a consensus statement, all freely available from the project's website www.validatehta.eu
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