Reply to the letter to the editor: 'The hard road to patient-centered care: 3 or 6 months of adjuvant chemotherapy for patients with stage III colon cancer?' By P. Trendsz et al.

n/

Current challenges and future perspectives in the medical treatment of solid tumours

n/

L’ORALITÀ A SCUOLA, DA PLATONE AL PORTFOLIO EUROPEO DELLE LINGUE

L'oralità risulta primaria rispetto alla scrittura sia per quanto riguarda la razza umana (filogenesi) sia per quanto riguarda lo sviluppo individuale (ontogenesi), tuttavia essa ha sempre goduto di minor prestigio della scrittura. Nella prima parte di questo articolo sono ricostruiti i diversi momenti in cui questa gerarchia è stata fondata e si è affermata stabilmente: dai contrasti epocali tra Socrate e  Platone da una parte e i Sofisti dall'altra all'affermazione della centralità della scrittura da parte di Aristotele e degli aristotelici; fino, poi, all'Illuminismo, in cui l'oralità veniva ormai identificata con l'inciviltà, la rozzezza e l'arretratezza, posizione che in qualche misura permane ancora oggi. Nella seconda parte dell'articolo si ricostruisce il graduale recupero del valore dell'oralità nell'insegnamento linguistico, attraverso un'analisi dei programmi scolastici italiani, dalla Legge Casati del 1859 ai Programmi della scuola media e di quella elementare rispettivamente del 1979 e del 1985, alle più recenti "Indicazioni Moratti e infine alle "Indicazioni Fioroni". In queste ultime si sottolinea la necessità di finalizzare l'insegnamento dell'oralità anche a scopi interculturali più ampi, prioritari nella società attuale, quali il rispetto e la promozione delle differenze linguistiche e culturali, lo sviluppo del plurilinguismo; la centralità e l'autonomia dell'apprendente.   Historically, the oral tradition has been more important than writing, both in human history (philogenesis) and in individual, personal history (onthogenesis), but it has always had far less prestige. The first part of this paper surveys important moments in the formation and establishment of this hierarchy, starting from the fundamental contrast between the Sophists on the one hand, and Socrates and Plato from the other, to the centrality of Aristotle and Aristotelianism, up to the Age of Enlightenment and the identification between orality, barbarism and roughness, still common today. In the second part, the gradual rediscovery and positive reevaluation of the oral tradition in language teaching is mapped out. Italian school programmes are analyzed, from Legge Casati (1859)  to the Programmes of 1979 and 1985, up to the recent 'Indicazioni Moratti' and 'Indicazioni Fioroni'. These latest pieces of legislation underline the need to highlight the oral tradition within didactics to meet the wider intercultural  goals that today have become real priorities.  This in order to promote respect for linguistic and cultural diversity, the development of plurilingualism as well as the centrality and autonomy of learners within the learning process. &nbsp

Scuola e alfabetizzazione in Italia. Caratteri e limiti di una correlazione spuria

The functional alphabetical competence and the competence in the matter of citizenship are closely interconnected in the training of the young person: their close functional link is well expressed and well-argued by the Recommendations of the Council of the European Union (in particular from that of 2018) within the general framework of key competences for learning, but in reality it occupies a strand of western thought that goes back so far as to be considered traditional, and takes up ideas and proposals advanced in the last half century mainly by Tullio De Mauro, through the principles of democratic linguistic education. The current cultural climate brings to the fore the link between language and citizenship and outlines a framework of educational obligations which the school cannot escape. But an examination of the limits and difficulties of the Italian school leads to downsizing the most advanced objectives, while aiming to respect the basic objectives indicated by the Council of the European Union. In conclusion, we propose a Decalogue of operational choices that take into account both the essential objectives that cannot be renounced and the current difficulties of the Italian school

Accidental falls in hospitalized children: an analysis of the vulnerabilities linked to the presence of caregivers

Introduction. This study stemmed from the data gathered by a research conducted by the coordinator of the Department of Healthcare Services and a group of nurses involved in a research on accidental falls in hospitalized children at the ?G. Gaslini? Children?s Hospital and Scientific Research Institute in Genoa, Italy. The first retrospective study evaluated the accidental falls in hospitalized children referred to the three-year period 2003- 2006, while the second perspective study, referred to the trimester March-May 2007, found that the main cause of falls in children was parent?s distraction. Methods. The method adopted in the first phase of our study was a proactive risk analysis (The Basics of Healthcare Failure Mode and Effect Analysis), identified in the first place by the VA National Centre for Patient Safety and applied to the ?Child and parent hospital admission process?. This proactive risk analysis has proven to be very effective in preventing the risk of accidental falls in hospitalized children through effective communication and educational interventions. The second phase of our study consisted of two Focus Groups for accidental traumatic events. Results. The analysis of the results of the study showed how effective communication is instrumental, not only to have a better awareness of the children and their parents during their stay in hospital, but also to implement educational sessions on prevention to reduce the risk of accidental traumatic events. Conclusions. The present study contributes to improve safety and the quality of care by motivating nurses to keep their attention high on falls in hospitalized children, by monitoring and the development of new risk assessment tools

Phase II study of a triplet regimen in advanced colorectal cancer using methotrexate, oxaliplatin and 5-fluorouracil

Building upon the concept of schedule-specific biochemical modulation of 5-fluorouracil (FU), which alternates bolus and continuous infusion (CI) FU, we have incorporated oxaliplatin (l-OHP) following the bolus part of the regimen to explore the activity of this new combination. Patients with advanced, untreated, measurable colorectal cancer received sequential methotrexate (MTX) (days 1 and 15)-->l-OHP+FU (days 2 and 16) (200, 85 and 600 mg m(-2), respectively) followed by 3 weeks of CI FU (200 mg m(-2) day(-1)) given from day 29 to 50, modulated by weekly leucovorin (LV) (20 mg m(-2)). After 1 week of rest, the second cycle was started. The treatment was continued until progression or patient's refusal. According to the intention-to-treat analysis on all 46 patients accrued, the response rate was 42% (95% CL=28-55%), with three complete responses and 16 partial responses. The median overall survival was 15.9 months and the median progression-free survival 6.9 months. Toxicity was very mild, with the bolus part of the regimen more toxic than the infusional part (24 vs 7% of grade III-IV, respectively). This new combination of MTX -->l-OHP-FU followed by FU CI is well tolerated, feasible and produces activity results similar to other more simple, but more toxic, regimens. Pros and cons of the different fluoropyrimidines-l-OHP combinations are discussed

PER UN APPROCCIO VARIETISTICO ALL’INSEGNAMENTO DELL’ITALIANO A STRANIERI - II

Si riprende la trattazione della prima parte, soffermandosi sugli spostamenti oggi in atto fra le diverse varietà della lingua e sulla ristrutturazione del repertorio linguistico italiano. Si introduce poi la nozione di competenza socio-pragmatica e culturale e si evidenzia la necessità che i docenti di lingua italiana, in contesto di italiano L2, non limitino la loro competenza ai vari livelli della lingua, in tutte le sue varietà, ma la estendano alle regole pragmatiche e culturali che entrano in gioco nel rapporto fra le due lingue / culture che entrano in contatto nel processo di apprendimento, e le facciano rientrare nel percorso didattico dell’italiano L2 in modi adeguati agli obiettivi che di volta in volta si perseguono. Ci si sofferma, a titolo esemplificativo, su due temi dell’intersezione lingua / cultura studiati dalla pragmatica interculturale: il rapporto fra significato di superficie e significato profondo; le strutture della conversazione. Ogni argomento è accompagnato da indicazioni didattiche operative.     For a varietistic approach to the teaching of italian to foreigners - II   Continuing the first part, this article focuses on the current shifts regarding the different varieties of language and on the renovation of the Italian linguistic repertory.  The notion of socio-pragmatic and cultural competence is introduced, highlighting the need for Italian language teachers, in an Italian L2 context, not to limit their competence to the various levels of the language, in all of its variety, but to include pragmatic and cultural rules which are part of the relationship between the two languages/cultures which come into contact in the learning process, and how this contact effects reaching the Italian L2 learning goals. Two themes from the field of intercultural pragmatics are addressed in particular regarding the language/culture point of contact: the relationship between superficial and deep meaning and the structure of conversation. Each topic has practical didactic suggestions

Metastatic colorectal cancer: integrating irinotecan into combination and sequential chemotherapy

n/

Orthostatic hypotension in a cohort of hypertensive patients referring to a hypertension clinic

n/

Real-world efficacy and safety of nivolumab in previously-treated metastatic renal cell carcinoma, and association between immune-related adverse events and survival: the Italian expanded access program

Background: The Italian Renal Cell Cancer Early Access Program was an expanded access program that allowed access to nivolumab, for patients (pts) with metastatic renal cell carcinoma (mRCC) prior to regulatory approval. Methods: Pts with previously treated advanced or mRCC were eligible to receive nivolumab 3 mg/kg every 2 weeks. Pts included in the analysis had received ≥1 dose of nivolumab and were monitored for drug-related adverse events (drAEs) using CTCAE v.4.0. Immune-related (ir) AEs were defined as AEs displaying a certain, likely or possible correlation with immunotherapy (cutaneous, endocrine, hepatic, gastro-intestinal and pulmonary). The association between overall survival (OS) and irAEs was assessed, and associations between variables were evaluated with a logistic regression model. Results: A total of 389 pts were enrolled between July 2015 and April 2016. Overall, the objective response rate was 23.1%. At a median follow-up of 12 months, the median progression-free survival was 4.5 months (95% CI 3.7-6.2) and the 12-month overall survival rate was 63%. Any grade and grade 3-4 drAEs were reported in 124 (32%) and 27 (7%) of pts, respectively, and there were no treatment-related deaths. Any grade irAEs occurred in 76 (20%) of patients, 8% cutaneous, 4% endocrine, 2% hepatic, 5% gastro-intestinal and 1% pulmonary. Of the 22 drAEs inducing treatment discontinuation, 10 (45%) were irAEs. Pts with drAEs had a significantly longer survival than those without drAEs (median OS 22.5 versus 16.4 months, p = 0.01). Pts with irAEs versus without irAEs had a more significant survival benefit (median OS not reached versus 16.8 months, p = 0.002), confirmed at the landmark analysis at 6 weeks. The occurrence of irAEs displayed a strong association with OS in univariable (HR 0.48, p = 0.003) and multivariable (HR 0.57, p = 0.02) analysis. Conclusions: The appearance of irAEs strongly correlates with survival benefit in a real-life population of mRCC pts treated with nivolumab