Etica e professioni sanitarie in Europa. Un dialogo tra medicina e filosofia

This multilingual volume brings together some of the results of research conducted at the Department of Literature and Philosophy of the University of Trento (Italy), in collaboration with the Bruno Kessler Foundation (Trento, Italy). Topics related to ethics and professions in the healthcare and other fields were covered, analyzed both from a theoretical and an empirical perspective. After presenting some introductory thoughts on the distinction between different levels and forms of ethical reflection on healthcare and the significance of the individual moral conscience as far as these levels are concerned, the first part of the book discusses some European traditions in healthcare professional ethics: it includes a Spanish account of different moral traditions in healthcare ethics, a reconstruction of the British experience and evolution of this field, a report on the Belgian contemporary situation, a presentation of the role of the Medical Associations in the German area, a description of the evolution of medical ethics in Croatia and a focus on nursing ethics and medical ethics in Italy. Two empirical studies are then described: one qualitative based on 40 interviews with clinicians, and one quantitative based on a web survey of more than 1,000 physicians; the first was conducted in the Province of Trento, the second in that of Verona (Northern Italy). The book concludes with a number of interviews with clinicians and a philosophical reflection on the nature of the obligations related to the practice of caring. The book is intended to cover the main moral questions faced by clinicians today and to offer a novel self-representation of their work and its ethical meaning in contemporary healthcare practice. Medicine and philosophy have a long history of dialogue: this volume continues that discussion, searching for new ways to combine a strong scientific approach with reflections on the moral and anthropological structures of clinical practice

Genuine participation in participant-centred research initiatives : the rhetoric and the potential reality

The introduction of Web 2.0 technology, along with a population increasingly proficient in Information and Communications Technology (ICT), coupled with the rapid advancements in genetic testing methods, has seen an increase in the presence of participant-centred research initiatives. Such initiatives, aided by the centrality of ICT interconnections, and the ethos they propound seem to further embody the ideal of increasing the participatory nature of research, beyond what might be possible in non-ICT contexts alone. However, the majority of such research seems to actualise a much narrower definition of ‘participation’—where it is merely the case that such research initiatives have increased contact with participants through ICT but are otherwise non-participatory in any important normative sense. Furthermore, the rhetoric of participant-centred initiatives tends to inflate this minimalist form of participation into something that it is not, i.e. something genuinely participatory, with greater connections with both the ICT-facilitated political contexts and the largely non-ICT participatory initiatives that have expanded in contemporary health and research contexts. In this paper, we highlight that genuine (ICT-based) ‘participation’ should enable a reasonable minimum threshold of participatory engagement through, at least, three central participatory elements: educative, sense of being involved and degree of control. While we agree with criticisms that, at present, genuine participation seems more rhetoric than reality, we believe that there is clear potential for a greater ICT-facilitated participatory engagement on all three participatory elements. We outline some practical steps such initiatives could take to further develop these elements and thereby their level of ICT-facilitated participatory engagement.Peer reviewe

Successful CAR-T cell therapy in a refractory MCL patient with bacterial, fungal and COVID-19 infection: a case report

BackgroundThe COVID-19 pandemic has had a significant impact on the management and care of onco-hematological patients, particularly those with lymphoproliferative disorders who are at higher risk for COVID-19 associated bacterial and fungal superinfections.Case presentationWe present the successful treatment of a 44-year-old male patient with refractory mantle cell lymphoma treated with chimeric antigen receptor T (CAR-T) cell therapy, despite concurrent COVID-19 infection. The patient developed grade II cytokine release syndrome, requiring admission to the intensive care unit. The CAR-T cells expanded effectively, and the patient achieved complete metabolic remission. During the treatment course, the patient experienced complications including COVID-19-associated pulmonary aspergillosis and a co-infection with Stenotrophomonas maltophilia and the SARS-CoV-2 omicron variant. Prompt antifungal and antibacterial therapy, along with appropriate COVID-19 treatment, led to the resolution of these infections. Dexamethasone was also administered to reduce inflammation and aid hematologic recovery. Despite the presence of multiple infections, the patient achieved complete remission of lymphoma, highlighting the effectiveness of CAR-T cell therapy in this high-risk patient.ConclusionDespite the challenges posed by concurrent infections, the decision to proceed with CAR-T cell therapy in this patient proved to be successful, resulting in complete remission of lymphoma. Early initiation of supportive therapies and the use of dexamethasone contributed to the resolution of complications. This case underscores the importance of individualized decision-making and the potential benefits of CAR-T cell therapy in similar high-risk patients

A Real Time Teleconsultation System for Sharing an Oncologic Web-based Electronic Medical Record

This poster presents an innovative real-time Teleconsultation System for synchronized navigation of the pages of a web-based Oncological Electronic Medical Record, designed to provide clinicians a cooperative work tool supporting the oncologic patient management between different hospitals. The system embeds additional tools supporting the discussion: digital whiteboard, chat and a digital audio channel

La diagnosi intraopertoria telelmatica tra Ospedali in Trentino: prime valutazioni ed ottimizzazione delle procedure

La diagnosi telematica può essere una valida risposta al congelatore negli ospedali periferici privi di Anatomia Patologica. Per tale scopo, nell`ambito del Progetto Telemedicina finanziato dal Ministero della Sanità, è stato sviluppato un sistema di telemicroscopia statica (STeMiSy) da provare tra l`Anatomia patologica di Trento e la Chirurgia di Cles, distanti tra loro oltre 40 chilometri di strada di montagna molto trafficata. Prima di passare però alla fase finale, al fine di verificare eventuali problemi anche organizzativi dell`intero sistema, si è pensato di testare il software e l`hardware definitivo sulla rete ospedaliera del Trentino tra le Anatomie Patologiche di Trento e Rovereto. La prova della durata di circa tre mesi non ha evidenziato sostanziali problemi di rete né di microscopio che guidato remotamente si è sempre dimostrato preciso e affidabile. La qualità e la rapidità di trasmissione delle immagini è buona ed ampiamente sufficiente per gli scopi prefissati. Il non riconoscimento di piccoli particolari, peraltro ininfluenti per la successiva decisione chirurgica, verosimilmente dipende dall`immagine panoramica, la vera mappa per la navigaziione successiva, che è meno dettagliata. L`uso della audioconferenza, utilizzando lo stesso canale di trasmissione, oltre a rallentare sia pur impercettibilmente la trasmissione ha creato qualche problema di interferenza con la stabilità del sistema. L`audioconferenza è stata pertanto per il momento abbandonata ricorrendo, ove necessario al telefono tradizionale. L`uso di immagini macroscopiche dell`intero pezzo operatorio, la responsabilizzazione del chirurgo per il campionamento, una buona preparazione tecnica del vetrino istologico e un po` di esperienza fanno ritenere che non sia indispensabile la presenza del patologo nell`ospedale periferico. Al fine dell`esperienza, si ritiene che la principale e forse unica difficoltà possa essere rappresentata dalla paura del Patologo a formulare una diagnosi telematica a distanza senza essere effettivamente presente, più che non in problemi di tipo tecnologic

Design and implementation of a regional tele-oncology project: design and initial implementation phase

In 1997 two tele-oncology projects started in the north of Italy (Province of Trento). The common aim of the projects concerns the design and the implementation of a non-surgical tele-oncology system intended to provide a suitable and flexible computing environment for a joint management of oncology patient on a WAN. The network designed for the first project (funded by Italian Health Ministry) links 5 rural hospitals of the province -lacking of oncology specialists on site- to the central one, where clinical oncology (CO) and radiotherapy services are provided. The specific purpose of the tele-oncology system is to support the rural hospitals oncology care by providing continuos expert remote advice from central site oncology specialists in formulating treatment plans and conducting follow-up sessions. The second project (funded by EC Adapt-bis Programme) is devoted to facilitate the communication between general practitioners (GPs) and the medical staff at the CO department of Trento through a computer network, allowing GPs and hospital specialists to share medical data. To satisfy the overall needs of the two projects an intranet-based OTCS was implemented. The basic component of the system is the multimedia digital medical record. A distributed relational database will allow users to store and retrieve medical records, accessed by a dedicated Web browser. The system incorporates Web-based applications (native and custom) such as synchronized navigation on medical records, image-sharing, audio-conferencing, white-boarding, local notepad, chat and e-mail service. The system provides a synchronous mode for real-time cooperative working between hospital specialists and an asynchronous mode for sharing clinical data between GPs and hospital specialists. Users acceptance during the prototype implementation periods and the training phase was high. Since summer 1999 the OTCS has been deployed in hospital and GPs setting and it is going to be tested in the hospital routin

Design and implementation of an intranet-based system for real-time tele-consultation in oncology

This study describes a tele-consultation system (TCS) developed to provide a computing environment over a Wide Area Network (WAN) in North Italy (Province of Trento), that can be used by two or more physicians to share medical data and to work co-operatively on medical records. A pilot study has been carried out in oncology to assess the effectiveness of the system. The aim of this project is to facilitate the management of oncological patients by improving communication among the specialists of central and district hospitals. Methods and Results: The TCS is an intranet-based solution. The intranet is based on a PC WAN with Windows NT Server, Microsoft SQL Server, and Internet Information Server. TCS is composed of native and custom applications developed in the Microsoft Windows (9x and NT) environment. The basic component of the system is the multimedia digital medical record, structured as a collection of HTML and ASP pages. A distributed relational database will allow users to store and retrieve medical records, accessed by a dedicated Web browser via the Web Server. The medical data to be stored and the presentation architecture of the clinical record had been determined in close collaboration with the clinicians involved in the project. TCS will allow a multi-point tele-consultation (TC) among two or more participants on remote computers, providing synchronized surfing through the clinical report. A set of collaborative and personal tools, whiteboard with drawing tools, point-to-point digital audio-conference, chat, local notepad, e-mail service, are integrated in the system to provide an user friendly environment. TCS has been developed as a client-server architecture. The client part of the system is based on the Microsoft Web Browser control and provides the user interface and the tools described above. The server part, running all the time on a dedicated computer, accepts connection requests and manages the connections among the participants in a TC, allowing multiple TC to run simultaneously. TCS has been developed in Visual C++ environment using MFC library and COM technology; ActiveX controls have been written in Visual Basic to perform dedicated tasks from the inside of the HTML clinical report. Before deploying the system in the hospital departments involved in the project, TCS has been tested in our laboratory by clinicians involved in the project to evaluate the usability of the system Discussion: The TCS has the potential to support a “multi-disciplinary distributed virtual oncological meeting”. The specialists of different departments and of different hospitals can attend “virtual meetings” and interactively discuss on medical data. An expected benefit of the “virtual meeting” should be the possibility to provide expert remote advice from oncologists to peripheral cancer units in formulating treatment plans, conducting follow-up sessions and supporting clinical researche