The Triage of "Blameworthy" Patients

One question that has sometimes cropped up in the debate on triage and the management of scarce healthcare resources concerns patients’ merits, demerits, and responsibility with regard to their own medical condition. During the current pandemic, some have wondered, when it comes to accessing healthcare, whether patients who have refused vaccination, despite the availability of vaccines and pressure to get vaccinated from the health authorities, should be given the same priority as patients who have diligently undergone vaccination in accordance with the authorities’ recommendations. The issue of patients’ merits and demerits is not new, and it did not emerge with the pandemic for the first time. In the past, the question was often posed whether terrorists have the right to receive the same treatment as their victims, with the same degree of priority, all clinical conditions being equal. Another issue that has been raised concerns patients suffering from diseases caused by unhealthy lifestyles that they have freely adopted: drinking, smoking, eating fatty foods, practising extreme sports, etc. The conclusion reached in the present article is that it is indeed possible to identify certain general rules for cases of this sort, as is shown by the literature on the topic. However, slavishly following these rules, even in exceptional cases for which it is impossible to make detailed provisions, can lead to disastrous consequences. Therefore, following Aristotle, the article seeks to take account both of the rule of justice and of equity, which is a form of “situational justice” capable of filling the gaps of general norms in the light of concrete cases

Lo stile ermeneutico di Paul Ricœur: spiegare di più per comprendere meglio

 In this essay the Author retraces the central themes of Ricoeurian hermeneutics. As heir to the philosophical tradition inaugurated by Heidegger and Gadamer, Paul Ricoeur follows the same line of the two undisputed masters of twentieth century hermeneutics, but gives his own very personal reading. By trying to overcome the dichotomy placed by Gadamer between truth and method, Ricoeur shows the complementarity between explanation (erklären), typical of the sciences, and understanding (verstehen), practiced by the humanistic disciplines. Explanation and comprehension are, in fact, two sides of the same hermeneutical arc, that arc which is stretched every time a reader is placed before a text and is called upon and questioned by it.In questo saggio l’Autore ripercorre i temi centrali della ermeneutica ricœuriana. Erede della tradizione filosofica inaugurata da Heidegger e Gadamer, Paul Ricœur ripercorrendo la via tracciata dai due maestri indiscussi dell’ermeneutica novecentesca, ma dandone una lettura del tutto personale. Cercando di superare la dicotomia posta da Gadamer tra verità e metodo, mostra la complementarità tra lo spiegare (erklären) tipico delle scienze e il comprendere (verstehen) praticato dalle discipline umanistiche. Spiegazione e comprensione sono, infatti, due lati dello stesso arco ermeneutico, quell’arco che si distende ogni qualvolta un lettore si pone di fronte a un testo e da esso si fa interpellare e interrogare.

Man Is What He Eats: The Philosophy and Ethics of Eating

The article is based on Feuerbach's well-known ruling that "man is what he eats", to analyse its possible different meanings, even the most recondited ones. To do this the research winds through a long journey, which begins with a reflection on the role that food has in some Western religions, especially in Judaism and Christianity. Two processes which have deeply characterized the relationship of Western man with food are then examined: the process of industrialization and that of the medicalization of food. Finally, coming to the contemporary, the article goes into the merits of the relationship that different cultures have with food in a multicultural society and offers some indications for alternative models compared to those currently dominant. The conclusion, with Feuerbach and beyond Feuerbach, is that man is yes what he eats, but also what he does not eat and, above all, man eats what he is

Modifiable and non-modifiable risk factors for surgical site infection after colorectal surgery: a single-center experience

PURPOSE: Surgical site infection (SSI) is the most common complication of colorectal surgery, resulting in significant burden in terms of morbidity and length of hospital stay. The aims of this study were to establish the incidence of SSI in patients undergoing colorectal surgeries and to identify potentially modifiable risk factors to reduce overall SSI rates. METHODS: This retrospective study analyzed patients who underwent colorectal resection at our Department. Patients were identified using a prospective SSI database. Univariate and multivariate analyses were used to identify risk factors. RESULTS: A total of 687 patients were enrolled in the study and the overall SSI rate was 19.9% (137 patients). Superficial incisional surgical site infections (SSSIs) developed in 52 (7.6%) patients, deep incisional surgical site infections (DSSIs) developed in 15 (2.2%), and organ/space infections (OSIs) developed in 70 (10.1%). Univariate and multivariate analyses confirmed that age, diabetes, emergency surgery, and a high infection risk index are risk factors for SSI. CONCLUSIONS: There are some modifiable and non-modifiable risk factors for SSI. IRI and age are non-modifiable, whereas the timing of surgery and diabetes can be modulated by trying to defer some emergency procedures to elective ones and normalizing the glycemia of diabetic patients

Touch Imprinting Cytology may be useful in the intraoperative evaluation of the sentinel lymph node in melanoma

The aim of the study was to assess whether the reliability of Touch Imprinting Cytology (TIC) of Sentinel lymph node biopsy (SLNB) in skin melanoma patients allows intraoperative decisions regarding simultaneous radical lymphadenectomy to be made. Previous experiences have shown that the limit of TIC in extemporaneous diagnosis was represented by the minimal deposits of the tumor. Many current data seem to show that in this situation radical lymphadenectomy is no longer necessary, so we wondered if TIC could regain importance in the intraoperative management of these patients

The ethics of distress: Toward a framework for determining the ethical acceptability of distressing health promotion advertising

© 2014 International Union of Psychological Science. Distressing health promotion advertising involves the elicitation of negative emotion to increase the likelihood that health messages will stimulate audience members to adopt healthier behaviors. Irrespective of its effectiveness, distressing advertising risks harming audience members who do not consent to the intervention and are unable to withdraw from it. Further, the use of these approaches may increase the potential for unfairness or stigmatization toward those targeted, or be considered unacceptable by some sections of the public. We acknowledge and discuss these concerns, but, using the public health ethics literature as a guide, argue that distressing advertising can be ethically defensible if conditions of effectiveness, proportionality necessity, least infringement, and public accountability are satisfied. We do not take a broad view as to whether distressing advertising is ethical or unethical, because we see the evidence for both the effectiveness of distressing approaches and their potential to generate iatrogenic effects to be inconclusive. However, we believe it possible to use the current evidence base to make informed estimates of the likely consequences of specific message presentations. Messages can be pre-tested and monitored to identify and deal with potential problems. We discuss how advertisers can approach the problems of deciding on the appropriate intensity of ethical review, and evaluating prospective distressing advertising campaigns against the conditions outlined

Surgical outcomes for colon and rectal cancer over a decade: results from a consecutive monocentric experience in 902 unselected patients

<p>Abstract</p> <p>Background</p> <p>This study evaluates the surgical morbidity and long-term outcome of colorectal cancer surgery in an unselected group of patients treated over the period 1994–2003.</p> <p>Methods</p> <p>A consecutive series of 902 primary colorectal cancer patients (489 M, 413 F; mean age: 63 years ± 11 years, range: 24–88 years) was evaluated and prospectively followed in a university hospital (mean follow-up 36 ± 24 months; range: 3–108 months). Perioperative mortality, morbidity, overall survival, curative resection rates, recurrence rates were analysed.</p> <p>Results</p> <p>Of the total, 476 colorectal cancers were localized to the colon (CC, 53%), 406 to the rectum (RC, 45%), 12 (1%) were multicentric, and 8 were identified as part of HNPCC (1%). Combining all tumours, there were 186 cancers (20.6%) defined as UICC stage I, 235 (26.1%) stage II, 270 (29.9%) stage III and 187 (20.6%) stage IV cases. Twenty-four (2.7%) cases were of undetermined stage. Postoperative complications occurred in 38% of the total group (37.8% of CC cases, 37.2% of the RC group, 66.7% of the synchronous cancer patients and 50% of those with HNPCC, p = 0.19) Mortality rate was 0.8%, (1.3% for colon cancer, 0% for rectal cancer; p = 0.023). Multivisceral resection was performed in 14.3% of cases. Disease-free survival in cases resected for cure was 73% at 5-years and 72% at 8 years. The 5- and 8-year overall survival rates were 71% and 61% respectively (total cases). At 5-year analysis, overall survival rates are 97% for stage I disease, 87% for stage II, 73% for stage III and 22% for stage IV respectively (p < 0.0001). The 5-year overall survival rates showed a marked difference in R0, R1+R2 and non resected patients (82%, 35% and 0% respectively, p < 0.0001). On multivariate analysis, resection for cure and stage at presentation but not tumour site (colon vs. rectum) were independent variables for overall survival (p < 0.0001).</p> <p>Conclusion</p> <p>A prospective, uniform follow-up policy used in a single institution over the last decade provides evidence of quality assurance in colorectal cancer surgery with high rates of resection for cure where only stage at presentation functions as an independent variable for cancer-related outcome.</p

Estensione della linfadenectomia nella chirurgia colorettale: problema aperto

2Il fine del presente lavorto retrospettivo è stato quello di analizzare se una una linfadenectomia estesa alla radice dei vasi colici principali poteva assumenre un significato prognostico e/o terapeutico. Dalla analisi dei dati è emerso che rinuciando ad una linfadenectomia estesa, solo per il fenomeno del "salto del linfonodo" si sarebbe verificata una sottostadiazione del 1,4% fra N0/N+ e del 8,5% fra N2/N3. Inoltre, sempre con una linfadenectomia estesa, si è osservato una sopravvivenza a 5 anni del 32,7% anche nei pazienti con metastasi ai linfonodi centrali. Non si sono invece osservate differenze significative nella mortalità e morbilità in rapporto al tipo di linfodenenctomia eseguita. Gli autori concludono considerando la linfadenectomia estesa ai linfonodi centrali il livello ideale di dissezione, sola in grado di garantire non solo una correta stadiazione ma anche un miglioramento della prognosi sopratutto per i pazienti N+.Il fine del presente lavorto retrospettivo è stato quello di analizzare se una una linfadenectomia estesa alla radice dei vasi colici principali poteva assumenre un significato prognostico e/o terapeutico. Dalla analisi dei dati è emerso che rinuciando ad una linfadenectomia estesa, solo per il fenomeno del "salto del linfonodo" si sarebbe verificata una sottostadiazione del 1,4% fra N0/N+ e del 8,5% fra N2/N3. Inoltre, sempre con una linfadenectomia estesa, si è osservato una sopravvivenza a 5 anni del 32,7% anche nei pazienti con metastasi ai linfonodi centrali. Non si sono invece osservate differenze significative nella mortalità e morbilità in rapporto al tipo di linfodenenctomia eseguita. Gli autori concludono considerando la linfadenectomia estesa ai linfonodi centrali il livello ideale di dissezione, sola in grado di garantire non solo una correta stadiazione ma anche un miglioramento della prognosi sopratutto per i pazienti N+.nonemixedLiguori G.; Turoldo A.Liguori, Gennaro; Turoldo, Angel