Accesso ai corsi di laurea in medicina: messa a punto di un questionario conoscitivo relativo a equilibrio personale e relazionale, attitudini, motivazioni e valori in contesti educativi (EMAV-E)

La grande domanda di accesso ai corsi di medicina richiede di individuare nei candidati le caratteristiche che ne possano fare un “buon medico”. A tal fine abbiamo sviluppato un questionario (EMAV-E) conoscitivo su alcune caratteristiche dei candidati, come base di partenza per l’incontro con l’esperto selezionatore. Le macro-aree indagate dal questionario sono state: equilibrio personale e relazionale (equilibrio e autoregolazione), attitudini accademiche e professionali (intelligenza emotiva, metacognizione, motivazioni), valori personali e professionali, e desiderabilità sociale dell’individuo, usata come controllo. Le macro aree erano divise in 20 aree di interesse entro le quali sono stati individuati 238 item ritenuti rappresentativi. Per la validazione del questionario, sono stati reclutati 653 studenti iscritti al primo anno di corsi di laurea di area medica. Dal questionario iniziale sono state ricavate tre versioni brevi di 80 items. Per saggiarne l’effettiva confrontabilità sono state risomministrate a 160 studenti diversi dal campione iniziale. I tre questionari avendo parametri statistici paragonabili, possono essere considerati forme parallele dello stesso questionario. La procedura ha consentito di sviluppare uno strumento per l’individuazione di punti di forza e di debolezza, secondo le macro aree prese in considerazione, degli studenti che ambiscono a intraprendere la formazione universitaria presso i corsi di laurea in medicina o delle professioni sanitarie

Qualità della vita e benessere psicologico: il caso dell'acalasia esofagea

Quality of Life and Psychological Well-being: The Case of Achalasia - The theoretical reflection on people, particularly on those affected by a rare illness, requires a multidisciplinar analysis. This shared reflection allows to gather the common denominator of the individual histories: a call for well-being even before health. During the 6th Meeting of Amae Onlus it was talked about Quality of the Life (QOL) for achalasia patients according to a biopsychosocial approach, tackling topics like the management of pain, the smart feeding, the doctor-patient relationship and the role of psychological cares in affecting the QOL of patients. Scholars converged on the need to overcome the strong paternalism in favour of the nudge: accompaning somebody to move towards a good choice. A path towards extraordinarium auxilium in which the final word is left to the individual and to his personal and indisputable choice of quality of life

Effects on the incidence of cardiovascular events of the addition of pioglitazone versus sulfonylureas in patients with type 2 diabetes inadequately controlled with metformin (TOSCA.IT): a randomised, multicentre trial

Background The best treatment option for patients with type 2 diabetes in whom treatment with metformin alone fails to achieve adequate glycaemic control is debated. We aimed to compare the long-term effects of pioglitazone versus sulfonylureas, given in addition to metformin, on cardiovascular events in patients with type 2 diabetes. Methods TOSCA.IT was a multicentre, randomised, pragmatic clinical trial, in which patients aged 50\ue2\u80\u9375 years with type 2 diabetes inadequately controlled with metformin monotherapy (2\ue2\u80\u933 g per day) were recruited from 57 diabetes clinics in Italy. Patients were randomly assigned (1:1), by permuted blocks randomisation (block size 10), stratified by site and previous cardiovascular events, to add-on pioglitazone (15\ue2\u80\u9345 mg) or a sulfonylurea (5\ue2\u80\u9315 mg glibenclamide, 2\ue2\u80\u936 mg glimepiride, or 30\ue2\u80\u93120 mg gliclazide, in accordance with local practice). The trial was unblinded, but event adjudicators were unaware of treatment assignment. The primary outcome, assessed with a Cox proportional-hazards model, was a composite of first occurrence of all-cause death, non-fatal myocardial infarction, non-fatal stroke, or urgent coronary revascularisation, assessed in the modified intention-to-treat population (all randomly assigned participants with baseline data available and without any protocol violations in relation to inclusion or exclusion criteria). This study is registered with ClinicalTrials.gov, number NCT00700856. Findings Between Sept 18, 2008, and Jan 15, 2014, 3028 patients were randomly assigned and included in the analyses. 1535 were assigned to pioglitazone and 1493 to sulfonylureas (glibenclamide 24 [2%], glimepiride 723 [48%], gliclazide 745 [50%]). At baseline, 335 (11%) participants had a previous cardiovascular event. The study was stopped early on the basis of a futility analysis after a median follow-up of 57\uc2\ub73 months. The primary outcome occurred in 105 patients (1\uc2\ub75 per 100 person-years) who were given pioglitazone and 108 (1\uc2\ub75 per 100 person-years) who were given sulfonylureas (hazard ratio 0\uc2\ub796, 95% CI 0\uc2\ub774\ue2\u80\u931\uc2\ub726, p=0\uc2\ub779). Fewer patients had hypoglycaemias in the pioglitazone group than in the sulfonylureas group (148 [10%] vs 508 [34%], p<0\uc2\ub70001). Moderate weight gain (less than 2 kg, on average) occurred in both groups. Rates of heart failure, bladder cancer, and fractures were not significantly different between treatment groups. Interpretation In this long-term, pragmatic trial, incidence of cardiovascular events was similar with sulfonylureas (mostly glimepiride and gliclazide) and pioglitazone as add-on treatments to metformin. Both of these widely available and affordable treatments are suitable options with respect to efficacy and adverse events, although pioglitazone was associated with fewer hypoglycaemia events. Funding Italian Medicines Agency, Diabete Ricerca, and Italian Diabetes Society

A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial

Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services