Le sfide della pedagogia medica oggi. Un’analisi SWOT della SIPeM

In modern times, the Italian Society of Medical Pedagogy (SIPeM) faces greater complexity. Over the last decades, great changes of the SIPeM goals and instruments there has been. Therefore it is necessary today a reflection on the goals reached, on the difficulties encountered and on future challenges. Procedure: a SWOT analysis of SIPeM was conducted with the members of the Direct Board and the Heads of the Local Sections. Results: 23 conceptual units were identified and divided into strength elements (5), weakness (7), opportunity (6) and risk (5). Conclusions: the analysis confirms some strategic choices made by SIPeM, such as the Green Line Project and underlines the need to define their own future goals in order to plan the resources distribution

Le sfide della pedagogia medica oggi. Un’analisi SWOT della SIPeM

In modern times, the Italian Society of Medical Pedagogy (SIPeM) faces greater complexity. Over the last decades, great changes of the SIPeM goals and instruments there has been. Therefore it is necessary today a reflection on the goals reached, on the difficulties encountered and on future challenges. Procedure: a SWOT analysis of SIPeM was conducted with the members of the Direct Board and the Heads of the Local Sections. Results: 23 conceptual units were identified and divided into strength elements (5), weakness (7), opportunity (6) and risk (5). Conclusions: the analysis confirms some strategic choices made by SIPeM, such as the Green Line Project and underlines the need to define their own future goals in order to plan the resources distribution

Performance of the model for end-stage liver disease score for mortality prediction and the potential role of etiology

Bakground & aims Although discrimination of the model for end stage liver disease (MELD) is generally considered acceptable, its calibration is still unclear. In a validation study, we assessed the discrimination and calibration performance of 3 versions of the model: original MELD-TIPS, used to predict survival after transjugular intra-hepatic portosystemic shunt (TIPS); classic MELD-Mayo; MELD-UNOS, used by United Network for Organ Sharing (UNOS). Recalibration and model updating were also explored. Methods 776 patients submitted to elective TIPS (TIPS cohort), and 445 unselected patients (non-TIPS cohort) were included. Three, 6 and 12-month mortality predictions were calculated by the 3 MELD versions: discrimination was assessed by c-statistics and calibration by comparing deciles of predicted and observed risks. Cox and Fine and Grey models were used for recalibration and prognostic analyses. Results Major patient characteristics in TIPS/non-TIPS cohorts were: viral etiology 402/188, alcoholic 185/130, NASH 65/33; mean follow-up± SD 25±9/19±21months; 3-6-12 month mortality were respectively, 57-102-142/31-47-99. C-statistics ranged from 0.66 to 0.72 in TIPS and 0.66 to 0.76 in non-TIPS cohorts across prediction times and scores. A post-hoc analysis revealed worse c-statistics in non-viral cirrhosis with more pronounced and significant worsening in non-TIPS cohort. Calibration was acceptable with MELD-TIPS but largely unsatisfactory with MELD-Mayo and -UNOS whose performance improved much after recalibration. A prognostic analysis showed that age, albumin, and TIPS indication might be used for a MELD updating. Conclusions In this validation study the MELD performance was largely unsatisfactory, particularly in non-viral cirrhosis. MELD recalibration and candidate variables for a MELD updating are proposed. Lay summary While discrimination performance of the Model for End Stage Liver Disease (MELD) is credited to be fair to good, its calibration, the correspondence of observed to predicted mortality, is still unsettled. We found that application of 3 different versions of the MELD in two independent cirrhosis cohorts yielded largely imprecise mortality predictions particularly in non-viral cirrhosis and propose a validated model recalibration. Candidate variables for a MELD updating are proposed

The biophysical properties of beta2-V287L mutant neuronal nicotinic receptors linked to ADNFLE

The biophysical properties of beta2-V287L mutant neuronal nicotinic receptors linked to ADNFL

Nicotinic acetylcholine receptors and nocturnal frontal lobe epilepsy

Sleep has traditionally been recognized as a precipitating factor for some forms of epilepsy, although differential diagnosis between some seizure types and parasomnias may be difficult. Autosomal dominant frontal lobe epilepsy is characterized by nocturnal seizures with hyperkinetic automatisms and poorly organized stereotyped movements and has been associated with mutations of the alpha 4 and beta 2 subunits of the neuronal nicotinic acetylcholine receptor. We performed a clinical and molecular genetic study of a large pedigree segregating sleep-related epilepsy in which seizures are associated with fear sensation, tongue movements, and nocturnal wandering, closely resembling nightmares and sleep walking. We identified a new genetic locus for familial sleep-related focal epilepsy on chromosome 8p12.3-8q12.3. By sequencing the positional candidate neuronal cholinergic receptor alpha 2 subunit gene (CHRNA2), we detected a heterozygous missense mutation, I279N, in the first transmembrane domain that is crucial for receptor function. Whole-cell recordings of transiently transfected HEK293 cells expressing either the mutant or the wild-type receptor showed that the new CHRNA2 mutation markedly increases the receptor sensitivity to acetylcholine, therefore indicating that the nicotinic alpha 2 subunit alteration is the underlying cause. CHRNA2 is the third neuronal cholinergic receptor gene to be associated with familial sleep-related epilepsies. Compared with the CHRNA4 and CHRNB2 mutations reported elsewhere, CHRNA2 mutations cause a more complex and finalized ictal behavior

Linear Viscoelastic Properties of Selected Polysaccharide Gums as Function of Concentration, pH, and Temperature

Hydrocolloids have been intensively investigated due to their ability to modify the rheology of the system where they are employed. They find application as thickening and gelling agents in many food, cosmetic, and pharmaceutical preparations, due to their biocompatibility and biodegradability. The present study aims to provide an exhaustive and comprehensive viscoelastic characterization of a series of hydrocolloid formulations, as function of concentration, pH, and temperature. Glucomannan, xanthan gum, tara gum, guar gum, konjac gum, and gellan gum have been analyzed at two concentrations (0.5% w/w and 1.5% w/w), using three different pH conditions (pH 1.2, 5.5, and 6.8). Their viscoelastic properties have been monitored measuring the main rheological parameters, namely, storage modulus G′ and loss modulus G′′ as function of frequency, time, and temperature. The results obtained show a clear dependence of the linear viscoelastic properties of the systems on concentration and pH, while the temperature was not a critical factor. Glucomannan, xanthan gum, tara gum, and guar gum samples prepared in phosphate buffer (pH 6.8) at the final concentration of 1.5% (w/w) have been selected as the most promising systems for further investigations, exploring the possibility of combinations to improve the rheological properties

Emotional intelligence as a mediator between attachment security and empathy in pre-clinical medical students: A multi-center cross-sectional study

Objective: To explore the association of emotional intelligence (EI) and attachment security (AS) with empathy dimensions in medical students by examining the mediating role of EI. Methods: In a cross-sectional design, the Interpersonal Reactivity Index (IRI), the Emotional Quotient Inventory (EQ-i), the Attachment Style Questionnaire (ASQ), and demographic questions were administrated to second-year medical students of two medical schools in Northern Italy. Results: 253 medical students (56.13% female), aged 19-29, participated in this study. AS positively correlated to Empathic Concern (r = 0.17, p = 0.008) and Perspective Taking (r = 0.24, p < 0.001), and negatively to Personal Distress (r = -0.33, p < 0.001). Individuals with the same level of AS and a higher score on EQ-i had a higher score (β = 0.072, p = 0.033) on empathy latent factor (at the basis of Empathic Concern and Perspective Taking) and a lower score (β = -0.290, p < 0.001) on Personal Distress than those with a lower EQ-i score. Conclusion: This study shows that EI completely mediated the relationship between AS and empathy dimensions among medical students. Practice implications: EI training and workshop should be considered when designing educational interventions and programs to enhance empathy and decrease interpersonal distress in medical students

Training in communication and emotion handling skills for students attending medical school: Relationship with empathy, emotional intelligence, and attachment style

Objective: To describe the Emoty-Com training, its impact on medical students' attitudes towards doctors' emotions and to explore the association between students' empathy, emotional intelligence (EI), and attachment style (AS) with post-training performance scores. Methods: The 16-hour Emoty-Com training was delivered to all second-year medical students of Verona and Milan (Italy) Universities. At pre-training, students filled out three questionnaires assessing empathy, AS and EI and responded to three questions on attitudes towards doctors' emotions in the doctor-patient encounter. The same three questions and a final evaluation test were proposed at post-training. Results: 264 students participated in the study. The training reduced students' worry about managing emotions during doctor-patient relationships. Gender was associated with specific subscales of empathy, EI, and AS. Final performance scores were associated with students' attitudes towards emotions but not with empathy, EI, and AS. Conclusion: The Emoty-Com training increased students' self-efficacy in handling their own emotions during consultations. Students' performance scores were related to their attitude towards doctors' emotions in clinical encounters. Practice implications: The Emoty-Com training suggests ways to teach and evaluate emotion-handling skills for medical students. Possible links between empathy, EI, AS, and the attitudes towards doctors' emotions during the years of education are highlighted

Association between relational attitudes and a training in communication and emotion handling skills

Background: The Emoty-Com training is a 16 hours-course based on interactive teaching to increase communication and emotion- handling skills for medical students. The study aimed to describe the Emoty-Com training impact on medical students’ attitudes towards patients’ emotions and to explore the association between students’ empathy, emotional intelligence (EI), attachment style (AS) and at- titudes with post-training performance scores. Methods: The Emoty-Com training was delivered to all second- year students of Medicine and Surgery Schools in Verona and Milan (Italy) Universities. Empathy, AS and EI were assessed at pre- training; attitudes towards emotions in the doctor-patient encounter were assessed at pre-training and post-training; at post-training, a final test evaluating the knowledge acquired during the training was administered. Findings: The Emoty-Com training increased the relevance at- tributed to doctor emotional involvement, at least by male students, and students’ perception of self-efficacy in handling their own emotions during a consultation. Students with higher final test scores were those with less perceived self-efficacy in dealing with patients’ emotions before the training, while students with lower final scores were those who tended to give scarce importance to doctors' emotions in the clinical encounter after the training. Discussion: In contrast with previous literature, the relationship between AS, EI, empathy, and communication skills measured by the final test was not confirmed. Students' acquired knowledge resulted related to their attitude towards emotions, which should be con- sidered in adapting future training to the specific needs of medical students

Lettera ai soci

Il Gruppo Internazionalizzazione dell’Aistarch si è formato, parallelamente ad altri gruppi di lavoro, all’inizio del mese di aprile 2021. Si tratta di un insieme intergenerazionale di studiosi, costituitosi spontaneamente fra i membri dell’Associazione impegnati in attività di didattica e di ricerca in atenei italiani e stranieri, che rappresenta ampia parte del territorio nazionale, da Torino a Palermo e non solo. Il fine è di consolidare i rapporti già attivi con istituzioni americane ed europee – anche con realtà solitamente meno battute, soprattutto nell’est d’Europa – grazie a molteplici collaborazioni, di diversa natura e tipologia, e di crearne altri provando a immaginare progetti condivisi con un numero sempre maggiore di associazioni disciplinari straniere, allargando la rete di contatti e contribuendo anche alla conoscenza di Aistarch in più contesti internazionali. Il gruppo in questi primi mesi ha lavorato all’elaborazione di alcuni progetti, da sviluppare nel tempo, tutti correlati tra loro e che hanno come tema centrale l’insegnamento della Storia dell’architettura. Questo perché riteniamo di grande interesse e attualità un dibattito sulla peculiarità dello studio della disciplina e della figura dello storico dell’architettura, tradizionalmente italiana, oggi quasi in via d’estinzione. Risulta pertanto fondamentale avviare proprio dall’Italia il confronto con ciò che accade all’estero, nelle grandi scuole con diverse tradizioni di studi e con una più netta divisione tra storici dell’architettura e storici dell’arte. Allo stato attuale, mentre una serie di proposte è in fase di studio, due progetti sono già stati definiti