One of the priorities of personalized medicine regards the role of early integration of palliative care with cancer-directed treatments, called simultaneous care. This article, written by the Italian Association of Medical Oncology (AIOM) Simultaneous and Continuous Care Task Force, represents the position of Italian medical oncologists about simultaneous care, and is the result of a 2-step project: a Web-based survey among medical oncologists and a consensus conference. We present the opinion of more than 600 oncologists who helped formulate these recommendations. This document covers 4 main aspects of simultaneous care: 1) ethical, cultural, and relational aspects of cancer and implications for patient communication; 2) training of medical oncologists in palliative medicine; 3) research on the integration between cancer treatments and palliative care; and 4) organizational and management models for the realization of simultaneous care. The resulting recommendations highlight the role of skills and competence in palliative care along with implementation of adequate organizational models to accomplish simultaneous care, which is considered a high priority of AIOM in order to grant the best quality of life for cancer patients and their families.
Background: Early integration of palliative care in oncology practice (“simultaneous care”, SC) has been shown to provide better care resulting in improved quality-of-life and also survival. We evaluated the opinions of Italian Association of Medical Oncology (AIOM) members. Patients and methods: A 37-item questionnaire was delivered to 1119 AIOM members. Main areas covered were: social, ethical, relational aspects of disease and communication, training, research, organizational and management models in SC. Three open questions explored the definition of Quality of Life, Medical Oncologist and Palliative Care. Results: Four hundred and forty-nine (40.1%) medical oncologists returned the questionnaires. Forty-nine percent stated they address non-curability when giving a diagnosis of metastatic tumor, and 43% give the information only to patients who clearly ask for it. Fifty-five percent say the main formative activity in palliative medicine came from attending meetings and 90% agree that specific palliative care training should be part of the core curriculum in oncology. Twenty-two percent stated they consulted guidelines for symptom management, 45% relied upon personal experience and 26% make a referral to a palliative care specialist. Seventy-four percent were in favor of more research in palliative medicine. An integration between Units of Oncology and Palliative Care Services early in the course of advanced disease was advocated by 86%. Diverse and multifaceted definitions were given for the concepts of Quality of Life, Palliative Care and Medical Oncologist. Conclusion: SC is felt as an important task, as well as training of medical oncologists in symptom management and research in this field.
Si bien la variable arquitectónica se cuenta entre las menos transitadas al analizar modelos educativos, las interacciones entre arquitectura y pedagogía tienen momentos de notable confluencia. Se aborda aquí una selección de actores, documentos y obras que abonan esta relación en el Cono Sur entre fines de la década de 1920 y 1930, cuando las experiencias modernas en arquitectura y los preceptos de modernidad pedagógica de la Escuela Nueva convergen. Se introducen a partir de fuentes primarias las interferencias de modernidad que supusieron los viajes y publicaciones del pedagogo Adolphe Ferrière y del arquitecto Joan Baptista Subirana con los proyectos escolares de Sánchez, Lagos y De la Torre en Argentina y de Juan Antonio Scasso en Uruguay. Con la hipótesis que la arquitectura se constituye allí en un instrumento pedagógico en sí mismo y con la presunción de la notable vigencia del ideario escolanovistas en la contemporaneidad, resignificando el espacio escolar en función de las nuevas infancias.
Este artículo se inscribe en una línea de trabajo que aborda las interferencias entre arquitectura y pedagogía. Más precisamente, parte de entender la arquitectura escolar en clave moderna en su relación con la pedagogía buscando aquellos casos donde los proyectos y edificios escolares se posicionan como legitimadores o promotores de enunciados pedagógicos. La relación entre innovaciones pedagógicas y arquitectónicas no es directa ni fluida. Sin embargo, las transformaciones en el diseño de la escuela primaria moderna acontecidas en la década de 1930 contribuyen y realimentan en muchas ocasiones la distinción pedagógica entre escuela tradicional y escuela nueva. La seguridad de estar pensando de manera científica, objetiva y universal -ya sea el espacio o cómo enseñar-es compartida por ambas disciplinas, al igual que la subestimación de lo anterior (escuela tradicional-tradición clasicista en arquitectura). La importancia adjudicada al niño, a sus juegos, actividades e intereses conlleva reflexionar sobre el espacio del aula, los lugares de encuentro e interacción, el patio como resultante de una redefinición del concepto de infancia -y no como mero producto disciplinar-y los lugares donde se emplazan las escuelas.El situarse en los treinta radica en que en esta década se verifica una notable atención cuantitativa y cualitativa al proyecto y construcción de edificios escolares. El impacto del conjunto de experiencias modernas en arquitectura centradas en la renovación espacial, tipológica y lingüística de las escuelas primarias se multiplica a través de viajes, exposiciones, congresos y publicaciones especializadas. Muchos de los "modelos", principalmente europeos y norteamericanos, que oficiaron de referencias autorizadas presentaban, legitimaban
Background Metastatic renal cell carcinoma is a “capricious” tumor. Many prognostic factors have been evaluated, treatment is still controversial, and results are not coincident. Methods We reviewed 156 patients with metastatic renal cell carcinoma. Survival from the time of diagnosis was the end point of the study. The influence on survival of age, sex, nephrectomy, disease-free interval, performance status, site and number of metastases was analyzed. Univariate and multivariate analysis were done. Survival according to different therapies was also evaluated. Results In our study, no nephrectomy, a disease-free interval < 24 months, > 2 metastatic sites and a performance status > 2 proved to be risk factors. According to the number of risk factors, 3 groups of patients were identified (low, intermediate and high risk). We observed 3 kinds of responses to treatments: 1) in untreated patients (n = 48), median overall survival was 6 months, and the 24-month survival rate was 8%; 2) in patients treated with hormone therapy and/or chemotherapy (n = 73), median overall survival was 13 months, and the 24-month survival rate was 24%; 3) in patients treated with interferon and/or interleukin-2 (n = 35), median overall survival was 16 months and the 24-month survival rate was 34%. Conclusions Our results are only partially in accordance with those observed by other authors. Risk factors and treatment must be determined in more defined and selected studies.
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