Prevention and the treatment of oral mucositis: the efficacy of sodium bicarbonate vs other agents: a systematic review

INTRODUCTION

Oral mucositis (OM) is a major side effect of cancer therapy, which is associated with significant symptoms, treatment delays and increased costs for the health system. It is an important component of the quality of life of cancer patients and, until now, there has been no gold standard regarding prevention or treatment of this pathology. Notwithstanding the paucity of treatment guidelines (due to limited evidence from high-quality, rigorous studies), sodium bicarbonate (SB) rinses are one of the most used agents for OM management.

OBJECTIVES

A systematic review (2000-2022) was performed in order to compare and examine different agents versus sodium bicarbonate (SB) in preventing or treating OM.

SOURCES

Eleven randomized controlled trials (RCT) were evaluated: four were conducted for the prevention and seven for the management of OM. The risk of bias of RCTs was assessed using the revised Cochrane risk of bias tool for randomized trials.

STUDY SELECTION

According to the RoB2 evaluation for randomized trials, four RCTs were judged to be at a high risk of bias, two were rated as 'problematic', while five were deemed to be a low risk of bias.

CONCLUSIONS

The results revealed that there was no evidence for supporting SB in OM treatment regarding management and prevention.

CLINICAL SIGNIFICANCE

Results showed in this review takes on a strategic importance in the use of SB for OM management or prevention; indiscriminate use of SB could be counterproductive because it causes a sudden pH increase and it delays proper OM pharmacological treatment.

The difficult role of Artificial Intelligence in Medical Liability: to err is not only human

ABSTRACT

The entrance of Artificial Intelligence (AI) as a new actor in the doctor-patient relationship has encouraged important legal and ethi-cal considerations among the experts. On the one hand, there is the request to establish a new and dedicated legal background involving AI and AI-related technologies, while others believe there is no need to add new laws in the attempt to define AI's role in healthcare. The aim of this paper is to analyse the possible role of AI in civil liability in healthcare practice, underlining its limits of autonomy in a field where the attribution of liability cannot be uncertain.

Teaching ethics and professionalism in rehabilitation: an empirical research on active learning with university rehabilitation students

BACKGROUND

Teaching ethics in university courses may benefit from different didactic approaches; nonetheless, it still seems unclear whether ethics teaching can be best offered in stand-alone courses or integrated into other courses, or perhaps both.

OBJECTIVE

We describe the experience derived from a structured teaching activity in the field of medical ethics, conducted during a lesson for the students of a rehabilitation university second-cycle degree course.

METHODS

The participating students were healthcare professionals with different graduate training in rehabilitation. The aim of the lesson was to discuss the essentials of the relationship between patients and rehabilitation healthcare providers, from an inter-professional viewpoint, focused on the principles of trust, mutual respect, power and personal closeness, which are essential components of the therapeutic relationship between patients and physical therapists.

RESULT

Shared moral norms guiding the professional conduct of healthcare professionals are a fundamental characteristic of these professions, promoting the public trust in these professions, tearing down barriers to inter-professional collaboration and communication.

CONCLUSION

The results are remarkable, and there has been very positive feedback from the students concerning the production of the oath and its contents, as well as about the proposed teaching method, resulting in great interest in clinical ethics.

Munchausen Syndrome by Proxy: balancing ethical and clinical challenges for healthcare professionals Ethical consideration in factitious disorders

Munchausen syndrome by proxy is a relatively rare behavioral disorder affecting a child's primary caregiver, typically the mother. Ethical dilemmas that physicians may face in such situations mainly concern the medical options for best protecting the child's welfare, that are important, in clinical pediatric practice, because critical conflicts might arise between health professionals and parents. In such cases, the physician's primary obligation is to protect the children involved, whose family environment may be essential to their wellbeing. Ev- ery ethical choice should be tailored to a given child's story, which should be viewed as a whole, considering the possible consequences for the family balance, and taking the complexity of the emotional and psychological dimensions of children's relationship with their parents into account. Specific protocols, discussion of clinical cases, open communi- cation of feelings will help doctors to deal more effectively with the families involved and ensure that treatment decisions are made in the child's best interest.

Ethical reflections of gender equality and equity in adolescence medicine

Gender differences, in both clinical and research environment, exist also in a particular category of patients, adolescents, who constitute a vulnerable group with respect to healthcare decisions. In clinical context, the main ethical issues that may be identified within gender medicine for adolescent patients are related to the information given to the patient and its parents, the adolescent's capacity of understanding considering his/her maturity, vulnerability and autonomy, the consent to medical treatment in relation to the different possible approaches to their different efficacy and possible side effects. Also, with regard to the research context, ethical issues may arise from the participation of female minors in clinical trials. Ethical concerns may also arise in the field of resource allocation in health policies, such as the equitable distribution and access to resources, considering the young age of the subjects involved. A bioethical reflection, which takes into account not only the differences biologically and epidemiologically relevant, but also the main determinants of health in adolescence, might find a role in structured education for diversity and gender equity. Given the magnitude of the problem, to encourage the pursuit of gender equity in health and, in some situations, also to promote the full recognition of the right to health of women are some of the most effective and direct ways to reduce inequalities and to ensure a rational and efficient use of available resources, including through a bioethical reflection on the topic. The Authors show the necessity to differentiate the various aspects of gender differences in adolescence medicine, providing arguments in support of the fact that interventions for health prevention and promotion should be modulated in relation to the gender of the recipients, emphasizing the most important aspects for each group of individuals. This approach could implement personalized medicine, even and especially considering gender differences, benefiting from the contribution that a bioethical reflection can provide.

Ethical governance in biobanks linked to electronic health records

In the last years an alternative to traditional research projects conducted with patients has emerged: it is represented by the pairing of different type of disease biobanks specimens with Electronic Health Records (EHRs). Even if informed consent remains one of the most contested issues of biobank policy, other ethical challenges still require careful attention, given that additional issues are related to the use of EHRs. In this new way of doing research harmonization of governance is essential in practice, with the aim to make the most use of resources at our disposal, and sharing of samples and data among researchers under common policies regulating the distribution and the use. A biobank-specific Ethics Committee could be seen as a new and type of Ethics Committee, that we suggest to be applied to each biobank, with possible different functions. In particular, considering the possible use of electronic health record data linked to biological specimens in biobanking research, this specific Ethics Committee could draft best practice and ethical guidelines for the utilisation of the EHRs as a tool for genetic research, addressing concerns on accessibility, return of results and privacy and help to educate patients and healthcare providers.

Paternity testing requested by private parties in Italy: some ethical considerations

In Italy, judicial and extrajudicial requests for paternity testing have increased in recent years. A retrospective analysis of such private extrajudicial requests received by the legal medicine unit of the Department of Environmental Medicine and Public Health of Padua University was conducted to identify problem areas most helpful in determining whether to accept private parties' requests for paternity testing. Such testing is most delicate when a presumptive father may be seeking to disown paternity and when testing is wanted without the consent of a member of the mother-child-father triangle. Tests that could establish paternity where none has been recognised are less problematic, as the child will not lose out. Legal and ethical-deontological aspects of consent, of the protection of minors and of children's and parents' need for follow-up interviews to deal with the outcome of such testing are carefully considered by the Padua University team when deciding whether to accept a request for testing. It is argued that because such issues are not dealt with by mail-order laboratories, the use of such services is inappropriate.