[The concept of medical professionalism of medical students: basic assessment for a cohort study]. / L'idea di professionalità medica degli studenti di Medicina: rilevazione di base per uno studio di coorte.

AIMS: Education for professionalism is an international challenge. This paper reports the results of the assessment performed on two cohorts of first year students of Medicine, relating to attitudes toward three basic components of the construct of professionalism such as sensitivity to sociocultural differences, empathetic behaviors and professional skills in relationship to self, colleagues, patients and society. These components are analyzed with respect to their importance in the process of healthcare. MATERIALS AND METHODS: The assessment of the three components was performed through the validated Italian versions of three instruments: the Socio-Cultural Attitudes in Medicine Inventory, the Jefferson Scale of Empathy and the Nijmegen Professionalism Scale, administered for two consecutive years to all the students of the C curriculum in Medicine of Sapienza University of Rome (Italy). RESULTS: On a total of 196 students, the responses showed no significant differences related to gender or type of high school for the three examined components. A trend is present toward a familiar influence when one of the parents is a doctor and an idea of professionalism more technical-oriented than addressed to communication and empathy. CONCLUSIONS: The follow up study of these cohorts of students will provide important information for further educational design.

[Guidelines for the routine assessment of respiratory surgical risk: thoracic radiography]. / Linee guida per la valutazione routinaria del rischio chirurgico respiratorio: la radiografia del torace.

Through the three years between June 1995 and June 1998 the authors applied an evaluation schedule for the respiratory surgical risk to all the patients undergoing general surgery. Chest X-ray was included in this schedule as a first-level test and it was performed systematically on all the patients. The purpose of the study was to verify the effectiveness of chest X-ray as a routine examination of the respiratory performance, evaluating its predictive value on 1715 cases. The routine employment of this preoperative test on patients resulting risk-free at an accurate clinical anamnestic examination doesn't seem to be justified, basing on the preliminary results achieved. Therefore, chest X-ray should be considered a second-level test, to be performed on the basis of a precise clinical query only. This way a significant health-care cost reduction could be achieved, without affecting the quality of patient's management.

SMART: a system supporting medical activities in real-time.

This paper describes the system SMART whose goal is real-time assistance to physicians who execute diagnostic or therapeutic protocols in a clinical context. SMART is able to retrieve a protocol from its knowledge base and to monitor its execution step by step for a single patient. Different protocols for different patients can be followed at the same time in a health care structure. The prototype realized supports the execution of protocols for evaluating surgical risks. It has been implemented according to the specifications given by the 4th Surgical Clinic of "Policlinico Umberto I" and reflects the activities actually performed in that hospital. However, the protocol model defined is general purpose and we envisage an easy application to other contexts and therefore to the informatization of other protocols.

[Fournier's syndrome: diagnostic and therapeutic assessment]. / La sindrome di Fournier: inquadramento diagnostico e terapeutico.

Fournier's syndrome is a disorder involving perineum and scrotum caused by invasive anorectal infection. Aerobic and anaerobic bacteraemia can lead to septic toxicity. Hence the importance of the multidisciplinary treatment and urgent surgical procedures including drainage and necrotic tissue removal is stressed. A case of Fournier's syndrome is reported.

Usefulness of preoperative CEA levels in the assessment of colorectal cancer patient stage.

In order to demonstrate a prognostic value of preoperative CEA levels, we have tried to define a correlation between CEA and histologic stage of tumor in 124 patients with colorectal carcinoma. CEA concentration has been evaluated by radioimmunologic assay and the histologic stage following Dukes' classification. The results show a 25.0% positivity rate for patients in stage A, 48.2% for stage B, 61.1% for stage C, and 85.7% for stage D. The mean CEA values are 7.8 ng/ml in the first group, 30.3 ng/ml in the second, 58.1 ng/ml in the third, and 134.3 ng/ml in the last group. Furthermore, we have tried to relate the histopathologic grade of the tumor (G) with CEA levels in 54 patients of the 124. We conclude that preoperative CEA has a prognostic value, and it is useful in the staging of colorectal cancer patients. A low concentration indicates an early stage of the tumor, while a high concentration indicates a wide spread of disease; on the other hand, there are not significant correlations with cancer grading.