2001: Intervista a Perry Klass pediatra e responsabile del progetto Reach out...Salvo Fedele
Questa intervista è stata fatta nel 2000 e pubblicata nel 2001. Forse è ancora utile la sua lettura. Il rapporto con Perry Klass ha permesso la nascita di Nati per leggere in Italia. Dello sviluppo successivo non amo parlare. Perché la tiro fuori adesso (giugno 2014)? Per rispondere al più bravo provocatore del mondo editoriale italiano (Luca De Fiore) e a un suo tweet di questi giorni
2001: Intervista a Perry Klass pediatra e responsabile del progetto Reach out...Salvo Fedele
Questa intervista è stata fatta nel 2000 e pubblicata nel 2001. Forse è ancora utile la sua lettura. Il rapporto con Perry Klass ha permesso la nascita di Nati per leggere in Italia. Dello sviluppo successivo non amo parlare. Perché la tiro fuori adesso (giugno 2014)? Per rispondere al più bravo provocatore del mondo editoriale italiano (Luca De Fiore) e a un suo tweet di questi giorni
2004 Prescrire: a drug company (MSD) sues an ISDB member bulletin, and loses...Salvo Fedele
MSD contro ISDB: Lo strano caso del Dr Donzelli e Mr MSD ha un precedente in Spagna raccontato in questo articolo di PRESCRIRE INTERNATIONAL - JUNE 2004 - VOLUME 13 N° 71- Pag 117
Lo strano caso del dottor Donzelli e del Signor MSDSalvo Fedele
Tempi davvero duri per l'industria farmaceutica
Questo può giustificare forse che un medico che esprime le sue documentate convinzioni in un bollettino di una ASL italiana possa essere invitato da un colosso come la MSD a ritrattare tutto pena imputargli il danno di 1,3 Milioni di euro?
Grazie al cielo questa volta qualcuno si fa sentire: la presa di posizione dei direttori delle riviste italiane che aderiscono all'ISDB
2004 Prescrire: a drug company (MSD) sues an ISDB member bulletin, and loses...Salvo Fedele
MSD contro ISDB: Lo strano caso del Dr Donzelli e Mr MSD ha un precedente in Spagna raccontato in questo articolo di PRESCRIRE INTERNATIONAL - JUNE 2004 - VOLUME 13 N° 71- Pag 117
Lo strano caso del dottor Donzelli e del Signor MSDSalvo Fedele
Tempi davvero duri per l'industria farmaceutica
Questo può giustificare forse che un medico che esprime le sue documentate convinzioni in un bollettino di una ASL italiana possa essere invitato da un colosso come la MSD a ritrattare tutto pena imputargli il danno di 1,3 Milioni di euro?
Grazie al cielo questa volta qualcuno si fa sentire: la presa di posizione dei direttori delle riviste italiane che aderiscono all'ISDB
Devo a Pierluigi Battista e alla sua stroncatura di oggi sul Corriera della Sera http://bit.ly/111OSzV la lettura di questo documento
P. Battista è infatti uno dei miei punti di riferimento. Una sua stroncatura vale oro e anche questa volta non mi ha deluso.
Il documento di Barca merita infatti molta attenzione.
Provate a leggerlo, mi farebbe piacere discuterne con gli amici.
Anteprima slideshare della traduzione italiana del libro "Testing Treatments: Better Research for Better Healthcare" Per il download usa il link del sito ufficiale curato dagli autori:
http://www.testingtreatments.org/new-edition/
Testing Treatments: Better Research for Better HealthcareSalvo Fedele
Mi sono accorto con colpevole ritardo che da circa un mese è uscita una nuova Edizione di "Testing Treatments: Better Research for Better Healthcare"
Il miglior libro divulgativo sulla Evidence Based Medicine per quanto attiene la terapia (purtroppo nessun libro analogo è mai stato scritto su altri campi di interesse dell'EBM, per esempio la diagnosi).
Il libro è stato generosamente messo a disposizione da autori ed editore gratuitamente sul web dal link che metto in evidenza alla fine del post.
Dallo stesso link è disponibile (e sempre gratuitamente) la traduzione italiana della prima edizione del libro (2007) Edizione: Il Pensiero Scientifico Editore (che evidentemente ha dato il consenso per questa divulgazione e che merita i ringraziamenti di tutti).
E presto sarà disponibile una versione interattiva del libro: http://bit.ly/tr1eC1
Il libro è stato tradotto in molte lingue ed ha avuto un enorme successo nei paesi anglosassoni, mentre la sua diffusione in Italia è stata davvero modesta.
Tradurre questo libro è una delle poche operazioni editoriali di EBM che ha ancora un senso: il testo infatti ha come interlocutori privilegiati i cittadini (non gli operatori sanitari) ma è una lettura davvero utile anche per tutti i medici italiani.
La versione cartacea direttamente sul sito dell'editore http://bit.ly/s2UXJg costa poco più della versione Kindle disponibile su Amazon.it: http://bit.ly/vOAMAx
(Ma anche se non volete compare la versione cartacea fate una visita alla pagina di questo editore che ricorda le ragioni della burrascosa relazione tra molti e pregevoli piccoli editori e il gigante della distribuzione mondiale di libri: http://bit.ly/sMfIC4 )
Il libro ha una quantità di pregi incredibili:
Da sola la prefazione curata da Ben Goldrace (l'autore di Bad Science) merita una segnalazione a parte: non perdete neppure una riga!
http://bit.ly/uvOnPy
Tutti gli altri pregi cercherò di analizzarli punto per punto in uno storify interamente dedicato a questo libro e reperibile da questo link http://bit.ly/w1uUIX
che includerò a lavoro ultimato sui sites WEBM.org http://webm.org/sites
Le 5 cose da sapere per usare facebook in una comunità di praticaSalvo Fedele
Questo articolo è stato pubblicato su "Va pensiero" n° 476 del 26 Aprile 2011 a questo URL: http://bit.ly/vbDwgY
"Va Pensiero" è la newsletter del Pensiero Scientifico Editore
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
#doctorbridge So... is this my country? Un paese cosi?
1. [ twitter: @salvo_fedele] [g+: plus.google.com/+salvofedele] [M: medium.com/@salvo_fedele]
So… is this my country?
Un paese così? #doctorbridge by salvo fedele
2. April 4, 2014
This is the webpage of the Medical Association of Palermo that announces the start of a CME course:
a Bridge Card Play Course for doctors.The official link is no longer active since April 18, 2014.
3. http://medium.com/comunita-pratica/717c10bf98dc
✤ On this webpage (short link: http://bit.ly/1tsPZtM) you will find, however, the
entire reconstruction of the story #doctorbridge and the playback of all
official documentation, the reactions on social networks and media until the
statement of the President of the Medical Association of Palermo that
announces the interruption of the course and the withdrawal of CME
credits to participants.
4. ✤ #doctorbridge is a story that looks like a prank but it isn’t.
Indeed the #doctorbridge course assigns 35.8 CME credits to the
participants. !
✤ Every italian MD must obtain 50 credits every year to continue to practice.
5. ✤ How is it that the italian CME system of national accreditation would allow
an organization to give 35 of the 50 annual credits only looking doctors who
play with Bridge Cards?
6. ✤ Unlike in other countries, the Italian CME system does not accredit
individual training projects, but accredits CME providers in exchange for a
large annual fee. !
✤ The Italian NHS does not invest in the training of doctors, but has found a
way to make money from CME. It sounds like the italian CME system is not
interested in the quality of the projects, but only to collect taxes from this
process.
7. ✤ The CME providers apply an evaluation grid that assigns a different score
depending on whether the training activities are carried out. If the course is
carried out with traditional lessons the score will be low. If the course
involves many interactive activities the score will be high. !
✤ In this case the provider has evidently given the high number of hours
dedicated to play Card Bridge as interactive activities like i.e role-playing or
problem-solving activities
8. ✤ The creator of this CME system that gives all this freedom of choice to the
local organization (CME providers) is one of the leading ministers of the
past Monti government: Mr. Balduzzi. !
✤ Before being Minister of Health, Mr Balduzzi was president of Agenas, the
agency that controls the CME commission, and he has a profound
knowledge of the Italian system that sees the proliferation of CME
providers who have little desire to experiment innovative forms of CME.
However these organizations know well how to use the CME system to
increase their power.
9. ✤ The Balduzzi system makes happy all the principal actors of the process.
Not only the national CME commission and the Agenas which collects a
good part of CME revenues but also the CME providers that increase their
power.!
✤ Why do doctors accept this typical Italian affair? Why agree to pay extra
fees in order to enrich CME providers and members of the CME national
commission in exchange for educational events of very low quality?
10. ✤ In stark contrast to the European legislation, for example, no doctor can ask
directly to the Italian CME national committee to have a CME score for
training activities conducted abroad. !
✤ To maintain the power of CME provider no doctor can ask CME credits for
a training activity directly to the national commission. Everything has to go
through local providers.
11. ✤ There is nothing that remotely resembles the portfolio of activities of the UK
NHS. Credits online can be recorded only if the CME provider is italian.
Our national system does not accredit UpToDate, the BMJ or the NEJM, but
a Bridge Card Play “course” can earn 35.8 CME credits. !
✤ Can you please help to describe this situation with only a word or a
hashtag? #doctorbridge? Do you agree?
12. the “scientific” background of #doctorbridge
✤ “The importance of the Bridge Card Play in the process of personal growth is
scientifically recognized so much so that in the 80s the President of the Republic of
China, Deng Xiaoping, introduced the study of Bridge Card Play in Chinese
universities”!
✤ “Mr Ninni De Santis one of the leading authorities in the field of education in
Sicily had helped the organization to adapt the course to the CME system”
13.
14. ✤ Indeed the course of Palermo was not the first course of Bridge Card Play in
the Italian CME system. Other courses were held already in Bergamo in
May 2013 and in January 2014, when the news was reported by the press.
18. ✤ Mr Calabresi, the reporter of the TV Show “le iene” asks Medical Doctors
what they are doing. !
✤ Mr Calabresi, the next day, asks the president of the organization a good
reason for what is happened. !
✤ I’m sorry, but I have no time to translate their words, but you are very lucky
to not understand what they say.
19. ✤ What you can see, the shooting and the facial expressions of the
participants, the hands of the president on the TV camera are a useful
example of the embarrassing situation in which it is the italian CME system.
Here the link to the video
20. 01
On April 18, 2014 it is
published this statement.
✤ What can I say more? A belated admission
of error can be felt in the words of the
president, but who is really the responsible
of damage of the image to the doctors of
the city of Palermo for this “accident”?!
✤ Blame the ambush of Journalists of “Le
Iene”?
21. ✤ Greater sensitivity of the leader of the CME provider, and a more careful
use of the words from who allowed himself to interviews during exercise of
“mind training” would make a service a little more dignified to our
profession.
22. April 22, 2014
What about #doctorbridge?
Sorry for this final statement but perhaps this is the prevalent opinion of italian MD about our CME system
I've got a
better idea.
How about
you mind
your own
fucking
business?
23. 01
Thanks for your
attention
Thanks to every italian MD that posted something about
#doctorbridge. Thanks to my friends of WEBM.org. Thanks
to Nino Cartabellotta and to the Facebook Group “Salviamo
il nostro SSN”. And… Thanks to Mr Calabresi “la iena”.