Elena Toader

Extra-intestinal malignancies in inflammatory bowel disease: Results of the 3rd ECCO Pathogenesis Scientific Workshop (III)

The incidence of lymphoproliferative disorders (LD) is increasing in developed countries. Patients with inflammatory bowel disease (IBD) exposed to thiopurines are at additional risk of three specific forms of LD: Epstein-Barr-Virus-related post-transplant like LD, hepato-splenic T-cell lymphoma and post-mononucleosis lymphoproliferation. The risk of the two latter forms of LD can be reduced when considering specific immunosuppressive strategies in young males. It is still unclear whether the risk of uterine cervix abnormalities is increased in IBD women, irrespective of the use of immunosuppressants. Given the excess risk demonstrated in various other contexts of immunosuppression, it is currently recommended that all women with IBD, particularly those receiving immunosuppressants, strictly adhere to a screening program of cervical surveillance and undergo vaccination against HPV, when appropriate. Patients with IBD receiving immunosuppressants are at increased risk of skin cancers. The risk of non-melanoma skin cancer is notably increased in patients receiving thiopurines. Recent data suggest that the risk of melanoma is mildly increased in patients exposed to anti-TNF therapy. All IBD patients should adhere to a program of sun protection and dermatological surveillance, whose details should take into account the other non-IBD-related risk factors.

Clinical simulation - Complementary Study Strategy in Medical Technological Education

Against the background of an era when the medical act is getting ever more technical, the accumulation and application of knowledge in a true-to-life medical practice is an active method of professional training. Medical education must rely on a state-of-the-art technical program, focused on simulations in clinical applications contributing considerably to the growth of practical performances and ethical responsibility. The absence of risk for the patient gives the possibility of a stress-free professional approach, especially in difficult or crisis situations. The possibility of reproducing and repeating rare and complex circumstances and the possibility of interrupting a procedure for theoretical explanations are only few of the advantages of standardizing the medical clinical education. To conclude, simulation is a teaching strategy with impact on competency and on patient care.

Clinical Simulation - Efficacy and Tendency in Medical Technological Education

The development of technology and using it on a large scale of medical devices implictes also legal, and social problems. The orientation of practical activities towards clinical simulation is specific to medical training, assuring a greater particularization in the training of the medical staff, contributing in a significant manner to the growth of practical performances and ethical responsibility. By reproduing a realistic medium, simulation does not substitutes clinical experience but completes it, assures the patient a safety and a better preparation for the medical staff.

Application of biomedical technologies - issues in modern bioethics

The substantial increase of the medical needs in society triggered the development of various medical domains which generated a wide field for the applicability of biomedical technologies, and thus facilitated new perspectives in the worldwide management of important health issues. Biomedical technologies are a useful segment of contemporary medicine and an omnipresent component of modern society, while they also provide enough reasons in support of the assertion that their implementation in current health care should not be an exception. However, scientific progress maintained by application of biomedical technologies in research, treatment and prevention is challenged by several ethical and moral issues. Therefore, within the framework of ethical discussions regarding the impact of biomedical technologies, the emphasis placed on the moral qualities of technological interventions is equivalent with the interest to evaluate quantifiable medical consequencest.

Ethical values of the medical education

This paper aims to approach from the ethical perspective the relationship between medical education of healthcare services providers and globalization. Starting from the argument that the approach from the ethical perspective of medical education within the context of globalization allows for a better understanding of the requirements of contemporary medical act, the main issues refer to the ethical needs of medical profession worldwide, the ethical aspects of medical education and to the extent to which medical education corresponds to the contemporary level of globalization.

Mobile phone interventions in the healthcare of chronic diseases

Chronic diseases are a major issue for healthcare both by the alarming increase of the number of new cases but also from the point of view of the negative consequences of prognosis and quality of life. Available treatments, although effective for most chronic diseases cannot guarantee the decrease of complications, as long as the best healthcare will be provided only by specialized centers. In the last decades, the integration of IT instruments at every level of healthcare reconfigured significantly the manner in which the care is offered and can ensure valuable and profitable remote healthcare far from the hospital. Successfully explored in several states, the interventions mobile-health confirmed through various software and applications that the integration of mobile technology in healthcare may be a viable manner to complete and improve the current strategies for the efficient management of chronic diseases. This paper aims to review the current state of art in a common field for the evolution of medicine, namely healthcare systems and mobile-health. For the presentation of the most important aspects that mobile-health entails in the management of chronic diseases we selected liver cirrhosis.

Software applications integrated in the management of the patient with chronic liver disease

The focal point in the debate on the management of the patient with chronic liver disease is the healthcare system and the health care services, with an accent on the health care provided at home, which can be discussed only when there is a connection integrated with the medical assistance, providing useful information. This paper discusses in theoretical synthesis (definitions, terms, classification), accompanied by empirical evidence, matters regarding the chronic diseases, followed by comments on the integration of the software applications in the management of the patient with chronic liver disease and the ethical concerns it involves. We believe that all the activities implicated illustrate the complexity of the management of the patient with a chronic disease, which concentrates on the minimization of the probability for complications and strives to offer a quality of life as best as possible.

Technological interventions in medicine - Ethic considerations and guidelines for the medical practice

The development and amplitude the advanced medical technologies knew in the last decades were determined by the issues that public healthcare required from medicine and also by the discoveries recorded in the medical and technological field. It is well known that the extensive usage of the medical devices generated huge benefits, translated through gained time, access to effective therapy and improvement in the quality of life. The diagnosis in medicine is almost exclusively technical, established with the help of the medical devices, their performance facilitating the comprehension of the disease as a pathologic phenomenon. Moreover, the implementation of the medical devices in the medical practice brought a significant contribution to the development of the interventional techniques, providing the possibility to heal patients in critical situations or with increased surgery risk and contributing to an improvement in the quality of life. The impact of medical technology in contemporary medicine and the ethical dimension of the debate on the priorities for the usage of these technologies in the medical practice require a wider approach on the advanced medical technology. This paper focuses on the manner in which the ethical analysis should be applied in the evaluation of advanced medical technology, even if the current trend favors a global approach on the evaluation of technology. At the basis of this discussion we intend to formulate arguments in support of the analogy between the opinions of representation of the technologic applications, gathered from the medical practice (medical staff and patients) and the medical technology (in all its instances), with the purpose to draw ethical guidelines for the technical research and development activities and for the implementation procedures in various domains of the medical practice (multi-professional and multidisciplinary).