INTERNAL MEDICINE III AND COMMUNITY MEDICINE
Academic year and teacher
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- Versione italiana
- Academic year
- 2022/2023
- Teacher
- STEFANO VOLPATO
- Credits
- 6
- Didactic period
- Primo Semestre
Training objectives
- The integrated teaching of Internal Medicine III and Medicine of the Territory includes the modules of:
Palliative care
Geriatrics
General and Applied Hygiene (Epidemiology)
Territorial medicine
Medical statistics
The teaching of the integrated course aims to:
- provide theoretical and practical knowledge of the physiopathology, clinic and therapeutic approach of the main geriatric pathologies and syndromes of the elderly;
- provide theoretical and practical knowledge of the clinical and diagnostic approach to the elderly patient with particular reference to multidimensional geriatric evaluation;
- illustrate the differences related to gender in terms of demography and age-related physiopathological modifications to understand their relevance on the aging process and as determinants of the quality of life of the elderly person;
- provide knowledge of the general principles of the organization and structure of the national health system, with particular regard to the organization and functioning of the Territorial Health Authorities and the Department of Primary Care;
- illustrate the function of territorial care with particular reference to the continuity of care between the different places of care and the continuity of care between the hospital and the territory;
- Illustrate the role and duties of the general practitioner and pediatrician of free choice, within the national health service;
- provide intermediate knowledge of epidemiology and biostatistics for research and advanced interpretation of scientific articles and for setting up observational databases and clinical trials;
- to provide basic knowledge on the objectives and goals of palliative care; illustrate the complex health needs of the patient and the family nucleus of patients with non-treatable pathologies; illustrate the ethical and medico-legal implications of palliative care
At the end of the course, students should be able to:
In terms of knowledge:
- know the main pathophysiological mechanisms of the aging process, the main geriatric syndromes, the main clinical and social peculiarities of the geriatric patient, the geriatric methodological approach (multidimensional assessment), the concept of continuity of care;
- know the organization of local health authorities and the primary care department; - know the role and duties of the general practitioner and pediatrician of free choice in territorial assistance.
- understand the importance of the epidemiological method for research and health organization;
- interpret the statistical measures of intermediate complexity most used in the clinical-diagnostic field;
- understand the multiple implications deriving from the use of different biostatistical methodologies.
- acquire the ability to interpret the main statistical methodologies of multivariate analysis, for the identification of risk/protection factors, taking into account the techniques of stratification (for example by sex/gender) and standardization.
- to learn the definition and the fundamental principles of palliative care (quality of life, early palliative care and end-of-life care);
- to identify the complex palliative care needs of patients with oncological and non-oncological pathologies;
- recognize the relational and communicative needs of the patient and the family;
- to recognize the pain, the symptoms and the most frequent conditions in the patient with incurable disease;
- understand the bioethical implications related to the field of palliative care.
At the end of the course, students should be able to:
In terms of skills:
- Correctly frame the main geriatric syndromes;
- perform and interpret a basic geriatric multidimensional assessment;
- recognize the expressed and unexpressed needs of the geriatric patient by planning an individualized care plan;
- make appropriate use of the different services and care settings of the Department of primary care;
- read and interpret the advanced results of a scientific study;
- set up a data collection and development of a database for a scientific study;
- identify the semiological signs of the incurable patient;
- apply the assessment scales of specific needs for palliative care;
- recognize the psychological, social, existential and spiritual needs of the patient and the family, as well as the possible psychopathological frameworks;
- recognize the different attitudes and emotional responses of the patient with incurable disease, with respect to dying, death, mourning;
-identify the factors that promote empathic and personalized communication with the patient and/or her family. Prerequisites
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Modulo: 30736 - GERIATRIA
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Passing the exam of Internal medicine II and medical therapy
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Modulo: 33775 - STATISTICA MEDICA
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Adequate basics of mathematics and computer science
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Modulo: 43725 - MEDICINA DEL TERRITORIO
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Passing the exam of Internal medicine II and medical therapy
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Modulo: 46920 - IGIENE GENERALE E APPLICATA (EPIDEMIOLOGIA)
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Knowledge provided by the biological and medical disciplines foreseen in the previous years of the course
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Modulo: 65382 - CURE PALLIATIVE
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Internal Medicine II exam passed and medical therapy Course programme
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Modulo: 30736 - GERIATRIA
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Introduction to geriatrics care
Demography of aging
Biology of aging
Multimorbidity
Comprehensive geriatric assessment
Frailty syndrome
Physical disability and functional assessment
Dementia in older persons
Delirium.
Falls and hip fracture
Bed-rest syndorme
Malnutrion and dehydratation
Osteoporosis and Sarcopenia.
Pharmacology in older patients: drugs interactions and adverse drugs events
All topics will be analyzed according to gender difference to encourage a personalized clinical approach focused on differences and specific characteristics of the single patient.
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Modulo: 33775 - STATISTICA MEDICA
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MEDICAL STATISTICS:
Diagnostic tests, screening programs, and related measures of efficacy and validity (advanced).
Concepts of statistical inference (advanced), variables, main statistical tests.
Problems of the statistical methodology used in scientific studies, critical reading and interpretation of the measures and of the tests used.
95% confidence intervals, statistical inference, and probability (advanced concepts)
Recall of the main epidemiological biases and their effects of analyses
Basic concepts of multivariate analysis
Methodology of database creation, and of synthesis and presentation of results (tables).
All topics will be analyzed according to gender difference to encourage a personalized clinical approach focused on differences and specific characteristics of the single patient
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Modulo: 43725 - MEDICINA DEL TERRITORIO
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General characteristics of the Italian National Health Care System
Organization and management of the national and regional health care system
Organization and management of the primary care department
Organization and function of the geriatric care setting
Role and function of the primary care physician
All topics will be analyzed according to gender difference to encourage a personalized clinical approach focused on differences and specific characteristics of the single patient
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Modulo: 46920 - IGIENE GENERALE E APPLICATA (EPIDEMIOLOGIA)
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GENERAL AND APPLIED HYGIENE (EPIDEMIOLOGY):
Basic concepts on epidemiological methodology (recall), study designs, bibliographic research, main epidemiological measures.
General and advanced concepts on the interpretation of studies, with specific examples taken from the preventive medicine field.
Searching for the scientific evidence. Importance of the epidemiological approach for research and healthcare management.
Evidence-based medicine and distortion of the results due to conflicts of interest, and discussion of some concrete cases taken from the scientific literature.
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Modulo: 65382 - CURE PALLIATIVE
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PALLIATIVE CARE
Palliative care and responses to the needs of patients with oncological and non-oncological pathologies
The improvement of the quality of life in chronic pathologies: meaning and holistic approach
Communication and relationship in palliative care
Ethical issues with the incurable patient and his family
Practical activities
Practical activities at the Ferrara hospice and/or acute geriatrics department.
Guided tour of the facility and/or individual or group coaching
Presentation and discussion of complex clinical cases addressing the following topics:
Pharmacological treatment of severe symptom
Use of outcome assessment scales
Refractory symptoms and palliative sedation
Difficult communication with patient and family
Psychological, existential and spiritual needs. Death and mourning
Informed consent and advance care planning
Integrated seminar activity on the topics:
-Psychological, existential and spiritual needs. Death and mourning
- Palliative care and responses to the needs of patients with oncological and non-oncological pathologies
All topics will be treated and developed from the point of view of gender differences in order to encourage the student's development of a personalized clinical approach to the specificities and peculiarities of the individual patient. Didactic methods
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Modulo: 30736 - GERIATRIA
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The module will be based of traditional classroom-taught lessons.. The lectures will be organized with real or virtual clinical cases, when appropriate according to the lecture topic, integrated by formal exposition and explanation of physiopatological, clinical and therapeutic issues related to the clinical case presented. Furthermore, there will be dedicated hours of teaching on the moodle certification platform for more detailed study of topics already addressed in class, including clinical cases presentation. Multiple choice tests will be embedded in the clinical case presentation. Correct answer to the question will be required to proceed in the clinical case presentation.
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Modulo: 33775 - STATISTICA MEDICA
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Lectures.
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Modulo: 43725 - MEDICINA DEL TERRITORIO
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The module will be based of traditional classroom-taught lessons.
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Modulo: 46920 - IGIENE GENERALE E APPLICATA (EPIDEMIOLOGIA)
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Frontal lectures.
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Modulo: 65382 - CURE PALLIATIVE
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Frontal lessons (with seminar activities) in presence with clinical cases, simulations and teaching material provided on Classroom Learning assessment procedures
- The learning verification will be carried out by a written exam consisting in 62 questions for a total duration of 75 minutes. The questions will be formulated with multiple choice questions (4 or 5 options for each question) relating to all the educational objectives of the course. The number of questions for each class of content will be calibrated to the number of CFUs.
Each question will have the same weight. Answers will be awarded 0.5 points for each correct answer, 0 points for each missing or incorrect answer.
The exam mark is assigned in a scale out of thirty rounding the fractions of the vote. The minimum score to pass the exam is 18, while the maximum mark, 30 cum laude, will be attributed to those who pass the score of 30. Reference texts
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Modulo: 30736 - GERIATRIA
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R. Antonelli Incalzi: Manuale di Geriatria, EDRA Edizioni
G. Zuliani S. Volpato: Lezioni di Geriatria e Gerontologia. Universitas Studiorum
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Modulo: 33775 - STATISTICA MEDICA
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HYGIENE - MEDICAL STATISTICS
Manzoli L, Villari P, Boccia A. Epidemiologia e Management in Sanità. Elementi di Metodologia (2° Ed.). Edi-Ermes, 2015.
Material provided by the teacher.
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Modulo: 43725 - MEDICINA DEL TERRITORIO
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CURE PRIMARIE E SERVIZI TERRITORIALI: Esperienze nazionali e internazionali
Gavino Macciocco
Carrocci Faber
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Modulo: 46920 - IGIENE GENERALE E APPLICATA (EPIDEMIOLOGIA)
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HYGIENE - MEDICAL STATISTICS
Manzoli L, Villari P, Boccia A. Epidemiologia e Management in Sanità. Elementi di Metodologia (2° Ed.). Edi-Ermes, 2015.
Slides other materials provided by the teacher
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Modulo: 65382 - CURE PALLIATIVE
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PALLIATIVE CARE
Turriziani A, Zaninetta G. Il mondo delle cure palliative. Società Editrice Esculapio
