Operational Unit for advanced gynecological oncology: the necessary requirements
General Medicine
Women with gynecological cancers must be treated in hospital centers of excellence, otherwise the risk of being subjected to sub-optimal treatments can significantly result in a negative effect on the outcome. This is confirmed by a recent search of the National Institute of Tumors in Milan which took into account a significant sample of 500 patients treated at the center of Milan after having undergone the first treatment in peripheral hospitals. The analysis of the data gathered in 2002 compared to 1992, revealed that the number of patients accepted with a worsening of the disease due to inadequate cancer treatment received in non-specialized hospitals, had increased of 32%. This finding has prompted The Institute of Cancer in Milan and the Italian Society of Gynecological Oncology to issued a volume entitled "Minimum requirements for the treatment of gynecological malignancies," to define the minimum standards that each university center / hospital should be able to guarantee for the proper treatment of women with gynecological cancers, such as ovary, cervix, and endometrium. The proposed standards, which we hope will be accepted by the Ministry of Health, list: -an independent commission in each hospital to analyze the work done for the cancer cases on the basis of certain criteria (number of new cases, the percentage of complications, recurrences and deaths, waiting times); -the identification of facilities specializing in gynecological oncology -the establishment of a gynecological oncology specialty. The multidisciplinary integration is the key to successful treatment. More specifically, as is the rule in the daily practice in the United States, the clinicians work as a team with the pathologists and researchers through the creation of mixed operational units with the same objectives. The individual specialties no longer create working groups, but rather the common areas of interests bring together professionals from different specialties. These established research units have shown tangible results, in terms of both, clinical care and research. The creation of working groups made up of gynecologists, pathologists, molecular biologists, oncologists and radiation therapists has profoundly changed the protocols for the treatment of gynecological malignancies. Weekly meetings are held to discuss clinical cases, to evaluate the results of ongoing research, and to constantly update keeping up with the international literature. In addition, this approach has led not only to a substantial improvement in the quality of care, but also in the quality of education offered to physicians training in this specialty. The close collaboration between clinical and basic research in the treatment of the patient is the key to get the best results. For example, a structure that does not have a sufficient case volume of at least some sixty cases a year can not be up to the desired level. The success, or the failure, is not conditioned by the doctors, but by the philosophy of the health institution: if a hospital wants to take care of women with gynecological tumors, it must unquestionably create an adequate diagnostic and therapeutic pathway. As demonstrated by a recent Norwegian study, it is clear that the prognosis of patients with cancer of the ovary (one of the most aggressive gynecological cancer) treated at centers with appropriate experience parameters, is definitely much better. The National Health Service should now take notice of this message and go from theory to practice.
Alessandro Bovicelli
*Ricercatore, Dipartimento di Ginecologia e Ostetricia, Università di Bologna
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Women with gynecological cancers must be treated in hospital centers of excellence, otherwise the risk of being subjected to sub-optimal treatments can significantly result in a negative effect on the outcome. This is confirmed by a recent search of the National Institute of Tumors in Milan which took into account a significant sample of 500 patients treated at the center of Milan after having undergone the first treatment in peripheral hospitals. The analysis of the data gathered in 2002 compared to 1992, revealed that the number of patients accepted with a worsening of the disease due to inadequate cancer treatment received in non-specialized hospitals, had increased of 32%. This finding has prompted The Institute of Cancer in Milan and the Italian Society of Gynecological Oncology to issued a volume entitled "Minimum requirements for the treatment of gynecological malignancies," to define the minimum standards that each university center / hospital should be able to guarantee for the proper treatment of women with gynecological cancers, such as ovary, cervix, and endometrium. The proposed standards, which we hope will be accepted by the Ministry of Health, list: -an independent commission in each hospital to analyze the work done for the cancer cases on the basis of certain criteria (number of new cases, the percentage of complications, recurrences and deaths, waiting times); -the identification of facilities specializing in gynecological oncology -the establishment of a gynecological oncology specialty. The multidisciplinary integration is the key to successful treatment. More specifically, as is the rule in the daily practice in the United States, the clinicians work as a team with the pathologists and researchers through the creation of mixed operational units with the same objectives. The individual specialties no longer create working groups, but rather the common areas of interests bring together professionals from different specialties. These established research units have shown tangible results, in terms of both, clinical care and research. The creation of working groups made up of gynecologists, pathologists, molecular biologists, oncologists and radiation therapists has profoundly changed the protocols for the treatment of gynecological malignancies. Weekly meetings are held to discuss clinical cases, to evaluate the results of ongoing research, and to constantly update keeping up with the international literature. In addition, this approach has led not only to a substantial improvement in the quality of care, but also in the quality of education offered to physicians training in this specialty. The close collaboration between clinical and basic research in the treatment of the patient is the key to get the best results. For example, a structure that does not have a sufficient case volume of at least some sixty cases a year can not be up to the desired level. The success, or the failure, is not conditioned by the doctors, but by the philosophy of the health institution: if a hospital wants to take care of women with gynecological tumors, it must unquestionably create an adequate diagnostic and therapeutic pathway. As demonstrated by a recent Norwegian study, it is clear that the prognosis of patients with cancer of the ovary (one of the most aggressive gynecological cancer) treated at centers with appropriate experience parameters, is definitely much better. The National Health Service should now take notice of this message and go from theory to practice. 
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Pregnancy is always a fascinating event in the life of the woman, of the couple, and of the environment around them, becoming an experience that is not only physical and biological, but that also extends to the mental, emotional and intellectual spheres.
Its physiological course can be compromised by preexisting diseases, diagnosed before the pregnancy or occurring during its course.
This is...
Physical activity in patients with diabetes mellitus type 1 and type 2 is an important item in the treatment of both diseases. Diabetic patients should engage in regular physical activity, mostly aerobic. Physical activity should be practiced for at least 3-4 times a week, and for at least 30 to 40 minutes at a time, because it has been shown that the benefit of a single training session lasts...
