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E A Moja

Publications and source records attributed to E A Moja.

At least 19 recordsLinked to original sources
PubMed2006

"All the rest is normal". A pilot study on the communication between physician and patient in prenatal diagnosis.

The aim of the study was to verify in the context of prenatal diagnosis if the communicative style in consultations is modified in relation to the seriousness of the diagnosis. Videoed consultations after executing amniocentesis and ultra-sound scanning of II level were included in the study with the consent of participants. Only visits with Italian speaking couples without psychiatric problems were analyzed for the study. Selected visits were grouped into "low" (L, minor anomalies) and "high" (H, serious anomalies) visits. A modified version of the RIAS tailored for the specific context was used in the analysis. 27 visits, respectively 13 H and 14 L, were studied. Analysis of the communicative structure of the consultations did not show significant differences between the two groups. The communication during the consultation seems to be mostly influenced by a highly disease-centered model that is not dependent on the content of the consultation itself. Only emotional exchanges showed a marginally significant decrease in the H visits (t = 1.995, p = 0.057), suggesting the probable difficulty of the disease-centered model to manage emotional items during a highly dramatic consultation. Due to the exploratory nature of the study, further research is needed to test the preliminary results.

Amniocentesis↗
PubMed2004

Stories from doctors of patients with pain. A qualitative research on the physicians' perspective.

GOAL OF WORK: The aim of this study was to explore the physicians' internal representation of the doctor-patient relationship in the dramatic field of the patient with pain. METHODS: Using an open narrative format, 151 physicians were asked to "Tell us about an episode during your professional experience in which you found yourself in difficulty whilst confronting a patient who was in pain". The narrations were examined in accordance with a clinical-interpretive method. MAIN RESULTS: Three "perspectives of observation" were identified, namely: the biological perspective, the professional perspective, and the personal perspective. The biological perspective is about the biological model and the "depersonalization" of pain. In the professional perspective, the narrative concerns the patient as a "person" and the reattribution of the pain to the suffering person. The personal perspective is about the emotional-relational explosion within the meeting between the doctor as human being and the patient as human being. Most of the narrations did not strictly connect to one or another of the perspectives, but each story seemed a journey without peace back and forth among the perspectives. CONCLUSIONS: The professional perspective seemed to be the only place in which physicians could "stop", a space not extreme in which they seemed to express the need for education about the management of the professional relationship with the other person.

Communication↗
PubMed2002

Improving patient-centred medicine: a preliminary experience for teaching communication skills to Italian general practitioners.

INTRODUCTION: A key concept for general practice nowadays is that of patient-centred medicine. In this model the physician's aim is to integrate the patient's experience of illness with the conventional understanding of disease, trying to reconcile the patient's agenda with his/her own. This paper describes a preliminary experience of a CME course on patient-centred medicine in Italy. AIM AND METHODS: The article focuses on a 7 hour course for teaching patient-centred medicine to Italian general practitioners. Assessment of the course was done both in terms of learner satisfaction and efficacy. Learner satisfaction was evaluated by a questionnaire with a 6-point Likert scale and course efficacy by a pre/post-paper-and-pencil test. FINDINGS AND DISCUSSION: The pilot course on patient-centred medicine seems to obtain high satisfaction in participants. Furthermore, an increase in competence with regards to patient-centeredness resulted after the course. The pilot study represents the first Italian CME seminar on patient-centered medicine. Results obtained both in terms of satisfaction and efficacy suggest that the CME course is a valid educational tool. The opportunity to extend the experience to a higher number of participants is therefore recommended.

Journal Article↗
PubMed2001

Giving bad news: a GPs' narrative perspective.

The purpose of this study was to explore GPs' perspectives on giving bad news during consultations. To this end, 168 GPs were asked to recall, and record on the first page of a questionnaire, an occasion when they had given medically related bad news to a patient. The stories were analysed with a qualitative and interpretative approach. Two axes, each with a semantic polarity, were identified: a relational axis (semantic polarity: escape vs accompanying) and an ethical axis (semantic polarity: the doctor's choice vs the patient's choice). Furthermore, two main topics appeared to be common to almost all the narratives: the need to reassure the patient and the account of the doctor's emotions. Two different relational patterns appear to be described by doctors. A substantial number of GPs implicitly describe a disease- or doctor-centred consultation: in these cases the physicians refer to signs and symptoms, diagnosis and treatments; they decide for themselves whether to tell the truth or not. On the other hand, a smaller number describe consultations that could be defined as patient centred: these doctors consider that their duty of care for the individual ill person is paramount and try to respect the patient's right to decide. In both these relational patterns, GPs feel it is a fundamental professional duty to reassure the patient; furthermore, they feel the most difficult aspect is managing their own emotional responses.

Adult↗
PubMed1999

[The video recording of medical visits for the study of physician-patient rapport in general medicine. An experimental experience in Italy].

The communication and relationship between doctors and patients has been given increased attention in recent years. There are many different methods by which to collect data on doctor-patient communication and relationship: of these, videorecording seems to have the most advantages. The objective of this article is to describe the method we used to make videorecorded consultations in General Medical Practice in Italy. In particular, the article addresses: 1) the technical feasibility of videorecording consultations; 2) a possible answer to the problem of informed consent both from doctors and from patients. At present, the archives collect 258 videotaped consultations of 14 General Practitioners: about three patients in four (75.9%) did consent to have their consultation recorded; a high range of videorecorded consultations (94.2%) does not present technical problems. In line with published surveys, these recording consultations are an increasingly important method of studying communication and doctor-patient relationship, and of teaching/learning these aspects of medical practice.

Adult↗
PubMed1996

Tryptophan depletion in obsessive-compulsive patients.

Twelve patients with obsessive-compulsive disorder were studied after the administration of a mixture of amino acids devoid of tryptophan (TRP) or a mixture containing all the essential amino acids, in a double-blind, crossover design. The TRP-free mixture caused a marked depletion of plasma TRP. After TRP decrease, mean ratings of obsessions and compulsions, measured by Visual Analogue Scales (VAS) ratings, did not worsen. In contrast with other reports in literature, TRP depletion also failed to alter mood in our subjects.

Adult↗
PubMed1996

Decrease in plasma phenylalanine and tyrosine after phenylalanine-tyrosine free amino acid solutions in man.

After an overnight fast, 5 male healthy subjects ingested increasing amounts of a solution containing a fixed proportion of seven essential amino acids (L-isoleucine, 13.3%; L-leucine, 21.0%; L-lysine, 15.2%; L-methionine, 21.0%; L-threonine, 9.5%; L-tryptophan, 4.8% and L-valine, 15.2%) and lacking phenylalanine and tyrosine. The solutions caused a rapid fall in plasma phenylalanine and tyrosine which was proportional to the total amount of amino acids ingested. Following the highest dose administered (31.5 g) plasma phenylalanine and tyrosine fell to a minimum of, respectively, 12.7% and 29.8% the initial levels and remained markedly reduced at 6 hours after treatment. The decrease of tyrosine and phenylalanine levels was associated with a decrease of systolic and diastolic arterial pressure.

Adult↗
PubMed1993

Failure of a tryptophan-free amino acid mixture to modify sexual behavior in the female rat.

Female Wistar rats, weekly injected with estradiol valerate after ovariectomy, were trained to cause a sexual contact with a potent male by operating a lever. Contact-response latencies, which vary according to the nature of the sexual contact, were measured as an index of the female's sexual motivation. In these experimental conditions the administration of a tryptophan-free amino acid mixture, which has been proved to decrease brain serotonin and to enhance male mounting behavior, failed to modify the sexual motivation of the female rats.

Amino Acids↗
PubMed1992

[The clinical implications of the use of an amino acid mixture without tryptophan in liver cirrhosis].

The ingestion of an amino acid mixture lacking tryptophan causes a rapid fall of plasma tryptophan in healthy subjects. This is because amino acids elicit protein synthesis and endogenous tryptophan is incorporated into new proteins. If protein synthesis is the mechanism through which tryptophan-free solution decrease blood tryptophan, it may be interesting to study tryptophan levels after a tryptophan-free mixture in subjects with impaired protein synthesis. In the present paper we show that in 27 cirrhotics the administration of a tryptophan-free solution caused a fall of total plasma tryptophan that began significantly later than in 14 control subjects, the delay being significantly proportional to the severity of the disease. The difference between control and cirrhotic subjects was due to the bound fraction of plasma tryptophan. The diagnostic and clinical usefulness of our findings are discussed.

Amino Acids↗
PubMed1991

Decrease in plasma tryptophan after a tryptophan-free amino acid solution. A comparison between cirrhotic and control subjects.

In healthy subjects the administration of an amino acid mixture devoid of tryptophan causes a marked decrease of plasma tryptophan. This is because amino acid mixtures induce protein synthesis and tryptophan in blood is incorporated into newly synthesized proteins. We hypothesized that a tryptophan-free mixture could differently affect plasma tryptophan levels in subjects with an impaired protein synthesis such as chronic liver patients. We studied tryptophan levels after a tryptophan-free amino acid solution in controls and cirrhotics fasting 12 hours. Plasma total tryptophan fell to 91% of the initial level 60 minutes after the administration of the diet, to 71% after 120, and to 50% after 210' in controls. In cirrhotics the solution caused a decrease of plasma tryptophan that began significantly later than in controls, the delay being proportional to the severity of the disease. Cirrhotics were subdivided into two groups in accordance to the Pugh modification of the Child-Turcotte criteria. Total plasma tryptophan was 100% of base line levels after 60', 88% after 120', and 65% after 210' in less severe clinical condition; total plasma tryptophan was 102% of base line levels after 60', 98% after 120', and 75% after 210' in more severe clinical condition.

Adult↗
PubMed1991

Cycloheximide blocks the fall of plasma and tissue tryptophan levels after tryptophan-free amino acid mixtures.

The hypothesis that incorporation of tryptophan (TRY) into proteins is the mechanism underlying the decrease in plasma and tissue TRY levels after a TRY-free amino acid mixture was investigated. Rats fasted 15 hours were pretreated with saline or with the protein synthesis inhibitor cycloheximide (CHEX) and treated with saline or a TRY-free amino acid mixture. In a first experiment, in saline pretreated rats the TRY-free mixture caused a decrease of 49% in total plasma TRY, of 64% in free plasma TRY, of 66% in brain TRY and of 42% in liver TRY. After 5 mg/kg of CHEX the same TRY-free diet caused a decrease of 5% in total plasma TRY, 14% in free plasma TRY, 18% in brain TRY and 9% in liver TRY. In a second experiment, the TRY-free diet caused a 43% decrease of total plasma TRY in saline pretreated animals and a decrease of 15%, 6% and 2% respectively after the pretreatment with 0.3, 1.0 and 5.0 mg/kg of CHEX. In brain TRY, the TRY-free diet caused a 62% decrease in saline pretreated rats and a decrease of 38%, 20% and 19% respectively after the pretreatment with 0.3, 1.0 and 5.0 mg/kg of CHEX. Since 5.0 mg/kg of CHEX almost completely block protein synthesis and since doses of CHEX from 0.3 to 5.0 mg/kg cause a dose-dependent inhibition of protein synthesis, our data support the hypothesis that protein synthesis is the mechanism through which TRY-free mixtures decrease TRY levels.

Amino Acids↗
PubMed1991

Effects of tryptophan depletion on Poggendorff illusion, corner Poggendorff illusion, and attention.

The effects of a tryptophan-free amino acid mixture on Poggendorff illusion, corner Poggendorff illusion, and attention were investigated with 12 male subjects who ingested either a balanced amino acid mixture or a tryptophan-free mixture, the latter known to cause a marked depletion of brain tryptophan and serotonin. No significant difference between the two mixtures on the perceptual illusions was found.

Adult↗
PubMed1990

An increase in strength of tilt aftereffect associated with tryptophan depletion.

The effects of a tryptophan-free amino acid mixture on tilt aftereffect, movement aftereffect, and the Mueller-Lyer illusion were studied. 12 male subjects ingested either a balanced amino acid mixture or a tryptophan-free mixture which causes a marked depletion of brain tryptophan and serotonin. The tryptophan-free mixture significantly increased the strength of tilt aftereffect but had no effect on movement aftereffect or the Mueller-Lyer illusion. These results were discussed with reference to the pharmacological activity of serotonin and its influence on the strength of lateral inhibition in mammalian brains.

Adult↗
PubMed1989

Dose-response decrease in plasma tryptophan and in brain tryptophan and serotonin after tryptophan-free amino acid mixtures in rats.

Rats fasted 15 hours were treated p.o. with increasing amounts (660 and 1320 mg/kg body weight) of a mixture containing a fixed proportion of seven essential amino acids (L-phenylalanine 13.6%, L-leucine 6.0%, L-isoleucine 12.1%, L-methionine 12.1%, L-lysine 30.3%, L-threonine 10.6%, L-valine 15.2%) and lacking tryptophan. The mixtures produced a dose-response decrease of free (by 34% after the lower dose and by 58% after the higher dose of the mixture) and total (by 10 and 31%) plasma tryptophan and of brain tryptophan (by 38 and 65%), serotonin (by 17 and 41%) and 5-hydroxyindole acetic acid (by 21 and 49%). The mechanisms of these changes are discussed.

Amino Acids↗
PubMed1988

Decrease in plasma tryptophan after tryptophan-free amino acid mixtures in man.

Male healthy subjects, fasting 12 hours, ingested increasing amounts of a mixture containing a fixed proportion of seven essential amino acids (L-isoleucine 11.5%, L-leucine 18.0%, L-lysine 13.1%, L-methionine 18.0%, L-phenylalanine 18.0%, L-threonine 8.2%, L-valine 13.1%) and lacking tryptophan. The diets produced a rapid fall in plasma tryptophan which was proportional to the total amount of the amino acids ingested. Following the highest dose administered (36.6 g) plasma tryptophan fell to a minimum of about 35% the initial level and remained markedly reduced at 6 hours after treatment. The mechanism of this decrease and its potential clinical relevance are discussed.

Adult↗
PubMed1984

Increase in stage 4 sleep after ingestion of a tryptophan-free diet in humans.

The polygraphic sleep pattern following the ingestion of an aminoacid mixture containing all essential aminoacids was compared with that following the same mixture lacking tryptophan in 12 healthy volunteers. The tryptophan-free mixture caused a decrease in stage 4 sleep latency and an increase (from 14.9% to 28.3%) in stage 4 sleep during the first 3 hours of sleep. A not significant decrease in light sleep and REM sleep was observed during the same period. During the second part of the night no significant differences were found between the two treatments.

Adolescent↗