Hospital communication between perception and cost savings: an Italian case study.

BACKGROUND: Communication field is very much studied by Companies but not so much from the Italian NHS. We aim to study the suffering communication that patients, relatives and customers feel when they approach a hospital. The research was carried out in an Italian region: Lazio. The Objective was to take a picture of the current state of Regional Health-Care System (RHS) communication by local Visual Communication (VC), telematic, internal perception, communication propensity and perception of hospital's brand. MATERIALS AND METHODS: We have sampled 7 hospitals (114 items): Web-site's analysis, Location's VC, Urp's manager interview, Focus-group, Analysis Valuator of the Hospital's Brand (AVoHB). RESULTS: WEB: 14% of web-sites had a positive score, 86% had an Hospital Service Guide, 43% hadn't Urp's e-mail, 29% had a ward's map, 0% was W3C. Average: -17pt. on ±74pt. VISUAL COMMUNICATION: 100% had a Help-desk at the entrance, 100% had readable signpost, 43% had a readable badge, 29% had chromatic signpost, 0% had an assistance signpost and none of them had the Toilettes signpost. Average: -10,42pt. on ±58pt. FOCUS-GROUP: Staff underline their very high interest in interpersonal communication. They report a lack of VC inside their hospitals that cannot help patients to be self-oriented. Lost users can only ask information to the first doctor they see, taking staff time, which is already lacked. AVOHB: Powergrid shows that the positioning of the Aggregated Brand (RHS) and of each hospital analyzed are in the III quadrant. CONCLUSIONS: By a Corporate Communication point of view we can see that almost all companies reach a good level in terms of effective communication but none of them excel in all critical areas for an effective communication.

[Camillo Golgi: historical profile of a Nobel Prize politically engaged]. / Camillo Golgi: (1844-1926), profilo di un Nobel politicamente impegnato.

The article analyzes the role and activity of Camillo Golgi as Senator of the Italian Parliament in the light of the official acts which testify his modalities of political intervention, his style and his proposals, with the aim of verifying if and how his experience as scientific researcher and teacher at the University of Pavia shaped his political life.

[Indicators of educational assessment and prospects of improving university life]. / Indicatori della valutazione didattica e prospettive di miglioramento nella vita universitaria.

INTRODUCTION: Five years after the establishment of the National Observatory for Assessment--now called National Committee for the Assessment of the University System--(L. 509/99), a critical analysis of the indicators chosen in relation to the aim suggested by the law itself becomes necessary. OBJECTIVE: To analyse the assessment system of the University Campus Bio-Medico as it has changed through time, in order to highlighten possible trends which have allowed a real improvement of the entire educational system. In these years our University has endeavoured to answer appropriately to the National Committee exhortations by creating its own system of self-assessment. This has strengthened the inner motivation to improve of all stakeholders of the educational process (students, teachers, tutors). The predominance of inner motivations on external ones is the essential feature in an university system which grants an educational model based on personal freedom and its related responsibility. This system, created and managed by the Department for Educational Research (DIE) of the University Campus Bio-Medico, is organized in three wider phases: planning of assessment tools and their administration; preparing the focus groups which address targeted groups of people so to evaluate the results and prepare new tools. RESULTS AND CONCLUSIONS: In our University assessment process certain values have acquired the structure of tracks along which it is possible to find concrete features: educational independence and planning governance as well as joint responsibility and cooperation. These are the key concepts which show the uniqueness and foundation of the entire educational system.

[Therapeutic education and the increased risk of postpartum depression]. / L'educazione terapeutica e l'aumentato rischio di depressione post-partum.

Postpartum depression affects approximately 13% of women irrespective of ethnic group and culture. In fact, it represents the main request for hospitalisation of a non-obstetric type for pregnant women. This is a particularly significant fact considering that women affected by postpartum depression have a depressive relapse twice as frequently compared with other women during a period of five years. Their children are exposed to an ambiguous relationship which does not help their cognitive, psychological and emotional development. Furthermore, in the most severe cases it can determine a serious risk for their life. Despite this, the syndrome symptoms and consequences are still not widely known and data seem to be underestimated both quantitatively and qualitatively. The present survey tries to study the causes producing this situation. It offers as well therapeutical and educational trends of intervention of a preventive and predictive type in order to control at least the major risk that can occur.

[Ethics of care and new profiles of the woman]. / Etica della cura e nuovi profili della donna.

INTRODUCTION: In health professions listening represents an essential condition for any cure relation. Learning to listen is thus neither easy nor granted. It requires the ability to put oneself in somebody else's place, maintaining self-possession of judgement and the ability of evaluating events. PROBLEM ANALYSIS: In health professions women have always occupied a privileged position for their sensitiveness and their ability of giving meaning even to everyday life. Empathy is the privileged way women have of getting to know, understand and take care of people. They follow a feminine style which accepts and welcomes other people even if they are not able to explain their intimate contradictions, their anxieties, their difficulties, their pain and weakness. Women know how to be near people, even if they understand they are not up to the situation, not expecting to solve pain: neither personal nor other people's. They act in a different way from men who instead are attached to a reductionism that assumes a theoretical scheme to understand the issue. Man's need to dominate the problem with knowledge makes him sacrifice the complexity of reality in which he lives. Men's simplicity, their tendency to generalize processes and easily find guidelines to proceed with no useless wastes, often sacrifices elements which find no place into the chosen standards. For women this way of behaving, apparently reassuring, is not possible because they are aware that such aspects while escaping their understanding express the personality of the people involved in this process, their uniqueness which does not accept generalisations. Behind interpretative schemes, behind apparently definitive diagnosis, women perceive vagueness and interpretative inadequacy. CONCLUSIONS: Female rationality is inclined to live with one's own and other's contradictions just because it is strongly attached to a reality which avoids simplification of understanding. It refuses interpretative schemes, theories which try to offer themselves as exhaustive models which can explain all events, lessening the value or even denying elements which do not fall within the interpretation model assumed. Women appear contradictory because they do not refuse confrontation with life contradictions and its perennial changes.

[Terri's case and the ethical challenge for an always more technologically advanced medicine]. / II Caso Terri e la sfida etica per una medicina tecnologicamente sempre più avanzata.

BACKGROUND: Highly technological medicine puts the physician in the condition of verifying always more and always better the patients' vital parameters. It also opens up new issues on the ethical side because it makes more difficult placing the borderline between life and death. The relation between the guarantee of the necessary cures, aggressive treatment and a possible request for euthanasia often appears smooth in the experts perception and in the public opinion. Indeed it feels involved in strongly expressing its opinion in a field which can affect each one of us or else in the treatment relation with patients and relatives. THE CASE: Terri Schiavo's recent death, after fifteen year of vegetative coma, occurred as a consequence of the withdrawal of feeding-tubes, has spread from the USA to Italy and the rest of the world the dramatic difficulty of clarifying issue of this impact. On one side there are solutions of an emotional kind, based on pietas, these affect the relatives who caring for such patients. This first considerations reveals its contradiction in the fact that the parents wish to keep on yielding their daughter's life and thus clash with her husband who, on the other hand, wants to interrupt all kind of treatment. On the other hand there are serious issues of a clinical and ethical kind according to which normal treatment is guaranteed at all cost and nutrition has to be considered as ordinary treatment. Aggressive treatment can reach other not lawful dimensions because they are against human dignity and end up in worsening pain and suffering. CONCLUSIONS: Nowadays there is a pressing need for a wide information campaign for public opinion on these issues as well, as there is the possibility that all citizen can write a living will fully conscious of his responsibility. Furthermore it is even more urgent that medical class and all those who take care of these patients are able to harmonise their technical and scientific culture, keeping in mind a ethical and anthropological vision in order to fully understand the dignity of the dying during their last days, in an atmosphere of warm welcome and paying attention not only to the patients but to their close relatives as well. This because the weight of the treatment is on them, as is the psychological and emotional tension. The new kinds of burnout are so important that are being considered by present medicine as a new challenge.

Bioethics, bridge to medical education.

INTRODUCTION: Research in education assumes that every intuition regarding the improvement of the educational process is followed by one demonstration and foundation. Creativeness and rigour with the relative implications in the context of research and difficulties are the two main elements. OBJECTIVES AND DIFFICULTIES: The knowledge that features the transition from a PHOG approach in teaching: prejudice, hunches, opinions, guess to an evidence-based education is not easy to collect, to document and to generalize. But this is still not easy to apply in a context that is very difficult to improve, to know and to check. To obtain high quality education research activity is needed, because the costs and consequences of the non quality are very high and serious and the relapsing could be very important from the assistance, social prevention and clinical research point of view. CONCLUSIONS: In the university research is done in everyone's cultural area, but it should also be done in the teaching area. This is important especially in a faculty of medicine where education depends on continuous improvements in assistance and also in the prevention to be carried out through projects aiming at education to health.

[Patient education and the use of the so called complementary or alternative medicine]. / L'educazione del paziente e il ricorso alle cosiddette medicine alternative ed integrative.

PURPOSE: Modern cultural trends are inclined to recognise to all human beings an always more ample right to become involved directly in choices affecting them. This even when health is concerned thus requiring expertise not always accessible to all. Informed consent to often gets reduced to a mere formality, having a mostly defensive purpose for the physician. DESIGN: Patients' education is becoming an ever more pressing issue in order to safeguard decision rights and the effective knowledge of the implications of every decision simultaneously. Patients' education has serious ethical implications which can't be eluded nor referred outside as happens when we let mass media inform on the advantages and disadvantages of various therapies. One of the major fields were this misinformed choice right is expressed is the so called complementary and alternative medicine. CONCLUSION: Nowadays physicians have to get back their therapeutical leadership once again, with renewed responsibility and through education as well. Information as such is a necessary and not sufficient condition. A sheer education involving the physician in a deeper as well as in an extended therapeutical alliance is needed. The challenge of taking care involves the whole human being: his/her sick body, his/her wounded feelings as well as intelligence which has to understand what is happening clearly.

[The new frontier of distance learning: the climate of the virtual lecture hall]. / La nuova frontiera della Formazione a distanza (FAD): il clima dell'aula virtuale.

INTRODUCTION: The recent ECM standards outline new dilemmas not only under an economic and/or management point of view, but even under a teaching and procedural aspect. FAD seems to solve problems, allowing us to arrange courses according to our demand, but it still doesn't solve all the issues, for example, the teaching-learning model. PROBLEM ANALYSIS: The article starts analysing formative procedures to reflect in an interactive logic about object and subject in FAD, to set a dynamic learning process in a knowledge management viewpoint, where the user is fully aware that he/she will be divided from his/her tutor and from his/her colleagues in the virtual classroom. The learning environment is a crucial circumstance to assure full functionality of the course and to make the FAD experience a valuable one and repeatable in the future for different courses. CONCLUSIONS: FAD is an asynchronous activity and for this it could be moulded according to the single user's requirements. It needs a relational dimension to facilitate the learning process through the strategy sharing of problem solving.

[The reciprocal evaluation in the Learning Organization]. / La valutazione reciproca nel contesto di una Learning Organization.

INTRODUCTION: The culture of the appraisal was introduced in the Italian Universities only five years ago and the collected data come from the evaluation nuclei in the university on the basis of grills structured, proposed from the national Observatory for the Appraisal, where data are dealt in comparative key. MATERIALS AND METHODS: The Medicine faculty of the University Campus Bio Medico every year carries out an evaluation survey where the judgments from the students are compared with their didactic results. We utilise questionnaires to both inquire into the quality of the logistic and organizational aspects and into the didactic teacher competences and tutors, taking them in consideration singularly and as a whole, through the integrated course's analysis. RESULTS: This study represents one further development regarding those already published in the previous years, because it compares every teacher's results of the last the five years and every student's academic career from the first moment the student entered into the faculty. The two evaluative lines have been discussed in meetings with students, teacher and administrative staff. CONCLUSIONS: From the quantitative type of data gained through questionnaires, through the curves of performance of the students and through the interpretation that are in question observations for the improvement of the didactic quality are obtained.

[The right to be born and the need to be born healthy... questions in medical ethics]. / Il diritto di nascere e il dovere di nascere sano... questioni di etica medica.

INTRODUCTION: Science, thanks to the commitment of huge amount of human capitals, in many cases supported even by enormous fund investment, gain continuously ground reaching new position and spreading out the borders on human chances in a sphere so delicate like birth. New genetic screening tests, new contraceptive drugs using even more sophisticated features, comply with the new law on assisted insemination, put up new challenges involving all the scientific-social environments and necessitate precise answers on ethical side, but even concrete commitment on vocational training. PROBLEM: In this case we take working examples distinguished only on perception, as the pre-implant diagnosis, the morning after pill, and certain about the recent legislation on assisted insemination, to highlight their common scientific and cultural milieu. These problems call for an unquestionable and unique response, to restore clarity about choices involving the need and ability on human being to look for and find answers about existential matter as the beginning of life. Human being value and its significance need to be relentlessly restated, just because they are endlessly debated by a synergy of the emotional point of view, even impressive, and new stand out techniques. PROPOSAL: in that sense vocational training is undeniable goal, even more, but not only, in a Faculty of Medicine. A student needs to learn to reflect on the relations between scientific forthcoming and their ethical and bioethical repercussion.

[Medical education and patient education: new teaching strategies and new communication dynamics]. / L'Educazione terapeutica: nuove strategie didattiche e nuove dinamiche comunicative.

INTRODUCTION: This study was designed to shed light on the learning difficulties of diabetic patients. MATERIALS AND METHODS: An open-ended questionnaire was sent to 50 patients and 50 diabetics patients and 100 health care professionals working in the field of diabetes and nutrition who had been trained in patient education techniques. They were asked to describe the skills that were the easiest to teach patients and those that patients mastered the best, as well as the skills they found hardest to teach patients, those that patients mastered the least and those that gave rise to errors persisting after the patients education was completed. RESULTS: On the whole, the results showed that the educators found it easy to teach techniques: patients mastered procedures well and made few mistakes. In contrast, diabetic patients seem to have problems learning skills, such as insulin dose adjustment, that require complex problem-solving (involving multiple variables). CONCLUSIONS: Based on these findings, the authors discuss the notions of learning complexity and the time needed for successful patient education.

Biotechnology and the birth of a third culture.

Biotechnology represents such an important challenge for present day culture that one can speak of a biotechnological revolution in many other scientific fields as well, such as biology, clinical medicine, pharmacology, and genetic engineering. It also significantly affects political and economic choices to such a degree that they call for a new kind of attention from jurisprudence which has to regulate an ever changing world. Many important queries arise particularly at a bioethical level, issues that will also affect future generations. Scientific progress has unexpectedly widened the biological knowledge of human kind. Thanks to the contribution of continuously more refined and advanced technology, it has nurtured the hope of solving all problems and of overcoming all limits. The scientist's intellectual curiosity, encompassing these new resources, is spurred on by the desire for knowledge and understanding. However sometimes he loses sight of the repercussions and of the possible uses his achievements may have. Only a profound personal education, integrated with the scientist's technical and scientific expertise, will allow science to knock down some barriers, advancing constantly but without losing respect for man's dignity. However the separation between scientific and ethical expertise can only raise new barriers and create limits to the freedom of science which will appear just restrictive, while a kind of medieval obscurantism will be opposed to ethical rigour.

[Old age: ethical and psychological perspectives]. / La vecchiaia tra riflessione etica e psicologica.

PREMISED: The extension of the average life and the contraction of the births have generated a negative evaluation of the future social models. The old age is seen more as a problem than as possible resource, more as something to be frightened from than something belonging to all of us. ANALYSIS OF THE PROBLEM: The current study aims at overturning this negative point of view that sees senility as a continuous recourse to Medicine and not as a progressive resource investment, seems to be dominating today the relation of care witch seems the old aged needing is a connection point in dialogue among generation opens new possibilities of interaction. For this reason it is important to understand the meaning of senility for the cognitive point of view grasping the elements of specific richness that are important to keep obtaining a new point of view of the old age. CONCLUSION: Bioethics and psychology can help induce to think that senility is that phase of life in which the subject nevertheless all the psycho-physical limitations, individualises the answer to important questions of life and death, that are removed when the pragmatic realization is more pursuing.

[The principle of caution in medical education]. / Il principio di precauzione nella formazione medica.

The relationship between the modern man and technology is full of paradoxes, even if it has been continuously proven that they cannot do without each other. From the debate in this field the superiority of the man on the world of technology has emerged, but not for those owning new generation technologies on the other men in the pre-tech era. The dominance belongs always to the man, as creator of the technology and user of the same, but above all to those having a competitive advantage because capable of grasping the innovation of new generation technologies and dedicating them to their service. The real problem is the intentional use done of technology seen as a service instrument to old and new patients or as an instrument of power for defining one's supremacy. The key point of the issue is ethics that is the responsibility with which men, who own the new generation technologies, renounce to exploit the other men using these new technologies, and show their superiority on technology, controlling their procedure and aims, since the man is definitively the person who re-invents it continuously.

[The physician-patient relation in the light of the attachment theory. Attachment counseling]. / La relazione medico-paziente alla luce della teoria dell'attaccamento. Il counseling di attaccamento.

INTRODUCTION: The doctor-patient relationship has always played a key role in the patient's treatment and recovery process. However, it is still difficult to interpret its dynamic healing aspects. Above all, the mechanisms that enable the patient to improve and to change are not still sufficiently clear. WORKING THEORY: The attachment theory assumes an emotional support of the doctor towards the patient. According to this, the patient completely "invests" the doctor of his emotions as in the ancestral model of family relationship. The possibility of obtaining success seems to be strictly linked to the doctors' capacity of accepting this "mandate" offered by the patient who autonomously takes this decision. CURRENT SITUATION: Physicians deal with the complexity of pathologies every day and this shows an increasing necessity of a "doctor-patient relationship", enabling the physician to identify the patients symptoms in a more extended way which involves pain and suffering as well. As for the pharmacological intervention, the patient's attitude and expectations of recovery have a definite effect on the simple assumption of medicine. CONCLUSION: Today's physicians' scientific education would be extremely insufficient, if it were not encouraged by the awareness that his/her duty goes beyond the simple medical prescription. It has to reach the patient's heart as well as arouse the understanding of events related to him/her. This is not just a cultural factor but also a precise way of interacting with the patient according to one's own Counselling models.

[Counseling in Internal Medicine and Family Medicine: old and new needs of the patients]. / Il Counseling in Medicina interna e nella Medicina di famiglia: vecchi e nuovi bisogni dei pazienti.

INTRODUCTION: Present proliferation of so called Complementary and Alternative Medicine (CAM), reveals the patient's deep discomfort, as s/he does no longer perceive as satisfying the relation with his/her family doctor, thus wanting to seek for different solutions. The lack of a scientific basis of the majority of these medicines often causes an effective risk to health. OBJECTIVE: The survey highlights how the acquisition of expertise in Counselling, together with the more specific clinical ones, enables the physician to manage the many relational issues more adequately. This skill will allow physicians to meet patients' needs more effectively, and as a consequence, it will make them more satisfied of the relation which will loose its present anonymous and bureaucratic nature. The intrinsic dignity of the help relation will be restored and this will help to face the treatment processes even if these do not bring to recovery. CONCLUSIONS: The new expertise proposed to physicians, could be part of the new ECM programmes. It could also allow to verify, in Italy as well, if a medical class more prepared under this aspect, corresponds to a reduction of request for CAM, and consequently to a substantial improvement of the scientific dimension of personal professional vocation.

[An uncommon application of counseling in medicine: encountering death in education and in practice]. / Una applicazione particolare del Counseling in Medicina: l'incontro con la morte nella formazione e nell'assistenza.

If scientific knowledge can be acquired through a series of learning strategies that are made easier by the tutorial system, personal and relational training is a more complex task. In fact, it means acquiring a particular mental structure that one only reaches with personal development. The emotional management of patients and of their relatives also requires a set of psychological and communicative abilities that are inborn predispositions, but have to be nurtured: learning from experience, sympathetic listening, self insight and understanding, attention towards transference and counter-transference, cannot be acquired from theory, but have to be experienced and verified hands-on. Living other people's emotional experience is not easy; sympathizing means being able to identify with them, but at the same time, to perceive oneself as separate. Moreover, the contact with suffering and sickness amplifies problems of the self, activating a set of emotions and defence mechanisms. One may get caught into other people's suffering, and be influenced by fear and anguish. Approaching illness, pain and death already represents a border-line experience. Students have to overcome the reassuring reality of theoretical study to carry out a strong and complex relational experience: that of a never-ending alternation of taking care and separation, of fulfilment and frustration, of continuous professional and personal testing. The emotional urge is varied and uninterrupted: managing patients cannot be reduced to a protocol of interventions technically defined.

[Teachers' education goes through students' evaluation as well]. / La formazione dei docenti passa anche attraverso la valutazione degli studenti.

OBJECTIVE: Students' opinion on the quality of the educational methods can represent an interesting factor useful to encourage teachers to reconsider their educational methodologies in view of the new planning required by changes in the study curricula. MATERIALS AND METHODS: The paper considers the evaluation expressed by medical students of the "Campus Bio-Medico" University during three consecutive years, in order to perceive the dynamic sense and the evolving prospective of the educational quality as a whole. From a methodological point of view the evaluation of each year and of each course are related to a general median line. This is a significant indicator of the variations of educational methodologies considered as a whole. The relation between the general median line and the course one allows taking into consideration the relative and the absolute variation of the quality. RESULTS: To be relevant the analysis of each course has to be put in relation with the progress of the previous year and with the overall state of the educational activities. While in the first case students evaluating the same course are not the same, in the second one the group of students is substantially stable and allows a better control of the evaluators' variable. CONCLUSIONS: Students' judgements on the educational quality have to be put always into a constructive frame. They have to be involved in the process of improving the educational methodologies by means of orienting teachers' education, pointing out possible critical aspects or stressing each time the results they expect. The dynamic aspect of evaluation allows constant confrontation of the results obtained during a course with the criteria of the expected quality growth. That is, a course apparently static or even dropping, can be considered as such only because the students expectations have grown.