Full Sails against Cancer.

BACKGROUND: Cancer is very disruptive in adolescence and hospitalizations interfere with this development stage in becoming independent, developing social relationships, and making plans for the future. A major challenge in the care of adolescents with cancer is being able to enhance their quality of life. The aim of this project is to increase our understanding of how adventure therapy influenced quality of life for adolescents with cancer. METHODS: Bambino Gesù Children's Hospital, in collaboration with the Tender to Nave Italia Foundation (TTNI), has been conducting a unique project, located on a beautiful brigantine of the Italian Navy. Adventure therapy is a form of experiential therapy that consists of various types of adventure, in particular outdoor and sailing activities. Ninety teenagers have been the protagonists of this project to date and filled out two questionnaires about quality of life and self-esteem, before and after the sailing experience. RESULTS: The adventure provides the opportunity for the participants to build interpersonal relationships and develop life skills that they can benefit from in the future experiences. All participants report a significant improvement in their quality of life and self-esteem at the end of this experience. CONCLUSION: This collaborative adventure project is a great way to learn and practice new behaviors, improve interpersonal skills, heal painful emotions, overcome personal obstacles and challenges, and help the teenagers to resume their developmental path after an onco-hematological diagnosis.

[Adventure therapy: principles, practice, perspectives.] / Terapia dell'avventura: principi, pratica, prospettive.

The high rates of psychological distress, disability and/or chronic illness reported among children, adolescents and young adults, are a recent stimulus for the development and evaluation of new initiatives. Adventure therapy, realized through sailing navigation or stay in the mountains are effective strategies to raise the welfare of the beneficiaries, implementing self-esteem, autonomy and social skills. A "Nave Italia" model is described and prospects for development in a sector not yet capable to produce high quality research and training, according to traditional gold standard criteria by medical research, are discussed.

[The National Health Service needs to train doctors who are leaders in change.] / Il Servizio Sanitario Nazionale ha bisogno di formare medici leader del cambiamento.

Several new health technologies are going to be introduced in the healthcare system, as well as new ways of making diagnoses, new drugs, new strategies for customizing therapy. Introducing innovation requires a considerable effort from healthcare decision-makers. In fact, every innovation may have an impact in terms of altering diagnostic and clinical pathways, but also in terms of processes, organizational structures, services and interventions delivery, costs. Facing these continuous changes, we need to support the growth of leading doctors: leadership development should start during medical school. Health systems should identify potential leaders, characterized by intelligence, deep medical culture, humanity and passion, involving them in task forces, committees, periodic retreat teams protected by the pharmaceutical industry influence, experiential training programs. Being trained on organizational, communication and team-building aspects, new medical leaders can master core competencies such as strategic planning and change management. Continuous support, through a system of tutoring by other leaders, will increase emotional intelligence, facilitating decision-making processes and improving communication and collaboration skills. Adopting strategies like those described, the health system will achieve the efficiency and organizational effectiveness needed to prevent waste and to grant the benefits of pharmacological and technological innovation to all the stakeholders.

[How clinicians make choices.] / Come scelgono i medici.

Humans are influenced by irrational preferences in making choices, so that clinicians also are prone to irrational decision-making. Exhaustive information about the value of therapies are frequently unavailable, full results of intervention trials are often hidden, conclusive evidence is highly desirable but it is seldom accessible. Healthcare could benefit from the new ways of approaching the decision framework due to behavioral economists: understanding the hidden traps in decision-making and the way the human brain works is an essential step and the best protection from biases is always awareness.