Midtgaardbanke0264

The engagement of citizens and patients in health care was one of the ethical principles that led to the Healthcare Reform of 1978 in Italy. Since then, this principle has been constantly reaffirmed. Yet, the patient is not at the center of the system rather, he suffers the bureaucratic and administrative burden of complex, irrational, inefficient paths in the labyrinth between primary care and specialist assistance. The working group of the MaCroScopio project aims to propose concrete and operational suggestions to the central and regional authorities, to enhance the role of the citizen and the patient.Palliative care and end-of-life (EOL) care are highly requested in hospital, especially in the Internal Medicine wards, exposed, as they are, to receive elderly, frail patients affected by multiple chronic diseases and limited life expectancy. Within the medical staff, the nurses are specifically responsible to guarantee an appropriate and non-futile standard of care for this kind of patients, oriented to their real requirements and primarily to the relief their symptoms, without disregarding their spiritual needs. The competence in EOL-care should be equally distributed and shared among physicians and nurses in all clinical settings, because every single component should be able to plan its own intervention according to the comfort care concept, and, in the meanwhile, should be able to share decisions in an interdisciplinary manner. This is the only way for clinical pathways to result efficacious as they should be.«Astieniti nelle ultime fasi di vita della persona assistita da procedure invasive, seleziona gli interventi da attuare a garanzia della sua dignità, della sua qualità di vita e della gestione di sintomi, in modo particolare del controllo del dolore».A large number of elderly patients end their life in general wards, where they hardly find appropriate for their specific needs. Physicians and nurses, irrespective of their specialization, should be able to provide the dying patients with end-of-life care (EOL-care) to meet their right to die well. Purposely tailored clinical paths, inspired to the comfort care, should be constructed and disseminated. A specific experience carried on for ten years in an Internal Medicine department is reported. After a two-years period of time spent educating a large group of physicians and nurses and to project its own path, the working group experienced substantial improvements for the patients and the staff itself, in terms of a better control of pain and other main disturbing symptoms, avoidance of futile procedures, a better quality of communication and comprehension, harmonization of the clinical decisions brought about by the physicians and the nurses. Based on this experience, the following recommendations are discussed after preparing the personnel, routinely implement end-of-life care as part of routine practice in a general ward, whenever appropriate; after starting, be aware that nurses are the main actors in the conduction of EOL-care; be aware that EOL-care in no way is a low profile care in as much as it is challenging and demanding task.The recent establishment of palliative care and medicine as a medical specialty to be taught in postgraduate courses starting from the 2021/2022 academic year in Italy is certainly good news. Some doubts arise, anyway, if the academic programs will be limited to the postgraduate area instead of involving every university in the undergraduate courses. The risk is to maintain the reductionism of future physicians receiving a kind of education centered on the biomedical paradigm only. Since at least thirty years we know that there should not be a definite time marking a clear break between previous active treatments for the disease and subsequent palliative ones. Mainly in very old people affected by multiple chronic disorders a simultaneous presence of both forms of treatment should be scheduled, with increasing weight of palliation as the disease progresses and the probability of responding to active treatments becomes less and less. Unfortunately the reality of assistance in the last thirty days of life of papists is mandatory.The spread of palliative care in Italy encountered many difficulties and took place outside - if not despite - the health establishment and medical academia. The lack of a recognized role has conditioned for years the work and lives of the doctors who have dedicated themselves to it. Now the diffusion of palliative care and its institutional acknowledgement have obtained the establishment of specific schools of speciality. This undeniable success involves two important orders of risk, capable of severely limiting if not completely cancelling the value and impact of palliative care the risk of becoming a marginal part of other medical disciplines much more rooted and organized on the one hand, and the other, the loss of their nature of authentic medical revolution, a new way of being doctors and of taking care of the "unhealed" people, the chronic ills, the elderlies, all the sufferers not necessarily in terminal phase. Crystallizing into a "medical speciality" could undo that paradigm shift that medical art, today more than ever, is in dire need of.With the conversion of law decree no. 34 of 19 May 2020, bearing urgent measures concerning health, support to work and the economy, as well as social policies related to CoViD-19 epidemiological emergency, thanks to the approval of an amendment to legislative decree "Rilancio" signed by Giorgio Trizzino, the Specialization school in medicine and palliative care will be established starting from a.y. selleck chemical 2021-2022. Additionally, a course in pediatric palliative care will be introduced in pediatrics specialization schools. The news has been welcomed with enthusiasm by the scientific community and the main stakeholders, some of which have made a strong contribution to this result the Italian Society for Palliative Care, the Italian Federation for Palliative Care, the Maruzza Levebvre d'Ovidio Foundation, as well as the many professionals, institutions, and NPOs that have been supporting for the past forty years the progress of palliative care in Italy. An assessment of the impact of such a measure and its effects entails due process and contextualization in different areas first of all, that of demand and current supply, followed by the historical-cultural, the social, and the normative.The so-called artificial intelligence tools applied to palliative care (machine learning, natural language processing) have great potential to support clinicians in improving decision-making processes and in identifying those who are at high risk of mortality or at greater risk of inappropriate treatment and/or non-positive outcomes. The improvement of prognostic abilities may help to avoid that some choices of patients with serious diseases are taken only in the last days of life, in the face of treatment options not previously discussed in an adequate and shared way. These tools can facilitate some essential aspects in the practice of palliative care, for example the activation of interviews that have as their objective the advance care planning and the definition of treatments consistent with the needs and desires of patients, especially in final stages of life. The development, also in our country, of projects for the application of artificial intelligence in palliative care requires particular attention to the possible organizational repercussions and to some ethical and relational aspects. It will be necessary to reflect on the most appropriate organizational models and on the specialized resources necessary in relation to the foreseeable increase in the number and variability of patients with early identified palliative care needs. These tools must not interfere in fundamental elements of the relationship between patient and doctor, that is the ability to communicate a poor prognosis in an individualized and ethically appropriate way.Machine learning techniques, applied in the palliative field, are able to define an increasingly accurate prognosis in patients with advanced neoplasms and to identify patients at greater risk of functional decline or short-term mortality. The improvement of predictive abilities can allow an enhancement of prognostic abilities and also a more accurate detection of the most complex needs of patients. Moreover, data, even scientific data, are not values, any intervention based on them must be endowed with meaning. Predictive models can therefore be useful but only as a complementary and above all optional tool for the doctor, one of the parameters to evaluate the usefulness in different specific situations. Otherwise, the risk is to add a new type of persistence, the prognostic one.In Italy, a recent legislative decree establishes that from the 2021-22 academic year, medical graduates can specialize in palliative care. The proposal is to be greeted with enthusiasm. However, some concerns remain about how palliative care will become part of the care process. Two scenarios are of concern. First, that training in this area is reserved for specialists only, rather than being part of the competence of any therapist. Second, that palliative care is implemented sequentially rather than when necessary throughout the entire care span. The palliative intervention cannot be equivalent to the finding of "there is nothing more to be done". Because palliative care is part of the care itself and not a residual intervention.Peripheral afferent input is critical for human motor control and motor learning. Both skin and deep muscle mechanoreceptors can affect motor behaviour when stimulated. Whereas some modalities such as vibration have been employed for decades to alter cutaneous and proprioceptive input, both experimentally and therapeutically, the central effects of mechanical pressure stimulation have been studied less frequently. This discrepancy is especially striking when considering the limited knowledge of the neurobiological principles of frequently used physiotherapeutic techniques that utilise peripheral stimulation, such as reflex locomotion therapy. Our review of the available literature pertaining to pressure stimulation focused on transcranial magnetic stimulation (TMS) and neuroimaging studies, including both experimental studies in healthy subjects and clinical trials. Our search revealed a limited number of neuroimaging papers related to peripheral pressure stimulation and no evidence of effects on cortical excogical studies.The detection of microsleeps in a wide range of professionals working in high-risk occupations is very important to workplace safety. A microsleep classifier is presented that employs a reservoir computing (RC) methodology. Specifically, echo state networks (ESN) are used to enhance previous benchmark performances on microsleep detection. A clustered design using a novel ESN-based leaky integrator is presented. The effectiveness of this design lies with the simplicity of using a fine-grained architecture, containing up to 8 neurons per cluster, to capture individualized state dynamics and achieve optimal performance. This is the first study to have implemented and evaluated EEG-based microsleep detection using RC models for the detection of microsleeps from the EEG. Microsleep state detection was achieved using a cascaded ESN classifier with leaky-integrator neurons employing 60 principal components from 544 power spectral features. This resulted in a leave-one-subject-out average detection in performance of Φ= 0.