Conscious sedation in critically ill patients is associated with stressors perception lower than assessed by caregivers.

Background: In ICU, the stay is frequently a stressful experience. Caregivers may help to understand patients' perceptions; however, their reliability is uncertain. Despite the recent recommendations of lighter sedation targets, little is known about the impact of "conscious sedation" on ICU patients memories.

Neurological assessment with validated tools in general ICU: multicenter, randomized, before and after, pragmatic study to evaluate the effectiveness of an e-learning platform for continuous medical education.

Background: International guidelines recommend systematic assessment of pain, agitation/sedation and delirium with validated scales for all ICU patients. However, these evaluations are often not done. We have created an e-learning training platform for the continuous medical education, and assessed its efficacy in increasing the use of validated tools by all medical and nursing staff of the participating ICUs during their daily practice.

Do occupational therapists' communication behaviours change with experience?

Background: An increasing amount of literature has studied changes in communication skills in medical and nursing undergraduate students.

Aim: To evaluate whether occupational therapists' communication behaviours change with experience.

Material And Methods: A total of 45 participants (second-year OT students, final-year OT students, professional OTs) were enrolled and met three simulated clients.

Difficult encounters with a hemophilic patient: the inner perspective of physicians.

This study aimed at exploring the hematologists' internal representation of a difficult encounter with a hemophilic patient, using a written open format. Narrations were analyzed with Interpretative Phenomenological Analysis. Three main issues were identified, each with sub-issues: (1) Inside the relationship: to tell or not to tell, the balance between a normal life and a deviant medical condition, the guilt; (2) The borders of the professional role: professional values, the "do-it-all" doctor; and (3) The existential confrontation.

Satisfaction for quality of life: a comparison of patient and occupational therapist perspectives.

Objective: To verify whether the patient's satisfaction with quality of life (QoL) is similar to or different from the occupational therapist's perception of the patient's satisfaction.

Materials And Methods: Each patient enrolled was given the Satisfaction Profile (SAT-P) questionnaire to be filled out personally; the same questionnaire, the SAT-P, was given to the respective occupational therapist who was asked to fill it out by evaluating the patient's satisfaction as perceived by the therapist. A descriptive statistic was applied for socio-demographic data to describe the cohort.

How Italian students learn to become physicians: a qualitative study of the hidden curriculum.

Background: A great deal of what medical students learn in terms of behaviors, values, and attitudes related to their profession is conveyed by the hidden curriculum.

Aim: To explore the messages conveyed by the hidden curriculum as perceived by third-year students of the Milan School of Medicine, Italy, following their first clinical internship.

Method: Three group interviews were conducted.

To be or not to be: the patient's view of thrombophilia testing.

Introduction: The literature on the psychological effects of thrombophilia testing is unclear. Little is known about the complex world of significance subjects construct around the test.

Objective: The study explored the peculiar network of implicit meanings that may be linked to the experience of being tested.

Cross-cultural adaptation of an innovative approach to learning about difficult conversations in healthcare.

Background: The Program to Enhance Relational and Communication Skills (PERCS) was developed at a large hospital in the United States to enhance clinicians' preparedness to engage in difficult conversations.

Aim: To describe the implementation of PERCS in an Italian hospital and assess the program's efficacy.

Methods: The Italian PERCS program featured 4-h experiential workshops enrolling 10-15 interdisciplinary participants.

Sudden unexpected death in epilepsy (SUDEP): a pilot study on truth telling among Italian epileptologists.

Sudden unexpected death in epilepsy (SUDEP) is a syndrome where a person with epilepsy dies suddenly and no other cause of death is found. The question of informing patients and their families about SUDEP remains a problematic issue. The aim of this study is to explore whether Italian physicians interested in epilepsy believe that they should discuss SUDEP with patients and/or their families.

A quantitative approach to measure occupational therapist-client interactions: a pilot study.

Aims: The purpose of this pilot study was to assess the feasibility of a quantitative approach to study occupational therapist-client interactions. Role plays were videotaped in which 10 therapists met three client-actors. A questionnaire assessed the occupational therapists' and the patient-actors' opinion of the role-play experience.

["Diabetes is for me ...": the health care workers perspective].

Aim: To analyze the representations and meanings of diabetes from the health workers perspective through an ethnographic approach.

Method: Participants who attended a national conference on diabetes care were asked to write a narrative responding to the question: "For me, diabetes is..

[Between science and suffering: difficult conversations in healthcare].

Introduction: This article describes the adaptation and implementation of the Program to Enhance Relational and Communication Skills (PERCS) in Italy. PERCS was originally developed at Children's Hospital Boston and aims to enhance clinicians' preparedness to engage in difficult conversations with patients/families.

Description: After a period of collaboration by the first author with the Children's Hospital Boston, PERCS was launched at San Paolo Hospital, Milan, in 2008.

[Efficacy of an emotional-based psycho-educational strategy for patients suffering from type 2 diabetes. An almost experimental pilot study].

The authors discuss the creation of a psycho-educational course based on emotions in a group of diabetes type 2 patients. Its effects were assessed : biologically, by measuring blood sugar levels and body weight; cognitively, by behavioral tests; psycho-emotionally, by Moreno's Social Atom test that evaluates the patient's personal life in the light of his/her pathological conditions. 12 subjects were studied (10 patients and 2 spouses).

An exploratory study on the Italian patients' preferences regarding how they would like to be told about their cancer.

Goal: Major cross-cultural differences in truth-telling attitudes and practices have been demonstrated. Until recently, in Italy the doctor could conceal both diagnosis and prognosis to seriously ill patients out of beneficence. Signs of change have been reported, but the extent and way patients would be informed is still unknown.

[Difficult conversations in medicine: an experiential, optional course with medical students].

A 24 hrs optional course was realized with 15 students at the Medical School of Milan, with the aim of undertaking the management of the emotional aspects in a difficult communication in medicine. The course was realized through the use of active teaching tools; issues resulted from what literature consider as "difficult communication". Photolangage was used as pre-post test to assess the effects of the course; a satisfaction questionnaire was also used.

Assumptions and blind spots in patient-centredness: action research between American and Italian health care professionals.

Objective: To examine how patient-centredness is understood and enacted in an American (US) and an Italian group of health care professionals.

Methods: An action research methodology was used. Two interprofessional groups of US (n = 4) and Italian (n = 5) health care professionals independently wrote a patient-centred dialogue between a doctor and a patient based on the same scenario.

[The doctor-patient and the doctor-patient-companion encounter in the General Medicine: a descriptive study].

The aim of the study is to describe the doctor-patient-companion interaction in the Italian General Practice compared to dyadic encounters. 819 videorecorded visits were included. 650 (79.

[When a doctor must treat a collegue].

The literature about the physician emotional life underlined how to care a collegue generates stress. However this situation is not so much investigated. The aim of this article is to investigate the nature of the relation and of the physician inner life when the doctor meets a patient-doctor, by means of narratives and a qualitative analysis.

[Perception of the quality of emergency care by the users: expectations and satisfaction with the care received].

The aim of this study was to examine patient satisfaction with emergency care at a teaching hospital Emergency Department (ED) in Northern Italy. Level of patient satisfaction was compared with patient expectations at ED access. A questionnaire using a 6-point Likert scale format was administered to 427 patients.

The effect of patient-centered contraceptive counseling in women who undergo a voluntary termination of pregnancy.

Objective: The aim of the study was to evaluate, by means of a randomized controlled trial, whether a patient-centered contraceptive counseling intervention increased the use of contraception, and the knowledge and positive attitudes towards contraception, in women who undergo a termination of pregnancy (TOP).

Methods: The study was carried out at the San Paolo Hospital of Milan between the 1st of February and the 31st of May 2004. Participants (41 women; ages 20-44 years) were randomly divided into two groups: an experimental group (n = 20), who received patient-centered contraceptive counseling, and a control group (n = 21), who received the routine treatment in use at the San Paolo Hospital and were referred to the community health centers after the TOP.

When talking to the patient is difficult: the physician's perspective.

The aim of the study was to analyze the difficult doctor-patient relationship from a doctor's perspective. A qualitative-interpretative approach was employed to analyze representations of difficult visits collected by means of written narrations. Two main scenarios were identified: (i) a 'personal scenario' in which the doctor had difficulties from a purely personal perspective; and (ii) a 'professional scenario' in which the doctor had difficulties as a professional when the 'other' resists or in facing the 'other' who resists.

[Breaking unexpected bad news: pilot study on communication style of physicians].

The aim of this study was to explore the physician's communication pattern when breaking a bad unexpected news. 30 videotaped consultations (VRM) were collected in which the physicians met an actress as a patient. The doctors received the x-ray report in which an apical mass was detected before (condition A) or during (condition B) the consultation.

[A very difficult question: a qualitative research from the nurses' perspective].

Unlabelled: Aim of this paper is to identify what is a difficult question, according to nurses' perceptions. Since the knowledge on this area is limited, a qualitative method was preferred for a pilot study.

Methods: As part of a training exercise, fifty-one nurses were requested to recall, from their own experience, and to describe, a difficult question asked by a patient, that created problems to the nurse.

The physician-patient-parent communication: a qualitative perspective on the child's contribution.

Objective: The aim of the present study was to explore (1) how and with which specificity the young patient contributes to the visit; (2) the communicative-relational manner with which adults handle the child's interventions.

Methods: Ten videoed visits with patients aged 2-6 years were selected. A content and discourse analysis was realized.

Effects of a course on ophthalmologist communication skills: a pilot study.

Introduction: Although the issue of communication skills is now considered crucial for ophthalmology, no previous research has discussed training in this field. This study aimed to discuss the effects of a 16 hour communication skills course for ophthalmologists. In particular the study assessed the interest of participants with respect to the topic and the efficacy on participants' communication skills, at least in a laboratory setting.