[Proposal for informed consent for the 'differentiated autonomy' experiment]. / Proposta di consenso informato per la sperimentazione dell'autonomia differenziata.

. Proposal for informed consent for the 'differentiated autonomy' experiment. Differentiated regional autonomy means the power given to the 15 ordinary Regions - the 5 special Regions are excluded - to obtain regulatory and management competences in areas that are today regulated and administered by the State. Although differentiated autonomy is bad for the entire country - which risks losing its ability to implement economic, social, environmental, and cultural policies at a national level - there is no doubt that the Southern Regions will pay the heaviest price for its implementation, since they are already far behind and penalised compared to the North, with a worsening of all the health parameters, such as: reduction in life expectancy, increase in avoidable mortality, increase in mortality, increase in trips of hope to seek treatment in the North, and more. But the North will also have its problems, with poorer areas even within the richest regions and in the urban peripheries. And if the idea of solidarity, contained in the Constitution, is rejected, it is easy to move from competition to conflict, not only between North and South but also within the Regions.

[Indicators and outcomes associated with the quality of care: how to use them and interpret results]. / Indicatori ed esiti associati alla qualità dell'assistenza: come usarli e come interpretare i risultati.

. Indicators and outcomes associated with the quality of care: how to use them and interpret results. Outcomes related to care (or nursing sensitive outcomes) such as pressure ulcers, failure to rescue, accidental falls are specific patient outcomes influenced by nursing care. They are used to monitor the quality of care and patient safety in hospitals across the country. However, their association with nursing care is not always clear, and the attention should be focused on avoidable events. From the following issue a reflection on the main indicators will be proposed with some hints on how to collect data and interpret the results.

[Oral cavity care and tooth brushing: useful for which patients?] / La cura del cavo orale e lo spazzolamento dei denti: utile per quali pazienti?

A recent meta-analysis emphasised the importance (and effectiveness) of tooth brushing in preventing hospital-acquired pneumonia. The results of the study are briefly reported and commented on.

[The grammar of the squares]. / La grammatica della piazza.

. The grammar of the squares. The yearly celebration of the international day against gender violence has been transformed in Italy, because of a particularly dramatic assassination of a young woman into a country-wide 'invasion' of the squares of the big and small cities and communities. Among the many comments and reports, a well-known young woman writer has produced a stimulating reflection which is especially suggestive as a methodological contribution for many aspects of nursing research. To understand, describe, look for changes of scenarios and values of life which are the expression of deep and contradictory components of the culture of a society, general principles and neutral roles of observers (so often advocated as normative rule for the production of knowledge) can be profoundly misleading. Only a direct, highly participatory, emotional involvement in the reality could be the appropriate methodology: a grammar and languages generated from and within the places, the times, the revolt, the desires of the collectivities who are involved.

[Visiting hospitalized loved ones: a right of family members and patients]. / La visita ai propri cari ricoverati: un diritto dei familiari e dei pazienti.

. Visiting hospitalized loved ones: a right of family members and patients. In hospitals and nursing homes, regulations apply different limitations to family visits: from a total ban even for critical and/or terminal patients, or in the delivery room (new mothers give birth alone), to limiting the number of visitors (one at a time) or the type (immediate family members only), to the time for the visit (a maximum of 10 to 45 minutes); other facilities allow access for critical and/or end-of-life patients. It is time to return to pre-covid normality. The patient has the right to be accompanied, by the people who matter to her/him; the presence of family members next to the patient is not a concession but a concrete expression of the respect and attention due to the patient and his/her dignity as a human being. To continue the debate on family visits to hospitalised loved ones, we publish two letters/appeals. One, from the relatives of nursing home residents, hospitalised and dead during the pandemics, without any contact with their relatives (edited by Anchise Comitato Nazionale Famiglie RSA RSD Sanità), which in sometimes very harsh, but hardly contestable tones, at the end of August 22 launched an appeal (which is still little heeded) to the future government, to reopen the doors of hospitals and nursing homes. The other, a press release of December 2022, from the Nursing College of Trento, reaffirms the importance of family visits as a right and responsibility to guarantee the care and caring of the person being cared for, recalling the attention and responsibility of nurses, who should consider a fundamental care to be able to care for patients with the closeness of the family.

[Does sleep flush wastes from the brain?] / Il sonno elimina ciò che è inutile dal cervello?

. Does sleep flush wastes from the brain? Sleep is vital across all species, and sleep deprivation has detrimental consequences for the organism. Sleep, but not wakefulness, seems to allow removal of waste metabolites from the brain, clearing the brain from the potential neurotoxic waste products that accumulate during wakefulness. The wastes are removed by cerebrospinal fluid transport, the 'glymphatic system', named after its dependence on the glia, and the resemblance with the lymphatic system in peripheral tissues. A brief synthesis of the new discoveries and their implications for the understanding of sleep functions and mechanisms is presented.

[Nurses and the new reform: is there space and resources for nursing care?] / Infermieri e PNRR: ci sono davvero spazi e risorse per l'assistenza?

. Nurses and the new reform: is there space and resources for nursing care? INTRODUCTION: The National reform for recovery and resilience (PNRR) may represent a unique opportunity for the development of the nursing profession. OBJECTIVE: A group of colleagues was asked to comment on the positive and critical aspects of the PNRR. METHODS: Questions or points for reflection were proposed: if and how the nurses'role is recognised and promoted in the redesigned National Healthcare System; the real attention to the continuum of care and to the actual fragmentation of social and health services in community care; if Mission 6: Health devotes sufficient attention and funding to the needed increase in the number of health professionals in the health care services and to the development of new skills. Everyone was free to choose which question to answer or could send free reflections. RESULTS: In addition to the positive aspects, a number of critical points and areas to be better defined were highlighted, for example, the need for more nurses requires investment in training; greater clarity is needed regarding the chain of coordination of home care and district services (who, how, whether public or private). CONCLUSIONS: It is important to continue paying attention, monitoring and speaking out to ensure that European funding enhances district, and public, care. And a key point to reach this aim is also the strengthening of the nursing care networks.

[Insulin: a story 100 years long]. / L'insulina: una storia lunga 100 anni.

. Insulin: a story 100 years long. Part of the November 13 issue of the Lancet was devoted to insulin, which this year celebrates 100 years since its discovery. In this issue, we report a of the main contributions both to illustrate the history, but also to highlight the emblematic path-not only for insulin-of drug pricing, which severely limits its accessibility to those who need it most.

[We were told "everything will be all right", but we were afraid]. / Ci dicevano "andrà tutto bene" ma avevamo paura.

. We were told "everything will be all right", but we were afraid. INTRODUCTION: During the pandemic, the elderly were an at-risk group. OBJECTIVE: To explore how older people >65 years lived through the pandemic. METHODS: Questionnaire available online for all members of the Italian Pensioners' Union of the CGL Lombardy, which explored the state of health, activities carried out, contacts with the doctor, psychological conditions. RESULTS: 1480 people responded, in good health and with a good level of schooling. Half did not change their habits during the pandemic. For 2/3 the psychological well-being did not change, with a substantially positive vision of the future, even if 64% reported having had stress symptoms. The aspect that was missing the most, as expected, was not being able to see their families. A very common feeling (60% of respondents) was a sense of isolation and abandonment. CONCLUSIONS: As shown in other papers, older people do not seem particularly at risk of psychological problems during the pandemic.