[Psychological interventions in hospital during the first-wave of CoViD-19: an overview of the experiences of the Units of Clinical Psychology in Lombardy, Italy.] / Interventi psicologici in ospedale ai tempi della CoViD-19: una panoramica delle realtà proposte dalle Unità Operative di Psicologia (UOPSI) della Lombardia.

The current CoViD-19 pandemic threatens both physical and psychological well-being. According to the bio-psycho-social model, Units of Clinical Psychology of the Hospitals in Lombardy (Italy) reacted to this risk, offering diversified interventions, described in the present contribution. The medical staff operated on the front line during the emergency: psychologists addressed their needs through individual clinical work, sessions of decompression and debriefing. At the same time, Units of Clinical Psychology supported the hospitalized positive patients by conducting psychological consultations, either on the ward or through devices. Moreover, some hospitals activated helplines to address the needs of the population and family members, who were particularly vulnerable during the relative's illness and after the mourning.

[The look into the look: how patients' suffering is perceived by health workers]. / Lo sguardo nello sguardo: la sofferenza del paziente nel vissuto dell'operatore.

The literature about the surgical treatment of the urologic patient shows an increased attention to the outcome measures related to the quality of life and satisfaction of the treated subject. In this context, a crucial position must be attributed to the quality of the relationships among all the subjects involved in the therapeutic process, and especially among caregivers and patients. Cognitive and emotional dimensions play an important role at this regard, to which a spread sensitivity as for the "local culture" of care must correspond. The aim of this study is to identify the health workers' perception and representation of the cognitive and emotional needs of the patients and their relationship with the organizational complexity of the department. The study was implemented in the Urology Department of the Ospedali Riuniti in Bergamo. It involved eleven health workers (two medical doctors and nine nurses). Each of them underwent a semi-structured interview. The anonymous interview transcripts were analyzed using the T-Lab thematic content analysis program. The study highlighted sensitive areas such as: informative dialogue with the patient, reactivity facing the intervention according to gender, the subject's self-adapting process to the clinical environment and the organizational functioning of the department. The health workers' need of new approaches to meet the needs of the subjects under treatment and their family is underlined. Furthermore, the requirement of consistent functional organizational changes to improve the quality of relationships in the process of care is pointed out. The health workers reported both critical situations, efforts, perceived difficulties and important relational resources to face them.

End-of-life decision-making and quality of ICU performance: an observational study in 84 Italian units.

PURPOSE: To appraise the end-of-life decision-making in several intensive care units (ICUs) and to evaluate the association between the average inclination to limit treatment and overall survival at ICU level. DESIGN: Prospective, multicenter, observational study, lasting 12 months. SETTING: Eighty-four Italian, adult ICUs. PATIENTS: Consecutive patients (3,793) who died in ICU or were discharged in terminal condition, in 2005. MEASUREMENTS: Data collection included patient description, treatment limitation and decision-makers, involvement of patients and relatives in the decision, and organ donation. A logistic regression model was used to identify predictors of treatment limitation and develop a measure of the inclination to limit treatment for each ICU. This was compared with the standardized mortality ratio, an index of the overall performance of the unit. RESULTS: Treatment limitation preceded 62% of deaths. In 25% of cases, nurses were involved in the decision. Half the limitations were do-not-resuscitate orders, with the remaining half almost equally split between withholding and withdrawing treatment. Units less inclined to limit treatments (odds ratio <0.77) showed higher overall standardized mortality ratio (1.08; 95% confidence interval: 1.04-1.12). LIMITATIONS: The voluntary nature of participation, with self-selected ICUs from a self-selected independent network. CONCLUSIONS: Treatment limitation is common in ICU and still principally a physician's responsibility. Units with below-average inclination to limit treatments have worse performance in terms of overall mortality, showing that limitation is not against the patient's interests. On the contrary, the inclination to limit treatments at the end of life can be taken as an indication of quality in the unit.