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An anthropologist's approach to patient engagement is different from that of other professionals. An anthropologist is used to asking himself apparently trivial questions that help deconstruct cultural constructs. In his work, narrative medicine has a fundamental importance: it is a clinical-assistance intervention methodology that allows you «to acquire, understand, integrate the different points of view of those involved in the disease and in the treatment process» (Italian Health Institute). Digital technologies help integrate psychosocial components with biological and clinical ones, allowing a matching between the patient and the doctor free from the tight spaces and times of the clinic.

Objectives We implemented narrative medicine in clinical practice using the Digital Narrative Medicine (DNM) platform. Methods We conducted a preliminary, open, uncontrolled, real-life study in the oncology and radiotherapy departments of Istituto di Ricovero e Cura a Carattere Scientifico National Cancer Institute Regina Elena, Rome, Italy. We recruited adult Italian-speaking patients who then completed the DNM diary from the start of treatment. The primary endpoint was DNM feasibility; secondary endpoints were health care professionals’ opinions about communication, therapeutic alliance, and information collection and patients’ opinions about therapeutic alliance, awareness, and coping ability. We used open- and closed-ended questions (scores 1 to 5) and a structured interview. Results Thirty-one patients (67%) used the diary (84% women). Health care professionals’ mean scores for feasibility and utility were ≥4.0. Patients’ utility scores were related to health care professionals’ feedback regarding the narratives. The main advantages for health care professionals were the opportunity to obtain relevant patient data and to strengthen communication and patient relationships (mean scores 4.4–5.0). Both groups strongly encouraged introduction of the diary in clinical practice. Conclusion Use of the DNM in oncology patients assisted clinicians with understanding their patients experience.

Narrative medicine makes explicit the experience of disease and enhances the subjective view in the cure. In addition, the narrative approach involves personal experience and emotional resonances of the health care professional leading him to redefine the values in terms of health and disease. The IMPERO study aims to explore the personal "life experience" of health care professionals involved in studies exploring a new methodological clinical approach: the use of a digital narrative diary in collecting and integrating theme-oriented narration in clinical practice.Qualitative study based on the interviews of three health care professionals (two oncologists and one nurse) involved in the AMENO study. The main topic of the interviews was the "perceived" and the intimate experience of each health care professional, particularly on the meaning and the role regarding their personal and professional experience while coping with patients narration. The analysis of data focuses on three aspects: a) the health care professionals' point of view using the diary as a tool for narrative-based medicine; b) the work environment as a framework for the use of the digital diary; c) the mental construction concerning the meaning of the tool and its preliminary use in clinical practice.The diary is appreciate as a tool for the application of narrative-based medicine; the reading/writing format is considered of high quality and suitable for clinical practice processes. The narration drives a change in the patient-health care professional relationship: the patient is valued as an "individual". An atmosphere of empathy and greater intimacy is created. The perceptions developed over the years of clinical practice, which reflect personal and professional concepts (knowledge and individual believes in illness, health, healing, etc.), influence the perception of the narrative instrument and its clinical use. The work context influences the use of the diary, limiting its potential. Narrative medicine is a way of reorganizing the criteria that contribute in defining the quality of patient care by focusing on the patient-health care professional relationship.The approach of narrative medicine must be reviewed in the light of the relational systemic theory which allows us to understand several aspects: the training in narrative medicine itself, the acquisition of professional skills by practitioners, and the organizational development of the institutions (the organizational structures but also the values and professional culture of work).

Among neurological conditions, epilepsy is the disorder best suited to a narrative approach. In epilepsy, the disease, i.e., the condition from the clinical and therapeutic point of view, the illness, the personal experience and impact of the condition, and the sickness, the representations, and social imaginary of epilepsy, are strongly interdependent. Within this context, the Italian League Against Epilepsy (LICE) has launched a multiyear narrative program in Italy resulting in the foundation of a specific Study Group on Narrative Medicine in Epileptology. The Epimena Study is part of this program and involves the “Epilepsy Center, Department of Human Neurosciences, Sapienza University of Rome and Umberto 1° Hospital”. The study consists of a pilot project whose aim is to assess the usefulness and feasibility of integrating narrative medicine methodologies into routine clinical practice through a digital platform. The carrying out of the study is based on the acquisition of narrative elements of the patient that the referring doctor uses, integrating them with clinical data, to share and customize the diagnostic–therapeutic pathway of patients. The Epimena Study preliminary results look encouraging. Over 12 months, 57% of the invited patients (37 out of a total of 65) decided to formalize their registration in the digital diary, and 46% responded to one or more narrative prompt generating the story of their experience. Every patient story was then analyzed according to a methodology (Illness Digital StoryMap - IDS) that made it possible to detect the existential impact of the disease and the perception of care. Patients' overall judgment on the project was positive. Through it, they were able to better focus on themselves, bringing out and communicating information to the physician that otherwise would not have been taken into consideration. The majority of patients involved believe that the methodology should be included in the regular clinical practice or in any case would like to continue using it. The data collected confirmed that the time spent on story sharing contributed objectively to a clinical practice of greater quality and effectiveness.

The SOCEUS survey aims to evaluate how contrast-enhanced ultrasound (CEUS) is effectively used in the focal liver lesions characterization.In the survey were involved Verona, Brescia and Trieste Radiological Centers and Arezzo and Bologna Non-radiological Centers. Inclusion criteria were liver focal lesion detection at conventional ultrasound and studied by means of CEUS, with or without CT or MRI examinations, done previous or subsequent to CEUS.1069 forms were collected. Patients with benign lesions, who did not undergo any other studies, were 255/561 (45.5 %). Among patients with diagnosis of hemangioma at CEUS, those who had no other investigations were 129/267 (48.3 %). Patients with malignant lesions who had studies pre-CEUS (CT and/or MRI) were 328/508 (65 %), whereas those who had examinations post-CEUS (CT and/or MRI) were 218/508 (42.9 %). Concordance rate between CEUS and CT investigations pre- and post-CEUS was, respectively, 66 and 89 %. Concordance rate between CEUS and MRI studies pre- and post-CEUS was, respectively, 87.5 and 81.5 %.This study proves contrast-enhanced ultrasound correct application in the involved centers.Il sondaggio SOCEUS ha lo scopo di valutare come l’ecografia con mezzo di contrasto sia effettivamente impiegata nella caratterizzazione delle lesioni focali epatiche.Nel sondaggio sono tati coinvolti i centri radiologici di Verona, Brescia e Trieste e i centri non radiologici di Arezzo e Bologna. I criteri di inclusione sono stati la presenza di lesione focale epatica all’esame ecografico convenzionale studiata con ecografia con mezzo di contrasto, con o senza correlazione TC or RM, prima o dopo l’esame ecografico.Sono state raccolte 1069 schede. I pazienti con lesioni benigne che non hanno fatto altri esami sono stati 255/561 (45.5 %). Dei pazienti con diagnosi di angioma alla ecografia con mezzo di contrasto, quelli che non hanno eseguito altre indagini sono stati 129/267 (48.3 %). I pazienti con lesioni maligne sottoposti ad indagini pre-ecografia con mezzo di contrasto (TC e/o RM) sono stati 328/508 (65 %), mentre quelli che hanno eseguito esami post- ecografia con mezzo di contrasto (TC e/o RM) sono stati 218/508 (42.9 %). La concordanza tra ecografia con mezzo di contrasto ed esame TC pre- e post-ecografia con mezzo di contrasto sono rispettivamente state pari al 66 e 89 %. La concordanza tra l’ecografia con mezzo di contrasto e l’esame RM pre- e post-ecografia con mezzo di contrasto sono state rispettivamente di 87.5 e 81.5 %.Lo studio prova che l’ecografia con mezzo di contrasto è utilizzata correttamente nei Centri valutati.