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BACKGROUND Communication with families is crucial in ICU care. However, only a few residency programs include communication and relationship training in their curricula. This study aimed to assess the impact of a communication-skill course on residents' empathy and self-reported skills. MATERIAL AND METHODS A single-center, observational study was conducted. Since 2017, the 4th-year residents of the Anaesthesia and Intensive Care School, University of Milan attended the mandatory "Program to Enhance Relational and Communication Skills in ICU (PERCS-ICU)". PERCS-ICU lasted 10 hours and involved small groups of residents. The course was articulated around the simulation and debriefing of 3 difficult conversations with trained actors. Before and after the course, residents completed the Jefferson Scale of Empathy and a questionnaire measuring self-assessed preparation, communication skills, relational skills, confidence, anxiety, emotional awareness, management of emotions, and self-reflection when conducting difficult conversations. The quality and usefulness of the course and the case scenario were assessed on a 5-point Likert scales. RESULTS Between 2017 and 2019, 6 PERCS-ICU courses were offered to 71 residents, 69 of whom completed the questionnaires. After the course, residents reported improvements in empathy (p<.05), preparation (p<.001), communication skills (p<.005), confidence (p<.001), self-reflection (p<.001), and emotional awareness (p<.001). Residents perceived the course as very useful (mean=4.79) and high-quality (mean=4.58). The case scenario appeared very realistic (mean=4.83) and extremely useful (mean=4.91). All residents recommended the course to other colleagues. CONCLUSIONS PERCS-ICU proved to be a well-received and effective course to improve residents' empathy and some self-reported skills. The long-term effects remain to be investigated.

In every relief run, both to the goals of medical performance quality and in the optics of a therapeutic alliance, it is fundamental to create a relationship of trust among the physician and the patient, in which communication assumes a fundamental role. The informed consent is set as an integral part of the sanitary action as conclusive moment of that "therapeutic alliance" fundamental to face in a correct way every illness, and it legitimates the same sanitary action, as it is the demonstration of the constitutionally guaranteed right of patient's autodetermination. The A.O.U.D. of Udine has undertaken a run of accreditation to the Joint Commission International that it foresees a revision of the informative runs and an updating of the forms of informed consent, with the purpose to overcome the traditional physician-patient relationship, recognizing to all the patients an active role in the exercise of the medical action and in the care process. In fact the information must be lived as integral part of the sanitary action, with the awareness that this, private of such a part, would result incomplete and inaccurate, independently from the result. In such optics, the consent form, created absorbing legislative, ethical and deontological principles and jurisprudential orientations, will be illustrated and particular considerations about the type of information that must be given to the patient for treatments effected in day-surgery, will be formulated.

Preoperative planning of any surgical procedure, especially rhinoplasty, is crucial in order to achieve an optimal outcome which will satisfy both the surgeon and patient. Use of imaging and the possibility of virtually displaying the changes planned by the surgeon definitely lead to a better understanding between doctor and patient. Although these new technologies have led to undeniable advantages, they have also generated unprecedented medical and legal problems. The Authors discuss a number of reflections on the legal consequences of image digital processing, the problems related to the storage of such images, and the appropriate way to draft an informed consent.

The authors, in order to identify the causes of mortal poisonings by carbon monoxide in the domestic use of gaseous hydrocarbons and to evaluate the efficacy of the inherent law in force, in particular, the italian law 5 March 1990, n. 46, report 43 cases of mortal poisoning occurred in the Parma district and observed at the Istituto di Medicina legal of Parma University. The authors, for each of these cases, have pointed out responsibilities, causal factors and mechanisms, examining also judicial inquiries and, when possible, experts' technical reports. From the evaluation of the results of their researches, the authors, even if with some perplexity, judge the law in force as suitable to a correct prevention, but only on condition that the controls provided for in law, should be actually carried out. Finally, they evidence a lacking of publicizing about the mortal risk deriving from the non-observation of the legal regulations.