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The nephrology and dialysis sector is characterized by a high technological content, considerable technological and digital complexity, continuous innovation within the care processes and a strong economic impact on the national and regional health system. The purpose of this article is to illustrate the application of the Health Technology Assessment (HTA) methodology in the evaluation of technological innovations in the nephrology and dialysis field. In particular, the evaluation steps of the multidimensional and multidisciplinary process applied to the nephrodialysis field will be described, specifically a device to be used in patients with chronic kidney disease, also considering important comorbidities such as cardiomyopathies and arrhythmias, which often require implantation of electronic cardiac implantable devices in renal patients. The HTA uses a rigorous scientific methodology, and today represents an essential tool for a governance of the modern health system, in which every innovative technological element that significantly modifies the organization must be evaluated. For this strategic reason, HTA becomes an important intervention for the dialysis sector, where technological innovations are a fundamental sector. For a precise understanding of the function of HTA in dialysis, a complete example of the application of HTA for the evaluation of a resorbable antibacterial device for the prevention of infections from cardiac implantable electronic devices on patients with high infectious risk has been shown, such as patients with chronic kidney disease., The nephrology and dialysis sector is characterized by a high technological content, considerable technological and digital complexity, continuous innovation within the care processes and a strong economic impact on the national and regional health system. The purpose of this article is to illustrate the application of the Health Technology Assessment (HTA) methodology in the evaluation of technological innovations in the nephrology and dialysis field. In particular, the evaluation steps of the multidimensional and multidisciplinary process applied to the nephrodialysis field will be described, specifically a device to be used in patients with chronic kidney disease, also considering important comorbidities such as cardiomyopathies and arrhythmias, which often require implantation of electronic cardiac implantable devices in renal patients. The HTA uses a rigorous scientific methodology, and today represents an essential tool for a governance of the modern health system, in which every innovative technological element that significantly modifies the organization must be evaluated. For this strategic reason, HTA becomes an important intervention for the dialysis sector, where technological innovations are a fundamental sector. For a precise understanding of the function of HTA in dialysis, a complete example of the application of HTA for the evaluation of a resorbable antibacterial device for the prevention of infections from cardiac implantable electronic devices on patients with high infectious risk has been shown, such as patients with chronic kidney disease.

The clinical condition experienced by dialysis patient affects his biopsychosocial functioning, as it alters his life rhythms, personal resources, and emotional ties, creating feelings of uncertainty for the future. This requires a complex process of psychological adaptation which often leads to the manifestation of two important expressions such as anxiety and depression. Music in support of conventional treatments promotes the care of the human being in all its aspects: physical, psychological, emotional, cognitive, social and spiritual as it represents a sort of “escape”, and allows a detachment from reality, albeit momentary. It acts as a regulator of emotions and mood, also creating beneficial effects on hemodynamic parameters such as blood pressure and heart rate. Furthermore, musical stimulations are able to stimulate pleasure by acting directly on the neuroanatomical structures responsible for attention, learning, thinking and behavior. The aim of this literature review is to describe the effect of music on anxiety and depression in patients undergoing haemodialysis in order to propose it as a therapeutic intervention during dialysis treatment., The clinical condition experienced by dialysis patient affects his biopsychosocial functioning, as it alters his life rhythms, personal resources, and emotional ties, creating feelings of uncertainty for the future. This requires a complex process of psychological adaptation which often leads to the manifestation of two important expressions such as anxiety and depression. Music in support of conventional treatments promotes the care of the human being in all its aspects: physical, psychological, emotional, cognitive, social and spiritual as it represents a sort of “escape”, and allows a detachment from reality, albeit momentary. It acts as a regulator of emotions and mood, also creating beneficial effects on hemodynamic parameters such as blood pressure and heart rate. Furthermore, musical stimulations are able to stimulate pleasure by acting directly on the neuroanatomical structures responsible for attention, learning, thinking and behavior. The aim of this literature review is to describe the effect of music on anxiety and depression in patients undergoing haemodialysis in order to propose it as a therapeutic intervention during dialysis treatment.

From the analysis of the national and international literature and considering the socio-demographic changes, it is necessary to rethink the organizational models capable of giving concrete answers to the new health and welfare needs of the population. The progressive increase of the elderly population and of people with at least one chronic disease and the SARS-CoV-2 pandemic have highlighted the need for a health and social system close to the population, which increases the territorial assistance, in particular at the patient’s home. Home care must become an elective place for prevention and health promotion activities. PNRR funds for proximity networks, telemedicine and innovation in the health field will enable assistance to be directed towards a new organizational and operational perspective, where the family and community nurse will play a key role. In the care of patients on home dialysis the evidence described in the literature reports the benefits of home hemodialysis treatment, in which the nurse of the family and community through his care skills, technical and psychological counselling, tele assistance and e-health can be integrated into the home care path, assisting the patient and the family unit and supporting them in the different health needs, especially in the quality of life outcome., From the analysis of the national and international literature and considering the socio-demographic changes, it is necessary to rethink the organizational models capable of giving concrete answers to the new health and welfare needs of the population. The progressive increase of the elderly population and of people with at least one chronic disease and the SARS-CoV-2 pandemic have highlighted the need for a health and social system close to the population, which increases the territorial assistance, in particular at the patient’s home. Home care must become an elective place for prevention and health promotion activities. PNRR funds for proximity networks, telemedicine and innovation in the health field will enable assistance to be directed towards a new organizational and operational perspective, where the family and community nurse will play a key role. In the care of patients on home dialysis the evidence described in the literature reports the benefits of home hemodialysis treatment, in which the nurse of the family and community through his care skills, technical and psychological counselling, tele assistance and e-health can be integrated into the home care path, assisting the patient and the family unit and supporting them in the different health needs, especially in the quality of life outcome.

This article has the aim of informing the reader about methodology and production of Clinical Practice Guidelines (CPG) and the instruments in order to be able to approach the whole process, from the production to the publication and distribution, but also to updated CPG. The importance of the issue is given by: 1) the need to avoid the CPG duplication, which is the reason of waste of resources and that raises confusion among users; 2) the need to ensure the independence of the experts involved and without conflict of interests; 3) the use of methodologies that respect the best quality standards; 4) the inhomogeneity of healthcare processes in the Italian territory and practices not based on scientific evidences; 5) the consultation and the commentary of stakeholders on the recommendations produced., This article has the aim of informing the reader about methodology and production of Clinical Practice Guidelines (CPG) and the instruments in order to be able to approach the whole process, from the production to the publication and distribution, but also to updated CPG. The importance of the issue is given by: 1) the need to avoid the CPG duplication, which is the reason of waste of resources and that raises confusion among users; 2) the need to ensure the independence of the experts involved and without conflict of interests; 3) the use of methodologies that respect the best quality standards; 4) the inhomogeneity of healthcare processes in the Italian territory and practices not based on scientific evidences; 5) the consultation and the commentary of stakeholders on the recommendations produced.

In recent years, the incidence rate of chronic diseases shows a steady increase in every industrialized Country. The almost logarithmic trend of the number of people living with chronic diseases is constantly on the rise. Each predictive statistical model indicates a strong impact for national health systems at the level of the organization of care and management costs. It is urgent to systematically introduce an evidence-based care model in chronic care management such as the Chronic Care Model. The Chronic Care Model is the reference model for WHO. The Chronic Care Model allows for personalized, holistic, multi-professional assistance, characterized by a strong humanization of care, by preventive interventions and relationships between healthcare professionals, patients and caregivers as a system of care and assistance. The fundamental roles are social integration and the improvement of the quality of life of patients. The Chronic Care Model involves the use of a computerized system of information flow and telemedicine and trained healthcare professionals. The Chronic Care Model showed an improvement in the quality of life, a reduction in the number of hospitalizations, a better adherence to therapies, and a reduction in costs., In recent years, the incidence rate of chronic diseases shows a steady increase in every industrialized Country. The almost logarithmic trend of the number of people living with chronic diseases is constantly on the rise. Each predictive statistical model indicates a strong impact for national health systems at the level of the organization of care and management costs. It is urgent to systematically introduce an evidence-based care model in chronic care management such as the Chronic Care Model. The Chronic Care Model is the reference model for WHO. The Chronic Care Model allows for personalized, holistic, multi-professional assistance, characterized by a strong humanization of care, by preventive interventions and relationships between healthcare professionals, patients and caregivers as a system of care and assistance. The fundamental roles are social integration and the improvement of the quality of life of patients. The Chronic Care Model involves the use of a computerized system of information flow and telemedicine and trained healthcare professionals. The Chronic Care Model showed an improvement in the quality of life, a reduction in the number of hospitalizations, a better adherence to therapies, and a reduction in costs.

The introduction of modern Information and Communication Technologies (ICT) was one of the most remarkable innovations of recent decades. ICT brings with it a remarkable technological background that conveys all kinds of information and multimedia content with a significant change in human-technology interaction and significant implications also in the health sector. The constant process of digitization is increasingly affecting national health systems (SSN) and they turn out to be influenced by the process itself, where the literature shows itself in favor of the use of technologies in health, improving their effectiveness and efficiency. These include eHealth, Telemedicine, Electronic Health File, Big Data, Virtual Reality, Augmented Reality, ePrescription. The technologies allow, even remotely, to have an always active and direct contact, between the various professionals, and between professionals and users, and are also useful for the training of both healthcare professionals and users themselves. The use of technology in the healthcare sector should therefore be encouraged as it allows direct contacts between users and healthcare personnel, speed and correlation of data analysis, tracking, time and cost savings, reduction of errors and a positive environmental impact with a reduction in the use of printed paper. For all the points listed, the technological revolution in hospital and territorial care can no longer be postponed., The introduction of modern Information and Communication Technologies (ICT) was one of the most remarkable innovations of recent decades. ICT brings with it a remarkable technological background that conveys all kinds of information and multimedia content with a significant change in human-technology interaction and significant implications also in the health sector. The constant process of digitization is increasingly affecting national health systems (SSN) and they turn out to be influenced by the process itself, where the literature shows itself in favor of the use of technologies in health, improving their effectiveness and efficiency. These include eHealth, Telemedicine, Electronic Health File, Big Data, Virtual Reality, Augmented Reality, ePrescription. The technologies allow, even remotely, to have an always active and direct contact, between the various professionals, and between professionals and users, and are also useful for the training of both healthcare professionals and users themselves. The use of technology in the healthcare sector should therefore be encouraged as it allows direct contacts between users and healthcare personnel, speed and correlation of data analysis, tracking, time and cost savings, reduction of errors and a positive environmental impact with a reduction in the use of printed paper. For all the points listed, the technological revolution in hospital and territorial care can no longer be postponed.

For some years now, the health care world has also been interested and influenced by issues related to immigration, integration, no integration, historical changes in our socio-anthropological field and cultural and linguistic differences; different worldviews and expectations, beliefs and non-evidence-based practices; prejudices and defense mechanisms for ethical and professional inability to care with patients with different cultures; scientific culture alongside a traditional and popular culture; little or no anthropological knowledge of many health professionals; improvised approaches to foreign patients, misunderstandings, tensions. The use of the cultural mediator is a very small part in the solution of the problem. Cross-cultural assistance represents the solution and it is a model, a discipline, a communication that allows an appropriate health care based on the cultural differences of the patients.

As a consequence of the Sars-CoV2 pandemic, the role of telemedicine in the healthcare sector was reviewed in order to ensure continuity of care and to contain infections. This new frontier involves professionals, caregivers, patients and can be applied in various fields, such as surgery, specialist visits, follow-ups, home care, health education, prevention and monitoring. Despite privacy may seem a deterrent for the implementation of this new goal in the healthcare sector, the community and the national legislation both provide rules to protect individuals and the community. This innovative method of assistance brings with it limits that must not detract attention from the great possibilities arising from the use of telemedicine., As a consequence of the Sars-CoV2 pandemic, the role of telemedicine in the healthcare sector was reviewed in order to ensure continuity of care and to contain infections. This new frontier involves professionals, caregivers, patients and can be applied in various fields, such as surgery, specialist visits, follow-ups, home care, health education, prevention and monitoring. Despite privacy may seem a deterrent for the implementation of this new goal in the healthcare sector, the community and the national legislation both provide rules to protect individuals and the community. This innovative method of assistance brings with it limits that must not detract attention from the great possibilities arising from the use of telemedicine.

The following study is original respect to the scientific panorama in fact, through a literature review that uses a qualitative metasynthesis method and follows the aggregative or meta-aggregative approach of the Joanna Briggs Institute, it returns to the reader 3 main results: the Anguish for an imminent death, the relationship with the body, sexuality, pain and dimension of the person, and the Perception of time and existentialism. Reflecting on the “philosophical state or philosophy of the patient in dialysis treatment” through these 3 macro-themes means investigating in depth the words of the patients, extrapolating their feelings, fears and worries, so as to understand their overall view of life and illness even in the most veiled aspects. Finally, the reflection will be used to direct the care of professionals towards a real and meaningful appointment of the dialysis patient. All thanks to the philosophy that goes beyond the methodology of research and evaluation of data, through the interpretation, direction and demonstration of the concept of limit, as an intrinsic part of man, disease and science. (Humanization), The following study is original respect to the scientific panorama in fact, through a literature review that uses a qualitative metasynthesis method and follows the aggregative or meta-aggregative approach of the Joanna Briggs Institute, it returns to the reader 3 main results: the Anguish for an imminent death, the relationship with the body, sexuality, pain and dimension of the person, and the Perception of time and existentialism. Reflecting on the “philosophical state or philosophy of the patient in dialysis treatment” through these 3 macro-themes means investigating in depth the words of the patients, extrapolating their feelings, fears and worries, so as to understand their overall view of life and illness even in the most veiled aspects. Finally, the reflection will be used to direct the care of professionals towards a real and meaningful appointment of the dialysis patient. All thanks to the philosophy that goes beyond the methodology of research and evaluation of data, through the interpretation, direction and demonstration of the concept of limit, as an intrinsic part of man, disease and science. (Humanization)

Art can be a way, together with Nature, to intercept that landscape and inner climate characterized by the rhythm of silence. That dimension of iridescent calm imbued with creative and vital energy, which pushes towards a universal, seductive, profound sphere. Man can, with courage, abandon himself in this harmony and melody of thoughts that suggest a vast and visionary possibility. Each person has the inner possibility to be Art, to get out of the continuous distortions of daily life, to produce a metamorphosis of one’s life. Art triggers the unconscious side of seeing, a rhythmic, dynamic principle, on which every gesture of maximum spontaneity depends, not touched by the artificial, by masks of fugacity and by false personalities. Without Art, it seems that part of real life is missing. The deep artistic power is fluid, without space or time, pulsating with new forms and substance and creating a new personal identity, contiguous to the real world, which inspires new desires. Many diseases of today and yesterday are produced by the lack of expressiveness or by the repression of personal creativity. Art produces well-being because it is the transformation of unconscious expressive energies, so life for our health., Art can be a way, together with Nature, to intercept that landscape and inner climate characterized by the rhythm of silence. That dimension of iridescent calm imbued with creative and vital energy, which pushes towards a universal, seductive, profound sphere. Man can, with courage, abandon himself in this harmony and melody of thoughts that suggest a vast and visionary possibility. Each person has the inner possibility to be Art, to get out of the continuous distortions of daily life, to produce a metamorphosis of one’s life. Art triggers the unconscious side of seeing, a rhythmic, dynamic principle, on which every gesture of maximum spontaneity depends, not touched by the artificial, by masks of fugacity and by false personalities. Without Art, it seems that part of real life is missing. The deep artistic power is fluid, without space or time, pulsating with new forms and substance and creating a new personal identity, contiguous to the real world, which inspires new desires. Many diseases of today and yesterday are produced by the lack of expressiveness or by the repression of personal creativity. Art produces well-being because it is the transformation of unconscious expressive energies, so life for our health.

Following the pandemic state, produced by the infection with the new coronavirus SARS-CoV-2, and the consequent state of health emergency, it is considered scientifically important to propose an update on ongoing clinical pharmacological trials, the most advanced international projects in the innovation sector and the most important statistical mathematical approaches to use a model for predictive purposes. In Italy there are several experimental molecules subjected to rigorous RCT studies approved by AIFA. In the Research & Development sector, the CERN in Geneve with the “CERN against COVID-19 project” represents the most advanced innovation, while in predictive statistical techniques, the mathematical model with wavelet approach allows to predict variables such as the persistence of the virus or to calculate the probability of transmission, strategic information for health planning., Following the pandemic state, produced by the infection with the new coronavirus SARS-CoV-2, and the consequent state of health emergency, it is considered scientifically important to propose an update on ongoing clinical pharmacological trials, the most advanced international projects in the innovation sector and the most important statistical mathematical approaches to use a model for predictive purposes. In Italy there are several experimental molecules subjected to rigorous RCT studies approved by AIFA. In the Research & Development sector, the CERN in Geneve with the “CERN against COVID-19 project” represents the most advanced innovation, while in predictive statistical techniques, the mathematical model with wavelet approach allows to predict variables such as the persistence of the virus or to calculate the probability of transmission, strategic information for health planning.

The contemporary social context shows a profound need to bring healthcare back to a meeting between the technical-organizational needs of the system and the needs for global understanding of the patient. The passage from the “patient” vision to a “person” perspective is the radical request for paradigmatic and operational change to be implemented to respond to new needs, trends and socio-cultural changes. Recent literature shows that the Newtonian-Cartesian reduction of the human being to biomachine, which still resists the culture and unconscious of many health professionals, is no longer justified from a scientific point of view. The conceptual model, the framework of the most advanced sciences is the holistic one. This model lays the foundations for a better understanding of the functioning of the human being and consequently for a new epistemological and anthropological vision, that of the bio-psycho-socio-cultural network, where interaction with the environmental context influences the feedback of this system. It seems fundamental to start a structured path of synergy between the humanization of care and its gradual implementation, for the improvement of the quality of life of nephrological patients and for a new clinical-assistance background for the health workers who work daily in nephrology, dialysis and transplantation., The contemporary social context shows a profound need to bring healthcare back to a meeting between the technical-organizational needs of the system and the needs for global understanding of the patient. The passage from the “patient” vision to a “person” perspective is the radical request for paradigmatic and operational change to be implemented to respond to new needs, trends and socio-cultural changes. Recent literature shows that the Newtonian-Cartesian reduction of the human being to biomachine, which still resists the culture and unconscious of many health professionals, is no longer justified from a scientific point of view. The conceptual model, the framework of the most advanced sciences is the holistic one. This model lays the foundations for a better understanding of the functioning of the human being and consequently for a new epistemological and anthropological vision, that of the bio-psycho-socio-cultural network, where interaction with the environmental context influences the feedback of this system. It seems fundamental to start a structured path of synergy between the humanization of care and its gradual implementation, for the improvement of the quality of life of nephrological patients and for a new clinical-assistance background for the health workers who work daily in nephrology, dialysis and transplantation.

Death is incurable. It precedes, transcends and overcomes any possibility of cure. Medicine cures, but leaves man's fundamental event, his death, without cure. After a lifetime of treatment, everyone dies, even those who have used all kinds of treatments, so as not to die. Molecules, surgery, nuclear medicine, technology is not and will never be adequate for death. What can be appropriate for death? Not the escape, but the awareness of its existence, in every minute of the short earthly passage. But how? Man has always used artistic expression, not science, as a way of seeing death. Literature, cinema, theater are human inventions that go through death, and in this article we expose some artistic productions that cure our existence from the "Incurable".

Background: Nurses guarantee assistance using different nursing theories, which present different conceptual frameworks, but which have a common vision in the whole of the human being, his holistic needs and the connection with the environment. Florence Nightingale was the first to introduce aspects of the scientific method, structuring a theory focused on the connection between the management of the physical environment and the actions of nurses. Methods: The aim is the evaluation of Nightingale's theory in reference to its contemporary integration, through a narrative review of the literature. Results: The action of nurses on the environment according to Nightingale's theory in care settings and hand hygiene are identified as fundamental in the fight against the spread of infections and in the implementation of the holistic vision. Discussion: Nightingale's theory shows elements of applicability and modernity, such as the acquisition of a greater awareness of healthcare professionals in relation to the care of environments and hand hygiene. Conclusions: Florence Nightingale's theory presents aspects of validity, but further studies are needed to contribute to the evolution of her model, especially in its contemporary contextualization., Background: Nurses guarantee assistance using different nursing theories, which present different conceptual frameworks, but which have a common vision in the whole of the human being, his holistic needs and the connection with the environment. Florence Nightingale was the first to introduce aspects of the scientific method, structuring a theory focused on the connection between the management of the physical environment and the actions of nurses. Methods: The aim is the evaluation of Nightingale's theory in reference to its contemporary integration, through a narrative review of the literature. Results: The action of nurses on the environment according to Nightingale's theory in care settings and hand hygiene are identified as fundamental in the fight against the spread of infections and in the implementation of the holistic vision. Discussion: Nightingale's theory shows elements of applicability and modernity, such as the acquisition of a greater awareness of healthcare professionals in relation to the care of environments and hand hygiene. Conclusions: Florence Nightingale's theory presents aspects of validity, but further studies are needed to contribute to the evolution of her model, especially in its contemporary contextualization.

BACKGROUND: Autosomal dominant polycystic kidney disease is the most common inherited renal disease and affects less than 1 every 400-1,000 people. There are many effective treatments, including blood pressure management, physical activity, low sodium diet and hydration. Therapeutic education is part of a patient’s care and treatment. This approach is an essential strategy in order to face the current healthcare scenario, in which the number of people affected by chronic diseases is progressively increasing. OBJECTIVES: This article aims to analyze the effect of therapeutic education in patients with ADPKD, the level of adherence to pharmacological therapy and their compliance to dietetic and lifestyle recommendations as part of a nursing-led education. METHODS: This is a prospective, longitudinal, observational pilot study. The following measurements were used: Kidney Disease Quality of life - Short Form, Hospital Anxiety and Depression Scale, Body Uneasiness Test. At the T0 visit, a nurse selected patients and carried out a personalized educational intervention with the aims of adhering to drug therapies, monitoring blood pressure and dietary behavior (physical activity and water intake). At the T1 visit, patients performed psychological tests. At the T2 visit, the following evaluations were performed: a psychological interview together with the delivery and evaluation of the tests performed, an interview with the nurse to evaluate the adherence to the prescriptions, and a control of parameters such as physical activity, diet, water intake, drug therapy, and blood pressure. RESULTS: Therapeutic education can have a positive impact on patients’ health by improving adherence to the pharmacological therapy, diet and lifestyle. CONCLUSIONS: Therapeutic education improve the patient’s knowledge, treatments and correct behaviors as well as promotes an independent management of the disease. Through an educational intervention, the patient acquires the ability and the awa