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Left ventricular assist devices (LVAD) are the most common mechanical circulatory support for patients with advanced heart failure, and can be used either as a temporary or permanent therapy. Normally, LVAD carriers show psychological distress related to the difficulties in adapting to their new clinical condition.This retrospective study aimed to analyze the quality of life of 21 patients after LVAD implantation and follow-up in a dedicated psychology outpatient clinic. The Short Form Health Survey (SF-36) was used to assess the quality of life, and the Hospital Anxiety and Depression Scale (HADS) to measure anxiety and depression levels. These constructs were examined according to the time of implant and their age, with correlational analyses.Outcomes seem to affect the quality of life of our population when compared with regulatory data, in terms of both physical health and mental health. Patient age was inversely related to the mental health index (Pearson's correlation coefficient -0.48, p0.05) and two subscales, i.e. "vitality" (Pearson's correlation coefficient -0.60, p0.05) and "mental health" (Pearson's correlation coefficient -0.44, p0.05). The most critical areas included physical pain and social limitations. The overall incidence of anxiety and depression was within normal limits according to the HADS test: LVAD patients supported for less than 1 year showed a lower incidence of anxiety compared with LVAD carriers supported for more than 1 year, while the incidence of depression was higher compared with LVAD carriers supported for more than 1 year.LVAD negatively impact physical and mental health, 'especially in older people; the scores obtained at SF-36, both for the physical health index and the mental health index, show lower average values than the regulatory standard. In addition, the depression levels vary based on the time elapsed from the date of implantation confirming the need for continuous monitoring of patients during treatment to prevent an increase of this index over the years. This patient subset requires continuing support and careful psychological monitoring, from preliminary assessment to LVAD implant, and later over the entire therapeutic process.

Background: This study aims to investigate the quality of life and the therapeutic compliance of the patients who received a liver transplant, from a living or deceased donor, at IRCCS ISMETT in the last three years. Liver transplantation is an effective therapeutic strategy for patients with end-stage liver failure. The quality of life (QOL) of liver disease patients is placed under considerable stress due to the debilitating clinical conditions and related issues experienced in everyday life by these individuals. The concept of QOL is being increasingly used to define the individual perception of health, including physical, mental, and social wellbeing. The success of a liver transplant should therefore be intended not only in terms of survival, but also of recovery of a satisfying quality of life. For this reason, our liver transplant recipients are closely monitored and supported from a psychological standpoint. This is done to monitor their ability to adapt to and comply with their clinical condition and to verify their gradual resumption of their path of life Methods: We retrospectively analyzed data collected by the IRCCS ISMETT Clinical Psychology Service during routine psychological follow-up of liver transplant recipients. Data refer to 82 patients who received a liver transplant between January 2017 and September 2019 and describe their QOL and therapeutic adherence. The obtained results were compared with the main studies on this issue available in literature. Results: Ninety-four percent of liver transplant recipients reported high mean scores of quality of life and therapeutic adherence 28% of patients reported at least one persistent annoying symptom after transplantation, although in some cases this did not affect the overall QOL. The results also refer to patients with a pre-transplant diagnosis of alcohol-related cirrhosis, who confirm their complete abstinence from alcohol. Conclusions: Our results confirm the efficacy of the liver transplantation to achieve of a good QOL. Furthermore, these patients seem to maintain high therapeutic adherence, thus ensuring a good outcome of the care received during the transplantation process.

The need for patients with a chronic kidney failure and on dialysis to embark on a kidney transplant process, poses the challenge to identify alternative and effective surgical strategies to overcome the insufficient number of deceased donors. The purpose is to allow the considerable number of patients on the kidney transplant waiting lists to receive appropriate treatment in time and under the most favorable clinical conditions. Living donation from a significant other is becoming increasingly widespread, on a national and international level. Furthermore, in the last years clinical experience is showing a special kind of kidney living donation : the Good Samaritan donation, i.e. when the donor has no emotional or blood bond with the recipient and decides to become a donor as a mere act of generosity, with no remuneration or reward in return. This article, after a brief analysis of the phenomenon through data obtained from recent international studies, shares the direct experience of the Clinical Psychology Service at IRCCS - ISMETT with regard to the psychological assessment and support throughout the clinical process of a Good Samaritan kidney donor. Sharing our experience and starting a discussion on this issue is the result of the need to define shared guidelines on the psychological approach to be used with potential Good Samaritan donors.

Health care workers need artificial intelligence. Artificial intelligence is a set of studies and techniques that tend to the realization of machines, which solve complex problems automatically, simulating or emulating human intelligence activities. Human intelligence is innate, creative, emotional, sporting, social in the collective and connected future. Knowledge is the faculty, act, mode, effect of taking possession, intellectually or psychologically, with systematic activity of any certain aspect of reality. The dates are given in the form of text, number, symbol, image, sounds that are used or stored in computers. Having many data or data does not mean having much information. Having a lot of information does not mean having a lot of knowledge. Symbolic reasoning uses symbolic logic, logical connectives, expert systems, production rules, genetic algorithms, validation, explanation, justification, verification of inference, heuristic research. The knowledge of symbolic reasoning is deterministic. Machine learning is the field of study that gives computers the ability to learn without being programmed to do so. Use algorithms for statistical and probability calculations, the learning phases may not be verifiable. They are mathematically structured human opinions, spoiled by the pre -understandings of those who design them, of those who want to look for something. The association between symbolic reasoning and automatic learning is excellent. The intelligence of health workers work connected and collective, develop knowledge bases to be subjected to symbolic reasoning, expert systems and rules to have deterministic knowledge. The deterministic knowledge subsequently elaborated by artificial intelligence will be returned to human intelligences.

Purpose Between 2000 and 2012, the incident dialysis population in the United States increased by nearly 60%, most sharply among adults 75 years and older. End-of-life (EOL) conversations among dialysis patients are associated with better patient-centered outcomes and lower use of aggressive interventions in the last month of life. This study examined how health literacy may affect engagement, comprehension, and satisfaction with EOL conversations among elderly dialysis patients. Design and methods Qualitative/descriptive study with semi-structured interviews about health literacy, EOL conversations, and goals of care with 31 elderly dialysis patients at 2 centers in Boston. Themes were interpreted in the context of Nutbeam's health literacy framework. Results Despite high mortality risk in this population, only 13% of patients had discussed EOL preferences with physicians, half had discussed EOL with their social network, and 25% of participants explicitly stated that they had never considered EOL preferences. Less than 30% of participants could correctly define terminology commonly used in EOL conversations. Analyses yielded 5 themes: (1) Misunderstanding EOL terminology; (2) Nephrologists reluctant to discuss EOL; (3) Patients conforming to socially constructed roles; (4) Discordant expectations and dialysis experiences; and (5) Reconciling EOL values and future care. Patients had limited understanding of EOL terminology, lacked of opportunities for meaningful EOL discussion with providers and family, resulting in uncertainty about future care. Implications Limited health literacy presents a substantial barrier to communication and could lead to older adults committing to an intensive pattern of care without adequate information. Clinicians should consider health literacy when discussing dialysis initiation.

In terapia, la coppia coterapeutica č coinvolta in un gioco di rispecchiamenti che evidenzia l'esistenza di isomorfismi all'interno dei sistemi di cui fa parte: coterapeutico, terapeutico, famiglia d'origine, terapeuta/partner e sistema di supervisione. Ne consegue che la differenziazione del terapeuta influenza le relazioni dei sistemi di cui fa parte. Queste perturbazioni creano tensioni tali da provocare nelle relazioni eventuali rimodulazioni, rotture transitorie o permanenti. I cambiamenti prodotti, nei sistemi extraterapeutici organizzati come sistemi complessi, si ripercuotono nel percorso terapeutico e viceversa in modo ricorsivo.

Nella societŕ italiana attuale, la famiglia ricomposta rappresenta una realtŕ sempre piů diffusa. Ciň spinge anche l'ambito della psicoterapia familiare a interrogarsi su cosa sia una famiglia ricomposta e quale sia la sua struttura. In questo articolo le autrici affrontano questo tema utilizzando la loro esperienza all'interno di un percorso di terapia familiare con una famiglia ricomposta. La ricerca di una nuova struttura sollecita il sistema terapeutico a confrontarsi con i propri vincoli e a trovare nuovi strumenti e strategie per trasformarli in risorse. Il bambino, attraverso i suoi sintomi, indica una direzione da percorrere, che impone a ciascuno una rinegoziazione delle regole e dei ruoli.

Knee arthrodesis was a common procedure before development of prosthetic replacement surgery. At present the most important indication for this intervention is septic failure of knee prosthesis. Several techniques can be used and each procedure may offer advantages and disadvantages which have to be analyzed before surgery according to the patient. Intramedullary nailing and external fixation are the most common techniques used for knee arthrodesis and both procedures show favorable results in most patients. Persistent infection and incomplete bone fusion are the main complications of knee arthrodesis. Because of residual functional impairment, all the candidates to knee arthrodesis should be informed about the results expected after the operation and possible alternative methods of treatment.

An increase in total and low density lipoprotein (LDL) cholesterol concentrations is related to the incidence of cardiovascular heart disease. The purpose of this study was to compare the efficacy and safety of pravastatin, an HMG-CoA reductase inhibitor, versus gemfibrozil, a fibrate, in the treatment of primary hypercholesterolaemia. 855 subjects (males and females, aged between 18 and 70 years) with total cholesterol (TC) concentrations > 240 mg/dl and triglyceride (TG) concentrations < 250 mg/dl were enrolled. After a pretreatment diet period, patients received either pravastatin 20 mg/day (659 patients) or gemfibrozil 1200 mg/day (196 patients). At the end of the 12-week treatment period, reductions in TC (−23%) and LDL-C (−31%) were noted in the pravastatin group. Gemfibrozil reduced TC by 16% and LDL by 20%. High density lipoprotein (HDL) cholesterol concentrations increased in a similar way in the two groups: pravastatin +10%, gemfibrozil+11%. Triglycerides decreased by 14% with pravastatin and by 22% with gemfibrozil. Pravastatin and gemfibrozil were both well tolerated. No significant adverse events or variations in laboratory parameters occurred during this study.

Effects of enalapril on congestive heart failure and survival until 12 months have been evaluated in 60 patients with congestive heart failure (II, III, IV NYHA class) versus 60 control patients. Enalapril has been administered with digitalis and diuretic for 12 months 5 mg twice a day; in 60 control patients only digitalis and diuretic have been administered. Patients have been controlled every month during 12 months evaluating: NYHA class, time of exercise at treadmill, ejection time of left ventricle, speed index of ejection, cardiac output, systolic output, ECG, blood pressure, creatinine, BUN and electrolytes. After 12 months a significant increase (p less than 0.001) of systolic and cardiac output in patients with enalapril has been recorded. Also the increase of exercise time was more evident in patients with enalapril (p less than 0.01). The results show that long term treatment with enalapril in patients with congestive heart failure, improving cardiac performance, gives an hemodynamic and symptomatic benefit.

Radioimmunologically determined digoxin and beta methyl digoxin values were the same in cardiopaths with and without clinical and instrumental changes referable to chronic cirrhosis or hepatitis. Lower values, however, were noted when gastroenteric disturbances were present. This was especially true of beta methyl digoxin in subjects with hyperkinetic-hyperchlorhydric syndromes due to depressed gastric pH, with a consequent inhibition of beta methyl digoxin absorption, presumably caused by lability of the molecule as a result of methylation of the terminal digitoxose group.