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Background. Guidelines for the implementation of narrative medicine in clinical practice exist; however, in Italy, no standard methodology is currently available for the management of oncological patients. Since 2017, at the “Regina Elena” National Cancer Institute, studies using “digital narrative diaries” (DNMLAB platform) have been carried out; this article focuses on a pilot, uncontrolled, real-life study aiming to evaluate the utility of DNM integrated with the care pathway of patients with bone and limb soft tissue sarcomas. Methods. Adult patients completed the diary during treatment or follow-up by writing their narrative guided by a set of narrative prompts. The endpoints were: (a) patients’ opinions about therapeutic alliance, awareness, and coping ability; (b) healthcare professionals’ (HCPs’) opinions about communication, therapeutic alliance, and information collection. Open- and closed-ended questions (Likert score: 1–5) were used to assess the items. Results. At the interim analysis of data from seven patients and five HCPs, DNM was shown to improve: (a) the expression of patients’ point of view, the perception of effective taking charge, disease awareness, and self-empowerment (score: 4.8/5); (b) patients’ communication, relationships, and illness knowledge (score: 4.6–4.8/5). Conclusions. The preliminary results supported the need to integrate patients’ narratives with clinical data and encourage further research.

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: To describe how the recent lock-down, related to SARS-COV-II outbreak in Italy, affected People With Epilepsy (PwE), we designed a survey focused on subjective reactions. Using Natural Language Processing (NLP), we analyzed words PwE and People without Epilepsy (PwoE) chose to express their reactions. Methods: As a subset of a larger survey, we collected from both PwE (427) and PwoE (452) single words (one per subject) associated to the period of lock down. The survey was spread thanks to the efforts of Italian league against epilepsy Foundation during the days of maximum raise of the pandemic. Data were analyzed via bag of word and sentiment analysis techniques in R. Results: PwoE and PwE showed significantly different distribution in word choice (X2, p = 4.904e-13). A subset of subject used positive words to describe this period, subjects with positive feelings about the lock down were more represented in the PwE group (X2, p = 0.045). Conclusion: PwoE developed reactive stress response to the restrictions enacted during lock-down. PwE, instead, chose words expressing sadness and concern with their disease. PwE appear to internalize more the trauma of lock down. Interestingly PwE also expressed positive feelings about this period of isolation more frequently than PwoE. Our study gives interesting insights on how People with Epilepsy react to traumatic events, using methods that evidence features that do not emerge with psychometric scales.

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.

Behcet disease (BD) is a rare, chronic, multisystemic, inflammatory syndrome with oral and genital ulcerations and ocular inflammation, relapsing uveitis, epididymitis and mucocutaneous, articular, gastrointestinal, neurologic, and vascular manifestations [1]. Classified as a systemic vasculitis, it can involve both the arteries and veins of almost any organ. This is an analysis of intestinal involvement in BD.

appeared few days later. Endoscopy with biopsies of the terminal ileum confirmed the diagnosis of CD. Computed tomography showed a thickened terminal ileum with an enterocutaneous fistula penetrating through the previous surgical incision; no other proximal sites of disease were detected with a small bowel enema. Despite medical treatment and good general and nutritional status, the fistula persisted, and the patient was referred for surgery. The patient consented to the intervention and was fully informed about the risk of conversion. He was positioned in the supine position, and a single port type Olympus asc-Triport (distributed by Olympus M.S.C., Japan) was inserted through the umbilicus. A 5-mm deflectable video laparoscope type Olympus HD EndoEYE (Olympus M.S.C., Japan) was used. The terminal ileum was grossly inflamed for 15 cm and adherent to the right iliac fossa. Adhesions were carefully liberated, and a full mobilization of the ascending colon was obtained starting by the right colic flexure. An incision contouring the previous McBurney’s site was realized, and the enterocutaneous fistula tract was extracted en bloc with the ileocecal region. Mesenteric vessel ligation and a hand-sewn side-to-side anastomosis was performed extracorporeally. Intraoperative as well as postoperative and specimen images are showed in Figure 1. Operative time was 115 minutes