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The COVID-19 pandemic meant that people’s lives and work changed significantly across the world. Governments took measures such as social distancing, lockdowns and quarantine protocols to stem the spread of the pandemic. This had a significant impact on music therapy clinical practice, generating reflections and adaptations among the worldwide music therapy community, with several studies still underway. A number of professional music therapy organisations have explored methods for carrying out remote interventions. MusicTeamCare is an approach developed by three Italian Certified Music Therapists that could offer access to support in emergency and crisis situations. This approach is rooted in receptive music therapy theory, with particular reference to Guided Imagery and Music (GIM). MusicTeamCare was used for the first time in March to April 2020, with healthcare workers in Italy who were treating COVID-19 patients. This article outlines theoretical framework, development and evaluation phases of MusicTeamCare. Detailed explanations are given of the theoretical framework, methods of musical analysis, assessment and evaluation strategies, criteria for constructing the playlists and interactive triangulation between the Music Therapists in the research team.

Background: Patients undergoing surgery and general anesthesia often experience anxiety, fear and stress, with negative bodily responses. These may be managed by the pre-procedural application of anxiolytic, analgesic, and anesthetic drugs that have, however, potential risks or side effects. Music therapy (MT) can be used as a complementary no-drug intervention alongside standard surgical care before, during and after medical procedures. The aim of this study was to evaluate the effects of preoperative MT intervention compared to premedication with midazolam on levels of anxiety, sedation and stress during general anesthesia for elective stomatology surgery. Methods: A two-arm randomized and controlled single-center, parallel-group, pre–post event study was conducted. In total, 70 patients affected by stage I or II (both clinically and instrumentally N0) micro-invasive oral cancer and undergoing elective surgery under general anesthesia were assigned to the control group (CG) or to the music therapy group (MTG). MTG patients received preoperative music therapy intervention (MT) from a certified music therapist before surgery, while the CG patients did not receive MT but instead received premedication with intravenous midazolam, 0.02 mg/kg. Anesthesia was the same in both groups. The systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were recorded at the entrance to the operating room, just before the induction of anesthesia and every 5 min until the end of surgery. An anxiety visual analogues scale (A-VAS) was used to evaluate the level of anxiety. The bispectral index (BIS) monitor was used to measure the depth of sedation just before and 10 min after both music intervention and midazolam administration. Stress response was assessed 5 min before and 20 min after surgery via the control of plasma prolactin (PRL), growth hormone (GH), and cortisol levels. The patient global impression of satisfaction (PGIS) was tested 1 h after surgery. Participants in the MTG were asked to answer 3 questions concerning their experience with MT. Results: No statistical differences among the PRL, GH and cortisol levels between the two groups were registered before and after the treatment, as well as for PAS, PAD and HR. Significant differences in the A-VAS scores between the MTG and CG (p < 0.01) was observed. Compared to the CG, MTG patients had a statistically significantly lower BIS score (p = 0.02) before induction. A PGIS score of 86.7% revealed that patients in the MTG were very satisfied, versus 80% in the CG (p < 0.05). Conclusion: Preoperative music therapy could be an alternative to intravenous midazolam when aiming to promote a preoperative and post-operative state of anxiolysis and sedation in stomatology surgery, even if no differences were found in terms of the surgery-related stress response according to physiological and hormonal determinations.

Music is an important tool to improve our human condition and better our mood, but the interesting thing is that some types of music seem to have "medicinal" qualities, so that they have coined the term "music therapy" to define the potential benefits on our body. However, we do not know if these effects can be measured and reproduced, as well as they are able to work on the cardiovascular system. Listening to music allows to explore deep and complex aspects of our soul, but also modulates the rhythm of some physiological components of our heart. The type of music that represents this particular form of sensitivity is probably the Baroque, but there are examples in any epoch and throughout all genres of music: from symphonic to rock, from new age to pop. Performing characters from different periods such as Mozart or the Beatles have left us masterpieces that can unexpectedly improve body and soul at the same time.

BackgroundA growing number of patients taking antiplatelet drugs, mainly low-dose acetylsalicylic acid (ASA) (75–150 mg/day), for primary or secondary prevention of thrombotic events, are encountered in every field of surgery. While the bleeding risk due to the continuation of these medications during the perioperative period has been adequately investigated in several surgical specialties, in thyroid surgery it still needs to be clarified. The main aim of this study was to assess the occurrence of cervical haematoma in patients receiving low-dose acetylsalicylic acid, specifically ASA 100 mg/day, during the perioperative period of thyroidectomy.MethodsPatients undergoing thyroidectomy in two high-volume thyroid surgery centers in Italy, between January 2021 and December 2021, were retrospectively analysed. Enrolled patients were divided into two groups: those not taking ASA were included in Group A, while those receiving this drug in Group B. Univariate analysis was performed to compare these two groups. Moreover, multivariate analysis was employed to evaluate the use of low-dose ASA as independent risk factor for cervical haematoma.ResultsA total of 412 patients underwent thyroidectomy during the study period. Among them, 29 (7.04%) were taking ASA. Based on the inclusion criteria, 351 patients were enrolled: 322 were included in Group A and 29 in Group B. In Group A, there were 4 (1.24%) cervical haematomas not requiring surgical revision of haemostasis and 4 (1.24%) cervical haematomas requiring surgical revision of haemostasis. In Group B, there was 1 (3.45%) cervical haematoma requiring surgical revision of haemostasis. At univariate analysis, no statistically significant difference was found between the two groups in terms of occurrence of cervical haematoma, nor of the other early complications of thyroidectomy. At multivariate analysis, the use of low-dose ASA did not prove to be an independent risk factor for cervical haematoma.ConclusionsBased on our findings, we believe that in patients receiving this drug, either for primary or secondary prevention of thrombotic events, its discontinuation during the perioperative period of thyroidectomy is not necessary.

PurposeIn addressing policy problems, it is difficult to disentangle public policies from private efforts, business institutions and civic activities. Societies may acknowledge that all these domains have a role in accomplishing social aims, but there are fundamental problems in understanding why, how and with what implications this occurs. Drawing upon the insights from the papers of this special issue, the authors aim to advance the understanding of governance and accountability in different contexts of hybridity, hybrid governance and organizations.Design/methodology/approachThe authors conceptualize common theoretical origins of hybrid organizations and the ways in which they create and enact value by reflecting on the articles of the special issue. Furthermore, the authors propose agendas for future research into hybrid organizations.FindingsHybrid organizations can be conceptualized through two types of lenses: (1) the dimensions of hybridity (ownership, institutional logics, funding and control) and (2) their approaches to value creation (mixing, compromising and legitimizing).Practical implicationsThis article provides more detailed and comprehensive understanding of hybridity. This contribution has also important practical implications for actors, such as politicians, managers, street-level bureaucrats, professionals, auditors and accountants who may be enveloped in various hybrid settings, policy contexts and multi-faceted interfaces between public, private and the civil society sector.Originality/valueHybridity lenses reveal novel connections between four types of hybrid institutional contexts: state-owned enterprises (SOEs), non-profit organizations (NPOs), social enterprises (SEs) and municipally owned corporations (MOCs). This paper provides theoretical instruments for doing so.

The COVID-19 pandemic has all features of a wicked problem. It is not only a crisis of intensive care but also a more complex health, social, economic, and humanitarian crisis. Moreover, its risks will continue until mass vaccination is undertaken, hence, the control of contagiousness relies on citizens’ responsible behavior. Strategies to fight COVID-19 in Lombardy, Veneto (Italy) and in Ticino (Switzerland) have shown that a more balanced approach focusing not exclusively on hospitals but also on a territorial basis, pays off. Therefore, a more integrated approach is beneficial from a clinical, social, and economic point of view providing procedures for future emergencies.

BACKGROUND AND AIMS Percutaneous kidney biopsy (PRB) is an invasive procedure performed under local anaesthesia that often creates anxiety, stress and pain in the patient before, during and after the procedure. Music therapy (MT), defined as the clinical- and evidence-based use of music, is administered by a trained professional to achieve individualized goals within a therapeutic relationship between patient, music and music therapist. MT can be used as a complementary non-drug intervention to prevent and treat emotional distress and pain. The main objectives of the study were 1. evaluate the effectiveness of MT in managing anxiety, pain and satisfaction in patients undergoing PRB. 2. investigate the effect of MTI on heart rate variability (HRV). METHOD This study was a two-arm, single-centre, parallel-group and pre–post PRB randomized controlled trial. Patients programmed for PRB were enrolled (n = 80) and assigned to the MT intervention group (MG, n = 40) or standard treatment [control group (CG), n = 40]. MG received, from a FAMI-certified music therapist, a personalized playlist administered during the PRB, adapted to the individual patient. Patient anxiety was assessed before and after PRB using the State Y-1 Trait Anxiety Inventory (STAI-Y1). A visual analog scale (VAS) was used for self-assessment of pain (VAS-P) and satisfaction (VAS-S). Physiological stress parameters (PRE–POST) were assessed using HRV (SDNN, RMSSD, LH/HF, SD1, SD2) from E4 wristbands—Empatica Inc.1. The bracelet was placed 5 min before the patient entered the operating room for the procedure and removed after the completion of the PRB. The data of each session were divided into two segments: (1) pre, before the administration of the local anesthetic and (2) post, after the conclusion of the biopsy. RESULTS A statistically significant difference in anxiety levels was observed between the MG and CG groups (35.35 ± 6.208 versus 42.83 ± 9.027; P CONCLUSION This study supports the efficacy of MT in reducing anxiety and pain and improving satisfaction in patients undergoing PRB. MT modulates the autonomic nervous system, reducing sympathetic activity, increasing parasympathetic activity and inducing physiological relaxation.

Simple Summary The increasing use of high-quality imaging techniques together with improved access to healthcare has led to an increase in the detection of thyroid nodules. Fine-needle aspiration cytology (FNAC) is currently considered the most accurate examination for the assessment of thyroid nodular disease. However, in about 25% of cases, FNAC leads to the diagnosis of an indeterminate thyroid nodule, which represents a problem because malignancy, although relatively low (up to 30%), cannot be excluded with certainty. According to the 2015 American Thyroid Association guidelines, patients with thyroid nodular disease with an indeterminate cytology can undergo, based on established factors, a total thyroidectomy or a hemithyroidectomy. However, if an intermediate or high-risk differentiated thyroid carcinoma is detected after the hemithyroidectomy, through histological examination, the above-mentioned guidelines recommend performing a completion thyroidectomy. The main aim of this study was to assess the rate of complications in patients undergoing a completion thyroidectomy after a hemithyroidectomy for a thyroid nodule with an indeterminate cytology. There is still controversy as to whether patients undergoing a completion thyroidectomy after a hemithyroidectomy for a thyroid nodule with an indeterminate cytology have a comparable, increased or decreased risk of complications compared to those submitted to primary thyroid surgery. The main aim of this study was to investigate this topic. Patients undergoing a thyroidectomy for thyroid nodular disease with an indeterminate cytology in four high-volume thyroid surgery centres in Italy, between January 2017 and December 2020, were retrospectively analysed. Based on the surgical procedure performed, four groups were identified: the TT Group (total thyroidectomy), HT Group (hemithyroidectomy), CT Group (completion thyroidectomy) and HT + CT Group (hemithyroidectomy with subsequent completion thyroidectomy). A total of 751 patients were included. As for the initial surgery, 506 (67.38%) patients underwent a total thyroidectomy and 245 (32.62%) a hemithyroidectomy. Among all patients submitted to a hemithyroidectomy, 66 (26.94%) were subsequently submitted to a completion thyroidectomy. No statistically significant difference was found in terms of complications comparing both the TT Group with the HT + CT Group and the HT Group with the CT Group. The risk of complications in patients undergoing a completion thyroidectomy after a hemithyroidectomy for a thyroid nodule with an indeterminate cytology was comparable to that of patients submitted to primary thyroid surgery (both a total thyroidectomy and hemithyroidectomy).

End-of-life accompaniment requires even greater care of the patient and their family by the multi-disciplinary team, which requires a clear, wellorganized interdisciplinary and interprofessional approach. Musictherapy (MT) is often use as a complementary approach to improve a person’s quality of life by helping to relieve symptoms, addressing psychological needs, offering support and comfort, facilitating communication, and meeting spiritual needs. Through songwriting, Ettore, a teenager was able to make choices and act on his own will. Songwriting represented a channel for effective and powerful communication and expression. The song became the means by which the relationship with the team was maintained and deepened; it became something tangible, a product with its own consistency, a further bond that unites Ettore to his family to this day.

Hospitalized COVID-19 patients are vulnerable to different degrees of stress disorders as well as depression, anxiety and fear. The aim of this study was to evaluate the feasibility of introducing Music therapy on site with Covid-19 patients and investigating the immediate effects a single session has on anxiety, heart rate (HR), oxygen saturation (O2Sat) and satisfaction compared to standard care. A randomized controlled trial of 40 patients was conducted. Participants were assigned to control group (CG) or the treatment group (MG). MG received an individual single session of music therapy in presence. CG received standard care. MG and CG were subjected to identical measurements (pre-during-post) of the parameters STAI-Y, HR and O2Sat. Participants in MG were asked to fill in an optional open-ended question concerning their experience with music therapy. Significant difference in anxiety levels between scores in MG and CG (34.50 (23.25–40.00) vs 45.00(38, 25–54.00); p = 0.000) was observed. MG compared to CG had statistically significantly higher values of O2Sat (97.50 (96.25–99.00) versus 96.00 (96.00–98.00); p = 0.026). Results show the feasibility of introducing music therapy as a supporting complementary/non-pharmacological intervention on site in Covid-19 patients. A single session of music therapy improves O2Sat and can significantly reduce anxiety.Trial registration: 14/10/2021 No. NCT05077306. https://www.clinicaltrials.cov.

The last global financial and economic crisis started in 2007–2008; it had serious effects on public sectors of OECD countries and was still affecting some of them when the COVID-19 pandemic began. Different streams of literature contribute to understanding the public management and governance challenges emerging from economic crises: the public administration literature on cutback management of the late 1970s and 1980s, the contemporary literature on managing austerity, and the more generic management literature on organizational decline. Although public administrations are reacting to the same global crisis, they are expected to adopt a variety of approaches when designing policy and managerial responses, including strategic approaches, across-the-board approaches (cheese-slicing or piecemeal incremental shifts), or rhetoric and inertia, avoiding real change and manipulating discursive frames. A strategic approach is based on systematic, selective, or targeted measures, and it includes different reactions to the crisis, such as a directive, hollow, or communitarian approach. In light of the different approaches available to public administrations for addressing an economic crisis, attention turns to the factors that determine such a choice. Public administrations’ responses to austerity are shaped by external and internal determinants. The external drivers make the crisis faced by each public administration longer or more severe and shape the way public managers react. External forces include economic and social features of the environment in which the public administration operates as well as national austerity policies. According to the literature, the harsher the fiscal stress, the more likely it is that targeted cuts will be adopted, instead of an across-the-board approach that doesn’t take into account the different levels of efficiency of public administrations or the strategic priority of different policy areas. Internal forces influencing crisis management approaches are financial and fiscal dimensions, such as financial autonomy (reliance on central government for revenue), spending autonomy and flexibility, degree of fiscal stress, and financial vulnerability. All these forces influence a proactive response to the crisis. Another key factor is leadership: the literature is excessively focused on incentives faced by political leaders, and few studies examine the role of administrative leadership. Finally, the crisis management approach matters in terms of impact; the literature developed after the 1970s and 2007–2008 global economic crises all agrees on this. Such a link, however, is difficult to assess. Strategic and longer-term approaches seem to favor the strengthening of trust, resilience, and avoidance of electoral costs, whereas shorter-term changes lower employee morale, create recruitment and retention problems, cause loss of managerial expertise, cause distraction from the core purpose of the service, and increase costs.

Gli incubatori di impresa costituiscono ormai una realtà consolidata soprattutto nei Paesi più sviluppati. Divenuti popolari come strumenti per lo sviluppo e il rafforzamento del tessuto economico, si sono articolati nel tempo dando vita a varie forme organizzative con differenti modelli di business. Il contributo analizza nello specifico una delle tipologie di incubatore d'impresa oggi esistenti: l'incubatore universitario. Attraverso un'attenta review della letteratura internazionale, che ha permesso, tra l'altro, di evidenziare ambiti, localizzazione spaziale e temporale delle ricerche condotte fino ad oggi, sono stati identificati i modelli di business più diffusi e i fattori critici di successo. In ultimo, dopo una rappresentazione della situazione italiana, con evidenza delle realtà esistenti e primi tentativi di un'analisi statistica sul fenomeno di questione, sono state presentate alcune proposte di riflessione di prospettiva, anche sulla base della letteratura internazionale.

Children affected by brain tumors experience significant levels of anxiety, nervousness, and fear regarding surgery, especially in the preoperative stages. The operating room can be an intimidating environment for them, and preoperative anxiety can adversely affect postoperative pain.1 Interest is growing in finding non-pharmacological means that may be used to reduce these symptoms. Music sessions are increasingly used in patients undergoing neurosurgery for this purpose.2 Regarding the relationship between music and human brain, some studies compare the functioning of the nervous system as the ability of a large orchestra to express a full range of melodies and rhythms, as well as various and complex harmonic solutions.3 Passive listening to pre-recorded music provided to the patient by nurses or by other medical staff to offer additional comfort is considered as music …

Covid-19 is not only a crisis of intensive care but a social and humanitarian crisis. Until mass vaccination is undertaken, control of contagion will rely on responsible behaviour by citizens. Strategies for fighting Covid-19 in different regions of Italy have shown that an area-specific approach, not just hospital-focused, pays off. This article proposes a community coproduction approach, in the light of discussions with politicians and key health decisionmakers and actors. IMPACT Preventing the spread of Covid-19 can mainly be achieved by social, not medical, means. Decision-makers should be aware that a strategy of relying only on the acute health system, placing a high burden on community-based public services, without any systematic attempt to co-ordinate or support the expansion of these services, is likely to fail. This article explains the benefits of a community co-production strategy.

Social incubation is a recent phenomenon, but it is rapidly growing on an international scale in response to the expansion of the social economy and the increased awareness that social enterprises can play a pivotal role in reforming the welfare system. The academic literature on this topic is still in its early days and detailed investigations of whether these organizations embrace sustainable business models are still missing. Consequently, we do not yet know whether social incubation creates value in a sustainable manner and, if so, how to maximize and optimize the creation of such value. Understanding the sustainability and the overall viability of social incubation is both important and timely, as the phenomenon consolidates and expands internationally. This chapter offers a preliminary, but systematic study of this issue through an extensive empirical investigation of 14 social incubators in Italy. The main theoretical contribution of this chapter is a new theoretical framework that elaborates on the literature streams of social entrepreneurship and social and business incubators. A secondary, empirical contribution is the first systematic mapping of the social incubators across Italy.

Scholars have been trying to fully comprehend the drivers of the performance of public networks. Based on the multilevel performance model proposed by Cepiku, this article employs a fuzzy-set Quali...

During COVID-19 pandemic, Italian pediatric oncology departments were obliged to adopt restrictive measures to minimize the risk of in-hospital infections in frail patients and staff members. Access to the wards was significantly reduced and music therapy (MT) activities were suspended. The aim of this study was to compare the level of anxiety and sedation in pediatric patients undergoing invasive procedure before (T1), during(T2) and after(T3) the pandemic, with and without the presence of MT. From January to September 2020, all children aged 2–15 with oncological and hematological diseases undergoing to invasive procedure were enrolled. During T1 and T3 children received preoperative preparation with MT by a certified music-therapist. In T2 they received music or video by clinical staff. Preoperative anxiety scores were measured with the m- YPAS scale. Interviews with mothers were performed. The average consumption of drugs used was analyzed. Significant differences in preoperative anxiety levels between scores in T1, T2 (p.value = 0,0000014) and in T2, T3 (p.value = 0,0000031) were observed. No difference between T1-T3 (p.value = 0,96). Higher dosage of midazolam in T2 (1,14 mg 0,189) compared to T1 (0, 71 mg 0,399) and T2 (1,14 mg 0,189) were observed. Mothers also recorded higher scores on anxiety and stress without music therapy.