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SISTEMA E METODO DI CONTROLLO DELLA QUALITÀ DI UN CORPO RIFLETTORE DI UN FANALE PER AUTOVEICOLI

SISTEMA E METODO PER DETERMINARE LA RIFLETTANZA DI UN CORPO RIFLETTORE DI UN FANALE PER AUTOVEICOLO

Since the 1990s, a general reflection has gradually evolved in Italy on the effects of the transformation of psychiatry from being mainly institutional to more community-oriented. Increasingly substantial epidemiological studies and processes of outcome evaluations have focused not only on the clinical aspects, but also on the social and functional level (quality of life, care needs, users’ satisfaction for the treatments received). With a certain delay compared to the Anglo-Saxon countries, in recent years, several elements of the concept of recovery have also increasingly emerged in Italy: hope, expectations, self-esteem, self-efficacy, awareness, personal autonomy, and dignity. The present article describes the most relevant experiences conducted in Italy in the latest years developing a recovery-oriented approach in psychiatry, in different areas: methodology, peer support, education, services transformation, and research. In particular, the Italian Study on Recovery (SIR) is described, a res...

Schizophrenia is a serious mental disorder affecting approximately 29 million people worldwide. The ideal treatment and care of patients with schizophrenia should be provided by a multidisciplinary 'team' involving psychiatrists, nurses and other healthcare professionals, together with carers and patients. In light of the key role carers play in the care of patients with schizophrenia, the present survey was designed to assess the opinions of family members and friends of patients with schizophrenia across Europe and to ascertain their attitudes towards the illness, medication and adherence to medication. Among carers participating in this survey, there was widespread awareness of the issues involved in supporting patients with schizophrenia and the importance of their role in improving poor adherence to medication. Three differences in opinion emerged between the views of carers and psychiatrists; psychiatrists rely more on the patient themselves when assessing adherence than carers would recommend; in contrast to psychiatrists, many carers believe the illness itself contributes to non-adherence; two thirds of carers think that schizophrenia medication damages health (higher than estimated by psychiatrists). The findings from the present survey, taken together with the results from the Adherencia Terapéutica en la Esquizofrenia surveys of psychiatrists and nurses, support the need for a collaborative approach to the issue of treatment nonadherence. In particular, healthcare professionals should recognize the valuable contribution that family carers can make to improve treatment adherence and consequently clinical outcomes for patients with schizophrenia. Schizophrenia carries a significant burden for families providing care. The Adherencia Terapéutica en la Esquizofrenia (ADHES) carers' survey was designed to assess the opinions of family and friends of patients with schizophrenia across Europe and ascertain their attitudes towards the illness, medication and adherence to medication. A questionnaire-based cross-sectional survey of 138 carers across 16 European countries. Interpretation of results was based on a descriptive comparison of responses. Carers recognized the importance of medication to help patients get better (76%) and improve their quality of life (76%) and relationships (74%). Sixty-seven per cent believed medication damages general health. Sixty-five per cent reported that treatment adherence was a burden for patients. Thirty-eight per cent indicated that it was a daily struggle to get patients to take their medication. Fifty per cent perceived that medication administered every few weeks rather than daily was quite/very important. Ninety-three per cent agreed on the importance of family support to boost adherence, with education and information deemed important for families and patients. Carers rely less on the patient themselves when assessing adherence than psychiatrists. The burden faced by carers and patients in taking medication provides an opportunity for healthcare professionals to provide support in a multidisciplinary 'team' involving psychiatrists, nurses and carers.

Recovery from psychiatric disability is related to the idea of developing personal potentials and regaining a valid social role even with limitations caused by mental illness. The concept of Recovery as a movement builds on the engagement and concepts developed by people with a lived experience of psychiatric diagnoses, treatment, and rehabilitation efforts. The current orientation toward empowerment and patient self-determination in medicine at large as well as in psychiatry in particular puts new emphasis on subjective and individualized assessments and treatment approaches. The concept and practice of person-centeredness not only respect these developments, but do need them, having thus the potential to establish new forms of collaboration among clinicians, service users, and families through a common natural language.

The family is not only affected by their loved one’s illness, but it often plays a central role in the patient’s care. Living with and caring for a person suffering from a mental illness on one side a big existential challenge, and on the other it affords family members a vast knowledge base and experience which can be available for sharing with the whole care team. During the past three decades, numerous factors have contributed to focus more than before on families who are coping with serious mental disorders, as follows: vital advocacy and self-help movements by relatives of mentally ill persons have been raised and have been organized at national and international levels. Their objectives have been to promote better care, have their voices heard and their rights respected. There is already a general recognition that carers’ needs are closely linked with those of the person they care for; however, burdens of carers themselves and circumstances of care deserve more specific attention and research. Some preliminary findings highlight the contribution of people caring for those living with schizophrenia, offering evidence of the immense and unspoken burden they carry and the overwhelming impact this condition has on their own lives. Engaging family members and carers through adequate communication becomes then fundamental. Family members have gained a great deal of experience and have much to offer the medical community. Their expertise should be acknowledged and valued. Families should be involved in education and training of medical staff working in mental health services.

Come si è già notato prima, le caratteristiche dei pazienti trattati nelle SR sono state molto poco studiate. In particolare, la maggior parte degli studi condotti sino ad oggi ha preso in esame campioni di limitata ampiezza (Andrews et al., 1990; Mowbray et al., 1992; Rimmerman et al., 1993), quindi poco rappresentativi delle popolazioni di pazienti da cui essi sono stati tratti. I soli studi effettuati su campioni più ampi sono stati condotti negli Stati Uniti (Randolph et al., 1991) ed in Gran Bretagna (Lelliott et al., 1996; Faulkner et al., 1993), ma queste ricerche non prevedevano una dettagliata valutazione individuale dei pazienti stessi.In questo capitolo verranno quindi riportati i risultati della valutazione dettagliata di 2.962 pazienti ospitati nelle 265 SR campionate nella fase 2 del Progetto Nazionale PROGRES. L'ampiezza del campione preso in esame permette di trarre interessanti indicazioni relative all'assistenza fornita attualmente in Italia a pazienti affetti da malattie mentali gravi a pochi anni dalla chiusura degli O.P., e può fornire dati utili anche per altri paesi impegnati in un analogo processo di cambiamento dell'assistenza psichiatrica.

Se le SR devono rappresentare, almeno per una parte dei pazienti che esse ospitano, un setting destinato al trattamento intensivo a lungo termine, l'analisi del processo assistenziale (ossia di ciò che concretamente si fa nelle SR, delle regole che caratterizzano lo svolgersi della vita comunitaria, delle attività condotte dagli operatori) appare una dimensione di fondamentale importanza da comprendere. Nell'ambito del progetto PROGRES, tale dimensione è stata oggetto di una valutazione approfondita, che viene descritta in questa sezione della monografia.La Scheda Struttura conteneva molti item che esploravano varie caratteristiche e dimensioni del processo assistenziale. L'analisi dei dati ha preso in esame la descrizione dei parametri rilevanti per la comprensione di specifici aspetti del processo assistenziale in atto all'interno delle SR. Si sono anche esplorate eventuali associazioni fra caratteristiche delle SR e dei pazienti ospitati.È stata inoltre condotta una analisi dei cluster al fine di individuare, sulla base dei dati disponibili, dei raggruppamenti omogenei di SR che consentano di cominciare a delineare una tassonomia di queste strutture e delle loro funzioni. In generale, l'analisi dei cluster classifica i casi in categorie o gruppi relativamente omogenei, basandosi sulla loro somiglianza o dissimiglianza rispetto alle variabili selezionate. Al fine di effettuare l'analisi dei cluster cercando di utilizzare il massimo numero di informazioni disponibili, sono stati messi a punto 4 punteggi sintetici: ciascuno di essi ha il compito di riassumere la presenza o assenza di varie caratteristiche o dimensioni inerenti al processo assistenziale.

La prima parte di questa monografia prende in esame le variabili di tipo strutturale delle SR, ovvero le caratteristiche quanti- e qualitative sia delle SR che dello staff curante. L'importanza delle caratteristiche strutturali delle SR è duplice: da un lato si trattava di comprendere in che misura il cambiamento strutturale innescato e promosso dalla Legge 180 si fosse tradotto in una effettiva e coerente trasformazione del contesto assistenziale, e dall'altro quale fosse il gradiente di variabilità delle strutture sul territorio nazionale (peraltro già messo in luce, in termini generali, nella fase 1 del progetto); è inoltre noto che la presenza di condizioni strutturali di qualità accresce le probabilità di un processo appropriato e quindi di un esito favorevole degli interventi.Oltre la metà delle 265 SR partecipanti (N=138, 52,1%) è localizzata nel Nord Italia, mentre le altre si distribuiscono in proporzione simile nel Centro (N=64, 24,2%) e nel Sud (N=63, 23,7%) del paese. Le SR del Sud presentano un numero medio di ospiti per struttura significativamente più elevato (14,1±7,2) rispetto a quelle del Nord (N=ll,2±8,6) e del Centro (N=9,4±5,8) (p20 posti-letto) presentano alcune differenze statisticamente significative rispetto alle SR di minore capacità ricettiva (

Way of diagnosis communication of cancer and its effects on the physician-patient and patient-family relationship

Although residential facilities (RFs) have largely replaced mental hospitals (MHs) in most developed countries for the long-term residential care of severely impaired patients, the process of care in RFs has not been well studied. The aim of this paper is to investigate the process of care in 265 RFs, representing 19.3% of all RFs in Italy, and to devise a classification of RFs based on process characteristics. Structured interviews were conducted with the manager and staff of each RF. Residents were evaluated using standardized rating instruments. Most RFs had specific admission criteria, with one third having a waiting list that averaged about 3 months. There was no formal limitation to the length of stay in three quarters of RFs, and turnover rates were very low. Although a homelike atmosphere was found in many RFs, most facilities had restrictive rules on patients’ daily lives and behaviours. RFs carried out several external activities targeted at integrating patients within the local community. Standardized assessment instruments and written treatment plans were rarely used. A cluster analysis based on the levels of restrictiveness and the standardization of the process of care classified RFs into five groups that differed with respect to daily staff coverage, size, geographical distribution and proportion of former MH residents. No significant intercluster differences were associated with the current clinical and psychosocial characteristics of residents, or with several other outcome variables. This study provides naturalistic evidence of the heterogeneity of the process of residential care on a large scale. Future efforts should focus on developing an empirical classification of RFs, as well as on national and international standards of care and staffing to address patients’ needs.

Introduction Schizophrenia is a serious mental illness that carries a significant burden for families providing care. Objectives The ADHES carers' survey canvassed opinions of families/friends of patients with schizophrenia across Europe. Aim To ascertain carer attitudes towards schizophrenia, its treatment and treatment adherence. Methods The survey was conducted from January-April 2011 in 16 European countries, comprising 10 questions relating to the respondents' understanding of schizophrenia, attitudes towards schizophrenia treatments, and perception of the family's/friend's role in supporting patients with schizophrenia. Results Results were obtained from 138 respondents. 76% of carers recognized the importance of medication to help patients get better, improve their quality of life (77%) and relationships (74%). 67% of carers responded that they believed schizophrenia treatment damages patients' general health. Two-thirds of the carers reported that treatment adherence was a burden for the patient and over a third of carers indicated that it was a daily struggle to get patients to take their medication. 50% of carers considered the benefits offered by long-acting injectable antipsychotics as very/quite important and thus, could provide a valuable tool in improving treatment adherence. 92% of carers agreed on the importance of family support to boost treatment adherence with education/information deemed important for families and patients alike. Conclusion Carers recognize the issues they face in caring for patients with schizophrenia and their role in improving partial/non-adherence to medication, especially to avoid suboptimal treatment outcomes. The important role of family carers should be considered by healthcare professionals when treating patients with schizophrenia.

While psychopharmacotherapy for psychosis is effective in reducing symptoms, improving the patient’s overall functioning and re-integration into society becomes increasingly the key target of psychiatric care. The goal is now moving beyond symptom remission, towards the patient’s recovery in his personal, relational and vocational functioning (Liberman et al., 2002).Measurement of psychopathologic dimensions of psychosis is common practice; on the contrary, the assessment of psychosocial functioning and its impairment is not so commonly used, even with the availability of valid instruments like the Personal and Social Performance (PSP) Scale (Morosini et al., 2000).Even less importance has till now been given to what personal and social functioning actually means to patients and their families and why this is such an important treatment goal.Aim of this study is to provide tangible examples of improvements in personal and social functioning, to facilitate greater understanding of its importance amongst a broad range of European audiences including carers, patients, healthcare professionals.During an informal roundtable session at the EUFAMI congress in Vilnius, Lithuania (26-27.11. 2009), a group of carers from all over Europe will discuss how they define personal and social functioning, sharing a series of personal, real-life scenarios that demonstrate an improvement in personal and social functioning of people with severe mental illness.Each scenario will focus on one of the four main domains of the PSP scale: self-care, socially useful activities, personal and social relationships, disturbing and aggressive behaviour.Results from the roundtable will be collected and discussed.

Una breve descrizione della Casa II A del quartiere ellenistico-romano di Agrigento A short description of the House II A of the Hellenistic-Roman Quartier in Agrigento