- Email: [email protected]
Interdisciplinary approach to diagnosis in medicine: the semeiotic integrated–the experience of Integrated Medicine Center of Pitigliano
40
Oral Presentations / European Journal of Integrative Medicine 4S (2012) 9–123
lysed under the guidance of structuration model of collaboration, a theoretical model for understanding interprofessional collaboration. From focus group findings we generated 28 possible approaches, and subsequently their acceptability was assessed by a two-round Delphi survey amongst BM and TCM policy stakeholders (n = 12). Results: Consensus was reached only on 13 statements. Stakeholders agreed that clinicians from both paradigms should share common goals of providing patient-centred care, promoting the development of protocols for shared care and information exchange, as well as strengthening interprofessional connectivity and leadership for integration. On the other hand, attitudes amongst policy stakeholders were split on the possibility of fostering trust and mutual learning, as well as on enhancing innovation and governmental support. Conclusions: Future policy initiatives should focus on these controversial areas. http://dx.doi.org/10.1016/j.eujim.2012.07.566 OP-072 Manifesto for Integrated Medicine: outcomes of an international debate forum Santini Gino 1 , Macrì Francesco 1 , Bernardini Simonetta 2 , Digiampietro Tiziana 3 , Grassi Italo 4 , Masciello Ennio 5 , Pulcri Roberto 1 1 SIOMI,
Rome Florence 3 SIOMI, Pescara 4 SIOMI, Reggio Emilia 5 SIOMI, Bologna, Italy 2 SIOMI,
The first ‘Manifesto for Integrated Medicine’ was illustrated in Florence (Italy), at Salone De’ Dugento in Palazzo Vecchio on 3 December 2011. Most of the Italian institutions of orthodox medicine attended the presentation, including the National Association of Medical and Dental Doctors, National Association of Drugs, National Association of Biologists, National Association of Scientific Societies, Italian Paediatrics Association and the national institutions of family doctors and paediatrics in the country, etc. Alongside the representatives of these institutions, there were also many other representatives of complementary medicine and wellness and health disciplines. The Manifesto was proposed as a document in progress and consequently carried out in only nine points. Hence, it is not to be considered as a guidebook, since the authors had only wanted to begin a debate regarding possibilities, critical issues and utility of reconsidering the public health-care system through the implementation of integrated health services, according to the increasingly widespread concepts of integrated medicine. The patron of the event, the Italian Society of Homeopathy and Integrated Medicine–SIOMI, opened the day following the event an on-line forum for national debates among the over 30 institutions which attended the event. The aim is to gather proactive views on the final draft of the Manifesto for Integrated Medicine, whose contents can be widely shared by orthodox medicine and
CAM key actors. Furthermore, another important objective is to set up a permanent forum that could lead the public health services towards initiatives of integrated health care according to the experimenting model at the Centre of Integrated Medicine in Pitigliano, Local Health Unit no. 9 (USL) in Tuscany. http://dx.doi.org/10.1016/j.eujim.2012.07.567 OP-073 Department of Complementary Medicine at the Hospital of Meran Ausserer Oskar, Thuile Christian Reparto di Medicina Complementare Ospedale di Merano, Merano, Italy The Government of South Tyrol has approved, with the resolution n. 37 of 12.01.2009, the master plan that sets up the complementary department in the hospital of Meran. The master plan will continue until 31.12.2012. In that period of time, the department will be directed by Dr. Christian Thuile, who will be in charge, as all other departments of the Hospital of Meran. There will be collaborations with all other departments, although priority will be given to patients with cancer. Methods applied will be acupuncture, phytotherapy, Chinese traditional medicine, orthomolecular medicine, infusion therapy, magnet therapy, hyperthermia, and also homeopathy, shiatsu, etc. Along with the master plan there will be a biometric study. Dr. Oskar Ausserer will be collecting data for the study ‘Quality of life and mental health in breast cancer patients. A study of complementary medicine at the Meran hospital’. The study will be directed and evaluated by Prof. Claudia Witt (Charité, Berlin). If the study indicates positive outcomes, the complementary medicine department will be established and gradually expanded to the rest of South Tyrol. The authors report on their experiences during the last two-and-a-half years and about the prospects for the future. http://dx.doi.org/10.1016/j.eujim.2012.07.568 OP-074 Interdisciplinary approach to diagnosis in medicine: the semeiotic integrated–the experience of Integrated Medicine Center of Pitigliano Cracolici Franco, Pulcri Roberto, Lucenti Cecilia, Rinaldi Massimo, Ferreri Rosaria, Bernardini Simonetta Hospital Centre for Integrated Medicine, Pitigliano Hospital, Tuscany Region, Italy The purpose of this work that uses multimedia content is to propose an integrated model of semeiotic that allows a comprehensive approach to the patient, better diagnostic and prognostic classification, a saving in terms of health spending and, ultimately, a better quality of care. In the Centre for Integrated Medicine, Pitigliano Hospital, thanks to the collaboration between the medical staff and medical doctors expert in
Oral Presentations / European Journal of Integrative Medicine 4S (2012) 9–123
complementary medicine, it was possible to develop a model of diagnosis that integrates the many comments that have been proposed over the centuries by traditional medicine in medical semiotics. This helped to identify striking similarities between the observations of our predecessor doctors at different latitudes and to rediscover semiological concepts long fallen into disuse in favour of a more extensive use of the instrumental diagnosis. Using integrated semeiotics, it is possible to increase information obtained from the analysis of patients. The signs and symptoms that are highlighted by homeopathic and Chinese diagnostic improve Western diagnostics by offering an overview of the patient and of the physiopathological process that interest him. http://dx.doi.org/10.1016/j.eujim.2012.07.569 OP-075 Integrated Medicine in the rehabilitation process for cerebral ischaemic and haemorrhagic pathologies within the Hospital Center for Integrated Medicine, Pitigliano and Manciano Hospital, Tuscany Region, Italy Rinaldi Massimo, Ferreri Rosaria, Lucenti Cecilia, Cracolici Franco, Pulcri Roberto, Bernardini Simonetta Hospital Centre for Integrated Medicine, Pitigliano Hospital, Tuscany Region, Italy Authors report the results obtained in rehabilitation processes on patients suffering from strokes and chronic-degenerative neurological pathologies and of hip replacement surgery and knee by using integrated medicine. Integrated medicine is a treatment pattern that joins conventional medical techniques such as physiotherapy and pharmacological cures to treatments that apply homeopathy and acupuncture, the so-called complementary medicine. Usage of acupuncture and homeopathy seems to improve patients’ performances and give a more rapid functional recovery and a better compliance to treatments. The parameters investigated are Motricity Index, Trunk Control Test, Nuova Barthel Index and Groningen Activity Restriction scale (GARS). The evaluation of the consumption of pain medication, and the data collected show that the use of integrated medicine determines a reduction. We evaluated the outcomes obtained using integrated medicine and those obtained by conventional medicine by comparing medical records according to age and sex of the disease before the introduction of integrated medicine. http://dx.doi.org/10.1016/j.eujim.2012.07.570
41
OP-076 Integrated medicine setting at the Hospital of Pitigliano (Italy), Public Healthcare Service, Tuscany Region Bernardini Simonetta, Cracolici Franco, Pulcri Roberto, Ferreri Rosaria, Lucenti Cecilia, Rinaldi Massimo Hospital Centre for Integrated Medicine, Pitigliano Hospital, Tuscany Region, Italy Even if integration between therapeutic resources (a combination of orthodox medicine and complementary and alternative medicine (CAM)) is a quickly developing world phenomenon and in the scientific literature, it is more and more typical to collect works dealing with integrative medicine or integrated medicine. The definition of this therapeutic model is unclear and ambiguous to the present day. Fundamentally, the term ‘integrative medicine’ is more developed in the United States and the term ‘integrated medicine’ is more applied in Europe. However, considering the projects for integrative/integrated medicine implemented in international public healthcare services, the difference between these two terms is linked to the idea of concept and, therefore, it is an operational rather than a difference in meaning. The Hospital Centre of Integrated Medicine at the Hospital for healthcare service of the Tuscany Region has been in service since February 2011 and is the first Italian facility providing homeopathy and acupuncture treatment, beyond health-care services of orthodox medicine within a public healthcare service hospital, not only towards outpatients, but also towards inpatients who accept the implementation of CAM treatment (informed consent). Integrated treatment is also applied at the neurological and orthopaedic rehabilitation Centre of the regional healthcare service of Manciano. To achieve such integrated medicine setting, specific legislative initiatives were to be taken by Tuscany Region and Hospital Local Healthcare Unit, but also cultural and planning initiatives were essential. This contribution depicts features of the integrated medicine model and, after a year and a half of being in service, the main critical situations faced during the achievement of this model will be discussed, together with the opportunities and the usefulness degree for the community’s health and the possible health-care perspectives. The model that has been carried out by the Hospital of Pitigliano allowed to achieve a real interdisciplinary treatment approach, entailing medical and nursing: it is an innovative health-care concept that could be taken as an example for additional similar and hopeful initiatives by the Italian Healthcare Service. http://dx.doi.org/10.1016/j.eujim.2012.07.571
Oral Presentations / European Journal of Integrative Medicine 4S (2012) 9–123
lysed under the guidance of structuration model of collaboration, a theoretical model for understanding interprofessional collaboration. From focus group findings we generated 28 possible approaches, and subsequently their acceptability was assessed by a two-round Delphi survey amongst BM and TCM policy stakeholders (n = 12). Results: Consensus was reached only on 13 statements. Stakeholders agreed that clinicians from both paradigms should share common goals of providing patient-centred care, promoting the development of protocols for shared care and information exchange, as well as strengthening interprofessional connectivity and leadership for integration. On the other hand, attitudes amongst policy stakeholders were split on the possibility of fostering trust and mutual learning, as well as on enhancing innovation and governmental support. Conclusions: Future policy initiatives should focus on these controversial areas. http://dx.doi.org/10.1016/j.eujim.2012.07.566 OP-072 Manifesto for Integrated Medicine: outcomes of an international debate forum Santini Gino 1 , Macrì Francesco 1 , Bernardini Simonetta 2 , Digiampietro Tiziana 3 , Grassi Italo 4 , Masciello Ennio 5 , Pulcri Roberto 1 1 SIOMI,
Rome Florence 3 SIOMI, Pescara 4 SIOMI, Reggio Emilia 5 SIOMI, Bologna, Italy 2 SIOMI,
The first ‘Manifesto for Integrated Medicine’ was illustrated in Florence (Italy), at Salone De’ Dugento in Palazzo Vecchio on 3 December 2011. Most of the Italian institutions of orthodox medicine attended the presentation, including the National Association of Medical and Dental Doctors, National Association of Drugs, National Association of Biologists, National Association of Scientific Societies, Italian Paediatrics Association and the national institutions of family doctors and paediatrics in the country, etc. Alongside the representatives of these institutions, there were also many other representatives of complementary medicine and wellness and health disciplines. The Manifesto was proposed as a document in progress and consequently carried out in only nine points. Hence, it is not to be considered as a guidebook, since the authors had only wanted to begin a debate regarding possibilities, critical issues and utility of reconsidering the public health-care system through the implementation of integrated health services, according to the increasingly widespread concepts of integrated medicine. The patron of the event, the Italian Society of Homeopathy and Integrated Medicine–SIOMI, opened the day following the event an on-line forum for national debates among the over 30 institutions which attended the event. The aim is to gather proactive views on the final draft of the Manifesto for Integrated Medicine, whose contents can be widely shared by orthodox medicine and
CAM key actors. Furthermore, another important objective is to set up a permanent forum that could lead the public health services towards initiatives of integrated health care according to the experimenting model at the Centre of Integrated Medicine in Pitigliano, Local Health Unit no. 9 (USL) in Tuscany. http://dx.doi.org/10.1016/j.eujim.2012.07.567 OP-073 Department of Complementary Medicine at the Hospital of Meran Ausserer Oskar, Thuile Christian Reparto di Medicina Complementare Ospedale di Merano, Merano, Italy The Government of South Tyrol has approved, with the resolution n. 37 of 12.01.2009, the master plan that sets up the complementary department in the hospital of Meran. The master plan will continue until 31.12.2012. In that period of time, the department will be directed by Dr. Christian Thuile, who will be in charge, as all other departments of the Hospital of Meran. There will be collaborations with all other departments, although priority will be given to patients with cancer. Methods applied will be acupuncture, phytotherapy, Chinese traditional medicine, orthomolecular medicine, infusion therapy, magnet therapy, hyperthermia, and also homeopathy, shiatsu, etc. Along with the master plan there will be a biometric study. Dr. Oskar Ausserer will be collecting data for the study ‘Quality of life and mental health in breast cancer patients. A study of complementary medicine at the Meran hospital’. The study will be directed and evaluated by Prof. Claudia Witt (Charité, Berlin). If the study indicates positive outcomes, the complementary medicine department will be established and gradually expanded to the rest of South Tyrol. The authors report on their experiences during the last two-and-a-half years and about the prospects for the future. http://dx.doi.org/10.1016/j.eujim.2012.07.568 OP-074 Interdisciplinary approach to diagnosis in medicine: the semeiotic integrated–the experience of Integrated Medicine Center of Pitigliano Cracolici Franco, Pulcri Roberto, Lucenti Cecilia, Rinaldi Massimo, Ferreri Rosaria, Bernardini Simonetta Hospital Centre for Integrated Medicine, Pitigliano Hospital, Tuscany Region, Italy The purpose of this work that uses multimedia content is to propose an integrated model of semeiotic that allows a comprehensive approach to the patient, better diagnostic and prognostic classification, a saving in terms of health spending and, ultimately, a better quality of care. In the Centre for Integrated Medicine, Pitigliano Hospital, thanks to the collaboration between the medical staff and medical doctors expert in
Oral Presentations / European Journal of Integrative Medicine 4S (2012) 9–123
complementary medicine, it was possible to develop a model of diagnosis that integrates the many comments that have been proposed over the centuries by traditional medicine in medical semiotics. This helped to identify striking similarities between the observations of our predecessor doctors at different latitudes and to rediscover semiological concepts long fallen into disuse in favour of a more extensive use of the instrumental diagnosis. Using integrated semeiotics, it is possible to increase information obtained from the analysis of patients. The signs and symptoms that are highlighted by homeopathic and Chinese diagnostic improve Western diagnostics by offering an overview of the patient and of the physiopathological process that interest him. http://dx.doi.org/10.1016/j.eujim.2012.07.569 OP-075 Integrated Medicine in the rehabilitation process for cerebral ischaemic and haemorrhagic pathologies within the Hospital Center for Integrated Medicine, Pitigliano and Manciano Hospital, Tuscany Region, Italy Rinaldi Massimo, Ferreri Rosaria, Lucenti Cecilia, Cracolici Franco, Pulcri Roberto, Bernardini Simonetta Hospital Centre for Integrated Medicine, Pitigliano Hospital, Tuscany Region, Italy Authors report the results obtained in rehabilitation processes on patients suffering from strokes and chronic-degenerative neurological pathologies and of hip replacement surgery and knee by using integrated medicine. Integrated medicine is a treatment pattern that joins conventional medical techniques such as physiotherapy and pharmacological cures to treatments that apply homeopathy and acupuncture, the so-called complementary medicine. Usage of acupuncture and homeopathy seems to improve patients’ performances and give a more rapid functional recovery and a better compliance to treatments. The parameters investigated are Motricity Index, Trunk Control Test, Nuova Barthel Index and Groningen Activity Restriction scale (GARS). The evaluation of the consumption of pain medication, and the data collected show that the use of integrated medicine determines a reduction. We evaluated the outcomes obtained using integrated medicine and those obtained by conventional medicine by comparing medical records according to age and sex of the disease before the introduction of integrated medicine. http://dx.doi.org/10.1016/j.eujim.2012.07.570
41
OP-076 Integrated medicine setting at the Hospital of Pitigliano (Italy), Public Healthcare Service, Tuscany Region Bernardini Simonetta, Cracolici Franco, Pulcri Roberto, Ferreri Rosaria, Lucenti Cecilia, Rinaldi Massimo Hospital Centre for Integrated Medicine, Pitigliano Hospital, Tuscany Region, Italy Even if integration between therapeutic resources (a combination of orthodox medicine and complementary and alternative medicine (CAM)) is a quickly developing world phenomenon and in the scientific literature, it is more and more typical to collect works dealing with integrative medicine or integrated medicine. The definition of this therapeutic model is unclear and ambiguous to the present day. Fundamentally, the term ‘integrative medicine’ is more developed in the United States and the term ‘integrated medicine’ is more applied in Europe. However, considering the projects for integrative/integrated medicine implemented in international public healthcare services, the difference between these two terms is linked to the idea of concept and, therefore, it is an operational rather than a difference in meaning. The Hospital Centre of Integrated Medicine at the Hospital for healthcare service of the Tuscany Region has been in service since February 2011 and is the first Italian facility providing homeopathy and acupuncture treatment, beyond health-care services of orthodox medicine within a public healthcare service hospital, not only towards outpatients, but also towards inpatients who accept the implementation of CAM treatment (informed consent). Integrated treatment is also applied at the neurological and orthopaedic rehabilitation Centre of the regional healthcare service of Manciano. To achieve such integrated medicine setting, specific legislative initiatives were to be taken by Tuscany Region and Hospital Local Healthcare Unit, but also cultural and planning initiatives were essential. This contribution depicts features of the integrated medicine model and, after a year and a half of being in service, the main critical situations faced during the achievement of this model will be discussed, together with the opportunities and the usefulness degree for the community’s health and the possible health-care perspectives. The model that has been carried out by the Hospital of Pitigliano allowed to achieve a real interdisciplinary treatment approach, entailing medical and nursing: it is an innovative health-care concept that could be taken as an example for additional similar and hopeful initiatives by the Italian Healthcare Service. http://dx.doi.org/10.1016/j.eujim.2012.07.571