Clowning in health care settings. The point of view of adults

Within the past decade, there has been a surge of interest in investigating the effects of clown intervention in a large variety of clinical settings. Many studies have focused on the effects of clown intervention on children. However, few studies have investigated clowning effects on adults. This paper presents an overview of the concept of medical clowning followed by a literature review conducted on the empirical studies drawn from three data bases (PubMed, PsycINFO, and Google Scholar), with the aim of mapping and discussing the evidence of clowning effects on non-children, namely adults. The following areas were investigated: Adult and elderly patients (mainly those with dementia), observers of clowning, namely non-hospitalized adults who are at the hospital as relatives of patients or health-care staff, and finally clowns themselves. The main results are that 1) clown intervention induces positive emotions, thereby enhancing the patient\u2019s well-being, reduces psychological symptoms and emotional reactivity, and prompts a decrease in negative emotions, such as anxiety and stress; 2) clown doctors are also well-perceived by relatives and healthcare staff and their presence appears to be useful in creating a lighter atmosphere in the health setting; 3) few pilot studies have been conducted on clown doctors and this lacuna represents a subject for future research

The use of humor by therapists and clients in cognitive therapy

The purpose of this study was to investigate several aspects of humour in cognitive therapy. Eight first therapy sessions were examined and seven examples of humour originating from the therapists or the clients are reported: three represent examples of humour initiated by the client, while four are representative of humour initiated by the therapist. This research focuses on the use of humour in psychotherapy and provides evidence that when the clients initiated humour, the therapists responded in three different ways, namely, by aligning themselves with the client, disaligning themselves, or by using a strategy comprising both alignment and disalignment. Diversely, in cases in which the therapist initiated humour, four different forms of humour were identified (i.e. rhetorical humour, humour relating to a surrealistic meaning, role shifting and humour relating to register). In these cases, the clients always laughed, thereby signaling their support. An analysis of these cases demonstrates that humour is an easily integrated therapeutic tool which may be used to favour positive changes

Correction to: Minimally invasive video-assisted thyroidectomy (MIVAT): the quest for a scarless approach

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D-VAT: End-to-End Visual Active Tracking for Micro Aerial Vehicles

Visual active tracking is a growing research topic in robotics due to its key role in applications such as human assistance, disaster recovery, and surveillance. In contrast to passive tracking, active tracking approaches combine vision and control capabilities to detect and actively track the target. Most of the work in this area focuses on ground robots, while the very few contributions on aerial platforms still pose important design constraints that limit their applicability. To overcome these limitations, in this paper we propose D-VAT, a novel end-to-end visual active tracking methodology based on deep reinforcement learning that is tailored to micro aerial vehicle platforms. The D-VAT agent computes the vehicle thrust and angular velocity commands needed to track the target by directly processing monocular camera measurements. We show that the proposed approach allows for precise and collision-free tracking operations, outperforming different state-of-the-art baselines on simulated environments which differ significantly from those encountered during training

Highly sensitive persons, caregiving strategies and humour: the case of Italian and Israeli medical clowns

The medical clown is a healthcare practitioner whose character is strictly associated with the performer's own personality. In this study, the relationships between level of sensory processing sensitivity (SPS), caregiving strategies and humour in Italian and Israeli clowns were compared. Participants were 159 medical clowns (97 Italian and 62 Israeli), ranging from 22 to 74 years of age, who completed a demographic questionnaire, the self-reported Highly Sensitive Person Scale, the Caregiving Strategies Scale and the BenCor. Results showed that higher SPS was related to higher hyperactivation and deactivation, and that hyperactivation was related to lower benevolent humour and greater corrective humour. Hyperactivation negatively predicts benevolent humour but positively predicts corrective humour, beyond the effect of SPS. Deactivation had no relationship to either benevolent or corrective humour. The results are also discussed in reference to differences between the two groups and to previous studies conducted with general populations

El museo como dispositivo de espectacularización de la naturaleza

La presente investigación se desarrolla desde el pensamiento del discurso y el dispositivo propuesto por Michael Foucault, adaptado para el estudio de espacios expositivos desarrollado por Susana Herrera Lima. Se discute el concepto de espectacularización desde el pensamiento de Guy Debord. Este estudio es una combinación de las propuestas del análisis crítico del discurso de Sigfried Jäger y la teoría fundamentada de Strauss y Corbin y se realizó con la participación de seis museos de Quintana Roo. En el trabajo se plantea al museo como un dispositivo de espectacularización que escenifica una verdad a partir de fragmentos discursivos y omisiones que determinan lo que es la naturaleza y dictan las maneras como se relaciona la sociedad con ella. De esta forma, el museo tiene la capacidad de legitimar una versión embellecida de la realidad natural que se presenta en otros medios de comunicación. A la par, es un dispositivo que puede hacer visibles los elementos que conforman el concepto de naturaleza e invisibilizar los que no la han de integrar. Los museos de Quintana Roo demostraron que en el fenómeno de espectacularización, el museo tiene una participación muy diversa. Algunos confirman los efectos discursivos del espectáculo, mientras que otros confrontan la hipótesis. En todos los casos se acepta que la espectacularización es una condición ontogénica del museo, pero cuyo papel en la lógica estratégica del discurso museográfico no es homogénea

Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P < 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p < 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes