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The traditional biomedical paradigm is no longer a guarantee of quality for health care, facing increasingly difficult challenges caused by chronic diseases and increasingly fragmented resources that current healthcare systems are dealing with. Health care organizations, considered to be the most complex enterprises of the modern era, must be able to focus on the flow of patients, integrating primary and secondary care through tools such as the Integrated Care Pathways (ICP). This brief discussion attempts to define the ICP its purposes, the elements that characterize it, its limitations and the mechanisms to push for a successful implementation. In order to highlight the elements and basic steps for the creation of an ICP, the authors have compared five different clinical pathways, whose implementation they have contributed to. The comparison was made using two grids: the first showing the essential elements for the definition of lCP and the second one with features that can facilitate their effectiveness. The conclusions of the work show what, pursuing the construction of a pathway, we must never forget: to analyze the gap between the clinical-care activities performed and the theoretical framework provided by the evidence; to see the barriers to change that may impede the implementation; to involve all actors in the system, with particular attention to patients and their associations, and finally to provide a plan for information and education, addressed to health professionals and patients as well.

The authors are reporting a practical experience about safety management of health workers through the adoption of a management model inspired to the indications of International Standard for Quality Management. In the discussion they describe the integration path between the Prevention and protection Service and the Quality Office of the University Hospital of Bologna in order to promote the accomplishment of a progressive spirit of collaboration through the implementation of a shared and common management system which helped in the adoption of appropriate Improvement solutions in order to protect the safety of the health workers.

A prospective observational study was conducted during a two-year period to evaluate the prevalence of hospitalized pneumonia in six hospital units of the Bologna S.Orsola-Malpighi hospital (Italy). The selected units were: general surgery, general medicine, internal medicine, geriatrics, respiratory physiopathology and pneumology, with a total of 205 beds and around 4,800 admissions per year. Data were collected from the clinical cards and cases of pneumonia were distinguished by origin (community-acquired or hospital-acquired according to CDC definition), individual and clinical characteristics, and aetiology. The study involved 486 cases of pneumonia: 75 hospital-acquired and 411 community-acquired (84.6%). Patients affected by hospital-acquired pneumonia were older (average age 77 years) compared to community-acquired cases (74 years) and show a more homogeneous gender distribution (males: 48.0% vs 59.4%). Hospital stays (42 vs 21 days) and mortality rates (24.0% vs 11.7%) were significantly higher in hospital-acquired pneumonia. The incidence rate of nosocomial pneumonia was 7.4 per 1000 hospitalized patients and increased to 17-23 per 1000 in the pneumology and respiratory physiopathology units. Only 16.9% of cases had an aetiological diagnosis (14.1% community-acquired; 31.8% hospital-acquired); the most common isolates were S. aureus and P. aeruginosa. The hospital-acquired cases were caused by Gram-negative bacilli more often than the community-acquired cases, and infections were more frequently polymicrobial (37.5% vs 3.4%). In order to reduce morbidity and mortality due to pneumonia it is important to implement prevention measures in the community (i.e. specific vaccination campaigns), improve clinical protocols for aetiological diagnosis in hospitalised patients and increase epidemiological surveillance of hospital-acquired infections.

This study seeks to identify which of the various climatic parameters is the most significant causative factor for the onset of cerebral ictus or TIA in subjects clinically "at risk". The research was conducted in the province of Brescia, where it was discovered that the most stressful climatic factor was a warm, dry south-westerly wind (SW). It was postulated that such climatic conditions may favour platelet aggregation by means of an increase in the charge of positive ions in the air.

A newly devised technique of electrical transcutaneous brain stimulation has been applied to a population of cephalalgic patients in order to assess its proficiency in pain relieving and in increasing the concentration of serum endorphins. A significant pain relief associated with an increase in serum endorphins has been obtained only in those patients in which clinical and instrumental evaluations had identified the headache as one of "organic" origin. By contrast both in "non organic" and in control subjects the technique has proved to be effectiveless. Our results suggest that transcutaneous electrical brain stimulation can affect the release of endogenous opioids relieving pain at least in selected patients.