The hospital in Pitigliano (Tuscany) is the first hospital in Italy to put into practice a model of Integrated Medicine. This clinical setting caters for the use of complementary medicine (homeopathy and acupuncture (針灸 zhēn jiǔ)) alongside orthodox therapies (conventional medicine). The therapeutic model implicates doctors who are experts in complementary and alternative medicine (CAM; 補充與替代醫學 bǔ chōng yǔ tì dài yī xué) and the rest of the hospital personnel working together as equals. This contribution explains the difficulties, critical aspects and potential of this innovative setting.The clinical setting for Integrated Medicine was evaluated in part through observation and in part through the analysis of approval questionnaires. The writers of the questionnaires were the orthodox medical personnel and the hospital patients.The project is still evolving today in spite of the initial partial contrariety of some doctors in the hospital and some external doctors in the area. However, it can already be considered a positive experience, as confirmed by the high approval gained from many health workers and most of the hospital patients. Moreover, the follow-up carried out through specific surgeries dedicated to CAM is extremely positive.Up to now 532 inpatients suffering from acute illnesses, relapse of a chronic illness or neurological or orthopaedic rehabilitation following strokes, brain haemorrhage, neurological illness or limb prosthesis operations have been treated. This work has tried to illustrate the innovative and positive experience for the Italian public health authorities so that it may also be useful to anyone who would like to promote similar initiatives within its public health Institution.

Background: To evaluate the clinical efficacy of treatment with integrated medicine (acupuncture and homeopathy in addition to conventional treatment) in improving measures of physical ability. Data from medical records with patient-reported information on background characteristics, diagnosis on admission (orthopaedic conditions and stroke) and movement performance indices.

Background: Complementary medicines (CM), including homeopathy, acupuncture, and traditional Chinese medicine, have been introduced for cancer patients undergoing chemotherapy and radiotherapy treatment in the Pitigliano Hospital Centre of Integrated Medicine in order to minimize the side effects of these treatments, which improves quality of life and adherence to conventional therapies. Methods: Cancer patients (240) were enrolled in an integrated care model offering a comprehensive protocol including homeopathy and acupuncture, provided in line with the stage of the disease as well as in consideration of any comorbidities in individual patients. The following data were collected upon enrollment and also after 1-2 months of the integrated therapies:SF-12 quality of life (QoL) questionnaire;Edmonton symptom assessment scale (ESAS);and a questionnaire on the use of conventional medications. Results: There was a 92.4% reduction in symptoms (as monitored by ESAS) caused by the patient's disease or by comorbidities. The SF-12 revealed reduced fatigue and increased wellness, as well as good adherence to the cancer treatments. Additionally, a reduction in

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Background: Acupuncture is an innovative and scientifically supported treatment for oncologic patients, as well as an effective palliative care option. At the Palliative Care Department of "Misericordia" Grosseto Hospital in Tuscany, real integration of acupuncture in palliative medicine has been possible. The objective of this work is to retrospectively evaluate patient treatment outcomes obtained using an integrated medical care approach administered within a palliative care unit. Methods: Medical records of oncology patients admitted to the palliative care unit who voluntarily underwent integrated therapy with acupuncture were retrospectively analyzed. Treatment was innovative and personalized and included the use of-points based on Traditional Chinese Medicine (TCM),-points based on the Microsystems Acupuncture Technique,-points based on psychic action (Shen Ling). Codified evaluation indexes were used to rate patient status at the beginning of treatment and after 1-2 months. Treatment outcomes were evaluated for oncologic patients voluntarily participating as palliative care outpatients or inpatients receiving integrated acupuncture therapy. Results: 172 cancer patients treated over a two-year period received a total of approximately 600 treatments, with 92.4% of patients reporting improvement of symptoms. Examination of patient data obtained from the SF 12 questionnaire and of patient assessments based on the Edmonton Symptoms Assessment Scale (ESAS) revealed remarkable improvement in perceived health 2 months after initiation of integrated therapy (p<0.01). Specifically, marked post-treatment improvement in symptoms of pain, fatigue, nausea, sleep disturbance, anxiety, loss of appetite, shortness of breath, cough and wellbeing were observed, with no improvement observed for dry mouth or depression. No major side effects were reported. Conclusions: Acupuncture is a promising and safe adjunctive therapy for management of common symptoms that afflict oncological patients during all stages of disease, including symptoms of patients nearing the end of life in a home or hospice setting.