IRIS UniSR (’Università Vita-Salute San Raffaele)
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A National Position Paper for the Strategic Development of HealthCare Simulation in Italy
No full textBeyond Care: A Scoping Review on the Work Environment of Oncology Nurses
Get PDFAbstract Background: The NursingWork Environment (NWE) plays a critical role in determining the quality of care, staff well-being, and organizational performance, particularly in oncology settings. Despite increasing attention, a comprehensive synthesis of organizational factors shaping oncology NWEs has been lacking. This scoping review aimed to describe the key features of oncology NWEs and to explore the outcomes associated with these characteristics. Methods: A scoping review was conducted following the Joanna Briggs Institute guidelines. Peer-reviewed studies published in English or Italian were included without time restrictions. Literature searches were performed in MEDLINE via PubMed, CINAHL, and Scopus between January and April 2025. Results: Twenty studies met the inclusion criteria. Key organizational characteristics of oncology NWEs were grouped into the following four domains: leadership and organizational support; workload and resource availability; ethical climate and collegial relationships; and physical and structural conditions of care settings. Across the studies, a positive NWE was frequently reported to be associated with improved nurse-related outcomes and, to a lesser extent, with patientrelated outcomes. However, these associations should be interpreted with caution due to the heterogeneity of contexts and the predominance of cross-sectional designs. Conclu- sions: The NWE is a strategic element in delivering effective, safe, and sustainable oncology care. Practical actions for nurse managers and healthcare leaders include implementing leadership training programs, ensuring adequate staffing and resource allocation, fostering open communication, and promoting interdisciplinary collaboration. These measures are essential to protect staff well-being and guarantee high-quality, patient-centered care
Advancing Toward P6 Medicine: Recommendations for Integrating Artificial Intelligence in Internal Medicine
Get PDFBackground: Internists formulate diagnostic hypotheses and personalized treatment plans by integrating data from a comprehensive clinical interview, reviewing a patient's medical history, physical examination and findings from complementary tests. The patient treatment life cycle generates a significant volume of data points that can offer valuable insights to improve patient care by guiding clinical decision-making. Artificial Intelligence (AI) and, in particular, Generative AI (GAI), are promising tools in this regard, particularly after the introduction of Large Language Models. The European Federation of Internal Medicine (EFIM) recognizes the transformative impact of AI in leveraging clinical data and advancing the field of internal medicine. This position paper from the EFIM explores how AI can be applied to achieve the goals of P6 Medicine principles in internal medicine. P6 Medicine is an advanced healthcare model that extends the concept of Personalized Medicine toward a holistic, predictive, patient-centered approach that also integrates psycho-cognitive and socially responsible dimensions. An additional concept introduced is that of Digital Therapies (DTx), software applications designed to prevent and manage diseases and disorders through AI, which are used in the clinical setting if validated by rigorous research studies. Methods: The literature examining the relationship between AI and Internal Medicine was investigated through a bibliometric analysis. The themes identified in the literature review were further examined through the Delphi method. Thirty international AI and Internal Medicine experts constituted the Delphi panel. Results: Delphi results were summarized in a SWOT Analysis. The evidence is that through extensive data analysis, diagnostic capacity, drug development and patient tracking are increased. Conclusions: The panel unanimously considered AI in Internal Medicine as an opportunity, achieving a complete consensus on the matter. AI-driven solutions, including clinical applications of GAI and DTx, hold the potential to strongly change internal medicine by streamlining workflows, enhancing patient care and generating valuable data
Cardiac resynchronization therapy for enabling guideline-directed medical therapy optimization in heart failure
No full textAims: We aimed to assess whether cardiac resynchronization therapy (CRT) might serve as an enabler for guideline-directed medical therapy (GDMT) optimization. Methods and results: Patients with heart failure with reduced ejection fraction (HFrEF) enrolled in the Swedish Heart Failure Registry between January 2009 and August 2022 were considered. Patients receiving a CRT close to the index registration were the cases, whereas controls had not received a CRT despite having an indication. Overall, 1543 (25%) HFrEF cases and 4537 (75%) controls were analysed in the intention-to-treat analysis. At baseline, beta-blockers, angiotensin-converting enzyme inhibitor (ACEi), angiotensin receptor blocker (ARB) or angiotensin receptor-neprilysin inhibitor (ARNi), mineralocorticoid receptor antagonist (MRA) and loop diuretic use was 84% versus 86%, 89% versus 88%, 57% versus 46% and 62% versus 59% in patients receiving versus not receiving CRT, respectively. At 1.5-year follow-up, patients receiving a CRT more likely experienced an improved use/dose of beta-blocker therapy (46% vs. 35%) and decreased loop diuretic use/dose (30% vs. 24%) versus controls. These associations were consistent after adjustments (odds ratio [OR] 1.83, 95% confidence interval [CI] 1.58-2.13, and OR 1.26, 95% CI 1.07-1.48, respectively), and confirmed in the per-protocol analysis (i.e. after excluding controls who received a CRT during follow-up). A significant association between CRT and the likelihood of ACEi/ARB/ARNi and MRA optimization (OR 1.22, 95% CI 1.04-1.44, and OR 1.25, 95% CI 1.05-1.50, respectively) was observed in the per-protocol analysis. Conclusions: In this large nationwide real-world population with HFrEF, CRT implantation was associated with enabled use/dose of heart failure GDMT and decreased loop diuretic need (use/dose)
A systematic review of the predictive factors for the recurrence of acute pancreatitis
Get PDFPurpose: Acute Pancreatitis (AP) is a prevalent clinical pancreatic disorder characterized by acute inflammation of the pancreas, frequently associated with biliary or alcoholic events. If not treated with cholecystectomy after the first episode, patients may experience a recurrence of AP, with consequent need for emergency surgery and increased risk of death. Analyzing the risk factors that may contribute to the recurrence of Biliary and Alcoholic Pancreatitis (BAP and AAP), future research can be driven toward new solutions for preventing and treating this pancreatic disease. Methods: A systematic review was conducted selecting studies from BiomedCentral, PubMed, Scopus and Web of Science by two independent reviewers. Publications were considered only if written in English in the time interval between January 2000 and June 2024 and investigated the risk factors for the recurrence of BAP and AAP. At the end of the selection, a quality assessment phase was conducted using the PROBAST tool. Results: In this systematic review, 8 articles were selected out of 6.945, involving a total sample of 11.271 patients of which 38.77% developed recurrence episodes. 37.5% of the included studies focus on recurrent acute biliary pancreatitis (RBAP), while 62.5% are dedicated to recurrent acute alcoholic pancreatitis (RAAP). The risk factors for the recurrence of AP showed a clear differentiation between the alcoholic and biliary etiology. Most of the considered studies adopted a retrospective design, characterized by a susceptibility to potential methodological biases. However, the trend indicated a more recent increase in prospective studies, together with a greater focus on identifying and understanding the possible risk factors associated with the recurrence of acute pancreatitis (RAP). This result highlighted the progress in the scientific approach toward a more rigorous and systematic assessment of the causes and dynamics that influence the recurrence of the disease. Conclusion: Studies highlighted the importance of lifestyle factors, clinical complications, and surgical interventions that can impact the risk of biliary or alcoholic recurrent acute pancreatitis. Increased and systematic adoption of artificial intelligence-based tools could significantly impact future knowledge relating to the risks of recurrence and relative possibilities of prevention
Transforming Gastrointestinal Diagnosis with Molecular Endoscopy: Challenges and Opportunities
No full textMolecular endoscopy represents a transformative advance in the detection, diagnosis, and management of gastrointestinal diseases, addressing the critical limitations of conventional techniques. Current diagnostic standards, such as white light endoscopy (WLE), often fail to detect early-stage lesions, particularly in high-risk populations like Barrett’s esophagus or inflammatory bowel disease patients. To overcome these challenges, molecular endoscopy, using fluorescent molecular probes, may offer ultimate precision by targeting disease-specific biomarkers. Technologies like Confocal Laser Endomicroscopy (CLE) and Immunoendoscopy are revolutionizing in vivo diagnostics, enabling the real-time visualization of tissue microarchitecture and physiological mechanisms. Fluorescence molecular endoscopy (FME) enhances the detection of precancerous and cancerous lesions, even those undetectable by conventional methods, by highlighting subtle molecular changes. Clinical applications include early tumor detection, therapy response monitoring, and improved lesion characterization. Despite these advancements, challenges persist, including high costs, a lack of standardization, and the need for specialized training. Recent innovations, such as a multi-parametric rigid standard, aim to ensure the reliable performance assessment and quality control of FME systems, addressing subjective variability and improving reproducibility. In addition, the integration of artificial intelligence (AI) with molecular endoscopy offers the potential to further reduce detection errors and significantly enhance diagnostic accuracy. This advancement underscores the potential of molecular endoscopy for personalized GI disease management, while highlighting the need for ongoing research to refine the technology, validate its clinical utility, and overcome the barriers to routine clinical application
Longitudinal assessment of white matter alterations in progressive supranuclear palsy variants using diffusion tractography
No full textIntroduction: White matter (WM) tract degeneration is a characteristic feature of progressive supranuclear palsy (PSP), with longitudinal changes observed in PSP-Richardson's syndrome (PSP-RS). Little, however, is known about the other PSP variants. We assessed cross-sectional and longitudinal WM degeneration across PSP variants using diffusion tractography. Methods: Forty-eight PSP patients were recruited by the Neurodegenerative Research Group, Mayo Clinic, and underwent two diffusion MRI, 1-year apart. We measured fractional anisotropy and mean diffusivity from eight WM tracts reconstructed using deterministic tractography. Baseline and rates of change were compared across PSP variants grouped into PSP-RS, PSP-cortical, and PSP-subcortical, and correlated with clinical disease severity. Results: PSP-RS, PSP-cortical and PSP-subcortical showed overlapping but distinct baseline patterns of WM alterations. Longitudinally, faster rates of degeneration were observed in the superior cerebellar peduncle (SCP) and dentatorubrothalamic tract (DRTT) in all groups compared to controls. In PSP-RS, the anterior thalamic radiation also showed faster rates of degeneration compared to controls. PSP-cortical had faster rates of degeneration in many WM tracts compared to controls and other PSP groups, including body of corpus callosum, superior thalamic radiation, superior corticostriatal tract, superior longitudinal fasciculus, and frontal aslant tract. Progression in the PSP-subcortical group was limited to SCP and DRTT. Greater rates of degeneration in the corpus callosum and SCP correlated with worsening disease severity. Conclusions: Different progression patterns of WM degeneration characterize the PSP variants, although degeneration of the SCP is a common feature and could be a useful potential biomarker for clinical treatment trials in PSP
Correlates of Processing Speed Change With Combined Cognitive Rehabilitation and Exercise in Progressive MS: Secondary Analysis of the CogEx Trial
No full textBackground: Cognitive rehabilitation and exercise training are promising approaches for improving cognition in persons with progressive multiple sclerosis (MS). Identifying heterogeneity of change and factors that influence the effects of cognitive rehabilitation and/or exercise training on cognitive outcomes at the individual level have direct relevance for developing tailored and optimized rehabilitation interventions for improving cognition in progressive MS. Objective: This study involved a secondary data analysis from the CogEx trial in progressive MS. This study first described heterogeneity of change in cognitive processing speed (CPS) across the intervention conditions and then identified possible adherence/compliance, baseline performance, and demographic/clinical variables as correlates of rehabilitation-related CPS changes. Methods: A total of 311 persons with progressive MS who were pre-screened for impaired CPS completed 12 weeks of combined cognitive rehabilitation (or sham) and exercise training (or sham). CPS was measured before and after the 12-week period. As potential correlates of CPS changes, we measured adherence/compliance (ie, treatment exposure), performance outcomes at baseline, as well as demographic and clinical characteristics at baseline. Results: There was heterogeneity of change in CPS across the 4 intervention conditions. We further identified baseline learning and memory impairment and premorbid intelligence quotient (IQ), but not adherence/compliance, other baseline performance outcomes, or demographic/clinical characteristics as significant correlates of CPS changes across the 4 intervention conditions. Conclusions: The overall pattern of results suggests that future trials in this area might account for impaired learning and memory and/or premorbid IQ as potential covariates, or more carefully consider the role of reserve within rehabilitation interventions in progressive MS