Organizational justice represents a key construct in healthcare settings, influencing professionals' well-being, quality of care, and the sustainability of healthcare systems. In nursing, the perception of fairness in decision-making processes, resource allocation, and professional relationships plays a particularly relevant role. This study aimed to analyse organizational justice in nursing settings, exploring its antecedents, consequences, and measurement approaches, integrating evidence from the literature with nurses' perceptions. A narrative literature review was conducted, consulting PubMed, CINAHL, Scopus, PsycINFO, and Google Scholar using search strategies structured around specific thematic areas. To further explore the findings, an exploratory qualitative study was conducted, based on semi-structured interviews with 16 nurses selected through purposeful sampling. Data were analysed using narrative synthesis and thematic analysis. Organizational justice emerged as a multidimensional construct articulated into distributive, procedural, and relational dimensions, and associated with outcomes such as job satisfaction, psychological well-being, burnout, and turnover. Key antecedents included leadership styles, decision-making processes, organizational communication, and recognition systems. Qualitative findings highlighted how organizational justice is experienced as a concrete, everyday phenomenon, shaped by inequalities in opportunities, limited participation in decision-making, lack of recognition, and relational dynamics perceived as arbitrary. These conditions are associated with frustration, loss of motivation, and progressive disengagement, leading to outcomes such as burnout, turnover, and forms of withdrawal, including forms of withdrawal that may be interpreted as quiet quitting. Organizational justice can be considered a structural dimension of healthcare settings, crucial for professionals' well-being and quality of care. Promoting transparent, participatory, and fair decision-making processes, together with inclusive leadership and recognition practices, represents a strategic priority to prevent disengagement and support the sustainability of healthcare systems.
BACKGROUND:The Prevention Department represents the technical and functional structure of the Italian National Health Service responsible for implementing collective prevention and public health activities. Ensuring the appropriate allocation of qualified healthcare workers (HCWs) within this setting is fundamental to guarantee the delivery of essential services, maintain system efficiency, and address emerging public health challenges. METHODS:This study proposes a methodological framework for estimating the annual workable hourly rate of Environmental Health Officers operating within Prevention Departments. The model integrates multiple parameters including, for the workplace safety topic, the size of the working population subject to territorial control activities, the number of companies intended for checks according to national and regional planning, contributing to the calculation of effective working time based on Full-Time Equivalent (FTE) hours. Additional corrective factors are incorporated to account for absenteeism, indirect activities, travel time related to territorial characteristics, and specific targeted prevention programs. The approach was informed by institutional standards, European policy recommendations, and data derived from a Local Health Authority located in the Veneto Region. RESULTS:The proposed model combines two main reference indicators: one Environmental Health Officer per 10,000 workers in the sector within the territorial jurisdiction and an additional professional per 400 companies. The calculation of effective workforce availability considers an estimated average of 1,408 working hours per year per FTE, adjusted for absenteeism and indirect activities. These parameters allow for a more realistic estimation of programmable activities based on standard average times to ensure adequate inspection, surveillance, and other prevention activities. CONCLUSIONS:The investigated methodology could provide a structured approach to workforce planning within Prevention Departments, supporting evidence-based staffing decisions and improving the alignment between service demand and human resources. In a context characterized by evolving public health needs, workforce shortages, organizational transformation, and flexible allocation of HCWs, useful policies for effectively managing human capital will be essential to ensure the sustainability and effectiveness of prevention services within the public health system.
BACKGROUND AND AIM:According to Legislative Decree 81/08, any university student performing any activity in a laboratory, including teaching laboratories, is considered a worker and therefore subject to current legislation. This study aimed to assess the chemical and biological risk in university teaching laboratories of Urbino. METHODS:The chemical and biological risk assessment was carried out in 6 teaching laboratories of Urbino University using the ISPRA method and INAIL questionnaires (one for intentional use and one for potential exposure), respectively. RESULTS:Overall, the activities carried out in the examined teaching laboratories resulted in chemical level lower than 1, except one activity (1.304). In total, 192 hazardous reagents were identified; 16, classified as carcinogens/mutagens, are handled exclusively by the technical assistants. As regards the biological risk, the activities with potential exposure resulted in an acceptable risk level (83%) and only one in a medium risk level (17%). In the case of the intentional use, all the examined activities showed a medium risk level, ranging from 2.29 to 3.43. DISCUSSION:These results highlight the importance of the safety training provided to students attending the laboratories, as well as the awareness of teachers regarding safety. The risk assessment here presented was referred to technical assistants and course instructors, rather than the students themselves. Even if this approach is certainly more conservative, the question of the true extent of the chemical and biological risks to which students are exposed during their laboratory activities remains open. CONCLUSIONS:The development of a standardized tool for this purpose, beside the standard risk assessments used in research laboratories, would provide more information on risk exposure and risk perceptions by the students.
Background Quality and patient safety policies in Italy are constantly evolving. Given the rapidly aging population and the increased vulnerability, it is essential to consistently ensure high levels of attention to quality and risk assessment in long-term healthcare facilities, providing medical and social care to elderly residents or to adults with disabilities (LTHFs). Objective The objective was to identify critical issues that persist in (LTHFs) in Lombardy despite the prevention and containment strategies currently in place or ongoing, and to identify areas for improvement. Materials and Methods The cross-sectional study was based on a questionnaire developed and applied by the Risk Managers of the eight Local Agencies for Health Protection, in the LTHFs in their respective geographical areas. Descriptive, correlation, and factorial analyses were performed. Results and discussion The response rate was 82% (674 LTHFs). Results for 2022 indicate that only 43.8% of the LTHFs had designated a Risk Manager, while 67.2% had established an Incident Reporting System. No incidents were reported in half of the LTHFs. Overall, the number of reported incidents varied greatly (mean: 13.8 ± 38.9). While data protection and ethical-behavioural risks were mapped in more than 80% of the LTHFs, risks concerning internal or external communication (53.5%), litigation (47.8%) and reputation (41.1%) were mapped in fewer LTHFs. The level of implementation of the Ministerial Recommendations applicable to LTHFs ranged from 94.6% for fall prevention, to 43.8% for prevention of violence against staff, to 43.4% for prevention of transfusion reactions caused by AB0 incompatibility, and to 34.3% for prevention of suicide in the facility. Most LTHFs implemented a range of risk prevention strategies, but those concerning the use of benzodiazepines (50.7%), the prevention of antibiotic resistance (47.8%), the antibiotic consumption (42.6%), and the provision of personalized packaging for safety and medication adherence (28.6%) were implemented in less than half of the LTHFs. The formal appointment of a Risk Manager was significantly correlated with the level of implementation of best practices related to risk management, quality of care, and communication. The psychometric properties of the questionnaire were acceptable for a model with 46 items grouped into 5 distinct domains: "General risk mapping"; "Main Ministerial Recommendations"; "Risk management strategies"; "Particular events and special medications" and "Quality and communication." Therefore, the authors encourage its widespread application in other LTHFs. Conclusion The study highlights both positive aspects and critical issues concerning risk management in LTHFs in the Lombardy region as well as opportunities for improvement. The collaboration between the Regional Centre for Management of Clinical Risk and Patient Safety, the Risk Managers of the Local Agencies for Health Protection, and the LTHFs remains essential for improving quality and resident safety.
The mpox outbreaks observed in 2025 highlighted significant shifts in transmission dynamics, viral clades, and public health responses, particularly in Africa. In contrast, Sierra Leone experienced its largest mpox outbreak that year-Africa's first major Clade IIb epidemic-which ran from 10 January to 17 December 2025. It involved 5,442 confirmed cases among 7,110 suspected cases, a case fatality rate of 1.1%, and 22,536 contacts identified. A public health emergency was declared on 13 January 2025. Transmission peaked in epidemiological week 20 (May 2025) with 654 confirmed cases. The burden was highest in Western Area Urban (55.4%, 3,014 cases), Western Area Rural (19.9%), and Bombali (6.1%). Cases predominantly affected young adults aged 20-39 years (median age 26) and males (52.5%). Key affected groups included sex workers, children under 15 years (6.5%), and pregnant women (1.6%). High population density in Freetown, limited resources, weak coordination, misinformation, and surveillance gaps facilitated spread. Genomic evidence revealed undetected Clade IIb (hMPXV-1 lineage, including G.1) circulating for ~3 months from Nigeria. Environmental contamination affected 13.5% of healthcare surfaces. Symptoms included rash, fever, headache, lymphadenopathy, sore throat, and pain; 28.9% of cases were hospitalized, often delayed by stigma and fear. Among those screened for HIV co-infection (23.6%), 82% of deaths occurred in co-infected individuals. The National Public Health Agency (NPHA) implemented seven response pillars: case management and isolation, infection prevention and control (IPC), risk communication, targeted vaccination (186,470 doses administered from 267,000 received), coordination, surveillance, and research. The outbreak ended after 42 consecutive case-free days, underscoring the importance of early surveillance and genomic monitoring to prevent sustained urban transmission.
Background Schools are key environments for children's daily lives, where urgent events such as syncope, hypoglycemia, seizures, and minor trauma can occur. In Italy, the absence of school nurses and the lack of mandatory first aid training for all teachers place initial emergency management largely on educational staff, whose preparation is variable. Enhancing first aid culture and readiness is therefore essential for prevention, early recognition, and timely response. Aim To assess the training level and preparedness of teachers-from nursery to lower secondary school-in managing pediatric urgent and emergency situations within school settings. Material and Methods A multicenter, descriptive, cross sectional observational study was conducted (April-October 2025) using a structured questionnaire integrating two validated instruments. Participants were recruited from nursery, kindergarten, primary, and lower secondary schools in the Marche region (Italy). Data were summarized as proportions with 95% CIs (Clopper-Pearson). Associations were tested with chi square (exact tests as needed), with effect size via Cramér's V. Significance α=0.05. Correct CPR sequence knowledge was estimated as prevalence. Results The sample included nursery (n=8), kindergarten (n=12), primary (n=23), and lower secondary (n=24) teachers, mostly aged 26-50 years; 64.2% held a university degree. While 91% reported first aid knowledge and 88% had attended at least one course, only 7.5% felt genuinely prepared; 64.2% felt insecure and 28.4% unprepared, and ~90% requested further practical training. Scenario items revealed procedural gaps: only 55.2% prioritized assessing consciousness in an injured/unconscious student; 71.6% would avoid manipulating a sprained ankle; responses on bleeding were split (direct pressure 52.2% vs gentle tamponing 46.3%). Diabetes knowledge was stronger (e.g., insulin via injection 95.5%; insulin does not raise glucose 92.5%), yet uncertainty remained for managing acute episodes on site. On epilepsy, misconceptions were largely rejected, but causal attributions mixed genetics (47.8%) and emotional factors (41.8%). Practical first aid sequencing showed fragmentation; only ~33% (95% CI 22-45%) knew the correct CPR sequence. Training was strongly associated with perceived preparedness (χ²(2)=22.95; p<0.001; V=0.59), age and seniority with lower confidence (V=0.66 and 0.61, respectively), and perception moderately with correct CPR sequence (p=0.003; V≈0.42). Training alone did not correlate with correct CPR sequencing (p=0.366). Discussion Current training reduces outright unpreparedness but often leaves teachers in a state of operational insecurity. Confidence and competence-especially CPR sequencing-appear to require hands on practice, realistic simulations, and regular refreshers rather than single-course exposure. Conclusions Teachers show acceptable theoretical awareness in selected areas but significant practical uncertainties in first aid, especially CPR and initial assessment. Structured, periodic, skills based programs and competency verification are priorities. Integrating the school nurse as a health educator could provide sustainable, on site support for training and emergency readiness.
BACKGROUND:The increasing clinical complexity of pediatric patients, combined with global nursing workforce shortages, requires reliable tools to measure nursing care complexity and support evidence-based staffing decisions. In highly specialized settings such as pediatric cardiovascular units, patient acuity and cognitive nursing workload are particularly demanding. However, data on validated tools for assessing care complexity in pediatric contexts remain limited. OBJECTIVE:To measure nursing care complexity in pediatric cardiovascular patients and to identify clinical and organizational factors associated with higher complexity levels using validated pediatric acuity tools. MATERIAL AND METHODS:A retrospective cross-sectional observational study was conducted on 313 patient records from the Pediatric and Congenital Cardiac Surgery and Cardiology Unit and the Pediatric Intensive Care Unit of a tertiary university hospital in Italy (January-December 2022). Nursing care complexity was assessed using the CAMEO II tool for intensive care and the Inpatient CAMEO tool for ward settings. Descriptive statistics were performed. Associations between complexity and categorical variables were analyzed using chi-square tests. Simple and multiple linear regression analyses were conducted to identify predictors of baseline complexity (T0). Statistical significance was set at p 0.05. RESULTS:All patients admitted to the intensive care unit showed medium nursing care complexity. In the inpatient cardiac unit, 27% of patients had low complexity and 73% had medium complexity; no high-complexity cases were observed. Younger age was significantly associated with higher complexity (B = -0.29, p 0.001). Urgent admission (B = 6.73, p 0.001) and longer hospital stay (B = 0.37, p 0.001) were also significant predictors. Organizational variables, including day of the week and work shift, were not significantly associated with complexity. The regression model explained 46% of the variance in baseline complexity scores (adjusted R² = 0.451). DISCUSSION AND CONCLUSIONS:In pediatric cardiovascular settings, nursing care complexity is primarily driven by patient-related clinical factors rather than organizational variables. Younger and urgently admitted patients with longer hospital stays require higher cognitive nursing workload. The systematic implementation of validated acuity tools such as CAMEO II and Inpatient CAMEO may support evidence-based workforce planning, optimize nurse-to-patient ratios according to patient acuity, and enhance quality and safety of care. These findings are particularly relevant in the context of healthcare resource constraints and contribute to improving organizational decision-making in specialized pediatric settings.
The pervasive adoption of Generative Artificial Intelligence tools in professional settings raises a question that those responsible for training can no longer avoid: what happens to expert intuition - that form of embodied, tacit knowledge built through years of practice and error - when the most cognitively demanding tasks are systematically delegated to a machine? This article argues that the risk is not technical but formative: it concerns the mechanism through which deep professional competence is constructed, with concrete implications for the design of professional development pathways in healthcare organisations.
COVID-19, which stands for Coronavirus Disease 2019, is a highly transmissible viral infection, caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) [1]. Its rapid dissemination prompted the World Health Organization (WHO) to officially declare it a global pandemic on March 11, 2020 [2]. It was later recognized as one of the most significant global health and socioeconomic crisis of modern times, leading to 776.8 million confirmed cases and over 7 million confirmed deaths [2, 3].
Media exposure has caused profound changes in family life, and because children's brains are extremely plastic in the early stages of development, the risks and benefits of any environmental stimulus are amplified (1,2,3). Therefore, the World Health Organisation (WHO) and the American Academy of Paediatrics (AAP) have implemented official recommendations on screen use, prohibiting exposure for children under one year of age and stating that children under five years of age should not spend more than one hour per day on screen-based activities (4,5). Although digital technology offers numerous advantages, from enhancing our capabilities to providing rapid access to large amounts of information, as is the case with distance learning, for example, it is also important to consider its possible negative effects.
INTRODUCTION:Sierra Leone has one of the highest maternal and under-five mortality rates in the world. Maternal death reviews can reduce maternal mortality. In Sierra Leone, the national Maternal Death Surveillance, and responses (MDSR) was developed in 2015 and introduced (implementation) in 2016. This study exploring the knowledge and perceptions of MDSR, challenges to reduce the cause of maternal deaths in Tonkolili Health district, Sierra Leone. MATERIALS AND METHODS:It was a qualitative evaluation among MDSR review meeting members in Tonkolili health district. We used individual interviews and focus groups for audio recorded. We stopped to collect the data with the saturation. The audios records were transcript to word text and, systematic coding and thematic analysis done by using NVIVO software version 15. RESULTS:We conducted 30 interviews and 3 focus groups with 16 (40% female) participants of MDSR review meeting members in Tonkolili health district on July 2025. MDSR's start in Tonkolili lack consensus, with estimates from 2015, aligning with national rollout in 2015-2016. Participants understand MDSR as a continuous, collaborative system to identify, review, notify, and respond to maternal deaths (pregnancy to 42 days postpartum) to prevent future ones, addressing gaps, three delays, and accountability without blame. Viewed as well-designed, non-judgmental, and action oriented, MDSR fosters team collaboration, learning from mistakes, and clinical knowledge improvement. Postpartum Hemorrhage (PPH) was cited as top cause of maternal death, follow by, Hypertensive disorders, infections/sepsis, unsafe abortions, obstructed labor, non-obstetric issues and first delay (seeking care) from cultural barriers; referral/transport issues. As challenges, we noted, logistical (equipment/supply shortages, blood bank delays, poor referrals/vehicles); human resources (training gaps, low attendance, overburdened staff); community (awareness lacks, traditional birth attendance home deliveries) and systemic challenges (communication, documentation, politicization, blame culture). CONCLUSIONS:To enhance MDSR implementation, ensure comprehensive support through resource provision, capacity building, community engagement, timely processes, motivation, infrastructure, policy reforms, and a blame-free culture.
One of the most important metrics for evaluating a researcher's performance is the h-index, which assesses productivity as well as citation effect. Emphasizing the significance of quality over quantity, the paper analyses the importance of publishing in high-impact journals and collaborating with influential researchers. It highlights the role of self-citation judiciously and advocates for active engagement in scholarly networks and conferences. Furthermore, it discusses the impact of open-access publications and the advantages of promoting research through social media and academic platforms. Researchers can greatly increase their exposure and intellectual impact in their field by putting these strategies into practice.
BACKGROUND:Road traffic accidents (RTAs) are a major public health concern, particularly among young adults. This study assessed road safety awareness, attitudes, and behaviors among medical students in Chennai, India. METHODS:A cross-sectional study was conducted with 320 undergraduate medical students and their interns. Data were collected using a semi-structured questionnaire and analyzed using SPSS version 22.0. Logistic regression was used to identify the associations between demographic variables and outcomes. RESULTS:Overall, 66.9% of the participants demonstrated good knowledge of road safety, 77.2% exhibited good behavior, and 52.2% held positive attitudes. Sex significantly influenced both knowledge (females: adjusted OR = 0.42, 95% CI: 0.23-0.77, p = 0.005) and attitudes (females: OR = 1.84, 95% CI: 1.06-3.19, p = 0.030). Formal road safety education was associated with better behavior (OR = 0.54, 95% CI: 0.32-0.92, p = 0.023). CONCLUSION:Although knowledge and self-reported behavior were relatively high, positive attitudes were less prevalent. Gender and formal education significantly impacted road safety awareness and adherence. These findings highlight the need for targeted interventions to improve road safety practices among healthcare professionals.
Background Nursemaid's elbow, or painful pronation of the elbow, is a common orthopedic condition in children aged 0-5 years. It is typically caused by sudden traction on the forearm, leading to subluxation of the radial head. Despite its benign nature and straightforward treatment, the condition remains frequent, largely due to insufficient awareness among parents and caregivers. Preventive strategies, including health education, are essential to reduce incidence and recurrence. Objective The primary objective of this study was to evaluate the level of knowledge and awareness of nursemaid's elbow among parents and caregivers in Italy. The secondary objective was to promote preventive measures through educational interventions, particularly focusing on safe alternatives to risky practices such as lifting children by the wrists or performing the "vola-vola" game. Material and Methods A descriptive observational study was conducted in three phases: (1) a pilot study to validate the questionnaire, (2) administration of the definitive questionnaire via social platforms, and (3) dissemination of an educational video. The pilot questionnaire was tested on 100 participants to assess clarity, comprehensibility, and privacy compliance. The final questionnaire, consisting of 13 closed-ended items, was distributed between November 2024 and February 2025 to parents of children aged 0-5 years. Data were analyzed using IBM SPSS Statistics v31, applying binomial tests, Fisher's exact test, and internal consistency analysis. The educational video was shared on Facebook, Instagram, and LinkedIn, and its impact was measured through visualization metrics. Results The pilot study confirmed the validity of the questionnaire, with over 90% of participants rating it clear and comprehensible. In the main survey, 45.5% of parents reported lifting children by the wrists, and 74.8% admitted practicing the "vola-vola" game. Although 64.9% perceived the practice as potentially harmful, only 38.3% had received explicit advice against it. Knowledge of nursemaid's elbow was limited: 49.5% had heard of it, but fewer understood its causes (45.3%) or recognized its clinical signs (38.1%). Only 6.3% reported direct episodes in their children, with a high recurrence rate (94.9%). The educational video reached 5799 views, with Facebook accounting for the majority (3549), particularly among adults aged 25-44 years. Discussion The findings highlight a significant gap between risk perception and preventive communication. International literature confirms similar trends, with recurrence rates up to 14% and widespread lack of awareness. Imaging is generally unnecessary for diagnosis, except in atypical cases. Preventive education remains the cornerstone of reducing incidence. Conclusions Nursemaid's elbow continues to be a frequent condition in early childhood, exacerbated by insufficient parental knowledge. Educational campaigns targeting parents, teachers, and caregivers are crucial to promote safe practices and reduce recurrence. The dissemination of evidence-based information, particularly through social media, represents an effective strategy to improve awareness and safeguard pediatric health.
Dear Editor, In a world which the disparities in access to health services are not problems that only concern minorities, vulnerable populations and societies with the lowest levels of development, the self care is an issue that transcends all borders and, therefore, constitutes together with others strategies the core of the global priorities, a need that, for instance, intersects the set of targets of the third goal of the 2030 agenda for sustainable development¹ within which the progress both in reducing maternal mortality across the world, that went from 228 to 197 deaths per 100 000 live births between 2015 and 2023, and in achieving universal health coverage has been exiguous².
BACKGROUND:The global rise in the ageing population has increased the burden of chronic oral diseases among older adults, particularly in regions with limited geriatric-focused healthcare resources. Age-related physiological decline, multimorbidity, and polypharmacy collectively heightened susceptibility to dental caries, periodontal disease, tooth loss, xerostomia, and prosthetic complications. Despite this growing concern, evidence on how comorbidities influence oral health and quality of life among geriatric individuals remained fragmented. AIM:This systematic review aimed to determine the prevalence of oral diseases among geriatric adults and to assess oral health-related quality of life (OHRQoL), while examining the impact of comorbidities, multimorbidity, and polypharmacy. MATERIALS AND METHODS:The review was conducted according to PRISMA 2020 guidelines and was prospectively registered in PROSPERO [CRD420251232457]. A comprehensive search of PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar was performed for studies published from January 2000 up to date. Observational studies involving adults aged ≥60 years that reported oral health indicators and OHRQoL using validated instruments (GOHAI, OHIP) were included. Data extraction and quality appraisal were carried out independently by two reviewers using the Joanna Briggs Institute (JBI) checklist. Due to heterogeneity across populations and assessment tools, a narrative synthesis was employed. RESULTS:Five studies met the eligibility criteria, representing institutionalized Italian elders, tribal elders in Kerala and Tamil Nadu, dental outpatients in Delhi, and community-dwelling older adults in Iran. Across all settings, high levels of dental caries, periodontal destruction, tooth loss, and inadequate prosthetic rehabilitation were observed. OHRQoL was consistently reduced, with the poorest scores among individuals with multimorbidity and functional impairment. Comorbidities and polypharmacy showed strong associations with compromised oral health and diminished OHRQoL. CONCLUSION:Oral diseases remained a major public-health concern among geriatric adults. The strong influence of comorbidities, multimorbidity, and polypharmacy on oral health underscored the need for integrating oral healthcare into routine geriatric services. Targeted preventive strategies, improved accessibility, and interdisciplinary care approaches are essential to enhance functional well-being and quality of life in ageing populations.
BACKGROUND:Artificial intelligence (AI) is increasingly applied in cardiology to enhance diagnostics, risk prediction, remote monitoring, and patient management. With the proliferation of wearable devices and advanced imaging technologies, AI promises to improve cardiovascular outcomes and healthcare efficiency. OBJECTIVE:This systematic review evaluates recent evidence on AI applications in cardiology, focusing on diagnostic accuracy, wearable and remote monitoring technologies, image interpretation, and clinical utility. METHODS:A comprehensive literature search was conducted across PubMed, Scopus, IEEE Xplore, Web of Science, and Google Scholar for studies published up to September 2025. Eligible studies included original research on AI-driven diagnostics, wearable-based monitoring, and imaging interpretation in cardiovascular medicine. Data extraction included study design, AI methodology, population, outcomes, and key findings. Quality assessment was performed using QUADAS-2 and NIH tools, and findings were synthesized narratively and comparatively. RESULTS:AI applications demonstrated high diagnostic performance across modalities. Wearable and edge-computing devices enabled real-time ECG analysis, arrhythmia detection, and heart failure monitoring with high accuracy, precision, and responsiveness. AR-assisted stethoscopes improved auscultation accessibility and diagnostic confidence. AI-driven quantitative coronary CT outperformed myocardial perfusion imaging in detecting obstructive coronary artery disease. Pediatric cardiology AI models exhibited limited accuracy, highlighting the need for further refinement. Overall, AI integration in cardiology shows potential for enhancing early detection, personalized management, and preventive care, though challenges such as data integration, validation, regulatory approval, and clinical adoption remain. CONCLUSION:AI technologies are transforming cardiology by enabling precise diagnostics, remote monitoring, and predictive analytics. Ongoing validation, standardization, and interdisciplinary collaboration are essential to ensure safe, effective, and clinically impactful implementation.
INTRODUCTION:The COVID-19 emergency has forced a rapid reorganization of healthcare services, suspending many non-urgent outpatient services and redefining the offering based on companies' potential for process and resource optimization and adapting it to the new context. In this period, therefore, it became necessary to use digital media and to verify the possibility of ensuring remote services for chronic patients. In light of this experience, ASL ROMA 2 has implemented a research project to ensure the remote rehabilitation of chronic patients with motor impairments, in particular with spinal cord injury. The project was funded by the Baroni Foundation Objectives: Since 2023, ROMA 2 local health authority (ASL ROMA 2) has launched a project for the use of a platform dedicated to telerehabilitation, funded by the Baroni Foundation, with the following objectives: Objectives: Since 2023, ROMA 2 local health authority (ASL ROMA 2) has launched a project for the use of a platform dedicated to telerehabilitation, funded by the Baroni Foundation, with the following objectives: ensure access and continuity of care, including continued rehabilitation at home. improve rehabilitation interventions through the appropriate use of remote services and capabilities; these allow for better tailoring of treatment frequency and intensity to the needs and preferences of The platform can be integrated with other healthcare systems and supports protocol and plan definition, wearable device integration, telerehabilitation, schedule management, clinical monitoring, and more. The technology architecture is based on open-source software solutions such as Kafka, Kubernetes, Java, Typescript, PostgreSQL, MongoDB, TimescaleDB, AWS, KeyCloak, Drools, DSL, Strapi, and Workflow Engine. increase the efficiency of home rehabilitation services, allowing for the provision of care to a greater number of patients requiring assistance. promote monitoring, health education, and/or the adoption of appropriate self-care practices. These objectives are consistent with the objectives outlined in the National Recovery and Resilience Plan (PNRR) Mission 6 - Health Component 1 (M6C1) Proximity networks, facilities, and telemedicine for community care. This paper describes the results of the research project "Fleexi-Rehab-Care-Tech (FRCT)" by ASL ROMA 2, focusing on tele-assistance and the provision of physiotherapy and occupational therapy for patients with motor and neuromotor injuries.
INTRODUCTION:The management of chronic and multiple chronic conditions is a major challenge for public health. The pilot study aims to develop a mathematical model which, together with a telemonitoring protocol, will ensure the reprogramming of chronic patients in the medium to long term, optimizing waiting lists and, consequently, the quality of the service provided, including through the pursuit of equity and accessibility to the service. MATERIALS AND METHODS:The study was conducted by the clinical rehabilitation team at the San Felice Polyclinic of ASL Roma 2 between September 2024 and April 2025. Fifty-four patients diagnosed with moderate COPD were recruited and treated, divided into three groups of 18, and were re-evaluated 3, 4 and 5 months after discharge. The patients underwent 20 group respiratory rehabilitation sessions and aerobic training with progressive load on exercise bikes. STATISTICAL ANALYSIS:For each sample of patients, the mean and standard deviation were calculated of the STS and 6MWT recorded at the beginning of treatment (T0) and at the end (T1) of this, at the beginning of the second cycle after the established period (T2) and at the end of the same (T3). To evaluate the effectiveness of treatment with readmission at 3, 4 and 5 months, the average of the test values at the end of the first cycle and at the beginning of the second cycle was considered; the Wilcoxon-Mann-Whitney hypothesis test was used to compare the distributions. RESULTS:For each of the tests carried out both at admission and discharge, the left extreme and right extreme are lower than those of the other groups. The Wilcoxon-Mann-Whitney hypothesis test shows that the treatment is more effective when carried out 3 or 4 months after the last treatment than when carried out 5 months after the last treatment. DISCUSSION:The study revealed the importance of initiating comprehensive and individualised pulmonary rehabilitation protocols to reduce the incidence of exacerbations, thus also producing economic and health benefits. Statistical analysis confirmed a shared approach to planning long-term readmissions, thus facilitating the management of waiting lists and the staff involved, improving the quality of the service in terms of efficiency and productivity. CONCLUSION:In a period of severe crisis for the Regional Health Service, the management of waiting lists ensures the constant pursuit of equitable access to care and accessibility to the service, understood as the ability of a service or environment to be usable without barriers for everyone and to reach the highest number of users with COPD. Telerehabilitation and telemonitoring could represent a great opportunity that can increase the level of enforceability of citizens' right to health, sustainability and innovation of the National Health System.
BACKGROUND:Emergency departments (EDs) worldwide are increasingly adopting multidisciplinary models of care in which physiotherapists play an evolving and expanding role. International evidence suggests that physiotherapy-led pathways may improve the management of low-acuity presentations such as musculoskeletal and vestibular conditions, which contribute substantially to ED overcrowding. In Italy, however, physiotherapists are not yet structurally integrated into ED teams, and the potential applicability of advanced physiotherapy roles remains unclear. OBJECTIVE:The objective of this scoping review is to identify, map, and describe current international models of physiotherapy practice within Emergency Departments, including first-contact roles, advanced practice, direct-access models, and multidisciplinary roles, and to explore their impact on the management of non-urgent conditions such as minor injuries, musculoskeletal disorders, and vestibular presentations. METHODS:This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). A systematic search of PubMed and Google Scholar was conducted from inception to November 2025, including peer-reviewed studies in English that described, evaluated, or implemented physiotherapy roles in EDs. Eligible populations were ED patients of any age presenting with non-urgent musculoskeletal, traumatic, or vestibular conditions. Data were charted on study design, setting, models of practice, clinical populations, and reported outcomes. RESULTS:The included studies were primarily conducted in Australia, Canada, and the United Kingdom, and comprised service evaluations, retrospective reviews, quality-of-care studies, pilot projects, validation studies of screening tools, and mixed-methods evaluations of pediatric pathways. Physiotherapy practice in Emergency Departments is mainly organized into First Contact Physiotherapy, Advanced Practice, and Direct Access models, often embedded within specialized pathways for musculoskeletal, vestibular, pediatric, or geriatric care. Overall, physiotherapist-led care is associated with reduced waiting times and ED length of stay, earlier administration of analgesia, improved clinical outcomes (including reduced pain and improved vestibular symptoms), high diagnostic agreement with emergency physicians, lower use of imaging and follow-up services, and high satisfaction among patients, parents, and clinicians. No serious adverse events related to physiotherapy interventions were reported. Most studies were observational, with a limited number of randomized or controlled studies, and no studies were conducted in Italy. CONCLUSIONS:International evidence indicates that physiotherapists can make a meaningful contribution to emergency department care, particularly for low-acuity musculoskeletal and vestibular presentations, through primary contact, advanced practice, and direct-access models. These roles appear safe, effective, and well accepted by patients and clinicians. However, the lack of Italian data, combined with a different regulatory framework and limited autonomy for physiotherapists, currently hinders the translation of these models into the Italian context. Pilot implementations and context-specific evaluations are needed to assess the feasibility and impact of integrating physiotherapists into Italian emergency departments.
