Designing an optimal digital pathology workspace is essential to ensure diagnostic accuracy and safeguard the long-term well-being of pathologists. While digital pathology improves reproducibility, facilitates multidisciplinary collaboration, and supports data-driven precision medicine, its clinical effectiveness depends not only on computational performance but also on the physical and ergonomic environment in which pathologists operate. Inadequate workstation design may impair visual perception, increase cognitive and musculoskeletal strain, and potentially affect diagnostic consistency. Moreover, the progressive integration of artificial intelligence (AI) into routine diagnostics introduces additional requirements related to display performance, visualization interfaces, and human–machine interaction. Despite the rapid global adoption of digital pathology systems, standardized recommendations addressing ergonomic, environmental, and technological aspects of the digital workspace remain limited. In this work, we propose a clinically oriented framework for the design of digital pathology workspaces suitable for AI-assisted diagnostics. Key elements include the selection and calibration of medical-grade displays, ergonomic furniture and input devices, optimized ambient lighting conditions, and institutional quality assurance procedures. Emerging developments, such as intelligent ergonomic monitoring, advanced visualization interfaces, and adaptive AI-assisted workflows, may further support safe, sustainable, and high-performance digital diagnostic environments.

The COVID-19 pandemic caused a surge in hospital waste (HW), posing an urgent public and environmental health challenge. Although a safe HW disposal method, high temperature incineration of fossil-derived materials contributes to air pollution. We analysed the monthly and yearly HW production of four Italian hospitals between 2016 and 2021, including COVID-19-related waste, to quantify the volume of activity related to COVID-19 patients, and estimate the environmental impact of HW through carbon emissions and social cost of carbon (SCC). A Mann-Kendall trend test and an Interrupted Time Series Analysis to detect trends and level changes in HW production after the COVID-19 outbreak were performed. ISMETT had the highest HW production (average annual variation (AAV) 0.89 kg/bed/day) and a positive correlation between HW generated per patient-day and the proportion of COVID-19-related bed-days. IFO (AAV 0.23 kg/bed/day) and IEO (AAV 0.19 kg/bed/day) both showed an overall increasing trend in HW production; CRH behaved similarly, although reporting the lowest HW production. ISMETT and IFO had the highest SCCs; CRH's SCC slightly decreased in the pandemic biennium, IEO's SCC peaked in 2019 and declined in 2020-2021. Optimizing waste management is vital, as disposal emissions pose significant risks to environmental sustainability and human health.

Whether Clonal Hematopoiesis (CH) represents a risk factor for severity of the COVID-19 disease remains a controversial issue. We report the first high- sensitivity analysis of CH in COVID-19 patients (threshold of detection at 0.5% vs 1 or 2% in previous studies). We analyzed 24 patients admitted to ICU for COVID-19 (COV-ICU) and 19 controls, including healthy subjects and asymptomatic SARS-CoV2-positive individuals. Despite the significantly higher numbers of CH mutations identified (80% mutations with <2% variant allele frequency, VAF), we did not find significant differences between COV-ICU patients and controls in the prevalence of CH or in the numbers, VAF or functional categories of the mutated genes, suggesting that CH is not overrepresented in patients with COVID-19. However, when considering potential drivers CH mutations (CH-PD), COV-ICU patients showed higher clonal complexity, in terms of both mutation numbers and VAF, and enrichment of variants reported in myeloid neoplasms. However, we did not score an impact of increased CH-PD on patient survival or clinical parameters associated with inflammation. These data suggest that COVID-19 influence the clonal composition of the peripheral blood and call for further investigations addressing the potential long-term clinical impact of CH on people experiencing severe COVID-19. We acknowledge that it will indispensable to perform further studies on larger patient cohorts in order to validate and generalize our conclusions. Moreover, we performed CH analysis at a single time point. It will be necessary to consider longitudinal approaches with long periods of follow-up in order to assess if the COVID-19 disease could have an impact on the evolution of CH and long-term consequences in patients that experienced severe COVID-19.

The correlation between immune responses and protection from SARS-CoV-2 infections and its duration remains unclear. We performed a sanitary surveillance at the European Institute of Oncology (IEO) in Milan over a 17 months period. Pre-vaccination, in 1,493 participants, we scored 266 infections (17.8%) and 8 possible reinfections (3%). Post-vaccination, we identified 30 infections in 2,029 vaccinated individuals (1.5%). We report that the probability of infection post-vaccination is i) significantly lower compared to natural infection, ii) associated with a significantly shorter median duration of infection than that of first infection and reinfection, iii) anticorrelated with circulating antibody levels.

AIM:Since 20 February 2020, Lombardy has been one of the most affected areas worldwide by the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study is to evaluate work and psychological impact of COVID-19 on Lombardy radiation therapy (RT) residents in the first 3 months of the outbreak (first lockdown).METHODS:An online questionnaire (22 multiple choice questions) via Microsoft Forms was administered on 30 May 2020 to RT residents.RESULTS:Nineteen Lombardy RT residents responded to the survey. Nineteen percent of residents underwent a nasal swab and 11% were quarantined. Seventeen residents (89%) reported an increase in workload. Twelve residents (63%) did not find any difference in terms of work distress; worsening was highlighted in 5 cases (26%). The majority has never considered the possibility of stopping work due to excessive stress (89%). Almost all the residents experienced self- or relative-referred apprehension (95%). Ninety-five percent reported having missed extra-work social relationships. Most of the sample noted worsening sleep quality and difficulty concentrating (69%). No residents requested psychological support, even if provided by the hospital.CONCLUSION:Overall, the residents adapted to the new workplace scenario, although some health risks and well-being challenges have been reported. An extension of the survey to all Italian RT residents endorsed by Italian Association of Radiotherapy and Clinical Oncology "Young AIRO" will allow an evaluation of COVID-19 impact on a national level. A second survey is planned to underline differences between the first lockdown and the current situation of the pandemic.

BACKGROUND:Gender differences are evident in many common health conditions, especially respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD). The aim of this review was to identify published studies describing gender differences in asthma and COPD, in particular regarding pathophysiology, diagnosis and treatment, with a focus on Italian data.METHODS:a literature review was performed from April to November 2015, using the PubMed scientific database and the following ??eywords: "gender differences" and "asthma" for the asthma review and "gender differences" and "COPD" for the COPD review.RESULTS:Gender differences in asthma are related to age groups. In the female population, asthma is generally more severe and disabling, and presents higher mortality rates with respect to same-age males. COPD prevalence is growing and is underestimated in women, because it tends to be diagnosed with difficulty and at a delayed stage. The same findings were observed when restricting the review to Italian data.CONCLUSION:Clinicians should collaborate to develop a more gender-oriented approach towards diagnosis and treatment of asthma and COPD. In Italy, this would also facilitate measures to improve compliance, particularly among women.

Risk management is a key tool in Clinical Governance. Our project aimed to define, share, apply and measure the impact of tools and methodologies for the continuous improvement of quality of care, especially in relation to the multi-disciplinary and integrated management of the hyperglycemic patient in hospital settings. A training project, coordinated by a scientific board of experts in diabetes and health management and an Expert Meeting with representatives of all the participating centers was launched in 2014. The project involved eight hospitals through the organization of meetings with five managers and 25 speakers, including diabetologists, internists, pharmacists and nurses. The analysis showed a wide variability in the adoption of tools and processes towards a comprehensive and coordinated management of hyperglycemic patients.

INTRODUCTION:Medical malpractice and litigation have a significant impact on the Italian National Health Service. The aim of this study was to analyze the state of the art of medical errors in Italy, in particular, assessing which specialties are most affected.METHODS:We performed a literature search in PubMed, Google Scholar; institutional websites (Ministry of Health, Higher Institute of Health, National Agency for Regional Health Services, National Institute of Statistics, National Research Council, Court of Auditors), gray literature and specialized magazines.RESULTS:Results show that data regarding the frequency of medical errors and the effectiveness of prevention measures in Italy are scarce. Most papers published on this topic refer to a few specialties, including Surgery, Radiology, Cardiology, and Laboratory medicine. Surgery is the specialty most affected.CONCLUSIONS:Despite a growing attention towards patient safety and quality of healthcare, medical errors continue to occur in clinical practice. Most errors are not due to individual incompetence or negligence but they are rooted in system breakdowns. A systematic approach is therefore required, based on: an analysis of critical aspects in the system; the selection and implementation, at different levels of the system, of appropriate and evidence-based risk management interventions involving all stakeholders; a context analysis to identify barriers and facilitators for change; a performance assessment to verify results and identify actions for improvement.

Aim This study evaluated the knowledge and attitudes of Italian mothers – whose daughters had been vaccinated in 2012 – towards primary (anti-HPV vaccination) and secondary (Pap test screening) cervical cancer prevention, as well as sources of information and mother-daughter communication on health issues. Methods The survey – part of a multicenter study carried out in 4 Italian cities (Ferrara, Rome, Cassino and Palermo) – was conducted through self-administered questionnaires. The first univariate analysis evaluated differences between mothers of under-18s and over-18s relative to knowledge and attitudes on HPV vaccination and Pap test. The second univariate analysis evaluated differences between the 2 groups of mothers and possible geographical variations regarding the sources of information on HPV and Pap test. Results The sample proved knowledgeable about the correlation between HPV and cervical cancer (>85%) but less aware of other HPV-related diseases. HPV vaccination should be administered before first sexual intercourse according to mothers of over-18s, and to 14- to 17-year-olds according to mothers of under-18s. Up to 88% of mothers of under-18s and 80% of mothers of over-18s declared that the vaccine should be given free of charge. More mothers of under-18s consulted a general practitioner (GP) or gynecologist before deciding to vaccinate their daughters. Mothers of under-18s received information on HPV vaccination mainly from GPs and gynecologists, while mothers of over-18s were informed through TV and books/journals. Over 80% of the sample declared satisfaction with the information received from their gynecologist during the Pap test. Conclusions The findings provide useful information for the development of effective public health interventions that may help improve acceptance of HPV vaccination among mothers.

AIM:The aim was of this pilot study was to validate a questionnaire to collect information on the number of health professionals, doctors and veterinarians working in the Departments of Prevention, Health Districts and Hospital Directions, their sociodemographic characteristics and cultural-background, define their educational needs, and subsequently extending the study to the maximum number of professionals in the classified services under study.METHODS:The survey was conducted through the use of a questionnaire, designed and prepared by the working group and subsequently reported on-line. Internal consistency of the questionnaire was measured by Cronbach's alpha.RESULTS:Overall, 128 health professionals were enrolled in the study. Their mean age was 57.5 years; 83.6% have a medical degree and 6.3% a degree in veterinary medicine. Most participants (64.8%) are employed by a Health District, 21.1% work in a Department of Prevention and 2.3% are part of a hospital clinical management staff. 32.3% are specialists in only one area, and, in particular, 22% of the sample is a Public Health specialist, 4% respectively are specialists in Occupational Medicine and Forensic Medicine. The alpha values for each section were, for Section A, 0.914; Section B, 0.963; Section C, 0.802; and Section D, 0.945.CONCLUSION:The questionnaire was shown to have good internal reliability. Identifying the educational needs of public health professionals, and the innovative and emerging issues that impact public health is essential to allow for National Health Service staff to be able to respond to the rapid cultural changes that characterize the current global health context.

Clinical Governance provides a framework for assessing and improving clinical quality through a single coherent program. Organizational appropriateness is aimed at achieving the best health outcomes and the most appropriate use of resources. The goal of the present study is to verify the likely relationship between Clinical Governance and appropriateness of hospital stay.

AIM: To investigate the 7-valent pneumococcal conjugate vaccine (PCV7) effectiveness.METHODS: A systematic literature review of studies which evaluated the effectiveness of PCV7 vaccine was performed searching the keyword "heptavalent pneumococcal conjugate vaccine" in PubMed and Scopus until March 16, 2013. The selection of potential eligible articles was done by two researchers independently on the basis of abstract and title and only post-marketing studies were included in the systematic review. Data extraction was carried out by two researchers with respect to invasive pneumococcal diseases due to both all and vaccine serotypes in pre-vaccine and post-vaccine periods in children less than 5 years. Results of studies which were considered suitable for meta-analysis were combined by means of relative risk (RR) with 95%CI. Vaccine effectiveness was calculated as (1-RR) x 100. Heterogeneity was assessed by I 2 and a random effects model was used to combine data in the case of heterogeneity. RevMan 5 was used to pool data.RESULTS: On the whole, 757 eligible papers were identified from the literature search in PubMed and Scopus. Of them, 62 were finally considered in the systematic review and 38 were included in the meta-analysis. In all post-marketing studies included in the systematic review the incidence of invasive pneumococcal diseases due to vaccine serotypes declined significantly with the exception of few studies showing stability or a slight, but not significant, increase. Furthermore most of studies highlighted also a reduction in the incidence of invasive pneumococcal diseases due to all serotypes. With regards to meta-analysis, a random effects model was used to combine data because of the high heterogeneity. Data combination showed that the effectiveness of PCV7 in reducing invasive pneumococcal diseases due to vaccine serotypes and to all serotypes was 84% (95%CI: 74%-90%) and 53% (95%CI: 46%-59%) respectively. These results are confirmatory with respect to the efficacy of PCV7 against invasive pneumococcal diseases due to vaccine serotypes.CONCLUSION: PCV7 implementation determines a significant decrease of invasive pneumococcal diseases.