Baglivo F, Diedenhofen G, De Angelis L
… +9 more, Pivetta A, Causio FA, D'Ambrosio A, Sacchi FA, Di Pumpo M, Belpiede A, Ghisalberti G, Ferro D, Rizzo C
Recenti Prog Med
· 2025 Oct · PMID 41037359
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Publisher ↗
Italy's National Health Service (SSN) serves one of Europe's oldest populations under fiscal constraint and a fragmented data infrastructure. Rather than a standalone fix, artificial intelligence should be treated as a c...Italy's National Health Service (SSN) serves one of Europe's oldest populations under fiscal constraint and a fragmented data infrastructure. Rather than a standalone fix, artificial intelligence should be treated as a catalyst for a human-centred digital transformation that improves access, quality, and sustainability. Building on the Italian Society for Artificial Intelligence in Medicine (SIIAM) vision, we outline a pragmatic agenda. First, reduce elective-care backlogs by automating confirmations, reminders, cancellations, and rescheduling; deploy multilingual conversational agents to collect structured pre-visit histories and deliver summaries, while natural-language processing flags overdue follow-ups. Second, advance equity by offering inclusive digital front doors and tele-triage that prioritise patients facing language, literacy, socioeconomic, or geographic barriers. Third, curb waste through clinical-decision support and workflow automation that standardise evidence-based practice and relieve documentation burden. Fourth, modernise surveillance by pairing large language model powered voice agents for behaviour and symptom monitoring with participatory systems and AI epidemic intelligence. Fifth, link data and people through multidisciplinary teams and a human-in-the-loop approach that embeds transparency, bias mitigation, privacy, and safety. Implementation should start where impact is fastest: risk-stratified booking, proactive reminders, and shared dashboards with comparable indicators. To sustain gains, ring-fence resources for regional multidisciplinary units, enforce interoperability and reference datasets, and align procurement with European requirements for auditability and post-deployment monitoring. AI can help reshape Italian healthcare, but success ultimately depends on integrated data, trained teams, and robust governance.
Sacchi FA, Cascini F, Conditi N
… +13 more, Ravizza A, Daverio M, Causio FA, De Vita V, Pivetta A, Maio P, De Angelis L, Baglivo F, Diedenhofen G, Di Pumpo M, Belpiede A, Ferro D, Bolognini L
Recenti Prog Med
· 2025 Oct · PMID 41037358
·
Publisher ↗
The integration of artificial intelligence (AI) in medicine has applications across several clinical domains, spanning from disease prevention and diagnosis through treatment and long-term care, as well as remote care. H...The integration of artificial intelligence (AI) in medicine has applications across several clinical domains, spanning from disease prevention and diagnosis through treatment and long-term care, as well as remote care. However, many AI systems are inherently characterized by limited explainability, meaning the processes behind their outcomes cannot be clearly understood or communicated to humans, whether developers or end users. This viewpoint explores the importance of AI explainability in medicine by first tracing its evolution from a primarily ethical concern to a legal requirement. It then examines the connection between explainability and the trustworthiness of AI systems. Finally, it considers how explainability is approached from a technical standpoint and its inherent tension with achieving high accuracy.
Recenti Prog Med
· 2025 Oct · PMID 41037357
·
Publisher ↗
"Artificial intelligence is transforming healthcare": this sentence is now so common it risks losing meaning. Technology alone does not change systems, people do: clinicians, researchers, decision-makers, and patients. A..."Artificial intelligence is transforming healthcare": this sentence is now so common it risks losing meaning. Technology alone does not change systems, people do: clinicians, researchers, decision-makers, and patients. AI is a lever, but without a fulcrum of skills, vision, and responsibility, it moves nothing. This conviction is at the core of the Italian Society for Artificial Intelligence in Medicine (SIIAM) and of the 3rd Annual Meeting (Naples, October 10-11, 2025). Our aim is not to celebrate technology for its own sake, but to bring together a multidisciplinary community capable of deciding how to use AI responsibly in the Italian healthcare system. This issue of Recenti Progressi in Medicina presents the collective output of this effort: commentaries by the Scientific Committee and contributions from participants. It is shown how rules and principles can be translated into practice, how Italian healthcare can evolve toward a Learning Health System, and why responsible infrastructures and evaluation frameworks are needed to guide AI innovation. Case studies highlight both promising advances and pitfalls to avoid. The central question is not whether AI will change medicine, but how we can use it to have a more equitable, proactive, sustainable and personalized one? If the lever is AI, the fulcrum remains the people and organizations who care for others. It is on this fulcrum that SIIAM continues to work, with rigor, openness, and trust, so that innovation becomes daily practice for the benefit of patients and professionals alike.
Diffuse large B-cell lymphomas (DLBCLs) represent one of the most common and aggressive forms of non-Hodgkin lymphoma (NHL), characterized by rapid B-cell growth and a significantly high risk of relapse or refractoriness...Diffuse large B-cell lymphomas (DLBCLs) represent one of the most common and aggressive forms of non-Hodgkin lymphoma (NHL), characterized by rapid B-cell growth and a significantly high risk of relapse or refractoriness. The clinical course for these patients is long and complicated with a sometimes dismal prognosis, and the therapeutic approach must include effective and innovative chemotherapeutic treatments. The therapeutic strategies for DLBCLs in recent years has seen considerable pharmacological enrichment, including drug-conjugated antibodies such as polatuzumab vedotin. Indeed, this drug has demonstrated its efficacy even in the age-unfit elderly patient, providing a good safety and tolerability profile. Specifically, is described the case of an elderly patient with relapsed/refractory DLBCL with extra-nodal and bone disease presentation, treated second-line with polatuzumab vedotin in combination with rituximab and bendamustine. This combination resulted in a complete clinical and metabolic response while preserving excellent drug tolerance during treatment and improving the patient's quality of life.
BACKGROUND: The global increase in caesarean section (CS) rates raises concerns about maternal and neonatal outcomes. Italy, with one of the highest CS rates in Europe, especially in the Calabria Region, faces challenges...BACKGROUND: The global increase in caesarean section (CS) rates raises concerns about maternal and neonatal outcomes. Italy, with one of the highest CS rates in Europe, especially in the Calabria Region, faces challenges in reducing this trend. The Calabria Region has joined the "Easy-Net" Network Program (NET-2016-02364191) for the evaluation of audit & feedback (A&F) interventions to reduce CS rate. This study aims to analyze past trends, describe maternity unit (MU) characteristics, and provide a baseline assessment of CS rates using the Robson's Ten Group Classification System (TGCS). METHODS: This population-based cross-sectional study analyses CS rates using data from National and Regional Birth Registers, categorizing women with the Robson's TGCS. RESULTS: From 2017 to 2020, 54,041 births were registered in the Calabria Region. The results reveal a fluctuating CS rate (36.2%-38.1%) with variations from different Robson groups. Group 5 (previous CS) consistently increased, impacting overall rates, while Group 1 (nulliparous, cephalic, spontaneous labor) decreased. The groups 2b (6.8%-4.8%) and 4b (2.5%-1.8%), which represent respectively nulliparous and multiparous women with pre-labour CS, showed high rates despite their reduction over the years. In 2020, variations in CS rates across 11 MUs highlighted complexities, emphasizing the need for localized interventions. CONCLUSIONS: The study highlights the critical issue of high CS rates in the Calabria Region. It is advisable to monitor and reduce unnecessary CSs through evidence-based interventions, taking advantage of the Robson classification and an A&F strategy. These findings guide future efforts to enhance CS appropriateness and improve maternal and child health outcomes.
INTRODUCTION: Medical Oncology was founded in Italy in the early 1970s, and with it those head doctors who with much effort made it grow. Today a fair number of them, honorary members of CIPOMO (Italian College of Hospit...INTRODUCTION: Medical Oncology was founded in Italy in the early 1970s, and with it those head doctors who with much effort made it grow. Today a fair number of them, honorary members of CIPOMO (Italian College of Hospital Medical Oncology Chiefs), have retired. In a situation of shortage of medical specialists in oncology and in light of clinical evidence, CIPOMO wanted to understand their situation and their attitude to get back into the work and continue to serve the community. MATERIALS AND METHODS: In March-April 2024, a survey was done via a web-based questionnaire consisting of 20 questions to 112 retired primary, and 82 responses (73.2%) were obtained, demonstrating the great interest and attention they perceived for this initiative. The questions were about their family situation, their activity, life outside the hospital, their financial situation and quality of life compared to before, and finally how they envisioned their future. RESULTS: Thirty-five percent of physicians said they would return to work at the hospital, more than 50% work as private practice or consultants on a limited time basis. Family commitments occupy them most of the time. Social life has improved as has their quality of life. Most report having a good economic situation and a few miss the hospital. About their willingness to put their skills back into work, 60.7% said they are available, especially for management-organizational activities, clinical consulting, training and mentoring young oncologists. In their future they see involvement in the world of healthcare mainly in non-clinical activities. CONCLUSIONS: The survey results show a reality of socially and economically satisfied oncology professionals, with great desire to do and willingness to get involved again should they be given the opportunity. The health system should find ways to enhance them especially in organizational and/or teaching skills.
Nodular goiter is a very frequent occurrence that rarely requires surgical treatments. Only a few of these nodules are the site of carcinoma which requires surgery. It is therefore necessary to precisely determine the na...Nodular goiter is a very frequent occurrence that rarely requires surgical treatments. Only a few of these nodules are the site of carcinoma which requires surgery. It is therefore necessary to precisely determine the nature of the nodule. The cytological examination of the biopsy performed with a fine needle is the most accurate diagnostic method for determining the benign or malignant nature of a thyroid nodule. However, in approximately 15% of cases the cytology is indeterminate. In these cases, it is possible to apply the knowledge of molecular biology to refine the diagnosis. Mutations of the BRAF and RAS genes and recombinations of the RET, TRK and PAX8/PPARγ genes are the most frequent genetic alterations in thyroid carcinomas. However, except for BRAF mutation, these genetic alterations are not pathognomonic of carcinoma. The new tests that combine the gene expression profile and the search for specific genetic alterations have excellent reliability in excluding the malignant nature of a nodule with indeterminate cytology, but they still have an unsatisfactory specificity, and their cost limits their use.
The treatment of patients suffering from chronic, potentially lethal diseases is a lengthy and disheartening process, especially in cases where patients cannot be satisfactorily treated with authorized medications. In th...The treatment of patients suffering from chronic, potentially lethal diseases is a lengthy and disheartening process, especially in cases where patients cannot be satisfactorily treated with authorized medications. In these cases, the only therapeutic option may be experimental drugs. However, in some cases, not all patients meet the inclusion criteria for enrollment in a trial. This problem can be addressed through a "compassionate use". Because inadequate information can be a barrier it is essential to clarify the regulatory framework. Despite the availability of reviews, information available on this topic is limited also due to changes in regulations that occur over time. Moreover, the different definitions between states and the lack of a common legislative approach makes the process confusing. The purpose of this article is to compare the legislative frameworks currently in place in European Union and Usa pharmaceutical markets, in order to highlight their strengths, analogies and differences, in a global context that goes beyond the regulatory realities of individual countries.
The availability of health technologies has facilitated improvements in the quality of care, playing a vital role in both hospital environments and remote patient monitoring. However, the growing complexity of these tech...The availability of health technologies has facilitated improvements in the quality of care, playing a vital role in both hospital environments and remote patient monitoring. However, the growing complexity of these technologies has also led to an increase in cyberattacks targeting healthcare systems over time. The CYLCOMED project was initiated to create cybersecurity solutions for connected health devices, testing them in two scenarios: first, protecting the security of a drug infusion pump; and second, monitoring pediatric patients with heart failure remotely. The project employs a combination of software and artificial intelligence (AI) algorithms to detect cybersecurity threats by overseeing the operation of connected devices in these case studies. Additionally, it addresses regulatory and ethical considerations to develop an AI-driven product suitable for clinical implementation. Integrating advanced technological tools, cybersecurity awareness, and preventive strategies is essential for ensuring patient safety.
In 1948, Aneurin Bevan launched the UK's National Health Service (NHS), emphasizing health as a right. Inspired by this, Italy created its NHS in 1978, based on universality and equity. Despite efforts focusing on clinic...In 1948, Aneurin Bevan launched the UK's National Health Service (NHS), emphasizing health as a right. Inspired by this, Italy created its NHS in 1978, based on universality and equity. Despite efforts focusing on clinical efficacy and economic efficiency, Italy's NHS faces a crisis: uncontrolled public spending, rising private costs, neglect of prevention, staff shortages, long wait times and regional disparities in care. Inefficiencies include overuse of ineffective treatments, underuse of effective ones, high costs, and conflicts of interest. Aging, chronic diseases, and lifestyle issues also impact healthcare use. Medical and managerial criteria alone can't justify healthcare choices, as they don't address how resources should be distributed across sectors or prioritize patient groups. Donald Berwick advocates for an ethical approach focused on justice, prioritizing care quality, fairness, transparency, and compassion. Daniel Callahan and others call for a cultural revolution in medicine, advocating a "limited" healthcare role, moving away from individualism, and fostering a realistic understanding of health. Without ethical principles, healthcare reform may fail.
This editorial discusses the national survey, by Barni et al., which examines the lives of retired medical oncology chiefs in Italy, focusing on their well-being, ongoing professional identity, and willingness to remain...This editorial discusses the national survey, by Barni et al., which examines the lives of retired medical oncology chiefs in Italy, focusing on their well-being, ongoing professional identity, and willingness to remain engaged in the healthcare system. In a time of critical workforce shortages in oncology, the findings reveal a valuable yet underutilized resource: retired physicians.
As oncology faces an ageing workforce and rising burnout among clinicians under 45, the strategic engagement of emeritus expertise could represent a valuable resource. CIPOMO data show 35% willing to return to clinical r...As oncology faces an ageing workforce and rising burnout among clinicians under 45, the strategic engagement of emeritus expertise could represent a valuable resource. CIPOMO data show 35% willing to return to clinical roles and 61% to mentor. Echoing the Winter-Jackson partnership, respectful intergenerational collaboration may enhance continuity, resilience, and the culture of care.
The definition of disease is not a purely theoretical exercise but a choice with significant implications for clinical practice, public health, and resource management. The expansion of diagnostic criteria, aimed at redu...The definition of disease is not a purely theoretical exercise but a choice with significant implications for clinical practice, public health, and resource management. The expansion of diagnostic criteria, aimed at reducing underdiagnosis, has led to an increase in overdiagnosis and overtreatment - critical issues still too little addressed in medical education and public communication.