Andrea Ceccarelli

Background: The integration of artificial intelligence (AI)-based systems into healthcare is accelerating rapidly, yet evidence of their real-world clinical and organizational effectiveness remains fragmented. Methods: A PRISMA 2020-compliant systematic review of randomized controlled trials (RCTs) evaluating AI-based interventions in real-world healthcare settings was conducted. MEDLINE (PubMed), CINAHL, Cochrane CENTRAL, and ClinicalTrials.gov were searched up to January 2026. AI interventions were classified post hoc into three functional categories: perceptive AI, predictive/decision support AI, and conversational/adaptive AI. The direction of effect was classified as positive, neutral, mixed, or negative based on the primary endpoint, effect magnitude, and authors’ interpretation. Risk of bias was assessed using the Cochrane RoB-2 tool. Results: A total of 54 RCTs were included. Overall, 40 studies (74.1%) reported a positive direction of effect, nine a neutral result, four a mixed result, and one a negative result. Perceptive AI (n = 17) showed consistent benefits in diagnostic accuracy. Predictive/decision support AI (n = 15) showed heterogeneous results, with effectiveness dependent on workflow integration. Conversational/adaptive AI (n = 22) showed the most consistent positive signal, particularly for chronic disease self-management, behavioral change, and therapeutic adherence. Conclusions: Evidence from randomized trials suggests that AI-based interventions may provide meaningful benefits in real-world healthcare settings, with effectiveness varying by functional category, implementation context, and outcome domain. Future research should prioritize pragmatic multicenter trials with standardized reporting of clinical, organizational, and implementation outcomes.

Background: New strategies for respiratory syncytial virus (RSV) prevention are available and are in development, but their acceptance is crucial to their effectiveness. Objectives: This systematic review aims to summarize current quantitative and qualitative evidence regarding knowledge and attitudes relating to RSV prevention. Methods: Six databases (PubMed, Scopus, APA PsycArticles; APA PsycInfo; CINAHL Complete; Psychology and Behavioral Sciences Collection) and two preprint repositories (medRxiv and Preprints) were searched up until 23 December 2024 (PROSPERO: CRD42024602351). Results: Sixty-one articles were included, focusing on vaccination for the elderly and adults at risk (n = 10) or pregnant people (n = 24, of which 8 also examined preferences for maternal vs. infant immunization) and infant immunization (n = 27, of which 16 focused on palivizumab, with 6 focusing on adherence to its monthly administration). Eighteen articles assessed attitudes in healthcare professionals. Overall, findings showed limited knowledge and awareness of RSV but generally positive attitudes towards prevention strategies and moderate to high intentions and uptake rates. Protection against the disease and perceived severity promoted acceptance, whereas concerns about side effects hindered it. Maternal vaccination was more acceptable than infant immunization. Conclusions: Attitudes towards RSV prevention options were generally favorable. Should more options become available, preferences may depend on which options are available, their characteristics, and how they are framed and presented. These insights highlight the importance of education on RSV grounded in decision-making literature, while recognizing the likely favorable reception of preventive measures across target age-populations.

Background: General practitioners (GPs) and primary care units collaborate with Prevention Departments (PDs) to improve immunization by participating in vaccination campaigns, sharing tools, and implementing educational programs to raise patient awareness. This review aimed to identify effective strategies for involving GPs in PD vaccination practices. Methods: A systematic review following PRISMA guidelines was conducted on MEDLINE, TripDatabase, ClinicalTrials, CINAHL, and Cochrane up to January 2024 to identify full-text studies in English evaluating the effectiveness of GP involvement. A meta-analysis was also performed. Results: Of 1018 records, 15 studies were included, with an intermediate quality assessment. Studies originated from the United States (n = 9), Europe (5), Singapore (1), and China (1). Eight studies investigated educational programs for GPs, while seven focused on organizational or technological interventions to enhance immunization practices. Twelve studies reported increased vaccine uptake after intervention. Vaccines addressed included influenza, SARS-CoV-2, pneumococcal, zoster, and trivalent (diphtheria, tetanus, pertussis). Interventions involving GPs in PD vaccination campaigns, focusing on organizational or technological strategies, demonstrated a significant increase in vaccine uptake (OR = 1.15; 95% CI: 1.03–1.27; p < 0.0001; I² = 96%). Conclusions: GPs emerged as valuable allies for PDs due to their extensive territorial reach and trusted relationships with patients. Additionally, up-to-date organizational and technological tools could play a decisive role in increasing vaccine uptakes. This study, offering valuable insights into the effectiveness of GPs involvement, may be useful to implement similar intervention in different contexts.

Human Papillomavirus (HPV) infection poses a significant health risk, particularly for high-risk groups such as men who have sex with men (MSM), people living with HIV (PLHIV), and transgender individuals. Despite the availability of effective vaccines, uptake among these groups remains suboptimal due to various social and behavioral barriers (BeSD). A cross-sectional survey was conducted at the Sexually Transmitted Infections (STIs) clinic in Bologna, Italy, from 8 April to 12 April 2024 using a paper questionnaire, investigating HPV vaccine uptake and BeSD factors influencing vaccination decisions. Statistical analyses included descriptive statistics and multivariate logistic regression. Among the 236 respondents, PLHIV and transgender individuals demonstrated lower uptake rates (60.0% and 15.6%) if compared to women under 30 years old (72.7%). Concern about HPV infection varied significantly across groups, with MSM showing the highest worry (48.7%). Perceptions of vaccine safety and access were mixed, influencing vaccination decisions. Multivariate analysis indicated that age inversely correlated with infection worry (OR: 0.94, 95% CI: 0.91–0.98), while being a woman under 30 (OR: 164.0, 95% CI: 17.2–1560.18) or MSM (OR: 3.53, 95% CI: 1.37–9.11) was positively associated with vaccine uptake. The study identifies disparities in HPV vaccine uptake among STI clinic users in Bologna, Italy, emphasizing the need for targeted public health campaigns. These campaigns could engage STI clinics and address awareness, safety perceptions, and access barriers to enhance vaccination coverage among sexual and gender minorities.

In Italy, free vaccinations for Herpes Zoster (HZ), pneumococcal (PCV), and influenza (FLU) are recommended each year for individuals turning 65. Despite this, achieving optimal vaccination coverage remains challenging. This study assesses coverage rates for HZ, PCV, and FLU in Forlì, Northern Italy, and examines how altitude, urban planning, and health organization variables (such as the presence of a vaccination center) impact vaccine uptake. Vaccination coverages were calculated for birth cohorts between 1952 and 1958 for each municipality in the Forlì area as of 1 March 2024. The geographical factors influencing the vaccination uptake were extracted from the Italian National Institute of Statistics (ISTAT) records and evaluated through a multivariate analysis. The sample analyzed included 15,272 vaccine campaign targets from Forlì’s province (185,525 citizens); the vaccine uptake rates for HZ, PCV, and FLU were 26.9%, 36.7%, and 43.5%, respectively. Gender did not appear to influence vaccine uptake. Living in a flat area appeared to increase vaccine uptake in a statistically significant way for all the vaccinations when compared to a mountainous area (HZ: OR: 1.50, PCV: OR: 1.33, FLU: OR: 1.67). The presence of a vaccine service in low-urbanized areas was shown to increase vaccine uptake for all vaccinations (HZ: OR: 1.65, PCV: OR: 1.93, FLU: OR: 1.53) compared with low-urbanized areas without a vaccination center or more urbanized areas with a vaccination center. This study emphasizes the significance of the territorial context, along with the ease of access to vaccinations and geographic barriers, as key determinants in achieving vaccination targets. Local health authorities should consider these factors when implementing vaccination campaigns.

Delirium, a multifactorial condition with an acute onset and diverse clinical manifestations, poses a significant challenge in the care of hospitalized individuals aged 65 years and older. This study aimed to evaluate the level of knowledge among nursing healthcare personnel regarding the diagnosis, recognition of complications, and treatment of delirium. A paper questionnaire consisting of 18 multiple-choice questions was distributed to nurses in twelve operational units located in four facilities within a local hospital in a specific geographical region under the jurisdiction of the Romagna Local Health Authority in Italy. Out of 194 respondents, the overall acceptance rate was 64.2%. The findings revealed an insufficient understanding of delirium among the nursing staff, with more than 40% of respondents answering incorrectly to five out of nine questions related to delirium knowledge, diagnosis, prevention, and treatment. Notably, gender emerged as a significant determinant, with female participants exhibiting a substantial odds ratio (OR) of 3.50 (p = 0.011 and CI95% = 1.34–9.16) compared to their male counterparts, indicating a higher likelihood of receiving delirium training among females. Furthermore, prolonged tenure within the same work context was associated with a reduced likelihood of receiving delirium training compared to those with less than two years of experience (OR = 0.21, p = 0.034, and CI95% = 0.05–0.89 for 6–10 years of tenure; OR = 0.22, p = 0.038, and CI95% = 0.05–0.92 for over 10 years of tenure). This study underscores the urgent need for enhanced delirium education and improved strategies among nurses to effectively manage patients with delirium. The results advocate regular educational sessions utilizing diverse formats to comprehensively address knowledge gaps among nursing staff. This study was not registered.

The Herpes Zoster (HZ) vaccination has proven both safe and effective in alleviating conditions related to HZ, leading to significant cost savings in national healthcare and social systems. In Italy, it is recommended and provided free of charge to individuals aged 65 and older. To achieve broad vaccination coverage, alongside ordinary immunization campaigns, active and catch-up campaigns were implemented. This retrospective observational study aimed to observe the vaccination coverage achieved in the Romagna Local Health Authority (LHA) during the 2023 active campaign, with a secondary goal of assessing the impact of the 2022 catch-up campaign and the 2023 active campaign compared to ordinary campaigns. As of 3 July 2023, an overall vaccine uptake of 13.5% was achieved among individuals born in 1958, with variations among the four LHA centers ranging from 10.2% to 17.7%. Catch-up and active campaigns together contributed to nearly half of the achieved coverage in Center No. 1 and a quarter in Center No. 2. Notably, individuals born in 1957, not included in the Center No. 2 catch-up campaign, reached significantly lower vaccination coverage compared to other cohorts and centers. Analyzing the use of text messages for active campaigns, it was observed that cohort groups did not show substantial differences in text-message utilization for warnings. However, having relatives who had experienced HZ-related symptoms significantly reduced the reliance on text messages as warnings. These results highlighted how catch-up and active campaigns effectively increased vaccine coverage. Nevertheless, differences in uptake among different centers within the same LHA and the limited contribution of other information sources compared to text messages suggest the necessity of designing campaigns involving all available channels and stakeholders to maximize vaccine uptake.

Community-oriented primary care (COPC) is an inclusive healthcare approach that combines individual care with a population-based outlook, striving to offer effective and equitable services. This study concentrates on assessing the perceived quality of a “Casa della Comunità” (CdC) implemented by the Romagna Local Health Authority, which embraces the COPC model. Through the examination of user experiences, the study aims to comprehend the influence of the CdC’s care delivery model on the community’s perception of service quality. From 13–18 March 2023, paper questionnaires were distributed by trained healthcare professionals and volunteers. The cross-sectional study enrolled participants aged 18 or older, capable of understanding written Italian, and willing to take part voluntarily. A total of 741 questionnaires were collected, resulting in an overall acceptance rate of 85.6%. Among the respondents, 37.9% were female, with an average age of 55.4 ± 16.2 years. While the respondents generally held a positive view of the quality, the results displayed varying levels of satisfaction across the different areas. Multivariate analysis revealed significant associations between factors such as gender, employment status, financial resources, education level, and distance from the healthcare center with the perceived quality of the facility in terms of accessibility, environment, staff, continuity of care, and overall satisfaction. The study yielded valuable insights, identifying strengths and areas for improvement and underscoring the importance of ongoing monitoring studies to enhance patient satisfaction continuously.

Herpes Zoster (shingles) is an infection that occurs when varicella-zoster virus reactivates from the latent state. Incidence and severity of Herpes Zoster disease increase with age. Antiviral drugs are the elective treatment; however, prevention of disease reactivation through effective and safe vaccines is available in Italy out-of-pocket from age 65 onwards. The Romagna Local Health Authority (northern Italy) administered catch-up vaccinations in March–May 2022 for immunizations not performed during the COVID-19 pandemic. In this study, adherence rates to the catch-up campaign and recall activities adopted in two centers were investigated. The uptakes for only the catch-up vaccinations were 11.4% and 12.4%. Having suffered from Herpes Zoster or having family members who suffered from it would not seem to be drivers of increased uptake. Although sending text-messages to all involved patients was the main motivation for vaccine uptake (85.7–95.1%), word of mouth and web/news advertising also contributed to adoption in Center No. 2. In both centers, the need for greater synergy between public health departments and general practitioners to engage their patients emerged, as did the need for additional recall measures. Studying the main drivers of vaccine hesitancy, especially at the local level, can help in targeting campaigns and catch-up activities in order to achieve widespread acceptance.