Background: In recent years, due to the epidemiological transition, the burden of very complex patients in hospital wards has increased. Telemedicine usage appears to be a potential high-impact factor in helping with patient management, allowing hospital personnel to assess conditions in out-of-hospital scenarios. Methods: To investigate the management of chronic patients during both hospitalization for disease and discharge, randomized studies (LIMS and Greenline-HT) are ongoing in the Internal Medicine Unit at ASL Roma 6 Castelli Hospital. The study endpoints are clinical outcomes (from a patient’s perspective). In this perspective paper, the main findings of these studies, from the operators’ point of view, are reported. Operator opinions were collected from structured and unstructured surveys conducted among the staff involved, and their main themes are reported in a narrative manner. Results: Telemonitoring appears to be linked to a reduction in side-events and side-effects, which represent some of most commons risk factors for re-hospitalization and for delayed discharge during hospitalization. The main perceived advantages are increased patient safety and the quick response in case of emergency. The main disadvantages are believed to be related to low patient compliance and an infrastructural lack of optimization. Conclusions: The evidence of wireless monitoring studies, combined with the analysis of activity data, suggests the need for a model of patient management that envisages an increase in the territory of structures capable of offering patients subacute care (the possibility of antibiotic treatments, blood transfusions, infusion support, and pain therapy) for the timely management of chronic patients in the terminal phase, for which treatment in acute wards must be guaranteed only for a limited time for the management of the acute phase of their diseases.

Objectives: In March 2020, the COVID-19 pandemic outbreak caused significant negative changes worldwide. Important investments were suddenly needed in the economic, social, and healthcare fields. This analysis sets out to show the economic impact of the administration of remdesivir in ambulatory patients, who are affected by Covid-19, at high risk for severe progression, and eligible for the antiviral treatment. Methods: The budget impact analysis is based on the assumptions already presented in a study published in 2020 by the same Authors. The analysis was updated with a new simulation of the pandemic curve which included the vaccination plan. Data were collected from official Italian sources and from the academic literature. The Italian National Health Service (NHS) perspective was used in the analysis. Remdesivir treatment was compared in terms of economic costs with the Standard of Care over a period of 20 weeks. Such timeframe was chosen because of the uncertainty of the pandemic evolution and considering that this is the time of a complete pandemic curve. A comparison with other therapeutic solutions was not performed in this analysis as the relative costs were not available at the time of the study. Results: The model estimates that, in 20 weeks, 8,002,015 subjects are infected by Covid-19, with a 0.8% hospitalization rate. Among hospitalized patients, 19.6% could be eligible for remdesivir treatment, for a total number of 3,619 patients, with a 12% market share. Conclusion: The analysis shows that remdesivir therapy is dominant and its use could determine a reduction in hospitalizations and transfers to intensive care units compared to the Standard of Care, with a potential saving of € 50.8 million and a decrease of the number of Covid-19-related deaths between 600 and 1,100.

Background: Wireless Vital Parameter Continuous Monitoring (WVPCM) allows the continuous tracking of patient physiological parameters, facilitating the earlier detection of clinical deterioration, especially in low-intensity care settings. The aim of this study is to evaluate the effectiveness of using WVPCM compared to the usual monitoring of critically ill patients hospitalized in Internal Medicine wards. An investigation of the attitude of health professionals towards the use of new technologies in daily practice to improve patient management was also carried out. Methods: The LIght Monitor Study (LIMS) is a prospective, open-label, randomized, multi-center pilot trial comparing WVPCM and conventional nurse monitoring during the first 72 h of hospitalization. A central randomization unit used computer-generated tables to allocate patients to two different types of monitoring. The main outcome was the occurrence of major complications. The study planned to enroll 296 critically ill patients with a Modified Early Warning Score (MEWS) ≥ 3 and/or National Early Warning Score (NEWS) ≥ 5 across two Internal Medicine (IM) Units in Italy. The investigation of the attitude of nurses towards the use of WVPCM was carried out by using a questionnaire and a qualitative survey. Results: Due to the COVID-19 outbreak, the study was interrupted early and only 135 patients (WVPCM = 68; standard care = 67) were randomized. One patient in the control group was excluded from analysis because of drop-out, leaving 134 patients for intention to treat analysis. No statistically significant differences between standard care and WVPCM were observed in terms of major complications (37.5%, vs. 31.2% p = 0.475), in-hospital mortality (17.5% vs. 11.1%, p = 0.309), and median hospital length of stay (9 vs. 10 days, p = 0.463). WVPCM decreased nursing workload compared to the control, as the average time spent by nurses on the detection of vital signs per patient was 0 min per patient per day compared to 24.4 min (p < 0.001) observed in the control group. Twenty-two percent of patients in the WVPCM group (15/68) experienced discomfort with the device, resulting in its removal. The investigation of nurses involved 16 out of 18 people participating in the study. Opinions on the wireless device for patient monitoring were particularly favorable; most of them considered remote monitoring clearly superior to traditional in-person visits and easy to use after a brief practice period. All participants recognized the safety benefits of the system. Conclusions: The reduced sample size of this pilot study does not allow us to draw any conclusions on the superiority of WVPCM compared to standard care in terms of clinical outcomes. However, we observed a positive trend in the reduction of major complications.

The “great man” theory excludes women by definition. Recently, in healthcare, there has been an increasing number of women in leadership positions; however, the number of women leaders is lower than that of men leaders, even though the number of female health workers is far greater than that of men. This article aims to investigate whether there is a difference between male and female leadership, the winning characteristics of the latter and whether (and possibly what) barriers and ob-stacles there are to female leadership. Method: a review of reviews available on Pub-med was conducted using a specific search query. The authors analyzed the articles according to specific inclusion and exclusion criteria, using the PICO methodology. Results: of 967 articles, 18 met the inclusion criteria. Among the typical characteristics of female leadership, the most common are: democratic and non-individualistic style, communication skills and empathy. Among the most common obstacles to the affir-mation of female leadership are lower compensation, the presence of prejudices due to stereotypes and the lack of support from institutions in solving the gender gap. Con-clusions. Academic studies confirm that women tend to apply a transformational leadership in contrast to the autocratic and assertive male leadership. Continued re-search into female leadership is essential for monitoring progress and fostering actions that allow women to prosper in top leadership positions.

Background: 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.