Extracellular vesicles (EVs) are nanometer-sized lipid structures actively secreted by Gram-negative and Gram-positive bacteria, representing a sophisticated microbial adaptation and communication strategy. These structures are involved in biomolecular transport, the regulation of biological processes, the modulation of host–pathogen interactions, and adaptation to hostile environmental conditions. EVs also play a crucial role in virulence, antibiotic resistance, and biofilm formation. This review will explore the biogenesis, composition, and biological mechanisms of outer membrane vesicles (OMVs) secreted by Gram-negative bacteria and membrane vesicles (MVs) generated by Gram-positive bacteria. In detail, the modulation of EVs in response to antibiotic exposure will be addressed. The role of EV morpho-functional adaptations will be studied in antimicrobial resistance, the gene determinant spread, and survival in adverse environments. This study aims to provide a comprehensive overview of the EV role in bacterial physiology, highlighting their ecological, evolutionary, and biotechnological implications. An overview of the enzymes and proteins mainly involved in OMV-mediated resistance mechanisms will also be provided. These insights could open new perspectives for developing therapeutic strategies that counteract EV secretion and biotechnological applications, such as vaccines and drug delivery systems.

Background. The COVID-19 pandemic has transformed people’s lifestyles by imposing social, economic, and labor changes. Health professionals have been in the spotlight, occasionally even elevated to the status of “heroes”, as they have been at the forefront of the health emergency. Media exposure has undoubtedly played a pivotal role in the evolution and perception of the public’s image of nurses, especially within the Italian context. Currently, there is only one study conducted in Italy during the pandemic period. For this reason, we have opted to delve further into this subject during the post-pandemic period, with the ultimate goal of identifying this perceptual evolution. Methods. An online snowball sampling survey was conducted among the Italian population using social networks between August 2022 and January 2023. The survey utilized the Nursing Attitude Questionnaire (NAQ) to collect data. Results. The sample consisted of 564 individuals. Among the respondents, 63.8% (n = 360) were familiar with the nursing pathway, and the level of agreement regarding the training of nurses was 81.5% (n = 260). In terms of recognizing the professional role of nurses, variations emerged in certain domains of the NAQ. Specifically, professional values of nurses were more pronounced in northern and central Italy (M = 26.27). Moreover, stereotypes were more prevalent in the north (23.73 ± 3.538) and the center (23.13 ± 4.104) (p = 0.001). Conclusions. The sample acknowledged a unique competence inherent to nurses that cannot be replaced by other professionals. The study population perceives the nursing profession as pivotal within the IHS (Integrated Health System). However, the attractiveness of the profession remains exceedingly low. This study was not registered on a publicly available registry.

Cases of dementia have increased significantly in recent years. The family represents the main cornerstone of assistance to the elderly suffering from dementia, in particular the caregiver. Family members who take on the role of caregiver are subjected to physical, psychological, emotional, social and financial stress, which can be conceptualised with the term “burden”. The aim of this study was to investigate which tools are best suited to measure the type of burden based on the type of dementia for each caregiver. A literature search was undertaken in MEDLINE, CINHAL and The Cochrane Database in September 2022, including articles from the last 20 years and using a combination of keywords and defined inclusion criteria. This literature review has been performed according to the PRISMA statement. From a total of 116 articles regarding the use of burden rating scales for caregivers, 18 scales were selected. The review provides a useful overview of burden assessment scales, classified into three categories, one-dimensional, multidimensional, or distinct concept with a subjective and objective component, in order to adopt appropriate strategies to assess caregiver burden and improve the quality of their health, both in the community and in hospitals. Indeed, the domestic context is the most studied as there is a greater risk of developing the burden of the caregiver: for this reason, some scales include the assessment of both the caregiver and the patient receiving treatment.

We conducted a bibliometrics analysis utilizing the Web of Science database, selecting 1925 articles concerning artificial intelligence (AI) in nursing. The analysis utilized the network visualization tool VOSviewer to explore global collaborations, highlighting prominent roles played by the United States, China, and Japan, as well as institutional partnerships involving Columbia University and Harvard Medical School. Keyword analysis identified prevalent themes and co-citation analysis highlighted influential journals. A notable increase in AI-related publications in nursing was observed over time, reflecting the growing interest in AI in nursing. However, high-quality clinical research and increased scientific collaboration are needed.

Background: Gamification is an innovative pedagogical strategy for improving learning outcomes, motivation, engagement, and knowledge retention. Nevertheless, evidence on the effectiveness of gamification remains heterogeneous. Methods: A systematic review was conducted. Searches were performed across PubMed/MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, Google Scholar, and grey literature (2010–2025). Eligible studies included quantitative, qualitative, and mixed-methods research involving undergraduate nursing students exposed to gamification interventions. Data extraction and quality assessment were independently performed using RoB-2, ROBINS-I, and JBI tools. Narrative synthesis was adopted due to the heterogeneity of interventions and outcome measures. Results: A total of 48 studies were included. Gamification strategies varied widely and included interactive quizzes, gamified flipped classroom models, serious games with explicit game elements, escape rooms, digital badges, and audience-response systems. For learning outcomes, most studies reported improvements in knowledge or performance, particularly when gamification included immediate feedback and repeated practice. While the knowledge retention was evaluated less frequently (12%), it was generally maintained or improved up to 2–4 weeks and across semester assessments. Strong positive trends of motivation and engagement were found across most studies, especially with competitive quizzes, missions, and narrative-based activities. Self-efficacy and satisfaction frequently improved, particularly in gamified simulations and team-based activities. Risk of bias was variable, with many quasi-experimental and descriptive studies limiting causal inference. Evidence certainty ranged from low to moderate according to GRADE criteria. Conclusions: Gamification is a promising educational approach in undergraduate nursing programs. Effects on long-term retention and practical skills remain less clear due to methodological variability and limited follow-up data. Future research focused on standardized outcome measures and longer follow-up intervals is required to consolidate evidence and guide educational policy. Protocol registered on PROSPERO (CRD420251117719).

Emergency Department (ED) overcrowding is a worldwide problem (Morley et al. 2018). Always, people who present to EDs are required to wait too much. This problem compromises the health management efficacy, the satisfaction of the patients, the quality of the public offered service, also impacting on the indicators of the quality of life. The reasons are different, and there is no all-inclusive solution. This research work is aimed to study the etiology of this problem, providing some evidence useful to support the health management board and to increase the awareness of the citizens. The main contribution is about the analysis of access to an Italian hospital during a timespan of one year. The paper shows the results of descriptive analytics by pointing out some aspects that may mitigate the problem of EDs overcrowding. Among others, one of the most important outcomes of this study is about the rate of appropriateness and inappropriateness of the accesses to the ED, where the meaning of inappropriate access is essentially a situation tractable outside the ED. These results could increase awareness, emphasizing the impact of the number of improper accesses.