[Artificial intelligence applied to the electrocardiogram.] / L'intelligenza artificiale applicata all'elettrocardiogramma.

Artificial intelligence is able to read and interpret Ecg traces quickly and precisely, increasing the diagnostic capacity and offering the possibility of anticipating preventive therapies. However, there is no evidence on the clinical utility and cost-effectiveness of certain practical applications. In fact, the literature shows the prognostic importance in favor of prevention, but clear evidence is not available that correcting strokes, embolisms, heart failure early improves quality and life span of patients.

Feasibility of contextualizing the Informed Health Choices learning resources in Italy: A pilot study in a primary school in Florence.

Background The Informed Health Choices (IHC) project team developed learning resources for primary school children to teach critical thinking about treatments claims and health choices and evaluated their effect in a randomized controlled trial of 120 schools in Uganda. Children taught with these resources showed a better ability to think critically about treatments claims and health choices than children not taught with these resources. Teams in multiple countries are contextualising the IHC resources for use in other languages and settings; in this pilot we describe contextualization for use in Italian primary school.  Methods After translating the IHC resources to Italian and holding an introductory workshop with participating schoolteachers, we piloted the resources with two classes of a primary school in Florence over nine lessons. Our aims were: 1) to assess the feasibility of introducing the IHC curriculum in Italian primary school; 2) to evaluate students' ability to assess health claims and make informed health choices; to explore 3) students' and 4) teachers' experiences with the IHC learning resources; 5) to identify barriers and facilitators to implementation of IHC learning resources in Italian primary school. To assess these objectives, we used qualitative and quantitative methods. Results Both qualitative and quantitative analyses consistently showed that the IHC learning resources had a positive impact on the objectives examined. The resources integrated well into the Italian primary school curriculum. Both students and teachers considered these resources comprehensible, appealing in design and content, and stimulating for the development of a critical attitude. The only barrier teachers and students expressed was using the resources in a remote learning context.  Conclusions Findings from our contextualisation of IHC learning resources in Italian primary school indicate that these resources are well-suited for Italian teachers and students in a primary school context and compatible with the Italian primary school curriculum.

To observe the observations on observational research: how do Italian online media report about a contemporary mainstream observational study?

BACKGROUND: The media's key role in conveying health information to the public is not always supported by the quality of the reporting. Despite findings from observational studies (OSs) represent a substantial proportion of media health news, limitations of OSs are often overlooked in medical journals' abstracts, in press releases, and in associated news stories. The objective of this analysis is to investigate how Italian online news media report on a contemporary OS published in a major medical journal and dealing with a topic of widespread interest. METHODS: The OS was published in Nature Medicine (Nat Med) in February 2022. It is a large retrospective cohort study aimed at characterizing the post-acute cardiovascular manifestations of covid-19. We collected Italian online news articles covering the Nat Med study that were released in the first two weeks after study publication. Based on resources focused on evaluation and proper reporting of OSs, we identified five thematic categories to be employed as a minimal reference standard to address the quality of reporting of the Nat Med study. Namely: 1) causality, 2) fear mongering, 3) spin, 4) actionability and 5) critical evaluation. Then, we defined a 13-item checklist aimed at exploring the existence of issues within each of the online news article with regard to the five thematic categories above. Outcome was the percentage of news articles covering the NM study showing issues with each of the five thematic categories. RESULTS: After checking for inclusion and exclusion criteria, we collected 30 news articles. Global inter-rater agreement related to the checklist completion by 4 raters was substantial. An issue with causality was identified in 30 articles out of 30 (100%). An issue with fear mongering was identified in 25 (83.3%) of the 30 articles, and an issue with spin in 21 (75%) of the 28 articles. Furthermore, an issue with actionability and critical evaluation was identified in 16 (53.3%) and 26 (86.7%) of the 30 articles, respectively. CONCLUSIONS: Our analysis of Italian online news media reporting about a contemporary OS published in a major medical journal and dealing with a topic of high public interest has shown that most news articles fail to properly report on the study's findings.

[About the communication of health research: generating trust through information and education.] / La comunicazione della ricerca scientifica: informare (e formare) generando fiducia.

Public communication strategies of scientific findings can be placed at various levels on a scale that originates from purely informative methods and, through increasingly persuasive methods, goes up to coercion. Institutional communication of science during the covid-19 pandemic is affected by the tension between the pursuit of the ethics of transparency and the need to achieve public health goals: a communication focused on information, that neutrally highlights both the risks and the advantages of an intervention, could reduce the acceptance of this intervention in the short term, but consolidate people's trust in institutions in the long term. On the other hand, a more persuasive communication could lead to a greater adherence to the proposed intervention in the short term, but weaken the trust of the communication's recipients towards the institutions. Whenever there is robust evidence in favor of the net benefit of an intervention, informative and persuasive communication tend to overlap, while interventions with an uncertain relation between pros and cons should orient communication towards more informative strategies: even when this is not possible, as in the case of health emergencies, transparency in communication remains decisive. In this regard, transparency is configured as the common denominator of a type of science communication that can generate trust in its recipients. But transparency alone is not enough. In fact, its effectiveness is lost if the communicated contents are not useful and if the recipients of the messages are not able to receive them adequately. Based on Italo Calvino's Six Memos, we define six requirements for transparent communication of scientific research and emphasize the importance of interventions aimed at promoting health literacy since primary school, such as the international Informed Health Choices project.

[Covid-19, myocarditis and return to play: it's time to be conservative.] / Covid-19, miocarditi e ripresa dell'attività sportiva: quando è il momento di essere conservativi.

Observational studies of cardiac magnetic resonance imaging in people with recent covid-19, including young asymptomatic athletes, have documented variable amounts of myocardial findings deemed suggestive of myocarditis. Despite a critical appraisal of the current literature points toward an insufficient evidence base about the existence of a peculiar association between covid-19 and myocarditis, the concern for unrecognized myocarditis and its potential consequences has led several sports medicine organizations to recommend a variety of cardiac tests to enable return to play in athletes with previous covid-19. We argue that some of these recommendations may lead to unnecessary tests or treatments, especially for asymptomatic SARS-CoV-2 positive people and for those with previous mild disease, and that sports participation may even be discouraged. As a response to current uncertainty, we advocate both for randomized studies that analyse the outcomes of different diagnostic strategies and for a prolonged follow-up of these people.

[The naked king in the pandemic: about the production and communication of scientific knowledge at the time of SARS-CoV-2.] / Il re nudo nella pandemia: sulla produzione e comunicazione del sapere scientifico ai tempi di SARS-CoV-2.

The SARS-CoV-2 pandemic has lifted the veil about how medical knowledge is produced and disseminated. Action Bias, together with economic, academic and media-related interests, has concurred to generate and spread low-value and even unreliable information about some hypothetical therapeutic interventions for CoViD-19. Not only this "infodemic" has weakened people's ability to make informed health choices, but it also has influenced the process of new evidence generation through the violation of the equipoise principle. The CoViD-19 infodemic has further highlighted the need for reliable health information and for people to enter the process of understanding and promoting valuable research. Through a randomized controlled trial, the Informed Health Choices project has shown that it is not impossible neither quixotic to better orient people about health choices since primary school. Similar competencies should be disseminated to everyone through sources that are selected and validated for their capability of reporting evidence based health information about the effects of treatments.

[New insights into the seriousness of acute myocardial injury during COVID-19]. / Nuove acquisizioni sulla gravità del danno cardiaco acuto in corso di COVID-19.

Retrospective data from Chinese cohorts published in the last few days have placed a strong emphasis on the possibility that acute myocardial injury represents a critical component in the development of serious complications in patients hospitalized with COVID-19. These analyses showed that 19-27% of hospitalized patients with moderate/severe COVID-19 developed acute myocardial injury, defined as an increase in troponin levels. Fifty-sixty percent of these patients died. The highest mortality rate was detected among patients with both progressively incremental troponin levels and a history of cardiovascular disease. Some pathophysiological reasons have been hypothesized regarding the frequently observed increase in troponin levels in patients hospitalized with COVID-19, but, at the moment, these data could already suggest some clinical management implications, also with the aim of prospectively collecting research data: a troponin dosage should be considered, as a prognostic indicator, in all patients with moderate/severe COVID-19 at hospital admission, periodically during hospitalization, and in the case of clinical deterioration. In those patients with increased troponin levels, serial determinations should be carried out to define the enzymatic trajectory and therefore also the degree of clinical attention that must necessarily be closer in those who turn out to have persistently high or increasing troponin levels. In order to reduce the overdiagnosis risk of acute myocardial injury in critically ill patients, detection of increased troponin levels should always be contextualized into a multi-parametric evaluation.

The duty of being a medical conservative. When in doubt, for the patient.

Recently, John Mandrola et al. established the tenets of medical conservativism. We endorse this approach to patient care, and we believe that, in order to have this perspective incorporated into medical reasoning, the foundations for being medical conservatives should be taught since medical school. In this Perspective, through an analogy between medicine's and criminal law's approaches to uncertainty, we suggest that the precautionary principle of in dubio pro reo could be adapted to medicine as a decisional strategy for medical conservatives. This principle would represent a cognitive and decisional filter that allows physicians to counterbalance the currently widespread propensity toward interventions with a conservative and precautionary attitude.

[The duty for being a medical conservative.] / Il dovere di essere medici conservativi nell'era dell'innovazione.

In the article by John Mandrola, Adam Cifu, Vinay Prasad and Andrew Foy translated below, the principles of being a medical "conservative" in the practice of contemporary medicine are exposed. In times projected towards progress, a manifesto to conservatism could seem an oxymoron, but today it is necessary to verify that every innovation is really such and that it contains scientific evidences to support what it claims.

The elephant in the record: On the multiplicity of data recording work.

This article focuses on the production side of clinical data work, or data recording work, and in particular, on its multiplicity in terms of data variability. We report the findings from two case studies aimed at assessing the multiplicity that can be observed when the same medical phenomenon is recorded by multiple competent experts, yet the recorded data enable the knowledgeable management of illness trajectories. Often framed in terms of the latent unreliability of medical data, and then treated as a problem to solve, we argue that practitioners in the health informatics field must gain a greater awareness of the natural variability of data inscribing work, assess it, and design solutions that allow actors on both sides of clinical data work, that is, the production and care, as well as the primary and secondary uses of data to aptly inform each other's practices.

["Handle with care": about the potential unintended consequences of oracular artificial intelligence systems in medicine.] / Potenziali conseguenze inattese dell'uso di sistemi di intelligenza artificiale oracolari in medicina.

Decisional support systems based on machine learning (ML) in medicine are gaining a growing interest as some recent articles have highlighted the high diagnostic accuracy exhibited by these systems in specific medical contexts. However, it is implausible that any potential advantage can be obtained without some potential drawbacks. In light of the current gaps in medical research about the side effects of the application of these new AI systems in medical practice, in this article we summarize the main unexpected consequences that may result from the widespread application of "oracular" systems, that is highly accurate systems that cannot give reasonable explanations of their advice as those endowed with predictive models developed with ML techniques usually are. These consequences range from the intrinsic uncertainty in the data that are used to train and feed these systems, to the inadequate explainability of their output; through the risk of overreliance, deskilling and context desensitization of their end-users. Although some of these issues may be currently hard to evaluate due to the still scarce adoption of these decisional systems in medical practice, we advocate the study of these potential consequences also for a more informed policy of approval beyond hype and disenchantment.

Value of Telemonitoring and Telemedicine in Heart Failure Management.

The use of telemonitoring and telemedicine is a relatively new but quickly developing area in medicine. As new digital tools and applications are being created and used to manage medical conditions such as heart failure, many implications require close consideration and further study, including the effectiveness and safety of these telemonitoring tools in diagnosing, treating and managing heart failure compared to traditional face-to-face doctor-patient interaction. When compared to multidisciplinary intervention programs which are frequently hindered by economic, geographic and bureaucratic barriers, non-invasive remote monitoring could be a solution to support and promote the care of patients over time. Therefore it is crucial to identify the most relevant biological parameters to monitor, which heart failure sub-populations may gain real benefits from telehealth interventions and in which specific healthcare subsets these interventions should be implemented in order to maximise value.

Acute infection-inflammation and coronary stent thrombosis: an observational study.

Coronary stent thrombosis (CST) is a major concern of interventional cardiology. Several risk factors for CST have been identified, but as a whole they do not explain the pathophysiology of CST. This study was designed to investigate whether acute infection-inflammation could facilitate the occurrence of CST. Forty-one patients, aged 66.6 +/- 11 years, consecutively admitted to our catheterization laboratory for acute, subacute or late CST, were retrospectively analysed. Transient acute infection-inflammation on admission for CST was diagnosed by predefined criteria. Prevalence of known risk factors for CST was also investigated. Twenty-one patients (51%) met predefined criteria for the occurrence of acute infection-inflammation. On admission, in these patients, levels of systemic humoral and cellular inflammatory markers were significantly higher than those of patients without recent or ongoing acute infection-inflammation (p < 0.05 for all). 62% of patients with acute infection-inflammation had less than two known risk factors for CST whereas only 37% patients without infection-inflammation showed less than two risk factors (p = 0.03) and showed more frequent interruption of antiplatelet treatment (17 vs. 2.4%, p = 0.02), mean longer stent length (20.5 +/- 4.8 vs. 16.5 +/- 5.1 mm, p = 0.02) and lower left ventricular ejection fraction before CST (42.9 +/- 14 vs. 47.3 +/- 11%, p = 0.02). In conclusion, acute infection-inflammation could play a role in facilitating the occurrence of CST in a subgroup with low risk profile for known risk factors. Our findings, if confirmed, could suggest new opportunities for prevention and treatment of CST.