Italian Journal of Medicine <p>The <strong>Italian Journal of Medicine (ITJM)</strong> is the official journal of FADOI, the Federation of Associations of Hospital Doctors on Internal Medicine and focus to describe the complex and variable situations confronted by Internists in daily practice. ITJM aims to promote excellence in the practice of internal medicine in hospitals and to disseminate the results of clinical research in internal medicine departments. The journal also contributes to the updating of hospital internists on general topics concerning public health, including ethical, legal, economical and health policy issues. The <strong>Italian Journal of Medicine (ITJM)</strong> is a quarterly peer-reviewed journal aiming to publish highest-quality material covering original basic and clinical research on all aspects of internal medicine. The Journal includes original clinical research papers, reviews, case reports and specific sections dedicated to clinical pharmacology, chronic diseases, health management. The Italian Journal of Medicine is currently indexed in <a title="Scopus" href="" target="_blank" rel="noopener">Scopus</a> and <a title="DOAJ" href="" target="_blank" rel="noopener">DOAJ</a> since September 2009.</p> <p>This journal does not apply the article processing charge&nbsp;to Authors as it is supported by institutional funds.</p> PAGEPress Scientific Publications, Pavia, Italy en-US Italian Journal of Medicine 1877-9344 <p><strong>PAGEPress</strong> has chosen to apply the&nbsp;<a href="" target="_blank" rel="noopener"><strong>Creative Commons Attribution NonCommercial 4.0 International License</strong></a>&nbsp;(CC BY-NC 4.0) to all manuscripts to be published.<br><br> An Open Access Publication is one that meets the following two conditions:</p> <ol> <li>the author(s) and copyright holder(s) grant(s) to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship, as well as the right to make small numbers of printed copies for their personal use.</li> <li>a complete version of the work and all supplemental materials, including a copy of the permission as stated above, in a suitable standard electronic format is deposited immediately upon initial publication in at least one online repository that is supported by an academic institution, scholarly society, government agency, or other well-established organization that seeks to enable open access, unrestricted distribution, interoperability, and long-term archiving.</li> </ol> <p>Authors who publish with this journal agree to the following terms:</p> <ol> <li>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> <li>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.</li> </ol> Granulomatosis with polyangiitis presenting with pachimeningitis and persistent headache <p>Granulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis (WG), is a systemic inflammatory disease, primarily involving the upper and lower respiratory tract and kidneys. It is a relatively uncommon condition, characterized by necrotizing granulomatous vasculitis of smalland medium-sized vessels and the presence of anti-neutrophil cytoplasmic antibodies (ANCA) in the serum as defined in the Chapel Hill Consensus Conference 2012. GPA presents a wide spectrum of manifestations and remains one of the most challenging diagnostic dilemmas in clinical medicine. From common respiratory and neurological symptoms to infrequent cardiac complications, this fatal systemic illness is difficult to distinguish from infectious etiologies, and is often mistaken for an isolated complaint. We report a case of granulomatosis with polyangiitis in a patient with persistent frontal headache, for a very long time considered as migraine versus tension-type headache.</p> Maria Sofia Cotelli Mirko Scarsi Marta Bianchi Valeria Bertasi Patrizia Civelli Filippo Manelli Marinella Turla ##submission.copyrightStatement## 2020-01-03 2020-01-03 13 4 10.4081/itjm.2020.1193 Consensus document ANMCO/FADOI/SIAARTI/SIC/SIMG/SIMI/SIMEU: The clinical-diagnostic and therapeutic pathway of patients with acute heart failure in the Emergency Department <p>Acute heart failure (HF) involves hospitals throughout the world and, as well as other acute cardiac pathologies such as coronary syndromes, has markedly unfavorable outcomes: the mortality or rehospitalization rate after 3 months is 33%, mortality 1 year after admission varies between 25% and 50%.</p> <p>A critical factor in managing acute HF is the multiplicity of health professionals involved in the diagnostic-therapeutic pathway of this syndrome - general practitioners, emergency doctors, cardiologists, internists, anesthesiologists/resuscitators - and therefore also the need to integrate different knowledge and skills and converge on care goals that can improve clinical outcomes.</p> <p>This consensus document originates from the joint work of the Scientific Societies, representing various professional figures involved in assisting patients with acute HF, and has shared strategies and pathways aimed at guaranteeing both quality care levels and better outcomes. The document details the entire journey of the patient with acute HF from the onset of symptoms at home, diagnosis, home management or sending to the Accident and Emergency/Emergency Admissions Department (AandE/EAD), mode of transport, early therapy, through the instrumental clinical pathways for diagnosis in AandE/EAD and the treatment, risk stratification and discharge of the patient in ordinary hospitalization or at home. It also analyses the possible role of cardiological "fast-track", Short Intensive Observation and regional welfare taking charge through general medicine and specialist clinics for the care of HF.</p> <p>The growing care burden and the complex problems generated by acute HF cannot find an adequate solution without an integrated multidisciplinary approach that effectively places emergency facilities in the network along with intensive and ordinary hospitalization units and within the context of regional care. Thanks to contributions from the most qualified Scientific Societies, this document pursues this objective by proposing a structured, shared and applicable pathway which can contribute to manage a widespread problem in the country.</p> Mariavittoria Vescovo ##submission.copyrightStatement## 2019-11-28 2019-11-28 13 4 247 276 10.4081/itjm.2019.1230 Fall Risk Assessment Tools <p>Falls in hospital are common and have serious consequences for patients, including physical and psychological harm, increase length of stay and hospital costs. A systematic approach is required to report and identify factors contributing to in-hospital falls and develop interventions to reduce inpatient fall rates. Different hospital settings have different fall rates and characteristics depending on type of hospital service and admission diagnosis. Screening tools were developed to assess fall risk but are usually insensitive to be useful in reducing falls. There is also a need for prospective validation in each hospital setting to ensure accuracy, resulting in a move away from using such scoring tools. A recommended approach for fall risk assessment is given, which integrates the process for outpatient settings and inpatients.</p> Shyh Poh Teo ##submission.copyrightStatement## 2019-11-28 2019-11-28 13 4 200 204 10.4081/itjm.2019.1196