The integration of WHO classifications and reference terminologies to improve information exchange and quality of electronic health records: the SNOMED\u2013CT ICF harmonization within the ICD-11 revision process

Introduction The Family of International Classifications (WHO-FIC) is a suite of integrated classification products of the World Health Organization (WHO) that can be used to provide information on different aspects of health and the health-care system. These tools and their national modifications allow, together with the related classifications of health interventions, full representation of the volumes of health services provided in the various countries that adopt case mix systems. The use of standardized terminologies in classifications, for the definition of the descriptive characteristics of the disease, is a necessary step to allow full integration between different information systems, making available information about the diagnosed diseases, the performed health procedures and the level of functioning of the person, for very different uses such as, for example, public health, safety of care and quality control. Materials and methods Within the WHO and International Health Terminology Standards Development Organization (IHTSDO) collaboration agreement, a work of independent review was carried out on all the Activities and Participation categories (A&P) of the WHO International Classification of Functioning, Disability and Health (ICF), in order to identify equivalence and gaps to the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) concepts in terms of lexical, semantic (content) and hierarchical matching, to harmonize WHO classifications and SNOMED CT. Results and conclusions The performed mapping suggests that the ICF A&P categories are semantically and hierarchically different from the terms of SNOMED CT thus confirming the high value of the WHO-IHTSDO synergy aiming to frame together, in a joint effort, their respective unique contribution. Recommendations were formulated to WHO and IHTSDO in order to better frame together, in a joint effort, their respective unique contribution ensuring that SNOMED CT and ICF can interoperate in electronic health records

Diabetes mellitus and colorectal cancer screening in the population of the Italian region Friuli Venezia Giulia

Aims: Colorectal cancer is the most common cancer in Italy, where screening programs are now in place all over the country. We conducted a research to assess whether the use and outcomes of colorectal cancer screening are different between diabetics, who are at increased risk of developing colorectal cancer, and non-diabetics in the Italian Northeastern region Friuli Venezia Giulia. Methods: This was a retrospective population-based study which used the administrative databases of the regional health information system as the sources of information. For the two screening rounds 2010-2011 and 2012-2013, we compared adherence to the program and the results of the fecal occult blood tests and of the colonoscopy among diabetic and non-diabetic residents. Results: Overall, more than 300,000 persons were invited for the colorectal cancer screening in each round. Of them, approximately 8.8% were diabetic. In the regional population, adherence to the screening program was significantly lower among diabetics than among non-diabetics. The proportion of positive fecal occult blood tests was higher among diabetics than among non-diabetics. Among diabetics, the detection rate for initial and advanced adenomas was higher than among non-diabetics, whereas no clear pattern was observed for the detection of cancers. Conclusion: In Friuli Venezia Giulia, efforts should be directed at improving the management of diabetic patients and at reducing the inequalities in access to care due to this comorbidity

Challenges and opportunities by bridging human and animal surveillance to tackle antimicrobial resistance

Introduction: Antimicrobial resistance (AMR) requires a global and multidisciplinary approach to improve awareness, understand dynamics and find preventive solutions. In this framework we set up a one-health tailored pilot surveillance network to monitor occurrence of Escherichia coli ESBL in humans and food producing animals FPA, to investigate on dissemination paths of ESBL resistant E. coli in human healthcare units and to plan and develop educational modules for prudent use of antimicrobials in human and animals. With the project network in place we could promptly investigate on the emergence of the plasmid-mediated colistin resistance gene mcr-1 that has been recently reported in E. coli of both animal and human origin. Materials and Methods: According to objectives: i) we set up a cross-sectional study (2016-2017) by collecting representative E. coli ESBL+ isolates from human communities and FPA industrial holdings in six Italian Regions; ii) we searched for available data sources for descriptors and parameters to develop dynamic mathematical models to describe E. coli ESBL+ dissemination paths between health care units and iii) we explored the learning needs to tackle AMR so to identify knowledge gaps to be addressed by specific educational proposals. In this frame, colistin resistance was investigated among E. coli ESBL+ isolates from both animal and human sources. MIC was determined by broth microdilution method and interpreted according to EUCAST breakpoints. mcr-1 gene was detected by PCR and sequencing. Results: Halfway through the project 827 E. coli ESBL+ isolates (277 were from FPA) were collected. A post graduate course and a distance learning courses were identified to fulfill learning needs of clinicians, veterinarians and microbiologists. Few E. coli ESBL+ of human origin were tested for colistin resistance so far and found all susceptible. On the contrary among colistin resistant E. coli ESBL+ isolates of animal origin mcr-1 was detected in 5% of poultry and 10% of bovines and of swine isolates. Data from antimicrobial susceptibility test (AMS) of patients from a high geographical coverage and statistics from health care units is feeding and providing parameters for mathematic dynamic models. Conclusions: A challenge in a one-health-based surveillance of opportunistic bacteria is the different reference population that require a wide animal sample to detect the targeted human pathogens. So far, our experience recommends to stick on strong case definitions of both clinical cases and isolates to be included in the study. Although the data herein reported is preliminary the proportions of mcr-1 carriers E. coli ESBL+ detected in FPA represents a serious public health threat that requires strict surveillance