Digital Pathology and Telepathology in Transplantation: Feasibility With the EHR

Digital pathology and telepathology play an emerging role conveying anatomical pathology diagnostic images in the Electronic Health Record. We sought to focus our attention to an innovative project, while identifying standards and practices between clinicians and the EHR (Electronic Health Record). The project aims at developing a second opinion network, based on telepathology, between two major transplantation centres over two years. The health authorities involved are the Hospital Trust of Verona and of Padua (Italy). In 2015 there were 376 renal and liver transplantations for both centres. We expect to significantly improve the transplantation workflow after combining the digital pathology platform with its proper and timely application in the telepathology network. Firstly it will allow the real time second opinion between pathologists in order to assess the suitability of the donor organs, avoiding the glass-slide transfer, with potential damage or loss. The technical partners delivered two slide scanners and software solutions to enable virtual microscopy and web-based digital slide sharing with storage resources. In addition, the project comprises an online survey which focuses on the accountability of the system, the user perception, and a concordance study for the project outcomes evaluation. The technical transactions between all the main actors and digital slides will be reviewed and updated in order to meet the integration standards and guideline according to IHE (Integrating the Healthcare Enterprise) initiative, Digital Imaging and COmmunications in Medicine (DICOM) and Health Level 7 (HL7). According to the first comparisons, we believe that the efforts to provide this new diagnostic imaging area to the actual EHR developments, will be rewarding and effective for the saving-life transplantation processes

Vaccination criteria based on factors influencing COVID-19 diffusion and mortality

SARS-CoV-2 is highly contagious, rapidly turned into a pandemic, and is causing a relevant number of critical to severe life-threatening COVID-19 patients. However, robust statistical studies of a large cohort of patients, potentially useful to implement a vaccination campaign, are rare. We analyzed public data of about 19,000 patients for the period 28 February to 15 May 2020 by several mathematical methods. Precisely, we describe the COVID-19 evolution of a number of variables that include age, gender, patient’s care location, and comorbidities. It prompts consideration of special preventive and therapeutic measures for subjects more prone to developing life-threatening conditions while affording quantitative parameters for predicting the effects of an outburst of the pandemic on public health structures and facilities adopted in response. We propose a mathematical way to use these results as a powerful tool to face the pandemic and implement a mass vaccination campaign. This is done by means of priority criteria based on the influence of the considered variables on the probability of both death and infection

A Terminology Service Compliant to CTS2 to Manage Semantics within the Regional HIE

Objectives: The correct semantics management represents a fundamental requirement to create health information exchange (HIE) systems able to support clinical data sharing. A research is now underway to set up an infrastructure to aggregate data coming from health information systems, and it will be experimented to support regional HIE in Veneto Region, Italy. Methods: In the first period, the focus was on the semantics management of Clinical Document Architecture Release 2 (CDA R2) laboratory reports in which observations must be encoded using LOINC\uae vocabulary. The existing components considered were the Laboratory Information Systems (LISs) of the local departments of the region (23 units) and the regional HIE. To manage the semantics of the data, the design and the implementation of a terminology service, the Health Terminology Service (HTS), compliant to the Common Terminology Service Release 2 (CTS2) standard was considered. Results: The HTS, formed by a set of web services, as CTS2 indicates, is the core of the proposed infrastructure. It is connected with an application that allows creating, deleting, updating and managing the versioning of the maps between the laboratory observations and the LOINC\uae entities. Conclusions: The adoption of CTS2 specification allows the HTS to support different use cases, which are essential to supports the clinical data sharing of the HIE content. During the development, the authors faced some problems that causes a delay in the implementation of the solution. The authors are still working to connect the HTS with the existing systems and to improve the solution

Home telemonitoring for patients with acute exacerbation of chronic obstructive pulmonary disease: A randomized controlled trial

BACKGROUND: Although a number of studies have suggested that the use of Telemonitoring (TM) in patients with Chronic Obstructive Pulmonary Disease (COPD) can be useful and efficacious, its real utility in detecting Acute Exacerbation (AE) signaling the need for prompt treatment is not entirely clear. The current study aimed to investigate the benefits of a TM system in managing AE in advanced-stage COPD patients to improve their Health-Related Quality of Life (HRQL) and to reduce utilization of healthcare services. METHODS: A 12-month Randomised Controlled Trial (RCT) was conducted in the Veneto region (Italy). Adult patients diagnosed with Class III-IV COPD in accordance with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification were recruited and provided a TM system to alert the clinical staff via a trained operator whenever variations in respiratory parameters fell beyond the individual's normal range. The study's primary endpoint was HRQL, measured by the Italian version of the two Short Form 36-item Health Survey (SF36v2). Its secondary endpoints were: scores on the Hospital Anxiety and Depression Scale (HADS); the number and duration of hospitalizations; the number of readmissions; the number of appointments with a pulmonary specialist; the number of visits to the emergency department; and the number of deaths. RESULTS: Three hundred thirty-four patients were enrolled and randomized into two groups for a 1 year period. At its conclusion, changes in the SF36 Physical and Mental Component Summary scores did not significantly differ between the TM and control groups [(-2.07 (8.98) vs -1.91 (7.75); p\u2009=\u20090.889 and -1.08 (11.30) vs -1.92 (10.92); p\u2009=\u20090.5754, respectively]. Variations in HADS were not significantly different between the two groups [0.85 (3.68) vs 0.62 (3.6); p\u2009=\u20090.65 and 0.50 (4.3) vs 0.72 (4.5); p\u2009=\u20090.71]. The hospitalization rate for AECOPD and/or for any cause was not significantly different in the two groups [IRR\u2009=\u20090.89 (95% CI 0.79-1,04); p\u2009=\u20090.16 and IRR\u2009=\u20090.91 (95% CI 0,75 - 1.04); p\u2009=\u20090.16, respectively]. The readmission rate for AECOPD and/or any cause was, however, significantly lower in the TM group with respect to the control one [IRR\u2009=\u20090.43 (95% CI 0.19-0.98); p\u2009=\u20090.01 and 0.46 (95% CI 0.24-0.89); p\u2009=\u20090.01, respectively]. CONCLUSION: Study results showed that in areas where medical services are well established, TM does not significantly improve HRQL in patients with COPD who develop AE. Although not effective in reducing hospitalizations, TM can nevertheless facilitate continuity of care during hospital-to-home transition by reducing the need for early readmission