Appropriateness of repeated execution of laboratory examinations: a CDSS approach

Repetitive laboratory testing has become a well- recognized problem in the practice of medicine, especially in the hospital inpatient setting, since it increases costs and causes patient discomfort. Among the interventions proposed to reduce unnecessary testing, Clinical Decision Support Systems (CDSS) have been shown to be effective. We present the project of a CDSS recommending professionals in real time regarding the appropriateness for repeating laboratory exams, embedded in a Computerized Physician Order Entry at the Azienda Ospedaliero-Universitaria and Azienda Unità Sanitaria Locale of Ferrara, Italy. Test-specific time intervals within which test repetition is redundant are encoded in formal rules, which are applied against the laboratory results done in the past for the patient. The rules-set implemented concerns: clinical chemistry, hematology, coagulation, infectious diseases serology, microbiology, inflammation, cardiac and tumor markers, hormones, autoimmunity, allergology, molecular biology and drug monitoring testing

A 49-year-old woman with dyspnoea, palpitations and syncope

Pulmonary hypertension is rarely described in association with Sjogren's syndrome. The authors report the case of a patient in which pulmonary hypertension was the inaugural clinical manifestation of primary Sjogren's syndrome. Clinical assessment, differential diagnosis, etiopathological implications, and therapeutic approach are discussed

The management of acute venous thromboembolism in clinical practice - study rationale and protocol of the European PREFER in VTE Registry

Background: Venous thromboembolism (VTE) is a major health problem, with over one million events every year in Europe. However, there is a paucity of data on the current management in real life, including factors influencing treatment pathways, patient satisfaction, quality of life (QoL), and utilization of health care resources and the corresponding costs. The PREFER in VTE registry has been designed to address this and to understand medical care and needs as well as potential gaps for improvement. Methods/design: The PREFER in VTE registry was a prospective, observational, multicenter study conducted in seven European countries including Austria, France Germany, Italy, Spain, Switzerland, and the UK to assess the characteristics and the management of patients with VTE, the use of health care resources, and to provide data to estimate the costs for 12 months treatment following a first-time and/or recurrent VTE diagnosed in hospitals or specialized or primary care centers. In addition, existing anticoagulant treatment patterns, patient pathways, clinical outcomes, treatment satisfaction, and health related QoL were documented. The centers were chosen to reflect the care environment in which patients with VTE are managed in each of the participating countries. Patients were eligible to be enrolled into the registry if they were at least 18 years old, had a symptomatic, objectively confirmed first time or recurrent acute VTE defined as either distal or proximal deep vein thrombosis, pulmonary embolism or both. After the baseline visit at the time of the acute VTE event, further follow-up documentations occurred at 1, 3, 6 and 12 months. Follow-up data was collected by either routinely scheduled visits or by telephone calls. Results: Overall, 381 centers participated, which enrolled 3,545 patients during an observational period of 1 year. Conclusion: The PREFER in VTE registry will provide valuable insights into the characteristics of patients with VTE and their acute and mid-term management, as well as into drug utilization and the use of health care resources in acute first-time and/or recurrent VTE across Europe in clinical practice. Trial registration: Registered in DRKS register, ID number: DRKS0000479