Holistic health: Predicting our data future (from inter-operability among systems to co-operability among people)

n/

IPICT - An Explanatory Scheme About The Innovation Phenomena Towards Integrated Care Enhanced By Digital Technologies

The introduction of innovative models of care, especially in the management of chronic diseases and other long-term conditions, responds to an urgent need of economic sustainability of the health and social system, while maintaining or increasing the level of quality of the system. In this context it is crucial to assure the proper co-evolution of organizational models and technological solutions. This paper presents an explanatory scheme about Innovation Phenomena towards Integrated Care enhanced by digital Technologies (IPICT), developed in the context of the European project STOPandGO: organisational and informational integration may be achieved both vertically among care settings and horizontally between healthcare and social care. Full integration may be the final goal of a long process made by a progressive local deployment of several initiatives, possibly coherent with regional or national plans. Within each initiative, innovation has not to be necessarily present in each individual activity or in each technological component, but it may be triggered by the appropriate combination of activities and technologies according a suitable model of care. The proposed scheme identifies six layers, ranging from a technological approach on enabling infrastructures in Layers L1 and L2, to a perspective on organizational models co-designed with technological solutions in Layers L3 and L4, up to the comprehensive vision of the overall (regional) strategies on Integrated Care in Layers L5 and L6. In particular, Layer L4 regards the measures able to “reify the innovation” in the models of care deployed within the initiatives of Layer L5. The list of L4 measures worked out by STOPandGO project was tested on the production of a coherent set of local tenders to improve the health and well-being of citizens across hetero-geneous organisational/clinical circumstances

The LITIS Conceptual Framework: Measuring eHealth Readiness and Adoption dynamics across the Healthcare Organizations

The Italian Federation of Healthcare Trusts and Municipalities promoted a national initiative, named LITIS, on the levels of technological innovation in healthcare, to assist its members in the governance of the eHealth phenomenon. The result is a toolkit (i) to compare the policies among HealthCare Organizations (HCOs) within a jurisdiction; (ii) to help negotiate and monitor the balanced evolution of eHealth solutions within and across the HCOs, and (iii) to facilitate the collaboration among HCOs to face common topics. The primary achievement is a Conceptual Framework, spanning over the complete spectrum of the support to care and administrative processes, assuming two perspectives: the Functions F (services for citizens, social/ healthcare professionals, managers, administrative staff) and the Enabling Components C (prerequisites to deploy the Functions and handle the change). The framework entails a taxonomy of indicators to assess the eHealth readiness and adoption in the HCOs: at first the raw data – from a survey that involved nearly two thirds of the Italian HCOs—were transformed to yield a lower layer of 145 micro-indicators, then the micro-indicators were aggregated at an intermediate layer for two different purposes, either as 36 topics or as 12 sectors; the upmost layer was made of 3 macro-area indexes and a global index, named “ICLI”. The ontological structure behind the framework allows to adapt the set of microindicators to the context of any particular jurisdiction. The global index was used to classify each HCO into one out of five “Classes of Innovation” of increasing functional completeness. The lessons learned on presentation and interpretation of results are described

The role of primary care during the pandemic: shared experiences from providers in five European countries

BACKGROUND: The COVID-19 pandemic necessitated wide-ranging adaptations to the organisation of health systems, and primary care is no exception. This article aims to collate insights on the role of primary care during the pandemic. The gained knowledge helps to increase pandemic preparedness and resilience. METHODS: The role of primary care during the pandemic in five European countries (Austria, Denmark, France, Hungary, Italy) was investigated using a qualitative approach, namely case study, based on document analysis and semi-structured interviews. In total, 31 interviews were conducted with primary care providers between June and August 2022. The five country case studies were subjected to an overarching analysis focusing on successful strategies as well as gaps and failures regarding pandemic management in primary care. RESULTS: Primary care providers identified disruptions to service delivery as a major challenge emerging from the pandemic which led to a widespread adoption of telehealth. Despite the rapid increase in telehealth usage and efforts of primary care providers to organise face-to-face care delivery in a safe way, some patient groups were particularly affected by disruptions in service delivery. Moreover, primary care providers perceived a substantial propagation of misinformation about COVID-19 and vaccines among the population, which also threatened patient-physician relationships. At the same time, primary care providers faced an increased workload, had to work with insufficient personal protective equipment and were provided incongruous guidelines from public authorities. There was a consensus among primary care providers that they were mostly sidelined by public health policy in the context of pandemic management. Primary care providers tackled these problems through a diverse set of measures including home visits, implementing infection control measures, refurbishing used masks, holding internal meetings and relying on their own experiences as well as information shared by colleagues. CONCLUSION: Primary care providers were neither well prepared nor the focus of initial policy making. However, they implemented creative solutions to the problems they faced and applying the learnings from the pandemic could help in increasing the resilience of primary care. Attributes of an integrated health system with a strong primary care component proved beneficial in addressing immediate effects of the pandemic

Immune Response to Mycobacterium tuberculosis Infection in the Parietal Pleura of Patients with Tuberculous Pleurisy

The T lymphocyte-mediated immune response to Mycobacterium tuberculosis infection in the parietal pleura of patients with tuberculous pleurisy is unknown. The aim of this study was to investigate the immune response in the parietal pleura of tuberculous pleurisy compared with nonspecific pleuritis. We have measured the numbers of inflammatory cells particularly T-cell subsets (Th1/Th2/Th17/Treg cells) in biopsies of parietal pleura obtained from 14 subjects with proven tuberculous pleurisy compared with a control group of 12 subjects with nonspecific pleuritis. The number of CD3+, CD4+ and CCR4+ cells and the expression of RORC2 mRNA were significantly increased in the tuberculous pleurisy patients compared with the nonspecific pleuritis subjects. The number of toluidine blue+ cells, tryptase+ cells and GATA-3+ cells was significantly decreased in the parietal pleura of patients with tuberculous pleurisy compared with the control group of nonspecific pleuritis subjects. Logistic regression with receiver operator characteristic (ROC) analysis for the three single markers was performed and showed a better performance for GATA-3 with a sensitivity of 75%, a specificity of 100% and an AUC of 0.88. There was no significant difference between the two groups of subjects in the number of CD8, CD68, neutrophil elastase, interferon (IFN)-γ, STAT4, T-bet, CCR5, CXCR3, CRTH2, STAT6 and FOXP3 positive cells. Elevated CD3, CD4, CCR4 and Th17 cells and decreased mast cells and GATA-3+ cells in the parietal pleura distinguish patients with untreated tuberculous pleurisy from those with nonspecific pleuritis

Clinical Features, Cardiovascular Risk Profile, and Therapeutic Trajectories of Patients with Type 2 Diabetes Candidate for Oral Semaglutide Therapy in the Italian Specialist Care

Introduction: This study aimed to address therapeutic inertia in the management of type 2 diabetes (T2D) by investigating the potential of early treatment with oral semaglutide. Methods: A cross-sectional survey was conducted between October 2021 and April 2022 among specialists treating individuals with T2D. A scientific committee designed a data collection form covering demographics, cardiovascular risk, glucose control metrics, ongoing therapies, and physician judgments on treatment appropriateness. Participants completed anonymous patient questionnaires reflecting routine clinical encounters. The preferred therapeutic regimen for each patient was also identified. Results: The analysis was conducted on 4449 patients initiating oral semaglutide. The population had a relatively short disease duration (42%  60% of patients, and more often than sitagliptin or empagliflozin. Conclusion: The study supports the potential of early implementation of oral semaglutide as a strategy to overcome therapeutic inertia and enhance T2D management

Minimal information for studies of extracellular vesicles (MISEV2023): From basic to advanced approaches

Extracellular vesicles (EVs), through their complex cargo, can reflect the state of their cell of origin and change the functions and phenotypes of other cells. These features indicate strong biomarker and therapeutic potential and have generated broad interest, as evidenced by the steady year-on-year increase in the numbers of scientific publications about EVs. Important advances have been made in EV metrology and in understanding and applying EV biology. However, hurdles remain to realising the potential of EVs in domains ranging from basic biology to clinical applications due to challenges in EV nomenclature, separation from non-vesicular extracellular particles, characterisation and functional studies. To address the challenges and opportunities in this rapidly evolving field, the International Society for Extracellular Vesicles (ISEV) updates its 'Minimal Information for Studies of Extracellular Vesicles', which was first published in 2014 and then in 2018 as MISEV2014 and MISEV2018, respectively. The goal of the current document, MISEV2023, is to provide researchers with an updated snapshot of available approaches and their advantages and limitations for production, separation and characterisation of EVs from multiple sources, including cell culture, body fluids and solid tissues. In addition to presenting the latest state of the art in basic principles of EV research, this document also covers advanced techniques and approaches that are currently expanding the boundaries of the field. MISEV2023 also includes new sections on EV release and uptake and a brief discussion of in vivo approaches to study EVs. Compiling feedback from ISEV expert task forces and more than 1000 researchers, this document conveys the current state of EV research to facilitate robust scientific discoveries and move the field forward even more rapidly

Technological Solutions Potentially Influencing the Future of Long-Term Care. ENEPRI Research Report No. 114, April 2012

This report provides a forecast of the potential direct and indirect influences of various kinds of technologies on the LTC milieu, answering the following question: from a technology-driven perspective: “Consider each technological solution. What could be its future usage in the LTC sector?” Future technological deployments will induce changes in the respective roles of the care recipient and of the formal and informal carers, with an impact on three major concerns: the transformation of the care recipient into a proactive subject, the augmented potentiality for home care and the new functions that informal carers could assume

The Influence of Technology on Long-Term Care Systems. ENEPRI Policy Brief No. 10, February 2012

New technologies may have a beneficial impact on long-term care (LTC) systems by improving the quality, effectiveness and efficiency of LTC provision, and even by decreasing the need for LTC in the first place. Given the great uncertainty about the diffusion and implementation of available technology, there is little point in trying to make quantitative forecasts about the impact of technology. A more useful approach is to study the mechanisms through which technology can have an impact on LTC. This is the subject of Work Package 4 of the ANCIEN project. Both generally and via a number of case studies, it develops a framework to analyse the impact of technology on LTC. The functioning of this framework is illustrated by considering a number of specific long-term conditions, such as dementia, obesity and diabetes

Role and potential influence of technologies on the most relevant challenges for long-term care. ENEPRI Research Report No. 113, 26 June 2012

This report considers three case studies (namely diabetes, dementia and obesity) for setting up a framework to assess the systemic influences of technologies in the long-term care milieu, using a problem-driven approach in relation to health care. Such technologies could be an enabling factor or a catalyser of advances taking place in the health and social sectors. They offer opportunities to support and amplify relevant organisational changes in the context of innovative care models, which stem from overall policies and regulations of a national or regional jurisdiction to address the future sustainability of health and social care