Criteria for the Evaluation of Italian Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS): Comparison with European Standards and Certification Models

The definition of the title 'Istituto di Ricovero e Cura a Carattere Scientifico' (IRCCS) and how this title is given by the Italian Ministry of Health is presented. Specifically, the first assessment of a commission concerning the essential information for the accreditation process is introduced. Moreover, the two years review process that aims to collect last updated information of the IRCCS, to identify level of excellence and critical aspects, is also explained. The present Italian forms and international manuals like Joint Commission, OECI and HCERES were schematized using UML diagrams. The current IRCCS accreditation forms are presented with the suggested updates organized in some levels of structuring. We compared the Italian forms with the manuals required to obtain international certifications (Joint Commission and OECI) and we analyzed the criteria for the evaluation of research units in France (the HCERES standards). Although it is a preliminary study, the use of UML diagrams allows to schematize a new accreditation model, in line with European guidelines and the most important international certifications

EU-Funded Telemedicine Projects – Assessment of, and Lessons Learned From, in the Light of the SARS-CoV-2 Pandemic

The SARS-CoV-2 health emergency has demonstrated the need for developing structured telemedicine systems to protect citizens from the spread of the virus. Thereby, their importance and the necessity to tailor their diffusion at large scale for providing services both at a distance and in time has been shown. For these reasons, the European Union advocates the digital transition of health systems for the next 5 years. The main aim of this work is to revisit the telemedicine research projects financed by European Community during the period 2000-2020 with particular respect to the results derived from their application. The analysis showed that some integration of tele-care and tele-health could be obtained with tele-monitoring systems and the implementation of Electronic Personal Record (EPR). Furthermore, telemedicine allows enhancing health care in critical environments, to protect health and life of the most vulnerable patients, and to encourage cross-border dialogue. The criteria of “from distance” and “timely delivered” are granted, but the effectiveness of the overall offered services highly depends on the availability and the quality of the input data. Unfortunately, this remains a relevant problem in the SARS-CoV-2 pandemic

Molecular tests for SARS-CoV-2: data from Liguria Region (Italy)

The current Covid-19 pandemic makes necessary to identify people affected by SARS-CoV-2. To do this, the most reliable method is the use of the molecular test that is the gold standard to detect positive peoples.Here, we provide a comprehensive review on the diagnostic processes through molecular tests for SARS-CoV-2 infection. First, we have obtained information about the testing technologies in the Liguria region's hospitals to find and describe the most common technologies used and to calculate the molecular test's average cost. Second, we have evaluated the sensitivity, the specificity, the safety with respect to the data reported on scientific literature (Real Word Data VS Registrative Studies) and the organizational aspects of the molecular tests.Clinical Relevance- This study aims to provide support to the decision makers on clinical, economic, organizational, social and ethical issues related to the use of molecular test for SARS-CoV-2

Helicopter Emergency Medical Service: Analysis and Evaluation of Helicopter Rescue in Liguria

Background: The Helicopter Emergency Medical Service (HEMS) is a type of helicopter rescue whose purpose is to optimize health care by operating in parallel and in synergy with the ground network of emergency vehicles to ensure complete coverage of the territory. In Liguria Region, in addition to an established agreement with the Fire Department for a Helicopter Emergency Technical Medical Service (HETMS), from July 2020, a second main helicopter of the private company AirGreen has been introduced. Here, we have carried out an analysis of the activity data on HEMS and medical cars to optimize the cost-effectiveness and highlight the qualitative evolution of the services after the introduction of the second helicopter. Moreover, we have designed a tool to drive the choice of which type of helicopter rescue to use in our Region from time to time. Methods: The data studied, derived from the Medical Priority Dispatch System (MPDS), were provided by the Regional Department of Territorial Health Emergency located at the IRCCS San Martino institute in Genoa. Data were organized into two separate databases, one related to helicopters (1491 rows and 18 columns) and the other related to medical car trips (70130 rows and 21 columns), and then analyzed by using Microsoft Excel software. Results: From the data processing, we have observed a significant increase in helicopter rescue service, which roughly doubled despite the impact of the pandemic, a clear distribution of the service between the Riviera di Ponente (mainly served by the private company AirGreen) and the Riviera del Levante (mainly served by the Fire Department) and a management of 'secondary transport' mostly handled by the private sector. On the other hand, medical-car data are too affected by the impact of the pandemic to be able to highlight a change in service following the introduction of the second helicopter. Focusing on efficiency, we remarked that both services are activated primarily for high severity and priority events. Conclusions: These studies have allowed us to prove graphically and in the regional context the management of helicopter rescue and to hypothesize changes that could optimize the effectiveness and efficiency of the service. In order to achieve this aim, it is considered necessary to create a mathematical model to support decision-making and help to estimate, through objective parameters, which emergency vehicles, between the two main helicopter and the medical cars, should preferentially be activated in case of need

Validation of full-remote reporting for cervicovaginal cytology: the Caltagirone-Acireale distributed lab

Introduction: Cervical cancer is the fourth most common cancer in women, and its prevention is based on vaccination and screening. Screening consists of molecular human papillomavirus (HPV) testing and cytologic analysis of cervical smears, which require expensive equipment and the interaction of numerous professionals such as biologists, cytologists, laboratory technicians, and pathologists. Materials and methods: We centralize the cervical samples from more than 51 clinics in 1 main laboratory, where automated HPV testing is performed. HPV-positive cases are collected and used to prepare a liquid-based cytology slide, which is stained and immediately scanned. The resulting whole-slide images (WSIs) are immediately available in a remote laboratory where they are examined by experienced cytologists using virtual microscopy. This setup was validated by making each of the 3 readers independently diagnose 506 specimens in random order, using both conventional light microscopy (CLM) and WSIs, with a minimum wash-out period of 3 weeks and with a final discussion for all cases. Results: Intraobserver agreement among CLM and WSI ranged from 0.71 to 0.79, and interobserver agreement for the 3 readers compared with the consensus diagnosis was similar for the 2 modes of assessment. Readers subjectively felt confident in their WSI diagnosis for inadequate and negative cases, but less so in other cases. The perceived difficulty was slightly higher in WSI readings. Conclusions: Interobserver agreement in cervicovaginal cytology is moderate and does not vary if the slides are examined conventionally or digitally. Despite higher reported subjective difficulty and lower confidence in the WSI diagnosis, we did not observe a deterioration in diagnostic performance using WSI compared with CLM