Cardiology in a Digital Age: Opportunities and Challenges for e-Health: A Literature Review

To date, mortality rates associated with heart diseases are dangerously increasing, making them the leading cause of death globally. From this point of view, digital technologies can provide health systems with the necessary support to increase prevention and monitoring, and improve care delivery. The present study proposes a review of the literature to understand the state of the art and the outcomes of international experiences. A reference framework is defined to develop reflections to optimize the use of resources and technologies, favoring the development of new organizational models and intervention strategies. Findings highlight the potential significance of e-health and telemedicine in supporting novel solutions and organizational models for cardiac illnesses as a response to the requirements and restrictions of patients and health systems. While privacy concerns and technology-acceptance-related issues arise, new avenues for research and clinical practice emerge, with the need to study ad hoc managerial models according to the type of patient and disease

A 14-Year Italian Experience in DM2 Genetic Testing: Frequency and Distribution of Normal and Premutated CNBP Alleles

Myotonic dystrophy type 2 (DM2) is a multisystemic disorder caused by a (CCTG)n in intron 1 of the CNBP gene. The CCTG repeat tract is part of a complex (TG)v(TCTG)w(CCTG)x(NCTG)y(CCTG)z motif generally interrupted in CNBP healthy range alleles. Here we report our 14-year experience of DM2 postnatal genetic testing in a total of 570 individuals. The DM2 locus has been analyzed by a combination of SR-PCR, TP-PCR, LR-PCR, and Sanger sequencing of CNBP alleles. DM2 molecular diagnosis has been confirmed in 187/570 samples analyzed (32.8%) and is mainly associated with the presence of myotonia in patients. This set of CNBP alleles showed unimodal distribution with 25 different alleles ranging from 108 to 168 bp, in accordance with previous studies on European populations. The most frequent CNBP alleles consisted of 138, 134, 140, and 136 bps with an overall locus heterozygosity of 90%. Sequencing of 103 unexpanded CNBP alleles in DM2-positive patients revealed that (CCTG)5(NCTG)3(CCTG)7 and (CCTG)6(NCTG)3(CCTG)7 are the most common interruption motifs. We also characterized five CNBP premutated alleles with (CCTG)n repetitions from n = 36 to n = 53. However, the molecular and clinical consequences in our cohort of samples are not unequivocal. Data that emerged from this study are representative of the Italian population and are useful tools for National and European centers offering DM2 genetic testing and counseling

Search for gravitational-lensing signatures in the full third observing run of the LIGO-Virgo network

Gravitational lensing by massive objects along the line of sight to the source causes distortions of gravitational wave-signals; such distortions may reveal information about fundamental physics, cosmology and astrophysics. In this work, we have extended the search for lensing signatures to all binary black hole events from the third observing run of the LIGO--Virgo network. We search for repeated signals from strong lensing by 1) performing targeted searches for subthreshold signals, 2) calculating the degree of overlap amongst the intrinsic parameters and sky location of pairs of signals, 3) comparing the similarities of the spectrograms amongst pairs of signals, and 4) performing dual-signal Bayesian analysis that takes into account selection effects and astrophysical knowledge. We also search for distortions to the gravitational waveform caused by 1) frequency-independent phase shifts in strongly lensed images, and 2) frequency-dependent modulation of the amplitude and phase due to point masses. None of these searches yields significant evidence for lensing. Finally, we use the non-detection of gravitational-wave lensing to constrain the lensing rate based on the latest merger-rate estimates and the fraction of dark matter composed of compact objects

Search for eccentric black hole coalescences during the third observing run of LIGO and Virgo

Despite the growing number of confident binary black hole coalescences observed through gravitational waves so far, the astrophysical origin of these binaries remains uncertain. Orbital eccentricity is one of the clearest tracers of binary formation channels. Identifying binary eccentricity, however, remains challenging due to the limited availability of gravitational waveforms that include effects of eccentricity. Here, we present observational results for a waveform-independent search sensitive to eccentric black hole coalescences, covering the third observing run (O3) of the LIGO and Virgo detectors. We identified no new high-significance candidates beyond those that were already identified with searches focusing on quasi-circular binaries. We determine the sensitivity of our search to high-mass (total mass M>70 M⊙) binaries covering eccentricities up to 0.3 at 15 Hz orbital frequency, and use this to compare model predictions to search results. Assuming all detections are indeed quasi-circular, for our fiducial population model, we place an upper limit for the merger rate density of high-mass binaries with eccentricities 0<e≤0.3 at 0.33 Gpc−3 yr−1 at 90\% confidence level

Telecardiologia: potenzialità e limiti. Una revisione strutturata della letteratura

To date, mortality rates associated with heart disease are dangerously increasing, making it the leading cause of death globally. From this point of view, digital technologies can provide health systems with the necessary support to increase prevention, monitoring and improve care delivery. Several studies and experiments have been launched in recent years to investigate the potential and possible barriers to implementing these tools within Cardiology departments. These issues are, in fact, much debated today because, although these technologies bring numerous benefits, such as a reduction in hospitalization and readmission rates with a consequent improvement in the quality of life for patients, on the other hand, they are still a source of concern, given the lack of a regulation that guarantees common and transparent ethical and privacy standards. Furthermore, there are several obstacles to the use of given solutions, such as the low digital literacy of patients and social-health personnel, as well as the poor acceptance of the new model of care. The present study, therefore, proposes a structured review of the literature that collects the results of given experiences, through which it is possible to build a reference framework to develop reflections to optimize the use of resources and technologies, favoring the development of new organizational models and intervention strategies

Il case manager infermieristico nel contesto dell'oncologia. Una revisione della letteratura

Obiettivo: I moderni sistemi sanitari sono alla costante ricerca di nuovi modelli organizzativi al fine di offrire risposte alle esigenze dei pazienti. In ambito oncologico si sta affermando il modello organizzativo basato sulle Disease Unit, sistemi che vedono il paziente al centro e che sono basati sulla collaborazione multidisciplinare tra professionisti sanitari. Nel contesto delle Disease Unit dovrebbe essere presente una figura professionale in ambito infermieristico denominata case manager, con il ruolo di supportare il coordinamento tra i vari professionisti incaricati e guidare il paziente nel percorso di cura. L’obiettivo del lavoro è quello di comprendere in modo approfondito il contesto, le caratteristiche, i vantaggi e le barriere all’istituzione di questa figura. Metodologia: L’articolo utilizza una revisione strutturata della letteratura internazionale attraverso il database Scopus per l’individuazione degli articoli e il software di analisi qualitativa NVivo 12 per la codifica degli articoli selezionati. Risultati: L’analisi di 19 articoli denota la necessità da parte del case manager di acquisire sia competenze tecniche ma soprattutto trasversali, quali la gentilezza, l’umorismo e l’empatia. I risultati fanno emerge il ruolo strategico di tale figura nel supporto al paziente, soprattutto nel miglioramento della qualità della vita, nell’aderenza alla cura e nella gestione della sfera psicologica e sociale, andando quindi a potenziare il concetto di sistema sanitario che vede il paziente al centro. Nonostante esistano ostacoli all’istituzione formale di tale figura, si auspicano dei cambiamenti anche normativi nei prossimi anni che possano favorire l’introduzione di case manager nell’ambito delle Disease Unit. Originalità: L’articolo vuole analizzare le caratteristiche di questa figura professionale in oncologia, il cui ruolo si presume diventerà sempre più strategico nel tempo

Economic and Performance Evaluation of E-Health before and after the Pandemic Era: A Literature Review and Future Perspectives

E-Health represents one of the pillars of the modern healthcare system and a strategy involving the use of digital and telemedicine tools to provide assistance to an increasing number of patients, reducing, at the same time, healthcare costs. Measuring and understanding the economic value and performance of e-Health tools is, therefore, essential to understanding the outcome and best uses of such technologies. The aim of this paper is to determine the most frequently used methods for measuring the economic value and the performance of services in the framework of e-Health, considering different pathologies. An in-depth analysis of 20 recent articles, rigorously selected from more than 5000 contributions, underlines a great interest from the clinical community in economic and performance-related topics. Several diseases are the object of detailed clinical trials and protocols, leading to various economic outcomes, especially in the COVID-19 post-pandemic era. Many e-Health tools are mentioned in the studies, especially those that appear more frequently in people’s lives outside of the clinical setting, such as apps and web portals, which allow for clinicians to keep in contact with their patients. While such e-Health tools and programs are increasingly studied from practical perspectives, such as in the case of Virtual Hospital frameworks, there is a lack of consensus regarding the recommended models to map and report their economic outcomes and performance. More investigations and guidelines by scientific societies are advised to understand the potential and path of such an evolving and promising phenomenon

Virtual hospital: il futuro del sistema sociosanitario? Un approccio basato su un expert consensus all’interno della Regione Veneto

Abstract. Today, social and health systems are globally facing some challenges dictated by a growing mismatch between the demand for care services and the supply of human and economic resources, a situation that in the past two years has been exacerbated by the covid-19 pandemic. This has led to an increase in digitalization, which has proved to be a crucial tool for developing and applying new organizational models at hospital and territorial levels to address the system's various critical issues. From such a perspective, the virtual hospital has emerged as a potential model for increasing the effectiveness and efficiency in the provision of health and social services. Starting from these premises, an Efte (estimate, feedback, talk, estimate) approach was used to acquire an expert consensus within a multidisciplinary panel of academics and healthcare executives from the Veneto Region, Italy. This article reports the experts' opinion on the possible application of the virtual hospital model in the national context, starting from the evidence and good practices existing at international level, noting the potential advantages and barriers to its implementation. In addition, the most relevant investment areas for the required tangible and intangible assets are analyzed

Virtual hospitals: The future of the healthcare system? An expert consensus

Today, social and healthcare systems at a global level are facing constant challenges dictated by an increasing mismatch between the demand for care services and the supply of human and economic resources. Such a situation has been exacerbated in the past two years by the Covid-19 pandemic. This has led to an increase in the leverage of digitalisation, which has proved to be a crucial tool for the development and application of new organisational models at both hospital and territorial levels, thus addressing the various criticalities already present in the system. In this sense, the Virtual Hospital has emerged as a potential model for increasing effectiveness and efficiency in delivering sociomedical services. Starting from these premises, an EFTE (estimate, feedback, talk, estimate) approach was used to acquire an expert consensus within a multidisciplinary panel of academics and healthcare managers of the Veneto Region in Italy. This article reports the expert opinion on the possible application of the Virtual Hospital model in the national context, starting from the existing international evidence and good practices, highlighting the potential advantages and barriers to its implementation. Furthermore, the article analyses the most relevant areas of investment for the development of intangible assets and the acquisition of tangible assets necessary for its implementation

Giureconsulti e giudici. L'influsso dei professori sulle sentenze, II, La dottrina nella giurisprudenza oltre i confini di spazio, giurisdizione e materia

Il volume, pubblicato nella Collana "Studi di Diritto Comparato", intitolato "La dottrina nella giurisprudenza oltre i confini di spazio, giurisdizione e materia", unitamente all'altro volume "Le prassi delle Corti e le teorie degli studiosi" (edito da Giappichelli nella Collana "Diritto privato comparato"), entrambi riuniti sotto l'unico titolo "Giureconsulti e giudici. L'influsso dei professori sulle sentenze", rappresenta il frutto di una ricerca scientifica triennale sul tema del rapporto tra dottrina e giurisprudenza delle Corti di vertice che ha coinvolto quattordici Università italiane e vari gruppi di ricerca internazionali. I saggi in essi raccolti sono stati presentati nel corso di convegni organizzati nell'ambito della ricerca presso le sedi universitarie di Napoli Federico II, Verona, Rabat (Marocco) e Torino. Come si legge nella premessa comune "i due libri sull'influsso dei professori sulla giurisprudenza delle corti di vertice testimoniano l'importanza del diritto comparato, che continua a proporsi come disciplina autonoma, vocata al ruolo di guardiano dei giudici, e attraverso di essi di custode del legislatore e di osservatore critico delle dottrine interne, che manifestino pretese di universalità". In particolare, il volume pubblicato in questa Collana include studi relativi all'influenza della dottrina sulla giurisprudenza di Corti accomunate dall'appartenenza a comuni ambiti territoriali e saggi che analizzano l'influsso dottrinario in sentenze di tribunali italiani e stranieri selezionate per materia e per rilevanza del contributo