eRMETE e INTESA: L'uso di sistemi italiani di telemedicina e loro Integrazione nel Sistema Sanitario Nazionale

not availableL'infrastruttura di comunicazione gioca un ruolo cruciale nel processo di trasferimento dell'informazione ed in particolare in quella biomedica dove ai fattori di affidabilit?, sicurezza e tempestivit? ? possibilmente legata la salute del cittadino. La disponibilit? della rete per la ricerca gestita dal GARR ha costituito la base per lo sviluppo di due grossi progetti per l'uso di moderne tecniche di telemedicina, l'uno (eRMETE) finanziato dal Ministero della Salute (ex art 12), e l'altro (INTESA) dal Ministero della Universit? e della Ricerca Scientifica nella linea Nuova Ingegneria Medica

Methods for full telematic integration of care delivery

The digitization process of all data concerning health care, the development of standards for e-health and the increase of computer education for all clinical personnel, are the fundamental requirements for the development of projects aimed to exploit new methods to solve the problem of data fragmentation and supply new and effective health care services to the National Health Systems (NHS). These principles have been the starting points of two research projects, called e-RMETE (Regions for Telematic Medicine) and INTESA (Telematic Integration for the continuity of the citizen health care process)

PORTABLE INSTRUMENT TO ANALYZE DIFFERENT PARAMETERS DURING LONG PERIOD EXERCISES

Introduction: During the study of different kinds of sport activity it is important to evaluate the pressure inside their footwear, together with different characteristics of their movements. In order to get data on real situations, the athlete must be free to execute his movements without restraint. For these reasons we have developed a new type of system composed of a datalogger and interface for different sensors. Methods: The datalogger was equipped with an Hitachi 16bit RISC microprocessor at 20 Mhz, 1 Megabytes RAM, Memory Card, a front end interface to different kind of sensors, optional display and keyboard. The datalogger can be connected to a pair of insoles with 64 FSR pressure sensors, each one and with another 6 different types of sensors. At the moment we have interfaced accelerometers and cardosensors for heartbeats. Under development is a method with which to interface the sensors for the surface EMG. The system contains a radio modem to transfer the data to a central unit (Portable Computer) equipped with software to analyze the data. The system can work at frequencies from 25HZ to 1KHz (depending on the type of sensors connected) and, in order to be synchronized with a video system, has an external trigger. Results: With this kind of system we made tests of volleyball athletes during normal training activity, runners running track events, golf players and skiers. The system can be used in different environments with athletes free in their movements, and we can obtain information about the activity of the foot together with information from accelerations of different parts of the body and the heartbeat. Conclusions: We consider this kind of system very useful in the study of athletes, because of its flexibility, and we think it could give a big advantage during the training and rehabilitation of athletes

EOLO: Sistema per la regolazione controllata di gas ad uso medico per terapia e diagnosi

not availableIl progetto riguarda principalmente l\u27ossigeno terapia e la somministrazione di ossido nitrico per terapia e diagnostica La somministrazione controllata di gas ad uso terapeutico ? oggi una pratica clinica consolidata in special modo nella ossigeno terapia per patologie quali le broncopneumopatie croniche ostruttive (BPCO). Nuove terapie con altri gas quali l\u27ossido nitrico NO rappresentano metodiche in corso di validazione clinica ma gi? accettate da organismi di controllo quali FDA, soprattutto nei casi di ipertensione polmonare primitiva. Ci si riferisce quindi a sistemi di somministrazione di gas, come quelli rammentati, mettendo a punto metodiche originarie di "feedback" su parametri fisiologici, misurati durante la terapia in modo incruento, per gestire i relativi dispositivi di erogazione del gas stesso e al monitoraggio delle variabili biologiche rilevanti da parte di centri opportuni. Le malattie respiratorie, dopo le malattie cardiocircolatorie ed i tumori, sono tra le maggiori cause di morte nel mondo. Il loro trend ? crescente, essendo esse causate, fra l\u27altro, da fattori come il fumo e l\u27inquinamento, che sono a loro volta in crescita. Da qui la necessit? di realizzare sistemi semplici ed efficaci per il controllo della strumentazione di ossigenoterapia in una vasta popolazione, anche per gli usi domiciliari. Non ultimo diventa importante con questi numeri, pensare ad una razionalizzazione automatica dei consumi di ossigeno. Per quel che riguarda l\u27ipertensione polmonare, altra patologia verso cui EOLO ? rivolto, un potenziale rimedio ? costituito dalla somministrazione in dosi terapeutiche di Ossido Nitrico in sostituzione ad esempio delle prostacicline con il vantaggio di non ricorrere ad applicazioni invasive cruente e di evitare effetti collaterali sistemici. L\u27uso di questo gas medicale ? per? limitata in quanto il mercato non propone dispositivi per la somministrazione di ossido nitrico ottimizzati alle sue indicazioni d\u27uso. Le indicazione d\u27uso prevedono, infatti, la somministrazione di ossido nitrico a bassi dosaggi(5-40 ppm) e la limitazione del tempo di contatto tra l\u27ossido nitrico e i gas inalatori che il paziente deve respirare. Tale metodologia di somministrazione ? requisito essenziale per il suo impiego, in quanto questo gas si combina molto velocemente con l\u27ossigeno formando Biossido d\u27Azoto (NO2), un gas altamente nocivo. Il biossido di azoto reagendo a sua volta con l\u27acqua forma acido nitrico (HNO3), che ? un acido particolarmente reattivo quindi pericoloso

Telematic integration of health data: the INTESA project

Following an approach based on the methods of basic research, the INTESA project has developed a complete architecture of health information system, capable to guarantee a smart and safe storing of the essential information, an effective and personalized retrieval of data, and some innovative models to compare the results of clinical and medical activities of all the "actors" of the health care process. Together with other metropolitan repositories based on HL7 messages and applications able to examine the data stored, the developed archive will contribute to keep a check on every citizen's health history, clinical examinations and cure therapies, but, above all, it will allow to verify the efficacy and efficiency of the health care processes related to particular pathologies.Non present

A web-based health technology assessment in tele-echocardiography: the experience within an Italian project

Due to major advances in the information technology, telemedicine applications are ready for a widespread use. Nonetheless, to allow their diffusion in National Health Care Systems (NHCSs) specific methodologies of health technology assessment (HTA ) should be used to assess the standardization, the overall quality, the interoperability, the addressing to legal, economic and cost benefit aspects. One of the limits to the diffusion of the digital tele-echocardiography (T-E) applications in the NHCS lacking of a specific methodology for the HTA . In the present study, a solution offering a structured HTA of T-E products was designed. The methodology assured also the definition of standardized quality levels for the application. The first level represents the minimum level of acceptance; the other levels are accessory levels useful for a more accurate assessment of the product. The methodology showed to be useful to rationalize the process of standardization and has received a high degree of acceptance by the subjects involved in the study.Grazie ai grandi progressi nell\u27information technology le applicazioni di telemedicina sono mature per un uso diffuso. Tuttavia per permettere la loro introduzione nel sistema sanitario nazionale devono essere utilizzate specifiche metodologie di health technology assessment (HTA ) per valutare il grado di standardizzazione, la qualit? totale, l\u27interoperabilit?, il rispetto dei requisiti legali ed economici e il rapporto costo-beneficio. Con riferimento alla tele-ecocardiografia digitale uno dei limiti ? la mancanza di una specifica metodologia di HTA . Nel presente studio, ? stata proposta una soluzione che offre un HTA strutturato di prodotti di tele-ecocardiografia (T-E) digitale. La metodologia ha assicurato anche la definizione di livelli standardizzati di qualit? per l\u27applicazione. Il primo livello rappresenta il livello minimo di accettazione; gli altri livelli riguardano aspetti accessori e sono utili per una pi? accurata valutazione del prodotto. La metodologia si ? mostrata di utilit? per razionalizzare il processo di standardizzazione ed ha ricevuto un elevato grado di accettazione dei soggetti coinvolti

Gas embolization of the liver in a rat model of rapid decompression

Occurrence of liver gas embolism after rapid decompression was assessed in 31 female rats that were decompressed in 12 min after 42 min of compression at 7 ATA (protocol A). Sixteen rats died after decompression (group I). Of the surviving rats, seven were killed at 3 h (group II), and eight at 24 h (group III). In group I, bubbles were visible in the right heart, aortic arch, liver, and mesenteric veins and on the intestinal surface. Histology showed perilobular microcavities in sinusoids, interstitial spaces, and hepatocytes. In group II, liver gas was visible in two rats. Perilobular vacuolization and significant plasma aminotransferase increase were present. In group III, liver edema was evident at gross examination in all cases. Histology showed perilobular cell swelling, vacuolization, or hydropic degeneration. Compared with basal, enzymatic markers of liver damage increased significantly. An additional 14 rats were decompressed twice (protocol B). Overall mortality was 93%. In addition to diffuse hydropic degeneration, centrilobular necrosis was frequently observed after the second decompression. Additionally, 10 rats were exposed to three decompression sessions (protocol C) with doubled decompression time. Their mortality rate decreased to 20%, but enzymatic markers still increased in surviving rats compared with predecompression, and perilobular cell swelling and vacuolization were present in five rats. Study challenges were 1) liver is not part of the pathophysiology of decompression in the existing paradigm, and 2) although significant cellular necrosis was observed in few animals, zonal or diffuse hepatocellular damage associated with liver dysfunction was frequently demonstrated. Liver participation in human decompression sickness should be looked for and clinically evaluated

Mind-body relationships in elite apnea divers during breath holding: a study of autonomic responses to acute hypoxemia

The mental control of ventilation with all associated phenomena, from relaxation to modulation of emotions, from cardiovascular to metabolic adaptations, constitutes a psychophysiological condition characterizing voluntary breath-holding (BH). BH induces several autonomic responses, involving both autonomic cardiovascular and cutaneous pathways, whose characterization is the main aim of this study. Electrocardiogram and skin conductance (SC) recordings were collected from 14 elite divers during three conditions: free breathing (FB), normoxic phase of BH (NPBH) and hypoxic phase of BH (HPBH). Thus, we compared a set of features describing signal dynamics between the three experimental conditions: from heart rate variability (HRV) features (in time and frequency-domains and by using nonlinear methods) to rate and shape of spontaneous SC responses (SCRs). The main result of the study rises by applying a Factor Analysis to the subset of features significantly changed in the two BH phases. Indeed, the Factor Analysis allowed to uncover the structure of latent factors which modeled the autonomic response: a factor describing the autonomic balance (AB), one the information increase rate (IIR), and a latter the central nervous system driver (CNSD). The BH did not disrupt the FB factorial structure, and only few features moved among factors. Factor Analysis indicates that during BH (1) only the SC described the emotional output, (2) the sympathetic tone on heart did not change, (3) the dynamics of interbeats intervals showed an increase of long-range correlation that anticipates the HPBH, followed by a drop to a random behavior. In conclusion, data show that the autonomic control on heart rate and SC are differentially modulated during BH, which could be related to a more pronounced effect on emotional control induced by the mental training to BH