Healthcare professional and manager perceptions on drivers, benefits, and challenges of telemedicine: results from a cross-sectional survey in the Italian NHS

Background: The Covid-19 pandemic provided new challenges and opportunities for patients and healthcare providers while accelerating the trend of digital healthcare transformation. This study explores the perspectives of healthcare professionals and managers on (i) drivers to the implementation of telemedicine services and (ii) perceived benefits and challenges related to the use of telemedicine across the Italian National Health Service. Methods: An online cross-sectional survey was distributed to professionals working within 308 healthcare organisations in different Italian regions. Quantitative and qualitative data were collected through a self-administered questionnaire (June-September 2021). Responses were analysed using summary statistics and thematic analysis. Results: Key factors driving the adoption of telemedicine have been grouped into (i) organisational drivers (reduce the virus spread-80%; enhance care quality and efficiency-61%), (ii) technological drivers (ease of use-82%; efficacy and reliability-64%; compliance with data governance regulations-64%) and (iii) regulatory drivers (regulations’ semplification-84%). Nearly all respondents perceive telemedicine as useful in improving patient care (96%). The main benefits reported by respondents are shorter waiting lists, reduced Emergency Department attendance, decreased patient and clinician travel, and more frequent patient-doctor interactions. However, only 7% of respondents believe that telemedicine services are more effective than traditional care and 66% of the healthcare professionals believe that telemedicine can’t completely substitute in-person visits due to challenges with physical examination and patient-doctor relationships. Other reported challenges include poor quality and interoperability of telemedicine platforms and scarce integration of telemedicine with traditional care services. Moreover, healthcare professionals believe that some groups of patients experience difficulties in accessing and using the technologies due to socio-cultural factors, technological and linguistic challenges and the absence of caregivers. Conclusions: Respondents believe that telemedicine can be useful to complement and augment traditional care. However, many challenges still need to be overcome to fully consider telemedicine a standard of care. Strategies that could help address these challenges include additional regulations on data governance and reimbursements, evidence-based guidelines for the use of telemedicine, greater integration of tools and processes, patient-centred training for clinicians, patient-facing material to assist patients in navigating virtual sessions, different language options, and greater involvement of caregivers in the care process

Cosmological data favor Galileon ghost condensate over Λ CDM

We place observational constraints on the Galileon ghost condensate model, a dark energy proposal in cubic-order Horndeski theories consistent with the gravitational-wave event GW170817. The model extends the covariant Galileon by taking an additional higher-order field derivative X2 into account. This allows for the dark energy equation of state wDE to access the region −2Theoretical Physic

Cosmological constraints and phenomenology of a beyond-Horndeski model

We study observational constraints on a specific dark energy model in the framework of Gleyzes-Langlois-Piazza-Vernizzi theories, which extends the Galileon ghost condensate (GGC) to the domain of beyond Horndeski theories. In this model, we show that the Planck cosmic microwave background (CMB) data, combined with datasets of baryon acoustic oscillations, supernovae type Ia, and redshift-space distortions, give the tight upper bound |α(0)H|≤O(10−6) on today’s beyond-Horndeski (BH) parameter αH. This is mostly attributed to the shift of CMB acoustic peaks induced by the early-time changes of cosmological background and perturbations arising from the dominance of αH in the dark energy density. In comparison to the Λ cold dark matter (ΛCDM) model, our BH model suppresses the large-scale integrated-Sachs-Wolfe tail of CMB temperature anisotropies due to the existence of cubic Galileons, and it modifies the small-scale CMB power spectrum because of the different background evolution. We find that the BH model considered fits the data better than ΛCDM according to the χ2 statistics, yet the deviance information criterion (DIC) slightly favors the latter. Given the fact that our BH model with αH=0 (i.e., the GGC model) is favored over ΛCDM even by the DIC, there are no particular signatures for the departure from Horndeski theories in current observations.Theoretical Physic

Angiosarcoma of the breast: a new therapeutic approach?

Introduction Angiosarcomas are highly malignant endothelial cell tumors with poor prognosis. These can be due to breast cancer itself or to subsequent therapeutic modalities. No evidence-based guidelines exist concerning the ideal treatment of angiosarcomas. Presentation of the case We report the case of a 76-year-old woman who developed an exuberant and aggressive post radiation angiosarcoma of the breast and discuss different aspects of therapy for this disease. A total left mastectomy was performed, followed by a right mastectomy. The lesions into the chest wall, and multiple abdominal skin nodules were treated with local Electrochemotherapy (ECT) with intravenous bleomicin. Discussion No evidence-based guidelines exist concerning the ideal treatment of angiosarcomas. Electrochemotherapy (ECT) is an efficient palliative treatment of cutaneous and subcutaneous tumor nodules. It consists of the combination of a cytotoxic drug and electroporation, using appropriate electrical parameters; destabilization of the membrane is reversible, ensuring a high survival of permeabilized cells and the delivery of non-permeant molecules inside the cell. Conclusion Due to the rarity of the disease, prospective studies concerning adjuvant or neoadjuvant therapy are limited and no evidence-based guidelines exist. The response to chemotherapy seems to be poor. Treatment with ECT in addition to systemic chemotherapy achieves a complete response in all the lesions and improving patient body image perception

Surveillance for Hepatocellular Carcinoma Also Improves Survival of Incidentally Detected Intrahepatic Cholangiocarcinoma Arisen in Liver Cirrhosis

Background: Due to its poor survival, intrahepatic cholangiocarcinoma (ICC) is held to be a much more aggressive cancer than hepatocellular carcinoma (HCC). In most published series, patients were diagnosed when symptomatic. However, ICC is now increasingly being discovered during the surveillance for HCC in cirrhosis. Whether this earlier detection of ICC is associated with an equally dismal prognosis or not is unknown. Methods: This is amulticenter retrospective study of consecutive ICC patients. Patients were stratified into subgroups according to the absence/presence of cirrhosis. A propensity score matching was performed to reduce the potential biases. Cirrhotic patients were further stratified according to their surveillance status. The lead-time bias and its potential effects were also estimated. Results: We gathered 184 patients. Eighty-five patients (46.2%) were cirrhotic. Liver cirrhosis was not related to a worse overall survival (33.0 vs. 32.0 months, p = 0.800) even after the propensity score analysis (43.0 in vs. 44.0 months in 54 pairs of patients, p = 0.878). Among the cirrhotic population, 47 (55.3%) patients had received a diagnosis of ICC during a surveillance programme. The 2 subgroups differed in maximum tumour dimensions (30 vs. 48 mm in surveyed and non-surveyed patients, respectively). Surveyed patients were more likely to receive surgical treatments (59.8 vs. 28.9%, p = 0.003). Overall survival was higher in surveyed patients (51.0 vs. 21.0 months, p 0.001). These benefits were confirmed after correcting for the lead-time bias. Conclusions: Cirrhotic patients have different clinical presentation and outcomes of ICC according to their surveillance status. In our series, ICC in cirrhosis was not associated with worse OS. Cirrhosis itself should not discourage either surgical or non-surgical treatments

Improving Healthcare Workers' Adherence to Surgical Safety Checklist: The Impact of a Short Training

Background: Although surgery is essential in healthcare, a significant number of patients suffer unfair harm while undergoing surgery. Many of these originate from failures in non-technical aspects, especially communication among operators. A surgical safety checklist is a simple tool that helps to reduce surgical adverse events, but even if it is fast to fill out, its compilation is often neglected by the healthcare workers because of unprepared cultural background. The present study aims to value the efficacy of a free intervention, such as a short training about risk management and safety checklist, to improve checklist adherence. Methods: In March 2019, the medical and nursing staff of the General Surgical Unit attended a two-lesson theoretical training concerning surgical safety and risk management tools such as the surgical safety checklist. The authors compared the completeness of the surgical checklists after and before the training, considering the same period (2 months) for both groups. Result: The surgical safety checklists were present in 198 cases (70.97%) before the intervention and 231 cases (96.25%) after that. After the training, the compilation adherence increased for every different type of healthcare worker of the unit (surgeons, nurses, anesthetists, and scrab nurses). Furthermore, a longer hospitalization was associated with a higher surgical checklist adherence by the operators. Conclusions: The results showed that a free and simple intervention, such as a two-lesson training, significantly stimulated the correct use of the surgical safety checklist. Moreover, the checklist adherence increased even for the operators who did not attend the training, maybe because of the positive influence of the colleagues' positive behaviors. As the results were promising with only two theoretical lessons, much more can be done to build a new safety culture in healthcare

Trisonomia 9 in pazienti affetti da MPN PH-: aspetti clinici e laboratoristici

Le neoplasie mieloproliferative ( MPN), comprendenti la Policitemia vera (PV), la Trombocitemia essenziale (TE) e la Mielofibrosi idiopatica (MFI), sono disordini clonali Philadelphia negativi caratterizzati, nel 20% dei casi, da anomalie cromosomiche ricorrenti. La trisomia 9 rappresenta la seconda anomalia cromosomica pi\uf9 frequente nelle MPN dopo la delezione 20q. Abbiamo eseguito l\u2019analisi citogenetica su aspirato midollare di una casistica monocentrica di 325 pazienti affetti da MPN; tutti i pazienti sono risultati Ph-, la trisomia 9 \ue8 stata riscontrata in 13 pazienti (9 affetti da PV e 4 da TE), in 10 casi come unica anomalia cromosomica, in un caso associata a trisomia 8 e in 2 casi in un cariotipo pi\uf9 complesso. Sono state analizzate le caratteristiche cliniche e di laboratorio e l\u2019evoluzione di malattia, al fine di individuare se tale anomalia citogenetica avesse delle particolari stigmate. I pazienti sono stati seguiti regolarmente per un periodo medio di 10,6 anni (range 1- 23 anni). L\u2019et\ue0 media alla diagnosi era 62 anni e il rapporto M:F di 1,2:1. I dati di laboratorio mostravano un valore medio di emoglobina di 16,7 g/dl, un numero medio di globuli bianchi di 9657/mmc, mentre la conta piastrinica media era di 690000/mmc. Il dosaggio dell\u2019 eritropoietina serica \ue8 risultato ridotto in tutti i pazienti e tutti presentavano la mutazione JAK2 V617F (carica allelica media 47,1%). E\u2019 interessante notare che nei pazienti affetti da TE, i valori di emoglobina alla diagnosi, pur non essendo sufficienti per porre diagnosi di PV erano comunque ai limiti superiori di norma. Dei 4 pazienti con TE, 3 (75%) sono evoluti a distanza di anni in PV, evento relativamente raro. I dati ottenuti evidenziano una maggior frequenza della trisomia 9 nei pazienti con PV rispetto alle altre neoplasie mieloproliferative ed inoltre sottolineano come i pazienti con TE portatori di tale alterazione citogenetica, abbiano un fenotipo simil-PV e un aumentato rischio di evoluzione in franca PV. Non \ue8 stata osservata trisomia 9 nelle Mielofibrosi. E\u2019 inoltre da segnalare che sul braccio corto del cromosoma 9 \ue8 stato mappato il gene JAK-2, gene che risulta mutato frequentemente nelle MPN Ph- e soprattutto nelle PV di cui rappresenta un marker molecolare

The Trigger System of the ARGO-YBJ detector

The ARGO-YBJ experiment has been designed to detect air shower events over a large size scale and with an energy threshold of a few hundreds GeV. The building blocks of the ARGO-YBJ detector are single-gap Resistive Plate Counters (RPCs). The trigger logic selects the events on the basis of their hit multiplicity. Inclusive triggers as well as dedicated triggers for specific physics channels or calibration purposes have been developed. This paper describes the architecture and the main features of the trigger system.Comment: 4 pages, to be published in the Proceedings of the 28th International Cosmic Ray Conference (Tsukuba, Japan 2003