Electronic Medical Records Optimize Clinical Data Management in the Outpatient Cardiological Clinic

A system based on a relational database with administrative and clinical information and integrated with an Information System, where the system covers the role of a Functional Island, is routinely used in our Institution. To analyze how Electronic Medical Records (EMR) may help physicians in organizing and reducing time waste in a busy outpatient clinic, a sample of 1000 reports were evaluated for system performance. The time needed for building new clinical histories or modifying the already acquired ones, to create physical examination and biochemical and instrumental exams reports, was assessed. Cardio-pulmonary tests, basal, dynamic and effort EKG, chest X-ray, Echo Doppler studies, nuclear medicine procedures, invasive techniques, were collected. Clinical management was integrated with the administrative system (ADT), to correctly identify each patient. This system provided not only easy retrieving of stored data such as clinical history, physical examination, instrumental exams reports but also the results of new exams performed in the same day of patient visit with a time lapse of 1 to 20\u27. Graphical interface structure contained preformatted fields which allowed selection or modifications of data/text models without additional waste of time. EMR represents an important tool for organization and synergy of different Laboratories in a outpatient clinic, optimizing the time needed for data entry and leading to an overall better quality of care

Hybrid Image Visualization Tool for 3D integration of CT coronary anatomy and quantitative myocardial perfusion PET

Purpose: Multimodal cardiac imaging by CTA and quantitative PET enables acquisition of patient-specific coronary anatomy and absolute myocardial perfusion at rest and during stress. In the clinical setting, integration of this information is performed visually or using coronary arteries distribution models. We developed a new tool for CTA and quantitative PET integrated 3D visualization, exploiting XML and DICOM clinical standards. Methods: The Hybrid Image Tool (HIT) developed in the present study included four main modules: (1) volumetric registration for spatial matching of CTA and PET datasets, (2) an interface to PET quantitative analysis software, (3) a derived DICOM generator able to build DICOM dataset from quantitative polar maps, and (4) a 3D visualization tool of integrated anatomical and quantitative flow information. The four modules incorporated in the HIT tool communicate by defined standard XML files: XML-transformation and XML MIST standards. Results: The HIT tool implements a 3D representation of CTA showing real coronary anatomy fused to PET derived quantitative myocardial blood flow distribution. The technique was validated on 16 datasets from EVINCI study population. The validation of the method confirmed the high matching between "original" and derived datasets as well as the accuracy of the registration procedure. Conclusions: Three-dimensional integration of patient-specific coronary artery anatomy provided by CTA and quantitative myocardial blood flow obtained from PET imaging can improve cardiac disease assessment. The HIT tool introduced in this paper may represent a significant advancement in the clinical use of this multimodal approach

A New Web Score to Predict Health Status in Paediatric Patients with Chronic Diseases: Design and Development of the PENSAMI Study

Paediatric chronic diseases (CD) are characterised by their ongoing duration and the fact that they are often managed throughout the lifespan, with the need to adjust lifestyle and expectations with the limitations coming from the CD. The aim of the PENSAMI study is to not only cure the disease, but to also care for the person from a clinical and psychosocial perspective. Data will be collected from 150 paediatric patients affected by heart disease, diabetes, and asthma admitted during in-hospital stay or outpatient visits, and from 200 healthy control subjects. The protocol will consist of two phases. The first one will aim at elaborating the predictive model by detecting (clinical, anthropometric at birth, environmental, lifestyle, social context, emotional state, and mental abilities) in order to develop a model predictive of the events considered: (1) re-hospitalisation; (2) severity and progression of the disease; (3) adherence to therapy; (4) HRQoL; (5) obesity and metabolic syndrome; (6) illness-stress related; (7) school drop-out; (8) school performance. The second one will address validating the previous predictive model. This model will aim to: (1) understand, prevent, and halt the progression of childhood CD; (2) develop new and improved diagnostic tools; (3) pave the way for innovative treatments and additional therapies to traditional clinical practice; and (4) create truly personalised therapeutic and preventive strategies in various sectors, such as cardiology, diabetes, and respiratory diseases

Data Integration in Cardiac Surgery Health Care Institution: Experience at G. Pasquinucci Heart Hospital

During the last ten years the Hospital Information System (HIS) was developed at the Institute of Clinical Physiology of National Research Council (IFC-CNR), recently reorganized on clinical side into the "Gabriele Monasterio Foundation" (FGM) by joint efforts of CNR, Tuscany Region and Universities. At G.Pasquinucci Heart Hospital (GPH), currently FGM\u27s section in Massa, the HIS was adapted and extended to Cardiac Surgery and Pediatric Cardiology. Data archiving and middleware integration through HIS network, connecting GPH with head institution in Pisa, allowed to achieve full secure access to patient information from any workstation within hospital or outside. PACS was developed using Open Source DICOM utilities. Electronic Medical Record is daily used since 2005 on both inpatients and outpatients. Recently telediagnosis was set up between Balkan countries and GPH in Massa

CMR T2* Technique for Segmental and Global Quantification of Myocardial Iron: Multicentre Transferability and Healthcare Impact Evaluation

The multislice multiecho T2* technique is transferable among scanners with good reproducibility. The network seems to be a robust and scalable system in which T2* CMR based cardiac iron overload assessment is available, accessible and reachable for a significant and increasing number of thalassemia patients, reducing the mean distance from the patients\u27 locations to the CMR sites

Multicentre multi-device hybrid imaging study of coronary artery disease: results from the EValuation of INtegrated Cardiac Imaging for the Detection and Characterization of Ischaemic Heart Disease (EVINCI) hybrid imaging population

AIMS: Hybrid imaging provides a non-invasive assessment of coronary anatomy and myocardial perfusion. We sought to evaluate the added clinical value of hybrid imaging in a multi-centre multi-vendor setting. METHODS AND RESULTS: Fourteen centres enrolled 252 patients with stable angina and intermediate (20-90%) pre-test likelihood of coronary artery disease (CAD) who underwent myocardial perfusion scintigraphy (MPS), CT coronary angiography (CTCA), and quantitative coronary angiography (QCA) with fractional flow reserve (FFR). Hybrid MPS/CTCA images were obtained by 3D image fusion. Blinded core-lab analyses were performed for CTCA, MPS, QCA and hybrid datasets. Hemodynamically significant CAD was ruled-in non-invasively in the presence of a matched finding (myocardial perfusion defect co-localized with stenosed coronary artery) and ruled-out with normal findings (both CTCA and MPS normal). Overall prevalence of significant CAD on QCA (>70% stenosis or 30-70% with FFR 640.80) was 37%. Of 1004 pathological myocardial segments on MPS, 246 (25%) were reclassified from their standard coronary distribution to another territory by hybrid imaging. In this respect, in 45/252 (18%) patients, hybrid imaging reassigned an entire perfusion defect to another coronary territory, changing the final diagnosis in 42% of the cases. Hybrid imaging allowed non-invasive CAD rule-out in 41%, and rule-in in 24% of patients, with a negative and positive predictive value of 88% and 87%, respectively. CONCLUSION: In patients at intermediate risk of CAD, hybrid imaging allows non-invasive co-localization of myocardial perfusion defects and subtending coronary arteries, impacting clinical decision-making in almost one every five subjects

Nuove ricerche a Luni. Il contributo dei recenti scavi e delle indagini aereotopografiche

Gli scavi di Luni-Porta Marina stanno fornendo interessanti dati per la topografia di Luni in una lunga prospettiva cronologica. Per l’età tardo-repubblicana/primo imperiale, in particolare, l’individuazione di due domus, di cui una con lussuoso apparato decorativo sulla quale in seguitosi impiantò un edificio templare, caratterizza in senso residenziale il quartiere posto ad est del Cardo Massimo, che quindi viene a configurarsi non come un asse di traffico commerciale dal porto ma come una via di rappresentanza per l’ingresso in città. Diventa quindi necessaria una riconsiderazione generale dell’assetto topografico lunense con la determinazione dei cardinese decumani minori e degli andamenti della viabilità secondaria, al fine di ricostruire il ritmo delle insulae e per l’individuazione dei settori destinati alle attività funzionali al sistema portuale lunense, con edifici e strutture per lo stoccaggio e gestione delle merci, ed unità abitative di minor pregio ove vivevano coloro che qui lavoravano Le indagini aereotopografiche senz’altro forniscono importante documentazione per affrontare queste problematiche

Luni. Gli scavi nel quartiere di Porta Marina

Vengono presentati i risultati degli Scavi che l’Università di Pisa conduce dal 2014 a Luni nel quartiere di Porta Marina, immediatamente ad est del Cardo Maximus. Al momento sono state portate in luce due domus costruite nella prima metà del I sec.a.C, che nel corso del tempo subirono notevoli cambiamenti e ristrutturazioni. La domus meridionale infatti nel I sec. d.C. fu occupata da un piccolo tempio, mentre nel V sec.d.C. un impianto artigianale, molto probabilmente per il lavaggio di tessuti, si installò nella domus settentrionale. L’area continuò ad essere abitata nei secoli successivi, nel periodo bizantino e poi in quello longobardo, come documentano una casa di VI-VII sec. e varie infrastrutture coeve (un pozzo, una struttura usata come discarica) e risulta abbandonata fra la fine del VII e gli inizi dell’VIII sec.The paper deals with the results of the excavations which are being carried out by the University of Pisa since 2014 in Luni, in the Porta Marina quarter, immediately east of the Cardo Maximus. At the moment two domus built in the first half of the 1st cent. BC, which over time have undergone remarkable changes and rebuilding activities, have been brought to light. In fact, in the 1st cent. AD the southern domus was occupied by a small temple, while a workshop, most probably for washing fabrics, was installed in the northern domus in the 5th century AD. The area continued to be inhabited in the following centuries, in the Byzantine and Lombard periods, as documented by a house dated to the 6th-7th century and various contemporary infrastructures (a well, a structure used as a dump), and was abandoned in the late 7th-early 8th cent

Radiologic image library for pathology related searches

The image archive becomes a real database, allowing the researcher as well as the clinician to perform longitudinal and transversal studies