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Introduction: One of the aims of Evidence-Based Medicine is to improve quality and appropriateness of care by the expedition of the knowledge transfer process. Computerized Decision Support Systems (CDSSs) are computer programs that provide alerts to the prescribing doctor directly at the moment of medical examination. In fact, alerts are integrated within the single patient electronic health record. CDSS based on the best available and updated evidence and guidelines may be an efficient tool to facilitate the transfer of the latest results from clinical research directly at the bedside, thus supporting decision-making., Objectives: The CODES (COmputerized DEcision Support) trial is a research program funded by the Italian Ministry of Health and the Lombardy Region. It aims to evaluate the feasibility of the implementation of a CDSS at the hospital level and to assess its efficacy in daily clinical practice., Methods: The CODES project includes two pragmatic RCTs testing a CDSS (i.e. the EBMeDS - MediDSS) in two large Italian hospitals: the first is a general hospital in Vimercate (Lombardy), the second is an oncologic research center in Meldola (Emilia Romagna). The CDSS supports a full spectrum of decisions: therapy, drug interactions, diagnosis, and management of health care services are covered by a hundreds of reminders. However only few reminders are activated per patient, highlighting crucial problems in the delivery of high-quality care. The two trials have similar design and primary outcome, the rate at which alerts detected by the software are resolved by a decision of the clinicians. The project also includes the assessment of barriers and facilitators in the adoption of these new technologies by hospital staff members and the retrospective evaluation of the repeated risks in prescription habits., Results: The trials are ongoing and currently more than 10,000 patients have been randomized. The qualitative analysis revealed a progressive shift in the perception of the tool. Doctors are now seeing it as a trusted second opinion, available 24/7, which is tailored to the needs of the patient. The retrospective analysis showed the opportunity to achieve a better healthcare quality through an active risk management. Aggregating data from whole hospitals emerge rare drug interactions that otherwise would not be recognizable., Discussion: CDSS are promising tools to support clinicians in everyday practice. They can be used as a real time app or to perform retrospective analyses. These data can provide unique resources to hospital management.

Introduction: Computerized Decision Support Systems (CDSSs) connect health care professionals with high-quality, evidence-based information at the point-of-care to guide clinical decision-making. Current research shows the potential of CDSSs to improve the efficiency and quality of patient care. The mere provision of the technology, however, does not guarantee its uptake. This qualitative study aims to explore the barriers and facilitators to the use of CDSSs as identified by health providers., Methods: The study was performed in three Italian hospitals, each characterized by a different level of familiarity with the CDSS technology. We interviewed frontline physicians, nurses, information technology staff, and members of the hospital board of directors (n=24). A grounded theory approach informed our sampling criteria as well as the data collection and analysis., Results: The adoption of CDSSs by health care professionals can be represented as a process that consists of six "positionings," each corresponding to an individual's use and perceived mastery of the technology. In conditions of low mastery, the CDSS is perceived as an object of threat, an unfamiliar tool that is difficult to control. On the other hand, individuals in conditions of high mastery view the CDSS as a helpful tool that can be locally adapted and integrated with clinicians' competences to fulfil their needs. In the first positionings, the uptake of CDSSs is hindered by representational obstacles. The last positionings, alternatively, featured technical obstacles to CDSS uptake., Discussion: Our model of CDSS adoption can guide hospital administrators interested in the future integration of CDSSs to evaluate their organizational contexts, identify potential challenges to the implementation of the technology, and develop an effective strategy to address them. Our findings also allow reflections concerning the misalignment between most Italian hospitals and the current innovation trends toward the uptake of computerized decision support technologies.

T2-weighted short-tau inversion recovery (T2w-STIR) imaging is the best approach for oedema-weighted cardiac magnetic resonance imaging (MRI), as it suppresses the signal from flowing blood and from fat and enhances sensitivity to tissue fluid. The purpose of this pictorial review is to illustrate the clinical use and application of this technique in various ischaemic and non-ischaemic conditions. In ischaemic heart disease, T2w-STIR represents the technique of choice for detecting oedema in patients with acute myocardial infarction (MI), allowing discrimination of acute and chronic injuries. Myocardial haemorrhage may also be depicted as a region of signal abnormality characterised by a central hypointense core with a peripheral hyperintense rim, presumably reflecting the presence of intracellular methaemoglobin within the necrotic area. In the acute setting, elevated T2 relaxation times in association with regional contractile dysfunction but no signs of delayed enhancement may also signify a reversible ischaemic injury without necrosis. In acute myocarditis, the distribution pattern of T2w hyperintensity may be focal in approximately 30% of patients or diffuse in the remaining 70%, and myocardial oedema may be the only marker of disease. Tissue oedema may also be observed in various other conditions, such as primary cardiomyopathies (CMP), storage disease, pulmonary hypertension and cardiac transplant rejection. T2w-STIR represents an appealing and versatile technique that can be applied in a wide variety of ischaemic and non-ischaemic conditions, allowing detection of segmental or global increase of myocardial free water content, reflecting an acute myocardial injury.

The commitment to fight against cancer is a part of European Community health strategies and of Italian health services planning. Interesting and useful results have been achieved in Europe and in our country where most of the population can participate to screening programmes. In Italy there are two main organisational models to deliver intervention for secondary prevention: population based and individual access. Several experimental data show population-based prevention is more fair and appropriate and achieves better results in reducing incidence and mortality rates; data are summarized. Because of this differences we go trough the different characteristics of the two models to handle them better planning and managing more efficiently a sustainable secondary-prevention.

Lazio District, by pointing out the guidelines of the "Obesity and Overweight for Lazio District Plan" (DGR no1166, 23/12/05), enacts the "National Prevention Plan 2005-2007". The Public Health Service for Food and Nutrition has been the main player of the Plan; the District and Department of Health of the District had a technical and organizational support role. Within the development of the Plan for prevention of obesity of ASL RMB, a technical multidisciplinary group was constituted and three more programs were developed, all of them were dedicated to promotion and support of breast-feeding, prevention of obesity and overweight in childhood and adulthood. The educational activity concerning promotion and support of breast-feed ing actively involved operators from consultory rooms and hospital staff from ASL. The reports about nutritional surveillance allowed a careful analysis of the service conditions and priorities. Special criticality facets have been pointed out such as the high prevalence of overweight (31%) and obesity (7%), the habit of skipping breakfast, a low fruit and vegetables consumption, a generally sedentary lifestyle and, during the intervention, the parents' low involvement. In geriatric age cases, a high malnutrition risk both for overnutrition and undernutrition was found in the elderly groups that were checked; the diets' nutritional density as well as the physical activity aspect recover an important role in the intervention planning. Moreover the discussions with catering companies were an important aspect in order to make several target groups aware. The globally considered experience highlighted positive elements of mobilization, consensus, reorientation of activities and resources, giving proof of the significance of integration concerning specifical aims of different company services. Nevertheless, the carrying on of such activities needs resource investments in the specifical area and enlargement of activities especially for the multisector-based efforts.