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The advancement of healthcare towards P5 medicine requires communication and cooperation between all actors and institutions involved. Interoperability must go beyond integrating data from different sources and include the understanding of the meaning of the data in the context of concepts and contexts they represent for a specific use case. In other words, we have to advance from data sharing through sharing semantics up to sharing clinical and medical knowledge. According to the Good Modeling Best Practices, we have to start with describing the real-world business system by domain experts using Domain Ontologies before transforming it into an information and communication technology (ICT) system, thereafter specifying the informational components and then transforming the system into an implementable solution. Any representation style – in the system development process acc. to ISO 10746 called system view – is defined by a related ontology, to be distinguished from real-world domain ontologies representing the knowledge spaces of involved disciplines. The system enabling such representational transformation shall also support versioning as well as the management of historical evolutions. One of such systems is the Common Terminology Service Release 2 (CTS2), which is a standard that allows the complete management of terminological contents. The main objective of this work is to present the choices we made to transform an ontology, written in the standard Ontology Web Language (OWL), into the CTS2 objects. We tested our transformation approach with the Alzheimer’s Disease Ontology. We managed to map all the elements of the considered ontology to CTS2 terminological resources, except for a subset of elements such as the equivalentClass derived from restrictions on other classes.

The Italian health system is organised on a regional basis and services are provided by both public and private operators, affecting the planning of services, access to services by citizens and their health rights. The creation of an observatory monitoring the methods and times of access to healthcare services has been pursued. The preliminary phase of the project is presented, which will lead to the comparison of the data obtained from 2019, with an eye on the Covid-19 pandemic impact.

Totally 167 patients were admitted at cardiology ward in Villa Scassi hospital, Genoa, Italy. We worked with two control groups: heart failure 59 patients (mean age: 71.37 ± 13.27 years) and chronic-ischemic heart disease 108 patients (mean age: 68.85 ± 11.3 years). Nine parameters: Hb, Serum Creatinine, LDL, HDL, Triglycerides, ALT, AST, hs-cTnI, CRP were evaluated onset to hospitalization. We aimed to identify significant independent predictors relative to the outcome of heart failure versus chronic-ischemic heart disease and select combination of biochemical parameters in logistic regression-based model that would provide on average excellent discrimination to the outcome of heart failure versus chronic-ischemic heart disease in elderly population.

Healthcare-associated infections (HAIs) surveillance is an essential part of any infection prevention and control programme. Repeated point prevalence surveys (PPSs) according to European Centre for Disease Prevention and Control (ECDC) protocol have been implemented in all Friuli Venezia Giulia (FVG) region (Italy) acute hospitals to reduce and control HAIs.Using the repeated PPSs within a regional-healthcare system (RHS) to promote and evaluate infection prevention and control (IPC) programmes.The standard versions of the ECDC PPS protocols were used in all four surveys (2011, 2013, 2015, 2017). All RHS public and private accredited hospitals were involved within the 'safe care network' programme.The numbers of surveyed patients in the four PPSs were 3172, 3253, 2969 and 3036, respectively. Prevalence of HAIs and antimicrobial use (AU) decreased significantly from 2011: HAIs (P0.05) 7.1%, 6.3%, 5.5%, 5.8% and AU (P0.01) 40.4%, 39.2%, 36.0%, 37.2%, respectively. The appropriateness of duration of surgical prophylaxis increased significantly (24 h increased through surveys related to one in 2011: odds ratio (OR), 95% confidence interval (CI) 1.29, 0.92-1.81; 1.95, 1.31-2.91; 1.78, 1.20-2.64, respectively). The most frequently detected HAIs were: bloodstream, urinary tract, pneumonia and surgical site (more than the 70% of HAIs in each PPS).The FVG regional approach to HAIs and AU surveillance was able to contribute to reduce prevalence over a 7-year period. Furthermore, it was able to keep hospital attention on HAIs and AU through the years and to guarantee a standardized and comparable evaluation of HAIs and AU burden in all RHS hospitals, as well as impacting on HAIs and AU regional programmes.

This report describes a case of meningitis caused by Listeria monocytogenes in a stem cell transplant recipient on immunosuppressive therapy for cutaneous chronic graft-versus host disease. A 59-year-old woman had undergone allogeneic stem cell transplantation (from a matched unrelated donor) 13 months previously for chronic lymphocytic leukemia. She was on regular hematologic follow-up. Though her previous malignancy has been in remission, she was immunosuppressed due to the pharmacological treatment. We describe a meningitis caused by a typical food-borne pathogen, dangerous in patients with impaired cell-mediated immunity. Moreover the bacterium had a multidrug resistance, a rare characteristic in clinical listeriosis. Rapid diagnosis and treatment are key factors in these cases. We chose ampicillin and rifampicin that allowed a complete resolution of the clinical manifestations.

A new method to analyze single ionic channel current conduction is presented. It is based on an automatic classification by K-means algorithm and on the concept of information entropy. This method is used to study the conductance of multistate ion current jumps induced by tetanus toxin in planar lipid bilayers. A comparison is presented with the widely used Gaussian best fit approach, whose main drawback is the fact that it is based on the manual choice of the base line and of meaningful fragments of current signal. On the contrary, the proposed method is able to automatically process a great amount of information and to remove spurious transitions and multichannels. The number of levels and their amplitudes do not have to be known a priori. In this way the presented method is able to produce a reliable evaluation of the conductance levels and their characteristic parameters in a short time

Mita Giacomini. Issued as part of the Canadian electronic library, Documents collection, and Canadian health research collection. "Version of 4 March 2009". Includes bibliographical references (p. 19-[22]). Access restricted to authorized users and institutions. Mode of access: World Wide Web.

In the present paper, the variations of seawater variables in the Taranto Sea System (i.e. the Mar Grande, Primo Seno e Secondo Seno of the Mar Piccolo) are presented. The variables examined were: temperature, salinity, chl-a, transparency and nutrients. Sampling was carried out from 2002 to 2004 at ten stations. The data obtained showed that the basins are characterised by different levels of confinement; moreover, the most confined basins exhibit a noticeable instability. This, probably, depends not only on their morphological characteristics but also on human activities.

Rurality can contribute to the vulnerability of people with chronic diseases. Qualitative research can identify a wide range of health care access issues faced by patients living in a remote or rural setting.To systematically review and synthesize qualitative research on the advantages and disadvantages rural patients with chronic diseases face when accessing both rural and distant care.This report synthesizes 12 primary qualitative studies on the topic of access to health care for rural patients with chronic disease. Included studies were published between 2002 and 2012 and followed adult patients in North America, Europe, Australia, and New Zealand.Qualitative meta-synthesis was used to integrate findings across primary research studies.Three major themes were identified: geography, availability of health care professionals, and rural culture. First, geographic distance from services poses access barriers, worsened by transportation problems or weather conditions. Community supports and rurally located services can help overcome these challenges. Second, the limited availability of health care professionals (coupled with low education or lack of peer support) increases the feeling of vulnerability. When care is available locally, patients appreciate long-term relationships with individual clinicians and care personalized by familiarity with the patient as a person. Finally, patients may feel culturally marginalized in the urban health care context, especially if health literacy is low. A culture of self-reliance and community belonging in rural areas may incline patients to do without distant care and may mitigate feelings of vulnerability.Qualitative research findings are not intended to generalize directly to populations, although meta-synthesis across a number of qualitative studies builds an increasingly robust understanding that is more likely to be transferable. Selected studies focused on the vulnerability experiences of rural dwellers with chronic disease; findings emphasize the patient rather than the provider perspective.This study corroborates previous knowledge and concerns about access issues in rural and remote areas, such as geographical distance and shortage of health care professionals and services. Unhealthy behaviours and reduced willingness to seek care increase patients' vulnerability. Patients' perspectives also highlight rural culture's potential to either exacerbate or mitigate access issues.People who live in a rural area may feel more vulnerable--that is, more easily harmed by their health problems or experiences with the health care system. Qualitative research looks at these experiences from the patient's point of view. We found 3 broad concerns in the studies we looked at. The first was geography: needing to travel long distances for health care can make care hard to reach, especially if transportation is difficult or the weather is bad. The second concern was availability of health professionals: rural areas often lack health care services. Patients may also feel powerless in "referral games" between rural and urban providers. People with low education or without others to help them may find navigating care more difficult. When rural services are available, patients like seeing clinicians who have known them for a long time, and like how familiar clinicians treat them as a whole person. The third concern was rural culture: patients may feel like outsiders in city hospitals or clinics. As well, in rural communities, people may share a feeling of self-reliance and community belonging. This may make them more eager to take care of themselves and each other, and less willing to seek distant care. Each of these factors can increase or decrease patient vulnerability, depending on how health services are provided.

Diet modification is an important part of self-management for patients with diabetes and/or heart disease (including coronary artery disease, heart failure, and atrial fibrillation). Many health care providers and community-based programs advise lifestyle and diet modification as part of care for people with these conditions. This report synthesizes qualitative information on how patients respond differently to the challenges of diet modification. Qualitative and descriptive evidence can illuminate challenges that may affect the success and equitable impact of dietary modification interventions.To (a) examine the diet modification challenges faced by diabetes and/or heart disease patients; and (b) compare and contrast the challenges faced by patients who are members of vulnerable and nonvulnerable groups as they change their diet in response to clinical recommendations.This report synthesizes 65 primary qualitative studies on the topic of dietary modification challenges encountered by patients with diabetes and/or heart disease. Included papers were published between 2002 and 2012 and studied adult patients in North America, Europe, and Australia/New Zealand.Qualitative meta-synthesis was used to integrate findings across primary research studies.Analysis identified 5 types of challenges that are common to both vulnerable and nonvulnerable patients: self-discipline, knowledge, coping with everyday stress, negotiating with family members, and managing the social significance of food. Vulnerable patients may experience additional barriers, many of which can magnify or exacerbate those common challenges.While qualitative insights are robust and often enlightening for understanding experiences and planning services in other settings, they are not intended to be generalizable. The findings of the studies reviewed here--and of this synthesis--do not strictly generalize to the Ontario (or any specific) population. This evidence must be interpreted and applied carefully, in light of expertise and the experiences of the relevant community.Diet modification is not simply a matter of knowing what to eat and making the rational choice to change dietary practices. Rather, diet and eating practices should be considered as part of the situated lives of patients, requiring an individualized approach that is responsive to the conditions in which each patient is attempting to make a change. Common challenges include self-discipline, knowledge, coping with everyday stress, negotiating with family members, and managing the social significance of food. An individualized approach is particularly important when working with patients who have vulnerabilities.Health care providers often encourage people with diabetes and/or heart disease to change their diet. They advise people with diabetes to eat less sugar, starch, and fat. They advise people with heart disease to eat less fat and salt. However, many patients find it difficult to change what they eat. This report examines the challenges people may face when making such changes. It also examines the special challenges faced by people who are vulnerable due to other factors, such as poverty, lack of education, and difficulty speaking English. Five themes were common to all people who make diet changes: self-discipline, knowledge, coping with stress, negotiating with family members, and managing the social aspect of food. Members of vulnerable groups also reported other challenges, such as affording fresh fruit and vegetables or understanding English instructions. This report may help health care providers work with patients more effectively to make diet changes.

Depression and anxiety are highly prevalent in patients with chronic disease, but remain undertreated despite significant negative consequences on patient health. A number of clinical groups have developed recommendations for depression screening practices in the chronic disease population.The objective of this analysis was to review empirical qualitative research on the experiences of patients with chronic disease (e.g., COPD, diabetes, heart disease, stroke) and comorbid depression or anxiety, and to highlight the implications of the screening and management of anxiety and/or depression on chronic disease outcomes.We performed literature searches for studies published from January 2002 to May 2012. We applied a qualitative mega-filter to nine condition-specific search filters. Titles and abstracts were reviewed by two reviewers and, for the studies that met the eligibility criteria, full-text articles were obtained. Qualitative meta-synthesis was used to integrate findings across relevant published primary research studies. Qualitative meta-synthesis produced a synthesis of evidence that both retained the original meaning of the authors and offered a new, integrative interpretation of the phenomenon through a process of comparing and contrasting findings across studies.The findings of 20 primary qualitative studies were synthesized. Patients tended to experience their chronic conditions and anxiety or depression as either independent or inter-related (i.e., the chronic disease lead to depression/anxiety, the depression/anxiety lead to the chronic disease, or the two conditions exacerbated each other). Potential barriers to screening for depression or anxiety were also identified.A wider array of issues might have been captured if the analysis had focused on broader psychological responses to the chronic disease experience. However, given the objective to highlight implications for screening for anxiety or depression, the more narrow focus seemed most relevant.Chronic disease and anxiety or depression can be independent or inter-related. Patients may be reluctant to acknowledge depression or anxiety as a separate condition, or may not recognize that the conditions are separate because of overlapping physical symptoms. More qualitative research is needed to specifically address screening for depression or anxiety.Depression is a common complication of chronic disease. It may worsen the disease, and it may also affect the self-management of the disease. Screening for depression earlier, and then treating it, may reduce distress and improve symptoms of the chronic disease, leading to better quality of life.

Background During the first coronavirus disease 2019 (COVID-19) pandemic wave, an unprecedented number of patients with respiratory failure due to a new, highly contagious virus needed hospitalization and intensive care unit (ICU) admission. The aim of the present study was to describe the communication and visiting policies of Italian intensive care units (ICUs) during the first COVID-19 pandemic wave and national lockdown and compare these data with prepandemic conditions. Methods A national web-based survey was conducted among 290 Italian hospitals. Each ICU (active between February 24 and May 31, 2020) was encouraged to complete an individual questionnaire inquiring the hospital/ICU structure/organization, communication/visiting habits and the role of clinical psychology prior to, and during the first COVID-19 pandemic wave. Results Two hundred and nine ICUs from 154 hospitals (53% of the contacted hospitals) completed the survey (202 adult and 7 pediatric ICUs). Among adult ICUs, 60% were dedicated to COVID-19 patients, 21% were dedicated to patients without COVID-19 and 19% were dedicated to both categories (Mixed). A total of 11,102 adult patients were admitted to the participating ICUs during the study period and only approximately 6% of patients received at least one visit. Communication with family members was guaranteed daily through an increased use of electronic devices and was preferentially addressed to the same family member. Compared to the prepandemic period, clinical psychologists supported physicians more often regarding communication with family members. Fewer patients received at least one visit from family members in COVID and mixed-ICUs than in non-COVID ICUs, l (0 [0–6]%, 0 [0–4]% and 11 [2–25]%, respectively, p Conclusions Visiting policies of Italian ICUs dedicated to adult patients were markedly altered during the first COVID-19 wave. Remote communication was widely adopted as a surrogate for family meetings. New strategies to favor a family-centered approach during the current and future pandemics are warranted.

Objectives: (i) To determine the types and impact of uncertainty in the decision-making process of policy-makers regarding the implementation of the human papillomavirus (HPV) vaccine. (ii) To determine the relative strengths and limitations of qualitative and quantitative knowledge synthesis methodologies as well as their contributing role to the policy-making regarding the HPV vaccine. Methods: A systematic review and a meta-ethnography were conducted concurrently. Four different search strategies, of nine different databases, were used to target all potential quantitative and qualitative literature published from 1990 to 2011. Studies were selected after abstract and full-text screening by two reviewers, with disagreements resolved by consensus. English language studies of any study design that addressed the HPV vaccine and policy were eligible for inclusion. Quality appraisal of included studies was undertaken using available criteria and tools according to study design. The criteria sets by Tong and colleagues and CASP were used for the qualitative literature while the economic evaluations were appraised with criteria set by Nujiten and colleagues. Quality of the cross-sectional study was not systematically appraised. Data extraction forms were designed for each study type. The data extracted included: study characteristics, types of uncertainty, number of types within each study, policy decision measured as the authors’ final recommendation, and perceptions of the confidence of these recommendations as rated by the reviewers. Chi-square tests were conducted to determine if presence or absence of uncertainty influenced decisions. Pearsons Correlations were conducted to determine the relationship between the amount of uncertainty and perceived certainty of the decision. The qualitative analysis was conducted using steps outlined by Noblit and Hare to determine how studies were related, to translate studies into one another, and to synthesize translations. Results: Of the initial pool (n= 865), 21 studies met inclusion criteria and were considered; 17 quantitative and 4 qualititative. (i) The simulation cohorts of the decision analytic models did not vary by study appreciably. Chi square analyses failed to find evidence that policy decisions were influenced by presence or absence of uncertainty. Further, no statistically significant correlation was found between amount of uncertainty and perceived certainty with the funding decision. At least four types of uncertainties were identified in each qualitative study including but not exclusive to cost, public acceptance due to the sexually transmitted nature of HPV, as well as the health care system’s ability to implement and monitor the vaccine. After employing the Noblit and Hare translation process, four broad types were identified: uncertainties around managing different public acceptability viewpoints, the manufacturer’s role and input, the actual vaccine’s characteristics, and the system’s ability to implement a vaccination program. (ii) Specific and measurable outcomes could only be identified a priori for the quantitative studies due to the nature of questions asked. Locating relevant qualitative studies was more complex and time-consuming due to variation in the manner that each study’s defining features and information are catalogued and searched. A lack of reporting in both the qualitative and quantitative studies disabled a thorough assessment of methodological quality. Data extraction only varied in the manner that the data was recorded. The quantitative results consisted of specific types of data (numerical or categorical) while qualitative results were descriptive.Within data analysis, the types of uncertainty were determined through reciprocal translation while the impact of uncertainty was tested using two statistical techniques. These differences highlight the rigidity and flexibility of quantitative and qualitative literature, respectively. Conclusions: Using both qualitative and quantitative methods enabled a more complete understanding of the role of uncertainty within the decision-making process. Regardless of the methodology used, each type of knowledge synthesis method provided relevant data in regards to the HPV vaccine; simply from different perspectives. Master of Science (MSc)

Objectives: To assess the success rate of pressure support ventilation (PSV) in acute lung injury patients undergoing continuous positive pressure ventilation (CPPV), to study physiologic changes after the transition from CPPV to PSV, and to investigate differences between patients who succeed and patients who fail PSV according to predetermined criteria. Design: Observational study. Setting: General intensive care unit in a teaching hospital. Subjects: We studied 48 patients having acute lung injury, as defined by a PaO2/FIO2 80 mm Hg, at positive end-expiratory pressure of 50 mm Hg) during CPPV, the (V) over dot(E) increase was higher than in normocapnic patients. In the latter patients, PaCO2 and pH did not change significantly going from CPPV to PSV. A total of 38 patients (79%) were allocated to Group S and the remaining 10 patients were included in Group F. In Group S, positive end-expiratory pressure of 9.4 +/- 2.9 cm H2O (range, 3-14 cm H2O) and a PSV level of 14.9 +/- 3.8 cm H2O (range, 9-22 cm H2O) were applied. In Group F, positive end-expiratory pressure of 8.9 +/- 3.1 cm H2O (range, 5-15 cm H2O) acid a PSV level of 21.6 +/- 4.6 cm H2O (range, 16-31 cm H2O) were adopted. Compared with Group S, Group F had a longer duration of intubation (20.2 +/- 19.2 days vs. 9.2 +/- 13.5 days), a lower static compliance of the respiratory system (30.4 +/- 16.5 mL/cm H2O vs. 41.7 +/- 15.0 mL/cm H2O), and a higher V-D/V-T (0.70 +/- 0.09 vs. 0.52 +/- 0.10), but similar oxygenation and positive end-expiratory pressure, (V) over dot(E) was higher in Group F during both CPPV and PSV. Conclusions: In a relatively high proportion of the investigated patients, PSV was successful. The institution of PSV led to no major changes in oxygenation or in hemodynamics, PSV was associated with increases in (V) over dot(E), and respiratory frequency. In patients who had been hypercapnic during CPPV, PaCO2 decreased despite a compensated pH. Compared with PSV success patients, patients who failed PSV appeared to be sicker, as shown by the higher duration of respiratory support, increased ventilatory needs, and decreased respiratory system compliance, despite similar arterial oxygenation and positive end-expiratory pressure.