Use of a maturity model for facilitating the introduction of CAR T-cell therapy-Results of the START CAR-T project.

Introduction: Chimeric antigen receptor (CAR) T-cell therapies are novel immunotherapies for the treatment of hematologic malignancies. They are administered in specialized centers by a multidisciplinary team and require the careful coordination of all steps involved in manufacturing and using cellular therapies. The Maturity Model (MM) is a tool developed and used for assessing the effectiveness of a variety of activities. In healthcare, it may assist clinicians in the gradual improvement of patient management with CAR T-cell therapy and other complex treatments. Methods: The START CAR-T project was initiated to investigate the potential of a MM in the setting of CAR T-cell therapy. Four Italian clinics participated in the creation of a dedicated MM. Following the development and test of this MM, its validity and generalizability were further tested with a questionnaire submitted to 18 Italian centers. Results: The START CAR-T MM assessed the maturity level of clinical sites, with a focus on organization, process, and digital support. For each area, the model defined four maturity steps, and indicated the actions required to evolve from a basic to an advanced status. The application of the MM to 18 clinical sites provided a description of the maturity level of Italian centers with regard to the introduction of CAR T-cell therapy. Conclusion: The START CAR-T MM appears to be a useful and widely applicable tool. It may help centers optimize many aspects of CAR T-cell therapy and improve patient access to this novel treatment option.

The role of radiation therapy in vulvar cancer: review of the current literature.

The purpose of this article is to discuss the current role of radiation therapy in vulvar cancer and especially to review the recent literature relative to the use of intensity-modulated radiotherapy (IMRT) in disease management. Owing to the low incidence of vulvar cancer, at present there are no available results of cooperative prospective trials. As evidenced in dosimetric and preliminary retrospective clinical studies, the use of IMRT has resulted in superior normal tissue sparing and lower rates of acute and chronic toxicities compared to previous studies that used conventional approaches. Data on long-term outcomes in these patients remain limited.

The evolution of hospital information systems and the role of electronic patient records: from the Italian scenario to a real case.

Health care organizations can gain great value from Information and Communication Technologies (ICT), yet, although there is growing awareness of the potential benefits associated with their use, results often fall far short of expectations. Each year, the "ICT in Health Care" Observatory--part of the Politecnico di Milano School of Management--outlines a profile of the role of ICT in the Italian health care industry, investigating current projects in terms of their impact on processes and organizations, implementation state of the art, governance models, and prospective pathways. The 2009 collaborative research process outlines the need for a change in the way health care CIOs approach technological and organizational evolutions. ICT departments lack vision, governance mechanisms, skilled resources, and top management commitment. This has led to a series of distortions in the innovation of Hospital Information Systems (HISs) and ICT departments themselves. Currently they are too concerned with day-to-day operations and delay comprehensive initiatives capable of leading to effective ICT-driven innovations. The paper points out the problems that health care organizations are tackling and how they are trying to solve them. The case of the Italian National Cancer Institute in Milan provides a valuable example of how a health care organization is developing its HIS.