Telemedicine and Remote Management of Patients with Heart Failure: From Theory to Daily Practice.

Background: Heart failure (HF) is responsible for a high number of hospitalizations, caused by a progressive worsening quality of life. Telemedicine allows for better management of patients' complex conditions, improving the care released. However, the risk of remaining at a testing stage often limits the integration of remote care in daily pathways for HF patients. The aim of this study is to outline the steps needed to integrate telemedicine activities into ordinary HF clinic practices. This methodology is applied to observe activities and trend improvements over a 12-month routine phase. Method: Three steps have been defined for an efficient introduction of remote care services in ordinary activities, integrating them with traditional in-person care: (i) introduction of temporary telemedicine projects, (ii) systematization of telemedicine pathways, and (iii) evaluation of monitoring phase. Observational data have been collected from structured interviews to show the rate of telemedicine activities achieved in clinical practice over the last year. Results: The methodology has been proposed in the HF clinic of the Italian hospital ASST Bergamo Est. After an initial testing phase, in which usability and user experience have been tested, four different remote activities were added: (i) telemonitoring for patients with an implantable device, (ii) follow-up televisits, (iii) nursing telephone support, and (iv) high-intensity telesurveillance pathways for patients after an HF acute event. During the last year, 218 telemonitoring pathways, 75 televisits, 500 telephone calls, and nine telesurveillance pathways have been performed. Success rates were high, and patients gave positive feedback. Conclusion: By integrating multiple telemedicine activities, it has been possible to better manage complex patients, keep track of disease progression, and improve their participation in care.

Motion acquisition of gait characteristics one week after total hip arthroplasty: a factor analysis.

INTRODUCTION: Clinical gait analysis can be used to evaluate the recovery process of patients undergoing total hip arthroplasty (THA). The postoperative walking patterns of these patients can be significantly influenced by the choice of surgical approach, as each procedure alters distinct anatomical structures. The aim of this study is twofold. The first objective is to develop a gait model to describe the change in ambulation one week after THA. The secondary goal is to describe the differences associated with the surgical approach. MATERIALS AND METHODS: Thirty-six patients undergoing THA with lateral (n = 9), anterior (n = 15), and posterior (n = 12) approaches were included in the study. Walking before and 7 days after surgery was recorded using a markerless motion capture system. Exploratory Factor Analysis (EFA), a data reduction technique, condensed 21 spatiotemporal gait parameters to a smaller set of dominant variables. The EFA-derived gait domains were utilized to study post-surgical gait variations and to compare the post-surgical gait among the three groups. RESULTS: Four distinct gait domains were identified. The most pronounced variation one week after surgery is in the Rhythm (gait cycle time: + 32.9 % ), followed by Postural control (step width: + 27.0 % ), Phases (stance time: + 11.0 % ), and Pace (stride length: -  9.3 % ). In postsurgical walking, Phases is statistically significantly different in patients operated with the posterior approach compared to lateral (p-value = 0.017) and anterior (p-value = 0.002) approaches. Furthermore, stance time in the posterior approach group is significantly lower than in healthy individuals (p-value < 0.001). CONCLUSIONS: This study identified a four-component gait model specific to THA patients. The results showed that patients after THA have longer stride time but shorter stride length, wider base of support, and longer stance time, although the posterior group had a statistically significant shorter stance time than the others. The findings of this research have the potential to simplify the reporting of gait outcomes, reduce redundancy, and inform targeted interventions in regards to specific gait domains.

Definition of a Method for the Evaluation of Telemedicine Platforms in the Italian Context.

Background: The COVID-19 outbreak led to the diffusion of several telemedicine solutions. The choice of the correct platform is crucial for ensuring the release of effective assistance. However, there is a lack of an objective method for the assessment of technical features. Objective: This study proposes a methodology for the evaluation of functional requirements of telemedicine platforms. This approach also permits the comparison of solutions in the Italian market by means of defined parameters, thus directing the choice of health care professionals. Methods: The study is divided into three phases. First, a mapping of the telemedicine platforms operating in Italy is performed. Then, the available platforms are selected based on the offered telemedicine activity. Finally, a method for evaluating the investigated platforms is defined. Results: Thirty-three (n = 33) technological systems were identified through an accurate investigation on the web and interviews with IT companies. Fifteen parameters were defined and organized into three categories: (1) usability of the telemedicine platform, (2) security, and (3) technological and organizational aspects. A score between 1 and 4 was assigned to each parameter, proportionally to the completeness of the platform. In particular, 62.96% of platforms reached an average score between 3.01 and 4 points; 33.33% of them had scores between 2.01 and 3, while the remaining 3.70% of solutions obtained a result between 1.01 and 2. Conclusions: The study provides an evaluation approach that is easily usable by health professionals to select the most suitable platform. The number of solutions and quality of information could be updated to obtain a complete tool.

Trends in occupational diseases in the Italian agricultural sector, 2004-2017.

OBJECTIVE: To estimate the incidence of, trends in and effect of change in reporting rules on occupational diseases (ODs) in the Italian agricultural sector. METHODS: Over a 14-year period (2004-2017), ODs among Italian agricultural workers were diagnosed by physicians and reported to the National Institute for Insurance against Workplace Accidents and Occupational Diseases. OD was defined as a disease with a specific clinical diagnosis (International Classification of Diseases) and was predominantly caused by work-related factors. Trends in incidence and effects of changed eligibility criteria for reporting occupational musculoskeletal disorders (MSDs) and noise-induced hearing loss (NIHL) were estimated using a Poisson regression model. RESULTS: In 2017, the incidence of all ODs was 1295 per 100 000 agricultural workers. MSDs (961 per 100 000 workers) were the most frequently occurring ODs. MSDs and NIHL showed statistically significant increasing time trends, 26% and 7% annual increase, respectively, during the 2004-2017 period. There was no statistically significant change in the incidence of occupational respiratory, skin and cancer diseases during the 14-year period. After changes in reporting rules, the incidence of MSDs showed an immediate increased effect, with an incidence rate ratio (IRR) of 2.9 (95% CI 2.65 to 3.14) and a significant annual decreasing trend of -9% (95% CI -6% to -12%) over the years after the changed reporting rules (from 2008 to 2017), and an immediate effect on NIHL with an IRR of 1.3 (95% CI 1.13 to 1.53). CONCLUSION: In total, 1.3% of the Italian agricultural workers were diagnosed in 2017 as having an OD. Over a 14-year period, the annual incidence of ODs showed a considerable increasing trend consistent with changed eligibility reporting criteria for occupational MSDs and to a lesser extent for NIHL.

Tracking and Characterization of Spinal Cord-Injured Patients by Means of RGB-D Sensors.

In physical rehabilitation, motion capture solutions are well-known but not as widespread as they could be. The main limit to their diffusion is not related to cost or usability but to the fact that the data generated when tracking a person must be elaborated according to the specific context and aim. This paper proposes a solution including customized motion capture and data elaboration with the aim of supporting medical personnel in the assessment of spinal cord-injured (SCI) patients using a wheelchair. The configuration of the full-body motion capturing system is based on an asymmetric 3 Microsoft Kinect v2 sensor layout that provides a path of up to 6 m, which is required to properly track the wheelchair. Data elaboration is focused on the automatic recognition of the pushing cycles and on plotting any kinematic parameter that may be interesting in the assessment. Five movements have been considered to evaluate the wheelchair propulsion: the humeral elevation, the horizontal abduction of the humerus, the humeral rotation, the elbow flexion and the trunk extension along the sagittal plane. More than 60 volunteers with a spinal cord injury were enrolled for testing the solution. To evaluate the reliability of the data computed with SCI APPlication (APP) for the pushing cycle analysis, the patients were subdivided in four groups according to the level of the spinal cord injury (i.e., high paraplegia, low paraplegia, C7 tetraplegia and C6 tetraplegia). For each group, the average value and the standard deviation were computed and a comparison with similar acquisitions performed with a high-end solution is shown. The measurements computed by the SCI-APP show a good reliability for analyzing the movements of SCI patients' propulsion wheelchair.

Carbon footprint of organic beef meat from farm to fork: a case study of short supply chain.

BACKGROUND: Sustainability of food systems is one of the big challenges facing humanity. Local food networks, especially those using organic methods, are proliferating worldwide, and little is known about their carbon footprints. This study aims to assess greenhouse gas (GHG) emissions associated with a local organic beef supply chain using a cradle-to-grave approach. RESULTS: The study determined an overall burden of 24.46 kg CO2  eq. kg-1 of cooked meat. The breeding and fattening phase was the principal source of CO2 in the production chain, accounting for 86% of the total emissions. Enteric methane emission was the greatest source of GHG arising directly from farming activities (47%). The consumption of meat at home was the second high point in GHG production in the chain (9%), with the cooking process being the main source within this stage (72%). Retail and slaughtering activities respectively accounted for 4.1% and 1.1% of GHG emissions for the whole supply chain. CONCLUSION: The identification of the major sources of GHG emissions associated with organic beef produced and consumed in a local food network may stimulate debate on environmental issues among those in the network and direct them toward processes, choices and habits that reduce carbon pollution. © 2018 Society of Chemical Industry.

Challenges and priorities for modelling livestock health and pathogens in the context of climate change.

Climate change has the potential to impair livestock health, with consequences for animal welfare, productivity, greenhouse gas emissions, and human livelihoods and health. Modelling has an important role in assessing the impacts of climate change on livestock systems and the efficacy of potential adaptation strategies, to support decision making for more efficient, resilient and sustainable production. However, a coherent set of challenges and research priorities for modelling livestock health and pathogens under climate change has not previously been available. To identify such challenges and priorities, researchers from across Europe were engaged in a horizon-scanning study, involving workshop and questionnaire based exercises and focussed literature reviews. Eighteen key challenges were identified and grouped into six categories based on subject-specific and capacity building requirements. Across a number of challenges, the need for inventories relating model types to different applications (e.g. the pathogen species, region, scale of focus and purpose to which they can be applied) was identified, in order to identify gaps in capability in relation to the impacts of climate change on animal health. The need for collaboration and learning across disciplines was highlighted in several challenges, e.g. to better understand and model complex ecological interactions between pathogens, vectors, wildlife hosts and livestock in the context of climate change. Collaboration between socio-economic and biophysical disciplines was seen as important for better engagement with stakeholders and for improved modelling of the costs and benefits of poor livestock health. The need for more comprehensive validation of empirical relationships, for harmonising terminology and measurements, and for building capacity for under-researched nations, systems and health problems indicated the importance of joined up approaches across nations. The challenges and priorities identified can help focus the development of modelling capacity and future research structures in this vital field. Well-funded networks capable of managing the long-term development of shared resources are required in order to create a cohesive modelling community equipped to tackle the complex challenges of climate change.

A Sustainable Approach to Telerehabilitation in Europe: Patients Are Ready, but Caregivers Are Essential.

BACKGROUND: Several studies have demonstrated the effectiveness of telerehabilitation. However, it remains unclear what proportion of people in need of rehabilitation can confidently use telecommunications networks and related devices. OBJECTIVES: The aim of this study is to estimate the proportion of patients who possess either the requisite digital literacy to perform telerehabilitation independently or have a family caregiver capable of providing effective support. METHODS: Synthetic populations with a realistic kinship network (i.e. family trees) representative of European countries are built. Age, sex, and location-specific prevalence rates of rehabilitation needs and digital skills are combined to estimate the percentage of digitally literate patients and patients with digitally literate relatives. RESULTS: In Europe, 86% of people in need of rehabilitation are potentially eligible for telerehabilitation. However, in four out of five cases, eligible patients over the age of 65 require caregiver support. CONCLUSION: Telerehabilitation has the potential to spread in Europe. Caregivers have an essential social role in ensuring sustainable access to telerehabilitation.

Support for Chronic Pain Management for Breast Cancer Survivors Through Novel Digital Health Ecosystems: Pilot Usability Study of the PainRELife Mobile App.

BACKGROUND: Chronic pain is one of the most common and critical long-term effects of breast cancer. Digital health technologies enhance the management of chronic pain by monitoring physical and psychological health status and supporting pain self-management and patient treatment decisions throughout the clinical pathway. OBJECTIVE: This pilot study aims to evaluate patients' experiences, including usability, with a novel digital integrated health ecosystem for chronic pain named PainRELife. The sample included patients with breast cancer during survivorship. The PainRELife ecosystem comprises a cloud technology platform interconnected with electronic health records and patients' devices to gather integrated health care data. METHODS: We enrolled 25 patients with breast cancer (mean age 47.12 years) experiencing pain. They were instructed to use the PainRELife mobile app for 3 months consecutively. The Mobile Application Rating Scale (MARS) was used to evaluate usability. Furthermore, pain self-efficacy and participation in treatment decisions were evaluated. The study received ethical approval (R1597/21-IEO 1701) from the Ethical Committee of the European Institute of Oncology. RESULTS: The MARS subscale scores were medium to high (range: 3.31-4.18), and the total app quality score was 3.90. Patients with breast cancer reported reduced pain intensity at 3 months, from a mean of 5 at T0 to a mean of 3.72 at T2 (P=.04). The total number of times the app was accessed was positively correlated with pain intensity at 3 months (P=.03). The engagement (P=.03), information (P=.04), and subjective quality (P=.007) subscales were positively correlated with shared decision-making. Furthermore, participants with a lower pain self-efficacy at T2 (mean 40.83) used the mobile app more than participants with a higher pain self-efficacy (mean 48.46; P=.057). CONCLUSIONS: The data collected in this study highlight that digital health technologies, when developed using a patient-driven approach, might be valuable tools for increasing participation in clinical care by patients with breast cancer, permitting them to achieve a series of key clinical outcomes and improving quality of life. Digital integrated health ecosystems might be important tools for improving ongoing monitoring of physical status, psychological burden, and socioeconomic issues during the cancer survivorship trajectory. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/41216.

Short communication: Lymphoproliferative response to lipopolysaccharide and incidence of infections in periparturient dairy cows.

This preliminary study aimed at assessing whether the in vitro proliferation of peripheral blood mononuclear cells in response to lipopolysaccharide permits individual characterization of periparturient dairy cows, and whether this parameter may be associated with incidence of infections and with some of the single nucleotide polymorphisms located on the toll-like receptor 4 (TLR4) gene. Based on the average response of peripheral blood mononuclear cells to lipopolysaccharide over 7 time points during the transition period, 31 cows were categorized as low (LO), medium (MED), and high (HI) responders. This categorization identified 7 HI, 19 MED, and 5 LO cows, respectively. Genomic DNA was genotyped for P-226 C>G and E3+2021 C>T TLR4 single nucleotide polymorphisms. Monitoring of the health status revealed that 8 of the 31 cows suffered from clinical mastitis, metritis, or interdigital dermatitis during the first 60d in milk. The association study pointed out that none of the HI cows and all of the LO cows developed an infection; cows with the CCGT haplotype remained healthy and none of them belonged to the LO responder category.

Effects of fatty acid mixtures on proliferation of peripheral blood mononuclear cells in dairy cows.

This in vitro study was performed to assess the effects of three different mixtures of nonesterifed fatty acids (NEFA) on mitogen-driven proliferation of peripheral blood mononuclear cells (PBMC) in dairy cows. Substantially, the three mixtures differed for n-6 to n-3 fatty acids (FA) ratio and were intended to mimic plasma NEFA composition of cows given fat supplements with different n-6 to n-3 FA ratio. PBMC from six Holstein heifers were cultured in media containing three different mixtures of oleic, palmitic, stearic, linoleic, palmitoleic, or linolenic acid at concentrations mimicking different degree of lipomobilisation. Proliferation of PBMC was stimulated by concanavalin A or pokeweed mitogen (PWM). Low concentrations of the three mixtures (62.5 and 125 µmol/l), did not affect the ability of PBMC to proliferate. Concentrations of the three mixtures mimicking medium-intense lipomobilisation (500, 1,000 and 1,500 µmol/l) impaired to the same extent proliferation of PBMC. The addition to cultures of the three mixtures at concentration of 250 µmol/l, impaired the proliferation only in PBMC stimulated with PWM. Even in this case, the three mixtures did not exert differential effects on PBMC proliferation. Present results reinforce the hypothesis that high concentrations of plasma NEFA play a role in the immunosuppression taking place in cows undergoing intense lipomobilisation, and authorize to suggest that under these conditions different composition of plasma NEFA in terms of different n-6 to n-3 FA ratio cannot prevent their negative effects on lymphocyte proliferation.

Usability of a continuous oxygen saturation device for home telemonitoring.

Background: The emergency for the COVID-19 pandemic has led to greater use of home telemonitoring devices. The aim of this study was to assess the usability of continuous home-monitoring care with an oxygen saturation device on post-COVID-19 patients. Method: The system consists of a digital continuous pulse oximeter and a smartphone with an App, which were provided to patients. A survey composed of a standard Post-Study System Usability Questionnaire, and a satisfaction questionnaire was exploited to conduct a usability and feasibility analysis of the service. Results: A total of 29 patients (17.2% female) with a mean age of 65 ± 11.5 years were enrolled: 20 patients were smartphone users (69%) with a mean age of 60.2 ± 9.5 years, and 9 patients (31%) did not own a smartphone (mean age 76.8 ± 5.9). The monitoring period was 1 month: a total of 444 recordings were conducted, 15 recordings per patient averagely. In total, 82% of the recordings performed did not require any intervention, while 18% led to the production of a report and subsequent intervention by a nurse who verified, together with the specialist, the need to intervene (i.e. the patient accessed the clinic for medical control and/or modification of oxygen therapy). A total of 17 patients compiled a usability questionnaire. The service was perceived as useful and well-structured, although it often required caregiver support. Conclusions: Using continuous home-monitoring care with an oxygen saturation device seems feasible and useful for patients who could be followed at home avoiding going back to the hospital every time a trend oximetry is needed. Further improvements in connections, data flow processes, and simplifications, based on patients' feedback, are needed to scale up the service.

Assessing the Accuracy of the Azure Kinect for Telerehabilitation After Breast Cancer Surgery.

BACKGROUND: Rehabilitation plays a key role in the recovery of upper extremity function after breast cancer surgery. Motion capture (mocap) systems for serious gaming have shown the potential to enable home-based rehabilitation, but clinical accuracy needs to be examined. OBJECTIVES: Validation of markerless mocap systems for telerehabilitation after breast cancer surgical intervention. METHODS: The accuracy of the markerless mocap device Azure Kinect in detecting compensatory movements and postural disturbances has been compared to a gold standard Optitrack system in five volunteers. Subsequently, a serious game for mocap-based shoulder exercises has been developed and integrated into a telerehabilitation platform. RESULTS: The Azure Kinect shows good reliability for scapular elevation (ICC >0.80; MAE <2.1 cm) and trunk tilt (ICC=0.88; MAE=5°), moderate reliability for rounded shoulders (ICC=0.51; MAE=2.6cm) and poor reliability for kyphosis angle (ICC=0.22; MAE=18°). CONCLUSION: The Azure Kinect provides reasonable performance for shoulder rehabilitation. The proposed telerehabilitation platform has been tested by rehabilitation specialists and received positive feedback.

Agronomic performance and remote sensing assessment of organic and mineral fertilization in rice fields.

Introduction: Rice heavily relies on nitrogen fertilizers, posing environmental, resource, and geopolitical challenges. This study explores sustainable alternatives like animal manure and remote sensing for resource-efficient rice cultivation. It aims to assess the long-term impact of organic fertilization and remote sensing monitoring on agronomic traits, yield, and nutrition. Methods: A six-year experiment in rice fields evaluated fertilization strategies, including pig slurry (PS) and chicken manure (CM) with mineral fertilizers (MIN), MIN-only, and zero-fertilization. Traits, yield, spectral responses, and nutrient content were measured. Sentinel-2 remote sensing tracked crop development. Results: Cost-effective organic fertilizers (PS and CM) caused a 13% and 15% yield reduction but still doubled zero-fertilization yield. PS reduced nitrogen leaching. Heavy metals in rice grains were present at safe amounts. Organic-fertilized crops showed nitrogen deficiency at the late vegetative stages, affecting yield. Sentinel-2 detected nutrient deficiencies through NDVI. Discussion: Organic fertilizers, especially PS, reduce nitrogen loss, benefiting the environment. However, they come with yield trade-offs and nutrient management challenges that can be managed and balanced with reduced additional mineral applications. Sentinel-2 remote sensing helps manage nutrient deficiencies. In summary, this research favors cost-effective organic fertilizers with improved nutrient management for sustainable rice production.

Efficacy and safety of Dynavisc® gel in prevention of scar adhesions recurrence after flexor tendons tenolysis in zone 2. Multicenter retrospective cohort study.

AIM: Dynavisc® is a novel surgical product made of carboxymethylcellulose (CMC) and Polyethylene Oxide (PEO) designed to reduce post-surgical adhesions in tendons surgery. A multicenter retrospective cohort study was performed to investigate the clinical safety and efficacy of the Dynavisc® gel in reducing post-surgical adhesions after flexor tenolysis in zone 2. MATERIAL OF STUDY: Thirty-one patients suffering from stiff finger after flexor tendon repairs in zone 2 treated with standard release with (18 Dynavisc®-treated group) or without (13 controls) anti-adhesion gel application into the flexor tendon sheath and around the site of the tenolysis, were collected in five different hand surgery units. Safety profile and functional outcomes (based on TAM test and the The Quick-DASH questionnaire) were examined from patients' charts and analyzed. RESULTS: The application of Dynavisc® posed no safety concerns and it was not related to any additional complication. The Dynavisc®-treated group showed greater progressive improvement of TAM value in all visits with superior TAM value at T(90) and T(180) compared to the control group. DISCUSSION: Tendon adhesions are the main cause of flexor tendon surgery failure. Multiple strategies (i.e. robust tendon repair, early rehabilitation and lubricant or barrier agents) have been proposed to minimize their formation. Among different products described in the literature Dynavisc® showed a significant role in limiting adhesions formation in a recent experimental study. CONCLUSIONS: This clinical study confirm the safety of Dynavisc® gel application in hand surgery demonstrating its potential long-term benefits after flexor tendon tenolysis. KEY WORDS: Flexor Tendon Repair, Tendon Adhesions, Tenolysis.

Usability Testing of a New Digital Integrated Health Ecosystem (PainRELife) for the Clinical Management of Chronic Pain in Patients With Early Breast Cancer: Protocol for a Pilot Study.

BACKGROUND: Chronic pain (CP) and its management are critical issues in the care pathway of patients with breast cancer. Considering the complexity of CP experience in cancer, the international scientific community has advocated identifying cutting-edge approaches for CP management. Recent advances in the field of health technology enable the adoption of a novel approach to care management by developing integrated ecosystems and mobile health apps. OBJECTIVE: The primary end point of this pilot study is to evaluate patients' usability experience at 3 months of a new digital and integrated technological ecosystem, PainRELife, for CP in a sample of patients with breast cancer. The PainRELife ecosystem is composed of 3 main technological assets integrated into a single digital ecosystem: Fast Healthcare Interoperability Resources-based cloud platform (Nu platform) that enables care pathway definition and data collection; a big data infrastructure connected to the Fast Healthcare Interoperability Resources server that analyzes data and implements dynamic dashboards for aggregate data visualization; and an ecosystem of personalized applications for patient-reported outcomes collection, digital delivery of interventions and tailored information, and decision support of patients and caregivers (PainRELife app). METHODS: This is an observational, prospective pilot study. Twenty patients with early breast cancer and chronic pain will be enrolled at the European Institute of Oncology at the Division of Medical Senology and the Division of Pain Therapy and Palliative Care. Each patient will use the PainRELife mobile app for 3 months, during which data extracted from the questionnaires will be sent to the Nu Platform that health care professionals will manage. This pilot study is nested in a large-scale project named "PainRELife," which aims to develop a cloud technology platform to interoperate with institutional systems and patients' devices to collect integrated health care data. The study received approval from the Ethical Committee of the European Cancer Institute in December 2021 (number R1597/21-IEO 1701). RESULTS: The recruitment process started in May 2022 and ended in October 2022. CONCLUSIONS: The new integrated technological ecosystems might be considered an encouraging affordance to enhance a patient-centered approach to managing patients with cancer. This pilot study will inform about which features the health technological ecosystems should have to be used by cancer patients to manage CP. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41216.

An open-label phase 2 study of twice-weekly bortezomib and intermittent pegylated liposomal doxorubicin in patients with ovarian cancer failing platinum-containing regimens.

BACKGROUND: Pegylated liposomal doxorubicin (PLD) is an established treatment for relapsed ovarian cancer. Preclinical and clinical evidences in other tumor types suggest that the proteasome inhibitor bortezomib can act synergistically with PLD. METHODS: Patients with relapsed ovarian cancer (N = 58), previously treated with platinum (100%) and taxane (95%), received bortezomib, 1.3 mg/m intravenous (days 1, 4, 8, and 11), and PLD, 30 mg/m intravenous (day 1), every 3 weeks. Tumor responses were assessed using Response Evaluation Criteria In Solid Tumors and Gynecologic Cancer Intergroup criteria. An optimal 2-stage design was implemented. Gene expression profiling in peripheral blood was characterized before and during treatment in 10 platinum-sensitive patients enrolled in stage 2 of the study. RESULTS: Median number of bortezomib-PLD cycles was 3.5. Of 38 patients in the platinum-sensitive group, 9 responses were observed (median duration, 4.8 months). The platinum-resistant group was closed at stage 1 owing to lack of response. Toxicity was moderate and mainly consisted of hematologic, gastrointestinal, and mucositis events. Of the total 58 patients, peripheral neuropathy was reported in 9 patients (none were grade 3). Transcription profiling identified the prevalence of genes associated with ribonucleoprotein complexes, RNA processing, and protein translation. The gene expression changes were more robust in patients who responded or had stable disease compared with patients who had progressive disease. CONCLUSIONS: The combination of bortezomib and PLD was well tolerated, but the antitumor activity is insufficient to warrant further investigation in ovarian cancer.

Improving the user experience of televisits and telemonitoring for heart failure patients in less than 6 months: a methodological approach.

BACKGROUND: With the spread of COVID-19, telemedicine solutions became crucial to release continuous and remote assistance to chronic patients. The rapid transition to telemedicine solutions did not allow a complete assessment of the user experience by both patients and medical personnel. Despite the well-known benefits in remote care, the lack of usability evaluation of already existing technologies for the vital signs measurement has emerged. A telemedicine platform must match video communication between patients and the medical staff with the possibility to measure vital parameters. Furthermore, technological assistance may overcome the unfamiliarity with telemedicine and drastically reduce the learning time for both patients and medical personnel. OBJECTIVES: The research work presents a method to improve the user experience of a telemedicine service based on the combination of televisits and telemonitoring with wearable sensors for heart failure patients. Skilled technological staff is proposed by the presented method to lead the learning process of both medical personnel and patients in order to reach a high level of usability in less than 6 months. METHODS: The proposed method is composed of 5 steps: identification of technological staff and end users; selection of the telemedicine platform; design of questionnaires for usability analysis; training of clinicians and patients; final usability evaluation of the telemedicine platform by means of customized satisfaction questionnaires and Post-Study System Usability Questionnaires (PSSUQs). The methodological approach has been tested in collaboration with a heart failure clinic by involving 5 physicians, 5 nurses, 15 heart failure patients, a research engineer and 4 technicians. A platform with 3 wearable sensors has been chosen: a wireless thermometer, a finger pulse-oximeter and an undershirt have been used for the detection of ECG trace. While these devices allowed asynchronous measurements of physiological data, scheduled televisits have been used for direct communication between physicians and patients. RESULTS: Satisfaction questionnaires of patients and clinicians reached respectively 65.18% and 65.83%, while PSSUQ scores were respectively 91.73% and 81.70%. Both groups of end users confirmed a good level of usability and their satisfaction about the ease of use and the perceived quality of the instrumentation. Moreover, 73% of patients did not require help from caregivers to use the kit of sensors. The results have been reached in 5.5 months according to the aim defined initially. Research engineers have played a crucial role in helping clinicians and patients to improve the user experience with the telemedicine platform. CONCLUSIONS: The high level of usability and satisfaction confirmed that the proposed methodological approach helps to learn the technological features of the telemedicine platforms, which are based on different types of technology, such as web applications, wearable sensors and virtual calls. The positive results with heart failure patients encouraged to plan further research studies by using the designed method with other categories of chronic patients.

An agent-based model to assess large-scale COVID-19 vaccination campaigns for the Italian territory: The case study of Lombardy region.

BACKGROUND: In Italy, the administration of COVID-19 vaccines began in late 2020. In the early stages, the number of available doses was limited. To maximize the effectiveness of the vaccine campaign, the national health agency assigned priority access to at-risk individuals, such as health care workers and the elderly. Current vaccination campaign strategies do not take full advantage of the latest mathematical models, which capture many subtle nuances, allowing different territorial situations to be analyzed aiming to make context-specific decisions. OBJECTIVES: The main objective is the definition of an agent-based model using open data and scientific literature to assess and optimize the impact of vaccine campaigns for an Italian region. Specifically, the aim is twofold: (i) estimate the reduction in the number of infections and deaths attributable to vaccines, and (ii) assess the performances of alternative vaccine allocation strategies. METHODS: The COVID-19 Agent-based simulator Covasim has been employed to build an agent-based model by considering the Lombardy region as case study. The model has been tailored by leveraging open data and knowledge from the scientific literature. Dynamic mobility restrictions and the presence of Variant of Concern have been explicitly represented. Free parameters have been calibrated using the grid search methodology. RESULTS: The model mimics the COVID-19 wave that hit Lombardy from September 2020 to April 2021. It suggests that 168,492 cumulative infections 2,990 cumulative deaths have been avoided due to the vaccination campaign in Lombardy from January 1 to April 30, 2021. Without vaccines, the number of deaths would have been 66% greater in the 80-89 age group and 114% greater for those over 90. The best vaccine allocation strategy depends on the goal. To minimize infections, the best policy is related to dose availability. If at least 1/3 of the population can be covered in 4 months, targeting at-risk individuals and the elderly first is recommended; otherwise, the youngest people should be vaccinated first. To minimize overall deaths, priority is best given to at-risk groups and the elderly in all scenarios. CONCLUSIONS: This work proposes a methodological approach that leverages open data and scientific literature to build a model of COVID-19 capable of assessing and optimizing the impact of vaccine campaigns. This methodology can help national institutions to design regional mathematical models that can support pandemic-related decision-making processes.

Communication and Decision Support Tool for an In-Hospital 3D Printing Service.

BACKGROUND: Effective communication is a key factor in healthcare, essential for improving process efficiency and quality of care. This is particularly true in new services, e.g., the 3D printing service inside the hospital. OBJECTIVES: A web platform, called 3DSCT, has been developed to act as an interface between the three categories of operators involved in 3D printing: physicians, radiologists and engineers. METHODS: The 3DSCT platform has been designed using Microsoft Visual Studio Code, enclosing .js scripts and HTML pages with the relative CSS formats. RESULTS: When applied to a real 3D printing service, the 3DSCT platform provided an effective solution that streamlined the process of designing and manufacturing 3D-printed artifacts, from physician's request through development to printing. CONCLUSION: By incorporating the platform into the hospital management system, it will be possible to reduce the overall lead time and decrease the waste of time for the operators involved in 3D printing inside the hospital.