[Guidelines for the routine assessment of respiratory surgical risk: thoracic radiography]. / Linee guida per la valutazione routinaria del rischio chirurgico respiratorio: la radiografia del torace.

Through the three years between June 1995 and June 1998 the authors applied an evaluation schedule for the respiratory surgical risk to all the patients undergoing general surgery. Chest X-ray was included in this schedule as a first-level test and it was performed systematically on all the patients. The purpose of the study was to verify the effectiveness of chest X-ray as a routine examination of the respiratory performance, evaluating its predictive value on 1715 cases. The routine employment of this preoperative test on patients resulting risk-free at an accurate clinical anamnestic examination doesn't seem to be justified, basing on the preliminary results achieved. Therefore, chest X-ray should be considered a second-level test, to be performed on the basis of a precise clinical query only. This way a significant health-care cost reduction could be achieved, without affecting the quality of patient's management.

Clinical protocol development using Inter/IntraNet technology: the FENARETE system.

In this work we present FENARETE, a software tool to design and distribute clinical protocols in an Inter/IntraNet framework. We consider a medical protocol as a clinical behaviour scheme, formally and clearly defined with sufficient details. Our work allows the knowledge content of any clinical protocol to be fully represented in a symbolic style. A computer based support tool that works as an interface between clinicians and the protocol knowledge base is regarded by the authors as a basic building block developing an integrated environment for medical protocols design and management. The FENARETE application has been developed in Java and it is available for any Internet-linked machine with a Java-compatible browser.

A cooperative methodology to build conceptual models in medicine.

We designed a methodology to perform distribute activities on conceptual modelling among cooperating centers. Our methodology assigns responsibilities and tasks and regulates interactions preserving coherence; it passes through the construction of unambiguous paraphrases to make explicit the context within the original sources, and through their compositional representation in an intermediate language. The process is intrinsically iterative, with continuous feedbacks and refinements, alternating analytic view on details and synthetic view on regularities and structures. Our methodology is based on requirements and experience made in the first GALEN project, and was applied in the GALEN-IN-USE project to coordinate modelling activities of three teams of surgeons in Rome with activities of other partners, during the production of an extensive model of surgical procedures.

Age-specific incidence and duration of known diabetes. The Cremona Study.

OBJECTIVE: To estimate the overall and age-specific incidence of known diabetes and its total duration through prevalence data and to assess the consistency of the results by mortality analysis of the same cohort. RESEARCH DESIGN AND METHODS: Two different sources were used. The first was a representative sample of 2,274 prevalent known-diabetic subjects. These data provided overall and age-specific incidence estimates by fitting a logistic model to the partial incidence rates for different diagnosis cohorts and to the disease duration. The age at diagnosis structure was built from the age-specific estimates. Prevalence data also provided total duration estimates by converting the prevalent duration-to-date structure into an incident total duration structure. The second source was 145 deceased subjects who were taken from the 6-year follow-up sample of 1,132 prevalent subjects. The age at diagnosis and estimates of total disease duration were provided for these subjects, who paralleled the characteristics of the incident cohort. RESULTS: The two independent estimates of total disease duration were similar (prevalent subjects, 15.7 years; deceased subjects, 14.1 years): the average duration was 14.9 years. The ratio between prevalence and total duration yielded an independent yearly incidence estimate of 2.2 per 1,000 person-years (men, 2.0; women, 2.4), which was close to the value given by the model of 2.1 per 1,000 person-years (men, 1.9; women, 2.3). Also, the independently determined age structures overlapped, and their average was used to calculate the age-specific incidence. Incidence was negligible for individuals < 30 years of age, and it was about 6.0 per 1,000 person-years for individuals > 50 years of age. CONCLUSIONS: This study provided reliable estimates of NIDDM age-specific incidence rates and total disease duration, data that are seldom investigated in this type of disease.

The effect of cigarette-smoking on cardiovascular risk factors: a study of monozygotic twins discordant for smoking.

The association of cigarette smoking with the development of occlusive vascular disease is firmly established. Unfavourable changes in a series of variables held independent risk factors for the development of vascular lesions (HDL-cholesterol, haematocrit, white blood cell count, fibrinogen and plasminogen activator inhibitor-1 (PAI-1)) are thought to be directly influenced by cigarette smoking. However, the role played by the genotype in the effect of smoking on the above parameters has not been investigated. To control the genotype, we studied the relationship between cigarette smoking and a series of cardiovascular risk factors in 27 monozygotic twin pairs (7 male and 20 female pairs, mean age +/- SD: 47.4 +/- 12.9 yrs) with a life-long discordance for smoking. Smoking twins had a life-long dose of smoking (Brickman index) of 287.3 +/- 241.5. Body mass index, blood pressure, haematocrit, haemoglobin and red blood cell counts, total cholesterol levels and the acute phase reactants alpha 1-acid glycoprotein and C-reactive protein were similar in smokers and non-smokers. Triglyceride was higher by 12.6% (9.5-35%, 95% confidence interval, p = 0.02) and HDL-cholesterol lower by 7.5% (0.2-15%, p = 0.04) in the smoking co-twins, who also had 8.4% (-0.2-17%, p = 0.06) higher white blood cell counts and 4.1% (1.2-7%, p < 0.01) larger mean platelet volume. There was no significant difference in clottable fibrinogen (by two methods) or in the activity of plasminogen activator inhibitor-1 between the two groups, nor was the within-pair difference in these parameters related to the smoking dose. Echo-doppler examination of the carotid arteries of 24 twin pairs showed mostly minor atherosclerotic lesions in 46% and 42% of the smoking and non-smoking co-twins. After adjustment for age, systolic blood pressure and platelet count and volume were the only variables significantly associated to the presence of vascular lesions. Cigarette smoking is associated with an atherogenic lipid profile and with changes in platelets and white cells potentially reflecting endothelial cell damage. When controlling the genotype, fibrinogen and PAI-1 activity levels did not seem directly influenced by cigarette smoking.