Azienda Sanitaria Locale N. 2 Savonese

The European Health Data Space (EHDS) is an European Union (EU) initiative, aimed at helping facilitate the secure and standardized sharing of health data to improve continuity of care, research and innovation. However, the successful implementation of such an ecosystem requires the active participation and cooperation of EU Member States (MS), each of which needs to adapt its local health data infrastructure to meet the requirements at the European level. The specific characteristics of the various European countries, such as size, number of citizens, and internal organization greatly influence the ease with which a country can integrate its health data structure into this supra-national system. States with higher levels of local autonomy are experiencing significant challenges in this process. For instance, the Italian National Healthcare System (NHS) is highly decentralized, with significant variability among regions and localities. This fragmentation raises problems for health data sharing and the integration of the Italian health ecosystem into the broader EHDS framework. This paper explores Italy’s organizational and regulatory challenges, the technical barriers to interoperability, and the implications of data sharing in a decentralized environment. Moreover, by examining key Italian projects, such as Digital Health Solutions in Community Medicine (DHEAL-COM), and the tools developed by Standards Developing Organizations (SDOs) and affiliated bodies, such as Health Level 7 (HL7) Europe and Italy, the paper identifies successful initiatives and proposes strategies to overcome existing obstacles, also including security and privacy aspects of healthcare data.

IntroductionThe gut microbiota is a central player in canine health, influencing digestion, immune modulation, and metabolic homeostasis. Microbiota imbalance fuels interest in dietary interventions such as prebiotics, probiotics, and synbiotics (a combination of prebiotics and probiotics).MethodsThis pilot feasibility study employed the SCIME™, a novel in vitro fermentation model simulating the canine colonic environment, to evaluate the metabolic effects of three dietary supplements using fecal inoculum from a single healthy canine donor. Products tested were Microbiotal (product M), a probiotic (product P, Lactobacilli reuteri), and a synbiotic (product M + P: Microbiotal +L. reuteri). Over a 2-week treatment period, fermentation parameters, including short-chain fatty acid (SCFA) production, acidification trends, and proteolytic activity, were measured using a high-resolution metabolomic profiling via the Laser-Assisted Rapid Evaporative Ionization Mass Spectrometry (LA-REIMS).ResultsDescriptive observations revealed distinct and complementary metabolic patterns. Microbiotal supplementation enhanced acidification in both the proximal and distal colon, with stimulation of acetate production in the proximal colon. Treatment with L. reuteri stimulated lactate production while reducing acetate and propionate levels. The synbiotic treatment showed combined effects, increasing acetate in the distal colon and producing metabolic shifts, as determined by LA-REIMS analysis. All treatments showed trends toward increased proteolytic markers in the distal colon.ConclusionThis pilot in vitro feasibility study demonstrates that prebiotics, probiotics, and synbiotics produce distinct metabolic fingerprints in vitro, warranting future validation through studies with multiple donors, independent SCIME™ runs, and in vivo trials to assess generalizability and explore potential applications in canine gastrointestinal research.

Aim of the study wasto define the patterns and determinants of symptom persistence in Long-COVID. The study population was represented bya multicenter cohort of patients with persisting symptoms after SARS-CoV-2 infection. Data collection included demographics, comorbidities, characteristics of acute infection, vaccination, reinfection, plus 30 different symptoms. The associations between covariates and persistence were assessed in multivariable logistic regression models. The study evaluated, at a mean interval of 453 days from acute SARS-CoV-2 infection, symptom persistence in 755 patients who had Long-COVID symptoms at a mean interval of 223 days from COVID-19. At second evaluation, 423 (56.0%) patients still presented one or more symptoms and 332 (44.0%) were symptom free. In those who remained symptomatic, the mean number of symptoms significantly reduced between the two evaluations. Compared to the first evaluation, the overall mean symptom regression rate was 72%, with lower regression rates observed for dyspnea (53%), anxiety (54%) and sleep disturbances (55%). The risk of persistence was increased for female sex, higher BMI, hospitalization and stronger ventilatory support during acute disease, higher number of initial symptoms and particular comorbidities (anxiety, chronic pulmonary disease, asthma), and decreased with the increase of age and time from acute SARS-CoV-2 infection. Neither SARS-CoV-2 vaccination nor reinfection showed significant associations with persistence. In this case series, roughly half of the patients that were symptomatic 7 months after acute SARS-CoV-2 infection remained symptomatic after an additional 7 months. The pattern and predictors of persistence draw attention to certain particular risk factors and manifestations that tend to persist longer than others.

The Ligurian HIV Network, based on HL7 CDA r2, is an Italian regional infrastructure for HIV surveillance and control. To expand this network to a European level, the alignment with the EHDS and the EEHRxF, which standardize EHR data exchange, becomes essential. EU-funded projects like XpanDH are developing HL7 FHIR IGs to support this framework. Therefore, the extension of the Ligurian HIV Network requires an architectural rethink, with the introduction of the HL7 FHIR format instead of CDA r2, ensuring compliance with European standards.

Innovation in cancer therapy has increased childhood cancer survival rates. However, survivors are still at risk of developing late effects. In the digital transformation of the health sector, the Survivorship Passport (SurPass) can support long-term follow-up care plans. Gaps in seamless connectivity among hospital departments, primary care, combined with the time of health professionals required to collect and fill-in health data in SurPass, are barriers to its adoption in daily clinical practice. The PanCareSurPass (PCSP) project was motivated to address these gaps by a new version of SurPass (v2.0) that supports semi-automatic assembly from organizational Electronic Health Record (EHR) systems of the treatment summary data using HL7 FHIR, to create SurPass, and to link it to regional or national digital health infrastructures in six European countries. In this paper we present the methodology used to develop the SurPass technical implementation strategy with special focus on the European Health Data Space (EHDS). The recently provisionally approved EHDS regulation instruments a digital health data ecosystem with opportunities for cost-effective SurPass implementation across Europe. Moving forward, a European HL7 FHIR SurPass Implementation Guide along with synthetic data sets, and validation tools can enrich the European Electronic Health Record Exchange Format (EEHRxF) with use cases on health & wellness of childhood cancer survivors.

Abstract Background/Introduction Since the establishment of the Cardiology Intensive Care Units to date, there have been many scientific and technological progresses that have involved not only the pathways of diagnosis and treatment of patients in this specialist area, but also the specialist competencies that nurses must acquire in order to work in these settings. The epidemiological picture and incidence of comorbidities suggest the care of patients requiring intensive and specialised care, with the use of high technology and circulatory support systems, changing the usual setting of a cardiology intensive care unit to a high-intensity cardiology intensive care unit. To date, a few studies have been described in the literature that have mapped the competences of the cardiology intensive care unit nurse, but the heterogeneity of training education at a European level has not yet made a reference framework for this specialist area generalisable. (Endacott R., et al. 2022). In Italy, there are no specific postgraduate courses focused on specialist cardiac intensive care skills development for nurses. To develop such courses, content incorporating appropriate competencies is required and this study was designed to meet this. Purpose To identify the core competencies of nurses working in High-intensity cardiology intensive care units (ICUs) in Italy to develop national competence framework. Methods A three-round e-Delphi study was conducted with a group of 30 experienced cardiac intensive care unit nurses; 28 completed all three rounds. The first round asked each participant to write down five competences, which they were asked to prioritize in the second round. In the third round, they were asked to prioritize again, considering the scores made in the second round. The final list of competencies was the one that achieved a greater than 70% agreement among the participants. Results We identified 12 core competencies that include a few competence areas, including high-tech care, emergency management, teamwork, and critical decision-making. Only slight differences emerged among the panel of experts regarding the priority given to certain core competencies, such as ECG reading, emergency management and technical and practical skills in the intensive care area. Conclusions This is the first study in Italy to identify the core and advanced competencies of nurses working in high level cardiac intensive care units. This study provides an important basis for the development of postgraduate educational programme and a framework for the definition of national standards to be implemented in clinical practice.

At San Martino IRCCS Hospital in Genoa, Italy, emergency and urgent surgery is classified according to the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) classification, whereby cases are divided into two categories and colour-coded accordingly: - EMERGENCY - (Colour-code: RED) "Surgery to be performed within minutes"; - URGENCY - (colour-code: YELLOW) "Surgery to be performed within hours". In this context, it is essential that the emergency surgical team gets clear and complete information from the proposing surgeon, in order to complete the surgical list. Between 14th April 2023 and 23th July 2023, a new method of requesting urgent and emergency surgery by filling out an online form was tested. A total of 406 online requests were made, resulting in 367 E/U surgeries. The greatest number of emergency operations concerned thoracic-abdominal surgery (45%), followed by urology (19%). The requests analysed classified 18% of cases as red and 71% as yellow. The remaining 11% contained compilation errors. Moreover, 11% of the interventions were not performed within the time limits defined according to the severity code. By means of this new tool, San Martino IRCCS Hospital's Healthcare Management Unit can monitor requests for surgery in real time, thereby achieving greater efficiency and implementing corrective measures in the use of Operating Room resources.

Introduction/BackgroundCervical cancer is the fourth most common female cancer worldwide. Squamous cell carcinoma (SCC) is the most prevalent histotype, while adenocarcinoma (AC) represents less than 25% of cervical malignancies, mostly caused by HR-HPV infection. The incidence of SCC is constantly decreasing, after cervical cancer screening implementation, whereas AC in young women still represents a critical problem. Women reaching the mean age of AC incidence may not have been vaccinated as HPV vaccination started off in 2007 and, in Italy, the cohorts 1997–1998 reports an adhesion of 63–65%.The aim of the present study is to analyze adenocarcinoma in situ (AIS) and adenocarcinoma invasive (ACI) characteristics in a large sample of Italian women aged 25–45 and their HPV vaccination status.MethodologyA multicenter retrospective study of women 25–45 years affected by AIS and/or ACI was performed between January 2018 and December 2022. The study was proposed by the Italian Society for Cervical Cancer Screening (GISCI) and involved eight gynecological centers.Patients’ HR-HPV status and vaccination was investigated along with previous cytology and eventual association of squamous cell lesions.Pathological details included lesion dimensions, margin status and Silva Pattern documentation.Results115 patients affected by AIS (76) and ACI (39) were identified. Median age was 41,6 years with 18% in the age group 25–30. A positive HPV test was registered in 85% of patients at the time of diagnosis and an associated squamous lesion was observed in 49% of cases.Women underwent conization in 79% of cases and 21% had hysterectomy. In 41% of cases the lesions were small (<5 mm) and 59% of positive margins were endocervical.Among the 115 patients, no one had HPV-vaccination.ConclusionThere is urgent need to implement and enhance primary prevention strategy in terms of HPV vaccination in challenging AC incidence in young women.DisclosuresNo disclosures.

Cervical spinal cord injuries (cSCI) severely affect upper limb function, yet research on post-injury neuromotor abilities is limited. In response, we developed an assessment integrating clinical, kinematic and muscle activity measures. Twelve cSCI (C5-C7) and six unimpaired participants underwent a clinical (Range Of Motion and Manual Muscle tests) and an instrumented assessment. During the latter, bilateral upper body kinematics and muscle activity were recorded as participants performed a set of unilateral movements, i.e. reaching movements toward different heights-directions and an object transfer along an arch-shaped structure (arc task). Kinematics and neuromuscular indicators were analyzed following a two-tiered approach: comparing unimpaired and cSCI and differentiating more and less impaired arms within the cSCI cohort based on their ability to complete the arc task. Clinical tests revealed shoulder mobility and strength limitations in cSCI participants, with a significant weakness in elbow extension noted in more impaired arms. The instrumented assessment revealed reduced movement speed, smoothness and accuracy in the cSCI cohort, primarily due to weaknesses in the pectoralis muscle affecting contralateral movements and deltoids affecting ipsilateral movements. Muscle activations were detected in the non-moving arm of cSCI participants, particularly noticeable during movements toward greater heights or in a contralateral direction. The pronounced weakness in the pectoralis muscle of the more impaired cSCI arms explained the related ability to complete only 28% of the arc task. Our findings provide a thorough insight into changes in upper limb neuromotor function following cSCI, underscoring motor deficits and related alterations in bilateral muscle activity.