ABSTRACT
BACKGROUND: Even though ePrescribing systems are now available in many healthcare systems and have been a crucial milestone of the roadmaps towards eHealth in the last years, there is still a large heterogeneity among functionalities and performances of different systems. OBJECTIVE: In this paper, we propose an updated comprehensive model for the ePrescribing process able to represent, analyze, and compare current systems and to support the design of new, more general, systems suitable also to sustain the ePrescription process in National Healthcare Systems. METHODS: After a preliminary literature review, we identified six main phases of the ePrescribing process, namely Assign, Transmit, Dispense, Administer, Monitor, and Analysis Decision. Each phase produces a digital object characterized by formal properties that ensure the collection of appropriate data and information and works as input for the next one. The impact, in terms of benefits, of ePrescribing on governance, drug surveillance, and quality of care at the individual, territorial, and governmental levels are related to the formal properties of the digital objects created at the end of each phase. RESULTS AND CONCLUSIONS: The model-based implementation of each phase has an impact on the quality of care, the access to care, and the effectiveness of care delivery. The model does not cover cost evaluation, but the benefits identified can be used as basis for cost-benefit or cost-effectiveness analysis of heterogeneous systems.
Subject(s)
Electronic Prescribing/standards , Models, Theoretical , Product Surveillance, Postmarketing/methods , Europe , Health Services Accessibility , Organizational Case Studies , Quality of Health CareABSTRACT
We performed a retrospective analysis of our experience with dual nucleoside regimens to look for predictors of long term benefit. The study evaluated a cohort of 68 HIV-infected patients treated at 3 Italian hospital-based facilities. The results were evaluated using univariate and multivariate statistical analysis. Fourty-three males and 25 females were treated for 22 +/- 14 months. Sixty three patients (92.6%) suffered no or low-grade side-effects. Thirty-four patients (50%) reached a viral load <400 copies/ml (undetectable). Viremia remained persistently undetectable in 9 cases (13.2%). Variable relapses of viremia were seen in 13 patients (19.1%) even though their therapys were not modified. Eight patients (11.8%) showed relapsing viremias persistently around or below 10,000 copies/ml. All patients reaching undetectable viremia but one showed increasing or stable CD4+ cell counts. Factors predicting favourable response were: pre-treatment CD4+ T-cells >150/microl, pre-treatment viremia <50,000 copies/ml, pre-treatment lymphocytes >1,500/microl, and no previous exposure to NRTI. Total lymphocyte counts and CD4+ T-cells showed a significant correlation. Dual NRTI regimens may be still considered for patients unable to tolerate HAART regimens and presenting with favourable predictors of response.
Subject(s)
HIV Infections/drug therapy , Reverse Transcriptase Inhibitors/therapeutic use , Adult , Aged , CD4-Positive T-Lymphocytes/drug effects , CD4-Positive T-Lymphocytes/immunology , Chi-Square Distribution , Cohort Studies , Confidence Intervals , Drug Therapy, Combination , Female , HIV Infections/virology , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Retrospective Studies , Reverse Transcriptase Inhibitors/pharmacology , Time Factors , Viral Load/statistics & numerical dataABSTRACT
We describe the case of a 35-year-old woman, hospitalised due to a fever lasting two days, with signs and symptoms of cerebro-spinal meningitis. The subsequent occurrence of a thromboembolic event with stroke suggests that the neurological symptoms were secondary to a centre of infective endocarditis (instrumentally proved) in the absence of further outstanding symptoms of endocarditis. This event is very unusual during the course of endocardic disease.
ABSTRACT
Presented herein is a randomized prospective study performed to evaluate the efficacy of the addition of lymphocyte immunotherapy (LI) to progesterone (P) therapy (LI/P) for the prevention of spontaneous abortion (SAB) in primary aborters with a history of three SABs. The incidence of intrauterine pregnancies in four cycles was 23 of 35 (65.7%) patients for LI/P vs. 14 of 31 (45.1%) patients treated with progesterone alone. SABs occurred in 6 of 23 (26.0%) LI/P-treated patients compared to 8 of 14 (57.1%) given progesterone alone. The mean number of previous abortions in both groups was 3.9. The mean age of the LI/P group was 34.1 vs. 33.6 years for the group treated with progesterone alone. These data could be interpreted to show that progesterone therapy and LI independently inhibit SAB or that LI/P acts synergistically to inhibit immune destruction. LI/P therapy was found to be more effective than progesterone therapy alone.
Subject(s)
Abortion, Habitual/prevention & control , Immunotherapy, Adoptive , Lymphocytes/immunology , Progesterone/therapeutic use , Adult , Female , Humans , PregnancyABSTRACT
Twenty-four patients with HCV and NonBNonC chronic hepatitis--4 with HIV coinfection--were treated with r-IFN alpha for at least six months. In this period 62.5% of patients show a normalization of ALT but not a sustained remission. Non-responders have histologically more severe and long-lasting chronic hepatitis.
