South Tyrol Healthcare Company: A Look at a Peculiar Model of Claims Management in Italy and Analysis of Its Last 11 Years.

BACKGROUND: Alternative Disputes Resolution (ADR) systems are becoming increasingly important tools in recent years for the management and resolution of health responsibility cases, but their dissemination and efficiency are still poorly described. The purpose of this paper is to present an ADR system in the autonomous province of Bolzano: the Conciliation Commission. METHODS: systematic collection of all claims of the South Tyrol Sanitary Service that were dealt with in the Conciliation Commission from 1 January 2012 to 31 December 2022. RESULTS: closing times of the applications received turn out to be less than a year in 63.8% of the cases, with a number of cases managed rather stably in the time, even if minimal if compared to the number of complaints received to the South Tirol Health Service. Only 5.3% of the application continued the legal process before a civil court. CONCLUSIONS: the Conciliation Commission of South Tirol appears to be an excellent instrument for the resolution of disputes in the healthcare field, with rapid resolution times and little to zero costs for the healthcare company, a public health institution. Despite its effectiveness, it seems to be a tool that is still little-known in South Tyrol.

Feasibility of an Integrated Telemonitoring System for Home-Recorded EEG with Automated AI-Based EEG Analysis.

BACKGROUND: Self-recorded EEG by patients at home might present a viable alternative to inpatient epilepsy evaluations. OBJECTIVES AND METHODS: We developed a novel telemonitoring system comprising seamlessly integrated hard- and software with automated AI-based EEG analysis. RESULTS: The first complete study participation results demonstrate feasibility and clinical utility. CONCLUSION: Our telemonitoring solution potentially improves treatment of patients with epilepsy and moreover might help to better distribute resources in the healthcare system.

Exploring the Impact of Saccharin on Neovascular Age-Related Macular Degeneration: A Comprehensive Study in Patients and Mice.

Purpose: We aimed to determine the impact of artificial sweeteners (AS), especially saccharin, on the progression and treatment efficacy of patients with neovascular age-related macular degeneration (nAMD) under anti-vascular endothelial growth factor (anti-VEGF-A) treatment. Methods: In a cross-sectional study involving 46 patients with nAMD undergoing intravitreal anti-VEGF therapy, 6 AS metabolites were detected in peripheral blood using liquid chromatography - tandem mass spectrometry (LC-MS/MS). Disease features were statistically tested against these metabolite levels. Additionally, a murine choroidal neovascularization (CNV) model, induced by laser, was used to evaluate the effects of orally administered saccharin, assessing both imaging outcomes and gene expression patterns. Polymerase chain reaction (PCR) methods were used to evaluate functional expression of sweet taste receptors in a retinal pigment epithelium (RPE) cell line. Results: Saccharin levels in blood were significantly higher in patients with well-controlled CNV activity (P = 0.004) and those without subretinal hyper-reflective material (P = 0.015). In the murine model, saccharin-treated mice exhibited fewer leaking laser scars, lesser occurrence of bleeding, smaller fibrotic areas (P < 0.05), and a 40% decrease in mononuclear phagocyte accumulation (P = 0.06). Gene analysis indicated downregulation of inflammatory and VEGFR-1 response genes in the treated animals. Human RPE cells expressed taste receptor type 1 member 3 (TAS1R3) mRNA and reacted to saccharin stimulation with changes in mRNA expression. Conclusions: Saccharin appears to play a protective role in patients with nAMD undergoing intravitreal anti-VEGF treatment, aiding in better pathological lesion control and scar reduction. The murine study supports this observation, proposing saccharin's potential in mitigating pathological VEGFR-1-induced immune responses potentially via the RPE sensing saccharin in the blood stream.

Tribute to the Flute: A Literature Review of Playing-Related Problems in Flautists.

Playing musical instruments places unusually high demands on specific parts of the human body. Relative to the instruments they play, musicians may experience instrument-related symptoms, as recorded in flute players. The objective was to provide an overview of the study findings addressing medical problems in flautists to better understand their complaints and pave the way for more personalized healthcare. Several electronic databases (PubMed, Embase, Cochrane Library) were systematically searched in July 2022. Furthermore, the references of all included articles were reviewed for additionally relevant sources. The resulting set of studies was summarized in a table, with quality assessment according to the SIGN grading system. From an initial 433 hits, the search yielded 95 studies with a total of 32,600 musicians, including at least 2134 flautists. Among the latter, evidence was found for musculoskeletal, neurological, dermatological, temporomandibular, and hearing complaints, overuse and reflux symptoms, velopharyngeal insufficiency, as well as upper and lower airway impairment. Other specialists may be consulted equally often and should be sensitive to the particular medical problems in flautists. Future studies would ideally contain specific outcome analyses on an international scale and consider flautists as an individual subgroup within a larger number of total participants.

DICOM® integrated EEG data: A first clinical implementation of the new DICOM standard for neurophysiology data.

OBJECTIVE: Demonstrating a pilot implementation of the Digital Imaging and Communication in Medicine (DICOM) neurophysiology standard published in 2020. METHODS: An automated workflow for converting EEG data from a proprietary vendor EEG format to standardized and interoperable DICOM format was developed and tested. RESULTS: Retrieval of proprietary EEG data, associated videos, annotations and metadata from the vendor EEG archive and their subsequent conversion to DICOM EEG was possible without changes to the departmental workflow. To transfer DICOM EEG data to the central radiology DICOM archive, only minor extensions in the parameterization of the archive's DICOM interfaces were necessary. Linkage with the electronic health record (EHR) and display in a DICOM EEG viewer could be demonstrated. A random sample of 88 DICOM EEG studies was compared to the original vendor files and EEG and video file sizes were comparable. CONCLUSIONS: Storing and reviewing EEG data in standardized DICOM format is feasible, facilitated by existing DICOM infrastructure, and therefore allows for vendor independent access to EEG data. SIGNIFICANCE: We report the first implementation of the DICOM neurophysiology standard, thus promoting standardization in the field of neurophysiology as well as data exchange and access to legacy recordings in an interoperable vendor independent format.

First Clinical Experiences with the New DICOM Neurophysiology Standard.

BACKGROUND: Exchange of EEG data among institutions is complicated due to vendor-specific proprietary EEG file formats. The DICOM standard, which has long been used for storage and exchange of imaging studies, was expanded to store neurophysiology data in 2020. OBJECTIVES: To implement DICOM as an interoperable and vendor-independent storage format for EEG recordings in the Clinic Hietzing. METHODS: A pilot implementation for automated conversion of EEG data from a proprietary to standardized DICOM format was developed. Additionally, EEG review based on a central DICOM archive in a DICOM EEG viewer (encevis by AIT) was implemented. RESULTS: More than 200 long-term video EEG recordings and over 3000 routine EEGs were archived to the central DICOM archive of the WIGEV. CONCLUSION: Using DICOM as a storage format for EEG data is feasible and leads to a substantial improvement of interoperability and facilitates data exchange between institutions.

Standardization of neurophysiology signal data into the DICOM® standard.

A standard format for neurophysiology data is urgently needed to improve clinical care and promote research data exchange. Previous neurophysiology format standardization projects have provided valuable insights into how to accomplish the project. In medical imaging, the Digital Imaging and Communication in Medicine (DICOM) standard is widely adopted. DICOM offers a unique environment to accomplish neurophysiology format standardization because neurophysiology data can be easily integrated with existing DICOM-supported elements such as video, ECG, and images and also because it provides easy integration into hospital Picture Archiving and Communication Systems (PACS) long-term storage systems. Through the support of the International Federation of Clinical Neurophysiology (IFCN) and partners in industry, DICOM Working Group 32 (WG-32) has created an initial set of standards for routine electroencephalography (EEG), polysomnography (PSG), electromyography (EMG), and electrooculography (EOG). Longer and more complex neurophysiology data types such as high-definition EEG, long-term monitoring EEG, intracranial EEG, magnetoencephalography, advanced EMG, and evoked potentials will be added later. In order to provide for efficient data compression, a DICOM neurophysiology codec design competition will be held by the IFCN and this is currently being planned. We look forward to a future when a common DICOM neurophysiology data format makes data sharing and storage much simpler and more efficient.

Achieving an Interoperable Data Format for Neurophysiology with DICOM Waveforms.

Modern healthcare faces multiple challenges: diagnosis and treatment happens multidisciplinary and distributed. The key principle to accomplish this is interoperability. Some disciplines like radiology are well experienced in interoperable workflows and cross institution data exchange; other disciplines just realize the growing importance. In this paper we analyze the situation in neurology and give an overview of attempts made in the past to establish an interchangeable, interoperable data format for biomedical signal data, which would be suitable for neurology, too. Focusing on EEG data we will discuss how DICOM Waveforms could be used to cover many of the requirements. As a result necessary adaptions and remaining issues are identified. With DICOM Waveforms a specification is available that covers most of the interoperability requirements. With only little adjustments DICOM Waveforms could establish data interoperability in neurology.