Recommend Documents. Broccoli seed deterioration was carried out at. P65 - CiteSeerX. The assembling of an object rassegne reali di medicina Colm pieces is called mosaicing . It is similar to The missing bottom of the pot is due to part 4, n.
Bargali 04 - CiteSeerX. Scalvini, M. Volterrani, A. Giordano, F. In una terza fase, la struttura del Centro Servizi viene implementata con nuove tecnologie HDLS e con un innovativo modello con altre figure professionali. Attualmente quattro sono i servizi disponibili: per i medici di medicina generale, il Rassegne reali di medicina Colm domicialiare per i pazienti con patologie croniche, la Telediagnosi per palpitazioni e un servizio di call center per ospedali.
In conclusione, il Boario Rassegne reali di medicina Colm Care project ha raggiunto la maturità e alcuni risultati preliminari. Monaldi Arch Chest Dis ; 3, Fondazione S. Health Telematic Network, Brescia, Italy. Corrispondenza: Dott.
Scalvini, Fondazione S. The development of telemedicine assumes advantages for the individual patient in the interaction between primary and secondary care. In addition, general practitioners can gain educationally and hospital follow-up appointments may be reduce in number, because the general practitioners can handle more advanced medical problems. Economic savings for the health service are a driving force. Evidence to date is that the patient seems satisfied and the general practitioner gains competence, but the extent to which telemedicine results in reduced follow-up appointments and economic savings are not yet established.
The seemingly intransigent problems of increasing cost and inequitable access to quality health care, coupled with the merger of the information technology and health rassegne reali di medicina Colm gave rise to the field of telemedicine.
We report an Italian experience, the Boario Home Care project, born inwith the aim of applying the new models of disease management and rassegne reali di medicina Colm new technology on the territory. In broad terms, since its inception in the history of Boario Home Care Project can be characterized as consisting of three major phases.
Each phase has been closely linked to significant advances in Information Technology and Telecommunication. In the rassegne reali di medicina Colm phase the project was to realize a telematic network for the General Practitioners in a mountain territory particularly hard to reach Vallecamonica, a valley in the PreAlps and to give them the possibility, over a 24 hour basis, of monitoring cardiovascular diseases rassegne reali di medicina Colm their patients using a mobile electrocardiographer.
The recorded ECG could be sent by a fixed and mobile GSM telephone to the rassegne reali di medicina Colm station in Boario Terme where a Cardiologist reported the trace, offering an interactive teleconsultation and prescribed therapy, rassegne reali di medicina Colm necessary.
In the second rassegne reali di medicina Colm the project was extended to the regional and then national territory and the number of enrolled GPs increased.
Afterwards the user was put through to the Cardiologist who received the trace at home on his PC by FAX, reported the trace and provided teleconsultation. In the third phase, that is nowadays, the structure of the Service Center has been implemented with new broad band technologies HDLS.
The nerve center is now equipped with 4 Hewlett Packard servers with back-up hardware to avoid activity interruptionsa WEB server for Internet connection, firewall for data security, a computerized call-center, 15 LAN workstations with 4 printers over a network and a central faxmaker. The system information flow is the following: a phone call arrives from General Practitioners, patients, Health Centers, Rest Homes, etc.
At this point the trace can be received, the user is put through to rassegne reali di medicina Colm Cardiologist or the Nurse on duty a three actors call takes place who are at home and are connected to the central data base through Internet. In this way the remote personal computer works in terminal emulation to prevent the data stored in the central server from being transferred on local disk or printed.
Up to today the GPs asked for a teleconsultation for patients: 35 cardiologists are involved. The diagnostic accuracy of the service as for the Emergency Department referral  was tested on a sample of patients and was of Moreover the potential reduction of costs for the National Health Service through a telecardiology service has been estimated. The good results, even if they are preliminary, must be attributed to the effective teleconsultation which takes place after the ECG transmission, between two professional figures, an experienced cardiologist and the GP who knows his patients very well; this aspect confirms the impression of the reciprocal reliance and compliance of GPs and specialists in managing problems and possibly in following diagnostic and therapeutic common protocols.
Improving this professional relationship, telecardiology can aid the appropriateness of hospital admissions and referrals to the Emergency Department, of diagnostic tests demands and of chronic disease home management . The physiologic data and biologic signals transmission gives objective data which may show the need of an intervention of a physician or a nurse; the rassegne reali di medicina Colm of real time transmission of these objective data by telephone in association with subjective data given by the patient allow telemedicine to become a new and unique approach to the problem .
Teleconsultation provided two different possibilities: scheduled appointments Telemonitoringevery week for patients with severe heart failure III NYHA class or every fifteen days for patients with moderate heart failure II NYHA class and calls in the presence of symptoms Teleassistancein which the patients could call the Service rassegne reali di medicina Colm 24 hours a day all year round and talk with the nurse.
This group rassegne reali di medicina Colm patients was compared with a group of patients with an usual follow-up. The preliminary results of the project are characterized by a significant reduction in instabilization Establishing the cause of palpitations may be difficult because historical clues are not always accurate. A hour Holter monitor is usually used, but the yield of this instrument is low in patients whose symptoms occur infrequently.
Another instrument used to study palpitations is a transtelephonic event recorder. This hand-held device was given to patients and they could apply it to the chest when the symptoms occurred. The patient pressed a button to record about 30 record of cardiac rhythm, which was stored in the memory of the device. The recording was later transmitted over the telephone for printing and interpretation to a call-center working 24 hours a day.
ER were used for 7 days or until two recordings were obtained while symptoms occurred. The percentage of patients in whom Event recorder was rassegne reali di medicina Colm to record the ECG trace during palpitations was In conclusion, more patients reach a clear diagnosis in real time when use ER in comparison with Holter for palpitation. For this reason Event Recorder should replace Holter monitoring for this purpose whenever possible.
The patient can now transmit his biological signals as ECG and he is automatically connected with the Nurse or the Cardiologist of their own Cardiological Division who provide teleconsultation and triage activity for example comparison of the ECG with the previous ones with updating of informatic clinical report.
At the end of all the procedures, the data are stored, transferred to the webserver and available on the net only for password owners The Service Center provides the technological and organizational support, rassegne reali di medicina Colm health activity is managed by the Cardiologists and the Nurses of the hospital. Now the Boario Home Care Project is five years old and it has demonstrated its value as for increased access to care, quality of care and reduction of costs for the National Health Service.
Another main characteristic of the project is that it can easily be transferred to another context with different accessibility and quality of local services. In conclusion, Boario Home Care project has reached its maturity and many results even if we can consider them preliminary; in fact in the field rassegne reali di medicina Colm Telemedicine, although claims about the utility and the efficacy of new telecommunication systems have been widely made, these are not founded on strong evidence.
Our research has shown some deficiencies in the design and they are often not controlled. Trying to solve these problems we have planned two controlled studies in cooperation with Rassegne reali di medicina Colm Health Ministry, hoping that these new results will be able to give some answers to the main open questions in the field of Telemedicine. This includes an exhibition on the successful use of ICT in public service provision at each of the respective conferences.
Each application was evaluated by a minimum of three expert evaluators; The best applicants will receive an award, to rassegne reali di medicina Colm presented by Commissioner Erkki Liikanen at the respective conferences.
Summary References 1. Boario Home Care project was born inwith the aim of applying the new models of disease management and the new technology on the territory. In the first phase the project was to realize a telematic network for the General Practitioners in a mountain territory; In the second phase rassegne reali di medicina Colm project was extended to the regional and then national territory and the number of enrolled GPs increased.
In the third phase, that is nowadays, the structure of the Service Center has been implemented with new broad band technologies HDLS and with an innovative teleworking model has been adopted for the professional figures involved. Four different types of services are now available: General Practitioners, Home Telenursing for chronic patients, Telediagnosis for palpitations and Call Center Services for hospitals.
In conclusion, Boario Home Care project has reached its maturity and many results even if we can consider them preliminary in the field of Telemedicine. Telecardiology community: a new approach to take care of cardiac patients. Cardiologia ; 44 10 : Italian Heart Journal Suppl ; 1 7 : Riduzione potenziale dei costi per il servizio sanitario nazionale mediante un servizio di telecardiologia dedicato ai medici di medicina generale.
Italian Heart Journal Suppl ; 2 10 : Telecardiologia: una nuova modalità per gestire il territorio. Monaldi Arch Chest Dis sept. Scalvini S, Giordano A. Monaldi Arch Chest Dis dec. Telemedicine: utility for care and monitoring in ischemic cardiac disease. Computers in Cardiology ; vol. Scalvini S, Zanelli E.
Telecardiology: a new support for general practitioners in the management of elderly patients. Age and ageing ; vol. Assessment of prehospital chest pain using telecardiology. Journal of Telemedicine and Telecare ; 8, number 4: Effect of a home based telecardiology on chronic heart failure outcomes: a case control pilot study. Event recorder transtelefonico per il monitoraggio del cardiopalmo accessionale. Pavia - La Certosa Read more. Your name. Close Save changes. Remember me Forgot password?