IRCCS Foundation Salvatore Maugeri

Pavia, Italy

IRCCS Foundation Salvatore Maugeri

Pavia, Italy

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Peleg M.,Haifa University | Shahar Y.,Ben - Gurion University of the Negev | Quaglini S.,University of Pavia | Broens T.,MobiHealth B.V. | And 23 more authors.
International Journal of Medical Informatics | Year: 2017

Objectives The MobiGuide project aimed to establish a ubiquitous, user-friendly, patient-centered mobile decision-support system for patients and for their care providers, based on the continuous application of clinical guidelines and on semantically integrated electronic health records. Patients would be empowered by the system, which would enable them to lead their normal daily lives in their regular environment, while feeling safe, because their health state would be continuously monitored using mobile sensors and self-reporting of symptoms. When conditions occur that require medical attention, patients would be notified as to what they need to do, based on evidence-based guidelines, while their medical team would be informed appropriately, in parallel. We wanted to assess the system's feasibility and potential effects on patients and care providers in two different clinical domains. Materials and methods We describe MobiGuide's architecture, which embodies these objectives. Our novel methodologies include a ubiquitous architecture, encompassing a knowledge elicitation process for parallel coordinated workflows for patients and care providers; the customization of computer-interpretable guidelines (CIGs) by secondary contexts affecting remote management and distributed decision-making; a mechanism for episodic, on demand projection of the relevant portions of CIGs from a centralized, backend decision-support system (DSS), to a local, mobile DSS, which continuously delivers the actual recommendations to the patient; shared decision-making that embodies patient preferences; semantic data integration; and patient and care provider notification services. MobiGuide has been implemented and assessed in a preliminary fashion in two domains: atrial fibrillation (AF), and gestational diabetes Mellitus (GDM). Ten AF patients used the AF MobiGuide system in Italy and 19 GDM patients used the GDM MobiGuide system in Spain. The evaluation of the MobiGuide system focused on patient and care providers’ compliance to CIG recommendations and their satisfaction and quality of life. Results Our evaluation has demonstrated the system's capability for supporting distributed decision-making and its use by patients and clinicians. The results show that compliance of GDM patients to the most important monitoring targets – blood glucose levels (performance of four measurements a day: 0.87 ± 0.11; measurement according to the recommended frequency of every day or twice a week: 0.99 ± 0.03), ketonuria (0.98 ± 0.03), and blood pressure (0.82 ± 0.24) – was high in most GDM patients, while compliance of AF patients to the most important targets was quite high, considering the required ECG measurements (0.65 ± 0.28) and blood-pressure measurements (0.75 ± 1.33). This outcome was viewed by the clinicians as a major potential benefit of the system, and the patients have demonstrated that they are capable of self-monitoring – something that they had not experienced before. In addition, the system caused the clinicians managing the AF patients to change their diagnosis and subsequent treatment for two of the ten AF patients, and caused the clinicians managing the GDM patients to start insulin therapy earlier in two of the 19 patients, based on system's recommendations. Based on the end-of-study questionnaires, the sense of safety that the system has provided to the patients was its greatest asset. Analysis of the patients’ quality of life (QoL) questionnaires for the AF patients was inconclusive, because while most patients reported an improvement in their quality of life in the EuroQoL questionnaire, most AF patients reported a deterioration in the AFEQT questionnaire. Discussion Feasibility and some of the potential benefits of an evidence-based distributed patient-guidance system were demonstrated in both clinical domains. The potential application of MobiGuide to other medical domains is supported by its standards-based patient health record with multiple electronic medical record linking capabilities, generic data insertion methods, generic medical knowledge representation and application methods, and the ability to communicate with a wide range of sensors. Future larger scale evaluations can assess the impact of such a system on clinical outcomes. Conclusion MobiGuide's feasibility was demonstrated by a working prototype for the AF and GDM domains, which is usable by patients and clinicians, achieving high compliance to self-measurement recommendations, while enhancing the satisfaction of patients and care providers. © 2017 Elsevier B.V.


Peleg M.,Haifa University | Shahar Y.,Ben - Gurion University of the Negev | Quaglini S.,University of Pavia | Fux A.,Haifa University | And 11 more authors.
User Modeling and User-Adapted Interaction | Year: 2017

MobiGuide is a ubiquitous, distributed and personalized evidence-based decision-support system (DSS) used by patients and their care providers. Its central DSS applies computer-interpretable clinical guidelines (CIGs) to provide real-time patient-specific and personalized recommendations by matching CIG knowledge with a highly-adaptive patient model, the parameters of which are stored in a personal health record (PHR). The PHR integrates data from hospital medical records, mobile biosensors, data entered by patients, and recommendations and abstractions output by the DSS. CIGs are customized to consider the patients’ psycho-social context and their preferences; shared decision making is supported via decision trees instantiated with patient utilities. The central DSS “projects” personalized CIG-knowledge to a mobile DSS operating on the patients’ smart phones that applies that knowledge locally. In this paper we explain the knowledge elicitation and specification methodologies that we have developed for making CIGs patient-centered and enabling their personalization. We then demonstrate feasibility, in two very different clinical domains, and two different geographic sites, as part of a multi-national feasibility study, of the full architecture that we have designed and implemented. We analyze usage patterns and opinions collected via questionnaires of the 10 atrial fibrillation (AF) and 20 gestational diabetes mellitus (GDM) patients and their care providers. The analysis is guided by three hypotheses concerning the effect of the personal patient model on patients and clinicians’ behavior and on patients’ satisfaction. The results demonstrate the sustainable usage of the system by patients and their care providers and patients’ satisfaction, which stems mostly from their increased sense of safety. The system has affected the behavior of clinicians, which have inspected the patients’ models between scheduled visits, resulting in change of diagnosis for two of the ten AF patients and anticipated change in therapy for eleven of the twenty GDM patients. © 2017 Springer Science+Business Media Dordrecht


Mina E.D.,University of Pavia | Ciccone R.,University of Pavia | Brustia F.,National Neurological Institute C Mondino | Bayindir B.,University of Pavia | And 16 more authors.
European Journal of Human Genetics | Year: 2015

We analyzed by next-generation sequencing (NGS) 67 epilepsy genes in 19 patients with different types of either isolated or syndromic epileptic disorders and in 15 controls to investigate whether a quick and cheap molecular diagnosis could be provided. The average number of nonsynonymous and splice site mutations per subject was similar in the two cohorts indicating that, even with relatively small targeted platforms, finding the disease gene is not an univocal process. Our diagnostic yield was 47% with nine cases in which we identified a very likely causative mutation. In most of them no interpretation would have been possible in absence of detailed phenotype and familial information. Seven out of 19 patients had a phenotype suggesting the involvement of a specific gene. Disease-causing mutations were found in six of these cases. Among the remaining patients, we could find a probably causative mutation only in three. None of the genes affected in the latter cases had been suspected a priori. Our protocol requires 8-10 weeks including the investigation of the parents with a cost per patient comparable to sequencing of 1-2 medium-to-large-sized genes by conventional techniques. The platform we used, although providing much less information than whole-exome or whole-genome sequencing, has the advantage that can also be run on 'benchtop' sequencers combining rapid turnaround times with higher manageability. © 2015 Macmillan Publishers Limited All rights reserved.


Fassina L.,University of Pavia | Saino E.,University of Pavia | Visai L.,University of Pavia | Visai L.,IRCCS Foundation Salvatore Maugeri | And 8 more authors.
International Journal of Immunopathology and Pharmacology | Year: 2012

One of the key challenges in reconstructive bone surgery is to provide living constructs that possess the ability to integrate in the surrounding host tissue. Bone graft substitutes and biomaterials have already been widely used to heal critical-size bone defects due to trauma, tumor resection and tissue degeneration. In the present study, gelatin-based cryogels have been seeded with human SAOS-2 osteoblasts followed by the in vitro culture of the cells. In order to overcome the drawbacks associated with static culture systems, including limited diffusion and inhomogeneous cell-matrix distribution, the present work describes the application of a bioreactor to physically enhance the cell culture in vitro using an electromagnetic stimulus. The results indicate that the physical stimulation of cell-seeded gelatin-based cryogels upregulates the bone matrix production. We anticipate that the scaffolds developed consisting of human bone proteins and cells could be applied for clinical purposes related to bone repair. Copyright © by BIOLIFE, s.a.s.


Sacchi L.,University of Pavia | Fux A.,Haifa University | Napolitano C.,IRCCS Foundation Salvatore Maugeri | Panzarasa S.,University of Pavia | And 5 more authors.
Studies in Health Technology and Informatics | Year: 2013

MobiGuide is a project devoted to the development of a patient-centric decision support system based on computerized clinical guidelines for chronic illnesses including Atrial Fibrillation (AF). In this paper we describe the process of (1) identifying guideline recommendations that will require patients to take actions (e.g., take measurement, take drug), thus impacting patients' daily-life behavior, (2) eliciting from the medical experts the corresponding set of personalized operationalized advices that are not explicitly written in the guideline (patient-tailored workflow patterns) and (3) delivering this advice to patients. The analysis of the AF guideline has resulted in four types of patient-tailored workflow patterns: therapy-related advisors, measurements advisors, suggestions for dealing with interventions that may require modulating patient therapy, and personalized packages for close monitoring of patients. We will show how these patterns can be generated using information stored in a patient health record that embeds clinical data and data about the patient's personal context and preferences. © 2013 IMIA and IOS Press.

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