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Introduction: Few evidences about methods to harvest educational needs by health care professionals in internal medicine have been published. In this project the following objectives have been pursued: to express preferences by each health care worker; to evaluate the efficacy of an intranet-based survey in order to structure continuing medical education (CME) planning., Methods: We created a form based on 7 questions, exploring the following areas: knowledge, know-how, communication, transversal competencies. This survey, implemented on a google drive platform, was accessible through the Azienda Sanitaria Unica Regione (ASUR) Marche intranet. Each questionnaire was analyzed with Google drive and the results were discussed within Medicine Department Committee., Results: 103/228 health care workers responded to the survey. On the basis of health care workers preferences, financial resources, relevance, untreated topics in the previous 5 years and congruence with ASUR targets, heart failure, malnutrition and non-invasive mechanical ventilation were chosen as main topics for the year 2017 and practical training, internal courses and focus groups were planned., Discussion and Conclusions: A relevant percentage of health care workers (45%) responded to our online survey and the analysis of the results has been used for planning users-centered educational courses; this approach represents a sure novelty in failure of published experiences about the relationship between collection of needs and CME planning.

This paper describes the experience of a hospital which has introduced a system of computerized management of letters of authorization for healthcare workers to access sensitive health data, through the use of open source software. A new corporate intranet portal was created with access given only to the privacy contacts of each operational unit of the hospital. Once the privacy contact has entered the relevant user authorization, these must be approved first by the Directors of the respective operational units and finally by the privacy officer. The introduction of this system has allowed a systematic approach to the management of authorization for access to health data by hospital staff, regular updating and monitoring of the authorization and the start of a process of digitalization of documents.

Background: In the context of an operative network for acute coronary syndrome consisting in telemedicine equipment and 24-h catheter facility availability, a database was worked out to verify clinical pathways, timeline, prevalence of cardiovascular risk factors, diagnostic and therapeutic choices, and clinical results. The aim of this study was to evaluate the adherence to guidelines in the real world in order to assess quality of care., Methods: We implemented a database in the preexisting hospital intranet due to open source interactive pages. From international guidelines we obtained performance measures for each step of the care process, in order to have a continuous and updated evaluation of our healthcare performance. After an accurate analysis of the results of the first 2-year data collection, we modified the performance measurement set to optimize our database. All data were analyzed with statistical program SPSS., Results: A total of 1066 patient characteristics within a period of 5 semesters were analyzed: trends for each of the 11 performance measures were evaluated. In 852 patients clinical and angiographic characteristics were analyzed: cardiovascular risk factors and TIMI risk score for ST-elevation myocardial infarction patients, different pathways and first-aid timeline. Data about pharmacological therapy on admission, during intensive care unit stay and at discharge were also collected., Conclusions: The present study assesses the utility of continuous monitoring and of verifying quality of care with a dedicated database in order to evaluate adherence to guidelines and to promote optimization of clinical practice.

Purpose: The purpose of this article is to illustrate a case where acquisition of digital imaging know-how by a modern radiotherapy division has helped to solve a technical problem while allowing substantial savings through the use of free and open-source resources. The problem was related to the necessity to route, with complex policies, the images produced by different digital imaging and communications in medicine (DICOM) sources within the department or in other divisions and/or hospitals., Materials and Methods: The problem was solved by using completely free, well-tested and stable technologies (PHP, Apache, MySQL, DCMTK OFFIS, Red Hat Linux 9A and Linux Fedora Core 4) and low-cost hardware to contain costs. In the development, we also considered integration of the routed images with the existing electronic clinical records., Results: The system developed, called the dicom router, implemented two kinds of routing: manual and automatic, both oriented to link the images acquired with the existing electronic clinical records. System stability was enhanced in a second phase by using a low-cost hardware redundancy solution. The system has now been operating for 1 year and has proved the value of the technologies used., Conclusions: The need to operate with more than one provider creates a series of integration issues, so that it becomes economically appealing to acquire internally the knowledge needed to interact more precisely with providers of big information technology (IT) solutions. This need is well catered for by open-source technologies, which are well documented and available to everyone. By using them, in-house IT technicians are able to implement valuable technical solutions for small-to medium-sized informatization problems, which would otherwise remain unsolved except with great economic efforts.

Information and communication are two components, influencing decisional and management activity in the Health Institutions. Information is retrieved, processed and diffused in any organization level, improving knowledge in the health and technical-administrative departments. In communication networks data flow from a "source" to different environments and structures requiring information, passing through "decisional points", called "nodes". The responsibility of the entire system is devoted to the process of the information in itself. Principal databases, allowed by actual technology information systems, used in a teaching hospital, thanks to the experience of our Azienda Ospedaliero-Universitaria in Ferrara, are described in this work. Several kinds of sources, processes and uses of data will be focused, including a description of the improving architecture of the "network" of our teaching hospital and its integration with our Regional and National Health Service.

In the era of evidence-based medicine, the monitoring of the adherence to the guidelines is fundamental, in order to verify the diagnostic and therapeutic processes. Informatic paperless databases allow a higher data quality, lower costs and timely analysis with overall advantages over the traditional surveys. The RUTA project (acronym of Triveneto Registry of ANMCO CCUs) was designed in 1999, aiming at creating an informatic network among the coronary care units of a large Italian region, for a permanent survey of patients admitted for acute myocardial infarction. Information ranges from the pre-hospital phase to discharge, including all relevant clinical and management variables. The database uses DBMS Personal Oracle and Power-Builder as user interface, on Windows platform. Anonymous data are sent to a central server.

Evidence-based Medicine is a product of the electronic information age and there are several databases useful for practice it--MEDLINE, EMBASE, specialized compendiums of evidence (Cochrane Library, Best Evidence), practice guidelines--most of them free available through Internet, that offers a growing number of health resources. Because searching best evidence is a basic step to practice Evidence-based Medicine, this second review (the first one has been published in the issue of March 1998) has the aim to provide physicians tools and skills for retrieving relevant biomedical information. Therefore, we discuss about strategies for managing information overload, analyze characteristics, usefulness and limits of medical databases and explain how to use MEDLINE in day-to-day clinical practice.

It is well-known that while RIS allows the management of all input and output data of a Radiology service, PACS plays a major role in the management of all radiologic images. However, the two systems should be closely integrated: scheduling of a radiologic exam requires direct automated integration with the system of image management for retrieval of previous exams and storage of the exam just completed. A modern information system of integration of data and radiologic images should be based on an automated work flow management in al its components, being at the same time flexible and compatible with the ward organization to support and computerize each stage of the working process. Similarly, standard protocols (DICOM 3.0, HL7) defined for interfacing with the Diagnostic Imaging (D.I.) department and the other components of modules of a modern HIS, should be used. They ensure the system to be expandable and accessible to ensure share and integration of information with HIS, emergency service or wards. Correct RIS/PACS integration allows a marked improvement in the efficiency of a modern D.I. department with a positive impact on the daily activity, prompt availability of previous data and images with sophisticated handling of diagnostic images to enhance the reporting quality. The increased diffusion of internet and intranet technology predicts future developments still to be discovered.

The dramatic advances in radiology have increased the number and type of machines and of daily performed exams. Consequently, workload and management organization problems have also markedly increased. Automated, computerized scheduling of radiologic exams is certainly a step forward in a modern rational management of a Diagnostic Imaging service: the relationship with the patient is improved with the optimization of care delivered and of the radiologist's work, who with the new technology is able to rapidly consult the previous exams as well as the list of exams to be performed. The advances in health care information technology imply communications at a distance. From each ward of the hospital, requests for radiologic exams can be automatically scheduled or kept on a dynamic waiting list for automated input in future work shifts. Via the same system, reports (and also radiologic images) can by rapidly transmitted to the wards. At the "Università Cattolica del S. Cuore" from several years, an integrated information system has been implemented for management of patient data, exams and care delivered. Radiology represents one of major departmental systems of the network for the number of machines installed and the amount of information supplied. The system will be soon able to store images from all digital and nondigital machines, and visualize on dedicated workstations the images of ongoing exams or stored previous ones.

When a complex reality as the Department of Diagnostic Imaging and its staff is aimed at the provision of a service, it may be extremely difficult to identify all present correlations and in turn, correlate them with the final goal. The relationship between human and technical resources, between organization and environment are of the utmost importance in planning the structure design. It should be kept in mind that "the person" is the pivot of any innovation for change. Participation by all members, a more flexible, structure, is required. In education and teaching, the global network we are heading for, could become the determining factor in a continuing training process and multispecialized research, facilitating the circulation of information in an interactive, formative dialogue.

One of the major and demanding problems in the management of a modern department of Radiology is undoubtedly the organization of a radiologic archive. Its management has been increasingly difficult in last years both for the increase in procedures and the number of radiologic exams. At the Radiology department of UCSC, since some years, this problem has been tackled. Major objectives have been identified in focusing on responsibilities, global management and planning of radiologic film retrieval and archiving integrated with health care activities (scheduling of admissions and exam appointments, reporting, discharge). Based on these assumptions, the archive has been divided into 3 sections, each dynamically integrated with the others. The 3 archives should be integrated with RIS and supported by information technology. RIS is considered the starting point of the process. In fact the system ensures communication to the archiving workstation and to the radiology room of patient admission and consequent execution of the exam which involves image production. This user-friendly procedure enables consistent information between RIS and archiving system and correct association of images to the patient medical report, for subsequent consultation.

The current trend towards a more intensive cancer treatment is possible thanks to the availability of a really important and effective supportive care. It is our opinion that it would be essential for the junior staff in oncology, for the practitioners, but also for the knowledge of anyone contributing in different ways to give the cancer treatment, to have reference points to give also the best supportive care. With this aim we thought to start a study, in Italy, to investigate, first, which is the supportive care used in the most common acute toxicities during or immediately after cancer therapy. We decided to begin with a survey addressed to hematologists, medical oncologists, radiotherapists; 105 centers were contacted. In order to have a high number of people able to answer to different clinical questions we decided to use Internet to communicate with participating centers without moving people. The final goal of the project is to formulate guidelines in supportive care, but also to promote the use of Internet as much as possible in the medical world with the aim to make easier every kind of communication and exchange of information.

The Internet, as a global computer network, provides opportunities to make available multimedia educational materials, such as teaching files and image databases, that can be accessed using "World-Wide Web" client browser to provide continuing medical education. Since August, 1995, at the Institute of Radiology-University of Palermo, we developed a World-Wide Web server on the Internet to provide a collection of interactive radiology educational resources such as teaching files and image database for continuing medical education in radiology. Our server is based on a UNIX workstation connected to the Internet via our campus Ethernet network and reachable at the uniform resource locator (URL) address: http:/(/)mbox.unipa.it/approximately radpa/ radpa.html. Digital CT and MR images for teaching files and image database are downloaded through an Ethernet local area network from a GE Advantage Windows workstation. US images will be acquired on-line through a video digitizing board. Radiographs will be digitized by means of a Charge Coupled Device (CCD) scanner. To set up teaching files, image database and all other documents, we use the standard "HyperText Markup Language" (HTML) to edit the documents, and the Graphics Interchange Format (GIF) or Joint Photographic Expert Group (JPEG) format to store the images. Nine teaching files are presently available on the server, together with 49 images in the database, a list of international radiological servers, a section devoted to the museum of radiology hosted by our Institute, the electronic version of the Journal Eido Electa. In the first 12 months of public access through the Internet, 12,280 users accessed the server worldwide: 45% of them to retrieve teaching files; 35% to retrieve images from the database; the remaining 20% to retrieve other documents. Placing teaching files and image database on a World-Wide Web server makes these cases more available to residents and radiologists to provide continuing medical education in radiology.

Internet is the most important computer network in the world that allow access to large amounts of information and services. During the last months, the internet has grown very rapidly. At January 1996, 147 countries and 6,642,000 computers worldwide (73,000 in Italy) were connected, and 90 millions of users (700,000 in Italy) could access the network (also called the Net). The increase of interest has also grown in the medical field and many medical and biomedical resources are now accessible through the Internet: databases of images and videos of medical interest, research and medical centres, congresses, medical journals (such as British Medical Journal, Circulation, Journal of the American Medical Association, New England Journal of Medicine), medical associations (such as American Heart Association, American College of Cardiology and recently Associazione Nazionale del Medici Cardiologi Ospedalieri). Internet introduced new ways of communication between users: they could use the electronic mall, organize forums on some medical topics through the newsgroups and the mailing lists, access directly to the references of an electronic paper and contact the author by electronic mail. The aim of the current paper is to present the technical aspects a user should know before connecting to the Internet, the accessible cardiological resources and what they could offer to the users.

Internet is an international computer network that uses standard communication protocols for the exchange of information. This facilitates the retrieval of multimedia data through a "web" of servers distributed in the whole world. Among Internet users, Radiologists are a potentially important segment, due to the inherent multimedia characteristics of the discipline, which requires a continuous international update of information. The Department of Radiology of the University of Pisa has an Internet access through the metropolitan area network which was installed in the framework of the CNR Telecomunicazioni Project. The Internet access allowed the implementation of a World Wide Web server made public on Internet in March, 1994, being the first European server specifically oriented to radiology. This server can be accessed at the following address: http:@www.rad.unipi.it:7080/IRMosaicHome.html . On the server, 3 hypermedia papers are present, a list of international servers containing radiological information, a questionnaire, and statistics concerning the number of users who accessed the server. In the first 18 months of public access through Internet (April 1, 1994-September 30, 1995) 16,166 users accessed the server, retrieving 127,349 documents, corresponding to 1,279.7 MByte of information. The mean amount of information retrieved in each access to the server in the considered quarters ranges from 72 to 85.8 kByte. The geographic distribution of the users who accessed the server is the following: United States, 7,158, Italy, 2,466; other European countries, 3,813; other extra-European countries, 2,729. The increasingly diffuse knowledge of Internet services had a substantial impact on the rise in number of the servers and of the users who can access them. It is likely that in the future this technology will be used with increasing interest by Radiologists, since it provides easier "navigation" through multimedia information, consisting of text and several images, without the inherent limitations of the printed paper.

Clinical users expectations from medical informatics are evolving due to the wide availability of biomedical information services on the Internet. Thanks to hypertexts and advanced browsing tools users with no informatical expertise can travel on the Internet and easily gain access to textual databases. With a multimedia computer other kinds of information can be grabbed: images, sounds and audiovisual documents. Basic Internet services (electronic mail, discussion lists, file transfer protocol, terminal emulation) can be accessed from a wide range of hardware equipment. However, the real power of a world-scale computer network like the Internet will be unleashed only when its global connectivity will be linked to the powerful retrieval ability of existing clinical and related databases. While biomedical journals editors and other medical information providers are in the way to offer electronic versions of their paper-based products, at the leading edge of this world-scale process is the USA National Library of Medicine, with the Internet-compatible version of its Grateful Med software which is expected to be launched during 1996.

What are the new perspectives for the radiologist with the development of new technologies of telecommunications? At present, when digitization of most biomedical images has become a reality, problems of remote transmission are simplified. However, telematic literacy is necessary to the radiologist. It is already possible through multimedia supports, as CD-ROM and Internet "navigation". Which are the modalities to access "the network of networks"? Through Internet, hypertexs can be consulted, databases can be accessed, programs and printings can be retrieved, electronic mail can be exchanged. The CD-ROM is a further source of knowledge, especially effective in education due to multimedia and hypertext technology. In this context in the education of the radiologist, the hypertext version of a radiology text, finds its place. It is conceived to offer to each user an individualized approach to learning.

Information technology in radiotherapy finds three separate fields of application: direct computerization is essentially aimed at the conformation of target volume. It is present in devices used for treatment planning and execution. Indirect computerization is essentially aimed at the acquisition of patient's data relevant to the routine and clinical management and at the ready access to the acquired information. Communication networks are intended to facilitate the definition of the patient's integrated reporting, to optimize available resources and multicentric research. Present information technology in radiotherapy is based on the need for a radiation therapy information system (RTIS). It should be designed as a transverse access between the various subsystems, unified in planning, even if implemented at different times and with different technologies, ready to work on a geographic scale, now feasible with the international communication networks.

The authors report the main characteristics and the goals of the development of the RIS of the II Chair of the Institute of Radiology, La Sapienza University, Rome. The system was developed with a commercial software (4th Dimension), for use with an Ethernet network and Macintosh Apple computers. One of the main problems was to obtain a user-friendly system. The main options of our system are: booking, registration, exam execution, reporting, archives and statistics and system administration. The main characteristics of our RIS is that it allows important images to be archived in limited number and at low resolution. The aim is to use images for consultation and teaching purposes, not for diagnosis which is made on the original images. Low resolution images permit to use limited storage space. Image quality is very similar to that of the original images for the equipment connected on line with the RIS--i.e., US and MR units in our institute. Conventional radiographic and CT images are digitalized by two scanners with maximum resolution of 4k x 4k x 11 bits. To date, good results have been obtained. Our RIS has been used by the medical and non-medical staffs, without any particular instruction and has allowed us to organize and make faster department management and reporting.

In every scientific field, research is based on communication and information share: scientific journals and meetings meet this natural need. Recently, there was a growing development of a new tool enabling knowledge share in fast and efficient manner: the Internet computer network. Now, Internet connects the majority of world scientific organizations and the number of network users is more and more increasing. In particular, the information hypermedia connection called World Wide Web, is very useful for scientific purposes. In addition, as biomedical informations are also available on Internet, it becomes an important and irreplaceable resource on physician's desk.

Our work was aimed at implementing and validating a system for the acquisition, local management and remote transmission of diagnostic images. Integration of imaging equipment was performed in each of the two sites (5 km apart) in which the Department of Radiology of the University of Pisa is divided. Teleradiology was carried out using 64 Kbit/s lines as well as a 140 Mbit/s Metropolitan Area Network compliant with the Distributed Queue Dual Bus standard. Application domains included remote expert consultation and teleprocessing of diagnostic images. Remote expert consultation was performed in particular by using the 34 Mbit/s interconnection with the Metropolitan Area Network of Florence. Remote processing of diagnostic images using the high speed link allowed the cooperative work with scientific institutions in a field often limited by the complexity of image transfer and by the lack of a timely feed-back concerning the clinical value of processed images. Advanced processing of diagnostic images was performed in the field of stereographic display of CT and MR data sets. Moreover, experience was gained in the visualization, on a single composite image, of the multiparametric data obtained by means of different MR sequences (T1, Spin Density, T2), thus allowing to summarize, by using false colors, different tissue contrast information.

Clinical trials are important research tools currently used in assessing new drugs and therapeutic strategies, which are unable to produce large effects evaluable in small series of patients. We describe methodological principles of clinical trials and significant advantages in their implementation produced by using a computer network for long-distance modem transmission of echocardiographic images and clinical data. This network has been recently developed in Italy and is operative at the University of Bari and the Associazione per la Ricerca in Cardiologia. Several clinical participating centers of the CEDIM Study and PHASE Study are connected in real time to a data center via modem by a special telephone network (RFD) of the Italian State Telephone Company (SIP). We describe the configuration, main features and applicative potential of such a powerful research tool in modem clinical trial methodology.

Data collected in epidemiological studies on large cohorts need to be evaluated through the organization of a specific computer laboratory in order to make all procedures simple and fast. This paper describes the basic elements composing a computer laboratory and discusses its implementation in epidemiological investigations.

Geriatric research shows that multidimensional assessment (MA) is the best method of approaching the complex functional problems of elderly subjects which are characterized by a close interdependence of clinical, social and mental factors. A correct and standardized communication of the results and the indications deriving from this complex interdisciplinary system is essential to enable the operators, despite their different professional backgrounds, to become involved in ensuring the health and welfare of their patients using integration and coordination criteria which are appropriate to the patient's individual situation. In this context, a computerized MA programme, known as "Senior", has been designed. The programme provides two communication sheets of data with different professional orientations: I) geriatric assessment sheet for doctors and other medical staff; II) graphic geriatric assessment sheet for non-medical operators. In practice, these assessment sheets are a useful backup in providing continuity between in- and out-patient programmes.