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Nowadays digital ultrasound-cardiovascular devices are able to send out directly digital images and films. Thanks to the large adoption of such devices, the echocardiographic world is facing new ways of exchanging images and collaborating. What we present in this paper is a review of the experimental projects carried in Lombardy, meant to support the work of specialists by means of second opinion and telemedicine services. On the medical point of view echocardiography is a widely used activity where operators are perfectly accustomed to do repetitive operations and steps. Tele-echocardiography (T-E) introduces new methods and technologies into stable and everyday medical practice, causing disruptions either on the side of the specialists' way of working or on the new opportunities and service. Introducing such a service means to properly model it in order to reduce the changes in the operators' way of working while maximizing the benefits. A proper method of modelling the operators' needs is then a key factor which must be correctly addressed. This paper will present some successful projects and the assessment procedure but it will also discuss a possible service modelling method, which has been adopted for the described experiences.

We assessed the body composition of 8-y-old children living in Livorno through the integration of bioelectrical and anthropometric evaluations.The study, conducted during December 2005, involved 8-y-old third graders of Livorno, Italy. We collected for each subject (449 children, 210 female and 239 male) anthropometric parameters and carried out bioelectrical impedance test with a STA/BIA Soft Tissue Analyzer. Data were processed with SPSS 14.0.According to anthropometric parameters, a statistically significant difference between genders was found only for height. Percentages of overweight and obese children by gender were 13.9 and 2.4 for girls and 21.3 and 2.1 for boys (P0.05). No significant differences were observed for weight, height, and body mass index percentiles from national reference values, whereras significant differences were found in mid-upper arm circumference between our sample and-lacking national data-the reference (U.S.) population for age and gender. With regard to bioelectrical impedance analysis, a common trend of distribution was observed in both genders toward the left and the area above the spatial ellipses and a statistically significant difference between genders for all parameters with the exception of phase angle. A gradual mean impedance shortening vector was observed with an increase of body mass index or mid-upper arm circumference. The comparison of the two techniques showed a good relation between anthropometric and bioelectrical parameters.An integrated interpretation of bioelectrical impedance analysis and anthropometry, demonstrated by the correlation of many parameters between the two techniques, seems to emerge as a good indication of nutritional status for most children of both genders.

Cardiologic Emergency Project is based on a hospital network in Milan, Italy, in order to provide patients with more efficient first aid immediately after the occurrence of an Acute Coronary Syndrome. The Project includes ECG transmission from running ambulances to the 118 telephone central help desk, and from there to the suitable hospital. Since the maximum total transfer time should stay within a few tens of minutes, and given that a number of different factors may cause very dangerous delays, the effective coordination of several healthcare systems, devices and organizations is critical. Monitoring of the activities on each component is a must. Cardiologic Emergency Project uses a Web application devoted to the monitoring and evaluation of the service levels. Web applications allow the quantitative monitoring of the durations of extra-hospital operations. Several types of tables and graphics are automatically filled for the best care of the patient. For example, given a lengthy total time request by a satisfactory full ECG transmission, the system allows analysis of the ECG machine, of the cellular phone partial-only coverage along the ambulance pathway, of the transfer time in rush hours, etc., to determine which elements in the process can be improved to avoid future delays.