Fabrizio Murgia

Management and Treatment of Type 1 And 2 Diabetes: State of Art

Background: Diabetes is a hormonal disorder that affects an estimated three hundred million people worldwide. In this review (meta-analysis) of the literature, we carefully analyzed the limits and methods of the management of diabetes in adolescents and adults. Objective: The study focused on the identification of technologies and therapeutic procedures currently used and tried to identify possible factors for future improvement. Methods: The literature review was carried out on search engines like: PubMed, ADA, Google Scholar and Google Patents. According to our search criteria, the selected articles were analyzed regarding evidence and critical issues reported by patients and clinicians. The results were then compared with the recalls of the U.S. Food and Drug Administration (FDA). Results: The currently in use drugs and the insulin infusion systems vary a lot and simultaneous develop of new technology adds to existing chaos. This study revealed possible areas for improvements both from a technological and a medical point of view. For instance: the multiple causes related to the different timing of insulin absorption according to the insertion site, the design of new algorithms focused on simplification of practical activities, and the identification of new methods for training patients and families on the different device’s functions. Moreover, some critical points were emerged related to the current limitations and lack of interchangeability between sensors for monitoring vital parameters. This condition restricts the correct sensor selection according to the patient’s personal preference, age and needs. However, the lack of interchangeability between different devices limits the choice of the most appropriate monitoring software and data storage. Conclusions: The collaboration between medical doctors and biomedical engineers is of great importance when analyzing available medical devices for the purpose, identifies possible weaknesses, technical problems, and areas for improvements. Moreover, multi-specialist collaboration is important to conceive new methods of training for patients and families.

Program of home telemonitoring in patients with cystic fibrosis over a period of 2 years: a contribution to the rationalization of care

OBJECTIVES In present study we tested the possible presence of a saving for Italian National Health Service (INHS) when using telemonitoring in the follow-up at home of patients with Cystic Fibrosis (CF), in the aim to assess the possible role of Telemedicine in rationalization of hospital admissions. MATERIALS AND METHODS We performed an economic analysis of the costs incurred by the INHS for patients with CF followed at home by telemonitoring, recalled to hospital under suspicion or diagnosis of acute pulmonary recurrence. RESULTS We calculated, for 19 patients retrieved in the period of the study, a total saving compared to traditional home care of € 132.144,91 in 24 months, corresponding to € 3.303,62/year/patient. CONCLUSIONS The presence of an economic advantage for the INHS is confirmed once again, although not significant. The data from this study are encouraging regarding the possible role of telemedicine in the organization of homecare of CF patients.

The application of telemedicine in the follow-up of lung transplantation in a patient with cystic fibrosis.

The Cystic Fibrosis (CF) Unit of Childrens Hospital Bambino Gesù in Rome (Italy) has more than 25 years of experience in diagnosis and treatment of Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) related diseases. The CF Unit actively collaborates with the Transplantation Division for the follow-up of patients with CF who undergo lung transplantation, performed in our Unit since 1991. We present the case of a 19 year-old girl with CF, with severe respiratory failure for which it was subjected to two lung transplant. During the follow-up the remote monitoring has allowed the identification of an early episode of pulmonary relapse and graft-versus-host reaction even before the onset of symptoms, allowing an effective intervention and a complete recovery of lung function.

Trend of FEV1 in Cystic Fibrosis patients: A telehomecare experience

Since 2001, in the Cystic Fibrosis Center of the Pediatric Hospital Bambino Gesù in Rome, we use telemedicine for monitoring of our patients. While in our first published works reporting this experience, we showed statistically significant reduction in hospital admissions and a tendency over time towards a better stability of the respiratory function for telehomecare (THC) patients, here we focus on the trend of the Forced Expiratory Volume in the first second (FEV1). In particular, we investigate the evolution of the clinical trend of the FEV1 index, by monitoring the activities of home patients from 2011 to 2014. THC is applied in addition to the standard therapeutic protocol by following 16 Cystic Fibrosis (CF) patients with specialized doctors. Our results show that THC patients improve their FEV1 values with a trend which can be considered significantly better than the one reported by the control group.

Telemedicine in pediatric wound care.

BACKGROUND Telemedical wound care is one of the possible applications of teledermatology. The treatment of pediatric wounds needs frequent and periodic assessments of their local status and adjustment of dressings choice. MATERIALS AND METHODS We present our experience using telemedicine in the successful assessment and treatment of 19 pediatric patients at the OPBG, Rome . Photographs with a digital camera were taken and sent weekly by mail to a wound care specialist in Rome. This allowed the expert to diagnose and evaluate the wounds periodically. RESULTS In the shown cases, telemedicine allowed us to have an immediate evaluation and therapy adjustment. The quality of the images was good enough that the physician could regularly evaluate the status of the wound and immediately give his feedback to the parents. Of these 19, 13 patients (68%) experienced a wound resolution during the remote monitoring period. The satisfaction of the parents detected at 3, 6 and 12 months was found to be respectively 57%, 71%, 84%. CONCLUSION Reducing transportation to the hospital to obtain a specialist advice, wound teleconsultation lowers health care costs and improve the quality of life for pediatric patients and their family, while still maintaining a high quality of pediatric wound care.