Hot balloon versus cryoballoon ablation in patients with atrial fibrillation: a systematic review and meta-analysis

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) incidence is expected to increase more than 60% in the following 30 years. Catheter ablation is the treatment of choice for medically intractable AF with arrhythmia recurrence remaining an unsolved issue.

Purpose

We systematically reviewed existing literature to compare the efficacy of hot balloon (HBA) versus cryoballoon ablation (CBA).

Methods

PubMed, Scopus, ClinicalTrials.gov, medRxiv and Cochrane Library (according to PRISMA guidelines) were scrutinized for relevant articles up to 2 December 2021. Eligible studies had to compare clinical outcomes (arrhythmia recurrence rates or/and procedural data or/and safety outcomes) between patients undergoing HBA and CBA for AF. Quality assessment of studies was conducted via the Newcastle-Ottawa Scale (high quality≥ 7, moderate 4-6, poor <4). Statistical pooling was performed according to a random-effect model with generic inverse-variance weighting of odds ratios and mean differences computing risk estimates with 95% confidence intervals. The presence of heterogeneity among studies was evaluated under the Cochran Q chi-square test. I² values of 25%, 50% and 75% have been assigned adjectives of low, moderate, and high heterogeneity. Publication biases were assessed by visual inspection of funnel plots.

Results

PRISMA study search and individual study characteristics are presented in Figure 1. Literature search identified 131 studies, 5 of which (evaluating 513 patients) met inclusion criteria. Patients undergoing HBA demonstrated similar long term recurrence rate as compared to CBA treated controls (OR: 0.68; 95% CI: 0.38-1.22; p-value: 0.19; I2: 0%). Procedural aspects, such as touch-up radiofrequency ablation (per pulmonary vein), procedure time (min) and fluoroscopic time (min) did not differ among treatment arms (OR: 1.79; 95% CI: 0.84-3.83; p-value: 0.13, I2: 80%, MD: 9.69; 95% CI: -2.78-22.16; p-value: 0.13, I2: 63%, and OR: 1.03; 95% CI: -9.50-7.44; p-value: 0.81, I2: 87%, respectively). Regarding safety outcomes (Figure 1), the small number of the reported events precluded us from analyzing these data. Yet, tamponade and phrenic nerve injury were infrequent in both modalities; pulmonary vein stenosis of at least moderate severity (>50% luminal narrowing) was reported in 18 instances in the HBA arm as compared to zero events in the CBA arm. Of note, all events were asymptomatic. Quality assessment scores are shown in Figure 1. Four studies were of high quality and one study was of moderate quality. Funnel-plot distributions of the pre-specified outcomes indicated absence of publication bias for all outcomes. High statistical heterogeneity and the small number of patients included are the main limitations of this study.

Conclusion

Hotballoon ablation is a promising therapeutic option for patients suffering from AF, featuring comparable efficacy and procedural outcomes with cryoablation. Safety outcomes, especially PV stenosis, mandate further evaluation.

Effects of anodal transcranial direct current stimulation on cognitive dysfunction in patients with progressive supranuclear palsy

Progressive supranuclear palsy (PSP) is a tauopathy characterized by motor, neurobehavioral and disabling brainstem deficits. No disease-modifying therapeutic options exist. The therapeutic potential of transcranial direct current stimulation (tDCS) has been highlighted in studies on patients with other neurodegenerative diseases. Therefore, by drawing upon the limited tDCS literature on PSP, we conducted a pilot study in order to evaluate the effect of tDCS over motor and premotor cortex in patients with PSP, with a particular emphasis on cognitive dysfunction. Eight patients affected by PSP were included (4 males and 4 females with mean age 67.4±7.4 years, range: 55-80 years and mean disease duration: 4.6±3.3 years, range: 1-11 years). The mean Unified Parkinson's Disease Rating Scale Part III (UPDRS III) was 49±16.1 and the mean Hoehn & Yahr (H&Y) scale was 3.9±1 at baseline. All pharmacological treatments (L-dopa, pramipexole, rotigotine, rasagiline, amantadine) were maintained stable during the study. We aimed at evaluating along with the motor outcome (as it is reflected on a disease-specific rating scale), the post-tDCS cognitive status after the completion of the intervention. The clinical evaluation involved the PSP-Rating Scale, the UPDRS III and the Timed Up and Go test. Neuropsychological assessment focused on auditory-verbal memory and learning, episodic memory, visuo-motor coordination and speed of information processing, executive functions and verbal fluency (phonemic and semantic). Anodal tDCS was applied over primary motor and pre-motor cortices in 10 daily sessions. During the tDCS stimulation a constant current of 2 mA was delivered for 30 minutes. Clinical evaluations were performed at baseline, day 11, day 30 and at day 90. The PSP-Rating score (total and sections I & III) improved significantly on day 11 compared to baseline and similarly on day 30. A positive effect was also seen on action tremor. In addition to the global mental status improvement, patients showed increases in neuropsychological performance in the domains of visuo-motor co-ordination and processing speed, auditory-verbal learning, episodic memory,phonological and semantic fluency (access and retrieval from lexical memory, selective inhibition and lexical access speed). Our results suggest that tDCS has a beneficial effect on Progressive Supranuclear Palsy patients' bulbar and motor symptoms, cognitive dysfunction, as well as daily activities, which lasts beyond the duration of the treatment.

P3450Aortic stiffness is significantly associated with left ventricular mass in females but not in males: insights from the CORINTHIA study

Introduction

Arterial stiffening may contribute to the increase of left ventricular mass (LVM) and the development of left ventricular hypertrophy (LVH). Although male gender has been also found to be an independent determinant of LVH, it is unknown if the adverse effect of increased aortic stiffening on LVM differs between males and females.

Aim

To evaluate the association of aortic stiffness as assessed by carotid-to-femoral pulse wave velocity (cf-PWV) with LVM and LVH in a general population and compare these associations between males and females.

Methods

Demographic, laboratory and clinical data of 1686 subjects (693 males and 993 females) from the cross-sectional, observational study “Corinthia” were analyzed. All subjects underwent applanation tonometry and pulse wave analysis for the measurement of cf-PWV and echocardiography examination for the computation of LVM which was adjusted by body surface area providing the LVM index (LVMI). Multivariate linear regression analysis was performed for the determination of independent factors related with LVMI. Receiver operator curve analysis (ROC) was used to compare the ability of cf-PWV to predict LVH, in males and females separately.

Results

In the female population, significant and independent determinants of LVMI were: age (beta=0.243, p<0.001), urea (beta=0.119, p=0.001), hypertension (beta=0.089, p=0.028) and cf-PWV (beta=0.096, p=0.021). In contrast, in the male population, LVMI was independently related with age (beta=0.242, p<0.001), systolic blood pressure (beta=0.095, p=0.027), LDL (beta=-0.087, p=0.047) and creatinine (beta=0.092, p=0.031). ROC analysis showed that cf-PWV is a stronger predictor of LVH in females than in males (figure).

Conclusion

Increased aortic stiffness measured by cf-PWV is significantly related with increased LVMI regardless from age and other risk factors only in females. Moreover cf-PWV was a stronger predictor of left-ventricular hypertrophy in females than males. These findings should be further explored in prospective studies.

P6596S100A8/A9 and sRAGE peripheral blood levels in patients with heart failure and an implanted cardioverter/defibrillator: relation with sustained, fast ventricular arrhythmias

Background

Prediction of sudden cardiac death in heart failure (HF) remains suboptimal. Blood levels of the S100A8/A9 heterodimer protein complex and the soluble receptor of advanced glucation end product (sRAGE) are promising biomarkers in HF, reflecting inflammatory/fibrotic and apoptotic pathways, possibly involved in ventricular arrhythmogenesis. The relation of S100A8/A9 and sRAGE with ventricular arrhythmias and sudden cardiac death risk has not been previously assessed.

Purpose

Purpose of the study was to investigate whether S100A8/A9 and sRAGE serum blood levels of patients (pts) with systolic heart failure are related to the occurrence of life-threatening ventricular tachyarrhythmias.

Patients and methods

We studied 60 pts with clinically stable heart failure due to coronary artery disease (n=37) and dilated cardiomyopathy (n=23), all with a chronically implanted ICD for primary (n=43) or secondary (n=16) sudden death prevention, all in sinus rhythm. Their mean age (±1 SE) was 62±2 years, NYHA class I-II, mean LVEF 28±1%, Nt-pro-BNP 893±85 pg/dl. Blood was drawn at study initiation for S100A8/A9 and sRAGE assessment (ELISA, R&D Systems). They all were systematically followed-up for 4 years regarding the occurrence of fast ventricular tachyarrhythmias (>180 bpm) necessitating antiarrhythmic intervention through the ICD.

Results

S100A8/A9 and sRAGE levels were 16±1.6 ng/ml and 1076±99 pg/ml respectively. S100A8/A9 levels were lower than in normal controls, while sRAGE levels were within normal limits. During the 4-year follow-up period, 39 pts had an uneventful course (Group I), while 16 pts exhibited fast ventricular tachyarrhythmic episodes necessitating ICD activation (anti-tachycardia pacing or shock, Group II). Three pts died of pump failure and 2 pts of non-cardiac causes. No differences were observed between Group I and Group II pts regarding mean NYHA class, Nt-pro-BNP levels. Group II patients had significantly lower LVEF as well as S100A8/A9 serum levels relative to pts without ventricular arrhythmias (LVEF: 30±1.2 vs, 25±1.3%, p<0.05, S1OOA8/A9: 18.9±2.2 vs 11.8±1.5 ng/ml, p<0.05), while no difference was observed between Groups regarding sRAGE levels 1097±101 1105±239 pg/ml, p:NS). S100A8/A9 levels were not related significantly to LVEF (r:-21, p=0.13).

Conclusion

S100A8/A9 protein levels are reduced in pts with stable HF and an implanted ICD. They are even lower among pts with rapid ventricular tachyarrhythmias occurring during follow-up. This finding implies that S100A8/A9 may constitute a biomarker of increased sudden cardiac death risk in HF, in addition to reduced LVEF.

Testicular tumors manifested as inferior vena cava thromboses: Case reports

Four cases of asymptomatic testicular tumors with inferior vena cava (IVC) involvement are reported. All patients were referred to our hospital with non-specific abdominal pain and abdominal US revealed an inferior vena cava thrombosis. CT showed an IVC thrombus extending from the first to second lumbar vertebrae and also retroperitoneal lymphadenopathy in 3 patients. Scrotal US demonstrated intratesticular tumors.

IVC thrombosis may result from asymptomatic intratesticular tumors (single or multiple). Because of that, scrotal US is of paramount importance as a routine screening test in patients who radiographically demonstrate caval thrombosis.

Contemporary antiplatelet treatment in acute coronary syndrome patients undergoing percutaneous coronary intervention: 1-year outcomes from the GReek AntiPlatElet (GRAPE) Registry

Essentials The comparative efficacy and safety of antiplatelet agents in 'real life' is not clear. We recruited acute coronary syndrome patients receiving percutaneous coronary intervention. At 1-year follow-up, prasugrel offers better anti-ischemic protection than clopidogrel. Prasugrel and ticagrelor are accompanied by more frequent bleeding events.

SUMMARY

Background The comparative efficacy and safety of antiplatelet treatment outside randomized trials is not clear. Objectives To investigate long-term efficacy and safety in 'real-life' acute coronary syndrome (ACS) patients treated by percutaneous coronary intervention (PCI) with contemporary use of clopidogrel, prasugrel and ticagrelor. Methods In a prospective, observational, multicenter cohort study, 2047 patients were recruited into the GReek AntiPlatElet (GRAPE) Registry and were followed-up for 1 year for major adverse cardiovascular events (MACE, a composite of death, non-fatal myocardial infarction, urgent revascularization and stroke) and bleeding events (Bleeding Academic Research Consortium [BARC] classification). Results Exposure to clopidogrel, prasugrel and ticagrelor by PCI occurred in 959, 363 and 717 patients, respectively. After adjustment, the rate of MACE (primary outcome endpoint) was lower in prasugrel-treated patients (4.4%) than in clopidogrel-treated patients (10.1%) (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.30-0.91), although not significantly different between ticagrelor (6.8%) and clopidogrel groups (HR, 0.78; 95% CI, 0.54-1.12). Any type of BARC-classified bleeding (secondary outcome endpoint) was more frequent in prasugrel-treated patients (51.2%) than in clopidogrel-treated patients (37.6%) (HR, 1.61; 95% CI, 1.33-1.95) and more frequent in ticagrelor-treated patients (56.9%) than in clopidogrel-treated patients (HR, 1.81; 95% CI, 1.55-2.10). An adjusted comparison between prasugrel and ticagrelor-treated groups did not reveal differences in any outcome measure. After adjustment, the death rate was more reduced by novel agents in comparison with clopidogrel (2.9% vs. 6.2%). Conclusions In ACS/PCI patients, prasugrel offered better anti-ischemic protection than clopidogrel, whereas use of both novel agents is accompanied by more frequent bleeding events.

Short-term fluctuations of plasma NT-proBNP levels in patients with new-onset atrial fibrillation: a way to assess time of onset?

OBJECTIVE

The objective of this study was to characterise short-term kinetics of plasma amino-terminal pro-B natriuretic peptide (NT-proBNP) levels in patients with new-onset atrial fibrillation (AF) without heart failure.

DESIGN

Prospective cohort study.

SETTING

Emergency departments and inpatient services of three large community hospitals.

PATIENTS

31 consecutive patients with new-onset atrial fibrillation (<24 h before presentation) persisting at least 48 h, without evidence of heart failure.

MAIN OUTCOME MEASURES

Plasma NT-proBNP levels were obtained at presentation and then 6, 12, 18, and 24 h after presentation. A final sample was obtained 48 h after onset of AF.

RESULTS

Mean plasma NT-proBNP levels and 95% CIs (pg/ml) during the 48-h period following onset of AF were: 0-6 h: 636 (395 to 928), 6-12 h: 1364 (951 to 1778), 12-18 h: 1747 (1412 to 2083), 18-24 h: 1901 (1549 to 2253), 24-36 h: 1744 (1423 to 2066) and 36-48 h: 1101 (829 to 1373). Mean time to peak NT-proBNP levels was 16.7 (0.7) h; 29 patients reached their peak levels within 24 h. The mean peak NT-proBNP level was significantly higher than those obtained at 0-6 h and at 36-48 h after onset of AF (p<0.001 for both). There was no correlation between ventricular rate and plasma NT-proBNP levels during any time period after onset of AF.

CONCLUSION

In patients with new-onset AF but no clinical or radiographic evidence of heart failure, plasma NT-proBNP levels rise progressively to a peak during the first 24 h and then rapidly fall. This pattern may serve as an aid to assess the time from AF onset.

The role of breastfeeding and passive smoking on the development of severe bronchiolitis in infants

AIM

Bronchiolitis is an acute infectious disease of the lower respiratory tract which causes the obstruction of bronchioles in children younger than 2 years. The aim of this study was to investigate the effect of passive smoking alone and in conjunction with breastfeeding on the severity of acute bronchiolitis in infancy and the duration of hospitalisation.

METHODS

We studied 240 consecutive infants aged from 6 to 24 months (137 boys and 103 girls) median age 14 months, who required hospital admission for acute bronchiolitis at the Paediatric Department of Democritus University Hospital, Alexandroupolis, Greece. The outcomes of interest were the severity of bronchiolitis and the duration of hospitalisation.

RESULTS

Among the entire cohort, 122 (50.8%) children presented a severe attack of bronchiolitis. In multivariate regression analysis adjusting for confounding factors, breastfeeding for less than four months (aOR=6.1, 95% CI=3.4-10.7), exposure to environmental tobacco smoke (aOR=2.2, 95% CI=1.1-3.6) and their combination (aOR=16.2, 95% CI=6.0-34.3) showed significant association with severe bronchiolitis and prolonged hospitalisation. Passive smoking did not increase the risk of severe bronchiolitis, when infants breastfed for more than four months (aOR=1.9, 95% CI=0.8-5.1).

CONCLUSION

In conclusion, exposure to environmental tobacco smoke worsens the symptoms and the prognosis of bronchiolitis, while breastfeeding seems to have a protective effect even in children exposed to environmental tobacco smoke.

Pyloric duplication: ultrasound appearance

This paper reports a case of pyloric duplication, an extremely rare abnormality usually discovered during infancy. Clinical findings involved mainly symptoms of obstruction and radiological evaluation included abdominal US, plain radiography and CT imaging. Pyloric duplication was diagnosed by US and confirmed by CT scans and surgery. This case shows that when the sign of two-layer pattern is present in US scans, a conclusive diagnosis for alimentary tract duplications can be reached and there is no need for further radiological evaluation.

Hypocalcemic Heart Failure in Thalassemic Patients

Hypocalcemic cardiomyopathy in primary or secondary hypoparathyroidism is usually refractory to conventional treatment of cardiac failure. We report the case of a thalassemic patient with severe cardiac failure that might have been attributed to several factors, such as hemosiderosis, hypomagnesemia, and hypocalcemia, refractory to conventional cardiac therapy. Cardiac echocardiography showed impaired biventricular performance, and laboratory analyses revealed hypoparathyroidism due to hemosiderosis. When concomitant treatment of heart failure and calcium supplementation was initiated, correction of hypocalcemia resulted in clinical and laboratory improvement, providing strong evidence in support of our hypothesis about hypocalcemic myocardiopathy.

Transfusional hemosiderosis and combined chelation therapy in sickle thalassemia

Although the indications for transfusions in sickle cell syndromes are well listed, and chronic transfusion has become practicable since the recent advances in chelation therapy have essentially eliminated the risk of secondary iron overload, multi-transfused, non-compliant to long-term chelation therapy patients confront the complication of iron overload and secondary hemosiderosis. In thalassemia major patients, combined therapy with desferrioxamine and deferiprone has maximized tissue iron removal and may reduce the overall occurrence of hemosiderotic heart failure. Despite this, safety and contradictions of chelating agents are still controversial. The aim of this report is to present the results of this combination in a long-term transfused sickle beta-thalassemic patient suffering from severe heart failure and liver dysfunction.

Reversal of heart failure in thalassemia major by combined chelation therapy: a case report

In patients with thalassemia major (TM) who are non-compliant with long-term desferrioxamine (DFO) chelation, survival is limited mainly because of cardiac complications of transfusional hemosiderosis. Combined chelation therapy with DFO and deferiprone has maximized the efficacy of the therapy and reduced cardiological complications. The aim of this report is to present the results of this combination in a desperate case of heart failure.

Waldenström's macroglobulinemia developing in a patient with multiple sclerosis: coincidence or association?

Multiple sclerosis (MS) has been reported in association with haematological abnormalities, including monoclonal gammopathies. We present a 54-year-old male patient with a 30-year history of MS who was admitted to our hospital for investigation of anaemia and increased erythrocyte sedimentation rate. A monoclonal IgM protein was detected by serum protein immunofixation, while bone marrow biopsy indicated a 70% infiltration by small lymphoplasmacytoid cells, in the context of a lymphoplasmacytoid immunocytoma, findings compatible to the diagnosis of Waldenström's macroglobulinemia (WM). To our knowledge, this is the first report of WM in a patient with MS. Further to the coexistence of the two diseases observed in the case presented here, there is additional evidence suggesting that the association of MS with plasma cell dyscrasias may not be coincidental.

Multifocal hydatid disease in a child

One of the most serious helminth infections in humans with widespread occurrence is hydatid disease. Although the majority of the cases are referred in adults, many of them have to do with children. The hydatid cysts can occur in any organ of the human body and in rare cases in a combination of different sites. We present the case of a young boy with hydatid cysts in both lungs and in the upper pole of the left kidney. The rarity of this case is the unusual combination of the cyst development in these organs without the involvement of the liver.

A macro-directive mechanism that facilitates automatic updating and processing of the contents of Electronic Healthcare Records: an extension to the CEN architecture

Facilitating data entry, eliminating redundant effort and providing decision support are some of the factors upon which the successful uptake of Electronic Healthcare Record (EHCR) technology is dependent. The European Standardization Committee (CEN), on the other hand, has proposed a standard EHCR architecture, which allows patient record contents to be highly diverse, customized to individual user needs; this makes their processing a challenging task and poses a demand for specially designed mechanisms. We describe the requirements for a macro-directive mechanism, pertaining to CEN-compatible EHCR software that can automate updating and processing of patient records, thus enhancing the functionality of the software. We have implemented the above-mentioned mechanism in an EHCR application that has been customized for use in the care process of patients suffering from beta-Thalassemia. The application is being used during the last two years in the Thalassemia units of four Greek hospitals, as part of their every day practice. We report on the experience we have acquired so far.

Testicular tumors manifested as inferior vena cava thromboses. Case reports

Four cases of asymptomatic testicular tumors with inferior vena cava (IVC) involvement are reported. All patients were referred to our hospital with non-specific abdominal pain and abdominal US revealed an inferior vena cava thrombosis. CT showed an IVC thrombus extending from the first to second lumbar vertebrae and also retroperitoneal lymphadenopathy in 3 patients. Scrotal US demonstrated intratesticular tumors. IVC thrombosis may result from asymptomatic intratesticular tumors (single or multiple). Because of that, scrotal US is of paramount importance as a routine screening test in patients who radiographically demonstrate caval thrombosis.

Extragonadal retroperitoneal endodermal sinus tumor in an eight-month-old female infant

We describe a rare case of an extragonadal retroperitoneal endodermal sinus (yolk sac) tumor in the minor pelvis. Radiologic investigation, which included abdominal ultrasound and computed tomography (CT), showed a large soft tissue mass occupying the pelvic cavity. Radionuclide bone scans demonstrated bone metastases. The serum alpha fetoprotein was elevated. Pathologic examination of the surgical specimen revealed extragonadal yolk sac tumor. Immunohistochemically, the tumor was positive for a-feto-protein and cytokeratins. After postoperative combination therapy, follow-up CT showed decreasing tumoral disease, while serum alpha fetoprotein returned to normal.

Primary muscular hydatidosis. US, CT and MR findings

We present a rare case of primary muscular hydatidosis in the left thigh of a 40-year-old female patient. US, CT and MR imaging showed a typical multilocular hydatid cyst deep in the vastus intermedius and vastus medialis muscles. Histopathological examination, which followed surgical excision, established the diagnosis of echinococcus cyst.

Primary muscular hydatidosis. US, CT and MR findings

We present a rare case of primary muscular hydatidosis in the left thigh of a 40-year-old female patient. US, CT and MR imaging showed a typical multilocular hydatid cyst deep in the vastus intermedius and vastus medialis muscles. Histopathological examination, which followed surgical excision, established the diagnosis of echinococcus cyst.

Abdominal wall endometriosis--ultrasound research: a diagnostic problem

Abdominal wall endometriosis (AWE) is a rare event. Only a few reports in the literature mention sonographic features of this clinical entity. We describe a case of a young woman with subcutaneous endometriosis under the surgical scar of a previous cesarean section. Physical examination, ultrasound findings, histopathological features and differential diagnostic problems are discussed. Ultrasound examination, in combination with clinical history, is a useful method in the diagnosis of abdominal wall endometriosis and the avoidance of diagnostic pitfalls.

Appraisal of imprint cytology in the diagnosis of mucinous carcinoma of the breast: a case report

A case of mucinous carcinoma of the breast is reported in a female aged 71 years. On gross examination of the left mastectomy specimen two relatively well-circumscribed masses with a gelatinous cut surface were found. Touch imprint cytology was consistent with a low-grade malignancy and histologic and histochemical examination revealed a mucinous carcinoma. Careful prospective correlation between the cytological appearances of cells in imprints and the subsequent histopathology may lead to a more precise cytodiagnosis of a tumor associated with a comparative good prognosis.

A Java-based electronic healthcare record software for beta-thalassaemia

BACKGROUND

Beta-thalassaemia is a hereditary disease, the prevalence of which is high in persons of Mediterranean, African, and Southeast Asian ancestry. In Greece it constitutes an important public health problem. Beta-thalassaemia necessitates continuous and complicated health care procedures such as daily chelation; biweekly transfusions; and periodic cardiology, endocrinology, and hepatology evaluations. Typically, different care items are offered in different, often-distant, health care units, which leads to increased patient mobility. This is especially true in rural areas. Medical records of patients suffering from beta-thalassaemia are inevitably complex and grow in size very fast. They are currently paper-based, scattered over all units involved in the care process. This hinders communication of information between health care professionals and makes processing of the medical records difficult, thus impeding medical research.

OBJECTIVES

Our objective is to provide an electronic means for recording, communicating, and processing all data produced in the context of the care process of patients suffering from beta-thalassaemia.

METHODS

We have developed - and we present in this paper - Java-based Electronic Healthcare Record (EHCR) software, called JAnaemia. JAnaemia is a general-purpose EHCR application, which can be customized for use in all medical specialties. Customization for beta-thalassaemia has been performed in collaboration with 4 Greek hospitals. To be capable of coping with patient record diversity, JAnaemia has been based on the EHCR architecture proposed in the ENV 13606:1999 standard, published by the CEN/TC251 committee. Compliance with the CEN architecture also ensures that several additional requirements are fulfilled in relation to clinical comprehensiveness; to record sharing and communication; and to ethical, medico-legal, and computational issues. Special care has been taken to provide a user-friendly, form-based interface for data entry and processing.

RESULTS

The experience gained through the use of JAnaemia in 4 Greek hospitals reveals a significant contribution towards (1) improvement of the quality of the data being recorded, since data entry is guided by appropriate forms, (2) easier cooperation between physicians, who share a common information repository, and (3) increased processing capabilities, which facilitate medical research.

CONCLUSIONS

JAnaemia appears to be a useful tool, which can improve the quality of care offered to beta-thalassaemic patients in Greece.