Skip to main content

Main menu

  • Home
  • Current issue
  • Early View
  • Archive
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • COVID-19 submission information
    • Institutional open access agreements
    • Peer reviewer login
  • Alerts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • Early View
  • Archive
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • COVID-19 submission information
    • Institutional open access agreements
    • Peer reviewer login
  • Alerts
  • Subscriptions

Time to change the single-centre approach to management of patients with tuberculosis: a novel network platform with automatic data import and data sharing

Niccolò Riccardi, Barbara Giannini, Maria Lucia Borghesi, Lucia Taramasso, Elena Cattaneo, Giovanni Cenderello, Federica Toscanini, Mauro Giacomini, Emanuele Pontali, Giovanni Cassola, Claudio Viscoli, Antonio Di Biagio
ERJ Open Research 2018 4: 00108-2017; DOI: 10.1183/23120541.00108-2017
Niccolò Riccardi
1University of Genoa, Genoa, Italy
2Dept of Infectious Diseases, Ospedale Policlinico San Martino, Genoa, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: niccolo.riccardi@yahoo.it
Barbara Giannini
3Dept of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Maria Lucia Borghesi
1University of Genoa, Genoa, Italy
2Dept of Infectious Diseases, Ospedale Policlinico San Martino, Genoa, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lucia Taramasso
1University of Genoa, Genoa, Italy
2Dept of Infectious Diseases, Ospedale Policlinico San Martino, Genoa, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Elena Cattaneo
1University of Genoa, Genoa, Italy
2Dept of Infectious Diseases, Ospedale Policlinico San Martino, Genoa, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Giovanni Cenderello
4Infectious Diseases, Ospedali Galliera, Genoa, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Federica Toscanini
5Clinic of Infectious Diseases, Ospedale Policlinico San Martino, Genoa, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Mauro Giacomini
3Dept of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), University of Genoa, Genoa, Italy
4Infectious Diseases, Ospedali Galliera, Genoa, Italy
5Clinic of Infectious Diseases, Ospedale Policlinico San Martino, Genoa, Italy
6Healthropy, Savona, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Emanuele Pontali
4Infectious Diseases, Ospedali Galliera, Genoa, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Giovanni Cassola
4Infectious Diseases, Ospedali Galliera, Genoa, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Claudio Viscoli
1University of Genoa, Genoa, Italy
2Dept of Infectious Diseases, Ospedale Policlinico San Martino, Genoa, Italy
5Clinic of Infectious Diseases, Ospedale Policlinico San Martino, Genoa, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Antonio Di Biagio
5Clinic of Infectious Diseases, Ospedale Policlinico San Martino, Genoa, Italy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Abstract

Time to change the single-centre approach to TB http://ow.ly/lCeM30hBcbB

To the Editor:

Ending the global tuberculosis (TB) epidemic by the year 2035 is one of the most ambitious goals of the World Health Organization (WHO). The WHO strategy is based on three major pillars: improving TB prevention and care, supporting bold policies, and enhancing research and innovation [1]. A better understanding of TB epidemiology, enhanced retention in care and employment of standardised regimens are mandatory to get closer to TB eradication both in low- and high-prevalence countries [2–5]. Mathematical modelling can be a useful tool to understand epidemiology and control of TB in low-prevalence countries, thus leading to better approaches in terms of public health interventions [6]. In this tough challenge for clinicians, the key actions are early diagnosis of TB patients with symptoms or signs suggestive for TB within migratory flux through a nation, and tracking of these patients as well as dealing with increased TB presentation in iatrogenically immunocompromised patients [7, 8]. Low-cost interventions aimed at improving patient-contacts recording, containing outbreaks, and enhancing adherence to diagnostic work-up and follow-up are welcome to better manage the disease burden [9]. Furthermore, a dramatic improvement in diagnostic paths and therapeutic approaches is needed nationally and globally to reach the WHO endpoint [10]. Therefore, healthcare providers who take daily care of TB patients require proper tools to access comprehensive data, for managing patients during follow-up, and for data collection and analysis in multicentre observational clinical trials (MCTs) [11].

The TB Genova Network platform (www.tbnetwork.it) was developed in 2016 and it is currently online. It allows recording of TB patients' data and tracking of their transfer to other hospitals or outpatient services within the network. To date, the two adult infectious disease departments of the metropolitan area of Genoa, Italy, (Policlinico San Martino and Ospedali Galliera) are implementing the platform, while other services (e.g. the Pneumology Dept and the Outpatient Service for Immigrants) have committed to join the network. Patients' administrative data are saved anonymously through a secure HTTP protocol that assures a secure data transfer on the Internet. Personal information such as date of birth, sex, nationality, number of cohabitants (adults and children), risk factors for TB (e.g. smoking, drinking, diabetes, HIV and exposure to silica) can be recorded. A postal code can be added to facilitate mapping. After registering personal information, clinical data such as patients' symptomatology on admission, anthropometric information, comorbidities and TB localisation can be stored. Laboratory tests performed during the hospital stay and follow-up can be automatically loaded onto the platform. Simple diagrams make it easy to follow weight changes, and liver and renal function parameters, thus facilitating early side-effect identification and trend monitoring (figure 1). Imaging results can be uploaded on the platform as well, thus becoming quickly available for comparison or online advices. For those patients who are HIV–TB co-infected, specific information about the HIV immune–virological status, treatment, etc., can be automatically loaded from the already-running online Ligurian HIV Network, a similar regional online platform [12]. Microbiological and molecular examinations can be registered and successfully tracked for each patient. Data on the anti-TB regimen are also collected, with initial and final date of drug administration, number of missing doses, and motivation for treatment switch, discontinuation or termination (figure 2). Links to major drug interaction checker websites are easily available on the platform to help avoid possible drug–drug interactions. Follow-up can be periodically reported. A visual interface supports and simplifies the report of side-effects and weight variations. To enhance visual impact, chromatic alerts of microbiological parameters have been added. Particularly for sputum, a red colour highlights a positive or in progress mycobacterial culture, while a green colour highlights a negative culture for Mycobacterium tuberculosis. All data can be both uploaded on the website or, since they are already available on the Laboratory Information System, automatically imported from the hospitals' databases (table 1) [14]. The database was approved by the Comitato Etico Regionale Ligure on September 22, 2016.

FIGURE 1
  • Download figure
  • Open in new tab
  • Download powerpoint
FIGURE 1

Example of alanine aminotransferase (ALT) monitoring during prolonged tuberculosis (TB) treatment.

FIGURE 2
  • Download figure
  • Open in new tab
  • Download powerpoint
FIGURE 2

Tuberculosis treatment front page.

View this table:
  • View inline
  • View popup
TABLE 1

Present and future functions of the TB Genova Network

In the first year of the project, 60 cases of TB (40 pulmonary and 20 extrapulmonary; 26 born in Italy and 34 foreigners) were recorded. This project represents an important effort to collect clinical, laboratory, radiological and therapeutic data about TB patients that can be used for both clinical and research purposes. The system minimises the risk of an incongruous duration or type of therapy for patients that decide to change their referral clinical centre. Importantly, when a patient is taken into care by a new centre after being lost to follow-up, all past data on their therapeutic history and any known TB resistance are readily available, and patients do not risk a delay in proper management. Second, the intuitive interface of the platform makes it easy to use for both input and data consultation, even for untrained users. Third, daily acquisition of laboratory results from hospital software is fully automatic and includes visual alerts to identify microbiological results. However, other clinical information must be added manually, with possible errors; this is mostly due to the limited diffusion of electronic medical records. Another weakness is the absence of an automatic alarm system to inform the clinician of missed follow-up visits, laboratory examinations or imaging studies because of the heterogeneity of follow-up programmes that need to be tailored to a single patient. Similarly, an alert for undelivered drugs might be useful. Future implementations might consist of regional and national distribution of the platform in order to better understand the challenge that TB poses at both local and national levels. Currently, in the Ligurian region, every TB case is notified through a paper document; however, other Italian regions are using online platforms to allow faster TB surveillance. The TB Genova Network may be connected to central surveillance systems to provide updated online surveillance data.

The TB Genova Network can support healthcare workers in administrating patients' data within primary care, in order to improve patients' treatment outcomes and retention in care. Focusing on epidemiological and clinical aspects of TB, the TB Genova Network differs from other online platforms and allows every user to recall clinical data about the patients' TB episodes. In addition, collected clinical information can be used to perform observational MCTs. Although current diagnostic procedures are all included in the network (e.g. sputum smear microscopy, sputum cultures, GeneXpert, etc.), any new diagnostic approach for active TB diagnosis, including genome-wide association studies, may be updated and uploaded on the TB Genova platform to improve the quality of recorded data [15]. As Sotgiu and Migliori suggested [16], better data will bring more tailored therapies for TB.

The TB Genova Network is an online tool to standardise and unify individual databases in Genoa, preventing data waste and ensuring anonymity for patients. This network is the first Italian online cohort of active TB and database for managing TB patients during the diagnostic work-up and during follow-up.

Extended national and international networks collecting information on diagnosis, management and outcomes of patients with active or latent TB infections can be useful tools to help reaching the WHO goal of ending global Tuberculosis epidemic by the year 2035 [1].

Footnotes

  • Conflict of interest: None declared.

  • Received August 2, 2017.
  • Accepted December 7, 2017.
  • Copyright ©ERS 2018

This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

References

  1. ↵
    1. Uplekar M,
    2. Raviglione M
    . WHO's End TB Strategy: From stopping to ending the global TB epidemic. Indian J Tuberc 2015; 62: 196–199.
    OpenUrl
  2. ↵
    1. World Health Organization
    . Global Tuberculosis Report. Geneva, WHO, 2016.
    1. Jackson C,
    2. Abubakar I
    . Ending tuberculosis in risk groups in Europe: challenges from travel and population movement. Euro Surveill 2017; 22: 30489.
    OpenUrl
    1. Solovic I,
    2. Centis R,
    3. D'Ambrosio L, et al.
    World TB Day 2017: strengthening the fight against TB. Presse Med 2017; 46: e1–e4.
    OpenUrl
  3. ↵
    1. D'Ambrosio L,
    2. Centis R,
    3. Sotgiu G, et al.
    New anti-tuberculosis drugs and regimens: 2015 update. ERJ Open Res 2015; 1: 00010-2015.
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. White PJ,
    2. Abubakar I
    . Improving control of tuberculosis in low-burden countries: insights from mathematical modeling. Front Microbiol 2016; 7: 394.
    OpenUrl
  5. ↵
    1. Bucher JN,
    2. Schoenberg MB,
    3. Freytag I, et al.
    Donor-derived tuberculosis after solid organ transplantation in two patients and a staff member. Infection 2016; 44: 365–370.
    OpenUrl
  6. ↵
    1. Sotgiu G,
    2. Dara M,
    3. Centis R, et al.
    Breaking the barriers: migrants and tuberculosis. Presse Med 2017; 46: e5–e11.
    OpenUrl
  7. ↵
    1. SchepisiScane M,
    2. Gualano G,
    3. Piselli P, et al.
    Active tuberculosis case finding interventions among immigrants, refugees and asylum seekers in Italy. Infect Dis Rep 2016; 8: 6594.
    OpenUrl
  8. ↵
    1. Lönnroth K,
    2. Migliori GB,
    3. Abubakar I, et al.
    Towards tuberculosis elimination: an action framework for low-incidence countries. Eur Respir J 2015; 45: 928–952.
    OpenUrlAbstract/FREE Full Text
  9. ↵
    1. Matteelli A,
    2. Centis R,
    3. D'Ambrosio L, et al.
    WHO Strategies for the programmatic management of drug-resistant tuberculosis. Expert Rev Respir Med 2016; 10: 991–1002.
    OpenUrl
  10. ↵
    1. Fraccaro P,
    2. Pupella V,
    3. Gazzarata R, et al.
    The Ligurian human immunodeficiency virus clinical network: a web tool to manage patients with human immunodeficiency virus in primary care and multicenter clinical trials. Med 2 0 2013; 2: e5.
    OpenUrl
    1. World Health Organization
    . Definitions and Reporting Framework for Tuberculosis – 2013 Revision. Geneva, WHO, 2013.
  11. ↵
    1. Giannini B,
    2. Riccardi N,
    3. Di Biagio A, et al.
    A web based tool to enhance monitoring and retention in care for tuberculosis affected patients. Stud Health Technol Inform 2017; 237: 204–208.
    OpenUrl
  12. ↵
    1. Goletti D,
    2. Petruccioli E,
    3. Joosten SA, et al.
    Tuberculosis biomarkers: from diagnosis to protection. Infect Dis Rep 2016; 8: 6568.
    OpenUrlCrossRef
  13. ↵
    1. Sotgiu G,
    2. Migliori GB
    . Better data, more tailored tuberculosis therapies. Lancet Infect Dis 2016; 16: 1096–1097.
    OpenUrl
PreviousNext
Back to top
Vol 4 Issue 1 Table of Contents
ERJ Open Research: 4 (1)
  • Table of Contents
  • Index by author
Email

Thank you for your interest in spreading the word on European Respiratory Society .

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Time to change the single-centre approach to management of patients with tuberculosis: a novel network platform with automatic data import and data sharing
(Your Name) has sent you a message from European Respiratory Society
(Your Name) thought you would like to see the European Respiratory Society web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Print
Citation Tools
Time to change the single-centre approach to management of patients with tuberculosis: a novel network platform with automatic data import and data sharing
Niccolò Riccardi, Barbara Giannini, Maria Lucia Borghesi, Lucia Taramasso, Elena Cattaneo, Giovanni Cenderello, Federica Toscanini, Mauro Giacomini, Emanuele Pontali, Giovanni Cassola, Claudio Viscoli, Antonio Di Biagio
ERJ Open Research Jan 2018, 4 (1) 00108-2017; DOI: 10.1183/23120541.00108-2017

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Time to change the single-centre approach to management of patients with tuberculosis: a novel network platform with automatic data import and data sharing
Niccolò Riccardi, Barbara Giannini, Maria Lucia Borghesi, Lucia Taramasso, Elena Cattaneo, Giovanni Cenderello, Federica Toscanini, Mauro Giacomini, Emanuele Pontali, Giovanni Cassola, Claudio Viscoli, Antonio Di Biagio
ERJ Open Research Jan 2018, 4 (1) 00108-2017; DOI: 10.1183/23120541.00108-2017
Reddit logo Technorati logo Twitter logo Connotea logo Facebook logo Mendeley logo
Full Text (PDF)

Jump To

  • Article
    • Abstract
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • PDF

Subjects

  • Respiratory infections and tuberculosis
  • Tweet Widget
  • Facebook Like
  • Google Plus One

More in this TOC Section

  • Unstable control of breathing can lead to ineffective NIV
  • Desmosine as a biomarker of azithromycin treatment response
  • Hypersensitivity pneumonitis in fish processing workers
Show more Original research letter

Related Articles

Navigate

  • Home
  • Current issue
  • Archive

About ERJ Open Research

  • Editorial board
  • Journal information
  • Press
  • Permissions and reprints
  • Advertising

The European Respiratory Society

  • Society home
  • myERS
  • Privacy policy
  • Accessibility

ERS publications

  • European Respiratory Journal
  • ERJ Open Research
  • European Respiratory Review
  • Breathe
  • ERS books online
  • ERS Bookshop

Help

  • Feedback

For authors

  • Instructions for authors
  • Publication ethics and malpractice
  • Submit a manuscript

For readers

  • Alerts
  • Subjects
  • RSS

Subscriptions

  • Accessing the ERS publications

Contact us

European Respiratory Society
442 Glossop Road
Sheffield S10 2PX
United Kingdom
Tel: +44 114 2672860
Email: journals@ersnet.org

ISSN

Online ISSN: 2312-0541

Copyright © 2023 by the European Respiratory Society