The prevalence of diabetes increased substantially between 2000 and 2007, mainly because there are more patients with a new diagnosis each year than those who die. The increase observed by 2007 almost reached the World Health Organization prediction for 2030. Our analyses suggest that the increase will continue over the next few decades. These data are important for defining the burden of diabetes in the near future, to help in planning health services and ensure proper allocation of resources.

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Timely treatment is essential in acute ischemic stroke as the chances of recovery diminish over time, so efforts are necessary to streamline in-hospital pathways and reduce delays. Here, we analyse the interventions to reduce door-to-needle time in stroke patients suitable for intravenous thrombolysis at the Emergency Department of San Carlo Borromeo Hospital, Milan, Italy. All stroke patients consecutively treated with intravenous thrombolysis at our centre from January 1, 2013 to December 31, 2015 were included in this analysis. The main interventions adopted were (1) continuous education of personnel, (2) reconsideration of blood tests and identify the ones really affecting treatment decision, (3) approval of a new high-urgency Stroke Code activated as soon as the triage nurse comes to know of a potential thrombolysis candidate. Median door-to-needle time progressively decreased from 103 min (iqr 78-120) in 2013, to 92 min (iqr 72-112) in 2014, and to 37 min (iqr 27-58) with the new Stroke Code (p < 0.001) in 2015. Simultaneously, median onset-to-treatment time decreased from 177 min (iqr 142-188) in 2013, to 155 min (iqr 141-198) in 2014, and to 114 min (iqr 86-160) with the new Stroke Code (p < 0.001 and p 0.005, respectively). We did not observe any significant difference in bleeding risks or deaths, whereas the likelihood of favourable outcome (mRS 0-2) increased. Streamlining in-hospital pathways with progressive interventions significantly decreases door-to-needle time and onset-to-treatment time and may contribute to improve stroke outcomes.

This paper presents methodological aspects of the Lombardia Stroke Registry. At the registry start-up, 36 recruiting centres were identified according to a regional survey. The registry recruits consecutive patients with acute stroke or transient ischaemic attacks (TIAs). A 3-month follow-up was planned to correlate acute care with outcomes. On 31st December 2007, data concerning 6,181 patients discharged alive were available. The registry aims at measuring performance parameters, identifying guidelines non-compliance and analysing care processes. In this first phase, 30% of the Lombardia acute stroke and 10% of TIA patients have been enrolled, thus the sample can be considered informative for the disease care in the region. The proportion of completed data items is very high with very small differences among items. The following critical points were highlighted: (1) lack of data input staff for 30% of centres, and (2) difficulty of obtaining the informed consent for post-discharge follow-up.

The determination of the number and location of ambulances in a densely populated area as Milan Province is a challenging task. Especially if the management wants to respect quality contracts with the population (time to patient less then x Minutes). GIS, Mathematical programming and Simulation models and techniques are included into the five steps, . Some results but not all are shown , the bid that will define contract with the crosses has yet to start .