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1. E-consensus on telemedicine in proctology: A RAND/UCLA-modified study

Author

Gaetano Gallo, Ugo Grossi, Alessandro Sturiale, Gian Luca Di Tanna, Arcangelo Picciariello, Sergio Pillon, Domenico Mascagni, Donato Francesco Altomare, Gabriele Naldini, Roberto Perinotti, Corrado Bottini, Salvatore Bracchitta, Luigi Brusciano, Filippo Caminati, Francesco Cantarella, Valerio Celentano, Gianpiero Cione Paola De Nardi, Francesco Ferrara, Cristina Folliero, Paolo Giamundo, Iacopo Giani, Ivana Giannini, Maria Carmela Giuffrida, Aldo Infantino, Marco La Torre, Andrea Lauretta, Giorgio Lisi, Luigi Losacco, Anna Maffioli, Stefano Mancini, Fabio Marino, Jacopo Martellucci, Piercarlo Meinero, Giovanni Milito, Massimiliano Mistrangelo, Lorenzo Mori, Simone Orlandi, Francesco Pata, Beatrice Pessia, Renato Pietroletti, Mauro Pozzo, Filippo Pucciani, Carlo Ratto, Lucia Romano, Maurizio Roveroni, Giulio Santoro, Alberto Serventi, Davide Telesco, Alessandro Testa, Paolo Tonello, Nicola Tricomi, Mario Trompetto, Roberta Tutino, Gloria Zaffaroni, Julio Mayol, Gallo, Gaetano, Grossi, Ugo, Sturiale, Alessandro, Di Tanna, Gian Luca, Picciariello, Arcangelo, Pillon, Sergio, Mascagni, Domenico, Altomare, Donato Francesco, Naldini, Gabriele, Perinotti, Roberto, Bottini, Corrado, Bracchitta, Salvatore, Brusciano, Luigi, Caminati, Filippo, Cantarella, Francesco, Celentano, Valerio, Paola De Nardi, Gianpiero Cione, Ferrara, Francesco, Folliero, Cristina, Giamundo, Paolo, Giani, Iacopo, Giannini, Ivana, Giuffrida, Maria Carmela, Infantino, Aldo, La Torre, Marco, Lauretta, Andrea, Lisi, Giorgio, Losacco, Luigi, Maffioli, Anna, Mancini, Stefano, Marino, Fabio, Martellucci, Jacopo, Meinero, Piercarlo, Milito, Giovanni, Mistrangelo, Massimiliano, Mori, Lorenzo, Orlandi, Simone, Pata, Francesco, Pessia, Beatrice, Pietroletti, Renato, Pozzo, Mauro, Pucciani, Filippo, Ratto, Carlo, Romano, Lucia, Roveroni, Maurizio, Santoro, Giulio, Serventi, Alberto, Telesco, Davide, Testa, Alessandro, Tonello, Paolo, Tricomi, Nicola, Trompetto, Mario, Tutino, Roberta, Zaffaroni, Gloria, and Mayol, Julio

Subjects
Male, medicine.medical_specialty, Telemedicine, Coronavirus disease 2019 (COVID-19), Settore MED/18 - CHIRURGIA GENERALE, e-consensus, MEDLINE, 030230 surgery, proctology, Pelvic Floor Disorders, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, medicine, Humans, Medical prescription, Anal fissure, telemedicine, business.industry, Colorectal Surgery, Female, Middle Aged, medicine.disease, Colorectal surgery, 030220 oncology & carcinogenesis, Family medicine, Surgery, business, telemedicina
Abstract

Background Coronavirus disease 2019 is revolutionizing healthcare delivery. The aim of this study was to reach a consensus among experts as to the possible applications of telemedicine in the proctologic field. Methods A group of 55 clinical practice recommendations was developed by a clinical guidance group based on coalescence of evidence and expert opinion. The Telemedicine in Proctology Italian Working Group included 47 Italian Society of Colorectal Surgery nominated experts evaluating the appropriateness of each clinical practice recommendations based on published RAND/UCLA methodology in 2 rounds. Results Stakeholder median age was 53 years (interquartile range limits 40–60), and 38 (81%) were men. Nine (19%) panelists reported no experience with telemedicine before the pandemic. Agreement was obtained on a minimum of 3 to 5 years of practice in the proctologic field before starting teleconsultations, which should be regularly paid, with advice and prescriptions incorporated into a formal report sent to the patient by e-mail along with a receipt. Of the panelists, 35 of 47 (74%) agreed that teleconsultation carries the risk of misdiagnosis of cancer, thus recommending an in-person assessment before scheduling any surgery. Fifteen additional clinical practice recommendations were re-elaborated in the second round and assessed by 44 of 47 (93.6%) panelists. The application of telemedicine for the diagnosis of common proctologic conditions (eg, hemorrhoidal disease, anal abscess and fistula, anal condylomas, and anal fissure) and functional pelvic floor disorders was generally considered inappropriate. Teleconsultation was instead deemed appropriate for the diagnosis and management of pilonidal disease. Conclusion This e-consensus revealed the boundaries of telemedicine in Italy. Standardization of infrastructures, logistics, and legality remain to be better elucidated.

Published
2021
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2. The COVID-19 Pandemic and the Need for an Integrated and Equitable Approach: An International Expert Consensus Paper

Author

Sergio Pillon, Mariella Catalano, Benjamin Brenner, Zsolt Pecsvarady, Ismail Elalamy, Joseph Lewis, Jean-Claude Wautrecht, D. Olinic, Vincent Maréchal, Mouna Sassi, Isabelle Mahé, Anna Falanga, Nusrat Jabeen, Charles A. Carter, Mary-Paula Colgan, Alexander Makatsariya, Alfonso Tafur, Kasse Aa, Tazi Mezalek Zoubida, Meletios-Athanasios Dimopoulos, Michèle Sabbah, Darko Antic, Yiannis Theodorou, Alex C. Spyropoulos, Vladimir Chekhonin, Meganathan Kannan, Katalin Farkas, Peter Klein-Wegel, Job Harenberg, P Massamba Mbaye, Joseph Gligorov, Manuel Monreal Bosch, Grigoris T. Gerotziafas, Pier Luigi Antignani, Hikmat Abdel-Razeq, James D. Douketis, Gerit Schernthaner, Petros Agathaggelou, Ali T. Taher, Jawed Fareed, Essam Abo Elnazar, Irina Panovska-Stavridis, Patrick Van Dreden, Fabio Leivano, Gerry Fowkes, Fakiha Siddiqui, Mark A. Ligocki, Tishya Indran, Kostantinos Konstantinidis, Bulent Kantarcioglu, Jin Shiomura, Bahare Fazeli, Chryssa Papageorgiou, Yongquan Gu, Anny Slama-Schwok, Eduardo Ramacciotti, Zenguo Zhai, Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Università degli Studi di Milano = University of Milan (UNIMI), Centre d'Immunologie et des Maladies Infectieuses (CIMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Sechenov First Moscow State Medical University, Campbell University [Buies Creek, NC, USA] (CU), University of Karachi, Heidelberg University, Università degli Studi di Milano-Bicocca = University of Milano-Bicocca (UNIMIB), Loyola University [Chicago], Cyprus Institute (CyI), University of Belgrade [Belgrade], Nuova Villa Claudia [Rome, Italy] (NVC), Universidad Católica San Antonio de Murcia (UCAM), Rambam Health Care Campus [Haifa, Israel], Technion - Israel Institute of Technology [Haifa], Ministry of Health of the Russian Federation (MHRF), St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Trinity College Dublin, National and Kapodistrian University of Athens (NKUA), McMaster University [Hamilton, Ontario], Firestone Institute for Respiratory Health [Hamilton, ON, Canada] (FIRH), Ministry of Health [Saudi Arabia], Szent Imre Hospital [Budapest, Hungary] (SIH), Mashhad University of Medical Sciences, University of Edinburgh, Capital University of Medical Sciences [Beijing] (CUMS), Hôpitaux Universitaires de l'Est Parisien [Paris] (HUEP), Monash Medical Centre [Clayton, Australia], Central University of Tamil Nadu [Thiruvarur, India] (CUTN), Central University of Tamil Nadu (CUTN), Okmeydani Training and Research Hospital [Istanbul, Turkey] (OTRH), Centre International de Cancérologie de Dakar [Dakar, Senegal] (CICD), Aristotle University of Thessaloniki, University Hospital Southampton NHS Foundation Trust, Université Virtuelle du Sénégal [Dakar, Senegal] (UVS), Innovations thérapeutiques en hémostase (IThEM - U1140), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), University Clinic of Hematology [Skopje, Republic of North Macedonia] (UCH), University of Medicine and Pharmacy [Cluj-Napoca, Romania] (UMP), Service d'Anesthésie réanimation [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Flor Ferenc Teaching Hospital [Kistarcsa, Hungary] (2FTH), San Camillo Forlanini Hospital [Rome], Loyola University Medical Center (LUMC), Science Valley Research Institute [São Paulo, Brazil] (SVRI), King Hussein Cancer Center [Amman, Jordan] (KH2C), CHU Fattouma Bourguiba [Monastir] (HFB), Medizinische Universität Wien = Medical University of Vienna, Nobelpharma Co. Ltd. [Tokyo, Japan], Hôpital Erasme [Bruxelles] (ULB), Faculté de Médecine [Bruxelles] (ULB), Université libre de Bruxelles (ULB)-Université libre de Bruxelles (ULB), North Shore University Cardiologists [Skokie, Illinois, USA] (NSUC), American University of Beirut Faculty of Medicine and Medical Center (AUB), Klinikum Ernst von Bergmann [Potsdam, Germany] (KEVB), Peking University [Beijing], Chinese Academy of Medical Sciences [Beijing, China] (CAMS), Peking Union Medical College [Beijing, China], Université Mohammed V de Rabat [Agdal] (UM5), Scientific Reviewer Committee: Gregory Y H Lip, Michael Makris, Sam Schulman, Wolfgang Siess, Christian Weber, Sabbah, Michèle, Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), University of Milan, Centre d'Immunologie et de Maladies Infectieuses (CIMI), Università degli Studi di Milano-Bicocca [Milano] (UNIMIB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and University of Mohammed V

Subjects
medicine.medical_specialty, Telemedicine, Economic growth, COVID-19 Vaccines, Population, Psychological intervention, Disease, 030204 cardiovascular system & hematology, Risk Assessment, Herd immunity, 03 medical and health sciences, COVID-19 Testing, 0302 clinical medicine, Consensus Paper, Pandemic, medicine, [SDV.BBM] Life Sciences [q-bio]/Biochemistry, Molecular Biology, Humans, [SDV.BBM]Life Sciences [q-bio]/Biochemistry, Molecular Biology, 030212 general & internal medicine, Disease management (health), education, Pandemics, thrombosis, education.field_of_study, SARS-CoV-2, Immunization Programs, pandemic, Public health, COVID-19, Disease Management, health care systems, Hematology, 3. Good health, Public Health, Business
Abstract

Background One year after the declaration of the coronavirus disease 2019 (COVID-19) pandemic by the World Health Organization (WHO) and despite the implementation of mandatory physical barriers and social distancing, humanity remains challenged by a long-lasting and devastating public health crisis. Management Non-pharmacological interventions (NPIs) are efficient mitigation strategies. The success of these NPIs is dependent on the approval and commitment of the population. The launch of a mass vaccination program in many countries in late December 2020 with mRNA vaccines, adenovirus-based vaccines, and inactivated virus vaccines has generated hope for the end of the pandemic. Current Issues The continuous appearance of new pathogenic viral strains and the ability of vaccines to prevent infection and transmission raise important concerns as we try to achieve community immunity against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and its variants. The need of a second and even third generation of vaccines has already been acknowledged by the WHO and governments. Perspectives There is a critical and urgent need for a balanced and integrated strategy for the management of the COVID-19 outbreaks organized on three axes: (1) Prevention of the SARS-CoV-2 infection, (2) Detection and early diagnosis of patients at risk of disease worsening, and (3) Anticipation of medical care (PDA). Conclusion The “PDA strategy” integrated into state policy for the support and expansion of health systems and introduction of digital organizations (i.e., telemedicine, e-Health, artificial intelligence, and machine-learning technology) is of major importance for the preservation of citizens' health and life world-wide.

Published
2021
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3. Cardiovascular Health in Migrants. Current status and issues for prevention. A Collaborative Multidisciplinary Task Force Report

Author

Modesti, Pietro A., Stefano, Bianchi, Claudio, Borghi, Matteo, Cameli, Giovambattista, Capasso, Antonio, Ceriello, Marco Matteo Ciccone, Giuseppe, Germano, Maria, Maiello, Maria Lorenza Muiesan, Salvatore, Novo, Luigi, Padeletti, Pasquale, Palmiero, Sergio, Pillon, Carlo Maria Rotella, Pier Sergio Saba, Pietro, Scicchitano, Bruno, Trimarco, Volpe, Massimo, Roberto, Pedrinelli, Matteo Di Biase, Cardiologia Societa' Italiana, D. I., Societa' Italiana Dell'Ipertensione Arteriosa, Medicina Interna, Societa' Italiana D. I., Nefrologia Societa' Italiana, D. I., Associazione Medici Diabetologi, Cardiostimolazione Associazione Italiana Aritmia, E., Società Italiana Dell'Obesità, Prevenzione Cardiovascolare Societa' Italiana, D. I., Telemedicina Osservatorio Nazionale Della Sanita Elettronica, E., Modesti, Pietro A, Bianchi, Stefano, Borghi, Claudio, Cameli, Matteo, Capasso, Giovambattista, Ceriello, Antonio, Ciccone, Marco Matteo, Germanò, Giuseppe, Maiello, Maria, Muiesan, Maria Lorenza, Novo, Salvatore, Padeletti, Luigi, Palmiero, Pasquale, Pillon, Sergio, Rotella, Carlo Maria, Saba, Pier Sergio, Scicchitano, Pietro, Trimarco, Bruno, Volpe, Massimo, Pedrinelli, Roberto, Di Biase, Matteo, Modesti, PA, Bianchi, S, Borghi, C, Cameli, M, Capasso, G, Ceriello, A, Ciccone, MM, Germanò, G, Maiello, M, Muiesan, ML, Novo, S, Padeletti, L, Palmiero, P, Pillon, S, Rotella, CM, Saba, PS, Scicchitano, P, Trimarco, B, Volpe, M, Pedrinelli, R, Di Biase, M., Modesti, Pa, Ciccone, Mm, Muiesan, Ml, Rotella, Cm, Saba, P, and Di Biase, M

Subjects
cardiovascular risk, Male, medicine.medical_specialty, Economic growth, ethnic, ethnicity, global health, immigration, migrant, minorities, Cardiovascular Diseases, Diabetes Mellitus, Europe, Female, Health Status, Humans, Kidney Diseases, Overweight, Transients and Migrants, Cardiology and Cardiovascular Medicine, Medicine (all), Kidney Disease, media_common.quotation_subject, Immigration, Ethnic group, Health Statu, minoritie, Cardiovascular Disease, Global health, medicine, media_common.cataloged_instance, European union, media_common, cardiovascular risk, ethnic, ethnicity, global health, immigration, migrant, minorities, business.industry, Public health, Diabetes Mellitu, General Medicine, Settore MED/11 - Malattie Dell'Apparato Cardiovascolare, Survey data collection, Social exclusion, business, Diversity (politics), Human
Abstract

OBJECTIVES: To review information on cardiovascular health and migration, to stress the attention of researchers that much needs to be done in the collection of sound data in Italy and to allow policy makers identifying this issue as an important public health concern. BACKGROUND: In Italy, the rate of immigrants in the total number of residents increased from 2.5% in 1990 to 7.4% in 2010, and currently exceeds 10% in regions such as Lombardia, Emilia Romagna and Toscana. METHODS: A consensus statement was developed by approaching relevant Italian national scientific societies involved in cardiovascular prevention. Task force members were identified by the president and/or the boards of each relevant scientific society or working group, as appropriate. To obtain a widespread consensus, drafts were merged and distributed to the scientific societies for local evaluation and revision by as many experts as possible. The ensuing final draft was finally approved by scientific societies. RESULTS: In several western European countries, the prevalence of hypertension, diabetes, chronic kidney disease, obesity and metabolic syndrome was found to be higher among immigrants than in the native population. Although migrants are often initially healthier than non-migrant populations in their host countries, genetic factors, and changing environments with lifestyle changes, social exclusion and insufficient medical control may expose them to health challenges. Cultural reasons may also hamper both the dissemination of prevention strategies and migrant communication with healthcare providers. However, great diversity exists across and within different groups of migrants, making generalizations very difficult and many countries do not collect registry or survey data for migrant's health. CONCLUSIONS: In the present economic context, the European Union is placing great attention to improve data collection for migrant health and to support the implementation of specific prevention policies aimed at limiting the future burden of cardiovascular and renal disease, and the consequent load for health systems. Wider initiatives on the topic are awaited in Italy.

Published
2014

4. Light-reflection rheography and acute deep vein thrombosis

Author

Sergio Pillon, Maria Laura Paiella, Mauro Bartolo, Flavio Grassi, and Pier Luigi Antignani

Subjects
Male, medicine.medical_specialty, Vascular disease, business.industry, Deep vein, Middle Aged, Thrombophlebitis, medicine.disease, Collateral circulation, Thrombosis, Surgery, medicine.anatomical_structure, Phlebothrombosis, Acute Disease, medicine, Plethysmograph, Humans, Female, Radiology, Plethysmography, Impedance, Cardiology and Cardiovascular Medicine, business, Vein, Pathological
Abstract

The authors examined 47 subjects affected by acute phlebothrombosis of the lower limbs by means of light-reflection-rheography (LRR). The diagnosis was based on the results of clinical, Doppler, and duplex scanner evaluations. The results were compared with those obtained in 30 healthy subjects (control group). The LRR examinations were performed by two methods: the one consisting of a passive execution of postural movements of the limb, the other using the technique of plethysmographic venous occlusion. The pathological LRR curves were characteristic for each type of disease and for the site of thrombosis and were different from the normal ones. The results obtained show the usefulness of the method and it potential in studying the collateral circulation and the effects of different therapies.

Published
1993

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