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Bolcato V, Basile G, Bianco Prevot L, Fassina G, Rapuano S, Brizioli E, Tronconi LP. Telemedicine in Italy: Healthcare authorization profiles in the modern medico-legal reading. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2024:JRS240004. [PMID: 39150835 DOI: 10.3233/jrs-240004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
BACKGROUND The ruling n. 38485, 20 June 2019, of the Italian Supreme Court, III criminal section, addressed by the perspective of the law the very sensitive and new issue of telemedicine. OBJECTIVE This commentary deals with the issue of authorization of telemedicine activities by the health authority, starting from the Italian Court of Criminal Cassation, III section, decision n. 38485/2019. The case law explored the authorization of a health point, which carries out telemedicine services. METHODS Starting from the perspective discussed by Italian health regulations, the paper examines how the health act could be defined, with the possibilities offered by telecommunications, and how it now relates legally to the physical place where it takes place. RESULTS Even if telemedicine opens the way to virtual spaces of health practice, the Ministry of Health Italian Guidelines pose functional and logistical issues to guarantee users' safety and health care system accountability. Then, functional requirements for health legitimate practice, and their continuous monitoring, together with the responsibilities of the service centers, health professionals and health facilities, are discussed. CONCLUSION The questioning of States' health law, in a broad health system such as that of the Europe, characterized by autonomous health regulations, is extremely important for cross-border health policy with telemedicine, as overall regulatory compliance in health care is the ground criterion for risk prevention and patient safety, to be properly verified.
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Affiliation(s)
| | - Giuseppe Basile
- Trauma Unit and Emergency Department, IRCCS Galeazzi Orthopaedics Institute, Milan, Italy
- Legal Medicine Unit, Clinical Institute San Siro, Milan, Italy
| | - Luca Bianco Prevot
- Trauma Unit and Emergency Department, IRCCS Galeazzi Orthopaedics Institute, Milan, Italy
| | - Giovanni Fassina
- Department of Public Health, Experimental and Forensic Medicine, Unit of Forensic Sciences, University of Pavia, Pavia, Italy
- Unit of Legal Medicine, IRCCS Fondazione Istituto Neurologico Nazionale C. Mondino, Pavia, Italy
| | - Silvia Rapuano
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Enrico Brizioli
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Livio P Tronconi
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy
- Department of Human Sciences, European University of Rome, Rome, Italy
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Mosadeghrad AM, Afshari M, Isfahani P, Ezzati F, Abbasi M, Farahani SA, Zahmatkesh M, Eslambolchi L. Strategies to strengthen the resilience of primary health care in the COVID-19 pandemic: a scoping review. BMC Health Serv Res 2024; 24:841. [PMID: 39054502 PMCID: PMC11270795 DOI: 10.1186/s12913-024-11278-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 07/03/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Primary Health Care (PHC) systems are pivotal in delivering essential health services during crises, as demonstrated during the COVID-19 pandemic. With varied global strategies to reinforce PHC systems, this scoping review consolidates these efforts, identifying and categorizing key resilience-building strategies. METHODS Adopting Arksey and O'Malley's scoping review framework, this study synthesized literature across five databases and Google Scholar, encompassing studies up to December 31st, 2022. We focused on English and Persian studies that addressed interventions to strengthen PHC amidst COVID-19. Data were analyzed through thematic framework analysis employing MAXQDA 10 software. RESULTS Our review encapsulated 167 studies from 48 countries, revealing 194 interventions to strengthen PHC resilience, categorized into governance and leadership, financing, workforce, infrastructures, information systems, and service delivery. Notable strategies included telemedicine, workforce training, psychological support, and enhanced health information systems. The diversity of the interventions reflects a robust global response, emphasizing the adaptability of strategies across different health systems. CONCLUSIONS The study underscored the need for well-resourced, managed, and adaptable PHC systems, capable of maintaining continuity in health services during emergencies. The identified interventions suggested a roadmap for integrating resilience into PHC, essential for global health security. This collective knowledge offered a strategic framework to enhance PHC systems' readiness for future health challenges, contributing to the overall sustainability and effectiveness of global health systems.
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Affiliation(s)
- Ali Mohammad Mosadeghrad
- Health policy and management, Health Economics and Management Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Afshari
- Health policy, School of Nursing and Midwifery, Saveh University of Medical Sciences, Saveh, Iran
| | - Parvaneh Isfahani
- Health management, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran
| | - Farahnaz Ezzati
- Health services management, Health Economics and Management Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Abbasi
- Health services management, Health Economics and Management Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Akhavan Farahani
- Health services management, Health Economics and Management Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Zahmatkesh
- Health Management, School of Business and Management, Royal Holloway University of London, London, UK
| | - Leila Eslambolchi
- Health services management, Health Economics and Management Department, Tehran University of Medical Sciences, Tehran, Iran.
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Battaglia C, Manti F, Mazzuca D, Cutruzzolà A, Corte MD, Caputo F, Gratteri S, Laganà D. Impact of the COVID-19 pandemic and COVID vaccination campaign on imaging case volumes and medicolegal aspects. FRONTIERS IN HEALTH SERVICES 2024; 4:1253905. [PMID: 38487373 PMCID: PMC10937363 DOI: 10.3389/frhs.2024.1253905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/14/2024] [Indexed: 03/17/2024]
Abstract
Purpose The coronavirus pandemic (COVID-19) significantly impacted the global economy and health. Italy was one of the first and most affected countries. The objective of our study was to assess the impact of the pandemic and the vaccination campaign on the radiological examinations performed in a radiology department of a tertiary center in Southern Italy. Materials and methods We analyzed weekly and retrospectively electronic medical records of case volumes performed at the Radiology Department of "Mater Domini" University Hospital of Catanzaro from March 2020 to March 2022, comparing them with the volumes in the same period of the year 2019. We considered the origin of patients (outpatient, inpatient) and the type of examinations carried out (x-ray, mammography, CT, MRI, and ultrasound). A non-parametric test (Wilcoxon Signed Rank test) was applied to evaluate the average volumes. Results Total flows in the pandemic period from COVID-19 were lower than in the same pre-pandemic period with values of 552 (120) vs. 427 (149) median (IQR) (p < 0.001). The vaccination campaign allowed the resumption of the pre-vaccination pandemic with total flows 563 (113) vs. 427 (149) median (IQR) p < 0.001. In the post-vaccination period, the number of examinations was found to overlap with the pre-COVID period. Conclusion The pandemic impacted the volume of radiological examinations performed, particularly with the reduction of tests in outpatients. The vaccination allowed the return to the pre-COVID period imaging case volumes.
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Affiliation(s)
- Caterina Battaglia
- Department of Experimental and Clinical Medicine, “Magna Graecia” University, Catanzaro, Italy
| | - Francesco Manti
- Department of Experimental and Clinical Medicine, “Magna Graecia” University, Catanzaro, Italy
| | - Daniela Mazzuca
- Department of Surgical and Medical Sciences, University “Magna Græcia” of Catanzaro, Catanzaro, Italy
| | - Antonio Cutruzzolà
- Department of Experimental and Clinical Medicine, “Magna Graecia” University, Catanzaro, Italy
| | - Marcello Della Corte
- Department of Surgical and Medical Sciences, University “Magna Græcia” of Catanzaro, Catanzaro, Italy
| | - Fiorella Caputo
- Department of Surgical and Medical Sciences, University “Magna Græcia” of Catanzaro, Catanzaro, Italy
| | - Santo Gratteri
- Department of Surgical and Medical Sciences, University “Magna Græcia” of Catanzaro, Catanzaro, Italy
| | - Domenico Laganà
- Department of Experimental and Clinical Medicine, “Magna Graecia” University, Catanzaro, Italy
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Tozzo P, Delicati A, Marcante B, Catelan D, Caenazzo L. Lessons Learned from the COVID-19 Pandemic: A Survey-Based Study on a Sample of Italian Physicians' Opinions on Telemedicine. J Pers Med 2023; 13:1267. [PMID: 37623517 PMCID: PMC10455507 DOI: 10.3390/jpm13081267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
Telemedicine was born out of the need to ensure clinical evaluation and personal care regardless of the physical presence of the healthcare professional nearby. Information technologies have been vital during the COVID-19 pandemic to ensure medical care and avoid the contagion between patients and clinicians. Accordingly, telecare services multiplied worldwide and gained paramount importance. The present work aims to collect field-based opinions about Telemedicine and ethics among Italian physicians. We developed a web-based questionnaire that was administered to Italian physicians from 1 May to 15 June 2022. The questionnaire was distributed as a link to Google Forms via social networks/instant messaging applications to groups of graduated and qualified physicians. A total of 180 physicians answered the questionnaire (with an age range from 25 to 68 years old). Physicians belonging to the medical area of expertise appear to more frequently use new technologies in comparison to other specialties. The vast majority believe that it is appropriate to use Telemedicine for monitoring and follow-up but not for evaluating a new patient. Concerns about changes in the physician-patient relationship, informed consent, digital barrier, and privacy and data protection also emerged. Finally, telehealth is thought to be a potential useful tool for the future by the majority of respondents but proper training for physicians is therefore needed.
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Affiliation(s)
- Pamela Tozzo
- Legal Medicine Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (A.D.); (B.M.); (L.C.)
| | - Arianna Delicati
- Legal Medicine Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (A.D.); (B.M.); (L.C.)
| | - Beatrice Marcante
- Legal Medicine Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (A.D.); (B.M.); (L.C.)
| | - Dolores Catelan
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy;
| | - Luciana Caenazzo
- Legal Medicine Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy; (A.D.); (B.M.); (L.C.)
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Machado PM, Verschueren P, Grainger R, Jones H, Piercy J, van Beneden K, Caporali R, Dejaco C, Fautrel B. Impact of COVID-19 pandemic on the management of patients with RA: a survey of rheumatologists in six European countries. Rheumatol Adv Pract 2022; 7:rkac108. [PMID: 36601518 PMCID: PMC9800854 DOI: 10.1093/rap/rkac108] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Objective We aimed to describe, from the perspective of rheumatologists in Europe, how the coronavirus disease 2019 (COVID-19) pandemic has impacted their management of people with RA and the continuing medical education of physicians. Methods Rheumatologists participating in the Adelphi RA Disease Specific ProgrammeTM in six European countries were contacted in August and September 2020 for a telephone survey. Rheumatologists were asked seven attitudinal questions on changes to patient management, prescription behaviour and continuing education owing to COVID-19. Results were summarized with descriptive statistics. Results The telephone survey was completed by 284 rheumatologists. The most commonly reported changes to patient management were increased utilization of video/telephone consultations (66.5% of respondents), fewer visits (58.5%) and limiting physical contact (58.1%). Furthermore, 67.9% of rheumatologists who indicated that prescribing behaviour had changed switched their patients to self-administered medication, and 60.7% reported not starting patients on targeted synthetic DMARDs, biologic originator DMARDs or biosimilar DMARDs. In total, 57.6% of rheumatologists believed that changes in management would persist. Rheumatologists reported that 38.0% of patients expressed concerns about how COVID-19 would impact treatment, including access to treatment and the risk of infection. The biggest impact on rheumatologist education was a switch to online training and conferences. Conclusion All countries saw changes in patient management and prescribing behaviour, including the rapid uptake of telemedicine. It is important that the international rheumatology community learns from these experiences to prepare better for future pandemics and to address ongoing rheumatologist shortages.
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Affiliation(s)
- Pedro M Machado
- Correspondence to: Pedro M. Machado, Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, 1st Floor, Russell Square House, 10–12 Russell Square, London WC1B 5EH, UK. E-mail:
| | | | - Rebecca Grainger
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Hannah Jones
- Autoimmune Franchise, Adelphi Real World, Bollington, UK
| | - James Piercy
- Health Economics and Outcomes Research, Adelphi Real World, Bollington, UK
| | | | - Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy,Division of Clinical Rheumatology, ASST Pini-CTO, Milan, Italy
| | | | - Bruno Fautrel
- Service de Rhumatologie, Sorbonne Université-Assistance Publique-Hôpitaux de Paris, Paris, France
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Ferorelli D, Moretti L, Benevento M, Mastrapasqua M, Telegrafo M, Solarino B, Dell’Erba A, Bizzoca D, Moretti B. Digital Health Care, Telemedicine, and Medicolegal Issues in Orthopedics: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15653. [PMID: 36497728 PMCID: PMC9735483 DOI: 10.3390/ijerph192315653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
The use of technologies in medicine has great potential to reduce the costs of health care services by making appropriate decisions that provide timely patient care. The evolution of telemedicine poses a series of clinical and medicolegal considerations. However, only a few articles have dealt with telemedicine and orthopedics. This review assesses the ethical and medicolegal issues related to tele-orthopedics. A systematic review was performed including papers published between 2017 and 2021 focusing on the main medicolegal and clinical-governance aspects of tele-orthopedics. Most of the articles were published during the COVID-19 pandemic, confirming the impetus that the pandemic has also given to the spread of telemedicine in the orthopedic field. The areas of interest dealt with in the scientific evidence, almost exclusively produced in the USA, Europe, the UK, and Canada, are quality, patient satisfaction, and safety. The impact of telemedicine in orthopedics has not yet been fully evaluated and studied in terms of the potential medicolegal concerns. Most of the authors performed qualitative studies with poor consistency. Authorizations and accreditations, protection of patient confidentiality, and professional responsibility are issues that will certainly soon emerge.
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Affiliation(s)
- Davide Ferorelli
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Lorenzo Moretti
- Orthopedics and Trauma Unit, AOUC Policlinico di Bari, Department DiBraiN, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Marcello Benevento
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Maurizio Mastrapasqua
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Michele Telegrafo
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Biagio Solarino
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Alessandro Dell’Erba
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Davide Bizzoca
- Orthopedics and Trauma Unit, AOUC Policlinico di Bari, Department DiBraiN, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Biagio Moretti
- Orthopedics and Trauma Unit, AOUC Policlinico di Bari, Department DiBraiN, University of Bari “Aldo Moro”, 70121 Bari, Italy
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Aulino G, Beccia F, Rega M, Siodambro C, Capece G, Boccia S, Lanzone A, Oliva A. Child maltreatment and management of pediatric patients during COVID-19 pandemic: Knowledge, awareness, and attitudes among students of medicine and surgery. A survey-based analysis. Front Public Health 2022; 10:968286. [PMID: 36203705 PMCID: PMC9531710 DOI: 10.3389/fpubh.2022.968286] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/30/2022] [Indexed: 01/25/2023] Open
Abstract
Purpose of the study To assess perception, awareness, and attitudes regarding the medico-legal relevance of child maltreatment and management of pediatric patients during the COVID-19 pandemic in a cohort of medicine and surgery students, with a particular focus on child safety and maltreatment. Methods A cross-sectional, web-based survey was conducted through an anonymous questionnaire on the personal websites of Università Cattolica del Sacro Cuore medical students. Results The study included 1,166 participants, the majority of whom were experienced with child maltreatment and defensive medicine; only a small percentage was aware of the government's efforts to prevent child maltreatment and safeguard vaccination physicians. Moreover, there was no agreement on the use of telemedicine for non-serious pediatric patients or on the consequences it might have on their health. Finally, the detrimental impacts of lockdown on children's mental health are a major worry. Conclusions Knowledge of these themes is mainly implemented by deepening these concepts during the undergraduate studies since a high level of knowledge on child maltreatment and on the management of COVID-19 pandemic was significantly associated with clinical years of course. Specific seminars analyzing telemedicine and legislative protections concerning minors and those concerning vaccination doctors should be included in the study plan to raise awareness these concepts.
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Affiliation(s)
- Giovanni Aulino
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Flavia Beccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michele Rega
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Chiara Siodambro
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy,*Correspondence: Chiara Siodambro
| | - Giuseppe Capece
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy,Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Lanzone
- Unit of Obstetrics and Obstetric Pathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
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Brichetto G, Tacchino A, Leocani L, Kos D. Impact of Covid-19 emergency on rehabilitation services for Multiple Sclerosis: An international RIMS survey. Mult Scler Relat Disord 2022; 67:104179. [PMID: 36130457 PMCID: PMC9474392 DOI: 10.1016/j.msard.2022.104179] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 11/29/2022]
Abstract
Background Covid-19 pandemic greatly impacted on the healthcare systems worldwide with negative consequences on several aspects of clinical populations. For neurological chronic conditions such as Multiple Sclerosis (MS), rehabilitation activities have been suspended or postponed during the pandemic. Rehabilitation is crucial for people with MS (PwMS) because it promotes recovery from relapses and maximizes opportunities for social participation. To better understand the impact of Covid-19 emergency on rehabilitation services for MS, the European network for rehabilitation in MS (RIMS) disseminated a survey to healthcare professionals (HPs) and representatives of the MS rehabilitation services (RSs), to explore the two different perspectives on the delivery of rehabilitation in usual circumstances and during the Covid-19 emergency. Methods The online survey was distributed from July 9th to September 20th, 2020. Besides general information on the responders (e.g. location of center, and memebership to RIMS), information was collected on usual service delivery (e.g. settings, specialities, and types of treatment), the impact of Covid-19 circumstances (e.g. restrictions, use of personal protective equipment, and impact on work), and the use of technologiesin rehabilitation. Results Twenty-two representatives of MS rehabilitation services (RSs)and 143 health care professionals (HPs) responded. Most of RSs and HPs worked in services specialized for MS including a mixture of all usual rehabilitation settings (i.e. inpatient, outpatient and community setting). The majority of services adopted a multidisciplinary framework, including physical therapy, occupational therapy, social service, speech and language therapy, psychological support, dietary interventions, medical management, vocational rehabilitation and cognitive rehabilitaton. Overall, most of responders indicated they did not use technologies in their practice (e.g. for treatment or assessment). However, depending on the type of technology a low-to-medium percentage of responders declared to use some technologies before Covid-19 crisis (5-55% for RSs and 12-53% for HPs) and a low percentage planned the use after pandemic (0-14% for RSs and 1-10% for HPs). Moreover, for the responders the most feasible interventions deliverable through tele-rehabilitation were psychological support and dietary interventions, with psychological support considered the most necessary intervention to be remotely implemented. Moderate feasibility (30-60%) was reported for hands-off interventions (e.g. aerobic exercise and cognitive rehabilitation) whereas low feasibility (<30%) was reported for hands-on interventions. Feasibility was especially low when tools were used that are not adaptable at-home (e.g. hyperbaric oxygen therapy). Conclusion The Covid-19 pandemic has stimulated the MS healthcare professionals to find new solutions to deliver alternative interventions to PwMS. In this context, the role of telemedicine is crucial to continue rehabilitation services at home, and limit exposure to infection. However, most of healthcare professionals have not incorporated the use of technologies. Therefore, the implementation of digital health solutions in the clinical practice needs more attention towards education on the potentials of technologies for rehabilitation and simplification of the national healthcare system reimbursement procedures for the rehabilitation technologies use.
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Affiliation(s)
- Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy; AISM Rehabilitation Service of Liguria, Genoa, Italy; Rehabilitation in Multiple Sclerosis (RIMS).
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy; Rehabilitation in Multiple Sclerosis (RIMS)
| | - Letizia Leocani
- Rehabilitation in Multiple Sclerosis (RIMS); Vita-Salute San Raffaele University and Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), IRCCS-Scientific Institute San Raffaele, Milan, Italy
| | - Daphne Kos
- Rehabilitation in Multiple Sclerosis (RIMS); Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.; National Multiple Sclerosis Center Melsbroek, Melsbroek, Belgium
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Yassa HA, Mohamed Hussein AAR, Makhlouf HA, Makhlouf NA, Youssef HMS, Sotohy RSA, Essa AA. Pros and cons of telemedicine in diagnosis and management: A cross sectional survey. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2022. [DOI: 10.29333/ejgm/12236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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10
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De Micco F, Fineschi V, Banfi G, Frati P, Oliva A, Travaini GV, Picozzi M, Curcio G, Pecchia L, Petitti T, Alloni R, Rosati E, De Benedictis A, Tambone V. From COVID-19 Pandemic to Patient Safety: A New “Spring” for Telemedicine or a Boomerang Effect? Front Med (Lausanne) 2022; 9:901788. [PMID: 35783642 PMCID: PMC9240206 DOI: 10.3389/fmed.2022.901788] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/26/2022] [Indexed: 12/22/2022] Open
Abstract
During the Covid-19 health emergency, telemedicine was an essential asset through which health systems strengthened their response during the critical phase of the pandemic. According to the post-pandemic economic reform plans of many countries, telemedicine will not be limited to a tool for responding to an emergency condition but it will become a structural resource that will contribute to the reorganization of Healthcare Systems and enable the transfer of part of health care from the hospital to the home-based care. However, scientific evidences have shown that health care delivered through telemedicine can be burdened by numerous ethical and legal issues. Although there is an emerging discussion on patient safety issues related to the use of telemedicine, there is a lack of reseraches specifically designed to investigate patient safety. On the contrary, it would be necessary to determine standards and specific application rules in order to ensure safety. This paper examines the telemedicine-risk profiles and proposes a position statement for clinical risk management to support continuous improvement in the safety of health care delivered through telemedicine.
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Affiliation(s)
- Francesco De Micco
- Bioethics and Humanities Research Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Rome, Italy
- *Correspondence: Vittorio Fineschi
| | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences (SAIMLAL), Sapienza University of Rome, Rome, Italy
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Mario Picozzi
- Department of Biotechnology and Science of Life, Center for Clinical Ethics, Insubria University, Varese, Italy
| | - Giuseppe Curcio
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Tommasangelo Petitti
- Hygiene, Public Health and Statistics, Campus Bio-Medico University of Rome, Rome, Italy
- Department of Medical Affairs, Fondazione Don Carlo Gnocchi Onlus, Rome, Italy
| | - Rossana Alloni
- Bioethics and Humanities Research Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Enrico Rosati
- Casa di Cura “Auxologico Roma–Buon Pastore”, Rome, Italy
| | - Anna De Benedictis
- Nursing Science Research Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Vittoradolfo Tambone
- Bioethics and Humanities Research Unit, Campus Bio-Medico University of Rome, Rome, Italy
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Pogorzelska K, Chlabicz S. Patient Satisfaction with Telemedicine during the COVID-19 Pandemic-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106113. [PMID: 35627650 PMCID: PMC9140408 DOI: 10.3390/ijerph19106113] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/12/2022] [Accepted: 05/14/2022] [Indexed: 12/26/2022]
Abstract
Telemedicine is a convenient tool for providing medical care remotely. It is routinely offered as an alternative to face-to-face consultations in healthcare settings all over the world. Due to the COVID-19 pandemic and increased use of telemedicine in everyday clinical practice, the effectiveness of this modality and patient satisfaction with telemedicine is a subject of growing concern. PubMed and Google Scholar databases were searched. Papers published between January 2020 and August 2021 which met inclusion and exclusion criteria were analyzed. During the COVID-19 pandemic patients have found telemedicine a beneficial tool for consulting healthcare providers. A high level of satisfaction with telehealth was observed in each study across every medical specialty. Telemedicine is undoubtedly a convenient tool that has helped ensure continuity of medical care during the COVID-19 pandemic thanks to its considerable potential. In particular situations, telehealth may adequately replace face-to-face consultation. Regular patients’ feedback is necessary to improve the use of telemedicine in the future.
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12
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Mazzuca D, Borselli M, Gratteri S, Zampogna G, Feola A, Della Corte M, Guarna F, Scorcia V, Giannaccare G. Applications and Current Medico-Legal Challenges of Telemedicine in Ophthalmology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5614. [PMID: 35565003 PMCID: PMC9101177 DOI: 10.3390/ijerph19095614] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/29/2022] [Accepted: 05/01/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The digital revolution is redesigning the healthcare model, and telemedicine offers a good example of the best cost-effectiveness ratio. The COVID-19 pandemic has catalysed the use of the telemedicine. The aim of this review is to describe and discuss the role and the main applications of telemedicine in the ophthalmic clinical practice as well as the related medico-legal aspects. METHODS 45 original articles and 5 reviews focused on this topic and published in English language from 1997 and 2021 were searched on the online databases of Pubmed, Scopus, Web of Sciences and Embase, by using the following key words: "telemedicine", "privacy", "ophthalmology", "COVID-19" and "informed consent". RESULTS Telemedicine is able to guarantee patient care using information and communication technologies. Technology creates an opportunity to link doctors with the aim of assessing clinical cases and maintaining high standards of care while performing and saving time as well. Ophthalmology is one of the fields in which telemedicine is most commonly used for patient management. CONCLUSIONS Telemedicine offers benefits to patients in terms of saving time and costs and avoiding physical contact; however, it is necessary to point out significant limitations such as the absence of physical examinations, the possibility of transmission failure and potential violations of privacy and confidentiality.
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Affiliation(s)
- Daniela Mazzuca
- Department of Surgical and Medical Sciences, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (D.M.); (S.G.); (M.D.C.); (F.G.)
| | - Massimiliano Borselli
- Department of Ophthalmology, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (M.B.); (V.S.)
| | - Santo Gratteri
- Department of Surgical and Medical Sciences, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (D.M.); (S.G.); (M.D.C.); (F.G.)
| | - Giovanna Zampogna
- Department of Law, Economics and Human Sciences (DIGIES), Mediterranea University of Reggio Calabria, Via dell’Università 25, 89124 Reggio Calabria, Italy;
| | - Alessandro Feola
- Department of Experimental Medicine, University of Campania ‘Luigi Vanvitelli’, Via Luciano Armanni 5, 80138 Naples, Italy;
| | - Marcello Della Corte
- Department of Surgical and Medical Sciences, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (D.M.); (S.G.); (M.D.C.); (F.G.)
| | - Francesca Guarna
- Department of Surgical and Medical Sciences, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (D.M.); (S.G.); (M.D.C.); (F.G.)
| | - Vincenzo Scorcia
- Department of Ophthalmology, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (M.B.); (V.S.)
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University ‘Magna Græcia’ of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (M.B.); (V.S.)
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13
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"Medical Assistance in Contextual Awareness" (AMICO): A Project for a Better Quality of Care for Patients in Cardiac Rehabilitation Unit. High Blood Press Cardiovasc Prev 2022; 29:305-309. [PMID: 35314963 DOI: 10.1007/s40292-022-00512-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022] Open
Abstract
The "Medical Assistance in Contextual Awareness" (AMICO) project proposes an infrastructure, called an "instrumented environment", consisting of the home environment and the person, both of which are suitably equipped with sensors, a telemedicine service platform (in the Internet of Things) and a Robot who acts as a mediator/master between the person, the surrounding environment and the external environment. This infrastructure, oriented to the citizen's well-being, can offer both services oriented to the person in his home environment, monitoring their behavior and psycho-physical state, and telemedicine services to support the remote monitoring of citizens affected by a cardiovascular event undergoing rehabilitation therapies from part of doctors or caregiver.
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14
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Effect of the First Year of COVID-19 Pandemic on Ophthalmological Practice: A Multi-Centre Italian Study with a Focus on Medico-Legal Aspects. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
During the COVID-19 era, several restrictions on surgery have been imposed to reduce the infectious risk among patients and staff and further preserve the availability of critical care resources. The aim of the study was to assess their impact on the ophthalmological practice and its medico-legal implications. A retrospective review of electronic medical records of the ophthalmological departments of the University of Cagliari (SGD) and University Magna Græcia of Catanzaro (UMG), from 16 March 2020 to 14 March 2021 (52 weeks), were compared with data from the corresponding period of the previous year. Weekly data on the number and type of diagnoses and procedures performed were collected and analysed in relation to the weekly average of the total number of COVID-19 patients in intensive care units (ICUs) and inpatients in Sardinia and Calabria. Results showed a significant decrease in cataract surgery operations by 47% and 31%, respectively, in the SGD and UMG (p < 0.05) during the second semester of the year; this drop occurred at the same time as the increase in COVID-19 patients in ICU and those hospitalised in both regions. Additionally, anterior segment surgery decreased at the UMG by 30% (p < 0.05). Vitreoretinal surgery decreased by 27% at the SGD, differently increased amount 31.5% at UMG (p < 0.05). The pandemic had a dramatic impact on elective surgery in ophthalmology, quantifying the backlog is the first step in order to understanding the measures to be taken in near future.
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15
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Giansanti D, Morone G, Loreti A, Germanotta M, Aprile I. A Narrative Review of the Launch and the Deployment of Telemedicine in Italy during the COVID-19 Pandemic. Healthcare (Basel) 2022; 10:healthcare10030415. [PMID: 35326894 PMCID: PMC8955340 DOI: 10.3390/healthcare10030415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023] Open
Abstract
Telemedicine is making an important contribution to the fight against the COVID-19 pandemic and to supporting the health domain. Its use has registered initial problems with often-patchy practise. The objective of this study was to analyze the launch and deployment of telemedicine in Italy through a narrative review. The narrative review faced two points of view: (a) the first point of view revised the institutional initiatives of the Italian government developed to promote the use of telemedicine; (b) the second point of view reviewed the evolution of scientific literature in the sector, with reference to the Italian situation. In the second point of view, we applied both a standard narrative checklist and an eligibility approach. The first point of view reported an analysis of national documents aimed at promoting, through indications and recommendations, the use of telemedicine. The second point of view analyzed 39 qualified references. The analysis highlighted: (a) that initially, there was a disorientation, followed by reflections that emerged immediately after; (b) a telemedicine application not only in the traditional sectors (e.g., diabetology, cardiology, oncology, neurology) but also in new and fields never explored before; and (c) a high level of acceptance and a desire to continue in the after-pandemic future (which emerged in some studies through dedicated questionnaires). The study offers stimuli for both stakeholders and scholars to improve the use of telemedicine during the pandemic and in the future.
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Affiliation(s)
- Daniele Giansanti
- Centro Nazionale Tecnologie Innovative in Sanità Pubblica, Istituto Superiore di Sanità, 00161 Rome, Italy
- Correspondence:
| | - Giovanni Morone
- Dipartimento di Medicina Clinica, Sanità Pubblica, Scienze della Vita e dell’Ambiente, Università degli Studi dell’Aquila, 67100 L’Aquila, Italy;
| | - Alice Loreti
- Facoltà di Medicina e Psicologia, Università Sapienza, 00185 Roma, Italy;
| | - Marco Germanotta
- Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (M.G.); (I.A.)
| | - Irene Aprile
- Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Don Carlo Gnocchi, 50143 Florence, Italy; (M.G.); (I.A.)
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16
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O'Malley EJ, Hansjee S, Abdel-Hadi B, Kendrick E, Lok S. A Covid -19 Virtual Ward Model: A Preliminary Retrospective Clinical Evaluation From a UK District General Hospital. J Prim Care Community Health 2022; 13:21501319211066667. [PMID: 34986693 PMCID: PMC8744202 DOI: 10.1177/21501319211066667] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: This study aims to evaluate the safety, utilization, ability to reduce length
of hospitalization and overall outcomes of a COVID-19 virtual ward providing
ongoing treatment at home. Method: A retrospective single-center study of patients discharged to the COVID-19
virtual “step down” ward between January 27th 2021 and March 2nd 2021. The
referral process, length of hospitalization, length of stay on the virtual
ward, readmissions, and ongoing treatment requirements including
supplemental oxygen, antibiotics, and/or steroids were all noted. Results: A total of 50 patients were referred to the virtual ward. 43 referrals were
accepted, 39 of which were from the respiratory ward. Four patients were
readmitted, all due to hypoxia. All readmissions occurred within 5 days of
discharge. 72% (n = 31) were discharged home with an ongoing oxygen
requirement. 14.3% of patients were discharged with antibiotics only, 9.5%
with steroids only and 23.8% with both antibiotics and steroids. The mean
length of hospital stay for patients discharged to the virtual ward was
10.3 ± 9.7 days and 11.9 ± 11.6 days for all covid positive patients during
this time. On average, patients spent 13.7 ± 7.3 days on the virtual ward.
The average number of days spent on oxygen on the virtual ward was
11.6 ± 6.0 days. Conclusion: The virtual ward model exemplifies the potential benefits of collaborative
working between primary and secondary care services, relieving pressure on
hospitals whilst providing ongoing treatments at home such as supplemental
oxygen. It also facilitates an early supported discharge of clinically
stable patients with an improving clinical trajectory by managing them in
the community.
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Affiliation(s)
| | | | - Basil Abdel-Hadi
- Hertfordshire Community NHS Trust, Welwyn Garden City, Hertfordshire, UK
| | - Elizabeth Kendrick
- Hertfordshire Community NHS Trust, Welwyn Garden City, Hertfordshire, UK
| | - She Lok
- Lister Hospital, Stevenage, Hertfordshire, UK
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17
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O’Sullivan SF, Schneider H. Developing telemedicine in Emergency Medical Services: A low-cost solution and practical approach connecting interfaces in emergency medicine. THE JOURNAL OF MEDICINE ACCESS 2022; 6:27550834221084656. [PMID: 36204523 PMCID: PMC9413501 DOI: 10.1177/27550834221084656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/15/2022] [Indexed: 11/15/2022]
Abstract
Background: In Germany, the number of calls for Emergency Medical Services (EMS) are increasing, while the number of general practitioners and hospitals are decreasing, resulting in a growing demand and workload for emergency physicians and paramedics. Furthermore, an aging population with increasingly complex medical histories, present emergencies in which a more detailed assessment and therapies are urgently needed. Therefore, common EMS systems need to find solutions to handle these problems. Methods: We used a user-focused five-step approach to define a technological solution: Research of current systems, definition of goals and requirements, development of concept, test series and evaluation, evaluation of costs and benefits. Results: Development of a holistic telemedical concept to connect in-hospital clinical emergency physicians and paramedics on the scene, by implementing and connecting systems that are already partially being used in common EMS in Germany. By using live audio and video communication, including vital signs between the two, a system can be established by keeping costs low, affordable and at the same time protecting patient data in line with General Data Protection Regulation. Conclusion: Implementing technologies in a practical specialty like Emergency Medicine with a user-focused approach demonstrates that the hurdle for integration into established routines can improve current processes. Evaluation of costs and usability is a main driver to define success of such concepts and can improve if such systems can be developed to be used in larger networks.
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Affiliation(s)
- Seán F O’Sullivan
- Faculty of Health Sciences, Technische Hochschule Mittelhessen, Giessen, Germany
| | - Henning Schneider
- Faculty of Health Sciences, Technische Hochschule Mittelhessen, Giessen, Germany
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18
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De Donno A, Acella A, Angrisani C, Gubinelli G, Musci G, Gravili G, Ciritella C, Santamato A. Suspension of Care for Patients With Spasticity During COVID-19 Pandemic: Ethical and Medico-Legal Point of View Starting From an Italian Study. Front Med (Lausanne) 2021; 8:754456. [PMID: 34917632 PMCID: PMC8669589 DOI: 10.3389/fmed.2021.754456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/25/2021] [Indexed: 11/18/2022] Open
Abstract
The COVID-19 pandemic has revolutionized the habits of entire communities, having even more profound negative effects on assistance for the chronically ill. The sudden demand for extraordinary resources caught all worldwide countries unprepared, highlighting shortages in provision of care services. This applies to all patients, affected by COVID-19 or not, as many need continuing access to chronic diseases treatments. Almost all of the energy available has been directed toward care of COVID-19 patients, and almost nothing has been done to continue therapy for patients with spasticity. This study builds on a recent article and discusses its results as a basis for highlighting the ethical dilemmas and unintended consequences of health systems changing their priorities during the pandemic. The above mentioned study has shown increased patient-perceived spasticity during lockdown (72.2%) with reductions in perceived quality of life (70.9%). Telemedicine tools have proved insufficient, with access by only 7.3% of these patients. Despite the health emergency, it cannot be denied that this situation is a violation of these patients' rights and dignity. The healthcare system will also have to bear increased costs in the future to recover the loss of previous therapies benefits, because of their interruption. The real challenge will be to exploit the critical issues emerged during the pandemic, and to resolve the measures needed to take the care to the patient, and not vice versa. This applies particularly to fragile patients, to respect their dignity and right to care.
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Affiliation(s)
- Antonio De Donno
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital, Bari, Italy
| | - Adriano Acella
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital, Bari, Italy
| | - Carmelinda Angrisani
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital, Bari, Italy
| | - Giulia Gubinelli
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital, Bari, Italy
| | - Gianluca Musci
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital, Bari, Italy
| | - Gianluca Gravili
- University of Bari-Section of Legal Medicine, Policlinico di Bari Hospital, Bari, Italy
| | - Chiara Ciritella
- University of Foggia-Spasticity and Movement Disorders Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, Foggia, Italy
| | - Andrea Santamato
- University of Foggia-Spasticity and Movement Disorders Unit, Physical Medicine and Rehabilitation Section, Policlinico Riuniti, Foggia, Italy
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19
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Solimini R, Busardò FP, Gibelli F, Sirignano A, Ricci G. Ethical and Legal Challenges of Telemedicine in the Era of the COVID-19 Pandemic. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1314. [PMID: 34946259 PMCID: PMC8705012 DOI: 10.3390/medicina57121314] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/26/2021] [Accepted: 11/28/2021] [Indexed: 12/11/2022]
Abstract
Background and objective: Telemedicine or telehealth services has been increasingly practiced in the recent years. During the COVID-19 pandemic, telemedicine turned into and indispensable service in order to avoid contagion between healthcare professionals and patients, involving a growing number of medical disciplines. Nevertheless, at present, several ethical and legal issues related to the practice of these services still remain unsolved and need adequate regulation. This narrative review will give a synthesis of the main ethical and legal issues of telemedicine practice during the COVID-19 pandemic. Material and Methods: A literature search was performed on PubMed using MeSH terms: Telemedicine (which includes Mobile Health or Health, Mobile, mHealth, Telehealth, and eHealth), Ethics, Legislation/Jurisprudence, and COVID-19. These terms were combined into a search string to better identify relevant articles published in the English language from March 2019 to September 2021. Results: Overall, 24 out of the initial 85 articles were considered eligible for this review. Legal and ethical issues concerned important aspects such as: informed consent (information about the risks and benefits of remote therapy) and autonomy (87%), patient privacy (78%) and confidentiality (57%), data protection and security (74%), malpractice and professional liability/integrity (70%), equity of access (30%), quality of care (30%), the professional-patient relationship (22%), and the principle of beneficence or being disposed to act for the benefit of others (13%). Conclusions: The ethical and legal issues related to the practice of telehealth or telemedicine services still need standard and specific rules of application in order to guarantee equitable access, quality of care, sustainable costs, professional liability, respect of patient privacy, data protection, and confidentiality. At present, telemedicine services could be only used as complementary or supplementary tools to the traditional healthcare services. Some indications for medical providers are suggested.
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Affiliation(s)
- Renata Solimini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Francesco Paolo Busardò
- Department of Excellence of Biomedical Science and Public Health, University “Politecnica delle Marche” of Ancona, 60126 Ancona, Italy
| | - Filippo Gibelli
- School of Law, Camerino University, 62032 Camerino, Italy; (F.G.); (A.S.); (G.R.)
| | - Ascanio Sirignano
- School of Law, Camerino University, 62032 Camerino, Italy; (F.G.); (A.S.); (G.R.)
| | - Giovanna Ricci
- School of Law, Camerino University, 62032 Camerino, Italy; (F.G.); (A.S.); (G.R.)
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20
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Street JA, Ricks MR. What are the medicolegal implications of virtual clinics? Br J Hosp Med (Lond) 2021; 82:1-6. [PMID: 34601926 DOI: 10.12968/hmed.2021.0304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Recently there has been increased interest in the use and development of virtual clinics, particularly in the wake of the COVID-19 pandemic. The need to provide clinical care, while minimising patient interaction, has led to wider adoption of both telephone and online consultations, with the potential complications and pitfalls that accompany such a change in practice. A literature search was performed using the Pubmed, MEDLINE and Embase databases, from database inception up to 25 January 2021. A total of 21 papers were identified as discussing virtual clinical assessment and the medicolegal implications. The main areas of concern included consent, misdiagnosis, lack of physical examination, privacy and patient satisfaction. This article assesses these areas and suggests techniques to address them.
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Affiliation(s)
- J A Street
- Department of Trauma and Orthopaedics, Wrightington Hospital, Appley Bridge, Lancashire, UK
| | - M R Ricks
- Department of Trauma and Orthopaedics, Wrightington Hospital, Appley Bridge, Lancashire, UK
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21
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Tornese G, Schiaffini R, Mozzillo E, Franceschi R, Frongia AP, Scaramuzza A. The effect of the COVID-19 pandemic on telemedicine in pediatric diabetes centers in Italy: Results from a longitudinal survey. Diabetes Res Clin Pract 2021; 179:109030. [PMID: 34461140 PMCID: PMC8438313 DOI: 10.1016/j.diabres.2021.109030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 12/05/2022]
Abstract
AIMS In March and April 2020, at the start of the COVID-19 pandemic, our previous survey of Italian pediatric diabetes centers showed that 75% of telemedicine use was voluntary. We hypothesized that the COVID-19 pandemic has acted as a picklock to overcome barriers to telemedicine regulation, use, and reimbursement. METHODS Between March 22nd and April 12th, 2021, the same survey administered in 2020 was sent to all 68 Italian pediatric diabetes centers belonging to the Italian Society for Pediatric Endocrinology and Diabetes (ISPED) to collect data on the demographic variables of respondents; information about the center; the use, codification, and reimbursement of telemedicine; and used tools. Descriptive data were evaluated to establish how the COVID-19 pandemic has changed telemedicine practice. RESULTS Eighty-two percent of responder centers reported an increase in the use of telemedicine, with televisits by video calling implemented in over half of centers. There was a significant increase in the number of centers formally tracking telemedicine use and obtaining reimbursement from the national health service (42% vs. 29% and 62% vs. 32%; p < 0.001, respectively). No reimbursement was provided to centers not using televisits. CONCLUSIONS From a voluntary procedure with a lack of traceability, telemedicine has become a new structured reality that may help our pediatric patients beyond this pandemic.
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Affiliation(s)
- Gianluca Tornese
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Regional Center for Pediatric Diabetes, University of Naples Federico II, Naples, Italy
| | | | | | - Andrea Scaramuzza
- Division of Pediatrics, ASST Cremona, "Ospedale Maggiore di Cremona", Viale Concordia 1, 26100 Cremona, Italy.
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22
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Abstract
During the last 20 years, telemedicine has evolved in Quebec despite several barriers. We studied how a university health centre in Montreal implemented a strategy to enhance the use of telemedicine with the deployment of appropriate infrastructures, continuous training, and the use of advanced technologies, before and during the pandemic. COVID-19 accelerated the use of telemedicine by overcoming some pre-existing barriers. However, telemedicine was mainly limited to a distance consultation during the pandemic using telephone calls or videoconference. The future of telemedicine depends on lifting these obstacles. We need to better define telemedicine and in-person medicine to guarantee the quality of medical and professional acts. We propose some strategies to achieve these goals, combining cultural change, continuous training, new technologies to improve quality of care, and a vision of healthcare with telemedicine oriented on value creation.
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Affiliation(s)
- Fabrice Brunet
- Executive Office, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Research Centre, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Kathy Malas
- Executive Office, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Research Centre, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Eve Desrosiers
- Network Coordination Office, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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23
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Telemedicine in the Time of the COVID-19 Pandemic: Results from the First Survey among Italian Pediatric Diabetes Centers. Healthcare (Basel) 2021; 9:healthcare9070815. [PMID: 34203306 PMCID: PMC8304480 DOI: 10.3390/healthcare9070815] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Use of telemedicine for children and adolescents with type 1 diabetes at the beginning of the COVID-19 pandemic was investigated. Method: 68 Italian pediatric diabetes centers were invited to complete a survey about telemedicine usage in their pediatric patients, allocated to the no-tech group (multiple daily injections and self-monitoring blood glucose) and the tech group (insulin pump and/or flash- or continuous-glucose monitoring). Results: 60.3% of the centers completed the survey. In both the no-tech and tech groups, the most used ways of communication were generic download portals, instant messaging with personal physicians’ mobiles, working emails, and phone calls to physicians’ mobiles, with no difference, except for the use of email being higher in the no-tech group (p = 0.03). Seventy-four percent of the centers did not have any systematization and/or reimbursement, with significant differences among regions (p = 0.03). Conclusions: Almost all Italian pediatric diabetes centers use telemedicine in a semi-volunteering manner, lacking proper codification, reimbursement system, legal traceability, and accreditation system.
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24
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Pareyson D, Pantaleoni C, Eleopra R, De Filippis G, Moroni I, Freri E, Zibordi F, Bulgheroni S, Pagliano E, Sarti D, Silvani A, Grazzi L, Tiraboschi P, Didato G, Anghileri E, Bersano A, Valentini L, Piacentini S, Muscio C, Leonardi M, Mariotti C, Eoli M, Nuzzo S, Tagliavini F, Confalonieri P, De Giorgi F. Neuro-telehealth for fragile patients in a tertiary referral neurological institute during the COVID-19 pandemic in Milan, Lombardy. Neurol Sci 2021; 42:2637-2644. [PMID: 33929645 PMCID: PMC8086222 DOI: 10.1007/s10072-021-05252-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/10/2021] [Indexed: 12/20/2022]
Abstract
Background Lombardy was severely hit by the COVID-19 pandemic since February 2020 and the Health System underwent rapid reorganization. Outpatient clinics were stopped for non-urgent patients: it became a priority to manage hundreds of fragile neurological patients who suddenly had less reference points. In Italy, before the pandemic, Televisits were neither recognized nor priced. Methods At the Fondazione IRCCS Istituto Neurologico C. Besta, we reorganized outpatient clinics to deliver Neuro-telemedicine services, including Televisits and Teleneurorehabilitation, since March 2020. A dedicated Working Group prepared the procedure, tested the system, and designed satisfaction questionnaires for adults and children. Results After a pilot phase, we prepared a procedure for Telemedicine outpatient clinics which was approved by hospital directions. It included prescription, booking, consenting, privacy and data protection, secure connection with patients (Teams Microsoft 365), electronic report preparation and delivery, reporting, and accountability of the services. During the March–September 2020 period, we delivered 3167 Telemedicine services, including 1618 Televisits, to 1694 patients (972 adults, 722 children) with a wide range of chronic neurological disorders. We successfully administered different clinical assessment and scales. Satisfaction among patients and caregivers was very high. Conclusions During the dramatic emergency, we were able to take care of more than 1600 patients by organizing Neuro-telehealth in a few weeks, lessening the impact of the pandemic on fragile patients with chronic neurological disorders; this strategy is now stably embedded in our care pathways. In Italy, Telehealth is at present recognized and priced and is becoming a stable pillar of the health system.
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Affiliation(s)
- Davide Pareyson
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. .,Rare Neurodegenerative and Neurometabolic Diseases Unit, Clinical Neurosciences Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | | | - Roberto Eleopra
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Isabella Moroni
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elena Freri
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Sara Bulgheroni
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Daniela Sarti
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Antonio Silvani
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Licia Grazzi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Giuseppe Didato
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elena Anghileri
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna Bersano
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Laura Valentini
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Cristina Muscio
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | | | - Marica Eoli
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Nuzzo
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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25
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Bolcato M, Trabucco Aurilio M, Di Mizio G, Piccioni A, Feola A, Bonsignore A, Tettamanti C, Ciliberti R, Rodriguez D, Aprile A. The Difficult Balance between Ensuring the Right of Nursing Home Residents to Communication and Their Safety. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052484. [PMID: 33802378 PMCID: PMC7967622 DOI: 10.3390/ijerph18052484] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/10/2021] [Accepted: 02/26/2021] [Indexed: 12/22/2022]
Abstract
The COVID-19 epidemic has had a profound impact on healthcare systems worldwide. The number of infections in nursing homes for the elderly particularly is significantly high, with a high mortality rate as a result. In order to contain infection risks for both residents and employees of such facilities, the Italian government passed emergency legislation during the initial stages of the pandemic to restrict outside visitor access. On 30 November 2020, the Italian President of the Council of Ministers issued a new decree recognizing the social and emotional value of visits to patients from family and friends. In addition, it indicated prevention measures for the purposes of containing the infection risk within nursing homes for the elderly. This article comments on these new legislative provisions from the medicolegal perspective, providing indications that can be used in clinical practice.
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Affiliation(s)
- Matteo Bolcato
- Legal Medicine, Department of Molecular Medicine, University of Padua, via G. Falloppio 50, 35121 Padua, Italy; (D.R.); (A.A.)
- Correspondence: (M.B.); (M.T.A.); Tel.: +39-0499941096 (M.B.); +39-081-778-316 (M.T.A.)
| | - Marco Trabucco Aurilio
- Department of Medicine and Health Sciences “V. Tiberio,” University of Molise, 86100 Campobasso, Italy
- Correspondence: (M.B.); (M.T.A.); Tel.: +39-0499941096 (M.B.); +39-081-778-316 (M.T.A.)
| | - Giulio Di Mizio
- Forensic Medicine, Department of Law, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy;
| | - Andrea Piccioni
- Department of Emergency Medicine, Gemelli, IRCCS (Scientific Institute for Hospitalization and Treatment), Catholic University of Rome-Teaching Hospital Foundation A, 00168 Rome, Italy;
| | - Alessandro Feola
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, via Luciano Armanni 5, 80138 Naples, Italy;
| | - Alessandro Bonsignore
- Department of Health Sciences, Section of Legal and Forensic Medicine, University of Genova, 16126 Genova, Italy; (A.B.); (C.T.)
| | - Camilla Tettamanti
- Department of Health Sciences, Section of Legal and Forensic Medicine, University of Genova, 16126 Genova, Italy; (A.B.); (C.T.)
| | - Rosagemma Ciliberti
- Department of Health Sciences, Section of History of Medicine and Bioethics, University of Genova, 16126 Genova, Italy;
| | - Daniele Rodriguez
- Legal Medicine, Department of Molecular Medicine, University of Padua, via G. Falloppio 50, 35121 Padua, Italy; (D.R.); (A.A.)
| | - Anna Aprile
- Legal Medicine, Department of Molecular Medicine, University of Padua, via G. Falloppio 50, 35121 Padua, Italy; (D.R.); (A.A.)
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