A multidisciplinary minimally invasive approach for the esthetics of the smile.

The aim of this work is to define a new multidisciplinary pathway for dental and gingival problems. The method consists of three different instruments that can resolve dental, labial, and periodontal imperfections with minimal invasiveness.

Consequences of COVID-19 Outbreak in Italy: Medical Responsibilities and Governmental Measures.

The COVID-19 pandemic has shocked the world causing more victims than the latest global epidemics such as Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) in 2003, and the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in 2012. Italy has been one of the most affected countries, and it had to deal with an already weak economic condition and cuts to public health services due to budgetary requirements from the last decade-something that made the situation even more dramatic. Deaths have exceeded 600.000 worldwide. During the emergency, regulatory measures were taken to counter the situation. This study highlights the main anti-COVID-19 government measures to support doctors and healthcare professionals, and it analyzes how to respond to the many requests complaining about neglectful healthcare professionals during the spread of the infection. For all those healthcare workers who died on duty, a compensation plan is assumed through a solidarity fund. The same solution cannot be granted to all patients, given the difficulty in assessing the responsibility of the doctor not only during an emergency but with insufficient instruments to cope with it as well.

An Original Approach for the Treatment of Varicose Veins of the Lower Limbs.

BACKGROUND: The Triplex method is a three-step treatment approach to reducing the appearance of small and medium-sized varicose veins and phlebological imperfections of the lower limbs. OBJECTIVE: This study evaluated the effectiveness, duration of results, adverse events, patient satisfaction, and improvements in quality of life in patients with small and medium-sized varicose veins who were treated with the Triplex method. METHODS: We conducted a six-year follow-up study of 4,000 patients from the years 2012 to 2018. Patients with chronic venous insufficiency of the lower limbs were included. Patients with active or previous phlebitis or phlebostatic ulcers were excluded. An average of three sessions was performed on each patient in the Triplex group. Follow-up assessments were performed 1, 3, 6, and 12 months after the completion of the treatment, and they included a morphofunctional study, histological examination, and photographic documentation. The first step of the treatment approach utilized an injectable shrinkage solution consisting of sodium salicylate, physiological solution with 10% glycerol, and lidocaine, which was injected into the varices to trigger a reduction of the vessel lumen. For patients in whom the targeted vessels were not sufficienty narrowed by the shrinkage solution, the second step - ultrasound-guided foam sclerotherapy, or scleromousse - was utilized, which consisted of either lauromacrogol 1% or sodium tetradecyl sulfate 1%, with one group of patients (n=50) receiving the former and the other group of patients (n=50) receiving the latter. All patients were administered Step 3 of the treatment approach, which usually included varicose treatment with low concentrations of sodium tetradecyl sulfate (STS) 0.2 to 0.50% or lauromacrogol 0.25%, with compression additionally prescribed in some patients. RESULTS: Over a follow-up period of six years, in patients who underwent full Triplex treatment, we observed 1) a greater duration of the narrowing of the vessel's caliber, with disappearance of the varices; 2) reduced utilization of the foam solution at the reflux point due to the narrowing of the gauge; and 3) no relevant hemodynamic effects emerged in patients with recanalization. In patients who underwent Steps 1 and 2 of the treatment approach, reflux was not hemodynamically significant. No significant differences were observed in the lauromacrogol group of patients compared to the sodium tetradecyl sulfate group. CONCLUSION: Compared to patients in whom only scleromousse was performed at the reflux site, the narrowing of the varicose wall that is achieved using the Triplex method is associated with longer lasting results in the treatment of small and medium-sized varicose veins, with physiological recovery of superficial venous circulation.

Factors affecting the quality and reliability of online health information.

BACKGROUND: Internet represents a relevant source of information, but reliability of data that can be obtained by the web is still an unsolved issue. Non-reliable online information may have a relevance, especially in taking decisions related to health problems. Uncertainties on the quality of online health data may have a negative impact on health-related choices of citizens. OBJECTIVE: This work consisted in a cross-sectional literature review of published papers on online health information. The two main research objectives consisted in the analysis of trends in the use of health web sites and in the quality assessment and reliability levels of web medical sites. METHODS: Literature research was made using four digital reference databases, namely PubMed, British Medical Journal, Biomed, and CINAHL. Entries used were "trustworthy of medical information online," "survey to evaluate medical information online," "medical information online," and "habits of web-based health information users". Analysis included only papers published in English. The Newcastle Ottawa Scale was used to conduct quality checks of selected works. RESULTS: Literature analysis using the above entries resulted in 212 studies. Twenty-four articles in line with study objectives, and user characteristics were selected. People more prone to use the internet for obtaining health information were females, younger people, scholars, and employees. Reliability of different online health sites is an issue taken into account by the majority of people using the internet for obtaining health information and physician assistance could help people to surf more safe health web sites. CONCLUSIONS: Limited health information and/or web literacy can cause misunderstandings in evaluating medical data found in the web. An appropriate education plan and evaluation tools could enhance user skills and bring to a more cautious analysis of health information found in the web.

A survey on feasibility of telehealth services among young Italian pharmacists

BACKGROUND: Telemedicine is defined as "the use of medical information exchanged from one site to another via electronic communications to improve a patient's health status". This relatively new concept of healthcare is based on the fusion between medical assistance and Information and Communication Technology (ICT) to provide support to people located in remote and underserved areas. It can be found not only in hospitals, but also in other healthcare facilities such as pharmacies. Starting from 2010, telemedicine or telehealth was formally introduced in the Italian pharmaceutical context with the "Pharmacy of Services Decree". In spite of this regulatory framework, the implementation of this technology was very slow and there are no data about the spreading and use of these services in Italian pharmacies. OBJECTIVE: The present study has therefore developed a survey to collect information on the diffusion of telemedicine/telehealth services within Italian pharmacies. METHODS: A two-part questionnaire in Italian was developed using SurveyMonkey, setting a mechanism aimed to have different outcomes according to the answers given. Six hundred eighty-three respondents returned the questionnaire. The results were then analysed statistically. RESULTS: The questionnaire results have shown a limited diffusion of telemedicine/telehealth services among Italian pharmacies and an apparently limited interest of health authorities in supporting the integration of this technology. CONCLUSIONS: More efforts should be spent by national public health stakeholders to better analyse the contribution of telemedicine services available in public pharmacies and to find the best solutions to implement this innovative technology as an established service

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A survey on feasibility of telehealth services among young Italian pharmacists.

BACKGROUND: Telemedicine is defined as "the use of medical information exchanged from one site to another via electronic communications to improve a patient's health status". This relatively new concept of healthcare is based on the fusion between medical assistance and Information and Communication Technology (ICT) to provide support to people located in remote and underserved areas. It can be found not only in hospitals, but also in other healthcare facilities such as pharmacies. Starting from 2010, telemedicine or telehealth was formally introduced in the Italian pharmaceutical context with the "Pharmacy of Services Decree". In spite of this regulatory framework, the implementation of this technology was very slow and there are no data about the spreading and use of these services in Italian pharmacies. OBJECTIVE: The present study has therefore developed a survey to collect information on the diffusion of telemedicine/telehealth services within Italian pharmacies. METHODS: A two-part questionnaire in Italian was developed using SurveyMonkey, setting a mechanism aimed to have different outcomes according to the answers given. Six hundred eighty-three respondents returned the questionnaire. The results were then analysed statistically. RESULTS: The questionnaire results have shown a limited diffusion of telemedicine/telehealth services among Italian pharmacies and an apparently limited interest of health authorities in supporting the integration of this technology. CONCLUSIONS: More efforts should be spent by national public health stakeholders to better analyse the contribution of telemedicine services available in public pharmacies and to find the best solutions to implement this innovative technology as an established service.

Current pharmacological treatments for SARS-COV-2: A narrative review.

The novel coronavirus, later identified as SARS-CoV-2, originating from Wuhan in China in November 2019, quickly spread around the world becoming a pandemic. Despite the knowledge of previous coronaviruses, such as those responsible for the SARS and MERS-CoV epidemic, there is no drug or prophylaxis treatment to this day. The rapid succession of scientific findings on SARS-CoV-2 provides a significant number of potential drug targets. Nevertheless, at the same time, the high quantity of clinical data, generated by a large number of rapidly infected people, require accurate tests regarding effective medical treatments. Several in vitro and in vivo studies were rapidly initiated after the outbreak of the pandemic COVID-19. Initial clinical studies revealed the promising potential of remdesivir that demonstrated a powerful and specific in vitro antiviral activity for COVID-19. Promising effects appear to be attributable to hydroxychloroquine. Remdesivir and hydroxychloroquine are being tested in ongoing randomized trials. In contrast, oseltamivir was not effective and corticosteroids are not currently recommended. However, few data from ongoing clinical trials are identifying low molecular weight heparins, innate immune system stimulating agents, and inflammatory modulating agents as potential effective agents. The authors assume that the current pandemic will determine the need for a systematic approach based on big data analysis for identifying effective drugs to defeat SARS-Cov-2. This work is aimed to be a general reference point and to provide an overview as comprehensive as possible regarding the main clinical trials in progress at the moment.

Telemedicine Practice: Review of the Current Ethical and Legal Challenges.

Background: Telemedicine involves medical practice and information and communications technology. It has been proven to be very effective for remote health care, especially in areas with poor provision of health facilities. However, implementation of these technologies is often hampered by various issues. Among these, ethical and legal concerns are some of the more complex and diverse ones. In this study, an analysis of scientific literature was carried out to identify the ethical and legal challenges of telemedicine. Materials and Methods: English literature, published between 2010 and 2019, was searched on PubMed, Scopus, and Web of Science by using keywords, including "Telemedicine," "Ethics," "Malpractice," "Telemedicine and Ethics," "Telemedicine and Informed consent," and "telemedicine and malpractice." Different types of articles were analyzed, including research articles, review articles, and qualitative studies. The abstracts were evaluated according to the selection criteria, using the Newcastle-Ottawa Scale criteria, and the final analysis led to the inclusion of 22 articles. Discussion: From the aforementioned sample, we analyzed elements that may be indicative of the efficacy of telemedicine in an adequate time frame. Ethical aspects such as informed consent, protection data, confidentiality, physician's malpractice, and liability and telemedicine regulations were considered. Conclusions: Our objective was to highlight the current status and identify what still needs to be implemented in telemedicine with respect to ethical and legal standards. Gaps emerged between current legislation, legislators, service providers, different medical services, and most importantly patient interaction with his/her data and the use of that data.

TelePharmaSea: proposing a novel approach to automate, organize and simplify management of medical chest on board commercial vessels.

BACKGROUND: The on-board pharmacy is the kit that allows the implementation healthcare on board ships, since it should contain everything that may be needed to guarantee proper and efficient health care interventions for seafarers. There are several problems that can lead to a difficult and non-optimal management of the on-board pharmacy. This work illustrates the "TelePharmaSea" software, specifically developed to optimise the management of the on-board pharmacy of commercial vessels without medical personnel. MATERIALS AND METHODS: We collected the Medical Scales of the various Flag States and brought them all into a standardised format which could be used. The Active Ingredients and Pharmaceutical form of each medicine is linked with the ATC Codes. Active Ingredients having similar effect are linked by ATC codes. Items that did not have an ATC code were given a unique system-generated code. Due to the proprietary nature of the software of which the database structure and functioning is unique, we cannot share the exact structure; however, the approach regarding the same has been highlighted. RESULTS AND CONCLUSIONS: The proposal of the TelePharmaSea software can be an effective tool capable of a significant improvement of the overall quality of medical and pharmacological assistance provided on ships without a doctor on board. The system can guarantee a better management of the on-board pharmacy's inventory, and it may also reduce the risks of mistakes in drugs administration.

First surveillance of malaria among seafarers: evaluation of incidence and identification of risk areas.

Malaria is a potentially deadly parasitosis. Due to its geographical distribution, seafarers are particularly exposed to it. This study is an epidemiological analysis on the morbidity of malaria onboard commercial ships without a physician, with the purpose of proposing solutions aimed at limiting further infections in this delicate and difficult working environment. METHODS: We examined 17,212 health records of patients embarked on ships assisted by the CIRM from 2011 to 2015. All the diagnosed diseases have been categorized based on the ICD-10 classification system by the WHO. This study analyzed the cases of suspected malaria and the cases of malaria confirmed by clinical tests. The geographical distribution of infections and the drugs chosen by physicians are also assessed. RESULTS: Although a reduction in malaria cases was appreciated during the 5-year period taken into consideration, this disease still covers an important percentage of all infectious diseases that occurred onboard. This proves that it is a major health problem for seafarers. CONCLUSIONS: In order to protect seafarers' population, strengthen malaria prevention and control programs, as well to improve the availability of antimalarial drugs onboard ships is necessary. This may ensure rapid and efficient health interventions in case of need.

Comparative analysis of the medicinal compounds of the ship's "medicine chests" in European Union maritime countries. Need for improvement and harmonization.

BACKGROUND: The contents of the ship pharmacy, namely "medicine chest" and its compliance with therespective regulations concerning the type of drugs to be provided for merchant vessels involved in long distance voyages and without a doctor on board were analysed. The current existing disparity between regulations can make medical assistance more complicated, and more often of low quality, due to frequent off-label use of supplied drugs. This study may represent a starting point leading to a model high-quality medicine chest on board ships. MATERIALS AND METHODS: A comparative analysis between the medicine chest requirements of 12 European countries and the CEE Directive 31 March 1992 n.92/29 was made. Prescriptions of the aforementioned Directive were compared with the WHO Model List of Essential Medicines (third Edition). RESULTS: The investigation showed a lack of homogeneity of contents. It emerged that some medicinechests lack of several pharmaceutical categories required by the reference standards. The subsequentcomparison of the European Directive with the WHO Model List of Essential Medicines has highlightedthe absence of some therapeutic categories that in the ship environment can be of important to ensureadequate therapy in many situations. CONCLUSIONS: There are disparities regarding regulations concerning the ship medicine chests. It is crucial toharmonize these and create a single medicine chest for all the ships without a doctor on board, undergoingperiodic updates and revisions, based on epidemiological analysis that will ensure high-quality healthcareto seafarers around the world.

Design and evolution of the Seafarer's Health Passport for supporting (tele)-medical assistance to seafarers.

BACKGROUND: Seafarers undergo periodic medical examination for their employment. This information inmost cases is not effectively used when requesting for medical assistance during service on board ships.The medical history of an individual is important for provision of medical care and can be critical to theoutcome. There is growing adoption of digital applications and electronic health records that are addinggreat value to the care provided. The Seafarer's Health Passport (SHP) is an application specifically designedfor improving the quality of medical assistance provided to seafarers both through telemedicineor classic medical check-ups in ports/hospitals worldwide. The SHP provides a secure and unique way toarchive and retrieve the seafarer's medical history in an electronic support. MATERIALS AND METHODS: The SHP that we have developed is a product with specific hardware and softwarespecifications. The basic features of this software are Linux operating system Debian/Ubuntu, ApacheWeb server 2.x, Server database MySQL/Maria DB PHP programming language 5.6.xx, and secure connectionin https. RESULTS: The SHP represents a helpful hint to physicians providing medical advices to seafarers enablingthem to make more decisions that are informed and curtailing possible complications due to misdiagnosis. CONCLUSIONS: Provision of high quality medical assistance requires knowledge of patient's medical history.The availability of an easy access and friendly use system of own medical history is useful for a populationof travellers, such as seafarers to guarantee a reasonable level of medical care at any time.

Benzodiazepine prescriptions on merchant ships without a doctor on board: analysis from medical records of Centro Internazionale Radio Medico (CIRM).

BACKGROUND: Benzodiazepines are drugs widely used for the treatment of anxiety and insomnia. The present study has analysed the prescriptions of this class of drugs among sailing seafarers, to evaluate the appropriateness of prescribed therapies. MATERIALS AND METHODS: This study assessed the benzodiazepine prescriptions made by Centro Internazionale Radio Medico (CIRM) doctors from 2011 to 2015. A total of 17,844 medical records were examined. Analysis considered the prescriptions of benzodiazepines in monotherapy, or in association with other drugs. Diagnoses of pathologies for which benzodiazepines were prescribed were made according to the ICD-10 classification system proposed by the World Health Organisation. RESULTS: Among medical records analysed, benzodiazepines were prescribed in 765 cases (3.29% of total cases assisted by CIRM). Benzodiazepines were prescribed as a single-drug treatment in 626 (81.83%) cases, whereas in 139 cases they were associated with other classes of drugs. In case of opioids prescribed in association with benzodiazepines, the drug used was codeine. This therapeutic association was prescribed in cases of severe pain. CONCLUSIONS: Although the "off label" use of benzodiazepines is not uncommon in medical practice, clear evidence indicates their potential side effects for human health. In this respect, medical professionals should comply with international guidelines on the use of benzodiazepines, both when prescribed as a single drug or in combination with other classes of drugs. These recommendations should be considered seriously in case of limited medical facilities such as on board of sailing ships.