Mobile Screening Units for the Early Detection of Breast Cancer and Cardiovascular Disease: A Pilot Telemedicine Study in Southern Italy.

Introduction: Telemedicine is the use of Information and Communication Technologies (ICT) to improve patient outcomes by increasing access to care, medical information and services. The aim of this pilot study was to evaluate and support the implementation of screening and early detection programs in the prevention of breast cancer and cardiovascular diseases with the establishment of a remote diagnosis through the use of ICT in mobile units. Materials and Methods: A total of 430 individuals were recruited in an area of Southern Italy. Particularly, 321 women were recruited to undergo breast cancer screening in accordance with Italian guidelines. Likewise, cardiovascular screening interested 109 subjects. A self-contained mobile unit with connectivity was provided to offer breast and cardiovascular screenings. To maximize the benefit, we have evaluated the return of investment. Results: The telemedicine screening program allowed the detection of early pathologies. In breast cancer screening, 40.8% of cases were negative to lesions, 34.9% were positive to benign lesions, and 3.1% presented suspicious malignant lesions; these lesions were further checked by histological analyses, which showed a positive response in 70% of cases. The cardiovascular screening concerned 109 participants based on age and other risk factors. We observed a significant difference among risk factors in patients with cardiac disease (p < 0.001); particularly, hypertension was significantly the most present risk factor (51.4%, p < 0.05), followed by smoking (28.4%, p < 0.05). A cardiovascular pathology was detected in 40.4% of enrolled subjects. A 3.3:1 return on investment was calculated. Conclusion: Our findings demonstrate that telemedicine may represent a promising approach to deliver several health services, such as screening programs, with users who cannot utilize services in their locations. The use of telemedicine on diagnostic campers greatly reduces the costs of screening for breast cancer and major cardiovascular diseases within the Southern Italian Health Service. We believe that public investment can have a further significant return on investment by implementing the principles of precision medicine.

Pregabalin and transcutaneous electrical nerve stimulation for postherpetic neuralgia treatment.

OBJECTIVE: Postherpetic neuralgia (PHN) is responsible for one of the most common types of neuropathic pain, described as a burning pain that shakes, hits, and tightens and includes allodynia and paresthesia. AIM OF THE STUDY: To evaluate the efficacy of Pregabalin when used during transcutaneous electric nerve stimulation (TENS) in patients with PHN and to analyze any changes in physical activity and sleep quality. METHODS: Patients aged 50 to 80 years were included in this randomized study. We enrolled 15 male (average age 65+/-8.6 y) and 15 female patients (average age 64+/-8.2 y). The male patients had a history of neuropathic pain lasting 15.6+/-8.8 months whereas the female patients had a history of neuropathic pain lasting about 14.9+/-8.6 months. We began with 1 week of patient screening followed by a week of Pregabalin titration. Then, we established the dose of Pregabalin for each patient to obtain visual analog scale (VAS) of less than 60 mm. The eligible patients were randomly divided into 2 groups receiving Pregabalin + TENS or Pregabalin+TENS placebo for the following 4 weeks. Patients underwent 8 outpatient visits during which they completed VAS, SF-McGill Pain Questionnaire, and sleep interference questionnaire. RESULTS: The resulting data showed that Pregabalin administration associated with TENS reduced pain in patients with PHN. At the end of the treatment, all the observed groups presented a reduction of mean VAS. The group treated with Pregabalin 300 (P300)+TENS had a reduction of pain of 30% and the group treated with Pregabalin 600 (P600)+TENS had a reduction of pain of 40%. The comparison between group P300+TENS versus group P300+TENS placebo showed a statistically significant reduction of VAS (P300+TENS 25+/-0.67 vs. P300+TENS placebo 39+/-1.19 P<0.02). Moreover, the comparison between group P600+TENS versus group P600+TENS placebo has shown a statistically significant reduction of VAS (P600+TENS 23+/-0.78 vs. P600+TENS placebo 32+/-0.81 P<0.02). At the end of the study, all groups showed a statistically significant difference in terms of sleep interference, Short-Form McGill Pain Questionnaire total score, and Short-Form McGill Pain Questionnaire Present Pain Intensity. CONCLUSIONS: These data support the conclusion that Pregabalin gives better results when combined with TENS therapy, which is an analgesic nonpharmacologic procedure. Therefore, a multidisciplinary treatment should be considered for this kind of pain.

Buprenorphine in long-term control of chronic pain in cancer patients.

The aim of this randomized open-label prospective study was to evaluate the analgesic activity of buprenorphine in a transdermal formulation for cancer chronic pain control versus sustained-release morphine, in all cases combined with oral tramadol. A transdermal system with 35 microg/h buprenorphine was applied to the first group of patients (BT); the second group received 60 mg/day of sustained-release morphine (MT). In both groups oral tramadol was administered to a maximum of 200 mg daily, in case of need. The administration of transdermal buprenorphine versus morphine resulted in significant differences in the physical pain (P = 0.01), mental health (P = 0.03) and vitality (P = 0.001). These data indicated that the BT group showed an improvement of pain and a positive effect on the quality life.