Reflections on Health Tourism and Cross-Border Health Care

Medical tourism is recognized as one of the oldest forms of tourism to obtain medical services and health care of high quality.1 It requires the realization of several services, such as coordination and cooperation between countries,2 to safeguard the right of access to quality care, the right to reimbursement for medical services, and the privacy of patients. A 2008 report forecasted that the number of medical tourists would rise from 750 000 in 2007 to between 5.25 and 6.25 million by 2010, and to between 10.5 and 23.2 million by 2017.3 Patients are informed consumers claiming the right to choose healthcare providers, including professionals, outside their national borders. In this research, patients are supported and encouraged by several factors, including use of the Internet and information about services and health professionals. Health tourism is under development in different countries4 and is spreading across the European Union as an example of cross-border healthcare. Directive 2011/24/EU,5,6 which has considered various aspects of cross-border care, recognizes the right of patients to receive healthcare in another member state and the right to reimbursement for medical care. The aim of this directive is to provide more legal certainties about the right to care in other European States. The directive is structured in three main areas: (1) identifying the member state responsible for ensuring observance of health care principles; (2) specifying the rights of patients to health care in another state; and (3) establishing a framework for European cooperatio

Eighty years of CIRM. A journey of commitment and dedication in providing maritime medical assistance

Background: A review of activities of Centro Internazionale Radio Medico (International Radio Medical Centre, CIRM) from its foundation in 1935 until its 80th anniversary in 2015 was accomplished. CIRM was founded in 1935 to provide medical assistance via radio to ships with no doctor on board and other distant patients who cannot be reached by a doctor. In 1950 CIRM was established as a non-profit-making foundation and has benefited since 1957 from an annual contribution from the Italian government. Methods: Review of CIRM case histories and other published material from 1935 to 2015 and presenting them in a scientific yet simplified manner through the use of basic mathematical analysis. All the data was collected from CIRM’s official archives in Rome. Results and Conclusions: The results achieved by the Centre over 80 years include medical assistance to 81,016 patients on board ships (as well as on small islands and aircraft), with more than 500,000 medical messages received and transmitted. CIRM from its inception was organised into a medical service, a telecommunications service and a studies section. In 2002 the Centre was recognised as the Italian Telemedical Maritime Assistance Service (TMAS). In the 2010 the Centre was reorganised as a structure articulated in 4 departments, namely maritime telemedicine, telecommunication, research and occupational medicine. This was achieved to cover the different activities related to comprehensive health protection of seafarers. The 24-h continuous medical service is provided by doctors at the CIRM headquarters. The doctor on duty gives instructions for managing the case and continues to follow the patient with subsequent appointments until recovery or landing. In case of emergencies CIRM co-ordinates the transfer of patients assisted on board ships to a hospital ashore. CIRM has developed innovative approaches for the treatment of diseases and accidents on board of seagoing vessels by introducing standard telemedicine equipment on board ships, allowing the transmission of biomedical data from ships to the Centre. These new solutions are aimed at bringing a significant improvement of medical care for seafarers

Past, present, and future perspectives of telemedical assistance at sea: a systematic review

Background: Telemedicine is an effective technology for evaluating, diagnosing, treating, and providing health care services for remote populations, including seafarers, in case of diseases or accidents on board. Delivery of telemedicine in a maritime environment is not an easy task and, in general, differs from what can be done onshore. The aim of this review is to provides an overview of Telemedical Maritime Assistance Services (TMAS) in Europe by describing the previous and current status in terms of communication technologies as well as the nature of services rendered at sea. Secondly, to discuss the areas needing improvement and future directions to improve the quality of offshore telemedicine services. Materials and methods: Different databases, including PubMed (Medline), Google Scholar, Scopus, and journal of International Maritime Health, were searched between August 1 and September 15, 2019. Articles only published from 1969 to 2019 were considered. Relevant articles were selected by reviewing keywords, titles, and abstracts initially based on our inclusion and exclusion criteria. We critically reviewed the full-text articles included in this review. Information on the means of communication, telemedicine services, years of publication, and the name of the first author was extracted from selected studies. The quality of the selected studies was assessed using the criteria of the Newcastle-Ottawa scale. Results: Initially, 135 articles were identified through searching various databases by using keywords, abstracts, and titles. After removing the duplicates, 121 articles remained. Then we performed an independent article assessment and selection based on the selection criteria, which removed an additional 61 studies, leaving 60 papers. Finally, 27 full-text papers left, and we critically reviewed it. In 27 accepted articles, email and telephone were used most often and accounted for 30% (17/57) and 28% (16/57) of all communication links, respectively. Teleconsultation was the most used telemedicine service on board and represented 58.6% (17/29) of accepted papers. Conclusions: Email and telephone were the principal means of TMAS doctors to provide medical advice as well as assistance for patients at sea. Despite the potential offered by technological progress, there are still many limitations to the provision of adequate medical care at sea. The modernisation of telemedicine services will help decrease the gap in healthcare delivery at sea

Model discovery, and replay fitness validation using inductive mining techniques in medical training of CVC surgery

Medical training is a foundation on which better health care quality has been built. Freshly graduated doctors have required a good knowledge of practical competencies, which demands the importance of medical training activities. As of this, we propose a methodology to discover a process model for identifying the sequence of medical training activities that had implemented in the installation of a Central Venous Catheter (CVC) with the ultrasound technique. A dataset with twenty medical video recordings were composed with events in the CVC installation. To develop the process model, the adoption of process mining techniques of infrequent Inductive Miner (iIM) with a noise threshold value of 0.3 had done. A combination of parallel and sequential events of the process model was developed. Besides, process conformance was validated with replay fitness value about 61.1%, and it provided evidence that four activities were not correctly fit in the process model. The present study can assist upcoming doctors involved in CVCs surgery by providing continuous training and feedback on better patient care

Machine learning in medicine: Performance calculation of dementia prediction by support vector machines (SVM)

Machine Learning (ML) is considered as one of the contemporary approaches in predicting, identifying, and making decisions without having human involvement. ML is quickly evolving in the medical industry ranging from diagnosis to visualization of diseases and the study of disease transmission. These algorithms were developed to identify the problems in medical image processing. Numerous studies previously attempted to apply these algorithms on MRI (Magnetic Resonance Image) data to predict AD (Alzheimer's disease) in advance. The present study aims to explore the usage of support vector machine (SVM) in the prediction of dementia and validate its performance through statistical analysis. Data is obtained from the Open Access Series of Imaging Studies (OASIS-2) longitudinal collection of 150 subjects of 373 MRI data. Results provide evidence that better performance values for dementia prediction are achieved by low gamma (1.0E-4) and high regularized (C = 100) values. The proposed approach is shown to achieve accuracy and precision of 68.75% and 64.18%. Keywords: Machine learning, OASIS, Support vector machines, Kernel, Gamma, Regularization (C

Performance analysis of different machine learning algorithms in breast cancer predictions

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the centro internazionale radio medico symposium the way forward of maritime telemedicine

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Neuroinflammatory Markers in Spontaneously Hypertensive Rat Brain: An Immunohistochemical Study

BACKGROUND: Spontaneously hypertensive rats (SHR) represent a model of hypertension and vascular injury. In the past decade, SHR were also considered as a model of vascular dementia. Several studies have shown that cerebrovascular changes in SHR may mimic brain vascular diseases of hypertensive individuals. Vascular and cerebrovascular changes during hypertension are often linked to inflammatory processes. Inflammation frequently affects vascular endothelium, perivascular astrocytes that form blood brain barrier. This inflammatory reaction may lead to neuro-inflammation with consequent damage of brain tissue. A significant brain atrophy, a reduction of white matter volumes, and BBB dysfunction were found in SHR. Micro- and macrogliosis in deep cortical regions were also observed. Based on these findings, this study was designed to define neuroinflammation entity in SHR, using immunohistochemistry technique for different inflammatory markers. METHODS: Thirty-two-week-old SHR and age-matched Wistar Kyoto rats were used. Brain was processed for immunohistochemistry. Astrogliosis markers for astrocytes (glial fibrillary acidic protein) and microglia (isolectin IB4) were used. The pro-inflammatory interleukins (IL-1b, IL-6) and tumor necrosis factor alpha (TNFa) expression were also evaluated. RESULTS: In SHR brain, an obvious glial reaction was found both for GFAP-immunoreactive astrocytes and for microglia. The pro-inflammatory IL-1b was significantly increased in CA1 sub-field of SHR hippocampus. The TNFa expression was higher in frontal cortex of SHR compared to WKY. CONCLUSION: The above neuromorphological evidences indicate that SHR are predictive animal models for vascular brain disorders and neuroinflammation. Furthermore, this model may be useful to evaluate anti-inflammatory and neuroprotective effects of different molecules