Avoidable blindness and value based healthcare: More value with a population approach

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COVID-19 and digital competencies among young physicians: Are we (really) ready for the new era? A national survey of the Italian Young Medical Doctors Association

Background. Digital health (DH) is nowadays fundamental for physicians. Despite the improvement of information and communications technology (ICT), Italian medical doctors' (MDs) education system seems inadequate in this area. Moreover, due to the COVID-19 pandemic, societies are waking up to their limitations. The aim of this paper is to analyze the Italian status quo in DH. Methods. The Italian Young Medical Doctors Association (Segretariato Italiano Giovani Medici - SIGM) proposed a web-based survey to assess DH awareness and previous knowledge among young doctors. Investigated areas were: big data, -omics technology and predictive models, artificial intelligence (AI), internet of things, telemedicine, social media, blockchain and clinical-data storage. Results. A total of 362 participants answered to the survey. Only 13% had experience in big data during clinical or research activities, 13% in -omics technology and predictive models, 13% in AI, 6% had experience in internet of things, 22% experienced at least one telemedicine tool and 23% of the participants declared that during their clinical activities data collection was paper-driven. Conclusions. Three categories of MDs, high-tech, low-tech and no-tech, can be identified from the survey-based investigation. Our survey's results indicate an urgent need for integration of pre- and post-graduation training in digital health to provide adequate medical education

Italian young doctors’ knowledge, attitudes and practices on antibiotic use and resistance: A national cross-sectional survey

Objectives: Antimicrobial resistance (AMR) is one of the major health issues worldwide. Clinicians should play a central role to fight AMR, and medical training is a pivotal issue to combat it; therefore, assessing levels of knowledge, attitudes and practices among young doctors is essential for future antimicrobial stewardship (AMS) programmes. Methods: A nationwide, cross-sectional, multicentre survey was conducted in Italy. A descriptive analysis of knowledge and attitudes was performed, along with a univariate and multivariate analysis of their determinants. Results: Overall, 1179 young doctors accessed the survey and 1055 (89.5%) completed all sections. Regarding the knowledge section of the questionnaire, almost all participants declared to know the different species of bacteria proposed, however the percentage of participants who correctly responded to clinical quizzes was 23% for the question on vancomycin-resistant enterococci (VRE), 42% on carbapenem-resistant Enterobacteriaceae (CRE), 32% on extended-spectrum β-lactamase-producing enterobacteria (ESBL) and 27% on methicillin-resistantStaphylococcus aureus (MRSA). Similarly, 81% of participants disagreed in stating that AMR was adequately addressed during their medical training and 71% disagreed that they received the right example from their tutors. Finally, a high rate of agreement with the proposed actions to combat AMR was documented; in particular, the percentage agreement was 76% for respondents who agreed to be part of an active surveillance system or AMS programme. Conclusions: Tackling AMR should be a priority for politicians and for all health workers. Inclusion of competencies in antibiotic use in all specialty curricula is urgently needed. © 2020 The Author

Multidisciplinariet\ue0 nella gestione dei pazienti oncologici. Impatto dei Tumor Board sugli outcome clinico-assistenziali [Poster]

INTRODUZIONE I Multidisciplinary Tumor Board (MTB) sono team in cui diversi specialisti lavorano insieme condividendo strettamente le decisioni cliniche. Essi sono generalmente composti da un nucleo di medici oncologi, radiologi, patologi e chirurghi, cui possono di volta in volta unirsi altri professionisti, a seconda del tipo di patologia tumorale discussa. L\u2019obiettivo dello studio \ue8 stato indagare l\u2019impatto dei MTB sulla gestione dei pazienti oncologici. MATERIALI E METODI \uc8 stata condotta una revisione sistematica della letteratura attraverso Pubmed e Scopus. Lo studio \ue8 stato limitato all\u2019intervallo di tempo 01/01/2004-30/04/2017 e ai seguenti criteri di inclusione: descrizione di esperienze applicative di MTB e del loro impatto clinico/organizzativo. Sono stati estratti e riassunti i dati su: primo autore, anno di pubblicazione, obiettivo, disegno dello studio, popolazione, Paese, setting, struttura del MTB, risultati chiave ed effetto (positivo o negativo) sull\u2019outcome riportato. \uc8 stata eseguita una metanalisi tramite Revman e l\u2019eterogeneit\ue0 \ue8 stata quantificata attraverso i test Cochran Q e I2. RISULTATI Cinquantatr\ue8 su 2041 articoli potenzialmente rilevanti sono stati inclusi nella revisione. Gli studi erano focalizzati su 11 tumori: esofago (5 studi), stomaco (4), pancreas (3), fegato (2), colon-retto (16), mammella (2), cervello (2), polmone (8), testa-collo (10), prostata (2), tratto urinario (3). Per quanto riguarda l\u2019impatto del MTB, 33 studi hanno riportato cambiamenti del tempo di sopravvivenza, 7 della diagnosi, 17 della terapia. Un impatto positivo \ue8 stato segnalato in 58 casi (85%). L\u2019impatto \ue8 stato positivo in 27 casi (82%), 7 (100%) e 15 (88%) rispettivamente per quanto riguarda il tempo di sopravvivenza, la diagnosi e la terapia. La meta-analisi degli studi sulla mortalit\ue0 a 3 anni per tumore colon-rettale \ue8 esitata in un OR = 0,61 (IC 95% = 0,50-0,74; p = 0,54; I2 = 0%). CONCLUSIONI I MTB sono gruppi di diversi specialisti e professionisti sanitari che condividono decisioni cliniche basate sull\u2019evidenza e coordinano l\u2019assistenza a pazienti oncologici. Lo studio ha mostrato un impatto positivo dei MTB sulla gestione clinica e sugli outcome di tali pazienti. In particolare, \ue8 stato evidenziato un miglioramento dell\u2019appropriatezza diagnostico/terapeutica e del tempo di sopravvivenza. Ulteriori studi potranno contribuire alla produzione di evidenze utili in merito all\u2019implementazione dell\u2019approccio clinico multidisciplinare e alle sue ricadute assistenziali

L\u2019insegnamento della Salute Globale nelle Facolt\ue0 di medicina e Chirurgia in Italia: l\u2019offerta formativa nel triennio 2007-2010

Global Health (GH) issues are becoming a common feature of Medical and Public Health Schools worldwide. In Italy the Network for Education on Global Health (RIISG) was created with the purpose of spreading the concept of GH. The aim of the study was to assess the availability of educational opportunities in Italian Health Faculties from 2007 to 2010. A survey was carried out using a questionnaire administered to Professors. A frequency distribution of GH elective courses, grouped by three Italian geographical areas (North, Centre, South and Islands), for each academic year was assessed. The features of the courses - consistent with the pattern of course, suggested by RIISG - were analysed through a score. From 2007 onwards, in chronological order, the surveyed faculties were 40, 36, 36 and the main coverage of survey was 92%.The courses listed were 26, 22 and 40 respectively for each academic year considered. The average of the courses number highlighted an increasing trend: national mean rose from 0.65 (SD\ub11.53) in 2007 to 1.11 (SD\ub11.18) in 2010. Regarding the evaluation of consistency a national improvement was shown

Impact of multidisciplinary tumor boards on clinical management of cancer patients [Poster walk]

Background: Multidisciplinary Tumor Boards (MTBs) are teams in which different specialists work together closely sharing clinical decisions. MTBs are generally composed of a core of medical oncologists, radiologists, pathologists and surgeons. Other health professionals can join the team, depending on the type of tumor discussed. The objective of the study was to investigate the impact of MTBs on cancer patient management. Materials and Methods: A systematic literature review was performed through Pubmed and Scopus. The study was limited to the time interval 01/01/ 2004-30/04/2017 and inclusion criteria were the description of MTBs applicative experiences and their clinical/organizational impact. Data about first author, publication year, objective, study design, population, country, setting, MTB structure, key findings and effect (positive or negative) on reported outcome were extracted and summarized. A meta-analysis was performed through Revman and heterogeneity was quantified through Cochran Q and I2 tests. Results: Fifty-three out of 2041 potentially relevant articles were included in the review. Studies were focused on 11 tumors: esophagus (5 studies), stomach (4), pancreas (3), liver (2), colorectum (16), breast (2), brain (2), lung (8), head-neck (10), prostate (2), urinary tract (3). Concerning MTBs impact, 33 studies reported changes of survival time, 7 of diagnosis, 17 of therapy. A positive impact was reported in 58 (85%) cases. Impact was positive in 27 (82%), 7 (100%) and 15 (88%) cases as for survival time, diagnosis and therapy respectively. The meta-analysis of studies on colorectal cancer 3-year mortality resulted in an OR = 0.61 (95%CI=0.50-0.74; p = 0.54; I2 = 0%). Conclusions: The study showed a positive impact of MTBs on cancer patient management. In particular, an improvement of diagnostic/ therapeutic appropriateness and survival time was highlighted. Considering promising results, the research field deserves further in-depth studies. Key messages: MTBs are teams of different specialists and health professionals sharing evidence-based clinical decisions and coordinating the delivery of cancer care. MTBs positively impact on clinical management and outcomes of cancer patients

Assessing hospital performance indicators. What dimensions? Evidence from an umbrella review

Background: Patients\u2019 increasing needs and expectations require an overall assessment of hospital performance. Several international agencies have defined performance indicators sets but there exists no unanimous classification. The Impact HTA Horizon2020 Project wants to address this aspect, developing a toolkit of key indicators to measure hospital performance. The aim of this review is to identify and classify the dimensions of hospital performance indicators in order to develop a common language and identify a shared evidence-based way to frame and address performance assessment. Methods: Following the PRISMA statement, PubMed, Cochrane Library and Web of Science databases were queried to perform an umbrella review. Reviews focusing on hospital settings, published January 2000\u2013June 2019 were considered. The quality of the studies selected was assessed using the AMSTAR2 tool. Results: Six reviews ranging 2002\u20132014 were included. The following dimensions were described in at least half of the studies: 6 studies classified efficiency (55 indicators analyzed); 5 studies classified effectiveness (13 indicators), patient centeredness (10 indicators) and safety (8 indicators); 3 studies responsive governance (2 indicators), staff orientation (10 indicators) and timeliness (4 indicators). Three reviews did not specify the indicators related to the dimensions listed, and one article gave a complete definition of the meaning of each dimension and of the related indicators. Conclusions: The research shows emphasis of the importance of patient centeredness, effectiveness, efficiency, and safety dimensions. Especially, greater attention is given to the dimensions of effectiveness and efficiency. Assessing the overall quality of clinical pathways is key in guaranteeing a truly effective and efficient system but, to date, there still exists a lack of awareness and proactivity in terms of measuring performance of nodes within networks. The effort of classifying and systematizing performance measurement techniques across hospitals is essential at the organizational, regional/national and possibly international levels to deliver top quality care to patients

Formazione e nuove sfide in Salute Globale: qual \ue8 la percezione dei bisogni formativi degli studenti di Medicina e Chirurgia? L\u2019esperienza dell\u2019Universit\ue0 Cattolica del Sacro Cuore (UCSC) di Roma

Introduzione La salute globale \ue8 una disciplina emergente per la formazione dei medici di oggi, dei futuri specialisti in sanit\ue0 pubblica e in discipline cliniche. Nonostante la formazione e l\u2019advocacy in salute globale nei percorsi universitari sia fortemente raccomandata a livello internazionale, essa non risulta ancora adeguatamente strutturata nell\u2019offerta formativa e nei curricula dei Corsi di Laurea in Medicina e Chirurgia in Italia. Materiali e metodi Un ciclo di Attivit\ue0 Didattiche Elettive rivolto agli studenti di Medicina e Chirurgia, \ue8 stato offerto dal Centro di Ricerca e Studi in Salute Globale dell\u2019Istituto di Sanit\ue0 Pubblica-Sezione Igiene UCSC con la collaborazione di associazioni e organizzazioni impegnate nella formazione in salute globale. Sei lezioni frontali e interattive tenute da esperti si sono svolte tra marzo e maggio 2019 relativamente ai seguenti temi: salute globale: priorit\ue0 e target di popolazioni vulnerabili; disuguaglianze in salute, tutela dei diritti e sfide per la copertura sanitaria universale; impatto delle politiche non sanitarie sulla salute con focus sui migranti e sui minori stranieri, Agenda 2030 per gli obiettivi di sviluppo sostenibile; tutela e presa in carico delle donne vittime di tratta e violenza; salute materno-infantile in Sierra Leone. Ai partecipanti \ue8 stato distribuito un questionario semi-strutturato pre-corso per indagare aspettative e bisogni formativi ed un questionario strutturato post-corso per esplorare la percezione della rilevanza formativa e dell\u2019impatto sulla professione futura. Risultati Il corso ha registrato complessivamente 146 partecipanti (61% femmine), iscritti soprattutto al secondo (40,44%) e al terzo anno (39%) di Corso, ed una media di 75,7 (\ub1 19,7 DS) iscritti per incontro. L\u2019analisi qualitativa del questionario pre-corso ha evidenziato come gli studenti ritengano centrale l\u2019insegnamento in salute globale per acquisire una maggior consapevolezza nell\u2019esercitare la professione di medico ed un approccio sistemico basato sui determinanti di salute. Le tematiche ritenute pi\uf9 interessanti sono state la tutela delle donne vittime di violenza (48,7%) e le disuguaglianze in salute (49,6%). Il questionario post-corso ha evidenziato come l\u201988,4% abbia ritenuto il corso stimolante, il 69,7% ritenga che questo incider\ue0 sul proprio percorso formativo e futuro professionale e il 65% che tali tematiche debbano costituire parte integrante nel Curriculum universitario. Conclusioni L\u2019insegnamento della salute globale ad oggi non \ue8 ancora pienamente entrato nel curriculum formativo del Corso di Laurea in Medicina e Chirurgia. Il progetto e i risultati dell\u2019indagine evidenziano il forte interesse degli studenti di Medicina nell\u2019acquisire competenze in salute globale e sembrano dunque incoraggiarne l\u2019inserimento curriculare

Students’ social networks and vaccination behaviour in Italian junior high schools: preliminary results from the "VacciniAmo le Scuole" project.

Students; social networks; vaccination; behavior; high school