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.

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 the respective 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 medicine chests lack of several pharmaceutical categories required by the reference standards. The subsequent comparison of the European Directive with the WHO Model List of Essential Medicines has highlighted the absence of some therapeutic categories that in the ship environment can be of important to ensure adequate therapy in many situations.  Conclusions: There are disparities regarding regulations concerning the ship medicine chests. It is crucial to harmonize these and create a single medicine chest for all the ships without a doctor on board, undergoing periodic updates and revisions, based on epidemiological analysis that will ensure high-quality healthcare to seafarers around the world.

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

telemedicine practice review of the current ethical and legal challenges

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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 in most 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 the outcome. There is growing adoption of digital applications and electronic health records that are adding great value to the care provided. The Seafarer’s Health Passport (SHP) is an application specifically designed for improving the quality of medical assistance provided to seafarers both through telemedicine or classic medical check-ups in ports/hospitals worldwide. The SHP provides a secure and unique way to archive 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 software specifications. The basic features of this software are Linux operating system Debian/Ubuntu, Apache Web server 2.x, Server database MySQL/Maria DB PHP programming language 5.6.xx, and secure connection in https.  Results: The SHP represents a helpful hint to physicians providing medical advices to seafarers enabling them 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 population of travellers, such as seafarers to guarantee a reasonable level of medical care at any time.

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 in most 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 the outcome. There is growing adoption of digital applications and electronic health records that are adding great value to the care provided. The Seafarer's Health Passport (SHP) is an application specifically designed for improving the quality of medical assistance provided to seafarers both through telemedicine or classic medical check-ups in ports/hospitals worldwide. The SHP provides a secure and unique way to archive 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 software specifications. The basic features of this software are Linux operating system Debian/Ubuntu, Apache Web server 2.x, Server database MySQL/Maria DB PHP programming language 5.6.xx, and secure connection in https. Results: The SHP represents a helpful hint to physicians providing medical advices to seafarers enabling them 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 population of travellers, such as seafarers to guarantee a reasonable level of medical care at any time

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

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

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 the respective 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 medicine chests lack of several pharmaceutical categories required by the reference standards. The subsequent comparison of the European Directive with the WHO Model List of Essential Medicines has highlighted the absence of some therapeutic categories that in the ship environment can be of important to ensure adequate therapy in many situations. Conclusions: There are disparities regarding regulations concerning the ship medicine chests. It is crucial to harmonize these and create a single medicine chest for all the ships without a doctor on board, undergoing periodic updates and revisions, based on epidemiological analysis that will ensure high-quality healthcare to seafarers around the world

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