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.

Markov logic networks for optical chemical structure recognition.

Optical chemical structure recognition is the problem of converting a bitmap image containing a chemical structure formula into a standard structured representation of the molecule. We introduce a novel approach to this problem based on the pipelined integration of pattern recognition techniques with probabilistic knowledge representation and reasoning. Basic entities and relations (such as textual elements, points, lines, etc.) are first extracted by a low-level processing module. A probabilistic reasoning engine based on Markov logic, embodying chemical and graphical knowledge, is subsequently used to refine these pieces of information. An annotated connection table of atoms and bonds is finally assembled and converted into a standard chemical exchange format. We report a successful evaluation on two large image data sets, showing that the method compares favorably with the current state-of-the-art, especially on degraded low-resolution images. The system is available as a web server at http://mlocsr.dinfo.unifi.it.

Analysis of the complex effect of donor's age on survival of subjects who underwent heart transplantation.

BACKGROUND: Only half of the patients waiting for a heart transplant undergo surgery, whereas several patients continue to die while on the waiting list. Donor organ availability still represents a major problem with respect to reducing the length of the cardiac transplant waiting list. One option to improve donor availability is the use of so called "marginal donors." The aims of the present study are to analyze the short-mid term survival of cardiac transplanted patients in Italy, and investigate the effect of donor age on prognosis. METHODS: A prospective cohort study including all adult patients who underwent heart transplantations in Italy was used to analyze the main factors contributing to organ survival. RESULTS: From 1995-2002, 2,504 adult subjects underwent a cardiac transplant, and were followed up for a period of 540.9 days. Overall, 1-year graft survival was 83.1%. Organs from donors older than 55 years had a lower survival than organs from younger donors. By multivariate analysis, both donor's and recipient's age seem to be important determinants of graft survival. A more sophisticated analysis shows that the trend of the risk of graft failure according to donor's age is not linear, with a peak at age 47.3 years, and differs according to sex. CONCLUSIONS: Results from the present analysis suggest that the association between heart transplant survival and donor's age is not a linear one, but follows a complex mathematical model, with influences of sex, at least in our sample.

Bioterrorism: development of large-scale medical readiness using multipoint distance-based simulation training.

Accordingly to HIRSA, 35,000 health professionals need to be trained in recognition and acute field treatment of victims of bioterrorism within year 2004 alone The Department of Defense anticipates even larger numbers. Training of very large number of healthcare workers is particularly daunting in the context of "just-in-time" education. The paper presents utilization of simulation-based distance training as a particularly useful tool in rapid development of readiness in a large population of widely distributed medical and lay personnel facing imminent threat of a chem/bioterrorism incident.

Strategies for evaluation of suitable donors: Italian experience.

Italy was lacking standardised procedures for donor safety evaluation. We developed practice guidelines, while a panel of experts coordinated by the National Transplant Centre, is available 24 hours a day to support decisions in difficult cases. The guidelines identify five levels of risk and give recommendations for the utilization of donors with HBV and HCV infections as well as for malignancies with negligible or very low risk of transmission. In conclusion we aim to standardize the process of donor evaluation across Italy, to increase the pool of utilised donors and to reduce the risk of communicable disease transmission.

Transatlantic medical education: preliminary data on distance-based high-fidelity human patient simulation training.

Advanced training using Human Patient Simulators (HPS) is, for the large part, unavailable for the majority of healthcare providers in rural, remote, and less developed regions of the world--either due to their separation from the major medical education centers or significant fiscal austerity. Remote access to HPS based on the Applications Software Provider principles may provide the solution to this problem. The medical ASP (MED-ASP) concept proposed and developed by MedSMART has been subjected to an extensive qualitative and quantitative international test conducted among France, Italy, and USA. Two SimMan HPSs (Laerdal, Norway) were used, with one unit based in Ann Arbor, MI, USA, and one in Laval, France. While the French site had both remote and hands-on access to the simulator, the Italian site could access the HPS only remotely. Simulator visualization was provided by 4 remotely operated cameras (Sony, zoom, pan, tilt) at each HPS site. HPS-generated vital signs were transmitted to each site together with the interactive simulator control panel using a communications hub at the MedSMART facility in Ann Arbor. All remote interactions were performed via the Internet (TCP/IP) using ISDN and/or ADSL connections at minimum 128 Kbps. During the course of training, the trainees were exposed to 3 emergency scenarios with the remote expert providing instruction. Interventions were performed either remotely (Italy) or remotely and hands-on (France). Quantitative measurement of the efficiency of training was performed at the Italian site based on the evaluation of video recordings of each session and the assessment of several performance measures. At the end of the training program, a Likert scale-based assessment test was also given. The trainees showed statistically significant (p<0.03 - 0.05) improvement in all testing measures. The Likert scale questionnaire revealed overwhelming satisfaction with the simulation-based distance training even when the access to the simulator was only remote (Italy). Confidence was also significantly improved. The trainees indicated the optimal frequency of distance training as one 2 hour-long session twice a month. In conclusion, simulation-based distance medical training proved to be a highly effective tool in improving emergency medical skills of junior physician trainees and, despite initial reservations, neither distance nor language and cultural differences posed significant obstacles. The present and historical data from our previous work confirm the concept of MED-ASP as a highly efficient tool in both national and international medical education and training. Moreover, we now validate for the first time the concept of simulation-based, fully interactive transatlantic medical ADL that we have proposed in our previous theoretical papers. The present experiments prove that training based on advanced technologies transcends barriers of distance, time, and national medical guidelines. Hence, international simulation-based distance training may ultimately provide the most realistic platform for a large-scale training of emergency medical personnel in less developed countries and in rural/remote regions of the globe.

[Laparoscopy in abdominal emergencies. Indications and limitations]. / La laparoscopia nelle urgenze addominali. Indicazioni e limiti.

Laparoscopy, which has been well known as a diagnostic procedure for more than a century, has recently established itself as an important therapeutic procedure in several branches of surgery. In the present study the authors report on 221 patients over a 10-year period (1991-2001), admitted to hospital with a diagnosis of acute abdomen or abdominal trauma. All patients were submitted to emergency laparoscopic surgery; 128 patients (57%) presented acute appendicitis, 40 (18%) acute cholecystitis, 13 (6%) occlusive ileus, 10 (5%) adnexal pathologies, 9 (4%) perforation of abdominal viscera, 3 (1.4%) acute diverticulitis, 3 (1.4%) subdiaphragmatic abscesses, 3 (1.4%) intestinal infarction, 2 (0.8%) other diseases and 10 (5%) abdominal trauma. The operation was completed laparoscopically in 192 cases (87%), while conversion to laparotomy proved necessary in 29 cases (13%). The morbidity of the cases completed laparoscopically was 3%, the mortality 0.5%, and the mean hospital stay 4 days. Advantages of laparoscopy (shorter hospital stay, rapid postoperative recovery and faster return to social activities) emerge from the present study and are confirmed by the literature. The possibility of combining a diagnostic procedure with curative therapy suggests that laparoscopy may have an important role in emergency surgery, demonstrating its efficacy also in acute abdominal syndromes. Nevertheless, emergency laparoscopic surgery is still a technically difficult procedure that needs to be performed by an expert surgical team.

["Sequential" treatment: is it the best alternative in cholecysto-choledochal lithiasis?]. / Il trattamento "sequenziale": la migliore delle alternative nella litiasi colecisto-coledocica?

Laparoscopic cholecystectomy has become the treatment of choice for patients with symptomatic cholelithiasis. About 10-20% of patients with gallbladder stones may also present associated common bile duct stones. The management of the latter remains controversial because many different surgical strategies are available: laparoscopic treatment (laparoscopic common bile duct exploration), sequential endoscopic and laparoscopic treatment (endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy [ERCP/ES] prior to laparoscopic cholecystectomy), inverted sequential endoscopic-laparoscopic treatment (laparoscopic cholecystectomy followed by ERCP/ES), and combined endoscopic-laparoscopic treatment (laparoscopic cholecystectomy with intraoperative ERCP/ES). The aim of this study was to evaluate the efficacy and safety of sequential endoscopic-laparoscopic treatment in patients with cholecystocholedocholithiasis. We retrospectively analyzed the clinical, biochemical and radiological features of 552 patients operated on for cholelithiasis from 1991 to 2001. Common bile duct stones were suspected on the basis of increased serum levels of bilirubin, GOT, GPT, GGT, alkaline phosphatase; presence of jaundice; history of pancreatitis or cholangitis; dilated common bile duct (diameter > 8 mm) or common bile duct stones at hepatobiliary ultrasonography; presence of common bile duct stones at MR-cholangiography or at i.v. cholangiography. In patients with suspected common bile duct stones, preoperative ERCP was performed; if common bile duct stones were confirmed, ES was performed. When common bile duct stones were not suspected preoperatively, laparoscopic cholecystectomy was performed directly. Overall morbidity, mortality and conversion rates in the two groups were evaluated. Of 552 patients admitted for cholelithiasis, 62 (11.3%) underwent preoperative ERCP for suspected common bile duct stones. In 41 patients (66.1%) common bile duct stones were identified and ES with common bile duct stone extraction was performed in 40 patients (clearance: 97.5%). The overall morbidity was 16% (10 cases of post-ERCP acute pancreatitis); no mortality occurred. The conversion rate during subsequent laparoscopic cholecystectomy was 4.8%. In the group of patients with no suspicion of common bile duct stones, the conversion rate was 4.9%. Sequential treatment cannot be considered the best approach for patients with cholecystocholedocholithiasis because of its morbidity rate and the high rate of negative preoperative ERCP findings. Combined endoscopic-laparoscopic treatment seems to present more advantages, especially in term of morbidity, hospital stay and patient compliance and may, in future, be considered the treatment of choice for patients with cholecystocholedocholithiasis.