Gaetano Gallo1, Ugo Grossi2, Alessandro Sturiale3, Gian Luca Di Tanna4, Arcangelo Picciariello5, Sergio Pillon6, Domenico Mascagni7, Donato Francesco Altomare5, Gabriele Naldini3, Roberto Perinotti8. 1. Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy. Electronic address: gallog@unicz.it. 2. IV Surgery Unit, Treviso Regional Hospital, DISCOG, University of Padua, Italy. 3. Proctology and Pelvic Floor Clinical Centre, Cisanello University Hospital, Pisa, Italy. 4. The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia. 5. Surgical Unit 'M. Rubino', Department of Emergency and Organ Transplantation, Bari, Italy; Apulian Breath Analysis Centre (CeRBA), Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II, Bari, Italy. 6. AO San Camillo Forlanini, Roma, Italy. 7. Department of Surgical Sciences, Policlinico Umberto I, "Sapienza" University of Roma, Roma, Italy. 8. Colorectal Surgical Unit, Department of Surgery, Infermi Hospital, Biella, Italy.
Abstract
BACKGROUND: Coronavirus disease 2019 is revolutionizing healthcare delivery. The aim of this study was to reach a consensus among experts as to the possible applications of telemedicine in the proctologic field. METHODS: A group of 55 clinical practice recommendations was developed by a clinical guidance group based on coalescence of evidence and expert opinion. The Telemedicine in Proctology Italian Working Group included 47 Italian Society of Colorectal Surgery nominated experts evaluating the appropriateness of each clinical practice recommendations based on published RAND/UCLA methodology in 2 rounds. RESULTS: Stakeholder median age was 53 years (interquartile range limits 40-60), and 38 (81%) were men. Nine (19%) panelists reported no experience with telemedicine before the pandemic. Agreement was obtained on a minimum of 3 to 5 years of practice in the proctologic field before starting teleconsultations, which should be regularly paid, with advice and prescriptions incorporated into a formal report sent to the patient by e-mail along with a receipt. Of the panelists, 35 of 47 (74%) agreed that teleconsultation carries the risk of misdiagnosis of cancer, thus recommending an in-person assessment before scheduling any surgery. Fifteen additional clinical practice recommendations were re-elaborated in the second round and assessed by 44 of 47 (93.6%) panelists. The application of telemedicine for the diagnosis of common proctologic conditions (eg, hemorrhoidal disease, anal abscess and fistula, anal condylomas, and anal fissure) and functional pelvic floor disorders was generally considered inappropriate. Teleconsultation was instead deemed appropriate for the diagnosis and management of pilonidal disease. CONCLUSION: This e-consensus revealed the boundaries of telemedicine in Italy. Standardization of infrastructures, logistics, and legality remain to be better elucidated.
BACKGROUND:Coronavirus disease 2019 is revolutionizing healthcare delivery. The aim of this study was to reach a consensus among experts as to the possible applications of telemedicine in the proctologic field. METHODS: A group of 55 clinical practice recommendations was developed by a clinical guidance group based on coalescence of evidence and expert opinion. The Telemedicine in Proctology Italian Working Group included 47 Italian Society of Colorectal Surgery nominated experts evaluating the appropriateness of each clinical practice recommendations based on published RAND/UCLA methodology in 2 rounds. RESULTS: Stakeholder median age was 53 years (interquartile range limits 40-60), and 38 (81%) were men. Nine (19%) panelists reported no experience with telemedicine before the pandemic. Agreement was obtained on a minimum of 3 to 5 years of practice in the proctologic field before starting teleconsultations, which should be regularly paid, with advice and prescriptions incorporated into a formal report sent to the patient by e-mail along with a receipt. Of the panelists, 35 of 47 (74%) agreed that teleconsultation carries the risk of misdiagnosis of cancer, thus recommending an in-person assessment before scheduling any surgery. Fifteen additional clinical practice recommendations were re-elaborated in the second round and assessed by 44 of 47 (93.6%) panelists. The application of telemedicine for the diagnosis of common proctologic conditions (eg, hemorrhoidal disease, anal abscess and fistula, anal condylomas, and anal fissure) and functional pelvic floor disorders was generally considered inappropriate. Teleconsultation was instead deemed appropriate for the diagnosis and management of pilonidal disease. CONCLUSION: This e-consensus revealed the boundaries of telemedicine in Italy. Standardization of infrastructures, logistics, and legality remain to be better elucidated.
Authors: Sara Vertaldi; Pietro Anoldo; Grazia Cantore; Alessia Chini; Anna D'Amore; Maria D'Armiento; Nicola Gennarelli; Francesco Maione; Michele Manigrasso; Alessandra Marello; Pietro Schettino; Carmen Sorrentino; Loredana M Sosa Fernandez; Giovanni D De Palma; Marco Milone Journal: Front Surg Date: 2022-03-03
Authors: Michele Manigrasso; Pietro Anoldo; Grazia Cantore; Alessia Chini; Anna D'Amore; Nicola Gennarelli; Francesco Maione; Alessandra Marello; Pietro Schettino; Carmen Sorrentino; Sara Vertaldi; Loredana Maria Sosa Fernandez; Giovanni Domenico De Palma; Marco Milone Journal: Front Surg Date: 2022-01-04