Background: Telemedicine involves medical practice and information and communications technology. It has been proven to be very effective for remote health care, especially in areas with poor provision of health facilities. However, implementation of these technologies is often hampered by various issues. Among these, ethical and legal concerns are some of the more complex and diverse ones. In this study, an analysis of scientific literature was carried out to identify the ethical and legal challenges of telemedicine. Materials and Methods: English literature, published between 2010 and 2019, was searched on PubMed, Scopus, and Web of Science by using keywords, including ''Telemedicine,'' ''Ethics,'' ''Malpractice,'' ''Telemedicine and Ethics,'' ''Telemedicine and Informed consent,'' and ''telemedicine and malpractice.'' Different types of articles were analyzed, including research articles, review articles, and qualitative studies. The abstracts were evaluated according to the selection criteria, using the Newcastle-Ottawa Scale criteria, and the final analysis led to the inclusion of 22 articles. Discussion: From the aforementioned sample, we analyzed elements that may be indicative of the efficacy of telemedicine in an adequate time frame. Ethical aspects such as informed consent, protection data, confidentiality, physician's malpractice, and liability and telemedicine regulations were considered. Conclusions: Our objective was to highlight the current status and identify what still needs to be implemented in tele-medicine with respect to ethical and legal standards. Gaps emerged between current legislation, legislators, service providers, different medical services, and most importantly patient interaction with his/her data and the use of that data.

Background and objectives: This paper addresses psychological resilience, a multidisciplinary theoretical construct with important practical implications for health sciences. Although many definitions have been proposed in several contexts, an essential understanding of the concept is still lacking up to now. This negatively affects comparisons among research results and makes objective measurement difficult. The aim of this review is to identify shared elements in defining the construct of resilience across the literature examined in order to move toward a conceptual unification of the term. Materials and methods: A literature review was performed using the electronic databases ‘PubMed’ and ‘PsycINFO’. Scientific studies written in English between 2002 and May 2019 were included according to the following key terms: ‘Psychological’, ‘resilience’, and ‘definition’. Results: The review identifies five macro-categories that summarize what has been reported in the recent literature concerning the resilience phenomenon. They serve as a preliminary and necessary step toward a conceptual clarification of the construct. Conclusions: We propose a definition of psychological resilience as the ability to maintain the persistence of one’s orientation towards existential purposes. It constitutes a transversal attitude that can be understood as the ability to overcome the difficulties experienced in the different areas of one’s life with perseverance, as well as good awareness of oneself and one’s own internal coherence by activating a personal growth project. The conceptual clarification proposed will contribute to improving the accuracy of research on this topic by suggesting future paths of investigation aimed at deeply exploring the issues surrounding the promotion of resilience resources.

Background and Objectives: The term “telepharmacy” indicates a form of pharmaceutical care in which pharmacists and patients are not in the same place and can interact using information and communication technology (ICT) facilities. Telepharmacy has been adopted to provide pharmaceutical services to underserved areas and to address the problem of pharmacist shortage. This paper has reviewed the multi-faceted phenomenon of telepharmacy, summarizing different experiences in the area. Advantages and limitations of telepharmacy are discussed as well. Materials and Methods: A literature analysis was carried out on PubMed, using as entry term “telepharmacy” and including articles on the topic published between 2012 and 2018. Results: The studies reviewed were divided into three categories of pharmacy practice, namely (1) support to clinical services, (2) remote education and handling of “special pharmacies”, and (3) prescription and reconciliation of drug therapies. In general, different telepharmacy services were effective and accompanied by a satisfaction of their targets. Conclusions: Nowadays, the shortage of health personnel, and in particular pharmacists, is a challenging issue that the health systems have to face. The use of a new technology such as telepharmacy can represent a possible option to solve these problems. However, there are unsolved limitations (e.g., legal implications) that make greater diffusion of telepharmacy difficult. Stronger data on the effectiveness of this area of pharmacy care, together with a critical evaluation of its limits, can make actors involved aware about the potentialities of it and could contribute to a larger diffusion of telepharmacy services in the interest of communities and citizens.

BackgroundApproximately 46.8 million people are living with dementia worldwide and their number will grow in the next years. Any potential treatment should be administered as early as possible because it is important to provide an early cognitive assessment and to regularly monitor the mental function of patients. Information and communication technologies can be helpful to reach and follow patients without displacing them, but there may be doubts about the reliability of cognitive tests performed by telemedicine.ObjectiveThe purpose of this study was to evaluate the reliability of the Mini Mental State Examination (MMSE) and the Alzheimer’s Disease Assessment Scale cognitive subscale (ADAS-cog) tests administered in hospital by videoconference to patients with mild to moderate Alzheimer's disease.MethodsThe tests were administered to 28 Alzheimer's disease outpatients (8 male, mean age 73.88, SD 7.45 years; 20 female mean age 76.00, SD 5.40 years) recruited and followed in the Alzheimer’s Unit of the A Cardarelli National Hospital (Naples, Italy) at baseline and after 6, 12, 18, and 24 months of observation. Patients were evaluated first face-to-face by a psychologist and then, after 2 weeks, by another psychologist via videoconference in hospital.ResultsThis study showed no differences in the MMSE and ADAS-cog scores when the tests were administered face-to-face or by videoconference, except in patients with more pronounced cognitive deficits (MMSE<17), in which the assessment via videoconference overestimated the cognitive impairment (face to face, MMSE mean 13.9, SD 4.9 and ADAS-cog mean 9.0, SD 3.8; videoconference, MMSE mean 42.8, SD 12.5 and ADAS-cog mean 56.9, SD 5.5).ConclusionsWe found that videoconferencing is a reliable approach to document cognitive stability or decline, and to measure treatment effects in patients with mild to moderate dementia. A more extended study is needed to confirm these results.

Demographic indicators forecast that by 2050, the elderly will account for about one-third of the global population. Geriatric patients require a large number of medicines, and in most cases, these products are administered as solid oral solid dosage forms, as they are by far the most common formulations on the market. However, this population tends to suffer difficulties with swallowing. Caregivers in hospital geriatric units routinely compound in solid oral dosage forms for dysphagic patients by crushing the tablets or opening the capsules to facilitate administration. The manipulation of a tablet or a capsule, if not clearly indicated in the product labeling, is an off-label use of the medicine, and must be supported by documented scientific evidence and requires the patient’s informed consent. Compounding of marketed products has been recognized as being responsible for an increased number of adverse events and medical errors. Since extemporaneous compounding is the rule and not the exception in geriatrics departments, the seriousness and scope of issues caused by this daily practice are probably underestimated. In this article, the potential problems associated with the manipulation of authorized solid oral dosage forms are discussed.

IntroductionSynovial cysts are cystic dilatations of the synovial sheaths; they are bordered not only by the connectival tissue structures of these sheaths but also by the mono-or pluri-stratified cuboid synovial epithelium. Anatomical continuity with the synovial sheaths of the joint cavities from which the cyst probably originates may not always be observed.While synovial cysts are quite a frequent occurrence in joints and tendon sheaths [3,10,23], especially in the joints of the hands and wrists [45], they are very rare in the spine [13,18,25,40,47,62]. In the lumbar spine 220 cases have been described [1,2,16,21,28,34,38,40,43,45,48,51,[54][55][56]60].The incidence of synovial cysts with a cervical location was evaluated, with reference to veterinary literature too [15], and was found to be an occurrence specific to humans, of which, to our knowledge, only 22 cases have been reported to date.We describe another case of cervical synovial cyst and discuss the pathological, etiopathogenetic, and clinical aspects of this rare pathology. Case reportA 58-year-old man was referred to us with a progressive spastic paraparesis, which had started 8 months earlier. About 2 months prior to admission, he had begun to suffer from genital-sphincteric ailments such as urinary retention and difficult erection.Examination revealed a severe motor deficit in the lower limbs (he was able to raise his legs while lying in bed for a few seconds only), as well as an increased response to knee and ankle jerks. There was superficial and deep hypoesthesia below C8 and apallesthesia below the iliac crests. There was also urinary retention, which required catheterization. AbstractThe authors describe the case of a 58-year-old man with a 6-month history of severe myelopathy. CT scan and MRI of the spine revealed a cystic formation, measuring about 1 cm in diameter, at C7-T1 at a right posterolateral site at the level of the articular facet. At operation the mass appeared to originate from the ligamentum flavum at the level of the articular facet and was in contact with the dura mater. Once the mass had been removed, there was a significant amelioration of the patient's symptoms. As previously suspected, histological aspect was synovial cyst. Cervical synovial cysts are extremely rare and, as far as we know, only 22 cases have so far been described in the literature. Diagnostic radiological investigations used were CT scan and MRI. At CT scan the most important diagnostic findings are a posterolateral juxtafacet location of the mass, egg-shell calcifications on the wall of the cyst, and air inside the cyst. At MRI the contents of the cyst are iso/hypointense on T1-and hyperintense on T2-weighted images. There may also be a hypointense rim on T2-weighted images, which enhances after i.v. administration of gadolinium. Surgical treatment consists of removal of the mass. Fixation of the vertebral segments involved is not always necessary.

Spinal cord cavernous malformations (SCCM), once thought to be extremely rare, have been diagnosed more frequently since the advent of MRI. In addition to the six personal cases surgically treated between 1992 and 1993 and already described in the literature, the authors report here a further ten cases operated on between April 1993 and January 2001. These involved five males and five females whose ages at operation ranged from 12 to 69 years. The SCCM were thoracic in five patients and cervical in five. In seven cases, the malformations bulged on the surface of the pia mater, while in the other three there was subpial discoloration due to the presence of hemosiderin. Removal was total in all cases. After surgery, two patients presented transient worsening of preoperative paraparesis. At follow-up ranging from 2.2 to 9.2 years (mean 5.7), nine patients had made complete motor recovery while one, in whom preoperative paraparesis had been severe, remained stationary. At least one follow-up MRI investigation was performed in each patient 6 to 12 months after operation. As previously reported, the authors confirm that the treatment of choice for symptomatic SCCM is total surgical excision in order to avoid recurrences and the possibility of further hemorrhage. Surgical outcome combines low mortality with a high probability of functional recovery, especially when paraparesis is not severe and of relatively recent onset.

MetS: Metabolic syndrome; WHO: World Health Organization; CVD: cerebrovascular diseases; AD: Alzheimer's Disease; VaD: Vascular Dementia; IDF: International Diabetes Federation; T2DM: type 2 diabetes mellitus; CAD: coronary artery disease; MCI: mild cognitive impairment; NCDs: Non Communicable Diseases; BMI: Body Mass Index; ICIDH: International classification of impairments, disabilities and handicaps.