PRELIMINARY TOPICS AND LINEUPS: Working groups composition is open
1. Novel minimally invasive endoscopic and surgical procedures in chronic disease
First deliverable (in press):
Surgical approaches for mitigating the worldwide burden of gastroesophageal reflux disease (Authors: Luigi Bonavina, Guglielmo Trovato, Rosario Caruso, Alberto Aiolfi, Rosario Squatrito, Roberto Penagini, Davide Bona, Giovanni Dapri, Jerome R. Lechien).
Lineup:
Appropriate use of new technologies and reduction of the cost of biomedical devices is expected to reduce barriers to healthcare and provide more personalized and equitable therapy. Gastroesophageal reflux disease and hiatus hernia are chronic conditions leading to typical (heartburn, regurgitation) and/or atypical (laryngopharyngeal and respiratory) complications (chronic inflammation and precancerous lesions). Potent acid suppressive medications, i.e. proton-pump inhibitors, fail to restore the antireflux barrier and are unable to relieve symptoms in about 40% of patients. The Nissen fundoplication is the surgical standard of care. With this procedure, the distal part of the esophagus is totally encircled by a portion of the proximal stomach (the fundus) to prevent return of acid, pepsin, and bile in the esophagus. However, the majority of patients and gastroenterologists are still skeptical and have not embraced this therapeutic modality due to the fear of side effects such as difficult swallowing, gas-bloating, and inability to burp and vomiting. Partial fundoplications have limited side-effects but also limited durability over time. Novel procedures using biomedical devices have been proposed to avoid the side effects of fundoplication and to provide a durable surgical repair that does not alter quality of life while curing reflux and reducing the need of acid suppressive medications. The global burden of GERD requires a call to action for planning healthcare services, enhancing quality of treatments, reducing variations in surgical practice, and breaking geographical barriers.
2. Optimize the preoperative risk profile and enhance perioperative recovery through prehabilitation before surgery
Working group:
Nidal Tourkmani, Luigi Bonavina, Guglielmo Trovato, Andrew Taylor-Robinson, Rosario Caruso and Vincenzo Costigliola.
Lineup:
The aim of this working group is to highlight the importance of reducing surgical stress response and the burden of postoperative complications associated with major elective surgical procedures by a comprehensive and structured patient-centered pre-habilitation approach. The immediate goal is a timely optimization of the conditions of the patient before major surgical procedures or neoadjuvant therapies for cancer, to lower the pre-operative risk profile and to enhance postoperative recovery. Potential advantages of a standardized and personalized prehabilitation program are the following: a) increase the likelihood of immediate extubation in the operating room after the surgical procedure; b) reduce the burden of critical care stay after surgery; b) reduce the need for perioperative blood transfusions; c) facilitate fast-track/ERAS programs; d) reduce morbidity and mortality; e) improve long-term survival and quality of life. This approach represents a true paradigm shift. The focus is on appropriate health literacy targets physicians, nurses, patients, and policy-makers to organize the necessary facilities.
Key questions are whether there is sufficient evidence that all this is beneficial, in which disease conditions, for which surgical procedures, and which are the barriers and the financial burden. Apart from the specific areas of evidence-based knowledge, statements should be good enough to match a coordinated theory of change, illustrating how and why a desired change is expected to happen in a particular context. Prehabilitation is an opportunity to improve patients’ lifestyles and therapies.
It is likely that the real paradigm shift will be to move the organizational model of pre-habilitation from the hospital, where there would not be sufficient space, to dedicated rehabilitation facilities, residential or as out-patient services, or rather focusing directly on the patient’s home by tele-prehabilitation.
3. Telemedicine: current and innovative technologies and applications
Working Group:
Francesco Amenta, Rosario Squatrito, Teresa Abbattista, Rosario Caruso, Simon Taylor-Robinson.
Lineup:
An agenda with a few strategic topics is currently discussed and developed, also considering the most relevant challenges and opportunities of greater impact on the healthcare system: maritime medicine, robotic surgery, eHealth, distance imaging counseling et al. An agenda with only one or a few topics suitable for proposing specific advancements is currently discussed and developed, also considering the opportunities of greater impact on the healthcare system and the potential of delivering policy briefs as position points of the Association.
4. History of Medicine: from the unwritten history to the revisitation or development of new skills, knowledge and mental attitude.
Working Group: Teresa Abbattista, Antonio Molfese
Lineup:
The focus is on the problems of disease and death in the ancient, modern and contemporary times. However, a special attention, in this working group, is deserved to the role of Women in medicine, having in mind the Schola Medica Salernitana and the Physician Women of Salerno. An agenda with a few topics suitable for actualization is currently discussed and developed, also considering the most relevant historical challenges which mirror the opportunities of greater impact on the healthcare system and the potential of delivering policy briefs as position points of the Association.
5. Environment and Health
Working Group:
Giovanni Leonardi, Prisco Piscitelli, Camille Huser, Luigi Bonavina, Vincenzo Costigliola, Rosario Caruso, Andrew Taylor-Robinson, and Guglielmo Trovato.
Lineup:
A global landscape has emerged of educational and professional training in environmental health (EH). It should include consideration of the health impacts of climate and other environmental changes, as well as pollution. A range of approaches to strengthening factual knowledge and competencies to support diagnosis and treatment at an individual and societal level will be argued and chosen. These disparate offers in principle will contribute to the development of medical practice to make health professionals more aware of preventable causes of ill health, as well as public health systems more aware of ecological or environmental dimensions. In this field there is a lack of consistent global implementation of training programs for clinical professionals, public health practitioners, and individuals across various disciplines, as well as standardized curricula for undergraduates. A conference is planned in September 2025 to provide a forum for making progress in this area within the European region to agree to a position delivered by the European Medical Association.
6. Humanization and Proximity in oncology: The challenges of Predictive, preventive, and personalized medicine.
Working Group:
Vincenzo Costigliola, Fabrizio Artioli, Guglielmo Trovato, Rosario Squatrito.
Lineup:
PPM oncology is the evidence-based, individualized approach that delivers the right prediction, prevention and care to the right patient at the right time and results in measurable improvements in cancer outcomes and a reduction on health care costs. Humanization in oncology patient care represents a significant innovation in health care practice, shifting the traditional focus solely on treating physical conditions to encompass the emotional and psychosocial dimensions of patient experience. The concept and practice of proximity in cancer care appears a promising complement to existing models of integration, especially in complex contexts such as cancer networks. Implementation of cancer screening projects with mobile units “right at the doorstep” can make prevention more feasible in the territory reducing pressure on healthcare services. The working group will develop a comprehensive document, suitable for publication, encompassing new technological advancements, including liquid biopsies, with strategies for overcoming barriers and inequities. Models and experiences will be considered and the potential launch of a topical collection on the journal can be pursued.
7. A medical strategy and call for action to ensure basic human rights, combat inequities, and enhance women's quality of life in relation to female genital mutilation worldwide.
Working Group: Giulia Bonavina, Randa Kaltoud, Alessandro Bulfoni, Massimo Candiani, Stefano Salvatore, Carol Pollard
Lineup:
Increased international migration has exposed Europe to a diversity of cultural and ethical issues regarding women’s health. The burden of female genital mutilations is now a global issue and requires a call to action for enhancing quality of treatments and reducing variations in care. Female genital mutilation/cutting (FGM/C) includes all non-medical procedures that involve partial or total removal of the external female genitalia, or any other injury to the female genital organs. It is estimated that, out of 230 million mutilated women worldwide, 10% have undergone infibulation (FGM/C type III), the most invasive procedure. This practice represents a violation of the human rights and a discrimination against women. FGM/C is practiced in 31 countries, mainly in Africa. Efforts to end FGM/C are included in the 2008 World Health Assembly resolution and in the 2020 Sustainable Development Goals of the United Nations. Genital mutilations are associated with significant morbidity and have a profound impact on women health and wellbeing. Health care professionals of multi-ethnic societies across the Western world are facing the boundaries set by legal and professional policies, including re-infibulation of women to allow for childbirth, sexual intercourse, or therapeutic gynecological procedures. A policy of no-reinfibulation may endanger trust in the community, potentially causing women to stop using healthcare services in the hosting country. Still, the question of whether FGM/C legislation applies to reconstructive plastic surgical care remains controversial. Inter-institutional and multicultural dialogue can serve as crucial driver of change to ensure protection of basic human rights and to avoid racism and ethnocentrism.
1. Novel minimally invasive endoscopic and surgical procedures in chronic disease
First deliverable (in press):
Surgical approaches for mitigating the worldwide burden of gastroesophageal reflux disease (Authors: Luigi Bonavina, Guglielmo Trovato, Rosario Caruso, Alberto Aiolfi, Rosario Squatrito, Roberto Penagini, Davide Bona, Giovanni Dapri, Jerome R. Lechien).
Lineup:
Appropriate use of new technologies and reduction of the cost of biomedical devices is expected to reduce barriers to healthcare and provide more personalized and equitable therapy. Gastroesophageal reflux disease and hiatus hernia are chronic conditions leading to typical (heartburn, regurgitation) and/or atypical (laryngopharyngeal and respiratory) complications (chronic inflammation and precancerous lesions). Potent acid suppressive medications, i.e. proton-pump inhibitors, fail to restore the antireflux barrier and are unable to relieve symptoms in about 40% of patients. The Nissen fundoplication is the surgical standard of care. With this procedure, the distal part of the esophagus is totally encircled by a portion of the proximal stomach (the fundus) to prevent return of acid, pepsin, and bile in the esophagus. However, the majority of patients and gastroenterologists are still skeptical and have not embraced this therapeutic modality due to the fear of side effects such as difficult swallowing, gas-bloating, and inability to burp and vomiting. Partial fundoplications have limited side-effects but also limited durability over time. Novel procedures using biomedical devices have been proposed to avoid the side effects of fundoplication and to provide a durable surgical repair that does not alter quality of life while curing reflux and reducing the need of acid suppressive medications. The global burden of GERD requires a call to action for planning healthcare services, enhancing quality of treatments, reducing variations in surgical practice, and breaking geographical barriers.
2. Optimize the preoperative risk profile and enhance perioperative recovery through prehabilitation before surgery
Working group:
Nidal Tourkmani, Luigi Bonavina, Guglielmo Trovato, Andrew Taylor-Robinson, Rosario Caruso and Vincenzo Costigliola.
Lineup:
The aim of this working group is to highlight the importance of reducing surgical stress response and the burden of postoperative complications associated with major elective surgical procedures by a comprehensive and structured patient-centered pre-habilitation approach. The immediate goal is a timely optimization of the conditions of the patient before major surgical procedures or neoadjuvant therapies for cancer, to lower the pre-operative risk profile and to enhance postoperative recovery. Potential advantages of a standardized and personalized prehabilitation program are the following: a) increase the likelihood of immediate extubation in the operating room after the surgical procedure; b) reduce the burden of critical care stay after surgery; b) reduce the need for perioperative blood transfusions; c) facilitate fast-track/ERAS programs; d) reduce morbidity and mortality; e) improve long-term survival and quality of life. This approach represents a true paradigm shift. The focus is on appropriate health literacy targets physicians, nurses, patients, and policy-makers to organize the necessary facilities.
Key questions are whether there is sufficient evidence that all this is beneficial, in which disease conditions, for which surgical procedures, and which are the barriers and the financial burden. Apart from the specific areas of evidence-based knowledge, statements should be good enough to match a coordinated theory of change, illustrating how and why a desired change is expected to happen in a particular context. Prehabilitation is an opportunity to improve patients’ lifestyles and therapies.
It is likely that the real paradigm shift will be to move the organizational model of pre-habilitation from the hospital, where there would not be sufficient space, to dedicated rehabilitation facilities, residential or as out-patient services, or rather focusing directly on the patient’s home by tele-prehabilitation.
3. Telemedicine: current and innovative technologies and applications
Working Group:
Francesco Amenta, Rosario Squatrito, Teresa Abbattista, Rosario Caruso, Simon Taylor-Robinson.
Lineup:
An agenda with a few strategic topics is currently discussed and developed, also considering the most relevant challenges and opportunities of greater impact on the healthcare system: maritime medicine, robotic surgery, eHealth, distance imaging counseling et al. An agenda with only one or a few topics suitable for proposing specific advancements is currently discussed and developed, also considering the opportunities of greater impact on the healthcare system and the potential of delivering policy briefs as position points of the Association.
4. History of Medicine: from the unwritten history to the revisitation or development of new skills, knowledge and mental attitude.
Working Group: Teresa Abbattista, Antonio Molfese
Lineup:
The focus is on the problems of disease and death in the ancient, modern and contemporary times. However, a special attention, in this working group, is deserved to the role of Women in medicine, having in mind the Schola Medica Salernitana and the Physician Women of Salerno. An agenda with a few topics suitable for actualization is currently discussed and developed, also considering the most relevant historical challenges which mirror the opportunities of greater impact on the healthcare system and the potential of delivering policy briefs as position points of the Association.
5. Environment and Health
Working Group:
Giovanni Leonardi, Prisco Piscitelli, Camille Huser, Luigi Bonavina, Vincenzo Costigliola, Rosario Caruso, Andrew Taylor-Robinson, and Guglielmo Trovato.
Lineup:
A global landscape has emerged of educational and professional training in environmental health (EH). It should include consideration of the health impacts of climate and other environmental changes, as well as pollution. A range of approaches to strengthening factual knowledge and competencies to support diagnosis and treatment at an individual and societal level will be argued and chosen. These disparate offers in principle will contribute to the development of medical practice to make health professionals more aware of preventable causes of ill health, as well as public health systems more aware of ecological or environmental dimensions. In this field there is a lack of consistent global implementation of training programs for clinical professionals, public health practitioners, and individuals across various disciplines, as well as standardized curricula for undergraduates. A conference is planned in September 2025 to provide a forum for making progress in this area within the European region to agree to a position delivered by the European Medical Association.
6. Humanization and Proximity in oncology: The challenges of Predictive, preventive, and personalized medicine.
Working Group:
Vincenzo Costigliola, Fabrizio Artioli, Guglielmo Trovato, Rosario Squatrito.
Lineup:
PPM oncology is the evidence-based, individualized approach that delivers the right prediction, prevention and care to the right patient at the right time and results in measurable improvements in cancer outcomes and a reduction on health care costs. Humanization in oncology patient care represents a significant innovation in health care practice, shifting the traditional focus solely on treating physical conditions to encompass the emotional and psychosocial dimensions of patient experience. The concept and practice of proximity in cancer care appears a promising complement to existing models of integration, especially in complex contexts such as cancer networks. Implementation of cancer screening projects with mobile units “right at the doorstep” can make prevention more feasible in the territory reducing pressure on healthcare services. The working group will develop a comprehensive document, suitable for publication, encompassing new technological advancements, including liquid biopsies, with strategies for overcoming barriers and inequities. Models and experiences will be considered and the potential launch of a topical collection on the journal can be pursued.
7. A medical strategy and call for action to ensure basic human rights, combat inequities, and enhance women's quality of life in relation to female genital mutilation worldwide.
Working Group: Giulia Bonavina, Randa Kaltoud, Alessandro Bulfoni, Massimo Candiani, Stefano Salvatore, Carol Pollard
Lineup:
Increased international migration has exposed Europe to a diversity of cultural and ethical issues regarding women’s health. The burden of female genital mutilations is now a global issue and requires a call to action for enhancing quality of treatments and reducing variations in care. Female genital mutilation/cutting (FGM/C) includes all non-medical procedures that involve partial or total removal of the external female genitalia, or any other injury to the female genital organs. It is estimated that, out of 230 million mutilated women worldwide, 10% have undergone infibulation (FGM/C type III), the most invasive procedure. This practice represents a violation of the human rights and a discrimination against women. FGM/C is practiced in 31 countries, mainly in Africa. Efforts to end FGM/C are included in the 2008 World Health Assembly resolution and in the 2020 Sustainable Development Goals of the United Nations. Genital mutilations are associated with significant morbidity and have a profound impact on women health and wellbeing. Health care professionals of multi-ethnic societies across the Western world are facing the boundaries set by legal and professional policies, including re-infibulation of women to allow for childbirth, sexual intercourse, or therapeutic gynecological procedures. A policy of no-reinfibulation may endanger trust in the community, potentially causing women to stop using healthcare services in the hosting country. Still, the question of whether FGM/C legislation applies to reconstructive plastic surgical care remains controversial. Inter-institutional and multicultural dialogue can serve as crucial driver of change to ensure protection of basic human rights and to avoid racism and ethnocentrism.