1,721,109 research outputs found
eHCM: Resources Reduction & Demand Increase, cover the gap by a managerial approach powered by an IT solutions.
No full textThe economic and financial crisis has also had an important impact on the healthcare sector. Available resources have decreased, while at the same time costs as well as demand for healthcare services are on the rise. This coalescing negative impact on availability of healthcare resources is exacerbated even further by a widespread ignorance of management accounting matters. Little knowledge about costs is a strong source of costs augmentation. Although it is broadly recognized that cost accounting has a positive impact on healthcare organizations, it is not widespread adopted. Hospitals are essential components in providing overall healthcare. Operating rooms are critical hospital units not only in patient safety terms but also in expenditure terms. Understanding OR procedures in the hospital provides important information about how health care resources are used. There have been several scientific studies on management accounting in healthcare environments and more than ever there is a need for innovation, particularly by connecting business administration research findings to modern IT tools. IT adoption constitutes one of the most important innovation fields within the healthcare sector, with beneficial effects on the decision making processes. The e-HCM (e-Healthcare Cost Management) project consists of a cost calculation model which is applicable to Business Intelligence. The cost calculation approach comprises elements from both traditional cost accounting and activity-based costing. Direct costs for all surgical procedures can be calculated through a seven step implementation process
Pervasive Tracking for Time-Dependent Acute Patient Flow: A Case Study in Trauma Management
No full textThe problem of tracking has gained a central role in healthcare research since it enables the acquisition of the information needed for improving healthcare management and efficiency, alongside patient safety. In literature, it is mainly discussed as an allocation problem that must deal with limited resources (rooms, physicians, equipment) to optimise workflows, and Real-Time Location Systems have been introduced with the main goal of locating and identifying assets and personnel in a healthcare facility. In this paper, we propose a novel perspective of pervasive tracking into Hospital 4.0, devised explicitly for time-dependent acute patient flow. The goal is to develop a tracking system that acquires not only the time and location of entities, exploiting state-of-the-art techniques, but also the main clinical events occurred. As an example application we describe TraumaTracker, a system developed to support the accurate and complete documentation of trauma resuscitation processes from pre-hospital care
Successful combined use of videolaryngoscopy and pediatric stylet in an adult case of acute epiglottitis
No full textTo the Editor:
Acute epiglottitis is a potentially life-threatening infection of the supraglottic structures, which can lead to sudden, fatal airway obstruction (1). Among children, the incidence of epiglottitis has been reduced by the introduction of vaccination against Haemophilus influenzae H. In contrast, the incidence in adults has shown a steady increase, becoming today a much more common disease (2,3). Epiglottitis in adults has many causes, and vigilance and familiarity with the clinical presentation is required for swift recognition and treatment. Non-infectious causes of epiglottitis also occur in the adult population; its onset is linked to the presence of foreign bodies, inhalation burns, inhalation of drugs, chemical burns, systemic disease, or reactions to chemotherap
Transoesophageal echocardiography during liver transplantation
Full text linkLiver transplantation (LT) has become the standard of care for patients with end stage liver disease. The allocation of organs, which prioritizes the sickest patients, has made the management of liver transplant candidates more complex both as regards their comorbidities and their higher risk of perioperative complications. Patients undergoing LT frequently display considerable physiological changes during the procedures as a result of both the disease process and the surgery. Transoesophageal echocardiography (TEE), which visualizes dynamic cardiac function and overall contractility, has become essential for perioperative LT management and can optimize the anaesthetic management of these highly complex patients. Moreover, TEE can provide useful information on volume status and the adequacy of therapeutic interventions and can diagnose early intraoperative complications, such as the embolization of large vessels or development of pulmonary hypertension. In this review, directed at clinicians who manage TEE during LT, we show why the procedure merits a place in challenging anaesthetic environment and how it can provide essential information in the perioperative management of compromised patients undergoing this very complex surgical procedure
BDI personal medical assistant agents: The case of trauma tracking and alerting
Full text linkPersonal assistant agents can have an important role in healthcare as a smart technology to support physicians in their daily work, helping to tackle the increasing complexity of their task environment. In this paper we present and discuss a personal medical assistant agent technology for trauma documentation and management, based on the Belief-Desire-Intention (BDI) architecture. The purpose of the personal assistant agent is twofold: to assist the Trauma Team in doing precision tracking during a trauma resuscitation, so as to (automatically) produce an accurate documentation of the trauma, and to generate alerts at real-time, to be eventually displayed either on smart-glasses or room-display
Impact of general vs. neuraxial anesthesia on neonatal outcomes in non-elective cesarean sections
Full text linkBackground: Cesarean section is a common surgical procedure, usually performed under neuraxial anesthesia and, more rarely, under general anesthesia. The choice of anesthesia in cesarean sections can significantly influence neonatal outcomes, especially in urgent and emergency cases. Previous studies have shown mixed results, often confounded by the inclusion of both elective and emergency cesarean section cases, varying statistical methods, and a focus solely on resuscitation immediate-term neonatal outcomes.
Objective: This study aims to use robust statistical methods to evaluate the impact of anesthesia type on immediate and longer-term neonatal outcomes in urgent and emergency cesarean section cases, where additional detrimental factors might influence this relationship.
Methods: We analyzed 395 women who underwent non-elective cesarean sections between 2021 and 2023. Inverse probability of treatment weighting (IPTW) served to focus on the role of anesthesia type eliminating confounding variables effect, in simulated randomized controlled trial conditions.
Results: General anesthesia increases odds of neonatal resuscitation (OR 6.1, p < 0.001), NICU admission (OR 1.8, p: 0.04), and a 15% lower Apgar score at 1 min (p: 0.02). General anesthesia also increased NICU admission rate for respiratory insufficiency (OR 7.6, p < 0.001), the need for oxygen (OR 4.8, p: 0.003) and CPAP (OR 3.6, p < 0.001) in NICU. Negative controls and consistent sensitivity analyses further validated the robustness of our findings.
Conclusion: General anesthesia in non-elective cesarean sections is associated with worse neonatal outcomes, extending beyond the resuscitation phase to sustained NICU morbidity. Our study provides novel insights into the specific neonatal resuscitation maneuvers required when general anesthesia is used, enhancing clinicians preparedness for managing high-risk deliveries. These findings underscore the critical importance of anesthesia choice, advocate for the preference of neuraxial techniques, and highlight the need for further research into long-term neonatal outcomes
Bronchial blocker positioning: learning curve and confidence in its use
No full textDespite simple and safe to use and cheap, EZ Blocker remains underused probably because it requires particular skills in recognizing airway and in using fiber- bronchoscopy to check the exact position of their cuffs. Thus, we planned an education training program on the use of EZB for novices in anaesthesia and evaluated the number of procedures required for the acquisition of the skills of this technique
Pre-hospital plasma in haemorrhagic shock management: current opinion and meta-analysis of randomized trials
No full textBACKGROUND: Trauma-induced coagulopathy is one of the most
difficult issues to manage in severely injured patients. The
plasma efficacy in treating haemorrhagic-shocked patients is
well known. The debated issue is the timing at which it should
be administered. Few evidences exist regarding the effects on
mortality consequent to the use of plasma alone given in
pre-hospital setting. Recently, two randomized trials reported
interesting and discordant results. The present paper aims to
analyse data from those two randomized trials in order to obtain
more univocal results. METHODS: A systematic review with
meta-analysis of randomized controlled trials (RCTs) of
pre-hospital plasma vs. usual care in patients with haemorrhagic
shock. RESULTS: Two high-quality RCTs have been included with
626 patients (295 in plasma and 331 in usual care arm).
Twenty-four-hour mortality seems to be reduced in pre-hospital
plasma group (RR = 0.69; 95\% CI = 0.48-0.99). Pre-hospital
plasma has no significant effect on 1-month mortality (RR =
0.86; 95\% CI = 0.68-1.11) as on acute lung injury and on
multi-organ failure rates (OR = 1.03; 95\% CI = 0.71-1.50, and
OR = 1.30; 95\% CI = 0.92-1.86, respectively). CONCLUSIONS:
Pre-hospital plasma infusion seems to reduce 24-h mortality in
haemorrhagic shock patients. It does not seem to influence
1-month mortality, acute lung injury and multi-organ failure
rates.Level of evidence: Level IStudy type: Systematic review
with Meta-analysis
Real-time tracking and documentation in trauma management
Full text linkIn trauma resuscitation, an accurate documentation is crucial to improve the quality of trauma care. Hospital emergency departments typically adopt handwritten paper records and flow sheets for acquiring data, which are often inaccurate. In this article, we describe TraumaTracker, a computer-based system for trauma tracking and documentation. Results demonstrate that completeness and accuracy of trauma documentation significantly improved using TraumaTracker, since it enables to add data and information that were not recorded in paper documentation – especially precise times and locations of events
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