OP44 HTA Of 3D Videolaparoscopy: Follow-up 12 Months After Introduction

2018 ◽  
Vol 34 (S1) ◽  
pp. 17-17
Author(s):  
Roxana di Mauro ◽  
Martina Andellini ◽  
Francesco Faggiano ◽  
Pietro Derrico ◽  
Matteo Ritrovato
Keyword(s):  
Blood Loss ◽  
Investment Decision ◽  
New Technology ◽  
A Priori ◽  
Hospital Setting ◽  
Length Of Hospital Stay ◽  
Good Alternative ◽  
Implementation Period ◽  
Video Laparoscopy ◽  
The Impact

Introduction:In 2016, a health technology assessment (HTA) was conducted to gather evidence on the safety and overall effectiveness of performing laparoscopic surgery by using 3D videolaparoscopy (3DVL) versus 2D videolaparoscopy (2DVL) display systems in a variety of pediatric surgical procedures in order to efficiently support the final investment decision on video system to be acquired. Results showed that 3DVL might be a good alternative to 2DVL. Moreover, sensitivity analysis has also confirmed that the results associated to the best technology (3DVL) are robust; this has led to a confident decision for recommending it in Bambino Gesù Children's Hospital (OPBG). The objective of this work is to evaluate the impact of 3DVL within the hospital setting after 12 months its introduction in clinical practice.Methods:After 12 months since the technology's introduction, clinical data, identified in previous HTA study, were extracted from surgery registries; data concerning the number of surgeries, duration of intervention, blood loss and surgery complications were analyzed. Statistical analyses on these data, between pre and post 3D system implementation period were carried out.Results:Results confirmed the 2016 HTA results, highlighting clinical advantages identified a priori. The percentage of the number of laparoscopic procedures significantly increased from 12 percent in pre-3D system installation period to the 20 percent in post 3D system installation (p=7,35E-6). No statistical differences in length of hospital stay, operative time, incidence of perioperative blood loss and surgery complication, between pre- and post- 3D installation period were identified.Conclusions:This study highlighted the importance of a HTA process before the acquisition of a technology for which the investment decision is not obvious, because benefits and drawbacks of the new technology are unclear. Preliminary results showed that 3D video laparoscopy system seems to be better than the 2D laparoscopy system. However, more data has to be examined to be able to establish the final judgement.

Predicting the impact of new health technologies on average length of stay: Development of a prediction framework

2005 ◽  
Vol 21 (4) ◽  
pp. 487-491 ◽  
Author(s):  
Sue Simpson ◽  
Claire Packer ◽  
Andrew Stevens ◽  
James Raftery
Keyword(s):  
Length Of Stay ◽  
Health Management ◽  
Average Length ◽  
New Technology ◽  
Length Of Hospital Stay ◽  
Health Technologies ◽  
Average Length Of Stay ◽  
Admission Policies ◽  
Mechanism Of Impact ◽  
The Impact

Objectives: The aim of this study was to develop a framework to predict the impact of new health technologies on average length of hospital stay.Methods: A literature search of EMBASE, MEDLINE, Web of Science, and the Health Management Information Consortium databases was conducted to identify papers that discuss the impact of new technology on length of stay or report the impact with a proposed mechanism of impact of specific technologies on length of stay. The mechanisms of impact were categorized into those relating to patients, the technology, or the organization of health care and clinical practice.Results: New health technologies have a variable impact on length of stay. Technologies that lead to an increase in the proportion of sicker patients or increase the average age of patients remaining in the hospital lead to an increase in individual and average length of stay. Technologies that do not affect or improve the inpatient case mix, or reduce adverse effects and complications, or speed up the diagnostic or treatment process should lead to a reduction in individual length of stay and, if applied to all patients with the condition, will reduce average length of stay.Conclusions: The prediction framework we have developed will ensure that the characteristics of a new technology that may influence length of stay can be consistently taken into consideration by assessment agencies. It is recognized that the influence of technology on length of stay will change as a technology diffuses and that length of stay is highly sensitive to changes in admission policies and organization of care.

scholarly journals A multistage mixed methods study protocol to evaluate the implementation and impact of a reconfiguration of acute medicine in Ireland’s hospitals

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
E. Hurley ◽  
S. McHugh ◽  
J. Browne ◽  
L. Vaughan ◽  
C. Normand
Keyword(s):  
Mixed Methods ◽  
Hospital Stay ◽  
Patient Care ◽  
Hospital Admissions ◽  
Hospital Setting ◽  
Length Of Hospital Stay ◽  
Comparative Case Study ◽  
Medical Patients ◽  
Acute Medicine ◽  
The Impact

Abstract Background To address deficits in the delivery of acute services in Ireland, the National Acute Medicine Programme (NAMP) was established in 2010 to optimise the management of acutely ill medical patients in the hospital setting, and to ensure their supported discharge to primary and community-based care. NAMP aims to reduce inappropriate hospital admissions, reduce length of hospital stay and ensure patients receive timely treatment in the most appropriate setting. It does so primarily via the development of Acute Medical Assessment Units (AMAUs) for the rapid assessment and management of medical patients presenting to hospitals, as well as streamlining the care of those admitted for further care. This study will examine the impact of this programme on patient care and identify the factors influencing its implementation and operation. Methods We will use a multistage mixed methods evaluation with an explanatory sequential design. Firstly, we will develop a logic model to describe the programme’s outcomes, its components and the mechanisms of change by which it expects to achieve these outcomes. Then we will assess implementation by measuring utilisation of the Units and comparing the organisational functions implemented to that recommended by the NAMP model of care. Using comparative case study research, we will identify the factors which have influenced the programme’s implementation and its operation using the Consolidated Framework for Implementation Research to guide data collection and analysis. This will be followed by an estimation of the impact of the programme on reducing overnight emergency admissions for potentially avoidable medical conditions, and reducing length of hospital stay of acute medical patients. Lastly, data from each stage will be integrated to examine how the programme’s outcomes can be explained by the level of implementation. Discussion This formative evaluation will enable us to examine whether the NAMP is improving patient care and importantly draw conclusions on how it is doing so. It will identify the factors that contribute to how well the programme is being implemented in the real-world. Lessons learnt will be instrumental in sustaining this programme as well as planning, implementing, and assessing other transformative programmes, especially in the acute care setting.

Investment and Capital Market Imperfections: Some Evidence from a Developing Economy, India

2008 ◽  
Vol 11 (03) ◽  
pp. 411-428 ◽  
Author(s):  
Saumitra N. Bhaduri
Keyword(s):  
Financial Constraints ◽  
Investment Decision ◽  
A Priori ◽  
Empirical Support ◽  
Switching Regression ◽  
Flow Sensitivity ◽  
Capital Market Imperfections ◽  
Cash Flow Sensitivity ◽  
The Impact ◽  
Insight Into

This paper presents a switching regression model of investment decision where the probability of a firm facing financial constraint is endogenously determined. The approach, therefore, obviates the use of a priori criteria to exogenously identify the financially constrained firms, and thereby addresses the potential misclassification problem faced in the existing literature. A sample of 576 Indian manufacturing firms, collected across 15 broad industries is used for this study. The study establishes that financially constrained firms exhibit a much higher investment-cash flow sensitivity than those identified to be unconstrained. It also probes into the possible determinants of financial constraints, and finds empirical support for its hypothesis that young, liquidity constrained and low dividend payout firms are more likely to face financial constraints, when compared to their respective counterparts. This paper also provides some insight into the impact of the ongoing liberalization program on the financial constraints faced by the Indian firms.

Impact of Surgical Mentorship on Retroperitoneoscopic Adrenalectomy with Comparison to Transperitoneal Laparoscopic Adrenalectomy

2013 ◽  
Vol 79 (2) ◽  
pp. 162-166
Author(s):  
James T. Broome ◽  
Carmen C. Solorzano
Keyword(s):  
Blood Loss ◽  
Laparoscopic Adrenalectomy ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
Perioperative Outcomes ◽  
Adrenal Tumors ◽  
Retroperitoneoscopic Adrenalectomy ◽  
The Mean ◽  
The Impact

Retroperitoneoscopic adrenalectomy (RA) provides a direct approach to the adrenal gland. RA represents a complex approach with unique orientation that is less intuitive. The authors objectively evaluated the impact of mentorship on the performance of RA and also compared it with laparoscopic adrenalectomy (LA). After implementing the use of RA, a retrospective review of the operative experience of two high-volume endocrine surgeons was performed. Both surgeons participated in a hands-on RA mentorship. Clinical presentation and perioperative outcomes were compared. Subgroup analysis was used to compare RA pre- and postmentorship and with LA. Sixty-one LAs and 31 RAs were included in the analysis. The mean operative time was 115 for LA versus 90 minutes for RA ( P = 0.002). Blood loss was greater for LA versus RA (56 vs 22 mL; P = 0.001). Length of stay (LOS) for LA was 2.2 versus 1.5 days for RA ( P = 0.029). Ten patients were treated by RA in the prementorship era versus 21 in the postmentorship era. The mean operative time for the prementorship group was 118 minutes, which decreased to 77 minutes postmentorship ( P < 0.0001). LOS also decreased from 2.0 to 1.2 days ( P = 0.04) in the postmentorship era. RA demonstrates a shorter operative time, less blood loss, and decrease length of hospital stay as compared with standard LA. After proper mentorship and patient selection, RA may represent a superior option for removal of small, benign adrenal tumors.

The Impact of Body Mass Index on Perioperative Outcomes of Robotic Adrenalectomy: An Update

2019 ◽  
Vol 26 (6) ◽  
pp. 687-691 ◽  
Author(s):  
Orhan Agcaoglu ◽  
Melis Akbas ◽  
Murat Ozdemir ◽  
Ozer Makay
Keyword(s):  
Body Mass Index ◽  
Robotic Surgery ◽  
Blood Loss ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Perioperative Outcomes ◽  
Total Operative Time ◽  
Estimated Blood Loss ◽  
Robotic Adrenalectomy ◽  
The Impact

Background. Robotic surgery has gained increasing popularity over the past 2 decades. However, factors including patient comorbidities and tumor characteristics are still crucial factors for outcomes of surgery. In this study, we evaluated the impact of body mass index (BMI) on perioperative outcomes in patients who underwent robotic adrenal surgery. Methods. Between May 2012 and November 2017, 66 consecutive patients who underwent robotic adrenalectomy were included in this study. Patients were divided into 2 groups based on their BMI: nonobese (<30 kg/m2) and obese (≥30 kg/m2). Additionally, patient demographics, tumor size, total operative time, docking time, console time, estimated blood loss, conversion to open, complications, additional analgesia requirement, length of hospital stay, and rough costs were evaluated. Results. Of the 66 patients, a total of 26 patients were obese (30%). Between study groups, the median BMI was calculated as 26 (18-29) and 33 (30-57). The groups were similar in terms of age, gender, American Society of Anesthesiologists scores, and previous history of abdominal surgery. Likewise, there were no significant differences between groups regarding total operative time ( P = .085), docking time ( P = .196), console time ( P = .211), estimated blood loss ( P = .180), complications ( P = .991), length of hospital stay ( P = .598), and rough costs ( P = .468). Five cases were converted to open surgery. Nonobese cases required additional analgesia ( P = .007). We had no unexpected hospitalizations in either group. Conclusion. Guidelines express the advantages of robotic surgery in obese patients. No statistically significant differences were detected between the 2 groups except for the additional analgesia required in nonobese patients.

scholarly journals The impact of mini-invasive right hepatectomy in the setting of living donation: a meta-analysis

2021 ◽  
Author(s):  
Quirino Lai ◽  
Francesco Giovanardi ◽  
Gianluca Mennini ◽  
Giammauro Berardi ◽  
Massimo Rossi
Keyword(s):  
Liver Resection ◽  
Blood Loss ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Medical Community ◽  
Cochrane Library ◽  
Right Hepatectomy ◽  
Donor Liver Transplantation ◽  
Estimated Blood Loss ◽  
The Impact

AbstractAdult-to-adult living-donor liver transplantation (A2ALDLT) represents a challenging procedure, mainly when the right hepatic lobe is donated. Therefore, especially in Western countries, the medical community still considers it a “risky procedure”. The present meta-analysis investigated the postoperative results reported in donors undergoing right hepatectomy for A2ALDLT through a minimally invasive liver resection (MILR) vs. open liver resection (OLR) approach, with the intent to clarify the hypothesis that the MILR approach should minimize the risks for the donor. A systematic literature search was performed using MEDLINE-PubMed, Cochrane Library, and EMBASE electronic databases. The primary outcome investigated was the complication rate after transplant. Fifteen studies were included (n = 2094; MILR = 553 vs. OLR = 1541). The MILR group only merged the statistical relevance in terms of advantage in terms of a lower number of complications (OR = 0.771, 95% CI 0.578–1.028; P value = 0.077). Investigating the complications ≥ IIIa according to the Dindo-Clavien classification, the estimated blood loss, and the length of hospital stay, no statistical difference was reported between the two groups. MILR represents a novel and promising approach for improving the results in A2ALDLT. However, no benefits have been reported regarding blood loss, length of stay, and postoperative complications. More extensive experiences are needed to re-evaluate the impact of MILR in right lobe live donation.

The impact of prepartum factor XIII activity on postpartum blood loss

2019 ◽  
Author(s):  
C Haslinger ◽  
W Korte ◽  
T Hothorn ◽  
R Brun ◽  
C Greenberg ◽  
...  
Keyword(s):  
Blood Loss ◽  
Factor Xiii ◽  
Postpartum Blood Loss ◽  
The Impact

The Process of Globalization and Its Impact on Media

2016 ◽  
Vol 1 (4) ◽  
pp. 150
Author(s):  
Veton Zejnullahi
Keyword(s):  
New Technology ◽  
World Order ◽  
Modern Society ◽  
Media Access ◽  
Four Corners ◽  
The World ◽  
The Media ◽  
The Republic ◽  
Human Eyes ◽  
The Impact

The process of globalization, which many times is considered as new world order is affecting all spheres of modern society but also the media. In this paper specifically we will see the impact of globalization because we see changing the media access to global problems in general being listed on these processes. We will see that the greatest difficulties will have small media as such because the process is moving in the direction of creating mega media which thanks to new technology are reaching to deliver news and information at the time of their occurrence through choked the small media. So it is fair to conclude that the rapid economic development and especially the technology have made the world seem "too small" to the human eyes, because for real-time we will communicate with the world with the only one Internet connection, and also all the information are take for the development of events in the four corners of the world and direct from the places when the events happen. Even Albanian space has not left out of this process because the media in the Republic of Albania and the Republic of Kosovo are adapted to the new conditions under the influence of the globalization process. This fact is proven powerful through creating new television packages, written the websites and newspapers in their possession.

The Impact of Competitive Quasi-Market on Service Delivery in Benue State University, Makurdi Nigeria

GIS Business ◽  
2019 ◽  
Vol 14 (4) ◽  
pp. 85-98
Author(s):  
Idoko Peter
Keyword(s):  
Service Delivery ◽  
A Priori ◽  
Least Square ◽  
Secondary Source ◽  
State University ◽  
Ordinary Least Square ◽  
Negative Effect ◽  
The Impact ◽  
The Relationship

This research the impact of competitive quasi market on service delivery in Benue State University, Makurdi Nigeria. Both primary and secondary source of data and information were used for the study and questionnaire was used to extract information from the purposively selected respondents. The population for this study is one hundred and seventy three (173) administrative staff of Benue State University selected at random. The statistical tools employed was the classical ordinary least square (OLS) and the probability value of the estimates was used to tests hypotheses of the study. The result of the study indicates that a positive relationship exist between Competitive quasi marketing in Benue State University, Makurdi Nigeria (CQM) and Transparency in the service delivery (TRSP) and the relationship is statistically significant (p<0.05). Competitive quasi marketing (CQM) has a negative effect on Observe Competence in Benue State University, Makurdi Nigeria (OBCP) and the relationship is not statistically significant (p>0.05). Competitive quasi marketing (CQM) has a positive effect on Innovation in Benue State University, Makurdi Nigeria (INVO) and the relationship is statistically significant (p<0.05) and in line with a priori expectation. This means that a unit increases in Competitive quasi marketing (CQM) will result to a corresponding increase in innovation in Benue State University, Makurdi Nigeria (INVO) by a margin of 22.5%. It was concluded that government monopoly in the provision of certain types of services has greatly affected the quality of service experience in the institution. It was recommended among others that the stakeholders in the market has to be transparent so that the system will be productive to serve the society effectively

The impact of applying the Common Customs Tariff on the armenian export of Cut and Polished Gems to Russia

2019 ◽  
pp. 33-41
Author(s):  
V. L. Harutyunyan ◽  
S. V. Dokholyan ◽  
A. R. Makaryan
Keyword(s):  
Manufacturing Sector ◽  
Practical Implication ◽  
Dominant Role ◽  
New Technology ◽  
Manufacturing Companies ◽  
Medium Term ◽  
Diamond Cutting ◽  
Global Trends ◽  
The Common ◽  
The Impact

The presented study discusses the issues of applying the Common Customs Tariff (CCT) rates of the Eurasian Economic Union (EAEU) on rough diamonds and the impact thereof on the exports of stones cut and polished inArmeniaand then exported toRussia.Aim. The study aims to identify the possible strategies Armenian diamond cutting and polishing companies could adopt as a response to the application of the CCT rates on rough diamonds and how it would affect exports to various destinations, namely to Russia.Tasks. The authors analyze the current state of the gems and jewelry sector and substantiate the need to either integrate it into the jewelry manufacturing sector or to apply various strategies to facilitate exports to either Russia or other destinations in the medium term in response to the application of the CCT rates.Methods. This study uses general scientific methods of cognition, including analytical and methodological approaches and elements of forecasting. Possible strategies the Armenian diamond cutting and polishing companies could adopt in the medium term in response to the application of the EAEU CCT rates are determined using the analytical research method, forecasts in the context of the developments in the Armenian gem processing and jewelry market and global trends, statistical data on the imports and exports of cut and polished gems and jewelry for 2014–2018 published by the UN Comtrade Statistics.Results. Statistics on the exports of processed diamonds from 2014 to 2018 highlights the issue associated with the loss of competitiveness suffered by Armenian companies (mainly in comparison with Indian diamond cutters). The major global trends in the diamond cutting and polishing business indicate that it could be virtually impossible for Armenian cutters and polishers to compete with Indian companies in the medium term if they do not comes to investing in new technology to achieve operational efficiency. For these companies, it is important not to lose the Russian market due to an increase in the tariff rate and concentrate on the processing of gems that are larger than 1 carat. Another strategy to avoid an increase in the customs tariff rates would depend on the Armenian government’s ability to negotiate with Russia in respect of direct imports of diamond stones from Russian manufactures. Two other options for Armenian cutters involve focusing on cutting and polishing of rubies, sapphires, emeralds, etc. or integrating into the jewelry sector either by being the primary supplier or by considering this business as a channel to sell processed diamond stones by setting up their own jewelry manufacturing companies.Conclusions. With CCT going into effect in January 2021 and India’s dominant role in the diamond cutting and polishing business, Armenia needs to carefully consider all of the strategies the Armenian companies could adopt, as discussed above. As a member state of the EAEU, Armenia freely exports to Russia, however, further exports to Russia would depend on Armenia’s ability to ensure that cost-effective operations are in place, or to concentrate on the processing of precious gems rather than diamonds, or to switch to the manufacturing of jewelry items as a major export item.Practical Implication. The findings of this study could be of interest to the Ministry of Economy of the Republic of Armenia and Business Armenia that could be used in elaborating the strategy for the development of Armenian gems and jewelry sector of the economy.

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