Pilot implementation of a technologically advanced system for the optimization of pre-hospital, trauma patient care.

BACKGROUND: Cooperation between medical informatics, wireless communication and pre-hospital emergency services is essential for the optimal pre-hospital patient treatment. The use of technological innovations improves medical care in the pre-hospital setting with regard to the organization of an integrated center, which coordinates all parties involved for the patient's best interest. METHODS: A dispatch center was developed in the city of Patras, in southwestern Greece, equipped with a Geographic Information System (GIS), which immediately points out the location of emergency vehicles (EVs) on a digital map depicting the city plan. Additionally, three ambulances of the National Center of Immediate Aid (NCIA) were equipped with a decentralized traffic management system for the vehicle's traffic priority at signaled junctions. The system consisted of a cellular-based (GSM) telemedicine module, a Global Positioning System (GPS) and a web camera system in the vehicle cabin. RESULTS: The aforementioned system provided considerable assistance to the pre-hospital treatment first by selecting the ambulance closest to the accident's location and then by pinpointing the optimum route to the hospital, thus significantly reducing the overall transportation time. CONCLUSION: The project's objective to coordinate emergency hospital departments involved in the treatment of trauma patients with other emergency services by utilizing high technology was achieved within this interdisciplinary effort.

Mini-laparotomy cholecystectomy versus laparoscopic cholecystectomy: which way to go?

PURPOSE: The aim of this paper is to report the results of a prospective clinical trial investigating traditional laparoscopic cholecystectomy versus "mini-lap" cholecystectomy in a tertiary care University Hospital. MATERIALS AND METHODS: This is a prospective, randomized, single-center observational study. Forty-four patients were allocated in each group; patients in group L underwent laparoscopic cholecystectomy, whereas patients in group M had open "mini-laparotomy" cholecystectomy with a small incision through the rectus abdominis muscle. RESULTS: The operation lasted significantly longer in group L compared with group M, whereas patients of group L had a shorter hospital stay. There was no difference between groups regarding postoperative day on which patients commenced eating. There was no significant difference between groups regarding doses of analgesics used during surgery or in the recovery room. However, patients in group M used significantly more opioids in the postoperative period. Time to resume normal activity was significantly shorter in group L. A very good aesthetic result was obtained in 97.7% of patients in group L and 77.3% of patients in group M. CONCLUSIONS: Cholecystectomy through a mini-laparotomy incision is a lower-cost, versatile, and safe alternative to laparoscopic cholecystectomy.