Evaluación preoperatoria «on line» frente a evaluación presencial: optimización de recursos / Online versus non-standard face to face preoperative assessment: Cost effectiveness

Objetivos. Evaluar la implementación de un nuevo modelo de consulta preoperatoria mediante la reducción de visitas presenciales y pruebas complementarias en distintos procedimientos. Métodos. Desarrollamos un nuevo modelo de evaluación preoperatoria en el que el anestesiólogo evalúa on line, sin presencia del paciente, la historia clínica y las pruebas complementarias procedentes de la atención primaria y hospitalaria. A partir de esa información, confirmada mediante una llamada telefónica, el especialista decidía la necesidad de visita presencial y seleccionaba las pruebas complementarias en base a la complejidad del procedimiento quirúrgico y riesgo anestésico del paciente. En determinados procedimientos la enfermera previamente «entrenada» recogía on line dicha información y en caso de duda consultaba al anestesiólogo. Comparamos una cohorte de pacientes prequirúrgicos antes de la implantación de este nuevo modelo preoperatorio (año 2008) y después (año 2010). Contabilizamos en ambos períodos, el número de visitas presenciales y pruebas complementarias realizadas. Se comparó la tasa de anulaciones quirúrgicas para ambos períodos. Resultados. Se valoraron 5.112 procedimientos de cirugía programada en el año 2008 y 6.867 procedimientos en el 2010. La complejidad quirúrgica fue similar en ambos períodos. En el 2010 las visitas presenciales descendieron a un 21%, el número de analíticas a un 15%, el de electrocardiogramas a un 6% y el número de radiografías de tórax a un 1%. La tasa de anulaciones quirúrgicas descendió del 2,3 al 1,75%. Conclusiones. Este método preoperatorio optimiza los recursos al reducir las visitas presenciales y las pruebas complementarias sin aumentar la tasa de anulaciones quirúrgicas(AU)

Objectives. We evaluate the efficiency of an online preoperative assessment service that allows early triage of patients that require further assessment in advance of the clinic and reduces the number of preoperative tests. Methods. We developed a preoperative assessment process where the anesthesiologist collected on-line information without the physical attendance of the patient that included the patient's health history and all the preoperative tests performed in the primary and hospital care. Once confirmed this information by a telephone call, the anesthesiologist identified those patients that required further face to face assessment and limited the number of preoperative tests according to the complexity of the operative procedure and the anesthetic risk. In some procedures trained nursery collected on - line information and in certain cases consulted the anesthesiologist. We compared a cohort of preoperative patients before (2008) and after (2010) developing this online preoperative assessment process. We determined in both periods the number of face to face preoperative assessments and preoperative tests performed. Finally, we compared the cancellation rate in both periods. Results. 5112 elective surgical procedures in 2008 and 6867 elective surgical procedures in 2010 were assessed. In 2010, face to face preoperative assessments dropped to 21%, the number of laboratory tests 15%, the number of electrocardiograms 6% and the number of chest x-rays 1%. The cancellations rate didn’t differ between 2008 (2,3%) and 2010 (1.75%). Conclusions. This preoperative process optimizes the resources reducing the number of face to face preoperative assessments and preoperative tests without increasing the cancellations rate(AU)

[Online versus non-standard face to face preoperative assessment: cost effectiveness]. / Evaluación preoperatoria «on line¼ frente a evaluación presencial: optimización de recursos.

OBJECTIVES: We evaluate the efficiency of an online preoperative assessment service that allows early triage of patients that require further assessment in advance of the clinic and reduces the number of preoperative tests. METHODS: We developed a preoperative assessment process where the anesthesiologist collected on-line information without the physical attendance of the patient that included the patient's health history and all the preoperative tests performed in the primary and hospital care. Once confirmed this information by a telephone call, the anesthesiologist identified those patients that required further face to face assessment and limited the number of preoperative tests according to the complexity of the operative procedure and the anesthetic risk. In some procedures trained nursery collected on - line information and in certain cases consulted the anesthesiologist. We compared a cohort of preoperative patients before (2008) and after (2010) developing this online preoperative assessment process. We determined in both periods the number of face to face preoperative assessments and preoperative tests performed. Finally, we compared the cancellation rate in both periods. RESULTS: 5112 elective surgical procedures in 2008 and 6867 elective surgical procedures in 2010 were assessed. In 2010, face to face preoperative assessments dropped to 21%, the number of laboratory tests 15%, the number of electrocardiograms 6% and the number of chest x-rays 1%. The cancellations rate didn't differ between 2008 (2,3%) and 2010 (1.75%). CONCLUSIONS: This preoperative process optimizes the resources reducing the number of face to face preoperative assessments and preoperative tests without increasing the cancellations rate.

[Foreigner workers in Lombardy. Occupational, relational and cultural problems at work places]. / I lavoratori stranieri in Lombardia. Problematiche occupazionali, relazionali e culturali ai posti di lavoro.

Our research included 1359 foreigner citizens actually working in Lombardy. To better evaluate the eventual presence of relational, cultural and work related problems in their daily work experience we used a specific questionnaire, directly filled in by Occupational Doctors during occupational medical surveillance enforced by law, composed by different items concerning occupational and relational single worker's life. We evidenced that foreigner workers' population changed significantly in these last years loosing the characteristics of an homogeneous group. A foreigner workers' complete socio cultural integration in our country and specifically in working environments seems far to be really achieved.

[Adaptation of the TriTEST TM for the investigation of blood samples for a multicenter study taken to a single laboratory]. / Adattamento del TriTEST TM per la raccolta di campioni ematici in studi multicentrici afferenti ad uno stesso laboratorio.

BACKGROUND: Immunotoxicological studies in humans are usually carried out via the determination of some selected immune parameters in subjects occupationally and/or environmentally exposed to immunotoxic substance. One of the most often measured parameters is the determination of lymphocyte subsets, which needs to be carried out in a very short time (a few hours) after blood collection. This is the major problem limiting the determination of lymphocyte subpopulations in field studies, where samples are usually collected directly at the workplace, and very often at the end of the workshift. Unfortunately, these collection modalities significantly prolong the time between collection and analysis. The problem is more evident in multicentric studies, where a further problem is represented by the time needed to send samples to the laboratory. OBJECTIVE: Since an immune evaluation was planned, including the determination of lymphocyte subpopulations CD4 (T-helper), CD8 (T-suppressor cytotoxic) and CD16/CD56 (natural killer) in the project "Assessing health effects in man from exposure to low doses of inorganic mercury in environmental and occupational settings", a method was developed for performing cytofluorimetric analysis in "field studies". METHODS: The method is based on commercially-available kits, and involves in loco treatment. Whole blood is labeled with monoclonal antibodies, and fixed samples immediately after collection. After the treatment, the samples are ready for flow cytometric analysis, which may be performed after a two-day period from sample collection. RESULTS AND CONCLUSION: The method described is adequate for immunotoxicity testing in field studies because it prolongs the maximum latency time from collection and cytofluorimetric analysis up to 48 hours. A second interesting characteristic of the method is the possibility of using whole blood, without any need of either complex manipulations or particular equipment.

Expression of vascular endothelial growth factor in human luteinizing granulosa cells and its correlation with the response to controlled ovarian hyperstimulation.

Ovulation induction represents one of the most important steps for the success of assisted reproductive technology (ART) procedures. To better understand the mechanisms that regulate follicle growth, oocyte maturation, and ovarian steroidogenesis, we investigated the correlations between vascular endothelial growth factor (VEGF) gene expression in human luteinizing granulosa cells, steroid production and oocyte retrieval in patients undergoing controlled ovarian hyperstimulation. We evaluated the messenger ribonucleic acid (mRNA) for VEGF in human luteinizing granulosa cells obtained at the time of oocyte retrieval from 24 women participating in an in vitro fertilization program at the Reproductive Endocrinology Center of our Department of Obstetrics and Gynecology. We found a positive linear correlation of VEGF mRNA with estradiol and progesterone serum levels at the day of oocyte retrieval (p < 0.05). Furthermore, VEGF mRNA expression was significantly higher in granulosa cells obtained from patients with an elevated number of oocytes and high fertilization rate (p < 0.05). Our data confirm that VEGF may play an important role in the regulation of vascular development during follicular growth and luteal differentiation.

Expression of 17 alpha-hydroxylase and aromatase in the syndrome of androgen resistance: a case report.

A complete form of testicular feminization with normal gonadotropin and high testosterone levels is described. The testicular histology of tubular atrophy and hyperplastic Leydig cells accords with the high testosterone levels. We evaluated the expression of the enzymes involved in the production of testosterone and estrogens. An increase in P450c17 (17 alpha-hydroxylase/17,20-lyase) messenger RNA expression has been shown in testis with androgen resistance compared with in normal testis. More P450 aromatase was expressed in normal testis than in testis with androgen resistance.

Breast reduction under intravenous sedation: a review of 50 cases.

Breast reduction is a surgical procedure most commonly performed on an inpatient basis under general anesthesia. In the current climate of health care reform, we must evaluate such procedures to determine if there are alternate, less expensive, but equally safe means to perform them. Our purpose is to present our experience with 50 bilateral breast reductions performed under local anesthesia with intravenous sedation between October of 1991 and October of 1994. We have excluded bilateral reductions under 500 gm total, unilateral reductions, mastopexies, and gynecomastia procedures. Patients were sedated with intravenous Versed and fentanyl and a local solution consisting of marcaine, lidocaine, and 1:2000,000 epinephrine. Intercostal blocks were not used routinely. Monitoring and sedation were performed by nonanesthesia personnel in 49 patients. There were no complications relating to the sedation or to the local solution. All reductions were performed by the inferior pedicle technique. The average patient age was 28.0 years (20 to 67 years). The total breast tissue resected was 1372 gm (516 to 2948 gm), with 33 patients having resections greater than 1000 gm. Operative times averaged 3 hours (115 to 275 minutes). Forty-nine of the 50 patients tolerated the procedure with little or no recall. Twenty-eight patients were discharged on the same day as admission. One patient recalled some significant discomfort during parts of the procedure. All stated that they would again have the procedure performed under local anesthesia with intravenous sedation. Our conclusions are as follows: (1) Breast reduction can be performed safely and comfortably under local anesthesia with intravenous sedation. (2) Patients should be chosen on their acceptability as intravenous sedation candidates and not with regard to the amount of breast tissue removed. (3) There will be a subset of patients who can be discharged on the same day.

Evaluation of the activity of the carbocysteine-sobrerol combination on mucus spinnability.

Among the rheological properties of bronchial mucus, "spinnability", i.e. the ability to form threads under the effect of traction, should be regarded as the most closely related to the mucociliary transport function. In the present study the "spinnability" parameter was included in the functional tests aimed at evaluating the efficacy of the carbocysteine-sobrerol combination in 16 patients suffering from chronic abstructive lung disease with bronchial hypersection. Treatment was administered for ten days under double-blind conditions compared with a placebo. The results obtained showed the tested combination to be able to favourably affect all the most important rheological parameters of mucus, including spinnability, leading to a rapid disappearance of signs and symptoms and to the improvement of the most important respiratory function indexes.

Identification of an acridine photoaffinity probe for trypanocidal action.

Twenty-four acridine derivatives were screened for trypanocidal activity in Trypanosoma brucei in order to determine which structural features of the acridine molecule confer maximal antiparasitic activity. The synthesis of several new azidoacridine derivatives are also reported as well as an assessment of their value as possible photoaffinity probes for the study of acridine trypanocidal action. The most effective and selective acridine trypanocides, with and without irradiation, were the 3-amino-10-methylacridinium salt derivatives. With brief irradiation, one azidoacridine, 3-amino-6-azido-10-methylacridinium chloride, showed considerable trypanocidal activity at very limiting drug concentrations (10(-7)M) and warrants consideration as a possible photoaffinity probe.