Influence of neonate's body position with and without a plastic blanket on body heat loss assessed from a thermal mannequin

International audienceThe present study aimed at assessing the net gain of body heat storage induced by a transparent plastic blanket draped over small premature neonates in the prone and the supine positions. Thermal stress is particularly important in premature and small-for-gestational-age infants characterized by high values of the ratio between skin surface area and body mass, the greater this ratio, the greater the body heat exchanges. The large skin permeability enhances body water loss. The risk of hypothermia is particularly increased at birth and during operations on naked neonates implying opening of the canopy (surgical operation, blood sampling and gastric aspiration). In the first day of life, the rate of evaporation can reach 100 g.h-1.m-2 in very preterm infants. To prevent the large amount of water loss it is sometimes recommended to cover the neonate with a plastic blanket. In closed incubator Fanaroff et al.(3) pointed out that a transparent plastic heat shield reduces the insensible water loss of 44 % in low birth weight neonates lower than 1250 g and postnatal age less than 10 days. For postnatal age greater than 10 days, the magnitude of this reduction was only 19 %. Bell et al.(2) also reported that the addition of a heat shield in an incubator decreased the water loss by 10 % in infants with mean birth weight of 1570 g. However the efficiency of this solution which depends on the physical environment but also on the inter individual difference in the ability to exchange heat with the environment remains questionable and the use of a plastic blanket is still a controversial topic. The total heat loss of premature infants depends on various factors such as gestational age, nutritional state, mean skin temperature, body hydromineral balance, vigilance state, metabolic rate and of the postnatal age which modifies the skin keratinisation. Thus, it is difficult to obtain homogeneous data base that takes into account all these factors and there are conflicting data on the effectiveness of plastic blanket. To rule out these confounding factors we use a sweating mannequin the advantage of which is that it measures directly the total heat loss with the environment without interference with these factors

Cultural orientations and information systems success in public and private hospitals: preliminary evidences from Italy

Abstract Background The effective adoption and use of digital and computerized systems and records in hospitals are crucial for increasing the overall quality, safety and outcomes of any national health community. Prior research found that hospitals’ dominant cultural orientation affects the adoption of new technology. However, the organizational culture of hospitals can greatly vary between public and private hospitals. Thus, the ownership type of the hospital is likely to affect, to some extent, the aforementioned relationship between culture and information system success. The present article focuses in detail on this issue and attempts to answer the following research question: which cultural orientations are promoting information system success in public and private hospitals? Methods The authors develop and test two hypotheses about this relationship via two regression approaches (single-level and multi-level). The authors collected data from 172 respondents—clinicians and non-clinicians—working in two (one public and one private) hospitals in Campania, one of the largest regions in Italy. Results The findings of this study show clear differences between private and public hospitals. First, a dominant cultural orientation that emphasizes flexibility values (clan and adhocracy cultures) positively influences information systems success in terms of individual impact. Second, the influence of a clan orientation on individual impact is stronger in the public hospital. Third, the influence of an adhocracy orientation is stronger in the private hospital. Overall, the type of ownership—either public or private—of these healthcare organizations affects the link between cultural orientations and IS success. Conclusion Managers of private hospitals should offer to their employees the opportunity to adopt and implement new information systems processes driven by openness towards the external environment in order to benchmark and learn from what was done previously in other organizations. Managers of public hospitals should set up human resource management practices, knowledge creation mechanisms, and internal communication capable of generating a friendly learning environment for their employees when adopting new technology