USAGE OF ANESTHESIA INFORMATION MANAGEMENT SYSTEMS IN EUROPEAN COUNTRIES IN 2020 – A SHORT SURVEY

The theoretical aspects and benefits of Anesthesia Information Management Systems (AIMS) are well described in literature already. However, certain existing systems are much less researched with most studies concentrating on the USA. In our study, we sent a link to a Google questionnaire to 403 European hospitals and to 382 European authors who have published in the last five years in a renowned anesthesiologic journal. We have not researched AIMS usage in the Czech Republic, as we have covered this topic in our previous study. We asked responders for information on their AIMS (name, vendor, length of use) or to explain why they do not use one. We received 14 responses from the hospitals and 38 responses directly from the authors. With the return rate of 8 per cent we evaluated our study in qualitative terms. Among the 23 respondents that use AIMS there are 12 different systems including two self-developed systems. A number of these systems have not previously been mentioned in the literature. Most use their systems longer than five years but only three respondents are implementing AIMS at the moment. Both these findings show slower progress in this field than in the USA. Typical reasons given from non-users were financial constraints and inability to recognize benefits of AIMS. Incompatibilities with other medical software and medical devices in use were also mentioned. The heterogeneity of AIMS used and perceived barriers corroborate our previous study from the Czech Republic

Groundwater Flow in Crystalline Carbonates (Jeseniky Mts., Chech Rep.): Using Stream Thermometry and Groundwater Balance for Catchment Delineation

Strips of metamorphosed carbonate rocks in a contact-karst area in the Jeseniky Mts, CzechRepublic, act as aquifers, drain­ing broad areas of crystalline rocks, mostly phyllites. Significant groundwater resources that are partly used as a water supply are in carbonate rocks. Detailed temperature and conductivity measurements coupled withdischarge measurements along all streams in the area demonstrate a relatively quick method to lo­cate virtually all important groundwater outflows from carbon­ates. Discharge measurements of streams crossing carbonate strips enabled us to locate and quantify the capacity of ponors and losing parts of streams in various water stages. Thanks to a detailed knowledge of losing and gaining parts of streams, we were able to select appropriate profiles to separate catchments withdiffering hydrologic balances (balanced, gaining, losing). Flow directions in carbonates and recharge and discharge ar­eas were delineated by comparing the specific discharges of individual catchments. Resulting flow directions agree withtracer tests in the area. Our outlined approachcan be used in many other areas to locate hidden inflows into streams and to estimate flow between individual small catchments, and it may partly compensate for tracer tests as it allows flow directions to be estimated from hydrological balance and rock geometry

The Prognostic Impact of Renal Function Decline during Hospitalization for Heart Failure

Introduction: We aimed to evaluate the prognostic impact of renal insufficiency and fluctuation of glomerular filtration observed during hospitalization for heart failure (HF). Methods: We followed 3,639 patients hospitalized for acute HF and assessed the mortality risk associated with moderate or severe renal insufficiency, either permanent or transient. Results: After adjustment, severe renal failure defined as estimated glomerular filtration (eGFR) <30 mL/min indicates ≈60% increase in 5-year mortality risk. Similar risk also had patients with only transient decline of eGFR to this range. In contrast, we did not observe any apparent mortality risk attributable to mild/moderate renal insufficiency (eGFR 30–59.9 mL/min), regardless of whether it was transient or permanent. Conclusion: Even transient severe renal failure during hospitalization indicates poor long-term prognosis of patients with manifested HF. In contrast, only moderate renal insufficiency observed during hospitalization has no additive long-term mortality impact

Patients with coronary artery disease and diabetes need improved management: a report from the EUROASPIRE IV survey: a registry from the EuroObservational Research Programme of the European Society of Cardiology

BACKGROUND: In order to influence every day clinical practice professional organisations issue management guidelines. Cross-sectional surveys are used to evaluate the implementation of such guidelines. The present survey investigated screening for glucose perturbations in people with coronary artery disease and compared patients with known and newly detected type 2 diabetes with those without diabetes in terms of their life-style and pharmacological risk factor management in relation to contemporary European guidelines. ----- METHODS: A total of 6187 patients (18-80 years) with coronary artery disease and known glycaemic status based on a self reported history of diabetes (previously known diabetes) or the results of an oral glucose tolerance test and HbA1c (no diabetes or newly diagnosed diabetes) were investigated in EUROASPIRE IV including patients in 24 European countries 2012-2013. The patients were interviewed and investigated in order to enable a comparison between their actual risk factor control with that recommended in current European management guidelines and the outcome in previously conducted surveys. ----- RESULTS: A total of 2846 (46%) patients had no diabetes, 1158 (19%) newly diagnosed diabetes and 2183 (35%) previously known diabetes. The combined use of all four cardioprotective drugs in these groups was 53, 55 and 60%, respectively. A blood pressure target of 9.0% (>75 mmol/mol). Of the patients with diabetes 69% reported on low physical activity. The proportion of patients participating in cardiac rehabilitation programmes was low (≈40 %) and only 27% of those with diabetes had attended diabetes schools. Compared with data from previous surveys the use of cardioprotective drugs had increased and more patients were achieving the risk factor treatment targets. ----- CONCLUSIONS: Despite advances in patient management there is further potential to improve both the detection and management of patients with diabetes and coronary artery disease

Primary prevention efforts are poorly developed in people at high cardiovascular risk: A report from the European Society of Cardiology EURObservational Research Programme EUROASPIRE V survey in 16 European countries

Background: European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V in primary care was carried out by the European Society of Cardiology EURObservational Research Programme in 2016–2018. The main objective was to determine whether the 2016 Joint European Societies’ guidelines on cardiovascular disease prevention in people at high cardiovascular risk have been implemented in clinical practice. Methods: The method used was a cross-sectional survey in 78 centres from 16 European countries. Patients without a history of atherosclerotic cardiovascular disease either started on blood pressure and/or lipid and/or glucose lowering treatments were identified and interviewed 6 months after the start of medication. Results: A total of 3562 medical records were reviewed and 2759 patients (57.6% women; mean age 59.0 11.6 years) interviewed (interview rate 70.0%). The risk factor control was poor with 18.1% of patients being smokers, 43.5% obese (body mass index 30 kg/m2 ) and 63.8% centrally obese (waist circumference 88 cm for women, 102 cm for men). Of patients on blood pressure lowering medication 47.0% reached the target of <140/90 mm Hg (<140/85 mm Hg in people with diabetes). Among treated dyslipidaemic patients only 46.9% attained low density lipoprotein-cholesterol target of <2.6 mmol/l. Among people treated for type 2 diabetes mellitus, 65.2% achieved the HbA1c target of <7.0%. Conclusion: The primary care arm of the EUROASPIRE V survey revealed that large proportions of people at high cardiovascular disease risk have unhealthy lifestyles and inadequate control of blood pressure, lipids and diabetes. Thus, the potential to reduce the risk of future cardiovascular disease throughout Europe by improved preventive cardiology programmes is substantial

The Economic Potential of Existing eHealth Systems in the Czech Republic

The purpose of this dissertation is to explore the contemporary area of information technologies employed in health care (eHealth). Focusing on the systems already employed in the Czech Republic, it aims to analyse them, to quantify expenditures of their introduction and maximum benefits derived from these, as well as to evaluate their real current profit. Out of the three existing national systems, this dissertation concentrates on the two only (eRecept, ePACS), as it became impossible to evaluate the third -- IZIP system due to scarcity of the relevant information available. In the field of expenditures not only generally published numbers are taken into consideration, but this dissertation also evaluates the expenditures of other subjects involved (IT systems producers, health care providers, etc.). As the first dissertation in the Czech Republic it quantifies benefits derived from the existing eHealth systems and unlike foreign theses it greatly emphasizes just the expenditures of other subjects involved. Included in this dissertation is also the evaluation of achievements of the eHealth systems in the Czech Republic complete with supposed grounds for this situation. This dissertation also recommends courses of action for contractors of these systems to ensure future basis for more economical and successful eHealth systems. These recommendations are mainly based on analysis of development of the existing national eHealth systems. For the complex evaluation of the costs, maximum of possible and real benefit of the individual eHealth systems the research approach adopted in this dissertation includes descriptive method and SWOT analysis, extrapolation and abstraction, comparative and factor analysis

FROM WHITE BOARD TO PATIENT TRACKING SYSTEM AND BEYOND (IN ANESTHESIA)

Every acute-care hospital in the Czech Republic is equipped with a Hospital information system, still there is no Anesthesia information management system (AIMS) deployed in any of these hospitals. Relaying the information obtained in anesthesia consultation and managing an anesthesia sub-department proved to be challenging when using a shared Word document and classic white board to keep track of the changing situation. We designed an in-house web-based system that stores the data obtained in anesthesia consultation, shares these data via email with relevant parties and then serves as a patient tracking system in the post operative care unit. This system also provides tatistical data associated with anesthesia required by our hospital. Although AIMS would be an ultimate solution for our needs, we were able to cover our most pressing needs by much more simple arrangement which we plan to develop further

The Economic Potential of Existing eHealth Systems in the Czech Republic

Práce se věnuje aktuálnímu tématu využití výpočetní techniky ve zdravotnictví (eHealth). Základním cílem práce je analýza existujících národních systémů eHealth v ČR, vyčíslení nákladů na zavedení těchto systémů, kvantifikace jejich maximálního možného přínosu a vyhodnocení jejich skutečného aktuálního přínosu. Ze tří existujících národních systémů se práce zabývá dvěma -- systémem eRecept a ePACS. Původně uvažovaný třetí systém IZIP nebylo možné hodnotit, neboť relevantní informace nejsou k dispozici. V oblasti nákladů se práce zabývá nejen obecně zveřejňovanými náklady, ale hodnotí také náklady dalších dotčených subjektů (výrobců informačních systémů, zdravotnických zařízení, atd). Jako první v ČR tato práce kvantifikuje přínosy existujících systémů eHealth, na rozdíl od zahraničních prací pak tato práce klade velký důraz právě na náklady dalších dotčených subjektů. Součástí práce je rovněž zhodnocení úspěšnosti systémů eHealth v ČR včetně předpokládaných důvodů tohoto stavu. Práce přináší rovněž celou řadu doporučení pro zadavatele těchto systémů, aby budoucí systémy eHealth byly ekonomičtější a úspěšnější -- tato doporučení vycházejí převážně z analýzy vývoje existujících národních systémů eHealth. Pro dosažení cíle práce (komplexní zhodnocení celkových nákladů, maximálního možného přínosu a reálného přínosu jednotlivých systémů eHealth) je použita deskriptivní metoda a SWOT analýza, extrapolace a abstrakce, komparativní a faktoriální analýza.The purpose of this dissertation is to explore the contemporary area of information technologies employed in health care (eHealth). Focusing on the systems already employed in the Czech Republic, it aims to analyse them, to quantify expenditures of their introduction and maximum benefits derived from these, as well as to evaluate their real current profit. Out of the three existing national systems, this dissertation concentrates on the two only (eRecept, ePACS), as it became impossible to evaluate the third -- IZIP system due to scarcity of the relevant information available. In the field of expenditures not only generally published numbers are taken into consideration, but this dissertation also evaluates the expenditures of other subjects involved (IT systems producers, health care providers, etc.). As the first dissertation in the Czech Republic it quantifies benefits derived from the existing eHealth systems and unlike foreign theses it greatly emphasizes just the expenditures of other subjects involved. Included in this dissertation is also the evaluation of achievements of the eHealth systems in the Czech Republic complete with supposed grounds for this situation. This dissertation also recommends courses of action for contractors of these systems to ensure future basis for more economical and successful eHealth systems. These recommendations are mainly based on analysis of development of the existing national eHealth systems. For the complex evaluation of the costs, maximum of possible and real benefit of the individual eHealth systems the research approach adopted in this dissertation includes descriptive method and SWOT analysis, extrapolation and abstraction, comparative and factor analysis

Immediate Removal of an Entrapped Central Venous Catheter Guide Wire

Extravasal guide wire entrapment due to fraying during central venous catheter placement using the Seldinger technique is a rare complication, which should be resolved as soon as possible. A 68-year-old male was scheduled for open right-side decortication. After the induction of general anesthesia, an attempt was made to place a central venous line in the right subclavian vein. However, the guide wire was entrapped extravasally between the right clavicle and the first rib. The exact site was located by palpating the bend of the guide wire in the subclavian triangle and the thoracic surgeon was available. Therefore, it was decided not to try to visualize the guide wire any further and to immediately proceed with surgical removal of the guide wire. The platysma muscle was dissected allowing access to the subclavian triangle. Venotomy of the external jugular vein was performed and the entrapped guide wire was removed via the venotomy. The whole complication was resolved within 30 minutes and the primary procedure was then performed. Managing rare complications of central venous line placement requires skill, ingenuity and, sometimes, interdisciplinary cooperation, either with a radiologist or a surgeon. The decision to proceed with immediate surgical removal of the guide wire proved a right one, and, to the best of our knowledge, such a strategy has not been described in the relevant literature to date

Kardiovaskulární revoluce

18218