Early impact analysis of remote vital sign monitoring after esophagectomy: a multi-method study design

Background: Esophagectomy is associated with serious postoperative complications in 20-40% of the patients. Early recognition and treatment of these complications is critical to prevent secondary damage. To support medical professionals in the timely detection of clinical deterioration in patients admitted to the ward, it is of interest to use wireless sensor technologies allowing unobtrusive continuous vital sign tracking. However, it is yet unclear under which circumstances and to what extent telemonitoring provides beneficial effects in this patient population. Methods: We designed a multi-methods and multicenter study to evaluate the expected effects of continuous vital sign monitoring in the postoperative ward trajectory of patients undergoing esophagectomy. Semi-structured interviews with nurses and surgeons are conducted to elicit the probability of earlier detection and treatment of postoperative complications and the effects on related clinical outcome measures (mortality, ICU readmissions, and hospital stay length). To support valid estimations, interviews include scenario’s incorporating the characteristics and outcomes from center-specific patient population. Decision tree analysis is performed to assess the relation between clinical outcome for current situation and the conceived situation with continuous ward monitoring. Findings: We expect that the proposed study will provide insight in the clinical effects of continuous remote vital sign monitoring in the postoperative ward in patients undergoing esophagectomy. Discussion: Decision tree analysis combined with expert elicitation enables assessment of the afferent (i.e. monitoring) and efferent (i.e. response chain) arm of telemonitoring, and facilitates impact analysis in an early stage. The results of this study can be used to optimize the strategy of vital sign monitoring in wards, and to target situations where improvement in patient outcome and safety is expected

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The value of improving patient safety: Health-economic considerations for Rapid Response Systems – a Rapid Review of the Literature and Expert Round Table

Objectives Failure to rescue deteriorating patients in hospital is a well-researched topic. We aimed to explore the impact of safer care on health economic considerations for clinicians, providers and policymakers.Design We undertook a rapid review of the available literature and convened a round table of international specialists in the field including experts on health economics and value-based healthcare to better understand health economics of clinical deterioration and impact of systems to reduce failure to rescue.Results Only a limited number of publications have examined the health economic impact of failure to rescue. Literature examining this topic lacked detail and we identified no publications on long-term cost outside the hospital following a deterioration event. The recent pandemic has added limited literature on prevention of deterioration in the patients’ home.Cost-effectiveness and cost-efficiency are dependent on broader system effects of adverse events. We suggest including the care needs beyond the hospital and loss of income of patients and/or their informal carers as well as sickness of healthcare staff exposed to serious adverse events in the analysis of adverse events. They are likely to have a larger health economic impact than the direct attributable cost of the hospital admission of the patient suffering the adverse event. Premorbid status of a patient is a major confounder for health economic considerations.Conclusion In order to optimise health at the population level, we must limit long-term effects of adverse events through improvement of our ability to rapidly recognise and respond to acute illness and worsening chronic illness both in the home and the hospital

Non-invasive bladder volume measurement for the prevention of postoperative urinary retention:validation of two ultrasound devices in a clinical setting

Ultrasound scanning of bladder volume is used for prevention of postoperative urinary retention (POUR). Accurate assessment of bladder volume is needed to allow clinical decision-making regarding the need for postoperative catheterization. Two commonly used ultrasound devices, the BladderScan (R) BVI 9400 and the newly released Prime (R) (Verathon Medical (R), Bothell, WA, USA), with or without the pre-scan' option, have not been validated in clinical practice. The aim of this study was to assess the performance of these devices in daily clinical practice. Between June and September 2016 a prospective observational study was conducted in 318 surgical patients (18years or older) who needed a urinary catheter perioperatively for clinical reasons. For acceptable performance, we required that the volume as estimated by the BladderScan (R) differs by no more than 5% from the actual urine volume after catheterization. The Schuirmann's two one-sided test was performed to assess equivalence between the BladderScan (R) estimate and catheterization. The BVI 9400 (R) overestimated the actual bladder volume by +17.5% (95% CI +8.8 to +26.3%). The Prime (R) without pre-scan underestimated by -4.1% (95% CI -8.8 to +0.5%) and the Prime (R) with pre-scan underestimated by -6.3% (95% CI -11.6 to -1.1%). This study shows that while both ultrasound devices were able to approximate current bladder volume, both BVI 9400 (R) and Prime (R) with and without pre-scanwere not able to measure the actual bladder volume within our predefined limit of +/- 5%. Using the pre-scan feature of the Prime (R) did not further improve accuracy

Is a preoperative multidisciplinary team meeting (cost)effective to improve outcome for high-risk adult patients undergoing noncardiac surgery:the PREPARATION study-a multicenter stepped-wedge cluster randomized trial

BACKGROUND: As a result of increased life expectancy and improved care for patients suffering from chronic disease, the number of patients with multimorbidity requiring surgical intervention is increasing. For complex surgical patients, it is essential to balance the potential benefits of surgical treatment against the risk of permanent loss of functional capacity and quality of life due to complications. European and US guidelines on perioperative care recommend preoperative multidisciplinary team (MDT) discussions for high-risk noncardiac surgical patients. However, the evidence underlying benefits from preoperative MDT meetings with all relevant perioperative specialties present is limited. The current study aims to investigate the effect of implementation of preoperative MDT discussions for high-risk patients undergoing noncardiac surgery on serious adverse events.METHODS/DESIGN: PREPARATION is a stepped-wedge cluster randomized trial in 14 Dutch hospitals without currently established preoperative MDT meeting. The intervention, preoperative MDT meetings, will be implemented sequentially with seven blocks of 2 hospitals switching from control (preoperative screening as usual) to the intervention every 3 months. Each hospital will be randomized to one of seven blocks. We aim to include 1200 patients. The primary outcome is the incidence of serious adverse events at 6 months. Secondary outcomes include (cost)effectiveness, functional outcome, and quality of life for up to 12 months.DISCUSSION: PREPARATION is the first study to assess the effectiveness of a preoperative MDT meeting for high-risk noncardiac surgical patients in the presence of an anesthesiologist. If the results suggest that preoperative MDT discussions for high-risk patients are (cost)-effective, the current study facilitates implementation of preoperative MDT meetings in clinical practice.TRIAL REGISTRATION: ClinicalTrials.gov NCT05703230. Registered on 11/09/2022.</p