Efficiency of Telematics Systems in Management of Operational Activities in Road Transport Enterprises

Implemented in road transport enterprises (RTEs) on a large scale, telematics systems are dedicated both to the particular aspects of their operation and to the integrated fields of the total operational functioning of such entities. Hence, a research problem can be defined as the identification of their efficiency levels in the context of operational activities undertaken by RTEs (including more holistic effects, e.g., lowering fuel/energy consumption and negative environmental impacts). Current research studies refer to the efficiency of some particular modules, but there have not been any publications focused on describing the efficiency of telematics systems in a more integrated (holistic) way, due to the lack of a universal tool that could be applied to provide this type of measurement. In this paper, an attempt at filling the identified cognitive gap is presented through empirical research analysing the original matrix developed by the authors that refers to the efficiency rates of organisational activities undertaken by RTEs. The purpose of this paper is to present a tool that has been designed to provide a holistic evaluation of efficiency of telematics systems in RTE operational management. The results are presented in a form of an individual (ontogenetic) matrix of the analysed companies, for which a determinant was calculated with the use of Sarrus’ rule. Obtained in such a way, the set of values identified for the determinants of the subsequent ontogenetic matrices came as an arithmetic progression that characterised the scope and the level of the influence exerted by the implemented IT (information technology) systems on the organisational efficiency of operational activities undertaken by the analysed RTEs. We present a hypothesis stating that the originally developed matrix can be viewed as a reliable tool used for comparative analysis in the field of efficiency of telematics systems in RTEs, and this hypothesis was positively verified during the research. The obtained results prove the significant potential for the wide application of the discussed matrix, which can be used as a universal tool for the analysis and comparison of efficiency indicated by the integrated IT systems in the operational activities undertaken by RTEs. Document type: Articl

Quality of life after bariatric surgery

INTRODUCTION AND PURPOSE: Morbid obesity together with obesity-related diseases has a negative impact on the quality of life. The aim of the study was to assess the quality of life amongst patients with morbid obesity as well as the impact of bariatric treatment on body weight and obesity-related diseases in addition to conducting an analysis of changes in the quality of life after surgical treatments, in the context of the surgical procedure type and degree of body weight loss. MATERIAL AND METHODS: Sixty-five patients were treated for morbid obesity. The sample group consisted of 34 patients treated with laparoscopic sleeve gastrectomy (LSG) and 31 persons qualified for laparoscopic Roux-en-Y gastric bypass (LRYGB). The average body weight before the procedure was 146.2 kg. In the sample group, 89 % of persons qualified for the surgical treatments were diagnosed with hypertension and 52 % persons that were operated on were diagnosed with diabetes type 2 before the surgical procedure. Before commencement of the surgical treatment, the quality of life was assessed, which in both groups qualified for given types of bariatric procedures was considerably low. RESULTS AND CONCLUSIONS: Percentage excessive weight loss (%EWL) was 58.8 %. No significant differences in body weight loss were noted between the two types of procedures. Improvement was observed in the treatment of obesity-related diseases. Also, the quality of life was enhanced significantly. No differences were noted in terms of the quality of life improvement between particular types of surgical procedures. No significant differences were observed during the analysis of body weight loss impact on the quality of life improvement

Enhanced recovery (ERAS) protocol in patients undergoing laparoscopic total gastrectomy

INTRODUCTION: Laparoscopic technique combined with the ERAS (Enhanced Recovery after Surgery) protocol enables a shorter hospital stay and a lower complication rate. Although it has been widely used in many patients undergoing elective abdominal surgery, especially in patients with colorectal cancer, there are only a few papers describing laparoscopic total gastrectomy and the enhanced recovery protocol in patients with gastric cancer. Minimally invasive gastrectomy is still an uncommon procedure, mostly because of its difficulty. AIM: To present the preliminary results of treatment of patients with gastric neoplasms who underwent laparoscopic gastrectomy D2 with perioperative care according to ERAS principles. MATERIAL AND METHODS: Eleven patients (5 male and 6 female, age 52–77 years) underwent laparoscopic D2 gastrectomy with intracorporeal esophagojejunal anastomosis. In all patients the ERAS protocol was implemented. We analyzed operation time, complications and hospital stay. Additionally we focused on operative technique as well as the perioperative care protocol. RESULTS: The mean duration of the procedure was 245 min. There was 1 conversion due to unclear tumor infiltration. Mean hospital stay was 4.6 days. One postoperative complication (central venous catheter sepsis) was reported. Histological analysis confirmed the tentative diagnosis (R0 resection) in 10/11 patients. There were no readmissions. CONCLUSIONS: Laparoscopic gastrectomy is a valuable alternative to the classical approach and combined with the ERAS protocol can result in reduced hospital stay. However, due to the small group of patients it is difficult to adequately assess the incidence of early and late complications of the laparoscopic procedures; therefore further research is needed

Short hospital stays after laparoscopic gastric surgery under an Enhanced Recovery After Surgery (ERAS) pathway : experience at a single center

INTRODUCTION: Recently, first reports on benefits from Enhanced Recovery After Surgery (ERAS) pathway in patients undergoing gastric surgery have appeared. It seems that maximal reduction of unfavorable surgery-induced trauma in patients with gastric malignancy via ERAS protocol combined with minimally invasive techniques can improve outcomes. OBJECTIVE: The aim of this study was to determine the influence of laparoscopic surgery and ERAS protocol in oncological gastric surgery on early outcomes. MATERIALS AND METHODS: Prospective analysis involved 28 patients (18 female and 10 male) with gastric malignancy who underwent laparoscopic gastric resection between 2009 and 2013. Gastric tumors (gastrointestinal stromal tumors or adenocarcinoma) were the indication for the surgery. A total of 17 patients underwent laparoscopic local excision, and 11 patients with adenocarcinoma or multiple neuroendocrine tumors underwent laparoscopic D2 total gastrectomy. Perioperative care was based on ERAS principles. Length of hospital stay, postoperative course, perioperative complications, and readmission rates were analyzed. RESULTS: There was one conversion in the gastrectomy group. All patients were mobilized on the day of surgery. Oral fluids were introduced on day 0 and were well tolerated. Full hospital diet was started on day 2 in all patients, but was well tolerated in only 18 of them. One postoperative complication requiring reoperation was noted. The length of stay after gastrectomy and gastric wedge resection was 4.6 (2–6) and 3.3 (2–6) days, respectively. No readmissions were noted in the entire group. CONCLUSIONS: The implementation of ERAS protocol to clinical practice in combination with laparoscopy in patients with gastric tumors can result in improved postoperative care quality, shortening of hospital stay, and quicker return to normal activity

Enhanced recovery after colorectal surgery in elderly patients

INTRODUCTION: The elderly will soon constitute 20% of the population. Their number is constantly rising, particularly in developed countries. It was found that they particularly benefit from the use of minimally invasive surgery. The Enhanced Recovery After Surgery (ERAS) protocol may further improve clinical outcomes in this group of patients. AIM: To assess the implementation of the ERAS protocol in elderly patients submitted to laparoscopic colorectal surgery. MATERIAL AND METHODS: Ninety-two patients who underwent elective laparoscopic colorectal surgery were included in the study. Patients were divided into group 1 (≤ 65 years) and group 2 (> 65 years). Perioperative care was based on ERAS Society guidelines. Length of hospital stay, time of first stool passage, perioperative complications and readmissions were analyzed. RESULTS: Group 2 patients had higher ASA grades in comparison to group 1. In all cases, oral fluid intake started on the day of surgery. The groups did not differ according to oral fluid tolerance, first stool passage time or length of hospital stay. Number and character of perioperative complications were comparable between the two groups. Four patients were readmitted within 30 days after discharge. One patient required reoperation. CONCLUSIONS: Implementation of the ERAS protocol is possible regardless of the age of surgical patients. Its use in the elderly allows the length of hospitalization to be shortened and is not associated with higher risk of postoperative complications or readmissions

Efficiency of Telematics Systems in Management of Operational Activities in Road Transport Enterprises

Implemented in road transport enterprises (RTEs) on a large scale, telematics systems are dedicated both to the particular aspects of their operation and to the integrated fields of the total operational functioning of such entities. Hence, a research problem can be defined as the identification of their efficiency levels in the context of operational activities undertaken by RTEs (including more holistic effects, e.g., lowering fuel/energy consumption and negative environmental impacts). Current research studies refer to the efficiency of some particular modules, but there have not been any publications focused on describing the efficiency of telematics systems in a more integrated (holistic) way, due to the lack of a universal tool that could be applied to provide this type of measurement. In this paper, an attempt at filling the identified cognitive gap is presented through empirical research analysing the original matrix developed by the authors that refers to the efficiency rates of organisational activities undertaken by RTEs. The purpose of this paper is to present a tool that has been designed to provide a holistic evaluation of efficiency of telematics systems in RTE operational management. The results are presented in a form of an individual (ontogenetic) matrix of the analysed companies, for which a determinant was calculated with the use of Sarrus’ rule. Obtained in such a way, the set of values identified for the determinants of the subsequent ontogenetic matrices came as an arithmetic progression that characterised the scope and the level of the influence exerted by the implemented IT (information technology) systems on the organisational efficiency of operational activities undertaken by the analysed RTEs. We present a hypothesis stating that the originally developed matrix can be viewed as a reliable tool used for comparative analysis in the field of efficiency of telematics systems in RTEs, and this hypothesis was positively verified during the research. The obtained results prove the significant potential for the wide application of the discussed matrix, which can be used as a universal tool for the analysis and comparison of efficiency indicated by the integrated IT systems in the operational activities undertaken by RTEs

Elective laparoscopic cholecystectomy – is it safe in the hands of residents during training?

The aim of the study was to assess safety of elective laparoscopic cholecystectomy (LC) performed by residents that are undergoing training in general surgery. Material and methods. A retrospective analysis was conducted on 330 patients operated electively due to cholelithiasis. Patients with acute cholecystitis, choledocholithiasis, undergoing cholecystectomy as a part of more extensive operation and patients with gall-bladder cancer were excluded. Group 1 included patients operated by resident, group 2 – by specialist. Duration of operation, mean blood loss, number of major complications, number of conversions to the open technique and conversions of the operator, reoperations and length of hospital stay were analyzed. Results. Mean operative time overall was 81 min (25 – 170, SD±28.6) and 71 min (30-210, SD±29.1) in groups 1 and 2 respectively (p=0.00009). Mean blood loss in group 1 was 45±68.2 ml and in group 2 – 41±73.4 ml (p=0.23). Six major complications has occurred (1.81%) – 2 (2%) in group 1 and 4 (1.7%) in group 2. 18 cases (15.5%) of conversion of the operator occurred in group 1, and 6 cases (2.6%) of conversion of the operator happened in group 2. Average LOS was 1.9 days in group 1 and 2.3 days in group 2 (p=0.03979). Conlcusions. Elective LC performed by a supervised resident is a safe procedure. Tactics of “conversion of operator” allowed to prevent major complications. Longer LC by residents is natural during the learning curve. Modifications of residency program in the field of laparoscopy may increase its accessibility