A Cognitive Model for Emergency Management in Hospitals: Proposal of a Triage Severity Index

Hospitals play a critical role in providing communities with essential medical care during all types of disasters. Any accident that damages systems or people often requires a multifunctional response and recovery effort. Without an appropriate emergency planning, it is impossible to provide good care during a critical event. In fact, during a disaster condition, the same “critical” severity could occur for patients. Thus, it is essential to categorize and to prioritize patients with the aim to provide the best care to as many patients as possible with the available resources. Triage assesses the severity of patients to give an order of medical visit. The purpose of the present research is to develop a hybrid algorithm, called triage algorithm for emergency management (TAEM). The goal is twofold: First, to assess the priority of treatment; second, to assess in which hospital it is preferable to conduct patients. The triage models proposed in the literature are qualitative. The proposed algorithm aims to cover this gap. The model presented exceeds the limits of literature by developing a quantitative algorithm, which performs a numerical index. The hybrid model is implemented in a real scenario concerning the accident management in a petrochemical plant

SECCA procedure for anal incontinence and antibiotic treatment: a case report of anal abscess

Background: Fecal Incontinence (FI) can seriously affect quality of life. The treatment of fecal incontinence starts conservatively but in case of failure, different surgical approaches may be proposed to the patient. Recently several not invasive approaches have been developed. One of these is the radiofrequency (RF) energy application to the internal anal sphincter. Case presentation: We report a rare case of an anal abscess related to a SECCA procedure in a 66-year-old woman affected by gas and FI for twenty years. Conclusions: The complications post-SECCA procedure reported in literature are generally not serious and often self-limited, such as bleeding or anal pain. This is a case of an anal abscess. We suggest that this finding could consolidate the importance of administering antibiotic therapy to patients and to run a full course of at least 6 days rather than a short-term (24 h) therapy, with the aim to minimize the incidence of this complication

Exeresi di uno schwannoma del collo: note di tecnica chirurgica

Un paziente di 49 anni giunge alla nostra osservazione con un quadro clinico caratterizzato da parestesie, sensazione di corpo estraneo in regione cervicale e disfagia. Eseguite una ecotomografia ed una risonanza magnetica del collo, si documenta una neoformazione che viene sottoposta ad exeresi radicale. L’intervento è stato eseguito con accesso cervicale laterale sinistro ed accurato isolamento e risparmio dei nervi e delle strutture muscolari e vascolari della regione antero-laterale del collo. La neoplasia originava da un nervo della catena simpatica cervicale. La diagnosi istologica è stata di schwannoma Il paziente a distanza di 48 mesi non presenta recidive, né postumi legati all’intervento. Queste lesioni sono rare. L’esatta identificazione del nervo di origine è spesso difficile sino al momento dell’intervento chirurgico, che rappresenta il trattamento di scelta dello schwannoma

eLaparo4D: first prototype of a physical training space for videolaparoscopic surgery

none5M. Gaudina; V. Zappi; E. Bellanti; G. Vercelli; F. MandolfinoGaudina, Marco; V., Zappi; E., Bellanti; Vercelli, GIANNI VIARDO; F., Mandolfin

La terapia chirurgica nelle complicanze della malattia di Crohn. Nostra esperienza

Su 35 pazienti affetti da malattia di Crohn (MC), 18 sono stati trattati con terapia medica e 17 (48.6%) sono stati sottoposti ad intervento chirurgico per : 1) refrattarietà al trattamento medico in 1 caso (5,9%); 2) complicanze locali (6 stenosi, 2 occlusioni, 3 ascessi, 3 fistole, 1 perforazione libera con peritonite, 1 megacolon tossico) in 16 casi (94,1%). Gli interventi eseguiti sono stati 19: 14 interventi resettivi (resezione del tenue e/o del colon) e 5 interventi conservativi. La mortalità è risultata nulla, la morbilità pari al 35,29%. L?incidenza delle recidive in un follow up medio di 5 anni è risultata pari al 42,9%. Gli Autori concludono che la chirurgia, indicata nel trattamento delle complicanze della MC, si avvale di interventi sia resettivi (resezioni cosidette regolate) che conservativi (stricturoplastica): i primi sono indicati nella cosiddetta perforating Crohn?s disease (fistole, ascessi), i secondi nella stenosing Crohn?s disease (stenosi). Del tutto recentemente sono stati proposti interventi conservativi anche nei casi di fistole e ascessi, solo a condizione che il processo flogistico sia modesto e che si tratti di pazienti già sottoposti ad interventi di resezione e quindi a rischio d?insorgenza di una sindrome da intestino corto. English cersion Thirty-five patients with Crohn?s Disease (CD) were observed: 18 have been treated with medical therapy and 17 (48.6%) underwent to surgical treatment : 1) intolerance to the medical treatment in 5.9% (1 case); 2) local complications in 94.1% (16 cases: 6 stenosis, 2 occlusions, 3 abscesses, 3 fistulas, 1 perforation with peritonitis, 1 case toxic megacolon). The operations have been 19: resective interventions 14 (bowel and/or colon resections), conservative interventions 5. The mortality was 0, the morbility 35,29%. The incidence of the recurrences in a follow up of 5 year was 42,9%. The Authors conclude that the surgery, indicated for the treatment of complications, can be resective surgery (perforating Crohn disease : fistulas, abscess) or conservative surgery (stenosing Crohn disease : stenosis). Recently the conservative intervention are proposed in the treatment of fistulas and abscesses too, but when the flogosys is mild and in patients that underwent to extensive intestinal resection with risk of short bowel syndrome

Training in laparoscopic surgery: face validity of a low cost virtual simulator

Aim of this study is to investigate the importance of acquiring basic and advanced laparoscopic skills using a virtual reality low cost simulator in laparoscopic surgery in a defined theathre, a Medical Simulation Centre. The study shows and describes the Medical Simulation Centre in terms of utilization and activities. The article describes also the technical features of the system and its validation process about the basic skills using a primary method: the face validity. It consents to evaluate the structural simulator characteristics through a specific questionnaire, used after the system testing (we have chosen a basic skill training). A sample of 40 participants was selected: 20 post graduate students, 20 expert surgeons. The groups were divided into two homogeneous subgroups according to the level of confidence with the use of video games, consolles, smartphones (a questionnaire has been used before the practical phase of training). We analyzed the results of the face validity obtained by comparing the two groups reported impressions. The simulator appears ergonomically satisfactory and its structural features are adapted to the laparoscopic training