A web-based health technology assessment in tele-echocardiography: the experience within an Italian project

Due to major advances in the information technology, telemedicine applications are ready for a widespread use. Nonetheless, to allow their diffusion in National Health Care Systems (NHCSs) specific methodologies of health technology assessment (HTA ) should be used to assess the standardization, the overall quality, the interoperability, the addressing to legal, economic and cost benefit aspects. One of the limits to the diffusion of the digital tele-echocardiography (T-E) applications in the NHCS lacking of a specific methodology for the HTA . In the present study, a solution offering a structured HTA of T-E products was designed. The methodology assured also the definition of standardized quality levels for the application. The first level represents the minimum level of acceptance; the other levels are accessory levels useful for a more accurate assessment of the product. The methodology showed to be useful to rationalize the process of standardization and has received a high degree of acceptance by the subjects involved in the study.Grazie ai grandi progressi nell\u27information technology le applicazioni di telemedicina sono mature per un uso diffuso. Tuttavia per permettere la loro introduzione nel sistema sanitario nazionale devono essere utilizzate specifiche metodologie di health technology assessment (HTA ) per valutare il grado di standardizzazione, la qualit? totale, l\u27interoperabilit?, il rispetto dei requisiti legali ed economici e il rapporto costo-beneficio. Con riferimento alla tele-ecocardiografia digitale uno dei limiti ? la mancanza di una specifica metodologia di HTA . Nel presente studio, ? stata proposta una soluzione che offre un HTA strutturato di prodotti di tele-ecocardiografia (T-E) digitale. La metodologia ha assicurato anche la definizione di livelli standardizzati di qualit? per l\u27applicazione. Il primo livello rappresenta il livello minimo di accettazione; gli altri livelli riguardano aspetti accessori e sono utili per una pi? accurata valutazione del prodotto. La metodologia si ? mostrata di utilit? per razionalizzare il processo di standardizzazione ed ha ricevuto un elevato grado di accettazione dei soggetti coinvolti

Surrogate-Based Optimization of a Centrifugal Pump with Volute Casing for an Automotive Engine Cooling System

This paper investigates the capability of a surrogate-based optimization technique for the advanced design of centrifugal pumps. The centrifugal pump considered in this work is designed for the automotive cooling system and consists of an impeller, a vaneless diffuser and a volute. A fully three-dimensional geometry parametrization based on Bézier surfaces is presented. The optimization procedure includes the following software packages: Scilab for the geometric parametrization, Ansys-CFX for the CFD simulations and DAKOTA for the optimization management. The initial geometry is defined by a 0D code that provides a preliminary design of the pump, given the operating conditions, i.e., the volumetric flow rate, the head and the rotating speed. In this work an operative point typical of high performance gasoline cars is considered

Randomized evidence for reduction of perioperative mortality

Objective: With more than 220 million major surgical procedures performed annually, perioperative interventions leading to even minor mortality reductions would save thousands of lives per year. This international consensus conference aimed to identify all nonsurgical interventions that increase or reduce perioperative mortality as suggested by randomized evidence. Design and Setting: A web-based international consensus conference. Participants: More than 1,000 physicians from 77 countries participated in this web-based consensus conference. Interventions: Systematic literature searches (MEDLINE/PubMed, June 8, 2011) were used to identify the papers with a statistically significant effect on mortality together with contacts with experts. Interventions were considered eligible for evaluation if they (1) were published in peer-reviewed journals, (2) dealt with a nonsurgical intervention (drug/technique/strategy) in adult patients undergoing surgery, and (3) provided a statistically significant mortality increase or reduction as suggested by a randomized trial or meta-analysis of randomized trials. Measurements and Main Results: Fourteen interventions that might change perioperative mortality in adult surgery were identified. Interventions that might reduce mortality include chlorhexidine oral rinse, clonidine, insulin, intra-aortic balloon pump, leukodepletion, levosimendan, neuraxial anesthesia, noninvasive respiratory support, hemodynamic optimization, oxygen, selective decontamination of the digestive tract, and volatile anesthetics. In contrast, aprotinin and extended-release metoprolol might increase mortality. Conclusions: Future research and health care funding should be directed toward studying and evaluating these interventions. © 2012 Elsevier Inc