Measurements of rates of cooling of a manikin insulated with different mountain rescue casualty bags

Background: Accidental hypothermia is common in those who sustain injuries in remote environments. This is unpleasant and associated with adverse effects on subsequent patient outcomes. To minimise further heat loss, a range of insulating systems are available to mountain rescue teams although the most effective and cost-efficient have yet to be determined. Methods: Under ambient, still, dry, air conditions, a thermal manikin was filled with water at a temperature of 42 °C and then placed into a given insulation system. Water temperature was then continuously observed via an in-dwelling temperature sensor linked to a PROPAQ 100 series monitor and recorded every 10 min for 130 min. This method was repeated for each insulating package. Results: The vacuum mattress/Pertex©/fibrepile blanket system, either on its own or coupled with the Wiggy bag, was the most efficient with water temperatures only decreasing by 3.2 °C over 130 min. This was followed by the heavy-weight casualty bags without the vacuum mattress/Pertex©/fibrepile blanket system, decreasing by 4.2–4.3 °C. With the Blizzard bag, a decline in water temperature of 5.4 °C was seen over the study duration while a decrease of 9.5 °C was noted when the plastic survival bag was employed. Conclusions: Under the still-air conditions of the study, the vacuum mattress/Pertex©/fibrepile blanket was seen to offer comparable insulation effectiveness compared to be both heavy-weight casualty bags. In turn, these three systems appeared more efficient at insulating the manikin than the Blizzard bag or plastic survival bag

Managing the Hybrid Organization: How Can Agile and Traditional Project Management Coexist?

Agile project management aims to increase the flexibility of product development processes through increased interaction among project stakeholders. Since its introduction in the software industry 20 years ago, Agile project management has progressively spread to other contexts, even though large-scale organizations seem to struggle to switch toward Agile-only practices. In these contexts, we see an integration of the traditional Stage-Gate project management, focused on planning and validation, with Agile, focused on responsiveness and flexibility. Although it’s effective, the Agile–Stage-Gate hybrid model is not easy to adopt, as it requires a clear alignment between the project team, the organizational objectives, and the project implementation. We collected interview data from eight Agile coaches experienced in Agile implementation in non-software industries. We identified practical actions that practitioners can use to manage the challenges connected to the implementation of hybrid models. These corrective actions can be grouped at three levels: integration aspects, cultural change, and perceptions of the Agile methodology

Intrathecal atropine to prevent postoperative nausea and vomiting after Cesarean section: a randomized, controlled trial.

Postoperative nausea and vomiting (PONV) is a common adverse effect of intrathecal morphine, especially after Cesarean section. This randomized controlled trial investigated the effects of intrathecal administration of a small-dose of atropine on postoperative nausea and vomiting after Cesarean section.Parturients with ASA physical status class I-II scheduled for elective Cesarean section and consenting to spinal anesthesia were enrolled. They received 0.5\% hyperbaric bupivacaine 12.5 mg, morphine 200 µg and one of the following three solutions: atropine 100 µg intrathecally and saline intravenously; saline intrathecally and atropine 100 µg intravenously; saline only both intravenously and intrathecally. We examined the incidence and severity of PONV, pain ratings and the need for analgesics.We followed 204 parturients. The incidence of PONV was 15\%, 37\% and 49\% in the three groups, respectively (P<0.001). The relative risk reduction for PONV when using intrathecal atropine was 69\% vs. placebo and 59\% vs. intravenous atropine. No differences were noted in terms of postoperative pain.Intrathecal atropine had a significant antiemetic effect, making it a useful adjunct for intrathecal opioid-related PONV

Improving laboratory test ordering can reduce costs in surgical wards

Background and Aim Laboratory blood tests for hospitalized patients are often overused. Excessive costs and no proof of benefit suggest re- evaluating the current approach to laboratory test ordering. The aim of the study is to improve the decision-making process of test ordering and to investigate what effect a rational, evidence-based use of laboratory test ordering in surgical wards would have on costs and healthcare resources. Methods Three-phase experimental prospective study carried out at the tertiary referral teaching hospital of Parma. Phase 1 (baseline status). The baseline status of laboratory test ordering was evaluated by recording the number of biochemical tests requested for patients undergoing elective surgery. Laboratory tests were grouped in "recommended" (RT) and "non recommended" (nRT) tests on the basis of pertinent literature. Phase 2 (improvement action): new guidelines were introduced into clinical practice. Phase 3 (feedback): Prospective data collection for first and second feedback was performed with no advance notice. Results A highly significant reduction in test ordering was found on occasion of the phases 2 and 3 of the study. The overall number of tests decreased, largely due to a decrease in the use of nRT. Conclusions Analysis was justified by the fact that most test requests proved not to be supported by clinical evidence. Inappropriate ordering of laboratory tests results in an unnecessarily high number of requests, which do not in turn improve patient management. Moreover, more appropriate, evidence-based laboratory test ordering for patients undergoing elective surgery may produce a significant reduction in costs, particularly in high-cost settings