Hybrid model: a promising type of public procurement in the healthcare sector of the European Union.

The management of health supplies in public hospitals has been a major concern of national and European institutions over time, often being a field of reforms and regulatory interventions. Health procurement systems constitute complex decision-making and supply chain management mechanisms of public hospitals, involving suppliers, health providers, administrators and political bodies. Due to this complexity, the first important decision to be taken when designing a procurement system, concerns the degree of centralization, namely to what extent the decision-making power on the healthcare procurement (what, how and when) will be transferred either to a central public authority established for this purpose, or to the competent local authorities. In this perspective, we attempt to analyse the types of public procurement in the healthcare sector of the European Union, in terms of degree of centralization. Employing a narrative approach that summarizes recent interdisciplinary literature, this perspective finds that the healthcare procurement systems of the EU Member States, based on the degree of centralization, are categorized into three types of organizational structures: Centralized, Decentralized and Hybrid procurement. Each structure offers advantages and disadvantages for health systems. According to this perspective, a combination of centralized and decentralized purchases of medical supplies represents a promising hybrid model of healthcare procurement organization by bringing the benefits of two methods together.

When to anatomically excise a benign lung tumor-correspondence regarding the article: "large mesenchymal cystic and chondroid pulmonary hamartoma mimicking lung cancer: case report".

The decision of whether to perform a large anatomic resection for a lung mass that is not definitely malignant comes often forward in the everyday practice of the thoracic surgeon. The general characteristics of the tumor as well as of the patient and the instinct and experience of the surgeon are the ones that dictate the final choice. Such a decision was made in the case of a large pulmonary hamartoma where a right middle lobectomy was performed with the postoperative course justifying the surgeons' choice.

Volumetric Tissue Imaging of Surgical Tissue Specimens Using Micro-Computed Tomography: An Emerging Digital Pathology Modality for Nondestructive, Slide-Free Microscopy-Clinical Applications of Digital Pathology in 3 Dimensions.

OBJECTIVES: Micro-computed tomography (micro-CT) is a novel, nondestructive, slide-free digital imaging modality that enables the acquisition of high-resolution, volumetric images of intact surgical tissue specimens. The aim of this systematic mapping review is to provide a comprehensive overview of the available literature on clinical applications of micro-CT tissue imaging and to assess its relevance and readiness for pathology practice. METHODS: A computerized literature search was performed in the PubMed, Scopus, Web of Science, and CENTRAL databases. To gain insight into regulatory and financial considerations for performing and examining micro-CT imaging procedures in a clinical setting, additional searches were performed in medical device databases. RESULTS: Our search identified 141 scientific articles published between 2000 and 2021 that described clinical applications of micro-CT tissue imaging. The number of relevant publications is progressively increasing, with the specialties of pulmonology, cardiology, otolaryngology, and oncology being most commonly concerned. The included studies were mostly performed in pathology departments. Current micro-CT devices have already been cleared for clinical use, and a Current Procedural Terminology (CPT) code exists for reimbursement of micro-CT imaging procedures. CONCLUSIONS: Micro-CT tissue imaging enables accurate volumetric measurements and evaluations of entire surgical specimens at microscopic resolution across a wide range of clinical applications.

Helicobacter pylori infection, dementia and primary open-angle glaucoma: are they connected?

BACKGROUND: The study aims to elucidate the putative association between various forms of dementia, including Alzheimer's disease, primary open-angle glaucoma and Helicobacter pylori (H.pylori) infection in all possible combinations. METHODS: We prospectively recruited for the study 156 patients, divided into a dementia group, a glaucoma group and two control groups. All patients were submitted to neuropsychological evaluation aiming to detect dementia, ophthalmological examination, aiming to detect glaucoma, and H.pylori diagnostic testing. The provided data were analyzed with the question of possible correlation between the aforementioned entities. RESULTS: Positive correlations were found between Hp infection and dementia, Hp infection and glaucoma, as well as between dementia and glaucoma. CONCLUSIONS: The study confirmed the hypothesis that neurodegenerative diseases such as dementia and glaucoma are linked to each other and to H.pylori infection.

Ondasetron versus haloperidol for the treatment of postcardiotomy delirium: a prospective, randomized, double-blinded study.

BACKGROUND: To investigate the controlling efficacy of ondasetron and haloperidol in regard to the postcardiotomy delirium. METHODS: We included in this prospective, randomized, double-blinded study 80 patients who developed delirium after heart surgery with the application of heart lung-machine. The patients were divided into two, equally-sized groups, which on detection of delirium received ondasetron 8 mg iv or haloperidol 5 mg iv respectively. The statistical analysis compared the baseline and demographic characteristics of the two groups (age, gender, comorbidities, years of education, type of surgery etc.). RESULTS: Both ondasetron and haloperidol had very good delirium controlling effects, without statistically significant differences. DISCUSSION-CONCLUSIONS: Ondasetron and haloperidol are efficient agents as far as the treatment of postcardiotomy delirium is concerned. As, in addition, ondasetron bares milder side-effects, we believe this could be the agent of choice in patients developing postcardiotomy delirium in the future.

Helicobacter pylori infection and primary open-angle glaucoma: is there a connection?

Glaucoma, the most common form of which is primary open-angle glaucoma (POAG), is a neurodegenerative disease which is the second most common cause of blindness worldwide. Among the factors that have been implicated in the pathophysiology of this disease is infection with Helicobacter pylori. This alleged association has caused a great deal of scientific discussion during the past decade, as the establishment of such a correlation might lead to therapeutic applications for all glaucoma patients. In this review, we assess all relevant major studies and trials in an effort to elucidate the issue.

Classic and non-classic forms of mitral valve prolapse.

OBJECTIVE: To investigate the significance of the established distinction between classic and non-classic forms of mitral valve prolapsed (MVP). METHODS: We included in this prospective study all patients examined in our preventive cardiology outpatient clinics during the biannual period October 2004-October 2006. We examined in total 10.818 patients, 238 of whom (2.2%) were diagnosed for MVP. We noted relevant demographic and clinical data (gender, age of diagnosis, symptoms, need for hospitalization) and performed statistical comparisons between patients with the classic and those with the non-classic form. Follow-up controls were performed three years afterwards. RESULTS: Patients with the classic form had an earlier age of first diagnosis, more prominent symptoms, and more frequently diagnosis for other disorders (atrial septal defect, ventricular septal defect, Marfan syndrome, Ehlers-Danlos syndrome) than the rest of the patients; however, there were no significant differences as far as certain major complications (stroke, death, submission to surgery) were concerned. CONCLUSION: The classic form of mitral valve prolapse is more tightly associated with morbid complications, and a more frequent follow-up control in this group of patients may be useful.

Alzheimer's disease and primary open-angle glaucoma: is there a connection?

AIM: To present, through a thorough literature research, current and older scientific efforts to investigate the putative association between Alzheimer's disease (AD) and glaucoma, especially primary open-angle glaucoma (POAG). METHODS: We included in our review article epidemiological, experimental and clinical laboratory studies. RESULTS: While many authors support the existence of a strong correlation between the AD and POAG, based on epidemiological, genetic and immunohistochemical data, others present contradictory results, leaving the issue unresolved. CONCLUSION: Further research, probably targeted towards genetic parameters and based on large, multicenter studies has yet to be conducted. It is the authors' opinion however, that the existing data already justify the need for at least some degree of elevated clinical alertness for the occurrence of AD in patients with glaucoma and of glaucoma in patients with AD.

Iridoschisis: case report and review of the literature.

Iridoschisis is a rare condition that consists of the separation of the anterior mesodermic layer of the iris. In more than two-thirds of cases it is associated with glaucoma. We report the case of an 80-year-old patient who had bilateral iridoschisis and presented with acute angle-closure glaucoma. The patient was free from a history of ocular trauma or of heritable ocular disease. Chronic open-angle glaucoma, as well as intermittent angle-closure glaucoma, should be excluded in all patients with iridoschisis, and regular follow-up should be established upon diagnosis of the entity.

Poland's syndrome and recurrent pneumothorax: is there a connection?

AIM: To investigate the possible connection of Poland's syndrome with the presence of lung bullae and, thus, with an increased risk for recurrent pneumothorax. PATIENTS-METHODS: Two male patients, aged 19 and 21 years respectively were submitted to our department after their second incident of pneumothorax. Both had Poland's syndrome (unilaterally hypoplastic chest wall with pectoralis major muscle atrophy) and both had multiple bullae to the ipsilateral lung based on CT findings. The patients were treated operatively (bullectomy, lung apicectomy, partial parietal pleurectomy and chemical pleurodesis) due to the recurrent state of their pneumothorax. RESULTS: The patients had good results with total expansion of the affected lung. CONCLUSIONS: Poland's syndrome can be combined with ipsilateral presence of lung bullae, a common cause of pneumothorax. Whether this finding is part or a variation of the syndrome needs to be confirmed by a larger number of similar cases.

Visual disorders or "eye stroke"after heart surgery: can we prevent it?

The aim of the study was to elucidate the problem of visual disorders after heart surgery, focusing on aetiology, modes of prevention and treatment. Information from a literature search and the authors' personal experience are provide clues as to the modes of development and the means of avoidance and therapy of this category of postoperative, neurosensory complications. Multiple morbid situations, such as preoperative augmented ocular pressure, perioperative bleeding and hypotension, are shown to be predisposing and precipitating factors. Medical treatment seems to be less important than minimisation of risk factors. Prevention rather than treatment is more helpful for heart-operated patients, as far as postoperative visual disorders are concerned.