This paper describes the technical approach in the TUFFA (Technology Procurement for Disabled in Working Life) project and a model for cooperating areas of competence based on a holistic view of the individual's abilities, the environmental conditions at the work site, and technical solutions.
Two cost calculation models were used. The "top down" model calculated an average cost of all investigations; this proved suitable for the calculation of the costs of autopsies and electron microscopical specimens. The "bottom up" model calculated the cost of an individual investigation, depending on the resources used in handling each particular specimen; it was necessary to adopt this model for specimens sent for microscopy. Information about the type of specimen and technical details were registered in a computer system. Production was registered in points and the costs were distributed between the clinical departments. The study showed that the cost of the histological specimens varied considerably depending on the material received from the clinical departments. A model using points for technical details in a department of cyto- and histopathology is suitable for calculating production and cost.
Comment In: Ugeskr Laeger. 1997 Jun 9;159(24):3798-99214058
Automated computer system for differential diagnosis and defining the indications for pathogenetic therapy is described, which was used in 2816 patients and was effective in 97% of cases. The system includes computer-regulated Lancet surgical lasers (wavelength 10.6 microns, power 60 W, frequency 0.05-1.0 Hz) and Optodan physiotherapeutic laser (wavelength 0.85 micron, power 4 W, frequency 0.08-3 kHz).
The information acquisition, decision-making and control system must be the basic tool for optimizing the information procedures in the interests of sanitary-epidemiological welfare of troops. It's necessary to make a thorough revision of the existing account and record documentation in order to study its value. Each pattern of record cards must be scientifically substantiated depending on its effectiveness for further decision making. It's necessary to exclude all futile information. Record and account procedures must be automated and computerized throughout all chains of command beginning from a single military unit. Special systems must be developed for this matter. Realization of these goals will completely assure the monitoring of health status indices of servicemen and the environmental situation, as well as monitoring of risk factors influence upon the health of personnel.
A simple functional application software has been developed to support care providers in information management related to perinatal care activities, family planning encounters and the immunization of infants. This was distributed to some sites and was implemented with no organizational change, though the methods differed. An early assessment of the software after a period of implementation is made based on the observations and experiences reported. This is presented in a framework outlined earlier as the OUST model. The systems objective to enhance the value of information was observed to have been partially achieved. The utility to the users is observed in the ability of the end-users at the sites to identify the local community needs and adopt accordingly suitable strategies. The social impact was seen in the assistance provided by the sentinel action of the system in tracking dropouts from the immunization programme at a site, thereby ensuring quality in care and also economic benefits. From a technical standpoint, the application software was small yet functional and in it were incorporated features that ensured data quality. The application software was designed to generate a unique identity code to assist in follow-up of the target population. Based on the data entered it compiled reports to meet administrative requirements, reports that gave the care providers feedback and lists to coordinate in the follow-up of the target population. The application software is a common data collection tool that can assist in building a data registry for health outcomes research.
We describe an audit system used in our Medical/Surgical Intensive Care Unit (ICU) during 1989-90. The system emphasizes the integration of data acquisition (database function) with the analysis and use of data (decision function). Resource input (human and technological) included patient demographics, diagnoses, complications, procedures, severity of illness (Apache II), therapeutic interventions (TISS), and nursing workload (GRASP and TISS). The output was assessed by survival, length of stay and ability to return home. The annual operating cost for 277 admissions (249 patients) to this ICU was $7,333. The implementation costs were $58,261 including program development and computer purchases. Non-survivors of ICU and hospital had higher Apache II scores on admission (P less than 0.0001) and longer ICU length of stay (P less than 0.05) than survivors. The nursing workload (both TISS and GRASP) on the day of admission and the last day in ICU were greater in non-survivors (P less than 0.0001) than survivors. Limitations of this audit system included the delay (6-9 mos) from ICU admission until data entry, the large number of diagnostic groups in the ICD.9.CM classification, and lack of a documented cause/effect relationship between interventions and complications. This audit system was more useful for utilization management than for quality assurance purposes.
Comment In: Can J Anaesth. 1992 Mar;39(3):210-31551150
OBJECTIVE: In 1995, a project was initiated in Trondheim, Norway, to investigate various possibilities for more frequent use of ultrasound in brain surgery. Since that time, the quality of ultrasonic images has improved considerably through technological adjustment of parameters. The objective of the present study was to explore essential clinical parameters required for the successful use of ultrasonic guidance in brain surgery. METHODS: During the study period, several surgical setups designed to optimize the use of intraoperative real-time two-dimensional ultrasonic imaging were explored. These included various positions of the ultrasound probe in relation to both the operation cavity and the lesion, as well as the position of the operation channel in relation to the gravity line. RESULTS: All lesions from the latest period (1997-2001; n = 114) were depicted well by ultrasound imaging, with the exception of two cases. High image quality and direct image guidance of the tool were maintained best throughout the operation by imaging through an intact dura and at an angle relative to a vertical operation channel. All tumor operations were performed without complications, and ultrasound imaging was found to be an important factor in the detection of remaining tumor tissue at the conclusion of surgery. For 14 low vascular tumors, the operation was guided only by ultrasound imaging. No bleeding complications occurred. A method of minimally invasive ultrasound-guided evacuation of hematomas was developed. In 19 patients, the method was found to be efficient (i.e., >90% of the hematoma was evacuated) and without complications, except for one patient who experienced rebleeding. CONCLUSION: With proper planning and surgical setup, ultrasound imaging may provide acceptable image quality for use in image-guided brain operations.
With the aid of a computer-based anaesthetic record-keeping system, all cardiac arrests during anaesthesia at the Karolinska Hospital between July 1967 and December 1984 were retrieved. There were a total of 170 cardiac arrests and 250,543 anaesthetics in the data file, which gives an incidence of 6.8 cardiac arrests per 10,000 anaesthetics. Sixty patients died, constituting a mortality of 2.4 per 10,000 anaesthetics: 42 were considered as inevitable deaths (rupture of aortic or cerebral aneurysm, multitrauma, etc.); 13 cases of cardiac arrest were considered as non-anaesthetic, i.e. complications due to surgery and other procedures. Nine of these patients died. 115 cases of cardiac arrest were considered as caused by the anaesthetic and nine of these patients died. Thus mortality caused by anaesthesia was 0.3 per 10,000 anaesthetics. The most common cause of cardiac arrest due to anaesthesia was hypoxia because of ventilatory problems (27 patients), postsuccinylcholine asystole (23 patients) and post-induction hypotension (14 patients). The highest mortality was seen when spinal or epidural anaesthetics were given to patients with impaired physical status including hypovolaemia. The incidence of cardiac arrest has declined considerably during the period studied, and this coincides with an increasing number of qualified anaesthetists employed in the department during the same period.
The possible effects of working with video display terminals (VDTs) during pregnancy on the occurrence of cardiovascular malformations in the offspring was studied in 500 cases and 1055 controls. The cases represented all registered cardiovascular malformations reported in Finland during 1982-84, excluding those with chromosomal anomaly or known genetic syndrome. The controls were randomly selected from all babies born during the same period. Both the case and control mothers were interviewed by midwives using a structured questionnaire approximately three months after delivery. In this interview the mother's occupation, job description and employer during the first trimester were noted, as were large number of other exposures to chemical and physical factors. An industrial hygienist examined all these records for information indicating exposure to VDTs, unaware of case/control status. Work with VDTs during the first trimester of pregnancy was ascertained for 30 case mothers (6.0%, 30/500) and 53 control mothers (5.0%, 53/1055). In logistic regression analysis maternal exposure to VDTs for at least 20h a week during the first trimester of pregnancy showed a point estimate of odds ratio of 1.4 with 95% confidence limits of 0.5 and 3.8, when adjusted for age and alcohol use. Maternal exposure to VDTs was not associated with indicators of fetal growth such as birthweight, placental weight or length of gestation.