Organization of laboratories in the German Democratic Republic

The effectivity of the clinical medicine becomes increasingly dependent on the efficiency of medico-experimental subjects, to which belong pathological chemistry and clinical biochemistry as well as haematology. The scientifically proved increasing demands made on the laboratories concern the quality of the results of investigations, constantly increasing numbers of investigations as well as a considerable enlargement of the investigation programmes. Adequate developments of workman are not to be expected. The requirements are to be met by the increase of the working productivity, for which a good organisation of work the use of mechanisation and automatisation means for the elaboration of large series of investigations are the prerequisite. A high degree of centralisation ascertains the effectivity of the adequate investments. Exceeding the ascertained foundations for a project of organisation of the laboratory work in the GDR in the next time still various problems must be solved which especially influence the organisation. Among others they concern the necessary investigation programme for the general practitioner in an out-patient practice, moreover the establishment of investigation programmes for several levels of care, the necessary quality (precision and exactness) of the results of investigations, the suitableness of stripe tests and the influence of preanalytic factors and especially of the biorhythmics on the findings of investigations. The tendencies described are accompanied by the danger that the reciprocities between clinic and laboratory becoming increasingly more necessary for the interpretation and classification of laboratory findings into the symptom complex become rather loose. Therefore, it will be one of the most important tasks of future to develop together reorganisation and collaboration.     

Preventive administration of ornithine alpha-ketoglutarate improves intestinal mucosal repair after transient ischemia in rats

Introduction; Healthcare professionals need to continually update their knowledge to provide care based on scientific evidence. In some cases it can be difficult to gain access to the different sources of medical information. In an attempt to overcome these problems, a toll-free telephone medical information service (Doctorline) was established. OBJECTIVE: To describe the development, aims, organization, and activities of this private service. METHODS: Doctorline is an independent, unbiased, toll-free medical information service that provides information on clinical, pharmacologic, and toxicologic issues; bibliographic searches; full-text articles; public and private clinics; details of forthcoming congresses; and legislative documentation. The service is available Monday through Friday, 1000 to 2000. Staff members are physicians trained in communication techniques, literature evaluation methodologies, and computerized database use. The main on-line facilities are MEDLINE, Micromedex-CCIS, and the Italian Formulary on CD-ROM. Books, bulletins, national and international drug formularies, and property files (i.e., directory of Italian public and private clinics) are also available. RESULTS: In 5 years, Doctorline has received 65 258 calls. Nearly 34% of the calls were made by general practitioners, followed by cardiologists (22%), orthopedists (15%), pharmacists (14%), gastroenterologists (13%), and urologists (10%). From 1991 to 1996, nearly 20% of the calls concerned pharmacologic issues, 43% nonpharmacologic issues, while the rest of the calls were for nonclinical requests. Approximately 21% of all questions received an answer during the same phone call (on-line answers); for the other answers (off-line answers) the mean +/- SD waiting time was 7.8 +/- 10.4 days. Although the nature of the questions has been recorded since 1991, data about the exact number of physicians who used the service are available only from 1994. Data from 1994 indicate that of the 52,181 physicians who could access the service, only 8817 (16.9%) called at least once, with a mean number of calls per physician of 3.9 (range 3.0-5.6). CONCLUSIONS: The future of Doctorline will depend on the quality and validity of the information provided (i.e., based exclusively on scientific evidence, independent of the source of funds), the promotion of the aims, organization, and clinical utility of the service (especially among physicians who made little or no use of the service), and differentiation of the service activities in relation to the physician's specific needs.     

The LabBase system for data management in large scale biology research laboratories

MOTIVATION: The development of laboratory information management systems (LIMSs) for large scale biology research projects can be a challenging problem. Many such projects generate complex datasets via complex procedures that undergo continuous refinement. A key software challenge is to simplify the database-development task so that databases can be built and modified quickly enough to keep pace with changing project-requirements. Results: LabBase extends the facilities offered by relational database systems to simplify the task of creating databases for large scale biology research projects. LabBase provides a structural object data model, similar to ACEDB, and adds to this the concepts of Materials, Steps, and States: Materials are objects representing the identifiable things that participate in a laboratory protocol; Steps are objects reporting the results of a laboratory or analytical procedure; and States are objects denoting places in a laboratory protocol. The system provides a data definition language for succinctly defining laboratory databases, and operations for conveniently storing and retrieving data in such databases. The system also provides support for workflow management. LabBase is implemented in Perl5 and provides a natural interface for laboratory application programs written in Perl. AVAILABILITY: The software is freely available. Contact the authors. CONTACT: nat@jax.org     

First intercalibration test of diffractometric measurements of asbestos in National Italian laboratories

The Ministry of Health established by law (D.M. 14/5/96) minimum requirements for laboratories intending to perform asbestos analyses, and identified the central facilities that are to coordinate the future quality control programme (based on the kind of techniques used), to which the laboratories must refer in order to continue to operate in the "asbestos" field. Before initiating the quality control programme for the gravimetric technique based on X-ray diffraction measurement, the central facilities decided to carry out a pilot test in a group of sample laboratories in order to assess the current situation in Italy and identify the main problems involved in implementing the programme. In fact, up to the present, no standardized method for the diffractometric measurement of asbestos exists in Italy, so that the various laboratories use different procedures and reference standards. In the pilot test, a group of 15 national laboratories with proven experience performed diffractometric measurements on 3 samples each containing one of the 3 commercial forms of asbestos (chrysotile, crocidolite and amosite). Besides the final result consisting of the percentage by weight compared to the whole sample, information was requested on the measurement procedure and on the reference standards used. The results, although they do not permit definite conclusions to be drawn due to their small number, do provide information that will be of relevance to the organisation of the future quality control programme. Analysis of the data appear to show that neither the measurement procedure used nor the type of asbestos influence the accuracy of the results. The main source of variability and of deviation from the true values seemed instead to depend on the type of standards used and on compatibility, in terms of particle size and comminution technique, between these standards and the samples analyzed.     

Comparison of public/private health care insurance parameters for independent psychological practice.

Managed care cost-cutting strategies are more prevalent in the private (employer provided) than public (Medicare/Medicaid) health care sectors. The main organizational managed care strategy pertaining to the independent practice of psychology has been the separation of the administration of mental from medical health care though behavioral health carve-outs. These organizations typically offer lower reimbursement rates and have greater preauthorization requirements than non-managed care public plans for the same psychological service. Dispute resolution in the private sector involves lawsuits and state consumer protection programs while public plans utilize internal review and are subject to investigations of provider billing fraud and abuse. Behavioral health carve-outs have reduced mental health care utilization rates with unknown effects upon outcome. There is some evidence that psychologists have chosen to limit practice within the private sector, but national data on the overall effect is lacking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Olfactory Receptor Database: a database of the largest eukaryotic gene family

The Olfactory Receptor Database (ORDB) is a WWW-accessible database that stores data on Olfactory Receptor-like molecules (ORs) and has been open to the public since June 1996. It contains a public and a private area. The public area includes published DNA and protein sequence data for ORs, links to OR models and data on their expression, chromosomal localization and source organism, as well as (i) links to bibliography through PubMed and (ii) interactive WWW-based tools, such as BLAST homology searching. The private area functions as a service to laboratories that are actively cloning receptors. Source laboratories enter the sequences of the receptor clones they have characterized to the private database and can search for identical or near identical OR sequences in both public and private databases. If another laboratory has cloned and deposited an identical or closely matching sequence there are means for communication between the laboratories to help avoid duplication of work. ORDB is available via the WWW at http://crepe.med.yale.edu/ORDB/HTML     

Surveillance for the emergence and dissemination of antimicrobial resistance in bacteria

Effective surveillance of antimicrobial-resistant bacteria is important for developing rational empiric therapy guidelines and for guiding public health efforts to control and prevent the spread of infective agents. Surveillance must include a timely and thorough review of the test results generated in clinical microbiology laboratories because this data serves as the core of surveillance activities. Besides ensuring data accuracy and optimizing detection of emerging resistance, the role of clinical microbiology also includes supporting the production of informative surveillance reports, providing laboratory resources for outbreak investigations, and monitoring the performance of commonly used susceptibility testing methods. Once the accuracy of susceptibility results has been validated, the data are used by public health agencies and professional societies to monitor resistance trends on a local, state, national, and international level. This information is also used to develop policies for prudent antimicrobial use locally and nationally.     

Evaluation of acceleration plethysmograms in dermatology--efficacy of lipo PGE1 preparations against herpes zoster and neuralgia following herpes

Utilisation of outpatient services in government owned district hospitals in Dar es Salaam, declined by more than 50% following the introduction of user charges in these health facilities in mid July 1993. Outpatient attendances in the private health facilities studied remained constant throughout the year although these charged higher fees. Education and employment status were found to be major factors influencing utilisation of public versus private health facilities. Public facility users (62.8%) had five to eight years of formal education. Private facility users with five to eight years of education were 45.5% and those with more than years of education were 47.1%. While 68.6% of public facility users paid for their own healthcare, more than a quarter (27.3%) had their costs met by relatives or friends. The employer paid for 72% of private facility users, 49.2% of whom stated that this was the reason why they used private facilities. Despite introduction of charges in public hospitals, availability of prescribed medication was poor. Drugs were reported to be always available by only 27.3% of public health facility users compared to 80% of private health facility users.     

St Jude Children's Research Hospital's International Outreach Program

Over 80% of children with cancer live in developing countries, where access to medical services is limited to varying degrees. In many of these countries, economic conditions and general health care have improved sufficiently to permit the development of more sophisticated medical services. The introduction of pediatric oncology programs becomes appropriate as deaths from malnutrition and infections decrease and cancer emerges as an important cause of childhood mortality. In the absence of such services, the worldwide war against pediatric cancer will ultimately be lost because of the rapidly growing pediatric populations in developing countries that now lack the facilities and expertise to treat childhood malignancies. We believe that the development of pediatric cancer centers in many of these countries is both appropriate and feasible. Partnerships in which established pediatric oncology centers work with the governments and private sectors of developing nations to implement key facilities are an efficient and cost-effective way to introduce such services. The challenges of these outreach efforts are significant -- as are the expected benefits.     

Disclosing of verbal material as a function of information requested, information about the interviewer, and interviewee differences.

Describes an experiment with 64 undergraduate males, differing in reported histories of self-disclosure and assessed level of need approval as measured by the self-disclosure questionnaire and the marlowe-crowne social desirability scale. Ss were given personal vs. Impersonal information by and about e at the outset of an interview, and were subsequently requested to disclose their attitudes, feelings, and experiences about public and private topics. Approval-dependent ss for the most part were not more defensive than low-need-approval ss, either in response to interviewer information models or types of topics. As expected, public topics elicited less guardedness and greater self-disclosure than private aspects of self. Contrary to expectations, low self-disclosers were most disclosing when presented with personal information about the interviewer, and more so than ss reporting high disclosure histories. Results are discussed in terms of viewing dyadic informational exchange from an interpersonal risk framework. (25 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

User's requests (from a practitioner's perspective)

As a practitioner, I have to rely on outside clinical laboratories and affiliated hospitals to perform laboratory tests. In this abstract, I describe specific problems I have encountered with third-party laboratories, and propose solutions for these problems to optimize use of laboratory tests. BLOOD TESTS: The most frequent problem in ordering blood tests is the lack of detailed information regarding sampling conditions. I often have to call laboratories to check whether the sample should be serum or plasma, what volume is needed, whether the sample should be cooled, etc. I propose that clinical laboratories should provide practitioners' manuals that describe specific sampling information. ULTRASONOGRAPHY: Most laboratories do not keep the data from ultrasonographic tests. The lack of these is most problematic when test results are interpreted differently by laboratories and by practitioners. Retaining the data would also help private laboratories improve the quality of the test by enabling them to compare their interpretations with others'. ANNUAL MEDICAL SCREENING: Even if an abnormal finding is detected at medical screening clinics, the final diagnosis is usually not sent back to the screening facilities. This is highly recommended to establish an official system that mediates the feedback to screening centers. MRI: Due to miscommunication between practitioners and radiologists, the test is sometimes performed inappropriately. A thorough consultation should occur before the test to clarify specific goals for each patient. PATHOLOGICAL TESTS: Interpretation of results is often inconsistent among laboratories. Independent clinical laboratories tend to report results without indicating sample problems, while pathology departments at affiliated hospitals tend to emphasize sample problems instead of diagnosis or suggesting ways to improve sample quality. Mutual communication among laboratories would help standardize the quality of pathological tests.     

Academia and the training of human service delivery program evaluators.

Many think the demand for high-quality evaluation personnel has reached the point where universities should consider the development of program evaluation curricula. Although much of this article focuses on the training of evaluators for the mental health service delivery system, the suggestions made are applicable to the training of evaluation specialists who will function in a variety of public and private human service settings. Among the several issues considered are the body of knowledge to be taught in program evaluation curricula, the specific concepts and skills needed by the evaluator to function effectively, and whether training should be structured as an interdepartmental or intradepartmental specialty. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Collaboration between a state psychological association and a labor union for public-sector hospital privileges.

Until this year, laws concerning medical staff membership for psychologists were permissive in California. These laws also were applied differently in the public and private sectors. Psychologists practicing in state-run facilities were systematically excluded from membership, while their counterparts in private practice often were granted access. In the middle 1980s, public service psychologists began using organized labor to gain entry to medical staff in state-run facilities. When collective bargaining failed, some psychologists left organized labor and began working within the California Psychological Association to seek legislative recourse. The legislative route was ultimately successful but only after support was garnered from labor as well. The California experience shows that state psychological associations are vehicles to advance psychology in the public sector and that support from organized labor can be critical. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Surveillance of tuberculosis in Europe. Working Group of the World Health Organization (WHO) and the European Region of the International Union Against Tuberculosis and Lung Disease (IUATLD) for uniform reporting on tuberculosis cases

Consensus-based recommendations have been developed by a Working Group of the World Health Organization (WHO) and the European Region of the International Union Against Tuberculosis and Lung Disease (IUATLD) on uniform reporting of tuberculosis surveillance data in the countries of Europe. A uniform case definition and a minimum set of variables for reporting on each case have been agreed which, when collated on a national basis, will allow comparison of the epidemiology of tuberculosis in different European countries. The Working Group recommends that the case definition includes "definite" cases, where the diagnosis has been confirmed by culture (or supported by microscopy findings in countries where diagnostic culture facilities are not available), and "other than definite cases" based on a clinical diagnosis of tuberculosis combined with the intention to treat with a full course of antituberculosis therapy. Both "definite" and "other than definite" cases should be notified by physicians and, in addition, laboratories should be required to report "definite" cases. The minimum set of variables to be collected on each case of tuberculosis should include: date of starting treatment, place of residence, date of birth, gender, and country of origin, to characterize the patient. Recommended disease-specific variables include: site of disease, bacteriological status (microscopy and culture), and history of previous antituberculosis chemotherapy. The minimum set of variables should be collated on all patients and should be as complete as possible. Additional variables may be collected for individual, local or national purposes, but, in general, completeness of reporting on cases is likely to be better if the information requested is kept to a minimum. Timely reporting of cases is essential for appropriate public health action. Cases should be reported to the health authority at the local and/or regional level within 1 week of starting treatment. Individual-case based information should be reported to the national level by the local or regional level. Feedback to reporters is essential. At the national level, preliminary quarterly reports should be produced and final reports should be published annually.     

Potential contribution of therapy to cancer mortality reduction

Reductions in cancer mortality may come about for a number of reasons, including improvements in treatment. The impact will vary from cancer to cancer. For some, expert curative surgery is crucial, whereas for others, the use of appropriate chemotherapy is a key factor. Examples of the latter, in which there are already discernible reductions in national cancer mortality data resulting from chemotherapy, include testicular cancer and Hodgkin's disease. For more common diseases, such as ovarian cancer, reductions also are being seen. For others, such as breast and colorectal cancer, the current more widespread use of adjuvant chemotherapy may lead to overall mortality reduction in the future. It should be recognized that chemotherapy should be given only by those experienced in its use, and that this facility should form part of a larger provision for health care in relation to cancer, ranging from public education to population screening and from better oncology training for clinicians to greater encouragement to participation in clinical trials. New drug development is clearly a priority, but further advances can be made in many countries already using available forms of chemotherapy if treatment facilities are organized appropriately.     

Two routes to privacy protection: a comparison of health information legislation in Canada and the United States

The privacy of health information is a subject of great sensitivity in both Canada and the United States. As a result of public demands for more effective protection of such information as medical records, Canada and, particularly, its provincial governments, have implemented extensive legislation. The United States, on the other hand, has largely confined its efforts to private sector initiatives that are more reflective of voluntary codes than legal statutes. Because new technologic developments facilitate data sharing in the medical field, especially in the face of a continual reduction of healthcare budgets, the concern for privacy protection in this domain has intensified. Correspondingly, there has been a gradual theoretical shift in protective health information policies on both sides of the border. As Canada pushes to extend its federal and provincial legislation to the private sector, the United States is on the brink of approving a national bill that would protect the privacy of personal medical records. It is becoming evident that efforts to secure the privacy of health information in both countries are converging.     

Privatization and the mental health system: A private sector view.

Privatization has received significant attention in the popular and professional press. The notion has gained increasing political acceptance with the private sector being seen as cost-effective, innovative, and responsive. Private mental health initiatives will grow because the private sector is seen as an efficient allocator of resources and because there are profit opportunities in traditionally public services. However, a partnership between the private and public sectors will be required in planning and development, serving difficult groups, and defining and measuring quality of care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spending-down to Medicaid in the nursing home and in the community. A longitudinal study from Monroe County, New York

Medicaid spend-down continues to be of considerable interest in public policy discussions regarding long-term care financing reforms. Yet, "measuring" of spend-down has been difficult because of data limitations. This study focuses on patterns of spend-down affecting those who become Medicaid eligible both in nursing homes and in the community. The study uses a longitudinal, person-specific, merged Medicare and Medicaid claims and eligibility file constructed for Monroe County, New York. The analyses show that 27% of those who enter nursing homes as private pay can be expected to spend-down to Medicaid while in a nursing home. The spend-downers remain in nursing homes for a prolonged time, with 63% staying for more than 3 years. On admission, spend-downers appear somewhat more likely than those who remained private pay or Medicaid throughout to have been less disabled in terms of activities of daily living (ADL). The community-based spend-down group is larger, younger, and more heavily represented by those who are poor or marginally poor, than the nursing home-based spend-down population. Their spend-down to Medicaid appears to have been triggered principally by the cost of acute medical care not covered by Medicare or another third-party payer. It is this population of the elderly that would have been the principal beneficiary of the short-lived 1989 Medicare Catastrophic Coverage Act. The results of this study indicate that neither the existing private long-term care insurance policies nor the currently circulating public coverage proposals alone are sufficient to protect older persons, at risk of spend-down to Medicaid, from impoverishment. Effective long-term care financing reform will need to create partnerships between public and private insurance, rather than look at them as competing options.     

The future of the national laboratories

The end of the Cold War has called into question the activities of the national laboratories and, more generally, the level of support now given to federal intramural research in the United States. This paper seeks to analyze the potential role of the laboratories, with particular attention to the possibility, on the one hand, of integrating private technology development into the laboratory's menu of activities and, on the other hand, of outsourcing traditional mission activities. We review the economic efficiency arguments for intramural research and the political conditions that are likely to constrain the activities of the laboratories, and analyze the early history of programs intended to promote new technology via cooperative agreements between the laboratories and private industry. Our analysis suggests that the laboratories are likely to shrink considerably in size, and that the federal government faces a significant problem in deciding how to organize a downsizing of the federal research establishment.     

3D automatic expansion: clinical application

Although the total number of active private dentists increased by 21.7 percent between 1982 and 1995, the number of active private part-time dentists increased by 104 percent, while the number of active private full-time dentists increased by 8 percent. Thus, the total number of hours active private dentists spent in the office has not increased to the same extent as the number of active private dentists. During the same period, however, the average number of hours spent treating patients increased, indicating that dentists are becoming more efficient in directing their office hours toward clinical dentistry. The distribution of active private part-and full-time dentists and the actual number of hours they spent in the dental office and spent treating patients provide a more complete picture of the capacity of the dental care delivery system than only looking at the increase in the total number of dentists.