Seven steps for adding value to integrated delivery systems

"Value is a spectrum of needs that you seek to fulfill," says Dean C. Coddington, senior author of Making Integrated Health Care Work. And adding value to products and services is becoming more crucial as healthcare organizations look for ways to stand out among competitors. The seven basic components of value for an integrated system, says Mr. Coddington, are improving quality of care, improving service, improving accessibility, reducing unit costs, increasing operating efficiency, strengthening customer ties and enhancing product offerings. In this issue, The Quality Letter reports on how several systems have used these seven components to increase patient and purchaser satisfaction.     

Seven steps to reduce your malpractice risk

More than ever, malpractice is one of the biggest concerns in the medical community. High premiums have caused providers to reduce services and even close shop in some areas or specialties, where premiums have increased by 100 to 200 percent. At this writing, the federal government is stymied in its efforts to provide relief. So what is a health-care organization to do? This article presents seven steps that may not lower premiums, but will help an organization decrease the likelihood of being entangled in a long, drawn-out lawsuit that has little or no medical basis.     

骨科植入器械国内外标准比较分析

通过对比分析骨科植入器械的ISO、ASTM和国内标准．得出以下结论：国内标准在材料、尺寸、分类与国际标准基本接轨;在植入器械疲劳性能、匹配性能．磨损性能存在较大差距。并提出了一些建设性建议。     

Pre-coated orthopedic implants with bone cement.

A study on the feasibility of implants pre-coated with an acrylic bone cement has been performed. Four types of implants, an actual canine femoral prosthesis, a polished steel rod (0.49 cm dia. x 13 cm long) with and without pre-coating, and a sandblasted steel rod with pre-coating were implanted into canine femurs in vitro and in vivo to evaluate the interfacial shear strengths in addition to the bench test. After serial sectioning the samples in discs, push-out tests were made to evaluate the interfacial strengths of cement-bone-implant. The weakest interfacial shear strength was exhibited by the polished rod/cement interface (0.5 MPa) while the strongest was the "old" and "new" cement interface (23.4 MPa). The bone/cement interfacial strength was in between for in vitro (1.17 MPa) and in vivo (1.68 MPa). The shear strength of rod/cement interface increased substantially by sandblasting (6.84 MPa). The microscopic observation of the interface showed somewhat smaller gaps developed for the pre-coated rod than the uncoated rod due to the shrinkage effect. In addition to the overall increase in interfacial strength, the pre-coating may furthermore reduce the setting temperature, the shrinkage, and the amount of monomer released during operation due to the reduced amount of cement at the time of implantation. The more gradual transmission of load from implant to bone and "auto-centering" of implants during operation by pre-coating, are believed to be advantageous over conventional cement fixation method.     

Porous polysulfone as an attachment vehicle for orthopedic and dental implants.

The mechanical properties of porous polysulfone (PSF) were determined and its performance as a surface coating on orthopedic and dental implants evaluated. Ten coated femoral prostheses were implanted in nine dogs. A second series of four uncoated "control" prostheses and all of the acetabular cups were implanted using conventional bone cement techniques. Six porous PSF coated tooth roots were implanted in healed mandibular premolar extraction sites in three Rhesus monkeys. The shear strength of porous PSF (6 MPa) was comparable to that of trabecular bone. Pushout tests of 1cm. thick sections of the prostheses yielded interfacial shear strength values over 1.4 MPa for the PSF coated hips after 14 weeks and mean values under 0.7 MPa for the bone cemented specimens after 3 and 36 weeks. Bone and fibrous tissue was identified in the pores of coated specimens. Preliminary clinical evaluation of the functioning dental implants revealed zero mobility and other favorable clinical and radiographic indications after 2 months.