The role of HE4 for prediction of recurrence in epithelial ovarian cancer patients—results from the OVCAD study

Tumor Biology - Patients with epithelial ovarian cancer (EOC) are at high risk of tumor recurrence. Human epididymis protein 4 (HE4) has been shown to be overexpressed in EOC. The primary aim of...     

Subtenonial application of triamcinolone in neovascular form of senile macular degeneration

The aim of this prospective study was to investigate the effectiveness of sub-tenon application of triamcinolone for neovascular age-related macular degeneration. The study included 38 eyes (26 patients; 14 women and 12 men, aged 63 to 82 years) with newly diagnosed subfoveal neovascular age-related macular degeneration. Each eye received sub-tenon injection of 0.5 mL suspension of triamcinolone-acetonide (20 mg of active substance). Follow up period was 12 months. After initial application, the injections were repeated on individual case, none to five times. Elevated intraocular pressure occurred in five patients (seven eyes) and was treated with topical antiglaucomatous therapy. Transient ptosis of upper eyelid occurred in one case and completely recovered in two days. The mean visual acuity was 0.13 +/- 0.17 on the beginning of the study and 0.22 +/- 0.22 at the end of the study. Visual acuity improved in 15/38 (39%) eyes, remained unchanged in 10/38 (26%) eyes, and worsened in 13/38 (35%) eyes. Improvement by three or more lines on Snellen optotype occurred in two cases. Comparing our results to those from other authors, sub-tenon application of triamcinolone did not prove as effective as when applied intravitreally, but is substantially less expensive and easier to perform.     

Bone bank at University Department of Orthopedics, Zagreb University Hospital Center, Zagreb, Croatia

AIM: Bone bank has to supply patients of our Department as well as patients from other hospitals with necessary bone grafts, but only in a case of appropriate medical indication that is evaluated by the Board of Orthopedic Surgeons. METHODS: The paper describes in detail the modalities of donor selection, explantation technique, transportation and preservation of frozen bone grafts. Also, the harvesting models and expenses of the bone bank are described. RESULTS: During the 1998-2006 period, explantation team retrieved bone grafts from 32 cadaver donors, in 10 of them bilaterally. Retrieving bone grafts from cadavers took 90 minutes and transportation 30 minutes on an average. Contamination rate of cadaveric bone grafts was 21%; all retrieved allografts were destroyed in two patients only. Bone grafts were used for reconstruction of bone defects after tumor resection, for revision hip or knee arthroplasty, spondylodesis, or corrective osteotomy. CONCLUSION: Bone bank is a service that retrieves, stores and distributes bone grafts. Appropriate documentation, control and harvesting for optimal indications provide a safe and relatively inexpensive system supplying surgeons and their patients with necessary bone stock in orthopedic surgery procedures.     

Clinical laboratory as an economic model for business performance analysis

Aim

To perform SWOT (strengths, weaknesses, opportunities, and threats) analysis of a clinical laboratory as an economic model that may be used to improve business performance of laboratories by removing weaknesses, minimizing threats, and using external opportunities and internal strengths.

Methods

Impact of possible threats to and weaknesses of the Clinical Laboratory at Našice General County Hospital business performance and use of strengths and opportunities to improve operating profit were simulated using models created on the basis of SWOT analysis results. The operating profit as a measure of profitability of the clinical laboratory was defined as total revenue minus total expenses and presented using a profit and loss account. Changes in the input parameters in the profit and loss account for 2008 were determined using opportunities and potential threats, and economic sensitivity analysis was made by using changes in the key parameters. The profit and loss account and economic sensitivity analysis were tools for quantifying the impact of changes in the revenues and expenses on the business operations of clinical laboratory.

Results

Results of simulation models showed that operational profit of €470 723 in 2008 could be reduced to only €21 542 if all possible threats became a reality and current weaknesses remained the same. Also, operational gain could be increased to €535 804 if laboratory strengths and opportunities were utilized. If both the opportunities and threats became a reality, the operational profit would decrease by €384 465.

Conclusion

The operational profit of the clinical laboratory could be significantly reduced if all threats became a reality and the current weaknesses remained the same. The operational profit could be increased by utilizing strengths and opportunities as much as possible. This type of modeling may be used to monitor business operations of any clinical laboratory and improve its financial situation by implementing changes in the next fiscal period.Increasing health care expenses and implementation of rationalization have brought about the need for a detailed computer modeling of economic business operations on which is based the analysis of health care management (1) and monitoring of spending, timing, and sources of largest or new expenses, and possible savings without changing the quality of the work performed (2).Although a hospital-based clinical laboratory is an integral part of a health care system, it may be observed as a separate unit. Quality management and good work organization aimed at achieving a continuous improvement in pre-analytical, analytical, and post-analytical phases are part of a good laboratory practice (3-5). Successful quality management in a clinical laboratory setting reduces both the need to repeat tests and raw material consumption, leading to increased business effectiveness.Analysis of business expenses of a clinical laboratory and calculation of the cost of laboratory tests under different work conditions are part of the laboratory manager’s job (6). For an overall picture of business performance, the manager has to have a detailed knowledge about revenues and expenses (7), which are used in the assessment of the financial profitability of the laboratory in general and individual laboratory tests in particular (8).Increased productivity of clinical laboratories is directly associated with the technological development of laboratory diagnosis (9) through automation, infomatization, computer networking, consolidation, and integration. Automation is a process in which laboratory analyzers carry out a large number of tests with a minimal participation of laboratory staff (10). Consolidation is a merger of laboratory and different specialties into new, separate units (eg, cytology, pathology, clinical chemistry, transfusiology, nuclear medicine, or microbiology). Integration is association of laboratories at different levels of health care system into an integrated laboratory.Implementation of laboratory information system may improve work organization, time saving, and control of the work process (11,12). In the beginning, a new technology incurs expenses because it requires financial investment to be made. Financial effectiveness of investments may be predicted by using an economic model, ie, a model of laboratory as an economic unit, and by calculating expected expenses and revenues resulting from the changes in the work of laboratory, which allows making of justifiable decisions based on the measured parameters.To develop the laboratory model as an economic unit, revenues and expenses have to be compared over a defined period of time, usually, over one year. The difference between total revenues and total expenses clearly shows whether or not the laboratory is profitable and presents a starting point for choosing the right measures to improve laboratory business operations.The aim of the study was to analyze business operations of a clinical laboratory as an economic unit. For that purpose, we used a SWOT analysis, ie, the analysis of strengths, weaknesses, opportunities, and threats, to identify the possibilities of improving laboratory business operations. Based on the SWOT analysis, it is necessary to identify and present possible calculated models of economic operations for the clinical laboratory. An economic sensitivity analysis of these business models revealed the factors influencing the profitability of clinical laboratory''s business operations. We hypothesized that comparison of these models enables decision-making for the economic benefit of a clinical laboratory.