Treatment data from practices and specialization centers, especially in the increasingly specialized areas which university clinics do not cover, are very important for evaluating the effectiveness and efficiency of dental examination and treatment methods. In the case of paper-based documentation, the evaluation of these data usually fails because of the cost it entails. With the use of electronic medical records, this expense can be markedly lower, provided the data acquisition and storage is structured accordingly. Since access to sensitive person-related data is simplified considerably by this method, such health data are protected, especially on the European level. Other than generally assumed, this protection is not restricted solely to the confidentiality principle, but also comprises the power of disposition over the data (data protection). The result is that from a legal point of view, the treatment data cannot be readily used for scientific studies, not even by dentists and physicians who have collected the data legally during the course of their therapeutic work. The technical separation of treatment data from the personal data offers a legally acceptable solution to this problem. It must ensure that a later assignment to individual persons will not be feasible at a realistic expense (effective anonymization). This article describes the legal and information technology principles and their practical implementation, as illustrated by the concept of a respective compliant IT architecture for the dentaConcept CMD fact diagnostic software. Here, a special export function automatically separates the anonymized treatment data and thus facilitates multicentric studies within an institution and among dental practices.
This article provides a structural outline of the many basic elements needing to be considered when institutions are developing a system for review of incidents that may fall below the applicable standard of care. Details for program development need to be explored and implemented with the mindset that the process will be modified and continuously improved over time. Protecting the interest of the individual licensee, the healthcare institution and the public are important aspects that demand attention when complying with the Kansas Risk Management Laws as they pertain to nursing practice.
In Response: The appropriate model to analyze costs should be based on a particular study's needs. We chose a linear model because, as in many other institutions, our magnetic resonance imaging (MRI) unit is located in a separate building requiring a separate postanesthesia care unit (PACU) that is designated only for children recovering from MRI. As a result, the nurse involved in the recovery of these patients cares only for one child at the time. If one group of nurses staffs all the PACUs including the MRI PACU, then the savings in nursing time in the MRI PACU can be directly translated into working hours in other PACUs. Zeev N. Kain, MD* dagger Dorothy J. Gaal, MD* Tatiana S. Kain, MD double dagger David D. Jaeger, MD* Stephen Rimar, MD* dagger Departments of *Anesthesiology, dagger Pediatrics, and double dagger Diagnostic Radiology, Yale University School of Medicine, New Haven, CT 06520
In Response: The appropriate model to analyze costs should be based on a particular study's needs. We chose a linear model because, as in many other institutions, our magnetic resonance imaging (MRI) unit is located in a separate building requiring a separate postanesthesia care unit (PACU) that is designated only for children recovering from MRI. As a result, the nurse involved in the recovery of these patients cares only for one child at the time. If one group of nurses staffs all the PACUs including the MRI PACU, then the savings in nursing time in the MRI PACU can be directly translated into working hours in other PACUs. Zeev N. Kain, MD* dagger Dorothy J. Gaal, MD* Tatiana S. Kain, MD double dagger David D. Jaeger, MD* Stephen Rimar, MD* dagger Departments of *Anesthesiology, dagger Pediatrics, and double dagger Diagnostic Radiology, Yale University School of Medicine, New Haven, CT 06520
Intravenous (IV) propofol was compared with IV thiopental/pentobarbital as a sedative for children undergoing magnetic resonance imaging (MRI) of the brain or spine. Fifty-eight outpatients (aged 11 mo to 6 1/2 yr, ASA grade I and II) were enrolled in the study and randomized to two groups. After IV cannulation, Group I received IV propofol (1-2 mg/kg), followed immediately by a propofol infusion (75-100 micrograms.kg-1.min-1). Group II received IV thiopental (1-3 mg/kg) followed by a pentobarbital bolus (2-3 mg/kg). Supplemental thiopental doses (1-2 mg/kg) were administrated to maintain adequate sedation. Discharge time and postanesthesia recovery scores were determined by an independent blinded observer. Time of recovery to full consciousness in Group I was significantly less than in Group II (19 +/- 7 min vs 35 +/- 20; P < 0.005). Time to discharge was also significantly less in Group I (24 +/- 6 min vs 40 +/- 11; P < 0.05). A preliminary cost analysis was applied to the clinical data obtained and to a theoretical model of a pediatric MRI center. Cost analysis of anesthesia services revealed added drug costs ($1600.76 per year for the propofol group) but significant savings of postanesthesia care unit (PACU) nursing time ($5086.67 per year). Outcomes such as patient morbidity and technical quality of the MRI scans did not differ significantly between the two groups. In conclusion, analysis of the clinical data suggests that propofol may be more suitable than barbiturates for children undergoing outpatient procedures despite its higher price.
We evaluated our experience with 846 consecutive transesophageal echocardiography (TEE) intraoperative monitoring procedures performed between November 1989 and July 1991. TEE frequency was 36 +/- 11 per month (range 16-55) and represented 69.8% of cardiac valve surgery cases, 40.2% of coronary artery bypass graft cases, and 2.2% of total operative caseload. Major patient complications consisted of transient vocal cord paresis and ingestion of glutaraldehyde-disinfectant solution. Minor complications consisted of a chipped tooth (one case) and pharyngeal abrasions (three cases). The Quality Assurance (Q/A) Program evaluated both record keeping and quality of imaging, as judged by cardiologist echocardiographer reviewers. The percentage of completion for each Q/A indicator was as follows: medical record documentation, 88%; database form annotation, 94%; and provision of videotape recording, 91%. TEE database forms were analyzed further in terms of the percentage of fields completed. Completion scores were 73%. The following scoring system was utilized for videotape evaluation by the cardiologists: 1 = excellent; 2 = good; 3 = poor. The median grade for both two-dimensional echocardiography and color flow Doppler (CFD) examinations was 2. Poor quality images (grade 3) were present in 15.2% of two-dimensional echocardiography and 20.3% of color flow Doppler examinations, and disproportionately associated with 4/26 attendings. Supplemental audit of the cardiology reviewers performance demonstrated 569/846 videotapes showed no objective evidence of review. The cardiology reviewer forms of the remaining 277 videotapes were evaluated in terms of the percentage of fields completed. The completion score was 56%. These data suggest the need for formal Q/A for intraoperative TEE, both for anesthesiologists and reviewing cardiologists.
