Preparation of a reference material for microplastics in water-evaluation of homogeneity.

Validation of analytical methods for measurements of microplastics (MP) is severely hampered because of a general lack of reference materials, RM. There is a great need to develop such reference materials. This study presents a concept of three-component kit with immobilised MP in solid NaCl, a surfactant and clean water that can be applied for the production of many types of MP RMs. As proof of concept, an RM for polyethylene terephthalate (PET) particles in water was prepared and evaluated for its homogeneity. The particles ranged from 30 µm (Feretmin) to about 200 µm adapted by wet sieving. A specific number of PET particles were immobilized in about 0.29 g of solid NaCl by freeze-drying 1 mL of a NaCl suspension. By using manual and automated counting, twenty reconstituted 1-L water samples were evaluated for homogeneity with respect to number of PET particles from 30 µm to > 200 µm/L of water. The number of particles was 730 ± 120 (mean ± one standard deviation (SD); n = 10) and 865 ± 155 particles (n = 10) obtained by optical microscopy in two independent laboratories. This corresponded to relative SDs of 16.4 and 17.9% and a mean of 797 ± 151 particles (18.9% RSD, for n = 20). Homogeneity studies of the NaCl carrier without reconstitution resulted in 794 ± 60 particles (7.5% RSD). The homogeneity of PET in the salt carrier was also evaluated directly with respect to mass of PET per vial using an ultra-micro balance. An average mass of 293 ± 41 µg of PET was obtained (14, % RSD for n = 14). Micrographs were recorded to demonstrate the absence of major sources of contamination of the RM components. Information about the particle size distribution and particle shapes was obtained by laser diffraction (LD) and dynamic image analysis (DIA). In addition, the identity of the PET polymer was confirmed by Raman and FT-IR spectroscopy. The RM was developed for a large-scale inter-laboratory comparison of PET particles in water (ILC). Based on the homogeneity results, the material was found to be sufficiently homogeneous to be of meaningful use in the ILC. In a 3-day process, more than 500 samples of PET particles in the NaCl carrier were prepared with good potential for further upscaling with respect to the number of vials or with other kinds of polymers. The stability of PET was not evaluated but it was deemed to be stable for the duration of the ILC.

Design and implementation of a point-of-care computerized system for drug therapy in Stockholm metropolitan health region--Bridging the gap between knowledge and practice.

INTRODUCTION: Stockholm County Council is the largest health care provider in Sweden with an annual budget of US$ 5 billion and catering the needs of a metropolitan population of 2 million people. About 10% of health care costs are used on drugs. In 1996 Stockholm County Council decided to address the main problems associated with the process and the quality of drug prescribing. METHODS: A multiyear strategy was designed, including the establishment of a strong evidence-based organisation, Drug and Therapeutics Committees and editorial resources to adapt information to the IT-media and the development of the IT-architecture. The development and implementation of computerized tools such as a physician drug order entry system including decision support, a drug information website and electronic transmission of prescriptions were started in 1996. RESULTS: The implementation was slow at the point-of-care units. It took about 6 years before the implementation process gained speed. In September 2005 almost 1000 doctors could use the decision support system for prescribing drugs and more than 70% of all prescriptions were transmitted electronically in our region. CONCLUSIONS: The work with the strategy has shown that improvements in drug use can be accomplished by providing access to simple, rapid and safe electronic tools, but the information provided has to be associated with well-recognized regional and national expert organisations.

Patient-focused urban tele-ophthalmology services.

Since 2000, routine tele-ophthalmology services have been provided by St Erik's Eye Hospital to three large urban primary care centres in Stockholm. Diagnostic support from the specialist eye hospital to primary care centres uses video slit-lamps and realtime videoconferencing. After the initial introduction period at the primary care centres, the number of teleconsultations stabilized at a very low level. Despite this, the general practitioners learned to handle more diagnostic conditions by themselves and to identify what diagnostic situations should be referred to a specialist without having to consult the specialist beforehand via telemedicine. The availability of instant eye expertise via telemedicine therefore proved to be an excellent on-the-job training tool to develop and maintain the diagnostic competence of general practitioners. Patient satisfaction was high.

New solutions for personalised health management: citizens' needs, healthcare changes, and market perspectives round table debate.

The aim with the round table was to give additional inputs and views to the specific technology oriented presentations focusing on issues dealing with the need, patients' view, the use and the business opportunities relating to wearable eHealth systems for personalised health management. Wearable eHealth systems for personalised health management are targeting citizens, patients at health risks and patients enrolled in open care or home care for monitoring, treatment or follow up. The developments so far show promises for these group categories, and in addition, could support developments in health care organisations and systems. However, the ethical issues and data privacy nature have to be seriously taken into account. The market is not yet developed, and this is the situation both in Europe and in the US. To be able to give the customers solid product information a standardised test bed for new equipment and services might speed up the market development. In the round table discussion it was highlighted that one has to differ between needs and demands. Needs are related to the prevalence of the diseases, the health risks, etc. Demands are more related to market developments and customers' willingness to pay for the new products and services. Further, technical interoperability was seen as a fundamental prerequisite for market acceptance. As wearable eHealth systems for personalised health management differ completely from traditional way of deliver healthcare, new reimbursement systems have to be developed and implemented.