[Cost-effectiveness in the detection of influenza H1N1: clinical data versus rapid tests]. / Costo-efectividad en la detección de influenza H1N1: datos clínicos versus pruebas rápidas.

OBJECTIVE: Evaluate the performance of clinical data and the rapid influenza diagnostic test (RIDT) in diagnosing influenza H1N1, and analyze the cost-benefit of using this diagnostic tool. METHODS: The RIDT was used for patients who came to four hospitals in Mexico City with an influenza-like illness (ILI) in October and November 2009. The diagnostic performance of the ILI clinical data and the RIDT was compared to that of the real-time reverse transcription polymerase chain reaction (rRT-PCR) test. The rRT-PCR test was conducted in a reference laboratory and blinded to the results of the RIDT. An economic evaluation also was conducted to estimate the budgetary impact of using the RIDT. RESULTS: The study included 78 patients, 39 of whom tested positive for influenza H1N1 and 6 tested positive for seasonal influenza A, according to the results of the rRT-PCR. The ILI clinical data yielded a sensitivity of 96% and specificity of 21%; the RIDT yielded a sensitivity of 76% and specificity of 82%; and the ILI clinical data and RIDT together yielded a sensitivity of 96% and specificity of 100%. The positive likelihood quotient for ILI-headaches was 31.5 and that of ILI-odynophagia, 330. The use of RIDT yielded savings of US$12.6 per each suspected case. CONCLUSIONS: Use of the RIDT to aid in the diagnosis of influenza H1N1 increases certainty and lowers the average cost per suspected and infected patient.

Costo-efectividad en la detección de influenza H1N1: datos clínicos versus pruebas rápidas / Cost-effectiveness in the detection of influenza H1N1: clinical data versus rapid tests

OBJETIVO: Evaluar el desempeño de los datos clínicos y la prueba rápida (PR) en el diagnóstico de influenza H1N1, y analizar el costo-beneficio que representa el uso de esta herramienta diagnóstica. MÉTODOS: Se aplicó la PR a pacientes que acudieron a cuatro hospitales en la ciudad de México con sintomatología similar a influenza (SSI) durante el período octubre y noviembre de 2009. Se comparó el desempeño diagnóstico de la SSI más la PR contra el de la reacción en cadena de la polimerasa en transcripción reversa en tiempo real (rRT-PCR). La rRT-PCR fue procesada en un laboratorio de referencia y cegado al resultado de la PR. Además, se llevó a cabo una evaluación económica a partir de la cual se estimó el impacto presupuestal relacionado con la utilización de la PR RESULTADOS: Se incluyó a 78 pacientes, de los cuales 39 fueron positivos para influenza H1N1 y 6 para influenza A estacional, de acuerdo al resultado de la rRT-PCR. La SSI mostró una sensibilidad de 96 por ciento y una especificidad de 21 por ciento, la PR de 76 por ciento y 82 por ciento y el conjunto de SSI más PR de 96 por ciento y 100 por ciento, respectivamente. El Cociente de Verosimilitud positivo de la SSI-cefalea fue de 31,5 y el de SSI-odinofagia fue de 330. El uso de PR mostró un ahorro de US$ 12,6 por cada caso sospechoso. CONCLUSIONES: El uso de la PR como auxiliar en el diagnóstico de influenza H1N1 incrementa la certeza y reduce el costo promedio por paciente sospechoso e infectado.

OBJECTIVE: Evaluate the performance of clinical data and the rapid influenza diagnostic test (RIDT) in diagnosing influenza H1N1, and analyze the cost-benefit of using this diagnostic tool. METHODS: The RIDT was used for patients who came to four hospitals in Mexico City with an influenza-like illness (ILI) in October and November 2009. The diagnostic performance of the ILI clinical data and the RIDT was compared to that of the real-time reverse transcription polymerase chain reaction (rRT-PCR) test. The rRT-PCR test was conducted in a reference laboratory and blinded to the results of the RIDT. An economic evaluation also was conducted to estimate the budgetary impact of using the RIDT. RESULTS: The study included 78 patients, 39 of whom tested positive for influenza H1N1 and 6 tested positive for seasonal influenza A, according to the results of the rRT-PCR. The ILI clinical data yielded a sensitivity of 96 percent and specificity of 21 percent; the RIDT yielded a sensitivity of 76 percent and specificity of 82 percent; and the ILI clinical data and RIDT together yielded a sensitivity of 96 percent and specificity of 100 percent. The positive likelihood quotient for ILI-headaches was 31.5 and that of ILI-odynophagia, 330. The use of RIDT yielded savings of US$12.6 per each suspected case. CONCLUSIONS: Use of the RIDT to aid in the diagnosis of influenza H1N1 increases certainty and lowers the average cost per suspected and infected patient.

Implementation and evaluation of a low-cost telemedicine station in the remote Ecuadorian rainforest.

A clinical workstation was developed to provide basic telemedicine services in a medical clinic in rural Ecuador. The unit cost was less than $1000. The system provided videoconferencing and a Spanish language electronic medical record (EMR) for clinic consultations. All partners participated in the development of the EMR. Over a six-month period, almost all new patient encounters and ultrasound studies were entered into the EMR. Of 2387 patient encounters, 572 were recorded in electronic format and 80% were transmitted over the Internet for consultation. Four hundred and eight ultrasound studies were filed with the EMR and 90% were transmitted over the Internet for shared evaluation. During the six months of the study, there were no serious software or hardware problems. The doctor in Ecuador was initially trained at the laboratory in the USA. The two sites were in contact by email almost daily. Without such interaction, the performance of the software and hardware would probably have been worse. When a structured programme of instruction, protocols, EMR and technology support is in place, telemedicine can support remote rural practice.

Low-cost, high reliability voice control unit (VCU).

A dedicated microcomputer system has been developed to provide voice control over a wide variety of motorized devices. Employing a 8051 microprocessor with 16 kilobytes of ROM and 16 kilobytes of non-volatile RAM, the system potentially realizes an OEM cost of under $100. Other features include: a simplified user interface, a failsafe stop and voice programmable capabilities. This system has the potential to bring voice control into the marketplace in a wide variety of applications. Currently, the system has been adapted to surgical microscopes and is used in controlling several types of hospital beds.

Standard cost accounting and productivity systems--an integrated approach.

Today's hospital managers require management systems that provide better operational and financial information. The standard response to meeting this need for more sophisticated management information has been the implementation of a fragmented set of information systems products. The result of this has been that managers are getting inconsistent information on the performance of their operations. This article describes the approach taken to respond to the need for better information through the development and implementation of an integrated productivity management, cost accounting, and flexible budgeting system.