Costing electronic private sector malaria surveillance in the Greater Mekong Subregion.

BACKGROUND: Private sector malaria programmes contribute to government-led malaria elimination strategies in Cambodia, Lao PDR, and Myanmar by increasing access to quality malaria services and surveillance data. However, reporting from private sector providers remains suboptimal in many settings. To support surveillance strengthening for elimination, a key programme strategy is to introduce electronic surveillance tools and systems to integrate private sector data with national systems, and enhance the use of data for decision-making. During 2013-2017, an electronic surveillance system based on open source software, District Health Information System 2 (DHIS2), was implemented as part of a private sector malaria case management and surveillance programme. The electronic surveillance system covered 16,000 private providers in Myanmar (electronic reporting conducted by 200 field officers with tablets), 710 in Cambodia (585 providers reporting through mobile app), and 432 in Laos (250 providers reporting through mobile app). METHODS: The purpose of the study was to document the costs of introducing electronic surveillance systems and mobile reporting solutions in Cambodia, Lao PDR, and Myanmar, comparing the cost in different operational settings, the cost of introduction and maintenance over time, and assessing the affordability and financial sustainability of electronic surveillance. The data collection methods included extracting data from PSI's financial and operational records, collecting data on prices and quantities of resources used, and interviewing key informants in each setting. The costing study used an ingredients-based approach and estimated both financial and economic costs. RESULTS: Annual economic costs of electronic surveillance systems were $152,805 in Laos, $263,224 in Cambodia, and $1,310,912 in Myanmar. The annual economic cost per private provider surveilled was $82 in Myanmar, $371 in Cambodia, and $354 in Laos. Cost drivers varied depending on operational settings and number of private sector outlets covered in each country; whether purchased or personal mobile devices were used; and whether electronic (mobile) reporting was introduced at provider level or among field officers who support multiple providers for case reporting. CONCLUSION: The study found that electronic surveillance comprises about 0.5-1.5% of national malaria strategic plan cost and 7-21% of surveillance budgets and deemed to be affordable and financially sustainable.

Assessment of the maintenance costs of electro-medical equipment in Spanish hospitals.

OBJECTIVES: Electro-medical equipment generates a high impact on the sustainability of a hospital and require high availability at a reasonable maintenance cost. The aim of this paper is to analyze the sustainability and performance of the maintenance of electro-medical equipment, through several healthcare variables (hospital admissions, surgeries, consultations, etc.), infrastructure variables (surface area, number of beds, number of operating theaters, etc.), human resources and the acquisition value of the equipment, relating them to the labor, materials and total and operative maintenance costs. METHODS: 4,586 electro-medical equipments were analyzed (grouped into 16 categories) installed in 12 Spanish hospitals of between 20 and 200 beds during the 2016-2018 period. RESULTS: The results show that the maintenance costs of electro-medical equipment correlate with the number of beds and operating theaters, nursing staff, equipment acquisition value, number of admissions, surgeries and the total length of hospital stay. CONCLUSION: Different equations are proposed to estimate maintenance costs based on the variables studied. They include indicators that give an overall view of maintenance operations.

Costs of hypothalamic stimulation in chronic drug-resistant cluster headache: preliminary data.

In about 20% of chronic cluster headache (CH) cases, drugs may become ineffective. Under these circumstances, steroids and triptans are frequently employed leading to fearful side effects in one and high costs in the other. The direct costs of drug-resistant chronic CH are mainly due to frequent medical consultations and frequent use of expensive drugs. In recent years, hypothalamic stimulation has been employed to treat drug-resistant chronic CH patients suffering multiple daily attacks and long-term results from different centres show a 60% overall benefit. Nine years since the introduction of this technique, we attempt a preliminary analysis of the direct costs of hypothalamic stimulation based on patients treated at our centre. We estimated the following direct costs as follows: cost of neurosurgery plus cost of equipment (electrode, connection and impulse generator = 25,000 euro), cost of hospital admissions in long-term follow-up (2,000 euro per admission), cost of single sumatriptan injection (25 euro). Number of daily sumatriptan injections in the year before and for each year after hypothalamic implantation was obtained from headache diaries. To estimate the saving due to the reduction in sumatriptan consumption following hypothalamic stimulation, we calculated the following for each year of follow-up after surgery: number of sumatriptan injections in the year before surgery minus number of sumatriptan injections in each year, updated to December 2008. In our 19 implanted patients, the costs of neurosurgery plus cost of equipment were 475,000 euro; the costs of hospital admissions during follow up were 250,000 euro. Reduction in sumatriptan consumption resulted in a total saving of 3,573,125 euro. Hence, in our 19 patients, the sumatriptan saving (3,573,125 euro) minus the direct costs due to operation and follow up hospitalisations (475,000 + 250,000) euro is equal to 2,848,125 euro. These preliminary results indicate that hypothalamic stimulation is associated with marked reduction of direct costs in the management of complete drug-resistant chronic CH.

New and low-cost auto-algometry for screening hypertension-associated hypoalgesia.

OBJECTIVE: The aim of the present work was to measure the pain threshold in hypertensive patients with a new auto-algometry method. DESIGN AND SETTING: Auto-algometry consists of asking the subjects to push their fingers against a fixed round-tip needle until they feel a pain sensation. An electronic force transducer permits the measurement of the force applied by the subjects and storage of the data on a personal computer. Eight tests are performed twice on each subject on the tip and back of four fingers. For each test, the maximal applied force (grams) is defined as pain threshold. The overall discomfort during the entire procedure is reported by the subjects on a 0 (no discomfort) to 10 (intolerable pain) scale. PATIENTS AND INTERVENTIONS: A group of hypertensive patients (n = 22) and a group of normotensive subjects (n = 22) underwent the auto-algometry examination. RESULTS: The pain threshold was higher in hypertensive patients compared with normotensive subjects. All discomfort scores referred by the subjects fell within the 4-6 range. CONCLUSION: The data obtained from this study indicate that the auto-algometer as described here can detect hypoalgesia associated with hypertension.

A professional and cost effective digital video editing and image storage system for the operating room.

We propose an easy-to-construct digital video editing system ideal to produce video documentation and still images. A digital video editing system applicable to many video sources in the operating room is described in detail. The proposed system has proved easy to use and permits one to obtain videography quickly and easily. Mixing different streams of video input from all the devices in use in the operating room, the application of filters and effects produces a final, professional end-product. Recording on a DVD provides an inexpensive, portable and easy-to-use medium to store or re-edit or tape at a later time. From stored videography it is easy to extract high-quality, still images useful for teaching, presentations and publications. In conclusion digital videography and still photography can easily be recorded by the proposed system, producing high-quality video recording. The use of firewire ports provides good compatibility with next-generation hardware and software. The high standard of quality makes the proposed system one of the lowest priced products available today.

Biosensor commercialization strategy - a theoretical approach.

Biosensors are analytical devices, which use biological interactions to provide either qualitative or quantitative results. They are extensively employed in many fields such as clinical diagnosis and biomedicine, military applications, anti-terrorism, farm, garden and veterinary analysis, process control, fermentation control and analysis, pharmaceutical and drug analysis, food and drink production and analysis, pollution control and monitoring, microbiology, bacterial and viral analysis, mining, and industrial and toxic gases. The biosensor market has significantly increased and will be mushrooming in the next decade. The total biosensor market is estimated to be 10.8 billion dollars by 2007. The emerging biosensor market presents both opportunities and obstacles to start-up biosensor entrepreneurs. The major challenge and threat for these entrepreneurs is how to predict the biosensor market and how to convert promising biosensor technology into commercialized biosensors. By adopting a simple commercialization strategy framework, we identify two key elements of biosensor commercialization strategy: excludability and complementary asset. We further divide biosensor commercialization environments into four distinct sub-environments: the Attacker's Advantage, Reputation-Based Idea Trading, Greenfield Competition and Ideas Factories. This paper explains how the interaction between these two key elements shapes biosensor commercialization strategy and biosensor industry dynamics. This paper also discusses alternative commercialization strategies for each specific commercialization environment and how to choose from these alternatives. The analysis of this study further provides a good reference for start-up biosensor entrepreneurs to formulate effective biosensor commercialization strategy.

Effect of an imaging-based streamlined electronic healthcare process on quality and costs.

RATIONALE AND OBJECTIVES: A streamlined process of care supported by technology and imaging may be effective in managing the overall healthcare process and costs. This study examined the effect of an imaging-based electronic process of care on costs and rates of hospitalization, emergency room (ER) visits, specialist diagnostic referrals, and patient satisfaction. MATERIALS AND METHODS: A healthcare process was implemented for an employer group, highlighting improved patient access to primary care plus routine use of imaging and teleconsultation with diagnostic specialists. An electronic infrastructure supported patient access to physicians and communication among healthcare providers. The employer group, a self-insured company, manages a healthcare plan for its employees and their dependents: 4,072 employees were enrolled in the test group, and 7,639 in the control group. Outcome measures for expenses and frequency of hospitalizations, ER visits, traditional specialist referrals, primary care visits, and imaging utilization rates were measured using claims data over 1 year. Homogeneity tests of proportions were performed with a chi-square statistic, mean differences were tested by two-sample t-tests. Patient satisfaction with access to healthcare was gauged using results from an independent firm. RESULTS: Overall per member/per month costs post-implementation were lower in the enrolled population (126 dollars vs 160 dollars), even though occurrence of chronic/expensive diseases was higher in the enrolled group (18.8% vs 12.2%). Lower per member/per month costs were seen for inpatient (33.29 dollars vs 35.59 dollars); specialist referrals (21.36 dollars vs 26.84 dollars); and ER visits (3.68 dollars vs 5.22 dollars). Moreover, the utilization rate for hospital admissions, ER visits, and traditional specialist referrals were significantly lower in the enrolled group, although primary care and imaging utilization were higher. Comparison to similar employer groups showed that the company's costs were lower than national averages (119.24 dollars vs 146.32 dollars), indicating that the observed result was not attributable to normalization effects. Patient satisfaction with access to healthcare ranked in the top 21st percentile. CONCLUSION: A streamlined healthcare process supported by technology resulted in higher patient satisfaction and cost savings despite improved access to primary care and higher utilization of imaging.

Comparison of a conventional probe with electronic and manual pressure-regulated probes.

We compared the accuracy, consistency, time, comfort, and cost of probing with a conventional hand probe (CP) with 3-mm banded markings, a manual pressure-regulated probe (MP), and two electronic probes (IP and FP). Twenty (20) examiners used all four probes on a test block to determine accuracy; measurements compared favorably to the reference block. Two calibrated examiners probed the Ramfjord teeth of 10 periodontal patients on maintenance regimens, six sites per tooth (n = 708), with all four probes; measurements were repeated after one week. Wilcoxon signed-rank test showed the CP measured more deeply (P < 0.0001) than MP, FP, and IP with mean differences of 0.40, 0.67, and 0.58 respectively. MP measured more deeply (P < 0.001) than FP and IP, with mean differences of 0.27 and 0.18 mm. There was no difference between FP and IP. Time (min:sec) required by one examiner to perform full mouth probing on six subjects (minimum of 26 teeth each) was CP = 3:59; MP = 4:18; FP = 6:16; and IP = 7:23. Subjects rated FP and IP as slightly more uncomfortable than CP or MP. Cost per 1,000 uses was computed based on available data. The IP and FP took longer to perform and cost more per procedure than did the CP and MP. Spearman rank-order correlation revealed that only probe depths measured by CP and MP were well correlated (rs = 0.67). Although some statistically significant differences were found between probes, no differences were considered to be of clinical significance when probing periodontally healthy or maintenance patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Development and evaluation of an inexpensive sensor system for use in measuring relative finger positions.

An inexpensive sensor was developed using a carbon-based electrically conductive ink. A correlation of the actual flex angle to the measured flex angle of the sensors was obtained by experimentally determining a third-order polynomial that represented the response of the sensor and its hardware system (r = 0.999). The response time, when going from an angle of 0-90 degrees, was extremely good. The sensors exhibited an acceptable dynamic response with an error of less than 5% when flexed repeatedly to an angle of 90 degrees. A second-order polynomial was found to express the resistance as a function of angle (r = 0.999) for all of the sensors tested. Although these sensors are not as precise as the more expensive sensors that are available, it was estimated that the production cost of these sensors was less then US $0.50 a piece. In addition, there are many ways that the sensor production method might be improved to produce more accurate sensors using carbon-based electrically conductive ink. While much additional work is still necessary, the system presented in this paper could be incorporated into a complete device to monitor the rehabilitation of an impaired hand. Unlike other systems that are currently available commercially, this system is inexpensive, easily manufactured, accurate, and could be readily used in a variety of clinical settings.

Cost effectiveness of tympanic thermometry in the pediatric office setting.

This study was designed to see if tympanic thermometry might be more cost effective than cheaper more traditional methods of thermometry when office staff time saved is taken into account. There were 224 patients enrolled from three private pediatric practices. Patients were alternately assigned to have their temperature taken with either a tympanic thermometer or with a rectal or oral thermometer depending on the patient's age. For each child enrolled in the study a nurse was asked to time the temperature taking process. Items included in the cost analysis: a) thermometer costs; b) disposable supply costs; c) personnel costs; d) equipment service costs. The mean duration of temperature taking was 35.2 seconds using tympanic thermometers, 73.4 seconds using electronic predictive thermometers, and 247.2 seconds using glass thermometers. In practices taking an average of 10 temperatures per day, tympanic thermometry saved $2,316/year when compared to glass thermometers and $442/year when compared to electronic predictive thermometers. The data presented in this study show that when nursing time is taken into account, tympanic thermometry is less expensive to perform than traditional methods of thermometry despite the initial higher cost of the thermometer.

The application of an Actel field programmable gate array in the design of an ECG RR interval recorder.

Field Programmable Gate Arrays (FPGAs) allow digital circuitry to be integrated on to a single device without the long time penalty incurred with mask programmable Application Specific Integrated Circuits (ASICs). This makes FPGA technology an attractive option to engineer involved in designing digital circuitry where space is at a premium. Furthermore, the relatively low cost of FPGAs at low volume, compared to mask programmable ASICs make them an excellent prototyping option for designers who are considering low cost volume production with mask programmable ASICs. There are several different types of FPGAs available which thus creates confusion for prospective users uncertain of their relative benefits. This paper serves as an introduction to FPGA technology and the stages involved in implementing a design, via the application of an Actel FPGA to the development of an ambulatory long term electrocardiogram (ECG) based RR interval recorder.

Implantable medical devices: current status and future developments within the healthy-aims project.

This paper describes the current situation concerning medical implants and suggests why the number of available devices is so limited. It then goes on to describe how a consortium was established from an EU network focussing specifically on Medical Devices. This consortium was successful in obtaining EU funding for the development of a range of medical implants that will help patients with specific disabilities relating to the nervous system, including deafness, blindness, lack of limb motion and urinary incontinence.

ECG boy: low-cost medical instrumentation using mass-produced, hand-held entertainment computers. A preliminary report.

A prototype low-cost, portable ECG monitor, the "ECG Boy," is described. A mass produced hand-held video game platform is the basis for a complete three-lead, driven right-leg electrocardiogram (ECG). The ECG circuitry is planned to fit in a standard modular cartridge that is inserted in a production Nintendo "Gameboy." The combination is slightly smaller than a paperback book and weighs less than 500 g. The unit contains essential safety features such as optical isolation and is powered by 9-V and AA batteries. Functionally, the ECG Boy permits viewing ECG recordings in real time on the integrated screen. The user can select both the lead displayed on the screen and the time scale used. A 1-mV reference allows for calibration. Other ECG enhancements such as data transmission via telephone can be easily and inexpensively added to this system. The ECG Boy is intended as a proof of concept for a new class of low-cost biomedical instruments. Rising health care costs coupled with tightened funding have created an acute demand for low-cost medical equipment that satisfies safety and quality standards. A mass-produced microprocessor-based platform designed for the entertainment market can keep costs low while providing a functional basis for a biomedical instrument.

[An alternative to rectal measurement of body temperature with a mercury thermometer]. / Et alternativ til rektal temperaturmåling med kviksølvtermometer.

An investigation was undertaken to demonstrate whether rectal Craftemp measurement of the temperature is a useful alternative to measurement of rectal temperature with a mercury thermometer. Measurements of temperature for more than 60 seconds on 57 patients hospitalised in a medical ward revealed a mean temperature difference of 0.2 degree C with a range of -0.3-0.7 degree C. Measurements for over two minutes on 23 patients revealed a mean temperature difference of 0.1 degree C and with a range of -0.2-0.2 degree C. The time of measurement recommended by the manufacturers of one minute is too short and should be two minutes. Craftemp measurement of the temperature is an employable but relatively expensive alternative to measurement of temperature with a mercury thermometer.

Designing small, low-cost, portable electromedical products.

In response to demands for smaller, cheaper, portable electromedical products, designers are developing circuitry that operates at reduced power levels, thereby allowing smaller batteries to be used. Application-specific integrated circuits (ASICs) enable products to have fewer components and are inherently more power efficient than circuits comprised of discrete components. In this article, the author examines the existing applications of ASICs and discusses how new design techniques can be used to reduce a product's overall power consumption and production costs.

The evolution of integrated passive components in medical devices.

As well as being space saving, integrated passive components offer other opportunities for medical device applications. This article examines their advantages and looks at what the future holds.

Life-cycle management: a long-term challenge.

With some electronics components being withdrawn after only two years, life-cycle management is becoming a key strategic issue for users and manufacturers of electromedical equipment. This article describes some approaches to tackling the challenge.