Flexible Use of Referents in the Construction of Organizational Identity: A Longitudinal Case Study

Rapid growth, acquisitions, and diversification are examples of major changes that often result in the need to redefine the distinctive characteristics of the organization in question thereafter. However, a sudden identity presentation that significantly differs from the past lacks credibility among both the organizational members and the organization’s external constituents. We contribute to previous research by showing the previously neglected potential that lies in the flexible selection, valuation, and spatio-temporal positioning of referents, and how this enables the construction of an identity that is simultaneously sufficiently congruent with the organization’s present activities and continuous with its previous identity. Moreover, we also reveal how this use of referents changes across the phases of organizational evolution. Empirically, our findings are grounded on an intensive case study of an organization over a 20-year time frame that evolved from a minor spin-off to a prominent and eventually to a major diversified company.

Compartmentalization of adenosine metabolism in cancer cells and its modulation during acute hypoxia

Extracellular adenosine mediates diverse anti-inflammatory, angiogenic and vasoactive effects, and has become an important therapeutic target for cancer, which has been translated into clinical trials. This study was designed to comprehensively assess adenosine metabolism in prostate and breast cancer cells. We identified cellular adenosine turnover as a complex cascade, comprising (1) the ectoenzymatic breakdown of ATP via sequential ecto-nucleotide pyrophosphatase/phosphodiesterase-1 (NPP1, officially known as ENPP1), ecto-5'-nucleotidase (CD73, also known as NT5E), and adenosine deaminase reactions, and ATP re-synthesis through a counteracting adenylate kinase and members of the nucleoside diphosphate kinase (NDPK, also known as NME/NM23) family; (2) the uptake of nucleotide-derived adenosine via equilibrative nucleoside transporters; and (3) the intracellular adenosine phosphorylation into ATP by adenosine kinase and other nucleotide kinases. The exposure of cancer cells to 1% O2 for 24 h triggered an ∼2-fold upregulation of CD73, without affecting nucleoside transporters, adenosine kinase activity and cellular ATP content. The ability of adenosine to inhibit the tumor-initiating potential of breast cancer cells via a receptor-independent mechanism was confirmed in vivo using a xenograft mouse model. The existence of redundant pathways controlling extracellular and intracellular adenosine provides a sufficient justification for reexamination of the current concepts of cellular purine homeostasis and signaling in cancer.This article has an associated First Person interview with the first author of the paper.

In the service of a higher good: Resilience of academics under managerial control

This article extends the literature of resistance in organisational settings by examining the forms and sources of resistance that endure even in the face of successive adversities. This article characterises such resistance as resilience and elaborates on this concept empirically in the university context by showing how academics find new ways to maintain and promote their professional agendas despite successive, unpredictable managerial interventions typical of the contemporary university. In our analysis, we identify three forms of resilience – protective, independent, and adaptive – each of which draws on specific professional values that we term constitutive goods. The focus on constitutive goods highlights the moral grounding of resistance that comes into play, especially in situations in which the actors have something fundamentally valuable at stake, and which they feel compelled to defend. Moreover, resilience extends the focus beyond situated resistance tactics to a process geared towards protecting constitutive goods against control over the long term.

The efficacy of a continuous quality improvement (CQI) method in a radiological department: Comparison with non-CQI control material

Objective: To study the efficacy of continuous quality improvement (CQI) compared to ordinary management in an on-duty radiology department.

Material and Methods: Because of complaints regarding delivery of on-duty radiological services, an improvement was initiated simultaneously at two hospitals, at the HUCH (Helsinki University Central Hospital) utilising the CQI-method, and at the OUH (Oulu University Hospital) with a traditional management process. For the CQI project, a team was formed to evaluate the process with flow-charts, cause and effect diagrams, Pareto analysis and control charts. Interventions to improve the process were based on the results of these analyses.

Results: The team at the HUCH implemented the following changes: A radiologist was added to the evening shift between 15:00-22:00 and a radiographer was moved from the morning shift to 15:00-22:00. A clear improvement was achieved in the turn-around time, but in the follow-up some of the gains were lost. Only minimal changes were achieved at the OUH, where the intervention was based on traditional management processes.

Conclusion: CQI was an effective method for improving the quality of performance of a radiology department compared with ordinary management methods, but some of this improvement may be subsequently lost without a continuous measurement system.

Materializing the Societal Effect: Organizational Forms and Changing Patterns of Dominance in the Paper Industry

This paper reports an empirical study on the co-evolution of competitive conditions dominating firms and organizational forms in the paper industry1. It has two main theoretical implications. First, with respect to research on national business systems and the societal effect, we suggest that the country of origin imprints firms especially by allowing them to develop distinctive organizational forms. Second, we show that the competitive conditions, dominant forms and dominant firms remain in constant flux even in mature industries. There is, therefore, a need for co-evolutionary research to continue to combine long-term perspectives and intensive research designs in the study of specific industries.

The Dominance of Firm-Level Competitive Pressures Over Functional-Level Institutional Pressures: The Case of the Finnish-Based Forest Industry Firms

Previous management and organization literature has recognized the contradictions between competitive and institutional pressures. Firms must simultaneously secure competitiveness by being different from their competitors, and legitimacy by being similar to them. While trade-offs between these conflicting pressures have been studied at the population and firm levels, little attention has been paid to the same phenomenon within firms. This paper suggests that, in order to achieve competitiveness at the firm level, firms need to deviate from some institutionally legitimate practices at the functional level. For example, we show how being strategically different at the firm level forces the Finnish-based forest industry firms to dismantle isomorphic practices in their organizational functions. Thus, we extend the previous work in this field by showing that the ability of firms to adopt and develop new practices is path-dependently biased in the sense that the firm-level definition of the strategic context can have a major impact on the types of organizational practices that are adopted, nurtured and abandoned within the functions.

Liver abscess and sepsis caused by clostridium perfringens

There is usually enough time for identifying the etiology of calculous cholestasis and cholangitis by imaging and laboratory investigations, provided that antimicrobial drug therapy is started immediately after collection of blood cultures and the patient's general condition is good. The situation changes, if the inflammation is caused by Clostridium perfringens, a rare causative agent of severe sepsis and massive intravascular hemolysis. Mortality from the resulting infection and sepsis is as high as over 70%. Quick recognition of the condition, initiation of antimicrobial drug therapy and drainage of a possible focus of infection may save the patient's life.

Dermal expression of laminin-332 and type IV collagen in humans with severe sepsis

BACKGROUND

An intact basement membrane at the dermal-epidermal junction is essential to the viability of the skin. The effect of sepsis on the basement membrane is unknown.

METHODS

Skin biopsies were used to study basement membrane structure in severe sepsis (Day 1). Subsequent biopsies were taken on Day 8 and at 3 months in the survivors. Immunohistochemical staining was undertaken using laminin-223 and type IV collagen. Twenty patients with severe sepsis and four control subjects were included in the analysis.

RESULTS

Intensive care unit mortality was 4/20, and total 30-day mortality was 5/20. Exactly, 7/17 of patients with severe sepsis exhibited weak or absent laminin-332 expression and 11/15 exhibited weak or absent type IV collagen expression compared with 0/4 of control subjects on Day 1 in intact skin. The proportion of sepsis patients with weak or absent laminin-332 expression was 5/11 on Day 8 and fell to 1/7 at 3 months. The proportion of sepsis patients with weak or absent type IV collagen expression was 10/11 on Day 8 and 4/7 at 3 months.

CONCLUSION

These findings suggest that basement membrane formation may be compromised in patients with severe sepsis.

A new endotoxin adsorber in septic shock: observational case series

AIMS

Effects of a new endotoxin adsorber on the length of noradrenaline (NA) treatment, LPS (lipopolysaccharide) levels and SOFA (sequential organ failure assessment) scores in septic shock were evaluated.

METHODS

Two-hour hemoperfusion with LPS adsorber was initiated in patients with septic shock and endotoxemia. Controls were matched for age, focus and severity of illness.

RESULTS

Adsorption treatment (n = 9) exhibited a significant decrease in EAA (endotoxin activity assay) activity (0.55 [0.44-0.68] vs. 0.25 [0.13-0.41], p = 0.019) and NA infusion rate (0.217 μg/kg/min [0.119-0.0508] vs. 0 μg/kg/min [0-0.09], p = 0.026) from pretreatment to 24 h post-treatment. The median decrease in SOFA scores from pretreatment to 24 h was 3.0 points (1.5-4.5), p = 0.002. Duration of NA infusion was significantly shorter compared to controls (39 h [31-48] vs. 54 h [43-151], p = 0.03).

CONCLUSIONS

LPS adsorber treatment was associated with a decrease in NA dose, decrease in SOFA scores and LPS concentrations.

Rage against Self-replicating Machines: Framing Science and Fiction in the US Nanotechnology Field

Research in the sociology of science has increasingly begun to acknowledge the role that external influences play in shaping the boundaries and content of science. However, a scarce understanding still prevails with regard to the role of peripheral, popular movements in the emergence of scientific fields, and of professional fields in general.Through their attention to boundary work, scientific fields also provide a fruitful yet neglected context to study how actors engage in efforts to alter frames in order to adjust and negotiate community boundaries. This qualitative study of the emergence of the US nanotechnology field from 1986 to 2005 makes several contributions to knowledge about these issues. First, our study shows that peripheral, popular movements open up avenues for scientific fields by generating understanding and receptivity for novel ideas through story-telling, which gives rise to their cultural embeddedness. Second, we find that by capitalizing on such culturally embedded concepts, scientists make science particularly vulnerable to external interventions, limiting the effect of boundary work. Third, the study shows how usually persistent hierarchies between communities are tested, challenged, and reproduced in an emerging professional field. The study therefore provides understanding on how actors in the key communities are able to use framing to negotiate their positions and community boundaries within a complex, emergent field.

Continuous retention suture for the management of open abdomen: a high rate of delayed fascial closure

BACKGROUND AND AIMS

Open abdomen is most often a consequence of damage control surgery, abdominal decompression or intra-abdominal infections. Ventral hernia after unsuccessful closure of open abdomen causes marked disability to the patient. Several methods for delayed fascial closure have been developed. Patients treated with continuous retention suture were evaluated to find out how often fascial closure was achieved, and what complications were related to the technique.

METHOD

A retrospective analysis of 16 open abdomen patients treated with continuous retention suture.

RESULTS

The most common cause of open abdomen was abdominal infection. Complete fascial closure was achieved in nine of the eleven surviving patients. Closure failed in one patient. Partial closure was also achieved in one patient. The median time between leaving the abdomen open and starting the process of closure was twelve days. The longest period of open abdomen before successful fascial closure was 29 days. Five patients died before the process of closure was complete.

CONCLUSION

Delayed fascial closure can be accomplished by using the retention suture method described here.

Epidemiology of intensive care unit (ICU)-acquired infections in a 14-month prospective cohort study in a single mixed Scandinavian university hospital ICU

BACKGROUND

Our aim was to evaluate the epidemiology of intensive care unit (ICU)-acquired infections in a prospective cohort study.

METHODS

Patients with longer than a 48-h stay in an adult mixed medical-surgical ICU in a tertiary level teaching hospital were included. The incidence (per cent) and incidence density (per 1000 patient days) of ICU-acquired infections and the device-associated infection rates per 1000 device days were analysed prospectively in a 14-month study.

RESULTS

Eighty (23.9%) of 335 patients, whose ICU stay was longer than 48 h, acquired a total of 107 infections (1.3 per patient) during their ICU stay, with an infection rate of 48 per 1000 patient days. The most common infections were ventilator-associated pneumonia (VAP) [33.8% (18.8 per 1000 respiratory days)], other lower respiratory tract infections (LRTIs) (20%) and sinusitis (13.8%). The rate of central catheter-related (CRI) or primary bloodstream infections was 6.3% (2.2 per 1000 central venous catheter days), and the rate of urinary tract infections was 1.3% (0.5 per 1000 urinary catheter days). The first ICU infection was observed in 58.8% (47/80) of cases within 6 days after admission. The median time from admission to the diagnosis of an ICU-acquired infection was 4 days (25th-75th percentiles, 4.0-6.0) for VAP, 6.0 days (4.5-7.0) for LRTIs and 9.5 days (6.5-13.0) for CRIs.

CONCLUSIONS

The rates of urinary tract infections and bloodstream infections were lower than reported previously, differentiating our results from the classic pattern of ICU-acquired infections, with the exception of the predominance of VAP.

Development of renal failure during the initial 24 h of intensive care unit stay correlates with hospital mortality in trauma patients

BACKGROUND

Although multiple organ failure is the leading late cause of death, there is controversy about the impact of acute organ dysfunction and failure on trauma survival.

METHODS

Consecutive adult trauma admissions between January 2000 and June 2003, excluding isolated head traumas and burns, were analysed for parameters of organ function during the first 24 h following intensive care unit (ICU) admission using the Sequential Organ Failure Assessment (SOFA) scoring system. A national prospectively collected ICU data registry was used for analysis, including data from 22 ICUs in university and central hospitals in Finland.

RESULTS

The study population consisted of 1044 eligible trauma admissions; 32% of the cases were treated at university hospital level, the rest being secondary referral central hospital admissions. The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 15 (SD8), ICU mortality was 5.6% and a further 1.6% of patients died during their post-ICU hospital stay. Forty-five per cent of the patients were categorized as having multiple traumas. In univariate analysis, APACHE II > or = 25 [odds ratio (OR), 35; 95% confidence interval (CI), 18-66] and renal failure (OR, 29.5; 95% CI, 14-63) produced the highest ORs for ICU mortality. In the APACHE II-, sex- and age-adjusted logistic regression model, renal failure was a significant risk factor for both ICU and hospital mortality (OR, 11.8; 95% CI, 3.9-35.4; OR, 8.2; 95% CI, 2.9-23.2, respectively).

CONCLUSION

The development of renal failure during the initial 24 h of ICU stay remained an independent risk factor for mortality in trauma patients requiring intensive care treatment even after adjusting for the APACHE II score, age and sex.

Pulp and Paper Fiction: On the Discursive Legitimation of Global Industrial Restructuring

Despite the central role of legitimacy in social and organizational life, we know little of the subtle meaning-making processes through which organizational phenomena, such as industrial restructuring, are legitimated in contemporary society. Therefore, this paper examines the discursive legitimation strategies used when making sense of global industrial restructuring in the media. Based on a critical discourse analysis of extensive media coverage of a revolutionary pulp and paper sector merger, we distinguish and analyze five legitimation strategies: (1) normalization, (2) authorization, (3) rationalization, (4) moralization, and (5) narrativization. We argue that while these specific legitimation strategies appear in individual texts, their recurring use in the intertextual totality of the public discussion establishes the core elements of the emerging legitimating discourse.

Organ system dysfunction following open cholecystectomy for acute acalculous cholecystitis in critically ill patients

BACKGROUND

Acute acalculous cholecystitis (AAC) refers to cholecystitis without gallstones and is a serious complication of critical illness. We describe the time course of organ system dysfunction associated with cholecystectomy in critically ill patients with AAC.

METHODS

The data of all intensive care unit (ICU) patients who had operatively confirmed AAC during their ICU stay between 2003 and 2004 were analyzed. Patients who also had other intra-abdominal pathologies were excluded. The Sequential Organ Failure Assessment (SOFA) scores were recorded 3 days before, on the day of operation and on the first, second, third and seventh post-operative day after cholecystectomy. The impact of open cholecystectomy on organ dysfunction was evaluated on the basis of the change in the total and individual organ SOFA scores.

RESULTS

Twenty-four patients underwent open cholecystectomy for AAC with no other intra-abdominal pathology. Sepsis was the most common admission diagnosis, followed by cardiovascular surgery. The mean (standard deviation, SD) Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS) II and SOFA scores on admission were 24.7 (5.8), 44.3 (12.3) and 9.4 (3.2), respectively. The median (25th, 75th percentiles) total SOFA score 3 days before cholecystectomy was 7.5 (1.3, 8.0), which increased to 10.5 (8.3, 13.0) (P < 0.0001) by the day of cholecystectomy, indicating developing multiorgan dysfunction. After the operation, the score decreased to 5.5 (3.3, 10.8) (P = 0.004) by the seventh post-operative day. The change was most obvious in cardiovascular and respiratory SOFA scores.

CONCLUSIONS

AAC is associated with multiorgan dysfunction in critically ill patients. Open cholecystectomy seems to alter the course of multiorgan dysfunction in these patients.

Glycoalkaloid aglycone accumulations associated with infection by Clavibacter michiganensis ssp. sepedonicus in potato species Solanum acaule and Solanum tuberosum and their interspecific somatic hybrids

Solanum acaule Bitt., a wild potato species, is closely related to cultivated potato (Solanum. tuberosum L.). Incorporation of desirable traits from allotetraploid [2n=4x=48, 2 endosperm balance number (EBN)] S. acaule (acl) into autotetraploid (2n=4x=48, 4EBN) S. tuberosum (tbr) is difficult due to incongruity boundaries. In this study, three hybrid combinations, each with a specific genome constitution, were produced through protoplast fusion: (1) hexaploid 2x acl (+) 4x tbr, (2) tetraploid 2x acl (+) 2x tbr, and (3) hexaploid 4x acl (+) 2x tbr hybrids. In terms of glycoalkaloid aglycones, the hybrids produced demissidine, tomatidine and solanidine, similarly to the S. acaule parental species, but S. tuberosum synthesised only solanidine. Inoculations with Clavibacter michiganensis ssp. sepedonicus (Cms), which is the causal agent of bacterial ring rot in potato, yielded significantly lower total glycoalkaloid aglycone accumulation both in S. acaule plants and in interspecific hybrids in comparison with the corresponding mock-inoculated plants. However, in S. tuberosum the aglycone levels were either higher or unchanged as a result of infection by Cms. To incorporate the desirable traits of the interspecific somatic hybrids into 4EBN S. tuberosum, sexual backcrosses were carried out. The hexaploid 4x acl (+) 2x tbr hybrids with the hypothetical 4EBN showed the greatest capacity to undergo backcrosses with S. tuberosum.

Acute acalculous cholecystitis in critically ill patients

BACKGROUND

Acute acalculous cholecystitis (AAC) is a serious complication of critical illness. We evaluated the underlying diseases, clinical and diagnostic features, severity of associated organ failures, and outcome of operatively treated AAC in a mixed ICU patient population.

METHODS

The data of all ICU patients who had operatively confirmed AAC during their ICU stay between 1 January 2000 and 31 December 2001 were collected from the hospital records and the intensive care unit's data management system for predetermined variables.

RESULTS

Thirty-nine (1%) out of 3984 patients underwent open cholecystectomy for AAC during the two-year period. Infection was the most common admission diagnosis, followed by cardiovascular surgery. The mean APACHE II score on admission was 25, and 64% of the patients had three or more failing organs on the day of cholecystectomy. The mean length of ICU stay before cholecystectomy was 8 days, and the mean total length of ICU stay was 19 days. Most patients (85%) received norepinephrine infusion, and 90% suffered respiratory failure before cholecystectomy. Hospital mortality was 44%. The non-survivors had higher Sequential Organ Failure Assessment (SOFA) scores on the day of cholecystectomy compared to the survivors (12.9 vs. 9.5, P = 0.007).

CONCLUSION

Acute acalculous cholecystitis was associated with severe illness, infection, long ICU stay, and multiple organ failure. Mortality was related to the degree of organ failure. Prompt diagnosis and active treatment of AAC can be life-saving in these patients.

On what are our end-of-life decisions based?

BACKGROUND

The incidence of withholding and withdrawing life support from the critically ill has increased in recent years. The aim of this study was to assess the degree of consistency between the weight assigned by intensivists to different determinants and their relation to end-of-life decisions, and to evaluate the current concepts in withholding or withdrawing intensive care in Nordic countries.

METHODS

Forty-one intensivists from Nordic countries completed a questionnaire sent by e-mail: consistency between contributing factors and the decisions regarding 10 actual cases was evaluated by logistic regression analysis and by the classification (leave-one-out) method. Concepts in management after the withdrawal decision were also analyzed.

RESULTS

The median (range) number of withdrawals per physician was four (range 0-10) out of 10 cases. No single factor was an independent covariant of all decisions made. The classification method revealed that approximately 70% only of decisions could be predicted correctly. Different actions taken after a decision to withdraw intensive care varied from 9.8% (discontinuing ventilator therapy) to 97.6% (informing relatives).

CONCLUSIONS

No generally accepted grounds for end-of-life decisions could be detected among Nordic intensivists. In addition, the current concept of management after decision to withdraw therapy varies markedly. This study has implications in further assessment of the individual decision-making process and the uniformity of actions after withdrawal decisions.

Determinants of ICU mortality in necrotizing pancreatitis: the influence of Staphylococcus epidermidis

BACKGROUND

The severity of acute necrotizing pancreatitis ranges from self-limited to rapidly progressive illness leading to multiple organ failure. Several scoring systems and clinical parameters have been used to predict the course of the disease. The aim of this study was to evaluate the clinical and microbiological determinants of poor outcome in necrotizing acute pancreatitis.

METHODS

Medical records of 67 consecutive patients admitted to the intensive care unit (ICU) of Oulu University Hospital due to acute necrotizing pancreatitis were retrospectively analyzed. All patients received standard surgical intensive care.

RESULTS

Patients who died (n=14) had significantly higher APACHE II, SAPS II and Ranson scores at admission to the ICU and maximum SOFA score achieved during ICU stay than did the survivors. The non-survivors were hospitalized later from the time the symptoms were first manifest (5.3 vs. 2.4 days, P=0.051). Mechanical ventilation (P=0.002), surgical management (P=0.028), open packing surgical management (P=0.03), renal replacement therapy (P<0.001), use of inotropic drugs (P=0.012) and Staphylococcus epidermidis growth (P=0.029) in infected pancreatic tissue were all associated with mortality.

CONCLUSIONS

In this study the time to hospitalization, severity of illness, intensity of care, and surgical management were associated with poor outcome. In addition, Staphylococcus epidermidis in pancreatic necrosis was associated with increased mortality.

Intensive Care Nursing Scoring System Part 2: nursing interventions and nursing outcomes

Different medical classifications and scoring systems have been developed to measure and compare intensive care outcomes in international contexts. Many of them, however, do not include outcome variables to describe autonomous nursing and its effects on the patient's experiences and restrictions as a result of the onset and process of illness, or relatives' or significant others' distress in the intensive care environment. The Intensive Care Nursing Scoring System (ICNSS) is a new instrument to describe and highlight nurses' work and its effects on the patients and their relatives in a way not allowed by medical classifications and scoring systems. ICNSS can be used to evaluate a single intensive care nursing process from admission to discharge or to compare patients in different intensive care units for certain variables. ICNSS can also be used to measure nurses' workload. The classification of nursing diagnoses was described in a previous article. This paper describes nursing outcomes and nursing interventions as well as the use of ICNSS in a computer-based information management system in three adult intensive care units in the Oulu University Hospital.

The efficacy of a continuous quality improvement (CQI) method in a radiological department. Comparison with non-CQI control material

OBJECTIVE

To study the efficacy of continuous quality improvement (CQI) compared to ordinary management in an on-duty radiology department.

MATERIAL AND METHODS

Because of complaints regarding delivery of on-duty radiological services, an improvement was initiated simultaneously at two hospitals, at the HUCH (Helsinki University Central Hospital) utilising the CQI-method, and at the OUH (Oulu University Hospital) with a traditional management process. For the CQI project, a team was formed to evaluate the process with flow-charts, cause and effect diagrams, Pareto analysis and control charts. Interventions to improve the process were based on the results of these analyses.

RESULTS

The team at the HUCH implemented the following changes: A radiologist was added to the evening shift between 15:00-22:00 and a radiographer was moved from the morning shift to 15:00-22:00. A clear improvement was achieved in the turn-around time, but in the follow-up some of the gains were lost. Only minimal changes were achieved at the OUH, where the intervention was based on traditional management processes.

CONCLUSION

CQI was an effective method for improving the quality of performance of a radiology department compared with ordinary management methods, but some of this improvement may be subsequently lost without a continuous measurement system.

Intensive care nursing scoring system. Part 1: Classification of nursing diagnoses

The introduction of computer-based information management systems to intensive care units offers new possibilities to describe and document the content of nursing. In different countries and health care organizations, the hospital culture and the approach taken by nurses and medical colleagues determine what, how and to what extent nursing is documented. There are nursing diagnosis classifications that are used in North America, such as NANDA (North American Nursing Diagnosis Association), and the European Union Telenurse project will promote the use of the ICNP (International Classifications of Nursing Practice) throughout Europe. The above classifications are used to describe individual, family or community responses to potential or actual health problems or life processes. But there is no nursing diagnosis classification that would take into account both the aims and the unique context of intensive care nursing. This first article describes part of our research: the action research process and the result of the development of a nursing diagnosis classification compatible with the goals of intensive care in three adult intensive care units in the Oulu University Hospital. The classification of nursing diagnoses is part of the Intensive Care Nursing Scoring System (ICNSS) which was developed in the course of this study. The other parts deal with nursing outcomes and nursing interventions. ICNSS is used to facilitate information exchange in the process of intensive care nursing and to describe the nursing workload.

Diagnosis of meningeoma. A comparison of costs before CT, during CT and after introduction of MR imaging

OBJECTIVE

To assess whether the capital investment required by advances in radiological technology is offset by savings in the direct costs of diagnostic services.

MATERIAL AND METHODS

Meningeoma was used as an indicator case. All meningeoma patients from three study periods were included: Twenty patients in 1976-77 before the introduction of CT, 22 patients in 1984-85 when CT was used and 16 patients in 1992 when MR imaging had replaced CT as the most informative imaging modality. Radiological and other diagnostic investigations, and the hospital stay were identified and cost analyzed.

RESULTS

The costs of radiological examinations increased from 293 Euros in 1976-77 to 513 Euros in 1992. The average number of diagnostic examinations per patient decreased from 5.1 in 1976 77 to 2.4 in 1992. The length of hospital stay decreased from 11.5 to 2.7 days and the total costs of the diagnostic work-up decreased to one-third of the original, i.e. from 3423 Euros in 1976-77 to 1282 Euros in 1992.

CONCLUSION

The costs of the radiological examinations rose, but the development of radiological technology simplified the diagnostic practice. The hospital stay drastically decreased. The total costs of diagnostic work-up per patient dropped to one-third of the baseline costs.

Activity-based costing in radiology. Application in a pediatric radiological unit

PURPOSE

To get an informative and detailed picture of the resource utilization in a radiology department in order to support its pricing and management.

MATERIAL AND METHODS

A system based mainly on the theoretical foundations of activity-based costing (ABC) was designed, tested and compared with conventional costing. The study was performed at the Pediatric Unit of the Department of Radiology, Oulu University Hospital. The material consisted of all the 7,452 radiological procedures done in the unit during the first half of 1994, when both methods of costing where in use. Detailed cost data were obtained from the hospital financial and personnel systems and then related to activity data captured in the radiology information system.

RESULTS

The allocation of overhead costs was greatly reduced by the introduction of ABC compared to conventional costing. The overhead cost as a percentage of total costs dropped to one-fourth of total costs, from 57% to 16%. The change of unit costs of radiological procedures varied from -42% to +82%.

CONCLUSION

Costing is much more detailed and precise, and the percentage of unspecified allocated overhead costs diminishes drastically when ABC is used. The new information enhances effective departmental management, as the whole process of radiological procedures is identifiable by single activities, amenable to corrective actions and process improvement.

Determination of solanidine- and tomatidine-type glycoalkaloid aglycons by gas Chromatography/Mass spectrometry

A combined derivatization method for gas chromatographic/mass spectrometric (GC/MS) analysis of steroidal glycoalkaloid (SGA) aglycons was developed using both trimethylsilylation and pentafluoropropionylation. In comparison with underivatized or only silylated aglycons, the new technique produces more specific and abundant fragmentation for compounds with a tomatidine-type structure. For example, the difference between solasodine and tomatidine, the former containing a double bond at position 5,6 in the steroidal skeleton, can be observed by their base peak fragments at m/z 417 (C(24)H(41)O(2)Si(2)) and m/z 419 (C(24)H(43)O(2)Si(2)). The method is well suited for the simultaneous determination of both solanidane- and spirosolane-type SGA aglycons from Solanum species and hybrids. The reproducibility of the method, including SGA extraction, hydrolysis, derivatization, and quantitative GC/MS analysis, was <6% (CV) for the principal aglycons determined from a hybrid between a wild potato species, Solanum brevidens Phil., and a cultivated potato, S. tuberosum L. A single ion monitoring technique using specific fragments m/z 419 and 417 could be applied for the determination of minor stereoisomers, which are often overlapped by large amounts of tomatidine.

Costs of plain-film radiography in a partially digitized radiology department. An activity-based cost analysis

PURPOSE

The aim of the study was to analyse the costs of computed radiography (CR) as part of a small picture archiving and communication system (mini-PACS), and to compare these costs with those of conventional analogue radiography using activity-based accounting (ABC).

MATERIAL AND METHODS

The study was conducted at the Central Hospital of Vaasa where in 1993 the Radiology Department acquired a mini-PACS with a CR reader, a chest CR unit, and a CT unit as digital image processing modalities. Of altogether 34140 plain-film examinations, 3/4 were made with CR and stored mostly on film, and 1/4 were made with conventional analogue radiography. The costs and activities of these two modes were analysed by means of the ABC method which identifies and allocates indirect costs in radiological procedures.

RESULTS

The costs of CR imaging were 9% higher than those of conventional radiography. The costs of the chest CR unit were equal to those of conventional radiography. The difference was due to higher investment costs in digital image processing. The time gained from a reduction in the number of retakes did not shorten the time spent by patients in the examination room, and its effect on film costs was minimal.

CONCLUSION

In planning the step-by-step transition of conventional film-based analogue radiography to fully digitized radiography, it should be noted that films are still used in the transition period and that this is associated with higher costs than in the previous system of conventional analogue plain-film imaging.

Magnesium substitution in elective coronary artery surgery: a double-blind clinical study

Magnesium may be beneficial in the control of ventricular ectopy and supraventricular tachyarrhythmias after coronary artery bypass graft (CABG) surgery, but it is not known whether a high-dose magnesium regimen is superior to a regimen keeping the patient normomagnesemic. A prospective randomized and double-blind clinical comparison was performed in 81 elective CABG patients in order to assess the effects of two different magnesium infusion regimens on electrolyte balance and postoperative arrhythmias. Forty-one patients (high-dose group, H) received 4.2 +/- 0.7 g (mean +/- SD), of magnesium sulfate before cardiopulmonary bypass, followed by an infusion of 11.9 +/- 2.8 g of magnesium chloride until the first postoperative (PO) morning, and a further 5.5 +/- 1.0 g until the second PO morning. Forty patients (low-dose group, L) received magnesium sulfate only after bypass to a total of 2.9 +/- 0.5 g at the first, and 1.4 +/- 0.1 g at the second PO morning. A blood cardioplegia technique was used in both groups, including bolus doses of magnesium chloride to a total of 2.4 +/- 0.6 g and 2.3 +/- 0.6 g to H and L patients, respectively. Continuous Holter tape-recording was used for 12 to 15 hours preoperatively, and for 48 hours postoperatively. Serum magnesium peaked in H patients on the first PO morning at 1.60 +/- 0.25 mmol/L, whereafter it declined to the normal level on the third PO morning. Patients in the L group were normomagnesemic, except after the start of bypass.(ABSTRACT TRUNCATED AT 250 WORDS)