Frequently asked questions at the Quality Control Centre Switzerland (CSCQ)

The Quality Control Centre Switzerland (CSCQ) is one of two National EQAS organisers for the medical laboratory. Frequently asked questions at the CSCQ from two time periods have been analysed and compared. They form one of the sources for continuous improvement. It turns out that question frequency per se is not a criterion for the intended purpose. Well formulated single questions or remarks from different sources, together with the institutionalized practice of process evaluation, can lead to specific measures.

The use of technology at home: what patient manuals say and sell vs. what patients face and fear

Over the past 15 years, the use of specialised medical equipment by patients at home has increased in most industrialised countries. Adopting a conceptual framework that brings together two research perspectives, i.e. the sociology of technology and the sociology of illness, this paper empirically examines why and how patients use health technology at home and in the broader social world. Our study compares and contrasts the use of four interventions: antibiotic intravenous therapy, parenteral nutrition, peritoneal dialysis and oxygen therapy. We conducted interviews with patients (n = 16) and caregivers (n = 6), and made direct observations of home visits by nurses (n = 16). The content and structure of patient manuals distributed by major manufacturers and hospitals were analysed (n = 26). The aim of our study was to determine how technology was supposed to be used versus how it was actually used. This study shows that patients are deeply ambivalent about the benefits and drawbacks of technology, and that these advantages and disadvantages are shaped by the various places in which the technology is used. While technology can be pivotal in making patients autonomous and able to participate in the social world, it also imposes heavy restrictions that are intimately interwoven with the nature of the particular disease and with the patient's personal life trajectory.

The empty OR-process analysis and a new concept for flexible and modular use in minimal invasive surgery

The reproducible advantages of minimal invasive surgery have led to a worldwide spread of these techniques. Nevertheless, the increasing use of technology causes problems in the operating room (OR). The workstation environment and workflow are handicapped by a great number of isolated solutions that demand a large amount of space. The Center of Excellence in Medical Technology (CEMET) was established in 2001 as an institution for a close cooperation between users, science, and manufacturers of medical devices in the State of Schleswig-Holstein, Germany. The future OR, as a major project, began with a detailed process analysis, which disclosed a large number of medical devices with different interfaces and poor standardisation as main problems. Smaller and more flexible devices are necessary, as well as functional modules located outside the OR. Only actuators should be positioned near the operation area. The future OR should include a flexible-room concept and less equipment than is in use currently. A uniform human-user interface is needed to control the OR environment. This article addresses the need for a clear workspace environment, intelligent-user interfaces, and flexible-room concept to improve the potentials in use of minimal invasive surgery.

Does standardisation have a role in nanotechnology and medicine?

A look at what nanotechnology means in the context of medical science and what developments are in the pipeline.

[Ergonomic bases of improving the quality of military medical equipment]

The definitions for the concepts of quality of military medical equipment (MME) sample and quality indices are given. The general ergonomic indices of the sample quality are presented. The heterogeneity of elements of "medical specialist--military medical equipment--the wounded--environment" system is shown the successful synthesis of which requires the co-ordination of technical, constructive factors, characteristics of the sample and human (personal) factors of medical specialist. The ergonomic defects typical of MME samples are revealed and the ways to improve the ergonomic characteristics of MME samples are charted. Some ergonomic aspects to improve the MME sample quality are described.

Appropriate technology for neurosurgery

Though more than 50 years have elapsed since neurosurgery has come to the developing countries, vast areas of the population do not have neurosurgical facilities available to them. This is due not only to the economic status of the country but also as a result of the training that the neurosurgical trainee receives. It is proposed in this article that while the young neurosurgeon must, without doubt, be very well trained in the latest technology, at the same time he must be taught to work with confidence with whatever facilities are available without any feeling of inferiority. The locally available appropriate technology should be fully utilized. The neurosurgeon at the periphery must be provided with the minimum essential neurosurgical equipment and also with good compensation. The concerned governments, the public, neurosurgical teachers, and neurosurgical societies and journals have a great role to play in this difficult task.

Keeping waived tests simple

Laboratories performing waived testing must follow the manufacturer's instructions as well as good laboratory practices to ensure that test results are reliable. Four things to concentrate on to maximize the performance and reliability of waived tests are to: 1. Read and follow the information found in the package inserts. 2. Follow the manufacturer's recommendations for running quality control. 3. Train staff members to perform tests correctly. 4. Follow established policies and procedures for patient testing in the practice.

[Experimental, innovative and standard procedures. Ethics and science in the introduction of medical technology]

The dividing lines between experimental, innovative and standard medical procedures are frequently blurred in current clinical practice. This is even more true in the fields of surgery and implantable devices. These differ substantially from pharmacological interventions, which are better regulated.However, the character of the various medical interventions applied in human subjects should be ethically and scientifically delimited as clearly as possible. This task cannot be abandoned to personal discretion and criteria, which are currently used, especially in the field of surgical innovation. External and independent review of the risk-benefit ratio of proposed innovations should enable specification of the particular features of a technique in the patient-doctor relationship, as well as the ethical and scientific requirements for more appropriate evaluation.

Developments in neonatal technology continue to improve infant outcomes

The past 20 years have yielded little success in reducing prematurity rates or decreasing the major morbidities of premature infants. Determination of interventions to decrease prematurity rates, and the development of methods to reduce premature neurologic damage, are the challenges for the next 20 years. With the advent of genetic analysis and the ability to study environmental and genetic interactions, we may be on the threshold of another significant decrease in mortality and morbidity in the premature infant.