Data warehouse approach to nursing management.

Aim: This article describes a data warehouse approach when designing an information system to meet nursing management needs in acute hospital setting.

Background: The rapidly changing health care environment has created new challenges for nursing leaders and requires appropriate, accurate and timely data for decision-making.

Method: Key aspects of current information needs were identified by a nursing expert group.

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.

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.

Variation of growth in height and weight of children. II. After infancy.

To provide for early detection of abnormal changes in growth, we propose the monitoring of all children for changes in relative height and relative weight as indirect indicators of growth velocity. To this end we analyzed the growth of 2,156 children, as recorded by the child health surveillance services at ages 2 to 19 years. From their data we constructed growth standards on charts of a novel type, which allow direct reading of relative height (SD score, SDS) and relative weight (percentage deviation of weight from median weight for height and sex, %DW).

Variation of growth in length and weight of children. I. Years 1 and 2.

As part of our work aiming at facilitation of growth screening, we analyzed the growth of 741 healthy infants from birth to 2 years of age. We 1) show that weight depends on length rather than age, 2) present new growth standards in a format which allows direct reading of relative length and relative weight, and 3) define the normal variation of changes over different periods in terms of relative length (SD score, SDS) and relative weight (deviation of weight from the median weight for length and sex, %DW). The group mean values for changes in length SDS and %DW were zero, but there were wide individual variations, which decreased with age and length.

Growth evaluation: parent and child specific height standards.

Data on the growth of 1063 children and their parents were analysed. Of the variation in height at prepuberty about 20%, and of the final height 30-46%, were explained by the variation in parental heights; the children's own height at the age of 1.0 year increased the proportion explained to half.

Femorotibial bypass grafting for lower limb ischaemia.

The results of 305 femorotibial bypass grafts performed in 246 patients are presented. Of these operations 246 were primary and 58 secondary or tertiary. A total of 66 diabetic patients were in the series.

Femoral-tibial bypass for limb salvage.

From 1967 to 1982, 305 femoral tibial bypasses were performed. Of these 180 (59%) were performed on limb salvage indication. A reversed autogenous saphenous vein was used in 134 instances, among 46 vein substitutes there were 15 vein allografts, 13 human umbilical cord vein grafts, 12 PTFE grafts and six dacron grafts.

Local management in primary breast cancer. Our experience of 331 cases.

The peroperative exploration of axillary content gave wrong result from the stage of axillary nodes in every fourth case compared with the final result of axillary evacuation. There were no locoregional recurrences in stage I-patients irradiated after mastectomy. In postoperatively irradiated stage II-patients there were locoregional recurrences in 2.

Fever, leucocytosis and C-reactive protein after open-heart surgery and their value in the diagnosis of postoperative infections.

The time course of body temperature (T), white blood cell count (WBC) and serum C-reactive protein (CRP) following uncomplicated open-heart surgery and the value of these three parameters in the diagnosis of postoperative infectious complications were analyzed in 153 patients. Preoperatively, all the patients had a normal T and the WBC level was under 10 X 10(9)/l. The CRP was elevated (over 20 mg/l) in five patients without having an influence on their postoperative courses.

Risk factors and markers associated with proliferative retinopathy in patients with insulin-dependent diabetes.

To define risk factors and markers associated with proliferative retinopathy (PR), we compared 44 insulin-dependent diabetic patients with PR with 45 matched patients without advanced retinopathy (NR). Glycemic control assessed by HbA1 measurements from 5 yr preceding diagnosis of PR was significantly worse than in NR patients. The NR patients had more frequently been treated with multiple daily insulin injections than the PR patients.

The usefulness of micro- and macrochromatographic determinations of glycohemoglobin in diabetic patients with nephropathy.

Determination of glycohemoglobin in blood (HbA1) represents an established measure of glycemic control in diabetic patients. In patients with uremia, however, the determination can be subject to pitfalls which may limit its reliability. In order to evaluate the clinical usefulness of HbA1 determinations in diabetic patients with nephropathy, concentrations of HbA1 and its subfractions HbA1c and HbA1a+b were measured by micro- and macrocolumn chromatography in 58 diabetic and 80 non-diabetic patients with impaired renal function.

Total gastrectomy with esophagojejunostomy. Analysis of 100 consecutive patients.

One hundred consecutive patients treated for gastric cancer by total gastrectomy from 1977 to 1982 at the second department of surgery of the Helsinki University Central Hospital were analyzed. The mean age of the patients was 61.5 years.

Changes in the treatment and prognosis of breast cancer.

The data of 331 women with breast cancer treated in the Second Department of Surgery, Helsinki University, during the period 1976-1980 (patient material, treatment, prognostic factors) is evaluated and compared with an equally large patient material treated during the period 1951-1961 in the same hospital. A breast lump was the main symptom in 94% and the tumour was found by the patient in most cases. Only two patients were younger than 30 years.

Pulmonary vein diameter in normal children.

A total of 24 normal children's hearts with their great vessels were examined at autopsy and the diameters of the pulmonary veins measured. The values so obtained were plotted against patient height, body-surface area, weight, and age and were subjected to multi-variate regression analysis. Height gave the best correlation with pulmonary venous diameter.

Factors influencing 5-year survival in gastric malignancies after total gastrectomy.

One hundred consecutive patients were analysed who had been treated with total gastrectomy in the Second Department of Surgery, Helsinki University Central Hospital, for malignancies of the stomach from 1977 to 1982. Hospital mortality was 8%. The 5-year survival rate in this selected group of patients was 43% and 34% for patients with gastric cancer.

Post-operative outcome in rhegmatogenous retinal detachment.

Anatomic and visual results of retinal detachment surgery were analyzed in 352 consecutive eyes operated on for rhegmatogenous type of retinal detachment in 1978-1981 at the University Eye Hospital in Helsinki. From 1978-79 to 1980-81, both the re-attachment rate and the visual results improved significantly (P less than 0.05).

Mortality from ischaemic heart disease among patients using anticonvulsive drugs: a case-control study.

Patients who use phenytoin and some other anticonvulsive drugs have been shown to have raised concentrations of plasma high density lipoprotein. As this lipoprotein is known to be inversely associated with the incidence of ischaemic heart disease the causes of death of all patients with epilepsy known to be taking anticonvulsive drugs who died during 1978-80 were studied. Of 1399 deaths of anticonvulsant users, 258 (18.

Significance of estrogen and progesterone receptors, disease-free interval, and site of first metastasis on survival of breast cancer patients.

Estrogen and progesterone receptors (ER/PR) were measured in primary tumors and metastases of 397 breast cancer patients. Survival following mastectomy was significantly longer in patients with ER and PR positive tumors, as was survival after first recurrence. The prognostic value of ER and PR was compared with such clinical factors as disease-free interval (DFI) and the dominant site of first metastasis by Cox's regression analysis.

Characteristics of rhegmatogenous retinal detachment.

Characteristics of rhegmatogenous retinal detachment and its predisposing factors were studied in a consecutive series of 342 patients operated on for retinal detachment (RD) at the University Eye Hospital in Helsinki in 1978-1981. On these, 234 were pre-operatively examined and operated on by the senior author. The mean age of the patients was 52.

Epidemiology of rhegmatogenous retinal detachment in a Finnish population.

During a -4 year period, 1978-1981, 310 eyes of 301 patients living in the district of the Helsinki University Central Hospital were examined for rhegmatogenous detachment of the retina. This corresponds to an annual incidence of 6.9 per 100 000 mean population.

Pharmacokinetics and metabolic effects of glibenclamide and glipizide in type 2 diabetics.

Fifteen Type 2 diabetics were treated for 4-week periods with once daily (10 mg) glibenclamide, glipizide and placebo according to a double-blind cross-over protocol. Post-dose glipizide concentrations were three times higher than those of glibenclamide, due to the incomplete bioavailability of the latter. On the other hand, pre-dose drug levels were similar, as an expression of the slower absorption and/or elimination of glibenclamide.

Transient effect of the combination of insulin and sulfonylurea (glibenclamide) on glycemic control in non-insulin dependent diabetics poorly controlled with insulin alone.

In a double-blind cross-over study we compared the effects of insulin plus glibenclamide, 5 mg twice daily, with insulin plus placebo during 8-week periods on metabolic parameters in 13 non-insulin dependent diabetic (NIDDM) patients poorly controlled with insulin alone. The combination therapy improved diabetic control as assessed by fasting blood glucose (p less than 0.001), 24-hour urinary glucose (p less than 0.