Adult-type granulosa cell tumor, presenting as extraovarian metastases: ultrastructural diagnosis.

All granulosa cell tumors have the potential to recur locally or metastasize, in spite of apparent complete surgical excision. Long-term follow-up is particularly important in these tumors, since recurrences may occur many years after the initial diagnosis. This report highlights the ultrastructural findings that led to the diagnosis of metastatic granulosa cell tumor in two patients presenting with extraovarian masses. In patient 1 the information about an ovarian granulosa cell tumor removed 9 years before the current admission was obtained only after the metastatic tumor was correctly diagnosed. In patient 2 the ovarian primary was found after abdominal wall involvement by granulosa cell tumor was diagnosed. Thus, in both cases the clinical circumstances were atypical and electron microscopic examination of the tumors was essential to make the diagnosis of granulosa cell tumor with confidence. Based on the features observed in these two extraovarian tumors as well as eight other primary ovarian granulosa cell tumors from our files, a consistent ultrastructural profile is identified that can be very useful for diagnosis.

Data comparability issues in international research and quality assurance.

Impediments to and progress toward valid and reliable international quality comparisons at the diagnosis or case type level are identified and discussed. The need for uniformity in each of the following is established: (1) international clinical data set, (2) definitions of clinical data elements and (3) data collection practices. The need to establish a clinically adequate international data base is discussed and action steps are identified.

Using billing data to improve hospital drug use.

All hospitals, both in the United States and abroad, have a critical need to ensure the appropriateness and safety of the drugs prescribed and administered to their patients. The sources of data to support this effort are typically patient charts or automated pharmacy information data bases. Patient charts allow the capture of all information relevant to the patient, but are laborious to review in detail. Pharmacy information systems provide much information on drugs prescribed, but lack information on laboratory values and patient diseases. A third source of data, namely billing data, is a byproduct of the automated order entry process in US hospitals, but is seldom used for research or quality management. By standardizing the individual charge codes used by the hospitals for billing for drugs, the billing data becomes more accessible, comparable to other institutions, and more valuable as a source of research, quality assurance and quality improvement.

Technology: a growing cost in knee implant surgeries.

The number of knee implant surgeries performed in the United States tripled between 1981 and 1987. While prosthesis costs for knee implants continue to soar, Federal reimbursement has remained at a relatively fixed level since 1983. Healthcare financial managers need to understand the technology, cost, and quality issues involved with knee implants. An implant that has a 10-year life may be well worth the extra money it costs.

The need for a "resource consumption profile" for monitoring patient care.

The implementation of a DRG-based payment system in the United States relied on a stream of data which already existed, namely that of patient billing data. The growing interest outside of the United States in a diagnosis-based payment system will, at some point, require hospitals to generate patient-specific resource consumption profiles (RCPs) for setting hospital payment rates, and budgeting. Our experience has been that the RCPs can be used for extremely specific quality assurance studies as well.

Patient bills provide a way to monitor quality of care.

Reverse protocols give chief financial officers a role in quality assurance. Under this system, department heads determine when technology, tests, and services should be used. Financial staff then check billing data to see if the procedures ordered follow protocol for a patient's diagnosis. This enables financial administrators to monitor the technology used and its effect on quality, without creating turf battles with clinicians.

Phase-matched electromagnetic scattering in active dielectric films.

An investigation of oblique plane-wave electromagnetic scattering from active dielectric films reveals the existence of anomalously large resonances that occur at discrete plane-wave angles of incidence. These resonances may be understood from a leaky-wave phase-matching condition whose predictions for the first few modes agree to within a few percent of those obtained from a rigorous treatment using Maxwell's equations. Enhancement in the scattered-field intensities of the order of 100 was observed in experiments using finite-diameter pump and probe laser beams and active films as thin as 6 microm.

Catheter cases show how new technology affects costs.

The cost of medical treatments for similar cases can often differ greatly, based on the technology selected to treat the patient. The type of device selected; the associated drugs, supplies, and equipment needed; and the possible complications that may result from the treatment combine to produce the differences in costs. In this article, the Swan-Ganz catheter and procedures associated with its use are discussed. Issues such as the generation of useful data and the necessity of use are analyzed to illustrate why the cost of technology can vary from procedure to procedure. It is important to develop better systems to help monitor all treatment costs. But it is also essential to know the workings of the devices used and the services provided to understand what drives these costs.

The high price of technology: factors affecting hip implant costs.

As the cost of new technology for hip implants escalates, financial managers are finding an increasing amount of the DRG payment is spent on the technology itself and not nursing care, maintenance, or overhead. Four factors affect the cost and quality of hip implant prosthetics--the materials, design, fixation, and instrumentation--and must be considered in the cost and quality issues associated with selecting a prosthetic device. Financial managers must be sensitive to quality issues associated with new technological advances in hip implants, and they must be able to communicate the financial impact of this new technology to the physicians who use it and the third-party payers who pay for it.

Integrating clinical, financial information: improving patient management.

The need for integrated financial and clinical information is becoming increasingly important to financial managers and clinicians alike. Typical billing systems collect only a small amount of clinical information. But by using billing systems more creatively--superimposing a clinical classification system on a billing system--hospital managers could retrieve clinical information from the billing system without undergoing chart review. The hospital's largest database, its billing information, could be used to more efficiently manager patient care.

Cost accounting in healthcare organizations: who needs it?

There is no question that improved cost information can lead to improved accountability in health care; however, the major proponents of borrowing cost accounting concepts from manufacturing have not gone far enough. They have ignored an important aspect of manufacturing cost accounting that is also a very important prt of hospitals and health care, namely the concern for quality.