Appropriateness and necessity research on the Internet: using a "second opinion system".

Appropriateness and necessity research of various procedures in medicine may be the most complex field of innovation in healthcare and technology assessment. Nevertheless, the appropriateness of the indication of any medical intervention is probably more important than the outcome since even ideal quality components of structures, processes and outcomes become irrelevant without a proper indication. The first part of our appropriateness initiative in interventional cardiology and gynecology was to formulate guidelines. To define the appropriateness for coronary angiography, coronary revascularization and hysterectomy, literature-based consensus methods were used. The second part was to disseminate the guidelines in a user-friendly manner via the Internet. Therefore, we relied on a system-driven query facility for propositional (experts) rules. The next part of the appropriateness initiative may be a user-friendly Internet-based data collection system to validate the national accepted guidelines. Most important may be that only data that is needed can be collected using a refined database technology. The described Second Opinion System can be found under: http:sos.inf.ethz.ch. Research on indications with data on clinical outcome may open new opportunities to validate indication guidelines using Internet/database technology for data analysis and browsing of decision graphs concerning clinical decision-making. This new technology facilitates the evaluation of appropriateness and necessity criteria in combination with clinical outcomes.

Compost produced from organic fraction of municipal solid waste, primary stabilized sewage sludge and natural zeolite.

The aim of this work is to present the physicochemical characteristics of the compost produced from dewatered anaerobically stabilized primary sewage sludge (DASPSS), organic fraction of municipal solid waste (OFMSW) and the metal uptaken by zeolite (clinoptilolite). The final results indicated that the composted material produced from clinoptilolite 20% w/w and 80% w/w DASPSS and OFMSW (60% and 40%, respectively) provided better soil conditioning compared to the compost produced from DASPSS. The co-composting products had a higher concentration of total humic and organic matter (O.M.) than the sewage sludge compost. Also, the heavy metals concentration in the final products was in lower concentration than in the sewage sludge compost. The zeolite appeared to uptake a significant (p<0.05) amount of metals. Specifically, the use of 20-25% w/w of clinoptilolite appears to uptake 100% of Cd, 10-15% of Cr, 28-45% of Cu, 41-47% of Fe, Mn 9-24% of Mn, 50-55% of Ni and Pb, and 40-46% of Zn. Although by the application of the composting process, the reduction in dry mass is between 30% and 40% for all samples.

The Swiss database on quality projects in medical institutions.

Since the early 1990s it is important for every medical institution to report on activities in the field of quality improvement and quality assessment because there is a certain pressure from the market and from health insurance laws in various countries. Nevertheless, researchers as well as clinicians or administrators are rarely informed on ongoing projects. To register projects in quality research, an Internet-based information system was established to register projects on quality of medical institutions. Among others, hospitals, private doctors' offices, medical specialty societies and cost-payers are regarded as institutions in this effort. An interactive database provides information on the institution performing a project and on what is being/has been performed in a certain place during a certain period of time. At present medical institutions are invited to report on their projects, but this initiative can only succeed if it provides information from as many different institutions as possible: for data skills and help your colleagues! Place your knowledge, activities and information at disposal to the public and profit from your colleagues.

[Possible future of the project for quality assurance of indications and outcome in interventional cardiology and gynecology]. / Die mögliche Zukunft der Projekte zur Qualitätssicherung der Indikationsstellung und der Ergebnisse in der interventionellen Kardiologie und der Gynäkologie.

In the last few years the basis for national guidelines for the indications of coronary angiography, coronary revascularisation and hysterectomy has been established. The guidelines have been published and are accessible to medical doctors and patients on the Internet using a database system called "Second Opinion System": http:/(/)sos.inf.ethz.ch Dissemination, implementation and validation of the guidelines will be of major importance in the near future. With reference to validation, the question remains whether the established guidelines are correct for the everyday treatment of patients. A suitable method of answering this important question is comparison between the appropriateness and necessity rates of the various indication groups, combined with outcome measurements. The Internet-based second opinion system (SOS) may be used for data collection in order to verify hypotheses. Because of the database architecture, only relevant information about the patients is collected via Internet, independent of time and place. In addition, the system allows users to evaluate their individual data, and special attention is given to data protection. The discussion about priorities in health care (rationing) will be increasingly important in the near future. The present project may offer a way of maintaining adequate access to health care services for patients. Therefore, the participation of as many institutions as possible in the project "quality assurance of indication and outcome in interventional cardiology and in gynaecology" is of great importance.

Effect of leachate from landfills on underground water quality.

A study was performed in order to evaluate the effect of leachate from a landfill, in the Athens region, to the underground water of the surrounding area. A number of physical chemical parameters were monitored, including metals from various sampling sites, covering an area up to 3 km from the landfill. The experimental results indicate that the underground water quality has been greatly affected by the leachate, since most of the parameters examined show increased concentrations.