Workmen's compensation for occupational hand injuries.

BACKGROUND: The Compensation for Occupational Injuries and Diseases Act No. 130 of 1993, as amended in 1997 (COIDA), provides payment to healthcare providers for treatment of occupational injuries in South Africa (SA). Patients and employers are often unaware of procedures for claiming, and patients then carry the burden of costs themselves. Additionally, under-billing results in a loss of income for treating hospitals. Hand injuries are common occupational injuries and form the focus of this study. OBJECTIVES: To investigate whether occupational hand injuries treated at the Martin Singer Hand Unit at Groote Schuur Hospital, Cape Town, were accurately captured and allocated correct professional fee coding and billing. Accurate capturing and billing would allow for access to the Compensation Fund and allocation of finances to improve service delivery, as well as avoid unnecessary costs to otherwise uninsured patients. METHODS: All new hand injuries presenting to the hand unit at the hospital in August 2017 were sampled in a retrospective folder review. Injuries on duty (IODs) were identified and analysed further. Coding and billing were compared with independent private quotes. RESULTS: Sixty new hand injuries presented during the month. Fifteen were IODs, but only 6 were recognised by administration. The other 9 were billed at minimum income rates and 5 of these patients also had operations, which were not billed for. A total of ZAR88 871.99 was under-billed in terms of professional fees only. The 9 incorrectly classified patients had to bear costs themselves at a median of ZAR130.00 each. CONCLUSIONS: There were large discrepancies in billing for occupational hand injuries. This resulted in costs to the patients and loss of income for the facility. Access to the Compensation Fund is vital in financing resources in the overburdened public sector. Suggestions for improvement include accessing COIDA funds in order to improve administration at the unit, so improving identification, coding and billing of occupational hand injuries.

CAPs-IDD: Characteristics of Assessment Instruments for Psychiatric Disorders in Persons with Intellectual Developmental Disorders.

BACKGROUND: Assessment of psychiatric disorders in persons with an intellectual developmental disorder (IDD) can be performed with a variety of greatly differing instruments. This makes the choice of an instrument best suited for the intended purpose challenging. In this study, we developed a comprehensive set of characteristics for the evaluation and description of assessment instruments for psychiatric disorders in adult persons with IDD. This simplifies the search for an instrument as it makes an easy and direct comparison possible and hereby allows a more thorough and appropriate decision making when selecting assessment tools. METHOD: A mixed-methods approach was used. First, a systematic literature search was conducted to identify existing tools for the description and evaluation of assessment instruments. Second, the content of these tools was combined and missing features and IDD-specific attributes were added. Finally, expert consultations were performed. RESULTS: The Characteristics of Assessment Instruments for Psychiatric Disorders in Persons with Intellectual Developmental Disorders (CAPs-IDD) lists characteristics to evaluate and describe instruments for psychiatric disorders in persons with IDD. It comprises two sections: first, the conceptual and measurement model; second, the psychometric properties. Each section consists of various subsections and a detailed response format for coding instruments. CONCLUSIONS: The use of the CAPs-IDD helps to identify and choose instruments that best suit the respective purpose. Filled with information, it could be made accessible via new technologies to researchers and practitioners and be updated when new information is available. Thus, it contributes to a more reliable and valid assessment of possible psychiatric disorders in persons with IDD.

[The modification of the metal ceramic bond by blended gold coating]. / Beeinflussung des metallkeramischen Haftverbundes durch Blendgoldbeschichtung.

The esthetic appearance of porcelain-fused-to-metal restorations is often compromised in areas in which the ceramic veneer has to be kept very thin. In order to overcome this esthetic problem, bonding gold products are offered by dental manufactures which act as an alloy seal, thereby improving the natural color appearance of the ceramic veneer. In addition, the bond strength between ceramic materials and alloys is said to be maintained or in some cases even increased. The present study investigated the effect of various types of bonding gold layers on strength of the bond between ceramic materials and numerous dental alloys as a function of the type of alloy used, using thermocycling over a period of two months with a total of 85,000 temperature changes. The analysis of the results obtained shows that, contrary to manufacturers' claims, only two of the eight bonding gold products can be recommended, and only for three of the twelve alloys tested, as far as the alleged added adhesion is concerned. Only very few combinations of alloys and bonding gold products did not adversely affect adhesion at all or only insignificantly.

Light and electronmicroscopic examination of calf lung tissue after left ventricular assisted circulation with the spindle pump.

The influence of the spindle pump, a nonpulsatile blood pump, used as LVAD on calf lung tissue was examined by means of the actual 16th protoype which was applied in 3 "acute" tests up to 13 hours of pumping duration and 8 prolonged experiments with pumping periods up to 63 hours. Samples were taken during the operation and after exitus of the test animal and investigated by light and electronmicroscopy. Histological findings of tissue changes could be ascribed to mechanical manipulations and shock-like influences. Regardless of the time of nonpulsatile perfusion this tissue damage remained within an acceptable range, indicating the absence of a deleterious effect of nonpulsatile flow.

The spindle pump. Development of a nonpulsatile blood pump for assisted circulation.

The spindle pump is a combined working nonpulsatile blood pump, i.e., a centrifugally propelling device. This special concept was chosen to tackle the main problems of nonpulsatile pumps, such as thromboembolic complications, sealing difficulties, and traumatic hemolysis. The first two of these problems were relatively simple to solve compared with the third problem--traumatic hemolysis. Various modifications and constructive steps of the spindle pump were necessary to keep stress on blood components within adequate limits. The actual prototype--tested in three acute experiments and eight experiments with a longer pumping duration (the longest lasting 63 hours)--is described in extenso, and its development is discussed.

Left heart assistance with the spindle pump.

The spindle pump--a new attempt at assisted circulation--was developed to prevent the main problems of nonpulsatile blood pumps, i.e. traumatic hemolysis, thrombus formation and sealing. It was essential to achieve adequate output with the lowest possible speed in order to minimize traumatic hemolysis. The result was a spindle pump with three windings in a U-shaped housing driven by an electric motor. Many tests were necessary to establish a prototype. The spindle was completely redesigned several times to reach an acceptable volume output and corresponding pressure output. In animal experiments this final prototype working as a LVAD, with a speed of 5400 RPM circulates 4 liters/min against BP of 110 mmHg. The hemolysis rate has been low in acute and survival experiments (27 hours up to now), and is between 25 and 30 mg/100 ml of free hemoglobin, thus within the normal range.

Artificial heart and cardiac transplantation: report on the first European combined procedure.

It became necessary to perform a staged procedure by means of total artificial heart followed by cardiac transplantation in a 26-year-old, female patient. The Ellipsoidheart, as an artificial heart, fitted excellently in the chest without compromising the surrounding structures. As soon as the patient recovered with the artificial heart, a consecutive transplantation was performed. This first European clinical experience gained confidence and suggests applying more artificial hearts as a bridge towards transplantation.

Endoscopic sealing of infected bronchus stump fistulae with fibrin following lung resections. Experimental and clinical experience.

Bronchus stump insufficiency following lung resection, with an average incidence of 4%, is a serious complication which carries a mortality of up to 90%. Operative transthoracic approaches have been largely unsatisfactory because of the high operative risk and rapidly spreading infection. In an experimental study on 18 pigs, endoscopic occlusion of infected bronchus stump fistulae was achieved with fibrin sealant (1 ml, 500 units/ml thrombin, 3500 units/ml aprotinin) applied via a flexible bronchoscope. During autopsy, all bronchus stump fistulae were found to have healed after the second postoperative week. Transitory local abscesses of the pleura could be prevented by high-dose systemic antibiotic therapy for 5 postoperative days but not by antibiotics added to the fibrin sealant. This endoscopic method has already been performed successfully in 3 clinical cases; additional sclerotherapy with (2-3 ml Ethoxysclerol applied around the fistula orifice was carried out before fibrin sealing to stimulate fibrosis. Endoscopic controls demonstrated fistula closure by granulation tissue after 2 weeks. This procedure could become the method of choice for infected postoperative fistulae of the bronchus stump and should be attempted in any case before operative approaches are considered.

A new hydraulic heart assist device.

For the right drive of a hydraulic biventricular assist device (HBVAD), a new lightweight magnet with a permanent magnetic armature was constructed. A miniature optically incremental position sensor was developed, which is an integral part of the control loop of the driving unit, and was incorporated in the armature. Mock circulation tests proved the stability of the drive and showed the expected sensitivity to the preload pressure. In vivo experiments in calves were carried out in order to test its haemodynamic efficiency on a beating and on a fibrillating heart, and to test the mutual interaction of the left and right hydraulic assist devices (LVAD, RVAD) via the vascular system. Both drives were controlled independently, operating in the volume-controlled mode. For the modelling of a heart disease, the heart was blocked by the administration of verapamil (Isoptin). It could be shown that the HBVAD is able to maintain the circulation. Various tests with the left and/or right drive active showed distinct unloading effects for the natural heart and proved the mutual interaction of both drives via the vascular system. An inherent feature of the hydraulic drive system is its ability to be triggered by a (weakly) beating heart. The preload sensitivity of the HBVAD was tested by the administration of adrenaline. Similar reactions of the drives resulted for a beating and for a fibrillating heart, showing the regulation characteristic according to Starling's law.

Hydraulic driving unit and control system for artificial hearts.

A driving unit for artificial ventricles was constructed in which the power transmission is hydraulic. This avoids the danger of an air embolism, which is characteristic of pneumatic drives in the case of membrane rupture. An electromagnet as a power source drives a rolling membrane pump to move the transmission fluid to the artificial ventricle. This incompressible connection allows direct control of membrane motion and pumped blood volume simply by measuring the armature stroke. The volume-controlled mode is characterized by automatic self-regulation according to Starling's law and self-synchronization when the drive is used as a left (or right) ventricular assist device. Several measures were taken to increase the operational safety. The hemodynamic efficiency of the drive was tested in a number of in vivo experiments. The long-term stability was proven in a 12-month durability test.

Orthotopic heart replacement by nonpulsatile axial blood pumps.

In the last decade, there have been many experiments with nonpulsatile blood pumps to perform functional heart replacement by biventricular assist devices. To determine if life is sustainable with nonpulsatile blood flow, two nonpulsatile blood pumps were implanted in the orthotopic position as an artificial heart after removal of the natural heart in extracorporeal circulation. In three preliminary experiments, the feasibility of total heart replacement with nonpulsatile implantable blood pumps was shown.

The spindle pump--a new concept for a nonpulsatile bloodpump.

The spindle pump--a new nonpulsatile bloodpump--has been developed as paracorporeal ventricular assist pump. The experiments with calves clearly demonstrated, that this pump as LVAD empties the left ventricle completely, the aortic pressure curve showing the typical nonpulsatile profil. A problem is the traumatic hemolysis, the free hemoglobin was in all experiments slightly but always above our standard. To solve this problem we will optimize shapes of the spindle and of the housing and coate all parts of the pump with polyurethane.