This study was carried out to estimate the direct and indirect costs associated with asthma and chronic obstructive pulmonary disease (COPD) in Sweden in 1980 and 1991, and to identify trends in the use of outpatient care, drugs and inpatient care, and the development of temporary morbidity, permanent disability and mortality for asthma and COPD. Routinely published administrative and population data were used to estimate the costs of asthma and COPD, and these figures were compared to corresponding estimates and trends for all respiratory diseases as well as for all diseases. Asthma and COPD each accounted for about SEK 3 billion, together roughly 2% of the economic cost of all diseases. Although the total costs associated with each disease were similar, the distribution of the different cost components and changes in each component over time differed. During the 1980s, the cost of drugs and out-patient care increased for both diseases. The cost of inpatient care for asthma decreased, whereas that for COPD increased. This study shows that asthma therapy has changed from inpatient to ambulatory care in Sweden, while the treatment of COPD to a higher degree still is based on inpatient care.
Searches for information that can be concentrated in one system saves time. Alerts inevitably draw physicians' attention to the information. Instant availability to drug recommendations in a computerised prescribing system such as Janus should increase adherence to recommendations, but this needs to be evaluated systematically. Small-scale pilot studies such as the one reported here have been shown to be invaluable in providing the theoretical basis for implementation of the system and for gaining an understanding of the complex change processes involved. Small-scale projects can therefore provided a base for further development and broader implementation of pharmacological tools and services.
Transcutaneous PO2 (tcPO2) measurement is a non-invasive method which gives continuous information about central PO2. The method has previously been testes primarily on newborns and adults, and reports on the applicability of the method on the fetus during labor are still scanty and restricted to case reports. This paper reports on a systematic study of intrapartum fetal and maternal tcPO2-monitoring. The material is comprised of 19 parturients, the majority being nulliparae. All fetal presentations were vertex. The tcPO2 recordings averaged one hour in duration (Tab. I). FHR was recorded simultaneously. In 12 cases the electrode was affixed with glue, and in 7 cases a suction device was used for fixation. The electrode was attached when the cervix was dilated 4 to 6 cm. The mean tcPO2 was 20 mm Hg in the beginning of the registration, and showed a small decline in level throughout labor reaching 14 mmHg at the end of the registration period (Fig. 5). These values are in good agreement with those found by other authors in previous investigations. In some of the present cases, very low tcPO2 values were recorded. The relevance of these low tcPO2 values is unclear, and it is impossible to determine to what extent these tracings have true physiological relevance versus might be due to technical factors.
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