Biomedical subjects
Anja Tuulonen
Publications and source records attributed to Anja Tuulonen.
The effects of structures on decision-making policies in health care.
BACKGROUND: There is plenty of evidence in the literature indicating how difficult it is to recognize, question and eventually change our current mental models of the structures and decision-making processes in health care. The citizens of western countries are offered more health care services than ever and report themselves to be somatically healthier than ever. Paradoxically, many health care systems claim to be in a state of crisis, for which the cure is believed to more services and more money. Growth is a major feature of modern medicine and most people assume that more medical care must lead to improved health and wellbeing. However, adding more resources and more health care may also have counterintuitive effects. OBJECTIVE: This perspective describes common phenomena seen in our health care structures and searches for reports and results that may challenge some of the 'self-evident' solutions to these problems. RESULTS AND DISCUSSION: Most organizations and systems learn poorly and it is difficult to recognize how we contribute to our own problems and crisis. Even if the evidence has been apparent for decades, it may simply be ignored or rejected when it is inconsistent with the underlying beliefs. Learning seems to be associated more with attitudes and mental models than with evidence. As we are part of the health care structure, we share responsibility for problems generated by the system. It is time for health care professionals to study and question the efficacy of our current paradigms and practices.
A pilot experiment using a network camera in ophthalmic teleconsultation.
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Is more always better?
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Optic disc biomorphometry with the Heidelberg Retina Tomograph at different reference levels.
PURPOSE: The Heidelberg Retina Tomograph (HRT) is a confocal scanning laser tomograph that produces high resolution optical section images of the optic disc and central retina. Measurement accuracy and reproducibility is good. Several of the stereometric variables depend on the definition of a reference plane level. The purpose of the present study was to evaluate the four different reference levels in terms of their advantages and disadvantages in clinical work. METHODS: Sixty-seven randomly chosen eyes belonging to 67 subjects were included in this study. Forty of the eyes were healthy and 27 had glaucoma. The HRT with software versions 1.09 and 1.11 was used to acquire and evaluate topographic measurements of the optic disc. Image analysis was performed at four different reference levels: 320 microm fixed offset reference level (REFd) (version 1.09), an individually determined reference level (REFi), a papillo-macular reference level (REFm) and a flexible reference level (REFf) (version 1.11). ANOVA was used to determine differences in the topographic parameters between the reference levels. RESULTS: In terms of the healthy eyes, all the variables using different reference levels give rather similar results. However, with advanced glaucoma the measurement values provided with REFd are clearly different to those of the other reference levels. The measurement values using REFm and REFf provide fairly similar results in all clinical groups. REFf indicates the lowest point in the segment between 350 degrees and 356 degrees along the contour line and thus provides the most stable and clinically useful reference level at present. CONCLUSION: At present, the flexible reference level REFf gives the most reliable and adequate HRT measurement values, both in normal and in glaucomatous eyes.