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PubMed1980

Health Care Financing Administration--Exclusion of heart transplantation procedures from Medicare coverage. Notice of HCFA ruling to discontinue medicare coverage of heart transplantation procedures.

This notice announces a HCFA ruling discontinuing Medicare coverage of heart transplantation. In Novemford University Medical Center, pending development of final criteria for coverage of heart transplantations at Stanford and other institutions. However, our continuing review of the question of coverage has disclosed the existence of a number of important issues, such as patient selection and potential social and economic implications, and a lack of sufficient current information to support development of generally applicable coverage criteria. Consequently, HCFA is now excluding heart transplantations from Medicare coverage until appropriate criteria can be issued.

Federal Government↗
PubMed1999

[Comparison of accreditation procedures, ISO 9000 certification procedures and total quality management. Personal experiences and application of quality assurance in a department of radiology and medical imaging].

Management of quality assurance protocols in a radiology department can be done by using several tools or models. Some are specific like accreditation manuals issued by some organizations, others like the ISO 9000 certification and the Total Quality management are more general and already well known by manufacturers. In order to implement a process of quality improvement, we have reviewed three models of quality assurance: evaluation in total quality based on the European model "EFQM", accreditation based on booklets from French cancer centers and Canadian radiology centers and, finally, accreditation based on the ISO 9002 certification model. Based on results of our comparative study, these three tools of quality management are not contradictory and may be complementary. However, they can be compared in terms of constraints they impose, of their historical background, of the criteria evaluated as well as the role of different teams. In conclusion, we suggest that directors of radiology department interested in implementing a quality assurance program first evaluate their department using the Canadian accreditation model issued in 1993 which is useful to become familiar with this new concept of quality. In a second step, a self assessment using the EFQM has to be done in collaboration with all members of the administration board in order to integrate all parameters and to share this protocol with all decision makers. The last step is to consolidate the organization of the quality assurance protocols by means of the ISO 9002 certification.

Accreditation↗
PubMed2001

Sensory nerve somatosensory evoked potentials as add-on diagnostic procedure to imaging procedures in patients with sciatica.

The aim of the present study was to evaluate the ability of sensory nerve somatosensory evoked potentials (SEP) to discriminate between lumbar spine computed tomography (CT) findings with and without relevance for the radiating sensory symptoms in patients with sciatica in whom myelography does not have such discriminatory capacity. Forty consecutive sciatic patients in whom CT without intrathecal contrast showed degenerative changes which did not cause probable compression in at least one symptomatic nerve root, or caused probable compression in at least one asymptomatic nerve root, and in whom there were corresponding discrepancies between the radiating sensory symptoms and myelographic nerve root compression, were studied. Sensory nerve SEP representing nerve roots L4, L5 and S1, were performed in all patients. The sensory nerve conduction velocity (SNCV) and the amplitude of the sensory nerve action potential (SNAP) were recorded from the stimulated nerves. The odds ratios (OR 95% CI) of the association of positive SEP to symptomatic nerve roots were 24.0 (4.8 to 54.5) in nerve roots with probable and 39.0 (5.9 to 258.9) with possible CT compression. The corresponding associations between myelography and sciatic symptoms were not statistically significant. Comparisons of SNCVs and SNAP amplitudes did not indicate that postganglionic nerve dysfunction contributed to the sensory symptoms or to the SEP results. SEP examination may be used to discriminate between CT findings with and without relevance to the radiating sensory symptoms in patients with sciatica in whom myelography does not show this discriminatory capacity.

Adolescent↗
PubMed1976

[Procedures for the early recognition of diabetics in Basle 1972. Contributions to the early diagnosis of diabetes mellitus by means of blood sugar analysis with special reference to the practical procedures under Swiss conditions].

In Basle in 1972 a diabetes survey was performed in subjects with increased risk of diabetes mellitus (overweight, age above 50, relatives of diabetics). For screening, the blood sugar was determined one hour after ingestion of 50 g of glucose. 404 males and 768 females (known diabetics excluded) were examined. One third of males and one quarter of females had a blood sugar value above 150 mg%. Blood sugar values of more than 200 mg% were found in 9% of the male and 7% of the female participants. A positive correlation existed between age and blood sugar values in males and females. Body weight and blood sugar value correlated only in females. However, in male subjects with pronounced obesity (Broca index greater than 1.23) there was a significantly higher incidence of blood sugar screening value above 150 mg% than in the rest of the males. It would appear that even slight overweight enhances glucose intolerance in females, whereas in males only marked overweight favours the manifestation of glucose intolerance. The cost of the detection of a new case of diabetes mellitus (blood sugar greater than 200 mg%) amounted to Sfr. 70.-. The Basle diabetes survey provides a model for successful conduct of a preventive program through cooperation of private organizations such as the local Medical Association and the local Diabetes Association.

Aged↗
PubMed2003

[Characteristic electrocardiographic procedures of isthmic-dependent atrial flutter; influence of clinical and echocardiographic procedures].

The appearance of the F waves on the ECG is considered to be related to the type of circuit of the anti-clockwise flutters and the clockwise isthmic-dependant flutters. In the authors' experience, the usual ECG description of these two types of flutter is not always observed. This study was undertaken to analyse the different appearances of anti-clockwise and clockwise flutters and to try and explain the reasons for these differences. Over a 4 year period, 139 patients with an ECG of atrial flutter required electro-physiological studies and echocardiography of the 156 flutters analysed: 130 were anti-clockwise and 26 clockwise. Three types of anti-clockwise flutter were observed: type 1 with exclusively negative F waves in the inferior leads: type 2 and 3 with negative F waves in the inferior leads and a small (type 2) or large (type 3) positive terminal components. The types 2 and 3 were associated with a higher incidence of left atrial dilatation, cardiac disease and atrial fibrillation than type 1. Two types of clockwise flutter were observed: type 1 with positive notched F waves in the inferior leads with a return to the iso-electric line and type 2 with wide F waves in the inferior leads with two components, predominantly positive and negative, without return to the iso-electric line. There are different ECG appearances of anti-clockwise and clockwise flutter which seem to be correlated with structural cardiac abnormalities. The anti-clockwise flutters with a positive terminal component of the F waves in the inferior leads corresponds to a subgroup with a high probability of cardiac disease and left atrial dilatation.

Atrial Flutter↗