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[Evaluation of quality of care in the United States].

Quality assessment in the USA has been undertaken during the past twenty years by different institutions sponsored by the Congress, the government and professional associations. The evaluation tools which were developed reflect both the diversity of the American medical scene fashions in health care management. They evolved from norms to incentives, but each step in this evolution left its marks in the form of regulations, financial incentives and traditions.

Consensus Statements as Topic↗

[Different disciplines, different diagnoses?--A survey among participants of a consensus conference on dementia].

It is hardly known to what extent consensus criteria for dementia are adhered to in clinical practice. An inquiry was held among the participants of the Dutch consensus meeting on dementia to investigate this point. 85 clinicians diagnosed the case descriptions of 10 patients with cognitive dysfunctions. The inquiry was split into two parts, i.e. before and after the meeting. There was no difference between the two parts in the level of consensus. There was not difference between the disciplines in syndrome diagnoses. However, with regard to etiology, significant differences existed between the specialties. Furthermore, the agreement increased with the severity of the cognitive disturbances. In cases where depressive symptoms coexisted, the diagnosis was more often in error. The nature of the diagnoses appeared to be dependent on the discipline of the diagnostician. This study underlines the necessity of a multidisciplinary diagnostic approach based on well accepted criteria.

Aged↗

Reflex sympathetic dystrophy syndrome: consensus report of an ad hoc committee of the American Association for Hand Surgery on the definition of reflex sympathetic dystrophy syndrome.

This report proposes that reflex sympathetic dystrophy be defined as a pain syndrome in which the pain is accompanied by loss of function and evidence of autonomic dysfunction. In the clinical setting, this diagnosis is usually associated with other anatomic and psychological diagnoses and may be associated with a variety of systemic illnesses and medicolegal factors. All components should be assessed before a treatment plan is established. Priorities should go to emergency care, acute injuries, and systemic illness, psychiatric problems, and chronic anatomic problems, in that order. Early, accurate diagnosis improves prognosis.

Consensus Statements as Topic↗