Cost of Alzheimer's disease in a developing country setting.

PURPOSE: To evaluate the economic impact of AD in Denizli, Turkey. DESIGN AND METHODS: This observational study was conducted with 42 AD patients and their primary caregivers. During the initial interview, demographic data and medical histories were collected with questionnaires. For an observational period of 15 days, data on time spent for patient care were collected using standard forms. Calculations on direct cost (e.g. per day medication, outpatient physician visits during the last 3 months), indirect cost (e.g. time spent for care by caregiver for daily living (ADL) and instrumental activity of daily living (IADL)) were made by summing up and taking averages of the appropriate items. ANOVA, and linear regressions were the methods for comparisons. RESULTS: The primary caregivers of the patients mainly were their children and/or spouses. The maximum mean time spent (h/week) was 21.0 (17.5) for severely damaged cognition. The average annual cost per case was between $1,766 [95% Confidence Intervals (CI); 1.300-2.231] and $4,930 (95% CI; 3.3714-6.147). The amount of caregiver cost was the most significant item in the overall cost and it showed an increase with the declining cognitive function of patients. Daily medication cost reflected the same pattern. In contrast, cost of outpatient physician was the lowest among the patients with the worst cognition. CONCLUSIONS: These results suggest that recently AD has become a significant cost for developing countries. This pilot study gives an idea of the cost of AD in developing countries where determining the actual cost can be difficult.

Teleradiology in urology: comparison of digital image quality with original radiographic films to detect urinary calculi.

PURPOSE: Teleradiology systems are now being evaluated as a mechanism to provide rapid, accurate and cost-effective diagnostic radiographs to off-site physicians. Little data are available on the role and safety of teleradiology in urology. To address these issues a personal computer based system was developed to assess the diagnostic accuracy and ease of use of transmitted digital images when evaluating for urinary calculi. MATERIALS AND METHODS: A total of 100 plain abdominal scout films from excretory urograms performed during acute urological referrals was digitized on a laser scanner. The 10 megabyte files were transferred over public telephone lines and written to compact disks. The images were viewed on a 1280 x 1640 resolution monitor using "Imager-3D" software run on a 133 MHz. pentium personal computer with 32 megabytes of random access memory. Two faculty urologists and 2 urology fellows each looked at 50 original radiographs and 50 digital images. Diagnostic interpretations of the presence and location of calculi were recorded, and confidence in the diagnosis, assessment of image quality and diagnostic difficulty were scored using a numerical scale. RESULTS: The accuracy for all readers was 86.5% for plain radiographs and 81.5% for digital images (p >0.2). There was no statistical difference between faculty and fellows. Diagnostic accuracy did not differ between plain films and screen images when the results were assessed with respect to image quality, diagnostic difficulty or the reader confidence in the diagnosis (p >0.1). Compared to plain films, more screen images were classified as lower image quality (60 versus 40%) and the diagnostic confidence was lower (low and medium grade 50 versus 35%), although this did not interfere with diagnostic accuracy. CONCLUSIONS: These data imply that a high quality affordable teleradiology system is effective and accurate compared to plain films for assessing urinary calculi.

Digital radiographic imaging transfer: comparison with plain radiographs.

Advances in digital imaging and computer display technology have allowed development of clinical teleradiographic systems. There are limited data assessing the effectiveness of such systems when applied to urologic pathology. In an effort to appraise the effectiveness of teleradiology in identifying renal calculi, the accuracy of findings on transmitted radiographic images were compared with those made when viewing the actual plain film. Plain films (KUB) were obtained from 26 patients who presented to the radiology department to rule out urinary calculous disease. The films were digitalized by a radiograph scanner into ARCNEMA-2 file format, compressed by a NASA algorithm, and transferred via a 28.8-kbps modern over standard telephone lines to a remote section 25 miles away, where they were decompressed and viewed on a 1600 x 1200-pixel monitor. Two attending urologists and two endourologic fellows were randomized to read either the transmitted image or the original radiograph with minimal clinical history provided. Of the 26 plain radiographic films, 24 were correctly interpreted by the fellows and 25 by the attending physicians (92% and 96% accuracy, respectively) for a total accuracy of 94% with no statistical difference (p = 0.16). After compression, all but one of the digital images were transferred successfully. The attending physicians correctly interpreted 24 of the 25 digital images (96%), whereas the fellows were correct on 21 interpretations (84%), resulting in a total 90% accuracy with a significant difference between the groups (p < or = 0.04). Overall, no statistical difference between the interpretations of the plain film and the digital image was revealed (p = 0.21). Using available technology, KUB images can be transmitted to a remote site, and the location of a stone can be determined correctly. Higher accuracy is demonstrated by experienced surgeons.