Unnecessary arterial Doppler examination of the legs. Clinical decision rules may help?

Health resources consumption depends mainly on physicians prescription habits. We identified reduction of unnecessary prescribed lower limbs arterial Doppler examinations as an area of potential cost control and quality improvement. We designed therefore a screening method based on clinical decision rules derived from epidemiological considerations: study of our records showed that patients with normal clinical examination and low risk factors score could be considered free from arterial disease by clinical grounds only, and that patients with normal clinical examination and very high risk score needed an extensive noninvasive evaluation. By offering a screening clinical examination (needing a working time shorter than a Doppler examination) with short waiting lists, we were able to safely exclude many normal patients from extensive Doppler examination, improving effectiveness by reducing total examination time by 22% and service quality by a Doppler examinations scheduling based on clinical severity judgement.

[Liver cirrhosis. Survival of a homogeneous population]. / Cirrosi epatica. Sopravvivenza di una popolazione omogenea.

The aim of the study was the evaluation of survival of 140 cirrhotic patients who had a liver biopsy between 1970 and 1987. It is interesting to point out that all the patients with cirrhosis were included in the study and that they were all coming from a limited geographic area. This justifies the limited drop-out (7/147 patients). The high survival rate could be due to the fact that only patients suitable to receive a liver biopsy were elected for the study. We found that factors critical for prognosis in the short term (6-12 months) are biochemical values such as prothrombin index, serum albumin, serum bilirubin, alkaline phosphatase, while the factors affecting long-term prognosis are age, sex, etiology of cirrhosis, high alcohol intake after biopsy, ascites and untreated portal hypertension.