General practitioners facing dementia: are they fully prepared?

We assessed knowledge about Alzheimer's disease (AD) in a sample of Italian general practitioners (GPs). We first carried out a propedeutic study to verify the ability of an Italian version of the University of Alabama at Birmingham's AD Knowledge Test for Health Professionals to distinguish between 20 AD specialists and 20 non-specialists and to gain reference values. We then administered the test, together with a short questionnaire, to 139 GPs attending an educational programme in November 2000. The cut-off score for discriminating specialists from non-specialists was >/=9. Among the 95 GPs who performed the AD Knowledge Test (68.3% response rate), 21% had a total score >/=9. Our findings suggest that particular focus should be given to dementia in continuing medical education (CME) programmes for GPs.

Hospital payment system based on diagnosis related groups in Italy: early effects on elderly patients with heart failure.

Prospective payment systems (PPS) based on diagnosis related groups (DRG) has recently been introduced in Italy and has already changed certain practice patterns of medical staff. Treatment of chronic diseases and those which specifically address the elderly population, such as chronic heart failure (CHF), can be strongly conditioned by this kind of system. This paper concerns an overview of CHF patients within the DRG system, supported by age-related variables, re-admission rates and cost analysis. We analyzed a sample of four hospitals in Central Italy and 1987 patients were admitted for CHF. The results show that after DRG introduction, length of stay was shorter, but re-admission rate increased, especially where the elderly were concerned. Average costs of service provision decreased, mainly due to the reduction in length of stay. However, no reduction was reported in the quality of care in terms of available diagnostic and the rapeutic resources. These early data indicate a change in the practice patterns of medical staff, including the risk of untimely discharge of elderly patients suffering from chronic diseases, for whom a long term monitoring system of service quality would be necessary.

[Analysis of the DRG rate system in cardiology. Results of a comparative study of diverse regions]. / Analisi del sistema tariffario a DRGs in cardiologia. Risultati di uno studio comparativo tra regioni.

Following the introduction of the reimbursement system for services, the use of a different rate system can have a singularly negative effect on the actual clinical activity. A discipline such as cardiology can be particularly exposed to the eventual variation in rates, and we feel it is necessary to introduce appropriate systems of analysis to deal with this problem. In the present study we carried out an analysis of the rate parameters adopted in Italy, by the Ministry and by two Regions: Lombardia and the Marche. The study took into account only the DRGs of cardiological diseases. We found that regional rates differed greatly according to the evaluation given to some diagnostic groups, inevitably determining the under valuation of the clinical complexity of some cases with the risk of a financial squeeze of certain structures. Variations in the composition of rate lists can also lead to distorted behaviour when selecting cases on condition of the quality of services given. The comparison of rates between the Marche and Lombardia regions showed a great difference in the number of subjects hospitalised for critical pathologies and stable ones, putting the wards in the Marche region in potential difficulty as their activity is aimed at more intensive and emergency therapy. The present study aims at underlining these problems, identifying the most evident inconsistencies and opening a debate on the subject.

EEG power spectrum typical of vascular dementia in a subgroup of Alzheimer patients.

A statistical comparative study was carried out between two subgroups of patients with dementia, i.e. 22 with Alzheimer's dementia (AD, 44% of the entire Alzheimer group examined) and 36 with vascular dementia (VaD, 97% of the entire vascular group). The selection of the two subgroups was based on a similar EEG spectral profile in the rest eyes closed condition: a great increase in low frequency powers and a dominant activity in the 6.5-12 Hz band. The aim was to identify any possible difference between the two groups analysing the spectral descriptors, of the two conditions eyes closed and open, the demographic figures and the mental deterioration scores. The results are as follows: (i) the spectral profiles and their numerical descriptors of the AD subgroup patients are not distinguishable from the same parametric figures of the VaD patients; (ii) the spectral analysis becomes useful in differentiating the two types of dementia when a dynamic EEG is processed, i.e. the power ratio of recordings during eyes closed and open; (iii) a more severe mental deterioration, especially in attention and spatial and temporal orientation was found in the AD group as compared to the VaD. The findings are explained in the light of the changes in neural mechanisms which underlie both the alpha and slow rhythms.

An EEG power index (eyes open vs. eyes closed) to differentiate Alzheimer's from vascular dementia and healthy ageing.

EEG differential power patterns between Alzheimer's (AD, 50 patients) and vascular (VaD, 37 patients) dementia and between these two and 36 healthy ageing subjects, were studied in the 6.5-12 Hz band of the ongoing EEG recorded during the rest eyes closed (REC) and eyes open (REO) conditions. From the EEGs (16 electrodes, 10-20 international system except for Fz, Cz, Pz), a 6.5-12 Hz band, wider than the alpha range (alpha-like), was chosen and processed to include the highest theta frequencies characterising the occipital dominant activity in dementia. A global and occipital EEG Power Index (PI) was calculated and used considering the absolute powers during REC and REO. The MANOVA was used to compare the figures. Bearing in mind that the higher the PI value the greater the difference between the 6.5-12 Hz EEG band powers of REC vs. REO, the results were as follows: (i) in the patients with Alzheimer's and vascular dementia the global and occipital PIs were significantly lower than those in controls; (ii) in the patients with Alzheimer's dementia the same PIs were significantly lower that those of the patients with VaD; (iii) healthy elderly subjects showed significantly lower powers in the 6.5-12 Hz frequencies at T5 and O1 in REO as compared to dementia patients. The pathophysiological implications and the clinical applications of these results are discussed.