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48 Care and follow-up of non-insulin treated diabetics in metropolitan France in 1998 Weill A. Ricordeau P. Vallier N. Bourrel R. Fender P. Allemand H. Diabetes and Metabolism (2000) 26:SUPPL. 6 (39-48). Date of Publication: 2000 The statistical analysis of French HealthCare's database allows a retrospective evaluation of the overall clinical care given to diabetics in the light of the guidelines (RBPC) promulgated by the National Agency of Health Accreditation and Evaluation (ANAES). This database contains no information on the stage of the disease process, the completeness of the clinical evaluation (neurological or foot examination) or the results of significant blood tests. We studied the follow-up care given to diabetics whom we were able to identify by isolating reimbursements for hypoglycemic agents using their corresponding drug codes. Considering the time needed for this new drug-coding system to become fully operational, the results can be extrapolated to the entire population of non-insulin treated diabetics. In 1998, almost all follow-up care was provided by general practitioners since only 5.5 % of the patients consulted an endocrinologist during the year studied. Blood sugar was generally monitored with fasting blood sugars rather than HbA1c which was only prescribed in 41.3 % of the patients during the final six months of the period under consideration. Screening and follow-up for degenerative complications were insufficient. Fewer than 40 % of the patients had received reimbursement for an ophtalmological consultation during the preceeding year and fewer than 30 % had an ambulatory resting EKG over the same time period. A certain number of factors were studied in order to determine if they were correlated to better clinical follow-up. The best follow-up was encountered in patients who had a consultation with an endocrinologist at least once during the year, those who were exonerated from co-payments (ALD 30) and finally, those aged between 40 and 59 years (at least with respect to appropriate laboratory tests). 49 Modalities of follow-up on non-insulin treated diabetics treated in metropolitan France in 1998 Weill A. Ricordeau P. Vallier N. Bourrel R. Fender P. Allemand H. Diabetes & metabolism (2000) 26 Suppl 6 (39-48) The statistical analysis of French HealthCare's database allows a retrospective evaluation of the overall clinical care given to diabetics in the light of the guidelines (RBPC) promulgated by the National Agency of Health Accreditation and Evaluation (ANAES). This database contains no information on the stage of the disease process, the completeness of the clinical evaluation (neurological or foot examination) or the results of significant blood tests. We studied the follow-up care given to diabetics whom we were able to identify by isolating reimbursements for hypoglycemic agents using their corresponding drug codes. Considering the time needed for this new drug-coding system to become fully operational, the results can be extrapolated to the entire population of non-insulin treated diabetics. In 1998, almost all follow-up care was provided by general practitioners since only 5.5 % of the patients consulted an endocrinologist during the year studied. Blood sugar was generally monitored with fasting blood sugars rather than HbA1c which was only prescribed in 41.3 % of the patients during the final six months of the period under consideration. Screening and follow-up for degenerative complications were insufficient. Fewer than 40 % of the patients had received reimbursement for an ophtalmological consultation during the preceeding year and fewer than 30 % had an ambulatory resting EKG over the same time period. A certain number of factors were studied in order to determine if they were correlated to better clinical follow-up. The best follow-up was encountered in patients who had a consultation with an endocrinologist at least once during the year, those who were exonerated from co-payments (ALD 30) and finally, those aged between 40 and 59 years (at least with respect to appropriate laboratory tests). 50 Clinical evaluation methods for new antimicrobial agents to treat respiratory infections: Report of the Committee for the Respiratory System, Japan Society of Chemotherapy Saito A. Miki F. Oizumi K. Rikitomi N. Watanabe A. Koga H. Niki Y. Kusano N. Journal of Infection and Chemotherapy (1999) 5:2 (110-123). Date of Publication: Jun 1999 The present report constitutes an attempt to improve and modify the existing clinical evaluation method for new antimicrobial agents to treat respiratory infections. One year ago, a general guideline on the clinical evaluation of antimicrobial agents to treat respiratory infections was drafted in Japanese, leaving scope for critical discussion, and this has been translated into English, as there were no major changes. In this report, respiratory infections have been discussed under the headings 'acute respiratory tract infection' and pneumonia and acute exacerbation of chronic pulmonary diseases. Standardized criteria were set for the assessment of severity of infection and effectiveness of the antimicrobial agent in question. Severity was evaluated on the basis of a combined assessment of the severity of infection and severity of the clinical condition of the patients. Clinical effectiveness of the antimicrobial agent used was evaluated on the basis of clinical outcome as well as micro- biological outcome of the trial. Body temperature, local pain, cough, change in sputum quality, peripheral white blood cell count, C-reactive protein level, and chest radiograph were used as the parameters for the evaluation. To maintain the quality of specimens to be examined, Geckler's classification of specimens was used. This report was constructed based on the analysis of large amounts of material collected over the years, incorporating internal and external factors concerning the present evaluation methods. The newly suggested standardized criteria for clinical evaluation of the new antimicrobial drugs are expected to be practiced properly hereupon and subjected to further improvement if necessary. |
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48 1998年法國(guó)大城市中非胰島素治療的糖尿病人的護(hù)理及復(fù)診/隨訪 Weill A. Ricordeau P. Vallier N. Bourrel R. Fender P. Allemand H. 糖尿病和新陳代謝 (2006) 26:SUPPL. 6(39-48). Date of Publication:2000 對(duì)法國(guó)健康護(hù)理中心數(shù)據(jù)庫(kù)的統(tǒng)計(jì)分析，使得我們可以對(duì)按照國(guó)家健康鑒定和評(píng)估署(ANAES)所頒布的指南(RBPC)對(duì)糖尿病患者的總體臨床護(hù)理進(jìn)行追溯性評(píng)估。該數(shù)據(jù)庫(kù)并不包含有關(guān)疾病治療的階段、臨床評(píng)估(神經(jīng)學(xué)或足部檢查)的完整性、或者重要的血液檢查結(jié)果等方面的數(shù)據(jù)。我們研究了對(duì)糖尿病患者的后續(xù)護(hù)理。這些患者身份是通過(guò)甄別使用相應(yīng)藥物代碼的低血糖藥物報(bào)銷單據(jù)來(lái)確認(rèn)的。考慮到該新型藥物編碼系統(tǒng)完全運(yùn)行的時(shí)間，本研究結(jié)果可被外推至所有接受非胰島素治療的糖尿病患者。在所研究的1998年度，幾乎所有后續(xù)護(hù)理都是由全科醫(yī)師實(shí)施的，而僅有5.5%的患者向內(nèi)分泌專家進(jìn)行咨詢。血糖主要通過(guò)禁食（空腹）血糖跟蹤監(jiān)測(cè)而非HbA1c，只是在所考慮周期的最后6個(gè)月中，也僅有41.3%的患者按醫(yī)囑進(jìn)行HbA1c監(jiān)測(cè)。對(duì)退行性并發(fā)癥的甄別和隨訪不充分。上一年度少于40%的患者報(bào)銷了眼科咨詢費(fèi)，而在同一時(shí)期少于30%做了非臥床靜止心電圖檢查。對(duì)一些因素進(jìn)行了研究，以便確定它們是否與更佳的臨床復(fù)診相關(guān)。碰上最佳復(fù)診的是那些該 年度中至少一次咨詢過(guò)內(nèi)分泌專家的患者，那些幸免于支付共付醫(yī)療費(fèi)(ALD 30)的患者，最后還有那些年齡在40至59年的患者（至少對(duì)于適宜的實(shí)驗(yàn)室試驗(yàn)是如此）。 |
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