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Biomedical subjects

G France

Publications and source records attributed to G France.

15 recordsLinked to original sources
PubMed2000

Health technology assessment in Italy.

Italy has a national health service (SSN) dating to 1978. Italy's system of government is characterized by a rather high degree of decentralization of power, and the health system is likewise decentralized. Most of the responsibilities for health care have been ceded to the regions. The state retains only limited coordinating and supervisory powers. The state has a financial responsibility for the national health service, but state contributions are limited and expenditures in excess of this made by the region must be financed from other sources. Health reforms of 1992-93 aimed at making the regions more sensitive to the need to control aggregate expenditure and to monitor measures to promote efficiency, quality, and citizen-patient satisfaction. The diffusion of individual health technologies has been relatively uncontrolled in many regions in Italy, although tight central constraints on capital spending have contained diffusion of new technology. Regulation of placement of services is a planning function and is the responsibility of both the Ministry of Health and the regions. Health technology assessment (HTA) activities have been expanding since the early 1990s, but these activities tend to be untargeted, uncoordinated, and without priorities. Nonetheless, the principal actors in the SSN at national, regional, and local levels are becoming more sensitive to the need to apply criteria of clinical and cost-effectiveness and to be more rigorous in deciding what services to guarantee. There are reasons to be guardedly optimistic about the future of HTA in Italy.

Delivery of Health Care↗
PubMed1994

Analysis and modelling of the structures of beta-cyclodextrin complexes.

A systematic computer graphics study of all available beta-cyclodextrin crystal structures has been carried out specifically to aid in the modelling and design of beta-cyclodextrin-drug complexes. The analyses show that the basic conformation of the molecule remains constant among natural, mono-substituted and partially permethylated beta-cyclodextrins, with major changes observed only in the case of full permethylation. In all the structures, however, there are no significant perturbations caused by guest molecule inclusion. On the basis of these observations models are proposed for the structures of beta-cyclodextrin-indomethacin complexes, the principal features of which are shown to be consistent with the data obtained in 1H-NMR studies.

Carbohydrate Sequence↗
PubMed1994

Centralised versus decentralised funding of evaluative research: impact on medical technology policy in Italy.

Medical technology assessment in Italy is considered to have had scant impact on policy. Government has played a limited role in financing evaluative research and increased public funding might therefore be expected to have a positive effect on the contribution that this activity makes to policy. The choice of arrangements for such funding, however, must take account of the broader institutional context in which these operate. Intergovernmental relations in any country are inherently difficult due to the fact that the distribution of powers is in general poorly specified and to a tendency for central government to try to impose itself. Budgetary difficulties may exacerbate the problem. Italy has quite a decentralised system of government and there has been significant disagreement over how to interpret the intergovernmental distribution of powers, including those relating to health care. Central government has also had difficulty in that sector making lower governments accountable for how they spend their central grants and for budget deficits. This has created serious problems for the implementation of medical technology policy developed at the centre. This state of affairs counsels against adopting funding arrangements for evaluative research in which central government plays a dominant role. Probably the most appropriate solution is that of a partnership between the centre and the Regions with each party having an equal say on the medical technologies studied, the evaluative methodologies adopted and how the data produced are used in policy development.(ABSTRACT TRUNCATED AT 250 WORDS)

Budgets↗
PubMed1992

Dolce vita.

Explore the source record for details and available documents.

Contract Services↗
PubMed1988

Emerging policies for controlling medical technology in Italy.

This article begins the sketching out the constitutional arrangements in Italy for the distribution of powers among different levels of government. The more important characteristics of the health system are then examined in some detail, the aim being to provide a sufficient basis for understanding the analysis of technology policy which follows later. The mechanisms used for funding medical technology are next described, after which data available on the diffusion of medical equipment are illustrated. Medical technology policies at the national and regional level are examined and an attempt made to appraise their effectiveness. The article concludes with a brief analysis of the possible role played by private medicine in the diffusion of medical technology in Italy.

Capital Expenditures↗
PubMed1985

Sequential sodium therapy allows correction of sodium-volume balance and reduces morbidity.

We investigated whether individually adjusting Na+ dialysis levels (Na+Di) combined with Na+ and UFR (ultrafiltration rate) programming, and a sodium/volume model (sequential sodium therapy, SST) can improve the end stage renal failure (ESRD) patient's homeostatic equilibrium intra- and interdialytically. One hundred and fifty patients were included in the study over a one year period. The results show that the patients are divided into two groups: 50 patients respond according to the sodium/volume model developed by F. Gotch [1983]. In this group it is possible to predict pre- and post dialysis plasma Na+ concentration (Na+o, Na+t) as a function of Na+Di and it becomes possible to choose Na+Di to allow Na+o and Na+t to virtually coincide, eliminating severe shifts in plasma tonicity. In the second group two subgroups can be distinguished: excess Na+ or excess H2O post dialysis, without possible correction at a single sodium level. SST corrects sodium/volume balance in this group by using sequential intermittent hypo or hypertonic dialysate, combined with fluid removal adapted to each episode. In both groups there was a significant improvement in the clinical condition of the patients who previously were less equilibrated. It is possible to conclude that SST improves tolerance intradialytically and achieves better equilibrium interdialytically. Implementation of SST requires precise control of the concentrate and the water, and equipment adapted for accurate, programmable sequential control of Na+Di and ultrafiltration rate.

Adolescent↗
PubMed1984

[Our experience with autotransplantation and cryopreservation of parathyroid tissue in thyro-parathyroid surgery].

Results are reported of four and a half years of experience with autotransplantation and cryopreservation of parathyroid tissue in thyro-parathyroid surgery. One hundred patients with hyperparathyroidism secondary to renal insufficiency were treated by total parathyroidectomy and partial autotransplantation, immediate in 98 cases and secondarily using their frozen stored tissue in the other two cases. Results were compared with those in 13 other patients treated during the same period by subtotal parathyroidectomy. Seven of 46 patients with primary parathyroid hyperplasia underwent total parathyroidectomy with immediate partial autotransplantation. Grafts were not used in the other two previously cervicotomized patients. All parathyroid tissue removed during these operations was frozen and stored if not used for grafting. Of 116 patients treated by enlarged total thyroidectomy for cancer, 34 received parathyroid autotransplants; complementary in 19 cases and substitutive in 15. Technique and results are described, and respective indications for autotransplantation and parathyroid cryopreservation discussed with respect to primary, secondary, persisting or recurrent hyperparathyroidism, and to total thyroidectomy for cancer.

Calcium↗
PubMed1983

[Parathyroid autotransplantation during expanded total thyroidectomy for cancer].

Autotransplantation of the parathyroid gland was performed in 28 out of 95 patients undergoing total thyroidectomy for carcinoma. The autotransplantation was supplementary in 15 patients who kept at least one parathyroid gland in the neck and substitutive in 12 patients who had total cervical parathyroidectomy. After 1 to 30 months' follow-up none of these patients had signs of hypoparathyroidism. The incidence of permanent hypothyroidism after total thyroidectomy was reduced from 7% to 2.1%. However, autotransplantation should be considered as a means of saving any cervical parathyroid that cannot be preserved and has been shown by histopathological examination to have escaped invasion by the carcinoma.

Adult↗
PubMed1983

[Parathyroid autotransplantation in hemodialysed chronic renal failure. Attempts to modulate secretion. First results apropos of 45 cases].

The authors report their experience of parathyroid autotransplantation in 45 cases of renal insufficiency undergoing hemodialysis. The operation, carried out by two teams, reduces to the minimum the time during which the grafts are exposed to environmental factors likely to impair their function. An immediate anatomopathological examination is necessary to determine the degree of hyperplasia in each gland and the corresponding choice of grafts. The tissue to be implanted must be raised in the least hyperplastic gland and the size of the graft, always difficult to specify, is dictated by the intensity of the hyperplasia. This technique ultimately permits and almost permanent modulation of the parathyroid secretion by action on the secreting tissue. In the event of post-operative persistent hypoparathyroidism, a second operation is desirable, using cryopreserved fragments for the implant. Conversely, in the event of clinical and biological recurrence, the ablation of a precise volume of grafted tissue can be performed without difficulty, under local anaesthetic.

Adult↗
PubMedDate not supplied

Results of reoperations for persistent or recurrent secondary hyperparathyroidism in hemodialysis patients.

Among 258 patients operated on for secondary hyperparathyroidism (HPT II) from 1971 to 1988, a total of 33 had one or more reoperations for persistent or recurrent HPT II. These reoperations did not induce any mortality or significant morbidity. After inadequate parathyroidectomy (25 cases), 15 patients were reoperated. Twelve of these had undergone initial surgery at another institution. Three patients died of causes unrelated to their HPT II. The other 12 patients are disease-free. After successful subtotal parathyroidectomy (79 cases), 2 patients (2.5%) had a recurrence 5 and 6 years later, respectively. Currently, the 2 patients remain disease-free. After total parathyroidectomy with autotransplantation (152 cases), 16 patients (10.5%) had reoperations on the grafts. The mean time before reoperation was 2 1/2 years. Hypertrophy of grafted fragments was observed in 4 cases (2.6%), but only 2 of these 4 patients were cured by removal of the grafts. Residual parathyroid tissue or a supernumerary gland in the neck or the mediastinum was suspected in 5 patients, but this could not be confirmed because one had already been reoperated on in the neck without success, another still refuses reoperation, and 3 died. In 6 other patients, the recurrence was debatable and HPT II was not confirmed. In the last 3 patients, the diagnosis was incorrect and aluminum intoxication was proved later. Results of reoperations for persistent or recurrent HPT II depend, first, on a correct diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Surgical treatment of secondary hyperparathyroidism in hemodialyzed patients with chronic renal failure. Results and choice of a technic].

Results are reported of surgical treatment of hyperparathyroidism secondary to chronic renal failure in 231 patients who had undergone 250 operations over 16 years: 152 total parathyroidectomies associated in 151 cases with an autotransplant, 58 subtotal parathyroidectomies, 9 incomplete parathyroidectomies, I white cervicotomy and 39 repeat operations for persistent or recurrent hyperparathyroidism. Results were evaluated clinically, biologically and radiologically after a mean follow up of 4 years, and were rated good in 71.4% of cases. The quality of the results was independent of the type of parathyroidectomy practised: 71% good results after total parathyroidectomy with autotransplantation and 69% after subtotal parathyroidectomy. No significant difference was demonstrated between the two techniques with respect to mortality, postoperative morbidity and late complications. The only divergence seen was in relation to recurrences: recovery surgery at the cervical level after subtotal parathyroidectomy leaving a clearly identified glandular stump associated with a better result than repeat operation on grafts at brachial level after total parathyroidectomy and autograft. These results led to the adoption of a surgical routine for hyperparathyroidism secondary to chronic renal failure using subtotal parathyroidectomy combined with bilateral thymectomy. The operation of total parathyroidectomy without immediate autotransplant is reserved for cervical recovery surgical procedures. Whatever the technique used, frozen storage of removed tissue is the indispensable complement of parathyroidectomy.

Follow-Up Studies↗