Herz
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It has been suggested that the myocardial perfusion can be qualitatively and quantitatively assessed by different ultrasound contrast techniques. It has been reported that the intracoronary or intraaortic administration of the ultrasound contrast agents can be used to visualize perfusion defects or to analyze the coronary flow reserve. The perfusion analysis after intracoronary injection of ultrasound contrast agents seems to be established, but there are a lot of open questions. ⋯ At the moment myocardial intensity will be increased after intravenous injection of transpulmonary contrast agents, but the value for perfusion analysis has not been shown. New ultrasound technologies such as second harmonic imaging, power-mode and raw data analysis have to show the clinical importance of these techniques for perfusion analysis in daily clinical routine. The open questions of the perfusion analysis by contrast echocardiography will be discussed in this review article.
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The term quality assurance is becoming increasingly important in medicine. Quality assurance has paved its way into the health reform laws as well as into the professional guidelines for physicians. ⋯ Quality assurance is thus turning into an important factor in medical practice and will gain relevance where diagnostic and therapeutic standards are to be set and met. This study gives an overview of status and development of quality assurance and its management in present and future medicine.
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An important aspect of quality assurance in cardiac surgery covers the epidemiological analysis of patient data. After an 8 year period of clinical experience with quality assurance, we summarize and evaluate current concepts and actual experiences regarding a special type of database application and organisation ("feedback-control-system") for quality assurance. It had been developed to meet and solve the problems related to the data acquisition process, that are typically present in the clinical routine of quality assurance. ⋯ The high acceptance of the database system is related to the advantages it provides for every participant. We conclude that the concept of data evaluation and improvement by means of "output functions" and "integration of data acquisition in clinical routines" has proved to be efficient in everyday practice. The sensitivity and specifity to such a feedback controlled system as a tool for measuring surgical quality, however, still remains a matter requiring further research.
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Short-term and long-term results are the classical parameters for quality assurance in coronary artery bypass graft surgery (CABGS). In contrast, waiting times and the inherent risks of waiting lists are usually neglected. Although the problem of "death on the waiting list" is generally known, related publications are scarce. ⋯ The reduction of waiting times by the factor of two between 1994 and 1996 did not, however, influence the death on the waiting list, because all deaths occurred within 4 weeks after diagnostic catheterization. Our results show that triage practices for patients requiring CABGS are not reliable. To minimize the risk of the "death on the waiting list", CABGS must be offered within a week after diagnostic coronary angiography, even for "elective" cases.