Revue médicale suisse
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Medical fee schedules are controversial. In this paper we examine the reasons that justify the imposition of fee schedules in the presence of a socially financed health insurance system, and examine the ways of constructing a medical fee schedule. ⋯ Current solutions to this problem--audit of doctors' average cost per case, freeze on new medical practices, or the insurers' discretion in choosing the doctors they reimburse--have multiple drawbacks. Alternatives to fee-for-service payment--such as flat fees, or payment based on the quality of medical services--are discussed.
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Episodes of delirium are present in a significant number of hospitalised patients. Prevention is essential, because, when established, delirium has a negative impact on clinical outcomes (morbidity and mortality). ⋯ Pharmacological treatment is associated with adverse effects and should therefore be reserved for situations leading to impending danger to the patient or others. If such a treatment is indicated, the literature suggests that haloperidol is the antipsychotic of choice.
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Bacterial meningitis in adults is fatal in 20% of patients and leads to sequels in 30%. The clinical presentation includes two of the following four symptoms and signs: fever, headache, stiff neck, altered mental status. The essential ancillary test is the analysis of the cerebrospinal fluid. ⋯ Corticosteroids are also recommended for some meningitis. A score can predict the evolution. Preventive measure must be taken for close contacts of a patient with a meningococcal meningitis.