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Reimbursement summary for angioplasty of arteries of lower extremities

This post presents an extract from our reimbursement analysis for angioplasty of arteries lower extremities using plain and drug-coated balloons (DCBs) for peripheral artery disease in England, France and Germany. Plain balloon angioplasty is reimbursement via DRG solely and DCBs are reimbursement via combination of DRG and add-on reimbursement.
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Updated regional guidelines for the management of patients with colostomy, ileostomy and urostomy in Veneto, Italy

11 Oct 2018

The objective of this decree is to provide the indications for the appropriate use of stoma products and to unify the patient management of the adults with colostomy, ileostomy and urostomy.

Each recommendation in the guideline is graded with a level of evidence (I – VI) and level of recommendation (A – E), according to the National Guideline Plan).

Levels of evidence:

  • I. Evidence derived from more than one RCT and/or systematic reviews of the literature
  • II. Evidence obtained from one (1) RCT
  • III. Evidence derived from non-randomized, controlled cohort studies
  • IV. Evidence obtained from retrospective case-studies or their meta-analyses
  • V. Evidence obtained from un-controlled case-series
  • VI. Evidence is based on experts’ opinion

Levels of recommendation:

  • A. Strongly recommended
  • B. There are doubts that it should always be used, but it should always be considered
  • C. Not confident whether to execute the procedure
  • D. The procedure is not recommended
  • E. The method is strongly advised not to be used

Guideline 1: What is the correct management of patients with colostomy, ileostomy and urostomy?

Pre-surgery phase

  1. Perform a thorough evaluation of the patient and his/her family (level of evidence II, level of recommendation A)
  2. Perform a pre-operative marking to all patients (III, A)
  3. Suggest the progressive, relaxing muscle therapy to the patients (II, B)

Post-surgery phase and discharge

  1. Check the stoma product and the skin nearby immediately after the surgery (VI, A)
  2. Educate the patient and his/her family how to use the product (VI, A)
  3. Discharge the patient with the domiciliary support (II, A)

Follow-up phase

  1. Regular control by the stoma therapy nurse in the first six months, and annually afterwards (III, A)
  2. Propose colon irrigation for the treatment of left colostomy to selected patients for at least one month after surgery. The best would be to do it every 48 hours, at the same time (III, A)

Each of these points has a detailed explanation. The document also contains other guidelines, such as:

  • Characteristics of the stoma aids and accessories
  • Criteria for the right choice of a stoma aid
  • Criteria for the right selection of a stoma accessory
  • Monitoring of the process and
  • The modules for prescription, authorization and use of stoma aids

You can find the full decree in Italian here.

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