A suitable test for identifying high risk adult patients of moderate-severe obstructive sleep apnea syndrome.

The aim of this study was the evaluation of the usefulness of a 7-items questionnaire, Rome Questionnaire (RQ), in identifying adult patients at risk of obstructive sleep apnoea syndrome (OSAS). 136 adults (76 M, 60 F) with snoring were enrolled. Each patient underwent to an overnight polysomnography (PSG) study and the patient's bed partner answered the "RQ". RQ survey items mainly addressed the presence and frequency of snoring behaviour, breathing pauses, sore throat, oral breathing and wake time sleepiness. Of the 136 initial patients, 111 (63 M, 48 F; mean age 54.6 +/- 10.84) with a complete PSG examination were included in the study. They were divided according to apnea-hypopnea index (AHI) into two groups: group A with a primary snoring or mild OSAS (AHI < or = 15) and group B with moderate-severe OSAS (AHI > 15). The RQ final score was 25.27 +/- 16.1 for group A and 42.29 +/- 15.2 for group B, with a statistically significant (p < 0.0001) difference. Analyzing the RQ score of group B (moderate-severe OSAS) we surprisingly noticed that most of patients (66%) showed an high RQ score (> 40). No patients with moderate-severe OSAS showed a RQ score < 20 and for every point scored in the questionnaire there is an extra 1.07 (0.7%) risk of belonging to group B. Group B showed a mean body mass index (BMI) of 31.53 (+/- 4.95), significantly (p < 0.001) higher than BMI of group A (26,86 +/- 3.28) and BMI results a good predictive factor (p = 0.013) of mild-severe OSAS. In conclusion, the "RQ", together with BMI, seems to be an useful tool to make a selection of the patients at higher risk of moderate-severe OSAS, who need a prompt PSG evaluation. Our findings will require further validation in larger sample of subjects.

[Radiology investment planning using the Break Even Point (BEP) method]. / Pianificazione di un investimento di radiologia mediante la metodica del Break Even Point (BEP).

The health care financing decision are becoming increasingly complex in all health care environments. As a managed care becomes a greater percentage of overall business, accurate financial planning and decision making will be key components of viable organization. Therefore, the priority for health care systems is to manage their costs at the same time as maintaining the relationships they have with patients, providers, payors, and communities in order to have long term success and short term survival. Principal wedge to value an investment is to define a planning in order to identify the activities, to attribute costs to the activities, to fix a full cost for every performances and to examine fixed costs and variable costs. This is the key to achieve a economic balance.