Hypertriglyceridaemia and Lewis (A-B-) phenotype in non-insulin-dependent diabetic patients.

A relationship between Lewis (a-b-) phenotype and the metabolic syndrome X has been suggested. We studied the frequency of Lewis (a-b-) phenotype in subjects with non-insulin-dependent diabetes mellitus (NIDDM) as well as the relationship between Lewis phenotype and lipid concentration in NIDDM patients. Lewis red blood cell phenotyping was done in 207 NIDDM subjects and 345 non-diabetic control subjects by immuno-agglutination with anti-Lewis a and b monoclonal antibodies. Among NIDDM patients, the proportion with the Lewis (a-b-) phenotype was significantly increased (23.6% vs 14.3%, p = 0.01), and this phenotype was associated with higher levels of triglycerides (2.40 +/- 2.58 vs 1.97 +/- 1.25, p = 0.03). This study shows a relationship between NIDDM and Lewis (a-b-) phenotype. Hypertriglyceridaemia in Lewis-negative NIDDM could suggest an increased risk of ischaemic heart disease for these subjects.

Elevated serum CA19-9 levels in poorly controlled diabetic patients. Relationship with Lewis blood group.

Many non-malignant diseases may be associated with elevated serum CA19-9 levels. Recent reports suggest that diabetes mellitus may also be responsible for some elevations. In this study we investigated the influence of the glycaemic level and Lewis phenotype on the serum CA19-9 levels in diabetic patients. In 15 out of 84 patients (17.8%) serum CA19-9 exceeded 100 kU/L (highest value: 208 kU/L). CA19-9 concentrations were significantly correlated with glycosylated haemoglobin levels. On the other hand, no correlation was found between CA19-9 levels and the type of diabetes, lipase levels, or the presence of anti-islet cell antibodies. Le(a-b-) patients had significantly lower serum CA19-9 levels. This study emphasizes the frequency of CA19-9 elevations in diabetic patients without cancer.

Patient accounting systems: are satisfaction levels rising?

A recently conducted survey on patient accounting system usage looked at the level of design, system, and vendor satisfaction. The survey revealed an increase in user satisfaction in the areas of system expansion and growth potential, ease of modification, capability to interface to other systems, and revision and updating capabilities. However, respondents also said that today's new systems were not any more satisfactory than they were five years ago in the areas of ease of installation, quality of vendor support, and documentation.

Selecting patient accounting systems: what are the key criteria?

A recent survey of healthcare finance executives on patient accounting system usage provided information on how key decisions about systems are made. Results show that decision makers are handicapped in the decision-making process because they are aware of only a subset of available systems, decreasing the likelihood of selecting the best possible system.

Patient accounting systems: needs and capabilities.

In the first article of this series, it was stated that most finance executives are not very satisfied with the performance of their current patient accounting systems. What steps can a patient accounting system planner take to help ensure the system selected will garner high ratings from managers and users? Two primarily steps need to be taken. First, the planner needs to perform a thorough evaluation of both near- and long-term patient accounting requirements. He should determine which features and functions are most critical and ensure they are incorporated as selection criteria. The planner should also incorporate institutional planning into that process, such as planned expansion of facilities or services, to ensure that the system selected has the growth potential, interfacing capabilities, and flexibility to respond to the changing environment. Then, once system needs are fully charted, the planner should educate himself about the range of patient accounting system solutions available. The data show that most financial managers lack knowledge about most of the major patient accounting system vendors in the marketplace. Once vendors that offer systems that seemingly could meet needs are identified, the wise system planner will also want to obtain information from users about those vendors, to determine whether the systems perform as described and whether the vendor has been responsive to the needs of its customers. This step is a particularly important part of the planning process, because the data also show that users of some systems are significantly more satisfied than users of other patient accounting systems.

Selecting patient accounting systems that stand out from the rest.

How satisfied is the average finance executive with the performance of his institution's patient accounting system? Not very. What causes this dissatisfaction? A variety of factors: Not enough flexibility, the inability to modify or expand the system, the lack of system interfaces, and inadequate support. These are all leading contributors to the finance executive's dissatisfaction. How much information does he have about the alternative patient accounting system vendors in the marketplace? On average, limited information. Many vendors who offer patient accounting systems have not done enough to disseminate information about their products to hospital decision makers. If the finance executive were more knowledgeable about the alternatives available, would he then be able to select a patient accounting system that fully meets the institution's needs? It would improve the odds. However, merely knowing about the alternatives is only the first step. He must be able to fully evaluate the institution's near and long-term needs to create the best match possible. The finance executive must also accept the possibility that there may not be a single system in the marketplace that can accommodate every perceived need. Only by knowledge of the marketplace will he be in a position to fully evaluate the potential benefits of the available systems.