Practice variability in the management of infrarenal arterial stenoses in seven Belgian hospitals

This multicentre retrospective study describes the variation of therapeutic options, treatment outcomes and costs for treating infrarenal arterial stenoses as observed in daily practice in 1997-99 in seven Belgian hospitals. Data were obtained from clinical record review and from the sickness fund claims database, and included preoperative functional state, presence of acute ischaemia, diabetes and polyvascular disease, state of the lower-leg run-off arteries, anatomical site and type of lesion, type of treatment, result at 30 days and up to 4 years. A total of 442 episodes were studied, but most analyses dealt with a subgroup of 240 lesions in the common iliac up to the superficial femoral artery. The proportion of surgical treatments (as compared to an endovascular or mixed approach) varied from 15% to 81% between the hospitals. In univariate survival analysis, relapse or failure rates at 4 years ranged from 5% for the common iliac artery to 35% for the superficial femoral artery. Polyvascular disease, a poor run-off, multiple stenoses and chronic occlusion were significant risk factors; age and diabetes were not. In the multivariate (stratified Cox regression) analysis, only a location in the superficial femoral artery and a poor preoperative clinical stage were significant risk factors, but type of therapeutic approach was not. The total average cost of treatment was 5,300 €, of which 15% was contributed by the patient. Surgery was associated with longer stays (median at 12 days) than endovascular treatments (median 2 d), and was 1.9 times more expensive. In conclusion, the results of the present study suggest that a multidisciplinary approach, orienting the patient to the most appropriate therapeutic pathway could increase both the quality and the cost-effectiveness of the care. In many clinical situations, the endovascular approach appears to offer similar long-term results as surgery, but at a substantially lower cost, both for the patient and for society, especially when performed in a (semi-)ambulatory radiology setting

The ESPRIT Project CAFE - High Security Digital Payment Systems

. CAFE ("Conditional Access for Europe") is an ongoing project in the European Community's ESPRIT program. The goal of CAFE is to develop innovative systems for conditional access, and in particular, digital payment systems. An important aspect of CAFE is high security of all parties concerned, with the least possible requirements that they are forced to trust other parties (so-called multi-party security). This should give legal certainty to everybody at all times. Moreover, both the electronic money issuer and the individual users are less dependent on the tamper-resistance of devices than in usual digital payment systems. Since CAFE aims at the market of small everyday payments that is currently dominated by cash, payments are offline, and privacy is an important issue. The basic devices used in CAFE are so-called electronic wallets, whose outlook is quite similar to pocket calculators or PDAs (Personal Digital Assistant). Particular advantages of the electronic wallets are that PIN..