Konsiliararzt und „unechter“ („schwarzer“) Belegarzt

Abstrakt 1. Eine mit der Ausübung vertrags?rztlicher T?tigkeit unvereinbare Interessen- und Pflichtenkollision liegt vor bei einer faktischen Wahrnehmung der T?tigkeit eines Krankenhausarztes durch einen zugelassenen Arzt. 2. Ein Konsiliararzt ist ein Arzt mit einer anderen Fachgebietsbezeichnung, der in einem konkreten Behandlungsfall w?hrend eines station?ren Aufenthalts auf seinem Fachgebiet untersucht und Behandlungsvorschl?ge macht, weil die entsprechende Fachkompetenz in dem Krankenhaus nicht vorhanden ist. (Leits?tze des Bearbeiters)     

Prevalence and Distribution of Coronary Disease in Claudicants Using 12-Lead Precordial Stress Electrocardiography

AIMS: to evaluate the prevalence of coronary artery disease (CAD) by means of modified stress electrocardiography in patients presenting with intermittent claudication. METHODS: three hundred consecutive patients (188 male) with intermittent claudication (post-exercise ankle brachial index <0.8), and 100 age and sex-matched controls, were assessed for CAD with resting and stress 12-lead-precordial ECG. A history of angina and previous myocardial infarction (MI) was recorded. Exclusion criteria: recent (<1 month) MI; unstable angina; prior coronary intervention; arrhythmias; conduction abnormalities; uncontrolled hypertension; heart failure, digoxin therapy, and inability to perform tests. RESULTS: based on antecedent angina, MI and abnormal resting ECG, CAD prevalence was 47% in claudicants and 6% in controls; on 12-lead-precordial ECG stress testing, CAD prevalence was 46% (95% CI: 40.1-51.7%) in claudicants and 11% (95% CI: 4.8-17.2%) in controls (both p <0.0001). Only 67% of claudicants (n=141) with antecedent angina, MI or an abnormal resting ECG, met the criteria of CAD on stress testing; also 28% of claudicants without antecedent angina, MI and a normal resting ECG (n=159) had evidence of CAD. The odds ratio for CAD in claudicants was 6.9. Based on 12-lead-precordial ECG stress testing we detected the presence of: one-, two- and three-vessel disease in 14.7% (95% CI: 10.6-18.7%), 19% (95% CI: 14.5-23.5%) and in 12.3% (95% CI: 8.6-16%) of claudicants; and in 8, 3 and 0% of controls, respectively. CONCLUSIONS: forty six percent of patients with intermittent claudication had concomitant CAD, and 31% two- or three-vessel disease. In the presence of claudication the odds ratio for CAD is 6.9 (95% CI: 3.5-13.4) and for two- or three-vessel disease 14.8. Non-invasive modified stress electrocardiography by enabling identification of those with multi-vessel CAD and thus by providing cardiac risk stratification may help bridge the gap between clinical evaluation and invasive coronary imaging.     

Vergütung psychotherapeutischer Leistungen; Korrekturbeschluss des Bewertungsausschusses vom 16.2.2000

Ohne Zusammenfassung     

Interleukin-1 alpha upregulates tumor necrosis factor receptors expressed by a human bone marrow stromal cell strain: implications for cytokine redundancy and synergy

To explore the biochemical and physiologic basis of the overlapping effects of interleukin-1 alpha (IL-1 alpha) and tumor necrosis factor alpha (TNF-alpha) on myeloid cytokine production, we have studied the dynamics of granulocyte colony-stimulating factor (G-CSF) and granulocyte-monocyte colony-stimulating factor (GM-CSF) production as well as IL-1 receptor and TNF receptor expression in a clonally derived bone marrow stromal cell strain (CDCL). IL-1 alpha and TNF alpha act in a synergistic manner to stimulate G-CSF and GM-CSF production by CDCL, resulting in an increase in CSF secretion that is 250-fold greater than that observed with either cytokine alone. This synergism in protein secretion is paralleled by synergistic increases the steady-state level of GM- and G-CSF mRNA, with supra-additive levels achieved by 24 hours. Coincident with this synergistic induction of myeloid CSFs, treatment of CDCL cells with IL-1 alpha induces a 300% increase in the expression of TNF receptors. IL-1 alpha induction of TNF receptors reaches a peak after 6 hours and gradually returns to baseline level by 24 hours. IL-1 alpha does not affect TNF receptor ligand binding affinity. A kinetic study comparing IL-1/TNF synergistic induction of growth factor secretion with IL-1 alpha induction of TNF receptors shows that these events occur in parallel. In contrast with the induction of TNF receptors by IL-1 alpha, treatment with TNF alpha has no effect on either the number of IL-1 receptors expressed by CDCL cells or IL-1 receptor ligand binding affinity. Brief treatment of IL-1 alpha/TNF alpha-stimulated CDCL cells with cycloheximide before receptor induction reduces the synergistic increase in growth factor mRNA by 40% to 60% compared with cells not treated with CHX. Taken together, these results raise the possibility that IL-1 alpha cross-induction of TNF receptors may contribute to the biochemical mechanisms underlying the synergistic stimulation of G-CSF and GM-CSF production by IL-1 alpha and TNF alpha.     

Zur Rechtmäßigkeit einer sachlich-rechnerischen Honorarberichtigung in Gestalt eines Vertikalvergleichs durch eine Kassenärztliche Vereinigung

Ohne Zusammenfassung     

Integrierte Versorgung – Voraussetzungen für den Abzug der sog. Anschubfinanzierung von der Gesamtvergütung durch eine Krankenkasse

Abstrakt 1. Für die Berechtigung der Krankenkasse zum Einbehalt der Anschubfinanzierung kommt es auf bereits geschlossene IV-Vertr?ge an. 2. Apotheken geh?ren nicht zu den nach § 140b SGB V zum Vertragsabschluss berechtigten Leistungserbringern. 3. Zum Sinn und Zweck einer Integrierten Versorgung. (Leits?tze des Bearbeiters)