DRGs in der Dermatologie: Erlösoptimierung durch Sicherung der Kodierqualität

Background: High‐quality coding of patient clinical data is mandatory for an effective DRG classification to result in adequate allocation of funding for in‐patient treatment. The aim of the study was to determine the effect of controlled documentation on patient clinical data and to ascertain the outcome of calculated DRG‐based yields depending on higher coding quality of patient treatment. Patients and methods: In a prospective study, 1914 patient clinical records from the Department of Dermatology, University of Muenster, were captured using different documentation standards and the data was analysed. Grouping was performed on the basis of the Australian Refined DRG system v4.1. Dermatological patients were broken down into eleven groups based on principle diagnosis. Results: As a result of a controlled documentation, case mix, case mix index and patient clinical complexity level (PCCL) value were increased within identical samples. Furthermore, it was shown that high‐quality coding may result in exact and reasonable classification of patient clinical data. Conclusions: Different documentation standards may cause undesired effects on the monetary yields of in‐patient treatment. It appears that high‐quality coding and controlled documentation may guarantee adequate yields. Faulty, incomplete and (up)coding could be a potential economic risk for hospitals.     

The long-acting dopamine agonist bromocriptine mesylate as additive immunosuppressive drug after kidney transplantation

BACKGROUND: Acute rejection is an important risk factor for kidney graft loss. As evidence suggests that prolactin has important immunostimulatory properties, we conducted a randomized, prospective open trial in which bromocriptine, a drug suppressing prolactin secretion, was administered as an additive immunosuppressive drug after first cadaver kidney transplantation. METHODS: In the treatment group bromocriptine was given intramuscularly to 22 patients after their first kidney transplantation along with conventional immunosuppression (cyclosporin A, glucocorticoids). Twenty-three patients receiving only conventional immunosuppression served as control subjects. The incidence of acute graft rejections, graft losses, and infections was evaluated. RESULTS: Serum prolactin concentrations were slightly elevated above normal values before transplantation (32 +/- 5.3 ng/ml) and decreased to values between 13 and 16 ng/ml in the control group and were totally suppressed in the bromocriptine group. After 6 months of follow-up overall patient and allograft survival was 97.7% and 91% respectively. Acute rejection episodes occurred in 31 patients (77.5%): 15 in the bromocriptine group vs 20 in the control group (n.s.). In each group eight patients experienced a cytomegalovirus infection. The incidence of severe bacterial infections (i.e. pneumonia and sepsis) was five and six respectively. The necessity of haemodialysis after transplantation was 3.1% in the patients on bromocriptine and 23% in those without. CONCLUSIONS: Suppression of circulating prolactin concentration by bromocriptine did not improve the clinical outcome of patients after kidney transplantation receiving cyclosporin and prednisolone.      

Dissection of antigenic and irritative effects of epicutaneously applied haptens in mice. Evidence that not the antigenic component but nonspecific proinflammatory effects of haptens determine the concentration-dependent elicitation of allergic contact dermatitis.

Allergic contact dermatitis differs from most other immune reactions by its strict dose dependence during the elicitation phase. Moreover, almost all known contact allergens can also induce dose-dependent irritative dermatitis and in general only elicit allergic contact dermatitis in sensitized individuals when applied within a narrow dose range. Therefore, we hypothesized that elicitation of contact hypersensitivity (CHS) may require two signals, antigen-specific effector cell activation and a non-antigen-specific proinflammatory signal, both of which are provided by application of a sufficient dose of hapten. To dissociate these putative two signals, oxazolone-sensitized mice were ear challenged with a dose of the specific hapten which was too low to elicit CHS. At the same time, an unrelated hapten was applied in a conventional concentration to the same skin site. Whereas neither treatment alone elicited a significant CHS response, application of both compounds together resulted in a strong CHS response that was indistinguishable from that elicited by the full dose of the specific hapten. Upon coadministration of the irrelevant hapten, allergic contact dermatitis could be elicited even when the dose of the specific hapten was further reduced by a factor of 10(3). In contrast, a dose reduction of the irrelevant hapten by a factor of two resulted in the loss of the CRS response. These data indicate that non-antigen-specific effects of epicutaneously applied haptens significantly contribute to the elicitation of CHS responses and that the capacity of the hapten to evoke this proinflammatory stimulus rather than its antigenicity is responsible for the strict concentration dependence.     

G-CSF和IFN-α对K562/A02耐药细胞株的抗耐药作用

[目的 ]观察G CSF ,IFN α分别或联合应用于K 562 /A0 2耐药细胞株时对柔红霉素敏感性的影响 .[方法 ]通过MTT法测定各组的K 562 /A0 2细胞的抑制率 .[结果 ]G CSF组及IFN α组K 562 /A0 2细胞抑制率明显升高 ,分别为 55 0 8%± 2 18%及 56 72 %± 1 77% ,与柔红霉素组比较具有显著性差异 ;联合用药组K 562 /A0 2细胞的抑制率明显升高 ,与柔红霉素组、G CSF组及IFN α组比较均具有非常显著性差异 . [结论 ]G CSF及IFN α逆转K562 /A0 2的多种药物耐药性 ,且具有协同作用     

PHB1 Efficient Strategies for Osteoporosis Testing

There are multiple screening and testing tools for osteoporosis. We need to understand the most cost-efficient way to utilize these tools to identify postmenopausal women with osteoporosis. The objective of this study was to identify efficient strategies for detecting low bone mass in postmenopausal women and estimate the incremental cost per case found.
METHODS: The study sample consists of 392 women age >50. Each participant completed the Simple Calculated Osteoporosis Risk Estimation (SCORE ^* ) (a prescreening questionnaire), and bone mineral density (BMD) levels were collected at different skeletal sites. Assumed costs were: $5 for SCORE, $35 for peripheral site (pDXA) testing at the forearm, $120 for single central (DXA) site testing at hip or spine, and $200 for multiple site DXA. An osteoporotic woman was defined as a woman with BMD < −2 SD below peak adult mean at any site.
RESULTS: The cost, efficient frontier consisted of 7 strategies ranging in cost from $33 to $189 per patient, with corresponding sensitivity of 53% to 100%. The incremental cost per case found ranged from $62.30 to $1,100. Most importantly, the current gold standard (testing all women at the hip and spine) is not on the efficient frontier.
CONCLUSION: The efficiency of osteoporosis testing can be greatly increased through the appropriate use of sequential instruments to identify postmenopausal women with osteoporosis.