Nichtzahlung der Praxisgebühr und gerichtliche Geltendmachung durch die KV

Abstrakt 1. Mit der Verpflichtung zum Einzug der Praxisgebühr in x 18 Abs. 5 BMV-Ä ist der Kassenärztlichen Vereinigung auch die Verpflichtung zur gerichtlichen Beitreibung der Zuzahlung in Höhe von 10 € nach x 28 Abs. 4 S. 1 SGB V i. V. mit x 61 S. 2 SGB V übertragen worden. Die Geltendmachung dieser Forderung erfolgt im Wege der gesetzlichen Prozessstandschaft.2. Einen Anspruch auf Erstattung der Mahn- und Portogebühren gegenüber dem Versicherten kann die Kassenärztliche Vereinigung hingegen nicht geltend machen. Ein solcher ergibt sich weder aus den Bestimmungen des SGB V bzw. SGB IV noch aus der analogen Anwendung des x 18 Abs. 5 BMV-Ä bzw. den Vorschriften des bürgerlichen Rechts. (Leitsätze des Bearbeiters)     

Auswirkung von Budgets auf die Terminvergabe in der Praxis

Abstrakt 1. Dem Vertragsarzt kann nicht das Recht abgesprochen werden, eine Praxisorganisation zu wählen, die seiner Leistungs- und Budgetkapazität angepasst ist.2. Der Vertragsarzt bewegt sich im Rahmen der gesetzlichen Vorgaben, wenn er bei Ablehnung der Behandlung aus Belastungsgründen Patienten an einen anderen Vertragsarzt verweist.3. Ein vorwerfbares Verhalten kann darin liegen, wenn der Vertragsarzt die Praxis der Terminsvergabe dazu benutzt, Patienten der gesetzlichen Krankenversicherung in die Privatliquidation zu treiben. (Leitsätze des Bearbeiters)     

Zur Bedeutung eines Kranken- und Berechtigungsscheines bei Leistungen zur künstlichen Befruchtung

Abstrakt 1. Das Vorliegen eines überweisungsscheins bei Inanspruchnahme vertrags?rztlicher Leistungen ist nicht Abrechnungsvoraussetzung. 2. Die Sterilit?t ist eine nachhaltig lebensver?ndernde Erkrankung, welche die Abrechnung der Nrn. 17/18 des EBM rechtfertigt. 3. Zur Auslegung des Umfangs einer Erm?chtigung kann auf die “Erm?chtigungsgeschichte” zurückgegriffen werden. (Leits?tze des Bearbeiters)     

Distribution of Unsaturated Metabolites of Valproate in Human and Rat Brain-Pharmacologic Relevance?

Summary: The concentrations of valproate (VPA) and six of its pharmacologically active, unsaturated metabolites (E-δ²-VPA, Z-δ³-VPA, E-δ³-VPA, E, E-δ^{2, 3}.-VPA, δ⁴-VPA, and E-δ^{2, 4}-VPA) were measured in serum and cortical brain samples from 24 patients undergoing epilepsy surgery. Collectively, the six metabolites were present at concentrations ≤13% of VPA brain concentrations. Because the six unsaturated metabolites were present at such low brain concentrations, we concluded that these metabolites probably did not contribute significantly to the anticonvulsant effect of VPA. Results from a parallel pharmacodynamic study in rats in which VPA was administered three times daily for 8 weeks supported this conclusion. Only three unsaturated metabolites (E-δ²-VPA, δ³-VPA, E, E-A^{2, 3}-VPA)were detected in rat brain. No correlation was observed between the time course of anticonvulsant effect [as measured by the timed intravenous pentylenetetrazol (PTZ) test] and the time course of VPA or metabolite concentrations in rat brain. Despite the structural similarity of VPA and its metabolites, striking differences were observed in their serum protein binding and blood-brain distribution properties. In the human brain, VPA and δ⁴-VPA exhibited brain-to-free serum concentration ratios that were less than unity. In contrast, compounds with the double bond at the 2-or 3-position had brain: free concentration ratios that were much higher than unity. The structure-distribution relationship observed with VPA and its unsaturated metabolites suggested that these branched-chain fatty acids differ in their asymmetric transport across the blood-brain barrier (BBB).     

Risk factors for development of dehydration in children aged under five who have acute watery diarrhoea: a case-control study

Objective: To identify risk factors for development of dehydration in under five year olds with acute watery diarrhoea.Design: Hospital based unmatched case-control study.Setting: Diarrhoea Treatment Unit, Government Medical College Hospital, Nagpur, India.Participants: The study included 387 cases of diarrhoea having severe or moderate dehydration and 387 controls suffering from diarrhoea with mild or no dehydration.Risk factors: The study included infancy, female sex, religion, residing in urban slums or rural area, under nutrition, cessation of breast feeding during diarrhoeal episode, fluid intake decreased/stopped during diarrhoea, ORS not received, home available fluids (HAF) not received, both ORS and HAF not received, non-washing of hands by mother before preparation of food, after defaecation, after disposal of faeces, history of measles in the previous six months, frequency of stools >8/d, frequency of vomiting more than twice per day and temperature more than 99°F, as risk factors for development of dehydration.Statistical analysis: Univariate analysis included OR, 95% CI for OR and Chi-square test. Multivariate analysis was carried out by unconditional multiple logistic regression (MLR).Results: This study identified the significance of infancy, religion, severe undernutrition, non-washing of hands by mother before preparation of food, frequency of stool >8/d, frequency of vomiting >2/d, history of measles in previous six months, withdrawal of breast feeding during diarrhoea, withdrawal of fluids during diarrhoea and not giving ORS, HAF or both during diarrhoea, in the outcome of development of moderate or severe dehydration.Conclusions: Timely intervention in the preventable risk factors included in this study may prevent the development of moderate or severe dehydration in the children suffering form acute watery diarrhoea.