Berechnung des Pflichtbeitrags eines niedergelassenen Arztes zum ?rztlichen Versorgungswerk bei Insolvenz

1. Wird dem Insolvenzsschuldner von den Gl?ubigern die Fortführung seiner Arztpraxis gestattet (sog. Betriebsfortführung), stellen die Pflichtbeitr?ge zur Altersversorgung sonstige Massenverbindlichkeiten dar, die gem. § 53 InsO vorweg durch den Insolvenzverwalter zu berichtigen sind. 2. Der Umstand, dass die Gl?ubigerversammlung im Rahmen der Betriebsfortführung für den fortführenden Arzt einen bestimmten monatlichen Unterhalt festgesetzt hat, bedingt keine Umqualifizierung der T?tigkeit als niedergelassener Arzt in eine Angestelltent?tigkeit. Die Pflichtbeitr?ge zur Altersversorgung sind daher nach den für Niedergelassene geltenden Satzungsbestimmungen zu berechnen, so dass nach wie vor allein der in der Praxis erzielte Gesamtumsatz und nicht der dem Arzt gew?hrte Unterhaltsbetrag als Berechnungsgrundlage für den Beitragssatz heranzuziehen ist.     

Vorrang des EU-Rechts im Approbationsrecht

1. Nach § 2 Abs. 1 S. 7 ZHG wird die Approbation nicht erteilt, wenn die naturwissenschaftliche Vorprüfung, die zahn?rztliche Vorprüfung oder die zahn?rztliche Prüfung nach der ZAppO endgültig nicht bestanden wurde. 2. Diese Regelung ist in Hinblick auf Art. 12 GG nicht zu beanstanden; allerdings bestehen gegen die Gültigkeit des § 2 Abs. 1 S. 7 ZHG verfassungsrechtliche Bedenken in Hinblick auf eine fehlende übergangs- bzw. Vertrauensschutzregelung.     

Keine Rundfunkgebühr für den Praxisweg

Abstrakt Fahrten eines Selbst?ndigen von seiner Wohnung zur Arbeitsstelle und zurück stellen eine „private“ Nutzung des Kraftfahrzeuges dar. In diesem Fahrzeug befindliche Zweitger?te unterfallen deshalb nicht gesondert der Rundfunkgebührenpflicht. (Leitsatz der Bearbeiterin)     

Loads applied tangential to a fingertip during an object restraint task can trigger short-latency as well as long-latency EMG responses in hand muscles

Electrical stimulation of the digital nerves can cause short- and long-latency increases in electromyographic activity (EMG) of the hand muscles, but mechanical stimulation of primarily tactile afferents in the digits generally evokes only a long-latency increase in EMG. To examine whether such stimuli can elicit short-latency reflex responses, we recorded EMG over the first dorsal interosseous muscle when subjects (n=13) used the tip of the right index finger to restrain a horizontally oriented plate from moving when very brisk tangential forces were applied in the distal direction. The plate was subjected to ramp-and-hold pulling loads at two intensities (a 1-N load applied at 32 N/s or a 2-N load applied at 64 N/s) at times unpredictable to the subjects (mean interval 2 s; trial duration 500 ms). The contact surface of the manipulandum was covered with rayon—a slippery material. For each load, EMG was averaged for 128 consecutive trials with reference to the ramp onset. In all subjects, an automatic increase in grip force was triggered by the loads applied at 32 N/s; the mean onset latency of the EMG response was 59.8±0.9 (mean ± SE) ms. In seven subjects (54%) this long-latency response was preceded by a weak short-latency excitation at 34.6±2.9 ms. With the loads applied at 64 N/s, the long-latency response occurred slightly earlier (58.9±1.7 ms) and, with one exception, all subjects generated a short-latency EMG response (34.9±1.3 ms). Despite the higher background grip force that subjects adopted during the stronger loads (4.9±0.3 N vs 2.5±0.2 N), the incidence of slips was higher—the manipulandum escaped from the grasp in 37±5% of trials with the 64 N/s ramps, but in only 18±4% with the 32-N/s ramps. The deformation of the fingertip caused by the tangential load, rather than incipient or overt slips, triggered the short-latency responses because such responses occurred even when the finger pad was fixed to the manipulandum with double-sided adhesive tape so that no slips occurred.     

Recording and quantifying sympathetic outflow to muscle and skin in humans: methods,caveats and challenges

The development of microneurography, in which the electrical activity of axons can be recorded via an intrafascicular microelectrode inserted through the skin into a peripheral nerve in awake human participants, has contributed a great deal to our understanding of sensorimotor control and the control of sympathetic outflow to muscle and skin. This review summarises the different approaches to recording muscle sympathetic nerve activity (MSNA) and skin sympathetic nerve activity (SSNA), together with discussion on the issues that determine the quality of a recording. Various analytical approaches are also described, with a primary emphasis on those developed by the author, aimed at maximizing the information content from recordings of postganglionic sympathetic nerve activity in awake humans.

     

A Prospective Study of Patient Reported Outcomes in Pancreatic and Peri-ampullary Malignancy

Background

The purpose of the present study was to describe the impact of treatment of pancreatic and peri-ampullary malignancy on patient reported outcomes (PRO). However, limited data are available describing the impact of curative or palliative therapy on pancreatic/peri-ampullary malignancy and quality of life.

Methods

Patients selected for pancreaticoduodenectomy (PD) completed the European Organisation for Research and Treatment of Cancer QLQ-C30 questionnaire pre-surgery and 6 weeks, 3, 6, 12, 18, and 24 months postoperatively. Patients selected for palliative treatments completed the same questionnaire before treatment and monthly thereafter. Mean scores and 95 % confidence intervals (CI) were calculated for functional scales. Symptom scales and single items were categorized as either minimal or severe, and they were reported as proportions of patients experiencing severe symptoms with 95 % CI.

Results

A total of 100 patients (53 planned PD, 47 palliative) were enrolled. Of the 53 patients planned for surgery, 12 had tumors that were unresectable and 41 underwent pancreatoduodenectomy (PD). Seven patients were excluded because of benign histology or concurrent malignancy. Baseline questionnaire compliance was 70 %. For those undergoing PD, there were 53 complications, 7 deaths at 1 year, and 14 deaths at 2 years. Post-surgery most functions and symptoms deteriorated. Recovery in global health and most symptoms occurred by 3 months, and functional scales recovered by 6 months. Recovery of PRO was maintained in the survivors at 2 years. Palliative patients had poorer function and more symptoms at baseline; however, poor follow-up questionnaire compliance prevented further analysis of this group.

Conclusions

Pancreaticoduodenectomy has a short-term negative impact on PRO that recovers within 6 months and is maintained at 2 years in survivors. Further work evaluating palliative and curative treatment in larger patient groups with disease-specific questionnaires is necessary.