Shaping the System - The DRG Evaluation Project of the German Society for Gynaecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG).

Introduction: The German DRG system is annually adapted to the changing services provided. For the further development, the self-governing body and its DRG Institute (InEK) depend on participation of the users. Methods: For one of the DRG evaluation projects initiated by DGGG, cost and performance data for the year 2011 from 16 hospitals were available. After plausibility checks and corrections, analyses for service and cost homogeneity were performed. In cases of inadequate DRG-representation attributes were sought that would make an appropriate reimbursement possible. Conspicuities and potential solutions were checked for clinical plausibility. Results: 44 concrete modification proposals for further development of the G-DRG system were formulated and submitted in due time to the InEK. In addition, 3 modification proposals were addressed to the German Institute for Medical Documentation and Information (Deutsches Institut für Medizinische Dokumentation und Information, DIMDI) for further development of the diagnosis classification ICD-10-GM. For all modification proposals care was taken to minimise misdirected incentives and to reduce the potential for disputes with the cost bearers and their auditors services in settlements. Discussion: The publication of the G-DRG system 2014 shows which modification proposals have been realised. Essentially, an appropriate redistribution of the resources among the gynaecological and obstetrics departments is to be expected. The financial pressure that is caused by the generally inadequate financing of hospitals will not be reduced by a further development of the G-DRG system.

RBE values for fast neutrons in connection with estimates of the radiation burden in space.

Much data concerning radiation in space as a serious danger to astronauts can be obtained in laboratories on Earth. For different parameters we investigated the relative biological efficiency (RBE) of 14-MeV neutrons on mice, rats and guinea pigs (being wholly exposed). Also the mitosis inhibition for isolated cells was determined. The RBE values found were: for lethality in the LD50(30d)-region--about 2 (for mice, rats and guinea pigs); for reduction due to radiation of living weight of different animals--2 to 3; for reduction of small gut weight of rats and guinea pigs--2.5 and 2; for histological changes in blood and albumin serum (rats and guinea pigs)--about 2; for the highly sensible cells of the lense epithelium from eyes of rabbits--2.5; for the mitosis inhibition of HeLa cells--2.5. The apparatus for radiation tests is described and measuring methods are indicated. The radiation of the whole body of mice, rats and guinea pigs was determined by activating of MgCl2 solution filled into phantoms. By means of a computer, the depth-dose curve can be determined for larger biological objects.

The impact of in-situ balloon occlusion of the renal artery and hypothermic perfusion on renal blood flow.

Unilateral renal blood flow was evaluated in-situ in 13 dogs by cineangiodensitometry and microsphere distribution studies before and after intermittent balloon occlusion with and without hypothermic perfusion of one kidney. The contralateral kidney served as control. No significant difference in renal blood flow and vascular resistance was noted before, and 5, 30 and 60 minutes after unilateral intra-arterial manipulation. Compartmental flow distribution studies in 5 dogs revealed no evidence of alteration of intra-renal haemodynamics. In a clinical pilot study, unilateral renal blood flow measured by cineangiodensitometry showed no change of clinical significance 5 and 60 minutes after intraluminal balloon occlusion of the renal artery for 60 seconds.