Tendência temporal de internação por queimadura no Sul do Brasil / Hospitalization trends due burns in the South of Brazil / Tendencia temporal de internación por quemadura en el Sur de Brasil

Objetivo: Avaliar a tendência temporal de internação por queimadura no Sul do Brasil, no período de 2008 a 2016. Método: Estudo ecológico de séries temporais, realizado a partir do Banco de Dados do SIH-SUS, com internações de residentes do Sul do Brasil, de 2008 a 2016. As taxas de internações foram padronizadas pelos estados do Sul, sexo e faixa etária e foi realizada regressão linear simples para estimar as tendências de internação. Resultados: No período estudado ocorreram 37.571 internações. A taxa de internação por queimadura em 2008, início do período, foi 13,11 internações por 100.000 habitantes, finalizando em 2016 com taxa de 14,60/100.000 habitantes, mantendo-se constante no período. No sexo masculino as taxas foram superiores, iniciando o período com 15,87/100.000, finalizando a série histórica com 19,76/100.000. No feminino, a taxa manteve-se linear durante o período. Verificou-se que o Paraná apresentou as maiores taxas em relação a Santa Catarina e Rio Grande do Sul. A faixa etária mais acometida foi de 0-19 anos. Conclusão: Há tendência de estabilidade na taxa geral de internação. O sexo masculino e a faixa etária de 0-19 anos são os mais acometidos por queimaduras no Sul do Brasil. O Paraná tem maiores taxas de internação quando comparado aos outros dois estados.

Objective: To evaluate the temporal trend of hospitalization for burns in the South of Brazil, from 2008 to 2016. Methods: Ecological study of time series, carried out from the Database of the SIH-SUS, with hospitalizations of residents of the South of Brazil, from 2008 to 2016. The hospitalization rates were standardized by the southern states, sex and age group and a simple linear regression was performed to estimate the hospitalization trends. Results: During the study period, 37,571 hospitalizations occurred. The hospitalization rate for burns in 2008, beginning of the period, was 13.11 hospitalizations per 100,000 inhabitants, ending the period (2016) with a rate of 14.60 / 100,000 inhabitants, remaining constant in the period. In males the rates were higher, starting the period with 15.87 / 100,000, finishing the historical series with 19.76 / 100,000. In the female, the rate remained linear during the period. It was verified that Paraná presented the highest rates in relation to Santa Catarina and Rio Grande do Sul. The most affected age group was 0-19 years. Conclusion: There was a trend towards stability in the general hospitalization rate. The male gender and age group of 0-19 years were the most affected by burns in the South of Brazil. Paraná has the highest hospitalization rates when compared to the other two states.

Objetivo: Evaluar la tendencia temporal de internación por quemadura en el Sur de Brasil, en el período de 2008 a 2016. Metodos: Estudio ecológico de series temporales, realizado a partir del Banco de Datos del SIH-SUS, con internaciones de residentes del Sur de Brasil, de 2008 a 2016. Las tasas de internaciones fueron estandarizadas por los estados del Sur, sexo y grupo de edad y se realizó una regresión lineal simple para estimar las tendencias de internación. Resultados: En el período estudiado ocurrieron 37.571 internaciones. La tasa de internación por quemadura en 2008, inicio del período, fue 13,11 internaciones por 100.000 habitantes, finalizando el período (2016) con tasa de 14,60 / 100.000 habitantes, manteniendo constante en el período. En el sexo masculino las tasas fueron superiores, iniciando el período con 15,87 / 100.000, finalizando la serie histórica con 19,76 / 100.000. En el femenino, la tasa se ha mantenido lineal durante el período. Se verificó que el Paraná presentó las mayores tasas en relación a Santa Catarina y Rio Grande do Sul. El grupo de edad más afectado fue de 0-19 años. Conclusión: Hubo tendencia de estabilidad en la tasa general de internación. El sexo masculino y el grupo de edad de 0-19 años fueron los más afectados por quemaduras en el sur de Brasil. El Paraná se quedó siendo el estado con mayores tasas de internación cuando comparado a los otros dos estados.

Does the Medicare 3-Day Rule Increase Length of Stay?

Medicare will only cover a stay in a skilled nursing facility (SNF) after TKA if the patient stays for at least 3 days at the inpatient hospital. The 3-day stay rule was instituted in 1965, to prevent over utilization of Medicare. We retrospectively reviewed 800 consecutive TKA, identifying patients that were discharged to rehab after surgery. 322 patients were discharged to SNF after surgery (209 Medicare, 113 private insurances). The LOS was 2.3 days for privately insured patients and 3.02 for Medicare recipients (P<0.05). No difference was found with regard to age, BMI, and ASA score. The Medicare 3-day rule independently increased the LOS in patients who required inpatient rehab, leading to increased cost. We suggest that this rule must be revised.

The impact of length of placement on self-reported mental health problems in detained Jordanian youth.

OBJECTIVE: This study reports the prevalence of emotional and behavioral problems among youths placed in juvenile correctional facilities in Jordan and describes the effect of length of stay on mental health outcomes. METHOD: The Youth Self Report (YSR) was administered to 187 adolescent males (mean age=16.4, SD=1.0) in all five juvenile detention facilities in Jordan in 2011. Descriptive statistics were calculated to estimate the prevalence of emotional and behavioral problems. Logistic regression models were estimated to evaluate the impact of placement length on mental health. Statistical models were weighted by the youth propensity to be 'long-stay' youths (>23 weeks) based on preplacement case characteristics. RESULTS: The prevalence of clinically significant emotional and behavioral problems was 84%. 46% had YSR scores above the clinical cutpoint in both the internalizing and externalizing subscales. 24% of youths reported suicidal ideation. The high prevalence of emotional and behavioral disorders was stable across placement for most YSR subscales. CONCLUSIONS: The prevalence of emotional and behavioral disorders among detained and incarcerated youth in Jordan mirrors the literature worldwide. These findings suggest that serious mental health problems for many youths persist throughout placement.

[Psychiatric polypharmacy: hazard through drug-drug-interaction and possibilities for prevention]. / Psychiatrische Polypharmazie: Risiken durch Arzneimittel-wechselwirkungen und mögliche Vermeidungsstrategien.

Psychiatric diseases and comorbidity have increased over the past years. Commonly used psychotropic drugs contain a high risk of drug interactions and adverse drug events (ADE). With a frequency of 10-12% psychotropic drugs are, among all pharmaceuticals, the most common cause of hospitalisation due to ADE. During a hospital stay the application of psychotropic drugs can also lead to adverse drug events--sometimes due to drug interactions. Currently, ADEs and drug interactions are the most frequent cause of death for in-patients (18% of all causes of death) with an overall mortality of 0.95%. As studies have shown, hospitals as well as insurers could save a considerable amount of resources by implementing a system with on-ward pharmacists, hereby reducing ADE and re-hospitalisation rates. In recent studies a large amount of current ADEs were rated as preventable. Patient impairment due to ADE is leading to an increase in liability cases with an expected 5% increase of compensation payments in 2011. To evaluate these ADE-related cases, a pharmaceutical assessment should be included in the expert trials, especially since a lack of awareness of medication errors is prevalent. When aiming towards a successful drug therapy, physicians must also consider that cheaper substances may often have an unfavourable drug interaction profile.

[How much diagnostics is required in palliative care? Results from a representative survey and own experiences]. / Wieviel Diagnostik braucht die Palliativmedizin? Ergebnisse einer multizentrischen Studie und Fallserie.

BACKGROUND: Applying diagnostic techniques in palliative care (PC) requires a thorough balance between a physical, psychosocial (and financial) burden and its therapeutic relevance in far advanced diseases. The extent of diagnostic employment in PC, preferred techniques, application problems, its informative value and therapeutic significance still have to be described. METHODS: The Hospice and Palliative Care Evaluation (HOPE) 2007 collected data from the application of microbiological and imaging techniques in German PC institutions. Furthermore, 70 consecutive ultrasound scans in our PC unit have been retrospectively analyzed.In 691 PC patients (from a total of 3184 in HOPE), diagnostic techniques (DIA) were applied and documented. RESULTS: In-patients with DIA (86,1 %) and the HOPE collective showed a comparable age and duration of hospital stay. Microbiological techniques contributed to 26,1 % of all documented in-patient investigations, imaging techniques 69,1 %. Ultrasound was the preferred imaging technique on PC units (67,1 %), whilst radiography, CT or MRI scans were rather employed on oncology wards. Nuclear imaging was rarely documented. In 80,8 %, imaging diagnostics were considered relevant for further treatment decisions (in-patients only); transportation problems and pain during imaging were relevant obstacles. In our own patient cohort, ultrasound was applied rather for general prognostic purposes, less often resulting in immediate therapeutic actions. Transportation problems could be almost entirely avoided by using a mobile ultrasound device. CONCLUSION: DIA in PC are applied independently of age or duration of hospital stay; its therapeutic significance is considered to be high; procedural problems may be resolvable. Therefore, this survey might challenge the tradition of low technology in PC.

[Patients unable to give consent and without a power of attorney or legal guardian in the geriatric department]. / Der einwilligungsunfähige Patient ohne Bevollmächtigten oder Betreuer in der Akutgeriatrie.

BACKGROUND: The importance of powers of attorney and legal guardians for patients in hospitals who are unable to make decisions for themselves is growing. Without an authorized person in these cases, treatment and discharge are more difficult. The goal of this study was to describe the problem from the point of view of an acute geriatric department and discuss the problems with respect to duration and expense of hospitalization. In addition, an attempt was undertaken to improve cooperation with the legal authorities in order to reduce the time required to process the request for the appointment of a legal guardian. MATERIALS AND METHOD: A total of 24 consecutive patients appointed a legal guardian during their hospitalization were compared with 25 patients after the intervention. RESULTS: Of all patients treated in 2008, 2.1% needed an application for an appointed legal guardian (4.6% in 2009). These patients were more seriously ill and treated longer in the hospital compared to all patients. The intervention reduced the length of stay on average by 2.8 days. Independent risk factors for longer treatment were more seriously ill patients and later submission of the application after admittance to the hospital. For patients above the maximum length of stay, the move to a nursing home and the need of a professional legal guardian prolonged significantly the hospital treatment compared to those below the maximum length of stay. CONCLUSION: The data demonstrate that the German DRG system does not sufficiently consider the difficult management caused by patients without the ability to give consent to treatment and without a valid power of attorney. The time required until a professional legal guardian is appointed is too long for patients in a hospital. The necessity of a power of attorney has to be promoted more intensely to the public. Currently, the only two ways to minimize the problem is to identify the patients without, but needing a power of attorney as quickly as possible and to remain in close contact with the legal authorities.

[REDIA--impacts of DRG introduction in the acute sector on medical rehabilitation]. / REDIA - Auswirkungen der DRG-Einführung auf die Rehabilitation.

The REDIA study is the only long-term (2003-2009), prospective, multicentre study analyzing the impact of the DRG system on quality and costs in rehabilitation facilities. In 2004, Diagnosis Related Groups (DRG) were implemented on a mandatory basis in the German healthcare system as a reimbursement scheme for hospitals based on administered prices for procedures. Experiences from other countries revealed that introduction of DRG does not only have a significant impact on hospitals but also on rehabilitation facilities. The study approach ensures a comprehensive analysis as it considers major clinical, therapeutic, psychological and economic aspects. The REDIA study is the only nationwide empirical study that includes all stages of the implementation process: before DRG implementation, during the convergence phase and following implementation. An indication-specific comparison of the phases showed significantly shorter stays in the acute sector as well as shorter transition times between the sectors, resulting in admission of patients into rehabilitative care at an earlier stage of their recovery process. Significant diversions of treatment efforts from the acute sector to the rehabilitative sector have been proven in terms of increased nursing efforts and potential changes in the therapeutic and medical treatments to be provided.

[Analysing the work of medical and nursing staff: comparison between PsychPV requirements and everyday activities on psychiatric wards]. / Tätigkeitsanalyse im ärztlichen und pflegerischen Dienst : Abgleich der PsychPV-Vorgaben mit dem Arbeitsalltag auf einer stationären psychiatrischen Einrichtung.

BACKGROUND: Since 1991 the German psychiatry personnel regulation act (PsychPV) defines the number and tasks of medical doctors and nursing staff on a psychiatric ward. However, there is the suspicion that there are differences, especially with regard to an increased proportion of activities not involving patients, such as documentation and administrative work. METHODS: To detect differences between requirements from the PsychPV and the actual amount of time spent on different activities, a task analysis was performed on a general psychiatric and a gerontological psychiatric ward. In this study the proportions of working time spent on five different types of activities with time that should have been spent according to the PsychPV were compared. RESULTS: Discrepancies were found on both psychiatric wards and for medical doctors as well as for nursing staff. Tasks of documentation and administrative work took significantly higher proportions of working time than required in the PsychPV. On the other hand psychiatric personnel spent less time for treatment or nursing in direct contact with the patients. CONCLUSION: The results of this study confirmed the suspicion that shifting tasks on psychiatric wards has led to changed treatment settings.

[Indication criteria for stationary psychosomatic treatment]. / Kriterien zur Indikation einer stationären psychosomatischen Behandlung (I).

In consideration of the existing possibilities in Germany, the author discusses the indication criteria and the duration of stationary psychosomatic treatment. Aside from the general criteria for hospitalisation, the traditional bio-psycho-social model of illness is emphasized as an important basic principle, to include social factors in the indication criteria for stationary psychosomatic treatment. Adjacent, backgrounds for the decision between a regional and a regionally distant treatment are proposed.

[Geriatric rehabilitation from the perspective of Book 9 of the German social code, SGB IX]. / Geriatrische Rehabilitation aus dem Blickwinkel des Neunten Buches Sozialgesetzbuch (SGB IX).

The legal foundations for provision and realization of geriatric rehabilitation benefits are contained in particular in Book 9 of the German social code, SGB IX (covering rehabilitation and participation of people with disabilities). This paper discusses claims foundations and benefit prerequisites of geriatric rehabilitation taking into consideration the relations between Book 5 (on health insurance) and Book 9 of the social code. The article includes a definition of "geriatric rehabilitation" in light of the SGB IX, describes the benefit carriers' obligations as well as the procedure in place for determining geriatric rehab need, in this context appraising the designation as "geriatric patient" in terms of its appropriateness as an identifying criterion in determining need. Provision of geriatric rehab benefits is contingent on a potential for attaining rehab goals as specified by SGB IX as well as on fulfillment of the benefit prerequisites. Responsibility for the content, extent and quality of geriatric rehabilitation lies with the benefit carriers, as is the case for the obligation to secure availability of the required numbers and quality of rehabilitation facilities and services. The article specifies the legal foundations of the various benefit types (ambulatory, mobile rehab, under a Personal Budget, integrated benefit provision, or early rehab), and discusses geriatric rehabilitation in the framework of an insurance-based medical care system as well as of activating care.

[Demands of private gastroenterologists for collaborative treatment concepts with clinics. Results of a Germany-wide survey]. / Welche Anforderungen stellen niedergelassene Gastroenterologen an integrierte Versorgungskonzepte mit Kliniken? Ergebnisse einer deutschlandweiten Umfrage.

BACKGROUND: New demands and possibilities of collaboration between hospitals and private practices in Germany have appeared, now that the way has been opened legally. A poll was conducted to analyse the current status of collaboration between outpatient gastroenterologists and hospital surgical departments and to identify possible future collaborations. MATERIALS AND METHODS: One thousand twenty-six private practices specialising in endoscopy were found by contacting the Association of Statutory Health Insurance Physicians and additional internet research. Of these, 50% were randomly selected (513 private practices) and contacted by mail with anonymous questionnaires about cooperation with their clinical partners. Two hundred three (39.6%) practices responded, of which 200 could be analysed. RESULTS: Of all practices reached, 75% considered the cooperation with clinics very valuable or even exceptional. Still, almost half (46%) suggested necessary improvements in these collaborations. Around a third of all contacted colleagues were already involved in projects following integrated care models. In about 80% of all participants, the main interest in integrated models was specified to be common therapy planning. CONCLUSION: The data analysis of this study shows a substantial interest of private-practice gastroenterologists in close collaboration with hospitals. It is now up to the hospitals to open contracts with their medical outpatient partners.