[OR minute myth : Guidelines for calculation of DRG revenues per OR minute]. / Mythos OP-Minute : Leitfaden zur Kalkulation von DRG-Erlösen pro Op-Minute.

The economic situation in German Hospitals is tense and needs the implementation of differentiated controlling instruments. Accordingly, parameters of revenue development of different organizational units within a hospital are needed. This is particularly necessary in the revenue and cost-intensive operating theater field. So far there are only barely established productivity data for the control of operating room (OR) revenues during the year available. This article describes a valid method for the calculation of case-related revenues per OR minute conform to the diagnosis-related groups (DRG).For this purpose the relevant datasets from the OR information system and the § 21 productivity report (DRG grouping) of the University Medical Center Göttingen were combined. The revenues defined in the DRG browser of the Institute for Hospital Reimbursement (InEK) were assigned to the corresponding process times--incision-suture time (SNZ), operative preparation time and anesthesiology time--according to the InEK system. All full time stationary DRG cases treated within the OR were included and differentiated according to the surgical department responsible. The cost centers "OR section" and "anesthesia" were isolated to calculate the revenues of the operating theater. SNZ clusters and cost type groups were formed to demonstrate their impact on the revenues per OR minute. A surgical personal simultaneity factor (GZF) was calculated by division of the revenues for surgeons and anesthesiologists. This factor resembles the maximum DRG financed personnel deployment for surgeons in German hospitals.The revenue per OR minute including all cost types and DRG was 16.63 €/min. The revenues ranged from 10.45 to 24.34 €/min depending on the surgical field. The revenues were stable when SNZ clusters were analyzed. The differentiation of cost type groups revealed a revenue reduction especially after exclusion of revenues for implants and infrastructure. The calculated GZF over all surgical departments was 2.2 (range 1.9-3.6). A calculation of this factor at the DRG level can give economically relevant information about the case-related personnel deployment.This analysis shows for the first time the DRG-conform calculation of revenues per OR minute. There is a strong dependency on the considered cost type and the performing surgical field. Repetitive analyses are necessary due to the lack of reference values and are a suitable tool to monitor the revenue development after measures for process optimization. Comparative analyses within different surgical fields on this data base should be avoided. The demonstrated method can be used as a guideline for other hospitals to calculate the DRG revenues within the OR. This enables pursuing cost-effectiveness analysis by comparing these revenues with cost data from the cost unit accounting at a DRG or case level.

[Organisational aspects of medical support for civilians employed in the Armed Forces in the military-medical institutions of the Ministry of Defence, deployed in Moscow].

Organisational aspects of medical support for civilians employed in the Armed Forces in the military-medical institutions of the Ministry of Defence, deployed in Moscow. To ensure social protection of the civilian personnel of the Armed Forces is one of the main tasks of the Ministry of Defence of the Russian Federation. In Moscow formed a territorial system of medical support of citizens who have the right for medical care in military medical institutions of the Ministry of Defence of the Russian Federation. Russian legislation does not provide the right for medical assistance provision to the civilian personnel of the Armed Forces in military medical institutions at the expense of funds allocated from the federal budget for the maintenance of the Ministry of Defence of the Russian Federation. The function of the physician in providing primary medical care performs primary care physician. Providing medical assistance to the civilian personnel of the Armed Forces of the Russian Federation in military medical institutions on the basis of their attachment to the clinics onlv the Russian Defence Ministrv. or in the direction of the clinics of Moscow.

[Improvement of the system of medical equipmet rationing for military units during the wartime].

The authors analyze new legal regulatory document--Medical equipment and reserves supply rate for military units and organisations of the Armed Forces of the Russian Federation, developed in the process of modernization of the system of medical equipment rationing for military units. New legal regulatory document was developed with the aim to replace the similar document d.d 1996-1997. The authors came to conclusion that costs of new medical equipment and reserves supply rates are similar to previous rates. At the same time costs new medical equipment supply rates for medical service increased more than 25%. It is related to change of the role of medical service in the system of medical supply of the Armed Forces of the Russian Federation. Modernization of the system of medical equipment supply rates for military unit of the Armed Forces of the Russian Federation, performed for the purpose of medical supplement for military unit in accordance with new state of the Armed Forces of the Russian Federation, allowed to actualize the regulatory framework of medical supply by means of development and adoption of new Supply and reserves rates be the Ministry of defence. Use if these rates will increase effectiveness and quality of medical supply during the wartime, provide a commonality of reserves of medical equipment and maintenance of established level of combat readiness of medical service of the Armed Forces of the Russian Federation.

[Socio-economic and health organizational problems of emergency and out-patient care for elderly and senile patients with arterial hypertension (according to the sociological monitoring)].

The article contains data about the peculiarities of socio-economic and health-organization factors in the rendering emergency and out-patient care for elderly and senile patients with arterial hypertension. The results of study of satisfaction by medical care quality depending on the age and gender of the patients are discussed. A large number of living alone and widowed patients among elderly patients is marked. About half of the respondents in both groups are low-income; among middle-income respondents a low proportion of the elderly is observed. The majority of patients can be admitted to the doctor in the polyclinic no earlier than 2 to 7 days from the moment of entry. The obtained data should be taken into account when forming a model of medical-social care for patients with arterial hypertension in older age groups.

[Improvement of pharmaceutical benefits for military retirees in outpatient care].

For the purpose of improvement of pharmaceutical benefits for military retirees was designed the drug usage standard. This standard consists of 216 drug titles and is utilized in outpatient care in case of consistency. Monthly outpatient care costs for one military retiree are more than 900 rubles. New procedural and institutional mechanisms, ways of interdepartmental interactions, rational forms of its organization are necessary for the improvement of the effectiveness. These measures correspond to main principals of reorganization of the system of health care.

[Medical and socio-economic effects of early rehabilitation of patients with acute cerebral vascular accidents].

Acute ischemic brain injury (stroke, stroke), a leader among the causes of morbidity and mortality in the world. This pathology is one of the most pressing health and social problems that cause enormous economic damage to society, due to the high fatality rate, significant disability and social maladjustment of patients, which is based in most cases are the motor and cognitive impairment. Despite the fact that, currently established risk factors and pathophysiological basis of this disease, the availability of effective methods of diagnosing illness, still a practicing neurologist in some cases difficult to find adequate therapy that could effectively reach a well-established neurological deficit. Therefore the search for treatments that effectively reduce the health and social consequences of vascular damage to the brain, is one of the priority areas of neurology.

[Meeting the needs of the European working time directive in german medical profession]. / Sollarbeitszeit und maximale Arbeitszeit bei angestellten Ärzten.

The legal obligation of the European Working Time Directive with its implementation into a German Working Hours Act requires German hospitals to give up old structures and requires the implementation of new working time models. The failure of the revision of the European Working Time Directive in April 2009 prevented that any changes of status quo might happen in the near future. Fundamental terms of the working law for the medical area have been elucidated and have been implemented into concrete calculation formulas. The planned working time has been clearly determined. Particularly, on-call duties and a signed "OptOut-declaration" have huge effects on the upper limit of the working time that is to be determined. Shift duty leads to the greatest limitations of the upper limit of the working time. The Working Hours Act defines the maximal, available, individual working time budget and thus the working time budget of a hospital and it limits the maximal availability of the service providers of a hospital as well as defining the maximal personnel costs. Transparency in this area lays the foundation for an effective time management and the creation of new working time models in accordance with the European Working Time Directive as well as the Working Hours Act and the "TVÄ" (labour contract for doctors at municipal hospitals). It is possible, with the knowledge of the maximal working time budget and the thereof resulting personnel costs, to calculate the economical revenues better. The reallocation of the working time of doctors enables efficiency enhancement. It is necessary to demand a clear definition of the tasks of doctors with the consequential discharge of tasks that should not/do not belong to the responsibilities of a doctor. This would lead to a more attractive working environment for doctors at hospitals and thus to an improvement of the care of the patients. The implementation of the European Time Directive is not to be seen as unrealizable, as has been generally heard; instead, it enables the urgently necessary structural reform at German hospitals.

[Some aspects of outpatient care in the modem world].

The problems of improvement of outpatient care are considered, methodology of more active implementation of hospitalization technologies, the use of day care, hospital at home is proposed. It is emphasized that the introduction of hospitalization technology makes it less than treatment in hospital costs to improve quality of life for huge numbers of patients.

[Dopplerographic assessment of therapeutic efficacy of incoherent quantum irradiation in combined therapy of acute pyelonephritis]. / Dopplerograficheskaia otsenka terapevticheskoi éffektivnosti nekogerentnogo kvantovogo izlucheniia v kompleksnom lechenii ostrogo pielonefrita.

The authors present a comparative estimation of therapeutic efficiency of conventional antibacterial therapy, coherent and incoherent impulse quantum irradiation at a constant magnetic field in combined therapy of 130 patients with acute pyelonephritis. Incoherent impulsive quantum irradiation at a constant magnetic field showed high clinical efficacy manifesting in early normalization of microcirculation of the affected kidney.

[Immunologic assessment of the risk of developing infectious-inflammatory complications after percutaneous operations for nephrolithiasis]. / Immunologicheskaia otsenka riska razvitiia infektsionno-voxpalitel'nykh osloznenii posle perkutannyklh operatsii pri nefrolitiaze.

A retrospective comparison of the evidence obtained at preoperative examination of 68 patients with urolithiasis operated with the use of percutaneous technologies has demonstrated that the risk of postoperative infectious-inflammatory complications depends much on the immune status of the patient. Patients with initially different states of phagocytic immunity and antibody production had different courses of the postoperative period. An algorithm of immunological prediction of an acute pyelonephritis attack after percutaneous operations for nephrolithiasis is proposed.

[Current problems in reforming of dental care services]. / Aktual'nye problemy reformirovaniia stomatologicheskoi sluzhby.

Orientation to priority utilization of economic and medical legal approaches to reformation of dental service is an obligatory condition for effective solution of the problems of Russian dentistry. The priority tasks are: creation of economic and legal models of a dental profession and improvement of its normative and legal basis; development and realization of general Russian and regional programs of transformation of state dental centers into other than state ones and privatization of dental institutions; practical reformation of economic mechanisms of dental service; development of methods for state regulation of dental activities during the transition period; determination of directions and choice of social measures to modify dentistry service; creation of a system of guarantee of high quality of dental care; improvement of legally-based professional protection of dentists.

[Qualitative and quantitative assessment of exposure to geomagnetic field variations on the functional status of the human brain]. / Kachestvennaia i kolichestvennaia otsenka vozdeistviia variatsii geomagnitnogo polia na funktsional'noe sostoianie mozga cheloveka.

The comparison of functional dynamics of human brain with reference to qualitative and quantitative characteristics of local geomagnetic field (GMF) variations was conducted. It was showed that just local GMF variations can be a principal reason of modulation the human brain's functional state. The steady and unsteady states of human brain can be determined: by geomagnetic disturbances before the observation period; by structure and doses of GMF variations; by different combinations of qualitative and quantitative characteristics of GMF variations. The optimal level of GMF activity, manifested in periodic oscillations in certain amplitude-frequency range is demanded for steady brain's functional state. The decrease of optimal GMF activity level and the appearance of aperiodic disturbances of GMF can be a reason of unsteady brain's state.

Family planning in Russia in 1993-94: the role of NGOs in demonopolising population policy.

PIP: While official figures show a steady decline in the number of induced abortions performed annually in Russia, changes in regulations on the provision of abortion services and in the data collection system are likely responsible for the declining figures. For example, abortions performed in commercial health centers and in many state-supported medical units are not reported. Also there are no reliable figures on contraceptive usage in Russia or on other facets of family planning, and indeed Russian health care statistics in general are lacking. Thus, the 30% reduction in abortions reported from 1989 to 1993 was not accompanied by a similar increase in the use of modern contraceptives. Also, 26% of maternal mortality still results from induced abortions. However, during 1993-94, a significant amount of social attention was paid to the issue of family planning in Russia, and induced abortion was identified as a social priority and a health care problem. Also, many public groups are beginning to become involved in the formulation of a population policy in Russia. This has resulted in development of a grassroots approach instead of a hierarchical approach to FP. The most important new players in FP and population policy development are the Russian Orthodox Church with its anti-abortion lobby, commercial health care providers, new nongovernmental organizations, Western pharmaceutical companies, and international foundations and agencies. Several legislative initiatives have led to an increase in the number of officially registered sterilizations and to a proposal to remove abortion from the list of medical services covered by the state insurance program. The platform of some political parties would prohibit abortion. While the provision of FP and the problems associated with abortion have received priority attention, the concept of a human rights approach to FP is not developed in Russia. Russia completed its first demographic transition using the archaic technology of abortion and traditional contraception. A second transition will occur as the use of modern contraception instead of abortion increases.^ieng

Family planning and induced abortion in the USSR: basic health and demographic characteristics.

In 1988, the USSR Ministry of Public Health published official statistics on abortion for the first time in 60 years. Using the official data published in 1988 and unofficial statistics from a variety of independent sources, this report attempts to describe some of the basic features of fertility regulation in the USSR. Induced abortion is the main method of fertility regulation throughout the country, and a high proportion of induced abortions are unregistered and performed illegally. The availability and use of modern contraceptives is low; among those who practice contraception, traditional methods predominate. The official data leave much to be desired in the way of accuracy, reliability, and completeness. However, it is clear that the level of induced abortion is higher in the USSR than in any other country in the world.

PIP: Official and unofficial data clearly indicate a low availability and use of modern contraceptives in the USSR, and induced abortion's centrality in fertility regulation. The level of induced abortion is, in fact, higher than that observed in any other country in the world, and is the main method of regulating fertility in the country. Wide regional differentials in the extent of induced abortion exist throughout the USSR, soaring to 770 abortions/100 births in the central, rural areas of the Russian Soviet Federal socialist Republic. Overall for the USSR, the number of officially registered abortions/1,000 women reached a high of 244.5 in 1956, and a low of 86.6 in 1988 over the period 1954-1988. Decreased levels are due in part to a changing age structure of women and increased menstrual regulations through the 1980s. 6.5 million official abortions occurred in 1988, constituting 10-20% of the world annual total. Not accounting for estimations that illegal abortions may account for up to 70% of total induced abortions in the USSR, this official level is nonetheless 2-10 times higher than those observed in Western and Eastern European countries. The USSR has both realized fertility transition and a stable, low total fertility rate of 2.4 due to the widespread use of abortion. These finding emerge from analysis of data from a variety of unofficial sources and the 1988 Ministry of Public Health officially published abortion statistics for the period 1960-88. Information on abortions in women under age 17, abortion mortality, and the health consequences of abortion is not, however, officially published. Despite inadequacies in data accuracy, reliability, and completeness, the validity of this broad trend and the predominant use of traditional methods among contraceptors can not be disputed.

Family planning in the USSR. Sky-high abortion rates reflect dire lack of choice.

PIP: The USSR, where family planning choice is virtually nonexistent, has undergone a demographic transition exclusively as a result of widespread use of induced abortion. Instead of promoting free and responsible choice in reproduction and parenthood, family planning in the USSR has served as a tool for the reproductive manipulation of the individual. Although the USSR has formally endorsed the right to family planning, services have remained out of reach of the population, which lacks information and access to qualified medical care and contraception. The only widely available method of family planning has been induced abortion. In 1988, the country registered an abortion rate of 92.6 abortions/1000 women aged 15-49 (or 118 abortions/100 births). The yearly number of abortions in the USSR, some 6.5 million (according to official figures), accounts for 10-20% of all abortions performed worldwide. Independent sources put the yearly number of abortions at 10-11 million. Within the USSR, however, there exists great variations in the abortion rate. In Dagestan ASSR, the rate is 45.6./100 births, while in some rural regions of the Central Economic Region in Russia have a rate as high as 770/100--by far the highest rate anywhere in the world. These astronomical rates reflect the lack of available services. Up to 70% of women at maternity clinics lack knowledge about contraception, and contraceptive availability ranges between 10-30%. Soviets who do practice contraception rely predominantly on traditional methods. The tragic consequence of the lack of family planning is evident in the level of maternal mortality, an extraordinarily high level for economically developed countries.^ieng

[Assessment of the dimensions and dynamics of the necrosis zone in acute myocardial infarct]. / Otsenka razmerov i dinamiki zony nekroza u bol'nykh ostrym infarktom miokarda.

In 165 patients with myocardial infarction admitted to the clinic within the first 24 hours of the disease, the size of the zone of affection and its dynamics in the immediate 4--5 days were appraised. Three methods were used for this purpose: cartographic analysis of the ECG in 35 precordial leads; vectorcardiography and serial determination of creatine phosphokinase activity (CPK) in blood plasma with calculation of the size of the necrosis in units of weight (grams). It is shown that ECG-cartography and serial determination of serum CPK activity are valuable methods in quantitative appraisal of the size of the necrotic focus in patients with myocardial infarction. Study of the ECG-cardiogram and vectorcardiogram in dynamics and analysis of CPK activity curves enables one to appraise the spreading of the zone of the necrosis in the first days of the infarction. According to the results of these methods, in most patients (68 to 82%) with macrofocal myocardial infarction the zone of the necrosis spreads in length and in depths in the first days of the disease.