[Epidemiology and perspectives in traumatology of the elderly]. / Epidemiologie und Perspektiven der Alterstraumatologie.

Corresponding to the demographic development, fractures of the humerus, wrist, or hip will occur noticeably more often during the next four decades. The number of patients with hip fractures will increase to 170% of present-day numbers, and in the age group >80 years to 250%. Trauma surgical departments should train their staff as well as adapt their workflows and ambient conditions to this demanding clientele to be prepared for these changes. For the elderly, a fracture may lead to need for permanent home care, which is why postoperative transfer to ambulatory care is especially important. The expected cost progression in traumatology of the elderly may be moderated by the conjunction of inpatient and ambulatory care, the utilization of synergies among the different service types, and by implementation of prophylaxis for osteoporosis and falls.

[Changes in the G-DRG System from 2003 to 2005 in Ophthalmology--Ophthalmologic G-DRG 2003 to 2005]. / Anderungen des G-DRG-Systems von 2003 bis 2005 in der Augenheilkunde -- Ophthalmologische G-DRGs von 2003 bis 2005.

BACKGROUND: The objective of the study was to illustrate the effect of the extensive changes of the German DRG System on reimbursement of clinical ophthalmology during the years 2003, 2004 and 2005. METHODS: All ophthalmologic patients treated as in-patients at the Department of Ophthalmology at the University Munich during the year 2003 served as a reference data basis. By means of appropriate software those cases were then re-grouped according to the G-DRG classification of the years 2003, 2004 and 2005. This resulted in different reimbursements caused only by system changes for an exemplary hospital of maximum medical care. In addition, the same calculations were performed for four virtual, typical clinics based on the calculation data of the "Institut für Entgeltsysteme (InEK)". For those four clinics it was assumed that 80 % of the cases came from one of the subspecialties retina, glaucoma, cataract or strabismus surgery. RESULTS: Changes in the G-DRG system caused the sample hospital of maximum care to loose 8.5 % case mix index (CMI) during the period of 2003 to 2005. For three of the four virtual, typical ophthalmological clinics the theoretic reimbursement conditions also deteriorated: retina surgery -- 10.6 %, glaucoma surgery - 15.8 % and cataract surgery -- 17.9 % CMI. Only strabismus surgery showed an increase of + 5.6 % in CMI during the period examined. CONCLUSION: Over the years 2003 to 2005 the CMI clearly deteriorated for many ophthalmological subspecialties given otherwise identical conditions. To calculate the changes specifically for an individual hospital, the individual base rates have to be considered.

Strain and substrain differences in context- and tone-dependent fear conditioning of inbred mice.

The performance of C57BL/6J (6J), C57BL/6N (6N), DBA/2J (2J) and DBA/2N (2N) mice in context- and tone-dependent fear conditioning was determined 24 h after fear conditioning to evaluate and compare different behavioral measures as indices of emotional learning. Freezing, the change in activity and the size of the explored area were evaluated as behavioral parameters indicating fear. Additionally, the heart rate (HR) increase elicited by tone presentation was evaluated as an autonomic indicator of fear. During the context-dependent memory test, freezing was high only in 6J and 6N mice, whereas a drop of activity and a reduced exploratory area was measured in all strains. During the tone-dependent memory test, high freezing, low activity, reduced exploratory area and a strong HR increase were demonstrated only in 6N and 6J mice, whereas behavioral and HR changes of 2J and 2N mice were always low. In extinction tests, context- and tone-dependent freezing of 6J mice decayed significantly faster than the freezing of 6N mice, whereas in both substrains the conditioned tachycardia to tone extinguished similarly in the home cage. The data demonstrate that monitoring of additional behavioral measures besides freezing and autonomic measures is necessary to interpret differences in associative learning performance of mouse strains that could be related to a differential expression of fear.

Psychopathology and psychotherapy in chronic physically ill patients.

Within the scope of psychosomatic medicine somato-psychic diseases are of great importance theoretically as well as practically, especially in view of problems dealing with the patient's attitude toward his illness and his coping with the disease. Among the somato-psychic illnesses chronic physical diseases are of primary interest. The knowledge of their general and specific psychological and psychopathological symptoms are of great importance for a better understanding of these patients and in view of a favourable direction in therapy. This is demonstrated in the form of extracts with three groups of the chronic physically ill: (1) hemophiliacs; (2) patients on regular hemodialysis treatment and following renal transplantation, and (3) diabetics.