[DGSMP - Interdisciplinarity to Advance Social Medicine and Prevention of Illness]. / DGSMP - Interdisziplinarität zur Förderung von Sozialmedizin und Prävention.

The German Society for Social Medicine and Prevention (DGSMP) refers back to a tradition of over more than 100 years, nevertheless having a critical look at it. As a scientific medical society the DGSMP promotes cross-sectoral configuration of contemporary social medicine to the benefit of both, general welfare and individual health in form of prevention, rehabilitation, re-integration, palliation and long-term care. Human medicine is the lead discipline in the interdisciplinary approach by the DGSMP in order to create - facing the dynamics in the health care system - professional prerequisites to maintain and update solidarity and equity in medical services on a scientific basis.

[Consistency and Reliability of MDK Expertise Examining the Encoding in the German DRG System]. / Einheitlichkeit der richtlinienkonformen Begutachtung durch den Medizinischen Dienst der Krankenversicherung bei der Prüfung der Kodierung im G-DRG-System.

INTRODUCTION: Hospital inpatient stays are reimbursed on the basis of German diagnosis-related groups (G-DRG). The G-DRG classification system is based on complex coding guidelines. The Medical Review Board of the Statutory Health Insurance Funds (MDK) examines the encoding by hospitals and delivers individual expertises on behalf of the German statutory health insurance companies in cases in which irregularities are suspected. A study was conducted on the inter-rater reliability of the MDK expertises regarding the scope of the assessment. METHODS: A representative sample of 212 MDK expertises was taken from a selected pool of 1 392 MDK expertises in May 2013. This representative sample underwent a double-examination by 2 independent MDK experts using a special software based on the 3MTM G-DRG Grouper 2013 of 3M Medica, Germany. The following items encoded by the hospitals were examined: DRG, principal diagnosis, secondary diagnoses, procedures and additional payments. It was analysed whether the results of MDK expertises were consistent, reliable and correct. RESULTS: 202 expertises were eligible for evaluation, containing a total of 254 questions regarding one or more of the 5 items encoded by hospitals. The double-examination by 2 independent MDK experts showed matching results in 187 questions (73.6%) meaning they had been examined consistently and correctly. 59 questions (23.2%) did not show matching results, nevertheless they had been examined correctly regarding the scope of the assessment. None of the principal diagnoses was significantly affected by inconsistent or wrong judgment. CONCLUSION: A representative sample of MDK expertises examining the DRG encoding by hospitals showed a very high percentage of correct examination by the MDK experts. Identical MDK expertises cannot be achieved in all cases due to the scope of the assessment. Further improvement and simplification of codes and coding guidelines are required to reduce the scope of assessment with regard to correct DRG encoding and its examination.

[The position of the sociomedical expert in the Medical Services of German Statutory Sickness Insurance Bodies (MDK) as influenced by changing challenges]. / Zur Stellung des sozialmedizinischen Experten im Medizinischen Dienst der Krankenversicherung (MDK) unter dem Einfluss sich wandelnder Anforderungen.

The "Medical Services of the German Statutory Sickness Insurance Bodies (MDK)" is a non-profit organisation providing socio-medical specialist advice to the German Statutory Health and Nursing Care Insurances. Facing demographic changes as well as progress in medicine, highly qualified expertises and consultations are of increasing importance to manage the social security system and to continue to develop its structure. Sociomedical assignments of the MDK as applied health science is so far mainly related to individual aspects of insured persons (case management) but more and more to general aspects such as quality, consumer protection, efficiency, guiding concepts and organisation of the health care system. Based on its widespread experience, profound knowledge and confidence in its expertise the MDK is aware of its great sociopolitical responsibility and faces the wide range of assignments with regard to personneldevelopment and organisational innovations. Identification with principles of genuine medical practice, creating a modern job profile, and exercising creative power in accordance with the fundamental social legislation. This characterises the self-image and roleperception of medical experts of the MDK.

Molecular cloning and functional expression of Xenopus laevis oocyte ATP-activated P2X4 channels.

All cells contain mechanosensitive ion channels, yet the molecular identities of most are unknown. The purpose of our study was to determine what encodes the Xenopus oocyte's mechanosensitive cation channel. Based on the idea that homologues to known channels might contribute to the stretch channels, we screened a Xenopus oocyte cDNA library with cation channel probes. Whereas other screens were negative, P2X probes identified six isoforms of the P2X4 subtype of ATP-gated channels. From RNase protection assays and RT-PCR, we demonstrated that Xenopus oocytes express P2X4 mRNA. In expression studies, four isoforms produced functional ATP-gated ion channels; however, one, xP2X4c, had a conserved cysteine replaced by a tyrosine and failed to give rise to functional channels. By changing the tyrosine to a cysteine, we showed that this cysteine was crucial for function. We raised antibodies against a Xenopus P2X4 C-terminal peptide to investigate xP2X4 protein expression. This affinity purified anti-xP2X4 antibody recognized a 56 kDa glycosylated Xenopus P2X4 protein expressed in stably transfected HEK-293 cells and in P2X4 cDNA injected oocytes overexpressing the cloned P2X4 channels; however, it failed to recognize proteins in control, uninjected oocytes. This suggests that P2X4 channels and mechanosensitive cation channels are not linked. Instead, oocyte P2X4 mRNA may be part of the stored pool of stable maternal mRNA that remains untranslated until later developmental stages.

Measurement of phase I volume breath by breath in spontaneously breathing guinea pigs.

A new method to determine phase I volume in tracheotomized spontaneously breathing guinea pigs is presented. Measurements were performed in three animals weighing 567-896 g. In simultaneous tracings of tidal volume (VT) and expiratory profiles of endogenous gases (PO2 or PCO2), the phase I volume of each breath was determined graphically as the volume expired up to the end of phase I of the expirogram. The mean phase I volume of different animals ranged from 0.29 to 0.43 ml with an arithmetic dispersion between 0.014 and 0.021 ml. Spontaneous sighs sometimes with doubling of the VT caused a significant rise of phase I volume up to 50% of the normal values. The linear regression curve was calculated for corresponding VT's and phase I volumes. The VT gradient of the phase I volume as the slope of this curve ranged from 0.108 to 0.217 ml/ml VT. The results of the new procedure, which works also with humans and rabbits, are discussed in respect to improvement of the characterization of the bronchial system. Compared with the human system, the VT gradient of the guinea pig is four times greater. By not being affected by disorders in pulmonary gas exchange, the phase I volume determined as described is a new suitable quantity to specifically assess actions and reactions of the bronchial system.

Wernicke's encephalopathy: unusual contrast enhancement revealed by magnetic resonance imaging.

Wernicke's encephalopathy is a serious neurologic disorder caused by vitamin-B1 or thiamine deficiency. The classical triad of clinical symptoms described by Wernicke (gait ataxia, ophthalmoplegia, and confusion) are found in only a third of patients upon initial examination. Typical findings upon MR imaging in patients with Wernicke's encephalopathy are well documented, with signal intensities in the medial thalami and periaqueductal regions of the midbrain. We report a case of Wernicke's encephalopathy revealing an unusual contrast enhancement. It is therefore important to note that the acute stage of Wernicke's encephalopathy may be associated with an intense contrast enhancement upon MR-imaging reflecting the disruption of the blood-brain barrier and inflammatory processes caused by thiamine deficiency. As a consequence from the guideline for managing Wernicke's encephalopathy by the Royal College of Physicians early B-vitamin treatment in suspected is recommended cases.

[An innovative procedure of oxygen detection in medicine, biology, environmental research and biotechnology based on luminescence quenching]. / Ein neuartiges Verfahren der Sauerstoffdetektion für Medizin, Biologie, Umweltforschung und Biotechnik auf Basis der Lumineszenzlöschung.

For most (aerobic) animal organisms, oxygen is a mandatory and global substrate. The accurate measurement of oxygen is therefore of importance in the fields of medicine, biology, environmental research and biotechnology. The fact that oxygen is not readily soluble in aqueous media makes its detection more difficult. In contrast to the technique of polarography, the use of luminescence quenching by paramagnetic oxygen, does not consume the oxygen. Another problem of oxygen detection in connection with respiration is the need for very short response times. A third problem, which is associated with luminescence itself, is the fading of the dyes, which results in long-term signal instability. The last two problems can be optimally resolved by adsorbing the luminescence dye onto chromatographic materials--in particular hydrophobic material--having a very large internal surface area, and using the decay time in accordance with the Stern-Volmer equation as oxygen signal. For this, continuous evaluation of the signal is necessary. The carrier material doped with dye is incorporated in a single-grain layer. For measurements in liquids, the detector layer is protected by a black silicone membrane. Two designs are possible for the oxygen detector: (I) a special form using glass fibres, and (II) a miniature detector utilizing optoelectronic solid state technology. Both fluorescence and phosphorescence can be employed, the dye used being excited by light, obviating the need for quartz. The detector layers may be either of high sensitivity for small oxygen concentrations, or have equal sensitivity over the entire oxygen concentration range. There is an optimal figure for the specific amount of adsorbed dye. Application examples are given for respiration and for the determination of oxygen uptake by suspended cells.

[A bipolar electrode with a radial asymmetrically aligned electric field. A new principle of nerve localization in regional anesthesia and pain therapy]. / Bipolare Elektrode mit radial asymmetrisch ausgerichtetem elektrischem Feld. Ein neues Prinzip der Nervenlokalisation in der Regionalaesthesie und der Schmerztherapie.

Electrostimulation is a common method of nerve localization. To improve the nerve-stimulating needle, we developed a new bipolar nerve-stimulating electrode with a more convenient extension of its electric field. Figure 1a shows the new nerve-stimulating needle; in Fig. 1b a longitudinal section is depicted. A hollow cannula (1) is surrounded by an isolator (5) that separates the internal electrode (1) from the external electrode (6). The surface of the latter is also covered by an isolator (8). Two cables, (2) and (7), connect the electrodes to a nerve stimulator. Syringes and tubes can be connected to the needle by using the attached part (4). Figs. 2a and b show top- and side views of the needle's sharp end. Except for small parts of the internal (1) and external electrode (2), both electrodes are covered by isolation (3). This arrangement leads to the radially asymmetric extension of the electric field. Studies with animal nerve-muscle preparations showed that the density of the electric field is higher, and thus electrostimulation can be carried out with up to 75% lower impulse amplitude as compared with insulated monopolar electrodes. The main advantage of the new arrangement of electrodes, however, is the dependency between revolution of the nerve-stimulating needle on its axis and the evoked muscle response. Muscle potentials measured by electromyography and respective degrees of needle torsion are shown in Fig. 3 (black circles: bipolar radially asymmetric electrode, white circles: insulated monopolar electrode).(ABSTRACT TRUNCATED AT 250 WORDS)

[Classification of social medical products provided by the German Medical Services of the Statutory Health Insurance in Hessen]. / Zur Klassifikation sozialmedizinischer Leistungen des Medizinischen Dienstes der Krankenversicherung in Hessen nach Produktgruppen1.

Based on agreements presented by a task force the German Medical Services of the Statutory Health Insurance in Hessen developed its own classification of social medical assignments. According to economic systematics they were arranged in groups of external and internal products reflecting providing services in form of medical expertises and fulfilment of legal obligations. Further typologisation of the products can be achieved by relational marks. Documentation based on this classification as a part of social medical controlling supports modern planning and management concepts. This way practical sociomedicine as an applied health science makes its contribution to economic efficiency of the statutory health care system.

[The future of social medicine from the practical viewpoint]. / Die Zukunft der Sozialmedizin aus praktischer Sicht.

Within the German statutory health care system the practice of sociomedicine as an applied health science is mainly related to individual aspects of theinsured persons. Combining factors due to medical and socio-economical developments it plays an important integrative role as so to say a lawyer of the patients. Furthermore, practical sociomedicine must provide consultant services to support the social insurance in the sphere of shaping the health care system. Profound knowledge on the required level must be acquired by graduate studies and can be deepened by well-planned continuing medical education. Professionalism in providing services and fulfillment of legal obligations can be achieved by standardisation of social medical procedures, scientific orientation towards public health aspects, appropriate methods of delivering medical knowledge, use of information systems, refinement of co-operation, quality management, social medical controlling, application of modern planning and control concepts as well as model leadership.

["Managed care"--perspectives in Germany]. / "Managed care"--Perspektiven in Deutschland.

There is a public discussion in Politics and Health services whether managed care should be realized in Germany. The German Medical Services of the Statutory Health Insurance (MDK) are also involved and have great interest and an opinion about this topic because the introduction of managed care or elements of managed care will influence the cooperation between the MDK and the German Statutory Health Insurance. The following article informs on certain elements of managed care already practised in Germany and discusses which of these elements can be used more intensively in the future according to Social Laws and developed structures.

Collagen type I metabolism after bone surgery.

This study follows the postoperative course of serum collagen type I metabolites in patients after uncomplicated implantation of a cemented total hip endoprothesis (TEP; n = 12, mean age: 69.3 years), a cemented hemiendoprothesis (HEP; n = 13, mean age 79.7 years), a dynamic condylar or hip screw (DCS/DHS; n = 12, mean age 75.1 years) and osteosynthetic treatment of a Weber B or C fracture (OS; n = 17, mean age 54.3 years). The course of the propeptide of human type I procollagen (PICP) as an anabolic marker as well as of I-carboxyterminal telopeptide (ICTP) as a catabolic marker of bone metabolism was characterized. Measurements were done preoperatively and weekly for 3 weeks after surgery. The concentrations of both markers increased and reached a maximum in the 2nd or 3rd week after surgery. However, the PICP values differed, depending on the kind of surgical intervention and the type of bone healing. Secondary fracture healing with formation of callus occurred in the DCS/DHS group, which developed the highest median PICP concentrations (initial 83 microg/l, second week 337 microg/l; P < 0.001). In contrast, the primary bone healing in the OS group showed increasing ICTP but unchanged PICP concentrations. Patients in the cemented TEP and HEP groups as a kind of artificial bone healing had comparable concentrations. To consider the effective metabolism of collagen type I, the PICP/ICTP ratio was calculated. Although the median PICP and ICTP concentrations of the studied groups differed, the PICP/ICTP ratios were similar. In comparison to 54 young and healthy volunteers (median PICP/ICTP ratio: 37), the ratios of the studied groups were still normal but low (median ratios: < 20). This could be an effect of decreasing collagen type I metabolism with age. Although the results are in agreement with animal studies and histomorphometric investigations, the clinical use of PICP and ICTP determination as a tool for the detection of complicated bone healing is limited by the marked interindividual variability and the uncertain bone specificity.

[Spontaneous motility of the human taenia coli under morphine, thiopental and dehydrobenzperidol]. / Die spontane Motilität menschlicher Dickdarmtaenie unter Morphin, Thiopental und Dehydrobenzperidol.

Intestinal dysfunction is well known after narcotic analgesics and anaesthetics. The site and extent of this action is not really known in man. We investigated the direct effect of morphine, thiopentone and droperidol on human taenia libera in vitro. The spontaneous motility of strips of fresh resected human taenia libera induced by a suitable preload was observed by isometric measurement of developed tension. Cumulative doses of morphine 1 X 10(-8) - 3.89 X 10(-6) g/ml, thiopentone 2.5 X 10(-6) - 9.75 X 10(-5) g/ml or droperidol 2.5 X 10(-8) - 9.72 X 10(-6) g/ml were added to the bath solution. The following parameters were analysed: amplitude, frequency and performance (Montevideo Units MU) of the spontaneous contractions and also the basal tone between contractions. Morphine showed no effects. Thiopentone reduced basal tone to 45.5% of the initial value and frequency to zero. The amplitude of contractions and the MU decreased with thiopentone more than 22.5 X 10(-6) g/ml. All effects are reversible. Droperidol has no significant effects with the exception of a light increase of frequency in high doses. The well known in vivo effect of morphine is therefore not induced by direct action on the smooth muscle of human intestine. Thiopentone in high dose can reduced intestinal motility by direct action on the smooth muscle. Droperidol in the dose used is probably without clinical relevance.

[Managed care--a possibility for German Health Insurance?]. / Managed care--eine Perspektive für die GKV?

Health services systems in nearly all developed countries face similar problems. This fact raises the question whether concepts used in different countries can be changed without affecting the historically grown foundations of national health services as have been accepted by majority. A group of experts of the German Medical Services of the Statutory Health Insurance were asked to analyse whether the managed care approach could play a substantial role in reforming the German "Bismarck model", given that the advisory responsibility of the social medical service for the sick funds is respected in such a consideration and that basic essentials of the system are maintained. The group concludes, in brief, that managed care and the "German model" are contradictory in respect of preconditions, aims and assumed results. Furthermore, the experts share the view that the "German model" incorporates sufficient to cope with its problems without changing the nature of health services, based on principles of solidarity in Germany. The system needs structural reforms rather than changes in monetary mechanisms.