Nosocomial pneumonia: a cost-of-illness analysis.

BACKGROUND: We investigated incremental cost of nosocomial pneumonia (NP) from the perspective of a hospital and health insurance funds. PATIENTS AND METHODS: The incremental cost was determined by calculating total costs for pneumonia patients and controls using prospective and retrospective matched-pairs analysis with 29 and 37 matched pairs, respectively. RESULTS: Compared to controls, patients who developed pneumonia had to be on artificial ventilation 5 days longer, needed markedly more intensive care with 6.55 additional days in intensive care. Excess cost per pneumonia patient amounted to DM 14,606 (95% CI: DM 5,285-23,927) from the hospital's perspective and to DM 7,988 (95% CI: DM 5,281-10,894) according to statutory insurance charges. According to the retrospective anaLysis carried out on the neurosurgical and neurological intensive care wards, pneumonia patients were ventiLated 5 days longer than patients without pneumonia, needed more intensive care over 30 days and had an additional 14.03 days of intensive care and 10.14 more days in hospital. Excess cost per patient was DM 29,610 (95% CI: DM 23,054-36,174) from the hospitals perspective and DM 18,000 (95% CI: 14,885-21,020) according to the statutory insurance criteria. CONCLUSION: The study gives insight into the structure of incremental cost caused by NP and shows that based on a conservative cost calculation the incremental cost per NP patient is higher for the hospital than for health insurance funds which indicates a significant financial deficit for the hospital. Antibiotics and microbiology together only contribute 6.8% to incremental cost. Therefore in a cost saving initiative their close relationship to length of hospitalization must be considered.

[Blepharitis. Demodex folliculorum, associated pathogen spectrum and specific therapy]. / Blepharitis. Demodex folliculorum, assoziiertes Erregerspektrum und spezifische Therapie.

UNLABELLED: Demodex folliculorum has been demonstrated with an elevated frequency in patients with blepharitis, and is thought to cause therapy-resistant blepharitis. This paper presents the germ spectrum of patients with blepharitis and demodex and discusses the efficiency of a specific therapy. METHODS: In all, 3152 cilia from 139 patients with blepharitis (38% blepharitis, 44% blepharoconjunctivitis, others) and 108 persons with quiet eyes were examined for demodex. Smears n = 125, from the conjunctive of symptomatic patients were investigated for bacteria, 3 weeks of therapy with mercury ointment, 2%: Lindan, cortisone (prednisolone, dexamethasone, hydrocortisone, fluorometholone) or antibiotics after antibiogram (gentamicin, kanamicin, neomicin, erythromicin, ofloxacin, polymyxin-B, colistin) followed in all Demodex-positive blepharitis patients (n = 41). RESULTS: Demodex was found in 52% (62/139) of patients with chronic blepharitis, as against 20% (3/15) of those with acute blepharitis (statistically significant difference, chi 2-test, alpha = 2.5%) and in 29% of quiet eyes (statistically significantly less, alpha = 2.5%, chi 2-test). Gram-positive cocci were isolated from 79% of 57 Demodex-positive patients with blepharitis and 72% of 68 Demodex-negative patients anaerobes in 39% and 37%, gram-negative rods in 11% and 3% (statistically significant difference for gram-negative rods, alpha = 5%, chi 2-test). Of the patients with Demodex, 25% apparently had no more parasites after mercury ointment, 2% (n = 8) and lindan (n = 5) and 15% after cortisone and antibiotics (n = 13). (The best and statistically very significant results (alpha = 1%) were those obtained with mercury ointment, 2%, and lindan: t-test for connected spot checks). CONCLUSIONS: Gram-positive and gram-negative bacteria grew more often in patients with Demodex. Demodex seems to be a mediator of chronic blepharitis; we recommend that mites be sought in cilia of chronic blepharitis patients. Mercury ointment, 2% and lindan proved efficient for specific therapy, the main problem being the laborious application and toxicity.

[Complex after-care--an important contribution to the rehabilitation of endogenous psychoses]. / Die komplexe poststationäre Betreuung--ein wichtiger Beitrag zur Rehabilitation endogener Psychosen.

Treatment of patients suffering from endogenous psychosis should not be broken off after the stationary discharge. It needs a gliding system in steps for therapy and after-care. Close to the medicamentous long-term treatment the occupational rehabilitation is, above of greatest importance. A close co-operation with the work group "Occupational Rehabilitation" may facilitate the patient's occupational use substantially. However, a great engagement is often necessary too, especially for the unattached patients' reenrolment in the dwelling sphere. The rehabilitation in the poststationary phase should already be prepared during the stationary care and can only be carried out effectively in close co-operation with the psychiatric care, the District Commission for Rehabilitation, The Rehabilitation Center, the office for employment, and the Department for Dwelling policy.

[Experiences with dexamethasone in the therapy of brain edema in the preoperative phase]. / Erfahrungen mit Dexamethason bei der Hirnoedemtherapie in der präoperativen Phase.

The therapeutic effect of Dexamethasone was tested in 45 cases of patients suffering from brain tumors. More than three quarters of the patients experienced a distinct improvement, in particular of the psychic syndrome due to organic disorder, but also in neurological symptoms. This rendered the patients more cooperative, making for more favorable conditions for an operation.

[Possibilities of rapid diagnosis in meningitis]. / Möglichkeiten der Schnelldiagnostik der Meningitis.

The paper reviews rapid diagnosis methods for meningitis, covering currently proved immunological and physiochemical procedures, supplemented by reference to clinical biochemical tests.

[Trigeminal involvement following preventive influenza vaccination]. / Trigeminus-Affektion nach Influenza-Schutzimpfung.

Neuralgia-like complaints occurred in the region served by the ramus ophthalmicus et maxillaris nervi trigemini dexter of a woman aged 48 years two days after she had been inocculated with an inactivated influenza-A adsorbate complete vaccine (A/Bangkok/1/79 (H3-N2)); (A/Brazil/11/78 (H1-N1)). The clinical findings are explained, and the possibility of a connection between the symptomatology and a previous inocculation is discussed.