Impact of Patient and Procedure Mix on Finances of Perinatal Centres - Theoretical Models for Economic Strategies in Perinatal Centres.

Introduction: In Germany, cost and revenue structures of hospitals with defined treatment priorities are currently being discussed to identify uneconomic services. This discussion has also affected perinatal centres (PNCs) and represents a new economic challenge for PNCs. In addition to optimising the time spent in hospital, the hospital management needs to define the "best" patient mix based on costs and revenues. Method: Different theoretical models were proposed based on the cost and revenue structures of the University Perinatal Centre for Franconia (UPF). Multi-step marginal costing was then used to show the impact on operating profits of changes in services and bed occupancy rates. The current contribution margin accounting used by the UPF served as the basis for the calculations. The models demonstrated the impact of changes in services on costs and revenues of a level 1 PNC. Results: Contribution margin analysis was used to calculate profitable and unprofitable DRGs based on average inpatient cost per day. Nineteen theoretical models were created. The current direct costing used by the UPF and a theoretical model with a 100 % bed occupancy rate were used as reference models. Significantly higher operating profits could be achieved by doubling the number of profitable DRGs and halving the number of less profitable DRGs. Operating profits could be increased even more by changing the rates of profitable DRGs per bed occupancy. The exclusive specialisation on pathological and high-risk pregnancies resulted in operating losses. All models which increased the numbers of caesarean sections or focused exclusively on c-sections resulted in operating losses. Conclusion: These theoretical models offer a basis for economic planning. They illustrate the enormous impact potential changes can have on the operating profits of PNCs. Level 1 PNCs require high bed occupancy rates and a profitable patient mix to cover the extremely high costs incurred due to the services they are legally required to offer. Based on our theoretical models it must be stated that spontaneous vaginal births (not caesarean sections) were the most profitable procedures in the current DRG system. Overall, it currently makes economic sense for level I PNCs to treat as many low-risk pregnancies and neonates as possible to cover costs.

[The occurrence of salmonellae in wild birds (Passeriformes, Lariformes)]. / Výskyt salmonel u volne zijících ptáku (Passeriformes, Lariformes).

The occurrence of salmonellae was investigated in 1011 cloacal smears of 21 species of wild birds caught at the locality of Hermanický rybník near Ostrava. Salmonella typhimurium serotype was isolated from one of the 23 laughing gulls (Larus ridibundus) which were examined; this corresponds to a 4.3% invasion frequency. The result of the examination of all other birds was negative. On the basis of the results of this study and the results published by other authors, laughing gull can be considered as a possible source of salmonellae for farm animal stocks, particularly water fowl. It is recommended that laughing gull should be taken into consideration when seeking, for diagnostic purposes, the sources of salmonellae from which water fowl are invaded.

[Control mechanisms of the ribonucleotide reduction in mammalian tissue (author's transl)]. / Steuermechanismen der Ribonucleotid-Reduktion in Säugetiergewebe.

The ribonucleoside diphosphate reductase (E.C.1.17.4.1) was partially purified from Ehrlich ascites carcinoma and regenerating rat liver. The specific activity of the two enzyme preparations did not vary with regard to the reduction of UDP, ADP, CDP and GDP. Similarly the regulation of the enzyme system by deoxyribonucleoside triphosphate (dNTP) is almost identical. Through the application of deoxyribonucleosides (10(-3) or 2 x 10(-3)M) and measurement of the dNTP content it was found in Ehrlich and Yoshida ascites tumours that these control mechanisms are transmissible to whole cells. dATP inhibits the reduction of all four nucleoside diphosphates. dTTP stimulates the reduction of GDP, dCTP that of UDP and dGTP that of ADP.

[Studies on the thymidine-triphosphate synthesis in malignant tumors. I. Effects of thymidine on deoxyribonucleoside triphosphate pools and deoxyribonucleic acid synthesis (author's transl)]. / Untersuchungen zur Thymidin-Triphosphat-Synthese in malignen Tumoren. I. Einfluss von Thymidin auf Desoxynucleosidtriphosphat-Gehalt und DNA-Synthese

Measurements of the deoxyribonucleoside triphosphate (dNTP) contents, the [14C] thymidine and deoxyuridine incorporation and the "key enzymes" of the thymidine triphosphate (dTTP) synthesis, thymidine kinase and ribonucleotide reductase, in diploid Ehrlich-ascites carcinoma, in Yoshida sarcoma-ascites cells and to a smaller extent in surgically removed malignant human tumours show 1. A distinctly increased dTTP content compared with the remaining dNTP is not a characteristic of tumour cells generally but a peculiarity of sarcoma and a sign of differentiation of a malignant tumour. 2. With simultaneous linear deoxyribonucleoside incorporation the dTTP content and the mix-proportion of [14C] dTTP to total dTTP in ascites tumour cells in short-term in-vitro incubation (120 min) remain constant. 3. Thymidine addition to the medium leads to a distinct rise of dTTP concentration even at a dosage of 3 X 10(-5) M. 4. The dNTP contents of ascites tumour cells are within the range of the endproduct-inhibiting concentrations of thymidine kinase and ribonucleotide reductase.