RESUMEN
We report on the first detailed comparison of evaluation results regarding the correct billing in the G-DRG (German diagnosis-related group) system. For two Medical Review Boards of the Statutory Health Insurance Funds of comparable size (MDK Baden-Württemberg and MDK Westfalen-Lippe), we analysed consecutive expertises regarding correct billing according to section sign 275 SGB V, and the results were compared in terms of the frequency of DRG-relevant error codes, their relevance to revenue, and the question of error clustering (specific DRGs, primary diagnoses, etc.). The analysis comprised 51,010 individual expertises pertaining to billings of the year 2005 (admittance to hospital from January 1 to December 31, 2005). The proportion of disapproved cases was 38.5% in Baden-Württemberg and 44.6% in Westfalen-Lippe. Among these, errors to the disadvantage of the Health Insurance (incorrectly high) were 33.9% and 39.3%, respectively, and errors to the disadvantage of the hospitals (incorrectly low) were 4.6% and 5.3%, respectively. The resulting ratio (incorrectly high vs. low) was an identical 7.4 in both cases. Not only the most commonly rejected DRGs but also the primary and secondary diagnoses were similar in both cases, while the disapproved procedure codes showed a significant variability (analysis based on the respective 10 most common objections). We discuss the similarities and differences in these results and their possible causes, and demonstrate the cost relevance of this audit segment. Result comparisons of this type can yield insights into streamlining of the review practice of Medical Review Boards, as well as increase the efficiency and effectiveness of the selection of cases.
Asunto(s)
Honorarios y Precios/legislación & jurisprudencia , Honorarios y Precios/estadística & datos numéricos , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Acampadores DRG/economía , Acampadores DRG/estadística & datos numéricos , Método de Control de Pagos/legislación & jurisprudencia , Alemania/epidemiología , Hospitalización/legislación & jurisprudencia , Modelos Econométricos , Modelos Estadísticos , Sensibilidad y EspecificidadRESUMEN
PURPOSE: To detect the frequency and circumstances of sore ulcers in comparatively unselected patients of the German nursing care insurance who claimed for compensation. Setting Cross-sectional/case-control. METHODS: Data sampling and descriptive analysis. Assembled data were biometric data, level of the need of care, grade of sore ulcer, duration of sore ulcer, bedding materials and frequency of wound dressings of sore ulcer. RESULTS: In 97 622 out-patients and 32 059 patients from nursing care units, there were 3.2 and 6.4% sore ulcers, respectively, with diverse grades of severity present. Despite the difference in frequency of sore ulcers, no distinction in the nursing quality could be shown between out-patients and patients from nursery care units. Our data possibly suggested a lack with regard to evidence-based prophylaxis and treatment of sore ulcers in both groups. CONCLUSIONS: For both out-patients and patients from nursing care units, prophylaxis and treatment of sore ulcers could possibly be improved. Further studies will be needed to reveal the short-comings in nursing-care and to map out strategies for improvement.
Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Atención de Enfermería/estadística & datos numéricos , Casas de Salud/estadística & datos numéricos , Úlcera por Presión/epidemiología , Garantía de la Calidad de Atención de Salud/métodos , Medición de Riesgo/métodos , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Estudios Transversales , Femenino , Alemania/epidemiología , Hogares para Ancianos/estadística & datos numéricos , Humanos , Incidencia , Masculino , Factores de Riesgo , Distribución por SexoRESUMEN
Annually the Medizinische Dienst der Krankenversicherung Westfalen-Lippe (MDK-WL) performs approximately 120,000 nursing care assessments according to the 11th social statute book (SGB XI). A prospective reflection on the amount of expert assessments and the spectrum of services for the Nursing Care Insurance until 2020, was performed in order to establish a long term strategic controlling. The insured party makes the request for nursing care according to their personal estimation when the need for assistance is increasing. To predict the future amount of expert assessments you have to take into consideration the social background of the families in addition to age and gender (there is a clear correlation between age and the need of assistance). The database from nursing care assessments in 2001 was projected on a demographic model for the region of Westfalen-Lippe. The amount of requests correlates as expected with the patients age and increases exponentially. The incidence in the need of care shows relevant gender differences, but taken into consideration the very different age structure, the overall incidence is very similar. Against the background of the current nursing care law, the MDK-WL has to deal with an annual increase in assessments of 2 %. The requests for single persons are extremely often without foundation (55 % not substantially in need of care vs. 35 %). Looking at the requests of couples, it shows that the ones for women are more often unfounded then the ones for men (39 % vs. 32 %). It is necessary to take the development of the amount of single living persons into consideration to achieve more accurate predictions for the amount of assessments.
Asunto(s)
Atención de Enfermería/estadística & datos numéricos , Garantía de la Calidad de Atención de Salud/métodos , Cambio Social , Medicina Social/estadística & datos numéricos , Factores de Edad , Demografía , Femenino , Predicción , Alemania , Humanos , Legislación de Enfermería , Masculino , Factores Sexuales , Medicina Social/tendenciasRESUMEN
Fourteen DRB alleles, DRB1*0705, DRB1*11014, DRB1*1134, DRB1*1136, DRB1*1141, DRB1*1335, DRB1*1337, DRB1*1338, DRB1*1342, DRB1*1343, DRB1*1349, DRB1*1510, DRB3*0105, and DRB5*0103, are described. Among them, eleven are variants which differ by only one nucleotide from previously described alleles, including one silent variant (DRB1*11014). Alleles, DRB1*0705, DRB1*1335 and DRB3*0105, display unique sequence motifs that have never been observed in DRB alleles.
Asunto(s)
Alelos , Antígenos HLA-DR/genética , Células Madre , Cadenas HLA-DRB1 , Cadenas HLA-DRB3 , Cadenas HLA-DRB5 , Humanos , Sistema de Registros , Análisis de Secuencia de ADN , Donantes de TejidosRESUMEN
A total of 42,160 individuals were typed for HLA-A and HLA-B by both serology and PCR-based typing. The HLA assignments included all of the known serological equivalents. The majority of the individuals (99.9%) were from U.S. minority population groups. The serologic typing was performed between 1993 and 1997 at the time of recruitment for the National Bone Marrow Program (NMDP) registry. The polymerase chain reaction (PCR)-based typing was carried out in two phases. In phase I, DNA typing was performed by PCR using sequence-specific oligonucleotide probes (PCR-SSOP) or PCR using sequence-specific primers (PCR-SSP) without knowledge of the serologic assignments. Discrepancies were identified between the serologic and DNA assignments in 24% of the volunteers (8% of volunteers differed for only HLA-A assignments, 13% for HLA-B, and 3% for both HLA-A and -B) and a potential explanation was assigned each discrepant serology/DNA pair. In phase II, a random sampling scheme was used to select a statistically significant number of individuals for repeat DNA typing from each of these categories. The categories included antigens missed by serology, nonexpressed (null) alleles, PCR amplification failures, misassignment of antigens and nomenclature issues. Only a single individual was found to carry a null allele. DNA-based testing correctly typed nearly 99% of the donors at HLA-A, more than 98% at HLA-B, and more than 97% at both HLA-A and -B validating this methodology for registry typing.
Asunto(s)
Trasplante de Médula Ósea , Pruebas Inmunológicas de Citotoxicidad/métodos , ADN , Antígenos HLA-A/genética , Antígenos HLA-B/genética , Prueba de Histocompatibilidad/métodos , Sistema de Registros , Donantes de Tejidos , Examen de la Médula Ósea/métodos , ADN/análisis , ADN/sangre , Antígenos HLA-A/sangre , Antígenos HLA-B/sangre , Humanos , Reacción en Cadena de la Polimerasa , Reproducibilidad de los ResultadosRESUMEN
Two novel HLA-A and three novel HLA-B alleles were identified within a group of Afro-Caribbean individuals who were recruited as potential donors for the Anthony Nolan Bone Marrow Trust Register. HLA typing was performed on DNA extracted from peripheral blood mononuclear cells using sequence-specific oligonucleotide (SSO) probes for HLA-A and -B loci. Eight individuals analysed exhibited hybridisation patterns for which a type could not be assigned. DNA from these individuals was further typed by two methodologies: direct sequencing of PCR products and reference strand conformation analysis (RSCA). The direct sequencing results allowed the identification of new alleles but did not allow confirmation of the cis/trans orientation of the new sequence motifs identified. RSCA analysis confirmed the results obtained by SSO and direct sequencing and in addition confirmed the cis/trans orientation of the new sequences. One individual possesses a new A*30 allele--A*3008 and two individuals possess an identical new A*74 allele--A*7404. The three novel HLA-B alleles were identified in three individuals: B*0812, B*1554 and B*4503 respectively. For the remaining two samples, A*2612 was identified. At present Caucasoid individuals, and therefore Caucasoid phenotypes, are predominantly represented on the various different volunteer bone marrow donor registries. The examples presented here highlight the potential for identification of further polymorphisms within the HLA system as more individuals from the much-needed ethnic minorities are recruited onto bone marrow donor registers.
Asunto(s)
Trasplante de Médula Ósea/inmunología , Variación Genética/genética , Antígenos HLA-A/genética , Antígenos HLA-B/genética , Donantes de Tejidos , Alelos , Población Negra/genética , Marcadores Genéticos/inmunología , Humanos , Modelos Moleculares , Datos de Secuencia Molecular , Indias Occidentales/etnologíaRESUMEN
DNA-based typing of HLA class I alleles of the HLA-A and HLA-B loci using sequence-specific oligonucleotide primers and/or probes has been used for the large-scale typing of individuals for the National Marrow Donor Program unrelated donor registry. Typing was performed by 16 laboratories at a low level of resolution (e.g. A*01, B*07). The results of blinded quality control analysis for the first 12 months of the project show the typing to be highly accurate, specific and reliable. The total error rate based on 11,545 HLA-A and 11,428 HLA-B assignments was 1.1% for HLA-A and 1.9% for HLA-B. This level of accuracy is particularly remarkable because the quality control samples could not be distinguished from 64,180 donor samples tested at the same time by the laboratories.
Asunto(s)
Antígenos HLA-A/análisis , Antígenos HLA-A/genética , Antígenos HLA-B/análisis , Antígenos HLA-B/genética , Prueba de Histocompatibilidad/normas , Trasplante de Médula Ósea/inmunología , Cartilla de ADN , Pruebas Genéticas/normas , Prueba de Histocompatibilidad/métodos , Humanos , Hibridación de Ácido Nucleico , Reacción en Cadena de la Polimerasa , Sistema de Registros , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
The National Marrow Donor Program (NMDP) has instituted an approach to address the impact of new alleles on the DNA-based HLA assignments obtained during volunteer donor typing. This approach was applied to the DRB typing results from 371,187 donors received from 14 laboratories in 1999. Samples were tested with a standardized set of sequence specific oligonucleotide reagents and the positive and negative hybridization results transmitted electronically to the NMDP. A software program interpreted the primary data into HLA assignments and rejected assignments which did not produce a result at the specified level of resolution. Comparison of the HLA assignments derived by the NMDP software to the assignments made by the laboratories using several local software prograins showed 90.5% of the assignments to be identical. Differences in assignments were explained by varying levels of typing resolution, variation in the inclusion of the second expressed DRB loci, disparity arising when alternative assignments were summarized, and failure to submit correct information. When the primary data collected in 1999 were interpreted into HLA assignments using the set of alleles defined in July 2000, 74% of the HLA-DRB assignments were altered by the description of new alleles, justifying the development of this software.
Asunto(s)
Antígenos HLA/genética , Trasplante de Células Madre Hematopoyéticas , Sistema de Registros , Donantes de Tejidos , Secuencia de Bases , Antígenos HLA-DR/genética , Cadenas HLA-DRB1 , Prueba de Histocompatibilidad/normas , Prueba de Histocompatibilidad/estadística & datos numéricos , Humanos , Sondas de Oligonucleótidos/genética , Programas Informáticos , Trasplante HomólogoAsunto(s)
Actividades Cotidianas/clasificación , Evaluación de la Discapacidad , Evaluación de Necesidades/estadística & datos numéricos , Determinación de la Elegibilidad/legislación & jurisprudencia , Alemania , Humanos , Seguro de Servicios de Enfermería/legislación & jurisprudencia , Análisis Multivariante , Programas Nacionales de Salud/legislación & jurisprudencia , Estudios RetrospectivosRESUMEN
Four previously unreported DR52-associated DRB1 alleles have been characterized through DNA sequencing, contributing to the diversity of the HLA system. DRB1*1424 is nearly identical to DRB1*1402 in the second exon, except that it contains the "I---A" motif found at codons 67-71 common to the DRB1*15 alleles. DRB1*1425 contains the "A--H" motif, found in DRB1*1401 at codons 57-60, in a sequence otherwise identical with the second exon of DRB1*1307. Compared with DRB1*11012, DRB1*1323 contains three predicted amino acid changes at codons 58 (ala-->glu), 67 (phe-->ile), and 71 (arg-->glu). The sequence of DRB1*1324 is identical to exon 2 of DRB1*1103, except that DRB1*1324 does not contain the GAG at codon 58 characteristic of the DRB1*11 alleles. These new alleles may have arisen through gene conversion, and they contribute to the complexity of the DR6 family.
Asunto(s)
Alelos , Antígenos HLA-DR/genética , Secuencia de Bases , ADN , Cadenas HLA-DRB1 , Humanos , Datos de Secuencia Molecular , Polimorfismo GenéticoAsunto(s)
Alelos , Antígenos HLA-DR/genética , Secuencia de Aminoácidos , Secuencia de Bases , Cartilla de ADN , Antígenos HLA-DR/aislamiento & purificación , Cadenas HLA-DRB1 , Humanos , Datos de Secuencia Molecular , Reacción en Cadena de la Polimerasa , Polimorfismo Conformacional Retorcido-Simple , Análisis de Secuencia de ADNRESUMEN
SV40 origin auxiliary sequence 1 (aux-1) encompasses T-antigen (T-ag) binding site I and facilitates origin core (ori-core) activity in whole cells or cell extracts. Aux-1 activity depended completely upon its sequence, orientation and spacing relative to ori-core. Aux-1 activity was lost either by inserting 10 base pairs between aux-1 and ori-core or by placing either orientation of aux-1 on the opposite side of ori-core. Reversing the orientation of aux-1 in its normal position actually inhibited replication. Easily unwound DNA sequences that stimulate yeast or E. coli origins of replication could not replace aux-1. Aux-1 did not affect bidirectional replication. Replication remained bidirectional even when aux-1 was inactivated, and deletion of aux-1 did not affect selection of RNA-primed DNA synthesis initiation sites in the origin region: the transition from discontinuous to continuous DNA synthesis that marks the origin of bidirectional replication occurred at the same nucleotide locations in both wild-type and aux-1 deleted origins. These results support a model for initiation of SV40 DNA replication in which T-ag binding to aux-1 (T-ag binding site I) facilitates the efficiency with which T-ag initiates replication at ori-core (T-ag binding site II) without affecting the mechanism by which initiation of DNA replication occurs.
Asunto(s)
Antígenos Transformadores de Poliomavirus/genética , Replicación del ADN/genética , Virus 40 de los Simios/genética , Secuencia de Bases , Sitios de Unión/genética , Línea Celular , ADN Viral/genética , Cinética , Datos de Secuencia Molecular , Plásmidos/genéticaRESUMEN
Using both electron microscopic immunohistochemistry and cell fractionation techniques, we show that transforming growth factor-beta 1 (TGF-beta 1) is found in mitochondria of rat and mouse cardiac myocytes and rat hepatocytes. Four different polyclonal antibodies, raised against various epitopes encompassing the mature portion of the TGF-beta 1 molecule as well as the pro-region of its precursor, were used for the electron microscopy studies. The localization of TGF-beta 1 in mitochondria was confirmed by detection of the native peptide in mitochondria isolated from rat heart and liver; the majority of native TGF-beta 1 found in liver homogenates was recovered in highly pure mitochondrial fractions. The functional role of TGF-beta in the mitochondrion is unknown at present.
Asunto(s)
Mitocondrias Cardíacas/química , Mitocondrias Hepáticas/química , Factor de Crecimiento Transformador beta/análisis , Animales , Fraccionamiento Celular , Inmunohistoquímica , Ratones , Ratas , Ratas EndogámicasRESUMEN
Disruption of intercellular communication (IC) by tumor promoters has been implicated as one of the major events in the promotion process. We studied the effect of 12-O-tetradecanoylphorbol-13-acetate (TPA) on IC in relation to colony formation (CF) in a coculture system of mouse epidermal JB6 cells, including unpromotable, promotable, and transformed clones. CF was evaluated in cocultures where cells were overlaid onto irradiated mat cells. IC was evaluated by the dye transfer assay in cocultures where overlaid cells were labeled with fluorescent beads. Enhancement of CF by TPA was observed in combinations where promotable clones were used as overlays. However, suppression of IC by TPA was observed in all clones of overlaid cells (day 1) and did not correlate satisfactorily to subsequent CF. Growth-arrested cells retained their capability to communicate with mat cells, while IC between colony-forming cells and mat cells was disrupted during CF (day 5), implying that selective communication is an event secondary to CF. It is suggested that in our experimental model, short-term suppression of IC by TPA may not be sufficient to explain subsequent colony formation and that other factors should be considered.
Asunto(s)
Agregación Celular/efectos de los fármacos , Comunicación Celular/efectos de los fármacos , Transformación Celular Neoplásica , Acetato de Tetradecanoilforbol/farmacología , Animales , División Celular/efectos de los fármacos , Línea Celular , Células Clonales , Epidermis , Colorantes Fluorescentes , Isoquinolinas , Cinética , RatonesRESUMEN
The possible in vivo role of TGF-beta 1 in regulating various proteins of the extracellular matrix, including fibronectin, collagen I and III, and glycosaminoglycans, was examined by immunohistochemical methods during critical stages of lung morphogenesis in the 11- to 18-day-old mouse embryo. Sections of Bouin-fixed, paraffin-embedded whole embryos were exposed to polyclonal antibodies specific to synthetic peptides present in the precursor part of TGF-beta 1 (pro-TGF-beta 1), in the processed TGF-beta 1 (antibody CC), collagen I and III, fibronectin, followed by the PAP or ABC technique to visualize the location of the antibody. GAG were stained with Alcian Blue 8GX. Our results indicate colocalization of TGF-beta 1 expression and that of matrix proteins in the developing lung when branching morphogenesis (cleft formation) and tissue stabilization occur. The presence of TGF-beta 1 at the epithelial-mesenchymal interfaces of stalks and clefts at a time when matrix proteins can first be visualized in these areas, suggests a direct participation of the growth factor in the development of the basic architecture of the lung.
Asunto(s)
Colágeno/análisis , Fibronectinas/análisis , Glicosaminoglicanos/análisis , Pulmón/química , Factor de Crecimiento Transformador beta/análisis , Animales , Matriz Extracelular/química , Inmunohistoquímica , Pulmón/embriología , Ratones , MorfogénesisRESUMEN
Transforming growth factors-beta (TGF-beta) are 25 kilodalton (kDa) homodimeric peptides with multifunctional actions controlling the growth, differentiation and function of a broad range of target cells of both epithelial and mesenchymal derivation. They are expressed early in embryogenesis and their tissue-specific and developmentally dependent expression is strongly suggestive of an essential role in particular morphogenetic and histogenetic events. Five distinct TGF-beta s have been characterized so far, with 65-80% homology to each other. By using both molecular biological and immunohistochemical techniques, we are currently attempting to define specific sites of expression of the different TGF-beta s and to determine whether TGF-beta s 1-5 might have unique functions in development and in the mature organism. Comparative study of the promoter regions for the different TGF-beta s and for any particular TGF-beta in different species is also underway. Mechanistically, TGF-beta s act to control gene expression of their target cells, many of their actions converging on a complex, multifaceted scheme of control of matrix proteins and their interactions with cells; these effects on matrix are thought to mediate many of the effects of TGF-beta on development.
Asunto(s)
Diferenciación Celular , Desarrollo Embrionario y Fetal , Crecimiento , Factores de Crecimiento Transformadores/fisiología , Secuencia de Aminoácidos , Animales , Matriz Extracelular/fisiología , Humanos , Datos de Secuencia Molecular , Homología de Secuencia de Ácido Nucleico , Factores de Crecimiento Transformadores/genéticaRESUMEN
We studied gap junctional intercellular communication (IC) in various clones of mouse epidermal JB6 cells and the effect of the tumor promoter, 12-O-tetradecanoylphorbol-13-acetate (TPA) on such communication. JB6 clones used included nonpromotable, promotable, and transformed clones, representing a spectrum in susceptibility to transformation from nontransformed, to initiated (postinitiated), to transformed cells. We used the dye transfer assay and the radioisotope transfer assay, and quantified IC both in homologous pairings, where IC among cells of a single clone was examined, and heterologous pairings, where cells of initiated or transformed clones were paired with cells of a nonpromotable clone. Both pairings showed good IC in the absence of TPA and poor IC in the presence of TPA. However, suppression of IC by TPA was more effective when cells had advanced in promotability. IC was more suppressed by TPA in heterologous pairing than in homologous pairing. These results implied that in advanced stages of promotion, the capability to retain IC with each other (homologous IC) and especially with their nontransformed counterpart (heterologous IC) is progressively lost. Thus we conclude that the interaction of initiated cells and transformed cells with nontransformed cells decreases progressively in this model system for tumor promotion and progression.
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Comunicación Celular/efectos de los fármacos , Células Epidérmicas , Uniones Intercelulares/efectos de los fármacos , Acetato de Tetradecanoilforbol/farmacología , Animales , Línea Celular , Células Clonales/efectos de los fármacos , Epidermis/diagnóstico por imagen , Uniones Intercelulares/diagnóstico por imagen , Ratones , CintigrafíaAsunto(s)
Matriz Extracelular/metabolismo , Proteínas/metabolismo , Factores de Crecimiento Transformadores/farmacología , Animales , Colágeno/biosíntesis , Matriz Extracelular/efectos de los fármacos , Fibronectinas/biosíntesis , Humanos , Integrinas/biosíntesis , Integrinas/efectos de los fármacos , Péptido Hidrolasas/metabolismoRESUMEN
We report here that extracellular TGF-beta 1 is associated exclusively with microfibrils of elastin which are present in the extracellular matrix of the inflamed articular joint of the rat. Inflammation was initiated by bacterial cell walls localized in the synovium following intraperitoneal injection of the bacterial components. This synovitis is associated with both destruction of connective tissue components and matrix deposition. The growth factor was localized by using a polyclonal antibody raised to a synthetic peptide corresponding to amino terminal 30 amino acids of TGF-beta 1 in conjunction with a gold-labeled secondary antibody. The results suggest a close association of TGF-beta 1 with proteoglycans which are known to be a major component of the microfibrils in elastin. Proteoglycan-mediated binding and concentration of TGF-beta 1 in specific areas of the extracellular matrix may constitute a mechanism whereby the growth factor could be targeted to specific sites of action.