RESUMEN
Over the last 20 years, urgently needed changes in the German health care system have forced hospitals to make a flexible adjustment to rising costs and the single handed, almost unmanageable dynamics of technical innovation in medicine. The partnership between the Salem Hospital and the Heidelberg University Hospital represents a pioneering management concept for the future. The alliance between a university surgical department with a basic peripheral hospital provides large advantages to patients, staff, hospitals and cost carriers.
Asunto(s)
Servicios Hospitalarios Compartidos/organización & administración , Hospitales Públicos/organización & administración , Hospitales Universitarios/organización & administración , Programas Nacionales de Salud , Servicio de Cirugía en Hospital/organización & administración , Asignación de Costos , Control de Costos , Alemania , Costos de Hospital/estadística & datos numéricos , Servicios Hospitalarios Compartidos/economía , Hospitales Públicos/economía , Hospitales Universitarios/economía , Humanos , Reembolso de Seguro de Salud/economía , Tiempo de Internación/economía , Programas Nacionales de Salud/economía , Servicio de Cirugía en Hospital/economíaRESUMEN
During the observation period between 2001 and 2003, all outpatient surgical therapy, including degrees of urgency, surgical care volume, regional provenance of patients, diagnoses, and referral channels were prospectively analysed at the Surgical Department of the University of Heidelberg, Germany. The data gathered do not merely describe the volume and characteristics of care encountered at this academic surgical institution but also provide further insight into the variability of resource utilisation and associated patient flow. Additionally, a retrospective evaluation using structured interviews and questionnaires was performed to differentiate and quantify patient care, teaching, and research activities. This study illustrates the high relevance of academic outpatient institutions to regional provision of general surgical care in Germany. There is a clear dominance of medical support functions, while research and teaching activities are of only minor relevance and realised particularly in subspecialty clinics. These data should give important stimuli for the future planning of health care in Germany. Outpatient clinics for general surgery appear to be an excellent basis for regional models of integrated health care delivery in the future.
Asunto(s)
Centros Médicos Académicos/estadística & datos numéricos , Procedimientos Quirúrgicos Ambulatorios/estadística & datos numéricos , Reforma de la Atención de Salud/estadística & datos numéricos , Programas Nacionales de Salud/estadística & datos numéricos , Centros Médicos Académicos/economía , Centros Médicos Académicos/legislación & jurisprudencia , Procedimientos Quirúrgicos Ambulatorios/economía , Procedimientos Quirúrgicos Ambulatorios/legislación & jurisprudencia , Ritmo Circadiano , Ahorro de Costo/legislación & jurisprudencia , Análisis Costo-Beneficio , Prestación Integrada de Atención de Salud/economía , Prestación Integrada de Atención de Salud/legislación & jurisprudencia , Prestación Integrada de Atención de Salud/estadística & datos numéricos , Episodio de Atención , Alemania , Reforma de la Atención de Salud/economía , Reforma de la Atención de Salud/legislación & jurisprudencia , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/legislación & jurisprudencia , Garantía de la Calidad de Atención de Salud/economía , Garantía de la Calidad de Atención de Salud/legislación & jurisprudencia , Garantía de la Calidad de Atención de Salud/estadística & datos numéricos , Asignación de Recursos/economía , Asignación de Recursos/legislación & jurisprudencia , Asignación de Recursos/estadística & datos numéricos , Especialidades Quirúrgicas/economía , Especialidades Quirúrgicas/legislación & jurisprudencia , Especialidades Quirúrgicas/estadística & datos numéricos , Revisión de Utilización de Recursos/estadística & datos numéricos , Carga de Trabajo/estadística & datos numéricosRESUMEN
There are too few reliable markers by which one can predict future function of a liver before implantation. Consequently, the purpose of this study was to test the hypothesis that amino acids in rinse-effluents could predict transplant outcome in marginal fatty livers from rats. Amino acids were measured in the rinse effluent from the livers immediately after harvest and graft preparation or cold storage. Amino acids in the effluent were twice as high in ethanol-treated animals compared to those in nonfatty controls. Ethanol-treated fatty livers survived for no longer than 7 days after transplantation while 83% of nonfatty controls survived (P < 0.05). In subsequent studies, the cold-storage time was decreased to 6 h to determine whether failing fatty livers released more amino acid than grafts that would function normally. There was a significant increase in amino acids in the effluent of fatty grafts compared to controls. Moreover, the sum of the four selected amino acids (alanine, valine, histidine, leucine) was lower than 23 nmol/g liver in functional livers, whereas failing grafts had totals significantly higher than 25 nmol/g liver. The sum of the four amino acids correlated well with 24 h post-transplant serum AST levels (r = 0.78, P < 0.0001). So we can conclude that amino acid release can serve as a useful marker of graft viability and reliably predicts survival.