Leistungen und Kosten der Hochschulambulanzen in Forschung, Lehre und Versorgung

BACKGROUND

Outpatient clinics of university hospitals (Hochschulambulanzen) play a significant role in the German health care system. Universities have in contrast to other hospitals the right to implement an outpatient clinic, but the health care services they can render are restricted to clinical research and teaching activities. The university outpatient clinic study evaluates the intensity of medical care, teaching, research activities, and the related costs. METHOD AND DATABASE: 6 university hospitals with 51 outpatient departments in Germany were included. The prospective documentation of consultations was restricted to 800 visits per department. A total of 26,312 consultations with approximately 40,000 diagnoses and 150,000 services were documented. Furthermore, data concerning costs, teaching activities and research facilities were documented.

RESULTS

Clinical treatment without any correlation to research or teaching activities amounted to about 81 % of the working time in the outpatient department (research 11 %; teaching 8 %). The primary task of the university outpatient clinics takes up less than 20 % of the working time. The physicians documented that the disease of every fourth visit was in accordance with their main field of research. 6.9 % of the visits were asked to take part in clinical trials, of these 1.25 % were included for the first time, 3.7 % were already included. 6.5 % of the visits were addressed to participate in specific teaching activities. The average total costs per case added up to 149 Euro. No outpatient clinic could cover the total per case costs with the lump sum payments. On the average 31 % of these costs were covered by lump sum payments (without cases concerning research and teaching).

CONCLUSION

Treatment in outpatient departments of university clinics is far beyond research and teaching activities required by law. However, the ability of outpatient departments of universities to provide excellent outpatient services should have a more dominant role in the health care system. Therefore access to care should be deregulated for the patients and reimbursement schemes should be adjusted to adjust for the present losses.

Prevalence and clinical role of GBV-C infection after cardiac surgery in childhood: a study on 414 patients

OBJECTIVES

GB-virus C (GBV-C) and hepatitis C virus (HCV) share similar modes of transmission. We, therefore, examined the prevalence and clinical role of GBV-C and HCV in patients after cardiac surgery in childhood.

METHODS

We analysed blood samples of 414 patients and compared them to 487 controls. Evidence of liver disease and risk factors for infection was analysed.

RESULTS

Overall prevalence of GBV-C infection was 22.5% in the patients, compared to 6.2% in the controls (HCV infection 11.3 vs. 0.7%). GBV-C RNA was detected in 8.2% of the patients vs. 3.7% in the controls (HCV RNA in 6 and 0%, respectively). Eleven patients had detectable RNA of GBV-C and HCV. 63.4% of patients infected with GBV-C and 46.8% of patients infected with HCV cleared the virus from circulation. GBV-C infection was not associated with hepatitis. Liver disease was not more frequent in patients co-infected with HCV and GBV-C.

CONCLUSIONS

before 1991 have a substantial risk for HCV and GBV-C infection. However, GBV-C infection seems not to be associated with a liver disease. Co-infection with GBV-C and HCV has no influence on long-term clinical outcome or viral clearance of HCV infection.

Similarities and Differences in Distortion-Product Otoacoustic Emissions Among Four FDA-Approved Devices

Similarities and differences in distortion-product otoacoustic emissions (DPOAEs) among four Food and Drug Administration (FDA) approved devices were assessed quantitatively. DPOAEs were recorded from 42 adult subjects (84 ears) ranging in age from 19 to 40 years. All subjects had hearing thresholds of 20 dB HL or better for the test frequencies from 0.25 to 8.0 kHz and normal acoustic immittance findings. DPOAEs were collected in a quiet non-sound-treated room. DPOAE measurement parameters included an f2/f1 ratio of ~1.2, with f1 at 65 dB SPL (L1) and f2 at 55 dB SPL (L2). There were no significant differences in the mean emissions levels among the four devices. This investigation showed that validity criteria, pass criteria, and strategies for DPOAE measurements interact to produce varying pass and refer results. However, when DPOAEs are obtained with consistent validity criteria, pass criteria, and strategies for measurement, the results are remarkably consistent.

Abbreviations: ANOVA = analysis of variance, CNS = central nervous system, DPOAEs = distortion-product otoacoustic emissions, FDA = Food and Drug Administration, L = level, OAEs = otoacoustic emissions, SNR = signal-to-noise ratio

Similarities and differences in distortion-product otoacoustic emissions among four FDA-approved devices

Similarities and differences in distortion-product otoacoustic emissions (DPOAEs) among four Food and Drug Administration (FDA) approved devices were assessed quantitatively. DPOAEs were recorded from 42 adult subjects (84 ears) ranging in age from 19 to 40 years. All subjects had hearing thresholds of 20 dB HL or better for the test frequencies from 0.25 to 8.0 kHz and normal acoustic immittance findings. DPOAEs were collected in a quiet non-sound-treated room. DPOAE measurement parameters included an f2/f1 ratio of approximately 1.2, with f1 at 65 dB SPL (L1) and f2 at 55 dB SPL (L2). There were no significant differences in the mean emissions levels among the four devices. This investigation showed that validity criteria, pass criteria, and strategies for DPOAE measurements interact to produce varying pass and refer results. However, when DPOAEs are obtained with consistent validity criteria, pass criteria, and strategies for measurement, the results are remarkably consistent.