299 research outputs found
The cost of intensive care medicine in Germany. Outcome of a benchmark survey of 110 anaesthesiological ICUs on the basis of the actual costs in 2009
No full textBackground: In 2003 the cost analysis of German intensive care units for the year 1999 was published by the working group "Anaesthesia and Economics" of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) and the Association of German Anaesthetists (BDA). One of the aims of the original study was, in view of the upcoming introduction of the DRG system, to analyse the cost data of German intensive care units headed by anaesthetists. The objective of the follow-up study presented here was to analyse the 2009 cost data of German intensive care units to obtain a current picture of the cost situation 10 years after the first study and 6 years after the introduction of the DRG-System. Methods: In June 2010 all members of the German Society of Anaesthesiology and Intensive Care Medicine recorded as "Head of Department" were invited to participate in a postal survey. The questionnaire was based in part on the original 1999 cost analysis by Prien et al. It comprised sections dealing with the hospital, its resources and departments, the intensive care unit with its personnel and equipment, and the cost data for the year 2009. For data analysis the ICUs were clustered according to hospital size (499 beds, university hospitals). Data were analysed using MS Excel 2003 and IBM SPSS Statistics 19. Results: 110 anaesthetist-headed ICUs participated in the study. The number of beds per ICU increased with increasing size of the hospital. The percentage of intensive care patients on ventilatory support varied between 20% (small hospitals) and 50% (university hospitals). The ratio of nursing and physician staff per bed was appreciably higher in university hospitals than in the other hospital types (nursing: 0.35 +/- 0.07 beds per nurse vs. 0.52 +/- 0.13; 0.53 +/- 0.14; 0.49 +/- 0.11; physician: 1.4 +/- 0.3 beds/physician vs. 1.9 +/- 0.6; 2.1 +/- 0.7; 2.2 +/- 0.7). The costs for drugs and materials were higher for university hospitals (drugs: 155 +/- 72 euros vs. 55 +/- 29; 73 +/- 30; 81 +/- 28 euros; materials: 129 +/- 85 euros vs. 64 +/- 45; 77 +/- 60; 86 +/- 45 euros). In comparison to the 1999 study the higher costs for physicians contrast with a stagnation of inflation-adjusted nursing costs; the costs of drugs in university hospitals and the material costs in all hospital groups have increased considerably. The accurate assignment of costs to intensive care units and to individual cases apparently continues to be a problem for the hospital administration, even 6 years on from the introduction of the DRG system. A case-severity adjustment of costs proved impossible, due to inadequate recording of case severity data. Conclusions: Intensive care cost transparency remains less than optimal, so that benchmarking would seem possible only on the basis of a staff count. Adjustment for case severity, however, continues to be indispensable
The cost of intensive care medicine in Germany. Outcome of a benchmark survey of 110 anaesthesiological ICUs on the basis of the actual costs in 2009
No full textBackground: In 2003 the cost analysis of German intensive care units for the year 1999 was published by the working group "Anaesthesia and Economics" of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI) and the Association of German Anaesthetists (BDA). One of the aims of the original study was, in view of the upcoming introduction of the DRG system, to analyse the cost data of German intensive care units headed by anaesthetists. The objective of the follow-up study presented here was to analyse the 2009 cost data of German intensive care units to obtain a current picture of the cost situation 10 years after the first study and 6 years after the introduction of the DRG-System. Methods: In June 2010 all members of the German Society of Anaesthesiology and Intensive Care Medicine recorded as "Head of Department" were invited to participate in a postal survey. The questionnaire was based in part on the original 1999 cost analysis by Prien et al. It comprised sections dealing with the hospital, its resources and departments, the intensive care unit with its personnel and equipment, and the cost data for the year 2009. For data analysis the ICUs were clustered according to hospital size (499 beds, university hospitals). Data were analysed using MS Excel 2003 and IBM SPSS Statistics 19. Results: 110 anaesthetist-headed ICUs participated in the study. The number of beds per ICU increased with increasing size of the hospital. The percentage of intensive care patients on ventilatory support varied between 20% (small hospitals) and 50% (university hospitals). The ratio of nursing and physician staff per bed was appreciably higher in university hospitals than in the other hospital types (nursing: 0.35 +/- 0.07 beds per nurse vs. 0.52 +/- 0.13; 0.53 +/- 0.14; 0.49 +/- 0.11; physician: 1.4 +/- 0.3 beds/physician vs. 1.9 +/- 0.6; 2.1 +/- 0.7; 2.2 +/- 0.7). The costs for drugs and materials were higher for university hospitals (drugs: 155 +/- 72 euros vs. 55 +/- 29; 73 +/- 30; 81 +/- 28 euros; materials: 129 +/- 85 euros vs. 64 +/- 45; 77 +/- 60; 86 +/- 45 euros). In comparison to the 1999 study the higher costs for physicians contrast with a stagnation of inflation-adjusted nursing costs; the costs of drugs in university hospitals and the material costs in all hospital groups have increased considerably. The accurate assignment of costs to intensive care units and to individual cases apparently continues to be a problem for the hospital administration, even 6 years on from the introduction of the DRG system. A case-severity adjustment of costs proved impossible, due to inadequate recording of case severity data. Conclusions: Intensive care cost transparency remains less than optimal, so that benchmarking would seem possible only on the basis of a staff count. Adjustment for case severity, however, continues to be indispensable
The Effect of Hospital Size and Surgical Service on Case Cancellation in Elective Surgery
No full textBACKGROUND: Short-term case cancellation causes frustration for anesthesiologists, surgeons, and patients and leads to suboptimal use of operating room (OR) resources. In many facilities, > 10% of all cases are cancelled on the day of surgery, thereby causing major problems for OR management and anesthesia departments. The effect of hospital type and service type on case cancellation rate is unclear. METHODS: In 25 hospitals of different types (university hospitals, large community hospitals, and mid-to small-size community hospitals) we studied all elective surgical cases of the following subspecialties over a period of 2 weeks: general surgery, trauma/orthopedics, urology, and gynecology. Case cancellation was defined as any patient who had been scheduled to be operated on the next day, but cancelled after the finalization of the OR plan on the day before surgery. A list of possible cancellation reasons was provided for standardized documentation. RESULTS: A total of 6009 anesthesia cases of 82 different anesthesia services were recorded during the study period. Services in university hospitals had cancellation rates 2.23 (95% confidence interval [CI] = 1.49 to 3.34) times higher than mid-to small-size community hospitals 12.4% (95% CI = 11.0% to 13.8%) versus 5.0% (95% CI = 4.0% to 6.2%). Of the surgical services, general surgical services had a significantly (1.78, 95% CI = 1.25 to 2.53) higher cancellation rate than did gynecology services-11.0% (95% CI = 9.7% to 12.5%) versus 6.6% (95% CI = 5.1% to 8.4%). CONCLUSIONS: When benchmarking cancellation rates among hospitals, comparisons should control for academic institutions having higher incidences of case cancellation than nonacademic hospitals and general surgery services having higher incidences than other services. (Anesth Analg 2011; 113: 578-85
Subito : Gegenwart in Rainald Goetz’ Heute Morgen-Komplex
No full textMasterarbeit, Otto-Friedrich-Universität Bamberg, 2017Das Thema von Rainald Goetz – Autor der Bücher Irre, Krieg, Kontrolliert, Festung, Heute Morgen und Schlucht – ist die Gegenwart: Wahrnehmung, Beschreibung und Kritik aus seinem gelebten Leben heraus. Leben heißt Handeln und Handeln heißt bei Rainald Goetz auch immer Schreiben.
In keinem anderen Werkabschnitt hat sich Rainald Goetz so umfassend mit der Gegenwart beschäftigt und sich so umfangreich zu ihr geäußert, wie in dem in den 90er Jahren entstandenen Heute Morgen-Komplex. Durch die Aufnahme früherer Schreibtechniken und die Ausbildung späterer können die fünf Bücher dieses Werkkomplexes, wenn nicht als repräsentativ, so doch als exemplarisch für die Poetik Rainald Goetz’ angesehen werden.
Diese Arbeit will dem Werk Rainald Goetz’ vom »Zauberort des Geistes und des Geistigen«, wie die Universität bei ihm bezeichnet wird, entgegentreten. Denn wo alle Ordnung wahnhaft ist und das wesentliche Strukturmerkmal der Welterfassung Expansion heißt, muss eine Ordnung gefunden werden, um Leben, Werk und Wirkung Rainald Goetz’ zu fassen. Die dazu notwendigen Kategorien sind Autor, Text und Leser. Anhand dieser soll der Komplex inhaltlich, formal und rezeptiv gefasst, analysiert und dargestellt werden, um Rainald Goetz’ Umgang mit der Gegenwart im Einzelnen betrachten und im Ganzen darstellen zu können.
»Und jetzt, los ihr Ärsche, ab ins Subito.«The subject of Rainald Goetz – author of the books Irre, Krieg, Kontrolliert, Festung, Heute Morgen and Schlucht – is the present: perception, description and criticism on the basis of his own life. For Goetz living means acting and acting always means writing.
In no other section of his work has Rainald Goetz dealt with the present so comprehensively and commented on it as extensively as in the Heute Morgen-Complex, created in the 90s. By including earlier writing techniques and the later development of further ones, the five books of this work complex can be regarded, if not as representative, but as exemplary for the poetics of Rainald Goetz.
This thesis seeks to counter the work of Rainald Goetz of the »magic place of spirit and the spiritual«, as the university is called by him. For where all order is delusional and the essential structural world-conception is expansion, an order must be found to grasp the life, work and impact of Rainald Goetz. The necessary categories for this purpose are author, text and reader. On this basis, the complex will be summarized, analyzed and presented in terms of content, form and receptivity, in order to be able to view Rainald Goetz’ handling of the present in detail and to present it as a whole.
»And now, you suckers, to the subito.
Land Grabbing and Home Country Development : Chinese and British Land Acquisitions in Comparative Perspective /
No full textBetween 2000 and 2016, China and the UK acquired large areas of land through investment projects in Sub-Saharan Africa. Illustrated by numerous rich and nuanced empirical accounts of such projects, Ariane Goetz explains the global phenomenon of 'land grabbing' from the perspective of two investor countries. She reflects on Chinese and British public policy, state-society relations, national developmental contexts, ideologies, and international relations and thereby gives insights into the political economies that enable these investments as well as the development ambitions and institutionalized paradigms of which they form a part.Between 2000 and 2016, China and the UK acquired large areas of land through investment projects in Sub-Saharan Africa. Illustrated by numerous rich and nuanced empirical accounts of such projects, Ariane Goetz explains the global phenomenon of 'land grabbing' from the perspective of two investor countries. She reflects on Chinese and British public policy, state-society relations, national developmental contexts, ideologies, and international relations and thereby gives insights into the political economies that enable these investments as well as the development ambitions and institutionalized paradigms of which they form a part.Online resource; title from PDF title page (publisher's Web site, viewed 23. Mai 2019).Includes bibliographical references (pages [305]-368).Added to collection customer.56279.
Season 7 Episode 3: Suburban Christianity
No full textIf you live in the suburbs, you see SUVs, large yards, and the latest greatest tractor mowers. But you don\u27t see poor people struggling to keep their kids from dropping out of school or worse. Dave Goetz, author of Death by Suburb: How to Keep the Suburbs from Killing Your Soul, discusses with host Shirley Hoogstra the costs of insulating our lives too much. Episode #703
Evidence based antiinfectives-programme "ABx" New possibilities through local adjustment
No full textPeer reviews in intensive care medicine: pragmatic approach to quality management
No full textCritical care medicine usually involves the implementation of measures resulting in significant consequences for the patient - including possible mistakes arising directly or indirectly from daily routine processes. In addition, an ever-widening range of pharmaceutical and technological options may also often have an impact. The increasing complexity of pharmaceuticals and technical aids must be monitored and taken into account. The need for 24-hour care requires the daily presence of a variety of IC specialists and the interchange of data. Immediate coordinated expert action is equally as important as professional competence in dealing with current limitations of medical science. Intensivists are increasingly being confronted with the demands of professional quality management requirements within the ICU. This aspect is highlighted by the Vienna declaration on ICU patient safety drawn up at the 2009 European Congress of the ESICM [1]. This includes a commitment to actively pursue quality management within the setting of intensive care medicine. The present article describes a practical and effective approach to this complex subject matter and the external evaluation of critical care by peer review, which has already been successfully implemented in Germany and is set to gain in significance
Evidence based antiinfectives-programme "ABx" New possibilities through local adjustment
No full textPeer reviews in intensive care medicine: pragmatic approach to quality management
No full textCritical care medicine usually involves the implementation of measures resulting in significant consequences for the patient - including possible mistakes arising directly or indirectly from daily routine processes. In addition, an ever-widening range of pharmaceutical and technological options may also often have an impact. The increasing complexity of pharmaceuticals and technical aids must be monitored and taken into account. The need for 24-hour care requires the daily presence of a variety of IC specialists and the interchange of data. Immediate coordinated expert action is equally as important as professional competence in dealing with current limitations of medical science. Intensivists are increasingly being confronted with the demands of professional quality management requirements within the ICU. This aspect is highlighted by the Vienna declaration on ICU patient safety drawn up at the 2009 European Congress of the ESICM [1]. This includes a commitment to actively pursue quality management within the setting of intensive care medicine. The present article describes a practical and effective approach to this complex subject matter and the external evaluation of critical care by peer review, which has already been successfully implemented in Germany and is set to gain in significance
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