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More than 30% of all patients undergoing surgery suffer from preoperative anemia. Iron deficiency anemia is the most common type of anemia. The diagnostics and treatment of iron deficiency anemia can be carried out before patients undergo surgery as an alternative to blood transfusion and is an interdisciplinary task. This article gives an overview of various billing modalities and payment arrangements for management of preoperative anemia in the German healthcare system.

In a field trial with the Spur variety Super Chief® Sandidge, three different levels of nitrogen supply (50, 100, 150 kg ha(-1)) in combination with 3 rootstocks (M9 at 8333 trees ha(-1), M26 at 5555 trees ha(-1) and Pi80 at 4166 trees ha(-1)) were compared with respect to soil nitrogen dynamics, leaf nutrient levels, tree vigour and yield. The experimental orchard was planted in 2007 and the trial lasted until 2014. The data collected in this period revealed no significant effect of nitrogen levels above 50 kg ha(-1) year-1 on tree vigour and fruit yield, whereas clear differences emerge with respect to the different planting systems (rootstock/planting density). The observed soil nitrogen dynamics indicate that a considerable amount of mineral nitrogen may be lost by leaching from the very permeable soil at the site of the experiment, in particular in the case of high fertilizer applications and humid climatic conditions. Leaf nitrogen contents were not significantly affected by fertilizer rates.

More than 30% of all patients undergoing surgery suffer from preoperative anemia. Iron deficiency anemia is the most common type of anemia. The diagnostics and treatment of iron deficiency anemia can be carried out before patients undergo surgery as an alternative to blood transfusion and is an interdisciplinary task. This article gives an overview of various billing modalities and payment arrangements for management of preoperative anemia in the German healthcare system.

Erganzend zu den Fallpauschalen (DRG, diagnosebezogenen Fallgruppen) wurden bereits ab 2005 Zusatzentgelte (ZE) und Innovationsentgelte (neue Untersuchungs- und Behandlungsmethoden, NUB) etabliert. Seltene und in der Regel teure Medikamente, Implantate und Verfahren konnen somit sachgerecht neben der DRG abgerechnet werden. Bis 2015 wurden bereits 170 solcher ZE eingefuhrt. Der Artikel analysiert deren Bedeutung fur die Onkologie. Anhand der Fallpauschalenkataloge der Jahre 2005 bis 2015 wird die quantitative und inhaltliche Entwicklung der ZE betrachtet. Zusatzlich werden wesentliche Neuerungen des Katalogs 2015 und ungeloste Probleme aus Sicht der Fachgesellschaften dargestellt. Ein relevanter Anteil der ZE (45 % im Jahr 2015) hat einen deutlichen Bezug zur Onkologie. Aus den 170 ZE lassen sich folgende onkologischen Leistungsschwerpunkte identifizieren (in Klammern die Anzahl der ZE im Jahr 2015): Zytostatika (20), monoklonale Antikorper (10), Blut und Blutprodukte (11), orale und sonstige Substanzen (7), Antimykotika (10), Wachstumsfaktoren (7) und diagnostische und therapeutische Verfahren (10). Die NUB-Entgelte sind die Eintrittspforte in das DRG-System. Aufgrund dieser strategischen Bedeutung sind sie trotz des hohen Aufwands aufgrund der Vereinbarung fur die onkologischen Zentren sehr wichtig. Dies zeigt sich schon an der Vielzahl der NUB-Anfragen beim InEK (Institut fur das Entgeltsystem im Krankenhaus) zu onkologischen Themen. Zusatzentgelte und NUB-Entgelte sind fur die Onkologie unverzichtbare Elemente der stationaren Vergutung und sorgen fur eine sachgerechte Abbildung der Aufwande. Neue Herausforderungen wie neue Applikationsformen bekannter Wirkstoffe, die Vergutung der molekulargenetischen Diagnostik und deutliche Preissteigerungen bewahrter Zytostatika mussen bewaltigt werden.

Background Relevant inhospital adverse drug events (ADE) are often documented in clinical administrative data (CAD) using ICD-10 codes (International Classification of Diagnosis Related Diseases, 10th revision). In a previous propensity matched cohort study, we analysed the CAD of 48 072 inpatients of a university hospital for potentially preventable inpatient ADE affecting length of stay. From a hospital’s perspective, particularly ICD-10 codes coding for drug induced renal failure, appeared to be preventable. Purpose We aimed to evaluate causes and conditions leading to renal failure in hospital and develop prevention strategies. Material and methods We assessed the validity of such codes in patient records and evaluated whether acute renal failure occurred during the hospital stay. Using the updated causality score by Begaud et al , we currently assess, using 2 independent reviewers, whether acute renal failure was drug related. 1 Based on root cause analyses, preventive strategies will be developed. Results The records of 69 patients were analysed (mean age 62 years (range 23–94), 33% women). 26 cases (38%) had a known history of renal failure or were hospitalised because of acute renal failure. In 43 cases (62%), the adverse event occurred in hospital. Nearly half of these cases (n=20) had a known history of renal failure. The pilot results of four randomly selected cases of this ongoing assessment revealed 6 suspect drugs with a high imputability to the ADE (1 drug with level I4 and 5 drugs with level I6 out of 7 possible scores from I0 to I6). As conceivable prevention strategies, we identified a priori dose adjustment and/or longer intravenous application duration for nephrotoxic drugs (eg, aciclovir) in patients with a known history of renal failure. Conclusion Unless CAD do not explicitly flag inpatient ICD-10 codes, CAD based ADE identification is laborious, and adequate risk management by the hospital is challenging. Screening for (pre-existing) renal (dys)function at the stage of hospitalisation for appropriate dose adjustment could prove a promising preventive strategy for our hospital. References and/or acknowledgements 1. Arimone Y, et al. Updating the French method for the causality assessment of adverse drug reactions. Therapie2013;68:69–76. No conflict of interest

Prescription forms enable the communication between physicians and pharmacists. Hence, incorrectly issued prescriptions may result in delay of health-care delivery, additional workload, and potentially adverse patient outcomes. We aimed to evaluate the formal prescription quality in our outpatient clinics (OC) before and after performing teaching sessions and using an electronic prescription system to replace handwritten prescriptions.All OCs of a university hospital were offered a short teaching session on how to issue prescriptions correctly and how to use the electronic prescription system. During four weeks before and after the teaching, we anonymously collected all prescriptions of the OCs in 20 surrounding community pharmacies and assessed whether they were error-free, required an intervention by the pharmacist, additional clarification by the OC, or had to be reissued.After the intervention, the absolute fraction of formally error-free prescriptions increased by 12.9% from 52.9% (516/976) to 65.8% (713/1084, p0.001; d = 12,9% 95% confidence interval [8,7%; 17,1%]). Largest improvements were seen in prescriptions requiring clarification by the OC (224/976 prescriptions at baseline versus 93/1084 post-intervention, p0.001). The fraction of electronic prescriptions increased from 34.9% (341/976) to 46.9% (509/1084, p0.001, d = 12,0% 95% confidence interval [7,8%; 16,2%]) with electronic prescriptions consistently being of higher formal quality than handwritten prescriptions.After increased use of electronic prescribing and teaching courses, formal prescription quality was significantly improved.