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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

Invasive fungal disease (IFD) causes increasing morbidity and mortality in haematological cancer patients. Reliable cost data for treating IFD in German hospitals is not available. Objective of the study was to determine the institutional cost of treating the IFD. Data were obtained by retrospective chart review in German hospitals. Patients had either newly diagnosed or relapsed acute myeloid leukaemia (AML) or myelodysplastic syndrome (MDS). Direct medical cost was calculated from hospital provider's perspective. A total of 108 patients were enrolled at 5 tertiary care hospitals, 36 IFD patients and 72 controls. The vast majority of IFD patients (74%) were diagnosed with invasive aspergillosis. On average, the hospital stay for IFD patients was 12 days longer than in control patients. All patients in the IFD group and 89% of patients in the control group received antifungal drugs. Mean direct costs per patient were €51,517 in the IFD group and €30,454 in the control group. Incremental costs of €21,063 were dominated by cost for antifungal drugs (36%), hospital stay (32%) and blood products (23%). From the perspective of hospitals in Germany the economic burden of IFD in patients with AML or MDS is substantial. Therefore, prevention of IFD is necessary with respect to both clinical and economic reasons.

Hintergrund Das deutsche G-DRG-System wurde im Rahmen des strukturierten Weiterentwicklungsverfahrens zur Systemversion 2011 erneut ausdifferenziert. Aus der Perspektive der Onkologie und Hamatoonkologie ergeben sich relevante Veranderungen bei Diagnosen, Prozeduren, Zusatzentgelten, Innovationsentgelten und der G-DRG-Struktur.

Ende 1998 wurde mit der ersten Isolierung und Kultivierung humaner embryonaler Stammzellen (humane ES-Zellen) eine sturmische Entwicklung in der Stammzellforschung eingeleitet, die bis heute von kontroversen Diskussionen begleitet wird. Adulte Blutstammzellen werden hingegen schon lange therapeutisch eingesetzt. Zunachst nach ihrer Entdeckung 1963 in Einzelfallen, bis sie Anfang der 1980er-Jahre Anerkennung als Zelltherapeutikum fanden. Der Weg von der Grundlagenforschung in die Klinik hat hier rund 20 Jahre gedauert und wurde anfangs sehr kontrovers diskutiert. Das damalige regulatorische Umfeld lies jedoch eine rasche Umsetzung der Ergebnisse aus der Grundlagenforschung in die Klinik zu. Inzwischen befinden sich neue Stammzelltherapien fur die Behandlung einer Vielzahl von Krankheiten in der Entwicklung. Vor ihrer klinischen Realisierung ist aber ein langer Entwicklungsweg zu durchlaufen, der uber das Arzneimittelgesetz (AMG) geregelt ist. Sowohl fur die vorklinische Forschung als auch fur den klinischen Einfuhrungsprozess gelten spezifische Regularien, die eine strukturierte und sichere Einfuhrung neuer therapeutischer Masnahmen gewahrleisten sollen. Zeitaufwand, Know-how und Kosten fur die Planung, Beantragung und Durchfuhrung der Studien sind nicht zu unterschatzen. Erst nach Prufung durch die zustandige Behorde und Erteilung einer entsprechenden Genehmigung durfen Stammzellprodukte in den Verkehr gebracht werden.

Das deutsche G-DRG-System wird jahrlich weiterentwickelt und auch 2008 erneut ausdifferenziert. Aus der Perspektive der Onkologie und Hamatoonkologie ergeben sich relevante Veranderungen bei Diagnosen, Prozeduren und der DRG-Struktur. Analyse der relevanten Diagnosen, Prozeduren und DRGs in den Systemversionen 2007 und 2008 anhand der durch das deutsche DRG-Institut InEK und das Deutsche Institut fur medizinische Dokumentation und Information (DIMDI) publizierten Informationen. Im Mittelpunkt der Veranderungen 2008 stand die Ubertragung der Parameter zur Aufwanddifferenzierung von hamatoonkologisch relevanten DRGs auf DRGs fur solide Tumore sowie die Erhohung der Sachgerechtigkeit der DRG-Zuordnung fur aufwandige hamatoonkologische Fallkonstellationen. Das G-DRG-System hat weiter an Komplexitat zugenommen. Fur onkologische und hamatoonkologische Fallkonstellationen resultieren deutlich erhohte Anforderungen an eine vollstandige und spezifische Kodierung. Weiterhin sind relevante Problembereiche wie z. B. die Differenzierung von Komorbiditaten und die zeitgerechte Implementierung von Innovationen ins DRG-System noch nicht ausreichend gelost.

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.

SummaryIn a ®eld experiment on `Golden Delicious' apple trees, different combinations of labelled (10 at. % 15N) urea concentrations (4, 20 and 40 g l±1) and spray volumes (1500, 300 and 150.l ha±1) were used in mid summer to foliar apply 920.mg N per tree by the following treatments: 1) low concentration-high volume, 2) medium concentration-low volume, 3) high concentration-ultra low volume. The fate of urea-N sprayed on leaves was followed during a 5.d period from spraying by determining 15N concentration on leaf samples collected at different timings and on entire branches, previously girdled. Basal and apical leaves were sampled 1, 5, 24, 48 and 120.h after spraying. Leaves intercepted on average 24.mg labelled N per m2 of leaf area, regardless of treatment and leaf age. Leaf N uptake within 48.h was highest when urea was sprayed at low concentration-high volume. At the end of the experiment (120.h), however, no signi®cant effect of treatments on leaf uptake was recorded. Urea-N penetrated at higher r...

Although reduced intensity conditioning (RIC) before allografting is associated with low treatment-related morbidity and mortality, graft-versus-host disease (GVHD) remains a significant complication of hematopoietic stem cell transplantation (HSCT). T cell depletion (TCD) has been successfully used in conventional allotransplantation to reduce the incidence of GVHD, but was associated with an increased rate of engraftment failure. In a small cohort of six patients at high risk of developing GVHD we have determined whether sustained engraftment could be achieved using reduced intensity conditioning and T cell depletion in combination. All patients engrafted and 5/6 developed high levels (i.e.or =95%) of donor chimerism, even though mismatched related or matched unrelated donors were used. Only one patient developed acute GVHD, as he received donor lymphocyte infusions (DLI) for relapse. In summary, TCD might be a useful prophylactic tool in RIC allogeneic HSCT. Although TCD after RIC might be associated with high relapse rate, as 5/6 patients are not in remission, this combined strategy might be appropriate for patients with less aggressive malignant or non-malignant diseases in which high transplant-related morbidity and mortality is not acceptable.

Invasive fungal disease (IFD) causes increasing morbidity and mortality in haematological cancer patients. Reliable cost data for treating IFD in German hospitals is not available. Objective of the study was to determine the institutional cost of treating the IFD. Data were obtained by retrospective chart review in German hospitals. Patients had either newly diagnosed or relapsed acute myeloid leukaemia (AML) or myelodysplastic syndrome (MDS). Direct medical cost was calculated from hospital provider's perspective. A total of 108 patients were enrolled at 5 tertiary care hospitals, 36 IFD patients and 72 controls. The vast majority of IFD patients (74%) were diagnosed with invasive aspergillosis. On average, the hospital stay for IFD patients was 12 days longer than in control patients. All patients in the IFD group and 89% of patients in the control group received antifungal drugs. Mean direct costs per patient were €51,517 in the IFD group and €30,454 in the control group. Incremental costs of €21,063 were dominated by cost for antifungal drugs (36%), hospital stay (32%) and blood products (23%). From the perspective of hospitals in Germany the economic burden of IFD in patients with AML or MDS is substantial. Therefore, prevention of IFD is necessary with respect to both clinical and economic reasons.

The discovery of human embryonic stem cells at the end of 1998 had a strong influence on the development of stem cell research and led to controversial discussions. The first therapeutic application of adult blood stem cells began after their discovery in 1963 and was accepted as an authorized therapy in the early 1980s. The way from basic research to therapeutic use needed about 20 years and was also discussed in a controversial way similar to the discussions of today. The regulatory environment at that time, however, allowed a quick translation of the results from basic research to the clinic. Today many new stem cell therapies for a multitude of diseases are under development. Their clinical realization is regulated by the AMG (Arzneimittelgesetz). For nonclinical research as well as for clinical research, specific regulations are enacted to guarantee a structured and safe launch. Time, know how and money for planning, request for authorization and conduction of a clinical trial should not be underestimated. For clinical application of stem cell products authorization by the proper authorities is mandatory.

18023 Background: This study assesses treatment patterns, resource consumption and costs related to FN in patients with AL receiving chemotherapy (CT) or in ASCT recipients. Methods: This is a multicentre observational,cost study. Interim results are presented for consecutive adult patients receiving CT or ASCT between 01–11/2006 at 4 academic hospitals. FN was defined as absolute neutrophil count