Zeitschrift für Rheumatologie
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Once more, the revision of the German DRG catalogue 2006 provides for more accurate reimbursement, particularly for specialised medical services. The newly established DRG I97Z (Rheumatologische Komplexbehandlung bei Krankheiten und Störungen an Muskel-Skelett-System und Bindegewebe) for the complex and multimodal treatment of rheumatic diseases allows an accurate picture of clinical practice in specialized rheumatologic departments and hospitals. ⋯ A precondition for the affected hospitals is to deal with budget planning and calculation of G-DRGs without calculated cost weights for 2006. In addition, this article discusses the relevance of other modifications to the G-DRG system, additional payments, the conditions for payment, the coding standards, and the classification systems for diagnosis and procedures.
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Rheumatic diseases in childhood and adolescence differ from those of adulthood according to type, manifestation, treatment and course. A specialized therapy, starting as early as possible, improves the prognosis, can prevent long-term damage and saves the costs of long-term care. Only a specialized pediatric care system can guarantee optimum quality of the processes involved and the results for rheumatology in childhood and adolescence within a global financial system. ⋯ A pediatric rheumatologist must be available 24 h a day, and it must be possible to reach other specialists within a short time. For painful therapeutic procedures, age-appropriate pain management is obligatory. A continuous adjustment of these recommendations to changing conditions in health politics is intended.
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Prosthetic replacement surgery for hip, knee, shoulder, and elbow joints has become commonplace due to the great success of these procedures in restoring function to persons disabled by arthritis. One of the most feared complications is prosthetic joint infection, which is associated with significant morbidity and health care costs. The pathogenesis of prosthetic joint infections is influenced by microorganisms growing in biofilms, making these infections difficult to diagnose and eradicate. ⋯ Successful treatment requires long-term antimicrobial therapy, ideally with an agent acting on adhering stationary-phase microorganisms, combined with an adequate surgical procedure. In this article, the epidemiology, pathogenesis, diagnosis and treatment of prosthetic joint infections are reviewed. We focus on difficult diagnostic aspects in the context of underlying rheumatologic disease.