Latest Articles
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Observational Study
The Potential for Providing Treatment on an Outpatient Rather Than Inpatient Basis: A Nationwide Analysis of Hospital Discharge Data in Germany for the Year 2022.
In an expert analysis by the IGES Institute, it was examined which inpatient hospital treatments could also be carried out on an outpatient basis. A method of determining the feasibility of performing any particular treatment in the outpatient setting based on routine documentation was proposed in the report. A new version of the German catalogue of operations that can be performed on an outpatient basis and other outpatient procedures (the AOP catalogue) was issued accordingly. In addition, sector-blind (hybrid DRG) reimbursement of selected treatments was introduced, i.e., the amount of the reimbursement is now the same regardless of whether the treatment is provided on an inpatient or outpatient basis. ⋯ Both the IGES model and the AOP catalogue identified a relevant potential for providing treatment on an outpatient rather than inpatient basis. However, the overlap between the two approaches is small. Further development of the AOP catalogue appears necessary for the more accurate identification of treatment cases that can be provided in the outpatient setting. The extent to which the new AOP catalogue and hybrid DRG remuneration can promote the provision of outpatient rather than inpatient care will need to be determined in future analyses.
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An estimated 17% of all couples worldwide are involuntarily childless (infertile). The clinically identifiable causes of infertility can be found in the male or female partner or in both. The molecular pathophysiology of infertility still remains unclear in many cases but is increasingly being revealed by genetic analyses. ⋯ Genetic causes, disease patterns, and the related investigations are becoming increasingly important in the diagnostic evaluation of infertile couples and have implications for further treatment, for the children of the affected couple, and for other family members.
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An increasing number of older people are being treated in German hospitals. In 2022, more than 35.7 million hospitalized patients in Germany were of age 65 or older. Comprehensive geriatric assessment (CGA) can help to structure and improve the diagnosis and treatment of these patients, many of whom suffer from multimorbidity. ⋯ The German clinical practice guideline on CGA can serve as a guide to personalized geriatric medicine in the hospital. Further complex interventional studies are needed to evaluate the efficacy of CGA in other settings.
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Sarcopenia is a progressive, generalized disease of skeletal muscle characterized by a loss of muscle strength and muscle mass. The combination of obesity and sarcopenia is called sarcopenic obesity. Because of the aging of the population in many countries around the world, sarcopenia and sarcopenic obesity are a challenge for global health policy. ⋯ A targeted and structured approach to the detection and treatment of sarcopenia and sarcopenic obesity can make a major contribution to the maintenance or improvement of these patients' functionality and quality of life.
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Collaborative and stepped care (CSC) models are recommended in guidelines because of their documented effectiveness in treating depression and anxiety disorders. The evidence for their efficacy against other mental disorders is limited. In this study, we evaluated the effectiveness of a collaborative and stepped care model (COMET) for patients with depressive, anxiety, somatoform and/or alcohol-related disorders and related comorbidities in the outpatient care setting in Germany. ⋯ We found no superiority of CSC in the treatment of the mental disorders addressed in this study. Methodological issues, including differences at baseline and high dropout rates, make these findings challenging to interpret. Future studies should ensure comparability of groups, allocate resources for quality management, and investigate more suitable outcome measures, with attention to factors of implementation.