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Biomedical subjects

M Kastrup

Publications and source records attributed to M Kastrup.

At least 19 recordsLinked to original sources
PubMed2007

[Analysis of personnel costs after reorganization of intensive care using calculated diagnosis-related groups comparative data. An investigation at the Charité Berlin].

BACKGROUND: In an extensive project intensive care units (ICUs) of the Charité University Hospital were reorganized. The aim of this investigation was to determine if staff costs after this reorganization are financed by modular profits of diagnosis-related groups (DRGs). METHODS: Staff costs of all non-pediatric intensive care units, including ICUs, intermediate care units and post-anaesthesia care units (PACUs) in the Charité University Hospital were compared with the modular profits of all DRGs of patients older than 14 years in 2005. These DRGs were converted into the German refined DRG (GDRG) system 4.0 from 2006 with calculations based on actual income for medical doctors and nurses in 2006. Due to changed wage agreements for the incomes of physicians in 2006 there was an increase of costs. For the other professional groups an increase in income is expected, which cannot be estimated at present. RESULTS: The calculation revealed that staff costs of the ICUs at the Charité University Hospital based on a current German mean base rate of 2,836 EUR were 4.2% above the modular profits of the DRGs. As a result of a structural reorganization of the ICUs, the costs of staff could be adapted to the modular profits. Under the conditions of the actual reduced base rate of Berlin of 2,955 EUR the costs and profits were nearly equal. As the financial impact of the reorganization of the ICUs will take full effect in the coming years, it can be anticipated that with an expected base rate of 2,949 EUR in 2010 the intensive care medicine of a University hospital in Germany can become profitable. DISCUSSION: The spectrum of intensive care medicine at the Charité University Hospital covers the maximum range of operative and non-operative medicine. After an extensive reorganization of the ICUs under the aspect of staff costs, intensive care medicine can become profitable under the 4.0 G-DRG system. With consequent reorganization the cost efficiency of staff can be optimized, particularly in the setting of high-end intensive care medicine.

Adolescent↗
PubMed2006

Current practice of hemodynamic monitoring and vasopressor and inotropic therapy in post-operative cardiac surgery patients in Germany: results from a postal survey.

BACKGROUND: In Germany, more than 100,000 patients are monitored and treated in 80 intensive care units (ICUs) following cardiac surgery each year. The controversies concerning the different methods of hemodynamic monitoring and the appropriate agents for volume therapy and inotropic support are well known. However, little is known about how monitoring and treatment are currently performed. METHODS: A questionnaire with 39 questions was sent to the leading physicians of 80 ICUs in Germany, treating patients after cardiac surgery. The questions to be answered covered the current practice of hemodynamic monitoring, volume replacement, inotropic/vasopressor support and transfusions in patients after cardiac surgery. RESULTS: Sixty-nine per cent of the questionnaires were completed and returned. All ICUs used basic monitoring as recommended by the societies. The use of advanced hemodynamic monitoring included the pulmonary artery catheter (58.2%), transesophageal echocardiography (38.1%) and transpulmonary dilution techniques (13%). Crystalloids (21.2%) and colloids (73%) were used for volume replacement. Epinephrine (41.8%) and dobutamine (30.9%) were the first-choice inotropic drugs for the treatment of low cardiac output syndrome, followed by phosphodiesterase inhibitors (14.5%). Second-choice drugs for the treatment of low cardiac output syndrome were enoximone (29%), milrinone (25%) and dobutamine (25%). A written transfusion protocol and a transfusion threshold for red blood cells existed in 59% and 79% of ICUs, respectively. CONCLUSION: Hemodynamic monitoring and the variability in clinical practice with regard to volume replacement, transfusion triggers and the use of vasopressors/inotropes in cardiac surgery patients tend to follow the results of traditional experience rather than current scientific knowledge. Guidelines are therefore necessary to help to improve the standards of intensive care after cardiac surgery and thus the outcome of patients.

Blood Transfusion↗
PubMed2004

[Levosimendan. Clinical indications of a new vasoactive substance].

Levosimendan is a recently developed drug which is not yet approved for clinical routine use in Germany. The clinical use is limited to a few selected cases and it has been used as a salvage therapy in patients with severe heart insufficiency. As a potent inodilator it has been given to patients with severe heart failure, when all other therapeutic options have failed. However, in some European countries levosimendan is used in clinical routine situations and the European Society of Cardiologists has included the drug in their guidelines for treatment of acute heart failure. The following article describes the main pharmacological characteristics of levosimendan and summarises the indications for this new drug for physicians working in the field of anaesthesia or intensive care.

Cardiotonic Agents↗
PubMed2001

Quality of life: a dimension in multiaxial classification.

The study provides an overview of the historical aspects of multiaxial classification. Particular reference is paid to the multiaxial formats of ICD-10, DSM-IV and the WPA International Guidelines for Diagnostic Assessment (IGDA). The IGDA proposes a tetraaxial format with quality of life as one axis as well as an axis on symptomatology, an axis on adaptive functioning and an axis on environmental/psychosocial conditions. The axis on quality of life is added in recognition of the increasing importance placed upon the patient's perception of his/her capacity of self fulfillment and the attention paid to quality of life as a major descriptor of health status as well as an outcome measure of clinical care.

Adaptation, Psychological↗
PubMed2000

Abuse of psychiatry.

The Geneva Declaration of 1948 states that doctors shall not permit considerations of religion, nationality, race, party politics or social standing to intervene between their duty as a doctor and their patients. They shall not use their medical knowledge contrary to the laws of humanity. The UN Principles of Medical Ethics also reminds doctors that their professional relation to persons deprived of their liberty is solely to evaluate, protect or improve their health. Similarly, the Hawaii Declaration from 1983 and the Madrid Declaration from 1996 outline the ethical duties of the psychiatric profession. Thus, there is no doubt as to the professional role as it is delineated in the medical ethics codes. The presence of such codes is, however, only one of the necessary steps to prevent the abuse of psychiatry; others include educational interventions or the establishment of international networks.

Ethics, Medical↗
PubMed1998

The Nordic Comparative Study on Sectorized Psychiatry: continuity of care related to characteristics of the psychiatric services and the patients.

The problem addressed in this paper is how continuity of care is related to characteristics of psychiatric services, previous events in a patient's pattern of care and patient characteristics. The present paper is a part of a Nordic Comparative Study on Sectorized Psychiatry in seven catchment areas in four Nordic countries. One-year-treated-incidence cohorts were used. Each patient was followed for 1 year after the first contact with the psychiatric service. Continuity of care was measured by the time from discharge from hospital to the first subsequent day-patient or outpatient contact. Notable findings were large differences in the continuity of care in the seven services, high proportions of discharges without any aftercare contacts and long time lags between discharges and aftercare contacts in most of the catchment areas. A Cox regression analysis revealed that aftercare following hospitalisation seems to be more probable if the outpatient services are located geographically close to the patients, if the hospitalisation lasted between 2 and 4 weeks, if there was a community care contact shortly before the hospital admission and if the patient is not retired and not divorced. Staff resources were not related to continuity of care.

Adult↗
PubMed1998

The Nordic Comparative Study on Sectorized Psychiatry: patients who use only psychiatric in-patient care in comprehensive community-based services--a 1-year follow-up study.

In the present paper a sample of patients using psychiatric in-patient care only is characterized and analysed with regard to characteristics of the psychiatric services. This paper forms part of the Nordic Comparative Study on Sectorized Psychiatry, designed to investigate contact rates and use of psychiatric care by new patients in 7 catchment areas in 4 Nordic countries during a 1-year follow-up. One-year treated incidence cohorts were used. The logistic regression analysis revealed that the variable 'psychiatric service' was one of the statistically significant determinants of using only in-patient care during the follow-up. The diagnostic groups with the highest probability of using only in-patient care were dependencies and functional psychoses. The following factors were associated with a high risk of using only in-patient care: older age, being referred by another psychiatrist, having received previous psychiatric in-patient care, male sex, being retired, and not living with one's parents or a partner. Patients who used only in-patient care had fewer admissions and days in in-patient care than others during the 1-year follow-up period. Lack of 24-hour emergency services in out-patient care correlated positively with the use of only in-patient care.

Adult↗
PubMed1996

The Nordic comparative study on sectorized psychiatry. Utilization of psychiatric hospital care related to amount and allocation of resources to psychiatric services.

As a part of a Nordic comparative study on sectorized psychiatry, utilization of inpatient care was related to resources and dynamic qualities of psychiatric services in seven catchment areas in four Nordic countries. One-year treated incidence cohorts were used. Each patient was followed for 1 year after first contact with the psychiatric service. Data were collected concerning number of beds and staff, number of long-term patients and turnover rate of patients in inpatient care. Findings gave some support to the earlier reports that the utilization of inpatient care is determined by the supply of available beds. Highly staffed community services did not themselves reduce the use of inpatient services, but availability of day care services seemed to reduce utilization of inpatient care among psychotic patients.

Adult↗
PubMed1996

The World Health Organization Short Disability Assessment Schedule (WHO DAS-S): a tool for the assessment of difficulties in selected areas of functioning of patients with mental disorders.

The World Health Organization Short Disability Assessment Schedule (WHO DAS-S) is an instrument for clinicians' assessment and rating of difficulties in maintaining personal care, in performing occupational tasks and in functioning in relation to the family and the broader social context due to mental disorders. The WHO DAS-S was developed and underwent preliminarily testing in the context of two international field trials of the multiaxial presentation of ICD-10 for use in adult psychiatry. The instrument was found to be useful, user-friendly and reasonably reliable for use by clinicians belonging to different schools of psychiatry and psychiatric traditions. Further work on the WHO DAS-S should include development of national adaptations of the instrument, studies of concurrent validity of the instrument and modification of the instrument to accommodate changes in the next edition of the International Classification of Impairments, Disabilities and Handicaps (ICIDH).

Disability Evaluation↗
PubMed1996

Contextual aspects of mental disorders: a proposal for axis III of the ICD-10 multiaxial system.

After several years of development and testing, the World Health Organization (WHO) has recently completed work on the multiaxial presentation of ICD-10 for use in adult psychiatry. Axis III of the ICD-10 multiaxial system is intended for clinicians' reporting of contextual factors which may influence the diagnosis, treatment or prognosis of mental disorders that are recorded on Axis I. It was tested in two WHO-co-ordinated international field trials and found to be user-friendly, reasonably reliable and useful in routine clinical work, in the training of mental health professionals and in research on mental disorders.

Adult↗
PubMed1995

The Nordic comparative study on sectorized psychiatry. I. Treated point prevalence and characteristics of the psychiatric services.

Comparative studies relating characteristics of psychiatric services to rates of treated prevalence are scarce. As part of a Nordic comparative study on sectorized psychiatry, a point-prevalence study was performed in 5 sectorized psychiatric services with comprehensive service facilities for a defined population under responsibility. The rates of treated prevalence on a census day were related to a number of characteristics of the respective services and to accessibility of care. The results showed a great variation in one-day point prevalence in the 5 services, with almost fourfold differences. There were also marked differences in the diagnostic distribution of the cohorts. A positive correlation was found between number of beds and point prevalence, measured both as total point prevalence and impatient prevalence. The rates of beds and psychiatrists were most strongly related to the prevalence of patients with organic disorders and functional psychoses. A closed referral system was associated with a lower level of treated prevalence.

Adolescent↗
PubMed1994

General health assessment in refugees claiming to have been tortured.

General health assessment of refugees claiming to have been previously exposed to torture takes place in a psychological atmosphere affected by the difficult situation of the refugee. Thirty-one refugees, mainly from the Middle East and Africa, were assessed as regards their physical and mental health. Assessment took place with the help of professional interpreters and was, during each interview, performed by two medical doctors using double-blind techniques. Based on a number of highly significant (P < 0.001) correlation coefficients and Kappa values, observers agreed frequently on gradients of symptom intensity and less frequently on absolute symptom levels. However, agreement was almost complete when assessing the presence of intense symptoms and the absolute absence of a symptom. Symptom patterns were demonstrated to be consistent, clinically interpretable and, furthermore, closely associated (P < 0.0001) with self-reported global (general) health. Reliability was moderate with respect to clinical observation during interview.

Adult↗
PubMed1993

The Danish psychiatric register as a tool in epidemiology.

The electronic part of the nationwide Danish Psychiatric Central Register is now almost 25 years old. In this period it has proved its high value in administration, planning, treatment of patients, and not least in psychiatric research. Due to its national coverage, the register makes it easy to conduct epidemiological studies, such as analysis of trends, register linkage research, identification of representative cohorts for further analysis and follow-up studies of clinically identified cohorts. After many years of political turmoil, the register now seems to have assumed a more reasonable form, making allowance for both research interest and data protection. A proposed directive on the protection of medical data from the European Community may be a serious threat to the register and will probably eliminate all epidemiological and clinical research based on registers.

Denmark↗
PubMed1990

Quantifying depressive symptomatology: inter-rater reliability and inter-item correlations.

In this study an evaluation of the inter-rater reliability of the Hamilton Depression Rating Scale, the Melancholia Scale and the Montgomery-Asberg Depression Rating Scale has been carried out. Furthermore, the inter-item correlations of these scales have been investigated in relation to diagnostic ratings. It was found that the quantitative scales had satisfactory inter-rater relationship. Only low agreement was found between the quantitative and diagnostic scales, as expected, while there was high agreement between the quantitative scales. The relevance of introducing new scales and the definition of major depression are discussed.

Adult↗