The Effects of Diagnosis-Related Group Payment on Diagnostic Cerebral Angiograms through a Transradial and Transfemoral Approach: A Comparative Observational Study

Background. Cerebral angiography is an X-ray examination technique widely used in hospitals. At present, it is mainly divided into two kinds of angiography examination: transfemoral artery and transradial artery puncture. The diagnosis-related group (DRG) system is a new type of payment standard recognized internationally, but its impact on medical care and health outcomes is currently controversial. Aim. In this study, we conducted a comparative study on two invasive approaches, transradial artery and transfemoral artery puncture and observed whether DRG had an impact on the quality of the medical process. Methods. We compared and analyzed patients undergoing cerebral angiography via the femoral artery and radial artery puncture by recording the relevant parameters and comfort scale scores (GCQ) during the operation, as well as postoperative complications. At the same time, we observed the proportion of different puncture routes and the success rate of cerebral angiography before and after the implementation of a DRG payment simulation. Results. The results of the comparative analysis of patients’ transradial artery and transfemoral artery puncture angiography showed that the puncture success rate (99.1% vs. 97.2%, P > 0.05 ), angiography success rate (97.3% vs. 95.1%, P > 0.05 ), and X-ray radiation time (4.82 vs. 5.15 min, P > 0.05 ) demonstrated no significant difference. The ambulation time (1.52 vs. 12.06 h, P < 0.05 ), puncture time (22.42 vs. 31.02 min, P < 0.05 ), and complications (3.57% vs. 9.03%, P < 0.05 ) of the radial artery group were significantly lower than those of the femoral artery group. In contrast, the GCQ score of the radial artery group at each stage after angiography was significantly higher than that of the femoral artery group ( P < 0.05 ). Compared with before the DRG simulation, the proportion of cerebral angiography with transradial artery puncture increased significantly after its implementation. Conclusion. Compared with transfemoral cerebrovascular angiography, transradial cerebrovascular angiography has many advantages, such as less local damage, less pain, less postoperative bed-rest time, significantly lower incidence of total complications, and a lower cost. Following the implementation of the DRG payment method, the quality of the angiography medical process improved.

Fitness of breeders in social Damaraland mole-rats is independent of group size

Damaraland mole-rats (Fukomys damarensis) are usually viewed as an obligatorily group living eusocial species in which successful reproduction is dependent on reproductive altruism of closely related group members. However, the reproductive ecology of social mole-rats in their natural environment remains poorly understood and it is unclear to what extent successful reproduction is dependent on assistance from other group members. Using data from a 7-year field study of marked individuals, we show that, after dispersal from their natal group, individuals typically settled alone in new burrow systems where they enjoyed high survival rates, and often remained in good body condition for several years before finding a mate. Unlike most other eusocial or singular cooperative breeders, we found that Damaraland mole-rats reproduced successfully in pairs without helpers and experimentally formed pairs had the same reproductive success as larger established groups. Overall there was only a weak increase in reproductive success with increasing group size and no effect of group size on adult survival rates across the population. Juveniles in large groups grew faster early in life but their growth rates declined subsequently so that they eventually plateaued at a lower maximum body mass than juveniles from small groups. Taken together, our data suggest that the fitness benefits of group living to breeders are small and we suggest that extended philopatry in Damaraland mole-rats has evolved because of the high costs and constraints of dispersal rather than because of strong indirect benefits accrued through cooperative behaviour.

Impact of Diagnosis-Related Group Payment System on the Variation in Hospitalization Expenditures: A Case-Control Study with a Propensity-Score-Matched Control Group

Background One of the important ways to reduce medical costs and improve quality of care is to enable physicians to provide standard medical services according to clinical guidelines, and the medical payment system is a significant means of guiding the behaviour of health service providers. This study aims to investigate whether the diagnosis-related group (DRG) payment system can improve the consistency of health services. Method Inpatients with three types of disease—chronic obstructive pulmonary disease (COPD), acute myocardial infarction (AMI) and cerebral infarction (CI)—were enrolled from 25 county-level hospitals in a DRG pilot city in China. Inpatients from hospitals that implemented DRG payment were selected as the intervention group, and similar inpatient cases from hospitals that still implemented fee-for-services (FFS) payment were designated as the control group. A propensity matching score (PSM) was used for data matching to control for age, gender and disease severity. The variation of hospitalization expenditures and their trends before and after implementation of the DRG policy were described by using these matched samples. Results After DRG implementation, the standard deviation (SD) of hospitalization expenditures in the COPD, AMI and CI intervention groups decreased by 11094 yuan, 4833 yuan and 425 yuan, respectively, which were 5972, 2484, and 2938 yuan more than that in the control group. In each year after DRG implementation, the interquartile range (IQR) of hospitalization expenditures was smaller in DRG group than that in FFS group. In most years, the degree of variation in costs of the intervention group decreased more than that of the control group. The medians of hospitalization expenditures of the intervention groups were lower than the fixed cost, while most medians of the control groups were higher than the fixed cost. Conclusion A comparison of patients with similar demographics and disease characteristics revealed that patients in the DRG group experienced a smaller degree of variation in hospitalization expenditures, and indicated the expenditures had a tendency to become progressively more concentrated over time. It is suggested that DRG system can promote better consistency in health services and reduce medical costs.

More Than Just a Spearhead: Diverse Functions of PAAR for Assembly and Delivery of Toxins of the Contractile Injection Systems

The type VI secretion system (T6SS) belongs to the evolutionarily related group of contractile injection systems that employ a contractile outer sheath to inject a rigid spear-like inner tube into target bacterial and eukaryotic cells. The tip of the rigid tube is often decorated by a PAAR-repeat protein as a key structural component.

Cost of TB services in the public and private sectors in Georgia (No 2)

BACKGROUND: Patient-centred care along with optimal financing of inpatient and outpatient services are the main priorities of the Georgia National TB Programme (NTP). This paper presents TB diagnostics and treatment unit cost, their comparison with NTP tariffs and how the study findings informed TB financing policy.METHODS: Top-down (TD) and bottom-up (BU) mean unit costs for TB interventions by episode of care were calculated. TD costs were compared with NTP tariffs, and variations in these and the unit costs cost composition between public and private facilities was assessed.RESULTS: Outpatient interventions costs exceeded NTP tariffs. Unit costs in private facilities were higher compared with public providers. There was very little difference between per-day costs for drug-susceptible treatment and NTP tariffs in case of inpatient services. Treatment day financing exceeded actual costs in the capital (public facility) for drug-resistant TB, and this was lower in the regions.CONCLUSION: Use of reliable unit costs for TB services at policy discussions led to a shift from per-day payment to a diagnosis-related group model in TB inpatient financing in 2020. A next step will be informing policy decisions on outpatient TB care financing to reduce the existing gap between funding and costs.

Evaluation of Bulls and Related Groups of the Jersey Breed on Dairy Productivity and Reproductive Capacity of Offspring

The article presents the results of research on the influence of paternal origin and belonging to a related group on the level of milk productivity of cows and the reproductive capacity of Jersey cows in the farm “Dan-Milk” of the Zhytomyr Region. The purpose of this study is to establish the influence of paternal origin and belonging to a related group on the level of milk productivity and reproductive capacity parameters of Jersey cows. The study established a substantial level of differentiation in the main economically useful features between groups of half-sisters by father. The best quantitative indicators of milk productivity were noted among the daughters of bulls DJ Jante 302761 (P<0.001) and Headline 114114336 (P<0.001), the worst indicators – among daughters of Karl 67037285. The highest indicators of fat and protein content in milk were noted in the cows bred from the bull Legal 61929249, the lowest – from the bull Karl 67037285. The influence of the origin of cows by father on the variability of milk yield and yield of milk fat and protein was 20.3–30.3% (up to P<0.001), the content of fat and protein in milk decreased to 13.2-20.0% (P<0.01 and P<0.05), and according to the reproductive capacity features – to 7.8-19.0% with an unreliable level of statistical significance. Prepotent as to milk yield are bulls Legal 61929249 and Headline 114114336, as to the content and yield of milk protein – Legal 61929249. Cows of the related group bred from the bull Observer 553236 are characterised by the highest milk yield and yield of milk fat and protein for both the first and best lactation, and cows of the related group bred from Surville 604694 are characterised by the worst yield. The influence of belonging to a related group on the studied features was several times lower (0.2-10.5%) compared to the influence of paternal origin. With an increase in the milk yield of cows over the first lactation, there is a stable and substantial decrease in the reproductive capacity coefficient due to the lengthening of the service period between the first and second calving. Such natural antagonism does not imply the goal of increasing the duration of the service period to obtain maximum milk yields for firstborn cows, since this will lead to a decrease in the yield of calves and render timely replenishment of the herd impossible. It is optimal to milk the firstborn up to 8 tonnes over 305 days of lactation while maintaining a satisfactory reproductive level

Neuronal activity reorganization in motor cortex for successful locomotion after a lesion in the ventrolateral thalamus

Thalamic stroke leads to ataxia if the cerebellum-receiving ventrolateral thalamus (VL) is affected. The compensation mechanisms for this deficit are not well understood, particularly the roles that single neurons and specific neuronal subpopulations outside the thalamus play in recovery. The goal of this study was to clarify neuronal mechanisms of the motor cortex involved in mitigation of ataxia during locomotion when part of the VL is inactivated or lesioned. In freely ambulating cats, we recorded the activity of neurons in layer V of the motor cortex as the cats walked on a flat surface and horizontally placed ladder. We first reversibly inactivated approximately 10% of the VL unilaterally using glutamatergic transmission antagonist CNQX and analyzed how the activity of motor cortex reorganized to support successful locomotion. We next lesioned 50-75% of the VL bilaterally using kainic acid and analyzed how the activity of motor cortex reorganized when locomotion recovered. When a small part of the VL was inactivated, the discharge rates of motor cortex neurons decreased, but otherwise the activity was near normal, and the cats walked fairly well. Individual neurons retained their ability to respond to the demand for accuracy during ladder locomotion; however, most changed their response. When the VL was lesioned, the cat walked normally on the flat surface but was ataxic on the ladder for several days post-lesion. When ladder locomotion normalized, neuronal discharge rates on the ladder were normal, and the shoulder-related group was preferentially active during the stride's swing phase.

The Financial Burden of Surgery for Congenital Malformations—The Austrian Perspective

Neonatal “surgical” malformations are associated with higher costs than major “non-surgical” birth defects. We aimed to analyze the financial burden on the Austrian health system of five congenital malformations requiring timely postnatal surgery. The database of the Austrian National Public Health Institute for the period from 2002 to 2014 was reviewed. Diagnosis-related group (DRG) points assigned to hospital admissions containing five congenital malformations coded as principal diagnosis (esophageal atresia, duodenal atresia, congenital diaphragmatic hernia, gastroschisis, and omphalocele) were collected and compared to all hospitalizations for other reasons. Out of 3,518,625 total hospitalizations, there were 1664 admissions of patients with the selected malformations. The annual mean number was 128 (SD 17, range 110–175). The mean cost of the congenital malformations per hospital admission expressed in DRG points was 26,588 (range 0–465,772, SD 40,702) and was significantly higher compared to the other hospitalizations (n = 3,516,961; mean DRG 2194, range 0–834,997; SD 6161; p < 0.05). Surgical conditions requiring timely postnatal surgery place a significant financial burden on the healthcare system. The creation of a dedicated national register could allow for better planning of resource allocation, for improving the outcome of affected children, and for optimizing costs.