ABSTRACT
BACKGROUND: The quality assurance directive for very low birthweight preterm infants (QFR-RL) by the German Federal Joint Committee calls for fixed nurse-to-patient ratios (NPRs) in neonatal intensive care, leading to considerable difficulties for staff planners, especially in smaller hospitals, as an extensive pool of nursing staff is required to ensure compliance with guidelines. Reliable parameters are therefore needed to provide a valid basis for staff planning. OBJECTIVE: To calculate the number of nurse full-time equivalents (FTE) required to meet the demands of the QFR-RL for individual diagnosis-related groups (FTE-debit) and in relation to relative caseweight (FTE-debit / RW); to compare the calculated estimates with real hospital expenses (FTE-real) with nurse-relevant DRG proportions calculated by the Institute for the Hospital Remuneration System (FTE-norm). METHODS: We included all very low birthweight infants (VLBW, <1,500 g) treated between 08/2013 and 07/2018. FTE-debit was determined on the basis of shifts with 1 : 1, 1 :2, and 1 : 4 NPR using the time infants underwent invasive or non-invasive mechanical ventilation, had a birthweight below 1,000 g, or with imminent death. FTE-real was extracted from hospital cost accounting, and FTE-norm was determined as nurse-relevant DRG proportions calculated by the Institute for the Hospital Remuneration System. RESULTS: 856 (50.1 % female) VLBW preterm infants were analysed. Calculated FTEs varied from 0.02 (95% confidence interval (CI) 0.02-0.02) to 1.16 (95%-CI 0.96-1.37) between individual DRGs. Calculated estimates (FTE-debit) were consistent with real expenses (FTE-real) and calculated nurse-relevant DRG-proportions (FTE-norm). In relation to the relative caseweight, an average demand of nurse FTE of about 0.02 FTE / relative weight point (FTE-debit / RW) was identified. CONCLUSIONS: This approach facilitates prospective planning which is in line with the FTEs required by the QFR-RL and based on remunerated DRGs; however, it is not supposed to replace shift-specific documentation.
Subject(s)
Infant, Premature , Infant, Very Low Birth Weight , Diagnosis-Related Groups , Female , Germany , Humans , Infant , Infant, Newborn , Male , Prospective StudiesABSTRACT
BACKGROUND: Recently, supplementation of L-carnitine to obese rats was found to improve the carnitine status and to counteract an obesity-induced muscle fiber transition from type I to type II. However, it has not been resolved if the change of muscle fiber distribution induced in obese rats and the restoration of the "normal" muscle fiber distribution, which is found in lean rats, in obese rats by supplemental L-carnitine is causally linked with the carnitine status. In the present study we hypothesized that fiber type distribution in skeletal muscle is dependent on carnitine status. METHODS: To test this, an experiment with 48 piglets which were randomly allocated to four groups (n = 12) was performed. All piglets were given orally either 60 mg sodium bicarbonate/kg body weight (group CON), 20 mg L-carnitine and 60 mg sodium bicarbonate/kg body weight (group CARN), 30 mg pivalate (dissolved in sodium bicarbonate)/kg body weight (group PIV) or 20 mg L-carnitine and 30 mg pivalate/kg body weight (group CARN + PIV) each day for a period of 4 weeks. RESULTS: Concentrations of total carnitine in plasma, liver and longissimus dorsi and biceps femoris muscles were 2.0-2.7 fold higher in group CARN than in group CON, whereas these concentrations were 1.9-2.5-fold lower in group PIV than in group CON. The concentrations of total carnitine in these tissues did not statistically differ between group CARN + PIV and group CON. Fiber type distribution of longissimus dorsi and biceps femoris muscles, mRNA and protein levels of molecular regulators of fiber distribution in longissimus dorsi and biceps femoris muscles and mRNA levels of genes reflecting the metabolic phenotype of longissimus dorsi and biceps femoris muscles did not differ between groups. CONCLUSION: Changes in the systemic carnitine status and the muscle carnitine concentration induced by either supplementing L-carnitine or administering pivalate have no impact on the contractile and metabolic phenotype of skeletal muscles in pigs.
