[Comparison of Costs and Revenues in Conservative and Invasive Treatment in Cardiology: a Contribution Margin Analysis]. / Vergleich der Kosten- und Erlössituation invasiver und konservativer kardiologischer Behandlungsfälle: Modell einer Deckungsbeitragsrechnung.

Aim of the study: Direct costing is a specialized form of cost analysis well suited for medical areas with DRG-orientated flat rate payments. By comparing case-related variable costs and payments, it is possible to compare the economic benefits of different medical treatments. This aim was pursued by developing a direct costing concept and by its application to invasively and non-invasively treated cardiac patients. Methods: The entire database comprised 7 330 cases of a tertiary cardiac center between 2007 and 2011. It was derived from databases of the hospital information system, the materials management department and the catheter laboratory. On the revenue side, DRG payments were included. Costs related to heart catheterization such as material, personnel and maintenance expenses were considered to be variable costs. Contribution margins and relative contribution margins were calculated by introducing the length of hospital stay as a time reference. Results: During the observation period, caseload and annual revenues increased by about 20 percent. Contribution margins were higher in invasively than in non-invasively treated patients (2 097±1 590 vs. 1 614±1 105 €; p<0,001). However, the relative relation of both patient groups was not altered during the observation period. A remarkable shortening of the duration of catheter laboratory examinations was observed between 2007 and 2011 (46,2±39,1 auf 36,7±33,5 min; p<0,001). In the same period, relative contribution margins increased from 461±306 to 530±335 € (p<0,001). Conclusions: Within existing supply structures, direct costing is a useful tool for economic comparison of different treatment services. Furthermore, temporal constraints of an economic bottleneck can be easily monitored and tackled with the help of time management tools.

[Congenital left ventricular aneurysm in a 17-year-old competitive athlete]. / Angeborenes linksventrikuläres Aneurysma bei einem 17-jährigen Leistungssportler.

We present the case of a 17-year-old competitive athlete with an asymptomatic left ventricular aneurysm (LVA). Echocardiography demonstrated hypoplasia of the septum and a large apical LVA. Magnetic resonance imaging (MRI) detected a very thin and fibrotic wall of the LVA. Due to the potential risk of rupture the LVA was surgically resected and the apex of the left ventricle was covered with a patch plasty. The patient had an event-free postoperative course. Because of the potential risk of arrhythmia, the patient was recommended not to participate further in competitive sport.

Cardiovascular effects of human-pet dog interactions.

Recent research on human-dog interactions showed that talking to and petting a dog are accompanied by lower blood pressure (BP) in the person than human conversation. To clarify whether cognition, conditioning, or tactual contact exerted the major influence in this so-called "pet effect," 60 male and female undergraduates with either positive or neutral attitudes toward dogs interacted with a dog tactually, verbally, and visually while BP and heart rate were recorded automatically. Results revealed that (a) subjects' BP levels were lowest during dog petting, higher while talking to the dog, and highest while talking to the experimenter and (b) subjects' heart rates were lower while talking or touching the dog and higher while both touching and talking to the dog. Touch appeared to be major component of the pet effect, while cognitive factors contributed to a lesser degree. Implications for coping with hypertension are discussed, and suggestions for further research are stated.

Backward contralateral masking by light and by random pattern.

Letter-stimuli as targets were presented to the right or left visual fields and followed either by a flash of light or by a flash of light plus a patterned mask. The patterned mask always appeared in the opposite visual field of the letter targets. Analysis showed that masking occurred for both types of masks but that subjects produced more errors at each of five intervals between onset of the target and onset of the mask for the flash of light plus a patterned mask in the opposite visual field than for the flash of light alone. A pattern mask, when presented to the opposite visual field of a target stimulus, interferes with target processing at short target-mask intervals. These findings suggest that central backward masking may involve target-mask interactions beyond the visual cortex (Area 17).