Procedure Codes Research Articles

Selected victim protection measures in ordinary criminal proceedings

The victim becomes a participant in the criminal proceedings not because he or she has consciously made such a decision. It is almost always that the victim becomes a participant against their will, which is caused by a direct violation or threat to its legal interest by a criminal offence. This is reflected in the legal definition of the victim contained in Article 49 § 1 of the Criminal Procedure Code (hereinafter CPC) . Cezary Kulesza notes that this definition contains the following elements: subjective (natural or juridical person) and objective, relating to the legal interest infringed by the criminal offence to the extent defined by that provision, but also a provision of substantive criminal law (Kulesza, 1995, p. 17–18). The victim's participation in criminal proceedings makes the victim a participant in those proceedings, whether natural or juridical person, and that participation is limited to fulfilling the role assigned to them by the criminal procedural law (Tylman, 2003, p. 47). The legislature attributes three roles to the victim: in the pre-trial proceedings, the victim is a party (Article 299 § 1 CPC), in the judicial proceedings, the victim may be an auxiliary prosecutor (Article 53 CPC), incidental or subsidiary, and in the course of the entire criminal proceeding, also a testimonial evidence source (Article 177 § 1 CPC, Article 185a § 1 CPC, Article 185c CPC). The status of a party to pre-trial proceedings is acquired by operation of law and does not require the victim to take any action. The situation is different in judicial proceedings, where acquiring the status of auxiliary prosecutor requires a certain effort to by the victim, namely expressing the will to act in that capacity.

Actions by administrative authorities justified by a state of higher necessity

This article deals with the actions of the administrative proceeding authorities justified by a state of higher necessity. In Poland, the state of higher necessity does not constitute a title for the encroachment of public administration bodies on the rights and obligations of persons without a legal basis. In terms of its essence, the state of force majeure under the Administrative Procedure Code is not uniformly understood. It may be treated narrowly or broadly. However, regardless of its treatment, it conditions the application of special and very often inherently exceptional solutions. This includes issuing decisions with the application of special regulations in matters of peace, security and public order, and sometimes in situations dictated by an even differently understood state of higher necessity. This article deals with the actions of the administrative proceeding authorities justified by a state of higher necessity. In Poland, the state of higher necessity does not constitute a title for the encroachment of public administration bodies on the rights and obligations of persons without a legal basis. In terms of its essence, the state of force majeure under the Administrative Procedure Code is not uniformly understood. It may be treated narrowly or broadly. However, regardless of its treatment, it conditions the application of special and very often inherently exceptional solutions. This includes issuing decisions with the application of special regulations in matters of peace, security and public order, and sometimes in situations dictated by an even differently understood state of higher necessity.

Historical and Current Perspectives on the Criminal Codes as Guarantees of Legal Security in Slovakia

The author describes two crucial periods in Slovak legal history from the perspective of the principle of legal security in criminal law. Firstly, the 19th-century Criminal Code, known as the Csemegi Code, is at the center of attention as it ended the centuries-long legal insecurity resulting from the lack of criminal law codification. The author analyses its leading principles as the safeguard of legal security. In contrast, the second part of the article focuses on the second codification of criminal law in Slovak legal history, the Criminal Code of 1950. The author demonstrates how the totalitarian regime destroyed the principle of legal security in criminal law in Slovakia, only slowly rebuilding it after the death of Joseph Stalin through amendments in 1956 and new legislation in 1961. The current Slovak Criminal Code and Criminal Procedure Code have been in effect since 2006. In conclusion, the author draws attention to how the latest changes in criminal law codes caused turbulences and worries over the principle of legal security in Slovakia.

Sex, gender and human rights: essential components of inclusive medical research

ABSTRACT Much of past medical research has been sex and gender ‘blind’ and has failed to take account of gender norms and practices that place men and women at different levels of risk of certain diseases. Further, non-binary, trans and people with intersex characteristics have been especially marginalised in research practices. Other forms of discrimination based on race, disability and socio-economic disadvantage have cut-across and exacerbated these research gaps. This paper considers that medical codes of ethics alone are insufficient to address sex and gender disparities in medical research and suggests that adopting a human rights approach to medical research provides a systematic way to collect, analyse and report on sex and gender data in ways that are person-centred, empowering and participatory.

A SETTLEMENT AGREEMENT IN ECONOMIC PROCEEDINGS

The article examines a settlement agreement as one of conciliation procedures in economic proceedings. For reconciliation, the parties must take active joint actions to achieve a result. It was revealed that the procedure for the reconciliation of the parties and the content of the settlement agreement are not and cannot be established by the current procedural legislation, since it is actually a negotiation process that is impractical to regulate in detail. However, the draft settlement agreement as a result of joint efforts is submitted to the court for further approval, and approval is not a formal, automatic act of the court. Domestic procedural codes are analyzed and it is proven that the grounds for a judge’s refusal to approve a settlement agreement are clearly established by the procedural law, but are not identical in different laws. It is proposed to supplement Article 192 of the Economic Procedural Code of Ukraine with such reasons for refusing to approve a settlement agreement as "the terms of the agreement do not meet the interests of society" and “there are reasonable grounds to believe that the conclusion of the agreement was not voluntary, or the parties have not reconciled”. The author agrees with the position that the parties to the settlement agreement should reach a compromise on all important substantative legal issues that belong to the subject of the dispute and can be implemented by the participants in the case. On the other hand procedural issues cannot be a part of the settlement agreement. It is proposed to highlight the following positive features of the settlement agreement: 1) the settlement agreement allows the parties to resolve the conflict without a lengthy court process, saving time and resources of business and the judicial system; 2) the settlement agreement gives the parties the opportunity to go beyond the requirements and independently choose the terms of dispute resolution; 3) resolving the dispute through an settlement agreement contributes to maintaining good business relations between the parties; 4) settlement agreements reduce the burden on the judicial system; 5) the use of settlement agreements by Ukrainian business entities increases the competitiveness of the Ukrainian business environment in the world. The task of the court is to prevent abuses in the process of concluding a settlement agreement and the infringement of the interests of the parties as well as other persons.

The Decline of Medicare Reimbursement in Clinical Pathology

Abstract Introduction/Objective Access to clinical pathology services nationwide is threatened by the lack of an annual inflationary update for physician reimbursement from the Centers for Medicare & Medicaid Services (CMS). Most recently, the 2024 Medicare Physician Fee Schedule (MPFS) implemented an overall 2.0% reduction in pathology reimbursement. The effects of recent inflationary trends on clinical pathology physician reimbursement are unknown. Thus, our study sought to analyze trends in Medicare reimbursement rates from 2004 to 2024 for clinical pathology procedures. Methods/Case Report The Physician Fee Schedule Look-Up Tool from the CMS was queried for the top 30 CPT codes utilized, and physician reimbursement data extracted. Monetary data was subsequently adjusted for inflation utilizing the Consumer Price Index and reported in 2024 US dollars. The average annual and total percent change in reimbursement were calculated for included procedures. A subset analysis was conducted to assess physician pathology clinical consultation services average annual and total percent change in reimbursement pre- and post- 2022 MPFS Update. The compound annual growth rate (CAGR) was calculated using 2024 and 2000 inflation- adjusted monetary data. Results (if a Case Study enter NA) Prior to adjusting for inflation, the average physician reimbursement decreased by 6.8% from 2004 to 2024 for included clinical pathology CPT codes. After adjusting for inflation, the average physician reimbursement decreased by 44.0% for included CPT codes. The greatest decrease in reimbursement observed from 2004 to 2024 was for flow cytometry interpretation, 2-8 minutes at 69.5% ($114.44 to $34.95) followed by flow cytometry interpretation, 9-15 minutes at 57.8% ($142.77 to $60.25) and flow cytometry interpretation, >16 minutes at 56.6% ($188.05 to $81.55). The average CAGR was -2.86%. Prior to adjusting for inflation, the average physician reimbursement for clinical pathology consultation services pre-2022 decreased by 0.9%, and when adjusted for inflation, decreased by 30.0%. Post-2022 MPFS revision, the average physician reimbursement for clinical pathology consultation services decreased by 3.5%, and when adjusted for inflation, decreased by 12.2%. The average CAGR pre-2022 was -2.0% and post-2022 was -4.3%. Conclusion Medicare physician reimbursement for common clinical pathology procedures is decreasing at an untenable rate annually. It is critical that policymakers understand these trends to ensure continued access to quality clinical pathology care at healthcare institutions.

Conformal Prediction and Large Language Models for Medical Coding

Abstract The assignment of current procedure terminology (CPT) codes to medical events is a highly cumbersome, logistic challenge for many healthcare organizations, as well as a significant contributor to medical expenses. Improvement in the allocation of medical resources and expenses dedicated to such tasks can be achieved through automation. However, because of the complex nature of medical records, automation of procedure terminologies is just now developing with the advent of machine learning methods. In this study, we develop a fine-tuned large language model (LLaMA-3B) as a high-reliability predictor for CPT codes. As input, we use 2018 pathology report text data, including gross report, microscopic description, brief medical history, and final diagnosis. We define our dataset with the top five most common technical component CPT codes, which account for 85% of all samples. As a (meta) predictor of the veracity of the large language model itself, we use the prediction’s softmax scalar value of the classification model, borrowing from similar recent approaches in conformal prediction. Specifically, the validation set, which is distinct from both the train and test set, is used to establish a prediction threshold below which the model withholds judgement. We show that, by fine tuning an off-the-shelf language model on pathology report text alone, we can achieve 95% prediction accuracy of the top 5 most common CPT codes on our dataset. We also then demonstrate the utility of combining large language models with conformal prediction. The two in combination raise our accuracy to 99.5% when we allow the model to abstain on making a prediction on 30% of the data, as is determined by a separate threshold on the scalar value of the predictor from the aforementioned validation set. We therefore present a highly flexible model for medical coding, which is simultaneously provably-reliable. Large language models can as such serve as a powerful tool for overcoming challenges in medical billing, thereby improving healthcare efficiency and reducing medical costs.

New York Medical Code of Ethics of 1823: a critical historical and topical commentary

New York Medical Code of Ethics of 1823: a critical historical and topical commentary

A Data-Driven Approach to Inguinal Hernia Repairs in Infants and Children.

Introduction: Laparoscopic inguinal hernia repair has become increasingly popular in children. The laparoscopic technique inherently assesses the contralateral processus vaginalis, reducing the risk of metachronous contralateral hernias. We hypothesized that primary laparoscopic repair would be associated with lower rates of subsequent hernia repair in the youngest patients, in whom metachronous contralateral hernias are most common. Materials and Methods: The Pediatric Health Information System database was queried for patients 0-15 years old, who underwent inguinal hernia repair between 2016 and 2022. The primary outcome was the need for subsequent hernia repair. Current Procedural Terminology (CPT) and ICD-10 procedure codes were used to determine laparoscopic versus open repair. Patients were excluded if the only recorded code was for recurrent hernia or if both laparoscopic and open codes were present for the same procedure. Results: A total of 109,456 patients were included in the study, with 20,338 patients (18.58%), undergoing laparoscopic inguinal hernia repair initially, and 2535 patients (2.32%) requiring a second hernia repair. Patients 6 months old and younger undergoing unilateral laparoscopic repair were less likely to require subsequent surgery (OR 0.82, 95% CI = 0.69-0.96). Across all ages, open bilateral repair less often required subsequent repairs (OR 1.93, 95% CI 1.48-2.51). Conclusion: Laparoscopic unilateral inguinal hernia repair decreases the need for subsequent surgical repair in infants 6 months and younger. No difference was detected in older patients. Open repair of bilateral hernias decreases the need for a second hernia operation in all age groups, suggesting that open repair is more durable.

TUTELA PROVISÓRIA EM ARBITRAGEM

This paper explores provisional measures in the context of arbitration, highlighting their significance in contemporary procedural law. Arbitration, as an alternative dispute resolution method, faces challenges in its interaction with state jurisdiction, particularly regarding the granting of provisional measures. The study addresses the models of competence for granting these measures, the interaction between state and arbitral tribunals, and the influence of the Civil Procedure Code on the arbitral procedure. The systematization of provisional measures in the CPC and their implications in arbitration are explored. The article examines provisional measures before and during arbitration, including the role of the emergency arbitrator and the complexities of simultaneous requests to the judge and arbitrator. The importance of the interaction between arbitration and the judicial system for the effectiveness of the arbitral process is emphasized, contributing to the understanding and development of procedural law in arbitration.

A Description of the Dental Health and Treatment of Ukraine Military at U.S. Army Clinics in Germany.

Since the start of the Russo-Ukrainian war, most reports have focused on trauma and combat conditions. Trauma care is essential; however, disease and nonbattle injuries (DNBIs) also burden armies and reduce combat effectiveness. Dental emergencies (DEs) account for a substantial portion of DNBI, but there is limited information on Ukrainian military dental readiness. In September 2023, investigators were informed that Ukrainian military personnel were treated for DEs at 2 dental clinics in Germany. The investigators requested deidentified data from the Corporate Dental System (CDS), which is a repository for dental treatment records utilized by the U.S. Army. The data request captured DE treatment performed for Ukrainian military personnel in Germany from January 1, 2023, to September 20, 2023. The CDS report on DE encounters included the following: Gender, age, procedure codes, and provider narratives. This study was approved by the U.S. Army Institute of Surgical Research Institutional Review Board as research not involving human subjects and provided Log Number H-24-030nh. The CDS report captured 408 Ukrainian military DE encounters. A total of 360 Ukrainian military personnel were treated for DE during the 9-month reporting period in 2023. Oral surgery was the most common DE treatment category and accounted for 55.8% (N = 201) of DE procedures. Restorative dentistry procedures accounted for 18.1% of DE procedures. Of the 27 multiple category treatments, 25 had oral surgery procedures as one of the treatments. Restorative dentistry procedures were performed in 19 of the multiple category cases. The DEs in the Ukrainian military cohort suggest that chronic, untreated dental disease has progressed without routine care for years. The assertion that caries has progressed to a nonrestorable condition is supported by the distribution that 63% of all DE visits included oral surgery treatment. Based on the distribution of dental treatment, US dental officers must be proficient in oral surgery and prosthodontic care.

The concept of an individual act as the subject of a public legal dispute

The article is devoted to the study of the issue of the definition of an individual act as the subject of a public-law dispute, which is extremely relevant at the current stage of reforming state institutions and harmonizing the legislation of Ukraine in the process of negotiations on joining the European Union. The article indicates that public-law disputes regarding the appeal of individual acts cover all spheres of the public life of citizens and are a direct consequence of the implementation of public­authority management functions by subjects of authority. The state of administration of justice by administrative courts in 2020-2023 was studied, and a conclusion was made about the increase in the number of public legal disputes considered by administrative courts. Attention is drawn to the fact that domestic legislation is inconsistent in the field of terminology. In particular, the Law of Ukraine «On Administrative Procedure» uses the concept of «administrative act,» the Code of Administrative Procedure of Ukraine uses the concept of «individual act,» and the Law of Ukraine «On Law-Making Activity» uses «acts application of law,» «other individual legal acts,» and «other legal acts that do not contain legal norms.» In connection with this, subjects of authority often approach issues of terminological apparatus in different ways when processing hundreds of legal acts. In addition, the scientific community does not have a unified approach to this issue, operating with the concepts of «legal acts of state administration», «administrative legal acts», «individual administrative acts», «individual administrative legal acts» and «legal acts of individual action». Taking into account the researched material, it is indicated that most often an individual act is equated with the concept of an administrative act, which is narrower. Therefore, in the context of a public legal dispute, which includes both administrative and judicial appeals, it is appropriate to use the term individual act. It has been concluded that a unified understanding of the definition of an individual act by the scientific community and the legislator is extremely important, as it forms a unified approach to their application. Therefore, the definition of an individual act is proposed.

Procedural decision of the detective to start a pre-trial investigation: some problematic issues

The article is devoted to problems related to the legal regulation of the detective’s procedural decision to initiate a pre-trial investigation. It was noted that although the legislator did not define the adoption of a separate procedural decision of the detective to start a pre-trial investigation, such a decision is embodied (enveloped) not in a procedural document, but in a procedural action - entering information about a criminal offense into the Unified Register of Pre-Trial Investigations. The problem of improper legislative regulation of the interaction between the detective and the head of the detectives department regarding the adoption of the specified procedural decision is outlined. The departmental acts of the ESBU and the NABU in relation to the norms of the Criminal Procedure Code of Ukraine were studied, on the basis of which it was concluded that the adoption of a procedural decision by the detective to start a pre-trial investigation is preceded by an order from the head of the detectives department to consider a statement, notification of the commission of a criminal offense in accordance with Article 214 of the Criminal Procedure Code of Ukraine (although such an order is not expressly provided for in the Criminal Procedure Code of Ukraine). Particular attention was paid to the legislator’s uncertainty of such interaction in case defective learns on his own about circumstances which are likely to indicate that a criminal offence has been committed, in connection with which possible options for such procedural interaction were considered: a) independent entry of information by the detective into the Unified Register of Pre­Trial Investigations with immediate notification of the head of the prosecutor’s office; b) notification by the detective to the head of the detectives department about the independent detection of signs of a criminal offense without independently entering such information into the Unified Register of Pre-Trial Investigations. The opinion that the last option of interaction is correct is substantiated. The scientific discussion is continued regarding the issues related to the literal interpretation of the Criminal Procedure Code of Ukraine regarding the duty of the detective to enter information into the Unified Register of Pre-Trial Investigations on the basis of the submitted application, notification of the committed criminal offense regardless of their content. The current practice of investigative judges is analyzed, based on which the formed approaches to understanding the grounds for making a procedural decision to start a pre-trial investigation based on statements and reports of the commission of a criminal offense are highlighted. The solutions of the outlined problematic aspects by making changes to the Criminal Procedure Code of Ukraine are proposed.

Legal consequences of the statement of provocation by the defense party: scientific and practical aspects

The article examines the legal consequences of the defense’s declaration of provocation of a crime. Based on the analysis of the practice of the European Court of Human Rights and the Supreme Court, the opinion was formulated that the declaration of the commission of a crime as a result of provocation by the defense gives rise to the corresponding obligations for the defense and the prosecution, as well as the court. It was analyzed that as a result of the influence of the precedent practice of the European Court of Human Rights, the practice of the Supreme Court began to form regarding the position of the defense on provocation of a crime, according to which the contradiction of the position of the defense, i.e. when the applicant denies the fact that he committed a crime and at the same time declares that he was provoked to commit it, is the basis for the court’s refusal to verify such an application, citing the relevant reasons in the decision. Based on the study of the principle of adversariality of the parties in criminal proceedings, the thesis that it is the defense party that is obliged to prove the presence of provocation, to indicate which facts and circumstances confirm this with reference to specific evidence examined at the court hearing, is substantiated. In turn, the prosecutor, supporting public accusations, except for the circumstances specified in Art. 91 of the Criminal Code of Ukraine, guided by the standard of proof «beyond a reasonable doubt», is obliged to prove the absence of provocation of the crime. Failure to prove «beyond a reasonable doubt» the absence of provocation is equivalent to proving its presence and causes legal consequences in the form of an acquittal by the court. It has been proven that when one of the arguments of the defense side was the presence of provocation of a crime, the court is obliged to properly evaluate both the arguments of the defense side and the arguments of the prosecution regarding the presence or absence of such provocation. According to the results of the analysis of the decisions of the Supreme Court in which the lower courts did not evaluate the arguments of the defense about provocation, or formally evaluated them formally, it was concluded that this is a significant violation of the requirements of the Criminal Procedure Code, which prevented or could have prevented the court from adopting a legal and justified court decision.

The use of electronic evidence in the criminal process of foreign countries

It is emphasized that electronic evidence has become indispensable for criminal investigations and trials around the world. The importance of legal regulation of the criminal procedural form of digital technologies is emphasized. The improper nature of such regulation entails certain legal consequences, including the recognition of electronic evidence as improper or inadmissible. The experience of some foreign countries in the field of recognition and use of electronic evidence (the USA, Great Britain, the People’s Republic of China and the countries of the European Union) is analyzed. It has been proven that each state builds its own way and approach to incorporating such evidence into its legal systems depending on legal traditions, technological infrastructure and privacy considerations. From the analysis of procedural codes, it was noted that procedural science develops a theory of electronic evidence according to the industry principle. It is emphasized that they are based on common digital technologies, therefore this provides an opportunity to develop uniform cross­industry rules for the use of electronic evidence in any process. It was determined that in the Anglo-Saxon legal system there is no clear division of evidence into types. Evidence law is based on typical problem situations. The US legislation, which regulates the use of electronic evidence in the criminal process, is analyzed. It is noted that the condition for their acceptance is its authenticity and relevance to the case. It is noted that in the UK, all electronic evidence is subject to the same rules and laws that apply to documentary evidence. The legislation of the European Union, which regulates electronic evidence and allows to strengthen cooperation between member states in the field of using electronic evidence, is analyzed. It is emphasized that as states continue to adapt to the age of digital technologies, the development of a reliable legal framework and international cooperation will be essential to ensure the effective and fair use of electronic evidence in the pursuit of justice.

Role of Court in Formation Evidential Matter in Economic Disputes in Russia and England as an Actual Problem in International Private Law

Introduction. The article unravels the role of court in formation evidential matter in economic disputes in Russia and England. It studies the distinctive features of formation evidential matter in economic disputes in Russia and England, addresses the role of court in the court’s formation of information on facts and (or) digital footprints of facts through providing instructions for formation evidential matter based on the example of electronic documents, evidence of witnesses, and expert evidence in Russia and England.Materials and methods. In the course of writing the work, a set of general scientific, formal-logical methods (including methods of analysis, synthesis, induction, deduction, systematization) and special methods (formal-legal, historical, comparative-legal, structural-legal methods, etc.) were used.Research results. The author demonstrates that fact finding of objective truth in economic disputes can be carried out by the court when the following condition are fulfilled: evidentiary materials are formed in the course to the directions of the court. In economic disputes in Russia and England, the court formation evidential matter both for the case as a whole and to provide for expertise.Discussion and conclusion. A conclusion on the similar role of court in formation evidential matter in economic disputes in Russia and England is made. The article formulates suggestions on the improvement of the Arbitration Procedural Code of the Russian Federation.

Examining Physicians' Approaches to Treating Relatives in Primary Health Care Centers: Insights from a Qualitative Study.

Introduction: Family medicine physicians take care of a diverse population of patients with a variety of acute and chronic diseases. These patients include family, friends, and acquaintances who may ask for direct medical care or help in accessing healthcare products and services within or outside of officially approved procedures. This is ethically challenging due to an ambiguous medical code of ethics, but it is commonly accepted as normal behavior by society. The aim of this study was to explore family medicine physicians' perspectives regarding the benefits, difficulties, and ethics of responding to medical care requests and/or favors from family, relatives, friends, and acquaintances and to make recommendations. Methods: The study sample consisted of junior and senior family medicine physicians working in primary healthcare centers affiliated with the Ministry of Health in Saudi Arabia. In-depth semi-structured interviews were conducted to collect data. Using social exchange theory, this qualitative study explores how family medicine physicians perceive and handle requests for medical favors from family members and others. Results: Semi-structured interviews were conducted with 19 family medicine physicians (six focus groups) with clinical experience ranging from 3 to 20 years. The data analysis identified three themes: perceived benefits and costs of cultural and social connectedness, shortcomings in patient management and healthcare systems, and recommendations to address challenges between physicians and patients who are relatives. Discussion and Conclusions: This study shows that treating others outside of normal access to healthcare services presents several ethical, moral, and professional challenges. Therefore, policy adaptation requires understanding this intricate dilemma and improving laws, system regulations, and guidelines for physicians and community members to improve access to care, reduce system abuse, empower providers, and enhance community awareness and compliance.

Outcomes in infective endocarditis among adults with CHD: a comparative national study.

Given increased survival for adults with CHD, we aim to determine outcome differences of infective endocarditis compared to patients with structurally normal hearts in the general population. We conducted a retrospective cross-sectional study identifying infective endocarditis hospitalisations in patients 18 years and older from the National Inpatient Sample database between 2001 and 2016 using International Classification of Disease diagnosis and procedure codes. Weighting was used to create national annual estimates indexed to the United States population, and multivariable logistic regression analysis determined variable associations. Outcome variables were mortality and surgery. The primary predictor variable was the presence or absence of CHD. We identified 1,096,858 estimated infective endocarditis hospitalisations, of which 17,729 (1.6%) were adults with CHD. A 125% increase in infective endocarditis hospitalisations occurred for adult CHD patients during the studied time period (p < 0.001). Adults with CHD were significantly less likely to experience mortality (5.4% vs. 9.5%, OR 0.54, CI 0.47-0.63, p < 0.001) and more likely to undergo in-hospital surgery (31.6% vs. 6.7%, OR 6.49, CI 6.03-6.98, p < 0.001) compared to the general population. CHD severity was not associated with increased mortality (p = 0.53). Microbiologic aetiology of infective endocarditis varied between groups (p < 0.001) with Streptococcus identified more commonly in adults with CHD compared to patients with structurally normal hearts (36.2% vs. 14.4%). Adults with CHD hospitalised for infective endocarditis are less likely to experience mortality and more likely to undergo surgery than the general population.

In-patient neurosurgical tumor treatments for malignant glioma patients in Germany.

Treatment for malignant gliomas involves multiple disciplines, including neurosurgery, radiation therapy, medical and neuro-oncology, and palliative medicine, with function-preserving neurosurgical tumor removal being crucial. However, real-world data on hospital cases, treatment types, especially regarding surgical approaches, and the associated complication and mortality rates in Germany are lacking. We analyzed data on hospital cases involving malignant gliomas (ICD-10-GM code C71) from the German §21 Hospital Remuneration Act, provided by the Institute for the Hospital Remuneration System (InEK GmbH), from 2019 to 2022. Our focus was on neuro-oncological operations defined by the German Cancer Society (DKG) and included specific operation and procedure (OPS) codes. From 2019 to 2022, there were 101,192 hospital cases involving malignant gliomas in Germany. Neurosurgical tumor removal was performed in 27,193 cases (26.9%). Microsurgical techniques were used in 95% of surgeries, intraoperative navigation systems in 84%, fluorescence-guided surgeries in 45.6%, and intraoperative neurophysiological monitoring (IONM) in 46.4%. Surgical or medical complications occurred in 2903 cases (10.7%). The hospital mortality rate was 2.7%. Mortality was significantly higher in patients aged 65 and older (Odds ratio 2.9, p < 0.0001), and lower in cases using fluorescence-guided procedures (Odds ratio 0.8, p = 0.015) and IONM (Odds ratio 0.5, p < 0.0001). Over the course of 4years, over 100,000 hospital cases involving adult patients diagnosed with malignant gliomas were treated in Germany, with 27,193 cases undergoing tumor removal using various modern surgical techniques. The hospital mortality rate was 2.7%.

Robotic assisted simple prostatectomy mitigates perioperative morbidity compared to open simple prostatectomy - a single institution report

BackgroundAccording to the guidelines of the European Association of Urology, open simple prostatectomy should be offered to men with a prostate size exceeding 80 mL suffering from moderate to severe LUTS in the absence of a transurethral enucleation technique. However, open simple prostatectomy is associated with complications such as bleeding, blood transfusions and increased length of stay compared to minimally invasive procedures. The aim of the study was to compare perioperative data from the first cases of robotic assisted simple prostatectomy (RASP) to that of patients subjected to open simple prostatectomy (OSP) at our department.MethodsThe patients were identified by a search for the respective procedure codes. In the OSP group enucleation of the adenoma was performed through the prostatic capsule (Millin procedure), while access to the adenoma was gained through the bladder in the RASP group. Complications were scored according to the Clavien-Dindo classification system.Results27 patients who underwent OSP were retrospectively identified and compared to the first 26 patients who were subjected to RASP. The groups were similar with respect to age, body mass index and ASA score. Operative time was significantly shorter in the OSP group compared to the RASP group. Bleeding volume, drop in postoperative hemoglobin and the number of blood transfusions were all significantly higher in the OSP group compared to the RASP group. Average length of stay was 5.5 (2–18) days in the OSP group compared to 1.6 (1–5) days in the RASP group (p < 0.001). The number of postoperative complications, Clavien-Dindo ≥ 2, were significantly higher in the OSP group (11) compared to the RASP group (none, p < 0.001).ConclusionsThe introduction of robotic assisted simple prostatectomy reduced perioperative morbidity at our department.