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Introduction: Osteoporosis is a major disease state associated with significant morbidity, mortality, and health care costs. Less than half of the individuals sustaining a low energy hip fracture are diagnosed and treated for the underlying osteoporosis. Objective: A multidisciplinary Canadian hip fracture working group has developed practical recommendations to meet Canadian quality indicators in post hip fracture care. Methods: A comprehensive narrative review was conducted to identify and synthesize key articles on post hip fracture orthogeriatric care for each of the individual sections and develop recommendations. These recommendations are based on the best evidence available today. Conclusion: Recommendations are anticipated to reduce recurrent fractures, improve mobility and healthcare outcomes post hip fracture, and reduce healthcare costs. Key messages to enhance postoperative care are also provided. [ABSTRACT FROM AUTHOR]

Background: The main aim of emergency medical services (EMS) should be to provide universal emergency medical care which is EMS system available to all those who need it. Most of the developed countries have an integrated EMS system that is accessible by a single dial number in the whole country. Nepal does not have a proper EMS system. We conducted a literature review regarding methods of developing an integrated EMS system in Nepal. Result: The fragmented system, high demand–low supply, inequity with the service, and inadequately trained responders are major problems associated with EMS in Nepal. Nepal too should develop an integrated single dial number EMS system to meet the current demand of EMS. Having a paramedic in ambulances as the first responders will prevent chaos and save critical time. Funding models have to be considered while developing an EMS considering the capital as well as operational cost. Conclusion: Nepal can develop a public private partnership model of EMS where capital cost is provided by the government and operational cost by other methods. Community-based insurance system looks more feasible in a country like Nepal for generating operational cost. [ABSTRACT FROM AUTHOR]

The European Society of Radiology (ESR) established a Working Group on Value-Based Imaging (VBI WG) in August 2016 in response to developments in European healthcare systems in general, and the trend within radiology to move from volume- to value-based practice in particular. The value-based healthcare (VBH) concept defines 'value' as health outcomes achieved for patients relative to the costs of achieving them. Within this framework, value measurements start at the beginning of therapy; the whole diagnostic process is disregarded, and is considered only if it is the cause of errors or complications. Making the case for a new, multidisciplinary organisation of healthcare delivery centred on the patient, this paper establishes the diagnosis of disease as a first outcome in the interrelated activities of the healthcare chain. Metrics are proposed for measuring the quality of radiologists' diagnoses and the various ways in which radiologists provide value to patients, other medical specialists and healthcare systems at large. The ESR strongly believes value-based radiology (VBR) is a necessary complement to existing VBH concepts. The Society is determined to establish a holistic VBR programme to help European radiologists deal with changes in the evolution from volume- to value-based evaluation of radiological activities. Main Messages • Value-based healthcare defines value as patient's outcome over costs. • The VBH framework disregards the diagnosis as an outcome. • VBH considers diagnosis only if wrong or a cause of complications. • A correct diagnosis is the first outcome that matters to patients. • Metrics to measure radiologists' impacts on patient outcomes are key. • The value provided by radiology is multifaceted, going beyond exam volumes. [ABSTRACT FROM AUTHOR]

The wrist is the most frequently injured body region among snowboarders. Studies have shown that the risk of sustaining a wrist injury can be reduced by wearing wrist protection. Currently, there are a wide variety of wrist protection products for snowboarding on the market that offer a range of protective features. However, there are no minimum performance standards for snowboarding wrist protectors worldwide. The International Society for Skiing Safety convened a task force to develop a White Paper to evaluate the importance and necessity of a minimum performance for all wrist protectors used in snowboarding. The White Paper outlines the need for a general framework for a harmonized international standard and reviews the existing evidence. Therefore, this White Paper may serve as a common base for future discussions. The broader goal of developing and implementing such a standard is to reduce the incidence and the severity of wrist injuries in snowboarding without increasing the risk of adverse events, such as upper arm or shoulder injury. The European standard for inline skating wrist protectors (EN 14120) can serve as a starting point for efforts related to a standard for snowboard wrist protectors, but certain modifications to the standard would be required. It is hypothesized that implementation of a snowboarding wrist protector standard would result in fewer and less severe wrist injuries in the sport and could translate into more riding days for healthy snowboarders and significant health-care costs savings. [ABSTRACT FROM AUTHOR]

Lung cancer is the most frequently fatal cancer, with poor survival once the disease is advanced. Annual low-dose computed tomography has shown a survival benefit in screening individuals at high risk for lung cancer. Based on the available evidence, the European Society of Radiology and the European Respiratory Society recommend lung cancer screening in comprehensive, quality-assured, longitudinal programmes within a clinical trial or in routine clinical practice at certified multidisciplinary medical centres. Minimum requirements include: standardised operating procedures for low-dose image acquisition, computer-assisted nodule evaluation, and positive screening results and their management; inclusion/exclusion criteria; expectation management; and smoking cessation programmes. Further refinements are recommended to increase quality, outcome and cost-effectiveness of lung cancer screening: inclusion of risk models, reduction of effective radiation dose, computer-assisted volumetric measurements and assessment of comorbidities (chronic obstructive pulmonary disease and vascular calcification). All these requirements should be adjusted to the regional infrastructure and healthcare system, in order to exactly define eligibility using a risk model, nodule management and a quality assurance plan. The establishment of a central registry, including a biobank and an image bank, and preferably on a European level, is strongly encouraged. Key points: • Lung cancer screening using low dose computed tomography reduces mortality. • Leading US medical societies recommend large scale screening for high-risk individuals. • There are no lung cancer screening recommendations or reimbursed screening programmes in Europe as of yet. • The European Society of Radiology and the European Respiratory Society recommend lung cancer screening within a clinical trial or in routine clinical practice at certified multidisciplinary medical centres. • High risk, eligible individuals should be enrolled in comprehensive, quality-controlled longitudinal programmes. [ABSTRACT FROM AUTHOR]

Purpose: Understanding how patients and families experience, respond to, and cope with the financial burden associated with cancer could assist in identifying future research priorities and developing relevant interventions to assist patients and families facing financial hardship. This systematic review offers a synthesis of the qualitative evidence on cancer-related financial toxicity from the perspective of patients and/or informal caregivers in publicly funded healthcare systems where it might be expected that financial protection would be strongest. Methods: Articles published between January 1, 2005, and March 7, 2019, describing financial burden experienced by cancer patients and/or informal caregivers were identified using OVID MEDLINE Embase and PsychInfo, CINAHL, Business Source Complete, and EconLit databases. English language, peer-reviewed qualitative papers describing studies conducted in countries with predominantly publicly funded healthcare systems were eligible. Quality appraisal was conducted using CASP Quality Appraisal Checklist. Narrative synthesis was completed with extracted data and themes identified inductively by all team members. Results: Twelve articles were identified as eligible. Articles reported on 10 studies conducted in Australia (n = 2), Canada (n = 2), England (n = 3), and Ireland (n = 3). The papers illustrate the complexity and multifaceted nature of experiencing financial hardship following a cancer diagnosis. Each contributes to the whole picture, providing different viewpoints regarding various and diverse forms of financial hardship, the process of confronting financial challenges, working to overcome difficulties, and coping with the resulting impacts. Synthesis of the studies suggested five themes: household and medical costs are increased, financial resources are reduced, financial change and financial hardship vary, financial hardship has many consequences, various mitigation strategies are used. Conclusion: Cancer patients and their families can experience a broad range of impacts when they are facing and coping with financial toxicity. Consistent gaps in support highlight that strategies to mitigate financial effects related to travel, accommodation, medications, family support, and income replacement are needed for many patients and families even in the context of publicly funded healthcare systems. Implications for Cancer Survivors: Survivors need to be informed early in their cancer experience about the potential financial burden associated with cancer treatment and its impact on survivors and their family members. [ABSTRACT FROM AUTHOR]

Objective: To provide up-to-date and comprehensive US data tables to estimate future net resource use, including nonlabor market production, and examine distributional impacts of including nonhealth and future costs in cost-effectiveness results. Methods: Using a published US cancer prevention simulation model, the paper evaluated the lifetime cost effectiveness of implementing a 10% excise tax on processed meats across age- and sex-specific population subgroups. The model examined multiple scenarios accounting for cancer-related healthcare expenditure (HCE) only, cancer-related and unrelated background HCE, adding productivity benefits (i.e., patient time, cancer-related productivity loss, and background labor and nonlabor market production), and with nonhealth consumption costs, adjusted for household economies of scale. Additional analyses include using population-average versus age–sex-specific estimates for quantifying production and consumption value, as well as comparing direct model estimation versus postcorrections with Meltzer's approximation for incorporating future resource use. Results: Accounting for nonhealth and future costs impacted cost-effectiveness results across population subgroups, often leading to changes in "cost-saving" determination. Including nonlabor market production had a noticeable impact on estimating future resource use and reduced the bias toward undervaluing productivity among females and older populations. The use of age–sex-specific estimates resulted in less favorable cost-effectiveness results compared with population-average estimates. Meltzer's approximation provided reasonable corrections among the middle-aged population for re-engineering cost-effectiveness ratios from a healthcare sector to a societal perspective. Conclusion: With updated US data tables, this paper can help researchers conduct a comprehensive value assessment to reflect net resource use (health and nonhealth resource use minus production value) from a societal perspective. [ABSTRACT FROM AUTHOR]

Current approaches to activity-assisted living (AAL) are complex, expensive, and intrusive, which reduces their practicality and end user acceptance. However, emerging technologies such as artificial intelligence and wireless communications offer new opportunities to enhance AAL systems. These improvements could potentially lower healthcare costs and reduce hospitalisations by enabling more effective identification, monitoring, and localisation of hazardous activities, ensuring rapid response to emergencies. In response to these challenges, this paper introduces the TransparentRFIDTag Wall (TRT-Wall), a novel system taht utilises a passive ultra-high frequency (UHF) radio-frequency identification (RFID) tag array combined with deep learning for contactless human activity monitoring. The TRT-Wall is tested on five distinct activities: sitting, standing, walking (in both directions), and no-activity. Experimental results demonstrate that the TRT-Wall distinguishes these activities with an impressive average accuracy of 95.6 % under four distinct distances (2, 2.5, 3.5 and 4.5 m) by capturing the RSSI and phase information. This suggests that our proposed contactless AAL system possesses significant potential to enhance elderly patient-assisted living. [ABSTRACT FROM AUTHOR]

Social work regulatory rules and practices should balance the social values of promoting consumer safety and workforce equity. As the two values often compete, the balancing act should be guided by empirical evidence about the effects of regulations on consumers and the workforce. Unfortunately, however, empirical studies investigating the relationships between various regulatory rules and practices and consumer safety and workforce equity are rare in the existing literature. This paper identifies critical gaps in the current knowledge base and proposes a series of future research agendas that call for empirical evidence, including detailed data on jurisdictional regulatory rules and practices, the measures of consumer safety, and licensed social workers' demographic, employment, and practice characteristics. The paper concludes by calling out to all social work stakeholders about the need for empirical evidence on the effects of social work regulatory rules and practices. [ABSTRACT FROM AUTHOR]

There is a mental health crisis in the United States that shows no signs of abating. Prevalence rates of mental disorders among both adults and children are rising and there are simply not enough mental health professionals to meet the growing demand. To address this problem, digital programs are being designed to diagnose and treat mental health conditions either adjunctively to a human clinician or as stand-alone treatments. Such developments hold great promise in ameliorating the mental health professional supply shortage. However, certain limitations of digital programs may prevent many users from desiring a digital psychotherapist. This paper surveys both the promise, and limitations, of digital psychotherapies. [ABSTRACT FROM AUTHOR]

Background: Novel tuberculosis (TB) drugs and the need to treat drug-resistant tuberculosis (DR-TB) are likely to bring about substantial transformations in TB treatment in coming years. An evidence base for cost and cost-effectiveness analyses of these developments is needed. Objective: Our objective was to perform a review of papers assessing provider-incurred as well as patient-incurred costs of treating both drug-susceptible (DS) and multidrug-resistant (MDR)-TB. Methods: Five databases (EMBASE, Medline, the National Health Service Economic Evaluation Database, the Cost-Effectiveness Analysis Registry, and Latin American and Caribbean Health Services Literature) were searched for cost and economic evaluation full-text papers containing primary DS-TB and MDR-TB treatment cost data published in peer-reviewed journals between January 1990 and February 2015. No language restrictions were set. The search terms were a combination of 'tuberculosis', 'multidrug-resistant tuberculosis', 'cost', and 'treatment'. In the selected papers, study methods and characteristics, quality indicators and costs were extracted into summary tables according to pre-defined criteria. Results were analysed according to country income groups and for provider costs, patient costs and productivity losses. All values were converted to $US, year 2014 values, so that studies could be compared. Results: We selected 71 treatment cost papers on DS-TB only, ten papers on MDR-TB only and nine papers that included both DS-TB and MDR-TB. These papers provided evidence on the costs of treating DS-TB and MDR-TB in 50 and 16 countries, respectively. In 31 % of the papers, only provider costs were included; 26 % included only patient-incurred costs, and the remaining 43 % estimated costs incurred by both. From the provider perspective, mean DS-TB treatment costs per patient were US$14,659 in high-income countries (HICs), US$840 in upper middle-income countries (UMICs), US$273 in lower middle-income (LMICs), and US$258 in low-income countries (LICs), showing a strong positive correlation. The respective costs for treating MDR-TB were US$83,365, US$5284, US$6313 and US$1218. Costs incurred by patients when seeking treatment for DS-TB accounted for an additional 3 % of the provider costs in HICs. A greater burden was seen in the other income groups, increasing the costs of DS-TB treatment by 72 % in UMICs, 60 % in LICs and 31 % in LMICs. When provider costs, patient costs and productivity losses were combined, productivity losses accounted for 16 % in HICs, 29 % in UMICs, 40 % in LMICs and 38 % in LICs. Conclusion: Cost data for MDR-TB treatment are limited, and the variation in delivery mechanisms, as well as the rapidly evolving diagnosis and treatment regimens, means that it is essential to increase the number of studies assessing the cost from both provider and patient perspectives. There is substantial evidence available on the costs of DS-TB treatment from all regions of the world. The patient-incurred costs illustrate that the financial burden of illness is relatively greater for patients in poorer countries without universal healthcare coverage. [ABSTRACT FROM AUTHOR]

Health and the environment are complex components of the countries, influenced by several factors, especially transport, and economics. Thus, this paper assesses the role of transportation and economic complexity in the environment and public health for the Organization for Economic Co-operation Development (OECD) countries from 2001 to 2020. This study also focuses on the relationship between transport and economic complexity with environmental and healthcare expenditures. Precisely, transport and economic activities stimulate healthcare expenditures through multiple channels. The current study employs the STIRPAT model to investigate the association with transportation, economic complexity, transport–carbon intensity, and healthcare expenditure. Besides, the current research confirms the plausible cross-sectional dependency across countries, and it adopts a second-generation technique. Analytical findings suggest that transportation-carbon intensity is positively and significantly associated with healthcare expenditures. Healthcare and transport–household expenditures increase transport–carbon intensity (TCI) by 75% and 45%, respectively, in the long run. In the contrast, TCI and transport–household expenditures have also a remarkable impact on healthcare expenditures and are estimated approximately 95% in the long run. Moreover, economic growth also upsurges TCI and healthcare expenditures through multiple economic activities. Besides, transport–household expenditures (THE) drastically impact transport–carbon intensity and healthcare expenditures (HEX) through passenger traffic (PTF). Diagnostic upshots unveil that the joint effect of THE and PTF increases TCI and HEX by 4 and 3%, respectively. Finally, findings recommend some policy implications and future research directions for the countries based on empirical outcomes. Countries should regulate economic activities to reduce transport carbon emissions. [ABSTRACT FROM AUTHOR]

Bipolar disorder (BD) can be especially challenging to treat due to the dynamic nature of its presentation; there is a critical need for a multimodal approach to adequately address patients' symptoms and quality of life concerns. However, most mental health professionals have not implemented a multimodal approach due to limited dissemination of evidence-based psychosocial interventions for BD and bias towards psychopharmacology-centered treatment. This is despite clear findings from numerous studies that medication alone fails to fully address most patients' needs and that psychosocial interventions lead to fewer relapses and a higher quality of life. This paper aims to review the evidence in support of psychosocial interventions as a key component of the treatment of BD and to highlight obstacles to the implementation of psychosocial treatment approaches. Additionally, we aim to make a case for an increase in the utilization of psychosocial interventions to improve quality of life and functioning for individuals with BD and their families, and to mitigate societal costs. [ABSTRACT FROM AUTHOR]

A recent study published by the Manhattan Institute, "Why Has Longevity Increased More in Some States than in Others? The Role of Medical Innovation and Other Factors," purported to show that the more rapid adoption of new drugs has substantial benefits in the form of increased life expectancy, higher productivity and lower non-drug health care expenditures. This study has been cited as evidence supporting the more rapid acceptance of new drugs in Medicaid, Medicare, and other public programs and has helped to shape public debate on the value of new drugs. This analysis questions the key conclusions of the study. It points out that the key statistical regressions appear to be misspecified, since they show anomalies such as a negative correlation between income growth and life expectancy and find no relationship between education and productivity growth. Methodological flaws addressed include lack of adjustment for infant mortality rates; inadequate proxy measures of health status; lack of adjustment for ages of individuals and other sociodemographic factors; inherent problems with the definition of drug age, or 'vintage;' and the failure to consider reverse causation as an obvious explanation for several findings. The Manhattan Institute study does not provide reliable evidence for favoring adoption of newer drugs in either public or private health care programs. [ABSTRACT FROM AUTHOR]

Unhealthy behaviors such as poor diet and tobacco use contribute to disease burden and escalating healthcare costs. This paper evaluates potential savings from people adopting reduced risk behaviors in Mexico. Using the Preventable Risk Integrated Model, we compare actual consumption in 2016 (baseline) to optimal intake following WHO guidelines (counterfactual) for salt, fiber, fruit/vegetables, and fat to estimate reductions in coronary, cerebrovascular, cancer, diabetes and hypertensive diseases. We also model 50% of smokers switching to e-cigarettes/heated tobacco with 65–97% lower disease risk. Results indicate over 650,000 preventable cases annually, mostly from diet changes (fruits/vegetables, fat, salt). Healthcare cost savings reach $3.4 billion USD; $2.8 billion from nutrition and $0.3 billion from smoking substitution. Fruit/vegetable intake and reduced fat confer over $1 billion savings each. Salt and fiber also contribute significantly. Adding smoking transitions provides further savings. Shifting Mexicans towards healthier diets and alternative nicotine products could substantially lower disease burden and healthcare costs. These findings underscore the economic imperative of promoting reduced-risk behaviors through public health policies. [ABSTRACT FROM AUTHOR]

Introduction: Out-of-pocket medical expenses are a crucial source of health care financing in a number of countries. With the ongoing population aging, health care costs are likely to increase. Therefore, disentangling the relationship between health care spending and monetary poverty is becoming increasingly important. Although there is extensive literature on the impoverishment effect of out-of-pocket medical payments, it lacks empirical studies on a causal relationship between catastrophic health expenditure and poverty. In our paper, we try to fill this gap. Methods: We estimate recursive bivariate probit models using Polish Household Budget Survey data covering years from 2010 to 2013 and from 2016 to 2018. The model controls for a wide range of factors and endogeneity between poverty and catastrophic health expenditure. Results: We show that the causal relationship between catastrophic health expenditure and relative poverty is significant and positive across different methodological approaches. We find no empirical evidence that a one-time incidence of catastrophic health expenditure creates a poverty trap. We also show that using a poverty measure which treats out-of-pocket medical payments and luxury consumption as perfect substitutes can lead to an underestimation of poverty among the elderly. Conclusion: Out-of-pocket medical payments should probably receive more attention from policymakers than the official statistics suggest. A current challenge is to correctly identify and appropriately support those who are most affected by catastrophic health expenditure. More prospectively, a complex modernization of the Polish public health system is needed. [ABSTRACT FROM AUTHOR]

Even though health expenditures are one of the significant determinants of accumulation of human capital and economic growth, researchers have paid less attention to unveiling interactions between health care expenditures and economic performance. The main objective of this study is to investigate disaggregated health care expenditures and economic growth nexus in Türkiye from 1979 to 2019 by using an asymmetric causality approach. The main empirical findings could be briefly summed up as follows: there exist asymmetric causal effects running from total health expenditures, out-of-pocket health expenditures and voluntary health expenditures to economic growth, while there is no asymmetric causal effect from compulsory health expenditures to economic growth. The policy inferences of empirical results for enhancing the productivity of health expenditures are stated in the body of the paper. [ABSTRACT FROM AUTHOR]

The aim of the study is to assess the feasibility of Drugs Rational Usage Guideline System (DRUGS)-supported clinical pathway (CP) for breast carcinoma, cataract, inguinal hernia and 2-diabetes mellitus whether the application of such a system could improve work efficiency, medical safety, and decrease hospital cost. Four kinds of diseases which included 1773 cases (where 901 cases using paper-based clinical pathways and 872 cases using DRUGS-supported clinical pathways) were selected and their demographic and clinical data were collected. The evaluation criteria were length of stay, preoperative length of stay, hospital cost, antibiotics prescribed during hospitalization, unscheduled surgery, complications and prognosis. The median total LOS was 1 to 3 days shorter in the DRUGS-supported CP group as compared to the Paper-based CP group for all types ( p < 0.05). Totel hospital cost decreased significantly in the DRUGS-supported CP group than that in Paper-based CP group. About antibiotics prescribed during hospitalization, there were no statistically differences in the time of initial dose of antibiotic and the duration of administration except the choice of antibiotic categories. The proportion of DRUGS-supported clinical pathway conditions where a broad-spectrum antibiotic was prescribed decreased from 63.6 to 34.5 % ( p < 0.01) in the Paper-based group. While after the intervention, the differences were statistically not significant in unscheduled surgery, complications and prognosis. In this study, DRUGS-supported clinical pathway for breast carcinoma, cataract, inguinal hernia, 2-diabetes mellitus was smoothly shifted from a paper-based to an electronic system, and confer benefits at the hospital level. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to provide a synthesis of prior research of estimates of the willingness to pay (WTP) for chronic disease treatment and examines the impact of economic and political institutions, cultures, and other important factors on WTP. Subject and method: The paper applies meta-regression analysis to 1053 estimates of WTP from 188 medical treatment studies from 40 countries. Results: The results suggest that patients assign higher values for medical treatment in more capitalistic and more democratic countries. Cultural traits also appear to matter, with higher WTP in societies characterized by individualism and indulgence. Further, disease types matter. Compared to cancer, WTP is lower for diabetes, obesity, asthma, and heart disease treatment, but higher for amyotrophic lateral sclerosis therapy. GDP per capita is positively associated with WTP. The higher public health expenditure is in a country, the higher citizens value health benefits. If individuals expect to live longer, then they will spend less on their health. The published studies estimate a lower value than unpublished studies. Conclusion: This paper presents a comprehensive synthesis of estimates of chronically ill patients' WTP for medical treatment and identifies the key factors determining WTP through a meta-regression analysis. The main finding is that economic and political institutions, cultural traits, the types of disease, socio-economic characteristics, and valuation methods all influence WTP estimates. [ABSTRACT FROM AUTHOR]

From its infancy in the 1910s, healthcare group insurance continues to increase, creating a consistently rising burden on the government and taxpayers. The growing number of people enrolled in healthcare programs such as Medicare, along with the enormous volume of money in the healthcare industry, increases the appeal for and risk of fraudulent activities. One such fraud, known as upcoding, is a means by which a provider can obtain additional reimbursement by coding a certain provided service as a more expensive service than what was actually performed. With the proliferation of data mining techniques and the recent and continued availability of public healthcare data, the application of these techniques towards fraud detection, using this increasing cache of data, has the potential to greatly reduce healthcare costs through a more robust detection of upcoding fraud. Presently, there is a sizable body of healthcare fraud detection research available but upcoding fraud studies are limited. Audit data can be difficult to obtain, limiting the usefulness of supervised learning; therefore, other data mining techniques, such as unsupervised learning, must be explored using mostly unlabeled records in order to detect upcoding fraud. This paper is specific to reviewing upcoding fraud analysis and detection research providing an overview of healthcare, upcoding, and a review of the current data mining techniques used therein. [ABSTRACT FROM AUTHOR]

Background: Chile, like many other countries, has seen major health reforms. It is now moving towards universal access using social protection strategies. It is essential at this point to have a clear view of the barriers to and facilitators of healthcare that Chile's population faces. Methods: We used ontological meta-analysis to formalize, standardize, and assess healthcare access in Chile by mapping the 200 research papers written about it. This methodology can be adapted to any other country to analyze its current situation. Results: The results highlight the frequent, infrequent, and absent research themes. Among some of the findings are the importance of improving access to healthcare using physical, virtual, and combined access, based on the resource conditions, type of care, and the adequacy of personnel providing care. Conclusions: This ontology and the analysis set the foundation for future research and establishment of policies in relevant areas where we are currently not paying enough attention. [ABSTRACT FROM AUTHOR]

Poor health is one of the fundamental causes behind the suffering and deprivation of human beings. One of the United Nations (UN) Sustainable Development Goals is to enhance the quality of healthcare for everyone, which includes economic coverage, availability of high-quality fundamental health-care services, and access to proper, efficient, high-quality, and affordable important vaccinations and medications. Question-Answering (QA) in the medical domain has recently piqued the interest among the researchers and other stakeholders. Medical QA systems have the potential to enhance access to healthcare services, improve patient interactions with doctors, and reduce medical costs through e-medicine. In this paper, we describe a knowledge enabled QA model, which demonstrates how large-scale medical information in the form of knowledge graphs can aid in extracting more relevant answers. The proposed model employs two scoring methods, viz.Medical Entity Scoring (MES) and Context Relevance Scoring (CRS). MES ranks the medical entities from graphs according to their relevance, while CRS is used to reason over the supporting paragraph using the query vector. The system's knowledge is obtained through the use of two distinct resources, viz. PharmKG is used for pharmaceutical terminology management, whereas Unified Medical Language System UMLS is used for general medical terminology management. Empirical results on the MASH-QA and COVID-QA datasets demonstrate that our proposed approach outperforms existing State-of-the-art in both machine evaluation and human judgment. [ABSTRACT FROM AUTHOR]

This paper explores the effect of COVID-19 on health care expenditure using data from a private Health Insurance Plan (HIP). As well known, at the beginning of the COVID-19 pandemic, governments had to rely on Non-Pharmaceutical Interventions against the spread of the virus. However, the stringency of lockdowns differed across space and time as governments had to adjust their strategy dynamically to the country-specific development of the crisis. These strategies have strongly changed the policyholders' behavior; however, after this period, a fundamental question is whether the policyholder behavior will return to a status quo (i.e. in traditional care delivery). We analyze these effects using a "pre-post" quantitative study using longitudinal data collected from 2017 to 2021. We consider as a consumption measure the health care expenditure amount within several types of health services, coming from a group of insured persons, followed overtime every quarter, and separating the effect per gender and age. Moving in this direction, the purpose of our contribution is to investigate if the traditional actuarial approach for assessing the loss cost, based on the Generalized Linear Models, could predict the effect on the health care expenditure due to COVID-19 and the capacity to which a HIP can anticipate these uncertainties. Our results provide a comprehensive picture of the different effects of COVID-19 on the health services offered by the HIP, as well as on the behavior ofpolicyholders during and after the pandemic period. [ABSTRACT FROM AUTHOR]

Medical imaging technology is producing a growing number of medical images types as well as patient-related information. The benefits of using modern medical imaging systems in healthcare are undeniable. Picture archiving and communication system (PACS) have revolutionized medical imaging practice. PACS have widely impacted the accessibility of medical images, reduced imaging costs, eliminated the physical storage of films, improved time management of radiologists, and allowed automated decision-making and diagnosis. Many health organizations and manufacturers have invested on developing commercial PACS. However, commercial PACS are not affordable for all hospitals while open-source PACS are increasingly becoming a viable option. Our research project is looking for an open-source PACS for the Donka University hospital of Guinea. Open-source PACS are currently available and are offering varying functionalities, documentation, and technical support from their developer communities. Selecting an open-source PACS is not an easy task and not only depends on the hospital requirements but also requires assessing each open-source PACS to find the best match. In this paper, the most popular open-source PACS are evaluated using a simple comparison approach based on four criteria. The result of this assessment shows that Orthanc, DCM4CHE, DCMTK, and Dicoogle are the most mature open-source PACS according to our criteria and the needs of Donka. [ABSTRACT FROM AUTHOR]

This paper analyzes the determinants of health insurance enrollment and health expenditure in Ghana using micro data from wave 7 of the Ghana Living Standards Survey (GLSS 7) with emphasis on the role of risk preferences and the availability of health facilities in one's own community. It is possible to analyze the determinants of health insurance enrollment in Ghana because its public health insurance system (the National Health Insurance Scheme or NHIS) is, in theory, mandatory, but is, in actual practice, voluntary, with only about 40% of the population enrolled in the scheme. Our empirical findings show that risk preferences have a significant impact on health insurance enrollment, with risk averse individuals being significantly more likely than other households to enroll in health insurance. Moreover, our findings also show that very poor households are significantly more likely to enroll in health insurance than other households, perhaps because they are exempt from paying premiums for health insurance. Finally, our findings also show that the availability of health facilities in one's own community significantly decreases expenditures on health care. Highlights: Ghana's National Health Insurance Scheme is, in principle, mandatory but only 40% of households are enrolled. Ghana's National Health Insurance Scheme is pro-poor, with higher enrollment rates for the very poor. Risk-averse households are more likely to enroll in Ghana's National Health Insurance Scheme than other households, as expected. Enrollees in Ghana's National Health Insurance Scheme do not have lower out-of-pocket health expenditures than other households. Proximity to health facilities enables households in Ghana to reduce health expenditures. [ABSTRACT FROM AUTHOR]

Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) remains the most frequent and severe complication following ERCP, elevating both patient suffering and healthcare costs, and posing challenges to the advancement of ERCP techniques. Empirical evidence supports the prophylactic use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the prevention of PEP, especially in high-risk populations, as endorsed by both the American Society for Gastrointestinal Endoscopy (ASGE) and the European Society for Gastrointestinal Endoscopy (ESGE). However, the prophylactic efficacy of NSAIDs in average-risk individuals, alongside the ideal drug selection, dosing, and timing of NSAID administration, remains to be elucidated. Furthermore, the synergistic preventive potential of NSAIDs when integrated with other interventions, such as hydration, pancreatic stenting, somatostatin administration, sublingual nitrate application, and epinephrine, warrants further clarification. In this paper, we conduct an exhaustive review of the prophylactic effect and clinical administration of NSAIDs for PEP. We comprehensively synthesize findings from clinical trials investigating NSAIDs, both in monotherapy and combination regimens, for PEP prevention. Additionally, we scrutinize the current landscape of NSAID usage in clinical practice and evaluate their cost-effectiveness. Future research should concentrate on refining NSAID prophylaxis strategies for PEP in patients at different risk levels, while also enhancing adherence to clinical guidelines and alleviating the issue of NSAID cost inflation. [ABSTRACT FROM AUTHOR]

In 1958, Apley and Naish authored a groundbreaking paper in Archives of Disease in Childhood, elucidating the epidemiology and risk factors of recurrent abdominal pain in children—a subject that had confounded clinicians of their time. Surprisingly, even after 65 years, there are several unanswered questions regarding the etiology, pathophysiology, and management of pediatric abdominal pain. Contrary to the prevailing notion that children naturally outgrow functional abdominal pain, compelling evidence suggests it's possible these children develop a number of clinically significant psychological issues that could profoundly impact their quality of life and, consequently, future health and educational outcomes. In this light, we aimed to comprehensively review the current literature to update the knowledge of practicing clinicians on functional abdominal pain, summarizing the evidence from the last 65 years. Conclusion: The enduring unanswered questions surrounding childhood abdominal pain continue to challenge clinicians, resulting in unnecessary investigations, thereby contributing to substantial healthcare expenditures. It is also evident that children with long-standing symptoms would progress to adulthood with the potential to develop irritable bowel syndrome and many psychological disturbances. Several key interventions using pharmacological agents, such as amitriptyline, showed that some of these drugs are no more effective than the placebo in clinical trials. Several research during the recent past suggest that psychological interventions such as gut-directed hypnotherapy alleviate symptoms and ensure better prognosis in the long run. Therefore, clinicians and researchers must join hands to explore the pathophysiological mechanisms underpinning functional abdominal pain and novel therapeutic strategies to ensure the well-being of these children. What is Known: • Functional abdominal pain disorders are common among children, with a worldwide prevalence of 13.5% of children suffering from at least one of these disorders • These disorders contribute to a significant reduction in the quality of life of affected children and their families and lead to an array of psychological problems What is New: • The biological basis of functional abdominal pain is becoming more explicit, including complex interactions between altered microbiome, deranged motility, and psychological dysfunction with gut-brain interactions • Novel approaches giving minimal emphasis on pharmacological interventions and exploring psychological interventions are showing promising results [ABSTRACT FROM AUTHOR]

The ICH E17 guidelines (2014–2017) on Multiregional Clinical Trials (MRCT) was a joint effort by the regulators and industry to facilitate simultaneous global drug development and registration through taking a strategic approach for clinical trials. In other words, the objective was to reduce the time it takes to bringing medications to patients around the world through minimizing unnecessary duplication of local or regional studies, which may add the regulatory burden to cost and time of bringing new therapies to patients. Under the auspices of ICH, training materials were created and provided to various stakeholders. Despite the successful promotion of the benefits of ICH E17 MRCT guidelines across the different regions, the uptake of some concepts (e.g., pooling strategy) in the ICH E17 guidelines has been slow. This paper describes various factors which could affect the conduct of MRCT at a global level, including ambiguity in definition of "region" (in MRCT), new regulatory requirements to enroll a diverse patient population, the use of decentralized clinical trials, use of data sources other than randomized clinical trials (e.g., use of Real Word Data), and the impact of the COVID-19 pandemic on the conduct of MRCT. [ABSTRACT FROM AUTHOR]

In this paper, we explore dynamic market share and public healthcare costs of trastuzumab's evergreening (subcutaneous) variant during introduction of trastuzumab's competitive biosimilar variants in the Netherlands. We used a time series design to assess dynamic market share of trastuzumab's evergreening variant after introducing trastuzumab's biosimilar variants, focusing on the number of treatments and patients. The public healthcare costs of this evergreening strategy were estimated using administrative claims data. Our results show that the original trastuzumab was completely replaced by the subcutaneous and biosimilar variants. The uptake of the subcutaneous form peaked at 50% market share but after the introduction of biosimilars progressively reduced to a market share of 20%, resulting in a more competitive market structure. The public healthcare costs for trastuzumab significantly decreased after the introduction of the biosimilars. After the introduction of the biosimilars, a substantial price drop is visible, with the subcutaneous version, still under patent, also falling sharply in price but less strongly than the iv/biosimilar version. As the costs are publicly funded, we recommend a more explicit societal debate to consider if the potential benefits of subcutaneous Herceptin® (and other similar medicines) are worth the additional costs, and at which price it should be reimbursed as the part of the benefit package. [ABSTRACT FROM AUTHOR]

Autism is associated with a range of costs. This paper reviews the literature on estimating the economic costs of autism spectrum disorder (ASD). More or less 50 papers covering multiple countries (US, UK, Australia, Canada, Sweden, the Netherlands, etc.) were analysed. Six types of costs are discussed in depth: (i) medical and healthcare service costs, (ii) therapeutic costs, (iii) (special) education costs, (iv) costs of production loss for adults with ASD, (v) costs of informal care and lost productivity for family/caregivers, and (vi) costs of accommodation, respite care, and out-of-pocket expenses. A general finding is that individuals with ASD and families with children with ASD have higher costs. Education costs appear to be a major cost component for parents with children with ASD. [ABSTRACT FROM AUTHOR]

The objectives of this paper are two-fold: first, to assess the healthcare utilization pattern among rural elderly and second, to examine the various covariates of Out of Pocket Expenditure (OOPE) in Odisha, India. Multiple Generalised Linear Regression Model (GLRM) was employed to explore the relative effect of various socio-economic and demographic covariates on the OOPE. Major source of financing for elderly population was their son for both inpatient and outpatient healthcare in the last episode of illness. Multivariate analysis, shows that age, saving or bank balance, risk behaviour (smoking), non-functionality, hearing defect and multi-morbidity are significantly influencing the spending pattern of the elderly on healthcare. Results suggest that there is an immediate need to relook at the existing pension schemes especially in the rural areas to manage the healthcare needs of elderly. [ABSTRACT FROM AUTHOR]

Using detailed data on the beneficiaries of the Korean National Health Insurance Service (c.2006–2015), this paper estimates the health effects of air pollution in South Korea while controlling for avoidance behaviors. In particular, we investigate changes in respiratory hospitalization rates due to increases in PM 10 and O 3 concentrations. To address the endogeneity of air pollution, this paper applies the historical average concentration of air pollution, which includes rich information about the meteorological and geographical factors that affect regional air pollution levels, as an instrumental variable and compares the results with other count data models. We find that a 10 μ g/m 3 increase in PM 10 and a 10 ppb increase in O 3 lead to an increase in daily respiratory hospital visits of up to 10.39% [95% confidence interval (CI) 4.04–16.80] and 10.93% (95% CI 9.23–12.63), resulting in additional health care costs of US$67 million and US$70 million, respectively. This paper also shows that the effects of PM 10 and O 3 are elevated in highly populated cities, children, and patients without chronic respiratory diseases. [ABSTRACT FROM AUTHOR]

Public-academic partnership-based program evaluations can generate actionable evidence for policymaking, program design and implementation in improving school-based mental health service delivery. The University of Pennsylvania Center for Mental Health and public behavioral health care agencies in Philadelphia in the United States have evaluated Philadelphia's school mental health programs reimbursable through Medicaid billing since 2008. The variety of evaluations include (1) examining acute mental health service use of children receiving school-based mental health care and Medicaid expenditure, (2) examining children's externalizing and internalizing behaviors to measure school mental health providers' performance, and (3) examining effects of different types of school mental health programs on children's behavioral health functioning, school outcomes, and other out-of-school service use. This paper reports key findings of these evaluations, discusses how programs have been refined based on evaluation results, and shares lessons learned for successful public-academic partnership-based evaluations to promote use of actionable evidence. [ABSTRACT FROM AUTHOR]

Recent research has documented a wide range of health, economic, and social benefits conferred by vaccination, beyond the direct reductions in morbidity, mortality, and future healthcare costs traditionally captured in economic evaluations. In this paper, we describe the societal benefits that would likely stem from widespread administration of safe and effective vaccines against Streptococcus pyogenes (Strep A), which was estimated to be the fifth-leading cause of infectious disease deaths globally prior to the COVID-19 pandemic. We then estimate the global societal gains from prospective Strep A vaccination through a value-per-statistical-life approach. Estimated aggregate lifetime benefits for 30 global birth cohorts range from $1.7 to $5.1 trillion, depending on the age at which vaccination is administered and other factors. These results suggest that the benefits of Strep A vaccination would be large and justify substantial investment in the vaccines' development, manufacture, and delivery. [ABSTRACT FROM AUTHOR]

Medication non-adherence is a prevalent healthcare problem with poor health outcomes and added healthcare costs. MedScrab, a gamification-based mHealth app, is the first attempt to deliver crucial life-saving medication information to patients and increase their medication adherence. The paper presents the development of MedScrab and a two-phase mixed-method usability evaluation of MedScrab. Phase I qualitatively evaluated MedScrab using a think-aloud protocol for its usability. With 51 participants, qualitative data analysis of Phase I revealed two themes: positive functionality of the app and four areas of improvement. The improvement recommendations were incorporated into MedScrab's design. Phase I also validated a widely used mHealth App Usability Questionnaire (MAUQ). Quantitative data analysis of Phase I reduced the original 18-item MAUQ scale to a 15-item scale with two factors: ease of use (4 items) and usefulness and satisfaction (11 items). Phase II surveyed 83 participants from Amazon's Mechanical Turk using a modified MAUQ. The modified MAUQ scale showed strong internal consistency (Cronbach alpha = 0.959) and high factor loadings (between 0.623 and 0.987). The study design of the usability evaluation can serve as a methodological guide for designing, evaluating, and improving mHealth apps. The usability study showed that MedScrab was perceived as ease of use (6.24 out of 7) with high usefulness and satisfaction (5.72 out of 7). The quantitative data analysis results support the use of the modified MAUQ as a valid instrument to measure the usability of the MedScrab. However, the instrument should be used with adaptation based on the app's characteristics. [ABSTRACT FROM AUTHOR]

Without proper treatment, people with co-occurring mental health and substance use problems are at great risk for poor outcomes and high treatment costs in multiple domains. Intermediary organizations can provide support to programs implementing integrated treatment and other evidence-based practices; this includes developing practical tools for programs built to encourage fidelity to a particular practice. In this paper, we describe a group curriculum workbook designed to help practitioners provide integrated treatment with fidelity and a pilot learning collaborative to evaluate whether this workbook is a helpful tool for programs to support people with serious mental health conditions and substance use in identifying and achieving personal goals. Results of the pilot found that nearly all participants demonstrated progress with respect to their identified goals, and group facilitators reported that the workbook was easy to use, that participants enjoyed the material, and that they intended to continue offering the group as part of their regular programming. [ABSTRACT FROM AUTHOR]

In this paper, we use unique health record data that cover outpatient care and the associated costs to quantify the health care costs of a sizable increase in the retirement age in Germany. For the identification, we exploit a sizable cohort-specific pension reform which abolished an early retirement program for all women born after 1951. Our results show that health care costs significantly increase by about 2.9% in the age group directly affected by the increase in the retirement age (women aged 60–62). We further show that the cost increase is mainly driven by the following specialist groups: Ophthalmologists, general practitioners (GPs), neurology, orthopedics, and radiology. While the effects are significant and meaningful on the individual level, we show that the increase in health care costs is modest relative to the positive fiscal effects of the pension reform. Specifically, we estimate an aggregate increase in the health costs of about 7.7 million euro for women born in 1952 aged 60–62 which amounts to less than 2% of the overall positive fiscal effects of the pension reform. [ABSTRACT FROM AUTHOR]

Objectives: This paper presents an Australian model that formed part of the health technology assessment for public investment in siltuximab for the rare condition of idiopathic Multicentric Castleman Disease (iMCD) in Australia. Methods: Two literature reviews were conducted to identify the appropriate comparator and model structure. Survival gain based on available clinical trial data were modelled using an Excel-based model semi-Markov model including time-varying transition probabilities, an adjustment for trial crossover and long-term data. A 20-year horizon was taken, and an Australian healthcare system perspective was adopted, with both benefits and costs discounted at 5%. The model was informed with an inclusive stakeholder approach that included a review of the model by an independent economist, Australian clinical expert opinion and feedback from the Pharmaceutical Benefits Advisory Committee (PBAC). The price used in the economic evaluation reflects a confidential discounted price, which was agreed to with the PBAC. Results: An incremental cost-effectiveness ratio of A$84,935 per quality-adjusted life-year (QALY) gained was estimated. At a willingness-to-pay threshold of A$100,000 per QALY, siltuximab has a 72.1% probability of being cost-effective compared with placebo and best supportive care. Sensitivity analyses results were most sensitive to the length of interval between administrations (from 3- to 6-weekly) and crossover adjustments. Conclusion: Within a collaborative and inclusive stakeholder framework, the model submitted to the Australian PBAC found siltuximab to be cost-effective for the treatment of iMCD. [ABSTRACT FROM AUTHOR]

In health intervention research, epidemiologists and economists are more and more interested in estimating causal effects based on observational data. However, collaboration and interaction between both disciplines are regularly clouded by differences in the terminology used. Amongst others, this is reflected in differences in labeling, handling, and interpreting the sources of bias in parameter estimates. For example, both epidemiologists and economists use the term selection bias. However, what economists label as selection bias is labeled as confounding by epidemiologists. This paper aims to shed light on this and other subtle differences between both fields and illustrate them with hypothetical examples. We expect that clarification of these differences will improve the multidisciplinary collaboration between epidemiologists and economists. Furthermore, we hope to empower researchers to select the most suitable analytical technique from either field for the research problem at hand. [ABSTRACT FROM AUTHOR]

Background: Treatment of chronic illness accounts for over 90% of Medicare spending. Chronic lymphedema places 3–10 million Americans at risk for recurrent cellulitis. Without convincing predictions of the costs and benefits of lymphedema treatment, insurers are reluctant to fully cover treatment of this common condition. Earlier papers discussed the costs and benefits of the first 5, 7, and 10 years of a lymphedema treatment mandate in Virginia. This paper updates these costs and benefits to 16 years of experience, and includes the impacts of the Patient Protection and Affordable Care Act of 2010 and the transition to ICD-10-CM diagnostic codes in 2015. It provides added confidence that costs of a lymphedema treatment mandate are reasonable, and can result in health insurance contract savings for reduced medical visits and hospitalizations for lymphedema patients. Methods: Virginia requires annual reporting of the segregated costs of each of its 30 medical mandates. Data on Virginia's lymphedema treatment mandate for the years 2004 to 2019 have been collected from the series of annual reports. These data include actual lymphedema treatment claims data, utilization data, and claims-based estimates of the premium impact. Results: The average actual lymphedema claim cost was $2.03 per individual contract and $3.54 per group contract for the years reported, representing 0.05 and 0.08% of average total claims. The estimated premium impact was 0.16–0.32% of total average premium for all mandated coverage contracts. While lymphedema claim costs increased 3–6% per year over the study period, generally following the rise of health care costs, claim costs as a percent of average contract claims fell at a rate of 1.26–1.52% per year over that period. Medical office visits for lymphedema-related services fell from 0.10 to 0.02 visits per year per contract from the beginning to the end of the study period, and hospitalizations for lymphedema or lymphedema-related cellulitis fell to almost zero. Conclusions: The Virginia data confirmed previous conclusions that the costs of treatment of lymphedema are a small part of a typical health insurance contract, and that treatment of lymphedema by managing swelling results in lower overall medical costs and fewer hospitalizations. This is a potent model for reduction in healthcare costs while improving the quality of care for cancer survivors and others suffering with this chronic progressive condition. [ABSTRACT FROM AUTHOR]

Background: In the Middle East and North Africa (MENA) the scarcity of local cost data is a key barrier to conducting health economic evaluations. We systematically reviewed reports of disease-related costs from MENA and analysed their transferability within the region. Methods: We searched PubMed and included full text English papers that reported disease-related costs from the local populations of Algeria, Bahrain, Egypt, Iraq, Jordan, Saudi Arabia, Kuwait, Lebanon, Libya, Morocco, Oman, Palestine, Qatar, Syria, Tunisia, United Arab Emirates and Yemen between 1995 and 2019. Screening, study selection and data extraction were done in duplicate. Study-related variables, costing methods, all costs and their characteristics were extracted and analysed via descriptive methods. From multi-country studies of MENA employing homogenous costing methods, we estimated the ratio (cost transfer coefficient) between the relative differences in direct medical costs and macroeconomic indicators via robust regression. We predicted each cost via the estimated cost transfer formula and evaluated prediction error between true and predicted (transferred) costs. Results: The search yielded 1646 records, 206 full text papers and 3525 costs from 84 diagnoses. Transferability was analysed involving 144 direct medical costs from eight multi-country studies. Adjusting the average of available foreign costs by 0.28 times the relative difference in GDP per capita provided the most accurate estimates. The correlation between true and predicted costs was 0.96; 68% of predicted costs fell in the true ± 50% range. Predictions were more accurate for costs from studies that involved the largest number of countries, for countries outside the Gulf region and for drug costs versus unit or disease costs. Conclusion: The estimated cost transfer formula allows the prediction of missing costs in MENA if only GDP per capita is available for adjustment to the local setting. Input costs for the formula should be collected from multiple sources and match the decision situation. Plain Language Summary: In the Middle East and North Africa (MENA) scarce local cost data hinder health economic evaluations. This systematic review summarized disease-related costs from 17 countries (Algeria, Bahrain, Egypt, Iraq, Jordan, Saudi Arabia, Kuwait, Lebanon, Libya, Morocco, Oman, Palestine, Qatar, Syria, Tunisia, United Arab Emirates and Yemen). Eight studies applied the same costing method across multiple countries. We used these data to estimate a formula for transferring costs between countries. We assumed that costs vary proportionally with gross domestic product per capita (GDP). Most accurate cost predictions were provided when relative cost differences were set to 0.28-times the relative differences in GDP per capita. The correlation between transferred and true costs was very high. Still, only 68% of transferred costs fell in the true ± 50% range. Cost estimates were more accurate if costs were transferred from multiple countries. Also, estimates were more accurate for countries outside the Gulf region and for drug costs when compared to unit- or disease costs. [ABSTRACT FROM AUTHOR]

Introduction: Regional anaesthesia (RA) is often used in shoulder surgery because it provides adequate postoperative analgesia and may enhance the patient outcome. RA reduces overall opioid consumption and is frequently used in enhanced recovery programs to decrease hospital stay. However, there is very limited literature confirming these advantages in the surgical repair of proximal humerus fractures. This paper reviews the current literature on the use of RA in pain management after surgical repair of these fractures and evaluates the effect of RA on the functional outcome, length of stay in hospital, and health care expenditure.Materials and Methods: The PubMed, Embase, Web of Science, and Cochrane Library databases were searched up to March 1, 2018. Studies investigating the use of RA in the management of proximal humerus fractures were included.Results: Eleven studies (containing 1872 patients) were eligible for inclusion. The analgesic effect of RA was investigated in eight studies that confirmed its pain-relieving ability. Two studies measured functionality and length of hospitalization and suggested that RA improved function and shortened the stay in hospital. Nine papers mentioned side effects associated with RA while three articles claim that RA decreases the incidence of adverse events associated with general anaesthesia.Conclusions: This systematic review suggests that RA is a good option for postoperative analgesia in patients undergoing surgical repair of a proximal humerus fracture and is associated with fewer adverse events, a shorter recovery time, and a better functional outcome than those achieved by general anaesthesia alone. However, given the limited amount of data available, conclusions need to be made with caution and prospective studies are needed in the future. [ABSTRACT FROM AUTHOR]

I was saddened to learn about the death of Daniel Callahan, one of the forefathers of the field of medical ethics, a thinker and a doer who influenced thousands of scholars all over the world. Dan sent me a draft paper titled "Trumping Drug Costs" [[10]] in which he wrote about the damaging feature of out-of-pocket costs for the elderly. Dan, who always tried to discern future patterns and find solutions, concluded that with many families already suffering bankruptcies from out-of-pocket costs-their numbers and health care cost rising - a real disaster could emerge in a few decades. Callahan called for comprehensive planning to deal with the enormous challenges that lie ahead, including populated planet, global warming, dementia, and growing healthcare costs. [Extracted from the article]

This paper critically examines efforts to "professionalize" the field of healthcare management and its corresponding costs. Drawing upon the scholarly critiques of professionalization in medicine and the broader field of management, this paper seeks to explore the symbolic role professionalization might play in the psyche of its constituents, and specifically its function as a defense against uncertainty and anxiety. This psychodynamic heuristic is then deployed to put forth the hypothesis that an ongoing crisis of professional identity continues to both propel and impede professionalization efforts in healthcare management, giving rise to a litany of standardization pressures that ultimately limit the field's potential. To mitigate these pressures, the call is made for rekindling healthcare management's moral, political, and existential aspects. Specifically, this entails engaging with the deeper themes that flow through the field: the experience of illness and what it means to suffer, the experience of life and what it means to have hope, and the experience of death and dying. It also entails squarely confronting questions of power, poverty and disease, and the pursuit of justice. [ABSTRACT FROM AUTHOR]

In the United Kingdom, more than 20% of the population live with a disability. Past evidence shows that being disabled is associated with functional limitations that often cause social exclusion and poverty. Therefore, it is necessary to analyse the connection between disability and poverty. This paper examines whether households with disabled members face extra costs of living to attain the same standard of living as their peers without disabled members. The modelling framework is based on the standard of living approach which estimates the extra income required to close the gap between households with and without disabled members. We apply an ordered logit regression to data from the Family Resources Survey between 2013 and 2016 to analyse the relationship between standard of living, income, and disability, conditional on other explanatory variables. We find that households with disabled members face considerable extra costs that go beyond the transfer payment of the government. The average household with disabled members saw their weekly extra costs continually increase from £293 in 2013 to £326 in 2016 [2020 prices]. Therefore, the government needs to adjust welfare policies to address the problem of extra costs faced by households with disabled members. [ABSTRACT FROM AUTHOR]

Aim: The Health Gym Program is the main health promotion strategy in the Brazilian public health system. This paper aims to measure the impact of the Health Gym Program on hospital admission expenses for stroke in the state of Pernambuco, Brazil. Subject and methods: This public health impact evaluation used a panel of socioeconomic, demographic, and epidemiological data from 2007 to 2019 for all 185 municipalities in the state of Pernambuco. The empirical strategy used pre-tests, ordinary least-squares econometric modeling, and quantile regression as a robustness test. Results: The municipalities that implemented the Health Gym Program spent an average of 21.04% less on hospitalizations for stroke than the municipalities that did not, and this result was statistically significant at the 1% level. Further, the density of program coverage within the municipality also impacts the reduction of expenses. This saving is directly proportional to the number of hubs of the program in the municipalities. An increase of one program hub for every 10,000 inhabitants results in a 4.57% reduction in expenditure on stroke hospitalizations in the municipalities. Conclusion: The presence of the Health Gym Program led to a reduction in expenses related to hospital admissions for stroke, which may indicate that this program effectively expands the scope of health promotion actions in primary healthcare. The evidence generated from this study can be used to implement evidence-based policies aimed at preventing and controlling chronic diseases in Brazil. [ABSTRACT FROM AUTHOR]

Background and objective: Developing harmonious doctor-patient relationships is a powerful way to promote the construction of a new pattern of medical reform in developing countries. We aim to analyze the effects of China's hierarchical medical system on doctor-patient relationships, thus contributing to China's medical and health system reform. Methods: With panel data on prefectural-level cities in China from 2012 to 2019, we used a time-varying difference-in-differences model to evaluate the effect of hierarchical medical treatment policy. Results: Hierarchical medical treatment policies can significantly improve doctor-patient relationships, and this conclusion is supported by various robustness tests. And improving doctor-patient relationships can be indirectly realized by the optimization of resource allocation and saving of medical costs. In addition, the marginal effect of the pilot policy on doctor-patient relationships decreased with age within the city population. In focal cities and cities with high levels of fiscal spending on health care, the effect of the pilot policy on doctor-patient relationships was stronger. Conclusion: While reinforcing the literature on the doctor-patient relationship, this study also provides a reference for further exploration of the pilot policy of hierarchical medical treatment and the development of new medical and health system reform in developing countries. [ABSTRACT FROM AUTHOR]

Background: Frailty has been associated with increased postoperative mortality and morbidity; however, the use of the modified frailty index (mFI-11) to assess patients undergoing surgery for diverticular disease has not been widely assessed. This paper aims to examine frailty, evaluated by mFI-11, to assess postoperative morbidity and mortality among patients undergoing operative intervention for colonic diverticular disease. Methods: We used data from the Healthcare Cost and Utilization Project National Inpatient Sample (October 1, 2015–December 31, 2019). ICD-10-CM codes were utilized to identify a cohort of adult patients with a primary admission diagnosis of diverticulitis. mFI-11 items were adapted to correspond with ICD-10-CM codes. Patients were stratified into robust (mFI < 0.27) and frail (mFI ≥ 0.27) groups. Primary outcomes were in-hospital postoperative morbidity and mortality. Secondary outcomes included system-specific postoperative complications, length of stay (LOS), total admission cost, and discharge disposition. Multivariable regression models were fit. Results: Of the 26,826 patients, there were 24,194 patients with mFI-11 < 0.27 (i.e., robust) and 2,632 patients with mFI-11 ≥ 0.27 (i.e., frail). Adjusted analysis showed significant increases in postoperative mortality (aOR 2.16, 95% CI 1.38–3.38, p = 0.001) and overall postoperative morbidity (aOR 1.84, 95% CI 1.65–2.06, p < 0.001). LOS was higher in the frail group (MD 1.78 days, 95% CI 1.46–2.11, p < 0.001) as well as total cost (MD $25,495.19, 95% CI $19,851.63-$31,138.75, p < 0.001). Conclusion: In the elective setting, a high mFI-11 (i.e., presence of the variables comprising the index) could alert clinicians to the possibility of implementing preoperative optimization strategies. In the emergent setting, a high mFI-11 may help guide prognostication for these vulnerable patients. [ABSTRACT FROM AUTHOR]

Information regarding the 7th Latin American Network Operations and Management Symposium (LANOMS 2011) that was held on October 10-11, 2011 in Quito, Ecuador is presented. Topics include the use of cloud computing by organizations, Internet's growth, and the role of the information and communications technologies (ICT) for reducing healthcare costs. The symposium featured several speakers including Vladimir Tosic, Nazim Agoulmine, and Otto Carlos M. B. Duarte.

Healthcare is a sensitive domain, and it is necessary to design an efficient solution in the healthcare system. Electronic Medical Records often have high privacy-sensitive data; unauthorized access to these patient data could hurt patients' reputations and cause financial losses to the organization. Most of the existing healthcare systems are based on a centralized architecture, which is more vulnerable such as hacking the healthcare system, arbitrary modification attacks, and single-point-of-failure. Also, these systems increase the cost due to various factors like—establishing a trusted network, cost per transaction, and limited access to patient health data, which are the problems that remain open until now. The blockchain is a general-purpose technology that seems to be an innovative and interesting technology that can improve the Health care domain by solving the above issues with a secure architecture. This paper address addresses the challenging problems. (1) How to provide secure data exchange and anonymity. (2) How to preserve the personal data privacy of the patient health records. The proposed solution leverages the Hyperledger Fabric, a permissioned blockchain that establishes a secured and trusted network to all stakeholders, ensuring the integrity of protected health information and providing authenticity and health access control. Further, the entire supply chain can be traced, decreasing duplicate tests and unnecessary service, increasing accountability, preserving the crucial documents, limiting the unauthorized sharing of the EHRs documents, and offering lower costs across the care continuum. [ABSTRACT FROM AUTHOR]