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Background: Depression and myocardial infarction (MI) often coexist and has been associated with worse health outcomes. Evidence suggest that hospital visits and prescription medications account for majority of the healthcare expenditure, even among MI patients and this is expected to increase over the next decade. However, little is known of the excessive burden of depression on health resource utilization and healthcare expenditure among patients with MI. Using a nationally representative sample of the US adult population, we compare healthcare expenditure(total and out-of-pocket) and health resource utilization(emergency room visits and hospitalizations) among MI patients without the diagnosis of depression with depressed MI patients. Methods: We used data from the 2006-2015 Medical Expenditure Panel Survey (MEPS) for this study. We included adults ≥18 years with a diagnosis of MI (ICD9 code 410 and/or self-reported) and stratified these individuals based on the presence of the diagnosis of Depression, identified by ICD9 code 311. We used the two-part econometric model to study cost data and regression models adjusted for sociodemographic characteristics and cardiovascular disease risk factors to compare health resource utilization between depressed and non-depressed MI patients. Results: The study sample consisted of 6,702 individuals, representing 7.16m MI patients without the diagnosis of depression and 1,381 individuals representing 1.42m depressed MI patients (aged 65 ± 13 years, 63% male). Compared with non-depressed MI patients, MI patients with a diagnosis of depression had higher odds for hospitalizations [OR 1.54 (1.29, 1.83)] and emergency room visits [OR 1.43 (1.21, 1.69)], significantly greater mean annual expenditure as well as an estimated $4,381 ($2,553, $6,209) & $402 ($225, $579) higher annual overall and out-of-pocket healthcare expenditures respectively (Table). Conclusion: Depression among MI patients is associated with a significant increase in annual healthcare expenditure and health resource utilization. As a quality improvement measure to increase healthcare efficiency, routine depression screening at follow up visits may be appropriate especially among these high risk population.

Background: Studies report that barriers to the relationship between patients and their healthcare providers contribute to racial disparities in healthcare experience. Although race is thought to play a major role in the disparities seen in patient report on healthcare experience, results reported by different scholars on the effect of race on patient provider communication and overall patient satisfaction has been heterogeneous. In this study, we explore the relationship between patient race/ethnicity and various domains of patient healthcare experience [patient provider communication, shared decision making and overall patient satisfaction] in a nationally representative adult US population with established atherosclerotic cardiovascular disease (ASCVD). Methods: The study population consisted of a nationally representative sample of 8223 individuals (age ≥ 18 years) representing 21.6 million with established ASCVD (self-reported or ICD-9 diagnosis) reporting a usual source of care in the 2010-2013 pooled Medical Expenditure Panel Survey (MEPS) cohort. We developed a weighted average score for each domain of patient report on healthcare experience, using responses to questions from the CAHPS survey related to patient provider communication, shared decision making and patient overall satisfaction. We compared these scores across patient race/ethnicity. Results: The proportion of ASCVD patients with an optimal score on all domains of patient reported experience was least among Asians (patient-provider communication 37.5%, shared decision making 36.1%, satisfaction 21.9%, p Conclusion: This study reveals a strong relationship between race and patent healthcare experience among individuals with ASCVD. Targeted policies focusing on reducing disparities and improving patient healthcare experience are needed among these vulnerable population.

Background: Little is known about national patterns of anticoagulant use among patients with atrial fibrillation after the availability of direct oral anticoagulants (DOACs) and the associated implications for health care spending. Methods: The Medical Expenditure Panel Survey, an annual nationally

Background Many injury victims die before reaching a hospital due to inadequate pre-hospital care and transport. Prompt emergency care can save lives and prevent disabilities but the inconsistent availability of formal Emergency Medical Services (EMS) makes it challenging. This is the case even in some high-income developing countries like Oman. For this study we analysed the trauma registry data from two large hospitals of Oman to understand the pre-hospital and hospital based emergency care in a rapidly developing country in the Arab Gulf. Methods The data was collected from Khoula and Nizwa hospitals between November 2014 and April 2015. All patients admitted through the emergency department with a history of trauma were included. Information about mechanism of injury, mode of transport, time interval between injury and hospital, pre-hospital care and emergency department (ED) disposition was collected. Results 2,340 patients were received in the ED during the study period. The majority (74%) were males, with a mean age 27 years. Transport injuries and falls accounted for 70% of all injuries. The most common mode of transport was private car (43%); only 13% of patients were transported via EMS. Only 30% of cases were transported to the hospital within an hour of injury; median transport time was 2.53 hours. Only 27% of patients received some form of pre-hospital care. Twenty-three ED deaths were recorded. Mean ED length of stay was 16.35 hours. In the study population, injury severity score in 85% of cases was ≤9, mean revised trauma score was 7.6382 and overall mortality ratio was 2.35%. Conclusion Despite rapidly developing health care services in the urban parts of Oman, EMS utilisation is low. Patients presenting to the hospital are those who have less severe injuries and thus have better chances of survival. A better-organised EMS system may provide a prompt transport and appropriate triage to patients with severe injuries.

Background Globally, injuries cause death and disability for millions of children every year. Literature from high-income rapidly developing countries, such as the Arab Gulf states, on this burden is sparse. Realising this gap, a surveillance system was established in two hospitals of Oman. Data on childhood injuries was collected and analysed to better understand such injuries in the Arab Gulf States. Methods Data was collected over a 6-month period in two large hospitals of Oman. All patients up to18 years who were admitted with a history of trauma between October 2014 and April 2015 were included. External cause and place of occurrence according to age and sex was analysed. Findings 35% of all cases were paediatric (891/2549 cases) and of those, 69.3% were males. Children between 0–5 years accounted for 53% of the study population. Most common external causes of injuries were falls (51%), exposure to mechanical forces (20.4%), and transport injuries (16.5%) for all ages. Analysis by age revealed that falls accounted for 50.9% of injuries for ages 0–5 years and 53.3% for 6–12 years. Transport injuries (43.5%) were the most common cause for children 13–18 years, which were also more common in males (20%) than females (8.4%). Larger proportion of females (13.5%) was injured by contact with heat and hot substances vs. males (6%). Home was the place of injury for most children 0–5 years (86.4%) and 6–12 years (61.5%), whereas streets and highways were the most common place of injuries for age 13–18 years. Conclusion Childhood injuries are a significant cause of hospital admissions in Oman. Significant age-related differences in cause of injury highlight the need for targeted interventions. Prevention of home-based falls and transport injuries must be a priority for all children. Additionally, road safety interventions and education must be the top agenda for young Omani males.

We studied the nonoperative treatment of proximal humeral fractures in severe injuries usually treated surgically. The natural history of 63 patients was followed prospectively for 2 to 9 years (mean, 42 months) with a nonrandomized protocol. A 3-dimensional classification system based on computed tomography scans was used to categorize the fractures. Assessment was made for range of motion, function via a validated testing instrument (Simple Shoulder Test), analog pain score, avascular necrosis (AVN), and fracture union. Magnetic resonance imaging for early signs of AVN was done in 16 cases. After conservative treatment of complex fractures of the shoulder, motion is considerably compromised but pain is minimal and functional status is acceptable to most individuals in this predominantly older patient population. Status comparable to a successful surgical shoulder fusion is achieved in most cases—Nature's fusion. Contrary to common belief, AVN, even in severely displaced injuries, is rare. Future randomized studies based on a 3-dimensional classification need to be done to compare these natural history results with various types of surgical interventions.