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Purpose Critical care pharmacists (CCPs) are essential members of the multidisciplinary critical care team. Professional activities of the CCP are outlined in a 2020 position paper on critical care pharmacy services. This study looks to characterize CCP perspectives for priorities in optimizing pharmacy practice models and professional activities. Methods This was a cross-sectional survey conducted from July 24 to September 20, 2023. A 41-question survey instrument was developed to assess 7 domains: demographics, CCP resource utilization, patient care, quality improvement, research and scholarship, training and education, and professional development. This voluntary survey was sent to members of the American College of Clinical Pharmacy's Critical Care Practice and Research Network. The survey was open for a total of 6 weeks. Results There was a response rate of 20.7% (332 of 1,605 invitees), with 66.6% of respondents (n = 221) completing at least 90% of the survey questions. Most respondents were clinical specialists (58.2%) and/or practiced at an academic medical center (58.5%). Direct patient care, quality improvement and medication safety, and teaching and precepting were identified as the CCP activities of highest importance to CCPs. The CCP-to-patient ratios considered ideal were 1:11-15 (selected by 49.8% of respondents) and 1:16-20 (33.9% of respondents). The ideal percentage of time dedicated to direct patient care activities, as identified by survey respondents, was 50% (interquartile range, 40-50). Conclusion These findings highlight the professional activities viewed as having the highest priority by CCPs. Future research is needed to define optimal CCP practice models for the delivery of patient care in real-world settings. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionTo estimate the cost and healthcare resource utilization (HRU) associated with the prevalence of comorbidities in people living with HIV (PLWH) in a Spanish cohort over ten years.A cohort study carried out at the HIV outpatient clinic of the University Hospital Virgen del Rocío based on data collected during 2007–2016. PLWH with at least one follow-up visit were included. Comorbidities were determined by examining diagnostic codes in the electronic medical records. Costs were estimated from hospitalizations, emergency and non-HIV visits, laboratory tests for conditions unrelated to HIV infection, HIV antiretroviral therapy, and other non-HIV diagnostic tests. A linear regression was performed with non-ART costs as the dependent variable and patient characteristics (sex, HIV transmission route, age, CD4, comorbidities, and infection duration) as independent variables.The study included 2,798 PLWH; 83% were men with a mean age of 38.6 years. Overall, 52.5% of PLWH had at least one non-HIV comorbidity and 21.2% had ≥3 comorbidities. The most prevalent comorbidities were hepatitis C (25.3%) and hypertension (22.9%). The presence of comorbidities increased the total healthcare cost up to 80% in PLWH with ≥3 comorbidities compared with those without comorbidities (over a 10-year period (115,867.3€ vs 64,290.7€, p < .001). The number of comorbidities was linked to higher healthcare costs in PLWH in the adjusted model.Comorbidities raised the total healthcare costs for PLWH, with a greater impact on those with multiple comorbidities compared to those with few or none. Both clinical and economic decision-makers must consider and assess the cost of comorbidities when evaluating HIV treatment guidelines or recommendations. [ABSTRACT FROM AUTHOR]

Background: Enhancing the accessibility and equity of primary healthcare (PHC) is a crucial objective of China's healthcare reform. However, spatial barriers remain a significant factor contributing to the inequitable access to PHC services among residents. Objective: This study aims to quantify the spatial accessibility (SA) and evaluate the equity of PHC resources in a pilot province for healthcare reform, and its municipalities, thereby providing insights that can be generalized to the broader context of China. Methods: The study used the navigation function provided by Gaode Map to estimate the time it takes for residents to visit PHC institutions. The two-step floating catchment area (2SFCA) method, weighted by a Gaussian function, was employed to measure the SA of PHC institutions, general practitioners (GPs), and beds across various residential areas. The Gini coefficient was utilized to assess disparities in SA among different regions. Additionally, Getis-Ord Gi* analysis was conducted to visualize these spatial disparities. Results: The study analyzed 25,601 residential and 1,451 healthcare points in Zhejiang Province, revealing significant disparities in SA of PHC. Urban residents reached PHC institutions faster than rural ones (7.05 ± 4.7 min vs. 9.17 ± 7.78 min, P < 0.001). Within 30 min, 98.4% of residential points and 99.1% of the population accessed PHC institutions. Disparities in PHC resources were notable, with Lishui having the highest SA for institutions and GPs, and Shaoxing for beds. Equity assessment showed high inequity for institutions (Gini 0.553), moderate for beds (Gini 0.497), and reasonable for GPs (Gini 0.332)​. Getis-Ord Gi* analysis demonstrated that areas further from urban centers were more likely to exhibit clusters of hotspots or cold spots. Conclusion: The study highlights substantial disparities in SA of PHC and equity across Zhejiang, underscoring the need for strategic resource distribution. Future research should include diverse transportation modes and more precise demand point data to enhance understanding of accessibility dynamics. [ABSTRACT FROM AUTHOR]

Background: To analyze the equity and efficiency of health resource allocation in Sichuan Province and to provide a scientific basis for promoting health resource development. Methods: Theil index, coefficient of variation, equalization index and health resource agglomeration degree (HRAD) were used to analyze the equity of health resource allocation, and data envelopment analysis (DEA) was used to analyze the efficiency of health resource allocation in Sichuan Province from 2017 to 2021. Results: The Theil index and coefficient of variation of health technicians, licensed (assistant) physicians and registered nurses are larger than those of the number of beds, indicating that the equalization of the number of beds is relatively good. The equalization index of health resources in Sichuan Province ranges from 3.228 2 to 3.404 4 between 2017 and 2021, showing a gradually decreasing trend. The equalization index of Northwest Sichuan Economic Zone is the largest, indicating that the equity is relatively good. The equalization index of Chengdu Plain Economic Zone is the lowest, indicating that the equity is relatively poor. The HRAD of the number of beds, health technicians, licensed (assistant) physicians and registered nurses in Chengdu Plain Economic Zone, South Sichuan Economic Zone and Northeast Sichuan Economic Zone are all greater than 1, indicating that the health resources in these regions are better allocated by geography. The HRAD/ population agglomeration degree (PAD) of health technicians, licensed (assistant) physicians and registered nurses in South Sichuan Economic Zone, Northeast Sichuan Economic Zone and Panxi Economic Zone is less than 1, indicating that the health resources in these regions are insufficient relative to the agglomerated population. The comprehensive efficiency of health resource allocation in Sichuan Province and the five economic zones in 2020 is not 1, and the DEA is relatively ineffective. The Panxi Economic Zone, Northeast Sichuan Economic Zone and Northwest Sichuan Economic Zone all have relatively ineffective DEA. Conclusions: From 2017 to 2021, health resources in Sichuan Province continue to grow, but equity has gotten worse. The degree of variation in the health resource allocation among the five major economic zones in Sichuan Province is large, with the Chengdu Plain Economic Zone having better equity in the health resource allocation by population and geography, and the Panxi Economic Zone and the Northwest Sichuan Economic Zone having insufficient equity in the health resource allocation by population and geography. The efficiency of health resource allocation in the Panxi Economic Zone, Northeast Sichuan Economic Zone and Northwest Sichuan Economic Zone needs to be improved. [ABSTRACT FROM AUTHOR]

Background: The prevention of thromboembolisms through anticoagulation and heart rate control is crucial in managing non-valvular atrial fibrillation (NVAF). This study aimed to analyze the consequences of poor anticoagulation control with vitamin K antagonists (VKAs) in Spanish patients with NVAF, focusing on thrombotic events, bleeding, mortality, healthcare resources (HRU), and costs. Methods: This observational, retrospective study used electronic medical records (BIG-PAC® database) of NVAF patients who started VKA treatment between 1 January 2016 and 31 December 2018. Patients were followed up for two years and classified by poor or adequate anticoagulation control. Demographic and clinical characteristics, treatments, incidence of cardiovascular events, mortality rates, HRU, and costs were analyzed. Results: Patients with poor control (n = 2136) had a 75% greater probability of suffering a cardiovascular event compared to patients with adequate control (n = 2351) (HR, 1.75 [95%CI: 1.43–2.14; p < 0.001]). Cardiovascular events, major bleeding, minor bleeding, systemic thromboembolism, and ischemic strokes were reduced by 32.1%, 46.2%, 29.6%, 22.2%, and 16.1%, respectively. It was estimated that adequate anticoagulant control saved EUR 455/patient with NAVF due to reduced hospitalization for cardiovascular events. Conclusions: For VKA-treated NVAF patients, poor anticoagulation control was associated with a higher number of cardiovascular events, greater consumption of HRU, and higher management costs than for patients with adequate control. [ABSTRACT FROM AUTHOR]

Aim: Public health depends on effective structures at all administrative levels. Focusing on the case of Germany, this study assesses the capabilities of local health authorities and how these organisations fulfil their role within the communal health structures. Subject and methods: German local health authorities; Explorative online survey. Results: Local health authorities face some organisational deficiencies (mostly in expertise) in living up to their role within communal health structures. Despite these challenges, they do engage in exchange with municipalities and get involved in programmes and public health surveillance. Conclusion: To strengthen public health and increase the effectiveness of health administrative structures, it would be wise to provide the necessary resources at the local level and to reassess the scope and mandate of local health authorities. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion A substantial percentage of people with HIV are still admitted for care at advanced disease stages. Here, we investigate the availability of the supplies and infrastructure required to provide care for this population in healthcare facilities and explore correlations with local demand.AIDS Healthcare Foundation's partner facilities were invited to respond to a survey addressing the availability of services to support clients with advanced HIV. We present results per continent and according to gross national income per capita using frequencies and percentages. We generated country‐level scores taking the average percentage of facilities with available resources on 10 key items and used Spearman's correlation to investigate relationships between country scores and local demand, depicted by the percentages of people with HIV newly enrolled in care with a CD4 T‐cell count <200/mm3 in 2022.A total of 643 facilities from 37 countries responded to the survey between September and December 2021. Overall, services requiring more costly equipment and/or supplies were less frequently available. Facilities in Africa, Asia, and Latin America/Caribbean and those with lower gross national income had a somewhat lower availability of diagnostic and therapeutic resources. Availability of services was not correlated with local demand: 14 countries (42%) had scores below the 50% percentile despite having >20% of newly enrolled people with HIV with a CD4 T‐cell count <200/mm3.Appropriate care can mitigate the morbidity and mortality associated with advanced HIV. We found that the healthcare services recommended by the World Health Organization as essential to support clients with advanced HIV are often unavailable in facilities providing HIV care, despite high local demand. [ABSTRACT FROM AUTHOR]

Background Aim Study Design Results Conclusion Relevance to Clinical Practice Children with medical complexity (CMC) are at increased risk of admission in intensive care. Despite improvements in mortality rates, there remains a burden of morbidity, long‐term health care needs and hospital readmissions. Beyond clinical factors, socio‐demographic determinants could impact utilization of acute services.To identify risk factors that can differentiate CMC who are admitted to the paediatric intensive care unit (PICU).A 6‐year longitudinal retrospective cohort study evaluated clinical, socio‐demographic and health care utilization.A total of 248 CMC were included, with a median age of 13 years (9.75–17.00). Intensive care admission rate was 47.2%. The risk of PICU admission was higher for children undergoing surgical interventions (HR = 1.58, 95% CI 1.34–1.86, p < .001) and those using medical devices (HR = 1.81, 95% CI 1.54–2.13, p < .001). Mother's higher educational level was a protective factor (HR = 0.66, 95% CI 0.55–0.79, p < .001). Multivariable analysis revealed significant associations between risk of admission and the presence of malignancy, comorbidities, home medical devices, surgical procedures and higher health care utilization. Children's age and higher maternal educational level acted as protective factors.Socio‐demographic factors should be considered in the provision of care to CMC. Individualized assessments to guide supportive interventions adapted to socio‐economic factors may prevent PICU admissions.This study highlights the importance of integrating individualized assessments of socio‐demographic risk factors, such as maternal educational level, into the clinical practice of paediatric nurses. Moreover, targeted interventions, including educational resources and community support programmes, may optimize care. [ABSTRACT FROM AUTHOR]

Introduction: The increasing prevalence of shiftwork among young adults poses significant health risks, primarily due to its disruptive effects on sleep, nutrition and physical activity. Addressing these risks necessitates the development of tailored, evidence‐based resources to support these key health behaviours. Participatory research approaches, engaging those with relevant lived experience (i.e., co‐design) are a novel and effective approach in developing these resources. As such, the aim of the present study was to explore whether sleep, nutrition and physical activity resources for young shiftworkers could be developed using participatory, co‐design approaches and how co‐designers would rate both the approaches used and the resulting resources. Methods: A participatory approach engaged co‐designers (young, experienced or previous shiftworkers; workplace health and safety specialists; science communicators and academic experts) to complete 2–3 online questionnaires and participate in 1–2 online workshops, to co‐design sleep, nutrition and physical activity resources for young shiftworkers. Following resource development, co‐designers assessed both the participatory approach and the resulting resources, through an online questionnaire, which included the Public and Patient Engagement Evaluation Tool (PPEET). Results: Co‐designers (n = 48) participated in the development of sleep, nutrition and physical activity resources for young shiftworkers. Co‐designers evaluated the participatory approach positively, with a mean rating across all PPEET items of 4.7 (±0.2) on a 5‐point Likert scale. Co‐designers also provided positive ratings for the resources, with the majority (91.7%) either agreeing or strongly agreeing that they were user‐friendly, valuable and informative for young shiftworkers and would serve as a credible source of health information. Conclusion: By adopting a novel participatory approach, we successfully co‐designed sleep, nutrition and physical activity resources for young shiftworkers. Participatory approaches, including co‐design, should be considered when developing health interventions for shiftworkers, given the value of embedding lived experience to address their unique lifestyle challenges. Patient or Public Contribution: Co‐designers and/or people with relevant lived experience were involved in all project activities: conceptualisation, design, recruitment, data collection, data analysis, knowledge translation and output generation. [ABSTRACT FROM AUTHOR]

Issue Addressed: In 2014 the 'Hep B Story App', the first hepatitis B educational app in an Aboriginal language was released. Subsequently, in 2018, it was assessed and adapted before translation into an additional 10 Aboriginal languages. The translation process developed iteratively into a model that may be applied when creating any health resource in Aboriginal languages. Methods: The adaptation and translation of the 'Hep B Story' followed a tailored participatory action research (PAR) process involving crucial steps such as extensive community consultation, adaptation of the original material, forward and back translation of the script, content accuracy verification, voiceover recording, and thorough review before the publication of the new version. Results: Iterative PAR cycles shaped the translation process, leading to a refined model applicable to creating health resources in any Aboriginal language. The community‐wide consultation yielded widespread chronic hepatitis B education, prompting participants to share the story within their families, advocating for hepatitis B check‐ups. The project offered numerous insights and lessons, such as the significance of allocating sufficient time and resources to undertake the process. Additionally, it highlighted the importance of implementing flexible work arrangements and eliminating barriers to work for the translators. Conclusions: Through our extensive work across the Northern Territory, we produced an educational tool for Aboriginal people in their preferred languages and developed a translation model to create resources for different cultural and linguistic groups. So What?: This translation model provides a rigorous, transferable method for creating accurate health resources for culturally and linguistically diverse populations. [ABSTRACT FROM AUTHOR]

Health communication is a critical component of public health, which includes health education resources. Resource effectiveness is improved where health literacy demands, including the cultural appropriateness of resources, match the intended audience. International guidelines support the tailoring of resources for migrants from culturally and linguistically diverse backgrounds (CaLD). Five focus groups (n  = 18) and interviews (n  = 9) with people from CaLD migrant backgrounds explored community perspectives on sexual health resources developed by a state department of health, specifically clarity, comprehensiveness, cultural appropriateness and strategies for dissemination. We identified three major thematic areas relating to simplicity, cultural norms and beliefs and dissemination. Participants recommended resource delivery in different formats as part of a broader intervention. Generally, sexual health information was deemed appropriate and easily understood. However, the resources used simplified language that participants reported was vague and inaccurate at times, potentially contributing to misinformation and reinforcing stigma relating both to the status of being a migrant and sexual health. Findings suggest the need for more nuanced health resource development beyond translation and language simplification. Resources developed in different formats, including different health literacy demands, using approaches that engage the target group in design and dissemination and contextualized within a comprehensive health promotion project, are likely to be more effective. [ABSTRACT FROM AUTHOR]

Abstract Background Enhancing the accessibility and equity of primary healthcare (PHC) is a crucial objective of China’s healthcare reform. However, spatial barriers remain a significant factor contributing to the inequitable access to PHC services among residents. Objective This study aims to quantify the spatial accessibility (SA) and evaluate the equity of PHC resources in a pilot province for healthcare reform, and its municipalities, thereby providing insights that can be generalized to the broader context of China. Methods The study used the navigation function provided by Gaode Map to estimate the time it takes for residents to visit PHC institutions. The two-step floating catchment area (2SFCA) method, weighted by a Gaussian function, was employed to measure the SA of PHC institutions, general practitioners (GPs), and beds across various residential areas. The Gini coefficient was utilized to assess disparities in SA among different regions. Additionally, Getis-Ord Gi* analysis was conducted to visualize these spatial disparities. Results The study analyzed 25,601 residential and 1,451 healthcare points in Zhejiang Province, revealing significant disparities in SA of PHC. Urban residents reached PHC institutions faster than rural ones (7.05 ± 4.7 min vs. 9.17 ± 7.78 min, P

Abstract Background To analyze the equity and efficiency of health resource allocation in Sichuan Province and to provide a scientific basis for promoting health resource development. Methods Theil index, coefficient of variation, equalization index and health resource agglomeration degree (HRAD) were used to analyze the equity of health resource allocation, and data envelopment analysis (DEA) was used to analyze the efficiency of health resource allocation in Sichuan Province from 2017 to 2021. Results The Theil index and coefficient of variation of health technicians, licensed (assistant) physicians and registered nurses are larger than those of the number of beds, indicating that the equalization of the number of beds is relatively good. The equalization index of health resources in Sichuan Province ranges from 3.228 2 to 3.404 4 between 2017 and 2021, showing a gradually decreasing trend. The equalization index of Northwest Sichuan Economic Zone is the largest, indicating that the equity is relatively good. The equalization index of Chengdu Plain Economic Zone is the lowest, indicating that the equity is relatively poor. The HRAD of the number of beds, health technicians, licensed (assistant) physicians and registered nurses in Chengdu Plain Economic Zone, South Sichuan Economic Zone and Northeast Sichuan Economic Zone are all greater than 1, indicating that the health resources in these regions are better allocated by geography. The HRAD/ population agglomeration degree (PAD) of health technicians, licensed (assistant) physicians and registered nurses in South Sichuan Economic Zone, Northeast Sichuan Economic Zone and Panxi Economic Zone is less than 1, indicating that the health resources in these regions are insufficient relative to the agglomerated population. The comprehensive efficiency of health resource allocation in Sichuan Province and the five economic zones in 2020 is not 1, and the DEA is relatively ineffective. The Panxi Economic Zone, Northeast Sichuan Economic Zone and Northwest Sichuan Economic Zone all have relatively ineffective DEA. Conclusions From 2017 to 2021, health resources in Sichuan Province continue to grow, but equity has gotten worse. The degree of variation in the health resource allocation among the five major economic zones in Sichuan Province is large, with the Chengdu Plain Economic Zone having better equity in the health resource allocation by population and geography, and the Panxi Economic Zone and the Northwest Sichuan Economic Zone having insufficient equity in the health resource allocation by population and geography. The efficiency of health resource allocation in the Panxi Economic Zone, Northeast Sichuan Economic Zone and Northwest Sichuan Economic Zone needs to be improved.

Abstract Background Status epilepticus (SE) is a top neurological and medical emergency. Adequate staff knowledge and sufficient hospital resources are mandatory for timely management and better outcomes. This study aims to evaluate Palestinian ER doctors’ knowledge and beliefs towards SE and assess the state and availability of hospital resources needed to manage SE appropriately. Methods This cross-sectional study surveyed all ER doctors working in the six governmental hospitals in the Gaza Strip during June 2022. A questionnaire assessed the knowledge and beliefs toward SE and the practice of SE knowledge acquisition. Simultaneous field surveys determined the availability of essential medications and resources at each hospital and doctors’ actual awareness about the status of these resources. Linear regression determined predictors of higher knowledge scores. Results 137 doctors participated (response rate 81%). Most were males, had graduated within six years of data collection, and 45.3% worked at Shifa Medical Complex. 63.5% of participants recognized the correct operational definition of status epilepticus. 85.4 and 83.9% recognized that it might cause permanent brain damage or death, respectively. Only 10.9% recognized the average mortality rate of a single convulsive SE episode. 44.5% believed that awaiting spontaneous SE resolution is a valid approach to management. Significant defects were noted in the awareness of subclinical SE, including its recognition and prevalence in ciritcally ill patients. Having a higher qualification and graduating from local medical schools predicted higher scores. In field surveys, EEG was unavailable at all hospitals, while CT scans and a neurologist physician were unavailable at two hospitals. IV phenytoin was the only second-line treatment available at all hospitals. IV valproate and levetiracetam were universally unavailable. Conclusions The survey revealed significant defects in Palestinian ER doctors’ knowledge and beliefs towards SE. Several hospitals also demonstrated a critical lack of resources to manage this condition appropriately. This should be addressed by the local health authorities to avoid potentially preventable SE-related mortality and morbidity.

Purpose : The declining recruitment rate of pediatric residents in Korea has led to a decrease in the number of emergency departments (EDs) offering a 24/7 pediatric emergency care (PEC). This study evaluated the impact of reduced PEC hours on the utilization patterns of a single ED. Methods : We reviewed medical records of pediatric patients who were defined as individuals aged 14 years or younger undergoing pediatricians’ practices in a tertiary hospital ED in Korea. Given the reduction of PEC hours from full-time to 08:00-24:00 on September 27, 2022, the patients were grouped as those who visited during March 27, 2022-September 26, 2022 (“control”), and those who visited during September 27, 2022-March 26, 2023 (“reduction”). The following variables were analyzed between the 2 periods: the number of patients, age, sex, visits via ambulances, severity by the Korean Triage and Acuity Scale with high acuity (a level 1-2 of the scale), disease-related visits, time of visit, ED length of stay (EDLOS), disposition, chief complaints, and diagnoses. Results : Among 3,577 pediatric patients, 1,315 visited the ED during the reduction period, down by 41.9% in numbers from the control period. From the control to reduction periods, we observed an increase in the median age (from 3.0 years [interquartile range, 1.0-7.0] to 4.0 years [1.0-8.0]; P = 0.005) and decreases in the median EDLOS (from 140.0 minutes [80.0-217.0] to 104.0 minutes [54.0-169.8]; P < 0.001) and proportion of hospitalization (from 22.1% to 12.6%; P < 0.001). No change was observed in the proportions of highacuity cases or chief complaints. We noted decreases in infection-related diagnoses during the reduction. Conclusion : Reducing PEC hours was associated with shorter EDLOS, fewer hospitalizations, and older age, with no difference in the severity. Even with reduced PEC hours, relevant resources should be redistributed to ensure the accessibility to PEC.

Abstract Background Increasing numbers of patients treated in the emergency departments pose challenges to delivering timely and high-quality care. Particularly, the presentation of patients with low-urgency complaints consumes resources needed for patients with higher urgency. In this context, patients with non-specific back pain (NSBP) often present to emergency departments instead of primary care providers. While patient perspectives are well understood, this study aims to add a provider perspective on the diagnostic and therapeutic approach for NSBP in emergency and primary care settings. Methods In a qualitative content analysis, we interviewed seven Emergency Physicians (EP) and nine General Practitioners (GP) using a semi-structured interview to assess the diagnostic and therapeutic approach to patients with NSBP in emergency departments and primary care practices. A hypothetical case of NSBP was presented to the interviewees, followed by questions on their diagnostic and therapeutic approaches. Recruitment was stopped after reaching saturation of the qualitative content analysis. Reporting this work follows the consolidated criteria for reporting qualitative research (COREQ) checklist. Results EPs applied two different strategies for the workup of NSBP. A subset pursued a guideline-compliant diagnostic approach, ruling out critical conditions and managing pain without extensive diagnostics. Another group of EPs applied a more extensive approach, including extensive diagnostic resources and specialist consultations. GPs emphasized physical examinations and stepwise treatment, including scheduled follow-ups and a better knowledge of the patient history to guide diagnostics and therapy. Both groups attribute ED visits for NSBP to patient related and healthcare system related factors: lack of understanding of healthcare structures, convenience, demand for immediate diagnostics, and fear of serious conditions. Furthermore, both groups reported an ill-suited healthcare infrastructure with insufficiently available primary care services as a contributing factor. Conclusions The study highlights a need for improving guideline adherence in younger EPs and better patient education on the healthcare infrastructure. Furthermore, improving access and availability of primary care services could reduce ED visits of patients with NSBP. Trial registration No trial registration needed.

Abstract Background Atherosclerotic Cardiovascular Disease (ASCVD) is a global public health concern. This study aimed to estimate the healthcare resource utilization (HRU) and costs stratified by cardiovascular disease (CVD) risk categories using real-world evidence, in a regional population in Portugal. Methods This is a retrospective observational study, using data from Electronic Health Records between 2017 and 2021. Patients aged ≥ 40 years, and with at least one general practitioner (GP) appointment in the 3 years before 31st of December 2019, were included. CVD risk categories were determined based on 2021 ESC prevention guidelines. HRU encompassed hospital data (hospitalizations, outpatient and emergency room visits) and GP appointments. Total direct costs per patient were calculated based on the reference cost of the Portuguese legislation for payment methodology on Diagnosis-Related Groups (DRGs). Results Analysis of 3 122 695 episodes, revealed consistent HRU and costs across the five years. Very high-risk patients, showed higher HRU, particularly in hospital admissions. Costs tended to rise with higher CVD risk level. Very high-risk patients with ASCVD had higher costs for hospital admissions, while low-to-moderate risk patients had higher costs for GP visits. Despite a smaller proportion, very high-risk patients with prior ASCVD represent the highest costs per patient across healthcare settings (from 115€ in emergency visits to 2 673€ in hospitalizations), followed by very high-risk patients without prior ASCVD (ASCVD-risk equivalents). Conclusion This study revealed a substantial HRU and costs by patients with very high CVD risk, particularly those with prior ASCVD. Moreover, ASCVD-risk equivalents emerge as notable consumers, emphasizing the importance of risk assessment and preventive measures in cost-effective management of these patients.

Abstract Introduction Current treatment guidelines for patients with epidermal growth factor receptor (EGFR)-mutated metastatic non-small cell lung cancer (mNSCLC) recommend EGFR tyrosine kinase inhibitors (TKIs) as the standard of care for first-line treatment, with third-generation osimertinib the preferred choice. However, most patients develop resistance to targeted therapy, and subsequent systemic chemotherapy is recommended. The aim of this study was to characterize the subsequent line of therapy (LOT) following osimertinib in patients with EGFR-mNSCLC. Methods Medical and pharmacy claims of adults who initiated a subsequent LOT (index) after initial osimertinib discontinuation between November 2015 and September 2019 were analyzed retrospectively. Results A total of 135 patients met the inclusion criteria. After metastatic diagnosis, 22.2% and 49.6% of patients were treated with osimertinib in the first and second line, respectively. After osimertinib discontinuation, most patients were treated with a platinum-based chemotherapy regimen (57%), of which 40.3% included immuno-oncology therapy. Reuse or continuation of EGFR TKIs was also common (24%). Overall, the median time to treatment discontinuation for the index LOT was 2.4 months. Proportions of patients with ≥ 1 inpatient or emergency department visit were 31.9% and 35.6%, respectively. Conclusions The duration of the LOT following osimertinib was short and associated with tolerability issues underscoring a high unmet need for new therapies to address EGFR TKI resistance.

Background: Increasing numbers of patients treated in the emergency departments pose challenges to delivering timely and high-quality care. Particularly, the presentation of patients with low-urgency complaints consumes resources needed for patients with higher urgency. In this context, patients with non-specific back pain (NSBP) often present to emergency departments instead of primary care providers. While patient perspectives are well understood, this study aims to add a provider perspective on the diagnostic and therapeutic approach for NSBP in emergency and primary care settings. Methods: In a qualitative content analysis, we interviewed seven Emergency Physicians (EP) and nine General Practitioners (GP) using a semi-structured interview to assess the diagnostic and therapeutic approach to patients with NSBP in emergency departments and primary care practices. A hypothetical case of NSBP was presented to the interviewees, followed by questions on their diagnostic and therapeutic approaches. Recruitment was stopped after reaching saturation of the qualitative content analysis. Reporting this work follows the consolidated criteria for reporting qualitative research (COREQ) checklist. Results: EPs applied two different strategies for the workup of NSBP. A subset pursued a guideline-compliant diagnostic approach, ruling out critical conditions and managing pain without extensive diagnostics. Another group of EPs applied a more extensive approach, including extensive diagnostic resources and specialist consultations. GPs emphasized physical examinations and stepwise treatment, including scheduled follow-ups and a better knowledge of the patient history to guide diagnostics and therapy. Both groups attribute ED visits for NSBP to patient related and healthcare system related factors: lack of understanding of healthcare structures, convenience, demand for immediate diagnostics, and fear of serious conditions. Furthermore, both groups reported an ill-suited healthcare infrastructure with insufficiently available primary care services as a contributing factor. Conclusions: The study highlights a need for improving guideline adherence in younger EPs and better patient education on the healthcare infrastructure. Furthermore, improving access and availability of primary care services could reduce ED visits of patients with NSBP. Trial registration: No trial registration needed. [ABSTRACT FROM AUTHOR]

Background: Atherosclerotic Cardiovascular Disease (ASCVD) is a global public health concern. This study aimed to estimate the healthcare resource utilization (HRU) and costs stratified by cardiovascular disease (CVD) risk categories using real-world evidence, in a regional population in Portugal. Methods: This is a retrospective observational study, using data from Electronic Health Records between 2017 and 2021. Patients aged ≥ 40 years, and with at least one general practitioner (GP) appointment in the 3 years before 31st of December 2019, were included. CVD risk categories were determined based on 2021 ESC prevention guidelines. HRU encompassed hospital data (hospitalizations, outpatient and emergency room visits) and GP appointments. Total direct costs per patient were calculated based on the reference cost of the Portuguese legislation for payment methodology on Diagnosis-Related Groups (DRGs). Results: Analysis of 3 122 695 episodes, revealed consistent HRU and costs across the five years. Very high-risk patients, showed higher HRU, particularly in hospital admissions. Costs tended to rise with higher CVD risk level. Very high-risk patients with ASCVD had higher costs for hospital admissions, while low-to-moderate risk patients had higher costs for GP visits. Despite a smaller proportion, very high-risk patients with prior ASCVD represent the highest costs per patient across healthcare settings (from 115€ in emergency visits to 2 673€ in hospitalizations), followed by very high-risk patients without prior ASCVD (ASCVD-risk equivalents). Conclusion: This study revealed a substantial HRU and costs by patients with very high CVD risk, particularly those with prior ASCVD. Moreover, ASCVD-risk equivalents emerge as notable consumers, emphasizing the importance of risk assessment and preventive measures in cost-effective management of these patients. [ABSTRACT FROM AUTHOR]

Introduction Congenital heart disease (CHD) has an incidence of 0.8% to 1.2% worldwide, making it the most common birth defect. Researchers have compared high-volume to low-volume hospitals and found significant hospital-level variation in major complications, health resource utilization, and mortality after CHD surgery. In addition, researchers found critical CHD patients at low-volume/non-teaching facilities to be associated with higher odds of inpatient mortality when compared to CHD patients at high-volume/teaching hospitals (odds ratio 1.76). We examined the effects of high-quality hospital (HQH) use on health care outcomes and health care costs in pediatric CHD care using an instrumental variable (IV) approach. Materials and Methods Using nationwide representative claim data from the United States Military Health System from 2016 to 2020, TRICARE beneficiaries with a diagnosis of CHD were tabulated based on relevant ICD-10 (International Classification of Diseases, 10th revision) codes. We examined the relationships between annual readmissions, annual emergency room (ER) use, and mortality and HQH use. We applied both the naive linear probability model (LPM), controlling for the observed patient and hospital characteristics, and the two-stage least squares (2SLS) model, accounting for the unobserved confounding factors. The differential distance between the patient and the closest HQH at the index date and the patient and nearest non-HQH was used as the IV. This protocol was approved by the Institutional Review Board at the University of Maryland, College Park (Approval Number: 1576246-2). Results The naive LPM indicated that HQH use was associated with a higher probability of annual readmissions (marginal effect, 18%; 95% CI, 0.12 to 0.23). The naive LPM indicated that HQH use was associated with a higher probability of mortality (marginal effect, 2.2%; 95% CI, 0.01 to 0.03). Using the differential distance of closest HQH and non-HQH, we identified a significant association between HQH use and annual ER use (marginal effect, −14%; 95% CI, −0.24 to −0.03). Conclusions After controlling for patient-level and facility-level covariates and adjusting for endogeneity, (1) HQH use did not increase the probability of more than one admission post 1-year CHD diagnosis, (2) HQH use lowered the probability of annual ER use post 1-year CHD diagnosis, and (3) HQH use did not increase the probability of mortality post 1-year CHD diagnosis. Patients who may have benefited from utilizing HQH for CHD care did not, alluding to potential barriers to access, such as health insurance restrictions or lack of patient awareness. Although we used hospital quality rating for congenital cardiac surgery as reported by the Society of Thoracic Surgeons, the contributing data span a 4-year period and may not reflect real-time changes in center performance. Since this study focused on inpatient care within the first-year post-initial CHD diagnosis, it may not reflect the full range of health system utilization. It is necessary for clinicians and patient advocacy groups to collaborate with policymakers to promote the development of an overarching HQH designation authority for CHD care. Such establishment will facilitate access to HQH for military beneficiary populations suffering from CHD. [ABSTRACT FROM AUTHOR]

Introduction: Current treatment guidelines for patients with epidermal growth factor receptor (EGFR)-mutated metastatic non-small cell lung cancer (mNSCLC) recommend EGFR tyrosine kinase inhibitors (TKIs) as the standard of care for first-line treatment, with third-generation osimertinib the preferred choice. However, most patients develop resistance to targeted therapy, and subsequent systemic chemotherapy is recommended. The aim of this study was to characterize the subsequent line of therapy (LOT) following osimertinib in patients with EGFR-mNSCLC. Methods: Medical and pharmacy claims of adults who initiated a subsequent LOT (index) after initial osimertinib discontinuation between November 2015 and September 2019 were analyzed retrospectively. Results: A total of 135 patients met the inclusion criteria. After metastatic diagnosis, 22.2% and 49.6% of patients were treated with osimertinib in the first and second line, respectively. After osimertinib discontinuation, most patients were treated with a platinum-based chemotherapy regimen (57%), of which 40.3% included immuno-oncology therapy. Reuse or continuation of EGFR TKIs was also common (24%). Overall, the median time to treatment discontinuation for the index LOT was 2.4 months. Proportions of patients with ≥ 1 inpatient or emergency department visit were 31.9% and 35.6%, respectively. Conclusions: The duration of the LOT following osimertinib was short and associated with tolerability issues underscoring a high unmet need for new therapies to address EGFR TKI resistance. [ABSTRACT FROM AUTHOR]

Background: Despite the key role family caregivers play in the US healthcare system, they are not systematically identified and tracked, limiting our knowledge about this important group. Objective: Our objective was to identify caregiver characteristics and barriers to service delivery in a primarily rural state. Methods: As part of a quality improvement project, a cross-sectional online survey was fielded in clinical and community settings. Participants included 85 self-identified adult caregivers of another adult with an illness, condition, or disability from within a US state healthcare network. Descriptive analyses were conducted, and inferential statistics were used to compare urban versus rural respondents and older versus younger respondents. Results: Caregivers were responsible for a wide range of care activities and particularly older caregivers spent a significant amount of time providing care. Older caregivers also reported significantly lower levels of burden compared to younger caregivers, yet both groups had clinically high levels on average. Caregivers reported receiving helpful emotional support, but needed more tangible support and were limited by availability and cost. Conclusions: There is a need to fund comprehensive caregiver programing and address caregivers' own social and physical health needs to reduce caregiver burden. [ABSTRACT FROM AUTHOR]

Background: Lacking causal treatment options in most cases, severe IgE-mediated food allergies (IgE-FA) are associated with a high burden of disease due to permanent risk of anaphylactic reactions after accidental allergen ingestion. To date, only few data comparing health resources and burden of disease between the pediatric and adult population are available. Objective: Our survey aimed to assess the care situation of pediatric and adult patients with severe, self-reported physician-diagnosed IgE-FA. Methods: The survey was conducted via an online questionnaire consisting of 32 items covering participant demographics, comorbidities, triggers, utilization of health resources, current management and burden of disease of FA, according to age groups (

ABSTRACT Introduction The increasing prevalence of shiftwork among young adults poses significant health risks, primarily due to its disruptive effects on sleep, nutrition and physical activity. Addressing these risks necessitates the development of tailored, evidence‐based resources to support these key health behaviours. Participatory research approaches, engaging those with relevant lived experience (i.e., co‐design) are a novel and effective approach in developing these resources. As such, the aim of the present study was to explore whether sleep, nutrition and physical activity resources for young shiftworkers could be developed using participatory, co‐design approaches and how co‐designers would rate both the approaches used and the resulting resources. Methods A participatory approach engaged co‐designers (young, experienced or previous shiftworkers; workplace health and safety specialists; science communicators and academic experts) to complete 2–3 online questionnaires and participate in 1–2 online workshops, to co‐design sleep, nutrition and physical activity resources for young shiftworkers. Following resource development, co‐designers assessed both the participatory approach and the resulting resources, through an online questionnaire, which included the Public and Patient Engagement Evaluation Tool (PPEET). Results Co‐designers (n = 48) participated in the development of sleep, nutrition and physical activity resources for young shiftworkers. Co‐designers evaluated the participatory approach positively, with a mean rating across all PPEET items of 4.7 (±0.2) on a 5‐point Likert scale. Co‐designers also provided positive ratings for the resources, with the majority (91.7%) either agreeing or strongly agreeing that they were user‐friendly, valuable and informative for young shiftworkers and would serve as a credible source of health information. Conclusion By adopting a novel participatory approach, we successfully co‐designed sleep, nutrition and physical activity resources for young shiftworkers. Participatory approaches, including co‐design, should be considered when developing health interventions for shiftworkers, given the value of embedding lived experience to address their unique lifestyle challenges. Patient or Public Contribution Co‐designers and/or people with relevant lived experience were involved in all project activities: conceptualisation, design, recruitment, data collection, data analysis, knowledge translation and output generation.

Abstract Background Telemedicine use increased with the Covid-19 pandemic. The impact of telemedicine on resource use in pulmonary clinics is unknown. Methods This retrospective cohort study identified adults with pulmonary clinic visits at the University of Miami Hospital and Clinics (January 2018-December 2021). The primary exposure was telemedicine versus in-person visits. Standard statistics were used to describe the cohort and compare patients stratified by visit type. Multivariable logistic regression models evaluated the association of telemedicine with resource use (primarily, computed tomography [CT] orders placed within 7 days of visit). Results 21,744 clinic visits were included: 5,480 (25.2%) telemedicine and 16,264 (74.8%) in-person. In both, the majority were

Introduction Spatial disparities impact population health and are linked to social and health disparities. Understanding the scope, nature, and trends of regional inequalities can help create policies, strategies, and interventions that affect the morbidity and mortality of various disease control. The variations in the distribution of health facilities have resulted in differences in health outcomes within Ghana’s administrative districts, of which the Lower Manya Krobo Municipality (LMKM) is no exception. The primary objective of this study was to examine the distribution of healthcare resources in the LMKM in the Eastern Region of Ghana. Methods A single case study approach involving all health resources, facilities, and supporting service centers in the LMKM was adopted. All functional health facilities in the municipality during the study were included. The study partly used records of generated coordinates using the global positioning system of other resources and services. Results The Municipality had 16 health facilities and 29 supporting centers. There were 285 clinical health workers in the municipality. Odumase and Akuse had higher percentages of clinical health personnel. The municipality’s population per single health worker ratio was 13,201:1. Agomanya had the highest number of facilities and support centers. The population per health facility ratio was 15,086 per facility. Conclusion The study demonstrated disparities in the distribution of health facilities across the municipality. There is a need to ensure that all health resources are allocated to the population size and the health needs of the LMKM.

Rare diseases are predominantly genetic or inherited, and patients with these conditions frequently exhibit neurological symptoms. Diagnosing and treating many rare diseases is a complex challenge, and their low prevalence complicates the performance of research, which in turn hinders the advancement of therapeutic options. One strategy to address this issue is the creation of national or international registries for rare diseases, which can help researchers monitor and investigate their natural progression. In the Republic of Korea, we established a registry across 5 centers that focuses on 3 rare diseases, all of which are characterized by gait disturbances resulting from motor system dysfunction. The registry will collect clinical information and human bioresources from patients with amyotrophic lateral sclerosis, spinocerebellar ataxia, and hereditary spastic paraplegia. These resources will be stored at ICreaT and the National Biobank of Korea. Once the registry is complete, the data will be made publicly available for further research. Through this registry, our research team is dedicated to identifying genetic variants that are specific to Korean patients, uncovering biomarkers that show a strong correlation with clinical symptoms, and leveraging this information for early diagnosis and the development of treatments.

Background: Telemedicine use increased with the Covid-19 pandemic. The impact of telemedicine on resource use in pulmonary clinics is unknown. Methods: This retrospective cohort study identified adults with pulmonary clinic visits at the University of Miami Hospital and Clinics (January 2018-December 2021). The primary exposure was telemedicine versus in-person visits. Standard statistics were used to describe the cohort and compare patients stratified by visit type. Multivariable logistic regression models evaluated the association of telemedicine with resource use (primarily, computed tomography [CT] orders placed within 7 days of visit). Results: 21,744 clinic visits were included: 5,480 (25.2%) telemedicine and 16,264 (74.8%) in-person. In both, the majority were < 65-years-old, female, and identified as Hispanic white. Patients seen with telemedicine had increased odds of having CT scans ordered within 7 days (adjusted odds ratio [aOR] 1.34, [95% confidence interval 1.04–1.74]); and decreased odds of chest x-rays (aOR 0.37 [0.23–0.57]). Telemedicine increased odds of contact of any kind with our healthcare system within 30-days (aOR 1.56 [1.29–1.88]) and 90-days (aOR 1.39 [1.17–1.64]). Specifically, telemedicine visits had decreased odds of emergency department visits and hospitalizations (30 days: aOR 0.54 [0.38–0.76]; 90 days: aOR 0.68 [0.52–0.89]), but increased odds of phone calls and electronic health record inbox messages (30 days: aOR 3.44 [2.73–4.35]; 90 days: aOR 3.58 [2.95–4.35]). Conclusions: Telemedicine was associated with an increased odds of chest CT order with a concomitant decreased odds of chest x-ray order. Increased contact with the healthcare system with telemedicine may represent a larger time burden for outpatient clinicians. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of data evaluating the use of enteral sedation in mechanical ventilation. A sedative shortage resulted in the use of this approach. Purpose: To evaluate the feasibility of using enteral sedatives to decrease intravenous (IV) analgesia and sedative requirements. Materials/Methods: This single-center, retrospective, observational study compared two groups of patients admitted to the ICU who were mechanically ventilated. One group received a combination of enteral and IV sedatives and the second group received IV monotherapy. Linear mixed model (LMM) analyses were performed to assess the impact of enteral sedatives on IV fentanyl equivalents, IV midazolam equivalents, and propofol. Mann-Whitney U tests were performed on percent of days at goal for Richmond Agitation and Sedation Scale (RASS) and critical care pain observation tool (CPOT) scores. Results: One hundred and four patients were included. The average cohort age was 62 years and 58.7% were male. The median length of mechanical ventilation was 7.1 days and the median length of stay was 11.9 days. The LMM estimated that enteral sedatives reduced IV fentanyl equivalents received per patient by an average of 305.6 mcg/day (P =.04), although did not significantly decrease midazolam equivalents or propofol. There was no statistically significant difference in CPOT scores (P =.57 and P =.46 respectively), however RASS scores in the enteral sedation group were more often at goal (P =.03); oversedation occurred more in the non-enteral sedation group (P =.018). Conclusion: Enteral sedation may be a possible way to decrease IV analgesia requirements during periods of shortage. [ABSTRACT FROM AUTHOR]

The past 2 decades have seen dramatic growth in the number of obstetrics and gynecology hospitalists, and many hospitals have created obstetrical-specific emergency departments. The goals of an obstetrics emergency department are to provide safe and efficient care to the pregnant dyad and postpartum patient, while generating revenue for emergency services provided. In an obstetrics emergency department, all patients must be evaluated in person by a licensed practitioner, whereas historically they may have been evaluated in person by nursing staff or a trainee. We make the argument that formation of an obstetrics emergency department has the potential to improve the safety and quality of patient care. In addition, the financial benefits to institutions are substantial and can subsidize the cost of maintaining obstetrician presence all the time in the hospital. There are various regulatory requirements to become certified, accredited, and licensed as an emergency department. In addition, there are many operational and systems issues that institutions should consider before implementation. We provide a guide for healthcare systems considering creating an obstetrics emergency department. [ABSTRACT FROM AUTHOR]

Background/Aims: The sharing economy comprises three main actors: sharing platforms, asset providers and end users (consumers). These actors arguably possess decision-making autonomy and make sharing-related decisions on their own behalf, but the growing prevalence of asset sharing in the healthcare sector implies the possibility of heteronomous, provider-driven decisions. This article reports the findings of the first part of a two-part study providing insights into the unintended effects of sharing healthcare assets when the sharing decision is made by the healthcare service provider, not the service user. Methods: Building on reactance theory, this study used an experimental scenario-based design. A total of 398 participants (all members of the general public) were randomly assigned to three groups and given a scenario involving a consultation with a physician. In one scenario, participants were told they would undergo an operation in a theatre used solely by the physician's practice, while in the other two scenarios the theatre was shared with either five or 10 other practices. Participants were asked about their perceptions of the physician and whether they would use their services again, ranking agreement to items on a 7-point Likert scale. Regression analyses were performed to assess the relationships between asset sharing conditions, participants' perception of the quality of the service and the intention to use the service again. Results: Healthcare asset sharing was significantly and negatively associated with perceived service quality (b=−0.54; P=0.000). While perceived service quality had a significant positive effect on intention to use the service again (b=0.91; P<0.001), none of the sharing or non-sharing conditions had a significant direct effect on intention to use the service again. This indicates that perceived service quality had a full mediating effect on the relationship between asset sharing and intention to use the service again. Conclusions: Sharing healthcare assets could negatively affect patients' intention to use the service again by reducing the perceived quality of the service. Healthcare organisations should work to reduce the impact of asset sharing on perceived quality in order to prevent a negative effect on patient-related outcomes, such as satisfaction and intention to use the service again. [ABSTRACT FROM AUTHOR]

Healthcare human resource planning is one of the biggest challenges facing the healthcare systems in many countries. Inadequate decisions in human resource planning can lead to an insufficient number of healthcare professionals then healthcare inequalities. One of the components of resource planning in the healthcare system is long-term data monitoring and the identification of potential trends. Since 1990, the number of physicians in Lithuania has decreased by 15.3% (−2266), but the decrease in the population has led to a 13.61% increase in the number of physicians per 10,000 inhabitants (5.32). During the analyzed period, the largest decrease in the number of physicians workforce by specialty was the number of medical physicians (−73.08%), epidemiology and hygiene (−69.30%), children's diseases (−49.08%), the most increased number was of family/general practitioners (GPs), geneticists, physical medicine, and rehabilitation specialists. Since 1992, the number of visits to physicians in Lithuania, which has been decreasing for a long time, began increasing, and in 2022 (9.3 visits) it has almost reached the number of visits (9.5) per capita as in 1991. The aim of this research was to collect long-term data from various databases, summarize them, and identify possible trends and the reasons for data changes. The study analyzed data from the Lithuanian healthcare system from the Declaration of Independence of Lithuania to the last 30 years. The data includes or affects the indicators of the healthcare system, changes in population and doctors, the number of visits to doctors, the number of medical students and residents, and data determining inequalities in the healthcare system. Long-term data analysis is useful for developing a model of healthcare human resource planning and for planning healthcare resources. [ABSTRACT FROM AUTHOR]

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Background Glaucoma is a chronic disease of the optic nerve and a leading cause of severe visual loss in the UK. Once patients have been diagnosed, they need regular monitoring at hospital eye services. Recent advances in technology mean patients with glaucoma can now monitor their disease at home. This could be more convenient for patients and potentially reduce costs and increase capacity for the NHS. However, it is uncertain whether self-monitoring would be acceptable or possible for patients with glaucoma. Objectives The objectives were to: identify which patients are most appropriate for home monitoring; understand views of key stakeholders (patients, clinicians, researchers) on whether home glaucoma monitoring is feasible and acceptable; develop a conceptual framework for the economic evaluation of home glaucoma monitoring; and explore the need for and provide evidence on the design of a future study to evaluate the clinical and cost-effectiveness of digital technologies for home monitoring of glaucoma. Design In-home Tracking of glaucoma: Reliability, Acceptability, and Cost (I-TRAC) was a multiphase mixed-methods feasibility study with key components informed by theoretical and conceptual frameworks. Setting Expert glaucoma specialists in the UK recruited through professional glaucoma societies; study site staff and patient participants recruited through three UK hospital eye services (England, Scotland, Northern Ireland); and UK research teams recruited though existing networks. Intervention Home tonometer that measures intraocular pressure and a tablet computer with a visual function application. Patients were asked to use the technology weekly for 12 weeks. Results Forty-two patients were recruited. Retention and completion of follow-up procedures was successful, with 95% (n = 40) completing the 3-month follow-up clinic visits. Adherence to the interventions was generally high [adherence to both devices (i.e. ≥ 80% adherence) was 55%]. Overall, patients and healthcare professionals were cautiously optimistic about the acceptability of digital technologies for home monitoring of patients with glaucoma. While most clinicians were supportive of the potential advantages glaucoma home monitoring could offer, concerns about the technologies (e.g. reliability and potential to miss disease progression) and how they would fit into routine care need to be addressed. Additionally, clarity is required on defining the ideal population for this intervention. Plans for how to evaluate value for money in a future study were also identified. However, the study also highlighted several unknowns relating to core components of a future evaluative study that require addressing before progression to a definitive effectiveness trial. Limitations The main limitation relates to our sample and its generalisability, for example, the over-representation of educated persons of white ethnicity who were generally experienced with technology and research motivated. Conclusions The In-home Tracking of glaucoma: Reliability, Acceptability, and Cost study has demonstrated ‘cautious optimism’ when considering patients’ and healthcare professionals’ views on the acceptability of digital technologies for home monitoring of patients with glaucoma. However, the study also highlighted several unknowns relating to the research question and design of a future evaluative study that require addressing before progression to a randomised controlled trial. Future work Further research is required to determine the appropriate population (i.e. low vs. high risk of progression) and further refine the intervention components and delivery for planning of future evaluation studies. Study registration This study is registered as Research Registry #6213. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR129248) and is published in full in Health Technology Assessment; Vol. 28, No. 44. See the NIHR Funding and Awards website for further award information. Plain language summary What is this research about? The In-home Tracking of glaucoma: Reliability, Acceptability, and Cost study explored whether glaucoma patients who would normally be monitored in hospital could do some monitoring themselves at home, and whether self-monitoring at home would be acceptable or possible for them. How was the research done? We delivered In-home Tracking of glaucoma: Reliability, Acceptability, and Cost in four phases by: Surveying expert glaucoma specialists to understand which patients would benefit most from home monitoring. Providing glaucoma patients with an iPad tablet and a device which measures eye pressure to use once a week for 3 months. The patients who participated and the clinical staff delivering the study were interviewed about their experiences. Interviewing researchers with experience of running large studies testing digital technologies to monitor patients’ health at home to understand challenges. Reviewing other researchers’ work and comparing it with ours to help us understand whether home monitoring of glaucoma could be good value for money. What did the research find out? Overall, patients and healthcare professionals were cautiously optimistic about the digital technologies for home monitoring of glaucoma. Most patient participants were able to use the technologies, and half told us they preferred home monitoring. Most clinicians recognised the potential advantages of glaucoma home monitoring but had concerns about the technologies (specifically reliability and the risk of missing disease progression) and how they would fit into routine care. Plans for how to evaluate value for money in a future study were identified. The study did not aim to identify whether the digital technology was better than what happens currently; a different study design with many more patients would be required to answer that question. The study did identify several important questions to answer before designing a future larger study; for example, how to ensure diverse patient participation. These questions should be the focus of future research in this area. Scientific summary Background Glaucoma is a chronic neurodegenerative eye disease and the second commonest cause of severe visual loss in the UK. Diagnosed patients require regular, lifelong monitoring to detect progression and assess effectiveness of treatment, with monitoring typically delivered within the hospital eye services (HES). Ophthalmology is the busiest NHS outpatient specialty, accounting for 10% of all outpatient visits, and glaucoma represents a significant part of this workload. In England alone there are over 1 million clinic visits per year for patients with glaucoma. Providing regular surveillance and treatment is already a major challenge for the NHS but as the prevalence of glaucoma increases with age, demand for glaucoma care is increasing (and will continue to do so) due to the ageing population. The two main measurements used in the assessment of glaucoma are intraocular pressure (IOP) measurement and visual field (VF) testing. Recent advances in technology mean it is now possible for patients with glaucoma to measure their IOP and test their VFs in their own home. Home monitoring could theoretically replace or supplement standard care, perhaps allowing patients to require fewer outpatient visits, while increasing convenience and potentially reducing costs and increasing capacity for the NHS. It is also possible that frequent home testing may lead to better outcomes than achieved with standard infrequent visits to HES, potentially leading to earlier detection of progression or highlighting high IOP undetected through conventional outpatient clinic-based tests. Currently though, it is not known if home monitoring is acceptable to people with glaucoma, or if home monitoring in the general glaucoma population is feasible. The main aim of this study was to assess acceptability and feasibility of home monitoring, and to make recommendations about future research to test how the NHS could use home monitoring. Objectives The aim of In-home Tracking of glaucoma: Reliability, Acceptability, and Cost (I-TRAC) was to determine the feasibility and acceptability of digital technologies to monitor glaucoma at home and inform the possible need for and design of a definitive evaluative study. The specific research objectives were to: identify which patients with glaucoma are most appropriate for home monitoring (e.g. all patients, those with stable disease, or those with severe glaucoma?) understand the views of key stakeholders (patients, clinicians, researchers) on whether home monitoring is feasible and acceptable develop a conceptual framework for the economic evaluation of home monitoring for glaucoma explore the need for and provide evidence on the design of a future study to evaluate the clinical and cost-effectiveness of digital technologies for home monitoring of glaucoma. Methods Design The I-TRAC study was a multiphase mixed-methods feasibility study with key components informed by theoretical (i.e. the Theoretical Framework of Acceptability and Theoretical Domains Framework) and conceptual [A process for Decision-making after Pilot and feasibility Trials (ADePT)] frameworks, utilising various data sources from a survey, interviews, focus groups, an observational intervention study, and literature reviews. Recruitment Recruitment to each of the I-TRAC study phases was as follows: Expert glaucoma specialists from the UK were recruited through a professional glaucoma society and invited to participate in a survey. Those who responded were asked to indicate their willingness to participate in a follow-up focus group or interview. Patient participants for the intervention study were recruited through three secondary care ophthalmology glaucoma clinics. All site staff involved in the patient-facing delivery of I-TRAC across the three sites were invited to participate in a focus group or interview. External researchers, such as Chief Investigators and Trial/Study Managers, who had been involved in evaluating digital technologies for home monitoring of eye disease or other diseases (as either feasibility, pilot or full-size trials) and who were either known to the I-TRAC team or identified through published literature were invited to participate in an interview. Intervention Patient participants were asked to use two home monitoring technologies to measure IOP and visual function (through a contrast sensitivity assessment) on a weekly basis for a duration of 12 weeks. Participants were provided with an iCare HOME 2 handheld tonometer (iCare Oy, Vantaa, Finland) to measure IOP, and the OKKO Visual Health App (OKKO Health, Bristol, UK) was used to measure visual function on a tablet computer. Site staff and patient participants received training in how to use the devices in hospital in advance of the home monitoring period. Participants received a prompt each week to remind them to use their home monitoring equipment; they could opt between receiving e-mail or text message electronic reminders. Results The key findings from I-TRAC are presented below in relation to the study objectives. Objective 1: Identify which glaucoma patients are most appropriate for home monitoring The online survey, completed by 49 expert glaucoma clinicians, aimed to determine which glaucoma patients may be most suitable for home monitoring using digital technology. The survey findings demonstrated agreement among expert glaucoma clinicians that there is a place for home monitoring of glaucoma patients using digital technology. However, based on the scenarios used in this study, there is limited agreement among clinicians about which glaucoma patients are most suitable for home monitoring using digital technologies to measure IOP and visual function. Clinicians reported that they were generally not supportive of the home monitoring of high-risk patients as a replacement for standard care, due to the fear of missing disease progression or unreliable readings. However, they were generally supportive of home monitoring having a role within low-risk scenarios. Clinicians anticipated that the integration of home monitoring into the current healthcare system could act as an adjunct to increase hospital capacity for glaucoma patients who require face-to-face assessment. The survey highlighted a range of issues and challenges related to the home monitoring of glaucoma patients using digital technologies. A central theme was clinicians’ lack of trust in home monitoring technologies, related to concerns about the reliability, accuracy and clinical usefulness of these technologies. Clinicians expressed concerns about patient safety (if standard care were to be replaced with home tonometry), decreased rather than increased glaucoma progression detection, and concerns about how resource efficient (time and financial) this approach could be in comparison to current provision. Objective 2: Understand the views of key stakeholders on whether home monitoring is feasible and acceptable Several key stakeholder groups were included in various I-TRAC phases in order to achieve this objective. Firstly, three focus groups (n = 2, n = 4, n = 4) and five individual interviews with expert glaucoma clinicians suggested there is cautious optimism about the use of digital technologies to monitor patients’ glaucoma at home. Clinicians reported that they are interested and enthused by the potential of glaucoma home monitoring, but there are several areas of concern that need to be addressed before they would feel reassured to buy-in to this approach. They believe home monitoring could meet an existing clinical need, addressing the present difficulties of inadequate capacity to meet increasing demand. They can see potential patient and service benefits, but they require reassurances about the technologies and how such a service would be implemented into routine care. Contextually, the influence of the coronavirus disease discovered in 2019 pandemic was evident; clinicians’ experiences throughout the pandemic have both prompted a need to adapt and change the way they monitor patients with glaucoma and highlighted that monitoring outside the clinic is possible and, in many ways, can be done safely. The current care backlog post pandemic is driving enthusiasm for innovative solutions. The multiphase mixed-methods study exploring the intervention’s acceptability demonstrated that for both patient participants and site staff tasked with delivering I-TRAC there were many positives and the intervention was deemed broadly acceptable. Overall, the I-TRAC study recruited well, recruiting 95% of its proposed sample size (42 patient participants of 45) in the planned recruitment period (November 2021–August 2022, 10 months). Retention and completion of follow-up procedures was also successful, with 95% (n = 40) completing the 3-month follow-up clinic visits. Adherence to the interventions was generally high, especially considering that our predetermined adherence levels were above 80%, and satisfaction with the process and the training were also scored highly by patient participants. However, 48% (n = 20) of patient participants contacted site staff at least once when at home, resulting in additional input from site staff regarding study process or intervention delivery. The qualitative data from the interviews and focus groups with patient participants (n = 10) and site staff (n = 9) did corroborate some of these findings (e.g. stating recruitment worked well and study processes were easy to follow and low burden). Yet the qualitative data also highlighted important areas not identified through the quantitative pilot, such as: the need for a refinement of eligibility criteria and associated recognition of limited sample diversity in I-TRAC; issues relating to inadequate training (for both site staff and patients); a lack of confidence in the technology (and their ability) in relation to the purpose of home monitoring; familiarity with the device and physical dexterity issues; and some anxieties in relation to a lack of clinical oversight when monitoring at home. These findings highlight that several key factors need to be deliberated when considering the feasibility of future trials evaluating digital technology for home monitoring of glaucoma. Finally for this objective, we interviewed researchers from external teams (n = 8) who had been involved in the evaluation of digital technologies for home monitoring patients’ health. Although researchers reported multiple challenges encountered while carrying out digital health technology studies/trials, they also had many suggestions as to how these could be prevented or overcome. The common barriers were low stakeholder acceptability, lack of understanding of digital technologies, poor resource planning, insufficient peripheral infrastructure, problematic relationships with commercial partners, and the unsolved dilemma of digital exclusion. The findings illustrate that researchers in the UK carrying out digital health technology studies encounter a number of challenges impacting on the successful design, conduct, and delivery of digital health technology studies/trials and potentially leading to wasted research efforts. This broader exploration of feasibility issues surrounding digital health technology studies/trials highlights significant agreement about critical trial design and conduct issues that require consideration in studies/trials of this type. Objective 3: Develop a conceptual framework for the economic evaluation of home monitoring for glaucoma Several methods were used to develop a conceptual framework to consider the future economic evaluation of home monitoring for glaucoma. Data sources used included evidence from two systematic reviews conducted for the I-TRAC project and secondary analysis of the data collected through all previous I-TRAC phases to identify resource use and patient preference components. Overall, the key categories of intervention costs of glaucoma home monitoring identified in this study include equipment cost, patient training, ongoing patient support during home monitoring, potential spill-over costs (e.g. high readings trigger hospital visits) and costs of data integration (to the existing medical records) and evaluation by artificial intelligence, while key sources of patient utilities of glaucoma home monitoring are categorised as health-related quality of life (HRQoL)-related (e.g. more frequent disease monitoring and faster identification of disease progression) and non-HRQoL related (e.g. convenience). Given the complexity and scarcity of relevant evidence in the literature, it is recommended that further qualitative/quantitative research needs to be conducted to better understand the study population, care pathways of the compared interventions, cost categories and benefits of home monitoring, before a formal economic evaluation can be conducted. A step-by-step approach is then recommended to carefully explore what economic evaluation approach can be suitable in the context of glaucoma home monitoring. Objective 4: Explore the need for and provide evidence on the design of a future study to evaluate the clinical and cost-effectiveness of digital technologies for home monitoring of glaucoma The data from across all phases of the I-TRAC study were mapped to the ADePT framework in order to establish the feasibility of a future evaluative study of the clinical and cost-effectiveness of digital technologies for home monitoring of glaucoma. Many of the 14 items in ADePT were successfully achieved (e.g. 93% of sample size was recruited in the original recruitment window, and overall acceptability of the home monitoring technologies was good). The mixed-methods data collection and analysis allowed in-depth investigation of key areas and highlighted uncertainties that need to be addressed before moving to an evaluative study. Some of these focused on aspects related to the population; that is, clarity is still required on which glaucoma patients would be most suitable for home monitoring, and this is linked to whether home monitoring is considered as an additional service (i.e. in addition to routine monitoring through HES) or as a replacement service (i.e. patients would not attend HES and instead would be monitored at home). While the interventions were broadly deemed as acceptable to patients and clinicians, further refinement of the intervention is required (e.g. frequency and duration) and consideration of how it ‘fits’ within the healthcare system is required before evaluation. As well as the intervention, considerations about an appropriate comparator were not explored in I-TRAC but should be. Lastly, determination of appropriate outcomes (and their importance for a range of stakeholders) for the evaluation of digital technologies for glaucoma home monitoring also requires attention. Conclusions The I-TRAC study has demonstrated ‘cautious optimism’ when considering patients’ and healthcare professionals’ views on the acceptability of digital technologies for home monitoring patients with glaucoma. Much of the caution from clinicians related to concerns around the reliability of the technologies and the potential to miss progression of the disease if patients were not monitored in clinic. The study evidenced sufficient fidelity, good adherence to the interventions among the patient population, and feasibility of delivery of both the interventions and the study processes. However, I-TRAC also highlighted several unknowns relating to the research question and design of a future evaluative study that require addressing before progression to a randomised controlled trial. The I-TRAC study has also considered the wider ecosystem challenges of running digital health technology trials through evidencing the views of external research teams experienced in digital home monitoring technology delivery. Further research is required to determine the appropriate population (i.e. glaucoma patients with low vs. high risk of progression) and further refine intervention components and their delivery, to allow future evaluation studies to be planned. Study registration This study is registered as Research Registry #6213. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR129248) and is published in full in Health Technology Assessment; Vol. 28, No. 44. See the NIHR Funding and Awards website for further award information.

ABSTRACT Aims/Introduction Healthcare resource utilization (HCRU) and healthcare costs are important factors to consider when selecting appropriate treatment for type 2 diabetes mellitus. We compared the HCRU and healthcare costs of sodium‐glucose cotransporter 2 inhibitors (SGLT2i) vs dipeptidyl peptidase‐4 inhibitors (DPP4i) in patients with type 2 diabetes mellitus in Japan. Materials and Methods This was a Japanese retrospective cohort study conducted using the JMDC Claims Database (January 1, 2015–December 31, 2021). Patients newly treated with an SGLT2i (31,872 patients) or a DPP4i (73,279 patients) were matched 1:1, using propensity score, after excluding patients without continuous SGLT2i or DPP4i prescriptions after the index date. HCRU and healthcare costs were compared between the treatment groups in the full cohort and subcohorts/subgroups of different baseline characteristics, including body mass index (BMI). Results After matching, patient characteristics were well balanced (17,767 patients each). Patients receiving an SGLT2i vs those receiving a DPP4i had significantly lower numbers of hospitalizations per person per month (PPPM) and outpatient visits PPPM, and had shorter lengths of stay per hospitalization. Healthcare costs, including all‐cause overall healthcare costs PPPM and all‐cause hospitalization costs PPPM, were generally lower in patients receiving an SGLT2i than those receiving a DPP4i. Similar results were observed among patients with a higher BMI but not among patients with a lower BMI. Conclusions SGLT2i were associated with lower HCRU and healthcare costs than DPP4i, suggesting economic benefits with SGLT2i vs DPP4i in type 2 diabetes mellitus management.

Abstract Background The various restrictions caused by the COVID-19 pandemic may have worsened the digital divide and health inequality. However, research to ascertain the association between Internet use and difficulties in acquiring health resources among older adults with disabilities is scarce. This study aimed to explore the relationship between Internet use and difficulties in acquiring health resources among older adults with disabilities during the COVID-19 pandemic and explore the associated factors by disability severity. Methods Data from the 2020 survey of people with disabilities in South Korea were used. This secondary analysis study included 4,871 older adults aged 55 and above among 7,025 total responders. Complex sample logistic regression analyses were conducted to identify the association between Internet use and difficulties in acquiring health resources during the pandemic. Results Only 23.66% of older adults with disabilities used the Internet. Internet non-users were more likely to experience difficulties in obtaining health resources than Internet users. The relationship between Internet non-use and difficulties in acquiring COVID-19-related information (OR 1.57, 95% CI 1.28–1.92) and buying and using personal protective equipment (OR 1.36, 95% CI 1.11–1.65) were statistically significant in the overall sample. Whereas, difficulties with using medical services were not statistically significantly associated with Internet use. Additionally, factors associated with difficulties in acquiring health resources differed by disability severity. Conclusions Considering that older adults with disabilities experience triple the burden amid COVID-19 due to old age, disabilities, and the digital divide, policymakers, healthcare professionals, and engineers should aim to narrow the gaps between Internet users and Internet non-users among this population. Narrowing the gaps will make decreasing health gaps and increasing well-being among older adults with disabilities more attainable.

Abstract Background The equitable distribution of healthcare resources represents a paramount objective in the realm of global health systems. Thus, the present study sought to assess the fairness in the allocation of health resources at Qazvin University of Medical Sciences (QUMS), both prior to and subsequent to the implementation of the Health Transformation Plan (HTP) using the Gini coefficient and the Hirschman–Herfindahl index (HHI). Methods This descriptive-analytical study aimed to investigate the distribution of healthcare resources among general practitioners (GPs), specialists, and subspecialists employed at QUMS between 2011 and 2017. Demographic data pertaining to the cities were obtained from the statistical yearbooks of the Statistical Center of Iran, while information regarding the healthcare workforce was extracted from QUMS records. The analysis utilized two key measures, namely the Gini coefficient and the HHI, to assess the fairness of resource distribution. Data analysis was performed using Microsoft Excel 2016 and the Stata statistical software. Results The highest number of GPs, specialists, and subspecialists was observed in 2014, 2017, and 2017, respectively, while the lowest number was recorded in 2016, 2011, and 2015, respectively. From 2011 to 2017, the Gini coefficient for GPs ranged between 0.61 and 0.63. Among specialists, the lowest Gini coefficient value was observed in 2015 (0.57), while the highest was recorded in 2017 (0.60). The Gini coefficient for subspecialists remained constant at 0.52 from 2011 to 2017. The HHI revealed a high concentration of GPs in the cities of Qazvin province. Although the disparity gradually decreased in the specialties of eye, ear, nose, and throat, and pediatrics, the concentration still persists in Qazvin. In general surgery, the index value is low, indicating some level of inequality. In anesthesia and neurology, the index value decreased after the HTP and reached 5700; however, achieving equality (below 1000) still requires further efforts. No significant change in the index was observed after the HTP in specialties such as neurosurgery, rehabilitation, and nuclear medicine. Subspecialists also exhibited a concentration in the city of Qazvin. Conclusion Based on the analysis of the Gini and HHI, it is evident that the distribution of GPs has not undergone significant changes following the implementation of the HTP. The Gini coefficient, which ranges from 0.4 to 0.6, indicates a high to complete level of inequality in the distribution of specialists and subspecialists. Moreover, the HHI exceeds 1000, reflecting a concentration of resources in specific areas. As a result, the HTP has not yet achieved its goal of ensuring a fair distribution of human resources. To address this issue, it is recommended to redesign distribution policies, including the allocation of physical health resources, such as specialized hospitals, beds, and medical equipment. Additionally, increasing student admissions in specialized and subspecialized fields and implementing tariff incentives can contribute to a more equitable distribution of resources. By aligning distribution policies with the principle of fairness, the healthcare system can better address the issue of resource distribution.

• The concept of physician care left undone is vastly understudied. • Physician care left undone is prevalent, varying between and within EU countries. • Physicians who experience high workloads have increased odds of leaving care undone. • Prioritise interventions that enable physicians to provide complete care. To examine the prevalence, antecedents and consequences of physician care left undone in acute care hospitals. A multicentre, multinational, cross-sectional survey. An 11-item scale measured physician reports of care left undone. Antecedent measures examined were work environment and perceived workload. Potential consequences examined included emotional exhaustion, job dissatisfaction and perceived quality of care. Generalized linear mixed models were estimated to quantify associations between physician care left undone and the theorized antecedents and consequences. 56 acute care hospitals in six European countries. 1 963 physicians providing direct patient care to adult in-patients. Four in five (78.3 %) physicians left one or more care activities undone during their last shift. On average 3.1 (SD 1.0) of 11 activities were left undone. This varied between and within countries. A 10 % increase at the hospital level of physicians saying they have too much work to do, significantly increased the odds of one or more activities being left undone (OR 1.414, 95 % CI 1.268–1.578). Physicians' reports of care left undone were associated with increased odds of emotional exhaustion (OR 3.867, 95 %CI 2.683–5.575) and rating quality of medical care as poor or fair (OR 3.395, 95 % CI 2.215–5.204). Physicians frequently report leaving some necessary care undone. A shortage of resources compromises physicians' ability to do their jobs, impacting the quality of care they deliver and their job satisfaction and well-being. Ensuring adequate healthcare personnel resources should be a top priority for hospitals. [ABSTRACT FROM AUTHOR]

Background: Hepatorenal syndrome (HRS) frequently complicates alcoholic hepatitis (AH) and portends poor survival in this population. Published literature indicates mixed benefits from renal replacement therapy (RRT) for HRS refractory to medical management. Therefore, we sought to assess the utilization of RRT in AH and clinical outcomes at a national level. Methods: Using the International Classification of Diseases, Tenth Revision (ICD‐10) codes, we identified adult patients with AH with a coexisting diagnosis of HRS from the National Readmission Database 2016 through 2019. Mortality, morbidity, and resource utilization were compared. We compared proportions using the Fisher exact test and computed adjusted P‐values based on multivariate regression analysis. Analyses were performed using Stata, version 14.2, considering a two‐sided P < 0.05 as statistically significant. Results: A total of 73 203 patients with AH were included in the analysis (mean age 46.2 years). A total of 3620 individuals had HRS diagnosis (5%), of which 14.7% (n: 532) underwent RRT. HRS patients receiving RRT had a higher mortality rate than those who did not (adjusted odds ratio [aOR] 1.8, 95% confidence interval [CI]: 1.3–2.6, P: 0.01), along with higher resource utilization. Only those patients with HRS who underwent liver transplantation (LT) experienced a mortality reduction (24.4% for those not receiving RRTs and 36.5% for those receiving RRT). Conclusions: RRT is associated with higher mortality and morbidity when offered to patients with AH and HRS, who do not undergo LT. Therefore, our results suggest careful selection of AH patients when deciding to initiate RRT for HRS. [ABSTRACT FROM AUTHOR]

Epistaxis is one of the common causes of emergency department (ED) visits. However, most cases are not severe and undergo an unnecessary medical evaluation, especially in non-traumatic epistaxis. This study investigated how many patients require a definite observational unit (DOU) and what factors are associated with DOU among nontraumatic epistaxis patients. This retrospective observational study included 1197 nontraumatic epistaxis patients who visited the ED from January 2016 to December 2020. Multiple logistic regression analysis was performed to evaluate the association between risk factors and DOU care. In addition, the receiver operating characteristic (ROC) curve for predicting DOU care was analyzed to estimate the diagnostic ability of risk factors. A total number of 1122 patients with non-traumatic epistaxis were included in the final analysis. Among them, 41 (3.65%) patients needed DOU care. Male sex (odds ratio (OR) = 3.606, p = 0.003), hypertension (OR = 2.362, p = 0.020), inter-hospital transfer (OR = 2.358, p = 0.039), verbal mental status (OR = 29.436, p = 0.035), hemoglobin (Hb) level (OR = 0.724, p < 0.001), revisit after initial discharge for epistaxis (OR = 8.813, p < 0.001), and delayed ED arrival (≥180 min) (OR = 2.451, p = 0.030) were significant factors for DOU care. In addition, the area under the curve of the multiple logistic regression model for predicting DOU care was 0.870. Among the patients who visited ED due to non-traumatic epistaxis, only 3.65% of patients required DOU care. Male sex, mental status, Hb level, ED revisit after initial discharge, inter-hospital transfer and delayed ED arrival (>180 min) were associated with DOU care. These findings will help to triage epistaxis patients before they visit the ED. [ABSTRACT FROM AUTHOR]

Aim: This research aims to examine the effects of variables that can affect COVID-19 deaths and cases in Organisation for Economic Co-operation and Development (OECD) countries during the years 2020 (first wave), 2021 (vaccine available), and 2022 (vaccine available and Omicron variant appeared). Material and method: The factors that are thought to affect the case and death rates in 37 OECD countries were examined by multiple linear regression analysis using SPSS 22. The dependent variables were the COVID-19 deaths and cases per 10,000 (in 2020, 2021, and 2022); the independent variables were universal health coverage, physicians, nurses, intensive care beds, hospital beds, non-communicable diseases mortality per 100,000 people, population over 65 years of age, out-of-pocket expenditure, private expenditure, and health expenditure per capita and percent of % GDP. Results: It was determined that the non-communicable diseases mortality is the relatively important variable COVID-19 cases and deaths in 2020 and 2021. After controlling for the scores of other variables, according to the ß coefficients, a one-unit increase in the number of physicians variable increases COVID-19 cases by 1.14 units in 2022; a one-unit increase in the universal coverage variable decreases COVID-19 deaths by 0.33 units in 2022. Conclusion: The results of this research provide evidence that the effects of the COVID-19 outbreak have changed between 2020, the first wave of the epidemic, 2021, when the vaccine is available, and 2022, when both the vaccine is available and the Omicron variant is seen. With the increase in vaccination in 2022, the impact of non-communicable diseases mortality on the number of COVID-19 cases has decreased. [ABSTRACT FROM AUTHOR]

Background: The latest update to the Australian adenoma surveillance guideline in 2018 introduced a novel risk stratification system with updated surveillance recommendations. The resource implications of adopting this new system are unclear. Aims: To quanitfy the resource demands of adopting new over old adenoma surveillance guidelines. Methods: We studied data from 2443 patients undergoing colonoscopies, in which a clinically significant lesion was identified in their latest, or previous procedure(s) across five Australian hospitals. We excluded procedures with inflammatory bowel disease, new or prior history of colorectal cancer or resection, inadequate bowel preparation and incomplete procedures. Old and new Australian surveillance intervals were calculated according to the number, size and histological characteristics of lesions identified. We used these data to compare the rate of procedures according to each guideline. Results: Based on the procedures for 766 patients, the new surveillance guidelines significantly increased the number of procedures allocated an interval of 1 year (relative risk (RR): 1.57, P = 0.009) and 10 years (RR: 3.83, P < 0.00001) and reduced those allocated to half a year (RR: 0.08, P = 0.00219), 3 years (RR: 0.51, P < 0.00001) and 5 years (RR: 0.59, P < 0.00001). Overall, this reduced the relative number of surveillance procedures by 21% over 10 years (25.92 vs 32.78 procedures/100 patient‐years), which increased to 22% after excluding patients 75 or older at the time of surveillance (19.9 vs 25.65 procedures/100 patient‐years). Conclusion: The adoption of the latest Australian adenoma surveillance guidelines can reduce demand for surveillance colonoscopy by more than a fifth (21–22%) over 10 years. [ABSTRACT FROM AUTHOR]

Efforts to address limitations in cancer diagnostics in low‐ and middle‐income countries should follow an approach that avoids two extremes: unproductive attempts to require implementation of high‐income country gold standards or acquiescence to the diagnostic status quo. The relative advantage of implementing new diagnostic tests (including sequencing‐based approaches) should be determined through comparison to local standards of care, with context‐specific clinical utility determined using locally available therapeutic options. [ABSTRACT FROM AUTHOR]

Cancer survivors often rely on the internet for health information, which has varying levels of readability, suitability, and quality. There is a need for high-quality online self-management resources for cancer survivors with fear of cancer recurrence (FCR). This study evaluated the readability, suitability, and quality of publicly available online FCR self-management resources. A Google search using FCR-related keywords identified freely available FCR self-management resources for cancer survivors in English. Resource readability (reading grade level), suitability, and quality were evaluated using relevant assessment tools. Descriptive statistics and cluster analysis identified resources with higher suitability and quality scores. Mean resource (n = 23) readability score was grade 11 (SD = 1.6, Range = 9–14). The mean suitability score was 56.0% (SD = 11.4%, Range = 31.0–76.3%), indicating average suitability and the mean quality score was 53% (SD = 11.7%, Range = 27–80%), indicating fair quality. A cluster of 15 (65%) resources with higher suitability and quality scores was identified. There were no significant associations between suitability or quality scores and the type of organisation that published the resources. Online FCR self-management resources varied in readability, suitability and quality. Resources with higher quality and suitability scores relative to other resources are identified for use by healthcare professionals and cancer survivors. Resources that are more culturally appropriate, with lower reading grade levels and detailed self-management strategies are needed. [ABSTRACT FROM AUTHOR]