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BACKGROUND: Mental, neurological, and substance abuse (MNS) disorders describe a range of conditions that affect the brain and cause distress or functional impairment. In the Middle East and North Africa (MENA), MNS disorders make up 10.88 percent of the burden of disease as measured in disability-adjusted life years. The Kingdom of Saudi Arabia (KSA) is one of the main providers of mental health services and one of the largest contributors to mental health research in the region. Within the past decade, mental health resources and services has increased. METHODS: We employ a needs-based workforce estimate as a planning exercise to arrive at the total number of psychiatrists, nurses, and psychosocial care providers needed to meet the epidemiological need of mental health conditions of the population of KSA. Estimates for a potential mental health workforce gap were calculated using five steps: Step 1-Quantify target population for priority mental health conditions. Step 2-Identify number of expected cases per year. Step 3-Set target service coverage for each condition. Step 4-Estimate cost-effective health care service resource utilization for each condition. Step 5-Estimate service resources needed for each condition. RESULTS: The planning exercise indicates an epidemiologic need for a total of 17,100 full-time-equivalent (FTE) health care providers to treat priority MNS disorders. KSA appears to have a need-based shortage of 10,400 health workers to treat mental disorders. A total of 100 psychiatrists, 5700 nurses, and 4500 psychosocial care providers would be additionally needed (that is, above and beyond current levels) to address the priority mental health conditions. The shortfall is particularly severe for nurses and psychosocial workers who make up 98.9 percent of the shortfall. This shortage is substantial when compared to other high-income countries. Overall, the workforce needed to treat MNS conditions translates to 49.2 health workers per 100,000 population. CONCLUSION: Challenges to addressing the shortfall are Saudi specific which includes awareness of cultural customs and norms in the medical setting. These challenges are compounded by the lack of Saudi nationals in the mental health workforce. Saudi nationals make up 29.5 percent of the physician workforce and 38.8 percent of the nursing workforce. Policymakers and planners supplement this shortfall with non-Saudi providers, who must be mindful of Saudi-specific cultural considerations. Potential solutions to reducing the shortfall of mental health care workers includes nurse task shifting and training of general practitioners to screen for, and treat, a subset of MNS disorders.

BackgroundObstructive sleep apnea (OSA) contributes to the generation, recurrence, and perpetuation of atrial fibrillation, and it is associated with worse outcomes. Little is known about the economic impact of OSA therapy in atrial fibrillation. This retrospective cohort study assessed the impact of positive airway pressure (PAP) therapy adherence on health care resource use and costs in patients with OSA and atrial fibrillation.Methods and resultsInsurance claims data for ≥1 year before sleep testing and 2 years after device setup were linked with objective PAP therapy use data. PAP adherence was defined from an extension of the US Medicare 90-day definition. Inverse probability of treatment weighting was used to create covariate-balanced PAP adherence groups to mitigate confounding. Of 5867 patients (32% women; mean age, 62.7 years), 41% were adherent, 38% were intermediate, and 21% were nonadherent. Mean±SD number of all-cause emergency department visits (0.61±1.21 versus 0.77±1.55 [P=0.023] versus 0.95±1.90 [P

BACKGROUND: To address needs for emotional well-being resources for Californians during the COVID-19 pandemic, the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website was developed in collaboration with multiple community partners across California, funded by the California Department of Health Care Services Behavioral Health Division federal emergency response. OBJECTIVE: This qualitative study was designed to explore and describe the perspectives of participants affiliated with California organizations on the T4W/Juntos website, understand their needs for web-based emotional health resources, and inform iterative website development. METHODS: After providing informed consent and reviewing the website, telephone interviews were conducted with 29 participants (n=21, 72% in English and n=8, 28% in Spanish) recruited by partnering community agencies (October 2021-February 2022). A 6-phase thematic analysis was conducted, enhanced using grounded theory techniques. The investigators wrote reflexive memos and performed line-by-line coding of 12 transcripts. Comparative analyses led to the identification of 15 overarching codes. The ATLAS.ti Web software (ATLAS.ti Scientific Software Development GmbH) was used to mark all 29 transcripts using these codes. After examining the data grouped by codes, comparative analyses led to the identification of main themes, each with a central organizing concept. RESULTS: Four main themes were identified: (1) having to change my coping due to the pandemic, (2) confronting a context of shifting perceptions of mental health stigma among diverse groups, (3) Feels like home-experiencing a sense of inclusivity and belonging in T4W/Juntos, and (4) Its a one-stop-shop-judging T4W/Juntos to be a desirable and useful website. Overall, the T4W/Juntos website communicated support and community to this sample during the pandemic. Participants shared suggestions for website improvement, including adding a back button and a drop-down menu to improve functionality as well as resources tailored to the needs of groups such as older adults; adolescents; the lesbian, gay, bisexual, transgender, and queer community; police officers; and veterans. CONCLUSIONS: The qualitative findings from telephone interviews with this sample of community members and service providers in California suggest that, during the COVID-19 pandemic, the T4W/Juntos website was well received as a useful, accessible tool, with some concerns noted such as language sometimes being too professional or clinical. The look, feel, and content of the website were described as welcoming due to pictures, animations, and videos that showcased resources in a personal, colorful, and inviting way. Furthermore, the content was perceived as lacking the stigma typically attached to mental health, reflecting the commitment of the T4W/Juntos team. Unique features and diverse resources, including multiple languages, made the T4W/Juntos website a valuable resource, potentially informing dissemination. Future efforts to develop mental health websites should consider engaging a diverse sample of potential users to understand how to tailor messages to specific communities and help reduce stigma.

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]

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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]

Objective: To analyse the incidence and risk of recurrent major adverse cardiovascular events (MACE), level of risk factor control, treatment persistence and cost of the CNIC polypill version containing acetylsalicylic acid (ASA) 100 mg, atorvastatin 20 mg (A20), and ramipril 2.5, 5.0 or 10 mg in secondary cardiovascular prevention patients. Method: Subanalysis of the observational, retrospective, multicentre, NEPTUNO study in patients treated for two years with the CNIC polypill A20, the same monocomponents as single drugs, equipotent drugs, and other therapies. Results: 922 patients were included in each group. The risk of recurrent MACE was lower among CNIC A20 polypill users than all others (21%, 23% and 26% increased risk among the monocomponents, equipotent or other therapy cohorts, respectively; p < 0.05). The magnitude of the mean change in low-density lipoprotein cholesterol and blood pressure, as well as the increase in the proportion of patients achieving target goals, was also greater among patients treated with the CNIC A20 polypill than in any of the other cohorts (all p < 0.001). Treatment persistence was significantly higher in patients treated with the CNIC A20 polypill (p < 0.001) and was a less costly strategy than any other therapeutic option. Conclusions: In patients in secondary cardiovascular prevention, the CNIC A20 polypill (ASA 100 mg, atorvastatin 20 mg, and ramipril 2.5, 5.0 or 10 mg) constitutes a valid therapeutic option with similar benefits and outcomes to the version of the polypill with atorvastatin 40 mg. [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.

Background Health care workers are vital service providers in primary healthcare, playing a crucial role in safeguarding public health, disease prevention, and chronic disease management. At present, research on healthcare resources mainly focuses on the quantity and structure, and there are few studies on the spatial distribution characteristics of healthcare resources. Objectives To analyze the spatial development trend of healthcare human resources in primary healthcare institutions nationwide, and to provide reference for optimizing the spatial allocation of healthcare resources and upgrading the level of primary healthcare services. Methods The data for this study were obtained during 2013-2017 China Health and Family Planning Statistical Yearbook, the 2018-2022 China Health and Wellness Statistical Yearbook, and the annual data of the National Bureau of Statistics (NBS) by province and the Ministry of Civil Affairs of China. From February to June 2023, the health density index (HRDI) was used to comprehensively reflect the demographic and geographic distribution of primary health care in China from 2012 to 2021, spatial autocorrelation analysis was applied to calculate the global Moran's I index to characterize the spatial distribution of primary health care resources in China from 2012 to 2021 analysis, and calculate the local Getis's G index to analyze the hotspots of primary care resource allocation in China from 2012 to 2021. Results The number of practicing physicians and nurses per 1 000 population at the grassroots level has increased in all regions of China, and the ratio of healthcare to nursing is still low. The high HRDI values for the number of practicing (assistant) physicians and nurses were in the eastern region, while the western region had lower HRDI values. The global Moran's I index for the number of practicing (assistant) physicians turned from negative to positive in 2016. The Moran's I index for nurses was always negative, but the overall trend was gradually approaching 0. Western regions such as Xinjiang and Xizang have low health density indices and are cold spots for resource distribution. Conclusion The allocation of medical and nursing resources to primary health care organizations has been increasing year by year, but there are obvious differences in allocation between provinces. The spatial correlation between physicians has gradually increased, and nurses have become more dispersed in their spatial distribution. It is recommended that the reserve of primary care physicians and nurses be strengthened, and that the ratio and collaboration between physicians and nurses be improved; that the planning of health care resources take into account both demographic and geographic configurations, and that Internet-based health care be promoted to improve the accessibility of health care services; and that the investment of resources in central and western China be increased, and that the construction of health care organizations be pushed forward in order to enhance the capacity of grass-roots-level services.

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 China is gradually entering an ageing society and the health of the middle-aged and elderly is a growing concern, with chronic diseases such as hypertension, diabetes, coronary heart disease and stroke becoming major health threats. At the same time, the uneven distribution of health resources has led to regional differences in medical level and service quality. Objective To explore the correlation between the prevalence of chronic diseases, regional differences in the types of diseases and health care resources among middle-aged and elderly people in China. Methods A total of 19 520 middle-aged and older adults ≥45 years of age were selected by cleaning, organizing and statistically analyzing the data from the China Health and Retirement Longitudinal Study (CHARLS) 2018 from October 2022 to March 2023, and 2018 statistics from the China Health Statistics Yearbook (2011-2020) were selected as the corresponding data related to health resources. Multiple linear regression analysis was used to analyze the correlation between Theil index of the number of beds, number of health technicians [practicing (assistant) physicians, registered nurses, rural doctors and health workers], financial expenditures (total health expenditure), number of health institutions (hospitals, primary care institutions, professional public health institutions) and the prevalence of chronic diseases in middle-aged and elderly people in each province. Results There were significant differences in the prevalence of chronic diseases (χ2=57.900, P

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.

BackgroundEsophageal squamous cell carcinoma (ESCC) is a major cause of cancer morbidity and mortality in Eastern Africa. The majority of patients with ESCC in Eastern Africa present with advanced disease at the time of diagnosis. Several palliative interventions for ESCC are currently in use within the region, including chemotherapy, radiation therapy with and without chemotherapy, and esophageal stenting with self-expandable metallic stents; however, the comparative effectiveness of these interventions in a low resource setting has yet to be examined.MethodsThis prospective, observational, multi-center, open cohort study aims to describe the therapeutic landscape of ESCC in Eastern Africa and investigate the outcomes of different treatment strategies within the region. The 4.5-year study will recruit at a total of six sites in Kenya, Malawi and Tanzania (Ocean Road Cancer Institute and Muhimbili National Hospital in Dar es Salaam, Tanzania; Kilimanjaro Christian Medical Center in Moshi, Tanzania; Tenwek Hospital in Bomet, Kenya; Moi Teaching and Referral Hospital in Eldoret, Kenya; and Kamuzu Central Hospital in Lilongwe, Malawi). Treatment outcomes that will be evaluated include overall survival, quality of life (QOL) and safety. All patients (≥18 years old) who present to participating sites with a histopathologically-confirmed or presumptive clinical diagnosis of ESCC based on endoscopy or barium swallow will be recruited to participate. Key clinical and treatment-related data including standardized QOL metrics will be collected at study enrollment, 1 month following treatment, 3 months following treatment, and thereafter at 3-month intervals until death. Vital status and QOL data will be collected through mobile phone outreach.DiscussionThis study will be the first study to prospectively compare ESCC treatment strategies in Eastern Africa, and the first to investigate QOL benefits associated with different treatments in sub-Saharan Africa. Findings from this study will help define optimal management strategies for ESCC in Eastern Africa and other resource-limited settings and will serve as a benchmark for future research.Trial registrationThis study was retrospectively registered with the ClinicalTrials.gov database on December 15, 2021,  NCT05177393 .

Background "Strengthening primary health care" is one of the focuses of China's health care reform, and the study of the efficiency and equity of rural medical and health resources allocation in China is of great significance in promoting the orderly development of primary health care services, but at present, there are few relevant literature based on the DEA-GIS methodology with both equity and efficiency. Objective To analyze the efficiency and equity of rural medical and health resources allocation in 29 provinces in China in 2020, in order to provide a reference for optimizing the allocation of rural medical and health resources and improving the rural medical and health service system in China. Methods The data for this study were collected from the Statistical Tables of Administrative Divisions of the People's Republic of China, the 2021 China Health Statistical Yearbook. After synthesizing the existing literature research, data availability and soliciting expert advice, the township hospitals and village clinics in 29 provinces in China (excluding Beijing, Shanghai, Hong Kong, Macao and Taiwan) were selected as the study objects, and the number of township hospitals and village clinics (hereinafter referred to as the number of health institutions) , the number of beds in township hospitals (hereinafter referred to as the number of beds) , and the number of health technicians in township hospitals and village clinics (hereinafter referred to as the number of health technicians) were used as input indicators; the number of consultations in township hospitals and village clinics (hereinafter referred to as the number of consultations) , and the number of hospital admissions to township hospitals (hereinafter referred to as the number of admissions) were used as output indicators. The data envelopment analysis (DEA) model was used to assess the efficiency of rural medical and health resources allocation in China, and the health resource agglomeration degree and geographic information system (GIS) technology were used to spatially map the rural medical and health resources allocation to analyze its equity. Results In 2020, China's rural medical and health resources had 4 provinces with effective DEA, 7 provinces with weakly effective DEA, and 18 provinces with ineffective DEA. Among them, the DEA ineffective regions all had different degrees of excess inputs, and only Shandong Province and Tibet Autonomous Region had insufficient outputs. The results of regional analysis showed that rural medical and health resources were concentrated in the eastern region, followed by the central region, with the lowest degree of concentration in the western region. Conclusion The government needs to pay attention to improving the technical efficiency of rural medical and health resources allocation, and promote equity and efficiency by applying precise measures to each region based on optimizing the input and output structure, reducing resource redundancy, rationally coordinating the allocation of resources in the eastern, central and western regions.

Background The aging of our population and the intensification of major chronic disease problems will inevitably lead to an increase in the number of disabled people, resulting in increased pressure on social care and a heavier burden on the government and families for the elderly. At the same time, the unbalanced allocation of health resources will pose even more serious challenge to the medical treatment and nursing care of the disabled population. Objective To explore the differences of disability rate, disability degree and influencing factors among middle-aged and elderly people in eastern, central and western regions of China. Methods Data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) were analyzed from 2022-10-05 to 2023-01-13, and 19 170 middle-aged and elderly people aged 45 years and above were selected as the study subjects. Activities of daily living (ADL) and instrumental activities of daily living (IADL) scales were used to determine disability. The situation and degree of disability in middle-aged and elderly people were considered as dependent variables, and independent variables were selected from three aspects of general demographic characteristics, health evaluation and lifestyle according to CHARLS data questionnaire. Binary and multivariate Logistic regression analyses were conducted to analyze the factors affecting the disability and degree of disability of middle-aged and elderly people in eastern, central and western regions of China. Results Comparison of the rate and degree of disability among middle-aged and elderly people in eastern, central and western regions showed statistically significant differences (χ2=143.014, P

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.

Background In the context of increasing aging, diversified medical needs of the elderly and the constrains of medical resources, the demand for home-based medical services is increasing. Therefore, the development of home-based medical services are strongly encouraged in China. Sichuan Province, as a pilot area for geriatric home-based medical services, is currently operating mainly in primary health care institutions, and it is necessary to explore its condition and the current situation of service development. Objective To investigate the condition and current situation of home-based medical service of primary health care institutions in Sichuan Province, so as to provide reference for further promoting the standardization and development of home-based medical services. Methods From August to October 2021, a convenience sampling method was used to select the relevant persons in charge of 62 primary health care institutions in 7 cities in Sichuan Province as the subjects. Through self-designed questionnaires, data collection and survey analysis were conducted on the general information, human resources, the development of home health care and obstacles of the situations. Results Among the 62 primary health care institutions, the number of full-time medical staff varied widely, ranging from 10 to 316, with a median of 40 (40). The average proportion of medical staff to full-time employees was (84.9±11.3) %; the median percentage of physicians with junior titles or lower was 45.5% (24.2%), and the median percentage of nurses with junior titles or lower was 71.9% (34.2%) ; the medical-to-nursing ratio ranged from 0.43 to 2.63, with an average of (1.44±0.50). The differences were statistically significant when comparing the participation in accreditation of graded hospitals and part-time medical and nursing staff with the different locations of the institutions (P

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.