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Most new medicines entering the market are high‐cost speciality drugs. These drugs can cost tens to hundreds of thousands of dollars per course of treatment and in some cases millions of dollars per dose. Approximately half of all spending on medicines is projected to target only 2–3% of patients, raising important questions about resource allocation. While there is no doubt that breakthrough innovations have transformed clinical care in some disciplines, it is also true that cost is becoming one of the primary barriers to treatment access and that many new medicines do not provide value commensurate with their prices. This article examines pricing trends, the reasons for high prices and their implications for access and clinical practice. [ABSTRACT FROM AUTHOR]

Background: 'High-cost' individuals with multimorbidity account for a disproportionately large share of healthcare costs and are at most risk of poor quality of care and health outcomes. Aim: To compare high-cost with lower-cost individuals with multimorbidity and assess whether these populations can be clustered based on similar disease patterns. Design and setting: A cross-sectional study based on 2019/2020 electronic medical records from adults registered to primary care practices (n = 41) in a London borough. Method: Multimorbidity is defined as having ≥2 long-term conditions (LTCs). Primary care costs reflected consultations, which were costed based on provider and consultation types. High cost was defined as the top 20% of individuals in the cost distribution. Descriptive analyses identified combinations of 32 LTCs and their contribution to costs. Latent class analysis explored clustering patterns. Results: Of 386 238 individuals, 101 498 (26%) had multimorbidity. The high-cost group (n = 20 304) incurred 53% of total costs and had 6833 unique disease combinations, about three times the diversity of the lower-cost group (n = 81 194). The trio of anxiety, chronic pain, and depression represented the highest share of costs (5%). High-cost individuals were best grouped into five clusters, but no cluster was dominated by a single LTC combination. In three of five clusters, mental health conditions were the most prevalent. Conclusion: High-cost individuals with multimorbidity have extensive heterogeneity in LTCs, with no single LTC combination dominating their primary care costs. The frequent presence of mental health conditions in this population supports the need to enhance coordination of mental and physical health care to improve outcomes and reduce costs. [ABSTRACT FROM AUTHOR]

We examined healthcare costs at HonorHealth, a community-based academic health center comprised of 5 hospitals and numerous ambulatory care facilities. Patient encounters that resulted in admission in 2019 were included in the study. Mean costs in 2019 for high costs and high needs (HCHN) patients were compared with all remaining patients using a framework developed by the National Academy of Medicine. HCHN patients were older (71 vs 52 years), with a lower percentage of females (41.7% vs 59.8%), more frequently White (90.1% vs 87.5%), less frequently married (52.4% vs 54.5%), with a longer length of stay (6.5 vs 3.0 days) and higher mean charges ($134 743 vs $16 414). The mean cost per patient in the HCHN group decreased by age group ($192, 963, $165 200, $144 584, $134 795, and $108 356) for 0 to 18, 19 to 44, 45 to 64, 65 to 84, and 85+ years, respectively. HCHN patients were more publicly insured (49% vs 38%). Targeted interventions to treat HCHN may lead to lower healthcare costs and improved health outcomes within this system. [ABSTRACT FROM AUTHOR]

The high cost of imported fishmeal as animal protein source is one of the limiting factors in raising broiler chickens particularly in Nigeria. Maggots are housefly larvae that are rich in protein which could be used as alternative to fishmeal in broiler production. This study assessed differently processed Maggot Meal (MM) as replacement for fishmeal in broilers diet in a completely randomized design. A total of 144 day old Arbor Acre broilers were randomly divided into 4 treatments. Each treatment (of 36 birds) was replicated thrice of 12 birds per replicate. Maggots were produced using blood and wheat offal as substrates in ratio 4:1 using either mango or intestinal offal as flies attractant. The maggots matured within 5days and harvested. The maggots were processed by sun-drying, oven drying and roasting. Four experimental diets were formulated for the study. A corn-soybean meal based diet that contained imported fishmeal was denoted as control. Sun dried MM, oven dried MM and roasted MM replaced imported fishmeal wholly denoting T1, T2 and T3, respectively. Data were collected on maggot yield, growth performance, nutrient digestibility and serum enzymes of experimental birds. Data collected were analyzed using One-Way Analysis of Variance. The results showed that the maggots yield from the substrates and intestinal offal as fly attractant produced more maggots than using mango as flies attractant. The highest crude protein (CP) was observed in roasted MM (43.75%). Broiler chickens fed roasted MM had final body weight comparable (P > 0.050) to the control. Broiler chickens fed roasted maggot meal had the highest (P = 0.011) CP digestibility (70.68%). Serum aspartate aminotransferase (AST) was significantly (P = 0.002) elevated for broiler chickens fed sun dried and oven dried maggot meals. In conclusion, processing maggots by roasting was the best for enhanced crude protein digestibility without any deleterious effect on serum enzymes.

ObjectivesTo examine high-cost patients in VA and factors associated with persistence in high costs over time.Data sourcesSecondary data for FY2008-2012.Data extractionWe obtained VA and Medicare utilization and cost records for VA enrollees and drew a 20 percent random sample (N = 1,028,568).Study designWe identified high-cost patients, defined as those in the top 10 percent of combined VA and Medicare costs, and determined the number of years they remained high cost over 4 years. We compared sociodemographics, clinical characteristics, and baseline utilization by number of high-cost years and conducted a discrete time survival analysis to predict high-cost persistence.Principal findingsAmong 105,703 patients with the highest 10 percent of costs at baseline, 68 percent did not remain high cost in subsequent years, 32 percent had high costs after 1 year, and 7 percent had high costs in all four follow-up years. Mortality, which was 47 percent by end of follow-up, largely explained low persistence. The largest percentage of patients who persisted as high cost until end of follow-up was for spinal cord injury (16 percent).ConclusionMost high-cost patients did not remain high cost in subsequent years, which poses challenges to providers and payers to manage utilization of these patients.

The high cost of imported fishmeal as animal protein source is one of the limiting factors in raising broiler chickens particularly in Nigeria. Maggots are housefly larvae that are rich in protein which could be used as alternative to fishmeal in broiler production. This study assessed differently processed Maggot Meal (MM) as replacement for fishmeal in broilers diet in a completely randomized design. A total of 144 day old Arbor Acre broilers were randomly divided into 4 treatments. Each treatment (of 36 birds) was replicated thrice of 12 birds per replicate. Maggots were produced using blood and wheat offal as substrates in ratio 4:1 using either mango or intestinal offal as flies attractant. The maggots matured within 5days and harvested. The maggots were processed by sun-drying, oven drying and roasting. Four experimental diets were formulated for the study. A corn-soybean meal based diet that contained imported fishmeal was denoted as control. Sun dried MM, oven dried MM and roasted MM replaced imported fishmeal wholly denoting T1, T2 and T3, respectively. Data were collected on maggot yield, growth performance, nutrient digestibility and serum enzymes of experimental birds. Data collected were analyzed using One-Way Analysis of Variance. The results showed that the maggots yield from the substrates and intestinal offal as fly attractant produced more maggots than using mango as flies attractant. The highest crude protein (CP) was observed in roasted MM (43.75%). Broiler chickens fed roasted MM had final body weight comparable (P > 0.050) to the control. Broiler chickens fed roasted maggot meal had the highest (P = 0.011) CP digestibility (70.68%). Serum aspartate aminotransferase (AST) was significantly (P = 0.002) elevated for broiler chickens fed sun dried and oven dried maggot meals. In conclusion, processing maggots by roasting was the best for enhanced crude protein digestibility without any deleterious effect on serum enzymes. [ABSTRACT FROM AUTHOR]

Background: Interventions to support patients with complex needs have proliferated in recent years, but the question of how to identify patients with complex needs has received relatively little attention. There are innumerable ways to structure inclusion and exclusion criteria for complex care interventions, and little is known about the implications of choices made in designing patient selection criteria. Objective: To provide insights into the design of patient selection criteria for interventions, by implementing criteria sets within a large health plan member population and comparing the characteristics of the resulting complex patient cohorts. Design: Retrospective observational descriptive study. Subjects: Patients identified as having complex needs, within the membership population of Kaiser Permanente Southern California, a large, population-based health plan with more than 4 million members. We characterize five commonly used archetypes of complex needs: high-cost patients, patients with multiple chronic conditions, frail elders, emergency department high-utilizers, and inpatient high-utilizers. Measures: We selected an initial set of criteria for identifying patients in each of the archetypical complex populations, based on available administrative data. We then tested multiple variants of each definition. We compared the resulting patient cohorts using univariate and bivariate descriptive statistics. Key Results: Overall, 32.7% of the 3,112,797 adults in our population-based sample were selected by at least one of the 25 definitions of complexity we tested. Across definitions the total number of patients identified as complex ranged from 622,560 to 1583 and complex patient cohorts varied widely in demographic characteristics, chronic conditions, healthcare utilization, spending, and survival. Conclusions: Choice of patient population is critical to the design of complex care programs. Exploratory analyses of population criteria can provide useful information for program planning in the setting of limited resources for interventions. Data such as these should be generated as a key step in program design. [ABSTRACT FROM AUTHOR]

In the US, many people are excluded from healthcare structures and systems, due to multiple macro and micro factors. Poverty, health ecosystems, mental health, and community amenities are some of the issues confronting those who are not able to access appropriate support. This population is often referred to as ‘high needs, high cost’ (HNHC), a term that has been applied to refer to people who repeatedly utilize services without significant benefit (we have replaced this term with ‘currently under-served’; C-US). For many traditional health solutions may not address the fundamental issues confronting their health. Community-Engaged Healthcare (CEH) is an approach that equips members of the community to levy power to advocate for their own health or social solutions, designing their own interventions to address needs with support from health providers. A realist review was conducted to identify the existing literature around CEH. This yielded ten papers that were reviewed by at least two authors and rated in terms of quality. A model describing the processes underpinning CEH was then iteratively generated, resulting in additional terms that were used in a second review of the literature. A further 16 peer-reviewed articles were identified and were independently reviewed and quality rated. These articles were used to refine further iterations of the model and included in the review where appropriate. The resulting model schematically posits a set of relational factors identified to be important in the establishment of CEH. Notably, the transfer of autonomy and power over health decision-making processes is emphasized, which will require revolutionary thinking about how healthcare is delivered for patients.

Abstract Aims This study aimed to determine the characteristics of patients with heart failure and high costs (top 1% and top 2–5% highest costs in perspective of the general population) and to explore the longitudinal health care utilization and persistency of high costs. Methods and results Longitudinal observational study using claims data from 2006 to 2014 in the Netherlands. We identified all patients that received a hospital treatment for chronic heart failure between 1 January 2008 and 31 December 2010. Of each selected patient, all claims from the Dutch curative health system and with a starting date between 1 January 2006 and 31 December 2014 were extracted. Pharmaceutical and hospital claims were used to establish characteristics and indicators for health care utilization. Descriptive analyses and generalized estimating equation models were used to analyse characteristics, longitudinal health care utilization and to identify factors associated with high costs. Our findings revealed that the difference in costs between top 1%, top 2–5%, and bottom 95% patients with heart failure was mainly driven by hospital costs; and the top 1% group experienced a remarkable increase of mental health costs. Top 1% and top 2–5% patients with heart failure differed from lower cost patients in their higher rate of chronic conditions, excessive polypharmacy, hospital admissions, and heart‐related surgeries. Heart‐related surgeries contributed to the incidental high costs in 54% of top 1% patients, and the costs of the remaining top 1% patients were driven by mental health and pharmaceuticals use and rates of chronic conditions and multimorbidity. Top 1% patients were relatively young. Anaemia, dementia, diseases of arteries, veins and lymphatic vessels, influenza, and kidney failure were significantly associated with high costs. The end‐of‐life period was predictive of top 1% and top 5% costs. More than 90% of the population incurred at least one top 5% year during follow‐up, and 31.8% incurred at least one top 1% year. Fifty‐seven per cent incurred multiple top 5% years whereas only 8.6% incurred multiple top 1% years. Top 5% years were more frequently consecutive than top 1% years. Conclusions Top 1% utilization occurs predominantly incidentally and among less than a third of patients with heart failure, whereas almost all patients with heart failure experience at least one top 5% year, and more than half experience two or more top 5% years. Both medical and psychiatric/psychosocial needs contribute to high costs in heart failure patients. Comprehensive and integrated efforts are needed to further improve quality of care and reduce unnecessary costs.

Information retrieval systems are widely used by people from all walks of life to meet diverse user needs. Hence, the ability of these retrieval systems to return the relevant information in response to user queries has been a matter of concern to the information retrieval research community. To address this concern, evaluations of these retrieval systems is extremely critical and the most popular way is the approach that employs test collections. This approach has been the popular evaluation approach in information retrieval for several decades. However, one of the limitations of this evaluation approach concerns the costly creation of relevance judgments. In recent research, this limitation was addressed by predicting performance metrics at the high cut-off depths of documents by using performance metrics computed at low cut-off depths. However, the challenge the research community is faced with is how to predict the precision and the non-cumulative gain performance metrics at the high cut-off depths of documents while using other performance metrics computed at the low cut-off depths of at most 30 documents. This study addresses this challenge by investigating the predictability of performance metrics and proposing two approaches that predict the precision and the non-cumulative discounted gain performance metrics. This study has shown that there exist dataset shifts in the performance metrics computed from different test collections. Furthermore, the proposed approaches have demonstrated better results of the ranked correlations of the predictions of performance metrics than existing research. [ABSTRACT FROM AUTHOR]

Endometriosis is an estrogen-dependent chronic disease characterized by the presence of endometriumlike tissue outside the uterus and is often associated with symptoms, such as dysmenorrhea, dysuria, dyschezia, chronic pelvic pain, and infertility. Moreover, women diagnosed with endometriosis can report gastrointestinal symptoms, including bloating, constipation or diarrhea, and abdominal cramping, which can be associated with irritable bowel syndrome and can result in the misdiagnosis of endometriosis as irritable bowel syndrome at first. Treatment usually involves hormonal therapy, pain management, surgery, and/or assisted reproductive techniques in case of infertility. Nonetheless, these treatment methods can be insufficient for alleviating symptoms or can have unacceptable side effects, leading to noncompliance. Therefore, women often apply self-management strategies, including dietary interventions. One of the diets frequently suggested as a tool to manage endometriosis-related symptoms on social media and patient forums is a gluten-free diet. Although a gluten-free diet has been proven effective in managing nonceliac wheat sensitivity or celiac disease, its effectiveness in endometriosis remains uncertain. The Nurses' Health Study II found it unlikely that gluten intake was a strong factor in endometriosis etiology and symptomatology. To the best of our knowledge, the most frequently cited and sole published intervention study on the efficacy of a gluten-free diet for endometriosis has several important limiting factors, including the absence of a control group. In addition, gluten consumption is highly susceptible to a placebo effect and a nocebo effect, where women might experience symptom relief after eliminating gluten and return of symptoms after they consume gluten again, solely because they believe that gluten is bad for them. Despite the inverse association between body mass index and endometriosis and between a gluten-free diet and increased body mass index, this is an association, and no causality was proven. In addition, other factors should be taken into consideration. Of note, a gluten-free diet is expensive, has limited availability, and has a significant effect on quality of life. Moreover, without proper dietary guidance, it may adversely affect the gastrointestinal microbiome. Therefore, scientifically substantiated advice regarding the use of a gluten-free diet for endometriosis-related symptoms is currently not available, and a gluten-free diet should be discouraged unless there is an additional diagnosis of nonceliac wheat sensitivity or celiac disease., (© 2024 The Authors.)

Background: Improving care for high-cost patients is increasingly important for improving the value of healthcare. Most prior research has focused on identifying patients with high costs, but the extent to which these costs are potentially preventable remains unclear. Objective: To identify patients with persistent preventable utilization and compare their characteristics with high-cost patients. Design: Descriptive analysis using Medicare claims data from 2013 to 2014. Participants: Medicare fee-for-service and dual-eligible beneficiaries (N = 515,689) from the New York metropolitan area who were continuously enrolled in Medicare Parts A and B in 2013 and 2014. Main Measures: The primary analysis focuses on patients with persistent preventable utilization (at least one preventable emergency department visit, hospitalization, or 30-day readmission in both 2013 and 2014) and high-cost patients in 2014 (top 10% of total annual spending). We compared demographic, medical, behavioral, and social characteristics and total and preventable healthcare utilization between these two groups. Key Results: Patients with persistent preventable utilization accounted for 4.8% of the overall patient population, 13.4% of overall costs, but 46.2% of preventable costs among all Medicare patients. Compared with high-cost patients, patients with persistent preventable utilization had lower median healthcare costs ($33,383 vs. $56,552), but their median potentially preventable costs were seven times higher ($7151 vs. $928). We also found that 1.9% of patients could be categorized in both the persistent preventable utilization group and the high-cost group. This subset of patients had the highest median Medicare costs and preventable costs and represented over 30% of total preventable spending and 9.4% of overall costs among all Medicare patients. Conclusion: Designing and targeting interventions for patients with persistent preventable utilization may offer an important opportunity to reduce unnecessary utilization and promote high-value care. [ABSTRACT FROM AUTHOR]

Large offshore wind farms located far from shore, as are being planned or built in the North Sea, will require high-voltage DC (HVDC) transmission to shore, and multi-terminal HVDC could offer further benefits. Currently proposed methods to protect against faults in the DC network are based on extremely fast-acting DC circuit breakers located on all cable ends, leading to high cost. A method is proposed based around discharging the DC network to isolate the fault, which drastically reduces the circuit breaker requirement, while making use of the inherent current-limiting behaviour of the wind turbines. The validity of this approach is demonstrated in simulation.

Aims: This study aimed to determine the characteristics of patients with heart failure and high costs (top 1% and top 2–5% highest costs in perspective of the general population) and to explore the longitudinal health care utilization and persistency of high costs. Methods and results: Longitudinal observational study using claims data from 2006 to 2014 in the Netherlands. We identified all patients that received a hospital treatment for chronic heart failure between 1 January 2008 and 31 December 2010. Of each selected patient, all claims from the Dutch curative health system and with a starting date between 1 January 2006 and 31 December 2014 were extracted. Pharmaceutical and hospital claims were used to establish characteristics and indicators for health care utilization. Descriptive analyses and generalized estimating equation models were used to analyse characteristics, longitudinal health care utilization and to identify factors associated with high costs. Our findings revealed that the difference in costs between top 1%, top 2–5%, and bottom 95% patients with heart failure was mainly driven by hospital costs; and the top 1% group experienced a remarkable increase of mental health costs. Top 1% and top 2–5% patients with heart failure differed from lower cost patients in their higher rate of chronic conditions, excessive polypharmacy, hospital admissions, and heart‐related surgeries. Heart‐related surgeries contributed to the incidental high costs in 54% of top 1% patients, and the costs of the remaining top 1% patients were driven by mental health and pharmaceuticals use and rates of chronic conditions and multimorbidity. Top 1% patients were relatively young. Anaemia, dementia, diseases of arteries, veins and lymphatic vessels, influenza, and kidney failure were significantly associated with high costs. The end‐of‐life period was predictive of top 1% and top 5% costs. More than 90% of the population incurred at least one top 5% year during follow‐up, and 31.8% incurred at least one top 1% year. Fifty‐seven per cent incurred multiple top 5% years whereas only 8.6% incurred multiple top 1% years. Top 5% years were more frequently consecutive than top 1% years. Conclusions: Top 1% utilization occurs predominantly incidentally and among less than a third of patients with heart failure, whereas almost all patients with heart failure experience at least one top 5% year, and more than half experience two or more top 5% years. Both medical and psychiatric/psychosocial needs contribute to high costs in heart failure patients. Comprehensive and integrated efforts are needed to further improve quality of care and reduce unnecessary costs. [ABSTRACT FROM AUTHOR]

Large offshore wind farms located far from shore, as are being planned or built in the North Sea, will require high-voltage DC (HVDC) transmission to shore, and multi-terminal HVDC could offer further benefits. Currently proposed methods to protect against faults in the DC network are based on extremely fast-acting DC circuit breakers located on all cable ends, leading to high cost. A method is proposed based around discharging the DC network to isolate the fault, which drastically reduces the circuit breaker requirement, while making use of the inherent current-limiting behaviour of the wind turbines. The validity of this approach is demonstrated in simulation. [ABSTRACT FROM AUTHOR]

Objective: Access to health care can be improved by controlling and optimizing expenditures, specifically the high-cost drugs such as atypical long-acting injectable (LAI) antipsychotics. This type of LAI is usually covered under the medical benefit and/or pharmacy benefit. We sought to compare financial outcomes of the medical benefit billing option with the pharmacy benefit billing option for atypical LAIs in an adult outpatient psychiatric clinic and to determine insurance companies' reasons for nonpayment when the medical benefit billing model was utilized.Methods: A retrospective chart review with patients 18 years of age and older who were receiving atypical LAI antipsychotics in the outpatient psychiatric department during two time periods--January 7 through February 6, 2016 and August 15 through September 14, 2016--to evaluate medical (N = 31) and pharmacy (N = 23) benefit study periods, respectively.Results: The estimated loss when using the medical benefit billing option was $14,520 per month. Switching to billing under the pharmacy benefit resulted in a monthly gain of $2,100. The net savings from the switch were estimated at $16,620 per month. No patient lost access to treatment or was switched to another medication solely because of the change in billing option. The reasons for nonpayment (N = 10) provided by medical insurance companies were prior authorization/step therapy required (40%), insurance terminated (30%), and coverage through Medicaid Rx only (30%).Conclusion: This study revealed a significant financial loss related to atypical LAI antipsychotics when the medical benefit model was utilized. By switching to billing under the pharmacy benefit, potential savings for high-cost drugs such as LAIs can be realized. [ABSTRACT FROM AUTHOR]

Measurement and transmission of temperature in industries are generally done by different conventional sensors like RTD, thermocouple, thermistor etc. that involve many limitations like high cost, temperature compensation and suffers from non‐linearity problems. Hence, a temperature sensing unit using AD590 temperature sensor is developed which is low cost, does not require any temperature compensation and exhibit linear characteristic. Furthermore, the signal transmission through electrical communication system is not acceptable through hazardous and inflammable areas and, therefore, optical transmission is being more acceptable as the signal does not alter due to electromagnetic interference and is free from explosions due to electric spark. So an optical communication technique has been proposed based on MZI. The proposed transmitter has been analysed theoretically, and the equations has been derived. The experiment has been performed on the fabricated prototype unit. The experimental and simulation results are presented in the paper which shows linear characteristic of the unit with very good repeatability and follows the theoretical equations. [ABSTRACT FROM AUTHOR]

It may be difficult to predict the consequences of provision of high-cost pediatric care (HCC) in low- and middle-income countries (LMICs), and these consequences may be different to those experienced in high-income countries. An evaluation of the implications of HCC in LMICs must incorporate considerations of the specific context in that country (population age profile, profile of disease, resources available), likely costs of the HCC, likely benefits that can be gained versus the costs that will be incurred. Ideally, the process that is followed in decision making around HCC should be transparent and should involve the communities that will be most affected by those decisions. It is essential that the impacts of provision of HCC are carefully monitored so that informed decisions can be made about future provision medical interventions.

Wide‐bandgap (WBG) devices such as SiC and GaN switches are regarded as next‐generation power semiconductors, due to their superior performance over conventional Si devices, for instance, a low switching loss and high thermal conductivity. Its bottleneck, however, is the high cost, which is critical for renewable energy and automotive industries. This study adopts SWISS AC/DC rectifier topology for the three‐phase 380–480 VAC along with an isolated DC/DC converter, indicating such topology can maximise the advantages of Si (low conduction loss) and SiC (high switching loss), altogether thereby yielding the high performance and low cost. A novel space‐vector pulse width modulation (SVPWM) was proposed to control such a current‐source power factor correction, where only two SiC devices were adopted for the DC‐bus voltage control. The closed‐loop control of the grid current is realised for the unity power factor. Such topology further allows the DC‐bus voltage to be varied with the output voltage, thereby minimising the system loss. A final prototype was built to charge a 48 V battery at 11 kW. Experimental results validated the effectiveness of such battery charger design. [ABSTRACT FROM AUTHOR]

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Health systems around the world are under tremendous fiscal pressures. Health system inflation continues to outpace GDP growth in most countries. Health system inflation has been resistant to policy measures, to traditional interventions such as productivity enhancing technologies and to optimization of performance metrics such as length of stay (LOS) and wait times. Organizations that are solving the issue are using specific information that individualizes costs per patient, rather than using average costs per case, which is misleading in most important, high cost, situations. In this paper, we propose an architecture for a health information system that not only individualizes costs, but also leverages the learning health system model to drive down costs, while increasing value for patients and the health care system. [ABSTRACT FROM AUTHOR]

Shortages and sudden price increases of certain drugs may both occur emergently, with little to no warning, and they can have a dramatic impact on patient care. Little data are available linking drug shortages and price increases. Many of the same characteristics that may make medications susceptible to shortages can also place them at risk for sudden price increases. These characteristics include unapproved drugs, off-patent sole-source medications, and infrequently used medications. We reviewed drug shortage data from the University of Utah Drug Information Service to demonstrate how frequently these characteristics occurred and resulted in higher drug prices. Clinicians can use drug shortage management principles to mitigate the impact of sudden price increases for patients and health care organizations. [ABSTRACT FROM AUTHOR]

Background: Currently, dental implants are widely accepted as a prosthetic treatment of completely or partially edentulous patients. To assess awareness of Dental Implants as a treatment modality among people visiting Mahatma Gandhi Dental College& Hospital, Jaipur. Methodology: A cross sectional survey was conducted among 114 patients visiting Mahatma Gandhi Dental College & Hospital, Jaipur using a self-explanatory questionnaire. Results: Out of the 114 dental patients, only 40.4% had heard about dental implants as a treatment modality, most of them being in the age group of 15- 30 years (44.73%). 25.4% had heard it from their dentist and the rest had heard it from other sources like internet and friends. 18.4%of the people were willing to undergo the treatment if needed and 75.3% cited high costs as the main reason for refusal of the treatment. Conclusion: Most of the studied subjects were not having information regarding implants. It showed need for providing more information to the patients about this treatment modality.

Background: We report our findings in three cases of unilateral macular edema associated with retinal vein occlusion (RVO) that improved after successful treatment of systemic hypertension alone. Methods: All three cases had systemic hypertension but no diabetes mellitus or other ocular diseases associated with macular edema. All patients were treated only with medication for systemic hypertension. Optical coherence tomography was performed to determine the foveal thickness before and after treatment. Results: Case one was a 72-year-old woman with a central RVO who had macular edema in her left eye and a visual acuity (VA) of 20/50. Her blood pressure (BP) was 169/96 mmHg. One month after the initiation of a calcium blocker to treat her systemic hypertension, her BP was decreased, macular edema was reduced, and her VA improved to 20/20. Case two was a 62-year-old woman with branch RVO. Her VA was 20/40 and her BP was 165/97 mmHg. Six weeks after initiation of medication to treat her systemic hypertension, her RVO-related macular edema had decreased and her VA improved to 20/20. Case three was a 71-year-old man with branch RVO. His VA was 20/50 and his BP was 165/87 mmHg. One month after initiation of treatment for systemic hypertension, his RVO-related macular edema had disappeared and his VA improved to 20/20. All three cases had nonischemic RVO by fluorescein angiography, and they did not develop ischemic changes for at least 1 year. Conclusion: The reduction of macular edema following a decrease in the systemic hypertension suggests that the edema was most likely caused by leakage of fluids from the blood vessels. We recommend that the blood pressure should be measured in all patients with macular edema before initiating intravitreal anti-VEGF therapy. [ABSTRACT FROM AUTHOR]

Aims: Sorafenib is the only systemic treatment shown to be effective against advanced hepatocellular carcinoma (HCC). Hepatic arterial infusion chemotherapy (HAIC) has been selected as an alternative therapeutic option for advanced HCC. We investigated the efficacy and safety of HAIC as an alternative treatment for sorafenib in advanced HCC. Methods: Between May 2008 and March 2011, 20 consecutive patients were treated with sorafenib monotherapy as a first-line treatment and 21 consecutive patients who could not take sorafenib because of cost were treated with HAIC monotherapy as an alternative. Sorafenib was administered in 400 mg b.i.d. doses. For HAIC, daily cisplatin (7 mg/m2 on days 1-5) and 5-FU (170 mg/m2 on days 1-5) were infused every 4 weeks. We assessed overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and toxicity. Results: Median OS was 4.9 months (95% CI, 3.4-6.4) for sorafenib and 7.3 months (95% CI, 4.5-10.2) for HAIC ( P = 0.599). Median PFS was 2.0 months (95% CI, 1.96-2.05) versus 3.0 months (95% CI, 1.98-4.02) for sorafenib and HAIC, respectively ( P = 0.303). ORR and disease control rate (DCR) for sorafenib were 10.0 and 35.0% versus 19.0 and 38.1% for HAIC (ORR, P = 0.413; DCR, P = 0.837). Patients treated with HAIC more frequently exhibited grade 3/4 neutropenia (23.8 vs 0% for sorafenib), whereas sorafenib therapy showed grade 3/4 hand-foot skin reaction in 10% of patients. Conclusion: HAIC is a useful alternative treatment for advanced HCC and further prospective investigations are required. [ABSTRACT FROM AUTHOR]

The purpose of this study was to develop an economic model that may be used to predict future high-cost asthma patients (recipients) based on past costs and health care service utilization. Retrospective data were obtained from the Louisiana Medicaid program for 1998, 1999, and 2000, and a multiple logistic regression model was built, which correctly estimated the predictive relationship between the independent variables and the dependent variable in 82.0% of the sample. Subsequently, Chi-square tests revealed that the economic model correctly predicted 30% high-cost asthma recipients in 2000 based on 1999 costs, utilization, and demographic factors. [ABSTRACT FROM PUBLISHER]

Chronic renal insufficiency is one of the highest cost pathologies of greater financial impact for the general system of social security health care in Colombia. High-cost case concentration in some health entities made it necessary to distribute resources and patients to other entities in order to counteract the financial unbalance. This paper proposes that demand induction is the principal failure in this case. It presents some hypotheses regarding incentives facing firms in an oligopolic market and argues for the necessity of regulatory intervention in prices and quality and, especially, prevention. [ABSTRACT FROM AUTHOR]

In the US, many people are excluded from healthcare structures and systems, due to multiple macro and micro factors. Poverty, health ecosystems, mental health, and community amenities are some of the issues confronting those who are not able to access appropriate support. This population is often referred to as 'high needs, high cost' (HNHC), a term that has been applied to refer to people who repeatedly utilize services without significant benefit (we have replaced this term with 'currently under-served'; C-US). For many traditional health solutions may not address the fundamental issues confronting their health. Community-Engaged Healthcare (CEH) is an approach that equips members of the community to levy power to advocate for their own health or social solutions, designing their own interventions to address needs with support from health providers. A realist review was conducted to identify the existing literature around CEH. This yielded ten papers that were reviewed by at least two authors and rated in terms of quality. A model describing the processes underpinning CEH was then iteratively generated, resulting in additional terms that were used in a second review of the literature. A further 16 peer-reviewed articles were identified and were independently reviewed and quality rated. These articles were used to refine further iterations of the model and included in the review where appropriate. The resulting model schematically posits a set of relational factors identified to be important in the establishment of CEH. Notably, the transfer of autonomy and power over health decision-making processes is emphasized, which will require revolutionary thinking about how healthcare is delivered for patients., Competing Interests: All authors declare that they have no competing interests in the manuscript., (© 2021 Published by Elsevier Ltd.)

In current era, the best treatment modality for partially or completely edentulous patients is dental implant prosthesis worldwide. Although replacing missing teeth with dental implants is believed as satisfactory experience by patients, the awareness and knowledge about dental implants vary between individuals as well as countries.The purpose of this study was to assess the patients' knowledge and awareness about dental implants. It was a questionnaire-based cross-sectional survey performed in Islamabad at Prosthodontics Department, Rawal Institute of Health Science, in which self-structured questionnaires were distributed among 400 outdoor patients. Questionnaire included patient age, gender, level of education, knowledge about different treatment options for missing teeth, awareness of dental implants as treatment option, positive and negative patient perception about dental implant and source of information. Only 38% (152) patients were aware of dental implants as treatment modality for missing teeth.Main reason given by patients not to avail dental implant as treatment option was cost (65.13%). Positive information among patients who were aware about implant option was high esthetic (50.67%) and high success rate (32.23%). Mainly dentists (44.08%) provided information about implant to patients. The association between patients' educational level and awareness about dental implant as treatment option for replacing missing teeth is statistically significant with the P-value = 0.01 The study concluded that majority of participants were not having knowledge regarding dental implants.Cost of dental implant is main hurdle for patients to choose implant as option. Reduced cost will facilitate patients with low socioeconomic status to choose dental implant as treatment option in developing countries like Pakistan. [ABSTRACT FROM AUTHOR]