Burden Of Care Research Articles

Impact of expediting formulary oncology drug approvals at a tertiary care safety net hospital.

410 Background: Advances in drug development and novel clinical trials have resulted in accelerated FDA approvals for oncology agents. These approvals often outpace the speed at which these agents are made “formulary” by hospitals. Non-formulary agents at most organizations need to undergo rigorous regulatory processes before their use and even after the approval for use, ordering them in the EMR poses a significant burden to both providers and pharmacists. Providers need to manually create treatment plans consisting of labs, medications, diluents, and infusion rates for non-formulary agents, consuming valuable time and leaving room for errors requiring extensive pharmacy review. Oncology agents can be considered non-formulary for at least 1 year post-FDA approval before they are approved by the pharmacy and therapeutics (P & T) committee and only 1 agent is approved per meeting. To expedite the formulary approval of oncology drugs, the 1 drug approval per meeting and 1 year post-FDA approval time limit rules were lifted within our institution. Methods: In September 2023, 8 oncology drugs were approved for formulary use by the P & T committee and their pre-built drug templates were established in the EMR. We obtained baseline data to order such non-formulary drugs through EMR prior to formulary approval and when drug templates were not pre-built, requiring manual order entry by providers and review by pharmacists. Baseline data was compared with data obtained post formulary approval and implementation of the pre-builtdrug template. We also created a process map to identify workflow inefficiencies in the formulary drug approval process for further optimization. Results: After the implementation of the pre-built oncology drug templatesand 8 simultaneous formulary drug approvals, the average total time required by physicians and pharmacists was reduced from 97 minutes to 12 minutes per order. The average number of edits made by pharmacists during order review changed from 21 to 4 per treatment order (Table). The use of pre-built drug templates resulted in an 87% reduction in time spent ordering and reviewing agents and an 81% reduction in edits made per drug order. Conclusions: Integration of treatment protocol building quickly into EMR by expediting formulary drug approval significantly reduced physician and staff burden in oncology care at a safety net hospital. Health systems should adopt innovative processes to streamline the formulary approval process and use pre-built drug templates, minimizing staff fatigue and increasing patient safety. Breakdown for provider order entry and pharmacist review with and without drug template. Manual Entry During Non-Formulary Period Template Entry after Formulary Approval Average provider order entry time (mins) 75 6 Average pharmacist review time (mins) 22 6 Average total time taken per order (mins) 97 12 Average edits/order by pharmacist 21 4 mins=time in minutes.

‘’It’s like I am always on a leash’’: A multi-stakeholder qualitative analysis of the time toxicity of cancer care.

209 Background: As the oncology community increasingly acknowledges the time burdens of cancer care, there is a critical need for foundational work to understand the sources, populations impacted, and consequences of time toxicity. We sought to evaluate these through qualitative interviews. Methods: We conducted semi-structured interviews with adults with advanced stage gastrointestinal cancer, informal care partners, and clinicians at an NCI-designated cancer center in MN, USA from Feb-Oct 2023. We explored aspects of cancer care that took up time and were perceived as burdensome, identified those most impacted, and the consequences. We recorded and transcribed interviews, and conducted inductive thematic analysis. Results: We interviewed 47 participants [16 patients (8 <60 years; 12 women), 15 care partners (10 <60 years; 9 women), and 16 clinicians (including advanced practice providers, nurses, physicians, schedulers, and social workers; 11 women)]. We identified 22 subthemes that we grouped into 5 themes (Table). Conclusions: This multi-stakeholder qualitative analysis provides a deeper understanding of time toxicity. These data will help the oncology community to map, measure, and ultimately address time toxicity. Theme Subthemes Illustrative quotes Source: Healthcare outside the home Travel, parking, and, waiting time, planned appointments, unplanned care, hospitalizations and facility-based care '’My wife and I made over 100 drives in two years, over an hour and a half in each direction.’’ (Patient) Source: Often invisible tasks performed at home Logistic and administrative tasks, learning about the disease and treatment, medical management, time spent managing symptoms and on recovery, home-based care ‘’A large burden was like the insurance paperwork.’’ (Care partner)‘’And that has happened before where I've just spent the whole day at home waiting for home care.’’ (Patient) Populations impacted: Care partners alongside patients Care partners are equally affected, taking over social responsibilities/ tasks of daily living ‘’Anything that takes time for me, is almost an equal burden on her. If not more sometimes.’’ (Patient) Consequences Care becomes all-consuming, short visits turn into ‘’all-day’’ affairs, missing important life events/work, emotional distress, demoralization, financial burdens ‘’ It’s like I am always on a leash. I really don't have any control.’’ (Patient)‘’Even for a 30-minute infusion, you'll be there, like half a day or a whole day.’’ (Patient) Positive interactions and hope for change Not all time spent is perceived as burdensome, clinicians are hopeful of decreasing time burdens, clinicians recognize their own time burdens as a barrier to addressing patients’ ‘’Patients having to walk through this incredibly long, circuitous way to check in, do labs as ritual—we are disdainful of a patient's time. We should demand change.’’ (Clinician)

Frustrations with time spent on cancer care among patients with metastatic breast or advanced ovarian cancer.

235 Background: Individuals with cancer face substantial demands on their energy and time due to the complexity of cancer care. We sought to describe frustrations with time-consuming aspects of cancer care among individuals with advanced ovarian or breast cancer. We hypothesized that frustrations would be highest for time spent on administrative tasks, particularly for those who are younger, employed, and have dependents. Methods: We analyzed baseline survey data from an ongoing prospective study of the time burdens of cancer care among individuals receiving treatment for ovarian or metastatic breast cancer at the University of Minnesota and University of Alabama-Birmingham. The survey included questions about frustrations with the time needed for cancer-related activities such as travel time, finding transportation, care coordination, receiving treatment, and paperwork (0=Not at all, 10=Extremely frustrated). We summarized the data using descriptive statistics and made comparisons across demographic and clinical characteristics using Wilcoxon rank-sum and Kruskal-Wallis tests. Results: A total of 67 participants completed the baseline survey, 37 (55.2%) with metastatic breast cancer and 30 (44.8%) with ovarian cancer. About 1/4 of participants (26.9%) were under 50 years old, 34.3% had dependents, 39.1% were employed, and 57.6% lived 30+ miles from the cancer clinic; 73.1% were non-Hispanic (NH) White and 22.4% NH Black; 4.5% reported another race/ethnicity. Over half (58.2%) agreed minimizing time spent on cancer-related activities was important to them; those employed were significantly more likely to agree (76.0% vs. 48.7%, p=0.03). Activities with the highest reported frustrations were the number of trips, time for care-related travel or paperwork, and wait time. Younger participants reported higher frustration with wait time (p=0.04) and time at the infusion center than older participants (p=0.03). Employed participants reported significant frustration with having to take time off work (p<0.0001), and those with dependents reported frustration needing to organize dependent care (p=0.01). Participants living 30+ miles from the cancer clinic reported greater frustrations with travel time (p=0.01), time needed for care coordination (p=0.01) and waiting for the provider (p=0.02). Some (10.6%) participants reported lacking reliable transportation and, among those, reported high frustration with the time needed for numerous activities, including finding transportation, paperwork, care coordination, and making appointments (all p<0.05). Conclusions: Cancer-related time demands are frustrating for many patients. Those employed, younger, with dependents, living further from the cancer clinic, and without reliable transportation experience greatest frustrations about time lost, underscoring the need to address these often unrecognized aspects of care.

Barriers Towards Healthcare Access and Services among People with Disabilities: A Scoping Review of Qualitative Studies

Healthcare access and services is one of the challenges faced by people with physical disability (PWPD). PWPD also has at risk of early death and preventable chronic illness. Lack of access to healthcare services includes delay or failure to receive needed care, lack of continuity of care and financial burden will result in deterioration of health, wellbeing and functional status. The aim of this paper was to review barriers towards healthcare access and services among PWPD based on the existing qualitative studies. We conducted a scoping review of relevant qualitative articles from PubMed, Scopus and ProQuest. The article search was based on the available keyword in the title with the publication restricted within 10 years (between 2012 to 2021). The search strategy was conducted using MeSH terms of ‘barriers, healthcare access, healthcare services and physical disability’. In this review, people with different kinds of physical disabilities were included. There were 2004 articles obtained from the initial search. 27 articles met the inclusion criteria for the final review. In each study, PWPD noted various barriers to access healthcare services. Findings from this review revealed five themes: personal; financial; attitudinal and communication; health system; structural and physical barriers. The findings showed that PWPD faces various barriers when accessing healthcare services. Addressing these barriers could help create a healthcare system that is inclusive and accessible for all.

359VP Social difficulties and care burden of adult Duchenne muscular dystrophy in Japan: A questionnaire survey based on the Japanese Registry of muscular dystrophy (Remudy)

359VP Social difficulties and care burden of adult Duchenne muscular dystrophy in Japan: A questionnaire survey based on the Japanese Registry of muscular dystrophy (Remudy)

Rapid On-Site Histology of Lung and Pleural Biopsies Using Higher Harmonic Generation Microscopy and Artificial Intelligence Analysis

Lung cancer is one of the most prevalent and lethal cancers. To improve health outcomes while reducing health care burden, it becomes crucial to move toward early detection and cost-effective workflows. Currently, there is no method for the on-site rapid histologic feedback on biopsies taken in diagnostic, endoscopic, or surgical procedures. Higher harmonic generation (HHG) microscopy is a laser-based technique that provides images of unprocessed tissue. In this study, we report the feasibility of an HHG portable microscope in the clinical workflow in terms of acquisition time, image quality, and diagnostic accuracy in suspected pulmonary and pleural malignancy. One hundred nine biopsies of 47 patients were imaged and a biopsy overview image was provided within a median acquisition time of 6 minutes after excision. The assessment by pathologists and an artificial intelligence algorithm showed that image quality was sufficient for a malignancy or nonmalignancy diagnosis in 97% of the biopsies, and 87% of the HHG images were correctly scored by the pathologists. HHG is therefore an excellent candidate to provide a rapid pathology outcome on biopsy samples, enabling immediate diagnosis and (local) treatment.

Determining the Care Burden and Burnout Levels of Family Members Providing Care for Cancer Patients

Objectives: Caregivers’ care burden and burnout levels are projected to increase as the physical independence of their patients decreases. This study aimed to determine the care burden and burnout perception of caregivers of cancer patients. Methods: The study was conducted with 143 patient relatives who were providing primary care for patients treated between March 1 and June 1, 2017, in the clinics of the Institute of Oncology of Istanbul University. The data were collected using the “ Personal information form “, “Zarit Caregiver Burden Scale” and “Maslach Burnout Inventory”. Data were analyzed using the SPSS statistical program. Descriptive statistics (frequency, percentage, mean, minimum, maximum, standard deviation) student t-test, one-way ANOVA, and Pearson correlation coefficient were used for data analysis. Results: The mean score from the burden interview was found 27.38±17.04. In the burnout inventory results, the mean of emotional exhaustion is 19.61±9.08, the mean of depersonalization is 8.78±5.38, and the mean of decrease in personal accomplishment is 29.66±5.91. Individuals’ perceptions of emotional exhaustion and depersonalization increase as their perception of care burden increases (p<.001). There was, however, no relationship between care burden and personal accomplishment (p>.05). The study demonstrated that caregivers’ care burden and burnout perceptions increased as cancer patients’ self-care ability worsened (p=.001). Conclusion: It has been found that the perceived care burden level is low and burnout level is middle among the caregivers of cancer patients. The patients’ level of dependency increases perceptions of caregiver burden and burnout increases too.

Associations between sensory impairment and functional limitations among older Chinese adults: mediating roles of social isolation and cognition

BackgroundThe high prevalence of sensory impairment and functional limitations in older adults is a significant concern, yet there is limited understanding of the relationship between these two conditions. Therefore, the objective of this study was to investigate the pathways connecting sensory impairment and functional limitations by examining serial multiple mediating effects of social isolation and cognition in older adults.MethodsUsing the China Health and Retirement Longitudinal Study dataset, a sample of 4871 older adults was selected. The study variables included sensory impairment, functional limitations, social isolation and cognition, and other covariates. A hierarchical multiple linear regression model was used to assess the association between sensory impairment and functional limitations. Mediation analysis was conducted to explore the sequential multiple mediating effects of social isolation and cognitive function in the relationship between sensory impairment and functional limitations.ResultsOur findings revealed a significant and positive association between sensory impairment and functional limitations (B = 0.615, 95% CI: 0.397, 0.834). After adjusting for social isolation and cognitive function, the impact of sensory impairment on functional limitations accounted for 87.19% of the total effect. Additionally, approximately 12.81% of the significant relationship between dual sensory impairment and functional limitations was mediated by social isolation and cognitive function. A serial multiple mediating pathway (sensory impairment → social isolation → cognition → functional limitations) was identified, with a coefficient of 0.013 (95% CI: 0.006, 0.020).ConclusionsOur study provides evidence for the mediating effects of social isolation and cognition in the relationship between sensory impairment and functional limitations. Given the prevalence of functional limitations among older adults with sensory impairment, it is crucial to consider social isolation and cognitive function in efforts to reduce the burden of disability care. Future validation of these findings through longitudinal studies is necessary.

EVALUATION OF GROSS MEDICAL CARE EXPENDITURE ENDURED BY PARENTS OF THALASSEMIA MAJOR PATIENTS

Background: Thalassemia major is a chronic problem and requires lifelong treatment that costs a lot to the parents directly or in directly. Objective of this study was to evaluate the gross medical care burden on the parents of thalassemia major patients visiting tertiary care hospitals for treatment. Methods: This cross-sectional research of six month duration (Jan-Jun 2024) was carried out in Quetta. Parents of malnourished thalassemia major patients admitted in paediatric wards were included whereas rest of the parents of thalassemia major patients with problems other than malnutrition were excluded. Systematic random sampling was used to gather data via preformed structured questionnaire. Ethical consideration was obtained from the parents and ERB of SOD before study. Descriptive statistics, i.e., frequencies and percentages were calculated and results were presented in the form of tabulation. Results: Among the 100 parents, more than half (65) were males and 35 were females. Majority (80%) parents had 1-5 siblings, 81% families had only a single earning member, 53% parents had 1 or 2 visits per month for blood transfusion. Ninety-seven percent and 89% parents respectively said that expenses on food and transport ranged from PKR 200-500. Conclusion: Parents spend about 300 rupees on food and about 300 rupees on travelling per visit so they had to spend about Rs. 1,200 (on an average) per month as most of them visit at least twice for the transfusion (some of them had to visit 3 times per month). Pak J Physiol 2024;20(3):84-6, DOI: https://doi.org/10.69656/pjp.v20i3.1793

The Lived Experience of Frailty: Are Frailty Intervention Teams Adding to Patient Quality of Life?

Abstract Background Numerous clinical tools are used to identify and quantify frailty, but the lived experience of frailty is not consistently measured or considered in clinical practice. The project aim was to understand the health perceptions of older adults treated by the Frailty Intervention Team (FIT) and establish if the team has an impact on care burden. Methods Participants were recruited from a hospital based, out-patient Frailty Intervention Clinic over a 4-month period. Older adults were classified as frail by the Clinical Frailty Scale (CFS). The lived experience of frailty was assessed via the EQ 5D 5L a self-rated quality of life measure with a visual analogue scale (EQ VAS). The impact of frailty on carers was examined by the Carer Strain Index (CSI). These subjective measures were recorded on initial assessment and 2 months post intervention. Results 31 individuals were assessed (male n=13, female n=18). The average CFS was 4.98 (4.91 male, 5.05 female), indicative of ‘Living with Mild Frailty’. 74.19% of participants (male n=9, female n=14) responded to the follow up questionnaires. Pre-intervention, EQ VAS average responses were 42.5/100 for males and 49.33/100 for females. Two months post intervention improvements were observed in both males and females with scores of 72.77/100 and 62.5/100 respectively. CFS ratings remained unchanged post intervention. 29% of carers reported a CSI of greater than 7/12 pre intervention – indicating high level of carer burden. Post intervention this figure reduced to 9.6% of carers. Conclusion This FIT model adds positively to the lives of older adults in a holistic manner. The average participant rated their health positively post intervention despite being classified as ‘Living with Mild Frailty’. This underscores that the patient is the expert of their own experience and challenges the negative perceptions of frailty. Highlighting the need for a holistic understanding of frailty beyond classification scales.

Storage practice and wastage of pharmaceuticals in Chinese urban-dwelling households: Description of urban-dwelling households.

At-home storage of medications could pose a threat to public health and the environment if not handled appropriately. Excessive storage also creates health care and economic burdens. This study investigated storage practices, waste, and their determinants in China. Data were collected by pharmacy staff of urban-dwelling households via online questionnaires. Descriptions at the household and medicine levels were conducted in Stata 16. Individual and family characteristics were associated with the presence of household medicine storage (84.6%, n=5290), but storage location was poor. Expiration was the primary reason for discarding medicines. Respondents were inclined to buy medicines in pharmacies without prescription for storage purposes at out-of-pocket expenses, and 60.7% of medicines were purchased at out-of-pocket expenses, despite medical insurance coverage. Regarding wastage, 11.2% of medicines had expired and 38.2% were no longer needed. Purchasing for storage purposes was related to less waste due to expiration, while purchasing for treating acute diseases rather than chronic diseases was related to more waste, due to less for use. Accounting for 12.2% of all medications, antibiotics were associated with expiration and no further need for use. Source-control measures targeting health facilities, pharmacies, and residents are needed under the combined efforts of all relevant departments.

Caregivers' burden of care during emergency department care transitions among older adults: a mixed methods cohort study.

Improving care transitions for older adults can reduce emergency department (ED) revisits, and the strain placed upon caregivers. We analyzed whether caregivers felt a change in burden following a care transition, and what may be improved to reduce it. This mixed-methods observational study nested within LEARNING WISDOM included caregivers of older patients who experienced an ED care transition. Burden was collected with the brief Zarit Burden Interview (ZBI-12), and caregivers also commented on the care transition. A qualitative coding scheme of patient care transitions was created to reflect themes important to caregivers. Comments were randomly analyzed until saturation and themes were extracted from the data. We followed both the SRQR and STROBE checklists. Comments from 581 caregivers (mean age (SD) 64.5 (12.3), 68% women) caring for patients (mean age (SD) 77.2 (7.54), 48% women) were analyzed. Caregivers overwhelmingly reported dissatisfaction and unmet service expectations, particularly with home care and domestic help. Communication and follow-up from the ED emerged as an area for improvement. Caregivers who reported an increased level of burden following a patient's care transition had significantly higher ZBI scores than caregivers who self-reported stable burden levels. Caregivers with increasing, stable, and improved levels of subjective burden all reported areas for improvement in the care transition process. Themes centering on the capacity to live at home and inadequate communication were most frequently mentioned and may represent serious challenges to caregivers. Addressing these challenges could improve both caregiver burden and ED care transitions.

Knowledge, Attitude and Practices Regarding Antibiotics usages among Medical Students at Zawia University

Antimicrobial resistance (AMR) is a serious threat to global public health. It increases morbidity and mortality, and is associated with high economic costs due to its health care burden. Medical students are particularly important since they will be the future leaders in clinic practice, responsible for antibiotic prescription and communication about antibiotic use with their patients. In this study we aimed to understand knowledge, attitude, and practice (KAP) with respect to antibiotic use among medical students in faculty of medicine, Zawia University. This is a cross-sectional design; it was undertaken in Faculty of Medicine during October and November: 2023. The questionnaire was administered to students in (III 3rd and IV 4th grades). All data were analyzed using Statistical Package for Minitab program. Majority of the respondents were female with ages of 22 years. Higher percentage of 4th-grade students (95.5%) correctly accepting the need to stop antibiotic use compared to 3rd-grade students (27.9%, p < 0.001). On other hand with a higher percentage of 4th-grade students reporting using non-prescribed antibiotics rarely compared to 3rd-grade students (46.3% for 4th grade and 69.8% for 3rd grade, p = 0.003). this study exposed an important awareness concerning the separate between medical students’ knowledge about antimicrobial resistance, and appalling attitudes and practices towards antibiotics use. We need for the re-evaluation of the educational curricula especially, teaching of clinical pharmacology courses in clinical years.

A qualitative study exploring the acceptability of a telehealth intervention for family members of people experiencing a first episode psychosis: PERCEPTION.

Family members of people experiencing a first-episode psychosis (FEP) can experience high levels of carer burden, stigma, emotional challenges, and uncertainty. This indicates the need for support and psychoeducation. To address these needs during the COVID-19 pandemic, we developed a multidisciplinary, blended, telehealth intervention, incorporating psychoeducation and peer support, for family members of FEP service users: PERCEPTION (PsychoEducation for Relatives of people Currently Experiencing Psychosis using Telehealth, an In-person meeting, and ONline peer support). The aim of the study was to explore the acceptability of PERCEPTION for family members of people who have experienced an FEP. Ten semi-structured interviews were conducted online via Zoom and audio recorded. Maximum variation sampling was used to recruit a sample balanced across age, gender, relatives' prior mental health service use experience, and participants' relationship with the family member experiencing psychosis. Data were analysed by hand using reflexive thematic analysis. Four themes were produced: 'Developing confidence in understanding and responding to psychosis'; 'Navigating the small challenges of a broadly acceptable and desirable intervention'; 'Timely support enriches the intervention's meaning'; and 'Dealing with the realities of carer burden'. Broadly speaking, PERCEPTION was experienced as acceptable, with the convenient, safe, and supportive environment, and challenges in engagement being highlighted by participants. Data point to a gap in service provision for long-term self-care support for relatives to reduce carer burden. Providing both in-person and online interventions, depending on individuals' preference and needs, may help remove barriers for family members accessing help.

Carers in post-stroke aphasia: a scoping review of interventions and outcomes beyond communication partner training

Purpose Carers of people with aphasia face unique challenges. Research has demonstrated that these carers have a higher burden of care and more negative stroke-related outcomes in comparison to carers of stroke survivors without aphasia. The aim of this scoping review was to map the range of interventions for carers other than communication partner training and to examine their outcomes. Materials and methods We conducted a scoping review on this topic. Results Twenty studies were included. Most studies were case series with four randomised control trials. Both quantitative and qualitative approaches were used. Most studies occurred during the long-term phase of care. Two interventions had only carers as participants. Interventions were comprised of different combinations of intervention components including psychoeducation, skill-building, and support. There was high variability on who led the interventions, the format, and the dose/schedule. Twenty-eight different outcome measures for carers and dyads were used across various domains with overall positive outcomes post-intervention. Conclusions This review uncovered a wide range of formats, dosages, and outcome measures in interventions for carers. Encouragingly, the majority of these interventions included psychoeducation, skill-building, and support components. While most studies were case series, there are promising interventions that have the potential to enhance carer wellbeing.

Stroke recovery—what are people talking about on Twitter? A content analysis

Purpose Prioritisation exercises seek out what matters to key stakeholders to inform the planning of research. Social media platforms are potentially useful data sources. The aim was to examine the content of tweets, short messages containing text and pictures, to ascertain the priorities of Twitter users regarding stroke recovery. Materials and methods Content analysis of Twitter was conducted. An electronic search used the identifiers: #strokesurvivor and #strokerecovery. Tweets spanning four weeks from January 2021 were analysed. Results There were 1361 tweets extracted and 486 analysed following exclusion of duplicates and unrelated material. Six themes were uncovered (n = number of tweets): maintaining motivation and positivity (153); sharing of resources (146); raising awareness of stroke (74); symptomatic aspects of recovery (39); experience of rehabilitation (63); and concerns about Covid-19 (17). Conclusions Despite the brevity of tweets, a rich picture arose. A key limitation was lack of biographical data about Twitter users. Recommendations about topics requiring attention from stroke researchers, clinicians and policy makers are: management of psychological problems; public perception of stroke; rehabilitation considerations including treatment burden, person-centred care and equality of care; symptom management including fatigue and aphasia. Findings can be used to supplement and validate other priority-setting exercises.

Various Approaches and Future Prospective for Therapies for Diabetes: A Review

The global prevalence of diabetes mellitus disease marked by increased blood glucose levels, has reached epidemic proportions. This review provides a comprehensive assessment of the current landscape of diabetes therapies and outlines future prospects for improving the management and treatment of this condition. The current scenario highlights a multifaceted approach to diabetes management, with a focus on lifestyle interventions, oral antidiabetic drugs, insulin therapy, and emerging technologies like continuous glucose monitoring and closed-loop systems. While these approaches have significantly improved the lives of people with diabetes, several challenges persist. These include medication adherence, hypoglycemia risk, and the financial burden of diabetes care. Innovative treatments that improve glucose regulation, improve cardiovascular health, and help patients lose weight—like SGLT-2 inhibitors and GLP-1 receptor agonists—have showed promise in treating these issues. The future prospects for diabetes therapies are exciting, with ongoing research into cell-based therapies, including pancreatic islet transplantation and stem cell-derived beta cells. Personalized medicine approaches, driven by genetics and artificial intelligence, hold the potential to optimize treatment regimens and predict individual responses to various therapies. Furthermore, advancements in telemedicine and digital health technologies will enhance patient self-management and remote monitoring.

Exploring Caregiver Burden in Alzheimer's Disease: The Predictive Role Of Psychological Distress

Background Alzheimer's Disease [AD], the most prevalent form of dementia, is on the rise in terms of its prevalence. Individuals affected by this condition typically require extensive care across all aspects of daily living. The mental well-being of caregivers for those with dementia stands as a significant public concern. Therefore, the current study aimed to investigate the association between the burden of caregiving and the psychological distress experienced by family caregivers of individuals with AD. Methods This cross-sectional study employed a census method and involved the participation of 150 caregivers of Alzheimer's patients in Shahroud, Iran. To assess the eligibility of family caregivers, the inclusion criteria comprised minimal literacy in reading and writing and at least six months of care for an individual with AD.. Exclusion criteria included being a formal caregiver or employed in healthcare, having mental disorders, or using neuroleptic drugs among family caregivers. Data collection tools consisted of the Zarit Care Burden Inventory [ZBI] and Lovibond's Depression, Anxiety, and Stress Scale [DASS-21]. Information was gathered online and through self-reporting, followed by analysis using descriptive statistics [frequency, percentage, mean, and standard deviation], as well as inferential statistical tests [multivariate linear regression]. Results In this study, the mean scores for caregiver burden, anxiety, stress, and depression were 28.09 ±13.01, 4.50 ±4.53, 8.12 ±4.98, and 4.69 ± 4.86, respectively. The study's findings revealed that with each additional hour spent on daily patient care, the burden score for caregivers increased by 0.327 units [p=0.025, β=0.327]. Furthermore, for every one-unit rise in stress [p<0.001, β=1.087] and depression scores [p=0.015, β=0.671], the burden score also increased by 1.087 and 0.671 units, respectively. Conclusion Caregivers of individuals with AD experienced notable levels of caregiving burden, particularly correlated with the duration of daily patient care and the manifestation of stress and depression symptoms. Hence, the study suggests the implementation of tailored interventions, such as psychoeducational programs, to provide vital support for these individuals.

Elderly care in an aging population: The impact of parental care needs on adult children

Abstract One of the challenges of population aging is the rising demand of elder care. Adult children fill a substantial portion of this care need. To understand its implication on their labor market choices and welfare outcomes, we build a simple static model where households can spend time and money producing care. We calibrate the model using data from the American Community Survey, the Health and Retirement Study, and National Health and Aging Trends Study/National Study of Caregiving to match moments in the labor market and caregiving patterns. With the calibrated model, we consider a few government programs under a projected aging population structure. Our results show that care subsidy and Medicaid expansion both cause a shift from informal care to formal care, relieving adult children from care burdens and thus improving their welfare. Caregiver allowance appears to have little effects on caregiving behaviors, which leads to minimal welfare improvement.

Association between patient-reported financial burden and catastrophic health expenditures in cancer survivors

PurposeTo measure rates of patient-reported financial burden, compare them across cancer types, and determine whether they are predictive of catastrophic health expenditures (CHE). MethodsWe extracted data from the Medical Expenditures Panel Survey from 2011 to 2017 to conduct a retrospective population-based cohort study and multivariable logistic regression to assess the financial burden of cancer across 16 cancer types and compare patient-reported metrics to CHE rates. ResultsPatients with ovarian cancer were most likely to report inability paying bills (34.5 %) and filing for bankruptcy (9.4 %), while patients with thyroid cancer were most likely to incur debt (22.4 %). Patients with kidney cancer had the highest mean debt ($46,915). CHEs were independently predicted by inability to pay medical bills (OR [95 % CI], 1.96 [1.14–3.35]) and bankruptcy filing (OR [95 % CI], 3.90 [1.21–12.60]. Conclusions and implicationsWe report important variations in the financial burden across cancer types and underscore the importance of assessing how patient-reported measures are related to CHEs. Policy implications. The financial burden of cancer care could explain the lack of improved outcomes with increased national health spending.