Burden Of Care Research Articles

Digital Health Technology Interventions for Improving Medication Safety: Systematic Review of Economic Evaluations

Background Medication-related harm, including adverse drug events (ADEs) and medication errors, represents a significant iatrogenic burden in clinical care. Digital health technology (DHT) interventions can significantly enhance medication safety outcomes. Although the clinical effectiveness of DHT for medication safety has been relatively well studied, much less is known about the cost-effectiveness of these interventions. Objective This study aimed to systematically review the economic impact of DHT interventions on medication safety and examine methodological challenges to inform future research directions. Methods A systematic search was conducted across 3 major electronic databases (ie, PubMed, Scopus, and EBSCOhost). The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed for this systematic review. Two independent investigators conducted a full-text review after screening preliminary titles and abstracts. We adopted recommendations from the Panel on Cost-Effectiveness in Health and Medicine for data extraction. A narrative analysis was conducted to synthesize clinical and economic outcomes. The quality of reporting for the included studies was assessed using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines. Results We included 13 studies that assessed the cost-effectiveness (n=9, 69.2%), cost-benefit (n=3, 23.1%), and cost-utility (n=1, 7.7%) of DHT for medication safety. Of the included studies, more than half (n=7, 53.9%) evaluated a clinical decision support system (CDSS)/computerized provider order entry (CPOE), 4 (30.8%) examined automated medication-dispensing systems, and 2 (15.4%) focused on pharmacist-led outreach programs targeting health care professionals. In 12 (92.3% ) studies, DHT was either cost-effective or cost beneficial compared to standard care. On average, DHT interventions reduced ADEs by 37.12% (range 8.2%-66.5%) and medication errors by 54.38% (range 24%-83%). The key drivers of cost-effectiveness included reductions in outcomes, the proportion of errors resulting in ADEs, and implementation costs. Despite a significant upfront cost, DHT showed a return on investment within 3-4.25 years due to lower cost related with ADE treatment and improved workflow efficiency. In terms of reporting quality, the studies were classified as good (n=10, 76.9%) and moderate (n=3, 23.1%). Key methodological challenges included short follow-up periods, the absence of alert compliance tracking, the lack of ADE and error severity categorization, and omission of indirect costs. Conclusions DHT interventions are economically viable to improve medication safety, with a substantial reduction in ADEs and medication errors. Future studies should prioritize incorporating alert compliance tracking, ADE and error severity classification, and evaluation of indirect costs, thereby increasing clinical benefits and economic viability.

Clinical outcomes of asynchronous telerehabilitation through a mobile app are equivalent to synchronous telerehabilitation in patients with fibromyalgia: a randomized control study.

This study aimed to compare the effectiveness of exercise therapy delivered via a smartphone mobile app, using asynchronous video-based tools, with synchronous telerehabilitation models using videoconferencing for individuals with fibromyalgia syndrome (FMS). The research, utilizing a randomized clinical study design, involves sixty-six FMS patients in an 8-week exercise program. Participants are divided into synchronous (n: 33) and asynchronous (n: 33) groups. Assessments, pain intensity (VAS), functional limitations (FIQr), health-related quality of life (SF 12), catastrophizing (PCS), anxiety and depression (HADS), functional capacity (6MWT), muscle strength (Arm curl test), and joint position sense (LI-RATT), are conducted at baseline, mid-treatment (week 4), end of treatment (week 8). No significant group-time interaction was found for total VAS, FIQ, SF 12, PCS, HADS, 6MWT, Arm curl tests, LI-RATT extension, LI-RATT flexion, LI-RATT right rotation scores (p > 0.05). Significant effects of time and interactions between groups and time were observed in the neck (p = 0.010, ES = 0.19) and back region (p = 0.039, ES = 0.19) of the Visual Analog Scale, left rotation score of the LI-RATT (p = 0.008, ES = 0.36), and HADS Anxiety Score (p = 0.029, ES = 0.31). Group differences were significant at all-time points for the outcomes (p < 0.001), except for the right rotation of LI-RATT (p = 0.633). The study suggests that asynchronous telerehabilitation is comparable to synchronous methods in addressing pain, quality of life, and other factors in FMS patients. The asynchronous approach may offer advantages in reducing the burden on healthcare professionals and being cost-effective. Future research should explore diverse telerehabilitation protocols and their impact on overall care burdens. NCT06299527 (01/03/2024).

Rhythmanalysis of care: Daily practices among informal caregivers of children with cancer.

An increasing number of people face the challenge of providing long-term, unpaid, informal care to children with cancer. The repetitive and staged processes of treatment create inherently rhythmic care practices, imposing a strict schedule on caregivers' daily routines. To explore the rhythmic nature of pediatric cancer informal care, we discuss the rhythms of daily life during intensive chemotherapy and maintenance therapy, and negotiated strategies of caring practice. We draw upon Lefebvre's rhythmanalysis and activity diary, and conduct semi-structured interviews with informal caregivers. We demonstrate the scale, stage, and dynamic nature of the daily life rhythm of caregivers of children with cancer, which is characterized by linear "alienation," arrhythmia, and "metastable" harmony. Structured therapeutic rhythms do not have overwhelming power; rhythms are intervened through insertion, negotiated adjustment, recharging, and alliances to maintain eurhythmia in caregivers of children with cancer. This study provides specific insights into the care of children with cancer in the context of the relationship between time, space, energy, and rhythm, which may help provide support to caregivers and reduce their burden of care.

Economic Impact of Respiratory Syncytial Virus Infections in Children Under 5 Years of Age Attending Primary Care in Italy: A Prospective Cohort Study in Two Regions.

Accurate cost estimates of respiratory syncytial virus (RSV) infections in primary care are limited, despite the majority of cases being managed in this setting. This study aims to estimate healthcare costs for children with RSV in primary care and the related costs of parental work absence. Children < 5 years of age with symptoms of acute respiratory infections were recruited via primary care paediatricians in two Italian regions for a prospective cohort study on the RSV burden in primary care, during the 2019/2020 winter. Healthcare utilization, medication use and parental work absence were assessed during a 14-day follow-up period. Average costs were estimated per RSV episode for the overall study population, as well as per age group. Two hundred ninety three children were recruited, of which 119 tested RSV positive (41%) and 109 were included. In total, 89% of RSV-positive children (97/109) had ≥ 1 repeat paediatrician visit(s), and 10% (11/109) visited the ED. The mean number of repeat visits was 3.8 (SD: 4.0) and the mean duration of work absence 4.0 days (SD: 5.0). Average costs per RSV episode were €730 (95% CI: €691-€771), with direct medical costs accounting for 25% (€183 [95% CI: €174-€191]) and indirect costs related to work absence for 75% (€547 [95% CI: €509-€587]). Costs associated with RSV infections in young children in primary care are considerable due to a substantial number of paediatrician visits and high rates of parental work absence. These costs are important to include in decision-making regarding the implementation of new RSV immunization strategies in national immunization programmes.

Out-of-Catchment Area Antiretroviral Therapy Initiation and its Factors among HIV Positive People on Lifelong Therapy in Western Ethiopia: Implementation of Decentralized ART Services.

Background: Decentralized human immunodeficiency virus (HIV) is a model adopted to improve access to antiretroviral therapy (ART) within communities and mitigate the burden of HIV treatment and care on health care facility. In Ethiopia, these services help HIV clients fully benefit from ART as they are able to access ART within their catchment areas. However, HIV clients still travel out of their catchment areas to commence the ART. Thus, this study aimed to assess the magnitude of out-of-catchment area ART initiation and its associated factors among people living with HIV (PLWHIV) in Western Ethiopia. Methods: This cross-sectional study was conducted among 423 PLWHIV from November 25 to December 30, 2025, at Nekemte Comprehensive Specialized Hospital. A systematic sampling method was used to recruit the study participants. Epi Data 3.1 and STATA 14.0 were used for data entry and analysis, respectively. Logistic regression analysis was computed to identify factors associated with out-of-catchment ART initiation among PLWHIV. Variables with a P value <.25 from the bivariable analysis were entered into the multivariable analysis. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and P value <.05 were used to determine a significant association. Results: A total of 423 PLHIV were included in the study. The mean age of study participants was 33.43 ± 9.79 years. One-fifth (22%) of the participants-initiated ART out of their catchment area with 95% (CI: 18.28-26.20). Participants who did not disclose their HIV (AOR = 4.39, 95% CI = 2.45-7.87), tested through voluntary counseling and testing (AOR = 3.99, 95% CI = 2.21-7.19), knowledgeable about HIV/AIDS (AOR = 2.15, 95% CI = 1.18-3.93), using traditional healing (AOR = 1.91, 95% CI = 1.03-3.55), being female (AOR = 2.42, 95% CI = 1.36-4.32), and perceived stigma (AOR = 3.41, 95% CI = 1.88-6.18) were significantly associated with out-of-catchment ART initiation. Conclusion and Recommendation: A substantial number of PLWHIV in study area had initiated ART outside their designated catchment areas. To address this, it is crucial to enhance HIV serostatus disclosure, combat discrimination associated with HIV/AIDS, and promote decentralized HIV care and ART services.

A qualitative study of the home-based time burdens faced by persons affected by GI cancer.

822 Background: As cancer care is increasingly delivered at home, more tasks and responsibilities fall on patients and informal care partners. This is especially relevant for people with GI cancer who often have specific home-based care needs such as feeding, ostomy care, 5-fluorouracil chemotherapy, and complex medication management. Home-based time costs are undercounted in current measures of time toxicity that only include care received in formal healthcare settings. Methods: We conducted semi-structured interviews with patients with GI cancer and their care partners at a single tertiary cancer center in MN, USA from March-Oct 2023. Interviews explored cancer care tasks at home, associated time burdens, and how they compare to in-facility care. We analyzed interview transcripts using a grounded theory approach to identify themes. Results: We included 33 individuals (11 aged &gt;60y, 21 female, 25 white) including 15 patients (8 colorectal cancer, 8 ECOG 0) and 18 care partners (15 lived with the patient, 7 working at least part-time). We identified 5 themes (Table). Conclusions: This foundational work characterizes time burdens of home-based cancer care for persons affected by GI cancer. In addition to providing the first input on incorporating home-based time burdens into objective measures of time toxicity, we highlight the complexity of assessing time burden which is context and role-dependent. Theme Subtheme Quote Unexpected home-based care is time burdensome Challenge with home as a site of healthcare, difficult transition from hospital to home ‘’What they would do at the clinic behind the scenes she was doing on my kitchen table.” (Patient) Other burdens compound time burdens Logistic/administrative, emotional, symptom “The time spent on administrative things and coordinating [...] are more stressful than going to the clinic.” (Patient) Time burdens evolve over the disease course and differentially impact patients and care partners Cancer care constantly changes, discomfort with some tasks at home, less support provided if more competent, home-based care allows for connection “They’re in a season of remission and [...] we want to live as normal a life as we can. And then there are other seasons where it’s the absolute opposite.” (Care partner) Factors influencing the choice of home-based care Need to manage family duties, supportive care partners matter, value connection with nurses, decreased travel “There is a different cost when you start doing things at home, especially when you have small children because if they’re witnessing it, that’s emotional.” (Patient) Home-based care is generally perceived as less time-burdensome than similar cares provided in-facility Different opinions on whether home-based care should be included in time toxicity measure “If you’re just talking about video visits I wouldn't consider that time toxic. But if I’m going [to the clinic], I’ve pretty much lost the whole day.” (Patient)

Ambivalent ageism and the pains and gains of informal caregiving for older adults: Findings from Germany

Background and ObjectivesWe analyzed the associations between ambivalent ageism, burden and positive experiences of care among informal caregivers of older adults (aged ≥60 years), to advance understanding of its role as psychosocial risk or resilience factor for informal caregivers. Design and MethodsData of 433 informal caregivers (≥18 years) of adults with care needs (≥60 years) from the Attitudes towards Informal Caregivers (ATTIC) project was used. The Ambivalent Ageism Scale, Positive Aspects of Care Scale and the Burden Scale for Family Caregivers were used. Linear regression analyses adjusted for context and personal factors were conducted, with age and gender included as moderators in additional tests. ResultsHigh ageism (total score) was significantly associated with a high level of positive aspects of care and burden. Further analyses showed a significant positive association between benevolent ageism and positive aspects of care, while stronger hostile ageism was associated with less positive aspects of care. Hostile ageism was also significantly associated with more burden, while benevolent ageism and burden were not associated. Additional analyses indicated no moderation by gender, but by age. The association between hostile ageism and burden was weaker with caregivers’ higher age. Discussion and ImplicationsWhile hostile ageism and worse caregiver burden were associated, positive care experiences seemed to benefit from benevolent ageism. This highlights the complex associations between ageism and caregivers’ well-being, which need to be taken into account in theory and practice focused on improving the care situation for both caregivers and care recipients.

Cross-Country Inequalities in Disease Burden and Quality of Care of Stroke, 1990-2021: A Systematic Analysis of the Global Burden of Disease Study 2021.

This study aims to assess the disease burden and care quality along with cross-country inequalities for stroke at global, regional, and national levels from 1990 to 2021. Data on stroke were extracted from the Global Burden of Disease (GBD) study 2021 for the globe, five sociodemographic index (SDI) regions, 21 GBD regions, and 204 countries/territories. The disease burden was quantified using the age-standardized disability-adjusted life years rate (ASDR). Quality of care (QoC) was evaluated through the age-standardized QoC index (QCI). To assess cross-country disparities in both disease burden and age-standardized QCI, the slope index of inequality (SII) and the concentration index were utilized. From 1990 to 2021, the global ASDR of stroke decreased from 3078.95 (95% uncertainty interval [UI]: 2893.58, 3237.34) to 1886.20 (95% UI: 1738.99, 2017.90) per 100,000 population, while the age-standardized QCI improved from 50.79 to 64.61. However, the results of inequalities showed worsening inequalities in both ASDR and QCI, with lower SDI countries shouldering a disproportionate burden and higher SDI countries maintaining higher QoC. The SII and concentration index for ASDR indicated a worsening inequality among lower SDI countries, with SII increasing to -2616.44 and the concentration index increasing to -0.1119 in 2021. Meanwhile, the SII and concentration index for age-standardized QCI showed a worsening inequality among higher SDI countries, with SII of 27.48 and concentration index of 0.0922 in 2021. Despite notable global advancements, significant disparities in stroke still exist, particularly in lower SDI regions facing high disease burdens and substandard care.

Comparative analysis of demographics and outcomes in hospitalized patients with young- versus average-onset colorectal cancer in New York state (2017-2022).

27 Background: Recent studies have shown an increasing incidence of colorectal cancer (CRC) among young patients. This study investigates clinical outcomes and healthcare utilization among young (&lt;50) versus average onset (≥50) CRC patients admitted to hospitals in New York State (NYS). Methods: We performed a retrospective analysis using the Statewide Planning and Research Cooperative System (SPARCS) database from 2017 to 2022. Patients were divided into two groups: young-onset colorectal cancer patients (YOCRC, &lt;50 years) and average onset colorectal cancer patients (AOCRC, ≥50 years). The study population was further stratified by demographic and clinical characteristics. All associations were compared using the Kruskal-Wallis test, along with multivariate linear and logistic regression in RStudio version 4.4.1, at a significance level of ≤0.05. Clinical characteristics, including severity of illness and risk of mortality, were defined using the All Patient Refined (APR) grading system. Results: A total of 9,904 patients were identified (948 YOCRC and 8,956 AOCRC) with a primary admitting diagnosis of CRC from 2017 to 2022. In comparing the two age groups, AOCRC patients had a higher proportion of White, and female patients, whereas the YOCRC group included a higher proportion of Black and male patients (p&lt;0.001). The median length of stay was greater for AOCRC patients (5 days) compared to YOCRC patients (4 days), p&lt;0.001. Both age groups showed an upward trend in total cost of stay in the recent years. AOCRC patients were more likely to have increased severity of illness graded as major-extreme (60% vs 48%), while a higher proportion of YOCRC patients were classified as minor-moderate disease (51% vs 40%), p&lt;0.001. Similarly, AOCRC patients experienced a higher risk of mortality compared to YOCRC patients (p&lt;0.001). Regarding procedures, AOCRC patients needed more transfusions (13%) than YOCRC patients (9.3%), p&lt;0.001. YOCRC patients were also more likely to be discharged home (71% vs 46%), while AOCRC patients often required home health services or skilled nursing (p&lt;0.001). Notably, while the risk of mortality was higher for AOCRC patients, it has been decreasing overall from 2017 to 2022 [OR 0.92 (95% CI: 0.84-0.99), p=0.039]. Conclusions: AOCRC patients experienced greater severity of disease, higher mortality risk, and required more assistive care at discharge compared to YOCRC patients. The total cost of hospital stays has been rising for both groups. Policies focused on earlier outpatient interventions may help reduce the burden of inpatient care and rising costs.

An interpretable machine learning tool for in-home monitoring of agitation episodes in people living with dementia: a proof-of-concept study.

Agitation affects around 30% of people living with dementia (PLwD), increasing carer burden and straining care services. Agitation identification typically relies on subjective clinical scales and direct patient observation, which are resource-intensive and challenging to incorporate into routine care. Clinical applicability of data-driven methods for agitation monitoring is limited by constraints such as short observational periods, data granularity, and lack of interpretability and generalisation. Current interventions for agitation are primarily medication-based, which may lead to severe side effects and lack personalisation. Understanding how real-world factors interact with agitation within home settings offers a promising avenue towards identifying potential personalised non-pharmacological interventions. We used longitudinal data (32,896 person-days from n=63 PLwD) collected using in-home monitoring devices between December 2020 and March 2023. Employing machine learning techniques, we developed a monitoring tool to identify the presence of agitation during the week. We incorporated a traffic-light system to stratify agitation probability estimates supporting clinical decision-making, and employed the SHapley Additive exPlanations (SHAP) framework to enhance interpretability. We designed an interactive tool that enables the exploration of personalised non-pharmacological interventions, such as modifying ambient light and temperature. Light Gradient-boosting Machine (LightGBM) achieved the highest performance in identifying agitation over an 8-day period with a sensitivity of 71.32%±7.38 and specificity of 75.28%±7.38. Implementing the traffic-light system for stratification increased specificity to 90.3%±7.55 and improved all metrics. Key features for identifying agitation included low nocturnal respiratory rate, heightened alertness during sleep, and increased indoor illuminance, as revealed by statistical and feature importance analysis. Using our interactive tool, we identified indoor lighting and temperature adjustments as the most promising and feasible intervention options within our cohort. Our interpretable framework for agitation monitoring, developed using data from a dementia care study, showcases significant clinical value. The accompanying interactive interface allows for the in-silico simulation of non-pharmacological interventions, facilitating the design of personalised interventions that can improve in-home dementia care. This study is funded by the UK Dementia Research Institute [award number UK DRI-7002] through UK DRI Ltd, principally funded by the Medical Research Council (MRC), and the UKRI Engineering and Physical Sciences Research Council (EPSRC) PROTECT Project (grant number: EP/W031892/1). Infrastructure support for this research was provided by the NIHR Imperial Biomedical Research Centre (BRC) and the UKRI Medical Research Council (MRC). P.B. is also funded by the Great Ormond Street Hospital and the Royal Academy of Engineering. C.S. is supported by the UK Dementia Research Institute [award number UK DRI-5209], a UKRI Future Leaders Fellowship [MR/MR/X032892/1] and the Edmond J. Safra Foundation. R.N. is funded by UK Dementia Research Institute [award number UK DRI-7002] and the UKRI Engineering and Physical Sciences Research Council (EPSRC) PROTECT Project (grant number: EP/W031892/1). M.B. and A.K.S. are funded by the UK Dementia Research Institute [award number UKDRI-7002 and UKDRI-5209]. N.F.L., A.C., C.W. and S.K.arefunded bythe UK Dementia Research Institute[award number UK DRI-7002].

Effectiveness of family based educational program on burden of care and stress among family caregivers of young adults with chronic mental disorders: a pilot study report

Effectiveness of family based educational program on burden of care and stress among family caregivers of young adults with chronic mental disorders: a pilot study report

Putting the broken pieces of life together, Baloch family caregivers' confrontation with schizophrenia: a phenomenological study.

Long-term care of patients with schizophrenia, which creates a burden of care, leads to disruption in interactions, social and personal relationships, changes in lifestyle, and shifts in the roles of family members. This study aimed to explore the lived experiences of family caregivers who are caring for a family member with schizophrenia within the Baloch ethnicity. This is a qualitative study, using a descriptive phenomenological approach. A total of fifteen family caregivers of patients with schizophrenia participated in the study. Data were collected by a semi-structured interview. Twenty-one categories, seven sub-themes and one theme were extracted. "Putting the broken pieces of life together" was the main theme with sub-themes of "Ignorance confrontation", "Schizophrenia acceptance process", "Restoring a chaotic context with human and non-human approaches", "Support seeking", "Escaping from stigma", "Roles restoring", and "Lifelong caring". For a family with a member with schizophrenia, restoring family life is a top priority. However, schizophrenia is so debilitating and destructive that it threatens not only the peace of the family but also the survival of the family, and it requires constant effort and complete support to restore and maintain life.

Clinical effectiveness and implementation outcomes of pMDI-to-DPI switch in children between 5 and 12 years of age: a scoping review protocol

IntroductionInhalers are critical in asthma treatment, and inappropriate inhaler use leads to poor asthma outcomes. In adults and adolescents, dry powder inhalers (DPIs) are safe and effective alternatives to mainstay...

Predicting COPD Readmission: An Intelligent Clinical Decision Support System

Background: COPD is a chronic disease characterized by frequent exacerbations that require hospitalization, significantly increasing the care burden. In recent years, the use of artificial intelligence-based tools to improve the management of patients with COPD has progressed, but the prediction of readmission has been less explored. In fact, in the state of the art, no models specifically designed to make medium-term readmission predictions (2–3 months after admission) have been found. This work presents a new intelligent clinical decision support system to predict the risk of hospital readmission in 90 days in patients with COPD after an episode of acute exacerbation. Methods: The system is structured in two levels: the first one consists of three machine learning algorithms —Random Forest, Naïve Bayes, and Multilayer Perceptron—that operate concurrently to predict the risk of readmission; the second level, an expert system based on a fuzzy inference engine that combines the generated risks, determining the final prediction. The employed database includes more than five hundred patients with demographic, clinical, and social variables. Prior to building the model, the initial dataset was divided into training and test subsets. In order to reduce the high dimensionality of the problem, filter-based feature selection techniques were employed, followed by recursive feature selection supported by the use of the Random Forest algorithm, guaranteeing the usability of the system and its potential integration into the clinical environment. After training the models in the first level, the knowledge base of the expert system was determined on the training data subset using the Wang–Mendel automatic rule generation algorithm. Results: Preliminary results obtained on the test set are promising, with an AUC of approximately 0.8. At the selected cutoff point, a sensitivity of 0.67 and a specificity of 0.75 were achieved. Conclusions: This highlights the system’s future potential for the early identification of patients at risk of readmission. For future implementation in clinical practice, an extensive clinical validation process will be required, along with the expansion of the database, which will likely contribute to improving the system’s robustness and generalization capacity.

"The biggest challenge is there's never a routine": a qualitative study of the time burdens of cancer care at home.

As cancer care is increasingly delivered in the home, more tasks and responsibilities fall on patients andtheirinformal care partners. These time costs can present significant mental, physical, and financial burdens,andare undercounted in current measures of time toxicity that onlyconsidercare received in formal healthcare settings. Semi-structured qualitative interviews were conducted with patients with gastrointestinal cancer andinformalcare partners at a single tertiary cancer center between March and October 2023. Interviews explored cancer care tasks conducted when home, associated time burdens, how these time burdens compared to facility-based care, and whether home-based care should be included in objective measures of time toxicity. Two coders transcribed interviews and analyzed data using a grounded theory approach. A single interviewer conducted semi-structured interviews with 15 patients and 18 care partners, and identified five major themes: (1) unexpected home-based care activities are time burdensome; (2) other burdens interact with and impact time burdens; (3) time burdens evolve over the disease course and differentially impact patients and care partners; (4) several factors influence the choice of home-based versus in-facility care; and (5) home-based care is generally perceived as less time-burdensome than in-facility care. Overall, 12 of 33 (36%) participants recommended including dayswithhome-based care in the current contact days measure of time toxicity. In addition to characterizing time burdens associated with home-based cancer care, this study builds on existing literature to explore if and how to incorporate days with home-based care into the contact days measure.

Preventing the progression of cirrhosis to decompensation and death.

Two main stages are differentiated in patients with advanced chronic liver disease (ACLD), one compensated (cACLD) with an excellent prognosis, and the other decompensated (dACLD), defined by the appearance of complications (ascites, variceal bleedingand hepatic encephalopathy) and associated with high mortality. Preventing the progression to dACLD might dramatically improve prognosis and reduce the burden of care associated with ACLD. Portal hypertension is a major driver of the transition from cACLD to dACLD, and a portal pressure of ≥10 mmHg defines clinically significant portal hypertension (CSPH) as the threshold from which decompensating events may occur. In recent years, innovative studies have provided evidence supporting new strategies to prevent decompensation in cACLD. These studies have yielded major advances, including the development of noninvasive tests (NITs) to identify patients with CSPH with reasonable confidence, the demonstration that aetiological therapies can prevent disease progression and even achieve regression of cirrhosis, and the finding that non-selective β-blockers can effectively prevent decompensation in patients with cACLD and CSPH, mainly by reducing the risk of ascites, the most frequent decompensating event. Here, we review the evidence supporting new strategies to manage cACLD to prevent decompensation and the caveats for their implementation, from patient selection using NITs to ancillary therapies.

Fiscal Policy Instruments for Inclusive Labor Markets: A Review

ABSTRACTThis paper critically reviews fiscal policy instruments—including active labor market policies, social protection measures, care policies, and tax reforms—focusing on their differentiated impacts on underrepresented groups and their potential to foster labor market inclusivity. Our review reveals that empirical studies often overemphasize the capacity of individual policies to mitigate inequalities, neglecting the complex interdependencies among various mechanisms and policies. Instead, we argue for a systematic approach to ensure equitable access to good jobs and address disparities across labor market groups. Although sector‐specific training and reskilling are essential, their effects often take time to materialize, highlighting the necessity of complementary labor demand measures, such as public works schemes, and employment subsidies, to address immediate challenges and promote inclusive growth. Care policies remain central to improving female labor market participation by alleviating their unpaid care burdens. The review also identifies critical research gaps, including the need for longitudinal studies on long‐term policy impacts, an exploration of regional disparities in labor market inequalities, and sector‐specific effects of fiscal measures.

"I Won't Put Myself or My Family Through That": Decision Preferences, Family Experiences, and Kidney Disease Decision-Making.

Chronic kidney disease (CKD) is a major public health concern that uniquely impacts older Black Americans, a population also likely to have family members also diagnosed with CKD. This study aimed to (1) describe how participants viewed their decision preferences considering the experiences of family, and friends previously diagnosed with CKD, and (2) to understand how these social complexities informed their own decisions for future CKD care. Utilizing a phenomenologically-informed approach, this study explored participants' perceptions of how patients and their family members' experiences with CKD influenced treatment-related decision-making. A reflexive, thematic content analysis was conducted to identify patterns across participant responses (N=52). Participants were pre-dialysis, diagnosed with stage four or five chronic kidney disease, and were receiving outpatient nephrology care at a large, urban midwestern hospital. Three primary themes emerged: (1) uncertainty regarding decision-making, (2) lived experience of racism, and (3) impact of quality of care, information, and education on decision-making. These three interconnected themes centered on factors that influenced why and how decisions related to chronic kidney disease were made and how racial identity and prior family experiences with CKD influenced these decisions. Over the next 40 years, the population of Black Americans aged ≥ 65 years will nearly triple. Because of the complex support requirements and burden(s) of care for CKD patients, there are implications for reshaping the negative and disorienting narratives that influence decision-making conflicts.

Laser-Induced Thermal Therapy in the Management of Low-Grade Gliomas: A Narrative Review

Background: Low-grade gliomas (LGGs) are slow-growing, World Health Organization Grade I and II tumors that can transform into more aggres-sive malignancies over time. This transformation pre- sents significant challenges in managing the burden of health care. Laser-induced thermal therapy (LITT) has emerged as a promising minimally invasive treat-ment option for LGGs, offering precise tumor ablation with minimal damage to surrounding tissues. Method: This narrative review synthesizes data from relevant studies on the evolution, clinical manifestations, mo-lecular characteristics, and emerging management strategies for LGGs, with a focus on the role of LITT. Results: LITT, a minimally invasive technique, offers targeted tumor ablation with the added benefit of disrupting the blood-brain barrier to enhance drug delivery. Studies have shown that LITT can effectively reduce tumor size and improve survival rates in patients with both primary and recurrent gliomas. However, challenges such as procedure-related complications, including motor deficits and cerebral edema, as well as the need for further research on long-term efficacy, remain. Conclusion: LITT represents a significant advancement in the treatment of LGGs, combining precision and minimal invasiveness. Future studies should focus on optimiz-ing protocols, integrating molecular and genetic in-sights, and assessing long-term outcomes to enhance therapeutic efficacy and patient quality of life.

Factors associated with higher caregiver burden among informal caregivers of Parkinson's disease: A systematic review.

Parkinson's disease is a progressive neurodegenerative disease and the care burden in informal caregivers is huge. Summarizing factors associated with the informal caregivers burden can improve our understanding of providing proactive support to informal caregivers caring for patients with Parkinson's disease (PwP) at risk, and provides evidence for clinical practice. PRISMA guidelines were followed in this systematic review. We searched 9 databases in May 2024 for studies reporting data on factors associated with the care burden of informal caregivers for PwP. We identified 16456 records of which 28 met inclusion criteria. Informal caregivers from 12 countries were included. There were 38 factors shown to be linked to higher care burden. The evidence indicated that informal caregivers who were depressed, caring for PwP with lower quality of life, caring for PwP with lower ADL scores, or caring for PwP with depression reported high care burden. Targeted interventions addressing those modifiable factors should be developed and investigated to lighten the care burden of informal caregivers for PwP.