Cost Of Health Care Services Research Articles

Burden of Medical Costs Associated with Severe Maternal Morbidity in South Korea

Background: Adverse maternal health outcomes lead to health loss and unnecessary medical costs. However, few have explored how severe maternal morbidity (SMM) affects medical costs separately from blood transfusion. Therefore, the aim of this study was to evaluate the delivery-related costs of healthcare services in patients with and without SMM as well as blood transfusion. Methods: This retrospective cohort study used the National Health Insurance Service (NHIS) Delivery Cohort database in South Korea. We included all delivering mothers in South Korea from 2016 to 2021, except those with incomplete data, totaling 1,517,773 participants. The measured outcomes included delivery-related medical costs associated with SMM. A generalized estimating equation model with a log link, gamma distribution, and robust standard errors was used to estimate the mean delivery-related medical costs of SMM. Results: SMM occurred in 2.2% of the cohort. The adjusted mean delivery-related medical costs were approximately 2.1- and 1.4-fold higher in cases with SMM without blood transfusion and only blood transfusion than in those without SMM, respectively ($2005, 95% CI: $1934–2078 and $1339, 95% CI: 1325–1354, respectively). The adjusted mean delivery-related medical costs were 1.5-fold higher in cases with SMM with blood transfusion than in those without SMM (SMM $1539, 95% CI: $1513–$1565). Conclusions: Medical costs associated with delivery-related SMM with or without blood transfusion were significantly higher than those of normal deliveries, with excess costs varying according to existing healthcare policies. Policymakers should consider supporting programs to prevent high medical costs by improving maternal health.

Impacts of economic sanctions on population health and health system: a study at national and sub-national levels from 2000 to 2020 in Iran

BackgroundFormal evidence regarding the effects of sanctions on population health status and the health system is scarse in Iran. Given the intricate and multifaceted nature of sanctions, a nuanced understanding of their impact is imperative. We aimed to investigate the magnitude and effects of sanctions on population health and healthcare system during the last two decades in Iran.DesignThis is a mixed-methods research. We quantified the impact of sanctions using 28 indicators, i.e. macroeconomic, healthcare resources and health outcomes indicators from 2000 to 2020. The concurrent qualitative study aimed to explore the pathway of the effect by considering perceptions of both patients and health policy makers towards sanctions; Interview data was analyzed using content analysis.SettingThis study was conducted in Iran at both national and sub-national levels.ResultsOur findings revealed that the trend of 11 indicators (39.2%) had changed after the change point in 2009; four indicators (14.2%) significantly deteriorated after the change point. Further, five indicators revealed significant increases during the sanctions period: Out-of-Pocket payment (OOP), household expenditure on food and mortality rates due to Chronic Obstructive Pulmonary Disease (COPD), thalassemia and hypertension. Our qualitative analysis revealed that patients identified availability, cost and quality of medicines and healthcare services as the most significant challenges that compromised population’s health. From the policy makers’ perspective, the effect of sanctions on health system functions and infrastructures, i.e. economic, political, social, educational and research had significant repercussions on population health.ConclusionWe could not find compelling evidence to establish significant associations between the imposition of sanctions and the trend of population health. Nevertheless, our qualitative study revealed people’s deteriorating life experiences, e.g. increasing catastrophic health expenditure, limited access to necessary medicine, medical equipment, procedures and interventions, imposed by sanctions, with ultimate reducing impact on the overall quality of life. It seems that sanctions have negatively affected financial and physical access to medication and healthcare services. Nonetheless, Iran has demonstrated remarkable resilience against their highly detrimental effects, maybe due to its established economic infrastructure and healthcare system.

End-of-Life Health Care Service Use and Cost Among Medicare Decedents With Neurodegenerative Diseases.

Although neurodegenerative diseases are a leading cause of death, little is known about health care utilization and cost during the end-of-life (EoL) period or how it compares with that of other life-limiting conditions. We aimed to describe and compare resource utilization among US Medicare decedents with neurodegenerative diseases with decedents with cancer. We conducted a retrospective study of Medicare Part A and B beneficiaries with Alzheimer disease (AD), Parkinson disease (PD), or amyotrophic lateral sclerosis (ALS) who died in 2018. Decedents diagnosed with malignant brain tumors or pancreatic cancer served as non-neurodegenerative comparators. Descriptive analyses examined demographic and clinical characteristics in the last year of life. The probabilities and associated costs of emergency department (ED), inpatient, skilled nursing facility (SNF), and hospice utilization during the last 12 and 6 months of life were also compared between persons with neurodegenerative diseases and cancer, adjusting for sociodemographic factors and comorbidity burden. A total of 1,126,799 Medicare beneficiaries died in 2018, of which 357,926 had a qualifying diagnosis. Persons with neurodegenerative diseases were older and more frequently received Medicaid assistance than persons with brain or pancreatic cancer. In all groups, health care service utilization increased over the last year of life, and total costs were predominantly attributable to inpatient care. In the last 6 months of life, neurologist care was infrequent among patients with neurodegenerative disease (AD: 1.5%; PD: 8.6%; ALS: 32.0%). Persons with neurodegenerative diseases as compared to persons with malignant brain tumors also had greater odds of ED use (AD: adjusted odds ratio [aOR] 1.17, 95% CI 1.11-1.23; PD: aOR 1.18, 95% CI 1.11-1.25; ALS: aOR 1.11, 95% CI 1.01-1.23), lower odds of hospitalization (AD: aOR 0.64, 95% CI 0.60-0.68; PD: aOR 0.65, 95% CI 0.61-0.69; ALS: aOR 0.33, 95% CI 0.30-0.37), and lower odds of hospice enrollment (AD: aOR 0.33, 95% CI 0.31-0.36; PD: aOR 0.33, 95% CI 0.31-0.36; ALS: aOR 0.41, 95% CI 0.36-0.46). The findings were similar in pancreatic cancer. Persons with neurodegenerative diseases in the United States are more likely to visit the ED and less likely to use inpatient and hospice services at EoL than persons with brain or pancreatic cancer. These group differences may stem from prognostic uncertainty and reflect inadequate EoL care practices, requiring further investigation to ensure more timely palliative care and hospice referrals.

Reconsidering the City of New York Directive on Mental Health Involuntary Removals.

Homelessness is a visible manifestation of large-scale societal challenges, such as lack of affordable housing, poverty, and health inequities. Governments may miss opportunities to address these structural problems by removing people experiencing homelessness from public spaces. On 29 November 2022, after a press conference by Mayor Eric Adams, the city of New York issued a directive entitled Mental Health Involuntary Removals. The program authorized mental health providers and NYPD officers to take any person into custody who appears mentally ill and displays inability to meet basic living needs, even when no dangerous act has been observed. We reviewed the existing literature from 1973 to 2023 for studies, enacted legislation, state and federal policies, and interventions related to homelessness, mental health, and admission of people experiencing homelessness into psychiatric hospitals in the United States. We used academic databases, including PubMed, PsycInfo, and JSTOR for peer-reviewed articles, government reports, and policy analyses. Our search strategy included keyword combinations such as "homelessness and mental health," "policy interventions for homeless populations," and "health care services costs." We applied inclusion criteria focusing on reports and articles that directly address the intersectionality of homelessness, mental health policy, and psychiatric care. Homelessness and mental illness frequently intersect, creating complex challenges that require nuanced solutions. Forced hospitalization of people experiencing homelessness in New York City, while intended to address critical social and health care issues, carries a risk for significant long-term harm. This approach places strain on the mental health care system and may ultimately exacerbate the problems it purports to resolve.

The effect of multidomain lifestyle intervention on health care service use and costs - secondary analyses from the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER): a randomised controlled trial.

The Finnish multidomain lifestyle intervention study to prevent cognitive impairment and disability (FINGER, N = 1259), a randomised controlled trial had beneficial effects on morbidity in older people, but to what extent such a lifestyle intervention may affect the use of health care services and their costs especially in long term are unknown. This study investigated the effect of a two-year FINGER multidomain intervention on health care service use during the 8-year follow-up. The costs of service use were also evaluated. Health care service use obtained from national health care registers (days of inpatient hospital stay and long-term care, number of visits to emergency services, hospital as outpatient, home care, primary care physician and primary care nurse) was analysed among participants of the FINGER. Trial targeted community-dwelling people aged 60-77years at risk for cognitive impairment, who were randomly allocated to the multidomain intervention or control group. Costs were evaluated as the mean costs of services used. There were no significant differences in total health care costs between the intervention and control groups. The participants in the intervention group, however, had a lower use of the hospital inpatient care (RR 0.73, 95% CI 0.54-1.00) and emergency services (RR 0.83, 95% CI 0.70-0.97) than those in the control group. Hospital inpatient care was lower especially among men. The use of other types of health care services did not differ between the groups. The costs of health care service use without including long-term care were lower in the intervention group (RR 0.81, 95% CI 0.68-0.99). The FINGER intervention has a potential to reduce the need for the inpatient hospital care and emergency visits and associated costs, especially among men.

Cost-utility analysis of provision of e-cigarette starter kits for smoking cessation in emergency departments: An economic evaluation of a randomized controlled trial.

To assess the cost-effectiveness of the Cessation of Smoking Trial in Emergency Department (COSTED) intervention compared with signposting to local stop smoking service (SSS) from the National Health Service (NHS) and personal social services (PSS) perspective. This was a two-group, multi-centre, pragmatic, individually randomized controlled trial set in six Emergency Departments (EDs) in urban and rural areas in the United Kingdom. Adult (≥ 18 years) daily smokers (at least one cigarette or equivalent per day) but not daily e-cigarette users, with carbon monoxide reading ≥8parts per million, attending the ED (n= 972) were included. The intervention consisted of provision of an e-cigarette starter kit plus brief smoking cessation advice and referral to a local SSS. Control was an information card on how to access local SSS. Intervention costs included costs of training and delivery. Control costs included costs of printing information cards. Costs of smoking cessation and health-care services were estimated based on quantities reported by participants and unit costs extracted from secondary sources. The effects were measured by quality-adjusted life years (QALYs) derived from EQ-5D-5L. Other outcomes were smoking cessation measures. The primary outcome was incremental cost-effectiveness ratio (ICER), which was calculated by dividing the difference in costs by the difference in QALYs between groups. The mean intervention costs were £48 [standard error (SE) = £0] per participant and the mean control costs were £0.2 (SE = £0) per participant. Using regression estimates, total costs were £31 [95% confidence interval (CI) = -£341 to £283] higher and 6-month QALYs were 0.004 (95% CI = -0.004 to 0.014) higher in the intervention group than in the control group. The ICER was calculated at £7750 (probability of cost-effective at range £20 000-30 000: 72.2-76.5%). The UK Cessation of Smoking Trial in Emergency Department (COSTED) intervention (provision of an e-cigarette starter kit plus brief smoking cessation advice) was cost-effective compared with signposting to local stop smoking services under the current recommendations of the maximum acceptable thresholds.

Carbon Emission Reduction Associated With Utilisation Of Telehealth In Outpatient Clinics In An Australian Quaternary Health Service

Objective: To assess the impact of implementing telehealth in outpatient clinics on the carbon emissions associated with the delivery of health care. Design & Setting: Retrospective cohort study in large metropolitan quaternary referral health service from January 2021- December 2022. Participants: All patients who attended an outpatient clinic appointment during the study period, either in-person, via telehealth or via telephone. Main outcome measures: The estimation of carbon emissions in tonnes (t) of CO2-equivalent (CO2-e) associated with in-person and telehealth appointments based on emissions associated with travel, telehealth platform usage and N95 mask usage. Results: There were 571,121 outpatient clinic appointments during the study period. Of the appointments, 251,458 (44%) were conducted remotely, resulting in an estimated reduction in 3,629t of CO2-e emissions in the two-year period. Telehealth consultations in this time contributed 4.5t of CO2-equivalent emissions. The total emission usage of telehealth clinic was only 0.12% of emissions generated from face-to-face clinic appointments. Conclusion: Telehealth offers the opportunity of substantial carbon emissions reduction within the healthcare sector, while also providing cost and time-saving benefits for healthcare services and patients. Limitations include generalisation of transportation modes and the retrospective nature of the data collection.

445P Utilization and costs of healthcare services and labour market affiliation of persons with adult-onset myotonic dystrophy – a Danish register-based study (Study II)

445P Utilization and costs of healthcare services and labour market affiliation of persons with adult-onset myotonic dystrophy – a Danish register-based study (Study II)

Evaluation of Social Media Tools in Health Tourism Marketing with Multi Criteria Decision Making Methods

Today, countries are turning to alternative tourism types due to the destructive and corrosive effect of mass tourism. Various factors in the global market affect consumer preferences and shape their demands. This situation leads countries to seek alternative tourism types. While developed countries tend to focus more on sports tourism, the rising value of health tourism stands out for developing countries. The high costs of healthcare services in developed countries, waiting times, and the lack of many health services offered by insurance companies lead consumers to outsource their helthcare needs. Relationship marketing plays a key role in health tourism services, and consumers seek first-hand answers to their questions. The health sector's sensitive and complex structure informs and raises consumers' awareness on the axis of relational marketing dimensions. This study aims to via multi criteria decision making to determine and rank the social media channels used in health tourism marketing. While the criteria weights are determined by the Best-Worst Method, the priority order of social media channels is determined by COmbinative Distance-based ASsessment. Expert opinions were consulted during the criteria determination and the ranking of the alternatives. As a result of the analyses, the importance of social media is emphasised once again. Social media tools, especially through mobile application applications, shape the age with the audience it reaches, the distribution between regions, the time spent and the information transmitted. The need for socialisation accelerates the development of technology with the rapid orientation of people towards this field. In this case, youtube, which has gained momentum with the number of users and the use of visual and auditory elements together, holds the leadership in the reflection of relational marketing on health tourism today, as it creates space for all segments, even though information pollution is experienced.

Care Nursing in Immune Disorder Assessment among Adult Oncology Patients: A Scoping Review.

International guidelines recommend a pathway for preferable nursing handling in a specific cancer topic, like chemotherapy toxicity, low adhesion in toxicity reported with a consequential increase in adverse events (AEs) frequency, poorer QoL outcomes, and increased use of healthcare service until death. Unpredictability, postponed reports, and incapability to access healthcare services can compromise toxicity-related effects by including patients' safety. In this scenario, a more attentive nursing intervention can improve patients' outcomes and decrease costs for healthcare services, respectively. The present scoping review aims to describe and synthesize scientific care nursing evidence assessment in oncology patients. PubMed, Embase, Nursing & Allied Health Database, and British Nursing were the databases examined. Keywords used and associated with Boolean operators were assessment, care, nursing, immune disorder, oncology, and patient. Research articles considered were published between 2013-2023. All systematic processes were performed according to the PRISMA procedure in order to reach all manuscripts considered in the present scoping review. The Embase database showed a total of 25 articles, PubMed displayed 77, the Nursing & Allied Health Database evidenced a total of 74, and the British Nursing database showed 252 records. Then, after a first revision in each database by considering the inclusion criteria, the abovementioned titles and abstracts were selected and, 336 records were removed, and 92 studies remained. Of these, 65 manuscripts were excluded after verifying abstracts. Finally, a total of 7 articles were carefully analysed and selected for this scoping review. Specifically, 2 articles belonged to the British Nursing Database, 3 articles belonged to Embase, 1 to the Nursing & Allied Health Database and one related to PubMed. Oncology nursing should consider several aspects, such as therapy-related toxicity and its related morbidity and mortality, worsening levels of quality of life, and increasing duty by the healthcare organization or endorsements for the principal symptoms and signs which may anticipate few diseases and worst clinical conditions, too. Therefore, careful monitoring may allow prompt recognition and subsequent earlier management in the treatment efficacy.

Ambulatory models for autologous stem-cell transplantation: a systematic review of the health impact.

Autologous stem-cell transplantation (ASCT) is the standard of care for the management of multiple myeloma and has a well-established role in the treatment of some types of lymphoma. Over the last decades, the number of ASCT performed has increased significantly, leading to elevated pressure and cost for healthcare services. Conventional model of ASCT includes the admission of patients to a specialized Transplant Unit at any stage of the procedure. To optimize healthcare provision, ambulatory (outpatient/at-home) setting should be the focus moving forward. Thus, ambulatory ASCT model permits reducing average hospital stays and pressures on healthcare services, with significant cost-saving benefits and high degree of patient and caregiver satisfaction. In addition, it facilitates the bed resource for other complex procedures such as allografts or CAR-T cell therapy. The aim of this systematic review is to document the health impact, feasibility and safety of the outpatient/at-home ASCT models, which are increasingly being applied around the world.

Levelling up health in the early years: A cost-analysis of infant feeding and healthcare.

Although breastfeeding is recommended as the optimal form of nutrition in the first six months, it is not sustained as the predominant mode of feeding infants in Scotland. This study estimated the impact of infant feeding choices on primary and secondary healthcare service costs in a 13-year birth cohort. Using linked administrative datasets, in a retrospective cohort design of 502,948 singletons born in Scotland between 1997 and 2009, we estimated the cost of GP consultations and hospital admissions by area deprivation and mode of infant feeding up to 6-8 weeks for ten common childhood conditions from birth to 27 months. Additionally, we calculated the potential healthcare savings if all infants in the cohort had been exclusively breastfed at 6-8 weeks. Discounting of 1.5% was applied following current health economic conventions and 2009/10 used as the base year. Over the study period, the estimated cost of hospital admissions in the cohort was £111 million and £2 million for the 2% subset of the cohort with primary care records. Within each quintile of deprivation, exclusively breastfed infants used fewer healthcare services and incurred lower costs compared to infants fed (any) formula milk. At least £10 million of healthcare costs may have been avoided if formula-fed infants had been exclusively breastfed within the first 6-8 weeks of birth. This study using a representative birth cohort demonstrates how breastmilk can promote equitable child health by reducing childhood illness and healthcare utilisation in the early years.

Comparing Mobile-Based to Group-Based Education for Weight Reduction in a Developing Country: A Randomized Study.

This study compared the impact of Short Message Service (SMS)-based education with traditional group-based education and the control group on body mass index, weight, and lifestyle in obese and overweight patients in a limited-resource country. It also compared the direct financial costs between the two intervention groups. In this controlled randomized educational study, 90 overweight or obese adults from four family physician clinics in Shiraz, Iran were randomly allocated to three training groups: SMS-based education, group-based education, and a control group. The participants' weight, body mass index (BMI), and waist circumference were measured at baseline, and the Physical Activity Scale questionnaire was completed. Group-based training was conducted in 1-hour weekly sessions. The SMS group received a text message each morning. The control group received routine care from a family physician. The intervention lasted 12 weeks. All participants were re-examined for the studied variables. Additionally, the direct costs were estimated, calculated, and compared. The mean weight, BMI, and waist circumference changed significantly after 3 months compared to baseline in each group. The mean weight change differed significantly among the three groups (P-value=0.04), and the mean BMI changes were near significant (P-value=0.06). A post hoc comparison of changes in weight and BMI showed a significant difference between the control and SMS groups. SMS education incurred much lower costs for patients and healthcare services than group-based education. The study showed that SMS is an effective and cost-saving educational method for weight loss compared to group-based education, especially in developing countries.

Parent SMART: Effects of residential treatment and an adjunctive parenting intervention on behavioral health services utilization

IntroductionScant research has examined the impact of residential treatment on adolescent behavioral healthcare utilization post-discharge, even though behavioral healthcare utilization is major driver of healthcare costs. In the primary analyses of a pilot randomized trial, Parent SMART – a technology-assisted intervention for parents of adolescents in residential treatment – was found to improve parental monitoring and parent-adolescent communication, reduce adolescent drinking, and reduce adolescent school-related problems, relative to residential treatment as usual (TAU). The goal of this secondary analysis of the pilot randomized trial was to assess the effects of residential treatment and the adjunctive Parent SMART intervention on both the amount and type of subsequent behavioral healthcare utilization. MethodThe study randomized sixty-one parent-adolescent dyads to residential TAU (n = 31) or residential TAU plus Parent SMART (n = 30). Of the 61 dyads, 37 were recruited from a short-term residential facility and 24 were recruited from a long-term facility. Adolescents completed a structured clinical interview and self-reported their behavioral health-related visits to the emergency department, nights in residential/inpatient, and outpatient visits over the past 90 days, at baseline, 12-, and 24-weeks post-discharge. Generalized linear mixed models (GLMMs) examined both linear and non-linear (pre- to post- residential treatment) trends, pooled, and stratified by residential facility to examine behavioral health service utilization. ResultsBoth the linear and pre-post GLMMs revealed that behavioral health-related emergency department visits and residential/inpatient nights decreased across both residential facilities. GLMMs estimating change from the pre- to post period indicated that outpatient visits increased across both facilities. There were no significant effects of the Parent SMART adjunctive intervention in GLMMs, though bivariate tests and the direction of effects signaled that Parent SMART was associated with more nights of residential/inpatient utilization. ConclusionResidential substance use treatment may reduce adolescents' subsequent utilization of costly behavioral healthcare services such as emergency department visits and residential/inpatient nights, while increasing utilization of outpatient services. Parent SMART was not associated with significant changes in behavioral healthcare utilization, but the pattern of results was consistent with prior literature suggesting that stronger parenting skills are associated with greater utilization of non-emergency services.

A novel ensemble learning framework based on a genetic algorithm for the classification of pneumonia

Pneumonia is a disease that can be detected by the opacity changes in chest X-rays and can lead to fatal consequences. Medical image analysis has several challenges, such as limited labeled datasets, imbalanced class distribution, image noise, and overfitting, so individual Convolutional Neural Networks (CNNs) are insufficient to detect pneumonia accurately. Although ensemble CNN models have been used in previous studies, the literature lacks guidance on identifying the optimal CNN models and weight ratio to combine them. In this study, we propose a novel ensemble CNN framework to accurately detect pneumonia, with optimum weights set by a Genetic Algorithm (GA). Firstly, a noise outside the lung was removed, and the model performance was enhanced by performing lung segmentation on Chest X-ray. The performances of several CNN models were analyzed by hyperparameter optimization. The framework combines the three models that give the best accuracy and the two models that provide the lowest false-negative value with the ensemble method in the ratio of the most appropriate weights. The proposed framework provided the best performance on the public test dataset with an accuracy of 97.23% and an F1-score of 97.45% compared to state-of-the-art methods. The study's main contributions are determining suitable models and their optimal weights of the ensemble method based on the GA. The proposed framework enables a rapid and effective diagnostic process, less costly healthcare services, and more efficient use of resources. The demo-link is https://www.youtube.com/watch?v=KZ50K3HL70U.

Estimating the Costs of End-of-Life Care in Patients With Advanced Cancer From the Perspective of an Insurance Organization: A Cross-Sectional Study in Iran

ObjectivesCancers are significant medical conditions that contribute to the rising costs of healthcare systems and chronic diseases. This study aimed to estimate the average costs of medical services provided to patients with advanced cancers at the end of life (EOL). MethodsWe analyzed data from the Sata insurance claim database and the Health Information System of Baqiyatallah hospital in Iran. The study included all adult decedents who had advanced cancer without comorbidities, died between March 2020 and September 2020, and had a history of hospitalization in the hospital. We calculated the average total cost of healthcare services per patient during the EOL period, including both cancer-related and noncancer-related costs. ResultsA total of 220 patients met the inclusion criteria. The average duration of the EOL period for these patients was 178 days, with an average total cost of $8278 (SD $5698) for men and $9396 (SD $6593) for women. Cancer-related costs accounted for 64.42% of the total costs, including inpatient and outpatient services. Among these costs, hospitalization was the primary cost driver and had the greatest impact on EOL costs. This observation was supported by the multiple linear regression model, which suggested that hospitalization in the final days of life could potentially drive costs in these patients. Notably, no specialized palliative care was provided to the patients included in this study. ConclusionsThe results demonstrate that there is a significant rise in costs of care in patients receiving routine cancer care rather than optimized EOL care.

Analysis of cost of illness and diagnosis-related group payment system in breast cancer patients with chemotherapy in Indonesia

Background: Often, breast cancer patients undergoing chemotherapy sacrifice their finances, and the financial costs also affect the government. Objective: This study aims to analyse the cost of illness and the application of an insurance payment system among breast cancer patients receiving various chemotherapy regimens. Method: This study was retrospective and used a bottom-up prevalence approach. Data were collected from a secondary hospital between 2020 and 2021. The inclusion criteria were breast cancer patients undergoing chemotherapy. Patients with incomplete detailed cost data were excluded. The cost of illness was calculated from direct medical costs and the estimated non-medical and indirect costs. Results: The cost of illness for a chemotherapy visit for a breast cancer patient spanned from USD 130.37 to USD 932.05. However, these values did not include healthcare service costs and laboratory tests. The highest regimentation chemotherapy cost is for the combination of docetaxel–cyclophosphamide–trastuzumab. There was a significant margin between insurance claims and variable medical costs (p < 0,05), ranging between USD 24.21 and 104.83. Conclusion: The cost of illness for chemotherapy for breast cancer patients is high, and the coverage of the diagnosis-related payment system is limited. Therefore, the government should accelerate prevention programmes to reduce the incidence of cancer.

Use of a novel bluetooth-connected device to measure handgrip strength: A practical tool to help healthcare professionals identify adults at nutritional risk

Background and AimsLow muscle strength is strongly tied to poor nutrition status, and nutritional interventions are likewise linked to maintenance and restoration of muscle strength and functional status. Nutrition plays a vital role in muscle mass, strength, and function, and losses in muscle (strength, function, and mass) are associated with poor health outcomes and added costs for healthcare services. For this study of outpatients, the main objective was to identify those at risk for low muscle strength, as evidenced by low handgrip strength (HGS) measures with risk stratified by age and sex. MethodsThis was a two-part study on HGS measures in adults attending outpatient clinics in India. In part one, we conducted HGS tests on dominant and non-dominant hands of patients who qualified for the study. For HGS measures, we used a validated tool, the SQUEGG device, a smart handgrip trainer, along with its companion Bluetooth-connected app, the Muscle Strength Assessment Tool (MSAT) app. In part two, we collected Healthcare Practitioners’ (HCP) feedback via a short digital survey on the use of the SQUEGG device + the MSAT app to do HGS risk screening as an indicator of needed nutritional intervention. ResultsNearly a third of community-living adults in India exhibited low HGS among the 3036 sampled. At each age stratum, dominant-hand HGS in women was lower by 25% to 35% compared to men. Among 353 HCPs, 293 (83%) provided insights via survey, and 85% of surveyed HCPs (n=249) strongly agreed or agreed that the SQUEGG device + MSAT app helped them identify HGS issues among their patients, and 85% (n=248) agreed or strongly agreed they would like to continue using the SQUEGG device + MSAT app to inform their practice. Nearly all surveyed HCPs (98%, n=288) recommended an oral nutritional supplement (ONS) to their patients with identified low HGS. ConclusionsOur findings demonstrate that HCPs would like to continue use of the SQUEGG device + MSAT app as it helped them identify adult patients who had decreased HGS (about 30% of the study population), in turn identifying opportunities to use nutritional interventions such as ONS to address nutrition shortfalls and to restore functional status.

A Digital Platform (Telepalliation) for Patients in Palliative Care and Their Relatives: Protocol for a Multimethod Randomized Controlled Trial.

The World Health Organization defines end-of-life palliative care as "prevention and relief of suffering, by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual." Over 20 million people worldwide are in need of palliative care. In Denmark, palliative care is given at a general and a specialist level. The general level comprises health care professionals (HCPs) who do not perform palliative care full-time. The specialist level comprises specialized palliative care (SPC), where HCPs perform palliative care full-time. In total, 20%-30% of patients who need palliative care are referred to SPC. Challenges with SPC include a short time span from referral to end of life, patients who are very ill and may therefore find it hard to travel to an outpatient clinic, and the SPC unit having a relatively small staff. The need for SPC is expected to rise, as the number of patients dying from terminal diseases is increasing. Telehealth has been successfully implemented in different home care settings, including palliative care. The aim of the study is to present the research design of the clinical testing of a telepalliation program by the use of a digital platform for patients in palliative care and their relatives. The telepalliation program will be conducted as a multimethod randomized controlled trial. The intervention group will follow the telepalliation program, while the control group will follow the traditional standard of care program for palliative care. The primary outcome of the study is increased quality of life. Secondary outcomes include enhanced sense of security; reduced experience of pain; satisfactory experiences of patients and relatives with the TelePal platform and degree of satisfaction in being a part of the program; experiences with the use of the TelePal platform on the part of HCPs and the professionals' experiences of being a part of the program; the use of a cross-sector communication platform and the telepalliation program by patients, relatives, and HCPs; and the projected lower cost of health care services. These outcomes will be assessed using questionnaires, data generated by digital technologies, and semistructured interviews. The collection of data began in May 2021 and will be completed in August 2024. The results of the study will be published in peer-reviewed journals and presented at international conferences. Results from the telepalliation program are expected to be published by fall 2024. The expected outcomes of the study are increased quality of life and increased sense of security. We also expect that the study will have a clinical impact on future telepalliation for those patients who are referred to a palliative team. ClinicalTrials.gov NCT04995848; https://clinicaltrials.gov/study/NCT04995848. DERR1-10.2196/49946.

Helping parents to cope with infant regulatory disorders

The term Regulatory Disorders (RDs) refers to infants and young children who cry a lot, have poorly organised sleep-waking, or whose feeding is impaired. The characteristic they share is a failure to acquire autonomous self-control of these key behaviours, which most children develop in the first postnatal year. The concept of RDs is helpful in highlighting this question of how infant self-regulation is, or isn't, accomplished, in drawing these characteristics together and distinguishing them from others, and in focusing research and clinical attention on a common, but relatively neglected, set of concerns for families. The main focus for research into RDs has been on the nature and causes of the infant behaviours involved. Here, the aim is to highlight the part played by parents, since that is central to the provision of clinical services for RDs. Three points are made. (1) The contributions of parents include: detection and monitoring of RDs; generating the resulting healthcare service costs; maintaining their own wellbeing, since that is in their infant’s best interest; delivering interventions to help infants and families, which are almost always provided by parents. Parenting may be involved in maintaining RDs in some cases. (2) Substantial differences exist between infant RD cases in the behaviours involved, the age at which they present, the complexity and severity of the RD, and in their persistence over time and age. Most cases have one, rather than all three RDs, making them the most common type seen by clinicians. Evidence is summarised that interventions tailored to fit the RD involved can be effective in these cases. Multiple and sustained RDs are much rarer, but associated with greater risk of long-term psychological and behavioural impairments. They are a priority, but less is known about the contributions of parenting and child factors to these cases. (3) The focus on parents with infants requires joined-up paediatric and adult mental health services. After summarising three main requirements for such services, an example designed to fulfil these requirements is described to illustrate what a service for supporting families with RDs might look like.