Expensive Treatment Research Articles

Public hospital reform, family health consumption and health inequality: evidence from China Family Panel Studies.

In 2017, China launched a comprehensive reform of public hospitals and eliminated drug markups, aiming to solve the problem of expensive medical treatment and allow poor and low-income people to enjoy basic health opportunities. This study attempts to evaluate the policy impact of public hospital reform on the health inequality of Chinese residents and analyze its micro-level mechanism from the perspective of household consumption structure. Studying the inherent causal connection between public hospital reform and health inequality is of paramount significance for strengthening China's healthcare policies, system design, raising the average health level of Chinese residents, and achieving the goal of ensuring a healthy life for individuals of all age groups. Based on the five waves of data from the China Family Panel Studies (CFPS) conducted in 2012-2020, We incorporates macro-level statistical indicators such as the time of public hospital reforms, health insurance surplus, and aging, generating 121,447 unbalanced panel data covering 27 provinces in China for five periods. This data was used to explore the impact of public hospital reform on health inequality. Logical and empirical tests were conducted to determine whether the reform, by altering family medical care and healthy leisure consumption expenditures, affects the micro-pathways of health inequality improvement. We constructed a two-way fixed model based on the re-centralized influence function (RIF_CI_OLS) and a chained mediation effects model to verify the hypotheses mentioned above. Public hospital reform can effectively improve the health inequality situation among Chinese residents. The reform significantly reduces household medical expenses, increases healthy leisure consumption, promotes the upgrading of family health consumption structure, and lowers the health inequality index. In terms of indirect effects, the contribution of the increase in healthy leisure consumption is relatively greater. Public hospital reform significantly alleviates health inequality in China, with household health consumption serving as an effective intermediary pathway in the aforementioned impact. In the dual context of global digitization and exacerbated population aging, enhancing higher education levels and vigorously developing the health industry may be two key factors contributing to this effect.

Expert consensus over genetic counseling for carrier screening of Spinal muscular atrophy

Spinal muscular atrophy (SMA), an autosomal recessive neuromuscular disease with a carrier frequency of 1/60 ~ 1/40, is characterized by severe clinical symptoms, high mortality rate, and expensive treatment costs. Carrier screening is of paramount importance to detect high-risk couples, and therefore to reduce the occurrence of SMA. In China, SMA carrier screening has become widespread, though there is still a lack of genetic counseling expertise. This article has focused on the current challenges for SMA carrier screening, including the screening methods, target population, screening procedures, and pre-/post-testing counseling. The aim is to standardize its application and counseling in the clinical practice.

Preferences of financial discussion among cancer care physicians and patients with cancer at a government cancer center in Nepal.

e23204 Background: Good communication of disease status between treating physicians and cancer patients with shared decisions of treatment plan helps patients to choose most suitable management options which further improves their quality of care. Methods: A structured survey was conducted with all Cancer care physicians and 100 randomly selected cancer patients at Bhaktapur Cancer Hospital. Physicians were asked about their preferences for financial communication with the patients, especially before starting treatment. Patients were surveyed for their willingness and satisfaction of financial communication with cancer physicians. Frequencies and percentages were calculated. Results: 31.57% were female among responded 38 cancer physicians (95%). 44% were female among 100 selected cancer patients. Cancer physicians were from different disciplines including surgical oncology (39.47%), radiation oncology (10.52%), medical oncology (7.89%), radiology (10.52%), pathology (15.78%), anesthesia (7.89%), and others. Financial distress was the most common cause of treatment default (63.15%) followed by the prevalent cancer myth of cancer being an incurable disease (31.57%) according to the physicians. All physicians believed discussing finances improves patient compliance, but only 68.42% believed it also helps decrease patients' financial distress. 28.94% of physicians always discussed finances with all patients, 50% discussed with a few patients only, and 7.89% never discussed finances with patients. Among physicians who discussed finances with few patients only, the major reasons were queries initiated by patients (61.35%), discussion about expensive treatment options (47.36%) and discussion based on number of patients appointed per day (21.05%). The common reasons behind unwillingness of financial discussions were physicians' ignorance about the total estimated cost (34.2%), physicians' anxiousness that patients will not initiate treatment after knowing the estimated cost (22.72%), and unawareness of possible consequences of discussion (7%). During the financial discussion, the most common discussion were about the information on government subsidies (53.33%), followed by the total estimated cost (40%), and queries about the source of money for treatment (26.66%). On the other part, 91% patients were willing for good cost communication with cancer physicians but only 12% patients were satisfied with the cost communication they had with their treating physicians. 86% patients believed good cost communication help to manage finances during treatment and decrease their financial distress. Conclusions: Optimal financial discussion between cancer care physicians and patients is lacking in our setup, which may be the important contributory cause to financial distress for patients and their families leading to non compliance to treatment.

Comparison of standard charges for complex proton therapy among Medicare Prospective Payment System (PPS) –exempt and –non-exempt cancer centers.

e23039 Background: Proton therapy is one of the most expensive treatment modalities offered to cancer patients, and only 44 proton therapy centers are operational in the U.S. Of those, 5 are Medicare Prospective Payment System (PPS)-exempt and are reimbursed based on their reported costs rather than predetermined prices. These PPS-exempt cancer centers set their adjusted payment rates to reflect the expense required for providing specialized care. We hypothesized that PPS-exempt centers would have higher rates for complex proton therapy delivery compared to non-exempt centers. Methods: We obtained online standard charge files for 44 proton therapy centers in the U.S. We used the CPT code 77525, the per fraction technical charge billed for complex proton treatment delivery, to extract the gross price (base charge for service), de-identified minimum and maximum negotiated price (lowest/highest charge negotiated with third-party payers), and cash price (charge for cash payment of service) per fraction of complex proton therapy. Prices were compared between PPS-exempt and non-exempt proton therapy centers using Wilcoxon/Kruskal Wallis test with a p-value < 0.05 considered significant. Results: Of the 44 proton therapy centers, 39 (88.6%) had publicly available standard charge files, and 5 (11.4%) are private practice not required to provide a standard charge file. Five of the 39 (12.8%) centers are PPS-exempt, and the remaining 34 (87.2%) are PPS non-exempt. Four (80%) PPS-exempt centers had their gross price, minimum and maximum negotiated price, and cash price available in their standard charge file for CPT 77525, while 23 (67.6%) PPS non-exempt centers had their gross price and cash price listed and 19 (55.9%) had the minimum and maximum price available. The median gross charge per fraction for complex proton treatment delivery was $8,035.25 (IQR $7,022.00-$9,427.50) at PPS-exempt versus $6,434.00 (IQR $5,213.00-$12,350.00) at PPS non-exempt centers. The median minimum price was $656.47 (IQR $178.04-$1,353.23) at PPS-exempt versus $1,294.70 (IQR $734.20-$2,267.46) at PPS non-exempt centers. The median maximum price was $8,120.10 (IQR $5,576.40-$11,529.86) at PPS-exempt versus $5,814.00 (IQR $4,830.00-$9,524.70) at PPS non-exempt centers. The median cash price was $5,360.65 (IQR $2,979.51-$6,897.08) at PPS-exempt versus $4,170.40 (IQR $2,828.00-$5,640.00) at PPS non-exempt centers. Conclusions: In summary, 80% of PPS-exempt and 67.6% of PPS non-exempt centers had publicly available standard charge files. Median charges for PPS-exempt centers are higher for gross charge, maximum price, and cash price, however did not meet statistical significance. [Table: see text]

Novel extended-release transdermal formulations of the psychedelic N,N-dimethyltryptamine (DMT)

There is considerable evidence from the literature that psychedelics, such as N,N-dimethyltryptamine (DMT), are safe and effective treatments for depression. However, clinical administration to induce psychedelic effects and expensive psychotherapy-assisted treatments likely limit accessibility to the average patient. There is emerging evidence that DMT promotes positive behavioral changes in vivo at sub-hallucinogenic dosages, and depending on the target indication, subjecting patients to high, bolus dosages may not be necessary. Due to rapid metabolic degradation, achieving target levels of DMT in subjects is difficult, requiring IV administration, which poses risks to patients during the intense hallucinogenic and subjective drug effects. The chemical and physical properties of DMT make it an excellent candidate for non-invasive, transdermal delivery platforms. This paper outlines the formulation development, in vitro, and in vivo testing of transdermal drug-in-adhesive DMT patches using various adhesives and permeation enhancers. In vivo behavioral and pharmacokinetic studies were performed with lead patch formulation (F5) in male and female Swiss Webster mice, and resulting DMT levels in plasma and brain samples were quantified using LC/MS/MS. Notable differences were seen in female versus male mice during IV administration; however, transdermal administration provided consistent, extended drug release at a non-hallucinogenic dose. The IV half-life of DMT was extended by 20-fold with administration of the transdermal delivery system at sub-hallucinogenic plasma concentrations not exceeding 60 ng/mL. Results of a translational head twitch assay (a surrogate for hallucinogenic effects in non-human organisms) were consistent with absence of hallucinations at low plasma levels achieved with our TDDS. Despite the reported low bioavailability of DMT, the non-invasive transdermal DMT patch F5 afforded an impressive 77 % bioavailability compared to IV at two dosages. This unique transdermal delivery option has the potential to provide an out-patient treatment option for ailments not requiring higher, bolus doses and is especially intriguing for therapeutic indications requiring non-hallucinogenic alternatives.

Analysis of the quality of surgical care for patients with consequences of gunshot combat wounds of the maxillofacial area

One of the most pressing problems of maxillofacial surgery (MFS) is the provision of specialized medical care to the wounded and injured in combat conditions. Even more complex tasks are reconstructive surgical treatment at the stages of evacuation and the most complete rehabilitation of patients with the consequences of combat injuries to the maxillofacial area (MFA). Gunshot combat wounds of the MFA are characterized by severe anatomical and functional disorders, they can manifest themselves as significant defects and severe deformations, which in turn leads to an increase in sanitary losses of army personnel, disability of young and middle (working) age patients, a decrease in the quality of their life, long-term and expensive treatment that requires special knowledge and manual skills from specialists. All this determines not only the medical, but also the socio-economic significance of the topic of this study.Objective. Present an analysis of the quality of surgical care provided to patients with consequences of gunshot combat wounds of the MFA.Methods. The study was carried out by specialists from the State Budgetary Healthcare Institution «Maxillofacial Hospital for War Veterans» of the Moscow Department of Health, under the guidance of the chief, PhD, professor, main specialist in MFS – V.A. Belchenko, for the period from October 2022 to July 2023. Diagnosis, planning and surgical treatment of adult patients with the consequences of gunshot combat wounds of the MFA were carried out at the stages of treatment and evacuation measures. A sample of medical documentation was made, the data obtained was processed by the generally accepted statistical method. The results were analyzed and compared with data from similar studies.Results. The study group included 55 males, aged from 23 to 56 years, the average age of the patients was 36.16±7.79 years. We divided the studied patients into subgroups according to the conditional zones of damage to the MFA: 1st – upper zone of the face (n=3, 5.45%), 2nd – middle zone of the face (n=28; 50.91%), 3rd – lower zone of the face ( n=32; 58.18%). The number of patients with isolated injuries is 18.18% (n=10); with multiple – 81.81% (n=45); with combined – 72.72% (n=40). The article presents the characteristics of patients with the pathology under study, discusses some features of diagnosis and planning, discusses tactics and problems associated with the surgical stage of treatment, as well as further rehabilitation measures.Conclusion. Despite the emergence of new medical equipment, equipment for diagnostics, planning and solving complex problems of surgical intervention, there is a clear need for training specialists, developing and improving the applied medical recommendations, with a clear indication of the method of choosing tactics and methods of surgical treatment. Medical care for adult patients with the consequences of gunshot combat wounds of the MFA must be comprehensive and carried out on the basis of specialized centers, and must include both surgical and orthopedic components, which will minimize the number of errors and complications, increase the effectiveness of treatment and, as a result, make rehabilitation as complete as possible.

Analyzing the Benefits and Costs of the Safe Step Act on Patients, Physicians, and Insurers

Pharmaceutical expenditures in the United States, particularly in dermatology, have grown rapidly, driven by expensive topical and biologic treatments. Insurers are employing cost-containing strategies such as step therapy, which mandates the use of lower-cost treatments before more expensive medications. The bipartisan Safe Step Act aims to enhance step therapy policies by introducing a transparent process for requesting exceptions and reasonable timelines for the process. However, there is limited analysis on how the Safe Step Act would affect the healthcare environment. We examine the policies of the Safe Step Act and existing literature on prior authorizations and discuss how the bill could affect patients, physicians, and insurers. While the act could expedite access to necessary medications and prevent irreversible harm to patients from delaying efficacious treatment, it falls short in relieving the administrative burdens on dermatology clinics. Although there is no ideal solution for managing healthcare costs, measures like step therapy encourage cost-effective treatments and optimizing care for the population. Curtailing step therapy with the exemptions process of the Safe Step Act might streamline patient access to treatments but could impede cost-containment strategies, weaken the bargaining power of insurers, and result in higher insurance premiums.

A review of the benefits and limitations of waste nutrient treatment in aquaculture pond facilities

AbstractManaging waste nutrients from intensive freshwater and marine pond aquaculture is a global challenge. Nutrient‐enriched water released from farms can have detrimental effects on aquatic ecosystem health. There are a range of treatment options for discharge water from fish and crustacean ponds, and this review examines the benefits and limitations of these options. Much of the nutrient waste is derived from the addition of formulated feed. In recent years, reduction in waste from feeds and feeding has been largely incremental. In terms of treatment, there are low‐cost approaches, such as settlement ponds, but they are inefficient at reducing nutrients. Biological systems, using aquatic plants, microalgae and filter feeders to reduce nutrient release from farms have variable levels of effectiveness. Establishing wetlands requires considerable additional land area, and success to date has been highly variable. Overall, this review found no simple cost‐effective solution for managing nutrient enriched water from ponds. This is due, in many cases, to challenges with treating the large volumes of discharge water with relatively low nutrient concentrations. This means that more technologically advanced and reliable treatment options, for example, bioreactors, are prohibitively expensive. However, some systems, such as use of recirculation systems typically increase nutrient concentrations, and hence the efficiency and effectiveness of more expensive treatment methods. Biofloc systems can also provide a mechanism for in‐situ nutrient treatment as well as a supplementary food source for animals. Overall, there is scope to improve treatment of waste nutrients, but significant modifications to many production systems are needed to achieve this.

Understanding the Association Between Social Determinants of Health and Receipt of Immunotherapy for Melanoma.

In this review article, we sought to elucidate how the social determinants of health, including socioeconomic status, education, neighborhood or physical environment, access to healthcare, and race/ethnicity, affect the likelihood of receiving immunotherapy, a novel and expensive treatment for melanoma.  Methods: The PubMed database was queried up to May 2023, for studies pertaining to health disparities in melanoma, including studies examining the utilization of immunotherapy agents for the treatment of melanoma across various social determinants of health. Disparities in the utilization of immunotherapy exist across various social determinants. A total of 10 studies were found to report on disparities in receipt of immunotherapy. These studies reported an association between insurance status, education level, socioeconomic status, as well as proximity to a cancer research center, and a lower likelihood of receiving immunotherapy. As the number of novel immunotherapy drugs grows, it is important to understand the various disparities affecting the delivery of immunotherapy across social determinants. The findings from this study can help to drive public health policy aimed at addressing inequities in the treatment of melanoma as well as other cancers.    J Drugs Dermatol. 2024;23(5):311-315. doi:10.36849/JDD.7803.

Antibody-dye Conjugates Targeting EGFR and HER2 for the Photoimmunotherapy of Bladder Cancer.

Although there are curative treatment options for non-muscle-invasive bladder cancer, the recurrence of this tumor is high. Therefore, novel targeted therapies are needed for the complete removal of bladder cancer cells in stages of localized disease, in order to avoid local recurrence, to spare bladder cancer patients from stressful and expensive treatment procedures and to increase their quality of life and life expectancy. This study tested a new approach for the photoimmunotherapy (PIT) of bladder cancer. We generated a cysteine modified recombinant version of the antibody cetuximab targeting the epidermal growth factor receptor (EGFR) on the surface of bladder cancer cells. Then, we coupled the novel photoactivatable phthalocyanine dye WB692-CB1 via a maleimide linker to the free cysteines of the antibody. PIT was performed by incubating bladder cancer cells with the antibody dye conjugate followed by irradiation with visible red light. The conjugate was able to induce specific cytotoxicity in EGFR-positive bladder cancer cells in a light dose-dependent manner. Enhanced cytotoxicity in RT112 bladder cancer cells was evoked by addition of a second antibody dye conjugate targeting HER2 or by repeated cycles of PIT. Our new antibody dye conjugate targeting EGFR-expressing bladder cancer cells is a promising candidate for the future PIT of bladder cancer patients.

Establishment of a model to predict mortality after decompression craniotomy for traumatic brain injury.

The mortality rate of patients with traumatic brain injury (TBI) is still high even while undergoing decompressive craniectomy (DC), and the expensive treatment costs bring huge economic burden to the families of patients. The aim of this study was to identify preoperative indicators that influence patient outcomes and to develop a risk model for predicting patient mortality by a retrospective analysis of TBI patients undergoing DC. A total of 288 TBI patients treated with DC, admitted to the First Affiliated Hospital of Shantou University Medical School from August 2015 to April 2021, were used for univariate and multivariate logistic regression analysis to determine the risk factors for death after DC in TBI patients. We also built a risk model for the identified risk factors and conducted internal verification and model evaluation. Univariate and multivariate logistic regression analysis identified four risk factors: Glasgow Coma Scale, age, activated partial thrombin time, and mean CT value of the superior sagittal sinus. These risk factors can be obtained before DC. In addition, we also developed a 3-month mortality risk model and conducted a bootstrap 1000 resampling internal validation, with C-indices of 0.852 and 0.845, respectively. We developed a risk model that has clinical significance for the early identification of patients who will still die after DC. Interestingly, we also identified a new early risk factor for TBI patients after DC, that is, preoperative mean CT value of the superior sagittal sinus (p<.05).

The Safety and Effectiveness of Bevacizumab in Metastatic Colorectal Cancer With Unresectable Metastases: A Real-Life Study From the South of Morocco.

Background Colorectal cancer constitutes a significant public health challenge, despite remarkable strides made in the last two decades, particularly in the medical management of metastatic stages. Notable progress has been achieved through targeted therapies such as anti-epidermal growth factor receptors or anti-angiogenic antibodies, as well as advancements in surgical approaches for hepatic metastases. This study seeks to assess the efficacy and safety of bevacizumab plus chemotherapy in individuals with metastatic colorectal cancer. Methodology This is an observational, cross-sectional, retrospective study of all patients who were followed up for metastatic colorectal cancer with unresectable metastases and were treated with bevacizumab in combination with standard chemotherapy from January 2010 until December 2019 in the medical oncology department of the Centre Hospitalier Universitaire (CHU) Souss-Massa of Agadir. Results Of the total 162 cases, 117 (72%) had metastatic disease, and 45 (28%) progressed to metastatic disease after initial treatment. The median age of the patients was 55 years (range = 23-79 years) with a sex ratio of 1.1 (M/F). The tumor was located in the left colon in 135 (83.3%)patients. The results represented adenocarcinoma in 137 (84.6)cases and mucinous subtype in 23 (14.19) cases. The three most common sites of metastasis were the liver (99, 61.1), peritoneum (67, 41.3), and lung (33, 20.3). In the first line, allpatients received bi-chemotherapy plus bevacizumab, i.e., fluorouracil, oxaliplatin, and leucovorin in 34 (20.9%) patients; capecitabine plus oxaliplatin in 88 (54.3%) patients; leucovorin, fluorouracil, and irinotecan in 17 (10.4%) patients; andcapecitabine plusirinotecan in 23 (14.1%) patients. Response after first-line treatment was progression in 74 (45.7) cases, stability in 42 (25.9) cases, partial response in 35(21.6) cases, and complete response in 11 (6.8) cases. Nine (6%) patients were able to benefit from surgical resection of metastatic lesions. Overall, 77 (47%)patients received second-line chemotherapy, i.e., 5-FU with irinotecan in 40 (51.8%)cases or with oxaliplatin in 30(38.8%) cases. Two patients developed undesirable side effects under bevacizumab (hypertension). The median progression-free survival and median overall survival of the study cohort were 9 months and 14 months, respectively. Nevertheless, patients who underwent primary tumor resection (p = 0.048), those with right‑sided tumors (p = 0.022), those who received a higher number of treatment cycles (p = 0.020), and those who received maintenance treatment (p = 0.001) had a longer median overall survival. Conclusions Chemotherapy combination with bevacizumab is considered as the cornerstone of metastatic colorectal cancer treatment in our region. With the new healthcare and social security systems, easier access to expensive treatments and molecular pathology tests is currently available. It is important to highlight that real-world data can offer valuable insights into the daily clinical practice of medical oncology.

Highly Stretchable Piezoelectric Elastomer for Accelerated Repairing of Skeletal Muscles Loss

AbstractSkeletal muscle loss is a common clinical disease, whose long treatment period and expensive treatment costs bring a heavy burden to patients. Currently, the use of piezoelectric materials to generate in situ and efficient electrical stimulation has been proven to significantly promote wound healing and other defects. However, skeletal muscle requires repaired materials with high elastic deformation to accompany its reciprocating movement during the healing process. Therefore, developing biocompatible materials that combine high piezoelectricity and stretchability is a great challenge. In the present work, a piezoelectric elastomer PPBE is prepared by copolymerization of bio‐based diacid and diol. PPBE has matching elastic modulus with the skeletal muscle to accompanied proceed stretching and recovery movements. Piezoelectrical charge from PPBE scaffold under ultrasound and mechanical stimuli could promote myogenic differentiation via Ca2+ signaling pathway and modulate cell functions, resulting in improved muscle morphology and functional performance of skeletal muscle. Thus, development of the degradable PPBE scaffold would provide new therapy strategy for volumetric muscle loss (VML) and present great potential in repairing of other tissues.

Current State And Trends In The Incidence Of Chronic Kidney Disease Among Adult Population And Opportunities For Its Prevention And Treatment In Moscow Healthcare Organizations

Introduction. Currently, the incidence of kidney diseases among adult population is growing. It is expected to become the fifth leading cause of death by 2040. Showing no symptoms at early stages, chronic kidney disease (CKD) is closely related to diabetes mellitus, hypertension, obesity and kidney dysfunction in older age, which requires long-term and expensive treatment. Organization structure and the strategy of medical care provided by Moscow nephrology service is aimed at implementing measures for risk prevention and active early detection of kidney disease, as well as informing general population and medical community about existing diagnostic methods, modern treatment options and schemes.&#x0D; The purpose of the study was to identify trends in CKD prevalence and incidence among able-bodied population in the context of Moscow nephrology service improvement. &#x0D; Materials and Methods. An analysis of disease prevalence and incidence among able-bodied population based on official statistics data of the Russian Research Institute of Health (RIH) of the Ministry of Health of the Russian Federation and the Centre of Medical Statistics of Moscow Healthcare Department was carried out; indicators of time series and average growth/decrease rates were calculated. In order to identify a long-term trend, least squares method was used. Incidence rates were expressed per 100,000 able-bodied population.&#x0D; Results. In 2022, the overall disease prevalence in Moscow was lower than for the country as a whole (31.3 and 74.2 cases per 100,000 population, respectively), while incidence of the able-bodied population in Moscow was lower than countrywide (2.9 and 11.5 cases per 100,000 population, respectively). The long-term dynamics of CRD prevalence and incidence was generally characterized by an upward trend. Thus, the average annual incidence in Moscow was 9.8% and 6.1%, while in the Russian Federation 7.2% and 5.4%, respectively. On average, 91.3% of able-bodied patients with CKD in Moscow are under follow-up monitoring for a year. The number of dispensary patients with CKD increased by 2.5 times in 2022 in comparison to 2013, from 11.7 to 29.5 per 100,000 population, respectively. Since 2016, patients with newly diagnosed CKD have been provided with 100% coverage of follow-up monitoring.

Case Series of Melioidosis in a Tertiary Health Care Centre in Puducherry, India

Melioidosis, a potentially fatal disease caused by the bacterium Burkholderia pseudomallei continues to be neglected in the Indian Subcontinent despite bearing about 44% of the global burden. Diagnosis poses a significant challenge since the disease presents a wide range of symptoms and closely mimics tuberculosis and pneumonia both of which are endemic in India. Sophisticated diagnosis and treatment often become unaffordable for patients from rural or low-income backgrounds. We present five cases of melioidosis from a tertiary care hospital (Mahatma Gandhi Medical College and Research Institute ) in Pondicherry that exhibited predominantly high-grade fever, abdominal pain, and vomiting. Radiological imaging revealed abnormalities in the brain (1/5, 20%), lung (3/5, 60%), liver (2/5, 40%), spleen (2/5, 40%), kidney (2/5, 40%), and prostate gland (1/5, 20%). Burkholderia pseudomallei infection was confirmed through blood culture. Treatment with meropenem or ceftazidime was initiated immediately. Neuromelioidosis was confirmed in one patient. The clinical diagnoses for the remaining cases were as follows: septic shock, melioidosis with urosepsis, and refractory shock. Three patients required intensive care and of the five, one patient was discharged, one died, and three discontinued treatments against medical advice. In the case of the deceased patient, the clinical diagnosis encompassed refractory shock accompanied by lactic acidosis, melioidosis, and community-acquired pneumonia, which subsequently progressed to acute respiratory distress syndrome (ARDS). Notably, this patient presented with co-morbidities, notably type 2 diabetes mellitus. This exemplifies the difficulty faced by patients from low-income backgrounds which forces them to discontinue expensive treatment. The true burden of melioidosis in the Indian Subcontinent is uncertain as many cases remain undiagnosed. Unawareness of the disease, low index of suspicion among medical professionals, incorrect treatment, and discontinuation contribute to the disease burden. It is therefore imperative that melioidosis is brought to the attention of healthcare policymakers to determine the true burden of the disease by prioritizing nationwide surveillance and diagnosis.

Emergency Physicians’ Ethical Issues with Hospital Business Models

BackgroundThe changing hospital business model has raised ethical issues for emergency physicians (EPs) in a healthcare system that often prioritizes profits over patient welfare. For-profit hospitals, driven by profit motives, may prioritize treating patients with lucrative insurance plans and those who can afford expensive treatments. Private equity investors, who now own many for-profit hospitals, focus on short-term financial gains, leading to cost-cutting measures and pressure on EPs to prioritize financial goals over patient welfare. Nonprofit hospitals, mandated to provide charity care to the underserved, may fail to meet their community service obligations, resulting in disparities in healthcare access. ObjectiveThis review examines the ethical challenges faced by emergency physicians (EPs) in response to the evolving hospital business model, which increasingly prioritizes profits over patient welfare. DiscussionEmergency physicians face ethical dilemmas in this changing environment, including conflicts between patient care and financial interests. Upholding professional ethics and the principle of beneficence is essential. Another challenge is equitable access to healthcare, with some nonprofit hospitals reducing charity care, thus exacerbating disparities. EPs must uphold the ethical principle of justice, ensuring quality care for all patients, regardless of financial means. Conflicts of interest may arise when EPs work in hospitals owned by private equity firms or with affiliations with pharmaceutical companies or medical device manufacturers, potentially compromising patient care. ConclusionEmergency physicians must navigate these ethical issues while upholding professional ethics and advocating for patients' best interests. Collaboration with hospital administrators, policymakers, and stakeholders is vital to address these concerns and prioritize patient welfare in healthcare delivery.

The effect of hierarchical medical treatment reform——research based on 205 prefecture-level cities

ABSTRACT The problems, such as difficult and expensive medical treatment, high medical costs, and low efficiency in utilizing medical resources, have been prominent for a long time. The state has taken a series of measures to solve these problems, and hierarchical medical treatment reform is one of the critical measures. This paper uses a staggered DID to empirically analyse the effect of hierarchical medical treatment in 205 prefecture-level cities. The results show that hierarchical medical treatment significantly shortens the hospital day but has no significant impact on visit ratio to primary medical institutions, and average outpatient and inpatient costs in hospitals. The reduction in the hospital stay is smaller in areas with higher vertical fiscal imbalance and fewer medical resources. The important reason for the failure of hierarchical medical treatment to achieve orderly treatment is that, it didn’t effectively improve the resources ratio in primary medical institutions. And the most fundamental reason lies in the incentive of the fiscal decentralization system. Therefore, this necessitates a more targeted approach in the reform to achieve the intended orderly treatment process.

Research Progress of Nanomaterials Acting on NK Cells in Tumor Immunotherapy and Imaging.

The prognosis for cancer patients has declined dramatically in recent years due to the challenges in treating malignant tumors. Tumor immunotherapy, which includes immune target inhibition and chimeric antigen receptor cell treatment, is currently evolving quickly. Among them, natural killer (NK) cells are gradually becoming another preferred cell immunotherapy after T cell immunotherapy due to their unique killing effects in innate and adaptive immunity. NK cell therapy has shown encouraging outcomes in clinical studies; however, there are still some problems, including limited efficacy in solid tumors, inadequate NK cell penetration, and expensive treatment expenses. Noteworthy benefits of nanomaterials include their chemical specificity, biocompatibility, and ease of manufacturing; these make them promising instruments for enhancing NK cell anti-tumor immune responses. Nanomaterials can promote NK cell homing and infiltration, participate in NK cell modification and non-invasive cell tracking and imaging modes, and greatly increase the effectiveness of NK cell immunotherapy. The introduction of NK cell-based immunotherapy research and a more detailed discussion of nanomaterial research in NK cell-based immunotherapy and molecular imaging will be the main topics of this review.

‘Empathy counterbalancing’ to mitigate the ‘identified victim effect’? Ethical reflections on cognitive debiasing strategies to increase support for healthcare priority setting

Priority setting is inevitable to control expenditure on expensive medicines, but citizen support is often hampered by the workings of the ‘identified victim effect’, that is, the greater willingness to...

TB-CXRNet: Tuberculosis and Drug-Resistant Tuberculosis Detection Technique Using Chest X-ray Images

Tuberculosis (TB) is a chronic infectious lung disease, which caused the death of about 1.5 million people in 2020 alone. Therefore, it is important to detect TB accurately at an early stage to prevent the infection and associated deaths. Chest X-ray (CXR) is the most popularly used method for TB diagnosis. However, it is difficult to identify TB from CXR images in the early stage, which leads to time-consuming and expensive treatments. Moreover, due to the increase of drug-resistant tuberculosis, the disease becomes more challenging in recent years. In this work, a novel deep learning-based framework is proposed to reliably and automatically distinguish TB, non-TB (other lung infections), and healthy patients using a dataset of 40,000 CXR images. Moreover, a stacking machine learning-based diagnosis of drug-resistant TB using 3037 CXR images of TB patients is implemented. The largest drug-resistant TB dataset will be released to develop a machine learning model for drug-resistant TB detection and stratification. Besides, Score-CAM-based visualization technique was used to make the model interpretable to see where the best performing model learns from in classifying the image. The proposed approach shows an accuracy of 93.32% for the classification of TB, non-TB, and healthy patients on the largest dataset while around 87.48% and 79.59% accuracy for binary classification (drug-resistant vs drug-sensitive TB), and three-class classification (multi-drug resistant (MDR), extreme drug-resistant (XDR), and sensitive TB), respectively, which is the best reported result compared to the literature. The proposed solution can make fast and reliable detection of TB and drug-resistant TB from chest X-rays, which can help in reducing disease complications and spread.