Financial Burden Research Articles

Everything, everywhere, and all at once: A blueprint for supra-organization of core facilities.

Core facilities are crucial for cutting-edge scientific research in academic institutions, yet they place a significant financial burden on budgets. The viability of these facilities can be improved through cross-institutional collaborations, although initiating and sustaining such partnerships poses challenges. Insights from Israel's recent nationwide organization of core facilities could offer valuable lessons for fostering similar cooperation elsewhere. Despite the chronic shortfall in public research funding, Israeli research institutions were slow to fully embrace infrastructure sharing. This gap led to the creation of the Israel Research Core Facilities (IRCF) in 2022, which linked core facilities across the country through a bottom-up approach. IRCF facilitated the formation of numerous specialized nation-wide networks for intellectual exchange, and supported training workshops and meetings aimed at core technology providers. These initiatives serve dual purposes: they ensure the ongoing advancement of technological capabilities across facilities, regardless of their size or location, and they strengthen the commitment to the IRCF mission by motivating the maintenance of the IRCF database. As a result, a model of "capacity sharing" emerged, connecting all of Israel's core facility centers. This model enhances infrastructure use, supports strategic planning, and fosters growth. With over 450 core experts offering over 1100 scientific services consolidated into a publicly accessible database, IRCF supports research in universities, hospitals, government, and industry. This strategy could act as a model for creating regional core facility organizations to elevate research quality and ensure efficient infrastructure development.

A Systematic Review and Comparative Analysis of Reconstructive Rhytidectomy: Advantages, Disadvantages, and Patient Outcomes.

Reconstructive rhytidectomy, commonly known as facelift surgery, is a prominent cosmetic procedure aimed at rejuvenating facial appearance by addressing signs of aging. This paper critically evaluates the advantages and disadvantages of various surgical techniques involved in rhytidectomy, including the superficial musculoaponeurotic system (SMAS), deep plane facelift, and subperiosteal approaches. This systematic review of recent literature highlights key outcomes such as scar quality, postoperative pain management, and patient satisfaction. While the techniques demonstrate significant improvements in aesthetic results and patient quality of life, they also present risks including complications, dissatisfaction with outcomes, and the financial burden of surgery. Future directions indicate a trend toward minimally invasive approaches, integration of regenerative medicine, and personalized surgical planning, aiming to optimize results and minimize risks.

Does outpatient mutual-aid reduce oncology patients' utilization of inpatient services?-An empirical study of outpatient mutual-aid policy in Wuhan, China.

The escalating costs of healthcare had prompted countries to undertake reforms, and in recent years China had focused on overhauling its outpatient healthcare system. China implemented the outpatient mutual-aid policy which had led to a change in the costs associated with outpatient treatment from being fully self-paid by the patient to being partially self-paid. This study aimed to assess the impact of the outpatient mutual-aid policy on inpatient services for oncology patients in Wuhan, China, exploring the impact that the cumbersome administration of health insurance would have on patient welfare. 24,260 oncology patients of the health insurance reimbursement database in Wuhan spanning from January 2022 to July 2023 were included. After data processing, 12,985 patients were included in the control group and 11,275 patients were included in the experimental group. The regression discontinuity design was employed to assess the impact of the policy. The findings was that the implementation of the outpatient mutual-aid would result in a reduction of 1.2days in the length of stay for oncology patients, a decrease in hospital costs by 5%, and a decline in expenditure of the health insurance reimbursement funds by 5 per cent. Incorporating outpatient costs into reimbursement supplanted the utilization of inpatient services, enhanced the allocation of healthcare resources, and alleviated the financial burden on oncology patients. Furthermore, it highlighted the detrimental impact of eligibility review to verify that a patient meets the reimbursement requirements of the health insurance policy on patient welfare.

Bridging Theory and Practice in Military Education Through Advanced Technologies

This study presents a comprehensive examination of the developmental trajectory and operational advancement of a pioneering military simulation apparatus explicitly engineered to facilitate the seamless integration of joint fire support principles within the ambit of military education, with a specific focus on artillery students. The Virtual Reality (VR) and Augmented Reality (AR) technology provided by industry leaders such as Microsoft and Meta present solutions for interdisciplinary pursuits situated at the confluence of emergent technologies and contemporary military instructional methodologies. Central to the efficacy of this endeavour is the incorporation of meticulously crafted virtual and augmented reality models of authentic military equipment to imbue the simulation experience with unparalleled realism and fidelity to the principles of artillery fires. Collaborative ventures with private enterprises have facilitated the production of a simulator characterized by its gamification elements and unparalleled verisimilitude, enhancing its efficacy as an educational tool. Augmented by spatial intelligence gleaned from Unmanned Aerial Vehicle (UAV) sensors, the simulation framework can be further enriched by integrating true-to-life topographic representations meticulously synthesized by amalgamating laser scanning methodologies. Positioned as an indispensable cornerstone within the academic purview of the esteemed Department of Fire Support at the University of Defence, this initiative aspires to impart foundational knowledge and cultivate a proactive ethos of inquiry and engagement amongst the students. Furthermore, the simulator is a pivotal instrument for military training, offering a risk-free environment devoid of the hazards associated with live artillery fire exercises. By mitigating financial burdens and other logistical constraints inherent in conventional training methodologies, this innovative simulation apparatus represents a paradigm shift in contemporary military education and training practices.

Relationship between sexist parenting, parental self-efficacy and life satisfaction in Colombian mothers: the moderating effect of gender-role-based parenting

ABSTRACT The relationship between parenthood, parental self-efficacy, and life satisfaction depends on several factors, such as financial burden, time investment and children’s challenging behaviour. Parental self-efficacy may play a mediating role in the relationship between life satisfaction and mental health. Hence, this research seeks (1) to examine the relationship between gendered parenting and childcare self-efficacy and life satisfaction in Colombian mothers of children aged 0–5 years, and (2) to establish the possible moderating effect of gender role-based parenting on the relationship between parental self-efficacy and life satisfaction. We used life satisfaction as an indicator of mental health. Psychometric analyses of the scales were performed using structural equation modelling and Cronbach’s Alpha coefficient, and gamma regression models were used to evaluate the study hypotheses. The findings indicate that parental sexism and maternal self-efficacy significantly influence women’s life satisfaction, with differences based on urban versus rural residence and education level, highlighting the complex relationship between gender norms, parental self-efficacy, and life satisfaction.

The Effects of Health Insurance on Demand for Healthcare Services in Tanzania

ABSTRACT: Consistent healthcare financing systems within a particular nation or community have been regarded as vital for making universal healthcare access. This study intended to examine the influence of health insurance on the demand for healthcare services and the influence of socio-economic, demographic and hospital-related factors on demand for health care services in Tanzania context. The study employed secondary data, which were analysed by descriptive statistics and the results were presented in tables and percentages. Econometric analysis was also done using binary probit regression model to determine the factors influencing demand for health care services in Tanzania. The instrumental variable was applied to address the problem of endogeneity of health insurance. The regression results revealed that gender, education level, household size, income, treatment cost, perceived health quality and health insurance type were significant and positively linked with demand for health care services. However, marital status was also significant but negatively associated with the demand for healthcare services. The study concluded that, despite of the efforts made by the government and other stakeholders on emphasis over having health insurance, the enrolment to health insurance schemes is still low although it has been noted to significantly influence the demand for health care services. Lastly, the paper recommends that the government and other stakeholders are required to formulate or strengthen the formulated policy in practice, purposively to improve access, affordability and the quality of health care services. Governmental and non-governmental organizations (NGO`s) and other stakeholders should put more effective strategies to improve coverage but also reduce the financial burden caused by illness. Also, the government needs to subsidize the healthcare sector, especially to the poor and provide subsidies to private healthcare facilities, improvement of insurance type, specifically, the NHIF which needs to increase coverage. Furthermore, health care managers should educate other people and make a clear observation on factors that make individuals demand for health care because they have a great role in the health care sector as well as strategies to improve household`s income to meet the health needs in Tanzania.

9359 Patients’ Perspectives On Telemedicine In Endocrinology

Abstract Disclosure: P. Rotman Pikielny: None. L. Barzilay Yoseph: None. M. Kasher Meron: None. K. Rodrig: None. S. Shapira: None. Background: Telemedicine has emerged as an important and sometimes crucial tool in patient care, particularly during the COVID-19 pandemic. It offers numerous benefits, including time efficiency and improved access to specialized services. However, its adoption by endocrinology is constrained by the traditional emphasis on the physician-patient relationship and physical examinations. Objectives: This study evaluated patients’ perspectives on telemedicine, regarding specific aspects of satisfaction, including communication, wait times, and financial and time burdens. Methods: Surveys were delivered via text messages sent after telephone vs. frontal visits in an outpatient endocrinology clinic in a tertiary referral center. The surveys, sent from Nov 2022 to Dec 2023, investigated various aspects of satisfaction with the appointment and were based on the Telemedicine Satisfaction Questionnaire, a 5-point Likert scale questionnaire. Variations in preference levels across diverse patient groups were also examined. Answers were received via the REDCap application. Patients were told that responses were optional and answering the survey granted informed consent. Results: A total 135 patients completed the questionnaire, 93 who attended telephone and 42 after frontal visits. The groups were similar clinically: 77% were women, with an average age of 63 years. Visits were held mainly due to diabetes (22%), osteoporosis (31%), or obesity 10%), with no statistical differences between groups. 60% were followed more than a year. More patients who had telephone visits (69.9%) had previous experience with telephone visits vs. patients who had frontal visits (40.5%; p<0.004). Patients who had telephone visits reported higher satisfaction with wait time (p=0.002), physicians' explanations (p=0.03) and lower financial and time burdens (p<0.001). However, they were less able to share personal situations with the physician (p<0.001). More patients who experienced telephone visits thought they were preferrable to frontal visits (p<0.001). Notably, individuals with long-term follow-up and non-diabetic endocrine conditions had more interest in telemedicine. Conclusions: Patients report high satisfaction with telemedicine, but constrained in-person interactions remain a notable limitation. Telemedicine may not suit all patient groups or all time-points of patient care, requiring adaptation for broader use. Further research with higher response rate and specifications of different patient populations are essential to generalize these findings. Presentation: 6/2/2024

Persons with Disabilities Living in Rural Areas of Bangladesh: An Exploration of Their Mental Health and Experiences in Accessing Support During the COVID-19 Pandemic

ABSTRACT The COVID-19 pandemic has presented a major public health challenge across the world, including in Bangladesh. Little scholarly work has explored the mental health experiences of persons with disabilities in rural areas of Bangladesh during the pandemic. A qualitative case study was conducted in the rural areas of Narayanganj, Gazipur, and Narsingdi. A total of 13 in-depth interviews (IDIs) with persons with disabilities and 13 key informant interviews (KIIs) with different stakeholders and caregivers were conducted. Thematic analysis was used to analyse the data. The findings revealed five major themes: lockdown-induced mental health problems, including fear of infection, symptoms of anxiety and depression, sleep disturbance, suicidal ideation, and domestic violence; perceived attitude towards mental health issues, including stigma and discrimination; perceived vulnerability was observed in relation to gender, age, and type of disability; barriers to seeking mental health care including distance, financial burden, and indifference towards mental health care; and finally, availability of mental health care which reaffirms a lack of mental health care in rural areas. The findings highlight the importance of integrating mental health into the primary healthcare system with a focus on persons with disabilities to minimise mental health repercussions during times of emergency.

Reintroduction of excluded food triggers as a crucial step in managing patients with food allergies

Introduction. Despite active research into the mechanisms of food allergies (FA), the main approach to managing patients with this condition remains the complete exclusion of causative allergens from the diet for a certain period. At the same time, the question of timely reintroduction of excluded food triggers into the diet is frequently raised, which is important both for maintaining oral tolerance and reducing the negative effects of long-term elimination diets, such as nutritional and eating behavior disorders, as well as financial burdens on families. However, clear recommendations on the reintroduction of previously excluded foods have not existed until recently. Regarding cow’s milk protein allergy (CMPA), such recommendations were provided in 2023 in the consensus document of the World Allergy Organization (WAO) — DRACMA.Aim. The aim of this review is to present current approaches to the reintroduction of food allergens into the diets of patients with food allergies and to evaluate various reintroduction protocols, including those used for cow’s milk protein allergy (CMPA).Material and methods. This review provides a concise summary of current approaches to reintroducing food allergens into the diet, covering both IgE-mediated and non-IgE-mediated forms of food allergy. The advantages of different patient management protocols are discussed, with special attention given to CMPA as one of the most common manifestations of FA in children.Results. An analysis of modern approaches has demonstrated that modern recommendations regarding the reintroduction of allergens, including those presented in the document of the World Allergological Organization — DRACMA for allergy to cow’s milk proteins, allow for a more personalized and safe approach to the reintroduction of allergens, which helps reduce risks and maintain food tolerance.Conclusions. The introduction of new guidelines for the reintroduction of food allergens is an important step in managing patients with food allergies. These recommendations provide a more personalized approach to treating food-allergic patients, including those with cow’s milk protein allergy, reducing the risks associated with reintroducing allergens into the diet. They also help to mitigate the negative effects of elimination diets and maintain oral tolerance in patients, which is particularly important for children with FA.

The Unseen Shift: How Partnership Long-Term Care Insurance Influences Caregiving Among Older Adults.

While the Partnership Long-Term Care Insurance (PLTC) Program was designed to mitigate the low uptake of long-term care insurance and reduce Medicaid's financial burden, research has predominantly focused on its direct impacts, leaving the effects on informal caregiving unexplored. This study aimed to investigate how the program alters the dynamics of family-provided care, leveraging nationally representative data to unveil the broader consequences on informal caregiving arrangements among older individuals. Data for this study were sourced from the U.S. Health and Retirement Study (1992-2018) and linked with the timing of the PLTC program implementation across states. The analysis compared individuals exposed to the program with those who were not, employing two-way-fixed-effects and dynamic models to assess its impact on long-term care insurance coverage and reliance on informal caregiving. The program positively affected long-term care insurance coverage, increasing insurance uptake among older individuals in the long run. Conversely, a significant negative effect was observed on the receipt of assistance from any helper, indicating a reduced reliance on informal care. This reduction extended specifically to family helpers and children's assistance with activities of daily living. The analysis suggests that the program effectively reduced the necessity for informal caregiving across several domains. These findings highlight the program's potential to reshape caregiving dynamics, suggesting the need for policies that balance promoting private insurance uptake with the implications for family caregiving roles. Policymakers should consider both the economic benefits and the social shifts induced by such programs in the long-term care landscape.

8725 Subcutaneous Compared With Intravenous Insulin Protocol For Management Of DKA: A Longitudinal Experience In A Single Center

Abstract Disclosure: S. Avula: None. M. Salim: None. E. Wetherbee: None. C. Wenner: None. A. Gravely: None. A.D. Westanmo: None. N.G. Ercan-Fang: None. Background: Diabetic ketoacidosis (DKA) is a critical condition requiring immediate medical attention to prevent severe health complications and even death. Typically, patients are placed under the care of the intensive care unit (ICU) to ensure close supervision. With implementation of effective subcutaneous insulin protocol (SIP), patients can be safely managed outside of ICU without any significant change in mortality or morbidity, potentially decreasing financial burden of costly ICU stay. Aim: To review and compare the experience with subcutaneous and intravenous insulin protocols for management of DKA at Minneapolis Veterans Affairs Health Care System (MVAHCS). Methods: We conducted a retrospective chart review of patients who were admitted with DKA at MVAHCS from 2013 - 2023 and were treated with either I.V insulin or SIP. Inclusion criteria: Adults (age >/=18 years) admitted with DKA between 2013 and 2023. Exclusion criteria: Non availability of VBG/ABG and patients who were not treated initially at MVAHCS. Statistical analysis used was basic descriptive analysis, Pearson’s Chi-Square and Two sample T test. Results: Majority of patients included were males: 57 (96.61%) and 16 (88.89) in SIP and I.V insulin, respectively. Racial distribution of patients was skewed towards a white population: Total of 57 (74.03%) were white, 12 (15.58%) were African American (AA). A significant majority of white patients 47 (79.66%) were on SIP, while 10 (55.56%) were on I.V insulin. Mean age of SIP and I.V insulin study populations were 58.9 (SD 16.21) and 59.2 years (SD 12.23), respectively. Baseline mean pH of the SIP and I.V insulin study populations were 7.27 (SD 0.08) and 7.13 (0.13), respectively. Mean bicarb for SIP was 14.9 mEq/L (SD 4.60) and I.V Insulin was 10.1 mEq/L ( SD 4.57). Mean time for anion gap (AG) closure among patients on SIP was modestly higher at 19.7 hours (SD 15.3) when compared to that on I.V insulin of 17.1 hours (SD 12.4) but the difference did not reach statistical significance. Similarly, 55.6% (n=10) of patients on I.V insulin and 58.6% (n=34) of those on SIP had anion gap closure of >/= 12 hours (p = 0.8187). When adjusted for baseline pH and bicarbonate, 46% of patients in the I.V insulin group had AG closure >=12 hours, whereas 67% of those in the SIP group had AG closure >=12 hours with total difference of 21% (p= 0.2098). Conclusion: Our results demonstrate that SIP can be safely implemented outside of the ICU setting. Compared with SIP, baseline pH was slightly less in the IV group (our protocol directs sicker patients with lower baseline pH towards the I.V insulin rather than SIP), however, AG closure time was similar between the two groups even after performing multiple regression analysis where we adjusted for baseline differences between two treatment groups in pH, bicarbonate, AG. These results indicate that SIP could be safe and potentially cost saving alternative for DKA management. Presentation: 6/3/2024

Impact of patient’s financial burden of COVID-19 treatment on antiviral prescription rates and clinical and economic outcomes

ABSTRACT Background In Japan, medical expenses for COVID-19 treatment transitioned from full public funding support to out-of-pocket (OOP) payment by patients plus partial public support in October 2023, and public support fully ended in March 2024. This study evaluated the clinical and economic impacts of initiating OOP payments. Research design and methods To assess the impact on prescription rates, we compared the prescription rates of antivirals from the 4-month pre- to post-OOP payment initiation period using a claims database. Subsequently, a budget impact model assessed the impacts of a hypothetical decline in the prescription rates on COVID-19-related hospitalizations, deaths, and direct medical costs for antiviral prescription and hospitalization. Results The antiviral prescription rate per 100 patients decreased from 17.5 for the pre-OOP payment initiation period to 11.5 for the post-OOP payment initiation period, that is, a change of − 34.3%. With prescription rate decreases of 40%, 60%, and 80%, the hospitalizations would increase annually by 22,533 (3.3%), 33800 (5.0%), and 45,066 (6.6%), respectively. The total costs would increase by JPY9.5 billion (USD67.3 million; 0.7%), JPY14.3 billion (USD100.9 million; 1.0%), and JPY19.0 billion (USD134.5 million; 1.3%), respectively. Conclusions Higher OOP payment decreased the antiviral prescription rate, potentially leading to clinical and economic loss.

Prevalence Trends and Treatment Patterns of Autism Spectrum Disorder Among Children and Adolescents in the United States from 2017 to 2020.

Autism spectrum disorder (ASD) poses a significant challenge due to its diverse impact on individuals, emphasizing the need for personalized treatment plans. The financial burden of ASD-related healthcare is substantial, necessitating a comprehensive understanding of its prevalence and evolving trends. This study aims to analyze the prevalence and trends of ASD, treatment patterns, gender differences, and racial-ethnic disparities in the United States from 2017 to 2020, utilizing nationally representative data from the National Survey of Children's Health (NSCH). The NSCH, a leading annual national survey, provided rich data on child health. A total of 108,142 participants aged 3-17 years were included, with ASD prevalence assessed based on self-reported diagnoses. Between 2017 and 2020, ASD prevalence in children aged 3-17 was 2.94% (95% confidence interval: 2.68-3.18). Significant disparities were observed: older age and male gender correlated with higher prevalence, while family income-to-poverty ratio and insurance coverage influenced prevalence. Racial/ethnic disparities existed, with Hispanics showing the highest prevalence. Treatment trends showed stability overall, but age influenced behavioral and medication interventions. The prevalence remained stable from 2017 to 2020, with variations in age groups and a significant increase among non-Hispanic Whites. This study highlights a higher but stable overall ASD prevalence, with nuanced disparities among different demographic groups. Gender differences persist, emphasizing the need for tailored interventions. Racial-ethnic disparities call for targeted healthcare strategies. The stability in treatment trends underscores the persistent challenge of addressing core ASD symptoms.

The Impact of Taxation on the Cost of Living: A Comprehensive Analysis

This study examines the taxation-related factors affecting Malaysia's cost of living. The rising cost of living, a persistent issue in economics and social well-being, is often linked to global challenges faced by emerging nations. Direct tax has been identified as a primary contributor to the financial strain on households, who must manage various essentials beyond food, clothing, and shelter, such as education, cellular services, and transportation. The study analyzes the relationship between seven independent variables—direct tax, unemployment rate, exchange rate, household consumption expenditure, house price index, subsidies, and net trade—and the cost of living in Malaysia, using 30 years of annual data (1992-2022) with EViews for econometric analysis. This study uses descriptive statistical analysis for the description of data, coefficient matrix analysis and regression analysis for determining the impact of dependent and independent variables. The findings show that the cost-of-living pressures are positively correlated with direct tax, housing price index, and net trade. Data was sourced from the National Property Information Centre (NAPIC), the World Bank, and the Economic Planning Unit (EPU). The analysis underscores the significant impact of direct tax on the cost of living. To mitigate this impact, governments could implement fair and progressive tax reforms, provide targeted subsidies, and promote economic growth to boost income levels. Additionally, social programs and efficient government investment can further reduce household financial burdens.

The Impact of SARS Epidemic on Firm Investment: Evidence from Listed Firms in China

ABSTRACT The outbreak of SARS in 2003 brought a great shock to China’s socio-economic development, but empirical studies on its long-term economic impact are relatively scarce. We use the outbreak of SARS as a quasi-natural experiment, employing city-level case data and listed firm data to study the impact of the pandemic on fixed investment. Compared with cities without SARS cases, firms in cities with SARS cases significantly increased their fixed investment by 26.4%. After conducting a series of endogeneity tests, represented by PSM-DID, our conclusions remain robust. Credit conditions in the affected cities were relaxed after the epidemic. This shift led to a notable decrease in firms’ financial constraints and burdens, thereby offering substantial financing support for fixed investments. To offset the losses endured during the epidemic, firms bolster their investment in high-risk projects. The results of our heterogeneity analysis also support the two mechanisms.

Effects of Medicare Eligibility at Age 65 Among Individuals With and Without Functional Disability.

Medicare coverage at age 65 improves access to and use of care and alleviates financial hardship for the general population. However, less is known whether the effects differ between individuals without and with functional disability. To examine the effects of Medicare eligibility at age 65 on health insurance coverage, financial burden of care, and access to care among individuals without and with functional disability. We used a regression discontinuity design, which exploits the discontinuity in eligibility for Medicare at age 65 and compares individuals just before and after age 65. Our analysis included 19,876 individuals (aged 59-71) without functional disability and 8376 individuals with functional disability from the 2014-2021 Medical Expenditure Panel Survey. We assessed health insurance coverage, financial burden of care, and access to care. Medicare eligibility led to increases in any and Medicare coverage for both groups, but those with functional disability had a decrease in Medicaid coverage by - 2.6 percentage points. Medicare eligibility resulted in lower financial burden of care for both groups, but the effects were greater among those with functional disability (- $578 vs. - $344 for out-of-pocket spending, - 3.7 vs. - 4.9 percentage points for cost-sharing, and - 2.5 vs. - 0.8 percentage points for paying medical bills over time). Although Medicare eligibility led to a decrease in delayed medical care among those without functional disability (- 2.1 percentage points), no change was observed among those with functional disability. Notably, access to care remained limited among those with functional disability after obtaining Medicare eligibility (8.6% and 3.9% for being unable to get medical care and experiencing delay in getting medical care). Medicare coverage can reduce financial hardship, especially for individuals with functional disability. However, there is a need to develop policies that ensure equitable access to care for those with functional disability.

Real-world evidence of avatrombopag for the treatment of immune thrombocytopenia intolerant or ineffective to eltrombopag/hetrombopag.

Due to the limited real-world research on the application of avatrombopag (AVA) for immune thrombocytopenia (ITP) in China, we evaluated the effectiveness and safety of AVA in clinical practice. We included 121 adult ITP patients treated with AVA across three medical centres. Based on the reasons for choosing AVA, these patients were divided into eltrombopag (ELT)/hetrombopag (HET) intolerance group (IG), and ELT/HET unresponsive group (UG). Compared with UG, more patients in IG had a history of liver disease and received fewer treatments before AVA. Amongst all patients, 83% had platelet response (≥30 × 109/L) after AVA and 62% achieved complete response (≥100 × 109/L, CR). Sixty-two percent in IG and 56% in UG were able to discontinue more than one concomitant ITP medication. A total of 17 patients underwent multiple switches of thrombopoietin receptor agonists (TPO-RAs), resulting in an 88% platelet response rate. Sixty-three patients discontinued AVA, 27% were due to unaffordability. AVA was well tolerated in most patients. In the ITP population, AVA proved effective and safe, particularly in patients intolerant or unresponsive to ELT/HET. Patients benefited from TPO-RAs switches, particularly those undergoing multiple switches. However, many patients struggled with the long-term financial burden of AVA.

Fostering healthcare system sustainability through efficient practices: Can adopting biosimilars ease the financial burden of rheumatoid arthritis?

Fostering healthcare system sustainability through efficient practices: Can adopting biosimilars ease the financial burden of rheumatoid arthritis?

Abusive litigation in China: comparative insights and practical approaches for reform

This article provides a comprehensive examination of abusive litigation in both civil and criminal cases in China, focusing on its forms and impacts. It proposes nuanced regulatory approaches that emphasize the importance of identifying responsible parties and implementing appropriate compensation measures. In the Chinese legal system, abusive litigation varies by context. In civil cases, it often manifests as actions that clog the courts and drain legal resources, raising concerns about lawyer accountability and the financial burdens on victims. Although frequently discussed in Chinese literature, the above topic has seen limited comparative analysis, despite similar problems existing across different jurisdictions and a clear need for mutual learning. The article suggests that, in civil cases, insights from English and Dutch law could assist Chinese regulators in reducing incentives for lawyers to pursue unmeritorious or abusive cases and improving compensation for victims. In the criminal law context, abusive litigation is more prevalent in minor offenses in China, primarily due to issues related to the public power structure. The proposal emphasizes the need to optimize power distribution within the Chinese legal system, thereby safeguarding the integrity of the law and upholding human rights.

Construction and validation of a nomogram prediction model for the catheter-related thrombosis risk of central venous access devices in patients with cancer: a prospective machine learning study.

Central venous access devices (CVADs) are integral to cancer treatment. However, catheter-related thrombosis (CRT) poses a considerable risk to patient safety. It interrupts treatment; delays therapy; prolongs hospitalisation; and increases the physical, psychological and financial burden of patients. Our study aims to construct and validate a predictive model for CRT risk in patients with cancer. It offers the possibility to identify independent risk factors for CRT and prevent CRT in patients with cancer. We prospectively followed patients with cancer and CVAD at Xiangya Hospital of Central South University from January 2021 to December 2022 until catheter removal. Patients with CRT who met the criteria were taken as the case group. Two patients with cancer but without CRT diagnosed in the same month that a patient with cancer and CRT was diagnosed were selected by using a random number table to form a control group. Data from patients with CVAD placement in Qinghai University Affiliated Hospital and Hainan Provincial People's Hospital (January 2023 to June 2023) were used for the external validation of the optimal model. The incidence rate of CRT in patients with cancer was 5.02% (539/10 736). Amongst different malignant tumour types, head and neck (9.66%), haematological (6.97%) and respiratory (6.58%) tumours had the highest risks. Amongst catheter types, haemodialysis (13.91%), central venous (8.39%) and peripherally inserted central (4.68%) catheters were associated with the highest risks. A total of 500 patients with CRT and 1000 without CRT participated in model construction and were randomly assigned to the training (n = 1050) or testing (n = 450) groups. We identified 11 independent risk factors, including age, catheterisation method, catheter valve, catheter material, infection, insertion history, D-dimer concentration, operation history, anaemia, diabetes and targeted drugs. The logistic regression model had the best discriminative ability amongst the three models. It had an area under the curve (AUC) of 0.868 (0.846-0.890) for the training group. The external validation AUC was 0.708 (0.618-0.797). The calibration curve of the nomogram model was consistent with the ideal curve. Moreover, the Hosmer-Lemeshow test showed a good fit (P > 0.05) and high net benefit value for the clinical decision curve. The nomogram model constructed in this study can predict the risk of CRT in patients with cancer. It can help in the early identification and screening of patients at high risk of cancer CRT.