Health Care Resources Research Articles

Web Application for Recommendation of Ayurvedic Drugs and Medicine using ML

This project aims to develop a comprehensive Ayurvedic drug recommendation website that seamlessly integrates traditional Ayurvedic principles with modern technology. The platform will cater to both students seeking educational resources and practitioners offering personalized healthcare guidance. The website's key features include drug prediction algorithms, herbal drug recommendations based on individualized assessments on symptoms, and a user-friendly interface. The initial phase involves meticulous planning, scoping, and research to define project objectives, target audiences, and select an appropriate technology stack. Subsequent weeks focus on design and prototyping, incorporating user feedback to ensure an intuitive and engaging interface. The front-end development phase emphasizes responsiveness and usability, while the back-end development integrates sophisticated algorithms for drug prediction and drug recommendation. User authentication and authorization mechanisms will be implemented to cater to both students and practitioners, ensuring a secure and personalized experience. The website's robustness and reliability will be validated through comprehensive testing, addressing any identified issues to guarantee a seamless user experience. The refinement and optimization phase involve continuous feedback collection, iterative improvements, and performance optimization. Beta testing will be conducted to gather user insights, refining the platform further. The deployment and launch process will involve hosting the website on a reliable platform, setting up monitoring tools, and officially releasing the Ayurvedic drug prediction and drug recommendation website to the public. This project combines the rich heritage of Ayurveda with cutting-edge technology, offering a valuable resource for education and healthcare in the Ayurvedic domain. The website aims to empower both students and practitioners with accurate drug predictions and personalized drug recommendations based on symptoms, fostering a holistic approach to healthcare that aligns with traditional Ayurvedic principle.

NANOMEDICINE BREAKTHROUGH: REVOLUTIONIZING CERVICAL CANCER TREATMENT WITH PRECISION DRUG DELIVERY

Cervical cancer, a global health issue, is a major concern, particularly in regions with limited healthcare resources. To address this, targeted drug delivery strategies have emerged as promising solutions. These involve delivering therapeutic agents directly to cancerous cells, minimizing systemic side effects, and enhancing treatment efficacy. Delivery systems like nanoparticles, liposomes, polymeric micelles, hydrogels, and local drug delivery devices have been developed to overcome barriers like drug resistance and limited penetration. Emerging targeting strategies like tumor-specific ligands, immunotherapy, virotherapy, and gene therapy are also promising for improving treatment specificity and efficacy in cervical cancer. These approaches address the intricate cellular pathways involved in the disease progression, paving the way for more personalized and effective treatments. The synergy between advancements in drug delivery technologies and targeting strategies offers hope for a future where cervical cancer can be effectively managed and potentially eradicated. KEYWORDS: Targeted drug delivery, Nanoparticles, Immunotherapy, Gene therapy, Personalized treatments, Cervical cancer

Evaluating Real World Health System Resource Utilization and Costs for a Risk-Based Breast Cancer Screening Approach in the Canadian PERSPECTIVE Integration and Implementation Project.

A prospective cohort study was undertaken within the PERSPECTIVE I&I project to evaluate healthcare resource utilization and costs associated with breast cancer risk assessment and screening and overall costs stratified by risk level, in Ontario, Canada. From July 2019 to December 2022, 1997 females aged 50 to 70 years consented to risk assessment and received their breast cancer risk level and personalized screening action plan in Ontario. The mean costs for risk-stratified screening-related activities included risk assessment, screening and diagnostic costs. The GETCOST macro from the Institute of Clinical Evaluative Sciences (ICES) assessed the mean overall healthcare system costs. For the 1997 participants, 83.3%, 14.4% and 2.3% were estimated to be average, higher than average, and high risk, respectively (median age (IQR): 60 [56-64] years). Stratification into the three risk levels was determined using the validated multifactorial CanRisk prediction tool that includes family history information, a polygenic risk score (PRS), breast density and established lifestyle/hormonal risk factors. The mean number of genetic counseling visits, mammograms and MRIs per individual increased with risk level. High-risk participants incurred the highest overall mean risk-stratified screening-related costs in 2022 CAD (±SD) at CAD 905 (±269) followed by CAD 580 (±192) and CAD 521 (±163) for higher-than-average and average-risk participants, respectively. Among the breast screening-related costs, the greatest cost burden across all risk groups was the risk assessment cost, followed by total diagnostic and screening costs. The mean overall healthcare cost per participant (±SD) was the highest for the average risk participants with CAD 6311 (±19,641), followed by higher than average risk with CAD 5391 (±8325) and high risk with CAD 5169 (±7676). Although high-risk participants incurred the highest risk-stratified screening-related costs, their costs for overall healthcare utilization costs were similar to other risk levels. Our study underscored the importance of integrating risk stratification as part of the screening pathway to support breast cancer detection at an earlier and more treatable stage, thereby reducing costs and the overall burden on the healthcare system.

Patient-Reported Racial and Ethnic Disparities in Patients With Ulcerative Colitis: Results From the National Health and Wellness Survey.

Ulcerative colitis (UC) is an inflammatory condition characterized by chronic, disabling gastrointestinal symptoms that can have detrimental effects on psychological, social, and professional quality of life. Few studies have examined patient-reported outcomes (PROs) and economic outcomes among individuals with varying UC severity and across different racial/ethnic groups. This cross-sectional study assessed sociodemographic data, PROs, and economic outcomes for participants from the National Health and Wellness Survey (2018, 2019, and 2020) with UC. Multivariable analyses were used to assess the association of self-reported UC severity and race/ethnicity with health-related quality of life (HRQoL), work productivity and activity impairment (WPAI), healthcare resource utilization (HCRU), and medical costs. This study included 1500 participants with UC (1150 non-Hispanic White, 99 non-Hispanic Black, and 251 Hispanic). Moderate/severe disease was associated with significantly worse HRQoL and WPAI, greater HCRU, and higher direct medical costs than mild UC. Compared with non-Hispanic White participants, non-Hispanic Black participants reported better HRQoL, whereas Hispanic participants reported more HCRU and higher medical costs. Race/ethnicity significantly interacted with UC severity level in predicting labor force participation. Participants with moderate/severe disease had worse outcomes than those with mild UC. Additionally, racial/ethnic differences were found in HRQoL, employment, WPAI, HCRU, and direct medical costs. Notably, Hispanic participants showed distinct patterns, particularly in how disease severity influenced employment outcomes. Further research is needed to better understand the differential burden among patients across racial/ethnic groups.

Proposal to estimate the required resources for healthcare

Objective. To present a proposal to estimate healthcare resource requirements for the population with no social security in Mexico City and the domestic projection, including access and coverage. Materials and methods. The gross domestic product percentage for healthcare is calculated using the Medical-Technical Baseline Cost (MTBC) or the Medical Economic Card (MEC) standard according to diagnosis and care treatment for the population with no social security, thus projecting the prospective resource requirements. Results. There is a shortfall of resources for 2024; the prospective per capita for the first level of healthcare is $3,813 and the historical one is $1,933; and the corresponding values for the second level are $4,430 and $3,861. The %GDP-healthcare for Mexico City in 2024 exhibits a 42% difference between the historical and prospective categories. The shortfall of resources for the three levels of healthcare in the entire country is 19%. Conclusions. The prospective budget makes it possible to calculate healthcare resource requirements with a higher degree of certainty and graduality.

Prevention of Postoperative Pancreatic Fistula: Systematic Review and Meta-Analysis

Background: After pancreatic surgery, the development of postoperative pancreatic fistula (POPF) is a serious concern. POPF involves the leakage of pancreatic fluids from the surgical site, which can lead to complications and even death. Preventing POPF is essential for enhancing patient recovery and lessening the impact on healthcare resources. This systematic review and meta-analysis evaluated medical methods and surgical techniques to prevent POPF. Methods: This study was registered under the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42024500938. An electronic search was conducted through the PubMed, Google Scholar, Web of Science, and ScienceDirect databases for all relevant articles published in English from 2018 to 2023. The following search terms were used: ((Whipple procedure OR Pancreaticojejunal OR Pancreaticogastrostomy) AND (Prevention of postoperative pancreatic fistula) AND (Prevention OR Octreotide OR Sealant agent OR Stent OR Postoperative drain)). Results: Of 260 papers, 28 articles extracted through the database search were considered suitable for the systematic review. The included studies investigated a variety of surgical approaches for pancreatic resection. Pancreaticoduodenectomy (PD) was the most prevalent intervention. The incidence rates for POPF varied widely across the studies, ranging from as low as 11.6% to as high as 100%. The incidence rate of clinically relevant POPF (CR-POPF) ranged from 11.7% to 33.3%. The length of postoperative hospital stays also varied significantly. Discussion: Postoperative pancreatic fistula (POPF) affects 13–41% of patients post-pancreatic surgery. Despite its high incidence, mortality rates are low. Postoperative hospital stay varies, with higher rates in older patients and overweight individuals. Advancements in surgical techniques and perioperative management have reduced mortality rates to <5%. Conclusions: This study provides insights into the outcomes of pancreatectomy, including the incidence of POPF, postoperative hospital stays, and mortality rate. The findings suggest that the incidence of POPF is similar to that suggested in the literature and is influenced by various factors.

Unraveling the drivers of inequality in primary health-care resource distribution: Evidence from Guangzhou, China

BackgroundPrimary health-care (PHC) resource plays a critical role in addressing challenges related to healthcare accessibility and costs, as well as implementing a graded diagnosis and treatment system. This study aims to analyze the extent and components of inequality in PHC resource allocation in Guangzhou. MethodsBy utilizing data from the Annual Report on Healthcare Institutions for community and township health centers in Guangzhou from 2012 to 2020, this paper analyses the distribution of human, material and financial resources. It examines inequities in health resource allocation using the Gini coefficient. Additionally, it investigates the internal structure of overall inequality through the two-stage nested Theil decomposition method and explores the influencing mechanisms of inequality using the concentration index decomposition method. ResultsThe findings indicate that between 2012 and 2020, except for beds in 2018 and 2019, the Gini coefficients for resource allocation relative to population size remained below 0.3. Moreover, the Gini coefficient for geographical area ranged from 0.1228 to 0.3481. The two-stage nested Theil decomposition results reveal that within-district disparity contributes the most to the overall inequality, exceeding 46 %. The Concentration indexes show negative values, and the decomposition analysis highlights the significant contribution of the number of individuals served (over 72 %) to the inequality in health resource allocation. ConclusionAt the administrative district level, the allocation of PHC resources in Guangzhou demonstrates overall equity, with within-district inequality identified as the primary contributor to the overall inequality. The distribution of PHC resources in Guangzhou follows a pro-poor pattern. The key factors influencing equity enhancement in PHC resource allocation in Guangzhou include the number of individuals served, the presence of township health centers among institution types, the number of hospital admissions per capita, and the proportion of children aged 0–3.

Outcomes with single-agent gilteritinib for relapsed or refractory FLT3-mutant AML after contemporary induction therapy

AbstractGilteritinib is the current standard of care for relapsed or refractory fms related receptor tyrosine kinase 3 (FLT3)–mutated acute myeloid leukemia in many countries, however outcomes for patients relapsing after contemporary first-line therapies (intensive chemotherapy with midostaurin, or nonintensive chemotherapy with venetoclax) are uncertain. Moreover, reported data on toxicity and health care resource use is limited. Here, we describe a large real-world cohort of 152 patients receiving single-agent gilteritinib in 38 UK hospitals. Median age was 61 years, and 36% had received ≥2 prior lines of therapy, including a FLT3 inhibitor in 41% and venetoclax in 24%. A median of 4 cycles of gilteritinib were administered, with 56% of patients requiring hospitalization in the first cycle (median, 10 days). Over half of patients required transfusion in each of the first 4 cycles. Complete remission (CR) was achieved in 21%, and CR with incomplete recovery (CRi) in a further 9%. Remission rates were lower for patients with FLT3–tyrosine kinase domain or adverse karyotype. Day-30 and day-60 mortality were 1% and 10.6%, respectively, and median overall survival was 9.5 months. On multivariable analysis, increasing age, KMT2A rearrangement, and complex karyotype were associated with worse survival whereas RUNX1 mutations were associated with improved survival. Twenty patients received gilteritinib as first salvage having progressed after first-line therapy with venetoclax, with CR/CRi achieved in 25% and median survival 4.5 months. Real-world results with gilteritinib mirror those seen in the clinical trials, but outcomes remain suboptimal, with more effective strategies needed.

Global bibliometric analysis of cost effectiveness analysis in healthcare research from 2013 to 2023

BackgroundCost-effectiveness analysis (CEA) has become a crucial technique in appraising the efficiency of healthcare interventions and resource allocation decisions. Cost-effectiveness analysis is now widely used to evaluate whether the effect of a healthcare intervention justifies additional expenditure.MethodWe used PubMed database with search descriptors: “Cost effectiveness” [Title / ] OR “Cost effectiveness analysis” [Title / ] AND “Healthcare” [Title / ]. The common bibliometric indicators were applied.ResultsWe retrieved a total of 7,561 articles within 2013 and 2023. The growth pattern showed a progressive pattern. Articles with 5 authors signature had the highest number in publication. The most productive authors in cost effectiveness research in healthcare were Liew Danny and Ademi Zanfina. The most utilized journals for the publications were BMJ Open, PLoS One and Journal of Medical Economics. The most productive institutions were resident in United Kingdom with the University of York and University of Oxford at the helm.ConclusionScientific production in Cost effectiveness in healthcare research was found to be progressive. This study provides a reference for health policy makers, funders, policy decision makers, academics, and hospital economics researchers.

Assessing Bronchiectasis Progression in Low-dose Screening for Lung Cancer: Frequency and Predictors.

Bronchiectasis is associated with loss of lung function, substantial use of health care resources, and increased morbidity and mortality in people with cardiopulmonary diseases. We assessed the frequency of progression or new development of bronchiectasis and predictors of progression in participants in low-dose computed tomography (CT) screening programs. We reviewed our prospectively enrolled screening cohort in the Early Lung and Cardiac Action Program cohort of smokers, aged 40 to 90, between 2010 and 2019, and medical records to assess the progression of bronchiectasis after five or more years of follow-up after baseline low-dose CT. Logistic and multivariate-analysis-of-covariance regression analyses were used to examine factors associated with bronchiectasis progression. Among 2182 baseline screening participants, we identified 534 (mean age: 65±9y; 53.6% women) with follow-up screening of 5+ years (median follow-up: 103.2mo). Of the 534 participants, 34 (6.4%) participants had progressed (25/126, 19.8%) or newly developed (9/408, 2.2%) bronchiectasis. Significant predictors of progression (progressed+newly developed) were: age (P=0.03), pack-years of smoking (P=0.004), baseline components of the ELCAP Bronchiectasis Score, including the severity of bronchial dilatation (P=0.01), its extent (P=0.01), bronchial wall thickening (P=0.04), and mucoid impaction (P<0.001). Assuming similar progression rates, ~136 out of 2182 participants are expected to progress on follow-up screening. This study sheds light on bronchiectasis progression and its significant predictors in a low-dose CT screening program. We recommend reporting bronchiectasis as participants who have smoked are at increased risk, and continued assessment over the entire period of participation in the low-dose CT screening program would allow for the identification of possible causes, early warning, and even early treatment.

Meta-analysis on Effectiveness of Palliative Care versus Conventional Care amongst Advanced Gynaecological Patients with Cancer and Caregivers

In cancer patients, physical and psychological issues are very common. There is a need for family support and high utilisation of healthcare resources commonly. Palliative care (PC) has grown in popularity to better fulfil of needs of patients and their families and potentially lowering hospital costs. Given that the majority of patients still die in hospitals, there is a need for an effective model of PC for advanced gynaecological cancer, as well as the wise allocation of scarce resources. The main aim of this study was to compare the efficacy of PC to conventional treatment for adults with cancer, including gynaecological cancers, and their caregivers. Four randomised controlled trials (RCTs) were identified by searching PubMed, PubMed Central, Clinical Key, Embase and other grey literature from a duration of 2011–2021. Cochrane criteria were used to calculate the risk of bias, and the Grade Profiler Guideline Development Tool was used to check the quality of the included studies. Standardised mean differences (SMDs), I2 value and forest plot were prepared by using Review Manager 4.0. A total of four RCTs were extracted by following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and found to have a high risk for bias and low to poor quality of evidence. Included study sample sizes ranged from 22 to 104 participants, including 670 people in total, including 289 patients with advanced cancer patients, including gynaecological cancer and 381 unpaid caregivers. Results also showed that PC enhances patients’ quality of life (SMD = 0.26; 95% confidence interval [CI] = −0.29–0.80; I2 = 76%), lowered symptom burden amongst patients (SMD = −0.75, 95% CI = −1.75–0.25; I2 = 89%), reduces patient depression (SMD = 0.08, 95% CI = −0.19–0.34; I2 = 0%) and decreases depression in unpaid caregivers (SMD = −0.16, 95% CI = −0.56–0.24; I2 = 59%). PC treatment increases patients’ quality of life and lowers their symptom burden. In comparison to conventional care, it also reduces depression among patients and caregivers. We believe that the findings should be viewed with care until more recent exclusive RCTs are available.

Real world analysis of treatment change and response in adults with attention-deficit/hyperactivity disorder (ADHD) alone and with concomitant psychiatric comorbidities: results from an electronic health record database study is the United States

BackgroundThe objectives of this study were to examine the association of psychiatric comorbidities and patient characteristics with treatment change and response as well as to assess the association between treatment change and healthcare resource utilization (HCRU) among adult patients with attention-deficit/hyperactivity disorder (ADHD) and psychiatric comorbidities.MethodsDe-identified electronic health records from the NeuroBlu Database (2002–2021) were used to select patients ≥ 18 years with ADHD who were prescribed ADHD-specific medication. The index date was set as the first prescription of ADHD medication. The outcomes were treatment change (discontinuation, switch, add-on, or drop) and HCRU (inpatient, outpatient, composite) within 12 months of follow-up. Cox proportional-hazard model was used to assess the association between clinical and demographic patient characteristics and treatment change, while generalized linear model with negative binomial distribution and log link function was used to assess the association between key risk factors linked to treatment change and HCRU rates.ResultsA total of 3,387 patients with ADHD were included (ADHD only: 1,261; ADHD + major depressive disorder (MDD): 755; ADHD + anxiety disorder: 467; ADHD + mood disorder: 164). Nearly half (44.8%) of the study cohort experienced a treatment change within the 12-month follow-up period. Treatment switch and add-on were more common in patients with ADHD and comorbid MDD and anxiety disorder (switch: 18.9%; add-on: 20.5%) compared to other cohorts (range for switch: 8.5–13.6%; range for add-on: 8.9–12.1%) Survival analysis demonstrated that the probability of treatment change within 12 months from treatment initiation in the study cohort was estimated to be 42.4%. Outpatient visit rates statistically significantly increased from baseline (mean [SD] 1.03 [1.84] visits/month) to 3 months post-index (mean [SD] 1.62 [1.91] visits/month; p < 0.001), followed by a gradual decline up to 12 months post-index. Being prescribed both a stimulant and a non-stimulant at index date was statistically significantly associated with increased risk of treatment change (adjusted hazard ratio: 1.64; 95% CI: 1.13, 2.38; p = 0.01).ConclusionsThis real-world study found that treatment change was common among patients with ADHD and psychiatric comorbidities. These findings support the need for future studies to examine the unmet medical and treatment needs of this complex patient population.

Real-world impact of acupuncture on analgesics and healthcare resource utilization in breast cancer survivors with pain

BackgroundThis study evaluated the real-world impact of acupuncture on analgesics and healthcare resource utilization among breast cancer survivors.MethodsFrom a United States (US) commercial claims database (25% random sample of IQVIA PharMetrics® Plus for Academics), we selected 18–63 years old malignant breast cancer survivors experiencing pain and ≥ 1 year removed from cancer diagnosis. Using the difference-in-difference technique, annualized changes in analgesics [prevalence, rates of short-term (< 30-day supply) and long-term (≥ 30-day supply) prescription fills] and healthcare resource utilization (healthcare costs, hospitalizations, and emergency department visits) were compared between acupuncture-treated and non-treated patients.ResultsAmong 495 (3%) acupuncture-treated patients (median age: 55 years, stage 4: 12%, average 2.5 years post cancer diagnosis), most had commercial health insurance (92%) and experiencing musculoskeletal pain (98%). Twenty-seven percent were receiving antidepressants and 3% completed ≥ 2 long-term prescription fills of opioids. Prevalence of opioid usage reduced from 29 to 19% (P < 0.001) and NSAID usage reduced from 21 to 14% (P = 0.001) post-acupuncture. The relative prevalence of opioid and NSAID use decreased by 20% (P < 0.05) and 19% (P = 0.07), respectively, in the acupuncture-treated group compared to non-treated patients (n = 16,129). However, the reductions were not statistically significant after adjustment for confounding. Patients receiving acupuncture for pain (n = 264, 53%) were found with a relative decrease by 47% and 49% (both P < 0.05) in short-term opioid and NSAID fills compared to those treated for other conditions. High-utilization patients (≥ 10 acupuncture sessions, n = 178, 36%) were observed with a significant reduction in total healthcare costs (P < 0.001) unlike low-utilization patients.ConclusionsAlthough adjusted results did not show that patients receiving acupuncture had better outcomes than non-treated patients, exploratory analyses revealed that patients treated specifically for pain used fewer analgesics and those with high acupuncture utilization incurred lower healthcare costs. Further studies are required to examine acupuncture effectiveness in real-world settings.

Disparity in healthcare seeking behaviors between impoverished and non-impoverished populations with implications for healthcare resource optimization

Globally, poverty and illness are linked, attracting widespread attention. In China, illness contributes to about 40% of rural poverty. This study sought to investigate how healthcare-seeking behavior differs between impoverished and non-impoverished populations within the same Chinese healthcare delivery system. It also sought to understand how differences should be considered when assessing spatial accessibility to provide more accurate recommendations for healthcare resource optimization and promote village revitalization and health equity in China. Methodologically, a survey conducted in May 2019 in Enshi Prefecture (a national impoverished region in Hubei Province, China) collected data on healthcare resource utilization regarding the inpatient and outpatient needs of both impoverished and non-impoverished populations. A Chi-square test compared their respective healthcare-seeking behaviors in three respects (e.g., preference for healthcare institution type, transportation mode, and travel time). Baidu Map data with healthcare institution locations and real-life travel times were then incorporated to assess spatial access to different types of healthcare institutions. Results showed that in Enshi, the most widespread village clinics (low-level) were generally the most utilized healthcare institutions for outpatient visits, with patients usually walking for about 30 min. The middle-level Township Health Centers (THCs) and high-level public hospitals were the most used for inpatient visits, with patients willing to drive up to 30 min to THCs and 60 min to hospitals. Comparatively, the impoverished have more frequent service demands but tend to choose lower-level healthcare institutions, with longer travel times and limited transportation modes. Although 75% of Enshi’s area was covered within 30 min by village clinics and 51% of the villages were within 60 min’ drive to hospitals, considerable areas remain under-served compared with the shortest travel time targets in China. In conclusion, spatial access to healthcare resources in Enshi must be further improved, especially by strengthening the service capacity of primary healthcare institutions to address the healthcare needs of Enshi’s impoverished population. The disparity in healthcare-seeking behavior between different population groups should be fully considered to effectively allocate limited healthcare resources to promote health equity for vulnerable populations as proposed in international and domestic policies.

A novel integrated logistic regression model enhanced with recursive feature elimination and explainable artificial intelligence for dementia prediction

Dementia is a major global health issue that significantly impacts millions of individuals, families, and societies worldwide, creating a substantial burden on healthcare systems. This study introduces a novel approach for predicting dementia by employing the Logistic Regression (LR) model, enhanced with Recursive Feature Elimination (RFE), applied to a unique dataset comprising 1000 patients, with 49.60% male and 50.40% female. The LR model, recognized for its simplicity and effectiveness in binary classification tasks, is optimized through RFE, a technique that iteratively eliminates less significant features to improve model performance. The model’s effectiveness was assessed using comprehensive metrics, including accuracy, precision, recall, F1-score, Matthews Correlation Coefficient (MCC), and Kappa score. Furthermore, SHapley Additive exPlanations (SHAP) values were employed to increase the interpretability of the model, providing insights into the most influential features for dementia prediction. To address the issue of overfitting, a standardization technique was implemented, which enhanced the model’s predictive performance. The findings of this study hold potential implications for early dementia detection, informing intervention strategies, and optimizing healthcare resource allocation.

Targeted education for clinicians and clinical coding staff improves the accuracy of clinical coding: A quality improvement project

The allocation of healthcare resources is reliant upon accurate information generated through clinical coding. Several factors contribute to coding inaccuracies, one of which is interpreting medical documentation. A lack of awareness among medical staff of the clinical coding process and the importance of detailed documentation exacerbates this problem. To investigate this further, 1 month of inpatient clinical coding data from a single hospital ward was reviewed by clinicians experienced in the coding and auditing process. If the reviewing clinician identified inaccuracies in the initial clinical coding, Healthcare Resource Group (HRG) codes were changed. Education sessions were then provided both to junior clinicians working on the hospital ward and to clinical coding staff and a further month of clinical coding data was again reviewed to assess for any difference after the sessions. HRG changes were made in 58.5% of 94 cases initially. Following the educational sessions, 20.5% of HRGs changed in 73 cases (p<0.0001), indicating more accurate initial clinical coding. There were also statistically significant reductions in the extent to which the primary and secondary diagnoses were changed. This study demonstrates that targeted education sessions for both junior clinicians and clinical coding staff can improve the accuracy of inpatient clinical coding.

Cost-effectiveness of proton beam therapy vs. conventional radiotherapy for patients with brain tumors in Sweden: results from a non-randomized prospective multicenter study

BackgroundThis study assessed the cost-effectiveness of proton beam therapy (PBT) compared to conventional radiotherapy (CRT) for treating patients with brain tumors in Sweden.MethodsData from a longitudinal non-randomized study performed between 2015 and 2020 was used, and included adult patients with brain tumors, followed during treatment and through a one-year follow-up. Clinical and demographic data were sourced from the longitudinal study and linked to Swedish national registers to get information on healthcare resource use. A cost-utility framework was used to evaluate the cost-effectiveness of PBT vs. CRT. Patients in PBT group (n = 310) were matched with patients in CRT group (n = 40) on relevant observables using propensity score matching with replacement. Costs were estimated from a healthcare perspective and included costs related to inpatient and specialized outpatient care, and prescribed medications. The health outcome was quality-adjusted life-years (QALYs), derived from the EORTC-QLQ-C30. Generalized linear models (GLM) and two-part models were used to estimate differences in costs and QALYs.ResultsPBT yielded higher total costs, 14,639 US$, than CRT, 13,308 US$, with a difference of 1,372 US$ (95% CI, -4,914–7,659) over a 58 weeks’ time horizon. Further, PBT resulted in non-significantly lower QALYs, 0.746 compared to CRT, 0.774, with a difference of -0.049 (95% CI, -0.195–0.097). The probability of PBT being cost-effective was < 30% at any willingness to pay.ConclusionsThese results suggest that PBT cannot be considered a cost-effective treatment for brain tumours, compared to CRT.Trial registrationNot applicable.

D-Dimer post-COVID19 in Karbala governorate, Iraq

After the Coronavirus epidemic, there are indications that a significant number of COVID-19 survivors experience long-term respiratory, cardiovascular, and psychological issues, necessitating the assessment of these complications for effective healthcare resource allocation. The test can help identify blood clotting problems. A positive result may suggest a blood clot has recently formed and broken down. In our study, the post-covid-19 d-dimer concentration was measured, and three groups were taken for each of males and females, with a total of 30 samples. The first group are those infected once with Covid-19 and then recovered included (5) males and (5) females, and the highest concentration found in the sample (10) was 211.2 μg FEU/ml in females, it within normal limits (500 μg FEU/ml). The second group are those hits twice with Covid-19 and then recovered, it consisted from 10 samples (5 males, 5 females). The highest concentration in sample (20) was 350.62 μg FEU/ml and it has short period between hits, also was the short period between hits higher concentration from long period between hits. In the last group, those hits three times with Covid-19, then recovered, included (10) samples (5 males, 5 females), maximum concentration in sample (30) was 386.7 μg FEU/ml, it has the short period between hits. In three group was d-dimer concentration higher in females from males, and in short period between hits higher long period. The factor can increase d-dimer age, Gender, diseases, treatment, pregnancy, trauma and the vaccine to covid-19

Peer Support Ambassadors: A Program to Advance a Supportive and Inclusive Clinical Learning Environment.

Peer support is beneficial to physicians in distress, but few institutions have created formal programs that train residents and fellows to effectively support their peers. Existing curricula also do not address the differential experience of residents from historically excluded groups, who are more likely to experience distressing mistreatment and discrimination in the clinical learning environment. The Graduate Medical Education (GME) Peer Support Ambassador (PSA) Program aimed to address this gap by: (1) offering peer support skills and trauma-informed care training to a diverse cohort of resident leaders representing a range of specialties, (2) deploying these leaders to support their peers, and (3) facilitating opportunities for participants to train other residents in these skills. In the PSA program's inaugural year, 10 residents were trained in fundamentals of peer support, trauma-informed care, and the restorative mindset. The training increased participants' confidence and skills in these areas, increased their understanding of when to refer a co-resident for additional levels of support, and their awareness of resources for mental health care and addressing mistreatment and discrimination. Beyond the skills training, the program broadened participants' perspectives about other residents' experiences and helped them feel more connected to residents in other specialties. Opportunities to improve the PSA program include creating more opportunities for program participants to connect between sessions and after the training, publicizing the program more effectively to residents experiencing distress, and training a larger number of residents in peer support skills.

Evaluating Medical Students' Knowledge, Attitudes, and Practices in Pharmacovigilance: A Cross-Sectional Study

Background: It is an indispensable tool for ensuring patient safety, while its practice raises numerous questions in developing countries, including Bangladesh. This paper aims at determining medical students’ Knowledge, attitude and practice (KAP) of pharmacovigilance to inform ADR reporting. Objective: To evaluate the KAP of pharmacovigilance with second-year students, final-year students, and interns enrolled in a community-oriented medical college in Bangladesh. Methods: A quantitative study design using the cross-sectional survey approach was used together with a self-administered, well-validated structured questionnaire. Second-year, final-year, and intern groups were selected with one hundred participants from each group. Descriptive statistical analysis and chi-square analysis were used in data analysis. Results: A total of 49 percent of the participants were able to correctly define pharmacovigilance; final-year students had the highest knowledge score of 72 percent. A total of 80–85% of the participants endorsed the need to report ADRs, and 75–84% believed that reporting ADRs is a professional responsibility. However, ADR reporting practice varied significantly: In the final-year students, 90% reported having filled out an ADR form, while the corresponding numbers for second-year students and interns were 12% and 34%, respectively. While 70-90% of the participants claimed to have ever been trained on how to report an ADR, only 20-28% of the participants reported to have ever experienced an ADR. Conclusion: Thus, though attitudes toward pharmacovigilance were mostly positive, major knowledge and practical implementation deficits were found, mainly concerning interns. The study underscores the need for enhanced systematic, comprehensive, and clinically focused instruction in pharmacovigilance learning in medical schools. This paper recommends that foresulfide should strengthen the existing knowledge prerequisite, integrate compulsory continuous education programs, advance practical practice, and smoothen the procedure of reporting ADRs to amplify the practices in pharmacovigilance among future healthcare human resources of Bangladesh.