Reduce Health Care Costs Research Articles

A novel scoring system for predicting disease severity without CT imaging in acute diverticulitis

PurposeClinical scoring could help physicians identify patients with suspected acute diverticulitis who would benefit from further evaluation using computed tomography imaging. The aim of the study was to identify risk factors for complicated acute diverticulitis and create a risk score to predict disease severity in acute diverticulitis.MethodsPatients diagnosed with CT-verified acute diverticulitis between 2015 and 2017 were included. Data on patients’ clinical and laboratory findings and medical histories were collected retrospectively. Risk factors for complicated acute diverticulitis were identified using univariate and multivariate analyses. Continuous laboratory values were categorised by cut-off points determined using receiver operating characteristic (ROC) analysis. The Acute Diverticulitis Severity Score was formulated using logistic regression analysis.ResultsOf the total 513 patients included in the study, 449 (88%) had UAD, and 64 (12%) had CAD. Older age, significant comorbidities, C-reactive protein level, leucocyte count, vomiting, and body temperature were found to be independently associated with a higher risk for CAD. The novel Acute Diverticulitis Severity Score could reliably detect patients with CAD. The area under the ROC curve was 0.856 (p < 0.001) in discriminating disease severity. While higher scores indicate radiological studies, patients with low scores face an almost non-existent risk for complicated disease, making such studies possibly redundant.ConclusionsThe Acute Diverticulitis Severity Score accurately separated patients with uncomplicated disease from those at risk for complicated disease. This score can be applied in daily clinical practice to select patients requiring further investigation, consequently reducing healthcare costs and burdens.

Developing a large-scale quality improvement program for thyroid cancer surgery.

Surgical quality improvement (QI) plays a critical role in optimizing patient outcomes and reducing healthcare costs. QI programs focusing specifically on thyroid cancer surgical care are lacking. This study aimed to (a) select and introduce surgical quality indicators for thyroid cancer and (b) identify areas for QI at the state-level. A multidisciplinary team of thyroid cancer and QI experts selected 10 thyroid cancer-specific quality indicators and assessed the quality of thyroid cancer surgical care compared to current national guidelines. Analysis of the first year (January-December 2023) of data collection was performed using descriptive statistics. The thyroid cancer quality indicators included preoperative cytology, postoperative pathology, staging, cancer size, margin status, extrathyroidal extension, lymph nodes, postoperative complications within 30days, documented follow-up treatment, and documented surveillance plans. 112 surgeons performed 360 thyroidectomies for thyroid cancer at 51 hospitals. Preoperative cytology was not performed in 34.3% (n=103) of cases with thyroid cancer on final pathology. When the extent of surgery was evaluated by papillary cancer size, 50.0% (n=38) of patients with <1cm cancers underwent total thyroidectomy, and 13.8% (n=4) with >4cm underwent thyroid lobectomy. Positive margins were found in 16.2% (n=53). Postoperatively, 19.2% (n=69) of patients lacked documented follow-up, and 18.6% (n=67) lacked thyroid cancer surveillance plans. Establishing a dedicated QI program for thyroid cancer provides a previously unharnessed opportunity to enhance the quality of thyroid cancer surgical care. Statewide surgical quality collaboratives offer a model for establishing thyroid cancer QI initiatives across diverse healthcare settings in other states and countries.

Mirtazapine: A One-Drug Intervention for the Physical and Psychological Symptoms of End-Stage Renal Disease (ESRD).

Patients with end-stage renal disease (ESRD), especially those on dialysis, experience myriad medical and psychological symptoms that impact theirquality of life. These symptoms range from nausea, emesis, and insomnia to pruritus, anxiety, depression, and loss of appetite. These symptoms often require multiple medications (e.g., anticholinergics, antihistamines, tricyclics, benzodiazepines, and Z-drugs), which can lead to polypharmacy, medication non-adherence, and potentially harmful drug-drug interactions, especially in older ESRD patients, a population with an age-related decline in drug metabolism, multimorbidity, and polypharmacy. The current perspective article will discuss evidence from extant literature supporting mirtazapine (a noradrenergic antagonist and selective serotonin antagonist, NASSA) as a potentially useful one-stop pharmacologic agent to alleviate multiple symptoms that ESRD patients face. A one-stop strategy has the potential to decrease polypharmacy, reduce adverse drug-drug and drug-disease interactions, reduce healthcare costs, and improve the quality of life in ESRD patients. Mirtazapine use in an ESRD setting merits a large randomized pragmatic double-blinded controlled trial to evaluate its efficacy as a potential pharmacotherapeutic agent for the management of multiple disabling gastrointestinal and other neuropsychological symptoms in older adults living with ESRD.

Association of early follow-up visits with reduced hospital readmissions of newborns: a French population-based data-linkage study.

Newborn care guidelines recommend assessments within a week of discharge from maternity care. However, the optimal timing and effectiveness to prevent neonatal hospital readmission are debated. This study aimed to determine the association between early follow-up visits (EFVs) within threedays of postpartum discharge and hospital readmission of newborns up to 15days of life. This population-based data-linkage study used data from the French National Health Care Database. "Healthy" singleton term infants with a gestational age (GA) of ≥36weeks, born between January 1, 2017, and November 30, 2018, in Southern France, were included. A multivariate regression analysis was performed. Among the 67,359 included infants, 1519 (2.25%) were hospitalized. The principal causes of hospitalization were infectious diseases (42.4%) and jaundice or growth/nutrition disorders (36.1%). Hospitalized infants were more likely to be born to young and socioeconomically deprived mothers, to be male (54.4% vs. 50.6%, P < 0.001), or born early (GA < 38weeks; 28.5% vs. 20.5%, P < 0.001). They received 6% less EFVs than non-hospitalized infants (63.7% vs. 67.8%, P < 0.001). The multivariable regression logistic analysis revealed that infants who received EFVs had 13% lower odds of being hospitalized than infants without EFVs, with an adjusted odds ratio of 0.87 (95% confidence interval=0.78-0.96; P < 0.01). EFVs within threedays were associated with a 13% reduction in the rate of neonatal hospital readmission. Therefore, EFVs should be implemented to improve infant health and reduce healthcare costs.

Harnessing magnetic forces: Discovery and development of biliary strictures treatment with compression anastomosis

Magnetic compression anastomosis (MCA) is emerging as a promising alternative that uses magnetic force to create an anastomosis bypassing the stenosis in biliary strictures (BSs) where techniques such as percutaneous transhepatic biliary drainage and endoscopic retrograde cholangiopancreatography with stent placement are inadequate in the presence of complete obstruction or severe stenosis. MCA offers potential benefits such as less operative trauma, shorter hospital stay and lower complication rates. By placing magnets proximal and distal to the stenosis, necrosis of fibrotic tissue occurs, creating a new anastomosis. Investigating the role of MCA in the treatment of BS is crucial because of its potential to revolutionize care, improve outcomes and reduce healthcare costs. It offers an alternative for patients who are not suitable for conventional surgery. A comprehensive review of the principles, techniques, outcomes and applications of MCA is essential to inform clinicians, researchers and policy makers and to guide future research and clinical practice to optimize patient care for BSs.

Long-Term Efficacy and Safety of Adhesion Prevention Agents in Abdominal and Pelvic Surgeries: A Systematic Review.

This systematic review evaluates the long-term efficacy and safety of adhesion prevention agents in abdominal and pelvic surgeries, synthesizing data from randomized controlled trials and meta-analyses. Adhesions, common postoperative complications, can lead to significant morbidity, including chronic pain, infertility, and bowel obstruction. Various agents, including hyaluronic acid-carboxymethylcellulose films and icodextrin solutions, have been developed to mitigate these risks. Our review highlights that agents like bioresorbable membranes (Seprafilm) and icodextrin significantly reduce the incidence and severity of adhesions, particularly in high-risk surgeries. However, certain complications such as anastomotic leaks and infections are associated with some agents, emphasizing the need for careful consideration in clinical decision-making. Additionally, while these agents reduce postoperative morbidity and enhance recovery, further research is needed to assess their long-term impact, particularly regarding fertility outcomes and chronic pain. This review underscores the importance of integrating adhesion prevention agents into surgical protocols, which has the potential to reduce healthcare costs, improve patient outcomes, and optimize postoperative care pathways. Standardization of adhesion prevention practices could further enhance surgical efficiency and patient recovery, particularly in high-risk patient populations and complex surgeries.

Development and validation of a prediction model for people with mild chronic kidney disease in Japanese individuals

BackgroundChronic kidney disease (CKD) poses significant health risks due to its asymptomatic nature in early stages and its association with increased cardiovascular and kidney events. Early detection and management are critical for improving outcomes.ObjectiveThis study aimed to develop and validate a prediction model for hospitalization for ischemic heart disease (IHD) or cerebrovascular disease (CVD) and major kidney events in Japanese individuals with mild CKD using readily available health check and prescription data.MethodsA retrospective cohort study was conducted using data from approximately 850,000 individuals in the PREVENT Inc. database, collected between April 2013 and April 2023. Cox proportional hazard regression models were utilized to derive and validate risk scores for hospitalization for IHD/CVD and major kidney events, incorporating traditional risk factors and CKD-specific variables. Model performance was assessed using the concordance index (c-index) and 5-fold cross-validation.ResultsA total of 40,351 individuals were included. Key predictors included age, sex, diabetes, hypertension, and lipid levels for hospitalization for IHD/CVD and major kidney events. Age significantly increased the risk score for both hospitalization for IHD/CVD and major kidney events. The baseline 5-year survival rates are 0.99 for hospitalization for IHD/CVD and major kidney events are 0.99. The developed risk models demonstrated predictive ability, with mean c-indexes of 0.75 for hospitalization for IHD/CVD and 0.69 for major kidney events.ConclusionsThis prediction model offers a practical tool for early identification of Japanese individuals with mild CKD at risk for hospitalization for IHD/CVD and major kidney events, facilitating timely interventions to improve patient outcomes and reduce healthcare costs. The models stratified patients into risk categories, enabling identification of those at higher risk for adverse events. Further clinical validation is required.

The Analysis Study of Prevalence, Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD): A Comprehensive Systematic Review

Background: Chronic Obstructive Pulmonary Disease (COPD) is a debilitating respiratory condition that significantly contributes to global morbidity and mortality rates. This systematic review aims to evaluate prevalence, diagnostic challenges, and management strategies for COPD based on the literatures of the last 10 years. Methods: The study adhered to PRISMA 2020 standards, examining English literature from 2014 to 2024. It excluded editorials, reviews from the same journal, and submissions without a DOI. PubMed, SagePub, SpringerLink, and Google Scholar were utilized as literature sources. Result: Initially retrieving 360 articles from online databases (PubMed, SagePub, SpringerLink and Google Scholar) eight relevant papers were selected after three rounds of screening for full-text analysis. Conclusion: COPD is a major global health issue, significantly impacting quality of life due to prevalent comorbidities. This review emphasizes the necessity for targeted interventions and innovative management strategies, including home-based treatments, to enhance patient outcomes and reduce healthcare costs.

Wearable devices as part of postoperative early warning score systems: a scoping review.

Postoperative deterioration is often preceded by abnormalities in vital parameters, but limited resources prevent their continuous monitoring in patients with no indication to ICU admission. The development of new technologies allowed the introduction of wearable devices (WDs), enabling the possibility of postoperative monitoring in surgical wards. We performed a Scoping Review to determine the current use of wearable devices as part of Continuous Remote Early Warning Score (CREWS) systems and their efficiency during postoperative period. This Scoping Review was conducted according to PRISMA-ScR guidelines. PICO framework was used before the search to define the review protocol. Systematic literature research has been performed on PubMed, MeSH, MEDLINE and Embase, considering a period between 2018 and February 2024. Prospective and retrospective studies involving patients undergoing cardiac and non-cardiac surgery are included. A total of 10 articles were included in the review. 11 different CE/FDA approved wearable devices were used in the studies analyzed. In all studies the WDs were applied the day of the surgery. The use of WDs as part of CREWS systems is feasible and safe. Furthermore, with the aid of other technologies (LoRa and Artificial Intelligence), they shorten Length of Stay (LOS) and reduce the number of ICU admissions with a reduction in healthcare costs. Continuous monitoring in surgical departments can facilitate the correct and timely identification of postoperative complications. This article is a starting point for the development of new protocols and for the application of these monitoring systems in clinical practice.

Comparing Machine Learning Techniques for Detecting Chronic Kidney Disease in Early Stage

CKD is a gradual disease that affects millions of people throughout the United States and results in high morbidity and mortality rates. Chronic Kidney Disease is an ailment that culminates in a gradual loss of kidney function over t,ime. Early detection is essential since timely interventions may prevent the progression of CKD, improve outcomes and survival for patients with CKD, and reduce healthcare costs. In the recent decade, machine learning models have emerged as a game-changing tool in medical diagnostics, leveraging big data and complex algorithms to find patterns almost invisible to clinicians and physicians. This study deployed and evaluated various machine learning approaches for the early detection of CKD, focusing on their comparative performance, strengths, and weaknesses. Machine learning transforms medical diagnosis by leveraging big data and sophisticated algorithms to find patterns that might otherwise elude healthcare professionals. The dataset used for this research will be the CKD dataset, which was contributed to by the Cleveland Clinic in 2021. The dataset can be accessed publicly through the University of California, Irvine's UCI Machine Learning Repository. In this project, the analyst compared and contrasted the performance of Logistic Regression, Decision Trees, and Random Forests. Experimentation results demonstrated that logistic regression had the best performance, yielding a perfect F1 score and accuracy, closely followed by random forest. This result showed that the Logistic model ideally classified all the instances in the test set. Consolidating machine learning algorithms into the early detection of Chronic Kidney Disease (CKD) holds substantial promise for transforming clinical practice. Healthcare professionals can enhance diagnostic accuracy and facilitate timely interventions by leveraging proposed algorithms such as logistic regression.

Integrated enhanced recovery after surgery protocol in radical cystectomy for bladder tumour-A retroprospective study.

Enhanced recovery after surgery (ERAS) is a patient-centerd, evidence-based approach to improve postoperative outcomes. The protocol involves multidisciplinary collaboration and standardisation of perioperative interventions. ERAS has shown positive results in reducing hospitalisation and complications. The study conducted in the Department of Urology was a retro-prospective study. It included an ERAS cohort group of 47 patients, studied prospectively from May 2021 to May 2023. These patients were compared to a historical cohort of 47 consecutive patients who underwent radical cystectomy with traditional care before the ERAS pathway was implemented. The primary outcome was hospital length of stay (LOS). Secondary outcomes included perioperative management, time to recovery milestones and complications. Implementation of ERAS pathway for radical cystectomy was associated with reduced hospital LOS (mean LOS 16.19 ± 2.53 days vs. 10.26 ± 3.33 days 7 days; p< 0.0001), reduced time to key recovery milestones, including days to first flatus (3.17 vs. 2.68; p= 0.013) and days to first solid food (5.19 vs. 3.45 p value < 0.0001), first stool (5.53 vs. 4.23; p< 0.0001), reductions in some complications like postoperative ileus (p value = 0.021) and need for total parental nutrition (p value = 0.023). In conclusion, the implementation of the integrated approach facilitates a more efficient recovery process, potentially reducing healthcare costs and enhancing patient comfort.

The response of Intravenous Iron sucrose in children with Iron Deficiency Anaemia unresponsive to Oral Iron Therapy.

Objective: To evaluates the efficacy and safety of intravenous iron sucrose in paediatric patients with IDA who have not responded to or tolerated oral iron therapy.Methodology: This observational study was conducted at Department of Paediatrics, Pakistan aeronautical complex (PAC) Hospital Kamra, from October 2023 to April 2024. Iron sucrose (Venofer®) was administered at a dose of 0.35 ml/kg, providing 100 to 200 mg of elemental iron per dose, on alternate days for three doses. Haemoglobin (Hb) and serum ferritin levels were measured 4 weeks post-treatment to evaluate response.Results: Among the participants, 70 (70%) were male and 30 (30%) were female, with a mean age of 34.23 ±19.54 months. Results showed a significant increase in mean Hb from 7.92 ± 0.74 g/dl before treatment to 10.46 ± 0.94 g/dl after treatment (p = 0.001)Conclusion: Clinicians should consider intravenous iron therapy to enhance patient outcomes, improve quality of life, and potentially reduce healthcare costs. Keywords: Iron Deficiency Anaemia (IDA), Anaemia, Haemoglobin (Hb), Oral Iron, Intravenous Iron.

6687 Indicators of Diabetes Management: Predicting Unplanned Healthcare Utilization and Mortality in a Suburban Integrated Delivery Network

Abstract Disclosure: K.M. Barton: None. J.Y. Yip: None. K.C. Geckeler: None. A. Popelka: None. D.J. Ramsey: None. Purpose: To explore whether patients with diabetes mellitus (DM) who met Comprehensive Diabetes Care Healthcare Effectiveness Data and Information Set (HEDIS) metrics had a reduced likelihood of experiencing unplanned emergency department (ED) visits, hospitalizations, or mortality. Introduction: The prevalence of DM among U.S. adults is approximately 15% and continues to rise. To enhance care for individuals with DM, Comprehensive Diabetes Care HEDIS quality measures have been established. These measures encompass criteria such as blood pressure control, hemoglobin A1c (HbA1c) levels, and the completion of an annual eye examination. However, the connection of these metrics to health outcomes remains insufficiently studied. Methods: This study comprised a retrospective, cross-sectional exploratory analysis of established patients aged 18 years or older with DM receiving primary care within a suburban integrated delivery network (IDN). Multivariate logistic regression was used to analyze patient characteristics, including demographics, sociomedical factors, and biometrics. Outcome variables encompassed one or more unplanned ED visits (including urgent care), one or more unplanned hospitalizations, or mortality within the one-year study period. Results: Out of 28,929 patients with DM, 5293 (18.3%) had ≥1 ED visit, 3725 (12.9%) had ≥1 hospital admission, and 614 (2.1%) died during 2022. After controlling for available demographic and sociomedical factors, patients with poor HbA1c control (considered HbA1c &amp;gt; 9.0) in the year prior were more likely to experience an ED visit in the study year (adjusted odds ratio [aOR] = 1.292, 95% CI, 1.121-1.489, p &amp;lt; 0.001). Patients who achieved HbA1c control (considered HbA1c &amp;lt; 8.0) in the year prior were less likely to experience an ED visit (aOR = 0.845, 95% CI, 0.763-0.936, p = 0.001) and less likely to experience a hospitalization in the study year (aOR = 0.878, 95% CI, 0.779-0.989, p = 0.032). Patients who completed an eye exam in the year prior were less likely to experience a hospitalization (aOR = 0.913, 95% CI, 0.847-0.984, p = 0.017) or die (aOR = 0.694, 95% CI, 0.579-0.831, p &amp;lt; 0.001) in the study year. Finally, patients who completed microalbumin testing in the year prior were less likely to experience an ED visit (aOR = 0.902, 95% CI, 0.84-0.968, p = 0.004), or die (aOR = 0.464, 95% CI, 0.389-0.554, p &amp;lt; 0.001). Conclusion: Achieving HbA1c control in the previous year is linked to decreased likelihood of experiencing an unplanned ED visit or hospitalization. An eye exam in the year prior was associated with decreased likelihood of hospitalization or death. Further research into interventions aimed at enhancing DM management and reducing associated complications may have potential to enhance patient health outcomes while reducing health care costs. Presentation: 6/3/2024

EVs meet health: A complex-systems policy integration approach for electric vehicle adoption and its impact on respiratory and cardiovascular disease

The transition from gasoline-combustion to zero-emission vehicles represents one of the most ambitious public and private enterprises around the globe to mitigate air pollution and its subsequent effects on climate change. The present study uses the rapid transition in the state of California to analyze the connections between the increasing utilization of electric vehicles (EVs) and two critical health outcomes: Asthma and acute myocardial infarction (AMI) emergency department (ED) visits. We fit simultaneous quantile and interquartile-range regression models to health and sociodemographic data from the California Office of Health and Hazard Assessment and electric vehicles registration data, 2011–2017. Results show that changes in EV utilization, from 2011 to 2013 to 2015–2017, have larger and more favorable effects as asthma and AMI deteriorate across zip codes. Looking at zip codes located at the 75th and 25th percentiles of the change in the asthma- and AMI-related ED visits distribution, a 5-percentage points change in the EV-to-gasoline combustion utilization ratio is associated with a 25-percentage points (p<.01) and 12.5-percentage points (p<.01) decline in asthma- and AMI-related ED visits, respectively. Our findings also suggest that, should the U.S. meet the goals of Executive Order N-79-20 by 2035, we could observe about 37,000 fewer asthma-related ED visits (95% CI: 16,154–59,280) per year, with an overall possible annual savings of about $65.5 million dollars (95% CI: $29.1M – $106.7M), and a possible decline of about 19,292 AMI-related hospitalizations, with possible annual savings of about $425 million dollars (95% CI: $365M – $509M). Our findings are optimistic in that spillover effects from increasing EV utilization can reduce healthcare costs while improving population health. Research should point toward the development of public-private coalitional strategies to effectively bridge usually disparate sectors of the economy and policy-making like energy and health.

8737 Primary Hyperparathyroidism (PHPT) “Phenotypes” and the Results of Parathyroid [99mTc]Tc-Sestamibi SPECT/CT Scintigraphy: Minimizing the Risk of Negative Imaging Results

Abstract Disclosure: K. Kucharczyk: None. A. Drynda: None. J. Podlewski: None. M. Trofimiuk-Muldner: None. A. Hubalewska-Dydejczyk: None. Introduction. Primary hyperparathyroidism (PHPT) is a prevalent endocrinopathy typically identified through biochemical testing. PHPT is characterized by hypercalcemia accompanied by increased or inappropriately normal plasma parathyroid hormone (PTH) concentrations. Preoperative imaging is conducted when surgery is indicated to pinpoint parathyroid adenomas. [99mTc]Tc-Sestamibi scintigraphy is highly specific and sensitive in diagnosing PHPT, with a higher adenoma detection rate demonstrated for patients with larger lesions or higher blood calcium concentrations. The study aimed to investigate the relationship between the results of biochemical tests and clinical manifestations (PHPT “phenotype”) and the rate of positive results of parathyroid [99mTc]Tc-Sestamibi scintigraphy. Materials and methods. This was a retrospective study of patients suspected of PHPT who underwent parathyroid [99mTc]Tc-Sestamibi SPECT/CT scintigraphy between 2010 and 2022. Patients’ cluster analysis was conducted based on PTH, serum calcium (Ca), and phosphate (Pi) concentrations to find distinct patterns in these parameters. Furthermore, we compared the distributions of additional patients’ attributes, including gender, lesion size, serum vitamin D, ALP concentrations, urinary calcium, urolithiasis prevalence, as well as parathyroid scintigraphy results. Results. 513 patients were divided into 5 clusters using different algorithms. Finally, clusters from K-means methods were selected based on statistical metrics and expert interpretation. Those were organized in ascending order of positive scintigraphy results, with Cluster 5 reaching a 79.5% positivity rate and median values of PTH - 315.5 pmol/L, Ca - 2.96 mmol/L, and Pi - 0.7 mmol/L. As the proportion of positive imaging outcomes declined, median PTH and calcium concentrations decreased while phosphate concentrations increased. In Cluster 1, with 30% of positive imaging results, medians were as follows: PTH - 79.06 pmol/L, Ca - 2.55 mmol/L and Pi - 1.1 mmol/L. A comparative analysis of various clinical and biochemical parameters revealed statistically significant differences between clusters. Patients from Clusters with a higher frequency of positive scintigraphy were significantly more likely to be males, vitamin D deficient, with higher ALP concentrations, diagnosed with urolithiasis, and harbouring larger lesions. Conclusions. PHPT “phenotypes” correlated with disease severity are evidently linked to parathyroid scintigraphy detection rate. Therefore, it is crucial to know that false-negative imaging is more likely in PHPT patients with minor deviations in laboratory tests. Judicious assessment of biochemical and clinical features may limit the number of redundant parathyroid scintigraphies and, in consequence, reduce healthcare costs and unnecessary radiation exposure. Presentation: 6/2/2024

A Nationwide Physical Activity Intervention for 654,500 Adults in Singapore: Cost-Utility Analysis.

Increasing physical inactivity is a primary risk factor for diabetes and hypertension, contributing to rising health care expenditure and productivity losses. As Singapore's aging population grows, there is an increased disease burden on Singapore's health systems. Large-scale physical activity interventions could potentially reduce the disease burden but face challenges with the uncertainty of long-term health impact and high implementation costs, hindering their adoption. We examined the cost-effectiveness of the Singapore National Steps Challenge (NSC), an annual nationwide mobile health (mHealth) intervention to increase physical activity, from both the health care provider perspective, which only considers the direct costs, and the societal perspective, which considers both the direct and indirect costs. We used a Markov model to assess the long-term impact of increased physical activity from the NSC on adults aged 17 years and older. A Monte Carlo simulation with 1000 samples was conducted to compare two situations: the NSC conducted yearly for 10 years against a no-intervention situation with no NSC. The model projected inpatient and outpatient costs and mortality arising from diabetes and hypertension, as well as their complications. Health outcomes were expressed in terms of the quality-adjusted life-years (QALYs) gained. All future costs and QALYs were discounted at 3% per annum. Sensitivity analyses were done to test the robustness of our model results. We estimated that conducting the NSC yearly for 10 years with a mean cohort size of 654,500 participants was projected to prevent 6200 diabetes cases (95% credible interval 3700 to 9100), 10,500 hypertension cases (95% credible interval 6550 to 15,200), and 4930 deaths (95% credible interval 3260 to 6930). This led to a reduction in health care costs of SGD (Singapore dollar) 448 million (95% credible interval SGD 132 million to SGD 1.09 billion; SGD 1=US $0.73 for the year 2019). There would be 78,800 (95% credible interval 55,700 to 102,000) QALYs gained. Using a willingness-to-pay threshold of SGD 10,000 per QALY gained, the NSC would be cost-saving. When indirect costs were included, the NSC was estimated to reduce societal costs by SGD 1.41 billion (95% credible interval SGD 353 million to SGD 3.80 billion). The model was most sensitive to changes in the inpatient cost of treatment for diabetes complications, time horizon, and program compliance. In this modeling study, increasing physical activity by conducting a yearly nationwide physical activity intervention was cost-saving, preventing diabetes and hypertension and reducing mortality from these diseases. Our results provide important information for decision-making in countries that may consider introducing similar large-scale physical activity programs.

Smart watch applications in atrial fibrillation detection: Current state and future directions.

Atrial fibrillation (Afib) is a prevalent chronic arrhythmia associated with severe complications, including stroke, heart failure, and increased mortality. This review explores the use of smartwatches for Afib detection, addressing the limitations of current monitoring methods and emphasizing the potential of wearable technology in revolutionizing healthcare. Current Afib detection methods, such as electrocardiography, have limitations in sensitivity and specificity. Smartwatches with advanced sensors offer continuous monitoring, improving the chances of detecting asymptomatic and paroxysmal Afib. The review meticulously examines major clinical trials studying Afib detection using smartwatches, including the landmark Apple Heart Study and ongoing trials such as the Heart Watch, Heartline, and Fitbit Heart Study. Detailed summaries of participant numbers, smartwatch devices used, and key findings are presented. It also comments on the cost-effectiveness and scalability of smartwatch-based screening, highlighting the potential to reduce healthcare costs and improve patient outcomes. The integration of wearable technology into healthcare can lead to earlier diagnosis, improved patient engagement, and enhanced cardiac health monitoring. Despite ethical considerations and disparities, the potential benefits outweigh the challenges. This review calls for increased awareness, collaboration with insurance companies, and ongoing research efforts to optimize smartwatch accuracy and encourage widespread adoption of Afib detection. With insights from major trials, this review serves as a comprehensive reference for healthcare professionals and policymakers, guiding future strategies in the early diagnosis and management of atrial fibrillation.

An Analysis of Consumer Awareness Regarding Jan Aushadhi Kendras

India has made significant advancements in various health aspects, including an increase in the life expectancy of both men and women, low infant and maternal mortality rates, improved immunization coverage, and the elimination of diseases like polio and smallpox. According to the World Health Organization, around 5.8 million Indians succumb to diseases like diabetes, cancer, stroke, and heart and lung diseases. Non-communicable diseases (NCDs) pose a substantial health challenge in India, with one out of every four Indians dying before the age of 70 due to an NCD. The Indian healthcare system is grappling with rising healthcare costs, which disproportionately burden the poor, as well as the emergence of new diseases and non-communicable diseases. Approximately 100 million Indians fall into poverty each year due to high healthcare expenses, with out-of-pocket spending constituting over 50 percent of this burden. To reduce healthcare costs, the government has established Jan Aushadhi Kendras, which offer generic medicines with the same composition as branded ones at affordable prices. A recent study focused on identifying the key factors influencing the purchase of generic drugs from Jan Aushadhi medical stores, public awareness of these stores, and consumer satisfaction. The study found that 40 percent of the public is unaware of Jan Aushadhi, and consumers opt for generic medicines due to their affordability, even though the quality is lower than that of branded drugs. Jan Aushadhi Kendra is known for selling significant quantities of sanitary pads. While most consumers are satisfied with Jan Aushadhi products, some express dissatisfaction due to differences in quality and composition. Government agencies and health departments must enhance the quality of generic medicines and educate healthcare professionals and the general public about them.

Risk Factors for Musculoskeletal Health: A Review of the Literature and Clinical Application.

Musculoskeletal disorders (MSKD) are currently the leading contributor to disability worldwide. Unlike other prevalent and disabling healthcare conditions such as CVD, risk factors associated with MSKD are not commonly discussed or integrated into current medical practice, rehabilitation practice or wellness programs. The primary purpose of this review is to describe the known risk factors most closely associated with MSKD. The secondary purpose is to propose a clinical model to manage MSK health aimed at maximizing the healthy pursuit of a physically active and healthy lifestyle. In this review the most common MSKD risk factors, with a focus on those that can be easily screened in clinical practice are presented. The importance of understanding the magnitude and number of risk factors present as well as the multidimensional nature of MSKD risk is discussed. A total of 11 MSKD risk factors were identified. Most of the risk factors are modifiable, and the evidence associated with modifiability for the most prominent risk factors is reviewed.Researchers have found that often patients are discharged from care with several known MSKD risk factors. In such instances, local pain and dysfunction are managed well, but expanding our rehabilitation care to include comprehensive risk factor management would ultimately benefit the patient and reduce healthcare costs. The most common MSKD risk factors are discussed and a clinical framework to individualize intervention is proposed. Addressing key risk factors within rehabilitation may be an important step to reduce the enormous and growing burden these disorders are having on society. 5.

Functional movement disorder similar to Parkinson’s disease: a case report

IntroductionFunctional neurological disorder challenges conventional medical understanding, presenting neurological symptoms without organic explanations. This report delves into the intricate interplay between psychological and physical manifestations, emphasizing the importance of timely diagnosis and intervention and its impact on a patient’s mental health and quality of life.Case presentationA 40-year-old single Iranian man was admitted for the third time owing to exacerbation of mood symptoms, including depression, irritability, aggression, suicidal ideation, and movement and sensory problems. The patient’s symptoms began with psychological stressors and family conflict, leading to muscle weakness and tremors in the left hand. Over a year, muscle weakness escalated, leading to slow movement, motor impairment in the lower limbs, and reliance on a cane for walking. The patient still exhibited symptoms, such as a mask-like face, stooped walking posture, and a relative improvement of symptoms periodically. At first, the patient was suspected of Parkinson’s disease and was placed on levodopa and amantadine. However, the medication was discontinued owing to an unsatisfactory response and the lack of strong evidence in favor of neurological problems on frequent examinations and reviews. Despite multiple hospitalizations, the patient’s symptoms remained unresolved. Finally, after years of investigations, based on specialists’ recommendations, he was admitted to the psychosomatic ward for diagnostic evaluationele, and he was diagnosed with functional neurological disorder (psychogenic parkinsonism). He underwent pharmacotherapy, electroconvulsive therapy, and psychotherapy. He was discharged with partial improvement of symptoms, but showed periods of relapse and remission during the following years.ConclusionThis case study illuminates functional neurological disorder complexities, emphasizing the need for a holistic diagnostic approach. Timely interventions, including psychological support, can alleviate symptoms, reduce healthcare costs, and improve the overall prognosis. The report contributes to evolving functional neurological disorder understanding in psychiatry and neurology. The report underscores early recognition, advocating for comprehensive interventions involving psychiatric support, cognitive-behavioral therapy, and patient psychoeducation.