Higher Healthcare Costs Research Articles

Key drivers of medical crowdfunding success: a comprehensive analysis of 84,712 projects

Medical crowdfunding, an emerging form of internet-based financing, has seen immense growth globally in recent years, playing a significant role in supporting vulnerable groups to afford medical expense. In China, the insufficiency of medical insurance to cover all medical expenses, coupled with significant urban-rural disparities, leaves certain households, especially those in impoverished regions, unable to bear unforeseen high healthcare costs. Consequently, there arises a need for medical crowdfunding as a supplementary mechanism to the healthcare insurance system. The performance of existing medical crowdfunding projects, as well as the factors affecting the success rate, however, have been largely been overlooked. This study collects a large dataset from one of China’s largest crowdfunding platforms, encompassing 84,712 unique projects, and employs comprehensive analysis on investigating the impact of a variety of factors, including project features and patient characteristics. The results indicate that both project features and patient characteristics significantly affect the performance of medical crowdfunding projects, encompassing aspects like fundraising target amount, patient age, disease type, and geographic location. Notably, donors in China tend to favor projects aiding teenagers, leukemia sufferers, and cancer patients. Additionally, an intriguing observation is that patients in affluent regions are more likely to receive financial support through medical crowdfunding, which reveals the inequity in the geographic distribution of medical crowdfunding. Our research not only contribute to providing a valuable addition to the field of medical crowdfunding, but also provide insightful guidance and practical recommendations for crowdfunding platforms and fundraisers.

Effects of Progressive Resistance Training After Hip Fracture: A Systematic Review

Hip fracture presents high morbidity, mortality, and healthcare costs. Some programs have focused on the effect of progressive strength work on post-hip fracture recovery. Therefore, the objective of this systematic review was to understand the effect of a progressive resistance training program on different variables in adults after hip fracture. This review includes randomized controlled trials that apply progressive strength programs in subjects after a hip fracture. The selected databases are PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Ebsco. A total of 7 studies were selected after screening. These studies were published between 2005 and 2022. Most of the research included adults over 65 years of age, showing a mean age of 77.80 years. In the majority of cases, the programs are applied between 3 and 12 months post-fracture. The most commonly applied intervention time is 3 months. The intervention time of the programs typically lasts for 3 months and includes 3–4 lower limb exercises involving, mainly hip and knee movements. All the investigations assess functional capacity and nearly all research the strength. It is shown that the intensity of strength work progresses from 60 to 80% of 1RM. Progressive strength training programs in post-hip fracture patients generally show an improvement in functional capacity, strength, balance, walking speed, flexibility, and cardiorespiratory fitness. However, the effects on independence, quality of life, self-reported physical disability, depression, and cognitive ability do not show conclusive results, and there is little research in this regard.

Improving lung protective mechanical ventilation: the individualised intraoperative open-lung approach.

Despite the maturity and sophistication of anaesthesia workstations, improvements in our understanding of intraoperative mechanical ventilation, and use of less invasive surgical techniques, postoperative pulmonary complications (PPCs) are still a common problem in surgical patients of all ages. PPCs are associated with a higher incidence of perioperative morbidity and mortality, longer hospital stays, and higher healthcare costs. PPCs are strongly associated with anaesthesia-induced atelectasis, which predisposes to lung damage when partially collapsed lungs are subjected to mechanical ventilation. Lung protective ventilation is thus a modifiable factor that can positively impact the incidence of PPCs after surgery. Intraoperative protective ventilation strategies have been based on two main but intrinsically different hypotheses: one based on sole reduction of tidal volume and pressures, using minimal positive end-expiratory pressure (PEEP), tolerating the presence of lung collapse, and the other also limiting tidal volume and pressures after actively resolving atelectasis by lung recruitment and PEEP individualisation, the individualised open-lung approach. We review the concepts of the individualised open-lung approach, its potential benefits, and outstanding questions. We conclude with a proposal for personalised lung protective ventilation.

Referral to a Functional Seizures Clinic Reduces Inpatient and Emergency Department Health Care Utilization and Costs.

People with functional seizures (FSs) experience high health care utilization and costs revolving around the emergency department (ED). Overall, appropriate treatment of FS is underused, and better care pathways are associated with lower ED reattendance. Our objective was to assess changes in total ED and inpatient visits and costs before and after referral to a specialized, comprehensive FS treatment clinic. We collected data from 100 consecutive patients referred to the University of Colorado (CU) FS Clinic between July 2019 and December 2021. Hospital account data were obtained directly from the electronic health record. Total ED and inpatient visits, charges, and payments 1 year before and 1 year after referral were collected and analyzed using the Wilcoxon signed-rank test. Ninety-four patients were included for analysis. 79% were female, 52% were on Medicaid, and the mean age was 41 (SD 13) years. Total visits after referral (ED and inpatient) were significantly reduced compared with total visits before referral (mean = 1.44 (SD 3.52) vs 1.83 (SD 3.52), p = 0.045). The same test was performed for total charges after and before referral ($15,551 (SD $38,712) vs $30,257 (SD $81,589), p = 0.03) and for total payments after and before referral ($2,469 (SD $6,682) vs $5,199 (SD $15,084), p = 0.02). Referral to a specialized FS clinic is associated with reduced health care utilization and costs. This proof-of-concept study reveals that hospitals should implement policies to support efficient care pathways to comprehensive FS treatment programs with potential for cost savings.

Risk Factors for Failed Below Knee Amputation in Patients with Diabetes.

Complications from below knee amputations (BKA), such as wound dehiscence and infections, incur high healthcare costs due to multiple and extended hospitalizations. Due to the significant morbidity still associated with proximal amputations, a careful patient selection process should be considered. This retrospective cohort study aimed to identify risk factors associated with failure of below-knee amputation (BKA), defined as progression to above-knee amputation (AKA), in patients with diabetes. Eligible patients were those who underwent primary BKA due to diabetic complications. Patients were divided into two groups: BKA and failed BKA group. Demographic variables were age, gender, BMI, smoking status, presence of vascular disease, dialysis status, nutritional status, pre-surgery hemoglobin, hemoglobin A1c, culture biopsies and use of antibiotics. Outcome variables included failure (i.e., above-knee amputation) and time to failure. Variables associated with failure of BKA included higher hemoglobin levels, prior vascular procedures, smoking, and perioperative use of oral antibiotics. Notably, oral antibiotics were linked to a higher risk of BKA failure, with patients on oral antibiotics experiencing failure more quickly than those treated with intravenous antibiotics. In addition, in the BKA group, there was a lower percentage of patients treated with PO antibiotics compared to the failed BKA group, 12% and 19%, respectively (P=0.0037). This study highlights that prior vascular procedures and smoking also elevate the risk of BKA failure.

Investigation of neurogenic dysphagia in commonly seen neurological diseases

Neurological disorders lead to varying degrees of impairment in the functions of vital swallowing structures, such as the cortex, cerebellum, brainstem, cranial nerves, and muscles. Neurogenic dysphagia is observed in approximately 50% of common neurological disorders such as stroke, multiple sclerosis, and Parkinson’s disease. Although the pathophysiology and course of the disease vary, dysphagia may occur at any stage of swallowing, including oral preparation, oral, pharyngeal, and esophageal phases. Neurogenic dysphagia ranks among the top symptoms that restrict patients’ independence in daily life activities, reduce their quality of life and increase morbidity and mortality rates. Despite being a prevalent and highly impactful symptom among patients, neurogenic dysphagia can go unnoticed among the multiple symptoms experienced by neurological disorders due to their nature. It is important to be aware of disease-specific risk factors for the early detection of neurogenic dysphagia. Overlooked dysphagia can lead to complications such as aspiration pneumonia, dehydration, malnutrition, and weight loss. Among these complications, aspiration pneumonia is the most common, requiring attention due to its recurrent hospitalizations, inpatient treatment, and high healthcare costs. Many patients exhibit common neurogenic dysphagia symptoms such as drinking liquids in small sips, cutting solid foods into small pieces, decreased appetite, and prolonged meal times. The aim of this study is to examine various aspects of neurogenic dysphagia in different neurological disorders, including its etiology, risk factors, symptoms, and prevalence.

P-1784. Reduction of bacterial resistance in isolates from nosocomial infections through a program of antibiotic stewardship based on a local mobile application in a hospital in Mexico City; 10 years of success

Abstract Background Hospital-acquired infections caused by multidrug-resistant microorganisms (MDR-HAI) are associated with high healthcare costs, prolonged hospital stays, and concerning morbidity and mortality. The prevalence of MDR-HAI has increased worldwide as a result of the COVID-19 pandemic. In this context, antimicrobial stewardship programs (ASP) have become more relevant. Methods A mobile application was implemented for hospital staff to guide optimal antibiotic use. This application is based on local resistance patterns for major nosocomial microorganisms, to provide treatment recommendations (initial regimen based on suspicion, adjustment according to microbiological results, antibiotic discontinuation, etc.). Descriptive statistics were performed. Results In 2013, before the implementation of the application, the compliance rate was 25% for hospital-acquired infections and 42.2% adherence to guidelines. After the introduction of the application, compliance in 2014 was 56.7%, with a reported 20% MDR-HAI rate. In 2015, the usage was 60.7% and MDR-HAI rate was 18%. In 2016, compliance was 68.7% and MDR-HAI rate was 16%. In 2017, compliance was 73.7% and MDR-HAI rate was 14%. In 2018, the prevalence of MDR-HAI was 15%, while the usage of local guidelines was 78.7%. In 2019, compliance was 81.1% and MDR-HAI rate was 16.9%. Considering the COVID-19 pandemic (starting in 2020) as a period in which there was a significant increase in the presence of MDR-HAI worldwide, thanks to the implementation of the application, the percentage of MDR-HAI decreased from 27.8% to 11.1% in 2023 (Image 1). The number of different types of infections (VAP, HAP, UTI, ICS, BSI) also decreased by following the guidelines recommendations. Conclusion These programs are necessary as part of the healthcare program to control the morbidity and complications of MDR-HAI. Simple and user-friendly electronic applications, such as the one implemented in our hospital, have led to increased compliance and a decrease in bacterial resistance of infections acquired in our institution. Disclosures All Authors: No reported disclosures

P-1609. Provider and Nursing Perspectives on "Panculture": Opportunities for Innovative Diagnostic Stewardship Interventions

Abstract Background Overutilization of diagnostic tests results in inappropriate antibiotic use, increased hospital length of stay, higher healthcare costs, overdiagnosis of healthcare-associated infections, and antimicrobial resistance. Table 1 Participant Characteristics Methods From January 3 – February 26, 2024, we conducted two prospective surveys focused on the evaluation of febrile inpatients at Rhode Island Hospital. One survey was of medical providers trained in internal medicine, surgery, pediatrics, emergency medicine, and neurology and the other was of nursing staff in inpatient areas and the emergency department (ED). Results 70 providers (9%) and 178 nursing staff (12%) completed their respective surveys. When asked about evaluating febrile inpatients, 64% of providers (n=43) reported “always” or “often” ordering full fever workups or ‘panculturing’ and 67% of providers (n=47) reported “always” or “often” physically evaluating febrile patients at the bedside (Table 2). In contrast, only 45% of nursing staff (n=80) reported that providers “always” or “often” evaluate febrile patients in person. 76% of nursing staff (n=135) responded providers “always” or “often” order full fever workups. When asked about hand-off practices for febrile patients, 71% of providers (n=50) reported “always” or “often” receiving written hand-offs. 86% of providers (n=60) reported the hand-offs are “always” or “often” accurate; however, only 17% of providers responded these were “always” accurate. 77% of providers (n=54) reported “always” or “often” following hand-off instructions to obtain a full fever workup if a patient becomes febrile, regardless of a patient’s clinical status. Responses differed significantly by nursing unit type (Table 3) and by provider specialty and position (Tables 3 & 4). Table 3 Nursing Staff Responses by Unit Type Conclusion This study elucidates drivers of inefficient and excessive utilization of diagnostic studies at RIH and identifies potential targets for diagnostic stewardship interventions. Table 4 Provider Responses by Specialty and Position Disclosures Leonard Mermel, DO, ScM, Citius Pharmaceuticals: Advisor/Consultant|CorMedix Pharma: Advisor/Consultant|Destiny Pharma: Advisor/Consultant|Lightline Medical: Advisor/Consultant|Lightline Medical: Stocks/Bonds (Private Company)|Pristine Access Technologies: Advisor/Consultant|Pristine Access Technologies: Stocks/Bonds (Private Company)

P-136. Epidemiological Shifts in Histoplasmosis Hospitalizations Across the United States, 2012-2021: A Retrospective Analysis

Abstract Background Histoplasmosis represents a substantial public health concern in the United States, especially prevalent in the Ohio and Mississippi River Valleys where seroprevalence rates range from 60% to 90%. Building on data indicating rising hospitalization rates from earlier studies covering 2001 to 2012, this research aims to further investigate the trends in histoplasmosis-associated hospitalizations post-2012, focusing particularly on mortality outcomes.Table 1:Demographic and Clinical Characteristics of Patients with Histoplasmosis (Unweighted) Categorized by Mortality Methods We conducted a retrospective cohort study using the National Inpatient Sample (NIS) to assess trends in histoplasmosis-associated hospitalizations from 2012 to 2021. We analyzed a total of 351,321,656 hospitalizations, identifying cases of histoplasmosis either as a primary or any diagnosis. Histoplasmosis diagnoses were identified using ICD codes, and trends were analyzed using simple linear regression to calculate annual rates per 100,000 hospitalizations, with significance tested at a p-value ≤ 0.05.Figure 1:Trend of Histoplasmosis as Primary Diagnosis per 100,000 Hospitalizations (2012 - 2021) Results There were 50,860 weighted hospitalizations with histoplasmosis listed as any diagnosis and 7,616 as the primary diagnosis over the study period. Analysis revealed a significant decline in hospitalizations, from an annual rate of 2.9 per 100,000 in 2012 to 1.9 in 2021 (p=0.0118). Patients who died were older on average compared to those who survived (59.86 years vs. 54.45 years, p< 0.001) and had significantly longer hospital stays and higher healthcare costs. The overall mortality rate was 4.7%. The most common presentations were pulmonary (5.8% died, p=0.0054) and disseminated forms (6.0% died, p=0.0436). Comorbid conditions had varied impacts on patient outcomes; particularly, patients with HIV had a higher mortality rate (6.67%, p=0.0031). Notably, an upward trend was observed in the incidence of histoplasmosis among diabetic patients (p=0.0113), while other comorbidities did not show significant trends.Figure 2:Trend of Histoplasmosis in Diabetic Patients per 100,000 Hospitalizations (2012 - 2021) Conclusion The significant reduction in histoplasmosis-associated hospitalizations between 2012 and 2021 reflects advancements in public health initiatives and enhancements in clinical management. Nonetheless, our study highlights an increased mortality rate linked to older age, the presence of comorbidities such as HIV, prolonged hospital stays, and elevated healthcare cost. Disclosures All Authors: No reported disclosures

Digital Home-Based Self-Monitoring System for People with Heart Failure: Protocol for Development of SmartHeart and Evaluation of Feasibility and Acceptability.

Heart failure (HF) is a chronic, progressive condition where the heart cannot pump enough blood to meet the body's needs. In addition to the daily challenges that HF poses, acute exacerbations can lead to costly hospitalizations and increased mortality. High health care costs and the burden of HF have led to the emerging application of new technologies to support people living with HF to stay well while living in the community. However, many digital solutions have not involved consumers and health care professionals in their design, leading to poor adoption. The SmartHeart project aimed to codevelop a smart health ecosystem to support the early detection of HF deterioration and encourage self-care, potentially preventing hospitalizations. This study aims to provide an overview of the SmartHeart project by describing our approach to designing the SmartHeart system, outlining its features, and describing the planned pilot study to determine the feasibility of the system. We used the Integrate, Design, Assess, and Share (IDEAS) framework to guide the development of the SmartHeart system, involving users (people with HF and their caregivers) and stakeholders (health care providers involved in the management of HF) in its design. SmartHeart is a complete remote heart health monitoring and automated feedback delivery system. It includes 2 user interfaces for patients: an Amazon Alexa conversational agent and a smartphone app. The system collects physiological, symptom, and behavioral data through wireless sensors and self-reports from users. These data are processed and analyzed to provide personalized health insights, self-care support, and alerts in case of health deterioration. The system also includes a web-based user interface for health care professionals, allowing them to access data, send messages to users, and receive notifications about potential health deterioration. A single-arm, multicenter pilot trial (N=20) is planned to determine the feasibility and acceptability of SmartHeart before evaluation through a randomized controlled trial. The primary outcome will be a description of the study's feasibility (recruitment, attrition, engagement, and changes in self-care). The SmartHeart study started in January 2021 on procurement of funding. Recruitment for the pilot trial started in August 2024 and will be completed by March 2025. We have currently enrolled 12 participants. Follow-up of all participants will be completed by the end of May 2025. We have co-designed and developed a complete remote heart health monitoring and automated feedback delivery system for the early detection of HF deterioration and prevention of HF-related hospitalizations. The next step is a pilot study, which will provide valuable information on feasibility and preliminary effects to inform a larger evaluation trial. SmartHeart has the potential to augment existing health services and help people with HF stay well while living in the community. DERR1-10.2196/62964.

Burden and Economic Impact of Respiratory Viral Infections in Adults Aged 60 and Older: A Focus on RSV

Background/Objectives: Respiratory syncytial virus (RSV) represents a significant cause of acute respiratory infections (ARIs) in adults aged 60 years and older, often leading to severe clinical outcomes and high healthcare costs. This study aimed to evaluate the clinical and economic burden of RSV compared to other ARIs, focusing on specific age groups, comorbidities, and demographic factors. Methods: A retrospective observational study was conducted using the electronic medical records of adults aged ≥60 years hospitalized for ARIs, including RSV, in Spain. Direct costs related to hospitalizations, intensive care unit (ICU) admissions, and treatments were analyzed. The study also assessed demographic, clinical, and comorbidity-related factors influencing the economic burden. Results: RSV infections resulted in significantly higher direct costs compared to other ARIs, particularly in patients aged 70–80 years. Comorbidities such as asthma and smoking history were associated with increased costs in RSV cases. Although ICU costs were comparable between groups, hospitalizations for RSV required longer stays and more intensive treatments, amplifying the overall economic burden. Differences in costs by age and sex highlighted the need for tailored clinical management strategies. Conclusions: RSV poses a substantial economic and clinical burden on adults aged 60 years and older, particularly in those with comorbidities. Preventive measures, such as vaccination, could reduce healthcare costs and improve outcomes in this vulnerable population. These findings support the inclusion of RSV vaccines in immunization programs, especially in aging populations like Spain, to alleviate healthcare pressures during peak respiratory disease seasons.

Identifikasi Methicillin-Resistant Staphylococcus Aureus pada Tenaga Kesehatan di Instalasi Gawat Darurat dan Rawat Inap Rumah Sakit Islam Sitti Maryam Manado

Improper use of antibiotics can lead to antibiotic resistance. According to the World Health Organization (WHO), antibiotic resistance is currently one of the greatest global health threats. The 2022 WHO Global Antimicrobial Resistance and Use and Surveillance System (GLASS) report indicates that One of the common bacteria that is found to be resistant to antibiotics is Staphylococcus aureus which is resistant to methicillin or Methicillin-Resistant Staphylococcus aureus (MRSA). MRSA is recognized as a leading cause of Healthcare-Associated Infections (HAIs) and is associated with high morbidity, mortality, and healthcare costs. Research on MRSA among healthcare workers in Indonesia, especially in Manado, is still very limited, which prompted this study. Purpose: To identify the presence of MRSA among healthcare workers in the Emergency Department (ED) and inpatient wards at Sitti Maryam Islamic Hospital, Manado. Methods: A cross-sectional study involving all nurses working in the ED and inpatient wards. Nasal swab samples were cultured on MSA media and further bacterial identification was conducted. Antibiotic sensitivity testing was performed using MHA media and cefoxitin disks 30 μg. Results: Out of the 23 anterior nasal swab samples taken from healthcare workers, it was found that 13 samples (57%) of healthcare workers had Staphylococcus aureus colonization and 5 samples (38%) of them had resistance to the antibiotic cefoxitin. The overall MRSA colonization in the nasal cavities of healthcare workers was 5/23 (22%). Conclusion: MRSA was identified among healthcare workers at Sitti Maryam Islamic Hospital, Manado.

Association of Frailty Index at 66 Years of Age with Health Care Costs and Utilization Over 10 Years in Korea: Retrospective Cohort Study.

The long-term economic impact of frailty measured at the beginning of elderhood is unknown. The objective of our study was to examine the association between an individual's frailty index at 66 years of age and their health care costs and utilization over 10 years. This retrospective cohort study included 215,887 Koreans who participated in the National Screening Program for Transitional Ages at 66 years of age between 2007-2009. Frailty was categorized using a 39-item deficit accumulation frailty index: robust (<0.15), prefrail (0.15-0.24), and frail (≥0.25). The primary outcome was total health care cost, while the secondary outcomes were inpatient and outpatient health care costs, inpatient days, and number of outpatient visits. Generalized estimating equations with a gamma distribution and identity link function were used to investigate the association between the frailty index and health care costs and utilization until December 31, 2019. The study population included 53.3% (n=115,113) women, 32.9% (n=71,082) with prefrailty, and 9.7% (n=21,010) with frailty. The frailty level at 66 years of age was associated with higher cumulative total costs (robust to frail: $19,815 to $28.281; P<.001), inpatient costs (US $11,189 to US $16,627; P<.001), and outpatient costs (US $8,625 to US $11,654; P<.001) over the next 10 years. In the robust group, a one-year increase in age was associated with increased total health care costs (mean change per beneficiary per year: US $206.2; SE: $1.2; P<.001), inpatient costs (US $126.8; SE: $1.0; P<.001), and outpatient costs (US $74.4; SE: $0.4; P<.001). In the frail group, the increase in total health care costs was greater compared to the robust group (difference in mean cost per beneficiary per year: US $120.9; SE: $5.3; P<.001), inpatient costs (US $102.8; SE: $5.22; P<.001), and outpatient costs (US $15.6; SE: $1.5; P<.001). Similar results were observed for health care utilization (P<.001). Among the robust group, a one-year increase in age was associated with increased inpatient days (mean change per beneficiary per year: 0.9 d; P<.001) and outpatient visits (2.1 visits; P<.001). In the frail group, inpatient days increased annually compared to the robust group (difference in the mean inpatient days per beneficiary per year: 1.5 d; P<.001), while outpatient visits increased to a lesser extent (difference in the mean outpatient visits per beneficiary per year: -0.2 visits; P<.001). Our study demonstrates the potential utility of assessing frailty at 66 years of age in identifying older adults who are more likely to incur high health care costs and utilize health care services over the subsequent 10 years. The long-term high health care costs and utilization associated with frailty and prefrailty warrants public health strategies to prevent and manage frailty in aging populations.

Combating antibiotic resistance: mechanisms, challenges, and innovative approaches in antibacterial drug development

Antibiotic resistance is a significant threat to public health and drug development, driven largely by the overuse and misuse of antibiotics in medical and agricultural settings. As bacteria adapt to evade current drugs, managing bacterial infections has become increasingly challenging, leading to prolonged illnesses, higher healthcare costs, and increased mortality. This review explores the critical role of antibiotics in fighting infections and the mechanisms that enable bacteria to resist them. Key antibiotics discussed include carvacrol, dalbavancin, quinolones, fluoroquinolones, and zoliflodacin, each with unique actions against bacterial pathogens. Bacteria have evolved complex resistance strategies, such as enzyme production to neutralize drugs, modifying drug targets, and using efflux pumps to remove antibiotics, significantly reducing drug efficacy. Additionally, the review examines the challenges in antibiotic development, including a declining discovery rate of novel drugs due to high costs and regulatory complexities. Innovative approaches, such as structure-based drug design, combination therapies, and new delivery systems, are highlighted for their potential to create compounds with enhanced action against resistant strains. This review provides valuable insights for researchers and developers aiming to combat antibiotic resistance and advance the development of robust antibacterial therapies for future health security.

P0785 Protocol for a Priority Setting Partnership to identify the top 10 global research priorities for perianal Crohn’s disease

Abstract Background Perianal Crohn’s disease (pCD) occurs in around 18.7% of patients with Crohn’s disease (1). This manifestation is associated with significant morbidity and impact on the quality of life of affected patients, as well as high healthcare resource utilisation and costs (2). Perianal Crohn’s disease often requires prolonged treatment and multiple interventions. Options for treatments and their efficacy, impact on QoL, use of setons, stomas and proctectomy need further investigation to establish optimal methods (3). A collaborative and patient-centred process is required to prioritise research questions so that limited funding resources can be more efficiently directed to the areas where it is needed most. Methods A priority setting partnership (PSP) with the James Lind Alliance (JLA) has been established in order to identify the “Top 10” most important global research priorities in pCD. The project will follow standard JLA methodology and collaborative principles. An international steering group has been formed, with representation from colorectal surgeons, gastroenterologists, radiologists, researchers, nurses, and patient experts. An initial survey will be distributed over several months to key stakeholders globally, in order to gather “unanswered research questions” relating to pCD, which will then be checked against the evidence base. A prioritisation exercise will be carried out to create a shortlist of research questions, which will be taken to a final consensus workshop involving patients, carers and healthcare professionals to identify the top 10 research priorities. Results There have been 200 responses to the initial survey in the first 4 weeks. 66% of responses were from healthcare professionals, 31% responses from patients, parents or carers, and 3% from other sources. Responses have been received from 27 countries globally, with 27% of responses from the UK, 21% from Brazil, 10% from Iran, 7% from Belgium, 5% from the Netherlands, 5% from the USA, 4% from Colombia, and 21% from a range of other countries. Responses thus far include a diverse range of questions relating to the causes, assessment, treatment and prognosis of pCD, as well as its impact on quality of life. The final top 10 research priorities will be established in the final workshop, and disseminated globally to better inform the development of research questions for basic science and clinical research. Conclusion This project will provide an opportunity for all key global stakeholders, including underrepresented end-users to collaborate and contribute to research prioritisation in pCD. Engagement in the initial survey and this process will aim to shape the future research agenda in perianal Crohn’s disease.

Acute kidney injury.

Acute kidney injury (AKI) is a common, heterogeneous, multifactorial condition, which is part of the overarching syndrome of acute kidney diseases and disorders. This condition's incidence highest in low-income and middle-income countries. In the short term, AKI is associated with increased mortality, an increased risk of complications, extended stays in hospital, and high health-care costs. Long-term complications include chronic kidney disease, kidney failure, cardiovascular morbidity, and an increased risk of death. Several strategies are available to prevent and treat AKI in specific clinical contexts. Otherwise, AKI care is primarily supportive, focused on treatment of the underlying cause, prevention of further injury, management of complications, and short-term renal replacement therapy in case of refractory complications. Evidence confirming that AKI subphenotyping is necessary to identify precision-oriented interventions is growing. Long-term follow-up of individuals recovered from AKI is recommended but the most effective models of care remain unclear.

Enhancing Therapy Adherence: Impact on Clinical Outcomes, Healthcare Costs, and Patient Quality of Life.

Adherence to therapy, defined as the extent to which a patient follows prescribed therapeutic recommendations, is a pivotal factor in the effective management of chronic diseases such as diabetes, hypertension, and cardiovascular conditions. This review highlights the profound influence of adherence on clinical outcomes, healthcare costs, and patient quality of life. Despite its critical importance, non-adherence remains a pervasive challenge globally, contributing to suboptimal treatment results, higher rates of complications, increased hospitalizations, and substantial healthcare expenditures. This narrative review examines the multifaceted impact of adherence, focusing on its role in achieving clinical efficacy, mitigating economic burdens, and enhancing patient well-being. The findings reveal that poor adherence exacerbates the risk of disease progression, complications, and higher healthcare costs. Conversely, improved adherence promotes better disease control, fewer complications, and enhanced patient quality of life. Interventions such as patient education, streamlined treatment regimens, and the integration of digital health tools have shown promise in addressing adherence barriers. Furthermore, the role of healthcare professionals is underscored as fundamental, with their continuous support, effective communication, and efforts to build patient trust being essential to fostering better adherence. In conclusion, adherence significantly affects clinical outcomes, healthcare costs, and patient quality of life. Addressing barriers to adherence requires a comprehensive and personalized approach, considering individual patient needs and circumstances. Future research should prioritize the long-term evaluation of emerging technologies and the development of tailored strategies to improve adherence across diverse patient populations. Strengthening adherence is not only crucial for individual patient outcomes, but also for enhancing the sustainability and efficiency of healthcare systems.

Exploring Antibacterial Properties of Marine Sponge-Derived Natural Compounds: A Systematic Review.

The rise in multidrug-resistant (MDR) bacteria has prompted extensive research into antibacterial compounds, as these resistant strains compromise current treatments. This resistance leads to prolonged hospitalization, increased mortality rates, and higher healthcare costs. To address this challenge, the pharmaceutical industry is increasingly exploring natural products, particularly those of marine origin, as promising candidates for antimicrobial drugs. Marine sponges, in particular, are of interest because of their production of secondary metabolites (SM), which serve as chemical defenses against predators and pathogens. These metabolites exhibit a wide range of therapeutic properties, including antibacterial activity. This systematic review examines recent advancements in identifying new sponge-derived compounds with antimicrobial activity, specifically targeting Pseudomonas aeruginosa, a prevalent Gram-negative pathogen with the highest incidence rates in clinical settings. The selection criteria focused on antimicrobial compounds with reported Minimum Inhibitory Concentration (MIC) values. The identified SM include alkaloids, sesterterpenoids, nitrogenous diterpene, and bromotyrosine-derived derivatives. The structural features of the active compounds selected in this review may provide a foundational framework for developing new, highly bioactive antimicrobial agents.

Accuracy of pulse wave velocity for screening coronary artery disease: a systematic review and meta-analysis.

Coronary artery disease (CAD) is the leading cause of cardiovascular events and showed high prevalence and healthcare costs in 2019. However, CAD screening for cardiovascular event prevention is invasive and expensive. This study aims to estimate the ability of a noninvasive method, pulse wave velocity (PWV), to detect the presence or absence of coronary artery disease in patients with suspected CAD. A systematic review and meta-analysis of the available evidence was conducted, comparing PWV with the gold standard diagnostic method, angiography. The literature search was systematically performed in the PubMed, Scopus and Web of Science databases from inception to August 2024. Study quality assessment was performed using the Diagnostic Accuracy Study Quality Assessment Tool (QUADAS-2). Publication bias was assessed using the method proposed by Deeks. Statistical analyses were performed with the STATA SE software, version 15. The eight included studies had a cross-sectional design, in which the presence of CAD was measured simultaneously by PWV and angiography. To assess the accuracy of the tests, the overall sensitivity and specificity were combined into a single value, the diagnostic odds ratio (dOR), which provided a value of 3.61, indicating a high probability of detecting CAD by PWV. The implementation of PWV as a screening technique in healthcare centers could bring great benefits to patients with suspected CAD and increase efficiency in the use of healthcare resources.

Prevalence and Economic Impact of Acute Respiratory Failure in the Prehospital Emergency Medical Service of the Madrid Community: Retrospective Cohort Study.

Chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and acute pulmonary edema (APE) are serious illnesses that often require acute care from prehospital emergency medical services (EMSs). These respiratory diseases that cause acute respiratory failure (ARF) are one of the main reasons for hospitalization and death, generating high health care costs. The prevalence of the main respiratory diseases treated in a prehospital environment in the prepandemic period and during the COVID-19 pandemic in Spain is unknown. The Madrid Community EMS is a public service that serves all types of populations and represents an epidemiological reference for supporting a population of 6.4 million inhabitants. The high volume of patients treated by Madrid's medical advanced life supports (ALSs) allows us to analyze this little-studied problem. Our goal was to lay the groundwork for comprehensive data collection and surveillance of respiratory failure, with an emphasis on the most prevalent diseases that cause it, an aspect that has been largely overlooked in previous initiatives. By achieving these objectives, we hope to inform efforts to address respiratory failure and establish a standardized methodology and framework that can facilitate expansion to a continuous community-wide registry in Madrid, driving advances in emergency care and care practices in these pathologies. The aim of this retrospective observational study was to determine the pathologies that have mainly caused respiratory failure in patients and required medicalized ALS and to evaluate the cost of care for these pathologies collected through this pilot registry. A multicenter descriptive study was carried out in the Madrid Community EMS. The anonymized medical records of patients treated with medical ALS, who received any of the following medical diagnoses, were extracted: ARF not related to chronic respiratory disease, ARF in chronic respiratory failure, exacerbations of COPD, APE, CHF, and bronchospasm (not from asthma or COPD). The prevalence of each pathology, its evolution from 2014 to 2020, and the economic impact of the Medical ALSs were calculated. The study included 96,221 patients. The most common pathology was exacerbation of COPD, with a prevalence of 0.07% in 2014; it decreased to 0.03% in 2020. CHF followed at 0.06% in 2014 and 0.03% in 2020. APE had a prevalence of 0.01% in 2014, decreasing to 0.005% in 2020 with the pandemic. The greatest economic impact was on exacerbation of COPD in 2015, with an annual cost of €2,726,893 (which equals to US $2,864,628). COPD exacerbations had the higher prevalence in the Madrid region among the respiratory diseases studied. With the COVID-19 pandemic, the prevalence and costs of almost all these diseases decreased, except for ARF not related to chronic disease. The cost of these pathologies over 5 years was €58,791,031 (US $61,832,879).