Higher Healthcare Costs Research Articles

National survey of financial burden and experience among patients with cancer and autoimmune disease receiving charitable copay assistance.

Little is known about the role that charitable copay assistance (CPA) plays in addressing access to care and financial distress. The study sought to evaluate financial distress and experience with CPA among patients with cancer and autoimmune disease. This is a national cross-sectional self-administered anonymous electronic survey conducted among recipients of CPA to cover the costs of a drug for cancer or autoimmune disease. Self-reported financial distress as measured by Comprehensive Score for Financial Toxicity as well as health care spending and experience with financial barriers to care were evaluated, as were perspectives on policy questions related to CPA and costs of care. Among 1566 respondents (1108 with cancer and 458 with autoimmune disease, median age 71, 51% female, 89% White, 69% household income <$60,000), 53% reported mild and 31% moderate/severe financial distress, despite CPA. Eighteen percent reported missing recommended care because of costs. Most respondents (96%) had Medicare, 55% reported supplemental insurance, and 66% believed that insurance would prevent them from facing high costs of health care. A total of 52% reported paying more than $100 monthly in drug costs and 41% spending more than 10% of monthly income on health care. Financial distress was similar among patients with cancer and autoimmune diseases. In multivariable regression analysis, younger age, less education, unemployment, higher comorbidity, and lower income were independently associated with higher financial distress. This study informs policy debate over the role of CPA foundations in the U.S. health insurance safety net and highlights the inadequacy of Medicare to guarantee access to care for older patients with chronic illness.

Genetic Variants Related to Increased CKD Progression-A Systematic Review.

The incidence and prevalence of chronic kidney disease (CKD) are increasing worldwide. CKD is associated with high morbidity, premature mortality, and high healthcare costs. Genetic variants may influence CKD development and progression. This study aimed to identify the associations between allelic variants and CKD progression. We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed, Embase, and Cochrane Central databases were used for data collection. Hereditary causes of CKD were excluded from the analysis. A total of 38 reports were included. The selected studies included cohort studies, case-control studies, and genome-wide association studies (GWASs). The studies involved patients of different ethnicities and with comorbid diseases. Several genetic variants were identified in genes that encode proteins related to metabolic processes, oxidative stress, immune regulation, the renin-angiotensin-aldosterone pathway, and epigenetics, among others. These genetic alterations can affect protein function and lead to renal damage, impacting CKD development and progression. Gene polymorphisms can influence CKD progression. Many of these are population-specific, and their relevance may be influenced by the presence of other diseases and environmental factors. Larger studies are needed to confirm the associations described here.

The impact of preoperative venous thromboembolism on patients undergoing TURBT: Perioperative outcomes and healthcare costs from US insurance claims data.

To assess the impact of a positive history of venous thromboembolism (VTE) on perioperative outcomes, including length of in-hospital stay, readmission rates, 90-day postoperative complications, and healthcare costs in bladder cancer (BCa) patients undergoing transurethral resection of bladder tumour (TURBT) in the United States. Patients aged ≥18 years with a BCa diagnosis undergoing TURBT were identified in the Merative® Marketscan® Research de-identified databases between 2007 and 2021. Multivariable logistic regression adjusted by relevant perioperative confounders was used to investigate the association between diagnosis of VTE before TURBT and 90-day complication rates, new postoperative VTE events, re-hospitalization, and total hospital expenditures (2021 US dollars). Sensitivity analyses on VTE severity (pulmonary embolism [PE], deep venous thrombosis [DVT] or superficial thrombophlebitis/phlebitis [SVT]), as well as TURBT extent (minor vs. major) were additionally examined. In total, 139 800 patients were identified, with 5.3% having preoperative VTE, including DVT (n = 3112, 42.20%), PE (n = 2046, 27.74%) and SVT (n = 2217, 30.06%). A history of preoperative VTE predicted higher rates of any complication (adjusted odds ratio [aOR] 1.28, 95% CI 1.14-1.43) and also higher rates of infectious and haemorrhagic complications. Additionally, preoperative VTE increased the risk of novel VTE events following TURBT (aOR 17.30, 95% CI 16.05-18.65), hospital length of stay (aOR 2.23, 95% CI 1.90-2.62), readmissions (aOR 1.47, 95% CI 1.39-1.56), and hospital associated costs (aOR 1.17, 95% CI 1.12-1.23). DVT and non-minor TURBT procedures did not increase the risk of any, infectious, or haemorrhagic complications, but other associations were maintained regardless of the severity of VTE (PE, DVT, SVT) or TURBT extent (minor/major). A history of VTE before undergoing transurethral procedures for BCa is associated with significantly worse perioperative outcomes and higher healthcare costs. These findings may help us to counsel on the risks of the intervention and hopefully improve our ability to mitigate such risks.

Clinical Competency in Managing Malnutrition-Sarcopenia Syndrome Among Physical Therapists: A Cross-Sectional Survey.

Malnutrition and sarcopenia are interrelated health concerns among the elderly. Each condition is associated with increased mortality, morbidity, rehospitalization rates, longer hospital stays, higher healthcare costs, and reduced quality of life. Their combination leads to the development of "Malnutrition-Sarcopenia Syndrome" (MSS), characterized by reductions in body weight, muscle mass, strength, and physical function. Despite being preventable and reversible through nutritional and physical interventions, the clinical competence of physical therapists (PTs) in managing MSS remains underexplored. This study aims to assess the clinical competency of PTs in MSS management. An anonymous cross-sectional survey was conducted from January to August 2024 among 337 certified PTs in Israel, using the "Qualtrics" platform. The survey assessed prior familiarity with MSS concepts, MSS knowledge levels, screening and treatment skills, attitudes and beliefs toward MSS management, and interprofessional collaboration practices. While 52% of PTs were familiar with MSS, familiarity with diagnostic guidelines was low (EWGSOP2: 3.6%; GLIM: 0.6%). The MSS knowledge score was moderate, but screening and treatment skills were low. Attitudes toward MSS management were moderately positive, but self-belief in diagnosing and treating MSS was low. Interprofessional collaboration was limited, particularly in malnutrition care. PTs familiar with MSS had higher knowledge, better skills, more positive attitudes and beliefs, and greater interprofessional collaboration. Significant gaps exist in the clinical competency of Israeli PTs in MSS management. Integrating MSS content into physical therapy curricula and providing continuing professional development are necessary to enhance competencies. Equipping PTs with essential tools, clarifying roles, and promoting interprofessional collaboration can optimize MSS management and improve patient outcomes.

Reusable Tourniquets as Potential Transmitters of Infection: A Microbiological Analysis.

Healthcare-associated infections (HAIs) pose a significant global challenge, resulting in prolonged hospital stays, higher healthcare costs, and increased morbidity and mortality rates. Reusable medical equipment, such as tourniquets, represents a potential vector for infection transmission. Despite frequent use and close contact with patients' skin, infection control protocols often overlook these devices. This study examines microbial contamination on the surface of reusable tourniquets in both emergency department and operating theatre settings. A cross-sectional study was conducted between March and September 2024 in Gdansk, Poland. Samples from tourniquets used in the emergency department and the operating theatre were collected after an indefinite period, 14 days, and 28 days. Bacterial contamination on the surfaces of the tourniquets was measured using Columbia agar blood medium and expressed as colony-forming units (CFUs) per cm2. Significant bacterial loads were detected on reusable tourniquets, with contamination levels varying by location and duration of use. The average number of CFU/cm2 across all stages of this study was 545 CFU/cm2 for the emergency department and 101 CFU/cm2 for the operating theatre. Tourniquets used in the emergency department exhibited higher bacterial counts compared to those from the operating theatre, which showed a greater diversity of bacterial species. These findings underscore the need to revise infection control protocols for reusable tourniquets. This study provides critical data that may influence future policy changes aimed at reducing the risk of HAIs through the improved management of reusable medical devices.

Trends in cutaneous melanoma mortality and incidence in European Union 15+ countries between 1990 and 2019.

Cutaneous melanoma (CM) is the leading cause of skin cancer mortality with associated high healthcare costs. Up-to-date reporting of epidemiological trends for CM is required to project future trends, assess the burden of disease and aid evaluation of new diagnostic, therapeutic and preventative strategies. To describe the trends in CM mortality, incidence, mortality-to-incidence indices (MIIs) and disability-adjusted life years (DALYs) over the last three decades. A population-based cross-sectional study of the Global Burden of Disease (GBD) database between 1990 and 2019 was performed. Nineteen high-income countries with similar health expenditure and classified as having high-quality mortality data including the United Kingdom, the United States, Australia and selected European Union countries were included. Annual age-standardized incidence rates (ASIRs), age-standardized death rates (ASDRs) and DALYs for each country were extracted. Mortality-to-incidence indexes were calculated by dividing the ASDR by the ASIR. Trends were described using Joinpoint regression analysis. Almost all countries demonstrated increasing ASDR in males over the observation period with greatest percentage increase in Greece (+87%), and there was greater heterogeneity between countries in females. CM mortality was greater for males than females in all countries. Most recent Joinpoint analysis shows significantly decreasing mortality in all countries except the United Kingdom (+0.5% males between 2007 and 2019, +0.1% females between 2002 and 2019). Incidence rates increased in all countries, with evidence of plateau from 2015 onwards. While MIIs cannot be used as a proxy for survival, statistically significant decreases in MII were observed in all countries. Overall, DALYs remained static. Over the past 30 years, CM mortality and incidence has increased in most EU15+ countries. There is evidence that in recent years, CM mortality is decreasing. The burden of disease as assessed using DALYs has remained mostly unchanged. Future work should not solely focus on expensive innovative therapies, but also on optimizing primary prevention.

Demand and Supply Drivers of Medicare and Non-Medicare Health Spending: An Analysis of U.S. States, 1991-2019.

For the last four decades, policymakers have attempted to control the United States's high health care costs by reducing patients' demand for care (e.g., by imposing managed-care restrictions or high costs on patients at the time of use). Yet studies based mostly on data from the public Medicare program, which covers mostly elderly Americans, suggest that supply (e.g., number of physicians or hospital beds) rather than demand drives aggregate service use and, hence, costs. Using variation between U.S. states in per enrollee Medicare spending versus per capita spending of all other (non-Medicare) individuals, we find that greater supply boosts costs for the entire population. Furthermore, we find that factors that suppress demand in the non-Medicare population do reduce non-Medicare health care spending, but simultaneously increase Medicare spending. This suggests that for a given supply of medical resources, suppressing demand for one group of patients may produce a compensatory increase in provision of care to those whose demand has not been suppressed. Health planning to assure adequate medical resources where they are needed while preventing excess supply where it is duplicative and wasteful is likely a more effective cost control strategy than the imposition of managed-care restrictions or imposing higher costs onto patients seeking care.

The Economic Burden of Herpes Zoster in Individuals Aged 50 Years or Older and Those With Underlying Conditions in Italy.

Risk of herpes zoster (HZ) infection increases with age and immunosuppression. We estimated the impact of HZ and post-herpetic neuralgia (PHN) on direct costs and health care resource utilization (HCRU) in patients ≥50 years, including those with comorbidities, as limited information exists in Italy. This retrospective analysis used reimbursement data from local health authorities in Italy (January 2009-June 2022). Cases of HZ and PHN identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes and drug prescriptions were characterized and followed up for 1 year before and after the index date. The direct HCRU costs for patients with HZ/PHN were compared with those for patients without HZ/PHN. Of the total 193 259 patients with HZ/PHN identified (mean age, 61.6 years), 145 923 were ≥50 years old (immunocompromised: 29.9%; ≥1 chronic condition: 76.1%). During follow-up, 18.8% of patients ≥50 years of age with HZ progressed to PHN complications, and 3618 hospital admissions were reported (median length of stay, 9 days). Drug prescriptions and all-cause hospitalizations were the main contributors to total annual direct health care costs, estimated at M€272 for patients with HZ/PHN, whose burden increased with age. Higher health care costs were observed in patients with HZ/PHN vs patients without HZ/PHN. Moreover, average health care costs were up to 4× higher for patients with HZ and PHN compared with those without PHN. HZ causes a significant economic impact on the health care system, driven mainly by high costs of medications and hospitalizations among older adults and those with comorbidities, particularly when complicated by PHN.

A Retrospective review of Leave against Medical Advice (LAMA) cases in the Emergency Department: Factors and Solutions

Abstract Background: Leave against medical advice (LAMA) is a constant source of frustration for all emergency physicians irrespective of the setup. These patients have higher healthcare costs and readmission rates and even carry a higher morbidity and mortality. The literature on the subject from India is limited. We conducted this study to find the proportion of patients LAMA from the emergency medicine department (EMD). Materials and Methods: The study was conducted at an EMD of a tertiary care hospital attached to a medical college in western Maharashtra with an aim to estimate the incidence of LAMA cases and describe various characteristics of these patients. Results: A total of 28,802 patients visited EMD during the study period and 6582 patients (22.8%) left against medical advice. Majority of LAMA patients were male (58.3%) and belonged to the age group of 18–40 (52.9%) years. Maximum patients who left against medical advice belonged to the basic specialties such as internal medicine, general surgery, and orthopedics. Among LAMA patients, majority were discharged between 5 PM and 9 AM (n = 4490; 68.2%). Symptomatic improvement (46.8%) and financial constraints (17.3%) were the reason why majority of patients left against medical advice. Conclusion: LAMA remains a significant problem globally. There are very limited data from India on the demography of LAMA patients and reasons for patients choosing to LAMA. Our study provides a few insights into the issue, but large-scale prospective studies are required to plan policies which can help in reducing the LAMA burden.

Understanding European patterns of deprescribing antithrombotic medication during end-of-life care in patients with cancer

BackgroundEven though antithrombotic therapy (ATT) probably has little or even negative effect on the well-being of patients with cancer near the end of life, it is often continued until death, possibly leading to excess bleeding complications, increased disease burden, reduced quality of life and higher healthcare costs. AimTo explore and describe European practice patterns and perspectives of healthcare professionals from different disciplines and specialties on ATT in the end-of-life care (EOLC) of patients with cancer. MethodsWe performed a two-week international cross-sectional survey study using flash-mob research methodology. Eligible were healthcare professionals from different institutions across Europe, who prescribed ATT and/or dealt with EOLC of patients with cancer. The survey comprised three parts, including a series of choice sets (hypothetical scenarios involving a set of characteristics changing in level [e.g., high vs. low thrombotic risk]) on ATT management in EOLC. The discrete choice experiment analysis was conducted using multinomial logistic regression. ResultsOut of 467 pre-registrants, 208 participated in the survey from 4 to 18 July 2023. The majority (53 %) considered a patient with cancer as in EOLC when life expectancy is below 3 months. Respondents reported seeing or treating 20 patients with cancer on ATT in EOLC per year (IQR 10–50). The median estimated frequency of considering ATT deprescription per healthcare professional was 10 times per year (IQR 4–10), while the frequency of actual deprescription was 5 times per year (IQR 2–10). Twenty percent of respondents had never deprescribed ATT in the context of EOLC. Across the eight choice sets, five respondents (2.7 %) found deprescribing inappropriate in any scenario. Deprescribing was more often considered in patients with poor ECOG-performance status, high bleeding risk and low-molecular-weight heparin use as opposed to oral ATT. Haemato-oncology and cardiovascular medicine specialists were more inclined to deprescribe antiplatelet therapy than other specialties. ConclusionOur study describes medical decision-making regarding ATT in EOLC of patients with cancer. Healthcare professionals' perspectives and practice patterns vary, and some preferences appear associated with the therapists' professional focus and region of practice.

Association between social determinants of health and premature atherosclerotic cardiovascular disease and sex differences in US adults: A cross-sectional study.

Premature atherosclerotic cardiovascular disease (ASCVD) is a major public health issue, leading to productivity losses and higher healthcare costs. This study examines the association between social determinants of health (SDoH) and premature ASCVD, with a focus on sex differences. Data on self-reported SDoH based on Healthy People 2030 criteria were obtained from U.S. National Health and Nutrition Examination Surveys (2003-2018). Weighted logistic regression models were used to examine the relationship between SDoH (including eight sub-items and the cumulative number of unfavorable SDoH) and premature ASCVD. Analyses were further stratified by sex. A total of 40,536 participants aged ≥18years (19,548 men and 20,888 women) were included in the analysis. The overall prevalence of premature ASCVD was 1756 cases, with a weighted estimate of 7,625,240. Although women had a lower prevalence of premature ASCVD (3.2% [n=784] vs. 4.3% [n=972]), they exhibited a higher level of unfavorable SDoH compared to men. Logistic regression indicated a 21% increase in risk for each additional unfavorable SDoH (AOR=1.21; 95% CI, 1.16-1.26), and the cumulative number of unfavorable SDoH were positively associated with the odds of developing premature ASCVD (P for trend <0.01). Notably, the impact of unfavorable SDoH was greater in women, revealing significant sex disparities in susceptibility to premature ASCVD. This study demonstrates that unfavorable SDoH significantly increase the risk of developing premature ASCVD. Furthermore, the cumulative effect of unfavorable SDoH pose a higher risk for women.

Investigating Gram-negative bacilli isolates’ sensitivity to ceftazidime/avibactam

ABSTRACT Background: Multidrug resistant (MDR) Gram negative organisms are becoming increasingly common. Carbapenem resistant Enterobacterales (CRE) pose a major threat and necessitate the development of new antibiotics. MDR and carbapenem resistant infections, which are common in intensive care units and hospitals, lead to increased morbidity, mortality, prolonged hospital stays, and higher healthcare costs. New antimicrobials such as ceftazidime avibactam offer potential alternatives to conventional treatments such as tigecycline and colistin, which have significant side effects and limitations. Aim: This study focuses on the antibiotic susceptibility of ceftazidime/ avibactam to Gram negative bacilli found in a large number of clinical samples collected from a tertiary care facility in Netaji Subhas Medical University and Hospital, Bihta, India. Methodology: The study included 81 Gram negative bacteria isolated from patient samples. Based on the Clinical Laboratory Standards Institute guidelines mentioned in the Kirby Bauer disc diffusion method. Result and Conclusion: the results showed that ceftazidime avibactam inhibited 89.9% of the Enterobacteriaceae isolates, which was higher than the 80.3% of amikacin and the 85.1% of meropenem. Ceftazidime avibactam was effective against CRE isolates in 69.9% of cases and against MDR isolates in urine in 94% of cases, which was higher than the 40% of ceftriaxone and 94% of nitrofurantoin. The results show that ceftazidime avibactam can cure MDR and CRE infections, especially urinary tract infections, better than conventional antibiotics, which is a great help in the fight against increasing antibiotic resistance.

Pooling the complex survey data across the 64 lower and middle-income countries: A study on antibiotic usage in under-five children.

Antibiotic exposure for fever/cough has been rising alarmingly, especially among children under five in low- and middle-income countries (LMICs). This excessive use could result in higher healthcare costs, and antibiotic resistance is an alarming trend in developing countries. As a result, it's crucial to look at the variables that affect antibiotic exposure and highlight the subgroups among whom antibiotic abuse is the most prevalent. We used the most recent standard Demographic and Health Survey (DHS) data for 64 LMICs. Sample weights were employed in studies to ensure exact standard errors and estimate p-values. To analyze antibiotic exposures across countries, continents, economic levels, and the top and bottom ten countries with fever/cough, we conducted descriptive statistics. Additionally, we provided accompanying bar diagrams for each descriptive finding to enhance visual understanding. For geospatial analysis, we utilized ArcGIS, a powerful tool for mapping and spatial analysis. We used data from 141,018 children under five who were reported to have had fever/cough recently in 64 LMICs. Among them, 30.4% were exposed to antibiotics for fever/cough. Congo (68.7%), Egypt (65.5%), and Tajikistan (61.8%) had the highest prevalence of antibiotic consumption across LMICs. On the other hand, Cameroon (0.3%), Armenia (4.0%), and Mauritania (6.1%) had the lowest. In the final binary logistic regression, mothers that had any formal education (Primary: OR=1.28, 95% CI:1.07-1.53, Secondary: OR=1.38, 95% CI:1.14-1.67, Higher Education: OR=1.69, 95% CI:1.23-2.33) were more likely to expose their children to antibiotics for fever/cough than illiterate ones. Additionally, children in richer households (Richer: OR=1.38, 95% CI:1.15-1.66, Richest: OR=1.46, 95% CI:1.19-1.80) were more likely to receive antibiotics than those in poorer households. Antibiotic exposure for fever/cough in children under five was relatively moderate across 64 LMICs. However, the rate was incredibly high in some LMICs and incredibly low in others. The researchers recommend that the countries with high and low percentages of antibiotic exposure investigate either any possibility of antibiotic abuse or proper healthcare service at the national level.

Global trends in proximal femoral trabecular research: A bibliometric and visualized analysis.

Hip disease is a global public health issue, associated with high morbidity, mortality, and healthcare costs. Although research on proximal femoral trabeculae has been conducted for over a century, no bibliometric analysis has been carried out. The purpose of this study is to evaluate the existing research landscape, identify emerging trends, and offer insights for future studies. The scientific output related to the trabeculae within the human proximal femur from 2004 to 2023 was sourced from the Web of Science Core Collection. Moreover, both the annual publications and cumulative totals over this period were summarized in Excel. The VOS viewer was utilized to analyze co-authorship and co-citation relationship between authors, institutions, countries, references and journals. CiteSpace was used to cluster the keywords and research frontiers in this field. A total of 365 publications were extracted, with the USA emerging as the primary contributor to this field, accounting for 133 publications with 5807 total citations, averaging 43.7 citations per publication. The Journal of Bone and Mineral Research has been identified as the most co-cited journal with a total of 1742 citations. The journals can be categorized into 5 distinct clusters, including medical imaging, orthopedic clinical research, research on endocrine and metabolic related diseases, human evolution and anatomy related research, biomechanics and modeling. The keyword with the highest co-occurrence frequency is "bone mineral density". The keywords were stratified into six clusters, including DXA, bone remodeling, diagnosis, titanium alloy bionic cannulated screws, individual trabecula segmentation, and QCT. More recently, the focus has expanded to three-dimensional modeling, falls, microarchitecture, and avascular necrosis. Evaluation of proximal femoral strength can be improved by combining structural parameters with bone mineral density by DXA or QCT. Three-dimensional analysis, microarchitecture, and bionic implants are emerging as significant areas of focus and trends for future research.

Risk Management Considerations and Multiple Responsibilities in Medical Pharmaceutical Practice

In the health field, risk assessment of health damage is a basic component in the control and maintenance of human health. Risk management is defined as the technique of assessing and preventing accidental losses through insurance, and safety measures by making the right decisions and ensuring accountability. The responsibility of those in the medical-pharmaceutical field is permanent and multiple, on several levels, and named as follows: professional responsibility towards the patient, legal responsibility, administrative responsibility, economic responsibility, and social responsibility. Accountability in decisions is ongoing all the time and is a constant, daily, and multi-layered activity. The double responsibility of the doctor and the pharmacist is very important: to the patient and to the community. The society holds physicians accountable for the high cost of health care. Public health programs, warn that the rate of increase in medical costs is growing faster than national income. Still, patients, who are becoming more and more informed about medical issues - are also demanding more diagnostic procedures, more drugs, more medical care, and more hospitalizations.

EFFECT OF POSTERIOR PERICARDIOTOMY IN REDUCING FREQUENCY OF ATRIAL FIBRILLATION IN POST OPERATIVE CORONARY ARTERY BYPASS GRAFTING SURGERY (CABG) PATIENTS IN PUNJAB INSTITUTION OF CARDIOLOGY LAHORE

Postoperative atrial fibrillation (POAF) is a common complication following coronary artery bypass grafting (CABG), associated with increased morbidity, prolonged hospitalization, and higher healthcare costs. Posterior pericardiotomy, a surgical technique that facilitates the drainage of pericardial fluid into the pleural cavity, has been proposed as a preventive measure against POAF. Objective: To evaluate the effectiveness of posterior pericardiotomy in reducing the incidence of POAF in patients undergoing CABG at the Punjab Institute of Cardiology, Lahore, Pakistan. Methods: This randomized controlled trial included 94 patients undergoing CABG, randomized into two groups: Group A (posterior pericardiotomy) and Group B (control). Demographic data, POAF incidence, and postoperative outcomes were collected. Statistical analysis was conducted using SPSS version 20, with a p-value ≤0.05 considered significant. Results: The incidence of POAF was significantly lower in Group A (6.4%) compared to Group B (25.5%) (p=0.014). Group A also exhibited a shorter hospital stay (7.8 ± 1.4 days vs. 8.5 ± 1.6 days; p=0.021) and a lower incidence of pericardial effusion (4.3% vs. 21.3%; p=0.032). Both groups were comparable in baseline demographics and comorbidities. Conclusion: Posterior pericardiotomy significantly reduces the incidence of POAF, pericardial effusion, and hospital stay duration in CABG patients. These findings support its use as a safe and effective intervention to improve postoperative outcomes in resource-limited settings like Pakistan.

Knee-Spine Syndrome, a Common Presentation in Elderly Patients Who Are Candidate for Knee Arthroplasty: Educational Corner

Low back pain (LBP) is a significant issue in both clinical and public health settings, resulting in high healthcare and social costs. While knee joint pain is more prevalent than hip joint pain, standing posture is influenced not only by spinal alignment but also by hip and knee joint alignment. The knee and spine are interconnected anatomically, and degenerative changes in one area could often cause discomfort in the entire axis, leading to what is known as "knee-spine syndrome". LBP is a common condition associated with knee pain and can significantly affect the results of total knee arthroplasty (TKA). Surgeons need to consider knee-spine syndrome before any surgical intervention in patients with knee or back pain and explain it to the patients before the surgery.

Perceptions of Multimorbid Patients When Health Care Staff Accompany Family Physicians In Primary Care Settings

Background: Multimorbidity, the presence of two or more chronic conditions in an individual, presents significant challenges in primary care, including fragmented care, higher healthcare costs, and difficulty in care coordination. Integrating nursing professionals into primary care teams has been proposed as a strategy to enhance access, improve care quality, and address these challenges. However, limited attention has been given to understanding patients’ perspectives, particularly those with multimorbidity, regarding the inclusion of health care staff in primary care practices. Methods: This qualitative descriptive study utilized semi-structured interviews to explore the perceptions of patients with multimorbidity toward the integration of health care staff in primary care settings. Participants were recruited from diverse healthcare environments, ensuring varied experiences with collaborative care models. Patients with five or more chronic illnesses were purposefully sampled, with interviews focusing on their experiences and expectations of health care staff involvement in primary care. Thematic analysis of interview transcripts was conducted using NVivo software, employing both inductive and deductive coding methods. Results: 28 participants with diverse chronic conditions were interviewed, with most expressing openness to health care staff involvement in primary care. Three central themes emerged: Expectations of Enhanced Care: Participants anticipated improved accessibility and continuity of care through health care staff integration but highlighted concerns about reduced access to physicians. Perception of the Health care staff ’s Role: While many viewed health care staff in supportive roles, others recognized their broader responsibilities in patient education, chronic disease management, and medication monitoring. Trust in health care staff ’ competence varied, with participants favoring physician oversight for complex tasks. Conditions for Effective Integration: Patients emphasized the need for clear role definitions, robust communication between health care staff and doctors, adherence to protocols, and continuity of care with the same health care staff to build trust. Conclusion: Patients with multimorbidity generally support the integration of health care staff into primary care teams, recognizing potential benefits in accessibility and care coordination. However, successful implementation requires clear delineation of roles, effective communication, and strategies to build trust. These findings highlight the importance of incorporating patient perspectives into healthcare system reforms to ensure collaborative care models meet their needs effectively.

Preclinical Identification of Poorly Controlled COPD: Patients with a Single Moderate Exacerbation Matter Too.

Background and Objectives: Chronic obstructive pulmonary disease (COPD) remains a critical global health challenge, characterized by high morbidity, mortality, and healthcare costs. Current guidelines may overlook patients who present with only one moderate exacerbation or with frequent short-acting beta-agonist (SABA) use. Building on findings from the Seleida study, this research refines the criteria for poor COPD control to include these patients, aiming to improve early identification of high-risk cases in primary care. Methods: A retrospectiveand multicenter study is conducted using data from 110 COPD patients in Spain. Poor control is redefined as having at least one moderate exacerbation or as using three or more SABA inhalers annually. Key predictors, such as SABA/short-acting muscarinic antagonist (SAMA) inhalers and antibiotic prescriptions, are identified using logistic regression and LASSO regularization to enhance predictive accuracy. Results: The model achieves a good predictive performance, with an AUC-ROC of 0.978, sensitivity of 92.86%, and specificity of 87.50%. Key predictors reliably identify high-risk patients, enabling timely interventions. This study demonstrates a statistically significant association between once-daily inhaler therapies and better COPD control compared to multiple daily doses, supported by chi-square analysis (p = 0.008) and binary logistic regression (p = 0.018). Nevertheless, the variable 'daily inhalation frequency' (1 vs. >1 inhalation/day) was excluded from the final model to prevent overfitting. Conclusions: By refining the criteria for COPD control to include patients with at least one moderate exacerbation or frequent SABA use, this model provides a practical tool for early risk stratification in primary care, particularly in resource-limited settings. Early identification of high-risk patients can reduce hospitalizations and healthcare costs, supporting a proactive approach to COPD management. Further validation in larger cohorts is essential to confirm its broader applicability.

Registry as a tool for assessing economic costs of managing pediatric patients with hypertrophic cardiomyopathy

Background. Hypertrophic cardiomyopathy (HCM) is one of the most common form of cardiomyopathy in children, with an estimated annual incidence of 2.9 per 100,000 children. The management of patients with HCM requires high healthcare costs. Registry-based medical research is an important tool in assessing health care decision making. Objective. To analyze the costs of the state for the management of pediatric HCM based on the data of the pediatric patient registry. Materials and methods. The study was performed on the basis of the Department of Pediatric Cardiology and Medical Rehabilitation of the Almazov National Medical Research Centre. Currently, the electronic database includes information on 159 children with HCM, including 52 (34 %) girls. The mean age of onset of HCM was 5 years [0; 11], and 68 (44.4 %) children had the onset of myocardial hypertrophy before the age of 1 year. Medical costs included direct medical costs of drug therapy, surgical treatments (implantation of a cardioverter-defibrillator and myectomy) and hospitalization, and indirect costs which included the costs of family caregiving; social benefits due to disability, and death impact on the gross domestic product. Results. The total economic impact of HCM in the context of government spending, is RUB 107.8 million, including medical costs of RUB 27.96 million, direct nonmedical costs of RUB 13.17 million, and indirect costs of RUB 66.7 million. Indirect costs accounted for the lion’s share (61.8 %) of economic impact. Direct medical costs were 26 % of economic impact. The average impact of family caregiving accounted to RUB 11,263.89, and total value were RUB 1.04 million. Conclusion. The intermediate results of our study allow to estimate the economic impact of pediatric HCM to the state. Optimization of financial resource use will help reduce the economic impact on the state to the healthcare sector in the future.