High Health Care Research Articles

Impact of COVID-19 Vaccine Rollout on Mental Health, Social Determinants of Health, and Attitudes Among Individuals With COPD.

Social distancing early in the COVID-19 pandemic helped mitigate viral spread and protect vulnerable populations. Broad availability of vaccines allowed social re-integration, but effects on mental health, social determinants of health, and attitudes among individuals with COPD, who are high-risk for adverse outcomes following COVID-19 infection, are unknown. Participants in the Losartan Effects on Emphysema Progression (LEEP) trial were recruited into an ancillary study from May-November 2020. Study coordinators administered telephone questionnaires to evaluate respiratory symptoms (COPD Assessment Test [CAT]), anxiety (Generalized Anxiety Disorder-7 [GAD-7]) and depressive (Patient Health Questionnaire [PHQ-8]) symptoms, social isolation, instrumental support, and attitudes and actions related to the COVID-19 pandemic. Generalized estimating equation models evaluated changes in patient-reported scores from the period before vaccine availability (pre-vaccine, May-December 2020) to the post-vaccine period (May 2021-September 2022). Of 157 enrolled participants, 138 were interviewed during both periods. Compared with the pre-vaccine period, severe respiratory symptoms (CAT>20) were higher in the post-vaccine period (odds ratio [OR] 1.36, 95% confidence interval [95%CI]: 1.00-1.85), as were moderate anxiety symptoms (GAD-7≥10; OR 1.65, 95%CI: 1.11-2.46) and moderate depressive symptoms (PHQ-8≥10; OR 1.77, 95%CI: 1.22-2.55). Social isolation improved, though not significantly, and instrumental support was unchanged. In the post-vaccine period compliance with COVID-19 mitigation strategies remained high and governmental healthcare entities were viewed as trustworthy by fewer respondents. Despite a trend towards less social isolation following broad availability of COVID-19 vaccines, individuals with COPD reported worse symptoms, and greater anxiety and depressive symptoms compared to the pre-vaccine period.

Long COVID: neurological manifestations - an updated narrative review.

Infection with the SARS-CoV-2 virus can lead to neurological symptoms in the acute phase and in the Long COVID phase. These symptoms usually involve cognition, sleep, smell disorders, psychiatric manifestations, headache and others. This condition is more commonly described in young adults and women. This symptomatology can follow severe or mild cases of the disease. The importance of this issue resides in the high prevalence of neurological symptoms in the Long COVID phase, which entails significant morbidity in this population. In addition, such a condition is associated with high health care costs, with some estimates hovering around 3.7 trillion US dollars. In this review, we will sequentially describe the current knowledge about the most prevalent neurological symptoms in Long COVID, as well as their pathophysiology and possible biomarkers.

Health Care Access and Quality of Life of Community-Dwelling Senior Citizens in Pampanga, Philippines.

This study examined the association between healthcare access and quality of life (QOL) among senior citizens in Pampanga, Philippines. We conducted a cross-sectional study among 410 community-dwelling senior citizens aged 60 and above. Using validated scales, we assessed both healthcare access and QOL. Descriptive statistics were employed to characterize the senior citizens, and multiple linear regression was used to examine the association between healthcare access and QOL. Senior citizens, averaging 69 years old, were predominantly women, single/widowed, and with comorbidities. They reported high healthcare access (mean = 120.13) and moderate QOL (mean = 70.79). Environmental health scored highest in QOL domains, while social relationships scored lowest. Overall healthcare access was positively associated with overall QOL (B [unstandardized beta] = .22, 95% CI [confidence interval] 0.10, 0.33) and its domains. Significant associations with overall QOL were observed for accessibility (B = 1.95, 95% CI 0.98, 2.91) and affordability (B = -1.60, 95% CI -2.46, -0.74). Filipino senior citizens in Pampanga demonstrated high healthcare access and moderate QOL. The study highlights the importance of healthcare access in enhancing senior citizens' QOL, particularly regarding accessibility and affordability. Further research is needed to explore the nuanced relationships between healthcare access subscales and specific QOL domains.

Antifungal Stewardship in Invasive Fungal Infections, a Systematic Review.

Invasive fungal infections (IFI) are a group of life-threatening diseases associated with significant morbidity, mortality and high healthcare costs. Some modern management programs known as AFS (antifungal stewardship programs) have now been developed. The purpose of this systematic review is to evaluate the different declinations of antifungal stewardship programs (AFPs). Articles were systematically reviewed using the PRISMA checklist 2020. EMBASE and MEDLINE/PubMED were searched using the term "antifungal stewardship" (2012-2022 data) on 2 January 2023. Eligible studies were those that described an AFS and included an intervention, performance evaluation and outcome measures. A total of 22/796 studies were included. Approximately two-thirds (16) were published between 2018 and 2022. 16 (72.7%) stated a minimal complete AFS team. 12 (54.5%) adopted a non-compulsory AFS approach, 6(27.3%) had an Educational AFS and 4(18.2%) a compulsory AFS. Cost analyses of 12 studies showed a decrease for 7 (31.8%) compared to an increase for 5 (22.7%). In terms of outcomes, 18 studies showed a lower (10;45.5%) or the same (8;36.4%) pre-post intervention mortality rate. AFS programs seem to be related to lower costs and better outcomes and should thus be implemented in tandem with antimicrobial stewardship programs.

The role of the skin microbiome in wound healing.

The efficient management of skin wounds for rapid and scarless healing represents a major clinical unmet need. Nonhealing skin wounds and undesired scar formation impair quality of life and result in high healthcare expenditure worldwide. The skin-colonizing microbiota contributes to maintaining an intact skin barrier in homeostasis, but it also participates in the pathogenesis of many skin disorders, including aberrant wound healing, in many respects. This review focuses on the composition of the skin microbiome in cutaneous wounds of different types (i.e. acute and chronic) and with different outcomes (i.e. nonhealing and hypertrophic scarring), mainly based on next-generation sequencing analyses; furthermore, we discuss the mechanistic insights into host-microbe and microbe-microbe interactions during wound healing. Finally, we highlight potential therapeutic strategies that target the skin microbiome to improve healing outcomes.

Patient-reported primary health care experiences in Canada: The challenges faced by Nepalese immigrant men

BackgroundDespite the Canadian universal healthcare system, new immigrants face a number of challenges in accessing primary healthcare (PHC) services. As immigration to Canada consistently increases, understanding various types of barriers to PHC and how they differ across different sub-groups is critical. We conducted a qualitative study among Nepalese immigrant men to learn from their experience with PHC access to inform healthcare providers, stakeholders, and policymakers to devise feasible approaches to enhancing access to care. MethodsWe undertook a qualitative research approach employing focus groups among a sample of first-generation Nepalese immigrant men who had prior experience with accessing PHC in Canada. Data collection and analysisWe conducted six focus groups in total with 34 participants (each group comprising 5–7 participants) in their preferred language, Nepalese, or English. Demographic information was collected prior to each focus group. Transcriptions of the discussions were prepared, and thematic analysis was employed in the qualitative data set. ResultsParticipants reported experiencing barriers at two stages: before accessing PHC services and after accessing PHC services. The barriers before accessing PHC were long wait time for an appointment with physicians, limited knowledge of own health- and services-related issues, limited service availability hours, cultural differences in health practices, and transportation and work-related challenges. The barriers after accessing PHC were long wait time in the clinic to meet with the physicians at the time of appointment, communication challenges and misunderstandings, high healthcare costs associated with dental and vision care and prescribed medicines, and inappropriate behaviours and practices of doctors and service providers. To our knowledge, this is the first study in Canada which explored barriers faced by Nepalese immigrant men in accessing PHC. ConclusionsThis study identifies barriers to accessing PHC in Canada from a group of immigrant men's perspective. It is important to account for these while making any reforms and adding new care services to the existing healthcare system so that they are equitable for these groups of individuals as well.

Use of Specific Borrelia Phages as a New Strategy for Improved Diagnostic Tests.

The high failure rate of tick-borne infection (TBI)-related testing underscores the need for novel approaches that do not rely on serology and two-tier testing. Delayed diagnosis of TBIs, especially Borrelia infections, results in high healthcare costs and great suffering. There is a significant need for a reliable blood test that can aid in the diagnosis of Lyme disease, particularly when the current FDA-approved serological test is not sensitive enough to detect early Lyme patients who have not yet produced antibodies against Borrelia. Bacteriophages are viruses that specifically associate with their bacterial hosts, particularly prophages, bacteriophages residing in bacteria, and have proven to be tightly correlated with their bacterial hosts. They are poised to have wider applications as markers to detect bacteria, particularly in infectious disease. The gene of choice depends on the prevalence of phages within a particular group of bacteria. Phage genes that have been used as molecular markers to examine phage diversity include structural genes encoding the major capsid protein, the portal protein, the DNA polymerase, and the terminase. Borrelia species carry specific phage sequences that can be used as a proxy to identify the bacteria. Using phages as a proxy for bacteria is beneficial, as phages can be detected more easily than bacteria and can be used to bypass the cryptic and tissue-bound feature that typifies human Borrelia infections.We explored a completely new way of detecting Borrelia using Borrelia-specific bacteriophages as a diagnostic tool. Our detection method, patented by Phelix R&D and Leicester University (WO2018083491A1), could potentially transform infectious disease diagnostics through the innovative use of real-time PCR to target circulating bacteriophage DNA in blood from patients with Lyme disease. Firstly, this bacteriophage-based approach offers increased sensitivity since bacteriophages are typically present in five- to tenfold excess over bacterial cells, making it more accurate and sensitive than conventional bacteria-targeting PCR tests. One of the reasons bacteria-based PCR tests are frequently negative is due to the low bacterial concentration in the blood. Bacteriophage-based PCR surpasses this barrier and offers a direct test, as phages are part of bacteria's own genetic material, in contrast to all existing indirect tests (ELISA, Western BLOT, LTT/ELISPOT test). Secondly, a phage-based test can differentiate between different Lyme disease-causing and relapsing fever-causing Borrelia subtypes (B. burgdorferi s.l., B. miyamotoi, etc.), given that bacteriophages are indicators of bacterial identity. Finally, this test can detect Lyme disease in both early and late stages.

Comparing Healthcare Service Utilization in Insured vs. Non Insured Households in Rural Atsbi Womberta

Community-based health insurance schemes (CBHI) in Africa are gaining attention due to high healthcare costs in developing nations, affecting 6% of individuals in extreme poverty. The World Health Organization emphasizes the need for sustainable health funding schemes to ensure access to health services. Ethiopia faces poor healthcare funding, making it one of the world’s poorest nations. Tigray implemented community-based insurance as a pilot study in 69 rural communities since 2010. The objective of this study was compare differences in healthcare service utilization between community-based health insurance among insured and non-insured households in rural Atsbi-Wemberta district. A community-based comparative cross-sectional study with a qualitative approach was conducted on 172 households. Data was analyzed using SPSS, and inferential statistics were used to measure factors’ association with outcome variables. A study in Kebelle revealed that the majority of respondents were female-headed, engaged in both insurance schemes, and had higher education levels. Marital status was also significant, with 89% living with their families. The majority were married, with 91.8% insured and 86.0% uninsured. Family size and income were significant factors, with high-salary households less likely to be members of the Community Based Health Insurance (CBHI) scheme. The study found that most participants considered themselves intermediate healthcare providers, with limited service due to affordability and segregation. The study suggests increasing healthcare service utilization by introducing Community Benefits Health Insurance (CBHI) to improve access to healthcare and promote good governance. However, the study faces criticism for unfairness and insufficient benefits for non-insured participants. Household were enrolled in CBHI (56.2%) were more probable to use health care service than households who were not enrolled (43.8%) (χ2=21.359, p<0.001). Community Benefits Insurance (CBHI) has increased healthcare utilization among insured households due to reduced illness costs and increased healthcare professional involvement. Factors like income, family size, and travel time contribute to higher utilization. However, challenges include lack of knowledge and community awareness.

Standardization of zebrafish drug testing parameters for muscle diseases.

Skeletal muscular diseases predominantly affect skeletal and cardiac muscle, resulting in muscle weakness, impaired respiratory function and decreased lifespan. These harmful outcomes lead to poor health-related quality of life and carry a high healthcare economic burden. The absence of promising treatments and new therapies for muscular disorders requires new methods for candidate drug identification and advancement in animal models. Consequently, the rapid screening of drug compounds in an animal model that mimics features of human muscle disease is warranted. Zebrafish are a versatile model in preclinical studies that support developmental biology and drug discovery programs for novel chemical entities and repurposing of established drugs. Due to several advantages, there is an increasing number of applications of the zebrafish model for high-throughput drug screening for human disorders and developmental studies. Consequently, standardization of key drug screening parameters, such as animal husbandry protocols, drug compound administration and outcome measures, is paramount for the continued advancement of the model and field. Here, we seek to summarize and explore critical drug treatment and drug screening parameters in the zebrafish-based modeling of human muscle diseases. Through improved standardization and harmonization of drug screening parameters and protocols, we aim to promote more effective drug discovery programs.

Meta-meta-analysis of the mortality risk associated with MRSA compared to MSSA bacteraemia.

Staphylococcus aureus bacteraemia (SAB) is a bloodstream infection that carries a high risk of exacerbating a diseased state and may result in an increased death rate. The aim of this study was to assess mortality risk in Methicillin Resistant Staphylococcus aureus (MRSA) bacteraemia compared to Methicillin Susceptible Staphylococcus aureus (MSSA) bacteraemia through meta-meta-analyses. The study followed PRISMA guidelines, conducting a comprehensive search in Scopus, PubMed, and Google Scholar. It included full-text systematic reviews and meta-analyses comparing MRSA vs. MSSA bacteraemia, excluding reviews without data pooling and unclear selection criteria. Validity was assessed using QUOROM and AMSTAR. Edwards' Venn diagrams were used to visualized overlaps between primary studies. Aggregated odds ratio (OR) and risk ratios with 95% confidence intervals were calculated using the random-effect model. Heterogeneity was evaluated using the Higgins I2 statistic. The study included 3 meta-analysis studies, a total of 38,159 patients, with 9,056 having MRSA bacteraemia and 29,103 having MSSA bacteraemia. Data were collected from 46 different outcome studies published between 2001 and 2022. The meta-analyses used 7 to 33 primary studies from 1990 to 2020, with no overlap. Odds ratios (ORs) ranged from 1.78 to 2.92, while relative risks (RR) ranged from 1.57 to 2.37 for the included meta-anlysis. The pooled analysis confirmed a higher risk of mortality in patients with MRSA bacteraemia (OR: 2.35, RR: 2.01, HR: 1.61) compared to MSSA bacteraemia. Heterogeneity among the studies was considerable (I2: 90-91%). The study strongly supports that most patient deaths from SAB are linked to MRSA rather than MSSA. This highlights the significant public health problem posed by SAB, with difficult and often unsuccessful treatment leading to increased mortality and high healthcare costs.

Prevalence of Musculoskeletal Pain among Chefs Working in Restaurants of Sialkot

Musculoskeletal pain is a pain coming from the structures such as bones, muscles, joints, tendons, and ligaments, clearly becoming more and more common. In addition to having a detrimental effect on a person's life quality, MSK pain's high healthcare expenses and concomitant loss of productivity have placed a heavy financial burden on societies. Objective: To find the prevalence of musculoskeletal pain among the chefs working in restaurants in Sialkot. Methods: The cross-sectional/observational survey study was conducted for 4 months and convenient sampling technique was used on chefs working in restaurants of Sialkot. Results: This study assessed prevalence and level of pain among chefs of different restaurants in Sialkot. This study included 178 participants with age range varied from 25 to 50 years. 61.2% of participants aged 25-29 years. 63.5% of participants were among those having 8 to 10 working hours. 24.7% of the participants had weight ranging from 55 to 59 kg. 58.4% of participants had mild pain. Duration of job of most of participants (40.4%) was 2 to 6 years. Most participants (20.8%) were having trouble in ankle/feet, (16.3%) had trouble in knees and lower back. Conclusions: We found that muscle and skeletal pain in chefs working in different restaurants of Sialkot most probably in ankles/feet, knees and low back. The pain was found to be mild on Numeric Pain Rating Scale (NPRS) mostly in male chefs of middle age with ideal weight.

The Tyrolean Federal Institute for Integrated Care (LIV Tyrol)

A constantly increasing life expectancy of society leads to an increase in severe chronic diseases, which are accompanied by negative effects on the quality of life for patients and an increasing number of hospital admissions as well as long hospital stays. This poses major challenges for the healthcare system and requires innovative and integrated approaches in order to provide high quality healthcare.
 Therefore, the Tyrolean Federal Institute for Integrated Care (LIV Tyrol) was founded from a joint initiative of the federal state government of the Province of Tyrol and the social insurance institutions to target the above mentioned challenges and reduce burdens for the health care system by developing and implementing integrated care approaches and programs for different chronic diseases. Integrated care is understood to be patient-oriented, continuous, cross-sectoral, interdisciplinary and/or multiprofessional care based on standardized care concepts.
 LIV Tyrol aims for optimal care for patients – especially patients suffering from chronic diseases – at their homes in order to increase their quality of life on the one hand and, on the other hand, to relieve the healthcare system through innovative approaches. As a result, different disease management programs are developed, implemented, coordinated, operated and evaluated.
 They include disease management programs for patients with heart failure (HerzMobil Tirol), dementia (Demenz Tirol), patients who suffered a stroke (Schlaganfallpfad Tirol) or in need of palliative care (Hospiz- und Palliativversorgung). LIV Tyrol also coordinates the care management for the Province of Tyrol, Austria and the post-Covid care. Some of these programs are supported by telemedical solutions including telemonitoring systems to provide a secure framework for patient care outside the hospital and to allow for immediate measures when needed. Furthermore, different registries, such as the Austrian birth registry, the Tyrolean cancer registry, the Tyrolean arthroplasty registry, or the Tyrolean diabetes registry are located and operated at the Institute of Clinical Epidemiology, which is part of LIV Tyrol. LIV Tyrol also supports data management and analytics for (clinical) problems but also provides an important contribution to quality assurance within the Tyrolean healthcare system.
 In order to implement such disease management programs, a close collaboration of different stakeholders is needed. Stakeholders of LIV Tyrol include but are not limited to health-policy makers, social insurance institutions, healthcare providers (hospitals, resident practitioners, other health-related professions), research institutions, and patients. 
 An institution like LIV Tyrol is unique in the Austrian health care system and contributes to optimal care security for patients in Tyrol and poses hub for new, innovative and flexible integrated care models.
 To make the health care system fit for the future, the federal and state governments have agreed to expand integrated care. The federal government of Tyrol has therefore commissioned the Tyrolean Federal Institute for Integrated Care to implement these targets and to design, organize and coordinate integrated care initiatives throughout the province of Tyrol.

Towards Active Integrated Waiting Lists: The Patient Lived Experience

Background: Specialist healthcare providers internationally face challenges managing elective care waiting lists. There is an increase focus on how we can provide integrated care solutions to achieve active rather than passive waiting. This requires potentially complex interactions across care boundaries and care providers alongside novel digital solutions. Crucially however we must also understand the lived patient experience of people on those waiting lists. Little research has considered the lived experience of people on waiting lists for specialist care.
 Methods: 46,000 individual patients on waiting lists at a major tertiary referral centre in the West Midlands, United Kingdom were sent a survey to understand their experiences of waiting for specialist care whilst remaining in the community context. Patients were contacted via SMS initially with a link to a web-portal with follow up contact via letter for those who did not complete the initial survey. This work is linked to/informed by extensive, commissioned, independent deliberative patient and public involvement work looking at waiting list management previously completed for this organization. This was approved locally as a service evaluation.
 Results: 20,741 responses were received, representing a 45% response rate. 62% of response were received via the website, with 38% via letter. 1,633 patients (7.9%) wished to be removed form the waiting list. 18.5% felt that being on the waiting list was severely stopping them from carrying out normal tasks, 17.7% reported that being on the waiting list was severely impacting their ability to work and 14.0% reported that being on the waiting list severely impacted their ability to care for others. 20.7% felt their condition had got severely worse whilst on the list. Impact of being on the waiting list was most notable for those in the most deprived population groups, with 25% of patients in the most deprived areas having been severely impacted by the wait time, compared with 14% in the least deprived areas. There was additional variation on the impact of waiting based on ethnicity, age and work status.
 Discussion: High healthcare demands result in an inevitability of patients waiting for specialist services. This work demonstrates the diversity of lived experiences for patients on elective care waiting lists, stressing differences between key population groups including those with protected characteristics. Patient cohorts within specialist waiting lists must be seen as diverse and dynamic. Much promised prioritisation and active waiting initiatives must be individualised to meet the diverse needs of the people on the waiting lists and recognise further work is needed to better understand how to engage with these groups.
 Funding received from: West Midlands Academic Health Science Network: Safety Innovation and Improvement Fund

Clusters of medical specialities around patients with multimorbidity – employing fuzzy c-means clustering to explore multidisciplinary collaboration.

Background: The increasing prevalence of multimorbidity challenges hospital care organization. Hospital care is structured around medical specialties and focused on separate treatment of individual organ systems. Consequently, patients with multimorbidity visit multiple healthcare professionals and have high healthcare utilization with a risk of interactions and contradictory treatments if multidisciplinary coordination is absent. Organizational structures for multidisciplinary collaboration between medical specialists in case of multimorbidity are, however, limited. To facilitate multidisciplinary, coordinated care and to prevent or minimize adverse health outcomes, it might be useful to organize hospital care around specific patterns of multimorbidity or medical specialties. Therefore, we hypothesized that the use of cluster analysis and real clinical data could be helpful to unravel groups of medical specialties who are simultaneously involved in hospital care for patients with multimorbidity. 
 Method: We performed a cross-sectional cohort study and used retrospectively collected electronic health record (EHR) from a Dutch hospital in 2017. We extracted EHR data of 22,133 patients with multimorbidity aged ≥18 years who had received outpatient clinical care for two or more chronic and/ or oncological diagnosis. We used a fuzzy c-means clustering algorithm and explored the patients’ membership degree factors to each cluster to distinguish subgroups of patients with a specific pattern of involved medical specialties.
 Results: The mean age was 67.9 years (interquartile range (IQR):20.9), and 56.0% was female. We identified six clusters and 22 subgroups. The clusters were: 1. dermatology/ plastic surgery, 2. six specialties, 3. pulmonology, 4. internal medicine/ cardiology/ geriatrics, 5. neurology/ rehabilitation/ anesthesiology, and 6. internal medicine. Most patients had a full or dominant membership to one cluster only (11 subgroups) and the remaining subgroups were combinations of two clusters. The prevalence of specific diagnosis groups, patient characteristics and healthcare utilization seemed to differ between subgroups. For instance, patients of the subgroup with high involvement of internal medicine, cardiology and geriatrics; was characterized by cardiometabolic diseases. These patients had the highest average age (median:73 years, IQR:16.2), number of diagnoses (median:5, IQR:3), and number of outpatient visits (median:7, IQR:6). Patients of the subgroup with involvement of both the cardiologist and pulmonologist had lower number of diagnoses (median:3, IQR:1) and outpatient visits (median: 5:, IQR:4). This subgroup was mostly characterized by pulmonary and heart diseases, which can both represent with symptoms as dyspnea. Thus, the subgroups and their characteristics can provide clues about potential target populations that might benefit from (more) multidisciplinary collaboration, such as a formalization of a cardiometabolic or dyspnea outpatient clinic. 
 Conclusion: Our study shows that it is possible to use fuzzy c-means cluster analysis and real clinical data to identify clinically relevant clusters and subgroups of medical specialties simultaneously involved in hospital care for patients with multimorbidity. With this strategy hospitals, healthcare professionals, and data scientists can further analyze which of these subgroups are target populations with multimorbidity that might benefit from improved multidisciplinary collaboration or new models of care.

NCI-Delirium Model: Co-caring to decrease the incidence of delirium among hospitalized older adults.

Delirium negatively impacts the health and wellbeing of older adults and their family carers and contributes to unnecessary high healthcare costs, estimated at $8.8 billion per year in Australia. Improvements to clinical practice are urgently needed, particularly now, as the COVID-19 pandemic is placing an enormous burden on our hospitals. 
 Innovative strategies that support partnerships with family carers have been reported as key to improved patient outcomes and satisfaction with care, particularly for older adults unable to participate in their own care. This is because carers have intimate knowledge of a family member’s cognitive state to identify early subtle changes others might not. Carers also provide valuable reassurance and familiarity to the older adults during their treatment and can orient them to place and time. 
 Founded on our clinical observations, informed by a scoping review of the literature (in press) and co-designed with carers, consumers, clinicians and policy analysts, we developed a new model of delirium care: NCI-Delirium. NCI-Delirium is a validated, scalable, low risk model that values the lived experience of older adults and carers. NCI-Delirium supports the integration of carers as partners in the care of the older adult from admission into the acute care setting. To support the integration of carers as partners, they are offered a web-based Delirium Toolkit that contains: an education package to build awareness and skill development (e.g., delirium risk factors, therapeutic and preventive strategies and non-pharmacological interventions to manage the reorientation of the hospitalised older adult); a 7-item psychometrically tested screening tool designed for carers to identify delirium symptoms and people at risk of delirium; access to support resources (e.g., counselling, social prescriptions, peer-support); and a co-designed discharge plan with the health team. 
 Preliminary results suggest that NCI-Delirium improves health service delirium outcomes. Carer involvement in this research, and the introduction of their perspectives, has elevated carers’ key relationships with clinicians. Our co-designed solution to support the integration of carers as partners in delirium management has improved carers’ caregiving burden, psychological wellbeing and knowledge of delirium. This translatable co-designed model of care provides the much needed rich and robust clinical, implementation and economic evidence, to address the risk factors associated with the prevalence of delirium in hospitalised older adults. It is anticipated that the model will transform how we integrate carers as partners in care to improve clinical practice, patient and carer experiences; and reduce caregiving burden.
 Globally, the identification and management of risk for delirium is imperative. Delirium is a potentially life-threatening condition, and not well detected in the acute or community care setting. If carers are integrated and supported as partners in care, the capacity to identify symptoms and support the diagnosis of delirium should increase, potentially reducing functional decline, transition to residential aged care facilities and mortality rates. The next steps are to evaluate this co-designed web-based delirium model of care for use by carers in the community and residential aged care setting.

Medical Costs Estimation Using Linear Regression Method

Medical costs are a significant issue in the health sector. High healthcare cost lead to the need to anticipate financial risks for individuals and insurance providers. Therefore, medical cost data analysis is necessary to estimate future medical expenses. This research implements data mining techniques using Simple and Multiple Linear Regression methods to estimate medical costs. The dataset used consists of insurance claim data obtained from Kaggle, which includes attributes such as age, gender, body mass index, number of children, smoking habits, region, and medical charges. The research findings that Multiple Linear Regression outperforms Simple Linear Regression in estimating the provided dataset, with R2 value of 80% and lower ?? MSE and MAE values than Simple Linear Regression. The application of linear regression in insurance claim data analysis can provide significant benefits for patients, hospitals, and insurance providers. Overall, this research highlights the effectiveness of data mining techniques, specifically linear regression, in estimating healthcare costs.

Association between pre-ICU statin use and ARDS mortality in the MIMIC-IV database: a cohort study.

Acute respiratory distress syndrome (ARDS) is a severe condition associated with high morbidity, mortality, and healthcare costs. Despite extensive research, treatment options for ARDS are suboptimal. This study encompassed patients diagnosed with ARDS from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. Pre-intensive care unit (ICU) statin use was assessed as the exposure variable. Kaplan-Meier survival analysis was conducted to evaluate mortality at 30 and 90 days. Adjusted multivariable Cox models were utilized to estimate hazard ratios. Subgroup analyses and propensity score-matching (PSM) were undertaken for further validation. Our study comprised 10,042 participants diagnosed with ARDS, with an average age of 61.8 ± 15.3 years. Kaplan-Meier survival analysis demonstrated a significantly lower prevalence of mortality at 30 and 90 days in individuals who used statins before ICU admission. Adjusted multivariable Cox models consistently showed a significant decrease in mortality prevalence associated with pre-ICU statin use. After accounting for confounding factors, patients who used statins before ICU admission experienced a 39% reduction in 30-day mortality and 38% reduction in 90-day mortality. We found a significant decrease in ICU stay (0.84 days) for those who used statins before ICU admission. These results were supported by subgroup analyses and PSM. This large cohort study provides evidence supporting the association between pre-ICU statin use, reduced risk of death, and shorter ICU stay in patients with ARDS, thereby suggesting the potential benefits of statin use in critically ill patients.

HEALTH BEYOND DISEASE IN OLD AGE: RELATIONSHIP OF INTRINSIC CAPACITY WITH HEALTH CARE UTILIZATION

Abstract In contrast to the traditional disease-centered approach, intrinsic capacity (IC) is a fine-grained and comprehensive measure of overall health. It plays an essential role in the healthy aging model proposed by the World Health Organization. However, how IC contributes to healthcare utilization and medical expenditures beyond the presence of chronic conditions in old age is not well understood. Data were from the China Health and Retirement Longitudinal Study. We used a validated, multidimensional tool (locomotor, cognitive, psychological capacity, sensory capacity, and vitality) for assessing IC at baseline (Wave 2011). Outcomes include outpatient and inpatient use, and their expenditure measured in Wave 2013. We used logistic and linear regression models to identify the association of IC with healthcare utilization, adjusting for demographics, lifestyles, and multi-morbidity (the presence 2+ out of 14 chronic conditions). We included 14,887 participants, and equally categorized them into three groups (low, intermediate, and high IC). Compared with those with a low IC, older adults with an intermediate level or high level of IC had a significant reduction of outpatient use (OR=0.80, 95% CI=0.72-0.90; OR=0.61, 95% CI=0.53-0.69) and inpatient use (OR=0.69, 95% CI=0.58-0.81; OR=0.58, 95% CI=0.49-0.70), after adjusting for demographics, lifestyles, and multi-morbidity. We did not find a significant association between IC and healthcare expenditure. Assessment of IC for older adults provides valuable information for healthcare use beyond chronic conditions. Assessment of IC in routine clinics may help screen for older adults with high healthcare utilization, which could optimize the allocation of healthcare resources and improve patient-centered care.

A GERIATRIC EDUCATION COURSE SPANNING COMMUNITY AND HEALTH CARE ENVIRONMENTS

Abstract To address gaps in the geriatrics-trained workforce, we implemented a Geriatric Resource Certificate (GRC) for interprofessional learners from healthcare and community provider settings. This program combines online self-paced didactics, real-time virtual lectures, and a real-world virtual team care planning experience. The education incorporates the 4Ms of the Age Friendly Framework and spans the geriatric experience from healthy aging through end-of-life. It includes Dementia Friends and ECHO sessions. The goal is to training people from a variety of care settings to be resource people regarding geriatric issues, much like the NICHE program in acute care. We had 37 learners who completed evaluations. Practice settings included ACO, Hospice, Emergency Department, nursing homes, hospitals, primary care, Area Agencies on Aging, and other community providers. Overall, the online didactics were rated an average of 4.53 on a 5 point Likert scale and the real-time lectures were rated an average of 4.41. The average score for “the GRC will help me provide care over the continuum” was 4.59. The average for the real team was 4.07, 4.26 for the ECHO, and 4.45 for Dementia Friends. All learners indicated they would refer others to the GRC. These results indicate that the GRC is an effective method to impart basic geriatric training into communities and raise awareness of resources available to assist older adults in maintaining their independence. In this era of high healthcare workforce turnover and staffing shortages, improving geriatric knowledge by training on-site geriatric resource staff is one way to improve care for older adults.

An overview on viral interference during SARS-CoV-2 pandemic.

Respiratory viruses represent the most frequent cause of mortality, morbidity and high healthcare costs for emergency visits and hospitalization in the pediatric age. Respiratory viruses can circulate simultaneously and can potentially infect the same host, determining different types of interactions, the so-called viral interference. The role of viral interference has assumed great importance since December 2019, when the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) came on the scene. The aim of this narrative review is to present our perspective regarding research in respiratory virus interference and discuss recent advances on the topic because, following SARS-CoV-2 restrictions mitigation, we are experimenting the co-circulation of respiratory viruses along with SARS-CoV-2. This scenario is raising many concerns about possible virus-virus interactions, both positive and negative, and the clinical, diagnostic and therapeutic management of these coinfections. Moreover, we cannot rule out that also climatic conditions and social behaviours are involved. Thus, this situation can lead to different population epidemic dynamics, including changes in the age of the targeted population, disease course and severity, highlighting the need for prospective epidemiologic studies and mathematical modelling able to predict the timing and magnitude of epidemics caused by SARS-CoV-2/seasonal respiratory virus interactions in order to adjust better public health interventions.