Higher Medical Care Costs Research Articles

Distinguishing factors in regional variations of TAVI in Japan: the unique role of administrative facility standards compared to other procedures in a high-cost medical care subsidy system

Abstract Background Transcatheter aortic valve implantation (TAVI) is less invasive than surgical aortic valve replacement and is becoming increasingly popular worldwide, particularly among patients with aortic valve stenosis (AS) due to aging. However, regional differences are expected to exist not only between countries but also within a single country. Reports from Western countries indicate the presence of regional differences in TAVI and the reasons for these differences, which include differences in medical infrastructure, economic resources, health insurance systems and policies, geographic factors, and availability of specialized medical personnel. TAVI is expensive, but in Japan, the economic aspect is relatively unimportant due to the high-cost medical assistance system. Furthermore, there is little socioeconomic disparity between regions. In such a society, we have reported that the number of specialists and resources for PCI can explain regional differences in ablation and endovascular treatment (EVT). However, unlike those other cardiovascular procedures, there are specific requirements for facilities to perform TAVI, such as the number of transesophageal echocardiographies, as well as cardiologists and cardiovascular surgeons, and the equipment itself, such as hybrid operating rooms. We examined how these facility requirements, which are thought to be controlled by the government, are related to regional differences in TAVI implementation. Methods and Results We used the Japanese Ministry of Health, Labour and Welfare national database to determine the rate of TAVI for patients with AS performed per 100,000 population aged ≥40 years in all 47 prefectures in 2022. A linear regression model was developed to assess factors contributing to the regional medical supply, including the rates of PCI per 100,000 population aged ≥40 years and the numbers of cardiologists, cardiovascular surgeons, cardiovascular intervention and therapy training facilities, cardiovascular surgery base facilities, and TAVI facilities. The numbers in the highest and lowest regions were 26.6 and 3.9 (a 6.8-fold difference) for TAVI number. The number of TAVI facilities contributed most significantly to the TAVI volumes (P = 0.0105), while the rates of PCI and other factors did not contribute significantly. The number of TAVI facilities was positively correlated with the number of transesophageal echocardiographies the most (r = 0.353). Conclusion This study revealed large regional variations in TAVI volumes in Japan, of which administrative facility standards were a major determinant.

Nationwide epidemiological survey of juvenile idiopathic arthritis during transition to young adulthood in Japan using the National Database of Designated Incurable Diseases of Japan.

Objectives We aimed to assess the unmet medical needs of young adult patients with juvenile idiopathic arthritis by evaluating real-world treatment data. Methods We analyzed data on juvenile idiopathic arthritis in the 20-29 age group from the National Database of Designated Incurable Diseases of Japan, which records severe cases or those requiring high-cost medical care registered between April 2018 and March 2020. Results Overall, 322 patients with juvenile idiopathic arthritis transitioning to adulthood were included. A high frequency of methotrexate use was observed among all juvenile idiopathic arthritis subtypes. The frequency of methotrexate use at registration was significantly higher in patients with rheumatoid factor-positive polyarthritis and those with oligoarthritis or polyarthritis than in those with systemic arthritis. The historical use percentage of any biological disease-modifying antirheumatic drug was ≥85% for all juvenile idiopathic arthritis subtypes. The proportion of patients with ≥2 biological disease-modifying antirheumatic drug prescriptions was significantly higher in patients with rheumatoid factor-positive polyarthritis than in those with systemic arthritis. Conclusions High-cost drugs were necessary for many patients with juvenile idiopathic arthritis transitioning to young adulthood and registered in the database. Further studies on the medical interventions and support for these patients are needed.

Polymer-Drug Anti-Thrombogenic and Hemocompatible Coatings as Surface Modifications.

Since the 1960s, efforts have been made to develop new technologies to eliminate the risk of thrombosis in medical devices that come into contact with blood. Preventing thrombosis resulting from the contact of a medical device, such as an implant, with blood is a challenge due to the high mortality rate of patients and the high cost of medical care. To this end, various types of biomaterials coated with polymer-drug layers are being designed to reduce their thrombogenicity and improve their hemocompatibility. This review presents the latest developments in the use of polymer-drug systems to produce anti-thrombogenic surfaces in medical devices in contact with blood, such as stents, catheters, blood pumps, heart valves, artificial lungs, blood vessels, blood oxygenators, and various types of tubing (such as for hemodialysis) as well as microfluidic devices. This paper presents research directions and potential clinical applications, emphasizing the importance of continued progress and innovation in the field.

Assessment of the living standard of elderly people and their well-being in a changing social environment

The current scientific article presents the results of assessing the living standard of elderly people, their well-being, livelihoods in conditions of economic instability and changing social space. Global and all-Russian official statistics indicate an increase in the ageing process of the population. Besides, there is a steady growth in the share of pensioners in its structure. In recent years, in the Russian Federation in general and in the Republic of Bashkortostan in particular, there has been a real trend of ageing population, longer life expectancy (73 years), and a greater number of senior citizens in total (28.5 %). Old age is associated with a period of loss and separation from the usual way of life. The assessment found the key problems of this category: deterioration of health, narrowing of the social world, loneliness, low living standard, and financial difficulties. It is identified that the Russian pensioners belong to the main group of the poor, especially the lonely ones. Their poverty is determined by a decline in living standards and material security, rising inflation, and the high cost of medical care along with utilities. It was revealed that for an elderly person, the main income source is a pension, and in-kind income from personal subsidiary farms is an additional one. Despite the generally low level of pensions, a significant part of non-working pensioners provides financial support to their family members at the cost of personal well-being. Therefore, family values dominate in the minds of older people, and many of their needs are realised in the household.

Traditional Medicine in Latin America: a holistic approach to health

Traditional medicine has been an integral part of human healthcare for centuries, offering a holistic approach to health that goes beyond merely treating physical symptoms. In Latin America, this approach has deep historical roots and has played a significant role in the region's cultural identity. such as social rejection of biomedicine, limited access to biomedical services, and the high cost of medical care. However, there has been a decline in the prevalence of traditional medicine in recent decades, with a decrease in traditional healers and an increasing reliance on biomedical care. This trend varies across different regions, but overall, there is a diminishing number of traditional healers, raising concerns about the potential disappearance of traditional medicine. Despite these challenges, traditional medicine remains a valuable part of healthcare in Latin America. Its cultural significance, holistic approach, and the trust it garners from certain communities make it relevant even in today's rapidly advancing medical landscape. Looking to the future, the field of medicine is poised for significant developments, including advancements in diagnosis, surgery, and treatment methods. While antibiotics have been essential in the fight against infectious diseases, bacterial resistance is a growing concern. Future medical breakthroughs are expected to involve vaccines, gene therapy, monoclonal antibodies, and stem cell transplants. In conclusion, traditional medicine in Latin America reflects a holistic approach to healthcare deeply intertwined with cultural and historical contexts. As modern medicine continues to evolve, there is potential for integrating traditional and scientific knowledge to create a more comprehensive approach to health and well-being, respecting the rich heritage of traditional practices.

Abstract A033: Use of a novel healthtech platform to record patient-reported needs in real time

Abstract Background: Financial toxicity refers to the challenges that a patient faces due to the high costs of medical care. BIPOC (Black, Indigenous, and People of Color), rural, and other vulnerable populations often bear a disproportionate burden when diagnosed with a chronic disease. As a result, these populations often experience financial toxicity at higher rates. The estimated annual costs of health disparities in the U.S. are $1.24 trillion. Financial toxicity and logistical barriers that affect daily life, such as transportation, family care, rent, and home maintenance, can negatively affect a patient’s life. Many clinical trial sponsors and patient advocacy groups focus on providing support to patients around these barriers, but services are often generalized and provided in a ‘one-size-fits-all’ format, which may not be beneficial on an individual level for each patient. In 2023, together with health IT provider The WiTT Group, Tigerlily launched the innovative web-based Resources and AssIstance for Support and Empowerment (RAISE) platform, which brings together the best of wedding registry, crowdsourcing, and digital payment concepts and tools to match patients with the non-clinical services they need in real time as they go through treatment. With RAISE, Tigerlily empowers Black women with breast cancer to specify needs in their registry in real time, delineated by the time and urgency of each need. Our research question is, “What is the relationship between patient informed financial and non- financial stressors and patient's geographical location, age, cancer sub type and staging?" Methods: Tigerlily captured the “voice of the patient” using user-generated profiles and patient-identified needs on the RAISE platform. Patient-submitted data during the months of May through July 2023 was analyzed. Results: Patients (n=60) documented current financial and non-financial stressors and challenges, as well as other impacted areas of their daily life. Preliminary results indicate that financial costs associated with groceries, insurance copays, and out-of-pocket medication costs were the most requested needs. Additionally, patients reported rent/mortgage, groceries, and childcare as the most financially necessary needs. Conclusions: RAISE allows breast cancer patients from BIPOC, rural, and other vulnerable populations to specify their needs on an individual basis. The most urgent and frequent patient-reported needs were. This approach will be used to inform community-based organizations, advocacy partners, and healthcare providers about patient-reported needs in their communities in order to guide the development of support programs and services. Future research will compare the impact of meeting patient-reported needs on outcomes such as quality of life and the impact of patient-identified stressors. Citation Format: Katherine Cornish, Mary Stober Murray, Maimah Karmo, Jeanne Regnante, Virginia Leach. Use of a novel healthtech platform to record patient-reported needs in real time [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A033.

Medical insurance, labor supply, and anti‐poverty initiatives: Micro‐evidence from China

AbstractThe high cost of medical care and its association with poverty have given rise to a growing concern for developing countries, but how insurance plans affect household income and alleviate poverty has been rarely discussed. This study aims to bridge this research gap by examining a medical insurance reform in China, a major program of the targeted poverty alleviation (TPA) strategy, which offers higher reimbursement rates and lower medical deductibles for low‐income households. We use an administrative data set on impoverished people in a Chinese county to examine how exogenous changes in the medical insurance system affect the income structure of low‐income households. We apply a two‐part model to a Difference‐in‐Differences framework, with households that received reimbursement of the insurance reform as the treatment group and others as the control group. Our results imply that the medical insurance reform could increase the overall household income diversity. The mechanism analysis suggests that the medical insurance reform improves the health conditions of patients and encourages caregivers to engage more in off‐farm work.

Cardiometabolic effect of sodium and glucosa cotransporter inhibitors type 2

Introduction: Type 2 diabetes mellitus has emerged as a leading cause of premature death and a growing threat to the healthcare system due to the high costs of medical care in the context of cardiovascular complications. Methods: We conducted a systematic electronic search of clinical trials published from 2015 to January 2023 in PubMed, Scopus, Web of Science and ScieLO databases, which evaluated the efficacy and safety of the use of type 2 sodium-glucose cotransporter inhibitors in patients with type 2 diabetes mellitus and established cardiovascular disease on routine treatment and their cost-effectiveness.Results: Significantly lower rates of acute myocardial infarction, stroke, cardiovascular death and hospitalization due to heart failure were observed when the study drugs were added to standard therapy. In addition, it was evidenced that the reduction in cardiovascular clinical events manages to offset the cost of type 2 sodium-glucose cotransporter inhibitors resulting in a cost-effective use of resources at the health care level.Conclusions: As the transition to a new evidence-based era of managing patients with type 2 diabetes mellitus and cardiovascular disease progresses, it is imperative that new therapies are developed that not only improve glycemic control, but also improve cardiovascular outcomes, because these events represent the major cause of mortality in this population.

Esmolol inhibits cognitive impairment and neuronal inflammation in mice with sepsis-induced brain injury.

Sepsis is a potentially fatal organ failure resulting from a dysregulated host response to infection. It can be a substantial financial burden on families and society due to the high cost of medical care. The study aims to investigate the protective roles of Esmolol in mice with sepsis-induced brain injuries against cognitive dysfunction and neuronal inflammation. Male C57BL/6J mice were intraperitoneally injected with LPS (10 mg/kg, L2630, Sigma) to establish a septic encephalopathy model. Esmolol (15 mg/kg/h, HY-B1392, MedChemExpress) was subcutaneously infused using osmotic mini-pumps for 6 h before LPS injection. Morris water maze and novel object recognition tests evaluated LPS-induced cognitive impairment and behavioral phenotypes. Cytokines and protein expression were assessed using ELISA assay and RT-qPCR. Esmolol treatment potentially improved cognitive impairment in septic mice. Esmolol administration markedly diminished the abnormal hippocampal neuronal structure, and the expression of interleukin (IL)-1β, IL-6, and tumor necrosis factor-α was significantly downregulated in the hippocampal tissue. Esmolol treatment significantly reduced apoptotic TUNEL-positive cells and reversed the related gene expression (BAX and BCL-2). The effects of esmolol on the reactive oxidative species and oxidative stress markedly reduce malondialdehyde MDA content and increase superoxide dismutase and catalase in hippocampal tissues. In addition, esmolol significantly reduced the percentage and density of Iba-1 + microglia in septic mice. Our results demonstrated that esmolol potentially improved cognitive impairment and neuronal inflammation in mice with sepsis-induced brain injury.

Neural tube defects: a review of global prevalence, causes, and primary prevention.

Neural tube defects (NTDs) are common birth defects and contribute to life-long disabilities, high medical care costs, and perinatal and child mortality. This review is a primer on prevalence, causes, and evidence-based prevention strategies for NTDs. The estimated average global prevalence of NTDs is two cases per 1000 births, amounting toapproximately 214,000-322,000 affected pregnancies worldwide annually. Prevalence and associated adverse outcomes are disproportionately high in developing countries. NTDs have multiple risk factors including genetic and non-genetic (i.e., maternal nutritional status, pre-pregnancy diabetes, early pregnancy exposure to valproic acid (anti-epileptic medication), and a previous pregnancy affected by aNTD) factors. Maternal folate insufficiency before and during early pregnancy is the most common risk factor and is preventable. Folic acid (vitamin B9) is required for formation of the neural tube early in pregnancy, around 28days after conception, when most women are unaware of their pregnancies. Current guidelines recommend that all women planning or capable of pregnancy take a daily supplement containing 400-800μg of folic acid. Mandatory folic acid fortification of staple foods (e.g., wheat flour, maize flour, rice) is safe, economical, and the effective intervention for primary prevention of NTDs. Currently, about 60 countries are implementing mandatory folic acid fortification of staple foods, preventing just a quarter of all preventable NTD cases worldwide. There is an urgent need for active champions, including neurosurgeons and other healthcare providers, to generate political will and promote effective mandatory food fortification with folic acid, and reach equitable primary prevention of NTDs in all countries.

MEDICAL METAVERSE: TECHNOLOGIES, APPLICATIONS, CHALLENGES AND FUTURE

Currently, medical technology is developing rapidly and more medical problems are being solved. However, the shortage of medical resources and the high cost of medical care have become severe medical problems in response to the needs of patients. The continuous improvement of medical experience and quality is one of the most critical issues and is widely valued. The metaverse is an emerging digital space that integrates all kinds of technologies, including artificial intelligence, virtual reality, augmented reality, internet technology, blockchain and digital twin, etc. These technologies can ensure an immersive experience in the metaverse for humans to complete various tasks efficiently. Many fields, including video games, industrial production and medical service, have started to pay attention to the application of the metaverse. In the medical field, medical personnel can use the metaverse to achieve efficient diagnosis, education and treatments. And the interaction between medical personnel and patients in digital space can be strong. In this paper, we review the technologies and the applications of the metaverse and explore the potential of the metaverse in healthcare from several application scenarios. Based on this, the current challenges are analyzed and the possible solutions are proposed as the future direction of medical metaverse.

Mobility Analysis of the Lumbar Spine with a Dynamic Spine-Correction Device.

According to data, 60-70% of the world's population experience low-back pain (LBP) at least once during their lifetime, often at a young or middle age. Those affected are at risk of having worse quality of life, more missed days at work, and higher medical care costs. We present a new rehabilitation method that helps collect and analyze data on an ongoing basis and offers a more personalized therapeutic approach. This method involves assessing lumbar spine rotation (L1-L5) during torso movement using an innovative dynamic spine correction (DSC) device designed for postural neuromuscular reeducation in LBP. Spinal mobility was tested in 54 patients (aged 18 to 40 years) without LBP. Measurements were made with 12-bit rotary position sensors (AS5304) of the DSC device. During exercise, the mean lumbar spine rotation to the right was greater (4.78° ± 2.24°) than that to the left (2.99° ± 1.44°; p < 0.001). Similarly, the maximum rotation to the right was greater (11.35° ± 3.33°) than that to the left (7.42° ± 1.44°; p < 0.0001). The measurements obtained in the study can serve as a reference for future therapeutic use of the device.

Health Beliefs, Health Practices, and Health-Seeking Behaviors among Swartzentruber Amish in Clark County, Wisconsin

Although the literature contains valuable information about Amish culture, few qualitative studies have been conducted on the health beliefs, health practices, and health-seeking behaviors of the Swartzentruber Amish, the most conservative group of Old Order Amish. The purpose of this study was to describe these dynamics for the Swartzentruber Amish of Clark County, Wisconsin. Utilizing the grounded theory approach, 25 participants were interviewed and seven themes were identified: shared decision-making is common in families; causes of illness are believed to be etiological or the will of God; home remedies are the first choice; preventive medicine is an unfamiliar concept; health information is sought from within their settlement; and professional medical care is a last resort in treatment. These Amish identified several obstacles to seeking or using professional medical care: unfamiliarity with the English medical system; communication barriers; lack of trust in medical professionals; the high cost of medical care; belief of diminished or no say in a child’s healthcare; and concern about prescription drugs. An understanding of the Swartzentruber Amish is important if healthcare professionals are to provide them with culturally congruent care. Numerous recommendations based on the findings are included for healthcare providers. [Abstract by author.]

Using Machine Learning to Establish the Concerns of Persons With HIV/AIDS During the COVID-19 Pandemic From Their Tweets

There are millions of People Living with HIV/AIDS (PLWHA) globally and over the years, addressing their concerns has been topical for many stakeholders. It is a well-known and established fact that PLWHA are at increased risk of victimization and stigmatization. Unfortunately, the world experienced an outbreak of the COVID-19 pandemic that has led to strict social measures in many states. Thus, it is the goal of this research to study the impact that the outbreak and its mitigation measures have had on the PLWHA. Specifically, we sought to highlight their concerns from sentiments expressed on social media based on posted tweets. By combining machine learning (ML) techniques such as textual mining and thematic analysis, we determined 14 major themes as factors that are worth exploring. In this work, we originally extracted 2,839,091 tweets related to HIV/AIDS posted from March 2020 to April 2022. After initially doing data cleaning and preprocessing, we performed topic modeling using the Latent Dirichlet Allocation (LDA) topic model to extract 25 topics that are made up of 30 keywords each. The topics were then narrowed into 14 themes. The paper details the negative, positive, and neutral sentiment polarities which we highlight as concerning. These sentiments were determined using the Valence Aware Dictionary and sEntiment Reasoner (VADER) Sentiment Analysis Library with a 90% F1-score compared to TextBlob which showed a 53% F1-score. The research findings highlight issues affecting PLWHA during and post-pandemic such as high cost of medical care, late diagnosis of HIV, limited access to medications, stigmatization and victimization, absence of testing kits in hospitals, and lack of urgency in the development of vaccines or cure for HIV.

Associations between Low‐value Medication in Dementia and Healthcare Costs

AbstractBackgroundLow‐value medication (Lvm) provides little or no benefit to patients may be harmful and wastes healthcare resources. However, there is evidence from the literature that Lvm is highly prevalent in age‐associated mental illnesses, such as dementia. Evidence about the financial consequences of Lvm among people living with dementia (PwD) is limited. This study analyzed the association between receiving Lvm and healthcare costs from a payers’ perspective.MethodThis analysis is based on data of 516 community‐dwelling PwD. In total, 14 Lvm were extracted from 1) dementia‐specific guidelines, 2) the German equivalent of the Choosing Wisely campaign, and 3) the PRISCUS list. Healthcare utilization was retrospectively assessed via face‐to‐face interviews with PwD, caregivers, and professional care staff and monetarized by standardized unit costs to calculate costs from a payer perspective. Associations between Lvm and healthcare costs were analyzed using multiple linear regression models.ResultEvery third person living with dementia (n = 159, 31%) received Lvm. PwD who received Lvm were less cognitively impaired (Mini Mental State 23.0 vs. 21.7, p = 0.013). To receive Lvm was associated with higher medical care costs (b = 2,520€; CI95% 1,252€ – 3,788€, p&lt; 0.001), particularly due to higher prevalence of in‐hospital treatment (b = 1,576€; CI95% 424€ – 2,728€, p = 0.007) and higher cost for medication (b = 784€; CI95% 466€ – 1,101€, p&lt; 0.001).ConclusionLvm was very prevalent, more likely to occur in the early stages of dementia and can cause financial harm for payers due to higher costs for in‐hospital care and medications. Further research is required to derive measures to prevent cost‐driving Lvm in primary care and move health expenditures towards higher‐value resource use.

Historical Aspects of Herbal Use and Comparison of Current Regulations of Herbal Products between Mexico, Canada and the United States of America

Increased life expectancy and high costs of medicines and medical care have led to the use of herbal products. However, these items may contain toxic compounds that have an impact on public health. We will focus on the regulatory aspects and differences of these products marketed in the North American region (USA-Mexico-Canada) from government websites and selected literature. Mexico has an ancestral tradition of using plants for the treatment, improvement, and maintenance of human health as compared with Canada and the USA Currently, the use of herbal products in this region has a regulatory framework. The legal framework in these three countries is related to their history, idiosyncrasies, socio-economic and cultural aspects. Therefore, there are different public policies for herbal products consumed in the region. Mexico has a more specific classification of these products. In Canada, all herbal products are classified as natural health products and the safety and efficacy must be scientifically proven. In the USA, the development of botanical drugs is very recent. In particular, both herbal products classified as food supplements in Mexico and dietary supplements in the USA may have risks in both safety and efficacy.

The effects of individual and community-level factors on community-based health insurance enrollment of households in Ethiopia.

IntroductionCommunity-based health insurance (CBHI) is a type of volunteer health insurance that has been adopted all over the world in which people of the community pool funds to protect themselves from the high costs of seeking medical care and treatment for the disease. In Ethiopia, healthcare services are underutilized due to a lack of resources in the healthcare system. The study aims to identify the individual and community level factors associated with community-based health insurance enrollment of households in Ethiopia.MethodsData from the Ethiopian mini demographic and health survey 2019 were used to identify factors associated with community-based health insurance enrollment of households in Ethiopia. Multilevel logistic regression analysis was used on a nationally representative sample of 8,663 households nested within 305 communities, considering the data’s layered structure. We used a p-value<0.05 with a 95% confidence interval for the results.ResultThe prevalence of community-based health insurance enrollment in Ethiopia was 20.2%. The enrollment rate of households in the scheme was high in both Amhara (57.9), and Tigray (57.9%) regions and low (3.0%) in the Afar region. At the individual level; the age of household heads, number of children 5 and under, number of household members, has land for agriculture, has a mobile telephone, receiving cash of food from the safety Net Program, Owning livestock, and herds of farm animals, wealth index, and at the community level; the region had a significant association with community-based health insurance enrollment.ConclusionBoth individual and community-level characteristics were significant predictors of community-based health insurance enrollment in households. Furthermore, the ministry of health, health bureaus, and other concerning bodies prioritize clusters with low health insurance coverage to strengthen health system financing and intervene in factors that negatively affect the CBHI enrollment of households.

Artificial Intelligence in the American Healthcare Industry: Looking Forward to 2030

Artificial Intelligence in the American Healthcare Industry: Looking Forward to 2030

A Retrospective Comparative Study Assessing Patients With Acute Appendicitis During the Pre and Through Lebanese Financial Crisis.

IntroductionIn the past three years, Lebanon, a country located in the Middle East, has faced a severe financial crisis. This crisis had many effects on several sectors in Lebanon, including the healthcare sector. The authors expected an increase in the rate of complicated appendicitis after the crisis due to the shortage of medical supplies. The aim of the study was to compare the rate of complicated acute appendicitis before and after the Lebanese crisis.MethodsThe study included two groups of patients with acute appendicitis. The first group included patients admitted in the period between November 2018 and November 2019 (before the crisis). The second group included patients admitted between November 2020 and November 2021 (during the crisis). The data were collected retrospectively and analyzed using SPSS software (version 25.00) (SPSS Inc., Chicago, IL). Ethical approval was obtained and the study was registered at Al Zahraa hospital, University Medical Center in Beirut, Lebanon.ResultsThe study included 49 patients in the first group (before the crisis) and 46 patients in the second group (after the crisis). The percentage of complicated appendicitis has increased from 22.4% before the crisis to 28.3% during the crisis. The study showed a statistically significant difference between the two groups in the white blood cell count (10,831 versus 7180 cu.mm, respectively, p=0.006), the operating time (59.9 versus 79.0 minutes, respectively; p=0.004), the need to obtain an intra-peritoneal swab for bacterial culture (83.7% versus 58.7%, respectively; p=0.007), and the need for intra-abdominal abscess drainage (6.1% versus 28.3%, respectively; p=0.004). There were no significant differences in the demographics, the duration of postoperative antibiotic use, the duration of stay in the hospital, and the postoperative complications in the first month following surgery.ConclusionDue to the decreased financial income, the high cost of medical care during the Lebanese crisis, and the delay of patients’ presentation to the hospital, the rate of complicated appendicitis increased during the crisis.

Cardiovascular Service Line Chaplain at an Academic Medical Center: Creation, Implementation, and Establishment

Problem Statement: As health care providers and organizations have become complex and specialized, efforts to address the spiritual needs of patients and care team members are often absent. Background: Medical advances, life-saving treatments, and increased efficiency of patient care have all come at a cost to patients and health care providers. We appropriately measure our care team’s performance with disease- and procedure-specific data on morbidity and mortality. However, these measurements come at the risk of rewriting Hippocrates’ endeavor from “cure sometimes, relieve often, comfort always” to “cure always.” The suggestion that failure is not an option is an unattainable expectation with a high price, namely the spiritual distress of care team members, patients, and their families. In 2018, The Joint Commission addressed the issue of unmet spiritual needs, stating that these needs can be associated with greater emotional distress, pain, and anxiety; higher medical care costs; and poorer quality of life. Application: In 2015, the cardiovascular service line at an academic medical center implemented a spiritual care provider position to address the unmet spiritual needs of patients and care team staff. In this article, we describe (1) the evolution of the spiritual care provider’s role and (2) the impact of this resource on the healing of patients and as a support for the personal and professional well-being of health care providers.