Higher Medical Costs Research Articles

Clinical and Economic Insights into Parkinson’s Disease Hospitalization: A Comprehensive Study of 19,719 Inpatient Cases in Hubei Province, China

Objective: Parkinson’s disease (PD) is a profoundly incapacitating neurodegenerative disorder, which presents a substantial challenge to the economic sustainability of the global healthcare system. The present study seeks to clarify the factors that contribute to the costs associated with PD hospitalization and analyze the economic burden it imposes. Methods: We examined data of 19,719 patients with a primary diagnosis of PD who were admitted to hospitals in Hubei Province, China, during the study period. Healthcare data were obtained from the database of electronic medical records. The study presents a comprehensive analysis of the demographic characteristics and investigates the factors that affect their healthcare expenditure. Results: The cohort consisted of 10,442 (53.0%) males and 9,277 (47.0%) females. The age-group of 66–70 years experienced the highest incidence of hospitalization among PD patients, with a mortality rate of 0.76‰. The average length of stay for patients was 9.9 ± 8.6 days and the average cost per patient was USD 1,759.9 ± 4,787.7. Surgical interventions were conducted on a mere 2.0% of the total inpatient population. The primary cost component for these interventions was material expenses, accounting for 70.1% of the total. Non-surgical patients primarily incurred expenses related to diagnosis and medication. Notably, surgical patients faced a substantial out-of-pocket rate, reaching up to 90.6%. Surgery was identified as the most influential factor that negatively affected both length of stay and hospitalization costs. Inpatients exhibited significant associations with prolonged length of stay and increased medical expenditure as age increased. Male patients had significantly longer hospital stays and higher medical costs than did females. Additionally, patient’s occupation and type of medical insurance exerted significant effects on both length of stay and medical expense. Conclusion: Age significantly affects PD hospitalization costs. Given the prevailing demographic shift toward an aging population, the government’s medical insurance burden related to PD will continue to escalate. Meanwhile, high treatment expenses and out-of-pocket rates impose substantial financial burdens on patients, limiting surgical intervention access to a small fraction of patients. Addressing these issues is of utmost importance in order to ensure comprehensive disease management for the majority of individuals affected by PD.

Assessment of potential drug–drug interaction knowledge, attitude, and practice among Egyptian hospital and community pharmacists: a cross-sectional multicenter study

BackgroundPharmacists have an important role in preventing prescribing errors and providing appropriate information. They can detect potential drug–drug interactions (DDIs), which are associated with a more extended hospital stay and higher medical costs that lead to substantial financial burdens on healthcare systems. This study aimed to evaluate and assess the knowledge of community and hospital pharmacists toward drug–drug interaction and their attitude and motivation to find DDI information, in addition to identifying the pharmacist factors affecting this knowledge. A cross-sectional multicenter study was conducted using a self-administered questionnaire. Nineteen drug pairs, that are common in clinical practice, were evaluated. This study aimed to evaluate and assess the knowledge of community and hospital pharmacists toward drug–drug interaction and their attitude and motivation to find DDI information, in addition to identifying the pharmacist factors affecting this knowledge.ResultsA total of 4363 pharmacists (2260 community pharmacists and 2103 hospital pharmacists) have completed the survey. The participants' knowledge of DDIs was 58.25%, and there was no significant difference in pharmacist knowledge between community and hospital pharmacists (p = 0.834). The highest correct answer was for sildenafil and isosorbide mononitrate pair 78.8%. The most used source of information was the internet or mobile applications, 47.1%. Participants who always considered PDDIs while prescribing detected more drug interactions than those who did not (p = 0.001).ConclusionAccording to the findings of this study, community and hospital pharmacists had comparable knowledge of DDIs. However, before dispensing uncommon prescriptions, they should consult evidence-based drug information resources and DDI software to identify potential drug interactions.

Prevalence, early predictors, and outcomes of sepsis in neurocritical illnesses: A prospective cohort study

Patients with neurocritically illness are an under-recognized population at high risk of sepsis. We aimed to investigate the prevalence, early predictors, and outcomes of sepsis in neuro-ICU. Daily and accumulative incidences of sepsis in neuro-ICU were explored. Demographics, medical history, baseline disease severity scores, and baseline biomarkers regarding inflammation, immunology, organ function, and nutritional status were collected and analyzed as potential predictors of sepsis. Logistic regression analyses were used to determine the independent predictors, and a nomogram was used to estimate the individual probability of sepsis in neuro-ICU. 153 patients were included in this study. Fifty-nine (38.6%) patients developed sepsis, and 21 (14%) patients developed septic shock. More than 86% of the septic cases occurred within the first week. Sequential organ failure assessment score ((relative risk) RR 1.334, P=.026), history of diabetes (RR 2.346, P=.049), and transferrin (RR 0.128, P=.042) on admission are independent predictors of sepsis. Septic patients had significantly higher mortality (P=.011), higher medical cost (P=.028), and a lower rate of functional independence (P=.010), compared to patients without sepsis. Sepsis afflicted more than one-third of neurocritically-ill patients and occurred mostly in the first week of admission. History of diabetes, serum transferrin, and sequential organ failure assessment score on admission were early predictors. Sepsis led to significantly worse outcomes and higher medical costs.

Evaluation of costs related to antimicrobial resistance of priority Gram-negative bacilli

Introduction. Antimicrobial Resistance (AMR) is one of the most serious threats to global public health, causing over 700 thousand deaths annually. In addition to the social burden, AMR generates high medical costs, and estimating these at the hospital level has been the subject of research in many international studies. 
 Material and methods. A comprehensive study was conducted, encompassing 172 cases of invasive infections recorded in patients hospitalized at the “Timofei Mosneaga” Republican Clinical Hospital, from which strains of antimicrobial-resistant E. coli, K. pneumoniae, A. baumannii, and P. aeruginosa were isolated in the years 2019-2021. Based on data regarding the duration of hospitalization, treatment costs, and expenses for investigations, indicators such as average cost, the median, minimum and maximum values of treatment, including the cost of antibiotics and laboratory analyses, were calculated.
 Results. The economic impact indicators of AMR at the hospital level include: the duration of hospitalization, the total costs of a treated case, the costs of antibiotics, and the costs of laboratory analyses. In the structure of microorganisms isolated from the patients included in the study, K. pneumoniae predominates, accounting for 44.2%, and the total treatment cost for this organism was the highest at 202731.5 dollars. The maximum duration of hospitalization was recorded in patients from whom A. baumannii was isolated (27.7 days).
 Conclusions. The resistance of strains isolated from patients has directly contributed to the extension of the hospitalization period. The resistance of A. baumannii and K. pneumoniae species has predominantly led to the increase in the economic burden of AMR.

Pricing of medicines as a factor influencing access to treatment

The article is devoted to the topic of access to treatment, and the issue of pricing as one of the factors that significantly affect the ability of the population to access treatment through the purchase of medicines, including expensive branded medicines that are not covered by government programs that provide such medicines free of charge. High medication costs can pose substantial barriers, particularly for those not covered by state programs, exacerbating health inequalities and hindering widespread access to necessary treatments.
 The article focuses on the existence of two pricing systems in the pharmaceutical market, namely, the state and market pricing. The aforementioned pricing systems are among the mechanisms for providing pharmaceutical care to the population in Ukraine. It is also argued that pricing is based on demand, cost, supply, and commodity and money circulation.
 The article presents the US experience of pricing and the problems of consumers who face the need to overpay for branded medicines by a significant number of times compared to European consumers.
 This dynamic reflects the delicate balance between the pharmaceutical industry’s need for fair returns on innovation investments and the imperative to make essential treatments financially accessible to the broader population.
 It is noted that the high price of medicines is due to the influence of numerous factors, including increased demand, insufficient supply of cheaper generic drugs on the pharmaceutical market, patent protection, and significant investment in the development and research of new medicines. At the same time, it is argued that the use of managed access agreements, along with both state and market pricing, can be a deterrent to the growth of prices for branded innovative medicines.

Improvement in Diabetic Patient’s Compliance: A Clinical Audit in Accordance with NICE Guidelines

Management of diabetes mainly depends on adherence to the prescribed medicine; however, majority of patients fails to cope with their diabetes management plans due to reasons such as high cost of medication, their side effects, and limited knowledge or understanding of the disease. Medication adherence was accessed in this audit among diabetic patients at the Outpatient department (OPD), Divisional Headquarters (DHQ) Teaching Hospital Mirpur, Azad Jammu and Kashmir (AJK), Pakistan, which focuses on alignment with National Institute for Health and Care Excellence (NICE) guidelines. Adherence was evaluated using a collection of the combination of prospective and retrospective data, through investigation from the patients and review of the records. On 2nd cycle of follow-up, a marked improvement in patients’ adherence to medication, HBA1c levels, smoking cessation and complication rate. Upon 2nd cycle of audit, study also showed a better control on reason of non-compliance to treatment. The cause for non-compliance due to cost issue and lack of understanding was 45% initially, that later shortened to 1% while due to forgetfulness, it also lessened to 1%. We also had a sufficient improvement in follow up visits and sugar monitoring of patients and overall adherence rate was improved. Significant gaps were revealed in the findings by comparing with NICE guidelines, which give emphasis on regular monitoring and focused care of patients. This audit recommends interventions such as education sessions for patients, consultations through tele consults, and regular medical reviews to improve adherence and optimize diabetic care outcomes.

Exploring the Barriers to Mental Health Care and Mitigation Strategies in Kenya

Barriers to mental health care globally remain a health concern, however, these are more pronounced in low- and middle-income countries. The prevalence of mental illness is approximately 10%. A gap exists between the need or demand for mental health services due to a set of barriers that limit access. Based on this gap, this paper aims to explore barriers to mental health services, treatment and services sought. This might contribute to mitigating them. The barriers include inadequate funds, poverty, stigma attached to mental health conditions, lack of faith in mental health services, high cost of medication, poor awareness, socio-cultural and religious influences and inadequate mental health facilities. These barriers have been shown to affect mental health. After decades of neglect, recent efforts by governments such as in Kenya to address barriers to mental health can demonstrate the growing importance of this issue. Evidence shows that barriers to mental health impacts on mental health in Africa, moreso Kenya and demonstrates that there is need for more contextual awareness and research in this area in Africa to mitigate potential mental health crises in the near future. It is important that institutions and governments in Africa, Kenya to begin paying attention to this emerging threat to the health of the population.

High Medical Costs and Homelessness Vulnerability Among Older Adults in Washington, DC: A Policy Analysis

The increasing risk of homelessness among older adults in Washington, DC, fueled predominantly by soaring medical expenses, represents a pressing societal concern. Despite notable reductions in overall homelessness rates, the number of older adults experiencing homelessness remains unchanged. As the demographic of older adults grows, the urgency to address this issue escalates. This article examines the complex nexus of high medical costs, poverty, and homelessness among the elderly community in Washington, DC. The article proposes, evaluates, and recommends five policy alternatives geared toward addressing this multifaceted predicament. After employing a rigorous policy analysis approach, alternative two, which focuses on expanding Medicare coverage by lowering eligibility criteria from 65 to 63 years of age, is the recommended policy choice. This proposed recommendation not only aims to ameliorate immediate financial vulnerabilities but also endeavors to democratize access to indispensable healthcare services. Through a blend of empirical analyses, this measure best mitigates the risk of homelessness among the elderly populace in the nation's capital. In synthesizing empirical insights, theoretical perspectives, and policy pragmatism, this article seeks to catalyze informed dialogue and efficacious action toward safeguarding the dignity and security of older adults in Washington, DC, and beyond.

Examining prevalence and predictors of pulmonary hypertension in adults with idiopathic pulmonary fibrosis: a population-based analysis in the United States.

Pulmonary hypertension (PH) often complicates idiopathic pulmonary fibrosis (IPF), a progressive parenchymal lung disease. We investigated predictors of PH in IPF hospitalizations in the United States. We identified IPF hospital- izations with or without PH using the National Inpatient Sample (2018) and relevant ICD-10-CM codes. We com- pared demographics, comorbidities, PH prevalence, and its multivariable predictors adjusted for confounders among patients with IPF. In 2018, 30,335 patients from 30,259,863 hospitalizations had IPF, of which 8,075 (26.6%) had PH. Black (41%), Hispanic (21.3%), and female (28.7%) patients had higher rates of PH compared to white patients (25%). The IPF-PH cohort was hospitalized more often in urban teaching (77.7% vs. 72.2%), Midwest, and West hospitals vs. non-PH cohort. Comorbidities including congestive heart failure (2.08 [1.81-2.39]), valvular disease (2.12 [1.74-2.58]), rheumatoid arthritis/collagen vascular disease (1.32 [1.08-1.61]) predicted higher odds of PH. The PH-IPF cohort was less often routinely discharged (35.4%) and more likely to be transferred to intermediate care facilities (22.6%) and home health care (27.1%) (P < 0.001). The PH-IPF group had higher rates of all-cause mortality (12.3% vs. 9.4%), cardiogenic shock (2.4% vs. 1%), dysrhythmia (37.6% vs. 29%), and cardiac arrest (2.7% vs. 1.5%) vs. non-PH cohort (all P < 0.001). Patients with PH-IPF also had longer hospital stays (9 vs. 8) and a higher median cost ($23,054 vs. $19,627, P < 0.001). Nearly 25% of IPF hospitalizations with PH were linked to higher mortality, extended stays, and costs, emphasizing the need to integrate demographic and comorbidity predictors into risk stratification for improved outcomes in patients with IPF-PH.

Risk estimation for recurrent cardiovascular events using the SMART-REACH model and direct inpatient cost profiling in Indonesian ASCVD patients: a large-scale multicenter study.

With atherosclerotic cardiovascular disease (ASCVD) cases increasing in Indonesia, there is a growing need to identify high-risk patients for recurrent cardiovascular events. Risk stratification could guide optimal secondary preventive therapy. Understanding the ASCVD direct inpatient costs could further provide insight in reducing the economic burden that comes with Indonesia's high number ASCVD cases. However, there is a significant gap in Indonesian large-scale research on both of these valuable data. Employing the SMART-REACH model, we can profile the risk of recurrent cardiovascular events in Indonesian ASCVD patients. Utilize the SMART-REACH model to estimate 10-year and lifetime risk of cardiovascular events in Indonesian ASCVD patients and describe the direct inpatient cost of ASCVD. This descriptive cross-sectional study gathered data from 3,209 ASCVD patients aged 45-80 from two major cardiovascular centers using purposive sampling. Participants were patients admitted between January 2020 and March 2023 with ST-elevated myocardial infarct (STEMI), non-ST-elevated myocardial infarct (NSTEMI), and chronic coronary syndrome (CCS) requiring elective percutaneous coronary intervention (PCI). The SMART-REACH risk estimation model required clinical data upon admission, laboratory results within the first 24 h of admission, and cardiovascular medication prescribed upon discharge. The SMART-REACH model is a Fine and Gray competing risk model incorporating cardiovascular risk factors that estimates individual 10-year and lifetime risk for recurrent cardiovascular events which includes myocardial infarction, stroke, or vascular death. Direct inpatient cost profiling totaled all medical expenses incurred from ASCVD diagnosis admission to discharge. Results were reported descriptively with subgroup analyses. The cohorts (mean age 60.15 ± 8.6 years) were predominantly male [n = 2,537 (79.1%)], hypertensive [n = 2,267 (70.6%)], and diagnosed with STEMI [n = 1,732 (54%)]. The SMART-REACH model calculated a mean 10-year risk of 30.2% (95% CI 29.7-30.6) and a lifetime risk of 62.5% (95% CI 62.1-62.9). The direct inpatient cost of ASCVD patients includes a median 3,033 USD, with highest median costs in the STEMI subgroup (3,270 USD). A significant number of Indonesian ASCVD patients exhibited notably high 10-year and lifetime risks of experiencing a major cardiovascular event. Combined with the direct inpatient cost, therapy optimization is crucially needed to mitigate these risks and further cost burden.

Cattle Pinkeye Disease Classification using Machine Learning

Pinkeye (infectious bovine keratoconjunctivitis, or IBK) is a bacterial infection of the cattle eye that causes inflammation and, in severe cases, temporary or permanent blindness. It is a painful, debilitating condition that can severely affect animal productivity. Due to lower weight gain, lower milk production, and higher medical costs, the cattle industry could experience large losses. Previous studies tried to classify livestock diseases using machine learning, but there has been a lack of studies conducted on pinkeye disease classification. The proposed study aims to design a classification model to classify whether the infected cattle have pinkeye or not at an early stage by analyzing a set of attributes. The study collected data from the Wolaita Sodo Kenido Koyisha Wereda Livestock and Fishery Office. The significance of this study is to prevent the expansion of disease among the cattle with an early detection for taking precautionary measures. The researchers used the percentage splits 80/20, 70/30, 60/40, and 90/10 to build classification models. Based on the results of the experiments, the researcher chose the 70/30 split due to the better performance obtained. The study trained four different models, including Random Forest, AdaBoost, Artificial Neural Network, and Extreme Gradient Boost algorithms. These models are selected based on an exhaustive study conducted. To assess the algorithm's performance, confusion matrix, accuracy, precision, recall, and f1-score have all been utilized. By a 99.15% accuracy, the Artificial Neural Network outperforms the other algorithms by all the metrics except recall.&#x0D; Keywords: Machine learning, Infectious bovine keratoconjunctivitis, IBK, Cattle pinkeye, Pinkeye disease classification

Feasibility Study of Music Therapy Based Autism in Children

With the significant increase in the number of children with autism in the last decade, it has attracted extensive attention from the society. Autistic children always have to bear a very high pressure of social opinion, while they themselves experience physical pain at the same time. At the same time, the families of autistic children need to bear very great financial pressure, and they need to pay high treatment costs and medication costs. The cost of time also increases as they need to spend more attention on the care of the autistic child. This is why autism treatment is especially important and relevant in today's society. The most common method used by healthcare providers today is the traditional applied behavior analysis (ABA) therapy. However, traditional applied behavior analysis (ABA) therapy have always ignored the uniqueness of each autistic child and how to integrate into society and increase communication skills. These shortcomings can be solved by the introduction of music therapy, and music therapy can help autistic children better control their emotions and soar in social skills. What is also not to be overlooked is that music therapy reduces the cost of therapy and has greater tolerance and possibilities for the therapeutic environment and equipment. This undoubtedly overcomes some of the drawbacks associated with traditional treatments and improves the efficiency of healthcare while reducing healthcare costs. This paper attempts to analyze the role of music therapy in the treatment of children with autism and to provide feasible recommendations. It also calls on the society to pay more attention to the group of autistic children and light up a light for them.

Efficacy of pantoprazole plus perforation repair for peptic ulcer and its effect on the stress response.

Peptic ulcer (PU) is an abnormal phenomenon in which there is rupture of the mucosa of the digestive tract, which not only affects patients' normal life but also causes an economic burden due to its high medical costs. To investigate the efficacy of pantoprazole (PPZ) plus perforation repair in patients with PU and its effect on the stress response. The study subjects were 108 PU patients admitted between July 2018 and July 2022, including 58 patients receiving PPZ plus perforation repair [research group (RG)] and 50 patients given simple perforation repair [control group (CG)]. The efficacy, somatostatin (SS) concentration, stress reaction [malondialdehyde (MDA), lipid peroxide (LPO)], inflammatory indices [tumor necrosis factor (TNF)-α, C-reactive protein (CRP), interleukin (IL)-1β], recurrence, and complications (perforation, hemorrhage, and pyloric obstruction) were compared. The overall response rate was higher in the RG than in the CG. Patients in the RG had markedly elevated SS after treatment, which was higher than that of the CG, while MDA, LPO, TNF-, CRP, and IL-1β were significantly reduced to lower levels than those in the CG. Lower recurrence and complication rates were identified in the RG group. Therefore, PPZ plus perforation repair is conducive to enhancing treatment outcomes in PU patients, reducing oxidative stress injury and excessive inflammatory reactions, and contributing to low recurrence and complication rates.

Impact of diabetes on medical costs in the pre- and postoperative year of lower extremity amputations in Belgium

AimsTo compare the medical costs of individuals undergoing lower extremity amputation (LEA) in Belgium with those of amputation-free individuals. MethodsBelgian citizens undergoing LEAs in 2014 were identified. The median costs per capita in euros for the 12 months preceding and following minor and major LEAs were compared with those of matched amputation-free individuals. ResultsA total of 3324 Belgian citizens underwent LEAs (2295 minor, 1029 major), 2130 of them had diabetes. The comparison group included 31,716 individuals. Amputation was associated with high medical costs (individuals with diabetes: major LEA €49,735, minor LEA €24,243, no LEA €2,877 in the year preceding amputation; €45,740, €21,445 and €2,284, respectively, in the post-amputation year). Significantly higher costs were observed in the individuals with (versus without) diabetes in all groups. This difference diminished with higher amputation levels. Individuals undergoing multiple LEAs generated higher costs (individuals with diabetes: €39,313–€89,563 when LEAs preceded index amputation; €46,629–€92,877 when LEAs followed index amputation). Individuals dying in the year after a major LEA generated remarkably lower costs. ConclusionsLEA-related medical costs were high. Diabetes significantly impacted costs, but differences in costs diminished with higher amputation levels. Individuals with multiple amputations generated the highest costs.

A FRAMEWORK OF SUPPORT: THE NURSING HOME PERSON-CENTERED OPTIONS COUNSELING CERTIFICATION PROGRAM

Abstract Person-centered initiatives and approaches are the cornerstone of best practices when it comes to supporting older adults and persons living with dementia. Lack of person-centered care has been associated with higher medical costs and negative health outcomes, particularly in low-resource communities. Implementing person-centered care may help to address disparities and improve care outcomes in these communities, although it is often unclear which approaches are most appropriate. The Person-Centered Options Counseling Certification program attempts to address this gap via a mentoring program and competency framework. Developed and piloted in rural New Hampshire, this framework helps professionals and organizations evaluate the approaches that works best for them, while creating fidelity for ongoing support through a rigorous mentorship program. The framework shows promise of being cost effective, an important consideration for many low-resource communities. Professionals can attain knowledge, skills, and abilities without incurring higher education costs and agencies can utilize pre-developed instructional materials. Pilot data was collected to evaluate the program and demonstrated that professionals found the educational training delivered within the framework was relevant to their community and increased their knowledge about person-centered care, although some expressed hesitancy when applying the skills learned with individuals. Professionals who completed both the training and participated in the mentorship program reported a high level of competency, satisfaction, and confidence in delivering person-centered care. The use of this framework may support staff retention in low-resource communities and approaches can be tailored across different environments to facilitate the delivery of person-centered care.

Research progress of nociplastic pain in the clinical treatment of chronic pain diseases

Chronic pain is increasingly developing into a worldwide health problem. Due to the money and treatment required for care and rehabilitation, as well as the complexity of the various types of pain, chronic pain sufferers often bear a huge financial burden as well as a psychological one. According to statistics, 23% of chronic pain sufferers have suicidal thoughts. In 2017, the third category pain named "nociplastic pain" was proposed for the first time by the International Association for the Study of Pain (IASP) which is disparate with the first kind nociceptive pain and the second pain neuropathic. The physiological mechanisms behind this type of pain are not known. However, it is commonly thought to be associated with a hypersensitivity response in the central nervous system and can be resulted in chronic nociceptive pain, so nociplastic pain is able to occur by itself, and can combine with other pain. At the same time, this type of pain affects the central system and produces other derived symptoms. Examples include stimulation of the limbic system, including impaired processing of emotions by the amygdala, amplified pain perception, sleep disturbances, increased fatigue and sensitivity to external environmental stimuli. There are no very clear and obvious diagnostic criteria or methods, and clinical detection is difficult. Due to the many symptoms, patients usually undergo multiple tests, with high medical costs and a poor prognosis. Patients suffer both physical and psychological distress. The disease with its complexity characteristic leads the difficulty for doctors to diagnosis it plagues patients with the condition, while increasing the difficulty of medical diagnosis and the cost of medical treatment. This article synthesizes the existing developments in outcomes in nociplastic pain from introduction and classification to diagnosis and treatment, it discusses the existing research findings.

Optimizing CFTR modulator therapy management for cystic fibrosis through the ReX platform.

Cystic fibrosis (CF) is a chronic multi-systemic disease that requires a complex daily treatment regimen. Therefore, there is sub-optimal adherence to CF therapies, and it was shown to impact its clinical and economic burden. Cystic fibrosis transmembrane conductance regulator modulators (CFTRm) are high-cost medications that demonstrated significant benefit in clinical trials. The aim of this study was to evaluate the safety, usability, and efficacy of the ReX platform in medication management of CFTRm for the treatment of people with CF (pwCF). ReX is a patient engagement platform consisting of a cloud-based management system and a cell-enabled handheld device intended to dispense oral medication into the patient's mouth, following a pre-programmed treatment protocol. It provides real-time adherence data to caregivers and timely, personalized reminders to patients. This is a prospective multi-center open study for pwCFs older than 12 years, who had been prescribed CFTRm [elexacaftor/tezacaftor/ivacaftor (ETI) or tezacaftor/ivacaftor (TI)], and provided consent to use ReX platform to receive CFTRm and record their health condition. Study duration was 12-24 months, with clinic visits where physical examination, body mass index (BMI), and pulmonary function tests were performed, and user experience questionnaires were filled in. Ten pwCFs from two CF centers in Israel were included. The mean age was 31.5 years (range 15-74 years); eight were taking ETI and two TI. Median adherence to CFTRm was 97.5% (range 70%-100%) in the first year and 94% (range 84%-99%) in the second year, which is higher than the previously reported CFTRm adherence of ∼80%. No adverse events related to the use of the platform were reported. Patients reported ReX to be valuable to their treatment management and user friendly. Estimated mean forced expiratory volume in 1 s (FEV1%) increased from 74.4% to 80.8% (p = 0.004) over 2 years. Similarly, estimated BMI percentile increased from 53.5 to 59.0 (p < 0.001). Using the ReX platform in medication management of pwCF treated by CFTRm is safe, easy to use, and effective in improving the adherence to treatment and the clinical outcomes. Consequently, this device may potentially reduce costs to healthcare providers. Further larger and long-term studies are required to examine the clinical benefits of the ReX platform.

A functionalized Sup35NM nanofibril-assisted oriented antibody capture in lateral flow immunoassay for sensitive detection of dengue type II NS1.

Rapid and sensitive dengue non-structural protein 1 (NS1) detection assay is essential for the treatment of disease and currentlyreleases high medical cost burdens. To address the limitations of conventional LFIA strips, we have developed an improved Sup35NM-Z-based LFIA that immobilizes antibodies on cellulose membranes in an orientated manner to increase the sensitivity of LFIA strips. A dual-functional Sup35NM nanofibril was fabricated by fusion with the antibody binding domain; resultant nanofibril from the amyloid Sup35NM was sprayed on the T-line to orientate the capture antibody and produces fluorescence signals. Antibody binding analysis showed that self-assembly of the Sup35NM monomer does not affect the binding activity of the Z-domain with the antibody. The NS1 for DENV-2 infection was chosen as a model target antigen to assess the feasibility of the Sup35NM-Z-domain-based LFIA platform. Under optimal conditions, the Sup35NM-Z-domain-based LFIA detected NS1 within 15 min with a detection limit of 1.29 ng/ml, while the detection limit of traditional LFIA with the same concentration of anti-NS1-Ab1 on the T-line by conventional physical adsorption was 2.20 ng/ml, 1.7 times higher than that of Sup35NM-Z-domain-based LFIA. As compared to traditional LFIAs, the Sup35NM-Z-based LFIA had a wide detection range of 1.29-625 ng/mL. The LFIA's clinical performance in identifying NS1 was also assessed using 15 clinical samples. The LFIA accurately recognized positive and negative samples, equal to 86.7% accuracy. The developed Sup35NM-Z-domain-based LFIA in this study offers great potential for the identification of target markers because of its greatly improved sensitivity and wider detection range.

GADNN: A graph attention-based method for drug-drug association prediction considering the contribution rate of different types of drug-related features

The simultaneous use of multiple drugs, known as drug combinations, is increasingly common in the treatment of complex diseases such as cancer. However, drug-drug interactions (DDIs) caused by the simultaneous use of multiple drugs can lead to unexpected side effects and even death, resulting in high medical costs. Therefore, understanding potential DDI is an essential step in reducing the risk of adverse drug reactions before administering clinical drug compounds. Recently, many machine learning-based methods for DDI prediction have been introduced, but in these methods, no attention is paid to determining the contribution rate of each type of drug feature. Here, a Graph Attention-based Deep Neural Network method called GADNN is proposed to predict DDIs based on considering the influence or contribution rate of different drug-related features. The introduced method consists of two stages. In the first stage, four basic drug datasets, including target, enzyme, infrastructure, and pathway, are used as types of drug features. Using a graph neural network-based method, the embedding vector is generated for each drug based on each dataset separately. In the second stage, the contribution coefficient of each dataset is calculated dynamically through a new graph attention mechanism. Then, the weighted combination of the separate vectors is used to predict the probability of drug-drug interactions using a dense neural network. The experimental results confirmed that the presented innovation has been able to improve the accuracy compared to state-of-the-art methods.

Application of telenursing as a nursing care delivery model in improving treatment adherence and glycemic control: A scoping review

Background: Diabetes mellitus is one of the chronic diseases that cause the highest mortality and high medical costs;, therefore medication adherence and glycemic control are important in disease management, one of which is through telenursing. Purpose: To determine the telenursing model to improve medication adherence and glycemic control in patients with type 2 diabetes mellitus. Methods: This study was designed a scoping review. The databases used are CINAHL, PubMed, ScienceDirect and Google Scholar. Articles published from 2016-2022 with appropriate inclusion and exclusion criteria. Thematic analysis was used based on study design, telenursing communication model, telenursing process, duration of telenursing and results. Results: There were 12 relevant articles out of 2112 articles. We found a telephone call follow up is the most common method used for delivery of telenursing intervention. Telenursing intervention is implemented from at least 3 months until 12 months, and includes the assessment of current disease conditions, assessment of adherence to the prescribed treatment plan, treatment plan information, and solutions or follow-up to current issue. Conclusion: Telenursing can be used as a nursing care delivery model in the diabetes mellitus type 2 patients because it is proven to reduce glycemic control, improve treatment adherence, reduce body mass index (BMI), glycosylated hemoglobin (HbA1c), and cholesterol, and improve diet adherence, physical exercise and self-management.