Increased Health Care Expenses Research Articles

Level of medication adherence and its determinants of cardiovascular disease patients attending at specialized teaching hospitals of Amhara regional state, Ethiopia: a multicenter cross-sectional study

BackgroundNon-adherence to medication in patients with cardiovascular disease continues to be a main cause of suboptimal management, increased morbidity and mortality, and increased healthcare expenses. The present study assessed the level of medication adherence and its determinants of cardiovascular disease patients.MethodsAn institutional-based multicenter cross-sectional study was conducted with patients with cardiovascular disease in Northwest Ethiopian teaching hospitals. The level of medication adherence was evaluated using a standardized questionnaire of the Adherence in Chronic Disease Scale (ACDS). To find determinants of the level of medication adherence, an ordinal logistic regression model was employed. Statistics were significant when P ≤ 0.05 at a 95% confidence interval (CI).ResultsIn the end, 336 participants were included in the research. According to this study, one-third of patients had low medication adherence, half had medium adherence, and one-fifth had high medication adherence. Elderly patients [adjusted odds ratio (AOR) = 2.691; 95% confidence interval (CI), 1.704–4.251; P < 0.000], marital status (AOR = 1.921; 95% CI, 1.214–3.039; P = 0.005), alcoholic patients (AOR = 2.782; 95% CI, 1.745–4.435; P < 0.000), Patients without physical activity (AOR = 1.987; 95% CI 1.251–3.156; P = 0.004), non health insurances (AOR = 1.593; 95% CI 1.003–2.529; P = 0.049), sever Charles comorbidity index (AOR = 2.486; 95% CI 1.103–5.604; P = 0.028), patients with polypharmacy (AOR = 2.998 (1.817–4.947) P < 0.000) and, manypolypharmacy (AOR = 3.031 (1.331–6.898) P = 0.008) were more likely to have low medication adherence.ConclusionThe current study concluded that one-third of study participants had low medication adherence. Older age, marital status, drinker, physical inactivity, drug source, comorbidity, and polypharmacy all contributed to the low level of medication adherence. To improve patients with cardiovascular disease’s adherence to their medications, intervention is necessary.

Comparison of short-wave diathermy, Transcutaneous electrical nerve stimulation of electrotherapy methods and exercise therapy in chronic low back conditions

Background: Low back pain is a significant contributor to global disability, impacting individuals across different age groups. Research suggests that around 80% of people will encounter low back pain at some stage in their lives. This condition is more prevalent among middle-aged and elderly individuals, with a higher occurrence among females. The socioeconomic consequences of low back pain are substantial, including increased healthcare expenses, absenteeism from work, and a diminished quality of life. Objective: To compare the effectiveness of short-wave diathermy with exercise, transcutaneous electrical nerve stimulation with exercise, and exercise alone among patients with chronic low back pain. Patients and Methods: 75 patients who were diagnosed with chronic low back pain, ages 20–50, participated. They were divided into three groups: group A received shortwave with exercise, group B received TENS with exercise, and group C received just exercise. Treatment was given for 12 sessions over a period of 4 weeks. All patients were evaluated before and after treatment using a visual analog scale and the Oswestry Low Back Pain Disability Questionnaire. Results: The results showed that all three interventions were effective in reducing pain and improving physical activities, with varying degrees of success. But also, the result showed that the mean difference for the short wave with exercise is much higher than both the TENS with exercise and the exercise alone types of interventions in each of the different categories, respectively. Conclusion: This study has shown that shortwave exercise is more effective in the treatment of chronic low back pain than TENS with exercise and exercise alone.

Comparison of short-wave diathermy, Transcutaneous electrical nerve stimulation of electrotherapy methods and exercise therapy in chronic low back conditions

Background: Low back pain is a significant contributor to global disability, impacting individuals across different age groups. Research suggests that around 80% of people will encounter low back pain at some stage in their lives. This condition is more prevalent among middle-aged and elderly individuals, with a higher occurrence among females. The socioeconomic consequences of low back pain are substantial, including increased healthcare expenses, absenteeism from work, and a diminished quality of life. Objective: To compare the effectiveness of short-wave diathermy with exercise, transcutaneous electrical nerve stimulation with exercise, and exercise alone among patients with chronic low back pain. Patients and Methods: 75 patients who were diagnosed with chronic low back pain, ages 20–50, participated. They were divided into three groups: group A received shortwave with exercise, group B received TENS with exercise, and group C received just exercise. Treatment was given for 12 sessions over a period of 4 weeks. All patients were evaluated before and after treatment using a visual analog scale and the Oswestry Low Back Pain Disability Questionnaire. Results: The results showed that all three interventions were effective in reducing pain and improving physical activities, with varying degrees of success. But also, the result showed that the mean difference for the short wave with exercise is much higher than both the TENS with exercise and the exercise alone types of interventions in each of the different categories, respectively. Conclusion: This study has shown that shortwave exercise is more effective in the treatment of chronic low back pain than TENS with exercise and exercise alone. Keywords: Shortwave, TENS, Exercise, Chronic low back pain.

Antifungal activity of a trypsin inhibitor from Salvia hispanica L. (chia) seeds against fluconazole-resistant strains of Candida spp. and evaluation of its toxicity in vitro.

The incidence of Candida species resistant to traditional antifungal drugs is increasing globally. This issue significantly impacts patients' lives and increases healthcare expenses, confirming the need to develop novel therapeutic strategies. Recently, a thermostable trypsin inhibitor named ShTI (11.558kDa), which has antibacterial effects on Staphylococcus aureus, was isolated from Salvia hispanica L. (chia) seeds. This study aimed to assess the antifungal effect of ShTI against Candida species and its synergism with fluconazole and to evaluate its mode of action. Preliminary toxicological studies on mouse fibroblasts were also performed. ShTI exhibited antifungal effects against C. parapsilosis (ATCC® 22,019), C. krusei (ATCC® 6258), and six clinical fluconazole-resistant strains of C. albicans (2), C. parapsilosis (2), and C. tropicalis (2). The minimum inhibitory concentration (MIC) values were 4.1µM (inhibiting 50% of the isolates) and 8.2µM (inhibiting 100% of the isolates). Additionally, when combined with fluconazole, ShTI had a synergistic effect on C. albicans, altering the morphological structure of the yeast. The mode of action of ShTI against C. krusei (ATCC® 6258) and C. albicans involves cell membrane permeabilization, the overproduction of reactive oxygen species, the formation of pseudohyphae, pore formation, and consequently, cell death. In addition, ShTI (8.65 and 17.3µM) had noncytotoxic and nongenotoxic effects on L929 mouse fibroblasts. These findings suggest that ShTI could be a promising antimicrobial candidate, but further research is necessary to advance its application as a novel antifungal agent.

Factors and Reasons Associated With Appointment Non-attendance in Hospitals: A Narrative Review.

Non-attendance at hospital appointments is an extremely prevalent issue impacting healthcare systems on a daily basis. This phenomenon adversely affects patient health and healthcare providers, leading to delays in diagnosis and treatment, inefficient resource utilization, and increased healthcare expenses. The detrimental impact of non-attendance is not limited to patients who miss appointments, the knock-on effects of extended waiting times and reduced appointment availability are felt throughout healthcare systems. The purpose of this narrative review is to explore the factors underlying appointment non-attendance in hospital settings, to improve healthcare delivery and patient adherence. An extensive review of the existing global literature was conducted. Quantitative studies that explored the relationship between appointment non-attendance and patient characteristics, such as age, gender, marital status, education level, distance from the hospital, and source of referral, were included. Younger patients, males, individuals with lower levels of education, and those living farther from hospitals were more likely to miss appointments. Marital status was significant, with married patients showing better attendance, as was referral source, with general practitioner referrals associated with higher non-attendance. Qualitative studies identifying both patient-centered and hospital-specific reasons, such as forgetfulness, appointment time, protracted waiting times, patient-physician relationship, and patients' knowledge and perception of their health condition, were also included in the review. Lack of appointment reminders, difficulties in managing appointments, and inadequate patient-physician communication were significant hospital-specific reasons given for non-attendance. Patients' lack of awareness regarding the importance of attending appointments and limited understanding of their health conditions were also identified as patient-centered contributors. Non-attendance at hospital appointments is a multifaceted issue influenced by a range of socioeconomic, personal, and systemic factors. Addressing these factors requires a holistic approach that includes patient education, improved communication, and tailored healthcare delivery strategies, especially for vulnerable populations in rural areas. Enhanced reminder systems and streamlined appointment management could serve as pivotal interventions to reduce non-attendance rates, ultimately improving healthcare outcomes and resource utilization.

Disability from cardiovascular diseases at Osh city, Kyrgyz Republic

Cardiovascular diseases (CVDs) are the leading global cause of death, contributing to health deterioration and increased healthcare expenses. Therefore, it is of interest to investigate the disability rates related to cardiovascular diseases at Osh city, Kyrgyz Republic. We report the prevalence of disability in both urban and rural areas, highlighting the impact of regional disparities in medical and social services. Data shows that adult cardiovascular disease impairment in Kyrgyzstan suggests challenges in accessing medical and social support, particularly in rural regions. Thus, the rural-urban divide in critical disability metrics impedes equitable research. Comprehensive assessments and interventions are imperative to mitigate cardiovascular diseases and associated disabilities in both rural and urban populations at Kyrgyz Republic.

Depression care integration in tuberculosis services: A feasibility assessment in Pakistan.

The co-occurrence of depression among tuberculosis (TB) patients is a critical issue, contributing to poor treatment outcomes, prolonged hospitalisations and increased healthcare expenses. The objective of this study was to assess the feasibility of delivering a co-designed depression care pathway within TB services in Pakistan. Mixed-method study. Routine depression screening for TB patients was conducted at three TB facilities in Peshawar, Pakistan, encompassing primary, secondary and tertiary care settings. All patients aged 18 or above (male and female) attending the three TB facilities between November 2021 and February 2022 were included in the study using the consecutive sampling technique. A total of 301 people with confirmed TB, within the past 4 weeks, visited the three TB care facilities; 191/301 patients were screened for depression. Approximately 35% of the 191 TB patients screened positive for depression, with varying severity levels. Qualitative findings highlighted the acceptability of integrated depression care, emphasising the importance of open communication and empathetic attitudes. Barriers to integration include stigma, logistical challenges, patient noncompliance and cost burdens. Facilitators included the empathetic attitude of healthcare providers and the availability of mental health services within the same facility. There is a high burden of depression in patients with TB, highlighting the pressing need for mental health support in this population. Acceptability of integrated care was evident, with factors such as co-located mental health services, training healthcare providers and provider empathetic attitudes playing a crucial role. Further research is required to evaluate the effectiveness of the integrated TB-depression screening systems towards improved health outcomes, implementation, scalability and impact on the broader healthcare system. To create a more inclusive and comprehensive TB and depression care pathway, we gathered input from both service providers and service users (TB patients, their carers). Reflective meetings with community leaders, social activists and health professionals from various sectors were also conducted during pathway delivery to get their insights. Power, gender and age imbalances were addressed by encouraging participation of patients and carers across gender and age groups. This approach ensured that the perspectives of all stakeholders were considered in the development of the care pathway.

Disability from cardiovascular diseases at Osh city, Kyrgyz Republic.

Cardiovascular diseases (CVDs) are the leading global cause of death, contributing to health deterioration and increased healthcare expenses. Therefore, it is of interest to investigate the disability rates related to cardiovascular diseases at Osh city, Kyrgyz Republic. We report the prevalence of disability in both urban and rural areas, highlighting the impact of regional disparities in medical and social services. Data shows that adult cardiovascular disease impairment in Kyrgyzstan suggests challenges in accessing medical and social support, particularly in rural regions. Thus, the rural-urban divide in critical disability metrics impedes equitable research. Comprehensive assessments and interventions are imperative to mitigate cardiovascular diseases and associated disabilities in both rural and urban populations at Kyrgyz Republic.

Risk of 30-Day All-Cause Readmission in Interstitial Lung Disease Patients after COVID-19: National-Level Data.

Rationale: Hospital readmission within 30 days poses challenges for healthcare providers, policymakers, and patients because of its impact on care quality, costs, and outcomes. Patients with interstitial lung disease (ILD) are particularly affected by readmission, which is associated with increased morbidity and mortality and reduced quality of life. Because small sample sizes have hindered previous studies, this study seeks to address this gap in knowledge by examining a large-scale dataset. Objective: To determine the rate and probability of 30-day all-cause readmission and secondary outcomes in patients with coronavirus disease (COVID-19) or ILD admitted to the hospital. Methods: This study is a nested cohort study that used the PearlDiver patient records database. Adult patients (age ⩾18 yr) who were admitted to hospitals in 28 states in the United States with COVID-19 or ILD diagnoses were included. We defined and analyzed two separate cohorts in this study. The first cohort consisted of patients with COVID-19 and was later divided into two groups with or without a history of ILD. The second cohort consisted of patients with ILD and was later divided into groups with COVID-19 or with a non-COVID-19 pneumonia diagnosis at admission. We also studied two other subcohorts of patients with and without idiopathic pulmonary fibrosis within the second cohort. Propensity score matching was employed to match confounders between groups. The Kaplan-Meier log rank test was applied to compare the probabilities of outcomes. Results: We assessed the data of 2,286,775 patients with COVID-19 and 118,892 patients with ILD. We found that patients with COVID-19 with preexisting ILD had an odds ratio of 1.6 for 30-day all-cause readmission. Similarly, an odds ratio of 2.42 in readmission rates was observed among hospitalized individuals with ILD who contracted COVID-19 compared with those who were hospitalized for non-COVID-19 pneumonia. Our study also found a significantly higher probability of intensive care admission among patients in both cohorts. Conclusions: Patients with ILD face heightened rates of hospital readmissions, particularly when ILD is combined with COVID-19, resulting in adverse outcomes such as decreased quality of life and increased healthcare expenses. It is imperative to prioritize preventive measures against COVID-19 and establish effective postdischarge care strategies for patients with ILD.

Mint (Mentha): A Herb and Used as a Functional Ingredient

Health never goes out of trend. There is increased interest in alternative medicines particularly those obtained from plants. Functional foods have the ability to prevent or lessen the severity of symptoms of disease. The world is gaining its interest in treatment through natural sources like foods and medicinal plants. Herbal medicines have already been utilized by various cultures around the world for several therapies including chronic pain, malaria, heart conditions, warts, skin diseases and bowel disorders. The need for functional foods is anticipated to increase as a result of three factors: changing laws, increased health care expenses, and scientific discoveries. Mint is a member of the Lamiaceae family. Mint is an excellent source of vitamins, minerals, phenolic compounds, dietary fiber and antioxidants. Mint is a mysterious herb because of its many unknown aspects through which it promotes good health that should be revealed. Mint is a rich source of Iron. Alkaloids, steroids, and tannins are among phytoconstituents found in mint essential oils that prevent the absorption of sugars and flavonoids.

Pharmacotherapies for Treatment-Resistant Depression: How Antipsychotics Fit in the Rapidly Evolving Therapeutic Landscape.

One in three adults with major depressive disorder (MDD) do not experience clinically significant improvement after multiple sequential courses of antidepressants and have treatment-resistant depression (TRD). The presence of TRD contributes to the morbidity and excess mortality associated with MDD and has been linked to significantly increased health care expenses. In the absence of a consensus definition of TRD, this report takes a broad approach by considering inadequate response to one or more courses of antidepressants and focuses on atypical antipsychotics that are approved by the U.S. Food and Drug Administration for treatment of depression (aripiprazole, brexpiprazole, cariprazine, extended-release quetiapine, and olanzapine-fluoxetine combination). While multiple acute-phase studies have demonstrated the efficacy of these medications in improving depressive symptoms, clinically meaningful improvement (i.e., remission) remains limited, with significant concerns about side effects (including weight gain, metabolic dysfunction, extrapyramidal symptoms, and tardive dyskinesia), especially with long-term use. With the rapidly evolving landscape of antidepressant treatments over the past few years, which has witnessed approval of rapid-acting antidepressants (e.g., esketamine nasal spray and dextromethorphan-bupropion combination) and several more in the late-stage pipeline (e.g., zuranolone and psilocybin), it remains to be seen whether the use of atypical antipsychotics will go the way of the older and rarely prescribed antidepressants (such as tricyclics and monoamine oxidase inhibitors). Pragmatic clinical trials are needed to compare the effectiveness of atypical antipsychotics with TRD-specific pharmacotherapies and neuromodulation treatments and to identify the optimal sequencing of these varied approaches for patients with MDD. When using atypical antipsychotics, clinicians and patients are encouraged to use a shared decision-making approach by personalizing treatment selection based on anticipated side effects, tolerability, cost, and feasibility.

Interval Assessment of Beta-Lactam Antibiotic Allergy Status and De-labeling Process of Pediatric Patients in Children's Hospital of Pittsburgh between 2020 – 2022.

Beta-lactam allergy is associated with suboptimal medical care and increased healthcare expenses. We hypothesize that introducing a multidisciplinary institutional beta-lactam de-labeling protocol at Children's Hospital of Pittsburgh (CHP) would lead to increased percentage of de-labeling encounters.

Natural Herbal Non-Opioid Topical Pain Relievers-Comparison with Traditional Therapy.

Pain is the predominant symptom of many clinical diseases and is frequently associated with neurological and musculoskeletal problems. Chronic pain is frequent in the elderly, causing suffering, disability, social isolation, and increased healthcare expenses. Chronic pain medication is often ineffective and has many side effects. Nonsteroidal over-the-counter and prescription drugs are frequently recommended as first-line therapies for pain control; however, long-term safety issues must not be neglected. Herbs and nutritional supplements may be a safer and more effective alternative to nonsteroidal pharmaceuticals for pain management, especially when used long-term. Recently, topical analgesic therapies have gained attention as an innovative approach due to their sufficient efficacy and comparatively fewer systemic side effects and drug-drug interactions. In this paper, we overview the main natural herbal pain relievers, their efficacy and safety, and their potential use as topical agents for pain control. Although herbal-derived medications are not appropriate for providing quick relief for acute pain problems, they could be used as potent alternative remedies in managing chronic persistent pain with minimal side effects.

Association of Coping Strategies and Medication Adherence: A Systematic Review.

Background: Medication adherence is difficult for most patients who take at least one medication. Poor drug adherence is a developing problem since it contributes to negative outcomes, prescription waste, increased healthcare expenses, and disease progression. Coping strategies are an important tool for managing a patient's condition because a patient's coping method influences how he or she perceives the situation and deals with the stress that comes with it, which can eventually affect adherence. Coping strategies are classified into five categories: problem-focused, emotion-focused, seeking understanding, support seeking, and problem avoidance. Objective: The goal of this study is to examine and illustrate the association of coping strategies on medication adherence. Method: A systematic review of PubMed/MEDLINE database was conducted in order to screen and select articles. A total of 15 studies were included where they were classified by endpoints. Endpoints that were considered are medication adherence, problem-solving/active coping strategy, emotion-focused coping strategy, seeking understanding coping strategy, support seeking coping strategy and problem avoidance coping strategy. The association of each coping strategy on medication adherence was then evaluated from each article assigned to every category of coping strategies to determine if it had a favorable, negative, or no impact on medication adherence. Results: Most studies which measured problem-solving/active coping strategy (78%) had a positive association on medication adherence, followed by studies which measured emotion-focused coping strategy (69%). Majority of the studies that evaluated for problem avoidance coping strategy (50%) showed a negative association on medication adherence and a small proportion of studies (30%) showed a positive association. Four(4) of the 5 coping strategies (problem-solving/active, emotion-focused, seeking understanding and support seeking) were found to have a greater number of studies showing positive association to medication adherence as opposed to problem avoidance. Conclusion: The findings may suggest that problem-solving and emotion-focused coping strategies can be useful to help people with chronic conditions improve their medication adherence. More study is needed to establish a link between coping strategies and medication adherence in patients, which will allow pharmacists and other healthcare professionals to deliver better interventions to patients and assess for medication nonadherence due to poor coping skills.

Characterization of Carbapenem-Resistant K. Pneumoniae Isolated from Intensive Care Units of Zagazig University Hospitals.

The advent of carbapenem-resistant Klebsiella pneumoniae (CRKP) poses a significant challenge to public health, as carbapenems are typically employed as a last resort to treat nosocomial infections caused by such organisms, especially in intensive care units (ICUs). This study aims to characterize the CRKP isolated from patients admitted to the Zagazig University Hospitals (ZUHs) ICU in Egypt. About 56.2%, 41.0%, and 32.4% of the isolates indicated the presence of blaNDM, blaOXA-48, and blaKPC, respectively. Carbapenemase-encoding genes were found in many isolates, and blaNDM was the most predominant gene. Nevertheless, this situation has become a heavy burden in developing countries, including Egypt, and is associated with substantial morbidity, mortality, and increased healthcare expenses.

Efflux-mediated ciprofloxacin and cefixime resistance in Pseudomonas aeruginosa

Pseudomonas aeruginosa is a gram-negative, motile and clinically relevant bacterium. It is a significant pathogen associated with immunosuppression, cystic fibrosis and malignancy. Infections due to multidrug-resistant P. aeruginosa cause greater morbidity, death rate, and increased healthcare expenses. Drug efflux is a prevalent mechanism of antibiotic resistance in P. aeruginosa. The objective of the study was to analyze the antibiotic susceptibility profile of a clinical strain of P. aeruginosa (GC14) and to identify the mechanism of antibiotic resistance. The antibiotic resistance of GC14 was tested against 19 antibiotics using an antibiotic susceptibility test. A polymerase chain reaction-based strategy was employed to detect the presence of mexB, mexD and mexY efflux pump genes. The efflux pump inhibition assay was conducted to analyze the effect of efflux pumps on antibiotic resistance in GC14, using carbonyl cyanide m‑chlorophenyl hydrazone (CCCP) as an efflux pump inhibitor. The antibiotic susceptibility test confirmed that GC14 is multidrug-resistant and showed resistance to tetracycline, cefixime, ciprofloxacin, erythromycin, meropenem, azithromycin, doxycycline, aztreonam, co-trimoxazole and gentamycin. The genes encoding transporter protein viz. mexB, mexD and mexY were amplified successfully from P. aeruginosa, revealing the presence of efflux pump genes. The data obtained from the efflux inhibition assay using CCCP showed that efflux pumps play a significant role in ciprofloxacin and cefixime resistance. The study emphasizes the importance of efflux pumps in antibiotic resistance and also confers the necessity of continuous surveillance and regular monitoring of the emergence of multidrug-resistant isolates of P. aeruginosa.

Antimicrobial Resistance and Predisposing Factors Associated with Catheter-Associated UTI Caused by Uropathogens Exhibiting Multidrug-Resistant Patterns: A 3-Year Retrospective Study at a Tertiary Hospital in Mogadishu, Somalia.

Background: Widespread and rapidly emerging multidrug-resistant uropathogens, particularly carbapenem-resistant pathogens, are a public health concern that impairs the determination of empirical therapy. This study aims to evaluate the antimicrobial susceptibility profile and factors associated with catheter-associated urinary tract infection (CA-UTI). Method: This retrospective study was carried out on a total of 779 urine cultures over a 3-year period. Antimicrobial sensitivity tests were performed using the standard Kirby–Bauer disk diffusion method. Results: The prevalence of CA-UTI in our study was 12.7%; a total of 47% of cultures had multi-drug-resistant (MDR) uropathogens, and 13% of the cultures showed extended-spectrum beta-lactamase (ESBL)-producing pathogens. Elderly patients, intensive care unit admissions, and associated comorbidities were correlated with higher rates of CA-UTI caused by multidrug-resistant uropathogens (p < 0.021, 95% CI: 0.893–2.010), (p < 0.008, 95% CI: 1.124–5.600), (p < 0.006, 95% CI: 0.953–2.617). Latex catheters and prolonged catheterization time were associated with increased risk of CA-UTI (p < 0.0001, 95% CI: 0.743–1.929, p = 0.012, 95% CI: 0.644–4.195). Patients with MDR uropathogens had prolonged hospital stays, i.e., 49% in more than 2 weeks (p < 0.04, 95% CI: 0.117–3.084). E. coli was the most common pathogen (26.3%), followed by Acinetobacter baumannii (24.3%). Acinetobacter baumannii showed the highest MDR pattern (88.5%), followed by Pseudomonas aeruginosa (68%). Acinetobacter baumannii and Klebsiella pneumoniae were associated with prolonged hospital stays (>2 w at 73.1 and 69%, respectively). Higher antimicrobial resistance against ceftriaxone (85.7%), meropenem (54.3%), ertapenem (50%), ciprofloxacin (58.5%), amikacin (27%), tigecycline (7.6%), and colistin (4.6%), was revealed in the study. Conclusion: Aside from the higher antimicrobial resistance against cephalosporins and fluoroquinolones, the findings of this study revealed that carbapenems are facing increased rates of antimicrobial resistance and are associated with substantial morbidity, prolonged hospitalization times, and increased healthcare expenses.

Risk Factors and Characteristics of Falls Among Hospitalized Stroke Patients

Abstract Falls and fall-related injuries during hospitalization may cause serious problems and consequences for patients, their quality of life as well as increased healthcare expenses. The aim of the paper were to assess fall risks and identify risk factors, related to falls among stroke patients. This was a retrospective cohort study that included 217 neurological patients with acute stroke who have experienced fall during hospitalization. Morse Fall Scale was used to estimate a likelihood of falling for hospitalized patients. In total, 1.4% patients with acute stroke experienced a fall during hospitalization. According to the fall risk assessment, 77% of the patients presented a high risk for falls. Women, older respondents and those who were hospitalized for period longer than 22 days and who had higher levels of care, had higher values of Morse score. The most common risk factors for falls are: the presence of other medical diagnosis, the use of disability aids while walking, the use of intravenous therapy, disorientation in time and space, and the largest contribution to Morse score comes from using disability aids while walking and transferring patients. Greater risk of falling was observed in older neurological patients with ischemic type of stroke and weakness on the left side of the body, patients with longer hospitalization period and those with higher level of care.

The safety, efficacy, and cost-effectiveness of gentamycin-collagen sponge in multicomponent prevention strategy of cardiac implantable electronic device infections - a single-center experience.

Cardiac implantable electronic device(CIED)infections are associated with significant morbidity, mortality, and increased healthcare expenses. Apart from standard systemic antibiotic therapy, locally acting agents are under investigation as a potential approach for the prevention of this complication. The study aimed to summarize our experience with a gentamycin-collagen sponge (GCS) in a multi-component prevention strategy of cardiac implantable electronic device infection. We retrospectively analyzed medical records of 312 consecutive patients who underwent CIED-related surgery and had at least a 6-month follow-up. All the individuals had GCS applied during surgery. An incidence of CIEDs-related infection in our group was compared to the risk level calculated according to the commonly used scores. Analysis of cost-effectiveness was also performed. Incidence of CIED-related infection, defined as a primary endpoint, occurred relatively rarely (0.33%) as compared to the infection risk calculated according to commonly used scores Prevention of Arrythmia Device Infection Trial (PADIT) - 0.83%; CIED-AI - 0.90% or Mittal score - 1.00%; P<0.001 - for all). We did not record any complications related to GCS. We analyzed the cost-effectiveness of our GCS-based approach, which appeared to be financially beneficial (number needed to treat 149-200; difference of CIED infection treatment cost and GCSs price was 5093-26525 $). We conclude that: (1) the use of GCS to reduce CIEDs infections is feasible and safe; (2) our multicomponent prevention strategy involving the GCS application seems to significantly reduce the rate of CIED infection, and it is cost-effective.

Evaluation of Factors to Respond to the COVID-19 Pandemic Using DEMATEL and Fuzzy Rule-Based Techniques

Since social and environmental conditions have changed dramatically in recent years, the spectrum of diseases caused by infections is also evolving rapidly. The outspread of COVID-19 has resulted in an emergency situation across the globe with significant effects on the population’s lives, families, and societies, leading to concerns the World Health Organization. Accordingly, the virus has substantially threatened the Malaysians’ public health and contributed considerably to increased healthcare expenses. Since the novel coronavirus was found in China, Malaysia’s government has started its actions according to the World Health Organization procedures and concentrated on addressing and preventing the spread of the infection. The present paper aims to find and evaluate the factors to respond to the COVID-19 outbreak in Malaysia, limiting the outspread of the disease in this country. This study used the Decision-Making Trial and Evaluation Laboratory (DEMATEL) and Fuzzy Rule-Based techniques to evaluate the factors through a set of questionnaires completed by the health care professionals. According to the data analysis results, movement control order, international travel restrictions, and the mass gathering cancellations were of most importance in the prevention of COVID-19 infections transmission.