Increased Health Care Costs Research Articles

DEMOGRAPHY OF AGEING POPULATION IN NIGERIA: TRENDS, CHALLENGES AND IMPLICATIONS

Nigeria, like many other African countries, is experiencing a rapidly ageing population, with significant implications for healthcare, social security, and economic growth. Lack of functional national policy on the care and welfare of older persons in Nigeria, the breakdown of the family structure and the absence of a social security system, present unique challenges to the elderly in Nigeria. This paper analyzes the demography of the ageing population in Nigeria with a focus on the trends, challenges, and implications for healthcare, social security and economic growth. The paper relied on secondary sources of data such as journal articles and books in the area of the ageing population in Nigeria for its analysis. The Disengagement Theory provided theoretical pathway for the study. Based on the review, it was found that the rapidly ageing population poses challenges to Nigeria’s development including strains on social security system, increased healthcare costs, and potential decline in economic productivity. These challenges are due to lack of policies and the appointment of personnel capable of understanding and responding to the current social priorities and complex needs of an increasingly aging population in the country. The paper recommends among others, the need for policy makers to put in place, functional policies towards a robust public pension, insurance and healthcare system to ensure a more sustainable and equitable future for the ageing population in Nigeria.

Case Report: First use of dental bisphenol A-glycidyl methacrylate composite without UV light polymerization for repair of iatrogenic CSF leak following a frontal craniotomy plus tumor resection

ObjectiveThis study aimed to evaluate the efficacy and safety of bisphenol A-glycidyl methacrylate (bis-GMA) without UV light polymerization for the repair of refractory iatrogenic cerebrospinal fluid (CSF) leaks with large skull base defects.BackgroundCSF leakage remains a common complication after neurosurgical interventions with a substantial resultant impact on morbidity and increased healthcare costs. The management of refractory CSF leaks with large skull base defects remains challenging. Radiological investigations are highly contributive as they visualize the defect and assess the herniated content. Optimal treatment depends on the breach parameters and the consequent hernia. Surgery, when indicated, consists of exposure of the defect and its reconstruction using different grafts. The dental composite bis-GMA has been investigated and has shown effectiveness for the repair of anterior skull base defects. This is due to its compactible mechanical properties, long-term stability, and good osteo-integration. Hence, it presents a promising solution for refractory CSF leaks not responding to extradural endoscopic techniques.Case reportWe describe the case of a 40-year-old female with persistent CSF rhinorrhea following a left frontal craniotomy performed 4 years before. A high-resolution cerebral CT scan and MRI revealed a bilateral fronto-ethmoidal osteo-meningeal breach and a hyperintense T2 signal in the ethmoidal sinus interrupting the hypo-intensity of the bone, respectively. In our patient, surgical treatment involved a bifrontal craniotomy and osteo-meningeal reconstruction with the use of bis-GMA without UV light polymerization. This reconstruction gave rigid structural support and watertight closure of the defect. Postoperatively, the CSF rhinorrhea ceased and there were no perceivable associated complications.ConclusionGiven the favorable outcome, the composite bis-GMA without UV light polymerization can be used as a reliable material for the repair of iatrogenic CSF leaks.

A transmural intensive dietetic care-pathway for optimal protein intake and physical functioning in malnourished older patients: A protocol for the randomised ProIntens trial

Background Disease-related malnutrition is common among hospitalised and recently discharged older adults. Consequences of malnutrition are physical limitations, negative health outcomes, decreased quality of life and increased healthcare costs. Dietetic care can counteract the effects of malnutrition by increasing protein and energy intake. The ProIntens study aims to evaluate the impact of an intensive dietetic care pathway on dietary protein intake and physical functioning in older adults during hospitalisation and after discharge. Process and economic evaluations will be performed. Methods The ProIntens study is a multicentre two-armed parallel individually randomised trial in five hospitals in the Amsterdam region. In total, 250 hospitalised older adults, aged ≥55 years and at risk of malnutrition will be randomised to receive regular care (control) or intensive dietetic care (intervention). The intervention consists of intensive personalised care which involves transmural guidance by trained dietitians, supportive materials on protein intake in a social context and a mobilization program during hospitalisation until three months after discharge. Controls will receive regular care. The primary outcome will be the between-groups difference in the mean change on the Short Physical Performance Battery three months after discharge. Secondary outcomes include dietary protein intake, body composition, physical activity, activities of daily living, quality of life and healthcare costs. Discussion The ProIntens trial will study the effects and costs of an intensive dietetic treatment on recovery outcomes in hospitalised older adults at risk of malnutrition. The intervention will result in practical tools for care professionals which aim to improve malnutrition treatment for older patients. Trial registration Landelijk Trial Register (NL8041; NL72069.029.19); registered 2019-09-23; covering all WHO Trial Registration Data Set items.

Localised Therapies Using 3D‐Printed Collagen‐Based Micro‐Implant for Ocular Indications

AbstractCurrent limitations in treating retinal diseases like age‐related macular degeneration (AMD) and diabetic retinopathy (DR) are due to the short ocular residence time of biologics and the difficulty of precise drug delivery. In turn, frequent injections are required, hindering patient compliance, and increasing healthcare costs. This study explores the development of a collagen‐based implant using 3D bioprinting platform to address these challenges. The implant offers dual functionalities: i) sustained and localized drug delivery using in situ polymerization collagen (IPC) to act as reservoirs for prolonged release of biologics to the target tissue and ii) scaffold stability through the incorporation of methacrylated hyaluronic acid (HAMA) to enhance the mechanical properties of the IPC implant, making it suitable for 3D printing of targeted drug delivery systems. This data demonstrates that IPC‐HAMA implants exhibit slow drug release and scaffold stability for over 80 days. Additionally, 3D bioprinting enables precise targeting and volumetric control within the simulated vitreous humor, overcoming challenges associated with traditional injection methods. This innovative approach has the potential to revolutionize drug delivery and localized tissue therapy for retinal diseases.

Antibiotic Susceptibility Patterns in Gram-Positive and Gram-Negative Isolates from Post-Operative Wound Infections

Background: Post-operative wound infections (POWIs) are a leading cause of morbidity and increase in healthcare costs, especially in low resource settings. The rising prevalence of antibiotic resistance among pathogens also increases the complexity of treatment strategies, highlighting the importance of local surveillance of microbiological and resistance patterns. This study aims to find out the antibiotic susceptibility patterns of gram positive and gram negative isolates from the post-operative wound infections from women undergoing obstetric and gynecological surgeries. Methods: A cross-sectional study was conducted at Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka from October 2019 to September 2021. A total of 200 women with post-operative wound infections were purposively selected. Among them, 134 had culture-positive findings. Bacteriological analysis and antibiotic susceptibility testing were performed on isolates following standard microbiological methods. Results: Among the 134 culture-positive cases, 33.6% of isolates were gram-positive, with Staphylococcus aureus being predominant. Gram-negative bacteria accounted for 66.4% of isolates, with E. coli and Pseudomonas aeruginosa equally prevalent (20.9%). Gram-positive isolates showed high sensitivity to piperacillin-tazobactam (91.1%) and sulbactam (53.3%) but were resistant to ceftriaxone (48.9%) and cefixime (51.1%). Gram-negative bacteria exhibited sensitivity to amikacin and meropenem but demonstrated widespread resistance to ceftriaxone and doxycycline. Conclusion: This study describes the diverse microbiological profile and high prevalence of antibiotic resistance in POWIs. Novel antibiotic therapy and strict infection control measures are essential to curb the burden of these infections.

Association Between Diagnostic Delay and Economic and Clinical Burden in Axial Spondyloarthritis: A Multicentre Retrospective Observational Study.

Axial spondyloarthritis (axSpA) is a chronic inflammatory condition associated with considerable pain and impaired health-related quality of life (HRQoL) for affected patients. Despite the documented increase in healthcare resource utilization (HRU) related to axSpA, few studies have explored the impact of diagnostic delays on these outcomes. This study sought to determine the association between diagnostic delay of axial spondyloarthritis (axSpA) and costs in the 3years after diagnosis. This is a retrospective, observational study based on routine follow-up data from adult patients with confirmed axSpA diagnosis in three tertiary Spanish hospitals. Sociodemographic and clinical variables were collected at diagnosis. Direct and indirect healthcare costs were estimated from healthcare resource use (HRU) and productivity losses. The correlation between diagnostic delay and total healthcare costs was analyzed. Eighty-two patients (62.2% men; mean age: 39.3 years at diagnosis) were included, mostly with radiographic axSpA (r-axSpA) (67.1%). The mean (standard deviation, SD) diagnostic delay was 10.1 (9.3) years, with a median (interquartile range, IQR) of 5.4 (2.3, 17.2) years. The mean total healthcare cost per patient accumulated over 3years was €25,812.6 (direct: €16,384.7; indirect: €9427.9). Patients with longer diagnostic delay (> 5.4years) had 57% higher total healthcare cost (€31,717.7 vs. €20,188.7, p = 0.029) and higher disease activity at diagnosis (BASDAI score 4.7 vs. 3.4, p = 0.007) and after 3years (3.9 vs. 2.9, p = 0.042) compared to those with shorter delay (≤ 5.4years). The diagnostic delay in axSpA remains high and is associated with an increase in healthcare costs post-diagnosis. Actions to reduce diagnostic delay should be prioritized by healthcare systems to potentially improve outcomes and reduce long-term costs.

Investigating the impact of microbiome-changing interventions on food decision-making: MIFOOD study protocol

BackgroundObesity is a multifactorial disease reaching pandemic proportions with increasing healthcare costs, advocating the development of better prevention and treatment strategies. Previous research indicates that the gut microbiome plays an important role in metabolic, hormonal, and neuronal cross-talk underlying eating behavior. We therefore aim to examine the effects of prebiotic and neurocognitive behavioral interventions on food decision-making and to assay the underlying mechanisms in a Randomized Controlled Trial (RCT).MethodThis study uses a parallel arm RCT design with a 26-week intervention period. We plan to enroll 90 participants (male/diverse/female) living with overweight or obesity, defined as either a Waist-to-Hip Ratio (WHR) ≥ 0.9 (male)/0.85 (diverse, female) or a Body Mass Index (BMI) ≥ 25 kg/m2. Key inclusion criteria are 18–60 years of age and exclusion criteria are type 2 diabetes, psychiatric disease, and Magnetic Resonance Imaging (MRI) contraindications. The interventions comprise either a daily supplementary intake of 30 g soluble fiber (inulin), or weekly neurocognitive behavioral group sessions, compared to placebo (equicaloric maltodextrin). At baseline and follow-up, food decision-making is assessed utilizing task-based MRI. Secondary outcome measures include structural MRI, eating habits, lifestyle factors, personality traits, and mood. Further, we obtain fecal and blood samples to investigate gut microbiome composition and related metabolites.DiscussionThis study relies on expanding research suggesting that dietary prebiotics could improve gut microbiome composition, leading to beneficial effects on gut-brain signaling and higher-order cognitive functions. In parallel, neurocognitive behavioral interventions have been proposed to improve unhealthy eating habits and metabolic status. However, causal evidence on how these “bottom-up” and “top-down” processes affect food decision-making and neuronal correlates in humans is still scarce. In addition, microbiome, and gut-brain-axis-related mediating mechanisms remain unclear. The present study proposes a comprehensive approach to assess the effects of these gut-brain-related processes influencing food decision-making in overweight and obesity.Trial registrationClinicalTrials.gov NCT05353504. Retrospectively registered on 29 April 2022.

The interaction of structured data using openEHR and large Language models for clinical decision support in prostate cancer.

Multidisciplinary teams (MDTs) are essential for cancer care but are resource-intensive. Decision-making processes within MDTs, while critical, contribute to increased healthcare costs due to the need for specialist time and coordination. The recent emergence of large language models (LLMs) offers the potential to improve the efficiency and accuracy of clinical decision-making processes, potentially reducing costs associated with traditional MDT models. We conducted a retrospective study of 171 consecutively treated patients with newly diagnosed prostate cancer. Relevant structured clinical data and the European Association of Urology (EAU) pocket guidelines were provided to two LLMs (chatGPT-4, Claude-3-Opus). LLM treatment recommendations were compared to actual treatment recommendations of the MDT meeting (MDM). Both LLMs demonstrated an overall adherence of 93% with the MDT treatment recommendations. Discrepancies between LLM and MDT recommendations were observed in 15 cases (9%), primarily due to lack of clinical information that could be provided to the LLMs. In 5 cases (3%), the LLM recommendations were not in line with EAU guidelines despite having access to all relevant information. Our findings provide evidence that LLMs can provide accurate treatment recommendations for newly diagnosed prostate cancer patients. LLMs have the potential to streamline MDT workflows, enabling specialists to focus on complex cases and patient-centered discussions. In this study, we explored the potential of artificial intelligence models called large language models (LLMs) to assist in treatment decision-making for prostate cancer patients. We found that LLMs, when provided with patient information and clinical guidelines, can recommend treatments that closely match those made by a team of cancer specialists, suggesting that LLMs could help streamline the decision-making process and potentially reduce healthcare costs.

Fine-tuning blood culture practices: implementing diagnostic stewardship in cardiothoracic surgery patients.

Overusing blood cultures (BCxs) can lead to false positives, unnecessary antibiotics, and increased healthcare costs. Despite studies on inpatient BCx algorithms, none have focused on cardiothoracic surgery (CTS) patients, with complex postoperative care and invasive devices. This study aimed to evaluate the impact of a BCx algorithm on BCx event (BCE) rates in CTS step-down units. The study was conducted in 3 CTS step-down units at Duke University Hospital. The BCx algorithm, based on Seidelman et al. (2023), was implemented in June 2023. BCE rates, incidence rate ratios (IRRs), and adverse outcome IRRs were compared between pre and postintervention periods using ITS and χ2 tests. We analyzed 4978 BCE during the study period: 3439 (893 patients) pre-intervention and 1539 (452 patients) postintervention. BCE rates decreased [IRR= 0.78 (95% CI 0.74,0.83, p-value< 0.01)] without significant differences in adverse outcomes such as central line-associated bloodstream infection (CLABSI) rates (IRR= 0.6, 95% CI 0.17, 2.30), readmission rates (IRR= 0.99, 95% CI 0.88, 1.12), or in-hospital mortality (IRR= 3.53, 95% CI 0.32, 38.90). Our study supports the beneficial effects of a BCx algorithm, which reduces unnecessary BCxs in CTS patients without compromising patient safety.

Methylglyoxal compromises callus mineralization and impairs fracture healing through suppression of osteoblast terminal differentiation.

Impaired fracture healing in diabetic patients leads to prolonged morbidity and increased healthcare costs. Methylglyoxal (MG), a reactive metabolite elevated in diabetes, is implicated in various complications, but its direct impact on bone healing remains unclear. Here, using a non-diabetic murine tibial fracture model, we demonstrate that MG directly impairs fracture healing. Micro-computed tomography revealed decreased volumetric bone mineral density in the callus, while callus volume remained unchanged, resulting in a brittle bone structure. This was accompanied by reduced expression of osteocalcin and bone sialoprotein, both critical for mineralization. Biomechanical analysis indicated that MG reduced the mechanical resilience of the fracture site without altering its elastic strength, suggesting that the impairment was not primarily due to the accumulation of advanced glycation end-products in the bone extracellular matrix. In vitro studies confirmed that non-cytotoxic concentrations of MG inhibited osteoblast maturation and mineralization. Transcriptomic analysis identified downregulation of Osterix, a key transcription factor for osteoblast maturation, without altering Runx2 levels, leading to decreased expression of key mineralization-related factors like osteocalcin. These findings align with clinical observations of reduced circulating osteocalcin levels in diabetic patients, suggesting that the detrimental effects of MG on osteoblasts may extend beyond bone metabolism. Our study highlights MG and MG-sensitive pathways as potential therapeutic targets for improving bone repair in individuals with diabetes and other conditions characterized by elevated MG levels.

Identification, classification, and documentation of drug related problems in community pharmacy practice in Europe: a scoping review.

Drug-related problems (DRPs) are significant issues in healthcare contributing to adverse health outcomes and increased healthcare costs. While community pharmacists play a pivotal role in identifying, classifying, and documenting DRPs, there is a need to map approaches undertaken. The aim of this scoping review was to examine the approaches to identifying, classifying, and documenting DRPs in community pharmacies in Europe, and their associated barriers and facilitators. The scoping review was conducted according to the Joanna Briggs Institute guidelines and reported according to the PRISMA-ScR guidelines. The search was conducted across 11 databases from inception until March 2023. Studies of all designs reporting DRPs in European community pharmacies were included. Titles, abstracts, and full texts were screened independently by two researchers, followed by data extraction and synthesis. The search yielded 67 relevant studies. Forty-eight studies described approaches to DRP identification as predominantly relying on professional knowledge and computer software. The classification methods, described in 41 studies, varied with reports of predefined systems and computer-generated classifications. Documentation approaches were described in 53 studies and were primarily computer-based. Facilitators included electronic support systems, pharmacist experience, while barriers encompassed the complexity of classification as well as variations in training, IT solutions, operational structures, and implementation. There is a lack of a standardized approach to identifying, classifying, and documenting DRPs in European community pharmacies. A framework for pharmacist education and a time-saving approach to documenting DRPs consistently could serve to overcome the barriers to their identification and documentation. Furthermore, the implementation of a standardised approach to classifying DRPs could facilitate comparison of the management of DRPs across Europe.

REVIEW OF PHARMACOLOGICAL STRATEGIES FOR REDUCING ANTIBIOTIC RESISTANCE IN HEALTHCARE SETTINGS

Background: Antibiotic resistance is a significant global health challenge, jeopardizing the efficacy of antibiotics and leading to increased healthcare costs, patient morbidity, and mortality. Objectives: This review explores key pharmacological strategies to combat antibiotic resistance, highlighting their effectiveness, challenges, and potential for application in healthcare settings. It also identifies gaps in current practices and proposes future research directions. Methods: A narrative synthesis of recent literature was conducted, focusing on strategies such as antimicrobial stewardship programs, combination therapies, personalized medicine, rapid diagnostics, and novel treatments. Results: Antimicrobial stewardship programs were found to be central to optimizing antibiotic use and reducing resistance. Combination therapies and personalized medicine further enhance treatment precision and efficacy. Emerging innovations, including artificial intelligence and advanced materials like nanoparticles, offer promising solutions. However, implementation gaps, particularly in resource-limited settings, and high costs of novel technologies remain significant barriers. Conclusions: This review underscores the importance of integrating evidence-based pharmacological strategies with emerging technologies to address antibiotic resistance. Future research should prioritize scalable, cost-effective interventions and a greater focus on community and outpatient settings to complement hospital-based efforts.

Expert-Based Narrative Review on Compression UltraSonography (CUS) for Diagnosis and Follow-Up of Deep Venous Thrombosis (DVT).

Deep venous thrombosis (DVT) is a pathological condition that develops when a thrombus forms within the deep venous system. Typically, it involves the lower limbs and, less frequently, the upper extremities or other unusual districts such as cerebral or splanchnic veins. While leg DVT itself is rarely fatal and occasionally can lead to limb-threatening implications, its most fearsome complication, namely pulmonary embolism, is potentially fatal and significantly contributes to increased healthcare costs and impaired quality of life in affected patients and caregivers. Thanks to its high accuracy, ease of use, and safety profile, duplex ultrasound (DUS), particularly compression ultrasound (CUS), has emerged as the first-line imaging modality for DVT diagnosis. The evaluation of suspected DVT needs a multifaceted approach, and in this context, CUS rapidly became a key diagnostic tool owing to its many unique advantages. Its central role in the diagnostic algorithm of suspected DVT is clearly established in the latest clinical practice guidelines from the European Society for Vascular Surgery and the American Society of Haematology. Indeed, DUS effectively visualizes blood flow and identifies abnormalities like clot formation with high sensitivity (typically exceeding 90% for proximal DVT) and specificity (often approaching 100% for proximal DVT). Additionally, CUS is non-invasive, readily available at the bedside, and avoids radiation exposure, resulting in an ideal method for various clinical settings. CUS has been shown to have a substantial role not only in the diagnosis of an acute DVT but also in the follow-up of its management. Moreover, this method can provide a prognostic assessment, mostly in terms of risk stratification for recurrent thrombosis and/or for potential complications, such as post-thrombotic syndrome. In summary, given its established benefits, CUS is a technique that many physicians should be familiar with, especially those working in emergency departments, intensive care units, or general wards. When needed, healthcare operators with more advanced US skills (such as radiologists, angiologists, or vascular surgeons) may be called upon to provide a second look in case of uncertainty and/or need for additional information.

Case Management of Delirium in Patients with Major Neurocognitive Disorders

Delirium is associated with lower quality of life, increased healthcare costs, longer hospitalizations, and worse prognosis when detected in patients who are already confronted with a severe and invalidating disease, like the major neurocognitive disorder (MND). In order to identify the most evidence-based interventions that could be included in case management for patients with both delirium and MND, this narrative review explored three electronic databases (Pubmed, Cochrane, and Web of Science/Clarivate) for primary and secondary sources dedicated to this topic. All papers published in English between the inception of each database and September 2024 were screened for relevant data on pharmacological and non-pharmacological therapies targeting delirium. The results supported the use of a multicomponent approach as the first line of treatment, mitigating the precipitating factors, and only as a second line, the use of pharmacological instruments. There is a lack of validated therapies targeting specifically the delirium superimposed on MND, most of the recommendations being extrapolated from studies with delirium in the general population or in elderly patients with different organic diseases. Further studies are required to investigate the specifics of delirium in patients with MND and potential strategies focused on neurobiological mechanisms instead of just clinical manifestations.

Economic impact and clinical benefits of clinical pharmacy interventions: A six-year multi-center study using an innovative medication management tool.

Increasing healthcare costs, particularly in Low- and Middle-Income Countries (LMICs) like Egypt, highlight the need for rational economic strategies. Clinical pharmacy interventions offer potential benefits by reducing drug therapy problems and associated costs, thereby supporting healthcare system sustainability. This study evaluates the economic impact and clinical benefits of clinical pharmacy interventions in four tertiary hospitals in Egypt by implementing an innovative tool for medication management, focusing on cost avoidance and return on investment (ROI), while accounting for case severity and drug therapy problem (DTP) resolution. Utilizing a digital tool, cost avoidance was assessed by considering the severity of patient cases and the effectiveness of clinical pharmacists' interventions in resolving identified DTPs. Additionally, ROI was calculated by incorporating both full-time equivalent (FTE) and non-FTE costs to evaluate the overall economic impact of clinical pharmacy services over a six-year period across four tertiary care hospitals in Egypt. Over six years, a total of 492,612 patients were reviewed, leading to 19,240 comprehensive clinical pharmacy interventions. These interventions achieved an 88.63% resolution of DTPs, significantly reducing patient risk by preventing adverse DTP consequences, resulting in a total cost avoidance of EGP 265.32 million (USD 8.60 million) and an average ROI of 7.6 (760%). This underscores the substantial economic impact of clinical pharmacy services, particularly in LMICs and countries transitioning to universal health insurance coverage, where cost efficiency and patient safety are critical. This study underscores the importance of clinical pharmacy interventions in improving healthcare outcomes and generating significant economic benefits, particularly in low- and middle-income countries. By accounting for case severity and the level of DTP consequences, along with the efficiency of clinical pharmacist-led interventions in resolving DTPs, the economic impact of these services can be more accurately evaluated. These findings are essential for informing policy decisions, highlighting the critical role of clinical pharmacy services in supporting healthcare systems facing economic constraints.

BRIDGING THE DIGITAL DIVIDE: A USER-CENTERED DESIGN APPROACH TO ENHANCING SOCIAL CONNECTIVITY AMONG OLDER ADULTS

Abstract Social isolation is highly prevalent among older adults, leading to negative health outcomes and increased healthcare costs. With the U.S. Census Bureau projecting a near doubling of adults aged 65 and older by 2060, addressing this issue is crucial. Innovative, user-centered solutions are imperative because older adults often face health, cognitive, and mobility limitations that diminish opportunities for engagement. Technologies can help overcome these barriers. This study aimed to develop a potential intervention to enhance social connectivity among older adults through user-centered design, understanding their needs in using digital technologies. This qualitative study employed an ethnographic approach, engaging 50 older adults in Los Angeles. Semi-structured interviews and participant observations were conducted. Thematic analysis informed the iterative design of a prototype named TwinFlame. The study revealed three key insights: 1. Older adults prioritized user-friendly interfaces facilitating communication with loved ones. 2. Participants expressed a need for educational support in using digital devices, particularly for advanced features. 3. Cultural competence was critical in ensuring inclusivity and acceptance of the proposed solution. TwinFlame, a device resembling a candle with integrated digital communication features, was developed to address these needs. Its design incorporates simplified interfaces, built-in tutorials, and culturally sensitive elements. While not yet tested, TwinFlame’s potential for enhancing social connectivity lies in its user-centered approach, directly addressing the identified needs of older adults. This research contributes to understanding how tailored digital tools can potentially reduce the digital divide and social isolation among older adults, highlighting the importance of user-centered design in gerontechnology.

MiRNA-200a and miRNA-200b expression, and vitamin-D level: Prognostic significance in obese non-diabetic and obese type 2 diabetes mellitus individuals.

Obesity and type 2 diabetes mellitus (T2DM) are frequent co-occurring disorders that affect regular metabolic functions. Obesity has also been linked to an increased risk of developing diabetes. Obesity and diabetes are on the rise, increasing healthcare costs and raising mortality rates. Research has revealed that the expression profile of microRNAs (miRNAs) changes as diabetes progresses. Furthermore, vitamin D may have an anti-obesity effect and inverse association with body weight and body mass index (BMI). Low vitamin D levels do not solely cause obesity, which could be a factor in the etiology of T2DM. To evaluate miRNA-200a and miRNA-200b expression, and vitamin-D levels in obese and obese T2DM individuals. This study included 210 participants, of which, 82 were obese (BMI > 30 kg/m2) without T2DM, 28 were obese with T2DM, and 100 were healthy controls. BMI was evaluated and both fasting and postprandial blood glucose were used to confirm T2DM. Exosomal miRNA-200a and miRNA-200b expression were analyzed using real-time PCR using Taqman probes, and vitamin-D levels were evaluated using an electrochemiluminescence-based immunoassay technique. All data analyses were performed using SPSS 20.0 and GraphPad Prism 5 software. Overall, a 2.20- and 4.40-fold increase in miRNA-200a and miRNA-200b expression was observed among participants compared to healthy controls. MiRNA-200a and miRNA-200b expression among obese participants increased 2.40-fold and 3.93-fold, respectively, while in obese T2DM participants these values were 2.67-fold, and 5.78-fold, respectively, and these differences were found to be statistically significant (P = 0.02) (P < 0.0001). Obese participants showed a vitamin D level of 34.27 ng/mL, while in obese-T2DM participants vitamin D level was 22.21 ng/mL (P < 0.0001). Vitamin D was negatively correlated with miRNA-200a (r = -0.22, P = 0.01) and miRNA-200b (r = -0.19, P = 0.04). MiRNA-200a sensitivity was 75%, and specificity was 57%, with a cutoff value of 2.07-fold. MiRNA-200b sensitivity was 75%, and specificity was 71% with a cutoff value of 4.12-fold, suggesting that miRNA-200a and miRNA-200b with an increased expression of 2.07- and 4.12-fold could be predictive indicators for the risk of diabetes in obese participants. MiRNA-200a and miRNA-200b were higher in diabetic obese participants vs non-diabetic obese participants, and insufficient vitamin D levels in obese T2DM participants may be involved in poor clinical outcome.

Examining the impact of rhythmic breathing and progressive muscle relaxation on acute pain following inguinal hernia repair: a parallel randomized clinical trial

BackgroundAcute postoperative pain is often reported after repair of inguinal hernia and can negatively impact patient satisfaction and clinical outcomes. This includes delayed wound healing, longer hospitalization, and increased health care costs. Non-pharmacological techniques like Progressive Muscle Relaxation (PMR) and Rhythmic Breathing (RB) have been suggested as possible interventions for managing this type of pain. The purpose of this study was to examine the effects of PMR and RB on postoperative pain following repair of inguinal hernia.MethodsThis parallel randomized controlled trial was conducted to examine 120 patients in the age range of 18 to 75 years with inclusion criteria: Repair of Inguinal Hernia under general anesthesia and no addiction to drugs and narcotics. These patients were randomly assigned to one of three groups: the RB group, PMR group, or the control group (which received standard care). The RB and PMR interventions were administered at 3, 6, 12, and 24 h after surgery. The primary outcome measure was the intensity of pain at the surgical site, assessed using the Visual Analog Scale (VAS). The secondary outcome measure was the amount of rescue analgesic (Pethidine). The one-way analysis of variance, Chi-square, post-hoc test, and repeated measures ANOVA were used for data analysis.ResultsFollowing the interventions, participants in both the RB and PMR groups exhibited significantly lower levels of acute pain after inguinal hernia repair compared to the control group across all four time periods, except at 12 h postoperatively in the RB group. However, there was no statistically significant difference between the RB and PMR groups. Additionally, the amount of pethidine consumed in the control group was significantly higher compared to the two experimental groups.ConclusionsBased on the results, both RB and PMR were found to be effective techniques in reducing patients’ pain. Therefore, it is recommended that healthcare team members, particularly nurses, actively learn and teach both RB and PMR.Trial registrationRegistered in the Iranian registry of clinical trials (www.irct.ir) in 31/01/2023 with the following code: IRCT20200206046395N2.

Evaluating and Improving Surgical Site Infection Prevention: Outcomes of a Two-Cycle Audit and Targeted Interventions in a Low-Resource Setting.

Background Surgical site infections (SSIs) are among the most common healthcare-associated infections (HAIs), leading to significant morbidity, mortality, and increased healthcare costs. Despite the existence of international guidelines, adherence to best practices remains inconsistent, particularly in low- and middle-income countries (LMICs). Objective The objectives of this study are to evaluate compliance with SSI prevention guidelines among medical professionals at Kasr El Ainy Teaching Hospital in Cairo, Egypt, identify gaps in practice and knowledge, and implement targeted interventions to improve outcomes. Methods A prospective two-cycle audit was conducted over a period of eight months involving 225 elective surgical patients and 229 healthcare providers. Questionnaires were distributed to foundation year (FY) doctors and surgical residents to assess their knowledge and practices related to SSI prevention across the preoperative, intraoperative, and postoperative phases. Patients were followed up to monitor the incidence of SSIs. Interventions implemented included educational sessions, dissemination of posters, and hands-on training to enhance adherence to best practices. Results The initial audit revealed an SSI rate of 12.6% and significant gaps in guidelines knowledge, including improper preoperative hair removal methods and prolonged postoperative antibiotic use (85.7%). Post-intervention, SSI rates decreased to 6.6%, with the questionnaire results showing marked improvements in understanding of key components in SSI prevention: 100% became aware ofappropriate intraoperative surgical antibiotic prophylaxis (SAP) (compared to 72.3%), a significant increase (p < 0.05) in the use of clippers (rather than razors) for hair removal (72.1% vs. 33.7%) and intraoperative (rather than preoperative) hair removal (91.8% vs. 10%) (p < 0.05), as well as the need for intraoperative warming practices (87.7% vs. 47.7%) (p < 0.05). Knowledge and adherence to aseptic techniques improved across all staff groups, with awareness increasing from 36.3% to 81.9% among junior doctors, representing a significant improvement(p < 0.05). Conclusion Targeted interventions, including education and practice standardization, significantly reduced SSI rates and improved compliance with prevention guidelines. These findings highlight the value of structured audits and educational programs in enhancing surgical outcomes and reducing the burden of SSI, particularly in resource-limited settings.

Excess hospital length of stay and extra cost attributable to primary prolonged postoperative ileus in open alimentary tract surgery: a multicenter cohort analysis in China

BackgroundProlonged postoperative ileus (PPOI) reportedly leads to compromised postoperative recovery and increased healthcare costs. However, the evidence for this claim was obtained from studies that included patients with both primary and secondary PPOI. How primary PPOI affects the hospital length of stay (LOS) and healthcare costs is not well documented. A multicenter cohort analysis was performed to investigate the potentially detrimental effect of primary PPOI on hospital LOS and healthcare costs.MethodsIn total, 2083 patients who underwent open abdominal surgery from 22 tertiary hospitals in China were prospectively registered in a PPOI cohort. Of these, 1863 patients without secondary PPOI were analyzed. Poisson regression for hospital LOS and log-transformed linear regression for healthcare costs were performed to identify whether primary PPOI was an independent risk factor.ResultsThe incidence of primary PPOI was 13.2% (246/1863). The median LOS was significantly longer in the PPOI than non-PPOI group (12 vs. 11 days, p < 0.001). The median healthcare cost was significantly higher in the PPOI than non-PPOI group (70,672 vs. 67,597 CNY, p = 0.016). Multivariate Poisson regression and log-transformed linear regression showed that 12% of prolonged LOS and 4.6% of healthcare costs were due to primary PPOI.ConclusionsPrimary PPOI is a potential source of prolonged hospital LOS and extra healthcare costs for patients undergoing open abdominal surgery. Cost-effective approaches are needed to manage and prevent primary PPOI.