Healthcare System Infrastructure Research Articles

Analyzing the roles, workflows, and communication dynamics of social workers within interprofessional care teams

ABSTRACT Social workers frequent interprofessional healthcare teams, but few studies examine the day-to-day experiences of these providers on interprofessional teams. Our study utilized semi-structured interviews with 54 medical social workers practicing on interprofessional healthcare teams. A thematic analysis was used to analyze the day-to-day functions of these social workers. The analysis resulted in three primary themes: 1) Social Workers’ Self-Perceptions of their Roles within Interprofessional Teams, 2) Social Workers Shifting Roles on Interprofessional Teams, and 3) Interprofessional Team Dynamics that Impact the Role of a Social Worker. Social workers perceived their primary roles as contributing a unique systems approach to interprofessional healthcare teams while emphasizing patient self-determination. These self-perceptions influenced their shifting roles on interprofessional healthcare teams (e.g. clinician, case manager, bridge builder). In addition to individual self-perceptions, the healthcare system infrastructure influenced social work roles. For example, social workers in outpatient settings more frequently assumed the role of a mental health practitioner compared to those in inpatient settings. Last, there was variation in interprofessional communication and workflow assignment based on the healthcare infrastructure. Future research should examine the education and training efforts of social workers and other allied health professions for interprofessional healthcare teams.

Latin American Consensus on the Treatment of Head and Neck Cancer.

Head and neck squamous cell carcinoma (HNSCC) is well known as a serious health problem worldwide, especially in low-income countries or those with limited resources, such as most countries in Latin America. International guidelines cannot always be applied to a population from a large region with specific conditions. This study established a Latin American guideline for care of patients with head and neck cancer and presented evidence of HNSCC management considering availability and oncologic benefit. A panel composed of 41 head and neck cancer experts systematically worked according to a modified Delphi process on (1) document compilation of evidence-based answers to different questions contextualized by resource availability and oncologic benefit regarding Latin America (region of limited resources and/or without access to all necessary health care system infrastructure), (2) revision of the answers and the classification of levels of evidence and degrees of recommendations of all recommendations, (3) validation of the consensus through two rounds of online surveys, and (4) manuscript composition. The consensus consists of 12 sections: Head and neck cancer staging, Histopathologic evaluation of head and neck cancer, Head and neck surgery-oral cavity, Clinical oncology-oral cavity, Head and neck surgery-oropharynx, Clinical oncology-oropharynx, Head and neck surgery-larynx, Head and neck surgery-larynx/hypopharynx, Clinical oncology-larynx/hypopharynx, Clinical oncology-recurrent and metastatic head and neck cancer, Head and neck surgery-reconstruction and rehabilitation, and Radiation therapy. The present consensus established 48 recommendations on HNSCC patient care considering the availability of resources and focusing on oncologic benefit. These recommendations could also be used to formulate strategies in other regions like Latin America countries.

Factors Affecting Post-trial Sustainment or De-implementation of Study Interventions: A Narrative Review.

In contrast to traditional randomized controlled trials, embedded pragmatic clinical trials (ePCTs) are conducted within healthcare settings with real-world patient populations. ePCTs are intentionally designed to align with health system priorities leveraging existing healthcare system infrastructure and resources to ease intervention implementation and increase the likelihood that effective interventions translate into routine practice following the trial. The NIH Pragmatic Trials Collaboratory, funded by the National Institutes of Health (NIH), supports the conduct of large-scale ePCT Demonstration Projects that address major public health issues within healthcare systems. The Collaboratory has a unique opportunity to draw on the Demonstration Project experiences to generate lessons learned related to ePCTs and the dissemination and implementation of interventions tested in ePCTs. In this article, we use case studies from six completed Demonstration Projects to summarize the Collaboratory's experience with post-trial interpretation of results, and implications for sustainment (or de-implementation) of tested interventions. We highlight three key lessons learned. First, ineffective interventions (i.e., ePCT is null for the primary outcome) may be sustained if they have other measured benefits (e.g., secondary outcome or subgroup) or even perceived benefits (e.g., staff like the intervention). Second, effective interventions-even those solicited by the health system and/or designed with significant health system partner buy-in-may not be sustained if they require significant resources. Third, alignment with policy incentives is essential for achieving sustainment and scale-up of effective interventions. Our experiences point to several recommendations to aid in considering post-trial sustainment or de-implementation of interventions tested in ePCTs: (1) include secondary outcome measures that are salient to health system partners; (2) collect all appropriate data to allow for post hoc analysis of subgroups; (3) collect experience data from clinicians and staff; (4) engage policy-makers before starting the trial.

Multi-agent Intelligent System Design for Telemedicine Applications to Develop Health Care Systems of Developing Countries

Various factors controlling health care in any country, but still there is a weakness in the infrastructure of health care systems in some developing countries, including many Arab countries, due to the shortage of medical specialists personnel, global economic crisis, and wars and disasters that struck many countries. A crying need for a tele-medical care becomes a necessity, and in order to overcoming this weakness we have proposed a multi-agent intelligent Telemedicine system in this research. The proposed system can help solve the shortage of specialists urgently and at lower costs. Furthermore, it can save the efforts of the patients' expensive travel for treatment abroad. Moreover, it can avoid infections from social closeness in times of disasters and pandemics.
 Nowadays Telemedicine systems have gradually become a popular medical model which have always attracted much attention due to the continuous development of the multi-agents' structure and capabilities of the artificial intelligence systems. So we will focus in the prototype design of our system on the algorithms, techniques and devices that support the multi-agents' structure and AI technologies. The Multi-agent approach happens to be a suitable structure for the development of Telemedicine systems. Worth mentioning it can solve problems that are difficult or impossible for an individual agent or a monolithic system, and the AI capabilities will minimize human errors and improve health care outcomes.
 We will start by a state-of-the-art literature survey as conducted on the E-health system architecture, AI capabilities, and multi-agent platform, and then we will illustrate prototype design of the suggested Multi-agent intelligent system for Telemedicine which will contribute in the development of the health care systems in the developing countries.
 Keywords: Healthcare system; Medical System; Artificial Intelligence; Multi-Agent, Telemedicine; Telehealth.

A review of implementation intentions as a tool to benefit high-need patients and healthcare systems: U.S. veterans affairs as an exemplar

Implementation intentions (if-then plans) are an evidence-based behavior change strategy designed to translate behavioral intentions into habits [1]. Despite extensive evidence of its potential utility, this behavior change strategy is underutilized and under-researched in high-need healthcare contexts within the United States (U.S.) which face high rates of chronic conditions and barriers to care such as rurality, lack of resources, and cognitive strain from mental health and neurological conditions [2,3]. Implementation intentions have demonstrated efficacy in promoting many health behaviors proven to mitigate chronic conditions, namely physical activity, healthy diet, and substance use reduction [4–6]. In addition, the accessible, adaptable, and self-driven nature of implementation intentions allow the technique to meet many of the individual and system-level priorities of these high-need care contexts. By being patient-driven, proactive, and personalized, implementation intentions can help these patients cultivate healthy habits as part of their everyday lives. At the systems-level, implementation intentions’ inexpensiveness, scalability, and compatibility with telemedicine platforms allow them to be integrated easily into existing healthcare system infrastructure [7,8]. This review describes these concepts in detail, and uses the Veterans Affairs (VA) healthcare system as an exemplar to provide concrete examples of how and where implementation intentions could be integrated in a healthcare system, within some existing programs, to benefit both the system and individual patients.

The IMpact of PerioperAtive KeTamine on Enhanced Recovery after Abdominal Surgery (IMPAKT ERAS): protocol for a pragmatic, randomized, double-blinded, placebo-controlled trial

BackgroundMultimodal analgesic strategies that reduce perioperative opioid consumption are well-supported in Enhanced Recovery After Surgery (ERAS) literature. However, the optimal analgesic regimen has not been established, as the contributions of each individual agent to the overall analgesic efficacy with opioid reduction remains unknown. Perioperative ketamine infusions can decrease opioid consumption and opioid-related side effects. However, as opioid requirements are drastically minimized within ERAS models, the differential effects of ketamine within an ERAS pathway remain unknown. We aim to pragmatically investigate through a learning healthcare system infrastructure how the addition of a perioperative ketamine infusion to mature ERAS pathways affects functional recovery.MethodsThe IMPAKT ERAS trial (IMpact of PerioperAtive KeTamine on Enhanced Recovery after Abdominal Surgery) is a single center, pragmatic, randomized, blinded, placebo-controlled trial. 1544 patients undergoing major abdominal surgery will be randomly allocated to receive intraoperative and postoperative (up to 48 h) ketamine versus placebo infusions as part of a perioperative multimodal analgesic regimen. The primary outcome is length of stay, defined as surgical start time until hospital discharge. Secondary outcomes will include a variety of in-hospital clinical end points derived from the electronic health record.DiscussionWe aimed to launch a large-scale, pragmatic trial that would easily integrate into routine clinical workflow. Implementation of a modified consent process was critical to preserving our pragmatic design, permitting an efficient, low-cost model without reliance on external study personnel. Therefore, we partnered with leaders of our Investigational Review Board to develop a novel, modified consent process and shortened written consent form that would meet all standard elements of informed consent, yet also allow clinical providers the ability to recruit and enroll patients during their clinical workflow. Our trial design has created a platform for subsequent pragmatic studies at our institution.Trial registrationNCT04625283, Pre-results.

Strategies to Improve Video Visit Use in Persons With Liver Disease

Strategies to Improve Video Visit Use in Persons With Liver Disease

Equitable and Holistic Public Health Measures During the Singaporean COVID-19 Pandemic.

This Covid-19 pandemic has been a trying time for all countries, governments, societies, and individuals. The physical, social, and organizational infrastructure of healthcare systems across the world is being stressed. This pandemic has highlighted that the healthcare of the country is as strong as its weakest link and that no aspect of life, be it social or economic, is spared from this pandemic.The authors would like to highlight some of the lessons learned from Singapores management of the Covid-19 pandemic. During the Singaporean Covid-19 pandemic, public health policy planning was all encompassing in its coverage, involving various stakeholders in government and society. The important role of individuals, governments, industry, and primary healthcare practitioners when tackling COVID-19 are highlighted. Singapores management of the Covid-19 pandemic involved an approach that involved the whole of society, with a particular focus on supporting the vulnerable foreign worker population, which formed the majority of Covid-19 cases in the country. Hopefully amidst the trying times, valuable lessons are learnt that will be etched into medical history and collective memory. We hope to highlight these lessons for future generations, both for members of the public and fellow healthcare practitioners.

Modelling rheumatic heart disease progression in australia using disease register data linked to administrative records

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Australian Government National Health and Medical Research Council OnBehalf ERASE project Background Rheumatic Heart Disease (RHD) is a major contributor to morbidity and mortality globally, and is endemic among Indigenous Australians. The RHD Endgame strategy was recently launched, outlining comprehensive methods for eliminating RHD in Australia by 2031. However, there is currently limited information on national rates of RHD and progression to severe or complicated RHD. Purpose This study provides current estimates of RHD progression prior to RHD Endgame Strategy implementation. We estimate the probability and predictors of progressing from RHD diagnosis to cardiovascular complications, death, or need for surgical intervention in the Australian population from expanded data sources, addressing methodological shortcomings in existing evidence by using cross-jurisdictional administrative datasets and a competing risks approach. Methods This retrospective cohort study used linked RHD register, hospital and death data from five Australian jurisdictions (>70% Australians). Progression from RHD diagnosis to all-cause mortality, non-fatal cardiovascular complications (heart failure, stroke, endocarditis, atrial fibrillation), or need for surgical intervention were estimated for people aged <35years diagnosed with first-ever RHD between 2010 and 2018. A minimum 8.5-year look-back excluded prevalent cases; maximum follow-up was 8 years. Proportional cause-specific hazard regression modelling investigated independent predictors of outcomes, with death treated as a competing risk. Sensitivity analyses compared results between all-sources and register-only cohorts. Results We identified 1714 first-ever RHD cases aged <35years in the all-sources cohort (84% Indigenous, 11% migrant, 63% women, 40% age 5-14years, 85% non-metropolitan). Six months after diagnosis, 8.1% (95%CI:6.9-9.5%) had experienced heart failure, other cardiovascular complications or surgical intervention and 23.6% (95%CI:20.2-27.5%) progressed to these outcomes within 8 years. The register-only cohort experienced less disease progression with estimated composite event rates of 5.6% (95%CI:4.7-6.6%) and 18.4% (95%CI:16.6-20.5%) at 6 month and 8 years respectively. Death rate in the all-sources cohort was 0.5% at 6 months and 3.2% at 8 years. Older age, Metropolitan residence, and history of acute rheumatic fever, but not sex or Indigenous status, were independent predictors of major cardiovascular outcomes. Conclusions This study provides the most definitive and contemporary estimates of RHD disease progression in young Australians. Despite Australia"s excellent healthcare system infrastructure, RHD complication rates remain high. Improvements in healthcare systems for diagnosis, monitoring, and management of RHD cases will need to be implemented in both Metropolitan and remote settings as Australia implements its Endgame strategy against RHD. However, primordial and primary prevention provides the best potential to reduce the burden of RHD in Australia and beyond.

Germline Genetics of Prostate Cancer: Prevalence of Risk Variants and Clinical Implications for Disease Management.

Simple SummaryAdvances in our understanding of the molecular basis of prostate cancer have resulted in the discovery of a subset of patients harboring germline variants that places them at increased risk of developing the disease. The goal of precision oncology in prostate cancer is to individualize treatments by tailoring them to the genetic characteristics of each patient’s cancer. Management of advanced prostate cancer is rapidly evolving with genomic-driven therapies. We provide a comprehensive overview of the current guideline recommendations for germline testing in prostate cancer. Expanding the use of genetic testing in prostate cancer patients can inform treatment strategies. We discuss prostate cancer germline genomic profiling and its impact on decision making of therapeutic options.Prostate cancer has entered into the era of precision medicine with the recent approvals of targeted therapeutics (olaparib and rucaparib). The presence of germline mutations has important hereditary cancer implications for patients with prostate cancer, and germline testing is increasingly important in cancer screening, risk assessment, and the overall treatment and management of the disease. In this review, we discuss germline variants associated with inherited predisposition, prostate cancer risk and outcomes. We review recommendations for germline testing, available testing platforms, genetic counseling as well as discuss the therapeutic implications of germline variants relevant to prostate cancer treatments. Understanding the role of germline (heritable) mutations that affect prostate cancer biology and risk as well as the subsequent effect of these alterations on potential therapies is critical as the treatment paradigm shifts towards precision medicine. Furthermore, enhancing patient education tactics and healthcare system infrastructure is essential for the utilization of relevant predictive biomarkers and the improvement of clinical outcomes of patients with prostate cancer or at high risk of developing the disease.

Is Korea Prepared for an Alzheimer's Disease-Modifying Therapy? Assessing the Korean Healthcare System Infrastructure and the Effect of Blood-Based Biomarker Tests.

BackgroundWith the rapid demographic change in Korea, Alzheimer’s disease has become a primary concern. Recent developments in disease-modifying therapies provide hope that therapy may become available soon. The high disease prevalence and complex evaluation process will create challenges for the healthcare system already burdened by the current pandemic. This study examined the preparedness of the South Korean healthcare system to identify and treat patients when such a therapy becomes available.MethodsWe used a Markov model to simulate a stylized patient’s journey. Based on national data and expert input, we presented projections of the diagnosis and treatment wait times and respective queues of patients under treatment and no-treatment scenarios and further simulated the possible option of adopting a blood-based biomarker test. ResultsUnder the current system, we estimated a peak waiting time of 14 months when a treatment became available, largely because of the limited number of dementia specialists. Adopting a blood-based biomarker test dramatically reduced the initial wait times by more than half. A disease-modifying therapy was estimated to avert 575,000 incident cases in the first 10 years after the treatment entered the market, and a blood-based test further avoided 86,000 additional cases.ConclusionSouth Korea’s healthcare infrastructure requires more preparation for the introduction of a disease-modifying therapy, with the primary capacity limitation being the low number of dementia specialists. The utilization of a blood-based test for Alzheimer’s disease biomarkers may be an effective solution.

The Role of Sociodemographic Factors During a Pandemic Outbreak: Aggravators and Mitigators

Many macro-and micro-level factors affect the spread of an infectious disease. Among them are sociodemographic, socioeconomic, sociocultural, health care system infrastructure, use of alcohol or substances, level of life disruptions because of chronic illnesses. Because of accuracy and timeliness issues, officials are often forced to make one-size-fits-all decisions across all regions. This paper offers a framework to analyze and quantify the interrelationships between a wide set of sociodemographic factors and the transmission speed of the pandemic to facilitate custom-fitted regional containment measures. The purpose of this paper is to investigate the role of a comprehensive set of sociodemographic factors in the diffusion of COVID-19 analytically. Our findings suggest that diverse sets of sociodemographic factors drive the transmission during different stages of the pandemic. In specific, we show that variables such as gender, age groups, daily commuting distances, modes of employment, poverty and transportation means are found to be statistically significant in the transmission speed of COVID-19. Our results do not suggest a statistically significant relationship between transmission speed and migration-related variables. We also find that the importance levels for the statistically significant variables vary across different stages of the pandemic. Our results point out a variety of public policy insights and implications. © 2021 Sociological Demography Press.

Resuming elective surgery in the time of COVID-19: a safe and comprehensive strategy.

The 2019 novel corona virus and the disease it causes (COVID-19) is a public health crisis that has profoundly modified the way medical and surgical care is delivered. Countries around the globe had a variable initial response to the COVID-19 pandemic from imposing massive lock downs and quarantine to surrendering to herd immunity. However, healthcare bodies worldwide recognized early on that a triumph against COVID-19 could only be achieved by maintaining the infrastructure of healthcare systems and their capacity to accommodate a potentially overwhelming increase in critical patient care needs. Therefore, they reacted by restricting medical care to emergency cases and postponing elective surgical procedures in all disciplines. The priority was made for treatment of COVID-19 patients and emergency cases. Nevertheless, the battle against the COVID-19 pandemic is still ongoing. In the absence of vaccines or effective drug treatments, its timeline remains uncertain and it cannot be forecast how long healthcare systems will need to cope with it in managing inpatient and outpatient services. Accordingly, extreme measures and restriction may become a recipe for a disaster in the context of the potential adverse health implications imposed by delaying timely medical and surgical care. Therefore, restrictive measures should be substituted with a comprehensive surgical and medical care strategy. One that provides a safe balance between the prevention of COVID-19 and the delivery of essential surgical care. This article provides an overview on how to safely deliver essential surgical care in the time of COIVD-19.

Is the incidence of breast cancer increasing? Using the NCDB and autoregressive integrated moving average models (ARIMA) to forecast breast cancer to 2030.

e13612 Background: The observed increase in the incidence rate of BC has been described due, in part, to higher, effective public health campaigns for screening, higher sensitivity among diagnostic testing modalities as well as an aging population. While the mortality rate associated with breast cancer has reported to fall by 1.8% every year since 2007, the disease burden itself has continued to grow and increased breast cancer rates will contribute to the strain already experienced within the United States healthcare system infrastructure. Therefore, the authors sought to use a large, national registry to develop a time series model that might help forecast the approximate breast cancer incidence rate, to the year 2030, as captured by the National Cancer Database (NCDB). Methods: In this time series forecast, autoregressive integrated moving average models (ARIMA) were constructed based on 2004-2016 historic breast cancer incidence rates, as reported by the NCDB. Multiple models were generated, using differing autoregressive parameters, and the most predictive model was chosen using the lowest Bayesian Information Criteria (BIC), and mean absolute percentage error (MAPE). Similar methodology has already been published to predict prostate cancer incidence. The best fit model was applied to forecast annual incidence in the NCDB to the year 2030. Statistics were performed using modeling systems in SPSS, version 26. Results: For this model, 12 years of NCDB breast cancer diagnoses were used, which included n = 1,924,425 cases, overall. Using ARIMA modeling, a best fit, stationary average was identified with autoregressive and difference terms of 1 (ARIMA (1,1,0), coefficient = 0.598; P = 0.028). Of the multiple models tested the model with the lowest BIC was chosen, with a MAPE of 4.71%. The best fit model forecasted n = 325,048 new breast cancer diagnoses to be captured annually by the NCDB, by 2030. Conclusions: In this analysis, the annual breast cancer incidence within the NCDB is predicted to increase by 21%, by 2030. This forecast, while slightly lower than previously reported by the National Cancer Institute, utilizes more recent historical data that reflects a period of leveling-off in disease incidence, during 2014-2016, as reported to the NCDB. This innovative model can be utilized to proactively plan public health strategies and allocate appropriate resources focused on reducing the burden of cancer.

PMU59 GLOBAL OUTCOMES-BASED CONTRACTING TRENDS IN THE US AND EUROPE OVER THE PAST 5 YEARS

As global spending on medicines continues to escalate, healthcare markets are experiencing increased pressure to improve patient access to highly effective, yet costly therapies. Outcomes-based contracts (OBCs) have been implemented as a sustainable solution to the rising cost of healthcare. Variation in healthcare system infrastructure, market priorities and the existence of formal health technology assessment bodies, may account for the differences in approaches to outcomes-based contracting between the US and EU.

Challenges to implementing the WHO Framework Convention on Tobacco Control guidelines on tobacco cessation treatment: a qualitative analysis.

To identify barriers to implementing the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) Article 14 guidelines on tobacco dependence treatment (TDT). Cross-sectional survey conducted from December 2014 to July 2015 to assess implementation of Article 14 recommendations. Survey respondents (n=127 countries) who completed an open-ended question on the 26-item survey. The open-ended question asked the following: 'In your opinion, what are the main barriers or challenges to developing further tobacco dependence treatment in your country?'. We conducted thematic analysis of the responses. The most frequently reported barriers included a lack of health-care system infrastructure (n=86) (e.g. treatment not integrated into primary care, lack of health-care worker training), low political priority (n=66) and lack of funding (n=51). The absence of strategic plans and national guidelines for Article 14 implementation emerged as subthemes of political priority. Also described as barriers were negative provider attitudes towards offering offer TDT (n=11), policymakers' lack of awareness about the effectiveness and affordability of TDT (n=5), public norms supporting tobacco use (n=11), a lack of health-care leadership and expertise in the area of TDT (n=6) and a lack of grassroots and multi-sector networks supporting policy implementation (n=8). The analysis captured patterns of co-occurring themes that linked, for example, low levels of political support with a lack of funding necessary to develop health-care infrastructure and capacity to implement Article 14. Important barriers to implementing the Framework Convention on Tobacco Control Article 14 guidelines include lack of a health-care system infrastructure, low political priority and lack of funding.

If it ain't broke don't fix it? Ethics of splinting deformed newborn ears

Neonatal ear splinting is a proven and safe method to mold deformed ears into a more common shape. Based on our earlier studies, splinting is recommended only before the age of six weeks and preferably within the first week after birth. This can be done by initiating a system in which this intervention is actively proposed to parents. In this paper, we ethically evaluate such a system. By molding perfectly healthy newborn ears, we reach the boundary between treatment and enhancement. A key question is, therefore, whether we could classify neonatal ear splinting as a therapy. On the level of the individual, the advantages outweigh the drawbacks, but on the level of society, it is more complicated. Making ear deformities a part of official national screening programs fails to meet WHO criteria. Moreover, by systematically offering ear molding, professionals may be promoting guilt or fear of missing the opportunity. Additionally, it could affect societal attitudes toward cosmetic deformities. However, if we argue that on the individual level infants may benefit from ear splinting, then active detection of ear deformities allows parents to choose in a timely way from the full range of options, including splinting and a wait-and-see approach. We are inclined to optimally inform parents without setting up a full-blown public health program. The extent to which it is possible to timely offer splints to parents of newborns depends on the infrastructure of health care systems. The key will be for everyone involved, public or commercial, to responsibly educate and facilitate.

Правове регулювання діяльності біобанків в Україні

Правове регулювання діяльності біобанків в Україні

Adherence to oral anticoagulant therapy in patients with atrial fibrillation. Focus on non-vitamin K antagonist oral anticoagulants.

Oral anticoagulation is pivotal in the management of thromboembolic risk in non-valvular atrial fibrillation (NVAF) patients. Effective anticoagulation is important to avoid major adverse events and medication adherence is central to achieve good anticoagulation control. Non-vitamin K antagonist oral anticoagulants (NOACs) are as effective and safe as vitamin K antagonist (VKAs) in NVAF patients. Due to the absence of routine anticoagulation monitoring with NOACs treatment, concerns have been raised about patient's adherence to NOACs and real-life data demonstrates variability in adherence and persistence. A multi-level approach, including patients' preferences, factors determining physicians' prescribing habits and healthcare system infrastructure and support, is warranted to improve initiation and adherence of anticoagulants. Adherence to NOACs is paramount to achieve a clinical benefit. Implementation of educational programs and easy-to-use tools to identify patients most likely to be non-adherent to NOACs, are central issues in improving the quality of NVAF anticoagulation management.

Model-Informed Risk Assessment and Decision Making for an Emerging Infectious Disease in the Asia-Pacific Region.

BackgroundEffective response to emerging infectious disease (EID) threats relies on health care systems that can detect and contain localised outbreaks before they reach a national or international scale. The Asia-Pacific region contains low and middle income countries in which the risk of EID outbreaks is elevated and whose health care systems may require international support to effectively detect and respond to such events. The absence of comprehensive data on populations, health care systems and disease characteristics in this region makes risk assessment and decisions about the provision of such support challenging.Methodology/principal findingsWe describe a mathematical modelling framework that can inform this process by integrating available data sources, systematically explore the effects of uncertainty, and provide estimates of outbreak risk under a range of intervention scenarios. We illustrate the use of this framework in the context of a potential importation of Ebola Virus Disease into the Asia-Pacific region. Results suggest that, across a wide range of plausible scenarios, preemptive interventions supporting the timely detection of early cases provide substantially greater reductions in the probability of large outbreaks than interventions that support health care system capacity after an outbreak has commenced.Conclusions/significanceOur study demonstrates how, in the presence of substantial uncertainty about health care system infrastructure and other relevant aspects of disease control, mathematical models can be used to assess the constraints that limited resources place upon the ability of local health care systems to detect and respond to EID outbreaks in a timely and effective fashion. Our framework can help evaluate the relative impact of these constraints to identify resourcing priorities for health care system support, in order to inform principled and quantifiable decision making.