Medical Care Support Research Articles

Improving the efficiency of the medicine provision system for patients with malignant neoplasms

Background. One of the priorities of health care is the balance between the financial resources and the availability of effective medical care. The current approach of access to cancer medicines limits the timeliness and availability of treatment. At the same time, financial support from the government provides great costs on cancer drugs. However, these great costs are not rational.Objective: to assess the financing needs of the complete transfer of financial support of medical care in the field of oncology to the Compulsory Health Insurance (CHI) system by means of optimizing the functions of the day hospital.Material and methods. The achievement of the goal is planned to be reached by eliminating the unusual functions of oncological day hospital. We analyzed the regulatory legal documents regulating drug care and drug provision in the Russian Federation, data from depersonalized (anonymized) registers of the structure of hospitalizations in a day hospital for 2021. The methods of expert assessments, mathematical modeling, as well as literature data analysis were used. The study developed a model for assessing the need to finance the full transfer of medicine provision to the CHI system, including taking into account the hidden deficit.Results. The total amount of funds released from the reduction of irrational hospitalizations in day hospital conditions amounted to 2.08% of the funding level of the analyzed schemes. Taking into account the data of hospitalizations in oncological day hospital for 2021, the number of irrational hospitalizations in case of transfer of selected schemes to the outpatient stage will decrease by 16.1%. The transfer of all the medicine therapy to financing from the CHI funds will require significant additional budget expenditures in the amount of 62.5 billion rubles or 2.65% of the total costs of the State Guarantees Program for Provision of Free Medical Care to Citizens.Conclusion. Despite the rationality of the proposed changes in the field of improving access to medicine provision concerning cancer drugs and the identified justifications for changing the distribution of financial resources within the State Guarantees Program, there are difficulties. In order to solve this problem, a coordinated consideration of potential strategies to address the access to cancer medicines is needed.

The medical demographic characteristic of group of citizen injured in road accidents on the Federal Highway.

The role of citizen of elderly age in road accidents on the Federal Highway was principally passive since passengers of vehicles predominated (p<0,0001). The most of victims of elderly age (66,7%) suffered of combined lesions. Considering gender of victim, presence of ethanol in blood at the moment of hospitalization, the role of victim of road accident and degree of severity of lesions in citizen of elderly age was in overall higher than in citizen of able-bodied age up to 2.3-2.9 points according ISS scale. The established medical demographic characteristics of victims of elderly age condition necessity of development of differentiated approaches to their medical care support, planning of measures of population prevention of medical sanitary aftermaths of road traumatism.

Transitional Medical Care Support Centers for Neurological Disorders

The establishment of a "Transition medical care support center" in each prefecture was requested by the Japanese Ministry of Health, Labour, and Welfare in 2017. To date, seven centers have been set up, including the Chiba Prefecture Transition Medical Care Support Center at the Chiba University Hospital. This review article introduces the current status and perspectives for the development of the care support system and autonomy/independence in patients with pediatric-onset chronic disease in their transitional age. The specific network acting on the total care and support should be warranted to achieve sufficient and proper assistance to the corresponding patients.

The Influence of Maternal Factors on Neonatal Intensive Care Unit Admission and In-Hospital Mortality in Premature Newborns from Western Romania: A Population-Based Study.

Background and Objectives: Neonatal mortality is a global public health issue, disproportionately affecting low- and middle-income nations. Although Romania is a high-income nation, according to the European Union’s most recent demographic data, it had the second-highest infant death rate in 2019. Although significant progress has been made in the last three decades in lowering newborn mortality, more initiatives to accelerate progress are required to meet the 2030 Sustainable Development Goals (SDG) objective. Therefore, we aimed to develop an observational study to determine the influence of maternal factors on in-hospital neonatal intensive care unit admission and mortality in premature infants born in western Romania. While newborn mortality has decreased globally, the pace of decline is far less than what is desired. Materials and Methods: A retrospective study comprising 328 premature patients and 422 full-term newborns, was developed at a tertiary obstetrics and gynecology clinic in western Romania, comprising the period of the last 24 months before the COVID-19 pandemic and the first 24 months of the pandemic. Results: The following variables were identified as statistically significant risk factors for neonatal intensive care unit admission: age > 35 years, OR = 1.59; twin births, OR = 1.14; low gestational age, OR = 1.66; preeclampsia, OR = 2.33; and peripartum infection, OR = 2.25. The same risk factors, with the exception of twin births, were significantly associated with in-hospital neonatal mortality. Except for a longer duration of maternal hospitalization and neonatal therapy with surfactant, steroids, and antibiotics, the COVID-19 pandemic did not cause significant differences in the evolution and outcomes of preterm newborns. Conclusions: The major maternal risk factors for NICU admission were advanced age, twin pregnancy, low gestational age, preeclampsia, and peripartum infection. Additionally, these characteristics contributed to a high likelihood of death, despite adequate access to medical care and advanced life support for the neonates. Understanding the causes of morbidity and death in neonates admitted to the neonatal intensive care unit enables better prioritization and planning of health services, resource reallocation, and care quality improvement.

Experience and Prospects of Creating Medical Information Systems and Information Technologies to Support Medical Care

Experience and Prospects of Creating Medical Information Systems and Information Technologies to Support Medical Care

Impact of the Covid-19 Pandemic on Children and Families in PICU Follow-Up Clinic

AbstractThe novel coronavirus disease 2019 (COVID-19) pandemic disrupted the lives of many families, especially those of children with chronic health problems. Little is known about the impact of this pandemic on the health and well-being of critically ill children and their families after their discharge from pediatric intensive care unit (PICU) hospitalization. This study describes the repercussions of the COVID-19-related lockdown on the physical and psychological wellbeing, quality of life, and access to resources of PICU survivors and their families. This was a prospective cohort study of children and families followed at the Centre Hospitalier Universitaire Ste-Justine PICU follow-up clinic from October 2018 to February 2020. Families were contacted by phone to complete validated questionnaires (Pediatric Quality of Life Inventory, Hospital Anxiety and Depression Scale) and to evaluate the impact of the COVID-19 pandemic on their access to medical care and extrafamilial support. Fifty-five families were contacted between November and December 2020. Quality of life scores were 88.1 ± 16.9 and 83.8 ± 13.9 for physical and psychosocial aspects, respectively. Symptoms of anxiety and depression were detected in 23.6 and 3.6% of respondent parents, respectively. A significant proportion of families reported canceled or delayed health care appointments (65.5%) and difficulty with medication access (12.7%). Twenty-five families (45.5%) reported a significant decrease in income. We could not identify any statistically significant predictors for lower quality of life scores. Difficulty accessing medical care was associated with higher symptoms of anxiety and/or depression in parents on multivariate analysis (p = 0.02). In conclusion, the COVID-19 pandemic has had a significant negative impact on PICU survivors' access to medical resources and extrafamilial support.

Who's in the House? Staffing in Long-Term Care Homes Before and During COVID-19 Pandemic.

Critical gaps exist in our knowledge on how best to provide quality person-centered care to long-term care (LTC) home residents which is closely tied to not knowing what the ideal staff is complement in the home. A survey was created on staffing in LTC homes before and during the COVID-19 pandemic to determine how the staff complement changed. Perspectives were garnered from researchers, clinicians, and policy experts in eight countries and the data provides a first approximation of staffing before and during the pandemic. Five broad categories of staff working in LTC homes were as follows: (1) those responsible for personal and support care, (2) nursing care, (3) medical care, (4) rehabilitation and recreational care, and (5) others. There is limited availability of data related to measuring staff complement in the home and those with similar roles had different titles making it difficult to compare between countries. Nevertheless, the survey results highlight that some categories of staff were either absent or deemed non-essential during the pandemic. We require standardized high-quality workforce data to design better decision-making tools for staffing and planning, which are in line with the complex care needs of the residents and prevent precarious work conditions for staff.

Cognition, Behavior, and Caregiver Stress in Dementia during the COVID-19 Pandemic: An Indian Perspective

Objectives: Little is known regarding the cognitive and behavioral status of patients with dementia and their caregivers in lower middle-income countries during the COVID-19 pandemic. This study aimed to understand the impact of the pandemic on persons with dementia and their caregivers in India. Methods: This was an observational study. A cohort of 66 persons with dementia and their caregivers were evaluated during the COVID-19 pandemic in 2 specialist hospitals in South India. Caregivers were interviewed at 2 distinct time points of the pandemic: during the national lockdown and 5 months after during later periods of the “cluster of cases” transmission phase. Participants were assessed via telephone utilizing validated instruments (Neuropsychiatric Inventory [NPI], Clinical Dementia Rating [CDR] Scale, and Depression, Anxiety and Stress Scale [DASS-21]) and a semi-structured questionnaire. The questionnaire documented sociodemographic information, clinical history, infection measures adopted, changes in caregiving routines, involvement in functional rehabilitation activities, and access to medical and long-term care support services. Results: The 2-phase follow-up study found a significant worsening of behavior in dementia patients, demonstrated by a difference in the NPI sub-domain scores for anxiety (mean difference [standard deviation, SD] = −0.552 [1.993], t₅₈ = −2.109, p = 0.039) and eating disturbances (mean difference [SD] = −1.121 [2.493], t₅₉ = −3.424, p = 0.001). A relatively high proportion of patients developed anxiety (cumulative incidence = 24.53%) and eating disturbances (cumulative incidence = 26.92%), without having these symptoms at baseline. There was a trend toward an increase in proportion of persons with severe dementia (19.7% vs. 39.4%) on follow-up. Caregiver distress reported was significantly associated with neuropsychiatric symptoms (r = 0.712, p < 0.001) and dementia severity (ρ = 0.365, p = 0.004). In addition, difficulties in accessing medical care persisted between the 2 assessments, and there were statistically significant differences between functional rehabilitation activities such as indoor activities (p < 0.001), outdoor activities (p = 0.013), and physical exercises (p = 0.003) between baseline and follow-up. Conclusion: Findings suggest interruption of functional rehabilitation activities and disruption in medical care services are likely to have had an adverse impact on patients with dementia and contributed toward caregiver distress.

Advance Care Planning Preferences in Hong Kong: A Cross-Sectional Study in a Community.

(1) Background: Hong Kong is experiencing population aging, but there is little research on advance care planning. This research asks for community-dwelling older adults’ views on advance care planning in order to provide a different angle to the results collected from nursing homes and hospitals. (2) Methods: The targeted respondents were people aged 55 or above. A total of 282 questionnaires were collected using the random sampling method. Respondents were asked whether they would make an advance care plan, whether they would prepare for their death, and whether they had received any death education; they were also given eight statements related to treatments and decision making. (3) Results: The study found that only 17% of the respondents would like to use advance care planning, even after it was explained to them. Advance care planning favorers would be more likely to insist on having wills and would be more likely to trust doctors rather than family members. (4) Conclusions: The results also suggested that the medical care and social support for end-of-life patients should be improved. The results also showed the importance of medical professionals as they showed that respondents wanted advice on end-of-life decision-making from medical professionals.

Military Responses to the COVID-19 Pandemic Crisis in Latin America: Military Presence, Autonomy, and Human Rights Violations.

The military in Latin America has been extensively involved in pandemic relief operations. This paper analyses the impact of militarization of pandemic relief operations on human rights. It argues that not all militarization is equally harmful to individuals in the region. When troops assume responsibilities regarding medical care and logistical support, human rights violations do not follow. When involved in policing the stay-at-home orders, the extent of human rights violations is explained by the level of operational autonomy the military has in public security operations. The more autonomous the military, more likely abuses are to occur. Additionally, military exposure to judicial prosecution for human rights offenses contributes to the explanation. After gathering original empirical evidence from 14 Latin American democracies on military presence in pandemic relief, we draw our inferences from process tracing on four comparative case studies of Argentina, Brazil, Chile, and El Salvador.

The specialized medical care of children with rare diseases

The article presents the results of analysis of specialized medical care of children with life threatening and chronic progressive rare (orphan) diseases resulting in life span shortening or disability. The possibility of medication support of children with rare diseases. The development of patient routing system considering characteristics of particular disease and possibilities of the subjects of the Russian Federation is one of most important directions of enhancement of needed medical care support.

The development of first medical care support to victims of road traffic accidents: The publications review

The medical and demographic losses because of road traffic accidents continue to be significant in most of economically developed and developing countries. The national strategies of reducing medical and demographic losses include two groups of measures, depending on object of exposure: (1) targeted to decreasing risk of road traffic accidents and (2) targeted to timely and adequate medical care support of victims. Beyond this classification are activities targeted to developing and improving in participants of road traffic skills of first self-care and mutual assistance. The availability of mentioned skills is important for saving lives and preventing permanent disability of victims of road traffic accidents.

The actual aspects of medical health and life insurance of members of ships' crews

The Maritime industry plays one of the key role in world economy, occupying central position in becoming unified system of global transportations. At that, crew members ensure necessary vessel seakeeping and high-quality and safe delivery of cargo under contract of sea transportation. In accordance with requirements of the legislation any employer is obliged to insure health and life of employees under professional duties performance. However, this issue has its own specific aspects in shipping. The article considers in detail procedure of insuring health and life of the crew members, considering current trends in medical care support under professional duties performance on voyage. The key problematic aspects are identified. The corresponding recommendations are proposed.

Machine learning model for predicting the length of stay in the intensive care unit for Covid-19 patients in the eastern province of Saudi Arabia

The COVID-19 virus has spread rapidally throughout the world. Managing resources is one of the biggest challenges that healthcare providers around the world face during the pandemic. Allocating the Intensive Care Unit (ICU) beds' capacity is important since COVID-19 is a respiratory disease and some patients need to be admitted to the hospital with an urgent need for oxygen support, ventilation, and/or intensive medical care. In the battle against COVID-19, many governments utilized technology, especially Artificial Intelligence (AI), to contain the pandemic and limit its hazardous effects. In this paper, Machine Learning models (ML) were developed to help in detecting the COVID-19 patients’ need for the ICU and the estimated duration of their stay. Four ML algorithms were utilized: Random Forest (RF), Gradient Boosting (GB), Extreme Gradient Boosting (XGBoost), and Ensemble models were trained and validated on a dataset of 895 COVID-19 patients admitted to King Fahad University hospital in the eastern province of Saudi Arabia. The conducted experiments show that the Length of Stay (LoS) in the ICU can be predicted with the highest accuracy by applying the RF model for prediction, as the achieved accuracy was 94.16%. In terms of the contributor factors to the length of stay in the ICU, correlation results showed that age, C-Reactive Protein (CRP), nasal oxygen support days are the top related factors. By searching the literature, there is no published work that used the Saudi Arabia dataset to predict the need for ICU with the number of days needed. This contribution is hoped to pave the path for hospitals and healthcare providers to manage their resources more efficiently and to help in saving lives.

Medical care and research: Two wings of a great eagle in critical care

Medical care and research: Two wings of a great eagle in critical care

Liminal Lives in Uncertain Times: Health Management During the COVID-19 Pandemic Among Transgender and Non-Binary Older Adults.

Older adulthood is a crucial time in the health management journeys of transgender and non-binary (TNB) people. Understanding how the COVID-19 pandemic has impacted TNB older patients (65 years and over) offers critical guidance for successful health services reform and continued delivery systems change. Using qualitative data from 47 semi-structured individual interviews, I investigate how TNB older Americans—as a medically and socially vulnerable population in the United States—manage their health during the COVID-19 pandemic. Results indicated a need for enhancing health services and resources for TNB older adults while creating a culture of age-friendly and gender-affirming healthcare. Four primary themes emerged: (1) exacerbated mental health challenges, (2) disrupted social relationships and support, (3) adopting cost-effective health management strategies, and (4) incorporating family care partners in health management. Such themes were shaped by respondents’ privileged and marginalized social locations, such as access to financial security, social support, and adequate medical care. Although these research findings should not be generalized to the TNB older adult population, they suggest that broader patterns of inequity affect how TNB older Americans manage their health during the COVID-19 pandemic.

Characterization of the Population Affected by the 6-Month Recertification Criterion of the Ryan White HIV/AIDS Program's AIDS Drug Assistance Program in Washington State, 2017-2019.

AIDS Drug Assistance Programs (ADAPs) provide financial support for medical care for people living with HIV (PLWH) in the United States. Federal policy requires that clients recertify for the program every 6 months, which has been described as a barrier to care access. Our objective was to describe the prevalence of and factors associated with ADAP disenrollment in Washington State. Between 2017 and 2019, we categorized ADAP clients by the success of their recertification applications as follows: (1) continuously enrolled, (2) ruled ineligible, or (3) disenrolled if they failed to recertify. We compared individuals who were disenrolled with those who were continuously enrolled by demographic and socioeconomic characteristics and engagement with case management using data from the Washington State HIV Surveillance and Ryan White data systems. From 2017 to 2019, 5480 clients were enrolled in ADAP, of whom 1423 (26%) were disenrolled and 984 (18%) were ruled ineligible at least once. Compared with those who were continuously enrolled, disenrolled PLWH were more likely to be Black [unadjusted prevalence ratio (PR) vs White 1.31, 95% confidence interval (CI): 1.17 to 1.46], uninsured (PR vs private insurance 1.24, 95% CI: 1.10 to 1.40), and younger (PR 25-34 vs 35-44 years 1.23, 95% CI: 1.08 to 1.41). The median time to return after disenrollment was 12 months (95% CI: 8 to 19 months). Disenrollment after failure to recertify was the most common reason why PLWH lost ADAP coverage in Washington State. ADAP recertification procedures disproportionately affect Black, young, and uninsured PLWH and may contribute to disparities in HIV outcomes.

The influence of social economic factors on level of morbidity of psoriasis among adult population of the Republic of Bashkortostan

To assess the social economic factors of development of morbidity of psoriasis in adult population within a separate region as exemplified by the Republic of Bashkortostan. The non-linear dynamic prognostic regression model with panel data was applied to establish role of social economic factors in development of morbidity of psoriasis in adult population. The model-based indicator is rate of total adult morbidity of psoriasis in 51 municipalities and 7 urban districts in 2014-2018. The factor space was generated by ten groups. The regression coefficients (elasticity) were obtained for every group of social economic factors. With increasing of factor of harmful emissions into atmosphere by 100.0%, morbidity of psoriasis in all municipalities can increase on average by 7.0% (elasticity coefficient -0.07). With increasing of economic well-being and incomes of population by 1.0%, a decrease of morbidity of psoriasis by 1.55% is possible. With changing of number of workers employed in harmful production by 100.0%, morbidity of psoriasis in adult population decreases on average by 3.9% (elasticity coefficient -0.39). The specific number of unemployed population (the unemployed, pensioners) and factor of social psychological stress in society turned out to be insignificant. The elasticity factor of level of support of population with public health resources was 0.08. At theoretical opportunity of increasing health care resources up to 100.0%, morbidity of psoriasis in adult population of municipalities can increase on average by 8.0%. The overall morbidity of psoriasis in adult population of the Republic of Bashkortostan is positively affected by economic development of municipality and level of urbanization. The unfavorable environmental factors have impact negatively. The increasing of volume of health care resources (provision of population with medical personnel, number of beds of day-and-night and daytime stay, capacity of polyclinic institutions, etc.) may result in increasing of morbidity of psoriasis in municipalities as consequence of increased accessibility of medical care. The study results can be applied in planning health care within the framework of medical care support of patients with chronic dermatitis in the Republic of Bashkortostan.

Clinical characteristics and prognostic factors of intracranial abscess in regional medical care support hospitals

Clinical characteristics and prognostic factors of intracranial abscess in regional medical care support hospitals

The medical care support of children population by "phthisiology" profile in The Russian Federation: The comparison of normative, factual and estimated rate of hospitalization

To compare normative, factual and estimated rate of hospitalization to provide medical care of children population on profile "phthisiology" in hospitals of the subjects of The Russian Federation. Such methods as analysis of statistical information, normative and analytic technique, method of ratios and proportions, correlation analysis were applied. The data on number of patients with active tuberculosis were used to estimate need in mentioned medical care by 14 groups of patients that made up to 0.2 cases per 1000 children that is three times less than factual (0.6) and four times less than normative (0,8) indices. In the comparison groups, deficiency of factual vs. normative volumes of medical care increases as group morbidity increases. However, there are no signs of unmet needs in medical care. Thus, as bed occupancy rate is below approved level in all study groups. There is no correlation between bed occupancy rate and factual vs. normative admission rates ratio (Kendall's tau_b=0,178, р=0,101). The mismatch between factual and normative admission rates on profile "phthisiology" demonstrates both uneven provision of medical care in the subjects of The Russian Federation and overestimation of approved (normative) medical care that is four times higher than the estimated rate. To validate the obtained results special study of health care in question is needed with focused on primary data combined with expert assessment of validity of hospitalization.