Medical Expenses Research Articles

Resolving sustainable development conflicts caused by vinyl leakage accidents in the USA: From the perspective of graph model under fuzzy preferences with self-confidence

On February 3, 2023, a railroad accident led to the release and combustion of 115,580 gallons of vinyl chloride monomer in East Palestine, Ohio, USA. The large leakage and long-time combustion of vinyl chloride monomer harmed the stability of local sustainable ecosystems and the health of residents, as the burning produced deadly toxins, triggering dissatisfaction from residents and environmental protection organizations. With the COVID-19 pandemic still unfolding globally, decision makers (DMs) in vinyl chloride leakage accidents must consider the existing environmental health uncertainty, potentially leading to uncertainty in their preference cognitive. Thus, this paper proposes a novel fuzzy preference with a self-confidence structure of the graph model for conflict resolution (GMCR) to resolve the sustainable development conflicts caused by the vinyl chloride leakage accident in Ohio. Fully considering the uncertainty of option choice by DMs and the different levels of confidence in DMs’ preference selection, four different fuzzy stability definitions of self-confidence are defined in GMCR. The analysis results suggest the following: (1) During conflicts, the US Norfolk Southern Corp should assume corporate responsibility by setting up a health monitoring system for residents in Ohio; the company should pay for the medical examinations and related care expenses for residents within the scope of the vinyl chloride leakage accident. (2) The negotiation of all stakeholders in conflicts can promote reconciliation. Finally, the analysis process and results of this study can provide guidance to government departments for properly handling major accidents and appeasing affected residents.

Cross-provincial inpatient mobility patterns and their determinants in China

BackgroundThe incongruity between the regional supply and demand of healthcare services is a persistent challenge both globally and in China. Patient mobility plays a pivotal role in addressing this issue. This study aims to delineate the cross-provincial inpatient mobility network (CIMN) in China and identify the underlying factors influencing this CIMN.MethodsWe established China’s CIMN by applying a spatial transfer matrix, utilizing the flow information from 5,994,624 cross-provincial inpatients in 2019, and identified the primary demand and supply provinces for healthcare services. Subsequently, we employed GeoDetector to analyze the impact of 10 influencing factors—including medical resources, medical quality, and medical expenses—on the spatial patterns of CIMN.FindingsBeijing, Shanghai, Zhejiang, and Jiangsu provinces are the preferred medical destinations for cross-provincial inpatients, while Anhui, Henan, Hebei, and Jiangsu provinces are the main sources for cross-provincial inpatients. Patient flow between provinces decreases with distance. The spatial distribution of medical resources, medical quality, and medical expenses account for 87%, 73%, and 56% of the formation of CIMN, respectively. Additionally, interactions between these factors enhance explanatory power, suggesting that considering their interactions can more effectively optimize medical resources and services.ConclusionsThe analysis of CIMN reveals the supply and demand patterns of healthcare services, providing insights into the inequality characteristics of healthcare access. Furthermore, understanding the driving factors and their interactions offers essential evidence for optimizing healthcare services.

Regional price differences of medical services: evidence from China

BackgroundPrice levels of medical services may vary across regions with different income levels, which would raise concerns about the equal access to medical services. This study aimed to estimate the spatial price index of medical services to measure price levels across 31 provincial regions in China.MethodsPrice data were collected from medical service price schedule in each region. Two methods based on the Purchasing Power Parities were used to estimate the spatial price index and measure price differences across regions. The two-way fixed effects models were used to examine the association between medical service price levels and income levels, and further investigate the impacts of price differences on utilization of medical services and medical expenditure.ResultsThe consistent estimation results were given by two methods. Medical service price level in the highest-price region was found to be 74% higher than the lowest. There was a significant negative correlation between price levels and income levels, as well as price levels and the utilization of outpatient services. Moreover, we also found a 1% increase in medical service price level was significantly associated with a 0.34% and 0.24% increase in the medical service expense per outpatient visit and per inpatient respectively.ConclusionsRegions in China had significant gaps in medical service price levels. Policymakers should pay more attention to regional price differences and take great measures such as enhancing financial protection to ensure the equal access to medical services and better achieve the universal health coverage.

A retrospective analysis of clinical characteristics and outcomes of pediatric fulminant myocarditis

BackgroundThe study aimed to explore clinical indicators that can predict the prognosis of children with acute fulminant myocarditis (AFM) through a retrospective analysis.MethodsA retrospective analysis was conducted on the clinical indices of 79 children diagnosed with AFM and hospitalized from March 2013 to March 2023. Relevant demographic and clinical data, including symptoms at admission, laboratory results, and outcomes were extracted to identify factors associated with in-hospital mortality.ResultsA total of 79 children with AFM were analyzed. The survival group (n = 61) had a longer median hospital stay and higher medical expenses compared to the death group (n = 18). Significant differences in the levels of left ventricular ejection fraction (LVEF)(P < 0.001), myoglobin (MYO)(P < 0.001), aspartate aminotransferase (AST)(P < 0.001), lactate dehydrogenase (LDH)(P = 0.004), B-type natriuretic peptide (BNP)(P = 0.005), arterial potential hydrogen (PH)(P < 0.001), bicarbonate (HCO3-)(P = 0.003), serum lactate (Lac)(P = 0.001), peripheral oxygen saturation (SpO2)(P = 0.008), and white blood cell count (WBC)(P = 0.007) were observed between the two groups. Additionally, there were significant differences in the incidences of multi-organ failure (P = 0.003) and respiratory failure (P = 0.001) between the two groups.ConclusionsSevere myocardial injury (AST > 194.00 U/L, LDH > 637.50 U/L, MYO > 265.75 µg/L, BNP > 1738.50 ng/L), acidosis (PH < 7.29, HCO3− <18.45 mmol/L, Lac > 12.30 mmol/L), hypoxia (SpO2 < 97.50%), inflammatory response (WBC > 9.69*109/L), left ventricular systolic dysfunction (LVEF < 28.25%), multi-organ failure, and respiratory failure are significantly associated with higher mortality rates. These factors can accurately identify AFM children at an increased risk of death.

AWGC2023 cachexia consensus as a valuable tool for predicting prognosis and burden in Chinese patients with cancer.

The Asian Working Group for Cachexia (AWGC) proposed the first consensus report on diagnostic criteria for cachexia in Asians in 2023. However, the current consensus lacks cohort evidence to validate its effectiveness and practicality. We aimed to explore the value of the AWGC2023 criteria for predicting the prognosis and medical burden of patients with cancer through a retrospective post hoc cross-sectional analysis of the Investigation on Nutrition Status and its Clinical Outcome of Common Cancers (INSCOC) project in China. Cox regression analyses were performed to assess the independent association between cachexia and long-term survival. We utilized C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), inflammatory burden index (IBI), albumin (ALB) and Glasgow prognostic score (GPS) as diagnostic markers for cachexia, designating them as CRP-based cachexia, NLR-based cachexia, IBI-based cachexia, ALB-based cachexia and GPS-based cachexia, respectively. Additionally, we diagnosed cachexia using body mass index (BMI) cutoff values of 18.5, 20, 21 and 22kg/m2, respectively, and subsequently compared their prognostic predictive value through Harrell's concordance index (C-index). Logistic regression models were used to assess the association between cachexia and medical burden. A total of 5426 patients with cancer were enrolled in this study. Cox regression analysis confirmed that cachexia based on the AWGC2023 criteria was an independent predictor of long-term survival in patients with cancer. Patients with cachexia had significantly poorer long-term survival than patients without cachexia (66.4% vs. 49.7%, P<0.001). Inflammatory biomarker-based cachexia was as an independent predictor of prognosis in patients with cancer, with inflammatory burden index (IBI)-based cachexia demonstrating the optimal prognostic discriminatory ability. The C-index indicated that cachexia based on BMI cutoff values of 18.5, 20, and 22kg/m2 did not perform as well as a BMI cutoff value of 21kg/m2. Logistic regression models revealed that using the AWGC2023 criteria, patients with cachexia had a 16.6% higher risk of prolonged hospitalization and a 16.0% higher risk of high medical expenses than patients without cachexia. The AWGC2023 criteria represent a valuable tool for predicting survival and medical burden among Chinese patients with cancer. Encouragement for further validation in other Asian populations is warranted for the AWGC2023 criteria.

Application of antibiotic bone cement combined with lobulated perforator flap based on descending branch of the lateral circumflex femoral artery in treatment of infected traumatic tissue defects of foot

ObjectiveTo evaluate the clinical effectiveness of antibiotic bone cement combined with the lobulated perforator flap based on the descending branch of the lateral circumflex femoral artery (d-LCFA) in the treatment of infected traumatic tissue defects in the foot, in accordance with the Enhanced Recovery after Surgery (ERAS) concept.MethodsFrom December 2019 to November 2022, 10 patients with infected traumatic tissue defects of the foot were treated with antibiotic bone cement combined with the d-LCFA lobulated perforator flap. The cohort comprised 6 males and 4 females, aged 21 to 67 years. Initial infection control was achieved through debridement and coverage with antibiotic bone cement, requiring one debridement in nine cases and two debridements in one case. Following infection control, the tissue defects were reconstructed utilizing the d-LCFA lobulated perforator flap, with the donor site closed primarily. The flap area ranged from 12 cm×6 cm to 31 cm×7 cm. Postoperative follow-up included evaluation of flap survival, donor site healing, and ambulatory function of the foot.ResultsThe follow-up period ranged from 7 to 24 months, averaging 14 months. Infection control was achieved successfully in all cases. The flaps exhibited excellent survival rates and the donor site healed by first intention. Based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, pain and function were evaluated as excellent in 3 cases, good in 5 cases, and moderate in 2 cases.ConclusionThe application of antibiotic bone cement combined with the d-LCFA lobulated perforator flap is an effective treatment for infected traumatic tissue defects of the foot with the advantages of simplicity, high repeatability, and precise curative effects. The application of the d-LCFA lobulated perforator flap in wound repair causes minimal damage to the donor site, shortens hospital stays, lowers medical expenses, and accelerates patient rehabilitation, aligning with the ERAS concept. Therefore, it is a practice worth promoting in clinical use.

A patient with out-of-hospital cardiac arrest saved from heart transplantation and amputation through a collaboration between modern and traditional Chinese medicine: A case report

IntroductionPatients with end-stage heart failure have limited options for medical treatment, and this ultimately necessitates heart transplantation. Patients undergoing heart transplant surgery are burdened with substantial costs related to finances, procedural risks, and postoperative quality of life. This report presents a case of heart failure in a patient whose limbs and heart were preserved through a collaboration between modern and traditional Chinese medicine (TCM). Patient PresentationA 47-year-old man was admitted to the emergency department with out-of-hospital cardiac arrest (OHCA) and was diagnosed with 3-vessel disease and acute decompensated heart failure on October 27, 2020. After extracorporeal membrane oxygenation (ECMO), the patient presented with cyanosis and gangrene in all four limbs. Cardiologists and plastic surgeons recommended heart transplantation and amputation. The patient wanted to keep his limbs and heart intact and requested to receive TCM. A TCM physician was consulted by visiting staff to provide combined care. After TCM intervention, both the ejection fraction (EF) and gangrene improved. Until now, the patient continues to receive TCM treatment, lives with preserved limbs and heart, and went through SARS-CoV2 infection smoothly in 2023. ConclusionTCM met the expectations of the patient and reduced the high medical expenses. This approach may improve the outlook and be a more economical option for patients with end-stage heart failure.

Universal health coverage saves more lives among severely ill COVID-19 patients: A difference-in-differences analysis of individual patient data in South Korea

BackgroundUniversal health coverage (UHC) ensures affordability of a variety of essential health services for the general population. Although UHC could mitigate the harmful effects of coronavirus disease 2019 (COVID-19) on patients and their socioeconomic position, the debate on UHC’s scope and ability to improve health outcomes is ongoing. This study aimed to identify the impact of UHC policy withdrawal on the health outcomes of South Korea’s severely ill COVID-19 patients.MethodsWe used a propensity score matching (PSM) and difference-in-differences combined model. This study’s subjects were 44,552 hospitalized COVID-19 patients contributing towards health insurance claims data, COVID-19 notifications and vaccination data extracted from the National Health Information Database and the Korea Disease Control and Prevention Agency from 1 December 2020 to 30 April 2022. After PSM, 2460 patients were included. This study’s exposures were severity of illness and UHC policy change. The primary outcome was the case fatality rate (CFR) for COVID-19, which was defined as death within 30 days of a COVID-19 diagnosis. There were four secondary outcomes, including time interval between diagnosis and hospitalization (days), length of stay (days), total medical expenses (USD) and the time interval between diagnosis and death (days).ResultsAfter the UHC policy’s withdrawal, the severely ill patients’ CFR increased to 284 per 1000 patients [95% confidence interval (CI) 229.1–338.4], hospitalization days decreased to 9.61 days (95% CI −11.20 to −8.03) and total medical expenses decreased to 5702.73 USD (95% CI −7128.41 to −4202.01) compared with those who were not severely ill.ConclusionsDuring the pandemic, UHC may have saved the lives of severely ill COVID-19 patients; therefore, expanding services and financial coverage could be a crucial strategy during public health crises.

Exploring lifestyles, work environment and health care experience of Nepalese returnee labour migrants diagnosed with kidney-related problems.

In recent years, international media and the scientific community have expressed concerns regarding rising kidney health-related risks among Nepalese labour migrants in Gulf countries and Malaysia. Previous studies have highlighted poor lifestyles and work conditions among Nepalese migrants, which could potentially impact their kidney health. This qualitative study aims to explore the lifestyles and work environment of returnee Nepalese migrants who were diagnosed with kidney health problems. In-depth interviews were carried out with twelve returnee migrants, all males, with half having worked abroad for at least a decade. Our analysis yielded seven themes: (a) living and lifestyles; (b) work environment; (c) exposure to pollutants; (d) Chronic Kidney Disease (CKD) experience; (e) use of painkillers and healthcare; (f) medical expenses for CKD patients; and (g) pre-departure training. This study indicates that Nepalese migrants face numerous challenges, including limited access to clean water and sanitation facilities, poor diets, exposure to occupational hazards, and overuse of pain medication, all of which may contribute to an increased risk of kidney disease. An enhanced pre-departure and on-arrival orientation programme focusing on kidney health-related topics, including the necessary advocacy at the country of destination to provide access to basic services, may encourage migrants to adopt healthy lifestyles and safe working environments, as well as help sensitise migrants to their kidney health risks.

Estimated economic costs of dental implants among older South Korean adults, 2015-2018.

Dental implants are a considerable financial burden for elderly people and their caregivers. This study aimed to calculate the estimated economic costs of dental implants on the Korean older population. The economic costs of dental implants for adults aged 75 years and older were estimated from a societal perspective, considering both direct and indirect expenditures. We used data from the Korean National Health Insurance Service for the period 2015-2018 to estimate the medical costs. Noninsured medical costs were estimated from research on medical expenses by the National Health Insurance Review and Assessment Service. Indirect costs related to transportation fees and time loss were obtained. The Cochran Armitage trend test was performed to examine the trend of the economic burden of dental implants. The estimated economic costs showed from 2015 to 2018 (total costs: $26.54-55.66 million, total costs after discount: $17.11-39.56 million). Direct costs, including insured and noninsured medical costs, represented from $25.81 to $47.03 million. Indirect costs, including transportation and time costs, ranged from $0.73 to $1.63 million. The impact of the total dental implant costs was 0.0018%-0.0034% of the Korean annual gross domestic product and 1.03%-1.59% of the annual total costs of dental care benefits. The estimated economic burden of dental implants significantly increased from 2015 to 2018 in older South Korean adults. These results will provide a foundation and guidance for further health economic studies on the burden of dental implants in the elderly population.

Analyses of Osteogenesis Imperfecta in South Korea Using the Nationwide Health Insurance Service Claim Data: A Propensity Score-Matched Study.

Osteogenesis imperfecta (OI) is the most common inherited form of bone fragility and includes a heterogeneous group of genetic disorders that most commonly result from defects associated with type I collagen. Although genetic analyses have been developed, nationwide research on the incidence and associated fractures in OI is lacking. This study aimed to investigate the patterns of OI prevalence, incidence, fracture rate, etc. in South Korea using National Health Insurance Service (NHIS) claims data. We found 1596 patients newly diagnosed with OI between March 2002 and February 2020. We evaluated the incidence, prevalence, and history of fractures, fracture site, prescription of anti-osteoporosis drugs, etc. To compare medical costs, fracture rates, and scoliosis rates, we created a control group comprising patients without OI using 1:1 propensity score matching. The prevalence of OI increased slightly each year, with an annual incidence of 20.20 per 100,000 live births. Mean fracture frequency in OI patients was 17 (2-32) times per patient and the most frequent fracture site was the lower leg. A total of 21.4% patients were prescribed anti-osteoporosis drugs, and the most popular drug was pamidronate. After 1:1 propensity score matching, in terms of scoliosis, OI patients had a 3.91 times higher prevalence of scoliosis than in healthy patients which was statistically significant. The sum of medical care expenses for patients with OI was 3.5 times higher than that for patients without OI. We identified nationwide trends in OI occurrence, fractures, and medication use. This study also highlighted the real-world data of scoliosis and medical costs compared to the control group.

A knowledge graph based intelligent auxiliary diagnosis and treatment system for primary tinnitus using traditional Chinese medicine

Primary tinnitus is a disabling disease with an unknown pathogenesis and a high incidence rate in China. Its diagnosis and treatment are complex and difficult to control. Although many treatments are available for primary tinnitus, their efficacy is often unsatisfactory. This paper proposes a new diagnosis and treatment method using knowledge graphs, and an intelligent assistant decision system is developed. To support diagnosis, a knowledge graph is created as a decision support tool using traditional Chinese medicine (TCM). Based on the knowledge graph, a model for the syndrome differentiation of tinnitus in TCM is built. At tinnitus treatment, an intelligent recommandation model for pentatonic music using knowledge graph based heterogeneous label propagation is then used to provide patients with personalized treatment plans. According to evaluation results, the proposed method achieves an accuracy of 87.1 % in tinnitus diagnosis. Compared with the control group, the recommended pentatonic music had a more obvious effect, and the efficacy of the five types of tinnitus was increased by 33.34 %, 33.33 %, 20 %, 26.67 %, 33.34 %, respectively. The system developed in this paper will help clinicians improve the diagnosis and treatment of tinnitus while reducing unnecessary medical expenses and offering significant social and economic benefits.

Predictors of length of hospital stay after pediatric Ebstein anomaly corrective surgery: a retrospective cohort study

BackgroundThe remarkable advancements in surgical techniques over recent years have shifted the clinical focus from merely reducing mortality to enhancing the quality of postoperative recovery. The duration of a patient’s hospital stay serves as a crucial indicator in evaluating postoperative recovery and surgical outcomes. This study aims to identify predictors of the length of hospital stay for children who have undergone corrective surgery for Ebstein Anomaly (EA).MethodsWe conducted a retrospective cohort study on children (under 18 years of age) diagnosed with EA who were admitted for corrective surgery between January 2009 and November 2021 at Fuwai Hospital. The primary outcome was the Time to Hospital Discharge (THD). Cox proportional hazard models were utilized to identify predictors of THD. In the context of time-to-event analysis, discharge was considered an event. In cases where death occurred before discharge, it was defined as an extended THD, input as 100 days (exceeding the longest observed THD), and considered as a non-event.ResultsA total of 270 children were included in this study, out of which three died in the hospital. Following the Cox proportional hazard analysis, six predictors of THD were identified. The hazard ratios and corresponding 95% confidence intervals were as follows: age, 1.030(1.005,1.055); C/R > 0.65, 0.507(0.364,0.707); Carpentier type C or D, 0.578(0.429,0.779); CPB time, 0.995(0.991,0.998); dexamethasone, 1.373(1.051,1.795); and transfusion, 0.680(0.529,0.875). The children were categorized into three groups based on the quartile of THD. Compared to children in the ≤ 6 days group, those in the ≥ 11 days group were associated with a higher incidence of adverse outcomes. Additionally, the duration of mechanical ventilation and ICU stay, as well as hospital costs, were significantly higher in this group.ConclusionWe identified six predictors of THD for children undergoing corrective surgery for EA. Clinicians can utilize these variables to optimize perioperative management strategies, reduce adverse complications, improve postoperative recovery, and reduce unnecessary medical expenses.

Effect of Ajwa Date Fruit (Phoenix dactylifera) Methanol Extract on Blood Glucose Levels in Mice with Diabetes Mellitus

Highlights: The widespread incidence of DM leads to costly treatments and often results in undesirable side effects. Flavonoids in ajwa date fruit are believed to lower blood glucose levels through several mechanisms. Methanol extract of ajwa date fruit can effectively lower blood glucose levels in diabetic mice at specific optimal doses. Abstract Introduction: High diabetes mellitus (DM) cases result in costly medical expenses. Ajwa date fruit contains triterpenoids, carbohydrates, and flavonoids believed to lower blood glucose, which requires research validation using methanol extract on streptozotocin (STZ)-induced mice. This study aimed to determine the effect of methanol extract of ajwa dates with several dose levels, namely 3 g/WB, 5 g/WB, and 7 g/WB, given orally to mice induced by STZ. Methods: This study utilized a randomized pre- and post-test control group design to assess ajwa date fruit methanol extract effects on blood glucose in Swiss-Webster mice (Mus musculus). The mice were divided into four groups: Group K (6 mice without date extract intervention), P1 (6 mice with 3 g/WB/day oral dose date extract intervention), P2 (7 mice with 5 g/WB/day oral dose date extract intervention), and P3 (7 mice with 7 g/WB/day oral dose date extract intervention) and were induced with 100 mg/WB streptozotocin. Administered daily for three weeks, ajwa dates fruit extract showed varying impacts. Weekly blood glucose measurements and analysis of variance (ANOVA) in the International Business Machines Corporation (IBM) Statistical Package for the Social Sciences (SPSS) version 27.0 disclosed significant group differences. Results: In the third week, blood glucose measurements revealed significant differences (p = 0.017), with an optimal reduction in P3 (7 mice with 7 g/WB/day oral dose date extract intervention). Conclusion: In the third week, ajwa dates fruit extract, at an optimal 7 g/WB dose, effectively reduced blood glucose levels via flavonoid hypoglycemic mechanisms.

Insomnia among patients with chronic pain: A retrospective study.

Insomnia can coexist with chronic pain and is a major cause of rapidly increasing medical expenses. However, insomnia has not been fully evaluated in patients with chronic pain. This retrospective study aimed to identify the risk factors for insomnia in patients with chronic non-cancer pain. A total of 301 patients with chronic non-cancer pain were enrolled. Patients with the Athens insomnia scale scores ≥ 6 and < 6 were classified into insomnia (+) and insomnia (-) groups, respectively. All patients completed self-report questionnaires as part of their chronic pain treatment approach. Univariate and multivariate analyses were performed to predict insomnia. We found that 219 of 301 (72.8%) patients met the AIS criteria for insomnia. Significant differences were depicted between patients with and without insomnia in terms of body mass index, numeric rating scale, pain catastrophizing scale, hospital anxiety, and depression scale (HADS), pain disability assessment scale, EuroQol 5 dimension (EQ5D), and pain self-efficacy questionnaire. Multiple regression analysis identified the numeric rating scale, HADS, and EQ5D scores as factors related to insomnia in patients with chronic non-cancer pain. Anxiety, depression, and disability were associated with a greater tendency toward insomnia. HADS and EQ5D scores are useful screening tools for preventing insomnia in patients with chronic non-cancer pain.

Disposable Carbon Electrochemical Sensor Modified with Gold Nanoparticles for Creatinine Detection

The social and economic impact of Chronic Kidney Disease on global health systems is devastating. It is estimated that annual spending on the treatment of Chronic Kidney Patients is in the order of 2 to 3% of annual health budgets. (1) In 2015, considering the United States, medical expenses for individuals with chronic kidney diseases were more than 64 billion dollars (1). Indeed, the early diagnosis of chronic kidney diseases is very important for the implementation of preventive measures that delay or even interrupt the progression to more advanced stages of the disease. In this context, this work aims to develop a disposable electrochemical sensor aimed at detecting creatinine for diagnosing kidney diseases. The flexible disposable lab made carbon sensor has been modified with gold nanoparticles. Morphological and electrochemical characterizations were carried out to better understand the proposed device. From cyclic voltammetry measurements, the proposed sensor showed reduction and oxidation peaks related to gold oxides formed on its surface. When adding creatinine there is a decrease in the electrochemical signal due to the adsorption of the target analyte. Therefore, it was inferred that it was possible to detect creatinine present in the solution from the reduction in the analytical response of the gold-modified electrode. Using the square wave voltammetry technique, in accordance with what was previously presented, when CNN was added to the solution, the Au-CNN interaction caused a reduction in the analytical response, therefore, with the increase in CNN concentration, this reduction increased linearly in the range of 0.5 to 10 µmol L-1 with a limit of detection and quantification, 0.15 and 0.45 µmol L-1, respectively, were calculated. Furthermore, it presented a sensitivity of 0.97 µA mol-1 L with a linear equation of Ipeak (µA) = 0.97 x C(CNN) + 0.23. Furthermore, the proposed sensor was successfully applied to determine creatinine in human serum samples and the recovery results were close to 100%. Therefore, the device modified with gold nanoparticles is an interesting alternative for creatinine detection.References(1) Luyckx V. A. et al. The global burden of kidney disease and the sustainable development goals, Bulletin of the World Health Organization Published online: 20 April 2018.

2229 A review of CT head scans in elderly patients admitted to hospital with falls and adherence to the NICE guidelines.

Abstract Introduction Falls remain the leading reason for elderly people to attend emergency department (ED), which in 2023 led to 250,000 hospital admissions in the UK. A seemingly large number of geriatric patients undergo CT head as an initial workup in ED which might not be necessary, especially in minor head trauma. NICE (National Institute for Health and Care Excellence), recommended risk stratification to reduce unnecessary head scanning which may potentially reduce ED length of stay, hospitalisation and medical expense. Our study evaluated the current practice of adherence to NICE guidance on Head Injury: assessment and early management for performing CT head scans in elderly admitted to Basildon hospital. Methods Two cycles of retrospective data collection were undertaken across three elderly care wards. Elderly patients admitted with falls who had CT head scans were identified. Indication for scanning were evaluated to determine adherence with NICE guidelines for head injury. Between cycles, formal educational sessions were provided to Junior Doctors by departmental teaching and distributing leaflets/posters explaining NICE guidance for indication of CT head scans in head injury. Results Following the interventions implemented, patient compliance to the NICE guidance for undergoing CT head with a history of falls, rose from 77.33% to 93.99%. No significant difference in abnormal CT head findings were demonstrated between cycles. In addition, mortality observed between cycles was near equivalent, 12% and 11.67% respectively. The mean time for CT head scans performed also improved, from 13 hours to 4 hours. Conclusion We demonstrated education regarding the indication for CT head scans in elderly with falls improved the appropriateness of scans performed in accordance with NICE guidance. CT head scans performed which more robustly met NICE guidance demonstrated no difference in adverse findings or patient mortality and may have contributed to reduced mean scan time, thus improving resource allocation.

Changes in patterns of multimorbidity and associated with medical costs among Chinese middle-aged and older adults from 2013 to 2023: an analysis of repeated cross-sectional surveys in Xiangyang, China.

Multimorbidity has become a major public health problem among Chinese middle-aged and older adults, and the most costly to the health care system. However, most previous population-based studies of multimorbidity have focused on a limited number of chronic diseases, and diagnosis was based on participants' self-report, which may oversimplify the problem. At the same time, there were few reports on the relationship between multimorbidity patterns and health care costs. This study analyzed the multimorbidity patterns and changes among middle-aged and older people in China over the past decade, and their association with medical costs, based on representative hospital electronic medical record data. Two cross-sectional surveys based on representative hospital data were used to obtain adults aged 45 years and older in Xiangyang in 2013 (n = 20,218) and 2023 (n = 63,517). Latent Class Analysis was used to analyze changes in the patterns of multimorbidity, gray correlation analysis and ordered logistics model were used to assess the association of multimorbidity patterns with medical expenses. The diagnosis and classification of chronic diseases were based on the International Classification of Diseases, Tenth Revision codes (ICD-10). The detection rate of chronic disease multimorbidity has increased (70.74 vs. 76.63%, p < 0.001), and multimorbidity patterns have increased from 6 to 9 (2013: Malignant tumors pattern, non-specific multimorbidity pattern, ischemic heart disease + hypertension pattern, cerebral infarction + hypertension pattern, kidney disease + hypertension pattern, lens disease + hypertension pattern; new in 2023: Nutritional metabolism disorders + hypertension pattern, chronic lower respiratory diseases + malignant tumors pattern, and gastrointestinal diseases pattern) in China. The medical cost of all multimorbidity patients have been reduced between 2013 and 2023 (RMB: 8216.74 vs. 7247.96, IQR: 5802.28-15,737 vs. 5014.63-15434.06). The top three specific multimorbidity patterns in both surveys were malignancy tumor pattern, ischemic heart disease + hypertension pattern, and cerebral infarction + hypertension pattern. Hypertension and type 2 diabetes are important components of multimorbidity patterns. Compared with patients with a single disease, only lens disorders + hypertension pattern were at risk of higher medical costs in 2013 (aOR:1.23, 95% CI: 1.03, 1.47), whereas all multimorbidity patterns were significantly associated with increased medical costs in 2023, except for lens disorders + hypertension (aOR:0.35, 95% CI: 0.32, 0.39). Moreover, the odds of higher medical costs were not consistent across multimorbidity patterns. Among them, ischemic heart disease + hypertension pattern [adjusted odds ratio (aOR):4.66, 95%CI: 4.31, 5.05] and cerebral infarction + hypertension pattern (aOR: 3.63, 95% CI: 3.35, 3.92) were the two patterns with the highest risk. Meanwhile, men (aOR:1.12, 95CI:1.09, 1.16), no spouse (aOR:1.09, 95CI: 1.03, 1.16) had a positive effect on medical costs, while patients with total self-pay (aOR: 0.45, 95CI: 0.29, 0.70), no surgery (aOR: 0.05, 95CI: 0.05, 0.05), rural residence (aOR: 0.92, 95CI: 0.89, 0.95), hospitalization days 1-5 (aOR: 0.04, 95CI: 0.04, 0.04), and hospitalization days 6-9 (aOR: 0.15, 95CI: 0.15, 0.16) had a negative impact on medical costs. Multimorbidity patterns among middle-aged and older adults in China have diversified over the past decade and are associated with rising health care costs in China. Smart, decisive and comprehensive policy and care interventions are needed to effectively manage NCDS and their risk factors and to reduce the economic burden of multimorbidity on patients and the country.

Family out-of-pocket expenditure for type 2 diabetes mellitus care and percentage of family income.

Type 2 diabetes has economic implications involving family income and out-of-pocket spending. Determine family out-of-pocket expenditure for type 2 diabetes mellitus care and percentage of family income. Study of family out-of-pocket spending in families with patients with type 2 diabetes treated at primary care level. Out-of-pocket expenses included expenses for transportation, food-drinks, and external medications. Family income corresponded to the total economic income contributed by family members. The percentage of out-of-pocket spending in relation to family income was identified with the relationship between these two variables. Statistical analysis included averages and percentages. The annual family out-of-pocket expenditure on transportation was $2,621.24, the family out-of-pocket expenditure on food and beverages was $1,075.67, and the family out-of-pocket expenditure on external medications was $722.08. The total annual family out-of-pocket expense was $4,418.89 and corresponds to 4.73% of family income. The family out-of-pocket expense in the family with a patient with diabetes mellitus 2 was $4,418.89 and represents 4.73% of the family income.

Composition and influencing factors of hospitalization expenses for epilepsy patients based on path analysis

ObjectiveThis study aimed to understand the composition and influencing factors of epilepsy patients’ hospitalization expenses, thus providing a reference for reducing the disease burden of epilepsy patients in low- and middle-income developing countries.MethodsA total of 4206 hospitalized cases of epilepsy from 2018 to 2020 were collected. Descriptive statistics were used to understand the patient cost composition, path analysis was used to understand the direct and indirect factors of hospitalization expenses.ResultsFrom 2018 to 2020, the average hospitalization expenses for epilepsy patients was 4,299.93 RMB yuan, and the average length of stay was 2.47 days. The highest proportion of hospitalization expenses was diagnosis costs (> 50%), followed by comprehensive medical service costs and drug costs. In terms of the total effect coefficient, the major factors affecting the hospitalization expenses were length of stay (0.880), emergency admission(0.463), and the comorbidities and complications(> 0.250). Hospital length of stay, discharge mode(death) and number of hospitalizations(2 times) affect hospitalization expenses through direct effect. Long-term hospitalization (> 30 days), admission routes(emergency), the comorbidities and complications, presence of drug allergy, and age also affect hospitalization expenses through indirect effects.ConclusionDiagnosis costs and length of stay are important factors affecting the medical expenses of epilepsy inpatients. In general, the quality control of the hospital is good, but it still needs to standardize the diagnosis and treatment behavior of medical staff through the clinical path.