Reduce Hospitalization Rates Research Articles

A Review Article on Analytical Method on Vericiguat

Vericiguat is a novel oral soluble guanylate cyclase (sGC) stimulator used in the treatment of chronic heart failure, aimed at reducing hospitalization rates and improving cardiac function by inducing vasodilation. The analysis of Vericiguat in pharmaceutical formulations and biological fluids requires robust and precise analytical methods. High-Performance Liquid Chromatography (HPLC) and UV-Visible Spectrophotometry are the primary techniques employed for this purpose due to their high specificity, sensitivity, and rapid analysis capabilities. This review discusses the development, validation, and application of these analytical methods for Vericiguat. Various HPLC methods have been developed, utilizing different columns, mobile phases, and detection wavelengths to ensure the accurate quantification of Vericiguat in bulk and tablet dosage forms. UV-Visible spectrophotometry has also been employed, offering a simpler and cost-effective alternative for routine analysis. The review consolidates the key parameters and findings of these methods, highlighting their advantages and suitability for the effective analysis of Vericiguat, thereby contributing to quality assurance in pharmaceutical development and therapeutic monitoring

Comparing outcomes of balloon-expandable vs. self-expandable valves in transcatheter aortic valve replacement: a systematic review and meta-analysis.

Aortic stenosis (AS) is a common heart condition categorized into congenital and acquired forms. Transcatheter aortic valve replacement (TAVR) is an innovative method for AS management, and two valve types, self-expanding valves (SEV) and balloon-expandable valves (BEV), are used in TAVR. The objective of this study is to compare the clinical outcomes associated with balloon-expandable and self-expandable valves in transcatheter aortic valve replacement. The researchers conducted a comprehensive meta-analysis following PRISMA guidelines and AMSTAR-2 tool. The methodology involved a systematic literature search, strict eligibility criteria, unbiased study selection, meticulous data extraction, quality assessment, and rigorous statistical analysis. Our analysis included twenty-six papers and 26553 patients. BEV exhibited significant advantages over SEV in overall mortality across 21 studies, particularly in perioperative and 30-day assessments. However, no substantial disparities emerged between the two valve types in stroke incidence. BEV demonstrated notable benefits in reducing hospitalization rates across 6 studies and significantly fewer instances of permanent pacemaker implantations across 19 studies, particularly evident in the perioperative setting. Other secondary outcomes like bleeding, acute kidney injury, and myocardial infarction showcased non-significant differences between BEV and SEV. The analysis indicates that BEV may offer benefits in specific aspects of TAVR outcomes, but further research is needed to fully understand the factors influencing patient outcomes and mortality in TAVR procedures.

Role of angiotensin receptor-neprilysin inhibitor in diabetic complications.

Diabetes mellitus is a prevalent disorder with multi-system manifestations, causing a significant burden in terms of disability and deaths globally. Angio-tensin receptor-neprilysin inhibitor (ARNI) belongs to a class of medications for treating heart failure, with the benefits of reducing hospitalization rates and mortality. This review mainly focuses on the clinical and basic investigations related to ARNI and diabetic complications, discussing possible physiological and molecular mechanisms, with insights for future applications.

Study on the Impact of Exercise Prescription on Medical Insurance Cost Control

This study examines the role of exercise prescriptions in controlling medical insurance costs amidst the increasing prevalence of chronic diseases and rising healthcare expenses. Exercise prescriptions are customized physical activity plans issued by healthcare professionals that aim to improve health outcomes and reduce the financial burden on healthcare systems. Using a mixed-methods approach, this research combines quantitative data from electronic health records (EHRs) with qualitative insights from interviews and focus groups involving healthcare providers, patients, and insurance professionals. The quantitative analysis shows significant health improvements among patients with exercise prescriptions, including a 20% reduction in hospitalization rates and a 15% decrease in medication usage. The cost-benefit analysis suggests that the annual cost of implementing an exercise prescription program is approximately $150,000, whereas the resulting healthcare savings amount to $250,000, leading to a net saving of $100,000. Participants in these programs also see a 12% reduction in insurance premiums due to decreased healthcare utilization and improved health outcomes. Qualitative insights highlight better patient engagement, stronger provider-patient relationships, and perceived benefits like enhanced physical fitness and more effective chronic disease management. However, challenges such as limited resources and insufficient coverage for exercise prescription services are noted. Case studies from the United Kingdom and the United States affirm the cost-effectiveness of exercise prescriptions, displaying significant health benefits and financial savings. The study concludes that exercise prescriptions are a cost-effective strategy for managing chronic diseases and reducing healthcare costs. It recommends integrating exercise prescriptions into routine clinical practice and supporting their adoption through strategic policies and incentives, paving the way for substantial health and economic gains for healthcare systems. Further research should investigate the long-term effects and ways to improve patient adherence to exercise prescriptions.

Maintenance electroconvulsive therapy: An effective yet underused treatment modality in psychiatry: A case series

Maintenance Electroconvulsive Therapy (M-ECT) refers to ECTs administered beyond 6 months after the remission of illness. Maintenance electroconvulsive therapy (M-ECT) can be used to reduce the risk for relapse and recurrence of illness in patients who fare poorly with standard medication regimens. There is improvement in the relapse rate of major psychiatric disorders when continuation or maintenance (C or M-ECT) are used with psychotropics. These are single-center, retrospective case studies of patients diagnosed with major psychiatric disorders (as per International Classification of Diseases, 11th edition) who are receiving M-ECT in Department of Psychiatry, B.J. Government Medical College and Sassoon Hospital, Pune. We included 12 patients- 8 males and 4 females in this study. 4 cases were of patients suffering from schizophrenia, 3 cases were of patients suffering from depression, 1 case of bipolar affective disorder and 4 cases of patients of intellectual disability with psychosis. There was a reduction in hospitalization rate for acute exacerbation and significant improvement in the patients’ overall functioning on standardized rating scales without any significant adverse effects. Maintenance ECT is an underused treatment option that can substantially reduce risks of relapse in patients with major depressive disorder, bipolar disorder and schizophrenia as well. Despite the potential value of these ECT schedules, these are relatively neglected in clinical practice. This article aims to explore the clinical utility of maintenance ECTs and emphasizes the use of maintenance ECTs in routine psychiatric care.

Impact of Pharmacist-led Interventions on Medication Adherence and Inhalation Technique in Adult Patients with COPD and Asthma

Introduction: Inhalation technique and medication adherence are essential prerequisites for achieving optimal therapeutic effects in patients with chronic obstructive pulmonary disease (COPD) and asthma. Although there are various effective treatments for respiratory disorders, disease control in these patients is still sub-optimal because of incorrect inhalation techniques and poor medication adherence. Pharmacist-led interventions have demonstrated a positive impact on improving inhalation technique, better medication adherence, and thus subsequently improving the quality of life of patients. Methods: Search engines such as PubMed, Google Scholar, and Science Direct were used to identify the relevant information using keywords: Chronic Obstructive Pulmonary Disease, Asthma, Pharmaceutical care, Pharmacist Intervention, Medication Adherence and Inhalation Technique. The relevant articles that were published between 2005 to 2021 were included and reviewed for the Pharmacist-led interventions to improve medication adherence, inhalation technique, and quality of life of patients with COPD and asthma. Results: Of the 300 articles screened, a total of 14 articles met the inclusion criteria and were included for review. Pharmacist-led interventions help to improve the medication adherence, inhalation technique, and quality of life of patients with COPD and asthma. Similarly, the articles mentioned in this review found that the interventions provided by the pharmacist to COPD and asthma patients were cost-effective in terms of reducing hospitalization rates and severe exacerbation rates. Conclusion: Our review concluded that the pharmacists’ interventions have a significant improvement in medication adherence and inhalation techniques with the enhancement of therapeutic effects in adult patients with COPD and asthma.

Continuity of care. Patient support from hospital-to-territory care plan: protected hospital discharges

PurposeTo facilitate the reception and care of discharged patients, streamlining processes at the University Hospital and promoting a seamless transition to continuity of care services post-discharge.Design/methodology/approachHospitalised patients undergo the Blaylock risk assessment screening score (BRASS), a screening tool identifying those at risk of complex discharge.FindingsPre-pandemic, patients with a medium-to-high risk of complex discharge were predominantly discharged to their residence or long-term care facilities. During the pandemic, coinciding with an overall reduction in hospitalisation rates, there was a decrease in patients being discharged to their residence.Originality/valueThe analysis of discharges, with the classification of patients into risk groups, revealed a coherence between the BRASS score and the characteristics of the studied sample. This tool aids physicians in decision-making by identifying the need for a planned discharge in a systematic and organised manner, preventing the loss of crucial information.

A multiobjective approach for weekly Green Home Health Care routing and scheduling problem with care continuity and synchronized services

Home Health Care (HHC) services are essential for delivering healthcare programs to patients in their homes, with the goal of reducing hospitalization rates and improving patients’ quality of life. However, HHC organizations face significant challenges in scheduling and routing caregivers for home care visits due to complex criteria and constraints. This paper addresses these challenges by considering both caregiver assignments and transportation logistics. The objective is to minimize the total travel distance and CO2 emissions while ensuring a balanced workload for caregivers, meeting patients’ preferences, synchronization, precedence, and availability constraints. To tackle this problem, we propose a multiperiodic Green Home Health Care (GHHC) framework. In the first stage, we utilize multiobjective programming and the NSGA-II algorithm to generate Pareto front solutions that consider travel distance and CO2 emissions. In the second stage, a Mixed-Integer Linear Programming (MILP) model is proposed to balance caregivers’ workload by assigning them to the patient routes generated in the first stage. The results highlight the trade-off between shorter routes and lower emissions. Furthermore, we examine the impact of prioritizing continuity of care and patient satisfaction. This research provides valuable insights into addressing the scheduling and routing challenges in HHC services, contributing to a more efficient and environmentally friendly healthcare delivery.

Clinical and economic burden of acute otitis media caused by Streptococcus pneumoniae in European children, after widespread use of PCVs-A systematic literature review of published evidence.

Acute otitis media (AOM) is a common childhood disease frequently caused by Streptococcus pneumoniae. Pneumococcal conjugate vaccines (PCV7, PCV10, PCV13) can reduce the risk of AOM but may also shift AOM etiology and serotype distribution. The aim of this study was to review estimates from published literature of the burden of AOM in Europe after widespread use of PCVs over the past 10 years, focusing on incidence, etiology, serotype distribution and antibiotic resistance of Streptococcus pneumoniae, and economic burden. This systematic review included published literature from 31 European countries, for children aged ≤5 years, published after 2011. Searches were conducted using PubMed, Embase, Google, and three disease conference websites. Risk of bias was assessed with ISPOR-AMCP-NPC, ECOBIAS or ROBIS, depending on the type of study. In total, 107 relevant records were identified, which revealed wide variation in study methodology and reporting, thus limiting comparisons across outcomes. No homogenous trends were identified in incidence rates across countries, or in detection of S. pneumoniae as a cause of AOM over time. There were indications of a reduction in hospitalization rates (decreases between 24.5-38.8% points, depending on country, PCV type and time since PCV introduction) and antibiotic resistance (decreases between 14-24%, depending on country), following the widespread use of PCVs over time. The last two trends imply a potential decrease in economic burden, though this was not possible to confirm with the identified cost data. There was also evidence of an increase in serotype distributions towards non-vaccine serotypes in all of the countries where non-PCV serotype data were available, as well as limited data of increased antibiotic resistance within non-vaccine serotypes. Though some factors point to a reduction in AOM burden in Europe, the burden still remains high, residual burden from uncovered serotypes is present and it is difficult to provide comprehensive, accurate and up-to-date estimates of said burden from the published literature. This could be improved by standardised methodology, reporting and wider use of surveillance systems.

Prevalence and risk factors for chronic pulmonary aspergillosis in chronic obstructive pulmonary disease patients with acute exacerbations.

Chronic obstructive pulmonary disease (COPD) patients often experience acute exacerbations requiring hospitalization. Recently, attention has focused on Aspergillus sensitization in the airways of these COPD patients. This study aimed to assess the prevalence of chronic pulmonary aspergillosis (CPA) in COPD patients with acute exacerbations and identify associated risk factors. A cross-sectional descriptive study was conducted at the Jawaharlal Institute of Postgraduate Medical Education and Research from January 2021 to June 2022. Sixty-one COPD patients presenting with acute exacerbations were included. Demographic details, blood investigations, and sputum examinations were performed for all patients. A high-resolution computed tomography thorax was conducted for eligible patients. The prevalence of CPA among patients with an acute exacerbation of COPD was found to be 9.8%, with chronic cavitary pulmonary aspergillosis being the most common presentation (50%). Among post-tubercular COPD patients, the prevalence of CPA was significantly higher at 22.7%. Hemoptysis (p<0.001) and a previous history of tuberculosis (p=0.008) were associated with Aspergillus sensitization. This study highlights the substantial prevalence of CPA in COPD patients with acute exacerbations, particularly in those with a history of tuberculosis. Early recognition and targeted management of CPA in COPD patients may improve outcomes and reduce hospitalization rates. Further large-scale multi-center studies are needed to validate these findings and comprehensively address the impact of CPA on all COPD patients.

The COVID-19 quandemic

BackgroundThe terms syndemic and infodemic have both been applied to the COVID-19 pandemic, and emphasize concurrent socio-cultural dynamics that are distinct from the epidemiological outbreak itself. We argue that the COVID-19 pandemic has exposed yet another important socio-political dynamic that can best be captured by the concept of a quandemic – a portmanteau of “quantification” and “pandemic”.Main textThe use of quantifiable metrics in policymaking and evaluation has increased throughout the last decades, and is driven by a synergetic relationship between increases in supply and advances in demand for data. In most regards this is a welcome development. However, a quandemic, refers to a situation where a small subset of quantifiable metrics dominate policymaking and the public debate, at the expense of more nuanced and multi-disciplinary discourse. We therefore pose that a quandemic reduces a complex pandemic to a few metrics that present an overly simplified picture. During COVID-19, these metrics were different iterations of case numbers, deaths, hospitalizations, diagnostic tests, bed occupancy rates, the R-number and vaccination coverage. These limited metrics came to constitute the internationally recognized benchmarks for effective pandemic management.Based on experience from the Nordic region, we propose four distinct dynamics that characterize a quandemic: 1) A limited number of metrics tend to dominate both political, expert, and public spheres and exhibit a great deal of rigidity over time. 2) These few metrics crowd-out other forms of evidence relevant to pandemic response. 3) The metrics tend to favour certain outcomes of pandemic management, such as reducing hospitalization rates, while not capturing potential adverse effects such as social isolation and loneliness. 4) Finally, the metrics are easily standardized across countries, and give rise to competitive dynamics based on international comparisons and benchmarking.ConclusionA quandemic is not inevitable. While metrics are an indispensable part of evidence-informed policymaking, being attentive to quandemic dynamics also means identifying relevant evidence that might not be captured by these few but dominant metrics. Pandemic responses need to account for and consider multilayered vulnerabilities and risks, including socioeconomic inequities and comorbidities.

Advancements in MitraClip Intervention for Mitral Regurgitation: A Comprehensive Review and Comparative Analysis of Clinical Trials.

This comprehensive review explores the evolution and clinical impact of MitraClip intervention in the management of mitral regurgitation. Mitral regurgitation results from dysfunction in the mitral valve (MV) apparatus. The MitraClip Clip Delivery System was approved by the Food and Drug Administration (FDA) in 2013. The discussion delves into the procedural foundation of MitraClip intervention, primarily based on Alfieri's technique of edge-to-edge leaflet approximation. As highlighted by key clinical trials, includingEndovascular Valve Edge-to-Edge Repair(EVEREST) II Trial, Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) Trial, and Percutaneous Repair with the MitraClip Device for Severe Functional/Secondary Mitral Regurgitation (MITRA-FR) trial, the efficacy and safety of MitraClip were evaluated in comparison to surgical interventions and guideline-directed medical therapy. Notably, the COAPT demonstrated significant benefits in reducing all-cause mortality and heart failure hospitalization, while the MITRA-FR presented contrasting results, emphasizing the importance of patient selection. An analysis of the EVEREST II trial underscores MitraClip's potential to achieve comparable outcomes to surgical intervention, emphasizing its role in reducing mitral regurgitation and improving clinical status. However, limitations and complications, such as device-related issues and the potential impact on future MV surgery, are discussed. The study also explores the evolving landscape of MV interventions, reflecting advancements and the growing acceptance of MitraClip. In conclusion, the MitraClip device represents a significant advancement in the treatment of mitral regurgitation. The data presented highlights its promising results in terms of reduced hospitalization rates, improved in-hospital mortality, and enhanced quality of life for patients. However, challenges remain, and careful consideration of patient selection and underlying pathology is crucial in determining the optimal treatment approach. Ongoing research and clinical experience will continue to refine our understanding of MitraClip's role in the evolving landscape of MV interventions.

Clinical diagnosis of overlapping symptoms in COVID-19 based on machine learning model

The global pandemic COVID-19 erupted and infected an estimated 10% of the worlds population. Since vaccinations greatly reduced hospitalization rates, most countries removed the restrictive policies implemented to combat the virus. It has become a rather common illness with more than twelve thousand active hospitalizations. As a result, convenient COVID-19 diagnosis from diseases that display overlapping symptoms has become increasingly important. An effective method for patient self-diagnosis greatly reduces hospital presentation, saving time and medical resources. This study uses machine learning techniques to classify and predict several common respiratory diseases quickly and accurately. The author trains several machine learning models that attempt to predict four diseases based on their distinct clinical signs. An open-access database on Kaggle developed for this disease classification is selected and further processed via principal component analysis to decrease database dimension and pinpoint critical symptoms. Support Vector Machine Classifier (SVM), Nave Bayes (NB), Logistic Regression (LR), and Random Forest (RF) models are used, and their performances are compared. Study results show that the LR model slightly outperforms the others. In conclusion, the effectiveness of the proposed method is proved for classifying the symptoms of patients with allergies, colds, flu, and Covid-19 in this study.

Rate of hospitalization and length of hospital stay during and post docetaxel for darolutamide in metastatic hormone-sensitive prostate cancer using ARASENS.

228 Background: ARASENS was a randomized, double-blind, Phase III trial of darolutamide (daro) + docetaxel + androgen deprivation therapy (ADT) vs. placebo (pbo) + docetaxel + ADT in patients with metastatic hormone sensitive prostate cancer (mHSPC). We sought to compare rates of hospitalizations and length of hospital stay (LoS) per patient due to any reason, and due to adverse events (AE) during or post docetaxel using data from ARASENS. Methods: We used mixed effects negative binomial regression to estimate time-varying rate of hospitalization and LoS by patient. Patients with records that began on the same start date were considered duplicates and were condensed into one visit, using the latest end date. Patients with multiple records with overlapping time periods were combined into one visit. A constant hospitalization rate assumption was considered inappropriate since docetaxel is administered for 6-cycles (~4.14 months). Hospitalizations that began within and after first 4 months of treatment were grouped together. Conversely, LoS was assumed to be time invariant. Results: The first 4 months of treatment (when patients were receiving docetaxel) were associated with increased hospitalization both due to any reason and to AE (Table 1). Daro was associated with a numerical reduction in rate of hospitalization (per year) due to any reason during docetaxel (0.75 days [95% CI: 0.61, 0.88]) vs. pbo (0.91 days [95% CI: 0.75, 1.07]) and after docetaxel (0.31 days [95% CI: 0.26, 0.37]) vs. pbo (0.38 days [95% CI: 0.31, 0.45]). A similar trend was observed for hospitalizations due to AE. Daro was associated with a marginally longer LoS per hospitalization compared with pbo (+1.90 days). Similar results were seen for LoS due to AE (+1.67 days). Conclusions: Daro was associated with a numerically lower rate of hospitalization, but marginally longer LoS compared to pbo. A lower rate of hospitalization was observed post docetaxel as opposed to during docetaxel. Clinical trial information: NCT102799602 . [Table: see text]

Rehabilitation of patients with inflammatory rheumatic diseases and comorbidities: unmet needs.

Comorbidities may contribute to inadequate response to therapy and accelerate disability in various rheumatic diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and psoriatic arthritis (PsA). Cardiovascular, oncological, and infectious comorbidities are common in rheumatic patients. The rehabilitation of patients with inflammatory rheumatic diseases (IRDs) with comorbidities requires a multidisciplinary approach to improving patients' functional mobility, slowing down the disease progression and minimizing the risks of complications. The evidence suggests that cardiac rehabilitation can be implemented in daily practice in patients with IRDs to reduce mortality for those with established risk factors. Physical exercises reduce the severity, improve the clinical course, and reduce hospitalization rates in patients with rheumatic diseases. A rehabilitation program with focused physical therapy can lead to functional improvements and reduction of disease activity in patients with lowered quality of life (QoL). Health professionals should provide evidence-based recommendations for patients with rheumatic diseases and comorbidities to initiate the self-management of their diseases and prevent complications.

Evaluation of the efficacy of N-acetylcysteine and bromhexine compared with standard care in preventing hospitalization of outpatients with COVID-19: a double blind randomized clinical trial

Introduction and aimSince its emergence in December 2019, the coronavirus disease caused by the severe acute respiratory syndrome coronavirus 2 has become a global emergency, spreading rapidly worldwide. In response to the early referral of these patients to outpatient health centers, we decided to seek more effective treatments in the early stages of their referral. This study aims to prevent both the progression and deterioration of the physical conditions of COVID-19 patients, reduce the rate of referrals, and mitigate the risks of hospitalization and death. Material and methodsConducted at Dibaj Therapeutic Center, Hamadan City, Iran, a double-blind randomized controlled trial encompassed 225 COVID-19 patients from April to September 2022. Ethical approval was obtained from Hamadan University of Medical Sciences (Approval No.: IR.UMSHA.REC.1400.957), with the protocol registered in the Iranian Registry of Clinical Trials (Registration No. : IRCT20220302054167N1). In this study, we included patients who tested positive for COVID-19- PCR and were symptomatic, excluding those who were pregnant or had received a COVID-19 vaccine. Patients with oxygen saturation above 92% were allocated to three groups: Group A received N-acetylcysteine, Group B received Bromhexine, and Group C received standard care. Follow-ups on oxygen levels, symptoms, and hospitalization needs were conducted on days 7 and 14, with hospitalized patients monitored for one month post-hospitalization. ResultsThe study found that both N-acetylcysteine and Bromhexine can effectively reduce hospitalization rates and mortality and shorten the duration of hospitalization. The third visit of patients who received N-acetylcysteine showed an increase of 1.33% in oxygen saturation compared to their first visit, and in patients who received Bromhexine, this increase was 1.19%. The mortality rate was 9.33% in the control group and zero in both groups of patients who received medication. ConclusionIn conclusion, the results of this study indicate that NAC and bromhexine may be effective in the treatment of patients with positive COVID-19, with a lower hospitalization rate, shorter hospitalization, faster recovery time, and reduced mortality compared to the control group.

Oral Prostacyclin Pathway Agents Used in PAH: A Targeted Literature Review.

Pulmonary arterial hypertension (PAH) is a rare and progressive pulmonary vascular disease that can result in right heart failure and death. Oral prostacyclins play an important role in the management of intermediate-low risk PAH. This targeted literature review (TLR) aimed to identify and compare evidence supporting use of oral prostacyclin pathway agents (PPAs: selexipag and oral treprostinil) in intermediate-low risk PAH. A targeted literature review was conducted. Literature databases (MEDLINE, Embase, and Cochrane reviews) were searched for studies describing clinical practice and treatment outcomes for oral treprostinil and selexipag globally, published in English (2012 to 2022). Electronic searches were supplemented by manual-searches of targeted conferences (2020 to 2022), and reference lists of identified publications were reviewed. One reviewer assessed studies for eligibility. In total, 95 publications met inclusion criteria: 47 full-text articles (selexipag n = 22; oral treprostinil n = 16; selexipag and oral treprostinil n = 9) and 48 conference materials. Selexipag and oral treprostinil target the prostacyclin pathway differently; their label-supporting trials had different primary endpoints (disease progression and hospitalization vs exercise capacity and disease progression), differing baseline therapy (0, 1 or 2 vs 0 or 1 baseline treatments), titration duration and dosing (personalized dose capped at 1600 ug twice daily (BID) vs increasing doses over time with no maximum dose), respectively. While both oral PPAs have demonstrated reduced risk of disease progression, only selexipag showed reduction in hospitalization rates. Oral PPAs have been shown to reduce healthcare costs in real-world clinical practice. This difference is reflected in labeled indications. Given differences in trial- and real-world outcomes, number of prior therapies, and dosing, personalizing the choice of oral PPA is critical to maximizing the benefit for individual patients.

A Pragmatic Randomized clinical trial: twice-weekly vs. thrice-weekly Incident hemoDialysis in Elderly patients (PRIDE): study protocol.

The optimal frequency for hemodialysis in older adults with end-stage kidney disease (ESKD) has not been established. This study aims to investigate whether a twice-weekly dialysis schedule using an incremental approach can reduce hospitalization rates in the elderly with incident dialysis, compared with conventional thrice-weekly dialysis. We have designed a pragmatic randomized controlled trial to compare the effects of twice-weekly versus thrice-weekly hemodialysis in 428 ESKD individuals (dropout rate 20%) aged 60 years or older with residual kidney function (urine output, >500 mL/ day). The trial will be conducted across 18 referral hospital-based dialysis centers in Korea. Individual participants will be randomized to either a twice-weekly (with incremental approach) or thrice-weekly dialysis group and will be followed up for 24 months. The primary outcome of the study is all-cause hospitalization rate, while secondary outcomes include dialysis-specific hospitalization rates, mortality, quality of life, frailty, and cost-effectiveness. Participants have the flexibility to transfer to other dialysis centers as needed. The decision to increase dialysis frequency will be made by the treating physicians. The study is ongoing and will be completed in May 2026. This study will provide valuable insights into the benefits and risks of twice-weekly dialysis with an incremental approach in elderly with residual kidney function compared to thrice-weekly dialysis.

Efficacy of Dialectical Behavior Therapy in the Treatment of Borderline Personality Disorder: A Systematic Review of Randomized Controlled Trials.

Objective: Borderline personality disorder (BPD) is a serious public health problem. Dialectical Behavior Therapy (DBT) is a program that has provided encouraging results for its treatment. However, scientific evidence about its efficacy is scarce. Therefore, we aimed to describe the scientific production on the components of the DBT program and its therapeutic efficacy in the treatment of people with BPD. Method : A systematic review with relevant keywords was conducted based on studies available in Scopus, Web of Science, and PubMed until June 2023, including studies in English, research on therapeutic intervention, studies with a randomized controlled trial (RCT) design that included people with the diagnosis of BPD. Results: We found 18 RCTs, most of which supported the effectiveness of DBT for BPD. There were a total of 1,755 participants in these studies, most of whom were women. These studies looked for treating self-injurious behaviors, suicidal thoughts or ideations, number of visits to emergency services, and frequency of hospital admissions. Most studies revealed that both short-term DBT and standard DBT improved suicidality in BPD patients with small or moderate effect sizes, lasting up to 24 months after the treatment period. Furthermore, these studies showed that DBT can significantly improve general psychopathology and depressive symptoms in patients with BPD. Improvement of compliance, impulsivity, mood instability, as well as reduction in hospitalization rate are other findings observed in the trials following DBT. Conclusion: Although DBT shows efficacy in the treatment of BPD, heterogeneity in the methodologies employed is highlighted. Therefore, it is necessary to design studies from a homogeneous theoretical and methodological framework.

Heavy industry regulations, hospitalization, and medical expenditures: Evidence from micro-level medical records in a northeast Chinese city

Heavy industry regulations are expected to significantly contribute to enhancing public health and reducing social health costs. Based on microlevel medical records from a northeast Chinese city, we prove that environmental regulations targeting heavy industry plants significantly decrease hospitalization rates and medical expenditures. Specifically, the rate of hospitalization decreases by 0.165 per 10,000 population per day for respiratory, cardiovascular, cerebrovascular, pulmonary, brain disease and adverse pregnancies, especially for those aged 0–15 years or older than 45 years. Our mechanistic analysis highlights that the reduction in hospitalization rates is attributed to the decreased concentrations of SO2 and NOx. Further analysis shows that heavy industry regulations lead to a reduction of 100,000 CNY in total medical expenditures within a span of 15 days for each plant. However, the benefits in medical costs remain significantly lower than the economic costs incurred by the policies.