Reduction In Mortality Rate Research Articles

Cost-effectiveness and return on investment of hepatitis C virus elimination in China: A modelling study.

The WHO set the goal of eliminating hepatitis C virus (HCV) by 2030, with 80% and 65% reductions in HCV incidence and mortality rates, respectively. We aimed to evaluate the health benefits, cost-effectiveness and return on investment (ROI) of HCV elimination. Using an HCV transmission compartmental model, we evaluated the benefits and costs of different strategies combining screening and treatment for Chinese populations. We identified strategies to achieve HCV elimination and calculated the incremental cost-effectiveness ratios (ICERs) per disability-adjusted life year (DALY) averted for 2022-2030 to identify the optimal elimination strategy. Furthermore, we estimated the ROI by 2050 by comparing the required investment with the economic productivity gains from reduced HCV incidence and deaths. The strategy that results in the most significant health benefits involves conducting annual primary screening at a rate of 14%, re-screening people who inject drugs (PWID) annually and the general population every five years, and treating 95% of those diagnosed (P14-R4-T95), preventing approximately 5.75 and 0.44 million HCV infections and deaths, respectively, during 2022-2030. At a willingness-to-pay threshold of $12,615, the P14-R4-T95 strategy is the most cost-effective, with an ICER of $5,449/DALY. By 2050, this strategy would have a net benefit of $120,997 million (ROI=0.868). Achieving HCV elimination in China by 2030 will require significant investment in large-scale universal screening and treatment, but it will yield substantial health and economic benefits and is cost effective.

A deep neural network model with spectral correlation function for electrocardiogram classification and diagnosis of atrial fibrillation

Atrial Fibrillation (AF) is a common type of irregular heartbeat, and early detection can significantly improve treatment outcomes and prognoses. Single-lead Electrocardiogram (ECG) devices are under extensive scrutiny for monitoring patients' heart health worldwide. Standardized ECG signal monitoring has demonstrated a significant reduction in mortality rates associated with severe cardiovascular diseases. However, the automatic detection method for AF requires significant improvement. This study presents a novel approach that utilizes the cyclostationary analysis of ECG signals, uncovering a spectral hidden periodicity between the QRS-T (the main wave components representing electrical activity in the heart) complexes of the ECG signal through the Spectral Correlation Function (SCF). To validate the proposed method's performance, the single ECG's SCF coefficients are applied to the Convolutional Recurrent Neural Network (CRNN), which consists of convolutional and long short-term memory (LSTM) layers, on the 2017 PhysioNet challenge dataset. The obtained results demonstrate that the proposed approach efficiently represents ECG signals through SCF coefficients, leading to the accurate detection of AF with an average accuracy of 92.76% and an average F1-score of 89.1%.

Echocardiographic Effects of Tiletamine-zolazepam and Ketamine-diazepam in Dogs Undergoing Ovariohysterectomy

Background: Echocardiography is ultrasound of heart. In order to promote reduction in mortality rates due to anaesthesia, it is essential to understand the potential depressant effects of anaesthetic drugs on the cardiovascular system, so that anaesthetic procedures are conducted in the best possible way. Cardiac monitoring during surgery offers rapid and safe information about the alterations that may appear during the surgical procedure that can affect cardiac functions. Methods: The present study was undertaken to evaluate the echocardiographic effects of Tiletamine-zolazepam and Ketamine-diazepam anaesthetic combination in twelve healthy female dogs for ovariohysterectomy. These twelve dogs were randomly allotted to two equal groups irrespective of age, breed and body weight. Dogs were anaesthetized with Tiletamine-zolazepam (7.5 mg/kg, IV) in group 1 and Ketamine (5.0 mg/kg, IV)-Diazepam (0.5 mg/kg, IV) in group II. Atropine sulphate (0.04 mg/kg IM) followed by butorphanol (0.2 mg/kg IM) after 10 minutes was used as preanaesthetic drugs. Echocardiographic indices were recorded at different time intervals during the study period. Result: Non-significant changes were found in both systolic and diastolic functions. Thus, present findings suggested that Tiletamine-Zolazepam and Ketamine-Diazepam anaesthetic combinations provided good cardiovascular stability in dogs undergoing ovariohysterectomy.

Cardiac Rehabilitation After Open Heart Surgery: A Narrative Systematic Review.

Postoperative cardiac rehabilitation (CR) programs are increasingly recommended by clinicians, but only a minority of patients who have undergone open heart surgery participate in such programs. Participation rates in postoperative CR, if anything, appear to be declining. This systematic review examines the effectiveness of post-operative CR and reveals possible participation barriers. A search of two scholarly databases for primary research papers published in the last decade examining the impact of post-operative CR was conducted and the resultant papers reviewed. The 21 resulting studies revealed physiological functioning improvement and a reduction in mortality and readmission rates, while highlighting an enhancement in mental status. Some of the studies recognized the need for nutritional support and suggested that age, gender, access to CR centers, and socioeconomic variables impact participation in CR. Post-operative CR participation rates continue to decline despite increasing evidence of the value of the approach.

“Effectiveness and safety of negative pressure wound therapy in patients with deep sternal wound infection: a systematic review and meta-analysis”

Background: Deep sternal wound infection (DSWI) is a severe and life-threatening complication following cardiovascular surgery. Negative pressure wound therapy (NPWT) has emerged as a promising therapeutic bridging option for DSWI. In this systematic review and meta-analysis, we aimed to evaluate the impact of NPWT on clinical outcomes in patients with DSWI. Material and Methods: A comprehensive literature search was conducted according to the PRISMA guideline in electronic databases, including PubMed, Embase, and Cochrane Library. Data extraction was performed independently by two reviewers, and risk of bias was assessed by ROBINS-I tool. The primary outcomes assessed were mortality rate and reinfection rate. The secondary outcomes assessed were length of hospital stay and intensive care unit stay. Results: In this systematic review identified a total of 36 studies, comprising 3,681 patients with DSWI who received treatment. The meta-analysis revealed that NPWT was associated with a significant reduction in mortality rate (RR 0.46, 95% CI 0.35-0.61, P<0.000001) and reinfection rate (RR 0.43, 95% CI: 0.25-0.74, P=0.002) compared to conventional wound management. Furthermore, pooling of these studies showed significant difference between the NPWT and conventional treatment groups in length of hospital stay (mean difference: -4.49, 95% CI: -8.14, -0.83; P=0.02) and length of ICU stay (mean difference: -1.11, 95% CI: -2.18, -0.04; P=0.04). Conclusion: This systematic review and meta-analysis provide evidence that NPWT is superior to conventional treatment for patients with DSWI following cardiovascular surgery.

Abstract 4117645: Ischemic Heart Disease Trends in Canada: A 30-Year Epidemiological Study

Introduction: Ischemic heart disease (IHD) results from coronary artery blockages that impede myocardial blood flow. We aim to examine the temporal trends of IHD in Canada from 1990 to 2019, assessing age-standardized mortality, disability-adjusted life years (DALYs), and other health indicators. Methods: We analyzed data from the 2019 Global Burden of Disease study on Canadian IHD cases over three decades. The study investigated age-standardized deaths, DALYs, years lived with disability (YLDs), years of life lost (YLLs), prevalence, and incidence across both sexes. We performed statistical analyses using Microsoft Excel 16.63.1. Results: Over the period from 1990 to 2019, Canadian men and women experienced notable decreases in IHD incident rates [-45.11%], overall mortality [-60.64%], YLLs [-62.824%], prevalence [-26.778%], YLDs [-48.729%], and DALYs [-50.467%]. Detailed analysis revealed a reduction in death rates by 61.311% in men and 61.119% in women, while YLLs decreased by 63.115% for men and 63.808% for women. Similarly, DALYs showed a decline of 62.67% for men and 63.25% for women. Prevalence rates fell by 25.417% in women and 29.594% in men, whereas YLDs decreased by 51.148% for women and 49.172% for men. The 2019 data confirmed a per 100,000 population count of 48.78 YLDs, 1020.28 YLLs, and 1069.06 DALYs across both sexes. Conclusions: This study illustrates a significant decrease in ischemic heart disease (IHD) metrics in Canada from 1990 to 2019, highlighting notable reductions in mortality, prevalence, and disability rates among both genders. The findings underscore the effectiveness of healthcare improvements and public health initiatives and IHD. Despite these advancements, IHD continues to pose a substantial health challenge, indicating the need for ongoing efforts in medical care, policy-making, and lifestyle modifications to further alleviate the disease's burden in Canada.

Abstract 4121359: Heart Disease and Heart Failure: Trends and Disparities in Mortality Rates in the United States from 2000 to 2020

Background: The remarkable decline in the overall prevalence and mortality rates of cardiovascular diseases (CVD) in the United States (US) over the past few decades has not been consistent across all age groups, sexes, races, and types of cardiovascular diseases. Heart disease (HD) and heart failure (HF) still pose a significant burden to the healthcare system. Objectives: This study sought to describe the age, sex and racial disparities in the trends in mortality rates for these two outcomes in the US over the past two decades. Methods: This was an ecological study with trend analysis of the mortality from heart disease and heart failure in the US between 2000 and 2020. Data on CVD was obtained from the National Centers for Disease Control and Prevention (CDC) surveillance databases and analyzed. Binomial regression models were used to evaluate trends in outcomes. Statistical significance was considered for p-values < 0.05. Results: There was a significant decrease in the age-standardized mortality for HD over the past two decades (from 343.5 per 100,000 cases to 215.1 per 100,000 cases (p<0.001)). Mortality rates were significantly higher in males (p<0.001, R2 = 0.92), non-Hispanic blacks (p<0.001) and non-Hispanic whites (p<0.001) compared to Hispanics, (R2 = 0.94) and in adults aged 65+ (p<0.001) and 75+ (p<0.001) (R2 = 0.98). There was no significant decrease in the age-standardized mortality for HF (from 26.9 per 100,000 cases to 25.7 per 100,000 cases (p=0.706)) due to a reversal in the trend after 2011. Though the rates were significantly lower in males overall (p=0.001, R2 = 0.27), these rates became higher in males and in non-Hispanic Blacks compared to non-Hispanic Whites beyond 2016. Mortality rates due to HF were highest in the 65+ and 75+ age groups. Conclusions: This study on national trends in heart disease and heart failure across age groups, sexes and races over the past two decades confirmed a significant reduction in heart disease mortality rates over this period, but with persistent disparities between males and females, non-Hispanic Blacks and other races and the older age groups. This study also highlights important reversals of heart failure mortality rates trends in more recent years in males and females, and non-Hispanic Blacks and Whites, the reasons for which are amenable to further research.

Population-pharmacokinetic/pharmacodynamic model of atractylodes lancea (Thunb.) DC. administration in patients with advanced-stage intrahepatic cholangiocarcinoma: a dosage prediction

BackgroundA recent phase 2A clinical study of Atractylodes lancea (Thunb.) DC. (AL) in patients with advanced-stage intrahepatic cholangiocarcinoma (iCCA) demonstrated significant reduction of the risk of tumor progression and mortality with a dose ranging from 1,000 to 2,000 mg. The present study aimed to determine the potential dosage regimen of AL for further phase 2B clinical study.MethodsPlasma-concentration time profiles of total AL bioactivity and clinical efficacy in patients with advanced-stage iCCA were obtained from Phase 2 A study. The population pharmacokinetic (pop-PK) model was developed. The pop-PK model and Monte-Carlo (MC) simulation, in conjunction with maximum concentration of AL (Cmax) as a cut-off criterion, was performed and validated with clinical data. The optimal model was used to simulate further dosage regimens and clinical efficacy of AL.ResultsThe pop-PK properties of total AL bioactivity were best described by a compartmental model with zero-order absorption (without delay) and linear clearance. None of the investigated covariates improved model accuracy.The developed pop-PK with MC simulations following once-daily dosing of 1,000 mg and 2,000 mg adequately predicted the clinical efficacy (tumor progression and mortality). The once-daily dose of 2,500 mg is recommended for further phase 2B clinical study due to its relatively high efficacy on tumor progression inhibition (73%) and mortality rate reduction (71%) without excessive number of the administered capsules (23 capsules) and low risk of toxicities (<5%).ConclusionsThe applied pop-PK model with MC simulation, along with the appropriate cut-off pharmacokinetic parameters, can be used as a potential tool for supporting dosage prediction and selection for clinical studies, and thus reducing the rate of drug development failures.Trial registrationwww.thaiclinicaltrials.org, WHO ICTRP search, TCTR20210129007, Registed 29 January 2021.

HIV mortality trends in Mexico, 2000-2022

About 39 million people are living with HIV worldwide, 62% of people living with HIV receive antiretroviral therapy. The combination of ART has allowed suppression of viral replication and disease progression, decreasing mortality. To analyze HIV trends in Mexico during the period 2000-2022. An ecological study of deaths due to HIV during the period 2000 to 2022 was carried out. Mortality rates were adjusted by the direct method and joinpoint regression was used to analyze trends and estimate the annual percentage change. The national HIV mortality rate was 0.05 per 100,000 population while in 2022 it decreased to 0.04 per 100,000 population. Trend analysis identified two points of change, with a significant reduction in mortality rates at the national level in the period 2007-2022 and a subsequent decrease in mortality. At the state level, there were variations in trends with some states showing significant increases at the end of the study period, such as Jalisco, Campeche, and Quintana Roo. Changes by sex were heterogeneous. Reductions in HIV mortality rates are limited to some states of the country, so it is necessary to implement health strategies according to social, economic, and cultural characteristics and with a gender perspective.

Association of dietary anthocyanidins intake with all-cause mortality and cardiovascular diseases mortality in USA adults: a prospective cohort study

Anthocyanins, as a type of polyphenolic compound, have been discovered to offer multiple health benefits to humans, including anti-aging and anti-inflammatory properties. This prospective cohort study aims to examine the relationship of dietary intake of anthocyanin with all-cause mortality and cardiovascular diseases mortality in the US. The aim of this research was to explore the possible correlation between anthocyanin consumption and the mortality rate from all causes as well as from cardiovascular disease. Based on the Public Access NHANES-linked National Death Index files up to December 31, 2019, we identified mortality status and heart disease-specific causes of death. A multivariate Cox regression analysis was employed to evaluate the effects of anthocyanin intake on mortality outcomes, generating hazard ratios and 95% confidence intervals, adjusting for various demographic characteristics, lifestyle factors, and comorbid conditions. Additionally, we utilized Kaplan-Meier survival curves, subgroup analyses. In different scenarios, dietary anthocyanin intake was assessed using restricted cubic spline models. A total of 11,959 participants completed the final cohort, averaging 47.12 years of age (SD ± 0.35). Following adjustments for multiple variables, an inverse relationship was identified between anthocyanin intake in the highest quartile and all causes mortality, yielding a hazard ratio (HR) of 0.68 (95% CI: 0.52–0.89). Similarly, elevated anthocyanin consumption was linked to a reduction in heart disease mortality, with HR of 0.61 (95% CI: 0.38–0.97). Additionally, dose–response curve revealed a consistent decrease in both all-cause and cardiovascular mortality with increasing anthocyanin intake. Further subgroup analyses revealed that elevated intake of anthocyanins was linked to decreased all-cause mortality in White individuals and males. Moreover, high anthocyanin intake was significantly correlated with reduced all-cause mortality irrespective of hypertension or hyperlipidemia status. Our research indicates that an appropriate dietary intake of anthocyanins is associated with a reduction in overall mortality rates. Furthermore, the findings reveal a substantial association between anthocyanin intake and decreased mortality from cardiovascular diseases, suggesting that anthocyanins may effectively lower the risk of cardiovascular-related deaths.

Patient and Surgical Factors Associated With Long-Term Mortality Outcomes Up to Fifteen Years After Total Hip and Knee Arthroplasty: An Australian Orthopaedic Association National Joint Replacement Registry Study

BackgroundMortality rates following total hip arthroplasty (THA) and total knee arthroplasty (TKA) arthroplasty display distinct temporal patterns often attributed to patient selection bias, perioperative optimization, and comorbidities. Understanding these mortality patterns is essential for epidemiological and health economic longitudinal modeling. MethodsWe conducted a national registry-based cohort study in Australia using data from 1999 to 2022, examining primary and revision THA and TKA procedures for osteoarthritis. We assessed patient factors (age, sex, body mass index, and American Society of Anaesthesiologists score), and surgical factors (procedure, fixation, bearing surface, and implant volume) in relation to long-term mortality. Standardized mortality ratios were calculated by comparing observed and expected deaths based on national mortality rates. ResultsOur study included 540,181 THA and 880,036 TKA procedures. Temporal trends in mortality rates were observed, with a reduction in mortality rate observed up to seven years for both primary THA and primary TKA after the index procedure and an increased mortality rate observed thereafter. All patient factors were associated with differences in mortality rates, with younger (age range, 45 to 49 years) patients for primary TKA demonstrating the strongest association with mortality excess (15 years; standardized mortality ratios 2.02; 95% confidence interval 1.66 to 2.46). Revision procedures were associated with higher mortality rates compared to their respective primary procedures at all time points. ConclusionsOur study finds noncausal associations between patient and surgical factors and mortality up to fifteen years following THA and TKA for osteoarthritis in Australia. These findings are crucial for calibrating epidemiological and economic models and enhancing the precision of longitudinal outcome predictions for arthroplasty patients. While limitations exist, our study informs clinical practice, healthcare policies, and future research in arthroplasty surgery on a national scale, with potential relevance to similar populations worldwide. Level of EvidenceLevel III, therapeutic study.

IMPLEMENTING AND EVALUATING A PAEDIATRIC EMERGENCY MANAGEMENT TRAINING PROGRAM FOR PRIMARY HEALTHCARE WORKERS IN ZARIA

Nigeria continues to grapple with alarmingly high under-five mortality rates, with approximately 2,300 children dying daily due to preventable and treatable diseases such as pneumonia, malaria, and diarrheal illnesses. This crisis is particularly pronounced in rural areas, where childhood mortality rates are significantly higher than in urban centres. For many rural communities, primary healthcare (PHC) centres serve as the sole access point to medical services, making these centres critical to addressing this public health challenge. Despite their importance, PHC centres often face significant challenges, including inadequate infrastructure, limited access to essential medications, and a shortage of adequately trained health personnel. This study aimed to implement and evaluate a Paediatric Emergency Management Training Program for healthcare workers at PHC centres in Zaria, Kaduna State. The primary objective was to assess the effectiveness of the training in improving the competency of health workers in managing common paediatric emergencies, thereby enhancing the overall quality of care provided at these centres. A cross-sectional descriptive study was conducted involving 139 healthcare workers from selected PHC centres in Sabon Gari and Zaria Local Government Areas, utilizing a multi-stage random sampling technique. Data collection was performed using a pre-tested, semi-structured, self-administered questionnaire designed to evaluate the participants' baseline knowledge, followed by an assessment after the training intervention. The data were analysed using SPSS version 21, with chi-square tests employed to examine the associations between variables. Results were presented using tables and charts for clarity. The findings revealed a generally low baseline competency in managing common paediatric emergencies among the healthcare workers. Specifically, 66 (48.5%) of the respondents demonstrated very poor knowledge regarding the causes of common paediatric emergencies, 32 (23.5%) had poor knowledge, 34 (25.0%) had good knowledge, and only 4 (2.9%) of the respondents exhibited excellent knowledge. Similarly, knowledge regarding the treatment of these emergencies was also lacking, with 46.7% of respondents showing very poor understanding, 34.1% having poor knowledge, 16.3% demonstrating good knowledge, and only 3.0% showing excellent knowledge. A statistically significant relationship was observed between academic qualifications and knowledge levels in both causes (p = 0.004) and treatment (p = 0.000) of paediatric emergencies. The low baseline knowledge underscores the critical need for targeted training interventions. The study highlights the importance of establishing a sustained partnership between the Department of Paediatrics at Ahmadu Bello University Teaching Hospital and the Departments of Primary Health Care in Zaria and Sabon Gari Local Governments. Regular training workshops, held quarterly, are recommended to continuously equip PHC workers with the necessary skills to effectively manage paediatric emergencies, ultimately contributing to a reduction in childhood mortality rates in the region.

Short and Mid-Term Outcomes of Rotarex Mechanical Thrombectomy for Acute Limb Ischemia in Taiwan: A Retrospective Study in a Single Medical Center.

Acute limb ischemia (ALI) is a medical emergency necessitating immediate action to avert irreversible tissue harm and limb loss. Rotarex mechanical thrombectomy (RMT) has become an efficient treatment alternative for ALI. However, there is a lack of data on RMT in Taiwan. We retrospectively analyzed 61 ALI patients treated with RMT at our hospital between January 2016 and January 2022. We collected baseline characteristics, laboratory and angiographic data. We also examined the outcomes at 30 days, 6 months, and 1 year, including major amputations, minor amputations, all-cause mortality, and major adverse limb events (MALEs). Among the 61 RMT-treated patients, the average age was 70 ± 14 years. ALI affected the upper extremities in 9 cases and lower extremities in 52 cases. One-year outcomes revealed 2 major amputations (3.3%), 2 minor amputations (3.3%), 6 all-cause deaths (9.8%), and 10 MALEs (16.4%). After multiple logistic regression analysis, hemoglobin drop was significantly associated with 1-year all-cause mortality, and a history of peripheral artery disease (PAD) was significantly associated with MALEs. Our research is the first investigation into the application of RMT for ALI in Taiwan. The short- and mid-term outcomes after RMT for ALI revealed reductions in amputation, mortality, and MALE rates. In addition, a decline in hemoglobin level was a significant predictor of increased mortality, and a history of PAD was a significant predictor of increased MALEs following RMT.

Development of integrated monitoring technology for hypothermia and hypoxia in low birth weight infants

Hypothermia and hypoxia are two conditions that often occur in Low Birth Weight (LBW) infants and can lead to serious complications if not promptly detected and addressed. The aim of the research is to develop a prototype of a medical device that integrates the detection of hypothermia and hypoxia in low birth weight infants. The research method uses a Research and Development approach. (R&D). The development process is carried out through several stages, namely needs analysis, design, development, testing, and evaluation. In the needs analysis stage, data is collected based on the results of previous research and through a literature review to determine the expected specifications of the tool. Next, in the design and development stage, the prototype is designed by integrating temperature sensors and an oximeter, as well as an automatic alarm system that provides early warnings when the baby's vital parameters are outside normal limits. In the initial stage, testing is conducted through simulations. The research results show that the prototype is capable of quickly detecting changes in body temperature and oxygen levels, as well as providing an alarm response to any abnormal changes. In further development, functional testing of the device will be conducted on infants. This device is expected to contribute to the improvement of neonatal care quality and the reduction of infant mortality rates due to complications from hypothermia and hypoxia.

Health economic value of postacute oral nutritional supplementation in older adult medical patients at risk for malnutrition: a US-based modelling approach

ObjectiveTo estimate the health economic value of postdischarge oral nutrition supplement (ONS) consumption among elderly adults who were malnourished during hospitalisation.DesignA cost-effectiveness model was developed from a US payer perspective based on a recent meta-analysis of randomised trials of nutritional support following hospital discharge and studies of US hospital mortality, readmission rates and costs.Participants and settingThe target population of this study was postacute care US patients aged ≥65 years who were identified as malnourished during hospitalisation.Intervention and outcome measuresA decision-tree model was used to evaluate the impact of postacute care daily consumption of ONS compared with no ONS. Outcomes were evaluated over a 1-year time interval. Clinical outcomes of interest included readmission and mortality rates. Economic value of ONS was quantified using three different metrics: cost per death averted, cost per readmission avoided and direct cost savings resulting from changes in postacute mortality and readmission rates. The economic value of ONS was also measured by gains in quality-adjusted life-years.ResultsCompared with patients not receiving ONS after hospital discharge, use of ONS during the postacute phase reduced mortality by 36.3% and readmissions by 11.0%. Reductions in readmissions resulted in annual savings of US$1113 per person. When extrapolating the results to the estimated 1 693 034 hospitalised elderly US adults at risk of malnutrition, the use of ONS after hospital discharge would prevent 67 747 deaths and 116 570 hospital readmissions per year. With the estimated cost of nutritional support at US$175 per patient per month corresponding to two servings ONS per day, the ONS cost per death and readmission avoided was estimated at US$4380 and US$2546, respectively.ConclusionsPostdischarge use of ONS among patients at risk for malnutrition is highly cost-effective with important reductions in mortality and readmission rates.

Impact of the Coronavirus Disease 2019 [COVID-19] Pandemic on Post-Acute Care of Patients with Heart Failure and the Effectiveness of Vaccine Prevention.

The Heart Failure Post-Acute Care [HF-PAC] program is a specialized healthcare program aimed at providing comprehensive care and support for patients with heart failure [HF] as they transition from acute hospital settings to home. But the impact of the coronavirus disease 2019 [COVID-19] pandemic on the HF-PAC program remains unknown. Furthermore, the effects of the comprehensive COVID-19 vaccination program on these patients with HF-PAC warrants further investigation. A total of 265 patients with acute decompensated HF were admitted to the hospital between May 2020 and October 2022. Of these, 159 patients underwent planned HF-PAC follow-up for 6 months, followed by scheduled follow-up visits every 3 months and unscheduled telephone randomized visits for at least another 6 months. The program completion rate was nearly 92%. COVID-19 significantly impacted patients with HF-PAC, leading to an increased mortality [13.3%] compared to before the pandemic [6.5%]. In our patient cohort, 83% had received at least 1 dose of vaccine and 61% had received > 3 doses. Of these patients with HF-PAC, 34% contracted COVID-19 infection post discharge, and 8.8% died owing to the infection. Of the mortality group, 42.9% patients were not vaccinated, and 28.6% received 1 vaccine dose, and their vaccination rate was lower than in the survival group [p = 0.01]. The COVID-19 pandemic had a significant impact on patients enrolled in the HF-PAC program; receiving more than 3 doses of the COVID-19 vaccine was associated with a significant reduction in mortality rates among these patients.

Gender disparities in short-term outcomes of STEMI patients: the influence of universal health coverage

Abstract Background Even after the event, individuals recovering from ST-elevation myocardial infarction (STEMI) face lingering risks, including potential subsequent events and mortality. The introduction of Universal Health Coverage (UHC) seeks to enhance healthcare outcomes for all segments of the population. Purpose This study evaluates the effect of UHC on 30-day mortality in post-STEMI patients, focusing on medication access and treatment disparities. Using a gender-stratified approach, we analyze changes before and after UHC implementation to provide insights into the difference in therapy between genders and how gender influences healthcare outcomes for post-STEMI patients. Methods Analyzing two cohorts, Cohort 1 (211 STEMI patients, 2013-2014 pre-UHC) and Cohort 2 (365 STEMI patients, 2018-2020 post-UHC), this study employed the chi-square test to determine differences between genders and the Kaplan–Meier log-rank test to compare survival rates. Results Comparing pre- and post-UHC, we observed a significant increase in both medication and reperfusion therapy (p&amp;lt;0.001). However, even in both periods, women continued to have lower rates of medication and reperfusion compared to men (Men vs Women: Before UHC 14.3% vs 0%; After UHC 58.5% vs 47.9%). Within 30 days after the STEMI event, we noted a reduction in mortality rates across genders before and after UHC implementation, yet the decrease was less pronounced in women compared to men (Before UHC: Men 13.0%, Women 22.0%; After UHC: Men 8.2%, Women 18.3%). Conclusion UHC led to improvements in medication and reperfusion therapy for STEMI patients. Despite this progress, persistent gender disparities were observed, with women consistently having lower treatment rates. While mortality rates reduced for both genders, the decrease was less pronounced in women, especially after the implementation of UHC. These findings emphasize the need for targeted interventions to address gender-specific healthcare discrepancies within the scope of comprehensive health coverage.Baseline characteristicsMortality outcomes within 30 Days

Breast cancer imaging-clinical experience with two-dimensional-shear wave elastography: A retrospective study.

Breast cancer morbidity has been increasing worldwide, but treatments are improving. The therapeutic response depends on the stage at which the disease is diagnosed. Therefore, early diagnosis has never been more essential for successful treatment and a reduction in mortality rates. Radiology plays a pivotal role in cancer detection, and advances in ultrasound (US) palpation have shown promising results for breast cancer imaging. The addition of two-dimensional-shear wave elastography (2D-SWE) US in the routine breast imaging exam can increase early cancer detection and promote better surveillance. To evaluate the clinical applications of 2D-SWE US in breast cancer detection and its combination with other imaging modalities. The 200 consecutive female patients aged 50-80 were examined to evaluate palpable breast lesions. All patients underwent mammography, bright mode (B-mode) US, and 2D-SWE followed by US-guided biopsy in two consecutive sessions. Combining B-mode and shear wave US imaging with X-ray mammography revealed 100% of the suspicious lesions, resulting in greater sensitivity, specificity, and negative predictive value. The result improves compared to either B-mode or 2D-SWE alone (P = 0.02). Combining 2D-SWE with conventional US and X-ray techniques improves the chance of early cancer detection. Including 2D-SWE in regular breast imaging routines can reduce the need for biopsies and improve the chance of early cancer detection and survivability with the proper line of therapy.

Is confidence in knowledge related to childbirth fear and mode of birth among Polish women?

Abstract Background In Poland, cesarean section (CS) rate is 48% what means that it is one of the highest rate among OECD countries and the highest in the European Union. WHO has considered that CS rates higher than 15% at the population level are not associated with reductions in maternal and newborn mortality rates. Fear and attitudes towards childbirth are shaped years before the first pregnancy. Yet, little is understood about how young people’s knowledge, attitudes and fears concerning the birth process shape their healthcare preferences around birth. Thus, the aim of the study was to examine whether confidence in knowledge was associated with childbirth fear prior to pregnancy and preference for CS. Methods We recruited 782 women aged 18 - 35 (mean 24.7, sd = 3.19) who had never been pregnant but wished to have at least one child in the future. The women answered questions about: (i) socio-economic situation, (ii) confidence in knowledge and educational needs related to pregnancy and childbirth; (iii) fear of childbirth prior to pregnancy; (iv) preferred mode of birth in the hypothetical pregnancy in which there are no medical indications for cesarean section. Results Almost one in four women (22.1%) preferred CS in a hypothetical low-risk pregnancy. In addition, most often young women gained knowledge on pregnancy and birth from experiences and stories of family members (62.3%). Women with moderate and high level of confidence in knowledge had respectively lower odds of high level of childbirth fear prior to pregnancy comparing to women with low level of confidence in knowledge (OR = 0.57, 95% CI: 0.39-0.83 and OR = 0.54, 95% CI: 0.33-0.88, respectively). Conclusions Increasing knowledge about pregnancy and childbirth among young women might lower childbirth fear and thus, indirectly, lower rates of CS in the future. Key messages • The results of this study may solve very important public health problem i.e. the growing rates of cesarean section. • Confidence in knowledge may be an important factor associated with the level of childbirth fear.

Influence of process-focused patient care on clinical outcomes among hospitalized heart failure patients in the cardiology ward

Abstract Background The implementation of a process-oriented organizational structure in patient care allows for a comprehensive and optimized approach. In the context of heart failure (HF), it remains uncertain whether the establishment of a specialized hospitalisation team can contribute to improved major clinical outcomes. Purpose To analyse the rates of all-cause hospitalisation, cardiovascular hospitalization, HF hospitalization and overall mortality at 180 days among patients admitted to the Cardiology ward for HF, both prior to and after the implementation of a specialized HF hospitalisation team. Methods The study included all patients discharged from the Cardiology department with HF as the primary diagnosis and subsequent outpatient follow-up by the Community HF Unit in both 2019 and 2022. Clinical outcomes were compared between two distinct periods: the pre-implementation year of 2019 and the subsequent year of 2022, characterized by process-oriented HF care. Statistical analyses were performed using Kaplan-Meier and adjusted Cox proportional-hazards models. Results A total of 140 patients were enrolled in the study, comprising 55 individuals receiving care from a conventional ward team in 2019 and 85 under the specialized HF team in 2022. The mean age of the cohort was 69.4 years (+/-11.8), with a mean LVEF of 40.6%. The pre-implementation group showed a higher percentage of male patients (73% vs. 47%; p=0.003) and LVEF was lower in the HF team period (38.9% vs. 43.4%; p=0.045), with no statistically significant differences in other baseline variables. As shown in figure 1, over 180 days of follow-up, 15 patients (27.6%) were admitted to hospital in the conventional ward team period and 13 (15.3%) in the HF team period (hazard ratio [HR] 0.44; 95% confidence interval [CI] 0.19 to 0.99; P=0.047). Of these hospitalisations, 13 patients (23.6%) in pre-implementation period and 10 (11.8%) in post-implementation period were attributed to cardiovascular events (HR 0.40; 95% CI 0.16 to 0.99; P=0.049). Additionally, there was a reduction in the rate of heart failure admissions in the post-implementation period compared to the pre-implementation time (HR 0.30; 95% CI 0.09 to 0.94; P=0.039). Furthermore, a significant decline in all-cause of death was observed in patients treated by HF-team in 2022 compared to patients receiving care from the conventional ward team (log-rank test, p=0.015). Conclusions The implementation of a process-oriented organizational model within the Cardiology unit consisting in the provision of patient care by a team specialized in HF management, is associated with a statistically significant reduction in major clinical outcomes such as all-cause hospitalization, cardiovascular hospitalization and HF readmission, alongside a reduction in overall mortality rates at 180 days.