Medicine Service Research Articles

Frailty in older adults admitted to hospital: outcomes from the Western Sydney Clinical Frailty Registry.

To examine baseline frailty and its association with rehospitalisation and mortality within 12 months among older adults enrolled in the Western Sydney Clinical Frailty Registry. Prospective observational cohort study. 592 adults admitted to an acute geriatric medicine service in NSW, Australia, were included in this study. The Western Sydney Clinical Frailty Registry is a study of adults admitted to acute geriatric wards in a 570-bed two-site district general hospital in Western Sydney, NSW, Australia. Recruitment began in April 2020 and is ongoing. Each participant is recruited while an inpatient and followed up for 12 months, including baseline visits and three-, six- and 12-month follow-ups via telephone interviews. The primary outcome of this study was rehospitalisation and/or mortality at 12 months. Median age 82 years; half the cohort were classified as mild-moderately frail, and 21% were classified as severely frail. A total of 134 participants died (22.6%) within the 12-month follow-up period. Increased cumulative incidence of first rehospitalisation and/or death during the first 12 months post-discharge was significantly associated with higher modified Charlson comorbidity (p < 0.001) and Clinical Frailty Scale (CFS) scores (p < 0.001). Compared to the 'non-frail' group (CFS 1-4), those who were severely frail (CFS 7-9) had an 85% increased risk of rehospitalisation and/or death (95% CI 1.36-2.52), and those who were mild-moderately frail (CFS 5-6) had a 52% increased risk after adjusting for effects of the other variables (95% CI 1.18-1.94). Frailty is very common in older adults admitted to acute geriatric services. Assessing frailty using the CFS is feasible and is independently predictive of rehospitalisation and mortality. Our findings suggest that integrating frailty assessment into clinical practice goes beyond simple risk stratification, offering valuable insights for tailored clinical management strategies.

The Effect of Lean Hospital Practices on Nurses' Direct Care Activities: Time and Motion Study.

This study investigates the effects of lean management practices on nurses' direct patient care activities and the interruptions they encounter in healthcare settings. The literature indicates that lean management enhances efficiency and improves patient care. Increased nursing time per patient correlates with better outcomes; however, rising patient loads and frequent interruptions hinder nurses' ability to deliver effective care, jeopardising patient safety. Addressing these inefficiencies is essential, given nurses' critical role in ensuring quality care. Using a single-centre, observational, pre-post time and motion design alongside participatory action research from August 2019 to July 2022, the study included three phases: a survey assessing nurses' views on problem-solving and lean management; observations identifying nurses' activities and interruptions; and focus group discussions. The results presented here are from the observation phase, with 34 nurses from surgical, internal medicine, and mixed services participating. Quantitative variables were expressed as means, standard deviations, and significance was assessed at a 95% confidence interval (p < 0.05). Observations in 2019 (324 h) and 2022 (314 h) revealed that nurses dedicated a significant portion of their time to direct patient care, which increased post-lean implementation (surgical: 50.67%, internal: 50.09%, mixed: 44.38%). Waste rates decreased by 35.81%, and documentation time decreased by 23.55%. Overall interruptions also decreased significantly (p < 0.05). Lean management effectively reduces waste and improves direct patient care time, enhancing patient safety and care quality. Continuous improvement initiatives in nursing practices are essential for success.

Abstract WP164: Creating an Acute Sleep Medicine Service for Veterans Hospitalized with an Acute Ischemic Stroke or Transient Ischemic Attack – A Comparative Case Study from the Addressing Sleep Apnea Post-Stroke/TIA Hybrid Type I Stepped-Wedge Cluster Randomized Trial

Abstract WP164: Creating an Acute Sleep Medicine Service for Veterans Hospitalized with an Acute Ischemic Stroke or Transient Ischemic Attack – A Comparative Case Study from the Addressing Sleep Apnea Post-Stroke/TIA Hybrid Type I Stepped-Wedge Cluster Randomized Trial

P-1642. The Devil's in the details: Developing metrics for discharge antibiotic stewardship

Abstract Background International Classification of Diseases, Tenth Revision codes (ICD-10s) are commonly used to identify antibiotic indications but may not reflect clinician intent. We investigated concordance of different antibiotic indication sources in the electronic health record (EHR) with clinician intent upon discharge.Figure 1:Indication choices for inpatient antibiotic orders Methods In this quality improvement project, we included prescriptions for patients discharged on oral antibacterials from January 2022-March 2023, including patients with &amp;gt; 1 admission. We excluded those with &amp;gt;90 days duration and those for dapsone or rifaximin. We randomly selected 100 prescriptions and performed manual chart review to obtain the discharge summary antibiotic indications which we categorized into syndromes (Table 1.) We compared discharge indication with other EHR indication sources: last inpatient antibiotic order indication (is required, Figure 1), ICD-10s from separate fields ( “principle”, “encounter”, “billing”) and “composite ICD-10” which included all ICD-10s from any field. We compared each indication source with the associated discharge indication (considered most accurate) and report concordance.Table 1:Syndrome Categories and associated ICD-10 codes Results We included 3,088 prescriptions and excluded 364. Of the 100 encounters reviewed, 62% patients were discharged from medicine services and 46% had a trainee involved in discharge. These encounters were associated with 184 unique ICD-10s and 132 (72%) representing non-infectious diagnoses; the most common infectious diagnosis was skin and soft tissue infections (12 (7%)) (Table 2.) Overall, 37% (30/100) of prescriptions had ICD-10s that were categorized only as non-infectious. Clinicians most commonly intended discharge antibiotics for genitourinary indications (32/108, 30%) (Table 2). Last inpatient antibiotic order indication matched clinician intent in 91% of cases, while composite ICD-10 matched clinician intent in 47% of cases. Any single ICD-10 field (principle, billing, encounter) matched clinician intent in only 1/3 of cases (Table 3.)Table 2:ICD-10 codes and Clinician Intent by Syndrome Data from 100 chart reviews. A total of 184 unique ICD-10 were collected from 100 prescriptions. 8 discharge summaries included two indications. Conclusion Compared to ICD-10s, last inpatient antibiotic order indication more accurately matched clinician intent for antibacterial discharge prescriptions. This may be a useful and simple way to facilitate discharge prescription stewardship.Table 3:Agreement of different indication sources from EHR with ICD-10 code “Composite ICD-10” includes all ICD-10s from “principle”, “encounter”, “billing” fields. And was considered to match clinical intent if any ICD-10 category was concordant with clinical intent. Disclosures All Authors: No reported disclosures

P-1880. An Innovative Infectious Diseases Hospitalist Model - Supporting Lean ID Teams

Abstract Background Two-thirds of the US population live in counties with no or below-average ID physician (ID/P) coverage. This workforce shortage is exacerbated by emerging ID threats and an inadequate fellowship match. In response to these demands, we developed an innovative ID hospitalist (ID/H) model. Subspecialty hospitalists have been increasing since the early 2000s, and ID/Hs may provide support to a stretched ID workforce and mitigate burnout. Methods Setting: Cambridge Health Alliance (CHA) is an academic, community, safety-net healthcare system in Massachusetts with two hospitals and multiple outpatient clinics. It serves &amp;gt;140,000 patients in Boston’s metro-north region. Intervention: CHA’s ID Division is composed of 4 attending physicians (2 FTE total in ID), 1 physician’s assistant (PA), and 1 ID pharmacist. Inpatient consultations are usually performed by 2 ID/Ps (1 at each hospital campus) with partial PA support. During high volume and low staffing weeks from 7/2021 to 4/2023 with only 1 ID/P available, a new staffing model was created. An ID/H provided in-person consultations at one campus (with over-the-phone discussion with the ID/P), while the ID/P provided in-person consultations at the other campus. Outcomes were evaluated via surveys to the ID/Ps, chart review analyzing recommendations, and financial modeling of compensation rates at CHA and locum agencies. Results An ID/H completed 59 clinical encounters during 21 shifts over 9 weeks in the study period. All ID/Ps had high/highest satisfaction working with an ID/H when ranked on a Likert scale. ID/Ps characterized the impact of the ID/H in Table 1. Qualitative themes included an increase in staffing flexibility and timely patient care. There was a high adoption rate of consult recommendations (58/59= 98.3%). The majority of consults were sought by the Medicine service (49/59= 83.1%). ID Consults are characterized in Table 2. This model was cost-effective for department finances compared to utilization of ID moonlighters or locums. Locums are compensated at a much higher hourly rate and due to delays with insurance processing, the institution may not receive reimbursement for their work. Conclusion An ID/H model is a novel way to support lean ID teams. Future research is needed to explore if this will attract more physicians to ID. Disclosures All Authors: No reported disclosures

P-855. Epidemiology and Clinical Pattern of Bacteremia in a Referral Hospital in Nicaragua: a Three Year Cohort Study

Abstract Background In recent years, some institutions have described changes in the epidemiological, microbiological, and clinical profiles of bacteremias. The Dr. Fernando Vélez Paiz Hospital (HFVP) is a teaching and referral hospital in Nicaragua, which opened its services 5 years ago. The aim of this study is to describe and analyze the epidemiological, microbiological, and clinical characteristics as well as risk factors for mortality of patients with bacteremia.Table 1.Medical History in Patients with Bacteremia Methods This is a bidirectional, observational, analytical cohort study. Conducted with 467 patients from the Internal Medicine, Surgery, Orthopedics, Burn Unit, and Intensive Care Unit services of the HFVP who presented bacteremia between January 2021 to December 2023. After filtering the data, the patients included for analysis were 374. Different variables were analyzed, and mortality was analyzed with some factors including SOFA, NEWS2, and Pitt scores.Table 2.Microbiology of Bacteremia in Hospital Dr. Fernando Vélez Paiz Results The mean age of the patients was 50.2 ± 19.9 years, and 63.7% had a comorbidity. The most frequent comorbidities were hypertension (54%), diabetes (45.1%), and chronic kidney disease (15.7%). Most of the patients were from the surgery (31.8%), internal medicine (31.8%), and intensive care unit (28.6%) departments. In the medical history were relevant factors: use of antibiotics in the last 30 days (47.3%), surgery in the last 3 months (40.1%), presence or history of central vascular catheter (38.8%) (Table 1). The most common sites of infection that were documented were respiratory (29.9%), intra-abdominal (27.8%), and urinary (22.5%). At the time of bacteremia, patients had a mean of leukocytes/mm3 of 15,590 ± 9,540, C-reactive protein (mg/L) of 123.0 ± 65.8, and procalcitonin (ng/mL) of 16.6 ± 19.2. The most frequent bacteria were E. coli (17.1%), S. aureus (12.8%), and A. baumannii (9.1%) (Table 2). 62.6% of Gram-negative were multidrug-resistant. Factors associated with mortality were recent steroid use, associated chronic disease, and multidrug-resistance (Table 3). SOFA, NEWS2, and Pitt scores correlated with the probability of survival (Figure 1).Table 3.Risk Factors for Mortality in Patients with Bacteremia. Conclusion This is the first study to characterize bacteremias in Nicaragua, finding independent risk factors for mortality and validating severity scales to predict probability of survival.Figure 1.ROC Curve for SOFA, NEWS2, and PITT Score for Mortality Prediction in Patients with Bacteremia Disclosures All Authors: No reported disclosures

P-1680. Retrospective Review of Adherence to Institutional Pneumonia Antimicrobial Guidelines at Hospital Admission

Abstract Background Literature supports the importance for institutions to have antimicrobial guidance accessible for providers in order to improve patient outcomes and antimicrobial stewardship (AMS). However, guideline adherence when prescribing for community acquired infections tends to be poor and includes more broad-spectrum antibiotics than required. We performed a review to assess adherence to our institutional pneumonia guidelines. Methods A retrospective chart review was conducted on all adult patients admitted to a Medicine or Hospitalist team at WVU Hospitals with an admission diagnosis of community acquired pneumonia (CAP)/pneumonia between January – June 2023. Demographic and clinical characteristics were collected as well as outcomes of interest: empiric antimicrobials and adherence to our institutional pneumonia guidelines. Data was collected and analyzed via WVU REDCap. Results We identified 154 patients with admission diagnosis of CAP to internal medicine services; however, 37 were excluded, as they were transfers from the ICU or outside facilities. Demographics showed 49.4% of the patients were female and median age was 69 years. 30% received antibiotics in preceding 90 days, with 77% of these for prior pneumonia. Identified comorbidities included: COPD (51.5%), Type II Diabetes (31.7%), CHF (43.6%), active malignancy (23.8%) and immunosuppressed (35.6%) (Figure 1). The median Patient Severity Index score was 91 (26-277). Adherence to institutional guidelines was 59% and of those non-adherent, 81% were over treated (Figure 2). Frequency of appropriate antibiotic use included: 24.8% ampicillin/sulbactam, 52.1% doxycycline, 33.3% ceftriaxone, and 12.8% azithromycin. Most common inappropriate antibiotic use included cefepime 28.2% and vancomycin 23.9%. Conclusion At 59% adherence to our pneumonia guidelines, this data shows there is a need for education and increased accessibility to institutional guidelines. Our QI intervention will include educational sessions on AMS guidelines and our CAP order panel, how to access the guidelines (via AMS app or webpage) and placement of guideline links within antibiotic orders. This study will also serve as a basis for assessing empiric treatment of other common infections and adherence to institutional AMS guidelines. Disclosures All Authors: No reported disclosures

P-1376. Impact of COVID-19 and Mpox on Inpatient Screening of STIs

Abstract Background Sexually transmitted infections (STIs) continue to pose a considerable public health challenge, with a notable uptick in STI rates over the last few years. Access to care, both inpatient and outpatient, was disrupted during COVID-19 with a subsequent increase in STIs reported in many areas, followed by additional strain on services with the emergence of Mpox in Oregon. Abbreviations: sexually transmitted infection (STI) STIs include chlamydia, gonorrhea, syphilis, human immunodeficiency virus (HIV), and hepatitis C Methods We conducted a retrospective cohort of hospitalized patients at the Oregon Health &amp; Science University (OHSU) Internal Medicine and Family Medicine services to evaluate STI screening and diagnoses (including chlamydia, gonorrhea, HIV, HCV and syphilis) across distinct periods: pre-COVID-19 pandemic (1/1/2018-2/29/2020), during the COVID-19 pandemic (3/1/2020-7/31/2022), and amidst the Mpox surge (8/1/2022-3/1/2023). We calculated the proportion screened, percent positivity by time and compared proportions between our pre-designated periods using the two-sample test of equal proportions. Results During the study period, 5802 patients were admitted to OHSU. Most were White (4705, 81.1%), non-Hispanic (5308, 91.5%) and Female sex (3600, 62.1%). In total, 2151 (37%) were screened for one or more STIs. HIV and syphilis were the most frequently screened STIs at 15.0% and 33.1%. The highest proportion of STI screenings were among those 25-44 years at 40.9% with the highest percent positivity in those 55-64 years at 34.0%. There was a statistically significant increase in proportion screened for all STIs (see Table 2), along with percent positivity for syphilis (P&amp;lt;0.01) between pre-COVID-19 and COVID-19 period, however this trend did not consistently continue after emergence of Mpox. Conclusion The proportion of inpatient STI screening is low for patients admitted to internal medicine and family medicine services with percent positivity by age ranging from 5.9-34.0%. We observed an overall increase in proportion screened during the COVID-19 period. Disclosures All Authors: No reported disclosures

P-1753. Impact of a Microbiology Reporting Change on Treatment Selection and Clinical Outcomes for Organisms at Low-Risk for Significant AmpC Production

Abstract Background AmpC β-lactamase production can be induced after exposure to beta lactam antimicrobials, most notably ceftriaxone (CRO), leading to development of resistance on therapy. New guidance from IDSA indicates that the risk of AmpC enzyme production is not equal among all Enterobacterales and those deemed low-risk may be treated with CRO. The purpose of this study was to evaluate the impact of a microbiology reporting change made in collaboration with our antimicrobial stewardship program (ASP) to guide antibiotic selection for low-risk AmpC organisms. Methods This was a pre-test, post-test quasi-experimental study with data collected by chart review. A microbiology comment warning against the potential for inducible resistance on therapy with CRO was present pre-test and was removed in the post-test period. A didactic education session was given by ASP to medicine services. The study enrolled hospitalized patients ≥1 month old treated for infection with a low-risk AmpC organism (Serratia marcescens, Morganella morganii, Proteus vulgaris, and Providencia spp.) pre- (3/21-2/22) and post-intervention (8/22-7/23). Further inclusion and exclusion criteria are in table 1. The primary outcome was rate of carbapenem-sparing definitive treatment. Secondary outcomes were rate of CRO definitive therapy along with 30-day readmission, retreatment, mortality, and development of CRO resistance. Results 73 patients were included: 36 (49%) pre- and 37 (51%) post-intervention. Patient, infection, and treatment characteristics are described in table 2.Serratia marcescens was the most common organism isolated with the most frequent sources being respiratory and urinary. There was no significant difference in the rate of carbapenem-sparing therapy between the pre- (83%) and post-(81%) intervention, p=0.59. No difference was found in CRO as definitive therapy in either group (25% vs. 33%, p=0.49) as well. No difference was seen in secondary clinical outcomes (table 3). For those with repeat positive cultures within 30 days, none developed CRO resistance. Conclusion The combination of changing microbiology reporting and a single ASP education session did not change antibiotic selection for low-risk AmpC producing organisms. Despite updated guidance the uptake in practice is slow. Disclosures All Authors: No reported disclosures

Improving Quality of Care for Neonatal Hyperbilirubinemia Admissions After Birth Hospitalization.

Infants with neonatal hyperbilirubinemia (NH) often require admission after their birth hospitalization for treatment with phototherapy. Our aim was to align local practice with updated national guidelines to promote efficiency and decrease length of stay (LOS) for this patient population by ∼ 10% over a 15-month period using quality improvement methodology. Our improvement initiative included infants younger than age 14 days born at more than 35 weeks' gestation admitted to the hospital medicine service with an NH diagnosis. Baseline data were collected from November 2021 to December 2022. A current state analysis highlighted targets for interventions. Interventions included aligning the local practice pathway with 2022 American Academy of Pediatrics guidelines for NH, adding additional phototherapy lights, and leveraging the electronic health record to improve inter-provider communication over 3 Plan-Do-Study-Act (PDSA) cycles between January 2023 and March 2024. Statistical process control was used for analysis. There were 130 patients included during the 15-month intervention period. After 3 PDSA cycles, there was no special cause variation in the primary outcome measure, LOS. There was special cause variation in the primary process measure, total serum bilirubin at discharge. Readmissions for phototherapy, tracked as a balancing measure, did not change during the study period. Successive interventions aimed at optimizing efficiency during NH admissions did not result in decreased LOS. It can be challenging to use LOS as an outcome measure given the influence of various systemic factors that may not be controlled or reasonably changed.

Parameters for Validating a Spectrometric System with Itinerant NaI(Tl) in the Ativimeter’s Calibration

In radiopharmaceutical production centers and nuclear medicine services, short half-life radionuclides are essential. They have been used as radiotracers since their use increased significantly and aroused the interest of national metrology laboratories, which are responsible for providing traceability to radioactive standards. Therefore, knowledge of the activity of administered radiopharmaceuticals must be obtained accurately. However, their short half-lives prevent the provision of traceability. To overcome these obstacles, an itinerant system based on a NaI(Tl)-type scintillator detector is being developed at the National Laboratory for Ionizing Radiation Metrology (LNMRI). This work aims to show the schematic arrangement of the system developed to calibrate activimeters, as well as the tests and experimental comparisons carried out in this study using performance indicator parameters to characterize and validate the itinerant NaI(Tl) detection system in the calibration of activimeters.

Challenges and improvement strategies in the hospitalization of chronic multimorbid patients

BACKGROUND Addressing the growing challenge of hospitalizing chronic multimorbid patients, this study examines the strain these conditions impose on healthcare systems at a local level, focusing on a pilot program. Chronic diseases and complex patients require comprehensive management strategies to reduce healthcare burdens and improve patient outcomes. If proven effective, this pilot model has the potential to be replicated in other healthcare settings to enhance the management of chronic multimorbid patients. AIM To evaluate the effectiveness of the high complexity unit (HCU) in managing chronic multimorbid patients through a multidisciplinary care model and to compare it with standard hospital care. METHODS The study employed a descriptive longitudinal approach, analyzing data from the Basic Minimum Data Set (BMDS) to compare hospitalization variables among the HCU, the Internal Medicine Service, and other services at Antequera Hospital throughout 2022. The HCU, designed for patients with complex chronic conditions, integrates a patient-centered model emphasizing multidisciplinary care and continuity post-discharge. RESULTS The study employed a descriptive longitudinal approach, analyzing data from the BMDS to compare hospitalization variables among the HCU, the Internal Medicine Service, and other services at Antequera Hospital throughout 2022. The HCU, designed for patients with complex chronic conditions, integrates a patient-centered model emphasizing multidisciplinary care and continuity post-discharge. CONCLUSION This study demonstrates the effectiveness of the HCU in managing patients with complex chronic diseases through a multidisciplinary approach. The coordinated care provided by the HCU results in improved patient outcomes, reduced unnecessary hospitalizations, and better management of patient complexity. The superiority of the HCU compared to standard care is evident in key outcomes such as fewer readmissions and higher patient satisfaction, reinforcing its value as a model of care to be replicated.

Immunotherapy-Related Adverse Events and Clinical Outcomes in Adult Solid-Tumor Patients Admitted to an Onco-Hospitalist Medicine Service

Background/Objectives: Few studies have focused on patients with immune-related adverse events (irAEs) after immune checkpoint inhibitor (ICI) treatment who were cared for primarily by hospitalists. The objective of our study was to describe the patterns and outcomes of adult solid-tumor cancer patients admitted to our onco-hospital medicine service. Methods: We retrospectively reviewed patients with solid tumors who received ICIs and were admitted to our service in 2021–2022 with an irAE and compared them to a control group (IOTOX vs. NO IOTOX, respectively). The primary outcome was the patterns of irAEs requiring hospitalization; secondary outcomes included 30-day emergency room visit, readmission, and 30-day mortality. Results: There were 144 patients in the IOTOX group and 286 controls. The most common tumor type was lung and thoracic malignancies (62, 43.1%). The most common ICI causing the irAEs was pembrolizumab (66, 45.8%). The most common irAEs were pneumonitis (49, 34%), colitis (28, 19.4%), hepatitis (18, 12.5%), and myocarditis (16, 11.1%). Of the 144 patients, eight (6%) died from the hospitalization irAE. Fifteen (15.6%) had an ER visit within 30 days due to the same irAE, and thirteen (13.7%) were readmitted. Survival at 30 days after discharge did not differ significantly between groups. Conclusions: Despite many patients having severe irAEs and irAEs associated with higher mortality, they generally had a favorable outcome compared to the literature.

Pharmacist-Directed Transition of Care Services Decrease Readmissions at a Safety-Net Hospital.

Limited data exist describing the influence of pharmacist-led transition of care (TOC) services in safety-net hospital settings. This analysis assessed the impact of pharmacist-led TOC services on hospital readmissions in a high-risk managed Medicaid population impacted by housing instability, substance use disorder (SUD), and mental health issues. A retrospective evaluation of patients who received safety-net hospital-based TOC pharmacy services between January 1, 2022, and December 31, 2022, was conducted. Patients 18 years and older, insured by a select managed Medicaid plan, and admitted to an inpatient medicine service were included. Patients were excluded if they were admitted from or discharged to a facility or hospice, discharged before medically ready, or died within 30 days of discharge. Interventions included an initial visit, discharge medication delivery and education, and a post-discharge follow-up phone call within 24 to 72 hours. Patients were provided with a number to call for medication-related questions post-discharge. The primary outcome was 30-day hospital readmissions. Secondary outcomes included time to and reason for readmission and a description of TOC services. There were 292 patients engaged in pharmacist-led TOC services. Nearly 1 in 6 patients were experiencing homelessness and almost 40% were struggling with SUD during the index admission. The median readmission performance in the target population 6 months prior to TOC service implementation was 20.2% and fell to 12.3% post-intervention. Substance use disorder was the leading contributor to re-hospitalization, accounting for 58% of readmissions. Six (16.7%) readmissions were medication-related; 5 of 6 were complicated by SUD. There were no preventable medication-related readmissions. There are limitations to this study; not all patients received all TOC program components. Prospective, randomized-controlled studies are needed to show cause and effect. This evaluation suggests pharmacist-led TOC discharge services may lead to hospital readmission reduction in a socially complex managed Medicaid population in a safety-net hospital setting.

Approaches to Incorporation of Preferences into Health Economic Models of Genomic Medicine: A Critical Interpretive Synthesis and Conceptual Framework.

Genomic medicine has features that make it preference sensitive and amenable to model-based health economic evaluation. Preferences of patients, caregivers, and clinicians related to the uptake and delivery of genomic medicine technologies and services that are not captured in health state utility weights can affect the intervention's cost-effectiveness and budget impact. However, there is currently no established or agreed-on approach for integrating preference information into economic evaluations. The objective of this study was to explore approaches for incorporating preferences into model-based economic evaluations of genomic medicine and to develop a conceptual framework to consider preferences in health economic models. We conducted a critical interpretive synthesis of published literature guided by the following question: how have preferences been incorporated into model-based economic evaluations of genomic medicine interventions? We integrated findings from the literature and expert opinion to develop a conceptual framework of ways in which preferences influence economic value in the context of genomic medicine. Our synthesis included 14 articles. Revealed and stated preference data were used to estimate choice probabilities and to value outcomes. Our conceptual framework situates preference data in the context of health system, patient, clinician, and family characteristics. Preference data were sourced from clinicians, patients and families impacted by a condition or intervention, and the general public. Evaluations employed various types of models, including discrete event simulation, microsimulation, Markov, and decision tree models. When evaluating the broad benefits and costs of implementing new interventions, sufficiently accounting for preferences in the form of model inputs and valuation of outcomes in economic evaluations is important to avoid biased implementation decisions. Incorporation of preference data may improve alignment between predicted and real-world uptake and more accurately estimate welfare impacts, and this study provides critical insights to support researchers who seek to incorporate preference information into model-based health economic evaluations.

Evidence and methods to assess preparedness among non-staff units of the Disaster Medicine Service of the Ministry of Defense of Russian Federation deployed in emergencies to eliminate emergency medical and sanitary consequences

Relevance. In Russia, emergency protection efforts by various ministries are guided by the relevant legal regulation based on the Integral National System for Emergency Prevention and Elimination. Its functionality relies on joint cross-departmental capacities to ensure national protection of the population and land from emergencies. Medical capacities are not an exception in this respect. The Medical Service of the Russian Armed Forces manages substantial resources to fulfill this goal. The Disaster Medicine Service of the Russian Defense Ministry was therefore established both as functional subunit of the Russian Armed Forces for emergency prevention and elimination and a critical link within the Russian National Disaster Medicine Service. To maintain the required level of preparedness, further studies regarding the performance of medical units within the Disaster Medicine Service is critically required.The study objective is to investigate the professional capacities among the military medical and civilian professionals employed by central and regional military medical organizations of the Defense Ministry, who are also non-staff members of the Disaster Medicine Service; to identify practical challenges in performing duties and assess the overall preparedness.Methods. This study is based on a survey among military medical and civilian professionals employed by central (n = 81) and regional (n = 146) military medical organizations of the Defense Ministry who are also non-staff members of the Disaster Medicine Service. The survey obtained data regarding the responders’ professional status, duties within non-staff teams, and demographic parameters. Mean and median values, including with upper and lower quartile are reported in the paper.Results and analysis. The study results show that the average age of among medical professionals among non-staff teams of central military medical organizations of the Russian Defense Ministry is 38.8 [6; 17] years and 38.2 [7; 14] years for those employed by regional medical organizations. In central military medical organizations, most medical teams are represented by therapists (25.9 %), followed by thoracic and abdominal surgery (17.3 %), and general surgery (13.6 %); whereas at the regional level teams comprising doctors and nurses prevail (54.8 %), followed by intensivists and general surgeons (9.6 % each), and therapists (8.2 %). Non-staff units of the Disaster Medicine Service of the Defense Ministry, operating within central military medical organizations include more subspecialty teams; on the contrary, regional non-staff units have broad and general specialties. Notably, military medical and civilian professionals employed by central military medical organizations provided emergency primary health care in 61.7 % of cases, whereas specialized medical care, including high-tech medical care was provided in 34.6 % of cases. Military medical and civilian professionals employed by regional military medical organizations provided emergency primary health care in 37.7 % of cases, and specialized medical care, including high-tech medical care in11.6 % of cases. The survey confirmed that while performing their duties, military medical and civilian professionals who were members of the non-staff teams were challenged by the following most significant factors: the level of specialized training, number and quality of staff in the teams, as well as compliance with the regulatory and legal requirements to medical activities performed within the efforts to eliminate medical and sanitary consequences of emergencies. This data allowed to develop relevant parameters and measurements to assess preparedness among the non-staff teams to perform their dutiesConclusion. Professional capacities among the military medical and civilian professionals employed by central and regional military medical organizations of the Defense Ministry, who are also non-staff members of the Disaster Medicine Service was investigated, with the most significant challenges affecting their performance identified. Preparedness was assessed among the non-staff teams of the Disaster Medicine Service of the Russian Defense Ministry in central and regional military medical organizations.

Factors Associated with the Use of Complementary and Alternative Medicine in Rural Northern Victoria, Australia.

About one-third of Australians use the services of complementary and alternative medicine (CAM); but debate about the role of CAM in public healthcare is vociferous. Despite this, the mechanisms driving CAM healthcare choices are not well understood, especially in rural Australia. From 2016 to 2018, 2,679 persons from the Goulburn Valley, northern Victoria, were surveyed, 28% (755) of whom reporting visiting CAM practitioners. A Generalized Linear Mixed Model was used to assess associations between various socio-demographic variables and the use of CAM services. The strongest significant inverse (p < 0.05) association with CAM use overall was being unemployed, with markedly lower odds of using CAM than those employed full-time (OR 0.22 [0.12, 0.41]). The next strongest inverse relationship was being retired (OR 0.44 [0.30, 0.65]). The strongest positive associations were with English spoken at home (OR 2.38 [1.34, 4.24]), private health insurance (hospital cover) (1.57 [1.28, 1.91]), being Australian born (OR 1.61 [1.14, 2.28]), and female sex (1.25 [1.02, 1.52])). Females had significantly higher odds of using osteopathy than males (OR 1.98 [1.33, 2.96]) but there were no significant sex differences for chiropractic or massage. This is the first such study conducted solely for a rural Australian population. The drivers of CAM use differed from previous nation-wide studies and they varied across modalities. The factors identified here as being associated with CAM use could be used by CAM practitioners in developing person-centred services. Similarly, the findings are relevant to primary-care services in understanding what sectors of society might eschew conventional health care for CAM in rural regions, where health services are often limited.

Sleep Quality Among Patients and Healthcare Providers in the Primary Healthcare Setting.

Background/Objectives: As adults spend about 30% of each day asleep, having a sleep disorder can negatively affect their functioning. The study objective was to determine the factors that influence sleep quality among patients and healthcare providers in the primary healthcare setting. Methods: This study included respondents of both sexes aged 18-90 years, comprising outpatients and the healthcare providers working in the General Medicine Service at the "Liman" Department of the "Novi Sad" Health Center in Novi Sad, Republic of Serbia. Demographic data along with factors related to lifestyle and sleep habits were collected using a demographic questionnaire specifically designed for this research. The standardized Pittsburgh Sleep Quality Questionnaire, Serbian version (PSQI), was used to assess sleep quality. Results: The study sample comprised 92 respondents (42 healthcare providers and 50 patients), 73.9% of whom were female, with an average age of 50.0 years. Although 50% of healthcare providers reported sleeping only 3-6 h the previous night, according to the PSQI results, patients had lower overall sleep quality (54.0% vs. 33.3%; p = 0.046) and achieved lower scores in the DISTB (sleep disturbances, p = 0.001), SLPQUAL (subjective sleep quality, p = 0.013) and MEDS (use of sleeping medication, p = 0.003) PSQI domains. Conclusions: Sleep quality is impaired in more than half of patients and more than a third of healthcare providers. By detecting and acting on the factors in the home and work environment that affect quality of sleep, and by changing lifestyle habits, sleep quality in adults can be improved.

Determinants of traditional Korean medicine utilization by individuals with physical disabilities: inference of causal relationships using Korea health panel data

BackgroundThe demand for health management services has grown among individuals with physical disabilities. It is noteworthy that a significant proportion of this demographic has sought the services of traditional Korean medicine (TKM). Nevertheless, there is a lack of research on the characteristics of TKM utilization within this population. Therefore, this study aims to explore the characteristics of individuals with physical disabilities who utilize TKM services, to support future policy development in TKM for enhancing the health and quality of life for individuals with physical disabilities.MethodsThe study utilized a dataset from the Korea Health Panel (KHP) version 1.7, from the years 2008 to 2018. A panel analysis was conducted to analyze the correlation between the characteristics of participants and their influence of the TKM utilization.ResultsBased on the panel logistic regression analysis, the probability of TKM utilization was higher for individuals with physical disabilities who were female (p < 0.001), had a chronic musculoskeletal disorder (p < 0.001), Charlson Comorbidity Index of 1 (p = 0.025), and multiple chronic conditions (p = 0.025). Based on the panel hybrid regression analysis, those covered with Medical Aid spent less on TKM than those covered with National Health Insurance (p < 0.001), while those who were female (p < 0.001), had chronic musculoskeletal disorders (p = 0.007), or multiple chronic conditions (p = 0.007) had higher medical expenses for TKM utilization.ConclusionsIndividuals with physical disabilities accompanying nonfatal chronic musculoskeletal disorders or other chronic conditions frequently utilized TKM services. Those covered by Medical Aid spent less on TKM, while females and individuals with chronic musculoskeletal disorders or multiple chronic conditions incurred higher medical expenses for TKM. These results suggest the need for targeted interventions and policy changes to improve TKM access and address financial burdens for people with disabilities.

An Inquiry into the Health Principles and Their Uses Made by the Ancients for Social Compassion (Based on Rajarata Civilization)

Since ancient times, health has been given priority among humans. This research aims to identify the health policies made by the ancients during the Rajarata civilization period. The research problem here is how the developed health policies were used for social solidarity and what is their utility. The historical research method was used as the research method here. Sourced facts confirm that the ancient Sri Lankan people also thought of health as an absolute profit. If the health system is of high quality, it is an indication that society at that time acted with compassion. Traditional folk beliefs also prevailed among the people at this time. Accordingly, the ancients strongly believed that diseases are caused by angering the forces called Va-Pit-Sem and other beliefs. It is a mandatory factor to have medical facilities in a state in case of emergencies such as epidemics, pneumonia and war. Therefore, based on these factors, the ancients worked to support the government in making health policies and to raise the health sector. It is stated in the Mahavamsa that ancient medicine was concerned with medical services such as various methods of treatment, style medicine, psychological treatment etc. According to the Mahavamsa, King Dutugemunu has fondly remembered the medical facilities he provided for the public as one of the highest services he did at the time of his death. King Buddhadasa played a special role in the ancient medicine service. The king, who worked with great kindness and compassion to cure the sufferings of his people by performing the affairs of the state well, was a physical and mental doctor who understood it well. During the Polonnaruwa era, King Maha Parakramabahu showed special interest in improving the health of the country's inhabitants. In the continuous history of several centuries, the implementation of the state policies applied by the rulers of the Rajarata Civilization period also on health shows the nature of formal governance. It can also be recognized that Sri Lankan society is not only concerned with public health but also with compassion towards animals and implemented those health policies.