Tertiary Care Level Research Articles

Evaluating the Utility of Initial Exams in Retinopathy of Prematurity: Proposal of FIRST-ROP Algorithm for a Medium-Risk Cohort.

To assess the utility of the first or second examinations for retinopathy of prematurity (ROP) in a medium-risk cohort of infants and to propose an optimization to the current ROP screening guidelines. Retrospective consecutive study. Infants screened for ROP between January 2017 and August 2023 at three different tertiary-level care neonatal intensive care units. The analysis focused on patients who did not meet criteria for micro or nanoprematurity (those born at ≥27 weeks and weighing ≥800 grams). The primary outcomes included the rates of ROP and treatment-warranted ROP (TW-ROP), the presence of TW-ROP at the first or second inpatient examinations, the number of inpatient examinations performed before the first ROP diagnosis, and the overall number of inpatient examinations performed. A total of 2,004 neonates were screened for ROP, of which 1,125 (56.1%) met the inclusion criteria. Of those patients, 237 (21.1%) had ROP. Eleven infants (1.0%) required treatment for active disease. The median postmenstrual age (PMA) at first ROP diagnosis was 35.3 weeks (IQR, 33.7-37 weeks; range, 30.3-46.7 weeks). The median PMA at stage 3 diagnosis was 39.3 weeks (IQR, 38.3-41.2 weeks; range, 35.1-44.4 weeks). The median PMA at first treatment was 39.6 weeks (IQR, 35.8-43.3 weeks; range, 35.3-49.6 weeks). The median number of inpatient examinations was 2.0 (IQR, 1-4 exams) for traditional screening, 1.0 (IQR, 1-3) after eliminating the first ROP inpatient examination, and 1.0 (IQR, 1-2) after eliminating the first and second ROP examinations (p<0.001). No patients were diagnosed with stage ≥3 nor met type 1 ROP treatment criteria at the first or second inpatient examination (100% sensitivity for TW-ROP). In this cohort, starting exams at 34 weeks PMA would be estimated to save 30.6% of the inpatient examinations. In infants not meeting criteria for micro and/or nanoprematurity, there was no type 1 ROP at either of the first two inpatient examinations. We propose an amendment algorithm (FIRST-ROP) in which ROP exams start at 34 weeks PMA for neonates born at ≥27 weeks gestational age and ≥800 grams.

Antibiotic consumption and utilization at a large tertiary care level hospital in Uganda: A point prevalence survey.

Effective antimicrobial stewardship programs require data on antimicrobial consumption (AMC) and utilization (AMU) to guide interventions. However, such data is often scarce in low-resource settings. We describe the consumption and utilization of antibiotics at a large tertiary-level hospital in Uganda. In this cross-sectional study at Kiruddu National Referral Hospital, we analyzed medicine delivery records for the period July 2021 to June 2022, accessed on 12/08/2022, to extract AMC data expressed as defined daily doses (DDDs) per 1000 inhabitants per day (DID). We used the WHO point prevalence survey (PPS) to analyze AMU data with a systematic sampling of outpatient department (OPD) for a period between June and August 2022 and selected all inpatient department (IPD) patients admitted before 8:00 AM on 27/11/2022. AMU data was analyzed as the proportion of individual antibiotic prescriptions, indications for prescriptions, and compliance with the national treatment guidelines. Both AMC and AMU data were categorized by the WHO AWaRe (access, watch, and reserve) criteria. In the year 2021-2022, a total of 6.05 DID of antibiotics were consumed comprising 3.61 DID (59.6%) access, 2.44 DID (40.3%) watch, and 0.003 (0.1%) reserve antibiotics. The most consumed antibiotics comprised penicillin (1.61 DID, 26.7%), cephalosporins (1.51, 25%), and imidazole (1.10 DID, 18.1%). A total of 119/211 (56%) patients in the OPD and 99/172 (57.5%) patients in the IPD were prescribed antibiotics. Of the 158 OPD antibiotic prescriptions, 73 (46.2%) were access, 72 (45.6%) were watch, 0 (0%) were reserve, and 13 (8.2%) were unclassified antibiotics. Of the 162 IPD antibiotic prescriptions, 62 (38.3%) were access, 88 (54.3%) were watch, 01 (0.6%) was reserve, and 11 (6.8%) were unclassified antibiotics. Indications for antibiotic prescriptions in the OPD comprised respiratory tract infections (53, 38.1%), urinary tract infections (34, 26.6%), gastrointestinal infections (20, 14.4%), sepsis (17, 12.2%), and medical prophylaxis (12, 8.7%). The indications for antibiotic prescriptions in the IPD comprised sepsis (28.2%), respiratory tract infections (18.3%), burn wounds (14.1%), and gastrointestinal infections (14.1%). Prescription of watch antibiotics in both OPD and IPD hospital settings was high. Establishment of robust antimicrobial stewardship measures could help improve the rational prescription of antibiotics.

Child Maltreatment Data After Implementation of Hospital-Wide Protocol and Utilization of Sexual Assault Forensic Examiners for Child Maltreatment Cases.

Child maltreatment is a significant global health concern with significant morbidity and mortality. Sexual assault forensic examiners (SAFEs) provide a valuable skill set and may be utilized in child maltreatment evaluations. The purpose of the study was to describe patient characteristics and trends after implementation of a hospital-wide standardized child maltreatment protocol including forensic examiners in child maltreatment cases. Data from January 2017 through December 2022 were retrospectively collected and reviewed on all children under 18 years old who had a child maltreatment evaluation after initiation of a standardized child maltreatment screening process and protocol incorporating SAFE forensic evaluations at a tertiary care Level 1 trauma center. From January 2017 through December 2022, there were 764 child maltreatment evaluations of 742 total patients completed, with 763 (99.9%) evaluations completed by a trained SAFE. There were 378 examinations (49%) completed in children under 2 years old, 281 (37%) in children 2 years old until the 10th birthday, and the remaining 105 (14%) in children 10 years and older. The overall number of cases increased since the initiation of standardized screening and protocol from 68 cases in 2017 to 158 cases in 2022, with peak of 167 cases in 2020. SAFE-trained providers can be successfully incorporated in the multidisciplinary evaluation of child maltreatment patients and can add invaluable education, forensic documentation, and standardization of practice in the care of this vulnerable population.

Antimicrobial stewardship leads from inpatient point prevalence surveillance of a tertiary-level care hospital

Antimicrobial stewardship leads from inpatient point prevalence surveillance of a tertiary-level care hospital

Birth defects reporting and surveillance in India: a narrative review.

Mortality attributable to birth defects (congenital anomalies, congenital disorders) is increasing in low and middle-income countries, including India. Surveillance is essential to inform strategies to address these disorders. The objective of this narrative review was to document the birth defects surveillance/reporting systems in India, their current status, structures and reporting formats. The review used empirical analysis of retrieved literature to answer the framed research questions. Publications on birth defects surveillance in India was negligible. Website searches yielded information on two surveillance systems. The WHO South East Asia Region-Newborn-Birth Defects (SEAR-NBBD) surveillance for congenital disorders uses a non-representative sample of hospitals to conduct passive surveillance for eight congenital anomalies. The system has a hierarchy of quality control measures to assure data accuracy. The second system is a child screening and early intervention service (the Rashtriya Bal Swasthya Karyakram, RBSK), which reports data on nine birth defects among children screened at birth, in the first six weeks of life, and till 18 years of age. The RBSK uses existing community-based staff and competency-appropriate screening tools that incorporate defined referral routes to secondary or tertiary level of care. Data from neither of these systems is available in the public domain. The review identified that the strengths and weaknesses of both these systems can be utilized to put in place a potentially sustainable sentinel surveillance for monitoring birth defects in India.

CUIDADOS PALIATIVOS NA ATENÇÃO PRIMÁRIA: REFLEXÕES TEÓRICO-PRÁTICAS

The study aims to know the interface between palliative care and primary health care. A theoretical-reflective study was carried out based on the concepts of continuing education and health promotion. Articles retrieved through the secondary databases Virtual Health Library (VHL), Latin American and Caribbean Literature in Health Sciences (LILACS), Scientific Electronic Library Online (Scielo) and Online System for Search and Analysis of Medical Literature (MEDLINE) were analyzed based on the specific descriptors retrieved through the health sciences descriptors. Studies published in Portuguese, English or Spanish and that dealt directly with the theme under study were considered. Palliative care is a real requirement in the face of the epidemiological transition of society and the technological advances that have made it possible to increase the life expectancy of individuals, in this sense, there is no possibility that only the tertiary level of health care is responsible for palliative care, thus, primary care must assume its role as an organizer of the health system, above all, considering the attributes of territoriality, first contact, longitudinality and comprehensiveness of care; It is urgent to transform the training of health professionals so that people can face finitude in a less aggravated way.

The Impact of Thoracic Trauma on Morbidity and Outcomes: A Six-Year Experience From a Tertiary Care Level 1 Center.

The study aimed to summarize the impact of thoracic injury on mortality and morbidity in thoracic trauma patients. This is a retrospective observational study of all patients with thoracic injuries admitted between July 2018 and June 2024. The demographic profile, mechanism of injury, type of injury, injury severity score, duration of injury, hemodynamic status, surgical findings, concomitant injuries, hospitalization, intensive care unit stay, need for mechanical ventilation, and blood transfusions were recorded. A total of 1,576 patients were admitted with thoracic injuries, representing 27.4% of all trauma admissions. The most common mechanism of injury was blunt chest trauma, which was found in 1,377 patients (87.4%). Of these 1,576 patients, 1,308 (83%) were hemodynamically stable, while 268 (17%) were unstable. The majority of patients were not treated surgically. The overall mortality was 119 (7.5%). Age, number of rib fractures, time interval to admission, and need for mechanical ventilation were found to be significantly related to mortality. The mortality rate for thoracic injuries depends on several factors, including age, late-onset, bilateral thoracic injuries, concomitant extrathoracic injuries, need for mechanical ventilation, and adequate pain management.

A "silent storm": uncovering the escalating crisis in mental healthcare for children and adolescents in Slovenia during and after the COVID-19 pandemic.

Our aim was to assess the burden of children and adolescents' mental health problems on the Slovenian outpatient healthcare system before, during and after the pandemic. In a retrospective analysis of healthcare indicators from 2008 to 2023, we analysed data from the National Institute of Public Health. Key domains included initial visits for mental and behavioural disorders (MBDs) to primary care for the population aged 0-19; the number of referrals to an initial assessment with a child and adolescent psychiatrist (CAP) at the secondary level for the population aged 0-17 along with the corresponding waiting times; and the number of urgent referrals for the population aged 0-17 to emergency mental health centres at the tertiary level. The calculations included rates per 1000 people. Descriptive statistics and diagrams were used to compare the data. Segmented linear regression analysis (SLR) was conducted on the primary healthcare data to identify the distinct temporal point indicating an increase. Comparing the average rates of the 2020-2022 period to those of the 2018-2019 period, there was a 20% increase in initial visits to primary care, a 23% increase in the referral rate to a CAP at the secondary level, and a 41% increase to the tertiary level of care. In secondary care, a four- to sevenfold increase in waiting times for the initial CAP assessment was observed between 2019 and 2023. The incidence of initial visits to primary healthcare services for MBD increased from 2008 to 2019 (average annual growth rate of 4.5%). The average annual growth rate for the 2020-2022 period tripled to 13.9%. The SLR showed that the trend of accelerating growth could have begun in 2017 for the 0-5 age group and possibly for the 15-19 age group as well. After the initial decline in 2020, all levels of the Slovenian healthcare system faced an increased burden of MBD in children and adolescents from 2021 to 2022 compared to pre-pandemic levels. Nevertheless, a portion of this increase aligns with longitudinal growing trends from 2008 onwards. Tackling the crisis requires urgent national action, significant improvement in organization, and investments in mental health.

A Prospective study on Impact of Nutritional Counseling for Maintenance Hemodialysis patients

Background: Patients with End-Stage Kidney Disease (ESKD) have complex medication regimens and specific food recommendations. Dietary restrictions and medication burden places dialysis patients at risk for drug-disease, food-disease, drug-food and drug-drug interactions and more. Ideal nutritional practices are challenging in maintenance hemodialysis (HD) patients, yet it has been found to be crucial in obtaining positive clinical and health outcomes. This study was to evaluate the impact of counseling by a clinical pharmacy researcher on ideal dietary practices and assess the food-drug and drug-drug interactions within this patient population. Methods: The study was a pre-post intervention design that included patients undergoing maintenance hemodialysis in a United Arab Emirates tertiary-level care hospital. The study adopted a population-based approach and involved counseling conducted by a clinical pharmacy researcher with the help of nutritionist in the study site. Data was processed using SPSS version 26 for descriptive analysis. Results: Data of 47 participants were analyzed. A significant improvement in ideal dietary practices were reported by the study participants after counseling compared to their practices before counseling (P 0.001). Food-drug interactions were significantly higher than drug-drug interactions and a significant association between food-drug interactions and malnutrition symptoms were found (P 0.001). Conclusion: Nutritional counseling to maintenance HD patients by a pharmacy professional improved patient reported ideal nutritional/dietary behaviors. This illustrates the importance of clinical pharmacy reinforcement to nutritionist services for patient care. Pharmacy professionals can integrate drug counseling with nutritional counseling in addition to nutritionist counseling.

Variation among venous thromboembolism risk assessment tools for postcesarean patients: a retrospective cohort study.

Venous thromboembolism (VTE) risk in pregnant women is four to five-fold higher than in nonpregnant women, and the risk of VTE is an additional four-fold higher after Cesarean section compared to normal vaginal delivery. Recommendations regarding anticoagulant prophylaxis are inconsistent across international guidelines, and VTE remains one of the leading causes of maternal morbidity and mortality. This study aimed to compare the need for postcesarean anticoagulation for VTE prophylaxis based on three major guidelines and our own institutional protocol. It was a retrospective cohort study that reviewed the medical records of patients who underwent a cesarean section at a tertiary-level care hospital in the United Arab Emirates (UAE). The need for anticoagulation was assessed using clinical tools from the American College of Obstetricians and Gynecologists (ACOG), Royal College Obstetricians and Gynecologists (RCOG), American College of Chest Physicians (ACCP), and the study site hospital protocol. A total of 1134 postcesarean women, aged 18-55 years, were included in the study. Most patients (87%) were at moderate risk for VTE. According to the study site hospital tool, 90.7% qualified for anticoagulant prophylaxis, while the ACOG, RCOG, and ACCP tools indicated that 0.5, 90.9, and 36.7% qualified, respectively. Enoxaparin was the primary anticoagulant used in 95% of cases. Only one patient developed VTE during the follow-up period. Anticoagulation needs assessment tools vary extensively in their estimations, highlighting the need for a uniform tool across multiple societies to establish a consistent standard of care and guide the development of evidence-based, site-specific protocols.

A-039 Parathyroid Hormone and Vitamin D Follow an Inversely Correlated Serum Level

Abstract Background Parathyroid hormone (PTH) is a polypeptide responsible for regulating the physiological level of serum calcium through a complex homeostatic process closely associated with bone metabolism. In response to a decreased serum concentration of calcium, PTH level is increased leading to the elevation of calcium via bone resorption. Furthermore, Vitamin D (Vit-D) is a critical component of the endocrine system that also contributes to calcium homeostasis. Vit-D increases the level of serum calcium by stimulating intestinal absorption and renal reabsorption. Vit-D impacts the serum level of PTH by two distinct mechanisms. First indirectly, an increase in serum concentration of calcium, caused by Vit-D-mediated intestinal absorption and renal reabsorption disengages the process of PTH release through interaction with calcium-sensing receptors on parathyroid cells. Secondly, Vit-D directly interacts with parathyroid cells resulting in a reduced expression of PTH. Taken together, Vit-D is assumed to negatively impact the serum level of PTH. This study examined the homeostatic correlation between the circulating concentrations of Vit-D and PTH. Methods Retrospective serum concentrations of PTH and Vit-D were retrieved from the biochemical profiles of hospitalized and ambulatory patients who presented to or admitted at the tertiary care level hospital of University of Texas Southwestern Medical Center during the period between July-to-September of 2021. Correlation analysis between Vit-D and PTH was performed using GraphPad-PRISM-version-8. Results A total of 163 corresponding serum Vit-D and PTH values were obtained. Vit-D and PTH values displayed an inverse correlation (Figure 1). Pearson r values for linear and logarithmic trendlines (-0.6745 and -0.785, respectively) demonstrated a negative correlation between Vit-D and PTH. Conclusions Measuring Vit-D and PTH levels are critically important for assessing the homeostatic status of calcium. PTH level maintains an inverse relationship with Vit-D. Therefore, therapeutic targeting of Vit-D or PTH would mutually affect their concentration eventually reflected in calcium homeostasis.

A retrospective study to assess adolescent nutritional deficiencies and the association with post-COVID-19 status

ABSTRACT Introduction: Adolescents represent 16% of the world’s population and around 21% of the Indian population. A study was done to assess the double burden of malnutrition, the proportion of inadequate intake of some important macronutrients and micronutrients, and the impact of COVID-19 pandemic on nutrient intakes among adolescents. Methodology: Retrospective data analysis of the adolescents presented at the Adolescent Health Clinic at a teaching hospital (tertiary care level) in Andhra Pradesh, India, between September 2022 and December 2022 was done in the current study. Results: A total of 800 adolescents were studied with the mean age of the participants as 15.8 (±2.38) years of age. Among the participants, the majority (59%) were immunized with Td vaccination at 10 years and/or 16 years, 21% were not immunized, and the rest 20% did not remember the status. Only 17 participants had a history of COVID-19 infection in the past. The majority (62.75%) of the participants belong to normal nutrition status as per BMI for age WHO growth charts. There is a significant difference in the nutrition status between males and females belonging to overweight and obese subgroups. There is no significant difference in the intake with respect to past COVID-19 status. Almost all the participants take inadequate amounts of carbohydrates (calories), pyridoxine, folate, iron, calcium, vitamin D3, and retinol. Protein intake is inadequate in 63% of participants, and the deficient intake rises with the age with respect to both EAR and RDA guidelines. Conclusion: A large proportion of adolescents suffer from the double burden of malnutrition in South India, and almost all the adolescents do not get the recommended intake of most of the macro- and micronutrients in their diet following the lockdown and online schooling due to the COVID-19 pandemic.

Nutritional status in Mexican pediatric oncology patients at a tertiary level of care

Nutritional status in Mexican pediatric oncology patients at a tertiary level of care

Comparison of Effectiveness of Conventional Polypectomy with Functional Endoscopic Sinus Surgery

It is common for rhinologists to face nasal polyposis. When other treatments have failed, patients must undergo Functional Endoscopic Sinus Surgery (FESS) with a microdebrider or traditional equipment to clear out their sinuses and restore normal airflow. Objective: To compare the effectiveness of conventional polypectomy with functional endoscopic sinus surgery in patients presenting to tertiary level care hospital in Islamabad, Pakistan. Methods: This study was conducted at Department of ENT Head and Neck Surgery, Pakistan Institute of Medical Sciences, Islamabad from November 2017 to December 2018. Eighty-eight patients were enrolled and they were randomly into group A and group B assigned for conventional polypectomy and functional endoscopic sinus surgery, respectively. Results: There were 27 (61.4%) males and 17 (38.6%) females and mean age was 34.59 ± 12.00 years in conventional polypectomy and 28 (63.6%) males and 16 (36.5%) females and mean age was 36.64 ± 10.76 years in function endoscopic sinus surgery. The recurrence rate after 6 months in patients underwent conventional polypectomy was 18 (40.9%) and functional endoscopic sinus surgery was 2 (4.5%). Conclusion: The frequency of recurrence of nasal polyps after conventional polypectomy was more than in patients receiving functional endoscopic sinus surgery procedure.

Use of antihypertensive agents and its present perspective: an observational retrospective study

Objectives: To evaluate the utilization of antihypertensive agents for the patients of Hypertension and subsequently their health outcome at a Tertiary Care Level Hospital and to observe the relationship among demographic profile of the patients. Materials and Methods: An observational retrospective study was undertaken collecting total 680 patients’ data from patient admission ticket of a Tertiary Care Level Hospital. Mainly drugs used and outcome of the patients were recorded. Of all patients 306 were found to be treated with calcium channel blockers (CCBs), 77 with angiotensin receptor blockers (ARBs), 229 with CCBs plus ARBs, 46 with CCBs plus ARBs and beta blockers and only 22 patients got CCBs, ARBs and diuretics. Data were statistically analysed in respect of demographic profile, drugs used and clinical features of the patients. Results: Best outcome was observed in patients treated with solely CCBs where in 289 out of 306 patients, hypertension was controlled. 194 out of 229 patients with CCBs and ARBs showed desired outcomes. 41 out of 77 with only ARBs, 29 out of 46 with CCBs, ARBs and beta blockers and 16 out of 22 with CCBs, ARBs and diuretics ended with positive results. Conclusion: Calcium channel blockers alone and in few cases in combination with angiotensin receptor blocking agents are very effective in controlling hypertension. Keywords: Hypertension, calcium channel blockers and angiotensin receptor blockers

Epidemiological Pattern and Case Fatality Rate among COVID-19 Patients during First and Second Wave of Pandemic in Madhesh Province, Nepal

Background &amp; Objectives: Evaluating multi-wave patterns of COVID-19 infection, hospitalization, and mortality across spatial scales can inform public health strategies for future pandemics. However, there is limited understanding of these patterns in developing countries, including Nepal. This study aimed to analyze epidemiological patterns, fatality rates, and factors associated with severe outcomes during the first and second waves of COVID-19 in Madhesh Province, Nepal. Materials and Methods: This retrospective cross-sectional study used provincial health records from Madhesh Province, covering April 9, 2020, to December 15, 2021, to analyze 37,551 positive COVID-19 cases and 1,037 deaths across two waves. The study examined changes in COVID-19-related deaths, with data on demographics, residence, isolation sites, treatment hospitals, care levels, and testing laboratories. The frequency and percentage of the variables were presented. The case fatality rate (CFR) for different categories were calculated. Additionally, the case fatality rate ratio (CFRR) for the first wave against second wave was obtained. Finally, case fatality risk ratios with 95% confidence intervals were presented. A p-value of &lt;0.05 was set as statistically significant. Results: The case fatality rate (CFR) for COVID-19 was significantly higher in the second wave, especially among the elderly (≥47 years), and in institutional isolation (7.82%). Tertiary level care and private hospitals consistently showed higher CFRs. Furthermore, the multivariable analysis of risk ratios (RR) for COVID-19 case fatality in revealed that the 25–34 year age group had the highest RR (2.39). Similarly, males had a higher RR (1.42) than females, and institutional isolation had a substantially higher RR (93.33) compared to home isolation. Primary level care RR (28.11) and government hospitals RR (4.32) showed a higher risk. Place of residence also impacted the RR, with Sarlahi (7.68) having higher. Conclusion: A significant increase in COVID-19 case fatality rates during the second wave, particularly among the elderly and those in institutional isolation. Higher mortality was observed in tertiary hospitals and among those who were tested in private laboratories, with substantial variations in risk ratios based on age, isolation type, and place of residence.

Design of hospitals for the post-pandemic era: an international survey of design professionals on infection control design strategies

ABSTRACT The COVID-19 pandemic placed unpreceded stress on healthcare systems, highlighting their deficiencies and vulnerabilities. The risk of cross-infection among patients and healthcare workers increased significantly, hindering the overall healthcare process. Hospital design should meet the challenges that will be posed by future pandemics, especially infection control. This paper reports on the results of an online survey for healthcare design professionals and academics from across the globe. The questionnaire addressed how hospital design can contribute to the infection control during future pandemic situations. Respondents agreed that the benefits of designing hospitals to meet the needs of pandemic/emergency situations outweigh the additional cost, and that infection control should play a more pronounced role when designing hospitals for the coming era. Results indicate that the overall organization of hospitals should allow for the compartmentation of critical/isolation departments/units and the creation of separate circulation routes to suit this compartmentation during pandemic times. The circulation system of the emergency departments and Intensive Care Units (ICU) should allow for the separation of infectious patients from others during pandemic times. 20–30% of the ICU beds of tertiary level care hospitals should be designed as single patient rooms. 53% of these rooms should be easily convertible to Air-Borne-Infection Isolation (AII) rooms, 44% should have an additional space for adding anterooms during pandemics, and 55% of these rooms should have permanent storage spaces for Personal Protective Equipment. The inpatient units should also be designed to support infection control. AII rooms should be grouped in designated inpatient units.

The economic burden of bipolar disorder: a case study in Southern Iran

BackgroundBipolar Disorder (BD) imposes considerable economic and social burdens on the community. Therefore, the present study aimed to determine the economic burden of bipolar disorder in patients referred to single-specialty psychiatric hospitals at the secondary and tertiary care level in 2022.MethodsThis partial economic evaluation was conducted as a cross-sectional study in the south of Iran in 2022, and 916 patients were selected through the census method. The prevalence-based and bottom-up approaches were used to collect cost information and calculate the costs, respectively. The data on Direct Medical Costs (DMC), Direct Non-Medical Costs (DNMC), and Indirect costs (IC) were obtained using the information from the patients’ medical records and bills as well as the self-reports by the patients or their companions. The human capital approach was also used to calculate IC.Findings: The results showed that in 2022, the annual cost of bipolar disorder was $4,227 per patient. The largest share of the costs was that of DMC (77.66%), with hoteling and ordinary beds accounting for the highest expenses (55.40%). The shares of DNMC and IC were 6.37% and 15.97%, respectively, and the economic burden of the disease in the country was estimated at $2,799,787,266 as well.ConclusionIn general, the costs of bipolar disorder treatment could impose a heavy economic burden on the community, the health system, the insurance system, and the patients themselves. Considering the high costs of hoteling and ordinary beds, it is suggested that hospitalization of BD patients be reduced by managing treatment solutions along with prevention methods to reduce the economic burden of this disease. Furthermore, in order to reduce the costs, proper and fair distribution of psychiatrists and psychiatric beds as well as expansion of home care services and use of the Internet and virtual technologies to follow up the treatment of these patients are recommended.

Cost of childhood severe pneumonia management in selected public inpatient care facilities in Bangladesh: a provider perspective

ObjectiveTo estimate inpatient care costs of childhood severe pneumonia and its urban–rural cost variation, and to predict cost drivers.DesignThe study was nested within a cluster randomised trial of childhood severe...

Transforming Lives Through Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (ABPMJAY): A Review

Background: The Pradhan Mantri Jan Arogya Yojana (PMJAY) program was created in line with the global goal of Universal Health Coverage (UHC), and aims to ensure everyone has access to quality healthcare services without suffering financial difficulties. In India, over 60% of healthcare spending is still borne by households, and a significant portion of the population lacks any form of health protection coverage. Discussion: The High-Level Expert Group (HLEG) recommended a shift from supply-side healthcare financing to demand-side financing, leading to the introduction of government-sponsored health insurance schemes. To achieve Universal Health Coverage (UHC), the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PMJAY) was launched following the recommendations of the National Health Policy 2017. The PMJAY program is the world's largest publicly sponsored social health insurance program, delivering comprehensive healthcare services covering primary, secondary, and tertiary care levels. The scheme covers approximately 12 crore households, including more than 50 crore beneficiaries, offering healthcare coverage of up to Rs. 5 lakh per family annually. PMJAY operates nationwide in India, covering all states and union territories except for a few.. Conclusion: To move forward, PMJAY can play a transformative role in the healthcare landscape, integrate with primary healthcare, contribute to economic development, and expand its scope to include more healthcare services.