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Sherri Rose
OBJECTIVE: To propose nonparametric double robust machine learning in variable importance analyses of medical conditions for health spending. DATA SOURCES: 2011-2012 Truven MarketScan database. STUDY DESIGN: I evaluate how much more, on average, commercially insured enrollees with each of 26 of the most prevalent medical conditions cost per year after controlling for demographics and other medical conditions. This is accomplished within the nonparametric targeted learning framework, which incorporates ensemble machine learning...
March 11, 2018: Health Services Research
Aziz Rezapour, Saeed Bagheri Faradonbeh, Vahid Alipour, Mani Yusefvand
BACKGROUND: Cardiomyopathies is a group of heart diseases that directly affects the heart muscle, and their causes is not just high blood pressure, congenital and pericardial diseases but ischemic cardiomyopathy disease are also caused by vascular disorders, and to confirm the diagnosis, angiography is required. There are several methods for treating and controlling ischemic cardiomyopathy in world health systems and especially in the Iran health system, which include medical treatment, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG)...
March 2018: Medicine (Baltimore)
Ruiqi Liu, Aijun Chao, Ke Wang, Jing Wu
We analyzed the incidence of medical complications after osteoporotic fractures and estimated its risk factors and cost impacts. Osteoporotic fractures can result in lots of serious medical complications, which is associated with patients' baseline characteristics such as patients' disease history and significantly increased patients' direct medical costs. PURPOSE: The purpose of the study is to investigate the incidence and identify the risk factors of medical complications after osteoporotic fracture, and quantify patients' economic burden...
February 27, 2018: Archives of Osteoporosis
Atsushi Asai, Sakiko Masaki, Taketoshi Okita, Aya Enzo, Yasuhiro Kadooka
BACKGROUND: Destination therapy (DT) is the permanent implantation of a left ventricular assist device (LVAD) in patients with end-stage, severe heart failure who are ineligible for heart transplantation. DT improves both the quality of life and prognosis of patients with end-stage heart failure. However, there are also downsides to DT such as life-threatening complications and the potential for the patient to live beyond their desired length of life following such major complications...
February 27, 2018: BMC Medical Ethics
Vlasta Bari, Marco Ranucci, Beatrice De Maria, Beatrice Cairo, Valeria Pistuddi, Alberto Porta
BACKGROUND: Postoperative atrial fibrillation (AF) might be favored by cardiovascular control impairment. We hypothesize that cardiovascular regulation indexes derived from directional model-based analysis of the spontaneous fluctuations of heart period (HP) and systolic arterial pressure (SAP) can identify subjects at risk to develop AF after coronary artery bypass graft (CABG) surgery. METHODS: Beat-to-beat HP and SAP series were derived from electrocardiogram (ECG) and invasive arterial pressure recorded for 5 min just before CABG surgery in conscious condition...
February 2, 2018: International Journal of Cardiology
Vanessa M Meyer
Background: Competitive athletes train body and mind in preparation for competition with mental fortitude often providing the "winning edge." Similarly, the current-day warfighter faces significant physical and psychological challenges and must be prepared to respond to life-threatening danger with mental and physical agility. Sport Psychology for the Soldier Athlete recognizes the soldier as an elite athlete and provides training required to perform at the highest caliber. Through this curriculum, mental skills coaching in goal setting, imagery, positive self-talk, and heart rate control is integrated into routine physical fitness training...
February 6, 2018: Military Medicine
David M Levine, Kei Ouchi, Bonnie Blanchfield, Keren Diamond, Adam Licurse, Charles T Pu, Jeffrey L Schnipper
BACKGROUND: Hospitals are standard of care for acute illness, but hospitals can be unsafe, uncomfortable, and expensive. Providing substitutive hospital-level care in a patient's home potentially reduces cost while maintaining or improving quality, safety, and patient experience, although evidence from randomized controlled trials in the US is lacking. OBJECTIVE: Determine if home hospital care reduces cost while maintaining quality, safety, and patient experience...
February 6, 2018: Journal of General Internal Medicine
Jing-Mei Ding, Xian-Zhi Zhang, Xue-Jun Hu, Huo-Liang Chen, Min Yu
BACKGROUND: The medical costs for inpatients with coronary heart disease (CHD) have risen to unprecedented levels, putting tremendous financial pressure on their families and the entire society. The objective of this study was to examine the actual direct medical costs of inpatients with CHD and to analyze the influencing factors of those costs, to provide advice on the prevention and control of high medical costs of patients with CHD. METHODS: A retrospective descriptive analysis of hospitalization expenditures data examined 10,301 inpatients with coronary heart disease of a tier-3 hospital in Xi'an from January 1, 2015 to December 31, 2015...
December 2017: Medicine (Baltimore)
Roger Williams, Graeme Alexander, Iain Armstrong, Alastair Baker, Neeraj Bhala, Ginny Camps-Walsh, Matthew E Cramp, Simon de Lusignan, Natalie Day, Anil Dhawan, John Dillon, Colin Drummond, Jessica Dyson, Graham Foster, Ian Gilmore, Mark Hudson, Deirdre Kelly, Andrew Langford, Neil McDougall, Petra Meier, Kieran Moriarty, Philip Newsome, John O'Grady, Rachel Pryke, Liz Rolfe, Peter Rice, Harry Rutter, Nick Sheron, Alison Taylor, Jeremy Thompson, Douglas Thorburn, Julia Verne, John Wass, Andrew Yeoman
This report contains new and follow-up metric data relating to the eight main recommendations of the Lancet Standing Commission on Liver Disease in the UK, which aim to reduce the unacceptable harmful consequences of excess alcohol consumption, obesity, and viral hepatitis. For alcohol, we provide data on alcohol dependence, damage to families, and the documented increase in alcohol consumption since removal of the above-inflation alcohol duty escalator. Alcoholic liver disease will shortly overtake ischaemic heart disease with regard to years of working life lost...
November 29, 2017: Lancet
I M Feisul, S Azmi, A M Mohd Rizal, H Zanariah, N J Nik Mahir, I Fatanah, A N Aizuddin, A Goh
INTRODUCTION: An economic analysis was performed to estimate the annual cost of diabetes mellitus to Malaysia. METHODS: We combined published data and clinical pathways to estimate cost of follow-up and complications, then calculated the overall national cost. Costs consisted of diabetes follow-up and complications costs. RESULTS: Patient follow-up was estimated at RM459 per year. Complications cost were RM42,362 per patient per year for nephropathy, RM4,817 for myocardial infarction, RM5,345 for stroke, RM3,880 for heart failure, RM5,519 for foot amputation, RM479 for retinopathy and RM4,812 for cataract extraction...
October 2017: Medical Journal of Malaysia
Elena Salmoirago-Blotcher, Michael P Carey
Medication adherence is a complex, multi-determined behavior that is often influenced by system- (e.g., cost), drug- (e.g., regimen complexity), and patient-related (e.g., depression) factors. System-level approaches (e.g., making medications more affordable) are critically important but do not address patient-level factors that can undermine adherence. In this paper, we identify patient-level determinants of non-adherence and discuss whether mindfulness-training approaches that target these determinants can help to improve adherence to medical treatment...
January 2018: Explore: the Journal of Science and Healing
Michael D Seckeler, Ian D Thomas, Jennifer Andrews, Omar Meziab, Tabitha Moe, Elissa Heller, Scott E Klewer
Adults with congenital heart disease (CHD) are a rapidly increasing population and their impact on healthcare resources is not fully understood. The purpose of this study was to describe the costs of hospitalizations for non-cardiac disease for adults with CHD. We conducted a retrospective review of hospital discharge data from the University HealthSystem Consortium Clinical Data Base/Resource Manager from January 2011 through December 2013. Patients were ≥ 18 years old at admission with any ICD-9 code for moderate or high severity CHD; cardiac surgical admissions were excluded...
November 15, 2017: Pediatric Cardiology
Leonie Korn, Daniel Rüschen, Niklas Zander, Steffen Leonhardt, Marian Walter
Classically, mock circulatory loops only simulate mechanical properties of the circulation. To connect the hydraulic world with electrophysiology, we present a real-time electrical activity model of the heart and show how to integrate this model into a real-time mock loop simulation. The model incorporates a predefined conduction pathway and a simplified volume conductor to solve the bidomain equations and the forward problem of electrocardiography, resulting in a physiological simulation of the electrocardiogram (ECG) at arbitrary electrode positions...
October 12, 2017: Artificial Organs
Peter Langhorne, Olivia Wu, Helen Rodgers, Ann Ashburn, Julie Bernhardt
BACKGROUND: Mobilising patients early after stroke [early mobilisation (EM)] is thought to contribute to the beneficial effects of stroke unit care but it is poorly defined and lacks direct evidence of benefit. OBJECTIVES: We assessed the effectiveness of frequent higher dose very early mobilisation (VEM) after stroke. DESIGN: We conducted a parallel-group, single-blind, prospective randomised controlled trial with blinded end-point assessment using a web-based computer-generated stratified randomisation...
September 2017: Health Technology Assessment: HTA
Glenn N Levine, Richard A Lange, C Noel Bairey-Merz, Richard J Davidson, Kenneth Jamerson, Puja K Mehta, Erin D Michos, Keith Norris, Indranill Basu Ray, Karen L Saban, Tina Shah, Richard Stein, Sidney C Smith
Despite numerous advances in the prevention and treatment of atherosclerosis, cardiovascular disease remains a leading cause of morbidity and mortality. Novel and inexpensive interventions that can contribute to the primary and secondary prevention of cardiovascular disease are of interest. Numerous studies have reported on the benefits of meditation. Meditation instruction and practice is widely accessible and inexpensive and may thus be a potential attractive cost-effective adjunct to more traditional medical therapies...
September 28, 2017: Journal of the American Heart Association
Nadia Aissaoui, Michiel Morshuis, Hassani Maoulida, Joe-Elie Salem, Guillaume Lebreton, Matthias Brunn, Gilles Chatellier, Albert Hagège, Michael Schoenbrodt, Etienne Puymirat, Christian Latremouille, Shaida Varnous, Salima Ouldamar, Romain Guillemain, Benoit Diebold, Paul Guedeney, Marc Barreira, Pierre Mutuon, Emmanuel Guerot, Lech Paluszkiewicz, Kavous Hakim-Meibodi, Uwe Schulz, Nicolas Danchin, Jan Gummert, Isabelle Durand-Zaleski, Pascal Leprince, Jean-Yves Fagon
OBJECTIVES: Heart transplantation (HT) and ventricular assist devices (VAD) for the management of end-stage heart failure have not been directly compared. We compare the outcomes and use of resources with these 2 strategies in 2 European countries with different allocation systems. METHODS: We studied 83 patients managed by VAD as the first option in Bad Oeynhausen, Germany (Group I) and 141 managed with either HT or medical therapy, as the first option, in Paris, France (Group II)...
July 26, 2017: European Journal of Cardio-thoracic Surgery
Joseph T Flynn, David C Kaelber, Carissa M Baker-Smith, Douglas Blowey, Aaron E Carroll, Stephen R Daniels, Sarah D de Ferranti, Janis M Dionne, Bonita Falkner, Susan K Flinn, Samuel S Gidding, Celeste Goodwin, Michael G Leu, Makia E Powers, Corinna Rea, Joshua Samuels, Madeline Simasek, Vidhu V Thaker, Elaine M Urbina
These pediatric hypertension guidelines are an update to the 2004 "Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents." Significant changes in these guidelines include (1) the replacement of the term "prehypertension" with the term "elevated blood pressure," (2) new normative pediatric blood pressure (BP) tables based on normal-weight children, (3) a simplified screening table for identifying BPs needing further evaluation, (4) a simplified BP classification in adolescents ≥13 years of age that aligns with the forthcoming American Heart Association and American College of Cardiology adult BP guidelines, (5) a more limited recommendation to perform screening BP measurements only at preventive care visits, (6) streamlined recommendations on the initial evaluation and management of abnormal BPs, (7) an expanded role for ambulatory BP monitoring in the diagnosis and management of pediatric hypertension, and (8) revised recommendations on when to perform echocardiography in the evaluation of newly diagnosed hypertensive pediatric patients (generally only before medication initiation), along with a revised definition of left ventricular hypertrophy...
September 2017: Pediatrics
Karin Diaconu, Yen-Fu Chen, Carole Cummins, Gabriela Jimenez Moyao, Semira Manaseki-Holland, Richard Lilford
BACKGROUND: Forty to 70 % of medical devices and equipment in low- and middle-income countries are broken, unused or unfit for purpose; this impairs service delivery to patients and results in lost resources. Undiscerning procurement processes are at the heart of this issue. We conducted a systematic review of the literature to August 2013 with no time or language restrictions to identify what product selection or prioritization methods are recommended or used for medical device and equipment procurement planning within low- and middle-income countries...
August 18, 2017: Globalization and Health
Donata Kurpas, Katarzyna Szwamel, Dorota Lenarcik, Marika Guzek, Artur Prusaczyk, Paweł Żuk, Jolanta Michalowska, Agnieszka Grzeda, Bożena Mroczek
Coordination of healthcare effectively prevents exacerbations and reduces the number of hospitalizations, emergency visits, and the mortality rate in patients with chronic respiratory diseases. The purpose of this study was to determine clinical effectiveness of ambulatory healthcare coordination in chronic respiratory patients and its effect on the level of healthcare services as an indicator of direct medical costs. We conducted a retrospective health record survey, using an online database of 550 patients with chronic respiratory diseases...
August 12, 2017: Advances in Experimental Medicine and Biology
Rick A Vreman, Alex J Goodell, Luis A Rodriguez, Travis C Porco, Robert H Lustig, James G Kahn
OBJECTIVES: Excessive consumption of added sugars in the human diet has been associated with obesity, type 2 diabetes (T2D), coronary heart disease (CHD) and other elements of the metabolic syndrome. Recent studies have shown that non-alcoholic fatty liver disease (NAFLD) is a critical pathway to metabolic syndrome. This model assesses the health and economic benefits of interventions aimed at reducing intake of added sugars. METHODS: Using data from US National Health Surveys and current literature, we simulated an open cohort, for the period 2015-2035...
August 3, 2017: BMJ Open
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