Accountable Care

OBJECTIVES: To evaluate the individual and community factors that contribute to dental utilization among young children on Medicaid utilizing the Anderson Model and the Socio-Ecological Framework. METHODS: This observational cross-sectional study was conducted using baseline data (socio-demographics, clinical dental need) from a cluster-randomized hybrid effectiveness-implementation trial among 1021 child-parent dyads recruited from primary care practices across northeast Ohio...

A sarcomatoid variant of urothelial carcinoma (SVUC) is an extremely rare variant, which accounts for only 0.1-0.3% of all urothelial carcinomas of the bladder. SVUC is distinguished by the presence of biphasic components; there can be morphological and/or immunohistochemical substantiation of epithelial and mesenchymal differentiation. The patients with this variant have been associated with very poor disease-specific and overall survival rates in comparison with the high-grade pure urothelial carcinoma. Being a rare entity, it usually presents at a higher grade and is related to a dismal prognosis in comparison with conventional urothelial carcinoma...

Left ventricular aneurysms (LVAs) represent a rare yet critical complication arising from late-presenting myocardial infarction (MI). Here, we present the case of an 88-year-old male with chest pressure, elevated troponin, B-type natriuretic peptide, and lactate. The electrocardiogram showed sinus tachycardia and an old right bundle branch block. The patient was started on heparin infusion, but progressively worsening hypotension necessitated transfer to the intensive care unit and the initiation of vasopressors...

Enhanced recovery after surgery (ERAS) protocols have transformed perioperative care by implementing evidence-based strategies to hasten patient recovery, decrease complications, and shorten hospital stays. However, challenges such as inconsistent adherence and the need for personalized adjustments persist, prompting exploration into innovative solutions. The emergence of artificial intelligence (AI) and machine learning (ML) offers a promising avenue for optimizing ERAS protocols. While ERAS emphasizes preoperative optimization, minimally invasive surgery (MIS), and standardized postoperative care, challenges such as adherence variability and resource constraints impede its effectiveness...

INTRODUCTION: blood transfusion remains an essential therapeutic intervention, but the occurrence of transfusion reactions makes its administration even more complex. Vigilant reporting of such reactions by recipients of blood products is essential for effective haemovigilance. This study aimed to determine the frequency and nature of transfusion reactions. METHODS: conducted over five years (2017-2021) at the Haemovigilance Department of the Rabat Regional Blood Transfusion Centre, this retrospective study exploited incident forms notified by health establishments and data from the regional blood transfusion centre's computer system...

AIM: To explore potential predictors of national out-of-hospital cardiac arrest (OHCA) survival, including health system developments and the COVID pandemic in Ireland. METHODS: National level OHCA registry data from 2012 through to 2020, relating to unwitnessed, and bystander witnessed OHCA were interrogated. Logistic regression models were built by including predictors through stepwise variable selection and enhancing the models by adding pairwise interactions that improved fit...

PURPOSE: Burnout is an occupational stress syndrome that gives rise to emotional exhaustion (EE) depersonalization (DP) and reduced personal accomplishment (PA). Increasing rates of burnout among health care professionals has been reported globally. Saudi Arabia appears to be among the highest in prevalence with reports of higher than 70%. Medical residents in training are the highest group at risk. The literature has repeatedly linked burnout among residents with poor academic performance on training exams, impaired quality of life, career choice regret and intentions to abandon medicine...

Aim: To investigate whether the youth with prenatal substance exposure (PSE) (aged 15-24 years, n  = 615) had been in hospital care more often due to injuries and poisoning in comparison with unexposed matched controls ( n  = 1787). Methods: Data from medical records (exposure) and national health and social welfare registers (outcome and confounders) were combined and youths were monitored from birth until either outpatient or inpatient hospital care for injury or poisoning, death or the end of the study period (December 2016)...

Data and indicator estimates are considered vital to document persisting challenges in maternal and newborn health and track progress towards global goals. However, prioritization of standardised, comparable quantitative data can preclude the collection of locally relevant information and pose overwhelming burdens in low-resource settings, with negative effects on the provision of quality of care. A growing body of qualitative studies aims to provide a place-based understanding of the complex processes and human experiences behind the generation and use of maternal and neonatal health data...

INTRODUCTION: The healthcare pathway is at the heart of public health organization concerns, but communication between the various players can be an obstacle. This work, produced by a French transdisciplinary team, offers a methodological approach based on formalized consensus to elaborate a glossary of healthcare pathways. A two-steps procedure was elaborated, including a double rounded Delphi method to formalize expert consensus, and two groups of experts: a workgroup and a review group...

As the forest health care in China is still in the early stage of development, the construction standards of forest health care base are not unified yet, resulting in large differences in the evaluation criterion for the ecological environment of forest health care bases. So, it is urgent to develop a new forest health care ecological environment quality assessment method. Yunnan, Guizhou and Sichuan provinces of China were selected as the study area, the previous 6 batches of 165 national forest health care pilot construction bases were selected as the main data source...

A variety of cutting-edge methods and good knowledge of the illness's complex causes are causing a sea change in the field of Alzheimer's Disease (A.D.) research and treatment. Precision medicine is at the vanguard of this change, where individualized treatment plans based on genetic and biomarker profiles give a ray of hope for customized therapeutics. Combination therapies are becoming increasingly popular as a way to address the multifaceted pathology of Alzheimer's by simultaneously attacking Aβ plaques, tau tangles, neuroinflammation, and other factors...

OBJECTIVES: COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2 virus). This virus evolved into several variants, each with different severity. There are surges in the numbers of infected patients, commonly described as "waves". In Kuwait, three waves occurred. Our study describes and compares the clinical presentation and outcomes of critically ill pregnant patients infected with different variants. METHODS: This was a retrospective cohort study in two intensive care units (ICU) dedicated to patients with COVID-19...

OBJECTIVE: Traditional hospital accounting fails to provide an accurate cost of complex surgical care. Here we describe the application of time-driven activity-based costing (TDABC) to characterize costs of head and neck oncologic procedures involving free tissue transfer. STUDY DESIGN: Retrospective cohort study. SETTING: Single tertiary academic medical center. METHODS: An analysis of head and neck oncologic procedures involving microvascular free flap reconstruction from 2018 to 2020 (n = 485) was performed using TDABC methodology to measure cost across operative case and postoperative admission, using quantity of time and cost per unit of each resource to characterize resource utilization...

BACKGROUND: While remote patient management (RPM) has the potential to assist in achieving treatment targets for cardiovascular risk factors in primary care, its effectiveness may vary among different patient subgroups. Panel management, which involves proactive care for specific patient risk groups, could offer a promising approach to tailor RPM to these groups. This study aims to (i) assess the perception of healthcare professionals and other stakeholders regarding the adoption and (ii) identify the barriers and facilitators for successfully implementing such a panel management approach...

BACKGROUND: Smoking households in Indonesia diverted a significant share of their budget to tobacco. Tobacco expenditure is deemed unproductive, as it crowds out resources from essential commodities and increases health care expenditure driven by tobacco-induced diseases. Therefore, despite having adequate resources, some smoking families in Indonesia may spend less on basic needs, which inadvertently puts their standard of living below the poverty line. METHODS: Employing data from 2021 (March) Indonesia's Socioeconomic Survey (SUSENAS), this research aims to quantify the impoverishing effect of tobacco consumption in Indonesia, considering spending on tobacco and tobacco-attributable health care costs as unproductive expenditure...

BACKGROUND: Symptoms of depression have been associated with greater incapability following total hip arthroplasty (THA). A brief, 2-question, measure of symptoms of depression - the Patient Health Questionnaire 2 (PHQ-2) - may be sufficient to measure associations with the magnitude of incapability during recovery from THA. This study investigated whether preoperative symptoms of depression (measured with the PHQ-2) correlated with levels of incapability 6 weeks and 6 months after THA, accounting for demographic and clinical factors...

PURPOSE: An increase in fungal and particularly filamentous keratitis has been observed in many geographic areas, mostly in contact lens wearers. This study seeks to characterize long-term trends in fungal keratitis in a continental climate area to provide guidance for diagnosis and treatment. DESIGN: Retrospective multicentric case series. METHODS: Cases of microbiology-confirmed fungal keratitis from 2003 to 2022 presenting to tertiary care centers across Canada were included...

AIMS: Patients undergoing emergency general surgery are at high risk of complications and death. Our objectives were to estimate the incidence of emergency general surgery in a Swiss University Hospital, to describe the characteristics and outcomes of patients undergoing such procedures, and to study the impact of age on clinical outcomes. METHODS: This was a retrospective cohort study of adult patients who visited the emergency department (ED) of Geneva University Hospitals between January 2015 and December 2019...

OBJECTIVE: Twin pregnancies are at an increased risk of stillbirth compared to singletons. Fetal growth restriction (FGR) is a leading cause of perinatal mortality and morbidity, in both singleton and multiple pregnancies. Whether the contribution of FGR to stillbirth in twin pregnancies differs from that in singletons is yet to be determined. The main aim of this study was to determine the association between FGR and stillbirth in twin compared to singleton pregnancies. The secondary objectives include an assessment of the contribution of FGR to stillbirths, stratified by gestational age at delivery...