Search Results (81)

Background: The role of clinical pharmacists in the emergency department continues to gain recognition, particularly during cardiac and trauma resuscitations. However, their contributions to patient outcomes remain unclear. The objective of this scoping review with narrative synthesis was to determine the impact of pharmacists on medication and patient outcomes during cardiac and trauma resuscitations and to identify barriers to integration. Methods: A literature search of databases in September 2024 identified randomized and non-randomized control trials, evaluating the impact of pharmacists’ involvement in cardiac or trauma resuscitations. Excluded were studies on acute stroke, acute hemorrhage, and sepsis. Data were extracted and analyzed for primary (e.g., medication errors and Advanced Cardiovascular Life Support [ACLS] compliance) and secondary outcomes (e.g., pharmacists’ education and training). Results: Of the 560 records screened, 26 records were included in the final analysis. Due to heterogeneity, quantitative analysis was not feasible. Among primary outcomes, ACLS guideline compliance and medication errors were commonly reported; mortality and length of stay were less commonly reported. ACLS certification improved pharmacists’ confidence in their tasks. Pharmacists’ presence also correlated with reduced healthcare costs. Conclusions: Our analysis suggests that the involvement of pharmacists in the context of emergency cardiac or trauma resuscitations may benefit direct patient outcomes and indirect outcomes. Full article

Cardiovascular disease (CVD) is the leading cause of mortality worldwide, often involving a strong genetic background. Polygenic risk scores (PRSs) combine the cumulative effects of multiple genetic variants to quantify an individual’s susceptibility to CVD. Pharmacogenomics (PGx) can further personalize treatment by tailoring medication choices to an individual’s genetic profile. Even with these potential benefits, the extent to which PRS can be integrated into the PGx of CVD remains unclear. Our review provides an overview of current evidence on the application of PRS in the PGx of CVD, examining clinical utility and limitations and providing directions for future research. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews protocol, we conducted a comprehensive literature search in PubMed, EMBASE, and the Web of Science. Studies investigating the relationship between PRS in predicting the efficacy, adverse effects, or cost-effectiveness of cardiovascular medications were selected. Of the 1894 articles identified, 32 met the inclusion criteria. These studies predominantly examined lipid-lowering therapies, antihypertensives, and antiplatelets, although other medication classes (e.g., rate-control drugs, ibuprofen/acetaminophen, diuretics, and antiarrhythmics) were also included. Our findings showed that PRS is most robustly validated in lipid-lowering therapies, especially statins, where studies reported that individuals with higher PRSs derived the greatest reduction in lipids while on statins. Studies analyzing antihypertensives, antiplatelets, and antiarrhythmic medications demonstrated more variable outcomes, though certain PRSs did identify subgroups with significantly improved response rates or a higher risk of adverse events. Though PRS was a strong tool in many cases, we found some key limitations in its applicability in research, such as the under-representation of non-European-ancestry cohorts in the examined studies and a lack of standardized outcome reporting. In conclusion, though PRS offers promise in improving the efficacy of PGx of CVD by enhancing the personalization of medication on an individual level, several obstacles, such as the need for including a broader ancestral diversity and more robust cost-effectiveness data remain. Future research must (i) prioritize validating PRS in ethnically diverse populations, (ii) refine PRS derivation methods to tailor them for drug response phenotypes, and (iii) establish clear and attainable guidelines for standardizing the reporting of outcomes. Full article

Generating accurate SQL queries from natural language is critical for enabling non-experts to interact with complex databases, particularly in high-stakes domains like healthcare. This paper presents an extensive evaluation of state-of-the-art large language models (LLM), including LLaMA 3.3, Mixtral, Gemini, Claude 3.5, GPT-4o, and Qwen for transforming medical questions into executable SQL queries using the MIMIC-3 and TREQS datasets. Our approach employs LLMs with various prompts across 1000 natural language questions. The experiments are repeated multiple times to assess performance consistency, token efficiency, and cost-effectiveness. We explore the impact of prompt design on model accuracy through an ablation study, focusing on the role of table data samples and one-shot learning examples. The results highlight substantial trade-offs between accuracy, consistency, and computational cost between the models. This study also underscores the limitations of current models in handling medical terminology and provides insights to improve SQL query generation in the healthcare domain. Future directions include implementing RAG pipelines based on embeddings and reranking models, integrating ICD taxonomies, and refining evaluation metrics for medical query performance. By bridging these gaps, language models can become reliable tools for medical database interaction, enhancing accessibility and decision-making in clinical settings. Full article

Background/Objectives: Rare diseases are conditions that are individually rare but collectively common. These diseases can incur significant direct and indirect costs with a combination of high medical expenses, loss of income, and additional non-medical costs. Despite this, research into the economic cost for families of children with a rare disease is lacking. This scoping review aimed to document the evidence on the economic impacts of living with a rare disease for children and their families. Methods: Six electronic databases were searched to identify relevant peer-reviewed literature that discussed the family costs (direct medical, direct non-medical, and indirect) of having a child with a rare disease, published between January 1983 and April 2023. The geographical location, type of rare disease, and language were not limited. Data were extracted from the included studies following the screening process and are reported following the PAGER framework for reporting scoping review results. Results: The final analysis included 28 studies. The studies highlighted areas of high costs, including visits to healthcare professionals (n = 36), medication costs (n = 11), presenteeism (n = 17), and informal care (n = 11). However, gaps in the existing research, such as the focus on metabolic or musculoskeletal rare diseases and the lack of a distinction between rare and ultra-rare diseases, were apparent. Conclusions: Having a child with a rare disease can significantly impact a family’s financial health, and these costs extend beyond healthcare costs. Understanding the costs experienced by the rare disease population is important to better define and comprehend the economic impact of rare diseases. Full article

In recent years, advances in both technology and medicine have made great progress. With the development of technology, low-cost and high-precision sensors have emerged and microcontrollers with high computing power and low power consumption have been created. In densely populated urban areas, health care is provided by a set of hospitals and medical centers where every patient can find an immediate response to their health concerns. However, medical care, particularly in non-urban areas, remains limited as many such areas do not have a hospital or medical center nearby. This results in inadequate medical care, both diagnostic and preventive, for the inhabitants of these areas. Today, the development of microprocessors, high-speed internet, and the low-cost sensors that have been developed can enable the creation of autonomous, accessible health monitoring units. In this work, an integrated low-cost, wearable electrocardiograph system is presented. The system is able to operate wherever there is an active internet connection. The proposed system consists of two parts. Firstly, the wearable ECG which can be located in the patient’s home. Secondly, the information system, in which the data from wearable ECG are collected and visualized, so that the doctor has direct access to the patient’s condition. Health is a precious commodity, and the application of technology is imperative, especially for the health care of citizens in remote areas. Full article

Hemobiologic reactions associated with the hemoincompatibility of extracorporeal circuit material are an undesirable and inevitable consequence of all blood-contacting medical devices, typically considered only from a clinical perspective. In hemodialysis (HD), the blood of patients undergoes repetitive (at least thrice weekly for 4 h and lifelong) exposure to different polymeric materials that activate plasmatic pathways and blood cells. There is a general agreement that hemoincompatibility reactions, although unavoidable during extracorporeal therapies, are unphysiological contributors to non-hemodynamic dialysis-induced systemic stress and need to be curtailed. Strategies to lessen the periodic and direct effects of blood interacting with artificial surfaces to stimulate numerous biological pathways have focused mainly on the development of ‘more passive’ materials to decrease intradialytic morbidity. The indirect implications of this phenomenon, such as its impact on the overall delivery of care, have not been considered in detail. In this article, we explore, for the first time, the potential clinical and economic consequences of hemoincompatibility from a value-based healthcare (VBHC) perspective. As the fundamental tenet of VBHC is achieving the best clinical outcomes at the lowest cost, we examine the equation from the individual perspectives of the three key stakeholders of the dialysis care delivery processes: the patient, the provider, and the payer. For the patient, sub-optimal therapy caused by hemoincompatibility results in poor quality of life and various dialysis-associated conditions involving cost-impacting adjustments to lifestyles. For the provider, the decrease in income is attributed to factors such as an increase in workload and use of resources, dissatisfaction of the patient from the services provided, loss of reimbursement and direct revenue, or an increase in doctor–nurse turnover due to the complexity of managing care (nephrology encounters a chronic workforce shortage). The payer and healthcare system incur additional costs, e.g., increased hospitalization rates, including intensive care unit admissions, and increased medications and diagnostics to counteract adverse events and complications. Thus, hemoincompatibility reactions may be relevant from a socioeconomic perspective and may need to be addressed beyond just its clinical relevance to streamline the delivery of HD in terms of payability, future sustainability, and societal repercussions. Strategies to mitigate the economic impact and address the cost-effectiveness of the hemoincompatibility of extracorporeal kidney replacement therapy are proposed to conclude this comprehensive approach. Full article

This study aimed to evaluate the cost-effectiveness of routine childhood immunization with the 20-valent pneumococcal conjugate vaccine (PCV20) in a four-dose regimen (3 + 1 schedule) versus the 15-valent PCV (PCV15/V114) in a three-dose regimen (2 + 1) in Germany. The study utilized a decision-analytic Markov model to estimate lifetime costs and effectiveness outcomes for a single birth cohort in Germany. The model tracked the incidence of acute pneumococcal infections and long-term pneumococcal meningitis sequelae for both vaccination strategies. The vaccine effectiveness data were derived from published clinical trials and observational studies of PCV7 and PCV13. Indirect effects, such as herd protection and serotype replacement, were included in the model. The model adopted a societal perspective, including direct medical, direct non-medical, and indirect costs. Scenario and sensitivity analyses were performed. In the base case, PCV20 prevented more pneumococcal disease cases and deaths, with an expected gain of 96 quality-adjusted life years (QALYs) compared to V114. However, PCV20 was associated with a total incremental cost of EUR 48,358,424, resulting in an incremental cost-effectiveness ratio (ICER) of EUR 503,620/QALY. Most of the scenario and sensitivity analyses estimated that the ICER for PCV20 exceeded EUR 150,000/QALY. Routine childhood immunization with PCV20 instead of V114 may not be an economically efficient use of healthcare resources in Germany. Full article

Background: Type 2 Diabetes Mellitus (T2DM) is a highly prevalent disease with a chronic nature and poses a significant health burden worldwide, with no exception in Pakistan. Hence, this study aimed to explore the financial burden of T2DM in Pakistan through cost of illness analysis. Methods: A prevalence-based, cross-sectional study was conducted using a structured data collection tool from the patient’s perspective. Through structured interviews by trained data collectors, the data regarding direct medical costs, direct non-medical costs, and indirect costs were collected and further verified through prescriptions and bills. After testing the normality of data, mean and median with interquartile range were used to present cost data, while non-parametric tests, i.e., the Mann–Whitney U test and the Kruskal–Wallis test, were used to assess factors associated with costs, as cost data were not normally distributed. Results: The study included 522 participants, with a majority being female (54%) and aged between 41 and 60 years (64%). The mean annual total cost per patient was USD 235.1 (median = USD 162.8), comprising direct medical costs, 93.2% (mean = USD 219.2; median = USD 150.0), direct non-medical costs, 5.3% (mean = USD 12.4; median = USD 7.1), and indirect costs, 1.5% (mean = USD 3.5; median = USD 1.9). Costs were significantly higher for patients with advanced age, high literacy, higher household incomes, duration of diabetes, more than one complication, and using combination therapy. Conclusions: The economic burden of T2DM in Pakistan is substantial, with medication costs being the largest component. Effective management strategies and policy interventions are crucial to mitigate this burden and improve the economic and health outcomes for diabetic patients. Full article

With increasing electronic medical data and the development of artificial intelligence, clinical decision support systems (CDSSs) assist clinicians in diagnosis and prescription. Traditional knowledge-based CDSSs follow an accumulated medical knowledgebase and a predefined rule system, which clarifies the decision-making process; however, maintenance cost issues exist in the medical data quality control and standardization processes. Non-knowledge-based CDSSs utilize vast amounts of data and algorithms to effectively make decisions; however, the deep learning black-box problem causes unreliable results. EXplainable Artificial Intelligence (XAI)-based CDSSs provide valid rationales and explainable results. These systems ensure trustworthiness and transparency by showing the recommendation and prediction result process using explainable techniques. However, existing systems have limitations, such as the scope of data utilization and the lack of explanatory power of AI models. This study proposes a new XAI-based CDSS framework to address these issues; introduces resources, datasets, and models that can be utilized; and provides a foundation model to support decision-making in various disease domains. Finally, we propose future directions for CDSS technology and highlight societal issues that need to be addressed to emphasize the potential of CDSSs in the future. Full article

Non-invasive transcranial electrical stimulation is a category of neuromodulation techniques used for various disorders. Although medically approved devices exist, the variety of consumer electrical stimulation devices is increasing. Because clinical trials and animal tests are costly and risky, using a brain phantom can provide preliminary experimental validation. However, existing brain phantoms are often costly or require excessive preparation time, precluding their use for rapid, real-time optimization of stimulation settings. A limitation of direct electric fields in a phantom is the lack of 3D spatial resolution. Using well-researched modalities such as transcranial direct current stimulation (tDCS) and newer modalities such as amplitude-modulated transcranial pulsed-current stimulation (am-tPCS), a range of materials was tested for use as electrical phantoms. Based on cost, preparation time, and efficiency, ground beef and agar gel with a 10% salt mix were selected. The measured values for the total dosages were 0.55 W-s for am-tPCS and 0.91 W-s for tDCS. Due to a low gain on the recording electrodes, the signal efficiency measured against the power delivered was 4.2% for tDCS and 3.1% for am-tPCS. Issues included electrodes shifting in the soft material and the low sensitivity of the recording electrodes. Despite these issues, the effective combination of the phantom and recording methodologies can enable low costs and the rapid testing, experimentation, and verification of consumer neuromodulation devices in three dimensions. Additionally, the efficiency factors (EFs) between the observed dosage and the delivered dosage could streamline the comparison of experimental configurations. As demonstrated by comparing two types of electrical neuromodulation devices across the 3D space of a phantom, EFs can be used in conjunction with a cost-effective, time-expedient phantom to rapidly iterate and optimize stimulation parameters. Full article

Severe acute malnutrition (SAM) is a high-fatality condition that affected 13.7 million children under five years of age worldwide in 2022, with complicated cases requiring extensive inpatient stay with an accompanying caregiver. Our objective was to assess the costs of inpatient treatment for complicated SAM in children aged 6 to 59 months in Northern Senegal and identify cost predictors. We performed a retrospective cost analysis, including 140 children hospitalized from January to December 2020 in five SAM inpatient treatment facilities. We adopted a societal perspective, including direct medical and non-medical costs and indirect costs. We extracted patients’ sociodemographic and clinical data from medical records and conducted semi-structured interviews with healthcare staff to capture information on time allocation and care management. A multivariable generalized linear model with gamma family and a log link was used to investigate the factors associated with direct costs. Costs are expressed in 2020 international USD using purchasing power parity. Mean length of stay was 5.3 (SD = 3.2) days and diarrhoea was the cause of the admission in 55.7% of cases. Mean total cost was USD 431.9 (SD = 203.9), with personnel being the largest cost item (33% of the total). Households’ out-of-pocket expenses represented 45.3% of total costs and amounted to USD 195.6 (SD = 103.6). Costs were significantly associated with gender (20.3% lower in boys), diarrhoea (27% increase), anaemia (49.4% increase), inpatient death (44.9% decrease), and type of facility (26% higher in hospitals vs. health centre). Our study highlights the financial burden of complicated SAM in Senegal in particular for families. This underscores the need for tailored prevention and social policies to protect families from the disease’s financial burden and improve treatment adherence, both in Senegal and similar contexts. Full article

Non-typhoidal Salmonella (NTS) infection and invasive non-typhoidal Salmonella (iNTS) infection cause a significant global health and economic burden. This systematic review aims to investigate the reported economic burden of NTS and iNTS infection, identify research gaps, and suggest future research directions. Data from PubMed and Embase databases up to April 2022 were reviewed, and articles were screened based on predefined criteria. Cost data were extracted, categorized into direct medical costs (DMCs), direct non-medical costs (DNMCs), and indirect costs (ICs), and converted into US dollars (year 2022). Data primarily originated from high-income countries (37 out of 38), with limited representation from Africa and resource-limited settings. For inpatients, DMCs were the primary cost driver for both NTS and iNTS illnesses, with estimates ranging from USD 545.9 (Taiwan, a region of China) to USD 21,179.8 (Türkiye) for NTS and from USD 1973.1 (Taiwan, a region of China) to USD 32,507.5 (United States of America) for iNTS per case. DNMCs and ICs varied widely across studies. Although study quality improved over time, methodological differences persisted. This review underscores the lack of economic data on NTS and iNTS in resource-limited settings. It also highlights the need for economic burden data in resource-limited settings and a standardized approach to generate global datasets, which is critical for informing policy decisions, especially regarding future vaccines. Full article

Quantitative analysis of human gait is critical for the early discovery, progressive tracking, and rehabilitation of neurological and musculoskeletal disorders, such as Parkinson’s disease, stroke, and cerebral palsy. Gait analysis typically involves estimating gait characteristics, such as spatiotemporal gait parameters and gait health indicators (e.g., step time, length, symmetry, and balance). Traditional methods of gait analysis involve the use of cameras, wearables, and force plates but are limited in operational requirements when applied in daily life, such as direct line-of-sight, carrying devices, and dense deployment. This paper introduces a novel approach for gait analysis by passively sensing floor vibrations generated by human footsteps using vibration sensors mounted on the floor surface. Our approach is low-cost, non-intrusive, and perceived as privacy-friendly, making it suitable for continuous gait health monitoring in daily life. Our algorithm estimates various gait parameters that are used as standard metrics in medical practices, including temporal parameters (step time, stride time, stance time, swing time, double-support time, and single-support time), spatial parameters (step length, width, angle, and stride length), and extracts gait health indicators (cadence/walking speed, left–right symmetry, gait balance, and initial contact types). The main challenge we addressed in this paper is the effect of different floor types on the resultant vibrations. We develop floor-adaptive algorithms to extract features that are generalizable to various practical settings, including homes, hospitals, and eldercare facilities. We evaluate our approach through real-world walking experiments with 20 adults with 12,231 labeled gait cycles across concrete and wooden floors. Our results show 90.5% (RMSE 0.08s), 71.3% (RMSE 0.38m), and 92.3% (RMSPE 7.7%) accuracy in estimating temporal, spatial parameters, and gait health indicators, respectively. Full article

Respiratory viral infections (RVIs) are common reasons for healthcare consultations. The inpatient management of RVIs consumes significant resources. From 2009 to 2014, we assessed the costs of RVI management in 4776 hospitalized children aged 0–18 years participating in a quality improvement program, where all ILI patients underwent virologic testing at the National Reference Centre followed by detailed recording of their clinical course. The direct (medical or non-medical) and indirect costs of inpatient management outside the ICU (‘non-ICU’) versus management requiring ICU care (‘ICU’) added up to EUR 2767.14 (non-ICU) vs. EUR 29,941.71 (ICU) for influenza, EUR 2713.14 (non-ICU) vs. EUR 16,951.06 (ICU) for RSV infections, and EUR 2767.33 (non-ICU) vs. EUR 14,394.02 (ICU) for human rhinovirus (hRV) infections, respectively. Non-ICU inpatient costs were similar for all eight RVIs studied: influenza, RSV, hRV, adenovirus (hAdV), metapneumovirus (hMPV), parainfluenza virus (hPIV), bocavirus (hBoV), and seasonal coronavirus (hCoV) infections. ICU costs for influenza, however, exceeded all other RVIs. At the time of the study, influenza was the only RVI with antiviral treatment options available for children, but only 9.8% of influenza patients (non-ICU) and 1.5% of ICU patients with influenza received antivirals; only 2.9% were vaccinated. Future studies should investigate the economic impact of treatment and prevention of influenza, COVID-19, and RSV post vaccine introduction. Full article

In light of the unsuccessful traditional therapies for Parkinson’s disease (PD) overmany years, there is an unmet need for the development of novel therapies to alleviate the symptoms of PD retardation or halt the progression of the disease itself. This systematic review aims to critically update some of the most promising novel treatments including gene therapy, cell-based therapies, targeted drug delivery, and neuroprotective agents, focusing on their challenges, limitations and future directions in PD research. Gene therapy in PD is encouraging, with AAV-based approaches targeting neurotrophic factors, dopamine production, and neuronal circuits in animal and clinical trials. A promising approach to targeted drug delivery for PD involves the use of nanotechnology to create drug delivery vehicles that can traverse the blood–brain barrier and deliver medications specifically to the regions of the brain affected by PD. Neuroprotective agents are compounds that have the ability to protect neurons from degeneration and death, and they hold great promise for the evolution of disease-modifying treatments for PD. Magnetic field therapy is a promising non-invasive method that promotes neural plasticity in PD. The establishment of standardized protocols for animal and human studies, safety, ethical considerations, and cost-effectiveness are the major challenges for the future research of novel PD therapies. The development of novel therapies for PD represents a promising path toward to effective personalized disease-modifying treatments for PD. Full article