Search Results (146)

Introduction and Objectives: Risk-sharing agreements (RSAs) have emerged as a key strategy for financing high-cost medical technologies while ensuring financial sustainability. These payment mechanisms mitigate clinical and financial uncertainties, optimizing pricing and reimbursement decisions. Despite their widespread adoption globally, Latin America has reported limited implementation, particularly for high-cost medical devices. This study aims to share insights from designing RSAs in the form of Outcome Protection Programs (OPPs) for medical devices in Latin America from the perspective of a medical devices company. Methods: The report follows a structured approach, defining key OPP dimensions: payment base, access criteria, pricing schemes, risk assessment, and performance incentives. Risks were categorized as financial, clinical, and operational. The framework applied principles from prior models, emphasizing negotiation, program design, implementation, and evaluation. A multidisciplinary task force analyzed patient needs, provider motivations, and payer constraints to ensure alignment with health system priorities. Results: Over two semesters, a panel of seven experts from the manufacturer designed n = 105 innovative payment programs implemented in Argentina (n = 7), Brazil (n = 7), Colombia (n = 75), Mexico (n = 9), Panama (n = 4), and Puerto Rico (n = 3). The programs targeted eight high-burden conditions, including Coronary Artery Disease, atrial fibrillation, Heart Failure, and post-implantation arrhythmias, among others. Private providers accounted for 80% of experiences. Challenges include clinical inertia and operational complexities, necessitating structured training and monitoring mechanisms. Conclusions: Outcome Protection Programs offer a viable and practical risk-sharing approach to financing high-cost medical devices in Latin America. Their implementation requires careful stakeholder alignment, clear eligibility criteria and endpoints, and robust monitoring frameworks. These findings contribute to the ongoing dialogue on sustainable healthcare financing, emphasizing the need for tailored approaches in resource-constrained settings. Full article

Precision neurosurgery is rapidly evolving as a medical specialty by merging genomic medicine, multi-omics technologies, and artificial intelligence (AI) technology, while at the same time, society is shifting away from the traditional, anatomic model of care to consider a more precise, molecular model of care. The general purpose of this review is to contemporaneously reflect on how these advances will impact neurosurgical care by providing us with more precise diagnostic and treatment pathways. We hope to provide a relevant review of the recent advances in genomics and multi-omics in the context of clinical practice and highlight their transformational opportunities in the existing models of care, where improved molecular insights can support improvements in clinical care. More specifically, we will highlight how genomic profiling, CRISPR-Cas9, and multi-omics platforms (genomics, transcriptomics, proteomics, and metabolomics) are increasing our understanding of central nervous system (CNS) disorders. Achievements obtained with transformational technologies such as single-cell RNA sequencing and intraoperative mass spectrometry are exemplary of the molecular diagnostic possibilities in real-time molecular diagnostics to enable a more directed approach in surgical options. We will also explore how identifying specific biomarkers (e.g., IDH mutations and MGMT promoter methylation) became a tipping point in the care of glioblastoma and allowed for the establishment of a new taxonomy of tumors that became applicable for surgeons, where a change in practice enjoined a different surgical resection approach and subsequently stratified the adjuvant therapies undertaken after surgery. Furthermore, we reflect on how the novel genomic characterization of mutations like DEPDC5 and SCN1A transformed the pre-surgery selection of surgical candidates for refractory epilepsy when conventional imaging did not define an epileptogenic zone, thus reducing resective surgery occurring in clinical practice. While we are atop the crest of an exciting wave of advances, we recognize that we also must be diligent about the challenges we must navigate to implement genomic medicine in neurosurgery—including ethical and technical challenges that could arise when genomic mutation-based therapies require the concurrent application of multi-omics data collection to be realized in practice for the benefit of patients, as well as the constraints from the blood–brain barrier. The primary challenges also relate to the possible gene privacy implications around genomic medicine and equitable access to technology-based alternative practice disrupting interventions. We hope the contribution from this review will not just be situational consolidation and integration of knowledge but also a stimulus for new lines of research and clinical practice. We also hope to stimulate mindful discussions about future possibilities for conscientious and sustainable progress in our evolution toward a genomic model of precision neurosurgery. In the spirit of providing a critical perspective, we hope that we are also adding to the larger opportunity to embed molecular precision into neuroscience care, striving to promote better practice and better outcomes for patients in a global sense. Full article

The COVID-19 pandemic disrupted routine care for individuals with type 2 diabetes mellitus (T2DM), raising concerns about its impact on glycemic control and medication management. This study evaluated the relationship between insulin use and glycemic control among T2DM patients during the pandemic. A retrospective analysis was conducted using deidentified clinical and prescription data from two family medicine clinics, comparing data from the pre-COVID-19 period (1 March 2019–13 March 2020) and during the COVID-19 pandemic (14 March 2020–31 March 2021). Patients included had at least two A1c values before the COVID and one during the COVID. A1c control was defined as less than 8%. Among 992 patients, 238 experienced a change in A1c status: 128 improved and 110 worsened. Mean A1c remained stable at 8.2 across both periods. A majority of patients who improved were using insulin during the COVID-19 era, although some discontinued insulin at some point during the study period. These findings suggest that consistent insulin therapy may have helped maintain glycemic control despite healthcare disruptions. This study highlights the importance of sustained medication management and suggests that integrating telehealth and pharmacist-led care could support diabetes control during future healthcare system challenges. Full article

Background and Objectives: Complete dentures remain a primary solution for oral rehabilitation in aging and medically compromised populations. The integration of digital workflows, regenerative materials, and smart technologies is propelling prosthodontics towards a new era, transcending the limitations of traditional static prostheses. Materials and Methods: This narrative review synthesizes historical developments, current practices, and future innovations in complete denture therapy. A comprehensive review of literature from PubMed, Scopus, and Web of Science (2000–2025) was conducted, with a focus on materials science, digital design, patient-centered care, artificial intelligence (AI), and sustainable fabrication. Results: Innovations in the field include high-performance polymers, CAD–CAM systems, digital impressions, smart sensors, and bioactive liners. Recent trends in the field include the development of self-monitoring prostheses, artificial intelligence (AI)-driven design platforms, and bioprinted regenerative bases. These advances have been shown to enhance customization, durability, hygiene, and patient satisfaction. However, challenges persist in terms of accessibility, clinician training, regulatory validation, and ethical integration of digital data. Conclusions: The field of complete denture therapy is undergoing a transition toward a new paradigm of prosthetics that are personalized, intelligent, and sustainable. To ensure the integration of these technologies into standard care, ongoing interdisciplinary research, clinical validation, and equitable implementation are imperative. Full article

Healthcare institutions are under increasing pressure to deliver high-quality, patient-centered care while reducing their environmental footprint. Integrating quality and environmental management systems (ISO 9001 and ISO 14001) into a unified integrated management system (IMS) offers a potential pathway to meet these dual imperatives. This study investigates the effects of IMS implementation in three European hospitals through a comparative qualitative analysis of institutional reports, audit documentation, and performance indicators. The methodology combines a literature-informed conceptual framework with a multi-case analysis guided by four domains: environmental impact, care quality, process efficiency, and stakeholder engagement. The data were collected from institutional documentation over a six-year period (three years before and after IMS implementation), covering key indicators such as energy and water consumption, medical waste recycling, audit compliance, and patient satisfaction. The findings show that IMS adoption was associated with a 20–28% improvement in resource efficiency, increased recycling rates, and consistent gains in compliance and satisfaction metrics. These results were supported by strategic leadership, cross-functional training, and digital monitoring tools. The study concludes that IMS enhances institutional performance and sustainability while aligning healthcare operations with broader governance and policy goals. Further research is recommended to explore the long-term impacts and generalize the findings across healthcare systems. Full article

Background/Objectives: The Republic of Korea is undergoing a significant demographic shift toward a population with a high proportion of older adults. In response, the Act on Integrated Support for Community Care was enacted. This study explores the role of tertiary hospitals in integrated care, aiming to enhance healthcare systems that support older individuals by facilitating the transition from hospital- to community-based care. Methods: Seoul St. Mary’s Hospital, operating under the Catholic Foundation, provides care grounded in healing and spirituality. As part of its mission, a multidisciplinary task force (TF) was formed to examine the hospital’s role in integrated care for an aging society. The TF, composed of eight experts from various departments, engaged in open discussions from September 2024 to January 2025. Results: The Integrated Care Act, which seeks to integrate medical care and caregiving within communities, requires the development of a digital system, the establishment of a governance framework for multidisciplinary collaboration, and the creation of institutions for training professionals in integrated care. Tertiary hospitals must develop department-specific models for transitional care and establish policy research institutes focused on holistic, patient-centered care. Family medicine departments can play a central role in coordinating between tertiary hospitals and local communities. Conclusions: This study highlights the importance of collaboration between medical, caregiving, and social welfare professionals as key enablers of “aging in place”. The findings underscore the evolving role of tertiary hospitals and contribute to fostering a more sustainable healthcare model for Korea’s aging population. Full article

Nowadays, evidence-based management (EBM) plays an important role in bringing sustainability into the decision-making process in the healthcare industry. The present study examines how evidence-based management affects the strategic decision criteria for the cost efficiency, equity, and accessibility of medical services in Saudi Arabia. A mixed-methods approach used hybrid surveys, interactive focus groups, digital ethnography, and experience sampling methods to collect data from healthcare managers, policymakers, and stakeholders. Structural equation modeling (SEM), latent semantic analysis (LSA), XGBoost models, and dynamic network analysis (DNA), among others, were used to provide robust insights about the system. The results showed a 25 percent increase in cost efficiency, a 20 percent improvement in inequitable resource allocation, and a 15 percent improvement in accessibility with evidence-based management adoption. According to the XGBoost models, streamlined resource management explains 30% of the variation in cost efficiency, and data-driven decision-making practices explain 35% of the variance in equity performance. After EBM implementation, collaborative efforts among stakeholders increased by 40%, as determined by DNA analysis. In addition, time-series analysis revealed a 22% reduction in operational delays, improving service delivery. These results suggest that evidence-based management is an important opportunity to ‘bend the curve’ of patient care, driving healthcare sustainability by optimizing resource use, equity, and accessibility. The contributions of this research to the broader discourse on sustainable healthcare management lie in its proven actionable insights and scalable framework for evidence-based management practices. The integration of advanced analytics underlines its relevance for global healthcare systems to attain long-term efficiency and sustainability. Full article

Glaucoma, a primary cause of irreversible blindness, is most effectively managed by reducing intraocular pressure (IOP). Topical eye drops, which are conventional treatments, frequently encounter constraints regarding patient compliance, inconsistent dosage, and tolerability. Slow-release drug delivery systems have emerged as a promising innovation in response to these challenges. The objective of these systems is to enhance the efficacy of treatment and patient compliance by ensuring the consistent and sustained delivery of therapeutic agents over extended periods. Implantable devices, injectable formulations, and external applications are all categorized as slow-release therapies. By delivering medication directly to the target tissues in a controlled manner, these technologies have the potential to circumvent common issues associated with traditional regimens, such as forgotten doses or improper administration. These systems have been shown to obtain clinically meaningful reductions in IOP in studies, with some demonstrating efficacy that is comparable to that of established daily topical treatments. Despite their potential, slow-release therapies encounter obstacles that necessitate resolution. Potential complications during implantation or removal, long-term biocompatibility, and the cost of treatment are all areas of concern. Furthermore, further investigation is required to comprehensively assess their relative economic feasibility, patient acceptability, and long-term safety profiles in comparison to conventional treatments. This review summarizes the most recent findings in the scientific literature, underlining the role and possible limits of slow-release therapies in glaucoma with the aim of offering a comprehensive understanding of their potential clinical applications and challenges. This emphasizes the potential for these innovations to revolutionize care by addressing current knowledge gaps, while also emphasizing the areas in which further development and research are required. Full article

Background/Objectives: This study identifies barriers to maternal and child healthcare access in Afghanistan under the Taliban and proposes solutions using the WHO Health System Building Blocks Framework. Methods: Midwives and mothers were recruited via chain-referral sampling. After obtaining IRB and the participants’ informed consent, in-depth virtual interviews, guided by Social Cognitive Theory, were recorded, transcribed, and analyzed using content analysis in MAXQDA 2020. Results: Data analysis revealed four primary consequences of the political unrest in Afghanistan that have exacerbated barriers to accessing maternal and child healthcare: (a) Taliban-imposed restrictions on women’s education and mobility, reducing female healthcare providers and limiting mothers’ access to care; (b) increased poverty, preventing women from attending perinatal visits due to out-of-pocket costs; (c) the deterioration of healthcare services, including medicine shortages, weakened health financing due to donor withdrawals, lack of insurance, and poor governance; and (d) the increased perpetuation of misinformation and harmful practices, such as the use of clergymen for medical advice instead of doctors. Using the WHO Health Systems Framework, we recommend solutions that address issues in service delivery, health workforce, health information systems, access to essential medicines, financing, and governance. Conclusions: This is the first qualitative study capturing Afghan mothers’ and healthcare providers’ experiences under Taliban rule. Our findings can inform international efforts to advocate for women’s healthcare and education rights and guide global aid programs in strengthening Afghanistan’s healthcare system in alignment with Sustainable Development Goal 5. Full article

Background: High-voltage injuries associated with train surfing are a distinct subset of electrical injuries, yet detailed analyses remain limited. This study retrospectively reviewed train-surfing injuries admitted between 1994 and 2024, comparing their characteristics and outcomes to work-related high-voltage injuries. Methods: Medical records of 102 patients admitted for high-voltage injuries were analyzed, including 32 train-surfing and 70 work-related cases. Demographics, injury patterns, and clinical outcomes were assessed. Results: Train surfers were predominantly young males (median age 19 years), while work-related injuries involved slightly older males (median age 34 years). Train surfers sustained more severe burns (%TBSA: 47.6% vs. 25.4%, p < 0.0001) and higher ABSI scores (6.7 vs. 5.3, p < 0.01). Vertical electrical flow was predominant in train surfing (65.6%), reflecting contact with overhead lines, while work-related injuries showed varied flow patterns, with diagonal flow being most frequent (58.6%). Train surfers had longer ICU stays (38.7 vs. 17.9 days, p < 0.001) and underwent more surgeries per patient (5.3 vs. 2.8, p < 0.01). Fasciotomy rates were significantly higher among train surfers (84.4% vs. 55.7%, p < 0.01), as were amputations (53.1% vs. 25.7%, p < 0.001). Mortality rates were similar in both groups (25%). Conclusions: Train-surfing injuries represent a distinct and highly severe subgroup of high-voltage trauma, marked by greater burn extent, predominantly vertical electrical flow due to contact with overhead lines, and significantly higher surgical complexity—including increased rates of fasciotomies and amputations. Despite comparable mortality, the clinical burden for train-surfing victims is substantially higher, reflected in longer ICU stays and more operations per patient. These findings underscore the urgent need for targeted prevention strategies addressing youth engagement in train surfing. Public health campaigns, railway infrastructure modifications (e.g., deterrent systems or physical barriers), and early educational interventions could play a critical role in reducing these preventable injuries. Furthermore, trauma centers should be prepared for the specific reconstructive and critical care demands posed by this high-risk group, emphasizing the importance of specialized multidisciplinary management protocols. Full article

Background. Polytrauma is one of the three leading causes of mortality worldwide and a major contributor to psychosocial morbidity and disability. Concomitant traumatic brain injuries further increase this risk. Methods. We present the case of a 6-year-old child who sustained significant trauma in a road accident, resulting in injuries to multiple anatomical regions, including the central nervous system. Results. Two years after the accident, the child experiences brief episodes of decreased visual acuity, dizziness, nausea, pallor, and headaches, along with occasional migraines that resolve spontaneously. Additionally, the child struggles with school adjustment. Brain injuries associated with polytrauma are crucial prognostic factors in both the short and long term, influenced by the brain’s reactivity and recovery capacity. There is also an increased risk of developing syncopal episodes, seizures, and other neurological manifestations. Conclusions. The direct and secondary effects of the trauma have contributed to psychosocial disabilities, necessitating complex medical care and family-centered interventions. Full article

Background. Cow’s Milk Protein Allergy (CMPA) is a prevalent pediatric food allergy affecting 2–5% of infants globally. CMPA presents significant clinical and economic challenges, requiring specialized diagnostic procedures, dietary management with hypoallergenic formulas, and multidisciplinary care. The financial burden on families and healthcare systems includes direct costs (e.g., diagnostic tests, medical consultations, and formula expenses), indirect costs (e.g., caregiver absenteeism and productivity loss), and intangible costs (e.g., psychological distress and impaired quality of life). Economic disparities further exacerbate these challenges, particularly in low-resource settings where access to specialized care is limited. Methods. A systematic review was conducted following PRISMA guidelines using PubMed, CINAHL, Scopus, and Cochrane databases to identify studies on the economic and psychosocial burden of CMPA. Studies published between 2010 and 2024 were analyzed. From an initial search of 11,565 articles, 802 duplicates were removed, leaving 10,763 articles for title and abstract screening. Twenty full-text articles meeting the inclusion criteria were included in the final analysis. Thematic categories focused on direct, indirect, and intangible costs, with findings synthesized to highlight global disparities and policy gaps. Results. CMPA management imposes substantial economic burdens, with hypoallergenic formulas alone accounting for up to 15% of household income in some regions. Indirect costs, including lost workdays and additional childcare expenses, further strain families. Intangible costs, such as heightened caregiver anxiety and reduced social participation, are significant yet frequently overlooked. Healthcare system disparities, particularly regarding insurance coverage for diagnostic tests and therapeutic formulas, contribute to financial inequities. The use of extensively hydrolyzed casein formulas with probiotics has demonstrated cost-effectiveness in promoting immune tolerance while reducing healthcare utilization. Conclusions. Addressing the economic impact of CMPA would benefit from standardized cost assessment frameworks and equitable access to cost-effective therapeutic options. Further analysis of reimbursement policies across diverse healthcare systems may provide insights into optimizing support for essential treatments. Integrating clinical and economic strategies can alleviate the burden on affected families and optimize healthcare resource allocation. Future research should prioritize longitudinal analyses and cross-regional comparisons to guide sustainable and equitable management strategies. Full article

Background: Personalized cancer medicine (PCM) tailors cancer treatments based on individual genetic profiles, enabling more precise and effective therapies. Despite its potential, integrating PCM into clinical practice remains challenging because of organizational and systemic barriers. This study examined the factors influencing PCM implementation at a major cancer center in Stockholm, Sweden. Methods: We conducted semi-structured interviews with 16 medical professionals and management staff from Karolinska University Hospital and Karolinska Institutet. Content analysis was used to identify key themes related to PCM implementation. This study followed the established Consolidated Criteria for Reporting Qualitative Research guidelines to ensure methodological rigor and transparency. Results: Informants framed PCM as both a technological innovation and a patient-centered approach. However, significant barriers to implementation were identified, including organizational inertia, fragmented funding models, and ethical challenges related to access and equity. Structural silos between academic and healthcare institutions complicate integration. Key facilitators include leadership commitment, cross-sectoral collaboration, and a supportive policy environment. Participants emphasized the need for integrated infrastructure, real-time data-sharing mechanisms, and interdisciplinary training programs to support PCM. Conclusions: Successful PCM implementation requires overcoming entrenched organizational and systemic barriers through a multi-stakeholder approach involving healthcare providers, researchers, policymakers, and patient advocates. The findings underscore the necessity of a “third-form organization” to mediate between academia and clinical care. Addressing these challenges requires adaptive governance models, evidence-based policy reforms, and sustainable funding frameworks. Future research should explore comparative contexts to enhance the scalability and generalizability of PCM integration strategies. Full article

Background/Objectives: Orthopedics is a medical specialty that is experiencing a significant increase in the volume of interventions due to an ageing population. By activating remote care pathways, orthopedic surgeons can contribute to improving environmental sustainability. The aim of this research is to develop assessment tools for remote care pathways in orthopedic surgery, inspired by advanced practices of international hospitals. Methods: The research methods consisted in identifying the key areas that make up the remote care pathways in orthopedic surgery and designing appropriate indicators to assess their sustainability. Their levels of achievement were designed by collecting from the literature the most advanced practices reported by hospitals worldwide. The practical validation of the developed model was performed at an orthopedic hospital. Results: Based on the recommendation of the College of Surgeons, we have identified four key areas: remote consultations in orthopedics, incentives for staff travel options, involvement of surgical patients, and minor surgical interventions. In each of these areas, we have designed an indicator, for which we have described the levels of achievement on a scale from 1 to 5. The indicators are also rated for their importance on a scale of 1 to 5, according to the extent to which they influence the achievement of the sustainability objectives. The practical implementation of the developed model at an orthopedic hospital has shown its suitability for the purpose of the research and its compatibility with the certifications held by the hospital. We computed the sustainability indicator in each area as the product between the achievement level and the importance of the indicator. The sum of the four indicators provides the global sustainability indicator. The fulfillment degree of the requirements related to remote care pathways in orthopedic surgery is obtained by reporting the actual value of the global sustainability indicator to the maximum value, which in the explored situation is 61.42%. To have high efficiency for improvement measures we have used the Eisenhower matrix. It is evidenced that the highest priority must be given to the indicator incentives for staff travel options. Conclusions: Implementation of the system in healthcare facilities promotes continuous improvement of remote care pathways in orthopedic surgery, improves environmental sustainability, and thereby contributes to reducing climate change. Full article

Emergency medical services (EMSs) are critical to reducing fatalities and improving patient outcomes in emergencies such as traffic accidents, where response time is a decisive factor. This study proposes a comprehensive and systematic approach to designing and optimizing EMS systems tailored for urban traffic accidents. By integrating Geographic Information Systems (GISs), hypercube queuing models, Economic Value Added (EVA) calculations, and multi-criteria decision-making (MCDM) techniques, we developed a model that balances service efficiency, financial sustainability, and equitable access to emergency care. The hypercube queuing model was applied to estimate key performance metrics, such as response time, coverage, and the GINI index for equity, under varying numbers of ambulances and demand scenarios. In addition, EVA was calculated for different configurations of leased and owned ambulances, offering a financial perspective to assess the viability of public–private partnerships (PPPs) in EMSs. Using the fuzzy Analytic Hierarchy Process (AHP) and CoCoSo (Combined Compromise Solution) methods, this study identified the optimal number of ambulances required to minimize response time, maximize coverage, and ensure financial sustainability. The proposed approach has been applied to a real case in Colombia. Furthermore, integrating leased ambulances offers a financially viable solution with positive EVA values that guarantee the long-term sustainability of the public–private partnership. This paper advances the literature by providing a practical framework for optimizing EMS systems, particularly in developing countries where financial constraints and resource limitations represent significant challenges. The proposed methodology improves service efficiency and economic sustainability and ensures equity in access to life-saving care. Full article