scholarly journals The Super-Wicked Problem of Antimicrobial Resistance

2020 ◽  
pp. 421-443
Author(s):  
Jasper Littmann ◽  
A. M. Viens ◽  
Diego S. Silva
Keyword(s):  
Antimicrobial Resistance ◽  
Global Economy ◽  
Bacterial Infections ◽  
Health Care Systems ◽  
Modern Medicine ◽  
Social Consequences ◽  
Wicked Problem ◽  
Lost Productivity ◽  
Care Systems ◽  
To Come

Abstract Antimicrobial resistance (AMR) – the progressive process by which microbes, such as bacteria, through evolutionary, environmental and social factors develop the ability to become resistant to drugs that were once effective at treating them – is a threat from which no one can escape. It is one of the largest threats to clinical and global health in the twenty-first century – inflicting monumental health, economic and social consequences. All persons locally and globally, and even all future persons yet to come into existence, all suffer the shared, interdependent vulnerability to this threat that will have a substantial impact on all aspects of our lives. For example, while reliable data are hard to find, the European Centre for Disease Prevention and Control (ECDC) has conservatively estimated that, in Europe alone, AMR causes additional annual cost to health care systems of at least €1.5 billion, and is responsible for around 25,000 deaths per year. Furthermore, AMR significantly increases the cost of treating bacterial infections with an increase in length of hospital stays and average number of re-consultations, as well as the resultant lost productivity from increased morbidity. With a combined cost of up to $100 trillion to the global economy – pushing a further 28 million people into extreme poverty – this is one of the most pressing challenges facing the world. Most troublingly, if we do not succeed in diminishing the progression of AMR, there is the very real potential for it to threaten common procedures and treatments of modern medicine, including the safety and efficacy of surgical procedures and immunosuppressing chemotherapy. Some experts are warning that we may soon be ushering in a post-antibiotic area.

Financing Health Care in the Viceroyalty of Peru: The Hospitals of Lima in the Late Colonial Period

1995 ◽  
Vol 52 (2) ◽  
pp. 123-154 ◽  
Author(s):  
David Cahill
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
A Priori ◽  
Modern Medicine ◽  
Welfare States ◽  
Spanish America ◽  
American Health Care ◽  
Care Systems ◽  
Adequate Provision ◽  
To Come

Perceptions of provision for health care in colonial Spanish America are invariably influenced by commonplaces familiar from the comparative history of pre-modern medicine. There is a danger that the reproduction of facile a priori judgements–such as lack of adequate provision, institutional underfunding, deficient nutrition, insanitary conditions, concomitant high mortality rates, and “Dickensian” institutions functioning as workhouses and death-traps for the poor–will distort our understanding of Spanish American health-care systems, such clichés being all too often simplistic, anachronistic, or culturally purblind. Moreover, the whole system, such as it was, may at first sight appear to have depended largely upon the desultory charity of some religious orders and a few pious individuals, with the royal exchequer occasionally rescuing financially-straitened institutions from the brink of bankruptcy and foreclosure. Like most such formulations, there is enough truth to this simplistic scenario for it to be a plausible enough portrait of health care not only in colonial Spanish America but in early modern Spain itself; indeed, of any pre-modern system of health provision. Some of these pejorative impressions–e.g., lack of adequate provision, underfunding–are hardy perennials that even today retain their currency in the wealthiest of welfare states, and are writ especially large in Third World countries. Then as now, such strictures, well-founded or not, are but part of the picture, and overlook considerable institutional achievements in making the best of available resources. Much of this criticism is of course susceptible to quantitative analysis, though statistical data on colonial health care are difficult to come by. As in so many spheres of colonial Spanish America, such figures as are available cluster in the second half of the eighteenth century, a product of the insatiable appetite of Bourbon ministers and bureaucrats for a quantitative dimension to policy-making.

scholarly journals Separating the wheat from the chaff – COVID-19 in a German emergency department: A Case-control study

2020 ◽  
Author(s):  
David Fistera ◽  
Dirk Pabst ◽  
Annalena Härtl ◽  
Benedikt Michael Schaarschmidt ◽  
Lale Umutlu ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Care Systems ◽  
University Hospital ◽  
Nasopharyngeal Swab ◽  
Workflow Model ◽  
Manchester Triage System ◽  
Efficient Management ◽  
Care Systems ◽  
To Come ◽  
The University

Abstract Background: COVID-19 pandemia is a major challenge to worldwide health care systems. Whereas the majority of disease presents with mild symptoms that can be treated as outpatients, severely ill COVID-19 patients and patients presenting with similar symptoms cross their ways in the Emergency Department. Especially the variety of symptoms is challenging with primary triage. Are there parameters to distinguish between proven COVID-19 and without before? How can a safe and efficient management of these inpatients be achieved?Methods: We conducted a retrospective analysis of 314 consecutive inpatient patients who presented with possible symptoms of COVID-19 in a German emergency department between March and April 2020 and were tested with a SARS-Cov-2 nasopharyngeal swab. Clinical parameters, Manchester Triage System categories and lab results were compared between patients with positive and negative test results for SARS-Cov-2. Furthermore, we present the existing COVID-19 workflow model of the university hospital in Essen which proved to be efficient during pandemia.Results: 43 of the 314 patients (13.7%) were tested positive for COVID-19 by SARS-Cov-2 nasopharyngeal swab. We did not find any laboratory parameter to distinguish safely between patients with COVID-19 and those with similar symptoms. Dysgeusia was the only clinical symptom that was significantly more frequent among COVID-19 patients. Conclusion: Dysgeusia seems to be a typical symptom for COVID-19, which occurred in 14% of our COVID-19 patients. However, no valid parameters could be found to distinguish clinically between COVID-19 and other diseases with similar symptoms. Therefore, early testing, a strict isolation policy and proper personal protection are crucial to maintain workflow and safety of patients and ED staff for the months to come.Trial registration: URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021675

scholarly journals Preventing and managing antimicrobial resistance in the African region: A scoping review protocol

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254737
Author(s):  
Chinwe Juliana Iwu-Jaja ◽  
Anelisa Jaca ◽  
Ishmael Festus Jaja ◽  
Portia Jordan ◽  
Phelele Bhengu ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Infectious Diseases ◽  
Scoping Review ◽  
Health Care Systems ◽  
Grey Literature ◽  
Antibiotic Consumption ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
African Region ◽  
Care Systems

Introduction Antimicrobial resistance (AMR) constitutes a significant threat to global health and food security, typically associated with high morbidity and mortality rate. The high burden of infectious diseases coupled with the weak health systems in most countries of Africa magnifies the risk of increasing AMR and its consequences thereof. This scoping review will be aimed at mapping the evidence on interventions used to prevent and manage antimicrobial resistance in Africa, guided by the “One Health” concept. Methods We will consider interventions targeting multiple sectors such as health care systems, the agricultural and veterinary sectors. The outcomes to be considered include reduction of AMR decreased morbidity and mortality due to infectious diseases, increased awareness for rational use of antimicrobials and reduced antibiotic consumption. We will include all types of studies regardless of study designs conducted within the context of the WHO African region. Studies will be excluded if they are not conducted in Africa and if they are literature reviews, only describing the concept of AMR without mentioning interventions. We will include studies identified through a comprehensive search of peer-reviewed and grey literature databases. In addition, we will search the reference lists of included studies and relevant reviews. Finally, we plan to do a citation search for included studies. Findings of this review will be narratively synthesized.

Health care and the future of economic growth: exploring alternative perspectives

2019 ◽  
Vol 15 (4) ◽  
pp. 419-439 ◽  
Author(s):  
Martin Hensher ◽  
John Tisdell ◽  
Ben Canny ◽  
Craig Zimitat
Keyword(s):  
Economic Growth ◽  
Health Care ◽  
Health Expenditure ◽  
Global Economy ◽  
Global Financial Crisis ◽  
Health Care Systems ◽  
Health Financing ◽  
Well Being ◽  
Gdp Growth ◽  
Care Systems

AbstractThe strong and positive relationship between gross domestic product (GDP) and health expenditure is one of the most extensively explored topics in health economics. Since the global financial crisis, a variety of theories attempting to explain the slow recovery of the global economy have predicted that future economic growth will be slower than in the past. Others have increasingly questioned whether GDP growth is desirable or sustainable in the long term as evidence grows of humanity's impact on the natural environment. This paper reviews recent data on trends in global GDP growth and health expenditure. It examines a range of theories and scenarios concerning future global GDP growth prospects. It then considers the potential implications for health care systems and health financing policy of these different scenarios. In all cases, a core question concerns whether growth in GDP and/or growth in health expenditure in fact increases human health and well-being. Health care systems in low growth or ‘post-growth’ futures will need to be much more tightly focused on reducing overtreatment and low value care, reducing environmental impact, and on improving technical and allocative efficiency. This will require much more concerted policy and regulatory action to reduce industry rent-seeking behaviours.

Health Policy

2020 ◽  
pp. 463-480
Author(s):  
Christy Ford Chapin
Keyword(s):  
Health Care ◽  
Private Health Insurance ◽  
Health Care Policy ◽  
Health Care Systems ◽  
Modern Medicine ◽  
Government Programs ◽  
Economic Framework ◽  
Care Systems ◽  
History Of ◽  
The Subject

This article reviews the history of the U.S. health care system and important themes in the scholarly literature pertaining to the subject. It argues that understanding the politics of health care, including the structure of government programs such as Medicare, requires careful attention to the private sector’s economic framework. This essay traces the development of modern medicine, health care systems in the 20th century, private health insurance, and federal and state health care policy.

scholarly journals Structured headache services as the solution to the ill-health burden of headache. 3. Modelling effectiveness and cost-effectiveness of implementation in Europe: findings and conclusions

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Michela Tinelli ◽  
Matilde Leonardi ◽  
Koen Paemeleire ◽  
Alberto Raggi ◽  
Dimos Mitsikostas ◽  
...  
Keyword(s):  
Health Care ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Health Care Systems ◽  
Analytical Models ◽  
Life Years ◽  
Headache Type ◽  
Lost Productivity ◽  
Care Systems

Abstract Background There have been several calls for estimations of costs and consequences of headache interventions to inform European public-health policies. In a previous paper, in the absence of universally accepted methodology, we developed headache-type-specific analytical models to be applied to implementation of structured headache services in Europe as the health-care solution to headache. Here we apply this methodology and present the findings. Methods Data sources were published evidence and expert opinions, including those from an earlier economic evaluation framework using the WHO-CHOICE model. We used three headache-type-specific analytical models, for migraine, tension-type-headache (TTH) and medication-overuse-headache (MOH). We considered three European Region case studies, from Luxembourg, Russia and Spain to include a range of health-care systems, comparing current (suboptimal) care versus target care (structured services implemented, with provider-training and consumer-education). We made annual and 5-year cost estimates from health-care provider and societal perspectives (2020 figures, euros). We expressed effectiveness as healthy life years (HLYs) gained, and cost-effectiveness as incremental cost-effectiveness-ratios (ICERs; cost to be invested/HLY gained). We applied WHO thresholds for cost-effectiveness. Results The models demonstrated increased effectiveness, and cost-effectiveness (migraine) or cost saving (TTH, MOH) from the provider perspective over one and 5 years and consistently across the health-care systems and settings. From the societal perspective, we found structured headache services would be economically successful, not only delivering increased effectiveness but also cost saving across headache types and over time. The predicted magnitude of cost saving correlated positively with country wage levels. Lost productivity had a major impact on these estimates, but sensitivity analyses showed the intervention remained cost-effective across all models when we assumed that remedying disability would recover only 20% of lost productivity. Conclusions This is the first study to propose a health-care solution for headache, in the form of structured headache services, and evaluate it economically in multiple settings. Despite numerous challenges, we demonstrated that economic evaluation of headache services, in terms of outcomes and costs, is feasible as well as necessary. Furthermore, it is strongly supportive of the proposed intervention, while its framework is general enough to be easily adapted and implemented across Europe.

scholarly journals An Osteopathic Perspective on COVID-19: Is There a Missing Link to Treatment?

2020 ◽  
Vol 30 (3) ◽  
pp. 7-14
Author(s):  
Richard Chmielewski
Keyword(s):  
Lymphatic System ◽  
Health Care Systems ◽  
Developed Countries ◽  
Modern Medicine ◽  
Pulmonary Complications ◽  
Missing Link ◽  
The Public ◽  
Technological Interventions ◽  
Care Facilities ◽  
Care Systems

Abstract As the COVID-19 pandemic progressed across the globe, clinical reports and autopsies on patient deaths proved that the pulmonary complications were the result of an acute respiratory distress syndrome caused by an excessive inflammatory response; a cytokine storm. Through literature research and review it has become apparent to the author that the lymphatic system is a vital, somewhat overlooked, missing link in the treatment of COVID-19 pulmonary infection. The major challenges the whole world is facing now have been a shortage of supplies such as PPE, or personal protective equipment, and intensive care facilities to treat the overwhelming numbers of COVID-19 cases, in under-developed countries as well as developed countries. Osteopathic manipulative medicine (OMM) and osteopathic manipulative treatment (OMT) have been proven, for over a century, to be very effective in the treatment of pulmonary diseases and previous pandemics. Osteopathic professionals must challenge the present paradigm of modern medicine which, only too often, relies less on the body’s own capacity to regulate itself, to compensate, and to heal, and more on outside intervention such as medications and vaccinations. Osteopathic physicians are needed to step forward and discuss, explain, teach and train the importance of the lymphatic system as a major component of the circulatory as well as the immune system which plays a vital, pivotal, role in fighting diseases such as the COVID-19 coronavirus. A “viral infection protocol” (VIP), as discussed in this article, needs to be promoted as a mainstream adjunct, along with all of the other modalities of modern medicine, to health professionals and the public, in the event that the health care systems are overwhelmed. The VIP treatment is easy to train and to certify practitioners, with proven results in other pulmonary infections and epidemics. It may prove invaluable in preventing clinical deterioration of masses of patients, who then would require more expensive, less available, and more dangerous technological interventions.

scholarly journals A One Health genomic approach to antimicrobial resistance is essential for generating relevant data for a holistic assessment of the biggest threat to public health

2019 ◽  
Vol 40 (2) ◽  
pp. 73
Author(s):  
Steven P Djordjevic ◽  
Branwen S Morgan
Keyword(s):  
Antimicrobial Resistance ◽  
Infectious Diseases ◽  
Global Economy ◽  
One Health ◽  
Global Financial Crisis ◽  
Modern Medicine ◽  
The World Bank ◽  
Medical Sector ◽  
Genomic Approach ◽  
Hospital Stays

Antimicrobial resistance (AMR) threatens modern medicine as we know it. AMR infections may ultimately be untreatable and routine surgeries will become inherently risky1. By 2050 more people may die of drug-resistant infections (DRIs) every year than of cancer, which equates to more than 10 million annual deaths globally2 and the World Bank has estimated that AMR could cost the global economy $1 trillion every year after 2030. DRIs also lead to an increase in the length of hospital stays, the use of more toxic or costly antibiotics and an increased likelihood of death3. BRIC nations (Brazil, Russia, India, China) and socio-economically challenged countries and people who already have higher rates of infectious diseases will feel the greatest impact2. Indeed, AMR has been likened to the 2008 global financial crisis on an annual repeat cycle. That is because the effects of AMR are not just confined to the human medical sector. The veterinary sector is also reliant on the availability of antimicrobials to treat infectious diseases in companion and food-producing animals.

scholarly journals The Best Peptidomimetic Strategies to Undercover Antibacterial Peptides

2020 ◽  
Vol 21 (19) ◽  
pp. 7349
Author(s):  
Joanna Izabela Lachowicz ◽  
Kacper Szczepski ◽  
Alessandra Scano ◽  
Cinzia Casu ◽  
Sara Fais ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Health Care Systems ◽  
Drug Resistant ◽  
Antibacterial Peptides ◽  
Living Matter ◽  
Nobel Lecture ◽  
Naturally Occurring ◽  
Increased Risk ◽  
Care Systems ◽  
Risk Of Disease

Health-care systems that develop rapidly and efficiently may increase the lifespan of humans. Nevertheless, the older population is more fragile, and is at an increased risk of disease development. A concurrently growing number of surgeries and transplantations have caused antibiotics to be used much more frequently, and for much longer periods of time, which in turn increases microbial resistance. In 1945, Fleming warned against the abuse of antibiotics in his Nobel lecture: “The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant”. After 70 years, we are witnessing the fulfilment of Fleming’s prophecy, as more than 700,000 people die each year due to drug-resistant diseases. Naturally occurring antimicrobial peptides protect all living matter against bacteria, and now different peptidomimetic strategies to engineer innovative antibiotics are being developed to defend humans against bacterial infections.

scholarly journals Biogenic Nanosilver against Multidrug-Resistant Bacteria (MDRB)

Antibiotics ◽  
2018 ◽  
Vol 7 (3) ◽  
pp. 69 ◽  
Author(s):  
Caio Barros ◽  
Stephanie Fulaz ◽  
Danijela Stanisic ◽  
Ljubica Tasic
Keyword(s):  
Health Care ◽  
Silver Nanoparticles ◽  
Bacterial Infections ◽  
Health Care Systems ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
New Paradigm ◽  
Multidrug Resistant Bacteria ◽  
Care Systems

Multidrug-resistant bacteria (MDRB) are extremely dangerous and bring a serious threat to health care systems as they can survive an attack from almost any drug. The bacteria’s adaptive way of living with the use of antimicrobials and antibiotics caused them to modify and prevail in hostile conditions by creating resistance to known antibiotics or their combinations. The emergence of nanomaterials as new antimicrobials introduces a new paradigm for antibiotic use in various fields. For example, silver nanoparticles (AgNPs) are the oldest nanomaterial used for bactericide and bacteriostatic purposes. However, for just a few decades these have been produced in a biogenic or bio-based fashion. This review brings the latest reports on biogenic AgNPs in the combat against MDRB. Some antimicrobial mechanisms and possible silver resistance traits acquired by bacteria are also presented. Hopefully, novel AgNPs-containing products might be designed against MDR bacterial infections.

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