scholarly journals Resource Utilisation and Costs of Depressive Patients in Germany: Results from the Primary Care Monitoring for Depressive Patients Trial

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Christian Krauth ◽  
Jona T. Stahmeyer ◽  
Juliana J. Petersen ◽  
Antje Freytag ◽  
Ferdinand M. Gerlach ◽  
...  
Keyword(s):  
Primary Care ◽  
Economic Burden ◽  
Early Stage ◽  
Resource Utilisation ◽  
Study Results ◽  
Significant Burden ◽  
Male Patients ◽  
Cost Categories ◽  
High Level ◽  
Depressive Patients

Background.Depression is the most common type of mental disorder in Germany. It is associated with a high level of suffering for individuals and imposes a significant burden on society. The aim of this study was to estimate the depression related costs in Germany taking a societal perspective.Materials and Methods.Data were collected from the primary care monitoring for depressive patients trial (PRoMPT) of patients with major depressive disorder who were treated in a primary care setting. Resource utilisation and days of sick leave were observed and analysed over a 1-year period.Results.Average depression related costs of €3813 were calculated. Significant differences in total costs due to sex were demonstrated. Male patients had considerable higher total costs than female patients, whereas single cost categories did not differ significantly. Further, differences in costs according to severity of disease and age were observed. The economic burden to society was estimated at €15.6 billion per year.Conclusion.The study results show that depression poses a significant economic burden to society. There is a high potential for prevention, treatment, and patient management innovations to identify and treat patients at an early stage.

scholarly journals Stage of colorectal cancer diagnosis for immigrants: a population-based retrospective cohort study in Ontario, Canada

2021 ◽  
Author(s):  
A. K. Lofters ◽  
E. Gatov ◽  
H. Lu ◽  
N. N. Baxter ◽  
A. M. Corrado ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Late Stage ◽  
Early Stage ◽  
Population Based ◽  
Administrative Databases ◽  
Related Factors ◽  
Relative Risks ◽  
High Level

Abstract Background Colorectal cancer (CRC) is the second most common cause of cancer death in Canada. Immigrants in Ontario, Canada’s most populous province, are known to have lower rates of CRC screening, but differences in stage of CRC diagnosis are not known. Methods We utilized linked administrative databases to compare early (stage I–II) versus late (stage III–IV) stage of CRC diagnosis for immigrants versus long-term residents among patients diagnosed in Ontario between 2012 and 2017 (n = 37,717) and examined the association of immigration-related, sociodemographic, and healthcare-related factors with stage. Results Almost 45% of those with CRC were diagnosed at a late stage. Immigrants were slightly more likely to be diagnosed at a late stage than their long-term resident counterparts [Adjusted relative risks (ARRs) 1.06 (95% CI 1.02–1.10)], but after adjusting for age and sex, this difference was no longer significant. In fully adjusted models, we observed a higher likelihood of late-stage diagnosis for people with the fewest co-morbidities (ARR 0.86 [95% CI 0.83–0.89]) and those with no visits to primary care (versus a high level of continuity of care) [ARR 1.07 (95% CI 1.03–1.12)]. Conclusion Immigrants were not more likely to have a late-stage CRC diagnosis after adjusting for relevant factors, but access to primary care and healthcare contact was significantly associated with diagnostic stage. Impact Attachment to a primary care provider who provides regular preventive care may play a role in more favorable stage at diagnosis for CRC and thus should be a healthcare system priority.

Therapeutic options in male osteoporosis

2013 ◽  
Vol 22 (04) ◽  
pp. 271-276 ◽  
Author(s):  
P. Farahmand ◽  
J. D. Ringe
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Public Health Problem ◽  
Male Osteoporosis ◽  
Individual Risk ◽  
Modes Of Action ◽  
Increased Risk ◽  
Study Results ◽  
Long Term Treatment ◽  
Male Patients

SummaryOsteoporosis in men is increasingly recognized as an important public health problem but affected patients are still under-diagnosed and -treated. As in women the diagnostic and therapeutic strategy has to be adapted to the individual case. In the practical management it is very important to detect possible causes of secondary osteoporosis, to explain the possibilities of basic therapy counteracting individual risk factors and communicate that osteoporosis is a chronic disease and adherence to a long-term treatment is crucial. In established severe osteoporosis a careful analgesic therapy is important to avoid further bone loss related to immobility. In elderly men with increased risk of falling insufficient Vitamin D supply or impaired activation of Vitamin D due to renal insufficiency must be taken into consideration. Specific medications available today for the treatment of male osteoporosis comprise among antiresorptive drugs the bis phosphonates alendronate, risedronate and zoledronic acid. Denosumab, the first biological therapy is approved for men with androgen deprivation therapy for prostate cancer. An important advantage of this potent antiresorptive drug is the increased adherence due to the comfortable application by sixmonthly subcutaneous injections. Study results from the 2-year multi-center randomized controlled ADAMO-Study will very soon allow the use of denosumab in all types of male osteoporosis. Teriparatide, the 34 N-terminal amino acid sequence of parathyroid hormone was approved for men with osteoporosis as an anabolic agent based on proven efficacy by different studies. Among drugs with other modes of action the D-hormone pro-drug alfacalcidol can be used in men alone or in combination with the advantage of pleiotropic effects on calcium absorption, parathyroids, bone and muscle. Recently also Strontium-ranelate was approved for male patients with the limitation to exclude men with clinical relevant cardiovascular risk factors. In general the possibilities to treat male osteoporosis have considerably improved during recent years. Today there is a choice of a spectrum of drugs from mild to strong potency with different modes of action on bone turnover to design strategies for individual male patients.

CRIMINOLOGICAL FEATURES OF CORRUPTION-RELATED CRIMES IN THE FUEL AND ENERGY COMPLEX

2020 ◽  
pp. 23-27
Author(s):  
Сергей Иванович Вележев ◽  
Антон Михайлович Седогин
Keyword(s):  
Legal Protection ◽  
Criminal Activity ◽  
Criminal Cases ◽  
Law Enforcement Agencies ◽  
Energy Complex ◽  
Significant Damage ◽  
Study Results ◽  
Wide Range ◽  
Illegal Activities ◽  
High Level

В представленной статье авторами рассматриваются вопросы уголовно-правовой охраны топливно-энергетического комплекса Российской Федерации от преступных проявлений, в том числе от коррупционной противоправной деятельности должностных лиц. Такие действия причиняют значительный ущерб нормальному функционированию предприятий топливно-энергетического комплекса. Авторами приводятся результаты исследования некоторых криминологических характеристик должностных лиц, совершивших преступления коррупционного характера. Дан анализ причин и условий, способствующих совершению вышеуказанных противоправных действий. Определена типовая модель преступника для данной категории преступлений и его характеристики: в первую очередь, это высокий уровень компетентности, специальное образование и т. д. Авторами отмечается высокий уровень латентной преступности в данной отрасли. Предложены некоторые пути профилактики данной категории правонарушений. Исследование проводилось на основе анализа конкретных уголовных дел, возбужденных следственными органами по результатам оперативно-розыскной деятельности правоохранительных органов. In the article the authors consider the issues of criminal and legal protection of the fuel and energy complex of the Russian Federation from criminal activity including corrupt illegal practices of officials. The authors cite the results of some criminological characteristics study of the fuel and energy complex staff committed corruption crimes. As a result of these illegal actions significant damage is caused to the normal functioning of the fuel and energy enterprises. Such officials` actions determine not only a wide range of other illegal activities, but also lead to public outcry and discredit the industry as a whole. The analysis of the reasons and conditions contributing to the above illegal actions commission is given. A typical model of a criminal for a given crime category and its characteristics are determined. First of all it is a high level competence, special education, etc. A high level of latent crime in this industry is shown. The study results are presented on the example of specific criminal cases initiated by the investigating authorities based on the results of the operation detection activities of law enforcement agencies. Some ways of preventing this category of offenses are proposed.

scholarly journals Learning health systems in primary care: a systematic scoping review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Danielle M. Nash ◽  
Zohra Bhimani ◽  
Jennifer Rayner ◽  
Merrick Zwarenstein
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Health Systems ◽  
Scoping Review ◽  
Early Stage ◽  
Point Of Care ◽  
The United States ◽  
Stage Of Development ◽  
Integrated Health ◽  
Google Search

Abstract Background Learning health systems have been gaining traction over the past decade. The purpose of this study was to understand the spread of learning health systems in primary care, including where they have been implemented, how they are operating, and potential challenges and solutions. Methods We completed a scoping review by systematically searching OVID Medline®, Embase®, IEEE Xplore®, and reviewing specific journals from 2007 to 2020. We also completed a Google search to identify gray literature. Results We reviewed 1924 articles through our database search and 51 articles from other sources, from which we identified 21 unique learning health systems based on 62 data sources. Only one of these learning health systems was implemented exclusively in a primary care setting, where all others were integrated health systems or networks that also included other care settings. Eighteen of the 21 were in the United States. Examples of how these learning health systems were being used included real-time clinical surveillance, quality improvement initiatives, pragmatic trials at the point of care, and decision support. Many challenges and potential solutions were identified regarding data, sustainability, promoting a learning culture, prioritization processes, involvement of community, and balancing quality improvement versus research. Conclusions We identified 21 learning health systems, which all appear at an early stage of development, and only one was primary care only. We summarized and provided examples of integrated health systems and data networks that can be considered early models in the growing global movement to advance learning health systems in primary care.

scholarly journals Testing the Mig-HealthCare Algorithm in Greece

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Riza ◽  
P Karnaki ◽  
D Zota ◽  
A Linos
Keyword(s):  
Health Care ◽  
Early Stage ◽  
Health Care Systems ◽  
Health Conditions ◽  
Health Issues ◽  
Host Countries ◽  
Local Hospital ◽  
Raising Awareness ◽  
Significant Burden ◽  
Care Systems

Abstract The Mig-HealthCare Algorithm is a tool, comprising a set of questions developed with the aim to (a) guide the user on how to access all the categories and tools that are available through the Roadmap & Toolbox (b) help the user identify the health issues of importance when providing care to a specific migrant/refugee. At the end of a series of questions, a brief report summarizing the main outcomes is generated. The algorithm was tested in Greece in two mainland reception centres and a local hospital in an area serving migrants/refugees. Results discuss the usefulness of the algorithm for improving the delivery of appropriate health services to migrants/refugees and its importance in raising awareness about the health conditions which are crucial for migrants/refugees and are expected to pose a significant burden on the health care systems of host countries unless dealt with adequately at an early stage.

scholarly journals Understanding the clinical reasoning processes involved in the management of multimorbidity in an ambulatory setting: study protocol of a stimulated recall research

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
M.-C. Audétat ◽  
S. Cairo Notari ◽  
J. Sader ◽  
C. Ritz ◽  
T. Fassier ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Reasoning ◽  
Primary Care Physicians ◽  
Video Sequence ◽  
Structured Interview ◽  
Ambulatory Setting ◽  
Structured Interviews ◽  
Stimulated Recall ◽  
Study Results

Abstract Background Primary care physicians are at the very heart of managing patients suffering from multimorbidity. However, several studies have highlighted that some physicians feel ill-equipped to manage these kinds of complex clinical situations. Few studies are available on the clinical reasoning processes at play during the long-term management and follow-up of patients suffering from multimorbidity. This study aims to contribute to a better understanding on how the clinical reasoning of primary care physicians is affected during follow-up consultations with these patients. Methods A qualitative research project based on semi-structured interviews with primary care physicians in an ambulatory setting will be carried out, using the video stimulated recall interview method. Participants will be filmed in their work environment during a standard consultation with a patient suffering from multimorbidity using a “button camera” (small camera) which will be pinned to their white coat. The recording will be used in a following semi-structured interview with physicians and the research team to instigate a stimulated recall. Stimulated recall is a research method that allows the investigation of cognitive processes by inviting participants to recall their concurrent thinking during an event when prompted by a video sequence recall. During this interview, participants will be prompted by different video sequence and asked to discuss them; the aim will be to encourage them to make their clinical reasoning processes explicit. Fifteen to twenty interviews are planned to reach data saturation. The interviews will be transcribed verbatim and data will be analysed according to a standard content analysis, using deductive and inductive approaches. Conclusion Study results will contribute to the scientific community’s overall understanding of clinical reasoning. This will subsequently allow future generation of primary care physicians to have access to more adequate trainings to manage patients suffering from multimorbidity in their practice. As a result, this will improve the quality of the patient’s care and treatments.

scholarly journals Primary Care Networks and Starfield’s 4Cs: A Case for Enhanced Chronic Disease Management

2021 ◽  
Vol 18 (6) ◽  
pp. 2926
Author(s):  
Chuan De Foo ◽  
Shilpa Surendran ◽  
Geronimo Jimenez ◽  
John Pastor Ansah ◽  
David Bruce Matchar ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Early Stage ◽  
Healthcare Delivery ◽  
Stage Of Development ◽  
Facilitators And Barriers ◽  
Design Options ◽  
First Contact

The primary care network (PCN) was implemented as a healthcare delivery model which organises private general practitioners (GPs) into groups and furnished with a certain level of resources for chronic disease management. A secondary qualitative analysis was conducted with data from an earlier study exploring facilitators and barriers GPs enrolled in PCN’s face in chronic disease management. The objective of this study is to map features of PCN to Starfield’s “4Cs” framework. The “4Cs” of primary care—comprehensiveness, first contact access, coordination and continuity—offer high-quality design options for chronic disease management. Interview transcripts of GPs (n = 30) from the original study were purposefully selected. Provision of ancillary services, manpower, a chronic disease registry and extended operating hours of GP practices demonstrated PCN’s empowering features that fulfil the “4Cs”. On the contrary, operational challenges such as the lack of an integrated electronic medical record and disproportionate GP payment structures limit PCNs from maximising the “4Cs”. However, the enabling features mentioned above outweighs the shortfalls in all important aspects of delivering optimal chronic disease care. Therefore, even though PCN is in its early stage of development, it has shown to be well poised to steer GPs towards enhanced chronic disease management.

Lung nodule classification using combination of CNN, second and higher order texture features

2021 ◽  
pp. 1-9
Author(s):  
Amrita Naik ◽  
Damodar Reddy Edla
Keyword(s):  
Malignant Tumors ◽  
Early Stage ◽  
Lung Nodule ◽  
Texture Features ◽  
Svm Classifier ◽  
Softmax Classifier ◽  
Spatial Features ◽  
High Level ◽  
Learning Architectures ◽  
Nodule Classification

Lung cancer is the most common cancer throughout the world and identification of malignant tumors at an early stage is needed for diagnosis and treatment of patient thus avoiding the progression to a later stage. In recent times, deep learning architectures such as CNN have shown promising results in effectively identifying malignant tumors in CT scans. In this paper, we combine the CNN features with texture features such as Haralick and Gray level run length matrix features to gather benefits of high level and spatial features extracted from the lung nodules to improve the accuracy of classification. These features are further classified using SVM classifier instead of softmax classifier in order to reduce the overfitting problem. Our model was validated on LUNA dataset and achieved an accuracy of 93.53%, sensitivity of 86.62%, the specificity of 96.55%, and positive predictive value of 94.02%.

The assessment of depressive patients’ involvement in decision making in audio-taped primary care consultations

2006 ◽  
Vol 63 (3) ◽  
pp. 314-318 ◽  
Author(s):  
Andreas Loh ◽  
Daniela Simon ◽  
Katrin Hennig ◽  
Benjamin Hennig ◽  
Martin Härter ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Depressive Patients

Comparison of Functional Ability Following Percutaneous and Open Surgical Repairs of Acutely Ruptured Achilles Tendons

1993 ◽  
Vol 2 (2) ◽  
pp. 115-127 ◽  
Author(s):  
Gregory J. Steele ◽  
Rod A. Harter ◽  
Arthur J. Ting
Keyword(s):  
Achilles Tendon ◽  
Open Repair ◽  
Plantar Flexion ◽  
Secondary Purpose ◽  
Percutaneous Repair ◽  
Study Results ◽  
Male Patients ◽  
Flexion Strength ◽  
Repair Group ◽  
Repair Techniques

The purpose of our study was to evaluate the functional outcomes of two methods of surgical treatment of acute closed raptures of the Achilles tendon, specifically, the primary open repair and the percutaneous repair techniques, utilizing (a) isokinetic plantar flexion strength, (b) midcalf girth, (c) ankle joint proprioception, and (d) ankle range of motion values. As a secondary purpose, the frequency of reruptures and postsurgical complications were compared between techniques. Twenty male patients (mean age, 43.8 ± 9.4 years) who sustained complete, closed ruptures of the Achilles tendon participated in this study. Results of pairedttests revealed significant differences between postsurgical and contralateral normal limbs for 6 of 12 variables. Results of the ANOVAs revealed no significant differences between the open repair group and percutaneous repair group for any of the evaluative parameters. The significant deficits in postoperative isokinetic plantar flexion strength and midcalf girth measurements, irrespective of surgical technique, suggest an incompleteness of rehabilitation or, more likely, the physiological inability to regain these characteristics postoperatively.

Sign in / Sign up

Export Citation Format

Share Document