The Excess Costs of Dementia: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-22
Author(s):  
Nadine Sontheimer ◽  
Alexander Konnopka ◽  
Hans-Helmut König
Keyword(s):  
Health Care Systems ◽  
Meta Analysis ◽  
Global Scale ◽  
Cochrane Library ◽  
Nursing Facilities ◽  
Policy Makers ◽  
Time Period ◽  
Excess Costs ◽  
Care Systems ◽  
Cost Studies

Background: Dementia is one of the costliest diseases for health care systems with growing importance for policy makers. Objective: The aim of this study is to systematically review the current literature of excess cost studies for dementia and to analyze excess costs in a meta-analysis. Methods: A systematic literature search was conducted in PubMed, EconLit, NHS-EED, and Cochrane Library. 22 studies were included and assigned to one of three subgroups according to the time period that they analyzed during disease progression: the time of diagnosis, the time between diagnosis and death, and the time prior to death. Excess costs were analyzed using the ratio of means (ROM) and meta-analysis was performed by pooling ROMs in a random effects model. Results: Total costs were significantly higher for demented persons compared to non-demented persons at the time of diagnosis (ROM: 2.08 [1.71, 2.54], p <  0.00001, I 2 = 98%) and in the time period between diagnosis and death (ROM: 2.19 [1.97, 2.44], p <  0.00001, I 2 = 100%). The ROM was highest for professional home care (ROM: 4.96 [2.62, 9.40], p <  0.0001, I 2 = 88%) and for nursing facilities (ROM: 4.02 [2.53, 6.40], p <  0.00001, I 2 = 100%) for the time period between diagnosis and death. Conclusion: This meta-analysis is the first to assess excess costs of dementia by the ROM method on a global scale. We conclude that our findings demonstrate that costs of dementia constitute a substantial economic burden.

The Golden Hour After Injury Among Civilians Caught in Conflict Zones

2019 ◽  
Vol 13 (5-6) ◽  
pp. 1074-1082 ◽  
Author(s):  
Joseph D. Forrester ◽  
Auriel August ◽  
Lawrence Z. Cai ◽  
Adam L. Kushner ◽  
Sherry M. Wren
Keyword(s):  
Democratic Republic Of Congo ◽  
Health Care Systems ◽  
Standard Of Care ◽  
Transport Time ◽  
Conflict Zones ◽  
Golden Hour ◽  
Time Period ◽  
Field Triage ◽  
Care Systems ◽  
Rapid Transport

ABSTRACTIntroduction:The term “golden hour” describes the first 60 minutes after patients sustain injury. In resource-available settings, rapid transport to trauma centers within this time period is standard-of-care. We compared transport times of injured civilians in modern conflict zones to assess the degree to which injured civilians are transported within the golden hour in these environments.Methods:We evaluated PubMed, Ovid, and Web of Science databases for manuscripts describing transport time after trauma among civilian victims of trauma from January 1990 to November 2017.Results:The initial database search identified 2704 abstracts. Twenty-nine studies met inclusion and exclusion criteria. Conflicts in Yugoslavia/Bosnia/Herzegovina, Syria, Afghanistan, Iraq, Israel, Cambodia, Somalia, Georgia, Lebanon, Nigeria, Democratic Republic of Congo, and Turkey were represented, describing 47 273 patients. Only 7 (24%) manuscripts described transport times under 1 hour. Transport typically required several hours to days.Conclusion:Anticipated transport times have important implications for field triage of injured persons in civilian conflict settings because existing overburdened civilian health care systems may become further overwhelmed if in-hospital health capacity is unable to keep pace with inflow of the severely wounded.

Machines and Medicines: A Projection of Analogies between Electric Power Systems and Health Care Systems

1986 ◽  
Vol 2 (2) ◽  
pp. 285-295
Author(s):  
Thomas P. Hughes
Keyword(s):  
Health Care ◽  
Power Systems ◽  
Policy Making ◽  
Health Care Systems ◽  
Electric Power Systems ◽  
Policy Makers ◽  
Care Systems ◽  
History Of ◽  
Large Systems ◽  
Capital Intensive

If medicine is becoming mechanized, as many indications suggest, then those interested in policy making for medical matters have much to learn from the history of technology. The mechanization of medicine, as in the case of the mechanization of production, will accelerate the transfer of skill and knowledge from people to machines and the transition of health care to a capital intensive industry (19, 196–226). Furthermore, mechanization and increasing capital intensification may bring the increased systematization of health care. If the development of mechanized medicine follows the precedent of the mechanization of production, then our society must deal with the evolution of another set of extremely large systems, systems that will become virtually impervious to social control. Historians of technology are currently providing a better understanding of the evolution of large systems of production (3;9;10); there are lessons to be learned from this history by policy makers in health care.

Health of Newcomers

2017 ◽  
Author(s):  
Patricia Illingworth ◽  
Wendy E. Parmet
Keyword(s):  
Health Care ◽  
Global Climate ◽  
Health Care Systems ◽  
Vital Role ◽  
Health Policies ◽  
Global Public Good ◽  
Policy Makers ◽  
Native Populations ◽  
Care Systems ◽  
The Right

Immigration and health are two of the most contentious issues facing policy makers today. Policies that relate to both issues—to the health of newcomers—often reflect misimpressions about immigrants, their health, and their impact on health care systems. Although immigrants are typically younger and healthier than natives, and many newcomers play a vital role in providing care in their new lands, natives are often reluctant to extend basic health care to immigrants. Likewise, many nations turn against immigrants when epidemics strike, falsely believing that native populations can be kept well by keeping immigrants out. This book demonstrates how such reactions thwart attempts to create efficient and effective health policies and efforts to promote public health. The book argues that because health is a global public good and people benefit from the health of neighbor and stranger alike, it is in everyone’s interest to ensure the health of all. Reviewing issues as diverse as medical repatriation, epidemic controls, the right to health, the medical brain drain, organ tourism, and global climate change, the book shows why solidarity between natives and newcomers is ethically required and in the service of health for all.

scholarly journals Workplace Stress among Nurses

2019 ◽  
Vol 4 (12) ◽  
Author(s):  
Alqahtani Ibtesam Mohammed
Keyword(s):  
Occupational Stress ◽  
Work Performance ◽  
Health Care Systems ◽  
Meta Analysis ◽  
Theoretical Models ◽  
Workplace Stress ◽  
Work Environments ◽  
Work Related ◽  
Care Systems ◽  
Work Related Stressors

Worldwide, occupational stress among care professionals, nurses in particular, is a major concern in health care systems. Work stress in nursing is linked to high rates of job dissatisfaction, burnout, absenteeism, turnover, and stress-related illness, thus placing job performance among nurses’ and patients’ lives at risk. The purpose of this integrative review is to explore the concepts of occupational stress among nurses. Three main theoretical models are included to illustrate different viewpoints of occupational stress. Meta-analysis of the basic literature and the results of previous research are used. Findings from studies have shown that evaluations of nursing work environments reflect a strong link with burnout. The excessive workload of nursing professionals, complexity of patient care activities, poor organized work environments, and lack of leaders’ support are considered as contributing factor to the job stress which has resulted in providing unsafe care. The findings highlight that nurses frequently experience occupational stress due to the nature of the nursing profession. Thus, it is critical to implement effective organizational interventions to minimize work-related stressors and work performance of nurses. It is significant to have supportive working environments that encourage collaboration and empower nurses to provide excellent care and reduce work-related stressors.

scholarly journals Interventions to reduce low-value imaging – a systematic review of interventions and outcomes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elin Kjelle ◽  
Eivind Richter Andersen ◽  
Lesley J. J. Soril ◽  
Leti van Bodegom-Vos ◽  
Bjørn Morten Hofmann
Keyword(s):  
Systematic Review ◽  
Health Care Systems ◽  
Health Planning ◽  
Final Analysis ◽  
Single Component ◽  
Cochrane Library ◽  
Medical Subject Headings ◽  
Medical Overuse ◽  
Care Systems ◽  
The Impact

Abstract Background It is estimated that 20–50% of all radiological examinations are of low value. Many attempts have been made to reduce the use of low-value imaging. However, the comparative effectiveness of interventions to reduce low-value imaging is unclear. Thus, the objective of this systematic review was to provide an overview and evaluate the outcomes of interventions aimed at reducing low-value imaging. Methods An electronic database search was completed in Medline – Ovid, Embase-Ovid, Scopus, and Cochrane Library for citations between 2010 and 2020. The search was built from medical subject headings for Diagnostic imaging/Radiology, Health service misuse or medical overuse, and Health planning. Keywords were used for the concept of reduction and avoidance. Reference lists of included articles were also hand-searched for relevant citations. Only articles written in English, German, Danish, Norwegian, Dutch, and Swedish were included. The Mixed Methods Appraisal Tool was used to appraise the quality of the included articles. A narrative synthesis of the final included articles was completed. Results The search identified 15,659 records. After abstract and full-text screening, 95 studies of varying quality were included in the final analysis, containing 45 studies found through hand-searching techniques. Both controlled and uncontrolled before-and-after studies, time series, chart reviews, and cohort studies were included. Most interventions were aimed at referring physicians. Clinical practice guidelines (n = 28) and education (n = 28) were most commonly evaluated interventions, either alone or in combination with other components. Multi-component interventions were often more effective than single-component interventions showing a reduction in the use of low-value imaging in 94 and 74% of the studies, respectively. The most addressed types of imaging were musculoskeletal (n = 26), neurological (n = 23) and vascular (n = 16) imaging. Seventy-seven studies reported reduced low-value imaging, while 3 studies reported an increase. Conclusions Multi-component interventions that include education were often more effective than single-component interventions. The contextual and cultural factors in the health care systems seem to be vital for successful reduction of low-value imaging. Further research should focus on assessing the impact of the context in interventions reducing low-value imaging and how interventions can be adapted to different contexts.

scholarly journals Effectiveness of health technology electronic prescribing: A protocol for systematic review and meta-analysis Study

2017 ◽  
Vol 3 (1) ◽  
pp. 8
Author(s):  
Saeed Eslami ◽  
Hamidreza Dehghan ◽  
Mahdieh Namayandeh ◽  
Arezo Dehghani ◽  
Saeed Hajian Dashtaki ◽  
...  
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Meta Analysis ◽  
Grey Literature ◽  
Quality Criteria ◽  
Analysis Data ◽  
Healthcare Services ◽  
Electronic Prescribing ◽  
Cochrane Library ◽  
Policy Makers

INTRODUCTION: There is increasing evidence that electronic prescribing (ePrescribing) can improve the quality and safety of healthcare services. However, it has also become clear that this implementation is not straightforward and may create unintended or undesired consequences once in use. In this context, the systematic review can provide us with a general overview of the results of the studies and can help us find the truth. This review will aim to identify, appraise and synthesise clinical trial studies on ePrescribing in hospital settings.METHODS AND ANALYSIS:  Data sources will include the following  databases: pubmed, scopus and cochrane library. In addition, other sources will be searched for ongoing studies (ClinicalTrials.gov) and grey literature. Studies will be independently screened for eligibility by 2 reviewers and data extraction is done by 2 people. Articles are evaluated on the basis of the quality criteria of JADAD. The data is analyzed by the STATA software.DISSEMINATION: The results of the study will be published in a peer-reviewed journal and presented at relevant conferences. Policy makers and healthcare decision-makers can use these results.

Medical Necessity, Benefit and Resource Allocation in Health Care

1997 ◽  
Vol 2 (4) ◽  
pp. 223-230 ◽  
Author(s):  
Jeremiah Hurley ◽  
Stephen Birch ◽  
Greg Stoddart ◽  
George Torrance
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Operational Definition ◽  
Management Tool ◽  
Allocation Of Resources ◽  
Medical Necessity ◽  
Policy Makers ◽  
Guiding Principle ◽  
Care Systems ◽  
Definition Of

Many health care systems espouse medical necessity, or need, as a guiding principle for the allocation of resources. Yet, logic and experience suggest that it is likely impossible to develop a concise, explicit, operational definition of medical necessity that would allow it to be used as an administrative or management tool. Even if such a definition could be developed, it would likely do little to solve the fundamental challenges facing policy-makers attempting to reform health care systems. This implies that we should refrain from further efforts to define medical necessity operationally. But does it follow that medical necessity is an empty concept? No. Even if it cannot be defined precisely, it can still serve as a guiding principle for health policy. Given that ability-to-benefit is a core concept underlying necessity, we develop a conceptual framework that encompasses alternative notions of benefit and then illustrate some selected implications of alternative benefit notions for processes required to use medical necessity as a guiding principle and for the types of services that would be deemed to produce a benefit.

scholarly journals Demographics and meta-analysis of complementary and alternative medicine in health care systems

Research ◽  
2014 ◽  
Vol 1 ◽  
Author(s):  
Said Ibrahim Shalaby ◽  
Mosleh Abd Elrahman Ismail ◽  
Mohammed Salem Nasrallah ◽  
Eman Ebraheem Mahmoud Darwish ◽  
Neelima Gupta
Keyword(s):  
Health Care ◽  
Alternative Medicine ◽  
Complementary And Alternative Medicine ◽  
Health Care Systems ◽  
Meta Analysis ◽  
Care Systems ◽  
Complementary And Alternative

Commentary to Special Issue on Health Discrepancies: Expanding the Frame of Understanding Health Disparities: From a Focus on Health Systems to Social and Economic Systems

2006 ◽  
Vol 33 (4) ◽  
pp. 538-541 ◽  
Author(s):  
Brian D. Smedley
Keyword(s):  
Health Care ◽  
Health Disparities ◽  
Health Systems ◽  
Access To Health Care ◽  
Health Care Systems ◽  
Ethnic Disparities ◽  
Policy Makers ◽  
Psychosocial Risks ◽  
Inequality In Health ◽  
Care Systems

Policy makers are increasingly attending to the problem of racial and ethnic health disparities, but much of this focus has been on evidence of inequality in health care systems. This attention is important and laudable, but eliminating inequality in the health care system would be insufficient to eliminate racial and ethnic disparities and improve the health of all Americans. Social and economic factors, such as disadvantaged socioeconomic status, racism, discrimination, and geographic inequality shape virtually all risks for poor health. Interventions that focus solely on improving access to health care, or on reducing individual behavioral and psychosocial risks, therefore have limited potential to reduce racial and ethnic health disparities. The elimination of health disparities requires comprehensive, intensive strategies that address inequality in many sectors, including housing, education, employment, and health systems. These interventions must be targeted at many levels, including individuals and families, workplaces, schools, and communities

scholarly journals Domestic violence related disclosure among women and girls in Ethiopia: a systematic review and meta-analysis

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Berhanu Boru Bifftu ◽  
Berihun Assefa Dachew ◽  
Bewket Tadesse Tiruneh ◽  
Lemma Derseh Gezie ◽  
Yonas Deressa Guracho
Keyword(s):  
Systematic Review ◽  
Domestic Violence ◽  
Service Providers ◽  
Meta Analysis ◽  
Collaborative Work ◽  
Public Health Problem ◽  
Cochrane Library ◽  
Policy Makers ◽  
Pooled Prevalence ◽  
Women And Girls

Abstract Background Domestic violence is common public health problem. Domestic violence related disclosure is an important first step in the process of prevention, control and treatments of domestic violence related adverse effect. Thus, this systematic review and meta-analysis aimed to determine the pooled prevalence of domestic violence related disclosure and synthesize its associated factors. Methods We followed the PRISMA Guidelines to report the results of the finding. Databases including PubMed, Cochrane Library and Web of Sciences were searched. The heterogeneity between studies was measured by the index of heterogeneity (I2 statistics) test. Funnel plots and Egger’s test were used to determine publication bias. Moreover, sensitivity analysis was carried out. To calculate the pooled prevalence, a random effects model was utilized. Results Twenty one eligible studies were included in this systematic review and meta-analysis. The pooled prevalence of domestic violence related non-disclosure was found to be 36.2% (95% CI, 31.8–40.5%). Considering violence as normal or not serious, shame, embarrassment and fear of disclosure related consequences were the common barriers for non-disclosure. Conclusion More than one third of women and girls were not disclosed their experience of domestic violence. The finding of this study suggests the need of evaluation and strengthening of the collaborative work among different sectors such as: policy-makers, service providers, administrative personnel and community leaders including the engagement of men partner. This study also suggests the needs of women empowerments against the traditional belief, attitude, and practice.

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