Changes in Acute Respiratory Infection Before and After COVID-19

Objective: During the outbreak of COVID-19,several coping strategies were implemented including strengthened social distancing, wearing masks and hand hygiene. Thisinfection control method might have been effective for other respiratory infections; however, it had not yet been clearly revealed. Therefore,we investigatedwhetherthe incidence of infectious respiratory diseases has reduced after excluding the effect of decreased medical utilization because of COVID-19 control measures.Design or methods: We used the Korean national claims data and analyzed incidences of acute respiratory infections (ARI) and diseases except ARI. The incidence rates of winter 2019 and 2020 were compared.Results: Excluding ARI,the reduction in overall hospital visits decreased by only 2%; however,the number of visits due to ARI decreased by 13%, and the number of visits due to influenza particularly decreased by 26%.Conclusions: Using national database, this study confirmed that a significant reduction in ARI, including influenza, occurred during the COVID-19 pandemic. Infection control measures including nationally enforced social distancing may be effective in controlling the transmission of other respiratory infections. Further studies are necessary to clarify the causal relationship.

Policy Spotlight Effect in Critical Time-Sensitive Diseases

Background: Categorization of hospital emergency capability (CHEC) is a policy implemented worldwide to regionalize critical emergent care. The CHEC policy mainly uses time-based indicators as emergency care quality measurements.Objectives: We aimed to explore the CHEC policy spotlight effect on critical time-sensitive diseases with and without the influence of time-based surveillance indicators and guidelines. Research Design: We conducted a nationwide retrospective cohort study between 2005–2011. Regarding critical time-sensitive diseases, our study targeted acute ischemic stroke (AIS), ST-segment elevation myocardial infarction (STEMI), septic shock, and major trauma. We selected diagnosis and treatment guideline adherence as process quality measures and defined medical utilization, upward transfer rate, and short-term mortality rate as outcome indicators. Subjects: The Taiwan National Health Insurance 2005 Longitudinal Health Insurance Database contains one million random cases, including medical records and hospital information. Results: During this 7-year study AIS, STEMI, septic shock, and major trauma, respectively. AIS and STEMI cohorts had significantly higher rates of guideline adherence and better process quality than those of septic shock and major trauma cohorts. Furthermore, AIS and STEMI cohorts had a significant increase in diagnosis costs. Conclusion: The CHEC policy spotlight effect exists in critical time-sensitive diseases with time-based quality indicators. Importantly, disease entities without these indicators may experience decreases in diagnosis and treatment guideline adherence, indirectly jeopardizing their outcomes.

The Use of Medical Cannabis on Cancer in Thailand

The objective of this paper is to indicate the beneficial utility of medical marijuana. Marijuana throughout history is known for its property to alternate consciousness. However, the medical utilization of marijuana or cannabis was dated as far back as 2900 BC, when it was used by Emperor Ru Hsi of Ancient Chinese. During the 19th century, marijuana was introduced to Western Medicine as a therapeutic drug, mostly known for its pain control properties. Marijuana by itself consists of more than 100 active components. In consideration of the amount of THC, tetrahydrocannabinol, a psychological chemical released by the glands of marijuana plants, CBD or cannabidiol, amongst the most prevalent ingredients in cannabis, is the least controversial extract extracted from the marijuana plants to be used. As of the year 2019, Thailand Narcotics Act legalized cannabis for medical use in Thailand. A study survey conducted by N.Z. shows that in just over a year, 20% of the patients report the use of cannabis for medical purposes regarding its benefits of neuropathic pain, chemotherapy-induced nausea and vomiting, Aids-related cachexia, intractable epilepsy, and palliative care conditions. Further clinical trials are conducted to further perceive the potential cannabis has on treating cancer. One of the two successful clinical trials that have been published proposes that cannabis may make it possible to treat brain cancer with few side effects. Keywords: Cancer, Marijuana, Tetrahydrocannabinol (THC), Cannabidiol (CBD), Medical Usage, Cannabis in Thailand.

Medical Utilization of Emergency Departments among Patients with Prostate Cancer: A Nationwide Population-Based Study in Taiwan

(1) Background: In Taiwan, prostate cancer is a major malignancy with an increasing incidence among men. This study explores the medical utilization of emergency departments among patients with prostate cancer in Taiwan. (2) Methods: This nationwide, population-based study was conducted via a cross-sectional method based on the Registry for Catastrophic Illness Patient Database from Taiwan’s National Health Insurance Research Database. Patients with newly diagnosed prostate cancer between 1997 and 2013 were enrolled in the study and divided into four treatment-related groups. The rate of emergency department presentation, disease categorization of emergency department visits, emergency department-related medical expenditures, and temporal trends were investigated. (3) Results: A total of 18,728 patients with prostate cancer were identified between 1997 and 2013, for whom 13,098 emergency department visits were recorded. The number of emergency department visits increased during the study period. The incidence rate for the medical utilization of emergency department visits was 822 per 1000 people during the study period. The incidence rates for patients with prostate cancer in the radical prostatectomy, radiotherapy, androgen deprivation therapy, and chemotherapy groups were 549, 1611, 1101, and 372, respectively. The average medical expenditure per emergency department visit was TWD 3779.8 ± 5116.2, and the expenditure was recorded for the chemotherapy group at TWD 4690.8 ± 7043.3. The most common disease diagnoses among patients with prostate cancer who presented to the emergency department were injury/poisoning (16.79%), genitourinary disorders (10.66%), and digestive disorders (10.48%). (4) Conclusions: This nationwide population-based study examined the emergency department visits of patients with prostate cancer in Taiwan, providing useful information for improving the quality of medical care.

Healthcare utilization, psychiatric disorders, and physical illnesses shortly before suicide mortality in adolescents in Taiwan

Background This study examined the pattern of medical utilization and the distribution of comorbidities shortly before death among adolescents who died from suicide and compared these data with those of living controls. Methods From Taiwan's National Health Insurance Research Database, this study identified adolescents aged 10–19 years who died from suicide (n = 935) between 1 January 2000, and 31 December 2016, by linking each patient with the national mortality database. The researchers conducted a nested case–control study through risk set sampling, and for each case, 20 age- and sex-matched controls (n = 18 700) were selected from the general population. The researchers applied conditional logistic regression to investigate differences in medical utilization and physical and psychiatric comorbidities between cases and controls. Results Cases had a higher proportion of contact with the psychiatric department but a similar proportion of contact with any non-psychiatric medical department within 1 year before suicide compared with controls. There were 18.6% of adolescent suicide victims who only had contacted with a psychiatric department 3 months before suicide. Moreover, cases had a higher proportion of contact with non-psychiatric services within 3 months before suicide, particularly with emergency, surgery, and internal medicine departments. Cases had higher risks of several psychiatric disorders and physical illnesses, including heart diseases, pneumonia, and ulcer disease, than did controls. Conclusions The findings of increased medical utilization and higher risks of physical and psychiatric comorbidities in adolescent suicide victims are crucial for developing specific interventions to prevent suicide in this population.

Quantitative Anatomical Characteristics of the Leaf Blades of the Several Species of Crataegus L.

Introduction. The Crataegus L. (Hawthorn) is a common herb in numerous Pharmacopoeias. The State Pharmacopoeia of the Russian Federation provides hawthorn fruits and flowers for medical utilization. With that, the literature data confirms the medical utility of hawthorn leaves since the “leaves” and the “flowers with leaves” have pharmacopoeial status worldwide. Therefore, those are considered as prospective forms of Crataegus raw material for Russian pharmaceutical production. However, most species remain poorly pharmacognostically investigated regarding the quantitative microscopic characteristics (the sizes of stomatal apparatus (SA) and epidermal leaf blade (LB) trichomes), which could be substantial for establishing the authenticity of the raw material.Aim. Examine epidermal anatomy of Crataegus spp. Leaf blades (LBs) and perform a comparative study of several quantitative diagnostic features of LBs of hawthorn plants from the sect. Sanguineae and the sect. Crataegus, growing in diverse regions of the Russian Federation.Materials and methods. Samples of hawthorn leaves (C. sanguinea, C. maximowiczii, C. dahurica, C. rhipidophylla, C. monogyna and C. pallasii) were collected in natural habitats in Western Siberia (Kemerovo) and in arboretums of Botanical Gardens (Moscow, Stavropol). Measurements of anatomical structures were carried out using a light microscope accompanied by an ocular micrometre.Results and discussion. The LB surface phenotypic diversity within hawthorn species and sections was studied. The LBs were described in terms of meterages (longitude and width) of SA, meterages and shape of sedentary multicellular leaf teeth glands. The peculiarities of pubescence and the sizes of simple unicellular non-glandular trichomes were also observed.Conclusion. The results of quantitative anatomical examination provided the characteristic features determining these elements at the species and section levels. Thus, it may facilitate authentication and quality control of whole or ground Crataegus medicinal raw material.

Korean Medicine Patient Registry of Postoperative Therapy for Musculoskeletal Disorders (KPOP-MD): A study protocol (Preprint)

BACKGROUND The frequency of patients undergoing musculoskeletal surgery has been increasing with the increase in average life expectancy of the population. An aging population with sustained musculoskeletal pain and disability is the main complaint of Korean medical institutions. Recently, Korean medicine clinicians have addressed the collection and analysis of the medical utilization pattern of patients with musculoskeletal discomfort after surgery, to identify the current demographics of patients and to provide empirical evidence for Korean medicine postoperative rehabilitation strategies as well as political decisions on the healthcare coverage of Korean medicine. OBJECTIVE Overall, the aims of Korean Medicine Patient Registry of Postoperative Therapy for Musculoskeletal Disorders (KPOP-MD) are to (1) explore the general characteristics of postoperative patients with musculoskeletal discomfort and (2) evaluate the overall improvement after performing various Korean medicine treatment regimens for musculoskeletal disorders, based on a process involving the collection of nationwide registry outcomes. METHODS KPOP-MD will collaborate with 17 traditional Korean medical institutions and register postoperative patients with musculoskeletal discomfort. A total of 150 patients who meet the eligibility criteria will be registered in the study. After registration, we will collect personal health information from each patient, such as general socio-demographics, surgical site discomfort, anthropometrics, and health-related quality of life (HRQoL) at each assessment. The primary endpoint will be a change in the numeric rating scale for pain at the surgical location. The additional evaluation variables will be a change in the site-specific patient-reported questionnaires, recovery status questionnaires, other discomfort assessments, and cost data. RESULTS not applicable CONCLUSIONS This is the first prospective, multicenter, patient-based registry of postoperative patients with musculoskeletal disorders in various traditional Korean medical institutions. The results of this registry will provide valuable information on the current status of postoperative patients who receive Korean medicine treatments and evidence for reasonable decision-making in the Korean medicine healthcare system in the future. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT03842098.

Costs and Outcomes Comparison of Diabetes Technology Usage Among People With Type 1 or 2 Diabetes Using Rapid-Acting Insulin

Background: Does initiation of a continuous glucose monitor (CGM) or insulin pump lower health care utilization and/or costs? Methods: Distinct cohorts of people with type 1 diabetes (T1D) or type 2 diabetes (T2D) using a blood glucose monitor (BGM), CGM, pump, or CGM with pump were identified from a large claims database. Patients ≥40 years old with 12 months of continuous enrollment before and after the device start date qualified for the study. Outcomes included one-year medical utilization and costs (minus device) for events such as hospitalizations and office visits. Generalized linear models were fitted, controlling for numerous baseline covariates. The Holm method corrected for the multiplicity of hypotheses tested. Results: Of the 8235 total patients, the BGM control group was the largest, had the lowest percentage of patients with T1D, and was significantly different from the device groups in most baseline categories. Formally, only two comparisons were statistically significant: Compared with BGM, the pump cohort had greater adjusted first-year total medical and office visit costs. Other secondary outcomes such as days hospitalized, emergency department visits and labs, favored pump. Most endpoints were favorable for CGM. Results for CGM with pump generally were intermediate between CGM and pump alone. Conclusions: During a one-year follow-up, unadjusted medical costs of both CGM and pump appear lower than BGM, but multivariable modeling yielded adjusted savings only for CGM use. Economic benefits might be observable sooner for CGMs than for pumps. Generalized linear models fitted to health care utilization event rates produced favorable results for both CGM and pump.