The Effect of Drug Vintage on Survival: Micro Evidence from Puerto Rico's Medicaid Program

Using micro data on virtually all of the drugs and diseases of over 500,000 people enrolled in Puerto Rico's Medicaid program, we examine the impact of the vintage (original FDA approval year) of drugs used to treat a patient on the patient's 3-year probability of survival, controlling for demographic characteristics (age, sex, and region), utilization of medical services, and the nature and complexity of illness. We find that people using newer drugs during January-June 2000 were less likely to die by the end of 2002, conditional on the covariates. The estimated mortality rates are strictly declining with respect to drug vintage. For pre-1970 drugs, the estimated mortality rate is 4.4%. The mortality rates for 1970s, 1980s, and 1990s drugs are 3.6%, 3.0%, and 2.5%, respectively. The actual mortality rate is about 16% (3.7% vs. 4.4%) lower than it would have been if all of the drugs utilized in 2000 had been pre-1970 drugs. Estimates for subgroups of people with specific diseases display the same general pattern.

Changes in the neonatal and infant mortality rate and the causes of death in Korea

Neonatal mortality rate (NMR) or infant mortality rate (IMR) are the rate of deaths per 1,000 live births at which babies of either less than four weeks or of one year of age die, respectively. The NMR and IMR are commonly accepted as a measure of the general health and wellbeing of a population. Korea's NMR and IMR fell significantly between 1993 and 2009 from 6.6 and 9.9 to 1.7 and 3.2, respectively. Common causes of infantile death in 2008 had decreased compared with those in 1996 such as other disorders originating in the perinatal period, congenital malformation of the heart, bacterial sepsis of newborns, disorders related to length of gestation and fetal growth, intra-uterine hypoxia, birth asphyxia. However, some other causes are on the increase, such as respiratory distress of newborn, other respiratory conditions originating in the perinatal period, other congenital malformation, diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism. In this study, we provide basic data about changes of NMR and IMR and the causes of neonatal and infantile death from 1983 to 2009 in Korea

Indications for Synergetic and Antagonistic Effects between Trace Elements in The Environment to Human Health

The objective of this work was to investigate the interactions between the level of concentrations of Ca, V, Cr, Mn, Fe, Ni, Cu, Zn, As and Pb in potable water, soil, vegetation and school children hair and disease incidences of neoplasms, diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism, endocrine, nutritional and metabolic diseases, mental and behavioral disorders and diseases of the circulatory system on the population groups which are homogeneously exposed to the environmental conditions. It was found that potable water among the other investigated aspects of the physical environment has the greatest impact on the public health. The environment- disease incidence interactions have been found for all investigated diseases groups. The results reported here emphasize the importance of the observation of the mutual effects of the environmental variables on the human health for the identification of their synergetic as well as antagonistic effects

The Cost of Care: New Insights into Healthcare Spending Growth

[Excerpt] The Bureau of Labor Statistics (BLS) is celebrating the first anniversary of experimental disease-based price indexes, which adjust expenditures on disease for inflation. Statistical agencies have long collected price information on medical procedures, drugs, equipment, and services, but the cost of treating a patient is typically some combination of these goods and services. Many users of the Federal Statistical System have asked that medical care spending be reported on a disease basis. Creating price indexes on a disease basis helps provide greater understanding of the cost of care for a given condition. The indexes are the result of a long-term research effort by staff in the BLS Office of Prices and Living Conditions. Using existing data products, we met the need for a new product, without incurring more data collection expenses. We construct the experimental indexes using two publicly available datasets: 1) the monthly producer price index (PPI) and consumer price index (CPI) published by BLS and 2) the Medical Expenditure Panel Survey (MEPS) published by the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. The monthly BLS data allow our experimental disease-based price indexes to be timely. MEPS supplies data on the use of medical service and products for the treatment of each disease. After a year of constructing the experimental disease-based index we reveal the wealth of information that the data show. This Beyond the Numbers article examines the reasons for reporting by disease rather than by service and explains the reasons behind the spending growth for each disease

Data analysis applied to healthcare

The Emergency Department (ED) is one of the essential departments of any hospital, often open 24 hours a day is the service that most provides patients to a hospital. Advances in medicine have resulted in an increase in average life expectancy and, consequently, an ageing population, which will lead to an increase in affluence and need for healthcare, so it is of extreme importance that the hospitals are able to carry out effective management of available hospital resources, so that the quality of service (QoS) it can offer to patients is not compromised and there are no cases where a patient cannot be admitted due to lack of beds, or is not treated due to lack of medication, among others. Hospitals today are aware of the growing importance of data analysis. Data Mining techniques allow extracting knowledge from the big data stored in their computer systems in the form of electronic health records (EHR). This analysis of big data produced by a hospital will, to some extent, help the hospital management to better manage these resources to improve its services, improving the quality of its service, making the patients more satisfied, which can contribute to a healthier society. The author of this thesis will analyze data from an ED provided by an hospital in the Lisbon region, processing the data and then performing a descriptive analysis that allows us to draw conclusions regarding the time a patient spends in the hospital (Length of Stay), among other metrics, taking into account several factors that may influence it, and then perform a predictive analysis of the Length of Stay in order to help the hospital in the decision-making process.O serviço de urgências é um dos departamentos mais importantes de qualquer hospital, muitas vezes aberto 24 horas por dia é o serviço que mais fornece utentes a um hospital. Posto isto, e perante uma população cada vez mais envelhecida, devido ao aumento da esperança média de vida, irá fazer com que a afluência a estes serviços venha a aumentar, assim é de extrema importância que o hospital seja capaz de realizar uma gestão eficaz dos recursos hospitalares disponíveis, de modo a que a qualidade de serviço que este pode oferecer aos utentes não seja comprometida e não se venha a verificar casos em que um utente não pode ser internado por falta de camas, ou que não tenha quarto disponível e tenha de ser colocado no corredor, entre outros. Hoje em dia os hospitais com vista na possibilidade de análise de dados através de técnicas de Data Mining, que permitem a extração de conhecimento a partir das grandes quantidades de dados (Big Data) guardadas nos seus sistemas informáticos sob a forma de registos médicos eletrónicos (Eletronic Health Records). A análise da Big Data produzida por um hospital vai permitir um olhar um para estes números e de certa forma ajudar a gestão do hospital a gerir melhor estes recursos de modo a melhorar os seus serviços, melhorando as condições dos utentes, deixando estes mais satisfeitos. O autor desta tese irá analisar dados reais de um serviço de urgências fornecidos por um hospital da região de Lisboa, tratando destes dados e de seguida realizando uma análise descritiva que nos permita retirar conclusões em relação ao tempo que um doente passa no hospital (Length of stay), entre outras métricas, tendo em conta vários fatores que o possam influenciar, e de seguida elaborar uma análise preditiva do Length of Stay com vista a ajudar a apoiar o processo de tomada de decisões pelo hospital

INTEGRATING GERIATRICS INTO THE ACUTE HOSPITAL SETTING: NOW OR IN THE FUTURE?

The demographic ageing of the population and its impact on social systems, economies or labor markets have often been analyzed and discussed in Germany. The German health care system is expected to face great challenges due to the “double-ageing” of the pmultimorbid elderly patients, department of acute geriatrics, acute hospital care

Characteristics of the optimized model ofmedical care for thepopulation with diseases of blood and blood-forming organs at the regional level

Bстатті представлено розроблену оптимізовану модельмедичної допомоги населенню з хворобами крові та кровотворних органів на регіональному рівні в сучасних умовах реформування галузі охорони здоров’я базуючись на чинній законодавчій базі України з питань реформування галузі охорони здоров’я та даних наукової літератури з питань організації медичної допомоги хворим з хворобами крові та кровотворних органів. Наукове обґрунтуванняоптимізованої моделігематологічної медичної допомоги на регіональномурівнів умовах реформування системи охорони здоров’я країнипроводилося в рамках існуючої медико-демографічної та соціально-економічної ситуації з урахуванням в перспективі позитивних змін. Ключовою ідеєю запропонованихінновацій є послідовне вирішення пріоритетної проблеми забезпечення пацієнтів з хворобами крові та кровотворних органівякі проживають в регіоні якісною та доступною медичною допомогоюшляхом оптимізації структури і процесів надання гематологічної медичної допомогив рамках сучасних системних перетворень галузі охорони здоров’я та запровадження якісно нової системи фінансуваннягалузі охорони здоров’я. Модель передбачає структуру та організацію медичної допомоги пацієнтам на всіх етапах та рівнях надання медичної допомоги.Структурну основу моделі надання медичної допомоги хворим на хвороби крові та кровотворних органівскладають наявні ресурси діючої системи охорони здоров’я. Її впровадження вимагає додат-кових фінансових ресурсів на матеріально-технічне забезпечення відповідно до галузевих стандартів, що має бути забезпечено при наданнімедичної допомоги і без впровадженнязапропонованої моделі. Модель забезпечує концентрацію ресурсів, що і визначає її економічну ефективність. Впровадження запропонованої оптимізованої моделі медичної допомоги населенню з хворобами крові та кровотворних органів на регіональному рівні дозволить забезпечити населення, яке страждає на вказані хвороби забезпечити доступою медичною допомогою за етапами і рівнями її надання в залежності від стану здоров’яThe article presents an optimized model of medical care for the population with diseases of the blood and blood-forming organs at the regional level in modern conditions of health care reform based on the current legislation of Ukraine on health care reform and scientific literature on the organization of medical care for patients with diseases of the blood and blood-forming organs.The scientific substantiation of the optimized model of hematological medical care at the regional level in the conditions of reforming the health care system of thecountry was carried out within the existing medical-demographic and socio-economic situation, taking into account the positive changes in the future. The model envisages the structure and organization of medical care for patients at all stages and levels of medical care. The structural basis of the model of providing medical care to patients with diseases of the blood and blood-forming organs is the available resources of the current health care system. Its implementation requires additional financial resources for logistics in accordance with industry standards, which should be provided in the provision of medical care and without the implementation of the proposed model. The model provides a concentration of resources, which determines its economic efficiency. The implementation of the proposed optimized model of medical care for the population with diseases of the blood and blood-forming organs at the regional level will provide the population suffering from these diseases to provide affordable medical care in stages and levels of its provision depending on health status

A first description of the Colombian national registry for rare diseases

Objective: Orphan diseases must be considered a public health concern, underlying country-specific challenges for their accurate and opportune diagnosis, classification and management. Orphan disease registries have not yet been created in South America, a continent having a population of ~ 415 million inhabitants. In Colombia ~ 3 million of patients are affected by rare diseases. The aim of the present study was to establish the first Colombian national registry for rare diseases. The registry was created after the establishment of laws promoting the development of clinical guidelines for diagnosis, management, census and registry of patients suffering rare diseases. Results: In total, 13,215 patients were recorded in the Colombian registry. The survey reported 653 rare diseases. The most common diseases were congenital factor VIII deficiency (hemophilia A) (8.5%), myasthenia gravis (6.4%), von Willebrand disease (5.9%), short stature due to growth hormone qualitative anomaly (4.2%), bronchopulmonary dysplasia (3.9%) and cystic fibrosis (3.2%). Although, a marked under-reporting of cases was observed, some pathologies displayed similar behavior to that reported by other initiatives and databases. The data currently available in the registry provides a baseline for improvement regarding local and regional surveys and the start for better understanding rare diseases in Colombia. © 2017 The Author(s)

RESULTS OF MONITORING OF PRESCRIPTION OF POTENTIALLY DANGEROUS COMBINATIONS OF DRUGS IN PHARMACOTHERAPY UNDER INPATIENT TREATMENT

In case of combined pharmacotherapy, between drugs can occur interactions, which can be dangerous to the life and health of patients. Such combinations of drugs are considered to be one of the serious clinical problems, and are considered as errors that can be prevented. Therefore, it is relevant to determine the frequency of such appointments for further work on their prevention. Aim of the research. Determine the structure and prevalence of the appointments of potentially dangerous combinations of drugs in the treatment of patients under inpatient treatment for further optimization of pharmacotherapy. Materials and methods. In the automated mode, the lists of medical appointments of patients who were under inpatient treatment of 30 health facilities of Zhytomyr region in 2017 were monitored for the purpose of the simultaneous use of drugs, the interaction of which is dangerous. For further analysis by the levels of clinical significance using the Drug Interaction Checker system, the "Major" (hazardous) and "Moderate" (significant) combinations were selected on the Internet resource www.drugs.com. The frequency of the appointments of dangerous combinations, their prevalence by the nosological classes and the profiles of the offices of medical institutions was determined. Results. As a result of the monitoring of 69405 cases, it was found that the average number of prescriptions per patient was 5.6±1.2 titles. In 1390 cases of treatment (2.0 % of 69405) simultaneously prescribed medicines, the interaction of which could be dangerous. In the structure of dangerous combinations, 81.5 % is taken with the simultaneous administration of drugs containing active substances ketorolac and pentoxifylline. The frequency of potentially dangerous appointments was greatest in the treatment of patients with diseases of the blood and blood-forming organs (D50-D89) – 11.6 %, in diseases of the musculoskeletal system and connective tissue (M00-M99) – 7.7 %, in diseases of the nervous system – 5.0 % of all cases of treatment