Cost-Savings Associated with Multi-Disciplinary Team Approach for Reducing Macrovascular and Microvascular Complications in Patients with Type 2 Diabetes: A Predictive Model

Abdulmajeed Alshowair,1 Saleh Altamimi,1 Faisal A Alruhaimi,1 Saad Alshahrani,2 Fatima Alsuwailem,3 Mona Alkhaldi,4 Haiam Abdalla,5 Fahad Hamad Alkhuraiji,6 Montaser Saad Alaqeel,6 Salman Sulaiman Almureef,7 Salman Alhawasy,8 Amro Abdel-Azeem3,9 1Community Health Excellence, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 2Academic and Training Affairs, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 3Population Health Management and Research, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 4Health Administration Office, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 5Model of Care, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 6Financial Affairs, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 7Cost Department, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 8Reporting Department, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 9Department of Community, Environmental and Occupational Medicine, Faculty of Medicine Zagazig University, Zagazig, EgyptCorrespondence: Amro Abdel-Azeem, Population Health Management and Research, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia, Tel +966547135224, Email [email protected]: This study aims to predict the expected cost savings associated with implementing a multidisciplinary team (MDT) approach to reduce macrovascular and microvascular complications among patients with type 2 diabetes mellitus (T2DM).Methods: This economic evaluation study was conducted in Riyadh First Health Cluster, Saudi Arabia as a predictive model conceptualized by the authors based on models used in previous studies, particularly the CORE Diabetes Model. Our model was designed based on 1) the level of glycemic control among 24,755 T2DM patients served by MDTs; 2) the expected incidence of diabetes-related complications without intervention; 3) the predicted risk reduction of developing diabetes-related complications with MDTs. Costs of complications and cost savings were then calculated and expressed as mean incremental annual cost savings adjusted for a 1% reduction in HbA1c, and a 10 mmHg reduction in systolic blood pressure (SBP).Results: Along with the expected reduction in all diabetes-related complications, the average incremental cost savings per diabetic patient is predicted to be ($38,878) with approximately ($11,108) in the year of complication onset and ($27,770) over the subsequent post-index 10-years. On adjustment of cost savings, the average incremental cost savings are predicted to be ($22,869) for each 1% reduction in HbA1c per diabetic patient and ($27,770) for every 10 mmHg reduction in SBP per diabetic patient.Conclusion: MDT as a model of care is effective in glycemic control among T2DM patients with a predicted significant reduction of all diabetes-related complications and in turn, a predicted significant cost savings.Keywords: cost-savings, multi-disciplinary team, complications, type 2 diabetes, predictive mode

Sex differences in cardiovascular complications and mortality in hospital patients with covid-19: registry based observational study

Objective To assess whether the risk of cardiovascular complications of covid-19 differ between the sexes and to determine whether any sex differences in risk are reduced in individuals with pre-existing cardiovascular disease. Design Registry based observational study. Setting 74 hospitals across 13 countries (eight European) participating in CAPACITY-COVID (Cardiac complicAtions in Patients With SARS Corona vIrus 2 regisTrY), from March 2020 to May 2021 Participants All adults (aged ≥18 years), predominantly European, admitted to hospital with highly suspected covid-19 disease or covid-19 disease confirmed by positive laboratory test results (n=11 167 patients). Main outcome measures Any cardiovascular complication during admission to hospital. Secondary outcomes were in-hospital mortality and individual cardiovascular complications with ≥20 events for each sex. Logistic regression was used to examine sex differences in the risk of cardiovascular outcomes, overall and grouped by pre-existing cardiovascular disease. Results Of 11 167 adults (median age 68 years, 40% female participants) included, 3423 (36% of whom were female participants) had pre-existing cardiovascular disease. In both sexes, the most common cardiovascular complications were supraventricular tachycardias (4% of female participants, 6% of male participants), pulmonary embolism (3% and 5%), and heart failure (decompensated or de novo) (2% in both sexes). After adjusting for age, ethnic group, pre-existing cardiovascular disease, and risk factors for cardiovascular disease, female individuals were less likely than male individuals to have a cardiovascular complication (odds ratio 0.72, 95% confidence interval 0.64 to 0.80) or die (0.65, 0.59 to 0.72). Differences between the sexes were not modified by pre-existing cardiovascular disease; for the primary outcome, the female-to-male ratio of the odds ratio in those without, compared with those with, pre-existing cardiovascular disease was 0.84 (0.67 to 1.07). Conclusions In patients admitted to hospital for covid-19, female participants were less likely than male participants to have a cardiovascular complication. The differences between the sexes could not be attributed to the lower prevalence of pre-existing cardiovascular disease in female individuals. The reasons for this advantage in female individuals requires further research

Comparison of strains for new generation CAD‐CAM implant‐supported crowns under loading

PURPOSE The behavior of implant-crowns fabricated from recently introduced CAD-CAM zirconia-reinforced lithium silicate ceramic (ZLS) or a hybrid ceramic containing resin-reinforced glass network (HC) for strains around the implant platform is not well-known. A force absorption capacity of the latter has been claimed by the manufacturer. The aim of this study was to measure and compare recently introduced ZLS and HC with commonly used CAD-CAM implant crown materials for strain distribution around the implant platform. METHODS Four implants (Legacy 1; Implant Direct) were placed into a resin block. Zirconia abutments (Straight contoured stock abutment; Implant Direct) were torqued into the implant fixtures to support crowns that were milled from a virtual design using four different CAD-CAM materials (Vita Suprinity PC (ZLS), Vita Enamix (HC), IPS Emax, ZirCAD Zirkonzahn) (N = 20). The crowns were cemented with a resin cement, loaded and strain values were recorded. Three-dimensional digital image correlation (3D-DIC) was used to measure compressive and tensile strains around the implant platforms. The tensile and compressive strains were recorded for each test and first analyzed for equality of variance using Levene's test, and further tested using a 2-way ANOVA repeated measures analysis of variance (α = .05). RESULTS The data analysis showed no statistically significant effect of crown material on the generated strains (P > .05). Compressive strains were significantly higher than the tensile strains (P < .05). One of the HC crowns fractured during loading. CONCLUSIONS Strains generated around implant platform when new generation CAD-CAM crown materials were used was similar to strains observed when CAD-CAM zirconia and lithium disilicate crowns were used. New generation crown materials did not have a significant load absorption effect to change or minimize the strains generated around the implant platform

Social Media Use and Sleep Quality Among Secondary School Students in Aseer Region: A Cross-Sectional Study

Abdulaziz M Al-Garni,1 Hasan S Alamri,1 Waddah M Alalmaei Asiri,1 Abdulaziz Muflih Abudasser,1 Amal Saad Alawashiz,2 Fatima Ahmed Badawi,2 Ghaidaa Abdulrahman Alqahtani,2 Sultan Saad Ali Alnasser,2 Abdulwahab Mufareh Assiri,2 Khalid Talab Salem Alshahrani,2 Osama Ayed Saleh Asiri,2 Ohoud Hussain Moalwi,2 Manar Saeed Alqahtani,2 Reema S Alqhatani2 1Department of Internal Medicine, College of Medicine, King Khalid University, Abha, 61421, Saudi Arabia; 2College of Medicine, King Khalid University, Abha, Saudi ArabiaCorrespondence: Abdulaziz M Al-Garni, Department of Internal Medicine, College of Medicine, King Khalid University, Abha, 61421, Saudi Arabia, Email [email protected]: Use of different social media platforms has increased radically over the past decade, emerging as an important part of adolescents and young people’s everyday life. This might exert potential adverse effects on sleep quality and daytime performance of young adults.Aim of Study: To assess the relation between use of social media platforms and sleep quality among public secondary school students.Methods: A cross-sectional study was conducted on 961 students in Aseer region, Saudi Arabia. Students were asked to fill in a structured interview questionnaire covering personal data, pattern of social media use, sleep quality using The Pittsburgh Sleep Quality Index (PSQI) and their mental health status using the depression, anxiety and stress scale (DASS-21).Results: Students’ ages ranged from 15 to 20 years with a mean age of 16.7 ± 2.1 years old. A total of 570 (59.3%) students were females. Tiktok (80%), Snapchat (77.9%), Instagram (63.8%) and YouTube (58.8%) were the most reported platforms used. Regarding their sleep quality, 34.7% of students were poor sleepers. TikTok use (OR 1.33, 95% CI 1.01– 1.77), hours spent on social media (OR 1.26, 95% CI 1.16– 1.37) and having moderate to severe depressive symptoms (OR 1.69, 95% CI 1.19– 2.40) were significant independent predictors of poor sleep among the studied sample.Conclusion: The present study emphasized the association between prolonged use of social media and poor sleep quality among Saudi adolescents. Awareness and behavioral change strategies and activities concerning the drawbacks of poor sleep and proper use of social media are urgently called for to control mental and physical health consequences of poor sleep and social media addiction.Keywords: adolescents, mental health, Saudi Arabia, screen time, sleep quality, snapchat, social media, students, tikto

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AimThe SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.MethodsThis was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.ResultsOverall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P ConclusionOne in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease