scholarly journals End-of-life costs of medical care for advanced stage cancer patients

2015 ◽  
Vol 72 (4) ◽  
pp. 334-341 ◽  
Author(s):  
Aleksandra Kovacevic ◽  
Viktorija Dragojevic-Simic ◽  
Nemanja Rancic ◽  
Milena Jurisevic ◽  
Florian Gutzwiller ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
Medical Care ◽  
End Of Life ◽  
Health Care Services ◽  
Distant Metastases ◽  
Medical Personnel ◽  
Malignant Neoplasms ◽  
Hospital Inpatient ◽  
Care Hospital ◽  
Hospital Inpatient Care

Background/Aim. Cancer, one of the leading causes of mortality in the world, imposes a substantial economic burden on each society, including Serbia. The aim of this study was to evaluate the major cancer cost drivers in Serbia. Methods. A retrospective, indepth, bottom-up analysis of two combined databases was performed in order to quantify relevant costs. End-of-life data were obtained from patients with cancer, who deceased within the first year of the established diagnose, including basic demographics, diagnosis, tumour histology, medical resource use and related costs, time and cause of death. All costs were allocated to one of the three categories of cancer health care services: primary care (included home care), hospital outpatient and hospital inpatient care. Results. Exactly 114 patients were analyzed, out of whom a high percent (48.25%) had distant metastases at the moment of establishing the diagnosis. Malignant neoplasms of respiratory and intrathoracic organs were leading causes of morbidity. The average costs per patient were significantly different according to the diagnosis, with the highest (13,114.10 EUR) and the lowest (4.00 EUR) ones observed in the breast cancer and melanoma, respectively. The greatest impact on total costs was observed concerning pharmaceuticals, with 42% of share (monoclonal antibodies amounted to 34% of all medicines and 14% of total costs), followed by oncology medical care (21%), radiation therapy and interventional radiology (11%), surgery (9%), imaging diagnostics (9%) and laboratory costs (8%). Conclusion. Cancer treatment incurs high costs, especially for end-of-life pharmaceutical expenses, ensued from medical personnel tendency to improve such patients? quality of life in spite of nearing the end of life. Reimbursement policy on monoclonal antibodies, in particular at end-stage disease, should rely on cost-effectiveness evidence as well as documented clinical efficiency.

Organization of primary health care and specialized medical care for patients with prostate cancer in the Nizhny Novgorod Region

2021 ◽  
pp. 20-31
Author(s):  
Egor Aleksandrovich Perevezentsev ◽  
Maya Andreevna Kuzmina ◽  
Dariya Dmitrievna Vasina ◽  
Denis Igorevich Volodin
Keyword(s):  
Prostate Cancer ◽  
Health Care ◽  
Primary Health Care ◽  
Medical Care ◽  
Medical Personnel ◽  
Malignant Neoplasms ◽  
Medical Organization ◽  
Primary Health ◽  
High Level ◽  
Nizhny Novgorod Region

At present, the quality and availability of medical care are the aspects to which close attention is paid in the system of organizing medical care. One of the ways to achieve a high level of quality and accessibility of medical care is building up human resources, i.e. the presence of highly qualified general practitioners, sub-specialties and middle medical personnel in sufficient numbers in a medical organization. Currently, the oncological service of Russia has been assigned tasks to fulfill the instructions from the State Program for the Development of Health Care. The results of the work should lead to a decrease in mortality and an increase in the quality of life of the population. To address the issue of reducing mortality from malignant neoplasms, in particular from prostate cancer, a three-level system of oncological care has been created on the territory of the Nizhny Novgorod Region, including 1 regional center, 2 interdistrict cancer centers, 88 primary oncology rooms and 96 examination rooms. The tasks set to reduce morbidity and mortality from oncological diseases can be realized only with close interaction of the oncological service with the primary health care sector, in which the prevention should be the priority direction of work.

scholarly journals Developing support systems for end-of-life discussions with elderly patients with dementia

Impact ◽  
2020 ◽  
Vol 2020 (9) ◽  
pp. 43-45
Author(s):  
Chiho Shimada
Keyword(s):  
Elderly Patients ◽  
Medical Care ◽  
End Of Life ◽  
Acute Care ◽  
Elder Care ◽  
Treatment Options ◽  
Hospital Setting ◽  
Medical Decision ◽  
Care Hospital ◽  
Psychological Burden

Advances in medicine mean that people are living longer, necessitating a need for elder care. In order to meet this demand, the needs of the elderly population, including the ways in which support can be provided, need to be understood. Advance care planning (ACP) involves making decisions about future medical care and can alleviate the psychological burden family members of elderly people may face as it decides, ahead of time, on preferences and requirements. Dr Chiho Shimada, Tokyo Metropolitan Institute of Gerontology, Japan, is working to shed light on ACP, which is a relatively new practice. She hopes, through her research, to improve care for elderly patients, with a key focus on dementia patients. Shimada advocates for a holistic approach to elder care in which understanding a patient's values and lifestyle choices is key. The idea is that a patient chooses their daily care and treatment plans and records their values with a view to facilitating end-of-life (EOL) care decisions when the time comes. This equips the surrogate decision maker with the best knowledge possible to make these decisions on behalf of the patient. Another key focus is the role of nurses in supporting medical decision making and care for elderly patients with dementia. She has discovered that many nurses are concerned by an over-reliance on medical care by patients and their families in the acute care setting. This led her to interview nurses and doctors about how they can better support patients regarding treatment options. This culminated in the development of a pamphlet to educate patients and families, as well as providing clarification on the ACPs that nurses in acute care hospitals can be involved in and those that are difficult to carry out in the acute care hospital setting.

scholarly journals Using Task Models to Understand the Intersection of Numeracy Skills and Technical Competence With Medical Device Design

2021 ◽  
Author(s):  
Judy Bowen ◽  
Diana Coben
Keyword(s):  
Medical Devices ◽  
Medical Personnel ◽  
Interactive Systems ◽  
Hospital Inpatient ◽  
Medical Device Design ◽  
Medication Delivery ◽  
Concepts Of Technology ◽  
Functional Correctness ◽  
Set Up ◽  
Hospital Inpatient Care

Abstract Task models are used in many different ways throughout the design and development of interactive systems. When the interactive systems are safety critical, task models can play an important role in ensuring system behaviours are consistent with user requirements, which may help to prevent errors. While task models can be used to describe a user’s goals and the steps required to achieve that goal, to understand where user errors may occur we also need to consider the users’ understanding of how to perform a task and how this relates to the system they are using. Our focus is on the use of medical devices such as syringe drivers and infusion pumps for intravenous medication, which forms a major part of hospital inpatient care throughout the world. While we might rely on software engineering and human factors techniques to ensure correctness of such devices, their use by medical personnel in practice includes other factors that are equally important. These include training medical personnel in the use of medical devices. Also numeracy education for medical staff to ensure that they are able to set up and perform the necessary calculations to convert prescribed medication into the appropriate values and measures for their delivery mechanisms. We have developed an approach that aims to bring together concepts of technology design (both functional correctness and usability concerns), numeracy and medication delivery competency. In order to do so we use task models as a common language that enables us to consider these different domains in a single way. We find that the ability to describe the two domains within a single process allows us to compare models of knowledge, tasks and use of devices, which can elicit potential mismatches and problems.

Medical Care for Children with Cancer in the North-Caucasian, Volga, Urals, Siberian and Far Eastern Federal Districts: An Ecological Study

2018 ◽  
Vol 5 (4) ◽  
pp. 214-237
Author(s):  
M. Yu. Rykov
Keyword(s):  
Medical Care ◽  
Russian Federation ◽  
Ecological Study ◽  
Medical Personnel ◽  
Malignant Neoplasms ◽  
Children With Cancer ◽  
The North ◽  
Federal Districts ◽  
The Russian Federation ◽  
Far Eastern

Background. The analysis of the quality of medical care for children with cancer is based on statistical data. Evaluation of the results is also the basis of the strategy for the development of medical care for this category of patients.Objective. Our aim was to analysie the main indicators characterizing medical care for children with cancer in the North-Caucasian, Volga, Urals, Siberian and Far Eastern Federal Districts.Methods. In ecological study the operative reports for 2017 of the executive authorities in the sphere of health protection of 44/48 (91.6%) subjects of the Russian Federation that are part of the listed above federal districts have been analyzed (Chuvash Republic, Irkutsk Region, Republic of Sakha (Yakutia) and Khabarovsk Territory did not provide data).Results. The number of children’s population was 15 555 306 people (0–17 years), the number of children’s oncological beds — 1166 (0.7 per 10 thousand 0–17 years), the average number of days of berth employment in the year — 324.6 bed days. In 13 (29.5%) subjects of the department of pediatric oncology are absent, in 6 (13.6%) — there are no children’s oncological beds. The number of doctors providing medical care to children with cancer is 213, of which 132 (62%; 0.08 for 10 thousand 0–17 years) have a certificate of a pediatric oncologist. In 6 (13.6%) subjects there are no doctors-children oncologists (6 more (13.6%) subjects did not provide data). The incidence of malignant neoplasms was 13.1 (per 100.000 0–17 years), the prevalence of 93.1 (per 100.000 0–17 years), mortality rate 2.5 (per 100.000 0–17 years), one-year lethality — 6.8%. 10.1% of patients were actively detected. 781 (38.3%) of primary patients were sent to medical organizations for federal subordination, 39 (1.9%) of primary patients left the territory of the Russian Federation.Conclusion. Obvious accounting defects (low incidence rate) and lack of reliable follow-up data (estimation of mortality levels is difficult) are eliminated by introducing electronic accounting systems. For reliable estimation of the level of provision of the population with children’s cancer beds and the percentage of patients sent for treatment in medical organizations of federal subordination, audit of patients’ illnesses is necessary. The traditional problems — the deficiency of doctors and children’s oncologists and a low percentage of patients identified actively — must be addressed through the reform of the training program for medical personnel.

scholarly journals GASTRIC CANCER IMMUNOTHERAPY

2019 ◽  
Vol 18 (4) ◽  
pp. 6-16
Author(s):  
D. Zh. Mansorunov ◽  
A. A. Alimov ◽  
N. V. Apanovich ◽  
A. Yu. Kuzevanova ◽  
T. A. Bogush ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Monoclonal Antibodies ◽  
Cytotoxic T Lymphocyte ◽  
Control Point ◽  
Distant Metastases ◽  
T Cell Response ◽  
Intestinal Microbiome ◽  
Malignant Neoplasms ◽  
Immune Control ◽  
Late Stages

Gastric cancer (GC) takes 5th place among the malignant neoplasms by incidence in the world. Mortality from GC is high, since in most cases the disease is diagnosed in the late stages, with distant metastases, the five-year survival in GC does not exceed 25–30 %. The standard for GC therapy is surgery with chemotherapy. There is a high resistance to chemotherapy in the late stages of GC, and this circumstance requires a fundamentally new therapy. Recently, studies have been actively conducted on the therapy of GC with the immune control point inhibitors. At the moment, the most studied are monoclonal antibodies against PD-1 (Programmed cell death 1, CD279) / PDL1 (Programmed death-ligand 1, CD274), CTLA-4 (Cytotoxic T-lymphocyte-associated protein 4, CD152). The article discusses the characteristics of PD-1, PD-L1, CTLA-4 molecules and their significance in suppressing the T-cell response, as well as the antitumor effect of immune control point inhibitors. The results of clinical studies of GC therapy with monoclonal antibodies against PD-1 / PD-L1, CTLA-4 were analyzed. The immune control point inhibitors are used as both first-line therapy and subsequent ones. The negative side of immunotherapy is immune-mediated adverse events that can affect the tissues of the kidneys, heart, gastrointestinal tract, liver, lungs, skin and endocrine glands. Biomarkers of the effectiveness of the immune control point inhibitors for GC are considered, among which one can distinguish PD-L1 expression, microsatellite instability, gene expression profile, tumor mutational load and composition of the intestinal microbiome.

Infectious safety of nursing staff in departments (offices) functional diagnostics in the context of the COVID-19 pandemic

2020 ◽  
pp. 30-33
Author(s):  
E. V. Panina ◽  
M. V. Pugachev ◽  
A. G. Shchesiu
Keyword(s):  
Medical Care ◽  
Nursing Staff ◽  
Personal Protective Equipment ◽  
Medical Personnel ◽  
Medical Waste ◽  
Daily Activities ◽  
Protective Equipment ◽  
Functional Diagnostics ◽  
Prevention Of Infections ◽  
Epidemiological Situation

The article shows that in the daily activities of nursing staff of functional diagnostics departments (offices), it is necessary to strictly observe the requirements and rules for the prevention of infections associated with medical care, especially during the COVID-19 pandemic. The types of personal protective equipment (PPE) of medical personnel (MP), as well as current effective methods of disinfection, rules for collecting medical waste in a complex epidemiological situation are presented.

Medical Care for Children with Cancer in the Donetsk People’s Republic: Results of an Ecological Study in 2014–2017

2018 ◽  
Vol 5 (3) ◽  
pp. 145-154
Author(s):  
M. Yu. Rykov ◽  
I. N. Inozemtsev ◽  
S. A. Kolomenskaya
Keyword(s):  
Medical Care ◽  
Pediatric Patient ◽  
Ecological Study ◽  
Medical Service ◽  
Care Delivery ◽  
Benign Tumors ◽  
High Tech ◽  
Malignant Neoplasms ◽  
Children With Cancer ◽  
Patient Capacity

Background.Analysis of medical care delivery for children with cancer in armed conflict is highly important because the high-tech treatment in this context is extraordinary difficult and challenging task. Objective. Our aim was to analyze the morbidity and mortality rates in children with malignant tumors, to assess the pediatric patient capacity and medical service density in the Donetsk People’s Republic.Methods.The ecological study was conducted where the units of analysis were represented by the aggregated data of the Republican Cancer Registry on the number of primary and secondary patients with malignant and benign tumors, the deceased patients in the DNR in 2014–2017, pediatric patient capacity, and medical service density.Results.The number of pediatric patient capacity for children with cancer was 10 (0.27 per 10,000 children aged 0–17), pediatric patient capacity for children with hematological disorders — 40 (1.37 per 10,000 children aged 0–17). The treatment of children with cancer was performed by 5 healthcare providers: 1 pediatric oncologist (0.02 per 10,000 children aged 0–17), 3 hematologists (0.08 per 10,000 pediatric population aged 0–17), and 1 practitioner who did not have a specialist certificate in oncology. Morbidity rate for malignant neoplasms from 2014 to 2017 decreased by 25% (in 2014 — 9.6 per 10,000 children aged 0–17; in 2017 — 7.2). In the morbidity structure, the incidence proportion of hemoblastoses was 68.4%, brain tumors — 2.6%, other solid tumors — 29%. The death rate due to malignant neoplasms decreased by 37% (in 2014 — 2.7; in 2017 — 1.7).Conclusion.Low levels of the incidence rate and pattern of morbidity indicate defects in the identification and recording of patients. This explains the performance of the bed: low average bed occupancy per year and low turnover. For a reliable analysis of mortality statistical data is not available: in 2014–2015 only the number of in-hospital deceased patients is presented. Limited data is due to the lack of reliable patient catamnesis which is explained by the high rate of population migration. 

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