healthcare policy

医疗保健政策
  • 文章类型: Journal Article
    骨科目前正在出现采用转化研究策略的以患者为中心的多重护理模式的几种趋势。这些与疼痛中的表观遗传学讨论无缝对齐,一种疼痛管理的临床方法,优先考虑根据个人需求定制医疗保健,preferences,和环境。认识到影响疼痛感知的独特遗传和表观遗传因素,医疗保健提供者可以将个性化见解整合到他们以患者为中心的方法中,提供更有针对性和有效的疼痛管理策略,适合每个人的经验。定制3D打印技术也可能与更有效和可靠地治疗疼痛性退行性结构异常变得越来越相关。预计他们将与精准医学对肌肉骨骼护理的重新定义齐头并进。需要更有效地分析外科医生的临床决策和患者对高价值骨科护理的看法。共享决策(SDM)对于确定每位患者的最佳解决方案以及提高利益相关者对影响付款人手术或非手术治疗的不同优先级价值的因素的理解至关重要。系统,和其他供应商。在骨科手术中通过有效的SDM识别高价值的骨科手术不仅需要向患者提供信息。Rasch对患者期望的分析可以提供这种细致入微的方法,包括理解患者的价值观,解决误解,并使手术建议与患者特定目标保持一致。在以患者为中心的框架内优化骨科治疗可以推动更广泛支持该领域的报销政策的创新。将高价值与低价值骨科手术分开的研究可能会影响医疗保健决策者的资源分配。
    Several trends toward patient-centered multi-care models employing translational research strategies are currently emerging in orthopaedics. These align seamlessly with epigenetics discussions in pain, a clinical approach to pain management that prioritizes tailoring healthcare to individual needs, preferences, and circumstances. Recognizing the unique genetic and epigenetic factors influencing pain perception, healthcare providers can integrate personalized insights into their patient-centered approach, offering more targeted and effective pain management strategies tailored to each individual\'s experience. Custom 3D-printing technologies may also become increasingly relevant to more effectively and reliably treat painful degenerative structural abnormalities. They are expected to go hand-in-hand with the precision medicine redefinition of musculoskeletal care. More effective analysis of surgeons\' clinical decision-making and patients\' perception of high-value orthopaedic care is needed. Shared Decision Making (SDM) is critical to identifying the best solution for each patient and improving stakeholders\' understanding of factors influencing the diverse prioritizing values of surgical or non-surgical treatments by payers, systems, and other providers. Identifying high-value orthopaedic surgeries via effective SDM in orthopedic surgery requires more than just presenting patients with information. The Rasch analysis of patient expectations can provide this nuanced approach that involves understanding patient values, addressing misconceptions, and aligning surgical recommendations with patient-specific goals. Optimizing orthopaedic treatment within the patient-centered framework can drive innovation in reimbursement policies that support the field more broadly. Research on separating high-value from low-value orthopaedic procedures may likely impact healthcare decision- makers\' resource allocation.
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  • 文章类型: Journal Article
    确保获得适当的眼睛健康服务不仅是一项基本人权,也是保持个人生活质量的关键。预防失明,促进整体福祉。在撒哈拉以南非洲(SSA)等低收入国家尤其如此,认识到获得医疗保健与健康的社会决定因素(SDOH)之间的复杂关系对于解决健康差距至关重要。这项研究的目的不仅是阐明和强调数百万人在获得眼部护理方面面临的障碍,而且还为旨在在不同人群中创造公平机会的干预措施和政策铺平道路。要做到这一点,对护理和相关健康文献累积指数(CINAHL)进行了范围审查,Embase,和PubMed数据库,用于符合搜索词和纳入标准的研究。结果表明,增加视力护理的干预策略必须超越医疗保健部门,以应对多方面的挑战。与参与解决更广泛的民生问题的利益相关者合作,比如粮食安全,教育,和SDOH,必须确保在SSA中全面和可持续地改善视力护理的可及性。
    Ensuring access to proper eye health services is not only a fundamental human right but also crucial for preserving an individual\'s quality of life, preventing blindness, and promoting overall well-being. This is especially true in low-income countries like Sub-Saharan Africa (SSA) where recognizing the intricate relationship between access to healthcare and social determinants of health (SDOH ) is crucial to addressing health disparities. The goal of this study was to elucidate and highlight not only the barriers millions face in obtaining eye care but also pave the way for interventions and policies aimed at creating equitable access across diverse populations. To do this, a scoping review was conducted across the Cumulated Index to Nursing and Allied Health Literature (CINAHL), Embase, and PubMed databases for studies meeting the search terms and inclusion criteria. The results show that intervention strategies that increase vision care must extend beyond the healthcare sector to address the multifaceted challenges. Collaborating with stakeholders involved in addressing broader livelihood issues, such as food security, education, and SDOH, becomes imperative to ensure comprehensive and sustainable improvements in vision care accessibility in SSA.
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  • 文章类型: Journal Article
    在医疗保健的变革性景观中,个性化医疗作为一个关键的转变,利用遗传,环境和生活方式数据,以定制医疗治疗,以提高结果和成本效率。其成功的核心是公众参与并同意在数据隐私问题日益加剧的情况下共享健康数据。为了调查欧洲公众对这一范式的看法,我们进行了一项全面的横断面调查,以捕捉公众对个性化医疗和数据共享模式的看法,包括数字工具和电子记录。该调查在八个主要欧洲联盟国家分发,其结果旨在指导未来的决策和建立信任措施,以确保卫生数据交换。这篇文章描述了我们的方法论方法,调查结果将在随后的出版物中阐述。
    [方框:见正文]。
    In the transformative landscape of healthcare, personalized medicine emerges as a pivotal shift, harnessing genetic, environmental and lifestyle data to tailor medical treatments for enhanced outcomes and cost efficiency. Central to its success is public engagement and consent to share health data amidst rising data privacy concerns. To investigate European public opinion on this paradigm, we executed a comprehensive cross-sectional survey to capture the general public\'s views on personalized medicine and data-sharing modalities, including digital tools and electronic records. The survey was distributed in eight major European Union countries and the results aim at guiding future policymaking and trust-building measures for secure health data exchange. This article delineates our methodological approach, whereby survey findings will be expounded in subsequent publications.
    [Box: see text].
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  • 文章类型: Journal Article
    慢性阻塞性肺疾病(COPD)是一种重要的呼吸系统疾病,在全球范围内被列为第三大死亡原因。在加拿大,与COPD相关的直接医疗费用估计每年为15亿美元.本研究利用定量分析来检验社会支持的具体维度的影响,即,指导,可靠的联盟,价值的保证,附件,在临床确定的COPD患者人群中表现出抑郁和焦虑症状。这项研究基于社会规定理论和压力缓冲假设,利用加拿大统计局2012年加拿大社区健康调查(CCHS)心理健康部分的大规模人口数据。在全国范围内,个人更有可能报告对一群朋友的归属感下降(社会融合),并在压力大的时候努力依赖他人(可靠的联盟),同时出现焦虑和抑郁的症状。这些发现强调了整合同行支持的潜在好处,社会化倡议,并将护理人员培训纳入为COPD患者设计的临床项目。
    Chronic obstructive pulmonary disease (COPD) is a significant respiratory disease and is globally ranked as the third leading cause of death. In Canada, the direct healthcare costs associated with COPD are estimated to be $1.5 billion annually. This study utilized quantitative analyses to examine the impact of specific dimensions of social support, namely, guidance, reliable alliance, reassurance of worth, attachment, and social integration within a clinically identified population of individuals with COPD who exhibit symptoms of depression and anxiety. The study was based on the Social Provisions Theory and stress-buffering hypothesis, utilizing large-scale population data from Statistics Canada\'s 2012 Canadian Community Health Survey (CCHS) Mental Health component. On a national scale, individuals were more likely to report a decreased sense of belonging to a group of friends (social integration) and struggle to depend on others in stressful times (reliable alliance) while experiencing symptoms of anxiety and depression. These findings underscore the potential benefits of integrating peer support, socialization initiatives, and caregiver training into clinical programs designed for individuals with COPD.
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  • 文章类型: Journal Article
    背景:人口的减少可能会影响医疗保健服务和系统,特别是在人口减少的医疗服务不足地区(MUA)。这项研究旨在模拟日本MUA的未来人口和土地面积。
    方法:这项研究涵盖了380,9481km网格,87,942个诊所,截至2020年,日本各地有8354家医院。医疗机构半径4公里以外的区域被认为是MUA,根据现行《日本医疗法》中的地区衡量标准。根据1公里网格的人口估计,使用地理信息系统分析,从2020年到2050年,每10年预测MUA的网格数量。如果距医疗机构4公里半径内的人口降至1000以下,则该机构在操作上被假定为关闭。
    结果:MUA的数量预计将从2020年的964,310(占日本总人口的0.77%)减少到2050年的763,410(0.75%)。到2050年,预计有48,105个网格(占日本总网格的13%)是新的MUA,表明从2020年到2050年,MUA增加了31%。到2050年,初步估计有1601家医疗机构在附近。
    结论:在日本,MUA的人口将会减少,而MUAs的土地面积将会增加。这些变化可能会改革农村医疗政策和制度。
    BACKGROUND: A decrease in populations could affect healthcare access and systems, particularly in medically underserved areas (MUAs) where depopulation is becoming more prevalent. This study aimed to simulate the future population and land areas of MUAs in Japan.
    METHODS: This study covered 380,948 1 km meshes, 87,942 clinics, and 8354 hospitals throughout Japan as of 2020. The areas outside a 4 km radius of medical institutions were considered as MUAs, based on the measure of areas in the current Japanese Medical Care Act. Based on the population estimate for a 1 km mesh, the population of mesh numbers of MUAs was predicted for every 10 years from 2020 to 2050 using geographic information system analysis. If the population within a 4 km radius from a medical institution fell below 1000, the institution was operationally assumed to be closed.
    RESULTS: The number of MUAs was predicted to decrease from 964,310 (0.77% of the total Japanese population) in 2020 to 763,410 (0.75%) by 2050. By 2050, 48,105 meshes (13% of the total meshes in Japan) were predicted to be new MUAs, indicating a 31% increase in MUAs from 2020 to 2050. By 2050, 1601 medical institutions were tentatively estimated to be in close proximity.
    CONCLUSIONS: In Japan, the population of MUAs will decrease, while the land area of MUAs will increase. Such changes may reform rural healthcare policy and systems.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    行业资助的宗教自由法律团体试图破坏医疗保健政策和法律,同时攻击性和性别少数群体的权利。过去的奖学金追踪了宗教相关的医疗保健提供者不断增长的政治权力和随之而来的法律学说的转变,我们的帐户强调了政治捐助者和有远见的人,他们利用宗教提供者和美国医疗保健系统的委托结构来更广泛地改变社会政策和官僚机构。
    Industry-funded religious liberty legal groups have sought to undermine healthcare policy and law while simultaneously attacking the rights of sexual and gender minorities. Whereas past scholarship has tracked religiously-affiliated healthcare providers\' growing political power and attendant transformations to legal doctrine, our account emphasizes the political donors and visionaries who have leveraged religious providers and the U.S. healthcare system\'s delegated structure to transform social policy and bureaucratic agencies more generally.
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  • 文章类型: Journal Article
    猴痘在刚果和尼日利亚流行至少五十年。自2022年5月初以来,世界各地发生了许多前所未有的疫情,此前没有任何病例报告。虽然大多数确诊病例在欧洲和美洲,一些病例发生在非地方性非洲国家。截至2022年12月,全球已报告82,999例引起世界卫生组织(世卫组织)成员的关注。虽然世卫组织尚未将这一流行病列为全球卫生紧急情况,成员国已经开始提出计划,以巩固其紧急疫苗库存,并分享由单一FDA批准的制造商生产的有限数量的疫苗,巴伐利亚北欧。许多国家担心疫苗将如何共享。一些较大的捐助国被定位为疫苗共享的最大受益者,虽然自1970年代以来一直感染该病毒的地区的国家没有得到任何分配。这种疫苗分布模式与COVID-19大流行早期的情况相呼应。由于猴痘和天花的相似性,接触预防措施和疫苗接种似乎是防止其迅速传播的有效策略。我们的目标是评估类似于天花的根除程序模型如何应用于Monkeypox,以及它是否可以解决疫苗不平等问题。要做到这一点,我们使用多管齐下的方法来针对疾病监测,疫苗意识,制造,成本,和分销策略。
    Monkeypox has been endemic in Congo and Nigeria for at least five decades. Since early May 2022, there have been numerous unprecedented outbreaks throughout the world in places without any previously reported cases. While a majority of the diagnosed cases have been within Europe and the Americas, several cases have occurred in non-endemic African countries. As of December 2022, 82,999 cases had been reported globally, prompting concern among the World Health Organization (WHO) members. While the WHO has not labeled this epidemic a Global Health Emergency, member states have begun to put forward plans to consolidate their emergency vaccine stockpiles and share the limited number of vaccines made by the single FDA-approved manufacturer, Bavarian Nordic. Many countries are concerned about how vaccines will be shared. Some of the larger donor States are positioned to be the biggest beneficiaries of vaccine sharing, while States from areas that have been suffering from the virus since the 1970s have not been allocated any. This pattern of vaccine distribution echoes that seen during the early part of the COVID-19 pandemic. Due to the similarities between Monkeypox and Smallpox, contact precautions and vaccination seem to be effective strategies to combat its rapid spread. We aim to evaluate how an eradication program model similar to that used for Smallpox can be applied to Monkeypox, and whether it can address vaccine inequity. To do this, we use a multi-pronged approach targeting disease surveillance, vaccine awareness, manufacturing, cost, and distribution strategies.
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  • 文章类型: Journal Article
    人类旅行在区域之间传染病的传播中起着至关重要的作用。受感染的个人从一个地区到另一个地区的旅行可以将病毒运送到以前未受影响的地方,或者可能加速疾病在疾病尚未确定的地方的传播。我们开发和应用模型和指标来分析区域间旅行相对于疾病传播的作用,从美国COVID-19的数据中提取。为了更好地了解运输如何影响疾病传播,我们建立了具有空间相互作用的多区域时变隔室疾病模型。隔室模型与区域间旅行的统计估计相结合。从集成模型来看,我们推导了一个传播进口指数来评估COVID-19在各州之间传播的风险。根据指数,我们确定了疾病传播到其他州的风险很高的州,我们分析了该指数在2020年随时间的变化。我们的模型为政策制定者提供了一个工具,以评估区域间旅行对疾病传播的影响,以支持流行病控制策略。
    Human travel plays a crucial role in the spread of infectious disease between regions. Travel of infected individuals from one region to another can transport a virus to places that were previously unaffected or may accelerate the spread of disease in places where the disease is not yet well established. We develop and apply models and metrics to analyze the role of inter-regional travel relative to the spread of disease, drawing from data on COVID-19 in the United States. To better understand how transportation affects disease transmission, we established a multi-regional time-varying compartmental disease model with spatial interaction. The compartmental model was integrated with statistical estimates of travel between regions. From the integrated model, we derived a transmission import index to assess the risk of COVID-19 transmission between states. Based on the index, we determined states with high risk for disease spreading to other states at the scale of months, and we analyzed how the index changed over time during 2020. Our model provides a tool for policymakers to evaluate the influence of travel between regions on disease transmission in support of strategies for epidemic control.
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  • 文章类型: Journal Article
    本研究旨在通过(1)住院的老年人的观点,检查在老年人家庭成员或朋友的医院护理中纳入护理人员的感知障碍和促进者,(2)住院的老年人的照顾者,(3)保健临床医生,(4)决策者。
    这项定性的描述性探索性研究利用了对N=24名参与者的半结构化访谈,并使用框架方法进行了分析。
    出现了八个代码,这些代码由社会生态模型指导分为四个领域。确定了护理人员和临床医生的个体水平因素。揭示了与沟通方式和方法有关的关系层面因素。医院层面的因素包括医院环境和资源。社会层面的因素包括医疗环境和政策。
    研究结果表明,医院的工作流程和政策不足以支持家庭护理人员。这项研究强调了护理人员融入医院工作流程的潜在解决方案。
    UNASSIGNED: This study aimed to examine perceived barriers and facilitators to caregiver inclusion in the hospital care of older adult family members or friends through the perspectives of (1) hospitalized older adults, (2) caregivers of a hospitalized older adult, (3) healthcare clinicians, and (4) policymakers.
    UNASSIGNED: This qualitative descriptive exploratory study utilized semi-structured interviews with N = 24 participants and was analyzed using a framework method.
    UNASSIGNED: Eight codes arose that were categorized into four domains guided by the Social Ecological Model. Individual-level factors were determined both for the caregiver and for the clinician. Relationship-level factors were revealed pertaining to communication style and method. Hospital-level factors included hospital environment and resources. Societal-level factors included healthcare climate and policies.
    UNASSIGNED: Findings indicated that hospital workflows and policies inadequately support family caregivers. This study highlights potential solutions to caregivers\' integration into hospital workflows.
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