Considerations on bringing warehoused HCV patients into active care following interferon-free, direct-acting antiviral drug approval.

OBJECTIVES: Until recently, lack of efficacious and tolerable hepatitis C virus (HCV) treatments prompted patient warehousing until better treatment options became available. We investigated whether the introduction of ledipasvir/sofosbuvir precipitated patient return to clinics, thereby changing HCV clinic dynamics. METHODS: Online questionnaire responses indicated the volume of HCV patients followed, the proportion of warehoused patients and those who were proactively offered new options, methods for identifying and contacting patients, and insurance authorization/reimbursement-related information. RESULTS: Of 168 practices surveyed, 19% indicated no patient warehousing in the previous 3 years; 81% had warehoused 40% of patients; 92% were able to handle their patient load; and 82% had not changed practices to accommodate more HCV patients in the previous 12 months. Of the 35% of patients who were ledipasvir/sofosbuvir-eligible, 50% already completed/are completing therapy, 21% were not treated due to insurance denial, and 19% were awaiting responses from insurance companies. CONCLUSIONS: Launch of a new treatment did not overburden HCV practices. Patients eligible to receive new treatments were being treated, but pre-authorization processes and reimbursement denials reduced the numbers of treated patients.

Consumer satisfaction with tertiary healthcare in China: findings from the 2015 China National Patient Survey.

OBJECTIVE: This study aims to develop understanding of Chinese patient satisfaction with tertiary hospitals. DESIGN: The study draws on data collected from the 2015 China National Patient Survey. A Likert five-point scale was used to formulate the questionnaires. Descriptive analysis and logistic regression analysis were conducted. SETTING: A structured questionnaire was used by 1432 interviewers to interview 27 475 outpatients and 19 938 inpatients in 136 tertiary hospitals from 31 provinces. PARTICIPANTS: Outpatients in the dispensing area and inpatients in the discharging area were randomly interviewed. MAIN OUTCOME MEASURE(S): Key domains of the questionnaire include the layout of service functions, environment maintenance, process management, quality of care, humane care and the patient-doctor relationship. Within each domain, several indicators were set, and each indicator was given a statement. RESULTS: The overall satisfaction scores are 4.42 ± 0.68 and 4.67 ± 0.62 for outpatient and inpatient, respectively. The domains with highest satisfaction are 'diagnosis and treatment' for outpatient and 'nursing care' for inpatient. Outpatients were least satisfied with long waiting time, while inpatients were least satisfied with the food. The strongest predictor of overall satisfaction appears to be 'patient-doctor relationship' for both outpatients (OR = 3.53, 95% CI: 3.17-3.92) and inpatients (OR = 7.34, 95% CI: 5.55-9.70). CONCLUSIONS: Chinese hospitals need to pay more attention to offering more humane care to patients, hospital environment and process management improvement, reducing waiting times for seeing doctors and outpatient testing, and improving amenity services such as better food in the wards.

Idiopathic pulmonary fibrosis: Physicians' perceptions of patient treatment with recently approved drugs.

Idiopathic pulmonary fibrosis (IPF) is a rare, chronic and ultimately fatal disease for which only palliative treatments existed until recently. Between 2011 and 2015, two new drugs, pirfenidone and nintedanib, were approved in the US and Europe for the treatment of IPF, providing hope for patients. The objectives of our work were to understand physicians' expected use of these new treatments in the US and Europe, and to estimate their potential. To achieve this goal, we conducted surveys amongst US and European Union (EU) pulmonologists caring for patients with IPF. There was a significant difference between EU and US physicians in the treatment of patients with mild disease with pirfenidone; the EU physicians anticipated using pirfenidone for 57% of their patients with mild disease, whereas the US pulmonologists anticipated using it for 34% of their patients (p = 0.01). Regarding patients with severe disease, the US pulmonologists anticipated treating 74% with either pirfenidone (46%) or nintedanib (28%), whereas the EU pulmonologists treated 28% with pirfenidone and anticipated treating 20% with nintedanib. These findings suggest treatment with pirfenidone and nintedanib based on disease severity may vary between US and EU physicians, which may affect patient outcomes.

Self-assembly and tissue fusion of toroid-shaped minimal building units.

A significant challenge of tissue engineering is to build tissues whose size is not limited by diffusion. We are investigating the use of scaffold-free lumen containing toroid-shaped microtissues as minimal building units. Monodispersed H35 cells, a rat hepatocyte cell line, were seeded onto micromolded agarose, forming self-assembled multicellular toroids within 48 h. Toroid and lumen diameter were easily controlled by micromold design, and toroid thickness was controlled by seeding density. When harvested, toroids were stable, but underwent predictable changes over time with their lumens narrowing. When brought into contact, these building units fused in the x-y plane, forming a double-lumen structure, as well as the z plane, forming a tubular structure, which completed within 72 h. Large, multi-luminal structures were assembled by multidimensional fusion of many toroids. Toroid settling was not entirely random, with most toroids lying flat with their lumens oriented along the z axis. The rapid production of toroid building units of controlled dimension and lumen size that undergo predictable changes and that can be fused to form larger structures is a step closer to tissue engineering large porous three-dimensional tissues with high cell density.