Metabolic syndrome and surgical complications: a systematic review and meta-analysis of 13 million individuals.

BACKGROUND: Metabolic syndrome (MetS) is characterised by the presence of at least three of the five following components: insulin resistance, obesity, chronic hypertension, elevated serum triglycerides, and decreased high-density lipoprotein cholesterol concentrations. It is estimated to affect 1 in 3 people around the globe and is reported to affect 46% of surgical patients. For people with MetS who undergo surgery, an emerging body of literature points to significantly poorer postoperative outcomes compared with nonaffected populations. The aim of this study is to review the current evidence on the risks of surgical complications in patients with MetS compared to those without MetS. METHODS: Systematic review and meta-analysis using PRISMA and AMSTAR reporting guidelines. RESULTS: The meta-analysis included 63 studies involving 1 919 347 patients with MetS and 11 248 114 patients without MetS. Compared to individuals without the condition, individuals with MetS were at an increased risk of mortality (OR 1.75 95% CI: 1.36-2.24; P <0.01); all surgical site infection types as well as dehiscence (OR 1.64 95% CI: 1.52-1.77; P <0.01); cardiovascular complications (OR 1.56 95% CI: 1.41-1.73; P <0.01) including myocardial infarction, stroke, cardiac arrest, cardiac arrythmias and deep vein thrombosis; increased length of hospital stay (MD 0.65 95% CI: 0.39-0.9; P <0.01); and hospital readmission (OR 1.55 95% CI: 1.41-1.71; P <0.01). CONCLUSION: MetS is associated with a significantly increased risk of surgical complications including mortality, surgical site infection, cardiovascular complications, increased length of stay, and hospital readmission. Despite these risks and the high prevalence of MetS in surgical populations there is a lack of evidence on interventions for reducing surgical complications in patients with MetS. The authors suggest prioritising interventions across the surgical continuum that include (1) preoperative screening for MetS; (2) surgical prehabilitation; (3) intraoperative monitoring and management; and (4) postoperative rehabilitation and follow-up.

Correction: The burden of chronic diseases among Australian cancer patients: Evidence from a longitudinal exploration, 2007-2017.

[This corrects the article DOI: 10.1371/journal.pone.0228744.].

Correction: The cost-effectiveness of controlling cervical cancer using a new 9-valent human papillomavirus vaccine among school-aged girls in Australia.

[This corrects the article DOI: 10.1371/journal.pone.0223658.].

Assessing health-related quality of life among cancer survivors during systemic and radiation therapy in Bangladesh: a cancer-specific exploration.

BACKGROUND: Evaluating the effects of cancer diagnosis and treatment on a patient's overall well-being is crucial and health-related quality of life (HRQoL) is a reliable metric for assessing this impact. Little is known about HRQoL among cancer survivors across various stages and treatments. The study examined individual and clinical factors influencing HRQoL among cancer survivors. METHODS: A cross-sectional study was conducted in two specialised cancer care hospitals in Dhaka, Bangladesh. Cancer-diagnosed adults receiving treatment at selected hospitals from January to May 2022 were enrolled. The 5-level EuroQol-5 Dimensions version (EQ-5D-5L) instrument was used to collect HRQoL data. HRQoL scores were derived using UK value sets. The investigation used a multivariable Tobit regression model to determine the association between independent variables and HRQoL scores. RESULTS: A total of 607 adult patients were enrolled, with 55% being females and 66% aged 36 to 64 years. Reported health problems in five EQ-5D domains include mobility (11%), self-care (11%), usual daily activities (19%), pain/discomfort (21%), and anxiety/depression (46%). Patients with throat, brain, lung, blood, and liver cancer had lower utility scores. Advanced-stage cancer survivors had lower utility scores (ß = -49 units, 95% codfidence interval [CI]: -0.75 to -0.22) compared to early-stage survivors. Physically inactive survivors had lower utility scores by 0.41 units (95% CI: -0.51 to -0.30) compared to their counterparts. Private hospital patients had higher utility scores, whereas patients belonged to poor socioeconomic groups scored worse than wealthier ones. CONCLUSIONS: This study highlights the impact of clinical and individual characteristics on HRQoL among cancer survivors. These findings advocate for an enhanced Bangladeshi cancer patient care model through timely interventions or programs, early detection or diagnosis, tailored treatments, and the promotion of physical activity to bolster HRQoL outcomes.

Correction: Cost-effectiveness evaluations of the 9-Valent human papillomavirus (HPV) vaccine: Evidence from a systematic review.

[This corrects the article DOI: 10.1371/journal.pone.0233499.].

Correction: Changes in inequality of childhood morbidity in Bangladesh 1993-2014: A decomposition analysis.

[This corrects the article DOI: 10.1371/journal.pone.0218515.].

Exploration of key drug target proteins highlighting their related regulatory molecules, functional pathways and drug candidates associated with delirium: evidence from meta-data analyses.

BACKGROUND: Delirium is a prevalent neuropsychiatric medical phenomenon that causes serious emergency outcomes, including mortality and morbidity. It also increases the suffering and the economic burden for families and carers. Unfortunately, the pathophysiology of delirium is still unknown, which is a major obstacle to therapeutic development. The modern network-based system biology and multi-omics analysis approach has been widely used to recover the key drug target biomolecules and signaling pathways associated with disease pathophysiology. This study aimed to identify the major drug target hub-proteins associated with delirium, their regulatory molecules with functional pathways, and repurposable drug candidates for delirium treatment. METHODS: We used a comprehensive proteomic seed dataset derived from a systematic literature review and the Comparative Toxicogenomics Database (CTD). An integrated multi-omics network-based bioinformatics approach was utilized in this study. The STRING database was used to construct the protein-protein interaction (PPI) network. The gene set enrichment and signaling pathways analysis, the regulatory transcription factors and microRNAs were conducted using delirium-associated genes. Finally, hub-proteins associated repurposable drugs were retrieved from CMap database. RESULTS: We have distinguished 11 drug targeted hub-proteins (MAPK1, MAPK3, TP53, JUN, STAT3, SRC, RELA, AKT1, MAPK14, HSP90AA1 and DLG4), 5 transcription factors (FOXC1, GATA2, YY1, TFAP2A and SREBF1) and 6 microRNA (miR-375, miR-17-5, miR-17-5p, miR-106a-5p, miR-125b-5p, and miR-125a-5p) associated with delirium. The functional enrichment and pathway analysis revealed the cytokines, inflammation, postoperative pain, oxidative stress-associated pathways, developmental biology, shigellosis and cellular senescence which are closely connected with delirium development and the hallmarks of aging. The hub-proteins associated computationally identified repurposable drugs were retrieved from database. The predicted drug molecules including aspirin, irbesartan, ephedrine-(racemic), nedocromil, and guanidine were characterized as anti-inflammatory, stimulating the central nervous system, neuroprotective medication based on the existing literatures. The drug molecules may play an important role for therapeutic development against delirium if they are investigated more extensively through clinical trials and various wet lab experiments. CONCLUSION: This study could possibly help future research on investigating the delirium-associated therapeutic target biomarker hub-proteins and repurposed drug compounds. These results will also aid understanding of the molecular mechanisms that underlie the pathophysiology of delirium onset and molecular function.

Changes in the prevalence of dementia in Australia and its association with geographic remoteness.

BACKGROUND: The exact prevalence of dementia in Australia is ambiguous. Australia is a vast continent with a small population, and 80% of the population live in five cities. This study explores recent changes in the prevalence of dementia. It also investigates geographic remoteness as a potential risk factor for developing dementia. METHODS: Survey of Disability, Ageing and Carers (SDAC), a nationally representative database, was used to conduct this study. A total of 74,862 and 65,487 individuals from 2015 and 2018, respectively, were considered for this study. A multivariable logistic regression model was used to evaluate the association between dementia and geographic remoteness for older adults aged 65 years and over. RESULTS: The results reveal that from 2015 to 2018, the prevalence of dementia among adults aged 65 years and older was higher in 2018 (5,229 per 100,000) than in 2015 (5,099 per 100,000). Significant geographical differences in the prevalence of dementia are observed among Australian adults, and this trend appears to be increasing. Furthermore, the unadjusted model revealed that, in 2015, older adults living in major cities had 1.29 (AOR: 1.29, 95% CI: 1.17-1.41) times higher odds of having dementia compared with their counterparts from outer regional and remote areas. In 2018, the adjusted model found that older adults living in major cities had 1.12 (AOR: 1.12, 95% CI: 1.01-1.25) times elevated odds of having dementia than their peers living in outer regional and remote areas. CONCLUSION: There is a rising prevalence of dementia in Australia. Further investigation is required to identify the causes of this increase. Increased public health initiatives should concentrate on behavioural characteristics and contextual environmental factors to ameliorate this trend.

The burden of chronic diseases, disease-stratified exploration and gender-differentiated healthcare utilisation among patients in Bangladesh.

BACKGROUND: Chronic diseases are considered one of the major causes of illness, disability, and death worldwide. Chronic illness leads to a huge health and economic burden, especially in low- and middle-income countries. This study examined disease-stratified healthcare utilisation (HCU) among Bangladesh patients with chronic diseases from a gender perspective. METHODS: Data from the nationally representative Household Income and Expenditure Survey 2016-2017 consisting of 12,005 patients with diagnosed chronic diseases was used. Gender differentiated chronic disease stratified-analytical exploration was performed to identify the potential factors to higher or lower utilisation of healthcare services. Logistic regression with step-by-step adjustment for independent confounding factors was the method used. RESULTS: The five most prevalent chronic diseases among patients were gastric/ulcer (Male/Female, M/F: 16.77%/16.40%), arthritis/rheumatism (M/F: 13.70%/ 13.86%), respiratory diseases/asthma/bronchitis (M/F: 12.09% / 12.55%), chronic heart disease (M/F: 8.30% / 7.41%), and blood pressure (M/F: 8.20% / 8.87%). Eighty-six percent of patients with chronic diseases utilised health care services during the previous 30 days. Although most patients received outpatient healthcare services, a substantial difference in HCU among employed male (53%) and female (8%) patients were observed. Chronic heart disease patients were more likely to utilise health care than other disease types, which held true for both genders while the magnitude of HCU was significantly higher in males (OR = 2.22; 95% CI:1.51-3.26) than their female counterparts (OR = 1.44; 1.02-2.04). A similar association was observed among patients with diabetes and respiratory diseases. CONCLUSION: A burden of chronic diseases was observed in Bangladesh. Patients with chronic heart disease utilised more healthcare services than patients experiencing other chronic diseases. The distribution of HCU varied by patient's gender as well as their employment status. Risk-pooling mechanisms and access to free or low-cost healthcare services among the most disadvantaged people in society might enhance reaching universal health coverage.

Parental role and peer support in adolescent suicidal behavior in eight South-East Asian countries.

BACKGROUND: This study aimed to estimate the prevalence of suicidal behaviors, i.e. suicidal ideation (SI), suicidal plan (SP), and suicidal attempt (SA) among adolescents with a focus on parental and peer support in eight South-East Asian countries including Bangladesh, Bhutan, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka and Thailand. METHOD: Data were drawn from Global School-based Student Health Survey (GSHS) covering 42,888 adolescents aged 11-17 years. Weighted prevalence of SI, SP, and SA along with country specific prevalence was computed and binary logistic regression was used to identify associated risk factors. RESULTS: Among 42,888 adolescents 19,113 (44.9%) were males and 23,441 (55.1%) females. Overall prevalence of SI, SP and SA is 9.10%, 10.42% and 8.54%, respectively. Myanmar demonstrated the lowest SI (1.07%) and SP (0.18%) whereas lowest SA was found in Indonesia (3.79%). Maldives had the highest prevalence of SI, SP and SA which were 14.13%, 19.02% and 13.38% respectively. Overall suicidal behaviors were associated with being female [AOR: SI-1.26 (1.06,1.50), SP-1.34 (1.14,1.57)], high levels of sedentary behavior [AOR: SI-2.08 (1.62,2.66), SP-1.86 (1.49,2.32), SA-1.96 (1.45,2.64)], involvement in physical fighting [AOR: SI-1.30 (1.07,1.58), SP-1.37 (1.14,1.65), SA-1.50 (1.17,1.90)], being seriously injured [AOR: SI-1.40 (1.17,1.67), SP-1.44 (1.22,1.69), SA-1.74 (1.39,2.17)], being bullied [AOR: SI- 1.68 (1.39,2.02), SP-1.34 (1.12,1.60), SA-1.88 (1.50,2.36)], feeling lonely (most of time or always) [AOR: SI-3.41(2.60,4.46), SP-1.92 (1.48,2.47), SA-2.25 (1.62,3.13)], lack of parental support (never checking homework) [AOR: SI-1.59 (1.25,2.02), SP-1.52 (1.22,1.90)] and not having close friends [AOR: SI-2.19 (1.66,2.89), SP-2.26 (1.74,2.94), SA-4.23 (3.10,5.78)]. CONCLUSION: Though prevalence of suicidal behaviors varies, a range of cross-cutting risk factors exists that warrant further examination. We recommend focusing on strengthening parental and peer support, targeted programs addressing physical activity, bullying, loneliness and mental-health of adolescents.

Inequity in psychiatric healthcare use in Australia.

BACKGROUND: Despite recent substantial mental healthcare reforms to increase the supply of healthcare, mental health inequality in Australia is rising. Understanding of the level of inequity (unmet need gap) in psychiatric service use in Australia's mixed public-private health care system is lacking. OBJECTIVE: To present a novel method to measure inequity in the delivery of psychiatric care. METHODS: Data came from wave 9 (year 2009, n = 11,563) and wave 17 (year 2017, n = 16,194) of the Household, Income and Labour Dynamics in Australia (HILDA) survey. Multiple logistic regression was employed to estimate the psychiatric care utilisation compared to its need and the Gini index was used to estimate the standardised distribution of utilisation to measure the extent of inequity. RESULTS: The results show the inequity indices (need-standardised Gini) in psychiatric care utilisation were significant and found to be 0.066 and 0.096 in 2009 and 2017, respectively, for all individuals. In 2009, the inequity indices were found to be 0.051 and 0.078 for males and females, respectively, and 0.045 and 0.068 for rural and urban residents, respectively. In 2017, the indices were calculated to be 0.081 and 0.109 for males and females, respectively, and 0.086 and 0.097 for rural and urban residents, respectively. CONCLUSIONS: This study showed a marked increase in unmet needs in psychiatric care utilisation since 2009. There is a greater need to develop policies to improve equity in psychiatric care utilisation in Australia.

Cost-effectiveness of single-inhaler triple therapy for patients with severe COPD: a systematic literature review.

INTRODUCTION: Evidence from non-randomized studies shows benefits for single-inhaler users compared with multiple-inhaler users who receive the same medication. As a result, comparative cost-effectiveness studies are required to inform treatment decisions with an increasing choice of medications and devices for chronic obstructive pulmonary disease (COPD). This study conducted a systematic literature review to evaluate the cost-effectiveness of using a single combination inhaler regimen for patients with severe COPD. This review also investigated the health impact on patients in different settings. AREAS COVERED: A systematic literature search was conducted in PubMed (MEDLINE), EMBASE, Web of Science, Scopus, Cochrane Library, EBSCO Host (including CINAHL and EconLit), Health Technology Assessment Database, National Institute for Health Research Economic Evaluation Database, Cost-Effectiveness Analysis Registry and Google Scholar. EXPERT OPINION: Based on the primary findings of 13 included studies: (1) single-inhaler triple therapy was a cost-effective treatment option for patients with severe COPD, and (2) triple therapy also resulted in better health outcomes (reduced exacerbations, life-years gained) and increased QALYs for patients with severe COPD. Nonetheless, eleven out of the thirteen selected studies were funded by the pharmaceutical industry, and none were conducted in the least developed countries. Therefore, the results should be interpreted with caution.

Meta-Data Analysis to Explore the Hub of the Hub-Genes That Influence SARS-CoV-2 Infections Highlighting Their Pathogenetic Processes and Drugs Repurposing.

The pandemic of SARS-CoV-2 infections is a severe threat to human life and the world economic condition. Although vaccination has reduced the outspread, but still the situation is not under control because of the instability of RNA sequence patterns of SARS-CoV-2, which requires effective drugs. Several studies have suggested that the SARS-CoV-2 infection causing hub differentially expressed genes (Hub-DEGs). However, we observed that there was not any common hub gene (Hub-DEGs) in our analyses. Therefore, it may be difficult to take a common treatment plan against SARS-CoV-2 infections globally. The goal of this study was to examine if more representative Hub-DEGs from published studies by means of hub of Hub-DEGs (hHub-DEGs) and associated potential candidate drugs. In this study, we reviewed 41 articles on transcriptomic data analysis of SARS-CoV-2 and found 370 unique hub genes or studied genes in total. Then, we selected 14 more representative Hub-DEGs (AKT1, APP, CXCL8, EGFR, IL6, INS, JUN, MAPK1, STAT3, TNF, TP53, UBA52, UBC, VEGFA) as hHub-DEGs by their protein-protein interaction analysis. Their associated biological functional processes, transcriptional, and post-transcriptional regulatory factors. Then we detected hHub-DEGs guided top-ranked nine candidate drug agents (Digoxin, Avermectin, Simeprevir, Nelfinavir Mesylate, Proscillaridin, Linifanib, Withaferin, Amuvatinib, Atazanavir) by molecular docking and cross-validation for treatment of SARS-CoV-2 infections. Therefore, the findings of this study could be useful in formulating a common treatment plan against SARS-CoV-2 infections globally.

Proportion and associated factors of the utilisation of complementary and alternative medicine exclusively in a hospital in Bangladesh.

BACKGROUND: Complementary and alternative medicine (CAM) has played a critical role in ensuring universal access to basic health care services around the world. In Bangladesh, conventional medicine is a common approach for health care practices, yet, due to Bangladesh's high out-of-pocket payment, millions of people utilise CAM-based healthcare services for illnesses. In Bangladesh, there is a scarcity of data on how CAM is perceived and utilised. The goal of this study was to determine the proportion and correlates of the utilisation of CAM among patients visiting a tertiary level hospital, in Bangladesh. METHODS: A cross-sectional survey involving 1,183 patients who received health care from a hospital in Bangladesh was interviewed for this study. The associated factors on utilising CAM were identified using multivariable logistic regression analysis. RESULTS: Thirty-three percent of patients utilised CAM exclusively to treat their illnesses, whereas the rest utilised conventional medicine before CAM. Young adult patients aged 26 to 45 years (AOR = 6.26, 95% CI:3.24-12.07), patients without education (AOR = 2.99, 1.81-4.93), and married patients (AOR = 1.79, 1.08-2.97) were the most likely to be only CAM users. The most common reasons for using CAM were belief in its effectiveness, less adverse effects, affordability and lower costs. CONCLUSION: In Bangladesh, CAM plays a significant role in health care delivery, with high-levels of patient satisfaction and health benefits. Patients who are older and have a higher level of education are more hesitant to use CAM for their illness, yet CAM has the potential to play a significant role in reducing hospitalisation by providing high reliability and low costs.

Morbid obesity, multiple long-term conditions, and health-related quality of life among Australian adults: Estimates from three waves of a longitudinal household survey.

This study aims to investigate the impact of morbid obesity and multiple long-term conditions (MLTCs) on health-related quality of life (HRQoL). Data for this study were sourced from three waves (waves 9, 13 and 17) of the Household, Income and Labour Dynamics in Australia (HILDA) survey. The paper analyses 37,887 person-year observations from 19,387 individuals during the period 2009-2017. The longitudinal random-effects Tobit model was fitted to examine the association between morbid obesity, MLTCs and HRQoL. This study found that morbid obesity and MLTCs were both negatively associated with HRQoL as measured through physical component summary (PCS), mental component summary (MCS), and the short-form six-dimension utility index (SF-6D) of the 36-item Short-Form Health Survey (SF-36). Morbidly obese scored lower points on the PCS (ß = -5.05, 95% CI: -5.73, -4.37), MCS (ß = -1.03, 95% CI: -1.84, -0.23), and in the SF-6D utility index (ß = -0.045, 95% CI: -0.054, -0.036) compared to their healthy weight counterparts. Similar findings were observed for individuals with MLTCs, with lower scores for the PCS (ß = -4.79, 95% CI: -5.20, -4.38), MCS (ß = -4.95, 95% CI: -5.43, -4.48), and SF-6D utility (ß = -0.071, 95% CI: -0.076, -0.066). Additionally, multiplicative interaction between morbid obesity and MLTCs was observed to modestly exacerbated the negative effect of morbid obesity on PCS scores (ß = -1.69, 95% CI: -2.74, -0.64). The interaction effect, on the other hand, significantly lessen the unfavourable effect of morbid obesity on the MCS score (ß = 1.34, 95% CI: 0.10, 2.58). The findings of this study will be useful for future cost-effectiveness analyses and measuring the burden of diseases since it provides information on the disutility associated with morbid obesity and MLTCs.

Do family and maternal background matter? A multilevel approach to modelling mental health status of Australian youth using longitudinal data.

PURPOSE: Most previous research place great importance on the influence of family and maternal background on child and adolescents' mental health. However, age of onset studies indicates that the majority of the mental health disease prevalence occurs during the youth years. This study investigates the relationship of family and maternal background, as well as individual circumstance on youth mental health status. METHOD: Data from 975 participants and 4632 observations of aged cohort 15 to 19 years in the Household, Income and Labour Dynamics in Australia (HILDA) longitudinal study were followed for 10 years (2007-2017). Multilevel logistic regression models were used to analyse the impact of youth circumstances on mental health status. RESULTS: The findings suggests that not all dimensions of family and maternal background (especially maternal education) have impacts on youth mental health. We found low household income (AOR: 1.572, 95% CI: 1.017-2.43) and adverse living arrangement (AOR: 1.586, 95% CI: 1.097-2.294) significantly increases mental disorder odds whereas maternal education or occupation fixed effects were not significant. Individual level circumstances have much stronger impact on youth mental health. We found financial shock (AOR: 1.412, 95% CI: 1.277-1.561), life event shock (AOR: 1.157, 95% CI: 1.01-1.326), long term health conditions (AOR: 2.855, 95% CI: 2.042-3.99), smoking (AOR: 1.676, 95% CI: 1.162-2.416), drinking (AOR: 1.649, 95% CI: 1.286-2.114) and being female (AOR: 2.021, 95% CI: 1.431-2.851) have significant deteriorating effects on youth mental health. CONCLUSIONS: Our finding is in contrast to the majority of studies in the literature which give a preeminent role to maternal characteristics in child and youth mental health status. Mental health interventions should consider heterogeneity of adverse youth circumstances and health-related behaviours.

Association of dietary risks, behavioural and lifestyle factors, and the magnitude of disability burden among Australian cancer patients: An observational epidemiology study.

BACKGROUND: Cancer patients are confronted with a variety of other health-related issues, including physical disability, poor quality of life, and psychological challenges. This study aims to quantify the association of dietary, behavioural and lifestyle risk factors and comorbidities on the magnitude and distribution of disability burden among cancer patients in Australia. METHODS: This study comprised a sample of 2283 cancer patients drawn from the latest nationwide Australian National Health Survey conducted in 2017-18. Negative binomial regression models were used to estimate the incidence rate ratio (IRR) of the number of disabilities and its associations. RESULTS: Forty-five percent of cancer patients experienced at least one disability. The magnitude of disability was significantly associated with sugar-sweetened drink consumption ≥ 3 days per week (IRR= 1.12, 95% CI: 1.02-1.26), a lack of physical activity (IRR = 1.69, 1.38-2.07), frequent or regular alcohol consumption (IRR = 1.95, 1.84-2.08), poor health status (IRR = 1.99, 1.78-2.24) and the presence of five or more chronic comorbid conditions (IRR = 3.59, 2.90-4.46). Cancer patients who consumed vegetables at least two or more times per day had a 10% lower risk of disability burden (IRR = 0.90, 0.82-0.99). CONCLUSIONS: This study shows the association of diet, behavioural, and lifestyle risk factors on the degree of disability burden among cancer patients, highlighting the need for bold and effective policies. The findings will inform the implementation of evidence-based lifestyle interventions and offer a foundation for evaluating their influence on cancer survivors' health.

Associated factors, assessment, management, and outcomes of patients who present to the emergency department for acute exacerbation of chronic obstructive pulmonary disease: A scoping review.

OBJECTIVE: The purpose of the scoping review was to examine the extant literature for factors contributing to presentations of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) to Emergency Departments (ED). METHODS: The review followed Arksey and O'Malley, and Levac's frameworks supplemented with the PRISMA-ScR checklist. We searched Cochrane Library, CINAHL, JBI, and PubMed from January 1, 2008 to March 23, 2020 for inclusions. We included studies reporting ED presentations for AECOPD among adults (≥18 years). The investigation included: pre-hospital factors; ED-related assessment, management and referral practices; holistic management (i.e., interdisciplinary); patient outcomes, admission/discharge status, and readmission. RESULTS: Forty-four studies were included. Environmental factors (e.g., air pollution, seasonal change); social determinants (e.g., poor literacy, ethnicity); and physical health (e.g., comorbidities, obesity, poor exercise capacity) contributed to ED presentation/re-presentation, and admission to hospital. Cigarette smoking was associated with hospital admission. Mortality was associated with longer-term oxygen therapy, poor exercise capacity, age, and loss of consciousness. Compliance with clinical guideline recommendations were generally low or mixed. Further, there was a lack of appropriate referral practices upon discharge. CONCLUSIONS: While there is considerable literature on factors contributing to AECOPD admission more research is required that investigates the impact that inter-professional care models can have on the discharge planning cycles for patients with COPD who are regular presenters to an ED.

Does distance to hospital affect emergency department presentations and hospital length of stay among chronic obstructive pulmonary disease patients?

BACKGROUND: The primary goal of chronic obstructive pulmonary disease (COPD) management is to optimise a patient's functional status and quality of life. By encouraging effective patient self-management within primary healthcare, unplanned and potentially avoidable COPD admissions to the emergency department (ED) can be avoided. AIM: The aim of this study is to examine whether distance to hospital influences the rate of ED presentation, hospital admission and hospital length of stay for COPD patients. METHODS: The 2016 to 2018 resulted in a total of 5253 patient presentations with a primary medical diagnosis code of J44 (COPD). These were at the main hospitals of three Queensland Hospital and Health Services: Toowoomba, Ipswich and Gold Coast. To examine the variations in patient characteristics based on distance, a one-way ANOVA (analysis of variance) test was conducted. The Kruskal-Wallis test indicated that there were group differences. RESULTS: This study identified significant variation in COPD-related hospital length of stay and distance to hospital among COPD patients within three hospitals in South East Queensland, Australia. These results confirm that distance plays an important role in determining duration of hospital stay (in number of days) among COPD patients, with clear evidence of the distance 'decay phenomenon'. It appears from the findings of the current study that distance to the hospital is not associated with the greater likelihood of ED presentation but may influence length of stay. CONCLUSIONS: Several distance-specific studies have concluded that lower utilisation of hospital care is associated with distance to hospital.

Hospitalisation costs associated with heart failure with preserved ejection fraction (HFpEF): a systematic review.

Heart failure with preserved ejection fraction (HFpEF) is problematic to treat, with guidelines for HFpEF management concentrated on treating prevalent comorbidities. The aim of this study is to conduct a systematic review of the economic burden of hospitalisation for HFpEF. We conducted a systematic literature search from 2001, when HFpEF was first identified as an isolated diagnosis, up to July 1, 2020. Databases searched include PubMed, Medline, EMBASE, EBSCO, National Health Service Economic Evaluation and the National Bureau of Economic Research. The primary outcome measure was hospitalisation costs related to HFpEF. A comprehensive search of the literature produced a total of 243 possible studies. A total of nine studies, six from the U.S., met inclusion criteria and were included in this review. All results are presented in United States Dollars (US$) for the financial year 2019. Costs of index (the first) hospitalisation ranged from mean US$8340 up to US$11,366 per admission and increased up to US$31,493 for those with comorbidities. Two studies reported 1-year costs, and these were US$27,174 and US$26,343, respectively. Hospitalisation accounts for approximately 80% of total costs of HFpEF treatment. The results of this systematic review reveal that published costs of HFpEF hospitalisation are limited to nine studies from a comprehensive database search. The costs of an initial HF hospitalisation are significant, and these costs increase when a person with HFpEF presents with comorbidities or other complications.