When do the risks of repeated courses of corticosteroids exceed the risks of surgery?

BACKGROUND: The management of chronic rhinosinusitis with nasal polyposis (CRSwNP) becomes unclear when patients require multiple courses of corticosteroids to maintain quality of life. Repeated courses of corticosteroids carry increased risks to patients. Although endoscopic sinus surgery (ESS) is an effective therapeutic modality, it also carries inherent risks. This study aims to identify the threshold at which the risks of repeated courses of corticosteroid exceed the risks of surgery. METHODS: An evidence-based risk analysis was simulated using literature-reported complication rates, quality of life changes, and Medicare costs. Simulations were performed from the Medicare patient perspective, societal perspective, and the universal healthcare patient perspective. RESULTS: All 3 simulations demonstrate a breakeven threshold favoring surgery over medical therapy when patients require oral corticosteroids (OCS) more often than once every 2 years in CRSwNP, once per year in CRSwNP/asthma, or twice per year for Samter's triad patients. CONCLUSION: This represents the first rationalized evidence-based analysis for when surgery should be considered in place of repeated courses of oral corticosteroids. This threshold provides a guide for otolaryngologists to use when making clinical decisions with patients.

Framing and measuring international patient management.

PURPOSE: Hospitals need to determine if an international patient department is a necessity to communicate with and manage international patients. DESIGN/METHODOLOGY/APPROACH: A benchmarking instrument was created to assess the level of professionalism in managing international patients, including reviewing and validating processes by two university hospitals, professionals, and an expert panel. FINDINGS: First, the differences between the hospitals depended on the will of the hospital to engage in such activities. Second, the differences depended on the embedding national context in which the hospital was situated. Further validation revealed the importance of other supportive services, such as cultural sensitivity and language. Finally, the microlevel phenomenon of international patient departments is placed within a macrolevel transnational health region development scheme. ORIGINALITY/VALUE: This study focused on the supply of services with respect to international patient departments, which could be related to efficiency and sustainability on a public health and health systems level.

Transnational health care: from a global terminology towards transnational health region development.

Within European cross-border health care, recent studies have identified several types of international patients. Within the Anglo-Saxon setting, the specific terminology of medical tourism is used. The analytical purpose of the paper is to resolve this semantic difference by suggesting an alternative terminology, 'transnational health care' that is understood as a 'context-controlled and coordinated network of health services'. For demand-driven trans-border access seekers and cross-border access searchers, there is a need to opt for regional health-policy strategies. For supply-driven sending context actors and receiving context actors, there would be organizational benefits to these strategies. Applying the terminology of trans-border access seekers, cross-border access searchers, sending context and receiving context actors results in a transnational patient mobility typology of twelve types of international patients, based on the criteria of geographical distance, cultural distance and searching efforts, public/private/no cover and private/public provision of health services. Finally, the normative purpose of the paper is to encourage the use of this terminology to promote a policy route for transnational health regions. It is suggested that the development of transnational health regions, each with their own medical and supportive service characteristics, could enhance governmental context-controlled decision power in applying sustainable health destination management.