Case Management Intervention Research Articles

Challenges and Benefits of Developing Case Management in an ICPOP Hub

Abstract Background Case management is a collaborative procedure involving assessment, planning, facilitation, care coordination, evaluation, and advocacy. Its aim is to address the comprehensive health needs of individuals and families by utilising communication and existing resources to achieve high-quality and cost-effective results. The Integrated Care Program for Older Persons (ICPOP) aims to improve life for older people by providing access to tailored interventions supporting them to live well in their own homes. (ICPOP, 2017). The goal of nurse-led case management interventions within the ICPOP Hub, is to provide continuous, patient-centred, comprehensive care for older adults with complex care needs. Methods The Nursing team, comprising Clinical Nurse Specialists, Candidate Advanced Nurse Practitioner, undertook case management of 40 patients with complex care needs, over a six-month period. Diagnoses included Delirium, Dementia, Parkinson’s disease, frailty syndromes. Particular attention was given to patients who, through case management, were able to be discharged earlier from the acute hospital, aligning with the goals of the Integrated Care Model. Quality Improvement methodologies were used aiming to improve service delivery, efficiency, patient outcomes. Results (Required) Benefits Challenges Conclusion Case management enables older adults to continue living independently at home but requires integration into a broader system prioritising seamless delivery utilising a collaborative, multidisciplinary approach to health and social care.

P146 EFFECT OF HOME BLOOD PRESSURE TELE-MONITORING PATHWAY WITH PHARMACIST CASE MANAGEMENT TO SUPPORT PATIENTS DISCHARGED FROM EMERGENCY DEPARTMENT WITH ASYMPTOMATIC HYPERTENSION: A STUDY PROTOCOL FOR MULTICENTRE RANDOMIZED CONTROLLED TRIAL (TEC4HOME-BP)

Background and Objectives: Severely elevated blood pressure (BP) in the emergency department (ED) has recently been associated with undiagnosed hypertension and adverse cardiovascular outcomes, regardless of the initial reason (e.g.: pain or anxiety) for the ED visit. Clinical uncertainty exists on how best to manage severe asymptomatic BP post-discharge from the ED. In this study protocol, we propose home BP telemonitoring with pharmacist case management intervention on participants discharged from the ED with severe asymptotic hypertension. The overall purpose of this trial is to evaluate whether home BP telemonitoring and pharmacist case management can improve BP management in participants discharged from the ED with severe asymptotic hypertension and whether participants find this intervention to be acceptable. Methods: The study is a multi-centre, randomized controlled trial of 408 participants discharged from the ED with severe hypertension (defined as average of 3 readings systolic blood pressure [SBP] ≥ 160 mm Hg and/or diastolic blood pressure [DBP] ≥ 100 mm Hg over 3 readings). Participants will be randomized to either usual care or home BP telemonitoring and pharmacist case management for 12-months. The primary outcome is proportion achieving disease specific SBP control using 24 h ambulatory BP monitoring (ABPM) at 12-months. Secondary outcomes are change in SBP and DBP based on 24 h ABPM and home BP averages at 6- and 12-months. Patient acceptability and satisfaction will be assessed using EuroQoL 5-level EQ5 version and patient Satisfaction Questionnaire Short Form. Exploratory outcomes include adverse events, prescription of anti-hypertensive medications, fidelity of interventions and health care utilization. Conclusions: Results from this study will advise the integration of home blood pressure telemonitoring and pharmacist case management pathway as key clinical strategy to improve patient flow in the ED, reduce length of stay in the ED, and improve BP control in patients with asymptomatic severe hypertension in the ED. Trial registration: ClinicalTrials.gov: NCT 06303206

Palliative care case management in a surgical department for patients with gastrointestinal cancer—a register-based cohort study

BackgroundThe effectiveness of generalist palliative care interventions in hospitals is unknown.AimThis study aimed to explore the impact of a palliative care case management intervention for patients with gastrointestinal cancer (PalMaGiC) on hospital admissions, healthcare use, and place of death.DesignThis was a register-based cohort study analyzing data from the Danish Register on Causes of Death, the Danish National Patient Register, and the Danish Palliative Database.Setting/participantsDeceased patients with gastrointestinal cancer from 2010 to 2020 exposed to PalMaGiC were compared over three periods of time to patients receiving standard care.ResultsA total of 43,969 patients with gastrointestinal cancers were included in the study, of whom 1518 were exposed to PalMaGiC. In the last 30 days of life, exposed patients were significantly more likely to be hospitalized (OR of 1.62 (95% CI 1.26–2.01)), spend more days at the hospital, estimate of 1.21 (95% CI 1.02–1.44), and have a higher number of hospital admissions (RR of 1.13 (95% CI 1.01–1.27)), and were more likely to die at the hospital (OR of 1.94 (95% CI 1.55–2.44)) with an increasing trend over time. No differences were found for hospital healthcare use.ConclusionPatients exposed to the PalMaGiC intervention had a greater likelihood of hospitalizations and death at the hospital compared to unexposed patients, despite the opposite intention. Sensitivity analyses show that regional differences may hold some of the explanation for this. Future development of generalist palliative care in hospitals should focus on integrating a home-based approach, community care, and PC physician involvement.

Views On Gender-Based Violence And Femicide: Implications For Policy And Practice Interventions

As an initial step toward developing a responsive and adequate service delivery to the victims of GBVF, this exploratory formative research was conducted to examine perspectives of GBVF among the South African Police Service (SAPS) and community members in the Kwazulu-Natal (KZN) policing area. A cross-sectional mixed-methods design was used for a bigger study, to evaluate a comprehensive case-management intervention in the KZN. This paper offers only the results of a quantitative method. Descriptive research was followed to present the opinions of the respondents. A self-administered survey design was deemed appropriate as the strategy enhances honesty in responses, especially when dealing with sensitive matters such as GBVF. The sampling strategy amounted to the purposive selection of two police stations as a sample (n=131). The findings highlighted that the SAPS is gradually making inroads towards responding to the scourge of GBVF in the policing area. Concerning the seemingly slow response to perceptions of, and response to, reported cases, the findings indicated that the SAPS has introduced the use of technology to promptly respond to assist the victims of GBVF. This study was conducted in one province and findings cannot be generalized to the other eight provinces. There is a need for a paradigm shift to address past structural inequities that have created a climate conducive to violence against women (VAW), especially in rural settings. Based on the findings, there is a need for the two stations to be installed with a victim-friendly room where victims of those crimes should be assisted.

Secondary Prevention via Case Managers in Stroke Patients: A Cost-Effectiveness Analysis of Claims Data from German Statutory Health Insurance Providers.

Strokes remain a leading cause of death and disability worldwide. The STROKE OWL study evaluated a novel case management approach for patients with stroke (modified Rankin Scale 0-4) or transient ischemic attack (TIA) who received support across healthcare settings and secondary prevention training from case managers for one year. The primary aim of this quasi-experimental study was a reduction in stroke recurrence. Here, we report the results of a health economic analysis of the STROKE OWL study, conducted in accordance with CHEERS guidelines. The calculations were based on claims data of cooperating statutory health insurance companies. In addition to a regression analysis for cost comparison, the incremental cost-effectiveness ratio was determined, and a probabilistic sensitivity analysis was carried out. In total, 1167 patients per group were included in the analysis. The intervention group incurred 32.3% higher direct costs (p < 0.001) than the control group. With a difference of EUR 1384.78 (95% CI: [1.2384-1.4143], p < 0.0001) and a 5.32% increase in hazards for the intervention group (HR = 1.0532, 95% CI: [0.7869-1.4096], p = 0.7274) resulting in an ICER of EUR 260.30, we found that the case management intervention dominated in the total stroke population, even for an arbitrarily high willingness to pay. In the TIA subgroup, however, the intervention was cost-effective even for a low willingness to pay. Our results are limited by small samples for both TIA and severe stroke patients and by claims data heterogeneity for some cost components, which had to be excluded from the analysis. Future research should investigate the cost-effectiveness of case management interventions for both severe stroke and TIA populations using appropriate data.

Effectiveness of self-management programmes for heart failure with reduced ejection fraction: a systematic review protocol

IntroductionChronic disease self-management (CDSM) is a vital component of congestive heart failure (CHF) programmes. Recent CHF guidelines have downgraded CDSM programmes citing a lack of gold-standard evidence. This protocol describes...

Patient and Caregiver Satisfaction With the Brain Injury Rehabilitation: Improving the Transition Experience (BRITE) Intervention.

To ascertain patient and caregiver satisfaction with an individualized case management intervention to improve transition from inpatient rehabilitation care to the community after traumatic brain injury (TBI). Participants from 6 National Institute on Disability, Independent Living, and Rehabilitation Research-funded TBI Model Systems sites in the United States. Adult, English-speaking patients with TBI who had moderate-to-severe TBI and were discharged from a TBI Model Systems site and who were in the intervention arm of the Brain Injury Rehabilitation: Improving the Transition Experience pragmatic clinical trial, as well as their caregivers. A survey of participants in the intervention arm, which included an individualized case management program administered by a TBI Care Manager (TCM) who facilitated resource connection, education, and support. Satisfaction with intervention was measured through Likert-scaled and open-ended questions. The survey was administered verbally through telephone, audio-recorded, and transcribed. Descriptive statistics were calculated for categorical variables, and content analysis was conducted for open-ended responses. Patient and caregiver participants were satisfied with the intervention and highlighted the benefits of the interpersonal and practical support provided by the TCM. Participants identified the need for a more intensive intervention and clear expectations of the TCM role, as well as gaps in available medical and rehabilitation services in the community, as areas for improvement. Patients with TBI and their caregivers reported satisfaction with the individualized case management program in supporting their transition from inpatient rehabilitation to the community. Further research is needed to understand the impact on outcomes.

Associations between health-related quality of life and subsequent need for specialized palliative care and hospital utilization in patients with gastrointestinal cancer—a prospective single-center cohort study

BackgroundWe lack knowledge of which factors are associated with the risk of developing complex palliative care needs. The aim of this study was to investigate the associations between patient-reported health-related quality of life and subsequent referral to specialized palliative care (SPC) and hospital utilization.MethodsThis was a prospective single-center cohort study. Data on patient-reported outcomes were collected through the European Organization of Research and Treatment of Cancer Questionnaire-Core-15-Palliative Care (EORTC QLQ-C15-PAL) at the time of diagnosis. Covariates and hospital utilization outcomes were collected from medical records. Adjusted logistic and Poisson regression were applied in the analyses. Participants were newly diagnosed with incurable gastrointestinal cancer and affiliated with a palliative care case management intervention established in a gastroenterology department.ResultsOut of 397 patients with incurable gastrointestinal cancer, 170 were included in the study. Patients newly diagnosed with incurable gastrointestinal cancer experienced a substantial burden of symptoms. Pain was significantly associated with subsequent referral to SPC (OR 1.015; 95% CI 1.001–1.029). Patients with lower education levels (OR 0.210; 95% CI 0.056–0.778) and a Charlson Comorbidity Index score of 2 or more (OR 0.173; 95% CI 0.041–0.733) were less likely to be referred to SPC. Pain (IRR 1.011; 95% CI 1.005–1.018), constipation (IRR 1.009; 95% CI 1.004–1.015), and impaired overall quality of life (IRR 0.991; 95% CI 0.983–0.999) were significantly associated with increased risk of hospital admissions.ConclusionThe study indicates a need for interventions in hospital departments to identify and manage the substantial symptom burden experienced by patients, provide palliative care, and ensure timely referral to SPC.

Systems Thinking for Supply Chains: Identifying Bottlenecks Using Process Mapping of a Child Health Intervention in the Democratic Republic of the Congo (DRC)

The quality of supply chains in public health interventions in low- and middle-income countries can determine how effectively a program is able to treat its intended population group and subsequently achieve its health targets. We aimed to disentangle where challenges exist hierarchically and administratively through the application of process mapping to the supply chain of an integrated community case management (iCCM) intervention in the Democratic Republic of the Congo (DRC). We conducted a document review, semi-structured key informant interviews, and focus group discussions with program agents involved in supply chain processes of the child health intervention. Enterprise architecture was used to map the intervention’s supply chain and its participatory actors, and detailed bottlenecks of the chain through the application of a health systems framework. The results of this study will be used to inform a system dynamics model of the supply chain of iCCM in DRC. The greatest bottlenecks leading to stockouts at the community level occurred upstream (from national to province and from zone to health facility). While the use of local procurement processes was partially attempted to strengthen systems, parallel supply chain activities compromised sustainable system integration and development. Initial delays in stock dispensation were due to international procurement at the supplier, inducing a trickle-down effect. Inadequate quantification of supply needs and subsequent insufficient product procuration were the single most important steps that led to stockouts. This study demonstrated that the community health supply chain would be most impacted by improvements made in processes at the highest administrative strata, while exposing its delicate dependence on activities at the lowest levels. Visibility of inventory at all levels and improved data quality and use through a transparent tracking system have the potential to significantly reduce stockouts. Future interventions should take care to not develop parallel processes or exclude local health system agents to avoid disruption and ensure sustainable health outcome gains. Causal loop studies and system dynamics can further identify the systems interactions and relationships and their underlying causal mechanisms in need of intervention.

Case management interventions seeking to counter radicalisation to violence and related forms of violence: A systematic review.

Case management interventions seeking to counter radicalisation to violence and related forms of violence: A systematic review.

North Macedonia interprofessional dementia care (NOMAD) - personalized care plans for people with dementia and caregiver psychoeducation delivered at home by interprofessional teams.

The increasing number of people living with dementia and its burden on families and systems particularly in low- and middle-income countries require comprehensive and efficient post-diagnostic management. This study aimed to explore the acceptability and efficacy of a multi-professional case management and psychoeducation model (North Macedonia Interprofessional Dementia Care, or NOMAD) delivered by mobile teams for people with dementia and their caregivers in North Macedonia. We conducted a two-arm randomized controlled trial comparing the intervention with treatment as usual. Participants were recruited from 12 general practitioner (GP) offices in the Skopje region. The NOMAD intervention included the delivery of a personalized care plan over four home visits to dyads of people with dementia and their caregivers by a team including a dementia nurse and a social worker, in collaboration with GPs and dementia experts, and the introduction of a caregiver manual. We assessed caregivers' depressive symptoms, burden, and quality of life and the neuropsychiatric symptoms, daily living activities, and service utilization of people with dementia at baseline and follow-up; we also assessed the acceptability of the intervention by analyzing case notes and attendance rates. One hundred and twenty dyads were recruited and randomized to either the control (n = 60) or the intervention group (n = 60). At follow-up, caregivers in the intervention group had, on average, scores that were 2.69 lower for depressive symptoms (95% CI [-4.75, -0.62], p = 0.012), and people with dementia had, on average, 11.32 fewer neuropsychiatric symptoms (95% CI [-19.74, -2.90], p = 0.009) and used, on average, 1.81 fewer healthcare services (95% CI [-2.61, -1.00], p < 0.001) compared to the control group. The completion of the home visits was 100%, but the intervention's acceptability was underpinned by relationship building, GP competencies, and resources to support families with dementia. There were no differences in the caregivers' quality of life and burden levels or daily living activities in people with dementia. NOMAD is the first case management, non-pharmacological, and multi-professional intervention tested in North Macedonia. The trial showed that it is effective in reducing caregivers' depressive symptoms and neuropsychiatric symptoms in people with dementia and the burden on health and social care services, and it is acceptable for families. Implementing NOMAD in practice will require building primary care capacity and recognizing dementia as a national priority.

Linkage Case Management and Posthospitalization Outcomes in People With HIV

Despite the widespread availability of antiretroviral therapy (ART), people with HIV still experience high mortality after hospital admission. To determine whether a linkage case management intervention (named "Daraja" ["bridge" in Kiswahili]) that was designed to address barriers to HIV care engagement could improve posthospital outcomes. Single-blind, individually randomized clinical trial to evaluate the effectiveness of the Daraja intervention. The study was conducted in 20 hospitals in Northwestern Tanzania. Five hundred people with HIV who were either not treated (ART-naive) or had discontinued ART and were hospitalized for any reason were enrolled between March 2019 and February 2022. Participants were randomly assigned 1:1 to receive either the Daraja intervention or enhanced standard care and were followed up for 12 months through March 2023. The Daraja intervention group (n = 250) received up to 5 sessions conducted by a social worker at the hospital, in the home, and in the HIV clinic over a 3-month period. The enhanced standard care group (n = 250) received predischarge HIV counseling and assistance in scheduling an HIV clinic appointment. The primary outcome was all-cause mortality at 12 months after enrollment. Secondary outcomes related to HIV clinic attendance, ART use, and viral load suppression were extracted from HIV medical records. Antiretroviral therapy adherence was self-reported and pharmacy records confirmed perfect adherence. The mean age was 37 (SD, 12) years, 76.8% were female, 35.0% had CD4 cell counts of less than 100/μL, and 80.4% were ART-naive. Intervention fidelity and uptake were high. A total of 85 participants (17.0%) died (43 in the intervention group; 42 in the enhanced standard care group); mortality did not differ by trial group (17.2% with intervention vs 16.8% with standard care; hazard ratio [HR], 1.01; 95% CI, 0.66-1.55; P = .96). The intervention, compared with enhanced standard care, reduced time to HIV clinic linkage (HR, 1.50; 95% CI, 1.24-1.82; P < .001) and ART initiation (HR, 1.56; 95% CI, 1.28-1.89; P < .001). Intervention participants also achieved higher rates of HIV clinic retention (87.4% vs 76.3%; P = .005), ART adherence (81.1% vs 67.6%; P = .002), and HIV viral load suppression (78.6% vs 67.1%; P = .01) at 12 months. The mean cost of the Daraja intervention was about US $22 per participant including startup costs. Among hospitalized people with HIV, a linkage case management intervention did not reduce 12-month mortality outcomes. These findings may help inform decisions about the potential role of linkage case management among hospitalized people with HIV. ClinicalTrials.gov Identifier: NCT03858998.

Case Management Consultant to Attorneys in Litigated Cases.

Rehabilitation nurses possess knowledge and skills that are ideally suited to a variety of roles. This article informs rehabilitation nurses about opportunities to work in private case management for medical-legal cases. A brief overview of the process of litigation gives nurses the context in which case management interventions are needed. Case examples illustrate the services that nurses provide to attorneys and their clients that help obtain needed care and aid in progressing litigation to resolution.

Confronting the dialectic between quality and access in early psychosis care in the United States: Finding the synthesis by leveraging psychological expertise.

Coordinated specialty care (CSC) is the dominant model for early psychosis care in the United States, representing a proactive recovery-oriented approach to serious mental illness in its early stages. CSC involves broad multidisciplinary support for participants, including from psychologists in some CSC teams, encompassing educational and vocational support, medication management, psychotherapy, case management, peer support, and family interventions. CSC programs have proliferated in the last 20 years, leading to a quality-access dialectic, where increasing access to treatment simultaneously prompts concerns about care quality, particularly in the context of staffing shortages and funding limits. Evidence-based psychosocial treatment, including psychotherapy, is an integral part of CSC, yet workforce training deficits, workforce turnover, and CSC financing pose threats to intervention fidelity and thus CSC participants' ability to access high-quality care. We propose an enhanced role for psychologists as a way of resolving the quality-access dialectic in the area of psychosocial treatment, specifically evidence-based therapy. We describe the potential of psychologists' skills in clinical supervision, formulation, evidence-based interventions and measurement-based care, drawing on practice examples. After considering possible limitations, we outline implementation models, for example, drawing on Early Psychosis Intervention Network and Project Extension for Community Healthcare Outcomes. We conclude with four recommendations: Psychologists should be placed in CSC team or network-leadership roles; psychological expertise should be made available to CSC teams for training, consultation, and technical assistance; psychological expertise should be used to address CSC implementation challenges; and research is needed to demonstrate psychologists' value to stakeholders. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

EAST MEETS WEST: INTERVENTIONS, PRACTICE MODELS, AND POLICIES TO SUPPORT FAMILY CAREGIVERS IN DIVERSE CULTURES

Abstract This East Meets West symposium consists of six studies that examined innovative interventions, practice models and policies designed to support family caregivers of older adults in the U.S., Taiwan, and mainland China. The first two papers both used case management interventions to assist family caregivers with a focus on caregiver depression. The paper from the U.S. found that more difficulties of performing caregiving tasks and less caregiver preparation contributed to higher levels of depression, and the paper from Taiwan found that caregivers who received the case management service reduced depression at four-month and six-month follow-up assessments. The third paper discussed a “time travel” paradigm developed to guide service design and delivery for persons with dementia at different stages. The fourth paper used the state of Michigan as a case to examine service gaps in the current aging service network, and identifies an urgent need for statewide policy renovations to support family caregivers. The fifth and sixth papers both used large secondary data analyses to examine the effects of piloted policy and practice efforts on family caregiver outcomes. One study found that the long-term care insurance programs have resulted in positive caregiver outcomes including reduced caregiving financial cost, time, and physical and psychological burden. The other study found the use of home-based care services reduced adult children caregiver burden and did not affect the relationship between older adults and adult children caregivers. After individual presentations are done, two discussants will summarize shared themes in these papers and provide critical feedback.

PARTNERING TO ADDRESS ADULT MALTREATMENT: HARD-EARNED LESSONS AND WISDOM GAINED BY APPLIED RESEARCHERS

Abstract We focus on three projects in which applied researchers collaborated with community-based and government partners to address adult maltreatment. In our first study with Texas, we partnered with a large healthcare system and Adult Protective Services (APS). Two APS workers served as consultants to clinicians and 529 patients were reported to APS. Researchers struggled with quantifying case notes on the consultations, pointing to the importance of creating a systematic method to document case notes for future studies. In the second grant, the same partners evaluated a case management intervention to prevent self-neglect among at-risk, adult primary care patients. A total of 477 randomly selected participants completed a baseline interview. Lessons learned included revising language in how to discuss self-neglect, particularly in consent forms and becoming more flexible in where to conduct interviews. Other challenges encountered included the time and effort it took to develop data use agreements that allowed us to access APS administrative data. Our third study with Oklahoma APS was conducted in the midst of a pandemic, requiring us to change study protocols from home to telephone-based interviews. Despite these challenges, we interviewed 188 clients over the phone. Drawing on the experiences across all three projects, we will discuss challenges – from contracting to IT issues, to recruitment and data collection – and how each one has presented an opportunity for growth and wisdom that can be applied to future research activities.

WHEN OLDER ADULTS GOT TRAUMATIC INJURY: EFFECTS OF CASE MANAGEMENT

Abstract Case management can improve patient outcomes from the acute to rehabilitation phase after traumatic injury. However, a lack of evidence on effects of case management in older patients with traumatic injury makes it difficult to translate research findings into practice. The study was to examine the effects of a case management intervention on illness perception, coping strategies used, and quality of life in older patients with traumatic injury across a 9-month span after hospital discharge. A 4-wave longitudinal, experimental design was used in older patients with traumatic injury hospitalized at a regional hospital in Taiwan. Subjects were randomly assigned to case management (experimental) or usual care (control) group. The intervention started during hospitalization and ended with a phone follow-up two weeks post discharge. Illness perception and/or coping strategies used along with health-related quality of life were measured at baseline, 3, 6 and 9 months after discharge. Generalized estimating equations were used for analysis. Findings showed significant differences of illness perceptions at 3 and 6 months as well as coping strategies used at 6 and 9 months after discharge between the two groups. However, no significant difference on quality of life over time between the two groups was found. While case management appears to help older patients with traumatic injury decrease illness perception and better cope with their injury, it does not significantly improve their quality of life nine months after discharge. It is recommended that healthcare professionals develop a comprehensive long-term case management program for older patients with traumatic injury.

Osteoporosis case manager intervention to improve medication possession ratio among osteoporotic patients with anti-osteoporotic medication for fragility fracture

Osteoporosis case manager intervention to improve medication possession ratio among osteoporotic patients with anti-osteoporotic medication for fragility fracture

Atypical presentation of mpox in Irrua environs: a case report

BackgroundMpox, previously known as monkeypox, -is an orthopoxvirus infection of the skin and previously a public health emergency of international concern. It reemerged in Nigeria over 5 years ago and has since spread to other parts of the world. This is a case report of a confirmed patient who was managed at Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria before the global surge. This report shows peculiar differences from previous patients managed at the same center in terms of the relatively prolonged eruptive phase, possible seasonal occurrence of mpox in the community, and some traditional care for mpox and skin rashes. It also corroborates previous reports of possible sexual transmission of mpox in Nigeria before the report from the global outbreak.Case presentationThe patient is a 30-year-old Nigerian male artisan with a 2-month history of raised rashes on the body that started on the genitals then involved other parts of the body. There was history of sore throat and unprotected sex with a female partner with similar rash whose other sexual history could not be ascertained. There was also history of “seasonal” rash in his village for about 7 years prior to his symptoms. Examination showed multiple vesicles and some nodules (ulcerating, healing, and healed) on the face, trunk, limbs, gluteal region, scrotum, palms, and sole, an almost circumferential penile ulcer, and lymphadenopathy. Polymerase chain reaction skin samples sent for mpox returned positive, while retroviral and coronavirus disease 2019 screenings were negative. He was managed in isolation while contact tracing in the affected community was initiated.ConclusionAtypical presentations of mpox, as managed in Irrua before the global surge, emphasize the varied spectrum of presentations (typical and atypical) in Nigeria. Therefore, there is a need for a higher index of suspicion for the uncommon presentations which will strengthen case recognition, case management, and community-based interventions as well as surveillance in the prevention and control of mpox in Irrua, its environs, Nigeria, and the world.

A Case Management Approach in Stroke Care: A Mixed-Methods Acceptance Analysis From the Perspective of the Medical Profession.

In terms of continuous and coordinated health care, cross-sectoral care structures are crucial. However, the German health care system is characterized by fragmentation of medical services and responsibilities. This fragmentation leads to multiple interfaces frequently causing loss of information, effectiveness, and quality. The concept of case management has the potential to improve cooperation between sectors and health care providers. Hence, a case management intervention for patients with stroke was evaluated with an acceptance analysis on the physicians' willingness to cooperate with stroke managers and their assessment of the potential of case management for the health care of patients with stroke. Primary practice settings included physicians working in the hospital, rehabilitation, and outpatient sectors who had actual or potential contact with a stroke case manager within the project region of East Westphalia-Lippe. The analysis was conducted using a mixed-methods approach. Expert interviews were conducted in 2020. Afterward a questionnaire was developed, which was then distributed to physicians in 2021. Both the interviews and the questionnaire included questions on conceptual knowledge and concrete expectations prior of the project, on experiences during the project and on recommendations and physicians' assessment of future organization in health care to classify and describe the acceptance. Nine interviews were conducted and 23 questionnaires were completed. Only slightly more than 50% of the physicians had prior knowledge of the case management approach. Overall, ambiguous results concerning the acceptance of case managers were revealed. Additional personal assistance for patients with stroke was seen as beneficial at the same time critical perspectives regarding further fragmentation of health care and overlapping of competences with existing professional groups or forms of health care were collected. General practitioners in particular were critical of the case management approach. From the physicians' point of view, at least two changes are necessary for the project approach to be integrated into standard care. First, the target group should be adapted according to the case management approach. Second, the delegation of tasks and responsibilities to case managers should be revised. The sectoral difference in the acceptance of case managers by physicians indicates that active cooperation and communication in everyday work has direct impact on the acceptance of a new occupational profession. Physician acceptance has a significant impact on the implementation of new treatment modalities and thus influences the overall quality of health care.