Case Management Research Articles

COVID-19 inflammatory signature in a Mozambican cohort: unchanged red blood series and reduced levels of IL-6 and other proinflammatory cytokines.

Alterations in haematological, biochemical parameters and cytokine levels, were reported in patients with COVID-19, however, there is an underrepresentation of the African population, which could provide evidence for understanding SARS-CoV-2 pathogenesis and useful tools for clinical management of cases. In this study, we aimed to determine the haematological, biochemical and cytokine profile in Mozambican individuals with SARS-CoV-2. A cohort of 85 Mozambican individuals with RT-PCR SARS-CoV-2 results, was stratified into negative, asymptomatic, mild, moderate, and severe categories. Haematological, biochemical and cytokines measurement were performed on samples from the study participants. Principal component analysis (PCA) was performed to identify similar patterns among the study cases. Comparisons between groups were performed using the Kruskal-Wallis test. Receiver operating characteristic (ROC) and area under the curve (AUC) analysis were conducted to evaluate the ability of these parameters to distinguish severe from non-severe cases of SARS-CoV-2 infection. SARS-CoV-2 infection was associated with a significant (p < 0.05) decrease in peripheral blood absolute counts of total lymphocytes and eosinophils, below the reference values along with no abnormal change (p > 0.05) in red blood cell count, haemoglobin, platelets and other red series parameters. At the serum level, SARS-CoV-2 infection was associated with an increase in serum levels of C-reactive protein (C-RP) and glucose above the reference values and to a significant reduction a significant (p < 0.05) reduction in levels of interferon-gamma (INF-γ), Tumour Necrosis Factor alfa (TNF-α) and the interleukin 1 beta (IL-1β) and IL-6 in severe cases, when compared to negative cases. Haematological, biochemical and cytokine profiles segregate severe from non-severe cases of COVID-19 with an excellent performance of C-RP (AUC = 0.95; p < 0.001) and good performance of lymphocytes (AUC = 0.88; p < 0.001) and IL-15 (AUC = 0.86; p < 0.001). The lack of variation in red and platelet series, coupled with a decrease in the levels of classical pro-inflammatory in severe cases, deviates from what has been reported in other contexts suggesting, that there may be peculiarities in COVID-19 manifestation within the context of this study population. Furthermore, these results identify parameters with potential for clinical management of COVID-19 and therefore good resource allocation, particularly for severe cases.

Orthodontic-orthognathic combined case management in postgraduate orthodontic and oral maxillofacial surgery programs.

With the development of three-dimensional (3D) image, the 3D virtual surgical planning (VSP) system has been broadly used in the treatment planning of orthodontic-orthognathic cases. This study aimed to understand the current education status regarding the use of orthodontic-orthognathic surgical planning tools in the postgraduate orthodontic and oral and maxillofacial surgery (OMFS) programs in North America. An electronic multiple-choice survey was sent via email with 2-week and 1-month follow-ups, requesting anonymous participation of program directors/department chairs from all postgraduate orthodontic and OMFS programs in North America. Responses were collected directly on Qualtrics for analysis. The response rate was 25.68% for orthodontic and 34.34% for OMFS programs. Two-dimensional traditional surgical planning (TSP) at initial treatment planning and 3D VSP right before surgery were most commonly utilized in both specialty programs. All responded postgraduate OMFS programs utilized VSP, yet 26.32% of responded orthodontic programs did not utilize VSP. For the surgical outcomes, fewer orthodontic programs were highly satisfied than OMFS programs. More orthodontic programs warranted secondary surgery at a higher rate due to the unsatisfied outcome. Additionally, the orthodontic programs that did not use VSP showed higher unsatisfied surgical outcomes than the programs that used VSP. Moreover, there were discrepancies between orthodontic and OMFS programs regarding the perceived level of collaboration of each other on the surgical planning for the patients. There were discrepancies between orthodontic and OMFS programs regarding the utilization of VSP, treatment outcomes satisfaction, and perceived level of collaboration on surgical planning for the patients.

Open sternal fracture with bilateral dislocation of the sternoclavicular joints after a high-speed bicycle accident: a case report

BackgroundOnly a few cases of bilateral traumatic sternoclavicular dislocations have been reported in the literature. This injury is considered one of the rarest injuries of the human musculoskeletal system. Therefore, we present the first documented case of a cyclist with a third-degree open thoracic trauma (Gustilo–Anderson 3a) associated with a dislocated manubrium sterni fracture in the upper thoracic aperture, bilateral anterior dislocations of the sternoclavicular joints, rib fractures, and pleural ruptures.Case presentationThe patient, a 27-year-old Caucasian male, incurred this injury while participating in a professional cycling race at Nürburgring, Germany and received immediate interdisciplinary surgical treatment and has encountered no complications. We conducted a 1-year follow-up and present the clinical findings of this follow up. Additionally, we conducted a comprehensive review of the existing literature on this injury.ConclusionsImmediate interdisciplinary intervention, including surgical repair and meticulous postoperative care, facilitated successful patient recovery. This underscores the critical role of comprehensive trauma management in complex polytrauma cases. In conclusion, this case report highlights the rarity and complexity of a traumatic injury involving bilateral sternoclavicular dislocation, with this case being the first case reported with concomitant open thorax trauma. Our patient benefited greatly from immediate air-bound transportation to an interdisciplinary care provider, which houses both thoracic and trauma surgery departments.

Mathematical analysis of the effects of precarious health system on COVID-19 transmission dynamics: case of Burkina Faso

n the early moments of the pandemic of coronavirus disease 2019 (COVID-19), the level of effectiveness in treatment and management of patients was limited due to the lack of effective medications and adapted infrastructures in several countries especially in most developing countries. In this study, we propose an SIR-pattern model to investigate the epidemiological effect of delay in hospitalization and case managements. After computing the basic reproduction number thanks to the Next Generation Matrix method, we proved that the model has a locally asymptotically stable disease-free equilibrium whenever the basic reproduction number is less than one, and condition which ensure the appearance of two endemic equilibria indicating the possibility of having backward bifurcation is determined. When the basic reproduction number exceeds one, Lyapunov functional technique is used to establish the global stability of the unique endemic equilibrium point. Also, we presented a local sensitivity analysis that gives better understanding of the role of each model parameter appearing in the basic reproduction number. Numerical simulation of the model is also performed to corroborate the analytical results. Finally, we fitted our model by using reported data for Burkina Faso, and the results showed that it can be used for predicting the disease outcomes.

A cross-sectional study of point-of-care lactate testing in integrated community care management (ICCM) for children with acute respiratory illness in rural uganda.

Integrated community case management (iCCM) programs leverage lay village health workers (VHWs) to carry out the initial evaluation of children with common conditions including malaria, pneumonia and diarrhea. Therefore, it is imperative that VHWs are able to identify children who are critically ill and require referral to a health facility. Elevated venous lactate levels have been associated with severe illness and adverse health outcomes, including death. However, lactic acidosis may not be recognized in rural settings because it is not routinely measured outside of hospitals and research studies. Point-of-care lactate tests may help identify patients in need of a higher level of care and improve VHWs' ability to make timely and appropriate referrals. The study was a cross-sectional evaluation of children aged <5 y presenting to VHWs in rural southwestern Uganda with complaints of fever and cough. Demographics, clinical presentation, evaluation, management and disposition were recorded. VHWs were trained and instructed to perform lactate testing using a point-of-care assay in eligible participants. During the study period, 238 children were enrolled and completed an initial assessment. Of the 204 participants included in the analysis, 113 (55.4%) were female, and the median (IQR) age was 23 (9-36) months. Most participants, 139/200 (69.5%), had negative results on the malaria rapid diagnostic test. The median lactate level was 2.1mmol/L; 12% (24/204) had a lactate ≥3.5 mmol/L and only nine participants (4.4%) had a lactate ≥5mmol/L. Having a lactate level above either cut-off was not associated with the presence of danger signs at presentation. Few children presenting with fever and cough to VHWs in western Uganda had elevated lactate levels. However, most of the children with elevated lactate levels did not otherwise satisfy established iCCM criteria based on physical examination findings for referral to a health facility. Therefore, while elevated lactate was not associated with danger signs in this small study, it is possible that there is under-recognition of severe illness using current iCCM guidelines.

Malaria treatment for prevention: a modelling study of the impact of routine case management on malaria prevalence and burden

BackgroundTesting and treating symptomatic malaria cases is crucial for case management, but it may also prevent future illness by reducing mean infection duration. Measuring the impact of effective treatment on burden and transmission via field studies or routine surveillance systems is difficult and potentially unethical. This project uses mathematical modeling to explore how increasing treatment of symptomatic cases impacts malaria prevalence and incidence.MethodsLeveraging the OpenMalaria stochastic agent-based transmission model, we first simulated an array of transmission intensities with baseline effective treatment coverages of 28%, 44%, and 54% incorporated to reflect the 2023 coverage distribution across Africa, as estimated by the Malaria Atlas Project. We assessed the impact of increasing coverage to as high as 60%, the highest 2023 estimate on the continent. Subsequently, we performed simulations resembling the specific subnational endemicities of Kenya, Mozambique, and Benin, using the Malaria Atlas Project estimates of intervention coverages to reproduce historical subnational prevalence. We estimated the impact of increasing effective treatment coverage in these example settings in terms of prevalence reduction and clinical cases averted in children under 5 years old and the total population.ResultsThe most significant prevalence reduction – up to 50% – was observed in young children from lower transmission settings (prevalence below 0.2), alongside a 35% reduction in incidence, when increasing effective treatment from 28% to 60%. A nonlinear relationship between baseline transmission intensity and the impact of treatment was observed. Increasing effective treatment coverage to 60% reduced the risk in high-risk areas (prevalence in children under 5 years old > 0.3), affecting 39% of young children in Benin and 20% in Mozambique previously living in those areas. In Kenya where most of the population lives in areas with prevalence below 0.15, and case management is fairly high (53.9%), 0.39% of children were estimated to transition to lower-risk areas.ConclusionsImproving case management directly reduces the burden of illness, but these results suggest it also reduces transmission, especially for young children. With vector control interventions, enhancing case management can be an important tool for reducing transmission intensity over time.

Managing Eating Disorders Within Medicaid-Funded Health Care Systems in California.

This study describes the current management of patients with eating disorders (EDs) served by publicly-funded Medicaid behavioral health systems. Behavioral health leaders across nine counties in California met on a quarterly basis to share experiences, challenges, and lessons in the management of EDs within publicly-funded service systems. Detailed notes were taken, and a qualitative content analysis was undertaken to identify key themes. County leadership noted insufficient outpatient capacity and difficulty building capacity for ED treatment, in addition to extraordinary challenges when facilitating admission to out-of-network higher level of care programs, at significant expense. Several challenges were identified in building an internal ED workforce, including the fact that many providers weren't eager to treat EDs due to training burden, patient complexity, and high levels of clinician burnout. When a higher level of care was required due to lack of outpatient resources or patient symptom severity or complexity, leaders dedicated significant resources to identify and contract with an appropriate program and secure the necessary funds. Our study supports the need for specialized ED treatment and case management, as well as standardized processes and centralized resources, in Medicaid-managed care. Findings also indicate the importance of protecting against clinician burnout, possibly through reduced caseload expectations, financial incentives, or increased support. Future policy change could reduce administrative burden and clinician burnout by facilitating admission to and reimbursement for higher levels of care.

Efficacy of Nebulized Dexmedetomidine and Lignocaine Inhalation versus Lignocaine Alone as Premedication for Flexible Fiber-optic Bronchoscopy under Sedation: A Randomized Comparative Study.

Airway management is an integral part of general anesthesia, allowing ventilation and oxygenation and working as a mode for delivering anesthetic gases. Awake fiber-optic-guided intubation is an essential component of airway management in difficult cases. We aim to study the benefits of nebulized dexmedetomidine with lignocaine over lignocaine alone for anesthetizing the airway for flexible fiber-optic bronchoscopy. In the study, after written informed consent, 50 patients were randomly allocated into two equal groups of 25 each. The intervention group received dexmedetomidine with lignocaine nebulization, while the control group received lignocaine nebulization alone. Baseline pulse rate, blood pressure, and, at regular intervals, cough, sedation, and pain scores were recorded along with the patient satisfaction score. Parametric data were analyzed by the Student's t-test, while nonparametric data were analyzed by the Wilcoxon Mann-Whitney U test. Out of a total of 54 patients, 4 patients did not give consent to participate in the study. The demographic profile was comparable in both groups. The pulse rate was comparable in both groups throughout the procedure; however, 10 min after the procedure, the pulse rate in the lignocaine group was (mean ± standard deviation) 114.2 ± 11.52, while in the intervention group, it was 87.32 ± 7.24 with a P = 0.027. The mean blood pressure was comparable throughout the procedure. The cough score yielded a Z-score of -5.12 and a P < 0.00001 favoring the dexmedetomidine group. Similarly, Richmond agitation-sedation score and Visual Analog Scale (VAS) also favored the intervention group, with P < 0.00054 and P < 0.00001 in RASS and VAS, respectively. Patient satisfaction score analysis found a Z-score of -5.29 and a P < 0.00001. The overall results favored dexmedetomidine with lignocaine nebulization over lignocaine alone for anesthetizing airways for flexible fiber-optic bronchoscopy.

Surgical Management of Symptomatic Recurrent/Progressive Craniopharyngioma: Is There a Gold-Standard Approach?

The standard treatment for craniopharyngiomas (CPs) involves either initial gross total resection or subtotal resection with adjuvant radiotherapy. However, there is no consensus regarding the management of recurrent cases. We reviewed a series of patients with CP to evaluate the characteristics of patients with recurrent/progressing CP. We retrospectively reviewed 31 patients with biopsy-proven recurrent/progressed CP who were initially operated on at our clinic from 2015 to 2023. Demographic and clinical data, including age, sex, tumor localization, lesion size and features, radiological findings, and endocrine, neurologic, and ophthalmological issues, were compared between those with and without recurrence. Fifteen out of 31 patients (48.4%) underwent transnasal/transsphenoidal endoscopic surgery; the remaining 16 underwent microscopic transcranial or neuroendoscopic surgery. After treatment, recurrence and events (any medical condition related to the patient's current condition other than recurrence) were observed in 48.4% and 32.3% of the cases, respectively. There were no statistically significant disparities between patients with and without recurrence in terms of age, tumor dimensions, tumor localization, gender distribution, surgical modality, or the presence of calcifications or hydrocephalus (p > 0.05). The highest and lowest overall survival was 25 years and 6 months, respectively. The management of recurrent CP is too complicated to fit into a standard treatment algorithm. Therefore, surgical treatment for these patients should be individualized and planned according to patient symptoms and radiological findings, which is presumably a more versatile, efficient, and safe approach for recurrent CPs.

Firearm Injury Prevention and Survivor Interventions: A Scoping Review.

To examine components of firearm injury prevention and survivor response programs, their outcomes, and gaps in this body of research. A total of 100 publications were identified across four databases: PubMed/Medline, PsycInfo, CINAHL, and Scopus. Articles were screened for inclusion in the scoping review and details were extracted into an electronic table for synthesis. A total of 27 articles were included. Education on firearm injury prevention was shown to be feasible and acceptable in health care settings, including emergency departments. Firearm survivor interventions to reduce violent injury recidivism may include peer or mentored support along with case management for coordination of mental health services, vocational training, and other services to address social determinants of health. Other community initiatives to clean up abandoned lots and engage community members in creating safe neighborhoods have been shown to reduce overall gun violence. Multi-level interventions that encompass education on reducing firearm injuries, strategies to improve psychosocial conditions and access to mental health services, as well as meeting the needs of firearm injury survivors, their families, and communities, are needed. Health sector and community partnerships can lead to integrated and sustainable programs to achieve safer neighborhoods and improve psychosocial outcomes for individuals affected by gun violence and impacted communities. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

An exploratory study on client service experience for health protection of medicaid case managers in Korea

An exploratory study on client service experience for health protection of medicaid case managers in Korea

Digital Transformation in Healthcare : Leveraging Technology to Enhance Patient Care

This article examines the successful implementation of Pega's Healthcare Customer Service and Care Management solutions at a major healthcare provider, demonstrating how digital transformation can revolutionize patient care delivery while optimizing operational efficiency. The implementation, which focused on integrated care coordination, patient case management, and compliance frameworks, resulted in significant improvements, including a 20% reduction in hospital readmissions, a 30% reduction in administrative costs, and a 25-35% reduction in operational costs. The organization achieved enhanced patient outcomes, streamlined operations, and improved regulatory compliance through comprehensive data integration, automated workflows, and user-centric design. The article highlights how strategic digital transformation initiatives, aligned with industry best practices and supported by robust change management, can successfully address healthcare's complex challenges while positioning organizations for future innovation in care delivery.

Opportunities of integrated care to improve equity for adults with complex needs: a qualitative study of case management in primary care

BackgroundPeople living in precarious socio-economic conditions are at greater risk of developing mental and physical health disorders, and of having complex needs. This places them at risk of health inequity. Addressing social determinants of health (SDH) can contribute to reducing this inequity. Case management in primary care is an integrated care approach which could be an opportunity to better address SDH. The aim of this study is to better understand how case management in primary care may address the SDH of people with complex needs.MethodsA case management program (CMP) for people with complex needs was implemented in four urban primary care clinics. A qualitative study was conducted with semi-structured interviews and a focus group with key informants (n = 24). An inductive thematic analysis was carried out to identify emerging themes.ResultsPrimary care case managers were well-positioned to provide a holistic evaluation of the person’s situation, to develop trust with them, and to act as their advocates. These actions helped case managers to better address individuals’ unmet social needs (e.g., poor housing, social isolation, difficulty affording transportation, food, medication, etc.). Creating partnerships with the community (e.g., streetworkers) improved the capacity in assisting people with housing relocation, access to transportation, and access to care. Assuming people provide their consent, involving a significant relative or member of their community in an individualized services plan could support people in addressing their social needs.ConclusionsCase management in primary care may better address SDH and improve health equity by developing a trusting relationship with people with complex needs, improving interdisciplinary and intersectoral collaboration and social support. Future research should explore ways to enhance partnerships between primary care and community organizations.

Enhanced predictability and interpretability of COVID-19 severity based on SARS-CoV-2 genomic diversity: a comprehensive study encompassing four years of data.

Despite the end of the global Coronavirus Disease 2019 (COVID-19) pandemic, the risk factors for COVID-19 severity continue to be a pivotal area of research. Specifically, studying the impact of the genomic diversity of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) on COVID-19 severity is crucial for predicting severe outcomes. Therefore, this study aimed to investigate the impact of the SARS-CoV-2 genome sequence, genotype, patient age, gender, and vaccination status on the severity of COVID-19, and to develop accurate and robust prediction models. The training set (n = 12,038), primary testing set (n = 4,006), and secondary testing set (n = 2,845) consist of SARS-CoV-2 genome sequences with patient information, which were obtained from Global Initiative on Sharing all Individual Data (GISAID) spanning over four years. Four machine learning methods were employed to construct prediction models. By extracting SARS-CoV-2 genomic features, optimizing model parameters, and integrating models, this study improved the prediction accuracy. Furthermore, Shapley Additive exPlanes (SHAP) was applied to analyze the interpretability of the model and to identify risk factors, providing insights for the management of severe cases. The proposed ensemble model achieved an F-score of 88.842% and an Area Under the Curve (AUC) of 0.956 on the global testing dataset. In addition to factors such as patient age, gender, and vaccination status, over 40 amino acid site mutation characteristics were identified to have a significant impact on the severity of COVID-19. This work has the potential to facilitate the early identification of COVID-19 patients with high risks of severe illness, thus effectively reducing the rates of severe cases and mortality.

A new nomogram for predicting extraurothelial recurrence in patients with upper urinary tract urothelial carcinoma following radical nephroureterectomy

PurposeWe sought to develop and validate a nomogram for predicting extra-urinary recurrence (EUR) following radical nephroureterectomy (RNU) in patients with upper urinary tract urothelial carcinoma (UTUC).MethodsData from 556 UTUC patients post-RNU at the First Hospital of Jilin University were retrospectively analyzed. These patients were categorized into a training group (n=389) and a validation group (n=167). Variables significantly associated with prognosis were identified using univariate Cox regression and most minor absolute shrinkage and selection operator (LASSO) analysis. These independent predictors were incorporated into the nomogram to estimate extra-urinary recurrence-free survival (EURFS). Validation of the nomogram involved ROC curves, calibration plots, and decision curve analysis (DCA). Patients were stratified into two risk categories based on their nomogram scores to compare EURFS using the Kaplan-Meier method.ResultsEight predictors were identified: T-stage, N-stage, tumor grade, local and nerve invasion, preoperative hemoglobin level, neutrophil-to-lymphocyte ratio (NLR), and creatinine, all proving to be independent predictors of EUR. A nomogram was created based on these eight factors, and using the ROC, calibration curves, and DCA, good prediction results were shown in both the training and validation groups. The training and validation groups also showed reliable predictive performance. In particular, there was a significant difference in survival between the high-risk and low-risk groups (P&amp;lt;0.0001). We have also built a network calculator that calculates patient survival time. The URL is https://haowu24.shinyapps.io/dynnomapp.ConclusionA nomogram for predicting distant metastases in UTUC patients was successfully developed, and its accuracy, reliability, and clinical value were demonstrated. This new tool helps to improve the clinical management of UTUC cases.

Impact of patient education by nurse case managers on decision making for out-of-pocket anti-osteoporotic pharmaceutical therapy: a single-center retrospective study.

Osteoporosis is a common condition that increases the risk of fracture and mortality. In Taiwan, clinical guidelines recommend pharmaceutical therapy for patients with a T-score of ≤ - 2.5; however, Taiwan's National Health Insurance (NHI) only covers these medications for those with a history of fragility fractures. This gap in coverage necessitates a discussion of out-of-pocket treatment options. To address this, we provided an integrated care program with patient education and shared decision-making by nurse case managers specializing in osteoporosis. We evaluated whether education by nurse case managers influences patients with a T-score ≤ - 2.5, who are not covered by the NHI, to choose out-of-pocket pharmaceutical therapy. We retrospectively reviewed medical records of patients who underwent bone density scanning at our hospital between January 2014 and December 2021. We identified 4,462 patients with a T-score of ≤ - 2.5 who were ineligible for NHI-covered anti-osteoporotic therapy and analyzed trends in out-of-pocket medication use. Since the integrated care program began in 2018, we evaluated whether education by nurse case managers between 2018 and 2021 influenced patients' decisions to pay out-of-pocket for therapy. After the implementation of the integrated care program, we identified 2,910 patients with a T-score ≤ -2.5 who were ineligible for NHI-covered anti-osteoporotic therapy. Of these, 640 opted for out-of-pocket treatment, while 2,270 chose conservative care. After a 1:1 propensity score match based on age and sex, logistic regression was used to analyze the impact of nurse case manager education on these decisions. Between 2014 and 2021, 888 of the 4,462 patients chose out-of-pocket pharmaceutical therapy. Before the implementation of the integrated care program and patient education by nurse case managers (2014-2017), 16% of the patients opted to pay out-of-pocket for anti-osteoporotic therapy. After the program was implemented (2018-2021), the rate increased significantly to 22% (P < 0.001). A multivariate logistic regression model showed that a history of osteoarthritis (adjusted odds ratio = 1.576; P = 0.009) and education provided by the nurse case managers (adjusted odds ratio = 5.044; P < 0.001) were significantly associated with choosing out-of-pocket therapy. Education from nurse case managers significantly increased the likelihood of patients choosing out-of-pocket anti-osteoporotic therapy in our hospital, thereby bridging the gap between clinical guidelines and NHI reimbursement criteria.

A study of the enablers and barriers to the collection of sociodemographic data by public health units in Ontario, Canada during the COVID-19 pandemic

BackgroundCollection and use of sociodemographic data (SDD), including race, ethnicity and income, are foundational to understanding health inequities. Ontario’s public health units collected SDD as part of COVID-19 case management and vaccination activities. This research aimed to identify enablers and barriers to collecting SDD during COVID-19 case management and vaccination.MethodsAs part of a larger mixed-method research study [1], qualitative methods were used to identify enablers and barriers to SDD collection during the COVID-19 pandemic. Purposive sampling was used to recruit participants from Ontario’s 34 public health units. Sixteen focus groups and eight interviews were conducted virtually using Zoom. Interview data were transcribed and analyzed using inductive and deductive qualitative description.ResultsSDD collection enablers included: legally mandating SDD collection and having dedicated data systems, technological and legal supports, senior management championing SDD collection, establishing rapport and trust between staff and clients, and gaining insight from the experiences from local communities and other jurisdictions. Identified barriers to SDD collection included: provincial data systems being perceived as lacking user-friendliness, SDD collection “was not a priority,” time and other constraints on building staff and client rapport, and perceived discomfort with asking and answering personal SDD questions.ConclusionA combination of provincial and local organizational strategies including supportive data systems, training, and frameworks for data collection and use, are needed to normalize and scale up SDD collection by local health units beyond the context of the COVID-19 pandemic.

Evaluation of the impact Of ChatGPT support on acromegaly management and patient education.

ChatGPT is a widely used artificial intelligence modeling tool. Healthcare is one potential area of use of ChatGPT. This study aimed to test the usability and reliability of ChatGPT in acromegaly, which is less known in society and should be evaluated by a group of specialized physicians. The study is designed in two parts. For the first part, 35 questions regarding acromegaly that patients frequently ask were identified, and these questions were asked to ChatGPT. In the second part, four patient examples were presented to ChatGPT using medical terminology. Three experts evaluated ChatGPT's answers to the questions and approaches in case management using 7-point scales in terms of safety, reliability, correctness, and usability. When the ChatGPT answers to the patient's questions were evaluated, a mean score of 6.78 ± 0.55 was given for correctness and 6.69 ± 0.60 for reliability. The mean scores given by the raters for correctness, safety and usability in the evaluation of the cases were as follows: 6.33 ± 0.88, 6.16 ± 0. 71 and 6.08 ± 0.79 points for case 1; 5.35 ± 1.88, 5.29 ± 1.80 and 5.20 ± 1.86 points for case 2; 6.08 ± 0.97, 6.00 ± 0.93 and 5.91 ± 0.82 points for case 3; 6.10 ± 1.29, 6.13 ± 1.30 and 6.16 ± 1.14 points for case 4. ChatGPT can actively answer the questions of acromegaly patients. Although it is not a reliable source alone in managing patients with acromegaly, it can be a supportive tool for physicians.

Congruent Weber-B ankle fractures do not alter tibiotalar contact mechanics.

Current treatment strategy for managing Weber B ankle fractures is mainly governed by mortise congruency, malleolar alignment, deltoid ligament competence and fracture stability. While nonoperative treatment has yielded good functional outcomes in satisfactorily aligned stable injuries, a biomechanical rationale is not firmly established. Furthermore, current radiographic analysis is obscured by observer inaccuracy and beam rotation. This study aimed to utilize weightbearing CT and computational biomechanics to analyse 3D mortise displacement and contact mechanics in Weber-B ankle fractures and compare them with the uninjured contralateral side. 32 patients were included who sustained a Weber-B ankle fracture and underwent bilateral weightbearing CT imaging at injury. Segmentation into 3D models of bone was performed semi-automatically, and individualized cartilage layers were modeled based on a previously validated methodology. The 3D mortise congruency was evaluated by use of following parameters: alpha angle, fibular length, talocrural angle, medial gutter- and tibiofibular clear space- distance mapping. Contact mechanics were evaluated by the mean and maximum contact stress of the tibiotalar articulation. Statistical analysis revealed that there were no significant differences for all anatomical parameters. There was also no significant difference between the mean contact stress of the injured (2.10 ± 0.42 MPa) and uninjured side (2.10 ± 0.41 MPa), nor the maximum contact stress of the injured (7.67 ± 1.55 MPa) and uninjured (7.47 ± 1.67), respectively. Contact mechanics were unaffected in congruent Weber-B fractures. These findings support consideration of nonoperative management in such cases, given their presumably low risk for posttraumatic arthritic development in the long term. Level of Evidence: Level III; retrospective case-control study.

Diagnostic and Interventional Imaging in Various Diseases

Diagnostic and interventional imaging is a cornerstone in the management of cases in various medical and surgical domains, such as neonatology, neurology, neurosurgery, otorhinolaryngology, dentistry, gynecology and urology [...]