Disease Management Plan Research Articles

The burden of psoriasis in Belgium, 2021

Abstract Psoriasis is a common, chronic, inflammatory skin disease with a great impact on healthcare systems. Given the limitations of the currently available burden estimates, estimates of the Belgian national burden of disease study are necessary in order to guide decision-making processes within the health sector. According to the Global Psoriasis Atlas, the prevalence of psoriasis is rising globally. The current study aims to estimate the burden of psoriasis in Belgium using national data. As there is no single comprehensive data source on prevalence of psoriasis in Belgium, a critical appraisal of existing local and national data sources was conducted. We estimated the non-fatal psoriasis burden in terms of years lived with disability (YLD). Estimated prevalence data were combined with disability weights to yield YLDs imposed by psoriasis. Mortality attributable to psoriasis was assumed to be zero, in line with the Global Burden of Disease study (GBD) 2019. We assessed three data sources containing information on existing cases with psoriasis in Belgium. Based on qualitative and quantitative appraisal, a widespread network of general practitioners was identified as the best available national data source. In 2021, the prevalence of psoriasis in Belgium was 2.1%, leading to 13084 DALYs (113 DALYs per 100 000). The burden of psoriasis was in line with national disease burden estimates for bipolar disorder, multiple myeloma, and hearing loss. Our prevalence, YLD, and DALY estimates for psoriasis in Belgium were however lower than those of the GBD study. Psoriasis imposes a non-negligible burden on population health in Belgium, despite it not being a cause of death. Along progression in psoriasis management, objective evaluation of psoriasis burden is critical to track the trends at the population level. Key messages • Psoriasis is a common skin disease with a relatively high morbidity burden. • Information on psoriasis prevalence and burden are crucial for disease management and appropriate health-care planning.

Tafamidis for the treatment of transthyretin cardiac amyloidosis (ATTR-CM) - Real-world data from a tertiary center

Abstract Introduction Tafamidis 61mg was shown to be the first treatment to reduce cardiovascular hospitalizations and to improve survival in patients with Transthyretin Amyloid Cardiomyopathy (ATTR-CM). Real-world data on the efficacy of transthyretin (TTR) stabilizers in patients with Heart Failure (HF) due to ATTR-CM is scarce. Purpose We aimed to assess the use of tafamidis in our center, that features a dedicated Cardiomyopathy Clinic. Methods We conducted an all-comers single-centre prospective study of consecutive patients with symptomatic HF due to ATTR-CM followed up to November 2023. As per site protocol, the diagnosis was established according to the ESC algorithm and all patients were assessed at least twice yearly. Disease management plans include HF treatment tailored to ATTR-CM (CHAD-STOP) and treatment with disease-modifying tafamidis 61mg. The latter is considered in patients who meet the local protocol criteria, including key inclusion criteria - NYHA class I-II - and none of the exclusion criteria - e.g. estimated glomerular filtration rate (GFR) <25mL/min. The primary endpoint was time to cardiovascular hospitalization or all-cause death. Results A total 226 ATTR-CM patients were identified, of whom 181 had a follow-up of at least 6 months and were included in the analysis (mean age 84 ± 7 years; 81% males, 16% hATTR-CM). Overall, there were 84 patients treated with tafamidis. Compared to non-treated patients, those receiving tafamidis were younger (mean age 83 vs. 86 years, p=0.007), more often with a lower NYHA functional class (e.g., NYHA I-II: 92 vs. 62%; p<0.001), scored higher on performance scales (e.g., Karnovsky >70: 67 vs 33%; p<0.001), and had less comorbidities (e.g., GFR: 40 vs. 30mL/min; p<0.001). Over a median follow-up of 16 months, 68 (37.6%) patients met the primary endpoint (49.5% vs. 22.6%, respectively; p<0.001). In multivariate analysis, treatment with tafamidis was an independent predictor of the primary endpoint (HR 0.24; 95%CI 0.13-0.43; p<0.001), adjusted for NYHA functional class (HR for NYHA I-II vs. III-IV: 0.54; 95%CI 0.32-0.92; p=0.023), NT-proBNP (HR 1.83; 95%CI 1.09-3.08; p=0.023) and high-sensitivity Troponin T (HR per 10 units: 1.01; 95%CI 1.01-1.02; p=0.024). These findings were consistent in multivariate analysis with any combination of the prior variables with either creatinine, GFR, albumin, or TTR type (wild-type vs. mutated). These results were primarily driven due to association of tafamidis treatment with increased survival. Conclusion The use of tafamidis in a cohort of patients with symptomatic HF and ATTR-CM was shown to be independently associated with reduced cardiovascular hospitalization or all-cause death. The effect had a similar magnitude of effect to that of the ATTR-ACT trial, suggesting that our local protocol based on the key criteria from this trial may allow for appropriate patient selection.

Integrated model of secondary fracture prevention in primary care (INTERCEPT): protocol for a cluster randomised controlled multicentre trial

BackgroundOsteoporotic fractures signal severely compromised bone strength and are associated with a greatly increased risk of refracture. Despite the availability of effective and safe medications that reduce fracture risk, 70–80% of patients are inadequately investigated or treated for osteoporosis following an initial fracture, constituting a significant ‘osteoporosis care gap’. Optimal methods of bridging this gap with primary care at the forefront of secondary fracture prevention remain undetermined. This protocol describes a cluster randomised controlled trial to evaluate the effectiveness of a novel integrated model of secondary fracture prevention and management in primary care.MethodsThe cluster randomised controlled trial involves multiple branches of a community-based radiology provider (CRP), a hospital-based secondary fracture prevention program (SFPP) and numerous primary care practices in metropolitan Sydney that refer to either the CRP or SFPP. Using natural language processing tools, patients diagnosed with a potential osteoporotic fracture will be identified by automatically screening radiology reports generated at the CRP or SFPP. The primary care practices that these patients attend will be randomised (1:1) to either the intervention or usual care. The intervention consists of (i) electronic and fax alerts informing the practice/primary care physician that their patient has been diagnosed with a potential osteoporotic fracture; (ii) provision of osteoporosis management guidelines and (iii) follow-up surveys at 4 weeks and 6 months. Practices in the usual care (control) group will receive no alerts and provide usual care. The primary outcome is the proportion of patients undergoing a bone density scan and/or filling a prescription for osteo-protective pharmacotherapy within 3 months of the initial diagnostic imaging report. Secondary outcomes are the proportion of patients: (i) undergoing an osteoporosis-related blood test within 3 months of the initial diagnostic imaging report; (ii) initiated on a chronic disease management plan within 3 months of the diagnostic report, and (iii) filling a second prescription for osteo-protective pharmacotherapy within 9 months post initial diagnostic imaging report. Outcomes will be obtained through de-identified linked data from Medical Benefits Schedule and Pharmaceutical Benefits Scheme held by the Australian Institute of Health and Welfare.DiscussionThis is the first randomised trial to integrate case-detection of potential osteoporotic fractures in a hospital and community setting with direct alerts to the patient’s primary care provider. This study will determine whether such an intervention is effective in improving investigation and/or treatment rates of osteoporosis in patients with a potential osteoporotic fracture.Trial registrationThis study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623000658617p.

Experimental Infection of California Ripe Olive Cultivars with Xylella fastidiosa Subspecies pauca De Donno and Acquisition by Glassy-Winged Sharpshooter

Strains of Xylella fastidiosa subspecies pauca can infect olive trees, and an introduction of this pathogen has caused significant damage to the olive industry in Europe. Although this subspecies is not known to be present in North America, the environment, plant hosts, and insect vectors in the United States olive-growing regions (mainly California) are conducive to X. fastidiosa spread and disease damage. This study evaluated several risk factors for X. fastidiosa disease in the California olive industry, including infection of the common cultivars and acquisition by insect vectors. Olive cultivars Manzanillo, Sevillano, and Mission all exhibited disease symptoms after inoculation with X. fastidiosa strain De Donno obtained from the olive disease outbreak in southern Italy. Glassy-winged sharpshooters were able to acquire X. fastidiosa De Donno from infected olive plants as soon as 30 days after plant inoculation. This information is valuable for risk assessment and disease management planning in the event of a future introduction of olive-pathogenic strains of X. fastidiosa to the United States. [Formula: see text] The author(s) have dedicated the work to the public domain under the Creative Commons CC0 “No Rights Reserved” license by waiving all of his or her rights to the work worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law, 2024.

Mortality of cases with chronic kidney disease and its risk factors admitted to hospital with COVID-19 in Almaty city, Kazakhstan

Aim: to determine the rate of mortality of cases with chronic kidney disease and its risk factors admitted to hospital with COVID-19 in Almaty City, Kazakhstan. Methods: Patients with coronavirus infections who were hospitalized at a hospital in the Kazakhstani Almaty region from June 2020 until June 2022 are included in the retrospective analysis. The Unified National Electronic Healthcare System (UNEHS) provided the database extraction. Individuals were considered eligible if they had been admitted to the hospital with the primary diagnoses of U07.1 (COVID-19, detected virus) and U07.2. Conclusion: In Almaty, Kazakhstan, hospitalization outcomes for coronavirus patients with and without chronic kidney disease were assessed in this study. Analysis was done on the impact of comorbidities and sociodemographic characteristics on mortality. While there are many ways to prevent and manage chronic kidney disease (CKD), coexisting medical diseases, particularly viruses that cause pandemics, might complicate matters. Thus, to prevent unplanned infectious disease outbreaks, a thorough disease management plan must be established

The Rise of Digital Twins in Healthcare: A Mapping of the Research Landscape.

The place of digital twin technology in any healthcare system is a truly disruptive innovation that has profound consequences all across medical research and practice. Digital twins represent the virtual replicas that correspond to some physical entity by pulling real-time data streams from different sources to model biological systems for health monitoring and personalization of treatment strategies. This paper presents a detailed review of the current research landscape into digital twins for healthcare. Through bibliometric analysis, we obtained 1,663 publications from 2012 to 2024, basically sourced from the Scopus database, establishing a portion of the trends, productive authors, influential sources, and collaboration networks in this fast-evolving field. Descriptively, our results indicate that although research into this area started way back, the bulk of research began to be realized from 2018 onwards, with appreciable contributions coming in from interdisciplinary fields of artificial intelligence, machine learning, and data analytics. Even with challenges to data interoperability and other privacy concerns, this change brought on by digital twin technology is undoubtedly a considerable promise for chronic disease management, predictive analytics, drug discovery, and surgical planning. This work brings immense insight into this new domain of digital twins in health, which shall set up a strong foundation for future research and innovation in this area.

An innovative business model using established Medicare items for delivery of cardiac rehabilitation: A value proposition for primary care.

Approximately 70% of Australians do not attend cardiac rehabilitation (CR). A potential solution is integrating CR into primary care OBJECTIVE: To propose a business model for primary care providers to implement CR using current Medicare items. Using the chronic disease management plan, general practitioners (GPs) complete four clinical assessments at 1-2 weeks, 8-12 weeks, and 6 and 12 months after discharge. The net benefit of applying this model, compared with claiming the most used standard consultation Item 23, in Phase II CR is up to $505 per patient and $543 in Phase III CR. The number of rural GPs providing CR in partnership with the Country Access To Cardiac Health (CATCH) through the GP hybrid model has increased from 28 in 2021 to 32 in 2022. This increase might be attributed to this value proposition. The biggest limitation is access to allied health services in the rural areas.

Burnout in podiatrists associated with individual characteristics, workplace and job satisfaction: A national survey.

Burnout is highly prevalent among health practitioners. It negatively impacts job performance, patient care, career retention and psychological well-being. This study aimed to identify factors associated with burnout among Australian podiatrists. Data were collected from registered podiatrists via four online surveys administered annually from 2017 to 2020 as part of the Podiatrists in Australia: Investigating Graduate Employment (PAIGE) study. Information was collected about work history, job preferences, personal characteristics, health, personality, life experiences and risk-taking behaviours. Multiple logistic regression analyses were used to determine if (i) individual characteristics, (ii) workplace factors and (iii) job satisfaction measures were associated with burnout (based on the abbreviated Maslach Burnout Inventory). A total of 848 responses were included, with 268 podiatrists (31.6%) experiencing burnout. Participants experiencing burnout were slightly younger, more recent to practice, had poorer health, greater mental distress, lower scores for resilience, extraversion, agreeableness, conscientiousness, emotional stability and openness to experiences. They were less likely to have financial and clinical risk-taking behaviour and more likely to have career risk-taking behaviour. Prediction accuracy of these individual characteristic variables for burnout was 72.4%. Participants experiencing burnout were also more likely to work in private practice, have more work locations, work more hours, more direct patient hours, see more patients, have shorter consultation times, more likely to bulk bill chronic disease management plans, have less access to sick leave and professional development and be more likely to intend to leave patient care and the profession within 5years than participants not experiencing burnout. Prediction accuracy of these workplace-related variables for burnout was 67.1%. Participants experiencing burnout were less satisfied with their job. Prediction accuracy of these variables for burnout was 78.8%. Many of the factors associated with burnout in Australian podiatrists are modifiable, providing opportunities to implement targeted prevention strategies. The strength of association of these factors indicates high potential for strategies to be successful.

Aligned or misaligned: Are public funding models for speech-language pathology reflecting recommended evidence? An exploratory survey of Australian speech-language pathologists

Government subsidised funding arrangements serve as an essential medium for families to access private speech-language pathology (SLP) services in Australia. This study aimed to investigate whether, from a provider perspective, contemporary public funding models (PFMs) align with best-available scientific evidence for management of children and young persons with swallowing and communication disorders within Australian private-practice settings. This exploratory study was distributed to paediatric speech-language pathologists throughout Australia via an online survey. A total of 121 valid surveys were completed by Australian speech-language pathologists with divergent career experiences. In comparing three familiar PFMs using mixed effects logistic regression models to estimate odds ratios, results indicated that perceived congruence with recommended scientific evidence for SLP management varied across PFMs: the odds of failing to align with scientific evidence was 4.92 times higher for Medicare’s Chronic Disease Management Plan (MBS_CDMP) than for the National Disability Insurance Scheme; and 7.40 times higher in comparison to Medicare’s Helping Children with Autism initiative. This study is the first to report on (in)congruence between PFMs that provide access to independent Australian SLP services for children and young persons and best available scientific evidence to inform clinical practice. Participants identified that: (a) four out of seven contemporary PFMs were unfamiliar to speech-language pathologists; and (b) MBS_CDMP initiative failed to align with the evidence-base for best scientific SLP management.

The effectiveness of chronic disease management planning on self-management among patients with diabetes at general practice settings in Australia: a scoping review

BackgroundMedicare provides significant funding to improve, encourage and coordinate better practices in primary care. Medicare-rebated Chronic Disease Management (CDM) plans are a structured approach to managing chronic diseases in Australia. These chronic disease care plans are intended to be a vehicle to deliver guideline-based / evidence-based care.. However, recommended care is not always provided, and health outcomes are often not achieved. This scoping review aimed to identify the specific components of CDM plans that are most effective in promoting self-management, as well as the factors that may hinder or facilitate the implementation of these plans in general practice settings in Australia.MethodA comprehensive search was conducted using multiple electronic databases, considering inclusion and exclusion criteria. Two reviewers independently screened the titles and abstracts of the identified studies via Covidence, and the full texts of eligible studies were reviewed for inclusion. A data extraction template was developed based on the Cochrane Effective Practice and Organization of Care Group (EPOC) to classify the intervention methods and study outcomes. A narrative synthesis approach was used to summarize the findings of the included studies. The quality of the included studies was assessed using the JBI Critical Appraisal Checklist.ResultsSeventeen articles were included in the review for analysis and highlighted the effectiveness of CDM plans on improving patient self-management. The findings demonstrated that the implementation of CDM plans can have a positive impact on patient self-management. However, the current approach is geared towards providing care to patients, but there are limited opportunities for patients to engage in their care actively. Furthermore, the focus is often on achieving the outcomes outlined in the CDM plans, which may not necessarily align with the patient’s needs and preferences. The findings highlighted the significance of mutual obligations and responsibilities of team care for patients and healthcare professionals, interprofessional collaborative practice in primary care settings, and regular CDM plan reviews.ConclusionSelf-management support remains more aligned with a patient-centred collaboration approach and shared decision-making and is yet to be common practice. Identifying influential factors at different levels of patients, healthcare professionals, and services affecting patients’ self-management via CDM plans can be crucial to developing the plans.

Utilisation of Chronic Disease and Mental Health Management Services and Cardioprotective Medication Prescriptions in Primary Care for Patients With Cardiovascular Diseases and Cancer: A Cross-Sectional Study

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among cancer survivors. Mental health is considered an important risk factor affecting the treatment of cardiovascular disease. However, little is known about the use of secondary prevention strategies for CVD in patients with both cancer and CVD. This study aimed to compare the utilisation of primary care chronic disease management plans, mental health care and guideline-indicated cardioprotective medications among CVD patients with and without cancer. Retrospective cross-sectional study utilising clinical data of patients with CVD from 50 Australian primary care practices. Outcomes included the use of chronic disease management plans, mental health care, guideline-indicated cardioprotective medications and influenza vaccination. Logistic regression, accounting for demographic and clinical covariates and clustering effects by practices, was used to compare the two groups. Of the 15,040 patients with CVD, 1,486 patients (9.9%) concurrently had cancer. Patients with cancer, compared to those without, were older (77.6 vs 71.8 years, p<0.001), more likely to drink alcohol (62.6% vs 55.7%, p<0.001), have lower systolic (130.3±17.8 vs 132.5±21.1 mmHg, p<0.001) and diastolic (72.2±11 vs 75.3±34 mmHg, p<0.001) blood pressure. Although suboptimal for both groups, patients with cancer were significantly more likely to have general practice management plans (GPMPs) (51.4% vs 43.2%, p<0.001), coordination of team care arrangements (TCAs) (46.2% vs 37.0%, p<0.001), have a review of either GPMP or TCA (42.8% vs 34.7%, p<0.001), have a mental health treatment consultation (15.4% vs 10.5%, p=0.004) and be prescribed blood pressure-lowering medications (70.1% vs 66.0%, p=0.002). However, there were no statistical differences in the prescription of lipid-lowering or antiplatelet medications. After adjustments for covariates and multiple testing, patients with cancer did not show a difference in GPMPs, TCAs, and a review of either, but were more likely to receive mental health treatment consultations than those without cancer (odds ratio 1.76; 95% confidence interval 1.42-2.19). Less than half of patients with CVD had a GPMP, TCA or review of either. Although those patients with cancer were more likely to receive these interventions, still around half the patients did not. Medicare-funded GPMPs, TCAs and a review of either GPMP or TCA were underutilised, and future studies should seek to identify ways of improving access to these services.

Diagnostic value of Video Electroencephalography combined with Magnetic Resonance Imaging-diffusion tensor imaging in epilepsy.

To explore the diagnostic value of video electroencephalography (VEEG) combined with magnetic resonance imaging diffusion tensor imaging (MRI-DTI) in epilepsy. In this retrospective observational study, clinical data of 60 patients who underwent both VEEG and MRI examinations at the Neurosurgery Department of Quzhou People's Hospital from December 2020 to March 2023 were retrospectively reviewed, and a total of 55 patients were finally included. We evaluated the diagnostic value of combining VEEG and MRI to determine seizure type, location of epileptic focus, and structural abnormalities of brain tissue, using surgical and pathological results as the gold standard. The accuracy of the combined approach for determining the seizure type was 98.18%, which was higher than the accuracy of MRI (85.45%, P<0.05) or VEEG (81.82%, P<0.05) alone. The accuracy of joint examination for lesion location was 100.00%, which was higher than those of MRI (85.45%, P<0.05) or VEEG (83.64%, P<0.05) alone. Similar abnormal brain tissue structure detection rates was found for both MRI and VEEG (P>0.05). The application of MRI-DTI combined with VEEG to diagnose patients with epilepsy allows for the identification of abnormal structural changes in brain and the location of lesions. Combining both approaches can improve the diagnostic accuracy of each technique alone and provide a reference for the formulation and adjustment of disease management plans.

Clinical and microbiological predictors of healing in Buruli ulcer disease

IntroductionWound measurements are relevant in monitoring the rate of healing (RoH) and may predict time to healing. Predicting the time to healing can help improve the management of Buruli ulcer. We examine three methods for the determination of RoH and their use as predictors of time to healing. MethodsLesion measurements of Buruli ulcer patients treated from 2007 to 2022 were obtained with acetate sheet tracings (2D) or Aranz software (3D) fortnightly. RoH was determined using the absolute area, percentage area reduction and linear methods at 4 weeks post onset of antibiotic treatment. Predicted time to healing was compared to the actual healing time. Baseline characteristics were assessed for associations with healing. ResultsAll three methods for calculating the RoH significantly distinguished between fast and slow healers (p < 0.0001). The predicted healing time using the linear method was comparable to the actual healing time for fast healers (p = 0.34). The RoH was influenced by the form of lesion, with plaques [OR 2.19 5 %CI (1.2–3.6), p = 0.009], and oedemas [OR 8.5; 95 %CI (1.9––36.9), p = 0.004] being associated with delayed healing. The proportion of patients with paradoxical reactions 16 % vs 3 %, p < 0.0001), higher baseline bacterial load (75/104;72 % vs 21/47;45 %, p = 0.001) and delayed clearance of viable organisms (71/104;68 % vs 9/47;19 %, p < 0.0001) was higher in the slow healers than the fast healers. ConclusionPredicted healing rates were comparatively lower for slow healers than fast healers. Baseline characteristics associated with healing can be explored for an improved disease management plan to reduce patient and caregiver anxiety.

Incidence and Distribution of the Fusarium sambucinum Species Complex Associated with Cannabis sativa in Kentucky

Hemp is an emerging crop that is cultivated for a variety of applications. Since commercial reintroduction in 2018, many pathogens and pests that threaten production have been identified, such as Fusarium head blight. The disease causes extensive blighting of floral tissues and presents a mycotoxin contamination risk. During the 2022 growing season, 25 sites were surveyed across 15 different counties to determine the incidence and distribution of toxigenic Fusarium species within the Fusarium sambucinum species complex. Fusarium graminearum was the most isolated species within the complex. The 15-DON chemotype was found to be the predominant F. graminearum population. The F. sambucinum species complex isolation rate varied by site and reached up to 46.6%. Isolation rates were found to be correlated with plant age and calendar day. Management strategies are currently limited for Fusarium head blight of hemp. Data from this survey will help develop future projects and disease management plans regarding spray timings and crop rotation.

Comparison of Proxy and Self-Reported Functional Ability in Heart Failure Patients with Cognitive Impairment

Background: Heart failure (HF) patients often experience cognitive impairment that negatively impacts self-management ability, predisposing these individuals to worse post-hospitalization outcomes. Patient proxies may have more insight into a patient’s self-management capability especially in the context of patient cognitive impairment. Here, we incorporate proxy input to evaluate associations between patient- and proxy-reported capacity for instrumental activities of daily living (IADL) stratified along a patient’s cognitive function in an older hospitalized heart failure population. Methods: We conducted a quality improvement study in older HF inpatients with cognitive impairment determined by Mini-Cog. Functional activity performance has been previously assessed using the Assessment of Living Skills and Resources Revision 2 (ALSAR), a validated index where higher numerical scores associate with increasing dependence in completing IADL and risk for needing a more structured living environment, nursing home placement, hospitalization, and death. We assessed ALSAR with patient self-report and proxy-report (range 0-44 lower scores equate to better performance) and calculated the absolute difference (ALSAR difference, lower scores show stronger agreement between patients and proxies). Patients’ Montreal Cognitive Assessment (MoCA) scores, among which scores less than 26 suggest clinically significant cognitive impairment, were correlated with ALSAR difference. Results: Median patient age was 74 years. Forty-two percent were female among our sample of 30 hospitalized HF patients with cognitive impairment. Median patient ALSAR score of 4 (range 2-7) differed from median proxy ALSAR score of 7 (range 4-12) (p&lt;0.01). Lower MoCA correlated with higher ALSAR difference (r=-0.58, p&lt;0.01). Conclusions: Assessing ALSAR difference in clinical practice is feasible and it correlates to MoCA score in hospitalized HF patients with cognitive impairment, consistent with prior work. These results support the notion that proxy-input of patient IADL assessment could improve patient needs detection among HF patients with cognitive impairment. This information may enhance risk assessment, disease management and discharge planning when targeting and proactively involving proxies. Prospective studies should evaluate this novel metric and its association with patient-centered outcomes.

A clinicopathological study of fungal diseases in patients with chronic rhinosinusitis and sinonasal polyposis

Chronic Rhinosinusitis (CRS) is a ubiquitous medical condition that has both individual and financial impacts, severely affecting the quality of life. A fungus instigated CRS is fungal rhinosinusitis (FRS) is becoming increasingly incident in recent years. However, the lack of knowledge in the etiology, pathogenesis, and natural history of the FRS complicates the disease management plan. : To study the prevalence of Fungal Diseases in all cases of Sinonasal polyposis and chronic rhino-sinusitis admitted for Functional Endoscopic Sinus Surgery: This research focuses on the clinical, microbiological, and radiological analysis of FRS patients for two years. Age, gender, and occupational categorization of FRS patients were done and assessed the risk factors were based on sinus involvements based on radiology and systemic diseases. : The incidence of FRS in 156 patients was higher in males within the age group of 30-40 (28%) and lower economic groups (38%). Symptoms like nasal obstruction (85%) and headache (56%) were predominantly observed. The involvement of multiple sinuses was confirmed through radiology studies. Microbiological tests revealed fungi in 18 samples (11.5%) through direct culture results and potassium hydroxide mount culture study. While Aspergillus genus pre-dominated etiological identification, A. flavus was more common in occurrence (65%), owing to the environment and living conditions that favor the exposure of spores. A recurrence study post-study period came up negative. : A detailed pathophysiological analysis could improve the understanding of the disease prognosis that could avoid developing complications and indiscreet administration of antibiotics, thereby improving the quality of life.

Research progress and management strategies of fungal diseases in Camellia oleifera

Camellia oleifera Abel, a woody oil plant, that is endemic to China. Tea oil, also referred to as “oriental olive oil,” is a superior quality plant-based cooking oil. The production of tea oil accounts for 8% of the total edible vegetable oil production in the country. Since 2022, the annual output value of C. oleifera industry has exceeded 100 billion yuan, making it one of the major economic contributors to China’s rural revitalization development strategy. In recent years, demand and production have grown in parallel. However, this has led to an increase in the incidence levels of pest and diseases. Pests and diseases significantly reduce the quality and yield of C. oleifera. C. oleifera diseases are mainly caused by pathogenic fungi. C. oleifera anthracnose, soft rot, leaf spot, coal stain, leaf gall disease, and root rot are the most important fungal diseases affecting the C. oleifera industry. However, the same disease may be caused by different pathogenic fungi. C. oleifera can be found in half of China and is found in several climatic zones. The geographical distribution of woody plant diseases is consistent with the distribution of the tree species and the ecology of the range, which also results in a highly complex distribution of fungal diseases of C. oleifera. The management of fungal diseases in C. oleifera is extremely challenging due to the variety of pathogenic fungal species, multiple routes of transmission, the lack of resistant plants, and the environmental safety of chemical measures. The optimal strategy for addressing fungal diseases in C. oleifera is to develop and apply an integrated disease management plan. This review provides a brief overview of the pathogenic species, pathogenesis, pathogenesis, geographical distribution, current management strategies, and potentially new methods of C. oleifera fungal diseases, to provide direction for the development of comprehensive management measures for C. oleifera fungal diseases in the future.

Unraveling pine wilt disease: Comparative study of stochastic and deterministic model using spectral method

The pinewood nematode, which causes a disease known as pine wilt, is a serious threat to pine forests all over the world. In this paper, we analyze the dynamics of pine wilt disease and its effects on forest ecosystems using mathematical modeling of pine wilt disease, its numerical simulations, and analytical techniques. Understanding the nematode’s spread, evaluating the efficiency of management efforts, and foreseeing the long-term effects on pine populations are some of our research’s goals. To gain a comprehensive understanding of the dynamics of the disease, we categorize pine trees and vectors systematically into susceptible, exposed, and infected groups. We first presented disease dynamics through a flow diagram which is then transformed to system of ordinary differential equations along with non-negative initial conditions. The deterministic model is then transformed to a stochastic model. Using both deterministic and stochastic modeling approaches, this study explores the complex transmission dynamics of Pine Wilt disease. Basic reproduction number has been calculated via next generation technique and some cases of stability analysis on the basis of the values of reproduction number has been discussed. For the solution of stochastic model Legendre Spectral collocation method has been used as it is known for its high accuracy in approximating solutions to complex stochastic models. It can achieve exponential convergence rates, making it suitable for problems where high precision is required. The results of both deterministic and stochastic models are compared via different figures. We find crucial thresholds for disease transmission and highlight significant factors affecting the spread of diseases through simulations. Our research shows that preventing the severe impacts of pine wilt disease requires early detection and intervention. Additionally, our mathematical model is a useful tool for enhancing disease management plans. This research advances our knowledge of the dynamics of the pine wilt disease and provides useful advice for managing forests and promoting conservation. Our research highlights the need for quick action to protect pine forests from this harmful virus.

The dyadic coping experience of ICU transfer patients and their spouses: A qualitative study.

The patient's spouse, in their role as the primary caregiver, assumes responsibility for the patient's care during the recovery process and provides the most robust social support. Previous research has primarily focused on the coping experiences and thoughts of individual intensive care unit (ICU) patients or caregivers, with limited attention afforded to the relationship between patients and their spouses. This study aims to explore the dyadic coping experiences of ICU transfer patients and their spouses, with the goal of providing evidence to support the subsequent development of an individualized intervention program. A qualitative study using a phenomenological research approach was undertaken. Purposive sampling was employed to select participants for face-to-face semi-structured in-depth interviews. The interviews took place at a tertiary general hospital in Nanjing from January 2023 to February 2023.Twelve ICU transfer patients and their twelve spouses were interviewed. The data were then summarized, and themes were derived using the Colaizzi 7-step analysis method. A total of four themes and eleven sub-themes emerged from the analysis. The identified themes include positive coping (actively seeking solutions, and facing challenges together), negative coping (avoiding problems, displaying overprotective behaviour, and bearing the burden alone), difficulties and challenges (a lack of information, high physical and psychological stress, and significant financial burden), and needs and suggestions (strengthening transition care, fostering increased intimacy, and reducing negative emotions). Both patients and spouses experience physical and psychological stress during the transfer from the ICU to the ward. Therefore, any intervention developed for caregivers should be designed in a dyadic manner. Increasing dyadic coping skills may represent an important area for future research and intervention. This study provides valuable evidence to inform the formulation of a comprehensive dual disease management plan for ICU transfer patients and their spouses.

The Queensland Virtual Integrated Practice (VIP) partnership program pilot study: an Australian-first model of care to support rural general practice

BackgroundThere is a critical lack of medical workforce internationally, and this is particularly notable in rural and remote Australia where strategies to address workforce shortages are urgently required. This pilot study aimed to implement and evaluate a Virtual Integrated Practice (VIP) Program in the Australian rural primary care setting.MethodsThe VIP model was developed using co-creation methodology and involves an urban GP joining a rural general practice team to provide ongoing care to patients remotely via secure telehealth. The pilot study was conducted in two western Queensland general practices, commencing in October 2021 with one rural practice and extending to an additional rural practice from November 2022. Evaluation included a retrospective review of service, billing and cost data, and an online survey for patients. Ethical approval was obtained from the University of Queensland Human Research Ethics Committee (Project number: 2021/HE002434).ResultsThere were 1468 services provided through to December 2022, including general consults (n = 1197), therapeutic procedures (n = 68), mental health treatment plans (n = 68) and chronic disease management plans (n = 59). Patients were predominantly female (73.1%) and did not have their appointment at the practice (57.8%). Among 1282 occasions of service, less than 20% of consultations (n = 224) required support from staff (e.g., a nurse), and more than half were repeat patient encounters (53.0%). Survey respondents (n = 45) indicated that they were satisfied (9.3%) or highly satisfied (90.7%) with the care provided, and importantly, 95.5% of respondents reported that the service improved their access to the GP. More than 20% of respondents indicated that they would attend the Emergency Department if virtual care was not available.ConclusionsData from this pilot study has informed translation to an additional 20 vulnerable rural general practices in three further rural regions in Queensland in 2023 and evaluation is ongoing. This pilot study demonstrates the feasibility and acceptability of an innovative, digitally supported community-focussed, healthcare initiative to arrest the decline in rural general practice workforce, improve patient care access and support rural practice viability.