Case Management Research Articles

The “Plus” in Cash Plus: Client-Perceived Implications of Homelessness Service Provision and Guaranteed Income

ABSTRACT As the number of guaranteed income projects grow across the United States, there has been increasing interest in understanding the role that services such as case management play in direct cash transfer programs. This study explores participant-perceived outcomes of receiving a guaranteed income and services from a homelessness service-providing agency including case management, housing navigation, and transitional housing. Researchers conducted semi-structured interviews with 11 participants of a guaranteed income project for adults experiencing homelessness. Rapid analysis was used to systematically organize the qualitative data and quickly share the findings with community partners. Findings suggest that participants perceive that the combination of cash and services helped ameliorate barriers to independent housing and allowed participants to access housing more quickly than they would have otherwise. Even in cases where participants had not accessed independent housing, findings suggest that building therapeutic and services-related relationships with clients in conjunction with a guaranteed income, helps participants feel an overall stability and structure and allows for movement toward independent housing, more autonomy, and the ability to build a financial safety net.

Interpretation of national clinical practice guideline on obesity management (2024 edition)

Entrusted by the National Health Commission, the national clinical practice guideline on obesity management aims to standardize the clinical diagnosis and treatment of obesity and prescribe scientific and effective treatment plans to patients, in order to continuously improve the homogenization across healthcare organizations, enhance the effectiveness of obesity treatment and improve long-term health benefits. This guideline is applicable to professionals engaging in the clinical practice on obesity, including clinical physicians, nutritionists, fitness and rehabilitation therapists, nurses, case managers, medical administrators, public health practitioners, as well as medical social workers. The purpose is to guide the clinical diagnosis, interventional treatment, health education, and construction of multi-disciplinary models of obesity management. This article aims to interpret the guidelines on key aspects such as the etiology of obesity, epidemiology, diagnostic assessment, classification and staging, risks of obesity related diseases and benefits of weight loss, principles of treatment, multidisciplinary treatment pathways, multidisciplinary treatment methods, and multidisciplinary collaborative treatment models.

Program Evaluation Study of CBT Interventions for Older Adults in Adult Day Health Care Center at Los Angeles, California

This study evaluated the effectiveness of CBT interventions including supportive presence and socialization for immigrant older participants who suffered from depression and anxiety and attended an Adult Health Care Center (ADHC) at Los Angeles, California. The evaluation strived to study patients at the ADHC who receive daytime health care service for at least a year consistently. The Patient Health Questionnaire-9 (PHQ-9) was utilized to measure and monitor the severity level of depressive symptoms. The Generalized Anxiety Disorder-7 (GAD-7) was also used to measure and monitor the severity level of anxiety symptoms. Of the eighty-five participants (N=85) were selected to be involved in this study, sixty-nine were women, and men account for sixteen. The findings support the hypothesis of this study which states that the CBT intervention of the Adult Day Health Care in L.A, CA will reduce symptoms of anxiety/depression among older immigrant clients. It appears that the comprehensive nature of the CBT intervention in the ADHC, which includes supportive presence and socialization, individual therapy, and case management, is effective at improving symptoms of anxiety and depression among the participants.

Non-pharmacological interventions for ADHD

ADHD is a common neurodevelopmental disorder with a negative impact on life trajectory. While medication is the most evidence-based treatment, multimodal intervention is strongly recommended. This review focuses on non-pharmacological interventions for ADHD that have been investigated in recent reviews and meta-analyses. In an individualised case management approach, it may be relevant to include interventions that are not (yet) evidence-based if personal factors indicate benefit. Clinicians should continuously monitor responses to interventions and adjust or add interventions to optimise outcomes.

NLP-Based Automation in Customer Support and Case Management

The paper looks at the utilization of Natural Language Processing (NLP) technologies in customer support and case management systems with a discussion about their role in operational efficiency and customer satisfaction. NLP is a branch of artificial intelligence (AI) that enables machines to understand, interpret, and generate human language to enable businesses to automate conversations that human agents otherwise handle. Using NLP, organizations can handle a high load of the customer’s requests and queries while offering quicker, more accurate, and customized support. NLP components, namely tokenization, sentiment analysis, and named entity recognition, are used within case routing, issue tracking, and status updates to remove the manual effort and resulting costs. The paper analyzes the NLP, AI, and Customer Relationship Management (CRM) systems synergy and the synergy between AI qualities and decision-making based on predictive analytics that further improves the case management processes. By the use of the NLP, businesses can accelerate resolving cases, prioritizing urgent cases, and provide better customer experience. Such as data privacy, model bias, and the need for human oversight, especially where customer interactions are complicated. Finally, the paper discusses future trends in the area of NLP models, chatbots, and virtual assistants based on their use of deep learning, as well as the possible development of fully automated customer service operations. These innovations will revolutionize ways the customer support functions can operate cost-effectively, efficiently, and on a scale that allows businesses to adapt to this new landscape of AI-powered service delivery.

Machine learning model to predict sepsis in ICU patients with intracerebral hemorrhage

Patients with intracerebral hemorrhage (ICH) are highly susceptible to sepsis. This study evaluates the efficacy of machine learning (ML) models in predicting sepsis risk in intensive care units (ICUs) patients with ICH. We conducted a retrospective analysis on ICH patients using the MIMIC-IV database, randomly dividing them into training and validation cohorts. We identified sepsis prognostic factors using Least Absolute Shrinkage and Selection Operator (LASSO) and backward stepwise logistic regression. Several machine learning algorithms were developed and assessed for predictive accuracy, with external validation performed using the eICU Collaborative Research Database (eICU-CRD). We analyzed 2,214 patients, including 1,550 in the training set, 664 in the validation set, and 513 for external validation using the eICU-CRD. The Random Forest (RF) model outperformed others, achieving Area Under the Curves (AUCs) of 0.912 in training, 0.832 in internal validation, and 0.798 in external validation. Neural Network and Logistic Regression models recorded training AUCs of 0.840 and 0.804, respectively. ML models, especially the RF model, effectively predict sepsis in ICU patients with ICH, enabling early identification and management of high-risk cases.

AI-Powered Legal Documentation Assistant Software

Abstract—This paper presents the development and implemen- tation of an AI-powered Legal Documentation Assistant Software using the MERN (MongoDB, Express.js, React.js, Node.js) stack. The proposed system revolutionizes legal case management by providing structured case input categorization, AI-driven legal pathway recommendations, and automated generation of sup- porting legal documents. This research evaluates the system performance compared to existing legal documentation tools, highlighting the advantages of a modern web-based system integrated with AI capabilities. The paper also discusses technical challenges, system design, and future enhancements. Index Terms—Legal Documentation Assistant, MERN Stack, AI Integration, Legal Case Management, Document Automation.

Assessing the impact of the TB response in Taiwan - the journey towards ending TB.

The incidence of TB in Taiwan declined by 62% from 2005 to 2023 (i.e., from 73/100,000 to 28/100,000). Here we review the past two decades of TB epidemiology, policy implementation, and outcomes, identifying gaps and solutions for domestic and global responses. An external review in 2024 assessed National TB Program progress towards the End TB goal, integrating feedback from an International Review Panel and a 2023 expert questionnaire. The findings informed Phase III (2026-2030) of the 'End TB by 2035 Project'. We present review materials, consensus recommendations, and follow-ups through 2024. In 2023, 64% of the TB cases were aged ≥ 65. TB incidence among those < 60 is projected to meet the End TB targets (<10/100,000) by 2035, while elimination (<1 per million) is expected among 0-14-year-olds. During 2005-2024, Taiwan universally adopted new diagnostic tools for drug-resistant TB, shorter regimens and user-friendly platforms for reporting and case management. Nationwide policy innovations included active case finding, and TB infection (TBI) treatment. Taiwan's consistent investment in TB reflects strong political commitment to End TB. Current challenges include aging, co-morbidities, high TB/TBI among foreign migrant workers and societal disparities, and we suggest that future efforts must leverage artificial intelligence, universal genotyping and greater inter-departmental collaboration.

CHALLENGES TO CANCER PATIENT ADVOCACY IN NURSING PRACTICE: A NARRATIVE REVIEW

Introduction: Advocacy by nurses caring for cancer patients is essential to ensure that their rights and wishes are respected throughout their care pathway. However, the ability of nurses to provide effective advocacy is limited by various organisational and managerial obstacles, potentially affecting the quality of care and patient well-being. Objective: Description of the barriers to nursing advocacy in oncology, providing a critical summary of the available evidence to identify the main challenges and propose strategies for improvement. Materials and Methods: A narrative review was conducted using databases such as PubMed, CINAHL and Cochrane Library between June and September 2024, using the Population, Intervention, Outcome (PIO) methodology. Results: Four articles were deemed to be relevant to the study objective. The main issues that emerged from the narrative review were barriers to advocacy (lack of effective communication and work overload; fragmented continuity of care), improvement strategies (training and psychological support) and patients' experiences in the transition from distress to empowerment. Conclusions: Various barriers hinder nursing advocacy in oncology, such as excessive workload, fragmentation of care and difficulties in addressing patients' emotional needs. This review underscores that the introduction of dedicated professionals, such as case managers, can provide organisational and coordinated support, helping to mitigate some of the barriers identified. Tackling the barriers to nursing advocacy is critical to ensuring high-quality, patient-centred cancer care. Strengthening organisational support, continuing education for nurses and the adoption of innovative care models are essential.

Mayer-Rokitansky-Kuster-Hauser syndrome with bilateral inguinal hernia of the adnexa - A rare coexisting anomaly.

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare congenital disorder characterised by the absence of the uterus and upper vagina. It typically presents in adolescent females with primary amenorrhoea despite normal secondary sexual characteristics and a 46 XX karyotype, with an incidence of 1 in 4500 female births. A 20-year-old married female presented with a chief complaint of bilateral inguinal swelling persisting for the past 5-6 months. She had primary amenorrhoea and was sexually active without dyspareunia or coital difficulties. A general examination was normal. Bilateral reducible inguinal hernias, measuring 4 cm × 5 cm (left) and 2 cm × 2 cm (right), with a positive cough impulse, were noted. Hormonal parameters were normal. Karyotyping showed a normal 46 XX in all cells. Magnetic resonance imaging revealed the absence of the uterus, with both ovaries present in the inguinal canals. Diagnostic laparoscopy confirmed the absence of the uterus, a wide left deep inguinal ring with herniating ovary and Müllerian structures, and an open right deep inguinal ring with a herniating ovary and Müllerian nodule. Hernia reduction followed by pre-peritoneal space dissection was performed. A 10 cm × 15 cm non-absorbable polypropylene mesh (Ethicon) was placed and fixed with tackers. The left round ligament was divided to prevent future recurrence of the hernia. Early diagnosis and management of such cases are essential to prevent complications like ovarian torsion. This case underscores the importance of recognising MRKH syndrome presentations for timely and effective treatment.

Mixed gonadal dysgenesis: a case report and management approach

Mixed gonadal dysgenesis: a case report and management approach

Human Rights Institutions: Systemic Underfunding and Policy Reform in Alberta

Canada's system of federal, provincial, and territorial anti-discrimination statutes enforced by commissions and tribunals faces a severe funding crisis. This study provides original data on funding and case management trends for each human rights institution in the country. It also documents efforts in Alberta—the jurisdiction in which funding cuts were the most severe—to address these challenges through policy reforms that might potentially serve as a model for other jurisdictions.

Case Management for Enhancing Wellbeing, Resilience, and Quality of Life in Caregivers of Children and Adolescents With Chronic Illnesses and Disabilities: A Systematic Review and Meta-Analysis.

Caregivers of children and adolescents with chronic illnesses often experience mental health challenges, which increase their risk of poor quality of life. This systematic review evaluates the effectiveness of case management interventions in improving caregivers' positive mental health, psychological distress, and satisfaction with health care services. We included (cluster) randomized controlled trials that evaluated the effects of case management. Systematic searches were conducted in PubMed, Scopus, CENTRAL, and PsycINFO up to 30 June 2024. Risk of bias was assessed using the Cochrane tool (RoB 2), and multi-level meta-analyses were performed for post-intervention outcomes, while follow-up data were synthesized qualitatively due to limited long-term evidence. A total of 17 studies were included, providing multiple effect estimates for different types of outcomes, showing small positive effects of case management on mental health (analyses based on 8 studies), psychological distress (6 studies), and satisfaction with health services (9 studies). Although case management interventions show promise in supporting carers, the limited number of studies limits the strength and generalizability of the findings. Further research is needed to explore the long-term effectiveness of such interventions. Trial Registration: The review protocol was prospectively registered at PROSPERO (CRD4202453375).

Unveiling the Hidden: Successful Surgical Management of a Rare Case of Chronic Perineal Sinus Tract

Unveiling the Hidden: Successful Surgical Management of a Rare Case of Chronic Perineal Sinus Tract

Bezold's Abscess and Internal Jugular Vein Thrombosis Extending to the Sigmoid Sinus: Unusual Complications of Cholesteatoma

Bezold's abscess is a rare suppurative complication of mastoiditis arising from chronic otitis media. It is a cervical abscess that spreads from the mastoid insertions of the sternocleidomastoid and digastric muscles due to erosion of the bony cortex at the mastoid tip. Management is both medical and surgical. Since the introduction of antibiotics, the number of reported cases of Bezold's abscess has significantly decreased. We report the case of a 29-year-old patient followed for chronic cholesteatomatous otitis media who presented with an inflammatory right lateral cervical mass. Cervical CT revealed a deep cervical abscess associated with right-sided internal jugular vein and sigmoid sinus thrombosis. We describe the clinical features, diagnostic work-up, and therapeutic management of this rare case.

Detection of maladaptive pain in dogs referred for behavioral complaints: challenges and opportunities

IntroductionDiagnosing maladaptive pain in dogs with behavioral complaints is challenging, as clinical signs are often non-specific and may be absent during examination. This paper supports veterinary teams in distinguishing behavioral changes that stem from a behavioral disorder, maladaptive pain, or both.MethodsThe medical records of ten client-owned dogs referred to the authors’ behavioral practice were selected to identify challenges in recognizing maladaptive pain and to highlight diagnostic tools. A Toolbox approach was used for assessment, integrating caregiver questionnaires, medical history, home video analysis, clinical observation, and a timeline. Behavioral signs were categorized as green (adaptive) or red (maladaptive) flags to facilitate differential diagnosis and guide treatment decisions.ResultsAll dogs (n = 10) were diagnosed with altered socioemotional functioning. In 7/10 cases, the Toolbox approach indicated maladaptive pain, confirmed by medical imaging in 3/7 cases. Multimodal treatment led to recovery in 6/7 dogs. In 3/10 dogs with behavioral histories, an acute worsening of signs suggested maladaptive pain, confirmed by imaging in all cases. Treatment led to partial recovery in 2/3 dogs, while one was euthanized due to neoplasia. Diagnostic challenges fell into three categories: bias in observation, clinical examination, and interpretation of behavioral signs.ConclusionDiagnosing maladaptive pain in dogs with behavioral problems requires a comprehensive approach. Recognizing red flags, using targeted diagnostic tools, and implementing multimodal treatment strategies can improve quality of life, reduce suffering, and enhance case management.

Clinical characteristics of 6,578 adult cholera patients admitted to community and referral cholera treatment centers in Lusaka, Zambia, October 2023- April 2024

Abstract Background Zambia experienced the largest cholera outbreak in the country history in 2023-24 in the capital Lusaka. This study aimed at determining the clinical characteristics of the adult patients hospitalized at the community and referral cholera treatment centers (CTCs) to determine factors associated with their severe clinical outcomes during the outbreak. Methods Clinical information of the adult cholera patients in the community and referral CTCs were retrospectively analyzed. Clinical factors associated with the fatal outcome was explored by multivariate analysis using the Firth’s penalized logistic regression. Results A total of 6,578 adult cases were identified. The overall case fatality rate (CFR) was 1.0% (51/5,020), and it was highest in a referral CTC specialized for patients with underlying conditions (4.1%, 32/772). In the multivariate analysis, age (odds ratio; OR 1.05, 95% confidence interval; CI 1.02-1.09), human immunodeficiency virus infections (OR 5.68, 95% CI 2.12-15.30), diabetes mellitus (OR 8.21, 95% CI 1.38-34.00), and severe dehydration at admission (OR 5.97, 95% CI 1.29-56.94) were independently correlated with the fatal outcomes. Conclusions Clinical factors including the age, underlying conditions, and disease severity at admission were shown to be associated with severe clinical outcomes of adult cholera patients. Enhanced case management strategies targeted for such high-risk groups might be beneficial in reducing the CFR during cholera outbreaks.

Improving access, mixed continuity: effects of multidisciplinary teams on primary health-care in Finland – a quasi-experimental study

Objective The multidisciplinary team (MDT) approach in primary care is a relatively recent innovation, developed over the past 15 years. There is limited data on MDTs’ effects on Quadruple Aim (QA) goals. The object of this study is to evaluate the implementation of a novel MDT from 2021 to 2023 and its impact on access and continuity of care, compared to an established model. Future research will explore its effects on staff satisfaction, costs, and health outcomes. Design, setting and patients This quasi-experimental study compares five intervention health centers with three control centers. It includes all primary care patients from 2021 to 2023, presenting data on access and continuity before and after the intervention. Intervention Nurse-only consultations were replaced with a multidisciplinary nurse-physician model to address issues during initial contact more effectively. Nurses also took on the role of case managers, enhancing relational continuity. Lean daily visual management with continuous improvement, strategic goal setting, and coaching leadership style were implemented. Main outcome measures Access was measured using the ‘third available appointment’ (T3) metric, and continuity with the COC-index, both for physicians only. Results Access improved at all intervention centers, with T3 reduced from 90 to 1.125–4.75 days, while controls remained at 90 days. COC improved at three intervention centers but declined at two, with declines also observed at control centers. Conclusion The novel MDT enhanced primary care access compared to the traditional model. However, relying solely on T3 may be insufficient for evaluating effectiveness. Mixed results in continuity underscore the need for further investigation.

Adaptations for Urogynecologic Surgery in Limited-Resource Settings: How to Do More with Less.

Pelvic floor disorders affect up to 50% of women in limited-resource settings (LRS) but are severely under-treated. Historically, attention has focused on urogenital fistulae, but pelvic organ prolapse (POP) is emerging as a growing issue, especially for women engaged in manual labor. Women in these regions often endure their conditions in silence owing to social stigma and mental health impacts, compounded by health care access barriers. Delivery of urogynecological services in LRS requires adaptable surgical models and skills because of limited tools and equipment. Diagnostic treatment approaches must be tailored to the unique challenges of these settings. This article presents a practical guide to managing vesicovaginal fistulae, chronic fourth-degree tears, and POP based on limited evidence and expert experience in LRS. Key diagnostic tools, surgical techniques, and case management strategies are outlined, addressing challenges such as resource scarcity and patient follow-up in LRS. The article emphasizes the importance of precise diagnosis with limited access to diagnostic testing, adaptable surgical interventions, and postoperative care, offering sustainable solutions that maximize patient outcomes despite restrictions in equipment availability. Cases are presented to illustrate practical diagnostic and surgical approaches to urinary leakage, fecal incontinence, and POP. The article underscores the need for an adaptable care model that prioritizes cost-effective, reproducible methods while considering patients' long-term health and social well-being.

Coordinating under constraint: a qualitative study of communication and teamwork along Ethiopia’s cervical cancer care continuum

BackgroundAs Ethiopia expands cervical cancer screening services, it urgently needs information to develop appropriate post-screening diagnostic and treatment services for women with abnormal results. Quality cancer care requires extensive coordination among multidisciplinary provider teams. This study explores experiences coordinating care among providers at multiple levels of the cancer-care continuum in Ethiopia.MethodsFrom February 2020 to January 2022, we conducted four focus group discussions (FGDs) and ten key-informant interviews with 34 purposively selected healthcare providers: health extension workers (HEWs) in communities; midwives and nurses at health centers; obstetrician-gynecologists at regional hospitals, and oncology nurses, oncologists, and pathologists at tertiary hospitals. FGDs and interviews were conducted in Amharic and audio-recorded. Audio transcripts were then simultaneously transcribed and translated into English for analysis. Investigators performed thematic analysis using inductive and deductive codes.ResultsWe found four themes: resource scarcity, care centralization, lack of formal coordination mechanisms, and recommendations. Themes were dynamically connected by eight sub-themes. Providers valued teamwork and coordination. However, severe shortages of cancer specialists and high patient loads left little time for communication and hampered the formation of stable care teams. Facilities lacked formal coordination systems, such as patient navigators and case managers. The relative centralization of cancer care specialists and equipment in the capital exacerbated coordination problems. It impeded pre- and post-treatment care communication between tertiary and secondary facilities and caused secondary facilities to unnecessarily refer patients because they lacked the resources to treat them locally. Referral communication was unidirectional, with lower-level providers communicating regularly to higher-level facilities but rarely receiving feedback. The exception was regular, structured feedback from primary facilities to HEWs. Lower-level providers wanted to learn whether their referrals were appropriate or completed, and many used informal channels to gain this information. Respondents recommend decentralizing cancer care services, significantly increasing staff and equipment investments, and adding liaison staff at secondary hospitals to track and communicate patient progress and counsel patients for referral.ConclusionsOur findings underscore the need to rapidly increase cancer specialist staff and regional cancer centers in Ethiopia and highlight the importance of developing robust coordination and feedback mechanisms at secondary and tertiary facilities.