Case Management Research Articles

Microbiology Test Results for White Edible Birds Nest with Fecal Contamination

Background: Southeast Asia's edible bird nest industry, particularly in Indonesia, has experienced rapid growth in recent years. Indonesia stands as the world's leading exporter of edible bird nests. However, concerns persist regarding the quality of edible bird nests produced in the country, specifically to do with meeting quality standards by ensuring freedom from microbial contaminants that can lead to foodborne illnesses. Purpose: To evaluate the microbiological contamination of cleaned edible bird nests sourced from Java Island, Indonesia. Cases(s): Yellow-brown discoloration of edible bird nests collected from bird houses of Javan origin. Case Management: Fifty samples of raw white edible bird’s nest samples (cup-shaped) with yellow-brown discoloration (n=25) originating from Java Island and raw white edible bird’s nest samples (cup-shaped) (n=25) were collected aseptically from the edible bird’s nest warehouses in Surabaya. These samples of edible nests from Java Island were subjected to microbiological analysis. The findings revealed a disconcerting trend, with 25 samples from Java Island exhibiting contamination by Escherichia coli (40%) and coliform bacteria (100%), surpassing established contamination thresholds. Conclusion: This raises critical concerns about the safety and quality of edible bird nests from the region, highlighting the need for enhanced production and processing practices, as well as rigorous quality control measures to ensure consumer safety and to maintain the industry's reputation on a global scale. Addressing these issues is imperative not only to safeguard public health but also to sustain and further develop the lucrative edible bird nest industry in Indonesia.

SACROCOCCYGEALTERATOMA

INTRODUCTION Sacrococcygeal teratomas are the most common of all the GCTs in pediatric age group that originate from the totipotent cells from Hansen\\\'s node or primitive germ cells.(1) incidence is approximately 1 in 40,000 live births with a male to female ratio of 1:3–1:4.Huge and highly vascular SCTs,may result in massive hemorrhagic complications. CASE REPORT A 5 day old male baby delivered via LSCS at 36 WOG was admitted to NICU due to large sacrococcygeal teratoma (20X15cms). The neonate had no other congenital abnormality. Total weight of neonate was 2.7kgs of which tumor was approximately 700gm. Ct Abdomen and pelvis Revealed Type 2 Mature sacrococcygeal teratoma with intrapelvic and large extrapelvic component with Spina bifida occulta and surgical removal of tumour was performed DISCUSSION: Sacrococcygeal tumors can be diagnosed antinatally,the cases with antenatal diagnosis are at a high risk of perinatal complications and fetal death from high output cardiac failure. Early surgical Management in above case and Good postoperative care, minimal blood loss during procedure resulted in Good outcome (2) CONCLUSION Mature sacrococcygeal teratoma appear to be benign in nature and complete surgical resection is main stay of treatment REFERENCES 1)Yadav DK, Acharya SK, Bagga D, Jain V, Dhua A, Goel P. Sacrococcygeal Teratoma: Clinical Characteristics, Management, and Long-term Outcomes in a Prospective Study from a Tertiary Care Center. J Indian Assoc Pediatr Surg. 2020 Jan-Feb;25(1):15-21. 2) Shrestha HK, Shrestha RG. Sacrococcygeal Teratoma: A Case Report. JNMA J Nepal Med Assoc. 2020 Jul 31;58(227):508-511

The Role of Artificial Intelligence (AI) and machine learning in social work practice

The integration of Artificial Intelligence (AI) and Machine Learning (ML) into social work practice is transforming the landscape of service delivery and decision-making. This paper explores how these technologies enhance case management, predictive analytics, and resource allocation in critical areas such as child welfare, mental health, and substance abuse treatment. Key trends highlighted include the use of AI-based predictive analytics to identify at-risk populations and facilitate early interventions, as well as the deployment of chatbots and virtual assistants for providing accessible mental health counselling and social support. Furthermore, the paper addresses ethical considerations and challenges associated with AI implementation, particularly the potential biases in algorithms that may affect the assessment of social needs. Additionally, the integration of AI tools into social work education and training is examined to prepare future professionals for a technology-driven environment. By analysing the current applications of Natural Language Processing (NLP) for client data analysis, AI-powered software for predictive risk assessments, and automated case management systems, this paper advocates for a balanced approach to AI adoption, ensuring that the core values of social work, such as equity and social justice, remain central to practice. Ultimately, this exploration underscores the potential of AI and ML to enhance social work outcomes while also emphasizing the necessity of ethical frameworks and ongoing training for practitioners.

Massed treatment of posttraumatic stress disorder, traumatic brain injury, and co-occurring conditions: the Home Base intensive outpatient program for military veterans and service members.

The two-week Home Base Intensive Clinical Program (ICP) provides treatment to veterans and active duty service members suffering from primary diagnoses of posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), anxiety, or depression. First launched in 2015, this paper provides a programmatic update, including new treatment components implemented since inception, and examines outcomes for all participants who entered the program from September 2015 to July 2024 (n = 2561). The Home Base ICP provides a massed care approach through daily individual Prolonged Exposure, Cognitive Processing Therapy, Unified Protocol, or cognitive rehabilitation, along with groups targeting coping skills. Participants entering the program are provided with core group programming, as well as individualized therapy sessions tailored to their unique needs and symptom presentation. Supplemental dual recovery support is also available for all participants with co-occurring substance use or behavioral addiction concerns. Participants' support people receive education, support, and case management services. Participants have a multidisciplinary team comprising therapists, psychopharmacology providers, case managers, nurses, and wellness providers. Results demonstrate that program participants exhibited statistically significant reductions in PTSD symptoms (Cohen's d = 0.80), depression (d = 0.68), post-concussion symptoms (d = 0.71), and increased satisfaction in social roles (d = -0.65). Completion rate was 94.60% (n = 2422), suggesting that the Home Base ICP is a well-received and effective model of care for veterans and service members.

Community-Associated MRSA—Not So Innocent Sibling per Se: A Case Report

Background: Methicillin-resistant S. aureus (MRSA) is a major healthcare burden and is classified as healthcare-associated (HA-MRSA) and community-associated (CA-MRSA). While HA-MRSA is clinically feared, CA-MRSA is often considered less pathogenic. This case report highlights the serious course of illness due to CA-MRSA infection and provides a treatment strategy for the management of such cases. Case description: A 41-year-old male presented with fever and breathlessness for five days. Upon admission, he was provided empirical treatment for atypical infections and vasopressor support for hypotension. His condition deteriorated, necessitating ventilator support. Although the initial tracheal Bio Fire test indicated MRSA, his clinical manifestations did not match MRSA pneumonia symptoms; however, CA-MRSA was confirmed within 12 h. Skin legions developed within 16 h and progressed gradually from ecchymosis, petechial, and palpable purpura to bullous lesions over 72 h. The antibiotic regimen was modified and optimized with the addition of Clindamycin, Vancomycin, and Meropenem–Colistin. Owing to high IL-6 levels, dual vasopressor support, and acute kidney failure, he was started on early (within 12 h) continuous renal replacement therapy (CRRT) with CytoSorb filter (for 3 days) for cytokine removal. IL-6 levels decreased after two days of CytoSorb use. Subsequently, the patient stabilized with reduced dependence on vasopressor and ventilator assistance. Discussion: Early diagnosis of CA-MRSA and management with CRRT using CytoSorb may help improve patient outcomes. To our knowledge, this is the first report of clinical management of CA-MRSA with CytoSorb therapy in India that resulted in positive outcomes.

Meningioma En Plaque associated with Cerebrospinal Fluid Rhinorrhea: A Systematic Review of Literature with Case Presentation

BackgroundMeningiomas are the most frequently diagnosed benign intracranial tumors. However, meningioma en plaque (MEP) is a rare subset accounting for 2.5% of all meningiomas and is characterized by flat, carpet-like proliferation along the dura, typically arising in the spheno-orbital region; therefore, causes proptosis, decreased visual acuity, and orbital pain. We present a unique case of MEP presenting with cerebrospinal fluid (CSF) rhinorrhea and conduct a systematic review of literature. MethodsFollowing PRISMA guidelines, a systematic search was conducted in PubMed and Embase databases. Keywords and standardized index terms related to MEP were used. The search was performed without restriction on the publication date. Screening, data extraction, and quality assessment were carried out. Data on demographics, clinical presentations, management modalities, and treatment outcomes were analyzed. ResultsThe search yielded 487 titles, with 36 studies eligible for inclusion. A total of 530 patients with MEP were reported, with a mean age of 50.1±11.62 years. Proptosis was the most common symptom (95%), followed by visual impairment (57.3%), orbital pain (38.3%), ophthalmoplegia (28.6%), and headache (23%). Our patient represented the only case with a spontaneous CSF leak. Surgical resection was performed in 85%, adjuvant radiotherapy in 15.7%, and one patient received primary radiotherapy, while 8 patients were closely followed up with no intervention. ConclusionMEP associated with spontaneous CSF rhinorrhea is extremely rare and poses diagnostic and therapeutic challenges. Conservative management for select cases of MEP can be a good choice, refraining the patient from surgical complications, especially for difficult-access skull base areas.

Lessons learned from implementing a digital rehabilitation care planning platform to improve care access for patients with work disability: qualitative process evaluation of the RehaPro-SERVE study

BackgroundInpatient rehabilitation therapies can be applied for in Germany by patients of working age to support their return to work. However, there are some problems that impede an easy and uncomplicated application process. An interdisciplinary case management approach for rehabilitation care planning was developed to facilitate the access to rehabilitation. Case conferences (CCs) were held with relevant stakeholders and took place on a digital communication platform. We conducted a qualitative process evaluation to understand the implementation of the intervention and to identify contextual factors as well as mechanisms for a successful implementation in the context of primary care.MethodsThe process evaluation included interviews with primary care physicians (PCPs), patients and stakeholders involved in the intervention process. Reflexive thematic analysis was used to analyse the data. Emerging themes were structured according to the Donabedian framework of structure, process and outcomes.ResultsA total of 18 interviews were conducted. Important results included the desire for more patient involvement and case management. Patients especially valued the opportunity to receive support from a social worker. Limitations of the platform related to usability and limited opportunities for stakeholder communication. Despite training for PCPs, several problems arose regarding the clarity of the intervention process. Patients were satisfied with their application process and the treatments offered, while PCPs reported an increase in workload.ConclusionsA digitalisation of the application procedure for rehabilitation and further treatment options is acceptable to patients and personal support of a social worker is particularly valued. However, patients should be included in the CC in terms of a shared decision-making process. The digital platform requires sufficient training and adjustments have to be made to enhance usability and to improve the efficiency of the process for PCPs. Overall, the exchange between the various stakeholders in the CC is considered particularly useful in more complex cases.Trial registrationDRKS German Clinical Trials Register, DRKS0 00242 07. Registered on 22 March 2021.

Digital rehabilitation care planning for people with chronic diseases (RehaPro-SERVE): study protocol for a German multicentre randomised controlled trial

BackgroundChronic diseases are a significant and growing problem of our time. They impair the ability to work and increase the risk of early retirement. To support the return to work, rehabilitation services can be applied for in Germany. Currently, the application system for rehabilitation allows only a limited degree of individualisation of the treatment and is associated with a lack of multidisciplinary communication. To facilitate rehabilitation care planning, we developed a complex intervention. A digital, platform-based case management approach (intervention) will ensure multidisciplinary communication and the tailored selection of medical treatments and/or non-medical support measures. The overall objective is to assess the effectiveness of the intervention compared to treatment as usual (control condition). The German Federal Ministry of Labour and Social Affairs (BMAS) funds the RehaPro-SERVE study (grant number: 661R0053K1).MethodsThis is the protocol for an investigator-initiated, pragmatic, multicentre, randomised and controlled two-arm parallel-group superiority trial with embedded qualitative process evaluation. The study will be conducted in Hesse state, Germany. N = 59 primary care physicians will be recruited and tasked with the recruitment of six eligible patients each. Eligibility criteria: age 40–60; minimum of 4-week work disability due to musculoskeletal, oncologic or psychological conditions or the post-COVID-19 syndrome within the last 6 months; at high risk for early retirement. In total, n = 352 patients will be randomised with a 1:1 allocation to intervention or control group and stratified by primary care practice using permuted blocks. The primary outcome is the number of days of sick leave during a 12-month period after the assumed completion of treatments (t1 to t2). Secondary outcomes include the number of days of sick leave (self-report), work ability, and health-related quality of life, as well as data from the qualitative process evaluation.DiscussionThe results of the study will inform the design of future care services and provide valuable information on multidisciplinary case management in the context of rehabilitation care planning. The results of the qualitative process evaluation will further contribute to the understanding of facilitating and hindering factors.Trial registrationDRKS-German Clinical Trials Register, DRKS0 00242 07. Registered on 22 March 2021.

Clinical Management and Pathophysiology of Infective Endocarditis: An Updated Review of Diagnostic Challenges and Therapeutic Approaches

Infective endocarditis (IE) is a severe and life-threatening condition characterized by infection of the endocardial surface of the heart, primarily affecting the heart valves. Despite advances in diagnostic techniques and antimicrobial therapies, IE remains associated with significant morbidity and mortality due to its complex pathogenesis and clinical variability. This article reviews the most recent developments in the pathophysiology, diagnostic criteria, and management strategies of infective endocarditis. Key issues such as microbial etiology, including common pathogens like Staphylococcus aureus and Streptococcus species, are discussed alongside less frequent organisms and their association with specific patient populations. The article emphasizes the importance of early diagnosis using advanced imaging modalities, such as echocardiography and PET-CT, and laboratory findings, particularly blood cultures. We explore both medical and surgical management strategies, highlighting the role of antibiotic therapy and the indications for valve surgery. A focus is given to the management of complex cases, including prosthetic valve endocarditis and infections in immunocompromised patients. The article aims to provide clinicians with a comprehensive understanding of the evolving landscape of infective endocarditis and its implications for patient outcomes.

A case study of consecutive pregnancies in a woman with liver cirrhosis and portal hypertension

Pregnancy in women with liver cirrhosis is a high-risk one that requires multidisciplinary care. Variceal bleeding occurs in up to half of women having associated portal hypertension and confers the greatest risk. Despite advances made in the management of such cases, maternal morbidity remains high. Pregnancy is rare in women with liver cirrhosis due to reduced natural fertility rates. We report a case of two consecutive pregnancies in a woman with liver cirrhosis. A 29-year-old primipara with hepatitis B-related liver cirrhosis with portal hypertension who had been on tenofovir for the past seven years. The first pregnancy was spontaneously conceived but the second was by assisted conception. Both pregnancies were complicated by recurrent episodes of variceal bleeding that necessitated multiple endoscopic variceal band ligation (EVBL) during pregnancy. Medical advancement has enabled women with cirrhosis to have more pregnancies with reduced maternal and perinatal morbidities. Multidisciplinary management is vital to achieving favourable pregnancy outcomes.

Effect of the second and third COVID-19 pandemic waves on routine outpatient malaria indicators and case management practices in Uganda: an interrupted time series analysis

BackgroundReports on the impact of COVID-19 pandemic on the quality of malaria care and burden in sub Saharan Africa have provided a mixed picture to date. The impact of the 2nd (Delta) and 3rd (Omicron) COVID-19 waves on outpatient malaria indicators and case management practices was assessed at three public health facilities with varying malaria transmission intensities in Uganda.MethodsIndividual level data from all patients presenting to the out-patient departments (OPD) of the three facilities (Kasambya, Walukuba and Lumino) between January 2019 and February 2022 were included in the analysis. Outcomes of interest included total number of outpatient (OPD) visits, proportion of patients suspected to have malaria, proportion of suspected malaria cases tested with a malaria diagnostic test, test positivity rates (TPR) and proportion of malaria cases prescribed artemether-lumefantrine (AL). Using the pre-COVID-19 trends between January 2019 and February 2020, interrupted time series analysis was used to predict the expected trends for these study outcomes during the 2nd wave (May 2021–August 2021) and 3rd wave (November 2021–February 2022). The observed trends of the study outcomes were compared with the expected trends.ResultsThere were no significant differences between the observed versus expected overall outpatient visits in the 2nd wave, however, a significant decline in OPD attendance was observed during the 3rd wave (15,101 vs 31,154; incidence rate ratio (IRR) = 0.48 [0.41–0.56]). No significant differences in the overall observed versus expected proportions of suspected malaria cases and test positivity rates in both COVID waves. However, a significant decrease in the overall proportion of suspected malaria cases tested with a malaria diagnostic test was observed during the 3rd wave (99.86% vs 99.99%; relative percent ratio [RPR] = 0.99 [0.99–0.99]). Finally, a significant decline in the overall proportion of malaria cases prescribed AL was observed during the 2nd wave (94.99% vs 99.85%; RPR = 0.95 [0.92–0.98]) but not the 3rd wave.ConclusionSignificant declines in OPD attendance and suspected malaria cases tested with malaria diagnostic test were observed during the 3rd COVID-19 wave, while AL prescription significantly reduced during the 2nd COVID-19 wave. These findings add to the body of knowledge highlighting the adverse impact of COVID-19 pandemic on the malaria which could explain the increase in the malaria burden observed during this period.

Promoting student success and retention through care teams and case management at small institutions

AbstractCare teams, an important structure at most institutions of higher education, coordinate the work of various units to intervene with students who are at risk of attrition, academic failure, and/or are experiencing socio‐emotional struggles. The authors provide various examples of how case management and Care Teamwork is structured in the small institution setting. Using their institutions as case studies, the authors provide examples of various collaborative structures that coordinate case management and support at‐risk students; and situate this work in the small institution setting, with particular attention to the expectations that these institutions and students’ families have for high touch student success efforts; and discuss ways in which technology supports and contributes to case management and Care Team work.

Primary health care models for refugees and the involvement of nurses: A systematic review

Abstract Background Primary health care is key to address the health and social needs of refugees. Nurses are often part of multidisciplinary teams in primary health care, but little is known about their roles and responsibilities in refugee health. Our systematic review aimed to synthesise the existing knowledge about models of care (MoC) for refugees in primary care settings and the involvement of nurses in these models. Methods We searched PubMed, CINAHL and Web of Science for literature published in English, Spanish, French and German. For grey literature, we additionally searched Google Search and Scholar, Microsoft Bing and DuckDuckGo. Eligible publications reported on MoC for refugees in a primary care setting and the involvement of nurses. We extracted and synthesised information about the structure of these models as well as the roles and responsibilities of nurses within these. Results 112 publications met our inclusion criteria. Our narrative synthesis focuses on 61 publications with in-depth insights into existing MoC and nurse involvement. We identified 45 MoC, mainly originating from high-income-countries and with almost a third from Australia. The majority of MoC set up a parallel health care structure that refugees could access for a limited period of time. In most MoC, the role of the nurse is described with a relatively high degree of autonomy and with clear areas of responsibility. Clinical and administrative tasks are only part of the nurse’s role, while educational and coordinating activities are often equally important. Conclusions Despite the significant number of refugees in European countries we identified only few reports on MoC specifically addressing their needs. While parallel care structures may be an appropriate approach for a short period of time, integration of refugees into the regular health system is key. Specially trained nurses are well placed to support refugees through a range of measures, including health education and case management. Key messages • Models of Care for refugees could help to navigate within a new healthcare system and ensure that no one is left behind. However, development of and research on such structures are still scarce. • Specially trained nurses are well placed to care for refugees and to support their integration into regular health systems through a range of measures, including health education and case management.

A Framework for Bariatric Surgery Patient Care: Patient and Professional Perceptions

Abstract Introduction A multidisciplinary health team for perioperative care of the bariatric patient, sustained in a viable framework to support a long-term follow-up service, may decrease rates of complications, help the recognition of the complexity of this chronic disease, and provide a comprehensive bariatric surgery process analysis. This study aimed to analyze patients’ and professionals’ experiences with the perioperative care process and identify their perceptions of the bariatric surgery process to support the long-term management of obesity surgical treatment. Methods This qualitative study was conducted in a bariatric surgery center in south Portugal. Seven health professionals participated in one focus group, and sixteen patients participated in one of the three focus groups. Patients’ focus group script had eleven open main questions with follow-up questions to probe for more information, addressing motivations, experiences with the pre-surgery and post-surgery process, and perceptions of lifestyle changes. Results Participants reported the need for a reference professional in the hospital to contact, the importance of psychological support to help patients deal with the ‘ups and downs’ of post-surgery life, and the financial support for physical activity programs. Conclusions This research helped identify a need for a framework for long-term follow-up and showed priorities to tailor health services for managing bariatric surgery patients. New bariatric surgery programs should incorporate a diverse health team, focusing on patient support in the long-term follow-up. This team should be led by a dedicated case manager and include physical activity specialists. Key messages • The positive effects of bariatric surgery go beyond weight loss, reinforcing the importance of developing a new conceptual framework based on a patient-centered care model. • A case manager specialist on the bariatric surgery process may be the key to improving the long-term benefits of bariatric surgery.

Community mental health care in Croatia: Mobile team for psychosocial support in the community

Abstract The Republic of Croatia has initiated numerous reforms in the mental health care system in the community. Within the framework of EU JA Implement, a mobile team was formed to provide interventions in the community, that is, in the homes of persons discharged from psychiatric hospitals. The mobile team was formed during 2023. The team includes: one psychiatrist, leader and coordinator of the mobile team, three graduate nurses, a case manager, a social worker, three experienced experts who are employed in the team as peer workers, and one social pedagogue and psychologist. The wider composition of the team includes a psychiatrist who provides outpatient psychiatric treatment, who is familiar with the individual recovery plan and, if necessary, participates in the development of the plan. The goal of establishing a mobile team is to implement an individual recovery plan in the community, that is, in the patient’s home, using biopsychosocial interventions, with the aim of better and faster recovery of the user and inclusion in the community, as well as prevention of rehospitalization and disability. Before the patients home visits, the experts in the team were trained. 15 patients were included in the pilot project, with whom 96 home visits or interventions were carried out in the time period from the establishment of the team to April 2024. As a result of the effectiveness of the pilot project, in 2024, in accordance with the Strategic Framework for the Development of Mental Health until 2030, the Republic of Croatia adopted a new network of health institutions, within which 30 mobile psychiatric teams and 24 psychological teams at the primary level of health care are planned. Empowerment of users, engagement of people with experience in the implementation of interventions, increase in mental health literacy of the population and destigmatization are additional results of the implementation of mental health protection in the community through JA impleMENTAL.

Verification about the usefulness of early cardiac rehabilitation initiation in patients with congestive heart failure requiring hospitalization

Abstract Background It is a well-known fact that for patients with decompensated congestive heart failure (CHF) who require hospitalization, starting cardiac rehabilitation (CR) early after hospitalization has a positive impact on their clinical course. To maintain their activity and nutritional status through the early mobilization by efficient medical care, we have introduced our own clinical pathway(PATH) for CHF since August 2015. In PATH, the initiation of CR early after admission was stipulated. With PATH introduction, starting time of CR was significantly earlier and the average hospitalization period for CHF cases was also significantly reduced. However, there are still some cases applied PATH who are unable to start CR early after admission for various reasons. Purpose We examined whether the clinical course after admission differs depending on the timing of CR initiation even in CHF cases applied PATH. Methods We enrolled 933 patients admitted with CHF for the first time from August 2015 to July 2023, applied PATH, started physical therapy (PT) as CR, and discharged alive. We divided them into two groups based on when they started PT, Early-group (649 cases: Starting time is within the 3rd hospital day) and the Late-group (284 cases: Starting time is after the 4th hospital day). And we investigated patient background, clinical data at admission, and clinical course after admission for all cases, and examined the differences in each item between the two groups. Results There were no differences in patient characteristics or clinical data at admission between the two groups (Table 1). On the other hand, although there was no difference in the performance rate of each acute treatment between the two groups, the performance duration of each treatment in cases introduced was significantly shorter in Early-group. Furthermore, the average meal (side dish) intake rate on the 2nd to 4th hospital days after admission was significantly higher in Early-group, and the average length of hospitalization was significantly shorter in the Early-group (Figure 1). Conclusions For 8 years, we have strived to begin cardiac rehabilitation interventions early after hospitalization with introduction of our own clinical pathway. However, we found that even with the introduction of the clinical pathway, cardiac rehabilitation was started on or after the 4th hospital day in 30% of all cases. And we found that in these cases, each treatment during the acute phase was prolonged, nutritional intake was inadequate, and the length of hospitalization tended to be prolonged. The delay in initiation of rehabilitation was thought to be related to factors such as the timing of hospitalization (admission on holidays or public holidays) or the location of hospital management (ICU management in severe cases). It seemed necessary to create a system that would allow cardiac rehabilitation to be started flexibly even in such situations.Table1Figure 1

Whooping cough – a recurrent epidemic

Abstract Background Whooping cough (WC), or Pertussis, is a vaccine-preventable and highly contagious infectious disease. Although it has a relatively low fatality rate, approximately 13% of reported cases develop secondary bacterial pneumonia. This was because of several recurrent epidemics across Europe in the last decades, with the latest beginning in mid-2023 and still ongoing. The Central Region of Portugal is currently being affected, and this study aims to describe the current epidemic at the regional level. Methods Data from epidemiological inquiries of confirmed and probable cases of WC pertaining to the Central Region of Portugal from January 2020 till April 2024 was gathered from the mandatory report national epidemiological surveillance system (SINAVE). Both a temporal comparison of number of cases and a statistical space-time scan with permutation were conducted (software SaTScan v10.) Results A comparison by month of reported cases shows an increase in cases from September 2023 until December 2023 followed by an exponential increase from January 2024 until April 2024 denoting an ongoing epidemic. In the statistical space-time analysis of 107 reported cases between September 2023 and April 2024, 8 nonsignificant clusters were identified with different locations involved in non-overlapping periods. Conclusions The finding of several unrelated clusters, even though nonsignificant, during a short time period indicates that Pertussis transmission is ongoing at the local level probably through asymptomatic or barely symptomatic cases that act as reservoirs. Clinicians must hold a high clinical suspicion for a timely diagnosis, treatment and report and health authorities must reinforce control measures to limit the spread of this disease. Key messages • Pertussis remains a disease of significant concern recurrent outbreaks across Europe show that public health local authorities have an important role in timely management of cases and outbreaks. • Local level transmission and intervention may play a pivotal role in the epidemiologic dynamic of Pertussis.

Factors influencing an advanced nursing practice service for people with intellectual disabilities

Abstract Background People with intellectual disabilities (PWID) have less access to preventive healthcare services and are therefore more likely to suffer from certain chronic diseases. Advanced Practice Nursing (APN) can be a suitable approach for this group. However, APN is not yet widespread in all European countries. This intervention focuses on PWID in Hamburg, Germany, who receive case management and prevention focusing on stress, nutrition, mobility and addiction through community-based APN to improve their health status. We aimed to explore the facilitators, barriers and experiences of stakeholders in the context of the APN intervention. Methods We conducted 90 semi-structured problem-centered interviews with PWID, family members, professional caregivers and prevention service providers in 2023 and 2024. We employed convenience sampling. Data were analyzed by qualitative content analysis with mixed inductive-deductive coding using MAXQDA. Results Overall interviewees were satisfied with the intervention. It was reported that the clients exercised more, ate healthier, learned techniques to reduce stress and coped better with addiction. In addition, barriers to preventive services were reduced. We identified factors that positively influenced the success of the intervention: good interprofessional collaboration, successful relationship building with clients, concise goal setting and target group-specific work materials. Barriers were: neglect of the professional care network, difussion of agreements, lack of available prevention services, and communication problems. The results are preliminary. Conclusions This is one of the first evaluation studies of an APN intervention for PWID in Germany. The results show that this new form of care can be implemented if the relevant stakeholders work together and good relationships with the clients are established. Specific goals should be defined and the professional carergivers should develop a community network. Key messages • APN is a suitable approach for disease prevention and health promotion for people with intellectual disabilities, given interprofessional collaboration and a well-established relationship with clients. • Preventive healthcare for the target group is difficult to implement if the stakeholders do not work together and if there are insufficient suitable preventive services available in the community.

The New Healthcare: AI-Driven Population Stratification, Proactive Medicine, and Predictive Analysis

Abstract Background The Covid-19 pandemic has highlighted structural and functional weakness of local health services. Italy carried out its reorganization with DM 77/2022, financed by Mission 6 PNRR of the CE. The model adopted aims to move from a reactive to proactive medicine, to be implemented close to the places where citizens live. The priority objective is to know data on the progress of chronic pathologies and non self-sufficiency using advanced digitalization tools. Methods 14 types of administrative data from 2022 to 2023, concerning 180000 (ISTAT data) people in the Lecce Social Health District (DSS Lecce), were analyzed with AI (Chat GPT). Results Thanks to algorithms, 6 categories of clinical complexity were identified. The analysis showed that the population assisted is 198696, for temporary presences, with the most represented age group being 50-55 years. Births decreased by 36% in 10 years (from 1681 to 1076), with 2197 deaths in 2023. 42,38% of the population (average age 38,58 years) did not use healthcare resources, while 57,62% (average age 54,19 years) required them. 48646 patients have cardiovascular disease, but only 10% with heart failure were actively monitored. 25047 have metabolic disease, 11195 are diabetics, 5929 have chronic respiratory diseases, 8167 chronic neurological diseases and 907 are cancer patients. Increasing age leads to polymorbidity and show signs of social, economic and health fragility. Conclusions the strategic objective of the Lecce DSS was management of chronicity according to specific care pathways, PDTA. Create healthcare teams capable of being case managers depending on the level of complexity (family doctors, nurses, etc). With the 2024 data there will be 3 consecutive years of analysis which will allow the development of predictive systems to identify population clusters at risk of increasing complexity and in need of proactive medical interventions, use of telemedicine with the support of a Territorial Operations Center. Key messages • AI-driven stratification supports personalized health plans to improve healthcare delivery, patient outcomes, and optimize resource allocation. • A new model of Population Health Management supported by Artificial Intelligence.

Inclusive Life Projects for people with Serious Mental Disorder and/or addictions

Abstract Project “Inclusive Life Projects” offers comprehensive and community care to people with SMD/A within projects of autonomous living, which provide a concrete and real response to their needs, with the ultimate objective of avoiding the risk of institutionalization. Currently, 26 actions have been designed and are being implemented within JA ImpleMENTAL pilot in five municipalities in the Region of Murcia: Caravaca, Cartagena, Lorca. Molina de Segura and Yecla with a participation of 50 people with SMD/A. The following elements are selected from the Belgian good practice: • Creation of local intersectoral networks promoting person-centered care process; • Personalization of care through the Individualized Care Plan, responding to the needs, and desires of people with SMI/A, activating the appropriate support; • Professional case manager. It generates the well-being of people on an empathy and trust basis and articulates coordination so that the agreed Plan can be developed as planned. A strategic and support coordination tool for action and facilitation of institutional support, the Social and Health Coordination Protocol for people with SMI/A, has been developed. The protocol facilitates the creation of coordination structures, among them the Socio-Health Coordination Base Teams stand out, teams made up of professionals from the different agents involved, multi-professional and intersectoral, (Mental Health, Primary Health Care, Social Services, Social Initiative) taking into account the needs of the person. It also serves to share information, detect training needs, influence resources, etc. PETRA, a computer platform, has been developed for sharing information between the systems involved, especially the health system and the social services system, both primary care, hospital care and specialized care. It allows the exchange of information, in real time, between professionals, the planning of actions, and the design of indicators and control and evaluation processes.