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Buttress plate fixation of coronoid process fractures via a medial approach

Chinese Journal of Traumatology 2019年第5期22卷 255-260页

作者： Kelvin Kah Ho Lor Dong Hao Toon Andy teck Huat Wee Department of Orthopaedic Surgery Khoo Teck Puat HospitalSingapore Pinnacle Orthopaedic and Sports Centre Pinnacle Orthopaedic GroupSingapore

Purpose:To assess the clinical and radiographic outcomes of coronoid process fractures surgically managed with buttress plate fixation via a medial ***:A retrospective review of all coronoid fractures surgically fixed in our institution using a buttress plate technique via a medial approach between June 2012 and April 2015 by the senior author was *** fractures were all sizeable fractures contributing to persistent elbow instability in terrible triad or varus posteromedial rotatory instability injury patterns.A prospective telephone questionnaire was conducted to assess patient outcomes using the disabilities of the arm,shoulder and hand(DASH)score and Mayo hlbow performance score(MEPS).Results:Twelve patients were included in the study,comprising 10 males and 2 females with an average age of 39 years(range,19-72 years).Mean follow-up was 16 months(range.4-18 months).The average time to radiographic union was 4 months(range.3-7 months).Range of motion measurements at final follow-up were obtained in 11 out of 12 patients,with one patient defaulting *** 11 patients displayed a functional elbow range of motion of at least 30°-130°.with an average arc of motion of 130°(range.110°-140°).mean elbow flexion of 134°(range.110°-140°)and mean flexion contracture of 3°(range.0°-20°).The mean DASH score was 16(range.2.5-43.8)and the mean MEPS was 75(range.65-100).Complications observed included one patient with a superfic ial wound infection which resolved with a course of oral antibiotics and one patient with radiographic evidence of heterotopic ossification which was conservatively *** residual elbow instability was observed and no reoperations were ***:Buttress plate fixation via a medial approach of coronoid process fractures that contribute to persistent elbow instability represents a reliable method of treatment that produces satisfactory and predictable outcomes.

关键词： Coronoid process Anteromedial facet fracture Complex elbow instability Terrible triad injury

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Lessons learned from the hospital to home community care program in Singapore and the supporting AI multiple readmissions prediction model

Health Care Science

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Health Care Science 2023年第3期2卷 153-163页

作者： John Abisheganaden Kheng Hock Lee Lian Leng Low Eugene Shum Han Leong Goh Christine Gia Lee Ang Andy Wee An Ta Steven M.Miller Department of Respiratory and Critical Care Medicine Tan Tock Seng HospitalNational Healthcare GroupSingaporeSingapore National Working Group for the hospital to Home Program SingaporeSingapore Department of Family Medicine and Continuing Care Singapore General HospitalSingHealth GroupSingaporeSingapore SingHealth Community hospitals SingHealth GroupSingaporeSingapore Population Health and Integrated Care Office SingHealth GroupSingaporeSingapore Office of Community Development Changi General HospitalSingHealth GroupSingaporeSingapore Data Analytics and AI Department Integrated Health Information SystemsSingaporeSingapore School of Computing and Information Systems Singapore Management UniversitySingaporeSingapore

In a prior practice and policy article published in Healthcare Science,we introduced the deployed application of an artificial intelligence(AI)model to predict longer‐term inpatient readmissions to guide community care interventions for patients with complex conditions in the context of Singapore's hospital to Home(H2H)program that has been operating since *** this follow on practice and policy article,we further elaborate on Singapore's H2H program and care model,and its supporting AI model for multiple readmission prediction,in the following ways:(1)by providing updates on the AI and supporting information systems,(2)by reporting on customer engagement and related service delivery outcomes including staff‐related time savings and patient benefits in terms of bed days saved,(3)by sharing lessons learned with respect to(i)analytics challenges encountered due to the high degree of heterogeneity and resulting variability of the data set associated with the population of program participants,(ii)balancing competing needs for simpler and stable predictive models versus continuing to further enhance models and add yet more predictive variables,and(iii)the complications of continuing to make model changes when the AI part of the system is highly interlinked with supporting clinical information systems,(4)by highlighting how this H2H effort supported broader Covid‐19 response efforts across Singapore's public healthcare system,and finally(5)by commenting on how the experiences and related capabilities acquired from running this H2H program and related community care model and supporting AI prediction model are expected to contribute to the next wave of Singapore's public healthcare efforts from 2023 *** the convenience of the reader,some content that introduces the H2H program and the multiple readmissions AI prediction model that previously appeared in the prior Healthcare Science publication is repeated at the beginning of this article.

关键词： hospital to home community care hospital to home lessons learned transitional care integrated care multiple readmissions AI prediction model machine learning in healthcare healthcare technology

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