Background: A coordinated care system helps provide timely access to treatment for suspected acute stroke. In Northwestern Ontario (NWO), Canada, communities are widespread with several hospitals offering various diagnostic equipment and services. Thus, resources are limited, and health care providers must often transfer patients with stroke to different hospital locations to ensure the most appropriate care access within recommended time frames. However, health care providers frequently situated temporarily (locum) in NWO or providing care remotely from other areas of Ontario may lack sufficient information and experience in the region to access care for a patient with a time-sensitive condition. Suboptimal decision-making may lead to multiple transfers before definitive stroke care is obtained, resulting in poor outcomes and additional health care system costs. Objective: We aimed to develop a tool to inform and assist NWO health care providers in determining the best transfer options for patients with stroke to provide the most efficient care access. We aimed to develop an app using a comprehensive geomapping navigation and estimation system based on machine learning algorithms. This app uses key stroke-related timelines including the last time the patient was known to be well, patient location, treatment options, and imaging availability at different health care facilities. Methods: Using historical data (2008-2020), an accurate prediction model using machine learning methods was developed and incorporated into a mobile app. These data contained parameters regarding air (Ornge) and land medical transport (3 services), which were preprocessed and cleaned. For cases in which Ornge air services and land ambulance medical transport were both involved in a patient transport process, data were merged and time intervals of the transport journey were determined. The data were distributed for training (35%), testing (35%), and validation (30%) of the prediction model. Results: In total, 70,623 records were collected in the data set from Ornge and land medical transport services to develop a prediction model. Various learning models were analyzed; all learning models perform better than the simple average of all points in predicting output variables. The decision tree model provided more accurate results than the other models. The decision tree model performed remarkably well, with the values from testing, validation, and the model within a close range. This model was used to develop the “NWO Navigate Stroke” system. The system provides accurate results and demonstrates that a mobile app can be a significant tool for health care providers navigating stroke care in NWO, potentially impacting patient care and outcomes. Conclusions: The NWO Navigate Stroke system uses a data-driven, reliable, accurate prediction model while considering all variations and is simultaneously linked to all required acute stroke management pathways and tools. It was tested using historical data, and the next step will to involve usability testing with end users.

The coronavirus pandemic highlighted the need for remote patient monitoring to deliver and provide access to patient care and education. A mobile-based app providing interactive tools for patient education and monitoring was piloted at Thunder Bay Regional Health Sciences Centre (TBRHSC) in November 2020. We aimed to examine the platform’s impact on postoperative length of stay, hospital readmissions, and emergency department (ED) visits 60 days postsurgery in total hip and knee arthroplasty patients in Northwestern Ontario. Data were assessed from patients undergoing primary total hip or knee arthroplasties at TBRHSC from March 1, 2020, to February 28, 2022. Patients were divided into 2 cohorts based on enrollment with the mobile-based app (SeamlessMD). Statistical differences in outcomes were determined using Mann-Whitney or χ² tests. An odds ratio was calculated for ED visits. Patients enrolled in the mobile-based app had statistically lower length of stay (U = 7779.0, P < .001) and fewer ED visits (χ²_(1,212) = 5.570, P = .018) than patients not enrolled in the program. Patients not enrolled had 2.31 times greater odds of visiting the ED postsurgery (odds ratio = 0.432, 95% confidence interval = 0.213-0.877, P = .022). There were no statistical differences found in readmission rates. The implementation of the mobile-based app at TBRHSC showed its potential value as a tool to reduce costs in the healthcare system and improve patient outcomes. Consequentially, more formal studies are required to elucidate the magnitude of this effect.

Case: We describe a case of a superior pole sleeve fracture of the patella in a healthy 12-year-old boy and provide a review of the literature. Patella pole sleeve fractures occur primarily in the paediatric population, with inferior pole fractures more commonly seen. Superior pole fractures are rare, which may make adequate diagnosis and treatment difficult. Conclusion: This case report aims to inform surgeons to be diligent of superior patella pole sleeve fractures and demonstrate the effective use of ultrasound imaging (as opposed to magnetic resonance imaging) in the diagnosis of the injury. Furthermore, this case report provides insight on diagnosis, treatments, and outcomes.

Background: An increasing number of total knee arthroplasties (TKAs) are performed in people with obesity, but TKAs in this population may come with increased risk of perioperative complications and decreased prosthetic survivorship. Given the lack of conclusive evidence on differences in functional outcomes, we aimed to use the Forgotten Joint Score-12 (FJS-12) to see how body mass index (BMI) affected functional outcomes after TKA. Methods: We recruited patients who underwent primary unilateral TKA because of osteoarthritic changes from January 2018 to November 2021. We collected the Forgotten Joint Score-12 (FJS-12) measure of functional outcomes and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) preoperatively and 6- and 12-months postoperatively. We also measured length of stay (LOS), readmission, and emergency department (ED) visits. We compared outcomes by BMI category using linear effects models. Results: We recruited 351 patients. No differences were found in LOS, readmissions, and ED visits by BMI category. Compared with the preoperative score, we observed significant differences by BMI category for the 6-month FJS-12 (β = −0.66, p = 0.007) and 12-month WOMAC (β = −0.34, p = 0.02) scores. At 6 months, patients with lower BMI showed a greater change in FJS-12 scores than those with higher BMI. However, by 12 months, all patients appeared to return to similar functional levels regardless of BMI. Conclusion: Despite a slower return to function, patients with elevated BMI were able to return to similar levels of function as those with a lower BMI by 12 months, with no significant differences in readmission, ED visits, or LOS. This similar return to function justifies candidacy for surgery. Contexte: Les chirurgies pour prothèse totale du genou (PTG) sont de plus en plus nombreuses chez les personnes obèses. Or, chez cette population, la PTG peut s’accompagner d’un risque accru de complications périopératoires et d’un abrègement de la durée de vie de la prothèse. Étant donné l’absence de données concluantes quant à des différences de résultats fonctionnels, nous avons voulu utiliser le « score de l’articulation oubliée » (Forgotten Joint Score-12 [FJS-12]) afin de mesurer l’impact de l’indice de masse corporelle (IMC) sur le fonctionnement post-PTG. Méthodes: Nous avons recruté des personnes ayant subi une PTG primaire unilatérale pour arthrose entre janvier 2018 et novembre 2021. Nous avons noté le score de fonctionnement FJS-12 et l’indice de gravité des symptômes de l’arthrose WOMAC (Western Ontario and McMaster University Osteoarthritis Index) avant l’intervention, puis 6 et 12 mois plus tard. Nous avons aussi mesuré les durées de séjour (DDS), les réadmissions et les consultations au service des urgences (SU). Nous avons comparé les résultats par catégorie d’IMC au moyen de modèles à effets linéaires. Résultats: Nous avons recruté 351 personnes. Nous n’avons observé aucune différence aux plans des DDS, des réadmissions et des consultations au SU selon la catégorie d’IMC. En comparaison avec les scores préopératoires, nous avons constaté des différences significatives selon la catégorie d’IMC pour le score FJS-12 à 6 mois (β = −0,66, p = 0,007) et l’indice WOMAC à 12 mois (β = −0,34, p = 0,02). Après 6 mois, les personnes dont l’IMC était moins élevé présentaient une plus grande amélioration de leurs scores FJS-12 comparativement aux personnes dont l’IMC était plus élevé. Par contre, après 12 mois, toutes les personnes semblaient avoir récupéré un niveau de fonctionnement similaire, indépendamment de l’IMC. Conclusion: Malgré une évolution plus lente, au bout de 12 mois, les personnes ayant un IMC élevé ont pu retrouver un niveau similaire de fonctionnement comparativement aux personnes dont l’IMC était plus bas, sans différences significatives aux plans des réadmissions, des consultations au SU, ou des DDS. Cette amélioration similaire du fonctionnement est un argument en faveur de l’intervention chez cette population.

Background: Patients with knee osteoarthritis (OA) in northwestern Ontario are referred by their primary care provider (PCP) to a centralized assessment clinic for evaluation by an advanced practice physiotherapist (APP) to determine if they will require surgical management. However, many patients are found to not require surgical management, resulting in delays for patients who do. A decision-support tool was developed to address this issue and to guide treatment options by determining the need for surgical or nonsurgical approaches. Methods: We used a proof-of-concept method to assess the use of the decision-support tool in northwestern Ontario. Data from 100 consecutive patients assessed for knee OA management were collected from the Thunder Bay centralized assessment clinic. Two levels of agreement analyses (calculated using Cohen κ statistic) were performed, between the APP assessment decision (surgical or non-surgical) and the decision-support tool recommendation, and between the surgeon’s decision (surgical or non-surgical) and the decision-support tool recommendation. Results: We found a near-perfect agreement (κ = 0.870, n = 65) between the APP decision and the decision-support tool recommendation, when controlled for patient preference. There was a substantial level of agreement (κ = 0.618, n = 72) between the decision-support tool recommendation and the surgeon’s decision. Conclusion: The decision-support tool recommendation showed considerable agreement with the decisions of the APP and surgeon indicating that it could be a valuable tool to guide PCPs caring for patients with knee OA. The applicability of a decision-support tool in northwestern Ontario displayed promising results, but further research is needed to examine the feasibility in a primary care setting.

It is well-known that immune checkpoint inhibitors (ICIs) can lead to uncommon but potentially life-threatening immune-related adverse events (irAEs) such as checkpoint-inhibitor pneumonitis (CIP). Early recognition, identification, and treatment are crucial with regard to decreasing toxicity from ICIs. However, there is a discrepancy in the incidence rates between the clinical trials and postmarketing studies. Several postmarketing studies have developed early detection methods and identified new risk factors in developing CIP. Thus, in this narrative review, we aim to review these incidence rates, early detection methods, and clinical risk factors for CIP in NSCLC patients, which could help to improve CIP diagnosis and management for enhanced NSCLC care. Major clinical trials and postmarketing studies of CIP incidence, early detection methods, and risk factors in NSCLC were reviewed. A wide array of potential risk factors has been implicated in the development of CIP in NSCLC, such as having preexisting interstitial lung disease, receiving PD-1 inhibitors, receiving combination ICI therapy instead of ICI monotherapy, lower pretreatment hemoglobin and albumin levels, increased baseline plasma IL-8 levels, and impaired baseline pulmonary function.