Machine learning in primary care: potential to improve public health.

It is estimated that missed opportunities for diagnosis occur in 1 in 20 primary care appointments. This is not only detrimental to individual patients, but also to the healthcare system as health outcomes are affected and healthcare expenditure inevitably increases. There are many potential solutions to limit the number of missed opportunities for diagnosis and management, one of which is through the use of artificial intelligence. Artificial intelligence and machine learning research and capabilities have exponentially grown in the past decades, with their applications in medicine showing great promise. As such, this review aims to discuss the possible uses of machine learning in primary care to maximise the quality of care provided.

Ligamentous constraint of the first carpometacarpal joint.

To examine the role of the ligaments in maintaining stability of the first carpometacarpal (CMC) joint, a sequential ligament sectioning study of sixteen specimens was performed. While a small compressive force was maintained, loads were applied to displace each specimen in four directions - volar, dorsal, radial, and ulnar. Translations of the specimen in both dorsal-volar and radial-ulnar axes were measured. Initially, the tests were conducted with the specimen intact. These tests were then repeated following sectioning of the CMC anterior oblique ligament (AOL), ulnar collateral ligament (UCL), intermetacarpal ligament (IML) and dorsal radial ligament (DRL). The first CMC joint translation was increased in the absence of IML and DRL (p < 0.05). Both IML and DRL were important in constraining the first CMC joint translation against external applied loads. Potential applications of these findings include the treatment of joint hypermobility and the reduction or delay of onset or progression of first CMC joint osteoarthritis.

Pelvic actinomycosis presenting as a single episode of postmenopausal bleeding in a 60-year-old woman whose intrauterine contraceptive device had been removed 10 years previously: A case report.

Actinomycosis is a rare opportunistic infection caused by Actinomyces bacteria entering tissue through a disruption in the normal mucosal barrier and spreading in a slow, progressive manner. Patients often present with mass lesions and abscesses which mimic malignancy. We present the case of a 60-year-old postmenopausal woman who presented with a single episode of spotting with no other symptoms. On hysteroscopic examination no abnormalities were found and Actinomyces spp. were cultured from an endometrial biopsy. The patient had last used an intrauterine contraceptive device (IUCD) 10 years previously; it had been removed at menopause. This is a rare presentation that highlights that pelvic actinomycosis can be precipitated by factors other than IUCD use. Biopsy is important, as ultrasound is not diagnostic.

Ehlers-Danlos Syndrome in Pregnancy: A Review.

Ehlers-Danlos syndrome (EDS) is a group of connective tissue disorders that can result in a range of complications during pregnancy. Pregnant EDS patients generally have a favourable outcome, but those with vascular EDS are more likely to suffer from severe maternal complications. Early diagnosis of EDS and subtype characterization can aid in pre-pregnancy counselling, planning of antenatal care, risk assessment of obstetric and neonatal complications, and influence both obstetric and anaesthetic management of these patients. This piece aims to outline the obstetric implications of classical, hypermobile, and vascular EDS, and review the current literature regarding their optimal obstetric management.