Consultation Team Research Articles

Places to belong : Practical considerations for creating inclusive and impactful places of work

This paper is designed to help corporate real estate (CRE) leaders create spaces that improve employee experiences and the impact of their workplace on organisational outcomes. With heightened interest in the role of post-pandemic corporate offices, home workspaces, flex spaces and other environments for supporting and connecting employees, now is an opportune time for CRE leaders to elevate the role of their workplace strategy by focusing on belonging. The paper draws upon years of research and exploration conducted by MillerKnoll brands and our customers. If desired, the foundational elements listed within it can be directly imported into an organisation’s existing workplace strategy while using this paper as a guide and catalyst to help team members, consultants and end users better understand the impact of the workplace in strengthening community, promoting a positive culture, and ensuring equitable opportunities for all employees to succeed.

Development of a screening tool for the need of specialist palliative care in oncologic inpatients: study protocol for the ScreeningPALL Study

IntroductionA range of referral criteria and scores have been developed in recent years to help with screening for the need of specialist palliative care (SPC) in advanced, incurable cancer patients....

News reporting of suicide in nurses: A content analysis study.

Media impact on suicide is well-established. Groups at heightened risk of suicide, such as nurses, may be particularly influenced by poor news reporting. This study aimed to examine UK newspaper reporting of suicide of nurses and student nurses, including during the COVID-19 pandemic. Print and online newspaper reports about suicide in nurses (including students) published in the UK between January 2018 and August 2021 were obtained and data extracted for analysis in collaboration with Samaritans' media advisory team. Content and quality of newspaper reports were examined using a content analysis approach. The study was compliant with the STROBE checklist. Nurse or student nurse suicides were reported in 134 articles, including 50 individual suicides. Most articles were acceptable against Samaritans' media guidelines. However, common problems included absence of signposting to support organizations and lack of suicide prevention messages. A minority of articles included methods of suicide within article headlines (18, 13.4%) and sensationalist or romanticizing language (14, 10.7%). Most contained occupation-related content. Many named the individual's specific hospital or university and a substantial proportion included occupation-related images. Working on the frontline was the most reported link between COVID-19 and nurse suicide. While reporting on suicide among nurses and students was largely acceptable, quality of reporting was variable. Occupation was often discussed, and most articles published during COVID-19 linked suicide to the pandemic. The research findings can help shape guidance on reporting of suicide in specific professions and occupations, including nursing, to encourage responsible reporting and reduce inadvertent promotion of suicide.

The first-party professional certification body: hope and reality

The first-party professional certification body in higher educational institutions plays a significant role in filtering the quality of the graduates as it certifies the students' competency. The low quality of the assessment process and the negative perceptions of the graduates indicated the mismanagement of this body that motivated the researcher to investigate the understanding of this body’s stakeholders toward the qualification scheme of competency. The objectives of this research were to identify the needs of five stakeholders and their understanding of the qualification scheme. This research made use of the deep interview to collect data from purposively listed informants. The analysis method applied for this research was Stakeholder Analysis and Interpretative Phenomenological Analysis (IPA). The results showed that the needs of stakeholders were not identified, so they were not addressed in designing the business process and its cascading assessment instruments. The second finding was that the understanding of the stakeholders toward the qualification scheme was very low, affecting their low performance in conducting competency assessments. The implications of the findings are the advisory and management teams need to identify the needs of stakeholders. Furthermore, dissemination or training or workshop on designing qualification schemes and their cascading instruments are urgently needed.

The real-time information provision problem in assessing rehabilitation needs among athletes with overtraining syndrome

One of the biggest challenges in sports medicine is the return-to-play decisions, making or breaking athletic careers. Since there are no protocols to guide team physicians and consultants for athletes with fatigue syndrome, illness, injury, or overtraining syndrome, real-time monitoring plays a crucial role in such cases. By monitoring a combination of performance (e.g., maximal lactate concentration, maximal heart rate at lactate threshold), physiological (e.g., resting heart rate and maximal heart rate), biochemical (e.g., glucose) and hormonal (e.g., cortisol) variables, there should be objective indices determining eligibility or disqualification for the ill or injured athletes, allowing rehabilitation practitioners to improve and adjust their plan accordingly on a real-time information provision basis.

Steps to the Adoption of Stapling Technique for Low Rectal Anastomoses in a Nigerian Tertiary Hospital.

Many patients who may otherwise benefit from anastomoses get a permanent colostomy for low rectal cancers in low- and middle-income countries because of lack of training and/or lack of equipment for low rectal anastomoses. Our local team provided stepwise training for stapled low rectal anastomoses. Local surgeons with overseas formal training in colorectal surgeries facilitated periodical simulation-based training workshops on stapled low rectal anastomoses for surgeons and trainees over 3y (2015-2017) in a Nigerian tertiary hospital. Additional training with live surgeries was conducted. Twenty-six participants, including 12 consultant surgeons and 14 senior registrars, concluded hand-on training modules in both wet and dry laboratory sessions. Two-thirds of them also had opportunities to assist during live surgeries. After initial training, stapled low rectal anastomoses were carried out by a team of consultants operating together. With time, locally trained residents assisted consultants in carrying out the procedures. Of the 198 colorectal procedures carried out within the study period, 18 (0.09%) were rectal resections and anastomoses, of which 14 were stapled low rectal anastomoses. A locally facilitated simulation-based training program aided the adoption of a stapled technique of low rectal anastomoses in a Nigerian tertiary hospital. We propose that such training can promote the adoption of other modern techniques in our tertiary surgical practices.

Boarding for Youth Mental Health Conditions: How Can Hospitalists Be Part of the Solution?

Boarding for Youth Mental Health Conditions: How Can Hospitalists Be Part of the Solution?

The Substance Use Treatment and Recovery Team (START) study: protocol for a multi-site randomized controlled trial evaluating an intervention to improve initiation of medication and linkage to post-discharge care for hospitalized patients with opioid use disorder

BackgroundPeople with opioid use disorder experience high burden of disease from medical comorbidities and are increasingly hospitalized with medical complications. Medications for opioid use disorder are an effective, life-saving treatment, but patients with an opioid use disorder admitted to the hospital seldom initiate medication for their disorder while in the hospital, nor are they linked with outpatient treatment after discharge. The inpatient stay, when patients may be more receptive to improving their health and reducing substance use, offers an opportunity to discuss opioid use disorder and facilitate medication initiation and linkage to treatment after discharge. An addiction-focus consultative team that uses evidence-based tools and resources could address barriers, such as the need for the primary medical team to focus on the primary health problem and lack of time and expertise, that prevent primary medical teams from addressing substance use.MethodsThis study is a pragmatic randomized controlled trial that will evaluate whether a consultative team, called the Substance Use Treatment and Recovery Team (START), increases initiation of any US Food and Drug Administration approved medication for opioid use disorder (buprenorphine, methadone, naltrexone) during the hospital stay and increases linkage to treatment after discharge compared to patients receiving usual care. The study is being conducted at three geographically distinct academic hospitals. Patients are randomly assigned within each hospital to receive the START intervention or usual care. Primary study outcomes are initiation of medication for opioid use disorder in the hospital and linkage to medication or other opioid use disorder treatment after discharge. Outcomes are assessed through participant interviews at baseline and 1 month after discharge and data from hospital and outpatient medical records.DiscussionThe START intervention offers a compelling model to improve care for hospitalized patients with opioid use disorder. The study could also advance translational science by identifying an effective and generalizable approach to treating not only opioid use disorder, but also other substance use disorders and behavioral health conditions.Trial registration: Clinicaltrials.gov: NCT05086796, Registered on 10/21/2021.https://www.clinicaltrials.gov/ct2/results?recrs=ab&cond=&term=NCT05086796&cntry=&state=&city=&dist =

Impact on mental health and wellbeing in Indigenous communities due to land loss resulting from industrial resource development: protocol for a systematic review

BackgroundIndigenous Peoples are impacted by industrial resource development that takes place on, or near, their communities. Existing literature on impacts of industrial resource development on Indigenous Peoples primarily focus on physical health outcomes and rarely focus on the mental health impacts. To understand the full range of long-term and anticipated health impacts of industrial resource development on Indigenous communities, mental health impacts must be examined. It is well-established that there is a connection between the environment and Indigenous wellbeing, across interrelated dimensions of mental, physical, emotional, and spiritual health.MethodsThis paper identifies how the Community Advisory Team and a team of Indigenous and settler scholars will conduct the review. The literature search will use the OVID interface to search Medline, Embase, PsycINFO, and Global Health databases. Non-indexed peer-reviewed journals related to Indigenous health or research will be scanned. Books and book chapters will be identified in the Scopus and PsycINFO databases. The grey literature search will also include Google and be limited to reports published by government, academic, and non-profit organizations. Reference lists of key publications will be checked for additional relevant publications, including theses, dissertations, reports, and other articles not retrieved in the online searches. Additional sources may be recommended by team members. Included documents will focus on Indigenous Peoples in North America, South America, Australia, Aotearoa New Zealand, and Circumpolar regions, research that reports on mental health, and research that is based on land loss connected to dams, mines, agriculture, or petroleum development. Literature that meets the inclusion criteria will be screened at the title/abstract and full-text stages by two team members in Covidence. The included literature will be rated with a quality appraisal tool and information will be extracted by two team members; a consensus of information will be reached and be submitted for analysis.DiscussionThe synthesized evidence from this review is relevant for land use policy, health impact assessments, economic development, mental health service planning, and communities engaging in development projects.Systematic review registrationRegistered in the International Prospective Register of Systematic Reviews (PROSPERO; Registration number CRD42021253720)

Extent of Adoption of Rythu Bharosa Kendra’s Technologies and Services in Ananthapuram District of Andhra Pradesh

Rythu Bharosa Kendras are the one stop shops for all farmers needs at Panchayat level in Andhra Pradesh. They provide services like e-crop booking to avail crop insurance, Agri-input shop, Farmer Knowledge Centres, Technical Advisory team, YSR Rythu Bharosa, Polambadi (FFS), CCRC cards, D-krishi (Seed distribution), etc. A sample of 90 beneficiaries were randomly selected from Anantapur district of Andhra Pradesh. Descriptive statistics including frequency, percentage, mean, standard deviation, mean scale value were used to analyse the data. The findings of the study indicated that, majority of the respondents (81.11%) having medium level of adoption followed by high (12.20%) and low (6.70%) levels of adoption.

Intimate Partner Violence, Sexual Assault, and Child Abuse Resource Utilization During COVID-19.

IntroductionKey measures in preventing spread of the virus that causes coronavirus disease 2019 (COVID-19) are social distancing and stay-at-home mandates. These measures along with other stressors have the potential to increase incidences of intimate partner violence (IPV), sexual assault, and child maltreatment.MethodsWe performed a retrospective review of county police dispatches, emergency department (ED) visits, Sexual Assault Nurse Examiner (SANE) consults, Domestic Violence Healthcare Project (DVHP) team consults, and Child Protection Team consults at a large, tertiary, Level I trauma center. We queried International Classification of Diseases Revision 10 codes most specific to IPV, sexual assault, and child maltreatment from March–October 2020 compared to 2019. Similarly, the number of consults performed by SANE, DVHP, and our Child Protection Team were collected. We compared all ED visits and consultations to total ED visits for the reviewed time period. Finally, the total number of calls and referrals to a child advocacy center and resource call line for victims were recorded during this timeframe.ResultsPolice dispatches for IPV-related assaults increased by 266 reports from 2019 to 2020 (P = 0.015). Emergency department visits related to IPV increased from 0.11% of visits in 2019 to 0.15% in 2020 (P = 0.032), and DVHP consults increased from 0.31% in 2019 to 0.48% in 2020 of ED visits in the first three months (P < 0.001). Child maltreatment visits increased from 0.47% of visits in 2019 to 0.81% of visits in 2020 (P = 0.028), and a higher percentage of patients required Child Protection team consults from 1% in 2019 to 1.6% in 2020 (P = 0.004). Sexual assault-related visits and SANE consults both showed a small increase that was not statistically significant. Fewer calls and referrals were made to our child advocacy center and resource call line, decreasing by 99 referrals and 252 calls, respectively.ConclusionDespite decreased ED volumes throughout the pandemic, we observed an increase in police dispatches, ED visits, and utilization of hospital consult services related to IPV and child maltreatment following the initiation of stay-at-home orders. However, use of community resources, such as the local child advocacy center, declined.

The Effectiveness of 6 versus 12 Months of Dialectical Behavior Therapy for Borderline Personality Disorder: A Noninferiority Randomized Clinical Trial

Introduction: Evidence-based psychotherapies for borderline personality disorder (BPD) are lengthy, posing a barrier to their access. Brief psychotherapy may achieve comparable outcomes to long-term psychotherapy for BPD. Evidence is needed regarding the comparative effectiveness of short- versus long-term psychotherapy for BPD. Objective: The aim was to determine if 6 months of Dialectical Behavior Therapy (DBT) is noninferior to 12 months of DBT in terms of clinical effectiveness. Methods: This two-arm, single-blinded, randomized controlled noninferiority trial with suicidal or self-harming patients with BPD was conducted at two sites in Canada. Participants (N = 240, M (SD)_age = 28.27 (8.62), 79% females) were randomized to receive either 6 (DBT-6) or 12 months (DBT-12) of comprehensive DBT. Masked assessors obtained measures of clinical effectiveness at baseline and every 3 months, ending at month 24. DBT-6 and DBT-12 were outpatient treatments consisting of weekly individual therapy sessions, weekly DBT skills training group sessions, telephone consultation as needed, and weekly therapist consultation team meetings. Results: The noninferiority hypothesis was supported for the primary outcome, total self-harm (6 months: margin = −1.94, M_diff [95% CI] = 0.16 [−0.14, 0.46]; 12 months: margin = −1.47, M_diff [95% CI] = 0.04 [−0.17, 0.23]; 24 months: margin = −1.25, M_diff [95% CI] = 0.12 [−0.02, 0.36]). Results also supported noninferiority of DBT-6 for general psychopathology and coping skills at 24 months. Furthermore, DBT-6 participants showed more rapid reductions in BPD symptoms and general psychopathology. There were no between-group differences in dropout rates. Conclusions: The noninferiority of a briefer yet comprehensive treatment for BPD has potential to reduce barriers to treatment access.

An Artificial Neural Networks model for predicting patients’ mortality due to COVID-19 "CoviSurv2021"

Introduction. COVID-19 is the pandemic of the century with the unusual circumstances it generated. Subsequently, there has been medical and human scarcity of resources leading to the health system collapse, especially in third world countries. Objective. To support the white army in grasping the pandemic behavior, several studies have pointed to the existence of patient-related factors affecting COVID-19 patients’ mortality-risk. In the current study, Artificial Neural Network (ANN) has been employed to predict COVID-19 mortality. Material and methods. In particular, the modeling phase was done using a database of 684 samples collected from Mohamed Seddik Ben Yahia Hospital of Jijel, with antecedent diseases and blood biomarkers data of patients. Firstly, 18 parameters were selected in the input layer based on the literature recommendation and expert medical team consultation. Furthermore, the optimal inputs have been modeled using the ANN, and their performance was assessed through four performance measures (sensitivity, specificity, precision, and accuracy). Results. The comparative study proved the effectiveness of (18-12-2) model trained by Tansig transfer function, which displayed a higher performance in predicting COVID-19 mortality, compared to other models proposed in the literature. Afterward, the proposed optimal model was utilized to develop a GUI public interface by Matlab software. Conclusion. Finally, a reliable and easy-to-use graphical interface is generated in the current study dubbed “CoviSurv2021”. This latter will be very helpful for the medical staff to select priority patients who have upper urgency to be hospitalized, prioritize patients when the hospital is overcrowded, and gain time to provide the care needed.

Systems analysis and improvement approach to optimize outpatient mental health treatment cascades in Mozambique (SAIA-MH): study protocol for a cluster randomized trial

BackgroundSignificant investments are being made to close the mental health (MH) treatment gap, which often exceeds 90% in many low- and middle-income countries (LMICs). However, limited attention has been paid to patient quality of care in nascent and evolving LMIC MH systems. In system assessments across sub-Saharan Africa, MH loss-to-follow-up often exceeds 50% and sub-optimal medication adherence often exceeds 60%. This study aims to fill a gap of evidence-based implementation strategies targeting the optimization of MH treatment cascades in LMICs by testing a low-cost multicomponent implementation strategy integrated into routine government MH care in Mozambique.MethodsUsing a cluster-randomized trial design, 16 clinics (8 intervention and 8 control) providing primary MH care will be randomized to the Systems Analysis and Improvement Approach for Mental Health (SAIA-MH) or an attentional placebo control. SAIA-MH is a multicomponent implementation strategy blending external facilitation, clinical consultation, and provider team meetings with system-engineering tools in an overall continuous quality improvement framework. Following a 6-month baseline period, intervention facilities will implement the SAIA-MH strategy for a 2-year intensive implementation period, followed by a 1-year sustainment phase. Primary outcomes will be the proportion of all patients diagnosed with a MH condition and receiving pharmaceutical-based treatment who achieve functional improvement, adherence to medication, and retention in MH care. The Consolidated Framework for Implementation Research (CFIR) will be used to assess determinants of implementation success. Specific Aim 1b will include the evaluation of mechanisms of the SAIA-MH strategy using longitudinal structural equation modeling as well as specific aim 2 estimating cost and cost-effectiveness of scaling-up SAIA-MH in Mozambique to provincial and national levels.DiscussionThis study is innovative in being the first, to our knowledge, to test a multicomponent implementation strategy for MH care cascade optimization in LMICs. By design, SAIA-MH is a low-cost strategy to generate contextually relevant solutions to barriers to effective primary MH care, and thus focuses on system improvements that can be sustained over the long term. Since SAIA-MH is integrated into routine government MH service delivery, this pragmatic trial has the potential to inform potential SAIA-MH scale-up in Mozambique and other similar LMICs.Trial registrationClinicalTrials.gov; NCT05103033; 11/2/2021.

Risk management in dialectical behavior therapy: Treating life-threatening behaviors as problems to be solved.

Dialectical behavior therapy (DBT) is an empirically supported behavioral treatment for individuals with borderline personality disorder who frequently exhibit life-threatening behavior, such as suicide attempts, nonsuicidal self-injury urges and actions, and suicidal ideation. We provide an overview of the theoretical framework by which DBT conceptualizes these life-threatening behaviors and the principles by which safety planning measures are implemented and maintained throughout treatment. The importance of orienting clients to treatment and obtaining their commitment to decrease life-threatening behavior is reviewed. Relevant strategies associated with risk management and assessment, such as the diary card, chain analysis, solution analysis, phone coaching, and consultation team, are described. The overview concludes with a case example to illustrate the application of these techniques with a DBT client with a long-standing history of engaging in life-threatening behaviors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

We need a broader debate on the sustainability of blockchain

Alexander Rieger is a postdoctoral researcher at the Interdisciplinary Centre for Security, Reliability and Trust (SnT) at the University of Luxembourg. His research interests include innovative digital technologies such as blockchain, decentralized digital identities, and artificial intelligence. Alex leads the scientific advisory team for the FLORA blockchain project of Germany's Federal Office for Migration and Refugees and acts as advisor to the European Blockchain Partnership and various public and private sector partners in Germany and Luxembourg. Tamara Roth is a postdoctoral researcher at the Interdisciplinary Centre for Security, Reliability and Trust (SnT) at the University of Luxembourg. Her research interests include the interplay of innovative technologies such as blockchain and decentralized digital identities with sociocultural and socioethical constructs in public administration and healthcare. Moreover, she investigates technology adoption and implications of technologies for sustainable development from a psychological and neurobiological perspective. Johannes Sedlmeir is a researcher on information systems at the FIM Research Center, University of Bayreuth. In his research, he focuses on the energy consumption and performance benchmarking of different blockchains, the application of cryptographic methods such as zero-knowledge proofs for scalable and privacy-oriented blockchain solutions in different sectors, and decentralized digital identities. He received his M.Sc. in theoretical and mathematical physics. Gilbert Fridgen is professor and PayPal-FNR PEARL chair in digital financial services at the Interdisciplinary Centre for Security, Reliability and Trust (SnT) at the University of Luxembourg. In his research, he analyzes the transformative effects of digital technologies on individual organizations and on the relationship between organizations. He addresses potentially disruptive technologies like blockchain, decentralized digital identities, artificial intelligence, or the Internet of Things. His research involves information systems engineering and IT strategy and (risk) management, as well as regulatory compliance. In his projects and partnerships, he collaborates with partners in financial services, energy, mobility, manufacturing, and consulting, as well as with public bodies and governments.

Integration of geriatric assessment in cancer care for senior adults during COVID-19 pandemic.

e24027 Background: Older patients with cancer are particularly vulnerable, and the risk of mortality and morbidity during this pandemic is high. Comprehensive geriatric assessment (CGA) helps in predicating toxicity and improve outcomes. SAOP3 is validated geriatric screening tool that can efficiently identify deficits in different GA domains. It was developed to determine when a multidisciplinary team consultation with GA-intervention is required. Methods: We performed a retrospective review of institutional cancer registry. We compared 2 groups of cancer patients ≥ 70 years old who completed SAOP3 questionnaire in the pre-COVID (9/1/2019- 3/10/2020) and during the pandemic period (3/11/2020-12/31/2020). Fisher’s exact test was used to statistical analysis. Analytical models were adjusted for age, cancer histology, stage, therapy type, and GA variables. Results: 951 patients were included (499 prepandemic,452 during pandemic). Median age was 76.6 yrs. (range = 71-86). A 50.7% male, 48.3% female and 34% (323) have metastatic disease. The capture and completion rate of SAOP3 were 82% (779) and 86% (817) respectively. There was a significant psychosocial impairment during the pandemic. More patients were feeling depressed 26% (118) during Vs. 3% (15) prior pandemic (P &lt; 0.001). The caregiver availability was different with 47% (212) during pandemic compared to 52% (259) in pre-pandemic (P = 0.0013). There was a statistically significant difference in the fall history with 4% (20) in pre-, in contrast to 10% (45) during pandemic (P = 0.003). There was a numerical difference in the cognitive impairment during the pandemic in compared to the pre-COVID [34% (171), 52% (235) respectively], but it was not statistically significant (P = 0.154). There was no difference observed in nutritional domains between the two groups. Conclusions: Data regarding patients’ domains of a CGA are crucial for optimal care. Screening with the SAOP3 questionnaire captured significant changes in CGA domains associated with the pandemic. These findings also suggest that Integration of high-yield brief geriatric screening tools such as SAOP3 is feasible in busy practice during the pandemic. It can help identify specific impairment of older cancer patients and trigger appropriate interventions to improve the quality of life and clinical outcomes.

Partnering with immigrant families to promote language justice and equity in education.

Despite USfederal legislation mandates institutions to provide meaningful access and participation to students and families in educational settings, culturally and linguistically diverse (CLD) families and caregivers of children in special education experience cultural and linguistic barriers. A Community Advisory Team (CAT) of parents, advocates, community interpreters and translators, researchers, and teachers explored CLD families' experiences and advocacy efforts. Critical bifocality and circuits of dispossession, privilege, and resistance informed the documentation of inequities and resistance to understand the linkages of structural arrangements of power. Focus groups with families (n = 21) speakers of Spanish, Portuguese, and Cantonese were conducted. Findings indicate perceived discrimination, poor and inadequate interpretation and translation services impact children's access to special education services, hinder family's communication with schools and reduce the perceptions of schools as trustworthy institutions. Families advocate relentlessly for their children and recommend schools listen to families and hire culturally and linguistically competent interpreters and translators. Community psychologists can make significant contributions to promote language justice in education settings through participatory approaches to inquiry that value CLD families' knowledge and expertise.

Clinical Impact of Heart Team Decisions for Patients With Complex Valvular Heart Disease: A Large, Single-Center Experience.

BackgroundA multidisciplinary approach might be pivotal for the management of patients with valvular heart disease (VHD), but clinical outcome data are lacking.Methods and ResultsAt our institution, since 2014, internal guidelines recommended heart team consultations for patients with VHD. The clinical/echocardiographic characteristics, treatment recommendations, performed treatment, and early clinical outcomes of consecutive, hospitalized patients with VHD undergoing heart team evaluation were collected. Surgical risk was prospectively assessed by the EuroSCORE II and STS‐PROM. The primary end point of the study was early mortality. A total of 1004 patients with VHD with high clinical complexity (mean age, 75 years; mean EuroSCORE II, 9.4%; mean STS‐PROM, 5.6%; 48% ischemic heart disease; 29% chronic kidney disease, 9% oncologic/hematologic diseases) were enrolled. The heart team recommended an interventional treatment for 807 (80%) patients and conservative management for 197 (20%) patients. Management crossovers occurred in only 5% of patients. The recommended intervention was cardiac surgery for 230 (23%) patients, percutaneous treatment in 516 (51%) patients, and hybrid treatment in 61 (6%) patients. Early mortality occurred in 24 patients (2.4%) and was independently predicted by aortic stenosis, left ventricular ejection fraction, pulmonary artery systolic pressure, and conservative management recommendation. In patients referred to treatment, observed early mortality (1.7%) was significantly lower (P<0.001) than expected on the bases of both the STS‐PROM (5.2%) and EuroSCORE II (9.7%).ConclusionsWithin the limitations of its single‐center and observational design, the present study suggests that heart team–based management of patients with complex VHD is feasible and allows referral to a wide spectrum of interventions with promising early clinical results.

Pilot Remote Video Restorative Consultation Clinics at the Eastman Dental Hospital – An Evaluation of User Experiences

Hospital-based face-to-face patient consultations in dentistry have traditionally been undertaken with patients traveling to the hospital. Digital technology has revolutionized patient care by improving access bringing benefits to patients. This pilot project evaluated the effectiveness of using digital platforms for dental patient consultations for patients referred to the Eastman Dental Hospital. Eleven general dental practitioners (GDPs) took part in the pilot which ran for 6 months. Two clinics using Attend Anywhere where patients were seen for consultation and Microsoft Teams where the patient referral was used for a second opinion discussion with the GDP. All patients and GDPs consented to participate and had their data shared with the other GDPs in the second clinic. Predesigned feedback questionnaires were sent to the GDPs, consultant team, and patient feedback was sought via a structured telephone conversation after the clinic. Fifteen patients participated with six being seen in the first clinic and nine in the second clinic. The feedback was positive from all patients and GDPs who participated in both clinics with consultant feedback stating that there were no issues with providing a diagnosis and treatment plan to the patient and GDP. Within the limitations of this pilot, the positive feedback from all users suggests that a digital platform for patient consultation and second opinion is effective in conducting consultations. This new way of working would reduce waiting times, expedite the start of treatment, and improve user access to care by improving GDPs confidence in managing patients.