Assessment Team Research Articles

Surgical Management in Patients With Liver Cirrhosis: A Multidisciplinary Approach

Objective: The objective of this study is to conduct a systematic review on the surgical management of patients with liver cirrhosis, aiming to investigate strategies that can optimize perioperative care and reduce associated complications. Theoretical Framework: This section addresses fundamental concepts related to liver cirrhosis, including severity classification through the Child-Pugh and MELD systems. The review considers clinical and observational studies discussing surgical interventions and multidisciplinary approaches, establishing a solid foundation for understanding the clinical context. Method: The methodology employed comprises a systematic literature review, selecting studies published between 2010 and 2023. The search was conducted across six databases and supplemented by specialized literature, prioritizing surgical interventions and multidisciplinary team approaches. Results and Discussion: The findings reveal significant challenges, such as elevated morbidity and mortality rates, particularly in patients classified as Child-Pugh B and C. Laparoscopic cholecystectomy emerges as the preferred approach, demonstrating lower complication rates when performed in specialized centers. The discussion contextualizes these findings within the theoretical framework, considering the study's limitations. Implications of the Research: The practical implications suggest the necessity for a multidisciplinary team and careful risk assessment, emphasizing the adoption of minimally invasive surgical techniques and stringent control of ascites to enhance clinical outcomes. Originality/Value: This study contributes to the literature by highlighting the complexity of surgical management in cirrhotic patients and the importance of specific strategies. The relevance of this research is underscored by the need for the development of less invasive techniques and a better understanding of the specific complications faced by these patients.

Use of insitu simulation to improve team performance and utilization of a rapid sequence intubation checklist.

Intubation checklists have emerged as tools to reduce adverse events and improve efficiency during rapid sequence intubation (RSI) in pediatric emergency departments (PEDs). This study aimed to use multidisciplinary simulation (SIM) training as an educational tool to improve PED team performance during RSI scenarios through utilization of an RSI checklist. We created a checklist modeled after previously published PED checklists. PED multidisciplinary teams participated in video-recorded SIM training sessions involving a scenario requiring intubation three times, first without interruption then while receiving our intervention of rapid-cycle deliberate practice (RCDP) debriefing focusing on checklist utilization and team dynamics. Learners went through the scenario once more uninterrupted to apply learned skills. Team performance was evaluated via video review using the Simulation Team Assessment Tool (STAT) focusing on airway management and human factors sections. Scores were compared before and after intervention along with pre- and postintervention surveys. A total of 483 learners participated in 64 SIM training sessions, 44 of whom met inclusion criteria and were included for data analysis. Scores increased postintervention for airway management, human factors and in total. Least-squares mean differences for total, airway, and human factors scores were 9.55 (95% confidence interval [CI] 7.24-11.85), 4.22 (95% CI 2.91-5.52), and 5.33 (95% CI 3.86-6.8), respectively, which was statistically significant with p-value of <0.001 across all categories. Surveys demonstrated improved role understanding and checklist utilization comfort postintervention. This study supports the benefit of multidisciplinary SIM training with RCDP-style methodology as an educational method for improving airway management, teamwork skills, and RSI checklist utilization for PED staff. Incorporation of additional maintenance SIM sessions for ongoing education is likely to be further beneficial and would allow evaluation of degradation of skills over time following initial training.

Evaluating Severe Therapy-Resistant Asthma in Children: Diagnostic and Therapeutic Strategies

Introduction: Worldwide, asthma is the most common non-communicable respiratory disease and causes considerable morbidity and mortality. Most people with asthma can be treated effectively with low-dose medications if these are taken correctly and regularly. Around 10% of people with asthma have an uncontrolled form of the disease or can only achieve control with high-dose medications, incurring disproportionately high health care costs. Areas Covered: PubMed and personal archives were searched for relevant articles on the definition, management and pharmacotherapy of severe asthma. The WHO classification of severe asthma and the treatment levels encompassed in the definition are discussed. Most children and young people referred for consideration of ‘beyond-guidelines therapy’ can in fact be managed on standard treatment after a multi-disciplinary team assessment focusing on ensuring correct basic management, and these steps are described in detail. Options for those with true therapy-resistant asthma are described. These include monoclonal antibodies, most of which target type 2 inflammation. Expert Opinion: Getting the basics right is still the most important aspect of asthma care. For those with severe, therapy-resistant asthma, an increasing number of life-transforming monoclonals have been developed, but there is still little understanding of, and a paucity of treatment options for, non-eosinophilic asthma.

Outcomes of Balloon-Expandable Transcatheter Aortic Valve Replacement in Younger Patients in the Low-Risk Era

Guidelines advise heart team assessment for all patients with aortic stenosis, with surgical aortic valve replacement recommended for patients younger than 65 years or with a life expectancy greater than 20 years. If bioprosthetic valves are selected, repeat procedures may be needed given limited durability of tissue valves; however, younger patients with aortic stenosis may have major comorbidities that can limit life expectancy, impacting decision-making. To characterize patients younger than 65 years who received transcatheter aortic valve replacement (TAVR) and compare their outcomes with patients aged 65 to 80 years. This retrospective registry-based analysis used data on 139 695 patients from the Society for Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (TVT) Registry, inclusive of patients 80 years and younger undergoing TAVR from August 2019 to September 2023. Balloon-expandable valve (BEV) TAVR with the SAPIEN family of devices. Comorbidities (heart failure, coronary artery disease, dialysis, and others) and outcomes (death, stroke, and hospital readmission) of patients younger than 65 years compared to patients aged 65 to 80 years. In the years surveyed, 13 849 registry patients (5.7%) were younger than 65 years, 125 846 (52.1%) were aged 65 to 80 years, and 101 725 (42.1%) were 80 years and older. Among those younger than 65, the mean (SD) age was 59.7 (4.8) years, and 9068 of 13 849 patients (65.5%) were male. Among those aged 65 to 80 years, the mean (SD) age was 74.1 (4.2) years, and 77 817 of 125 843 patients (61.8%) were male. Those younger than 65 years were more likely to have a bicuspid aortic valve than those aged 65 to 80 years (3472/13 755 [25.2%] vs 9552/125 001 [7.6%], respectively; P < .001). They were more likely to have congestive heart failure, chronic lung disease, diabetes, immunocompromise, and end stage kidney disease receiving dialysis. Patients younger than 65 years had worse baseline quality of life (mean [SD] Kansas City Cardiomyopathy Questionnaire score, 47.7 [26.3] vs 52.9 [25.8], respectively; P < .001) and mean (SD) gait speed (5-meter walk test, 6.6 [5.8] seconds vs 7.0 [4.9] seconds, respectively; P < .001) than those aged 65 to 80 years. At 1 year, patients younger than 65 years had significantly higher readmission rates (2740 [28.2%] vs 23 178 [26.1%]; P < .001) and all-cause mortality (908 [9.9%] vs 6877 [8.2%]; P < .001) than older patients. When propensity matched, younger patients still had higher 1-year readmission rates (2732 [28.2%] vs 2589 [26.8%]; P < .03) with similar mortality to their older counterparts (905 [9.9%] vs 827 [10.1%]; P = .55). Among US patients receiving BEV TAVR for severe aortic stenosis in the low-surgical risk era, those younger than 65 years represent a small subset. Patients younger than 65 years had a high burden of comorbidities and incurred higher rates of death and readmission at 1 year compared to their older counterparts. These observations suggest that heart team decision-making regarding TAVR for most patients in this age group is clinically valid.

Immune-checkpoint myocarditis phenotype when using systematic troponin surveillance in cancer patients.

Abstract Background ICI myocarditis, often described as potentially fulminant in registries from specialized centers, lacks sufficient data on its subclinical forms. ESC 2022 guidelines advocate systematic troponin measurements for early detection, resulting in numerous suspected cases of ICI myocarditis. Additionally, many patients receive other potentially cardiotoxic cancer drugs (e.g.,anthracyclines), adding complexity to the management. Purpose To identify factors associated with ICI-myocarditis diagnosis in a single-center unselected cohort referred for suspicion of CV immune-related adverse events(irAEs). Patients underwent standardized evaluation, including serum testing, ECG, echocardiogram, cardiac MRI(CMRi) and multidisciplinary team assessment including cardiology and internal medicine specialists. Coronary imaging and myocardial biopsy (EMB) were performed as needed. ICI-myocarditis diagnosis was adjudicated by expert panel (FC, MM, SH) based on Dallas, ESC, and IC-OS criteria. Results We enrolled 175 consecutive patients from March 2022 to October 2023; 40 (22.89%) were male, with a median age of 61 (IQR 48.0-72.0) years. 92(52.57%) were referred for lone asymptomatic troponin raise, 101 (57.7%) had breast cancer; 142 (81.11%) received other cardiotoxic drugs. We identified 95 (61.71%) patients with CV irAEs at referral (8 had &amp;gt;=2 CV irAEs) with a total of 108 CV irAEs after follow up, including 72 (41.14%) with ICI-myocarditis at referall. No CV deaths occurred within 30 days from referall. Characteristics and univariate analysis are depicted in the Table1. Reasons for referral in the ICI-myocarditis population are depicted in the Figure1. On multivariate regression analysis, prior CV disease history (OR 6.232 [CI 1.204-32.260], p=0.029), EMB (OR 24.969 [5.139-121.32], p=&amp;lt;.0001), IC-OS criteria fulfilled (OR 43.108 [9.222-201.510], p=&amp;lt;.0001), and positive Lake Louise criteria on CMRi (OR 6.583[1.416-30.610], p=0.0163) were associated with myocarditis. In a sub-analysis group of breast cancer patients (largely receiving anthracyclines), ICI-myocarditis was associated on multivariate regression with abnormal ECG (OR 14.227 [CI 1.632-124.040], p=&amp;lt; 0.0163) and EMB (OR 8.508 [CI 2.718-26.638], p=0.0002). The same characteristics were significantly associated with other CV irAEs in the group of breast cancer patients. In the group of patients with cancers other than breast, factors significantly associated with ICI myocarditis diagnosis were: EMB (OR 70.656 [CI 5.970-836.161], 0.0007), and no arterial hypertension (OR 9.554 [CI 1.792-50.940], p= 0.0082). Conclusions The FAST TRACK study highlights the high proportion of patients fulfilling ICI-myocarditis criteria despite no or mild symptoms, mainly referred for troponin elevation. However, subclinical ICI-myocarditis appears to bear good prognosis. Endomyocardial biopsy is key to increase the diagnosis rate of ICI-myocarditis across different cancer populations when mildly symptomatic.Table 1Figure 1

29 A call for action - The lived experiences of caregivers of children diagnosed with Fetal Alcohol Spectrum Disorder during assessment and following diagnosis

Abstract Background Individuals diagnosed with Fetal Alcohol Spectrum Disorder (FASD) have a heterogeneous range of neurodevelopmental impairments with lifelong impacts on functioning. In Canada, a FASD diagnosis is made through a multidisciplinary team assessment, using the 2015 Canadian FASD Diagnostic Guidelines. Studies show that early diagnosis and intervention reduces secondary FASD related disabilities and improves outcomes in adulthood. However, little has been published about accessibility of services and intervention for children diagnosed with FASD in Canada. Objectives The current study explores the lived experiences of caregivers in (1) undergoing a diagnostic assessment for FASD and (2) obtaining services and interventions for their child in the first two years following diagnosis. Using a qualitative approach, the study aimed to identify strengths and gaps in the system with respect to supporting Canadian children with FASD and their families. Design/Methods Seventy one (71) children were diagnosed with FASD/At Risk for FASD over a one year period at a tertiary Developmental Assessment Center in Canada. Through non-random convenience sampling, 18 caregivers (the child’s legal guardians: 1 biological parent, 9 adoptive parents, 6 family guardians and 2 social workers) consented to participate in semi-structured interviews. Interviews explored caregiver experiences with the FASD diagnostic process as well as access to supports and intervention services after diagnosis. Interviews were transcribed and analyzed using reflexive thematic analysis. Results The following overarching themes were identified: (1) The journey of raising a child with FASD is overwhelming for caregivers; (2) The assessment process was both affirming and disheartening for caregivers; (3) There are significant, multi-level, systemic barriers to accessing supports for children with FASD, and their caregivers; (4) Equity deserving caregivers and their children are particularly vulnerable to falling through the cracks of the medical, educational, and social systems. Within each theme, subthemes further highlight protective factors and specific gaps in the system in supporting children and their families with respect to early intervention, educational/vocational, community and family support. Conclusion Children newly diagnosed with FASD are falling through the cracks of our healthcare system. There are clear disparities in the accessibility of intervention and support for children with developmental differences, even with a diagnosis. Wrap around support is needed for children with FASD and their families, as soon as functional impairments are recognized. A formal funding and support system, based on function, is essential for all children with developmental differences - including children with FASD.

Exact methods for the Selective Assessment Routing Problem

AbstractThe Selective Assessment Routing Problem (SARP) is a problem in humanitarian logistics addressing the site selection and routing decisions of rapid needs assessment teams which aim to evaluate the post-disaster conditions of different community groups, each carrying a distinct characteristic. The aim is to construct an assessment plan that maximizes the covering of different characteristics in a balanced way. We explore exact approaches based on mixed integer linear programming. Different mathematical formulations are presented, and theoretical results regarding their strengths are derived. The models are experimentally evaluated on a set of test instances including a real-world scenario.

Outcomes of Accelerated 3-Year MD Graduates at NYU Grossman School of Medicine During Medical School and Early Residency.

For accelerated 3-year MD (3YMD) pathways to be fully adopted in medical education, a comprehensive analysis of outcome data is needed. This study includes 7 accelerated 3YMD graduating classes at NYU Grossman School of Medicine (NYUGSOM) and reports on outcomes from both medical school and internship compared to their 4-year MD (4YMD) counterparts. Outcomes across the undergraduate-graduate medical education continuum for the first 7 classes of NYUGSOM graduates (matriculated from 2013-2019) from the accelerated 3YMD (n = 136) and 4YMD pathways (n = 681) were compared. For the internship outcomes, 3YMD interns were compared with 4YMD interns who graduated from NYUGSOM and all 4YMD interns (4YMD graduates from NYUGSOM and any other medical school) at NYUGSOM residencies. Accelerated 3YMD students were approximately 5 months older at admission and had higher multiple mini-interview scores than 4YMD students. Overall, accelerated 3YMD students performed similarly to 4YMD students during medical school and internship. Significant differences included higher performance by 3YMD students on preclerkship exams and lower performance on Steps 1 and 2 (average: 5.6 and 8.3 fewer points, respectively) and the physical examination portion of the NYUGSOM Comprehensive Clinical Skills Exam. Internship data indicated comparable team assessments across all residencies, statistically significant higher performance on Step 3 when compared to all 4YMD interns, and, in internal medicine, comparable clinical reasoning between 3YMD and all 4YMD interns. When comparing 3YMD interns to all 4YMD interns in the internal medicine residency program, 3YMD interns had a statistically significantly higher performance on milestones. The outcomes from 7 years of graduating accelerated 3YMD students at NYUGSOM show similar performance in medical school and early residency to 4YMD graduates. Long-term study of accelerated 3YMD students from NYUGSOM and other medical schools is needed to further validate the success of this innovative medical education pathway.

Understanding Special Educational Needs and Disabilities Assessment and Review Team experiences to improve and inform special educational needs and disabilities systems in England

Understanding Special Educational Needs and Disabilities Assessment and Review Team experiences to improve and inform special educational needs and disabilities systems in England

Developing and Validating a Multimodal Dataset for Neonatal Pain Assessment to Improve AI Algorithms With Clinical Data.

Using Artificial Intelligence (AI) for neonatal pain assessment has great potential, but its effectiveness depends on accurate data labeling. Therefore, precise and reliable neonatal pain datasets are essential for managing neonatal pain. To develop and validate a comprehensive multimodal dataset with accurately labeled clinical data, enhancing AI algorithms for neonatal pain assessment. An assessment team randomly selected healthy neonates for assessment using the Neonatal Pain, Agitation, and Sedation Scale. During painful procedures, 2 cameras recorded neonates' pain reactions on site. After 2weeks, assessors labeled the processed pain data on the EasyDL platform in a single-anonymized setting. The pain scores from the 4 single-modal data types were compared to the total pain scores derived from multimodal data. The On-Site Neonatal Pain Assessment completed using paper quality scales is referred to as OS-NPA, while the modality-data neonatal pain labeling performed using labeling software is MD-NPL. The intraclass correlation coefficient among the 4 single-modal groups ranged from 0.938 to 0.969. The overall pain intraclass correlation coefficient score was 0.99, with a Kappa statistic for pain grade agreement of 0.899. The goodness-of-fit for the linear regression models comparing the OS-NPA and MD-NPL for each assessor was greater than 0.96. MD-NPL represents a productive alternative to OS-NPA for neonatal pain assessment, and the validity of the data labels within the Multimodality Dataset for Neonatal Acute Pain has been validating. These findings offer reliable validation for algorithms designed to assess neonatal pain.

Silver Fast Track – Prioritising People Over 75 in the Emergency Department (ED)

Abstract Background The National Emergency Medicine Programme prioritised the care of older adults in a three-year Unscheduled Care Improvement Programme, coinciding with the “Integrated NCAGL Acute Operations and Older Persons body of work on Older Adults with Frailty in Acute hospitals”. In May 2023 a three-month pilot in the ED commenced to reduce the time for people over the age of 75 awaiting assessment by a doctor. Using the Manchester Triage system, a separate filing box on triage (Category 3+) was created to identify all people aged over 75 years who would then be prioritised to be seen within 4 hours of arrival. In addition, if a person aged over 75 years was waiting over 4 hours to be seen they would be re-triaged and seen within 15 minutes (Category 2). Methods A Prospective analysis of waiting times for people aged over 75 years, assessing: (1) time to be assessed by the Older Persons Assessment and Liaison (OPAL) Team; (2) time to see the ED doctor and (3) time to discharge. Results Four months prior to commencement, the median time from arrival to be seen by OPAL was 10 hours 58 mins. Following commencement, for the remainder of 2023, the median time from arrival to seen by OPAL was 6 hours 36 mins. The time to see the doctor reduced by 49 mins and time to discharge reduced by 1 hour 19 minutes. Conclusion The category 3+ for patients aged over 75 years is now an established feature in the ED. It has enabled the OPAL team to undertake earlier assessment of the patients journey alongside the medical team ensuring a more collaborative discharge pathway. In the future, we hope to further reduce the time to be assessed by OPAL through the introduction of clinical frailty scoring at ED triage &amp; expanding the team.

Frailty Screening and Assessment in the Emergency Department: Meeting the Growing Demand with an Expanded Acute Frailty Team

Abstract Background Frailty screening and early comprehensive geriatric assessment (CGA) in the emergency department (ED) is recommended to deliver optimal care for older adults with frailty and to reduce associated pressures on hospital systems.1 Interdisciplinary acute frailty teams (AFT) are best placed to lead these specialist assessments and a newly-expanded AFT was launched in February 2024.2 Activity data from the initial months of the AFT’s operations was analysed to understand the patient profile, service demand vs capacity and the impact of the team expansion. Methods A newly-expanded interdisciplinary AFT was launched, including Speech and Language Therapy (SLT) for the first time. Aims were to screen all those aged &amp;gt;70 years in ED for frailty using Clinical Frailty Scale (CFS) and commence CGA where appropriate, during core working hours. Additionally, the team expanded their remit from usually seeing patients pre disposition decision to include those referred for admission. Data reports for AFT activity in the first 55 working days and all-ED &amp;gt;70s presentations in the same time period, including weekends (78 days) were generated and analysed using excel. Results N = 920 patients were seen in the first 55 working days, n=513(53%) female, mean age 79.2 (6.7 SD, range 70-100), 65.4% living with frailty (CFS ≥4), admitted n=581(63%) vs discharged n=339(36%). The AFT saw 36% of all &amp;gt;70s ED presentations. On weekdays, there is a mean demand of n=35.9 (1.4 SD) &amp;gt;70s, and the AFT met 42% of this demand (mean n=15 (2.1 SD)). Compared to the same period in 2023, n=622 (313%) more patients were assessed or screened. Novel services provided were CGA and interdisciplinary team assessments commencing in ED for admitted patients and a SLT ED service. Conclusion An expanded AFT has increased capacity to screen for frailty and commence CGA. Future work will focus on hospital-wide frailty pathways.

FOLLOW-UP OF PATIENTS WITH POST COVID-19 CONDITION AFTER A MULTIDISCIPLINARY TEAM ASSESSMENT: A PILOT STUDY.

To follow up patients with post-COVID-19 condition (PCC) 6 months after a multidisciplinary team assessment in specialist care regarding symptoms of pain, anxiety, depression, fatigue and cognition, level of activity, physical activity and sick leave. A prospective pilot study conducted in a clinical setting of patients (n = 22) with PCC referred from primary healthcare to a specialist clinic for a 2 day-multidisciplinary team assessment followed by a subsequent rehabilitation plan. Data were collected through questionnaires filled in prior to the team assessment and 6 months later. Fifteen of the initial 22 patients participated in the follow-up. No statistically significant improvements were seen in any of the questionnaires after 6 months. However, 76.9% of the participants perceived the intervention as being helpful. This differed between the genders, where all the women 100% (n = 8) perceived it as being helpful, compared with 40% (n = 2) of the men (p = 0.012). Based on these findings, the benefit of a multidisciplinary team assessment of PCC is not fully convincing. However, since the participants themselves perceived the intervention as being helpful, the team assessment seems to be of some value. Further studies with larger populations would be of interest.

The Effectiveness of The Recommendations Of The Integrated Assessment Team (TAT) of The National Narcotics Agency of Bali Province as A Judge's Consideration In Granting Drug Case Decisions

This study aims to analyze the procedure and effectiveness of the recommendations provided by the Integrated Assessment Team (TAT) of the National Narcotics Agency of Bali Province in determining rehabilitation for narcotics abusers. The research employs a normative legal method, incorporating a statute approach, case approach, and conceptual approach. The findings indicate that the TAT, consisting of a legal and medical team, conducts assessments to provide rehabilitation recommendations for narcotics abusers. The recommendations serve as evidence in court to help judges decide on rehabilitation for narcotics abusers, victims, and addicts. The research, which analyzed 10 narcotics cases, reveals that in 9 cases, the judges considered TAT’s recommendations when issuing their verdicts. However, the judges' decisions did not always align with the content of the recommendations. This demonstrates that while the TAT's recommendations are effective in influencing judicial decisions, full alignment between recommendations and verdicts is not guaranteed. The study concludes with a suggestion for stronger inter-agency commitment to ensure that TAT’s recommendations are consistently applied in legal proceedings. Additionally, it proposes the inclusion of norms related to integrated assessments in future revisions of Indonesia's Narcotics Law.

The Authority of The Integrated Assessment Team For Legal Certainty Regarding Rehabilitation For Suspected Drug Abusers

This study aims to analyze the authority of the Integrated Assessment Team (TAT) in determining rehabilitation for narcotics abuse victims and to identify obstacles in implementing rehabilitation recommendations, especially for those undergoing legal proceedings. The research uses a normative legal method, supported by empirical data, relying on primary legal materials such as laws and regulations, and secondary materials like literature related to the authority of TAT. The findings show that the TAT holds a crucial role in recommending medical and social rehabilitation for narcotics abusers. However, several obstacles hinder the effective implementation of TAT's recommendations, including poor coordination among law enforcement agencies and the limited resources available to support the rehabilitation process. Additionally, the social stigma surrounding narcotics abuse further complicates the rehabilitation process. The discussion emphasizes the need for stronger inter-agency coordination and increased support for rehabilitation programs to ensure better outcomes for narcotics abuse victims. The study concludes that despite the TAT’s authority being clearly regulated, several implementation challenges remain, which require urgent attention to improve the effectiveness of rehabilitation for narcotics abusers within the legal system.

TEAMs go VR—validating the TEAM in a virtual reality (VR) medical team training

BackgroundInadequate collaboration in healthcare can lead to medical errors, highlighting the importance of interdisciplinary teamwork training. Virtual reality (VR) simulation-based training presents a promising, cost-effective approach. This study evaluates the effectiveness of the Team Emergency Assessment Measure (TEAM) for assessing healthcare student teams in VR environments to improve training methodologies.MethodsForty-two medical and nursing students participated in a VR-based neurological emergency scenario as part of an interprofessional team training program. Their performances were assessed using a modified TEAM tool by two trained coders. Reliability, internal consistency, and concurrent validity of the tool were evaluated using intraclass correlation coefficients (ICC) and Cronbach’s alpha.ResultsRater agreement on TEAM’s leadership, teamwork, and task management domains was high, with ICC values between 0.75 and 0.90. Leadership demonstrated strong internal consistency (Cronbach’s alpha = 0.90), while teamwork and task management showed moderate to acceptable consistency (alpha = 0.78 and 0.72, respectively). Overall, the TEAM tool exhibited high internal consistency (alpha = 0.89) and strong concurrent validity with significant correlations to global performance ratings.ConclusionThe TEAM tool proved to be a reliable and valid instrument for evaluating team dynamics in VR-based training scenarios. This study highlights VR’s potential in enhancing medical education, especially in remote or distanced learning contexts. It demonstrates a dependable approach for team performance assessment, adding value to VR-based medical training. These findings pave the way for more effective, accessible interdisciplinary team assessments, contributing significantly to the advancement of medical education.

Development of Modified Ride-On-Cars for Children with Mobility Impairments

Introduction: The ability to move independently is an integral part of a child's development. Children with motor impairments often experience significant challenges with moving independently, resulting in expensive powered wheelchairs being purchased or having caregivers push them in strollers or wheelchairs. The purpose of this research is to adapt motorized ride-on-cars to enable children with motor impairments to explore their environment independently. Engineers, physiotherapists, and occupational therapists co-designed customized ride-on-cars with 10 children and their caregivers to support each child’s individual needs. Methods: Physiotherapists and occupational therapists led an initial diagnostic session to assess each child’s clinical needs. The engineers then brainstormed and implemented solutions. On the final day of testing, physiotherapists and occupational therapists conducted one further clinical assessment and made final changes. This process was repeated for 10 children ages 1-3 years old who had been identified as having mobility impairment. Results: The final cars were designed to minimize cost, weight, and size while prioritizing each child’s ability to operate the car independently and safely. The main modifications included replacing the original gas pedal with an assistive switch and constructing a support frame to ensure the child’s safety. Additional modifications such as adding a steering T-bar, adding LED lights, and varying the switch location were also implemented for specific children. Each modified car was tested to ensure client safety and car durability. Client feedback was positive, and caregivers expressed how their modified car will increase mobility for their child. Conclusions: The results from this iterative co-design process emphasize the importance of team assessment and implementation when creating assistive devices. It shows that modifying standard off-the-shelf toys to the specific needs of children with disabilities can be successful and improve their quality of life.

WP8.1 - Perceptions of Higher General Surgical Trainees and Trainers towards Multidisciplinary Team assessment: A deanery’s experience of the new General Surgical curriculum

Abstract Aims Explore how multidisciplinary team (MDT) working is assessed as a capability in practice (CiP). Understand perceptions of problems with assessment of MDT as a CiP. Methods Semi-structured interviews were conducted virtually with 8 Higher Surgical Trainees (HST) and 4 Trainers following recruitment within a single deanery. Interviews were transcribed and analysed using reflexive thematic analysis. Ethical approval was granted. Results Most participants did not feel that they engaged meaningful with assessment of MDT as a CiP. Despite forming part of the Multi-Consultant Report (MCR), 75% of trainers were unaware of any formal assessment and expressed confusion over the introduction of the new curriculum. All participants reported that they felt MDT as a CiP was most appropriate for senior HST, particularly those peri-FRCS. HST felt excluded from the MDT process while trainers felt trainees did not engage. Trainees placed more value on MDT assessment in their declared subspeciality. All interviewed expressed that other activities were prioritised above MDT, particularly operating. When assessed, participants felt it was based on a balance of knowledge, presentation and preparation. Both HST and trainers felt participation rather than attendance was vital but currently not practiced. When considering grading of assessment, there was confusion from all participants in how to differentiate Level3 (Indirect Supervision) from Level4 (Day1 consultant), particularly in the context of multiple trainers in attendance. Conclusion Implementation of MDT as CiP has caused confusion among HST and trainers. It is poorly used and valued. The CiP is perceived as more beneficial to senior HST.

Primary health care in Nigeria: best practices and quality of care in Nigeria

IntroductionThe significance of Primary Healthcare Centers (PHCCs) in fostering health equity and enhancing health outcomes cannot be overstated, especially in low and middle-income countries. This paper’s primary area of interest is to create evidence and innovation for PHCs, with a particular emphasis on underserved groups. Thus, the study aimed to investigate the state of primary health care in Nigeria, with a particular emphasis on best practices, challenges to best practices, and quality of care.MethodologyA cross-sectional quantitative study was conducted to collect secondary data from 29 primary healthcare facilities. The data was collected using staff and facility activity indicators over a year (2022). Descriptive statistics and chi-square tests were used to analyze the collected data.ResultOur study data showed that all of the PHCCs have service rosters that can be utilized for follow-up with patients. About 85 (84.1%) respondents have reported that deliveries were taken by the reporting midwife, and 55 (54.5%) respondents indicated that their facilities provided on-the-job training to their staff. This is considered as the best practice in the facility. However, the majority of the PHCCs (71.3%) lacked assessment teams, which was found to have a negative impact on the quality of healthcare provided at these facilities (p < 0.05).ConclusionOur study underscores the pressing need for primary healthcare services in Nigeria. Government authorities and healthcare providers must take action to overcome the challenges of limited capacity, service delivery, and quality of care. By adopting effective strategies and ensuring access to primary healthcare, citizens’ health outcomes can be greatly enhanced. Thus, it is essential to revamp and optimize healthcare facilities to establish an efficient healthcare system that caters to the needs of all citizens.

Leveraging Pre-trained Deep Learning Models for Remote Sensing Image Classification: A Case Study with ResNet50 and EfficientNet

The procedure of categorizing images from remote sensing is also another application of machine learning not just ground-based platforms (for instance satellites), aerial platforms become platforms sometimes in aviation either. They erase the counterparts that were based on individual categories and are portrayed on a specific part of the image. Geospatial Supply of gravel mainly is used for producing railway track, road and concrete surface. Data by analyzing their buildup, dams, bridges, extraordinary open spaces, reservoirs and canals. It targets to be specific and exact as possible in a different specific area of the land. Aspects of the enlarged portrait or distinctions weaved into the completed arts. This might have aspects such as mapping of the trees, plants, rivers, cities, farms and woodlands, and other items. Geospatial image classification is necessary for the identification and real-time analysis of different hazards and unrests. Provide numerous applications, including waste management, water resources, air quality, and traffic control in the urban contexts. Planning, monitoring the environment, land cover, mapping, as well as post-disaster recovery. Management team, traffic control, and situation assessments. In the past, human experts situated in a selected area classified geographical images by means of manual processing. One that involved the allocation of too much time. As this is one of the two broad categories, how to get rid of it is consequently. Applying machine learning and deep learning methods we analyze and interpret the data in order to reduce the time required to provide feedback which allows the system to reach a higher accuracy. The procedure will also be more reliable and the outcome will hopefully be more efficient CNNs are one of the deep learning subclasses in which the network learns and improves without the need for human intervention. It extracts features from images. They are main for the performance and metrics to help the organization to decide on whether they have accomplished their goals, using visual imagery.