Case Conference Research Articles

Castleman disease. A rare clinical case of retroperitoneal tumor localization in an elderly patient

Castleman disease is an extremely rare benign disease of the lymphatic system with an estimated incidence of 1–9 cases per 1,000,000. Its etiology remains unknown; interleukin 6 (IL-6) plays an important role in pathogenesis. Castleman disease has two clinical forms: localized (up to 90 % of cases) with a favorable prognosis, treated predominantly by surgical method; generalized (up to 10 % of cases) with less favorable prognosis, treated by pharmacological therapy. The diagnosis is rarely established at the preoperative stage.The aim. To present a clinical case of diagnosis and treatment of Castleman tumor of a rare topical localization.Results. A 66-year-old patient was admitted at the Abdominal Oncology Department of the G.E. Ostroverkhov Kursk Oncology Scientific and Clinical Center.Diagnosis: Retroperitoneal mass on the right found at the preventive examination; no peripheral lymphadenopathy was detected on ultrasound and computed tomography (CT). After the examination, a preliminary diagnosis was made: Gastrointestinal stromal tumor (GIST) of the small intestine mesentery. Based on the results of the case conference, the decision was taken to perform a surgery – laparoscopic removal of the tumor under endotracheal anesthesia. For surgical approach, a fan-shaped arrangement of ports was chosen. The surgery had no complications. Intraoperative blood loss was 50.0 ml. The total operating time was 98 minutes.According to the results of the histological study, the following diagnosis was made: Castleman disease, unicentric form, hyaline-vascular variant. En bloc surgery is the standard method for the treatment of localized forms of the Castleman disease. In all cases, long-term follow-up shows a long relapse-free period in almost all patients.During follow-up examinations (ultrasound of the abdominal cavity and retroperitoneal space, CT of the abdominal cavity with contrast enhancement, CT of the chest), no disease recurrence was detected during the year of observation.Castleman disease is a rare non-clonal lymphoproliferative disease of unknown etiology. A rare case of its retroperitoneal localization indicates that in cases with an uncertain nature of the peritoneal mass, Castleman disease should be included in the differential diagnostic search.

Evaluating Change in Student Pharmacists’ Familiarity, Attitudes, Comfort, and Knowledge as a Result of Integrating Digital Health Topics Into a Case Conference Series: Cohort Study

Background The use of technology in health care, often referred to as digital health, has expanded rapidly because of the need to provide remote care during the COVID-19 pandemic. In light of this rapid boom, it is clear that health care professionals need to be trained in these technologies in order to provide high-level care. Despite the growing number of technologies used across health care, digital health is not a commonly taught topic in health care curricula. Several pharmacy organizations have called attention to the need to teach digital health to student pharmacists; however, there is currently no consensus on best methods to do so. Objective The objective of this study was to determine if there was a significant change in student pharmacist scores on the Digital Health Familiarity, Attitudes, Comfort, and Knowledge Scale (DH-FACKS) after exposure to digital health topics in a yearlong discussion–based case conference series. Methods Student pharmacists’ initial comfort, attitudes, and knowledge were gathered by a baseline DH-FACKS score at the beginning of the fall semester. Digital health concepts were integrated into a number of cases in the case conference course series throughout the academic year. The DH-FACKS was administered again to students after completion of the spring semester. Results were matched, scored, and analyzed to assess any difference in DH-FACKS scores. Results A total of 91 of 373 students completed both the pre- and postsurvey (response rate of 24%). Using a scale from 1 to 10, the mean student-reported knowledge of digital health increased from 4.5 (SD 2.5) before intervention to 6.6 (SD 1.6) after intervention (P<.001) and the mean self-reported comfort increased from 4.7 (SD 2.5) before intervention to 6.7 (SD 1.8) after intervention (P<.001). There was a significant increase in scores for all 4 elements of the DH-FACKS. The mean familiarity scores increased from 11.6 (SD 3.7) to 15.8 (SD 2.2), out of a maximum of 20 (P<.001). The mean attitudes scores increased from 15.6 (SD 2.1) to 16.5 (SD 1.9), out of a maximum of 20 (P=.001). The mean comfort scores increased from 10.1 (SD 3.9) to 14.8 (SD 3.1), out of a maximum of 20 (P<.001). The mean knowledge scores increased from 9.9 (SD 3.4) to 12.8 (SD 3.9), out of a maximum of 20 (P<.001). Conclusions Including digital health topics in a case conference series is an effective and approachable way of providing education on important digital health concepts to students. Students experienced an increase in familiarity, attitudes, comfort, and knowledge after the yearlong intervention. As case-based discussions are an important component of most pharmacy and other medical curricula, this method can be easily applied by other programs that wish to give their students practice applying their knowledge of digital health to complex case-based scenarios.

Presence and Persistence of Perceived Subjective Cognitive Complaints and Incident Mild Cognitive Impairments Among Community-Residing Older Adults

ObjectivesTo examine whether Subjective Cognitive Complaints (SCCs) predicted incident mild cognitive impairment (MCI). DesignProspective Study. SettingCentral Control of Mobility and Aging (CCMA), a cohort study of community-residing older adults. ParticipantsParticipants were dementia-free community-residing older adults. MeasurementsSCCs were assessed at the baseline and via bi-monthly structured phone interviews during the first year using the Ascertain Dementia 8 (AD8). Nonpersistent status required one or two SCCs endorsements and Persistent status required three or more SCCs endorsements. Outcome, presence of mild cognitive impairments (MCI) was determined by established case conference diagnostic procedures. Participants were followed annually. Generalized estimating equations (GEE), logistic model type, were used to determine the odds of developing MCI during follow-up. SCCs served as the three-level predictor (no/nonpersistent/persistent) and cognitive status (MCI versus normal) as the binary outcome. Analyses were adjusted for age, sex, education, race, health status, depressive symptoms, and global cognition. ResultsThe sample (n=454; mean age=75.67 ± 6.43; %female=55.3) included 245 participants who reported no SCCs, 156 who reported 1–2 SCCs, and 53 who reported 3 or more SCCs. Sixty-eight participants developed MCI during follow-up. Results showed that compared to no SCCs, persistent SCCs, and nonpersistent SCCs were significantly associated with increased odds of developing MCI during follow-up. ConclusionsThe presence of SCCs regardless of their persistence was associated with increased odds of developing MCI even when adjusting for objectively-assessed cognitive performance.

Osteoporosis treatment and pain relief: A scoping review.

Anti-osteoporosis (OP) drugs have been suggested to contribute to pain reduction during OP management. This scoping review aimed at mapping the literature on pain relief with anti-OP drugs in OP treatment. Medline, Pubmed and Cochrane databases were searched by two reviewers with keywords combinations. Randomized controlled and real-life English studies, pain as an endpoint, antiosteoporosis drugs were inclusion criteria. Case reports, surveys, comment letters, conference abstracts, animal studies and grey literature were excluded. Predetermined data were extracted by two reviewers and disagreement solved through discussion. A total of 130 articles were identified, 31 publications were included, 12 randomized clinical trials and 19 observational studies. Pain reduction was assessed by different tools: Visual Analogue Scale, Verbal Rating Scale, Facial Scale or as a domain of quality of life questionnaires including Short form 8, 36, mini-OP, Japanese OP, Qualeffo, Roland Morris Disability questionnaires. Collective data show that anti-OP drugs may display an analgesic effect that may be linked to the local mode of action of drugs on bone and consecutive modulation of pain sensitization. The methodology of the studies showed a heterogeneity of endpoints, comparators, statistical approaches and follow-up duration. Considering the limitations of the literature, there is a need for more rigorous trials and larger real-life studies taking into account the recommendations published for research in rheumatology and in pain medicine. The identification of responders, patient subtypes, and of analgesic-effect doses would allow optimization and individualization for pain relief in patients with OP. This scoping review shows that anti-OP drugs may improve pain and quality of life of patients with OP. The heterogeneity in design, choice of endpoints, methodology, comparators and follow-up duration of included randomized clinical trials and real-life studies does not allow so far to identify a predominant antiosteoporosis drug or an optimal dosage for pain relief. These gaps need to be addressed and warrant further research in the future for optimizing pain improvement in the course of OP drug treatment.

Consultation-Liaison Case Conference: Suicidal Ideation in a Patient at the End-of-Life.

Psychiatric comorbidities are common among patients approaching the end of life, often necessitating the involvement of consultation-liaison psychiatrists. We present the case of a patient with advanced metastatic prostate cancer and a complicated hospital course who made suicidal remarks and requested a hastened death. This common and challenging clinical scenario requires a multidisciplinary approach. In this article, experts in consultation psychiatry, palliative care, and psycho-oncology describe helpful diagnostic and therapeutic strategies for such cases. The key learning points are the differential diagnoses in end-of-life patients endorsing suicidal ideation, the psychiatric management of oncological and palliative care patients, the implementation of a safe discharge plan, and the role of the consultation-liaison psychiatrist in hospice care.

Evaluating variation in pre-operative evaluation and planning for children undergoing atrial or ventricular septal defect repair.

CHD care is resource-intensive. Unwarranted variation in care may increase cost and result in poorer health outcomes. We hypothesise that process variation exists within the pre-operative evaluation and planning process for children undergoing repair of atrial septal defect or ventricular septal defect and that substantial variation occurs in a small number of care points. From interviews with staff of an integrated congenital heart centre, an initial process map was constructed. A retrospective chart review of patients with isolated surgical atrial septal defect and ventricular septal defect repair from 7/1/2018 through 11/1/2020 informed revisions of the process map. The map was assessed for points of consistency and variability. Thirty-two surgical atrial septal defect/ventricular septal defect repair patients were identified. Ten (31%) were reviewed by interventional cardiology before surgical review. Of these, 6(60%) had a failed catheter-based closure and 4 (40%) were deemed inappropriate for catheter-based closure. Thirty (94%) were reviewed in case conference, all attended surgical clinic, and none were admitted prior to surgery. The process map from interviews alone identified surgery rescheduling as a point of major variability; however, chart review revealed this was not as prominent a source of variability as pre-operative interventional cardiology review. Significant variation in the pre-operative evaluation and planning process for surgical atrial septal defect/ventricular septal defect patients was identified. If such process variation is widespread through CHD care, it may contribute to variations in outcome and cost previously documented within CHD surgery. Future research will focus on determining whether the variation is warranted or unwarranted, associated health outcomes and cost variation attributed to these variations in care processes.

Incorporation of fellow-driven, interactive case-based discussions to improve fellowship education in a new fellowship program.

e23001 Background: Evidence-based education is crucial for meeting the evolving needs of learners in the oncology workforce. In this new virtual era, engagement of trainees in educational presentations has become increasingly difficult and reaping the benefits of a conventional didactic learning environment is challenging. Case-based learning is a relatively newer modality that is being used more commonly in teaching programs. In this study, we aimed to incorporate a novel, interactive case-based learning paradigm to improve fundamental knowledge and engagement among oncology trainees. Methods: We conducted six case conferences over 6 months. The case conferences were designed to encourage open discussion of real-life oncology cases. A faculty expert and specific topics were assigned to the presenters: colon, breast, gastric, hepatocellular (HCC), prostate, and non-small cell lung (NSCLC) cancer. Guidelines on the preparation of the case presentation were provided with 5 main pillars: specific staging/workup, first-line management with a landmark trial, second-line management, case-specific challenges, and mechanism of action and monitoring parameters for discussed drugs. Fellows completed a pre- and post-conference survey that assessed their perceived comfort level with the topic, quality of the presentation (post-conference) utilizing the 1–5 Likert scale (5 being extremely satisfied/comfortable), and test questions. Results: Nearly all of the 6 fellows responded to all surveys. The table shows the mean scores given by fellows on the surveys using the Likert scale and the percentage of test questions answered correctly. Overall, the fellows felt that the case conferences were a worthwhile experience. When comparing pre- and post-conference questions, the percentage of test questions correct overall improved for 5 of 6 conferences. Conclusions: The results of our study could have implications for the curriculum planning of hematology/oncology fellowships. [Table: see text]

Oral care reduces incidence of pneumonia after esophagectomy: systematic review and meta-analysis.

Post-operative pneumonia after esophagectomy is a major contributor to morbidity and mortality. Prior studies have demonstrated a link between the presence of pathologic oral flora and the development of aspiration pneumonia. The objective of this systematic review and meta-analysis was to evaluate the effect of pre-operative oral care on the incidence of post-operative pneumonia after esophagectomy. A systematic search of the literature was performed on September 2, 2022. Screening of titles and abstracts, full-text articles, and evaluation of methodological quality was performed by two authors. Case reports, conference proceedings, and animal studies were excluded. A meta-analysis of peri-operative oral care on the odds of post-operative pneumonia after esophagectomy was performed using Revman 5.4.1 with a Mantel-Haenszel, random-effects model. A total of 736 records underwent title and abstract screening, leading to 28 full-text studies evaluated for eligibility. A total of nine studies met the inclusion criteria and underwent meta-analysis. Meta-analysis revealed a significant reduction in post-operative pneumonia among patients undergoing pre-operative oral care intervention compared to those without an oral care intervention (OR 0.57, 95% CI 0.43-0.74, p < 0.0001; I2 = 49%). Pre-operative oral care interventions have significant potential in the reduction of post-operative pneumonia after esophagectomy. North American prospective studies, as well as studies on the cost-benefit analysis, are required.

Freiburg Neuropathology Case Conference

Freiburg Neuropathology Case Conference

Autism Spectrum Disorders in Adulthood: Empirical Findings on Comorbidities, Differential Diagnoses, and the Clinical Utility of the AQ

DDX and comorbidities were recorded with standardized scales in an autism outpatient clinic in 106 individuals. The AQ was tested against the expert judgment of an interdisciplinary case conference using ROC analysis. Affective disorders were common in both groups (48%); other DDX were phobias (33%) and personality disorders (22%). The AQ showed an AUC of 0,527 with sensitivity/specificity of 70%/35%. Adults suspected of having autism are highly burdened by DDX and comorbidities. An interdisciplinary diagnostic procedure based on standardized scales is useful, whereas the AQ hardly differentiates between persons with and without ASD.

Is there an association between oral hygiene and head and neck cancer?

PubMed, Web of Science, the Cochrane Library and Embase were utilised as databases from inception till November 2021. The inclusion criteria consisted of cohort and case-control studies published in the English language, which dealt with diagnosed cases of head and neck cancer reporting survival, oral hygiene and comparative data. Studies pertaining to animal experiments along with case reports, conference proceedings, reviews, letters, editorials, errata and protocols were excluded. Data such as publication year, authors' names, country, sources, study groups, age, gender, participant number, education, alcohol, tobacco, study quality, cancer site and outcomes were extracted for each included study. A modified Newcastle-Ottawa Scale was utilized to evaluate the quality of these studies. A total of forty-four studies were included, of which forty were case-control and four were cohort in nature. These comprised of a total of 52,863 patients of which 33,000 were devoid of head and neck cancer (HNC) while, 19,863 had a confirmed diagnosis of HNC. Oral hygiene and HNC were found to be associated. Poor oral hygiene was concluded to be associated with HNC and the subsites thereof.

Consultation-Liaison Case Conference: Psychiatric Care of Patients Who Undergo Bariatric Surgery.

We present the case of a 42-year-old female with major depressive disorder who received a Roux-en-Y gastric bypass and subsequently decompensated in her depression symptoms and began newly engaging in problematic alcohol use. Top experts in the consultation-liaison field, specifically bariatric surgery psychiatry, provide guidance for this commonly encountered clinical case based on their experience and a review of the available literature. Key teaching points include the presurgical psychosocial assessment, pertinent perioperative psychopharmacology, and problematic alcohol use after bariatric surgery.

Identification of Benefits of Participating in Content Mastery Services at SMPN 37 Muaro Jambi

Purpose of the study: The purpose of this study was to identify the benefits of participating in content mastery services in terms of attitudes and study habits, learning techniques/learning methods, and educational planning. Content mastery services in junior high schools are core activities supporting the implementation of the content mastery service process.&#x0D; Methodology: The population in this study were all students at SMP Negeri 37 Muaro Jambi with a total of 38 students. This research is a population research because all members of the population are the research samples. Data in this study were collected through a questionnaire with a dichotomous scale and processed using a percentage formula.&#x0D; Main Findings: The results of the study showed that (1) Identification of the benefits of participating in content mastery services related to attitudes and study habits at SMP Negeri 37 Muaro Jambi was at good quality (76.9%) meaning that attitudes and study habits were good. (2) Identification of the benefits of participating in content mastery services for indicators of learning techniques / learning methods at SMP Negeri 37 Muaro Jambi that are related to being of good quality (75.6%) meaning that learning techniques / learning methods are good, and (3) Identification of the benefits of participating in services mastery of the related educational planning indicator content at SMP Negeri 37 Muaro Jambi is of good quality (81%) meaning that planning for education is good. The implications of the research results for guidance and counseling services can be carried out in the following steps: (1) Help develop a classroom atmosphere, teacher-student relationships and student-student relationships that support the implementation of guidance and counseling. (2) Providing opportunities and facilities for students who need guidance and counseling services/activities to participate/undergo the intended services/activities. (3) Participate in special activities for handling student problems, such as case conferences, and (4) Assist in gathering information in the context of evaluating guidance and counseling services and follow-up efforts.&#x0D; Novelty/Originality of this study: Knowing the benefits of participating in content mastery services in terms of attitudes and study habits, learning techniques/learning methods, and educational planning.

P183 Disease activity, comorbidities and functional status predict treatment response to biologic and targeted synthetic disease-modifying anti-rheumatic drugs in psoriatic arthritis

Abstract Background/Aims Much discussion surrounds the optimal therapeutic treatment plan for biologic and targeted synthetic disease modifying anti-rheumatic drugs (bDMARDs/tsDMARDs) when treating psoriatic arthritis (PsA). The current study aims to identify predictors of treatment response among PsA patients initiating bDMARD/tsDMARD treatment, focusing on disease activity, functional status (Health Assessment Questionnaire, HAQ), and comorbidities. Methods The systematic review of clinical trials and observational studies used Medline, Embase and Cochrane databases. Eligible studies included full text papers with quantitative estimates of effect (or data to allow these to be computed). Papers also required a validated assessment of treatment response i.e., Minimal Disease Activity (MDA), or some other marker of treatment response such as treatment continuation. Case reports and conference abstracts were excluded. Results From 2824 articles identified, 27 were included. Across these, &amp;gt;15 different outcomes were used, and measured at &amp;gt; 10 different timepoints. There was consistent evidence to suggest that higher baseline disease activity was associated with a reduction in the likelihood of treatment response, see Table 1. Some studies reported up to 20% reduction in odds of LDA at 6 months associated with each 1 unit increase in DAPSA. Others demonstrated that patients with a high DAS28 (&amp;gt;3.2) experienced over a 90% reduction in the odds of MDA at 12 weeks. Eleven studies (from 15) demonstrated a significant association between baseline function and odds of treatment response. Each 1 unit increase in HAQ-DI decreased the odds of a good EULAR response at 3 months by up to 66%. The presence of comorbidities was also consistently associated with a decrease in treatment response. Studies showed that the presence of comorbidities at baseline lessened the odds of MDA at 6 months by up to 80%. Others reported that comorbidities were associated with a reduction in the odds of 5 year treatment persistence by up to 40%. Conclusion This review shows clear evidence of reduced bDMARD/tsDMARD response in PsA among patients with disease activity, poor function, and comorbidities. Clinicians should be aware of the reduced chances of treatment success and should consider early review of therapy, to consider whether treatment escalation or switching is required. Disclosure C. Addae-Kyereme: None. S. Lembke: None. G.J. Macfarlane: None. G.T. Jones: None.

Effects of high temperatures and heatwaves on dengue fever: a systematic review and meta-analysis

Studies have shown that dengue virus transmission increases in association with ambient temperature. We performed a systematic review and meta-analysis to assess the effect of both high temperatures and heatwave events on dengue transmission in different climate zones globally. A systematic literature search was conducted in PubMed, Scopus, Embase, and Web of Science from January 1990 to September 20, 2022. We included peer reviewed original observational studies using ecological time series, case crossover, or case series study designs reporting the association of high temperatures and heatwave with dengue and comparing risks over different exposures or time periods. Studies classified as case reports, clinical trials, non-human studies, conference abstracts, editorials, reviews, books, posters, commentaries; and studies that examined only seasonal effects were excluded. Effect estimates were extracted from published literature. A random effects meta-analysis was performed to pool the relative risks (RRs) of dengue infection per 1°C increase in temperature, and further subgroup analyses were also conducted. The quality and strength of evidence were evaluated following the Navigation Guide systematic review methodology framework. The review protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO). The study selection process yielded 6367 studies. A total of 106 studies covering more than four million dengue cases fulfilled the inclusion criteria; of these, 54 studies were eligible for meta-analysis. The overall pooled estimate showed a 13% increase in risk of dengue infection (RR=1.13; 95% confidence interval (CI): 1.11-1.16, I2=98.0%) for each 1°C increase in high temperatures. Subgroup analyses by climate zones suggested greater effects of temperature in tropical monsoon climate zone (RR=1.29, 95% CI: 1.11-1.51) and humid subtropical climate zone (RR=1.20, 95% CI: 1.15-1.25). Heatwave events showed association with an increased risk of dengue infection (RR=1.08; 95% CI: 0.95-1.23, I2=88.9%), despite a wide confidence interval. The overall strength of evidence was found to be "sufficient" for high temperatures but "limited" for heatwaves. Our results showed that high temperatures increased the risk of dengue infection, albeit with varying risks across climate zones and different levels of national income. High temperatures increased the relative risk of dengue infection. Future studies on the association between temperature and dengue infection should consider local and regional climate, socio-demographic and environmental characteristics to explore vulnerability at local and regional levels for tailored prevention. Australian Research Council Discovery Program.

Clinical ethics problems in psychiatry and the need for clinical ethics consultation in Japan: A cross-sectional study.

Psychiatrists often encounter ethical dilemmas in their daily clinical practice. Clinical ethics consultations (CECs) have been recently increasing, especially in general hospitals. However, the current situation in the psychiatric field is unclear. This study clarifies clinical ethics problems in psychiatry and determines the need for CECs. We conducted an anonymous self-administered questionnaire survey in February 2022, which targeted directors and supervisors of psychiatric specialty training programs at 1224 psychiatry facilities. Responses were received from 311 facilities (response rate: 25.4%). CEC systems existed in 223 (72.2%) facilities, and medical safety committees were the most common. Clinical ethics problems occurred at 248 (80.3%) facilities; the most common method for managing the problems was discussions at case conferences without using CECs. The top four reasons for psychiatrists to solicit advice were conflicts with patients' relatives, treating a patient with cognitive impairment, discontinuation of treatment, and suicide/attempted suicide. Most respondents (89.9%) considered CECs necessary. Although CECs exist in psychiatry, they may not meet the needs of clients. Future studies are needed to investigate client satisfaction and CEC evaluation methods in facilities where psychiatric CECs are provided.

Information and Communication Technology Based Integrated Care for Older Adults: A Scoping Review.

Integrated care is an important initiative to respond positively to the ageing of society and information and communication technology(ICT) plays an important role in facilitating the integration of functional and normative health and social care. The scoping review aims to synthesize evidence on the experience and practice of ICT-based implementation of integrated care for older adults. This study followed the research framework developed by Arksey and O'malley for the scoping review and systematically searched for relevant studies published between 1 January 2000 and 30 March 2022 from nine electronic databases, three specialist journals, three key institutional websites, 11 integrated care project websites, google scholar and references of the studies to be included. Two reviewers independently screened and extracted data and used thematic analysis to sort out and summarize the core elements, hindrances and facilitators of ICT-based integrated care. A total of 77 studies were included in this study, including 36 ICT-based practice models of integrated care with seven core elements of implementation including single entry point, comprehensive geriatric assessment, personalized care planning, multidisciplinary case conferences, coordinated care, case management and patient empowerment, which generally had a positive effect on improving quality of life, caregiver burden and primary care resource utilization for older adults, but effectiveness evaluations remained Heterogeneity exists. The barriers and facilitators to ICT-based implementation of integrated care were grouped into four themes: demand-side factors, provider factors, technology factors and system factors. The implementation of ICT-based integrated care for the elderly is expected to improve the health status of both the supply and demand of services, but there is still a need to strengthen the supply of human resources, team training and collaboration, ICT systems and financial support in order to promote the wider use of ICT in integrated care.

Bilateral trauma case conferences: an approach to global surgery equity through a virtual education exchange.

With increased interest in international surgical experiences, many residency programs have integrated global surgery into their training curricula. For surgical trainees in low- and middle-income countries (LMICs), physical exchange can be costly, and laws in high-income countries (HICs) prevent LMIC trainees from practicing surgery while on visiting rotations. To enrich the educational experience of trainees in both settings, we established a monthly virtual trauma conference between surgery training programs. General surgery teams from two public institutions, a public university with two surgical training programs in Kenya and a public university with two level I trauma centers in the United States, meet monthly to discuss complex and interesting trauma patients. A trainee from each institution presents a clinical case vignette and supplements the case with pertinent peer-reviewed literature. The attendees then answer a series of multiple-choice questions like those found on surgery board exams. Monthly case conferences began in September 2017 with an average of 24 trainees and consultant surgeons. Case discussions serve to stimulate dialogue on patient presentation and management, highlighting cost-conscious, high-quality care and the need to adapt practice patterns to meet resource constraints and provide culturally appropriate care. Our 5-year experience with this virtual case conference has created a unique and robust surgical education experience for trainees and surgeons who have withstood the effects of the pandemic. These case conferences have not only strengthened the camaraderie between our departments, but also promoted equity in global surgery education and prioritized the learning of trainees from both settings.

Low Prevalence of Use of Allied Health and Community Services for Patients with Cirrhosis in Australia: A Need for Greater Engagement.

Psychosocial, lifestyle and practical needs are not routinely attended to during outpatient hepatology management, and little is known about the type and effectiveness of support services accessed by patients with cirrhosis. We quantified the type and use of community and allied health services in patients with cirrhosis. The study included 562 Australian adults with a diagnosis of cirrhosis. Health service use was assessed via questionnaire and via linkage to the Australian Medicare Benefits Schedule. Patient needs were assessed using the Supportive Needs Assessment tool for Cirrhosis (SNAC). Although most patients (85.9%) used at least one community/allied health service for support with their liver disease, many reported requiring additional help with psychosocial (67.4%), lifestyle (34.3%) or practical needs (21.9%) that were not met by available services, or patients did not access services. A multidisciplinary care plan or case conference (in the 12 months prior to recruitment) was accessed by 48% of patients, 56.2% reported the use of a general practitioner for support with cirrhosis, and a dietician was the allied health clinician most accessed by patients (45.9%). Despite the high prevalence of psychosocial needs, there was relatively limited use of mental health and social work services (14.1% of patients reported the use of a psychologist), confirmed by a low prevalence of use of mental health services (17.7%) in the linked data. Patients with cirrhosis who have unmet complex physical and psychosocial needs require better strategies to increase their engagement with allied health and community services.

Participatory rights of older adults at risk in adult protection case conferences

PurposeThe Adult Support and Protection (Scotland) Act 2007 (ASP Act) mandates public bodies to investigate situations of harm and to support and protect adults at risk. One of the fundamental principles of the legislation is to involve the person in the adult protection process. Older people are highly represented among those defined as adults at risk and have the right to participate in decisions about their lives. However, contextual factors can impact participatory parity, and participation can be tokenistic. Drawing on the author’s practice experience, this paper aims to explore the supports and barriers to meaningful participation in adult protection.Design/methodology/approachBased on practice during the first decade of the ASP Act, this paper uses amalgamated scenarios involving older adults at risk to illustrate some of the key themes emanating from literature.FindingsDespite Human Rights Conventions and law promoting participatory principles, research evidence and practice experience suggests that ethical principles do not always translate to practice. Within adult protection case conferences (APCCs), participation is nuanced and multifaceted, involving individual and structural facilitators and impediments. APCCs can be inhospitable environments for the adult at risk. But they also have the potential to be collaborative and supportive spaces, promoting the person’s self esteem and agency. The author plans to conduct research with service users and practitioners exploring the extent to which APCCs can facilitate meaningful participation.Originality/valueThis paper contributes to the wider debate about the participatory rights of service users and the value of experiential knowledge.