Survey Of Clinical Practice Research Articles

Developing a Clinical Service in Interventional Radiology: Results from the 2024 CIRSE Clinical Practice Survey.

Engaging in clinical service development is a prerequisite for Interventional Radiology (IR) to prosper as a full clinical discipline. The CIRSE Clinical Services in IR Task Force conducted a survey of CIRSE members worldwide to assess the current status of their clinical practice and to identify areas of practice requiring further support. An online questionnaire with 63 structured items was sent to 7,501 CIRSE members in November 2023. The survey was closed in January 2024 and a statistical data analysis was performed. A total of 520 complete responses were collected. 49.6% of respondents have an IR outpatient clinic, 34.5% have a dedicated IR day-case ward and 19.8% have dedicated inpatient beds. While 62% of respondents treat patients as the primary consultant responsible for their patients' care, 40.3% of respondents currently without their own beds have admitting rights to the hospital. Clinical practice activities are itemised in the work schedule of 41.3% of respondents and 45% routinely perform ward rounds. A total of 40% feel very positive with their personal clinical practice competency. With half of responding IRs having primary patient access and clinical services in place, the results are encouraging; however further engagement by those who are not yet involved is required. The authors advocate a step-wise approach towards clinical services starting with ward rounds, and subsequently taking increasing responsibility for each step in the IR patient pathway.

Barriers to Pediatric Rheumatology Care: A Survey of Pediatric Clinical Practices at Sheikh Khalifa Medical City in Abu Dhabi, United Arab Emirates.

Background Access to pediatric rheumatology (PR) is limited in Abu Dhabi, United Arab Emirates, with only three trained pediatric rheumatologists in Abu Dhabi. However, the limited access and current levels of PR care in the Abu Dhabi workforce have not yet been formally assessed. The objective of this study was to evaluate the confidence in the delivery of PR patient care and the need for a structured PR training program among pediatricians. Methods The anonymous web-based Google Forms survey (Google LLC, Mountain View, CA, USA) included 16 items on PR training programs and patient care. The survey was sent to physicians in the pediatric department in Sheikh Khalifa Medical City, Abu Dhabi, through June 2024. Results Among the 54 participants, the majority were general pediatricians (70.4%). Most participants encountered PR patients monthly (51.9%) or weekly (29.6%), yet 87% had less than one year of experience in PR. Confidence levels in examining, investigating, and managing PR patients were generally low to moderate, while physicians primarily reported high confidence in referring patients. A significant need for a structured PR training program at SKMC was identified, with 92.6% of participants advocating for its implementation. Conclusions The majority of pediatricians do not feel confident in examining, investigating, and managing pediatric patients with rheumatic diseases. There is a need for a structured PR program at Sheikh Khalifa Medical City, Abu Dhabi, due to a significant shortage in PR physicians.

Effectiveness of combined botulinum toxin and fissurectomy on chronic anal fissures - a systematic review.

Anal fissures are a debilitating benign condition, thought to be due to the hypertonicity of the internal anal sphincter resulting in localized ischaemia inhibiting healing. There are several surgical and non-surgical treatment options for chronic anal fissures. Clinical practice surveys report a trend toward sphincter-sparing options, reserving the more successful treatment of lateral sphincterotomy, with an incontinence rate up to 10%, for refractory fissures. A search of MEDLINE, Cochrane Database of Systematic Reviews and EMBASE for studies assessing sphincter-sparing treatment with botulinum toxin and fissurectomy was performed following PRISMA guidelines. Outcomes assessed included healing rate, persistence, recurrence, re-intervention and incontinence rates. Fifteen non-randomized studies assessed 978 patients managed with botulinum toxin and fissurectomy. The mean age was 40.8 years with a female predominance of 58.9%. Healing rate was reported on 14 of the 15 studies, with a healing rate of 81% (95% CI:0.67, 0.90). Persistence rate was reported as 15% (95% CI:0.07, 0.28) and a recurrence rate of 6% (95% CI: 0.01, 0.19). Re-intervention was required in 8% of patients with 55.1% requiring a repeat dose of botulinum toxin with or without fissurectomy. Incontinence appears to be transient with studies reporting a rate of 1% with median long-term follow up 23 months (range: 5-60 months). Combination fissurectomy and botulinum toxin is a safe and viable sphincter sparing treatment option, with moderate success rate and negligible complications. Randomized controlled trials are required to further strengthen the evidence for its use in chronic anal fissures.

An exploration of UK speech and language therapists' treatment and management of functional communication disorders: A mixed-methods online survey.

Functional Communication Disorders (FCDs) are one specific presentation of Functional Neurological Disorder (FND). FND is characterised by neurological symptoms, such as sensory and motor symptoms, which are not explained by neurological disease. Speech and language therapists (SLTs) have expertise in managing communication disorders, including FCDs, though is not known is what clinicians do in practice to treat and manage FCDs. To explore the clinical practices of SLTs who regularly manage FCDs in the UK, including the assessment and intervention approaches taken. An online survey was developed using Qualtrics software and piloted before dissemination. Participants were experienced SLTs working in the UK who managed at least three FCD referrals a year. The survey was developed with a mix of qualitative and quantitative questions. The survey was disseminated via social media and professional networks. There were 73 completed responses to the survey. Participants reported working with a range of FCDs clinically, with functional stuttering and articulation disorders seen most frequently. SLTs reported working with a wide range of multidisciplinary professionals when managing patients with FCDs, though lack of access to mental health professionals was raised as an issue. SLTs reported using a combination of formal and informal communication assessments. Interventions varied, with a wide range of psychological approaches informing treatment. Lack of specific training, evidence base and negative attitudes around functional neurological disorder (FND) were raised as ongoing issues. Therapists encountered a wide range of FCDs as part of their clinical practice, though there was a significant disparity in the service and interventions offered. SLTs feel their input can be effective, but lack the resources, training and evidence-based interventions to provide adequate care. What is already known on the subject FCDs are one manifestation of FND and can present as a wide range of communication disorders. SLTs encounter FCDs as part of clinical practice, but report feeling unsure and underprepared to manage these disorders. Consensus recommendations have provided some guidance on how to manage these disorders, though what was not known was what practising SLTs are doing in practice with FCD patients: what assessment, intervention and management strategies they use, and what they feel are the facilitators and barriers to effective management. What this study adds to the existing knowledge This is the first UK-wide survey of FCD SLT clinical practice. The survey found that SLTs are seeing a range of FCDs as part of their clinical practice. SLTs reported that they feel their input is effective, that they had confidence in their ability to provide assessment and intervention, and that SLT for FCDs should be routine. SLTs reported using a wide variety of approaches to assessment and intervention. Barriers to effective management included a lack of resources, training, negative staff attitudes towards FND, and lack of research and evidence-based interventions. What are the practical and clinical implications of this work? This survey has found that SLTs working across the UK are providing input for patients with FCDs, but frequently reported feeling isolated and lacking clinical peer support. This shows the potential for networking groups to support SLTs to learn and share resources. There is a training need for SLTs and other healthcare professionals to tackle pervasive negative attitudes towards FND. Common themes in intervention approaches were found, but there was variability in the specific approach taken. This requires further research to guide SLTs on the best evidence-based practice.

Sexuality after breast cancer treatment: A physician’s survey of current clinical practice

BackgroundSide effects of breast cancer treatment (BCT) impact patients’ general and sexual wellbeing. Sexuality related complaints are reported by 70% of breast cancer survivors mainly due to the genitourinary syndrome of menopause (GSM). In clinical care, sexual side effects are often un(der)detected because physicians as well as patients experience barriers to discuss sexuality-related issues. Materials and methodsWe composed an online survey ourselves using known definitions about sexuality and menopause and known factors for not discussing sexuality. We used multiple-choice questions with a Likert scale to optimize interpretation of the statements. 64 practitioners completed the survey. With this online survey, we examined physicians’ knowledge of −and attitude towards- sexual wellbeing and detection and treatment of GSM in breast cancer survivors (BCS). ResultsVaginal dryness and dyspareunia were the symptoms most associated with menopause (n = 63/64 (98 %) and n = 56/64 (87 %)) and sexuality (n = 63/64 (98 %) and n = 61/64 (95 %)). These 2 complaints were also the most discussed symptoms of menopause (vaginal dryness n = 51/64 (80 %) and dyspareunia n = 45/64 (70 %)). The main reason to not discuss these issues were absence of reporting GSM (n = 40/64 (62 %)) and absence of a direct cause to discuss GSM (n = 35/64 (55 %). 64 % (n = 41/64) of practitioners don’t feel sufficiently educated to discuss and treat GSM. They proposed vaginal estrogens to treat GSM as first or second line respectively in 12 % (n = 8/64) and 46 % (n = 30/64) of symptomatic BCS. DiscussionAlthough sexuality related complaints are common in BCS, 64% of all participating physicians feel they are not adequately trained to handle them. More attention towards training of physicians is needed to discuss GSM related complaints also when they are not spontaneously reported by a patient and with clear guidance towards the medical treatment of GSM in BCS.

Developing bullying prevention guidelines for nurse interns’ and its effects on their assertiveness

BackgroundBullying is a serious problem that has short and long term negative consequences for nurse interns. Bullying prevention guidelines have a great impact on reducing the incidence of bullying among nurse interns.AimThe present study aimed to evaluate the effect of developing bullying prevention guidelines on nurse interns’ assertiveness levels.MethodsA methodological study design was used to conduct the study at Ain Shams University Hospitals in Cairo Governorate, Egypt. The study subjects consisted of all nurse interns enrolled in the 2022–2023 internship year and their number 121 nurse interns. The data were collected using four tools: the Bullying Knowledge Questionnaire, the Negative Act Questionnaire Revised (NAQ-R), the Individual Bullying Behaviors in Clinical Practice Survey, and the Assertiveness Inventory.ResultsThe scores for total bullying knowledge and assertiveness after the implementation of the prevention guidelines were significantly increased (91.4% and 86.3%, respectively) among those who were exposed to bullying than among those with pretest scores of (34.7% and 11.8% respectively) (P < 0.001).ConclusionBullying prevention guidelines significantly reduced nurse interns bullying and improved their assertiveness. The study recommended the dissemination and generalization of the developed bullying prevention guidelines in different training settings.

Real-world outcomes in patients with chronic spontaneous urticaria receiving omalizumab: insights from a clinical practice survey

Objective Chronic spontaneous urticaria (CSU) is a debilitating inflammatory skin condition, often impacting quality of life. International guidelines recommend omalizumab, an anti-immunoglobulin E antibody, for second-line treatment. Our objective was to understand patient characteristics associated with prescription of omalizumab, and assess real-world outcomes in patients with CSU treated with omalizumab. Methods We analyzed data from the Adelphi Real World CSU Disease Specific Programme, a cross-sectional survey with retrospective data collection (December 2020–October 2021) from physicians and patients with CSU in the United States. Results Data from allergists (n = 45), dermatologists (n = 51), and primary care physicians (PCPs; n = 20) were included. At the time of data collection, one-third of patients were receiving omalizumab (n = 220) and 67% were eligible for but not receiving omalizumab (n = 455). Using logistic regression, the odds of receiving omalizumab were higher in patients whose entire bodies were affected by hives [odds ratio (OR) = 2.551; 95% confidence interval (CI) 1.502–4.333; p < 0.001] or with deteriorating/unstable prognoses at treatment initiation [OR = 2.219; 95% CI 1.031–4.777; p = 0.042], and lower in patients managed by PCPs [OR = 0.276; 95% CI 0.130–0.584; p < 0.001]. Estimates from an inverse probability weighted regression adjustment model indicated that patients receiving omalizumab had higher treatment satisfaction, improvements in itching, hives, angioedema, insomnia, and anxiety, and lower impact on work productivity, compared with patients not receiving omalizumab. Conclusion Around two-thirds of patients with CSU considered eligible for omalizumab were not receiving the guideline-recommended therapy. Patients receiving omalizumab had better real-world outcomes compared with patients not receiving omalizumab. Ensuring patients receive the most appropriate treatment could benefit patients with CSU.

Psychological aspects of vestibular disorders: a national survey of clinical practice.

This study examines how psychological aspects of vestibular disorders are currently addressed highlighting any national variation. An online survey was completed by 101 UK healthcare professionals treating vestibular disorders. The survey covered service configurations, attitudes towards psychological aspects and current clinical practice. Ninety-six per cent of respondents thought there was a psychological component to vestibular disorders. There was a discrepancy between perceived importance of addressing psychological aspects and low confidence to undertake this. Those with more experience felt more confident addressing psychological aspects. History taking and questionnaires containing one or two psychological items were the most common assessment approaches. Discussing symptoms and signposting were the most frequent management approaches. Qualitative responses highlighted the interdependence of psychological and vestibular disorders which require timely intervention. Barriers included limited referral pathways, resources and interdisciplinary expertise. Although psychological distress is frequently identified, suitable psychological treatment is not routinely offered in the UK.

A Chinese survey of clinical practice on the management of thyroid eye disease.

The management of thyroid eye disease (TED) has undergone significant changes for decades. The study sought to investigate current clinical practice on the management of TED in China. An online questionnaire survey was conducted from April to May 2023. The questionnaire involved diagnostic criteria for TED, multidisciplinary treatment (MDT) collaboration, and treatment preference for mild, moderate, and severe TED. A total of 289 questionnaires were collected, with 165 from endocrinologists and 124 from ophthalmologists. Only 36.7% of participants claimed there was an MDT clinical pattern for TED in their institutions. The coverage of biological agents was around 10% or lower. These were distinctly lower than in Western countries. About 62.6% of participants believed the incidence of TED has increased in recent years. Imaging techniques were used widely to assist in the diagnosis of TED. However, there was still controversy regarding the definition of proptosis in the Chinese population. Most doctors managed risk factors and provided orbital supportive treatments of artificial tears and glasses. For mild active TED, endocrinologists (39.4%) were inclined to recommend therapy for hyperthyroidism alone, while ophthalmologists (43.6%) preferred orbital corticosteroid injections. Currently, the most widely used treatment for moderate to severe active TED was high-dose intravenous corticosteroid (94.8%), while orbital radiotherapy combined with immunosuppressive agents was the most recognized second-line therapy (43.6%). The study documented the consistency and differences between current clinical practices in the management of TED in China and the recently updated guidelines. There was a remarkable difference between ophthalmology and endocrinology departments, warranting management optimization.

Brachytherapy for rhabdomyosarcoma: Survey of international clinical practice and development of guidelines

Background and purposeThe purpose of this study was to address the lack of published data on the use of brachytherapy in pediatric rhabdomyosarcoma by describing current practice as starting point to develop consensus guidelines. Materials and methodsAn international expert panel on the treatment of pediatric rhabdomyosarcoma comprising 24 (pediatric) radiation oncologists, brachytherapists and pediatric surgeons met for a Brachytherapy Workshop hosted by the European paediatric Soft tissue Sarcoma Study Group (EpSSG). The panel’s clinical experience, the results of a previously distributed questionnaire, and a review of the literature were presented. ResultsThe survey indicated the most common use of brachytherapy to be in combination with tumor resection, followed by brachytherapy as sole local therapy modality. HDR was increasingly deployed in pediatric practice, especially for genitourinary sites. Brachytherapy planning was mostly by 3D imaging based on CT. Recommendations for patient selection, treatment requirements, implant technique, delineation, dose prescription, dose reporting and clinical management were defined. ConclusionsConsensus guidelines for the use of brachytherapy in pediatric rhabdomyosarcoma have been developed through multicenter collaboration establishing the basis for future work. These have been adopted for the open EpSSG overarching study for children and adults with Frontline and Relapsed RhabdoMyoSarcoma (FaR-RMS).

Addressing ADL ability in people with poststroke cognitive impairments: A Danish survey of clinical practice

Background In Denmark, stroke represents a leading disability cause. While people with difficulties in performing activities of daily living (ADL) due to poststroke cognitive impairments are often referred to occupational therapy, limited knowledge is available on the nature of these services. Aim/Objective To explore how Danish occupational therapists describe their practice when addressing decreased ADL ability in people with poststroke cognitive impairments in hospital and municipality settings. Material and Methods National, cross-sectorial, web-based public survey. Results 244 occupational therapists accessed the survey; 172 were included in the analysis. Most respondents could indicate the theory guiding their reasoning; half used standardised assessments. Regarding intervention, restorative and acquisitional models were preferred; specific strategies were identified. Intensity: 30-45 min 3-4 times/week in hospitals; 30-60 min 1-2 times/week in municipalities. Conclusions Therapists report to be guided by theory in their reasoning. Standardised assessments are used to a higher extend than previously reported. Still, the results invite critical reflections on correct use of assessment instruments, content and intensity of interventions, and how therapists keep themselves updated. Significance The results document the need for practice improvements and may inform the definition of standard care in future trials.

P1039 RECtal OUtcomes in Paediatric Ulcerative Colitis (RECOUP-UC): An International Clinical Practice Survey of Paediatric Gastroenterologists

Abstract Background Ulcerative Colitis (UC) in childhood is associated with a higher risk of developing acute severe colitis and colectomy compared to adult populations. Following subtotal colectomy, the rectal remnant is typically oversewn and remains in-situ until ileal continuity surgery is undertaken. Access to such surgical expertise determines the timing of restorative surgery, which may range from months to years. There is a paucity of data regarding residual rectal activity during this interval, its medical management and clinical outcomes. Methods An electronic survey (SurveyMonkey) of clinical practice was disseminated to the paediatric inflammatory bowel disease (PIBD) community internationally. Data collected included treating centre demographics, local colectomy practices, expert opinion on rectal cuff assessment and management. Clinicians were asked to rank order the symptoms and signs considered most relevant to determining disease activity. They also ranked the clinical features they believed most important to patients. Descriptive statistics were used to present findings. Results Responses were collated from over 10 countries, including Ireland, Sweden, UK, Australia, Israel, Canada, Iran, Finland, UAE and Austria. Centre sizes were categorised based on total PIBD population. There was heterogeneity across centres - 16% of respondents were from small volume centres in the range of 0-100 patients, 45% were from medium sized centres (101-300), 25% were from large volume centres (301-500) and 12% treat &amp;gt;500 patients which we categorised as very large volume. Despite variation in centre volume majority of respondents (75%) diagnose &amp;gt;20 new cases of UC annually. Over 90% of respondents reported having no formal guideline for managing rectal disease. Most centres’ patients (60%) waited at least 3 months post-colectomy for restoration surgery. Mild intermittent symptoms were expected to continue by 60% of respondents. Of these symptoms, 45% ranked haematochezia as the most important in determining severity. There was no consensus on the best assessment tool to use; 30% use the PUCAI. Most (80%) use blood markers and endoscopy routinely to assess rectal activity. Favoured treatments include rectal therapy (80%) followed by oral steroids and surgical referral. All respondents agreed that additional research was needed. Conclusion International management of the rectum following subtotal colectomy in children is characterised by variable clinical practises, and a lack of guidelines or validated assessment tools. Additional research in the field is needed to address current literature deficits and improve care for children.

Respiratory Virus Transmission During Orthopaedic Surgery in Low and Middle Income Countries: A Survey of Knowledge and Clinical Practices

Healthcare workers are at high risk of contracting respiratory viruses at work by virtue of their increased levels of exposure [1,2,3]. Orthopaedic surgeons are particularly vulnerable due to aerosolization that occurs with the use of power tools [4,5]. Therefore, it is important for orthopaedic surgeons to be familiar with the proper use of personal protective equipment (PPE) as a part of their risk-reduction strategies against respiratory viruses. This, however, is not an area that receives much attention in most orthopaedic surgical departments, especially in low and middle income countries (LMICs) where PPE may not be universally available [4,5]. The aim of this study was to investigate the knowledge, beliefs and practices on PPE use by orthopaedic surgeons in a LMIC in the Eastern Caribbean. The data gleaned from this study would be valuable to inform future public health strategies in the face of evolving health challenges. This becomes especially important in light of the recent global pandemic with the respiratory virus, COVID-19.

Barriers and facilitators to the assessment of cognitive-communication disorders in children and adolescents after traumatic brain injury: a survey of Australian clinical practice

Barriers and facilitators to the assessment of cognitive-communication disorders in children and adolescents after traumatic brain injury: a survey of Australian clinical practice

International clinical assessment of smell: An international, cross-sectional survey of current practice in the assessment of olfaction.

Olfactory dysfunction (OD) is common and carries significant personal and societal burden. Accurate assessment is necessary for good clinical and research practice but is highly dependent on the assessment technique used. Current practice with regards to UK/international clinical assessment is unknown. We aimed to capture current clinical practice, with reference to contemporaneously available guidelines. We further aimed to compare UK to international practice. Anonymous online questionnaire with cross-sectional non-probability sampling. Subgroup analysis according to subspeciality training in rhinology ('rhinologists' and 'non-rhinologists') was performed, with geographical comparisons only made according to subgroup. ENT surgeons who assess olfaction. Responses were received from 465 clinicians (217 from UK and 17 countries total). Country-specific response rate varied, with the lowest rate being obtained from Japan (1.4%) and highest from Greece (72.5%). Most UK clinicians do not perform psychophysical smell testing during any of the presented clinical scenarios-though rhinologists did so more often than non-rhinologists. The most frequent barriers to testing related to service provision (e.g., time/funding limitations). Whilst there was variability in practice, in general, international respondents performed psychophysical testing more frequently than those from the UK. Approximately 3/4 of all respondents said they would like to receive training in psychophysical smell testing. Patient reported outcome measures were infrequently used in the UK/internationally. More UK respondents performed diagnostic MRI scanning than international respondents. To our knowledge, this is the most comprehensive UK-based, and only international survey of clinical practice in the assessment of OD. We present recommendations to improve practice, including increased education and funding for psychophysical smell testing. We hope this will promote accurate and reliable olfactory assessment, as is the accepted standard in other sensory systems.

Use of platelet transfusions and tranexamic acid in patients with myelodysplastic syndromes: A clinical practice survey.

Thrombocytopenia and bleeding are common in myelodysplastic syndromes (MDS), but optimal management is unknown. We conducted a survey to identify current clinical practice regarding platelet transfusion (PLT-T) and tranexamic acid (TXA) to inform future trial design. A 25-question survey was distributed to members of the ALLG from December 2020 to July 2021. Sixty-four clinicians across Australia, New Zealand and Singapore responded. Clinicians treated a median of 15 MDS patients annually. Twenty-nine (45%) reported having institutional guidelines regarding prophylactic PLT-T. Although 60 (94%) said they would consider using TXA, most (58/64; 91%) did not have institutional guidelines. Clinical scenarios showed prophylactic PLT-T was more likely administered for patients on disease-modifying therapy (49/64; 76%, commonest threshold <10 × 109 /L) or with minor bleeding (32/64 [50%] transfusing at threshold <20 × 109 /L, 23/64 [35%] at <10 × 109 /L). For stable untreated patients, 29/64 (45%) would not give PLT-T and 32/64 (50%) would. Most respondents (46/64; 72%) were interested in participating in trials in this area. Potential barriers included resource limitations, funding and patient/clinician acceptance. Real-world management of MDS-related thrombocytopenia varies and there is a need for clinical trials to inform practice.

Prosthetic Curricular Threads: Pilot Survey of Clinical Practice and Physical Therapy Education

ABSTRACT Introduction Physical therapists play a critical role in the rehabilitation of persons with limb loss/limb difference. The introduction to the skills and knowledge necessary to provide skilled care occurs during the physical therapist’s education in an accredited physical therapy program. Although clinical practice evolves as technological changes manifest and the evidence base progresses, it is unclear whether physical therapy education is adapting to stay current with clinical practice. Purpose The aim of this study was to explore the alignment of clinical practice with physical therapy education as it relates to prosthetic-specific curriculum. Methods Surveys were sent to inpatient rehabilitation hospitals, prosthetic service clinics, and accredited physical therapy programs. Each survey was designed to assess both limb loss/limb difference rehabilitation and prosthetic specific-content germane to the setting being surveyed. Results Sixty-eight physical therapy programs, 48 prosthetic-service providers, and 14 rehabilitation hospitals responded. Just over one third of physical therapy education programs reported having a course dedicated solely to prosthetic-related content. There was general alignment between what is being taught and what is being practiced in the clinics; however, there was variation in specific content and time devoted to prosthetic-related curriculum across programs. Conclusions Further alignment of prosthetic-related content and clinical practice is needed in physical therapy programs. Clinical Relevance Statement More careful alignment of prosthetic curricular content with clinical practice in physical therapy programs will increase the effectiveness of rehabilitation programs and help persons with amputations regain more function and quality of life.

Shoulder Spasticity Treatment With Botulinum Toxin: A Nationwide Cross-Sectional Survey of Clinical Practices

Shoulder Spasticity Treatment With Botulinum Toxin: A Nationwide Cross-Sectional Survey of Clinical Practices

Neuropsychological feedback: a survey of Australian clinical practice

ABSTRACT Objective There is increasing evidence for the benefits of providing neuropsychological assessment feedback to patients and caregivers, but the current practices of clinical neuropsychologists are unclear. This survey study aimed to determine the provision of neuropsychological feedback practices by Australian neuropsychologists across a range of settings and patient groups. Method An online survey was circulated to eligible practising clinicians via an Australian Google Group of clinical neuropsychologists. The survey comprised demographic, education, and practice-related questions, followed by questions relating to the participants’ training, experience and confidence in providing neuropsychological feedback. Participants were also asked about the usefulness and barriers to feedback. Results Of the 102 clinicians who participated, 60% reported that they routinely provide neuropsychological assessment feedback and a further 16% provide it frequently. Participants reported high confidence in their capacity to provide feedback. However, there was variability across different patient groups, with the highest frequency of routine feedback seen in the paediatric setting and the lowest in the areas of mild cognitive impairment and dementia. The duration and aims of feedback were relatively consistent, with most sessions lasting 30–60 minutes and covering similar themes. Conclusions In summary, Australian neuropsychologists who participated are providing regular neuropsychological feedback services across a range of patient groups and are confident to do so. However, there were substantial differences in the frequency of feedback provided across patient groups. Further research is needed to determine the effectiveness of neuropsychological feedback across patient groups and the barriers to providing routine feedback, particularly for older adults.

Multidisciplinary Management of Phyllodes Tumours and Breast Sarcoma: A Cross-sectional Survey of Clinical Practice across the UK and Ireland

AimsPhyllodes tumours and breast sarcomas are uncommon tumours and their rarity poses significant challenges in diagnosis and management. This cross-sectional study was conducted to evaluate the multidisciplinary clinical practice for these tumours across the UK and Ireland, with the aim of identifying gaps in knowledge and providing direction for establishing national guidelines. Materials and methodsAn international survey was adapted and circulated to breast and/or sarcoma surgeons and oncologists in the UK and Ireland through national organisations. Multidisciplinary team (MDT) responses were analysed anonymously. ResultsTwenty-eight MDTs participated in this study, predominately from high-volume units (85.5%). Although only 43% of the surveyed units were part of a trust that holds a sarcoma MDT, 68% of units managed malignant phyllodes and angiosarcoma, whereas 64.5% managed soft-tissue sarcoma of the breast. Across all subtypes, axillary surgery was recommended by 14–21% of the MDTs and the most recommended resection margins for breast surgery were ‘no tumour on ink’ in benign phyllodes (39%) and 10 mm in the remaining subtypes (25–29%). Immediate breast reconstruction was supported by 11–18% of MDTs for breast sarcoma subtypes, whereas 36% and 32% advocated this approach in benign and borderline phyllodes tumours, respectively. Adjuvant radiotherapy and chemotherapy were recommended by up to 29% and 11% of the MDTs, respectively. ConclusionThe results of this study demonstrate a wide variation in clinical practice across the surveyed MDTs. As only 28 MDTs participated in our study, with under-representation from low-volume units, our results might be an underestimation of the variability in practice across the UK and Ireland. This multi-institutional study sheds light on controversial aspects in the management of phyllodes tumours and breast sarcoma, identifies the need for national guidelines to inform best practice, and calls for the centralisation of the management of breast sarcoma within specialist centres.