Cohesive Multidisciplinary Team Research Articles

Team‐Based Learning Approach to Practice Improvements in a Memory Clinic

AbstractBackgroundWorkface projections indicate an increasing shortfall in neurologists and other medical specialists to treat persons with Alzheimer’s disease and other causes of dementia (Dall et al. Neurology 2013). This problem will be further magnified by available disease modifying therapies aimed at earlier stages of illness, markedly expanding the patient pool (Anderson et al. J Prev Alzheimers 2022; Hlavka et al. Rand 2019). With the Alzheimer’s disease treatment landscape approaching these turning points the University of Alabama at Birmingham Brain Aging and Memory (BAM) Clinic undertook a multidisciplinary expansion to improve access and increase the role of nonphysician professionals to optimize care. Onboarding this interdisciplinary team was complicated by separation of staff members mandated by the COVID‐19 pandemic. These factors, along with emerging use of “team‐based learning” educational models led to the creation of the BAM Learning Club (BAM LC).MethodsBAM LC is a weekly synchronous online series of didactics, lectures, case discussions, journal reviews, and team‐building wellness activities. Participants include Neurologists, Psychiatrists, Psychologists, RN Case managers, RN Clinical Care Coordinators, Social Workers, Nurse Practitioners, Pharmacists, Caregiver Counselors, Research Scientists, Clinical Trial Coordinators, Postdoctoral Fellows, Residents, and Medical Students. Sessions are recorded for future onboarding and educational needs. Content is generated by the BAM LC members with support from its director.ResultsBAM LC began in June 2021 and has continued weekly with increasing interest and attendance. Shared learning has led to practice improvements, a collaborative environment, and a cohesive multidisciplinary team. Recorded sessions have been used to provide education outside of our cohort and will be maintained for future use.ConclusionTeam‐based learning has resulted in better academic, clinical, and communication outcomes among health care professionals (Joshi et al. Cureus 2022). Multidisciplinary team‐led learning opportunities focused on dementia care could serve as a tool to promote further practice improvement, collaboration, and cohesion within healthcare organizations. Normalization of synchronous remote learning during the pandemic facilitated acceptance, uptake, and participation across disciplines. This process also has the potential to provide further system‐wide education in health systems to diversify the workforce and improve readiness to treat a rapidly expanding patient population.

A63The use of simulation based education (SBE) to improve recognition and management of patients in the transition from acute to end of life care

Recognizing and managing a deteriorating patient, in any setting, can be a challenging and distressing event for health care providers (HCPs). End of life care is a core component of nursing and medical education, yet historically has received minimal focus. Simulation Based Education (SBE) has been shown to be an effective tool for enhancing HCPs competence and confidence when involved with complex clinical scenarios and advocating patient-centred care [1]. The national drive to increase recognition and provision of timely, individualized end of life care is catalysing the need for multidisciplinary team education [2] [3]. To design, deliver and modify SBE programme to enhance quality of patient care as they deteriorate. SBE will be utilized to achieve this by increasing both confidence and competence of a cohesive multidisciplinary team when involved in the care of deteriorating patients. Three SBE study days are held each year which are booked through an online portal. The sessions are facilitated by HCPs from intensive care, palliative medicine, and the practice development team. A handbook outlining SBE scenarios and learning objectives is distributed in advance, this pre-brief allows learners to prepare and understand the format of the day. The teaching day is structured with three clinical scenarios following a patient through different stages of their illness: initially an acute assessment and escalation, leading to consideration of individual treatment escalation plans and ultimately their end-of-life care. Learning through simulation is multifaceted through evidence-based role play, with observers as learners and collective debriefing through facilitated feedback after every scenario. Online feedback provided by all learners has been collated throughout the four-year course development process. Evaluations revealed three main themes; learners valued SBE in terms of replicating practice, de-briefing discussions consolidated learning and enabled learners the opportunity to understand how it will improve their practice and value was placed on multidisciplinary team learning. SBE is an effective method of enhancing the quality of individualized and coordinated care delivered to a deteriorating patient in any setting by HCPs. As an effective tool it also stands aligned with the national drive to improve recognition of patients at the end of their life with proactive advance care planning discussions and holistic care for the dying and their families. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Practical approaches to building up a cardiorenal clinic.

The population with concomitant heart and kidney disease (often termed 'cardiorenal' disease) is expected to grow, significantly impacting public health and healthcare utilization. Moreover, the cardiorenal nexus encompasses a bidirectional relationship that worsens prognosis and may complicate pharmacological management in often elderly and frail patients. Therefore, a more cohesive multidisciplinary team approach aiming to provide holistic, coordinated and specialized care would be a positive shift towards improving patient outcomes and optimizing healthcare resources. This article aims to define the organizational aspects and key elements for setting up a multidisciplinary cardiorenal clinical program as a potential healthcare model adapted to the particular characteristics of patients with cardiorenal disease.

Evaluating the impact of a joint Clinical Nurse Specialist and Allied Health Care Professional clinic for neuro-oncology patients attending Velindre Cancer Centre, Cardiff

Abstract Aims Key governing guidelines recognise that the holistic and complex needs of neuro-oncology patients are best served by a cohesive multidisciplinary team (MDT). Achieving a joint Clinical Nurse Specialist (CNS) and Allied Healthcare Professional (AHP) clinic (including Speech and Language Therapy, Physiotherapy, Dietetics and Occupational Therapy) for neuro-oncology patients has been a longstanding vision at Velindre Cancer Centre (VCC) in Cardiff. A successful funding application to Welsh Government in July 2020 allowed the establishment of a virtual “one stop shop” clinic with CNS and AHPs available along the care trajectory to improve patient and carer quality of life. The project reports on whether this innovative clinic model successfully achieved the desired coordinated, anticipatory and holistic care. Method The project utilised service improvement methodology principles with aims inherent within quarterly timeframes. This included robust data collection on patient attendances and interventions, improving patient education and self-management and wide patient, care and staff engagement by means of questionnaires and semi-structured interviews. The mixed methods approach yielded rich quantitative and qualitative data. Results The data demonstrates an increasing demand for the joint neuro-oncology clinic indicating that additional resources may be required. From triangulation of patient, carer and wider team engagement the key benefits were perceived to be having accessibility to the team in a convenient way, the provision of support and timely information and the overall perception of enhanced holistic care. Conclusion The data demonstrates the huge successes of the joint neuro-oncology clinic so far, including improvements to patient and carer quality of life, wider VCC benefits and cost saves. The persuasive case was presented to Welsh Government, and ongoing endorsement has been achieved for the next financial year.

54. Evaluation and Management Considerations of Gynecologic Issues in Adolescents with Anorectal Malformations

<h3>Background</h3> Girls born with anorectal malformations (ARMs) and bladder exstrophy have a greater incidence of Mullerian and genital anomalies requiring early gynecologic assessment and frequent surgical intervention. As early childhood surgical and medical management of children with ARMs and bladder exstrophy has improved over recent decades, there remains little guidance or framework for recognizing and managing gynecologic and pubertal concerns in the adolescent and young adult years. <h3>Case</h3> A retrospective review was performed for 10-25-year-old female patients born with ARMs, cloaca, or exstrophy that presented to our multidisciplinary clinic between 2009 and 2019. This resulted in twelve unique patients who presented with gynecologic concerns at an average age of 14.6 years. Nine patients had ARMs (including 2 with cloaca and 4 with cloacal exstrophy). The most common presenting symptom was dysmenorrhea (n=8). Six were identified as having an obstructed Mullerian anomaly and 3 had a gynecologic obstruction due to stenosis from prior surgery. Compared to the younger children with ARMs, this population had concerns about vaginal and introital cosmesis, fertility, gender identity, sexuality, and mental health. An overarching theme was the need for a cohesive multidisciplinary team including the surgical subspecialists, gastroenterologists, and psychologists with a heightened awareness of increasing patient autonomy in the adolescent period. <h3>Comments</h3> Patients with ARMs, cloaca, or exstrophy may re-present during adolescence with a unique set of gynecologic concerns. The adolescent should be actively involved in the decision making, and the physician team should have a heightened awareness of psychological and reproductive issues and considerations of long-term concerns and needs.

Value of clinical, ultrasonographic and MRI signs as diagnostic differentiators of non-benign lipomatous tumours

Suspicion of malignant change within a lipoma is a common and increasing workload within the UK Sarcoma multidisciplinary team (MDT) network, and a source of considerable patient anxiety. Currently, there is no lipoma-specific data, with regard to which clinical or radiographic features predict non-benign histology, or calculate an odds-ratio specific to a lipomatous lesion being non-benign. We performed a 9-year, double-blind, unmatched cohort study, comparing post-operative histology outcomes (benign versus non-benign) versus 15 signs across three domains: Clinical (size of tumour, depth, growth noticed by patient, previous lipoma, patient felt pain), Ultrasonographic (size, depth, vascularity, heterogenous features, septae) and MRI (size, depth, vascularity, heterogenous features, septae, complete fat signal suppression). Receiver operating characteristic (ROC) analysis, odds ratios and binary logistic regression analysis was performed double-blind. When each sign is considered independently, (ROC analysis, followed by binary logistic regression) only Ultrasound depth is a significant predictor (p = 0.044) of a histologically non-benign lipoma. Ultrasonographically determined vascularity and septation were not statistically significant predictors. None of the clinical signs were statistically significant (p > 0.05). Of the MRI signs none was statistically significant (p > 0.05). However, heterogeneous MRI features fared better than MRI depth. Ultrasound signs (Pseudo R-Square = 0.105) are more predictive of the post-operation histology outcome than Clinical signs (Pseudo R-Square = 0.082) or MRI tests (Pseudo R-Square = 0.052) Ultrasound and Clinical tests combined (Pseudo R-Square = 0.147) are more predictive of the post-operation histology outcome than MRI tests (Pseudo R-Square = 0.052). This work challenges the traditional perception of “red-flag” signs when applied to lipomatous tumours. We provide accurate data upon which an informed choice can be made, and provides a robust bases for expedited risk/benefit. The importance of an experienced and cohesive MDT network is emphasised.

Efectos fisiológicos y psicológicos de la risoterapia en la población pediátrica: una revisión sistematizada

The aim of this study is to review the physiological and psychological effects of laughter therapy among paediatric population. A systematic database review will be carried according to the modified PRISMA’s statement criteria. To do so, articles that may reflect the chosen topic will be researched. This research will be limited to last decade discoveries in languages such as: Spanish, English, Portuguese and French. Laughter therapy is performed by specialised trained clowns, known as “Clown-Doctors”. It has been recognised in the hospital environment that hospital clowning offers a positive impact to the children’s hospitalisation process. Moreover, studies confirm that the interaction with Clown-Doctors lessens the children’s anxiety. This also contributes to the ensuring higher rates of adherence to medical treatment. Furthermore, it has been widely recognised by health professionals that Clown-Doctors facilitate therapeutic processes and the handling of paediatric patients when diagnostic-therapeutic procedures or parent’s separation occur. Humour, games, music and magic tricks are some of tools used to create a therapeutic relationship with the child. Paediatric hospitalisation should guarantee both physical therapy and the proper care of possible psychological side effects that the process may produce. Nursing staff therefore, must ensure they provide an integral care to the patient having in mind the different caring tools at their disposition. Laughter therapy, as a complementary treatment, ensures a holistic approach in the taking care of the paediatric population. These patients constitute a vulnerable group in hostile environments such as that of hospitals. For this reason, a cohesive multidisciplinary team, in which communication is prioritised, is necessary.

Safety and Outcomes of Combined Liver Transplantation and Cardiac Surgery in Cirrhosis

Decompensation of liver function after cardiac surgery in patients with cirrhosis has resulted in high morbidity and mortality. A treatment strategy, for which there is a scarcity of data in the literature, encompasses combined liver transplantation and cardiac surgery. We performed a retrospective analysis of prospectively collected data on 15 patients who underwent combined liver transplantation and cardiac surgery between 2005 to 2017 at our institution. Between 2005 and 2017, 15 patients with cirrhosis and coronary artery disease or valve disease were identified who underwent combined liver transplantation and cardiac surgery. The cardiac disease was considered severe enough to preclude liver transplantation alone. Likewise, the advanced cirrhosis precluded cardiac surgery alone. Eighty percent of the patients were male and average age was 60 years. Six patients had coronary artery disease, 2 patients had severe aortic stenosis and coronary artery disease, 1 patient had severe mitral regurgitation and coronary artery disease, 2 patients had severe aortic stenosis, 1 patient had mitral valve prolapse, and 3 patients had severe aortic insufficiency. The mean model for end-stage liver disease score was 24. Four subjects were Child-Pugh class B, and 11 were class C. One-year survival was 73.3%. Combined liver transplant and cardiac surgery is feasible in this selected, otherwise inoperable, patient population with an acceptable early and midterm survival when performed in high volume centers with a cohesive multidisciplinary team.

Lasting lessons learnt in the radiology department from the battle with COVID-19

Lasting lessons learnt in the radiology department from the battle with COVID-19

A cohesive multidisciplinary team approach to the management of patients with eating disorders

Eating disorders can be a life threatening illness not only due to the effects of starvation, but also the effects of impaired capacity. At Robina Hospital, patients admitted with a BMI < 14 are admitted to the Acute Medical Unit (AMU) for nutritional restoration and medical management before being transferred to a suitable mental health ward for ongoing treatment. The AMU at Robina has been managing patients with eating disorders, in particular Anorexia Nervosa for a number of years. The treatment plan implemented by the Acute Medical team is considered to be of a very high standard by the Eating Disorders Outreach Service (EDOS), a specialist consulting liaison service provided by the Royal Brisbane and Women's Hospital. The AMU prides itself on developing a cohesive multidisciplinary team approach, striving for best practice management by utilising protocols and guidelines developed by the EDOS service. This presentation will discuss the experiences of the Acute Medical Team in managing eating disorder patients. It will outline the team structure, current practices and guidelines used and identify areas of improvement recognised through lessons learned. The aim is to present information and experiences that may assist other acute inpatient medical settings in managing eating disorder patients discussing evidence based strategies developed to support and improve the management and physical health of patients with eating disorders. This abstract was presented in the Care in Inpatient and Community Settings stream of the 2013 ANZAED Conference.

P47 Inter professional practice placements in a Hospice setting

BackgroundPalliative care patients can have complex multidimensional needs. A cohesive multidisciplinary team is vital in the provision of quality care. To achieve this, healthcare professionals need to work alongside and...

PURE Communication: A Strategy to Improve Care Coordination for High-Risk Birth

High-risk birth can be an emotionally charged and, sometimes, emergent event that requires a cohesive multidisciplinary team. Communication breakdowns in perinatal emergencies are known to contribute to errors and adverse patient outcomes. One approach to breaching these barriers is the Purposeful, Unambiguous, Respectful, and Effective (PURE) process. The PURE process is a method of communication that emphasizes coordination and recognizes the contributions of each member of the team. The purpose of this article is to describe how the PURE process works and how teamwork strategies, group skills training, and structured communication techniques complement it.

Achieving quality: the need for a multiprofessional approach

Donal O'Donoghue describes how the complexities of advanced renal disease result in the need for cohesive multidisciplinary team working to meet the patient's varied needs—clinical as well as practical, psychological and social. He argues that multidisciplinary team work includes involving patients in decision making about their treatment and health for a holistic care approach.

Research Issues Affecting Preoperative Systemic Therapy for Operable Breast Cancer

Preoperative systemic therapy (PST) in operable breast cancer allows a small increase in breast conservation rates and has significant potential as a research platform. PST offers the ability to discern treatment effect in vivo, and may allow smaller trials targeting specific breast cancer subtypes and making more efficient use of resources. Early observations of a specific outcome of interest in individual patient subgroups may improve the design of larger definitive randomized adjuvant trials using survival as a main outcome. PST offers the potential for therapeutic adjustments midcourse, which assumes the existence of validated intermediate end points and effective alternative therapies. This article reviews critical research issues affecting the design of PST trials, including the appropriate selection of trial end points and markers for long-term outcome, baseline marker expression as a predictor of response, and statistical considerations using novel trial designs. Key issues regarding optimal tumor subtype selection for individual trials, novel approaches using nontherapeutic window trial designs, and ethical and advocacy considerations are also discussed. PST requires an experienced and cohesive multidisciplinary team for it to fulfill its potential in both research and clinical care.

Universal newborn hearing screening: fine-tuning the process.

Universal newborn hearing screening (UNHS) is rapidly becoming the standard of care in hospitals across the country. The goals of Healthy People 2010 are to provide newborn hearing screening to all infants, ensure follow-up audiologic evaluations by 3 months of age, and provide smooth transition to early intervention by 6 months of age. Programs implemented in the 1990s are beginning to report data that will be useful to states new to screening. This article reviews recent trends, suggests appropriate screening protocols, and identifies areas for improvement in UNHS. Recent studies indicate the following: (1) screening programs can be cost-effective with low referral rates; (2) maternal stress is not necessarily a byproduct of screenings that end in referral; and (3) developmental outcomes for hearing-impaired infants born in screening hospitals are particularly encouraging. Areas for improvement include the following: (1) compliance in follow-up testing and (2) the establishment of a cohesive multidisciplinary team to manage the infant and provide support to the family. Hearing screening is only the first step in the care of a hearing-impaired infant. Programs need to ensure that families understand the necessity of follow-up testing without creating undue stress. The transition to early intervention should be seamless, with a cohesive team of health care professionals capable of providing medical, audiologic, communication, and educational management for the infant as well as emotional support for the family.