Consultation Team Research Articles

Choosing the right (HR) metrics: digital data for capturing team proactivity and determinants of content validity

PurposeThe purpose of this paper is to explore how positive organizational behaviors, specifically team proactivity, can be captured through digital data and what determines content validity of these data. The aim is to enable scientifically rigorous HR analytics projects for measuring and managing organizational behavior.Design/methodology/approachResults are derived from interview data (N = 24) with team members, HR professionals and consultants of HR software.FindingsBased on inductive qualitative content analysis, the authors clustered six data types generated/recorded by 13 different technological applications that were proposed to be informative of team proactivity. Four determinants of content validity were derived.Practical implicationsThe overview of technological applications and resulting data types can stimulate diverse HR analytics projects, which can contribute to organizational performance. The authors suggest ways to control for the threats to content validity in the design of HR analytics or research projects.Originality/valueHR analytics projects in the application field of managing organizational behavior are rare. This paper provides starting points for choosing data to measure team proactivity as one form of organizational behavior and guidelines for ensuring their validity.

A Functional Approach to the Assessment and Treatment of Non-Suicidal Self-Injury in Veterans: A Dialectical Behavior Therapy–Informed Perspective

Given that non-suicidal self-injury (NSSI) is related to increased odds of suicidal ideation and suicide attempts, treating NSSI in veterans is a key treatment priority to help reduce suicide risk and increase quality of life. Treating NSSI can be difficult for clinicians and training in addressing NSSI can enhance therapist empathy and decrease negative attitudes. The current paper describes prevalence of and risk factors for NSSI in veterans and presents a Dialectical Behavior Therapy (DBT)-informed approach for arriving at a functional understanding of NSSI in order to inform assessment and treatment. This DBT-informed approach is demonstrated with two case examples of veteran clients. While in many circumstances treatment of NSSI may be most effective in the context of full model DBT (i.e., individual therapy, group skills training, phone coaching, and therapist consultation team), many aspects of the functional approach discussed herein are not specific to DBT and could therefore be integrated into behavioral analyses and case formulations conducted within non-DBT therapeutic approaches.

Empowering Communities: Future‐Making through Citizen Ethnography

This paper proposes a way to harness the power and benefits of community‐led future change through the process of “citizen ethnography”. Just as “citizen science” has become a potent method for non‐scientists to collect and contribute to scientific knowledge and outcomes, citizen ethnography is where non‐ethnographers are trained in the tools and techniques of ethnography to research social phenomena to understand, recommend and lead their own change initiatives.Citizen ethnography essentially flips the model of a single or small team of ethnographers and consultants working with a community, to one where groups of community members research their own challenges in order to identify their own needs, preferred futures and mechanisms for change. Importantly, this approach requires a significant ‘stepping away’ of the ethnographer as the research expert and move towards a role of skill‐builder, coach and facilitator. This democratisation of ethnography helps to equip and empower communities with useful skills, while also reconnecting ethnography to the fundamentals of its well‐established method and foundation in the ethics of representation. We provide an example of how citizen ethnography is being used to deal with youth suicide in Australia, highlighting how through engaging community members in the process and skills of ethnography they can unpack their own questions of belonging and identity, participate with eachother in the solutions to their current challenges and approach their future as engaged and empowered citizens.

Integrating Neuropsychology into Interprofessional Geriatrics Clinics.

Interprofessional healthcare teams are increasingly viewed as a clinical approach to meet the complex medical, psychological, and psychosocial needs of older adult patients. Despite the fact that older adults are at risk for cognitive difficulties, neuropsychologists are not routinely included on Geriatrics consult teams. The primary aim of this paper is to highlight the utility of neuropsychology within an interprofessional Geriatrics consult clinic. To address this aim, we describe specific benefits to patient care that may be associated with the inclusion of neuropsychologists on Geriatrics consult teams, including differential diagnosis, enhanced patient care, and reduced barriers to care. We provide a description of the integration of neuropsychology within a Veterans Health Administration (VA) interprofessional Geriatrics consult clinic team in order to illustrate the implementation of this model.

SP1.2.4A Single Centre experience in Robot-assisted Colorectal Surgery: First 70 cases

Abstract Aim To analyse the short-term outcome of robot-assisted colorectal surgery (RACS) in a single centre. Methods All the patients who underwent RACS using the DaVinci Xi platform between June 2018 and December 2020 were included in our study. RACS was performed by two consultant team. Data was collected from a prospectively maintained database. Results Over the 31-month study period, 70 RACS were performed with no 30-day mortality. Male to female ratio was 4:3, with mean age was 66 years (SD 12). The mean body mass index was 28.7 (SD 5.1). Pre-operative American society of anaethesiology (ASA) score was reported as 1-2 in 65% of patients and 35% as 3. Indication for surgery was malignancy in 89% (62/70) of patients and the remainder benign pathology. Type of surgery performed was high anterior resection (AR) in 39% (27/70) patients, low AR 33% (23/70), right hemicolectomies 21% (15/70), Hartmann’s procedure 3% (2/70), abdominoperineal resections 3% (2/70), and left hemicolectomy 1% (1/70). The mean operating time was 295 minutes (SD 92), with only 1 reported case of conversion to open. Complete resection (R0) was achieved in 95% (59/62) of malignant resections. The mean lymph nodes harvested were 19 (range 7-36). Post-operative complications occurred in 23% (16/70) of patients, including 6% (4/66) anastomotic leaks. The mean length of stay was 8 days (range 1-53), with readmission rate of 14% (10/70). Conclusion The robotic minimally invasive technique can be safely introduced for major colorectal resections without excessive morbidity.

The Diagnosis of Brain Death

Organ transplantation is impossible without donation which is performed both intra vitam and posthumously. Each case of multi-organ collection provides help to 4 to 6 patients. We believe that presentation of modern algorithms for diagnosing brain death is quite feasible, and such information can be useful not only for anesthesiologists, but also for doctors of other specialties. This paper presents materials related to organ donation. Diagnostic criteria for human brain death, as well as the procedure for ascertaining human brain death and the actions of doctors of healthcare institutions in relation to persons who are in these institutions and who have clinical indications for the diagnosis of brain death, are determined by "The procedure for cancellation of active measures to maintain the patient's life…". Active measures (ventilation, infusion therapy and vasopressor support, etc.) to support the patient's life are cancelled after the patient's brain death is ascertained, except for cases where the deceased person is considered a potential donor. Verification of the human brain death is carried out by the case management team of the healthcare institution involving, if necessary, members of consultative and diagnostic mobile team, specialists of other healthcare institutions. The head of the healthcare institution is responsible for timely and proper engagement and work of the case management team. The responsible person determines the membership of the case management team by making an appropriate entry in the case record and is responsible for its work.
 An anesthesiologist and a neurologist (neurosurgeon) who have at least 5 years of practical experience in the specialty are engaged in the case management team to ascertain brain death in persons over 18 years of age.
 Physicians involved in the removal of human anatomical materials and transplantation thereof, as well as transplant coordinator, may not be included in the case management team.

When is enough, enough? Exploring ethical and team considerations in paediatric cardiac care dilemmas.

Therapies for paediatric congenital and acquired heart disease continue to evolve and the appropriateness of pursuing life sustaining interventions at margins of standard therapy is ethically challenging. With ongoing emphasis on shared decision making, recent literature explored physician and parental perspectives on communication with families and offering interventions for complex congenital heart disease and advanced heart failure. The inclusion of parental values and views in this process is now widely accepted. Identified outstanding challenges include difficulty with prognostication from the outset, adjusting long-term goals of care to changes in clinical parameters, need for consistency in communication including regular review meetings with family or surrogate decision-makers. Bioethics consultation and multidisciplinary team reviews may be helpful supports. Palliative care involvement in this population improves quality of life and alleviates parental distress but this collaboration is not optimized. Decision to offer, forgo, or discontinue life-sustaining therapies for children with heart disease has nuanced and context-specific considerations, and must integrate burdens of interventions with patient and family values. Thus, decision making remains complex and demands thoughtful review of not only risks and benefits, but views and values, clearly communicated to team and family.

Facilitating treatment engagement for early psychosis through peer-delivered decision support: intervention development and protocol for pilot evaluation

BackgroundEmerging adults with early psychosis demonstrate high rates of service disengagement from critical early intervention services. Decision support interventions and peer support have both been shown to enhance service engagement but are understudied in this population. The purposes of this article are to describe the development of a novel peer-delivered decision coaching intervention for this population and to report plans for a pilot study designed to gather preliminary data about its feasibility, acceptability, and potential impact.MethodsThe intervention was developed based on formative qualitative data and in collaboration with a diverse team of researchers, key stakeholders, and expert consultants. The pilot trial will utilize a single-group (N = 20), pre-post, convergent mixed-methods design to explore whether and how the intervention addresses decision-making needs (the primary intervention target). The impact of the intervention on secondary outcomes (e.g., engagement in the program) will also be assessed. Additionally, through observation and feedback from the peer decision coach and study participants, we will evaluate the feasibility of research and intervention procedures, and the acceptability of information and support from the peer decision coach.DiscussionThe peer-delivered decision coaching intervention holds promise for assisting young people with making informed and values-consistent decisions about their care, and potentially enhancing service engagement within this traditionally difficult-to-engage population. If the intervention demonstrates feasibility and acceptability, and pilot data show its potential for improving treatment decision-making, our work will also lay the foundation for a new evidence base regarding roles for peer specialists on early intervention teams.Trial registrationThis trial was registered with ClinicalTrials.gov (Identifier: NCT04532034) on 28 August 2020 as Temple University Protocol Record 261047, Facilitating Engagement in Evidence-Based Treatment for Early Psychosis.

A Descriptive Analysis of a Learning-Curve Cohort: Prospective Study of the First 2 Years of a Newly Established Robotic Colorectal Surgery Program at a Tertiary Care Centre

Introduction: The latest robotic platform has made 4-quadrant robotic abdomino-pelvic surgery technically easier. A direct beneficiary of this development is colorectal surgery. Worldwide, there is an increasing uptake of robotic-assisted surgery (RAS) for colorectal conditions including for cancer. Methods: Within a 6-speciality multi-disciplinary robotic surgery service, a colorectal RAS program was established. A 2-consultant team led the program from November 2017 to December 2019. The program was paused at the beginning of the COVID-19 pandemic. All data was captured prospectively in a dedicated database. The 30-day outcome measures of the first 2-years of activity are reported. Results: In the 2-year study period, 65 patients (35-males, 30-females) underwent colorectal RAS. The mean age of patients was 61-years (21 to 86). Forty-four (68%) resections were for cancer and 27 (43%) were total mesorectal excisions. The conversion rate was 12.3% (8 of 65). The median anaesthetic, docking, console, surgery and total times for colorectal robotic procedures was 34 (25 to 44), 5 (3 to 8), 103 (74 to 145), 161 (102 to 249) and 255 (195 to 324) minutes respectively. The median length of hospital stay was 8-days (6 to 12 days). 12%, 7.7% and 1.5% of patients had a complication, an unplanned return to theatre or an unplanned readmission within 30 days with no recorded mortality. Conclusion: The reported 30-day outcomes of a newly established colorectal RAS program confirm its feasibility and safety. Dual consultant team during its implementation facilitated shared experiential learning. Case selection remains critical for the success.

Perceptions on the use of opioids in COVID-19 : Asurvey of members of the German Association for Palliative Medicine

HintergrundObwohl Opioide wirksam Schmerzen und Dyspnoe lindern, findet dies in Leitlinien zur Symptomkontrolle unterschiedliche Gewichtung. Dies kann zu Unsicherheiten bezüglich Indikationen und ethischer Implikationen im Umgang mit Opioiden auch bei COVID-19 führen.Ziel der ArbeitWir untersuchten bei Mitgliedern der Deutschen Gesellschaft für Palliativmedizin (DGP) die persönliche Wahrnehmung des Umgangs mit Morphin/Opioiden (M/O) zur Symptomkontrolle innerhalb und außerhalb der Palliativmedizin (PM), auch bei der Betreuung COVID-19-Erkrankter.Material und MethodenMittels Survey Monkey® wurden DGP-Mitglieder anonymisiert nach ihrer eigenen Wahrnehmung des Umgangs mit M/O zur Symptomkontrolle befragt.Ergebnisse und DiskussionVon den 6192 DGP-Mitgliedern nahmen N = 506 teil. Den Umgang mit M/O innerhalb der PM beschrieben 98 % der befragten Ärzt:innen und Pflegekräfte als „sicher und vertraut“ bzw. 95 % als „klar geregelt“, während dies für die Bereiche außerhalb der PM von weniger als der Hälfte angegeben wurde (48 %/38 %). Bei der Betreuung COVID-19-Erkrankter wurde der Umgang mit M/O außerhalb der PM noch seltener als „sicher und vertraut“ (26 %) oder „klar geregelt“ (23 %) wahrgenommen. Dyspnoe (99 %/52 %), Erleichterung des Sterbeprozesses (62 %/37 %), Unruhe (30 %/15 %) und Angst/Panik (27 %/13 %) wurden häufiger innerhalb als außerhalb der PM als allgemeine Indikationen genannt. 89 % der Befragten wünschten sich die Einbindung eines PM-Konsilteams.SchlussfolgerungMitglieder der DGP nahmen deutliche Unsicherheiten im Umgang mit M/O außerhalb der PM wahr. Einheitliche interdisziplinäre Leitlinien zur Symptomkontrolle etwa bei Dyspnoe, mehr Lehre und die Einbindung eines PM-Konsilteams sollten zukünftig mehr bedacht werden.

Development of a Theoretically Informed Web-Based Mind-Body Wellness Intervention for Patients With Primary Biliary Cholangitis: Formative Study.

BackgroundMind-body interventions have the potential to positively impact the symptom burden associated with primary biliary cholangitis (PBC). Interventions are more likely to be effective if they are informed by a theoretical framework. The Behaviour Change Wheel (BCW) and the behaviour change technique taxonomy version 1 (BCTv1) provide frameworks for intervention development.ObjectiveThis study describes how theory has guided the development of a 12-week multicomponent mind-body wellness intervention for PBC.MethodsThe steps involved in developing the BCW intervention included specifying the target behavior; explaining barriers and facilitators using the Capability, Opportunity, Motivation, and Behaviour and the theoretical domains framework; identifying intervention functions to target explanatory domains; and selecting relevant behavior change techniques to address intervention functions. Qualitative data from patients with inflammatory bowel disease using an earlier version of the program and feedback from a PBC patient advisory team were used to guide intervention development.ResultsBarriers and facilitators to intervention participation associated with capability, opportunity, and motivation were identified. Intervention functions and behavior change techniques were identified to target each barrier and facilitator.ConclusionsThe Peace Power Pack PBC intervention was developed to help individuals with PBC manage their symptom burden. The theoretical frameworks employed in this intervention provide direction on targeting antecedents of behavior and allow standardized reporting of intervention components.Trial RegistrationClinicalTrials.gov NCT04791527; https://clinicaltrials.gov/ct2/show/NCT04791527

121 Embedding Palliative Consultants in the Emergency Departmet Creates Significant Value for Healthcare Systems

A vast majority of patients with serious illness present to emergency departments (EDs) in their last year of life with unmet palliative needs. ED-requested palliative care (PC) consults have been shown to reduce hospital length-of-stay and costs. As integrated care delivery models evolve, many health systems are considering how to best deploy PC resources and protocols to the ED to facilitate earlier engagement. Our objective was to demonstrate the financial and operational viability of embedding a palliative consultant in the ED. This single-site hospital with 42,000 annual ED visits featured a mature PC team, with historically high ICU/ward but minimal ED engagement. Institutional alignment was acquired from key stakeholders (ED, PC, ICU, hospitalists, administration) to fund a new ED-embedded PC consult service. A single PC physician or nurse practitioner was co-located in the ED fishbowl between the hours of 11am-7pm daily, initially weekdays and expanded to weekends after 10 weeks. ED consults were both proactively identified by PC and actively requested by ED clinicians. Clinical and financial data from 08/2020-04/2021 were tracked through the electronic health record, Palliative Care Quality Network registry, and McKesson Horizon Performance Manager. Over 8.5 months, the ED-embedded PC service saw 565 consults. Of these, 46% had a code status change, 8% admitted to a lower level of care, 9% avoided hospitalization, and 13% newly referred to hospice. ED consult volume was consistent month-over-month. ED length-of-stay did not appreciably lengthen. None of these cases were related to COVID-19. Importantly, this additional consult team did not cannibalize inpatient consult volume from usual practice. Compared to inpatient PC consults, median hospital length-of-stay decreased from 10.8 days to 3.3 days (p<0.001). Likewise, median direct costs per hospitalization decreased from $17,726 to $4,617, a 75% reduction or $13,019 per hospitalization (p<0.001). Annualized direct cost avoidance will be $6.5M. Subsequently, the ED provider group volunteered to include ED-palliative consults as a performance metric in their compensation model. ED-embedded palliative consultants are a high cost but even higher-reward intervention. For this hospital, return on investment will exceed 15x. True impact is likely even greater given analyses were not compared against all-comers, and did not account for future deferral of ED revisits and healthcare utilization from earlier introduction into outpatient palliative and hospice services. ED-palliative partnerships significantly advance the quadruple aim and position the ED to lead change in healthcare systems which increasingly prioritize value-based care.

Phone consultation and burnout among providers of dialectical behaviour therapy.

Adherent dialectical behaviour therapy (DBT) includes between-session phone consultation to help clients generalize skills, solve problems during crises, and repair relationships. Despite benefits of phone consultation, it is frequently not implemented in outpatient settings. The perceived burden phone consultation places on providers is one of the most frequently cited reasons for its omission. The current study examined phone consultation in relation to providers' burnout using a cross-sectional design. We hypothesized that (1) DBT experience and support from peer consultation team members, including perceived team efficacy and shared coaching responsibilities, would be associated with lower rates of burnout and (2) higher numbers of crisis contacts and "other" contacts, but not noncrisis skills generalization contacts, would be associated with increased burnout. Participants were 65 DBT therapists who completed an anonymous survey online. Results suggest that both having more effective consultation teams and sharing phone consultation among team members were associated with decreased burnout. Additionally, more crisis contacts were found to be associated with higher burnout, whereas higher number of skills generalization calls was not. This study represents an important first step towards evaluating the impact of phone consultation on providers and highlights the importance of effective peer consultation in reducing therapist burnout.

Create a Productive Advisory Team

The Volunteer Management ReportVolume 26, Issue 10 p. 1-1 Seeking Volunteer Input Create a Productive Advisory Team Kerry Nenn, Kerry NennSearch for more papers by this author Kerry Nenn, Kerry NennSearch for more papers by this author First published: 06 September 2021 https://doi.org/10.1002/vmr.31745Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume26, Issue10October 2021Pages 1-1 RelatedInformation

Barriers and facilitators to interdisciplinary communication during consultations: a qualitative study

ObjectiveCommunication failures between clinicians lead to poor patient outcomes. Critically injured patients have multiple injured organ systems and require complex multidisciplinary care from a wide range of healthcare professionals and...

Engaging Economics and Traffic Engineering Students in Community Issues Using the MultiCreation Approach

Abstract Effective teaching methods for the coming generations of pragmatic students and teachers are evolving towards much greater involvement on all sides, attempting to bridge real life and academia in innova-tive ways. Our theoretical foundation lays upon the Triple Helix, n-Tuple Helix theory and the innova-tion triangle, but in a problem-based multidisciplinary setting. After introducing and validating the Mul-tiCreation approach in teaching/learning for the business-academia collaboration, where multiple disci-plines, diverse profiles of students, professors, and managers have taken up various roles to address relevant business issues, we were encouraged to expand its applicability beyond the business world - toward societal problems. We retained the problem-based and participatory learning but shifted the positioning of the problem towards the safety of primary school children, incorporating economic, pro-ject-based, managerial, traffic engineering, logistical, regulatory, and governance issues. By including two primary schools, collaborating with their principals, advisory teams, and teachers, as well as chil-dren and parents, in two different cities, we aimed to provide complete research, engineering and educa-tion for the stakeholders so that the schools could just hand in documentation to the relevant municipal bodies to be acted upon effectuation. The involved students came from two faculties -of economics and traffic engineering, steered by three university professors on the subjects of project management and basic and advanced techniques for traffic management. The blended learning components took place as prescribed in the MultiCreation approach, during two semesters of two academic years. They combined countermeasures and solutions. The MultiCreation approach has been enhanced regarding its components and workflow and its effectiveness has been validated in a multi-stakeholder environ-ment of direct and indirect educational beneficiaries.

Leveraging management engineering and business consulting for rapid response, mitigation and recovery during a pandemic

The novel severe acute respiratory syndrome coronavirus 2, which causes coronavirus disease 2019 (COVID-19), has presented healthcare delivery challenges the world has never encountered before. Healthcare and its practitioners, while finding themselves in difficult situations, must still care for patients with emergent needs and ensure the safety and well-being of all patients and staff. At Mayo Clinic, effective navigation of the dynamic and complex situation created by COVID-19 required unique multidisciplinary collaborations to design and implement solutions quickly. Frontline care providers and staff of ancillary services and other critical healthcare functions partnered with the Department of Management Engineering and Consulting (ME&amp;C) team to organise and re-engineer operations to iteratively adapt to the dynamic ‘new normal’. Health systems engineers (HSEs) and project managers (PMs) accelerated the implementation of innovative interventions by leveraging advanced engineering and consulting frameworks, models and methods. Utilising a patient and staff-centric systems approach to align electronic systems, operational processes, staffing resources and organisational infrastructure has been invaluable for speed and effectiveness. Harnessing the promise of digital technology and advanced analytics was imperative and set the stage for a broader set of possibilities to transform healthcare. These possibilities include scaling of consumerfocused virtual services in multiple and unfamiliar settings, new assets that could be reused for future emergencies, accelerating the implementation of time-sensitive solutions, applied analytics and modelling to predict clinical, financial and community impacts and reimaging the healthcare supply chain. As more has been learned about the trajectory and management of COVID-19, the need to rapidly evolve and pivot interventions for short-, medium-, and long-term applications continues. This article addresses the unique contributions of ME&amp;C during the COVID-19 crisis and the results-oriented collaborations with staff in critical business functions. We believe that the experiences, outcomes and lessons learned through this journey are broadly transferable to other healthcare and nonhealthcare organisations.

Palliative Care Teams Reduce Hospital Mortality and Utilization: Causal Evidence from a Quasi‐Experimental, Nationwide Evaluation in Ireland

Research ObjectiveTo evaluate the causal effect of palliative care consultation teams (PCCTs) on in‐hospital mortality and health care utilization in public hospitals in Ireland for the period 2005–2018 using a quasi‐experimental research design.Study Design Setting: Ireland is a country in north‐western Europe with a population of approximately 4.6million. The health system has both public and private provision, but the 40 acute public hospitals account for 95% &lt; of inpatient admissions and 90% &lt; of hospital deaths nationally. Population: All adults admitted to a public hospital with a primary diagnosis of advanced cancer, organ (heart, liver, kidney, lung) failure, or Alzheimer's disease. Analysis: We applied decomposed difference‐in‐differences (Goodman‐Bacon method) to exploit the implementation of PCCTs by different hospitals at different times across the study period. For each hospital we identified the year that a PCCT was founded, and so for each year allocated each hospital a treatment variable value of 1 (had a PCCT for the entirety of that year) or 0 (did not). The method then calculates a weighted average of all possible two‐group/two‐period difference‐in‐difference estimators in the data. We controlled for hospital size, type, location and socioeconomic catchment as additional predictors. Sources: We collected PCCT data by hand from each individual hospital service. Outcome data and other predictors were routinely collected administrative data from a national database.Population StudiedAll adults admitted to a public hospital with a primary diagnosis of advanced cancer, organ (heart, liver, kidney, lung) failure, or Alzheimer's disease.Principal FindingsWe had sufficient data for 34 hospitals (85% of sites, 90% &lt; relevant admissions to public hospitals in the study period). There were 600,306 eligible admissions in the data, with an overall mortality rate of 6% (N = 38,595) and a mean LOS of 10.0 days. Sixteen hospitals (47%) had a PCCT at the start of the study period and 34 hospitals (100%) had a PCCT at the end of the study period. Implementation of a PCCT was associated with a mean absolute reduction in in‐hospital mortality of 0.9% (95% CI: −1.6% to −0.2%), a proportional reduction of 10%. Implementation of a PCCT resulted in an absolute reduction in LOS of 0.86 days (95% CI: −1.3 days to −0.4 days), a proportional reduction of 8.6%. Secondary analysis of these data using validated unit costs for acute inpatient stays in Ireland suggests a mean estimated saving per admission of €1500 (~$1250) per admission.ConclusionsPCCTs improve the value of hospital care for people admitted with serious medical illness. These results were derived using quasi‐experimental methods, an important advance in a field where observational studies are at high risk of selection bias and high‐quality trials are rare. The magnitude of effect estimates is lower than reported by most previous studies. We consider the implications for future research.Implications for Policy or PracticePCCTs both reduce costs and improve outcomes for people admitted with serious illness. Services should be expanded to meet current and future needs. The optimal level of this expansion is unknown and requires further development of appropriate methods.Primary Funding SourceHealth Research Board (Ireland).

Multidisciplinary team efforts to improve the pregnancy outcome of pregnancy complicated with primary hyperparathyroidism: case series from a single hospital

BackgroundThere is no consensus or management algorithm for primary hyperparathyroidism (PHPT) in pregnancy.MethodsThis study comprises a retrospective case series. From August 2014 to December 2020, 9 cases of PHPT in pregnancy were diagnosed by a multidisciplinary team (MDT) consultation center of obstetrics in our hospital. Their clinical manifestations, treatment strategies, and maternal and infant outcomes were analyzed.ResultsThe median onset age of the patients was 32 (25 ~ 38) years. PHPT was diagnosed in two cases before pregnancy, in six cases during pregnancy and in one case postpartum. The main clinical manifestations were nausea, vomiting, and other nonspecific symptoms, with anemia as the most common maternal complication. Hypercalcemia crisis was developed in one case. The median levels of preoperative serum calcium and parathyroid hormone (PTH) were 3.08 (2.77 ~ 4.21) mmol/L and 300.40 (108.80 ~ 2603.60) pg/ml, respectively. The parathyroid ultrasonography tests were positive in eight cases and negative in one patient who had an ectopic lesion localized by 99mTc-MIBI. Parathyroidectomy was conducted in 7 cases during the 2nd trimester, including 2 patients diagnosed before pregnancy who refused surgery, 1 patient during the 1st trimester, and 1 patient postpartum, with a significant reduction in serum concentrations of calcium and PTH. A management algorithm was developed.ConclusionThis case series suggests that pregnant women with PHPT should be managed by MDT according to the algorithm. If PHPT is confirmed in fertile women before pregnancy, parathyroidectomy should be strongly suggested and performed. If PHPT is diagnosed during pregnancy, even in its mild form, surgical treatment, optimally during the 2nd trimester, is effective and safe for pregnancy and neonatal outcome.

PERSPECTIVE FROM THE WESTERN BALKANS AND STRENGTHENING THE NATO’S EASTERN FLANK

A reflection process shall be launched to see if the NATO is ready to face the challenges of tomorrow. The main aim of this paper will be to outline what are the perspectives and challenges according to the Balkan countries and what is the role of NATO in the Eastern Flank. Collecting of views from the region will give some ideas and propositions how to make the Alliance stronger and more effective politically and militarily.&#x0D; The western Balkans is one of the longest lasting and largest investments that NATO has made throughout time. The Western Balkans is the most articulate because of the complexity of the region. As the WB is so articulate and complex and the relationships since the 1990s between NATO and the region of the WB have evolved. The three main pillars of the NATO strategic concept are deterrence and defence crisis management and cooperative security. Now we have two new NATO tools that are helping the region - capacity building to the civil military team (NATO advisory team which support the set up of security force in Kosovo) and enhanced interaction which is a basket of tailored activities (it is not a partnership because there are some of the Allies that do not the declaration of independence of Kosovo) that have been revised by the North Atlantic Council- building integrity and civil emergency planning. The common point between all the countries of the WB which have joined the partnership of peace is the contribution that they give to the security and stability of the region and to this idea of projecting stability. When NATO’s neighbours are stable the Alliance itself will be more stable. The open door policy a cornerstone of the Washington treaty– for many countries of the WB it is a cornerstone for becoming members and to assume the responsibilities and the obligations (and the willingness and ability to assume them) that come with this membership. Political dialogue and practical cooperation are crucial for the countries especially from the region of the Western Balkans to foster the regional understanding and to share common expertise. Speaking about the Geopolitics in the Balkans and in South Eastern Europe, my first point is about the current geopolitical dynamics. SE Europe and even The Balkans are not anymore in the centre of world politics in the role of the trouble maker in the region, like it was in the late 90s of the last and in the beginning of this century. But they continue to be a field for political manoeuvring of the geopolitical players dominated by the desire to confer spheres of interest and to mutually deter each other. We shall not forget that precisely democracy is the element that binds all members and the liberal economic principles are the cornerstone of this common identity. A more equitable burden sharing and ascending defense spending (2% or less currently) is an important benchmark for the future preparedness of the Alliance. The transatlantic relation was a point discussed largely in reflection process. A future goal for the Alliance shall be defining a mutually beneficial strategic and burden sharing equilibrium between North American and European members. An advance in the foreign and security policy objectives of Washington in Asia will be a good addition to this. What can be more is that NATO must continue to deepen and strengthen the already existing relationship. This mainly can be conducted through expanding its roster of partnerships, gaining actionable intelligence, strengthening early warning systems and improving crisis management to be nimbler politically and operationally.&#x0D; B9 Alliances members need to leave their operational comfort zones and look to further their contributions in zones of instability in Africa and Middle East that could spill over to Europe.