Expert Advisory Group Research Articles

An Audit of Pre-Pregnancy Maternal Obesity and Diabetes Screening in Rural Regional Tasmania and Its Impact on Pregnancy and Neonatal Outcomes.

Maternal obesity in pregnancy, a growing health problem in Australia, adversely affects both mothers and their offspring. Gestational diabetes mellitus (GDM) is similarly associated with adverse pregnancy and neonatal complications. A low-risk digital medical record audit of antenatal and postnatal data of 2132 pregnant mothers who gave birth between 2016–2018 residing in rural-regional Tasmania was undertaken. An expert advisory group guided the research and informed data collection. Fifty five percent of pregnant mothers were overweight or obese, 43.6% gained above the recommended standards for gestational weight gain and 35.8% did not have an oral glucose tolerance test. The audit identified a high prevalence of obesity among pregnant women and low screening rates for gestational diabetes mellitus associated with adverse maternal and neonatal pregnancy outcomes. We conclude that there is a high prevalence of overweight and obesity among pregnant women in rural regional Tasmania. Further GDM screening rates are low, which require addressing.

System-Level Barriers to Uptake of Existing and Novel Radioimmunotherapy for People with Lymphoma

System-Level Barriers to Uptake of Existing and Novel Radioimmunotherapy for People with Lymphoma

Evidence Synthesis to support the public health response during the COVID-19 pandemic

Abstract Background In January 2020, the Irish National Public Health Emergency Team (NPHET) for COVID-19 was established. NPHET oversees and provides national direction, guidance, support and expert advice on the development and implementation of strategies to contain COVID-19 in Ireland. Since March 2020, HIQA's COVID-19 Evidence Synthesis Team has provided research evidence to support the work of NPHET and associated groups and inform the development of national public health guidance. From September 2020, as part of the move towards a sustainable response to the public health emergency, HIQA also provides evidence based advice in response to requests from NPHET. The advice provided to NPHET is informed by research evidence developed by HIQA's COVID-19 Evidence Synthesis Team and with expert input from HIQA's COVID-19 Expert Advisory Group. Methods This presentation describes the establishment and organisation of the COVID-19 Evidence Synthesis Team, with an overview of the processes and methodological approaches involved. The role of HIQA's COVID-19 Evidence Synthesis Team in informing the public health response during the COVID-19 pandemic is discussed, along with the challenges and opportunities this presents. The relevance now and for future pandemic preparedness is outlined. Results As of 19 April 2021, HIQA has produced, and in some instances has regularly updated, 25 evidence summaries, 11 advice documents, 9 reviews of international guidance, 3 scoping reports, 5 reviews of care pathways, 2 analyses/models and 2 databases. Conclusions In the context of the COVID-19 pandemic, HIQA has developed and implemented a process to ensure rapid access to the best available evidence relevant to the COVID-19 outbreak to inform decision-making at each stage of the pandemic.

9.F. Workshop: Rapid evidence synthesis to inform the national response to the COVID-19 pandemic in Ireland

Abstract The Health Information and Quality Authority (HIQA) is an independent statutory authority in Ireland. Since March 2020, HIQA has been conducting evidence syntheses to support decision-making by the Irish National Public Health Emergency Team (NPHET). This work has informed guidance developed by national and international agencies such as the European Centre for Disease Prevention and Control (ECDC), Newfoundland and Labrador Center for Applied Health Research, Sciensano (Belgium), Alberta Health Services and Sante Publique France. The HIQA COVID-19 Evidence Synthesis Team draws on a broad range of evidence with expert clinical and public health input from HIQA's COVID-19 Expert Advisory Group, and produces a range of outputs to best suit the evidence needs of decision-makers. Across the world, agencies have had to adapt rapidly to provide up-to-date COVID-19 research evidence to decision-makers. Similarly, evidence users, including the public, have had to assimilate information on COVID-19 generated by such agencies. Significant challenges exist given the speed at which the evidence base is evolving on COVID-19, its sometimes conflicting nature and often poor quality, and the subsequent influence of its dissemination on policy and on individual behaviour and risk perceptions. This workshop describes the work of HIQA's COVID-19 Evidence Synthesis Team in its role to support the national response to the COVID-19 pandemic. The aim of this workshop is to share learnings on the structure, methodological approaches, and impact of a COVID-19 Evidence Synthesis Team. The presenters who all work on, or are affiliated with HIQA's COVID-19 Evidence Synthesis Team, will discuss a range of topics including the establishment of the team, the conduct of rapid evidence syntheses, and the impact and media coverage of the outputs. The presenters will each present their topic in turn and will allow ample time for engagement, and will use e-voting systems, to enable shared learning. The objectives for this workshop are to: Describe the establishment and organisation of a COVID-19 Evidence Synthesis Team Provide case examples of completed rapid evidence syntheses Examine the media coverage of selected outputs Present the findings of a an in-action evaluation Share learnings on the organisation of evidence synthesis teams, the conduct of rapid evidence syntheses and the subsequent communication of findings. As the pandemic moves into a new phase it is important that agencies involved in conducting, and using the findings of, evidence syntheses reflect on processes and impact to-date. Lessons learned from the COVID-19 evidence synthesis experience can inform the development of future evidence synthesis approaches as well as support future pandemic preparedness. There is a need to remain flexible and to innovate, and this workshop presents an ideal opportunity for a European public health audience to share experiences and ideas. Key messages The challenges and opportunities associated with conducting rapid evidence synthesis during a pandemic will be explored. This workshop will provide a space to share learnings and ideas.

GlioCova: Treatment and hospital admissions for patients with GBM in England

Abstract Aims Data on the treatment and outcomes of patients with primary brain tumours in England is sparse. The GlioCova project uses linked national data from England to explore the incidence, treatment, outcomes, and treatment costs of all adult brain tumour patients in all 50,000 patients in England from 2013 – 2018. Here we present initial results from patients with glioblastoma (GBM). Method We used a linked dataset from the national cancer registration system in England including all adult patients diagnosed with a malignant or benign brain tumour between 2013 and 2018 (51,775 patients in total). Glioblastoma patients were selected based on ICD-10 codes (C70, C71, C72), morphology codes (9440, 9441, 9442), and grade (G4, G3, GX and NA) from the national cancer registry. We extracted data on treatment (radiotherapy, chemotherapy, brain surgery or biopsy) and measured how many patients who had adjuvant Temozolomide completed 6 cycles. Results We identified 15,294 glioblastoma patients. Most had glioblastoma morphology (14,924), followed by gliosarcoma (264) and giant cell glioblastoma (106). Almost all had a cranial tumour (C71) while 17 had a tumour originating in the spinal cord, cranial nerves or other part of central nervous system (C72). Median age was 66 (IQR=17) and 60% were male. 51.9% (7,935) underwent surgery; an additional 18.2% (2,784) had a biopsy; 3,701 (24.2%) out of 15,294 patients received radiotherapy (only) and 316 (2.1%) received chemotherapy (only). 5,520 (36.1%) received both radiotherapy and chemo. Out of 4,101 GBM patients receiving temozolomide after radiotherapy, only 1,535 (37.4%) completed 6 cycles. The 7,935 GBM patients who had surgery had a median length of stay in hospital of 5 days (IQR=6) while those that had a biopsy had a median of 3 days (IQR=6). Conclusion We have presented a description of treatment of all GBM patients in England over a five-year period. This is the first time we have been able to understand detailed treatment patterns at a national scale, and significantly extends previous analyses. Further work will look at patient safety indicators, variation across centres and costs of treatment. Acknowledgements We would like to thank the GlioCova Expert Advisory Group for their input and discussion. This work uses data provided by patients and collected by the NHS as part of their care and support.

Towards an integrated model for supervision for mental health and psychosocial support in humanitarian emergencies: A qualitative study.

BackgroundDespite recent advances in the development and provision of mental health and psychosocial support (MHPSS) in humanitarian settings, inadequate supervision remains a significant barrier to successful implementation. The present study sought to incorporate broad stakeholder engagement as part of the first phase of development of a new Integrated Model for Supervision (IMS) for use within MHPSS and protection services in humanitarian emergencies.MethodsSemi-structured interviews were conducted with 26 global mental health professionals. Data was analysed thematically, using a combination of inductive and deductive methods. Codes and themes were validated through co-author cross-checks and through a webinar with an expert advisory group.ResultsResults reinforce the importance of effective supervision to enhance the quality of interventions and to protect supervisees’ wellbeing. Participants generally agreed that regular, supportive supervision on a one-to-one basis and as a separate system from line management, is the ideal format. The interviews highlight a need for guidance in specific areas, such as monitoring and evaluation, and navigating power imbalances in the supervisory relationship. Several approaches to supervision were described, including some solutions for use in low-resource situations, such as group, peer-to-peer or remote supervision.ConclusionAn integrated model for supervision (IMS) should offer a unified framework encompassing a definition of supervision, consolidation of best practice, and goals and guidance for the supervisory process.

In Case You Haven't Heard…

Some clarification on the use of marijuana in the Olympics: The World Anti‐Doping Agency (WADA) has endorsed the decision of its Prohibited List Expert Advisory Group to initiate in 2022 a scientific review of the status of cannabis. Currently, cannabis is prohibited “in competition only,” WADA spokesman James Fitzgerald told us. “It will continue to be [prohibited in competition] in 2022.”

973Eliminating Cervical Cancer in the Asia Pacific- From Research to Policy and Practice

Abstract Focus and outcomes for participants Rationale for the symposium, including for its inclusion in the Congress Cervical cancer, caused by persistent infection with oncogenic human papillomavirus (HPV), is one of the most preventable and treatable forms of cancer, yet more than 300,000 women die from the disease annually and over 500,000 cases are diagnosed. Modelling has shown that effective integration of HPV immunization programmes, HPV-based screening, and access to high-quality cancer treatment and palliative care services has the potential to eliminate cervical cancer in most countries in the world over the next century. In 2018, the Director-General of WHO made a global call to action for the elimination of cervical cancer as a public health problem. As a result, WHO has developed a global strategy towards eliminating cervical cancer as a public health problem due for endorsement at the World Health Assembly in May 2020, which proposes an elimination threshold of four cases per 100 000 women and includes 2030 triple-intervention coverage targets for scale-up of HPV vaccination of 90%, twice-lifetime cervical screening of 70%, and treatment of pre-invasive lesions and invasive cancer of 90%. As the first country to establish a national HPV immunization programme and one of the first countries to move to an HPV based screening programme, Australia has played a leading role in the global battle against cervical cancer and is on course to eliminate the disease within the next decade. However, while the burden of disease and the highest mortality from cervical cancer occur in lower income countries, factors such as the inequitable cervical cancer burden in Indigenous populations and vaccine hesitancy mean that significant barriers to the elimination of cervical cancer also exists within high-income countries. This session will have seven experts working in four countries within the Asia Pacific region. By sharing experiences and providing evidence-based guidance on key technical and strategic issues, we hope to generate a comprehensive understanding and new knowledge on factors impacting participation in, and the potential for effective scale up of, cervical cancer control programmes within the region. Presentation program Names of presenters -Dr Kate Simms is a Postdoctoral Research Fellow at Cancer Council NSW, Australia. Her research focusses on modelling the impact of HPV vaccination and cervical cancer screening across a range of settings, including predictions for the potential elimination of cervical cancer across 181 countries. -Associate Professor Julia Brotherton is a public health physician and Medical Director of VCS Population Health. She is involved in research and policy development informing the implementation and evaluation of HPV vaccination programs in Australia and is member of the WHO Director General's Expert Advisory Group on Cervical Cancer Elimination. -Assistant Professor Sharon Hanley is a cancer epidemiologist at Hokkaido University, Japan. Her research interests include HPV vaccine hesitancy and HPV self-sampling to increase cervical screening uptake in never/under screened Japanese women. - Associate Professor Lisa Whop is an Indigenous Senior Research Fellow at the Australian National University, Canberra, Australia. Her research focuses on improving health outcomes for Aboriginal and Torres Strait Islander people with cancer, with a key focus on equity. - Dr Megan Smith is a Postdoctoral Research Fellow whose research focuses on optimizing and successfully implementing cervical cancer prevention, at the population level and in different population subgroups. She has contributed to a large number of reports to government, including several evaluations that have directly informed policy in Australia, New Zealand and England. -Professor Andrew Vallely is a clinical epidemiologist at the Kirby Institute, University of New South Wales, Australia. He recently completed a field evaluation comparing point-of-care Xpert HPV testing using self-collected specimens with visual inspection of the cervix with acetic acid (VIA), to detect high-grade cervical disease. - Professor Woo Yin Ling is a Consultant Obstetrician and Gynaecologist at the University of Malaya. She is the programme designer of Project ROSE (Removal of Obstacles to Cervical Screening), a novel cervical screening research programme which employs HPV self-sampling and digital technology to increase access to cervical screening in Malaysia. Names of facilitator or chair Assistant Professor Sharon J.B. Hanley, Hokkaido University and Professor John Kaldor, Kirby Institute, University of New South Wales?

Developing a behavioural intervention to increase lay-people"s intentions to initiate CPR in the event of Out-of-Hospital Cardiac Arrest (OHCA)

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Medical Research Council OnBehalf BICeP Study Group Background Prompt, effective bystander cardiopulmonary resuscitation (CPR) is the single most important factor determining survival from out of hospital cardiac arrest (OHCA), increasing survival up to 4-fold. However only 35%-45% of people trained in CPR actually attempt it when required. This study uses psychological theory and behaviour change techniques (BCTs) to increase the proportion of bystanders who attempt CPR in a real emergency. Design Intervention development study Methods Intervention content was informed by two recent systematic reviews, which identified barriers to bystander CPR and BCTs within existing training programmes (PROSPERO CRD42018117438; CRD42019126745) and a qualitative study exploring participants’ views (n = 12) of draft text messages. A lay bystander user-involvement panel (n = 7) and an expert advisory group (comprising representatives from CPR training organisations) worked with the research team to co-produce the final intervention and agree the schedule for text message delivery. BCT content was assessed by two independent experts. A framework analysis of interviews was undertaken. Results Recognising and addressing fears, and helping people to better prepare for real-life situations were identified to be important to participants. Short, simple texts from a credible source and with a positive tone were strongly preferred, there was a strong aversion to anything "guilt-inducing". Pictures and personalisation were important, rewards less so. Regarding frequency: participants varied but around 1/week was considered adequate by most. A total of n = 35 text-messages with verified BCT content were co-developed with participants. Conclusions A text message intervention incorporating BCTs, which is acceptable to intended users and CPR trained individuals has been produced and will be subject to future evaluation.

Physician associate/assistant contributions to cancer diagnosis in primary care: a rapid systematic review

BackgroundSymptom recognition and timely referral in primary care are crucial for the early diagnosis of cancer. Physician assistants or associates (PAs) have been introduced in 18 healthcare systems across the world, with numbers increasing in some cases to address primary care physician shortages. Little is known about their impact on suspected cancer recognition and referral.This review sought to summarise findings from observational studies conducted in high income countries on PAs’ competence and performance on processes concerned with the quality of recognition and referral of suspected cancer in primary care.MethodA rapid systematic review of international peer-reviewed literature was performed. Searches were undertaken on OVID, EMBASE, Web of Science, and CINAHL databases (2009–2019). Studies were eligible if they reported on PA skills, processes and outcomes relevant to suspected cancer recognition and referral. Title and abstract screening was followed by full paper review and data extraction. Synthesis of qualitative and quantitative findings was undertaken on three themes: deployment, competence, and performance. Preliminary findings were discussed with an expert advisory group to inform interpretation.ResultsFrom 883 references, 15 eligible papers were identified, of which 13 were from the USA. Seven studies reported on general clinical processes in primary care that would support cancer diagnosis, most commonly ordering of diagnostic tests (n = 6) and referrals to specialists (n = 4). Fewer papers reported on consultation processes, such as examinations or history taking (n = 3) Six papers considered PAs’ competence and performance on cancer screening. PAs performed similarly to primary care physicians on rates of diagnostic tests ordered, referrals and patient outcomes (satisfaction, malpractice, emergency visits). No studies reported on the timeliness of cancer diagnosis.ConclusionThis review of peer-reviewed literature combined with advisory group interpretation suggests the introduction of PAs into primary care may maintain the quality of referrals and diagnostic tests needed to support cancer diagnosis. It also highlights the lack of research on several aspects of PAs’ roles, including outcomes of the diagnostic process.

The Antenatal Risk Questionnaire-Revised: Development, use and test-retest reliability in a community sample of pregnant women in Australia

BackgroundRoutine psychosocial assessment during pregnancy and the first postnatal year is a public health strategy that prioritises early identification of known risk factors for poor perinatal mental health. We aimed to report on the development and use of the Antenatal Risk Questionnaire-Revised (ANRQ-R), contribute normative data for a community sample of pregnant women and examine its test-retest reliability. MethodsThe ANRQ-R was developed in consultation with an expert advisory group. Women completed the ANRQ-R with their midwife at their first antenatal appointment. Test-retest analysis was restricted to women who consented to follow-up and completed a repeat ANRQ-R within four weeks. Results7183 women completed the ANRQ-R (total score M = 12.05, Mdn=10; range =5–49). There were some statistically significant differences in total score across maternal age group (χ2=69.75, p<.001), country of birth (χ2=144.01, p<.001) and socioeconomic quintiles (χ2=20.13, p<.001), however the effect sizes of all differences were either small or not clinically significant. Test-retest reliability for the ANRQ-R total score was good (N = 1670; ICC=0.77). Item-level test-retest reliabilities were moderate to good (ICC range=0.65–0.80; kappa coefficient range=0.31–0.74). LimitationsThe study was conducted at a single site. Although there was significant diversity in terms of maternal age and country of birth, the majority of participants were partnered and resided in socio-economically advantaged areas, limiting the generalisability of results. ConclusionsThis study contributes significant normative data for the ANRQ-R and offers valuable insights for clinicians and researchers working with particular sub-groups of the perinatal population. Additional psychometric examination of the ANRQ-R, including its concurrent and predictive validity, is required.

Editorial introductions.

Editorial introductions.

Collaboratively Designing a National, Mandated Teaching Performance Assessment in a Multi-University Consortium: Leadership, Dispositions and Tensions

It is a requirement for pre-service students in Initial Teacher Education programs in Australia to successfully complete a teaching performance assessment (TPA) before they graduate. This follows similar requirements in other international contexts, particularly the United States, where standard-based assessment is also a focus. As members of the design team of a TPA, which was affirmed by a nationally appointed Expert Advisory Group in Australia, we examine the social processes contributing to the development of a high-stakes assessment task. Significant challenges emerged through the nature of the task and the responsibility developers had for ensuring validity and fairness, but also because the design team comprised of teacher educators from ten universities. Using collaborative self-study as a methodology we examine our reflexive narratives and find that collaborative leadership and key personal dispositions are at the heart of the design process. These enable us to identify, examine and navigate arising tensions.

A Uniquely Targeted, Mobile App-Based HIV Prevention Intervention for Young Transgender Women: Adaptation and Usability Study.

BackgroundYoung transgender women (YTW) are a key population for HIV-related risk reduction, yet very few interventions have been developed to meet their needs. Mobile health interventions with the potential for both efficacy and wide reach are a promising strategy to reduce HIV risk among YTW.ObjectiveThis study aims to adapt an efficacious group-based intervention to a mobile app, Project LifeSkills, to reduce HIV risk among YTW, and to test its acceptability and usability.MethodsThe group-based intervention was adapted to a mobile app, LifeSkills Mobile, with input from an expert advisory group and feedback from YTW collected during user-centered design sessions. A beta version of the app was then tested in a usability evaluation using a think-aloud protocol with debriefing interviews, recordings of screen activity, and assessments of usability via the Post-Study System Usability Questionnaire (PSSUQ) and the Health Information Technology Usability Evaluation Scale (Health-ITUES).ResultsYTW (n=8; age: mean 24 years, SD 3 years; racial or ethnic minority: 7/8, 88%) provided feedback on the app prototype in design sessions and then tested a beta version of the app in a usability trial (n=10; age: mean 24 years, SD 3 years; racial or ethnic minority: 8/10, 80%). Both usability ratings (Health-ITUES: mean 4.59, SD 0.86; scale range: 1-5) and ratings for satisfaction and accessibility (PSSUQ: mean 4.64, SD 0.90; scale range 1-5) were in the good to excellent range. No functional bugs were identified, and all mobile activities were deployed as expected. Participant feedback from the usability interviews indicated very good salience of the intervention content among the focal population. Participants’ suggestions to further increase app engagement included adding animation, adding audio, and reducing the amount text.ConclusionsWe conclude that the LifeSkills Mobile app is a highly usable and engaging mobile app for HIV prevention among YTW.

Towards the development of a national patient transfer document between residential and acute care-A pilot study.

BackgroundA lack of standardisation of documentation accompanying older people when transferring from residential to acute care is common and this may result in gaps in information and in care for older people. In Ireland, this lack of standardisation prompted the development of an evidence based national transfer document.ObjectivesTo pilot a new national transfer document for use when transferring older people from residential to acute care and obtain the perceptions of its use from staff in residential and acute care settings.MethodsThis was a pre‐ and post‐study design using purposive sampling following the STROBE guidelines. The pilot was conducted in 26 sites providing residential care and three university hospitals providing acute care. Pre‐pilot questionnaires focused on current documentation and were distributed to staff in residential care (n = 875). A pilot of the new paper‐based transfer document was then conducted over three months and post‐pilot questionnaires distributed to staff from both residential and acute care settings (n = 1085). The findings of the pilot study were discussed with multidisciplinary expert advisory and stakeholder groups who recommended some revisions. This consensus informed the development of the final design of the new revised transfer document.ResultsPre‐pilot: 23% response rate; 83% (n = 168) participants agreed/strongly agreed that existing documentation was straightforward to complete but could be more person‐centred. Post‐pilot: 11% response rate; 75% (n = 93) of participants agreed/strongly agreed that the new transfer document promoted person‐centred care but recommended revisions to the new document regarding layout and time to complete.ConclusionsThis study highlighted some of the challenges of providing safe, effective and relevant transfer information that is feasible and usable in everyday practice.Implications for practiceStandardisation and being person‐centred are important determining factors in the provision of relevant up to date information on the resident being transferred.

Charting a Course to Rebuild and Strengthen the US Refugee Admissions Program (USRAP): Findings and Recommendations from the Center for Migration Studies Refugee Resettlement Survey: 2020

Charting a Course to Rebuild and Strengthen the US Refugee Admissions Program (USRAP): Findings and Recommendations from the Center for Migration Studies Refugee Resettlement Survey: 2020

Experts in emergencies: A framework for understanding scientific advice in crisis contexts

This paper draws on several recent cases to analyse the particular challenges for experts who are called to provide scientific advice under time-critical circumstances. It uses the notion of civic epistemologies (Jasanoff, 2005) [1] to consider the testing of knowledge claims in time-pressured situations. It argues that an interdisciplinary approach that incorporates diverse perspectives is needed to manage these high-stakes crises. This poses a major challenge: time-critical crises do not allow for the identification of key experts and of stakeholders – as is typically the case for the assembling of expert advisory groups for non-time-critical issues. These issues have again arisen in the COVID-19 pandemic in 2020, but not for the first time, and flexible cross-case, cross-discipline learning provides a means of enhancing resilience for future emergencies. There are some critical lessons to be learned in this crisis from other situations involving high stakes and rapid response. This paper uses its case studies to build a framework for analysing the roles of experts in emergencies, and suggests that understanding the power dynamics inherent in these situations is critically important in the context of the Sendai Framework.

Degrees of Multidisciplinarity Underpinning Care Planning for Patients with Cancer in Weekly Multidisciplinary Team Meetings: Conversation Analysis.

PurposeDespite an increase in research on multidisciplinary team (MDT) meetings, the implementation of MDT-driven decision-making, ie, its fidelity, remains unstudied. We report fidelity using an observational protocol measuring degree to which MDTs in their weekly meetings in the UK adhere to 1) the stages of group decision-making as per the ‘Orientation-Discussion-Decision-Implementation’ framework, and 2) cancer guidelines on the composition and characteristics of their weekly meetings produced by the UK’s Department of Health, UK’s National Cancer Action Team, Cancer Research UK, World Health Organization, and The Expert Advisory Group on Cancer to the Chief Medical Officers of England and Wales.Patients and MethodsThis is a prospective cross-sectional observational study of MDT meetings in the UK. Breast, colorectal, and gynecological cancer MDTs across three hospitals in the UK were video recorded over 12 weekly meetings, respectively, encompassing 822 case-reviews. A cross-section of 24 case-reviews was analysed with the main outcomes being adherence to the ‘Orientation-Discussion-Decision-Implementation’ framework, and the cancer guidelines.ResultsEight percent of case-reviews in the MDT meetings involved all five core disciplines including surgeons, oncologists, radiologists, histopathologists, and specialist cancer nurses, and 38% included four. The majority of case-reviews (54%) were between two (25%) or three (29%) disciplines only. Surgeons (83%) and oncologists (8%) most consistently engaged in all stages of decision-making. While all patients put forward for MDT meeting were actually reviewed, 4% of them either bypassed the orientation (case presentation), and 8% did not articulate the final decision to the entire team.ConclusionWe found that, despite being a set policy, cancer case-reviews in MDT meetings are not entirely MDT-driven, with more than half of the case-reviews not adhering to the cancer guidelines, and just over 10% not adhering to the group decision-making framework. The findings are in line with the UK recommendation on streamlining MDT meetings and could help decide how to re-organise the meetings to be most efficient. Implications are discussed in relation to quality and safety of care.

Indigenous perspectives on concepts and determinants of flourishing in a health and well-being context: a scoping review protocol

IntroductionIndigenous people, including Māori in New Zealand, face many inequities in health and the determinants of health. Historically, the analysis and reporting of Indigenous health in the literature has usually...

Editorial introductions

Editorial introductions