Inter-institutional Collaboration Research Articles

Applications of Bacteriocins of Lactic Acid Bacteria in Biotechnology and Food Preservation: A Bibliometric Review

Introduction: Due to the growing prevalence of antibiotic resistance in microorganisms and the demand for safe food, there is increasing interest in using natural bioproducts such as the antimicrobial peptides bacteriocins to extend the shelf-life of foods. This is because of their spectrum of activity, ease of synthesis and applicability. This study reports on the global trends in lactic acid bacteria (LAB) bacteriocins based research publications in the Web of Science core collections within the last 20 years (2000-2019), with specific focus to their applications in biotechnology and food science. Methods: Data analysis was undertaken using VOSviewer and HistCite software to evaluate relationships between articles and visualise research linkages amongst authors, institutions and countries. Results: In the 20 years under review, a total of 1741 bacteriocin related articles were published, with the most cited publication examining the anti-infective activity of Lactobacillus salivarius. The highest research output was recorded by the United States, followed by Spain and China. However, Europe as a continent had the highest research output with a higher inter-institution collaboration network and stronger food safety legislations. Discussion: The bibliometric analysis gave insights into the research areas, cooperation network of authors, co-citation maps and co-occurrence of keywords utilized in the research field and indicates that bacteriocin-based research is highly multidisciplinary with a global reach. Conclusion: Key focus is on the control of foodborne disease pathogens, search for new producer organisms and approaches to improve bacteriocin yield and application. This class of antimicrobial peptides has the potential to replace chemical food preservatives in the future.

Performance Management of The Regional Inflation Control Team Central Kalimantan Province In Inflation Control

Inflation control necessitates inter-institutional collaboration and coordination, particularly between Bank Indonesia and the government. To continue to increase cooperation, the Government and Bank Indonesia formed an Inflation Monitoring and Control Team (TPI) at the central level in 2005, followed by the establishment of a Regional Inflation Control Team (TPID) in 2008. It is vital to take strategic efforts to control and suppress inflation by forming the Central Kalimantan Regional Inflation Control Team with the collaboration of regional agencies (TPID). The goal of this article is to identify the performance management strategies used by TPID in Central Kalimantan to keep inflation under control. This study employs a qualitative descriptive method and is conducted in the field. The secretaries and members of the TPID in Central Kalimantan were the subjects of this investigation. The research data was gathered through observation, interviewing, and recording techniques, which were then validated through source triangulation and analyzed through simplification, presentation, and conclusion stages. The findings of this study show that TPID's administration of inflation control efforts in Central Kalimantan complies with Governor Regulation No. 10 of 2015's inflation control guidelines. Because the inflation control procedure carried out by the Central Kalimantan TPID is in accordance with the planning, organizing, executing, and regulating functions, the Central Kalimantan TPID indirectly performs a management function. The Central Kalimantan TPID's inflation control management was highly effective. The Central Kalimantan TPID's inflation control administration was fairly effective in keeping inflation in Central Kalimantan and Palangkaraya generally regulated and constant.

Inter-Institutional Collaboration Between Quaternary and Tertiary Hospitals: Cardiac Surgery Impact.

An inter-institutional collaboration between a quaternary hospital (QH) with a high volume of cardiac surgery and a community-based, tertiary hospital (TH) with a newly established cardiac surgery program was established. We retrospectively reviewed data of patients admitted to the TH between September 2015 and June 2017 for cardiac surgery. The decision to transfer a patient to the QH was based on a Society of Thoracic Surgeon-Predicted Risk of Mortality (STS-PROM) score of ≥ 3%, the potential need for hemodialysis, and other risk factors. The same team of surgeons performed operations at both hospitals. We analyzed the perioperative outcomes of the patients and the referral pattern. A total of 116 patients met eligibility criteria; 105 underwent surgery at the TH, while 11 were transferred to the QH. Among the 11 patients transferred to the QH, eight had a score of 3% (median = 8.2 [IQR 5.7-25.0]). The patients transferred to the QH prior to surgery had a significantly higher STS-PROM score (P = ≤ .001). Overall, the mortality of patients who underwent surgery at the TH was 0.9% (1/105); while surgeries at the QH had a mortality rate of 0% (0/11). The collaborative effort between high-volume cardiac surgery programs and emerging community-based hospitals showed acceptable outcomes in perioperative cardiac surgical mortality. Elevated STS-PROM scores (>3%), previous sternotomy and anticipation of coagulopathy, and low left ventricular ejection fraction or dilated ventricles are factors that influenced the need to transfer from a TH to QH.

A Scopus-Based Bibliometric Analysis of Global Research Contributions on Milk Fluoridation.

Fluoridated-milk schemes have been developed and implemented in many countries to prevent dental caries. This study aimed to evaluate the impact/influence of scientific publications, researchers, and institutions conducting research on milk fluoridation; to explore the international and inter-institutional collaboration and illustrate scientific output trends; and to pinpoint research hotspots in milk fluoridation research. This bibliometric analysis of original research articles on milk fluoridation includes all of the original articles published in peer-reviewed journals systematically extracted from the SCOPUS database. In total, 108 articles were included in this study, with a total of 11,789 citations. A majority (67.6%) of these articles were in the subject area of ‘dentistry’, 22.2% externally funded, 14.8% published in the journal, Caries Research, 7.4% authored/co-authored by Twetman S, 6.5% by authors from Universidad de Chile, and the UK had the highest output (24.1%). The network visualizations showed that those countries with current/past histories of implemented milk fluoridation programs were interconnected on the network visualization map, and they were predominantly the hotspots for original research on milk fluoridation. This study also identified inequalities in research outputs on the topic. With the current enormous global burden of dental caries in children, particularly in low- and middle-income countries, there is an urgent need for greater and more equitable funding of milk fluoridation research globally.

Initial Efforts to Manage IPE during the COVID-19 Pandemic: Reports from the Big Ten Academic Alliance

Purpose: The COVID-19 pandemic required higher education institutions to quickly transition to a virtual platform. This was challenging for those involved in interprofessional education (IPE), given the goal that students from two or more professions learn about, from, and with one another. The Big Ten IPE Alliance is a subgroup of the larger Big Ten Academic Alliance. The purpose of this paper is to share the collective experiences of multiple large, research intensive universities in addressing the challenge of implementing IPE programs under the conditions established by the COVID-19 pandemic. Methods: To better understand how the Big Ten schools dealt with the transition to virtual learning for didactic and clinical IPE given the COVID-19 pandemic, a subset of representatives from the Big Ten IPE Alliance met to discuss best practices for virtual learning in the IPE realm. Each participating university completed an electronic 14 question survey related to their IPE curriculum during the COVID-19 pandemic from March 2020 thru August 2020 and the responses were analyzed. Results: Four categories were identified as needing to be addressed to develop and implement successful interprofessional didactic and clinical experiences. The categories identified included content/assessment, virtual technologies, faculty and facilitators, and learners. Conclusions/Recommendations: Consider including authentic and innovative mechanisms to deliver IPE experiences that meet the learning needs and accreditation requirements. Interinstitutional collaborations such as within the Big Ten IPE Alliance can be beneficial in assessing current and future best practices in IPE.

High-temporal-resolution hydrometeorological data collected in the tropical Cordillera Blanca, Peru (2004–2020)

Abstract. This article presents a comprehensive hydrometeorological dataset collected over the past two decades throughout the Cordillera Blanca, Peru. The data-recording sites, located in the upper portion of the Rio Santa valley, also known as the Callejon de Huaylas, span an elevation range of 3738–4750 m a.s.l. As many historical hydrological stations measuring daily discharge across the region became defunct after their installation in the 1950s, there was a need for new stations to be installed and an opportunity to increase the temporal resolution of the streamflow observations. Through inter-institutional collaboration, the hydrometeorological network described in this paper was deployed with the goal of evaluating how progressive glacier mass loss was impacting stream hydrology, and understanding better the local manifestation of climate change over diurnal to seasonal and interannual time scales. The four automatic weather stations supply detailed meteorological observations and are situated in a variety of mountain landscapes, with one on a high-mountain pass, another next to a glacial lake, and two in glacially carved valleys. Four additional temperature and relative humidity loggers complement the weather stations within the Llanganuco valley by providing these data across an elevation gradient. The six streamflow gauges are located in tributaries to the Rio Santa and collect high-temporal-resolution runoff data. The datasets presented here are available freely from https://doi.org/10.4211/hs.35a670e6c5824ff89b3b74fe45ca90e0 (Mateo et al., 2021). Combined, the hydrological and meteorological data collected throughout the Cordillera Blanca enable detailed research of atmospheric and hydrological processes in tropical high-mountain terrain.

62. The Burden of Covid-19 on Plastic Surgeons Financial Relationships With the Industry: Insights From The Physician Payments Sunshine Act

Purpose: The healthcare system has been greatly affected by the coronavirus disease 2019 (COVID-19) pandemic. Quantification of industry-physician payments under the Physician Payments Sunshine Act has not been performed since the start of the COVID-19 pandemic. The aim of this study is to compare pre- and post-COVID-19 payments between industry and medical providers for all physicians, surgeons, and subspecialized surgeons. Methods: Payment information was obtained from the Open Payments Program (OPP) database for the 2019 and 2020 reported periods for three physician groups: all physicians, all surgeons, and each surgical subspecialty. Comparison and analysis of payment amount and type between these years was performed for each cohort. Results: Physicians experienced a 36% decrease in industry payments with surgeons experiencing a 30.4% decrease. All surgical subspecialties experienced a significant decrease in industry payments excluding transplant surgery (-34.25, p=0.7366) and trauma surgery (-46.46, p=0.1712) which decreased insignificantly, and neurological surgery which increased insignificantly (+2.29, p=0.2002). Charitable contributions (+22.49, p=0.1198) and compensation for services other than consulting (+170.93, p<0.0001) were the only payment types that increase from 2019 to 2020. Among plastic surgeons, total amount of payments had significantly decreased from $47,929,752.87 and 72,044 unique payments in 2019 to $33,319,238.14 (-31%) and 29,946 (-58%) payments in 2020. Variations among the different states were identified. The number of plastic surgeons who received payment also decreased (-21%). Payments to general plastic surgeons had the greatest decrease (-56%, p<0.0001), while payments to plastic surgeons within the head and neck had the least (-9.4%, p=0.3513). Types of payments to plastic surgeons by industry for gifts (-89%), travel and lodging (-83%), speaker fees (-68%), and entertainment (-65%) had the highest decline. In contrast, industry payments to plastic surgeons for charitable contributions (61%) and grants (273%) were considerably higher in 2020 compared to the year prior despite the overall decrease in total payments. Conclusion: The COVID-19 pandemic has significantly impacted industry physician payments across all medical and surgical fields with payment decreases across almost all specialties. Quantification of industry-physician payment trends can help hospitals, patients, and providers better understand the detrimental impact of COVID-19 on physician education, support of surgical practices, and inter-institutional collaboration.

A systematic review of interventions embedded in curriculum to improve university student wellbeing

BackgroundAs concerns around student mental health increase, universities are looking at preventative and universal interventions. The aim was to conduct a systematic review of curriculum-embedded interventions that target student mental health and wellbeing at university. MethodThis was a systematic review of longitudinal pre-/post-studies of curriculum-embedded interventions to improve the mental health and wellbeing of students. Seven electronic databases were searched from June 2015 to May 2020. The vote counting method was used to synthesise studies. ResultsForty-six studies were included in the review. Studies were heterogeneous, and mostly underpowered and rated ‘poor’ in the risk of bias assessment due to poor and inconsistent reporting. Overall, most curriculum-embedded interventions did not influence stress or anxiety. DiscussionThere is no strong evidence to support the impact of curriculum-embedded interventions for improving student mental health or wellbeing. Greater funding opportunities would allow for multi-programme and inter-institutional collaboration to improve the power of studies. Improved quality of reporting would enable high-quality meta-analyses, optimizing conclusions being drawn.

National policies encounter municipal realities: A critical analysis of the outcomes of the List of Priority Municipalities in curbing deforestation in the Brazilian Amazon

At the peak of Amazonian deforestation in the mid-2000s, a suite of initiatives to curb deforestation was implemented, narrowing their scopes to particular agents, critical municipalities, and economic activities and supply chains. The List of Priority Municipalities (LPM) launched in 2008 became a central tenet of these efforts. It requires local agents in listed municipalities to individually and collectively reduce deforestation and implement a comprehensive farm-geocoding registry across the municipality. We combine region-wide spatial–temporal land-cover analysis and census data with in-depth fieldwork to examine the LPM policy at regional and municipal levels, discussing the policy's limitations in inducing effective responses across diverse municipalities. At the regional level, our study presents a new historical-geographic categorization and map of 530 Amazonian municipalities. We propose four regional clusters of municipalities according to patterns of deforestation, agricultural activities, demographic and agrarian structures, emancipation history, and socioenvironmental protection. We draw on this analysis to contextualize the trajectories of the 62 listed municipalities within the region’s moving deforestation frontier and discuss why many of the achievements observed locally have not been replicated regionally. At the municipal level, we investigate four case studies in-depth to unveil the factors underlying the LPM policy mixed outcomes. We discuss how local agents’ responses to the LPM policy are context-specific, reflecting their perception of trade-offs between the economic impacts of sanctions, incentives to collaborate, and potential benefits arising from environmental compliance. We detail and discuss how dynamic macro-political and institutional settings altering law enforcement mechanisms and market incentives interact with subnational environmental governance, either facilitating or inhibiting individual and collective actions locally. Finally, we discuss the role of inter-institutional collaboration and coordination among command-and-control policies, market-oriented initiatives, and incentives for local collective actions in triggering incentives for land-use and governance innovations against deforestation, both locally and regionally.

What the public wants and how it is best served: forensic scientists’ perceptions of the drivers of public value creation

Government agencies are embracing the rhetoric of public value, but what does the empirical evidence tell us about drivers of its creation? One critical source of insight are the practitioners who turn public investment into public value through complex forms of labour. This article identifies how public value is interpreted and created by forensics scientists in the Criminal Justice System using Q Methodological interviews. The results indicate that two very similar types of forensic scientist exist The study finds that while the decisions of scientists are grounded in their expertise, their public value motivations are to ‘add value’ to the public through their science. They serve the citizen through their science. They do not serve the consumer, client or victim directly. The findings also indicate that there is a need to recognise hidden forms of value-added activity that take place upstream in public-value chains, ensuring that there are systems in place to maximise their impact downstream. Points for practitioners Forensic scientists are motivated to serve the public, not the consumer or customer. In order to build capacity within Criminal Justice Systems, agency leaders need to build a relationship based on mutual professional respect rather than a supplier–consumer relationship. If administrative reform is to be guided by academic research, practitioners should use the language of public value rather than the language of new public management. Public value is often created through inter-institutional value chains that can conceal the contribution of upstream value-added activity to desirable public outcomes. It is critical that the value-added process is traced on an inter-institutional basis, and maximised through effective forms of inter-institutional collaboration.

Communities of practice in the production and resourcing of fact-checking

This article considers the ways in which national and international institutional alliances and professional organizations form the basis of a collaborative approach to the resourcing, production, and distribution of fact-checks through a case study of CoronaCheck, the COVID-19 fact-checking project of Australia’s RMIT ABC Fact Check. In doing so, it builds on a theorization that conceives of journalism as a “community of practice.” Two themes emerge from attention to the conceptual framework, content analysis of CoronaCheck newsletters and interviews with fact-checkers and journalists. The first relates to the nexus between fact-checking communities of practice and the productive and collaborative networks that underpin their operation. The second builds on this to consider the structures, resources, and approaches that facilitate experimentation within the community. Taken together, the findings suggest that understanding the practices of international and inter-institutional collaboration in fact-checking efforts such as CoronaCheck is key to shedding light on how a subcommunity of journalism practice broadens its remit and reorients the concerns of the domain in response to change.

A SWOT analysis of medical school adaptations to COVID-19: A national survey of deans in Taiwan

Introduction: The COVID-19 pandemic forced medical schools worldwide to transition online. While there are ample reports about medical education adaptations to this crisis, there are limited studies evaluating the impact. Methods: This study includes a case study of how Taiwanese medical school deans maintained in-person education during the COVID-19 pandemic. Additionally, it demonstrates how SWOT analyses can help medical educators reflect on adaptations during the COVID-19 pandemic and future crises. This study employed two online surveys and a semi-structured interview regarding curricular adaptations. Eligible participants were deans or associate deans of all medical schools in Taiwan. Results: Through a SWOT analysis, this study identified Strengths as strong leadership, prior experience with SARS, and ability to promptly adapt curriculum; Weaknesses as lack of faculty confidence in online education, limited numbers of administrative staff, and inability to rapidly add new topics; Opportunities as centralised anti-epidemic policies, inter-institutional collaborations, and educational innovations; and Threats as concerns from parents, patients, and teaching hospitals. It is reported that the quality of education was maintained as students’ evaluations of courses, performances in written exams, clerkship supervisors’ assessments, national OSCE, and national board exams remained comparable to pre-COVID times. Strengths and Opportunities such as strong leadership and centralised anti-epidemic policies can overcome Weaknesses and Threats, such as lack of confidence in online education and familial pressure to suspend hospital-based education. Conclusion: This study recommends that medical school leaders conduct SWOT analyses as early as possible to plan strategies to continue safe and quality medical education during COVID-19 and future crises.

Creating and sustaining collaborative connections: tensions and enabling factors in joint international programme development

The joint development and delivery of co-branded programmes across universities and countries promises enhanced visibility for partnering institutions, stimulating synergistic collegial relationships for teachers, and expanded opportunities for students to access a wider range of courses enhanced by a broader range of international expertise. At the same time, the development of such programmes is potentially fraught with difficult logistical, interpersonal, organisational and managerial challenges. A growing literature from fields of inquiry outside higher education has begun to address these challenges. This literature offers useful guidance to higher education practitioners and researchers in appreciating the range of factors involved in significant collaborations across institutional and national boundaries, identifying issues that commonly arise in such work and considering ways of accommodating these factors and issues in order to navigate the complexities of international collaboration in programme development. Data from a case study of such programme development across two universities on different continents, one in the UK and one in Australia, are used to identify critical factors to be taken into account. These factors, considered in the context of inter-institutional collaboration literature, provide the basis of a framework for joint international programme development which explicates each factor and the relationships between them in order to guide future collaborations. A common collaborative space that enables such joint work to occur despite inevitable differences between the parties is a central part of this framework.

Are outcomes in congenital cardiac surgery better than ever?

Congenital heart disease is the most common congenital defect among infants born in the United States. Within the first year of life, 1 in 4 of these infants will need surgery. Only one generation removed from an overall mortality of 14%, many changes have been introduced into the field. Have these changes measurably improved outcomes? The literature search was conducted through PubMed MEDLINE and Google Scholar from inception to October 31, 2021. Ultimately, 78 publications were chosen for inclusion. The outcome of overall mortality has experienced continuous improvements in the modern era of the specialty despite the performance of more technically demanding surgeries on patients with complex comorbidities. This modality does not account for case-mix, however. In turn, clinical outcomes have not been consistent from center to center. Furthermore, variation in practice between institutions has also been documented. A recurring theme in the literature is a movement toward standardization and universalization. Examples include mortality risk-stratification that has allowed direct comparison of outcomes between programs and improved definitions of morbidities which provide an enhanced framework for diagnosis and management. Overall mortality is now below 3%, which suggests that more patients are surviving their interventions than in any previous era in congenital cardiac surgery. Focus has transitioned from survival to improving the quality of life in the survivors by decreasing the incidence of morbidity and associated long-term effects. With the transformation toward standardization and interinstitutional collaboration, future advancements are expected.

Demand for community-based Case Management in Austria - a qualitative analysis

BackgroundThe number of people with complex nursing and care needs living in their own homes is increasing. The implementation of Case and Care Management has shown to have a positive effect on unmet care needs. Research on and implementation of Case and Care Management in the community setting in Austria is limited. This study aimed to understand the changes and challenges of changing care needs by mobile nurses and to evaluate the need for Case Management in mobile care organizations by investigating the evolution of mobile care nurses‘task profiles and the challenges in working in a dynamic field with changing target groups and complexifying care needs.MethodsA qualitative study with reductive-interpretative data analysis consisting of semi-structured focus groups was conducted. Community care nurses, head nurses, and managers of community mobile care units as well as discharge managers of a community hospital (n = 24) participated in nine qualitative, semi-structured focus groups. The recorded focus groups were transcribed and analyzed using qualitative content analysis.ResultsThe analysis revealed three main categories: the complexity of the case, innerinstitutional frameworks, and interinstitutional collaboration, which influence the perception of need for further development in the direction of Case and Care Management. Feelings of overwhelmedness among nurses were predominantly tied to cases that presented with issues beyond healthcare such as legal, financial, or social that necessitated communication and collaboration across multiple care providers.ConclusionsCare institutions need to adapt to changing and increasingly complex care needs that necessitate cooperation between organizations within and across the health and social sectors. A key facilitator for care coordination and the adequate service provision for complex care needs are multidisciplinary institutional networks, which often remain informal, leaving nurses in the role of petitioner without equal footing. Embedding Case and Care Management in the community has the potential to fill this gap and facilitate flexible, timely, and coordinated care across multiple care providers.

New interinstitutional, multimodal presurgical evaluation protocol associated with improved seizure freedom for poorly defined cases of focal epilepsy in children.

In an attempt to improve postsurgical seizure outcomes for poorly defined cases (PDCs) of pediatric focal epilepsy (i.e., those that are not visible or well defined on 3T MRI), the authors modified their presurgical evaluation strategy. Instead of relying on concordance between video-electroencephalography and 3T MRI and using functional imaging and intracranial recording in select cases, the authors systematically used a multimodal, 3-tiered investigation protocol that also involved new collaborations between their hospital, the Montreal Children's Hospital, and the Montreal Neurological Institute. In this study, the authors examined how their new strategy has impacted postsurgical outcomes. They hypothesized that it would improve postsurgical seizure outcomes, with the added benefit of identifying a subset of tests contributing the most. Chart review was performed for children with PDCs who underwent resection following the new strategy (i.e., new protocol [NP]), and for the same number who underwent treatment previously (i.e., preprotocol [PP]); ≥ 1-year follow-up was required for inclusion. Well-defined, multifocal, and diffuse hemispheric cases were excluded. Preoperative demographics and clinical characteristics, resection volumes, and pathology, as well as seizure outcomes (Engel class Ia vs > Ia) at 1 year postsurgery and last follow-up were reviewed. Twenty-two consecutive NP patients were compared with 22 PP patients. There was no difference between the two groups for resection volumes, pathology, or preoperative characteristics, except that the NP group underwent more presurgical evaluation tests (p < 0.001). At 1 year postsurgery, 20 of 22 NP patients and 10 of 22 PP patients were seizure free (OR 11.81, 95% CI 2.00-69.68; p = 0.006). Magnetoencephalography and PET/MRI were associated with improved postsurgical seizure outcomes, but both were highly correlated with the protocol group (i.e., independent test effects could not be demonstrated). A new presurgical evaluation strategy for children with PDCs of focal epilepsy led to improved postsurgical seizure freedom. No individual presurgical evaluation test was independently associated with improved outcome, suggesting that it may be the combined systematic protocol and new interinstitutional collaborations that makes the difference rather than any individual test.

Analysis of the Production and Inter-institutional Collaboration in Spanish Psychology from a Gender Perspective between 1970 and 1989.

Analysis of the Production and Inter-institutional Collaboration in Spanish Psychology from a Gender Perspective between 1970 and 1989.

The evolution of the Pure Community Module: How lessons learned from national, regional, and subject-focused use cases have been used to support inter-institutional collaboration

This abstract provides an update on development and implementation progress of the Pure community module in the 5 years since the initial launch of the service. The paper revisits the conclusions of our 2018 presentation [1], providing updates on the ‘future developments’ and encourages a discussion of the complexities in supporting multi-institutional collaborations. In addition, we will provide an overview of some key challenge areas we have been working on together with community customers and community owners (technical and operational).

Strengthening the Mentorship and Leadership Capacity of HIV/AIDS and Tuberculosis Researchers in South Africa.

Programs to increase emerging and established HIV and tuberculosis (TB) researchers' capacity to be more effective leaders and mentors are urgently needed in low- and middle-income countries (LMICs). Although conceptual frameworks of mentoring and mentoring toolkits have been developed by and for researchers in LMIC settings, few mentor training programs have been implemented and evaluated in these settings. We created, implemented, and evaluated a 9-month, certificate-level mentorship training program to strengthen the pipeline of HIV and TB researchers in South Africa. Differentiating features of the program included careful contextualization of mentorship tools and approaches, inclusion of a leadership curriculum to improve participant ability to work effectively in teams and organizations, and attention to processes that promote interinstitutional collaboration in mentorship. Twelve mid-career researchers graduated from the first cohort of the program. Among participants, we observed significant longitudinal improvement in mentorship competencies, increased numbers of network connections in multiple domains of collaboration, and high levels of satisfaction. We anticipate that the program description and results will be useful to researchers, research institutions, and funders seeking to build research mentorship and leadership capacity in LMIC settings.

Training facilitated by interinstitutional collaboration and telemedicine: an alternative for improving results in the placenta accreta spectrum

Placenta accreta spectrum is a severe condition that requires trained, interdisciplinary group intervention. However, achieving the level of training that is required is difficult without academic programs or hospitals dedicated to teaching the necessary skills to deal with placenta accreta spectrum. We describe an interinstitutional collaboration process focused on improving placenta accreta spectrum treatment, which is facilitated by telemedicine. Lastly, we propose a replicable model for other centers.This was a retrospective, descriptive study that included placenta accreta spectrum patients treated over a 10-year period in a low-middle income country hospital (local hospital). We evaluated the clinical results and impact of interinstitutional collaboration with a placenta accreta spectrum expert group at another low-middle income country hospital. Virtual strategies of continuous communication between the local hospital and expert group were used, such as telemedicine, teleradiology, and telepresence during surgeries.A total of 89 placenta accreta spectrum patients were included. We observed a progressive improvement in the clinical outcomes (intraoperative bleeding, transfusion frequency, postoperative length of stay, and frequency of complications) as the fixed interdisciplinary group at the local hospital gained experience by treating more cases.Interinstitutional collaboration (through telemedicine and remote supervision) and placenta accreta spectrum team formation were the 2 factors associated with the best outcomes in the most recent years of observation. Thus, ongoing placenta accreta spectrum team training, facilitated by interinstitutional collaboration and telemedicine, is a valid strategy for improving the clinical outcomes in placenta accreta spectrum.