Interdisciplinary Consultation Research Articles

Metaverse: a new reality in surgery. Review

The metaverse is a relatively new concept in technological advancement. It is a three-dimensional immersive environment including real and virtual world elements, in which various digital agents, more precisely, avatars, interact with each other and various activities (educational, cultural, and financial) can be carried out. It is an emerging controversial concept without precise definition and will likely continue to evolve as technology improves. Works of literature from 2020 to 2023, posted in the PubMed and Web of Science databases, were extracted using the following keywords: “metaverse”, “education”, “digital therapy”, “interdisciplinary consultation”, “medical Internet of things”, “virtual reality”, “superimposed reality”, “extended reality”, “mixed reality”, “lifelogging”, “mirror world”, “digital twins”, and “surgery”. In the PubMed search using the original terms, no publications were extracted in 2020, 9 in 2021, 161 in 2022, and 246 in 2023. In the healthcare context, metaverse technology refers to the use of virtual reality and interactive and other immersive technologies, such as augmented reality, to create simulated environments intended for training, education, and clinical applications. Various aspects of medicine such as digital therapeutics, multidisciplinary team discussions, medical Internet of things, surgical simulations, conferences and meetings, research programs, etc., are being explored. Depending on the requirements, the metaverse provides a versatile platform that can be modeled accordingly, providing a flexible tool for medical development. In this review, we discussed in detail the possible applications of the metaverse in surgery. All scoping rubrics are based on the sparse evidence in the scientific literature and are adequately evaluated to provide compelling evidence on the utility of the metaverse in the future of medicine.

(Uro)genital developmental disorders

Congenital anomalies of the urogenital tract are common, whereas isolated developmental disorders of the genital organs are rare and varied. The type and timing of imaging to characterize these developmental disorders and the planning of any treatment are the subject of discussion. The aim of this article is to provide a brief overview of embryology, diagnostic procedures, and examples of findings. The primary procedure for imaging the genitals is sonography, which must be performed with appropriate empathy. In addition to the genitals, the general situation of the kidneys and urinary tract should be examined, as urogenital malformations are often combined. Dedicated magnetic resonance imaging (MRI) is indicated as advanced imaging in interdisciplinary consultations. Invasive procedures, such as genitography combined with micturition cystourethrography (MCU) using X‑rays or contrast-enhanced sonography, are rarely required. Computed tomography (CT) or excretory urography play no role. Imaging plays an important role in the assessment of genital anomalies. Knowledge of embryology facilitates anatomical understanding and the assessment of pathologies.

A Pilot Study to Evaluate a New Hep-GRP Care Pathway to Improve Outcomes Among Canadian Older Adults with Liver Cirrhosis.

Older adults with cirrhosis have complex medical needs that are not satisfied by organ specific management. Interdisciplinary approach may mitigate comorbidity and improve patient satisfaction. A pilot study consisted of dual specialist interdisciplinary referral pathway and mixed virtual care delivery model are prospectively evaluated in older adults (65 years and older) with cirrhosis during the COVID-19 pandemic between September and December 2022. Participant attitudes towards telemedicine were surveyed. 68 participants with cirrhosis were consecutively assessed by hepatology. The mean age was 73 years. 39 (57%) screened positive for one or more geriatric syndrome(s). Comprehensive geriatric assessments were conducted via telemedicine in 18 participants, with additional referrals to physiotherapy and nutritional education. Compared to a historic cohort matched for age, sex, and Child-Pugh class, acute health service utilization measured by ER visits among those received dual specialist interdisciplinary consultation were lowered by 1.11 per patient at three-month follow up period (p = .0006, 95% CI 0.47-1.74). Majority participants (87.6%) preferred telemedicine or mixed method visits. An interdisciplinary approach to older adults with cirrhosis will likely be beneficial, and routine screening for geriatric syndrome may lead to reduced acute health-care utilization in the short term. Telemedicine and virtual screening tools in seniors should be fully explored to improve access to care.

Post-hospitalization Care Transition Strategies for Patients with Substance Use Disorders: A Narrative Review and Taxonomy.

Hospitalizations represent important opportunities to engage individuals with substance use disorders (SUD) in treatment. For those who engage with SUD treatment in the hospital setting, tailored supports during post-discharge transitions to longitudinal care settings may improve care linkages, retention, and treatment outcomes. We updated a recent systematic review search on post-hospitalization SUD care transitions through a structured review of published literature from January 2020 through June 2023. We then added novel sources including a gray literature search and key informant interviews to develop a taxonomy of post-hospitalization care transition models for patients with SUD. Our updated literature search generated 956 abstracts not included in the original systematic review. We selected and reviewed 89 full-text articles, which yielded six new references added to 26 relevant articles from the original review. Our search of five gray literature sources yielded four additional references. Using a thematic analysis approach, we extracted themes from semi-structured interviews with 10 key informants. From these results, we constructed a taxonomy consisting of 10 unique SUD care transition models in three overarching domains (inpatient-focused, transitional, outpatient-focused). These models include (1) training and protocol implementation; (2) screening, brief intervention, and referral to treatment; (3) hospital-based interdisciplinary consult team; (4) continuity-enhanced interdisciplinary consult team; (5) peer navigation; (6) transitional care management; (7) outpatient in-reach; (8) post-discharge outreach; (9) incentivizing follow-up; and (10) bridge clinic. For each model, we describe design, scope, approach, and implementation strategies. Our taxonomy highlights emerging models of post-hospitalization care transitions for patients with SUD. An established taxonomy provides a framework for future research, implementation efforts, and policy in this understudied, but critically important, aspect of SUD care.

P496 Interdisciplinary student-led screening clinics can identify undernutrition, sarcopenia and mental health risk in ambulatory patients with Inflammatory Bowel Disease

Abstract Background The changing landscape of allied health practice has led to the emergence of student-led clinics as a resource to enable workforce capacity. Undernutrition, sarcopenia, and poor mental health are common in inflammatory bowel disease (IBD) and affect quality of life. Despite high prevalence, these co-morbidities are under-recognised due to lack of service capacity. This study aimed to determine the frequency of undernutrition, reduced physical performance and mental health risk identified by a novel student-led interdisciplinary screening clinic in ambulatory patients with IBD. Methods Sixteen final year dietetic, physiotherapy or exercise physiology students conducted 5-10 weekly half day interdisciplinary outpatient clinics within a tertiary IBD service between July and October 2023. Following training, students completed all aspects of the interdisciplinary consult under direct dietetic supervision. Risk screening assessments comprised of anthropometrics, depression anxiety and stress scale-21 (DASS21), subjective global assessment (SGA), short physical performance battery (SPPB), handgrip strength (HGS) and inflammatory bowel disease-nutrition screening tool (IBD-NST). Consecutive patients attending a tertiary IBD outpatient service were contacted to participate in the clinic following their gastroenterology appointment. Descriptive statistics were completed, and prevalence is presented as number (n) and percentage. Results Screening assessments were completed for 88 patients in the 15-week period (Table1). Patient acceptance was high with 86% of patients approached consenting to participate. High hip to waist ratio was present in 68% (n=60/88) of patients suggestive of visceral adiposity (Figure 1a). The IBD-NST identified mild nutrition risk in 5% (n=4/88) of patients and generated a referral to dietetics with a moderate nutrition risk in 21% (n=19/88) of patients (Figure 1b). Malnutrition was detected in 10% (n=8/88) of the patient population (Figure 1c). Mental health risk was elevated in 63% (n=50/79) of patients screened (Figure 1e, f, g). Physical impairment was present in 52% (n=46/88) of patients (Figure 1h &1i). The screening clinic generated 48 referrals through to varied allied health disciplines for individualised therapy. Conclusion A student-led interdisciplinary screening clinic ensures timely identification of patient risk for undernutrition, sarcopenia and poor mental health, improving access to early intervention opportunities. Students can act as a valuable enabler for workforce capacity at a time when the health service providers are stretched.

Reevaluation of the indications for permanent pacemaker implantation after cardioneuroablation

Abstract Background Cardioneuroablation(CNA) is promising and innovative method to cure vagally mediated bradycardia.However, according to current ESC2021 guidelines patients may have indications for permanent pacing. CNA is still referred to patients as an experimental and alternative method,not being recommended in guidelines due to too small amount of evidence.The study sought to validate criteria for permanent pacemaker(PPM) implantation,discontinuation of PPM therapy(PPMT) and risk of PPM implantation after CNA in a large population of patients qualified for electrophysiologic study(EPS),Extracardiac vagal nerve stimulation(ECVS) and CNA. Methods Data were collected from POLish prospective multicentre CardioneuroAblation registry(POLCA) with comprehensive management, interdisciplinary consultations, state-of-art autonomic tests, atropine tests, EPS as well as ECVS. Shared-decision making was used to developed patient-oriented therapy with clear declaration of fulfilling indications for PPMT according to ESC guidelines,(when applicable) and CNA only as alternative and developing technique. Results A total of 195 consecutive adult patients(mean age:55,6+/-14,3 years; min 20,0 Q1 44,96-Q2 58,4 - Q3 67,2; max 82;107(54%)females,) underwent first CNA. Out of them, 17(8,2%) had already PPM. According to current guidelines 100/178(51%) patients had de novo indications for PPM implantation prior to CNA including: SND(n=88,45%), AVB(n=21, 10%), TBS (n=26, 13%), CI-VVS(n=41; 21%),M-VVS(n=1;0,5%), CI-CCS(n=41;21%) or mixed etiologies (n=45;23%). Indications for de novo PMT were present in 32(37%) patients above age 60. During moderate-term (23,7+/-10,3 months), no patient died, and only 10 had syncope (which was diagnosed as orthostatic or vasodepressive). Despite preprocedural positive atropine test and positive ECVS, 6 out of 195 patients (had early and elective PPM implantation due to coexistence of functional and structural bradycardia(n=3) or bradycardia recurrences(n=2) or severe sinus chronotropic incompetence(n=1). There were 7(3,5%) major complications (tamponade (n=2), pericarditis(n=2), pericardial effusion(n=1), femoral aneurysm(n=1), pneumothorax(n=1) of CNA. Only 4 of patients with indications for PPM implantation before CNA still had those indications during follow-up. Out of 6 patients with late PPM implantations after CNA, 1 patient had syncope due to development of AVB. Conclusions About 51%patients referred for CNA had indications for PPM therapy. CNA in subgroup of patients with functional bradycardia is becoming alternative choice to PPMT and allowed to give up PPM implantation at least temporarily in 96%patients without prior PPMT. However some patients require PMT due to failed CNA or reinnervation,but also co-existence or development of complex structural bradyarrhythmias.

GLIOMA-08 INTRACRANIAL HIGH-GRADE GLIOMA MANAGEMENT IN COTE D’IVOIRE : ABOUT 19 COALIGATED CASES FROM MARCH 2019 TO JUNE 2021

Abstract INTRODUCTION Intracranial malignant gliomas are serious conditions that constitute a therapeutic challenge. In Côte d'Ivoire, since 2019, their care meets international standards with the advent of the National Center of Radiotherapy and Medical Oncology Alassane Ouattara and interdisciplinary consultation meetings. Our objective was to evaluate the morbidity and mortality of patients treated for high-grade gliomas in Côte d'Ivoire. MATERIALS AND METHODS We realized from March 2019 to June 2021, a retrospective cohort study on 19 patients with malignant intracranial glioma, without distinction of age and sex, whether alive or deceased. They were 12 male patients and 07 female patients. The parameters studied were, among others, the type and quality of complementary treatment, the evolution under treatment, and the time to onset of recurrence and death. RESULTS The time to consultation was early in 57.9% of cases. High ICP syndrome was the main reason for consultation at 51.6%, followed by neurological deficit. Surgery was performed on average in all patients within 30 days after imaging. The histological diagnosis of grade 4 glioma was pronounced in 16 patients. Postoperative radiotherapy was performed in 94.7% of cases, associated with concomitant then adjuvant chemotherapy with temozolomide in 84.2% of patients. During the treatment, two cases of local recurrence were notified. At the end of the cohort, the death rate was estimated at 73.7%, with a median survival of 11 months and extremes ranging from 06 months to 34 months. CONCLUSION Despite the availability and application of reference therapeutic processes, malignant glioma remains, due to many factors related to our context, a very pejorative prognosis. This study should continue with the inclusion of a larger number of patients in order to review the state of play of the management of high-grade gliomas in Côte d'Ivoire.

Case report of idiopathic normal pressure hydrocephalus: a challenging diagnosis

Introduction: This report concerns the case of a 70-year-old man with idiopathic normal pressure hydrocephalus (iNPH). The diagnosis in the current case took more than 2 years. iNPH is characterised by ventriculomegaly with a known triad of symptoms: gait disturbance, cognitive impairments and urinary incontinence. Although this is a difficult diagnosis and other conditions must be ruled out, several points in the process could lead to a correct diagnosis. The aim of the report is to identify several reasons why the diagnosis was delayed for such a long time, as well as lessons for the future. Case: This patient developed several symptoms over time. First, he presented with depressive mood and altered behaviour. He later developed gait difficulties and, finally, urinary incontinence. Multiple consultations and examinations failed to provide an exact explanation for all his symptoms. After 2 years, a new doctor at the hospital started from scratch and recognised the iNPH triad, and the diagnosis was confirmed by the radiologist. Conclusion: The diagnosis of iNPH is difficult, as symptoms may manifest over time. In this case, the delay of diagnosis exceeded estimations. A broader view through interdisciplinary consultation could provide new insights and lead to earlier diagnosis.

Endovascular coil-embolization of an unruptured, true UAA during early pregnancy- a case report

BackgroundTrue uterine artery aneurysms, especially during pregnancy, are a rare entity and not well understood. Clinical symptoms are unspecific pelvic pain and pressure. Diagnosis can be confirmed by transvaginal color-coded-sonography and/or magnetic resonance imaging. Because of potential risk of rupture, immediate interdisciplinary discussion and treatment planning in the best interests of both mother and child is crucial.Case presentationWe present a 31-year-old pregnant woman with increasing pelvic pain and pressure. Diagnosis of an unruptured uterine artery aneurysm was confirmed by color-coded-sonography and magnetic resonance angiography. After interdisciplinary consultation, successful endovascular super-selective coil-embolization was performed by using X-ray fluoroscopy. Thus, fetal radiation dose during treatment with 4.33 mGy (VirtualDoseTM) was as low as possible with no immediate harm to the fetus.ConclusionsUnruptured true uterine artery aneurysms can be successfully treated by endovascular super-selective coil-embolization during early pregnancy with no immediate harm to the fetus.

Perioperative management of a patient with haemophilia B and PSVT undergoing radiofrequency ablation: A case report.

Haemophilia B is a rare inherited bleeding disorder in which patients have impaired coagulation. This study describes a patient with Haemophilia B and paroxysmal supraventricular tachycardia (PSVT) who underwent radio frequency catheter ablation (RFCA). The perioperative replacement therapy with coagulation factor IX (FIX) was agreed upon after an interdisciplinary consultation involving a team of specialists in haematology, cardiovascular medicine and cardiothoracic surgery. There were no obvious bleeding points or complications during the perioperative period following the treatment, nor recurrence of PSVT within a three-year follow-up period. In summary, RFCA can be performed safely in patients with haemophilia B on the premise of developing an individualized perioperative exogenous coagulation factor supplementation regimen based upon an adequate preoperative evaluation and clinical monitoring and management by an interdisciplinary team.

66.3 If You Build It, Will They Come? Developing an Interdisciplinary Consultation Clinic for Gender-Diverse Youth in a Rural Catchment Area

66.3 If You Build It, Will They Come? Developing an Interdisciplinary Consultation Clinic for Gender-Diverse Youth in a Rural Catchment Area

The Effect of an Interdisciplinary Dermatological-Rheumatological Consultation on the Outcome of Patients with Psoriasis with Musculoskeletal Pain: A Prospective, Single-Center Cohort Study.

Psoriatic arthritis (PsA), a disease with complex inflammatory musculoskeletal manifestations, complicates psoriasis in up to 30% of patients. In this study, we aimed to determine the effect of an interdisciplinary dermatological-rheumatological consultation (IDRC) for patients with psoriasis with musculoskeletal symptoms. This prospective study enrolled 202 patients with psoriasis. Patients with musculoskeletal pain (MSP) (n = 115) participated in an IDRC 12weeks after enrollment. The outcome was evaluated after 24weeks. In 12/79 (15.2%) patients seen in the IDRC, the prior diagnosis was changed: eight with a first diagnosis of PsA, four with a diagnosis of PsA rescinded. Treatment was modified in 28% of patients. Significant improvements in Psoriasis Area and Severity Index (PASI) (from 5.3 to 2.0; p < 0.001) and Dermatology Life Quality Index (DLQI) (from 6.7 to 4.5; p = 0.009) were observed. By comparing changes in PASI and DLQI over the study period, an improvement in PASI of 0.7 ± 1.4 points (p = 0.64) and in DLQI of 2.9 ± 1.5 points (p = 0.051) could be attributed to participation in the IDRC. An IDRC of patients with psoriasis with MSP leads to a valid diagnosis of PsA and improvement in quality of life. Based on these results, an IDRC is a valuable and time efficient way for psoriasis patient with MSP to receive optimal care.

A precision-based exercise program for patients with multiple myeloma.

Aim of this study was to retrospectively evaluate an interdisciplinary consultation followed by a precision-based exercise program (PEP) for myeloma patients with stable and unstable bone lesions. Data of myeloma patients (n = 100) who received a PEP according to an orthopedic evaluation were analyzed. Bone stability was assessed by established scoring systems (Spinal Instability Neoplastic Score [SINS], Mirels' score). All patients with stable and unstable osteolyses received a PEP and n = 91 were contacted for a follow-up interview. In 60% of patients at least one osteolysis of the spine was considered potentially unstable or unstable. Following consultation, the number of patients performing resistance training could be significantly increased (≥2 sessions/week, 55%). Musculoskeletal pain was reported frequently. At the follow-up interview, 75% of patients who performed PEP stated that painful symptoms could be effectively alleviated by exercise. Moreover, only patients who exercised regularly discontinued pain medication. No injuries were reported in association with PEP. We were able to demonstrate that individualized resistance training is implementable and safe for myeloma patients. By means of a PEP, patients' self-efficacy in managing musculoskeletal pain was enhanced and pain medication could be reduced.

The Interdisciplinary Family Consultation in Pediatrics - An Integrative Approach to Complex Burdened Families of Chronically ill Children

For families of chronically ill children with a high level of psychosocial stress, it is necessary to involve child and adolescent psychiatric or psychosomatic specialists directly in the pediatric treatment process. For this purpose, a family consultation was set up in the Heidelberg University Pediatrics as part of a model project, which deals with these families in an interdisciplinary and systemic way. It shows that the implementation of the consultation works despite a high organizational effort and is regularly used. The first evaluation results confirm the already described high levels of psychosocial stress in the affected families. They indicate a positive assessment of the consultation and a desire for a permanent offer. First follow-up results indicate a significant decrease in treatment-related concerns, uncertainty and a reduction in treatment-related problems. The lack of a viable funding model poses a challenge for long-term implementation.

Differential Diagnosis Challenges of Facial Pain (Clinical Case)

Annotation. The diagnosis of facial pain falls within the realm of professional competence for dentists, orthopedic dentists, ophthalmologists, otolaryngologists, neurosurgeons, neurologists, and physiotherapists. The complex and highly subjective nature of clinical symptoms often poses challenges for practitioners across these specialties. Consequently, a patient with facial pain may undergo multiple consultations with different specialists before a definitive diagnosis is established and effective treatment is provided. The aim of this study is to demonstrate a developed routing protocol for a patient with atypical facial pain through a clinical case. The stages of interdisciplinary simultaneous consultation, a comprehensive approach to diagnosis and treatment of patients with facial pain, and differential diagnosis are considered using the example of a clinical case of a 15-year-old female patient K., who presented to a dental surgeon with complaints of constant facial pain and a preliminary diagnosis of “Temporomandibular joint dysfunction. Impacted wisdom teeth 38 and 28”. The pain was constant, dull, deep, and piercing. She experienced decreased sensitivity in the lower lip and the anterior half of the tongue on the left side, as well as stuffiness and ringing in the left ear. Consultations with a neurologist and an orthopedic dentist were conducted, which led to the prescription of additional diagnostic methods: needle electromyography and magnetic resonance imaging of the brain. The article assesses the relevance and effectiveness of a multidisciplinary approach to the comprehensive diagnosis of facial pain syndrome, including a thorough history-taking by a dental practitioner, conclusions of a neurologist, and the results of additional diagnostic methods. Based on the electromyographic signs, the trigeminal nerve damage was detected, and a voluminous brain tumor causing compression of the trigeminal nerve and its peripheral endings was visualized on magnetic resonance tomography. Following the consultation with the dental surgeon, the patient was referred for further treatment to the A.P. Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine. Thus, interdisciplinary consultation is recognized as the basis for the comprehensive management of patients with atypical facial pain, requiring the involvement of a primary care physician - a dentist, who develops a routing protocol for timely diagnosis and effective treatment of these kind of patients.

Experience of personalized management of patients with breast cancer associated with pregnancy

The clinical case of a patient with pregnancy-associated breast cancer observed in Sverdlovsk Regional Oncological Dispensary was analyzed. The information obtained from the electronic map of obstetric database and the medical history of oncological dispensary regarding the results of clinical examination as well as the data of instrumental and laboratory research were used. The tactics of managing this patient was discussed at the Regional Obstetric and Interdisciplinary Consultation with the participation of oncologists; a compromise concept was chosen, which implies surgical treatment of malignant neoplasms followed by chemotherapy during pregnancy and early delivery at the term when a child is viable 34 weeks of pregnancy. At present, preference is given to personalized tactics of pregnancy management and treatment of pregnancy-associated breast cancer using an interdisciplinary approach with the participation of medical specialists: obstetrician-gynecologist, oncologist-surgeon, oncologist-chemotherapist, radiotherapist, anesthesiologist-resuscitator, neonatologist, pathologist. The described clinical case demonstrates successful implementation of this approach, as evidenced by the favourable outcome of childbirth as well as the absence of recurrence and progression of the tumor process in dynamics.

Impaired health-related quality of life in long-COVID syndrome after mild to moderate COVID-19

A growing number of patients with SARS-CoV-2 infections experience long-lasting symptoms. Even patients who suffered from a mild acute infection show a variety of persisting and debilitating neurocognitive, respiratory, or cardiac symptoms (Long-Covid syndrome), consequently leading to limitations in everyday life. Because data on health-related quality of life (HRQoL) is scarce, we aimed to characterize the impact of Long-Covid symptoms after a mild or moderate acute infection on HRQoL. In this observational study, outpatients seeking counseling in the interdisciplinary Post-Covid consultation of the University Hospital Zurich with symptoms persisting for more than 4 weeks were included. Patients who received an alternative diagnosis or suffered from a severe acute Covid-19 infection were excluded. St. George’s Respiratory Questionnaire (SGRQ), Euroquol-5D-5L (EQ-5D-5L), and the Short form 36 (SF-36) were distributed to assess HRQoL. 112 patients were included, 86 (76.8%) were female, median (IQR) age was 43 (32.0, 52.5) years with 126 (91, 180) days of symptoms. Patients suffered frequently from fatigue (81%), concentration difficulties (60%), and dyspnea (60%). Patients mostly stated impairment in performing usual activities and having pain/discomfort or anxiety out of the EQ-5D-5L. EQ index value and SGRQ activity score component were significantly lower in females. SF-36 scores showed remarkably lower scores in the physical health domain compared to the Swiss general population before and during the COVID-19 pandemic. Long-Covid syndrome has a substantial impact on HRQoL. Long-term surveillance of patients must provide clarity on the duration of impairments in physical and mental health.Trial registration: The study is registered on www.ClinicalTrials.gov, NCT04793269.

Somatoform disorders—chronic pelvic pain in women

Pelvic pain in women is aclinically common symptom and afrequent finding in general practitioner, urological, gynecological, and pediatric practice. The list of possible differential diagnoses is long and the clarification ranges from avisual diagnosis to technical and surgical examinations to complex interdisciplinary consultations. But when do we talk about chronic lower abdominal pain? What can be the cause of this and how can we approach it diagnostically and therapeutically? What should we pay attention to? The difficulty begins with the definition. If we look at the national and international guidelines and publications, we find different definitions for chronic pelvic pain. There are various causes of chronic pelvic pain. There is often acombination of physical and psychological factors, which is why it is often not possible to identify asingle diagnosis behind chronic pelvic pain syndrome. The clarification of these complaints requires abiopsychosocial approach. Multimodal approaches should be considered in assessment and treatment, and experts from other disciplines should be consulted.

Fetal Neurology Practice Survey (P10-9.001)

<h3>Objective:</h3> To study the fetal neurology care delivery across centers in the US. <h3>Background:</h3> Fetal neurology is a rapidly evolving subspecialty that centers on the diagnosis and treatment of neurologic conditions of the developing brain. Innovations in fetal diagnostic tools and therapies have resulted in an increased need for specialized training. Prenatal diagnostic input with postnatal continuity of care can better address sequelae including developmental, behavioral, epileptic and mental health disorders. Despite the growing need for fetal neurology services, little is known about the current practice. <h3>Design/Methods:</h3> The Fetal Neurology Consortium (representatives from 9 sites across the US) distributed a survey characterizing fetal neurologic care delivery to practicing child neurologists using a Redcap database posted to the Child Neurology Society member website in November 2021 and March 2022. The results were summarized using descriptive statistics. <h3>Results:</h3> Representatives from 43 US institutions responded. Most centers had a fetal diagnostic center (n=38/43, 88%), with about half using a fetal neurology registry. Most performed fetal ultrasound and MRI on site. The annual fetal consultations ranged between &lt;20 for 40% to &gt;100 for 17%. About 50% of respondents were subspecialty trained. Earliest gestational age of fetal MRI was 16–19 weeks in 30% and 20–23 weeks in 30%. 25% of respondents participated in interdisciplinary consultations. Majority of the respondents followed neurodevelopment clinically. 91% were interested in participating in a collaborative national registry. The top-five priorities ranked by respondents were clinical guidelines, long-term follow-up data, imaging, practice improvement and prenatal counseling technique. <h3>Conclusions:</h3> This survey highlights heterogeneity in fetal neurology practice, lack of standardization, and high demand for practice guidelines and education. Interdisciplinary collaborations will be crucial for relevant curriculum and program development, including increasing attention to healthcare disparities. This synergy among different disciplines will improve outcomes and may reduce the burden of neurological diseases with fetal origins across the lifespan. <b>Disclosure:</b> Dr. Tarui has nothing to disclose. Dr. Venkatesan has nothing to disclose. Dr. Gano has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Clifford Law Offices. The institution of Dr. Gano has received research support from Cerebral Palsy Alliance Research Foundation. Dr. Lemmon has received research support from NINDS. Dr. Lemmon has received research support from BAND foundation. Dr. Lemmon has received research support from Doris Duke Charitable Foundation. The institution of Dr. Mulkey has received research support from Thrasher Research Fund. The institution of Dr. Mulkey has received research support from Centers of Disease Control. The institution of Dr. Mulkey has received research support from National Institutes of Health. The institution of Dr. Pardo has received research support from UCB Biosciences. The institution of Dr. Pardo has received research support from The Patrick G. and Shirley W. Ryan Foundation . The institution of Dr. Pardo has received research support from NINDS- Stroke Trials Network. The institution of Dr. Pardo has received research support from NINDS-I-ACQUIRE. The institution of Dr. Pardo has received research support from NINDS- VIPS-II. Dr. Emrick has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Arkema. The institution of Dr. Emrick has received research support from Lysogene. The institution of Dr. Emrick has received research support from PTC. The institution of Dr. Emrick has received research support from Roche. The institution of Dr. Emrick has received research support from NIH. Dr. Scher has nothing to disclose. Dr. Agarwal has nothing to disclose.

Radiological imaging in CUP syndrome

If no obvious primary tumour is detectable in metastatic tumours (cancer of unknown primary, CUP), it should nevertheless be identified if possible, as specific therapy achieves better results than empirical, palliative treatment of CUP. The new guideline of the European Society of Medical Oncology (ESMO) defines algorithms for the evaluation of CUP, in which radiological and nuclear imaging procedures play acentral role. Important clues to apossible primary tumour are the size and morphology of foci and the presence of adominant lesion, as well as the pattern of hematogeneous metastatic spread in affected organs, and the anatomical distribution of affected lymph nodes. In patients with metastases, imaging plays an important role in identifying apossible primary tumour, but the diagnosis must be made with knowledge of the clinical and immunohistochemical results. In difficult cases, there should be interdisciplinary consultation between reference oncology, radiology, and pathology on the presence of CUP.