Interdisciplinary Team Approach Research Articles

Use of Ketamine and an Interdisciplinary Team Approach to Rapidly Taper a Patient's Ultra-High Opioid Regimen

Use of Ketamine and an Interdisciplinary Team Approach to Rapidly Taper a Patient's Ultra-High Opioid Regimen

Perinatal Palliative Care and Ethical Issues

Perinatal palliative care is a specialty that covers the fields of obstetrics, fetal medicine, pediatric palliative medicine and neonatal medicine. In this care, healthcare professionals offer an individualized care plan based on the needs of the fetus/newborn and family members in a multidimensional way with an interdisciplinary team approach. Unlike adult, neonatal and pediatric palliative care, the patient is not only a single person but a mother-fetus couple in perinatal palliative care; therefore this care type is based on family-centered care philosophy. Due to lack of information about preferences or requests of the fetus, families are expected to make the best medical decision for their baby considering their wishes and values. In this respect, it is important for the team members to inform the families during this process and for multidisciplinary healthcare professionals to support them for making the most appropriate decision. This review article examined the importance of perinatal palliative care, ethical issues, and the roles and responsibilities of the nurse.

Obesity: current state of the problem, multidisciplinary approach. (based on the consensus of the World Gastroenterological Organization “Obesity 2023” and the European guideline on obesity care in patients with gastrointestinal and liver diseases, 2022)

Obesity is the largest pandemic in the world, and its prevalence continues to increase. The purpose of the presented publication is to raise awareness of doctors about modern methods of diagnosing obesity and approaches to therapy, using an interdisciplinary team approach similar to that used in other chronic diseases, such as diabetes, heart disease and cancer. The article presents data from the World Gastroenterological Organization (2023) and the European Guidelines for the Treatment of Obesity in patients with diseases of the gastrointestinal tract and liver (2022). According to modern approaches, obesity should be considered as a chronic recurrent progressive disease, the treatment of which requires a comprehensive interdisciplinary approach involving psychologists and psychiatrists, nutritionists/nutritionists, therapists, endoscopists and surgeons, including lifestyle changes, a well-defined diet and exercise regimen, drug therapy, endoscopic or surgical methods of treatment. Conclusions. In order to stop the growing wave of obesity and its many complications and costs, doctors, insurance companies and health authorities should make systematic efforts to raise public awareness of both the adverse health risks associated with obesity and the potential reduction of risks through a comprehensive approach to therapy.

Treatment of Diabetic Foot Ulcers Based on an Interdisciplinary Team Approach: Exploratory Cross-Sectional Study of Patients' Views on Quality of Care.

The purpose of this study was to evaluate patients' perception and quality of diabetic foot ulcer (DFU) care delivered by an interdisciplinary team approach (ITA). Exploratory cross-sectional study. Twenty patients with a healed plantar DFU were recruited from an interdisciplinary Wound Care clinic of a Canadian University affiliated hospital. Their mean age was 64years (75% were males [n=15]), 18 (90%) were living with type 2 diabetes, and 45% (n=9) had osteomyelitis in the previous year of their enrollment in the study. The validated short form of the Quality From the Patient's Perspective questionnaire was used to evaluate quality of care dimensions (medical-technical competence of the caregivers; physical-technical conditions of the care organization; degree of identity-orientation in the attitudes and actions of the caregivers; and sociocultural atmosphere of the care organization). Respondents reported experiencing a high level of quality care with an ITA. All indicators of patient-perceived reality of care delivered were superior or equal related to their subjective importance in all dimensions of quality care (with scores ranging from 3.85 to 4.00 on a 4-Point Likert scale). Patients' satisfaction regarding the ITA was high. Study findings suggest that an ITA model provided high quality of care for treating DFUs for all quality dimensions judged important for patients.

Successful Pregnancy in Uncorrected Tetralogy of Fallot with Right Aortic Arch: An Interdisciplinary Team Approach

Background: Tetralogy of Fallot (ToF) is the most common cyanotic disorder, with a global prevalence of congenital heart disease nearly reaching 10%. The anomalies observed in individuals with ToF result from the anterior and cephalad displacement of the infundibular (outflow tract) component of the interventricular septum. ToF continues to be a significant contributor to maternal morbidity, mortality, and adverse outcomes in newborns with the condition. Case presentation: An 18-year-old woman in her 28th week of pregnancy was referred to our tertiary referral center, Saiful Anwar Hospital, diagnosed with uncorrected Tetralogy of Fallot (TOF), which had been noticed since she was 2 years old. At that time, her parents refused treatment. She became pregnant unexpectedly and was then directed to RSSA for further management. Conclusion: We present a successful case of pregnancy in a woman who has not undergone surgical repair for ToF. An interdisciplinary pregnancy heart team, including a cardiologist, obstetrician, anesthesiologist, midwives, and neonatologists at our tertiary hospital, developed a care plan based on an individualized assessment of the patient's comorbidities and ToF. The life expectancy of this pregnant woman and her baby is higher with a team approach. The choice of contraception and family planning should be part of the discussion and follow-up from the teenage years, allowing patients with ToF to control their fertility and make informed decisions about having children.

Examining the Benefits of Multidisciplinary Rehabilitation Intervention for Stroke Patients

Background: Stroke is the second leading global cause of death and disability, affecting 80 million survivors with residual symptoms. Rehabilitation, involving an interdisciplinary team approach, plays a crucial role in enhancing functional recovery, addressing deficits in fine motor skills, cognition, and communication through customized therapies, as highlighted in a randomized controlled trial comparing integrated rehabilitation approaches to conventional physical therapy for stroke recovery. Methods: The study was a randomized controlled trial comparing integrated rehabilitation approaches with conventional rehabilitation in post-stroke patients aged 40-60 years over a four-month period. Conducted in a multidisciplinary rehabilitation center, the study included 90 participants, with 45 in each group. The experimental group received integrated rehabilitation involving tailored physical therapy to enhance balance, occupational therapy targeting fine motor skills, and speech therapy addressing swallowing and communication issues. The control group underwent conventional rehabilitation primarily focusing on physical therapy, omitting integrated approaches like occupational and speech therapy. Results: The analysis of the findings had revealed that interdisciplinary rehabilitation program yielded a significantly better results p<0.05 in improving patients’ conditions. The findings provided evidences that all outcome measures that were balance, fine motor function and swallowing and dysphagia were significantly improved p<0.05 both at within and between the group analyses after four months of integrated rehabilitation program. Conclusion: The interdisciplinary rehabilitation programme that included physical, occupational, and speech therapies producednoticeably better outcomes than the conventional rehabilitation methods. The results highlight how well the integrated strategy works to improve swallowing/dysphagia, fine motor function, and balance outcomes. Keywords: Physical Therapy, Occupational Therapy, Post-stroke Patients, Speech Therapy

Internal hemipelvectomy: A single institution's learning curve and longitudinal experience.

Wide margin resection for pelvic tumors via internal hemipelvectomy is among the most technically challenging procedures in orthopedic oncology. As such, surgeon experience and technique invariably affect patient outcomes. The aim of this clinical study was to assess how an individual surgeon's experiences and advancements in technology and techniques in the treatment of internal hemipelvectomy have impacted patient outcomes at our institution. This study retrospectively examined a single tertiary academic institution's consecutive longitudinal experience with internal hemipelvectomy for primary sarcoma or pelvic metastases over a 26-year period between the years 1994 and 2020. Outcomes were assessed using two separate techniques. The first stratified patients into cohorts based on the date of surgery with three distinct "eras" ("early," "middle," and "modern"), which reflect the implementation of new techniques, including three-dimensional (3D) computer navigation and cutting guide technology into our clinical practice. The second method of cohort selection grouped patients based on each surgeon's case experience with internal hemipelvectomy ("inexperienced," "developing," and "experienced"). Primary endpoints included margin status, complication profiles, and long-term oncologic outcomes. Whole group multivariate analysis was used to evaluate variables predicting blood loss, operative time, tumor-free survival, and mortality. A total of 72 patients who underwent internal hemipelvectomy were identified. Of these patients, 24 had surgery between 1994 and 2007 (early), 28 between 2007 and 2015 (middle), and 20 between 2016 and 2020 (modern). Twenty-eight patients had surgery while the surgeon was still inexperienced, 24 while developing, and 20 when experienced. Evaluation by era demonstrated that a greater proportion of patients were indicated for surgery for oligometastatic disease in the modern era (0% vs. 14.3% vs. 35%, p = 0.022). Fewer modern cases utilized freehand resection (100% vs. 75% vs. 55%, p = 0.012), while instead opting for more frequent utilization of computer navigation (0% vs. 25% vs. 20%, p = 0.012), and customized 3D-printed cutting guides (0% vs. 0% vs. 25%, p = 0.002). Similarly, there was a decline in the rate of massive blood loss observed (72.2% vs. 30.8% vs. 35%, p = 0.016), and interdisciplinary collaboration with a general surgeon for pelvic dissection became more common (4.2% vs. 32.1% vs. 85%, p < 0.001). Local recurrence was less prevalent in patients treated in middle and modern eras (50% vs. 15.4% vs. 25%, p = 0.045). When stratifying by case experience, surgeries performed by experienced surgeons were less frequently complicated by massive blood loss (66.7% vs. 40% vs. 20%, p = 0.007) and more often involved a general surgeon for pelvic dissection (17.9% vs. 37.5% vs. 65%, p = 0.004). Whole group multivariate analysis demonstrated that the use of patient-specific instrumentation (PSI) predicted lower intraoperative blood loss (p = 0.040). However, surgeon experience had no significant effect on operative time (p = 0.125), tumor-free survival (p = 0.501), or overall patient survival (p = 0.735). While our institution continues to utilize neoadjuvant and adjuvant therapies following current guideline-based care, we have noticed changing trends from early to modern periods. With the advent of new technologies, we have seen a decline in freehand resections for hemipelvectomy procedures, and a transition to utilizing more 3D navigation and customized 3D cutting guides. Furthermore, we have employed the use of an interdisciplinary team approach more regularly for these complicated cases. Although our results do not demonstrate a significant change in perioperative outcomes over the years, our institution's willingness to treat more complex cases likely obscures the benefits of surgeon experience and recent technological advances for patient outcomes.

Successful Pregnancy with Uncorrected Tetralogy of Fallot: An Interdisciplinary Team Approach

BACKGROUND: With an overall incidence of congenital cardiac disease, tetralogy of fallot (ToF) is the most clinical of cyanotic heart disease. The anomalies seen in patients with ToF are due to an inappropriate anterior and cephalad displacement of the interventricular septum’s infundibular (outflow tract) component. Ventricular septal defect, right ventricular hypertrophy, overriding aorta, and pulmonary stenosis are the four defects that result from this condition. The physiology of healthy women will undergo several changes affecting body system, including the cardiovascular system. Pregnancy and delivery have a high risk for most ill women, including those with uncorrected ToF, due to extensive physiological adaption and alterations. For patients with ToF, it continues to be a significant contributor to maternal morbidity (62.5%), mortality (10%), and neonatal adverse outcomes. CASE PRESENTATION: A 18-year-old female in her first pregnancy at 28 weeks was referred to Saiful Anwar Hospital with uncorrected ToF since she was 2 years old. She suggested repairing ToF at National Cardiovascular Center Harapan Kita Jakarta but her parents still refused. She married at 18 years old and she was pregnant unplanned before. Then, she was referred to RSSA for further management. CONCLUSSION: Pregnancy has been related with higher risks of morbidity and mortality for women with congenital cardiac disease. ToF is the most prevalent cyanosis congenital heart disease. These are poorly tolerated and produce serious complications, including maternal and neonatal mortality. Prenatal counselling is crucial to identify risk factors for the patients and to reassure many patients who are at low risk.

Practical Principles of Palliative Care in Veterinary Oncology: Alleviating the Suffering of the Animal, Owner, and Veterinarian.

Palliative care for pets is a developing area that encompasses animals with cancer and other chronic and degenerative diseases. To elucidate the guiding principles of palliative care in veterinary oncology. This article was structured from an extensive literature review and addresses the growing need for improved palliative care in veterinary medicine. Methods of quality of life assessment in animals with cancer, owner education, and the importance of an interdisciplinary team approach are discussed. Palliative care aims to improve the animal's quality of life, alleviating its physical, emotional, and social suffering. Through attentive communication, palliative care also seeks to alleviate owners suffering from the moment of diagnosis to mourning the patient's death. The importance of offering palliative care alongside anticancer techniques and treatments should not be underestimated and should ideally use a multidisciplinary team approach.

Implementing an integrated care pathway for Somatic Symptoms and Related Disorders (SSRDs) in paediatric population

Introduction: Somatic symptom and related disorders (SSRDs) are commonly encountered in pediatric hospital settings. These children and youth, who present with physical symptoms (e.g., headache, abdominal pain, dizziness) of emotional distress (e.g., anxiety, stress) are diagnostically and psychosocially complex, posing significant challenges for medical and behavioral health care providers. Children and adolescents with SSRDs have high health system utilization and costs and present in multiple clinical settings, have high school absenteeism, and are at elevated risk of iatrogenic harm and missed diagnoses. Patients and their caregivers present with variable readiness to engage in mental health assessment and treatment, with only 40% receiving physician-based mental health care within a year of diagnosis. There is a lack of standardization of care across and within institutions for youth with these disorders. As part of the hospital’s broader strategic direction to integrate physical and mental health care, a SSRD pathway, was developed to address care needs of one of the highest resource intensive populations at a tertiary care hospital. &#x0D; Methods: In 2021, a survey was conducted by our hospital’s implementation team to understand hospital stakeholder priorities when considering the many areas where new integrated care project could be launched. Stakeholders engaged in the survey included physician and operational leaders, clinical staff across the spectrum of disciplines, and a youth and family advisory panel. Focus groups (n = 57) were also conducted to solicit input and feedback. The results highlighted the need to develop a specialized care pathway for children and youth with SSRD focused on integrating physical and mental health care and support with system navigation. Using a logic model with iterative presentations to key stakeholders, the design phase included an interdisciplinary team approach with project management and operational resources to support project implementation and evaluation. Care pathways were developed based on a patient’s readiness to engage in mental health treatment and where they we along their diagnostic odyssey and care journey and intensity of resources required to support their care needs.&#x0D; Integrated Care Pathway: As part of the pilot pathway, a patient’s care journey will be planned in accordance with their level of readiness to accept both a somatization diagnosis and a need for mental health treatment. Patients who are partially or non-receptive to mental health supports will have access to a care manager with both physical and mental health expertise. The care manager will engage with families in shifting their focus and understanding about the mind-body connection and provide extended support with care navigation. Patients who are receptive to mental health treatments, will be referred to a group treatment program led by psychiatry and psychology with a focus on psychoeducation relating to the mind-body connection. Patients in this pathway will also have access to occupational therapy and physiotherapy resources to support with restoring function and improving school attendance, when needed. Pilot evaluation will include process and outcome measures such as number of children engaged in this pathway, time to return to functioning, completion of various mental health measures, and health resource utilization."

Driving Hospital-Acquired Pressure Injuries to Zero: A Quality Improvement Project.

To implement a collaborative, interdisciplinary team approach to reducing hospital-acquired pressure injuries (HAPIs) through nurse empowerment and engagement. This quality improvement project was conducted at a 288-bed community hospital. The Donabedian model was used to design this intervention. The authors used a collaborative, interdisciplinary team approach for pressure injury prevention and management, utilizing nurse empowerment and engagement as driving forces to reduce HAPI rates. The incidence of HAPI decreased from a peak of 5.30% in April 2019 down to 0% from August 2019 to December 2020. Pressure injuries are key quality indicators for patient safety and avoidance of patient harm. Through nurse empowerment and engagement, HAPIs were avoided, resulting in improved quality care outcomes and maintenance of a safe patient environment.

Associations among spiritual pain and the frequency and intensity of physical and psychological distress in patients with advanced cancer evaluated in a supportive care center during COVID-19 pandemic.

284 Background: Patients with cancer are considered a highly vulnerable group, especially during the COVID-19 pandemic. There is limited literature describing the level of spiritual distress during the COVID pandemic and its association with the physical and psychological and distress in this population. Methods: Retrospective chart review of 1264 patients seen by the Outpatient Palliative Care Team from May 1st, 2020 to December 31st, 2020 (during COVID-19), 85% of the consults was delivered by Telemedicine. The association with ESAS-FS physical symptoms, Spiritual Pain (SP), anxiety and depression (none=0/10, the worst 10/10 were measured. Spiritual Pain was defined as “Pain deep in your Soul/Being that is not physical” (SP ≥1/10). Results: Spiritual Pain was present in 284/1264 (23%). Patients with Spiritual Pain were younger [Median years (Min-Max): 61 (21-90) vs. 62 (21-97), p=0.008], Hispanic [20% vs 16%, p&lt;0.001], more single [15% vs. 10%, p&lt;0.001], and divorced [13% vs. 9% p&lt;0.001]. There was no association with gender and race. The frequency (%) and median intensity (0-10/10, 95%CI) of symptoms in patients with and without Spiritual Pain were, pain [90% vs 81%, 5 (0-10) vs 4 (0-10), p=0.691], fatigue [96% vs 90%, 6 (0-10) vs 5 (0-10), p&lt;0.001], anxiety [90% vs 60%, 5 vs. 2 (0-10), (p&lt;0.001], depression [87% vs 44%, 4 vs 0 (0-10), p&lt;0.001], well-being [97% vs 81%, 5 (0-10) vs 3 (0-10), p=0.011], financial distress [78% vs 26%, 3 (0-10) vs 0 (0-10), p&lt;0.001], total ESAS-FS distress [51 (7-113) vs 30 (0-92), p&lt;0.001], respectively. 49% of patients with spiritual pain were evaluated by our psychological team vs. only 29% of those who did not have it (&lt;0.001). Multivariate analysis for Spiritual Pain was financial distress (OR:1.24, p&lt;0.001) and depression (OR:1.16, p&lt;0.001). Conclusions: Important percentage of patients living with cancer experienced Spiritual Pain during COVID pandemic, this spiritual distress affected the expression of physical, psychological symptoms and worse well-being. An inclusive interdisciplinary team approach including spiritual care is needed. More research is warranted.

Prognostic value of extended cardiac risk assessment before elective open abdominal aortic surgery.

Major vascular surgery is associated with ahigh perioperative risk and significant mortality. Despite advances in risk stratification, monitoring, and management of perioperative complications, cardiac complications are still common. Stress echocardiography is well established in coronary artery disease diagnostics; however, its prognostic value before high-risk aortic surgery is unknown. This prospective, single-center study compared the outcome of patients undergoing extended cardiac risk assessment before open abdominal aortic surgery with the outcome of patients who had received standard preoperative assessment. The study included patients undergoing elective open abdominal aortic surgery. Patients who underwent standard preoperative assessment before the start of adedicated protocol were compared with patients who had extended cardiac risk assessment, including dobutamine stress echocardiography, as part of astepwise interdisciplinary cardiovascular team approach. The combined primary endpoint was cardiovascular death, myocardial infarction, emergency coronary revascularization, and life-threatening arrhythmia within 30days. The secondary endpoint was acute renal failure and severe bleeding. In total, 77patients (mean age 68.1 ± 8.1years, 70% male) were included: 39underwent standard and 38underwent cardiac risk assessment. The combined primary endpoint was reached significantly more often in patients before than after implementation of the extended cardiac stratification procedure (15% vs. 0%, p = 0.025). The combined secondary endpoint did not differ between the groups. Patients with extended cardiac risk assessment undergoing elective open abdominal aortic surgery had better 30-day outcomes than did those who had standard preoperative assessment.

Recent Advancement in Evidence-based Psychological Therapies for Eating Disorders: A Review

Eating disorders (ED) is a behavioral problem defined by severe and persistent eating pattern disorder and severe mental illness, which will cause serious and even life-threatening risks to the physical and mental health of patients. The best nursing guidelines include early detection and immediate intervention, supported by a science-focused interdisciplinary team approach involving experts in the fields of medicine, psychology and nutrition. This article summarized the current treatment suggestions by understanding ED diagnosis, the Association for Eating Disorders (AED) treatment guidelines, and the evidence-based psychotherapy recommended by AED for children/adolescents, adults, and special populations. Future modifications of the recommendations will take into account fresh scientific knowledge as it emerges because the body of evidence is growing quickly.

A Study of Professional Quality of Life and Environmental Factors among Pediatric Registered Nurses

Aim. This research study aims to investigate the professional quality of life (ProQOL) among pediatric registered nurses. Background. Professional quality of life encapsulates two fundamental components, namely, compassion satisfaction and compassion fatigue, which comprises burnout and secondary traumatic stress. Methods. A descriptive cross-sectional design was used in this study, which included 217 pediatric registered nurses. Self-administered questionnaires compiled sociodemographic and occupational characteristics before measuring Professional quality of life (Version 5) items were used to collect data. Results. Most respondents were 30 to 35 years of age (65%), female (99%), and hold a diploma certificate (63%). The ProQOL scores for compassion satisfaction was 35.9 (SD = 9.7), compassion fatigue (burnout) was 21.8 (SD = 9.64), and compassion fatigue (secondary traumatic stress) was 23.5 (SD = 9.7). A significant mean difference ( p &lt; 0.001 ) were found in the ProQOL level based on environmental factors related to pediatrics and family. Conclusion. The results of this study show a moderate compassion satisfaction level, a low burnout level, and a moderate secondary traumatic stress level among pediatric registered nurses. Different related environmental factors that can impact the professional quality of life of pediatric registered nurses. Implications for Nursing Management. Pediatric nurses will benefit from a supportive work environment, which fosters collaboration and respect among nurses and their pediatric patients’ families to improve the health outcomes of pediatric patients. Hospitals should offer specialized training programs that address the unique needs of pediatric nursing, encompassing areas such as child development, communication techniques with children, and age-specific healthcare interventions. This will equip nurses with the necessary skills and knowledge to provide optimal care for pediatric patients. Also, the following support systems, such as regular debriefing sessions and counseling services, are established to help nurses cope with the emotional challenges they may encounter in their work and to foster a collaborative work environment that encourages effective teamwork among nurses and promotes positive relationships between nurses and the families of pediatric patients. This can be achieved by implementing interdisciplinary team approaches, regular team meetings, and open communication channels. In addition, to ensure that pediatric nurses have access to the necessary resources, such as up-to-date medical literature, technological tools, and equipment, to provide the best care possible. Adequate staffing levels should also be maintained to prevent excessive workloads, which can contribute to burnout and decreased job satisfaction.

Prosthetic Management of Flap-Related Complications Following Glossectomy in Locally Advanced Tongue Cancer.

Total glossectomy defects resulting from postoncologic resection are commonly reconstructed with locoregional or free flaps. However, effectively managing complications that may arise after reconstruction can be a significant challenge. We present a unique case series describing prosthetic management of flap-related complications following glossectomy in patients treated for locally advanced tongue cancer. Three patients underwent total glossectomy, neck dissection, reconstruction using free flap, and tracheostomy. Two patients developed an intraoral fistula located in the anterior region of the floor of the mouth. The third patient developed a flap failure requiring a second procedure using a pectoralis major myocutaneous flap for correction of the orocutaneous fistula that ultimately did not heal. Mandibular obturator prostheses lined with a soft liner were fabricated for all the patients, which helped reduce salivary incontinence and improve swallowing and speech. This case series highlights that a collaborative interdisciplinary team approach is crucial for optimizing postoperative function and outcomes when managing complications from reconstructive procedures.

An Interdisciplinary Team Approach to Bariatric Surgery Evaluation for High-Risk Candidates

An Interdisciplinary Team Approach to Bariatric Surgery Evaluation for High-Risk Candidates

Impact of an interdisciplinary patient care model and routine screening on clinical outcomes in patients with hepatitis C.

Testing for hepatitis C in hospital emergency departments (ED) and linkage to care to clinics have been reported to provide the most opportunity for screening patients and facilitating continuum of care. Treatment model initiatives have expanded to include telehealth services and open treatment capacity to non-physician providers, such as pharmacists. This study's objective was to assess the impact of implementing automated routine screening for hepatitis C virus (HCV) and a clinical pharmacist into the interdisciplinary care model on HCV diagnosis and treatment outcomes. This retrospective cohort study compared outcomes in a pre-intervention and post-intervention group. Patients were screened and diagnosed with HCV at Jersey City Medical Center (JCMC) and completed linkage to care at JCMC Center for Comprehensive Care. Interventions were the implementation of automated routine HCV screening in the ED and addition of a clinical pharmacist to the interdisciplinary patient care model. Primary endpoints analyzed the number of patients who have achieved sustained virologic response after 12 weeks of treatment (SVR12) and patients who have completed treatment with no reported record of SVR12. Secondary endpoints analyzed the number of patients lost to follow-up, appointment type, time spent in appointments, and clinical pharmacist specialist interventions. Data was collected as categorical variables and chi-squared tests assessed if there were differences between the two samples. Data was collected from 46 patients in the pre-intervention group and 37 patients in the post-intervention group. Patients consisted of mostly males. Ages ranged from 27 to 83 years old. Race included Black, White, Asian, and Other. This study's results showed the positive impact on implementation of routine screening, telehealth services, and an interdisciplinary team approach to HCV diagnosis and management. Given the timeframe, it also showed the potential positive impact on these interventions during a global pandemic.

Certified Child Life Specialist role in implementation of individualized coping plans for children receiving botulinum toxin injections.

The purpose of this paper is to describe the implementation of evidence-based, individualized coping plans and to compare the rates of child anxiety, child cooperation, and parent anxiety before and after implementation of these coping plans for children receiving recurring BoNT-A injections emphasizing the role of Certified Child Life Specialists (CCLSs) within the interdisciplinary team approach. A retrospective chart review was conducted for children receiving BoNT-A injections at a Physical Medicine clinic pre- and post-implementation of the coping plan. Descriptive statistics were used to evaluate care plan implementation, child cooperation, child anxiety, and parent anxiety. Post-implementation of coping care plans, children experienced improved cooperation during BoNT-A injections. Parental anxiety decreased once coping plans were implemented. Documentation improved after the implementation of coping plans specific to areas involving cooperation, child's anxiety and distress, and parental anxiety and distress. It was also noted that there was an increase in child anxiety assessments within documentation. CCLS were able to utilize their expertise to collaboratively create individualized coping care plans to increase child's cooperation and decrease parental anxiety during BoNT-A injections.

Opinion article: Neurosurgical treatment for neuro-ophthalmologic conditions.

A significant role of the neuro-ophthalmologist is to counsel patients on appropriate management and anticipated visual prognosis for conditions affecting the afferent and efferent visual systems, including those requiring neurosurgical treatment. However, the literature regarding anticipated neuro- ophthalmologic prognosis after neurosurgical intervention for cerebral aneurysms, sellar lesions, optic pathway tumors, and elevated intracranial pressure is limited with many key questions unanswered. For example, if a cerebral aneurysm is equally amenable to clipping or endovascular coiling, is there a preferred approach in terms of visual prognosis based on aneurysm location? Is dural venous sinus stenting (VSS) for idiopathic intracranial hypertension (IIH) superior, equivalent or inferior to shunting in terms of visual recovery and safety profile? Landmark studies on pituitary tumors using pre-operative optical coherence tomography (OCT) imaging of the optic nerve head to predict visual recovery after surgical decompression of the optic chiasm have changed neuro-ophthalmologic practice and enabled patients to be better informed regarding expected visual outcomes. 1,2 In order to optimize an interdisciplinary team approach to patient care, further studies of visual outcomes for neuro- ophthalmologic conditions requiring neurosurgical intervention are needed.