Interdisciplinary Team Of Experts Research Articles

An evidence-informed pedagogical approach to support professional identity formation in medical students: AMEE Guide No. 171

There is a long and impressive scholarly history evidencing why it is important to address professional identity formation (PIF) in medical curricula. In this AMEE Guide, the authors present an evidence-informed pedagogical approach to assist educators in developing educational practices to foster a healthy PIF in medical students. The authors first describe the theoretical framework that underpin this approach. At the core of this framework is the recognition that, for a healthy PIF, students need to become aware that they have the autonomy, but also responsibility, to form their professional identity in a way that fits both their personality and their (future) professional role. In other words, students need to learn to navigate the interplay between socialization and subjectification. Next, the authors outline the six-step structure of their pedagogical approach, designed to help students: (1) undergo a PIF-related experience, (2) observe their responses to the experience, (3) externalize their reflections, (4) share their reflections, (5) broaden their perspective, and (6) explore their freedom of choice through experimentation. The authors also describe six conducive conditions to facilitate the implementation of the pedagogical approach. These conditions include (1) creating a setting that enables students to slow down, (2) adopting a longitudinal approach, (3) making it part of the formal curriculum, (4) refraining from grading, (5) establishing an interdisciplinary expert team, and (6) providing teacher training. The authors conclude that the theoretical framework leads to a coherent and consistent pedagogical approach that, when implemented according to the conducive conditions, enables students to gradually internalize the reflective process and help them to cultivate a reflective attitude towards their PIF.

Phenotypic Plasticity and Cancer: A System Biology Perspective.

Epithelial-to-mesenchymal transition (EMT) is a major axis of phenotypic plasticity not only in diseased conditions such as cancer metastasis and fibrosis but also during normal development and wound healing. Yet-another important axis of plasticity with metastatic implications includes the cancer stem cell (CSCs) and non-CSC transitions. However, in both processes, epithelial (E) and mesenchymal (M) phenotypes are not merely binary states. Cancer cells acquire a spectrum of phenotypes with traits, properties, and markers of both E and M phenotypes, giving rise to intermediary hybrid (E/M) phenotypes. E/M cells play an important role in tumor initiation, metastasis, and disease progression in multiple cancers. Furthermore, the hybrid phenotypes also play a major role in causing therapeutic resistance in cancer. Here, we discuss how a systems biology perspective on the problem, which is implicit in the 'Team Medicine' approach outlined in the theme of this Special Issue of The Journal of Clinical Medicine and includes an interdisciplinary team of experts, is more likely to shed new light on EMT in cancer and help us to identify novel therapeutics and strategies to target phenotypic plasticity in cancer.

Systemic treatment of patients with metastatic neuroendocrine Neoplasia

Due to the complexity and heterogeneity of metastatic NEN an interdisciplinary expert team should be involved in an individualized treatment strategy. SSA is the mainstay of antisecretory treatment in most functioning tumors. In antiproliferative intention SSA are first line treatment in receptor positive low proliferative NET. In intestinal metastatic disease PRRT is best established second line treatment. Further options are Everolimus (labeled) and tyrosine kinase inhibitors (off-label). Everolimus is the only approved drug for antiproliferative treatment in patients with metastatic lung NET, whereas in pancreatic NET more therapeutic options are available (SSA, chemotherapy, PRRT, Sunitinib, Everolimus) without a standard of best sequence. In patients with metastatic NEC standard first line treatment (platinum + etoposide) has not changed for decades and new treatment options for this fatal disease are urgently needed. Benefit of immunotherapy is limited to a small subset of patients - new combinations are under investigation. This review summarizes the standard of care, criteria of treatment selection and new developments for systemic therapy in patients with metastatic NEN.

A Sleep Health Education Intervention Improves Sleep Knowledge in Social Work Students

Introduction: Social workers, the largest group of mental health clinicians in the United States, play a pivotal role in mental health promotion. Despite the importance of sleep for mental health, there is no empirical research on sleep education interventions for social workers. Method: We designed an online sleep health education intervention to equip social work students to promote healthy sleep practices among their clients. An interdisciplinary team of experts devised the 90 min intervention using an empirically supported behavioral change theoretical model (COM-B). The intervention discusses multi-level factors that impact sleep and emphasizes considerations for health disparities in populations commonly served by social workers (e.g., unhoused populations, clients with substance use disorders, etc.). We assessed sleep knowledge, sleep quality, and acceptability using survey and focus group data. Results: Ninety social work students (92.2% female, 38.8% non-Hispanic white) completed pre- and post-intervention assessments. Participants demonstrated significant improvements in sleep health knowledge and their personal sleep quality. Quantitative and qualitative data revealed perceived usefulness for social work practice. Conclusions: A short online sleep education intervention can improve sleep health knowledge, offering a practical method to expand social workers’ understanding of healthy sleep promotion that can be readily implemented in clinical training and practice.

Integration of Family Navigation into ECHO Autism for Pediatric Primary Care in Underserved Communities.

Children with autism from underserved communities face complex system-, provider-, and family-level barriers to accessing timely diagnosis and early intervention. The current study evaluated the preliminary effects and feasibility of a new program (ECHO Autism LINKS) that integrated pediatric primary care provider (PCP) training with family navigation (FN) to bridge the gaps between screening, referral, and service access. Three cohorts of PCPs (n = 42) participated in the program, which consisted of 60-minute sessions delivered by Zoom twice per month for 12 months. Each session included didactics, case-based learning, and collaborative discussion with participants and an interdisciplinary team of experts. Family navigators were members of the expert team and provided FN services to families referred by PCP participants. Program attendance and engagement were strong, with 40 cases presented and 258 families referred for FN services, most of whom (83%) needed help accessing and connecting with services, and 13% required ongoing support due to complex needs. PCPs demonstrated significant improvements in self-efficacy in providing best-practice care for children with autism, reported high satisfaction, and observed improved knowledge and practice as a result of the program. The results of this initial pilot provide support for the feasibility, acceptability, and preliminary efficacy of the ECHO Autism LINKS program. The model holds promise in addressing complex barriers to healthcare access by providing both PCPs and families with the knowledge and support they need. Future research is needed to evaluate the efficacy and effectiveness of the program in improving child and family outcomes.

Streamlining intersectoral provision of real-world health data: a service platform for improved clinical research and patient care.

Obtaining real-world data from routine clinical care is of growing interest for scientific research and personalized medicine. Despite the abundance of medical data across various facilities - including hospitals, outpatient clinics, and physician practices - the intersectoral exchange of information remains largely hindered due to differences in data structure, content, and adherence to data protection regulations. In response to this challenge, the Medical Informatics Initiative (MII) was launched in Germany, focusing initially on university hospitals to foster the exchange and utilization of real-world data through the development of standardized methods and tools, including the creation of a common core dataset. Our aim, as part of the Medical Informatics Research Hub in Saxony (MiHUBx), is to extend the MII concepts to non-university healthcare providers in a more seamless manner to enable the exchange of real-world data among intersectoral medical sites. We investigated what services are needed to facilitate the provision of harmonized real-world data for cross-site research. On this basis, we designed a Service Platform Prototype that hosts services for data harmonization, adhering to the globally recognized Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) international standard communication format and the Observational Medical Outcomes Partnership (OMOP) common data model (CDM). Leveraging these standards, we implemented additional services facilitating data utilization, exchange and analysis. Throughout the development phase, we collaborated with an interdisciplinary team of experts from the fields of system administration, software engineering and technology acceptance to ensure that the solution is sustainable and reusable in the long term. We have developed the pre-built packages "ResearchData-to-FHIR," "FHIR-to-OMOP," and "Addons," which provide the services for data harmonization and provision of project-related real-world data in both the FHIR MII Core dataset format (CDS) and the OMOP CDM format as well as utilization and a Service Platform Prototype to streamline data management and use. Our development shows a possible approach to extend the MII concepts to non-university healthcare providers to enable cross-site research on real-world data. Our Service Platform Prototype can thus pave the way for intersectoral data sharing, federated analysis, and provision of SMART-on-FHIR applications to support clinical decision making.

Effect on patient empowerment through the EPEP program.

e21009 Background: There is a critical need to support oncology providers seeking to empower their patients and care partners by connecting them to trusted resources. To fill this gap, the Patient Empowerment Network (PEN) created the Empowering Providers to Empower Patients (EPEP) program to improve physician-patient communication and shared decision-making by creating a clear path to support providers in empowering their patients and care partners. Methods: The EPEP program, developed by an interdisciplinary team of experts for oncology health care professionals, launched in March 2023 with a focus on lung cancer resources. The program includes digital resources such as Roundtables (30-minute webinars + segments with leading experts, clinicians, and peers), an HCP Portal (a system that informs and collates vetted resources), a Resource Guide (resource guide for HCPs), and a Roundup Blog (article with key takeaways summarizing program). Following two roundtables in March 2023, we assessed initial provider engagement with EPEP using digital engagement metrics and a five-item questionnaire. Results: Since the launch, 212 oncology providers have access to the suite of digital resources. The content has been viewed and downloaded almost 13,595 times. Surveys conducted following the roundtables indicated that the program was well-received. Of 21 respondents, n=18 (86%) rated their experience as very positive; agreed or strongly agreed that the program gave them the confidence to better facilitate shared decision-making with their patients; and said they found relevant resources to share with their patients and their families. Sample feedback included, “I would say it gave me the confidence to raise the flag on timing. Sometimes we test and are not doing this in a timely way. Thanks for this program.” And “These conversations are so critical. Thank you for a great program.” And, “I thought the conversation was excellent; we need more of this. I thought the tips were spot-on and very helpful.” Providers wanted communication tools focused on the “timing of testing following the initial workup,” “pathology conversations” and “anxiety and fear after the cancer diagnosis, long-term side effects, screening and early detection of lung cancer.” Conclusions: The EPEP program serves as a trusted digital space for providers to objectively share and recommend resources to their oncology patients. The program now includes removing practice barriers that may be caused by a lack of awareness and outdated practices. The long-term goal is to improve physician-patient communication and shared decision-making while also empowering cancer patients and family members to ask informed questions based on where they are in their cancer journey.

A Standardized Treatment Pathway for Telehealth-Based Care of Chronic Wounds in Austria.

Chronic wounds present a significant healthcare challenge in Austria as well as in other countries. The interdisciplinary approach to wound treatment involving various caregivers, doctors, and relatives, poses challenges in documentation and information exchange. To overcome these barriers and promote patient-centered care, a new telehealth-supported treatment pathway for chronic wounds has been developed. The primary focus was to regularly update the status of the chronic wound by responding to predefined questions and transmitted images of the chronic wound. This was achieved by an interdisciplinary team of experts in chronic wound care, providing a new perspective for digital implementation in the healthcare system.

Robotics goes PRISMA

Abstract In this article, we review the main results achieved by the research activities carried out at PRISMA Lab of the University of Naples Federico II where, for 35 years, an interdisciplinary team of experts developed robots that are ultimately useful to humans. We summarize the key contributions made in the last decade in the six research areas of dynamic manipulation and locomotion, aerial robotics, human-robot interaction, artificial intelligence and cognitive robotics, industrial robotics, and medical robotics. After a brief overview of each research field, the most significant methodologies and results are reported and discussed, highlighting their cross-disciplinary and translational aspects. Finally, the potential future research directions identified are discussed.

Nutritional care is a human right: incorporating principles into clinical practice

The landmark Vienna Declaration (VD), initiated by the international human rights working group (IHRWG) and endorsed by more than 75 professional societies acknowledged that nutritional care is a human right alongside the right to food and the right to health. In a series of position papers the IHRWG have elaborated on the commitments required for translating human rights and ethical principles into clinical practice.1-3 The ultimate objective of the VD is to ensure all patients have a right to be screened and diagnosed for disease related malnutrition (DRM) then to receive evidence based artificially administered nutrition and hydration (AANH) administered by an interdisciplinary team of experts to positively impact clinical outcomes and survival. Unfortunately, nutritional care in hospitals and post discharge is frequently below standard and is not part of the patient's holistic care.2 Reasons include; inadequate education of healthcare professionals (HCPs), lack of malnutrition awareness, no reimbursement for nutrition treatments, or absence of public health policy.2,4

Assessing the impact of healthcare service risks on healthcare demand under evolving economic and social structures: An improved GLDS decision making method considering risk attitudes

Faced with backward and uneven economic conditions and an irrational and increasingly inequitable social structure, healthcare disparities are widening and the healthcare inequalities are expanding. This can lead to an increasing public demand for healthcare services, posing unprecedented risk, such as resource shortages, quality deterioration and rising healthcare costs. By identifying, managing, and optimizing the aforementioned risks within the healthcare system, it helps the healthcare system better address the challenges of expanding healthcare demands under evolving economic and social structure. To achieve this, this paper employs failure mode and effects analysis (FMEA) to identify severe failure modes in healthcare services. However, traditional FMEA methods possess limitations in assessing the dynamics of trust relationships and interaction effects among experts within social networks. Therefore, this paper proposes an improved gained and lost dominance score (GLDS) based social network decision-making method considering risk attitudes for FMEA to prioritize failure modes in healthcare services. First, transform linguistic risk assessment information from an interdisciplinary team of experts based on probabilistic linguistic term sets handle uncertain efficiently. Meanwhile, experts’ influence is reflected by an extended PageRank algorithm with trust degrees based on social networks analysis. Next, an improved GLDS method considering the differentiated risk attitudes of individuals and groups is developed to prioritize failure modes. Especially, to solve the problems of soft preference and incomparability relation among failure modes, which are ignored by the traditional GLDS method, a conflict analysis is established to determine the preference, indifference, and incomparability relations. Finally, the practicality of the proposed method is illustrated by the healthcare service risk case in the emergency department and the effectiveness of the developed method is validated by comparison and sensitivity experiments. The results suggest that failure to update labels showing patient severity promptly is the most dangerous. In addition, it would be more economically efficient to analyze the non-comparable failure modes facing different risk factors.

P07.15.B NEUROMUSCULAR HIGH-RESOLUTION ULTRASOUND IN PERIPHERAL NEUROTOXICITY OF SYSTEMICALLY TREATED CANCER PATIENTS

Abstract BACKGROUND Up to 40 % of cancer patients treated with neurotoxic cytostatic chemotherapies develop treatment-induced peripheral neuropathy. Furthermore, in patients treated with immune checkpoint inhibitors neuromuscular immune-related adverse events (irAEs) are the most common neurological complication. The differentiation between various types of peripheral neurotoxicity, neurological comorbidities and (para-)neoplastic conditions requires experienced clinical and neurophysiological diagnostics within an interdisciplinary team of experts. High-resolution ultrasound (HRUS) is a widely used diagnostic tool for peripheral neuropathies. As there are no generally approved biomarkers of treatment-related neurotoxicity so far, HRUS might extend the repertoire of diagnostic and neuromonitoring methods in patients with neuropathies induced by cytostatic agents, immunotherapy, and targeted therapy. MATERIAL AND METHODS We present the integration of HRUS into a standardized algorithm for suspected peripheral neurotoxicity by characterizing a case series from our neuro-oncological center. We show representative HRUS findings of seven cancer patients (diagnosed with breast cancer, cholangiocarcinoma, colorectal carcinoma, or multiple myeloma) treated with platinum derivates, immune checkpoint inhibitors, bortezomib, or lenalidomide. RESULTS We describe the potential of HRUS independently of a certain cancer treatment regimen and beyond that in patients with both neurological co-morbidities and concomitant neoplastic infiltration of the nervous system. In our retrospective cohort, HRUS revealed partly continuous and partly discontinuous nerve swelling as well as compression syndromes. Moreover, we detected enlargements of dorsal roots and vagus nerve in cancer patients with treatment-induced neuropathies for the first time. In addition, we identified significant discordance between clinical, electrophysiological and HRUS findings and discuss how peripheral neurotoxicity may be amenable to complementary HRUS assessment and neuromonitoring. CONCLUSION At our institution, neuromuscular ultrasound is an integral part of the interdisciplinary algorithm for peripheral neuropathies in systemically treated cancer patients. HRUS expands the neurological tool inventory for cancer patients and accelerates the differentiation of peripheral neurotoxicity, neurological comorbidities, and neoplastic affection of the nervous system in a non-invasive and cost-sparing manner. Our data may help to detect distinct patterns of nerve enlargement as new biomarkers of peripheral neurotoxicity. Thus, we employed our data to conduct a prospective, cross-sectional trial (PARTICIPATE), which has the potential to define the diagnostic relevance of HRUS for patients treated with agents affecting the PNS and its impact on cancer patient care.

Beyond the Imodium, a One Health Discussion on Diarrhea and the Impact of Climate Change.

Our ability to tackle the looming human, animal, and global ecosystem health threats arising from the issues of climate change and extreme weather events will require effective and creative cross-disciplinary collaboration. There is a growingnational and international interest in equipping the next generation of clinicians and health scientists for success in facing these important challenges by providing interprofessional training opportunities. This paper describes how we assembled an interdisciplinary team of experts to design and deliver a case-based discussion on a cross-species illness outbreak in animals and humans using a One Health framework. The small group, case-based approach highlighted the impact of climate change-driven extreme weather events on human and animal health using a diarrhea outbreak associated with a contaminated community water supply precipitated by extreme flooding. Post-activity survey data indicated that this team-taught learning activity successfully engaged a cross-disciplinary cohort of medical, veterinary, and public health students in the issues of environmental public health threats and helped them understand the importance of an integrative, cross-functional, team-based approach for solving complex problems. The data from this study is being used to plan similar interprofessional, One Health learning activities across the health sciences curriculum in our institution.

„Neuropsychology for You“

Abstract: “My Logbook” is a method to translate evidence-based guidelines for psychosocial care in pediatric neurooncology into practice. One part of “My Logbook” is the standardized instrument “Neuropsychology for You,” developed by an interdisciplinary expert team. It consists of two booklets that include creative and challenging methods to support the implementation of basic standards into practice. The booklet “1, 2, 3 – All About Neuropsychology” focuses on neuropsychological therapy, while “Look Carefully – Psychosocial Assessment” addresses psychosocial assessment. Both booklets explain the topics in a patient-oriented and age-appropriate way and motivate patients to actively participate in two sessions each (psychoeducational, work and exercise, and reflection). The evaluation of the booklets showed a positive association between neuropsychological assessment and therapy. Furthermore, the patients’ positive emotions and the subjective level of information increased. Therefore, “Neuropsychology for You” is a promising tool for the practical and low-threshold implementation of neuropsychological assessment and therapy into clinical practice.

Consensus Panel Recommendations for the Pharmacological Management of Pregnant Women with Depressive Disorders.

The initiative of a consensus on the topic of antidepressant and anxiolytic drug use in pregnancy is developing in an area of clinical uncertainty. Although many studies have been published in recent years, there is still a paucity of authoritative evidence-based indications useful for guiding the prescription of these drugs during pregnancy, and the data from the literature are complex and require expert judgment to draw clear conclusions. For the elaboration of the consensus, we have involved the scientific societies of the sector, namely, the Italian Society of Toxicology, the Italian Society of Neuropsychopharmacology, the Italian Society of Psychiatry, the Italian Society of Obstetrics and Gynecology, the Italian Society of Drug Addiction and the Italian Society of Addiction Pathology. An interdisciplinary team of experts from different medical specialties (toxicologists, pharmacologists, psychiatrists, gynecologists, neonatologists) was first established to identify the needs underlying the consensus. The team, in its definitive structure, includes all the representatives of the aforementioned scientific societies; the task of the team was the evaluation of the most accredited international literature as well as using the methodology of the "Nominal Group Technique" with the help of a systematic review of the literature and with various discussion meetings, to arrive at the drafting and final approval of the document. The following five areas of investigation were identified: (1) The importance of management of anxiety and depressive disorders in pregnancy, identifying the risks associated with untreated maternal depression in pregnancy. (2) The assessment of the overall risk of malformations with the antidepressant and anxiolytic drugs used in pregnancy. (3) The evaluation of neonatal adaptation disorders in the offspring of pregnant antidepressant/anxiolytic-treated women. (4) The long-term outcome of infants' cognitive development or behavior after in utero exposure to antidepressant/anxiolytic medicines. (5) The evaluation of pharmacological treatment of opioid-abusing pregnant women with depressive disorders. Considering the state of the art, it is therefore necessary in the first instance to frame the issue of pharmacological choices in pregnant women who need treatment with antidepressant and anxiolytic drugs on the basis of data currently available in the literature. Particular attention must be paid to the evaluation of the risk/benefit ratio, understood both in terms of therapeutic benefit with respect to the potential risks of the treatment on the pregnancy and on the fetal outcome, and of the comparative risk between the treatment and the absence of treatment; in the choice prescription, the specialist needs to be aware of both the potential risks of pharmacological treatment and the equally important risks of an untreated or undertreated disorder.

Factors Influencing Nutritional Intake and Interests in Educational Content of Athletes and Sport Professionals Toward the Development of a Clinician-Supported Mobile App to Combat Relative Energy Deficiency in Sport: Formative Research and a Description of App Functions.

Relative energy deficiency in sport (RED-S) as a consequence of athlete malnutrition remains a prominent issue. However, it remains underrecognized, in part due to the perceived outward health of athletes. The Eat2Win app was designed to combat RED-S and athlete malnutrition by providing education, behavior modification, and direct communication with expert sports dietitians to athletes and sport professionals (professionals who work with athletes, eg, sport coaches and athletic trainers). The purpose of this formative research was to gain critical insight on motivators and barriers to optimal nutritional intake from both the athletes' and sport professionals' perspectives. Additionally, since these 2 groups represent the primary end users of an app aimed at improving athlete nutrition and reducing the risk of RED-S, a secondary objective was to gain insight on the preferences and perceptions of app-based educational content and functionality. An electronic survey was developed by an interdisciplinary team of experts. Survey questions were established based upon prevailing literature, professional dietetic field experience, and app design considerations to obtain respondent knowledge on key sports nutrition topics along with motivations and barriers to meal choices. Additionally, the survey included questions about the development of an integrative, clinician-support app aimed at addressing RED-S. These questions included preferences for educational content, modes of in-app information, and communication delivery for the target population (app end users: athletes and sport professionals). The survey was distributed through Research Electronic Data Capture (REDCap) to athletes and sport professionals using targeted email, social media, and community engagement campaigns. The electronic survey was available from May 4 to August 2, 2022. Survey respondents (n=1352) included athletes and professionals who work with athletes from a variety of settings, like high school, collegiate, professional, and club sports. Respondents reported high interest in 8 core sports nutrition topics. The preferred modes of information and communication delivery were visual formats (eg, videos and infographics) and in-app alerts (eg, direct messaging and meal reminders). Only athlete respondents were asked about motivators and barriers that influence meal choices. "Health" and "sports performance" were the highest scoring motivators, while the highest scoring barriers were "cost of food," "easy access to unhealthy food," and "time to cook or prepare food." Notably, survey respondents provided positive feedback and interest using a novel function of the app: real-time meal feedback through food photography. The Eat2Win app is designed to combat RED-S and athlete malnutrition. Results from this study provide critical information on end-user opinions and preferences and will be used to further develop the Eat2Win app. Future research will aim to determine whether the Eat2Win app can prevent RED-S and the risk of athlete malnutrition to improve both health and performance.

Food Based Dietary Guidelines and accompanying Visual Dietary Guidelines

National Food Based Dietary Guidelines (FBDG, simply - dietary guidelines) are intended to establish a basis for public nutrition, food, health and agricultural policies and nutrition education programs to foster healthy eating habits and lifestyle. Generally, they advocate combination of food groups and dietary patterns to provide the required nutrients to promote overall health, prevent chronic diseases, and lessen the environmental burden of food production. Dietary guidelines are developed and/or influenced by interdisciplinary teams of experts, comprising representatives of agriculture, health, education, nutrition and food science, consumers, non-governmental organizations, the food industry, communications, and anthropology. Many sources of information are reviewed in this process, such as scientific evidence of the relationship between diet, nutrition and health, and data on food production, food consumption, food composition, cost, accessibility, and environmental impact. The last 40+ years have seen an extraordinary flood of nutrition research and information which in turn influenced the content of these FBDGs as knowledge progressed. While reflecting this evolution and inevitably having some shortcomings, overall FBDG have been and will remain a major influence on healthier eating habits and lifestyle, on what society believes as being healthy diet patterns, on food production and distribution, and on government food, nutrition, and environmental legislation.

A causal network approach using a community well-being framework for an initial impact assessment of large-scale energy infrastructure projects

Impact assessment as a discipline continues to evolve and search for ways to address challenges that are wicked, systemic, and unconventional. More guidance however is required on integrating multi-disciplinary and novel approaches without losing the richness of impact assessments. This paper explores integrating the causal network approach, underpinned by a community well-being framework, into environmental and social impact assessments. We do this by using a hypothetical scenario of large-scale green hydrogen industry in Australia and engage an interdisciplinary team of experts representing a broad experience across the social, economic, and environmental sectors, via interviews and a workshop. The result is a complex detailed causal network, depicting both environmental and social risks and opportunities associated with the hydrogen industry. We discuss using simple and complex versions of causal networks as both are needed to when communicatng with all relevant stakeholders. We found that the causal network approach is useful for the initial scoping of potential social and environmental impacts, especially for a multi-disciplinary team. Three areas were identified to further strengthen such an approach to facilitate a fully-fledged impact assessment in a real case. First, causal relationships need to be evaluated to assess the magnitude of the impacts and identify mitigation measures and incentives. Second, stakeholders, including local communities, should be involved throughout the assessment process, beginning from the conceptualisation of such assessments. Third, the causal network approach presented in this paper is likely to benefit from incorporating ecological frameworks (or similar) to expand environmental pathways in the network.

Мониторинг деятельности междисциплинарной команды специалистов по психолого-педагогической диагностике нарушений развития в учреждениях здравоохранения

The issues of the content and organization of diagnostics in the conditions of health care institutions were studied; the development of ways of interaction of specialists in different areas. The following types of diagnostics are considered: medical, pedagogical, psychological, medical-psychological-pedagogical. Analyzed the work of the interdisciplinary team; developed a model of interaction between interdisciplinary teams of experts in psychological and pedagogical examination of children with developmental disorders and the results of implementing the model

Maternal and Perinatal Outcome in a Contemporary Cohort of Patients with Portal Hypertension: A Single-Center Experience.

Portal hypertension in pregnancy is characterized by an increased perinatal and maternal complication rate. The purpose of this study was to evaluate the perinatal and maternal outcomes of these high-risk pregnancies at our tertiary center. We identified pregnancies with portal hypertension in our departmental database for the years 2013 to 2021. The medical history and perinatal and maternal data were extracted from medical records. Eleven cases were identified. In pregnancy, delivery and postpartum, complications occurred in 72.7% of cases and included among others ascites, subclavian thrombosis, variceal-ligation-induced ulcer bleeding and postoperative hemorrhage. The cesarean delivery rate was 72.7% (n = 8); five of these were done for obstetric or fetal indications. The rate of preterm birth and admissions to neonatal intensive care unit were high (54.5% and 45.5%, respectively). Our case series substantiates the high maternal and perinatal complication rates seen in portal hypertension. The prevention of thromboembolic and bleeding complications was the main challenge. Care by an interdisciplinary team of experts is crucial for a successful perinatal and maternal outcome.