Team Involvement Research Articles

Sustaining Higher Education Institutions: Enhancing School Climate, Leadership, and Faculty-Efficacy

The study sought to analyze school climate, leadership, and faculty efficacy towards sustaining effectiveness in the private Higher Education Institutions (HEIs) in the City of Meycauayan, Bulacan for the School Year 2015-2016 using descriptive methods and questionnaires as specific techniques. The study was geared to describe the school climate of the HEIs as perceived by the faculty and school heads. It investigated the leadership of the heads in terms of School Management Team (SMT) composition, significant responsibility, and involvement in school tasks. It was undertaken to find out the faculty’s efficacy level in student engagement, classroom management, and instructional practice. It intended to explore the significant difference between the perceptions of school heads and faculty in school climate as to school staff’s relationship, capacity to provide quality instruction and school climate issues. Major findings revealed that HEIs fostered good relationship status. Heads and the faculty perceived that HEIs’ capacity in providing quality instruction is only “moderately good.” The findings showed that HEIs utilized SMT composition and a School Governing Board (SGB). Heads’ major tasks include determining course content both national and regional curricula, appointing, or hiring teachers, and establishing student disciplinary policies and procedures. Heads allocated most of their time to administrative duties, like curriculum and teaching-related tasks while the least of their time was spent on interactions with students, parents, and local, regional, and business industries. On faculty efficacy, the data confirmed that teachers were “highly efficacious” in student engagement and “very highly efficacious” in instructional practice and classroom management. The perceptions of the heads and faculty on the school climate as to relationships among school staff do not differ significantly. In contrast, the perceptions of heads and faculty differ significantly on the school climate in terms of the school’s capacity to provide quality instruction and school climate issues. Keywords: perceptions, climate, efficacy, leadership, school effectiveness

Body image disturbances in adolescent and young adult patients with cancer confronting infertility risk and fertility preservation decisions.

e24175 Background: Body image is a major psychosocial concern for all cancer patients but can affect the adolescent and young adult (AYA) population in distinct ways. Similarly, the prospect of infertility and the fertility preservation process can create additional stress during cancer treatment. Discussions regarding infertility inherently implicate the body and its reproductive function, but downstream effects on self-perception have not been previously described. The aim of this study was to better elucidate the relationship between oncofertility discussions and body image disturbances in the AYA cancer population. Methods: AYA cancer patients (n = 27) aged 12-25 years whose cancer treatment conferred the risk of infertility were recruited through electronic health record query at an NCI-Designated Comprehensive Cancer Center. Participants completed semi-structured interviews which were recorded, transcribed, and deductively coded for themes related to information needs, knowledge of treatment effects on fertility, and reproductive concerns after cancer. Emergent, inductive themes related to body image were identified. Results: Body image concerns, including those related to both physical appearance and body functioning, emerged as common themes. Specific concerns included 1) anticipating and coping with body changes, 2) discomfort in experiencing and discussing one’s own body, 3) fear of judgement, and 4) failing to meet both internal and external expectations of the body. Some participants expressed a sense of loss when learning about infertility risk and the emotional challenges associated with accepting this risk. Several respondents worried that they would be negatively judged by their peers for a perceived defect of the body. Still others struggled with facing the unknown regarding fertility preservation and the difficulty in sharing this information with loved ones and future romantic partners. Conclusions: AYA cancer patients experience a multitude of body image related disturbances when faced with the possibility of infertility and decisions regarding fertility preservation. In identifying and exploring these themes, future opportunities, and novel interventions for improving oncofertility practice and discussions among AYAs with a focus on body image positivity emerge. These include the dual involvement of multidisciplinary teams (oncology and reproductive medicine) at initial clinical consultation and frequent follow-up contact; AYA and oncofertility-specific peer support programs, both in-person and virtual; and early, frequent involvement of social workers and mental health providers experienced in both cancer care and reproductive medicine.

294 Outcomes in Stevens-johnson Syndrome/toxic Epidermal Necroylsis Patients Treated Without Admission to a Verified Burn Center

Abstract Introduction The care of patients with Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necroylsis (TEN) has traditionally been delivered within a burn center. Our burn center utilizes a multi-disciplinary approach which involves admission to the medicine service, with support from the burn team. The aim of this study is to determine whether SJS/TEN patients cared for with our system, including burn involvement but not burn admission, demonstrate equivalent outcomes. Methods A retrospective review of all SJS/TEN patients admitted to the medicine service at a single academic medical center from 2009 to 2021 was conducted. Demographic characteristics and outcome measures such as mortality, length of intensive care unit (ICU) stay and total length of hospitalization were collected. The Severity-of-Illness Score for Toxic Epidermal Necrolysis (SCORTEN) was used to calculate expected mortality rates within the cohort [2]. The observed mortality rates were then compared to the expected mortality rates. Results 126 patients who were admitted for SJS/TEN were included (70 SJS, 40 SJS/TEN overlap, 16 TEN). The mortality rate for the entire cohort was 10.32% as compared to a 22.33% expected mortality rate (p=0.010). The observed and expected mortality rates for SJS, SJS/TEN overlap, and TEN sub-groups were 1.43% observed versus 10.22% expected (p=0.029), 20.00% observed versus 35.83% expected (p=0.133), and 25.00% observed version 44.06% expected (p=0.264) respectively. The mean ICU length of stay was 3.58 days, and the mean length of total hospitalization was 11.69 days. Conclusions Mortality rates in SJS/TEN patients admitted to medicine units are equivalent or decreased as compared to SCORTEN predicted mortality rates. Applicability of Research to Practice Admission of SJS/TEN patients to a medicine unit is appropriate as long as there is burn team involvement in their care, which may be more suitable for patients who require management of complex medical comorbidities.

A typology of healthcare pathways after hospital discharge for adults with COVID-19: the evolution of UK services during pandemic conditions.

Over half of post-COVID-hospitalisation adults have persistent symptoms 2 years after discharge, providing a challenge for individuals and healthcare systems. We therefore aimed to describe a typology of UK healthcare pathways post-hospital discharge as a first step towards understanding clinical effectiveness and cost-effectiveness of different healthcare pathways. In 2021, we surveyed hospital sites taking part in the UK Post-hospital COVID-19 (PHOSP-COVID) study. The online survey explored the availability of proactive follow-up, patient selection, involvement of multidisciplinary teams, investigations, assessment and access to mental health and rehabilitation interventions. The typology was defined by a three-stage process: 1) using the survey results to develop a bespoke algorithm to inform a draft classification, 2) a stakeholder event for refinement and 3) finalisation between the Project Advisory Group and research team. The bespoke algorithm was used to map each site onto the classification with further mapping by level of mental health and rehabilitation provision. 70% of hospital sites (45 out of 64) responded to the survey. 82% (37 out of 45) reported delivering a follow-up service after hospital discharge during the first few months of the pandemic. Only 13 out of 37 services (35%) were delivered by permanent staff. The final typology of five categories included no proactive follow-up, and a matrix of four groups based on patient selection (prespecified subgroup/all patients) and complexity of assessment (low/high). The complexity of assessment, rehabilitation and mental health interventions was variable within sites. We describe the first typology of post-hospitalisation COVID-19 healthcare pathways to enable modelling of clinical effectiveness and cost-effectiveness to inform future policy. Our results highlight the heterogeneity and vulnerability of healthcare services after COVID-19 hospitalisation.

Pituitary Apoplexy causing Panhypopituitarism

We present an atypical presentation of pituitary apoplexy as a pontine mimic with drowsiness and pin-point pupils. The patient had a known pituitary macroadenoma with suprasellar extension with hypogonadism and hypothyroidism. Initial investigations revealed hyponatraemia and imaging suggested a localised cerebral ischaemia in the basal ganglia and no change in the pituitary adenoma. Only further assessment with MRI showed the extent of the haemorrhage. Management was conservative, although close involvement of neurosurgery and ophthalmology teams is essential. We believe, that awareness of such unusual association is important for clinicians to consider apoplexy in the differential, even if the initial CT imaging is not suspicious.

Perspectives on relative energy deficiency in sport (RED-S): A qualitative case study of athletes, coaches and medical professionals from a super league netball club.

Research into relative energy deficiency in sport (RED-S) has increased substantially over recent years given the impact on athletes' health and performance. Most studies have considered sports that place emphasis on the aesthetics, endurance, or weight-restriction. Fewer studies exist in team sports. Netball is a team sport yet to be explored despite players potentially being at risk of RED-S given the high training volumes, sporting culture, internal and external pressures, and small network of coaches and medical professionals. A qualitative case study was used to explore the perspective of athletes, coaches, and medical professionals on RED-S. Semi-structured interviews were conducted with 13 players, 4 coaches and 4 medical professionals affiliated to a Super League club. Interviews were recorded and transcribed verbatim. The data was analysed using thematic analysis. Five main themes were identified in this study. Awareness of RED-S amongst athletes and coaches was generally inadequate whereas medical professionals had some awareness of RED-S. Some athletes used contraception to reduce discomfort/pain during menstruation whilst others expressed concerns around long-term contraceptive use and previous menstrual cycle disturbance. Sporting demands, individual and contextual factors, and a preoccupation with body image were associated with nutritional restriction, whilst appearance was a source of internal and external pressure. External pressures also extended to coaches, assessments/feedback, social media, and commentary. Strategies suggested to reduce the risk of RED-S included "hard hitting cases", multidisciplinary team involvement, and support from the governing body. The findings of this study provide insight into factors potentially associated with the risk of RED-S from an athletes, coaches, and medical professional perspective. This insight can be used to increase overall awareness of RED-S in key stakeholders as well as improve the recognition for the pressures netball athletes face that might alter the level of risk.

Provision of revision knee arthroplasty services across Scotland: A national audit

BackgroundThere is increasing evidence that both low surgeon and centre case volumes are associated with poorer outcomes following Revision Knee Arthroplasty (rTKA). Given the unique challenges faced in Scotland relating to funding and geography, understanding details on the complexity of cases is required to guide development of future rTKA services. MethodsUtilising the Scottish Collaborative Orthopaedic Trainee Research Network (SCOTnet) a retrospective review of all Scottish 2019 rTKA cases was undertaken. Regional leads co-ordinated local data collection using individual case note review. The number of cases performed by regions, hospitals and individual surgeons were identified. Patient demographics and case complexity (Revision Knee Complexity Classification [RKCC]) were also collected. Results were compared against current standards. Results17 units performed rTKA, delivered by 77 surgeons. A total of 506 cases were included. The mean age was 69 years (46% male). Revision for infection accounted for 147/506 (29%) cases. Extensor compromise was present in 35/506 (7%) and 11/506 (2%) required soft tissue reconstruction. According to the RKCC − 214/503 (43%) were classified as R1 (Less complex cases), 228/503 (45%) R2 (complex cases), and 61/503 (12%) R3 (most complex / salvage cases).5/17 (29%) units met current national guidelines for case volume/year, with only 11/77 (14%) surgeons meeting recommended individual case volumes. 37/77 (48%) surgeons performed ≤ 2 cases per year. ConclusionsMost individual centre volumes could be increased by re-organising services or locations providing rTKA within a region. This should provide better access to Multidisciplinary Team (MDT) involvement. We recorded a significant number of very low volume surgeons (≤2 year) that is contradictory to current evidence-based practice.

P109 Personalised comprehensive care packages for people with rheumatoid arthritis: a survey-based study

Abstract Background/Aims Socioeconomic and clinical factors are closely associated with long-term disease outcomes in rheumatoid arthritis (RA). There is increasing evidence for holistic, targeted management of people with RA, including at first presentation. This study aimed to determine how people with, and those involved in the treatment of RA, benefit from personalised care packages and treatment programmes. Methods An online survey was developed by an expert panel comprising physicians, psychologists, epidemiologists and patients, following three multidisciplinary workshops which included patients. Questions were designed to evaluate participants’ views on multidisciplinary Team (MDT) involvement in the care of patients at early-stage RA and onwards. The online survey underwent extensive revisions by patients and clinicians, before dissemination to patients and healthcare professionals (HCPs) in the UK. Results We received 41 complete responses: 23 (57.5%) rheumatology consultants/trainees, seven (17.5%) rheumatology specialist nurses, five (12.5%) occupational therapists, three (7.5%) physiotherapists, one dietician (2.5%) and one patient (2.5%). 82.9% of respondents agreed that people with RA need access to the same “early” care package (comprising a core MDT) at time of diagnosis. On subsequent clinical reviews, 85.4% of respondents agreed that the care package for people with early RA may need to be tailored to an individual’s clinical, psychological and social needs. 58.5% of respondents confirmed that a standard core packaging with input from a consultant rheumatologist, clinical nurse specialist/patient educator, general practitioner and pharmacist is appropriate for patients with early RA, irrespective of patient or disease-related factors; 36.6% disagreed and 4.9% were unsure. Of those disagreeing with this statement, 36.7% agreed not all of these healthcare professionals are relevant to patient care at time of diagnosis, whilst 53.3% gave another reason and 10% were unsure. 68.3% of participants suggested additional involvement of 1-6 MDT members in patient care, specifically occupational therapists, physiotherapists and psychologists. Other posited that primary care may be included occasionally, and additional MDT members’ expertise in early disease may be overwhelming and require frequent review. There was strong agreement (median 10/10 on Likert scale) for the following two statements: ‘A care package with core members of the multidisciplinary rheumatology team need to be available to people newly diagnosed with RA’; ‘Personalised comprehensive care packages, comprising a core plus various additional members of the multidisciplinary team, need to be offered and adapted according to a person’s individual disease characteristics and socio-economic circumstances’. Conclusion HCPs caring for people with RA overwhelmingly agree with a tailored MDT involvement from an early stage of disease, reviewed regularly and adapted. Care packages need to be personalised to account for bio-psycho-social factors. HCPs need to acknowledge that the “ideal” care package may vary markedly between patients to maximise impact and benefit for patients. Disclosure M. Dey: None. A.D. Busby: None. H. Lempp: None. E. Nikiphorou: None.

Reduction in thrombolytic order‐to‐needle time with addition of a pharmacist to a pulmonary embolism response team

AbstractIntroductionPulmonary embolism (PE) is the third most common cause of cardiovascular death in the United States. Institutions have implemented pulmonary embolism response teams (PERT) to hasten clinical decision making and therapeutic interventions. The extent to which critical care pharmacists are included in PERTs is not known. Although improved outcomes with pharmacist involvement in other emergency response teams (e.g., stroke teams) is well described, literature surrounding the impact of pharmacist inclusion in PERTs is limited. The objective was to evaluate if direct pharmacist inclusion in a PERT resulted in reduced time to systemic thrombolysis from time of medication order release in appropriate PE candidates.MethodsThis was a retrospective, observational study of patients with submassive or massive PE who received systemic thrombolysis at a large academic medical center. Patients were divided into two groups based on if they received systemic thrombolysis before or after the intervention. This intervention was the addition of a pharmacist to the PERT with emphasis on early communication between the PERT pharmacist and other stakeholders at time of PERT activation, and a revised thrombolytic preparation workflow emphasizing bedside preparation by the pharmacist. The primary outcome was time to administration of thrombolytic from time of medication order release.ResultsThirty‐four patients were included. Median time to thrombolytic administration was reduced in the post‐intervention group compared to the pre‐intervention group (23 min [14.8–42] vs. 54 min [42.8–69], p = 0.007). Bleeding events were not different between groups. Time to resumption of systemic anticoagulation after systemic thrombolysis was greater in the post‐intervention group.ConclusionInclusion of a pharmacist in the PERT at this institution significantly reduced time to administration of systemic thrombolysis from time of medication order release in appropriate PE candidates. Larger studies should be conducted to expand upon and confirm these findings.

Do adolescents and emerging adults receive the diabetes care they truly need? A nationwide study of the quality of diabetes health care during the transition from paediatric to adult care.

The aim of this study was to assess the paediatric and adult diabetes care provided to adolescents and young adults with childhood-onset type 1 diabetes during the transition. This nationwide population-based cohort study included 776 individuals with type 1 diabetes who were last registered in the Norwegian Childhood Diabetes Registry (NCDR) between 2009 and 2012 and had received adult health care for at least 2 years. The patients' experiences were reported in a validated questionnaire. Clinical data from the annual registrations in the NCDR were coupled with data from the medical records in adult diabetes care. The longitudinal measures of glycaemic control were analysed using a growth mixture model. A total of 321 young people answered the questionnaire and provided written informed consent for the collection of their data from their medical records. The mean age at transfer was 18.0 years (range = 15.0-23.5 years), and the mean age at participation was 22.7 years (range = 20.9-26.7 years). Significant differences (p < 0.001) in patient experiences were found between paediatric and adult diabetes care in several areas: contact with health-care personnel, continuity of care, interval between consultations and overall satisfaction. Registry and medical records data confirmed the patient-reported experiences. The longitudinal analyses identified two groups with distinctly different trajectories of glycaemic outcome over time. Patient-provider continuity and perceived preparedness for transfer were the most influential predictors. This study highlights several areas to be addressed for improving health care and the transition to adult diabetes care in adolescents and young adults with type 1 diabetes, including provider continuity, individualised care and involvement of multidisciplinary teams.

The effectiveness of the program for improving tactical actions in the attack of student teams in 3x3 basketball

The purpose of the study is to find out the change in the tactical indicators of the competitive activity of student teams in 3x3 basketball under the influence of the program for improving tactical preparedness. Research organization. The pedagogical experiment was conducted with the involvement of qualified teams of 3x3 basketball players of the experimental group (n=12) and the control group (n=12). At the beginning of the experiment, we analyzed 64 games for the experimental and control groups with the determination of quantitative and qualitative data of the indicated indicators of competitive activity in 3x3 basketball. At the end of the experiment, 56 games were analyzed for the experimental group and 62 games for the control group according to the indicated indicators of competitive activity. The following indicators were determined: general group (number of points scored per game, total and "net" playing time), adjacent group (total number of rebounds, number of rebounds on the "own" and "alien" boards, the number of ball losses and the number of made and interceptions), shooting group (number of attacks and throws, number of one-point, two-point and free throws, their effectiveness and efficiency), technical-tactical group (number of individual and group tactical actions, their effectiveness and efficiency, number of group tactical actions of different duration with differentiation by the cost of the throw). Research results. At the end of the pedagogical experiment in the control group, there were significant changes in 13 of the 59 indicators that were studied. In the experimental group, probable changes were recorded in 35 out of 59 indicators of competitive activity of qualified teams in 3x3 basketball. These include more points scored, overall attack efficiency, better two-point shooting efficiency, etc. Intergroup differences at the end of the pedagogical experiment were established in 36 out of 59 indicators, namely in the time characteristics of the game, overall efficiency, effectiveness of two-point shots, effectiveness and efficiency of group offensive actions. Conclusions. As a result of the study, it was established that in the experimental group, the indicators of the number of points scored on average per game increased by 1.5 points (p&lt;0.01), the total and "net" time of the game decreased, which indicates an increase in the intensity of the game. In the experimental group, a smaller number of ball pickups on the "alien" shield and the number of ball losses were recorded. According to the results of the pedagogical experiment, a significant decrease in the quantitative performance of individual tactical actions and an increase in the number of group tactical actions in the experimental group were recorded.

Paauglio politrauma žemdirbystės pramonėje: klinikinio atvejo analizė

Polytrauma is a condition when a patient has sustained multiple injuries, which can lead to disability or death. While the agriculture industry is growing, the number of polytrauma patients in children is increasing as well. It is high-energy traumas when it is important to immediately assess injuries and life-threatening conditions and to start trauma protocols guided treatment. In this article, we present a case of a 17-year-old boy who suffered extensive injuries caused by a straw pellets machine. We discussed the importance of prehospital care, multidisciplinary team involvement, and treatment methods.

Palliative team involvement in end-of-life care for Jewish and Muslim children in Jerusalem: A unique clinical and cultural context.

Pediatric palliative care services improve the quality of life for children with life-limiting and life-threatening diseases, although little has been published about variation based on cultural and religious factors. This article sets out to describe clinical and cultural characteristics of pediatric end-of-life patients in a majority Jewish and Muslim country with religious and legal constraints around end-of-life care. We conducted a retrospective chart review of 78 pediatric patients who died during a 5-year period and could potentially have utilized pediatric palliative care services. Patients reflected a range of primary diagnoses, most commonly oncologic diseases and multisystem genetic disorders. Patients followed by the pediatric palliative care team had less invasive therapies, more pain management and advance directives, and more psychosocial support. Patients from different cultural and religious backgrounds had similar levels of pediatric palliative care team follow-up but certain differences in end-of-life care. In a culturally and religiously conservative context that poses constraints on decision-making around end-of-life care, pediatric palliative care services are a feasible and important means of maximizing symptom relief, as well as emotional and spiritual support, for children at the end of life and their families.

Information System Assessment of the Creditworthiness of an Individual

Nowadays enterprise information systems of banks provide modules for calculating creditworthiness of the business. Such systems are complex and it is difficult to maintain and develop them. Moreover, it requires the involvement of large teams. In addition, systems are complicated to change and update in accordance with changes in current legislation. From another point of view, demand for consumer loans is high, and creating a separate module for calculating the creditworthiness of an individual is appropriate in case of increasing the adaptability to changes and updates of the system. Calculating the creditworthiness of an individual is relevant not only for the banking system, but also for other spheres such as logistics and marketing.The work describes the created information system for calculating the creditworthiness of an individual, which calculates the class of the borrower based on data from credit history, credit rating, quality characteristics, financial indicators of the person and characteristics of the credit transaction.The use of the Asp.Net Core platform and the Vue.js framework to build a software module that can be used both independently and easily integrated into other corporate systems is demonstrated.In this work the major steps of designing and developing the system are described.

Clinical implementation of 177Lu-PSMA-617 (LuPSMA) at a major academic center: Initial experiences.

108 Background: LuPSMA received FDA approval in March 2022 for patients with PSMA-positive metastatic castrate-resistant prostate cancer (mCRPC). Clinical implementation of this treatment requires multidisciplinary team (MDT) involvement and has been beset by challenges in drug supply. We established a joint DFCI GU/Nuclear Medicine Tumor Board (GU-NM TB) to review patients for therapy, and our initial experiences are described. Methods: A joint GU-NM TB was established. All patients with mCRPC who had received at least one prior chemotherapy and a novel hormonal agent were considered eligible and referred to TB through an online referral system after undergoing PSMA-PET/CT. Case details, including prior treatment history, performance status and organ function, and PET/CT imaging were reviewed at TB, with patients either being approved, deferred, or declined for LuPSMA therapy. Patients were scheduled for therapy on a first-come first-served basis. Treatment was delivered per standard-of-care at 180-200 millicurie doses every 6 weeks within NM. A questionnaire was sent to 25 referring physicians 2 months after implementation of the TB to evaluate the referral process. Results: Between May-September 2022, a total of 108 patients were referred for LuPSMA therapy. Median age at time of referral was 73 (range 52-93), and 90% of patients were Caucasian. Median duration between PSMA-PET/CT and TB review was 10 days (IQR 6-17). 84 patients (78%) were approved for therapy, 16 (15%) were deferred and 7 (6%) were declined (reasons including absence of prior chemotherapy, high risk for toxicities, poor performance status); 1 patient died before TB review. Prior therapies included docetaxel (84%), cabazitaxel (56%), abiraterone (67%), enzalutamide (57%), darolutamide (23%), radium-223 (21%) and apalutamide (7%). Median number of prior treatments was 4 (range 2-12). Sites of disease on PSMA-PET/CT included bone (81%), pelvic lymph nodes (42%), extrapelvic lymph nodes (88%), lung (27%) and liver (22%). As of September 2022, a total of 40 patients (48%) have received at least 1 cycle of therapy and 17 (20%) have received 2 cycles; 6 patients (7%) approved for therapy died before receiving 177Lu-PSMA-617. Of the patients that have received 1 cycle of therapy, median duration between TB acceptance and C1 was 52 days (range 32-114). Out of 13 survey respondents, all 13 (100%) reported that their overall experience of the referral process was positive or very positive, and 12 (92%) noted that the Tumor Board had provided additional clinical insights on occasion or frequently. Conclusions: Due to drug supply shortages, &lt;50% of patients approved for LuPSMA therapy have started treatment to date. Median time between TB approval and start of therapy was 7-8 weeks, with 7% of patients dying before receiving therapy. Establishment of a GU-NM TB to review cases and facilitate treatment was viewed favorably by treating physicians.

Does the physicians’ medical team joining behavior affect their performance on an online healthcare platform? Evidence from two quasi-experiments

With the growing interest in and use of online healthcare platforms (OHPs), online medical team (OMT) services have gradually been recognized by physicians as an important multi-channel initiative. However, only a handful of studies have explored the pros and cons of the OMT channel over the traditional individual online service channels in an OHP or examined the critical roles of physicians’ OMT joining behavior. To fill this gap, utilizing two sets of unbalanced panel data, representing high- and low-risk diseases, from 3,500 physicians in a leading OHP in China, we investigate the impacts of physicians’ OMT joining behavior on their online performance based on the trust-transfer theory. The moderating effect of physician’s team involvement is investigated based on data from a famous OHP application. Employing a combination of propensity score matching and difference-in-differences identification, the results indicate that physicians’ OMT joining behavior positively influences their online performance. Furthermore, for the physicians who deal with low-risk diseases, their OMT involvement weakens the positive relationship between their OMT joining behavior and online performance although it has the opposite impact in the case of high-risk diseases. Our subsample analyses provide further insights into how physicians’ OMT joining behavior influences their online performance based on their seniority levels. Specifically, for physicians with higher seniority levels, the team joining behavior positively influences their online performance whereas there is no significant effect for the physicians with lower seniority levels.

Palliative and Supportive Care Consultation for Patients With Malignant Gastrointestinal Obstruction is Associated With Broad Interdisciplinary Management.

The aim of this study was to assess rates of palliative care (PC) involvement in the care of patients with malignant gastrointestinal obstruction (GIO) and its influence on interdisciplinary team involvement. Malignant GIO is an advanced oncologic diagnosis with associated poor prognosis. Data regarding PC and interdisciplinary team involvement in these patients is lacking. We identified consecutive surgical consultations for GIO in cancer patients at a single institution from August 2017 to July 2019. Clinical characteristics were collected. Rates of PC consultation, ACP discussion, code status change to do not resuscitate, and interdisciplinary service consultation were evaluated. We identified 200 patients with consultations for GIO, of whom 114 (57%) had malignant GIO and were included in our study. Of these patients, 95 (83%) had stage IV disease; 68 (60%) had peritoneal metastasis, and 70 (61%) had other intra-abdominal recurrence or metastasis. PC consultation was obtained in 69 patients (61%). PC consultation was associated with higher rates of ACP discussion (64% vs 29%; P < 0.001), code status change to do not resuscitate (30% vs 2%; P < 0.001), nonsurgical procedure (46% vs 11%; P < 0.001), discharge to hospice (30% vs 7%; P < 0.001), and involvement of spiritual care (48% vs 22%; P = 0.01), social work (77% vs 42%, P < 0.001), psychology/psychiatry (42% vs 4%, P < 0.001), nutrition (86% vs 62%, P = 0.006), physical therapy (54% vs 31%, P = 0.02), and occupational therapy (42% vs 16%, P = 0.004). PC consultation benefits patients with malignant GIO by facilitating comprehensive interdisciplinary care, ACP discussions, and transition to hospice care, where appropriate. Diagnosis of malignant GIO should be a trigger for PC consultation or, in facilities with limited PC resources, consideration of deliberately broad interdisciplinary consultation.

Diversification mechanisms and their effectiveness

The work is devoted to finding effective mechanisms for the implementation of diversification and commercialization in large companies. World practice outlines that big are quite actively use the purchase (mergers and acquisitions) of other companies as a powerful diversification tool. Mergers and acquisitions allow companies - buyers quickly increasing the number of new products and services in their portfolio. This mechanism is used in the military and civilian sectors simultaneously. Boeing, Northrop Grumman, Raytheon Corp., Intel, Google, NEC and others are constantly buying third-party companies and sell their own assets. Based on the analysis of domestic and foreign experience in this area, it is concluded that, among currently used, the most optimal diversification mechanisms are the purchase of innovative companies, the involvement of external teams in the organization. Also among these mechanisms are buying the specialists with innovative technological competencies, the acquisition (purchase) of external innovative technologies and competences.

Deadly suicidal attempt and burdensome airway management, challenges to anesthesiologist with exposed airway

Rationale: Showcasing this case report is of essential importance to shed the light on this rare situation propelling advancement in clinical rationale to detect and manage such cases. Patient Concerns: A 25-year-old male patient presented with suicidal injury by cutting his throat open using a knife due psychiatric history of depression. Diagnosis: Clear-cut injuries to the neck area present with significant impairment to the human body functions from breathing to vascular injuries that eventually will lead to obstructed airways and haemorrhagic shock later. Interventions: In this case, we stress on the essentialness of the multidisciplinary team to manage and treat such critical situations, and this underlines the involvement of the anaesthesiologist to protect the airways in such difficult situations and immediately shifting the patient to the operation theatre involving the otolaryngologist, vascular surgeon and postoperatively by intensivists and psychiatrists. As the patient was arrested in the accident and emergency department, it was not applicable to take the patient to any imaging modality and this even created more challenge for the team to exclude any further injuries and to treat according to the standard acute care approach. Outcomes: Improved physical and psychiatric status which helped the patient to return to pre-injury state after fatal suicidal attempt. Lessons: Here, we highlight the urgency and the importance of immediate action in protecting the airways while following the ABCDE guidelines in addition to the rapid intervention, while minimizing time for imaging and shifting of the patient in such critical situations. Importance of the multidisciplinary team involvement while harmonizing treatment to avoid relapse and failure.

The Outcome of Multidisciplinary Treatment of Spinal Tumors: Institutional Experience of a Tertiary Care Hospital

Objective: Spinal metastatic tumors are mostly extradural. Intradural extramedullary tumors include neurofibromas and meningiomas while intramedullary tumors are mostly astrocytoma and ependymoma. The purpose of this study was to share the experience of managing these patients as a multidisciplinary team (neurosurgeons, general surgeons, thoracic surgeons, ENT surgeons, plastic surgeons, and oncology) in selected cases where the tumors grow into the surrounding structures.&#x0D; Material and Methods: This study was conducted at the Neurosurgery Department at Jinnah hospital Lahore from January 2021 to September 2022. 50 patients admitted to the Neurosurgery Department from OPD/emergency with the diagnosis of a spinal tumor confirmed on MRI were included in the study. Those patients who were unfit for surgery were not included in the study. Data was analyzed for gender, region, and location of the tumor, histopathological diagnosis, and multidisciplinary team involvement.&#x0D; Results: Out of 50 patients, 28 (56%) patients were male and 22 (44%) patients were female while ages ranged from 14 to 63 years. Extradural location was the most frequently encountered location, i.e., 50%. Metastatic tumors were the commonest. A multidisciplinary treatment board was conducted in 31 (62%) patients whereas adjuvant treatment was done in 15 (30%) patients.&#x0D; Conclusion: Multidisciplinary treatment of spinal tumors should be encouraged at tertiary care hospitals and routine multidisciplinary treatment boards conducted before and after surgical excision.