Joint Decision Research Articles

Clinical predictors of treatment response to gabapentin in women with unexplained chronic pelvic pain.

Chronic pelvic pain affects up to 24% of women worldwide and for up to 55% of these there is no associated pathology. Despite this there are no established treatments in this cohort. This is a secondary analysis of a randomised-controlled trial (GaPP2) to explore if there are measures which enable us to predict treatment outcome. GaPP2 recruited women with chronic pelvic pain and no identified pathology and compared the response to gabapentin and placebo. This analysis used variables collected at baseline including validated questionnaires. Binary logistic regression was used to create models to explore whether baseline variables predicted treatment response. Treatment response was determined using 30% reduction in average pain intensity, 30% reduction in worst pain intensity and the Patient Global Impression of Change ('marked' or 'very marked' improvement) individually. We also explored whether baseline variables predicted the occurrence of side-effects (dizziness, visual disturbances and drowsiness). Using the Patient Global Impression of Change questionnaire, we found a significant binary logistic regression (p = 0.029, explaining 31% of the variance), with those with lower worst pain intensity (odds ratio (OR) of 0.393, 95% CI [0.217, 0.712]), lower bladder symptom score (OR = 0.788, CI [0.628, 0.989]), and higher mental component quality of life score (OR = 0.911, CI [0.840, 0.988]), more likely to have 'marked' or 'very marked' improvement when treated with gabapentin. We could not identify predictors of experiencing side-effects to gabapentin. However, we did find predictors of these in the placebo group (binary logistic regression (p = 0.009) and explained 33% of the variance). Worse mental health (OR = 1.247, CI [1.019, 1.525]) and lower baseline pain interference (OR = 0.687, CI [0.483, 0.978]) were associated with having side effects, whilst the use of hormones reduced the risk of experiencing side effects (OR = 0.239, CI [0.084, 0.676]). Researchers and clinicians are increasingly aware of the importance of personalised medicine and treatment decisions being driven by knowledge of what treatments work for whom. Our data suggests an important role of the Patient Global Impression of Change in clinical trials as it may better reflect balance between symptoms reduction and side-effects and therefore be more useful in clinician-patients joint decision making.

Joint optimization of recyclable inventory routing problem under uncertainties in an incentive-based recycling system

Due to the value of resource recovery and the development of a circular economy, waste recycling has gathered global attention. Recently, many emerging cities designed new systems like an incentive-based recycling system (IBRS). In such systems, recyclables are collected through community recycling nodes by offering incentives, then transported to street recycling stations and sorted before being finally recycled. The increased recycling nodes and the incentives enhance the convenience and residents’ enthusiasm for waste recycling, but also intensify the uncertainty of recycling quantities and the complexity of the recycling operation management. Poor recycling operation management may result in increased recycling costs or greater loss of recyclables, which discourages residents from participating in recycling. Based on an existing IBRS, this study investigates the joint optimization problem of the recyclable inventory management at each community recycling node and the vehicle routing from the recycling nodes to the recycling station. A two-stage dual-objective multi-period stochastic programming model is established to minimize the loss of recyclables and logistics costs, which is further reformulated using the weighting method and transportation cost approximation parameters. To solve the reformulated model, a three-phase iterative algorithm is designed by combining the progressive hedging algorithm and route splitting algorithm based on the Lin-Kernighan heuristic. A case study is conducted using data from Shanghai’s IBRS. The proposed joint decision model is superior to separate decisions and the three-phase iterative algorithm can reduce the average total cost by up to 42.12% compared to the genetic algorithm and the Iteration-Move-Search method in the literature. Additionally, a sensitivity analysis is conducted to provide managerial insights.

The application of mechanisms of social dialogue in alternative methods of resolving labour disputes

The article defines the legal characteristics of alternative methods of resolving labour disputes, considering their role within the mechanism of social dialogue as a guarantee of interaction and mutual understanding between the parties involved. It highlights the trend in the development of modern labour legislation towards increasing the significance of social dialogue mechanisms in resolving both individual and collective labour disputes, as well as fostering greater involvement of social dialogue participants in the resolution of these disputes. It emphasises that conciliation and mediation procedures should be applied under current conditions in resolving both rights-based and interest-based labour disputes. A critical analysis is presented of the legislative limitation that confines conciliation procedures solely to the development of draft regulatory acts. Alternative methods of resolving labour disputes are considered as a form of conciliation procedure. It is emphasised that alternative methods of resolving labour disputes offer the possibility for the parties to the dispute to independently resolve their disagreements through a joint decision or to involve an impartial third party, jointly authorising them to develop an acceptable resolution that both sides will recognise as binding. The author identifies the following alternative methods for resolving labour disputes: direct negotiations, conciliation through settlement procedures, mediation, and arbitration procedures. It is highlighted that appointing a labour dispute commission at a general meeting or conference of employees contradicts the principles of social dialogue established in Article 3 of the relevant Law of Ukraine. It is proposed that such a body be formed on the basis of social dialogue, comprising representatives of both employees and the employer. Functionally, the labour dispute commission should operate as a permanent conciliation body rather than a jurisdictional one. It is suggested to regulate the use of mediation for resolving labour disputes at the local level within a collective or employment agreement. Arguments are presented that mediation is a subtype of one form of social dialogue—namely, conciliation procedures—since it aims to reconcile the parties to a dispute and to find a mutually acceptable solution. Mediation can be used not only for resolving labour disputes but also during negotiations for the conclusion of collective agreements, particularly to address disagreements that may arise during the preparation of draft versions of such agreements.

Deliberative Democracy in the Digital Age Opportunities and Challenges of Online Public Discourse

Deliberative democracy is a model of democracy in which decision-making processes are based on public participation, and public debate is prioritised. In this model, citizens make joint decisions through rational discussion and negotiation, and this process forms the basis of democratic legitimacy. As one of the main actors in 21st-century democracy debates, deliberative democracy aims to create more inclusive and fair policies by encouraging broad participation. In the digital age, the concept of deliberative democracy faces new challenges and opportunities. This study examines the intersection between deliberative democracy and digital technologies, focusing on how online platforms influence public discourse and democratic engagement. The core objective is to explore how digital technologies enhance inclusivity, speed, and scalability in deliberative processes while simultaneously raising concerns about misinformation, polarization, and exclusion. Drawing from the theoretical framework of deliberative democracy, which emphasizes rational discourse and public reasoning, the paper investigates the benefits and challenges that arise when deliberation moves online. Through case studies such as Iceland's crowdsourced constitution, global climate change discussions, and the role of social media during the 2020 U.S. election, the paper highlights how digital platforms facilitate rapid, large-scale deliberation but also contribute to political fragmentation and echo chambers. The study employs a qualitative research methodology, analyzing the impact of digital platforms on deliberative processes through literature reviews and case studies. The hypothesis is that while digital platforms offer significant potential for enhancing democratic deliberation by broadening participation, they also present new risks to the integrity of public discourse, particularly due to misinformation and the manipulation of algorithms. Ultimately, the paper argues that deliberative democracy must adapt to the realities of the digital age by integrating online and offline deliberation, fostering digital literacy, and establishing regulatory frameworks for transparency and accountability. The findings offer theoretical contributions to understanding the relationship between digital technology and democracy while also providing practical recommendations for enhancing the quality of digital public discourse.

Off-farm employment, farmland transfer and agricultural investment behavior: A study of joint decision-making among North China Plain farmers

Improving farmers’ ability to make joint decisions on multi-factors is crucial for efficient resource allocation in agriculture, promoting sustainable land use, and fostering rural revitalization. Using survey data from 1780 households in the North China Plain, this study used the Conditional Mixed Process (CMP) joint estimation to address potential endogeneity issues and investigate the interaction of off-farm employment, farmland transfer, and agricultural capital investment. First, the results reveal a significant relationship between the three factors in farmers’ decision-making. Particular, there is a positive relationship between off-farm employment and farmland outflow (ρ = 0.163, P < 0.05), while a negative correlation is observed between farmland outflow and capital investment (ρ = − 0.476, P < 0.01). Secondly, there is heterogeneity in the correlation of joint decision-making regarding off-farm employment types and agricultural capital input types. For risk-averse farmers and farmers with low capital liquidity, off-farm employment is not significantly correlated with farmland outflow, while farmers with land-poor farmers have the strongest positive correlation between farmland inflow and capital input. Third, even if increasing farmland outflow can facilitate the expansion of large-scale land operations, the investment effect of off-farm employment remains unrealized. Finally, the lag of the farmland transfer market relative to the labor transfer market and the rural capital market hinders the growth of optimal-scale agricultural management.

Summary of the best evidence for vocal rehabilitation training in adults with unilateral vocal fold paralysis.

To search, evaluate, and summarize the relevant evidence of voice rehabilitation training in adults with unilateral vocal fold paralysis (UVFP). Using the '6S' model, the database of UpToDate, BMJ Best Practice, domestic and foreign guidelines, and voice rehabilitation training for adults with UVFP were systematically searched. The search includes clinical decisions, guidelines, systematic reviews, randomized controlled trials, and expert consensus. Data search since the establishment of the database to 27 November 2023. The quality evaluation of the literature methodology and the extraction and integration of evidence were carried out independently by two researchers. A total of 12 literature were included, including 2 systematic reviews, 2 expert consensus, 4 guidelines, 2 clinical decisions, and 2 randomized controlled trials. Four categories of 16 pieces of evidence were summarized: evaluation of vocal cord paralysis, voice rehabilitation training, health education, joint decision-making, and multidisciplinary cooperation. This study summarized the best evidence of voice rehabilitation training for adults with UVFP and provided evidence-based summary for clinical staff to carry out relevant interventions.

Green Disposable Packaging and Communication: The Implications of Bring-Your-Own-Container

Problem definition: A growing number of firms are encouraging consumers to participate in “bring-your-own-container” (BYOC) behavior in which consumers bring their own reusable packaging to purchase and consume products, thus reducing single-use packaging waste. In this paper, we study the environmental implications of a firm’s BYOC implementation when considering its disposable packaging choice and communication strategy. Methodology/results: We build a stylized model to study a firm’s joint decisions on BYOC, disposable packaging choice, and communication and their implications on the environment. Our main results follow. First, allowing BYOC reduces the firm’s incentive to make fraudulent green claims about its disposable product packaging; however, BYOC implementation may harm the overall environment while improving the firm’s profit, thereby creating a new form of greenwashing. Second, the adoption of third-party certification for green disposable packaging is an effective remedy to mitigate the negative environmental impact of BYOC. In addition, the environmental implications of adopting third-party certification (either voluntarily or because of government mandates) depend on the relationship between the environmental qualities of green disposable packaging and reusable packaging. Whereas it always benefits the environment when the firm’s green disposable packaging has better environmental performance, adopting certification may negatively impact the environment if consumers’ reusable packaging is greener. Furthermore, we find numerically that offering a price discount for BYOC may encourage the firm to adopt certification because of increased profitability, thereby leading to the aforementioned environmental implications. Managerial implications: We offer operational insights on how firms should make joint decisions on BYOC, disposable packaging choice, and communication. We also generate insights on how governments should regulate firms’ green claims when firms start to allow BYOC. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2021.0605 .

Barriers and facilitators to conducting randomised controlled trials within routine care of neurorehabilitation centres: a qualitative study

BackgroundRandomised controlled trials (RCTs) are considered the gold standard for generating clinical evidence. The focus on high internal validity in RCTs challenges the external validity and generalisability of findings, potentially hindering their application in routine care. In neurorehabilitation, limited literature addresses conducting RCTs feasibly and efficiently. We investigated barriers and facilitators to conducting RCTs within routine care of neurorehabilitation centres from the perspective of stakeholders in neurorehabilitation in Germany and Austria.MethodsWe conducted semi-structured interviews with stakeholders in neurorehabilitation from four centres in Germany and Austria, informed by the Theoretical Domains Framework (TDF) and the Capability, Opportunity, Motivation and Behaviour model (COM-B). Employing a hybrid approach, the interview analysis integrated both deductive, theory-driven analysis based on the TDF domains and COM-B model and inductive, reflexive thematic analysis.ResultsTwelve stakeholders (4 physicians, 4 therapy managers, 4 therapists; 5 females, 7 males; with research experience spanning 0–40 years) were interviewed. Key barriers to conducting RCTs in neurological rehabilitation centres include limited financial, human, and time resources, high clinical workloads, and a lack of interest of some therapists. Ineffective leadership, perceived lack of research expertise, and communication issues were also significant barriers. Social influence factors such as lack of employer support and inadequate training access further contributed to the challenges. Additionally, barriers included insufficient research infrastructure, limited space, internal power struggles, and rigid cost bearer specifications. Key facilitators included physicians’ and therapists’ motivation to advance the field, contribute to knowledge, and to prioritise patient health. Support from supervisors, joint decision-making, and efficient organisation were crucial facilitators. Flexible therapy planning, mutual support, and interdisciplinary collaboration also played important roles.ConclusionOur results suggest that increasing professional development and understanding, along with providing adequate financial, human, time, and spatial resources to support research endeavours, implementing effective communication strategies to enhance interdisciplinary collaboration and coordination among team members may contribute to increased motivation and facilitate RCTs within the setting of neurorehabilitation centres.Trial registrationThis study was prospectively registered with the German Clinical Trials Register (08.04.2021 DRKSID DRKS00024982).

Analysis of Airport Operation Control Center (AOCC) Unit Services at Adi Soemarmo Boyolali International Airport

Airport Operation Control Center (AOCC) is the front line in supervising and controlling all problems and is the control center of Adi Soemarmo Solo International Airport operations in serving Airport Service Users. AOCC involves all stakeholders at the Airport by integrating the systems owned by each stakeholder so that they can operate effectively and efficiently. This study aims to determine how the AOCC unit service system is at Adi Soemarmo Boyolali International Airport and what factors can cause problems and solutions to AOCC unit service problems. This study uses a descriptive qualitative approach. The data used are primary and secondary data. Primary data is obtained from observation and interviews, while secondary data comes from literature studies and photographs related to the problems studied. The data analysis techniques used are data reduction, data presentation and drawing conclusions. To test the validity of the data, triangulation techniques are used. The research time is in August - September 2023. The results of this study indicate that a good service system was found by the Airport Operation Control Center (AOCC) Unit to service users starting from coordination with all parties, namely Airlines and Ground Handling, Air Traffic Control (ATC), Apron Movement Control (AMC), Information Unit, Aviation Security, Airport Operation Landside And Terminal (AOLT), Traffic Administration Office and Central Flight Schedule Office (CFSO) and the Airport Mechanical Unit. The service system uses the ACDM (Airport Collaborative Decision Making) system, namely with collaboration between stakeholders to share information between related parties in real time and make joint decisions in a win-solution manner. Factors that can cause problems are related to coordination between one and another so that it can harm several parties. The solution to various problems is to implement ACDM (Airport Collaborative Decision Making), where related units in airport operations synergize with each other, receive and share information from each unit, make proactive and appropriate joint decisions, anticipate unexpected events and provide the best quality of service, cohesiveness and unity of vision and mission.

The effects of a dyadic empowerment-based heart failure management (De-HF) programme on self-care and HRQL : a randomized controlled trial

Abstract Background The ever-growing epidemiology of heart failure (HF) and its detrimental impacts on patients’ quality of life and healthcare cost urge for effective interventions to ameliorate the modifiable prognostic factors. As substantial evidence suggests ineffective self-care as an important candidate especially for the post-discharge outcomes, various care approaches are developed to optimize this behavioral outcome. However, even family carers are heavily involved in the self-care process, dyadic approach to improve the health outcomes of both interactive partners are least applied in the HF transitional care model. Purpose To evaluate the effects of a dyadic empowerment-based heart failure management program (De-HF) on dyadic health and hospital service utilization outcomes. Methods This double-blind RCT randomized 88 HF patient-carer dyads to receive the De-HF program or a dialectic education program, after hospital discharge. Based on the Theory of Dyadic Illness Management, the 16-week De-HF Program, comprising i) a dyadic assessment, ii) five online empowerment modules and iii) follow-up telecare, integrated explicit strategies (scenario-based training, teach-back and goal-setting) to actively engage the care dyads in collaborative disease management. Figure 1 is the graphical presentation of the De-HF Program. The primary outcome is health-related quality of life (HRQL) of the care dyads. Secondary outcomes include patients’ self-care as well as shared care and perceived control of the dyad. Results The mean age of the HF patients was 76.8 (9.4). The patients were in moderate disease severity [NYHA II/II: 56/44%; mean LVEF = 42.5%]. Figure 2 shows the consort flow diagram. After adjusting the socio-demographic characteristic, two-way analysis of covariance showed that patients in the De-HF program showed significantly greater improvement in patients’ self-care domains [Mean difference in change of score (95% CI): Self-care maintenance = 7.15 (1.82-12.46),Cohen’s d = 0.26, p=0.009; Self-care management = 10.04(3.29-16.79), Cohen’s d=0.65, p=0.004; symptom perception = 15.59 (8.20-22.98), Cohen’s d=0.928, p&amp;lt;0.001] and Minnesota Living with Heart Failure score [Mean different in the change of score (95% CI) = -11.45 (-18.24 - -4.66). Cohen’s d = -0.742, p=0.001]. The patient-carer dyads also have significantly greater improvement in perceived control (p=0.001) and collaborative disease management in terms of joint decision-making (p=0.001) and sense of reciprocity (p=0.026). Conclusion Dyadic science has evolved in self-care research for HF. This trial provides the first evidence to inform the positive effects of a theory-based dyadic transitional care program in improving the collaborative self-care management in a family context and patient health outcome. Longer-term evaluation on the effects of De-HF program on health service utilization outcomes and cost-effectiveness will be followed.The De-HF Managment ProgramThe Consort Flow Diagram

Food and exercise practices among British Pakistanis; how can Bourdieu's theory of practice help to understand them?

The prevalence of cardiovascular diseases (CVDs) are significant among the Pakistani ethnic group in the UK. Existing literature has identified food and exercise practices as contributing factors. This qualitative inquiry investigates food and exercise practices among this group. The study also identifies any cultural resistance to changing prevailing unhealthy practices. Five qualitative semi-structured interviews with local Pakistani community leaders, two focus group discussions, and 40 individual interviews with participants of both genders. Bourdieu's theory of practice was used to analyse the data. The lifestyle choices of the participants mainly follow the cultural practices of their home country. In particular, three cultural phenomena might have been contributing to CVDs among this community: a culture of consuming fatty and calorie-dense food, complexity in joint decision-making among family members, and a lack of motivation and cultural support for healthy physical activities, especially among women and older adults. It would be challenging to significantly influence this unhealthy lifestyle in the short term. Integrating religious discourse within health promotion, adopting a whole-family approach, and working with the community on healthier cooking and making exercise options culturally relevant could be helpful for reducing the prevalence of CVDs among the Pakistani community in the UK.

Prostate cancer screening with Prostate-Specific Antigen (PSA) testing: A retrospective study.

To evaluate the results of the prostate-specific antigen (PSA) test used in prostate cancer screening. This retrospective study was conducted on a total of 1106 male individuals, including 615 people (55.6%) aged 40-54, 379 people (34.3%) aged 55-69, and 112 individuals (10.1%) aged 70 and over. In the study, prostate-specific antigen (PSA) blood test results were performed on a total of 1106 male individuals aged 40 and over registered in the Uludag University Family Health Center, Bursa, Turkey during the 5-years between June 1, 2018, and May 31, 2023, were taken from the database and analyzed. Relationships with sociodemographic characteristics, comorbidities, and risk factors were examined. Data was analyzed using SPSS 25. About 15.5% of the participants were married, 78.4% were single, and 6% were separated from their spouses or widows. The PSA values of the patients referred to the urologist were found to be significantly different between the ages of 55 and 69. It was determined that the PSA levels of the patients with benign prostatic hypertrophy and prostate cancer were higher than the patients without any finding, and the mean was 6.81±4.39 (p=0.01). In our study, it is important to diagnose benign prostatic hypertrophy or prostate cancer in patients aged 55-69 years, whose mean PSA levels were 6.81±4.39, and referred to a urologist. As a contribution to the discussions in the literature, we recommend that the patient with symptoms be referred to the urologist after the test request and the joint decision with the family physician.

Affect heuristics and peer effect on substance use among adolescents in Brazil

Significant changes are observed during adolescence with respect to health-related habits and risky behaviors. Among the behavioral changes, the consumption of substances such as alcoholic beverages, cigarettes, and illicit drugs, and social interactions are relevant factors for the intake of such substances. This study aims to analyze the relationship between the joint decisions of substance use by adolescents and their peers from the perspective of the affect heuristics. To this end, a multivariate probit model was estimated, based on microdata from the 2019 National School Health Survey. The results showed that substance use by adolescents was positively related to substance use by their peers; therefore, having friends who consume alcohol, illicit drugs, and cigarettes or having parents who consume alcohol or cigarettes increases the likelihood of an adolescent consuming these substances. The study also identified that the substance consumption decision was governed by an unobserved common factor compatible with the affect heuristic.

Enzalutamide in metastatic hormone-sensitive prostate cancer: A plain language summary of the ARCHES and ENZAMET follow-up studies.

This summary includes information from the ARCHES and ENZAMET follow-up studies. Both studies looked at enzalutamide treatment for people with metastatic hormone-sensitive prostate cancer (known as mHSPC). In ARCHES, researchers compared the medications enzalutamide+androgen deprivation therapy (known as ADT) with placebo+ADT. In ENZAMET, researchers compared enzalutamide+ADT with standard treatment+ADT. Some people in ENZAMET also took enzalutamide with docetaxel (a chemotherapy treatment). In both studies, researchers wanted to find out if enzalutamide helps people with mHSPC live longer. In both studies, researchers found that people with mHSPC who took enzalutamide lived longer than people who did not. People who took enzalutamide also lived longer without their cancer getting worse. The results were mostly similar in groups of people dependingon when and where their cancer was found. Researchers did not find any new safety concerns. People with mHSPC may benefit from long-term treatment with enzalutamide+ADT. They may also benefit from taking enzalutamide with other treatments, like docetaxel. It may be better for people with mHSPC to have enzalutamide treatment before their cancer gets worse, rather than waiting. These people and their doctors should carefully consider the benefits and risks of each treatment to make a joint decision for treating mHSPC.Clinical Trial Registration: NCT02677896 (ARCHES), NCT02446405 (ENZAMET) (ClinicalTrials.gov).

Potential risk and efficiency analysis of decision-making dilemmas in connected dual-vehicle interactions at uncontrolled intersections

In dual-vehicle interactive scenarios, drivers often encounter decision-making dilemmas, even with connected information, thus posing significant risk challenges to traffic operations. This study explored the impact of such dilemmas on decision-making and traffic operations for drivers involved in straight-going (SG) and left-turning (LT) vehicles at uncontrolled intersections. Employing driving simulation technology, a decision-making experiment incorporating preemptive (P) and yielding (Y) strategies was conducted with 72 S G and 72 L T drivers under connected information provision. By analyzing joint decisions (P-P, Y-P, and Y-Y) made by drivers on both sides, we investigated implications for traffic operational safety and efficiency. Furthermore, recognizing the diversity in individual characteristics and time pressure, we developed a random parameters multinomial logit model to examine the relationship between potential traffic operational performance (both safety and efficiency) and various contributing factors. Moreover, we calculated the marginal effects of these contributing factors. By assessing the probability change of Y-P joint decisions balancing safety and efficiency, we identified reference values for each contributing factor that promote effective interactive operations. The findings suggest that: (1) Regarding interactive dilemmas conditions, Conditions where the SG vehicle had higher speed and farther distance than the LT vehicle were more likely to result in heterogeneous Y-P joint decisions, in which one driver chooses to yield and the other party passes quickly, thereby improving traffic performance. (2) Time pressure increased the likelihood of heterogeneous Y-P joint decisions but also increased P-P joint decisions. (3) heterogeneous individual attributes did not always lead to higher heterogeneous decisions. Overall, this study provides insights into factors influencing joint decisions and traffic operational performance under connected information provision, considering individual heterogeneity and time pressure, aiming to the advancement of more efficient and safer vehicle-connected transportation systems.

Partnering Implementation in SMEs: The Role of Trust

Resource Dependence Theory suggests that (a) power balance with resource interdependency, (b) formal/informal procedures for resource exchange, and (c) matching in goals and operational philosophies positively affect partnering implementation (information exchange and joint decision-making). Additionally, improved partnering implementation positive affects commitment fulfillment and dispute resolution. In a setting where SMEs supply to small local retailers, the SMEs do not suffer from low bargaining power and rely on informal contracts, and both firms are compatible. The small trading partners in this study predominantly have face-to-face and telephonic interactions with each other (possible due to the small number). Knowledge of one another and a simple transaction process reduces risk and uncertainty, and leads to trust. In this study, trust is a contextual factor, and we aim to determine if there is a positive effect of (a), (b), and (c) on partnering implementation, and if the effect strengthens with an increase in the level of trust. Survey data are used to calibrate and validate a structural equation model independently. Through empirical research, we aim to identify deviations in results, determine the cause of deviation in the study characteristics, and add explanatory power to research findings. Except for the influence of trust on the positive relationship between informal procedures and partnering implementation, the finding fits with the theoretical bases. With a high level of trust, clarity in time, accuracy, and relevance of information exchanged may be lacking, compromising decision-making and adding to the ambiguity of partnering implementation with an informal agreement.

7506 Rare Case of Hyperparathyroidism in Third Trimester Pregnancy Requiring Urgent Parathyroidectomy

Abstract Disclosure: A. Rothstein Costris: None. E. Davydov: None. S. Levy: None. Introduction: Primary hyperparathyroidism (PHPT) during pregnancy has risks to both the mother and her fetus. Complications include maternal pre-eclampsia, miscarriage, hyperemesis gravidarum, nephrolithiasis and pancreatitis. Fetal complications encompass hypocalcemia, tetany, intrauterine growth retardation and fetal demise. Though medical treatment is available, parathyroidectomy is the only definitive treatment. Traditionally, surgery is done in the second trimester of pregnancy. We report a case of a third trimester parathyroidectomy in a 29 yo female with PHPT. Case representation: A 29-year-old G1P0 woman at 28 weeks gestation presented with persistent nausea and vomiting, constipation, joint pain, and increased forgetfulness. She has moved to USA from Saudi Arabia and had not received prenatal care in the USA. She was found to have a PTH of 224 (15-65 pg/mL), Calcium of 13.5 (8.2-10.2 mg/dL), Ionized Calcium of 1.63 (1.00-1.35 mmol/L), and a corrected Calcium of 14.2 (8.7-10.1 mg/dL). Electrolyte abnormalities were also noticed, with a Potassium of 2.8 (3.5-5 mmol/L), Phosphorus of 1.7 (2.5-4.5 mg/dL) and Magnesium of 1.2 (1.8-2.3 mg/dL). Vit. D levels were found to be extremely low &amp;lt;7 (20-40 ng/mL). Due to severe dehydration, persistent nausea, vomiting, and hypercalcemia, the patient received fluid resuscitation and Vit. D supplementation. A neck CT scan identified an 11 x 6 x 14 mm arterially hyperenhancing soft tissue structure at T1-T2, suggesting a probable parathyroid adenoma in the right paratracheal region. Management options included surgery or conservative therapy with fluids and Cinacalcet. A joint decision was made between Maternal Fetal Medicine, ENT and Endocrinology to proceed with parathyroidectomy. Surgical excision revealed an enlarged, hypercellular right inferior parathyroid gland (0.51g). Postoperative laboratory studies at 2 weeks showed normal PTH, Ca, Ionized Ca. Conclusion: It is preferable to conduct surgery for PHPT during the second trimester of pregnancy. However, when PHPT leads to severe symptoms, surgery might be considered in the third trimester. The severity of our patient’s symptoms led to inability to tolerate oral intake, deeming surgery necessary. The multidisciplinary team agreed that surgery in the third trimester would be the best course of treatment as it will result in normocalcemia immediately. Second trimester parathyroidectomy is viewed as safer due to the completion of organogenesis and lower teratogenicity risks. Performance of surgery during the third trimester may lead to an increase in the risk of premature birth. However, untreated hypercalcemia may increase fetal loss and thus third trimester parathyroidectomy can be considered as a treatment option for PHPT in pregnancy. It is also imperative to discuss all options with the patient. In our case, the patient had opted for surgery which was successful. Presentation: 6/3/2024

6622 Severe Primary Hypothyroidism in a Child Presented as a Pituitary Tumour; a case Report

Abstract Disclosure: S.S. Awadalla: None. A 9-year-old patient showed up to the emergency department due to a headache that had been going on for a month without other symptoms and no neurological alterations. Complete blood count and glycemia were normal. A Cerebral MRI was requested and showed a pituitary adenoma. The patient was initially evaluated by neurosurgeons and referred to a pediatric endocrinologist. TSH, free T4, IGFI, and cortisol were evaluated, TSH was found to be high at 936 (normal, 0.4-4.2), free T4 &amp;lt; 0.4; suggestive of severe primary hypothyroidism. The case was analysed with the neurosurgery department, and a joint decision to start therapy with LT4 was taken, whilst monitoring the evolution of the pituitary adenoma. TSH and Free T4 were normal, and the MRI of Sella Turcica three months later showed complete pituitary normality. The presentation of this case is of relevance as the primary modality of treatment is thyroid hormone supply and not surgery. Interprofessional team integration is recommended for the treatment of patients with this condition. Presentation: 6/1/2024

Structured Debriefing to Assess Performance of Entrustable Professional Activities.

Background The medical workplace presents challenges for workplace-based learning. Structured debriefing of shared clinical experiences has been proposed as a way to take advantage of workplace-based learning in a setting that facilitates deep learning conversations. Objective To investigate faculty and learner acceptance of private, face-to-face, structured debriefing of performance of entrustable professional activities (EPAs). Methods During the 2020-2021 academic year, faculty at the University of Colorado (CU) and the University of Utah (UU) debriefed fellow performance of jointly selected EPAs in neonatal-perinatal medicine pertinent to shared 1- to 3-week clinical rotations. Private face-to-face debriefing was structured by a comprehensive EPA-specific list of behavioral anchors describing 3 levels of entrustment/accomplishment. Sessions ended with joint decisions as to level of entrustment/accomplishment and goals for improvement. We used thematic analysis of semistructured fellow interviews and faculty focus groups to identify themes illustrated with representative quotations. Results We interviewed 17 fellows and 18 faculty. CU participants debriefed after clinical rotations; UU usually debriefed during rotations. Debriefing sessions for 1 to 2 EPAs lasted 20 to 40 minutes. Themes represented in fellow interviews and faculty focus groups suggested that debriefing facilitated formative feedback along with shared understanding of clinical performance and assessment criteria. The standardized format and private conversations supported assessment of aspects of performance for which review might otherwise have been overlooked or avoided. The conversations also provided valuable opportunities for formative discussion of other matters of importance to fellows. Conclusions Structured debriefing of recently shared clinical experiences fostered formative assessment viewed positively by teachers and learners.

Diagnosis and treatment of abdominally inserted (sacrocolpopexy/sacrohysteropexy) mesh complications for vault/uterine prolapse

Background:Sacrohysteropexy and sacrocolpopexy are established treatments of uterine or vaginal vault prolapse respectively and involve insertion of mesh abdominally, often using permanent sutures and fixation devices. Complications following these procedures may be serious, and there is lack of evidence about long-term functional outcomes in terms of pain, dyspareunia and development of lower urinary tract and bowel symptoms. Objective:A non-systematic review of the available literature was performed and recommendations on assessment and management were developed by expert consensus. Conclusion:The current evidence is limited in quantity and quality, and recommendations on assessment management of mesh-related complications were made by experts in the field. Assessment and treatment of complications following abdominally placed mesh for pelvic organ prolapse will often require a multidisciplinary approach. Assessment may require EUA, and/or cystourethroscopy, sigmoidoscopy, and laparoscopy. MRI is the most useful imaging modality. Surgery to remove meshcarries a risk of urinary tract and bowel injury, as well as development of recurrent pelvic organ prolapse. A joint decision between the surgeon and the patient should be made before embarking on a partial removal of mesh; removal of all the mesh may be a better option albeit with higher risk of surgical complications. Complete removal of mesh and tacks or sutures from the sacral attachment may not be possible and is associated with risk of major haemorrhage.