Medicine Team Research Articles

P-1680. Retrospective Review of Adherence to Institutional Pneumonia Antimicrobial Guidelines at Hospital Admission

Abstract Background Literature supports the importance for institutions to have antimicrobial guidance accessible for providers in order to improve patient outcomes and antimicrobial stewardship (AMS). However, guideline adherence when prescribing for community acquired infections tends to be poor and includes more broad-spectrum antibiotics than required. We performed a review to assess adherence to our institutional pneumonia guidelines. Methods A retrospective chart review was conducted on all adult patients admitted to a Medicine or Hospitalist team at WVU Hospitals with an admission diagnosis of community acquired pneumonia (CAP)/pneumonia between January – June 2023. Demographic and clinical characteristics were collected as well as outcomes of interest: empiric antimicrobials and adherence to our institutional pneumonia guidelines. Data was collected and analyzed via WVU REDCap. Results We identified 154 patients with admission diagnosis of CAP to internal medicine services; however, 37 were excluded, as they were transfers from the ICU or outside facilities. Demographics showed 49.4% of the patients were female and median age was 69 years. 30% received antibiotics in preceding 90 days, with 77% of these for prior pneumonia. Identified comorbidities included: COPD (51.5%), Type II Diabetes (31.7%), CHF (43.6%), active malignancy (23.8%) and immunosuppressed (35.6%) (Figure 1). The median Patient Severity Index score was 91 (26-277). Adherence to institutional guidelines was 59% and of those non-adherent, 81% were over treated (Figure 2). Frequency of appropriate antibiotic use included: 24.8% ampicillin/sulbactam, 52.1% doxycycline, 33.3% ceftriaxone, and 12.8% azithromycin. Most common inappropriate antibiotic use included cefepime 28.2% and vancomycin 23.9%. Conclusion At 59% adherence to our pneumonia guidelines, this data shows there is a need for education and increased accessibility to institutional guidelines. Our QI intervention will include educational sessions on AMS guidelines and our CAP order panel, how to access the guidelines (via AMS app or webpage) and placement of guideline links within antibiotic orders. This study will also serve as a basis for assessing empiric treatment of other common infections and adherence to institutional AMS guidelines. Disclosures All Authors: No reported disclosures

P-1797. Implementation of a Handshake Stewardship Pilot for Inpatient General Medicine Teams at an Academic Medical Center

Abstract Background Handshake stewardship is an approach to antimicrobial stewardship that relies on in-person discussions between ASP teams and primary inpatient teams. This model has been implemented in pediatric and intensive care settings, and outcomes have been described in observational studies. In November 2023, UNCMC implemented a handshake stewardship pilot with crossover design for select inpatient general medicine teams. Methods Three pairs of matched inpatient general medicine teams at UNCMC were selected, with one team from each pair included in a three month intervention period. After three months, the teams were switched. The intervention consisted of twice weekly meetings of ASP physician and/or pharmacist and primary teams, during which antimicrobial regimens of all patients were reviewed except those with an ID consult. The intervention was delivered via in-person meetings for the two pairs of teams located at UNCMC, and via teleconference for a pair of teams located on a separate campus. The remote teams withdrew from the pilot during the intervention period. Recommendations made were catalogued as iVents in the Epic EMR and electronic surveys were circulated to primary team providers. Results 287 patients were reviewed across 95 meetings to date, yielding 73 recommendations. Common themes included narrowing coverage and transitioning to oral agents, although in some cases ASP teams recommended broadening therapy or a formal ID consult (Figure 1). 93% of recommendations were implemented. Survey data from 23 participants showed positive attitudes (Figure 2), with many valuing the opportunity to discuss patients that didn’t require a formal ID consult. Survey feedback from the virtual team included frustration with cessation of in-person ID consults at the site (unrelated to this pilot). Conclusion Handshake stewardship with in-person meetings has been well-received at UNCMC based on logged interventions and provider surveys, although the virtual component was unsuccessful. A planned crossover comparison between teams and paired controls will be helpful in assessing whether this has had an impact on antimicrobial use. Facilitating successful virtual handshake ASP will require improved coordination of meeting times and ensuring adequate access to in-person ID consults. Disclosures All Authors: No reported disclosures

Emergency Medicine and Rapid Response Virtual Team (EM-RRVT): Insights from the Hajj 1445/2025 Experience

Introduction: The use of telemedicine in acute care settings has not been investigated in large mass gatherings. Further exploration is needed to determine its efficacy, applicability and to explore challenges and opportunities. Aim: This study aims to evaluate a pilot deployment of virtual emergency team during one of the largest mass gatherings in the world, the Hajj religious season. Methods: The Emergency Medicine and Rapid Response Virtual Team (EM-RRVT) was launched from June 13 to July 6, 2024. The pilot was conducted in phases, with Phase One occurring in Mecca from June 13 to June 19. Subsequently, the team was activated on an on-demand basis. The team's role was to complement the on-ground teams as well as various emergency departments. Results: The team encountered a total of 324 patients from 20 countries, with a variety of medical conditions. The most prevalent condition was acute coronary syndrome, followed by trauma, within the peak hours from 10:00 to 22:00 coinciding with the movement of pilgrims. Over half of the patients were treated and released back to their Hajj contingents during surge hours. Conclusion: The use of telemedicine in an acute setting showed promising results. The establishment of the Emergency Medicine and Rapid Response Virtual Team proved to be both feasible and applicable. The scalability and flexibility of the service contributed to its efficiency.

Malpractice Liability Exposure and the Sports Medicine Team Physician: Caring for Professional Athletes in the National Football League, Major League Baseball, and National Hockey League

Background: Orthopaedic surgeons play a critical role in ensuring the health and safety of professional athletes. Despite the privilege of treating elite athletes, there exists great financial exposure to individual physicians in the event of a malpractice lawsuit. Hypothesis/Purpose: The purpose of this study was to evaluate and model malpractice liability exposure of the sports medicine surgeon caring for athletes in the National Football League (NFL), Major League Baseball (MLB), and National Hockey League (NHL) with respect to player position and additional supplemental malpractice insurance needs. It was hypothesized that routine liability coverage cannot adequately address the demands of caring for elite athletes in professional sports leagues. Study Design: Economic and Decision Analysis; Level of evidence, 3. Methods: In total, 2447 NFL, 992 MLB, and 980 NHL player contracts from the 2022-2023 season were aggregated from a publicly available online database. Position, team, total contract value, and mean yearly salary were noted. Risk ratios were calculated with respect to 1 million US dollars (USD) and 3 million USD of annual occurrence-based malpractice liability awards and used to generate a “covered-to-treat” analysis. Supplemental malpractice liability insurance was quantified. Results: Assuming 1 million and 3 million USD occurrence-based awards covered by malpractice liability insurance, team physicians can fully treat 17.3% and 50.0% of NFL players, 43.2% and 59.7% of MLB players, and 13.6% and 41.0% of NHL players, without incurring additional personal financial risk, from a risk-based medicolegal model. Liability policies of 52.6 million, 108.1 million, and 64.1 million USD are required to treat 95% of NFL, MLB, and NHL players, respectively. Positions carrying the greatest risk ratios are quarterback (QB) (9.9) in the NFL, right field (15.1) in the MLB, and center (5.7) in the NHL. Conclusion: Sports medicine specialists caring for elite athletes face potential personal financial risk due to insufficient medicolegal coverage. While coverage may vary among different practice settings including private, academic, or public state institutions, medical malpractice risk is crucial in partnerships between sports franchises, hospitals, players, agents, and physicians to protect sports medicine physicians and offer the highest-quality care.

Optimizing Healthcare: Implementation of a Pharmacist-To-Pharmacist Transitions of Care Pilot Program.

Background: Transitions of care (TOC) is defined as the movement of patients between healthcare practitioners, settings and home. Ineffective TOC can lead to hospital readmissions, increased costs, and patient dissatisfaction. Pharmacists have a unique opportunity to ensure that continuity of care, in regard to medication optimization and education, is continued throughout the transition between settings. With both inpatient and ambulatory pharmacists supporting smooth discharge for hospitalized patients, an opportunity was identified to implement a pharmacist-to-pharmacist TOC program at Ascension Genesys Hospital (AGH). Objective: Implement a pharmacist-to-pharmacist TOC program at AGH. Methods: This was a single-center pilot program in which a pharmacist-to-pharmacist TOC program was implemented at AGH between January 1st and April 30th, 2024. Patients were included if they were 18 years of age and older, managed by the family medicine (FM) team, and had at least 5 medications at discharge. The FM and ambulatory pharmacists provided recommendations and all medication related problems (MRPs) and interventions were documented. Descriptive analysis was conducted. Results: A total of 25 hospitalized patients and 10 follow-up patients were included. A total of 44 inpatient MRPs and 41 outpatient MRPs were recorded. The most common inpatient MRP was antibiotic stewardship. The most common clinic MRP was medication access barrier. Conclusion: Implementation of the pilot program occurred and results were reported. These results demonstrate the importance of pharmacist involvement in TOC.

General concepts on health economic evaluations.

Health economics is an area of study that has critical tools for evidence-based healthcare decision making, among which are economic evaluations. These tools allow us to weigh the costs incurred for a given intervention in relation to its health outcomes. The main utility of these studies lies in accomplishing decision-making in healthcare and the formulation of public policies. This article is the first of two reviews on whose main purpose is to address fundamental theoretical concepts of health economic evaluations to facilitate their understanding and critical analysis. The text is part of a methodological series on clinical epidemiology, biostatistics and research methodology conducted by the Evidence-based Medicine team at the School of Medicine of the University of Valparaíso, Chile.

Single-Cell Transcriptomics Sheds Light on Tumor Evolution: Perspectives from City of Hope's Clinical Trial Teams.

Tumor heterogeneity is a significant factor influencing cancer treatment effectiveness and can arise from genetic, epigenetic, and phenotypic variations among cancer cells. Understanding how tumor heterogeneity impacts tumor evolution and therapy response can lead to more effective treatments and improved patient outcomes. Traditional bulk genomic approaches fail to provide insights into cellular-level events, whereas single-cell RNA sequencing (scRNA-seq) offers transcriptomic analysis at the individual cell level, advancing our understanding of tumor growth, progression, and drug response. However, implementing single-cell approaches in clinical trials involves challenges, such as obtaining high-quality cells, technical variability, and the need for complex computational analysis. Effective implementation of single-cell genomics in clinical trials requires a collaborative "Team Medicine" approach, leveraging shared resources, expertise, and workflows. Here, we describe key technical considerations in implementing the collection of research biopsies and lessons learned from integrating scRNA-seq into City of Hope's clinical trial design, highlighting collaborative efforts between computational and clinical teams across breast, brain, and ovarian cancer studies to understand the composition, phenotypic state, and underlying resistance mechanisms within the tumor microenvironment.

National Survey of Airway Management Practices and Training Among Emergency Medicine Residency Programs in the United States.

As airway management becomes more complex with the adoption of new technologies and strategies, it is important to ensure that emergency medicine residents, the future of the specialty, receive extensive training. This study was designed to understand the prevailing airway management practices and training within emergency medicine residency programs. A survey consisting of 19 multiple-choice questions was sent to program directors of 258 emergency medicine residency programs in the United States. A total of 63 emergency medicine residency programs completed the airway survey, a response rate of 24%. Programs from all regions of the country are represented, most of them from university-based teaching hospitals (40%) and 3-year programs (78%). The majority of programs provide their residents with 50-100 intubations (50.8%) during their training. Pediatric intubations remain scarce with 54.1% of programs having only 5-10 pediatric intubations per resident. The emergency medicine team manages 93.6% of all trauma intubations, and residents complete 81% to 100% of all the department's intubations 88.9% of the time. Video laryngoscopy is on the rise, with GlideScope® (93.7%) and C-Mac® (55.6%) being the most common devices available. Overall, programs use both succinylcholine and rocuronium equally, but there is a trend toward using rocuronium more frequently than succinylcholine. By employing different teaching modalities, multiple times a year, residency programs expose residents to a variety of backup tools and surgical airway techniques. Emergency medicine residents are exposed to multiple advanced airway adjuncts and comprehensive airway curriculums as emergency airway management practices evolve and become more complex.

Introduction of the 'Blue Card' Concussion Policy to Semi-Elite Australian Football: Medical Staff Experiences and Perceptions.

The Western Australian Football League (WAFL) introduced a new umpire driven 'blue-card rule' for concussion, but its benefit to the sports medicine team is unknown. To determine the experiences and perceptions of medical staff within the 2022-2023 Men's and Women's WAFL competitions following the introduction of the 'blue-card rule'. Cross-sectional study. An online survey was delivered through Qualtrics to all WAFL medical staff (doctors, physiotherapists, head trainers). The survey contained four sections (demographics, concussion knowledge, concussion exposure and blue-card perceptions) with closed and multiple-answer questions. Standard methods for reporting descriptive data were applied, including mean ± standard deviation (SD) and proportions (%). Between-group differences were assessed using chi-square tests, and significance was accepted at p <0.05. Response rate was 48% (n=7 doctors, n=12 physiotherapists, n=12 head trainers). Most staff (70%) did not agree that the 'blue-card rule' was a helpful concussion policy or should remain within the WAFL. Staff also felt umpires are not qualified to identify suspected concussions on-field (67%). Over two-thirds of medical staff feel the Football Commission needs to provide education about concussion policies before the commencement of each season. Only 33% of medical staff felt completely confident in delivering a sideline assessment, and 17% felt completely confident in their diagnostic capabilities. Relationships between medical and other staff were not substantially impacted by the 'blue-card rule'. Medical staff within the WAFL reported the 'blue-card rule' as an ineffective concussion identification tool and did not support its continued use for future WAFL seasons. Staff suggested that the Football Commission needs to provide more education on concussion policies before the commencement of each season. 3.

An anesthesiology-led perioperative outreach service: experience from a Canadian centre and a focused narrative literature review.

Approximately 320 million surgeries occur annually worldwide, increasingly performed on an ageing, comorbid population in whom postoperative complications contribute significantly to mortality. While anesthesiologists have led advances in perioperative care, the optimal structure of the provision of postoperative care has lacked discourse. In this article, we describe the implementation, structure, role, and benefits of an Anesthesiology Perioperative Outreach Service (APOS) at a Canadian tertiary hospital, providing proactive daily review and management of high-risk surgical patients. The APOS involves routine reviews and care on surgical wards, emphasizing collaboration among anesthesiology, internal medicine, surgery, and geriatric medicine teams, with a specific screening pathway to identify patients experiencing myocardial injury after noncardiac surgery. We discuss case vignettes to illustrate common examples of how the APOS enabled early detection and treatment escalation for deteriorating patients and provide a focused narrative literature review. The anesthesiology-led perioperative outreach model described herein could provide an implementable framework for institutions seeking to enhance their quality of postoperative care-particularly among complex, comorbid patients at risk of postoperative morbidity.

The Integration of Nurse Practitioners Into Mass Gathering Medical Teams.

Mass gathering events can greatly impact overburdened emergency medical service systems and emergency departments, which frequently experience staffing shortages and overcrowding. Nurse practitioners (NPs) were introduced into an event medicine team at mass gatherings to reduce emergency transports to local emergency departments as well as offering a "treat and release" disposition for patients presenting to medical tents. This study aimed to examine the impact of NPs at mass gathering events; 147 chart reviews were performed from 05/01/2023 to 09/30/2023 for all patients assessed by an NP at events staffed by an event medicine team; 60% of patients assessed by an NP were treated and released from the event, potentially reducing the number of patient transports and emergency department visits considerably. NPs can provide higher levels of care at events, treating common complaints such as heat-related illness, nausea, vomiting, minor trauma, and laceration repairs. Although this study did not compare data from events where NPs were not present versus when they were utilized to grasp the statistical impact their presence has had since their introduction to the team model, the study clearly shows the benefits NPs bring to mass gathering medical care. This is significant for emergency NPs as this research validates the need to include these providers in this new setting and role in which they can practice. More research is needed to compare patient outcomes with and without NPs present.

Return to Play After Shoulder Stabilization –What If This Isn't Going Well?

Traumatic shoulder instability is prevalent among athletes, often leading to surgical intervention and challenging rehabilitation outcomes. This chapter explores the complexities surrounding return to play (RTP) following shoulder stabilization procedures, highlighting the significant variance in RTP rates and the common lag in returning to pre-injury performance levels, particularly in throwing athletes. Factors influencing successful outcomes include the nature of the instability, surgical approach, and individual athlete characteristics. A consensus on RTP criteria remains elusive, with a predominant reliance on time-based recovery, yet evidence suggests that other physical and psychological variables must be considered. Emphasizing a shared decision-making process and ongoing assessment of range of motion, strength, and proprioception, this chapter aims to identify key deficits and interventions that can enhance rehabilitation success for athletes struggling to return to play. Effective communication among the sports medicine team and the athlete is essential to optimize adherence to rehabilitation protocols and improve overall outcomes.

Abstract 211: Building a Stroke Program in Urban Tanzania: Needs Assessment and a Plan to Move Forward

Introduction Stroke is a leading cause of morbidity and mortality globally with high social and economic burden that disproportionately effects low‐ and middle‐income countries (LMICs). Mechanical thrombectomy (MT) is an effective treatment for stroke but is not available in the majority of LMICs. Tanzania (TZ) lacks MT and has limited access to thrombolytics with very few patients receiving any intervention for acute ischemic stroke (AIS). Key stakeholders in TZ are motivated to build a stroke program and provide treatment of AIS, including MT. Here we present the initial needs assessment and model for developing a system of stroke care in TZ. Methods A needs assessment was performed in TZ through discussion with a multidisciplinary team. Key leaders from the national hospital leadership, Emergency Medicine, Neurology, Neurosurgery, Radiology, Interventional Radiology, and international stroke teams were involved in discussions regarding current stroke management and goals for the future. Key stakeholders provided insight into the current state of stroke management within their health system, including the referral system within TZ, review of data from an existing stroke registry, review of standard operating procedures (SOPs) in place for patients presenting with AIS. Recommendations for improving access to acute stroke treatment were identified and discussed. Results Existing infrastructure and systems within TZ designed to care for patients with AIS include: two newly established, thrombolysis ready stroke units; AIS registry which involves 8 referral hospitals. The barriers to providing AIS treatment include: delayed presentation to healthcare due to lack of public awareness; lack of affordable and rapid access to appropriate imaging; lack of established consulting service between emergency physicians and stroke neurology; lack of epidemiological data as to the true incidence of AIS at the district level, lack of access to endovascular treatment. A model to develop AIS program in TZ was identified consisting of three partially overlapping avenues and targeted at the public, healthcare systems and medical teams. Public: sensitization of the public with media campaigns and education will be focused on identification of stroke symptoms and knowledge about treatments. Healthcare systems: development of a formalized consultation service between district emergency teams and stroke neurology; development and implementation of new SOPs for diagnosis and access to imaging at the district level; expansion of stroke registry to include district level hospitals. Medical teams: continued mentorship through the World Stroke Organization for neurology on identification and acute management of patients with stroke; development of the first endovascular neuro‐intervention training program in collaboration with Mission Thrombectomy 2020. Conclusions There is significant need for a system of stroke care for patients in TZ. Key stakeholders are motivated to establish this system and bring acute interventions, including thrombolysis and MT. to patients suffering from AIS in TZ. This endeavor will require significant effort by many groups, but concurrent efforts in these three domains can help bring this important care to the people of TZ.

Enhancing Patient Safety: The Role of Interdisciplinary Teams in Reducing Blood Culture Contamination.

Blood cultures are vital to diagnostic workups among many hospitalized patients, providing valuable information about bloodstream infections (BSIs), which cause roughly 250 000 deaths annually between North America and Europe. Despite advances in health care, blood culture contamination remains a substantial problem, with deleterious effects on patient mortality, patient and hospital costs, and microbial resistance. This article reviews the repercussions of blood culture contamination on the health care system and delineates evidence-based strategies to decrease contamination rates. To reduce blood culture contamination rates, our health care facility undertook a quality improvement initiative. A task force was created, consisting of leadership from the laboratory, phlebotomy, nursing, pathology, internal medicine teams, emergency medical services, and others. Measures included comprehensive staff training, standardization of protocols and supplies across facilities, and the introduction of waste tubes and smaller-volume chlorhexidine applicators for skin preparation. Data on blood culture contamination rates were collected before and after implementation. Prior to the intervention, the average monthly blood culture contamination rate across our facilities was 3.76%. Following the intervention, this rate decreased significantly to 2.07%, representing a reduction of 44.95%. Statistical analysis revealed a strong association between the implemented interventions and the decreased contamination rates, with a chi-square value of 62.3, 1 degree of freedom, and a P value of less than .001. These results indicate that the interventions were highly effective. Furthermore, the reduced contamination rates were sustained in the subsequent months, consistently remaining below 2%. The study demonstrated a substantial reduction in blood culture contamination rates through targeted interventions, highlighting the efficacy of combining evidence-based strategies with interdisciplinary teamwork to improve patient care outcomes.

Clinical features and outcomes of patients diagnosed with diabetic ketoacidosis (DKA) who were hospitalized for conditions outside of internal medicine

AimsTo assess the clinical features and outcomes of patients diagnosed with DKA who were hospitalized for conditions outside of internal medicine. MethodsRetrospective analysis of admissions for DKA in adult patients between 2005 and 2022 at a tertiary hospital in Israel. Patients with DKA were stratified into medical vs non-medical groups, the primary outcome was in-hospital mortality. Results429 patients were included in the study, 385 patients (89.7 %) were treated by an internal medicine team, while 44 patients (10.3 %) were hospitalized with surgical or obstetrical conditions. Patients in the non-internal medicine group were older (52 ± 18.9 vs 43.6 ± 20.4, p < 0.005) and had higher rates of diabetes complications such as chronic ischemic heart disease (20.5 % vs. 4.2 %, p < 0.0001) and chronic kidney disease (50 % vs. 3.4 %, p < 0.001). Glucose level on presentation was lower for non-internal medicine patients (398 ± 221 mg/dL vs 551 ± 180 mg/dL) and outcomes of mechanical ventilation and length of hospitalization were more severe (29.5 % vs. 6 %, p < 0.001 and 8.0 vs. 3.0, p < 0.001). Multivariate analysis demonstrated that composite outcome of in-hospital mortality, ICU admission and longer hospitalization was more likely in the non-internal medicine group (OR 3.99, CI 1.89–8.4, p < 0.001). ConclusionDKA is a universal pathology that concerns various medical fields. It is essential for every clinician to be familiar with this condition. Patients diagnosed with DKA who were hospitalized for conditions outside of internal medicine may be at high risk and may present with lower glycemic levels. Future research is needed to characterize the unique features of subgroups of patients with DKA.

Improving access to syphilis screening among unhoused people in Yolo County

Background: This study aimed to increase syphilis screening rates amongst unhoused residents of Yolo County, California, through the implementation of plan-do-study-act (PDSA) cycles. Yolo County has a strategic goal to eliminate congenital syphilis cases. Homelessness is a known risk factor for syphilis. Methods: The primary researcher was embedded in a street medicine team. Using quality improvement tools like stakeholder interviews, workflow diagrams, and best practices from literature, we outlined the team's workflow for syphilis screening and developed ideas to improve uptake and expand capacity. The most effective cycle implemented gift card incentives for syphilis screening. During the patient intake we offered the option to receive a syphilis test, informing the patient of the gift card incentive. Results: Prior to gift card incentives, the team screened 1.6 patients on average per clinic for a total of 30 patients screened in April to June of 2022. After the gift card incentive was implemented, the team screened 3.0 patients on average per clinic, screening a total of 223 patients from July 2022 to May 2023. The intervention produced an 87.5% increase in screening rates (P=0.0094). The data showed a significant increase in syphilis testing upon implementing the gift card incentive program. Conclusion: These findings contribute to evidence supporting the use of patient incentives for public health prevention measures. This model could be applied to other populations to increase health screening participation. More research is needed on the effect of gift card incentives on confirmatory testing and treatment rates for syphilis.

Best Patient Care Practices for Administering PSMA-Targeted Radiopharmaceutical Therapy.

Optimal patient management protocols for metastatic castration-resistant prostate cancer (mCRPC) are poorly defined and even further complexified with new therapy approvals, such as radiopharmaceuticals. The prostate-specific membrane antigen (PSMA)-targeted agent 177Lu vipivotide tetraxetan ([177Lu]Lu-PSMA-617), approved after the phase III VISION study, presents physicians with additional aspects of patient management, including specific adverse event (AE) monitoring and management, as well as radiation safety. Drawing on our experience as VISION study investigators, here we provide guidance on best practices for delivering PSMA-targeted radiopharmaceutical therapy (RPT) to patients with mCRPC. After a comprehensive review of published evidence and guidelines on RPT management in prostate cancer, we identified educational gaps in managing the radiation safety and AEs associated with [177Lu]Lu-PSMA-617. Our results showed that providing sufficient education on AEs (e.g., fatigue and dry mouth) and radiation safety principles is key to effective delivery and management of patient expectations. Patient counseling by health care professionals, across disciplines, is a cornerstone of optimal patient management during PSMA-targeted RPT. Multidisciplinary collaboration is crucial, and physicians must adhere to radiation safety protocols and counsel patients on radiation safety considerations. Treatment with [177Lu]Lu-PSMA-617 is generally well tolerated; however, additional interventions may be required, such as dosing modification, medications, or transfusions. Urinary incontinence can be challenging in the context of radiation safety. Multidisciplinary collaboration between medical oncologists and nuclear medicine teams ensures that patients are monitored and managed safely and efficiently. In clinical practice, the benefit-to-risk ratio should always be evaluated on a case-by-case basis.

Assessing the effects of interprofessional education by hospital pharmacists on pharmaceutical students using a self-evaluation scale

BackgroundUnderstanding the roles and competencies of professions outside of one’s specialty is essential for providing efficient healthcare. However, it is difficult for medical professionals to understand the roles and competencies of other related professions while performing their duties. This study examined the impact of clinical practice-based interprofessional education (IPE) on pharmacy students, who are future medical professionals.MethodsSixty-eight pharmaceutical students undergoing clinical practice were divided into non-IPE or IPE groups, with the IPE group attending an educational program with medical students conducted by doctors, pharmacists, and teachers during the clinical practice period. The effect was evaluated through a group survey using self-administered questionnaires focusing on contributing to multidisciplinary team medicine based on the Readiness for Interprofessional Learning Scale. The survey included specific behavioral objectives (SBOs), the Readiness for Interpersonal Learning Scale (RIPLS), and Kikuchi’s Scale of Social Skills (KiSS-18).ResultsRegardless of group, SBOs [non-IPE: 3.2, 95% CI (2.6–3.8), p < 0.001; IPE: 3.7, 95% CI (2.5–4.9), p < 0.001] and social skills [non-IPE: 4.0, 95% CI (2.5–6.1), p < 0.001; IPE: 6.7 95% CI (3.0–10.4), p < 0.001] showed improvement after the clinical practice. In RIPLS Factor 3, pharmacy students with IPE awareness scored significantly higher by 1.5 points [95% CI (0.2–2.8), p = 0.025] post-practice than those without IPE awareness.ConclusionsThis study suggests that IPE for students during clinical practice could enhance their expertise in multidisciplinary medicine and facilitate the development of seamless team care in the future.Trial registrationThis study was retrospectively registered and conducted in compliance with the “Ethical Guidelines for Medical Research Involving Human Subjects” and was approved by The Ethics Committee of Tokushima University Hospital (approval number: 3544).

To Print or Not to Print - Sustainable Practice in Geriatric Integrated Care Clinics

Abstract Background The Comprehensive Geriatric Assessment (CGA) is a cornerstone of geriatric medicine and is frequently carried out in integrated care clinics using a paper document (1). The expansion of integrated care services occurs alongside climate change, an increasingly challenging public health crisis at a local and national level (2). Paper waste is a contributor to deforestation and carbon emissions. We aimed to assess the environmental impact of paper use within our geriatric integrated care service. Methods 12 months of Geriatric Integrated Care attendances were included between 1st January 2023 to 1st January 2024. We measured the number of CGAs performed and A4 pages used in documentation. Environmental impact was evaluated based on carbon emissions per A4 page (3). Results A CGA was completed on 780 patients in a 12-month period which included in-hospital, frailty at the front door and 2 community specialist teams' assessments. This resulted in 11,700 pages of A4 paper in documentation. Estimated carbon emissions are 70.2kg CO2 emissions for the 12-month period. Extrapolating this solely to the 32 ICPOP teams in geriatric medicine in Ireland it would result in the equivalent of 22 trees per year, emitting 1,123.2 Kg of CO2 emissions per year from these assessments alone or equivalent to driving 8028.6km (4). Conclusion The benefits for patients and staff of integrated digital healthcare records are well established. The environmental impact of how we provide healthcare is not. Paperless solutions are required for both patient safety, seamless record keeping and environmental sustainability in keeping with UN sustainable development goals.

Goals of Care Discussions Among Patients Who Suffer Cardiac Arrest

Abstract Background Outcomes following in-hospital cardiac arrest remain poor despite advances in resuscitation techniques. Establishing “goals of care” is crucial to optimizing patient care and avoiding burdensome interventions in those who are unlikely to benefit from resuscitation. Doctors often avoid discussions regarding ‘goals of care’ with patients in whom cardiac arrest is not deemed likely at the time of admission. Methods All cardiac arrest team activations for non-pregnant, adult inpatients on medical and surgical wards at our institution from December 2022 – June 2023 were prospectively analysed. Qualitative analysis of inpatient charts was performed to assess; incidence of cardiac arrest, demographic and clinical data, and the degree to which discussions regarding escalation of care had taken place. Results 66 cardiac arrest team activations were screened, of which 23 calls were included for analysis. The estimated incidence of cardiac arrest was 1.11-1.67 events per 1,000 patient discharges. 18 patients (78.2%) were under the care of general medicine or geriatric teams at the time of arrest call. 12 (52%) patients were older than 70 and 4 (17%) were older than 80. Falls were the most common reason for admission (22.7%) among patients for whom the cardiac arrest team was activated. 2 patients (12.5%) with confirmed cardiac arrest survived to hospital discharge. Discussions regarding goals of care were documented for 8/23 patients (34.7%). Conclusion Cardiac arrests were uncommon in our institution. Discussions regarding goals of care were documented in only a third of cases, possibly because many patients presented with issues not typically associated with a risk of subsequent arrest. Given the low survival rates to discharge, routine discussion of goals of care should be considered at the point of admission in all patients who are unlikely to benefit from resuscitation, regardless of the presenting complaint.