Multidisciplinary Meetings Research Articles

Integration of an online application to optimise multi-disciplinary meetings: a retrospective analysis.

Multi-disciplinary Meetings (MDM) play a crucial role in complex patient care, involving input from various specialties to formulate evidence-based management plans. However, traditional unidirectional approaches and reliance on manual processes have led to inefficiencies in the MDM pathway. This study identified and aimed to improve four critical moments where Information Communication Technologies (ICTs) could enhance the MDM process. Initial referral, information synthesis, meeting presentation and the creation of actionable/auditable items. Microsoft Office Forms, a customisable survey platform, was implemented to streamline MDM processes. Forms were created to gather patient information, develop agendas, and track outcomes. Automation through Excel scripting further optimised data organisation and agenda creation. Referrals using Forms takes an average of 7min and 21s. Over 15months the submission time has reduced and is trending towards under 5min for each referral. The system's scalability has allowed 1744 cases to be discussed over a 15-month period. Active departments using Forms is expanding to seven from two prior to the pilot. Microsoft Office Forms proved to be a valuable and adaptable tool for MDMs, offering benefits such as streamlined information gathering, real-time collaboration, and scalability. The study highlights the potential of existing tools within Microsoft licenses for healthcare process optimisation, providing a cost-effective and customisable solution for MDM agendas. While recognising some limitations, the study concludes that leveraging Microsoft Office Forms can significantly improve system efficiency in a multi-disciplinary setting.

Impact of a quality improvement initiative and monthly multidisciplinary meetings on outcomes after posterior spinal fusion for adolescent idiopathic scoliosis.

Several studies have demonstrated the benefits of enhanced recovery after surgery (ERAS) protocols for patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal instrumented fusion (PSIF). However, there are relatively few studies investigating the effect of regular multidisciplinary team meetings on level selection, surgical performance parameters, and patient outcomes after PSIF for AIS. The aim of this study was to assess changes in intra- and postoperative outcomes following multidisciplinary team meeting implementation for patients undergoing PSIF for AIS. The medical records of 96 adolescents (10 to 18years old) diagnosed with AIS and undergoing PSIF at a major academic institution from 2017 to 2022 were retrospectively reviewed. A quality improvement (QI) initiative was implemented in February 2020, including institution of monthly multidisciplinary conferences focusing on preoperative indications, level selection, postoperative review of surgical performance parameters for previous cases, and discussion and optimization of postoperative ambulation and pain control protocols. Patients were placed into "Pre-QI" (treated pre-February 2020) and "Post-QI" (treated post-February 2020) cohorts. Patient demographics, comorbidities, deformity characteristics, intraoperative variables, ambulation status, postoperative complications, length of stay (LOS), and unplanned readmission rates were assessed. Of the 96 study patients, 44 (45.8%) were in the Pre-QI cohort, and 52 (54.2%) were in the Post-QI cohort. Mean major curve was not significantly different between the two cohorts (Pre-QI: 58.0 ± 7.3° vs Post-QI: 57.9 ± 14.5°, p = 0.169). The Pre-QI cohort had a greater mean minor curve degree (Pre-QI: 42.7 ± 11.8° vs Post-QI: 36.8 ± 12.4, p = 0.008). The Pre-QI cohort had significantly greater mean spinal levels fused (Pre-QI: 11.7 ± 1.7 vs Post-QI: 10.4 ± 2.6, p = 0.009), significantly greater mean estimated blood loss (Pre-QI: 1063.6 ± 631.5ml vs. Post-QI: 415.8 ± 189.9ml, p < 0.001), significantly greater mean operative time normalized to levels fused (Pre-QI: 0.6 ± 0.1h/level fused vs Post-QI: 0.4 ± 0.1h/level fused, p < 0.001), and a significantly greater proportion of patients with intraoperative drain placement (Pre-QI: 93.2% vs Post-QI: 5.8%, p < 0.001). The Post-QI cohort had significantly shorter time to postoperative ambulation (Pre-QI: 2.1 ± 0.9days vs Post-QI: 1.3 ± 0.5days, p < 0.001). A significantly greater proportion of patients in the Pre-QI cohort developed any postoperative complication (Pre-QI: 72.7% vs Post-QI: 34.6%, p < 0.001), and mean LOS was significantly greater among Pre-QI patients (Pre-QI: 4.5 ± 1.1days vs Post-QI: 3.2 ± 0.8days, p < 0.001). Discharge disposition (p = 0.758) and 30-day unplanned readmissions (p = 0.207) were similar between the cohorts. Our findings suggest that monthly multidisciplinary pediatric spine team meetings may improve patient care. Further studies exploring the incorporation of QI implementation with frequent multidisciplinary team meetings into existing ERAS protocols are merited.

Quality and Patient Safety Metrics: Developing a Structured Program for Improving Patient Care in the Department of Medicine at The Ottawa Hospital.

Despite increasing recognition of the importance of quality and patient safety in academic medicine, challenges remain with ensuring physician participation in quality assurance and quality improvement efforts, such as lack of compensation and enabling resources. An organizational culture that includes physician leadership and a supportive infrastructure is needed to encourage physician backing of quality and patient safety initiatives. The authors describe the development of a robust quality and patient safety program in the Department of Medicine at The Ottawa Hospital over the past 7 years and highlight how the department changed its organizational culture by prioritizing quality and patient safety and establishing the necessary infrastructure to support this program. Program development was characterized by 4 overarching themes: incentives, administrative structure and physician leadership, training and support, and system enhancements. As a result of the program, the department broadly implemented a standardized framework for conducting quality committee meetings and morbidity and mortality rounds and reviewing patient safety incidents and patient experience across its 16 divisions. This has led to 100% departmental compliance on corporate quality assurance metrics each year (e.g., regular multidisciplinary divisional quality committee meetings), along with physician participation in formal quality improvement initiatives that align with larger corporate goals. The authors reflect on lessons learned during the implementation of the program and the essential elements that contributed to its success. Next steps for the program include using a centralized repository of quality and patient safety data, including patient safety incident dashboards, to encourage greater divisional collaboration on quality improvement initiatives and continuous institutional learning over time. Another important avenue will be to create an academic hub for excellence in quality and a formal approach to reward and promote physicians for their quality work.

Attitudes and barriers to pulmonary arterial hypertension screening in systemic sclerosis patients: A survey of UK-based rheumatologists.

The objectives were to explore rheumatologists' current clinical screening practices of pulmonary arterial hypertension in patients with systemic sclerosis in the United Kingdom and to identify barriers to screening and consider potential solutions. A survey of 31 questions was developed and included six sections: clinician demographics, the importance of screening, screening practices, barriers to screening, treatment and patient education. The survey was disseminated among rheumatologists working in the United Kingdom. Forty-four rheumatologists working in the United Kingdom participated in the study, and the majority completed all the questions. Around one-third (37.0%) worked in specialised systemic sclerosis units (university or general hospitals (54.5% and 45.4%, respectively)). The majority recognised that systemic sclerosis-pulmonary arterial hypertension is a major cause of morbidity and mortality. Over half (60.0%) reported using the DETECT algorithm to screen for systemic sclerosis-pulmonary arterial hypertension, although other algorithms were also sometimes used. All of the respondents utilised transthoracic echocardiogram, and almost all (95.0%) performed pulmonary function tests for screening purposes. Various challenges and barriers were identified relating to systemic sclerosis-pulmonary arterial hypertension screening, with the difficulty in interpreting results from other hospitals and extended wait times for diagnostic tests being the most reported (76.0% and 74.0%, respectively). Most respondents agreed that access to key investigations (87.0%), ongoing clinician education (82.0%), multidisciplinary meetings (79.5%) and a better understanding of proposed screening algorithms (79.5%) could be potential solutions. Screening patients with systemic sclerosis for pulmonary arterial hypertension is crucial to improve survival, but variable practices exist among UK rheumatologists. Solutions include educating healthcare professionals on guidelines, sharing information between centres and integrating care services.

Implementation of streamlining measures in selecting and prioritising complex cases for the cancer multidisciplinary team meeting: a mini review of the recent developments.

In January 2020, NHS England and NHS Improvement, in the United Kingdom, issued a permissive framework for streamlining cancer multidisciplinary (MDT) meetings. Streamlining is defined as a process whereby complex cases are prioritized for full discussion by an MDT in an MDT meeting (MDM), while the management of straightforward cases is expedited using Standards of Care (SoC). SoC are points in the pathway of patient management where there are recognized guidelines and clear clinical consensus on the options for management and should be regionally agreed and uniformly applied by regional Cancer Alliances. While this report marks the first major change in cancer MDT management since the Calman-Hine report in 1995, its implementation, nationally, has been slow with now nearly four years since its publication. It is argued however that streamlining is a necessary step in ensuring the viability of MDT processes, and therefore maintaining patient care in the current socioeconomic context of rising workload and cancer incidence, financial pressures, and workforce shortages. In this mini review, we offer a succinct summary of the recent developments around the implementation of the 2020 streamlining framework, including challenges and barriers to its implementation, and the potential future directions in this field, which we propose should increase utilisation of implementation science. We conclude that ensuring successful implementation of the framework and the SOC requires securing a buy-in from key stakeholders, including MDTs and hospital management teams, with clearly defined (a) management approaches that include triage (e.g. through a mini MDT meeting), (b) assessment of case complexity (something that directly feeds into the SOC), and (c) roles of the MDT lead and the members, while acknowledging that the SOC cannot be universally applied without the consideration of individual variations across teams and hospital Trusts.

Impact on patient outcomes of spondyloarthritis-inflammatory bowel disease multi-disciplinary meetings.

To assess the impact on patient outcomes of the spondyloarthritis (SpA) and inflammatory bowel disease (IBD) multidisciplinary team (MDT) meetings in a large university hospital. A single-centre retrospective observational case-note review was conducted assessing the outcome of all 226 cases discussed at the SpA-IBD MDT meetings in a large UK university hospital between 2017-2022. A total of 226 patients were discussed. It was deemed that 97% of MDT meetings helped to improve communication between teams, and 100% were educational. A total of 57% of discussions led to an instant change of disease management, while 40% of discussions resulted in a treatment plan that avoided the use of dual advanced therapy. This improved patient safety by reducing immunosuppression. The MDT meetings were highly cost and time efficient; 125 referrals between specialists were avoided, and in 51 cases there was a significant chance of reducing future drug costs. A timely investigation or appointment was arranged following 50% of MDT discussions, helping to clarify the diagnosis and optimise patient care. 9% of meetings enabled drugs to be prescribed to patients that are not yet licenced for the other speciality, thereby improving treatment options available in the management of complex cases. The MDT meetings have been beneficial for patients, the clinical team and the institution. This approach might be considered by other rheumatology and gastroenterology departments.

Disease Behaviour Classification: A pragmatic model for predicting outcomes in Interstitial Lung Disease

Background and objectiveThe interstitial lung diseases (ILD) are a heterogenous group of disorders with similar clinical presentation, but widely varying prognoses. The use of a pragmatic disease behaviour classification (DBC), first proposed in international guidelines in 2013, categorises diseases into five behavioural classes based on their predicted clinical course. This study aimed to determine the prognostic utility of the DBC in an ILD cohort. MethodsConsecutive patients presented at the weekly multidisciplinary meeting (MDM) of a specialist ILD centre were included. MDM consensus was obtained for diagnosis and DBC category (1–5). Baseline and serial clinical and physiological data were collected over the study period (median 3.9 years, range 0–5.4 years). The relationship between DBC and prognostic outcomes was explored. Results137 ILD patients, [64 (47%) female] were included with mean age 67.0 ± 1.1 years, baseline FVC% 72.7 ± 1.7, and baseline DLco% 57.8 ± 1.6%. Patients were stratified into DBC by consensus at MDM: DBC1 n = 0 (0%), DBC2 n = 16 (12%), DBC3 n = 10 (7.3%), DBC4 n = 55 (40%), and DBC5 n = 56 (41%). On univariable Cox regression, increasing DBC class was associated with poorer progression-free survival (HR 1.6, 95% CI 1.2–2.0, p < 0.001). On multivariable Cox regression, DBC remained predictive of PFS when combined with age and gender (HR 1.4, 95% CI 1.1–1.9, p = 0.011), baseline FVC% (HR 1.5, 95% CI 1.1–1.8, p = 0.003) and ILD diagnosis (HR 1.6, 95% CI 1.2–2.2, p < 0.0001). ConclusionDBC as determined at ILD multidisciplinary meeting may be a useful prognostic tool for the management of ILD patients.

Abstract TP265: Comparison of Medical Therapies on Outcomes From Index Vascular Event to PFO Closure

Introduction: Recent trials have shown the benefit of PFO closure in recurrent stroke prevention. The literature has shown the benefit of PFO closure plus medical therapy versus medical therapy alone. In subgroup analyses of prior studies, recurrent stroke events between medical therapy only groups found decreased stroke recurrence in the anticoagulation (AC) group when compared to the antiplatelet (AP) group. The timeline of investigation was also notably over multiple years. There is no standardized practice to dictate appropriate AC/AP therapy in the setting of stroke secondary to PFO prior to closure. This study aims to compare recurrent stroke risk of AC versus AP therapy in the interim from index stroke/TIA to PFO closure in a more limited timeline. Methods: The study design was a retrospective cohort study, including patients discussed at an institution’s multi-disciplinary PFO committee meetings between September 2019 and October 2022. Chart review yielded key features of the patient’s stroke/TIA presentation, treatment and PFO characteristics. A total of 90 patient charts were reviewed, of which 26 underwent PFO closure and were analyzed for the primary outcome. The primary outcome was recurrent stroke/TIA events that occurred between the Index event and PFO closure. Results: The average time between index event and closure was 472 days. Of the 26 patients who underwent closure, 16 were in the AP group and 10. Primary outcome occurred in 2 patients within the AP group prior to closure versus 0 in the AC group, 12.5% v. 0% respectively. Conclusions: This outcomes analysis favors the use of AC therapy in the interim between the PFO index event and PFO closure. The results should be considered for AC/AP decisions, while appreciating that the average interim timeline was likely prolonged due to the COVID-19 pandemic with delayed elective procedures. The analysis was not powered to achieve significance due to sample size, however it did display some important trends.

Racial Disparities in Pelvic Floor Disorders.

To investigate the impact of racial disparities and Socioeconomic Status (SES) on pelvic floor disorder (PFD) care. Racial disparities in colorectal PFD remain uninvestigated, despite prior research in urogynecology. This retrospective study was conducted at Guy's and St. Thomas' Hospital of London in 2023. Patients with colorectal PFD from 2013 to 2018 were evaluated. Patients were classified according to the Index of Multiple Deprivation (IMD) scores and divided into quintiles. The lowest quintile represents the most deprived, whereas the higher quintile represents the least deprived. Assessed variables: patient complaint, symptoms, consultant and biofeedback referrals, investigations, multidisciplinary meeting (MDM) discussions, treatment, and follow-up appointments. 2001 patients were considered. A total of 1126 patients were initially analyzed, and 875 patients were excluded owing to incomplete data. Eight ethnic groups were identified in this study. Constipation was the most common compliant across ethnic groups (P=0,03). Diagnostics, MDM discussions, and conservative treatment did not vary between ethnicities. White British and Asian patients were significantly more likely to be seen by a consultant (P=0.001) and undergo surgery (P=0.002). In the second part of the study, the IMD was calculated for 1992 patients who were categorized into quintiles. Diagnostic tests, discussion in MDM, Consultant review, and surgical treatments were significantly lower in the two lowest quintiles (P<0.001, P<0.001, P=0.02, and P=0.02, respectively). Conservative treatment did not vary between the IMD groups. Disparities in the diagnosis and treatment of colorectal PFD exist among ethnic minorities and patients of low SES. This study allows for the replication of service provision frameworks in other affected areas to minimize inequalities.

Pre-TAVI imaging: an Italian survey by the CT PRotocol optimization (CT-PRO) group

PurposeThe purpose of this survey was to evaluate the current state-of-art of pre-TAVI imaging in a large radiological professional community.MethodsBetween December 2022 and January 2023 all members of the Italian Society of Medical and Interventional Radiology (SIRM) were invited by the CT PRotocol Optimization group (CT-PRO group) to complete an online 24-item questionnaire about pre-TAVI imaging.Results557 SIRM members participated in the survey. The greatest part of respondents were consultant radiologists employed in public hospitals and 84% claimed to routinely perform pre-TAVI imaging at their institutions. The most widespread acquisition protocol consisted of an ECG-gated CT angiography (CTA) scan of the aortic root and heart followed by a non-ECG-synchronized CTA of the thorax, abdomen, and pelvis. Contrast agent administration was generally tailored on the patient’s body weight with a preference for using high concentration contrast media. The reports were commonly written by radiologists with expertise in cardiovascular imaging, and included all the measurements suggested by current guidelines for adequate pre-procedural planning. About 60% of the subjects affirmed that the Heart Team is present at their institutions, however only 7% of the respondents regularly attended the multidisciplinary meetings.ConclusionsThis survey defines the current pre-TAVI imaging practice in a large radiological professional community. Interestingly, despite the majority of radiologists follow the current guidelines regarding acquisition and reporting of pre-TAVI imaging studies, there is still a noteworthy absence from multidisciplinary meetings and from the Heart Team.

Use of genotypic HIV DNA testing: a DELPHI-type consensus.

As many disparities in the clinical use of HIV DNA sequencing are observed, a DELPHI-type consensus was initiated in France to homogenize use, techniques and interpretation of results. Based on a literature review and clinical experience, a steering committee (SC) of eight virologists and one infectious disease specialist formulated statements. Statements were submitted to an independent and anonymous electronic vote of virologists and HIV clinicians in France, between October 2022 and December 2022. The SC developed 20 statements grouped into six categories: clinical situations for the use of HIV DNA genotyping; techniques for performing HIV DNA genotyping; consideration of apolipoprotein B mRNA editing enzyme (APOBEC) mutations; genotyping results reporting; recycling of antiretrovirals; and availability of HIV DNA genotyping tests and delays. Twenty-one virologists and 47 clinicians participated in two voting rounds and 18/20 (90%) assertions reached a 'strong' consensus. For example, that prior genotyping on HIV DNA is useful for clinical decision-making when considering switching to some long-acting regimens or to reduce the number of antiretroviral agents in virologically suppressed patients for whom RNA data are unavailable/not exploitable/not sufficiently informative. Two statements achieved no consensus: reporting any detected viral minority population for discussion in multidisciplinary meetings (virologists), and possible risk of virological failure when using a second-generation InSTI plus lamivudine or emtricitabine regimen in patients with undetectable viral load within ≥1 year and in the presence of a documented M184V mutation within the last 5 years (clinicians). This DELPHI-type consensus will facilitate the strengthening and harmonization of good practice when performing HIV DNA sequencing.

Guidelines for the diagnosis and management of adult aplastic anaemia: A British Society for Haematology Guideline.

Pancytopenia with hypocellular bone marrow is the hallmark of aplastic anaemia (AA) and the diagnosis is confirmed after careful evaluation, following exclusion of alternate diagnosis including hypoplastic myelodysplastic syndromes. Emerging use of molecular cyto-genomics is helpful in delineating immune mediated AA from inherited bone marrow failures (IBMF). Camitta criteria is used to assess disease severity, which along with age and availability of human leucocyte antigen compatible donor are determinants for therapeutic decisions. Supportive care with blood and platelet transfusion support, along with anti-microbial prophylaxis and prompt management of opportunistic infections remain key throughout the disease course. The standard first-line treatment for newly diagnosed acquired severe/very severe AA patients is horse anti-thymocyte globulin and ciclosporin-based immunosuppressive therapy (IST) with eltrombopag or allogeneic haemopoietic stem cell transplant (HSCT) from a matched sibling donor. Unrelated donor HSCT in adults should be considered after lack of response to IST, and up front for young adults with severe infections and a readily available matched unrelated donor. Management of IBMF, AA in pregnancy and in elderly require special attention. In view of the rarity of AA and complexity of management, appropriate discussion in multidisciplinary meetings and involvement of expert centres is strongly recommended to improve patient outcomes.

The Impact of Hospice Care Structures on Care Processes: A Retrospective Cohort Study.

Background: Palliative care is subject to substantial variations in care, which may be shaped through adapting the organisational structures through which care is provided. Whilst the goal of these structures is to improve patient care, there is a lack of evidence regarding their effect on care processes and patient outcomes. Aims: This study aims to describe the relationship between care structures and the quantity and domains of care processes in hospice care. Design: Retrospective cohort study. Settings/Participants: Data were collected from Dutch hospice patient's clinical records and hospice surveys, detailing hospice structures, patient clinical characteristics and care processes. Results: 662 patients were included from 42 hospices, mean age 76.1years. Hospices were categorised according to their care structures - structured clinical documentation and multidisciplinary meetings. Patients receiving care in hospices with structured multidisciplinary meetings had an increased quantity of documented care processes per patient on admission through identification (median 4 vs 3, P < .001), medication (2 vs 1, P = .004) and non-medication (1 vs 0, P < .001) interventions, monitoring (2 vs 1, P < .001) and evaluation (0 vs 0, P = .014), and prior to death. Similar increases were identified for patients who received care in hospices with structured documentation upon admission, but these changes were not consistent prior to death. Conclusions: This study details that the care structures of documentation and multidisciplinary meetings are associated with increased quantity and breadth of documentation of care processes in hospice care. Employing these existing structures may result in improvements in the documentation of patient care processes, and thus better communication around patient care.

A national survey of current practice on patients with long term and additional needs in paediatric intensive care units.

Patients with long term and additional needs (LEAP) in paediatric intensive care units (PICUs) are a growing and heterogenous cohort that provide unique challenges to clinicians. Currently no standard approach to define and manage this cohort exists. To analyse bed occupancy, examine current practice, and explore ideas to improve PICU care of patients with long term and additional needs. Patients with LEAP were defined as meeting two or more of the following criteria: length of stay >14 days; life limiting condition; ≥2 failed extubations; hospital stay >1 month prior to PICU admission; likely to require long-term ventilation. An electronic survey was then sent to all UK PICUs, via the UK Paediatric Critical Care Society, to collect quantitative and qualitative data relating to bed occupancy, length of stay, multidisciplinary and family involvement, and areas of possible improvement. Data collection were occurred between 8 February 2022 and 14 March 2022. Quantitative data were analysed using Microsoft Excel 365 and SPSS Statistics version 28.0. Raw data and descriptive statistics were reported, including percentages and median with interquartile range for non-parametric data. Qualitative raw data were examined using thematic analysis. Analysis was undertaken independently by two authors and results assessed for concordance. 70.1% (17/24) PICUs responded. 25% (67/259) of PICU beds were occupied by patients with long term and additional needs. 29% (5/17) of responding units have tailored management plans to this cohort of patient. A further 11% (2/17) have guidelines for children with generic chronic illness. 12% (2/16) of responding units had a designated area and 81% (13/16) of responding units had designated professionals. The majority (68% and 62%) of responding units engaged families and community professionals in multidisciplinary meetings. When asked how the care of long term and additional needs patients might be improved five themes were identified: consistent, streamlined care pathways; designated transitional care units; designated funding and hospital-to-home commissioning; development of roles to facilitate collaboration between hospital and community teams; proactive discharge planning and parallel planning. This survey provides a snapshot of UK practice for a cohort of patients that occupies a considerable proportion (29%) of PICU beds. While only a minority of responding PICUs offer specifically tailored management plans, the majority of units have designated professionals. Opportunities exist to improve PICU care in LEAP patients in areas such as: streamlined care pathways, designated clinical areas, designated funding, and development of defined collaborative roles. Next steps may involve working group convention to develop a consensus definition and share good practice examples.

Evaluation of the accuracy and quality of ChatGPT-4 responses for hyperparathyroidism patients discussed at multidisciplinary endocrinology meetings.

Chat Generative Pre-trained Transformer (ChatGPT) is now utilized in various fields of healthcare in order to obtain answers to questions related to healthcare-related problems and to evaluate available information. Primary hyperparathyroidism is a common endocrine disorder. We aimed to evaluate the accuracy and quality of ChatGPT's responses to questions specific to hyperparathyroidism cases discussed at multidisciplinary endocrinology meetings. ChatGPT-4 was asked to respond to 10 hyperparathyroidism cases evaluated at multidisciplinary endocrinology meetings. The accuracy, completeness, and quality of the responses were scored independently by two endocrinologists. Accuracy and completeness were evaluated on the Likert scale, and quality was evaluated on the global quality scale (GQS). No misleading information was detected in the responses. In terms of diagnosis, the mean accuracy scores (ranging from 1 to 5) were 4.9 ± 0.1 and the mean completeness scores (ranging from 1 to 3) were 3.0. In the responses given in terms of further examination, the mean accuracy and completeness scores were 4.8 ± 0.13 and 2.6 ± 0.16, respectively. The mean accuracy and completeness scores for treatment recommendations were 4.9 ± 0.1 and 2.4 ± 0.16, respectively. The GQS evaluation result was 80% high quality and 20% medium quality. In this study, the accuracy and quality rates of ChatGPT-4 were generally high in responding to questions as to hyperparathyroidism patients. It can be concluded that artificial intelligence may serve as a valuable tool in healthcare. However, the limitations and risks of ChatGPT should also be evaluated.

External validation of the Brain Tumour Reporting and Data System (BT-RADS) in the multidisciplinary managementof post-treatment gliomas.

To independently and externally validate the Brain Tumour Reporting and Data System (BT-RADS) for post-treatment gliomas and assess interobserver variability. In this retrospective observational study, consecutive MRIs of 100 post-treatment glioma patients were reviewed by two independent radiologists (RD1 and RD2) and assigned a BT-RADS score. Inter-observer agreement statistics were determined by kappa statistics. The BT-RADS-linked management recommendations per score were compared with the multidisciplinary meeting (MDM) decisions. The overall agreement rate between RD1 and RD2 was 62.7% (κ = 0.67). The agreement rate between RD1 and consensus was 83.3% (κ = 0.85), while the agreement between RD2 and consensus was 69.3% (κ = 0.79). Among the radiologists, agreement was highest for score 2 and lowest for score 3b. There was a 97.9% agreement between BT-RADS-linked management recommendations and MDM decisions. BT-RADS scoring led to improved consistency, and standardised language in the structured MRI reporting of post-treatment brain tumours. It demonstrated good overall agreement among the reporting radiologists at both extremes; however, variation rates increased in the middle part of the spectrum. The interpretation categories linked to management decisions showed a near-perfect match with MDM decisions.

Effect of Magnetic Resonance Imaging on Multidisciplinary Meeting decision and the outcome of Rectal Cancer

Effect of Magnetic Resonance Imaging on Multidisciplinary Meeting decision and the outcome of Rectal Cancer

Perceptions regarding the multidisciplinary treatment of patients with severe trauma in Korea: a survey of trauma specialists.

Patients with multiple trauma necessitate assistance from a wide range of departments and professions for their successful reintegration into society. Historically, the primary focus of trauma treatment in Korea has been on reducing mortality rates. This study was conducted with the objective of evaluating the current state of multidisciplinary treatment for patients with severe trauma in Korea. Based on the insights of trauma specialists (i.e., medical professionals), we aim to suggest potential improvements. An online questionnaire was conducted among 871 surgical specialists who were members of the Korean Society of Traumatology. The questionnaire covered participant demographics, current multidisciplinary practices, perceived challenges in collaboration with rehabilitation, psychiatry, and anesthesiology departments, and the perceived necessity for multidisciplinary treatment. Out of the 41 hospitals with which participants were affiliated, only nine conducted multidisciplinary meetings or rounds with nonsurgical departments. The process of transferring patients to rehabilitation facilities was not widespread, and delays in these transfers were frequently observed. Financial constraints were identified by the respondents as a significant barrier to multidisciplinary collaboration. Despite these hurdles, the majority of respondents acknowledged the importance of multidisciplinary treatment, especially in relation to rehabilitation, psychiatry, and anesthesiology involvement. This survey showed that medical staff specializing in trauma care perceive several issues stemming from the absence of a multidisciplinary system for patient-centered care in Korea. There is a need to develop an effective multidisciplinary treatment system to facilitate the recovery of trauma patients.

Integrated care with families with multiple and complex problems. An in-depth view

Introduction: Complex problems regarding child development and parenting require integrated services and efforts of all those involved: parents, children and professionals from different organisations (both youth and adult services). In this session, we present results and bundle insights from three practice-oriented studies on integrated services. Based on an analysis of similarities in our studies, we focus on the collaboration among professionals and between clients (families/parents, children) and professionals.&#x0D; Why a workshop? We are practice researchers in the Netherlands, who organized themselves in a network in order to exchange experiences and knowledge. in this workshop, we aim to create a joint learning process with the participants of the session, by inviting them to reflect on their own practice, based on the joint lessons from the various research projects.&#x0D; For who? The target group of this workshop are researchers, policy makers, managers, practitioners. Our studies focuses on services for youth and families.&#x0D; Session: The workshop starts with a short presentation of 1) a literature review and 2) pitches from the three research projects. The three projects focus on integrated services, each with a specific target group (serious and long-term problems in families; domestic violence; children aged 18-27 years not in education, employment, or training.&#x0D; The first study discusses a qualitative action research into an integral specialist working method for families with multiple and complex problems. The study followed five integrated care teams, by observing their multidisciplinary care meetings and by conducting interviews with various stakeholders.&#x0D; The second study discusses a participatory action research into the collaboration in domestic violence cases in which a network organisation is involved that supports integrated services in very complex situations. Participants in this study developed a discussion tool for multidisciplinary case meetings, which will be presented in the workshop.&#x0D; The third study focuses on the outcomes of a intervention for uneducated and unemployed young adults (aged 18 to 27) who avoid care. After intervention, 85% of the participants completed their education, went back to school, or got (volunteer) work. Frequent and persistent contact and renewed confidence in one’s own capacities are crucial for intervention success.&#x0D; Although the focus differs in terms of target group, research design and outcomes, each of the projects shows the importance of collaboration with clients and among professionals.&#x0D; Then we will discuss in small groups three topics with the participants: &#x0D; 1.How can we encourage shared decision-making with clients in multidisciplinary case meetings?&#x0D; 2.How can professionals keep learning and improving integrated care?&#x0D; 3.How can integrated services be financed sustainable?&#x0D; The workshop participants will be divided into three groups. Participants will discuss challenges and successes they face.&#x0D; Program:&#x0D; 1.Introduction (5 min.)&#x0D; 2.Presentation of all three studies (25 min.)&#x0D; 3.Two rounds: Discussion of the three topics in small groups (40 min.)&#x0D; 4.Brief reaction on the results from the small groups (10 min.)&#x0D; 5.Take home message (5 min.)&#x0D; How to summarize the take home messages? We end up with lessons learned and sum these up in take home messages.&#x0D; &#x0D; &#x0D;

Goal-oriented care in an integrated care organization

i-mens is the largest integrated care organization in Flanders and Brussels with 12,000 employees serving over 70 000 customers yearly. It provides care through all phases of life, with a wide range of services. Providing Goal-Oriented Care is inherently part of the vision of i-mens. However, a clear and standardized opproach is lacking. &#x0D; By implementing a new framework, a transparent approach is created to help our customers in an equitable way, while keeping into account that everyone has different life goals/needs. &#x0D; At the beginning of 2022 i-mens started a process, with the support of the King Baudouin Foundation and in collaboration with Steunpunt Mantelzorg, to implement GOC within the organization. The new methodology is to be evaluated by the persons with a care and support needs, our internal staff, as well informal caregivers. i-mens believes it is important to involve the informal caregiver, because they guarantee continuity of care when the professional support ends. European research shows that 80% of long-term care is provided by informal caregivers.&#x0D; During ICIC23 we wish to highlight the following topics: The choice of methodology based on the following parameters: There are various methods of GOC in Flanders. These methods were evaluated on the parameters: ‘understandable’, ‘personal input’, ‘time investment’, usable in their context, etc. We opted for 2 possible methods. These methodologies were presented to a test audience (focus groups).&#x0D; The survey from the focus groups: During autumn 2022, we organized three focus groups: clients, informal caregivers and our employees. The two chosen methodologies were presented to a test audience. Based on their findings, we opted for one methodology.&#x0D; The testings: After the decision has been made about the chosen methodology, we are going to start the implementation (spring 2023). Employees initiate the methodology in collaboration with the client and their informal caregiver. &#x0D; In a later stage, this methodology will be used as a guideline during multidisciplinary meetings where various stakeholders (general practitioners, home nurses and other primary care actors) participate.&#x0D; The target audience: The GOC-methodology is aimed at every customer, but due to practical and efficiency reasons we initially focused on the customer living at home. During the presentation, their findings will be communicated.&#x0D; Challenges: Whitin this topic we explain the various challenges that we encounter along the way: rethinking of the customer, informal caregiver (empowerment), external primary actors and the internal employees.&#x0D; However it should be stressed that besides choosing a methodology, the basic attitude of professional caregivers plays a key role as well in achieving a successful Goal-Oriented Care. Both elements form the basis of Goal-Oriented Care as you cannot have the one without the other. Since autumn 2022, we have been communicating about GOC to all our 12,000 employees through (digital) newsletters, conversations with the training department, organizing information moments, etc.