Multidisciplinary Education Program Research Articles

Multidisciplinary co-development of a chronic constipation management education programme for older people with dementia and the establishment of a model facility

Chronic constipation (CC) is prevalent among the elderly population and particularly those with dementia. Associate Professor Tomoyoshi Naito, School of Nursing, Seirei Christopher University, Japan, is exploring supportive care of elderly patients with dementia. He is working with collaborators to develop a multidisciplinary CC management education programme for healthcare professionals involved with elderly patients suffering from dementia. The researchers will also build a model facility to implement and verify the impact of the programme. Part of this research concerns gaining a more in-depth understanding of management and care techniques, based on the Japanese Chronic Constipation Treatment Guidelines from 2017, especially in relation to the diet and differentiation of chronic functional constipation. The goal is to reduce the number of painful medical procedures by enhancing therapy, exercise therapy, lifestyle guidance and making it possible to select step-by-step drug therapy. The programme will be executed at two facilities in Japan, targeting specialist caregivers who work with elderly patients with dementia, including doctors, nurses, pharmacists and other healthcare professionals. They will receive basic education on chronic constipation in elderly people with dementia, as well as practical training on the management of CC in addition to self-training and evaluations based on case studies. In a randomised controlled trial, Naito sought to verify the impact of bowel training as a treatment for CC and found that, together with the training, encouraging patients to use appropriate defecation posture significantly improved the condition. This was associated with a corresponding improvement in the mental health and wellbeing of patients and caregivers.

Multidisciplinary Educational Program to Standardize Education and Management of Immune-related Adverse Events: Review and Outcomes of a Single-institution Initiative.

The use of immune checkpoint inhibitors (ICIs) as anticancer therapy across a variety of malignancies has led to durable efficacy in a subset of patients. However, associated side effects denoted immune-related adverse events (irAEs) have emerged and can result in substantial morbidity and mortality. Particularly early in the experience of using these agents, a lack of standardized education regarding irAEs among patients and clinical providers may have contributed to poor outcomes. Optimal management of these emerging toxicities depends on a coordinated institutional approach. We hypothesized that centralized educational programs and electronic health record (EHR)-based interventions, targeted both toward ICI-treated patients as well as patient-interfacing providers, would improve patient outcomes. We created a multidisciplinary team of clinicians and associated staff to direct a coordinated approach to the education and management of patients receiving ICIs across our institution. A 3-tiered approach was designed: patient-centered, internally centered, and externally centered. Multimedia educational products were produced for patients to improve knowledge and awareness of ICIs and associated irAEs. An EHR-based banner was deployed to improve identification of patients receiving ICIs across disciplines. Tailored educational seminars were provided to clinicians who interact with ICI-treated patients at all levels. Educational seminars were also offered to local physicians and institutions. We assessed patient uptake of educational products and surrogate patient outcomes to measure the potential impact of our interventions. Fox Chase Cancer Center (FCCC)-specific ICI identification cards were created and distributed to patients. By the end of the investigational period, 98.6% of ICI-treated patients reported receiving a card. An ICI-focused on-line portal was created accessible only to ICI-treated patients, with 9.4% of these patients accessing the portal in the first 6 months without marketing promotion. Deidentified surrogate clinical endpoints of corticosteroid use, direct referral unit (DRU) visits, and hospital admissions all improved during the study period. Institutionally directed educational initiatives are feasible at a free-standing academic cancer center and may lead to improved outcomes in patients developing irAEs from ICIs. More granular patient-specific data and studies at other types of institutions are necessary to determine the applicability of similar approaches on a broader scale.

MEANINGFUL MULTIDISCIPLINARY REHABILITATION FOR HEART AND LUNG CONDITIONS: A COLLABORATION BETWEEN ORGANISATIONS AND SECTORS TOWARDS SELF-MANAGEMENT

It is well documented that mainstream services are not always well attended by Aboriginal and Torres Strait Islander people due to a range of issues including transport and culturally safe practice. Establishing these services within the community-controlled sector is one way to increase access and culturally responsive care. This initiative involved a new model of service delivery, whereby a partnership between Hospital Health Services and community-controlled Aboriginal and Torres Strait Islander primary healthcare organisations enabled the establishment of new Cardiac and Pulmonary Rehabilitation Programs within the Institute for Urban Indigenous Health (IUIH) Network for First Nations people. This Network is comprised of the five Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ATSICCHO’s) who operate as a regional collective with IUIH providing leading strategic direction and coordination. Through a multidisciplinary team, specialised cardiac and pulmonary rehabilitation is provided to First Nations people as a culturally capable alternative to hospital cardiac and pulmonary rehabilitation, particularly for those not currently accessing treatment. The specialised rehabilitation programs are supported by the IUIH System of Care that supports clients to access a wide array of holistic health services and programs designed to meet community needs and strengthen pathways for clients to self-manage their health needs in a self-led manner. The Rehabilitation Programs are a multidisciplinary exercise and education program delivered by a range of health professionals including Accredited Exercise Physiologist’s, Physiotherapists, Nurses and Aboriginal and Torres Strait Islander Allied Health Assistants. Clients also have access to a range of other Allied Health Professionals, including Dieticians Occupational Therapists, Pharmacists, Social Health, Podiatrists, Optometrists, Speech Therapists and Audiologists. Referrals are received from ATSICCHOS, Queensland Health and Primary Health General Practitioners and Specialists. The client journeys through a multidisciplinary assessment to then determine their goals and health needs. This presentation will provide insights into the First Nations-led partnership, challenges and solutions to working across the whole health sector and outcomes for clients.

Influential factors for final neurorehabilitation outcome scores in patients with spinal cord injury: A longitudinal cohort study

Study designLongitudinal prospective cohort study. ObjectivesTo assess the coefficient of efficacy and the influence of various demographic and neurological factors on changes in Spinal Cord Independence Measure III (SCIM-III) scores over time in traumatic spinal cord injury (TSCI) patients. SettingPatient recruitment and evaluations were conducted at the Brain and Spinal Injury Research Center in Imam Khomeini Hospital Complex, Tehran, Iran. MethodsThe study was performed over an 8-year period in our outpatient rehabilitation setting. Changes in SCIM-III scores were assessed in 559 TSCI patients (of 1460 enrolled patients) who fit the inclusion criteria. All included patients participated in our outpatient rehabilitation program, which consisted of a multidisciplinary education program combined with occupational therapy, physical therapy, and home nursing as a rehabilitation package for a 6-month period. Patients then received follow-up assessments every 6 months. ResultsPredictors of the SCIM-III score as a rehabilitation outcome tool, and of its change over time, included age (younger patients had better outcomes, p = 0.067), marital status (married patients had better outcomes, p = 0.031), education level (patients with university education had better outcomes, p = 0.003), occupation status (employed patients had better outcomes, p = 0.009), and neurological level of injury (patients with injuries at lower levels had better outcomes, p < 0.001). However, sex and injury severity as per the American Spinal Injury Association Impairment Scale (AIS) had no significant effects on functional outcomes (i.e., SCIM-III score changes over time). ConclusionAge, marital status, education level, employment, and neurological level all affected the final SCIM-III scores of SCI patients. By contrast, sex and AIS grade were not significant predictors of SCIM-III outcomes. Further studies that include additional factors may be useful for future SCIM-III models.

A Quality Improvement Project to Measure and Improve the Quality of Below-Knee Ankle Cast Application in Emergency Departments.

Background Ankle fractures are very common injuries seen in an emergency setting. Initial management involves the application of below-knee plaster casts. At our local trauma meetings, we have observed that below-knee casts are often applied incorrectly which can result in suboptimal outcomes for patients and increase the burden on plaster room services if re-application is required. This quality improvement project aimed to assess the quality of below-knee cast applications for ankle fractures in two local district general hospitals (DGHs). Methodology We performed a closed-loop audit utilising a retrospective analysis of patients who underwent casting for unstable ankle fractures. Two audit cycles were completed over a 90-day period across two DGHs. Working within our local orthopaedic unit, we created a targeted, multi-disciplinary educational programme led by experienced plaster technicians. Between audit cycles, we organised a single interactive session with specialist nurses in the urgent treatment centre (UTC) of our DGH while a second DGH did the same with junior doctors working in the emergency department. Both sessions demonstrated correct casting techniques and discussed the importance of a neutral ankle position for optimal patient recovery. Our audit criteria were based on AO Foundation guidance, which states that the ankle should be immobilised in a neutral plantigrade position. All patients with an unstable ankle fracture requiring immobilisation in a below-knee cast were included in the audit. We measured the angle of plantarflexion from neutral, with 90° representing a neutral angle. The angle between the axis of the tibia and the sole of the foot was measured and judged to be within an acceptable range if it was between 80° and 100°, representing a stable ankle position. The audit findings were presented in our local audit meeting. Results In our first audit cycle, we collected data from 65 patients across both sites (N = 32 for DGH 1 and N = 33 for DGH 2). The mean angle was 108.5° and 18 of the 65 (27.7%)patients had angles of ankle plantarflexion that were in the acceptable range (80°-100°). Following the intervention, we again collected data from 61 patients across both sites (N = 28 for DGH 1 and N = 33 for DGH 2). The mean angle was 106.2° and 23 of the 61 (37.7%)patients had an acceptable angle of ankle plantarflexion (80°-100°). Both of our outcome measures showed an improvement but were not statistically significant. The hospital that provided an educational session for the doctors showed an improvement in acceptable ankle casts of 3% while the hospital which provided an educational session for the UTC team improved by 22%. Conclusions We demonstrated a quantifiable approach to assess and improve the quality of below-knee cast application for ankle fractures via a single intervention that would be easily reproducible in other hospitals. We suggest further studies to investigate below-knee cast application quality and its association with patient outcomes as our data and other preliminary sources suggest that current standards are unsatisfactory.

Abstract P256: Rationale, Development, and Implementation of a Multidisciplinary Digital Lifestyle Health Education Program for Older Adults With Cardiovascular Disease and Osteoarthritis

Introduction: Cardiovascular disease (CVD) is the leading cause of death worldwide. Globally, osteoarthritis (OA) affects 654 million. In 2018, of the 1.2 million Australians who had CVD, half also had arthritis, with the most common form in Australia being OA. Ongoing pain and physical limitations from OA can affect lifestyle choices, contributing to the shared risk factor profile of CVD and OA (physical inactivity, overweight/obesity, poor diet, high medication use). This contributes further to the burden of both diseases including reduced 6-minute walk (6MW) performance, which is directly related to increased CVD mortality. This project outlines the rationale for and development of a multidisciplinary digital lifestyle health education program for the treatment and secondary prevention of CVD and its common comorbidity of OA. Methods: This study is a cross-sectional analysis of older adults in Sydney. Class was classified based on the Australian socioeconomic index for areas. Conditions were defined according to Australian national guidelines. Medical history, body mass index (BMI), waist measurement, muscle strength, and 6MW measurements were assessed. Differences between those with and without OA were determined via one-way analysis of variance. Simple linear regressions assessed potential relationships. Results: In a cohort of 532 adults; n=341 (64.1%) had diagnosed CVD; 48.4% of which had OA (mean age 66±12 years; 73.3% female). Socioeconomic index was deemed high. In the OA cohort mean BMI and waist were above healthy heart recommendations according to the World Health Organisation. There were no significant differences between those with OA and those without for cardiovascular risk factors of body weight, BMI, waist measurement, blood pressure, 6MW, or muscle strength. However, in those with CVD and OA, the relationship between age and 6MW was stronger and age accounted for more of the variance in performance (r=-0.44; r 2 =0.19; p&lt;0.001) than those without OA (r=-0.37; r 2 =0.17; p&lt;0.001), indicating a greater reduction in walking ability in those with OA as they get older. Conclusion: With 6MW performance being related to CVD mortality, interventions are needed to improve health and fitness in this cohort. International guidelines for CVD and OA recommend treatment should prioritise lifestyle changes, including a healthy diet, regular physical activity, and interventions that address all risk factors. Lifestyle LIFEMAP will assess the efficacy of a widely translatable multidisciplinary digital evidence-based 10-module lifestyle, food, exercise, medication, and park prescription education program for adults with the comorbidity of CVD and OA. We expect this program to improve knowledge, and healthy lifestyle choices, thereby improving physical activity and health outcomes in this highly vulnerable population.

Designing and implementing a new icon-based difficult airway cart: a two-phase prospective qualitative improvement project.

The difficult airway cart is essential for difficult airway management. Recognition of the importance of human factors in critical scenarios promoted the evolution of the difficult airway cart. Limitation to essential equipment, a structured layout, and proper labelling should be observed. We sought to redesign the difficult airway cart accordingly and analyze how perioperative professionals reacted to it. We conducted a two-phase prospective qualitative improvement project involving a multidisciplinary team. In phase 1, we reconfigured our difficult airway cart, including developing icons for labelling the drawers and discussing the equipment content. In phase 2, we delivered a multidisciplinary educational program and pre- and postsession questionnaires were administered to the professionals involved and compared. Phase 1 of the project encompassed 21 participants. We presented the final layout and content of the difficult airway cart. In phase 2, 44 participants responded the presession questionnaires, and 30 participants answered the postsession questionnaires. The results showed that the new design and the implementation program increased the comfort level of professionals involved in a potential airway crisis (presession mean [standard deviation (SD)]: anesthesiologists, 8.0 [1.9]; anesthesia assistants/respiratory therapists [AAs/RTs], 9.3 [0.8]; operating room registered nurses [OR RNs], 6.3 [2.7]; P = 0.001; postsession: anesthesiologists, 8.5 [2.0]; AAs/RTs, 9.6 [0.5]; OR RN, 7.9 [2.0]; P = 0.10). Nevertheless, the improvement was only statistically significant among the OR RNs (presession mean [SD]: 6.3 [2.7]; postsession: 7.9 [2.0]; P = 0.01). Additionally, the program facilitated the recognition of the location of airway equipment in the airway cart (positive responses ranging from 97% to 100%). Our quality improvement project successfully designed and implemented a new visual-based difficult airway cart at our institution. We believe this report enables other institutions to reproduce our project.

A Financial Toxicity Screening and Care Coordination Quality Improvement Program in a Gynecology Oncology Urban Practice.

Educating a multidisciplinary team on financial toxicity (FT) risk, screening, and care coordination is an approach to addressing gaps in care among newly diagnosed patients with stage III or IV cancer. The goal of this quality improvement project (QIP) was to supply an education program for the multidisciplinary team providing insights for the following objectives: (1) Increase the rate of FT screening where there was no baseline screening, (2) Increase referrals for resource care coordination among patients experiencing FT, and (3) Evaluate the relationship between FT and selected demographic identifiers during the 8-week project. The Plan-Do-Study-Act (PDSA) model was adopted for learning and leading the change during the QIP, focusing on the COmprehensive Score for financial Toxicity (COST) and resource care coordination for newly diagnosed participants with stage III or IV gynecologic cancer. Of the 42 (80.75%) participants consenting to the QIP, 61.90% had COST scores below 23, with 100% (26) of the participants receiving referrals for resource care coordination. On average, 6.50 patients enter the practice for care, with 50% (3.25) reporting FT. At this rate, 162.50 patients were experiencing FT in a 50-week year and were not receiving resource care coordination. However, because some patients did not consent to the QIP, the average FT (Yes) count could potentially be between 199.50 to 225.00 patients in a 50-week year, leading to a potential 62.50 with FT (or 28% of 225.00) not receiving referrals. Age was the main driver for FT COST Score in this QIP. Many variables were unobserved in this QIP and could impact the FT COST Score. However, separate modeling reveals that age alone explains approximately 15% of FT COST scores' observed changes. Controlling for more variables may refine the model, but it seems unlikely by the data analysis that age would disappear as a driver of change in the FT COST score. Developing a multidisciplinary education program focusing on a structured QIP-PDSA plan can be an example of standardizing an FT screening and care coordination program. The QIP team successfully incorporated a PDSA model roadmap screening program to identify the participants experiencing FT and promptly referred 100% for resource care coordination.

Diagnostic delay and health-related quality of life in Egyptian women with endometriosis

BackgroundFirstly, to measure indicators of health-related quality of life (HRQoL) in Egyptian women with endometriosis; and secondly, to estimate time interval from start of symptoms until endometriosis diagnosis is made (diagnostic delay) in Egyptian women with the disease.Material and methodsBefore laparoscopy for pelvic pain and/or infertility, eligible Egyptian women completed Global Study of Women’s Health (GSWH) questionnaire and validated Arabic version of Rand SF 36 (SF-36). According to laparoscopic findings, participants were divided to endometriosis group and control women with no pelvic abnormalities.ResultsSeventy women with endometriosis and 57 symptomatic controls without endometriosis were enrolled. A diagnostic delay of 36 months (IQR 22.5–60) was observed in women with endometriosis while symptomatic controls had a delay of 48 months (IQR 24–84). The difference was not statistically significant (P = 0.08). Bodily pain (BP) scores were significantly lower in women with endometriosis than controls [80.0 (45.0–100.0) versus 100.0 (68.75–100.0) respectively, P is 0.01]. Women with advanced endometriosis had significantly lower scores for physical functioning (PF), role limitation due to physical function (RP), and BP compared to women with mild endometriosis, and to controls. Physical component summary (PCS) scores were significantly lower in women with advanced stage endometriosis [41.51 (34.19–51.54] compared to women with early-stage disease [58.33 (50.98–60.37)] or control group [54.72 (48.81–59.58)]. Patient’s age, intensity of noncyclical pelvic pain, and disease stage are determining factors of HRQoL in women with endometriosis.ConclusionsEgyptian women with endometriosis experience relatively short diagnostic delay, poor bodily pain scores, and impaired physical health for which age, disease stage, and non-cyclic pain are determinants. Multi-disciplinary endometriosis centers, educational programs, and patient support groups are needed in Egypt.

A Skills Assessment Pathways-Based Program Assessment Approach in Multidisciplinary Graduate Health Informatics.

Multidisciplinary graduate education programs are hard to assess because of interdependent competencies. Students in these programs come with diverse disciplinary undergraduate degrees, and it is critical to identify knowledge gaps among these diverse learner groups to provide support to fill these gaps. Health Informatics (HI) is a multidisciplinary field in which health, technology, and social science knowledge are foundational to building HI competencies. In 2017, the American Medical Informatics Association identified ten functional domains in which HI competencies are divided. Using pre/post-semester knowledge assessment surveys of graduate students (n=60) between August 2021 to May 2022 in one of the largest graduate HI programs in the United States, we identified courses (n=9) across the curriculum that help build HI-specific competencies. Using statistical analysis, we identified three skills pathways by correlating knowledge gained with course learning objectives and used this to modify the curriculum over four semesters. These skills pathways are connected through one or two courses, where students can choose electives or, in some instances, course modules or assignments that link the skills pathways. Moreover, there is a statistically significant difference in how students gain these skills depending on their prior training, even though they take the same set of courses. Gender and other demographics did not show statistical differences in skills gained. Additionally, we found that research assistantships and internships/practicums provide additional skills not covered in our HI curriculum. Our program assessment methodology and resulting curricular changes might be relevant to HI and other multidisciplinary graduate training programs.

Multidisciplinary co-development of a chronic constipation management education programme for older people with dementia and the establishment of a model facility

Chronic constipation (CC) is prevalent among the elderly population and particularly those with dementia. Associate Professor Tomoyoshi Naito, School of Nursing, Seirei Christopher University, Japan, is exploring supportive care of elderly patients with dementia. He is working with collaborators to develop a multidisciplinary CC management education programme for healthcare professionals involved with elderly patients suffering from dementia. The researchers will also build a model facility to implement and verify the impact of the programme. Part of this research concerns gaining a more in-depth understanding of management and care techniques, based on the Japanese Chronic Constipation Treatment Guidelines from 2017, especially in relation to the diet and differentiation of chronic functional constipation. The goal is to reduce the number of painful medical procedures by enhancing therapy, exercise therapy, lifestyle guidance and making it possible to select step-by-step drug therapy. The programme will be executed at two facilities in Japan, targeting specialist caregivers who work with elderly patients with dementia, including doctors, nurses, pharmacists and other healthcare professionals. They will receive basic education on chronic constipation in elderly people with dementia, as well as practical training on the management of CC in addition to self-training and evaluations based on case studies. In a randomised controlled trial, Naito sought to verify the impact of bowel training as a treatment for CC and found that, together with the training, encouraging patients to use appropriate defecation posture significantly improved the condition. This was associated with a corresponding improvement in the mental health and wellbeing of patients and caregivers.

Diagnosing knee osteoarthritis in patients, differences between general practitioners and orthopedic surgeons: a retrospective cohort study

Backgroundknee complaints are one of the most common reasons to consult the general practitioners in the Netherlands and contribute to the increasing burden on general practitioners. A proportion of patients that are referred to orthopedic outpatient clinics are potentially referred unnecessarily. We believe osteoarthritis is not always considered by general practitioners as the cause of atraumatic knee complaints. This may impede early recognition and timely care of osteoarthritis complaints and lead to unnecessary referrals.Methodsthe aim of this study was to compare the frequency of (differential) diagnosis of osteoarthritis mentioned in referral letters of general practitioners with the frequency of osteoarthritis mentioned as orthopedic diagnosis at the outpatient clinic. Therefore we conducted a retrospective cohort study based on data collected from referral letters and the corresponding outpatient clinic reports of patients with atraumatic knee complaints of 45 years or older referred to a regional hospital in Nijmegen, The Netherlands in the period from 1-6-2019 until 1-01-2020.Resultsa total of 292 referral letters were included. In the younger aged patients (45–54 years) osteoarthritis was mentioned less frequent and meniscal lesions were mentioned more frequent in referral letters when compared to diagnoses made at the outpatient clinic. Differences in differential diagnosis of osteoarthritis as well as meniscal lesions between orthopedic surgeon and general practitioners were found (both p < 0.001, McNemar). Matching diagnoses were present in 58.2% when all referral letters were analyzed (n = 292) and 75.2% when only referrals containing a differential diagnosis were analyzed (n = 226). Matching diagnoses were present in 31.6% in the younger age categories (45–54 years). A linear trend showing fewer matching diagnoses in younger patient categories was observed (p < 0.001).ConclusionsOsteoarthritis was less frequently mentioned in general practitioner referral letters among the differential diagnosis then it was diagnosed at the outpatient clinic, especially in younger patients (45–54 years). Also matching diagnoses in younger patients were evidently lower than in older patients, partly explained by underdiagnosing of osteoarthritis in younger patients in this cohort. Better recognition of osteoarthritis in younger patients and changing the diagnostic approach of general practitioners might improve efficacy in knee care. Future research should focus on the effectiveness of musculoskeletal triage, the need for multidisciplinary educational programs for patients and promotion of conservative treatment modalities among general practitioners.

Effectiveness of a Therapeutic Educational Oral Health Program for Persons with Schizophrenia: A Cluster Randomized Controlled Trial and Qualitative Approach.

The oral health of people with schizophrenia (PWS) is very poor, suggesting a need for oral health promotion programmes with a high level of evidence. The aim of the EBENE study (Clinicaltrials.gov: NCT02512367) was to develop and evaluate the effectiveness of a multidisciplinary therapeutic educational programme in oral health (TEPOH) for PWS. A multicentre cluster randomised controlled trial, with outpatient psychiatry centres as the unit of randomisation, was designed to compare the effectiveness of TEPOH (intervention group) versus standard care (control group). The trial was conducted in 26 outpatient psychiatry centres in France (14 in the intervention group, 12 in the control group). Eligible patients with a diagnosis of schizophrenia were enroled between 2016 and 2020 and followed for 6 months. The TEPOH group received a multicomponent intervention (comprising an introductory session, three educational sessions, and a debriefing session). The primary endpoint was the evaluation of periodontal disease as a community periodontal index (CPI) score ≥ 3 at Month 6. The trial was completed using a qualitative approach based on semi-structured interviews with caregivers conducted between July 2018 and December 2019. The trial was stopped early due to difficulties in recruiting patients. Overall, 81 patients (of 250 planned) were included, and 54 patients completed the trial: 40 in the TEPOH group and 14 in the control group. At baseline, the percentage of CPI ≥ 3 was 42.5% in the TEPOH group and 9.1% in the control group. At Month 6, the percentage of CPI ≥ 3 was 20% in the TEPOH group and 14.3% in the control group. The qualitative evaluation underlined that the professionals emphasised the "seriousness" and "assiduity" of the patients' participation in this programme and that the TEPOH reinforced carers' investment in oral hygiene. It also highlighted structural factors (lack of resources for professionals, lack of teeth in PWS, COVID-19 pandemic) that may have exacerbated the difficulties with enrolment and follow-up. The effectiveness of this TEPOH, developed for PWS as part of the EBENE study, has not been demonstrated. Certain aspects of the programme's content and implementation need to be reconsidered. In particular, an adapted subjective measurement scale should be developed.

Verification of Safety and Efficacy of Sleeve Gastrectomy Based on National Registry by Japanese Society for Treatment of Obesity.

In Japan, bariatric surgical treatment was started in 1982. The Japanese Society for Treatment of Obesity (JSTO) was established in 2007, and then, JSTO started the national registry of bariatric surgery cases and multidisciplinary educational program. A total of 44 facilities registered 4055 bariatric surgical cases until 2021. In this study, the purpose is to clarify the indication, the safety and the effectiveness of the sleeve gastrectomy using national registry database compiled by JSTO. Preoperative BMI ranged from 27.6 to 90.7 kg/m2, and the mean value was 42.7. With regard to gender, men/women was 1/1.3. Age was 42.2 as mean. As preoperative comorbidities, DM ratio was 54.4% of the patients, hypertension 64.5%, dyslipidemia 65.1%, and sleep apnea syndrome 69.8%. As an operation method, laparoscopic method was conducted in 99.7% of the cases. The intraoperative incidence rate was 0.9%. Conversion rate to open method was 1.1%. Postoperative morbidity ratio was 5.6%, and mortality was 0%. Reoperations were performed in 1.5% of the cases. Postoperative hospital stay was 5 days in median value. Body weight loss was 27.6 kg in the mean value after follow-up days of 279 ± 245. As the effect on the preoperative metabolic comorbidities, DM has improved in 82.9% of the cases, hypertension 67.9% and dyslipidemia 66.6%. In conclusion, using JSTO database, we evaluated the indication, postoperative complications and weight loss effect of sleeve gastrectomy in Japan. Regarding the evaluation of the effect on preoperative comorbidities, future follow-up based on more detailed criteria was considered to be necessary.

Strengthening Digital Transformation and Innovation in the Health Care System: Protocol for the Design and Implementation of a Multidisciplinary National Health Innovation Research School.

Digital health technologies have the potential to transform health care services to be more cost-effective, coordinated, and accessible on equal terms for entire populations. In the future, people will be assisted by such technologies to monitor their health status, take preventive measures, and have more control of their health situation. An increase in digital supplementation or substitution of physical care visits can potentially add value to patients and care providers by increasing accessibility, safety, and quality of care. However, health care organizations struggle with the challenges of developing and implementing digital health technologies and services in practice. As a response to this, we have developed a national multidisciplinary research school to increase competence and capacity for research on the development, implementation, and dissemination of digital health technology solutions. The overall aim of the research school is to increase national competence and capacity for the development, implementation, and dissemination of digital health technology to increase the preparedness to support and facilitate the ongoing digital transformation in the health care system. The purpose of this paper is to outline the protocol for the development and implementation of a national multidisciplinary doctoral education program of health innovation supporting digital transformation in the health care system. A national multidisciplinary research school for health innovation was planned in collaboration between 7 Swedish universities and their partners from industry and the public sector. The research school will run over 6 years, of which 5 years are dedicated for the doctoral education program and 1 year for the project start-up and closing. In this paper, we outline the methodological approach of the research school; the combining of knowledge and expertise of the universities that are important to run the research school; the jointly formulated research-oriented and societally relevant research focus, goals, and objectives for the research school; the established and developed relationships with partners from industry and the public sector for joint research training projects; the forms of collaboration in the research school; and the format of the doctoral education process. The research school was funded in December 2021 and started in March 2022. The research school starts with an initiation period from March 2022 to December 2022 where the infrastructure and the action plans to run the school are set up. The PhD projects start in January 2023, and these projects will be completed in 5 years. Additional activities within the research program are doctoral courses, networking activities, and dissemination of results. The network of several partners from industry, public sector, and academia enables the research school to pose research questions that can contribute to solving relevant societal problems related to the development, evaluation, implementation, and dissemination of methods and processes assisted by digital technologies. Ultimately, this will promote innovation to improve health outcomes, quality of care, and prioritizations of resources. PRR1-10.2196/46595.

Designing implementation strategies to improve identification, cascade testing, and management of families with familial hypercholesterolemia: An intervention mapping approach.

Familial hypercholesterolemia (FH) is a common inherited cholesterol disorder that, without early intervention, leads to premature cardiovascular disease. Multilevel strategies that target all components of FH care including identification, cascade testing, and management are needed to address gaps that exist in FH care. We utilized intervention mapping, a systematic implementation science approach, to identify and match strategies to existing barriers and develop programs to improve FH care. Data were collected utilizing two methods: a scoping review of published literature, related to any component of FH care, and a parallel mixed method study using interviews and surveys. The scientific literature was searched using key words including "barriers" or "facilitators" and "familial hypercholesterolemia" from inception to December 1, 2021. The parallel mixed method study recruited individuals and families with FH to participate in either dyadic interviews (N = 11 dyads/22 individuals) or online surveys (N = 98 respondents). Data generated from the scoping review, dyadic interviews, and online surveys were used in the 6-step intervention mapping process. Steps 1-3 included a needs assessment, development of program outcomes and creation of evidence-based implementation strategies. Steps 4-6 included program development, implementation, and evaluation of implementation strategies. In steps 1-3, a needs assessment found barriers to FH care included underdiagnosis of the condition which led to suboptimal management due to a myriad of determinants including knowledge gaps, negative attitudes, and risk misperceptions by individuals with FH and clinicians. Literature review highlighted barriers to FH care at the health system level, notably the relative lack of genetic testing resources and infrastructure needed to support FH diagnosis and treatment. Examples of strategies to overcome identified barriers included development of multidisciplinary care teams and educational programs. In steps 4-6, an NHLBI-funded study, the Collaborative Approach to Reach Everyone with FH (CARE-FH), deployed strategies that focused on improving identification of FH in primary care settings. The CARE-FH study is used as an example to describe program development, implementation, and evaluation techniques of implementation strategies. The development and deployment of evidence-based implementation strategies that address barriers to FH care are important next steps to improve identification, cascade testing, and management.

1294 ASSESSMENT AND MANAGEMENT OF FRAILTY: A SURVEY OF HEALTHCARE PROFESSIONALS

Abstract Introduction By 2030, it is estimated that 25% of Europeans will be aged over 65. [Dugarova; UN Development Programme; 2017] Frailty in this group is a key contributor to poorer outcomes. [Eamer; BMC Anesthesiology; 2017; 17:99] The term is common in healthcare but research into the issues faced by staff around assessment and management of frailty has been limited. We undertook a survey to identify challenges faced in providing care to those living with frailty and considered potential interventions. Method The survey was across three hospitals in our health board (which serves a population of around 390,000 with a range of services). [SBUHB;2022] It was developed iteratively through consultation in a multidisciplinary group and adapted questions from other similar validated surveys. [Eamer; BMC Anesthesiology; 2017; 17:99][Taylor; Future Healthcare Journal; 2017; 4(3):207-212]. Results 218 responses were received covering a variety of medical and surgical specialties. Participants showed a strong (80%) self-reported understanding of frailty as a clinical concept, but only 46% felt confident in their ability to assess patients for frailty. 74% stated they would benefit from more education on frailty. Other barriers included systemic challenges such as staffing and social care, but also a lack of understanding of frailty by patients and relatives which impacted shared decision-making. Conclusions The survey showed a significant demand for more education, especially awareness of pathways and assessment methods. It also highlighted the issue of patients’ (and relatives’) lack of understanding of frailty. In response, we are planning a targeted multi-disciplinary educational programme on frailty across the health board, as well as introducing patient information leaflets.

Educación terapéutica de mujeres con diabetes gestacional (edugest): datos correspondientes al período de reclutamiento

Introducción: la prevalencia de diabetes gestacional (DG) en Argentina es de 4,7%, lo que implica mayor riesgo de desarrollar complicaciones tanto maternas como del recién nacido, prevenibles mediante un diagnóstico precoz y un tratamiento oportuno. Objetivos: promover la consulta precoz, el diagnóstico oportuno y el tratamiento adecuado mediante un programa de educación estructurado y multidisciplinario a nivel de Centros de Atención Primaria de la Salud (CAPs) y maternidades. Materiales y métodos: se reclutaron embarazadas con DG en CAPs y maternidades de Buenos Aires, Corrientes, Chaco y Ciudad Autónoma de Buenos Aires (CABA), con la participación de obstetras, diabetólogos, enfermeras, asistentes sociales, educadores, nutricionistas y médicos comunitarios. Para el diagnóstico de DG se aplicaron los criterios de la Asociación Latinoamérica de Diabetes (ALAD) y se relevaron simultáneamente hábitos nutricionales y parámetros clínicos, metabólicos y terapéuticos. También se desarrollaron cursos de educación y seguimiento durante el embarazo, parto, postparto y lactancia. Resultados: las embarazadas con DG consultaron tardíamente (la mayoría en el tercer trimestre de embarazo) y presentaron factores de riesgo para DG no prevenibles (el más frecuente fue el antecedente familiar de diabetes) y prevenibles (obesidad, hipertrigliceridemia y macrosomía) en embarazos previos. Conclusiones: el EduGest pretende interrumpir el círculo vicioso generado por la DG sobre la futura diabetes mellitus tipo 2 en la madre y el niño al promover la adopción de hábitos saludables.

Redefining Health through Multidisciplinary Obesity Prevention and Treatment in the United Arab Emirates

Obesity poses a multifaceted challenge in the United Arab Emirates (UAE), demanding a comprehensive review of its epidemiology, causes, prevention strategies, and challenges. This article explores the intricate web of factors contributing to obesity, emphasizing a multidisciplinary approach that engages nutritionists, exercise physiologists, behavioral therapists, and surgeons. The epidemiology reveals a concerning rise in obesity rates, necessitating targeted interventions. Demographic influences, cultural dynamics, dietary patterns, sedentary lifestyles, and genetic factors are dissected to provide a nuanced understanding. Health implications extend beyond body weight, impacting public health systems and imposing an economic burden. Prevention strategies encompass childhood obesity initiatives, community-based interventions, workplace wellness programs, and government policies. Challenges in implementing these strategies include cultural perceptions of body image, access to healthcare services, socioeconomic disparities, and resistance to change. Cultural sensitivity emerges as a key theme, guiding interventions tailored to align with diverse cultural norms. Multidisciplinary care, leveraging technology, community engagement, and educational programs are explored as integral components of a holistic approach. This review emphasizes the need for societal commitment, empowering communities and individuals, policy advocacy, and the pivotal role of healthcare professionals in the fight against obesity. Future perspectives call for sustained commitment, research investment, and the integration of technology to pave the way for a healthier UAE. This review also provides a roadmap for forging a healthier future, acknowledging the complexity of obesity, and offering insights into tailored, culturally sensitive interventions.

Knowledge, attitude, and practice of physical activity among patients with diabetes: a cross-sectional study

Objective: This study aimed to examine the knowledge, attitude, and practices regarding physical activity (PA) among patients with type-2 diabetes mellitus (T2DM) in Saudi Arabia. Methods: This was a cross-sectional study that included diabetic patients in Saudi Arabia. A self-administered online questionnaire consisting of 22 questions was used to assess the knowledge and attitude of participants toward PA. Results: A total of 610 patients with diabetes participated in the study. The participants&amp;apos; age ranged from less than 40 to more than 60 years old. The majority of the participants (62.1%) were less than 40 years old. Men accounted for 75.6% of all study participants. More than one-third of the participants (39%) were obese, and 19% were overweight. All participants never consumed alcohol (100%). However, 60.8% of participants were current smokers. About half of the participants (47.2%) added salt when eating, and 33.3% consumed processed food. About half of all participants (53.6%) had poor knowledge of PA; however, the majority of them (82%) had a positive attitude toward PA. The knowledge of PA in diabetes was significantly associated with the attitude of diabetic patients toward PA. Conclusion: There was insufficient knowledge and a positive attitude toward PA among patients with T2D in Saudi Arabia. The presence of multidisciplinary intensive education programs targeting T2DM patients might be helpful for the higher levels of knowledge among the study population. Thus, increasing the efforts toward education would improve the knowledge about the effect of PA in managing diabetes.