Multidisciplinary Research Articles

Abstract 4124120: Rare but Deadly - Eosinophilic Myocarditis in a Patient with Eosinophilic Granulomatosis Polyangiitis

Eosinophilic myocarditis (EM) is a rare inflammatory myocarditis characterized by eosinophilic infiltration of myocardial tissue. Despite the high mortality rate, EM is frequently underdiagnosed and is often first identified in postmortem studies. We share a case of EM as an early manifestation of newly diagnosed eosinophilic granulomatosis polyangiitis (EGPA). The patient is a 46-year-old female with a past medical history of ulcerative colitis and adult-onset asthma who presented to the emergency department with a 2–3-week history of worsening positional chest pain radiating to the left upper extremity. Associated symptoms include 3 months of fatigue, headaches, right foot neuropathy, urticaria, and B-symptoms. Prior to admission, the patient was started on empiric prednisone for presumed EGPA. Initial lab work on admission was notable for elevated troponin (602 ng/L), hyper-eosinophilia (19.5%), thrombocytosis (680K/uL), and elevated ESR (42 mm/h) that have improved since initiation of prednisone. Transthoracic echocardiogram revealed a newly reduced LVEF of 40% with basal and mid-septal wall motion abnormalities. Cardiac catheterization showed normal coronaries confirming the diagnosis of non-ischemic cardiomyopathy. Late gadolinium enhancement in cardiac MRI was seen in basal to mid segments with patchy pericardial enhancement, meeting the Lake Louise criteria for myocarditis. An endomyocardial biopsy showed substantial myocardial infiltration with lymphocytes, histiocytes and eosinophils, confirming the diagnosis of EM. After multidisciplinary team discussion with cardiology and rheumatology, the patient was started on guideline-directed medical therapy for her HFrEF and pulse dose steroids with a prolonged taper and cyclophosphamide. She is tolerating her treatment well. This case highlights the importance of early recognition, comprehensive assessment and targeted treatment for EM depending on its underlying etiology. In the case of autoimmune dysfunction, it involves a combination of immunosuppressive and symptomatic therapy. Ongoing research is crucial to enhance our understanding and improve clinical outcomes, like arrhythmias and cardiogenic shock, for this complex condition.

Telemedicine technologies in combat settings: efficiency and prospects (literature review)

Relevance. Large-scale military conflicts involving a technically well-equipped peer enemy are associated with a higher risk of delayed evacuation of the wounded which therefore requires extended medical care at advanced medical evacuation stages, especially amid absence or shortage of skillful medical professionals. Telehealth can offer solutions to overcome the difficulties in medical care provision amid combat settings. The objective is to study the prospects and efficiency of telemedicine technologies in enhancing availability of medical care during modern military operations.Methods. The PubMed database and the Scientific Electronic Library (eLIBRARY.ru) were used to collect research papers published from 2014 to 2024 studying the development and implementation of telemedicine technologies to backup combat operations.Results and discussion. Consultations by phone together with transfer of photos and text messaging remain the most common technology to provide telehealth assistance in combat settings. Teleconference connection allowing for two-way audio and video communication involving real-time data transfer is a most promising telecommunication format. Telehealth capacities can be expanded by augmented and mixed reality technologies, AI, drones, or robotic surgery. In combat environments, however, using telemedicine is limited by cybersecurity concerns and the signal bandwidth of modern communications systems. An efficient military telemedicine requires an integral centralized system involving multidisciplinary teams of experienced medical consultants providing round-the-clock emergency and routine telemedicine care to military units, including those engaged in combat operations.Conclusion. In combat settings telemedicine technologies have great untapped potential and can contribute largely in terms of evidence-based decision-making in process of medical triage and evacuation, thus optimizing the distribution of medical capacities and resources and improving the results of injury treatment. Although unfit to replace advanced combat medicine training, telemedicine can reinforce existing capacities by providing specialized medical advice to combat medics.

Envisioning the sustainable and climate resilient hospital of the future

ObjectivesThis study aims to create a vision of the future hospital to help healthcare leaders understand how changes in society and the healthcare system, compounded by climate change, could affect future hospital estate. Study designThe study is part of a larger project based on participatory backcasting aimed at providing integrated strategies for transitioning to a zero-carbon future and adapting to existing climate change through improved asset management. MethodsThe data presented in this paper were collected during a full-day workshop to construct the vision of the future hospital in 2050. A multidisciplinary team of 19 participants participated in the discussions. A six-phase thematic analysis was applied to the data to develop the narrative vision and graphic recording. ResultsThe healthcare system is undergoing transformative changes due to evolving healthcare delivery, patient expectations, emerging technologies, climate change, and sustainability. However, current hospital strategies often fail to consider the interrelationship between the hospital estate and its socio-environmental context. Policymakers, healthcare system leaders, and hospital leaders need a clear vision of the hospital of the future to implement transformational strategies. ConclusionsHealthcare transformations require shifting from traditional centralised hospitals to a more flexible, distributed model. Healthcare leaders need to proactively assess how hospitals respond to current and future hazards and consider the impacts within the context of integrated and dispersed healthcare delivery. To address this, a systematic approach to modelling hazards and evaluating design or upgrading options is essential to mitigate the transfer of climate-related risks within healthcare systems.

Abstract 4138717: Infective Root Aortitis: Medical Therapy Alone or Medical Therapy and Surgery?

Clinical presentation: A 75-year-old male with previous 3 vessel CABG and bioprosthetic aortic valve (BAV) surgical replacement in 2013 was admitted with severe sepsis from diabetic foot ulcer complicated with Group A Streptococcus bacteremia and infective root aortitis. Imaging Findings: Initial technically limited transthoracic echocardiogram was followed by a transesophageal echocardiogram (TEE) that demonstrated a well seated BAV with mildly thickened leaflets but no vegetations, mild intra-valvular regurgitation, and 9 mm end-diastolic soft tissue echoreflectant thickening of the posterior aortic root (AoR) extending up 3 cm from the aortic annulus to the ascending aorta (Fig 1A,B). There were no signs of perivalvular abscess formation. Initial FDG PET-CT demonstrated heterogenous hypermetabolic activity at the annulus of the BAV (Fig 1C) and AoR (Fig 1D) consistent with aortitis. Decision-making: In the absence of guidelines for the management of these patients, a multidisciplinary team including cardiology, cardiothoracic surgery, and infectious disease opted for a conservative medical therapy instead of high-risk surgery. Patient then underwent left foot first digit amputation to achieve infectious source control. Upon completion of 4 out of 6 weeks of intravenous ceftriaxone 2 grams daily, repeat TEE showed improved AoR thickening to 6 mm (Fig 1E,F), no AoR abscess, and unchanged BAV structure and function. Repeat FDG PET-CT at the same time of TEE demonstrated persistent but improved hypermetabolic activity of the BAV annulus and AoR. After 10 weeks of IV antibiotics, repeat FDG PET-CT showed further decrease in metabolic activity on both areas. However, an Indium-111 labeled leukocyte scan showed no activity at the BAV annulus and root (Fig 1G) and therefore indicated healed AoR aortitis, which was further supported by significant decrease of ESR and CRP initial values of 126 mm/hr and 122.7 mg/L to 11 mm/hr and 3 mg/L, respectively. Patient is currently clinically stable 8 months later. Conclusion: This case illustrates that a conservative management of infective AoR aortitis with an extended course of intravenous antibiotics is a reasonable alternative to high-risk re-do valve and root surgery.

Urgent focus on enhanced recovery after surgery of AIDS patients with limb fractures

AimsThe incidence of limb fractures in patients living with HIV (PLWH) is increasing. However, due to their immunodeficiency status, the operation and rehabilitation of these patients present unique challenges. Currently, it is urgent to establish a standardized perioperative rehabilitation plan based on the concept of enhanced recovery after surgery (ERAS). This study aimed to validate the effectiveness of ERAS in the perioperative period of PLWH with limb fractures.MethodsA total of 120 PLWH with limb fractures, between January 2015 and December 2023, were included in this study. We established a multidisciplinary team to design and implement a standardized ERAS protocol. The demographic, surgical, clinical, and follow-up information of the patients were collected and analyzed retrospectively.ResultsCompared with the control group, the ERAS group had a shorter operating time, hospital stay, preoperative waiting time, postoperative discharge time, less intraoperative blood loss, and higher albumin and haemoglobin on the first postoperative day. The time to removal of the urinary catheter/drainage tube was shortened, and the drainage volume was also significantly reduced in the ERAS group. There was no significant difference in the visual analogue scale (VAS) scores on postoperative return to the ward, but the ERAS group had lower scores on the first, second, and third postoperative days. There were no significant differences in the incidence of complications, other than 10% more nausea and vomiting in the control group. The limb function scores at one-year follow-up were similar between the two groups, but time to radiological fracture union and time to return to physical work and sports were significantly reduced in the ERAS group.ConclusionThe implementation of a series of perioperative nursing measures based on the concept of ERAS in PLWH with limb fracture can significantly reduce the operating time and intraoperative blood loss, reduce the occurrence of postoperative pain and complications, and accelerate the improvement of the functional status of the affected limb in the early stage, which is worthy of applying in more medical institutions.Cite this article: Bone Joint Res 2024;13(11):647–658.

Abstract 4135215: Eosinophilic Coronary Periarteritis (ECPA): An Under-recognized Coronary Disease with Fatal Consequences

Clinical presentation: A 50-year-old male with a paraesophageal hernia and grade D esophagitis presented to the ER with complaints of heartburn. He subsequently went into cardiac arrest and was diagnosed with a hemopericardium with tamponade physiology from a ruptured right coronary artery (RCA). Imaging Findings: Initial CT of the chest found a 1.5x1.5 cm dilation of the proximal RCA (Fig1A). Post cardiac arrest, repeat CT of the chest revealed an interval increase of the proximal RCA measuring 3.5x3.5 cm and a moderate-to-large hemopericardium (Fig1B). An emergent limited TEE demonstrated a large circumferential hemopericardium and biventricular standstill. Decision-making: In the ER, the initial symptoms resolved and he remained under observation. Hours later, he became bradycardic with a heart in the 20s and was found unresponsive. ACLS was activated and the patient was emergently cannulated and ECMO was initiated due to refractory cardiac arrest. Despite efforts from a multidisciplinary team including cardiology, cardiothoracic surgery and cardiac critical care, ROSC could not be achieved thus portending a poor prognosis. The family decided to withdraw care and the patient expired. Autopsy revealed a 925 mL hemopericardium from a ruptured 3.5 cm severely aneurysmal RCA and other remarkable findings included a 2 cm proximal aneurysm of left anterior descending artery and a 1 cm proximal aneurysm of left circumflex artery (Fig2A,B). Genetic testing for connective tissue disease was negative. Histopathology showed an eosinophilic predominant inflammatory infiltrate of the adventitia suggesting periarteritis (Fig2C) without signs of vasculitis in other organs. Conclusion: ECPA (eosinophilic coronary periarteritis) is a fatal entity with reported cases of sudden cardiac death and findings of vessel medial degeneration and coronary dissection. This case raises awareness of an under-recognized condition with limited guidance in diagnostic and therapeutic interventions.

Chinese expert consensus on the management of hypertension in adults with type 2 diabetes

AbstractBoth hypertension and type 2 diabetes are attributable to premature death, cardiovascular and kidney diseases with largely overlapping population. Followed the GRADE approach, this expert consensus aimed to reduce the cardiovascular and kidney death and disability due to hypertension and minimize the treatment burden in adults with type 2 diabetes. Through online survey and discussion, a multidisciplinary team comprehensively prioritized seven key guideline questions. Informed by the evidence synthesis and online discussion, the team developed 12 recommendations under the GRADE Evidence‐to‐decision (EtD) framework. The recommendations covered the screening of hypertension in adults diagnosed with type 2 diabetes but not hypertension and the monitoring, lifestyle interventions, and medications in those diagnosed with type 2 diabetes and hypertension.

Quantitative Analysis of Predictors of Acoustic Materials for Noise Reduction as Sustainable Strategies for Materials in the Automotive Industry

This study proposes a qualitative analysis for identifying the best predictors for ensuring passive noise control, aiming to achieve superior acoustic comfort in transportation systems. The study is based on real experimental data, collected through acoustic measurements performed by the authors on materials from six different classes and employs a multidisciplinary approach, including Mann–Whitney U tests, Kruskal–Wallis analysis with Dunn’s post hoc multiple comparisons and multilinear regression. This research presents an analysis and evaluation of how the physical properties of various materials influence acoustic comfort, acoustic absorption class and absorption class performance and proposes quantitative models for material selection to address sustainable strategies in the automotive industry. The results highlight significant differences between material categories in terms of acoustic absorption properties and demonstrate the importance of rigorous material selection in vehicle design to enhance acoustic comfort. Additionally, the research contributes to the development of predictive models that estimate acoustic performance based on the physical properties of materials, providing a basis for optimizing material selection in the design phase.

Virtual Healthcare for Older Adults With Preventable Chronic Conditions: A Meta-synthesis of Quality Aspects

Our study employed a six-step meta-synthesis approach to understand quality aspects of virtual healthcare trajectories and identify effective strategies for older adults with preventable chronic conditions across the world. Review of twenty-one articles revealed four key themes: functionality of virtual healthcare, equity in service delivery, satisfaction with care, and cost-effectiveness. Despite the challenges posed by technological and clinical complexities, virtual healthcare initiatives have significantly improved accessibility and availability of health services, thereby reducing disparities. Notably, telehealth saved an average of 166-minutes of travel time, demonstrating a clear benefit of virtual healthcare. While all parties expressed satisfaction with virtual healthcare, several challenges were reported, including a digital divide, limited access to digital devices, absence of a multidisciplinary approach, and lack of rural-specific programs.

Abstract Su706: New risk markers of sudden cardiac death in the young : insights from machine learning on EHR data

Background: Sudden Cardiac Death (SCD) in young adults is a significant public health issue, with survival rates often less than 15%. Effective prevention is critical as many SCD cases go undetected due to nonspecific symptoms and ineffective risk stratification methods, especially among the youth. Objective: To explore risk markers specific to SCD in younger populations using Artificial Intelligence (AI) trained on systematically collected Electronic Health Records (EHR) data, and to compare these markers with those in older populations. Methods: We conducted a retrospective cohort study using data from 46,060 participants in Paris and its inner suburbs, spanning 2011 to 2020. The cohort included 1,100 SCD cases and 1,100 controls aged 40 years or younger, and 21,930 SCD cases and 21,930 controls aged over 40. A machine learning model was developed, trained, and validated on these cohorts. We used the Catboost algorithm and evaluated model performance using AUC, sensitivity, and specificity. The SHAP algorithm was employed to elucidate the relationship between variables and predicted risk. Results: The model achieved on validation sets an AUC of 0.75 (95% CI 0.67-0.83) for the younger cohort and AUC of 0.82 (95% CI: 0.70-0.83), for the older cohort. Neuropsychiatric drugs were the most influential predictors for the younger cohort, whereas age and cardiovascular drugs were most predictive for the older cohort. The results indicate that traditional cardiovascular risk factors play a secondary role in predicting SCD among younger individuals. Conclusion: In analyzing predictors of sudden death in individuals under 40, we developed a personalized SCD prediction model using EHR data tailored to this demographic. Psychiatric medications, and possibly underlying psychiatric conditions, emerged as significant predictors. Our findings emphasize the need for a multidisciplinary approach to SCD prevention, integrating neuropsychiatric and cardiovascular considerations.

Enhancing vascular surgery outcomes through geriatric co-management: a study on the impact of the POPS team

Introduction Peripheral arterial disease (PAD) involves atherosclerotic stenosis and occlusion of lower leg arteries, leading to significant disability, high cardiovascular and cerebrovascular morbidity and mortality. Critical limb ischemia (CLI) is the most severe form of PAD. With the UK's aging population set to increase, the prevalence of PAD and the burden on vascular teams are expected to rise. This study evaluates the impact of regular input from the Proactive Care of Older People Undergoing Surgery (POPS) team on vascular surgery outcomes. Methods This prospective cohort study examined the impact of Care of the Elderly (CoE) input on predefined parameters, focussing primarily on the length of stay (LoS) over 12 months. Data included baseline demographics, comorbidities, frailty scores (assessed using the Rockwood frailty score), LoS and referrals to medical specialties. A retrospective pilot study of 50 consecutive patients indicated a need for CoE input, showing higher local LoS compared with the national average. Results Patients in both pilot and project groups were matched for comorbidities, frailty scores and interventions. Despite higher mean age and a greater proportion of patients aged 75+ years in the project group, the study aimed to reduce LoS. Post-quality improvement project implementation, LoS beyond fit-for-discharge decreased from 11.7 days to 9 days in 6 months and to 6 days after 12 months. Referrals to medical specialties decreased from 77% to 40%, and new diagnoses on discharge increased from 28% to 37%. Conclusions CoE team input in vascular surgery patient care significantly improved outcomes, reducing LoS and medical specialty referrals, demonstrating cost-effectiveness and suggesting a feasible multidisciplinary approach for other regions.

The Contemporary Novel in the Context of Interdisciplinarity, With Specific Reference to DeLillo’s Zero K and McCarthy’s The Road

The interdisciplinary approach greatly enriches contemporary novels, allowing researchers to explore complex issues from a multiplicity of angles and perspectives. Communication and collaboration across different disciplines within novels, which some refer to as “consilience,” have had a noticeable impact on these novels’ literary elements and overall narrative. This paper will examine the impact of the interdisciplinary approach on themes, plot, and characterization on two selected contemporary novels: Zero K (2016) by Don DeLillo and The Road (2006) by Cormac McCarthy. It aims to provide a new reading of the two novels from an interdisciplinary perspective, demonstrating how a multidisciplinary approach reveals more meanings and aspects that cannot be revealed as effectively when examined from the viewpoint of a stand-alone discipline.

Leiomyosarcoma of the inferior vena cava: case report

Introduction and Importance: Leiomyosarcomas of the inferior vena cava are exceedingly rare tumors, presenting diagnostic dilemmas due to their nonspecific clinical features. This case report aims to shed light on the challenges associated with diagnosing and managing such tumors, emphasizing the importance of a multidisciplinary approach. This article uses SCARE2023 criteria as a framework to sort out a case report in order[1]. Case Presentation: We present a case of leiomyosarcoma of the inferior vena cava in a patient presenting with abdominal pain. Initial clinical signs, supported by computed tomography (CT) and magnetic resonance imaging (MRI), led to the suspicion of the tumor. Histological analysis confirmed the diagnosis, prompting surgical intervention. Clinical Discussion: The diagnosis of tumors within the inferior vena cava is often challenging due to their nonspecific presentation. Imaging modalities such as CT and MRI play an important role in describing the extent of the tumor and guiding surgical planning. Histological analysis remains supreme for definitive diagnosis. Surgical resection, aimed at complete excision, is the keystone of treatment to minimize the risk of recurrence. Conclusion: Leiomyosarcomas of the inferior vena cava pose diagnostic and therapeutic challenges due to their rarity and nonspecific clinical presentation. A comprehensive approach integrating clinical assessment, imaging, and histological analysis is essential for accurate diagnosis and optimal management. Multidisciplinary collaboration is key for navigating the complexities associated with these rare vascular neoplasms, ensuring positive patient outcomes.

Impaired oxytocin signalling in the central amygdala in rats with chronic heart failure

AbstractHeart failure (HF) patients suffer from cognitive decline and mood impairments, but the molecular signals and brain circuits underlying these effects remain elusive. The hypothalamic neuropeptide oxytocin (OT) is critically involved in regulating mood, and OTergic signalling in the central amygdala (CeA) is a key mechanism that controls emotional responses including anxiety‐like behaviours. Still, whether an altered OTergic signalling contributes to mood disorders in HF remains unknown. To address this, we used an ischaemic rat HF model, along with a highly multidisciplinary approach, to mechanistically study multiple levels of the hypothalamus‐to‐CeA OTergic circuit in male rats with HF. We aimed to test the hypothesis that sustained activation of the OT system following an infarct leads to depletion of OT content in this pathway, with subsequent changes in OT receptor expression and blunted modulation of local GABAergic circuits. We found that most of OTergic innervation of the CeA originated from the supraoptic nucleus (SON). While no differences in the numbers of SON→CeA OTergic neurons was observed between sham and HF rats, we observed a blunted content and release of OT from axonal terminals within the CeA. Moreover, we report downregulation of neuronal and astrocytic OT receptors, and impaired OTR‐driven GABAergic synaptic activity within the CeA microcircuit of HF rats. We provide the first evidence that male HF rats display perturbations in the hypothalamus‐to‐amygdala OTergic circuit, laying the foundation for future translational studies targeting either the OT system or GABAergic amygdalar microcircuit to ameliorate mood impairments in rats or patients with chronic HF. imageKey points Heart failure patients suffer from cognitive decline, depression and mood impairments, but the underlying mechanisms remain elusive. Acting within the central amygdala, the neuropeptide oxytocin regulates emotional responses, including anxiety‐like behaviours. However, whether changes in oxytocin signalling occurs during heart failure is unknown. In this study, we used an ischaemic rat heart failure model to mechanistically study multiple levels of the hypothalamus‐to‐amygdala oxytocinergic circuit in this disease. We report an overall blunted oxytocinergic signalling pathway in rats with heart failure, including blunted content and release of oxytocin from axonal terminals, downregulation of neuronal and astrocytic oxytocin receptors, and impaired oxytocin‐driven GABAergic synaptic activity within the central amygdala microcircuit of HF rats. These studies shed light on mechanisms that contribute to mood disorders in cardiovascular disease states and help to identify potential molecular targets for their improved treatment.

Migration communication campaigns: towards a research agenda and open database

ABSTRACT Every year, government agencies, international organisations, and civil society associations produce public communications campaigns designed to inform, persuade, and motivate behaviour regarding numerous facets of migration. Despite their increasing ubiquity, resources, and – possibly – impact, as well as the profound scientific relevance in understanding them, such campaigns remain relatively understudied and existing research is disjointed across various disciplines. This article takes three steps to propose and initiate a unified, interdisciplinary research agenda on migration communication campaigns (MCCs). First, we overview the need for a research agenda based on their increased substantive importance and scientific interest. Second, we outline what such a research agenda should look like, proposing six research themes. Third, we contribute to this proposed research agenda in two ways: with a typology of MCCs and by presenting our open-access, collaborative database to kick-start more systematic research in this field, including theoretical justifications for each variable. The database includes 301 MCCs conducted in 32 European countries between 2012 and 2022. We invite submissions of all types of MCCs globally to create a bridge between communities of academics, policymakers, and communicators.

Antropología forense, conservación y nuevas tecnologías. Aplicación de fotogrametría de rango corto en restos óseos humanos en Córdoba, Argentina

The objective of this work is to contribute to the discussion of the incorporation of new technologies to improve the conservation of human remains, from the implementation of short-range photogrammetry. The study was carried out on human skulls that are under the care of the Institute of Forensic Medicine of the Province of Córdoba, Argentina. Forensic Anthropology and short-range photogrammetry together make up an interdisciplinary field of study where our objective is focused on incorporating new documentation techniques for processing sensible remains and improving the conservation. The incorporation of a digital technique in the practice of this discipline allows us to propose an approach from another perspective to specific problems in this field, allowing the generation of new explanatory possibilities for issues that continually arise during the traditional work of forensic disciplines. In this sense, in the long term, we are interested in generating an information base that in the future will be transformed into a virtual repository with 3D records of human skulls of forensic, bioanthropological, historical and archaeological interest, and in the short term, optimizing the registration and conservation tasks of human remains through their three-dimensional digitization to be able to contribute to the identification and documentation tasks of judicial investigations that enter the institution. On the other hand, we are interested in discussing some ethical concepts focused on the growing digitization of human remains and the care that must be prioritized for their correct diffusion considering that at least in our country there is legislation that protects the exhibition of human remains.

The Myth of the Liberal Arts vs. National Universities Divide: A Marketing Strategy

This manuscript critically examines the commonly held distinction between liberal arts colleges and national universities, arguing that the divide is largely a product of marketing rather than substantive educational differences. Drawing on data from leading higher education research organizations, it highlights how both institution types share similar goals in fostering critical thinking, offering interdisciplinary programs, and preparing students for diverse career paths. Through an analysis of academic structures, faculty-student interactions, and post-graduation outcomes, the manuscript underscores that the unique characteristics attributed to each institution type are often overstated for promotional purposes. The findings suggest that the decision between these institutions should be guided more by individual preferences than by assumed educational superiority.

Correlation of Seismic Data and Sediment Cores From the Seabed in the Medieval Harbour at Avaldsnes, Norway

ABSTRACTThis interdisciplinary study demonstrates the successful integration of non‐destructive geophysical methods and sediment core analyses for mapping the seabed in the historical harbour at Avaldsnes in south‐west Norway. In the Medieval Period, this was a royal manor, with the harbour as a central hub for the Hanseatic League in the 14th to 15th centuries. The use of an Autonomous Surface Vehicle (ASV) mounted with two distinct sub‐bottom profiler (SBP) systems facilitated the acquisition of high‐resolution seismic data, providing efficient imaging of the seafloor and subsurface layers. Sequence of fifteen sediment cores allowed for the description and dating of stratigraphy and the depositional environment. In combination, these methods provided a multidimensional understanding of the distribution of subsea sediments in the harbour, while preserving most of the archaeological context. The analysis revealed organic‐rich sediments, primarily consisting of fine detritus gyttja, accumulated over the last 1700 years, trapping certain archaeological features. Deposition of the soft sediments likely commenced due to a lower relative sea level, possibly accompanied by intensified land‐use and harbour activity. The study identified several minor anomalies in the seismic data, potentially representing artefacts of archaeological importance. An anomaly of significant size might correspond to a buried shipwreck or harbour structure. By providing a comprehensive understanding of sediment dynamics and human‐environment interactions in the harbour, the research contributes to the preservation and management of an important cultural heritage site.

Multidisciplinary Approaches in General Medical Practice: Enhancing Collaboration for Better Patient Care

Multidisciplinary approaches in general medical practice have become integral to providing comprehensive, patient-centered care, as the complexity of modern health issues often requires a diverse range of expertise. This review explores the role and benefits of multidisciplinary teams in enhancing patient outcomes, improving resource efficiency, and increasing patient satisfaction in general medical settings. By examining the contributions of various healthcare professionals—including primary care physicians, specialists, allied health professionals, and behavioral health specialists—this review emphasizes how collaborative efforts address complex health needs more effectively than traditional, siloed approaches. Key case studies illustrate successful multidisciplinary practices in managing chronic diseases and complex conditions, highlighting the advantages of coordinated care models. The review also addresses challenges, such as communication barriers, hierarchical dynamics, and logistical constraints, that can hinder effective collaboration. Furthermore, it discusses technological supports, such as electronic health records (EHR) and telemedicine, which facilitate real-time communication and care coordination. The article concludes with recommendations for expanding multidisciplinary teams in primary care, promoting educational initiatives for team-based care skills, and advocating for policy support to institutionalize multidisciplinary approaches in general medicine. These findings suggest that well-coordinated multidisciplinary teams can transform patient care, making it more holistic, efficient, and responsive to individual needs.

QLTI-01. ASSESSING THE EFFECTIVENESS OF SUPPORT FROM ST. JUDE CHILDREN’S RESEARCH HOSPITAL TO VIETNAMESE TEAM IN TREATMENT FOR CHILDREN WITH BRAIN TUMORS

Abstract BACKGROUND Treatment for children with brain tumors requires multidisciplinary team (MDT) which is lacking in Vietnam which negatively impacts outcome. This study aims to describe the implementation and promotion of MDT approach in Vietnam with the support of St. Jude Children’s Research Hospital. METHODS We conducted a prospective descriptive study of St. Jude Children’s Research Hospital’s activities with the Vietnamese team between August 2023 and March 2024 and its impact on education, patient care and disseminating of MDC approach in Vietnam. RESULTS Onsite and online training were provided for the Vietnamese team during this time. The onsite training included exchange visits for both teams and St. Jude support for Vietnamese colleagues to attend regional and international neuro-oncology conferences. Online case discussions have been held every month from January 2024 and there are 40-60 participants each meeting from 5 main oncology centers in Vietnam. There are 3- 4 complex case discussions each meeting. A zalo group (a social media platform) for Vietnamese doctors (92 doctors) with multidisciplinary team members was established. After discussion, references and summaries of each case were distributed to the zalo group. For emergency cases, email consults are requested directly for timely input. In addition, key educational textbooks covering different disciplines of neuro-oncology (pathology, radiology and medical) were provided to different Vietnamese teams. All participants (92 doctors) found the online discussion (100.0%) benefical to further their knowledge in different fields (chemotherapy, radiation, pathology and surgery) and the outcome of consultations which guided teams to manage difficult cases. For some cases, pathology samples with local reports are sent to St. Jude to review the diagnosis and classification. CONCLUSIONS Training plays an important role in bringing knowledge and building team-based experience for Vietnamese clinicians in the treatment for children with brain tumor.