Multidisciplinary Setting Research Articles

Cervical Tuberculosis Mimicking Cervical Cancer in a Postmenopausal Woman: A Case Report

Cervical tuberculosis is a rare form of genital tuberculosis. A case of a 73-year-old woman who presented with cervical wall thickening on magnetic resonance imaging, suggesting an invasive malignant neoplasm, is documented. Cervical cone excision was performed for histopathological study. Microscopy showed epithelioid granulomas, without appreciable caseous necrosis, in the wall of the uterine cervix, associated with erosion of the overlying cervical mucosa. Histochemical stains for microorganisms (Ziehl–Neelsen, Grocott, and Warthin–Starry) were negative. Immunohistochemistry for Treponema pallidum revealed scarce, spiral-shaped bacilli, which raised the diagnostic possibility of secondary syphilis. The serological study for syphilis was negative, however. Polymerase chain reaction (PCR) tests for Mycobacterium tuberculosis and Treponema pallidum were performed in the formaldehyde-fixed, paraffin embedded tissue and resulted positive for Mycobacterium tuberculosis and negative for Treponema pallidum, confirming the diagnosis of cervical tuberculosis. Our objective was to report a rare case of cervical tuberculosis, discussing the advantages and limitations of complementary techniques used in the pathological diagnosis of infectious agents and highlighting diagnostic pitfalls. In conclusion, correct microbiological diagnosis requires the implementation of integrated workflows employing complementary techniques in a multidisciplinary setting to improve the accuracy of histopathological examination in infectious diseases.

Advanced Radiotherapy Technologies in Spine Tumors: What the Surgeon Needs to Know.

Narrative review of existing literature. Significant technological advancements in radiotherapy planning and delivery have enabled new radiotherapy techniques for the management of spine tumors. The objective of this study was to provide a comprehensive summary of these treatment techniques for practicing spine surgeons. A narrative review of the existing literature on stereotactic body radiation therapy (SBRT) and particle beam therapy (PBT) for the treatment of spine tumors was performed. The characteristics, implementation and evidence supporting these strategies in the management of primary spinal neoplasms were summarized. The clinical effectiveness of SBRT for the control and symptom palliation of metastatic spinal tumors are well demonstrated in multiple clinical trials. Risks such as fracture, radiculopathy and plexopathy exist after spine SBRT, necessitating an individualized approach in a well experienced multidisciplinary setting. SBRT should be considered a key component of a well-rounded treatment plan for metastatic spine tumors in combination with surgery, vertebral augmentation, and drug therapy, where indicated, to achieve optimal patient outcomes. Additionally, PBT and SBRT are also leading to promising results for primary spine tumors, though comparative effectiveness studies and prospective clinical trials are required to establish these modalities more formally as alternatives to conventionally fractionated photon radiotherapy. SBRT and PBT are emerging as effective and well tolerated treatment options for primary and metastatic spine tumors. Additional investigation is needed to personalize these treatment options and further strengthen these approaches as key components in a multidisciplinary approach to the management of spinal neoplasms.

Hepatocellular carcinoma: updates on epidemiology, surveillance, diagnosis and treatment.

Hepatocellular carcinoma (HCC) is a major global burden, ranking as the third leading cause of cancer-related mortality. HCC due to chronic hepatitis B virus (HBV) or C virus (HCV) infection has decreased due to universal vaccination for HBV and effective antiviral therapy for both HBV and HCV, but HCC related to metabolic dysfunction associated steatotic liver disease (MASLD) and alcohol-associated liver disease (ALD) is increasing. Biannual liver ultrasonography and serum α-fetoprotein are the primary surveillance tools for early HCC detection among high-risk patients (e.g., cirrhosis, chronic HBV). Alternative surveillance tools such as blood-based biomarker panels and abbreviated MRIs are being investigated. Multiphasic CT or MRI is the standard for HCC diagnosis, but histological confirmation should be considered, especially when inconclusive findings are seen on cross-sectional imaging. Staging and treatment decisions are complex and should be made in multidisciplinary settings, incorporating multiple factors including tumor burden, degree of liver dysfunction, patient performance status, available expertise, and patient preferences. Early-stage HCC is best treated with curative options such as resection, ablation, or transplantation. For intermediate-stage disease, locoregional therapies are primarily recommended although systemic therapies may be preferred for patients with large intrahepatic tumor burden. In advanced-stage disease immune checkpoint inhibitor (ICI)-based therapy is the preferred treatment regimen. In this review article, we discuss the recent global epidemiology, risk factors, and HCC care continuum encompassing surveillance, diagnosis, staging, and treatments.

Assessing the professional social capital of psychiatrists: development of the Resource Generator for Psychiatrists (RG-Psy)

BackgroundIn the field of psychiatry, the dissemination of clinical innovations greatly depends on the social capital of clinicians. An instrument specifically aimed at measuring their professional social capital therefore needs to be developed.MethodsThis survey was conducted to develop and validate the Resource Generator for Psychiatrists, an 11-item questionnaire measuring the social capital of psychiatrists. The online questionnaire was administered through a link sent by e-mail to all psychiatrists and residents in psychiatry licensed to work in Belgium, after excluding ineligible psychiatrists. A total of 1618 psychiatrists or residents were reached. An exploratory factor analysis was conducted. Internal consistency was assessed using Pearson’s correlation, item-total correlation and Cronbach’s alpha. Test-retest reliability was also measured. Multivariable linear regression analysis assessed the association between the total score of the social capital and psychiatrist demographics.ResultsA total of 196 psychiatrists responded to the survey (response rate: 12.1%). The Resource Generator for Psychiatrists showed a normal distribution with a mean of 23.6 (SD = 15.5), good test-retest reliability (ICC = 0.81) and a good total Cronbach’s alpha (0.74). Exploratory factor analysis revealed two main subtypes in psychiatrists’ social capital: “Resources for the clinician” and “Resources for the professional”, with a Cronbach’s alpha of 0.62 and 0.7 respectively. Clinicians attending institutional seminars (β = 5.52, SE = 2.2, p = .013) and working in multidisciplinary settings, such as hospitals (β = 4.75, SE = 2.06, p = .023) or a mobile team (β = 8.75, SE = 3.52, p = .014) were more likely to have higher social capital.ConclusionPsychiatrists’ access to professional resources can be reliably measured by using an 11-item questionnaire.

Completion Rate of Paper-Based and Electronic Patient Reported Outcome Measures in a Multidisciplinary Cancer Survivorship Clinical Setting.

Integrating Patient-Reported Outcome Measures (PROMs) into clinical practice is increasing, with research showing benefits in patient outcomes. However, evidence regarding patient's acceptance of PROMs is limited. Sydney Cancer Survivorship Centre (SCSC) clinic is a multidisciplinary clinic where clinicians use PROMs to guide patient consultation. This study explored SCSC patient acceptability of PROMs in clinical care by evaluating PROMs' completion rates. This retrospective audit of PROMs completion rates evaluates two periods: 1) September 2013-November 2019 (pre-coronavirus disease 2019) and 2) October 2020-September 2023, following the implementation of electronic PROMs. Overall, 866 new patients attended SCSC during the two audit periods, with 822 (95%) giving consent for data to be included. Descriptive statistical methods were used to analyse completion rates. Between September 2013 and November 2019 (audit period 1), 656 new survivors attended the SCSC clinic; 622 (95%) consented to data use. The highest completion rate for paper-based PROMs was the food questionnaire (92%); with 91% for distress thermometer, symptoms, and exercise-related PROMs; 85% for quality of life; 77% for self-rated performance status, and 55.5% for a 3-day food diary. From October 2020 to September 2023 (period 2), the response rate for PROMs was 99% (n = 198/200) for initial clinic attendees; and 92% for electronic PROMs (n = 169/184). Using comprehensive PROMs in clinical care is feasible. The completion rate was high; similar between paper-based and electronic PROMs. Comprehensive PROMs can guide clinical consultations. PROMs may improve communication between survivors and clinicians and enhance the quality of care.

Maternal pulmonary hypertension and cardiopulmonary outcomes during delivery hospitalization in the United States: A nationwide study from 2016–2020

BackgroundMaternal pulmonary hypertension can pose substantial morbidity and mortality risks, particularly during labor and delivery. Although maternal pulmonary hypertension is conventionally considered a contraindication to pregnancy, advances in the management of pH may contribute to improving outcomes. ObjectivesIn this nationwide study, we aim to characterize the prevalence of maternal pulmonary hypertension in the United States and its association with adverse cardiopulmonary outcomes during delivery hospitalizations. Study DesignIn this cross-sectional cohort study, we analyzed delivery hospitalizations in the National Inpatient Sample from 2016 to 2020. The primary exposure was maternal pulmonary hypertension. The primary outcome was a composite of maternal cardiopulmonary morbidity events during the delivery hospitalization including: death, heart failure, intraoperative heart failure, pulmonary edema, cardiac arrest, myocardial infarction, ventricular fibrillation, respiratory failure, pneumonia, acute kidney injury, and cardiac conversion. Propensity score matching was used to estimate the association between maternal pulmonary hypertension and adverse cardiopulmonary outcomes, adjusting for sociodemographic variables and validated clinical comorbidities as covariates. Secondary outcomes included mechanical circulatory support utilization, length of stay, and total hospitalization costs. ResultsAmong 18,161,315 delivery hospitalizations, 4,630 patients had pulmonary hypertension, yielding a maternal pulmonary hypertension prevalence of 25 per 100,000 delivery hospitalizations with a yearly trend of increasing prevalence (odds ratio = 1.06, 95 % CI 1.01 to 1.11, P = 0.028). After propensity score matching to create well-balanced groups, 4,560 patients with pulmonary hypertension were compared to 4,560 patients without pulmonary hypertension. In this confounder-adjusted analysis, the primary composite outcome of cardiopulmonary morbidity and mortality occurred in 41.1 % of the PH group compared to 14.4 % in the no PH group (adjusted odds ratio = 4.16, 95 % CI 3.32 to 5.23, P < 0.001). Additionally, patients with PH had a higher incidence of mechanical circulatory support use (adjusted odds ratio = 9.08, 95 % CI 1.14 to 71.81, P = 0.037), longer length of stay (length of stay ratio = 2.82, 95 % CI 2.74 to 2.9, P < 0.001) and higher total hospitalization costs (total cost ratio = 1.67, 95 % CI 1.52 to 1.85, P < 0.001). ConclusionsMaternal pulmonary hypertension is increasing in prevalence and is strongly associated with adverse cardiopulmonary outcomes in the United States, with 41.1% of pH patients experiencing a composite outcome of cardiopulmonary morbidity and mortality during delivery hospitalization. Our findings emphasize the importance of caring for patients with maternal pulmonary hypertension in a multidisciplinary setting at high-acuity centers to ensure appropriate management of cardiopulmonary complications that arise during labor and delivery.

Regional anaesthesia research priorities: a Regional Anaesthesia UK (RA-UK) priority setting partnership involving patients, carers and healthcare professionals.

Regional anaesthesia provides important clinical benefits to patients but is underutilised. A barrier to widespread adoption may be the focus of regional anaesthesia research on novel techniques rather than evaluating and optimising existing approaches. Research priorities in regional anaesthesia identified by anaesthetists have been published, but the views of patients, carers and other healthcare professionals have not been considered previously. Therefore, we launched a multidisciplinary research priority setting partnership that aimed to establish key regional anaesthesia research priorities for the UK. Research suggestions from key stakeholders (defined by their interaction with regional anaesthesia) were gathered using an online survey. These suggestions were analysed to identify common themes and then combined to formulate indicative research questions. After an extensive literature review, unanswered and partially answered questions were prioritised via an interim online survey and then ranked as a top 10 list during a final live virtual multidisciplinary prioritisation workshop. In total, 210 individuals completed the initial survey and suggested 518 research questions. Fifty-seven indicative questions were formed, of which three were considered fully answered after literature review and one not feasible. The interim online survey received 335 responses, which identified the 24 highest priority questions from the 53 presented. At the final live prioritisation workshop, through a nominal group process, we identified the top 10 regional anaesthesia research priorities. These aligned with three broad thematic areas: pain management (two questions); patient safety (six questions); and recovery from surgery (two questions). This initiative has resulted in a list of research questions prioritised by patients, carers and a multidisciplinary group of healthcare professionals that should be used to inform and support future regional anaesthesia research in the UK.

A Critical Analysis of Healthcare Accessibility and Equity in Multidisciplinary Settings

Universal healthcare and healthcare disparity remain major hurdles to effective health delivery systems worldwide, including major health sectors designed to offer complex, interprofessional care. In this paper, barriers, including socioeconomic differences, organizational or systemic prejudice, and resource distribution within the healthcare system, are the focus of the discussion. Through a review of the literature and quantitative data analysis, we identify areas of inaccessibility and provide recommendations for improving equality in a large interprofessional healthcare team. These insights confirm that coordinated, integrated care increases a patient's health benefits but that much of the gap remains unconsidered by standard and integrated care models.

Sjögren's Disease and Gastroesophageal Reflux Disease: What Is Their Evidence-Based Link?

Sjögren's disease (SjD), or primary Sjögren's syndrome (pSS), is a heterogeneous chronic autoimmune disorder with multiple clinical manifestations that can develop into non-Hodgkin's lymphoma in mucosa-associated lymphoid tissue. SjD is one of the autoimmune diseases with the maximum delayed diagnosis due to its insidious onset, heterogeneous clinical features and varied course. It is increasingly recognized that extraglandular manifestations represent a clinical challenge for patients with SjD. The European League Against Rheumatism (EULAR) Sjögren's Syndrome (SS) Disease Activity Index (ESSDAI) is a systemic disease activity index designed to measure disease activity in patients with primary Sjogren's syndrome. It consists of 12 domains: cutaneous, pulmonary, renal, articular, muscular, peripheral nervous system, central nervous system, hematological, glandular, constitutional, lymphadenopathy and lymphoma, biological. More than a quarter of patients with pSS may have systemic features that are not included in the ESSDAI classification, i.e., various cardiovascular, ophthalmic, ENT, and other systemic or organ involvement that increase the magnitude of the systemic phenotype in the disease. The ESSDAI also excludes the gastrointestinal (GI) tract, and unfortunately, GI manifestations are not routinely assessed. Gastroesophageal reflux disease (GERD) is one of the most prevalent gastrointestinal disorders, impairing quality of life and consuming a large volume of medical resources. Recently carried out the Mendelian randomized trial confirmed the causal link between SjD and gastroesophageal reflux disease (GERD) and showed that GERD is a risk factor for SjD. This review aims to provide an overview of the research describing evidenced based links between Sjögren's disease and gastroesophageal reflux disease, with the intention of ensuring that any systemic pathology in Sjögren's disease is properly assessed and that management of the disease is directed towards the patient. A comprehensive literature search was carried out on PubMed, Web of Science, Scopus and the Cochrane Library databases. Two researchers searched for published studies indexed from inception to 1 September 2024 using the keywords 'Sjögren's syndrome' OR 'Sjögren's disease' AND 'gastroesophageal reflux disease' AND 'microbiota' OR microbiota dysbiosis'. We limited our search for scientific articles to human studies, and only included articles in English. Overall, there is a lack of evidence-based studies assessing the association between GERD and Sjögren's disease and the changes in the microbiota associated with GERD in a multidisciplinary setting. Such studies are needed for the future, as this will improve the early diagnosis of Sjögren's disease and the personalized management of the disease.

The Processuality of ‘Sex’ in Biomedicine: Exploring Stem Cell Research, Cancer Medicine and Vaccine Safety Research

Incorporating sex into biomedical research is envisioned as key to addressing inequalities in health. However, feminist research suggests that it is a complicated task. This is, we argue, especially the case with research that seeks to mobilise sex across different scales involving bodies, samples and populations to provide a basis for personalised biomedical prevention and treatment. Through case studies from stem cell research, cancer medicine and vaccine safety research, we analyse how sex is enacted, foregrounded and sidelined at different stages of research. We argue that sex becomes suspended between individual bodies, samples and population groups, and that this postpones biomedical analysis of sex differences in health. Yet, research on sex differences in complex embodied processes, such as drug metabolism or immunity, appears as a future potentiality. This potentiality shapes research practices that may open biomedicine towards multi-disciplinary study settings that bring together physiological and social dimensions of bodily difference.

Exploring clinician perspectives of systems-based practice: A physician training challenge.

Systems-based practice (SBP) has been a competency in US graduate medical education for over 20 years, but it is not well implemented. SBP is loosely defined as physician's responsiveness to the larger system of healthcare. The aim of this study was to describe healthcare professionals' perspectives regarding: (1) their knowledge and beliefs about SBP and (2) their beliefs regarding factors in clinical learning environments (CLE) that facilitate or hinder operationalisation and learning of SBP. Semi-structured interviews were conducted between November 2020 and April 2021 with 42 individuals from four health systems. Participants were healthcare professionals involved in graduate medical education, including physicians and interprofessional clinicians (e.g., nursing staff). Interviews were transcribed and coded using a social constructivist, codebook thematic analysis approach and themes were agreed upon through discussion amongst the research team. Five themes were constructed: (1) SBP remains a challenge to define, (2) SBP may be intuitively understood, particularly when framed at the microsystem level, (3) SBP aligns with the Health Systems Science framework, (4) SBP learning must be intentionally integrated into the CLE, through training such as onboarding and (5) multidisciplinary settings and work processes are critical to engage in SBP. Workload compression is a barrier to SBP implementation. Healthcare professionals highlighted that current CLEs are not designed to prioritise SBP. Graduate medical education programmes may benefit from focusing systems content at the microsystem level and purposefully integrating onboarding procedures, clinical settings and rotations specifically designed to teach SBP into their residencies.

Nutrition Interventions for Youth with Dyslipidemia: Who, What, When, and Where?

A heart-healthy lifestyle adopted during childhood and sustained throughout life can reduce cardiovascular disease risk in youth with dyslipidemia. In this review, we discuss nutrition recommendations for youth (< 18years-of-age) with dyslipidemia, compare recommendations for youth versus those for adults, review published data regarding nutrition management in the pediatric population, and discuss strategies for successful implementation in a clinical setting. Recent publications highlight the characteristics of genetic and acquired hypertriglyceridemia disorders, dietary adjuncts used for lipid-lowering, and the effectiveness of a multi-disciplinary team approach. Nutrition interventions remain a cornerstone of lipid management and cardiovascular disease risk reduction in youth with dyslipidemia. Nutrition counseling should include age and developmentally appropriate education while also addressing barriers to implementing a heart-healthy lifestyle. A registered dietitian nutritionist plays an important role within a multidisciplinary clinic setting by providing dietary recommendations to address the needs of youth with dyslipidemia.

Salary Benchmarking for Voice-Specialized Speech-Language Pathologists

Purpose: This study aimed to understand how salaries of voice and upper airway–specialized speech-language pathologists (SLPs) differ from medical SLPs based on prevailing wage data and to give clinicians resources to better negotiate their salary and benefits. Method: A nationwide survey of voice-specialized SLPs was disseminated via various online platforms including American Speech-Language-Hearing Association Special Interest Group 3, Instagram, voice-specialized Facebook groups, and e-mail. Data were collected via REDCap. The survey investigates SLPs' salary, benefits, experience, clinical responsibilities, and profit generated through Current Procedural Terminology codes. Two separate analyses were completed. First, annual salary, as reported by participants, was compared against annual salary, as estimated by prevailing wage data. Second, a multiple regression driver analysis was completed to identify significant predictors of wage level within our sample. Outliers in the sample were removed using the Difference in Fits procedure. Results: A total of 111 participant surveys were included for analysis. Our data demonstrate that, between participant data and prevailing wage data, salaries for voice and upper airway disorders (VUAD) SLPs are significantly higher in the West, Midwest, and Southern regions. There is no significant difference in the Northeast. Several factors proved statistically significant predictors of increased salaries including years of work ( p ≤ .0001), cost of living ( p = .0030), and work in multidisciplinary setting ( p = .0223). Conclusions: As practitioners navigate negotiations for equitable compensation, leveraging localized salary data and emphasizing the value of specialized expertise may prove instrumental. Moreover, advocating for employer-sponsored professional development opportunities and benefits can enhance the overall well-being and professional satisfaction of VUAD SLPs, ensuring optimal delivery of care within this specialized field.

Expert opinion on candidacy for bone conduction hearing implants Osia System and Baha Connect System.

&lt;b&gt;Introduction:&lt;/b&gt; Bone conduction hearing implants (BCHI) are a widely used rehabilitation solution for patients with conductive hearing loss (CHL), mixed hearing loss (MHL), or single-sided deafness (SSD).&lt;b&gt;Aim:&lt;/b&gt; This expert review presents candidacy criteria considerations when choosing between active transcutaneous bone-conduction hearing devices (Osia&lt;sup&gt;&lt;/sup&gt; System) and passive percutaneous bone-conduction hearing devices (Baha&lt;sup&gt;&lt;/sup&gt; Connect System) to help streamline the decision-making process in those contexts where economics have a major impact on professionals' and patients' choice.&lt;b&gt;Methods:&lt;/b&gt; Eight experts participated in two online surveys and two virtual meetings to discuss real-world clinical experience to highlight treatment approaches and factors considered when counseling the patients and selecting an optimal BCHI solution. Key considerations for decision-making were recorded following consensus from all experts.&lt;b&gt;Conclusions:&lt;/b&gt; Aspects in decision making include the requirement to use local &lt;i&gt;versus&lt;/i&gt; general anesthesia for the implantation procedure, bone thickness, considerations for future magnetic resonance imaging (MRI) procedures, and patient preference. Increased risk of skin infections, requirements for cleaning and managing the implant site, particularly for those with limited dexterity, as well as esthetic concerns could make the Baha&lt;sup&gt;&lt;/sup&gt; Connect System unsuitable for some patients. In these cases, the Osia&lt;sup&gt;&lt;/sup&gt; System may provide clear advantages, particularly in patients for whom good hearing performance is a priority, and this would need to be discussed individually with the patient in a multidisciplinary setting. Conversely, for patients requiring minimally invasive surgery, who have contraindications for general anesthesia or require frequent head MRI scans in the future, the Baha Connect System may be more suitable.

8592 Parathyroid Carcinoma: A Rare Cause of Primary Hyperparathyroidism

Abstract Disclosure: S.E. Koshy: None. C.F. Mulcahy: None. P.S. Kothari: None. E.M. Jacobi: None. T.D. Cubb: None. Introduction: Parathyroid carcinoma (PC) is a rare malignancy that accounts for &amp;lt;1% of cases of primary hyperparathyroidism (PHPT). Patients often present with symptoms of hypercalcemia, serum calcium (Ca) &amp;gt;14 mg/dL, large tumor size, and a very high parathyroid hormone (PTH) level. We report a case of an asymptomatic patient with incidentally found hypercalcemia consistent with PHPT who was ultimately diagnosed with PC. Clinical Case: A 31yo male was found to have elevated serum Ca of 12.7 mg/dL (8.6-10.3 mg/dL) on labs obtained during routine physical exam. He had no known significant medical or family history and notably had no laboratory evaluation within the prior 10 years. He denied constipation, polyuria, confusion, depression, bone pain, and history of fractures or nephrolithiasis. Workup showed an inappropriately elevated PTH of 505 pg/mL (16-77 pg/mL). Neck ultrasound demonstrated a left inferior 3.9 cm complex thyroid nodule. Sestamibi scan confirmed increased uptake in the inferior left thyroid. Left neck exploration was performed. Intraoperatively, a 3.7 cm left parathyroid mass weighing 13.0 grams was encountered and excised in an en bloc fashion. The left superior parathyroid gland was evaluated and found to be normal. Intraoperative PTH level decreased from 529 pg/mL to 48 pg/mL 10 minutes after excision. Left hemithyroidectomy was not performed. Surgical pathology revealed PC with lymphovascular invasion, suspected capsular invasion, and negative margins. Immunohistochemical staining showed a Ki67 proliferation index up to 5% and complete loss of nuclear staining for parafibromin. Next generation sequencing demonstrated a somatic CDC73 p.L8fs mutation, tumor mutational burden 4.7m/MB, and stable microsatellite instability. Germline testing was negative for a CDC73 mutation. Postoperative staging did not demonstrate evidence of metastatic disease in the neck or chest. Serum Ca remained within normal limits. After multidisciplinary discussion, no further surgical intervention was recommended and plan was for ongoing biochemical and imaging surveillance. Conclusion: Though rare, PC should be considered as a cause of PHPT. The primary treatment is complete surgical resection. Unfortunately, there is a high rate of recurrence, &amp;gt;50%, with most occurring 2-5 years after initial surgery with a median overall survival of 14 years. Thus, long-term surveillance is of utmost importance. Treatment of recurrent disease is surgical resection when feasible as well as medical management of hypercalcemia. Further research is needed to better understand the role of targeted systemic therapy in addition to immunotherapy. PC is most commonly sporadic but can be hereditary, thus genetic evaluation is recommended. Given its rarity and complexity, PC is best managed in a multidisciplinary setting. Presentation: 6/1/2024

8592 Parathyroid Carcinoma: A Rare Cause of Primary Hyperparathyroidism

Abstract Disclosure: S.E. Koshy: None. C.F. Mulcahy: None. P.S. Kothari: None. E.M. Jacobi: None. T.D. Cubb: None. Introduction: Parathyroid carcinoma (PC) is a rare malignancy that accounts for &amp;lt;1% of cases of primary hyperparathyroidism (PHPT). Patients often present with symptoms of hypercalcemia, serum calcium (Ca) &amp;gt;14 mg/dL, large tumor size, and a very high parathyroid hormone (PTH) level. We report a case of an asymptomatic patient with incidentally found hypercalcemia consistent with PHPT who was ultimately diagnosed with PC. Clinical Case: A 31yo male was found to have elevated serum Ca of 12.7 mg/dL (8.6-10.3 mg/dL) on labs obtained during routine physical exam. He had no known significant medical or family history and notably had no laboratory evaluation within the prior 10 years. He denied constipation, polyuria, confusion, depression, bone pain, and history of fractures or nephrolithiasis. Workup showed an inappropriately elevated PTH of 505 pg/mL (16-77 pg/mL). Neck ultrasound demonstrated a left inferior 3.9 cm complex thyroid nodule. Sestamibi scan confirmed increased uptake in the inferior left thyroid. Left neck exploration was performed. Intraoperatively, a 3.7 cm left parathyroid mass weighing 13.0 grams was encountered and excised in an en bloc fashion. The left superior parathyroid gland was evaluated and found to be normal. Intraoperative PTH level decreased from 529 pg/mL to 48 pg/mL 10 minutes after excision. Left hemithyroidectomy was not performed. Surgical pathology revealed PC with lymphovascular invasion, suspected capsular invasion, and negative margins. Immunohistochemical staining showed a Ki67 proliferation index up to 5% and complete loss of nuclear staining for parafibromin. Next generation sequencing demonstrated a somatic CDC73 p.L8fs mutation, tumor mutational burden 4.7m/MB, and stable microsatellite instability. Germline testing was negative for a CDC73 mutation. Postoperative staging did not demonstrate evidence of metastatic disease in the neck or chest. Serum Ca remained within normal limits. After multidisciplinary discussion, no further surgical intervention was recommended and plan was for ongoing biochemical and imaging surveillance. Conclusion: Though rare, PC should be considered as a cause of PHPT. The primary treatment is complete surgical resection. Unfortunately, there is a high rate of recurrence, &amp;gt;50%, with most occurring 2-5 years after initial surgery with a median overall survival of 14 years. Thus, long-term surveillance is of utmost importance. Treatment of recurrent disease is surgical resection when feasible as well as medical management of hypercalcemia. Further research is needed to better understand the role of targeted systemic therapy in addition to immunotherapy. PC is most commonly sporadic but can be hereditary, thus genetic evaluation is recommended. Given its rarity and complexity, PC is best managed in a multidisciplinary setting. Presentation: 6/1/2024

Revisiting the prescription of intravenous thiamin in hospitalised adult patients in a multi-disciplinary setting

Revisiting the prescription of intravenous thiamin in hospitalised adult patients in a multi-disciplinary setting

Identifying Locations Where Self-Reported Dizziness Occurs In Patients With Vestibular Disorders In A Day Hospital Setting

Abstract Background World falls guidelines recommended that where vestibular issues are identified such as Benign Paroxysmal Positional Vertigo (BPPV), therapeutic interventions should always be sought, as potential benefits to health-related quality of life are high (Montaro-Odasso et al., 2022). Identifying potential BPPV in older adults, however, can be challenging, as many older adults experience BPPV as vague unsteadiness rather than dizziness, leading to under diagnosis of the condition (Li et al., 2023). This audit aimed to identify the locations where patients with self- reported dizziness and falls experienced dizziness, and if they subsequently were diagnosed with vestibular disorders. If potential high-risk locations for experiencing dizziness with vestibular issues are identified, this may aid in the timely identification of vestibular disorders. Methods A retrospective chart audit was undertaken in a multidisciplinary day hospital setting, where patients aged 75 years and older attend for assessments. Paper charts of patients discharged from the day hospital between January and March 2024 were reviewed. A Microsoft excel sheet was used to track data. Data on self-reported dizziness and falls as well as the location of dizziness occurring was gathered. Results A total of 103 patient charts were reviewed. Of those, 39 reported experiencing dizziness, with 90% of those patients also reporting a history of falls. 18 of these patients were subsequently diagnosed with vestibular disorders. 78% of patients diagnosed with BPPV reported experiencing dizziness getting out of bed or in their bedroom with 28% also reporting dizziness on getting up from a chair. However, 100% of patients with dizziness and falls without vestibular disorders reported dizziness on getting out of their bed. Conclusion People with all cause dizziness reported dizziness on getting out of bed. Based on the results of this audit, vestibular screening is not aided by questions surrounding location of dizziness occurring.

18F]FDG PET/CT Integration in Evaluating Immunotherapy for Lung Cancer: A Clinician's Practical Approach.

The advent of immune checkpoint inhibitors (ICIs) has revolutionized the treatment paradigm of lung cancer, resulting in notable enhancements in patient survival. Nevertheless, evaluating treatment response in patients undergoing immunotherapy poses distinct challenges due to unconventional response patterns like pseudoprogressive disease (PPD), dissociated response (DR), and hyperprogressive disease (HPD). Conventional response criteria such as the RECIST 1.1 may not adequately address these complexities. To tackle this issue, novel response criteria such as the iRECIST and imRECIST have been proposed, enabling a more comprehensive assessment of treatment response by incorporating additional scans and considering the best overall response even after radiologic progressive disease evaluation. Additionally, [18F]FDG PET/CT imaging has emerged as a valuable modality for evaluating treatment response, with various metabolic response criteria such as the PERCIMT, imPERCIST, and iPERCIST developed to overcome the limitations of traditional criteria, particularly in detecting pseudoprogression. A multidisciplinary approach involving oncologists, radiologists, and nuclear medicine specialists is crucial for effectively navigating these complexities and enhancing patient outcomes in the era of immunotherapy for lung cancer. In this review, we delineate the key components of these guidelines, summarizing essential aspects for radiologists and nuclear medicine physicians. Furthermore, we provide insights into how imaging can guide the management of individual lung cancer patients in real-world multidisciplinary settings.

Pain in chronic pancreatitis: What can we do today?

The aim of this study is to illustrate the complexity of pain management in chronic pancreatitis (CP). In this context, pain represents the most common and debilitating symptom, and it deeply affects patient's quality of life. Multiple rating scales (unidimensional, bidimensional and multidimensional) have been proposed to quantify CP pain. However, it represents the result of complex mechanisms, involving genetic, neuropathic and neurogenic factors. Considering all these aspects, the treatment should be discussed in a multidisciplinary setting and it should be approached in a stepwise manner. First, a lifestyle change is recommended and nonsteroidal anti-inflammatory drugs represent the gold standard among medical treatments for CP patients. The second step, after medical approach, is endoscopic therapy, especially for complicated CP. In case of failure, tailored surgery represents the third step and decompressive or resection procedures can be chosen. In conclusion, CP pain's management is challenging considering all these complex aspects and the lack of international protocols.