Members Of Multidisciplinary Team Research Articles

Mapping patient education encounters in elective surgery: a cohort study and cross-sectional survey.

Develop a process map of when patients learn about their proposed surgery and what resources patients use to educate themselves. A mixed methods design, combining semistructured stakeholder interviews, quantitative validation using electronic healthcare records (EHR) in a retrospective cohort and a cross-sectional patient survey. A single surgical centre in the UK. Fourteen members of the spinal multidisciplinary team were interviewed to develop the process map.This process map was validated using the EHR of 50 patients undergoing elective spine surgery between January and June 2022. Postprocedure, feedback was gathered from 25 patient surveys to identify which resources they used to learn about their spinal procedure. Patients below the age of 18 or who received emergency surgery were excluded. Elective spine surgery and patient questionnaires given postoperatively either on the ward or in follow-up clinic. The primary outcome was the percentage of the study cohort that was present at encounters on the process map. Key timepoints were defined if >80% of patients were present. The secondary outcome was the percentage of the study cohort that used educational resources listed in the patient questionnaire. There were 342 encounters which occurred across the cohort, with 16 discrete event categories identified. The initial surgical clinic (88%), anaesthetic preoperative assessment (96%) and admission for surgery (100%) were identified as key timepoints. Surveys identified that patients most used verbal information from their surgeon (100%) followed by written information from their surgeon (52%) and the internet (40%) to learn about their surgery. Process mapping is an effective method of illustrating the patient pathway. The initial surgical clinic, anaesthetic preoperative assessment and surgical admission are key timepoints where patients receive information. This has future implications for guiding patient education interventions to focus at key timepoints.

P.069 Development of a streamlined multi-disciplinary care pathway for compression neuropathies

Background: Care for patients with compression neuropathies (carpal tunnel syndrome, ulnar neuropathy) is often fragmented, uncoordinated, and slow. Patients go through multiple steps (neurology consultation, nerve testing, ultrasound, splints, injection, surgical opinion, surgery) with waits between each step. We used a Value-Based Health Care (VBHC) model to develop a multidisciplinary clinic with a novel care pathway. Methods: A Shared Care initiative supported the development of an Integrated Practice Unit (IPU). Key multidisciplinary team members were identified. Participants attended a curated three part VBHC workshop. Process mapping enabled identification of efficiencies. Results: 14 team members participated in the workshops. Condition specific outcome measures were identified (Boston CTS measure, 10-point touch, MRC strength and pain scale) and will be collected longitudinally. Criteria and clinical pathways were developed for mild, moderate, and severe carpal tunnel syndrome. Resource materials for patients and providers were developed. Conclusions: A VBHC framework supported development of a novel clinic for compression neuropathy. Responsibility for the full cycle of care rests with the IPU. Systematically tracking functional outcome measures enables quality improvement. By streamlining the patient journey and substantially reducing wait times between steps, the new care pathway reduces complexity and improve outcomes. Evaluation of impact if this new clinical model is ongoing.

Abstract PO5-06-10: Evaluating Disparities in Access to Quality Cancer Care for Black Women with Triple Negative Breast Cancer in the US: A Provider Perspective

Abstract Introduction: Triple-negative breast cancer (TNBC) presents unique challenges due to its aggressive nature and limited treatment options. Black women are disproportionately affected by TNBC, experiencing higher incidence rates and poorer outcomes compared to other racial/ethnic groups. This study aims to evaluate disparities in access to quality cancer care for Black women with TNBC from the perspective of oncology healthcare providers. Methods: From December 2022 to February 2023, the Association of Community Cancer Centers conducted a survey of 84 multidisciplinary care team members who provided care to Black patients with TNBC. The online survey captured quantitative and qualitative data on challenges related to accessing timely TNBC diagnosis and treatment services, care coordination for work-up and biomarker testing, confidence in TNBC treatment, clinical trial enrollment, supportive care services, and related referrals. Additionally, a follow-up focus group was conducted in May 2023 to further interpret select survey data, with a focus on shared decision-making, patient-provider communication, and ways to support cancer programs in improving screening, biomarker testing, and care coordination for individuals with TNBC. Results: Respondents reported several barriers to accessing timely diagnosis and treatment services for Black women with TNBC, including challenges in coordinating care for work-up and biomarker testing, providers' confidence in providing guideline-concordant comprehensive cancer care services for this patient population, enrolling patients in clinical trials, and making referrals for supportive care services. The survey revealed that community cancer programs treated an average of 21-50 patients with TNBC annually, with 31% of them being Black. Perceived patient-level factors contributing to challenges in accessing TNBC diagnosis and treatment included geographic distance to care facilities (14%), health literacy (18%), and insurance-related factors (21%). Practice-level barriers included limited accessibility of practice location (19%), capacity to accommodate new patients (27%), and insurance-related factors (34%). Additional findings highlighted slightly lower provider confidence in areas such as tobacco cessation (only 54% very confident), breast reconstruction (59% very confident), fertility counseling (52% very confident), and coordinating care across a fragmented healthcare system (52% very confident). Respondents identified the most commonly offered comprehensive cancer care services as palliative care (82%), nutrition support (77%), telemedicine (68%), psychological counseling (68%), and financial advocacy (68%). Less commonly offered services include recreational therapy (21%), legal aid (17%), and childcare (16%). Conclusion: This study highlighted the barriers faced by providers in delivering quality cancer care to Black women with TNBC. The findings underscore the importance of addressing challenges related to timely diagnosis and treatment services, care coordination, confidence in treatment options, clinical trial enrollment, and referrals for supportive care services. Insights from the focus group discussions further highlight the need for shared decision-making, improved patient-provider communication, and identification of opportunities to support cancer programs in addressing the specific needs of Black women with TNBC. To advance equity in cancer care, targeted interventions should focus on enhancing provider education, improving care coordination systems, and promoting cultural sensitivity. Efforts should also be made to overcome barriers related to limited accessibility of practice location, and insurance-related factors. By addressing these gaps, providers can play a crucial role in reducing disparities and improving outcomes for Black women with TNBC. Citation Format: Doreen Effange, Niharika Dixit, Ruth O'Regan, Ogori Kalu, Ryann Norcereto, Richard Simonds, Elizabeth Valencia, LaToya Bolds-Johnson, Aubrey Van Kirk Villalobos, Christie Mangir, Elana Plotkin, Karen Tacka, Leigh Boehmer. Evaluating Disparities in Access to Quality Cancer Care for Black Women with Triple Negative Breast Cancer in the US: A Provider Perspective [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-06-10.

Exploring the role of the pharmacist within the Hospital@Home team at a tertiary centre in England

Abstract Introduction Hospital@Home (H@H) is an emerging healthcare model providing hospital-level care within patients’ homes (1). Despite its global presence for three decades, H@H adoption remains limited in the United Kingdom. The COVID-19 pandemic prompted National Health Service (NHS) England to promote virtual wards, including H@H, as an innovative care alternative (2). Among the pivotal functions in H@H are prescribing, administering, or stopping medications, where pharmacists play a critical role, undertaking these tasks along with the multidisciplinary team (MDT). However, there has been little research that investigates pharmacists’ scope of practice in H@H. Aim To explore the role of the pharmacist within the H@H team at a tertiary centre in England. Methods A qualitive study was conducted using 1) online (via Microsoft Teams) or in-person audio-recorded semi-structured interviews with pharmacists working in the tertiary centre’s H@H team, and 2) non-participant observations of purposively sampled MDT H@H team meetings; heart failure, general care and antibiotic. Pharmacists’ collaboration with MDT members, tasks they performed and how the MDT made decisions were the focus of the observations. Interview transcripts and observation field notes were concurrently analysed inductively to generate key themes. All three H@H pharmacists were approached to take part in the study. All members of the respective MDTs were recruited to take part in the observations. All participants gave informed consent. Results All three H@H pharmacists participated in interviews. Six MDT meetings were observed, attended by doctors (n=7), nurses (n=8) and pharmacists (n=3). Interviews lasted approximately 45 minutes each and MDT meetings lasted 30-120 minutes. Four main themes were generated from the analysis: 1. Scope of practice extends beyond a “traditional” pharmacist. 2. Being open-minded to a changing scope of practice. 3. Active collaboration with MDT members underpins and expands role. 4. Is intentional about, and advocates for the provision of patient-centered care. Pharmacists’ varied scope of practice (e.g. participating/co-leading MDT meetings and conducting home visits) placed them in pivotal roles in patient care coordination, treatment planning, and decision-making. Pharmacists were open-minded and proactive in expanding the scope of H@H care, and their role. They continuously acquired new skills as they encounter and provide diverse care scenarios. Their specialised knowledge and skillsets were viewed by the MDT as an asset. Pharmacists were reflective practitioners, saw patients as complex individuals with specific needs to care for and advocated for their needs. Conclusion To our knowledge, this is the first study exploring the role of the H@H pharmacist in England, adding to the knowledge base in this emerging service delivery; pharmacists undertake non-traditional clinical roles in the team, work collaboratively with others to expand the service and their own skillset, to advocate for the need of patients. Although only three pharmacists were interviewed, this was the entire available sample. The study did not include home visit observations, which could provide insights into pharmacists’ interactions with patients in their homes. Future research can focus on complementing the findings of this study with in-depth exploration of the pharmacist’s role in H@H settings.

P005 Early inflammatory arthritis combined nurse and therapist clinic

Abstract Background/Aims NICE guidelines recommend patients have ongoing access to a multidisciplinary team (MDT). However, ensuring all patients are seen by physiotherapy, podiatry, and occupational therapy (OT), when needed, can be challenging. The aim of the project was for patients to be seen by a therapist, in the first six months of their disease. The plan was to provide treatment and encourage long-term self-management, by providing knowledge of when self-referring to the different therapy services would be beneficial. Methods A Nurse and therapist pilot clinic was implemented at the first Disease Modifying Anti-Rheumatic Drugs review appointment. The clinic allowed 15-minutes with a specialist nurse to discuss medication issues and drug counselling. This was followed by 30-minutes with a therapist, to discuss any functional needs and objectively assess any joint issues and to provide treatment. Patients were educated about their condition and signposted to information. Patients were also provided with self-management advice and informed about the role of MDT members. Written or emailed advice was provided. Patients were invited to complete an anonymous questionnaire evaluating their experience. Results 60 patients were seen in the first three months. Personalised therapy input was given to each patient; however, hand exercises and joint protection advice was given to over 60% of patients. Other therapy input included exercises for other specific joints that were problematic, the provision of wrist splints and relaxation advice. Results of the patient questionnaire showed 98% of patients felt they ‘definitely’ had more information to help manage their arthritis and 100% felt they knew where to go to get more information, if needed. Patients also had a greater understanding of the role of physiotherapy and OT. 88% of patients were confident they would ‘definitely’ know when to ask to be referred to these specialities in the future. Less than 15% of patients required further therapy input following the appointment. Conclusion The pilot clinic received excellent patient feedback and fulfilled the aims of providing therapy input, early in patient’s journey. Patients liked the convenience of seeing both the professionals in one visit, felt they had gained more information on their condition and were able to help themselves. Patient’s comments included ‘feeling more supported’ and ‘being able to help myself’. One experienced therapist seeing the patients was more cost effective than separate physiotherapy and OT appointments. The next stage will be to invite all newly diagnosed patients into this clinic as part of an early inflammatory arthritis pathway. We will then audit the impact on therapy referral rates and assess if early intervention reduces the number of therapy referrals long-term, encourages patient self-management and improves patient outcomes. Disclosure H. Harrison: None. R. Allan: None.

Role of a Pharmacist in Postdischarge Care for Patients With Kidney Disease: A Scoping Review.

The objective was to explore and describe the role of pharmacists in providing postdischarge care to patients with kidney disease. PubMed, Embase (Elsevier), CINAHL (Ebscohost), Web of Science Core Collection, and Scopus were searched on January 30, 2023. Publication date limits were not included. Search terms were identified based on 3 concepts: kidney disease, pharmacy services, and patient discharge. Experimental, quasi-experimental, observational, and qualitative studies, or study protocols, describing the pharmacist's role in providing postdischarge care for patients with kidney disease, excluding kidney transplant recipients, were eligible. Six unique interventions were described in 10 studies meeting inclusion criteria. Four interventions targeted patients with acute kidney injury (AKI) during hospitalization and 2 evaluated patients with pre-existing chronic kidney disease. Pharmacists were a multidisciplinary care team (MDCT) member in 5 interventions and were the sole provider in 1. Roles commonly identified include medication review, medication reconciliation, medication action plan formation, kidney function assessment, drug dose adjustments, and disease education. Some studies showed improvements in diagnostic coding, laboratory monitoring, medication therapy problem (MTP) resolution, and patient education; prevention of hospital readmission was inconsistent. Limitations include lack of standardized reporting of kidney disease, transitions of care processes, and differences in outcomes evaluated. This review identifies potential roles of a pharmacist as part of a postdischarge MDCT for patients with varying degrees of kidney disease. The pharmacist's role in providing postdischarge care to patients with kidney disease is inconsistent. Multidisciplinary care teams including a pharmacist provided consistent identification and resolution of MTPs, improved patient education, and increased self-awareness of diagnosis.

Occupational therapy practice with burn injuries: A Rapid Review

Introduction: The Occupational Therapy Association of South African commissioned a task team to gather evidence that would inform upcoming National Health policies on the role and practice of occupational therapists. This rapid review aimed to identify level 1 and 2 peer reviewed published evidence that describes occupational therapists’ practice and intervention in all types of burn injuries, at all levels of care, and for all age groups.
 Method: Using the South African Department of Health template and the Cochran Rapid Reviews method guide, a search for level 1 and 2 evidence sourced articles from CINAHL (EBSCO), MEDLINE (EBSCO), the Cochrane Library (Wiley) and OTSeeker data bases through the Stellenbosch University library with hand searching of references in the selected articles. Rayyan was used for the screening and selection of articles. The CASP appraisal tool was used for risk bias and quality assessment of the selected articles. Data was captured in Excel and Word, and analysed and synthesised in Microsoft Excel and Taguette. Results were presented in the form of an online workshop to stakeholders and discussions and questions incorporated into the discussion and conclusion of this review.
 Results: Eleven articles were selected and their quality assessed. Seven categories of evidence of occupational therapy interventions were extracted from selected articles: pain, oedema, scaring and abnormal skin sensations, joints and range of motion, psycho-social and functional impact of burn injuries, the education of burn injury victims and their families, and vocational rehabilitation. All interventions took place in healthcare facilities. Nine articles referred to occupational therapists working in multi-disciplinary teams. Occupational therapist worked with children and adult burn injury victims and with a variety of type of burn injury from acute to post discharge phases.
 Conclusion: There is level 1 and 2 evidence conderming occupational therapy intervention with burn injury victims with all ages and at all stages of injury within healthcare facilities. None of the evidence found is from the South African context. Such levels of evidence are needed to promote occupational therapy intervention in primary, preventative and community contexts.
 Implications for practice:
 Internationally there is level 1 and 2 evidence that conderms occupational therapists are members of multi-disciplinary teams addressing the functional ability and participation in activities of burn injury victims. None of this evidence is from South Africa. As a matter of priority, South African clinical occupational therapy practice and intervention within the deeld of burn injury, need to be researched and disseminated as level 1 and 2 evidence

Quality of life in young Romanian athletes

Quality of life means different things to different people, according, also, to the area of application. The aim of the research was to capture the quality of life experienced by young athletes, according to gender, sport performance, and related to the type of sport practiced. 116 athletes participated in the research, practicing individual and team sports. Starting from the Quality of Life Inventory developed by Michael B. Frisch, fifteen life domains were measured. After applying the t test for independent samples, no gender-related differences were observed in terms of perceived quality of life. However, athletes practicing individual sports were significantly more satisfied by their work and creativity (manifested in daily activities), and, also, regarding love and children (as life domains), compared to athletes practicing team sports. Using one-way analysis of variance, the experienced life quality according to the practiced type of sport (football, other team sports, striking combat sports, respectively other individual sports) was examined. Furthermore, data analysis emphasized that athletes with international results express significantly higher levels of satisfaction regarding their self-esteem in life domains such as love and children, compared to athletes who attain local or regional performances. Additionally, they exhibit significantly greater satisfaction with their creativity in daily activities but express less satisfaction with their community, compared to athletes achieving national-level sports results. The findings provide important data to coaches, multi-disciplinary team members and parents on the areas of quality of life that athletes are currently more or less satisfied with. In-depth interviews with athletes are necessary to better understand the differences observed.

Exploring the Role of Medical Social Workers in Teaching and Non-Teaching Hospitals: A Study on the Potential Establishment of a Department of Medical Social Work

Medical social work plays a pivotal role in ensuring comprehensive and quality healthcare delivery, particularly in hospital settings. This paper delineates the multifaceted responsibilities undertaken by medical social workers, encompassing ethical treatment, transparency in hospital management, and advocacy for the welfare of vulnerable patients. It examines the historical evolution of medical social work in India, tracing its roots to the pioneering efforts of institutions like the Dorabji Tata Graduate School of Social Work. Furthermore, it elucidates the guidelines set forth by the Medical Council of India, emphasizing the critical need for medical social workers in both rural and urban healthcare facilities. In exploring the possibility of establishing dedicated departments for medical social work, this paper proposes a complementary framework to the existing department of community medicine. By delineating the roles and responsibilities of medical social workers in rural and urban health training centers, it underscores their significance in addressing community health determinants and facilitating access to essential services. It also highlights the potential for medical social workers to contribute as multidisciplinary team members across various hospital departments, thereby amplifying their impact on patient care and rehabilitation processes. In conclusion, the paper underscores the imperative of recognizing and strengthening the role of medical social workers in healthcare delivery systems. By fostering greater awareness, professional development, and institutional support, we can harness the full potential of medical social work to promote health equity and social justice for all individuals.

Headache Specialists' Perceptions of the Role of Health Psychologists in Headache Management: A Qualitative Study.

Background Since headache specialists cannot treat all the patients with headache disorders, multidisciplinary teams that include health psychologists are becoming more prevalent. Health psychologists mainly use a form of cognitive-behavioral therapy (CBT), along with biofeedback on occasion, to effectively address patients' pain and headache disorders. The Veterans Health Administration (VHA) is one setting that routinely includes a health psychologist with advanced training in pain disorders in their pain care to its veterans. The VHA has established Headache Centers of Excellence (HCoE) around the country to provide multidisciplinary treatment for patients with headache disorders, which enables headache specialists to regularly interact with health psychologists. Objective The study's objective is to evaluate headache specialists' views of health psychologists in the treatment of patients with headache disorders. Method Semi-structured interviews were conducted with headache specialists in academic-based healthcare settings, the community, and VHA HCoE sites. The interviews were audio-recorded and de-identified so they could be transcribed and analyzed using content matrix analysis. Results Four themes emerged: headache specialists desired to work with health psychologists and included them as members of multidisciplinary teams; valued health psychologists because they provided non-pharmacological treatments, such as CBTand biofeedback; preferred in-person communication with health psychologists; and used multiple titles when referring to health psychologists. Conclusion Headache specialists valued health psychologists as providers of behavioral and non-pharmacological treatments and considered them essential members of multidisciplinary teams. Headache specialists should strive to work with a headache psychologist, not just a general health psychologist. By committing to this, headache specialists can foster changes in the quality of care, resource allocation, and training experiences related to health psychologists.

The Integration of Physical Therapists and Occupational Therapists into Burn Wound Care Increases Therapist Productivity, Job Satisfaction, and Multidisciplinary Collaboration.

When attempting to deliver specialized rehabilitation therapy interventions, physical therapists (PTs) and occupational therapists (OTs) must account for dynamic and logistical patient factors such as: daily wound care, pain, difficultly progressing range of motion with dressings donned, and ongoing surgical interventions. Additionally, they must attain institution-specific productivity standards. Given burn patients often require considerable multidisciplinary interventions, efficiently planning and delivering rehabilitation therapy interventions within productivity expectations may prove difficult. The purpose of this study was to assess the feasibility of integrating rehabilitation therapists, PTs and OTs, into daily burn wound care by investigating therapist productivity and multidisciplinary perceptions of this practice change. The quality improvement project involved six rehabilitation therapists (three PTs and three OTs) practicing exclusively in the burn unit within an American Burn Association (ABA) verified burn center at an urban, tertiary care academic medical center. One rehabilitation therapist was responsible for providing interventions within the burn wound care team five days a week. General duties included wound assessment, functional wound dressings, and skilled therapeutic interventions such as manual therapy, therapeutic exercise, and compression interventions. The primary outcome was changes in group productivity and individual therapist productivity, as measured by total billed CPT codes per hour worked, which were tracked 22 weeks pre- and 28 weeks post-implementation. Program feasibility and general perceptions were assessed by a qualitative questionnaire. For both the entire group of therapists and each individual rehabilitation therapist, billed CPT codes per hour increased post implementation, 1.81 versus 1.54 (p=0.005) and a matched increase of 0.27/hr (p=0.003). Of the 23 survey respondents, 96% had a favorable impression of the program and reported it eased staffing demands. All respondents reported improved unit workflow and multidisciplinary communication. The majority of multidisciplinary burn team members actively supported the pilot program and commented on improvements in patient care. Full-time rehabilitation therapy participation in wound care increases therapist productivity and job satisfaction. Future efforts, however, should focus on measuring specific patient outcomes and cost as a result of therapist integration into daily wound care practice.

Applications of motivational interviewing in adolescent solid organ transplant.

Adolescence is a developmental period that is known for the highest risk of difficulties with adoption and maintenance of health behaviors for successful transplant. Motivational interviewing (MI) has been demonstrated to be an effective strategy in the management of modifiable factors impacting adherence in both adult transplant and analogous pediatric chronic illness populations. This paper describes MI and its applicability to adolescent transplant, providing examples of its potential use at each stage of the transplant journey. Literature on the principles and utilization of MI are reviewed, as well as the use of MI in adult transplant and similar pediatric populations. Evidence suggests high applicability of concepts of MI to pediatric transplant. Systems-level factors influencing health behavior change are discussed, along with the importance of recognizing and managing provider bias in MI-based interactions. MI does not require a licensed behavioral health provider to use it effectively; rather, it can be used by various multidisciplinary team members throughout the course of clinical care. MI shows great promise as a useful intervention through all stages in the transplant journey. Though particularly well-suited to adolescents, its principles are effective across the lifespan, including with caregivers. It represents an interactional style for use by multidisciplinary team members in many patient-and caregiver-facing scenarios. As the goal is to support the patient's autonomy in decision-making, it is important for providers to recognize their own biases. Further resources for training are provided.

Social network analysis of the CaRE2 health equity center: Team science in full display.

Cancer health disparities that exist in the Black or African American and Hispanic or Latino/x communities are scientific challenges, yet there are limited team science approaches to mitigate these challenges. This article's purpose is to evaluate the team science collaborations of the National Institutes of Health-funded Florida-California Cancer Research, Education & Engagement (CaRE2 ) Center partnership underscoring the inclusion of multidisciplinary team members and future under-represented minority (URM) cancer researchers. To understand our collaborative efforts, we conducted a social network analysis (SNA) of the CaRE2 Center partnership among University of Florida, Florida A&M University, and University of Southern California with data collected via the dimensions.ai application programming interface. We downloaded metadata for all publications associated with dimensions.ai IDs. The CaRE2 collaboration network increased over time as evidenced by accruing more external collaborators and more publishing of collaborative works. Degree centrality of key personnel was stable in each wave of the networks. CaRE2 key personnel averaged a total of 60.8 collaborators in 2018-2019 (SD = 57.4, minimum = 3, maximum = 221), and 65.8 collaborators in 2020-2021 (SD = 56.06, minimum = 4, maximum = 222). Betweenness was largely stable across all groups and waves. We observed a steady decline in transitivity, the probability that a pair of CaRE2 co-authors shared a third co-author, from 0.74 in 2018 to 0.47 in 2022. The SNA findings suggest that the CaRE2 Center partnership's publications show growth in team science collaborations with the inclusion of multidisciplinary team members from the three partner institutions and future URM cancer researchers who were mentored as trainees and early-stage investigators.

Experience of multidisciplinary medical teams on humanistic palliative care in oncology wards: a descriptive qualitative study in Southern China

ObjectivesThis study aimed to explore the experiences of multidisciplinary medical teams in implementing humanistic palliative care within the oncology ward.DesignPurposive and snowball sampling methods were used in this qualitative study,...

Improving attitudes toward trauma-informed care in the neonatal intensive care unit through comprehensive multi-disciplinary education.

This study measured staff understanding and integration of trauma-informed care following comprehensive education. This mixed method design used the validated Attitudes Related to Trauma-Informed Care (ARTIC) scale and open-ended survey questions via REDCap optional surveys. Trauma-informed care education was made available to staff members in a level IV NICU. Pre- and post-intervention ARTIC scores were compared and post-intervention REDCap surveys were analyzed. There were 245 multi-disciplinary NICU team members who completed the ARTIC survey before and/or after the educational intervention; and 764 REDCap surveys were completed throughout the study time. ARTIC scores increased from pre- to post-training both for participants with data at both time points (0.5 SD mean increase) and among those with data at only one time point (0.4 SD mean increase). Content analysis of the REDCap survey corroborated the ARTIC results. System-wide trauma-informed education can achieve measurable effect in a NICU setting.

A Scoping Review of Compassion Fatigue and Compassion Satisfaction in Burn Therapists.

Occupational and physical therapists who routinely provide potentially painful and distressing rehabilitation to burn survivors are at risk for developing compassion fatigue. Burn therapists may also experience compassion satisfaction based on the successes their patients accomplish. The purpose of this review was to synthesize the literature related to compassion fatigue and satisfaction in therapists who work with burn survivors, explore previously reported predictors and mediators of (and responses to) these constructs, and identify gaps in the literature. Original, peer-reviewed papers published from journal inception to May 2023 were obtained from 5 electronic bibliographic databases: CINAHL, Embase, PsycINFO, PubMed, and Web of Science. Studies were eligible if they (1) reported compassion fatigue or its related concepts and (2) focused on occupational or physical therapists who work with burn survivors directly or as a member of a multidisciplinary burn treatment team. The initial search revealed 284 articles, 2 of which met inclusion criteria and are summarized in this scoping review. Neither article focused solely on burn therapists but examined the experiences of multidisciplinary burn team members working in single burn centers in North America. Both studies used a cross-sectional survey-based design to assess concepts related to compassion fatigue and compassion satisfaction. This scoping review uncovered important gaps in the literature related to compassion fatigue or satisfaction in burn therapists. More research is needed to better understand the interplay between concepts as well as their relationship to burn therapists' outcomes.

Future directions for patient engagement in research: a participatory workshop with Canadian patient partners and academic researchers

BackgroundPatient engagement in research (also commonly referred to as patient or patient and public involvement in research) strives to transform health research wherein patients (including caregivers and the public) are regularly and actively engaged as multidisciplinary research team members (i.e. patient partners) working jointly towards improved health outcomes and an enhanced healthcare system. To support its mindful evolution into a staple of health research, this participatory study aimed to identify future directions for Canadian patient engagement in research and discusses its findings in the context of the international literature.MethodsThe study met its aim through a multi-meeting pan-Canadian virtual workshop. Participants (n = 30) included Strategy for Patient-Oriented Research-funded academic researchers and patient partners identified through a publicly available database, personal and professional networks and social media. All spoke English, could access the workshop virtually, and provided written informed consent. The workshop was composed of four, 1.5–3-h virtual meetings wherein participants discussed the current and preferred future states of Canadian patient engagement in research. Workshop discussions (i.e. data) were video and audio recorded. Themes were generated through an iterative process of inductive thematic analysis that occurred concurrently with the multi-week workshop.ResultsOur participatory and iterative process identified 10 targetable areas of focus for the future of Canadian patient engagement in research. Five were categorized as system-level (systemic integration; academic culture; engagement networks; funding models; compensation models), one as researcher-level (engagement processes), and four crossed both levels (awareness; diversity and recruitment; training, tools and education; evaluation and impact). System level targetable areas called for reshaping the patient engagement ecosystem to create a legitimized and supportive space for patient engagement to be a staple component of a learning health system. Researcher level targetable areas called for academic researchers and patient partners to collaboratively generate evidence and apply knowledge to inform values and behaviours necessary to foster and sustain supportive health research spaces that are accessible to all.ConclusionsFuture directions for Canadian patient engagement in research span 10 interconnected targetable areas that require strong leadership and joint action between patient partners, academic researchers, and health and research institutions if patient engagement is to become a ubiquitous component of a learning health system.

LIONS PREY: A New Logistic Scoring System for the Prediction of Malignant Pulmonary Nodules.

Classifying radiologic pulmonary lesions as malignant is challenging. Scoring systems like the Mayo model lack precision in predicting the probability of malignancy. We developed the logistic scoring system 'LIONS PREY' (Lung lesION Score PREdicts malignancY), which is superior to existing models in its precision in determining the likelihood of malignancy. We evaluated all patients that were presented to our multidisciplinary team between January 2013 and December 2020. Availability of pathological results after resection or CT-/EBUS-guided sampling was mandatory for study inclusion. Two groups were formed: Group A (malignant nodule; n = 238) and Group B (benign nodule; n = 148). Initially, 22 potential score parameters were derived from the patients' medical histories. After uni- and multivariate analysis, we identified the following eight parameters that were integrated into a scoring system: (1) age (Group A: 64.5 ± 10.2 years vs. Group B: 61.6 ± 13.8 years; multivariate p-value: 0.054); (2) nodule size (21.8 ± 7.5 mm vs. 18.3 ± 7.9 mm; p = 0.051); (3) spiculation (73.1% vs. 41.9%; p = 0.024); (4) solidity (84.9% vs. 62.8%; p = 0.004); (5) size dynamics (6.4 ± 7.7 mm/3 months vs. 0.2 ± 0.9 mm/3 months; p < 0.0001); (6) smoking history (92.0% vs. 43.9%; p < 0.0001); (7) pack years (35.1 ± 19.1 vs. 21.3 ± 18.8; p = 0.079); and (8) cancer history (34.9% vs. 24.3%; p = 0.052). Our model demonstrated superior precision to that of the Mayo score (p = 0.013) with an overall correct classification of 96.0%, a calibration (observed/expected-ratio) of 1.1, and a discrimination (ROC analysis) of AUC (95% CI) 0.94 (0.92-0.97). Focusing on essential parameters, LIONS PREY can be easily and reproducibly applied based on computed tomography (CT) scans. Multidisciplinary team members could use it to facilitate decision making. Patients may find it easier to consent to surgery knowing the likelihood of pulmonary malignancy. The LIONS PREY app is available for free on Android and iOS devices.

Evaluation of UK paediatric nephrology teams' understanding, experience and perceptions of oral health outcomes and accessibility to dental care: a mixed-methods study.

Oral health conditions are common in children and young people (CYP) with kidney disorders. There is currently limited literature on how confident paediatric nephrology teams feel to identify and manage oral health concerns for their patients. An exploratory mixed-method survey was distributed across all 13 UK specialist paediatric nephrology centres with responses received from consultants, registrars, specialist nurses and special interest (SPIN) paediatricians. Responses received from 109 multidisciplinary team members of 13/13 (100%) UK tertiary units. Ninety-two percent (n = 100) of respondents reported they had never received any training in oral health and 87% (n = 95) felt that further training would be beneficial to optimise care for patients and improve communication between medical and dental teams. Most respondents reported that they did not regularly examine, or enquire about, their patients' oral health. Only 16% (n = 17) reported that all their paediatric kidney transplant recipients underwent routine dental assessment prior to transplant listing. Severe adverse oral health outcomes were rarely reported and only 11% (n = 12) of respondents recalled having a patient who had a kidney transplant delayed or refused due to concerns about oral infection. Seventy-eight percent (n = 85) felt that joint working with a dental team would benefit patients at their unit; however, 17% (n = 18) felt that current infrastructure does not currently support effective joint working. Across the UK, paediatric kidney health professionals report lack of confidence and training in oral health. Upskilling subspecialty teams and creating dental referral pathways are recommended to maximise oral health outcomes for CYP with kidney diseases.

1846 A bespoke teaching programme for Hospital at Home improves staff confidence in the clinical management of HaH presentations

Abstract Background Hospital at Home (HaH) provides high acuity clinical care for patients in the community. HaH teams are varied and multidisciplinary. A successful HaH service depends upon streamlined communication between multidisciplinary team (MDT) members, facilitated by an integrated knowledge base. Whilst training protocols are under development, there are currently no published teaching programmes for HaH. We responded to this unique challenge by devising a teaching programme for the HaH team at St John’s Hospital, Livingston. Methods We identified learning needs within our team with a preliminary survey. We conducted a literature review to select four competency resources which were mapped to five domains: clinical care; pharmacy; service design and delivery; anticipatory care planning and palliative care; and ethical and legal guidance. We formalised a weekly teaching session and linked teaching topics to the core competencies. We conducted a review at 3 months and 6 months to assess the impact of the programme on staff learning and clinical confidence. Results A tailored teaching programme with domains linked to multidisciplinary competencies increases staff confidence in the clinical management of common HaH presentations. Our bespoke programme has successfully delivered teaching that caters for multiple clinical backgrounds. Conclusions HaH teams represent an opportunity to learn from MDT colleagues with diverse training backgrounds and offer a unique challenge in tailoring teaching to multiple learning needs. A formal programme with clear, identifiable domains linked to learning objectives provides an essential framework for staff to demonstrate engagement with professional development, allows staff to develop personal teaching skills and cultures a strong collaborative learning environment. Going forward, we aim to evaluate the impact on staff competence and formalise a cyclical HaH curriculum for circulation to the NHS Lothian HaH teams with scope for wider dissemination.