Multidisciplinary Team Of Specialists Research Articles

Alström Syndrom: A Clinical Case

Background. Alström syndrome is a rare autosomal recessive disease characterized by multiple organ dysfunction. The prevalence in the population is less than one person per 1 million. Genomic mutation analysis study identified 109 new mutations increasing the number of known mutations of the ALMS1 protein to 239 which highlights the allelic heterogeneity of this disease and its phenotypic diversity.The aim of the work. Increasing awareness among medical professionals regarding Alström syndrome.Materials and methods. The analysis of the medical record of an outpatient patient, data from paraclinical research methods of the child of patient P., born in 2013, who was examined at the Children’s Regional Clinical Hospital (CRCH; Krasnodar).Results. The disease debuted with an acute respiratory infection at the age of 4 months, the primary clinical manifestations were acute respiratory failure, and therefore, the child was hospitalized at CRCH. The results of additional research methods revealed dilated cardiomyopathy with reduced global contractility of the left ventricle. For further disease diagnosis and treatment correction, the child was referred to the National Medical Research Center for Children’s Health (NMRCCH), where he was observed for several years by a multidisciplinary team of specialists. Based on results of molecular genetic studies (pathogenic homozygous mutation in the ALMS1 gene), the child was diagnosed with Alström syndrome at the age of 8 years.Discussion. This report illustrates difficulty diagnosis and lack of specific treatment.Conclusion. This clinical case demonstrates a wide range of phenotypic features of the rare hereditary Alström syndrome.

Decision making for health-related research outcomes that alter diagnosis: A model from paediatric brain tumours.

The question of how to handle clinically actionable outcomes from retrospective research studies is poorly explored. In neuropathology, this problem is exacerbated by ongoing refinement in tumour classification. We sought to establish a disclosure threshold for potential revised diagnoses as determined by the neuro-oncology speciality. As part of a previous research study, the diagnoses of 73 archival paediatric brain tumour samples were reclassified according to the WHO 2016 guidelines. To determine the disclosure threshold and clinical actionability of pathology-related findings, we conducted a result-evaluation approach within the ethical framework of BRAIN UK using a surrogate clinical multidisciplinary team (MDT) of neuro-oncology specialists. The MDT identified key determinants impacting decision-making, including anticipated changes to patient management, time elapsed since initial diagnosis, likelihood of the patient being alive and absence of additional samples since cohort inception. Ultimately, none of our research findings were considered clinically actionable, largely due to the cohort's historic archival and high-risk nature. From this experience, we developed a decision-making framework to determine if research findings indicating a change in diagnosis require reporting to the relevant clinical teams. Ethical issues relating to the use of archival tissue for research and the potential to identify actionable findings must be carefully considered. We have established a structured framework to assess the actionability of research data relating to patient diagnosis. While our specific findings are most applicable to the pathology of poor prognostic brain tumour groups in children, the model can be adapted to a range of disease settings, for example, other diseases where research is dependent on retrospective tissue cohorts, and research findings may have implications for patients and families, such as other tumour types, epilepsy-related pathology, genetic disorders and degenerative diseases.

589 Survivorship After Radical Gastrectomy with Adjuvant Chemoradiotherapy for Locally Advanced Gastric and Junctional Adenocarcinoma

Abstract Introduction In the US Intergroup-0116 trial adjuvant chemoradiotherapy (aCRT) significantly improved overall survival (OS) compared with surgery alone for locally advanced gastric adenocarcinoma. Subsequently, the CRITICS and ARTIST-2 trials demonstrated no additional benefit to aCRT compared with chemotherapy alone. The aim of this study was to evaluate long-term outcomes in survivorship among patients previously treated with radical D2 gastrectomy and aCRT (MacDonald Regimen). Method Consecutive patients who underwent aCRT following radical D2 gastrectomy between 2002-2018 were identified from a prospectively maintained database. Among patients without evidence of recurrence at 1 year postoperatively, long-term radiotherapy complications were coded using the framework of the Common Toxicity Criteria for Adverse Events (CTCAE) V5, and use of nutritional adjuncts and micronutrient supplementation recorded. Results Some 49 patients were included (pT3-4, 88%; pN2-3, 61%; diffuse type, 45%). Median, 1-, 3- and 5-year OS were 29.8 months, 90%, 45% and 41%. Late effects data were available for 18 patients. Gastrointestinal late effects were evident in 81% (most commonly dysphagia, subacute obstructive symptoms, food intolerance and diarrhoea). Small bowel obstruction occurred in 2 patients, small intestinal bacterial overgrowth in 2 patients and pancreatic exocrine insufficiency in 2 patients. 3 patients required long-term oral nutritional supplementation, and 2 required home enteral nutrition. Conclusions Despite adverse pathological features, long-term survival was achieved in a significant proportion of patients. However, these data highlight that adjuvant chemoradiotherapy following radical gastrectomy with D2 lymphadenectomy may be associated with considerable late effects in survivorship, and management within specialist multidisciplinary teams is advocated.

The Role of Musculoskeletal Training During Return to Performance Following Relative Energy Deficiency in Sport.

Relative energy deficiency in sport (REDs) is a condition that is associated with negative health and performance outcomes in athletes. Insufficient energy intake relative to exercise energy expenditure, resulting in low energy availability, is the underlying cause, which triggers numerous adverse physiological consequences including several associated with musculoskeletal (MSK) health and neuromuscular performance. This commentary aims to (1) discuss the health and performance implications of REDs on the skeletal and neuromuscular systems and (2) examine the role that MSK training (ie,strength and plyometric training) during treatment and return to performance following REDs might have on health and performance in athletes, with practical guidelines provided. REDs is associated with decreases in markers of bone health, lean body mass, maximal and explosive strength, and muscle work capacity. Restoration of optimal energy availability, mainly through an increase in energy intake, is the primary goal during the initial treatment of REDs with a return to performance managed by a multidisciplinary team of specialists. MSK training is an effective nonpharmacological component of treatment for REDs, which offers multiple long-term health and performance benefits, assuming the energy needs of athletes are met as part of their recovery. Supervised, prescribed, and gradually progressive MSK training should include a combination of resistance training and high-impact plyometric-based exercise to promote MSK adaptations, with an initial focus on achieving movement competency. Progressing MSK training exercises to higher intensities will have the greatest effects on bone health and strength performance in the long term.

Use of telehealth to improve health outcomes for those with motor neuron disease: a mixed-methods systematic literature review

Background: Multidisciplinary care has been shown to improve the quality of life and extend survival for patients with motor neuron disease (pwMND). Several barriers to accessing care have been previously identified. Telehealth can potentially mitigate this by providing remote specialist healthcare services. Aims: Systematically review the existing literature to assess if and how telehealth can reduce barriers to access multidisciplinary team (MDT) care and improve health outcomes for pwMND. Methods: A mixed-methods, systematic literature review was conducted to identify evaluations of telehealth interventions. Telehealth interventions were evaluated using the Evaluating Digital Health Interventions Framework. Findings: A total of 293 articles were identified from the search and 16 studies met the criteria for inclusion in the review. Modes of telehealth delivery included video conferencing, app-based self-assessment and remote monitoring. Healthcare outcomes identified as being approved included accessibility, improved communication, timely interventions and satisfaction. Conclusion: Telehealth has the potential to mitigate barriers to access to specialist MDT and improve healthcare outcomes for pwMND. Patients’ preferences should always be considered in decision-making when considering available options.

Use of telehealth to improve health outcomes for those with motor neuron disease: a mixed-methods systematic literature review

Background: Multidisciplinary care has been shown to improve the quality of life and extend survival for patients with motor neuron disease (pwMND). Several barriers to accessing care have been previously identified. Telehealth can potentially mitigate this by providing remote specialist healthcare services. Aims: Systematically review the existing literature to assess if and how telehealth can reduce barriers to access multidisciplinary team (MDT) care and improve health outcomes for pwMND. Methods: A mixed-methods, systematic literature review was conducted to identify evaluations of telehealth interventions. Telehealth interventions were evaluated using the Evaluating Digital Health Interventions Framework. Findings: A total of 293 articles were identified from the search and 16 studies met the criteria for inclusion in the review. Modes of telehealth delivery included video conferencing, app-based self-assessment and remote monitoring. Healthcare outcomes identified as being approved included accessibility, improved communication, timely interventions and satisfaction. Conclusion: Telehealth has the potential to mitigate barriers to access to specialist MDT and improve healthcare outcomes for pwMND. Patients’ preferences should always be considered in decision-making when considering available options.

Leveraging the pleural space for anticancer therapies in pleural mesothelioma.

Most patients with pleural mesothelioma (PM) present with symptomatic pleural effusion. In some patients, PM is only detectable on the pleural surfaces, providing a strong rationale for intrapleural anticancer therapy. In modern prospective studies involving expert radiological staging and specialist multidisciplinary teams, the population incidence of stage I PM (an approximate surrogate of pleura-only PM) is higher than in historical retrospective series. In this Viewpoint, we advocate for the expansion of intrapleural trials to serve these patients, given the paucity of data supporting licensed systemic therapies in this setting and the uncertainties involved in surgical therapy. We begin by reviewing the unique anatomical and physiological features of the PM-bearing pleural space, before critically appraising the evidence for systemic therapies in stage I PM and previous intrapleural PM trials. We conclude with a summary of key challenges and potential solutions, including optimal trial designs, repurposing of indwelling pleural catheters, and new technologies.

Value of a multidisciplinary geriatric oncology committee on patient care in a community-based, academic cancer center.

e13771 Background: The heterogeneity in health and functional ability among older patients makes the management of cancer a unique challenge. The Geriatric Oncology Program at the University of Maryland Baltimore Washington Medical Center (BWMC) was created to optimize cancer management and recommendations for older patients. This study aimed to assess the benefits of the implementation of such a program at a community- based academic cancer center. Materials and Methods: We retrospectively analyzed patients aged ≥80 years presenting to the Geriatric Oncology Program between January 2017 and July 2022. A multidisciplinary team of specialists collectively reviewed each patient using geriatric-specific domains and stratified each patient into one of three management groups- Group 1: those deemed fit to receive standard oncologic care (SOC); Group 2: those recommended to receive optimization services prior to reassessment for SOC; and Group 3: those deemed to be best suited for supportive care and/ or hospice care. ANOVA, chi-square, and Kaplan-Meier analyses were used to assess patient outcomes. Results: Among 233 patients included, 76 (32.6%) received SOC (Group 1), 43 (18.5%) were optimized (Group 2), and 114 (49.0%) received supportive care or hospice referral (Group 3). There was no significant difference in sex, race, or age among all three groups. The Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) score was implemented in 2019 (n=90). Patients receiving supportive/ hospice care only had an average score of 5.8, while the averages for those in the optimization and SOC groups were 4.6 and 4.1, respectively (p=< .001). SOC patients had the longest average survival of 2.71 years compared to the optimization (2.30 years) and supportive care groups (0.93 years) (p= <0.001). 69.8% of optimized patients were deemed fit for SOC upon re-evaluation following optimization services. For all patients that underwent surgical interventions, post- operatively, 23 patients (85%) were discharged home and 4 (15%) were discharged to a rehab facility. The average survival after surgery for all patients was 3.16 years, while patients who were optimized prior to surgery had an average survival after surgery of 3.21 years. Conclusions: The present study demonstrates the need for specialized consideration of the heterogeneity that cancer diagnoses present in older individuals. The Geriatric Oncology Program at BWMC is able to maximize treatment outcomes for geriatric patients through the provision of SOC therapies and optimization services, while also minimizing unnecessary interventions on an individual patient-centric level.

Nonspecific therapy for Eisenmenger syndrome

Eisenmenger syndrome (ES) is systemic pulmonary hypertension with venoarterial or bidirectional shunting of blood between the ventricles, atria or great arteries due to the progression of pulmonary vascular disease in the natural course of “simple” and “complex” congenital heart defects.Patients with ES require constant attention from a multidisciplinary team of specialists. One of the main tasks is not to destabilize the fragile pathological physiology, which relies on the balance of pulmonary and peripheral vascular resistance. Surgical interventions with anesthesia, if they cannot be avoided, should be performed in specialized centers. Pregnancy is contraindicated in patients with ES. Clinical symptoms of blood hyperviscosity in ES are rare.The anachronistic practice of venesections, which leads to a decrease in the oxygen transport function of the blood, iron deficiency and an increased risk of cerebrovascular complications, should be avoided. Oral and intravenous replenishment of iron deficiency improves exercise tolerance and quality of life. Routine administration of anticoagulants for ES is not indicated. In most cases, endovascular embolization of pathological collateral arteries can eliminate hemoptysis. The use of venous access requires careful prevention of embolism. Therapeutic tactics for ES are discussed in detail in this review

Complicated pregnancy and perinatal outcomes in women with type 1 and type 2 diabetes mellitus

Complicated pregnancy and perinatal outcomes in women with type 1 and type 2 diabetes mellitus

Substratifying the risk of covert malignancy in significant rectal polyps: Outcomes from a specialist multidisciplinary team (MDT).

A treatment strategy for patients with a significant polyp or early colon cancer (SPECC) of the rectum presents a challenge due to the significant rate of covert malignancy and lack of standardized assessment. For this reason, NICE recommends multidisciplinary meetings to improve outcomes. The primary aim of the present study was to report the performance of our specialist early rectal cancer (SERC) multidisciplinary team (MDT) in correctly substratifying the risk of cancer and to discuss the limitations of staging investigations in those patients with "poor outcomes". This was a retrospective review of patients referred to our SERC MDT from 2014 to 2019. Lesions were assigned by the MDT to three pre-resection categories (low, intermediate, high) according to the risk of covert malignancy. Resection method and final histology were compared to the pre-resection categories. Of 350 SPECC lesions, 174 were assessed as low-risk, 108 intermediate-risk and 68 high-risk. The cancer incidence was 4.8%, 8.3% and 53%, respectively (15.5% overall). Eight lesions were categorized as low-risk but following piecemeal resection were found to be malignant. Five lesions, three of which were categorized as high-risk, were ultimately benign following conventional surgery. One pT1sm1 cancer, removed by anterior resection, may have been treated by local excision. A total of 83% of malignant polyps were triaged to an en bloc resection technique and surgical resection avoided for nearly all benign lesions. However, 12 patients from this cohort were deemed to have a poor outcome because of miscategorization. Further comparative research is needed to establish the optimum strategy for rectal SPECC lesion assessment. There is currently no consensus for staging significant polyps of the rectum. This paper reports the effectiveness of a specialist early rectal cancer MDT to correctly risk-stratify significant rectal polyps. It underscores the importance of accurate categorization for treatment decision-making, while acknowledging the limitations of current staging modalities.

Multidisciplinary proactive e-consults to improve guideline-directed medical therapies for patients with diabetes and chronic kidney disease: an implementation study

IntroductionWe hypothesized that multidisciplinary, proactive electronic consultation (MPE) could overcome barriers to prescribing guideline-directed medical therapies (GDMTs) for patients with type 2 diabetes (T2D) and chronic kidney disease (CKD).Research design...

METABOLIC SYNDROME IN PEDIATRIC PRACTICE: DEFINITION, DIAGNOSTIC CRITERIA AND PRINCIPLES OF PATIENT MANAGEMENT (OVERVIEW)

The article comprehensively reviews epidemiological indicators, risk factors, pathophysiological mechanisms, diagnostic criteria, and contemporary management principles of metabolic syndrome in pediatric practice. The study relies on the extensive analysis of literature sources retrieved from electronic databases such as PubMed, UpToDate, Web of Science, ScienceDirect, Scopus, MedLine, and Elsevier. The literature review highlights the escalating prevalence of metabolic syndrome as an urgent medical and social concern among children and adolescents, primarily attributed to the global epidemic of childhood obesity. The article not only outlines key findings but also presents recommendations from international medical societies concerning screening strategies, diagnostics, and therapeutic approaches for the individual components contributing to metabolic syndrome in childhood. The review also focuses on pivotal studies exploring alternative therapies targeting the principal pathogenic factors of the disease. In conclusion, the authors emphasize the pressing issue of the absence of standardized criteria for diagnosing metabolic syndrome in children, highlighting the imperative role of a multidisciplinary team of specialists in the effective management of this pathology in pediatric practice.

Design and implementation of automated notification systems and an electronic whiteboard for radiation therapy planning monitoring.

Radiotherapy (RT) treatment and treatment planning is a complex process prepared and delivered by a multidisciplinary team of specialists. Efficient communication and notification systems among different team members are therefore essential to ensure the safe, timely delivery of treatments to patients. To address this issue, we developed and implemented automated notification systems and an electronic whiteboard to track every CT simulation, contouring task, the new-start schedule, and physician's appointments and tasks, and notify team members of overdue and missing tasks and appointments. The electronic whiteboard was developed to have a straightforward view of current patients' planning workflow and to help different team members coordinate with each other. The systems were implemented and have been used at our center to monitor the progress of treatment-planning tasks for over 2 years. The last-minute plans were relatively reduced by about 40% in 2023 compared to 2021 and 2022 with a p-value<0.05. The overdue contouring tasks of more than 1 day decreased from 46.8% in 2019 and 33.6% in 2020 to 20%-26.4% in 2021-2023 with a p-value<0.05 after the implementation of the notification system. The rate of plans with 1-3 day planning time decreased by 20.31%, 39.32%, and 24.08% with a p-value<0.05 and the rate of plans with 1-3 day planning time due to the contouring task overdue more than 1 day decreased by 49.49%, 56.89%, and 46.52% with a p-value<0.05 after the implementation. The rate of outstanding appointments that are overdue by more than 7 days decreased by more than 5% with a p-value<0.05 following the implementation of the system. Our experience shows that this system requires minimal human intervention, improves the treatment planning workflow and process by reducing errors and delays in the treatment planning process, positively impacts on-time treatment plan completion, and reduces the need for compressed or rushed treatment planning timelines.

Value of a multidisciplinary geriatric oncology committee on patient care in a community-based, academic cancer center

IntroductionThe heterogeneity in health and functional ability among older patients makes the management of cancer a unique challenge. The Geriatric Oncology Program at the University of Maryland Baltimore Washington Medical Center (BWMC) was created to optimize cancer management for older patients. This study aimed to assess the benefits of the implementation of such a program at a community-based academic cancer center. Materials and MethodsWe analyzed patients aged ≥80 years presenting to the Geriatric Oncology Program between 2017 and 2022. A multidisciplinary team of specialists collectively reviewed each patient using geriatric-specific domains and stratified each patient into one of three management groups- Group 1: those deemed fit to receive standard oncologic care (SOC); Group 2: those recommended to receive optimization services prior to reassessment for SOC; and Group 3: those deemed to be best suited for supportive care and/or hospice care. ResultsThe study cohort consisted of 233 patients, of which 76 (32.6%) received SOC, 43 (18.5%) were optimized, and 114 (49.0%) received supportive care or hospice referral. Among the optimized patients, 69.8% were deemed fit for SOC upon re-evaluation following their respective optimization services. The Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) score was implemented in 2019 (n = 90). Patients receiving supportive/hospice care only had an average score of 5.8, while the averages for those in the optimization and SOC groups were 4.6 and 4.1, respectively (p ≤0.001). Patients receiving SOC had the longest average survival of 2.71 years compared to the optimization (2.30 years) and supportive care groups (0.93 years) (p ≤0.001). For all patients that underwent surgical interventions post-operatively, 23 patients (85%) were discharged home and four (15%) were discharged to a rehabilitation facility. DiscussionThe present study demonstrates the profound impact that the complexities in health status and frailty among older individuals can have during cancer management. The Geriatric Oncology Program at BWMC maximized treatment outcomes for older adults through the provision of SOC therapies and optimization services, while also minimizing unnecessary interventions on an individual patient-centric level.

Neurocysticercosis of the third ventricle: illustrative case.

Neurocysticercosis is a parasitic infection of the central nervous system. Cysts located in the ventricles, intraventricular neurocysticercosis (IVNCC), can cause symptoms of increased intracranial pressure and, if untreated, can be fatal. Neuroendoscopic removal of IVNCC is recommended as the first-line treatment. The authors present the case of a healthy 30-year-old male originally from Mexico who presented with headaches and vomiting. He was found to have a cyst in the third ventricle on imaging, consistent with IVNCC. The authors successfully performed neuroendoscopic surgery with removal of the cyst en bloc. A multidisciplinary team of neurosurgery and infectious disease specialists is recommended for successful management of patients with IVNCC. These patients typically require neuroendoscopic surgical removal for definitive treatment. In this case, the authors show surgery resulted in an effective cure without the need for antiparasitic medication and excellent long-term outcomes.

Osteogenesis imperfecta in children: treatment experience

Osteogenesis imperfecta (OI) is a genetic disorder primarily characterized by an impairment in the synthesis of type I collagen, leading to bone fragility, frequent fractures, scoliosis, short stature, and other symptoms. The disease is mostly inherited from parents to children, and its severity can vary significantly. This article describes the approach to treatment and therapy outcomes for 10 children with osteogenesis imperfecta. Objective — сomplex examination of pediatric patients with OI, treatment with bisphosphonates and further support by multidisciplinary team of specialists for therapy evaluation. Materials and methods. The treatment was aimed to minimize the frequency of fractures and improve the quality of life of patients. Key aspects of the treatment included: medicinal treatment (bisphosphonates were used to reduce bone resorption, thereby increasing bone mass and reducing bone fragility, as well as vitamin D and calcium, administered to support normal bone mineralization); physical therapy (included exercises to develop muscle strength, coordination, and joint mobility, minimizing the risk of injury); and management by a multidisciplinary team (consultations with an orthopedist, psychologist, and other specialists as needed). Results and discussion. The treatment results were positive, showing a reduction in the frequency of fractures and improvements in functionality and quality of life. Conclusions. Over the course of 11 months, the significant reduction in medical complications and improvements in the overall health status of the study participants have been noticed, demonstrating the importance of a comprehensive approach to the treatment of osteogenesis imperfecta.

Understanding patients’ perspectives of clinical communication within a Major Trauma Centre

Clinical communication between major trauma patients (MTP) and healthcare professionals is extremely complex. Multiple demands are placed on specialist multi-disciplinary teams (MDT) and patients in all stages of treatment. Patient-staff clinical communication has an integral role in MTP healthcare experiences, supporting them with a range of physical and psychological difficulties post-injury. This study aimed to understand MTP perspectives of clinical communication within a MTC through qualitative semi-structured interviews. Twenty participants were purposively sampled from an outpatient follow-up clinic and interviews were analysed using a pluralistic qualitative approach. Three themes were conceptualised from the data; “Challenges to speaking up” “Conversations left me feeling” and “Strategies need to be clinical but tailored”. Patients often found it challenging to speak up due to feelings of vulnerability, confusion, and challenges navigating medical terminology. Patients spoke of not wanting to burden staff and family members playing a role in patient-staff communication, but these challenges require further exploration. Patients highlighted the positive (feel reassured, cared for, and human again) and negative (feeling like an object, angry, confused, and dependent) emotional impact of staff communication. Patients also described the benefits of being provided with written information, clear explanations of injuries and person-centred communication. MTP require multiple options to communicate and address psychological difficulties. Greater training on the emotional impact of conversations, skills to respond to psychological distress and communication guidance for staff, is needed to improve clinical communication with MTP.

Microbiological monitoring of a multidisciplinary medical organization: the basis of strategic planning in the framework of the implementation of epidemiological safety

Relevance. Monitoring of antibiotic resistance and the frequency of isolation of microorganisms at the regional level in each medical organization is of paramount importance for the implementation of epidemiological safety. Objective. To identify the main microbiological trends based on the analysis of the microflora of patients in a single — profile hospital in order to implement weaknesses in strategic planning activities. Materials and methods. A comprehensive analysis of the pharmacoepidemiological results of the consumption of antimicrobial drugs with calculated drug resistance indices and microbiological monitoring data demonstrated the presence of weaknesses and strengths for the strategic development of a multidisciplinary hospital at the regional level in terms of epidemiological safety. Results . Statistically significant differences in the microbiological structure of pathogens are predetermined by the profile of medical care. The main trends in the change in the microflora of a multidisciplinary hospital as a whole are the prevalence of fungal and gram-negative pathogens over gram-positive ones. The presence of a relatively high index of consumpion of cephalosporins of 3–4 generations, fluoroquinolones, carbapenems, protected penicillins determines the high drug resistance index of Klebsiella pneumoniae (0.86) and characterizes the main microbiological trends of a multidisciplinary clinic. Conclusion. Risk stratification by the level of multidrug-resistant pathogens, the use of deterrent strategies for prescribing antimicrobials, the implementation of educational modules, the evaluation of the effectiveness and monitoring of the risk stratification program with in the framework of antimicrobial technologies, the analysis of microbial landscape data using decision support programs are the main tasks of the functioning of a multidisciplinary team of specialists in a multidisciplinary clinic to control antibiotic resistance.

Amplifying awareness of cardiac amyloidosis and the need for early recognition

Improvements in clinical awareness of cardiac amyloidosis have led to earlier recognition of signs and symptoms, access to diagnostics and a specialist multidisciplinary team. Yet, it remains a life-limiting disease. This editorial discusses cardiac amyloidosis and how nurses can identify ‘red flags’ to facilitate earlier diagnosis.