Multidisciplinary Team Of Specialists Research Articles

European Cancer Summit 2022 submission for Health Systems and Treatment Optimisation NetworkUnderstanding health system factors for cancer survival across the International Cancer Benchmarking Partnership: the role of leadership and health system capacity in 7 high-income countries

BackgroundCharacteristics of health systems almost certainly play some role in the well-documented differences in cancer survival across countries, but which ones are important drivers of these differences is less clear. As part of the International Cancer Benchmarking Partnership (ICBP), we asked what roles leadership and health system capacity play in cancer survival. MethodsWe (i) developed a conceptual (‘logic’) model visualising the components of the cancer care system and the relationships between them; (ii) analysed cancer plans and strategies in 20 ICBP jurisdictions (1995-2018); and (iii) conducted interviews with 79 key informants in 13 jurisdictions to obtain perspectives on how health system factors impact survival. ResultsLeadership emerges as important: political leadership to initiate and maintain progress; intellectual leadership to drive change; clinical leadership to translate policy into action; and coherent visions shared by leaders across each level of the system. The most important aspects of health system capacity identified were primary care providing access to diagnostic evaluation, specialist care providing access to treatment, and the cancer care workforce. Improved infrastructure for diagnosis and treatment was associated with better cancer outcomes in all jurisdictions but was insufficient on its own if staffing was inadequate. Consolidation of services and greater surgical specialisation brought improvements in some jurisdictions if accompanied by reconfigurations of services, in particular the creation of specialist multidisciplinary teams, along with supporting capacity in the wider health system. Staff shortages were commonly cited as reasons why some jurisdictions lagged behind others. ConclusionsContinued progress in cancer outcomes requires strong leadership at all levels of the health system, political commitment to progress strategies, and expertise and engagement by clinicians advising on strategy and making changes on the ground. It also requires sustained strategic investment in plans to deliver and maintain the workforce engaged in cancer care and in the infrastructure on which they depend. Strategic plans must recognise that systems for cancer care do not work in isolation from the rest of the health system.

Values-based healthcare (systematic review)

The current demographic situation is characterized by an increase in life expectancy and gain in the number of chronic non-communicable diseases. Healthcare is faced with the task of preserving the population health in these additional years of life, which, in turn, will lead to an increase in the shortage of resources in healthcare and, in general, negatively affect the economies of states. One of the modern concepts of optimal use of resources, evaluation of the effectiveness of health systems is value-based healthcare. In the described model, the value for the patient is the result of medical care in relation to health, which is important for the patient, the criteria for achieving which are determined by the patient himself. According to the concept of the Center, measuring the results and costs for each patient is part of the strategic program for the transition to a highly efficient healthcare system. 
 The purpose of the study is to investigate the features of value-based healthcare in different countries of the world.
 A systematic review was conducted according to the PRISMA guidelines.
 The literature search was performed in the electronic databases PubMed/MEDLINE, Scopus, eLibrary, CyberLeninka, and Yandex and Google systems among English and Russian-language reports. In the healthcare systems of countries that have implemented a value-based approach, the activities of medical institutions are evaluated according to indicators that reflect the value to the patient. To combine the available resources and coordinate the provision of medical care, multidisciplinary teams of specialists are being created and the patient is provided with a full range of services without delay at all stages. In such models, all processes in medical institutions are standardized, which makes it possible to reduce losses and costs at all stages of medical care and increase the results that are valuable for patients.

ФОРМИРОВАНИЕ СИСТЕМЫ ДИНАМИЧЕСКОГО НАБЛЮДЕНИЯ ЗА ДЕТЬМИ, РОЖДЕННЫМИ РАНЬШЕ СРОКА, КАК ВАЖНАЯ СТРАТЕГИЯ ПО СНИЖЕНИЮ ИНВАЛИДНОСТИ И УЛУЧШЕНИЯ КАЧЕСТВА ИХ ЖИЗНИ

Recent revolutionary changes in domestic neonatology were caused by the dynamic development and practical implementation of a large number of modern technologies: medical, organizational and educational, which significantly improved the quality of medical care for newborns, which in its turn has ultimately led to a significant reduction in infant mortality in Russia. Modern technologies for nursing of premature newborns, including those with very low and extremely low birth weight, ensured a high survival rate for this group of infants and set up a new task for pediatric physicians: the need for long-term follow-up and comprehensive habilitation of such kind of patients in the outpatient clinics. In order to improve the developmental outcomes, to reduce the incidence of disability, reduce the severity of diseases and improve the quality of life of these children the new medical and organizational forms of work are needed with the involvement of a multidisciplinary team of specialists trained in habilitation programs for premature newborns. In order to solve these problems it is necessary to create departments of dynamic follow-up and a comprehensive program of medical examination and habilitation for premature newborns who have undergone critical conditions, which will require the development and implementation of a regulatory Procedure for the provision of medical care.

The management of non-diagnostic soft tissue tumour biopsies using a multi-disciplinary team approach: A 10-year retrospective review at a specialist sarcoma unit

Non-Diagnostic (ND) biopsies are occasionally encountered during the investigation of soft tissue sarcoma. We performed a retrospective review of all ND soft tissue biopsies discussed at our regional Multi-Disciplinary Team (MDT) meeting between 2004 & 2014 with the aim of establishing the incidence of ND biopsies, identifying predictive factors for repeat biopsies and evaluating the effectiveness of MDT decisions. We identified 80 ND out of 3233 biopsies. Diagnostic Yield (DY) was 97.5%, 76.0% and 77.8% for the first, second and third successive biopsy respectively. With an MDT approach utilising radiological and clinical information, the diagnostic success rate achieved was 98.5%, 82.0% and 77.8% for the first, second and third biopsies respectively. Malignant tumours (sarcoma & carcinoma) were 19 times more likely to undergo an increasing number of biopsies compared to benign lesions (p < 0.01), while repeat biopsies were less useful for suspected benign lesion. Although a repeat biopsy was only performed in 63% of cases, there were no patients originally diagnosed with a benign lesion that re-presented with the same lesion subsequently being malignant throughout the study period. Our study shows that a specialist MDT approach leads to high diagnostic rates and is a safe and effective method of preventing unnecessary, repeat biopsies where the initial biopsy is ND.

Cancer MDT’s oversubscribed and need to change: A Novel Clinical Radiological Assessment Meeting (CRAM) as a "mini-MDT" reduces referral response times and MDT workload

Background: Multidisciplinary Team (MDT) meetings are now considered the standard of care for decision making and management of patients with cancer. However, most MDT’s now face capacity issues and supplementary approaches should be considered. We report our experience with a novel clinical radiological assessment meeting (CRAM) as a “mini-MDT” to expedite decision making and enhance the function of the parallel specialist MDT.

SARCOPENIA IS A FREQUENT DISEASE IN SARS-COV-2 INFECTION.

We aimed to investigate the clinical symptoms and specific care requirements of SARS-CoV-2 patients who were admitted to a COVID-19 Rehabilitation Unit while still infectious for SARS-CoV-2 and in the subacute phase of the disease. Patients admitted to our COVID-19 Rehabilitation Unit from March 2020 to December 2020 were evaluated for sarcopenia, and they also completed the following assessments: functional independence measure, short physical performance battery and Hamilton Rating Scale for Depression. Age and body mass index and symptoms of dysosmia or dysgeusia were also recorded. A total of 126 patients were enrolled (50 women, median age 72 years, 18.7 years), of whom 82% of patients presented with low grip strength. Sarcopenia was diagnosed in 52 patients. Sarcopenic patients were older than non-sarcopenic ones (median age 73.4 years, IQR 13.2 vs 63.9 years, IQR 14.5, respectively, p = 0.014). Sarcopenia was associated with the presence of depression (p = 0.008), was more common in women (p = 0.023) and was associated with greater functional deficits (functional independence measure and short physical performance battery analyses, p < 0.05). Sarcopenic patients also had a lower body mass index than other patients (p < 0.01). More than 40% of our patients suffered from sarcopenia, which was associated with ageing, depression, low body mass index, reduction in functional autonomy and being a woman. Such data provide evidence for the need to assist hospitalized COVID-19 patients by means of a multidisciplinary specialist team.

Methods of assessing the quality of life in women with malignant neoplasms of the reproductive system

HAC (Russian) RSCI (Russian) EBSCO DOI (USA) Ulrichsweb (Ulrich’s Periodicals Directory) Scientific Indexing Services Methods of assessing the quality of life in women with malignant neoplasms of the reproductive system Primary tabs View(active tab) Edit Manage display Translate DOI: https://doi.org/10.29296/25877305-2023-01-02 Issue: 1 Year: 2023 Professor A. Solopova(1), MD; D. Blinov(1–3), Candidate of Medical Sciences; Professor E. Achkasov(1),MD; L. Sandzhieva(1), D. Korabelnikov(3), Candidate of Medical Sciences; G. Bykovshchenko(1), D. Petrenko(1), 1-I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia 2-Institute of Preventive and Social Medicine, Moscow 3-F.P. Haass Moscow Medical and Social Institute The growth of malignant neoplasms of the female reproductive system in recent years has acquired a tendency to "rejuvenation" – more frequent appearance in women of reproductive age. Radical methods of treating pathologies of the oncogynecological spectrum leave severe consequences in the form of genitourinary syndrome, disorders of endocrine-metabolic processes, sexual function, unstable psychological state, social maladaptation and a decrease in the quality of life. To restore the effects of antitumor treatment, a comprehensive rehabilitation is required, developed by a multidisciplinary team of specialists, including questionnaires on the quality of life. Numerous studies have shown the effectiveness of questionnaires FACT-G, FACT-En, EORTC, FSFI, HADS, the health, activity, mood questionnaire, modified Kupperman–Uvarova menopausal index, MDQ, magnesium deficiency assessment test, stress tolerance self-assessment test. These questionnaires allow us to assess the patient's condition in a timely manner, his perception of his own quality of life and the presence of comorbid diseases and conditions. The introduction of questionnaires into routine clinical practice will make it possible to more effectively carry out rehabilitation measures in oncogynecological patients.

Concordance of Diagnosis of Autism Spectrum Disorder Made by Pediatricians vs a Multidisciplinary Specialist Team

Wait times for autism spectrum disorder (ASD) diagnosis are lengthy because of inadequate supply of specialist teams. General pediatricians may be able to diagnose some cases of ASD, thereby reducing wait times. To determine the accuracy of ASD diagnostic assessments conducted by general pediatricians compared with a multidisciplinary team (MDT). This prospective diagnostic study was conducted in and a specialist assessment center in Toronto, Ontario, Canada, and Ontario general pediatrician practices from June 2016 to March 2020. Children were younger than 5.5 years, referred with a developmental concern, and without an existing ASD diagnosis. Data analysis was performed from October 2021 to February 2022. The pediatrician and MDT each conducted blinded assessments and recorded a decision as to whether the child had ASD. Main outcomes included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). A logistic regression was performed to identify factors associated with accurate pediatrician assessment for children with or without an ASD diagnosis. Seventeen pediatricians (12 women [71%]) participated in the study and referred 106 children (79 boys [75%]; mean [SD] age, 41.9 [13.3] months). Sixty participants (57%) were from minoritized racial and ethnic groups (eg, Black, Asian, Hispanic, Middle Eastern, and multiracial). Seventy-two participants (68%) received a diagnosis of ASD by the MDT. Sensitivity and specificity of the pediatrician assessments compared with MDT were 0.75 (95% CI, 0.67-0.83) and 0.79 (95% CI, 0.62-0.91), respectively. The PPV of the pediatrician assessments was 0.89 (95% CI, 0.80-0.94) (ie, 89% agreement with the MDT), and NPV was 0.60 (95% CI, 0.49-0.70) (ie, 60% agreement with the MDT). Higher pediatrician certainty (odds ratio [OR], 3.33; 95% CI, 1.71-7.34; P = .001) was associated with increased diagnostic accuracy for children with ASD. Lower accuracy was seen for children with higher Visual Reception subscale developmental skills (OR, 0.93; 95% CI, 0.89-0.97; P = .001), speaking abilities (OR, 0.17; 95% CI, 0.03-0.67; P = .03), and White race (OR, 0.32; 95% CI, 0.10-0.97; P = .04). Age, gender, and Autism Diagnostic Observation Schedule, 2nd Edition composite scores were not significantly associated with the accuracy of assessments. All 7 children with a sibling with ASD received an accurate diagnosis; otherwise, no significant factors were identified for accuracy in children without ASD. This study of concordance of autism assessment between pediatricians and an expert MDT in young children found high accuracy when general pediatricians felt confident and lower accuracy when ruling out ASD. These findings suggest that children with co-occurring delays may be potential candidates for community assessment.

UK prescribing practice of anticoagulants in patients with chronic kidney disease: a nephrology and haematology-based survey

A survey to gain insight into anticoagulant prescribing practice in the setting of chronic kidney disease (CKD) across the UK was disseminated via renal and haematology networks. Areas of anticoagulant use included patients with venous thromboembolism (VTE), requiring thromboprophylaxis for VTE, Atrial Fibrillation (AF) and nephrotic syndrome.An online-survey was disseminated via British Haematology Society, UK Kidney Association, and Renal Pharmacy Group over a five month period. All responses were voluntary and anonymous.Among 117 responses there were 49 nephrology doctors, 47 renal pharmacists and 20 haematology clinicians. A specialist multidisciplinary team to discuss the specific anticoagulant management of these patients was only available to 3% (4/117) respondents. Renal function estimate used for anticoagulant dosing was mainly Cockcroft-Gault for pharmacists and haematology but lab-based estimates were used by nephrology doctors. Therapeutic dose of Low Molecular Weight Heparin was mostly likely to be reduced by one-third when used for VTE treatment, with the majority of units undertaking anti-Xa monitoring in CKD stage 5 and dialysis. Direct-acting Oral Anticoagulants are being used in patients with nephrotic syndrome, those with CKD stage 5 and on dialysis for VTE and AF in the absence of license in these indications.This survey highlighted the significant differences between anticoagulant prescribing in CKD between two professional specialties and marked variation between centres in anticoagulant management strategies employed for these patients. With gaps still existing in the evidence base and answers to these not expected within the next few years, development of a best-practice guideline would be warranted to support clinicians in this field.

Late-onset Pompe disease - literature review and summary of current knowledge

Introduction: Pompe disease is a glycogen storage disorder caused by the deficient activity of the lysosomal enzyme acid α-glucosidase (GAA). Mutations in the GAA gene lead to the accumulation of glycogen in different organs. In a late-onset form (late-onset Pompe disease), the disease is characterized by slow, progressive proximal limb and respiratory muscle weakness. The diagnosis is based on a low level of GAA either in the muscle biopsy or in the leucocytes. LOPD is treated with enzyme replacement therapy (ERT). Purpose: Summary of currently knowladge about Late-onset Pompe disease - characteristic, diagnosis and treatment. Methods: A review of literature available in the PubMed database and Google Scholar. by searching for keywords: Pompe disease, Late-onset Pompe disease, LOPD, alglucosidase- α. Results: The diagnosis of late-onset Pompe disease can often be difficult. It is a very rare disease and the clinical presentation is similar to other neuromuscular disorders, such as Duchenne and Backer muscular dystrophies, glycogenosis or autoimmune or mitochondrial myopathies and others. Despite available specific enzyme replacement therapy LOPD is progressive. Patients require support from a multidisciplinary team of specialists, including care from neurologists, pulmonologists or physiotherapists. Conclusion: Although rare, Pompe disease should be considered in patients with proximal paresis and respiratory failure. More research into LOPD can help increasing precocity of diagnosis and treat it more effectively.

The effects of rehabilitation on functional independence of Eastern Taiwanese children with rare or genetic diseases.

This study investigated the effects of outpatient rehabilitation therapy (RT) on the functional performance of children from Eastern Taiwan with rare or genetic diseases. This retrospective observational cohort study included 73 children from Eastern Taiwan who were affected with rare or genetic diseases, with an average age of 8.57 ± 5.33 years (47 boys and 26 girls). Each child received the goal-directed therapy known as outpatient RT, which was delivered by a multidisciplinary team of specialists. To assess the effectiveness of RT, the WeeFIM-C questionnaire data were collected and analyzed. After receiving outpatient RT, most of the children only required low-to-moderate assistance with self-care tasks (4.36 ± 2.38), and they could perform mobility-related activities under supervision or independently (5.70 ± 2.29). Moreover, most only required minimal assistance with tasks related to cognitive functioning and tended to complete such tasks under supervision (4.97 ± 2.05). The functional performance was significantly different among three studied groups, in terms of self-care (F[2, 68] = 5.42, P < 0.007), mobility (F[2, 68] = 8.17, P < 0.001), cognitive functioning (F[2, 68] = 3.31, P < 0.042), and overall (F[2, 68] = 6.44, P < 0.003) functional performance. The results of this study demonstrated that the functional status was different among three studied groups in terms of self-care, mobility, and cognitive functioning after receiving outpatient RT.

Нейропсихологическая диагностика и реабилитация пациентов с нарушениями праксиса при поражениях головного мозга различной этиологии

Background. Praxis disorders are one of the most common consequences of brain damage. In this regard, neuropsychological diagnosis and rehabilitation of patients with praxis disorders is of great practical importance. Since people with apraxia and their families continue to live in society, they have to deal with issues of social functioning in the context of the patient's limited abilities. As social well-being is impossible without taking into account the psychological and behavioral aspects of the patient and his environment, the modern approach to diagnosis and rehabilitation includes working with all of these aspects. This work is implemented through the organization of a partnership between the patient, his environment and a multidisciplinary team of specialists. Objective. The article aims to analyze and summarize the diagnostic and rehabilitation experience accumulated in neuropsychology, as well as to identify quality criteria for neuropsychological diagnosis and rehabilitation of patients with praxis disorders arising from brain damage. These criteria are recommended for use in the practice of a clinical psychologist. Results. Based on the analysis of applied research and practical guidelines, recommendations on the choice of diagnostic tools for detecting praxis disorders are presented. The main directions and methods of rehabilitation work, which have shown their effectiveness in overcoming kinetic, kinesthetic, spatial and regulatory apraxia, are highlighted. Conclusion. The practical work of a clinical psychologist with patients suffering from praxis disorders should be aimed at maintaining the level of preserved voluntary movements and actions as a “support” for further restoration of motor functions or for maintaining the existing level of motor functioning. Practical work should seek to restore disturbed praxis with the help of internal / external means or special techniques and focus on the organization of the patient's household environment in order to minimize restrictions in functioning.

Virus Infections in Older People.

Older people are more prone to viral infections, and often have worse outcomes. This was well demonstrated during the COVID-19 pandemic, where a disproportionate number of deaths occurred in the oldest and frailest people. The assessment of the older person with a viral infection is complicated by the high prevalence of multiple comorbidities and sensory or cognitive impairment. They often present with common geriatric syndromes such as falls or delirium, rather than the more typical features of a viral illness in younger people. Comprehensive geriatric assessment by a specialist multidisciplinary team is the gold standard of management, as viral illness is unlikely to present in isolation of other healthcare needs. We discuss the presentation, diagnosis, prevention, and management of common viral infections-respiratory syncytial virus, coronavirus, norovirus, influenza, hepatitis, herpes, and dengue viruses-with special consideration of infections in the older patient.

Implementation and Preliminary Effectiveness of a Multidisciplinary Telemedicine Pilot Initiative for Patients with Chronic Non-Cancer Pain in Rural and Underserved Areas at a Major Academic Medical Center.

Arkansas lacks adequate access to high-quality pain care, as evidenced, in part, by it having the second highest opioid prescribing rate in the United States. To improve access to high-quality treatment of chronic pain, we developed the Arkansas Improving Multidisciplinary Pain Care and Treatment (AR-IMPACT) Telemedicine Clinic, a multidisciplinary and interprofessional team of specialists who provide evidence-based pain management for patients with chronic pain. We conducted a single-arm pilot trial of the AR-IMPACT Telemedicine Clinic with rural, university-affiliated primary care clinics. We assessed the AR-IMPACT Telemedicine Clinic using an implementation framework and preliminary effectiveness measures. Specifically, we assessed 5 of the 8 implementation outcomes of the framework (ie, penetration, adoption, acceptability, appropriateness, and feasibility) using a mixed methods approach. To evaluate implementation outcomes, we used surveys, interviews, and administrative data. We used electronic health record data to measure preliminary effectiveness (ie, changes in average morphine milligram equivalents per day and pain and depression scores). The AR-IMPACT team saw 23 patients that were referred by 13 primary care physicians from three rural, university-affiliated primary care clinics over one year. Of the 19 patients willing to participate in the pilot study, 12 identified as women, 31.6% identified as Black, and over 50% had less than a bachelor's level education. Patients rated the clinic positively with high overall satisfaction. Referring physicians indicated high levels of appropriateness, acceptability, and feasibility of the program. AR-IMPACT team members identified several barriers and facilitators to the feasibility of implementing the program. No changes in preliminary effectiveness measures were statistically significant. Overall, the AR-IMPACT Telemedicine Clinic obtained moderate penetration and adoption, was highly acceptable to patients, was highly acceptable and appropriate to providers, and was moderately feasible to providers and AR-IMPACT team members.

Плановые лапароскопические резекции кишечника у детей с болезнью Крона

Currently, laparoscopic operations are widely used in pediatric surgical practice (both emergency and elective surgery). Separately, it is worth noting the difficulty of performing reconstructive surgical interventions using endovideosurgical technologies in pediatric coloproctology and surgery of inflammatory bowel diseases (Crohn's disease, ulcerative colitis, etc.). Objective. Present the experience of performing laparoscopic reconstructive surgical interventions in pediatric patients with Crohn's disease. Patients and methods. For the period from 2005 to 2023, 64 children with various forms of Crohn's disease on the basis of the FNCC of children and adolescents of the FMBA of Russia (Moscow), Morozovskaya DGKB (Moscow) underwent planned reconstructive laparoscopic interventions: ileocecal resection, resection of the small and large intestine with equipment side-to-side anastomosis, rectal resection with manual low colorectal anastomosis, subtotal colectomy. Results. The average surgery time was 150 minutes. In the postoperative period, complications developed in 6 children (9.4%). The duration of postoperative hospitalization averaged 7 days. In 6 cases, postoperative complications were noted, in 4 cases (inflammatory changes from the umbilical wound and the formation of the intestinal fistula here) it was possible to resolve them conservatively through antibacterial therapy and local treatment. But in the 2 remaining cases, repeated interventions were required due to the failure of the hardware suture and the formed stricture in the anastomosis zone. Conclusion. Treatment of children with complicated forms of Crohn's disease should be carried out in specialized centers with the participation of a multidisciplinary team of specialists at all stages of treatment. With the correct selection of patients and the timing of surgery, the laparoscopic technique allows efficient and safe resection and restoration of intestinal continuity at any location and length of strictures. Key words: Crohn's disease, inflammatory bowel disease, apparatus anastomosis, children, laparoscopy, laparoscopic resection

The Time is Now: An Overview on Perinatal Psychiatry

Perinatal mental health (PMH) has been a growing field of practice for psychiatry in the last decades. It focuses on mental health during pregnancy, childbirth and the postpartum period including the distinctive presentations of mental illness and well‐being challenges associated with parenting experiences. Mental health problems in pregnancy and the postnatal period can have significant differences and challenges to its approach compared to other periods of life. Working in PMH requires specific and updated know­ ‐ledge regarding carers’ experiences and manifestations of mental illness in this particular life stage and psychotropic management during pregnancy and breastfeeding, as well as regarding the mother/parent and baby relationship and bond, and the baby’s safeguarding along several developmental issues. For all this, PMH specialist services and multidisciplinary teams with specific training have been developing to cater to this need in several countries around the world. To provide a broadened overlook on the matter, some key aspects of PMH will be discussed below in this perspective.

Primary CNS Lymphoma in an Immunocompetent Patient: An Unusual Case Illustrating the Usual Problems Facing Brain Tumour Management in a Lower-Middle-Income Country

Primary central nervous system lymphoma (PCNSL) is a rare extra-nodal non-Hodgkin lymphoma (NHL). It primarily affects the immunocompromised but is rarely seen in immunocompetent individuals. The pitfalls in the healthcare system of lower-middle-income countries produce many obstacles, impeding timely diagnosis, timely treatment, and optimal quality of care. A 57-year-old immunocompetent, diabetic female presented with progressive generalised fatiguability, forgetfulness, and subtle behavioural changes for the last one and a half years. MRI revealed an area of gyri from dense post-contrast enhancement in the right posterior parietal region. Her symptoms kept aggravating with periods of partial remission as steroids were being administered. Reasons for delays in diagnosis and hence timely treatment include lack of primary care referral, conflicting neurosurgical opinion, and absence of multidisciplinary team management. A right posterior parietal parasagittal craniotomy was performed to excise the lesion. The patient was subsequently referred for adjuvant therapy. We use our patient's clinical journey to exemplify the structural barriers to providing optimal and timely care for brain tumour patients in a developing country. Primary CNS Lymphomas in immunocompetent patients are rare. Poor infrastructure and referral pathways contribute to delayed diagnosis. Lack of multi-disciplinary care owing to organisational issues is a major problem faced by brain tumour patients in a lower-middle-income country like ours. Brain tumour management requires a specialist multidisciplinary team approach to ensure timely diagnosis and optimal treatment

The advent of stroke units

General intensive care units, as well as specialised units such as those for coronary care, have been in existence for several decades. The aim of a stroke unit—similar to that of comprehensive cancer centres (based on care, research, and training)—was to focus stroke care around a multidisciplinary team of stroke specialists in a single unit. Stroke units were introduced in the 1950s in Norway, Sweden, the USA, and the UK, and by the late 1990s had become technically sophisticated, with the discovery of thrombolysis and with increased funding.

The Global Initiative for Children's Surgery: conception, gestation, and delivery.

More than two thirds of the global population lack access to safe, affordable surgical and anesthesia care. This inequity disproportionately affects children in low- and middle-income countries (LMIC). In 2016, a group of pediatric surgical care providers founded the Global Initiative for Children's Surgery (GICS). Their goal was to assemble a multidisciplinary team of specialists and advocates to improve surgical care for children, with a particular emphasis on those in low-resource settings. This review details the history of GICS, the process of its inception, the values guiding its work, its past achievements, and its current initiatives. The experience of GICS may serve as an effective model for global collaboration on other areas of public and global health.

HPB P02 Audit of Delays in the Definitive Management of Suspected Pancreatic Malignancies

Abstract Background Approximately 10,500 people in the UK are diagnosed with pancreatic cancer each year. (1) Patients can present to their GP, to A&amp;E, or can be referred following an incidental finding on a pathology review. Decisions within the South-West of England regarding patient's most appropriate treatment pathways are made during Specialist Multi-Disciplinary Team (SMDT) meetings hosted by University Hospitals Plymouth (UHP). Treatment options can include surgery, chemotherapy or a palliative approach. (2) The NHS standard for patients to have their first definitive treatment following an urgent GP referral is a maximum of 62 days. (3) Shorter waiting times have been shown to correlate to an improved patient experience, and may result in earlier diagnoses, treatment, fewer complications, and overall improved cancer outcomes. (4) This audit aims to review the current practice of the time taken between the date of referral and the first definitive treatment of pancreatic malignancies discussed within the SMDT over a two-year period. Currently, there are no studies examining the relationship between delays and patient outcomes with pancreatic malignancies in England. (5) Our evaluation will also examine this and enable future planning into research studies with a particular focus on reducing delays in treatment. Methods A retrospective, cohort study across the South-West of England analysing the delays in the definitive management of suspected pancreatic malignancies within a two-year period of weekly SMDT discussions. The inclusion criteria consists of patients referred locally from Plymouth Hospitals NHS Trust with pancreatic and peri-ampullary malignancies, discussed between 01/01/19 and 31/12/20. A total of 94 patients were discussed within the SMDT with suspected pancreatic and peri-ampullary cancers in 2019. 61 of these patients were referred locally from Plymouth Hospitals NHS Trust and will be the focus for this abstract. Following approval from the hospitals ethics board, data has been retrospectively collected by our team of four medical students into the online RedCap database. (6) Data has been collected from following hospital systems: Somerset Cancer Register, Clinical Record Interactive System, e-discharge and patient care manager and the main hospital electronic system. Data collection points include patient age, date of initial presentation, dates and types of investigations, date of SMDT referral, number and outcome of SMDT discussions, date of treatment commencement, and date of death if applicable. The data has been anonymised to explore the sources of delay from the date of referral until definitive treatment in patients with pancreatic malignancies. Results The age range for our preliminary data is 50–91. The median age is 71. Preliminary data shows that overall: For patients surgically managed, it took a median of 0 days from their first presentation until their date of surgery (range 189), with longer delays for those referred form their GP compared to those referred via admission. For patients managed with chemotherapy, it took a median of 81 days from their date of first presentation until their date of first chemotherapy treatment (range 231).For patients treated palliatively, it took a median of 23 days from their date of first presentation to the date of decision for palliative treatment (range 77). The number of SMDT discussions per patient had a range of 7, with a median of 2. On further analysis, delays lie between: The date of first presentation to SMDT referral, especially if referred via GP (median 9, range 17) compared to via admission (median 0, range 72) The date of SMDT referral and date of first discussion (median 9, range 53) The date of first SMDT discussion and date of first biopsy (median 31, range 165) Conclusions Preliminary data analysis shows that patients are waiting longer than nationally stipulated NHS guidelines. Upon complete data analysis of all patients first discussed within the SMDT in 2019 and 2020, an evaluation of the timeframe and delays to receiving definite management will highlight the adherence to the NHS 62-day target and whether this has improved over time. We will consider the impact of recurring SMDT discussions on patient outcomes. We will identify any trends between the time taken from being first seen until definitive treatment and analyse the impact of these on the mortality of our patient cohort. Could this be contributing to the poor survival of pancreatic malignancies in England compared to the rest of Europe? (7) On completion, analysis will enable identification of the factors contributing to any delays in the existing treatment pathway in the South-West of the England. We will suggest future means of addressing these to improve this timeframe in accordance with NHS targets, with the goal to potentially improve patient outcomes.