Multidisciplinary Teamwork Research Articles

'Let's work together to pass medical school': a qualitative study of medical student attitudes to teamwork, competition and collaboration.

Teamwork is vital to all types of work, and graduates of higher education programmes must be prepared to contribute to a wide variety of professional teams. This is especially true in healthcare, where graduates will work in multidisciplinary teams (MDTs) under considerable pressure. This study is a follow-up to a previous study, where we described how competition between students is a barrier to constructive teamwork. Since then, we have made considerable enhancements to our transferable skills curriculum, moved away from norm referencing, and there have been national changes to the way that graduate Foundation training places are allocated. Here we present findings from a qualitative study of students from all six stages of our medical degree programme (5 years plus predegree foundation year). We explored whether there had been changes in how students perceived the importance of teamwork, their own teamwork development and how they collaborated with their peers. Following analysis of in-depth, semi-structured interviews, five themes emerged: (a) competition between students; (b) importance of teamwork; (c) what makes effective teamwork; (d) preparing for work in MDTs; and (e) recommendations for teamwork education. Competition between students was perceived as both positive and negative, but there has been a shift since our last study towards collaboration, with students now more willing to help each other succeed. Students also show more insight into their teamwork development, and were able to discuss what aspects of the programme, and higher education more broadly, were most valuable in helping them develop.

Visual Outcomes of Children With Craniosynostosis.

Craniosynostosis can impact the visual development of a child. Historically, children with craniosynostosis, particularly when associated with a syndrome, had a significant risk of vision loss. The authors aimed to study the incidence of ophthalmic pathology in a modern, multidisciplinary craniosynostosis practice. Children aged 7 to 13 years attending face-to-face ophthalmic craniofacial clinics between February 2020 and June 2021 were included in a retrospective case note review. Visual acuity, ocular alignment, optic nerve function, and retinal nerve fiber layer (RNFL) condition using optical coherence tomography (OCT) were recorded. Forty-three children (30 girls) were assessed at a median age of 10.3 years (7.8-13.1). Eleven children had unicoronal synostosis, 15 had single-suture synostosis not involving the coronal, 14 had multisuture synostosis involving the coronal, and 3 had multisuture synostosis not involving the coronal. Thirty-two out of 43 had craniofacial surgery. Sixty-seven percent required glasses. Forty-nine percent had strabismus, 11/43 (26%) had squint surgery, and 2/43 (5%) had tarsorrhaphy for corneal protection. Four out of 43 (9%) had papilloedema detected; however, at the final review, 15/68 (22%) eyes showed RNFL changes on OCT imaging, none of whom had optic atrophy. Two children did not meet UK driving standards due to refractive amblyopia; no children were registered as sight impaired. In this cohort, optic atrophy and visual loss due to exposure keratopathy were not seen. A high incidence of strabismus, glasses wear, and amblyopia is persistent. Binocular visual impairment was rare in this cohort: 95% met UK driving standards. Visual outcomes appear to be improving coinciding with improved craniofacial care alongside multidisciplinary team working.

THE STRUCTURE AND CONTENT OF THE COURSE "INNOVATIONS IN SOCIAL WORK" (FROM THE TEACHING EXPERIENCE)

The topic relevance is determined by the requirements for the training of social work specialists for innovative activities in conditions of modern challenges. The article aims to characterize the structure and content of the course "Innovations in Social Work" for the 2nd (master's) level of higher education, specialty 231 "Social Work" (from teaching experience). Scientific methods applied: generalization, abstraction, explanation, systematization, system-structural, and descriptive analysis. The author notes the importance of a systematic approach to the development of the general concept of the training course. It is justified by taking into account not only theoretical and practical aspects of innovative activity, but also regulatory and legal ones. The structure of content modules tested in the teaching process is proposed: 1) theory of innovative activity; 2) regulatory and legal support of innovations; 3) innovation as a factor in overcoming social problems of our time. A brief overview of the lectures and recommendations for seminars are provided. Considering the absence of thematic sections on innovations in the field of social protection of the population in cross-sectoral normative documents, special attention is paid to the Plan for the implementation of the Ukraine Facility 2024-2027. The reforms for the next 4 years are presented in this document. It is emphasized that some of them are considered in the module No.3 ("Social work in multidisciplinary rehabilitation teams", "Implementation of the veteran's assistant institute", "Evolution of the deinstitutionalization reform in Ukraine") with logical transition to module No.3. The proposed structure and content of the course "Innovations in Social Work" can contribute to the formation of program learning outcomes defined by the educational standard., Special emphasis is placed on the challenges of teaching innovative activities: taking into account the requirements of the standard of higher education and the professional standard, the interdisciplinary nature of knowledge, the incompleteness of legal support for innovative activities in the field of social work. Both the theoretical and legal and educational issues of teaching the course "Innovations in social work" are among the directions of further scientific research.

Collaborative and integrated working between general practice and community pharmacies: A realist review of what works, for whom, and in which contexts.

Collaborative and integrated (C + I) working between general practice and community pharmacies has the potential to increase accessibility to services, improve service efficiency and quality of care, and reduce health care expenditures. Many existing studies report challenges and complexities inherent in establishing effective C + I ways of working. The aim of our review is to understand how, when and why working arrangements between General Practitioners (GP) and Community Pharmacists (CP) can provide the conditions necessary for effective communication, decision-making, and C + I working. We conducted a realist review to explore the key contextual factors and mechanisms through which GP-CP C + I working may be achieved. MEDLINE, Embase, CINAHL, PsycINFO, HMIC, Web of Science, IBSS, ASSIA, Sociological Abstracts, Sociology Database and the King's Fund Library Database were searched for articles and grey literature published between January 2000 and April 2022. A total of 136 documents were included in the final synthesis. Our findings highlight the importance of mutually beneficial remuneration models to support effective integration of services; supportive organisational cultures and values; flexible and agile IT systems/technologies; adequate physical infrastructure and space design to support multidisciplinary teamworking; the importance of establishing patient's trust in collaborative processes between GP-CP; and the need to acknowledge, support and utilise effective triadic relationships. Our research generates new insights regarding how, why and in which contexts C + I working can be achieved between GPs and CPs. The findings of our review can be used to inform future policy, research and clinical practice guidelines for designing and delivering C + I care.

Qualitative drivers of postoperative prophylactic antibiotics use and resistance in Ethiopia.

The World Health Organization (WHO) cautions against unnecessary prolongation of postoperative antibiotics to prevent surgical site infections (SSI), however this practice is still common in many countries. This study aims to describe drivers of prolonged postoperative antibiotic prescribing and clinicians' perspectives on antibiotics resistance and stewardship in Ethiopia. We conducted semi-structured interviews of 16 surgeons and nine surgical ward nurses at three academic referral hospitals in Addis Ababa. Audio recordings were transcribed verbatim and coded. Codes were inductively and iteratively derived between two researchers, tested for inter-rater reliability (IRR), and the codebook was consistently applied to all transcripts. Thematic analysis was performed to understand drivers of prolonged prophylactic antibiotic use in surgical patients. Interviews revealed factors contributing to postoperative prophylactic antibiotics overprescribing, including inadequate infection prevention and control (IPC) practices, wide variability in local prescribing practices, and distrust in the applicability of WHO guidelines. Antimicrobial resistance was also identified as a major concern by staff. Barriers to improving stewardship included a lack of multidisciplinary teamwork to inform prescribing decisions, while solutions included constructing appropriate context-specific guidelines and improving evidence-based practices through input from local stakeholders, including surgeons, clinical pharmacists, and nurses. Study participants perceived that existing evidence and guidelines did not apply in their settings due to high rates of surgical site infections and gaps in perioperative IPC practices (e.g., availability of water for handwashing, sterility breaches). These gaps were a key contributor to prophylactic antibiotic overprescribing, reinforcing the need to strengthen upstream and perioperative surgical antisepsis processes. The findings of this study underscore the importance of engaging multidisciplinary teams in strengthening antimicrobial stewardship efforts, aligning processes to achieve compliance with best practices, and the need for rigorous, contextually appropriate studies from these settings to inform policy.

Caring in crisis: addressing patient safety, burnout, and long hours in healthcare

Madam, The World Health Organization defines patient safety as preventing errors and adverse effects to patients associated with health care and “to do no harm to patients”. Specifically, in low and middle-income countries (LMICs), about 134 million adverse events occur each year due to unsafe care in hospitals, resulting in 2.6 million deaths annually. [1] Along with other determining factors, professional well-being, long hours, and burnout syndromes also influence patient care. [2] Burnout is a condition directly linked to workplace environment, stemming from occupational stress and extended working hours. Garcia, C.L. et al., through meta-analysis, found a relationship between the development of burnout and patient safety actions, with a probability of superiority of 66.4%. High levels of burnout and worsening patient safety are related to external factors such as high workload, long working hours, lack of a secure environment, and interpersonal relationships. [3] These findings raise concerns, particularly in a country like Pakistan, where the extent of understaffing and high workload can be inferred from the following statistics: The doctor-to-population ratio in Pakistan was 1:1000 in 2018 [4]. In contrast, the doctor-to-population ratio in Malaysia was 2.2:1000 in 2018 [5]. As a result of this shortage, the current workforce in Pakistan is negatively affected. In a study by Kasi PM et al. on postgraduate trainees in Pakistan, individuals under stress were more likely to report longer working hours. This increased workload made them prone to medical errors, which ultimately undermines the patient safety culture. A study conducted at a tertiary care hospital in Pakistan using the Hospital Survey on Patient Safety Culture (HSOPSC) compared the benchmarks from hospitals in the USA and discovered that high staff workload is a significant concern among staff [6] In Pakistan, where healthcare resources are limited, fostering a culture of effective work-hour management and breaks is essential for creating a healthier and safer environment for health professionals and patients. Ensuring adequate staffing levels to distribute the workload and prevent overburdening is essential. Providing designated areas for relaxation, offering mental health resources and mindfulness programmes like yoga or meditation can help doctors to cope with stress. Furthermore, promoting a culture of multidisciplinary teamwork, a mentorship program, and effective handover protocols during shift changes can ensure continuity of care. Medical institutes should invest in technology that can streamline administrative tasks and reduce paperwork burden. ---Continue

INTEGRATING ALLIED HEALTH PROFESSIONALS DURING THE ONCOLOGICAL TREATMENT PHASE FOR GLIOBLASTOMA PATIENTS: A CASE STUDY AT A UK CANCER CENTRE

Abstract AIMS Primary brain tumour patients should be offered neurological rehabilitation assessment at diagnosis and every stage of follow With only 5% of glioblastoma patients surviving more than 5 years, specialist management that spans across all phases of the Dietz rehabilitation model is required to optimise function, treatment tolerance and Quality-of-life. At Guy’s cancer centre an Allied health multi-disciplinary team (Physiotherapy, Occupational therapy and Speech and language therapy) work alongside the oncologist-led clinic to support this patient group. METHOD Case history A 54-year-old, male, was diagnosed with right parietal Glioblastoma, WHO grade 4, IDH wildtype, MGMT 5.47% methylated (August 2023) on biopsy only. He underwent chemo/radiotherapy - 60gy/90 fractions with Temozolmide (TMZ) on 3/11/2023 Currently C4 of adjuvant TMZ. Dexamethazone 2mg was discontinued on 29/11/2023, he continues with Keppra 500mg twice daily. RESULTS Dietz Intervention approach in phases: PREVENTATIVE Fatigue management was introduced prior to radiotherapy including a physical activity review, advice on pacing, sleep hygiene and relaxation techniques. Given the patient’s history of shift work and altered sleep patterns, managing risks of treatment-related fatigue was of particular importance. Restorative & Supportive: A targeted and periodised exercise programme was initiated, comprising 1:1 gym based physiotherapy sessions. The aims included enhancing exercise confidence, improve balance, endurance, maintain strength, pain management and weight maintenance during chemo/radiotherapy and adjuvant TMZ. Education was deployed on adjusting activity levels based on chemotherapy cycle and day to day side effects, alongside ongoing fatigue management advice around pacing and sleep hygiene. CONCLUSION Learning and Recommendations Implementing tailored rehabilitation interventions early in the patient’s treatment pathway, enables proactive management to mitigate the impact of treatment-related side effects on their QOL. Based on our experience, early engagement with a dedicated therapy team is recommended to foster strong rapport with both the patient and their caregivers. This facilitates timely rehabilitation planning for optimal outcomes.

Severe multiple injuries in a 15-year-old boy with pelvic fracture complete anterior dislocation of the sacroiliac joint and rupture of the internal and external iliac arteries: A case report of a rare injury.

Anterior dislocation of the sacroiliac joint combined with pelvic fractures is relatively rare in clinical practice. It is often associated with hemodynamic instability and severe injuries to other regions, resulting in a complex condition, prolonged treatment duration, and high rates of mortality and disability. However, there are few reports in the literature describing the diagnosis and treatment of anterior dislocation of the sacroiliac joint. In this case, the patient sustained a pelvic fracture with anterior sacroiliac joint dislocation and rupture of both the internal and external iliac arteries following a motor vehicle accident, making it an even rarer and more challenging case to treat. Reporting such cases can enhance the understanding of the diagnosis and treatment of anterior sacroiliac joint dislocation with rupture of the iliac arteries and provide valuable references for similar cases. The patient was riding an electric bicycle and was hit by a small truck, resulting in a pelvic fracture, anterior dislocation of the sacroiliac joint, and rupture of the internal and external iliac arteries. The patient was diagnosed with open pelvic fracture (type C1.2), left complete anterior dislocation of the sacroiliac joint, left acetabular fracture, left internal and external iliac arteriovenous rupture. emergency room resuscitation, intensive care unit resuscitation, 6 surgeries and perioperative management. He has been discharged from the hospital for more than 1 year and was rechecked every month after discharge, the fracture has healed, there is no obvious pain and discomfort in and around the wound, he has been fitted with a prosthesis, and he is doing the walking function exercise. Pelvic fracture with anterior sacroiliac dislocation is clinically rare and critical, and is associated with large vessel rupture, severe organ damage, and high mortality and disability rates. Rapid restoration of pelvic stability and hemodynamic stability is the key to treatment. Rapid transfer to a tertiary trauma center, rapid examination through the green channel to clarify the diagnosis, close intensive care, and reasonable multidisciplinary teamwork for surgical intervention are all valuable experiences that we have concluded.

9324 X-Linked Hypophosphatemic Rickets (XLH): Experience Argentina

Abstract Disclosure: E. Giacoia: Research Investigator; Self; Ultragenyx. A.C. Cantó: Research Investigator; Self; Ultragenyx. M.C. Balonga: Research Investigator; Self; Ultragenyx. Introduction: XLH is a genetic disease characterized by rickets and osteomalacia caused by pathogenic variants in PHEX with disruptions in bone mineral homeostasis. In adults, the deformities described in childhood persist, in addition to osteomalacia, pain, stiffness, enthesopathies, arthrosis, delayed fracture consolidation and hypoacusia1,2.Objective: To describe the clinical, biochemical characteristics and complications such as kidney stones, hypoacusia, enthesopathy and type of mutation (isolated or familiar).Materials and methods: Descriptive and analytical study. 10 patients diagnosed with XLH were analyzed and evaluated from January to December 2023. Laboratory samples and complementary studies were carried out. The PHEX gene mutation was searched. Informed consents were obtained. Results: P: Phosphate, Ca: Calcium, 25OHD: Vitamin D3/10 patients had kidney stones, 4/10 hypoacusia, 4/10 enthesopathies.3/10 were de novo mutations and rest were familial.Conclusions: We observed a tendency towards hypophosphatemia and slightly increased PTH values. We consider that the experience acquired through follow-up consultations is the best tool to advance medical knowledge and thus achieve early diagnosis, access to medical treatment and multidisciplinary teamwork for improving the quality and survival of life of patients with this rare disease. Reference: (1) Juan Guillermo Cardenas-Aguilera et al. Expert Consensus on evidence-based recommedations for the diagnosis, treatment, and follow-up of X-linked hypophosfatemic rickets (XLH). Revista colombiana de nefrología, vol 11, number 1, marzo 20242. Andrea Trombetti et al. Interdisciplinary management of FGF23-related phosphate wasting syndromes: a Consensus Statement on the evaluation, diagnosis and care of patients with X-linked hypophosphataemia. Nat Rev Endocrinol. 2022 Jun;18(6):366-384. Presentation: 6/1/2024

Tinnitus prevalence and care experience among population of Almaty city

The prevalence of tinnitus is increasing worldwide along with the aging population. The absence of a gold standard for diagnosis and treatment makes it difficult to assess the health status of a patient with tinnitus.The aim was to determine the prevalence of tinnitus among older adults in Almaty city and to evaluate the healthcare experience among the respondents who received treatment for tinnitus. MethodsA cross-sectional study was conducted among people aged 18 years and above in Almaty city. The data were collected using a questionnaire sent via a Google form and/or as a printed version. Fully completed responses were received from 851 respondents. The questionnaire consists of 31 questions. Simple and multiple logistic regression analyses were performed to identify the risk factors of tinnitus. ResultsThe prevalence of tinnitus in Almaty was 23.3%. The data showed that smoking and sleep regimen were associated with tinnitus. Older respondents indicated more symptoms associated with tinnitus than younger respondents did. Additional consultation was needed as part of the treatment of tinnitus. In addition, 49.4% of the respondents indicated a need of a support group for people with tinnitus. The respondents also indicated that the access to appropriate resources for the treatment of tinnitus was poor. ConclusionSimilar to other studies, this analysis confirmed that tinnitus is prevalent in the adult population of Almaty city. Future activities should include measures for the improvement of public awareness of the risk factors of tinnitus, and multidisciplinary teamwork among healthcare specialists should be improved.

A Blueprint for Clinical-Driven Medical Device Development: The Feverkidstool Application to Identify Children With Serious Bacterial Infection

Clinical decision rules (CDRs) integrated into applications enhance diagnostic and treatment prediction support for clinicians, necessitating CE-mark certification to enter the European market. We describe the development of a CDR as a medical device, focusing on challenges from a physician's perspective exemplified by the Feverkidstool (FKT), a validated CDR for febrile children. We pursued a local process, aligned with the CE-marking process, to develop the FKT as in-house developed device. We aim to provide a blueprint for colleagues.Medical device development, conform the Medical Device Regulation and performed by a multidisciplinary team, encompassed five stages: market scan, design, production, verification and validation and conformity assessment. Regulatory processes were continuously updated. The market scan identified a need for the FKT compared to existing applications. A prototype was designed in stage 2, further adjusted and improved based on the qualitative and quantitative results of stage 2-4. Lastly, stage 5 confirmed FKT's performance and safety. Medical device development presents challenges for physicians, requiring collaboration for technical, regulatory, and financial expertise. Multidisciplinary teamwork also poses challenges, including uncertainties regarding responsibility and timelines. After CE-certification, adapting to evolving needs and ensuring data privacy highlights the ongoing nature of medical device development.

All On One Page: Getting Daily Meal Ordering Right In A Rehabilitation Setting

Abstract Background Recently the rehabilitation hospital expanded to over 100 beds providing improved access to rehabilitation for older persons in the area. During this time, an increase in incident report forms occurred due to the incorrect provision of diet/fluid to patients at ward level. In collaboration with relevant stakeholders, the Speech and Language Therapy (SLT) and Dietetic teams reviewed the current hospital meal ordering form and process in order to standardise a new system. The aim of this project was to reduce risk for patients and improve collaborative team working and communication. Methods A multidisciplinary team (MDT) approach was adapted involving; SLT, dietitians, catering department, nursing team and the patient quality and safety department. The HSE change framework provided scaffolding for this work. A new Daily Meal Order form was created and approved by the Nutrition Steering Committee and the process was agreed using input from all stakeholders. A pilot was carried out, reviewed and rolled out across the campus. The number of incidents recorded at ward level was used to measure if risk was reduced. A staff survey was conducted to gather feedback on the new system. Results The new Daily Meal Order form is now being used across the campus. Additional checks are completed each day via email to reduce the risk of errors. No incident reports were filed since launching the new form and process. A staff survey showed that all staff feel the new system and form constitutes an improvement, that it saves clinical time and that they would recommend it to others. Conclusion The project aims have been met in reducing patient risk, in line with the HIQA Safer Better Healthcare Programme. It has also improved MDT working and communication. This project is easily replicable to other settings and staff would recommend this approach to others.

The Role of Plain Radiography in Assessing Aborted Foetal Musculoskeletal Anomalies in Everyday Practice.

Conventional radiography is widely used for postmortem foetal imaging, but its role in diagnosing congenital anomalies is debated. This study aimed to assess the effectiveness of X-rays in detecting skeletal abnormalities and guiding genetic analysis and counselling. This is a retrospective analysis of all post-abortion diagnostic imaging studies conducted at a centre serving a population of over 300,000 inhabitants from 2008 to 2023. The data were analysed using descriptive statistics. X-rays of 81 aborted foetuses (total of 308 projections; mean: 3.8 projections/examination; SD: 1.79) were included. We detected 137 skeletal anomalies. In seven cases (12.7%), skeletal anomalies identified through radiology were missed by prenatal sonography. The autopsy confirmed radiological data in all cases except for two radiological false positives. Additionally, radiology failed to identify a case of syndactyly, which was revealed by anatomopathology. X-ray is crucial for accurately classifying skeletal abnormalities, determining the causes of spontaneous abortion, and guiding the request for genetic counselling. Formal training for both technicians and radiologists, as well as multidisciplinary teamwork, is necessary to perform X-ray examinations on aborted foetuses and interpret the results effectively.

Accelerating rare disease detection: an experience of multidisciplinary team model in undiagnosed diseases program in a children's hospital.

A definite diagnosis goes undiscovered for a percentage of children with undiagnosed disorders, with significant medical, psychological, and social effects. Other than specialized clinical centers, exceptional molecular studies, common procedures, and devoted activities at the national and international levels, children with complex undiagnosed disorders require innovative approaches. In March 2016, Children's hospital of Fudan university represented the Children's Undiagnosed Diseases Program (UDP). The purpose of this study is to describe the project findings and underline the critical significance of multidisciplinary teamwork in China's undiagnosed rare illnesses program. We investigated the 758 cases in our UDP system retrospectively. Demographic information, laboratory test results, and genetic information were gathered. Between January 2017 and December 2021, 758 cases were examined. Males made up 436 (57.5%) of the total. Over half of the patients were children under the age of five. The average patient course time preceding admission to UDP was 6.0 months (95% CI 10.512.6). These patients visited an average of 1.8 clinics during their diagnostic journey. Except for 69 individuals (90.9%), all had more than one presenting symptom in various organs: 460 (60.7%) had neurology difficulties, 151 (19.9%) had endocrine problems, and 141 (18.6%) had immunology problems. UDP has a diagnosis rate of 61.3%. Genetic testing was performed on 469 of the 758 patients, for a genetic diagnosis rate of 15.8%. The UDP method has a sensitivity of 94.5%, a specificity of 86.4%, a positive predictive value of 92.8%, and an negative predictive value of 89.5%. Our UDP targets an unmet need, namely the diagnosis of patients with complicated, multisystem illnesses. Using a multidisciplinary team model approach, this UDP pilot study achieved a reasonable diagnosis success rate, increasing the possibility of more diagnoses and new scientific discoveries of difficult and rare diseases.

Polish infection control nurses’ burnout in the context of cooperation of different hospital professionals during COVID-19 pandemic

BackgroundsInfection control nurses’ job are crucial for patient and healthcare workers safety. However, effective infections prevention is based on the interdisciplinary team work, involving almost all hospital employees professionals. Difficulties in cooperation in such a team, especially prolonged ones, as well as crisis situations, may cause burnout. The aim of the study was to determine burnout among infection control nurses working during the COVID-19 pandemic in the context of difficulties in cooperation with different professionals working in hospitals.MethodsThe observational study was conducted between May and September 2021, using an online survey questionnaire consisting of two parts: describing difficulties in ICNs cooperation with different hospital professionals and Maslach Inventory Burnout scale, describing emotional exhaustion (EE), depersonalization (DP) and personal accomplishment rates (PA). Correctly completed online surveys were obtained from 177 participants.ResultsMost of the respondents (176 of 177) were women, working in public hospitals (81.48%). All respondents had considerable experience in work as nurses - the median was 30 years. However, the median experience in the ICNs position was 12 years. Median age of respondents was 51 years. The median level of EE was 31.0, w ith the range 23.0 to 39.0. For DP it was 5.0, with the range 3.0 and 11.5, while for PA – 24.0 (19.0–29.0). The highest values of EE were observed in the context of high level of difficulties with cooperation with management – the median was 36.0. DP was lowest among nurses declaring the lowest difficulties in cooperation with doctors. For PA the lowest level was observed in the group declaring high difficulties in the cooperation with doctors – median 22.0, with range 14.0–29.0.ConclusionsThe surveyed ICNs had higher rates of EE and PA than nurses working with patients, both before and during the pandemic. The level of burnout found in the ICN study group reached a level correlating in other studies with the intention to quit the job. The obtained results indicate the need to include effective training in the skills of working in multidisciplinary teams and the art of communication and achieving goals by ICNs.

Clinical Predictors of Mood Disorders and Prevalence of Neuropsychiatric Symptoms in Patients with Systemic Lupus Erythematosus.

Background/Objectives: We aimed to determine the prevalence and clinical correlations of mood disorders in a sample of systemic lupus erythematosus (SLE) patients. Hence, we hypothesized that the prevalence of mood disorders would be lower than reported in the literature and that patients would remain clinically stable and show less damage accrual despite low-dose corticosteroid prescription. Methods: In total, 92 SLE outpatients gave informed consent to participate in this cross-sectional study. Psychiatric and autoimmune clinical data were obtained, and a structured psychiatric interview was performed. The main clinical scales for the assessment of clinical symptomatology were included. To examine the potential relationships of presenting a mood disorder in SLE, clinical correlations and multivariate analyses were performed. Results: Mood disorders were the most prevalent disorder reported by SLE patients (16%), followed by adjustment disorders (5%). A significant proportion of patients presented psychosocial disturbances that did not meet the ICD-10 criteria for psychiatric diagnosis. According to the cut-off criterion for the Montgomery-Åsberg Depression Rating Scale (MADRS), up to 27% of the sample met the clinical criteria for depression. The multivariate analysis revealed a relationship between the presence of a mood disorder with total scores of the MADRS and the Young Mania Rating Scale (YMRS). Conclusions: The prevalence of mood disorders in patients with SLE was lower than previously reported. Although self-report clinical scales are useful for assessing clinical symptomatology, they should not be used in place of a comprehensive standardized interview conducted by a trained mental health specialist. Multidisciplinary teamwork is required for the early identification and therapeutic management of autoimmune patients with neuropsychiatric disorders.

Integrating frailty management into cardiac intensive care unit nursing practice: A qualitative study

BackgroundFrailty is prevalent among older patients in intensive care units (ICUs) and poses significant challenges to recovery. Despite its importance, there is limited research on effective nurse-led frailty management strategies in this context. ObjectiveThe purpose of this qualitative study was to explore nurses' perceptions of frailty management in cardiac ICUs through the lens of the Wuli-Shili-Renli (WSR) system approach. MethodsSixteen nurses from two tertiary hospitals in Shandong province, China, participated in semi-structured interviews. Participants were selected based on their involvement in frailty training, educational background, and cardiac ICU work experience. Thematic analysis was conducted to identify key themes and sub-themes. ResultsAnalysis in three categories revealed the need for foundational support, including the need for appropriate screening tools, updated evidence-based practices, and institutional support. Closed-loop management involved frailty screening, personalized program implementation, information management, and follow-up assessment. Personnel training and coordination emphasized enhancing nurses' professionalism, multidisciplinary teamwork, and cooperation from patients and their caregivers. ConclusionThe insights gained can inform evidence-based practices and improve the quality of care provided to frail patients in cardiac ICUs. There is a need for future research to empirically investigate these strategies.

FP5.4 - Improving Assessment of General Surgical Trainees in Multidisciplinary Team Working as a Capability in Practice: Perceptions of General Surgical Trainees and Trainers

Abstract Aim To explore how Higher Surgical Trainees (HST) and Trainers feel multidisciplinary team (MDT) working as a capability in practice (CiP) can be improved. Methods Within a deanery, 8 General Surgical HST and 4 Consultants were recruited to participate in virtual semi-structured interviews. Once transcribed, reflexive thematic analysis was performed. Ethical approval was granted. Results MDT is not worked into most trainees’ rotas. Participants felt that by formalising MDT, as with other CiP, it could be better assessed. Trainers, half of whom are MDT leads, stated that responsibility for MDT training and assessment should be placed on all consultants, rather than solely the leads. Participants explored how pathways could be instituted for HST to maintain ‘ownership’ of some patients from assessment clinic to MDT meetings to fully engage. In order to build to this level, a baseline of preparing patients but not presenting was suggested by one of the consultants. While, with one exception, no participants favoured a further work-based assessment, it was advocated by all that further clarification from ISCP regarding expectations of trainees at MDT would allow for more comprehensive assessment in the future. Most participants proposed that all members of MDT contributed to an assessment rather than relying on the Multi-Consultant Report. To prevent issues with timing or resources, a shadow or simulated MDT was suggested for HST. Conclusion General HST and consultants expressed concerns with the current way in which MDT is assessed as a CiP however they proposed ways in which it could be improved in the future.

Pulmonary alveolar proteinosis: presentation, diagnostic challenges, and management.

Pulmonary alveolar proteinosis is a rare diffuse lung disease; diagnosis and treatment of which is often delayed. We present the case study of a 43-year-old male with a six-month history of worsening breathlessness and non-productive cough referred for specialist respiratory input. Rapid investigations, including high-resolution computed tomography (HRCT) and bronchoalveolar lavage, confirmed the diagnosis of pulmonary alveolar proteinosis. Treatment with whole lung lavage significantly improved pulmonary function and quality of life. We discuss the diagnosis and management of this condition and highlight the importance of early recognition and multidisciplinary teamwork in managing pulmonary alveolar proteinosis.

WP8.1 - Perceptions of Higher General Surgical Trainees and Trainers towards Multidisciplinary Team assessment: A deanery’s experience of the new General Surgical curriculum

Abstract Aims Explore how multidisciplinary team (MDT) working is assessed as a capability in practice (CiP). Understand perceptions of problems with assessment of MDT as a CiP. Methods Semi-structured interviews were conducted virtually with 8 Higher Surgical Trainees (HST) and 4 Trainers following recruitment within a single deanery. Interviews were transcribed and analysed using reflexive thematic analysis. Ethical approval was granted. Results Most participants did not feel that they engaged meaningful with assessment of MDT as a CiP. Despite forming part of the Multi-Consultant Report (MCR), 75% of trainers were unaware of any formal assessment and expressed confusion over the introduction of the new curriculum. All participants reported that they felt MDT as a CiP was most appropriate for senior HST, particularly those peri-FRCS. HST felt excluded from the MDT process while trainers felt trainees did not engage. Trainees placed more value on MDT assessment in their declared subspeciality. All interviewed expressed that other activities were prioritised above MDT, particularly operating. When assessed, participants felt it was based on a balance of knowledge, presentation and preparation. Both HST and trainers felt participation rather than attendance was vital but currently not practiced. When considering grading of assessment, there was confusion from all participants in how to differentiate Level3 (Indirect Supervision) from Level4 (Day1 consultant), particularly in the context of multiple trainers in attendance. Conclusion Implementation of MDT as CiP has caused confusion among HST and trainers. It is poorly used and valued. The CiP is perceived as more beneficial to senior HST.