Multidisciplinary Team Of Specialists Research Articles

Management of Patients with Vulvar Cancers: A Systematic Comparison of International Guidelines (NCCN-ASCO-ESGO-BGCS-IGCS-FIGO-French Guidelines-RCOG).

Vulvar carcinoma is an uncommon gynecological tumor primarily affecting older women. Its treatment significantly impacts the quality of life and, not least, aesthetics because of the mutilating surgery it requires. The management requires a multidisciplinary team of specialists who know how to care for the patient in her entirety, not neglecting psychological aspects and reconstructive surgery. How do the guidelines address multidisciplinarity, team surgical management, passing through preoperative diagnosis, and follow-up in such a challenging rare tumor to treat? To answer these questions, we compared the main scientific recommendations to identify similarities and differences in diagnostic and therapeutic management to provide an overview of the gaps that there are currently in European and American international recommendations in providing management guidance in a cancer that is both among the rarest and most difficult to manage. In this way, we aim to encourage an update in practices based on the latest scientific evidence. A review of various international guidelines, some dating back to 2014, shows significant variation in approaches, ranging from initial diagnostic procedures to managing relapses. The most recent guidelines also lacked references to the latest literature, indicating that more robust scientific evidence is needed before new treatments, such as electrochemotherapy for palliation and reconstructive surgery post exenteration, can be widely adopted. From the systematic comparison of the main international guidelines, a strong heterogeneity emerged in the diagnostic and therapeutic recommendations as well as for the multidisciplinary approach that today is essential. Our work certainly stimulated an update of the main guidelines.

EATING DISORDERS IN CHILDREN AND ADOLESCENTS AS A COMPLEX PUBLIC HEALTH ISSUE: RISKS, TRENDS, MANAGEMENT

The medical and social significance of eating disorders (EDs) in adolescents is determined by their prevalence, impact on patients' quality of life, consequences, and the burden they place on the public health system. The high level of stress due to the COVID-19 pandemic and the full-scale Russian-Ukrainian war has led to a deterioration in the mental health of citizens in our country, restricted access to medical care for all segments of the population, resulting in late diagnoses of these disorders, low treatment effectiveness, and insufficient preventive measures. The purpose of the article is to study EDs in children and adolescents as a complex public health issue, covering such aspects as prevalence, classification, etiology, early diagnosis, treatment, development of preventive programs and promotion of healthy eating behavior in this age category, as well as analysis actions and policies of national healthcare systems in various countries regarding the management of this pathology. The methods used include the analysis and synthesis of current scientific sources from the databases PubMed, Scopus, and Google Scholar covering the years 2010–2024. The main findings of the study identify key issues related to the understanding, diagnosis, treatment, and prevention of eating disorders in adolescents. The study summarizes the needs of the national public health system to ensure proper management of these disorders. It describes the contemporary understanding of the multifactorial nature of eating disorders. The necessity of involving a multidisciplinary team of specialists in the treatment process is demonstrated, along with the use of trauma-focused, biopsychosocial, and age-dependent approaches to achieve high therapeutic efficacy. The negative impact of the COVID-19 pandemic and the war on the onset and course of eating disorders is also evidenced. The practical value of this work lies in the fact that its results serve as a foundation for developing effective programs for the diagnosis, treatment, and prevention of eating disorders in adolescents, with mandatory involvement of the patients' families and communities. The findings also provide a basis for creating training programs for multidisciplinary team professionals in the management of eating disorders, as well as for developing recommendations on counseling activities and promoting mental health and healthy eating behaviors. The results of this study provide a foundation for implementing alternative treatment options that can be effectively contrasted with traditional inpatient care

Нейрофиброматоз 1 типа и ассоциированные заболевания: педиатрические аспекты диагностики, наблюдения, терапии

Neurofibromatosis type 1 (NF1) is a genetically determined disease characterized by damage to all organs and systems with dominant involvement of the skin and peripheral nervous system. One of the main NF1 features is the age-dependent representation of its clinical symptoms, which is the reason for untimely diagnosis verification and inadequate medical care which in its turn entails the risks for severe disability and reduced life expectancy. Obviously, the key factors in improving the prognosis for life and its quality are the improvement of screening, diagnostics, therapy and rehabilitation programs, both in childhood and in adult patients. The issues of social and psychological adaptation of patients and their families are highly relevant, this therefore requires the availability of information sources and the involvement of a multidisciplinary team of medical specialists at all stages of medical care. The purpose for publication of this bibliographical review was to highlight the features of diagnosis and observation of children with NF1 as well as existing treatment options for associated diseases.

Trust, belief and transitions: people’s experiences of multidisciplinary inpatient treatment for persistent physical symptoms. A qualitative study

Purpose People with Persistent Physical Symptoms experience physical symptoms that are not wholly explained by a medical disorder or disease. Multidisciplinary treatment is recommended for people with severe difficulties and is provided in a small number of specialist centres in the UK. Only brief descriptions of this treatment are available, and the experiences of people receiving this treatment as an inpatient have not been explored. This study aimed to explore how people with persistent physical symptoms experience inpatient treatment from a specialist multidisciplinary team, and to identify which factors facilitated their engagement in the rehabilitation. Materials and Methods 18 people who had received inpatient multidisciplinary treatment for persistent physical symptoms participated in semi-structured interviews. The transcripts were analysed using reflexive thematic analysis. Results Participants’ experiences were influenced by whether they felt believed by the healthcare team, and whether they could place their own trust and belief in the staff team and the treatment approach. Their experiences involved a series of transitions; both in environment and understanding. Conclusions Improvements are possible for people receiving inpatient multidisciplinary treatment for severe PPS. Trusting relationships between patients and staff members take time to develop but play a major role in patients’ experiences of treatment.

Public health, policy, and clinical interventions to improve perinatal care for migrant women and infants in high-income countries: a systematic review

Migrant women who are pregnant or postpartum and their infants are often at increased risk of poorer perinatal outcomes compared to host country populations. This review aimed to identify public health, policy, and clinical interventions to improve maternity care for migrant women and their infants in high-income countries (HICs). In this systematic review we searched EMBASE, EMCARE, MEDLINE and PsycINFO, CENTRAL, Scopus, CINAHL Plus, Web of Science, and grey literature from inception to 13th March 2024, with no language or date restrictions (PROSPERO: CRD42022380678). Interventional and observational studies assessing the effectiveness of any intervention to improve perinatal care for migrant women and their infants in HICs delivered in the pregnancy, peripartum, or postpartum period (up to one year after birth) were included. Quantitative outcomes were extracted. Qualitative studies were excluded. The main outcomes of interest were preterm birth, birthweight, and appointment attendance. Quantitative synthesis was conducted using Harvest plots and binomial exact calculations. 15,689 records were retrieved, 29 studies comprising data from 16,763,837 women were included. 22 studies (75.9%) included multiple interventions. Five interventions had strong evidence of effectiveness. Two clinical interventions: 100.0% of studies including specialist multidisciplinary teams improved one or more of the main outcomes of interest, namely preterm birth, birthweight, and appointment attendance (95% confidence interval 73.5-100.0%; p<0.001); and 90.9% of studies including specialist in-person interpreting improved one or more of the main outcomes of interest (58.7-100.0%; p=0.012). Three public health or policy interventions: 100.0% of social welfare interventions (75.3%-100.0%; p<0.001) improved one or more of the main outcomes of interest; 100.0% of maternal education interventions (71.5-100.0%. p<0.001), and 83.3% of studies assessing access to free healthcare (51.6-97.9%; p=0.039). The findings suggest that multicomponent interventions comprising multidisciplinary teams, in-person interpreting, maternal education, and social welfare support can improve perinatal outcomes for migrant women and their infants. Removing financial barriers to care may improve perinatal outcomes and be cost saving to healthcare systems. However, these findings should be interpreted with caution given that most included studies were of poor quality and that sensitivity analysis restricting to interventional studies only did not demonstrate any effect on the main outcomes of interest. KS is supported by a National Institute for Health Research (NIHR) Doctoral Fellowship (NIHR302577). HRJ is supported by an NIHR Advanced Fellowship (NIHR303183). HRJ is supported by NIHR Applied Research Collaboration (ARC) South London. MM is supported by a Medical Research Council Clinical Research Training Fellowship (Grant number MR/W01498X/1). GF is supported by a Nuffield Department of Population Health Clinical Research Fellowship. MK is an NIHR Senior Investigator (NIHR303806). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Follow-up and transition practices in esophageal atresia: a review of European Reference Network on rare Inherited and Congenital Anomalies (ERNICA) centres and affiliates

PurposeThe purpose of this study was to understand the provision and distribution of esophageal atresia (EA) follow-up (FU) and transition services across European Reference Network for rare Inherited and Congenital Anomalies (ERNICA) member and affiliate centers.MethodsA REDCap questionnaire was sent to clinical leads of 18 ERNICA members and 14 affiliate centers.Results29 of 32 centers responded (91%), the majority of which were highly specialized. Two-thirds had a dedicated EA clinic with a specialist multi-disciplinary team (MDT), offered to selected/complex patients only in 40% of centers. ERNICA centers were more likely to offer an MDT FU clinic than affiliates, with lack of resources most cited as a barrier to uptake (67%). Delivery of routine investigations was heterogeneous, particularly provision of three endoscopies over the course of FU (24%). Only 55% had a dedicated transition pathway, more prevalent in ERNICA centers (81% vs. 30%; p < 0.01). Self-reported awareness of ERNICA and European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidance for FU and transition was poor (28%).ConclusionDespite the existence of European follow-up and transition guidelines, their delivery is not uniform and may be limited by lack of awareness of the guidelines and a lack of resources.

Examining the clinical role and educational preparation of heart failure nurses across Europe. A survey of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) and the Association of Cardiovascular Nursing and Allied Professions (ACNAP) of the ESC.

To describe the clinical practice and educational preparation of heart failure (HF) nurses across Europe and determine the key differences between countries. A survey tool was developed, in English, by the Heart Failure Association Patient Care committee of the European Society of Cardiology (ESC). It was translated into eight languages, before electronically disseminated by nurse ambassadors, presidents of HF national societies and through social media. A total of 837 nurses involved in the daily care of patients with HF from 15 countries completed the survey. Most nurses, 78% (n = 395) worked within a hospital outpatient setting, and 51% (n = 431) had access to a specialized HF multidisciplinary team. Nurses performed a range of activities including patient education to promote self-care, virtual and in-person symptom monitoring. A third had more than 5-year experience in cardiac care and 22% (n = 182) prescribed HF medications. There was a significant correlation between HF nurses that prescribed HF medications and access to a specialist multidisciplinary team (p = 0.04). A small number of nurses, mainly from Belgium, supported invasive monitoring (n = 68, 8%) with 14% (n = 120) of mostly Danish nurses supporting exercise programmes. The majority of nurses surveyed were committed to further academic professional development, with 41% (n = 343) having completed a HF course. The role of the HF nurse varies across Europe, however involvement in patient education, symptom monitoring and follow-up remain core to their practice. In specific activities including the prescribing of HF medications and involvement in invasive monitoring, practice has advanced with collaboration in the multidisciplinary team. Consequently, harmonization of education, training and career pathways are required to standardize HF care aligned with expert guidelines across Europe.

Metastatic pituitary lesion

Metastatic lesion of pituitary is a rare condition and is diagnosed in 1.8-4% of cases. Monitoring and treatment of such patients is a complex task and requires increased attention from a multidisciplinary team of specialists. The authors represent three patients with metastatic pituitary lesion who underwent neurosurgical treatment at the National Research Center of the National Research Institute of Endocrinology with subsequent pathomorphological confirmation of the diagnosis. The primary tumors were breast cancer, lung carcinoid, and clear cell kidney cancer. Two patients had distant metastases other than the pituitary gland. The clinical manifestation consisted in the appearance of symptoms of panhypopituitarism, chiasmal syndrome and mass effect in all cases. The follow-up period after surgical treatment was 0.25-2.5 years. Progression of the underlying disease was noted in two patients. One of them carried out stereotactic radiosurgical treatment and stereotactic oriented irradiation. One patient has a stable condition.

Healthcare workers’ experience of screening older adults in emergency care settings: a qualitative descriptive study using the Theoretical Domains Framework

BackgroundIn emergency care settings, screening for disease or risk factors for poor health outcomes among older adults can identify those in need of specialist and early intervention. The aim of this study was to identify barriers and facilitators to implementing older person-centred screening in emergency care settings in the Mid-West of Ireland.MethodsThis study employed a qualitative descriptive design underpinned by the theoretical domains framework (TDF). This design informs implementation strategy by establishing a theoretical foundation for focused objectives. One on one semi-structured interviews were conducted with a purposive sample of healthcare workers (HCWs) to explore their screening experiences with older adults in emergency care settings. Information power guided sample size calculation. In data analysis, verbatim interview transcripts were deductively mapped to TDF constructs forming meta-themes that revealed specific barriers and facilitators to person-centred screening for older individuals. These findings will directly inform implementation strategies.ResultsThree themes were identified; Preconditions to Implementing Older Person-Centred Screening; Knowledge and Skills Required to Implement Older Person-centred Screening and Motivation to Deliver Older Person-Centred Screening. Overall, screening in emergency care settings is a complicated process which is ideally undertaken by knowledgeable and skilled practitioners with a keen awareness of team dynamics and environmental challenges in acute care settings. These practitioners serve as champions and sources of specialist knowledge and practice. Less experienced clinicians seek supervision and support to undertake screening competently and confidently. Education on frailty and aged related syndromes facilitates screening uptake. Recognition of the value of screening is a clear motivator and leadership is vital to sustain screening practices.ConclusionsScreening serves as an entry point for specialist intervention, necessitating a specialist multidisciplinary team (MDT) approach for effective implementation in emergency care settings. Strengthening screening practices for older adults who attend emergency care settings involves employing audit, supervision and tailored supports. Skilled and experienced practitioners play a key role in mentoring and supporting the broader MDT in screening engagement. Long-term and sustainable implementation relies on utilising existing managerial, practice development and educational resources to underpin screening practices. Communication between Emergency Department (ED) staff, the specialist team and wider geriatric team is vital to ensure a cohesive approach to delivering older person-centred care in the ED.

OSSEOINTEGRATIVE PROSTHETICS: OPPORTUNITIES, CHALLENGES, AND PROSPECTS FOR ITS APPLICATION IN THE REHABILITATION OF PATIENTS WITH AMPUTATED LIMBS (LITERATURE REVIEW)

Rehabilitation of patients with amputated limbs is a pressing medical and social issue in modern society. A novel method for partial restoration of limb function is osseointegrative prosthetics. Its main advantage lies in the fact that the implant allows mechanical loads and forces to be transmitted directly to the bone, whereas in traditional prostheses, they mainly act on soft tissues. Despite nearly 30 years of experience with osseointegrative implants globally, these technologies have not yet been implemented in either scientific or clinical practice in Ukraine. Objective. To conduct a literature review of the global practical experience with the use of osseointegrative prosthetics in patients with amputations and to identify its main features, advantages, and disadvantages. Methods. The information search was performed in the bibliographic databases PubMed, Scopus, and Google Scholar. Results. The analysis of literature sources allowed us to distinguish the main types of osseointegrative implants, which differ in terms of design, materials, and surgical techniques: either single-stage or two-stage procedures, and fixation by threading or press-fitting. The rehabilitation period ranges from 6 months to 2 years. Within the first two years, certain complications such as bone infections and skin inflammation should be expected. Hфowever, most of these pathological conditions can be effectively managed. Conclusions. Successful fixation of osseointegrative implants requires optimizing the patient’s bone, the prosthetic surfaces, and the ‘skin-implant’ interface. The implementation of these technologies requires multidisciplinary teams of specialists, including physicians, engineers, and rehabilitation experts. Osseointegrative implants significantly enhance patients’ functional abilities and quality of life, opening up greater opportunities for the use of bionic and robotic prosthetics.

Under-Prescription of Drugs in the Elderly Population of Western Romania: An Analysis Based on STOPP/START Version 2 Criteria.

Background/Objectives: Numerous European countries, including Romania, are facing the concern of rapid ageing of their populations. Moreover, Romania's life expectancy ranks among the lowest in the European Union. In light of this, it is imperative that the assessment of medication-related harm be given national priority in order to secure and enhance pharmacotherapy and the medical act. In this study, we sought to describe and evaluate the under-prescribing practices among the Romanian elderly population. Methods: We conducted a cross-sectional study in urban areas of two counties in Western Romania (Timis and Arad) from November 2017 to February 2019. We collected chronic electronic prescriptions issued for elderly patients (>65 years old) with chronic conditions. The medication was prescribed by generalist or specialist physicians for periods ranging between 30 and 90 days. To assess inappropriate prescribing behaviours, a multidisciplinary team of specialists applied the Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert to Right Treatment (STOPP/START) v.2 criteria to the collected prescriptions. Results: Within the 1498 prescriptions included in the study, 57% were issued to females, the mean age was 74.1 ± 6.95, and the average number of medicines per prescription was 4.7 ± 1.51. The STOPP criteria most commonly identified were the (1) long treatment duration (23.6%) and (2) prescription of neuroleptics (14.6%) or zopiclone (14.0%) as medications that increase the risk of falls. According to START criteria, the following medicines were under-prescribed: (1) statins (47.4%), (2) beta-blockers (24.5%), (3) antiresorptive therapy (10.0%), and (4) β2-agonists and muscarinic antagonists for chronic obstructive pulmonary disease (COPD) (4.5%). Within our study group, the prevalence of potentially inappropriate medications was 18.58%, whereas the prevalence of potential prescribing omissions was 49.2%. Conclusions: To decrease medication-related harm and morbid-mortality, and to increase the quality of life for elderly people in Romania, immediate actions are needed from national authorities. These actions include reinforcing primary care services, providing periodic training for physicians, implementing medication review services by pharmacists, and utilising electronic health records at their full capacity.

7756 Gonadectomy in Individuals with Differences of Sex Development - A Prospective I-DSD Registry Study

Abstract Disclosure: M.A. O'Connell: None. A.K. Lucas-Herald: None. J. Bryce: None. M. Chen: None. J.H. Davies: None. M. Shnorhavorian: None. N. Atapattu: None. I. Bachynska: None. N. Birkebaek: None. M. Cools: None. K. Demir: None. L. de Vries: None. H. Elsedfy: None. M.A. Fahmy: None. E. Globa: None. R. Grinspon: None. G. Guaragna-Filho: None. G. Guerra-Junior: None. D. Janus: None. Z. Kolesinska: None. I. Mazen: None. S.M. O'Connell: None. S.N. Seneviratne: None. M. Stancampiano: None. G. Verkauskas: None. S.F. Ahmed: None. O. i-DSD gonadectomy surveillance consortium: None. Introduction: Gonadectomy may be indicated in people with differences of sex development (DSD), but variation in practice is reported. This study aims to determine, through prospective surveillance, the frequency of gonadectomy and associated care pathways in individuals with DSD internationally. Methods: All I-DSD centres were invited to participate; the study commenced in December 2022. Participating centres receive a monthly email asking whether a gonadectomy has been performed in an individual with DSD. Where informed consent for inclusion in the I-DSD Registry has been obtained in a reported case, a secondary survey captures additional clinical information. Results: Of 208 centres invited, 74 have responded to monthly email surveys. Over the first 12 months of surveillance, gonadectomies were reported in 71 individuals from 34 centres in 19 countries (median [range]: 1[1, 5]); 40 centres reported no gonadectomy. Secondary survey data are available for 30/65 (46%) of reported cases to date. Twenty-four (80%) individuals are female; median (range) age at gonadectomy was 9.2 (2.1,20.0) years. All had specialist multidisciplinary team involvement prior to gonadectomy: endocrinology (97%), genetics (77%) and psychology (67%) were most frequently involved. Gonads were intra-abdominal in 25/30 (83%). Differences of gonadal development (13/30 [43%]) and Turner syndrome (8/30 [27%]) were the most frequent underlying DSD. Pre-gonadectomy investigations included: hormonal testing (28/30 [93%]), imaging (23/30 [77%] - US alone n=14; US + MRI n=7; MRI alone n=2), direct visualisation at laparoscopy (7/30 [23%]) and gonadal biopsy (2/30 [7%]). Bilateral gonadectomy was undertaken in 25/30 (83%). Mitigation of future malignancy risk in the context of gonadal insufficiency was the most common primary indication for gonadectomy (19/30, [63%]); additional indications were concerning changes on biopsy/imaging (3/30 [10%]), hormone production incongruent with sex assigned (4/30 [13%]) or gender identity (2/30 [7%]) and parental choice (2/30 [7%]). Histopathology confirmed neoplastic change in 7 individuals (23%). Gonadectomy was intentionally deferred in 8/30 (27%) individuals, most commonly to allow their involvement in decision making. Twelve individuals (40%) were 12yrs or older at gonadectomy; all were involved in the pre-operative decision-making process. Conclusions: This study offers important contemporary insights into the practice of gonadectomy in individuals with DSD internationally. Multidisciplinary care provision prior to gonadectomy is standard; however, management pathways vary, likely reflecting diversity of clinical presentations and lack of consensus regarding optimal approach. The I-DSD platform shows clear utility for performing prospective surveillance of rare procedures; such studies are essential for care quality improvement. Presentation: 6/2/2024

Improving influenza vaccination assessment and uptake, one step at a time in a cancer center.

280 Background: Influenza immunization has shown to decrease morbidity and mortality of influenza infections. From September to December 2022, at the infectious diseases (ID) clinic at our institution, 73% of the patients did not undergo influenza immunization assessment during their clinical encounters and only 3% of the patients had the influenza vaccine administered. Furthermore, documentation of vaccine discussion was done in 73% of cases. Our aim was to improve vaccination assessment from 73% noncompliant to 50%. Methods: A multidisciplinary team of nurses, nurse leaders, pharmacists, and quality specialists was assembled to analyze baseline data on influenza vaccination assessment, administration, and documentation at the ID clinic from Sept to Dec 2022 using The Model for Improvement. Quality tools were utilized including Cause and Effect Diagram, Current State Process Flow Chart and Prioritization Matrix, to identify and prioritize opportunities for improvement creating a worklist for improvement focus. Vaccine assessment measured via EPIC immunization tab marked as reviewed, discrete areas to document vaccination and their administration were not a part of nursing or provider’s workflow. Using the Plan, Do, Study, Act (PDSA) method, the following changes were tested: PDSA Cycle 1; A green sticker highlighted those patients needing vaccine assessment. PDSA Cycle 2; A smart phrase was created for documentation in nurses’ notes and PDSA Cycle 3; provider’s notes regarding vaccine recommendations. Results: Interventions were associated with an improvement of influenza assessment via the immunization tab marked as reviewed in the ID outpatient clinic from 73% noncompliance to 3% noncompliance from September 2023 to March 2024. Concurrent with improvement of our assessment process, our on-site vaccination rate increased from 97% error to 89% error (Table) and there was 50% improvement in provider’s documentation. Conclusions: The formation of a multidisciplinary working group and implementation of quality tools interventions resulted in timely significant improvement in vaccination assessment, documentation, and administration. Subsequently, we were granted institutional approval to add an EPIC clinical decision support tool to standardize influenza vaccination documentation. Future strategies include implementation and evaluation of the utilization of Health Maintenance tool in the ID clinic before expansion to other clinics in our institution. Influenza vaccine administration vs outpatient visits in the ID clinic. Month/Year # Outpatient visits # Vaccines administered in clinic % of vaccines administered Influenza Sep-Dec 2022 1827* 54 2.95% Influenza Sept 2023-March 2024 2682 251 9.36% *Includes video and telephone visits.

Playing Ping- Pong: Keeping Frail Older Adults Out Of Hospital

Abstract Background EDITH (Emergency Department in the home) is a rapid response team consisting of a doctor/Advanced Nurse Practitioner and Occupational Therapist who assess patients in their home to avoid an ED attendance. The Integrated Care Team for Older People (ICPOP) is a community-based specialist multidisciplinary team that provides assessment and intervention for frail older adults in order to maintain them living at home. The teams have developed a close working relationship and utilise each other’s services to provide right time, right place patient care with the ultimate shared goal of keeping older adults living well at home. Methods A high frequency service user was identified, and a retrospective chart review was completed between the two teams. Outcome measures such a CFS, 4AT, medical status, social supports and environment set up were noted. Patient journey was conceptualised and handover of medical responsibility from team to team was explored along with identifying other factors that maintain older adults living well in their homes. Results Over a 12-month period, patient X case was “ping ponged” between the two services. The patient attended ED with EDITH review in the home facilitating a direct discharge home. The ICPOP team provided ongoing interdisciplinary and specialised intervention. ICPOP also identified changes to medical status that warranted timely EDITH review and thus negated the need for ED attendance. Patient X avoided a hospital admission during that period due to co working and open communication between both teams. Conclusion Rapid access, timely communication and team work between the EDITH/ICPOP yielded a positive result for patient X and allowed them to remain at home, despite a high level of frailty and low threshold for hospital admission. It appears that having services working with a collaborative approach affords better outcomes for this vulnerable population and reduces pressure on hospital resources.

“Conversations with Friends”: A review of communication between two services

Abstract Background EDITH (Emergency Department in the home) is a rapid response team consisting of a doctor/ANP and OT who assess patients in their home to avoid an ED attendance. The Integrated Care Team for Older People (ICPOP) is a community-based specialist multidisciplinary team that provides assessment and intervention for frail older adults in order to facilitate them to remain living at home. These two teams work collaboratively to keep older adults out of hospital and refer a high volume of patients between the two services. It is imperative to reflect on current communication practices in order to future proof these services and ensure optimum patient care. Methods An electronic survey was designed to evaluate the service and was circulated to members of both teams. Quantitative data was captured via likert scales and qualitative feedback was analysed via thematic analysis. There was a total of 13 respondents. Results One hundred percentage of participants rated confidentiality of communication “average” and “above average”. 92% rated accuracy and accessibility of communication as “average” and “above average” while 15% rated speed of communication as “below average”. Key themes such as “prompt communication”, “friendly working relationships” and “using therapy specific language” emerged as areas that are working well. Area for improvement include “close loop communication/referral process” and “lack of a shared electronic healthcare record”. Conclusion Overall, the feedback from both teams appears to be positive and it is beneficial to reflect on communication processes. It is important to build on good working relations between acute and community teams as it likely results in better patient outcomes. Key areas for improvement have been highlighted and an action plan to address same can be formulated.

Nursing, Care and Rehabilitation in Case of Stroke in the Program of the Clinical and Educational Complex "STROKE"

The Ministry of Health of the Russian Federation, in accordance with the State Program for the Development of Healthcare of the Russian Federation and within the framework of the national project "Health", has been conducting the Clinical and Educational Training Complex "STROKE" in all federal districts of the Russian Federation since 2012. The program is aimed at improving the provision of medical care to patients with vascular diseases in the regions of Russia. In the multidisciplinary team of specialists, the niche of training in nursing care with elements of rehabilitation is occupied by the St. Demetrius Sisterhood.

Co-creating a Data Asset Inventory for Equity-Oriented Research

BackgroundData asset inventories (DAI) are invaluable resources providing high-level information about datasets, including name, region, purpose, scope, and contents. An effective DAI improves understanding about what data exists, how they can be used, and where they may be limited. Strategies for integrating principles of inclusion, diversity, equity, and accessibility (IDEA) into DAIs are not widely available, which inhibits efforts to improve existing data infrastructure’s capacity for equity-oriented research. ApproachHealth Data Research Network Canada (HDRN) is a pan-Canadian network that works collaboratively to enable innovative multi-regional research that can improve health and health equity. Central to HDRN’s mandate is strengthening researcher capacity to apply IDEA principles within their research. Within this scope of work, we convened a multi-disciplinary team of computer scientists, data experts, and IDEA specialists to build a DAI of Canadian health and social data using de-stigmatizing language. Through discussion the team identified key data categories and co-created definitions. Data sets were annotated accordingly. ResultsDiscussions highlighted disciplinary differences in understandings of IDEA and its relevance to DAIs. Overcoming these differences required IDEA specialists to be both subject matter experts and advocates. Project delays occurred due to the additional time needed for education. Productive conflict resulted in consensus-building to establish respectful and inclusive terms to describe data. DiscussionEmbedding IDEA within health data infrastructure requires a lens that may not be associated with one’s training. Developing that lens within a project is possible but requires additional time and effort. These components must be factored into project planning.

Optimisation of the quality of care for patients with severe asthma: ASfarMA project

Severe asthma has an important impact on patients and healthcare resources. Recently, the new specific treatments have defined a new scenario in which person-focused care and specialist multidisciplinary teams are...

Multidisciplinary monitoring in pediatric patients with medulloblastoma by primary care physician

Diagnostic and treatment facilities in pediatric oncology have reached a very technological advances in a short period of time, contributing to increased relapse-free and overall survival rates. Obviously, the key factors are the improvement of diagnostic and screening programs, anticancer and concomitant therapy, including personification of clinical guidelines for monitoring and correction of early and late complications in time. Issues regarding the quality of life of patients, including social, psychological rehabilitation and aspects of reproductive potential, are becoming highly actual. The critical importance is that an informed multidisciplinary team of specialists at all stages of anticancer treatment should be involved. This article presents the main algorithms and the most significant issues for pediatricians in the diagnosis and supervision of patients with an oncological diagnosis, using the example of medulloblastoma, as the most common malignant tumor of the central nervous system in children. The proposed recommendations are based on a retrospective analysis of pediatric patients with relapsed and refractory forms of medulloblastoma (n = 270) who received antitumor therapy in the period from 07/01/1993 to 07/01/2023, as well as international clinical data.

Workplace wellness across the lifespan: A pilot program for health promotion in a low- and middle-income country.

Considering that a sizable segment of the population spends significant amount of time at work, workplaces have been identified as practical platforms for health educational programs. Although employee wellness programs in high-income countries have shown measurable benefits in productivity and physical and mental health, evidence-based programs in low- and middle-income countries, such as Lebanon, are unavailable. The aim is to develop and implement a pilot workplace wellness program focusing on health-related areas to improve health knowledge and behavior among working men and women of reproductive age. In collaboration with March of Dimes, the National Collaborative Perinatal Neonatal Network developed a culturally sensitive health education program focusing on lifestyle, infection, nutrition and family planning. Sessions were delivered by a multidisciplinary team of specialists at a local bank in Lebanon. To assess the impact of the program, participants completed Knowledge and Behavior Assessment Questionnaire (KBAQ) before and after implementation. KBAQ was conducted 6 months after implementation to measure retention and continuing impact. Forty-seven participants completed the program, of whom 44.7% are male, 98% have university degree and 56.5% are married. Total knowledge score improved significantly from 64.2 to 74.3 and remained significant at 6 months post-implementation with a score of 71.7 (p < 0.001). At 6-month follow-up, emotional score improved (p = 0.028), while smoking decreased (p = 0.008). Also, employees' health knowledge and behavior showed sustained and significant improvement. We plan to implement our program at other sites and among employees from different backgrounds to understand the impact of the wellness program on employees' knowledge and behaviors at a larger scale.