Multidisciplinary Teamwork Research Articles

Reducing catheter-associated urinary tract infections in a large health system: a quality improvement approach using a fractal management system

Abstract Objective: Although preventable through established infection control practices, catheter-associated urinary tract infections (CAUTIs) remain prevalent in acute-care settings. Our goal was to improve the CAUTI rates through multiple hospitals through implementing sustainable practices, including enhancing communication, provider engagement, accountability, and transparency in reporting to achieve long-term improvements. Design: Quality improvement with multiple levels of interventions Setting: A health system in northern Ohio with 21 affiliated hospitals across 16 counties. Patients: Adult patients admitted to the hospital between June 2020 and June 2023. Methods: A broad set of quality improvement (QI) strategies was developed by an interdisciplinary team and guided by the Fractal Management System framework to ensure accountability, communication, and alignment across teams and facilities. Key drivers were indwelling urinary catheter (IUC) alternatives, insertion, maintenance, removal, and smart diagnostics. The main outcome measures were standardized infection ratios (SIR) and standardized utilization ratio (SUR), comparing period 1 (P1, June 2020 to December 2021) and period 2 (P2, January 2022 to June 2023). Results: Enhanced communication and management played crucial roles in minimizing IUC placement. Updated policies and protocols, coupled with clear guidelines and decision support tools, facilitated effective urinary management. Performance tracking and visual management boards provided real-time insights, while collaborative efforts, including staff huddles and multidisciplinary teamwork, ensured consistent adherence to best practices. Conclusions: A systemwide QI initiative focused on enhanced communication, management, and collaboration contributed to improved SIR and reduced CAUTI rates across multiple hospitals, highlighting the impact of strong communication and proactive management in healthcare settings.

Prehabilitation and Perioperative Multidisciplinary teamwork in hepatectomy for liver cancer

Prehabilitation and Perioperative Multidisciplinary teamwork in hepatectomy for liver cancer

Sinusoidal obstruction syndrome/veno-occlusive disease: a complication to overcome

Sinusoidal obstruction syndrome (SOS)/veno-occlusive disease (VOD) is a well-known, potentially fatal liver complication. Some clinical diagnostic criteria have been proposed over the years. Defibrotide is the only approved treatment for SOS/VOD and should be administered within two days of diagnosis. Recently, the EBMT 2023 criteria aimed at early diagnosis were published, and the ultrasound diagnostic tool HokUS-10 has attracted worldwide attention. Although the incidence of SOS/VOD is decreasing, it remains a significant complication that must be addressed. Early diagnosis and prompt treatment are crucial, and achieving this requires multidisciplinary teamwork between physicians, nurses, sonographers, pharmacists, and other healthcare professionals. This collaborative approach is essential to optimize treatment and save SOS/VOD patients.

Acil servise kabul edilen travmalı hastaların yakınlarının yaşadıkları kaygı

Introduction: Emergency departments, which are the busiest and most complex units of hospitals, are areas where multidisciplinary teamwork is performed. Patients and their relatives admitted to emergency departments in an unprepared manner because of traumas face many uncertainties. Aim: The aim of the study was to determine the anxiety levels of relatives of patients admitted to emergency departments with trauma. Material and Methods: This descriptive study was conducted in the emergency department of a university hospital with the participation of a total of 97 patient relatives between December 2020 and April 2021. Data were collected using Information form and State Anxiety Inventory. Results: The mean age of the patient relatives was 35.1±8.4, and 54.6% of the patient relatives were men, and 55.7% were undergraduates. The mean State Anxiety Inventory score of patient relatives was found to be 37.3±6.3. It was also found that 63.9% had mild anxiety, and 36.1% had moderate anxiety levels. It was determined that the anxiety of the relatives of the patients varied according to the positive alcohol test results and the type of shift in which they were admitted (p < 0.05). Conclusion and suggestions: It was determined that the patient relatives admitted to the emergency department with traumas experienced mild anxiety during the first 24 hours after admission. Training should be continued to support the skills of emergency department staff in patient communication and psychosocial support, and patient relatives should be informed about the process.

Supporting clinical workflow: The role of pharmacist-nurse relationships in delivery of care

Background: There has been an increasing acknowledgement of the need for interprofessional cooperation in healthcare in recent years. Aim of the Study: This review thoroughly analyzes the significance of pharmacist-nurse interactions in facilitating clinical workflow, specifically exploring the advantages, difficulties, and methods for improving collaborative practice. Materials and Methods: The literature reviewed in the analysis included a wide variety of research methods, offering valuable information on the potential benefits and challenges of cooperation between pharmacists and nurses. Results: The examination of the literature demonstrated that cooperative partnerships between pharmacists and nurses may enhance the management of medications and the delivery of patient care, resulting in improved patient outcomes. The research identified key themes that highlighted the advantages of multidisciplinary teamwork, such as greater drug safety, improved patient education, and more effective care delivery. Nevertheless, the analysis also identified many obstacles, such as language difficulties, unclear job responsibilities, and limitations within the organization, which might impede the successful cooperation between pharmacists and nurses. The results underscore the need for improved cooperation and correspondence among these medical practitioners in order to surmount the highlighted obstacles and optimize the advantages of their alliance.

Mastitis in lactating women: A case report

Mastitis, or breast inflammation, is classified as either non-lactational or lactational. Mastitis that occurs during lactation is the most prevalent type. Worldwide, only 50% of women are able to breastfeed for six months. It could be the result of an inflammatory breast condition, such as puerperal mastitis or milk stasis, which in certain cases requires supplementation or stopping breastfeeding entirely. We describe a complicated case of a primipara patient who appeared three months after giving birth with lactational mastitis. In this review, we emphasize how crucial multidisciplinary teamwork using Midwifery care is to accurate diagnosis and successful treatment. We go over the usage of oral antibiotics and provide examples of the kind of client support needed to help patients heal and successfully breastfeed during the postpartum phase. Giving the mother the right care and guidance is therefore crucial since poorly managed mastitis can result in an early end to breastfeeding and cause suffering for both the mother and the child.

Early and targeted mobilization after surgical interventions

Early mobilization, which still has no standard definition, is an important component of enhanced recovery after all surgical interventions. By providing early and targeted mobilization, many postsurgical complications can be prevented, and the recovery period and hospital stay can be shortened. However, there are many obstacles reported by both healthcare team members and patients in the achievement of early and targeted mobilization. In addition, there is currently no strong evidence to guide clinical practice in this context. The establishment of mobilization programs specific to surgical patients in healthcare institutions, informing patients about the mobilization process in the preoperative period, determining step goals, promoting motivation, monitoring the number of steps, and encouraging patients to keep a mobilization diary are among the practices that can be implemented to ensure early and targeted mobilization. It is also underlined that early mobilization involves multidisciplinary teamwork. As healthcare professionals, nurses are an important member of the multidisciplinary team in the implementation of early and targeted mobilization programs to maintain the quality of care after surgery. This review aimed to highlight the roles and responsibilities of surgical nurses in early and targeted mobilization practices after surgery and the importance of early and targeted mobilization and discuss the barriers encountered in achieving early and targeted mobilization and the recommendations of current guidelines on this subject.

A Pilot Study: Assessing the Synergy of Student Multidisciplinary Teamwork in Collaborative Projects

This pilot study delves into the efficacy of a novel scale, combining established measurements, to evaluate student teamwork in mixed collaborative environments. The article is split into two parts: the creation of the new scale and its application in evaluating four small heterogeneous groups' teamwork. Upon utilizing this newly developed scale to assess the diverse working teams, statistical analysis shows no significant differences in the three new dimensions, namely in communication skills (F=1.10, p=0.38), teamwork skills (F=0.20, p=0.89), or management skills (F=1.04, p=0.41). These findings suggest that despite variations in nationality, educational specializations, and gender, the teams displayed comparable competency in teamwork capabilities. The non-significant disparities underscore the potential effectiveness and equity of the new scale in appraising teamwork in diverse groups, emphasizing its utility in assessing cross-cultural and interdisciplinary collaborations. This research contributes with insights into evaluating and enhancing multidisciplinary teamwork, offering a possible instrument for fostering successful collaboration in varied student groups.

Exploring Factors Shaping Primary Health Care Readiness to Respond to Family Violence: Findings from a Rapid Evidence Assessment

Abstract Purpose Family violence (FV) is defined as any situation where an individual employs abusive behaviour to control and/or harm a former or current spouse, non-marital partner, or a member of their family. The health consequences of FV are vast, including a wide range of physical and mental health conditions for individuals experiencing violence or survivors, perpetrators, and their children. Primary health care (PHC) is recognized as a setting uniquely positioned to identify the risk and protective factors for FV, being an entry point into the health care system and a first, or only, point of contact for families with professionals who can facilitate access to specialist care and support. Methods A rapid evidence assessment of empirical studies on FV interventions in PHC was conducted to examine outcomes of effective FV interventions that promote identification, assessment, and care delivery within diverse PHC settings, factors shaping PHC provider and system readiness, and key intervention components that are important for sustaining PHC responses to FV. After completing data extraction, quality appraisal, and a hand search, a total of 49 articles were included in data synthesis and analysis. Results Several FV interventions that include multiple components such as, screening and identification of FV, training of PHC providers, advocacy, and referrals to supports, have been rigorously tested and evaluated in diverse PHC settings in rural and urban areas including primary care/family medicine practice clinics and community PHC centers. These interventions have demonstrated to be effective in identifying and responding to violence primarily experienced by women. There is a dearth of FV interventions or programs from empirical studies focused on men, children, and perpetrators. Additionally, provider and system readiness measurement tools and models have been implemented and evaluated in PHC specifically to assess physician or the health care team’s readiness to manage FV in terms of knowledge and awareness of FV. The findings highlight that there is no clear or standardized definition of provider or system “readiness” in the literature related to FV responses in PHC. Further, the findings revealed four key intervention components to facilitate PHC provider and organization readiness to address FV: (1) multidisciplinary teamwork and collaboration, (2) improving provider knowledge on the social and cultural determinants impacting FV, and (3) embedding system-level supports within PHC. Conclusions FV is a serious public health concern and PHC providers have a vital role in early detection of FV and the poor health outcomes associated with violence A focus on comprehensive or multi-component FV interventions are more likely to change provider behavior, and would allow for safe, confident, and professional identification and assessment of FV within PHC.

Enablers and barriers to referral and delivery of multidisciplinary prehabilitation in the autologous stem cell transplant population: a theory-based interview study.

Health care professionals (HCP) play a vital role in effectiveness of prehabilitation programs, but information is limited about what assists HCP deliver an effective service. This study evaluated HCP perceptions of enablers and barriers to two behaviours: referral for, and delivery of, multidisciplinary prehabilitation prior to autologous stem cell transplant. Based on the Theoretical Domains Framework (TDF) of behaviour change, we conducted semi-structured interviews, purposively sampling 14 participants (from various healthcare disciplines) at a tertiary cancer centre. Discipline-specific topic guides were created based on the TDF and the behaviours appropriate to each discipline. Interviews were audio-recorded, transcribed verbatim, anonymised, content analysed (grouping, then labelling, thematically similar responses), and classified into theoretical domains. Structured decision rules were used to classify themes as high, medium, or low priority. Fifty enablers and 31 barriers were identified; of these 26 enablers and 16 barriers classified as high priority. Four domains had the most frequent high-priority enablers: Social professional role and identity (e.g. multidisciplinary teamwork); Beliefs about consequences (e.g. patient benefit); Memory, attention, and decision processes (e.g. refer as early as possible); and Environmental context and resources (e.g. electronic medical records are beneficial). High-priority barriers were most frequent in four domains: Memory, attention, and decision processes (e.g. conflicting views about who should be referred); Environmental context and resources (e.g. lack of time); Social influences (e.g. families); and Emotions (e.g. patient distress). Participants reported more enablers than barriers. Findings can support delivery of prehabilitation programs in hospital settings where uptake remains low.

Simultaneous surgical management of renal cancer with atrial thrombotic extension and severe chronic coronary artery disease: a case report

BackgroundRenal cell carcinoma accounts for 2–3% of all malignant cancers in adults and is characterized by the potential development of venous tumor thrombus.Case presentationWe present a rare case of a 62-year-old Caucasian man who arrived in the emergency department for monosymptomatic hematuria. Further investigation revealed a right renal cell carcinoma with 16 cm intravascular extension through the renal vein into the inferior vena cava and right atrium associated with significant coronary artery disease based on the computed tomography scan and coronary angiography. To the best of our knowledge, after an extensive literature review, only one similar case has been reported with involvement of the contralateral kidney. Therefore, there are no applicable management recommendations. After performing coronary artery bypass graft surgery, we proceeded with an open right radical nephrectomy and inferior vena cava and right atrium thrombectomy under cardiopulmonary bypass and while the patient’s heart was still beating. The postoperative course went without complications, and the patient was discharged from the hospital on the 10th postoperative day.ConclusionsRadical nephrectomy and thrombectomy with reconstruction of the inferior vena cava combined with coronary artery bypass graft can be performed safely and effectively in selected patients with renal cell carcinoma and significant coronary artery disease. Multidisciplinary teamwork and careful patient selection are essential for optimal outcomes.

Facilitators and barriers in the rehabilitation process described by persons with spinal cord injury: a deductive-inductive analysis from the Finnish spinal cord injury study

Background This study aimed to determine the factors that promote and facilitate rehabilitation as well as challenges and possible barriers perceived by people with spinal cord injury (SCI). Materials and Methods This study was part of a larger, mixed-method Finnish Spinal Cord Injury (FinSCI) study. We interviewed 45 persons with SCI representing participants from the FinSCI study and used a qualitative approach and a deductive-inductive content analysis to analyse the data. Results We identified 28 facilitators and 19 barriers in the rehabilitation process. The majority of the facilitators and barriers were related to the rehabilitation planning phase. There were more barriers than facilitators in applying for and accessing treatment or rehabilitation and during the implementation of rehabilitation. Facilitators consisted of successful, realized, or planned treatments or rehabilitation events; clear goals; multidisciplinary teamwork; support and monitoring in various changing situations; and the rehabilitees’ own capabilities and activities, among other things. The barriers included delays, challenges and deficiencies in the planning and implementation of treatment or rehabilitation; the lack of different skills; and resources of rehabilitation professionals; and different personal factors, which made the rehabilitation process cumbersome. Conclusions Good communication and interaction between stakeholders are crucial for the progress of rehabilitation.

Intentional rounding: a realist evaluation using case studies in acute and care of older people hospital wards

BackgroundIn response to concerns about high hospital mortality rates, patient and carer complaints, a Mid Staffordshire NHS Foundation Trust public inquiry was conducted at the request of the UK government. This inquiry found serious failures in the quality of basic care provided and as a consequence, recommended that patients should have more regular visits, organised at predictable times from nursing staff. Intentional rounding, also known as nursing ward rounds, was widely adopted to meet this need.ObjectiveTo test, refine or refute eight programme theories to understand what works, for whom, and in what circumstances.SettingSix wards (older people and acute wards) in three NHS trusts in England.ParticipantsBoard level and senior nursing managers (N = 17), nursing ward staff (N = 33), allied health and medical professionals (N = 26), patients (N = 34) and relatives (N = 28) participated in an individual, in-depth interview using the realist method. In addition, ward-based nurses (N = 39) were shadowed whilst they conduced intentional rounds (240 rounds in total) and the direct care of patients (188 h of patient care in total) was observed.MethodsThe mixed methods design included: Phase (1) Theory development - A realist synthesis was undertaken to identify any programme theories which were tested, refined and/or refuted, using data from phases 2 and 3; Phase (2) A survey of all English NHS acute Trusts; Phase (3) Six case studies of wards involving realist interviews, shadowing and non-participant observations, analysis of ward outcome and cost data; and Phase (4) Synthesis of findings from phases 1, 2 and 3.ResultsThe realist synthesis identified eight programme theories of intentional rounding: ‘Consistency and comprehensiveness’, ‘Accountability’, ‘Visibility of nurses’, ‘Anticipation’, ‘Allocated time to care’, ‘Nurse-patient relationships’, ‘Multi-disciplinary teamwork and communication’ and ‘Patient empowerment’. Key findings showed that of the original eight programme theories of intentional rounding, only two partially explained how the intervention worked (‘Consistency and comprehensiveness’ and ‘Accountability’). Of the remaining six programme theories, the evidence for two was inconclusive (‘Visibility of nurses’ and ‘Anticipation’) and there was no evidence for four (‘Allocated time to care’; ‘Nurse-patient relationships’; ‘Multi-disciplinary teamwork and communication’; and ‘Patient empowerment’).ConclusionsThis first theory-informed evaluation of intentional rounding, demonstrates that the effectiveness of intentional rounding in the English healthcare context is very weak. Furthermore, the evidence collected in this study has challenged and refuted some of the underlying assumptions about how intentional rounding works. This study has demonstrated the crucial role context plays in determining the effectiveness of an intervention and how caution is needed when implementing interventions developed for the health system of one country into another.

Cognitive impairment prevention and healthy aging. A multidisciplinary team work

AbstractBackgroundCognitive impairment (CI) is often diagnosed at moderate stages, with an estimated time for diagnosis of two years. However, the early diagnosis of CI allows the control of modifiable risk factors to prevent the development of dementia at later ages. In addition, the community pharmacy is a close, accessible, and trustworthy health establishment where the pharmacist often participates in disease prevention, becoming a suitable healthcare center for facilitating the detection of cases of CIMethodA cross‐sectional observational study was designed using a structured personal interview. Participants were aged 50 or older with subjective memory complaints. Pharmacies in the province of Valencia (Spain) were invited to participate voluntarily by the organization entities. Before the start‐up of the service, the participating pharmacists received specific training. In the personal interview with the patient, after signing the corresponding informed consent, three validated questionnaires were conducted to assess their cognitive status: Memory Impairment Screening (MIS), Semantic Verbal Fluency (FVS), and Pfeiffer’s Short Portable Mental State Questionnaire (SPMSQ). Whenever possible, a fourth questionnaire was carried out: Brief Informant Test (Brief TIN). Data collection was carried out through a computer platform. This project was approved by the Ethics Committee of the University CEU‐Cardenal Herrera (registration number CEEI21/198).ResultBetween February 2021 and July 2023, 44 pharmacies participated, and 534 patients were screened. Of them, 194 (36%) had at least one positive test result, therefore having possible CI. After their corresponding referral to the doctor, 52 (29%) patients were referred to the hospital neurology department, of which 42 (81%) had been diagnosed with cognitive decline. Finally, the average time from the first evaluation by a pharmacist to a diagnosis by the specialist was six months.ConclusionPreliminary results of the screening for cognitive impairment show that the community pharmacy is a critical point in the approach to early detection of dementia and that collaboration and coordination between different levels of care is enhanced through such programs.

Nursing teamwork is essential in promoting patient-centered care: a cross-sectional study

BackgroundThere has been little research regarding nursing teamwork, despite its important role in multidisciplinary teamwork in healthcare settings and its significance in ensuring high-quality nursing care. This study aimed to determine the teamwork levels of Korean nurses and examine the relationship between nursing teamwork and patient-centered care while controlling for other individual and work-related factors.MethodsWe conducted a cross-sectional analysis of online survey data. The study population consisted of 992 Korean registered nurses employed in hospitals who had a minimum of six months of clinical experience. We performed latent profile analysis to identify latent teamwork subgroups based on response patterns. We performed analysis of variance and Chi-square tests to examine differences in individual and work-related characteristics according to teamwork group. We used multiple linear regression to investigate how nursing teamwork could affect patient-centered care after controlling for covariates.ResultsWe identified three nursing teamwork subgroups: low, mid, and high. Nurses with a higher level of teamwork in their units tended to work fewer hours with more adequate staffing (F = 5.88, p = 0.003 for working hours; F = 7.68, p < 0.001 for staffing adequacy). There was a significant positive association between nursing teamwork and patient-centered care after controlling for personal and work-related characteristics. Compared with low teamwork, mid and high teamwork increased patient-centered care scores by 0.32 (95% confidence interval [CI] = 0.23–0.40) and 0.57 (95% CI = 0.48–0.66), respectively.ConclusionOur findings indicate that enhancing nursing teamwork can serve as an effective strategy for promoting patient-centered care. Providing nurse education and training to equip nurses with the necessary knowledge and skills for effective teamwork is a crucial step. Additionally, fostering management commitment to create a supportive working environment, including adequate staffing, can facilitate improved nursing teamwork and, subsequently, patient-centered care.

Healthcare apprenticeships: assessing the potential benefits to an acute care provider NHS organization.

The introduction of healthcare-based apprenticeships to become both a physician associate and a doctor has been approved for delivery in England. This will revolutionize medical training and it is hoped that medical training would be more accessible. This has generated a mixture of reactions, some enthusiastic and others concerned. This paper gauges interest among staff at Barking, Havering, and Redbridge University Hospitals NHS Trust in pursuing training as a doctor and/or physician associate through the apprenticeship route. Applicants were interviewed to discover their motivations for interest, and the potential benefit to the Trust of these new opportunities was also assessed. This revealed that applicants were primarily driven through intrinsic motivations, such as a lifelong dream to be a doctor and a desire to fulfil a patient-facing role. Many expressed financial and social situations were a barrier to prior application, making the apprenticeship role more attractive. Healthcare professionals should accurately represent the population that they serve, which is currently not the case. The prospective applicants, with diverse backgrounds and existing healthcare experience, can help to improve patient care through their diverse perspective and understanding of multidisciplinary team working. This article highlights the potential of medical-based apprenticeships to help address longstanding challenges in medical education and workforce diversity. Furthermore, there could be significant financial and practical benefits to the trust of upskilling enthusiastic staff. However, there is currently a lack of clarity regarding selection processes and entry criteria, which must be addressed.

Lean and Safety Management in Primary Care Centres: an Italian Case Study

The primary care sector is globally recognised as the pillar of an efficient and patient-centred care model. Despite its importance, many countries fail to ensure equitable access and individualised care. This problem significantly impacts the most vulnerable part of the population, such as chronic and elderly patients. In this context, considering the large number of people affected by multiple diseases, multidisciplinary and multi-organisation teamwork has become fundamental to guarantee high levels of quality, increasing patient satisfaction, and continuity of care. Furthermore, working in a multidisciplinary primary care team can improve information exchange between care providers and patients, positively impacting on clinical performance. Despite these opportunities, the primary care workforce is often overloaded in its daily activities and not adequately organised and coordinated to avoid burnout experiences and inefficient skills deployment. In this context, implementing Lean and Safety Management (L&amp;SM) as a process improvement methodology can increase care pathways performance and integration, patient safety and satisfaction through the reduction of wastes and risks. The current study aims to implement L&amp;SM in a primary care centre in Italy, with the final goal of increasing productivity and effectiveness in daily activities performed by primary care physicians. This project is carried out following the DMAIC cycle; a managerial approach that combines qualitative and quantitative techniques to support process improvement. The implementation roadmap will combine HLM and CRM, planning to achieve the main steps listed as follows: mapping the care demand and the available resources to define the focus of the study; identifying the most representative and critical patients; mapping the target care pathway; identifying wastes and risk and their root causes; identifying critical aspects and improvement events; implementing countermeasures; evaluating and monitoring results. The expected results of the forthcoming months consist of measurable improvements within the healthcare pathway, supporting the optimisation of the primary care centre. Moreover, this initiative may represent a pilot case for other similar projects, contributing to spread L&amp;SM culture throughout primary care centres with benefits for both patients and clinical staff.

A conceptual analysis of system responses to the issue of problematic sexual behaviors in children and recommendations for future work in Children's Advocacy Center multidisciplinary teams.

Problematic sexual behavior (PSB) in children is a common, yet frequently misunderstood and mishandled issue facing communities. Because of the intersection of children both causing harm and being harmed, societies across the globe struggle with whether to punish or support during these times. For Children's Advocacy Centers (CACs), whose mandate it is to support victimized children, this tension is exacerbated. CACs have historically relied on identifying a "perpetrator" and "victim" when providing their services, however PSB displaying youth do not fit this classic dichotomy. Compared with other children, PSB displaying youth are more likely to experience greater incidents and types of violent childhood trauma, have increased parent instability, decreased familial support, and struggle with co-occurring mental health diagnoses. Due to the stigma and fear surrounding sexual behaviors in children and systemic barriers including varied definitions of PSB, uncertainty regarding how to respond within the context of child-serving roles, and the criminalization of children's behaviors, access to supportive services is complicated and challenging. Treatment completion rates for this population are as low as 13%, despite most methods being short-term, non-invasive, and community based. This conceptual analysis paper identifies five key themes in the literature that influence these barriers and proposes an interdisciplinary approach for CAC multidisciplinary teams (MDTs) to better support this vulnerable population.

MRI of Endometriosis: Single institute experience including MRI classification and Laparoscopic correlation with ENZIAN classification

BackgroundEndometriosis is a chronic gynecological condition affecting women of reproductive age and may cause pelvic pain and infertility. MRI is the best imaging technique for mapping and preoperative staging of endometriosis as it provides a tool for the assessment of deep infiltrating endometriosis. The aim of this study was to evaluate the role of magnetic resonance imaging (MRI) in detection and characterization of endometriosis in correlation between it and the laparoscopic findings according to ENZIAN classification.MethodsWe assessed 100 patients by MRI dedicated pelvis protocol for endometriosis with an assessment of the ovaries, uterus, uterosacral ligaments (USL), broad ligaments, and round ligaments, cul-de-sac, rectosigmoid colon, bladder, ureters, and rectovaginal septum. All these patients are submitted for laparoscopy, and then, data from both investigations were correlated.ResultsMRI provided a road map for surgeons before laparoscopy. The sensitivity of MRI was 87.5% in small deep infiltrating endometriosis (DIE) (grade A1) and 100% in large DIE (A2). MRI detected 82.3% of uterosacral ligament involvement, specificity 80%. Detection rate in rectal involvement was 71.4%, specificity 75%. There was 100% sensitivity and specificity in adenomyosis and urinary bladder endometriosis.ConclusionsPreoperative detection of endometriotic lesions is recommended using a dedicated MRI endometriosis protocol to choose the surgical approach and for proper multidisciplinary teamwork planning.

Evaluation of health literacy and its predictive formative factors among Spanish military personnel

ABSTRACT Health literacy (HL) is an aspect that has been widely studied. However, in the military population there are hardly any studies on the influence of educational variables. Knowing the level of health literacy of military professionals is important as it has an impact on adequate health decision making, avoids the abuse of health services and makes it possible to ask for help when needed, especially in aspects related to mental health. The aim of this study was to measure the level of literacy, as well as its association with other training variables in a sample of military personnel. The study was carried out in 695 military personnel of the Spanish Army. A cross-sectional observational design was used, using a survey with the HLS-EU-Q47 scale. Among the results, it stands out that the level of health literacy of the military is high compared to the rest of the population. The results showed that the level of HL does not seem to be influenced by the level of languages, nor by the degree they hold, nor by experiences abroad. On the other hand, it was observed that the performance of professional internships and work in multidisciplinary teams, extracurricular training, does influence the level of HL, especially in the dimension related to health promotion. This fact seems to mean that the military have learned during these experiences to keep abreast of health-related issues, to understand, to value and to form a considered opinion on health-related information.