Multidisciplinary Treatment Plan Research Articles

Fertility-sparing uterine displacement for pelvic malignancies: surgical options and radiotherapy dosimetry on a human cadaver

BackgroundRadio(chemo)therapy is often required in pelvic malignancies (cancer of the anus, rectum, cervix). Direct irradiation adversely affects ovarian and endometrial function, compromising the fertility of women. While ovarian transposition is an established method to move the ovaries away from the radiation field, surgical procedures to displace the uterus are investigational. This study demonstrates the surgical options for uterine displacement in relation to the radiation dose received. MethodsThe uterine displacement techniques were carried out sequentially in a human female cadaver to demonstrate each procedure step by step and assess the uterine positions with dosimetric CT scans in a hybrid operating room. Two treatment plans (anal and rectal cancer) were simulated on each of the four dosimetric scans (1. anatomical position, 2. uterine suspension of the round ligaments to the abdominal wall 3. ventrofixation of the uterine fundus at the umbilical level, 4. uterine transposition). Treatments were planned on Eclipse® System (Varian Medical Systems®,USA) using Volumetric Modulated Arc Therapy. Data about maximum (Dmax) and mean (Dmean) radiation dose received and the volume receiving 14 Gy (V14Gy) were collected.ResultsAll procedures were completed without technical complications. In the rectal cancer simulation with delivery of 50 Gy to the tumor, Dmax, Dmean and V14Gy to the uterus were respectively 52,8 Gy, 34,3 Gy and 30,5cc (1), 31,8 Gy, 20,2 Gy and 22.0cc (2), 24,4 Gy, 6,8 Gy and 5,5cc (3), 1,8 Gy, 0,6 Gy and 0,0cc (4). For anal cancer, delivering 64 Gy to the tumor respectively 46,7 Gy, 34,8 Gy and 31,3cc (1), 34,3 Gy, 20,0 Gy and 21,5cc (2), 21,8 Gy, 5,9 Gy and 2,6cc (3), 1,4 Gy, 0,7 Gy and 0,0cc (4).ConclusionsThe feasibility of several uterine displacement procedures was safely demonstrated. Increasing distance to the radiation field requires more complex surgical interventions to minimize radiation exposure. Surgical strategy needs to be tailored to the multidisciplinary treatment plan, and uterine transposition is the most technically complex with the least dose received.

Outcome of Abdominal Tuberculosis Complicated by Portal Hypertension, Pulmonary Tuberculosis, and Severe Acute Malnutrition

Background: Abdominal tuberculosis (TB) is a form of extrapulmonary TB that can present with or without involvement of the lungs. The diagnosis is difficult to establish, which may lead to diagnostic delays. Effective management of adolescent TB requires a holistic approach from various medical disciplines and interventions. This case presented a rare case 13-year-old girl diagnosed with abdominal TB Case: A 13-year-old girl presented with seven-months history of subfebrile fever, lymph node enlargement, abdominal distention, pallor, and severe weight loss. She was diagnosed with abdominal TB. The diagnosis was further complicated by portal hypertension, pulmonary TB, and severe acute malnutrition. To address these challenges, a multidisciplinary treatment plan was implemented and closely monitored for a period of 12 months Discussion: Multiple factors are significantly contributing to the successful outcome of the treatment for abdominal tuberculosis, including good adherence to the prescribed anti-tuberculous medications, absence of side effects from the drugs, the patient's positive knowledge, attitude and health behaviours, and housing and environmental health. Conclusion: This case highlights the importance of factors influencing disease outcomes of abdominal TB. Proper management of the factors would lead to significant clinical and nutritional status improvement, reduce TB transmission, and improved the overall quality of life.

Rapid Metabolism of Monthly Extended-Release Buprenorphine Formulation: A Case Report

Background: Medication-assisted treatment constitutes the gold standard management for patients with opioid use disorder. Many factors can alter the response to medications, including genetic variations. In this case report, we discuss the presentation of a patient maintained on subcutaneous extended-release buprenorphine formulation who repeatedly presented objective and subjective signs of opioid withdrawal when he was switched from weekly to monthly formulation. We particularly highlight the role of metabolic pharmacogenes in this presentation. Case Presentation: Mr. Y, a 31-year-old single man, presented to our rehabilitation center seeking assistance for his polysubstance dependence, mainly opioid use disorder. As part of his multidisciplinary treatment plan, he was started on weekly extended-release buprenorphine. After maintenance for several months, he was transitioned to the monthly equivalent formulation. Since the transition, he began to develop severe withdrawal symptoms 1-2 weeks before his next due injection. This was paralleled by a noted decrease in buprenorphine level on his urine drug screening test. As soon as the patient was placed back on the weekly formulation, his symptoms resolved. Conclusion: This is a novel case highlighting the potential role of pharmacogenomics in clinical presentation and response to medications. Switching patients from weekly to monthly extendedrelease buprenorphine formulation might make rapid or ultra-rapid metabolizers at risk of earlyonset withdrawal symptoms. =In such a case, earlier provision of the injection or switching to another formulation or medication can be considered.

Salvage lung resection after immunotherapy is feasible and safe

ObjectivesPatients with non–small cell lung cancer treated with immunotherapy and modern chemoradiation regimens show improved progression-free and overall survival. However, patients with limited oligo-progression represent a potential population in which local therapy such as surgery may have a potential role as salvage treatment. The objectives of our study were to evaluate the feasibility and safety of salvage lung resection after immunotherapy in patients with non–small cell lung cancer. MethodsThe National Cancer Database was queried for patients diagnosed and treated for non–small cell lung cancer stage I to IV, from 2013 to 2020. Patients who underwent surgery as salvage after immunotherapy were defined as undergoing surgery >5 months from the initiation of immunotherapy. As a sensitivity analysis, patients who underwent surgery as salvage after chemoradiation were also analyzed in a similar fashion. Surgical outcomes such as type of surgery, complete resection (R0) rates, and complete pathologic response rates were determined for feasibility. Length of stay, 30-day readmission rates, and 30-day mortality rates were determined and overall survivals were estimated with Kaplan-Meier analysis to evaluate for safety. ResultsOf the 934,093 patients diagnosed with non–small cell lung cancer stage I to IV from 2013 to 2020, 164 patients received immunotherapy and after 5 months underwent surgery. Lobectomy was the most commonly performed operation (74%) and pneumonectomy was required in 9% (n = 15). R0 resection was achieved in 89% (n = 146) and of these patients, 23% (n = 37) had complete pathologic response. Median length of stay was 4 days, 30-day readmission was 5%, and 30-day mortality was 0.6%. In our sensitivity analysis of chemoradiation patients (n = 445), the above data were similar to previously reported cohort studies of patients undergoing chemoradiation and subsequently salvage surgery. ConclusionsLung resection after immunotherapy appears to be a feasible salvage treatment option, with lobectomy being most common and with high R0 resection rates. Low patient morbidity and mortality rates also suggest the safety of this approach. Salvage surgery may be considered in patients who have oligo-progression after immunotherapy within the context of a comprehensive multidisciplinary treatment plan.

CBCT and modern intraoral scanners as tools for developing comprehensive, interdisciplinary treatment plans.

The aim of this narrative literature review is to present the possibilities of using cone beam computed tomography (CBCT) and 3D dental scanners to prepare comprehensive, interdisciplinary treatment plans. Scanners are instruments whose usage seems to be a key element of modern digital dentistry. Their importance in orthodontic treatment with overlay appliances, planning modern prosthetic treatments (CAD/CAM) and implantology cannot be overestimated. These scanners allow for accurate imaging of the tooth structures and their positioning independently in the maxilla and mandible as well as in the occlusion. As a result, dentists can plan treatment, e.g., in the case of the need to implant dental implants, prosthetic crowns or orthodontic braces. Dentistry was revolutionized to a similar extent by the introduction of CBCT to everyday diagnostics, which is the most advanced imaging technology that provides even more detailed images in 3 dimensions. Its use has enabled a wider and more precise range of diagnostics, which in turn has improved the quality of multidisciplinary treatment planning. This paper explains how scanners and CBCT can be used in orthodontics and prosthetics based on the articles found in 3 databases: PubMed, Scopus and Embase. The review included 28 articles on the aforementioned topics and was presented with a brief description of the content of each article.

A Systematic Review and Classification of Factors Influencing Diabetic Foot Ulcer Treatment Adherence, in Accordance With the WHO Dimensions of Adherence to Long-Term Therapies.

Effective treatment of diabetic foot ulcers (DFUs) involves a multidisciplinary treatment plan to promote wound healing and prevent complications. Given the lack of consensus data on the factors affecting patient adherence, a systematic review was performed to identify and classify factors according to the WHO Dimensions of Adherence to Long-Term Therapies. Six hundred and forty-three articles from PubMed, Embase, and Scopus were reviewed. The inclusion criteria included qualitative and quantitative studies which discussed factors affecting patient adherence to DFU treatment, had study populations that comprised patients with either prior history of or existing DFU, and had either prior history of DFU treatment or were currently receiving treatment. Factors, and associated measures of adherence, were extracted and organized according to the WHO Dimensions of Adherence to Long-Term Therapies. Seven quantitative and eight qualitative studies were included. Eleven patient-related factors, seven condition-related factors, three therapy-related factors, five socioeconomic factors, and five health system-related factors were investigated by the included studies. The largest proportion of factors studied was patient-related, such as patient insight on DFU treatment, patient motivation, and patient perception of DFU treatment. There was notable overlap in the range of discussed factors across various domains, in the socioeconomic (including social support, income, social and cultural acceptability of DFU therapy, cost) and therapy-related domains (including duration of treatment, offloading footwear, and reminder devices). Different studies found that specific factors, such as gender and patients having a low internal locus of control, had differing effects on adherence on different cohorts. Current literature presents heterogeneous findings regarding factors affecting patient adherence. It would be useful for future studies to categorize factors as such to provide more comprehensive understanding and personalized care to patients. Further research can be done to explore how significant factors can be addressed universally across different cohort populations in different cultural and socioeconomic contexts.

MANAGEMENT CONSIDERATIONS IN THE CONTEXT OF MULTIPLE OBSTETRIC COMORBIDITIES - A CASE REPORT

Background: Obstetric comorbidities significantly increase the risk of adverse obstetric outcomesbecause of their association with complications that can occur suddenly and escalate rapidly.Case presentation: A morbidly obese 26-year-old primigravida initially presented with first-trimesterbleeding. She consistently declined monitoring and was not adherent to the multidisciplinary treatmentplans despite serial counseling. This state persisted even when she was diagnosed with gestationaldiabetes mellitus and preeclampsia. She incurred gross fetal macrosomia and was admitted at term forinduction of labor. By the third prostaglandin, there was overt fetal tachycardia that necessitated anemergency cesarean delivery. Failed spinal anesthesia necessitated generalization. Access wasimpeded by a massive panniculus, necessitating tape retraction to reveal the surgical site. A distressedapneic baby was delivered, after which she developed an atonic uterus that necessitated uterine bracesuturing and intramyometrial PGF2α. The baby underwent therapeutic hypothermia. Postoperatively, shewas monitored and underwent repeated counseling.Discussion: This patient was noncompliant to medication and monitoring, she had multiple interactingcomorbidities, and she ended up having an avoidable multiple near-miss. There is a need to develop anobstetric comorbidity scoring index and validate it locally.Conclusion: If guided by a logical algorithmic sequence of guided responses, the development andapplication of a local risk and comorbidity scoring index may substantively reduce the risk of adverseobstetric outcomes. This is vital if sustainable development goals are to be realized.

"Establishing a Multi-disciplinary Adult Oncology Unit at Muhimbili National Hospital: Lessons Learned, Challenges, and Opportunities Amidst Tanzania's Growing Cancer Burden"

The escalating cancer burden, particularly in low- and middle-income countries such as Tanzania, necessitates innovative strategies. One strategy is to increase access to cancer services through the establishment of treatment in existing referral hospitals that offer multidisciplinary care, as was the case in the opening of the adult oncology unit at Muhimbili National Hospital (MNH) in Tanzania. A comprehensive facility assessment served as the foundation for this expansion, encompassing assessments of the spatial requirements of human resources, equipment, and drug availability. Aiming to ensure optimal resource allocation and effective implementation by capitalizing on existing systems. The main objective of opening the MNH adult oncology unit was to increase coverage and accessibility to comprehensive cancer care services. This initiative has substantially improved patient outcomes, with reduced wait times for oncology care initiation, facilitating seamless care coordination that capitalizes on multidisciplinary treatment planning. The unit has provided benefits to MNH by fostering collaborative efforts, serving as a revenue generation point, and expanding care that aligns with institutional goals. Nonetheless, challenges persist, including space constraints and an inadequate number of trained human resources for oncology care. The successful establishment of the MNH's adult oncology unit exemplifies the significance of stakeholder engagement, adaptability, and collaboration. A comprehensive approach that emphasizes workforce development, community awareness, and infrastructure enhancement offers promise in confronting Tanzania's mounting cancer burden.

The general medical approach in dentistry: the competitive advantage of the clinic, improving the quality of patient care, the evidence of the doctor’s skill.

In complex clinical cases, dentists join forces to draw up a collegial (interdisciplinary, comprehensive) treatment plan, but even here the traditional paradigm operates, limited to the elimination of violations in the oral cavity. Further progress in dentistry is possible with the transition to the paradigm of “Taking care of health in general” – HEALTH CARE. The ability to perform a GENERAL MEDICAL (multidisciplinary) treatment plan comes to the fore of improving the skills of dentists and their interaction with patients.

Implementation of the Adult Oncology Unit at Muhimbili National Hospital (MNH)

The escalating cancer burden, particularly in low- and middle-income countries such as Tanzania, necessitates innovative strategies. One such strategy is increasing access to cancer services through the establishment of treatment in existing referral hospitals that offer multidisciplinary care, as was the case in the opening of the adult oncology unit at Muhimbili National Hospital (MNH) in Tanzania to address the burgeoning cancer crisis. A comprehensive facility assessment served as the foundation for this transformation, ensuring optimal resource allocation and effective implementation. The rising cancer burden in Tanzania is dominated by cervical, breast, and prostate cancers. However, reported figures might underestimate the issue due to the lack of a centralized national cancer registry and limited access to diagnostic and treatment facilities throughout the country. The MNH oncology unit's creation aimed to decentralize care from the Ocean Road Cancer Institute (ORCI); as the cancer burden increased over the years, the center was getting strained by demand. The MNH facility assessment encompassed assessments of spatial requirements for human resources, equipment, and drug availability. This unit adopts a multidisciplinary approach, enabling personalized treatment plans and collaborative decision-making, aimed at expanding capacity and promoting inter-departmental cooperation. A "train-the-trainer" model empowered nursing staff in chemotherapy administration, and pharmacist involvement ensured accurate medication management. This initiative has substantially improved patient outcomes, with reduced wait times for oncology care initiation, facilitating seamless care coordination that capitalizes on multidisciplinary treatment planning. The opening of the oncology unit has given benefits to MNH through fostering multidisciplinary collaboration, an increase in revenue generation, and the expansion of care that aligns with institutional goals. Nonetheless, challenges, including space constraints and an inadequate number of trained human resources for oncology care, persist. The successful establishment of MNH's adult oncology unit exemplifies stakeholder engagement, adaptability, and the significance of collaboration. A comprehensive approach, emphasizing workforce development, community awareness, and infrastructure enhancement, offers promise in confronting Tanzania's mounting cancer burden.

Een blik vooruit: casusbespreking van functionele oscillopsie bij een adolescente

Looking ahead: case report of functional oscillopsia in an adolescent A conversion disorder or functional neurological disorder (FND) is a rare condition with disturbances in voluntary body functions, sensory or motor, unexplained by any known somatic condition. This case report describes intermittent horizontal oscillopsia with normal neuro-ophthalmic findings in a 14-year-old girl. ‘Oscillopsia’ refers to the perception of unstable vision, i.e. an oscillating image. This is usually caused by a newly acquired eye movement disorder type nystagmus, ocular flutter or myokymia. Clinical examination showed positive symptoms of a conversion disorder. During a pediatric admission with multidisciplinary assessment, the diagnosis of FND was made. A multidisciplinary treatment plan was established, starting with psychoeducation about the diagnosis to arrive at a shared perspective of disease theory. This article aims to demonstrate the need for multidisciplinary collaboration in the diagnostic phase of particular symptom presentations with attention to a functional mechanism. This approach contributes to a more rapid and integrated conclusion and reduces the likelihood of an exclusionary diagnosis. The authors provide some examples for communicating with patients, as this is crucial to achieve shared meaning.

Multidisciplinary management of advanced complexity tooth wear cases: patient needs beyond the direct and indirect restorations dichotomy

There is increased evidence supporting the different management modalities of tooth wear, be it direct or indirect resin composite through an additive approach, or ceramics through a subtractive one. However, there remains a cohort of patients with complex clinical case presentations that require careful assessment, formulation of a multidisciplinary treatment plan, and the delivery of a restorative-led systematic intervention involving additional oral surgery or orthodontic specialties. This case series presents the multidisciplinary management of advanced complexity tooth wear cases, with treatment needs extending beyond the scope of direct and indirect restorative management, through a systematic treatment planning approach. CPD/Clinical Relevance: To highlight the potential multidisciplinary management options of tooth wear.

Restorative dentistry clinical decision-making for hypodontia: complex cases

Hypodontia is a relatively common condition and patients will be seen by both general dental practitioners and specialist dental colleagues. Although hypodontia can be described as mild, moderate and severe, this does not directly correlate with the complexity of treatment required to provide an acceptable outcome. In addition, the complexity of treatment provided by one colleague in the multidisciplinary team may not be the same as for other colleagues.When treatment planning and delivering dental care for these patients, especially those with severe hypodontia, it is useful to recognise the factors that make their care complex and also to follow principles for multidisciplinary treatment planning.

Multidisciplinary sequential treatment for obstructive sleep apnea hypopnea syndrome and malocclusion in children

With the high incidence of chronic rhinitis, mouth breathing is becoming the hot topic in orthodontics. The incidence of obstructive sleep apnea hypopnea syndrome (OSAHS) with malocclusion in children is also increasing. Dentofacial deformities such as maxillary constriction and mandibular retrognathia may be the primary cause of OSAHS, or they may be complications caused by chronic mouth breathing. Orthodontic treatment is of great significance in relieving obstructive sleep apnea and hypopnea. More attention should be paid by orthodontists to sleep disordered breathing. Orthodontists should routinely consider the condition of patients' upper airway in treatment designs. For children with malocclusion and OSAHS, the point of diagnosis and treatment is to carefully identify the complex pathogenesis and formulate a multidisciplinary sequential treatment plan.

Pelvic Floor Dysfunction

The purpose of this chapter is to introduce pelvic floor dysfunction and treatment in female athletes. Pelvic floor dysfunction (PFD) is a composed of a variety of disorders that involve some level of impairment of the pelvic floor musculature. Pelvic floor dysfunction can affect both sports performance and quality of life in female athletes. PFD during elite performance years can increase the likelihood of PFD symptoms later in life as well. This chapter delves into the anatomy, exam, and potential treatments of PFD to be aware of. There is crucial importance in early recognition and multi-disciplinary treatment plan tailored to these specific dysfunctions and compensatory muscle behaviors, postural imbalances, and psychosocial manifestations. This chapter provides a comprehensive guide for healthcare professionals and athletes to foster a holistic approach to female athlete well-being.

Public sense of dental implants on social media: A cross-sectional study based on text analysis of comments

ObjectivesTo investigate the most discussed topics and possible new interests in dental implants among the public, as well as the public sentiments toward dental implants through topic and sentiment analysis of online comments. MethodsComments of the top 100 most viewed dental implant-related YouTube videos were studied. The comments were analyzed by topic analysis (LDA topic model, Word co-occurrence analysis) and sentiment analysis. The basic information of videos was collected and classified. Video quality was evaluated by GQS criteria and 9-point usefulness scoring system. Statistical analyses were performed using Kruskal-Wallis test, Mann-Whitney U-tests, and Spearman correlation analysis. Results74 videos with 61,618 comments were considered eligible in this study. Most videos targeted the public with high viewing and comments, but the theme was single and the quality was low. From topic analysis, the most discussed topics in the comments were procedure, cost, feelings associated with prognosis, and expectations. Multidisciplinary approaches in implant dentistry were frequently discussed. From sentiment analysis, the public mainly expressed positive sentiment through comments. In detail, the public had positive feelings about aesthetics and health, negative feelings about pain, and neutral feelings about cost. ConclusionThe hot topics of public concern were procedure, cost, feelings associated with prognosis, and expectations. Intriguingly, multidisciplinary approaches in implant dentistry have emerged as a new hot subtopic within the topic “procedure”. Based on the sentiment analysis of the comments, the general sentiment expressed by the public toward dental implants was predominantly positive. Clinical SignificanceText mining can extract data from social media to explore public interest in dentistry. Clinicians should convey reasonable expectations and understanding about dental implants, especially addressing the most public-concerned topics (procedure, cost, feelings, and expectations), and provide patients with well-grounded multidisciplinary treatment plans to meet the growing public demand.

Dystrophic calciphylaxis in panniculitis: features of the clinical picture and diagnosis

The clinical presentation of lobular panniculitis (PN) associated with calciphylaxis (CP, calcification) can vary widely and may be associated with joint and internal organs involvement, making the diagnosis of the disease difficult.Objective: to evaluate the frequency and significance of CP in patients with PN using long-term prospective follow-up.Material and methods. From 2018 to 2023, at the V.A. Nasonova Research Institute of Rheumatology 217 patients with referral diagnosis "erythema nodosum" or "panniculitis" were examined. In 19.3% of cases (9 men and 33 women aged 37 to 72 years) CP was confirmed with an average disease duration of 56.3±11.2 months. Clinical examination of patients was performed according to the standards recommended by the Russian Association of Rheumatologists. International criteria were used to confirm the diagnosis of systemic lupus erythematosus (SLE), idiopathic inflammatory myopathies (IIM), systemic sclerosis (SS), and lipodermatosclerosis (LDS). In 12 patients with indurations, pathological examination of biopsy specimens of skin and subcutaneous fatty tissue from the area of induration was performed, which allowed confirming the diagnosis of idiopathic lobular PN (ILPN) in 3 cases. Four grades of calcification were distinguished according to the size and depth of the calcifications. In addition, considering the type of radiological changes and clinical manifestations, four subtypes of CP were identified: mousse-like, stone-like, mesh-like and lamellar-like.Results and discussion. In the study group, the ratio of women to men was 3.6:1, and the mean age was 43.8±7.6 years. On clinical examination we determined, in 60% of cases CP predominantly stone-like subtype (71.4%) of first grade (47.6%), which was significantly more frequently located on the upper and/or lower extremities and/or trunk (57.1%; p=0.05). Using clinical, laboratory and instrumental data, we confirmed the development of CP in ILPN (n=3), SLE (n=3), LDS (n=21), IIM (n=5), SS (n=1), and idiopathic CP (n=9) with a mean disease duration of 8.7±2.4 years.An increase in ESR and CRP levels occurred in different diseases, while urinary syndrome was associated with SLE (66.6%) and an increase in creatinine phosphokinase with IIM. Decreased calcium and 25-hydroxyvitamin D levels and increased phosphorus and parathyroid hormone levels were found in many patients studied.Conclusion. In the absence of clear diagnostic criteria for CP in patients with PN, early diagnosis is critical for the development of an effective multidisciplinary treatment plan.

Diagnostics and Management of Pediatric Headache: An Exploratory Study among Dutch Physical Therapists.

Physiotherapists are often part of a multidisciplinary treatment plan for children with headaches. The literature on physical therapeutic diagnostics and management of headaches is often focused on adults. To gain insight, identify knowledge gaps, and increase the evidence needed for clinical physical therapeutic practice with children with headaches, an exploratory method is warranted. The purpose of this study was to describe the views, beliefs, and experiences of physical therapists regarding diagnostics and treatment options for children with headaches. The method consisted of a survey and two peer consultation group meetings. A total of 195 individual surveys were returned and 31 out of 47 peer consultation groups participated. Most participants were specialized in pediatric physical therapy (93.3%). They use the 4P-factor model (predisposing, precipitating, perpetuating, and protective factors) as a guiding principle in the diagnostic and therapeutic process in children with headaches. This model helps to organize and to understand how a variety of factors interact in a biopsychosocial relationship. Pediatric physical therapists focus their treatments on factors interfering with movement and functional abilities of the child with headaches. Knowledge of how temporomandibular disfunction can relate to headaches is currently insufficient for pediatric physical therapists.

Pediatric feeding disorders among children with parental history of feeding disorders: a distinct group of patients with unique characteristics.

To investigate factors associated with pediatric feeding disorders (PFD) among children of parents that reported to have had feeding disorders during their own childhood compared to children with PFD with no history of parental PFD. We retrospectively reviewed the medical records of children diagnosed with PFD according to the recent WHO-based definition. The demographic and clinical characteristics of children with PFD with a parental history of PFD were compared to those of children with a PFD with no history of parental PFD. Included were 231 children with PFD (median [interquartile range] age 10months [5.5-29] at diagnosis, 58% boys) of whom 133 children had parents without PFD and 98 children had parents with PFD. Unexpectedly, children of parents without PFD had a higher rate of low birth weight (28% vs. 19%, respectively, p = 0.007), more delivery complications (10% vs. 2%, p = 0.006), more hospitalizations (33% vs. 17%, p = 0.004), more prescription medications (27% vs. 18%, p = 0.05), and a higher percent of gastrostomy tube use (6% vs. 0, p = 0.02). Moreover, more parents with PFD had academic background compared with parents without PFD (72% vs. 59%, p = 0.05). There were no significant group differences in sex, history of breastfeeding, parental marital status, or type of the child's feeding disorder. Conclusion: PFD among children with a parental history of PFD comprise a distinct group of patients with unique characteristics and outcomes. Since parental feeding history may explain their child's PFD in highly differing ways, such information may help in devising a specific family-based and multidisciplinary treatment plan for those children. What is Known: • Pediatric feeding disorder (PFD) is relatively common and its prevalence is increasing. • Information on an association between parental PFD and their child's feeding disorder is limited. What is New: • PFD among children with a parental history of PFD comprise a distinct group of patients with various characteristics and outcomes. • The parents' feeding history during childhood may provide important clues to their child's PFD.

Telemedical Interdisciplinary Care Team Evaluation and Treatment of People With Low Back Pain: A Retrospective Observational Study

ObjectiveTo evaluate the effects of an interdisciplinary care team (ICT) model delivered by telemedicine on patients with low back pain (LBP). DesignRetrospective analysis of deidentified pre-existing data. SettingRetrospective observational study of patients presenting with LBP to a nationwide telemedicine practice using an ICT model. ParticipantsOver a 9-month period all patients with a diagnosis related to LBP and who had an ICT evaluation (medical doctor, advanced practice provider, health coach, and physical therapist) were included in the study (n=36). A minimum of 2 follow-up physical therapy visits were required for inclusion. InterventionsPatients were evaluated for LBP, received a diagnosis, and were offered a multidisciplinary treatment plan. Additional real-time audio visual medical, health coaching, registered dietician, and physical therapy services were received as deemed clinically appropriate. Main Outcome MeasuresBaseline, 30 day, and final pain (mean 81 day) measurements via numerical pain rating scale (NPRS). Baseline and final Patient-Reported Outcomes Measurement Information System (PROMIS)-10 Global Mental/Physical domains. Secondary Outcome MeasuresUse of prescription medication, referral for imaging, need for injections, or surgery. Results36 patients met criteria. Pain levels included mild (n=6, 16.7%), moderate (n=19, 52.8%), and severe (n=11, 30.6%). Clinically significant pain improvements were noted in 83.3% (n=25) of those with moderate or severe pain. PROMIS Mental and Physical Health categorization from Fair/Poor to Good/Excellent significantly improved over time. The initial 20% (n=7) in Fair/Poor Mental Health improved to 6.3% (n=2) at finish, while the 80% (n=28) in Good/Excellent Mental Health at start improved to 93.8% (n=30) at finish. Regarding Physical Health, 51.4% (n=18) rated Fair/Poor at start and 31.3% (n=10) at finish, while the 48.6% (n=17) rated Good/Excellent at start improved to 68.8% (n=22) at finish. The need for prescription medication was low (n=6, 16.7%) and spinal imaging orders were negligible (n=1, 2.8%). Injections were warranted in 11.4% (n=4) of patients and surgical referral with operative treatment in 2.8% (n=1). ConclusionInterdisciplinary care delivered through telemedicine can significantly improve pain and support improved health-related quality of life in patients with LBP, with low rates of imaging, prescription, and interventional use.