Multidisciplinary Treatment Team Research Articles

‘Why Do We Treat Different Families Differently?’: Social Workers’ Perspectives on Bias and Ethical Issues in Pediatric Emergency Rooms

ABSTRACT In pediatric emergency rooms (ERs), social workers must navigate diverse responsibilities including acting as advocates and liaisons between families and multidisciplinary treatment teams, providing compassionate support to families in crisis, and assessing for and reporting any suspicions of child abuse or neglect. These potentially contrasting roles can place social workers at the center of dealing with ethical dilemmas and advocating against ethical violations, such as bias and discrimination toward families. This qualitative study seeks to gain insight into ethical issues commonly encountered in pediatric ERs by exploring the perspectives of 23 social workers at Level 1 trauma centers in the United States. Thematic analysis was used to develop major themes and subthemes related to ethical violations, dilemmas, and best practices in pediatric ERs. Major themes emerged related to unfair treatment of families (with subthemes of bias, discrimination, and compassion fatigue), ethical dilemmas (with subthemes of cultural issues, safety and system issues), and promoting ethical practices (with subthemes of self-awareness, advocacy, and efforts to change the system). This study provides important insights into ethical issues in pediatric ERs as experienced by social workers and can inform efforts to improve the quality and equity of care for all families in pediatric ERs.

Selective dorsal rhizotomy for spastic cerebral palsy: report of 18 cases performed in the North of Vietnam

The purpose of this report is to describe a case series of children undergoing selective dorsal rhizotomy (SDR) for treatment of spastic cerebral palsy in Vietnam. Also described is an international cooperation model to facilitate the development of a new, multi-disciplinary team for evaluation and treatment of these children. Details of international collaboration are described, including in-person travel and virtual interactions. All cases of children under 18 undergoing SDR for treatment of spastic cerebral palsy at a single center in Hanoi, Vietnam are described, including pre-operative evaluation of spasticity and gait as well as results at 6 and 12 months. Results are summarized using descriptive statistics. Since the beginning of cooperation in training and transferring SDR techniques by experts from the United States, in the period from June 2016 to December 2022, 18 SDR surgeries were performed in Hanoi. Age ranged from 2-14 years; 13 were male and 5 were female. Overall, approximately 60% of nerve rootlets were cut. Modified Ashworth scores at 6- and 12-months post-surgery in the hip, knee, and ankle joints showed improvement from pre-operative values. There were two recorded complications: intracranial hypotension causing subdural hemorrhage and a case of skin infection at the incision site. The ongoing international cooperation between Vietnamese and American physicians has helped improve the surgical treatment of spasticity in children with cerebral palsy in Hanoi, providing children with a surgical treatment option with successful outcomes.

Immunotherapy in resectable NSCLC: Answering the question or questioning the answer?

As immunotherapy makes its way into the perioperative setting, a growing number of clinical trials are expanding the evidence base for resectable non-small cell lung cancer (NSCLC) management. Identifying the optimal treatment pattern-whether it's neoadjuvant, adjuvant, or a combination of both-is a crucial next step, particularly in pinpointing which patients benefit the most. This decision-making process requires a multi-disciplinary treatment team capable of utilizing tissue and plasma genomic testing to inform therapeutic choices. Leveraging the perioperative treatment platform, it remains pivotal to integrate circulating tumor DNA (ctDNA) monitoring into clinical trial design efficiently and provide clear guidance on treatment.

Changing the Game? Increasing the Impact of Peer-Run Organizations.

Employment and deployment of peer support specialists in both clinical and non-clinical mental health settings has increased substantially since the 1990's. Peer-run organizations are defined as those led and managed by individuals with self-disclosed lived experience of mental health conditions. Many peer-run organizations promoting advocacy and offering services have been established during the past 30 years. Some adherents assert the effectiveness of peer-run organizations over hybrid mental health service providers in which peer support workers are integrated or partnered with existing community mental health agency multidisciplinary clinical and treatment teams. Although research has indicated the positive contributions of peer-run organizations to service user recovery, the impact of peer-run organizations on system transformation is not well documented. This concept paper explores benefits, accomplishments, and challenges faced by a peer-run organization during its 30-year evolution in offering self-help groups, supported housing, peer support services, peer specialist training, and systems change projects in Los Angeles County, California. Future research topics and policy options are suggested, along with recommendations for the SAMHSA Office of Recovery.

How Essential Oils Affect Children with Congenital Zika Virus Syndrome (CZVS)

Introduction: Within the field of dentistry, essential oils are well-known and extensively researched; eugenol is one of the most used, which until recently characterized the predominant smell of dental offices. Children with congenital Zika virus syndrome (CZVS) have various impairments, and in the dental area, the vast majority exhibit underdevelopment of the stomatognathic system compared to established normality standards. Many use various medications, such as anticonvulsants, muscle relaxants, sedatives, neuroleptics, among others, to control symptoms. These drug interactions can trigger involuntary muscle movements, including bruxism. There are several treatment proposals for teeth grinding and clenching, including appliance therapy, emotional therapies, medication, and also aromatherapy. Material and method: Syndromic and bruxist children were selected through validated questionnaires and clinical examination. A convenience sample of 19 syndromic children from Maceió was divided into two random groups: group 1 received a blend of essential oils, and group 2 received a control oil. They were instructed to apply it topically to the masseter, temples, and cervical area twice a day for two months. Sleep analysis was carried out through a questionnaire with 15 questions plus filling out a sleep chart for three days and collecting saliva in Salivette tubes for cortisol evaluation, with both data sets collected pre and post-use of essential oils. Discussion: Previous studies report that individuals with cognitive difficulties are more prone to bruxism due to spasticity, however, they are not definitive according to other studies. There are other factors such as stress, depression, external environmental stimuli that can influence this condition, in addition to the drug interaction they use to alleviate symptoms such as seizures, drooling, muscle spasms, muscle stiffness, insomnia. The etiology of bruxism is still considered multifactorial, requiring a multidisciplinary clinical team for more effective treatment. The use of essential oils as a stress and insomnia reliever is reported in studies with satisfactory results, being observed in this research. Result: In the finalization phase. Conclusion: Given the above, the proposal was to evaluate the efficacy of using essential oils in syndromic and bruxist children. Although we cannot confirm results yet, there are reports from mothers who evaluated the initiative positively, corroborating in some way the alleviation of symptoms and drug interactions, providing more emotional and physical comfort for those involved. However, more clinical trials are still necessary regarding the safety and efficacy aspects of essential oils.

Influence of General Health on Quality of Life by the Caregiver and Burden Care as a Mediator: Bayesian Estimator Structural Equation Analysis

Objectives: To test structural equation models of General Health on quality of life by the caregiver and burden care as a mediator. Methods: The quality of life scale was administered to 297 caregivers of persons with schizophrenia. The models were examined using maximum likelihood confirmatory factor analysis (ML-CFA) and Bayesian structural equation modeling (BSEM). The path analysis with direct and indirect effects was discussed in the model. Results: The results reveal that the models fit well for evidence-based. The BIC 1412.998 < 3161.387, DIC 1365.247 < 3094.673, and WAIC 1370.802 < 3094.651 were the lowest BIC of the models and displayed a simple and parsimonious factor-loading pattern. Conclusions: Overall, both of the scales demonstrated excellent measurement properties supporting its relevance to comprehensively measure caregivers' impact and burden on persons with schizophrenia. Psychiatric and mental health care teams and clinical researchers could use the quality of life scale to generate strategies to support the family caregiver and measure the multidisciplinary treatment team interventions' outcomes.

A Scoping Review of Compassion Fatigue and Compassion Satisfaction in Burn Therapists.

Occupational and physical therapists who routinely provide potentially painful and distressing rehabilitation to burn survivors are at risk for developing compassion fatigue. Burn therapists may also experience compassion satisfaction based on the successes their patients accomplish. The purpose of this review was to synthesize the literature related to compassion fatigue and satisfaction in therapists who work with burn survivors, explore previously reported predictors and mediators of (and responses to) these constructs, and identify gaps in the literature. Original, peer-reviewed papers published from journal inception to May 2023 were obtained from 5 electronic bibliographic databases: CINAHL, Embase, PsycINFO, PubMed, and Web of Science. Studies were eligible if they (1) reported compassion fatigue or its related concepts and (2) focused on occupational or physical therapists who work with burn survivors directly or as a member of a multidisciplinary burn treatment team. The initial search revealed 284 articles, 2 of which met inclusion criteria and are summarized in this scoping review. Neither article focused solely on burn therapists but examined the experiences of multidisciplinary burn team members working in single burn centers in North America. Both studies used a cross-sectional survey-based design to assess concepts related to compassion fatigue and compassion satisfaction. This scoping review uncovered important gaps in the literature related to compassion fatigue or satisfaction in burn therapists. More research is needed to better understand the interplay between concepts as well as their relationship to burn therapists' outcomes.

Despite multi-disciplinary team discussions the socioeconomic disparities persist in the oncological treatment of non-metastasized colorectal cancer

BackgroundThe introduction of national guidelines should eliminate previously observed associations between socioeconomic status (SES) and colorectal cancer treatment. The aim of the study was to investigate whether inequalities remain. MethodsCRCBaSe, a register-linkage originating from the Swedish Colorectal Cancer Registry, was used to identify information on patient and tumour characteristics, for 83,460 patients with stage I-III disease diagnosed 2008–2021. SES was measured as disposable income (quartiles) and the highest level of education. Outcomes of interest were emergency surgery, multidisciplinary team (MDT) conference discussion, and oncological treatment. Differences in treatment between SES groups were explored using multivariable logistic regression adjusted for year of diagnosis, age at diagnosis, sex, civil status, comorbidities, tumour location and stage. ResultsPatients in the highest income quartile had a lower risk of emergency surgery (OR 0.73 95%CI 0.68–0.80), a higher chance of being discussed at the preoperative (OR 1.39 95%CI 1.28–1.51) and postoperative MDT (OR 1.41 95%CI 1.30–1.53), receiving neoadjuvant (OR 1.15 95%CI 1.06–1.25) and adjuvant treatment (OR 2.04 95%CI 1.88–2.20). Higher education level increased the odds of MDT discussion but was not associated with oncological treatment. The proportion of patients discussed at the MDT increased, with almost all patients discussed since 2016. Despite this, treatment differences remained when patients diagnosed since 2016 were analysed separately. ConclusionThere were significant differences in how patients with different SES were treated for colorectal cancer. Further action is required to investigate the drivers of these differences as well as their impact on mortality and, ultimately, eliminate the inequalities.

Process analysis of the patient pathway for automated data collection: an exemplar using pituitary surgery.

Automation of routine clinical data shows promise in relieving health systems of the burden associated with manual data collection. Identifying consistent points of documentation in the electronic health record (EHR) provides salient targets to improve data entry quality. Using our pituitary surgery service as an exemplar, we aimed to demonstrate how process mapping can be used to identify reliable areas of documentation in the patient pathway to target structured data entry interventions. This mixed methods study was conducted in the largest pituitary centre in the UK. Purposive snowball sampling identified frontline stakeholders for process mapping to produce a patient pathway. The final patient pathway was subsequently validated against a real-world dataset of 50 patients who underwent surgery for pituitary adenoma. Events were categorized by frequency and mapped to the patient pathway to determine critical data points. Eighteen stakeholders encompassing all members of the multidisciplinary team (MDT) were consulted for process mapping. The commonest events recorded were neurosurgical ward round entries (N = 212, 14.7%), pituitary clinical nurse specialist (CNS) ward round entries (N = 88, 6.12%) and pituitary MDT treatment decisions (N = 88, 6.12%) representing critical data points. Operation notes and neurosurgical ward round entries were present for every patient. 43/44 (97.7%) had a pre-operative pituitary MDT entry, pre-operative clinic letter, a post-operative clinic letter, an admission clerking entry, a discharge summary, and a post-operative histopathology pituitary multidisciplinary (MDT) team entries. This is the first study to produce a validated patient pathway of patients undergoing pituitary surgery, serving as a comparison to optimise this patient pathway. We have identified salient targets for structured data entry interventions, including mandatory datapoints seen in every admission and have also identified areas to improve documentation adherence, both of which support movement towards automation.

Niemann-Pick Disease With Bilateral Adrenal Mass

Abstract Niemann–Pick disease (NPD) is a heterogeneous group of lysosomal storage disorders with autosomal recessive inheritance pattern. There are 4 types of NPD. Patients with NPD type B generally have better prognosis, allowing them to survive into adulthood. They have a widespread clinical presentation, affecting multiple organs but rarely neurological involvement. Here, we describe the case of a 38-year-old woman with unexplained hepatosplenomegaly and young hypertensive intracranial bleed. Evaluation for young hypertension further revealed a nonfunctional bilateral adrenal mass and gross hepatosplenomegaly. NPD was confirmed through dried blood spot investigation. It showed low activity of acid sphingomyelinase and genetic testing also detected 2 pathogenic mutations. She is being managed by a multidisciplinary team for supportive treatment that includes regular symptoms monitoring and genetic counseling.

3 Validity of the tele-administered Montreal Cognitive Assessment for identifying geriatric neurocognitive disorders

Objective:With the emergence of the coronavirus 2019 pandemic, investigating the validity of tele-screenings for neuropsychological status has become increasingly necessary. While the telephone version of the Montreal Cognitive Assessment (MoCA-T) has been validated for use in patients with Parkinson’s and stroke/cerebrovascular disease, the clinical utility of this instrument in geriatric patients with other suspected cognitive disorders has yet to be determined. Thus, the present study aimed to examine the classification accuracy of the MoCA-T in a mixed clinical sample of patients with mild cognitive impairment (MCI) or dementia.Participants and Methods:Ninety-one older adults were administered the MoCA-T via videoconferencing technology as part of a comprehensive neurocognitive evaluation performed by a multidisciplinary treatment team within a dementia specialty clinic. Based on this evaluation, 51 (56.0%) patients were diagnosed with dementia, 27 (29.7%) with MCI, and 13 (14.3%) with no neurocognitive diagnosis (i.e., subjective cognitive complaints). In addition to MoCA-T total and item scores, we also computed subscale scores for between-group comparisons as the sum of items assessing orientation, language, attention/executive function, and memory. ANOVA/ANCOVA and ROC curve analyses were used to examine between-group differences on the MoCA-T and its psychometric properties in discriminating patients with MCI or dementia, respectively.Results:Participants had a mean age of 74.3 ± 8.7 and education of 16 ± 2.9 years. Patients with dementia were significantly older than those with MCI and no diagnosis, but there were no other significant between-group differences in clinical characteristics. MoCA-T total [F(2,86)=28.5, p<0.001] and all subscale scores (p<0.01) differed significantly between groups and in the expected direction (dementia<MCI<no diagnosis) even after controlling for age. The only exception was language for which there was initially a statistical trend (p=0.06) that reached significance (p<0.05) after controlling for age. In terms of individual items, abstraction, fluency, orientation to place/city, and category cued recall were the only items that did not differ significantly between groups. ROC curve analyses revealed -5 points to be the optimum cut-off for distinguishing between cognitively normal individuals from patients with MCI (Sensitivity=0.67; Specificity=0.77; AUC=0.78), and a cut-off of -8 points optimally distinguished between patients with MCI and dementia (Sensitivity=0.77; Specificity=0.74; AUC=0.81).Conclusions:The current study provides further evidence for the clinical utility of the MoCA-T as a screening instrument for neurocognitive disorders in older adults and extends prior work to include administration via videoconferencing technology. While previous studies have focused on the use of MoCA-T in specific patient populations, here, we demonstrate the validity of this screening tool in a mixed-clinical sample, which suggests its broader use in clinical settings for distinguishing between neurocognitive disorders, regardless of the underlying etiology.

SAT398 Pubertal Status And Trends In Gender Affirming Treatment Of Transgender And Gender Diverse Youth

Abstract Disclosure: C. Lin: None. M. Oransky: None. R. Fader: None. N.R. Malhotra: None. E.M. Baldiserroto: None. C.J. Romero: None. J.D. Safer: None. M. Yau: None. Background: Transgender and gender diverse (TGD) youth seek care to affirm their gender identities and improve quality of life and mental health. Gender affirming care of youth includes pubertal assessment, pubertal suppression with gonadotropin-releasing hormone agonist (GnRHa) and gender-affirming hormone therapy (GAHT). Management choices are made collaboratively among the patient, the patient’s family, and the multidisciplinary treatment team. Objective: We sought to characterize the pubertal status of the TGD youth to consider medical intervention. Method: The medical records of 58 TGD youth referred to pediatric endocrinology from 2020-2022 were retrospectively analyzed. Pubertal assessments were made by visualization of pubic hair and breast development according to the Tanner scale and determination of testicular volume with an orchidometer. We labeled Tanner stage 1 as prepuberty; stages 2-3 as early puberty; and stages 4-5 as late puberty. Results: The median age was 15 years (range 8-18 years). 46.6% were trans girls (n=27), 44.8% were trans boys (n=26), and 8.6% were non-binary (n=1 natal male and n=4 natal female). Of the trans girls, 7.4% were prepubertal (n=2), 51.9% were in early puberty (n =14), and 40.7% were in late puberty (n=11). Of the trans boys, none were prepubertal, 3.6% were in early puberty (n=1), and 96.4% were in late puberty (n=25). Of the non-binary youth, 20% were in early puberty (n=1) and 80% were in late puberty (n=4).For the prepubertal patients, monitoring for onset of puberty without treatment was recommended. Of the 15 patients in early puberty, 73.3% started GnRHa (10 trans girls, 1 trans boy) and 26.7% started GAHT (4 trans girls). Of the 36 patients in late puberty, 2.8% received no treatment (1 trans boy), 25.0% started GnRHa (7 trans girls, 2 trans boys) and 72.2% started GAHT (4 trans girl, 22 trans boy). Of the 5 non-binary patients, 1 patient in early puberty (1 natal female) was treated with GnRHa, and 4 were in late puberty and initiated on GAHT (1 natal male, 3 natal female). Conclusion: In our multidisciplinary practice, trans feminine patients are evenly divided between those who present in early and late puberty. This presents possible implications for fertility preservation strategies. Trans masculine patients overwhelmingly present in late puberty, perhaps owing in part to earlier timing for typical “female” puberty. This means that even prompt initiation of GnRHa therapy cannot entirely prevent the potential future need for chest masculinization surgery. Presentation: Saturday, June 17, 2023

Health-related quality of life aspects of the 'Periodontitis prevalence in ulcerative colitis and Crohn's disease' (PPCC) cohort.

To assess whether oral health problems affect disease-specific quality of life (QoL) of inflammatory bowel disease (IBD) patients, and vice versa, whether IBD affects oral-health-related QoL. Individuals reporting IBD and matched controls were surveyed on general anamnestic information, oral-health-related questions and the Oral Health Impact Profile (OHIP)-5. IBD patients were additionally surveyed on years since diagnosis, disease activity and severity as well as health-related QoL (Short Inflammatory Bowel Disease Questionnaire, sIBDQ). OHIP-5 and sIBDQ were defined as primary outcome parameters, and several predictors and confounders were used in adjusted univariable and multivariable regression analyses. Answers from 1108 IBD patients and 3429 controls were analysed. Compared with controls, IBD patients reported significantly more frequently an oral impact on daily life and worse oral-health-related QoL, with Crohn's disease (CD) patients being more severely affected than ulcerative colitis (UC) patients. The diagnosis of UC and CD, having <20 teeth, severe periodontitis and stressful daily-life experience were associated with a higher prevalence of poor oral-health-related QoL. Among IBD patients, an impaired IBD-specific, health-related QoL was significantly associated with the diagnosis of CD and depression, IBD activity and severity, having <20 teeth, presence of oral lesions and stressful daily-life experience, while a longer time since diagnosis was significantly associated with an improved IBD-specific, health-related QoL. The results of the present study indicate, for the first time, that oral health problems are associated with an impairment of IBD-specific health-related QoL, and vice versa, IBD is associated with an impaired oral health-related QoL. This emphasizes the potential advantages of including dental professionals in the multi-disciplinary treatment teams of IBD patients.

Augmentation of a multidisciplinary team meeting with a clinical decision support system to triage breast cancer patients in the United Kingdom

Aim: Multidisciplinary team (MDT) meetings struggle with increasing caseloads. Recent National Health Service (NHS) guidance proposes that patients are triaged for ‘no discussion at MDT’. We examine whether an artificial intelligence (AI)-based clinical decision-support system (CDSS) can support human triage. Methods: Local best practice breast cancer MDT treatment decisions were compared with treatment decisions made by: two, two-person MDT triage teams with and without the CDSS; the CDSS acting ‘alone’; and the historical MDT. A decision tree on whether to triage patients to the CDSS or the MDT was created using supervised learning algorithms. Results: When localized, the CDSS achieved high concordance with local best practice (treatment plan decisions: 92% CDSS vs 96% team 1 vs 92% team 2, not significant [NS]; treatment type decisions: 89% CDSS vs 93% team 1 vs 82% team 2, NS). Using a decision tree 40.2% of cases can be correctly triaged to the CDSS for a treatment plan, and 34.6% for treatment type recommendations. Conclusion: AI-enabled CDSSs can potentially reduce the clinical workload for a breast cancer MDT by up to 40%. Before routine deployment they need to be appropriately localized and validated in prospective studies to evaluate clinical effectiveness and economic impact.

A protocol for randomized controlled trial on multidisciplinary interventions for mobility limitation in the older adults (M-MobiLE)

BackgroundMobility limitation—the loss of exercise capacity or independent living ability—is a common geriatric syndrome in older adults. As a potentially reversible precursor to disability, mobility limitation is influenced by various factors. Moreover, its complex physiological mechanism hinders good therapeutic outcomes with a single-factor intervention. Most hospitals have not incorporated the diagnosis and evaluation of mobility limitation into medical routines nor developed a multidisciplinary team (MDT) treatment plan. We aim to conduct a clinical trial titled “A Multidisciplinary-team approach for management of Mobility Limitation in Elderly (M-MobiLE)” to explore the effect of the MDT decision-making intervention for mobility limitation.MethodsThe M-MobiLE study will be a multicenter, randomized, and controlled trial. We will recruit a minimum of 66 older inpatients with mobility limitation from at least five hospitals. Older patients with mobility limitation admitted to the geriatrics department will be included. Short-Physical Performance Battery (SPPB), Activities of Daily Living (ADL), Function Impairment Screening Tool (FIST), Geriatric Depression Scale (GDS-15), Short Form − 12 (SF-12), Fried frailty phenotype, social frailty, Morse Fall Risk Scale, SARC-CalF, Mini-Mental State Examination (MMSE), Mini-Nutritional Assessment Short-Form (MNA-SF), and intrinsic capacity will be assessed. The intervention group will receive an exercise-centered individualized MDT treatment, including exercise, educational, nutritional, medical, and comorbidity interventions; the control group will receive standard medical treatment. The primary outcome is the change in the SPPB score, and the secondary outcomes include increased SF-12, ADL, FIST, MMSE, MNA-SF, and intrinsic capacity scores and decreased GDS-15 and SARC-CalF scores.ConclusionOur results will help develop a multidisciplinary decision-making clinical pathway for inpatients with mobility limitation, which can be used to identify patients with mobility limitation more effectively, improve mobility, and reduce the risk of falls, frailty, and death in older inpatients. The implementation of this MDT strategy may standardize the treatment of mobility limitation, reduce adverse prognosis, and improve quality of life.Trial registrationChiCTR, ChiCTR2200056756, Registered 19 February 2022.

Machine learning to predict curative multidisciplinary team treatment decisions in oesophageal cancer

BackgroundRising workflow pressures within the oesophageal cancer (OC) multidisciplinary team (MDT) can lead to variability in decision-making, and health inequality. Machine learning (ML) offers a potential automated data-driven approach to address inconsistency and standardize care. The aim of this experimental pilot study was to develop ML models able to predict curative OC MDT treatment decisions and determine the relative importance of underlying decision-critical variables. MethodsRetrospective complete-case analysis of oesophagectomy patients ± neoadjuvant chemotherapy (NACT) or chemoradiotherapy (NACRT) between 2010 and 2020. Established ML algorithms (Multinomial Logistic regression (MLR), Random Forests (RF), Extreme Gradient Boosting (XGB)) and Decision Tree (DT) were used to train models predicting OC MDT treatment decisions: surgery (S), NACT + S or NACRT + S. Performance metrics included Area Under the Curve (AUC), Accuracy, Kappa, LogLoss, F1 and Precision -Recall AUC. Variable importance was calculated for each model. ResultsWe identified 399 cases with a male-to-female ratio of 3.6:1 and median age of 66.1yrs (range 32–83). MLR outperformed RF, XGB and DT across performance metrics (mean AUC of 0.793 [±0.045] vs 0.757 [±0.068], 0.740 [±0.042], and 0.709 [±0.021] respectively). Variable importance analysis identified age as a major factor in the decision to offer surgery alone or NACT + S across models (p < 0.05). ConclusionsML techniques can use limited feature-sets to predict curative UGI MDT treatment decisions. Explainable Artificial Intelligence methods provide insight into decision-critical variables, highlighting underlying subconscious biases in cancer care decision-making. Such models may allow prioritization of caseload, improve efficiency, and offer data-driven decision-assistance to MDTs in the future.

Trauma-Informed, Sensory-Based Pediatric OT Interventions: A Systematic Review

Abstract Date Presented 04/20/2023 Systematic review results support the role of OT practitioners on multidisciplinary treatment teams working with children with complex trauma histories and a variety of sensory-based and trauma-informed care approaches. Primary Author and Speaker: Victoria Lehr Additional Authors and Speakers: Allison F. Sullivan, Tina Champagne, Stacey E. Szklut

Mental Health and Placenta Accreta Spectrum.

Nearly half of women describe childbirth as traumatic in some way, making them more vulnerable to perinatal psychiatric illness. Patients with high risk pregnancies, such as abnormal placentation, are even more susceptible to childbirth related mental health sequelae. There are no formal recommendations for mental health intervention in women with placenta accreta spectrum (PAS). In many institutions, the Edinburgh Postpartum Depression Scale is used to assess for depressive and anxiety symptoms during pregnancy and postpartum. Women with PAS should be screened at time of diagnosis, monthly until delivery, and at multiple time points through the first year postpartum. It is also recommended to screen women for PTSD prior to and after delivery. Interventions shown helpful in the PAS population include establishing a multidisciplinary team, patient access to a support person or care coordinator, development of a postpartum care team and plan, and extending mental health follow up through the first year postpartum. Women with PAS are at increased risk for negative mental health outcomes. To support the mental health of women with PAS and their families, we recommend a multi-disciplinary treatment team, screening for mental health sequelae early and often, referring women with positive screens to mental health professionals, involving the partner/family in care, and considering referral to a PAS support group for peer support.

Factors Predicting Outcomes in Patients with Critical Limb Ischemia After Multidisciplinary Team Treatment: A 5-year Single-Center Retrospective Review for CME Credit June 2023

Factors Predicting Outcomes in Patients with Critical Limb Ischemia After Multidisciplinary Team Treatment: A 5-year Single-Center Retrospective Review for CME Credit June 2023

A New Treatment Program: Focused Integrated Team-based Treatment Program for Bipolar Disorder (FITT-BD).

Bipolar disorder (BD) is complicated by a dynamic, chronic course along with multiple comorbid psychiatric and medical conditions, making it challenging for clinicians to treat and patients to thrive. To efficiently manage the complexity of BD and help patients recover, we developed a Focused Integrated Team-based Treatment Program for Bipolar Disorder (FITT-BD). The purpose of this paper is to describe how we developed this clinic and the lessons we learned. We developed FITT-BD by integrating strategies from stepped care, collaborative care, and learning health care systems. We describe the rationale, details, and lessons learned in developing FITT-BD. By integrating stepped care, collaborative care, and a learning health care system approach, FITT-BD aims to reduce barriers to care, leverage the expertise of a multidisciplinary treatment team, ensure patient-centeredness, and use assessments to inform and continuously improve outcomes in real time. We learned that there are challenges in the creation of a web-based application that tracks the treatment of patients within a network of hospitals. The success of FITT-BD will be determined by the degree to which it can increase treatment access, improve treatment adherence, and help individuals with BD achieve their treatment goals. We expect that FITT-BD will improve outcomes in the context of ongoing clinical care. The treatment of BD is challenging and complex. We propose a new treatment model for BD: FITT-BD. We expect that this program will be a patient-centered approach that improves outcomes in the context of ongoing clinical care for patients with BD.