Proposed Management Plan Research Articles

Not just a BLiP: early experience with a novel multidisciplinary case conference for benign hepatopancreatobiliary disease at a tertiary Canadian healthcare center.

Benign Liver and Pancreas (BLiPs) rounds, implemented in 2022 at our Canadian tertiary care center, are a novel concept of a multidisciplinary case conference (MCC) for discussion of benign hepatopancreatobiliary (HPB) disease. BLiPs Rounds are a monthly virtual meeting of surgeons, gastroenterologists, and interventional radiologists experienced in biliary and pancreatic disease. This case series was completed to review the patient cases discussed over the first year of BLiPs rounds, and to evaluate the effect of the multidisciplinary discussion on patient management plans. Meeting minutes were reviewed for BLiPs rounds between May 2022 and July 2023. Data were collected retrospectively on all discussed patients by review of the electronic medical record, and analyzed using frequencies and means with standard deviations. Between May 2022 and July 2023, 56 cases were discussed at 12 case conferences. 68% of cases concerned pancreatic pathology, 25% concerned biliary pathology, the remainder liver or duodenal pathology. 49 cases (88%) were presented to discuss therapeutic options, and 7 presented as diagnostic challenges. Cases were usually presented once, but 7 patients were discussed at multiple conferences due to complex issues or ongoing symptomatology. 40 patients (71%) had undergone previous endoscopic, percutaneous, or surgical interventions prior to discussion. Endoscopic intervention was recommended in 32% of cases, percutaneous interventional approach in 13%, a combined endoscopic and percutaneous approach in 9%, and surgery in 18%. Repeat imaging or observation was recommended in 29% of cases. Discussion at rounds led to a change or adjustment in the proposed management in 46 cases (82%). The plan recommended by the MCC was carried out in 71% of cases. BLiPs case conference provides a valuable venue to discuss cases, encourage interdisciplinary collaboration, and refine treatment approaches, leading to a change in proposed management plan in over three-quarters of cases presented.

Implementation of Field Study Courses in Teacher Education Institutions (TEIs) in Oriental Mindoro

This study assessed the extent of the manifestation of the learning experiences. Specifically, it determined the extent of manifestation of learning experiences in the areas of observations of teaching-learning in the actual school environments, participation and teaching assistantship, and teaching internship and the differences in the assessments of students and teachers on the extent of manifestation of learning experiences. This research study used the descriptive design of research. The subjects of this study were 345 composed of 259 Field Study students and 86 faculty members of the education programs among TEIs in Oriental Mindoro. The researcher used a researcher-made questionnaire. The data collected were treated statistically using the most appropriate statistical methods. Descriptive statistics such as weighted mean, standard deviation and a four-point rating scale were employed in analyzing and interpreting the data gathered. Results revealed that the extent of manifestation of the learning experiences is lower in terms of participation and teaching assistantship compared to teaching internship, and observations of teaching-learning in actual school environment. Moreover, the assessment made by students and teachers on the extent of manifestation of learning experiences varies significantly. A proposed management plan may be developed and endorsed to the administrators of TEIs in Oriental Mindoro for further checking and validation. The proposed management plan may be implemented by the Deans of Education programs of TEIs in Oriental Mindoro. Future researchers may replicate the study including the Baco Community College.

BT14 Diamonds in the rough: patient-captured images can be used to triage out benign lesions

Abstract Dermatology is struggling with 2-week-wait (2WW) cancer referrals, resulting in a lack of capacity to review other dermatoses. National data indicate that only 6% of the 500 000 referrals are confirmed skin malignancies (www.england.nhs.uk/wp-content/uploads/2022/04/B0829-suspected-skin-cancer-two-week-wait-pathway-optimisation-guidance.pdf), and our local data suggest that 40% of referrals are, in fact, benign, with 24% being seborrhoeic keratoses. Could there be a way to triage these lesions safely? Novel consumer-level smartphone attachments could be the way forward. Patient-led teledermatology has proven to be a convenient, environmentally friendly way of assessing cutaneous lesions. Dermoscopic modalities such as the Molescape™ and Dyplens™ show promise in facilitating the triage of skin lesions, but have we really established the efficacy of these devices first-hand with our local patient cohorts? Studies suggest that the resolution and clarity of these images are comparable to clinical dermatoscopes. To challenge this theory, we obtained patient-led dermoscopic images of lesions that were referred under the 2WW pathway. We then allocated a blinded dermatology consultant to analyse these images (n = 50) for diagnoses and proposed management plan, based on the patient-captured image and brief history. We compared the proposed diagnoses with histological and clinical outcomes for those 50 patients. We found an accuracy of 78% vs. in-person assessment, but, most importantly, all benign lesions, including seborrhoeic keratoses, were excluded safely. All malignancies were triaged as suspicious with the use of these simple devices, with basal cell carcinomas (n = 3) being diagnosed with 100% accuracy. Could these smartphone attachments be the answer to improved national triaging pathways? We may have found a solution. However, will this affect patient expectation, experience and satisfaction? Surprisingly, our local survey revealed that 80% of our 2WW patients would prefer these devices as opposed to attending primary care or photograph clinics. We appreciate that patient-led dermoscopy may not have the accuracy needed to diagnose complex cutaneous lesions, and these will always warrant prompt clinical review. However, these pioneering devices may be the solution to filtering out simple benign lesions, preventing unnecessary hospital footfall and reducing carbon footprint. In keeping with the contemporaneous goals set by the National Health Service COVID-19 recovery plan, these innovative devices should be considered as part of our existing triage pathways, to help optimize skin cancer triage and treatment and to better patient care.

INSTRUCTIONAL COMPETENCE OF SOCIAL STUDIES TEACHERS: BASIS FOR A PROPOSED MANAGEMENT PLAN

This study sought determine the instructional competence of Social Studies teachers in the public secondary schools of Bautista as basis for a proposed management plan during the school year 2021-2022. In consonance with the primary objective, the study sought to answer the following specific questions: (1) What is the profile of Social Studies teachers in terms of the following variables: educational attainment; teaching experience; and monthly income. (2) What is the instructional competence of the Social Studies teachers as evaluated themselves? (3) What is the instructional competence of the Social Studies teachers as evaluated by their school heads themselves? (4) Is there a significant relationship between the profile of Social Studies teachers and their instructional competence level? (5) Is there a significant difference between the evaluation of the school heads and of the Social Studies teachers on the instructional competence? (6) What management plan can be proposed to enhance the instructional competence of the teachers in Social Studies? In relation to the foregoing sub-problems, the following research hypotheses were tested at .05 level of significant in its null form to wit: (1) There is no significant relationship between the profile of the Social Studies teachers and their instructional competence. (2) There is no significant difference between the evaluation of the school heads and the Social Studies teachers on their instructional competence? The coverage of this study was the evaluation of the level of instructional competency of the teachers in Social Studies. It includes the 31 teachers teaching Social Studies and 26 school heads of Bautista, Division of Pangasinan II for the school year 2021-2022. An output of the study was the proposed management plan for teachers teaching Social Studies in order to improve and strengthen their instructional competency level for the benefit of the students. This study used of the descriptive-normative method of research. The method is chosen because the technique is expected to illicit information that are objective in nature in order to realistic answer the research sub-problems. This method was appropriate because it reveals the actual condition of the respondents concerning their instructional competency level. The researcher used a questionnaire-checklist as the main data-gathering instrument. After which an unstructured interview was conducted to countercheck responses in the questionnaire, which the respondents finds difficult to understand. The data that was gathered from this study was tabulated, analyzed and interpreted using frequency count, percentage, weighted mean, and analysis of variance. To get the relationship between the profile and the evaluated competency level of teachers – the contingency coefficient was used. KEYWORD: Teaching, Social Studies, Instruction, Teaching Strategies, Competence of Teachers

An environmental management plan for construction waste management

This study presents a proposed environmental management plan (EMP) for construction waste management (CWM). This life cycle thinking (LCT)- based EMP for CWM is set to constitute three sections. The former investigates means of waste minimization via source control strategies. The second section discusses CWM by monitoring and tracking the path of input building materials and output construction waste. The final section presents an input–output quantitative assessment of the CWM strategies undertaken. The proposed LCT-based EMP defines actions and activities for different phases and pinpoints the methods and procedures across the entire building process. Finally, it is applied to two groups of case studies showing the difference between CWM practices for green-certified and non-certified projects. The outcome shows how the proposed plan can present a novel approach integrating environmental management and best practices for CWM. This shall facilitate complying with international standards and building rating systems for achieving environmental stewardship.

Phenotypic diversity of Medicago crop wild relatives growing in Lebanon

Medicago L. (Fabaceae; Papillionoidae) has high nutritive value, palatability, and ability to improve the soil fertility which puts it as one of the world’s most important forages. Medicago genetic resources are suffering from anthropogenic destructions, overgrazing, climate change and drought. Using the results of a previous gap analysis, which prioritized the species and sites for in situ and ex situ conservation, this study aims to undertake ex situ conservation activities for high priority annual Lebanese species. Accessions of the target species were collected, multiplied, characterized and conserved at Genebank of The International Center for Agricultural Research in the Dry Areas (ICARDA). Based on characterization data, morphological diversity assessment is carried out to analyse the phenotypic variability pattern in relation with the environmental conditions of the collection sites. The analysis of 26 characters applied on 19 collected species has shown a significant variability for 13 characters. The species Medicago polymorpha L. from Chwaifat, M. polymorpha from Shebenieh, M. truncatula Gaertn and M. orbicularis (L.) Bartal from Jeita, and M. constricta Durieu from Bwerij had characters that could be related to drought tolerance as they have displayed a high early vigour and an early flowering. In depth analysis of the characters early vigour, days to flowering and days to pod formation within the species in relation to drought tolerance further informed our proposed management plan. On this basis, the accessions showing a high adaptability to harsh conditions will be subject to in situ conservation.

Pre-empting and preventing iatrogenic oral trauma: A case report

In keeping with the principles of autonomy, beneficence, and non-maleficence, no dental treatment shouldbbe commenced prior to carrying out all the requisite preparatory stages. This includes a thorough initial assessment, establishing an accurate diagnosis, drawing up a list of possible treatment options, presenting these to the patient, and allowing them to make an autonomous and educated decision. This should be followed with the formulation of a structured and carefully considered treatment plan.This case illustrates a case of iatrogenically induced damage suffered by a patient where unplanned treatment was carried out with no consideration of the possible immediate, short term or long terms outcomes. It stresses the need for dentists to consider and pre-empt the consequences of their treatment (or lack there-of) and formulate the best possible plan for each patient. It also needs to be stressed that the proposed management plan must be informed by the principle of ‘shared decision making’ wherein the patient assumes part of the responsibility and accountability in the decisions taken. The ultimate aim of any plan must be to promote the best possible outcome for the patient (beneficence), and as far as possible prevent iatrogenically induced harm (non maleficence).

Building the ecosystem for pediatric neuro-oncology care in Pakistan: Results of a 7-year long twinning program between Canada and Pakistan.

Low- and middle-income countries sustain the majority of pediatric cancer burden, with significantly poorer survival rates compared to high-income countries. Collaboration between institutions in low- and middle-income countries and high-income countries is one of the ways to improve cancer outcomes. Patient characteristics and effects of a pediatric neuro-oncology twinning program between the Hospital for Sick Children in Toronto, Canada and several hospitals in Karachi, Pakistan over 7 years are described in this article. A total of 460 patients were included in the study. The most common primary central nervous system tumors were low-grade gliomas (26.7%), followed by medulloblastomas (18%), high-grade gliomas (15%), ependymomas (11%), and craniopharyngiomas (11.7%). Changes to the proposed management plans were made in consultation with expert physicians from the Hospital for Sick Children in Toronto, Canada. On average, 24% of the discussed cases required a change in the original management plan over the course of the twinning program. However, a decreasing trend in change in management plans was observed, from 36% during the first 3.5 years to 16% in the last 3 years. This program also led to the launch of a national pediatric neuro-oncology telemedicine program in Pakistan. Multidisciplinary and collaborative efforts by experts from across the world have aided in the correct diagnosis and treatment of children with brain tumors and helped establish local treatment protocols. This experience may be a model for other low- and middle-income countries that are planning on creating similar programs.

Implementing the "Getting It Right First Time" (GIRFT) Report Recommendations: The Results of Introducing a Shoulder and Elbow Multidisciplinary Team.

ObjectiveIn this study, we aimed to analyse the impact of implementing the “Getting It Right First Time” (GIRFT) recommendations in our shoulder and elbow unit, which included the introduction of a shoulder and elbow multidisciplinary team (MDT) meeting for all patients being considered for surgery.MethodsA retrospective patient case-note review was undertaken to assess the impact of replacing the pre-admission clinic with an MDT meeting. We analysed how many of the proposed management plans were changed as a result of this new MDT, as well as the associated cost savings.ResultsOf note, 118/148 patients who attended the MDT had a provisional operative plan; 24/118 (20%) had their plan changed to non-operative management, 13/118 (11%) had a change of operation, and 6/118 (5%) were recommended further investigations or tertiary referral. This reduced theatre time required by 47 hours, an estimated saving of over £51,000. Significantly, 20/24 patients who had their plan changed from operative to non-operative still had not had an operation after a median follow-up of 39 months.ConclusionThe introduction of a shoulder and elbow MDT for all patients being considered for an operation has improved decision-making, allowed optimisation of non-operative management, and helped prevent patients from having unnecessary operations. This has led to a better patient experience and a more efficient service delivery, which is associated with cost savings.

Recommendations on Cultural Heritage Site Management Plan for the Punjulharjo Boat in Rembang, Central Java

The Punjulharjo boat is a wooden watercraft, built in the traditional Southeast Asian boat building technique called lashed-lug tradition. It was found in 2008, excavated, and later was dismantled for a lengthy conservation process. In early 2018, the hull was reassembled to be displayed for public. The site where the boat was found, and now displayed, has been listed as a heritage site under the Regulation of The Minister of Culture and Tourism No. 57 of 2010, but a management plan of it is still non-existent. Recommendations in this proposed management plan was amassed in accordance to international standards on site management plan. Data was collected from direct site observation, with the assistance of consultations to related references. This plan outlines objectives and strategy in managing the Punjulharjo site, and hopefully can serve as guidelines for the Regional Government of the District of Rembang as the manager of the site.

Widefield imaging with Clarus fundus camera vs slit lamp fundus examination in assessing patients referred from the National Health Service diabetic retinopathy screening programme.

ObjectivesTo compare diabetic retinopathy (DR) grading and management plan between virtual review using widefield Clarus imaging and macular optical coherence tomography (OCT) versus slit lamp clinical examination and macular OCT.MethodNew referrals over 3 months from the National Diabetic Eye Screening programme (DESP) were screened. Patients who had both Clarus widefield imaging and macular OCT were included. All patients underwent slit lamp examination in clinic. Data obtained from electronic patient records included referral reason, DR grading and management plan. Two graders retrospectively reviewed imaging and formulated a management plan blinded to results from patients’ clinic visit. Results from virtual examination were compared with those from slit lamp examination.ResultsOne-hundred and two eyes of 51 patients were assessed. 11 fundus photos from 7 patients and 15 fundus photos from 10 patients were deemed inadequate by grader G1 and G2, respectively. Eighteen (35%) patients and 11 (22%) patients from virtual assessment by G1 and G2, respectively were found to need a face a face appointment to aid diagnosis. Compared to slit lamp examination, 15% and 7.5% of patients from G1 and G2’s virtual assessment respectively had different proposed management plan. Agreement of DR grading between both virtual graders and slit lamp examination was fair (Kappa’s coefficient = 0.56). One case of slit lamp noted retinal neovascularization, which was graded as background retinopathy by DESP was also graded as such on virtual assessment.ConclusionWidefield Clarus and OCT imaging allowed two-thirds of DESP referrals to be safely managed virtually.

Prevalence of mastitis in Nigerian livestock: a Review

AbstractMastitis is a disease of livestock that directly impede livestock production and thus hindering the socio-ecological development of sub-Saharan Africa. Studies have estimated the prevalence of this disease in 30% of Africa countries, with Ethiopia having the highest prevalence. The coverage is low, despite the wide livestock and dairy farms distribution in Africa. Furthermore, estimated economic losses due to the impact of mastitis are lacking in Nigeria. The disease is endemic in Nigeria as indicated by the available data and there are no proposed management plans or control strategies. This review is thus presented to serve as a wakeup call to all parties involved to intensify efforts towards the diagnosis, control, and management of the disease in Nigeria.

Indicating sustainable salmon farming: The case of the new Norwegian aquaculture management scheme

Norway, the world's leader in the production and export of farmed Atlantic salmon, recently established a new management regime with a view to promoting substantial long-term growth in the industry. The government stated plainly, however, that the industry would have to be environmentally sustainable. The determination would be made through the use of indicators, but only one indicator would go into effect as the new regime was instituted: the amount of salmon lice (Lepeophtheirus salmonis) on wild salmon. This paper asks why this one, lone variable was selected. Using policy documents, the draft white paper outlining the new management plan sent out for comment by the government and the responses made by key stakeholders to the draft plan, this paper argues that the selection of this one indicator was overdetermined. Many factors contributed to the selection, including the government's fundamental decision to expand production, the momentum of Norwegian policy development, how the draft white paper defined and discussed environmental sustainability, the criteria established for acceptable indicators and the specifics of the proposed management plan. These had a political effect: For these reasons and more, no solid block of stakeholders emerged to press unambiguously for additional indicators at the start of the scheme, merited or not. This study also demonstrates the difficulties presented by a public debate on a management plan such as this.

MANAGEMENT PLAN FOR THE PROTECTION AND PROMOTION OF GEOHERITAGE AT MEDOBORY NATURE RESERVE

The article deals with the management plan for the geoheritage sites as a component of the “Management Plan for the Medobory Nature Reserve and the Protection of its Natural Sites”. Critical analysis of the need for a comprehensive study of components of inanimate nature, in particular, geological-geomorphological structure of the protected areas with distinct geographic heritage, in the basic national documents “Management Plan for the Nature Reserve and the Protection of its Natural Sites” and “Chronicle of Nature of the Areas and Sites of the Nature Reserve Fund of Ukraine”. In particular, the experience of scientific support for Polish plans for the national parks involves special documentation focusing on the geological environment. It substantiates the algorithm for the study of geoheritage at the Medobory Nature Reserve: from the inventory of the geological-geomorphological component of the territory to the measures for geoeducational support and geoheritage promotion. It analyzes peculiarities of the geological-geomorphological structure of the Medobory Nature Reserve, which represents the fossil barrier reef of the Badenian-Sarmatian age. The basic lithologic-stratigraphic and geomorphological scientific-educational values of the territory of the reserve were emphasized. The proposed management plan for the conservation and promotion of the Medobory Nature Reserve's geoheritage presupposes appropriate strategic objectives for a ten-year period and operational activities for a five-year period. The key strategic objectives and the corresponding measures to preserve and promote the geoheritage of the Medobory Nature Reserve are as follows: conservation of the geoheritage sites and geo-archaeological heritage sites with the inventory of valuable outcrops and reefogenic formations, inventory of parent and mantle rocks to develop the consolidated stratigraphic section; development of a permanent infrastructure for geoeducational activities with measures aimed at creating educational exhibition in the administrative building of the reserve; development of geotourist trails with information-educational support of existing ecoeducational trails and development of new scientific and geoeducational trails. It is important to elaborate the project for creating the National Geopark “Fossil Barrier Reef of Podillya” at the Medobory Nature Reserve and the Podilski Tovtry National Nature Park. Its main functions will include conservation of the Tovtry Ridge as a unique geological-geomorphological phenomenon, combined with the organization of elements of geoeducation and geotourism as a component of the sustainable development of the region. Key words: reserve, geoheritage, geological and geomorphological structure, management plan, strategic objectives, operational activities, promotion, Medobory, fossil barrier reef.

Autonomic involvement in Guillain-Barré syndrome: an update.

Guillain-Barré syndrome (GBS), an inflammatory, usually demyelinating polyradiculopathy, is characterized by ascending symmetrical limb weakness, sensory disturbances, and absent or reduced deep tendon reflexes. There is extensive literature suggesting that GBS is associated with autonomic dysfunction in up to two-thirds of patients. However, it is interesting that there is still no consensus amongst medical professionals regarding whether GBS patients should be routinely screened for autonomic nervous system (ANS) neuropathy. This is an important issue, as the mortality rate from presumed ANS abnormalities now exceeds that of respiratory failure. Given the long interval since this literature was last comprehensively reviewed, an update on this topic is warranted. A PubMed search yielded 193 results with the terms "GBS or Guillain-Barré syndrome and autonomic symptoms" and 127 results with the terms "GBS or Guillain-Barré syndrome and dysautonomia." This review will summarize the current literature involving GBS and autonomic dysfunction in terms of presentation, management, and a brief discussion of prognosis. We also examine prospective approaches that may be helpful and update a proposed management plan.

The SOS Pesca Project: A Multinational and Intersectoral Collaboration for Sustainable Fisheries, Marine Conservation and Improved Quality of Life in Coastal Communities.

Healthy fisheries, particularly small-scale fisheries, are closely linked to prosperous and healthy coastal communities and resilient marine environments. Cuba's marine and coastal ecosystems are highly biodiverse and support fisheries vital to food security and the national economy. Cuban government and state institutions, scientists, managers and fishers-along with colleagues from other countries-have expressed growing concern about the decline of fishing resources. In 2012, under the aegis of the National Center for Protected Areas, Cuban institutions from the Ministry of Science, Technology and Environment and the Ministry of Foreign Investment partnered with the Italian nongovernmental organization, COSPE Onlus, to launch SOS Pesca, a four-year project to achieve sustainable fisheries management, conserve marine habitats and improve quality of life in two Cuban fishing communities (Guayabal in Las Tunas Province and Playa Florida in Camagüey Province). SOS Pesca involved the municipal governments of Amancio Rodríguez (in Las Tunas Province) and Florida (in Camagüey Province), delegates to the Municipal Assembly of People's Power (municipal government) from Guayabal (Amancio Rodríguez Municipality) and Playa Florida (Florida Municipality), the state-owned fishing industry, private fishers, local families, protected area officials and staff scientists, municipal governments and international nongovernmental organizations. By the end of 2012, a new US-Cuban collaboration emerged when COSPE recruited Environmental Defense Fund to provide scientific and technical support, trainings and exchanges focused on fisheries. SOS Pesca succeeded at community, regional fishing zone and national levels. Outcomes included: an assessment of finfish identifying species most vulnerable to fishing (methods and capacities), a proposed management plan for finfish, a National Plan of Action for sharks and rays, two marine protected areas established, increased employment through socioeconomic alternatives, revitalization of community environmental brigades, and greater capacity to use fishery assessment methods and develop management strategies. Perhaps the greatest achievement was communities' and fishers' changed perceptions of their marine environment, the need for conservation and sustainable resource management, and their active role in this objective. SOS Pesca spurred a more participatory form of integrated marine and coastal management in Cuba-one that integrates fisheries and spatial management, links fishing families and coastal communities with scientists and administrators to find solutions that support sustainability, and connects economic alternatives to community-based conservation and improved food security. This innovative multinational collaboration benefited coastal communities, marine and coastal ecosystems and international cooperation.

Improving the Consent Process in Foot and Ankle Surgery With the Use of Personalized Patient Literature

A patient-specific letter was introduced to the consent process to observe the effect, if any, on information recall and satisfaction for patients undergoing elective foot and ankle surgery. The patients attending the clinic were written a personalized letter—this was a simple personalized letter that outlined their treatment options, the proposed management plan, likely treatment course, and the benefits, risks, and likely period required for recovery. The personalized letter system was compared with the 2 existing methods of consent process: signing for consent at their outpatient encounter at which they were scheduled for surgery and a separate consent clinic without the personalized letter. A total of 111 patients (87 females, 24 males) undergoing elective foot and ankle surgery were assessed on the day of surgery for recall of the procedure, risks, postoperative course, and satisfaction with the consent process. Patients receiving a personalized letter recalled more than those who had attended a routine preoperative consent clinic visit and significantly more than those who had provided consent at their last clinic visit. Patient satisfaction with the consent process was also greater in the personalized group. Our results suggest that the consent process is improved using routine preoperative consent clinics and, most notably, with patient-specific information to improve patient recall and satisfaction.

The Impact of 68Ga-PSMA PET/CT on Management Intent in Prostate Cancer: Results of an Australian Prospective Multicenter Study.

68Ga-PSMA PET/CT scanning has been shown to be more sensitive than conventional imaging techniques in patients with prostate cancer. This prospective Australian multicenter study assessed whether 68Ga-PSMA PET/CT imaging affects management intent in patients with primary or recurrent prostate cancer. Methods: Before undertaking 68Ga-PSMA PET imaging, referring medical specialists completed a questionnaire detailing relevant demographic and clinical data as well as their proposed management plan. A separate follow-up questionnaire was completed after the 68Ga-PSMA PET/CT scan results were available to determine whether the management plan would change. Results: A total of 431 patients with prostate cancer from 4 Australian centers had pre- and post-68Ga-PSMA management plans completed. Scans were obtained for primary staging of intermediate- and high-risk disease in 25% of patients and for restaging/biochemical recurrence in 75% of patients. Overall, 68Ga-PSMA PET/CT scanning led to a change in planned management in 51% of patients. The impact was greater in the group of patients with biochemical failure after definitive surgery or radiation treatment (62% change in management intent) than in patients undergoing primary staging (21% change). Imaging with 68Ga-PSMA PET/CT revealed unsuspected disease in the prostate bed in 27% of patients, locoregional lymph nodes in 39%, and distant metastatic disease in 16%. Conclusion:68Ga-PSMA PET/CT scans detect previously unsuspected disease and may influence planned clinical management in a high proportion of patients with prostate cancer. The impact was greater in patients with biochemical recurrence. These results demonstrate the potential clinical value of 68Ga-PSMA PET/CT in management of prostate cancer.

Formalising multidisciplinary peer review: developing a haematological malignancy-specific electronic proforma and standard operating procedure to facilitate procedural efficiency and evidence-based clinical practice.

Multidisciplinary team (MDT) meetings aimed at facilitating peer review have become standard practice in oncology. However, there is scant literature on the optimal structure and conduct of such meetings. To develop a process for formal peer review of patients with haematological malignancies and to audit any resulting changes made to the management recommendations of the treating physician. A standard operating procedure (SOP) for MDT meetings was developed essentially to integrate clinical peer review with weekly pathology and radiology meetings. The centrepiece is the electronic submission of a patient-specific proforma (Microsoft InfoPath) prior to the meeting. It serves as the template for presentation, discussion and recording of recommendations and conclusions. The final verified document is stored in the electronic patient record, and a copy is sent to the general practitioner. The proposed management plans were compared to the consensus recommendations of the meeting for the first 4 years since inception. Both SOP and proforma underwent continual improvements. These provided the framework for the conduct of a robust weekly MDT meeting for peer review of the management of patients with haematological malignancies. On 20% of occasions, patient management plans were altered to optimise patient care as a direct consequence on peer review at the MDT. Our streamlined process, in its ultimate format, has provided a mature and efficient forum for formal peer review in a genuine multidisciplinary environment. Both initial data and informal feedback support its ongoing activity as an integral component of delivering quality patient care.

Management and control of invasive brown hares (Lepus europaeus): contrasting attitudes of selected environmental stakeholders and the wider rural community

Management of wildlife is often a contentious issue in which stakeholders are increasingly influential. The European hare (Lepus europaeus) is a non-native invasive species, now established in Northern Ireland. The European hare impacts the endemic Irish hare (L. timidus hibernicus), a priority species of conservation concern, via competition and hybridisation to the extent that control of European hares is a priority. We conducted a questionnaire survey among members of Countryside Alliance Ireland (CAI)—an organisation that promotes rural interests, including field sports—and non-members, to ascertain the contrasting attitudes to the lethal control of European hares in Northern Ireland; a total of 342 (20%) questionnaires were returned. We hypothesised that: (i) CAI members would exhibit greater support for intervention than non-members; and (ii) respondents in the core invasive range will differ in their outlook when compared to respondents from other zones. CAI members were more likely to be aware of the presence of the non-native species and to support lethal management. Both groups considered the threat posed to biodiversity by the European hare to be important. We conclude that members of rural interest groups may be important advocates of intervention, whilst non-members of field sports organisations may be more reluctant to support any proposed management plan involving lethal control. Active engagement to develop a mutual understanding, prior to developing management options, is crucial in ensuring long-term success.