Team Conference Research Articles

RETROSPECTIVE STUDY OF ULTRASONOGRAPHIC AND FNAC CORRELATION OF THYROID LESIONS WITH HISTOPATHOLOGY

INTRODUCTION: Thyroid diseases, a common clinical problem have prevalence rate of 4–7% in the general population. Fine-needle aspiration cytology (FNAC) is a minimally invasive, accurate diagnostic tool which can differentiate neoplastic from non-neoplastic lesions and reduces the number of unnecessary thyroidectomies, but has limitations . Our study was a retrospective an METHODOLOGY: alysis of 124 cases of thyroid lesions over a period of 3 years from April2019 to April 2022. The FNAC ndings were reviewed and data was compared with the histopathological, imaging ndings and data was analysed. Majority of the pat RESULTS: ients were females in the age group of 41–60 years with a mean age of 42 years and most were non-neoplastic lesions. 76 cases were diagnosed as colloid nodular goitre and benign cystic lesions by FNAC. 44 cases were diagnosed as neoplastic lesions (follicular neoplasm, papillary carcinoma, and suspected malignancy) by FNAC. 18 of these cases were non neoplastic lesions, 24 were papillary carcinoma, 2 were follicular carcinoma on histopathological examination . Statistical analysis of neoplastic lesions showed sensitivity, specicity, accuracy, false positive rate, false negative rate, positive predictive value, and negative predictive value of FNAC to be 69.09%, 90.7%, 80.8%, 9.2%, 30.9%, 86.3% and 77.6% respectively. Ultrasound was foun CONCLUSION: d to be more reliable than palpation, but denitive diagnosis can be reached only with FNAC/Biopsy. Bethesda system of reporting thyroid cytology should be meticulously followed to minimize errors and a repeat FNAC asked for discordant cases after a multidisciplinary team conference.

18F]FET-PET in children and adolescents with central nervous system tumors: does it support difficult clinical decision-making?

PurposePositron emission tomography (PET) with O-(2-[18F]fluoroethyl)-L-tyrosine ([18F]FET) is a well-established tool for non-invasive assessment of adult central nervous system (CNS) tumors. However, data on its diagnostic utility and impact on clinical management in children and adolescents are limited.MethodsTwenty-one children and young adults (13 males; mean age, 8.6 ± 5.2 years; range, 1–19 at initial diagnosis) with either newly diagnosed (n = 5) or pretreated (n = 16) CNS tumors were retrospectively analyzed. All patients had previously undergone neuro-oncological work-up including cranial magnetic resonance imaging. In all cases, [18F]FET-PET was indicated in a multidisciplinary team conference. The impact of PET imaging on clinical decision-making was assessed. Histopathology (n = 12) and/or clinical and imaging follow-up (n = 9) served as the standard of reference.ResultsThe addition of [18F]FET-PET to the available information had an impact on further patient management in 14 out of 21 subjects, with avoidance of invasive surgery or biopsy in four patients, biopsy guidance in four patients, change of further treatment in another five patients, and confirmation of diagnosis in one patient.Conclusion[18F]FET-PET may provide important additional information for treatment guidance in pediatric and adolescent patients with CNS tumors.

Physician-led in-hospital multidisciplinary team conferences with multiple medical specialities present - A scoping review.

Multidisciplinary Team Conferences (MDTs) are complex interventions in the modern healthcare system and they promote a model of coordinated patient care and management. However, MDTs within chronic diseases are poorly defined. Therefore, the aim of this scoping review was to summarise the current literature on physician-led in-hospital MDTs in chronic non-malignant diseases. Following the PRISMA-ScR guideline for scoping reviews, a search on MDT interventions in adult patients, with three or more medical specialties represented, was performed. We identified 2790 studies, from which 8 studies were included. The majority of studies were non-randomised and focused on a single disease entity such as infective endocarditis, atrial fibrillation, IgG4-related disease, or arterial and venous thrombosis. The main reason for referral was confirmation or establishment of a diagnosis, and the MDT members were primarily from medical specialties gathered especially for the MDT. Outcomes of the included studies were grouped into process indicators and outcome indicators. Process indicators included changes in diagnostic confirmation as well as therapeutic strategy and management. All studies reporting process indicators demonstrated significant changes before and after the MDT. MDTs within chronic diseases appeared highly heterogeneous with respect to structure, reasons for referral, and choice of outcomes. While process indicators, such as change in diagnosis, and treatment management/plan seem improved, such have not been demonstrated through outcome indicators.

A Multiple-Path Model of Workforce Development for Improving the Fidelity of Family Team Conference in the Child Welfare System

ABSTRACT Family Team Conference (FTC) has been suggested as a promising practice model to improve child welfare outcomes. However, there is little understanding of developing an effective workforce to ensure FTC fidelity. Using data involving 891 caseworkers who implemented FTC in a Midwestern state, path analysis showed that both effective training and supervision that parallels the same principles of FTC are necessary conditions to enhance FTC fidelity either directly or indirectly by increasing caseworkers’ facilitation skills. This paper suggests that organizational readiness and ongoing support are essential for ensuring the high-quality implementation of family-centered practice in the public child welfare system.

Developing prediction models for short-term mortality after surgery for colorectal cancer using a Danish national quality assurance database.

The majority of colorectal cancer surgeries are performed electively, and treatment is often decided at the multidisciplinary team conference. Although the average 30-day mortality rate is low, there is substantial population heterogeneity from young, healthy patients to frail, elderly patients. The individual risk of surgery can vary widely, and tailoring treatment for colorectal cancer may lead to better outcomes. This requires prediction of risk that is accurate and available prior to surgery. Data from the Danish Colorectal Cancer Group database was transformed into the Observational Medical Outcomes Partnership Common Data Model. Models were developed to predict the risk of mortality within 30, 90, and 180days after colorectal cancer surgery using only covariates decided at the multidisciplinary team conference. Several machine-learning models were trained, but due to superior performance, a Least Absolute Shrinkage and Selection Operator logistic regression was used for the final model. Performance was assessed with discrimination (area under the receiver operating characteristic and precision recall curve) and calibration measures (calibration in large, intercept, slope, and Brier score). The cohort contained 65,612 patients operated for colorectal cancer in the period from 2001 to 2019 in Denmark. The Least Absolute Shrinkage and Selection Operator model showed an area under the receiver operating characteristic for 30-, 90-, and 180-day mortality after colorectal cancer surgery of 0.871 (95% CI: 0.86-0.882), 0.874 (95% CI: 0.864-0.882), and 0.876 (95% CI: 0.867-0.883) and calibration in large of 1.01, 0.98, and 1.01, respectively. The postoperative short-term mortality prediction model showed excellent discrimination and calibration using only preoperatively known predictors.

Prediction of survival in patients with colorectal liver metastases- development and validation of a prognostic score model

BackgroundMetastatic spread of colorectal cancer to the liver impacts prognosis. Advances in chemotherapy have resulted in increased resectability rates and thereby improved survival in patients with colorectal liver metastases (CRLM). However, criteria are needed to ensure that patients selected for hepatic resection benefit from the invasive therapy. The study aimed to construct a predictive model for overall survival (OS) in patients with CRLM, based on preoperatively available information. MethodsThe retrospective cohort study reviewed all patients with CRLM discussed at multidisciplinary team conference at Karolinska University Hospital, Stockholm, Sweden, 2013–2018. Independent prognostic factors for OS were identified, based on which a score model was generated. The model was validated on patients treated for CRLM at Hôpital Universitaire Paul Brousse, Villejuif, France, 2007–2018. Calibration and discrimination methods were used for internal and external validation. ResultsThe Swedish development cohort included 1013 patients, the French validation cohort 391 patients. Poor OS was significantly associated with age>60years (hazard ratio (HR) 3.57 (95%CI 2.18–9.94)), number of CRLM (HR 4.59 (2.83–12.20)), diameter of largest CRLM>5 cm (HR 2.59 (1.74–5.03)), right-sided primary tumour (HR 2.98 (2.00–5.80)), extrahepatic disease (HR 4.14 (2.38–15.87)) and non-resectability (HR 0.77 (0.66-0.90)). The C-statistic for prediction of OS was .74, in the development cohort and 0.69 in the validation cohort. ConclusionThe presented predictive score model can adequately predict OS for patients at the initial diagnosis of CRLM. The prognostic model could be of clinical value in the management of all patients with CRLM, by predicting individualized survival and thereby facilitating treatment recommendations.

Reducing length of stay for patients undergoing transcatheter aortic valve replacement using a prescreening approach.

As transcatheter aortic valve replacement (TAVR) becomes a preferred treatment option for patients with aortic valve stenosis, and demand for TAVR increases, it is imperative that length of stay (LOS) is reduced while maintaining safety and effectiveness. As TAVR procedures have become less invasive and more streamlined, current protocols have not been updated to reflect today's postprocedure requirements. The next-day discharge (NDD) protocol was established using available literature. A convenience sample was evaluated for NDD protocol inclusion during aortic multidisciplinary team conference using predetermined inclusion and exclusion criteria. Length of stay for NDD protocol participants was compared with LOS from a retrospective convenience sample of patients undergoing TAVR in the time frame mirroring NDD protocol initiation of the year prior. Patients meeting inclusion criteria were enrolled in the NDD protocol with a goal of discharge to home on postprocedural day 1 by 2:00 p.m. The NDD protocol included preprocedure expectation setting, prescheduled same-day postprocedure imaging, and discharge priority on postprocedure day 1. There is a significant difference in LOS between the NDD eligible retrospective and prospective groups. The prospective group has a significantly lower LOS than the retrospective group (M = 1.6 vs 2.1, respectively; p = .0454). An NDD protocol can help reduce LOS after TAVR in appropriately selected patients. Further protocol revision will be required to optimize LOS outcomes.

POS0059 COMPLEMENT PROTEINS ARE ELEVATED IN PATIENTS WITH axSpA COMPARED WITH RELEVANT CONTROLS OF PATIENTS WITH LOW BACK PAIN AND SpA-FEATURES WITHOUT AXSPA.

BackgroundAxial spondyloarthritis (axSpA) is associated with a certain genetic predisposition, i.e., with the presence of human leukocyte antigen (HLA)-B27. However, the pathogenesis remains largely unexplained. Animal models of ankylosing spondylitis have shown inhibition of complement to be beneficial in terms of limiting structural damage (1). The lectin pathway of complement activation serves as a key component of the innate immune system and plays a pivotal role in both homeostasis and development. The influence of complement in axSpA is mainly unexplored. We have, however, previously reported elevated plasma levels of the lectin pathway proteins L-ficolin and H-ficolin in patients with axSpA compared with blood donors (2).ObjectivesOur aim was to investigate plasma levels of lectin pathway proteins in a clinical cohort of patients with axSpA and compare them to relevant controls that we often experience significant challenges in differentiating from axSpA.MethodsPlasma samples were obtained from individuals in a cohort of patients suffering from low back pain (LBP) including: 1) 23 patients with axSpA, 2) 55 patients without axSpA experiencing SpA-features/symptoms, and 3) 64 patients with nonspecific LBP without SpA-features or MRI findings suggestive of axSpA. Diagnosis of axSpA was based on multidisciplinary team conference consensus after 3.5 years of follow-up (3). Plasma levels of 10 lectin pathway proteins (MBL, CL-L1, H-ficolin, L-ficolin, M-ficolin, MASP-1, MASP-2, MASP-3, MAp44, and MAp19) were measured by immunoassays developed in-house.ResultsPatient characteristics are shown in Table 1. Plasma levels of lectin pathway proteins L-ficolin, M-ficolin and CL-L1 differed significantly in the patient groups (p ≤ 0.03). L-ficolin and M-ficolin were elevated in axSpA-patients compared with patients with SpA-features without axSpA and nonspecific LBP patients (Figure 1). CL-L1 was elevated in axSpA-patients and patients with SpA-features without axSpA compared with nonspecific LBP patients (Figure 1). No significant differences were observed for MBL, H-ficolin, MASP-1, MASP-2, MASP-3, MAp44, and MAp19. L-ficolin levels correlated with CRP in axSpA-patients (Spearman’s rho=0.58 p=0.004). M-ficolin levels correlated weakly with CRP in nonspecific LBP patients (Spearman’s rho=0.36 p=0.003). Lectin pathway protein levels did not correlate with disease activity (ASDAS).Table 1.Patient characteristicsaxSpA (n=23)Not axSpA (n=55)Non-specific low back pain (n=64)p-valueMedian age, years (range)32 (19-40)33 (19-41)32 (18-39)0.75aMales, n (%)10 (43)37 (67)26 (41)0.01bHLA-B27 positive, n (%)17 (74)11 (20)5 (8)0.00bInflammatory back pain, n (%)18 (78)28 (51)0.03cGood response to NSAID14 (61)17 (31)0.01cSacroiliitiis on MRI acc. ASAS, n (%)22 (96)45 (82)0.11cElevated CRP, n (%)3 (13)7 (13)0.97ASDAS (range)2.5 (1.2-3.7)2.3 (0.8-3.8)0.52da compared by Kruskal-Wallis test.b all three groups compared by Chi2 test.c compared by Chi2 test.d compared by Mann Whitney U test.Figure 1.Plasma levels of L-ficolin, M-ficolin and CL-L1.ConclusionL-ficolin and M-ficolin are increased in patients with axSpA when compared with relevant control cohorts of patients with LBP or with SpA-features without axSpA. Our findings support a potential pathogenic role for complement in axSpA, however, further studies are needed to elucidate the diagnostic potential of the specific complement proteins.

Real Life Outcomes of Infrapopliteal Endovascular and Surgical Bypass Intervention for Chronic Limb Threatening Ischaemia in GLASS Stages II and III

Great efforts have been made to choose between bypass surgery and angioplasty as the first choice for revascularisation in chronic limb threatening ischaemia (CLTI). Endovascular therapy predominates despite limited evidence for its advantages. The purpose of this observational cohort study was to investigate outcomes after open and endovascular infrapopliteal revascularisation in extensive infrainguinal arterial disease. The medical records of 1 427 patients who underwent infrainguinal revascularisation exclusively for CLTI in the period January 2014 to February 2019 were reviewed. After detailed analysis, only infrapopliteal revascularisations classified as GLASS stage II or III were considered, resulting in 326 procedures. In total, 127 patients underwent endovascular therapy and 199 patients underwent bypass graft surgery (BGS). The primary endpoints included amputation free survival (AFS) and overall survival (OS). Secondary endpoints included the analyses of multiple factors related to long term AFS. Regarding the primary endpoint, AFS was 75.2% and 65.2% at one and three years, respectively. OS at one and three years was 91.2% and 83.1%, respectively. In the univariable analysis, the hazard of the combined endpoint of major amputation or death was higher after bypass surgery than after endovascular therapy (hazard ratio [HR] 1.80, 95% confidence interval [CI] 1.13 - 2.89; p= .013). After either revascularisation method, TASC II femoropopliteal D was associated with a higher risk of amputation or death (HR 1.69, 95% CI 1.10 - 2.58; p= .015). Multivariable Cox regression analysis revealed no association between the variables analysed for AFS. Patients with CLTI submitted to infrapopliteal revascularisation and classified as GLASS II and III had satisfactory AFS and OS rates after an individualised team conference decision. Furthermore, the revascularisation modality (endovascular or open) did not influence the AFS results.

Standardized care pathways for patients with suspected urinary bladder cancer: the Swedish experience

Objectives To compare time intervals to diagnosis and treatment, tumor characteristics, and management in patients with primary urinary bladder cancer, diagnosed before and after the implementation of a standardized care pathway (SCP) in Sweden. Materials and methods Data from the Swedish National Register of Urinary Bladder Cancer was studied before (2011–2015) and after (2016–2019) SCP. Data about time from referral to transurethral resection of bladder tumor (TURBT), patients and tumor characteristics, and management were analyzed. Subgroup analyses were performed for cT1 and cT2–4 tumors. Results Out of 26,795 patients, median time to TURBT decreased from 37 to 27 days after the implementation of SCP. While the proportion of cT2–T4 tumors decreased slightly (22–21%, p < 0.001), this change was not stable over time and the proportions cN + and cM1 remained unchanged. In the subgroups with cT1 and cT2–4 tumors, the median time to TURBT decreased and the proportions of patients discussed at a multidisciplinary team conference (MDTC) increased after SCP. In neither of these subgroups was a change in the proportions of cN + and cM1 observed, while treatment according to guidelines increased after SCP in the cT1 group. Conclusion After the implementation of SCP, time from referral to TURBT decreased and the proportion of patients discussed at MDTC increased, although not at the levels recommended by guidelines. Thus, our findings point to the need for measures to increase adherence to SCP recommendations and to guidelines.

Perceptions on handling of opioids: focus COVID-19 : A survey among anesthesiologists via the specialist societies DGAI/BDA

HintergrundOpioide gehören zum Klinikalltag in Anästhesiologie, Intensivmedizin und Palliativmedizin. Hinsichtlich der Behandlung von Dyspnoe mit Opioiden finden sich in Leitlinien jedoch unterschiedliche Gewichtungen. Dies kann zu Unsicherheiten bezüglich Indikationsstellung und ethischer Implikationen im Umgang mit Opioiden – auch bei COVID-19 – führen.Ziel der ArbeitErfassung der Wahrnehmung bezüglich Umgang mit Morphin/Opioiden (M/O) zur Symptomkontrolle inner- und außerhalb der Palliativmedizin, auch bei COVID-19-Erkrankten.Material und MethodenMittels SurveyMonkey® (Momentive Inc., San Mateo, CA, USA) wurden Mitglieder der Deutschen Gesellschaft für Anästhesiologie (DGAI) und des Berufsverbands Deutscher Anästhesisten (BDA) im Oktober 2020 anonymisiert nach ihrer eigenen Wahrnehmung zum Umgang mit M/O zur Symptomkontrolle befragt.Ergebnisse und DiskussionVon N = 1365 teilnehmenden Anästhesist:innen beschrieben 88 % den Umgang mit M/O innerhalb der Palliativmedizin als „sicher und vertraut“ bzw. 85 % als „klar geregelt“, während dies für die Bereiche außerhalb der Palliativmedizin deutlich seltener angegeben wurde (77 %/63 %). Bei der Betreuung COVID-19-Erkrankter wurde der Umgang mit M/O außerhalb der Palliativmedizin noch seltener als „sicher und vertraut“ (40 %) oder „klar geregelt“ (29 %) wahrgenommen. Dyspnoe (95 %/75 %), Erleichterung des Sterbeprozesses (84 %/51 %), Unruhe (59 %/27 %) und Angst/Panik (61 %/33 %) wurden häufiger innerhalb als außerhalb der Palliativmedizin als allgemeine Indikationen genannt. Von den Befragten wünschten sich 85 % die Einbindung eines palliativmedizinischen Konsilteams.FazitAnästhesist:innen nahmen deutliche Unsicherheiten im Umgang mit M/O wahr, insbesondere außerhalb der Palliativmedizin. Einheitliche, interdisziplinäre Leitlinien zur Symptomkontrolle etwa bei Dyspnoe, mehr Lehre und die Einbindung eines palliativmedizinischen Konsilteams sollten zukünftig intensiver bedacht werden.

Does 18F-FDG PET/CT change the surgical management of potentially resectable colorectal liver metastases?

Resectability assessment of patients with colorectal liver metastases is based on computed tomography and liver magnetic resonance imaging. Addition of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography has been recommended, but the impact of the added information remains unclear. The primary aim of this study was to determine how preoperative positron emission tomography/computed tomography changed management in patients with potentially resectable colorectal liver metastases. The secondary aim was to investigate whether findings on positron emission tomography/computed tomography correlated to metastatic disease in cases with extended surgery and influenced oncological outcomes. A retrospective observational study of the impact of adding positron emission tomography/computed tomography to conventional imaging in the surgical decision-making of colorectal liver metastases. All patients with colorectal liver metastases diagnosed by conventional imaging were included and assessed by a multidisciplinary team conference at Umeå University Hospital between June 2013 and December 2017. Eligibility criteria were all patients with potentially resectable colorectal liver metastases. Patients who underwent preoperative positron emission tomography/computed tomography in addition to conventional radiology were compared with those who underwent conventional imaging only. 151/220 patients underwent preoperative positron emission tomography/computed tomography. Findings on positron emission tomography/computed tomography changed the management in 10.6% of the patients. Eight patients were excluded from surgery after detection by positron emission tomography/computed tomography of extrahepatic disease. Eight patients underwent more extended surgery than initially planned due to positron emission tomography/computed tomography. Five of these positron emission tomography-positive resected sites were verified by pathology as metastatic disease. No difference in overall survival was seen following surgical resection in patients with and without a preoperative positron emission tomography/computed tomography. Preoperative positron emission tomography/computed tomography resulted in a changed surgical management in 10.6% of cases in a selected cohort.

Crowning Achievements: African Arts of Dressing the Head

Crowning Achievements: African Arts of Dressing the Head

Clinical Implications of Mask Wearing for Special Populations in an Inpatient Rehabilitation Setting during COVID-19 Global Pandemic

Research ObjectivesTo describe the clinical implications of wearing a mask among special populations in inpatient rehabilitation.DesignNarrative Review.SettingInpatient rehabilitation.ParticipantsPatients undergoing acute inpatient rehabilitation.InterventionsMask wearing.Main Outcome MeasuresEffect of mask wearing on exercise outcomes, including perceived exertion, shortness of breath, and patient perception; clinical implications for the interdisciplinary team.ResultsFive trials which observed exercise outcomes after mask wearing were identified and summarized. Findings for the effect of face masks on exercise and vital signs varied due to heterogeneity of exercise protocols and outcome measures. Relevant findings show that patients who wore masks had higher ratings of perceived exertion, increased shortness of breath, and feelings of claustrophobia while wearing a face mask during exercise. Wearing masks affected physical and mental outcomes despite exercise intensity (low, moderate, or high).ConclusionsModerate-to-high intensity exercise is needed for neuroplasticity. This type of exercise may not be possible in neurological populations, who do not have normal oxygen consumption at rest or with exercise, and may be further affected by wearing masks. Clinicians should their patients' mask wearing into consideration, and change the frequency, intensity, timing and types of exercises when patients are wearing a face mask. Frequent measurement of vital signs and fatigue symptoms are critical to maintain patient safety, and adjustments should be made as necessary. Other neurological challenges to monitor include impaired cognitive function, limited communication, reduced mood, and interactions with medications. These can affect the patients' ability to accurately determine and state their perceived effort or may hinder physiological and autonomic responses. Lastly, interdisciplinary teams should communicate patient findings related to mask wearing at team conferences, huddles and include discussion for ways to increase patients' participation and how to optimize health outcomes.Author(s) DisclosuresNone.

The potential use of extended criteria donors and eligible recipients in liver transplantation for unresectable colorectal liver metastases in Central Sweden.

Unresectable colorectal liver metastases (CRLM) is a condition with poor prognosis. A recent treatment alternative improving survival in patients with unresectable CRLM, has emerged with the introduction of liver transplantation (LT), yet not uncontroversial with the current organ shortage. This study aimed to retrospectively investigate the potential of declined donors with acceptable risk as liver graft donors and patients with unresectable CRLM as potential recipients. All declined donors in central Sweden and all patients with CRLM discussed at multidisciplinary team conference at Karolinska University Hospital, January 2013-October 2018, were identified. Donors were classified according to the European Committee Guide to the quality and safety of organs for transplantation and potential recipients were evaluated by selection criteria, based on studies on the Norwegian Secondary Cancer study database. Out of 1,462 evaluated potential donors, 62 (2.7 pmp) donors were identified, corresponding to 6-18% of the utilized donor pool. Out of 1,008 included patients with CRLM, 25 (2.1 pmp) potential recipients were recognized. Eligibility for LT and left-sided colon cancer were favorable prognostic factors. Today's donor pool could increase with the use of extended criteria donors, which is sufficient and display an acceptable risk-benefit ratio for patients with unresectable CRLM. With current selection criteria a small subset of patients with unresectable CRLM are eligible recipients. This subset of patients has a better survival compared to patients ineligible for LT.

Clinically decisive (dis)agreement in multidisciplinary team assessment of esophageal squamous cell carcinoma; a prospective, national, multicenter study

Background Decisions regarding tumor staging, operability, resectability, and treatment strategy in patients with esophageal cancer are made at multidisciplinary team (MDT) conferences. We aimed to assess interobserver agreement from four national MDT conferences and whether this would have a clinical impact. Methods A total of 20 patients with esophageal cancer were included across all four upper gastrointestinal (GI) cancer centers. Fully anonymized patient data were distributed among the MDT conferences which decided on TNM category, resectability, operability, curability, and treatment strategy blinded to each other’s decisions. The interobserver agreement was expressed as both the raw observer agreement and with Krippendorff’s α values. Finally, a case-by-case evaluation was performed to determine if disagreement would have had a clinical impact. Results A total of 80 MDT evaluations were available for analysis. A moderate to near-perfect observer agreement of 79.2%, 55.8%, and 82.5% for TNM category was observed, respectively. Substantial agreement for resectability and moderate agreement for curability were found. However, an only fair agreement was observed for the operability category. The treatment strategies had a slight agreement which corresponded to disagreement having a clinical impact in 12 patients. Conclusions Esophageal cancer MDT conferences had an acceptable interobserver agreement on resectability and TM categories; however, the operability assessment had a high level of disagreement. Consequently, the agreement on treatment strategy was reduced with a potential clinical impact. In future MDT conferences, emphasis should be on prioritizing the relevant information being readily available (operability, T & M categories) to minimize the risk of disagreement in the assessments and treatment strategies, and thus, delayed or suboptimal treatment.

Diagnosing axial spondyloarthritis by multidiciplinary team conference at 3.5 years’ follow-up in a cohort of patients with disease features according to the ASAS criteria

Objectives During the past two decades, magnetic resonance imaging (MRI) has increasingly been used diagnostically in axial spondyloarthritis (axSpA), and in 2009 MRI was introduced in the Assessment of SpondyloArthritis Society (ASAS) classification criteria. In clinical practice, there is a risk of overdiagnosis if MRI findings are not related to clinical and biochemical findings. The aim of this study was to provide an estimate of the prevalence of axSpA in a cohort of clinical patients with low back pain and findings suggestive of axSpA according to ASAS through consensus diagnosis at a multi-disciplinary team (MDT) conference, and to describe the performance of the features included in the ASAS criteria. Method Consensus diagnoses of axSpA at MDT conferences were retrospectively established at 3.5 years’ follow-up in a cohort of 84 patients, initially referred with disease features according to the ASAS criteria. Patients were examined clinically regarding spondyloarthritis features, and biochemical tests and MRI of the sacroiliac joints and entire spine were performed at baseline and after a mean of 3.5 years. Results According to the MDT consensus, 25 patients (30%) of the total cohort had axSpA at follow-up; 40% of individuals who fulfilled the ASAS criteria at baseline had axSpA, and 37% at follow-up; 96% of axSpA patients according to the MDT consensus met the ASAS criteria at baseline and 92% at follow-up. Conclusion Approximately one-third of the included patients had axSpA when evaluated at the MDT conference. The ASAS criteria had low predictive value, but high sensitivity at both baseline and follow-up.

287 East? I Thought You Said Weast! The Influence of Travel on College Football Team Performance

Abstract Introduction Previous research in professional basketball and baseball has shown that traveling up to three hours westward can hamper performance due to circadian disadvantages. However, findings in the context of collegiate football are conflicting, as some prior studies have reported negative effects on scoring during either eastward or westward travel. The current study extends the literature by investigating the impact of travel on both offensive and defensive team performance within National Collegiate Athletic Association (NCAA) Division I college football. Methods Following the NCAA’s introduction of the College Football Playoff in 2014, data from 1,909 away games from 64 “Power Five” conference teams played during the 2014 to 2019 regular seasons were collected from the publicly available sports database, Sports-Reference. For the purposes of our analyses, we excluded all games played at neutral sites. We examined the effects of the direction of travel away from the college’s home city and time of game day on visiting team performance, specifically game outcomes, points scored, points allowed, completion percentages, penalties, fumbles, interceptions, and total turnovers forced and committed, controlling for both visiting and home team conference, day of game, and team rankings. Results Teams playing in the afternoon allowed significantly more points (OR = 1.05, p &amp;lt; .001) and forced more opponent turnovers than those playing in the evening (OR = 1.14, p = .05). Teams traveling eastward threw significantly more interceptions than those traveling in the same time zone (OR = 1.48, p = .004). A significant interaction between direction of travel and time of day was detected for points allowed (χ2 = 12.30, p = .02), and a marginal interaction was present for points scored (χ2 = 8.42, p = .08). Several other marginal differences were also identified for points scored, interceptions, and team turnovers (OR &amp;gt; 1.03, p &amp;lt; .10). Conclusion Findings from our study offer evidence for the influence of circadian factors on team points allowed, interceptions, and opponent turnovers forced. Specifically, travel in varying directions and the time of day when a game is played can impact team performance during away games within college football. Support (if any) None

Conversion therapy in patients with colorectal liver metastases

BackgroundThe occurrence of colorectal liver metastases (CRLM) impairs prognosis, yet long-term survival can be achieved by enabling liver resection. This study aims to describe factors associated with conversion therapy leading to liver surgery and treatment outcome. MethodsA retrospective cohort study was conducted including all patients with CRLM discussed at multidisciplinary team conference at Karolinska University Hospital, Stockholm, Sweden, from 2013 to 2018. Factors associated with conversion therapy and outcome following conversion therapy were analysed with logistic regression and survival analyses. ResultsOut of 1023 patients with CRLM, 100 patients (10%) received conversion chemotherapy, out of whom 31 patients (31%) subsequently underwent liver resection. Patients in whom conversion chemotherapy resulted in liver resection were younger (median age 61 vs. 66 years, p = .024), less likely to have a KRAS/NRAS-mutated primary tumours (25% vs. 53%, p = .039) and more likely to have received anti-EGFR agents (32% vs. 4%, p = .001) than patients progressing during conversion chemotherapy. The median OS for patients treated with conversion chemotherapy leading to liver resection was 24 months, compared to 14 months for patients progressing during conversion chemotherapy, p < .001. The OS for patients progressing during conversion chemotherapy was similar to patients given palliative chemotherapy, approximately 13 months. ConclusionConversion therapy offers a survival benefit in selected patients. Despite treatment advances, the majority of patients undergoing conversion chemotherapy never become eligible for curative treatment.

Model Fidelity and Child Well-Being in Family Team Conference: The Interaction Effect of Racial Matching and Child Race

AbstractFamily Team Conference (FTC) has been suggested as a promising practice model to effectively reduce racial disproportionality and disparities in child welfare. However, previous studies have noted ongoing challenges to promoting cultural responsiveness in FTC. This study analysed caseworkers’ survey data (n = 736) to explore the role of racial matching between caseworkers and children as an effective practice to strengthen the high fidelity of FTC associated with child well-being. The results of the extended regression model indicate that high FTC fidelity was a necessary condition to improve child well-being. However, racial matching was neither a significant factor of child well-being nor a moderator that strengthened the positive association between FTC fidelity and child well-being. Instead, a follow-up analysis showed that caseworkers’ competencies for facilitating FTC were a significant moderator to promote the positive effect of FTC fidelity on the well-being of all children regardless of their race. This paper concludes with research and practice implications to make FTC more culturally responsive to achieve its intended outcomes especially for children of colour.