Team Decision Research Articles

Developing online group art psychotherapy for children with long-term health conditions

ABSTRACT Background: Paediatric long-term physical health conditions such as juvenile idiopathic arthritis can have a significant impact on the mental health and well-being of children and their families. Arts-based therapies have been shown to have a beneficial effect for this group. Aims: The aim of the study was to develop an online group art therapy intervention for children with long-term physical health conditions. Methods: The process of developing the intervention was informed by guidelines for the development of complex interventions and comprised four key stages: (1) an expert development process, (2) formation of a stakeholder group and (3) decision-making team, (4) identification of relevant literature and use of existing theories/a theoretical model. Results: The GAIN (Group Art Therapy Intervention for communicating Needs of children with long-term conditions) was developed. GAIN comprises a treatment manual, six 90-minute online sessions for children (age 8–11 years) and six 30-minute parent-led home sessions. Conclusions: Next steps are to evaluate the GAIN in a feasibility study. Implications for practice/policy/future research: The intervention has potential to benefit children and their families; it offers a psychosocial approach for integration with medical care of paediatric long-term physical health conditions and aligns with NHS England’s focus on supported self-management of healthcare.

Knowledge and Skills Needed for Future Health Administrators: A Systematic Review.

The educational needs of future health administrators, prioritizing their needs, and developing a relationship between these needs and the needs of the community are very important to provide better responsiveness. We aimed to identify the knowledge and skills required for health care management students as future managers of the health community. In this systematic literature review, all studies conducted between 1990 and 2021 were searched in such databases as MEDLINE, Scopus, Web of Science, ProQuest Iran Medex, Magiran and Scientific Information Database (SID), and the collected data were analyzed via the thematic analysis method. Findings of this study were divided into two main categories and fourteen subcategories, including knowledge-related factors (awareness of the structure and processes in the field of health and knowledge of management science) and skill-related factors (planning, coordination, organization, leadership, control and evaluation, management of financial resources and budgeting, service management, communication and information management, human resource management, implementation of participatory and team activities, crisis management, entrepreneurship, innovation, marketing, policymaking, and decision-making). By identifying the knowledge and skills that students need, it is possible to empower them through necessary education. Therefore, by providing responsive education, developing skills, and improving capabilities, we can take an effective step to improve the quality of health system services.

Cultivating Resilience: Multiple Case Study of School Heads’ Leadership in Integrated Senior High Schools

School leaders must be resilient in order to navigate the always shifting challenges in the field of education. This study employed a qualitative multiple case study, having three (3) distinct cases aimed to explore the perspectives of the school heads on resilient leadership in integrated senior high schools of Division of Davao de Oro. There were three (3) participants and six (6) informants underwent in-depth interviews. Participants were chosen through a purposive sampling technique. Each data was analyzed through thematic analysis and cross-case analysis. Case 1’s unique characteristics were resource management and optimization, hierarchical communication and strategic delegation, and crisis management and contingency planning. Participant experiences were complex stakeholder management, innovative problem-solving, and resilience amidst bureaucratic challenges. In times of challenges, the coping mechanism was structured decision-making processes delegation and team empowerment professional support networks. The policy recommendations were promotion of interpersonal communication skills, development of community engagement strategies, and investment in staff well-being programs. Further, Case 3’s unique characteristics were the following: strategic financial management and sustainability, stakeholder engagement and partnerships, brand differentiation and market positioning. The experiences were cultivating philanthropic relationships, navigating parental expectations, and ensuring financial sustainability. The coping mechanisms were strategic partnerships and fundraising initiatives, ethical leadership and values integration, and self-care and well-being practices while the policy recommendations were introduction of ethics and values integration policies, creation of leadership succession plans, and investment in infrastructure and technology. Moreover, cross-case analysis shows each case about distinct characteristics and commonalities such as strategic vision and planning, effective communication and collaboration, and resource management and optimization. Each case has distinct experiences, the common themes were resourcefulness and creativity, and community engagement and collaboration. Their coping mechanisms were effective leadership practices and ethical leadership and well-being. Their policy recommendations were leadership development policies and data-informed policies. This suggests that resilient leadership was crucial for school heads in managing and leading integrated senior high schools, despite the challenges and circumstances they faced in their workplace. Both teachers and learners benefit from the leadership styles promoted by the school heads.

Total Knee Arthroplasty in Patients Who Have Skeletal Dysplasia: A Center’s Experience With a Mean 9-Year Follow-Up

BackgroundTotal knee arthroplasty (TKA) in patients who have skeletal dysplasia (SD) is a technically challenging surgery due to deformity, joint contracture, and associated comorbidities. Patients presenting with this condition have traditionally been treated with conservative measures, leading to poor outcomes. The aim of this study was to follow-up on patients who had SD following TKA, specifically with regards to clinical outcomes. MethodsA total of 31 knees (22 patients) with SD that had undergone TKA in our institution were included in our study. The mean follow-up from index surgery was 110.3 months (range: 20 to 291). The type of dysplasia, implant used, and clinical outcomes with patient-reported outcome measures are presented. ResultsThere were 8 patients (36.3%) who had a diagnosis of achondroplasia, followed by multiple epiphyseal dysplasia (31.8%) and spondyloepiphyseal dysplasia (22.7%). There were 14 men and 8 women who had a mean age of 51 years (range: 28 to 73). Custom implants were required in 12 cases (38.7%), custom jigs were used in 6 cases (19.4%), and robotic-assisted surgery was used in 2 (6.5%) TKAs. Hinged prostheses were used in 17 cases (54.8%), posterior-stabilized in 9 (29.0%), and cruciate-retaining implants in 5 (16.1%). There was 1 patient who sustained an intraoperative medial tibial plateau fracture treated with concomitant open reduction and internal fixation. There was 1 revision that occurred during the follow-up period with a patella resurfacing for continued anterior knee pain. Postoperatively, Oxford Knee Scores improved on average by 12.2 points. The 10-year and 20-year all-cause revision-free survival was 96.8, respectively. ConclusionsDespite the technical challenges and complexity associated with this unique patient cohort, we demonstrated excellent implant survivorship and clinical outcomes post-TKA with mid-term to long-term follow-up of more than 20 years. We recommend preoperative cross-sectional imaging for precise planning and implant templating with multidisciplinary team decision-making. Despite our results, functional outcomes remain inferior to primary arthroplasty within the general population, although we still recommend this treatment modality to appropriately counseled patients. Level of EvidenceIII.

Collaborative student-to-student communication during Team-Based Learning test-taking

ABSTRACT This study explores teams engaged in student-to-student collaborative test-taking. Participants were undergraduate students enrolled in 16-week Team-Based Learning (TBL) course who completed the Readiness Assurance Process four times throughout the semester. A mixed-methods approach incorporated the transcription of intragroup dialogue coded to measure the amount of verbal communication, nonevidence, evidence, and process dialogue to then quantitatively analyze how student ability influenced students’ collaborative test-taking interactions. Results demonstrate high-ability members’ contributions in talk time, evidence, and nonevidence to team conversation. Low-ability members’ offered similar contributions to test functionality process dialogue. Findings suggest intragroup communication plays a vital role in TBL, particularly in terms of how member ability enhances and detracts from discourse and accountability. The implications indicate that team members must feel empowered to communicate with peers to enhance team decision-making, and educators play a critical role in framing team discussions for collaborative test-taking when using TBL.

Deep Learning Models for Predicting Malignancy Risk in CT-Detected Pulmonary Nodules: A Systematic Review and Meta-analysis

BackgroundThere has been growing interest in using artificial intelligence/deep learning (DL) to help diagnose prevalent diseases earlier. In this study we sought to survey the landscape of externally validated DL-based computer-aided diagnostic (CADx) models, and assess their diagnostic performance for predicting the risk of malignancy in computed tomography (CT)-detected pulmonary nodules.MethodsAn electronic search was performed in four databases (from inception to 10 August 2023). Studies were eligible if they were peer-reviewed experimental or observational articles comparing the diagnostic performance of externally validated DL-based CADx models with models widely used in clinical practice to predict the risk of malignancy. A bivariate random-effect approach for the meta-analysis on the included studies was used.ResultsSeventeen studies were included, comprising 8553 participants and 9884 nodules. Pooled analyses showed DL-based CADx models were 11.6% more sensitive than physician judgement alone, and 14.5% more than clinical risk models alone. They had a similar pooled specificity to physician judgement alone [0.77 (95% CI 0.68–0.84) v 0.81 (95% CI 0.71–0.88)], and were 7.4% more specific than clinical risk models alone. They had superior pooled areas under the receiver operating curve (AUC), with relative pooled AUCs of 1.03 (95% CI 1.00–1.07) and 1.10 (95% CI 1.07–1.13) versus physician judgement and clinical risk models alone, respectively.ConclusionDL-based models are already used in clinical practice in certain settings for nodule management. Our results show their diagnostic performance potentially justifies wider, more routine deployment alongside experienced physician readers to help inform multidisciplinary team decision-making.

Materials inventory optimization using various forecasting techniques and purchasing quantity in packaging industry

Purpose: This paper studies the problem that occurs on material purchase quantity in price uncertainty situation. Larger buying quantity when the price at high will increase the purchase amount while smaller buying quantity could risk the inventory level. The decision on the purchase quantity of a cycle takes future price as input from price prediction output.Design/methodology/approach: This paper examines five price prediction models, Classification and Regression Tree (CART), Random Forest Regressor (RFR), Support Vector Regressor (SVR), Seasonal Autoregressive Integrated Moving Average (SARIMA) and Long Short Term Memory (LSTM) to predict four Petrochemical products, Linear Low Density Polyethylene (LLDPE), Low Density Polyethylene (LDPE), Biaxially Oriented Polypropylene (BOPP) and Cast Polypropylene (CPP) using dataset built from weekly datapoints from January 2020 to June 2023. The most performing model is validated with data from July 2023 to September 2023 where the prediction result is fed into Linear Programming Simplex method to minimize the amount of purchase by making advanced or postpone orders.Findings: Result that RFR performs higher at most products tested, while SVR performs higher in LDPE product. The fitting of RFR and SVR models prediction, as predicted price to Linear Programming that decides optimum purchase quantity, delivers a total 2.2% of purchase amount reduction compared to original purchase quantity reflecting base scenario issued by the planner.Research limitations/implications: This study does not include additional prediction factors such as freight cost and the hyperparameters tuning studies on the existing factors.Originality/value: The novelty of this paper is prediction value is followed up by an optimization model that would guide the Procurement team decisions for future anticipation because imported raw materials should be purchased ahead of time. This research will provide a scientific approach input that would counterbalance or strengthen decision making that is typically made by individuals owning years of experience. This combined approach is rarely researched and has not been done to polymer products.

Bias in team decision-making for advanced heart failure therapies: model application

ABSTRACT Bias in advanced heart failure therapy allocation results in inequitable outcomes for minoritized populations. The purpose of this study was to examine how bias is introduced during group decision-making with an interprofessional team using Breathett’s Model of Heart Failure Decision-Making. This was a secondary qualitative descriptive analysis from a study focused on bias in advanced heart failure therapy allocation. Team meetings were recorded and transcribed from four heart failure centers. Breathett’s Model was applied both deductively and inductively to transcripts (n = 12). Bias was identified during discussions about patient characteristics, clinical fragility, and prior clinical decision-making. Some patients were labeled as “good citizens” or as adherent/non-adherent while others benefited from strong advocacy from interprofessional team members. Social determinants of health also impacted therapy allocation. Interprofessional collaboration with advanced heart failure therapy allocation may be enhanced with the inclusion of patient advocates and limit of clinical decision-making using subjective data.

Polytrauma in Children.

Inadequate clinical experience still causes uncertainty in the acute diagnostic evaluation and treatment of polytrauma in children (with or without coagulopathy). This review deals with the main aspects of the acute care of severely injured children in the light of current guidelines and other relevant literature, in particular airway control, volume and coagulation management, acute diagnostic imaging, and blood coagulation studies in the shock room. This review is based on literature retrieved by a selective search in PubMed, Medline (OVIDSP), the Cochrane Central Register of Controlled Trials, and Epistemonikos covering the period January 2001 to August 2023. Review articles and the updated S2k clinical practice guideline on polytrauma management in childhood were considered. Most accidents in childhood occur at home and in the child's free time, with varying mechanisms and patterns of injury depending on age. The outcome of treatment depends largely on the presence or absence or traumatic brain injury, which affects 66% of children with polytrauma and is thus the most common type of injury in this group, and of hemorrhagic shock with or without coagulopathy. Acute care follows the ABCDE algorithms with attention to special features in children, including age-specific reference values. According to a registry study, coagulopathy and hypovolemic shock are associated with 22% and 17% mortality, respec - tively. Treatment in a pediatric trauma reference center of the trauma network is recommended. Computed tomography (CT) should be carried out in children in accordance with defined criteria (PECARN), as a team decision and with the use of age-specific low-dose CT protocols. In children as in adults, viscoelasticity-based point-of-care tests enable the prompt diagnosis of relevant coagulopathies and their treatment in consideration of age-specific target values. The administration of tranexamic acid remains controversial. 4% of polytrauma patients are children. Because children differ from adults both anatomically and physiologically, the diagnostic evaluation and management of polytrauma in children presents a special challenge. The evidence base for pediatric polytrauma management is still inadequate; current recommendations are based on consensus, in consideration of the special features of children compared to adults.

Abstract PO4-20-09: Successful outcome of locally advanced HR+HER2+ breast cancer treatment in a young female after pancreas-kidney transplantation. 3-year follow-up

Abstract Background Solid organs recipients with subsequent cancer comprise a group of patients with unmet medical needs: they lack any clinical trials or guidelines for treatment. There are only individual case reports in literature. Meanwhile their number is growing due to achievements in transplantology and improved cancer diagnosis. Case presentation А young 34-year-old female attended our center in September 2019 with a palpable mass and peau d'orange of the left breast. A core-needle biopsy of the left breast mass revealed invasive ductal carcinoma G3, estrogen receptor 7 (Allred), progesterone receptor 6 (Allred), HER-2 (3+), Ki-67 49%. Left axillary lymph node biopsy revealed metastatic breast cancer. After a complete examination the clinical stage was cT4bN1fM0, IIIB stage. The patient had a history of Type 1 diabetes mellitus since 2003 leading to multiple complications including terminal diabetic nephropathy, which required renal replacement therapy with the use of long-term hemodialysis since July 2014. The other complications consisted of severe retinopathy with corneal transplantation on the left eye in April 2013, an episode of right eye hemophthalmia in March 2016 with consequent loss of vision in the right eye, polyneuropathy, gastropathy and enteropathy. The patient underwent a simultaneous pancreas-kidney transplantation in April, 2016 and was on permanent immunosuppressive therapy with tacrolimus 8 mg daily and methylprednisolone 8 mg daily. The function of both transplants was satisfactory. This unique case was published by Pinchuk A. et al. in Transplant Proceedings, 2017 [doi: 10.1016/j.transproceed.2017.10.005]. A multidisciplinary approach was applied to tailoring treatment plan for this patient. Initially immunosuppressive therapy was modified: the patient discontinued methylprednisolone and started everolimus with simultaneous tacrolimus dose reduction (their doses adjusted according to blood concentrations). The tumor board decision was to start neoadjuvant therapy with regimen with the mildest and the most manageable toxicity profile and to avoid anthracyclines. From October to December 2019 the patient received 12 cycles of paclitaxel 80 mg/m2 day 1 weekly and 4 cycles of anti-HER2 dual blockade: trastuzumab 8 mg/kg day 1 followed by 6 mg/kg day 1 every 21 days + pertuzumab 840 mg day 1 followed by 420 mg day 1 every 21 days. Adverse events were: stomatitis grade 1, palmar-plantar erythrodysesthesia grade 1, diarrhea grade 2. Partial response was evaluated in the end of December 2019, but due to persistent skin edema, she was not a candidate for surgical treatment. The tumor board decision was to proceed with T-DM1 + pertuzumab based on the results of the KRISTINE trial [doi:10.1016/s1470-2045(17)30716-7]. From January to March 2020 the patient received 4 cycles of trastuzumab-emtansine 3,6 mg/kg day 1 every 21 days + pertuzumab 420 mg day 1 every 21 days. The patient tolerated this treatment with mild toxicity: ALT & AST increase grade 2 and diarrhea grade 2. Considering that the edema was significantly reduced, surgical treatment was planned. The patient underwent a modified radical mastectomy for left breast cancer on 14 of April 2020. The pathological stage was ypT1аN0 R0, RCB I. The patient continued trastuzumab emtansine until November 2020 (up to 1 year of anti-HER2 targeted therapy) in the adjuvant setting. In June 2020 she underwent locoregional radiation therapy. Tamoxifen with ovarian function suppression (LHRH agonists) for 5 years was started in June 2020. Fortunately, after 3 years of follow-up after surgery there is no evidence of disease and no delayed cancer treatment complications. Conclusion: Personalized multidisciplinary team decisions for cancer patients after organ transplantation are crucial to further improve the long-term outcome of these patients. Citation Format: Lyudmila Zhukova, Natalya Polshina. Successful outcome of locally advanced HR+HER2+ breast cancer treatment in a young female after pancreas-kidney transplantation. 3-year follow-up [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-20-09.

Quantitative flow ratio versus fractional flow reserve for Heart Team decision-making in multivessel disease: the randomised, multicentre DECISION QFR trial.

Vessel-level physiological data derived from pressure wire measurements are one of the important determinant factors in the optimal revascularisation strategy for patients with multivessel disease (MVD). However, these may result in complications and a prolonged procedure time. The feasibility of using the quantitative flow ratio (QFR), an angiography-derived fractional flow reserve (FFR), in Heart Team discussions to determine the optimal revascularisation strategy for patients with MVD was investigated. Two Heart Teams were randomly assigned either QFR- or FFR-based data of the included patients. They then discussed the optimal revascularisation mode (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) for each patient and made treatment recommendations. The primary endpoint of the trial was the level of agreement between the treatment recommendations of both teams as assessed using Cohen's kappa. The trial included 248 patients with MVD from 10 study sites. Cohen's kappa in the recommended revascularisation modes between the QFR and FFR approaches was 0.73 [95% confidence interval {CI} : 0.62-0.83]. As for the revascularisation planning, agreements in the target vessels for PCI and CABG were substantial for both revascularisation modes (Cohen's kappa=0.72 [95% CI: 0.66-0.78] and 0.72 [95% CI: 0.66-0.78], respectively). The team assigned to the QFR approach provided consistent recommended revascularisation modes even after being made aware of the FFR data (Cohen's kappa=0.95 [95% CI:0.90-1.00]). QFR provided feasible physiological data in Heart Team discussions to determine the optimal revascularisation strategy for MVD. The QFR and FFR approaches agreed substantially in terms of treatment recommendations.

Effects of Explanation Types on User Satisfaction and Performance in Human-agent Teams

Automated agents, with rapidly increasing capabilities and ease of deployment, will assume more key and decisive roles in our societies. We will encounter and work together with such agents in diverse domains and even in peer roles. To be trusted and for seamless coordination, these agents would be expected and required to explain their decision making, behaviors, and recommendations. We are interested in developing mechanisms that can be used by human-agent teams to maximally leverage relative strengths of human and automated reasoners. We are interested in ad hoc teams in which team members start to collaborate, often to respond to emergencies or short-term opportunities, without significant prior knowledge about each other. In this study, we use virtual ad hoc teams, consisting of a human and an agent, collaborating over a few episodes where each episode requires them to complete a set of tasks chosen from available task types. Team members are initially unaware of the capabilities of their partners for the available task types, and the agent task allocator must adapt the allocation process to maximize team performance. It is important in collaborative teams of humans and agents to establish user confidence and satisfaction, as well as to produce effective team performance. Explanations can increase user trust in agent team members and in team decisions. The focus of this paper is on analyzing how explanations of task allocation decisions can influence both user performance and the human workers’ perspective, including factors such as motivation and satisfaction. We evaluate different types of explanation, such as positive, strength-based explanations and negative, weakness-based explanations, to understand (a) how satisfaction and performance are improved when explanations are presented, and (b) how factors such as confidence, understandability, motivation, and explanatory power correlate with satisfaction and performance. We run experiments on the CHATboard platform that allows virtual collaboration over multiple episodes of task assignments, with MTurk workers. We present our analysis of the results and conclusions related to our research hypotheses.

Modeling of stakeholder influence on effectiveness of team decisions in the digital network space of crisis management centres of the EMERCOM of Russia

The article deals with issues related to modeling of stakeholder influence on effectiveness (sustainability) of teamwork in crisis management centres (hereinafter referred to as CMC) of the Ministry of the Russian Federation for Civil Defence, Emergencies and Elimination of Consequences of Natural Disasters (hereinafter referred to as EMERCOM of Russia) while analysing, forecasting development and resolving/reducing conflictness of social emergencies (hereinafter referred to as SE). The problem is considered from the perspective of using a nonlinear approach in modeling in the form of the Verhulst equation which allows to analyse complex social processes. The influence of different stakeholder groups is modeled at different values of the “a” parameter of its intensity– weak, medium, strong. The article presents the results of practical research on assessing the influence of stakeholders, primarily the external ones, on effectiveness (sustainability) of the CMC teamwork in the analysis, forecast of development, and resolution/reduction of conflictness of SE. The definition of SE is given as an attractor that has emerged due to unresolved social contradictions which have caused an imbalance in public relations. The work of the CMC teams is conducted in the digital network environment of the centres, and it introduces certain specifics into its activities. The research shows the general scheme of the stakeholder approach implementation in team management in the analysis, forecast of development and resolution/reduction of conflictness of SE. The author presents the results of the nonlinear modeling of effectiveness (sustainability) of the CMC teamwork, depending on the intensity of stakeholder influence on decisions made by the team. A system of indicators characterising the regression model of the “a” coefficient of stakeholder influence is proposed, the specific values of which can be measured during field research. Three modes (three types of attractors) of teamwork are investigated. The key objective of the study is to create prerequisites for the formation of a digital twin of the CMC teamwork of the EMERCOM of Russia in SE.

A multidisciplinary obesity registry for Iranian adults: a protocol.

Obesity is a global health challenge due to its high prevalence and increased related morbidity and mortality. Accordingly, creating a platform to enter data on patients with obesity, treatment process and outcome is mandatory. The objective of this registry is to provide such a database regarding Iranian adults with obesity in order to facilitate future research designs and effective decision making to control this condition. After obtaining informed consent from eligible individuals, a practical questionnaire will be used to gather information about basic characteristics, family history, past medical history, regular medications, dietary intakes and other relevant information of adults with obesity. This data along with the results of laboratory tests, physical examination, and anthropometric measurements will be registered into the registry system by trained members of the team during an in-person visit. Patients will undergo a specific treatment plan based on the multidisciplinary medical team's decision. Then, changeable variables and the outcomes of their treatment process will be registered later in the follow-up sessions. This registry aims to provide a comprehensive dataset on the epidemiology, outcomes and management process of obesity to serve as a foundation for later research projects and improve medical approaches toward this condition.

Healthcare team resilience during COVID-19: a qualitative study

BackgroundResilience, in the field of Resilience Engineering, has been identified as the ability to maintain the safety and the performance of healthcare systems and is aligned with the resilience potentials of anticipation, monitoring, adaptation, and learning. In early 2020, the COVID-19 pandemic challenged the resilience of US healthcare systems due to the lack of equipment, supply interruptions, and a shortage of personnel. The purpose of this qualitative research was to describe resilience in the healthcare team during the COVID-19 pandemic with the healthcare team situated as a cognizant, singular source of knowledge and defined by its collective identity, purpose, competence, and actions, versus the resilience of an individual or an organization.MethodsWe developed a descriptive model which considered the healthcare team as a unified cognizant entity within a system designed for safe patient care. This model combined elements from the Patient Systems Engineering Initiative for Patient Safety (SEIPS) and the Advanced Team Decision Making (ADTM) models. Using a qualitative descriptive design and guided by our adapted model, we conducted individual interviews with healthcare team members across the United States. Data were analyzed using thematic analysis and extracted codes were organized within the adapted model framework.ResultsFive themes were identified from the interviews with acute care professionals across the US (N = 22): teamwork in a pressure cooker, consistent with working in a high stress environment; healthcare team cohesion, applying past lessons to present challenges, congruent with transferring past skills to current situations; knowledge gaps, and altruistic behaviors, aligned with sense of duty and personal responsibility to the team. Participants’ described how their ability to adapt to their environment was negatively impacted by uncertainty, inconsistent communication of information, and emotions of anxiety, fear, frustration, and stress. Cohesion with co-workers, transferability of skills, and altruistic behavior enhanced healthcare team performance.ConclusionWorking within the extreme unprecedented circumstances of COVID-19 affected the ability of the healthcare team to anticipate and adapt to the rapidly changing environment. Both team cohesion and altruistic behavior promoted resilience. Our research contributes to a growing understanding of the importance of resilience in the healthcare team. And provides a bridge between individual and organizational resilience.

Feasibility of the interdisciplinary multimodal assessment-The team perspective

Secondary preventive outpatient diagnostic services for patients with pain and risk factors for chronification have not yet been sufficiently established. In the PAIN2020 project (Innovation Fund, 01NVF17049) an outpatient interdisciplinary multimodal assessment (IMA) was introduced for the first time early in the course of the disease. For the implementation of the IMA procedures for team cooperation and decision criteria were developed, which were implemented by ateam of medical, physiotherapeutic and psychological therapists. These procedures and decision criteria are to be discussed against the background of clinical experience and examined with respect to their feasibility (qualitative). In PAIN2020 aworkshop on IMA was held in September 2021 to jointly reflect on the findings and experiences gained in the process so far through monitoring and structuring documentation in the implementation with staff or teams of PAIN2020 centers on the feasibility of implementing astructured interdisciplinary multimodal assessment. In three work phases, occupational group-specific and cross-occupational group topics were addressed. In the decision-making processes of the occupational groups, in addition to profession-specific focal points within the framework of the assessment of findings (somatic, functional or psychosocial core criteria), overarching core criteria within the professions as well as complementary patient-related aspects are evident, which are included in the integrative team process. With respect to team collaboration, the implementation of the team meeting and the final discussion can be used to identify structural and process parameters that promote or inhibit implementation, which are also accompanied by interactional factors. For the implementation of the IMA, there were (1)adaptations of the IMA, which is currently implemented as A‑IMA in the selective agreement with BARMER and (2)new dimensions or task fields and ideas for evidence-based concepts for the content design of integrative diagnostics as well as for the feedback of the results to the patients, which should be discussed in the future.

Cardiac Surgery After Transcatheter Aortic Valve Replacement: Trends and Outcomes

BackgroundReports of cardiac operations after transcatheter aortic valve replacement (TAVR) and early TAVR explantation are increasing. The purpose of this report is to document trends and outcomes of cardiac surgery after initial TAVR. MethodsThe Society of Thoracic Surgeons Adult Cardiac Surgery Database was queried for all adult patients undergoing cardiac surgery after a previously placed TAVR between January 2012 and March 2023. This identified an overall cohort and 2 subcohorts: nonaortic valve operations and surgical aortic valve replacement (SAVR) after previous TAVR. Cohorts were examined with descriptive statistics, trend analyses, and 30-day outcomes. ResultsOf 5457 patients who were identified, 2485 (45.5%) underwent non-SAVR cardiac surgery, and 2972 (54.5%) underwent SAVR. The frequency of cardiac surgery after TAVR increased 4235.3% overall and 144.6% per year throughout the study period. The incidence of operative mortality and stroke were 15.5% and 4.5%, respectively. Existing The Society of Thoracic Surgeons risk models performed poorly, because observed-to-expected mortality ratios were significantly >1.0. Among those undergoing SAVR after TAVR, increasing preoperative surgical urgency, age, dialysis, need for SAVR, and concomitant procedures were associated with increased mortality, whereas type of TAVR explant was not. ConclusionsThe need for cardiac surgery, including redo SAVR after TAVR, is increasing rapidly. Risks are higher, and outcomes are worse than predicted. These data should closely inform heart team decisions if TAVR is considered at lowering age and risk profiles in the absence of longitudinal evidence.

20 Optimising cancer multi-disciplinary team decision-making in virtual meetings: recommendations from a national mixed-methods study in England

20 Optimising cancer multi-disciplinary team decision-making in virtual meetings: recommendations from a national mixed-methods study in England

A study of ChatGPT in facilitating Heart Team decisions on severe aortic stenosis.

Multidisciplinary Heart Teams (HTs) play a central role in the management of valvular heart diseases. However, the comprehensive evaluation of patients' data can be hindered by logistical challenges, which in turn may affect the care they receive. This study aimed to explore the ability of artificial intelligence (AI), particularly large language models (LLMs), to improve clinical decision-making and enhance the efficiency of HTs. Data from patients with severe aortic stenosis presented at HT meetings were retrospectively analysed. A standardised multiple-choice questionnaire, with 14 key variables, was processed by the OpenAI Chat Generative Pre-trained Transformer (GPT)-4. AI-generated decisions were then compared to those made by the HT. This study included 150 patients, with ChatGPT agreeing with the HT's decisions 77% of the time. The agreement rate varied depending on treatment modality: 90% for transcatheter valve implantation, 65% for surgical valve replacement, and 65% for medical treatment. The use of LLMs offers promising opportunities to improve the HT decision-making process. This study showed that ChatGPT's decisions were consistent with those of the HT in a large proportion of cases. This technology could serve as a failsafe, highlighting potential areas of discrepancy when its decisions diverge from those of the HT. Further research is necessary to solidify our understanding of how AI can be integrated to enhance the decision-making processes of HTs.

Climate services for agriculture: Steering towards inclusive innovation in Australian climate services design and delivery

CONTEXTClimate services are integral to climate change adaptation in agriculture. Inclusive innovation prioritises inclusion of marginalised actors, grassroots knowledge and accessibility of use. Yet many innovation processes are multi-stakeholder, complex and may not prioritise inclusion from the outset. In these circumstances, researchers and designers may seek to influence existing projects towards greater inclusivity. OBJECTIVESThis paper explores efforts to increase the inclusivity of existing innovation processes, focusing on the design of My Climate View, an online Australian climate services platform for agriculture. Findings relate to contemporary issues in inclusive innovation literature, including: (1) Who should be included in innovation processes (within given resourcing)?; (2) How requirements for inclusion or exclusion can emerge through the design and use of a technology; and (3) The influence of program level structures upon inclusivity and design. METHODSOur approach is informed by Responsible Innovation and Inclusive Innovation theory and enacted through user-centred design. Findings are synthesised from analysis of 60 semi-structured interviews with farmers, advisors and extension officers. We additionally draw on observations as researchers in the multi-actor My Climate View development team, where extensive engagement separate to research activities has included agricultural and Indigenous stakeholders. RESULTS AND CONCLUSIONEngaging with a broad sample of potential target users enabled diverse and sometimes unexpected use cases. Customisation of interface parameters allowed the incorporation of tacit knowledge and positively affected the inclusivity of My Climate View, extending the value of the platform to growers of niche commodities outside of the original scope. Inclusivity in innovation can be impacted by diverse factors, including design team decisions, structural factors, budget and external factors. Requirements for inclusion and exclusion can emerge and evolve throughout a design process, supporting Responsible Innovation's framing of inclusivity alongside principles of reflexivity and responsiveness. SIGNIFICANCEThe findings enrich the evidence base for climate services and broader agricultural technology development processes by providing insights for those seeking greater impact by practicing inclusivity in innovation. We provide four implications for increasing inclusivity in the design of climate services: (1) Maximising customisation and avoiding prescriptive interpretation enables greater flexibility of use; (2) Sampling broadly within target users to uncover unanticipated values and opportunities for inclusion and exclusion; (3) It is important to embed efforts towards inclusion alongside processes of reflexivity; and (4) Responsible and inclusive approaches to climate services design are valuable even if brought in once development has commenced.