Team Of Specialists Research Articles

Nonspecific therapy for Eisenmenger syndrome

Eisenmenger syndrome (ES) is systemic pulmonary hypertension with venoarterial or bidirectional shunting of blood between the ventricles, atria or great arteries due to the progression of pulmonary vascular disease in the natural course of “simple” and “complex” congenital heart defects.Patients with ES require constant attention from a multidisciplinary team of specialists. One of the main tasks is not to destabilize the fragile pathological physiology, which relies on the balance of pulmonary and peripheral vascular resistance. Surgical interventions with anesthesia, if they cannot be avoided, should be performed in specialized centers. Pregnancy is contraindicated in patients with ES. Clinical symptoms of blood hyperviscosity in ES are rare.The anachronistic practice of venesections, which leads to a decrease in the oxygen transport function of the blood, iron deficiency and an increased risk of cerebrovascular complications, should be avoided. Oral and intravenous replenishment of iron deficiency improves exercise tolerance and quality of life. Routine administration of anticoagulants for ES is not indicated. In most cases, endovascular embolization of pathological collateral arteries can eliminate hemoptysis. The use of venous access requires careful prevention of embolism. Therapeutic tactics for ES are discussed in detail in this review

#2232 Personalized kidney replacement therapy in critically ill patients: unity makes strength!

Abstract Background and Aims The complexity of the critically ill patient with kidney disease has increased in recent years. A holistic and multidisciplinary approach is, therefore, necessary in order to provide the best therapeutic guidance. Multiple modalities of kidney replacement therapies (KRT) are available in this setting, namely continuous kidney replacement therapies (CKRTs) and hybrid therapies, also such as sustained low-efficiency dialysis (SLED) and slow continuous ultrafiltration (SCUF). These techniques can be used in conjunction with other extracorporeal clearance therapies such as plasmapheresis (PF), and immunoadsorption (IA). Their prescription must be individualized according to the characteristics of each patient. In our hospital all KRT and extracorporeal techniques used are reviewed daily by a nephrologist. This study aims to describe the 20-year experience of our centre in individualized KRT prescription in intensive care. Methods A retrospective cohort, single centre study was conducted. We reviewed adult patients (age ≥18 years) admitted in all the ICUs of our hospital centre between January 2002 and December 2022, who required a KRT. We aimed to describe demographic data, different stages of kidney disease [AKI, AKI in CKD, chronic hemodialysis (HD), peritoneal dialysis (PD), kidney transplant (KT), rapidly progressive kidney failure (RPKF), other causes], the KRT used and the main outcomes. Results During the study period, 1578 patients who required a KRT were admitted to the ICU. Median age was 65 (IQR: 45-81) years old and 59.9% were male. Among these patients 715 (45.3%) had AKI, 380 (24.1%) were in HD, 315 (20%) had AKI in CKD, 130 (8.2%) had a KT and 31 (2%) were in PD. Four patients had RPKF and 3 patients had other causes for KRT, such as hyperammonemia and sodium valproate poisoning. The main KRT performed were: SLED—1365 (86.5%) patients; continuous venovenous hemodiafiltration (cvvHDF)—120 (7.6%) patients; SLED + cvvHDF—66 (4.2%). Other KRT executed were SLED + PF (11 patients), continuous venovenous hemofiltration (cvvHF) (8 patients) and SCUF (2 patients). Among all patients mortality rate was 42.3%, 33% had renal recovery and 7.4% started chronic HD. In AKI group the median age was 64 (IQR: 48-80) years and 56.3% were male. 576 (80.7%) performed SLED, 91 (12.7%) did cvvHDF and 36 (5.0%). Mortality rate was of 52.1%, renal recovery 45% and 2.9% started chronic HD. Conclusion Our ICU multidisciplinary approach model with a critical care nephrology specialists team translates into a large amount of accumulated experience with SLED. Our results are comparable to centres that predominantly use CKRTs. The range of different techniques used reflects the fact that KRT has become a complex treatment for critically ill patients, which allows for the prescription to be precisely tailored to the different daily clinical needs.

Naval Wargaming as a Requirements Elucidation Tool for Warship Design Teams

This paper discusses some of the challenges of setting the requirements for a future warship program and how manual naval wargaming might be employed to make the process more efficient and structured. It goes on to describe some case studies where UCL’s wargame “A Balanced Fleet” was applied to requirement phase problems, in particular the ASW Barrier wargame conducted for the NATO Specialist Team on Naval Ship Systems Engineering. The paper concludes that wargaming is a useful tool in the requirements phase, in particular for helping to direct subsequent and more detailed operations analysis work.

Exploring the impact of solar radiation on skin microbiome to develop improved photoprotection strategies.

The skin microbiome undergoes constant exposure to solar radiation (SR), with its effects on health well-documented. However, understanding SR's influence on host-associated skin commensals remains nascent. This review surveys existing knowledge on SR's impact on the skin microbiome and proposes innovative sun protection methods that safeguard both skin integrity and microbiome balance. A team of skin photodamage specialists conducted a comprehensive review of 122 articles sourced from PubMed and Research Gateway. Key terms included skin microbiome, photoprotection, photodamage, skin cancer, ultraviolet radiation, solar radiation, skin commensals, skin protection, and pre/probiotics. Experts offered insights into novel sun protection products designed not only to shield the skin but also to mitigate SR's effects on the skin microbiome. Existing literature on SR's influence on the skin microbiome is limited. SR exposure can alter microbiome composition, potentially leading to dysbiosis, compromised skin barrier function, and immune system activation. Current sun protection methods generally overlook microbiome considerations. Tailored sun protection products that prioritize both skin and microbiome health may offer enhanced defense against SR-induced skin conditions. By safeguarding both skin and microbiota, these specialized products could mitigate dysbiosis risks associated with SR exposure, bolstering skin defense mechanisms and reducing the likelihood of SR-mediated skin issues.

Current Trends in the Use of Machine Learning for Error Correction in Ukrainian Texts

The article's authors have provided a detailed problem description of identifying and correcting errors in Ukrainian-language texts. This paper provides a detailed analysis of the latest research and publications aimed at solving the problems of identifying and correcting errors in Ukrainian-language texts. The analysis of modern tools related to error correction in texts is presented along with a comparative description. Investigated the existing data corpora for the Ukrainian language so that they are relevant to solving GEC tasks. Discovered the need to create a large annotated data corpus, which will be prepared by a special team with linguistic expertise. Analysed the opportunities, advantages and disadvantages of modern machine learning models that interpret the task of detecting and correcting errors in texts as classification or machine translation. Introduced the need to develop a machine-learning algorithm that will take into account the specifics of morphologically complex languages, such as Ukrainian. Demonstrated the work of the modern models and provided screenshots. Revealed the need for further research in the Ukrainian segment of machine learning to solve the problems of correcting errors in texts using various methods and approaches.

THE PRACTICE OF PROVIDING PSYCHOLOGICAL ASSISTANCE AT THE UNIVERSITY OF THE THIRD AGE AND HUMANITARIAN CENTER FOR UKRAINIAN REFUGEES IN SLOVAKIA

Relevance. Universities of the third age (U3A) are institutions aimed at the post-labor socialization of the older generation, aimed at realizing the idea of "Education throughout life", which, unfortunately, have not become particularly widespread in Ukraine. All the more interesting is the experience of creating such an institution at the beginning of the war by Ukrainian specialists who ended up in Slovakia, and the generalization of the features of their interdisciplinary work on psychological support and social therapy of elderly Ukrainian refugees who are abroad. Methodology. As part of the implementation of the project "Social and psychological assistance for children and adults" on the initiative of the NGO "League of Mental Health" (Slovakia), a University of the Third Age for elderly refugees from Ukraine was established in the city of Gabchykovo. Its activity is based on interdisciplinary, person-oriented and integrative approaches and principles of trust, mutual assistance, tolerant attitude towards the elderly. Sample: 15 people aged 62 - 80 years. Methods. The Spielberger-Khanin (1976) method, conversations, individual, couple, group consultations, occupational therapy, art therapy, social and educational therapy for the elderly; intergenerational programming program for children and the elderly. The results. During the 5 months of work of the team of specialists at U3A, a favorable psychological climate was created; adaptation of the elderly to existence in a local foreign-language environment was carried out; their family conflicts were resolved; integrative classes for the elderly with children were implemented in the center for refugees, which contributed to the development of tolerance and mutual understanding between the two generations. These measures ensured a reduction in the manifestations of stress and anxiety of the study participants, and the steady development of the cognitive and creative spheres of the elderly participants of the U3A.

UK guidelines for the management of soft tissue sarcomas.

Soft tissue sarcomas (STS) are rare tumours arising in mesenchymal tissues and can occur almost anywhere in the body. Their rarity, and the heterogeneity of subtype and location, means that developing evidence-based guidelines is complicated by the limitations of the data available. This makes it more important that STS are managed by expert multidisciplinary teams, to ensure consistent and optimal treatment, recruitment to clinical trials, and the ongoing accumulation of further data and knowledge. The development of appropriate guidance, by an experienced panel referring to the evidence available, is therefore a useful foundation on which to build progress in the field. These guidelines are an update of the previous versions published in 2010 and 2016 [1, 2]. The original guidelines were drawn up by a panel of UK sarcoma specialists convened under the auspices of the British Sarcoma Group (BSG) and were intended to provide a framework for the multidisciplinary care of patients with soft tissue sarcomas. This iteration of the guidance, as well as updating the general multidisciplinary management of soft tissue sarcoma, includes specific sections relating to the management of sarcomas at defined anatomical sites: gynaecological sarcomas, retroperitoneal sarcomas, breast sarcomas, and skin sarcomas. These are generally managed collaboratively by site specific multidisciplinary teams linked to the regional sarcoma specialist team, as stipulated in the recently published sarcoma service specification [3]. In the UK, any patient with a suspected soft tissue sarcoma should be referred to a specialist regional soft tissues sarcoma service, to be managed by a specialist sarcoma multidisciplinary team. Once the diagnosis has been confirmed using appropriate imaging and a tissue biopsy, the main modality of management is usually surgical excision performed by a specialist surgeon, combined with pre- or post-operative radiotherapy for tumours at higher risk for local recurrence. Systemic anti-cancer therapy (SACT) may be utilised in cases where the histological subtype is considered more sensitive to systemic treatment. Regular follow-up is recommended to assess local control, development of metastatic disease, and any late effects of treatment.

Complicated pregnancy and perinatal outcomes in women with type 1 and type 2 diabetes mellitus

Complicated pregnancy and perinatal outcomes in women with type 1 and type 2 diabetes mellitus

A pre-post study design: evaluating the effectiveness of a new community-based integrated service model on patient outcomes

This study aimed to evaluate a new service model, Specialists Together In the Community (STIC), in terms of patient outcomes. This model integrates Flexible Assertive Community Treatment (FACT)-principles with expertise of specialized teams that offer diagnosis-related outpatient treatment. In a pre-post design, symptoms and quality of life of 930 former FACT-patients were measured repeatedly pre- and post-STIC. Regarding patients in former specialized teams, pre- and post-treatment social functioning and symptoms were measured for the pre- (n = 944) and post-STIC (n = 544) groups. Against expectation, symptoms of former FACT-patients remained stable post-STIC compared to a slight decrease pre-STIC. According to expectation, pre- and post-STIC groups had an equal symptom reduction. Unexpectedly, the post-STIC group did not improve more on social functioning than the pre-STIC group. Explorative analysis showed less treatment contacts in the post-STIC group. The highly similar patient outcomes post-STIC could be improved by monitoring process outcomes and prolonging study duration.

Patient satisfaction and sexual issues in vulvar lichen sclerosus treatment: a monocentric certified dysplasia unit survey analysis

ObjectiveVulvar lichen sclerosus (VLS) is an underestimated chronic disease. It can cause significant symptom burden and sexual dysfunction. This study aimed to evaluate patient satisfaction and current challenges in the management of VLS in a certified dysplasia unit, particularly during the COVID-19 pandemic.MethodsThis survey analyzed patients who had been diagnosed with VLS and treated at our DKG-certified dysplasia unit. The study was conducted during the COVID-19 pandemic in the Department of Gynecology and Obstetrics at the University of Aachen. The questionnaire contained 43 questions on general treatment, diagnostic delays, disease education, psychologic and sexual issues, and specific questions regarding the COVID-19 pandemic. The questionnaires were distributed between January 2021 and September 2023.ResultsThis study included 103 patients diagnosed with VLS, who were treated at our certified dysplasia unit. Overall, 48% of the patients were satisfied with the success of the therapy. Most participants reported psychologic problems (36.8%), fear of cancer (53.3%), or sexual restrictions (53.3%). Among the patients, 38% were bothered by the regular application of topical cortisone. However, 72% were willing to undergo treatment for more than 24 months. The COVID-19 outbreak in March 2020 had a significant negative impact on general VLS care from the patient’s perspective (3.83/5 before vs. 3.67/5 after; p = 0.046). There was a general request for booklets to inform and educate the patients about their disease. Furthermore, the respondents demanded a telephone hotline to answer the questions and wished for follow-up visits via e-mail to cope better with their current situation.ConclusionThis study highlights the need for more effective treatments for VLS and an increased awareness of psychologic and sexual distress. To ensure patient well-being and satisfaction, it is imperative to offer individualized care with adequate disease education in a team of specialists from various disciplines.

Determinants of the optimal selection of vascular access devices: A systematic review underpinned by the COM-B behavioural model.

Optimal selection of vascular access devices is based on multiple factors and is the first strategy to reduce vascular access device-related complications. This process is dependent on behavioural and human factors. The COM-B (Capability, Opportunity, Motivation, Behaviour) model was used as a theoretical framework to organize the findings of this systematic review. To synthesize the evidence on determinants shaping the optimal selection of vascular access devices, using the COM-B behavioural model as the theoretical framework. Systematic review of studies which explore decision-making at the time of selecting vascular access devices. The Medline, Web of Science, Scopus and EbscoHost databases were interrogated to extract manuscripts published up to 31 December 2021, in English or Spanish. Among 16 studies included in the review, 8/16 (50%) focused on physical capability, 8/16 (50%) psychological capability, 15/16 (94%) physical opportunity, 12/16 (75%) social opportunity, 1/16 (6%) reflective motivation and 0/16 (0%) automatic motivation. This distribution represents a large gap in terms of interpersonal and motivational influences and cultural and social environments. Specialist teams (teams created for the insertion or maintenance of vascular access devices) are core for the optimal selection of vascular access devices (75% physical capability, 62% psychological capability, 80% physical opportunity and 100% social opportunity). Specialist teams predominantly lead all actions undertaken towards the optimal selection of vascular access devices. These actions primarily centre on assessing opportunity and capability, often overlooking motivational influences and social environments. A more implementation-focused professional approach could decrease inequity among patients and complications associated with vascular access devices. Optimal selection of vascular access devices is the primary strategy in mitigating complications associated with these devices. There is a significant disparity between interpersonal and motivational influences and the cultural and social environments. Furthermore, specialized teams play a pivotal role in facilitating the optimal selection of vascular access devices. The study can benefit institutions concerned about vascular access devices and their complications. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. No Patient or Public Contribution. WHAT DOES THIS ARTICLE CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Optimal selection of vascular devices remains a growing yet unresolved issue with costly clinical and patient experience impact. Interventions to improve the optimal selection of vascular devices have focused on training, education, algorithms and implementation of specialist vascular teams; alas, these approaches do not seem to have substantially addressed the problem. Specialist vascular teams should evolve and pivot towards leading the implementation of quality improvement interventions, optimizing resource use and enhancing their role.

Pre- and post-procedural cardiac imaging (computed tomography and magnetic resonance imaging) in electrophysiology: a clinical consensus statement of the European Heart Rhythm Association and European Association of Cardiovascular Imaging of the European Society of Cardiology.

Imaging using cardiac computed tomography (CT) or magnetic resonance (MR) imaging has become an important option for anatomic and substrate delineation in complex atrial fibrillation (AF) and ventricular tachycardia (VT) ablation procedures. Computed tomography more common than MR has been used to detect procedure-associated complications such as oesophageal, cerebral, and vascular injury. This clinical consensus statement summarizes the current knowledge of CT and MR to facilitate electrophysiological procedures, the current value of real-time integration of imaging-derived anatomy, and substrate information during the procedure and the current role of CT and MR in diagnosing relevant procedure-related complications. Practical advice on potential advantages of one imaging modality over the other is discussed for patients with implanted cardiac rhythm devices as well as for planning, intraprocedural integration, and post-interventional management in AF and VT ablation patients. Establishing a team of electrophysiologists and cardiac imaging specialists working on specific details of imaging for complex ablation procedures is key. Cardiac magnetic resonance (CMR) can safely be performed in most patients with implanted active cardiac devices. Standard procedures for pre- and post-scanning management of the device and potential CMR-associated device malfunctions need to be in place. In VT patients, imaging-specifically MR-may help to determine scar location and mural distribution in patients with ischaemic and non-ischaemic cardiomyopathy beyond evaluating the underlying structural heart disease. Future directions in imaging may include the ability to register multiple imaging modalities and novel high-resolution modalities, but also refinements of imaging-guided ablation strategies are expected.

Relevance of Patient-Reported Outcome Measures in Patients with Cancer: Detection of Underrated Psychological Distress of Palliative Care Patients in an Outpatient Setting.

The overall level of physical and psychological symptom burden of advanced cancer patients (ACP) in an outpatient setting is notoriously difficult to assess. Therefore, more efficient and objective assessment is needed to accomplish this important task. The aim of this study was to compare the physical and psychological symptom burden rated by palliative care nurse (PCN) versus patient's self-rating. This retrospective German cohort study analyzed symptom burden using an electronic patient-reported outcome measure (ePROM). After referral to an outpatient specialized palliative care team, a PCN assessed the patient's symptoms both up to three months before initial presentation (IP) and at IP.Group differences were identified using analyses of variance (ANOVA). Further descriptive analysis of patient characteristics was used. The study enrolled 164 ACP who were referred to a specialized palliative care (SPC) team. Mean age was 62 (± 12.6) years. Gastrointestinal (n = 46; 28.0%), lung (n = 32; 19.5%), and breast cancer (n = 34; 20.7%) were the most common entities. Most frequent reasons for referral were pain (n = 55; 33.5%) and social care problems (n = 36; 22.0%). Patients reported significantly higher grades on depression (n = 144; Z = -2.8, p = 0.005), anxiety (n = 144; Z = -2.376, p = 0.018), and worsened general condition (n = 139; Z = -7.005, p < 0.001). ACP in an outpatient setting were more frequently referred to SPC for pain management and assistance with social problems with regard to the cancer and its limitations. Psychological distress was underrated by the PCN in comparison with patient self-reporting through ePROM. This underlines the importance of self-reported outcome measurement.

Multidisciplinary proactive e-consults to improve guideline-directed medical therapies for patients with diabetes and chronic kidney disease: an implementation study

IntroductionWe hypothesized that multidisciplinary, proactive electronic consultation (MPE) could overcome barriers to prescribing guideline-directed medical therapies (GDMTs) for patients with type 2 diabetes (T2D) and chronic kidney disease (CKD).Research design...

METABOLIC SYNDROME IN PEDIATRIC PRACTICE: DEFINITION, DIAGNOSTIC CRITERIA AND PRINCIPLES OF PATIENT MANAGEMENT (OVERVIEW)

The article comprehensively reviews epidemiological indicators, risk factors, pathophysiological mechanisms, diagnostic criteria, and contemporary management principles of metabolic syndrome in pediatric practice. The study relies on the extensive analysis of literature sources retrieved from electronic databases such as PubMed, UpToDate, Web of Science, ScienceDirect, Scopus, MedLine, and Elsevier. The literature review highlights the escalating prevalence of metabolic syndrome as an urgent medical and social concern among children and adolescents, primarily attributed to the global epidemic of childhood obesity. The article not only outlines key findings but also presents recommendations from international medical societies concerning screening strategies, diagnostics, and therapeutic approaches for the individual components contributing to metabolic syndrome in childhood. The review also focuses on pivotal studies exploring alternative therapies targeting the principal pathogenic factors of the disease. In conclusion, the authors emphasize the pressing issue of the absence of standardized criteria for diagnosing metabolic syndrome in children, highlighting the imperative role of a multidisciplinary team of specialists in the effective management of this pathology in pediatric practice.

Experiments as Code and its application to VR studies in human-building interaction

Experiments as Code (ExaC) is a concept for reproducible, auditable, debuggable, reusable, & scalable experiments. Experiments are a crucial tool to understand Human-Building Interactions (HBI) and build a coherent theory around it. However, a common concern for experiments is their auditability and reproducibility. Experiments are usually designed, provisioned, managed, and analyzed by diverse teams of specialists (e.g., researchers, technicians, engineers) and may require many resources (e.g., cloud infrastructure, specialized equipment). Although researchers strive to document experiments accurately, this process is often lacking. Consequently, it is difficult to reproduce these experiments. Moreover, when it is necessary to create a similar experiment, the “wheel is very often reinvented”. It appears easier to start from scratch than trying to reuse existing work. Thus valuable embedded best practices and previous experiences are lost. In behavioral studies, such as in HBI, this has contributed to the reproducibility crisis. To tackle these challenges, we propose the ExaC paradigm, which not only documents the whole experiment, but additionally provides the automation code to provision, deploy, manage, and analyze the experiment. To this end, we define the ExaC concept, provide a taxonomy for the components of a practical implementation, and provide a proof of concept with an HBI desktop VR experiment that demonstrates the benefits of its “as code” representation, that is, reproducibility, auditability, debuggability, reusability, & scalability.

Abordaje global del paciente con pie diabético: Una revisión

Diabetic foot is one of the most prevalent and severe complications that can develop in patients with diabetes mellitus, presenting numerous clinical challenges due to the complexity of the lesions and the multiple associated comorbidities. Effective resolution of this condition requires coordinated participation from a multidisciplinary team of specialists, including endocrinologists, surgeons, orthopedists, and specialized nurses. The objective of this paper is to present the "System for the Evaluation and Treatment of Diabetic Foot" as an integral and user-friendly tool that facilitates the management of diabetic foot in various clinical settings, including primary care, hospitals, and emergency services. This system standardizes evaluation and treatment, enhances communication among professionals, and has demonstrated, over more than 20 years, a significant reduction in the number of amputations and an improvement in clinical outcomes for patients.

Contextual barriers and enablers to establishing an addiction-focused consultation team for hospitalized adults with opioid use disorder

BackgroundHospitalization presents an opportunity to begin people with opioid use disorder (OUD) on medications for opioid use disorder (MOUD) and link them to care after discharge; regrettably, people admitted to the hospital with an underlying OUD typically do not receive MOUD and are not connected with subsequent treatment for their condition. To address this gap, we launched a multi-site randomized controlled trial to test the effectiveness of a hospital-based addiction consultation team (the Substance Use Treatment and Recovery Team (START)) consisting of an addiction medicine specialist and care manager team that provide collaborative care and a specified intervention to people with OUD during the inpatient stay. Successful implementation of new practices can be impacted by organizational context, though no previous studies have examined context prior to implementation of addiction consultation services (ACS). This study assessed pre-implementation context for implementing a specialized ACS and tailoring it accordingly.MethodsWe conducted semi-structured interviews with hospital administrators, physicians, physician assistants, nurses, and social workers at the three study sites between April and August 2021 before the launch of the pragmatic trial. Using an analytical framework based on the Consolidated Framework for Implementation Research, we completed a thematic analysis of interview data to understand potential barriers or enablers and perceptions about acceptability and feasibility.ResultsWe interviewed 28 participants across three sites. The following themes emerged across sites: (1) START is an urgently needed model for people with OUD; (2) Intervention adaptations are recommended to meet local and cultural needs; (3) Linking people with OUD to community clinicians is a highly needed component of START; (4) It is important to engage stakeholders across departments and roles throughout implementation. Across sites, participants generally saw a need for change from usual care to support people with OUD, and thought the START was acceptable and feasible to implement. Differences among sites included tailoring the START to support the needs of varying patient populations and different perceptions of the prevalence of OUD.ConclusionsHospitals planning to implement an ACS in the inpatient setting may wish to engage in a systematic pre-implementation contextual assessment using a similar framework to understand and address potential barriers and contextual factors that may impact implementation. Pre-implementation work can help ensure the ACS and other new practices fit within each unique hospital context.

The Landsteiner lung cancer research platform (LALUCA) : Objectives, methodology and implementation of areal-world clinical lung cancer registry.

Lung cancer is amajor health burden in Austria; however, limited real-world data exist on the diagnostic and treatment reality of lung cancer patients in Austria. The collection of high-quality data in aclinical setting is needed to gain insights into the real-world diagnostic and therapeutic management of lung cancer patients. The Karl Landsteiner Institute for Lung Research and Pulmonary Oncology implemented the Landsteiner lung cancer research platform (LALUCA), recruiting unselected lung cancer patients from two high volume centers in Vienna. This article describes the objectives, design, methodology of the registry and the process of implementation. Amultidisciplinary team of lung cancer specialists created acustom designed variable catalogue for the LALUCA platform consisting of 17categories with 180 variables. Detailed information on clinical characteristics, diagnostic interventions, molecular pathology as well as curative and palliative treatment modalities are collected. During an implementation phase in 2020, the platform was optimized using the data of 50patients. Since then atotal of 1200 patients have been enrolled. Recruitment for the registry is ongoing with arecruitment rate of approximately 400 patients per year. The LALUCA registry is aweb-based platform for the collection of real-world clinical data of lung cancer patients. Combining alarge number of patients with afocus on gathering comprehensive data on diagnosis and treatment, the LALUCA registry provides atool for investigation, evaluation, and improvement of the clinical management, survival and quality of care of Austrian lung cancer patients.

“STEPS”: A Simulation Tool to Enhance Psychological Safety

BackgroundCreating and maintaining a psychologically safe and welcoming environment is an essential element in simulation-based teaching. The purpose of this project was to describe a novel tool the authors developed to visually enhance psychological safety. Using constructs related to psychological safety, the tool was designed and named “Simulation Tool to Enhance Psychological Safety” (STEPS). MethodsSTEPS was designed by a core team of simulation education specialists and then evaluated by a convenience sample of prelicensure (n = 5) and advanced practice (n = 3) nursing simulation educator experts. Using open-ended responses, thes reviewers gave feedback and suggestions for improvement. ResultsFindings revealed that STEPS was positively evaluated as a visual aid to promote psychological safety. Reviewers offered suggestions for improving design features such as making it more inclusive of other disciplines and adding inspirational quotes. The reviewers unanimously agreed that STEPS would be a successful adjunct for promoting psychological safety in simulation. ConclusionsSTEPS is an innovative visual aid to promote a psychologically safe learning environment. We plan to use the tool in simulations across nursing programs.