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Abstract Background Postpartum Anxiety [PPA] is a prevalent problem in society, posing a significant burden to women, infant health, and the National Health Service [NHS]. Despite this, it is poorly detected by current maternal mental health practices. Due to the current lack of appropriate psychometric measures, insufficiency in training of healthcare professionals, fragmentation of maternal mental healthcare policy and practice, and the magnitude of the effects of PPA on women and their infants, PPA is a critical research priority. This research aims to develop a clear understanding from key stakeholders, of the current landscape of maternal mental health and gain consensus of the needs associated with clinically identifying, measuring, and targeting intervention for women with PPA, in the NHS. Methods Four focus groups were conducted with a total of 21 participants, via Zoom. Data were analysed using Template Analysis. Results Analysis rendered four main themes: (1) Defining Postpartum Anxiety; (2) Postpartum Anxiety in Relation to other Mental Health Disorders; (3) Challenges to Measurement and Identification of Maternal Mental Health; and (4) An Ideal Measure of Postpartum Anxiety. Conclusions Findings can begin to inform maternal mental healthcare policy as to how to better identify and measure PPA, through the implementation of a postpartum-specific measure within practice, better training and resources for staff, and improved interprofessional communication.

Objective To identify the characteristics of nutritional problems in patients with Parkinsonism who participated in multi-disciplinary team (MDT) and to investigate the correlation between nutritional status and dysphagia in these patients. The predictive value of video fluoroscopic swallowing study (VFSS) and EAT-10 scale for malnutrition was compared. Methods Subjects were patients with Parkinsonism participated in joint MDT consultation project in Peking Union Medical College Hospital from November 2020 to January 2023. Subjective and objective dysphagia were evaluated by EAT-10 scale score and VFSS dysphagia score. Nutritional status of the patients was evaluated by geriatric nutrition risk index (GNRI), albumin, prealbumin, serum folic acid, vitamin B12 and temporal muscle thickness. Results A total of 30 participants met the criteria and were included in the study. The age was 45-82 (66.1±9.0) years old. Six (20%) were at risk of malnutrition shown b a comprehensive nutritional status assessment using GNRI. The areas under receiver operating characteristic(ROC) curves(AUC) of VFSS dysphagia score and EAT-10 score to predict malnutrition were 0.781 (0.568-0.995) and 0.927 (0.827-1.000), respectively. EAT-10 score was correlated with GNRI(r=-0.524, P＜0.01), BMI(r=-0.618, P＜0.001), prealbumin (r=-0.616, P＜0.001). The VFSS dysphagia score was only correlated with BMI (r=-0.446, P＜0.05) and prealbumin(r=-0.387, P＜0.05). Conclusions Patients with Parkinsonism requiring MDT often have multiple micronutrient imbalance. Patients′ subjective perception of dysphagia has a greater impact on their nutritional status than objective assessment of dysphagia.

Objective: To study the effect of a multi-disciplinary team (MDT) integrated management combined with all-media health education intervention on patients with coronary heart disease (CHD) and diabetes mellitus (DM). Methods: Fasting plasma glucose (FPG), systolic blood pressure (SBP), and total cholesterol (TC) were evaluated before and after the intervention. The general self-efficacy scale (GSES) was utilized to assess the self-efficacy. Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to evaluate depression and anxiety. The Seattle Angina Questionnaire (SAQ), a CHD-specific functional status and quality of life self-measurement tool, was employed to evaluate the quality of life. Results: After the intervention, the levels of FPG, systolic blood pressure, SAS, SDS, and TC in the three groups all decreased (C>B>A,P<0.05). After the intervention, the self-efficacy scores of all three groups were improved (A>B>C, P < 0.05). After the intervention, the score of quality of life in group A and group B was higher than that in group C, and the score in group A was higher than that in group B (P<0.05). Conclusion: MDT integrated management combined with all-media health education intervention can effectively ameliorate blood glucose, blood pressure, and blood lipids of patients with CHD and DM, promote their healthy life, improve their self-efficacy, and improve their negative emotions and quality of life. [ABSTRACT FROM AUTHOR]

Aims/Background A multidisciplinary team (MDT) approach is a nurse-led pain management method that involves collaboration with staff from other departments. The purpose of this paper was to discuss the construction and application effect of a pain care ward in orthopedics utilizing the MDT approach. Methods A retrospective analysis of case data was conducted, selecting 90 patients with hip joint fractures who underwent hip replacement arthroplasty (HRA) at our hospital between February 2021 and February 2024. The patients were divided into two groups based on the nursing methods: a control group (n = 43), which received a conventional analgesic management program, and an intervention group (n = 47), which received the same conventional analgesic management program along with the implementation of an orthopedic pain care ward under the MDT approach. The study compared the pain knowledge and attitudes of the responsible nurses in both groups through questionnaires. Additionally, the accuracy of pain assessments and the awareness rates of patients' pain-related health education were evaluated and compared between the two groups. Furthermore, the effectiveness of pain intervention, range of motion (ROM), and Hospital for Special Surgery (HSS) scores before and after the intervention were analyzed. The incidence of complications and overall nursing satisfaction were also compared between the two groups. Results The general knowledge, pain assessment, drug analgesia, comprehensive application, and total scores of nurses in the intervention group were significantly higher than those in the control group (p < 0.05). The accuracy rate of nurses' pain assessments and the awareness rate of patients' pain health education in the intervention group were 91.49% and 93.62%, respectively, both significantly higher than the 72.09% and 79.07% observed in the control group (p < 0.05). The total effective rate of pain intervention in the intervention group was 74.47%, significantly higher than the 53.49% in the control group (p < 0.05). After the intervention, both the ROM and HSS scores in the intervention group were significantly higher than those in the control group (p < 0.05). The overall incidence of complications in the intervention group was 6.38%, significantly lower than the 20.93% in the control group (p < 0.05). Finally, the total satisfaction rate with nursing care in the intervention group was 91.49%, significantly higher than the 74.42% in the control group (p < 0.05). Conclusion The construction and application of an MDT pain care ward can effectively enhance the accuracy of nurses' pain assessments, increase patients' awareness of pain-related health education, and improve the efficiency of pain interventions. Additionally, it can lead to better joint mobility and improved hip function, promoting the sustainable development of the pain care ward. These improvements contribute to higher patient satisfaction and enrich the quality of nursing services. [ABSTRACT FROM AUTHOR]

Background: Postpartum Anxiety [PPA] is a prevalent problem in society, posing a significant burden to women, infant health, and the National Health Service [NHS]. Despite this, it is poorly detected by current maternal mental health practices. Due to the current lack of appropriate psychometric measures, insufficiency in training of healthcare professionals, fragmentation of maternal mental healthcare policy and practice, and the magnitude of the effects of PPA on women and their infants, PPA is a critical research priority. This research aims to develop a clear understanding from key stakeholders, of the current landscape of maternal mental health and gain consensus of the needs associated with clinically identifying, measuring, and targeting intervention for women with PPA, in the NHS. Methods: Four focus groups were conducted with a total of 21 participants, via Zoom. Data were analysed using Template Analysis. Results: Analysis rendered four main themes: (1) Defining Postpartum Anxiety; (2) Postpartum Anxiety in Relation to other Mental Health Disorders; (3) Challenges to Measurement and Identification of Maternal Mental Health; and (4) An Ideal Measure of Postpartum Anxiety. Conclusions: Findings can begin to inform maternal mental healthcare policy as to how to better identify and measure PPA, through the implementation of a postpartum-specific measure within practice, better training and resources for staff, and improved interprofessional communication. [ABSTRACT FROM AUTHOR]

Summary: Bariatric surgery is an effective treatment for severe obesity, affording significant improvements in weight loss and health‐related quality of life. However, bariatric surgeons' views on whether certain pre‐operative factors predict improvements in post‐operative health‐related quality of life, and if so, which ones, are largely unknown. This cross‐sectional survey study examined the views of 58 bariatric surgeons from Australia and New Zealand. A total of 18 factors were selected for exploration based on their mention in the literature. Participants rated the extent to which they thought these pre‐operative factors would improve post‐operative health‐related quality of life. Responses showed that bariatric surgeons held diverse perspectives and revealed a lack of consensus regarding "predictive" factors. Generally, respondents agreed that better than average health literacy, higher socioeconomic status, good physical and psychological health, and positive social support were predictors of improved health‐related quality of life following surgery. However, poor eating behaviours, smoking, and the use of alcohol or other substances were deemed negative predictors. Interestingly, aside from higher socioeconomic status, good psychological health, and positive social support, none of the aforementioned views aligned with existing literature. This study offers an initial insight into bariatric surgeons' views on the influence of different pre‐operative factors on post‐operative health‐related quality of life. The array of views identified suggests that there may be an opportunity for medical education, but the findings warrant caution due to the sample size. Replication with a larger survey may be useful, especially as predicted health‐related quality of life outcomes could guide decisions regarding surgical (non)progression. [ABSTRACT FROM AUTHOR]

The aim of this study was to survey Chinese sport scientists to develop an understanding of their demographics, job characteristics, future career intentions, and opinions. This study adapted online survey and used convenience sampling to investigate the role of sport scientists across China. Ninety-seven practitioners across 18 provinces/municipalities participated in this study. Participants were typically married (70%), male (71%), aged between 30 and 39 (52%), and held a master's degree (66%). Most participants were employed full time (90%) by sport science institutes (66%), with a wide salary range, long working hours (≈48 hours per week), and irregular working time (40%). Most participants remained at the same institute (85%) throughout their careers. The most frequent reason why sport scientists remained in their current position was " job enjoyment " (4.04/5). The most frequently reported issue encountered by participants was " opinion differences with sport coaches " (21%). The ability to "gain trust" and "communication" were deemed important in the role of a sport scientist. Approximately half (44%) of the participants were satisfied with their current position and employer, while others wanted promotion (34%) or to leave their role (11%). The results revealed that (1) China's sport scientists are engaged in their current job mainly due to their enthusiasm, (2) their jobs are stable but highly demanding and relatively low paid. Poor working conditions and low retention are evident across Chinese sport scientist roles. Governing bodies should make efforts to improve the work conditions to improve the sustainability of sport scientist roles in the Chinese sport industry. [ABSTRACT FROM AUTHOR]

An Intensive Care Medicine (ICM) rotation provides fantastic learning opportunities for doctors of all specialties. Understanding your role in this highly specialised field will assist you in gaining maximal benefit from your time in ICM while ensuring the best outcomes for your patients. It can be quite daunting reviewing deteriorating patients and admitting patients to the Intensive Care Unit (ICU). This article provides tips and advice for doctors new to the specialty, and will be a useful guide for medical, surgical, and emergency medicine trainees before they begin working in the ICU for the first time. We provide a structured, systematic framework which can be used comprehensively to assess ICU patients. [ABSTRACT FROM AUTHOR]

Simple Summary: Horse owners have a responsibility to safeguard their horse's welfare and are often assisted in this role by various equestrian professionals forming a multi-disciplinary team (MDT). Saddle fit is a complex issue, and the advice given to horse owners by equestrian professionals on matters associated with saddle fit can be influential in achieving optimal saddle fit. This study investigated how equestrian professionals assess, manage, and act upon saddle fit. Participants (n = 483) completed an online questionnaire, which was split into three major sections: (1) participant demographics; (2) saddle fit for the horse; and (3) saddle fit for the rider. Differences in experience and practice between professional groups were analysed. From the UK, 184 saddle fitters, 77 therapists, and 116 coaches completed the survey (n = 377). Significant differences existed between saddle fitters, therapists, and coaches with respect to the number of years qualified, the number of horses seen per week, the frequency with which they ask clients when they last had their saddle fitted, how they themselves assess saddle fit, and the most frequent saddle fit issues encountered. The findings provide insight into MDT working and the interactions of equestrian professionals on matters associated with saddle fit. The horse owner and the multi-disciplinary team (MDT) are responsible for safeguarding horse welfare by ensuring the equipment being used is correctly fitted. The aim of this study was to investigate how saddle fit is assessed, managed, and acted upon by equestrian professionals. Participants (n = 483) completed an online questionnaire, which was split into three major sections: (1) participant demographics; (2) saddle fit for the horse; and (3) saddle fit for the rider. Descriptive statistics, Kruskal–Wallis, and univariable and multivariable analyses were performed (p < 0.05). Inductive content analysis identified themes from open-question responses. From the UK responses (n = 377), 184 saddle fitters, 77 therapists, and 116 coaches completed the survey. Compared to coaches, saddle fitters and therapists asked more frequently when their clients last had their saddle fitted (p = 0.0004). Saddle fitters typically assessed the saddle statically and dynamically vs. therapists, where it was dependent on the circumstances of the assessment (p = 0.0004). Saddle fitters experienced the saddle being out of balance more than therapists (p = 0.032) and made more alterations to the saddle than therapists and coaches (p = 0.0004). This study highlights opportunities for professions within the MDT to better support each other and horseowners to achieve improvements in overall fit for horses and riders. [ABSTRACT FROM AUTHOR]

Copyright of Basic & Clinical Medicine is the property of Editorial Office of Basic & Clinical Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Individuals facing socioeconomic hardship experience higher than average rates of chronic disease, such as diabetes, with less access to evidence-based treatment. One solution to address these inequities is a team-based care (TBC) model, defined as one in which at least two providers work collaboratively with a patient and their caregiver(s) to make healthcare decisions. This paper seeks to describe the implementation of a TBC model within a safety-net healthcare setting and determine the extent to which it can be an effective, patient-centered approach to treating individuals with diabetes. Methods Semi-structured interviews were conducted with staff (n = 15) and patients (n = 18). Clinical data were extracted from the electronic medical record of patients (n = 1,599) seen at a safety-net health system in Chicago, Illinois, United States. The mixed methods study was guided by implementation science and participatory research principles. Staff interviews were 60 min and covered patient care activities, work flow, perceived patient experience, and facilitators/barriers to care coordination. Patient interviews were 60 min and covered satisfaction, attitudes about diabetes management, quality of life, and technology. Patient interviews were co-analyzed by research staff and members of a patient advisory committee. Clinical data were collected at an index visit, two years prior and at one-year follow up (n = 1,599). Results Four themes emerged from the interviews: (1) patients perceived the TBC model to be patient centered and of high quality; (2) technology can be an innovative tool, but barriers exist; (3) diabetes management is a complex process; and (4) staff communication enhances care coordination, but misinterpreting roles reduces care coordination. From pre-enrollment to the follow-up period, we found a statistically significant increase in missed visits, decrease in hemoglobin A1c (HbA1c), decrease in body mass index, and decrease in the percent of patients with high blood pressure. We found that each medical visit during the follow-up period was associated with an HbA1c decrease of 0.26 points. Conclusions A TBC model is a patient-centered approach to providing care to patients with complex health needs, such as diabetes, patients were satisfied with the care they were receiving, and the model was associated with an improvement in clinical outcomes.

The emergency department and hospital provide a unique and important opportunity to identify elder mistreatment and offer intervention. To help manage these complex cases, multi-disciplinary response teams have been launched. In developing these teams, it quickly became clear that social workers play a critical role in responding to elder mistreatment. Their unique skillset allows them to establish close connections with community resources, collaborate with various hospital stakeholders, support patients/families/caregivers through challenging situations, navigate the legal and protective systems, and balance patient safety and quality of life in disposition decision-making. The role of the social worker on these multi-faceted teams includes conducting a comprehensive biopsychosocial assessment, helping to develop a safe discharge plan, and making appropriate referrals, among other responsibilities. Any institution considering developing a multi-disciplinary program should recognize the critical importance of social work. [ABSTRACT FROM AUTHOR]

Interdisciplinary Emergency Department/hospital-based teams represent a promising care model to improve identification of and intervention for elder mistreatment. Two institutions, Weill Cornell Medicine/NewYork-Presbyterian Hospital and the University of Colorado Anschutz Medical Campus have launched such programs and are exploring multiple strategies for effective dissemination. These strategies include: (1) program evaluation research, (2) framing as a new model of geriatric care, (3) understanding the existing incentives of health systems, EDs, and hospitals to align with them, (4) connecting to ongoing ED/hospital initiatives, (5) identifying and collaborating with communities with strong elder mistreatment response that want to integrate the ED/hospital, (6) developing and making easily accessible high-quality, comprehensive protocols and training materials, (7) offering technical assistance and support, (8) communications outreach to raise awareness, and (9) using an existing framework to inform implementation in new hospitals and health systems. [ABSTRACT FROM AUTHOR]

Strength and conditioning (S&C) interventions for golfers consistently demonstrate improvements in performance metrics such as clubhead speed. Golfers typically employ Professional Golfers' Association (PGA) coaches to support technical and tactical development. These coaches need to ensure golfers balance S&C training alongside competitions and technical golf practise, although no empirical data exist that demonstrates how this integration occurs practically. This study aimed to investigate the perceptions and practises of PGA Professional golf coaches and how S&C is integrated into the golf year. Forty-three (male = 35; female = 8) PGA coaches completed a mixed-methods survey with questions on themes such as coaching approach, perceptions of S&C, annual planning and goal setting. Results show that formal planning processes are highly variable or absent. The majority (n = 29; 70.7%) of PGA coaches stated they worked with an S&C coach and see the role of the S&C coach to support golfers with their input. However, when planning the season, 63.4% (n = 26) of coaches do so without input from the S&C coach. These and other related disconnects between desire for S&C intervention and inclusion of the S&C coach in planning processes were evident throughout survey responses. There may be subsequent risks of conflict or misunderstanding between PGA coach, S&C coach and golfer. It is recommended golf coaches, golfers and S&C coaches work collaboratively as a multidisciplinary support team to ensure coordinated golfer support is obtained. [ABSTRACT FROM AUTHOR]

Introduction: There is a growing interest in personalized decision-making in oncology. According to the Integrated Oncological Decision-Making Model (IODM), decisions should be based on information from three domains: (1) medical technical information, (2) patients' general health status and (3) patients' preferences and goals. Little is known about what kind of tool/strategy is used to collect the information, by whom this is collected (nurse, clinician) when this is collected (moment in the care pathway), and how this information should be collected and integrated within decision-making in oncological care pathways, and what its impact is. Methods: We searched PUBMED, Embase and Web of Science in October 2023 for studies looking at tools to collect and integrate information from the three domains of the IODM. We extracted data on the content and implementation of these tools, and on decision and patient outcomes. Results: The search yielded 2576 publications, of which only seven studies described collection of information from all three domains (inclusion criteria). In the seven included studies, information on the three domains was collected through dialogue, questionnaires, and assessments (what) by a nurse (2 out of 7 studies) or by other members of the Multi-Disciplinary Team (by whom) (5 out of 7 studies). Members of the Multi-Disciplinary Team subsequently integrated the information (5 out 7 studies) during their meeting (when), with patients and family attending this meeting in 2 studies (how). In terms of decision outcomes, 5 out of 7 studies compared the treatment recommendations before and after implementation of the tools, showing a modification of the treatment plan in 3% to 53% of cases. The limited data on patient outcomes suggest positive effects on well-being and fewer complications (3 out of 7 studies). Conclusion: The seven studies identified that integrated information from the three IODM domains into treatment decision-making lacked comprehensive information regarding the strategies, process, timing and individuals involved in implementing the tools. Nevertheless, the few studies that looked at patient outcomes showed promising findings. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Society & Social Work is the property of Journal of Society and Social Work and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Individuals facing socioeconomic hardship experience higher than average rates of chronic disease, such as diabetes, with less access to evidence-based treatment. One solution to address these inequities is a team-based care (TBC) model, defined as one in which at least two providers work collaboratively with a patient and their caregiver(s) to make healthcare decisions. This paper seeks to describe the implementation of a TBC model within a safety-net healthcare setting and determine the extent to which it can be an effective, patient-centered approach to treating individuals with diabetes. Methods: Semi-structured interviews were conducted with staff (n = 15) and patients (n = 18). Clinical data were extracted from the electronic medical record of patients (n = 1,599) seen at a safety-net health system in Chicago, Illinois, United States. The mixed methods study was guided by implementation science and participatory research principles. Staff interviews were 60 min and covered patient care activities, work flow, perceived patient experience, and facilitators/barriers to care coordination. Patient interviews were 60 min and covered satisfaction, attitudes about diabetes management, quality of life, and technology. Patient interviews were co-analyzed by research staff and members of a patient advisory committee. Clinical data were collected at an index visit, two years prior and at one-year follow up (n = 1,599). Results: Four themes emerged from the interviews: (1) patients perceived the TBC model to be patient centered and of high quality; (2) technology can be an innovative tool, but barriers exist; (3) diabetes management is a complex process; and (4) staff communication enhances care coordination, but misinterpreting roles reduces care coordination. From pre-enrollment to the follow-up period, we found a statistically significant increase in missed visits, decrease in hemoglobin A1c (HbA1c), decrease in body mass index, and decrease in the percent of patients with high blood pressure. We found that each medical visit during the follow-up period was associated with an HbA1c decrease of 0.26 points. Conclusions: A TBC model is a patient-centered approach to providing care to patients with complex health needs, such as diabetes, patients were satisfied with the care they were receiving, and the model was associated with an improvement in clinical outcomes. [ABSTRACT FROM AUTHOR]

Abdulmajeed Alshowair,1 Saleh Altamimi,1 Faisal A Alruhaimi,1 Saad Alshahrani,2 Fatima Alsuwailem,3 Mona Alkhaldi,4 Haiam Abdalla,5 Fahad Hamad Alkhuraiji,6 Montaser Saad Alaqeel,6 Salman Sulaiman Almureef,7 Salman Alhawasy,8 Amro Abdel-Azeem3,9 1Community Health Excellence, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 2Academic and Training Affairs, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 3Population Health Management and Research, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 4Health Administration Office, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 5Model of Care, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 6Financial Affairs, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 7Cost Department, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 8Reporting Department, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia; 9Department of Community, Environmental and Occupational Medicine, Faculty of Medicine Zagazig University, Zagazig, EgyptCorrespondence: Amro Abdel-Azeem, Population Health Management and Research, Riyadh First Health Cluster Ministry of Health, Riyadh, Saudi Arabia, Tel +966547135224, Email dr_amro_osh@hotmail.comPurpose: This study aims to predict the expected cost savings associated with implementing a multidisciplinary team (MDT) approach to reduce macrovascular and microvascular complications among patients with type 2 diabetes mellitus (T2DM).Methods: This economic evaluation study was conducted in Riyadh First Health Cluster, Saudi Arabia as a predictive model conceptualized by the authors based on models used in previous studies, particularly the CORE Diabetes Model. Our model was designed based on 1) the level of glycemic control among 24,755 T2DM patients served by MDTs; 2) the expected incidence of diabetes-related complications without intervention; 3) the predicted risk reduction of developing diabetes-related complications with MDTs. Costs of complications and cost savings were then calculated and expressed as mean incremental annual cost savings adjusted for a 1% reduction in HbA1c, and a 10 mmHg reduction in systolic blood pressure (SBP).Results: Along with the expected reduction in all diabetes-related complications, the average incremental cost savings per diabetic patient is predicted to be (&dollar;38,878) with approximately (&dollar;11,108) in the year of complication onset and (&dollar;27,770) over the subsequent post-index 10-years. On adjustment of cost savings, the average incremental cost savings are predicted to be (&dollar;22,869) for each 1% reduction in HbA1c per diabetic patient and (&dollar;27,770) for every 10 mmHg reduction in SBP per diabetic patient.Conclusion: MDT as a model of care is effective in glycemic control among T2DM patients with a predicted significant reduction of all diabetes-related complications and in turn, a predicted significant cost savings.Keywords: cost-savings, multi-disciplinary team, complications, type 2 diabetes, predictive model

Abstract Background The availability of consistent psychological therapy within acute inpatient psychiatric units and the integration of psychologists into multi-disciplinary inpatient teams is a newly evolving development in mental healthcare. To the authors’ knowledge, there has been no examination of the inpatient multi-disciplinary team’s (MDT) perspective on how psychology can be best integrated into the team in Lebanon. This study aims to explore the perceptions of different medical personnel working within an MDT on the role of psychologists in an acute psychiatry inpatient unit in Lebanon. It is qualitative in nature, using a semi-structured interview design. The overarching aim of this study is to assess and identify the gaps in the MDT’s insight into the various responsibilities of psychologists which may result in more efficient collaborative teamwork and hence overall patient care. Results Four primary themes are identified from the findings of our study. The themes highlighted the value of a multidisciplinary approach to patient care, the vital roles that psychologists play in direct clinical work and supporting other staff members, important factors related to patient-centered psychological care, limitations that exist in the inpatient unit, and suggestions for improvement. Conclusion This study served as a baseline for more research and development of psychological services in the psychiatric inpatient units of Lebanon, emphasizing the integral role of psychology in patient care.

Abstract Background As primary care pharmacists take on an increasingly important and collaborative role in managing patients with chronic diseases, communication barriers with patients and healthcare colleagues have emerged. This study aimed to explore the communication barriers faced by pharmacists when managing patients with hypertension in a primary care team. Methods Twelve pharmacists working in five government primary care clinics were interviewed by a researcher using a topic guide. The interviews were audio-recorded, transcribed verbatim and subjected to thematic analysis. Results Pharmacists’ management of patients with hypertension was found to be affected by communication challenges at three different levels: between pharmacists and patients, pharmacists and physicians, and physicians and patients. Barriers to communication between pharmacists and patients include language barrier, physical disabilities, medication brand changes, and specific challenges faced during video consultations. Barriers to communication between pharmacists and physicians include lack of access to patient information across institutions on the electronic medical records (EMR), inadequate and inappropriate documentation by physicians, and disruptive and ineffective phone calls by pharmacists to physicians. Barriers to communication between physicians and patients had a spillover effect on pharmacists; these barriers included language barrier, patients not discussing medication nonadherence with physicians, and conflicting advice given by physicians and pharmacists. Conclusions The communication barriers pharmacists faced when managing patients with hypertension involved multiple stakeholders. Many of the challenges resulted in patients having difficulty understanding and adhering to their management plan. Effective interventions to foster stronger interprofessional relationships and create a conducive platform of communication should be developed to address these communication barriers.

Hematopoietic stem cell transplantation (HSCT) has been widely used in the treatment of malignant hematological diseases, non-malignant refractory hematological diseases and some solid tumors. Preconditioning of HSCT will inevitably cause damage to the gastrointestinal tract and increase the incidence of malnutrition. Malnutrition can affect hematopoietic reconstitution, increase the incidence of acute graft-versus-host disease (aGVHD) and infection, and prolong hospital stay. At present, there are few reports on systematic nutritional intervention in patients with hematopoietic stem cell transplantation. This article reviewed the nutritional risk screening and assessment tools, nutritional support methods and nutritional intervention models for patients undergoing HSCT, and provided reference for establishing related nutritional plan. (造血干细胞移植(HSCT)被广泛应用于恶性血液病、非恶性难治性血液病和某些实体瘤的治疗。HSCT预处理会对胃肠道造成不可避免的损伤, 增加营养不良风险。营养不良会影响造血功能重建, 增加急性移植物抗宿主病( aGVHD)及感染的发生率, 延长住院时间, 严重影响HSCT患者生存质量。本研究就HSCT患者营养风险筛查和评估工具、营养支持方式及营养干预模式进行综述, 旨在为HSCT患者营养干预方案的制定提供参考。)

Objective To evaluate the effectiveness of multi-disciplinary team (MDT) mode in the prevention and control of multidrug resistant organism (MDRO) infection in lung transplant recipients. Methods Lung transplant recipients admitted to the hospital from 2019 to 2022 were enrolled. MDT expert group was established in January, 2020. A series of prevention and control measures were conducted. The implementation rate of MDRO prevention and control measures and the detection rate of MDRO on the environmental surface from 2020 to 2022, and the detection rate of MDRO in lung transplant recipients from 2019 to 2022 were analyzed. Results The overall implementation rate of MDRO prevention and control measures for medical staff was increased from 64.9% in 2020 to 91.6% in 2022, showing an increasing trend year by year (P<0.05). The detection rate of MDRO on the environmental surface was decreased from 28% in 2020 to 9% in 2022, showing a downward trend year by year (P<0.05). The detection rate of MDRO in lung transplant recipients was decreased from 66.7% in 2019 to 44.3% in 2022, showing a decreasing trend year by year (P<0.001). Conclusions MDT mode management may enhance the implementation of MDRO prevention and control measures for medical staff, effectively reduce the infection rate of MDRO in lung transplant recipients and the detection rate of MDRO on the environmental surface, which is worthy of widespread application. [ABSTRACT FROM AUTHOR]

Background: The availability of consistent psychological therapy within acute inpatient psychiatric units and the integration of psychologists into multi-disciplinary inpatient teams is a newly evolving development in mental healthcare. To the authors' knowledge, there has been no examination of the inpatient multi-disciplinary team's (MDT) perspective on how psychology can be best integrated into the team in Lebanon. This study aims to explore the perceptions of different medical personnel working within an MDT on the role of psychologists in an acute psychiatry inpatient unit in Lebanon. It is qualitative in nature, using a semi-structured interview design. The overarching aim of this study is to assess and identify the gaps in the MDT's insight into the various responsibilities of psychologists which may result in more efficient collaborative teamwork and hence overall patient care. Results: Four primary themes are identified from the findings of our study. The themes highlighted the value of a multidisciplinary approach to patient care, the vital roles that psychologists play in direct clinical work and supporting other staff members, important factors related to patient-centered psychological care, limitations that exist in the inpatient unit, and suggestions for improvement. Conclusion: This study served as a baseline for more research and development of psychological services in the psychiatric inpatient units of Lebanon, emphasizing the integral role of psychology in patient care. [ABSTRACT FROM AUTHOR]

Background: As primary care pharmacists take on an increasingly important and collaborative role in managing patients with chronic diseases, communication barriers with patients and healthcare colleagues have emerged. This study aimed to explore the communication barriers faced by pharmacists when managing patients with hypertension in a primary care team. Methods: Twelve pharmacists working in five government primary care clinics were interviewed by a researcher using a topic guide. The interviews were audio-recorded, transcribed verbatim and subjected to thematic analysis. Results: Pharmacists' management of patients with hypertension was found to be affected by communication challenges at three different levels: between pharmacists and patients, pharmacists and physicians, and physicians and patients. Barriers to communication between pharmacists and patients include language barrier, physical disabilities, medication brand changes, and specific challenges faced during video consultations. Barriers to communication between pharmacists and physicians include lack of access to patient information across institutions on the electronic medical records (EMR), inadequate and inappropriate documentation by physicians, and disruptive and ineffective phone calls by pharmacists to physicians. Barriers to communication between physicians and patients had a spillover effect on pharmacists; these barriers included language barrier, patients not discussing medication nonadherence with physicians, and conflicting advice given by physicians and pharmacists. Conclusions: The communication barriers pharmacists faced when managing patients with hypertension involved multiple stakeholders. Many of the challenges resulted in patients having difficulty understanding and adhering to their management plan. Effective interventions to foster stronger interprofessional relationships and create a conducive platform of communication should be developed to address these communication barriers. [ABSTRACT FROM AUTHOR]

The Ehlers-Danlos syndromes (EDS) are a group of rare hereditary connective tissue disorders. EDS is clinically and genetically heterogeneous and usually involves multiple systems. EDS has 14 subtypes, the common features of which include joint hypermobility, skin hyperextensibility, tissue fragility, and etc. The clinical manifestations and their severity differ between the subtypes, involving recurrent joint dislocations, scoliosis, arterial aneurysm and dissection, organ rupture, and others. The complexity of the disease poses challenges to the diagnosis and management of EDS, together with the rareness of the disease. The development of clinical guidelines and implementation of coordinated multi-disciplinary team (MDT) approaches to the EDS is in priority in the world.Therefore, we formed the Multi-Disciplinary Working Group on the Ehlers-Danlos Syndromes in China. Based on GRADE methodology, the MDT group developed the Guidelines. The Group highly recommends a coordinated MDT approach to the diagnosis and management of EDS. The first drafted guidelines on EDS will facilitate the shortening of the diagnostic odyssey and meeting the unmet medical needs of the patients.

Objective To summarize the experience of multi-disciplinary team (MDT) in the pediatric department of Qujing Maternal and Child Health Hospital, and to evaluate the effectiveness of MDT on neonatal brain injury. Methods The clinical data of children with brain injury and treated in the pediatrics department of Qujing Maternal and Child Health Hospital from November 2019 to April 2023 were collected. The children with brain injury and treated from October 2019 to June 2020 were regarded as the non-MDT group, and the children with brain injury and treated from July 2020 to April 2023 were regarded as the MDT group for comparative analysis. Chi-square test /t-test was used to compare and analyze the clinical data of the two groups. Results Among the 890 cases of pediatric brain injury, there were 519 males and 371 females. The median and quartiles of the age distribution for the two groups were as follows：MDT group 2.00 (0.82, 5.00) years and non-MDT group 1.00 (1.00, 4.00) years. Craniocerebral injury was the main type of brain injury in both groups, in addition, among children with craniocerebral injury and intracranial hemorrhage, the cure rate of MDT group was higher than that of nonMDT group, and the difference was statistically significant (P < 0.05). Among the 405 children in MDT group, 154 (38.0%) underwent the surgery, while among the 485 children in non-MDT group, 121 (24.9%) underwent the surgery. The difference was statistically significant (P < 0.05). 23.2% of children in MDT group were in critical condition during the hospitalization, which was significantly lower than that in non-MDT group (30.5%), and the difference was statistically significant (P < 0.05). The unhealed rate of MDT group (2.0%) was also significantly lower than that of non-MDT group (5.6%), the cure rate of MDT group (40.5%) was significantly higher than that of non-MDT group (34.4%), and there was a statistically significant difference (P < 0.05). The expense of treatment, medicine and sanitary materials in MDT group were lower than those in non-MDT group, and the differences were statistically significant (P < 0.05). The multivariate Logistic regression model analysis of the cure rate of children with brain injury showed that the MDT model could effectively improve the cure rate of children with brain injury (RR = 1.513, 95%CI = 1.134-2.020). The results of multiple linear regression model analysis showed that there was no statistical difference in the effect of MDT on the actual hospitalization days of children (P > 0.05). Conclusion Using MDT model to diagnose and treat children with brain injury is helpful to improve the cure rate, reduce the risk of children’s disease aggravation, and achieve the significant therapeutic effects in children with brain injury. MDT model is worth popularizing and applying in children with brain injury. [ABSTRACT FROM AUTHOR]

Objective To explore the application and clinical effect of preoperative interventional embolization combined with surgical resection of nidus in the treatment of high flow extracranial arteriovenous malformations (AVW). Methods From March 2016 to August 2021, patients at the Department of Plastic Surgery, of Peking University Third Hospital who were diagnosed as high flow arteriovenous malformation by ultrasound, CTA, MR, DSA and other examinations were treated with interventional embolization for the purpose of removing nidus by surgery. Results A total of 16 patients underwent preoperative embolization design and were embolized within 48 hours before the surgery. All the 16 patients were successfully resected the arteriovenous malformation lesions completely, and no severe complications such as massive bleeding and hemorrhagic shock occurred. There was no recurrence in 1 to 5 years' follow-up. Conclusion Massive bleeding is the biggest obstacle in high-flow arteriovenous malformation surgery. If surgical resection is possible, interventional embolization should be performed before the surgery to reduce blood flow velocity. Surgical excision of the lesion usually within 48 hours after the blood flow rate is reduced. This solution can not only help us improve the safety of the operation, enable the operator to easily complete the entire operation process and avoid serious complications, but also can cure high-flow arteriovenous malformations and reduce recurrence. [ABSTRACT FROM AUTHOR]

Background Given the globally ageing population, care homes have an important role in delivering palliative and end-of-life care. Advance care planning (ACP) is promoted to improve the quality of end-of-life care in this setting. While many professionals can be involved in ACP, little is known about what influences multi-professional involvement and how multi-professional working impacts the ACP process in the UK. This study investigated multi-professional practice in relation to ACP in nursing homes. Design and methods An ethnography was undertaken in two UK nursing homes using multiple methods of data collection: observations, interviews and document review. Participants included the following: nursing home residents (n  = 6), relatives (n  = 4), nursing home staff (n  = 19), and visiting health and social care professionals (n  = 7). Analysis integrated thematic analysis, mapping of resident ACP trajectories and documentary analysis. Findings This paper suggests that multi-professional and relatives' involvement in ACP was disjointed. Continuity and coordination were disrupted by misalignment of visiting professional and nursing home organisational structures. Findings show a 'knotworking' approach to teamwork and power imbalance between nursing home staff and visiting professionals, such as general practitioners. While residents wished their relatives to be involved in their ACP, this was not formally recognised, and limited support existed to facilitate their involvement. Conclusion The structure and organisation of multi-professional and relatives' involvement in ACP led to fragmentation of the process. This marginalised the voice of both the resident and nursing home staff, thereby limiting ACP as a tool to enhance quality of end-of-life care. [ABSTRACT FROM AUTHOR]

A multidisciplinary team (MDT) brings together a group of healthcare professionals from different fields at a specific time to discuss a case. People in an MDT can contribute to the decisions and plans for diagnosing and managing the patient. [1]. MDT in healthcare settings is essential; the main aim is to bring together a group of healthcare professionals from different fields and combine their inputs—this assistance in discussing patients’ presentations and findings, determining comprehensive treatment plans, and treatment side effects. The physical and psychological effects of impaired of these functions can significantly impact patients' quality of life and social well-being. [1]. In war-torn countries with limited resources and complex specialities like neurosurgery, MDT-based decisions may significantly impact the treatment process and outcome. In this paper, we try to highlight the differences in MDT-based work environments compared to the paucity of such organized decisions in war-torn regions of Iraq.

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Introduction and hypothesis: Following the publication of the National Institute for Health and Care Excellence guidelines on the management of pelvic floor dysfunction, articles speculating on the benefits and costs of local and regional multi-disciplinary teams (MDTs) have been in circulation. To date, there has been no formal assessment of the impact of a regional MDT on the management of women with complex urogynaecological conditions. Methods: Throughout the existence of the West of Scotland (WoS) Regional Urogynaecology MDT, from May 2010 to December 2015, 60 patients with complex Urogynaecology conditions were discussed. Data were collected on presenting condition, pre- and post-MDT management plans, and treatment outcomes. Results: The average age was 52.6 years (range 21–91 years). All meetings had at least 1 urogynaecologist, 1 gynaecologist, 1 reconstructive female urologists, 1 urodynamicist and, on average, 3 continence nurses, 4 physiotherapists, as well as 1 clinical librarian to conduct a literature search and 1 secretary for administrative support. The majority of the referrals dealt with urinary incontinence (n=34) and 8 patients presented with mesh complications alongside other pelvic floor disorders. The MDT made changes to the original referrer's management plan in at least 25 (41.7%) patient presentations. Twenty-two out of all the patients discussed (36.7%) were reported as cured or improved in their condition following the MDT-recommended management. Conclusion: The WoS Regional Urogynaecology MDT had a positive impact on the management of women presenting with complex condition(s). Cross-sharing of resources between hospitals within the region provided a wider range of management plans, better tailored to each individual. [ABSTRACT FROM AUTHOR]

Nephrolithiasis in pregnancy is a common non-obstetric indication for hospital admission in obstetric patients, which is often associated with pain, nausea, vomiting, decreased renal function, urinary infection and other symptoms, and improper treatment for which will lead to abortion, premature delivery and other adverse pregnancy outcomes. In response, a multi-disciplinary team from a single academic medical center in the United States was assembled to create the management of nephrolithiasis in pregnancy: multi-disciplinary guidelines from an academic medical center to standardize the care for obstetric patients presenting with suspected nephrolithiasis. A total of 10 guideline statements were constructed, including four for guiding diagnosis and imaging, and six for guiding clinical treatment. It is noteworthy that compared with relevant Chinese guidelines, the guidelines provide practice-based evidence that proves the safety and effectiveness of low-dose non-contrast CT scan preferably used when condition changes and diagnostic uncertainty exists. This paper offers an in-depth interpretation of the above-mentioned contents in the guidelines.

Non-Diagnostic (ND) biopsies are occasionally encountered during the investigation of soft tissue sarcoma. We performed a retrospective review of all ND soft tissue biopsies discussed at our regional Multi-Disciplinary Team (MDT) meeting between 2004 & 2014 with the aim of establishing the incidence of ND biopsies, identifying predictive factors for repeat biopsies and evaluating the effectiveness of MDT decisions. We identified 80 ND out of 3233 biopsies. Diagnostic Yield (DY) was 97.5%, 76.0% and 77.8% for the first, second and third successive biopsy respectively. With an MDT approach utilising radiological and clinical information, the diagnostic success rate achieved was 98.5%, 82.0% and 77.8% for the first, second and third biopsies respectively. Malignant tumours (sarcoma & carcinoma) were 19 times more likely to undergo an increasing number of biopsies compared to benign lesions (p < 0.01), while repeat biopsies were less useful for suspected benign lesion. Although a repeat biopsy was only performed in 63% of cases, there were no patients originally diagnosed with a benign lesion that re-presented with the same lesion subsequently being malignant throughout the study period. Our study shows that a specialist MDT approach leads to high diagnostic rates and is a safe and effective method of preventing unnecessary, repeat biopsies where the initial biopsy is ND. [ABSTRACT FROM AUTHOR]

A multidisciplinary team (MDT) brings together a group of healthcare professionals from different fields at a specific time to discuss a case. People in an MDT can contribute to the decisions and plans for diagnosing and managing the patient. [1]. MDT in healthcare settings is essential; the main aim is to bring together a group of healthcare professionals from different fields and combine their inputs--this assistance in discussing patients' presentations and findings, determining comprehensive treatment plans, and treatment side effects. The physical and psychological effects of impaired of these functions can significantly impact patients' quality of life and social well-being. [1]. In war-torn countries with limited resources and complex specialities like neurosurgery, MDT-based decisions may significantly impact the treatment process and outcome. In this paper, we try to highlight the differences in MDT-based work environments compared to the paucity of such organized decisions in war-torn regions of Iraq. [ABSTRACT FROM AUTHOR]

Diabetic Foot in Primary and Tertiary (DEFINITE) Care is an inter‐institutional and multi‐disciplinary team (MDT) health systems innovation programme at a healthcare cluster in Singapore. We aim to achieve coordinated MDT care across primary and tertiary care for patients with diabetic foot ulcers (DFU), within our public healthcare cluster ‐ an integrated network of seven primary care polyclinics and two acute care tertiary hospitals (1700‐bed and 800‐bed) with a total catchment population of 2.2 million residents. Results from prospective DEFINITE Care is referenced against a retrospective 2013–2017 cohort, which was previously published. Cardiovascular profile of the study population is compared against the same population's profile in the preceding 12 months. Between June 2020 and December 2021, there were 3475 unique patients with DFU with mean age at 65.9 years, 61.2% male, mean baseline HbA1c at 8.3% with mean diabetes duration at 13.3 years, mean diabetes complication severity index (DCSI) at 5.6 and mean Charlson Comorbidity Index (CCI) at 6.8. In the 12‐months preceding enrolment to DEFINITE Care, 35.5% had surgical foot debridement, 21.2% had minor lower extremity amputation (LEA), 7.5% had major LEA whilst 16.8% had revascularisation procedures. At 18‐months after the implementation of DEFINITE Care programme, the absolute minor and major amputation rates were 8.7% (n = 302) and 5.1% (n = 176), respectively, equating to a minor and major LEA per 100000 population at 13.7 and 8.0, respectively. This represents an 80% reduction in minor amputation rates (P <.001) and a 35% reduction in major amputation rates (P =.005) when referenced against a retrospective 2013–2017 cohort, which had minor and major LEA per 100000 population at 68.9 and 12.4, respectively. As compared to the preceding 12 months, there was also a significant improvement in cardiovascular profile (glycemic and lipid control) within the DEFINITE population, with improved mean HbAc1 (7.9% from 8.4%, P <.001), low‐density lipoprotein (LDL) levels (2.1 mmol/L from 2.2, P <.001), total cholesterol (3.9 mmol/L from 4.1, P <.001) and triglycerides levels (1.6 mmol/L from 1.8, P =.002). Multivariate analysis revealed a history of minor amputation in the preceding 12 months to be an independent predictor for major and minor amputation within the study period of 18 months (Hazard Ratio 3.4 and 1.8, respectively, P <.001). In conclusion, within DEFINITE care, 18‐month data showed a significant reduction of minor and major LEA rates, with improved medical optimisation and cardiovascular profile within the study population. [ABSTRACT FROM AUTHOR]

Multidisciplinary team (MDT) working is essential to optimise and integrate services for people who are frail. MDTs require collaboration. Many health and social care professionals have not received formal training in collaborative working. This study investigated MDT training designed to help participants deliver integrated care for frail individuals during the Covid-19 pandemic. Researchers utilised a semi-structured analytical framework to support observations of the training sessions and analyse the results of two surveys designed to assess the training process and its impact on participants knowledge and skills. 115 participants from 5 Primary Care Networks in London attended the training. Trainers utilised a video of a patient pathway, encouraged discussion of it, and demonstrated the use of evidence-based tools for patient needs assessment and care planning. Participants were encouraged to critique the patient pathway, reflect on their own experiences of planning and providing patient care. 38% of participants completed a pre-training survey, 47% a post-training survey. Significant improvement in knowledge and skills were reported including understanding roles in contributing to MDT working, confidence to speak in MDT meetings, using a range of evidence-based clinical tools for comprehensive assessment and care planning. Greater levels of autonomy, resilience, and support for MDT working were reported. Training proved effective; it could be scaled up and adopted to other settings. [ABSTRACT FROM AUTHOR]

Introduction: De‐escalated treatment of hemithyroidectomy without radioactive iodine (RAI) is now accepted for patients with low‐risk, well‐differentiated thyroid cancer (WDTC). The benefit of long‐term follow‐up care remains controversial. This study aims to describe parameters associated with less than total thyroidectomy, and discharge from specialist follow‐up in patients with low‐risk WDTC in Australia. Methods: An online survey was distributed to Australian members of Endocrine Society of Australia, Australian and New Zealand Endocrine Surgeons, and Australian Society of Otolaryngology, Head and Neck Surgery. Clinicians completed a survey of management and follow‐up care preferences for four clinical vignettes (all low‐risk WDTC). Results: 119 clinicians (48% endocrinologists, 55% male) answered at least one question. The majority (59%) of respondents recommended less than total thyroidectomy and omission of RAI in patients with WDTC <2 cm. Most (62%) would discharge a patient with micropapillary thyroid cancer within 1 year following total thyroidectomy. In contrast, for WDTC 1–4 cm, >90% of clinicians would continue specialist follow‐up for at least 5 years. The majority of clinicians felt that patients experienced disproportionate fear of recurrence and were reassured by follow‐up. After multivariable analysis, clinicians who participated in multidisciplinary teams (MDTs) were more likely to choose de‐escalated care for both initial treatment (p =.005) and follow‐up care (>5 years, p =.05). Conclusion: Clinician attitudes captured by this survey reflect recent changes in guidelines towards hemithyroidectomy for low‐risk WDTC, particularly amongst MDT attendees. There is a need to further examine the impact of de‐escalated care on fear of recurrence and quality of life in thyroid cancer survivors. [ABSTRACT FROM AUTHOR]

Abstract Background Medical education has changed continually throughout the covid-19 pandemic, creating additional stress for medical students. Personal reflection can empower an individual to adapt to new challenges, and reflection has gradually become incorporated into medical student training. Schwartz Rounds (SR) offer a compassionate group reflective forum for healthcare staff. SRs have been extensively introduced throughout the NHS, however medical student rounds are yet to be widely adopted. Entirely unresearched is how the multi-disciplinary team impacts a medical student SR. This study aims to compare medical student experience of a single-discipline and a multi-discipline SR using mixed methodology. Methods Two virtual SRs were run at an NHS district general hospital, using the existing structure of the Trust’s rounds. The first round included only medical students on placement at the hospital, whereas the second round also involved other student health disciplines. Following each round Likert scale questionnaires were collected, and focus groups were held with a small number of participants. Quantitative analysis used median averages as well direct comparison of scores for each round. Qualitative data from the focus groups underwent thematic analysis. Results The quantitative data showed a positive response to both styles of student SRs, with over 87% of participants at both rounds stating they intended to attend further rounds. Direct comparison between the two rounds showed higher feedback scores for the single-discipline round. Qualitative analysis showed strong student interest in further group reflection, noting the value of SRs in improving workplace culture and inter-professional relationships. The analysis also highlighted frustrations with the existing SR structure, namely large group sizes and scripted panellists. Conclusions Both data sets showed a strong positive response to SRs, and a desire to attend again. There is some evidence to suggest the addition of multiple student disciplines at SRs impaired medical student reflection. Changes to the format of the round could result in even greater success in student rounds.

Objective To explore the effect of the nurse-led multidisciplinary team (MDT) model of continuous care in patients with psoriasis vulgaris. Methods From December 2019 to December 2020,96 inpatients with psoriasis vulgaris at our hospital were randomly divided into the observation and the control groups, 48 patients per group. Following the discharge, the patients in the control group were given the traditional nurse-led continuous care, while the patients in the observation group were given multi-disciplinary team (MDT) model of continuous care, i.e. with the participation of pharmacists and clinicians. Patients in both groups were followed up for 6 months after discharge. Results The 6-month follow-up showed that patients in the observation group had lower PASI scores (3.87±1.82 vs 6.43±2.57, t=7.87, P

Abstract Introduction De‐escalated treatment of hemithyroidectomy without radioactive iodine (RAI) is now accepted for patients with low‐risk, well‐differentiated thyroid cancer (WDTC). The benefit of long‐term follow‐up care remains controversial. This study aims to describe parameters associated with less than total thyroidectomy, and discharge from specialist follow‐up in patients with low‐risk WDTC in Australia. Methods An online survey was distributed to Australian members of Endocrine Society of Australia, Australian and New Zealand Endocrine Surgeons, and Australian Society of Otolaryngology, Head and Neck Surgery. Clinicians completed a survey of management and follow‐up care preferences for four clinical vignettes (all low‐risk WDTC). Results 119 clinicians (48% endocrinologists, 55% male) answered at least one question. The majority (59%) of respondents recommended less than total thyroidectomy and omission of RAI in patients with WDTC 90% of clinicians would continue specialist follow‐up for at least 5 years. The majority of clinicians felt that patients experienced disproportionate fear of recurrence and were reassured by follow‐up. After multivariable analysis, clinicians who participated in multidisciplinary teams (MDTs) were more likely to choose de‐escalated care for both initial treatment (p = .005) and follow‐up care (>5 years, p = .05). Conclusion Clinician attitudes captured by this survey reflect recent changes in guidelines towards hemithyroidectomy for low‐risk WDTC, particularly amongst MDT attendees. There is a need to further examine the impact of de‐escalated care on fear of recurrence and quality of life in thyroid cancer survivors.

Background: Diabetic foot ulceration (DFU) has become an increasingly common emergency presentation. These patients are presenting at a younger age and with increasingly complex co-morbidities. They require frequent hospitalisation for management of DFU which has significant consequences for management of health resources but also for quality of life in the diabetic patient population. Aim: The aim of this study was to evaluate the impact of the development of a coordinated, streamlined acute diabetic foot pathway for management of in-patients presenting as emergencies with DFU on length of stay, re-admission to hospital and minor and major amputations. Methods: A dedicated acute diabetic foot pathway was introduced to St. Vincent's University Hospital (SVUH) in April 2016. Management of patients admitted urgently to the emergency department or out-patient clinics of St. Vincent's University Hospital during the 3-year period before April 2016 was compared to that of patients admitted in the 3 years after April 2016 following introduction of the acute diabetic foot pathway. Demographic data hospital length of stay, need for re-admission, major and minor amputations performed and cost of hospital stay were compared before and after introduction of the pathway. Results: There were 931 admissions with acute diabetic foot ulceration or infection between January 2012 and December 2019; 419 were admitted between January 2012 and March 2016 and 512 between April 2016 and December 2019. There was no difference in demographic data between the two time periods. Length of stay decreased from 13 +/- 4.24 to 3 +/- 1.41 days between the two time periods (p < 0.001). Re-admission rates within 30 days decreased from 21.7 to 10.1% (p < 0.05). The number of major lower limb amputations decreased over the two time periods from 8.8 to 7.2% with a concomitant increase in minor amputations from 16.7 to 25.3%. Risk of major lower limb amputation was significantly higher in those patients living more than 20 km from the hospital. Costs associated with in-patient stay for management of DFU decreased from €9,247,700 to €8,988,100 despite an 18% increase in the number of patients treated and a 9.9% increase in hospital admissions. Conclusion: Introduction of a dedicated, streamlined pathway involving multi-disciplinary input resulted in a significant improvement in patient management as assessed by length of hospital stay and need for re-admission. While the number of major lower limb amputations has decreased there has been a significant increase in the number of minor amputations. [ABSTRACT FROM AUTHOR]

Coaches within the same sport often have varying methods to achieve performance outcomes, and, therefore, it is crucial to understand their performance model to maximise the impact of strength and conditioning (S&C) support. Having a deliberate approach for understanding the demands of a sport from a sports coach's lens and aligning S&C support to the coaches' performance model rather than utilising a generic needs analysis to guide S&C support is vital to provide impactful S&C support. The multi-disciplinary team (MDT) may also play a pivotal role in providing insight into various aspects of performance beyond a generic needs analysis. It is to the S&C coaches' advantage to utilise the expertise of the MDT. Finally, the S&C coach must develop a technical framework that consists of avenues of impact or objectives for S&C support and demonstrates how biomotor qualities developed within the S&C programme may support determinants of performance and technical models for key sporting actions, in line with the coaches' performance principles. The current paper aims to utilise the authors' experience of working with the head coach of two national rowing performance programmes over the last three Olympic cycles, with specific reference to the preparation for the 2020 Tokyo Olympic games to articulate a philosophical approach for aligning S&C support to a coach's performance model. [ABSTRACT FROM AUTHOR]

In the anti-human trafficking movement, multi-disciplinary teams have emerged as a best practice for collaborating and coordinating efforts in combating human trafficking. Many multi-disciplinary teams are comprised of federal, state and local partners representing law enforcement, prosecutors and service providers. The concept of sustaining the multi-disciplinary teams is a relatively new area of discussion in the anti-human trafficking movement. This paper explores the Greater New Orleans Human Trafficking Task Force sustainability process as an illustrative example to shed light on the issues that arose during the process for this Task Force, and which may be salient for other Task Forces. This retrospective presentation of the comments and observations made by the Greater New Orleans Human Trafficking Task Force members suggest emerging themes that may help to clarify the concepts other Task Forces should consider and to predict the sustainability outcomes. The members' accounts incorporated in this article are presented as valid points of view for framing conclusions that may be applicable in other contexts and to further the conversation in this understudied area of sustainability. The key focal points related to sustainability explored in this conceptual paper include leadership, funding, collaboration, trust and relationship building, and change is constant. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has been associated with an unprecedented number of critical care survivors. Their experiences through illness and recovery are likely to be complex, but little is known about how best to support them. Aim: This study aimed to explore experiences of illness and recovery from the perspective of survivors, their relatives and professionals involved in their care. Study design: In‐depth qualitative interviews were conducted with three stakeholder groups during the first wave of the pandemic. A total of 23 participants (12 professionals, 6 survivors and 5 relatives) were recruited from 5 acute hospitals in England and interviewed by telephone or video call. Data analysis followed the principles of Reflexive Thematic Analysis. Findings: Three themes were generated from their interview data: (1) Deteriorating fast—a downhill journey from symptom onset to critical care; (2) Facing a new virus in a hospital—a remote place; and (3) Returning home as a survivor, maintaining normality and recovering slowly. Conclusions: Our findings highlight challenges in accessing care and communication between patients, hospital staff and relatives. Following hospital discharge, patients adopted a reframed 'survivor identity' to cope with their experience of illness and slow recovery process. The concept of survivorship in this patient group may be beneficial to promote and explore further. Relevance to clinical practice: All efforts should be made to continue to improve communication between patients, relatives and health professionals during critical care admissions, particularly while hospital visits are restricted. Adapting to life after critical illness may be more challenging while health services are restricted by the impacts of the pandemic. It may be beneficial to promote the concept of survivorship, following admission to critical care due to severe COVID‐19. [ABSTRACT FROM AUTHOR]

There have been consistent calls for more research on managing teams and embedding processes in data science innovations. Widely used frameworks (e.g., the cross-industry standard process for data mining) provide a standardized approach to data science but are limited in features such as role clarity, skills, and cross-teamcollaboration that are essential for developing organizational capabilities in data science. In this study, we introduce a data workflow method (DWM) as a new approach to break organizational silos and create a multi-disciplinary team to develop, implement and embed data science. Different from current data science process workflows, theDWMis managed at the system level that shapes business operating model for continuous improvement, rather than as a function of a particular project, one single business unit, or isolated individuals. To further operationalize the DWM approach, we investigated an embedded data workflow at a mining operation that has been using geological data in a machine-learning model to stabilize daily mill production for the last 2 years. Based on the findings in this study, we propose that the DWM approach derives its capability from three aspects: (a) a systemic data workflow; (b) multi-disciplinary networks of collaboration and responsibility; and (c) clearly identified data roles and the associated skills and expertise. This study suggests a whole-of-organization approach and pathway to develop data science capability. [ABSTRACT FROM AUTHOR]

Background: Medical education has changed continually throughout the covid-19 pandemic, creating additional stress for medical students. Personal reflection can empower an individual to adapt to new challenges, and reflection has gradually become incorporated into medical student training. Schwartz Rounds (SR) offer a compassionate group reflective forum for healthcare staff. SRs have been extensively introduced throughout the NHS, however medical student rounds are yet to be widely adopted. Entirely unresearched is how the multi-disciplinary team impacts a medical student SR. This study aims to compare medical student experience of a single-discipline and a multi-discipline SR using mixed methodology. Methods: Two virtual SRs were run at an NHS district general hospital, using the existing structure of the Trust’s rounds. The first round included only medical students on placement at the hospital, whereas the second round also involved other student health disciplines. Following each round Likert scale questionnaires were collected, and focus groups were held with a small number of participants. Quantitative analysis used median averages as well direct comparison of scores for each round. Qualitative data from the focus groups underwent thematic analysis. Results: The quantitative data showed a positive response to both styles of student SRs, with over 87% of participants at both rounds stating they intended to attend further rounds. Direct comparison between the two rounds showed higher feedback scores for the single-discipline round. Qualitative analysis showed strong student interest in further group reflection, noting the value of SRs in improving workplace culture and inter-professional relationships. The analysis also highlighted frustrations with the existing SR structure, namely large group sizes and scripted panellists. Conclusions: Both data sets showed a strong positive response to SRs, and a desire to attend again. There is some evidence to suggest the addition of multiple student disciplines at SRs impaired medical student reflection. Changes to the format of the round could result in even greater success in student rounds. [ABSTRACT FROM AUTHOR]