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Objectives: The main objective of this study was to evaluate the alignment between treatment decisions made during multidisciplinary team meetings (MTMs) and the treatments received by patients with upper aerodigestive tract cancers. The secondary objective was to identify factors influencing potential discrepancies. Methods: This retrospective, single-center study was conducted at a tertiary referral center and included 147 patients diagnosed with squamous cell carcinoma of the upper aerodigestive tract. Patients were divided into two groups based on the match between MTM-decided and actual treatments. Multivariate analysis was performed to assess factors independently associated with discrepancies. Results: Out of 147 patients, 28 (19%) received treatment that did not align with MTM decisions. Among these, eight died before treatment, one patient refused care, five received supportive care, five patients underwent surgery, three received radiotherapy alone, one patient underwent surgery and adjuvant radiochemotherapy, one patient underwent surgery and adjuvant radiotherapy alone, three patients received radiochemotherapy, and one patient received palliative chemotherapy. Independent significant factors associated with non-concordance included poor performance status (PS) and treatment not received at a tertiary reference center. Treatment shifts mainly involved downgrading from curative to palliative care. Conclusions: This study highlights the importance of patient health status in determining deviations from MTM decisions. Further efforts should focus on improving the integration of patient comorbidities and health status into MTM decision-making to optimize care delivery. [ABSTRACT FROM AUTHOR]

Abstract Introduction Cancer multi-disciplinary team meetings (MDTM) assemble clinical experts to make diagnostic and treatment recommendations. MDTMs can take place in person, virtually, or in a hybrid format. Virtual and hybrid MDTMs have been in use for over two decades. This systematic scoping review aims to map the evidence on virtual and hybrid MDTM formats over time, providing insights into their quality, and the facilitators and barriers to their effective delivery. Methods The PRISMA scoping review checklist has been followed. A systematic search of PubMed, PsychINFO, and Embase between 1990–2023 identified 9399 records. These were independently screened by two researchers to identify primary research of any design that assessed quality or effectiveness of cancer VMDTMs. Results were narratively synthesised. Results Eight quantitative, two qualitative and three mixed-methods studies were included. All were observational and most were retrospective (n = 8). Varied outcome measures were used to evaluate meeting quality, including treatment recommendations, survival, time from diagnosis, and overall attendance. VMDTMs were superior (N = 6) or sometimes equivalent (N = 4) to face-to-face meetings. Studies identified implementation factors critical to their effective delivery, including internet-stability and chairing. Conclusion The heterogeneous literature suggests VMDTMs offer some benefits over face-to-face meetings. Training and infrastructure are key to prevent risks to patient safety. A definitive comparative evaluation is needed to inform best practice.

Objectives: There is currently limited local and international literature on the characteristics of uro-oncology multi-disciplinary team meetings (MDTMs) and their impact on clinical decision making. The aims of this study were to provide a comprehensive descriptive analysis of MDTMs at an Australian tertiary hospital over a 12-month period and their impacts on patient management, and to evaluate adherence to MDTM plans. Methods: We conducted a review of a prospectively maintained database of all uro-oncology MDTMs held within the Northern Adelaide Local Health Network (NALHN) over a 12-month period in 2020–2021. Results: During this 12-month period, 24 MDT meetings were conducted, in which 280 patients were discussed. Overall, MDTMs resulted in modifications to the management of 25.7% of patients, which was consistent across all three major tumour streams (24% for prostate cancer, 29% for renal cell carcinoma, and 22% for urothelial carcinoma). MDTMs also facilitated cross referrals between specialties for 105 patients (37.5%), including 5 patients who were considered for entry into clinical trials. There was a high acceptance rate, with adherence to MDT recommendations for 270 of the 278 patients discussed (96.4%). MDTM plans were fully implemented within a 6-month period. Conclusions: We provided a detailed analysis of uro-oncology MDTMs at an Australian tertiary referral centre, demonstrating that MDTMs facilitate optimal cancer management for patients with urological cancers.

The multidisciplinary team meeting has become a fundamental component of cancer care across most of Europe, North America, and Australia. In certain institutions, it holds a mandatory role in the treatment planning of all patients with cancer. Although the multidisciplinary team meeting has demonstrated improved adherence to clinical protocols in the oncology field and serves as a valuable educational tool for clinicians, it is difficult to truly gauge its impact on clinical outcomes due to the wide heterogeneity in interinstitutional meeting practices and the varied data reporting clinical outcomes. This literature review will provide an overview of the history and contextual role of the multidisciplinary team meeting in cancer management and discuss the barriers to its implementation, offering means to navigate these barriers. This review will also explore the barriers to adherence to treatment recommendations offered by the multidisciplinary team meeting in cancer care, through the lens of the patient and health care provider. [ABSTRACT FROM AUTHOR]

Abstract Background Interprofessional collaboration is essential to maintain high-quality care in long-term care and geriatric rehabilitation. However, little is known regarding perceived factors influencing interprofessional collaboration by people involved in care. This concerns both long-term care and geriatric rehabilitation. Moreover, knowledge of using patient outcome measures to enhance interprofessional collaboration during multidisciplinary team meetings is insufficient. This study examined the perceived facilitators of and barriers to interprofessional collaboration in general and during multidisciplinary team meetings, specifically according to healthcare professionals, patients, and informal caregivers. Differences between long-term care and geriatric rehabilitation were also investigated. Finally, it was examined which patient outcome measures were used in multidisciplinary team meetings. Methods A constructivist qualitative study using 10 focus groups and 18 semi-structured interviews with 14 patients, 13 informal caregivers,10 managers, and 22 healthcare professionals from eight Dutch long-term care and geriatric rehabilitation facilities. A combined inductive and deductive approach to a thematic analysis was performed. Results The perceived influencing factors of interprofessional collaboration were classified into two general themes: (1) ‘Involvement of patient, informal caregiver, and healthcare professional’, categorised into: ‘participation of patients and informal caregivers’, ‘behaviour and attitude of team members’, ‘expectations of team members towards each other’, and ‘exchange of information, knowledge, and reciprocity in communication’; and (2) ‘A systematic approach to providing care for older people’, consisting of: ‘coordination of team procedures’, and ‘coordination of organisational procedures’. Also, one theme for multidisciplinary team meetings was identified: ‘Organised participation of patient, informal caregiver, and healthcare professional in multidisciplinary team meeting, categorised into: ‘team procedures’, ‘working systematically’, and ‘participation in multidisciplinary team meetings. Standardised patient outcome measures were scarcely used in multidisciplinary team meetings. Conclusion People involved in long-term care and geriatric rehabilitation indicated that, apart from working systematically, being involved in care and multidisciplinary team meetings are essential factors for interprofessional collaboration. These factors must be taken into consideration to provide valuable, high-quality care to older people residing in long-term care and geriatric. Trial registration Not applicable.

Multidisciplinary team (MDT) meetings are common to many fields of medicine and widely established internationally. They are intended to ensure higher-quality decision-making and improved patient outcomes. For patients with end-stage kidney disease (ESKD), decisions on whether to place marginally suitable candidates on the kidney transplantation waiting list can be challenging and as such they are supported by MDT meetings. Uncertainty in terms of the best course of action can be linked with a dearth of knowledge or evidence on specific medical conditions and likely implications for successful transplantation, but also on unforeseen outcomes influenced by patient behaviours. In this project, we observed how MDT meetings work in practice in kidney transplant listing, unpacking issues of risk and uncertainty in transplant decision-making processes. Our findings indicate that a central value of MDT meetings is managing medical uncertainty and psychosocial risks, and distributing responsibility for complex transplant listing decisions to ensure equity of access to transplantation as well as an efficient use of scarce kidneys. This sheds light on strategies enacted to mitigate these risks and uncertainties, and the role played by different types of knowledge (experiential versus scientifically evidence-based) in the overall decision-making process. [ABSTRACT FROM AUTHOR]

Abstract Multidisciplinary team meetings are a current international practice in cancer care, but to date, few data exist on the specificity of its practice in hematology. In this manuscript, we present the result of the first national study, realized with quantitative and qualitative methods in France, which brings new insights in order to improve the collegial decision-making process. To improve the effectiveness of MDTMs, the needs to focus on complex cases, to enhance patient centeredness and teamwork are relevant aspects, and a specific focus on hematological particularities is warranted to truly improve process. Background Understanding the Multidisciplinary team meetings (MDTMs) process in different medical specialties facilitates the identification of core factors supporting effective MDTM work. Our mixed-methods study explores the participants’ perceptions of hematology MDTMs. Design Online questionnaires collected data concerning the decision-making process, benefits and inconveniences of MDTMs for both patients and professionals. Semi-directive phone interviews were conducted and analyzed, thereby supplying qualitative data. Results A total of 205 professionals responded to the questionnaire and 22 participated in the qualitative interviews. The data indicate the unique characteristics of hematology, including a specific definition of collegiality, the frequent solicitation of expert advice and the anticipation of treatment even prior to the occurrence of MDTMs. Additional information concerning patients’ wishes and psychosocial conditions are also needed. Participants emphasize the subjective aspects and the impact of the climate of MDTMs on medical decisions. Conclusion Although MDTMs are recognized to be a valuable tool, organizational and relational issues may interfere with their efficiency. To improve the effectiveness of MDTMs, the needs to focus on complex cases, to enhance patient centeredness and teamwork are relevant aspects. A specific focus on hematological particularities might be warranted to truly improve the collegial decision-making process in the context of hematology.

Background: For therapy planning in cancer patients multidisciplinary team meetings (MDM) are mandatory. Due to the high number of cases being discussed and significant workload of clinicians, Clinical Decision Support System (CDSS) may improve the clinical workflow. Methods: This review and meta-analysis aims to provide an overview of the systems utilized and evaluate the correlation between a CDSS and MDM. Results: A total of 31 studies were identified for final analysis. Analysis of different cancers shows a concordance rate (CR) of 72.7% for stage I-II and 73.4% for III-IV. For breast carcinoma, CR for stage I-II was 72.8% and for III-IV 84.1%, P≤ 0.00001. CR for colorectal carcinoma is 63% for stage I-II and 67% for III-IV, for gastric carcinoma 55% and 45%, and for lung carcinoma 85% and 83% respectively, all P>0.05. Analysis of SCLC and NSCLC yields a CR of 94,3% and 82,7%, P=0.004 and for adenocarcinoma and squamous cell carcinoma in lung cancer a CR of 90% and 86%, P=0.02. Conclusion: CDSS has already been implemented in clinical practice, and while the findings suggest that its use is feasible for some cancers, further research is needed to fully evaluate its effectiveness. [ABSTRACT FROM AUTHOR]

Multidisciplinary team meetings are a current international practice in cancer care, but to date, few data exist on the specificity of its practice in hematology. In this manuscript, we present the result of the first national study, realized with quantitative and qualitative methods in France, which brings new insights in order to improve the collegial decision-making process. To improve the effectiveness of MDTMs, the needs to focus on complex cases, to enhance patient centeredness and teamwork are relevant aspects, and a specific focus on hematological particularities is warranted to truly improve process. Background Understanding the Multidisciplinary team meetings (MDTMs) process in different medical specialties facilitates the identification of core factors supporting effective MDTM work. Our mixed-methods study explores the participants' perceptions of hematology MDTMs. Design Online questionnaires collected data concerning the decision-making process, benefits and inconveniences of MDTMs for both patients and professionals. Semi-directive phone interviews were conducted and analyzed, thereby supplying qualitative data. Results A total of 205 professionals responded to the questionnaire and 22 participated in the qualitative interviews. The data indicate the unique characteristics of hematology, including a specific definition of collegiality, the frequent solicitation of expert advice and the anticipation of treatment even prior to the occurrence of MDTMs. Additional information concerning patients' wishes and psychosocial conditions are also needed. Participants emphasize the subjective aspects and the impact of the climate of MDTMs on medical decisions. Conclusion Although MDTMs are recognized to be a valuable tool, organizational and relational issues may interfere with their efficiency. To improve the effectiveness of MDTMs, the needs to focus on complex cases, to enhance patient centeredness and teamwork are relevant aspects. A specific focus on hematological particularities might be warranted to truly improve the collegial decision-making process in the context of hematology. [ABSTRACT FROM AUTHOR]

Christian Heuser,1,2 Barbara Schellenberger,1,2 Nicole Ernstmann,1,2 Annika Diekmann,1 Emily Krüger,1 Leonie Schreiber,1 Isabelle Scholl,3 Lena Ansmann4 1Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, 53127, Germany; 2Chair for Health Services Research, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, 50933, Germany; 3Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany; 4Division for Organizational Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, 26129, GermanyCorrespondence: Christian Heuser, Chair for Health Services Research, Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, 50933, Germany, Tel +49-221-478-97133, Email christian.heuser1@uk-koeln.dePurpose: This study aimed (1) to analyze patients’ perceived shared decision-making (SDM) experiences over 4 weeks between patients participating or not in multidisciplinary tumor conferences (MTCs) and (2) to analyze the association of patients’ active participation in and organizational variables of MTCs with patients’ perceived SDM experience directly after MTC.Patients and Methods: From the N=317 patients, this observational study included patient surveys, observations, and audio transcripts from MTCs with (N=82) and without (N=145) patient participation in six breast and gynecologic cancer centers. We performed t tests for within- and between-group comparisons and linear regression with “patients’ perceived SDM experiences in MTC” as the dependent variable.Results: Patients’ perceived SDM experiences increased at 4 weeks after MTC (p< 0.001) with lower perceived SDM experiences for participating versus nonparticipating patients (p< 0.001). Linear regression showed that the organizational variable “round table seating arrangement” was significantly associated with higher perceived SDM experiences compared with a theater or U-shape arrangement (beta=− 0.38, p=0.043; beta=− 0.69, p=0.010) directly after MTC.Conclusion: Results provide first insights into patients’ perceived SDM experiences in MTCs. SDM in MTCs is associated with organizational variables of MTCs. A round table seating arrangement in MTCs with patient participation seems important for patients’ perceived SDM experiences. The relatively low perceived SDM experiences of participating patients directly after MTC indicates room for improvement, eg concerning patient-centered communication.Keywords: multidisciplinary healthcare, multidisciplinary tumor conference, multidisciplinary team meetings, shared decision making, oncology, patient-centered communication

Purpose: Surgical site occurrences after transversus abdominis release in ventral hernia repair are still reported up to 15%. Evidence is rising that preoperative improvement of risk factors might contribute to optimal patient recovery. A reduction of complication rates up to 40% has been reported. The aim of this study was to determine whether prehabilitation has a favorable effect on the risk on wound and medical complications as well as on length of stay. Methods: A retrospective cohort study was performed in a tertiary referral center for abdominal wall surgery. All patients undergoing ventral hernia repair discussed at multidisciplinary team (MDT) meetings between 2015 and 2019 were included. Patients referred for a preconditioning program by the MDT were compared to patients who were deemed fit for operative repair by the MDT, without such a program. Endpoints were patients, hernia, and procedure characteristics as well as length of hospital stay, wound and general complications. Results: A total of 259 patients were included of which 126 received a preconditioning program. Baseline characteristics between the two groups were statistically significantly different as the prehabilitated group had higher median BMI (28 vs 30, p < 0.001), higher HbA1c (41 vs 48, p = 0.014), more smokers (4% vs 25%, p < 0.001) and higher HPW classes due to more patient factors (14% vs 48%, p < 0.001). There were no significant differences in intra-operative and postoperative outcome measures. Conclusions: This study showed prehabilitation facilitates patients with relevant comorbidities achieving the same results as patients without those risk factors. The indication of a preconditioning program might be effective at the discretion of an MDT meeting. Further research could focus on the extent of such program to assess its value. [ABSTRACT FROM AUTHOR]

Introduction: In cancer care, multidisciplinary team (MDT) meetings are the gold standard. While they are trying tomaximize productivity on the back of the steadily increasing workload, growing cancer incidence, financial constraints, and staff shortages, concerns have been raised with regards to the quality of team output, as reported by Cancer Research UK in 2017: "Sometimes we discuss up to 70 patients. This is after a whole day of clinics, and we do not finish until after 19.00. Would you want to be number 70". This study aimed to explore systematically some of the dynamics of group interaction and teamwork in MDT meetings. Materials and methods: This was a prospective observational study conducted across three MDTs/university hospitals in the United Kingdom. We video-recorded 30 weekly meetings where 822 patient cases were reviewed. A cross-section of the recordings was transcribed using the Jefferson notation system and analyzed using frequency counts (quantitative) and some principles of conversation analysis (qualitative). Results: We found that, across teams, surgeons were the most frequent initiators and responders of interactional sequences, speaking on average 47% of the time during case discussions. Cancer nurse specialists and coordinators were the least frequent initiators, with the former speaking 4% of the time and the latter speaking 1% of the time. We also found that the meetings had high levels of interactivity, with an initiator-responder ratio of 1:1.63, meaning that for every sequence of interactions initiated, the initiator received more than a single response. Lastly, we found that verbal dysfluencies (laughter, interruptions, and incomplete sentences) were more common in the second half of meetings, where a 45% increase in their frequency was observed. Discussion: Our findings highlight the importance of teamwork in planning MDT meetings, particularly with regard to Cancer Research UK in 2017 cognitive load/fatigue and decision-making, the hierarchy of clinical expertise, and the increased integration of patients' psychosocial information into MDT discussion and their perspectives. Utilizing a micro-level methodology, we highlight identifiable patterns of interaction among participants in MDT meetings and how these can be used to inform the optimization of teamwork. [ABSTRACT FROM AUTHOR]

Background: Tumor boards (TB) are synonymous with quality of care but have been occasionally misunderstood and underutilized. This survey aimed to evaluate health professionals' perceptions of TBs in Brazil. Materials & methods: The survey was sent electronically. Results: Of 206 respondents, 67.8% attended TBs at least once and 82.4% dedicated at least 1 h weekly to them; 64.2% preferred a more &educational' model over case discussions only; 63.1% had institutional leadership capable of promoting multidisciplinarity; 21.1 and 32.7% of the physicians and nonphysicians, respectively, felt intimidated to express their opinions; 91.6% believed that TBs improve cancer outcomes. Postpandemic, 52.7% preferred a hybrid (virtual/face-to-face) model. Conclusion: This study provides a glimpse of the reality of TBs in Brazil, with potential implications for clinical practice. This survey study of 206 oncology healthcare professionals addressed their perceptions of tumor boards in Brazil. It produced results that have potential implications for the practice of multidisciplinary oncology. [ABSTRACT FROM AUTHOR]

The integration of multidisciplinary team meetings (MDTMs) for neurosurgical care has been accepted worldwide. Our objective was to review the literature for the limiting factors to MDTMs that may introduce bias to patient care. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis was used to perform a literature review of MDTMs for neuro-oncology, pituitary oncology, cerebrovascular surgery, and spine surgery and spine oncology. Limiting factors to productive MDTMs and factors that introduce bias were identified, as well as determining whether MDTMs led to improved patient outcomes. We identified 1264 manuscripts from a PubMed and Ovid Medline search, of which 27 of 500 neuro-oncology, 4 of 279 pituitary, and 11 of 260 spine surgery articles met our inclusion criteria. Of 224 cerebrovascular manuscripts, none met the criteria. Factors for productive MDTMs included quaternary/tertiary referral centers, nonhierarchical environment, regularly scheduled meetings, concise inclusion of nonmedical factors at the same level of importance as patient clinical information, inclusion of nonclinical participants, and use of clinical guidelines and institutional protocols to provide recommendations. Our review did not identify literature that described the use of artificial intelligence to reduce bias and guide clinical care. The continued implementation of MDTMs in neurosurgery should be recommended but cautioned by limiting bias. [ABSTRACT FROM AUTHOR]

Multidisciplinary team meetings (MTMs) are considered a pillar of cancer care; however, evidence of the independent benefit of MTMs on survival in rectal cancer is controversial. This population-based cohort analysis included patients undergoing surgery for primary rectal cancer with curative intent. We drew data derived from three clinical audits conducted in Catalonia from 2011 to 2020. The primary outcome was 2-year survival. Multivariable Cox regression analysis was used to assess the hazard ratio for death in patients whose cases were versus were not discussed in a preoperative MTM. A total of 5249 patients were included (66.1 % male, 58.3 % aged 60–79 years, 63.2 % receiving anterior resection): 4096 cases were discussed in a preoperative MTM, and 1153 were not. Multivariable Cox proportional hazards regression analysis showed that the MTM group had better survival than those with no preoperative MTM (hazard ratio 1.22, 95 % confidence interval 1.02–1.48), after adjusting for potential confounders. Preoperative MTM may be associated with improved survival in patients with rectal cancer in Catalonia. Efforts to ensure universal access to MTMs for all newly diagnosed patients should be supported. • Between the audit periods 4096 (78 %) patients' cases were discussed at preoperative MTM • The coverage rate of patients' cases discussed increased from 67.6 % to 87.1 % • More advanced disease increased the likelihood of case discussion at preoperative MTM. • Very advanced age (≥80 years) was not a risk factor for no preoperative MTM. • Preoperative MTM is associated with improved survival in patients with rectal cancer. [ABSTRACT FROM AUTHOR]

Abstract Background Cancer treatment requires a multidisciplinary approach. Therefore, multidisciplinary team meetings (MDTMs) have been widely used to determine the direction of treatment. However, no standard provisions exist for conducting MDTMs, and recommendations discussed in MDTMs are sometimes not implemented. ​This study analyzed the indications for radiotherapy discussed and recommended at MDTMs, identified the rate of radiotherapy recommendations for patients that were not implemented, and clarified the reasons at a single academic center in Japan. Methods This was a cross-sectional study that analyzed the minutes and electronic medical records of cases discussed at MDTMs held between April 2012-March 2017 at Yamagata University Hospital. We categorized how radiotherapy was initially presented at MDTMs, determined the rate of radiotherapy recommendations made through MDTMs, analyzed whether treatment recommendations were subsequently implemented, and examined the causes of non-implementation. We performed a statistical analysis to assess some clinical factors (sex, age, number of multidisciplinary team meetings, and classification of planned treatment) associated with the non-implementation of radiotherapy recommendations from MDTMs. Results A total of 1813 cases were discussed at MDTMs, of which 71% (1293 cases) were presented with treatment plans, including radiotherapy. Further, 66% (1205 cases) were recommended for radiotherapy through the MDTMs. Recommendations from MDTMs were not implemented in 7% (142 cases). The most typical reason for non-implementation was the clinician’s opinion (30%), followed by patient preferences (27%) and disease progression (20%). Change in cancer stage and improvement in symptoms were 12% and 4%, respectively. These ratios were similar each year. We could not find the factors associated with the non-implementation of radiotherapy recommendations from MDTMs. Conclusions MDTMs had a significant effect on the recommendation of radiotherapy for each patient with a tumor. The primary reason for the non-implementation of decisions made at MDTMs was the opinion of clinicians and the patient’s preference. These results were similar to previous studies. We need to establish a monitoring system where patients themselves can decide the treatments based on their choices while using the recommendations from MDTMs.

Khee Chee Soo,1 Issam Al Jajeh,2 Raymond Quah,3 Hoe Kuen Brandon Seah,4 Sharon Soon,4 Espen Walker4 1General Surgery Department, Farrer Park Hospital, Singapore; 2Department of Pathology, Farrer Park Hospital, Singapore; 3Department of Diagnostic Radiology, Farrer Park Hospital, Singapore; 4Roche Diagnostics Asia Pacific, Ltd, SingaporeCorrespondence: Espen WalkerRoche Diagnostics Asia Pacific, Ltd, 8 Kallang Avenue #10-01/09 Aperia Tower 1, 339509, SingaporeTel +65 8428 0386Email espen.walker@roche.comObjective: Integration of distinct clinical perspectives in multi-disciplinary tumor board meetings is critical to determine optimal patient care. Digital tools can support the data consolidation needed for meeting preparation and data sharing during complex case reviews. In this paper, we assessed the value of a clinical decision support tool on workflow efficiency and conducting a complex case review of a dermatofibrosarcoma protuberans (DFSP) tumor.Methods: Case presentation was performed by each unique clinical specialty that had relevant information about the patient; an oncologist, a pathologist, and a radiologist. Virtual discussion was completed online with case presentation and documentation with NAVIFY Tumor Board. Workflow efficiency assessment was done through interviews and observation of the # of steps across different team members involved in preparing and conducting cancer multidisciplinary team (MDT) meetings before and after the implementation of the NAVIFY Tumor Board solution.Results: Case review consisted of surgical and therapeutic intervention history, distinct histological and sequencing patterns representative of DFSP, with radiological review to determine areas for surgical intervention. Consolidation of clinical input led to a recommendation of a formal external hemipelvectomy with potential chemotherapy. Workflow assessment demonstrated a 46% total reduction in the # of steps for meeting preparation (from 69 to 37), with specific changes based on role: data manager (33 to 15), pathologist (26 to 13), radiologist (no change), and logistics (5 to 4). There was a 31% total reduction in the # of steps for conducting the meeting (from 51 to 35).Conclusion: Utilizing a digital clinical decision support tool helped to consolidate patient data and improved case presentation through workflow efficiency. This allowed for improved interdisciplinary discussion on a complex DFSP case and supported the determination of a clinical decision.Keywords: multidisciplinary team meetings, clinical decision support, digital tool, workflow efficiency, virtual MDT

Abstract Background This study aimed to assess a multidisciplinary team (MDT) meeting approach for the management of patients with complex extremity defects, analyze treatment recommendations, and evaluate factors influencing non-implementation. Methods All patients introduced to an MDT meeting for complex extremity defects from 2015 to 2017 were included in a retrospective cohort study. Patients’ characteristics and defect causes were evaluated. Treatment recommendations (TR) of MDT meetings and subsequent implementation were reviewed (cohort with implementation of TR versus cohort with non-implementation of TR), and factors associated with non-adherence to recommendations were statistically analyzed using logistic regression. Results Fifty-one patients (41 male) with a mean age of 54 years were presented in 27 MDT meetings. Most of the patients (70%) suffered from reconstructive challenging or combined bone- and soft tissue defects, primarily located at the lower extremity (88%). Large skeletal defects, chronic osteomyelitis, and multi-fragmented fractures were present in 65% of cases. Forty-five percent of the patients suffered from peripheral vascular disease, necessitating surgical optimization. Of the 51 MDT decisions, 40 were implemented (78%; (32/40) limb salvage versus 22%; (8/40) limb amputation). Limb salvage was successfully achieved in 91% (29/32) of the cases. Failed limb salvages were due to flap failure (33%; 1/3), recurring periprosthetic joint infections (66%; 2/3) and concomitant reconstructive failure. Patients who underwent limb amputation, as recommended, showed proper stump healing and regained mobility with a prosthesis. Overall the MDT treatment plan was effective in 92.5% (37/40) of the patients, who adhered to the MDT treatment recommendation. In eleven patients (22%; 11/51), the MDT treatment was not implemented. MDT decisions were less likely to be implemented, if amputation was recommended (p = 0.029). Conclusions MDT meetings represent a valid tool to formulate individualized treatment plans, avoiding limb amputation in most patients with severe extremity defects. Recommendation for limb amputation is less likely to be implemented than plans for limb salvage. Trial registration: Retrospectively registered

Background: Cancer treatment requires a multidisciplinary approach. Therefore, multidisciplinary team meetings (MDTMs) have been widely used to determine the direction of treatment. However, no standard provisions exist for conducting MDTMs, and recommendations discussed in MDTMs are sometimes not implemented. ​This study analyzed the indications for radiotherapy discussed and recommended at MDTMs, identified the rate of radiotherapy recommendations for patients that were not implemented, and clarified the reasons at a single academic center in Japan.Methods: This was a cross-sectional study that analyzed the minutes and electronic medical records of cases discussed at MDTMs held between April 2012-March 2017 at Yamagata University Hospital. We categorized how radiotherapy was initially presented at MDTMs, determined the rate of radiotherapy recommendations made through MDTMs, analyzed whether treatment recommendations were subsequently implemented, and examined the causes of non-implementation. We performed a statistical analysis to assess some clinical factors (sex, age, number of multidisciplinary team meetings, and classification of planned treatment) associated with the non-implementation of radiotherapy recommendations from MDTMs.Results: A total of 1813 cases were discussed at MDTMs, of which 71% (1293 cases) were presented with treatment plans, including radiotherapy. Further, 66% (1205 cases) were recommended for radiotherapy through the MDTMs. Recommendations from MDTMs were not implemented in 7% (142 cases). The most typical reason for non-implementation was the clinician's opinion (30%), followed by patient preferences (27%) and disease progression (20%). Change in cancer stage and improvement in symptoms were 12% and 4%, respectively. These ratios were similar each year. We could not find the factors associated with the non-implementation of radiotherapy recommendations from MDTMs.Conclusions: MDTMs had a significant effect on the recommendation of radiotherapy for each patient with a tumor. The primary reason for the non-implementation of decisions made at MDTMs was the opinion of clinicians and the patient's preference. These results were similar to previous studies. We need to establish a monitoring system where patients themselves can decide the treatments based on their choices while using the recommendations from MDTMs. [ABSTRACT FROM AUTHOR]

Abstract Background and Objective There is increasing emphasis in cancer care globally for care to be reviewed and managed by multidisciplinary teams (ie, in tumor boards). Evidence and recommendations suggest that the complexity of each patient case needs to be considered as care is planned; however, no tool currently exists for cancer teams to do so. We report the development and early validation of such a tool. Methods We used a mixed‐methods approach involving psychometric evaluation and expert review to develop the Measure of case‐Discussion Complexity (MeDiC) between May 2014 and November 2016. The study ran in six phases and included ethnographic interviews, observations, surveys, feasibility and reliability testing, expert consensus, and multiple expert‐team reviews. Results Phase‐1: case complexity factors identified through literature review and expert interviews; Phase‐2: 51 factors subjected to iterative review and content validation by nine cancer teams across four England Trusts with nine further items identified; Phase 3: 60 items subjected to expert review distilled to the most relevant; Phase 4: item weighing and further content validation through a national UK survey; Phases 5 and 6: excellent interassessor reliability between clinical and nonclinical observers, and adequate validity on 903 video case discussions achieved. A final set of 27 factors, measuring clinical and logistical complexities were integrated into MeDiC. Conclusions MeDiC is an evidence‐based and expert‐driven tool that gauges the complexity of cancer cases. MeDiC may be used as a clinical quality assurance and screening tool for tumor board consideration through case selection and prioritization.

Introduction: Management of bone and joint infections (BJI) requires prolonged and high-dose antibiotic therapy to achieve target concentrations in bone tissue. However, these therapies often lead to adverse effects in patients who are frequently fragile, with multiple comorbidities and associated medications. The decision to treat these complex cases is made during a multidisciplinary team meeting at the reference centre for complex osteoarticular infections (CRIOAC)., Material and Methods: Elaborated by a pharmacist during CRIOAC meetings, a single-centre before-and-after comparative study of drug-related issues observed during pharmaceutical interventions (PIs), was conducted. For each patient included, a retrospective case was added. PIs were independently evaluated by a committee of infectiologists and pharmacists to assess their criticality., Results: Sixty patients were included in the intervention group, with 59 controls. The population was homogeneous, with a median age of 65 years. Most BJI cases were complex (65.5 %), primarily involving prosthetic joint infections. Staphylococcus species were the predominant pathogens. Antibiotic therapy adapted to antibiograms was orally relayed for 74 % of patients, with 5.9 % requiring re-hospitalization due to adverse effects. Sixty-two PIs were performed, representing an average of 1.8 PIs per meeting or 34.4 % of patients. Dosage adjustment accounted for 42 % of PIs, drug interactions for 46 %, and treatment availability in community pharmacies for 8 %. Regarding criticality, three PIs were classified as vital, 22 as major, 22 as moderate, and 15 as minor in both groups, with the same distribution between the intervention and control groups., Conclusion: This study demonstrates that by collaborating with surgeons and infectiologists, pharmacists participating in CRIOAC meetings can strongly help to prevent drug-related problems in patients with BJIs., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

The healthcare industry compares unfavorably with other ultra-safe industries such as aviation and nuclear power plants, which address complexity by reducing the vulnerability of a single person and promoting teams and strong systems. A multidisciplinary tumor board (MTB) is an evidence-based organizational approach to implementing a more effective concept in oncology practice. Studies addressing the correlation between MTBs and cancer outcomes show promising results, and other potential benefits are also addressed. The objectives of this article are to define and characterize MTBs in modern oncology practice, review the current literature on MTBs effectiveness and address challenges to the implementation and maintenance of MTBs. In this commentary-type narrative review, the authors present their opinions and, whenever possible, substantiate recommendations by citing supportive literature. [ABSTRACT FROM AUTHOR]

The multidisciplinary team approach has been employed internationally for decades, as an attempt to bring collaborative decision-making and concentrate clinical experience from multiple specialties on single patient cases in a systematic fashion. Adoption is not yet worldwide, but is increasing. The role of the histopathologist is central, providing vital information and context to clinical diagnosis and management. Our review summarizes some of the most relevant research on the topic of MDT usage and efficacy in relation to breast cancer, attempting to draw together its advantages and challenges. It is hoped that this review will make a contribution to the current international literature regarding multidisciplinary approaches in breast cancer care.

Les réunions de concertation pluridisciplinaire (RCP) ont pour objectif de proposer la meilleure prise en charge aux patients en fonction de l'état de la science. Si la RCP d'oncologie a su démontrer son importance, ce n'est pas le cas de la RCP de médecine interne. Nous avons conduit une étude descriptive rétrospective au sein du CHU de Grenoble Alpes, incluant les données issues de 247 comptes rendus de RCP établis sur la période de janvier 2013 à février 2019. Nous avons examiné les éléments relatifs aux patients, à la tenue des séances et aux avis rendus par la RCP. Les discussions pouvaient concerner une prise en charge diagnostique et/ou thérapeutique. Trois spécialités médicales, parmi lesquelles la médecine interne, étaient représentées au cours des réunions. Sur le plan des avis diagnostiques, 18 % des dossiers nécessitaient l'avis d'un médecin spécialiste, 12 % des dossiers étaient considérés « complexes ». Sur le plan thérapeutique, des recommandations étaient disponibles dans 35 % des cas ; 50 % des propositions thérapeutiques concernaient des thérapeutiques onéreuses, hors-AMM dans 75 % de ces situations. Les comptes rendus mentionnaient le référentiel utilisé pour la prise de décision dans 6 % des cas. L'avis formulé par la RCP était appliqué dans 72 % des cas. La RCP de médecine interne répond à un réel besoin de la part des médecins, dans l'intérêt final du patient. Une analyse prospective serait intéressante pour une meilleure définition des critères d'évaluation de ces RCP. Multidisciplinary team (MDT) meetings purpose is to optimize the disease management regarding state of science. While cancer MDT has proven its effectiveness, this is not yet the case with internal medicine MDT. We performed a descriptive monocentric retrospective study. Data were collected from 247 MDT meeting reports which took place at the Grenoble University Hospital over a 5 years period. We investigated the data related to patient, MDT features, and decision-making process and reporting. Discussions were classified as diagnostic and/or therapeutic. Three specialties, among which at least internal medicine, attended to meetings. While 12% of cases were considered as "complex", a specialist opinion was required in 18% of diagnostic discussions. With regards to therapeutic discussions, 35% were supported by guidelines, 50% of therapeutic implementation involved innovating and expensive drugs, with off-label prescription in 75% of them. The decision-making process was described in 6% of the reports. Treatment recommendations were actually implemented in 72% of the patients. MDT meetings in Internal medicine meets a real need of physicians, in the ultimate interest of the patient. A prospective analysis would be interesting for a better definition of the evaluation criteria of these MDT meetings, meeting the physicians' needs, in patient management best interest. Prospective analyses are needed to better define MDT meetings assessment criteria. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess a multidisciplinary team (MDT) meeting approach for the management of patients with complex extremity defects, analyze treatment recommendations, and evaluate factors influencing non-implementation.Methods: All patients introduced to an MDT meeting for complex extremity defects from 2015 to 2017 were included in a retrospective cohort study. Patients' characteristics and defect causes were evaluated. Treatment recommendations (TR) of MDT meetings and subsequent implementation were reviewed (cohort with implementation of TR versus cohort with non-implementation of TR), and factors associated with non-adherence to recommendations were statistically analyzed using logistic regression.Results: Fifty-one patients (41 male) with a mean age of 54 years were presented in 27 MDT meetings. Most of the patients (70%) suffered from reconstructive challenging or combined bone- and soft tissue defects, primarily located at the lower extremity (88%). Large skeletal defects, chronic osteomyelitis, and multi-fragmented fractures were present in 65% of cases. Forty-five percent of the patients suffered from peripheral vascular disease, necessitating surgical optimization. Of the 51 MDT decisions, 40 were implemented (78%; (32/40) limb salvage versus 22%; (8/40) limb amputation). Limb salvage was successfully achieved in 91% (29/32) of the cases. Failed limb salvages were due to flap failure (33%; 1/3), recurring periprosthetic joint infections (66%; 2/3) and concomitant reconstructive failure. Patients who underwent limb amputation, as recommended, showed proper stump healing and regained mobility with a prosthesis. Overall the MDT treatment plan was effective in 92.5% (37/40) of the patients, who adhered to the MDT treatment recommendation. In eleven patients (22%; 11/51), the MDT treatment was not implemented. MDT decisions were less likely to be implemented, if amputation was recommended (p = 0.029).Conclusions: MDT meetings represent a valid tool to formulate individualized treatment plans, avoiding limb amputation in most patients with severe extremity defects. Recommendation for limb amputation is less likely to be implemented than plans for limb salvage.Trial Registration: Retrospectively registered. [ABSTRACT FROM AUTHOR]

Multidisciplinary (MD) care is essential in the management of patients with spondyloarthritis (SpA) and is one of the main pillars of disease management and patient care. However, evidence supporting the effectiveness and benefits of this strategy in SpA is scarce. In this review we discuss the three types of MD care models: (i) combined clinics (MD units), including 'face to face', 'parallel' and 'circuit approach' clinics; (ii) MD team meetings; (iii) group consultations. The most frequently used model in SpA studies has been the 'parallel' combined clinic and usually encompasses a rheumatologist and another specialist, most commonly a dermatologist or a gastroenterologist, that work in tandem according to predefined referral criteria and treatment algorithms. MD working seems to improve the care of patients with SpA by a better identification and diagnosis of the disease, an earlier and more comprehensive treatment approach, and better outcomes for patients in terms of disease activity, physical function, quality of life and patient satisfaction. Nevertheless, challenges remain. Data on effectiveness and feasibility are scarce and are mostly derived from studies with design issues and often without a unidisciplinary care comparator arm. Although patient centricity is one of the core values of patient care and MD setting in SpA, the patient often does not play an active role in most of the MD settings studied or in common clinical practice. Further efforts should be made so that MD care reflects patients' expectations and needs. Overcoming these limits will help to implement successfully SpA MD care in daily clinical practice and subsequently to achieve a higher quality of care for our patients. [ABSTRACT FROM AUTHOR]

Background and Objective: There is increasing emphasis in cancer care globally for care to be reviewed and managed by multidisciplinary teams (ie, in tumor boards). Evidence and recommendations suggest that the complexity of each patient case needs to be considered as care is planned; however, no tool currently exists for cancer teams to do so. We report the development and early validation of such a tool. Methods: We used a mixed‐methods approach involving psychometric evaluation and expert review to develop the Measure of case‐Discussion Complexity (MeDiC) between May 2014 and November 2016. The study ran in six phases and included ethnographic interviews, observations, surveys, feasibility and reliability testing, expert consensus, and multiple expert‐team reviews. Results: Phase‐1: case complexity factors identified through literature review and expert interviews; Phase‐2: 51 factors subjected to iterative review and content validation by nine cancer teams across four England Trusts with nine further items identified; Phase 3: 60 items subjected to expert review distilled to the most relevant; Phase 4: item weighing and further content validation through a national UK survey; Phases 5 and 6: excellent interassessor reliability between clinical and nonclinical observers, and adequate validity on 903 video case discussions achieved. A final set of 27 factors, measuring clinical and logistical complexities were integrated into MeDiC. Conclusions: MeDiC is an evidence‐based and expert‐driven tool that gauges the complexity of cancer cases. MeDiC may be used as a clinical quality assurance and screening tool for tumor board consideration through case selection and prioritization. [ABSTRACT FROM AUTHOR]

Accurate pathological subtyping of tumours is important in the diagnosis and management of patients presenting with primary lung carcinoma (cancer). For those patients who are considered suitable candidates for surgical resection, pathological evaluation and staging of the cancers within these specimens is also integral to this process, often providing additional information central to those management decisions. In this article, we aim to review the principles of the widely used clinical and pathological TNM staging process and guide an enhanced understanding of the significance of the pTNM and stage groupings provided with each surgical resection report for primary lung cancer. It will also highlight some of the major changes in moving from the 7th to the 8th TNM edition, reinforcing the importance of appreciating, when reading a report, which edition is or was being utilized at any given particular time in the evaluation of a patient's cancer. [ABSTRACT FROM AUTHOR]

Purpose: Multidisciplinary team meetings (MDTs) are the standard of care for safe, effective patient management in modern hospital-based clinical practice. Medical imaging data are often the central discussion points in many MDTs, and these data are typically visualised, by all participants, on a common large display. We propose a Web-based MDT visualisation system (WMDT-VS) to allow individual participants to view the data on their own personal computing devices with the potential to customise the imaging data, i.e. different view of the data to that of the common display, for their particular clinical perspective. Methods: We developed the WMDT-VS by leveraging the state-of-the-art Web technologies to support four MDT visualisation features: (1) 2D and 3D visualisations for multiple imaging modality data; (2) a variety of personal computing devices, e.g. smartphone, tablets, laptops and PCs, to access and navigate medical images individually and share the visualisations; (3) customised participant visualisations; and (4) the addition of extra local image data for visualisation and discussion. Results: We outlined these MDT visualisation features on two simulated MDT settings using different imaging data and usage scenarios. We measured compatibility and performances of various personal, consumer-level, computing devices. Conclusions: Our WMDT-VS provides a more comprehensive visualisation experience for MDT participants. [ABSTRACT FROM AUTHOR]

We evaluate breast cancer (BC) pathway at a regional level including public, private and university institutions. We assessed the quality of multidisciplinary team meetings (MTM) and compliance with a panel of European high-quality indicators (EUSOMA QIs). We conducted a retrospective multicenter (n = 20) study in the largest health care region in France. Between January and April 2015, we included all patients discussed at an MTM after a diagnosis of BC (n = 619). We analyzed quality of MTM by assessing the quorum, the reliability of data transcription and the exhaustivity of pre-therapeutic MTM. We then analyzed the compliance with a selected panel of 16 EUSOMA QIs. During MTM discussion, data were more than 95% consistent with medical records for 9/11 items. Pre-operative tumor histology (90.6%) and post-operative resection margins (84.3%) were the least concordant between medical records and MTM. Minimum standards as defined by EUSOMA were reached for 11/16 QIs, but not reached for pathology reports in non-invasive BC (78.2%), proportion of exclusive sentinel lymph node biopsies in patients with clinically negative axilla (85.2%), performing adjuvant chemotherapy (76.6%), and proportion of patients discussed in pre-therapeutic and post-operative MTM (63.5%). In this multicentric study evaluating the quality of BC care with a representative sample of institutions, compliance with EUSOMA indicators was satisfactory for all type of institutions. However, too few patients were discussed in pre-therapeutic MTM (especially in non-university hospitals 43.7% [39.4–48.1]) versus 88.7% for others [82.2–95.1]) and data transcription was likely responsible for up to 15% of discordance. • Real-life breast cancer care access includes private, public and universitary institutions. • Compliance with EUSOMA Quality indicators was satisfactory in real-life conditions. • Improvements need to be made regarding discussion in pre-therapeutic MTMs. • Reliability of the data transcription for pathology reports exceeded 95%. • Up to 15% of pathology data regarding post-operative resection margins were missing. [ABSTRACT FROM AUTHOR]

Background: Oncological computerized clinical decision support systems (CCDSSs) to facilitate workflows of multidisciplinary team meetings (MDTMs) are currently being developed. To successfully implement these CCDSSs in MDTMs, this study aims to: (a) identify barriers and facilitators for implementation for the use case of lung cancer; and (b) provide actionable findings for an implementation strategy. Methods: The Consolidated Framework for Implementation Science was used to create an interview protocol and to analyze the results. Semi-structured interviews were conducted among various health care professionals involved in MDTMs. The transcripts were analyzed using a thematic analysis following a deductive approach. Results: Twenty-six professionals participated in the interviews. The main facilitators for implementation of the CCDSS were considered to be easy access to well-structured patient data, and the resulting reduction of MDTM preparation time and of duration of MDTMs. Main barriers for adoption were seen in incomplete or non-trustworthy output generated by the system and insufficient adaptability of the system to local and contextual needs. Conclusion: Using a CCDSS in lung cancer MDTMs was expected to increase efficiency of workflows. Successful implementation was seen as dependent on the reliability and adaptability of the CCDSS and involvement of key users in the implementation process.

Background: To develop methods for cancer teams to work effectively, it is first necessary to understand how multidisciplinary teams work together as part of an organization. Implementation and adoption of new clinical practices such as team working is a challenging task. It is known that implementation of multidisciplinary working depends on a complex, multilevel interaction of team, and organizational factors. However, little is known about the threats to the sustainability of functioning multidisciplinary teams.Materials and Methods: A questionnaire was mailed to 125 multidisciplinary team meetings (MTMs) attendees. Five focus groups were gathered in order to discuss threats and strengths of cancer team-working. Discussions at the meetings were transcribed verbatim and analyzed for emergent themes using standard qualitative research methodology.Results: About 31 physicians and MTMs attendees participated in the focus groups. They perceive that meetings are very useful for making a good decision over patients. Lack of dedicated time and lack of support by the institution were the most recurrent themes which could be considered as threats for sustainability of cancer conferences. Leadership and decision-making process should be refined.Conclusions: Physicians see enormous value in MTMs but the lack of support from the organization could compromise the future effective working. This research highlights the need to explore local strengths and threats for sustainability of periodic cancer team working. [ABSTRACT FROM AUTHOR]

Abstract: Background: Multidisciplinary team meetings (MDTM) have proven efficacy in cancer management. Whilst widely implemented in inflammatory bowel disease (IBD) care, their value is yet to be investigated. We reviewed the performance of MDTM for IBD patients. Methods: Retrospective review of MDTM from March 2013 to July 2016. Each patient’s first MDTM was considered. Data collected included: report production and location, disease factors, recommendation(s), implementation and barriers to implementation. The MDTM process was considered successful when at least top‐level recommendations were implemented within 6 months. Results: MDTM attendance included an IBD gastroenterologist, surgeons, a radiologist, nurses, dieticians, psychologists and clinical trial staff. Initial MDTM encounters of 166 patients were reviewed: 86 females, mean age 40 years, 140 (84.3%) with Crohn disease and mean disease duration of 10.8 years (interquartile range 15 years). Electronic reports were filed for all patients, with hard copies in 84%. In 151 of 166 episodes, all (n = 127) or top‐line (n = 24) recommendations were implemented, although there was a delay beyond 6 months in 5. Of 146 patients with a successful MDTM, 85 (58.2%) were in clinical remission at last review (median follow up: 27 months). Amongst patients with unsuccessful MDTM (n = 13), only two (15.4%) were in clinical remission at follow up. Barriers to implementation included patients declining recommendations and loss to follow up. Conclusion: The majority of MDTM encounters were successful from both a process and clinical outcome perspective. System opportunities to improve the process include ensuring that 100% of reports are available and addressing implementation delays. Patient factors that require addressing include improved engagement and understanding reasons for declining recommendations. [ABSTRACT FROM AUTHOR]

The concept of multidisciplinary team meetings (MDTs) in cancer care is endorsed internationally, but its uptake varies considerably. In Belgium, MDT meetings were financially recognised in 2003 to encourage healthcare professionals to join their knowledge and competences to improve the quality and coordination of cancer care. This study aimed to evaluate for seven cancer types diagnosed between 2004 and 2011, the practices of MDT meetings in Belgium by means of population‐based administrative databases. Results show a clear increase over time in the proportion of individual patients discussed at MDT meetings. Although this evolution may be partly explained by the legal implementation of several financial initiatives to stimulate MDT meetings, it also suggests an increase in specialists’ awareness of the importance of such meetings. Nevertheless, there is still room for improvement, for specific cancer types as well as for certain subgroups such as older patients. From the specialists’ point of view, reducing the administrative burden and time these meetings demand may entail a greater participation to MDT meetings. Further research is needed to identify the barriers to discuss more patients at MDT meetings and to elucidate the impact of MDT meetings on the quality of cancer care. [ABSTRACT FROM AUTHOR]

Objectives: Multidisciplinary team meetings (MTM) are essential in the choice of a therapeutic strategy in head and neck cancer. In many centres patients attend MTMs and are examined by the team. The aim of this study was to assess the influence of the patient's presence on therapeutic decisions. Study design: Prospective study of 119 consecutive patients. Methods: Two therapeutic situations were compared: the therapeutic decision taken following discussion of the patient's file in the MTM (D1) and the therapeutic decision taken after examination of the patient during MTMs (D2). Concordance between the two situations was measured. Results: Concordance between D1 and D2 was 97%. No factors likely to decrease concordance were identified. Decisions taken during MTMs were acted upon for 97% of the patients. Conclusion: The presence of the patient during MTMs is not essential if the files are thoroughly presented and discussed. [ABSTRACT FROM AUTHOR]

Background: For therapy planning in cancer patients multidisciplinary team meetings (MDM) are mandatory. Due to the high number of cases being discussed and significant workload of clinicians, Clinical Decision Support System (CDSS) may improve the clinical workflow., Methods: This review and meta-analysis aims to provide an overview of the systems utilized and evaluate the correlation between a CDSS and MDM., Results: A total of 31 studies were identified for final analysis. Analysis of different cancers shows a concordance rate (CR) of 72.7% for stage I-II and 73.4% for III-IV. For breast carcinoma, CR for stage I-II was 72.8% and for III-IV 84.1%, P≤ 0.00001. CR for colorectal carcinoma is 63% for stage I-II and 67% for III-IV, for gastric carcinoma 55% and 45%, and for lung carcinoma 85% and 83% respectively, all P>0.05. Analysis of SCLC and NSCLC yields a CR of 94,3% and 82,7%, P=0.004 and for adenocarcinoma and squamous cell carcinoma in lung cancer a CR of 90% and 86%, P=0.02., Conclusion: CDSS has already been implemented in clinical practice, and while the findings suggest that its use is feasible for some cancers, further research is needed to fully evaluate its effectiveness., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Oehring, Ramasetti, Ng, Roller, Thomas, Winter, Maurer, Moosburner, Raschzok, Kamali, Pratschke, Benzing and Krenzien.)

Introduction: Multidisciplinary team meetings (MTMs) in the field of pelvic floor diseases in women tend to generalize, as they are required as mandatory before mid-urethral sling implantation or sacrocolpopexy by recent decrees published by the French health authorities. However, access to these meetings is variable in the French territory. The goal of the present study was to describe the existence and the settings of these kinds of meetings in France., Materiel and Methods: An on-line survey was conducted between June and July 2020 (stage 1) then between November 2021 and January 2022 (stage 2). A 15-item questionnaire was sent to all members of the Association française d'urologie (AFU). A descriptive analysis was conducted., Results: Three hundred and twenty-two completed questionnaires were sent back during stage 1 and 158 during stage 2. Early 2022, 61.3% of respondents had access to a pelviperineology MTM, with important difference according to geographical areas. Main activity of MTMs was case discussion of complex situations (68% of meetings). At the end of 2021, 22% of the respondents declared willing to stop partially or totally their pelviperineology activity, given the new regulations set in place by the authorities., Conclusion: Despite being absolutely mandatory in current clinical practice, MTMs in pelvic floor disease have spread slowly. MTMs implementation was still insufficient in 2022, and variable on the French territory. Some urologists declare having no access to such resources and about 1 out of 5 were considering to voluntary stop of decrease significantly their activity in this difficult context., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

The way we provide healthcare is influenced by ongoing experiences, increased knowledge, new discoveries and scientific as well as technological advances. The rapid pace of important developments that have taken place in recent years have significantly influenced our choices of the ways we provide our health service. Like other medical specialties, pathology and its practice have had to respond to the rising needs and challenges within the health service in general and those facing the speciality in particular. This article addresses some of the challenges, particularly those which are unique to pathology. It discusses the choices that are available to different pathology departments depending on their individual circumstances.

The purpose of this study was to develop a novel index for preoperative, non-invasive prediction of complete primary cytoreduction in patients with FIGO stage IIIC-IV epithelial ovarian cancer. Prospectively collected clinical data was registered in the Danish Gynecologic Cancer Database. Blood samples were collected within 14 days of surgery and stored by the Danish CancerBiobank. Serum human epididymis protein 4 (HE4), serum cancer antigen 125 (CA125), age, performance status, and presence/absence of ascites at ultrasonography were evaluated individually and combined to predict complete tumor removal. One hundred fifty patients with advanced epithelial ovarian cancer were treated with primary debulking surgery (PDS). Complete PDS was achieved in 41 cases (27 %). The receiver operating characteristic curves demonstrated an area under the curve of 0.785 for HE4, 0.678 for CA125, and 0.688 for age. The multivariate model (Cancer Ovarii Non-invasive Assessment of Treatment Strategy (CONATS) index), consisting of HE4, age, and performance status, demonstrated an AUC of 0.853. According to the Danish indicator level, macro-radical PDS should be achieved in 60 % of patients admitted to primary surgery (positive predictive value of 60 %), resulting in a negative predictive value of 87.5 %, sensitivity of 68.3 %, specificity of 83.5 %, and cutoff of 0.63 for the CONATS index. Non-invasive prediction of complete PDS is possible with the CONATS index. The CONATS index is meant as a supplement to the standard preoperative evaluation of each patient. Evaluation of the CONATS index combined with radiological and/or laparoscopic findings may improve the assessment of the optimal treatment strategy in patients with advanced epithelial ovarian cancer. [ABSTRACT FROM AUTHOR]

Background Single point of access meetings represent a critical juncture in the lives of mental health clients. The decision-making process undertaken by mental health professionals during this time is therefore crucial. Method Glaserian grounded theory, with observations and interviews through theoretical sampling, was used to investigate the decision making of attendees. Findings A basic social process named handling role boundaries emerged, consisting of four phases: recognising, positioning, weighing up and balancing. Conclusion Handling role boundaries is an innovative, sociological theory that allows conceptual understanding to show how personality traits contribute to the discussions and decisions, as well as professional roles. These need to be managed effectively to make decisions in a limited time frame. Handling role boundaries explains how this is done in a local mental health trust. [ABSTRACT FROM AUTHOR]