Developing sensor materials for screening intestinal diseases

Intestinal diseases have always been the focus of clinicians and scientific researchers, which have high mortality and morbidity rates, and bring huge encumbrance on the public medical system and economy worldwide. In the progression of many intestinal diseases, early diagnosis and intervention are valuable. Fortunately, the emergence of sensor materials can effectively assist clinical early diagnosis and health monitoring. By accurately locating the lesion and sensitively analyzing the level of disease markers, these sensor materials can help to precisely diagnose the stage and state of lesions, thereby avoiding delaying the treatment. In this review, we provide a comprehensive and in-depth knowledge into diagnosing and monitoring intestinal diseases with the assistance of sensor materials, particularly emphasizing the design and application of them in bioimaging and biodetection. This review is dedicated to conveying the practical applications of sensor materials in the intestine, a critical analysis of their mechanisms and applications, and discussion of their future roles in medicine. We believe that this review would promote the multidisciplinary communication between material science, medicine, and the relevant engineering fields, thus improving the clinical translation of sensor materials

Extending Our Scientific Reach in Arboreal Ecosystems for Research and Management

The arboreal ecosystem is vitally important to global and local biogeochemical processes, the maintenance of biodiversity in natural systems, and human health in urban environments. The ability to collect samples, observations, and data to conduct meaningful scientific research is similarly vital. The primary methods and modes of access remain limited and difficult. In an online survey, canopy researchers (n = 219) reported a range of challenges in obtaining adequate samples, including ∼10% who found it impossible to procure what they needed. Currently, these samples are collected using a combination of four primary methods: (1) sampling from the ground; (2) tree climbing; (3) constructing fixed infrastructure; and (4) using mobile aerial platforms, primarily rotorcraft drones. An important distinction between instantaneous and continuous sampling was identified, allowing more targeted engineering and development strategies. The combination of methods for sampling the arboreal ecosystem provides a range of possibilities and opportunities, particularly in the context of the rapid development of robotics and other engineering advances. In this study, we aim to identify the strategies that would provide the benefits to a broad range of scientists, arborists, and professional climbers and facilitate basic discovery and applied management. Priorities for advancing these efforts are (1) to expand participation, both geographically and professionally; (2) to define 2–3 common needs across the community; (3) to form and motivate focal teams of biologists, tree professionals, and engineers in the development of solutions to these needs; and (4) to establish multidisciplinary communication platforms to share information about innovations and opportunities for studying arboreal ecosystems.

To Look or Not to Look? Axillary Imaging: Less May Be More

Axillary lymph node status in patients with breast cancer is an important prognostic indicator and often guides vital treatment decisions. Although in many cases imaging plays a crucial role in the assessment of the axilla, it is essential that targeted axillary US and/or image-guided biopsy of an axillary lymph node be performed by the radiologist only when clinically appropriate. This decision-making process requires multidisciplinary communication and collaboration among radiologists, surgeons, medical oncologists, and radiation oncologists. Our goal is to review axillary imaging for patients with breast cancer in two distinct clinical settings, the patient with newly diagnosed breast cancer who meets American College of Surgeons Oncology Group Z0011 criteria and patients undergoing neoadjuvant chemotherapy, with a specific focus on potential reasons to not perform axillary US and/or image-guided biopsy in these settings.

Enhancing palliative care consultation workflow on an inpatient oncology unit.

208 Background: The American Society of Clinical Oncology practice guidelines recommend early palliative care integration for all patients with cancer. At UMass Memorial Medical Center from Sept. to Nov. 2020, only 16% (29/184) of patients on the inpatient oncology unit received a palliative care consultation. Of these consultations, 55% (16/29) were placed within 72 hours of admission. Results from a pre-pilot survey of nurses (n = 20) and providers (n = 14) about attitudes toward palliative care, team communication, and perceptions of barriers to palliative care consultation highlighted a lack of multidisciplinary communication and consensus on criteria for palliative care consultation. Methods: An evidence-based palliative care screening tool and multidisciplinary communication process was piloted to support team collaboration and early identification of oncology patients who may benefit from specialty-level inpatient palliative care. The primary objective was to increase the percentage of palliative care consultations placed within 72 hours of admission from 55% to 65%. Nurses screened patients upon unit arrival for palliative care needs. Patients who screened positive were discussed during daily multidisciplinary rounds, attended by the resource nurse, primary team, case manager and social worker. Results: In March 2021, the percentage of palliative care consultations placed by providers within 72 hours of inpatient admission increased to 68% (13/19). The proportion of patients who received palliative care consultation also increased to 29%. All the patients who screened positive for palliative care needs received a consultation. In a post-pilot survey of providers (n = 9) and nurses (n = 14), most providers (78%) reported that discussions of patients’ palliative care needs occurred more frequently during multidisciplinary rounds. A majority of nurses (57%) agreed the screening tool led to enhanced multidisciplinary communication. 63% of providers agreed that criteria for palliative care consultation was clearer as a result of the pilot; both nurse and provider perceptions of “lack of provider agreement on palliative care consultation criteria” as a barrier decreased compared to the pre-pilot survey. Although a majority of nurses (71%) found the screening tool easy to use, only half were comfortable with all the questions or understood them completely. All providers and 93% of nurses preferred to continue using the screening tool and communication process, and supported electronic medical record integration. Conclusions: The palliative care screening tool and workflow process had a positive impact on earlier identification of oncology patients who could benefit from specialty palliative care, and increased the total number of palliative care consultations. This improved process also enhanced team communication and collaboration. Next steps include refining the screening tool and EMR integration.

Temporary device malfunction of an MR conditional cardiac resynchronization defibrillator when undergoing MRI without appropriate re-programming: a case report

Background Magnetic resonance (MR) imaging (MRI) for patients with implantable cardiac devices is becoming more routine, with the development of MR conditional devices allowing more patients access to the imaging they need. However, for this to be performed safely, strict protocols must be followed necessitating close collaboration between cardiology and radiology departments. We present a case where mandatory device re-programming of a cardiac resynchronization therapy defibrillator device into MRI mode was not performed pre-scan leading to temporary device dysfunction with no clinical consequences. Case summary A 72-year-old man presented to a device clinic for a routine device interrogation. An atrial tachycardia response episode was recorded at the same time as the patient reported having undergone an MRI scan at a local centre. The electrogram demonstrated temporary right ventricular loss of capture with standard output programming, and a short episode of oversensing on the atrial and ventricular channel which was not sustained for long enough to meet tachycardia detection. Discussion We demonstrate two potential electrophysiological effects of MRI on pacemakers, where the device had not been appropriately re-programmed pre-procedure. This illustrates that whilst MRI in patients with implantable cardiac devices is safe, strict protocols must be followed requiring robust multidisciplinary communication.

Patients With Substance Use Disorder

Palliative care providers, including physician assistants, frequently encounter substance use disorder (SUD) in patients or their families. Many of these patients with SUD remain undiagnosed at the time of palliative care referral, with most patients with these issues having preexisting conditions. Management of these patients requires proper screening and diagnosis, and teams must establish clear expectations. This chapter teaches palliative care teams to detect SUD and differentiate addiction behaviors from incompletely managed symptoms; diagnose and manage associated psychosocial issues; communicate clear expectations regarding treatment; safely prescribe controlled medications; manage intoxication or withdrawal; and develop plans to deal with drug diversion. Ongoing timely multidisciplinary communication is paramount in managing these challenging illnesses.

Completion of electronic nursing documentation of inpatient admission assessment: insights from Australian metropolitan hospitals

INTRODUCTION: Electronic nursing documentation is an essential aspect of inpatient care and multidisciplinary communication. Analysing data in electronic medical record (eMR) systems can assist in understanding clinical workflows, improving care quality, and promoting efficiency in the healthcare system. This study aims to assess timeliness of completion of an electronic nursing admission assessment form and identify patient and facility factors associated with form completion in three metropolitan hospitals. MATERIALS AND METHODS: Records of 37,512 adult inpatient admissions (November 2018-November 2019) were extracted from the hospitals eMR system. A dichotomous variable descriptive of completion of the nursing assessment form (Yes/No) was created. Timeliness of form completion was calculated as the interval between date and time of admission and form completion. Univariate and multivariate multilevel logistic regression were used to identify factors associated with form completion. RESULTS: An admission assessment form was completed for 78.4% (n=29,421) of inpatient admissions. Of those, 78% (n=22,953) were completed within the first 24 hours of admission, 13.3% (n=3,910) between 24-72 hours from admission, and 8.7% (n=2558) beyond 72 hours from admission. Patient length of hospital stay, admission time, and admitting units nursing hours per patient day were associated with form completion. Patient gender, age, and admitting unit type were not associated with form completion. DISCUSSION: Form completion rate was high, though more emphasis needs to be placed on the importance of timely completion to allow for adequate patient care planning. Staff education, qualitative understanding of delayed form completion, and streamlined guidelines on nursing admission and eMR use are recommended.

LINKAGE, an online tool to support interdisciplinary biomimetic design teams

Implementation of biomimetics in practical innovation strategies still faces various impediments. Multidisciplinary communication is one of the most recognized one. Enabling teammates having various cognitive and conceptual frameworks to properly exchange information is a key lever for optimization. In a previous study, we performed a comparative analysis of biologists' and engineers' cognitive and conceptual frameworks in order to support the establishment of a shared framework of reference within biomimetic teams. This theoretical work led us to consider various guidelines, embodied in a tool, LINKAGE, guiding the team along the biomimetic process, and more specifically during analysis and abstraction steps. This article presents a first version of this free access computerized tool, LINKAGE 1.2. After the description and positioning of LINKAGE, comparing to other existing tools, a testing phase involving 19 professionals divided into 5 interdisciplinary teams is presented. The results of this evaluation lead to the validation of some of the tool's objectives while underlining some lines of improvements. Various perspectives on the tool's development are also presented.

Musculoskeletal anatomy and physiology

This chapter uses text and illustrations to provide an overview of anatomical terminology, musculoskeletal anatomy, and the physiology of bone. It emphasizes the importance of practitioners having a sound understanding of anatomy and physiology of the musculoskeletal system to underpin patient assessment and examination and understanding of pathophysiology and injury. The use of a common language is essential to effective multidisciplinary communication and consequent safe and effective patient care.