Carotid artery web with fetal posterior cerebral artery variant masquerading as recurrent ipsilateral cryptogenic ischaemic strokes

A 31-year-old woman was referred to vascular surgeons with the history of recurrent ischaemic strokes in two cerebral artery territories over a span of 1 year. On investigation, she was found to have a right internal carotid artery web, with thrombus and a fetal right posterior cerebral artery (PCA), which explained the ischaemic strokes in right middle cerebral and PCA territory. The rare association of these two infrequent entities makes the case a singular one in the medical literature. Successful surgical excision was done after multidisciplinary teamwork. The carotid web was excised as part of carotid artery endarterectomy and repaired with great saphenous vein patch angioplasty. The patient made a good recovery.

EP.TU.23Impact of a multi-disciplinary team teaching programme on understanding of roles and communication among the multi-disciplinary team

Background Multidisciplinary teamwork is a critical aspect of patient care. It has a well recognised impact on patient healthcare outcomes. Communication among the multidisciplinary team (MDT) is paramount for effective collaboration, joint care planning and co-ordinated assessments of patients. Aim To evaluate the impact of an MDT teaching programme on understanding of roles, and communication among the MDT. Methods A questionnaire was distributed among ward staff who rated their understanding of roles and experience of communication for 8 teams within the MDT. An MDT teaching programme was designed and ran weekly over 6 weeks, aimed at improving understanding of roles and communication among the MDT. Sessions were attended by various members of staff including junior doctors, occupational therapy, physiotherapy, junior and senior nursing staff, consultants, and ward clark. The questionnaire was repeated and results were compared. Results Understanding of MDT roles was rated 15-32% higher after the teaching programme. For MDT teams not involved in the teaching programme, understanding of roles was rated the same or lower than before the programme. Staff experience of communication among the MDT was rated higher by 18% after the teaching programme. Additionally, the teaching programme provided an opportunity for MDT members to organise weekly MDT-based activities aimed at improving patient healthcare outcomes. Conclusion In conclusion, MDT teaching programmes are an effective way of improving understanding of roles and communication among the MDT.

Cardiac Arrest due to Tamponade during Endovascular Stent Implantation: a Case Report

Hemorrhagic cardiac tamponade is one of potentially fatal complications of endovascular intervention. Usually it is because of perforation of heart or rupture of aorta. Cases of pericardial effusion without any arterial or heart injury are rare. Case presentation we reported is a clinical case of cardiac arrest due to tamponade in a patient with DeBakey type I aortic dissection (AD) undergoing thoracic aortic stent implantation. In the early phase of the procedure, hemodynamic changes of increased central venous pressure and decreased blood pressure - by tamponade were noticed but unrecognized and lead to cardiac arrest ultimately. During resuscitation, cardiac tamponade was suspected and confirmed by transesophageal echocardiography (TEE). The patient was successfully resuscitated after pericardiocentesis. Conclusion This case of cardiac tamponade emphasizes the importance of vigilant clinical and echo assessments, efficient multidisciplinary teamwork in deal with the rare but severe complication.

Presence of Two Separate Hairy Polyps with Meningothelial Elements in a 15-Month-Old Child

Hairy polyps are benign embryological tumors of the head and neck region that are derived from two germinal layers, the ectoderm and mesoderm. At an incidence of 1 : 40000, hairy polyps are considered rare growths. Presenting symptoms of hairy polyps can vary greatly depending on the size and location of the tumor. To the best of our knowledge, our reported case is the first in the literature to highlight an extremely rare occurrence of two separate hairy polyps being simultaneously present in one patient, in the clivus and the nasion, with the presence of meningothelial cells within both tumors, histopathologically. With surgical resection as the management of choice, the approach of surgery differs greatly depending on many factors. Since the patient in our reported case had a cleft palate, we used a combined transnasal and transoral approach to fully release the clival mass and a direct skin incision for the nasion mass. Recurrence after complete surgical resection is rare, and if happens, it should rise suspicion of histopathologically misdiagnosed tumor. We amplified the importance of advanced radiological investigations along with proper multidisciplinary teamwork to exclude CNS connections and other histologically malignant tumors and to early pick up a possible simultaneous lesion.

Managing post-stroke fatigue: A qualitative study to explore multifaceted clinical perspectives

Introduction Post-stroke fatigue (PSF) is common and debilitating. However, while its effective management is a priority for clinicians and stroke survivors, there remains little evidence to provide guidance or underpin practice. Our aim, therefore, was to gain insights into the experiences of clinicians who routinely manage patients with fatigue. Method Qualitative interview study. The target was to recruit a purposeful sample of approximately 20 participants with expertise in managing PSF and fatigue arising from other conditions. Maximum variation sampling was used to ensure a balance of participants across different settings. Data were analysed using a framework approach, iteratively developed and refined by including emergent themes. Results We recruited 20 participants: nine occupational therapists (OTs), five physiotherapists, three nurses and three psychologists, which included three ‘fatigue experts’ from Europe and Australia. Analysis generated core themes around management and strategies used; these were similar regardless of professional background, clinical or geographical setting or condition treated. OTs felt a particular responsibility for fatigue management, although multidisciplinary teamwork was stressed by all. Conclusion There are clear similarities in clinicians’ experiences of managing PSF and fatigue across different conditions and also across professional groups. Clinicians rely predominantly on their own clinical knowledge for guidance.

Literature as a Pedagogical Tool in Medical Education: The Silent Patient Case

The arts have seen increasing use in medical education over the last 4 decades. Literature in particular is now frequently used as an educational tool in different medical humanities programmes. This paper analyses Alex Michaelides’ novel The Silent Patient with the goal of examining the professional issues presented in this psychological thriller and how the novel’s themes can be used to prompt discussion among medical students about professionalism and ethics in psychiatric settings. Following Strauss and Corbin’s qualitative procedure for conventional content analysis, this study employs content analysis of the literary text. The process of analysis began with open coding in which codes were assigned to all relevant sentences and paragraphs addressing professionalism in working with silent patients in psychiatry. These codes were then analysed to identify five major themes: multidisciplinary teamwork; therapy for the therapist; patient-centred care for silent patients; communication with silent patients; professional challenges in working with silent patients. The paper concludes that The Silent Patient novel represents important issues related to ethics and professionalism in working with silent patients in psychiatric settings. The novel can be used as a creative tool to guide discussion surrounding these issues. The paper argues that although the impact of its use is short-term, literature can make a significant contribution by provoking thought and discussion about professional and ethical aspects of practising medicine and caring for patients.

Music therapy in the Hospital-at-home: A practice for children in palliative care

This pilot research study investigated music therapy in a hospital-at-home setting for children in palliative care, focusing on parental and nurses experiences of music therapy. Nine families included in the study were interviewed after receiving a maximum of five individual music therapy sessions at home with a Music Therapist. In addition, a focus group interview with allied health professionals involved in the patients’ care was conducted investigating the multidisciplinary team’s experiences with music therapy. Results revealed that the families drew attention to the feeling of being isolated–yet connected due to music therapy. All the families reported the importance of the relationship to the Music Therapist, while emphasizing flexibility and joint music-making. Music therapy within hospital-at-home treatment was reported as a meaningful and much appreciated form of therapy, while the multidisciplinary teamwork was highly valued by both the health personnel and the families. The results showed the need for a highly skilled Music Therapist to support the families’ complex and dynamic needs within a hospital-at-home setting. The results demonstrated the need for, and the possibilities of, a dynamic music therapy programme adapting not only to the patients’ individual needs but additionally providing family-centred care that considered shifting locations.

Invasive para-aortic Candida glabrata: a multidisciplinary management challenge

A 69-year-old man was admitted with recurrent fungal bloodstream infection on a background of abdominal aneurysm, diabetes and chronic obstructive pulmonary disease. Investigations revealed a para-aortic mass, previously thought to be lymphoma, which was culture positive for Candida glabrata on biopsy. Diagnosis and management involved multidisciplinary teamwork, diagnostic uncertainty and significant risk taking.