ABSTRACT
Background/Purpose: The craniofacial team meeting represents a critical timepoint at which a diverse group of disciplines assemble in quorum to discuss the complex medical and psychosocial issues facing their patients and create treatment plans to address them. Professionals from not only different disciplines but from entirely different fields must efficiently amalgamate their expertise to create one intricate plan for their unique patient population. It is this diversity of disciplines represented and the complexity of subject matter that makes craniofacial team meetings ideal for studying team functioning during multidisciplinary meetings. The global pandemic necessitated a shift of these complex meetings to the virtual setting. While providing direct patient care (i.e. tele-health) has been studied extensively, the literature on virtual team meetings is lacking. The authors of this study evaluated the team functioning of one craniofacial team by studying their virtual team meetings. Methods/Description: Ten virtual team meetings, including 94 patient case discussions, from a 3-month period in late 2020 were recorded and scored individually by three members of the research team using modified versions of the standardized multidisciplinary team Meeting Observational Tool (MOT) and the Metric of Decision-Making (MODe). The mean score amongst the three observers for each category of team functioning was used for analysis. Participants' subjective assessments of team meetings were elicited through monthly Qualtrics surveys. Results: Our results indicate that team functioning during virtual team meetings was high for providing case history, exhibiting optimal team behavior, and providing a treatment plan for individual case discussions. Patient-centered and psychosocial categories received lower scores. Survey respondents generally regarded their team as highly functioning during team meetings, with lower marks given only for decision-making efficiency and full participation from all disciplines. The meeting technology and equipment received a high score on average. Additionally, participants indicated that the virtual format did not enhance or hinder team functioning during team meetings. Conclusions: Amidst the ongoing COVID-19 pandemic it is important to study the effectiveness of multidisciplinary team meetings held in a virtual format. Our findings suggest that virtual setting allows for high team functioning as measured by both objective and subjective assessments and should therefore be considered a viable alternative to in-person meetings. The team performed best in discussing clinical topics, generating treatment plans, and team behavior, including equality among disciplines. Psychosocial matters and patient perspectives were not discussed as extensively as clinical topics and the team overestimated their coverage of both psychosocial matters and patient perspectives, consistent with previous studies on team functioning.
ABSTRACT
Background: Natalizumab (NZB) is a disease-modifying treatment (DMT) used in persons with MS (PwMS) with an active relapsing course, either as a first-line, or after previous treatments. The principal biological effect of NZB is thought to be the blockade of the molecular interaction between β4β1-integrin (also known as very late antigen-4) expressed by mononuclear inflammatory cells, and vascular cell adhesion molecule-1 (CAM-1) expressed by cerebral vascular endothelial cells. NZB is a potent DMT which must be monitored with caution, its use being hampered by the risk of opportunistic infections, mostly progressive multifocal leukoencephalopathy (PML). Objectives: To document the efficacy and safety of NZB for the treatment of RRMS in a population of persons with MS (PwMS) followed in a regular MS Clinic setting. Methods: We report our single-centre experience over a period of 13 years: from JAN 2007 through the end of May 2020. All PwMS treated with NZB were included, regardless of the treatment duration. The retainment of patients in our MS Clinic is 95%. We use the iMed database, an international MS registry. . Results: We report on 230 PwMS, 159 women, 71 men treated with NZB since 2007, up to 30 April 2020. We had no PML case. We had 2 PML 'clinical alerts', but CSF search for JC virus (JCV) was negative. There was no rebound of activity, nor IRIS, after NZB cessation, as we usually quickly switch to an alternative DMT. Median age at MS onset: 26.3 years. Median age at NZB initiation: 35 years. Median disease duration before treatment: 8.07 years. First line use: 94. Previous BRACE DMT: 136. Risk factors: previous immuno-suppression: 7;NZB duration > 24 months: 112;JCV index > 1: 81. Median treatment duration: 23 months;still active: 71 including 7 after > 6 years. ARR at NZB onset: 1.5;during NZB: 0.27;current: 0.89. Median EDSS at NZB start: 3.0. Current median EDSS: 2.8. EDSS stable: 65, worsened: 58;improved: 60. MRI: stable: 133 (58%) ;improved: 5 (2%);worsened: 35 (25%). Conversion to SPMS: 48 (20%) 29 W, 19 M. Reasons for NZB cessation: planned: 27;pregnancy: 3;loss of efficacy: 39;increased JCV index: 62. No blood toxicity (CBC, ALT). We had 9 pregnancies: 4 planned interruptions;5 full term, with normal babies. Treatment after NZB cessation: 48 fingolimod, glatiramer: 17;ocrelizumab: 16;others: 29;none: 32 (no rebound observed). One patient had COVID 1 year after NZB: complete recovery;needed only nasal O2 during 3 day hospital admission. Conclusions: NZB, when used with caution, is an effective and safe MS DMT during the RRMS phase, even after extended disease and treatment durations. NZB is most effective to reduce relapse frequency, less effective against progression, as 20% of PwMS transited to the secondary progressive phase. Gender, disease duration, and age do not influence outcomes. We encountered no significant toxicity, in particular no PML. Clinical, JCV index measures, and MRI monitoring are paramount to maintain safety.