Conceptualisation and Implementation of a Competency-based Multidisciplinary Course for Medical Students in Neurosurgery.

The field of medicine is quickly evolving and becoming increasingly more multidisciplinary and technologically demanding. Medical education, however, does not yet adequately reflect these developments and new challenges, which calls for a reform in the way aspiring medical professionals are taught and prepared for the workplace. The present article presents an attempt to address this shortcoming in the form of a newly conceptualized course for medical students with a focus on the current demands and trends in modern neurosurgery. Competency-based education is introduced as a conceptual framework comprising academic and operational competence as well as life-world becoming. This framework provides a sound educational foundation for future medical professionals, equipping them with the knowledge as well as skills needed to successfully navigate the medical field in the current day and age. Three competencies are identified that are central to day-to-day medical practice, namely digitalization, multidisciplinarity, and the impact of recent developments on the changing patient-practitioner relationship. These competencies are relevant for all medical disciplines, but are demonstrated here in a neurosurgical context and visualized using a real patient's case study. Students follow this sample patient's way through each step of the neurosurgical workflow, from planning to performing the procedure, and can see for themselves the importance and application of the aforementioned competencies based on this real-world example. Courses such as the one presented here may prepare medical students more adequately for their future work by combining theoretical and practical skills and critical reflection, thereby providing holistic and practical insights as well as a conceptual framework for their future careers.

Immune checkpoint inhibitors and neurotoxicity: a focus on diagnosis and management for a multidisciplinary approach.

INTRODUCTION: Although immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment, the consequential over activation of the immune system is often complicated by adverse events that can affect several organs and systems, including the nervous system. The precise pathophysiology underlying neurological irAEs (n-irAEs) is not completely known. Around 3.8% of patients receiving anti-CTLA-4 agents, 6.1% of patients receiving anti-PD-1/PD-L1, and 12% of patients receiving combination therapies have n-irAEs. Most n-irAEs are low-grade, while severe toxicities have rarely been reported. in this article, we performed an updated literature search on immuno-related neurotoxicity on main medical research database, from February 2017 to December 2023. AREAS COVERED: We have also compared the latest national and international guidelines on n-irAEs management with each other in order to better define patient management. EXPERT OPINION: A multidisciplinary approach appears necessary in the management of oncological patients during immunotherapy. Therefore, in order to better manage these toxicities, we believe that it is essential to collaborate with neurologists specialized in the diagnosis and treatment of n-irAEs, and that a global neurological assessment, both central and peripheral, is necessary before starting immunotherapy, with regular reassessment during treatment.

[Prehabilitation and enhanced recovery after surgery: a continuum for the benefit of the patient]. / La préhabilitation et la récupération améliorée après chirurgie : un continuum au bénéfice du patient.

Improved recovery after surgery leads to a significant reduction in postoperative morbidity, but this is concentrated in the intra- and postoperative periods. Prehabilitation complements this, by taking charge of the pre-operative phase. Its aim is to improve pre-operative functional capacity and physical, nutritional and psychosocial status. Interdisciplinary collaboration is a key element of this integrated approach.

Chronic rhinosinusitis with nasal polyposis and biological agents: the ARIA-ITALY Survey.

Summary: Background. Chronic rhinosinusitis (CRS) is an inflammatory disease that affects the nasal mucosa and the paranasal sinuses. CRS can be associated by nasal polyposis (CRSwNP phenotype) in up to 30% of patients and it is frequently associated with bronchial asthma. CRSwNP shows predominantly an underlying activation of type 2 inflammatory pathways with the involvement of eosinophils, IgE, interleukin (IL)-4, IL-5 and IL-13. Biological drugs that target these inflammatory cytokines are currently a therapeutic option recognized by guidelines for the treatment of uncontrolled form of the disease. Methods. As part of the activity of the "ARIA-Italy" working group, a panel of 255 Italian Ear, Nose and Throat (ENT) specialists, pneumologists and immuno-allergologists actively participated in this national survey and answered a series of questions geared toward understanding the main criteria for patient characterization and therapeutic decision, highlighting multidisciplinarity, and the implementation of the management of CRSwNP patients, as a part of the precision medicine concept and the appropriate use of the biologicals. Results. Two hundred and fifty-five experts and specialists participated in the survey. Conclusions. The results of this survey obtained from an extensive number of active specialists throughout Italy allow some important concluding remarks to be drawn. The main points of agreement were that multidisciplinary care teams provide many benefits but that, once the team is established, meetings and communication between members must be coordinated. Finally, the dissemination of national disease registries and the continuous updating of guidelines and position papers related to CRSwNP and comorbidities should be encouraged.

An ode to multidisciplinarity: the 'Bacteria Orchestrate Life' international meeting.

If scientists stick to their research expertise without collaborating with other experts in different fields, it could stall the progress of their work in a world where interdisciplinary thinking and working should be second nature. Biologists are at the forefront of this trend. That is why a consortium formed by the faculty of sciences of Tunis El Manar University, Tunisia, the GetGenome Foundation and Learn and Win, decided to organise an international conference on bacteria, a perfect field for multidisciplinarity. For 3 days, from 14 to 16 December 2023, more than 200 interdisciplinary researchers and students of life sciences and more than 20 international speakers and trainers met at the faculty of sciences in Tunis, to discuss microbiology and bacteria from different horizons, from the most fundamental to the most imaginative, with a strong focus on technologies and discoveries. This Meeting Review describes the scientific event and highlights the main results of both the conferences and the practical sessions.

Lyme borreliosis and medical wandering: what do patients think about multidisciplinary management? A qualitative study in the context of scientific and social controversy.

INTRODUCTION: To answer to patients' medical wandering, often due to "unexplained symptoms" of "unexplained diseases" and to misinformation, multidisciplinary care centers for suspected Lyme borreliosis (LB), such as the 5 Tick-Borne Diseases (TBDs) Reference Centers (TBD-RC), were created a few years ago in France, the Netherlands and Denmark. Our study consisted of a comprehensive analysis of the satisfaction of the patients managed at a TBD-RC for suspected LB in the context of scientific and social controversy. METHODS: We included all adults who were admitted to one of the TBD-RC from 2017 to 2020. A telephone satisfaction survey was conducted 12 months after their first consultation. It consisted of 5 domains, including 2 free-text items: "What points did you enjoy?" and "What would you like us to change or to improve?". In the current study, the 2 free-items were analyzed with a qualitative method called reflexive thematic analysis within a semantic and latent approach. RESULTS: The answer rate was 61.3% (349/569) and 97 distinctive codes from the 2-free-text items were identified and classified into five themes: (1) multidisciplinarity makes it possible to set up quality time dedicated to patients; (2) multidisciplinarity enables seamless carepaths despite the public hospital crisis compounded by the COVID-19 pandemic; (3) multidisciplinarity is defined as trust in the team's competences; (4) an ambivalent opinion and uncertainty are barriers to acceptance of the diagnosis, reflecting the strong influence of the controversy around LB; and (5) a lack of adapted communication about TBDs, their management, and ongoing research is present. CONCLUSION: The multidisciplinary management for suspected LB seemed an answer to medical wandering for the majority of patients and helped avoid misinformation, enabling better patient-centered shared information and satisfaction, despite the context of controversy.

[The multi-professional alliance in the diagnostic process]. / L'alliance pluriprofessionnelle dans la démarche diagnostique.

Professional support for elderly people suffering from cognitive impairment needs to be comprehensive, and requires the active involvement of a wide range of professionals. Two clinical cases show how the combined support of a therapeutic day-care center and medical specialists can improve the quality of life of patients and their families, by helping to refine diagnoses or adjust treatment.

[The role of the social worker in the orthopedics and traumatology department]. / Le rôle de l'assistant social en service d'orthopédie et traumatologie.

Trauma patients often lose their autonomy in the aftermath of an accident. This handicap adds to the burden of other social problems that pre-existed the trauma. The social worker's role with these patients is therefore essential.

[What place for ethics in psychiatry?] / Quelle place pour l'éthique en psychiatrie ?

At a time when healthcare establishments are facing sensitive financial and institutional challenges, how can ethics be given a place in psychiatry? In society, ethical debates focus on surrogate motherhood, active euthanasia or assisted suicide, and embryo research. In psychiatry, the question often crystallizes around violent incidents that are hardly representative of the daily lives of professionals and patients. Militant discourse prevails over listening to the people concerned. The law requires establishments to reflect on the ethical issues raised by the reception and medical care of patients, without specifying the boundaries. Ethics in healthcare facilities focuses on care situations - what is possible or desirable - with no single theoretical model to serve as an example to follow.

[Anorexia nervosa and the perinatal period]. / Anorexie mentale et période périnatale.

As a complex pathology, anorexia nervosa interacts with the psychological challenges of pregnancy, and raises questions about how to support the women concerned. As part of a multidisciplinary approach, support groups are particularly important, offering both individual and social support. Child-parent drop-in centers can also provide a supportive space for the psychological work of parenting.

Difficulties in Combining Somatic and Psychiatric Care in Psychogeriatry.

BACKGROUND: This article attempts to understand the difficulties encountered in the articulation of health care, particularly between the organic and psychiatric aspects. It also aims to provide solutions to these collaboration issues. METHODS: We realized a literature review based on articles dated from 2002 to 2021 and selected from following databases: Pubmed, Cochrane, Scopus, Cairn, Psychinfo and Google. Used key words are "aging, multidisciplinarity, psychiatric stigma, impotence, efficiency". RESULTS: Medical staff may encounter different problems in terms of care, faced to psychogeriatricpatients.These are both related to the medical aspect, including the difficulty of establishing a clear diagnosis in the face of a complex medical situation,clinical unknownledge, multiplication of intervenants with loss of centralisation in terms of care, etc. Added to this, is the organization of health care, which is increasingly specialized and restrictive in terms of hospitalization criteria. Finally to this, is the relational experience of the caregiver, both in relation to the patient and his disorders, and to their colleagues. CONCLUSION: In the era of the advent of medicinal progress and the advance of diagnostic and therapeutic techniques, it seems mandatory to place the human being at the center of our care. Interhuman interactions constituting the basis of medical care especially in terms of transdisciplinary collaboration. This last point could lead to cost reduction, a more efficient diagnostic and therapeutic management. It seems to be mandatory to reinforce our health care politics in order to time and importance to these various essential and fundamental relational issues.

[CAR-T cells, an innovative therapy]. / Les CAR-Tcells, une thérapie innovante.

CAR-T cell therapy for patients with hematological malignancies has been practiced at the Basse-Normandie Hematology Institute since November 2022. This treatment requires the care pathway to be coordinated by the nurse coordinator. Nurses play a key role in the early diagnosis of side effects induced by this drug. Interdisciplinary collaboration and the value of teamwork are also emphasized.

Thirty Years of Global Deep Brain Stimulation: "Plus ça change, plus c'est la même chose"?

BACKGROUND: The advent of deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's disease 30 years ago has ushered a global breakthrough of DBS as a universal method for therapy and research in wide areas of neurology and psychiatry. The literature of the last three decades has described numerous concepts and practices of DBS, often branded as novelties or discoveries. However, reading the contemporary publications often elicits a sense of déjà vu in relation to several methods, attributes, and practices of DBS. Here, we review various applications and techniques of the modern-era DBS and compare them with practices of the past. SUMMARY: Compared with modern literature, publications of the old-era functional stereotactic neurosurgery, including old-era DBS, show that from the very beginning multidisciplinarity and teamwork were often prevalent and insisted upon, ethical concerns were recognized, brain circuitries and rational for brain targets were discussed, surgical indications were similar, closed-loop stimulation was attempted, evaluations of surgical results were debated, and controversies were common. Thus, it appears that virtually everything done today in the field of DBS bears resemblance to old-time practices, or has been done before, albeit with partly other tools and techniques. Movement disorders remain the main indications for modern DBS as was the case for lesional surgery and old-era DBS. The novelties today consist of the STN as the dominant target for DBS, the tremendous advances in computerized brain imaging, the sophistication and versatility of implantable DBS hardware, and the large potential for research. KEY MESSAGES: Many aspects of contemporary DBS bear strong resemblance to practices of the past. The dominant clinical indications remain movement disorders with virtually the same brain targets as in the past, with one exception: the STN. Other novel brain targets - that are so far subject to DBS trials - are the pedunculopontine nucleus for gait freezing, the anteromedial internal pallidum for Gilles de la Tourette and the fornix for Alzheimer's disease. The major innovations and novelties compared to the past concern mainly the unmatched level of research activity, its high degree of sponsorship, and the outstanding advances in technology that have enabled multimodal brain imaging and the miniaturization, versatility, and sophistication of implantable hardware. The greatest benefit for patients today, compared to the past, is the higher level of precision and safety of DBS, and of all functional stereotactic neurosurgery.

Asthma improvement in patients treated with dupilumab for severe atopic dermatitis.

Introduction: Atopic dermatitis (AD) is considered a systemic type 2 immune driven disease, and it is associated to many atopic comorbidities including asthma. The aim of our study was to prospectively evaluate the respiratory outcomes in patients with persistent allergic asthma treated with dupilumab due to severe AD (sAD). Methods: We enrolled eligible patients with sAD for dupilumab treatment from September 2018 to December 2020. We then selected the subgroup of patients sensitized to perennial allergens. Dupilumab's efficacy and safety on AD and comorbid asthma were assessed at baseline, one month, four months, and then every 4 months up to one year. Results: A total of 437 patients with sAD were enrolled for dupilumab treatment due to sAD, and 273 reached 48 weeks of therapy. Respiratory outcomes were evaluated in the 85 asthmatic patients with positivity only to perennial allergens. Our patients showed statistically and clinically significant improvement in asthma control (Asthma Control Test and Asthma Control Questionnaire) and airway obstruction parameters (FEV1), in addition to the expected AD-related skin outcomes. Specifically, a significant improvement was achieved at the fourth month of dupilumab therapy, and this trend was maintained up to twelve months, regardless of asthma severity. Conclusions: Our results showed the overall improvement of the clinical picture that dupilumab offers for patients with severe AD and persistent allergic asthma of any severity, highlighting the importance of a global multidisciplinary approach of type 2 driven disease.

A multisectoral and multidisciplinary endeavor: a review of diabetes self-management apps in China.

BACKGROUND: While the use of self-management apps has considerable promise to efficiently reduce the diabetes burden that disproportionally affects low- and middle-income countries (LMICs), and the multisectoral and multidisciplinary approaches have been encouraged to be used in diabetes management, little is known about the status of the integration of these approaches in the existing diabetes self-management apps. This review examines the diabetes apps in China as an indication of the current status of integrating multisectoral and multidisciplinary approaches in diabetes mHealth care in LMICs. METHODS: Eligible diabetes apps were searched on major Chinese app stores up to December 23, 2022. The app comprehensiveness index (ranging 0-80) regarding the app functions and diabetes management domains was created. The multisectoral and multidisciplinary features were summarized using indices derived from current guidance. RESULTS: Sixty-six apps were reviewed, all developed by private companies. The average comprehensiveness score was 16, with many major self-management domains and functions not represented among the reviewed apps. Forty apps (61%) involved multiple sectoral entities, with public/private and private/private collaborations being the most common collaborative combinations. Thirty-seven apps (56%) involved multiple disciplines, among which endocrinology/metabolism, nutrition, and cardiovascular medicine were the top three most common disciplines. Compared to non-multidisciplinary apps, multidisciplinary apps tended to provide more comprehensive services in apps (6.14 vs. 5.18, p = 0.0345). Different sectors and disciplines tended to work independently, without robust interactions, in providing diabetes management services in the reviewed apps. CONCLUSION: Multisectoral and multidisciplinary features has presented in the current diabetes self-management apps in China; however, it is still in its infancy and significant limitations existed. More engagement of civil society organizations and community groups and innovative collaborations between sectors and disciplines are needed to provide comprehensive, continuous, and patient-centered mHealth care for patients with diabetes in LMICs like China. Clear guidance for integrating and evaluating the multisectoral and multidisciplinary efforts in self-management apps is necessary to ensure the effective use of mHealth solutions for diabetes management in LMICs.

[Reception and initial assessment when caring for a person with severe obesity]. / Accueil et bilan initial lors de la prise en charge d'une personne en situation d'obésité sévère.

In France, there are 37 specialist obesity treatment centres (CSOs), located in mainland and overseas France. Attached to public or private health establishments, they have two main missions, which they carry out within the framework of national specifications: the multidisciplinary management of severe or complex obesity, and the organisation, coordination and development of the regional obesity care network. This article illustrates the practice of the Caen Normandy CSO.

[Cancer pain, a challenge for the nurse's own role]. / La douleur cancéreuse, un enjeu pour le rôle propre infirmier.

Because of its many specific features, cancer pain requires special management and a sound knowledge base. This article aims to take a fresh look at this type of pain, and share some of the elements that make it so specific. It also aims to provide a reminder of what cancer pain is, as well as clarifying the specific role of the state-registered nurse in its management.

[Multidisciplinary reflections on parental support in congenital cardiac resuscitation]. / Réflexions pluridisciplinaires autour de l'accompagnement parental en réanimation cardiaque congénitale.

Half of all children with congenital heart disease develop specific neurodevelopmental disorders. As these are influenced as much by factors intrinsic to the pathology as by the environmental and family support that the young patient receives from birth, the team at the congenital heart disease unit at Bordeaux's university hospital has devised an individualized global pathway for these families to support the neurodevelopment of these toddlers from the antenatal period onwards.