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Optimising operating theatre (OT) efficiency while maintaining the standardised patient care in adolescent idiopathic scoliosis (AIS) surgery with the dedicated spine team approach: a specialised spine unit experience

Lee SY, Chan CYW, Chiu CK, Chung WH, Hasan MS, Kwan MK

Eur Spine J, 2024 Oct;33(10):3806-3813.
PMID: 38861024 DOI: 10.1007/s00586-024-08352-0

PURPOSE: To report the efficiency of OT utilisation and perioperative outcomes with a dedicated spine team approach in AIS patients who underwent posterior spinal fusion (PSF) surgeries in a consecutive case operation list.
METHODS: Three AIS patients operated in a day (8:00 AM-8:00 PM) by a dedicated spine team were recruited between 2021 and 2022. The dedicated team comprised of three senior spine consultants who operated using a dual attending surgeon strategy, an anaesthetic consultant, dedicated surgical scrub nurses, anaesthesiology nurses, radiographers, and neuromonitoring technicians. Patients were categorised according to the sequence of operation list of the day (Case 1, Case 2, and Case 3). OT efficiency was represented by OT time in five stages (preoperative time, operative time, postoperative time, total OT time, and turnover time). OT time and perioperative outcomes were compared.
RESULTS: 102 cases were analysed. On average, Case 1 began at 8:38 AM whereas Case 3 ended by 5:54 PM. OT efficiency was consistent throughout the day of operation with comparable OT time in all five stages between groups (p > 0.05). The mean turnover time was 15.1 ± 13.5 min and the mean operative time was 123.0 ± 28.1 min. Intraoperative arterial blood gas (ABG) parameters were maintained in an optimal range. The complication rate was 2.0% (N = 2/102).
CONCLUSION: Consistent OT efficiency was demonstrated with a dedicated spine team approach. Despite performing three AIS cases in a consecutive case operation list, patients' safety was not compromised as perioperative outcomes between groups were comparable.

Matched MeSH terms: Patient Care Team
Implementation of clinical pharmacist recommendations and services at a University Hospital in Yemen

Kubas MA, Halboup AM

Int J Clin Pharm, 2020 Feb;42(1):51-56.
PMID: 31713107 DOI: 10.1007/s11096-019-00936-x

Background Studies have revealed that the inclusion of a clinical pharmacist as a member in multidisciplinary medical team has been associated with improved medication use, reduced adverse drug reaction, reduced cost of treatment, and improved health outcomes. Objective The objectives of this study were to evaluate the implementation of clinical pharmacy recommendations and services, the acceptance rate by the physicians, and the anticipated outcomes of the recommendations at a hospital in Yemen. Methods Different units of the University of Science and Technology Hospital, Sana'a were included in this study. All the recommendations and services provided by the clinical pharmacist during daily activities were documented between June 2013 and November 2015. The provided recommendations were classified based on the type, acceptance rate, and the anticipated outcomes. Main outcome measure Type and quality of clinical pharmacists' recommendations, anticipated impact of the recommendations on health outcomes, and their acceptance rate. Results Throughout the study period, a total of 957 patients in different hospital units were visited and provided with a total of 3307 interventions and services. The most frequent types of clinical pharmacist's interventions were drug discontinuation (23.6%, n = 782), inappropriate dose interval or time (n = 735, 22.2%), and add medication (18.9%, n = 626). Overall, 61.8% (n = 2044) of the provided recommendations were accepted by the physicians. The most anticipated outcomes were improved the effectiveness of therapy (45.1%, n = 1909), avoid adverse drug reactions (29%, n = 1228), and decrease the cost of medications (18.8%, n = 797). Conclusion Clinical pharmacist's recommendations resulted in improving drug therapy and decreasing adverse effects for inpatients at the University of Science and Technology Hospital. This suggests that the implementation of clinical pharmacy services is essential and has a positive outcome on patient care.

Matched MeSH terms: Patient Care Team/standards; Patient Care Team/trends*
Intestinal failure-associated liver disease (IFALD): insights into pathogenesis and advances in management

Lee WS, Chew KS, Ng RT, Kasmi KE, Sokol RJ

Hepatol Int, 2020 May;14(3):305-316.
PMID: 32356227 DOI: 10.1007/s12072-020-10048-8

Premature infants and children with intestinal failure (IF) or short bowel syndrome are susceptible to intestinal failure-associated liver disease (IFALD, previously referred to as parenteral nutrition-associated liver disease, or PNALD). IFALD in children is characterized by progressive cholestasis and biliary fibrosis, and steatohepatitis in adults, and is seen in individuals dependent upon prolonged administration of PN. Many factors have been proposed as contributing to the pathogenesis of IFALD. In recent years, the focus has been on the potential synergistic roles of the intestinal microbiome, increased intestinal permeability, activation of hepatic innate immune pathways, and the use of intravenous soybean-oil-based intravenous lipid emulsions (SO-ILE). In vitro and in vivo studies have identified stigmasterol, a component of the plant sterols present in SO-ILE, as playing an important role. Although various strategies have been adopted to prevent or reverse IFALD, most suffer from a lack of strong evidence supported by well-designed, prospective clinical trials with clearly defined endpoints. Reduction in the amount of SO-ILEs or replacement with non-SO-ILEs has been shown to reverse IFALD although safety and long-term effectiveness have not been studied. Medical and surgical modalities to increase intestinal adaptation, advance enteral feedings, and prevent central line bloodstream infections are also important preventative strategies. There is a continued need to conduct high-quality, prospective trials with clearly define outcome measures to ascertain the potential benefits of these strategies.

Matched MeSH terms: Patient Care Management/methods; Patient Care Management/trends
Knowledge and Attitudes Towards Pregnancy in Females with Inflammatory Bowel Disease: An International, Multi-centre Study

Laube R, Yau Y, Selinger CP, Seow CH, Thomas A, Wei Chuah S, et al.

J Crohns Colitis, 2020 Sep 16;14(9):1248-1255.
PMID: 32191292 DOI: 10.1093/ecco-jcc/jjaa047

BACKGROUND AND AIMS: Poor knowledge of inflammatory bowel disease [IBD] in pregnancy underlies unwarranted voluntary childlessness [VC], and risks poorer obstetric outcomes and adverse fetal outcomes. IBD is increasing worldwide but education on IBD issues might be heterogeneous based on cultural differences and variations in models of care.
METHODS: Consecutive female IBD subjects aged 18-45 years were prospectively recruited from two dedicated IBD-pregnancy clinics, two multidisciplinary IBD clinics and nine general gastroenterology clinics. Subjects completed the validated CCPKnow [score 0-17] with questions on demographics, medical history and pregnancy knowledge. The primary outcome was knowledge per clinic-type and per geographical region.
RESULTS: Surveys were completed by 717 subjects from 13 hospitals across ten countries. Dedicated IBD-pregnancy clinics had the highest knowledge, followed by multidisciplinary IBD clinics then general IBD clinics (median CCPKnow 10.0 [IQR: 8.0-11.0], 8.0 [IQR: 5.0-10.5] and 4.0 [IQR:2.0-6.0]; p Patient perception of disease severity [r = -0.18, p

Matched MeSH terms: Patient Care Team/organization & administration; Patient Care Team/standards
Aligning Islamic Spirituality to Medical Imaging

Zainuddin ZI

J Relig Health, 2017 Oct;56(5):1605-1619.
PMID: 26058599 DOI: 10.1007/s10943-015-0074-x

This paper attempts to conceptualize Islamic spirituality in medical imaging that deals with the humanistic and technical dimensions. It begins with establishing an understanding concerning spirituality, an area that now accepted as part of patient-centred care. This is followed by discussions pertaining to Islamic spirituality, related to the practitioner, patient care and the practice. Possible avenues towards applying Islamic spirituality in medical imaging are proposed. It is hoped that the resultant harmonization between Islamic spirituality and the practice will trigger awareness and interests pertaining to the role of a Muslim practitioner in advocating and enhancing Islamic spirituality.

Matched MeSH terms: Patient Care
Fulltext Transformation of surgical training through national transformation 2050 (TN50): a National agenda

Razman, J.

Journal of Surgical Academia, 2017;7(1):1-3.
MyJurnal

Surgical training worldwide has been reformed from
the since 19th century until the present era. It started as
a trade which eventually was transformed into a
profession that acquires skills and knowledge. The
apprenticeship model was introduced amongst the
Western surgeons as the standard approached for
surgical training. The surgery was learned through
direct observation without any formal and structured
education. William S Halstead had introduced the new
approach of training the surgeons in America
following his landmark lecture at Yale University in
1904 (1). His principle was based on direct the
German Surgical training which emphasized on basic
sciences in the curriculum and Sir William Ossler
concepts of bedside rounds. This has lead to the
development of Halsted principals of surgical training
which included intense and repetitive exposure in
managing surgical patients under the supervision of
skilled surgeons, acquiring the knowledge of scientific
basis of surgical diseases and as the surgical trainee
received enhanced responsibility and independence
with each advancing year (2). Since then, Halsted
principle of surgical training has become the
foundation of most established surgical training
worldwide. The principles have been expanded and
upgraded and since then six cores competencies have
been identified for the surgical residents to achieve
and master during the training course (3). There were
medical knowledge, patient care, interpersonal and
communication skills, professionalism, practice-based
learning and improvement and system based practice.
From the Malaysia perspective, surgical training was
done through the overseas Royal colleges after the
independence in 1957. The local programme started in
1982 through the initiative of local universities that
initially offered surgical training programme in
General surgery, Orthopedics and otorhinolaryngology
(4). Since then through the collaborations of Ministry
of Health and other professional bodies various
surgical training programme has been established to
provide training opportunities which will eventually
serving the nation. The subcommittee of the National
Conjoint Board for General Surgery was the
consultative body to oversee and manage the
implementation of the surgical training. Since the
establishment, the subcommittee was responsible in
streamlined the training curriculum for all the
universities that offered the course, centralized and
standardized the intake of the trainees, coordinating
the national exit examination and advising new
application for graduate training in general surgery.
The important milestone of the subcommittee was the
task given to develop the national surgical
postgraduate curriculum for the doctors who are
interested in becoming a surgeon in the country. The
curriculum is being developed to create a pathway for
surgical training from the internship until subspecialty
training. The development encompasses the
governance, the curriculum development, the training
process and learning outcome according to the latest
evidence based on post graduate training. The
programme should be the foundation in producing well
trained surgeons towards 2050 through TN50.

Matched MeSH terms: Patient Care
Fulltext Muslim female healthcare personnel dress code: a proposed guideline

Saidun, S., Akhmetova, E., Awang Abd Rahman, A.

International Medical Journal Malaysia, 2018;17(2):57-70.
MyJurnal

Introduction: The struggle of Muslim women to comply with Islamic teaching while working in the healthcare sector has been a long-standing issue. Following the case of a Muslim nurse who was allegedly fired for non-adherence to the short-sleeve uniform rule, the Malaysian Muslim Consumers Association highlighted the need for a uniform guideline to prevent similar instances. Yet, no guideline has been issued to date. Materials and Methods: This conceptual study employed library research method to gather relevant materials. Library research was able to retrieve guidelines from seven Muslim-minority countries but none from Muslim-majority countries. Document analysis of the materials gathered was undertaken. The different guidelines were compared, with special reference to awrah-related issues. Results: Several major issues that healthcare personnel dress code considers are the safety, health, cleanliness, and comfort for both patients and healthcare personnel. Islamic dressing requirement is not only in line with clinical practice but Islam also highly promotes maintenance of safety, health, cleanliness, and comfort. The widely adopted ‘bare below the elbows (BBE) policy is the only practice that may contradict Islamic rules. However, some healthcare institutions in Muslim-minority countries allow modifications of uniform rules on religious grounds; some of the modifications are not observed in Muslim-majority countries. When providing direct patient care that requires BBE, the use of disposable over-sleeves is a good alternative to adhere to both clinical and Islamic standards. Conclusion: Healthcare personnel dress code policy that is concordant to both clinical and Islamic standards is possible although it may require greater resources.

Matched MeSH terms: Patient Care
Fulltext Caring for moderate to severe dementia patients - Malaysian family caregivers experience

Zuria Idura A.M., Noorlaili M.T., Rosdinom R., Azlin B.., Tuti Iryani M.D.

International Medical Journal Malaysia, 2018;17(1):93-102.
MyJurnal

Introduction: Caring for those with dementia affects the quality of life for both the caregivers and the patients themselves, particularly in the informal care system here in Malaysia. To date, only a few studies have explored from the family caregivers’ perspectives in the communities of different cultural background. The purpose of this study is to describe the Malaysian family caregivers’ perspectives of their experiences in providing care to for their family members suffering from moderate to severe dementia in Kuala Lumpur, Malaysia. Methods: This qualitative study involved in-depth individual interviews with twelve caregivers to patients with moderate to severe dementia. Participants were recruited via purposive sampling from the outpatient psycho-geriatric clinic at UKM Medical Centre, Kuala Lumpur. All interviews were audio-recorded and transcribed verbatim. Transcribed data was later analysed using a thematic approach. Results: Four themes identified in this study were; i) the feeling that ‘it is like caring for a baby’, ii) the caregivers’ perception of inadequate knowledge and skills, iii) the need for caregivers’ support system and iv) the importance of spirituality in enhancing care giving experiences. Conclusions: The framework of care shared by the caregivers in this study demonstrated strong cultural and spirituality influences in addition to the common issues of the challenges in managing the behavioural and psychological symptoms in people with dementia. Hence, culture and spirituality aspects should be addressed in the development of appropriate intervention to manage the needs of informal caregivers in this community.

Matched MeSH terms: Patient Care
Fulltext The Pictorial Fit-Frail Scale: Developing a Visual Scale to Assess Frailty

Theou O, Andrew M, Ahip SS, Squires E, McGarrigle L, Blodgett JM, et al.

Can Geriatr J, 2019 Jun;22(2):64-74.
PMID: 31258829 DOI: 10.5770/cgj.22.357

Background: Standardized frailty assessments are needed for early identification and treatment. We aimed to develop a frailty scale using visual images, the Pictorial Fit-Frail Scale (PFFS), and to examine its feasibility and content validity.
Methods: In Phase 1, a multidisciplinary team identified domains for measurement, operationalized impairment levels, and reviewed visual languages for the scale. In Phase 2, feedback was sought from health professionals and the general public. In Phase 3, 366 participants completed preliminary testing on the revised draft, including 162 UK paramedics, and rated the scale on feasibility and usability. In Phase 4, following translation into Malay, the final prototype was tested in 95 participants in Peninsular Malaysia and Borneo.
Results: The final scale incorporated 14 domains, each conceptualized with 3-6 response levels. All domains were rated as "understood well" by most participants (range 64-94%). Percentage agreement with positive statements regarding appearance, feasibility, and usefulness ranged from 66% to 95%. Overall feedback from health-care professionals supported its content validity.
Conclusions: The PFFS is comprehensive, feasible, and appears generalizable across countries, and has face and content validity. Investigation into the reliability and predictive validity of the scale is currently underway.

Matched MeSH terms: Patient Care Team
Fulltext Growing teratoma syndrome of mediastinal nonseminomatous germ cell tumor

Diong NC, Dharmaraj B, Joseph CT, Sathiamurthy N

Ann Thorac Med, 2020 01 02;15(1):38-40.
PMID: 32002046 DOI: 10.4103/atm.ATM_296_19

Mediastinal nonseminomatous germ cell tumor (NSGCT) is rare. NSGCT shows excellent response to cisplatin-based chemotherapy. However, some tumors continue to enlarge despite normal tumor markers after chemotherapy, a rare condition called growing teratoma syndrome (GTS). Recognition of this condition is imperative for prompt surgical resection to prevent further cardiopulmonary compression and to improve survival. Multidisciplinary team meeting is important for perioperative preparation and care to improve the outcome of this high-risk surgery. Here, we report two cases of mediastinal GTS and underwent surgical resection, of which one died of pericardial decompression syndrome and the other is well.

Matched MeSH terms: Patient Care Team
Fulltext COVID-19 pandemic: Practical considerations on the organization of an allergy clinic-An EAACI/ARIA Position Paper

Pfaar O, Klimek L, Jutel M, Akdis CA, Bousquet J, Breiteneder H, et al.

Allergy, 2021 03;76(3):648-676.
PMID: 32531110 DOI: 10.1111/all.14453

BACKGROUND: The coronavirus disease 2019 (COVID-19) has evolved into a pandemic infectious disease transmitted by the severe acute respiratory syndrome coronavirus (SARS-CoV-2). Allergists and other healthcare providers (HCPs) in the field of allergies and associated airway diseases are on the front line, taking care of patients potentially infected with SARS-CoV-2. Hence, strategies and practices to minimize risks of infection for both HCPs and treated patients have to be developed and followed by allergy clinics.
METHOD: The scientific information on COVID-19 was analysed by a literature search in MEDLINE, PubMed, the National and International Guidelines from the European Academy of Allergy and Clinical Immunology (EAACI), the Cochrane Library, and the internet.
RESULTS: Based on the diagnostic and treatment standards developed by EAACI, on international information regarding COVID-19, on guidelines of the World Health Organization (WHO) and other international organizations, and on previous experience, a panel of experts including clinicians, psychologists, IT experts, and basic scientists along with EAACI and the "Allergic Rhinitis and its Impact on Asthma (ARIA)" initiative have developed recommendations for the optimal management of allergy clinics during the current COVID-19 pandemic. These recommendations are grouped into nine sections on different relevant aspects for the care of patients with allergies.
CONCLUSIONS: This international Position Paper provides recommendations on operational plans and procedures to maintain high standards in the daily clinical care of allergic patients while ensuring the necessary safety measures in the current COVID-19 pandemic.

Matched MeSH terms: Patient Care Team
Artificial intelligence and soft skills in radiation oncology: Data versus wisdom

Boon IS, Lim JS, Yap MH, Au Yong TPT, Boon CS

J Med Imaging Radiat Sci, 2020 12;51(4S):S114-S115.
PMID: 32859543 DOI: 10.1016/j.jmir.2020.08.011
Matched MeSH terms: Patient Care Team
Fulltext Knowledge, Attitude, and Practice Towards Biosimilars and Interchangeable Products: A Prescriptive Insight by the Pharmacists

Shakeel S, Hassali MA, Rehman H, Rehman AU, Muneswarao J

Int J Gen Med, 2020;13:1075-1082.
PMID: 33204142 DOI: 10.2147/IJGM.S266545

Background: Pharmacists being the drug experts need to be well aware of the applied handling of biosimilar medicines (BSMs). They are an integral educator, trailblazer, and advocate of biosimilar integration across all clinical settings. Therefore, the current study was conducted to assess the pharmacists' knowledge, attitude, and practices of integrating BSMs into clinical practice.
Methods: The cross-sectional study was conducted from August 2019 to November 2019. The community pharmacies, clinical and academic settings in Karachi were approached for gathering the responses of pharmacists towards BSMs and interchangeable products using a 30-item survey form. Pearson correlation and independent sample t-test were used to identify the relationship among independent variables and the responses, considering p values <0.05 as statistically significant.
Results: Overall, there were 305 survey forms used with a response rate of 87.14%. More than 80% of the respondents have good knowledge about the definition, characteristics, safety and efficacy, compatibility, cost issues, and utilization of BSMs. Around half of the respondents (48.9%, [95% CI 46.6-51.2]) were confident in using BSMs in clinical practice. However, they were concerned about the BSM's safety profile (45.2%, [95% CI 42.1-48.3]), quality (30.2%, [95% CI 28.3-32.1]), and efficacy issues (32.3%, [95% CI 31.2-37.5]).
Conclusion: The findings revealed that pharmacists were well informed about the BSMs. However, some of the responses to the attitude demonstrated a lack of understanding of the application of that knowledge. The respondents persuaded that advanced patterns of diseases, product marketing stipulations, and need for better patient care drives higher demand for developing BSMs and were enthusiastic about gaining more insight to integrate BSMs into routine clinical practice.

Matched MeSH terms: Patient Care
Neuromuscular ultrasound competency assessment: Consensus-based survey

Tawfik EA, Cartwright MS, Grimm A, Boon AJ, Kerasnoudis A, Preston DC, et al.

Muscle Nerve, 2021 05;63(5):651-656.
PMID: 33382094 DOI: 10.1002/mus.27163

Neuromuscular ultrasound is a rapidly evolving specialty with direct application for patient care. Competency assessment is an essential standard needed to ensure quality for practitioners, particularly for those newly acquiring skills with the technique. Our aim was to survey experts' opinions regarding physician competency assessment of neuromuscular ultrasound and to identify minimal competency of knowledge and skills. The opinions of 18 experts were obtained through the Delphi method using two consecutive electronic surveys. A high degree of consensus was achieved on items regarding framework and the conduct of neuromuscular ultrasound assessment and the knowledge and skills that a candidate needs to attain minimal competency in neuromuscular ultrasound. In this study, a group of neuromuscular ultrasound experts developed a general framework for neuromuscular ultrasound competency assessment and recommended testable areas of knowledge and skills suitable for establishing minimal competency.

Matched MeSH terms: Patient Care
Fulltext Effects of Multidrug Resistant Tuberculosis Treatment on Patients' Health Related Quality of Life: Results from a Follow Up Study

Ahmad N, Javaid A, Syed Sulaiman SA, Basit A, Afridi AK, Jaber AA, et al.

PLoS One, 2016 Jul 28;11(7):e0159560.
PMID: 27467560 DOI: 10.1371/journal.pone.0159560

At present, within the management of multidrug resistant tuberculosis (MDR-TB) much attention is being paid to the traditional microbiological and clinical indicators. Evaluation of the impact of MDR-TB treatment on patients' Health Related Quality of Life (HRQoL) has remained a neglected area.

Matched MeSH terms: Patient Care Management
Fulltext Ozone- A Biological Therapy in Dentistry- Reality or Myth?????

Naik SV, K R, Kohli S, Zohabhasan S, Bhatia S

Open Dent J, 2016;10:196-206.
PMID: 27386005 DOI: 10.2174/1874210601610010196

The usage of ozone in dentistry has been proposed because of its antimicrobial, disinfectant, biocompatibility and healing properties. In the last decade a number of therapeutic protocols with ozone have been developed to address common dental infections associated with periodontal disease, RCT and caries. Despite these advantages, therapeutic ozone's application in dentistry is limited because of its possible side effects. Hence, dental practitioners need to know the proper usage of ozone therapy that can provide better patient care and considerably cut down the time and cost of the treatment.

Matched MeSH terms: Patient Care
Nursing overseas: tuberculosis in West Malaysia

Arokianathan A

Nurs Times, 1980 Feb 14;76(7):296-7.
PMID: 6899163
Matched MeSH terms: Patient Care Planning
Fulltext Rapidly enlarging renal tumor during pregnancy: diagnostic and management dilemma

Tiang KW, Ng KL, Vega-Vega A, Wood S

J Kidney Cancer VHL, 2014;1(1):12-16.
PMID: 28326245 DOI: 10.15586/jkcvhl.2014.6

Urological tumors diagnosed during pregnancy are rare. However, the incidence seems to be increasing largely due to advancements in modern imaging techniques and improved antenatal care. The diagnosis and management of renal tumors during pregnancy poses a dilemma to clinicians. This case report highlights the challenges in managing a large chromophobe renal cell carcinoma in a young primigravida patient. Proper antenatal assessment, a multidisciplinary team approach and appropriate discussion with patient are important determinants to achieve the best clinical outcomes for both the mother and the baby.

Matched MeSH terms: Patient Care Team
Fulltext Mastering tasks of adolescence: the key to optimum end -of- life care of an adolescent dying of cancer.

Suriati Mohamed Saini, Susan, Mooi KoonTan.

ASEAN Journal of Psychiatry, 2011;12(1):0-0.
MyJurnal

Objective: This case report highlights the optimum end-of-life care of an adolescent dying of cancer. Method: We report our experience, as part of a multidisciplinary team in managing the cancers of a female student who died an untimely death at the age of 15. Results: Our role of motivating her for chemotherapy of her initial treatable carcinoma, became that of palliative care upon discovery of a second malignancy. We helped the patient “live life to the fullest” during her last days, she helped us realize that helping her master the tasks of adolescence was optimum “end-of-life care” as well. Conclusion: to help an ill adolescent die with dignity is to help her live whatever time she has left of her life. Allowing her to participate in decisions regarding her treatment and in other bio-psycho-social needs of that stage of life is crucial in helping her prepare for the end of life.

Matched MeSH terms: Patient Care Team
Fulltext Chronic disease management in Singapore polyclinics

Lee VKM, Tan NC, Chong MH

Malays Fam Physician, 2006;1(2):94-96.
PMID: 27570599 MyJurnal

Singapore health care has taken a major leap and invested a large amount of money and work force in chronic disease management. These changes attempt to integrate population perspectives and personcentred perspectives. Primary health care team can play a lead role in chronic illness care, but health care organisation system support and policy are critical to its success. (Copied from article).

Matched MeSH terms: Patient Care Team

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