Multidisciplinary Research Articles

At a glance: pressure injuries.

Pressure injuries, also known as pressure ulcers or 'bed sores', are caused by prolonged pressure on the skin and underlying tissues and are common in healthcare settings. They result from a variety of factors including pressure, moisture and friction, with a higher risk among older adults, post‑surgical patients and those with limited mobility or long‑term conditions. These injuries can extend hospital stays and significantly impact patient recovery and mortality risk. Prevention includes regular repositioning, the use of pressure‑relieving devices, skin care and nutritional support. The National Institute for Health and Care Excellence provides guidelines to mitigate these risks through systematic risk assessments and targeted interventions. Early detection and specialist care by a multidisciplinary team are crucial to improving patient outcomes. Consistent pplication of prevention strategies are needed to reduce incidence, improve patient care and alleviate the economic burden of thesex injuries on the NHS.

On the computation of robust examination timetables: methods and experimental results

AbstractWith ever-rising student numbers and an increasing shift towards more interdisciplinary study programs, the requirements for finding schedules for courses and exams become ever more complex. In real-world scenarios, the models used for calculating solutions to the course and the examination timetabling problem often must be provided to the students at the time of registration. In the field of curriculum-based course timetabling, timetables are calculated based on the structure of the study programs. For the examination timetabling problem, only a few papers focus on scheduling exams without registration data, as the requirements for exams are often more strict, or partial information is known from course registrations. In this paper we show that with the use of robustness techniques, we can also define the examination timetabling problem based on curricula. We introduce three robustness measures that address the inherent uncertainty when using the curriculum-based model. These robustness measures, along with other quality measures, are analyzed using a multi-objective simulated annealing algorithm. The results are compared on the Pareto front approximations found. We present a case study showing that, without a significant loss in solution quality, the chance is significantly reduced that rescheduling will be required after the exact numbers for the model are known.

Towards a history of parliamentary culture in the early modern world: concept, geopolitical scope, and method

ABSTRACT This article proposes an innovative approach to early modern representative institutions, from the later fifteenth century to the early eighteenth. It argues that only a transnational, interdisciplinary, and comparative study of such bodies can reveal their shared culture and prominence in contemporary political discourse, public memory, and cultural production. Central to this new approach is the concept of ‘parliamentary culture’, which sees representative assemblies as collective constructs and embodiments of a political community, and encompasses the transnational tradition of customs, ideas, and cultural expressions associated with them. The article aims to: (1) sketch out the institutional, geopolitical, and historical scope of our enquiry; (2) define parliamentary culture as a collection of practices of legitimation, negotiation, and debate in political assembly that are central to the life of a community; and (3) demonstrate that the distinctive institutional cultures of representative assemblies were an essential component of the public life and political thought of early modern countries; and that there was a common culture of representative assembly shared and recognized throughout Europe which was variously transplanted to and adapted in the overseas territories of the Iberian, Anglo-British, and Dutch empires, often through interaction with Indigenous traditions of assembly. The underlying argument is that only by looking at early modern representative bodies in this way can we appreciate the vitality and significance of this type of political organization.

Going Paperless: Using Electronic Questionnaires to Improve the Quality of Well-Child Checkups.

At our large, university-affiliated primary care clinic, we aimed to enhance the quality of well-child checkups (WCCs) to align with Bright Futures/American Academy of Pediatrics recommendations. Our primary goal was to increase the rate of complete WCCs from 45.6% to 80% by April 2024. Our secondary aims were to ensure WCC improvement for all language groups and to increase referrals to 2 community partners. A multidisciplinary team initiated a quality improvement project primarily focused on transitioning from paper-based to electronic questionnaires for patient screenings. Clinic processes were developed to assist families in completing questionnaires. The percentage of complete WCCs was the primary outcome measure. We defined complete WCCs as those that included note documentation of all required patient-reported elements. Our primary outcome measure was analyzed by using statistical process control charts to identify special cause variation. We reviewed 51 809 WCCs from July 2022 to April 2024, and the rate of complete WCCs improved from 45.6% to 84.7%. We significantly improved the rates for all measured aspects of WCCs as follows: 7 different common pediatric questionnaires and 7 routine WCC assessments. Referrals to 2 community nutrition and literacy resources increased. Despite large improvements across all language groups, disparities remained for patients who spoke languages other than English. Transitioning to electronic questionnaires and revised clinic procedures led to more comprehensive WCCs and connected more families with community resources. Although progress was made across all language groups, we note ongoing challenges in eliminating disparities.

Navigating new horizons in inflammatory bowel disease: Integrative approaches and innovations

This editorial offers an updated synthesis of the major advancements in the management and treatment of inflammatory bowel disease (IBD), as documented in the World Journal of Gastroenterology between 2023 and early 2024. This editorial explores substantial developments across key research areas, such as intestinal microecology, computational drug discovery, dual biologic therapy, telemedicine, and the integration of lifestyle changes into patient care. Furthermore, the discussion of emerging topics, including bowel preparation in colonoscopy, the impact of the coronavirus disease 2019 pandemic, and the intersection between IBD and mental health, reflects a shift toward a more holistic approach to IBD research. By integrating these diverse areas of research, this editorial seeks to promote a holistic and multidisciplinary approach to IBD treatment, combining emerging technologies, personalized medicine, and conventional therapies to improve patient outcomes.

Walking Ability After Microsurgical Reconstruction of Pediatric Popliteal Pterygium Syndrome—A Case Report

Background: Popliteal pterygium syndrome (PPS) is a rare congenital disorder characterized by orofacial, cutaneous, musculoskeletal, and genital anomalies. Surgical interventions are necessary to address the severe knee flexion contracture and equinovarus deformity, but there are no established treatment guidelines. Methods: We present the case of a one-year-old patient with PPS and discuss the challenges in managing the knee deformity. The surgical option chosen for the unilateral knee contracture of 80° consisted of skin management by a large Z-plasty, lengthening of popliteal vessels by grafts, lengthening of the tibial and peroneal nerves by autografts and allografts, capsular releases, and tendon releases to improve mobility and preserve foot sensibility. Results: With a three-year follow-up, the surgical interventions resulted in proper ability to walk freely. Wearing of a foot orthesis was necessary to balance the leg length differences and support the midfoot deformity. Furthermore, sensation of the foot could be restored in terms of touch sensibility and perfusion was always stable during growth. Discussion: The treatment of PPS requires a multidisciplinary approach, considering the rarity and complexity of the syndrome. Surgical interventions aim to release contractures, correct deformities, and preserve foot sensibility. Each treatment option has its advantages and disadvantages, highlighting the need for individualized care.

Enhancing Coronary Revascularization Decisions: The Promising Role of Large Language Models as a Decision-Support Tool for Multidisciplinary Heart Team.

While clinical practice guidelines advocate for multidisciplinary heart team (MDHT) discussions in coronary revascularization, variability in implementation across health care settings remains a challenge. This variability could potentially be addressed by language learning models like ChatGPT, offering decision-making support in diverse health care environments. Our study aims to critically evaluate the concordance between recommendations made by MDHT and those generated by language learning models in coronary revascularization decision-making. From March 2023 to July 2023, consecutive coronary angiography cases (n=86) that were referred for revascularization (either percutaneous or surgical) were analyzed using both ChatGPT-3.5 and ChatGPT-4. Case presentation formats included demographics, medical background, detailed description of angiographic findings, and SYNTAX score (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery; I and II), which were presented in 3 different formats. The recommendations of the models were compared with those of an MDHT. ChatGPT-4 showed high concordance with decisions made by the MDHT (accuracy 0.82, sensitivity 0.8, specificity 0.83, and kappa 0.59), while ChatGPT-3.5 (0.67, 0.27, 0.84, and 0.12, respectively) showed lower concordance. Entropy and Fleiss kappa of ChatGPT-4 were 0.09 and 0.9, respectively, indicating high reliability and repeatability. The best correlation between ChatGPT-4 and MDHT was achieved when clinical cases were presented in a detailed context. Specific subgroups of patients yielded high accuracy (>0.9) of ChatGPT-4, including those with left main disease, 3 vessel disease, and diabetic patients. The present study demonstrates that advanced language learning models like ChatGPT-4 may be able to predict clinical recommendations for coronary artery disease revascularization with reasonable accuracy, especially in specific patient groups, underscoring their potential role as a supportive tool in clinical decision-making.

A conservative management approach for spinal tuberculosis causing cauda equine syndrome in pregnancy

Background: Spinal tuberculosis in pregnancy leading to neurological sequelae is rare and a challenging condition to manage. The usual approach is to perform urgent decompression surgery, but patients with a more stable course of the disease may benefit from a conservative approach with anti-tuberculosis (ATT) therapy.Case presentation: A pregnant mother in her second trimester presented with a history of chronic backache exacerbated by right-sided foot drop, L5 root sensory loss and intermittent urinary retention. MRI revealed L5 vertebral collapse with para-vertebral collection causing cauda equine compression at the L5-S1 level. High ESR, strongly positive tuberculin test, and the clinical and radiological findings were compatible with a diagnosis of spinal tuberculosis. Based on the multi-disciplinary team’s decision, a conservative management approach with ATT and supportive therapy was initiated with close observation. The patient showed a remarkable response to ATT with clinical and radiological improvement. She underwent an elective caesarean section at 37 weeks and delivered a healthy baby. On the fourth week postpartum, she underwent decompressive surgery with complete neurological recovery,Discussion and conclusion: Spinal TB in pregnancy causing neurological impairment is usually managed with urgent surgical interventions. This is one of the few reported cases where a conservative approach was undertaken, with close observation and a positive outcome.Therefore, it is important to carefully select patients needing surgical interventions and those who would benefit better from a conservative approach. High suspicion, early diagnosis, prompt treatment initiation and close monitoring are vital components in achieving the best outcome.

Recognition and Management of Postpartum Hemorrhage

Abstract Postpartum hemorrhage (PPH) is an obstetric emergency and refers to excessive blood loss after birth. Loss of blood volume and oxygen-carrying capacity may lead to maternal hypovolemia and hypotension resulting in tissue hypoxia, the onset of anaerobic metabolism, and multiorgan failure. If timely and appropriate action is not taken, cardiac arrest and maternal death may occur. If the amount of blood loss exceeds 500 mL following a vaginal birth or 1000 mL during or following a cesarean section, it is termed PPH. Similar to any other surgical hemorrhage, PPH is classified into primary PPH (occurs within 24 hours of birth) or secondary PPH (between 24 hours and 12 weeks postpartum). PPH is a major contributor to maternal deaths worldwide, and it is estimated that a person dies because of PPH approximately every 5 minutes. Therefore, measures should be directed at prevention and early detection of PPH with prompt management. The prevalence of PPH varies globally and is influenced by location, socioeconomic factors, and the availability and quality of health care. The World Health Organization reported that PPH accounts for a quarter of global maternal deaths. The Mothers and Babies Reducing Risks through Audits and Confidential Enquiries report from the United Kingdom (2023) highlighted that despite rare mortality due to hemorrhage, the number of people dying of obstetric hemorrhage is not decreasing, particularly among people with abnormally invasive placentation. Additionally, substandard care was found to be responsible for more than 50% of deaths due to PPH in the United Kingdom. Therefore, it is vital that adequate healthcare infrastructure, trained and competent healthcare professionals, and immediate access to resources, interventions, and multidisciplinary teams are essential both in well-resourced and resource-restrained healthcare systems. Healthcare professionals must identify the potential risk factors for PPH and initiate preventive measures whenever possible. Additionally, they must respond swiftly if PPH occurs and ensure a multidisciplinary, multilayered approach for a synchronized response to optimize outcomes. This review article emphasizes the etiopathogenesis, diagnosis, and management of PPH based on current scientific evidence as well as international best practice recommendations.

The Role of the Equestrian Professional in Bridle and Bit Fit in the United Kingdom

To ensure the comfort of ridden horses, equipment including bridles and bits should be suitable and fit correctly. Horse owners employ a variety of equestrian professionals with varying degrees of responsibility regarding bridle and bit fit. This study aimed to compare the frequency and manner in which equestrian professionals within a multidisciplinary team (MDT) engage with clients on matters of bridle and bit fit, and to capture their perceptions of the key issues in bridle and bit fit. The participants completed an online questionnaire to obtain information regarding participant demographics, bridle fit and bit fit for the horse. Descriptive statistics and Kruskal–Wallis analyses were performed (p ≤ 0.05). Inductive content analysis identified themes from open-question responses. The results from 377 respondents were analyzed: 184 saddle fitters, 116 coaches and 77 therapists. The results showed that 65% of coaches ‘nearly always’ or ‘very often’ ask clients when they last had their bridle fitted, which was significantly more than saddle fitters (p = 0.002). More saddle fitters assess bridle fit statically and dynamically compared with coaches (p = 0.02). ‘Browband too small’ featured in the top three bridle fit issues for all professions. More professionals reported issues of bit suitability than fit. The findings demonstrate that whilst various equestrian professionals assess and act upon issues of bridle and bit fit, the extent to which this occurs is lower than for the saddle. Further work should quantify the prevalence of issues in bridle and bit fit and suitability in ridden horses.

Interdisciplinary Operating Room Ergonomics Needs and Priorities: A Survey of Operating Room Staff.

To examine perceived OR ergonomics facilitators and barriers, with a focus on the interdisciplinary team. Poor ergonomics causes musculoskeletal injuries affecting all operating room (OR) staff with repercussions on patient care, outcomes, and sustainability. Lack of ergonomic awareness and education are risk factors. We conducted a self-administered web-based survey of OR nurses, surgeons, and anesthesiologists at a single centre (n=238). We developed a questionnaire through items generation and reduction, followed by reliability and validity testing. Response rate was 53.8%. Respondents perceived that on average 80% of nurses, 70% of surgeons, and 40% anesthesiologists experienced MSK injuries, with no difference in professional groups' perceptions. Guideline ergonomics interventions were rarely used (<25%) except for specialized clothing (33%), equipment repositioning (59%), and seating (37%), though perceived beneficial by 80-90%. Reported barriers to optimal ergonomics were organizational/structural (lack of time, space, equipment, funding), whereas solutions were individual. Fear of unfavourable perception from others was a concern for 62%. Teams discussing, prioritizing, monitoring, or helping with ergonomics was indicated by <50%. Individual ergonomic adaptations were perceived as convenience by other staff. While structural/organizational issues are reported as barriers to ergonomics, solutions appeared as individual responsibilities. Team dynamics did not prioritize nor support ergonomics. Education tools leveraging the interdisciplinary team are warranted. This work will be supplemented by interviews and live observations to build tailored educational tools for OR teams.

The effects of exercise on anxiety symptoms in women with gestational diabetes mellitus: a pilot study.

Anxiety is a common mental health issue during pregnancy. Moreover, women with gestational diabetes mellitus (GDM) seem to have to cope with higher levels of anxiety, being at higher risk for several health and mental complications. Women with GDM are recommended to undertake regular physical exercise to improve metabolic and reproductive outcomes. However, there are no specific guidelines for exercise in women with GDM and data on its relationship with mental health are scarce. The aim of this study was to investigate the effect of exercise on anxiety symptoms in pregnant women with GDM. The present non-randomized, open-label clinical trial was a pilot study intended to provide initial data on the effect of exercise on anxiety symptoms of pregnant women with GDM. Forty-three women were assigned to three the following three study groups, (a) Advice Group (n = 17), Walking Group (n = 14), and Mixed Exercise Group (n = 12), from GDM diagnosis to delivery. Based on the Beck Anxiety Inventory (BAI) scores, all groups showed normal anxiety changes or mild anxiety levels pre- and post-intervention, ranging between 9.00 (1.00-32.00) (pre-intervention) and 7.5 (1.00-26.00) (post-intervention), but none experienced severe anxiety. In the present study, a trend of self-selected pace walking to reduce the BAI scores was identified since the Walking Groups had lower scores after the intervention. However, this trend did not reach statistical significance. Brisk walking (30-45min) three times per week may produce positive changes in both the treatment plan and the anxiety state of women with GDM. Moreover, the study confirms that routine medical care, counseling, and support by an interdisciplinary team are protective against anxiety in women with GDM.

Successful pregnancy outcome following selective uterine artery embolization in a case of perforating gestational trophoblastic neoplasia

Gestational trophoblastic neoplasia (GTN) includes a range of premalignant and malignant disorders of trophoblastic tissue. Invasive mole can present as a surgical emergency with rapidly progressive and highly vascular trophoblasts causing uterine perforation. Often hysterectomy is resorted to as a life-saving measure but in women desirous of future fertility, other options should be considered. We present the case of a nulliparous woman who presented with hemoperitoneum following perforating GTN. She was pale with stable vitals. Serum beta hCG at presentation was 98,156IU/L. Ultrasound pelvis revealed a highly vascular heterogenous hypoechoic mass of 5.8cm×5.5cm×6.5cm in the region of fundus and anterior myometrium showing significant internal and peripheral vascularity and displacing endometrium posteriorly. Ultrasound guided tap revealed hemoperitoneum. We decided for uterine artery embolization following clinical stabilization of the patient followed by chemotherapy. Figure 1 shows CT angiography done prior to uterine artery embolization. She conceived spontaneously two years later and was followed up closely in antenatal period. She was induced at 38 completed weeks due to oligohydramnios and decreased fetal movements and vaginally delivered a healthy baby with no postnatal complications. Fertility sparing procedures should be considered as a first possible option in selective cases. Multidisciplinary approach in high-risk cases is a key to optimal outcome.

Primary Congenital Glaucoma presenting with Acute Corneal Hydrops: a challenging approach to amblyopia prevention

Introduction: Acute hydrops is a rare initial manifestation of Primary Congenital Glaucoma (PCG). It can result in significant corneal opacity, posing an additional risk for amblyopia development in PCG patients. We report a case of a newborn with PCG presenting with acute corneal hydrops and significant corneal scarring, discussing the management and challenges of amblyopia prevention. Case Presentation: A 3-day-old female newborn was referred to our department due to bilateral corneal clouding. Anterior segment examination revealed bilateral corneal edema, with severe corneal prolapse in the right eye consistent with acute hydrops. The anterior chamber structures of the right eye were indiscernible due to significant corneal edema. The left eye presented a deep, quiet anterior chamber with no dysgenesis of anterior segment structures. Intraocular pressure (IOP) measurements were &gt;40 mmHg in both eyes. Corneal diameters were 10 mm OD and 12 mm OS. Fundoscopic posterior segment assessment was not possible due to unclear media. B-scan ultrasonography revealed no significant changes. The patient underwent urgent bilateral trabeculotomy. Postoperatively, intense mechanical stretching induced by severely increased IOP was visible, with the right cornea exhibiting a central opacity managed with topical corticosteroids and showing improvement. Right corneal opacity spared the superior cornea, and atropine drops combined with left eye occlusion were employed to mitigate right eye deprivation amblyopia. Eighteen months later, the patient can fixate and follow objects with the right eye. Left eye corneal transparency was restored, and bilateral IOP control was achieved. Conclusion: Despite prompt surgical treatment, acute hydrops presents a postoperative management challenge and may result in irreversible corneal scarring. Timely management of corneal opacities is crucial to prevent amblyopia. A multidisciplinary approach is essential for the best visual outcome.

Comprehensive walkability assessment of urban pedestrian environments using big data and deep learning techniques.

Assessing street walkability is a critical agenda in urban planning and multidisciplinary research, as it facilitates public health, community cohesion, and urban sustainability. Existing evaluation systems primarily focus on objective measurements, often neglecting subjective assessments and the diverse walking needs influenced by different urban spatial elements. This study addresses these gaps by constructing a comprehensive evaluation framework that integrates both subjective and objective dimensions, combining three neighbourhood indicators: Macro-Scale Index, Micro-Scale Index, and Street Walking Preferences Index. A normalization weighting method synthesizes these indicators into a comprehensive index. We applied this framework to assess the street environment within Beijing's Fifth Ring Road. The empirical results demonstrate that: (1) The framework reliably reflects the distribution of walkability. (2) The three indicators show both similarities and differences, underscoring the need to consider the distinct roles of community and street-level elements and the interaction between subjective and objective dimensions. (3) In high-density cities with ring-road development patterns, the Macro-Scale Index closely aligns with the Comprehensive Index, demonstrating its accuracy in reflecting walkability. The proposed framework and findings offer new insights for street walkability research and theoretical support for developing more inclusive, sustainable and walkable cities.

MAGUS (Model for the Analysis of Geomorphological Urban Systems): From Conception to Validation on the Historic City Center of Turin (Italy)

This study introduces and tests the MAGUS (Model for the Analysis of Geomorphological Urban Systems), a GIS-based methodological framework designed to analyze the complex interplay between urbanization and natural landscapes. Focusing on the historical evolution of Turin city center (Italy), the research employs an interdisciplinary approach to examine how urban expansion has interacted with pre-existing geomorphological features. The study leverages historical documents, digitized and georeferenced within a cartographic space, to reveal the relationships between natural and anthropogenic landforms from the Roman period through the 20th century. A key innovation of MAGUS is the integration of Multi-Temporal Markers (MTM) and Volumetric Unit of Building (VUB), which enhances the accuracy of historical data analysis. The results demonstrate that urbanization significantly alters the natural landscape in the historic city center of Turin, where the stratification of urban expansion phases partially obscures the original landform. By overlaying topographical data with historical urban expansion maps, the research highlights the concealed geomorphological elements beneath Turin’s urban fabric. This interdisciplinary study not only contributes to the field of urban geomorphology but also provides a foundation for future research into the impacts of urbanization on natural landscapes, which is increasingly critical as urban populations continue to grow.

The roles and patterns of critical care pharmacists: a literature review and practical operation model in China

Drug-related problems (DRPs) are prevalent in critically ill patients and may significantly increase mortality risks. The participation of critical care pharmacists (CCPs) in the medical team has demonstrated a benefit to healthcare quality. Research indicates that CCP medication order evaluations can reduce DRPs, while their participation in rounds can reduce adverse drug events and shorten hospital stays. Pharmacist medication reconciliation often proves more effective than physicians, and CCPs play a crucial role in antimicrobial management and reducing treatment costs. Despite these benefits, there is a noticeable lack of practical guidance for implementing CCP roles effectively. Their workflow heavily influences the efficiency of CCPs. Integrating results from the literature with our practical experience, we have detailed workflows and critical entry points that CCPs can refer to. Pharmacists should be proactive rather than passive consultants. Pre-round medication order evaluations are crucial for determining the depth of a pharmacist’s involvement in patient care. These evaluations should cover the following aspects: medication indication, dosage, treatment duration, detection of DRPs, implementation of therapeutic drug monitoring, dosing of sedatives and analgesics, and pharmaceutical cost containment. Beyond identifying medication issues, a primary task during rounds is gathering additional information and building trust with the medical team. Post-round responsibilities for CCPs include patient and caregiver education on medication, medication reconciliation for transitioning patients, and follow-up care for post-ICU patients. Establishing a rationalized and standardized workflow is essential to minimize daily work omissions and maximize the pharmacist’s value. A multidisciplinary pharmacist-led team can significantly promote the rational use of antibiotics. Participation in post-ICU outpatient follow-ups can reduce drug-induced injuries after discharge. This review provides a detailed overview of the tasks performed by CCPs before, during, and after medical rounds, serving as a valuable reference for establishing an efficient workflow for CCPs.

"It's Just Really Important for us all to be on the Same Page": Qualitative Evaluation of Factors that Influence Written Mobility Communication.

Poor interdisciplinary team communication is a known barrier to increasing inpatient mobility. Understanding why and how clinicians from different disciplines communicate about mobility would help inform communication improvements. This qualitative interview study aimed to describe and explore clinician perceptions about written mobility communication, and perceived barriers and enablers to this communication. A rapid deductive qualitative approach was used to efficiently capture information for local improvement. Clinicians (physical therapists, nurses, physicians, and occupational therapists) working on 3 internal medicine wards in a metropolitan teaching hospital in Brisbane, Australia were purposefully sampled and invited to participate in individual interviews. Questions were based on the Consolidated Framework for Implementation Research. Interviews were recorded, transcribed, and analyzed using deductive and inductive thematic methods. From 17 interviews, key themes identified that written communication about patient mobility is important and valued by clinicians; clinicians learn documentation on the job, often from physical therapists; clinicians are not aware of organizational responsibility for mobility communication; multiple purposes for written communication contribute to multiple locations and inconsistency; and clinicians perceive that improvement would require a multi-disciplinary and multi-level approach. Suggestions for improvement included use of a common language, consistent use of existing bedside communication tools, and clearer responsibility for written communication about mobility. Written communication about patient mobility was valued by clinicians and a range of barriers to effective interdisciplinary communication identified. Clear professional roles and responsibility for written mobility communication is important. Suggestions for improvement included an interdisciplinary language supported by multi-disciplinary education and organizational governance. Written communication about patient mobility is recognized as critical to safe, high-quality hospital care. Our findings suggest that successful mobility communication improvements must involve multiple disciplines and include clear organizational governance to support staff training, clear role responsibilities, and quality monitoring.

Sustainable Education for Sustainable Heritage: Managing the Tension Between Professional Practice and Critical Inquiry

ABSTRACT This paper reflects on Uppsala University’s experiences from organizing higher education in conservation, and argues how curricula can be rethought and reorganized to foster a genuine shift towards sustainable education. It discusses various experiences of developing and planning interdisciplinary higher education programs in conservation and how curricula can be transformed to broaden the sustainability competence of future heritage professionals. We need to foster heritage professionals that are capable of exploiting the dynamic and negotiated nature of heritage for the good of society. By embracing change and loss there are opportunities to use heritage in more benign and sustainable ways. But there are profound differences between how heritage and its role in society are understood in conservation as a field of practice and as a field of inquiry. Based on the experience from Uppsala University, the authors argue that there is a need for a conservation curriculum in higher education that balances and integrates normative competence and critical inquiry: a middle path, where opposing perspectives can thrive in parallel.

Revalidation of Proactive Gastrostomy Tube Placement Guidelines for Head and Neck Cancer Patients Receiving Helical Intensity-Modulated Radiotherapy

The Royal Brisbane and Women’s Hospital (RBWH) Swallowing and Nutrition Management Guidelines for Patients with Head and Neck Cancer were developed to enable evidence-based decision-making by the Head and Neck Multidisciplinary Team (H&amp;N MDT) regarding enteral nutrition support options. The purpose of this study was to revalidate these guidelines in a cohort of patients receiving helical intensity-modulated radiotherapy (H-IMRT) compared to a historical cohort who received primarily 3D-conformal radiotherapy. Eligible patients attending the RBWH H&amp;N MDT between 2013 and 2014 (n = 315) were assessed by the guidelines, with high-risk patients being recommended proactive gastrostomy tube placement. Data were collected on guideline adherence, gastrostomy tube insertions, the duration of enteral tube use and weight change. Sensitivity, specificity and positive predictive and negative predictive values were calculated and compared with the historical cohort. Overall guideline adherence was 84%, with 60% and 96% adherence to the high-risk and low-risk pathways, respectively. Seventy patients underwent proactive gastrostomy tube placement (n = 62 high-risk; n = 8 low-risk). Validation outcomes were sensitivity 73% (compared to 72%) and specificity 86% (compared to 96%). The guidelines yielded a high sensitivity and specificity, remaining valid in a cohort of patients treated with H-IMRT. Further studies are recommended to improve the sensitivity and understand the decrease in specificity in order to make ongoing guideline improvements.