Interdisciplinary Coordination Research Articles

A qualitative evaluation of the oncologists’, neurologists’, and pain specialists’ views on the management and care of chemotherapy-induced peripheral neuropathy in The Netherlands

PurposeIn treating cancer, different chemotherapy regimens cause chemotherapy-induced peripheral neuropathy (CIPN). Despite recent international guidelines, a gold standard for diagnosis, treatment, and care is lacking. To identify the current clinical practice and the physicians’ point of view and ideas for improvement, we evaluated CIPN care by interviewing different specialists involved.MethodsWe performed semi-structured, audio-recorded, transcribed, and coded interviews with a purposive sample of oncologists, pain specialists, and neurologists involved in CIPN patients’ care. Data is analyzed by a constant comparative method for content analysis, using ATLAS.ti software. Codes, categories, and themes are extracted, generating common denominators and conclusions.ResultsWith oncologists, pain specialists, and neurologists, nine, nine, and eight interviews were taken respectively (including three, two, and two interviews after thematic saturation occurred). While useful preventive measures and predictors are lacking, patient education (e.g., on symptoms and timely reporting) is deemed pivotal, as is low-threshold screening (e.g., anamnesis and questionnaires). Diagnosis focusses on a temporal relationship to chemotherapy, with adjuvant testing (e.g., EMG) used in severe or atypical cases. Symptomatic antineuropathic and topical medication are often prescribed, but personalized and multidimensional care based on individual symptoms and preferences is highly valued. The limited efficacy of existing treatments, and the lack of standardized protocols, interdisciplinary coordination, and awareness among healthcare providers pose significant challenges.ConclusionBesides the obvious need for better therapeutic options, and multidisciplinary exploration of patients’ perspectives, a structured and collaborative approach towards diagnosis, treatment, referral, and follow-up, nurtured by improving knowledge and use of existing CIPN guidelines, could enhance care.

Using the Tasmanian Palliative and End of Life Care Policy Framework (2022) to assess service delivery in a rural general practice.

This commentary uses the Tasmanian Palliative and End of Life Care Policy Framework (2022; the TPE Framework) to reflect upon palliative care services delivered by a rural Tasmanian general practice. Rural populations have challenges in accessing many healthcare services, including palliative care. General practitioners (GPs) and other primary healthcare workers are frequently relied upon to deliver palliative care in rural Australia. Palliative care is often needed before the end-of-life phase and patients prefer this to be delivered in the community or at home. GPs face challenges and barriers in continuing to deliver home-based palliative care services. All Medical Benefit Scheme billings for after-hours or home-based palliative care provided by the practice, between September 2021 and August 2022, were identified and patient demographic and clinical details collated. To further understand this data, nine GPs were surveyed to explore their attitudes to provision of palliative care service to the local rural communities they serve. These data highlighted several priority areas of the TPE Framework. The TPE Framework is used here to add to the shared understanding of palliative care service delivery in a rural community, and to see if GP's responses align with the priorities of the TPE Framework. Of the 258 after-hours and home-visits delivered over a 12-month period, almost 58% (n = 150) were for palliative care. Patients receiving palliative care were generally older than non-palliative patients visited (79.9 years vs. 72.0 years respectively; p = 0.004). Patients not at imminent risk of death (64.0%) were more frequently recipients of home-visits. Of the nine GPs responding to the survey, most intended to continue home visits for palliative patients. Disincentives to providing palliative care during home visits included a lack of time during the day (or after hours), low levels of interdisciplinary coordination or role-definition, and inadequate remuneration. Existing frameworks can be used as an implementation and evaluation guide to help understand local palliative care services. Using a Framework, a rural general practice in Tasmania reflected on their provision of palliative care services. Providing holistic palliative care services from a rural general practice is desirable and achievable with a coordinated, team-based approach. Access to and integration with specialist services remains a key component of community-based palliative care pathways.

Of lakes and knowledges: between disciplinary enclosures and the pursuit of “full transdisciplinarity”

AbstractThe article discusses the challenges and opportunities facing interdisciplinary attempts to produce knowledge about water and lake-related processes. It examines key aspects of the long-standing debates on this topic and discusses the state of the art providing empirical examples. The article argues that, notwithstanding the significant progress achieved in disciplines and fields of knowledge relevant to water-related research, the development of interdisciplinary coordination, particularly between the physical–natural and the social sciences remains underdeveloped. However, the fact that the extreme global crisis affecting water and life in the planet, more generally, has a primarily anthropogenic nature suggests that there are urgent reasons to promote greater collaboration between different forms of knowledge relevant to these processes. The main objective is contributing to raise awareness about obstacles and opportunities for enhanced interdisciplinary coordination in these areas, to tackle the urgent problems facing the socio-hydrosphere.

Sustaining the collaborative chronic care model in outpatient mental health: a matrixed multiple case study.

Sustaining evidence-based practices (EBPs) is crucial to ensuring care quality and addressing health disparities. Approaches to identifying factors related to sustainability are critically needed. One such approach is Matrixed Multiple Case Study (MMCS), which identifies factors and their combinations that influence implementation. We applied MMCS to identify factors related to the sustainability of the evidence-based Collaborative Chronic Care Model (CCM) at nine Department of Veterans Affairs (VA) outpatient mental health clinics, 3-4years after implementation support had concluded. We conducted a directed content analysis of 30 provider interviews, using 6 CCM elements and 4 Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) domains as codes. Based on CCM code summaries, we designated each site as high/medium/low sustainability. We used i-PARIHS code summaries to identify relevant factors for each site, the extent of their presence, and the type of influence they had on sustainability (enabling/neutral/hindering/unclear). We organized these data into a sortable matrix and assessed sustainability-related cross-site trends. CCM sustainability status was distributed among the sites, with three sites each being high, medium, and low. Twenty-five factors were identified from the i-PARIHS code summaries, of which 3 exhibited strong trends by sustainability status (relevant i-PARIHS domain in square brackets): "Collaborativeness/Teamwork [Recipients]," "Staff/Leadership turnover [Recipients]," and "Having a consistent/strong internal facilitator [Facilitation]" during and after active implementation. At most high-sustainability sites only, (i) "Having a knowledgeable/helpful external facilitator [Facilitation]" was variably present and enabled sustainability when present, while (ii) "Clarity about what CCM comprises [Innovation]," "Interdisciplinary coordination [Recipients]," and "Adequate clinic space for CCM team members [Context]" were somewhat or less present with mixed influences on sustainability. MMCS revealed that CCM sustainability in VA outpatient mental health clinics may be related most strongly to provider collaboration, knowledge retention during staff/leadership transitions, and availability of skilled internal facilitators. These findings have informed a subsequent CCM implementation trial that prospectively examines whether enhancing the above-mentioned factors within implementation facilitation improves sustainability. MMCS is a systematic approach to multi-site examination that can be used to investigate sustainability-related factors applicable to other EBPs and across multiple contexts.

A study on the epidemiology of brucellosis in bovine population of peri-urban and rural areas of district Multan, southern Punjab, Pakistan

BackgroundBrucellosis is a zoonotic disease caused by a bacterial pathogen belonging to the genus Brucella. It is one of the most frequent bacterial zoonoses globally but unfortunately, it is still considered as a neglected disease in the developing world. Keeping in view, this study was conducted to determine the prevalence and risk determinants of brucellosis in large ruminants of peri-urban and rural areas of district Multan-Pakistan. For this purpose, blood samples (n = 490) were collected from the cattle (n = 245) and buffalo (n = 245) population of the study area and subjected to preliminary screening of brucellosis using local and imported RBPT reagents. All the samples were further analyzed using commercially available multi-specie indirect ELISA kit followed by their confirmation by PCR using genus and species-specific primers. Data obtained from lab analysis and questionnaires were subjected to statistical analysis for Pearson Chi-square, Odds Ratio and Confidence intervals (95%).ResultsThe results showed that the maximum seropositivity was recorded with local RBPT reagent (VRI, Pakistan; 12.45%; 95%CI = 9.72–15.65%) followed by RBPT-IDEXX (12.24%; 95%CI = 9.52–15.45%) and RBPT-ID.vet (11.84%; 95%CI = 9.18–14.95%) however statistical difference was non-significant (P = 0.956). The ELISA results showed an overall seroprevalence rate of 11.22% (95%CI = 8.59–14.33%) with comparatively higher rate in cattle (12.65%; 95%CI = 8.82–17.44%) as compared to buffaloes (9.80%; 95%CI = 6.49–14.15%). The PCR analysis confirmed the presence of genus Brucella in all seropositive samples whereas frequency of B. abortus and B. melitensis in seropositive samples was 80% and 20%, respectively. The co-existence of both species was also observed in 5.45% samples. The statistical analysis showed a significant association of bovine brucellosis with herd size, breed, reproductive disorders, mode of insemination, educational status and farmers’ awareness about brucellosis (P < 0.05). Conversely, locality, age, weight, gender, pregnancy status, parity and puberty status had no associations with brucellosis (P > 0.05).ConclusionIn conclusion, brucellosis is prevalent in large ruminants of district Multan, Pakistan. It is suggested to devise and implement stringent policies for the effective control and prevention of brucellosis in the region. Further, the current situation also warrants the need to strengthen interdisciplinary coordination among veterinarians and physicians in one health perspective to ensure and strengthen the human and animal health care systems in the region.

A project management model for architectural restoration projects

Architectural restoration projects have many peculiarities that differentiate them from other construction projects. Despite the universal guidelines, standards and bylaws, a specialized approach on the management of architectural restoration projects is yet a knowledge gap. Inadequate use of project management knowledge in the field results in time and budget overruns, quality problems, insufficient research, incorrect scope definition, lack of interdisciplinary coordination, disconnection between phases, inefficiency in change management, and further ambiguities. Following an exploratory sequential research process consisting of qualitative and quantitative data from a focus group meeting, a questionnaire survey, and a 48-h on-site training; the authors focus on the peculiar nature of architectural restoration projects from project management perspective. The study aims to explore the extent to which the conventional project management knowledge, tools and techniques can be applied to architectural restoration projects, investigate if more adaptive and contemporary approaches can fit better to them, and propose a practically applicable management model tailored for such projects. The results show that a hybrid model combining agile and waterfall project management approaches with an appropriate business context targeting the unique requirements of architectural restoration projects can be instrumental to cope with the complexities of such projects.

Closing the Gap: Multidisciplinary Coordination of a Care Plan for Patients with Multimorbidity

Introduction: Multidisciplinary communication and collaboration are of utmost importance in order to transition from fragmented and disease-centered care to patient-centered care for people with multimorbidity. Interdisciplinary coordination of a care plan is a vital part of this collaboration, yet can take many different forms. Our primary aim is to uncover the existing pathways of multidisciplinary communication and collaboration to reach an integrated treatment plan. Our secondary aim is to identify potential limitations and strengths of these pathways, in order to propose ways to improve interdisciplinary coordination, and ultimately improve outcomes of care for patients with multimorbidity in the hospital.&#x0D; Methods: Seven focus groups were organized, in both secondary and tertiary hospitals in the Netherlands. Each focus group was centered around a recent, local case study regarding a patient with multimorbidity. All involved health care professionals related to this specific patient were invited to participate in the focus group. Focus groups followed a discussion guide and were transcribed verbatim. Text was fragmented, coded and thematized using the principles of grounded theory. Member checking was performed by experts in the field.&#x0D; Results: 20 medical professionals were interviewed from three secondary, and four tertiary hospitals. None of the focus groups included all invited professionals due to their conflicting schedules. Analysis showed that the process of interdisciplinary coordination could be divided into the ‘reason’, ‘timing’, ‘modality’ and ‘outcome’. The ‘reason’ to seek interdisciplinary coordination could be medical complexity, a signal from a patient that indicates uncoordinated care, need for division of care roles, or to explore if care plans are aligned with the patient as a whole. Care providers could opt for different modalities to collaborate, such as: a phone call, referral to a colleague, or organizing a multidisciplinary team meeting. Possible outcomes could be integrating patient goals into the care plan, reduction in care consumption, and/or higher patient satisfaction. Factors of influence were identified for all main elements of this process: e.g. level of experience of the health care professional and available financial structures for different modalities of collaboration.&#x0D; Implications: We introduce a process model describing the current pathways in multidisciplinary coordination of care for patients with multimorbidity. This model shows that depending on the reason to collaborate, and with the desirable outcome in mind, different modalities of collaboration and communication are possible. Using case studies, we illustrate how and where current pathways can fall short and new innovative ways of providing care can be developed. For the Netherlands, we are developing a new mode of seeking coordination based on this model which ensures better multidisciplinary collaboration and inclusion of the patient perspective: a structured multidisciplinary patient review (MPR) for patients with multimorbidity. We hope to inspire the international community to adapt this innovative model to their own context of care.&#x0D; &#x0D;

Oropharyngeal teratoma in a newborn: A case report

Background: Facial teratomas are rare congenital tumors in the craniocervical region. They constitute only 2-5% of all childhood teratomas. Case Presentation: This report presents a case of an oral teratoma in an infant, attached to the palate and extending sublingually on the right side, along with a cleft palate. The patient underwent successful surgical excision on the 17th day of life performed by a team of pediatric and maxillofacial surgeons. Conclusion: The case emphasizes the importance of interdisciplinary coordination for the management of facial teratomas, involving maxillofacial and pediatric surgeons, neonatologists, anesthesiologists, and obstetrics specialists.

Perioperative hemostatic management of patients with type A aortic dissection.

Coagulopathy is common in patients undergoing thoracic aortic repair for Stanford type A aortic dissection. Non-critical administration of blood products may adversely affect the outcome. It is therefore important to be familiar with the pathologic conditions that lead to coagulopathy in complex cardiac surgery. Adequate care of these patients includes the collection of the medical history regarding the use of antithrombotic and anticoagulant drugs, and a sophisticated diagnosis of the coagulopathy with viscoelastic testing and subsequently adapted coagulation therapy with labile and stable blood products. In addition to the above-mentioned measures, intraoperative blood conservation measures as well as good interdisciplinary coordination and communication contribute to a successful hemostatic management strategy.

Contraceptive Use in Females With Advanced CKD: A Qualitative Study

Pregnancy in females with kidney disease is not uncommon and is associated with adverse maternal and fetal outcomes. The use of contraception in females with chronic kidney disease remains low. We sought to describe the perspectives of female patients with advanced chronic kidney disease on the use of contraception. Qualitative study. We conducted 5 focus group interviews involving 16 adult female patients with advanced chronic kidney disease (n=3nondialysis nontransplant chronic kidney disease, n=9kidney transplant, and n=4kidney failure receiving dialysis) in the United States, following which thematic saturation was reached. Interview transcripts were analyzed thematically. We identified the following 5 themes: 1) variable knowledge regarding reproductive health with kidney disease, 2) inadequate counseling about contraceptive use, 3) lack of interdisciplinary coordination regarding contraceptive use, 4) insufficient educational resources available to guide the contraceptive discussion, and 5) need for research to better understand reproductive needs in females with kidney disease. Patients were from a single center in the United States, and the study is limited by the transferability of findings to other settings. Patients with chronic kidney disease report emotional challenges with reproductive health, lack of counseling and care coordination, and insufficient resources for contraceptive use. Strategies to strengthen these factors may improve the quality of reproductive care and increase contraceptive use for females with chronic kidney disease. Pregnancy in females with kidney disease is common and associated with a higher risk of adverse maternal and fetal outcomes, but the use of contraception remains low. Little is known about female patients' experiences in contraceptive use that may contribute to low contraceptive use in this high-risk population. In the present study using focus group interviews, patients with chronic kidney disease reported emotional challenges with reproductive health, lack of counseling and care coordination, and insufficient resources for contraceptive use. Interventions are needed to strengthen these factors to improve the quality of reproductive care and increase contraceptive use for females with chronic kidney disease.

Application of teaching methods and tools in "Linguistic study" classes (german language) in the training of students of the specialty "Business communications and translation"

During the training of highly qualified specialists of the "Business Communications and Translation" program, the course "Linguistic Studies (in German) is studied. In this course, teaching methods and tools are widely used to ensure perception and consolidation with the help of feedback and self-control and taking into account the individual capabilities of students of authentic material of a country science nature. The aforementioned discipline contributes to the formation of communicative and translation competence for effective communication, as well as adequate translation and mutual understanding. Thus, in classes, those methods and teaching tools are widely used, which provide an opportunity to improve students' communication skills in combination with grammar skills.&#x0D; In our study, the methods and means of education are considered through the prism of training students – future translators. This makes it possible to prepare qualified and competitive translators for work on the world market of labour and services with appropriate interdisciplinary coordination of all cycles of humanitarian and specialized educational disciplines. It is a well-known fact, that perfect command of a foreign language involves not only the knowledge and ability of students to correctly use lexical units in combination with grammatical constructions at the level necessary for oral and written communication. In the educational process, students learn to perceive information of authentic content by ear and improve their reproduction skills. In practical classes, future specialists learn to model professional situations in German in order to prepare for foreign language professional communication, as well as when writing business letters, drawing up annotations, able to conduct dialog-conversation, presentation-advertising and presentation-report.&#x0D; When training future translators, it is essential to evaluate the achievements of the culture of native speakers in German-speaking countries, to understand its essence, meaning and role for humanity. The fact of awareness of the importance of using information and computer technologies in order to improve professional activity is integral. It is also worth paying attention to the personal traits of the communicator - the future translator: features of the use of oratory, sociability, self-development skills and self-evaluation in certain professional and communicative situations. Such methods as "Brain-ring", press conference, round aquarium, simulation games, game design, trainings, creation of a situation of success, etc. contribute to this. The following tools are important: the Internet, virtual simulators, audio and video recordings of a creative direction, video conferences, presentations

Prospective and Comprehensive Characterization of an Inpatient Radiation Oncology Consult Service: Examining Interdisciplinary Coordination of Palliative Radiation Access and Receipt

Studies have increasingly demonstrated the benefit of dedicated palliative radiation therapy (PRT) models on care quality, coordination and cost-effectiveness. However, these studies are primarily retrospective and volume-based, limiting broad application of findings. Through prospective, comprehensive characterization of inpatient consults, we investigated trends in interdisciplinary coordination and PRT delivery. Inpatient consult pages at a single institution from 11/1/21-5/31/22 were prospectively tracked and characterized. Consult type, temporality and decision-making, and patient demographics, disease and treatment details, and mortality outcomes were recorded. Chi-square and logistic and linear regressions evaluated associations between consult and patient-specific features. Of 460 pages received, 131 (28.5%) were requests for further communication following initial consultation. For the 329 original consults, 20.1% related to care coordination for established on-treatment or recently treated patients who were hospitalized. RT was recommended for 57% of patients-81.3% with palliative intent. With a mean 1.85 vs. 0.8 consults per day for weekday vs. weekend, 52.6% and 34.0% of pages occurred from 7am-noon or noon-5pm respectively, with 13.4% received overnight. This distribution did not significantly differ between weekday vs. weekend. Consult type (RT consideration vs. care coordination) was not associated with day or time period. Concern regarding benefit and/or safety of radiation was the main reason for treatment deferral (31.3%). Neurologic compromise (38.7%), pain (33.8%) and obstruction (ex. airway, luminal; 11.6%) were the most frequent non-post-operative palliative indications. Median time from admission to consult was 2 days (range 0-70), with a median of 1 day for neurologic compromise, 2 days for pain and 4 days for obstruction. For PRT scenarios, patients treated or untreated with RT had no significant difference in 30 days (25.2% vs. 28.2%, respectively) or 60 days (39.6% vs. 46.3%, respectively) mortality. 53.5% of patients had either a palliative medicine consultation while an inpatient or one scheduled at the time of discharge. Prospective characterization at a tertiary-care institution reveals high-volume care coordination- and communication-related consults with temporal distribution similar to consults for RT consideration for new patients. Association of timing with palliative indication and the observed rate of palliative medicine involvement highlight opportunities for interdisciplinary education regarding early multidisciplinary engagement to ensure provision of comprehensive palliative oncologic care.

Data in medicine: from numbering to narration.

Precision medicine aims to use big data to analyze all dimensions of the individual and "tailor" treatment to individual characteristics. Care precisely "tailored" to the individual must, moreover, also (especially?) include his or her narratives, his or her histories, biological but also biographical. Responding to the challenges of complexity therefore requires a recomposition of the fragmentation of knowledge, collaboration among professionals, and interdisciplinary coordination to ensure that the goals of number experts coincide with those of clinicians, so as to respond to the real needs of people and their care needs.«Con un computer possiamo trasformare quasi tutti i problemi umani in statistiche, grafici, equazioni. La cosa davvero inquietante, però, è che così facendo creiamo l'illusione che questi problemi siano risolvibili con i computer». Naief Yehya1.

Immunisation status of children receiving care and support in Wales: a national data linkage study.

In the UK, a robust childhood immunisation programme ensures children are offered protection against serious infections; identifying inequalities in vaccination coverage is essential. This is one of the first data linkage studies to examine coverage of primary, as well as pre-school booster and second dose of MMR vaccines, in children receiving support from social care services across Wales. By accessing records held within the Secure Anonymised Information Linkage (SAIL) Databank, vaccination status of children receiving social care and support between April 2016 and March 2021 (n = 24,540) was ascertained. This was achieved through linkage of the Children Receiving Care and Support (CRCS) Census and National Community Child Health Database which holds vaccination records for all children in Wales registered for NHS care. This sample was split into three groups - those children who had never been recorded on the Child Protection Register (CPR) or as 'Looked After' but in CRCS (n = 12,480), children ever on the CPR (n = 6,225) and those ever recorded as 'Looked After' but who were never on the CPR (n = 5,840). The comparison group of children and young people (CYP) never receiving welfare support consisted of 624,905 children. Children receiving care or support were more likely to be up-to-date with all six vaccines (no recorded vaccines: 0.6-6.3%) compared to children in the comparison group (no recorded vaccines: 3-10.3%). However, of those who were vaccinated, they were less likely to be vaccinated in a timely manner; both early (5.2% vs. 22.2%; margin of error [ME] = 0.52, 95% CI [confidence interval] = -0.18 - -0.17, p < 0.001) and delayed vaccinations were more common (62.7% vs. 71.3%; ME = 0.58, 95% CI = 0.08-0.09, p < 0.001). Validation of the CRCS immunisation flag showed moderate levels of accuracy. Around 70% of immunisation flags were correct across all three groups. Findings suggest a positive association between receiving services under a care and support plan and being up-to-date with immunisations; children receiving support under a care and support plan were more likely to have experienced early or late vaccinations, demonstrating that there is still more inter-disciplinary co-ordination and planning needed to improve these outcomes. Thus, identifying inequalities in vaccination coverage is essential to target interventions and to prioritise geographic areas for catch-up.

Enhanced Recovery After Surgery (ERAS) Protocol in Geriatric Hip Fractures: An Observational Study.

Geriatric hip fractures are the new global pandemic. It is predicted to reach 7.3-21.3 million cases worldwide by 2050. Even with optimal care, geriatric patients suffer a higher morbidity and mortality rate when compared with the general populationand often demand expensive hospital aftercare. This study aims to assess the implications of the successful adoption of the enhanced recovery after surgery (ERAS) protocol in the management of geriatric hip fractures in an Indian facility. This is a retrospective study conducted in a tertiary care hospital in India and reported following REporting of studies Conducted using the Observational Routinely collected health Data (RECORD) guidelines.We included all geriatric patients over 60 years of age who were admitted with hip fractures for surgical management between January 2021 and January 2023. The individual perioperative components of the ERAS protocol focus on key areas such as preoperative nutritional support, effective multimodal analgesia with optimal pain control, fluid management, and early postoperative mobilization. Thirty-eight geriatric patients with a mean age of 77.5 (± 9.6) years were included for analysis. Twenty-three patients sustained intertrochanteric fractures and underwent fixation with proximal femur nailing and the remaining had 15 sustained neck or femur fractures of which 11 underwent hemiarthroplasty surgery and the remaining four underwent a total hip replacement. The mean time to surgery was 2 (± 0.2) days. Eighty-two percent (n=31) of the patients were mobilized with a walking frame within a day after surgery and were followed up after discharge with home physiotherapy. The mean time to ambulation was 2 (± 0.62) days. The mean length of stay was 4 (± 1.6) days. We had a 30-day readmission rate of 5.2% (n=2) and a 30-day mortality rate of 5.2% (n=2). The one-year mortality rate was 13% (n=5). Management of geriatric hip fractures requires exceptional interdisciplinary coordination and carefully planned strategies to optimize patient care.With the implementation of the ERAS protocol, we could perceive clinical benefits in terms of early recovery and short length of hospital stay in patients with hip fractures. Further comparative studies are required, which can determine the relative importance of individual measures in the ERAS protocol and understand their longer-term outcomes in hip fracture surgeries.

Educating young children with diverse languages and cultures By KarenNemeth, London: Routledge. 2023. pp. 174. £39.99 (paperback). ISBN: 9780367535087

Karen Nemeth's book, Educating Young Children with Diverse Languages and Cultures, equips early childhood educators to assist and work with young children (ages 0–8) with a variety of languages, cultures, and learning needs. The most crucial step in creating equitable access to early education is being ready for all children. Early childhood educators do not necessarily need to be experts in all areas, but they do need to have the self-assurance to deal with any child. To guarantee that all young children have equitable access to education should be our shared goal in this subject. Throughout this book, readers will find more information on how to accomplish this aim using evidence-based, all-inclusive solutions for addressing experiences, cultures, abilities, and languages. Ten chapters make up this book and they centre around 6 main topics: (1) facilitating remote learning to support learners from varied linguistic and cultural backgrounds; (2) the National Association for the Education of Young Children has released two new position statements, Advancing Equity in Early Childhood Education and Developmentally Appropriate Practice; (3) a focus on interdisciplinary coordination of learning for both adults and children; (4) the application of proactive Universal Design strategies; (5) an anti-bias focus on ensuring that all children have equitable access to early education and the value of developing a diverse early childhood workforce; and (6) practices that are trauma-informed and asset-based. As a result, this book underlines how important it is for learning to communicate across cultures and languages. It has a layered format with multiple uses. As a practitioner in teaching language to children, I find the subject matter of chapters 2 and 3 to be particularly fascinating. In chapter 2, readers are assisted in understanding language in the context of individual learning and development by descriptions of the diverse experiences and classifications of children who are dual language learners. Readers will receive the most valuable insights into all facets of child development and learning by thoroughly examining the language development of dual language or multilingual learners, which will help them succeed in their work. In addition, the author offers advice on how to start a profession in early childhood education in chapter 3. What can you do to get ready to educate students from varied linguistic and cultural backgrounds? Have you had any practical experience working with kids or adults who speak different languages? Before you start applying for jobs, how could you add that experience to your resume? Anyone who plans to work with young children should take all of these factors into account. With an eye on success and resilience in a sector that is evolving, Chapter 3 successfully responds to these queries and assists readers in getting ready to become early childhood educators. Overall, the book presents fresh viewpoints on preparing early childhood educators to effectively work with and support young children with diverse languages, cultures, and learning needs that will get readers thinking. However, the book could have struck a better balance if it had included chapters from authors on other continents (such as Asia and Africa). They can offer many different viewpoints on the subject. By doing this, the reader may become more engaged and interested in the book. Even so, it is an excellent resource for early childhood educators and researchers who want to enhance their fields.

Physical therapy and occupational therapy management of a person with bilateral transradial amputations: a case report

Objective This longitudinal case study describes the physical and occupational therapy interventions and recommendations for treatment of a person with bilateral transradial amputations during subacute rehabilitation, as there are currently few recommendations. Materials and methods A 53-year-old female with subacute bilateral transradial amputations received inpatient rehabilitation. Impairments include decreased balance, global weakness, and need for assistance with ADLs and transfers. Physical therapy, occupational therapy, nursing, a peer mentor, and a prosthetist collaborated. Interventions included task-specific and generalized strengthening, standing balance re-education, assistive device prescription, education using body-powered prostheses, home adaption recommendations, and activities of daily living practice. Results Patient progressed to independent functional mobility but required assist for activities of daily living and stairs negotiation due to limited caregiver support and poor prosthetic dexterity. She discharged to a skilled nursing facility. Conclusion Rehabilitation of a person with bilateral transradial amputations requires clinicians experienced with prostheses; excellent interdisciplinary coordination; early discernment of the available social support system; task-specific strengthening and coordination exercises to prepare the patient for prostheses; significant task-practice with prostheses; and a working knowledge of home modifications and adaptive equipment. This article describes recommendations, successful interventions, and lessons learned for future therapists when rehabilitating someone with bilateral transradial amputations. IMPLICATIONS FOR REHABILITATION Bilateral transradial amputations (BTAs) are a life-altering, but rare condition, meaning that literature surrounding this population is sparse and that guidelines for rehabilitation are unclear. This article provides recommendations so that clinicians can be better informed when treating BTA patients in the subacute phase and more quickly progress patients toward functional independence and discharge to the community.

Can University Leaders Effectively Promote Research on Complex Societal Challenges? A Change-Agency Perspective.

In recent years, new expectations have been placed on universities, demanding academic contributions towards solving large-scale, interdisciplinary challenges. This is in conflict with existing insights from university governance research, which emphasises that scientific communities focus on reproducing disciplinary practices that are unsuitable in addressing societal challenges, because the problems associated with them are usually large-scale, complex and interdisciplinary. In light of this seeming paradox, we revisit the question of how-and on which theoretical grounds-universities may still be able to develop suitable internal governance mechanisms that allow them to address complex societal challenges effectively. Because university leaders are usually unable to coerce individual researchers to address such challenges in their research simply through their bureaucratic powers, we will argue that university leaders can, however, leverage individual researchers' agency to deviate from routine and disciplinary practice by developing novel or legitimising existing interdisciplinary scripts necessary to deal with such societal problems. Specifically, we outline that university managements can create a dual role consisting of the communication of legitimising interdisciplinary research on societal challenges, as well as providing for the necessary degree of interdisciplinary coordination by convening researchers around these topics.

Implementation of a Biopsychosocial History and Physical Exam Template in the Electronic Health Record: Mixed Methods Study.

Patients' perspectives and social contexts are critical for prevention of hospital readmissions; however, neither is routinely assessed using the traditional history and physical (H&P) examination nor commonly documented in the electronic health record (EHR). The H&P 360 is a revised H&P template that integrates routine assessment of patient perspectives and goals, mental health, and an expanded social history (behavioral health, social support, living environment and resources, function). Although the H&P 360 has shown promise in increasing psychosocial documentation in focused teaching contexts, its uptake and impact in routine clinical settings are unknown. The aim of this study was to assess the feasibility, acceptability, and impact on care planning of implementing an inpatient H&P 360 template in the EHR for use by fourth-year medical students. A mixed methods study design was used. Fourth-year medical students on internal medicine subinternship (subI) services were given a brief training on the H&P 360 and access to EHR-based H&P 360 templates. Students not working in the intensive care unit (ICU) were asked to use the templates at least once per call cycle, whereas use by ICU students was elective. An EHR query was used to identify all H&P 360 and traditional H&P admission notes authored by non-ICU students at University of Chicago (UC) Medicine. Of these notes, all H&P 360 notes and a sample of traditional H&P notes were reviewed by two researchers for the presence of H&P 360 domains and impact on patient care. A postcourse survey was administered to query all students for their perspectives on the H&P 360. Of the 13 non-ICU subIs at UC Medicine, 6 (46%) used the H&P 360 templates at least once, which accounted for 14%-92% of their authored admission notes (median 56%). Content analysis was performed with 45 H&P 360 notes and 54 traditional H&P notes. Psychosocial documentation across all H&P 360 domains (patient perspectives and goals, mental health, expanded social history elements) was more common in H&P 360 compared with traditional notes. Related to impact on patient care, H&P 360 notes more commonly identified needs (20% H&P 360; 9% H&P) and described interdisciplinary coordination (78% H&P 360; 41% H&P). Of the 11 subIs completing surveys, the vast majority (n=10, 91%) felt the H&P 360 helped them understand patient goals and improved the patient-provider relationship. Most students (n=8, 73%) felt the H&P 360 took an appropriate amount of time. Students who applied the H&P 360 using templated notes in the EHR found it feasible and helpful. These students wrote notes reflecting enhanced assessment of goals and perspectives for patient-engaged care and contextual factors important to preventing rehospitalization. Reasons some students did not use the templated H&P 360 should be examined in future studies. Uptake may be enhanced through earlier and repeated exposure and greater engagement by residents and attendings. Larger-scale implementation studies can help further elucidate the complexities of implementing nonbiomedical information within EHRs.

Characterizing patients hospitalized without an acute care indication: A retrospective cohort study.

Hospitalizations by patients who do not meet acute inpatient criteria are common and overburden healthcare systems. Studies have characterized these alternate levels of care (ALC) but have not delineated prolonged (pALC) versus short ALC (sALC) stays. To descriptively compare pALC and sALC hospitalizations-groups we hypothesize have unique needs. A retrospective study of hospitalizations from March-April 2018 at an academic safety-net hospital. Levels of care for pALC (>3 days) and sALC (1-3 days) were determined using InterQual©, an industry standard utilization review tool for determining the clinical appropriateness of hospitalization. We examined sociodemographic and clinical characteristics. Of 2365 hospitalizations, 215 (9.1%) were pALC, 277 (11.7%) were sALC, and 1873 (79.2%) had no ALC days. There were 17,683 hospital days included, and 28.3% (n = 5006) were considered ALC. Compared to patients with sALC, those with pALC were older and more likely to be publicly insured, experience homelessness, and have substance use or psychiatric comorbidities. Patients with pALC were more likely to be admitted for care meeting inpatient criteria (89.3% vs. 66.8%, p < .001), had significantly more ALC days (median 8 vs. 1 day, p < .001), and were less likely to be discharged to the community (p < .001). Patients with prolonged ALC stays were more likely to be admitted for acute care, had greater psychosocial complexity, significantly longer lengths of stay, and unique discharge needs. Given the complexity and needs for hospitalizations with pALC days, intensive interdisciplinary coordination and resource mobilization are necessary.