Interdisciplinary Health Care Research Articles

Toronto Bariatric Interprofessional Psychosocial Assessment Suitability Scale: Evaluating A New Clinical Assessment Tool for Bariatric Surgery Candidates

Patients who are referred for possible bariatric surgery (BS) intervention undergo a series of assessments conducted by an interdisciplinary health care team to determine suitability for surgery. Herein, we report the initial validation and reliability studies of the Bariatric Interprofessional Psychosocial Assessment Suitability Scale (BIPASS) and its relationship to interdisciplinary psychosocial assessment practices for BS. This study was conducted at the Toronto Western Hospital, a Level 1A BS center of excellence accredited by the American College of Surgeons. Phase I: a total of 4 blinded raters applied the BIPASS to 31 randomly selected BS cases referred to our program to establish interrater reliability. Phase II: in all, 3 raters with clinical experience in bariatric psychosocial care applied the BIPASS to 54 randomly selected BS cases. In total, 46 of 54 (85.1%) patients were women. The median age of all patient cases was 49 years (range: 21-74). Raters׳ BIPASS scores ranged from 4-52 (median = 19.24, standard deviation =10.38). BIPASS scores were highly predictive of the BS psychosocial outcome (area under curve = 0.915; 95% CI: 0.844-0.985; p < 0.001). A BIPASS score of ≥16 was chosen as the cutoff score for further clinical assessment before proceeding with surgical evaluation based on a receiver operating characteristic curve analysis (sensitivity = 0.839; specificity = 0.783). The instrument has very good interrater reliability (Pearson correlation coefficient = 0.847) even among novice raters. The findings show that the BIPASS is a comprehensive screening tool in the psychosocial assessment of BS candidates, which standardizes the evaluation process and systematically identify at-risk patients for negative outcomes after BS.

Women's Health Care Teams and the Future of Obstetrics and Gynecology

Health care delivery is in a stage of transformation and a meaningful change in provision of care must also be accompanied by changes in the educational process of health care professionals. This article lays out a roadmap to better prepare obstetrician-gynecologists (ob-gyns) to succeed in interdisciplinary women's health care teams. Just as our current educational programs emphasize the development of competent surgical skills, our future programs must encourage and support the development of communication, teamwork, and leadership skills for ob-gyns. Formal integration of these fundamentals at all levels of the health care training continuum will create an educational system designed to equip all practitioners with a basic level of knowledge and provide opportunities to acquire additional knowledge and skills as needs and interest dictate. Integral to the implementation will be the evaluation of the effects of the contributions of interprofessional education on patient, practice, and health system outcomes. Successful demonstration of value will lead to the sustainability of the educational programs through recognition by physicians, health care teams, academia, health care systems, and payers.

The 5As team intervention: bridging the knowledge gap in obesity management among primary care practitioners.

BackgroundDespite opportunities for didactic education on obesity management, we still observe low rates of weight management visits in our primary care setting. This paper describes the co-creation by front-line interdisciplinary health care providers and researchers of the 5As Team intervention to improve obesity prevention and management in primary care.MethodsWe describe the theoretical foundations, design, and core elements of the 5AsT intervention, and the process of eliciting practitioners’ self-identified knowledge gaps to inform the curricula for the 5AsT intervention. Themes and topics were identified through facilitated group discussion and a curriculum relevant to this group of practitioners was developed and delivered in a series of 12 workshops.ResultThe research question and approach were co-created with the clinical leadership of the PCN; the PCN committed internal resources and a practice facilitator to the effort. Practice facilitation and learning collaboratives were used in the intervention For the content, front-line providers identified 43 topics, related to 13 themes around obesity assessment and management for which they felt the need for further education and training. These needs included: cultural identity and body image, emotional and mental health, motivation, setting goals, managing expectations, weight-bias, caregiver fatigue, clinic dynamics and team-based care, greater understanding of physiology and the use of a systematic framework for obesity assessment (the “4Ms” of obesity). The content of the 12 intervention sessions were designed based on these themes. There was a strong innovation values fit with the 5AsT intervention, and providers were more comfortable with obesity management following the intervention. The 5AsT intervention, including videos, resources and tools, has been compiled for use by clinical teams and is available online at http://www.obesitynetwork.ca/5As_Team.ConclusionsPrimary care interdisciplinary practitioners perceive important knowledge gaps across a wide range of topics relevant to obesity assessment and management. This description of the intervention provides important information for trial replication. The 5AsT intervention may be a useful aid for primary care teams interested to improve their knowledge of obesity prevention and management.Clinical Trials.gov (NCT01967797)

Cenário de Práticas para a Formação Universitária: O Olhar dos Estudantes

&lt;p&gt;A Educação Universitária tem como desafio atual o aprimoramento de suas práticas pedagógicas. O objetivo do presente trabalho foi conhecer os valores e significados atribuídos, por estudantes do curso de Nutrição da USP, às suas experiências de extensão universitária. Trata-se de um estudo de abordagem qualitativa, utilizando-se o grupo focal como técnica de coleta de dados. Foram realizados cinco grupos, divididos entre as principais atividades realizadas: Empresa Júnior, Iniciação Científica, Associação Atlética, Clínica de Nutrição e Jornada Universitária. Verifica-se que os estudantes consideraram que cada atividade colabora com o desenvolvimento de competência ou habilidade profissional específica. Dentre elas, destacam-se: autonomia, autoconfiança, comunicação interpessoal, comunicação social, trabalho em equipe, visão ampliada dos problemas e das necessidades sociais, conhecimento técnico e teórico específico, atenção integral, contato com a realidade profissional, entre outras. Conclui-se que as atividades de extensão universitária contribuem tanto para que, especificamente na área da saúde, os projetos pedagógicos sejam flexíveis para a incorporação dessas atividades.&lt;/p&gt;

Using Semantic Components to Represent Dynamics of an Interdisciplinary Healthcare Team in a Multi-Agent Decision Support System.

In healthcare organizations, clinical workflows are executed by interdisciplinary healthcare teams (IHTs) that operate in ways that are difficult to manage. Responding to a need to support such teams, we designed and developed the MET4 multi-agent system that allows IHTs to manage patients according to presentation-specific clinical workflows. In this paper, we describe a significant extension of the MET4 system that allows for supporting rich team dynamics (understood as team formation, management and task-practitioner allocation), including selection and maintenance of the most responsible physician and more complex rules of selecting practitioners for the workflow tasks. In order to develop this extension, we introduced three semantic components: (1) a revised ontology describing concepts and relations pertinent to IHTs, workflows, and managed patients, (2) a set of behavioral rules describing the team dynamics, and (3) an instance base that stores facts corresponding to instances of concepts from the ontology and to relations between these instances. The semantic components are represented in first-order logic and they can be automatically processed using theorem proving and model finding techniques. We employ these techniques to find models that correspond to specific decisions controlling the dynamics of IHT. In the paper, we present the design of extended MET4 with a special focus on the new semantic components. We then describe its proof-of-concept implementation using the WADE multi-agent platform and the Z3 solver (theorem prover/model finder). We illustrate the main ideas discussed in the paper with a clinical scenario of an IHT managing a patient with chronic kidney disease.

Prevalence of Suicide Risk Among Adolescents With Depressive Symptoms

ObjectiveTo determine the prevalence of the risk of suicide among adolescents and to investigate associations between the risk of suicide and depressive symptoms. MethodsA population-based cross-sectional study was conducted with 1,379 students aged 10–17 years enrolled in state-run public schools in northeastern Brazil in 2014. The following instruments were used to collect data: a socio-bio-demographic questionnaire; the Children's Depression Inventory (CDI) and the International Neuropsychiatric Interview (M.I.N.I. Brazilian version 5.0.0). Unidimensional and bidimensional tables were constructed for the data analysis, with absolute and relative frequencies. Odds ratios (OR) and respective intervals (95% confidence) were calculated and associated with the descriptive levels of Pearson's chi-square independence test. ResultsThe prevalence of the risk of suicide was 29.7% in the population studied. Females aged between 14 and 17, those with siblings and those with depressive symptoms were at the greatest risk. ConclusionThe present findings revealed a very high risk of suicide and confirmed the significant that depressive symptoms are significantly associated with the risk of suicide among adolescents. Thus, it is necessary to develop suicide prevention programs for schools, with interdisciplinary primary healthcare actions.

Interdisciplinary Diabetes Care: A New Model for Inpatient Diabetes Education.

A patient-centered interdisciplinary diabetes care model was implemented at Vidant Medical Center in Greenville, N.C., a 909-bed tertiary care teaching hospital, for the purpose of providing all patients with diabetes clear and concise instructions on diabetes survival skills. Survival skills education during hospitalization is needed for safe transition to community resources for continued and expanded diabetes self-management education. This article describes the process used to develop, implement, and evaluate the model. This initiative achieved substantial cost savings, with no significant changes in length of stay (LOS) or diabetes readmission rates. This patient-centered model demonstrates how a team of interdisciplinary health care professionals can integrate services in providing care for a large population of patients with chronic disease.

Movin' On Up: An Innovative Nurse-Led Interdisciplinary Health Care Transition Program

This article provides an overview of an innovative nurse-led interdisciplinary health care transition (HCT) model of care entitled Movin' On Up for adolescents and emerging adults (AEAs) with spina bifida (SB) that was originally implemented in 2011. The components of the HCT service model include an HCT nursing specialist, who is an advanced practice nurse; interdisciplinary health care transition plans based on the individualized needs of AEAs; an interdisciplinary HCT team that meets on a weekly basis; direct HCT services provided in the weekly SB clinic; and telephonic follow-up with AEAs, families, and providers. The characteristics of this nurse-led HCT program can be described as an integrated, interdisciplinary, and comprehensive model of care based on a life span approach. To date, a total of 210 AEAs with SB, ages 10 to 20 years, have been enrolled into the program. An important feature of this HCT service model is that it is self-supporting; it generates the revenue needed for sustainability and, unlike other HCT programs, is not reliant on extramural programmatic support. Other accomplishments of Movin' On Up include the development of a transfer protocol wherein 35 AEAs with SB have been supported in their transfer to adult care; implementation of a standardized process to ensure that service referrals to community-based services for postsecondary education, employment, training, and initiation of conservatorships are made; timely performance of evaluations; close tracking of needs and outcomes of self-management knowledge and skills instruction; and attention to equipment needs prior to transfer.

Observe, Coach, Assist, and Report: An Emerging Framework for Integrating Unregulated Healthcare Providers into Interdisciplinary Healthcare Teams

Background: Unregulated healthcare providers known as personal support workers (PSWs) provide the majority of home care services in Ontario, Canada. However, there is little direction to guide their activities as members of interdisciplinary healthcare teams. The purpose of this study was to explore and describe the role of PSWs in interdisciplinary evidence-based stroke care.Methods and Findings: A concurrent triangulation mixed-methods design was used. Data sources included surveys (N = 270), chart audits (N = 234), interviews (N = 28), focus groups (N = 7), textbook review, an advisory committee (N = 14), and knowledge fairs (N = 112). PSWs can participate in team-based stroke care by observing vital information about clients in their homes, coaching clients to follow care plans, assisting to implement recommendations made by other healthcare providers, and reporting client progress, challenges, needs, and preferences to the healthcare team.Conclusions: The Observe, Coach, Assist, and Report (OCAR) themes have the potential to be used as a framework to guide improvements in intra-team communication, information sharing, and awareness of the PSW role, in order to support a more integrated home care experience for clients and families. Next steps include pilot testing the OCAR framework at the point of care in various settings to enhance interdisciplinary collaboration that is inclusive of PSWs.

"When Things Are Really Complicated, We Call the Social Worker": Post-Hip-Fracture Care Transitions for Older People.

Social workers play a key role in the delivery of interdisciplinary health care. However, in the past decade, concerns have been raised about social work's sustainability and contributions in a changing health care sector. These changes come at a time when older patients are more complex and vulnerable than ever before. In this article, using a strengths-based approach, the authors examine the key contributions made by social workers working with older patients with hip fracture as they strive to achieve successful care transitions. Twenty-five interviews with health care professionals (HCPs) were conducted and then analyzed using an analytical coding framework. Although social workers are vital, they are often underused and overlooked in the care of hip fracture patients. The authors sketch the important contributions that social workers make to care transitions after hip fracture, specifically informational continuity; patient-HCP relational continuity; conflict resolution; mediation among family, patient, and HCP (for example, doctors and nurses); collaboration with family caregivers and community supports; and relocation counseling.

Model of care for a changing healthcare system: are there foundational pillars for design?

Currently, healthcare organisations are being challenged to provide optimal clinical services within budget limitations while simultaneously being confronted by aging consumers and labour and skill shortages. Within this dynamic and changing environment, the ability to remain responsive to patient needs while managing these issues poses further challenges. Development or review of the model of care (MOC) may provide a possible solution to support efficiencies in service provision. Although MOC are not readily understood or appreciated as an efficiency strategy, they can be more easily explained by considering several recurring pillars when developing or redesigning an MOC. Generic and recurring foundational pillars include integrated care models, team functioning and communication, leadership, change management and lean thinking. These foundational pillars should be incorporated into the development and application of MOC in order to achieve desired outcomes. However, sustainability requires continuous review to enable improvement and must be integrated into routine business. Moreover, successful review of MOC requires collaboration and commitment by all stakeholders. Leaders are critical to motivating clinicians and stakeholders in the review process. Further, it is imperative that leaders engage stakeholders to commit to support the agreed strategies designed to provide efficient and comprehensive healthcare services. Redesign of MOC can significantly improve patient care by applying the agreed strategies. In the current healthcare environment, these strategies can favourably affect healthcare expenditure and, at the same time, improve the quality of interprofessional health services.

How can GPs and community health services work more effectively together?

On 23 October 2014, NHS England Chief Executive Simon Stevens published a new 5-year plan for the NHS. Highlighting the challenges facing the NHS associated with an ageing population, the document argues: ‘The traditional divide between primary care, community services, and hospitals — largely unaltered since the birth of the NHS — is increasingly a barrier to the personalised and coordinated health services patients need .’1 It then goes on to discuss what models of care might look like under the plan. The focus is on integration and collaboration, eschewing further structural change but highlighting the potential of new service models which bring GPs together with a wide range of other providers, including community, social, and acute care services. Moving care closer to patients’ homes is highlighted, with vulnerable patients cared for proactively by multidisciplinary teams. None of this is new. GP fundholders pioneered better access to diagnostic tests and outreach by hospital consultants in the 1990s,2 while the 2000s brought Community Matrons, Virtual Wards, and Models of Case Management.3 However, integration between primary and community health services (CHS) has not been easy to achieve,4 and it is far from clear that such service models can, in fact, reduce costs.5 Against this background, an extensive review of existing literature was conducted to explore what factors should be taken into account in planning for primary care and CHS to work more effectively together. Starting with interdisciplinary healthcare teamworking (the micro-level), evidence was examined across all levels of the current care system to account for the diversity of the services. At the meso level (that is, …

Understanding the Experience of Dominican American Women Living With Late-Stage Breast Cancer: A Qualitative Study.

Hispanic women between the ages of 35 and 44 years who are often diagnosed with larger and more invasive malignant breast tumors have poorer outcomes and a higher mortality rate compared with non-Hispanic White women. Yet, there is a paucity of qualitative research focused on the lived experience of specific ethnic subgroups. The goal of this descriptive phenomenological study was to gain in-depth insight regarding late-stage (Stage IV) breast cancer experience from Dominican American women. The results of this study provide preliminary information to interdisciplinary health care providers on the impact this illness has on the participants' lives and the role culture plays in helping these women cope. Implications for nursing research and practice are discussed.

Care of the Childbearing Family With Intrauterine Fetal Demise

Intrauterine fetal demise (IUFD), or stillbirth, is the death of a fetus greater than 20 weeks gestation. Several factors contribute to risk for IUFD, although in many cases the exact etiology is unknown. Nurses are a vital part of the interdisciplinary health care team caring for families with IUFD, who require timely and sensitive care to enable an uncomplicated birth and grieving process.

Project Medishare's Historic Haitian Earthquake Response.

This article describes the immediate large-scale medical and surgical response of Project Medishare to the 2010 Haitian earthquake. It summarizes the rapid evolution of critical care and trauma capacity in a developing nation after earthquake and discusses the transition from acute trauma treatment to interdisciplinary health care sector building.

Teachers' Health.

Almost 800,000 teachers were working in Germany in the 2012-13 school year. A determination of the most common medical problems in this large occupational group serves as the basis for measures that help maintain teachers' health and their ability to work in their profession. We present our own research findings, a selective review of the literature, and data derived from the German statutory health insurance scheme concerning medical disability, long-term illness, and inability to work among teachers. Compared to the general population, teachers have a more healthful lifestyle and a lower frequency of cardiovascular risk factors (except hypertension). Like non-teachers, they commonly suffer from musculoskeletal and cardiovascular diseases. Mental and psychosomatic diseases are more common in teachers than in non-teachers, as are nonspecific complaints such as exhaustion, fatigue, headache, and tension. It is commonly said that 3-5% of teachers suffer from "burnout," but reliable data on this topic are lacking, among other reasons because the term has no standard definition. The percentage of teachers on sick leave is generally lower than the overall percentage among statutory insurees; it is higher in the former East Germany than in the former West Germany. The number of teachers taking early retirement because of illness has steadily declined from over 60% in 2001 and currently stands at 19%, with an average age of 58 years, among tenured teachers taking early retirement. The main reasons for early retirement are mental and psychosomatic illnesses, which together account for 32-50% of cases. Although German law mandates the medical care of persons in the teaching professions by occupational physicians, this requirement is implemented to varying extents in the different German federal states. Teachers need qualified, interdisciplinary occupational health care with the involvement of their treating physicians.

Support for Interdisciplinary Approaches in Emergency Medical Services Education

&lt;p&gt;This article analyzes the need for Emergency Medical Services (EMS) educational programs and academicians to develop interdisciplinary educational and training opportunities with other healthcare disciplines. A literature review was conducted on EMS education and interdisciplinary approaches in healthcare education. In general, support for both didactic and simulated interdisciplinary education in healthcare is supported by positive impacts on student learning and improved patient outcomes. Support for interdisciplinary approaches in EMS education was constructed by applying research on interdisciplinary healthcare education to the identified criticisms of EMS education. A critical analysis of the literature allowed for recommendations to be made on the implementation of and further research for interdisciplinary approaches in EMS education. This article supports EMS students to be educated in a way that is reflective of a profession that must work collaboratively to provide out-of-hospital healthcare. &lt;/p&gt;

Impact of crisis resource management simulation-based training for interprofessional and interdisciplinary teams: A systematic review

Crisis resource management (CRM) abilities are important for different healthcare providers to effectively manage critical clinical events. This study aims to review the effectiveness of simulation-based CRM training for interprofessional and interdisciplinary teams compared to other instructional methods (e.g., didactics). Interprofessional teams are composed of several professions (e.g., nurse, physician, midwife) while interdisciplinary teams are composed of several disciplines from the same profession (e.g., cardiologist, anaesthesiologist, orthopaedist). Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and ERIC were searched using terms related to CRM, crisis management, crew resource management, teamwork, and simulation. Trials comparing simulation-based CRM team training versus any other methods of education were included. The educational interventions involved interprofessional or interdisciplinary healthcare teams. The initial search identified 7456 publications; 12 studies were included. Simulation-based CRM team training was associated with significant improvements in CRM skill acquisition in all but two studies when compared to didactic case-based CRM training or simulation without CRM training. Of the 12 included studies, one showed significant improvements in team behaviours in the workplace, while two studies demonstrated sustained reductions in adverse patient outcomes after a single simulation-based CRM team intervention. In conclusion, CRM simulation-based training for interprofessional and interdisciplinary teams show promise in teaching CRM in the simulator when compared to didactic case-based CRM education or simulation without CRM teaching. More research, however, is required to demonstrate transfer of learning to workplaces and potential impact on patient outcomes.

A game of snakes and ladders: negotiating the ‘ups and downs’ of endorsement as a nurse practitioner in Australia

Background: Australian legislation supporting the nurse practitioner (NP) role was enacted in 1998. Since then, NPs have played an important advanced practice role within the interdisciplinary healthcare team. However, the literature suggests that transition to the NP role can be challenging.Aim: This paper highlights the complex transition experiences of ten recently endorsed Australian NPs. The convoluted legislative and regulatory requirements that were negotiated by the NPs are presented as narratives.Methods: Informed by an ethnographic approach, participants were interviewed several times during their first year. Interview transcripts were thematically analysed and aggregated into three narratives representative of key findings.Key Findings: The findings exemplify the complexity of navigating through a labyrinth of bureaucracy and the extensive negotiations required to appease those who yielded power over their future practice.Conclusion: This study raises awareness of the transition experiences of Australian NPs and their challenges and barriers during this time.

Intercultural-global competencies for the 21st century and beyond.

Increased diversity exists in Anglo-Saxon countries, such as Australia, the United Kingdom, and the United States. By 2050, no single ethnic group is expected to be in a majority in the United States. Health care reform points to an urgent need for health care professionals, such as nursing, medicine, allied health, nutrition, and other interdisciplinary health care team members, to serve a multi-ethnic population by developing intercultural-global and 21st-century competencies. Nurse educators must acknowledge the need to familiarize themselves and integrate these competencies into university and continuing education programs by evaluating and reporting outcomes. All nurses can be expected to have these competencies as global citizens through local, intercultural, and global interactions and exchanges.