Interdisciplinary Medical Team Research Articles

Knowledge and perception of physiotherapy among healthcare science students at the Maldives National University

IntroductionPhysiotherapy is a crucial profession of interdisciplinary medical team, in which healthcare professionals need to comprehend the duties of other members in the team to offer a holistic management to the patients. Healthcare professionals who uphold negative beliefs and perceptions about other healthcare professions can be a barrier to ‘patient- centered’ approach. Nevertheless, there is a paucity of research on knowledge and awareness of physiotherapy by healthcare professionals or students. There has been no study conducted in the Maldives to investigate the knowledge and perception of physiotherapy by healthcare students. Therefore, the aim of the study was to explore the knowledge and perceptions among healthcare science students at The Maldives National University (MNU). MethodsA cross-sectional study was conducted at the Faculty of Health Sciences (FHS), School of Nursing (SN), and School of Medicine (SM). A stratified random sampling method was adopted to recruit the participants. A self-administered questionnaire was used to obtain the data from the participants. The data was analyzed using the SPSS version 25.ResultsA total of 318 students from three different schools and faculties of MNU participated in the study. The mean age of the respondents was 23 ± 4, with 89.9% being female. The overall K-score of 12 indicated poor knowledge, whereas the P-score of 10 reflected a positive perception among the participants, with no significant difference observed between genders. The Kruska-Wallis test indicated a significant difference in K-score across courses and years of study enrolled.ConclusionThis study’s findings revealed a disparity between healthcare students’ positive perception towards physiotherapy and their lack of knowledge regarding the profession, indicating barriers to knowledge acquisition. Significant differences were found between different healthcare courses and years of study.

Effectiveness of Huddles in Improving the Patient Safety Attitudes Among Clinical Team Members.

Huddles among members of interdisciplinary medical teams involve short stand-up sessions and allow team members to focus on existing or emerging patient safety issues, thereby facilitating team communication. Hospital managers are able to recognize the current situation of the organization through patient safety attitudes, strengthen team members' awareness of patient safety, and improve the quality of health care. The purpose of this study was to determine the effects of huddles on improving team members' attitudes toward patient safety. We used a quasi-experimental design and selected 2 adult wards with similar properties as the experimental and comparison groups by convenience sampling. Data collection was from December 1, 2021, to June 30, 2022, at a teaching hospital in central Taiwan. Team members of the ward performing huddles formed the experimental group, and they participated 2 times per week in 15-minute huddles from 8:15 to 8:30 am for a total of 4 weeks. The comparison group adopted the routine team care process. Both groups completed the Safety Attitudes Questionnaire during the pre- and post-tests of the study. The experimental group scored significantly higher in the post-test than in the pre-test in all aspects of safety attitudes, with the exception of stress recognition . These improved aspects were teamwork climate (76.47 ± 15.90 vs 83.29 ± 13.52, P < .001), safety climate (75.94 ± 16.14 vs 82.81 ± 13.74, P < .001), job satisfaction (74.34 ± 20.22 vs 84.40 ± 17.22, P <.001), perceptions of management (78.02 ± 19.99 vs 85.51 ± 15.97, P < .001), and working conditions (78.85 ± 17.87 vs 86.81 ± 14.74, P < .001). Through the huddles, clinical team members improved their understanding of different aspects of safety attitudes. Such a study provided ward units with real-time improvement and adjustment in terms of patient safety during their medical work processes with better patient safety.

How to ventilate critically ill children with cancer?: a narrative review

Abstract The management of respiratory failure and hypoxemia in children with cancer presents a critical challenge. Choosing between invasive and noninvasive mechanical ventilation can profoundly impact mortality rates, especially in resource-limited settings. Choosing between invasive and noninvasive mechanical ventilation can impact mortality rates, particularly in resource-limited settings. Extensive clinical studies are imperative to thoroughly evaluate the efficacy of invasive mechanical ventilation (IMV) and noninvasive ventilation (NIV) during the early stages of treatment. Further research is crucial to determine the most optimal therapeutic approach. Early implementation of IMV or NIV could significantly reduce mortality rates in these patients.[ 1 ] Additionally, this article examines the admission of children with terminal cancer, evaluating their use of invasive and noninvasive ventilatory support versus palliative care. The interdisciplinary medical team, in collaboration with the family, must carefully consider the benefits and risks of these interventions, whether in the early or terminal stages of the disease. Furthermore, the article delves into the controversies surrounding the utilization of ventilation in critically ill children with cancer.

Prevalence and Risk Factors of Intensive Care Unit-acquired Weakness in Patients With COVID-19: A Systematic Review and Meta-analysis.

Intensive care unit acquired weakness (ICUAW) is a common neuromuscular complication of critical illness, impacting patients' recovery and long-term outcomes. However, limited evidence is available on pooled prevalence and risk factors of ICUAW specifically in the COVID-19-infected population. We searched on PubMed, Embase, Cochrane Library, Web of Science, PEDro, and EBSCOhost/CINAHL up to January 31, 2024. Data synthesis was conducted using the Freeman-Tukey double-arcsine transformation model for the pooled prevalence rate and odds ratios with corresponding 95% confidence intervals was used to identify risk factors. The pooled prevalence of ICUAW in COVID-19 patients was 55% in eight studies on 868 patients. Risk factors for developing ICUAW in these patients were: old age (WMD 4.78, 95% CI, 1.06-8.49), pre-existing hypertension (OR = 1.63, 95% CI, 1.02-2.61), medical intervention of prone position (OR = 5.21, 95% CI, 2.72-9.98), use of neuromuscular blocking agents (NMBA) (OR = 12.04, 95% CI, 6.20-23.39), needed tracheostomy (OR = 18.07, 95% CI, 5.64-57.92) and renal replacement therapy (RRT) (OR = 5.24, 95% CI = 2.36-11.63). The prevalence of ICUAW in patients with COVID-19 was considered relatively high. Older age, pre-existing hypertension, medical intervention of prone position, NMBA use, needed tracheostomy and RRT were likely risk factors. In the future, interdisciplinary medical team should pay attention to high-risk groups for ICUAW prevention and early treatments.

VEXAS and Myelodysplastic Syndrome: An Interdisciplinary Challenge.

VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a recently recognized systemic autoinflammatory disease caused by somatic mutations in hematopoietic progenitor cells. This case series of four patients with VEXAS syndrome and comorbid myelodysplastic syndrome (MDS) aims to describe clinical, imaging, and hematologic disease presentations as well as response to therapy. Four patients with VEXAS syndrome and MDS are described. A detailed analysis of imaging features, hemato-oncological presentation including bone marrow microscopy and clinical-rheumatological disease features and treatment outcomes is given. All patients were male; ages ranged between 64 and 81 years; all were diagnosed with MDS. CT imaging was available for three patients, all of whom exhibited pulmonary infiltrates of varying severity, resembling COVID-19 or hypersensitivity pneumonitis without traces of scarring. Bone marrow microscopy showed maturation-disordered erythropoiesis and pathognomonic vacuolation. Somatic mutation in the UBA1 codon 41 were found in all patients by next-generation sequencing. Therapy regimes included glucocorticoids, JAK1/2-inhibitors, nucleoside analogues, as well as IL-1 and IL-6 receptor antagonists. No fatalities occurred (observation period from symptom onset: 18-68 months). Given the potential underreporting of VEXAS syndrome, we highly recommend contemporary screening for UBA1 mutations in patients presenting with ambiguous signs of systemic autoinflammatory symptoms which persist over 18 months despite treatment. The emergence of cytopenia, especially macrocytic hyperchromic anemia, should prompt early testing for UBA1 mutations. Notably conspicuous, pulmonary alterations in CT imaging of patients with therapy-resistant systemic autoinflammatory symptoms should be discussed in interdisciplinary medical teams (Rheumatology, Hematology, Radiology and further specialist departments) to facilitate timely diagnosis during the clinical course of the disease.

Medical and Psychological Aspects of Pregnancy in Women with Obesity and after Bariatric Surgery.

Chronic diseases are potential risk factors for pregnancy duration and neonatal outcomes. This narrative review aimed to summarize the research results on the specifics of pregnancy in women with obesity and after bariatric surgery. PubMed and Google Scholar databases were searched. Systematic reviews, meta-analyses, clinical trials, and references to identified articles from the last ten years (2013-2023) were included. Ultimately, 107 literature items were qualified. It has been shown that women with obesity planning pregnancy should reduce their body weight because obesity is a risk factor for adverse obstetric and neonatal outcomes. Bariatric surgery effectively reduces excessive body weight and the health risks in women with obesity during pregnancy and their offspring. However, at least a year interval between surgery and conception is recommended. An interdisciplinary medical team should provide patient care during pregnancy with knowledge and skills related to people after bariatric surgery. Due to the increased risk of mental disorders, especially depression, it is necessary to constantly monitor the mental state of women and provide psychological support and education on a healthy lifestyle during pregnancy and the postpartum period.

Evaluation of the Relationship between Body Mass Index, Dental Caries, and Diet among a Group of 6-12 Years Old School Going Children.

These results are from research conducted on a sample of healthy school-aged children (ages 6-12) to determine whether or not there is a correlation between BMI, dental caries, and food. About 500 kids are a part of the study. A stature meter was used to get the tallest possible measurement, and a small electronic scale was used to get the smallest possible weight. Body mass index was determined using the standard CDC growth charts (2000). The presence of caries was evaluated using an intraoral examination guided by WHO (1997) standards. For three days in a row, including the weekend, participants recorded what they ate and drank. It was discovered that there is a huge gap in the body mass index (BMI) categories between sexes, with the vast majority of persons falling into the average weight category. The deft and DMFT caries scores of young men and women did not significantly differ across any of the BMI-for-age categories (P > 0.05). Consumption of supplements on a daily basis did not vary significantly between the BMI-for-age categories (P > 0.05). Pediatric dentists should play an active role in reducing this worldwide epidemic since pediatric obesity and dental caries have comparable causes and necessitate an all-encompassing, coordinated care strategy from interdisciplinary medical teams.

Inpatient Neurology Huddle Quality Improvement Project (P3-7.006)

<h3>Objective:</h3> To implement a standardized huddle checklist that includes the important patient related issues that need to be addressed daily during inpatient neurology huddle and to assess the level of satisfaction of neurology health care providers about daily huddle flow both before and after implementing the checklist. <h3>Background:</h3> Inpatient interdisciplinary medical team members’ daily huddle is a meeting at which key issues related to patient care and management are discussed among medical team members. Clear communication is important for good patient outcome as well as health care providers satisfaction. Daily huddle improves patient care, safety, and outcomes by facilitating direct communication among all key members involved in patient care. <h3>Design/Methods:</h3> Using Survey monkey, a pre-implementation data was collected to assess the level of satisfaction of the healthcare providers with huddle flow and patient safety. Post-implementation data collected after 9 months of standard checklist implementation. Descriptive analysis was performed for survey results. <h3>Results:</h3> 33 health care providers participated in the pre-implementation survey: 10 (30.3%) nurses, 20 (60.6%) physicians, 2 (6.06 %) case managers, 1 (3.03%) social worker. 32 health care providers participated in the post-implementation survey: 11 (34.38%) nurses, 17 (53.13%) physicians, 2 (6.25%) case managers, 2 (6.25%) social workers. Prior to checklist implementation, 13 (39.39%) of the participants were satisfied with overall huddle flow. After checklist implementation 25 (78.13%) were satisfied with overall huddle flow. Regarding overall patient’s safety as a result of daily huddle, 14 (42.4%) of the participants were satisfied, 5 (15.15%) were dissatisfied and 14 (42.4%) were neither satisfied nor dissatisfied prior to checklist implementation. After checklist implementation, 24 (75 %) were satisfied, 2 (6.25%) were dissatisfied and 6 (18.75%) were neither satisfied nor dissatisfied with the overall patient’s safety because of daily huddle. <h3>Conclusions:</h3> Our data suggest that standardized huddle checklist improves provider’s satisfaction with huddle workflow and patient safety. <b>Disclosure:</b> Dr. Matloub has nothing to disclose. Dr. Carter has nothing to disclose. Dr. Wang has nothing to disclose.

The Significance of Cooperation in Interdisciplinary Health Care Teams as Perceived by Polish Medical Students.

The aim of the study was to explore the opinions of medical students with regard to cooperation in the interdisciplinary team, as well as the factors affecting the formation of opinions. The study was conducted using the Polish version of the questionnaire Attitudes Towards Interprofessional Health Care Teams. The study involved 1266 participants, including students of medicine (n = 308), midwifery (n = 348), nursing (n = 316) and physiotherapy (n = 294). According to the opinions of the students participating in the study, the therapeutic process based on the interdisciplinary model improves the quality of medical care provided, increases patient safety, and improves communication between members of the therapeutic team. The factors affecting the assessment of cooperation in interdisciplinary medical care teams included the faculty and the year of studies, gender, as well as participation in the multidisciplinary courses. Students recognize the need for interdisciplinary medical teams. The training of future medical professionals should incorporate the elements of interprofessional education. This form of education allows students to develop both a professional identity and identification with their own profession, as well as encourages teamwork skills and shapes the attitude of openness towards representatives of other medical professions. However, in order to provide the students with the relevant knowledge, skills and competencies, it is essential to respect their diversity in terms of the faculty, as well as to account for the impact of gender and the year of studies which may affect their readiness to engage in teamwork.

Pre-surgical management of primary leiomyosarcoma of the bone

"Leiomyosarcoma is a rare type of smooth muscle cell tumor, with an incidence of 7-10% compared to other types of sarcomas. It develops primarily in the retroperitoneal cavity, the genital tract and extremities. Leiomyosarcoma can also affect the bone, either as a primary tumor or as metastasis. Primary osseus leiomyosarcoma is a rare finding in patients with radiologically identified osteolytic lesions having an incidence of &lt;1% of total primary bone tumors.Due to its low incidence patients with primary osseous leiomyosarcoma are never diagnosed before immunohistochemical analysis and case management is difficult because of the lack of specific indications pertaining to primary osseus leiomyosarcoma. Data on age specific incidence is scarce but there seems to be a tendency towards a higher incidence with advanced age. The purpose of this work is to discuss the complete management of primary osseus leiomyosarcomas based on interdisciplinary medical teams’ indications in a Romanian hospital setting"

77 Evaluating virtual family-centered rounds effectiveness, efficiency and usability during the COVID-19 pandemic

Abstract Background Virtual care has seen exponential growth since the onset of the COVID-19 pandemic, however, the evaluation of virtual care tools and services is lacking, particularly in the inpatient setting. In April 2020, we virtualized our in-person family-centered rounds (FCR) process and demonstrated the ability to perform virtual family-centered rounds (vFCR). In this study, we evaluate vFCR against the accepted standard of in-person FCR to ensure high quality care is maintained and encourage adoption by health care providers, administrators, patients and caregivers. Objectives The objective of this study is to compare vFCR to established core components and timing for in-person FCR. Perceptions of overall satisfaction, safety and technology usability were also explored. Design/Methods This is a mixed methods process evaluation of vFCR. Data collection was through virtual and in-person observation and post-vFCR survey of participants. Virtual observations focused on timing and adherence to core components of FCR, while in-person naturalistic observations focused on technology interaction and usability. Observation data underwent quantitative and content analysis. Data from post-vFCR questionnaires were subject to descriptive statistical analysis and content analysis of free-text responses. Results Sixty-two vFCR were observed virtually and 35 vFCR were observed in-person. Adherence to the core components of FCR during vFCR was variable (Table 1). Mean duration of a single patient round was 8.44 ± 4.93 minutes, with a mean transition time between patients of 3.96 ± 2.96 minutes. One hundred and four surveys were completed (76% response rate), 42 by patients and caregivers and 62 by members of the interdisciplinary medical team. The majority (93%) of respondents surveyed were satisfied or very satisfied with vFCR, and 67% felt it was important or very important to do FCR virtually during the pandemic to keep people safer. Importantly, vFCR was perceived by 96% of medical team members as supporting shared decision making with patients and caregivers, and 78% of patients/caregivers felt like a valued partner in their (child’s) care. Virtual family-centered rounds technology was perceived as easy or very easy to use by 95% of respondents. Additional positive and negative comments were submitted by 38% of respondents about their experience with vFCR (Figure 1). Conclusion Virtual family-centered rounds afford adherence to the core components of family-centered rounds. Satisfaction with vFCR and perceived usability of vFCR technology were both highly rated. Respondents also felt vFCR were important for safety during the pandemic. Rounds duration and transition times between patients were seen as opportunities for improvement. Observation and questionnaire data suggest the efficiency and quality of vFCR may be optimized through routine training on the rounding process and technology, as well as recognition of family-centered rounds as a component of inpatient pediatric care that should be prioritized.

Commentary on Integration of primary care and behavioral health services in Midwestern community health centers: A mixed methods study.

Comments on the original article by Staab et al. (see record 2022-14598-001) regarding the integration of primary care and behavioral health services in Midwestern community health centers. As a clinician, the author identifies with many of the findings in Staab et al.'s paper. Limited resources related to patient access were cited as a barrier to integration. In the academic medical center and the larger community, we have experienced too few behavioral health providers (BHPs) to meet the increasing demand for behavioral health (BH) services. There are long waitlists for BH care, and patients report difficulty accessing appropriate BH resources. A lack of funding within the health care system has been a barrier to hiring an adequate BH workforce to meet the demand of internal and external BH referrals. Integrated care requires a specific set of skills and training experiences to competently provide brief interventions and work as part of an interdisciplinary medical team in a fast-paced medical setting. The pool of qualified applicants for integrated care positions is limited, challenging recruitment efforts. Another factor reducing access within the integrated care setting is difficulty adhering to a short-term treatment model with patients who have severe mental health issues and long-term therapy needs, given their difficulty obtaining longer-term services. Unlike the majority of community health centers (CHCs) in this study, we have insufficient social work support to adequately meet all patients' care management needs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

An ICU Expansion of a Novel Chaplain Intervention, "This is My Story," to Support Interdisciplinary Medical Teams Delivering Care to Non-Communicative Patients in an Academic Medical Center.

The intervention “This is My Story” (TIMS) was previously developed and presented as a case study involving chaplains and support to non-communicative patients (Tracey et al in J Religion Health, 60(5):3282–3290, 2021). This further investigation aims to determine feasibility by looking at eight criteria: acceptability, demand, implementation, practicality, adaptation, integration, expansion, and limited-efficacy testing (Bowen et al in Am J Prev Med 36(5):452–457, 2009). Chaplains conducted recorded conversation with a patient’s loved one, then it was edited for brevity and succinctness, and uploaded to the patient’s medical chart and can be listened to at any time by medical providers. A completed interview, posted to the patient’s electronic medical record (EMR), and able to be listened to by the medical team, was found to be contingent upon two factors: proximity to time between referral to call completion and amount of clinical experience of the chaplain.

Characteristics, expectations, experiences of care, and satisfaction of patients receiving chiropractic care in a French University Hospital in Toulouse (France) over one year: a case study

BackgroundIn October 2017, a partnership was established between the University Hospital of Toulouse and the French Chiropractic College, “Institut Franco-Européen de Chiropraxie” (IFEC). Before 2017, chiropractors did not practice in hospitals in France. Chiropractic students and chiropractors are now integrated in an interdisciplinary medical team at University Hospital.Our study aimed to describe the characteristics of patients who received chiropractic care at the University Hospital of Toulouse, their expectations, experiences of care, and satisfaction.MethodA prospective case study was conducted. Patients referred for chiropractic care in the French University Hospital of Toulouse from January to December 2020 were eligible to participate. Participants provided the following data: demographics, previous chiropractic care treatments, pain location, intensity (NRS) and duration, disability (NDI, ODI), health-related quality of life (SF-12) and depressive symptomatology (PHQ-9). We conducted semi-structured interviews to explore their expectations, barriers and facilitators impacting their experience of care, and satisfaction.ResultsSeventeen participants were recruited and seven were interviewed. All participants had chronic pain with a median pain intensity of 05/10 (IQR 04–06) on the NRS scale. Nine of 17 participants presented with multiple pain locations. Thirteen of seventeen participants presented with low back pain and eight with neck pain. The median SF-12 health-related quality of life score was 50/100 (IQR 28.5–60.5) for physical health, and 52/100 (IQR 43–62) for mental health. The PHQ-9 median score of depressive symptomatology was 7.7/27 (IQR 2.0–12.5).Overall, participants were satisfied with their care and the collaboration between chiropractors and physicians. Participants expected a caring communication with the chiropractic team. Their experience was facilitated by their trust in their physician. Patients perceived the turnover of chiropractic students as a barrier to their satisfaction.ConclusionOur participants presented with chronic musculoskeletal pain and depressive symptoms. Our study identified facilitators and barriers for patient expectation and satisfaction with chiropractic care in a hospital setting. This study provides the first data describing the collaboration between chiropractors and physicians in France in the management of musculoskeletal disorders. These findings will inform the quality improvement of our partnership, student’s training and the development of future hospital-based collaborations integrating chiropractic care in a multidisciplinary team in France.

Speech Language Pathologists' Perspectives on Medical Communication in the Hospital: Discussion of the Theory Practice Gap

<h3>Research Objectives</h3> 1. To investigate how medical SLPs view the quality of communication between healthcare professionals and inpatients with and without communication disorders 2. To investigate how medical SLPs define ideal informed consent for medical procedures 3. To investigate, in situations where a gap is observed, how medical SLPs characterize the theory-practice gap between existing methods of informed consent for medical procedures versus the ideal. <h3>Design</h3> Qualitative, observational design using video footage and transcript of a focus group to analyze emerging themes in the perspectives of medical speech-language pathologists regarding the communication between their patients and other healthcare professionals. <h3>Setting</h3> Inpatient hospital. <h3>Participants</h3> Convenience sample of 5 SLPs with 3-20 years experience in acute care. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> 1. SLPs' consensus-developed definition of ideal informed consent for medical procedures 2. SLPs' descriptive accounts of the reality of informed consent as well as other medical communication with the inpatients, with and without communication disorders 3. SLPs' collaborative discussion of the existing theory-practice gap, reasons for that gap, and potential solutions for closing the gap. <h3>Results</h3> Several themes emerged as a result of content and thematic analysis of the discussion, including but not limited to: 1) SLPs' understanding of ideal informed consent closely follows established ethical and philosophical guidance 2) SLPs identified and discussed examples of shortcomings in the reality of medical communication with inpatients with and without communication disorders, with a greater number and significance of obstacles identified in the case of communication deficits. 3) SLPs identified a number of potential reasons for the gap, as well as potential solutions to assisting in closing that gap. <h3>Conclusions</h3> SLPs, because of their extensive training in human communication, their proximity to patients with communication deficits, as well as their position in interdisciplinary medical teams, constitute a unique and valuable resource in improving medical communication with all patients. <h3>Author(s) Disclosures</h3> This author is part of the inpatient SLP team being studied. The author's own biases and their potential impact on the discussion and results were accounted for in the interpretation.

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This photo depicts a WWII veteran, his VA-based interdisciplinary medical team, and his daughter. See the related article by Padala et al., pages 3068-3070.

Clinical considerations for the assessment, management, and treatment of concussion in females

: This review paper describes an individualized, targeted clinical care approach for the assessment, management, and treatment of sport-related concussions (SRC), and also highlights important clinical considerations for providing care to females with a SRC. Ideally, SRCs should be managed by an interdisciplinary medical team including but not limited to neuropsychologists, primary care sports medicine physicians, and physical therapists. The clinician that coordinates care should employ a multi-modal assessment approach (e.g., neurocognitive, vestibular/ocular motor, symptoms, balance, clinical exam/interview) to capture the heterogeneity of symptoms and impairments that are associated with SRC. Clinicians must also be aware of certain factors, specific to females that may complicate SRC recovery such as female preferences for clinical care, their greater risk for established risk factors (e.g., concussion history and migraine) and female sex hormone cycles that may influence multiple concussion outcomes (e.g., symptom reports and neurocognitive scores). Concussion management has moved away from a one-size-fits-all approach and clinicians must be willing to provide a comprehensive assessment that caters to the needs of females in order to individualize the treatment recommendations and avoid a prolonged recovery.

An Introduction to a Novel Intervention, "This is My Story", to Support Interdisciplinary Medical Teams Delivering Care to Non-Communicative Patients.

This set of three case studies portrays a unique intervention undertaken at The Johns Hopkins Hospital in response to the COVID-19 pandemic with a goal to reduce the impact of absentee visitors during patient care on physicians, nurses, and the patient’s loved ones. The intervention, known by the acronym TIMS, “This is My Story”, involves a chaplain-initiated telephone call to a loved one, someone who has been identified by the patient as part of their care discussions, of hospitalized patients who have difficulty with communicating to the medical team. The call is recorded then edited for conciseness, and attached to the electronic health record for the entire medical care team to hear. The focus of the chaplain lead conversation with a loved one centers around gathering and presenting information about the patient as a person. Medical team members listen to the edited audio file either on rounds or by utilizing a hyperlink in the electronic health record (EHR). The audio file is two minutes or less in length, as this is the optimal size for comprehension without overburdening the care provider. While conducting the interview, there is an opportunity for chaplains to provide spiritual and emotional support to loved ones and medical staff, contributing substantively to patient care, as is illustrated in the case studies.

Positive evidence for clinical pharmacist interventions during interdisciplinary rounding at a psychiatric hospital

Clinical pharmacists have not yet become an integral part of interdisciplinary ward rounds in most psychiatric hospitals across the European Union. This retrospective observational pre-post study examined the impact of clinical pharmacist recommendations in an interdisciplinary medical team during psychiatric hospital rounding. The study included all patients in a Slovenian psychiatric hospital who were hospitalized 2019–2020. The clinical pharmacist made 315 recommendations for a total of 224 participants (average age M = 59.4, median = 56). Psychiatrists accepted 295 (93.7%) of the recommendations. After the recommendations, the number of expressed and potential drug-related problems decreased in 166 (93.8%) and 129 (93.8%) interventions, respectively. Three months after discharge, 222 accepted recommendations were continued (70.5%). The most common recommendations were related to antipsychotics (19.4%, N = 61) followed by antidepressants (16.8%, N = 53). Including a clinical pharmacist in the interdisciplinary ward rounds at a psychiatric hospital reduced the number of expressed and potential drug-related problems with a very high recommendation acceptance rate. These results are the first in Central Europe to explore the benefits of including a clinical pharmacist in ward rounding.

Three cases of hearing impairment with surprising subjective improvements after prayer. What can we say when analyzing them?

Aimto enhance the understanding of documented mismatches between ‘subjective’ experiences and ‘objective’ data in three cases of self-reported instantaneous healing of hearing impairment upon prayer. Methoddescription of three cases taken out of a larger retrospective case-based study of prayer healing in the Netherlands. In this larger study multiple reported healings were investigated using both medical files and patients’ narratives through in-depth interviews. A subset of three cases with dramatic subjective reduction of hearing impairment upon prayer was studied. These patients underwent extensive additional investigations at the audiology center of the Amsterdam University Medical Centre. All data was evaluated by an interdisciplinary medical assessment team, subsequent analysis was transdisciplinary. Resultsthe three case histories with self-reported healing after prayer demonstrated a clear mismatch between subjective experiences and objective findings. No measurable improvements were found in four different audiological testing methods. However, in-depth interviews, hetero-anamnesis and a validated questionnaire all confirmed the healings. The medical assessment team could not label these healings as ‘medically remarkable’ because of absence of measurable ‘objective’ changes, but they did consider them as ‘remarkable in a broader sense’. On expert consultation no equivalents of mismatches to this extent could be found. The healing experiences of our participants involved their entire being with profound positive effects in different domains of their lives, and a perception of a benevolent God who acted upon them. There was a distinctive pattern, labelled by the participants as a healing of mind, soul and body. ConclusionsThe subjective-objective incongruities that were found were not well understood. We noticed a paradox: the ‘objective’ measurements did not reflect hearing abilities in daily life where-as ‘subjective experiential’ data did. The latter could be ‘objectified’ and validated in various ways. In fact, a rigid distinction between ‘objective’ and ‘subjective’ was not relevant here, nor a hierarchy among them. A model leaving room for different causations (horizontal epistemology) complied best with the multi dimensionality we came across.