Interdisciplinary Response Research Articles

The scope of mental health research during the COVID-19 pandemic and its aftermath.

The effects of the COVID-19 pandemic on population mental health are unknown. We need to understand the scale of any such impact in different sections of the population, who is most affected and how best to mitigate, prevent and treat any excess morbidity. We propose a coordinated and interdisciplinary mental health science response.

Update diagnosis and therapeutic management of pulmonary embolism

Pulmonary embolism (PE) is a life-threatening disease and the third most frequent cardiovascular cause of death after stroke and myocardial infarction. The annual incidence is increasing. The recently published 2019 guidelines of the European Society of Cardiology integrate numerous new study findings and provide updated diagnostic and therapeutic algorithms. A standardized diagnostic approach based on clinical probability, D-dimer levels, compression sonography of the leg veins and (if necessary) CTPA should also be applied in pregnant patients with suspected PE. Assessment of right ventricular function on imaging should be part of risk stratification in every patient; the RV/LV diameter ratio can be assessed on CTPA performed for diagnosis of PE. Low risk patients are eligible for home treatment if no other reasons for hospitalization are present. Treatment decision for hemodynamically unstable patients should be made by interdisciplinary Pulmonary Embolism Response Teams. NOACs are recommended as the therapy of choice for anticoagulation of patients with PE. The duration of anticoagulation should be at least 3 months and prolonged anticoagulation should be considered for all patients without a strong triggering reversible risk factor.

COVID-19 Outbreak Response for an Emergency Department Using In Situ Simulation.

In January 2020, the WHO declared COVID-19 an epidemic in China and the possibility of evolving into a pandemic. During early phases, most emergency departments did not have contingency plans for an outbreak of this scale and therefore necessitating adequate preparation.This study aims to describe the utility of in situ simulation in identifying system errors and latent safety hazards in response to preparation for the expected COVID-19 surge. We also aim to describe the corrective measures taken to improve our outbreak response locally. We hope that others may be able to use this information as foresight in preparing their own departments for this outbreak.The emergency department and anesthesiology department of Galway University Hospital conducted a series of multidisciplinary, in situ simulations to rapidly identify operational errors and latent safety hazards in response to this outbreak. Each simulation involved an interdisciplinary response to a suspected/COVID-19 patient. The cases were used as a training opportunity for staff and ultimately a platform to expeditiously implement system changes in response to deficits identified during the simulations.Conclusively, with the complexities and intricate structure of every emergency department, we understood that preparation for an outbreak requires evaluation of the current system before implementing any changes. It is not a "one size fits all" concept. Therefore, conducting in situ simulations and the use of foresight, is pivotal as it could prevent loss of resources and time in preparing for an outbreak.

Sallie McFague and an Ecotheological Response to Artificial Intelligence

AbstractMilitary, commercial, and industrial application of artificial intelligence (AI) presents distinct historical challenges for theological reasoning. To date, interdisciplinary theological responses have been limited. Contextual and ecological theologies provide an understanding of the human that is helpful in theological responses to AI. These theologies emphasize a relational, embodied view of the human that responds to and resolves many of the shortcomings found in AI research and related theological responses. Sallie McFague's emphasis on embodiment and the world as God's body is an especially useful contribution to these efforts.

Effects of Mock Code Blue Simulations on Interdisciplinary Team Response and Confidence

Objective: To identify the relationship between performing mock code blue simulations and overall interdisciplinary response time and confidence.Design: Quasi-Experimental, DescriptiveSetting: Hays Medical CenterParticipants: Health Care ProvidersMethods: During a three-month period, Hays Medical Center healthcare providers will undergo mock code blue simulations to improve response times and increase interdisciplinary team confidence levels. This study will identify the relationship both before and after implementation of mock code blue simulations. The same 100 health care providers will be observed for response times before implementation of the mock code blue simulation, and then will be observed again following a three-month training period with mock code blue simulations. In addition, the sample will voluntarily participate in a pre- and post-survey to identify self-perception of confidence levels in responding to mock code blue simulations using a visual analogue scale (VAS).Results/Conclusion: Pending results and data collection.

Responding to Hospital Staff’s Paranormal Experiences Related to a Medical Assistance in Dying Room

Staff reported paranormal experiences in connection with the outpatient Medical Assistance in Dying (MAiD) room at the hospital. This case study reports on staff experiences and illustrates how the Ethics team’s role expanded to deal with this novel situation by facilitating an interdisciplinary response.

A guide to architecture for the public health workforce

BackgroundPublic health and environmental challenges facing the world in the 21st century, including the ageing population, increasing urbanisation, rise of non-communicable diseases and climate instability, require an interdisciplinary response. A significant proportion of the population's time is spent indoors, be it at home, school, work or in leisure time; the work of an architect can cover all of these sectors, but their role in health and well-being remains an under explored area. ObjectiveThis article examines the architecture profession's potential to contribute to improved health and well-being of the population through healthier buildings and places. MethodologyThis short communication adopts a descriptive approach. First, it maps the remit, skills and influence of the architecture profession and applies this to a well-accepted public health model, the prevention pyramid. Second, it uses themes identified by the Royal Society for Public Health to discuss ways to improve engagement with the architecture profession as part of the wider public health workforce. ResultsThis article finds that the remit, skills and potential influence of architects places them in a key position to improve the health and well-being of the population. Despite this, there has been relatively little engagement between public health and this profession. Much more attention to date has been on integrating the planning sector with public health. ConclusionOpportunities for improved engagement exist through partnership working, incorporating health into both undergraduate and postgraduate education and continuing professional development training, building the evidence base and developing architecture and health-related policy and legislation.

Incorporating a Resident-Driven Quality Improvement Process Change Through a Lean Transformation of Post-Partum Hemorrhage (PPH) Care

PURPOSE: To investigate a resident-driven quality improvement lean event to improve satisfaction in PPH management. BACKGROUND: Interdisciplinary PPH response strategies are recommended as standard of care. OBGYN resident perceptions regarding PPH management prompted an interprofessional quality improvement lean event to create a systems process change on the post-partum unit. METHODS: This was a pre-/post-intervention study evaluating the impact of a lean event that created new hemorrhage protocols (intervention) on postpartum units including: medication safety bundle, assigned/clarified roles for providers, and a streamlined communication process. The survey queried respondents regarding team communication, access to uterotonics and analgesia, and perception of overall patient safety during PPH. It was administered to resident physicians and post-partum nurses prior to the system changes and at 6 and 12-month intervals. These results were compared using nonparametric analyses. RESULTS: Participants included 15 residents and 16 nurses. Pre-intervention, there was a significant difference in the overall perception of safety when comparing resident and nurse response (p=0.0495) with residents perceiving a less safe environment. Post-intervention, overall satisfaction among the 2 groups was improved at the 6 & 12 month intervals (p<0.05) without discrepancy between the groups. Nurse results demonstrated significantly increased satisfaction with team communication and IV access protocols (p<0.05). DISCUSSION: Resident led quality improvement events can result in improved satisfaction of interprofessional team members in PPH care with improvements maintained over 12 months. Reaching a shared perception and mental model between nursing and residents in the care of PPH can further be studied from the patient’s perspective.

Disrupted breath, songlines of breathlessness: an interdisciplinary response

Health research is often bounded by disciplinary expertise. While cross-disciplinary collaborations are often forged, the analysis of data which draws on more than one discipline at the same time is...

Clinical and Demographic Predictors of Interdisciplinary Chronic Pain Rehabilitation Program Treatment Response

Patients treated in interdisciplinary chronic pain rehabilitation programs show long-term improvements in symptoms; however, outcomes may vary across heterogenous patient subpopulations. This longitudinal retrospective study characterizes the influence of opioids, mood, patient characteristics, and baseline symptoms on pain and functional impairment (FI) in 1,681 patients 6-months to 12-months post-treatment in an interdisciplinary chronic pain rehabilitation program incorporating opioid weaning. Linear mixed models showed immediate and durable treatment benefits with nonuniform worsening at follow up which slowed over time. Latent class growth analysis identified three post-treatment trajectories of pain and FI: mild symptoms and durable benefits, moderate symptoms and durable benefits, and intractable symptoms. A fourth pain trajectory showed immediate post-treatment improvement and worsening at follow up. Whether a patient was weaned from opioids was not predictive of treatment trajectory. Racial ethnic minority status, higher levels of post-treatment depression, and lower perceived treatment response were associated with less resolution (moderate symptoms) or intractable symptoms. Not having a college education was predictive of intractable or worsening pain and a moderate course of FI. Older age and male gender was associated with intractable FI. Treatment outcomes may be improved by the development of targeted interventions for patients at risk of poor recovery and/or deteriorating long-term course. PerspectiveThis study examined predictors of treatment response in 1,681 patients treated in an interdisciplinary chronic pain rehabilitation program incorporating opioid weaning. Opioid weaning did not predict outcome. Higher levels of symptoms, lower levels of education, and being a racial-ethnic minority were associated with a less salubrious long-term treatment response.

Interdisciplinary Responses to Climate Change in the University Classroom

Abstract This case report describes a novel bridge course developed by the authors, entitled, What If They're Right? Individual Responses to Climate Change. The course challenges university student...

Detecting and reducing post-traumatic stress among children exposed to domestic violence: A multi-agency early intervention program

Exposure to domestic violence (DV) has serious implications for youth, increasing risk for a range of problems, including post-traumatic stress. The Child Trauma Response Team is a multi-agency collaboration aimed at providing coordinated, immediate, trauma-informed, and interdisciplinary response to children and their impacted family members who are exposed to domestic violence. This mixed-methods study analyzed CTRT administrative data along with qualitative stakeholder interview data to describe the children and families served by CTRT, examine the reach of CTRT services, and articulate the lessons learned in the early stages of CTRT program implementation. Results show the majority of children accessing CTRT services were young and came from racial and/or ethnic minority backgrounds. The vast majority of families engaging with CTRT received safety assessment and planning and child trauma education, with many families receiving at least one other service. Stakeholders identified challenges to implementation as: identification of eligible families; initiating and ensuring program engagement; and collaboration and communication across multiple agencies. Several strategies to overcome these challenges were identified. Findings from this study indicate that, through inter-agency collaboration, reaching and serving children exposed to DV in the days and weeks immediately following a violent event is feasible—even in a large city with complex inter-agency relationships.

Building an Interdisciplinary Team for Disaster Response Research: A Data‐Driven Approach

Building an interdisciplinary team is critical to disaster response research as it often deals with acute onset events, short decision horizons, constrained resources, and uncertainties related to rapidly unfolding response environments. This article examines three teaming mechanisms for interdisciplinary disaster response research, including ad hoc and/or grant proposal driven teams, research center or institute based teams, and teams oriented by matching expertise toward long-term collaborations. Using hurricanes as the response context, it further examines several types of critical data that require interdisciplinary collaboration on collection, integration, and analysis. Last, suggesting a data-driven approach to engaging multiple disciplines, the article advocates building interdisciplinary teams for disaster response research with a long-term goal and an integrated research protocol.

Every ENT anesthesia fellowship needs a simulation-based education program

Every ENT anesthesia fellowship needs a simulation-based education program

Converging drivers of interpersonal violence: Findings from a qualitative study in post-hurricane Haiti.

Interpersonal violence affecting women and children is increasingly recognized as a public health priority in humanitarian emergencies. Yet, research and intervention efforts have been fragmented across gender-based violence and child protection sectors. Using data from the Transforming Households: Reducing Incidence of Violence in Emergencies (THRIVE) project, this study sought to qualitatively investigate the intersecting drivers of multiple forms of violence in Côteaux, Haiti, while obtaining insight on how these drivers may be influenced by a humanitarian emergency. This analysis used transcripts obtained using a photo elicitation approach over the course of three sessions per person. Thirty-six individuals participated in the study: eight adult females, ten adult males, eight adolescent females, ten adolescent males. Participants were given cameras to capture images related to family relationships, family safety, and changes to family dynamics due to Hurricane Matthew and its aftermath. In subsequent sessions, these photographs were used as prompts for qualitative interviews. Multiple and converging drivers of interpersonal violence were identified including the accumulation of daily stressors, loss of power/control, learned behavior (intergenerational cycle of abuse), and inequitable gender norms, all of which were influenced by the humanitarian context caused by Hurricane Matthew. Our findings suggest multiple and converging drivers of violence may be exacerbated in times of crises, requiring interdisciplinary responses. In order to comprehensively address the drivers of violence, practitioners and policy makers should consider the needs of individuals and their families holistically, integrating community-led, gender transformative efforts and positive parenting with basic needs provision.

Leadership and School Social Work in the USA: A Qualitative Assessment

School social workers provide unique insight into the biopsychosocial factors that influence students and overall well-being. Social work training in the person-in-environment perspective offers a unique understanding of issues within the school environment, making them ideal professionals to lead holistic, interdisciplinary response options and programs that help foster positive school climates and student success. However, current research suggests there is little information about what school social work practice actually looks like in the schools and how this practice is consistent with leadership roles and tasks. The purpose of this study is to examine school social work leadership in today’s schools. A sample of school social work practitioners across the USA (N = 375) provided a response to the question: “In what ways do you provide leadership within your school setting?” An inductive, thematic study was conducted to determine the aspects of leadership in which school social workers engage in most. Using coding procedures, three salient themes of leadership emerged: (1) increasing training and services; (2) focusing on school–community partnerships; and (3) advocating for policy and school structural changes that affect school safety. Findings from this study build upon past research and suggest that efforts to prepare and improve current leadership skills for school social workers are warranted. Implications for student education and social work programs are discussed, and recommendations for future research are provided.

Active Learning and Teaching through Digital Technology and Live Performance: ‘Choreographic Thinking’ as Art Practice in the Tertiary Sector

AbstractThis article is an interdisciplinary reflective response to an intensive studio learning and teaching experience involving artists, academics and postgraduate students. The authors of this article teach, research and practise in coding, digital design, dance, and virtual and live performance. As lecturers and students we reflect upon and propose future approaches to art practice in tertiary education informed by live performance, performance capture and studio‐based responses to digital and virtual platforms. We reflect on an innovative contribution to the field of research–teaching nexus as informed by digital and virtual data capture identifying the key element of immediacy in live performance and choreographic improvisation with systems. We reflect on practice‐based inquiry via the Choreographic Coding Lab (CCL) model – a dialogical negotiation between capture technology and interdisciplinary artists in industry and academia. How can we encourage potential studio inquiry as an adapted model in tertiary learning and teaching? Our interdisciplinary voices, presented as authors’ reflections, provide suggestions for future studio‐based, active learning contexts.

Author response: An interdisciplinary response to contemporary concerns about brain death determination.

We appreciate the interest and comments of Verheijde et al., Dr. Sethi, Machado et al., and Dr. Shabtai.

Reader response: An interdisciplinary response to contemporary concerns about brain death determination.

We disagree with redefining death “based on loss of clinical function of the heart and lungs or the brain,”1 because it deviates from the legal definition of irreversible cessation of cardiorespiratory function or of all functions of the brain, including the brainstem. The latter was intended to protect the general public from injury and harm due to incorrect death declaration. The contemporary clinical criteria have been challenged on scientific, philosophical, legal, and religious grounds.2–4 Lewis et al. reduce this opposition to “moral or religious beliefs, hope that a patient will recover, or a lack of acceptance that a determination of brain death is the legal equivalent of a determination of cardiopulmonary death.”1 Religious objection stems from incongruence with the hylomorphic Thomistic concept of death (body-soul connection) underlying Abrahamic faith traditions. The “lack of acceptance” originates from low-level supporting scientific evidence and absence of a coherent philosophical rationale.4 Furthermore, American Academy of Neurology practice guidelines are more consistent with the brainstem rather than the whole-brain death definition.

Editors' note: An interdisciplinary response to contemporary concerns about brain death determination

“An interdisciplinary response to contemporary concerns about brain death determination” generated several readers' responses. Commenting on the paper, Verheijde et al. argue that cardiopulmonary death is not the equivalent to brain death and add that public trust in brain death requires that there be zero false-positive determinations of death. Dr. Sethi suggests that lawsuits related to brain death may be linked more to breakdowns in communication between the medical teams and patient families rather than validity of determination of death by neurologic criteria. Machado et al. suggest that ancillary tests should have a decisive role in helping to delineate the brain death concept since clinical evaluation might have pitfalls. Finally, Dr. Shabtai feels that it is an error to frame the debate as one of religious or moral beliefs vs science, and suggests continued discussion, including broad public debate. Authors Lewis et al. defend their article citing several prominent American medical societies who support that brain death is equivalent to cardiopulmonary death. They add that when the American Academy of Neurology guidelines are appropriately applied, there are zero false-positive determinations of death. They suggest including a social worker, psychologist, palliative care specialist, chaplain, and religious figure in conversations about brain death. They explain that ancillary testing is recommended to assess for lack of intracranial blood flow or cerebral activity if a clinical evaluation cannot be completed, but the gold standard for determination of brain death is a full clinical evaluation. Further, they add that ancillary testing is imperfect and there are risks when performing testing and interpreting the results. Finally, they remind the reader that the 1981 President's Commission determined that death should be defined based on complete loss of function of the brain or the heart and lungs, but deferred to the medical community to establish the specific criteria for determination of death. They stress that it is the medical community's responsibility to ensure that it is clear what constitutes “accepted medical standards” for determination of death and that these criteria are adhered to consistently and accurately. “An interdisciplinary response to contemporary concerns about brain death determination” generated several readers' responses. Commenting on the paper, Verheijde et al. argue that cardiopulmonary death is not the equivalent to brain death and add that public trust in brain death requires that there be zero false-positive determinations of death.