Multidisciplinary Professionals Research Articles

Perspectives on the use of Virtual Reality within a public hospital setting: surveying knowledge, attitudes, and perceived utility among health care professionals

BackgroundVirtual reality (VR) is a burgeoning technology within healthcare, though routine implementation of VR within hospital settings remains limited. Health professionals are key stakeholders in knowledge translation, though limited research has explored their knowledge and attitudes towards using VR for different purposes within healthcare. This study aimed to scope health professionals’ knowledge of, and attitudes towards, the use of VR applications in a public hospital setting.MethodsA cross-sectional survey of multidisciplinary health professionals (medical, nursing, allied health professionals) was conducted in a major metropolitan public hospital in Australia. The custom survey was comprised of 28 mixed categorical and free-text fields designed to scope levels of knowledge, prior experience, and interest in VR; the perceived utility of VR within a hospital context; and perceived barriers and enablers of VR use within the hospital setting. Data were analyzed via descriptive and non-parametric statistics.ResultsOne hundred and thirty-seven health professionals participated (38% allied health, 37% nursing, 24% medical). The majority had no prior exposure to VR in clinical (95%) or recreational (67%) settings; and only 16% were aware of any clinical research evidence for VR. Despite limited awareness, participants expressed support for VR use in hospitals. 99% reported VR had potential utility in healthcare, most commonly for clinical simulations (81%), clinical education (80%) and as a physical therapy tool (68%). Participants identified multiple barriers to VR implementation most commonly relating to perceived cost, lack of required infrastructure, time, knowledge and technical skill. Prominent enablers related to increasing capability at provider and system levels. Participants’ familiarity with VR was associated with stronger support for its’ use (Rho = 0.4, p < 0.001).ConclusionsHealth professionals in the hospital workforce reported limited knowledge and familiarity with VR; yet they perceived VR had broad utility and expressed overall support for different VR applications within hospitals. Health professionals appear interested in VR though face multiple barriers to its use in a hospital context. Increasing capability among multidisciplinary health providers and the wider hospital system appear to be important considerations for the success of future VR implementation in public hospitals.

P182 Exercise and activity in polymyalgia rheumatica: co-creating an education resource acceptable to patients and health professionals

Abstract Background/Aims People with PMR report experiencing pain, stiffness and weakness, often impacting everyday tasks. Many fear exercise will exacerbate symptoms and need reassurance that exercise is helpful and not harmful. However, no PMR-specific, exercise educational resource currently exists. The aim of this funded study was to co-create an exercise educational resource for, and with, people with PMR that would be acceptable to both patients and health professionals. Methods A steering group of people with PMR and UK clinicians/academics from Keele and Leeds universities was identified. People with PMR and clinical/academic health professionals with specific interest in PMR were invited to participate in a one-hour online focus group (FG), recruited via social media, the PMRGCAuk charity and professional networks. Ethical approval was obtained. Separate FGs (four with patient participants and two with multi-disciplinary health professionals), held during the summer of 2023, were facilitated by steering group members over two rounds. Exemplars of non-PMR health education literature were shared with participants in round 1 to prompt discussion and invite participant opinions about what might be essential exercise content and the optimal format of the new PMR educational resource. Summaries of proposed content and resource format suggestions were collated after each FG and informed the next iteration of the exercise and physical activity educational resource. In the final round 3 a prototype version of the educational booklet was shared with all FG participants via email. All participants were invited to provide final feedback and comments, after which the booklet was finalised. Results Participants desired a visually appealing pocket-size (A5), multiple-page, patient education booklet suitable for either printing or reading online. Colour-themed text and images with logos of PMRGCAuk and contributing universities were requested. Positive messaging promoting movement and physical activity, as well as exercise, were considered important. Feedback following draft booklet iterations concluded “a self-help guide” title was valuable, as were starter and progression instructions to accompany exercise illustrations. Participants desired explanation of prioritised “top tips”, including keeping moving, listening to your body, balancing rest and activity, and the physical and mental health benefits of exercising. Patient quotations were included with permissions together with signposting to other resources. Conclusion An exercise-focused education booklet, acceptable to both people with PMR and UK expert health professionals, has been co-created and professionally designed. Future research plans include piloting the feasibility of using this resource to support people living with PMR to engage and continue with exercise, and to evaluate the impact of people with PMR exercising. Disclosure A.V. O’Brien: Grants/research support; This project was funded by Polymyalgia Rheumatica, Giant Cell Arteritis UK charity - PMRGCAuk. S. Eng: None. S.L. Mackie: Consultancies; Roche/Chugai, Sanofi, AbbVie, AstraZeneca, Pfizer. Grants/research support; chief investigator on STERLING-PMR trial, funded by NIHR; patron of the charity PMRGCAuk. NIHR Leeds Biomedical Research Centre. Investigator on clinical trials for Sanofi, GSK, Sparrow. N. Scrafton: None. S. Hider: None. A. Tan: None. C. McClean: None. J. Barber: None. J. Gundle: None. M. Lonsdale: None. M. Baxter: None.

Identification and support of autistic individuals within the UK Criminal Justice System: a practical approach based upon professional consensus with input from lived experience

BackgroundAutism spectrum disorder (hereafter referred to as autism) is characterised by difficulties with (i) social communication, social interaction, and (ii) restricted and repetitive interests and behaviours. Estimates of autism prevalence within the criminal justice system (CJS) vary considerably, but there is evidence to suggest that the condition can be missed or misidentified within this population. Autism has implications for an individual’s journey through the CJS, from police questioning and engagement in court proceedings through to risk assessment, formulation, therapeutic approaches, engagement with support services, and long-term social and legal outcomes.MethodsThis consensus based on professional opinion with input from lived experience aims to provide general principles for consideration by United Kingdom (UK) CJS personnel when working with autistic individuals, focusing on autistic offenders and those suspected of offences. Principles may be transferable to countries beyond the UK. Multidisciplinary professionals and two service users were approached for their input to address the effective identification and support strategies for autistic individuals within the CJS.ResultsThe authors provide a consensus statement including recommendations on the general principles of effective identification, and support strategies for autistic individuals across different levels of the CJS.ConclusionGreater attention needs to be given to this population as they navigate the CJS.

Effects of clinical interventions through a comprehensive medication management program: A retrospective study among outpatients in a private hospital

IntroductionThe intricate nature of certain diseases necessitates complex medication regimens, utilization including high-cost medications, and continual vigilance to avoid potential complications. To address these exigencies, numerous healthcare institutions have instituted multidisciplinary management teams, exemplified in pharmaceutical care through Comprehensive Medication Management (CMM) programs. These programs oversee diverse facets such as patient education, medication adherence promotion, clinical monitoring, dose adjustments, and scrutiny of prescribed drug therapies. Given the emphasized significance, it is relevant to possess evidence to continue endorsing these initiatives from management positions within health centers, and it is for this reason that this study aims to evaluate the clinical and economic benefits provided by a CMM program within a private hospital in Latin America, by analyzing the effects of clinical interventions. MethodsA retrospective examination was conducted involving documented pharmaceutical interventions in an outpatient setting from January 2019 to September 2022. To assess the interventions' repercussions, a retrospective analysis was undertaken. The collated data included patients' basic characteristics, a comprehensive pharmacist-generated description of interventions, potential associated complications, and avoided medical services. Multiple clinical projections, which were endorsed by internal medicine physicians, were developed to explore potential scenarios in the absence of pharmaceutical care. These projections were associated with conceivable complications, aligned with the most plausible circumstances. Subsequently, utilizing the average cost of healthcare within a private hospital in Latin America, the cumulative savings were quantified. These savings were then attributed to the intrinsic advantages offered by pharmaceutical care. ResultsThe study discloses demographic trends among patients within distinct age groups in the CMM program. Rheumatology predominated as the main referral source, and interventions centering on monitoring emerged as the pivotal drug-related concern. This encompassed a collaborative approach, involving interdisciplinary efforts toward patient education and critical parameter monitoring. Of the total 347 pharmaceutical interventions, 66.3% (N = 230) specialty office visits, 14.1% (N = 49) general practitioner consultations, 12.4% (N = 43) hospitalizations, and 7.2% (N = 25) ER visits were avoided. The economic analysis underscores cost savings ensuing from pharmaceutical interventions, amounting to a cumulative 603,792.82 USD. Extrapolating these findings to a patient cohort of 400 enrolled in the pharmaceutical care program approximates per-patient savings of 361.47 USD. ConclusionThis study reveals the significant clinical and economic benefits of CMM programs, led by multidisciplinary pharmaceutical professionals. The findings provide compelling evidence for hospital management to consider promoting such programs, drawing from the patient-centered care model in the United States applicable to Latin America.

ICU Care Team's Perception of Clinical Research in the ICU: A Cross-Sectional Study.

Adequate recruitment is essential for successful clinical research. ICU nurses play a crucial role in identifying eligible patients, introducing research teams, facilitating informed consent, and caring for enrolled patients. However, a larger group of multidisciplinary healthcare professionals (the ICU care team) is equally important in promoting clinical research participation.To describe the ICU care team's experiences in ongoing clinical research, identifying perceived barriers and enablers to their participation, and apply a behavior framework to enhance research engagement. Cross-sectional survey study. Four adult ICUs and one PICU between June 2021 and March 2023. We recruited nurses, physicians, nurse practitioners, allied health professionals, and unit clerks. We developed and validated a cross-sectional survey based on the Capability, Opportunity, Motivation, Behavior model. This survey included: 1) demographic questions (n = 7); 2) research experience questions (n = 6), 3) capability questions (n = 8); 4) opportunity questions (n = 11); 5) and motivation questions (n = 13).A total of 172 ICU care team members completed the survey. Results showed differences in capabilities, opportunities, and motivations among ICU care team members. For example, fellow/attending physicians and nurse practitioners reported higher confidence in discussing research with patients/families, while registered nurses and allied health professionals expressed less confidence. ICU care team members face multiple barriers that impact their involvement with the conduct of ICU research. To effectively engage healthcare professionals in this process, it is essential to address their capabilities (research knowledge and skills to communicate research with patients/families), create opportunities (collaboration/communication with research team, discuss research during multidisciplinary rounds), and motivate them (recognize their help and share the results of the research being conducted at their site) to improve ICU care team engagement in the conduct of ICU research.

A qualitative study on psycho-social needs of the family caregivers of persons with spinal cord injury

ABSTRACT Background: Spinal cord injury is a high-cost long-lasting disability and a life-changing experience for family caregivers (FCGs). The current study aimed to explore the psycho-social needs of the FCGs of persons with spinal cord injury (PwSCI). Materials and Methods: An exploratory qualitative approach was used, and sixteen FCGs of PwSCI participated in the face-to-face interviews. All the interviews were audio-recorded, and session notes were added to the existing data and later transcribed. Thematic analysis was used to identify the main themes. Results: Three main themes have emerged, namely, awareness needs, resource needs, and personal care needs, from the data as a result of the qualitative analysis: The main themes have been categorised into nine sub-themes, such as want to know, alternative ways of contacting, the helpful or conducive environment of arrangements, sources to get money, pension certificate needs, resources for livelihood, resources for continuing the treatment, need my own time, and controlling of feelings. Conclusion: The findings of this research aid in designing or developing need-based tailor-made psychosocial interventions for the FCGs of PwSCI in India. Multidisciplinary team professionals involved in managing spinal cord injury and other stakeholders should understand the importance of meeting the mentioned psycho-social needs of FCGs of PwSCI and delivering such tailor-made psycho-social interventions in a timely.

Perinatal Palliative Care and Ethical Issues

Perinatal palliative care is a specialty that covers the fields of obstetrics, fetal medicine, pediatric palliative medicine and neonatal medicine. In this care, healthcare professionals offer an individualized care plan based on the needs of the fetus/newborn and family members in a multidimensional way with an interdisciplinary team approach. Unlike adult, neonatal and pediatric palliative care, the patient is not only a single person but a mother-fetus couple in perinatal palliative care; therefore this care type is based on family-centered care philosophy. Due to lack of information about preferences or requests of the fetus, families are expected to make the best medical decision for their baby considering their wishes and values. In this respect, it is important for the team members to inform the families during this process and for multidisciplinary healthcare professionals to support them for making the most appropriate decision. This review article examined the importance of perinatal palliative care, ethical issues, and the roles and responsibilities of the nurse.

Application of the ICF on students with disabilities at school in India

ICF serve as the basis for both the assessment and measurement of disability in many scientific, clinical, administrative and social policy contexts. However, few studies have used the application of ICF on students with disabilities in scientific and clinical context in India. The objective of this study is to identify the problems and record information by implementing the ICF as the basis for both the assessment and measurement of barriers/facilitator in students with disability in educational setting on clinical and social policy contexts. Method &amp; procedure - A focus group of participants selected as to represent each level of school and each type of disability service provider working in rehabilitation institute. The group for the Identification Card included only teachers; that for the Functional Diagnosis was constituted only by multi-disciplinary health professionals from Disability Services; that for the Achievable Functional Goal Setting Profile and the Individual Educational Action Plan were mixed, including both teachers and operators from Disability Services. Results- In the school year 2021-23, the school sent 206 identification cards to disability services using the ICF model; the disability services issued 118 new disability certifications (57.3% of the received 206 identification cards). The school received 220 Functional Diagnosis from the disability services. The number of achievable functional goal setting profile stands at 132 and reached 54 number of Individual Educational Action Plan. Conclusion- In summary, the study suggested that to make any treatment effective for students with disabilities the medical, allied health expert like occupational therapist and the skilled teacher need to work hand in hand.

State Policies Associated with Availability of Mobile Crisis Teams.

Mobile crisis teams are comprised of multidisciplinary mental health professionals that respond to mental health crisis calls in community settings. This study identified counties with mobile crisis teams and examined state policies associated with mobile crisis teams. Descriptive statistics and geographic information system software were used to quantify and map counties with mobile crisis teams in the United States. Relationships between state policies and mobile crisis teams were examined using an adjusted logistic regression model, controlling for county characteristics and accounting for clustering by state. Approximately 40% (n = 1,245) of all counties in the US have at least one mobile crisis team. Counties in states with legislation in place to fund the 988 Suicide and Crisis Lifeline were more likely to have a mobile crisis team (Adjusted Odds Ratio (AOR): 2.0; Confidence Interval (CI): 1.23-3.26), whereas counties in states with 1115 waivers restricting Medicaid benefits were less likely to have a mobile crisis team (AOR: 0.43; CI: 0.21-0.86). Additionally, counties with the largest population were more likely to have a mobile crisis team (AOR: 2.20; CI:1.43-3.38) than counties with the smallest population. Having a mobile crisis teams was positively associated with legislation to fund 988. Legislation that encourages expansion of existing crisis care services, specifically funding aimed at mobile crisis teams, may help increase availability of services for people who are experiencing a mental health crisis in the community.

Child torture victimization: Review of criminal statutes and medico-legal issues

A renowned group of pediatricians and an attorney with expertise in child abuse matters proposed a medical definition of intrafamilial child torture perpetrated by a caretaker in a landmark 2014 publication in the health sciences literature. Representing one of the most widely cited publications on non-politically motivated child torture to date, this medical definition encompassing physical abuse, psychological abuse, deprivation, and neglect characterizing child torture has been broadly recognized and accepted by multidisciplinary professionals across medical, child welfare, and criminal justice sectors. While the medical community's efforts aimed to compel legislative changes, including adoption of explicit torture-specific statutes that would enable criminal justice system responses reflective of abuse severity, subsequent legal analyses have revealed tremendous variability in criminal investigations, prosecution, sentencing, and case outcomes. In this discussion piece, medico-legal issues relevant to intrafamilial child torture case prosecution are reviewed. The impact of the established medical definition on jurisdictional legal approaches and unique case challenges related to longitudinal nature of abuse, frequent psychological injury, and victim-perpetrator dynamics are explored in depth. Utilizing available legal research platforms, investigative information, health sciences literature, and prosecutor self-report, existing child torture statutes and case outcomes were compared with focus on perpetrator, victim, socio-environmental, and community influence on legal outcome. Prosecutorial challenges facing jurisdictions lacking child torture statutes are discussed with emphasis placed on the critical role played by the medical community to support diagnosis of physical and emotional impacts to the child. Finally, the process by which states can establish a jurisdictional torture statute are suggested.

Development of a core outcome set for breast cancer-related lymphedema: a Delphi study.

For breast cancer survivors (BCS) living with breast cancer-related lymphedema (BCRL), what outcome domains (OD) should be measured to assess the burden of the disease and efficacy of interventions? A Core Outcome Set (COS) that promotes standardized measurement of outcomes within the constraints of time influenced by work environments is essential for patients and the multidisciplinary professionals that manage and research BCRL. Using Delphi methodology, a multidisciplinary group of BCRL experts (physical and occupational therapists, physicians, researchers, physical therapist assistants, nurses, and massage therapist) completed two waves of online surveys. BCRL expert respondents that completed the first survey (n = 78) had an average of 26.5years in practice, whereas, respondents who completed the second survey (n = 33) had an average of 24.9years. ODs were included in the COS when consensus thresholds, ranging from 70% to 80%, were met. A total of 12 ODs made up the COS. Reaching a minimum consensus of 70%; volume, tissue consistency, pain, patient-reported upper quadrant function, patient-reported health-related quality of life, and upper extremity activity and motor control were recommended at different phases of the BCRL continuum in a time-constrained environment. Joint function, flexibility, strength, sensation, mobility and balance, and fatigue met an 80% consensus to be added when time and resources were not constrained. The COS developed in this study thoroughly captures the burden of BCRL. Using this COS may reduce selective reporting, inconsistency in clinical use, and variability of reporting across interdisciplinary healthcare fields, which manage or research BCRL.

Enabling local provision of assistive products in rural South India: an organisational survey of needs, barriers, and facilitators

Objective: Access to assistive products (APs) is essential to maximising function, participation, and inclusion of persons with disabilities. Challenges to AP access in low- and middle-income countries include stigma, costs, supply, and rehabilitation capacity gaps. This study aimed to examine AT access in the context of a low-resource setting in rural South India. Objectives were to examine rehabilitation professionals’ perceptions of AP needs, barriers and facilitators of AP provision, and AT knowledge.Methods: A descriptive study design with a 2-part online survey methodology was utilized. This study was conducted in April-September 2020 at a non-governmental organization (NGO) serving children and adults with disabilities in 3 districts of rural South India. Purposive sampling of NGO’s multidisciplinary rehabilitation professionals (N=62) was used. The survey was developed based on WHO’s Assistive Products List (APL). Barriers and facilitators were classified according to the principles of AT access. Analyses revealed acceptability, affordability, and availability as the top three barrier themes across disciplines, including poor acceptance by clients/families due to stigma, high AP costs, and a long waitlist for government-provided devices. Acceptability, affordability, and accessibility were the top three facilitator themes, including community awareness, availability of AP funding, client/family education, and AT service provision training.Impact: Our study identified key enabling strategies for AT access, aimed at reducing reported barriers. Enabling AP provision was determined to be multi-factorial, aimed at users/ families, service providers, organizations, communities, and policymakers. Local stakeholder groups are crucial to understanding challenges and opportunities to AP provision within a low-resource context.

Adaptive strategies used by surgical teams under pressure: an interview study among senior healthcare professionals in four major hospitals in the United Kingdom

BackgroundHealthcare systems are operating under substantial pressures, and often simply cannot provide the standard of care they aspire to within the available resources. Organisations, managers, and individual clinicians make constant adaptations in response to these pressures, which are typically improvised, highly variable and not coordinated across clinical teams. The purpose of this study was to identify and describe the types of everyday pressures experienced by surgical teams and the adaptive strategies they use to respond to these pressures.MethodsWe conducted interviews with 20 senior multidisciplinary healthcare professionals from surgical teams in four major hospitals in the United Kingdom. The interviews explored the types of everyday pressures staff were experiencing, the strategies they use to adapt, and how these strategies might be taught to others.ResultsThe primary pressures described by senior clinicians in surgery were increased numbers and complexity of patients alongside shortages in staff, theatre space and post-surgical beds. These pressures led to more difficult working conditions (e.g. high workloads) and problems with system functioning such as patient flow and cancellation of lists. Strategies for responding to these pressures were categorised into increasing or flexing resources, controlling and prioritising patient demand and strategies for managing the workload (scheduling for efficiency, communication and coordination, leadership, and teamwork strategies).ConclusionsTeams are deploying a range of strategies and making adaptations to the way care is delivered. These findings could be used as the basis for training programmes for surgical teams to develop coordinated strategies for adapting under pressure and to assess the impact of different combinations of strategies on patient safety and surgical outcomes.

Xylazine and Adulterants in the Evolving Drug Supply: Urgent Call for Responsive Education Models.

Novel adulterants and synthetic substances are rapidly infiltrating the US drug supply causing new clinical harms. There is an urgent need for responsive education and training to address these evolving harms and mitigate new risks. Since 2020, xylazine, a veterinary tranquilizer, has become increasingly common in the illicit opioid supply, especially alongside fentanyl. Training and technical assistance (TTA) programs employing an adaptive model can quickly disseminate emerging information and provide the tools to respond effectively. We describe our TTA program's experience developing and delivering virtual instructor-led xylazine training to a diverse group of addiction care professionals. The training objectives included the following: (1) introducing epidemiologic trends, pharmacology, and existing literature related to xylazine; (2) reviewing xylazine-associated harms and management; and (3) discussing harm reduction strategies related to xylazine use. We conducted 14 training sessions between October 2022 and July 2023, which were attended by over 2000 individuals across 49 states. We review our experience developing innovative training content and managing flexible training logistics and highlight our lessons learned, including targeting multidisciplinary professionals, leveraging online synchronous delivery methods, and a need for sustainable funding for TTA programs.

Is it "all in the bag?"Multidisciplinary perspectives on ostomy surgery in pediatric IBD across the ImproveCareNow network.

Pediatric inflammatory bowel disease (IBD) is a chronic illness with various treatments, including ostomy surgery. Ostomy-related medical decision-making (MDM) is complex for multidisciplinary healthcare professionals (HCPs). This study sought to understand national multidisciplinary HCPs' perceptions about pediatric IBD ostomy surgery in the United States. This cross-sectional REDCap survey recruited HCPs in pediatric IBD HCP roles from the ImproveCareNow (ICN) Learning Health System. The survey gathered data on, (1) demographics, (2) participants'perspectives on patients/families'ostomy perceptions,(3) participants'own perspectives on ostomies, and (4) participants'perspectives on multidisciplinary collaboration in ostomy surgery. Participants (n = 69, across n = 30 American ICN sites) were 84% White, 62% female, and 54% gastroenterologists. In reflecting on patients/families'perceptions, participants endorsed most (86%) view ostomies as a "failure," various psychosocial concerns (e.g., 97% endorsed body image concerns), and most (81%) have moderate to significant stigma about ostomies. In reflecting on their own perceptions, nearly half (44%) endorsed some to moderate stigma about ostomies and felt ostomy discussions were difficult when families had negative perceptions (88%). Over half (54%) endorsed currently having multidisciplinary care for pediatric IBD surgery. Most (70%) endorsed variability in the amount and/or quality of multidisciplinary collaboration. MDM related to pediatric IBD ostomy surgery presents nuanced clinical complexities for HCPs. This work underscores interest in multidisciplinary care, notable ostomy-related psychosocial needs, and ostomy-related stigma. Future work should develop systematic approaches to multidisciplinary pediatric IBD ostomy care, bolster psychosocial support, and evaluate how systematic care may impact psychosocial, and healthcare utilization outcomes.

Remote pulmonary rehabilitation for interstitial lung disease: developing the model using experience-based codesign

BackgroundRemote delivery may improve access to pulmonary rehabilitation (PR). Existing studies are largely limited to individuals with COPD, and the interventions have lacked codesign elements to reflect the needs and...

Co-design of the Spinal Cord Injury Health Maintenance Tool to Support Self-Management: A Mixed-Methods Approach.

There is a lack of consumer-friendly tools to empower and support people living with spinal cord injury (SCI) to self-manage complex health needs in community. This article describes the co-design process of the new SCI Health Maintenance Tool (SCI-HMT). Co-design of the SCI-HMT using a mixed-methods approach included a rapid review, e-Delphi surveys with range of multidisciplinary health care professionals (n = 62), interviews of participants with SCI (n = 18) and general practitioners (n = 4), focus groups (n = 3 with 7, 4, and 4 participants with SCI, respectively), design workshops with stakeholders (n = 11, 8), and end-user testing (n = 41). The SCI-HMT (healthmaintenancetool.com) was developed based on participatory research with data synthesis from multiple sources. Five priority health maintenance issues for bladder, bowel, skin, pain, and autonomic dysreflexia were originally covered. Best practice recommendations, red flag conditions, referrals, and clinical pathways were agreed on through an e-Delphi technique. Qualitative analysis identified six broad key concepts for self-management, including early symptom recognition, role of SCI peers, knowledge sharing with primary care, general practitioners as gatekeepers, and shared decision-making and highlighted a need to place much stronger emphasis on mental health and well-being. Design workshops and end-user testing provided key insights about user experience, functionality, and content for the SCI-HMT. The co-design process engaging end users, including people with SCI and general practitioners, enabled a shared understanding of the problem and identification of important needs and how to meet them. Informed by this process, the SCI-HMT is a freely accessible resource supporting SCI self-management, shared decision-making, and early problem identification.

A Survey on Environmental Sustainability Among Anesthesiologists: An Opportunity for Changing Behaviors.

Introduction Environmental sustainability (ES) is a current issue related to natural resource scarcity, pollution and climate change. Although operating rooms (ORs) comprise a small proportion of the entire hospital infrastructure, they significantly impact the environment. Anesthesiologists are ideally positioned to assume leadership, mitigating this negative impact regarding OR waste in the environment. We created a Green Team, comprising multidisciplinary professionals from different areas of a tertiary Portuguese medical center, and conducted a survey that was sent to all the institution's anesthesiologists to assess the current state of ES. Results From the sample of 133 participants, 101 responses were obtained. Concerning knowledge and training on ES, a significant portion of the respondents (66.7%) seem to attribute "great importance" to the subject. As to the greatest barrier to waste separation in the OR, several respondents highlighted the issues of "inadequate information/education/training" (62.6%) and "lack of support from hospital/OR in-chief/administration" (26.3%). Finally, among seven methods to raise awareness of ES, "training during residency" was the top choice for these professionals, with 52.5% of the votes. Discussion Most anesthesiologists who responded to the survey recognize the utmost importance of ES and have perceived the environmental impact of their anesthetic practices in the OR. Overall, this tendency is consistent with other international studies. Moreover, most of those surveyed separate waste at home and want to extend this practice -in a more structured approach- to their workplace, with an effective separation of anesthetic and general waste in the OR. Conclusion Professionals perceive barriers to performing green practices, whether the lack of environmental education and awareness, the absence of recycling containers or waste separation bags, or the lack of protocols and guidelines implementing these circuits. With the publication of this work, we aim to encourage other institutions to implement ES projects in their hospitals and ORs.

Role of occupational therapy in person-centred dementia care: Exploring family member and clinician perceptions.

This study aimed to explore the role of occupational therapy in dementia facilities using a person-centred model of care, from the perspective of family members, occupational therapists and multidisciplinary health professionals. A descriptive qualitative approach was adopted, and all data were evaluated using thematic analysis. Semi-structured interviews were completed with eight family members and five multidisciplinary health professionals. Four occupational therapists practising in dementia care also provided qualitative data via an online survey. The analysis identified two key themes around perceptions of occupational therapy in person-centred dementia care. These themes were (1) the poorly defined scope of the occupational therapy role and (2) the perceived features of the occupational therapy role. While the perceptions and experiences of participants varied, the scope of this role is currently poorly defined. Occupational therapists in this setting commonly facilitate positive social interaction and present-oriented occupational engagement with residents and are also recognised as building workforce capacity with multidisciplinary colleagues. Without a clearly defined scope of practice, the role of occupational therapy in enabling health and well-being for people with dementia cannot be coherently articulated. This could lead to underutilisation of occupational therapy services, and lost opportunities for residents to experience improved health and well-being.

PROCare4Life integrated care model validation

This article focuses on reporting the methodology and results of the EU funded project PROCare4Life, whose main goal has been to develop an integrated, personalised, IT system, to empower and improve the Quality of Life of elderly people living with Parkinsons’, Alzheimer’s or other dementia. Research has been implemented to evaluate the results against PROCare4Life integrated care strategy. Multimethod, quantitative, and qualitative research has been performed, profiting from the pilot 3 results gathered by consortium members. The article has been organised according to the research questions, which were based on the expected results by PROCare4Life that might relate to supporting the future integration of care when the system is further developed and integrated into healthcare provision organisations. The PROCare4Life system is a digital tool that includes features that might support the advance of the integration of care, such as data sharing among multidisciplinary healthcare professionals and with patients and caregivers, the enhancement of direct communication among them or the constant sharing of the data monitored by the PROCare4Life system. TRL 7 was achieved by the final prototype of the PROCare4Life system. Pilot representatives consider the PROCare4Life idea and underlying model of care very innovative and promising, and believe it can certainly improve care practice through more enhanced integrated care. It is usable for people of different ages, conditions, socioeconomic levels. It has been assessed to be more effective for elderly people living with Parkinson’s than with dementia. Patients and caregivers indicated that the system helped them reduce their anxiety and increase their quality of life. Although overall assessment of the system by healthcare professionals was positive, divided opinions were shared on its capability to save time. Requirements for future scalability have been included in the last section.