Multidisciplinary Project Research Articles

‘Tabs versus Jabs’ time and motion study involving experiential learning student pharmacists: how long to prepare intravenous versus oral antibiotics?

Abstract Introduction Approximately one-third of inpatients in Scotland are prescribed antibiotics1. Patients prescribed IV antibiotics should be reviewed regularly and switched to oral therapy when clinically appropriate. Optimising IV to oral switch (IVOST) is often perceived as challenging2 and risks associated with IV access and patient comfort benefits to IVOST are well known. Workforce time required to administer IV medicines compared to oral equivalents is rarely considered in the risk-benefit assessment to IVOST2. To quantify this difference, a medicines administration time and motion study was undertaken. Aim To conduct a time and motion study to explore antibiotic administration in NHS Lanarkshire (NHSL) district general hospitals: University Hospitals Hairmyres, Wishaw, and Monklands. Objectives To measure time taken by nursing staff to prepare and administer IV/oral antibiotics. To explore potential nursing time saved if IVOST. To make recommendations to NHSL’s Antimicrobial Management Committee on inpatient antibiotic use. To involve final year Student Pharmacists in a multidisciplinary (MDT) project during placement. Methods Data were collected by Student Pharmacists on Antimicrobial/Surgical Experiential Learning (EL) placements as a novel approach to specialist EL. Data were collected during midday medication rounds in a surgical ward at each hospital. Nurses were observed administering antibiotics and the time taken recorded included medicine preparation; patient identification; assessment of peripheral venous catheter; and gathering IV equipment. The timer stopped when medication was administered to the patient. IV infusion duration was not included. Data were recorded in an Excel spreadsheet in HH:MM:SS. This study did not require review by an NHS Research Ethics Committee under the updated Governance Arrangements for Research Ethics Committees (GAfREC) 2020 Edition; although local permission was sought from service leads. Results Mean nursing time to prepare IV antibiotic administration was 11 minutes 55 seconds (n=20). Mean nursing time for oral administration was 1 minute 59 seconds (n=10). Nursing staff take 6 times longer to prepare IV compared to oral antibiotics for patient administration. Potential nursing time saved per individual IVOST is approximately 10 minutes. Discussion/Conclusion Results suggest IVOST would reduce nursing time involved in medicines administration, with IVOST for one patient taking antibiotics three times daily potentially saving 30 minutes of nursing time alone. Some antibiotics have excellent oral bioavailability and this project highlights the need to educate clinical teams on selecting oral route for high bioavailability antibiotics when safe and clinically appropriate. Student pharmacists observed that nurses managed multiple interruptions and spent time looking for IV equipment, commenting that IV antibiotics produced more waste (single use plastics, syringes, packaging). Student pharmacists had a better understanding of medicines administration and nursing roles following involvement in the study. Limitations Small sample size, time constraints, data did not include infusion durations or administrations outside drug rounds. Benefits of IVOST are well known and the results of this study are comparable to similar studies in the UK. NHSL’s Antimicrobial Team are disseminating key information from this study in line with local and national guidelines. Student Pharmacists effectively contributed to a novel EL placement project and this improved their understanding of nursing roles within the MDT.

The development of critical thinking, team working, and communication skills in a Business School – a Project-Based Learning approach

This study presents a Project-Based Learning (PBL) approach – the Multidisciplinary Project I course (MPI) - conceived to improve critical thinking skills of first-year business students while also mobilising teamwork and communication skills. The main goals are to 1) describe the methodological PBL approach of MPI and 2) analyse changes in critical thinking, team working, and communication skills during the semester (pre- and post-test) by comparing management and economics students enrolled in MP1 (n = 946) to a control group (n = 210) including students from other courses. Our findings show that, at the end of the semester, MPI students reported a greater reduction in their critical thinking difficulties and communication apprehension and improvements in teamwork skills. This study provides evidence supporting the inclusion of PBL approaches to promote skills in business students that can be transferable to real-world settings.

Environmentally sustainable health and social care – A proposal for goals and steering for Finland

Abstract Issue Health and social services cause significant environmental impacts. In Finland, national steering towards environmentally sustainable health and social care has been lacking. Description of the problem A multidisciplinary research project (EKO SOTE 2022-2023) was designed to investigate aims and steering mechanisms for environmentally sustainable social and health care in Finland. The project aimed to propose national steering and monitoring mechanisms for stronger environmental sustainability within the sector. Data for the proposal was collected from literature, review of national legislation, interviews, surveys, and co-development events. The project also aimed to calculate the carbon footprint of Finnish health and social care with the EEIO model ENVIMAT. Results It was estimated that health and social care contributed to 6.5% of Finland’s national carbon footprint in 2019, of which the share of health care was 4.2%. The new goal ‘Social and health care is carbon neutral and minimizes the environmental burden by 2035’ was proposed to be incorporated in the national strategic steering. Wellbeing service counties (WSC) as public care providers were suggested to be included as responsible actors in the Finnish Climate Act. National networks and targeted project funding for WSCs were found important. Three sets of indicators were designed for monitoring environmental sustainability: minimum indicators for all WSCs for national monitoring, voluntary indicators for regional monitoring, and indicators for advanced regions to pioneer best practices. Lessons According to the informants, national steering for environmentally sustainable health and social care is urgently needed. The national goal should be ambitious, wide-ranging, and feasible, and cover environmental aspects broadly. The steering requires multiple mechanisms: normative, strategic, informational, and economic. WSCs should be empowered to develop suitable means to achieve the national goal. Key messages • The project provided an ambitious, feasible, and comprehensive national goal and steering model for reducing the environmental impact of health and social care in Finland. • Collaborative efforts and joint steering model could advance environmental sustainability in health and social care.

UROLATAM Project: A multidisciplinary comprehensive care project for prostate cancer

Abstract Introduction Prostate Cancer (PCa) represents a health problem in the world and its management is heterogeneous in care, depending on the resources each country has, modifying its effectiveness in prevention, diagnosis, treatment and follow-up. Methods The UROLATAM program was implemented based on the Design Thinking quadruple helix innovation model, consisting of the immersion, design, idea and prototype phases, characterized by being multidisciplinary and comprehensive. Teachers and students from different careers at the Universidad Veracruzana participated. Linkages were made with: Local government, government health institutions, colleges of specialist doctors, private institutions and civil society. This program was broadcast on radio, television and social networks inviting the population to participate in education and prevention activities, in addition to participating in diagnosis, treatment and follow-up actions for men over 40 years of age. The duration of the program was 4 days, including educational sessions for doctors, patients, family members and caregivers, as well as determination of prostate-specific antigen, urological consultation and prostate ultrasound, as well as rehabilitation exercises, diagnostic confirmation and treatment. who needed it. Results During the sessions, 944 patients aged 60.7 (±15.0) years were treated, 443 (47%) had never received a urological consultation, identifying a prevalence of 11.7% of Cap. The human team present with the patient was 25 specialist doctors, 16 medical residents, 38 undergraduate students, 3 rehabilitators and 6 administrative staff. None of the participants received a salary for participating in this project. Conclusions The multidisciplinary UROLATAM linkage project constitutes a useful educational, training and assistance tool for the population, as well as an educational element for the students who are part of the work team. Key messages • The UROLATAM project is replicable in countries that require additional support in the prostate cancer approach. • The structure of the UROLATAM project can be replicated to address other public health problems.

5.X.2. Improving indoor air quality: a public health challenge

Abstract Indoor air quality (IAQ) may have a profound effect on a person’s physical and mental health and well-being. The Knowledge for Indoor Air Quality and Health (K-HEALTHinAIR) project (grant no 101057693) is an interdisciplinary European research project that brings together 15 partners across 8 countries to study the sources, determinants and health outcomes related to IAQ. We aim to increase knowledge and provide input for more accurate monitoring and interventions, promoting healthy indoor air quality across several public health settings. The main aim of this workshop is to engage the public health community in the relevance of IAQ as a public health concern. We will share the innovative and new methodologies applied in the K-HEALTHinAIR project to study IAQ and health and discuss opportunities as well as challenges in this field of research to support shared learning. This workshop highlights IAQ pollutant sources and determinants, seasonal variation in IAQ, older people’s IAQ and health, and presents the project’s open access platform that is developed to share knowledge. We will zoom in on the evidence available for the sources and determinants of exposure to indoor air pollutants. This activity, a systematic review, was fundamental to identify the gaps of knowledge and guide the preparation of data collection tools. It also depicts the main pollutants present in indoor settings and the respective sources and determinants of exposure. Then, one of the 9 public health scenarios studied in the project is presented. We will focus on the first results regarding (determinants of) IAQ variation in primary schools at several locations in Poland. Next, the pilot study in older people living in senior homes in the Netherlands presents first findings of IAQ and health data in this vulnerable population. Finally, the project will deliver an open-access platform aiming to be the one-stop-shop for IAQ Knowledge. The user-profiles identified are presented. At the end, the workshop participants will be up to date on the project’s activities, its relevance for public health and the open access platform via which all output will be shared. Participants will leave with increased understanding of public health research needed to further study IAQ and its impact on health and well-being. Key messages • Indoor air quality is a public health concern impacting health and well-being, especially in vulnerable populations such as children and older people. • The K-HEALTHinAIR project is a multidisciplinary research project in which innovative methodologies are applied to increase knowledge on indoor air quality and health.

Career Guidance and Employment Issues for Neurodivergent Individuals: A Scoping Review and Stakeholder Consultation

ABSTRACTGrowing recognition of neurodivergence amongst individuals poses challenges for career counselors and human resource practitioners when advising, guiding, and supporting the careers of this diverse group. Despite the potential for neurodivergent individuals to contribute to organizations, career guidance for these individuals is a relatively new area. We conducted a multidisciplinary project comprising a scoping review and stakeholder consultation to generate evidence‐based recommendations for identifying and supporting career paths that lead to positive employment outcomes for neurodivergent individuals. The scoping review included 78 articles on career guidance and associated employment issues (e.g., facilitators and barriers to employment) for neurodivergent individuals, while stakeholders, including neurodivergent individuals, counselors, and others, provided insights into their employment experiences. Our scoping review yielded nine themes: career guidance practice, predictors of employment, employment interventions, different forms of employment, work barriers and facilitators, strengths and challenges, person‐job fit, occupation and industry fit, and employment outcomes. The stakeholder consultations complemented the scholarly themes. Results were interpreted using the Stone and Colella theoretical model of factors influencing the treatment of people with disabilities. The model was extended across educational and work contexts, and to include the nature of occupations and industries. Building on this project and our overarching theoretical model, we map a future research agenda for the study of careers amongst neurodivergent individuals. Specifically, we highlight persistent methodological limitations of the literature before turning to theoretical implications across career stages. We conclude with practical implications for career counselors and human resource practitioners. Ultimately, our review calls for researchers and practitioners to help promote sustainable, high‐quality, and fulfilling careers for neurodivergent individuals.

MUDA: dynamic geophysical and geochemical MUltiparametric DAtabase

Abstract. In this paper, the new dynamic geophysical and geochemical MUltiparametric DAtabase (MUDA) is presented. MUDA is a new infrastructure of the National Institute of Geophysics and Volcanology (INGV), published online in December 2023, with the aim of archiving and disseminating multiparametric data collected by multidisciplinary monitoring networks. MUDA is a MySQL relational database with a web interface developed in PHP, aimed at investigating possible correlations between seismic phenomena and variations in endogenous and environmental parameters in quasi real time. At present, MUDA collects data from different types of sensors such as hydrogeochemical probes for physical–chemical parameters in waters, meteorological stations, detectors of air radon concentration, diffusive flux of carbon dioxide (CO2) and seismometers belonging both to the National Seismic Network of INGV and to temporary networks installed in the framework of multidisciplinary research projects. MUDA publishes data daily, updated to the previous day, and offers the chance to view and download multiparametric time series selected for different time periods. The resultant dataset provides broad perspectives in the framework of future high-frequency and continuous multiparametric monitoring as a starting point to identify possible seismic precursors for short-term earthquake forecasting. MUDA can be accessed at https://doi.org/10.13127/muda (Massa et al., 2023).

Empowering computing students through multidisciplinary project based learning (PBL): Creating meaningful differences in the real world

Project-based learning (PBL) has become essential in bridging the gap between theoretical education and the practical skills required by modern industries, especially in computing and multidisciplinary fields. This study employs a mixed-methods approach, using the 'Instructional Materials Motivation Survey' (IMMS) and the Kirkpatrick model, to evaluate PBL's effectiveness in enhancing key competencies such as problem-solving, practical application, time management, and confidence. The findings demonstrate that PBL significantly improves these skills, preparing students for professional environments. However, challenges such as managing project timelines, enhancing workflow strategies, and integrating domain-specific knowledge are highlighted as areas needing attention. This study aims to refine PBL practices, making them more effective in aligning education with industry demands. The insights from this research contribute to the ongoing development of educational strategies that better prepare students for the complexities of the modern workforce.

Facial trauma education in radiology: using surgeon feedback as the benchmark for success.

Interpreting CT studies of facial trauma is challenging, and there are often substantial differences in the characterization of complex facial trauma between radiologists and surgeons. We designed a collaborative multidisciplinary project to reconcile differences in facial fracture interpretation through an educational intervention. The effectiveness of this intervention was evaluated through surgeon feedback on radiology reports. Radiology residents, neuroradiology fellows, and neuroradiology attendings were recruited as participants at a single tertiary care academic center. Otolaryngology residents were recruited as evaluators. Participants completed surveys and provided preliminary reports for example cases of facial trauma before and after attending an educational session. Evaluators performed a blinded review of these preliminary reports based on ideal reports developed by surgical and neuroradiology attendings. 26 participants (20 residents, 1 neuroradiology fellow, 5 neuroradiology attendings) completed the study. Six otolaryngology residents participated as evaluators. To assess interrater reliability, three evaluators graded a shared set of 15 reports and demonstrated substantial agreement with a Kendall's W of 0.71. Participants demonstrated significant improvement in overall report accuracy, clarity, and organization. In subunit analysis, there were significant improvements in reporting Le Fort, nasoseptal, and nasoorbitoethmoid fractures. No significant improvements occurred in the reporting of upper face, zygomaticomaxillary complex, or mandibular fractures. In contrast, survey analysis demonstrated significantly improved confidence in interpreting trauma involving all facial subunits. Compared with survey results, surgeon assessment of radiology reports better demonstrated areas of improvement after an educational intervention. A multidisciplinary approach to assessing educational efforts may better evaluate the practical effectiveness of educational interventions.

Investigating Heritage and Climate Change in the Coastal and Maritime Environments of Wales and Ireland: A Guide to the CHERISH Toolkit

Abstract In March 2023 the EU-funded CHERISH project published its free user-guide and methodology for investigating heritage and climate change in the coastal and maritime environment (Barker and Corns 2023). This paper provides an overview of the publication, specifically the CHERISH toolkit – the 15 approaches employed by the multi-disciplinary project to investigate at-risk heritage sites in Wales and Ireland. Using the eroding coastal hillfort of Dinas Dinlle in Wales as a case study, the toolkit which combines air, land and sea-based investigation techniques is highlighted. This article will assist users going forward in identifying relevant approaches to the study of their own at-risk sites. It is relevant to a wide-ranging audience anywhere in the world, taking into consideration a variety of requirements such as the environment, budget, and outputs.

Bioarchaeological analysis of human skeletal remains associated with the wrecking of the retourschip “Batavia”, 1629: burials BIB 11–14

The voyage and subsequent mutiny associated with the wrecking of the VOC retourschip “Batavia” (1629) in the Houtman Abrolhos, off the western coast of Australia, represents one of the earliest documented European encounters with Australia. Much of our understanding of events surrounding the mutiny is detailed in a rich historical record, supplemented in the modern period with targeted archaeological research. Most recently, a large-scale multidisciplinary project, ‘Shipwrecks of the Roaring Forties’ (2014–2019), resulted in the archaeological excavation and analysis of a further 11 individuals on Beacon Island, long dubbed ‘Batavia’s Graveyard’, where the survivors of the wrecking spent several months trying to survive. The latter work brings the total number of individuals recovered from Beacon Island to 21. The present paper considers research undertaken on Beacon Island between 2015 and 2018, specific to the archaeological excavation and analysis of four individuals, designated BIB-11 to BIB-14. These burials represent the first discovery of human remains on the Island through archaeological investigations and for which their burial context and physical integrity had not been compromised by prior human actions, intentional or otherwise. The archaeological and biological anthropological interpretation of these individuals and their burial context, relative to the other sites excavated on the Island, facilitates new and significant insight into these people and the events surrounding their untimely demise on Beacon Island in the early seventeenth century.

Empowering healthcare education: A multilingual ontology for medical informatics and digital health (MIMO) integrated to artificial intelligence powered training in smart hospitals.

Objective: A comprehensive understanding of professional and technical terms is essential to achieving practical results in multidisciplinary projects dealing with health informatics and digital health. The medical informatics multilingual ontology (MIMO) initiative has been created through international cooperation. MIMO is continuously updated and comprises over 3700 concepts in 37 languages on the Health Terminology/Ontology Portal (HeTOP). Methods: We conducted case studies to assess the feasibility and impact of integrating MIMO into real-world healthcare projects. In HosmartAI, MIMO is used to index technological tools in a dedicated marketplace and improve partners' communication. Then, in SaNuRN, MIMO supports the development of a "Catalog and Index of Digital Health Teaching Resources" (CIDHR) backing digital health resources retrieval for health and allied health students. Results: In HosmartAI, MIMO facilitates the indexation of technological tools and smooths partners' interactions. In SaNuRN within CIDHR, MIMO ensures that students and practitioners access up-to-date, multilingual, and high-quality resources to enhance their learning endeavors. Conclusion: Integrating MIMO into training in smart hospital projects allows healthcare students and experts worldwide with different mother tongues and knowledge to tackle challenges facing the health informatics and digital health landscape to find innovative solutions improving initial and continuous education.

Assessment of cone beam computed tomography use in pediatric and adolescent patients: a cross-sectional study

BackgroundThe use of cone beam computed tomography (CBCT) for dentomaxillofacial diagnostics in pediatric dentistry is expanding and concerns have been raised about the radiation risks associated with this imaging modality, especially for children. Dentomaxillofacial paediatric imaging: an investigation towards low-dose radiation induced risks (DIMITRA) is a multidisciplinary project focused on optimizing CBCT exposure for children and adolescents. This study aims to clarify the indications behind CBCT scans in children aligned with DIMITRA’s recommendations.MethodsFor each CBCT examination, data were collected on patient age at the time of the CBCT examination, gender, reason for request, referring department, CBCT-requested region, and the field of view (FOV) dimension of imaging. The CBCT indications were categorized under six headings according to an adaptation of the DIMITRA project recommendations: impacted teeth, dentoalveolar trauma, orofacial clefts, dental anomalies, bone pathology, syndromes. Indications not categorized in DIMITRA were recorded below the heading “other”.ResultsThe most common indication was the “other” category (34.8%), which included implant, temporomandibular joint dysfunction, orofacial anomalies, foreign object and root canal morphology. The least common indication was “orofacial cleft” (1.9%) and no requests were made for cases related to syndromes. Detection of supernumerary tooth in dental anomalies (68.6%) was the most common CBCT indication, while dentigerous cysts (37.6%) were among the most common CBCT indication in bone pathologies and orofacial anomalies (68.1%) in the other category. The most common size was External Center (15 × 15 cm) (27%) and the least common size was Both Arches/small (8 × 8 cm) (0.4%) when the CBCT FOV was analysed.ConclusionsAlthough the option of a smaller FOV size was available, the larger FOV size that included the both jaws were most frequently used. When justifying CBCT requests, patient-specific radiation dose risks should be considered and specific guidelines should be followed.

Feasibility study on virtual reality-based training for skin cancer screening: Bridging the gap in dermatological education

AbstractDespite growing interest in the inclusion of virtual reality (VR) in medical education, its full potential for immersive and interactive training remains underutilized, particularly in dermatology. As part of a multidisciplinary project, we tested the feasibility of integrating a VR training scenario for a complete skin cancer screening into the curriculum with 58 medical students. The evaluation focused on simulation usability, cognitive task load, immersion, change in perceived competence, suitability, and cybersickness using established and adapted questionnaires. Participants reported rather high levels of system usability and immersion and medium cognitive task load. Self-assessed competence in performing a skin cancer screening increased significantly after the training simulation.Prior skin cancer screening experience correlated positively with self-assessed competence and theoretical knowledge, which themselves were neither related to gender nor age. Age correlated negatively with perceived usability and immersion, enjoyment of learning during the simulation and assessed appropriateness of the simulation to learn a dermatological full-body examination while being positively correlated with perceived cybersickness. Gender was significantly associated with the need for technical help during the simulation and openness to new technologies.As a blueprint of a feasibility evaluation, this study can contribute to further refinement of the presented and relatable VR applications in medical curricula.

P.041: Switching from ciclosporin to tacrolimus as de novo calcineurin inhibitor in lung transplantation: First results of a multidisciplinary quality assurance project.

P.041: Switching from ciclosporin to tacrolimus as de novo calcineurin inhibitor in lung transplantation: First results of a multidisciplinary quality assurance project.

THE SOFT SCHOOL MANAGEMENT METHODOLOGY

The article presents the distinctive features of school management, justifies the necessity of reviewing school management approaches and reveals the trends and possibilities of its development at the current stage. It defines the concepts of “flexible methodology”, “soft skill”, “soft competence”, “intelligent quotient”, “vital energy quotient”. It also characterizes soft skills from the point of view of communicative competence, compares the cognitive, communicative and emotional aspects of the formation and development of soft skills and emphasizes the role of flexible skills formation from the perspectives of individualization of learning and the development of individual educational tracs, justifies the role of using soft strategies in the context of the application of multi-disciplinary educational projects, reveales the concept of “school is an organization or enterprise of learners” to increase the independence of the school, the independence of the teacher, the student from the aspects of formation and development. It presents the novelty as a result of the discussion of the mentioned and other key issues, which is justified by the complex application of fsoft skills of education, teaching and upbringing, the observation of soft skills and competencies in the cognitive, communicative and emotional spheres, the discovery of the connection between emotional intelligence, mental abilities and vital energy, “the school of students is an enterprise” with the need to apply the concept.

Multidisciplinary Reliability Design Optimization Modeling Based on SysML

Model-Based Systems Engineering (MBSE) supports the system-level design of complex products effectively. Currently, system design and optimization for complex products are two distinct processes that must be executed using different software or platforms, involving intricate data conversion processes. Applying multidisciplinary optimization to validate system optimization often necessitates remodeling the optimization objects, which is time-consuming, labor-intensive, and highly error-prone. A critical activity in systems engineering is identifying the optimal design solution for the entire system. Multidisciplinary Design Optimization (MDO) and reliability analysis are essential methods for achieving this. This paper proposes a SysML-based multidisciplinary reliability design optimization modeling method. First, by analyzing the definitions and mathematical models of multidisciplinary reliability design optimization, the SysML extension mechanism is employed to represent the optimization model based on SysML. Next, model transformation techniques are used to convert the SysML optimization model generated in the first stage into an XML description model readable by optimization solvers. Finally, the proposed method’s effectiveness is validated through an engineering case study of an in-vehicle environmental control integration system. The results demonstrate that this method fully utilizes SysML to express MDO problems, enhancing the efficiency of design optimization for complex systems. Engineers and system designers working on complex, multidisciplinary projects can particularly benefit from these advancements, as they simplify the integration of design and optimization processes, facilitating more reliable and efficient product development.

Collaborating with non-radiological clinical colleagues.

Paediatric radiology is a challenging and intriguing subspecialty, dealing with children, guardians and non-radiological clinical colleagues. Paediatric radiologists are routinely in contact with numerous paediatric and surgical subspecialties, all having different needs, perceptions, prioritisations and expectations. Moreover, the radiologist is part of the team of radiographers, sonographers, nurses and secretaries, assisted by appropriate equipment and electronic tools. The framework of good collaboration to ensure safety and effectiveness for the imaged child is a shared responsibility among all medical practitioners involved. Communication in routine practice has many forms and includes appropriately filled radiology requests in accordance to the patient's medical records, routine and timely production of structured, problem-solving radiology reports, face-to-face or electronic-assisted communications and discussions on a pre-defined framework, mutually-agreed and evidence-based protocols adjusted to local availability, skills and national and international guidelines. Mutual understanding of advantages and limitations of imaging is paramount. Well-meant discussions, professionalism and empathy should promote soft skills, bidirectional communication and good collaboration for the benefit of added-value paediatric radiology. International societies, health authorities, medical directors and senior consultants have the responsibility to suggest and safeguard frameworks and recommendations. Regular multidisciplinary meetings and multidisciplinary research projects under openness, honesty and transparency are pathways favouring good collaboration.

Avoiding Unintended Consequences of Pediatric Blood Order Set Updates through In Situ Usability Testing.

Blood product ordering is a complex process and mistakes can harm patients and lead to poor outcomes. Orders and order sets can be designed to help mitigate errors, but major changes in design can unintentionally cause new errors. Our objective was as follows: (1) utilize formative in situ usability testing to iteratively improve the design of a redesigned blood product order set prior to go-live, (2) implement changes based on feedback derived from this testing, and (3) compare the error rate, system usability scale (SUS) score, time to task completion, and click counts between the prior order set in use at the time and the revised redesigned order set. A multidisciplinary project team convened to redesign blood product orders and order sets from scratch based on a review of the literature and benchmarking against four pediatric academic institutions with the goal of addressing prior ordering errors. The newly redesigned blood product order set was iteratively updated via in situ formative usability testing performed with available clinical users using a concurrent think-aloud protocol in real clinical environments. Errors, SUS scores, time to task completion, and click counts were assessed for the revised redesigned order set using summative testing. Formative usability testing with 20 participants led to seven design changes in the redesigned order set which reduced the error rate at go-live. Summative usability testing showed that even though the usability scores were only slightly improved for the revised redesigned order set, the error rates in blood orders were significantly decreased. Usability testing can identify design errors early in the process which can be rectified prior to implementation, thus avoiding unintended consequences of changes.

Development of a research agenda for medical grade footwear in the Netherlands: A multidisciplinary multiphase project to determine the key research questions to advance scientific knowledge in the field.

The field of medical grade footwear is dynamic. Originally, a field where individual knowledge, expertise and skills determined the footwear and its outcomes, now becoming a more evidence-based and data-driven field with protocols and systems in place to create appropriate footwear. However, scientific evidence concerning medical grade footwear is still limited. Evidently, all stakeholders, from patients to pedorthists to rehabilitation physicians, will profit from a larger evidence-base in this field. A widely supported research agenda is an essential first step to advance and facilitate new knowledge. We formed a multidisciplinary team and followed the methodology from Dutch medical societies for the development of a research agenda on medical grade footwear. This consisted of seven steps: (1) inventory of relevant questions with users and professionals; (2) analyses of responses; (3) analyses of existing knowledge and evidence; (4) formulating research questions; (5) prioritising research questions by users and professionals; (6) finalising the research agenda and (7) implementing the research agenda. In phase 1, 109 participants completed a survey, including 50% pedorthists, 6% rehabilitation physicians and 3% users. Participants provided 228 potential research questions. In phases 2-4, these were condensed to 65 research questions. In phase 5, 152 participants prioritised these 65 research questions, including 50% pedorthists, 13% rehabilitation physicians and 9% users. In phase 6, the final research agenda was created, with 26 research questions, categorised based on the International Classification of Functioning Disability and Health 'process description assistive devices'. In phase 7, an implementation meeting was held with over 50 stakeholders (including users and professionals), resulting in seven applications for research projects based on one or more research questions from the research agenda. This research agenda structures and guides knowledge development within the field of medical grade footwear in the Netherlands and elsewhere. We expect that this will help to stimulate the field to tackle the research questions prioritised and with that to advance scientific knowledge in this field.