Multidisciplinary Skills Research Articles

An Airway Rapid Response System: Implementation and Utilization in a Large Academic Trauma Center

Rapid response teams mobilize resources to patients experiencing acute deterioration. Failed airway management results in death or anoxic brain injury. A codified, systems-based approach to bring personnel and equipment to the bedside for multidisciplinary airway assessment and rescue was reflected in the initial implementation of an airway rapid response (ARR) team. A retrospective review of records of 117 ARR events in a 40-month period (August 2011-November 2014) was undertaken at the Hospital of the University of Pennsylvania, a 789-bed, academic, urban, tertiary care, Level 1 trauma center. Of the 117 ARR events, 60 (51.3%) were called in the ICU, and 43 (36.8%) in the general ward. A definitive airway was secured in all patients for whom airway management was attempted. A new surgical airway was performed in five of the patients. Seven patients went to the operating room for airway management. Nine patients died or had care withdrawn shortly after the ARR. Difficult airway emergencies represent a small but critical element of airway rescue scenarios. Before the implementation of the ARR system, the process to bring the right team, equipment, expertise, and consensus on the right actions to critical airway emergencies was ad hoc. ARR activation, which brings multidisciplinary airway consultation, expert skills, and advanced airway equipment to the bedside, contributed to definitive airway management for surgical and nonsurgical airways. Performance of a bedside emergency surgical airway was uncommon. The ARR system represents a significant enhancement of the "anesthesia stat" system that typifies the airway emergency system at many institutions.

Application of Smart FRP Devices for the Structural Health Monitoring of Heritage Buildings - A Case Study: The Monastery of Sant’Angelo d’Ocre

The preservation of heritage buildings requires multidisciplinary skills ranging from materials and seismic design up to structural monitoring.One of the most interesting innovative solution that is being developing in the last years is based on smart FRP (FRP – Fibre Reinforced Polymer) devices, which can combine contemporary reinforcing and monitoring purposes. The use of composite materials has many advantages in comparison with traditional retrofitting techniques, such as low weight, high strength-to-weight ratio, ease of handling, drapability, speed of installation, low thickness and visual impact. At the same time, monitoring the structure during its lifetime (strain, cracks, temperature, etc.) and evaluating its in-service integrity, in order to predict possible anomalous situations, can be achieved by the combination of FRP materials and embedded fibre optic sensors into a smart FRP device, suitable for both reinforcing and monitoring purposes. Optical fibres can provide reliable measurement even in harsh environment, as they are chemically durable, corrosion resistant, stable and insensitive to external electromagnetic and environmental perturbations, allowing long distances signal transmission and several measures in different points along the same optical fibre (multiplexing). Furthermore, the embedding into composite material will preserve them from rupture during handling and installation.In the present work, the application of smart FRP devices for the structural health monitoring of the Monastery in Sant’Angelo d’Ocre, L’Aquila, performed in the framework of the national project PROVACI, is reported.Six Smart Patches, consisting of FRP reinforcing sheet with point FBG (Fibre Bragg Grating) sensors embedded were applied on the extrados of two different vaults, while four Smart Rebars, consisting in FRP pultruded bars with distributed optical fibres sensors embedded, were installed in four buttress of one same vault. All the smart FRP devices, after being cabled, have been connected to the relative control units (BraggMETER from Fibersensing for FBG sensors and OBR4600 control unit of Luna Technologies for the distributed optical sensors) connected with a remote server for on-line remote monitoring.Before the installation, the Smart FRP devices have been preliminary calibrated and tested in the laboratory in terms of mechanical properties, strain sensitivity and accelerated aging.The monitoring on the Monastery has been conducted for five months, showing the reliability of entire system and of the signal transmitted by each sensor over the time.

Reducing lumbar puncture failure rates in febrile neonates with multidisciplinary practical skills teaching, early stylet removal and atraumatic needles

Reducing lumbar puncture failure rates in febrile neonates with multidisciplinary practical skills teaching, early stylet removal and atraumatic needles

Supporting Multidisciplinary Analytic Skills: An Innovative Training Platform for Capacity Building

ABSTRACTObjectivesTo serve the emerging multidisciplinary skills and capacity building needs of Population Health Researchers within a rapidly diversifying field.
 Population Health Research is inherently interdisciplinary, multifaceted and firmly rooted in the evolving connections between place, time and related socioeconomic processes. To excel in this rapidly diversifying field, individuals require a broad range of multidisciplinary skills. Supporting the development of these skills through innovative training platforms is one key way to build capacity for emerging 21 Century researchers and health professionals.
 ApproachEstablishment of an innovative research training platform that supports skill development in a timely, collaborative and practiced based environment.
 The growing importance of data analytics and spatial thinking as it pertains to the worlds growing health concerns, be they social, physical or environmental – demands approaches that serve real time and remotely accessed, exploratory and highly collaborative research environments. A case example will be provided concerning a tri-party training platform that is serving the multidisciplinary skill requirements of new and mid-career population health professionals. Designed in collaboration with a tri-university research platform, the innovative, practice-based training environment both mirrors and supports many of the day to day skill development needs of health and social science researchers.
 ResultsThe multidisciplinary focus of this specialized training platform is successfully addressing the skill development needs of a diverse cross section of health research professionals.
 Trainees are bringing a wealth of experience and knowledge to share with their online colleagues, supporting a rich, practice based education and skills development environment. Those enrolled in the program possess backgrounds ranging from Population and Public Health, Epidemiology, Statistics and Sociology to Medicine to Psychology, Geography, Biostatistics and International Health.
 ConclusionProviding timely, practical, hands-on analytic skills training is critical to building the capacity of new and mid-career researchers and health professionals.
 Direct application of these new skills is an essential outcome and best measure of success. We are listening to our trainees and learning as we grow.Read what trainees are saying about our certificate courses.https://www.popdata.bc.ca/etu/testimonials/PHDA

So, You Think You Have an Idea: A Practical Risk Reduction-Conceptual Model for Academic Translational Research.

Translational research for new drugs, medical devices, and diagnostics encompasses aspects of both basic science and clinical research, requiring multidisciplinary skills and resources that are not all readily available in either a basic laboratory or clinical setting alone. We propose that, to be successful, “translational” research ought to be understood as a defined process from basic science through manufacturing, regulatory, clinical testing all the way to market. The authors outline a process which has worked well for them to identify and commercialize academic innovation. The academic environment places a high value on novelty and less value on whether, among other things, data are reproducible, scalable, reimbursable, or have commercial freedom to operate. In other words, when investors, strategic companies, or other later stage stakeholders evaluate academic efforts at translational research the relative lack of attention to clinical, regulatory, reimbursement, and manufacturing and intellectual property freedom to operate almost universally results in more questions and doubts about the potential of the proposed product, thereby inhibiting further interest. This contrasts with industry-based R&D, which often emphasizes manufacturing, regulatory and commercial factors. Academics do not so much choose to ignore those necessary and standard elements of translation development, but rather, they are not built into the culture or incentive structure of the university environment. Acknowledging and addressing this mismatch of approach and lack of common language in a systematic way facilitates a more effective “translation” handoffs of academic project concepts into meaningful clinical solutions help translational researchers more efficiently develop and progress new and better medical products which address validated needs. The authors provide an overview and framework for academic researchers to use which will help them define the elements of a market-driven translational program (1) problem identification and validation; (2) defining the conceptual model of disease; and (3) risk evaluation and mitigation strategies.

Picture Pieces Activity: An effective Team Building Strategy

Practice of Profession requires having the ability to work in teams. This is well articulated in Graduate Attribute 9 of Washington Accord. Furthermore, engineering problem solving requires multi-disciplinary skills. This necessitates the need for engineers to be able to work in multi-disciplinary teams. The challenge for academia is to make the Future Engineers to understand the need for working in teams, with multidisciplinary skills. Projects during are an important part of engineering curriculum. These projects offer learning contexts, which enhance student learning. The challenge for academia is to make the students realize the importance of Project management which is an art of managing the project and its deliverables with a view to produce finished products or service.Accomplishing this goal requires that all team and team members work together with a common Strategy and Goal. Keeping this in mind, an activity was designed in Project Management module, in a course titled Engineering Exploration. This course is designed for freshman engineering students of undergraduate program in KLE Technological University, Hubballi. Through this activity called Picture Pieces Activity, the authors have attempted to communicate to students. 1) The need to work in team in order to successfully accomplish a given task. 2) The factors that contribute to effective team execution of a project. This paper shares the details of the activity, the experiences of authors and the learnings in doing this activity.

The Relevance of Social Sciences Teacher Education Programme in Preparing Effective Secondary School Educators

In Mauritius, the teaching of social studies presents educators with a unique set of challenges, as they are expected to have multi-disciplinary knowledge and multi-dimensional skills to be effective in classrooms. Many of these social studies educators have undertaken the PGCE (Post Graduate Certificate in Education) course offered by the Mauritius Institute of Education (MIE), which is the leading teacher training institute in the country. This paper explores the relevance of the social sciences teacher education programme offered by the MIE in preparing secondary school educators to meet the challenges in their practice in the wake of current curricular reforms. The study used focus group discussions as the main tool to gather in depth views of the participants. Preliminary findings tend to show that although educators may possess skills, lack of mastery in multi-disciplinary knowledge influences their proficiency in classrooms. An analysis of the different modules of the social sciences programme also shows a gap between the educators' needs and the modules offered.

Nurses' perceptions of the impact of Team-Based Learning participation on learning style, team behaviours and clinical performance: An exploration of written reflections.

Team-Based Learning (TBL) is a teaching strategy designed to promote problem solving, critical thinking and effective teamwork and communication skills; attributes essential for safe healthcare. The aim was to explore postgraduate student perceptions of the role of TBL in shaping learning style, team skills, and professional and clinical behaviours. An exploratory descriptive approach was selected. Critical care students were invited to provide consent for the use for research purposes of written reflections submitted for course work requirements. Reflections of whether and how TBL influenced their learning style, teamwork skills and professional behaviours during classroom learning and clinical practice were analysed for content and themes. Of 174 students, 159 participated. Analysis revealed three themes: Deep Learning, the adaptations students made to their learning that resulted in mastery of specialist knowledge; Confidence, in knowledge, problem solving and rationales for practice decisions; and Professional and Clinical Behaviours, including positive changes in their interactions with colleagues and patients described as patient advocacy, multidisciplinary communication skills and peer mentorship. TBL facilitated a virtuous cycle of feedback encouraging deep learning that increased confidence. Increased confidence improved deep learning that, in turn, led to the development of professional and clinical behaviours characteristic of high quality practice.

A bibliometric and classification study of Project-based Learning in Engineering Education

Abstract Engineering education has been the subject of studies in search of approaches that provide better results in terms of learning. The Project Based Learning approach (PBL) is the subject of this study from the point of view of its application in Engineering. The objective is to present a classification and bibliometric analysis of PBL in Engineering. Publications on the subject were identified through queries at the journal databases at ISI Web of Science and Scopus SCImago between 2000 and 2016. The results highlight the benefits from the use of the PBL approach to learning in Engineering showing increased absorption of technical content by students and the development of soft and multi-disciplinary skills. The bibliometric analysis revealed the most relevant journals in the subject, authors and the most cited papers and keywords. New horizons to advance the use of PBL in engineering education are discussed.

A Novel Wearable Apparatus to Measure Fingertip Forces in Manipulation Tasks Based on MEMS Barometric Sensors.

Artificial tactile sensing is a challenging research topic in robotics, motor control, and rehabilitation engineering encompassing multi-disciplinary skills and different technologies. This paper presents the development of a wearable tactile thimble system using MEMS barometric sensors and flexible printed circuit board. Barometric sensors were carefully processed to make them able to transduce contact forces. Thumb, index, and medium fingers were equipped with an array of six sensing elements each, covering the central, lateral, and medial aspects of the fingertip. The sensor integration, signal read-out and processing, hardware architecture of the device, along with the calibration protocol, were described. The test results showed adequate sensitivity at very low forces with an almost linear transduction range up to about 4N (RMSE: 0.04N). Tests on object manipulation tasks highlighted the value of the proposed system demonstrating the ability of measuring both the force amplitude and contact points, demonstrating the suitability of barometric sensors for tactile applications.

A way forward: Process mapping and the delivery of mental health services

Introduction: This paper demonstrates the practical application of process mapping principles as a model for evaluating NHS improvement. The NHS improvement in question was the merger of three crisis resolution teams within an NHS trust in 2012. The aims were to improve overall operational efficiency and enhance multidisciplinary working to meet operational targets. This paper examined changes following the merger to capture the effects of service improvement and the reality of the patient journey. Methods: A pooled cross-sectional approach, using six years of aggregated hospital data, was taken. To achieve operational efficiency, a process map of referrals, readmissions, length of stay and waiting times for crisis resolution team assessments was examined. Prevalence of clinical referral rates and disease classification before and after the merger were compared. Conclusion: Between 1 April 2009 and 30 March 2015, length of stay and readmissions for patients to crisis resolution team rates reduced. Operational sustainability and capacity was enhanced through the redistribution of clinical human resources. Multidisciplinary skill mix (e.g. through improved team composition) also improved.

Can voicing conflict within experiential learning groups facilitate connection? building and developing effective multi-disciplinary team-working skills

In the UK, Clinical Psychologists (CPs) work in a variety of settings within the National Health Service (NHS), often within Multi-Disciplinary Teams (MDTs). Problem-Based Learning (PBL) within CP training at the University of Hertfordshire (UH) offers unique opportunities to combine scientist-practitioner and reflective-practitioner models to learn about group dynamics from the personal experience of working within an experiential learning group.Further, given Trainees work three days per week on placement within MDTs in the NHS, the learning gained within a ‘safer’ PBL context can be utilised within these clinical settings. For two years, Trainees at UH have to work in small PBL groups with five or six members learning to work together to achieve a goal (four assessed presentations) negotiating their own personal and professional journey, as well as a group journey. Consequently, PBL offers trainees opportunities to learn (1) how individuals work within a group; (2) how personal experiences influence this process; (3) how others influence them and are influenced by them; and (4) how a group of diverse individuals conceptualise, understand and convey case vignettes to an audience. Within these groups, many Trainees learn to speak out, reflect, listen attentively, empathise, validate and accept diverse experiences. Further, when differences dominate they often learn to negotiate these, finding a way to maintain effective team working in order to complete the presentation. Focusing on the conflict that can occur within (any) group, this paper explores themes from the reflective narratives of six trainees: parallels and differences between MDTs and PBL groups, striving for and achieving authenticity; and conflict as a ‘swear’ word. We conclude that exploring the role PBL can play in training individuals to work effectively in teams may be of benefit within the training of other professional groups.

Image-guided transoral approach in severe craniovertebral junction malformations at the golden age of endoscopy: Regarding 2 cases

IntroductionThe image-guided transoral approach (IGTOA) provides a safe exposure to skull base midline lesions and the ventral aspect of the craniovertebral junction (CVJ). The IGTOA has several advantages: the head being placed in the extended position, it decreases the brainstem angulation during surgery; the approach being done through the avascular median pharyngeal raphe, not only lowers the bleeding risk but also provides a direct access to the bony pathology and granulation tissue accessible only via the ventral route. Wide field exposure and maneuverability are necessary to deal with the entire ventral brainstem compression in case of severe CVJ malformation to safely perform partial clivectomy and odontoidectomy. Presentation of two casesWe illustrate the cases of two patients, 52-year-old and 42-year-old males, who presented with an impressive craniovertebral junction malformation, confirmed on CT and MRI images. They first underwent surgery by IGTOA, later completed by occipitocervical fixation. For the two patients, outcomes were assessed respectively at 4 and 5 years and showed satisfactory results both clinically and radiologically. ConclusionIn patients with marked ventral compression, the IGTOA provides direct and guided access to the anterior aspect of the CVJ and effective means for odontoidectomy and clivectomy. This approach is more easily maneuverable compared to the endonasal endoscopic approach. The IGTOA approach is quite a complex technique, requiring multidisciplinary skills, but it should primarily be used in difficult situations. We suggest that endonasal endoscopy is over-utilized. We consider that endoscopy should not be routinely performed and kept only for well-selected cases.

A Master Plan for the Implementation of Sustainable Enterprise Resource Planning Systems (Part III): Evaluation of a Roadmap

An implementation of Sustainable Enterprise Resource Planning (S-ERP) systems is challenging that requires multidisciplinary skills, knowledge, and coordinated efforts of all levels in an organization. Related study in S- ERP systems had been done, however, they only highlighted on the imperative of the system and empirical analysis of the system implementation without looking into detail on how to implement this integrated system. This lack of comprehensive plan and direction to guide practitioners in implementing S-ERP system would result in increased sustainability implementation cost and time and the decline in the quality of products and services. This problem motivates the researchers to propose a master plan of the S-ERP system implementation that consists of a roadmap, a framework, and guidelines. A development of S-ERP roadmap has been underscored in the previous paper. For the next phase, the roadmap is then evaluated by using a peer review method, which is the focus of this paper. The evaluation consists of two main processes including data collection and data analysis. In this regard, twelve experts had participated in the peer review. As a result, the developed roadmap needs to be expanded into two roadmaps, namely roadmap towards sustainable enterprise and roadmap towards sustainable integrated enterprise. From the evaluation results, the experts confirmed that the proposed S-ERP implementation roadmap can generally be used for implementing the S-ERP systems in all types of industry. The roadmap could serve as a theoretical base for further research into S-ERP system research, which can give more insight into the system implementation. In addition, this roadmap could serve as a tool for practitioners in implementing S-ERP systems within organizations.

Preffered Competence Structure of University Graduates: Russian Employers‘ Point of View

Purpose of the article: The article examines preffered structure of competences from Russian employers’s point of view in order to provide universities with the knowledge on how graduates’ skills are viewed by the main customers. Methodology/methods: The article is based on factor analysis of competences which are derived from the questionnaire which was distributed to Russian enterprises (mainly meduim sized manufacturing enterprises). The questionnaires were gathered from management of the companies, and evaluated by factor analysis using varimax method. Significance of the findings is confirmed by the level of Cronbach alpha. Scientific aim: The scientific aim of the article is to define the main competences of university graduates as they are seen by employers. The paper also aims to define whether the structure of preffered competences differs alone the timeline, i.e. do employers evaluate their requirements in past, present and future differently. Findings: In the article it is revealed that preferred structure of competences university graduates should possess evolves overtime, and that employers have lower understanding of their needs and requirments for the future. Second, it appeared that the most signigicant graduates’ competences are systemic thinking and professional skills, but the other factors may only be considered moderator of these skills in future. Finally, multidisciplinary skills appear to gain significance along the timeline of the study, so employers are looking for multidisciplinary skills for the future as a response for existing high turbulence. Conclusions: The main limitations of the study are small sample and focus on mid-Russian medium enterprises, which are mainly manufacturing. The study has distinct applications to practice by defining the most significant graduates’ competences from employers’ perspective, and to theory by proposing evolution paths for competence significance.

Current training on the basics of robotic surgery in the Netherlands: Time for a multidisciplinary approach?

IntroductionThe following research questions were answered: (1) What are the training pathways followed by the current robot professionals? (2) Are there any differences between the surgical specialties in robot training and robot use? (3) What is their opinion about multidisciplinary basic skills training?MethodsAn online questionnaire was sent to 91 robot professionals in The Netherlands. The questionnaire contained 21 multiple-choice questions focusing on demographics, received robot training, and their opinion on basic skills training in robotic surgery.ResultsThe response rate was 62 % (n = 56): 13 general surgeons, 16 gynecologists, and 27 urologists. The urologists performed significantly more robotic procedures than surgeons and gynecologists. The kind of training of all professionals varied from a training program by Intuitive Surgical, master-apprenticeship with or without duo console, fellowship, and self-designed training programs. The training did neither differ significantly among the different specialties nor the year of starting robotic surgery. Majority of respondents favor an obliged training program including an examination for the basics of robot skills training.ConclusionTraining of the current robot professionals is mostly dependent on local circumstances and the manufacturer of the robot system. Training is independent of the year of start with robotic surgery and speciality. To guarantee the quality of future training of residents and fellows in robot-assisted surgery, clear training goals should be formulated and implemented. Since this study shows that current training of different specialities does not differ, training in robotic surgery could be started by a multidisciplinary basic skills training and assessment.

What is new in the surgical management and prevention of breast cancer?

Breast cancer is the most common malignancy in Australian women. As most women now survive breast cancer, improving quality-of-life outcomes is increasingly important and major changes are occurring in breast surgery to meet this challenge. Use of neoadjuvant chemotherapy results in lower mastectomy rates, broader surgical options and less surgical morbidity. Oncoplastic breast surgery (OBS) facilitates less frequent need for mastectomy, better aesthetic outcomes and improved quality of life. Immediate breast reconstruction (IBR) improves quality of life and can be considered in a large proportion of women requiring mastectomy; however, Australia's rate of IBR is low compared with similar countries. Breast cancer risk reduction can be achieved with lifestyle modifications and, in women at high risk, chemoprevention with selective oestrogen receptor modulators or aromatase inhibitors. Bilateral prophylactic mastectomy is an option for BRCA gene mutation carriers or those women otherwise established to have a high level of risk. Contralateral prophylactic mastectomy (CPM) is increasingly performed at the time of initial breast cancer management, largely driven by patient preference. However, CPM does not improve survival and has similar rates of complications as therapeutic mastectomy. It should be cautiously considered, with full discussion of risks and benefits. Breast Surgeons of Australia and New Zealand (BreastSurgANZ) coordinates training of most new breast surgeons and is fostering a broader range of multidisciplinary oncology, OBS and IBR skills in its members. The BreastSurgANZ Quality Audit monitors the quality of care provided by members. Training breast surgeons now have access to a Graduate Certificate in Surgery (Breast Surgery) to broaden their knowledge base.

Training decision-makers: Existing strategies for natural and technological crisis management and specifications of an improved simulation-based tool

Serious games and environmental computer-based simulations can be useful training tools for people who have to act in emergencies. Currently, stakeholders who deal with crises have to make decisions under stress, for example in order to mitigate consequences or avoid negative impacts on high-stake elements.Many factors are critical in a training environment for ensuring that effective learning occurs, principally: experience improvement, engagement and immersion, and realism.This paper aims to identify the limits of existing learning systems for emergency stakeholders within a crisis cell and then to propose a set of recommendations in order to specify a system to improve the effectiveness of peoples’ actions in case of a major crisis.The development of this approach requires the pooling of information concerning varied and multidisciplinary skills. The paper first focuses on the classical difficulties of crisis management, after which the notion of experience in decision-making is defined. The issue is studied from three points of view: the educational approach, the simulation system, and the training environment. The last section of this paper contributes to establishing a set of enhancements which can lead to the specification of simulation based learning systems for further development. More particularly, we specify the needed characteristics of our learning approach and teaching strategy. Finally, we propose a model with the main steps that have to be implemented in order to design a new learning system: a semi-virtual training environment for strategic crisis management.

Address of the President, Sir Paul Nurse, given at the Anniversary meeting on 30 November 2015.

Address of the President, Sir Paul Nurse, given at the Anniversary meeting on 30 November 2015.

Potentially curative multivisceral resections for locally advanced colorectal cancer

Background. Performing multivisceral resections in locally advanced colorectal cancer is the only way to achieve the surgical radicality in the treatment of this disease. The frequency of such cases remains high as a result of the global increase in morbidity and poor health culture of the population. Locally advanced colorectal cancer has exclusive specificity in terms of its location - upper abdominal floor, pelvic area and requires multidisciplinary surgical skills and experience. In this publication are reported early perioperative results in 128 cases of potentially curative multivisceral resections. Aim. To assess the early perioperative results in patients with multivisceral resections for advanced colorectal cancer. Material and method. For period of 8 years 2007 – 2014, 191 patients with advanced colorectal cancer were operated. In 128 cases multivisceral resections were performed in attempt for achieve surgical radicalism. Results. Average age in the group was 66.7years. Perioperative mortality amounted to 3.1%(4 patients). Perioperative complications were observed in 25 (19.5%) patients. Conclusion. Surgery is the only method for achieve long term survival in patients with advanced colorectal cancer. Performance of multivisceral resections is challenging for the surgeon and often multidisciplinary approach is needed. Key words. Multivisceral, locally advanced, colorectal