Multidisciplinary Teamwork Research Articles

The history of resection prosthesis.

The purpose of this historical review is to highlight the progression and development of prosthetic reconstruction with a focus on the modular distal femur with hinged total knee arthroplasty. Scientific literature was searched for descriptions of endoprosthetic reconstruction of the extremities to provide a thorough overview of the subject, focusing the research on the evolution of limb salvage of the distal femur. After the first works of Gluck and Giordano, with ivory and metal and the pioneer shoulder prosthesis by Pean in the late 1890s, a great advancement was brought by reconstructions performed for injured soldiers of the Great War. By the 1940s, replacement of all the main joints had been attempted, and documented. Walldius in the 1950s developed a fully constrained hinge knee, offering for the first time a consistent and replicable method of substituting the joint. In 1953, Shiers' prosthesis allowed for good flexion and extension. Stanmore and GUEPAR group prosthesis in the 1960s were the first to have a different right and left side model. The rotating hinge was developed in 1978 by Walker, with the innovative concept of six degrees of freedom. Between 1979 and 1982, Kotz developed the modular segmental replacement that, added to a fixed hinge knee, permitted the revolutionary creation of the modern distal femur replacement. The study of the materials and mechanical solutions that was brought to the modern distal femur resection prosthesis is a good example of a virtuous multidisciplinary teamwork between orthopaedic surgeons, anatomists, and biomechanical engineers.

The ambiguity of “we”: Perceptions of teaming in dynamic environments and their implications

In healthcare, organizations increasingly call on clinicians and staff to team up fluidly to deliver integrated services across disciplines and settings. Yet little is known about how clinicians and staff perceive of team membership in healthcare environments where team boundaries are often ambiguous and continually shifting. We draw on the context of primary care in the United States, where fluid multi-disciplinary teamwork is commonly exhorted, to investigate the extent to which clinicians and staff perceive of various roles (e.g., physician, front desk) as members in their teams, and to identify potential implications. Using a survey fielded within 59 clinics (n = 828), we find substantial variation in individuals' perceptions of the roles they consider as team members during an episode of care (e.g., mean team size = 10.60 roles; standard deviation = 5.09). Perceiving more expansive sets of roles as team members exhibits a positive association with performance as measured by care quality (b = 0.02; p < .01) but a curvilinear association with job satisfaction. Separating an individual's perceived core (roles always perceived as part of the team) and periphery (roles sometimes perceived as part of the team), perceiving a larger core is positively associated with performance (b = 0.03 p < .01). In contrast, perceiving a larger periphery is marginally negatively associated with performance (b = −0.02, p < .10). This appears to be driven by divergence from the norm perception of the core, i.e., when individuals attribute to the periphery the roles that are considered by most others to be core. Our findings suggest that individuals viewing the roles they must team with more expansively may generate higher quality output but experience a personal toll. Delivering on the ideal of team-based care in dynamic environments may require helping team members gain clarity about their teammates and implementing policies that attend to job satisfaction as team boundaries shift and expand.

Difficult diagnosis in the ICU: making the right call but beware uncertainty and bias.

Dealing with an uncertain or missed diagnosis is commonplace in the intensive care unit setting. Affected patients are subject to a potential decrease in quality of care and a greater risk of a poor outcome. The diagnostic process is a complex task that starts with information gathering, followed by integration and interpretation of data, hypothesis generation and, finally, confirmation of a (hopefully correct) diagnosis. This may be particularly challenging in the patient who is critically ill where a good history may not be forthcoming and/or clinical, laboratory and imaging features are non-specific. The aim of this narrative review is to analyse and describe common causes of diagnostic error in the intensive care unit, highlighting the multiple types of cognitive bias, and to suggest a diagnostic framework. To inform this review, we performed a literature search to identify relevant articles, particularly those pertinent to unclear diagnoses in patients who are critically ill. Clinicians should be cognisant as to how they formulate diagnoses and utilise debiasing strategies. Multidisciplinary teamwork and more time spent with the patient, supported by effective and efficient use of electronic healthcare records and decision support resources, is likely to improve the quality of the diagnostic process, patient care and outcomes.

Accessibility and dissemination of the cultural heritage in a museum library: case study in the National Archaeological Museum (Spain)

The bibliographic heritage held by GLAM (Galleries, Libraries, Archives and Museums) institutions is an invaluable source for research, culture and education in a country. This paper aims to present a research project plan to improve the visibility, accessibility and dissemination of the bibliographic heritage of the National Archaeological Museum Library through the generation of virtual bibliographic exhibitions. The research project is highly praiseworthy and innovative in the field of Spanish heritage. Firstly, this is the first challenge undertaken in a Spanish state museum library with the stated general objective and, secondly, because the project proposal was supported and funded in 2021 by the Spanish Ministry of Science and Innovation in the call ‘R+D+i Oriented to the Challenges of Society’. After formulating some research questions, the research design was divided into five phases. It included drafting scientific-technical reports, selecting stakeholders as well as the configuration of the project team to conclude with the project implementation phase. The proposed research project plan also included the general and specific objectives, the research team, phases of the proposal as well as its dissemination and communication plan. Conclusions highlight the importance of creating multidisciplinary work teams and combining the use of technologies with the bibliographic collections of cultural institutions.

Implementing the Community Healthcare Network Model in Mid West community health care.

Integrated care, underpinned by a health and wellbeing approach, is central to Ireland's health service reform. This new Community Healthcare Network (CHN) model is in the process of implementation across Ireland as part of the Enhanced Community Care (ECC) Programme, a key deliverable of the Sláintecare Reform Programme that aims to 'shift left', ie change the way health care is delivered and bring more support closer to home. ECC aims to deliver integrated person-centred care, enhance Multidisciplinary Team (MDT) working, strengthen links with GPs and strengthen community supports. There are nine learning sites and 87 further CHNs.DeliverablesA new Operating ModelStrengthening governance and enhancing local decision-making through the development of a Community health network operating model, including a Community Healthcare Network Manager (CHNM), a GP Lead and Multidisciplinary Network Management Team.Enhancing primary care resources.Enhanced MDT workingProactive management of people with complex care needs in the community facilitated by the Multidisciplinary Team and new Clinical Coordinator (CC) and Key Worker (KW) roles.Redesign of the Clinical Team Meeting to allow virtual attendance and focused case discussion will facilitate GP attendance.Developing integrated care pathways between CHNs, Specialist Hubs (Chronic Disease and Frail Older Persons) and Acute Hospitals.Strengthening Community Supports, eg ALONE.Population Health ApproachPopulation health needs assessment utilising census data and health intelligence, local knowledge from GPs, PCTs, community services and service user engagement.Risk Stratification - resources applied intensively in a targeted manner to a defined population.Enhanced Health Promotion - addition of a Health Promotion and improvement officer to each CHN and the Healthy Communities Initiative, which aims to implement targeted initiatives to tackle challenges within specific communities, eg smoking cessation, social prescribing.Key enablers for implementationAppointment of a GP lead in all CHNs is essential to strengthen relationships and bring GP voice to health service reform.The CHN model has the potential to support the delivery of integrated care, providing opportunities for enhanced MDT working by identifying key personnel (CC, KW and GP lead) to support effective MDT functioning.Redesign of the clinical team meetings will support GP involvement and enhance collective decision making and joint working.Population risk stratification is necessary to deliver targeted services. CHNs need to be supported to carry out risk stratification. Furthermore, this is not possible without strong links with our CHN GPs and data integration.An integrated community case management system that can 'talk' to GP systems is a critical enabler for integration. The Centre for Effective Services completed an early implementation evaluation of the 9 learning sites. From initial findings, it was concluded that there is an appetite for change, particularly in enhanced MDT working. Key features of the model, such as the introduction of the GP lead, clinical coordinators and population profiling, were viewed positively. However, respondents perceived communication and the change management process as challenging.

Outcomes of pregnant women hospitalized with unrepaired congenital heart disease: Insights from a multidisciplinary center in Vietnam

Background In developing countries, fewer women have access to multidisciplinary congenital heart disease and reproductive programs staffed by experts. We report pregnancy outcomes of a multidisciplinary healthcare strategy utilizing an in-hospital teamwork approach in Vietnam. Methods This retrospective cohort study included pregnant women with unrepaired congenital heart disease managed at a referral cardiovascular center. Results Undiagnosed congenital heart disease before pregnancy, a lack of pre-pregnancy cardiology counseling, and modified World Health Organization class III/IV were common. Under the multispecialty healthcare strategy, although the rate of maternal death was 8.2% in the modified World Health Organization class IV group, no deaths occurred in any other group. Fetal/neonatal complications occurred in 54% of pregnancies, and 49.4% of neonates survived. Poor pregnancy outcomes were associated with admission during the first/seconde trimester for fetus/neonates, third trimester for mother, modified World Health Organization class III/IV, cyanosis, and heart failure. Conclusion The outcomes of pregnant women with unrepaired congenital heart disease were poor but seemed to improve with a multidisciplinary in-hospital healthcare teamwork strategy.

What does it take to be a major trauma nurse practitioner?

Role combines aspects of critical care, leadership and multidisciplinary teamwork in a dynamic environment

Providing care for children with tracheostomies: a qualitative interview study with parents and health professionals

ObjectivesTo explore the experience of caring for children with tracheostomies from the perspectives of parents and health professional caregivers.DesignQualitative semistructured interview study.SettingOne region in England covered by a tertiary care...

Evaluating and Selecting Employees for Undertaking and Implementing New Projects

This paper presents the issue of selecting people for effective, multi-disciplinary working teams. We describe how to create working teams that are best suited to work in the three departments of the enterprise analysed, on the basis of a real-life example. The selection of the right people to carry out the tasks assigned to them, is a key element in achieving success in any project.

Assessment of the Psychosocial Care Center multidisciplinary team from users' and family members' perspective.

to assess the multidisciplinary team of a Psychosocial Care Center I from users' and family members' perspective. an evaluative study, anchored in the fourth generation evaluation theoretical-methodological framework, carried out in a Psychosocial Care Center I, from September 2021 to March 2022. Eleven users and 06 family members participated. Data were collected through non-participant observation, individual interviews and negotiation sessions, and analyzed using the Constant Comparative Method, using the MAXQDA software. the team develops its care based on individual and collective care, with integrated and complementary work by professionals. They seek to facilitate treatment initiation and continuation, considering health needs and offering support, understanding and guidance to users and their families. the multidisciplinary team's work is based on the psychosocial paradigm, which can qualify care and strengthen the service role in the mental health network.

Intra- and post-operative outcomes in benign gynaecologic surgeries before and after the implementation of enhanced recovery after surgery protocols: A comparison.

To compare intra- and post-operative outcomes in patients undergoing benign gynaecologic surgery before and after the implementation of enhanced recovery after surgery (ERAS) protocols. ERAS is a multidisciplinary teamwork with the aim to reduce the body's reaction to surgical stress. The key components of ERAS include pre-operative counselling, avoiding prolonged fasting, standardised analgesic and anaesthetic regimes, early mobilisation and early discharge. Women undergoing hysterectomy and myomectomy were included in the study. The pre-ERAS group had 100 cases and the ERAS group had 104. Demographic data of both the groups were compared. Duration of surgery, amount of blood loss, intra-abdominal drain, oral feed, catheter removal, ambulation, passage of flatus and length of stay were compared. The demographic profiles of both the groups were comparable. Time taken to intake of liquids (P < 0.001), solid food (P < 0.001), passage of flatus (P = 0.001), removal of Foley's catheter (P = 0.023), ambulation (P = 0.007), pain score (P = 0.001) and length of stay in hospital (P < 0.001) were statistically significantly shorter in the ERAS group when compared to the pre-ERAS group. A significant difference was seen in the use of intraperitoneal drains in the ERAS group (81% vs. 23.1%), and if used, drains were removed early in the ERAS group (66.66% vs. 28.39%) within 40 h. Both the groups had similar intra- and immediate post-operative complications. ERAS helps in reducing length of stay with early feeding and ambulation, leading to early discharge without increase in intra- and post-operative complications in women undergoing benign gynaecological surgeries.

The application of robotic surgery in gynecology in the age of artificial intelligence

In the field of gynecology, the selection of surgical approach should be carefully considered based on individual patient characteristics. The development of minimally invasive surgery has greatly impacted gynecological surgeries, and the number of robotic surgeries has been increasing yearly. Robotic surgery offers many benefits. The use of robotic surgery techniques in the multidisciplinary teamwork (MDT) surgery can make surgical operations more convenient, and has resulted in many successful cases, such as in advanced ovarian cancer and deep infiltrating endometriosis surgeries. Single-port robotic surgery has its operational limitations but shows potential for development. The use of remote robotic surgery is being explored. The support of national policies in China has contributed to the development of domestically produced surgical robots. The future of surgical robots lies in technological advancements, market dominance, and the integration of intelligence and miniaturization. Our goal is to disseminate high-quality medical resources and provide services to a larger number of patients.

Клиническое наблюдение тяжелого течения болезни Иценко — Кушинга

Cushing's disease is a severe neuroendocrine disorder caused by excessive release of adrenocorticotropic hormone by pituitary tumor. The rate is 39.1 per 1 million and the incidence is 1.2–2.4 per 1 million. Typical symptoms include rapid weight gain associated with muscle weakness, hypertension, diabetes, and osteoporosis. The key diagnostic tool is brain MRI after laboratory confirmation of a diagnosis of hypercortisolemia. The key treatment is transsphenoidal adenomectomy, which provides remission in 65–90% of patients. This paper describes the severe course of Cushing's disease in a male patient, which has long remained undiagnosed. Diagnostic search steps, differential diagnostic difficulties, and follow-up results (including inferior petrosal sinus sampling) are discussed. A multidisciplinary approach and teamwork ensure timely diagnosis, prevent complications of Cushing's disease, and improve prognosis and quality of life. KEYWORDS: Cushing's disease, case report, hypercortisolism, hypercortisolemia, ACTH, somatostatin receptor scintigraphy, transsphenoidal adenomectomy FOR CITATION: Gorbunova N.P., Prokhorova G.V., Zubkova A.S., Korotkikh S.M., Volynkina A.P., Reshetnyak Ya.Ya. Case report of a severe course of Cushing's disease. Russian Medical Inquiry. 2023;7(9):606–610 (in Russ.). DOI: 10.32364/2587-6821-2023-7-9-8.

ОПТИМИЗАЦИЯ ОКАЗАНИЯ МЕДИЦИНСКОЙ ПОМОЩИ ПАЦИЕНТАМ С ОСТРЫМ НАРУШЕНИЕМ МОЗГОВОГО КРОВООБРАЩЕНИЯ В МНОГОПРОФИЛЬНОМ СТАЦИОНАРЕ

Significance. Acute cerebrovascular accident also known as stroke is one of the most common causes of morbidity, mortality and disability in Russia and abroad. In this regard, constant efforts are being undertaken to improve and optimize the diagnosis and provision of emergency specialized medical care to patients with this condition. The purpose of the study is to demonstrate experience of a multidisciplinary team at the regional vascular center, set up at a multidisciplinary medical institution that also operates in an ambulance mode, City Clinical Hospital named after M.P. Konchalovsky of the Moscow Healthcare Department. Material and methods. The material of the study was performance evaluation of a multidisciplinary team at the City Clinical Hospital named after M.P. Konchalovsky for the period from 2019 to 2022 to optimize the diagnosis and choice of treatment for patients with stroke. Results. Optimizing routing of patients with suspected stroke upon admission made it possible to save time and reduce the timespan before the thrombolytic therapy or thromboextraction is initiated. The introduction of a multidisciplinary team made it possible to reduce time for making the right decisions related to the treatment of patients with stroke. The change in the concept of diagnosing and treating patients with stroke from “sequence” to “parallelism” has significantly reduced the time spent on making a diagnosis, initiating thrombolytic therapy, thromboextraction if necessary, and reducing disability and mortality in patients with stroke. Conclusion. Specialized vascular centers and departments have proven to be effective in improving the diagnosis, treatment and functional performance of patients with stroke. However, the lack of regulatory documents requires further development of algorithms of the work of multidisciplinary teams. The introduction of multidisciplinary teams at the Regional Vascular Center of the "stroke network" made it possible to: achieve medical efficiency by reducing the "door-to-needle" time, mortality and severity of disability indicators; attain cost effectiveness by reducing length of hospital stay and cost of inpatient treatment of patients with stroke. Scope of application. Public health and health organization

Centralization of Liver Cancer Surgery and Impact on the Advanced Multidisciplinary Team Working on Stage IV Colorectal Cancer

Centralization of Liver Cancer Surgery and Impact on the Advanced Multidisciplinary Team Working on Stage IV Colorectal Cancer

Communication and Teamwork as a Nursing Competence: Aspects of Facilitating and Impediments

Interdisciplinary nursing teamwork enhances an important model for patient healthcare delivery. Patient care and effective safety depend on a multidisciplinary team of professionals in healthcare. Unfortunately, the field currently lacks an evidence-based framework for effective teamwork that can be integrated into medical education and practice across health professions. This article aims to describe the importance of multidisciplinary teamwork as a nursing competence in coronary and critical care. It discusses identifying common challenges to teamwork in healthcare and evidence-based strategies for quality improvement initiatives. As physicians and nurses provide parts of patient care, coordinating the various treatments and interventions provided is critical to preventing errors and fragmenting of care. Tensions, misunderstandings, and conflicts arising from differing opinions and interests can interfere with effective communication and interdisciplinary collaboration. It's appropriate to conduct new studies to approach agent management and also, to develop and implement collaboration and cooperation as a potential integrating tool between agents and their knowledge, in the context of holistic care, as well as qualification and vocational training to working in the coronary care unit.

Advances in multidisciplinary team-based collaborative care models in the nutritional management of patients with hepatocellular carcinoma

Liver cancer is a common and highly prevalent malignancy in China, and is a high prevalence of malnutrition. With the continuous innovation of medical technology and nursing model, the multidisciplinary teamwork nursing model has become inevitable for the care of liver cancer patients. This study reviews the concept of MDT nursing model, its development status at home and abroad and its application in the postoperative nutritional management of hepatocellular carcinoma patients, aiming to provide a basis for clinical hepatocellular carcinoma nutritional management.

Nurses' perceptions of the potential evolution of their role in antibiotic stewardship in nursing homes: a French qualitative study.

In nursing homes, infections and antibiotic prescriptions are frequent. Nursing home nurses (NHNs) and advanced practice registered nurses (APRNs) could promote antibiotic stewardship (ABS). Few studies have explored nurses' knowledge, perceptions and practices towards ABS in nursing homes and none has investigated the potential evolution of their roles. To explore French nurses' perceptions on ABS, current and future potential roles in ABS in nursing homes, as well as facilitators and barriers. We conducted a qualitative study in north-eastern France between October 2020 and March 2021 using semi-structured individual interviews with NHNs and a focus group with APRNs. Transcripts of the interviews were analysed using a thematic analysis. Twenty NHNs and seven APRNs participated. They were aware of antibiotic misuse and potential adverse events but lacked knowledge on some ABS aspects. NHNs' current ABS roles ranged from the detection of clinical infectious signs to clinical monitoring of residents, with some heterogeneity between nurses. They had positive opinions towards playing a more prominent role in ABS. In the future, with additional training, changes in the legislative framework and greater multidisciplinary teamwork, NHNs thought they could prescribe laboratory microbiological analyses and some targeted antibiotic treatments. APRNs thought they could prescribe first-line antibiotics for urinary tract infections. French NHNs' current ABS roles could be expanded and new roles might be considered while taking into account several facilitators and barriers. According to APRNs, they could help to compensate for the limited presence of doctors in nursing homes and develop infectious diseases skills.

Exploring multidisciplinary teamwork of applied physics and engineering students in a challenge-based learning course

ABSTRACT Background In responding to the global problems facing humankind, there is great value in equipping science and engineering students with skills to function well in multidisciplinary teams. Little attention has been paid into the factors that influence multidisciplinary collaboration and teamwork of science and engineering students. Purpose This research describes multidisciplinary teamwork of applied physics and mechanical engineering students in a challenge-based learning (CBL) course. The study aimed to: a) identify the facilitators and barriers to multidisciplinary teamwork and b) explore learning outcomes connected to working in multidisciplinary teams. Sample 30 students registered to the course, two teachers, and three tutors participated in this research. Design and Methods An instrumental case study was conducted in the context of a pilot CBL course. Data included interviews, reflection reports, observations, and design posters. Transcribed video recordings were searched in an attempt to demonstrate the codes revealed with the qualitative content analysis of interview transcripts and reflection reports. Results The results indicated knowledge acquisition, application, and an awareness of other disciplinary approaches as the learning outcomes with some differences for engineering and physics students. The findings also yielded individual (e.g. knowledge of control theory), team (e.g. disciplinary perspectives), and course factors (e.g. disciplinary connections to the challenge) that influenced multidisciplinary teamwork. Conclusion Multidisciplinary teamwork is supported by the unique ways of thinking and approaching problems of the two disciplines. Implications contribute to future research and thinking for similar learning environments while improving student learning in multidisciplinary teams.

A report on the blended short-term supplementary course on “Developmental Care for infants and toddlers” taught with a multidisciplinary approach for pediatricians -qualitative and quantitative study

BackgroundThe implementation of follow-up programs for high-risk infants and toddlers aimed to promptly diagnose developmental delays and disorders and initiate early intervention to help improve their developmental status, reduce their care costs in the future, as well as improve their productivity as members of society. There is a lack of qualified specialists in the infant and toddler development field in Iran. To compensate for the lack of training in this area, for the first time, Tabriz University of Medical Sciences has designed a short-term supplementary course of “Developmental Care for Infants and Toddlers”. Due to the multidisciplinary nature of the field of child development, this course has been designed as such. The current study aimed to evaluate this course and explain the graduates’ relevant experiences using a multidisciplinary approach.MethodsThe current study is a quantitative/qualitative study conducted in two phases. In the first step, the learners were asked to assess the teaching quality of the short-term supplementary course of “Developmental Care for Infants and Toddlers” in 5 areas of “educational design,“ “course administrators’ support”, " learners’ motivation “, “acquisition of general learning and specialized skills” using the Australian Course Experience Questionnaire (CEQ). All graduates completed the questionnaires. The data from the questionnaires were analyzed using descriptive statistics of medians, and interquartile ranges in SPSS software. The second step was a qualitative study to explain the graduates’ experiences of this course with a multidisciplinary approach. The samples were selected using a purposive sampling technique. The samples were those who had completed the course mentioned above, had rich experiences in this field, and were willing to share them. The data were collected through semi-structured interviews and analyzed using conventional content analysis.ResultsIn general, the graduates’ satisfaction with the course in terms of the five areas studied was evaluated as follows: Educational design, motivating participants to do their best had the greatest median. 5(4-5), Learning objectives; in all items, the median was 4. Course content and resources; all items median were 4 .Relevant learner assessment methods; in all items, the median was 4.The median learners’ satisfaction in the areas of “course administrators’ support” in all items was 4 and “learners’ motivation “, was 5. Learner’s motivation” in all items it was 4, indicating the highest level of satisfaction with the “acquisition of specialized skills”. In the area of education design, the highest satisfaction was found with the appropriateness of teaching strategies. The codes extracted from the analysis of interviews with the graduates, are divided into four categories: “Ethical and professional commitment of course teachers”, “Being a role model in the observance of patients and their caregivers’ rights”, “Course planning with a multidisciplinary approach and teamwork” as well as “The use of virtual platforms to strengthen and maintain team communication between learners”.ConclusionThis course was the first experience of applying a multidisciplinary approach in an interprofessional course. Ideally, it is indispensable for the Iranian medical education system to move away from specialization and connect all related specialties and disciplines to achieve its educational and therapeutic goals. Therefore, the design of this course can be applied as an educational model for other disciplines and clinical courses.