Multiprofessional Network Research Articles

Activity Centred Signature Pedagogies for the Creation of Digital Educational Publications

In this paper, we draw together three sets of ideas to create a framework for understanding and improving the networked creation of digital educational artefacts. We combine ideas on learning networks and networked learning, activity-centred analysis and design (ACAD) and signature pedagogies. Focusing on establishing a framework for understanding the network practices, the participation of people from different professions and the nature of learning in doing, the paper explores the possibility of constructing a framework that can be customised to the needs of specific professions or of industry-specific multi-professional networks. The case on which we focus, and which we use to inform, illustrate and sharpen some of the argument, is that of digital educational publishing – specifically, the activity of the educational publishing company Systime. However, we see the framework as applicable to a much more extensive range of situations. Consequently, the paper contributes to wider theoretical and practical work on the creation of digital educational artefacts. It also contributes to thinking more deeply about assumptions and practices involved in professional knowledge-building networks: especially where participants develop what we describe as a ‘reflexive designerly disposition’, capable of improving what a network achieves and how it functions.

Multidisciplinary management of immunotherapy-related adverse events in solid tumors: An inter-institutional and telemedicine-based working team.

Although immune checkpoint inhibitors (ICIs) show a more favorable toxicity profile than classical cytotoxic drugs, their mechanism of action is responsible for peculiar new toxicities. There is an urgent need for a multidisciplinary approach to advice on how to manage organ-specific toxicities. Our project aims to integrate the practices of two different hospitals into a single Italian regional collaborative model to treat immune-related adverse events (irAEs). The team structure is a multi-professional and multidisciplinary cooperative network that consists of different medical specialists. The team referrer is the medical oncologist and an existing telematic platform is used for specialists' cooperation. The leading oncologist first evaluates patients' clinical condition, therefore team intervention and teleconsultation are planned to activate proper management. After a first phase structured for general setting, outcomes analysis, data collection, and identification of critical issues, it is planned to define appropriate key performance indicators (KPIs) in quality, structure, process, and outcome settings. Therefore, a second phase would serve to implement KPIs. In the third phase, the proposal for the enlargement of the network with the extension to more centers in the context of the Regional Health Service will be performed. The multidisciplinary management of irAEs based on telemedicine fits into the debate on the renewal of healthcare systems and the push for change toward multidisciplinary with the rising use of telemedicine. To our knowledge, this is the first project reporting a multi-institutional experience for change of service in irAEs management.

Assessing resilience though a health system performance lens

Abstract Health system resilience testing has generated keen interest since the COVID-19 pandemic but so far no methodology for this complex exercise exists. Our concept of resilience testing is inspired by the experience of stress tests in the banking sector. The novel approach is a mixed-method country-led exercise, which applies a health system lens to a particular shock scenario, and identifies vulnerabilities using the Health System Performance Assessment Framework for Universal Health and the Shock Cycle. In the first part of the presentation we describe the resilience testing methodology, based on the two conceptual frameworks. We share lessons from the required preparatory work: shock scenario selection, scope of background research, formation of a resilience testing group, resilience test day structure and process, and the facilitator's role. We also discuss the outcomes of the resilience testing process, which includes a formal assessment of the resilience of the health system. This will provide workshop participants with an overview of key concepts to conduct a country-led resilience testing exercise. The second part of the presentation focuses on the overarching results from the country-led pilots. These show that the resilience testing method can identify specific health system weaknesses at different stages of the shock cycle. Given the appropriate selection of resilience test facilitator and participants, the method can also detect system-wide challenges, shock implications and spill-overs. The participant interaction on the test day may identify key priorities for action and strengthen relevant national multiprofessional networks. Overall, the resilience testing approach is an important new tool to identify strengths and weaknesses of the current health system and in scenario-specific preparedness planning.

How Can Interprofessional Skills Be Taught during University Studies? Student Teachers, and Social Work and Law Students Solving Complex Student Welfare Cases

This study focused on the learning of interprofessional skills through an interdisciplinary university course provided to student teachers, and social work and law students. This study explored the development of the course, the aim of which was to raise the student’s understanding of interprofessional work to a more conscious level. The key research question was as follows: what kind of assignments and arrangements can be used to promote the interprofessional skills of students and their ability to solve complex student welfare cases? In this practice-oriented case study, we analyzed our own development process for the course, as well as the student’s reflective essays. Through our analysis, we identified four central themes of an interdisciplinary course that can enhance interprofessional skills in students: (1) identifying discipline-specific expertise as a part of a multi-professional network; (2) gaining an understanding of interprofessional working processes; (3) realizing the complexity of student welfare cases; and (4) orienting towards working life. Our research demonstrates that building an interdisciplinary university course based on flipped learning principles, which incorporates collaborative and reflective assignments supported by various course materials and literature, can promote the learning of interprofessional skills and processes by students.

A Stepped Health Services Intervention to Improve Care for Mental and Neurological Diseases: Protocol for a Prospective Cohort Trial

Mental and neurological disorders cause a large proportion of morbidity burden and require adequate health care structures. However, deficits in the German health care system like long waiting times for access to specialized care and a lack of coordination between health care providers lead to suboptimal quality of care and elevated health care costs. To overcome these deficits, we implement and evaluate a unique stepped and coordinated model of care (the Neurologisch-psychiatrische und psychotherapeutische Versorgung [NPPV] program) for patients with mental and neurological diseases. Patients included in the program receive an appropriate treatment according to medical needs in a multiprofessional network of ambulatory health care providers. The therapy is coordinated by a managing physician and complemented by additional therapy modules, such as group therapy, internet-based cognitive behavioral therapy, and a case management. Statutory health insurance (SHI) routine data and data from a longitudinal patient survey will be used to compare the program with regular care and evaluate SHI expenditures and patient-related outcomes. A health care provider survey will evaluate the quality of structure and processes and provider satisfaction. Finally, an analysis of ambulatory claims data and drug prescription data will be used to evaluate if health care providers follow a needs-led approach in therapy. Ethics approval for this trial was obtained from the ethics committee of the chamber of physicians in North Rhine (September 13, 2017, reference No. 2017287). Patient enrollment of NPPV ended in September 2021. Data analysis has been completed in 2022. The results of this study will be disseminated through scientific publications, academic conferences, and a publicly available report to the German Federal Joint Committee, which is expected to be available in the first half of 2023. The NPPV program is the first intervention to implement a stepped model of care for both mental and neurological diseases in Germany. The analysis of several data sources and a large sample size (more than 14,000 patients) enable a comprehensive evaluation of the NPPV program. German Clinical Trials Register DRKS00022754; https://tinyurl.com/3mx9pz5z. DERR1-10.2196/37569.

The potential of transformative learning for sustainability transitions: moving beyond formal learning environments

AbstractTransformative learning has become one of the most prominent learning theory in regard to sustainable development. It holds enormous potential for explaining and accompanying learning processes related to processes of transformation for sustainability, especially due to its emphasis on changing meaning perspectives in discussions with others in spaces free of coercion. In addition, it inspires learners and educators to pay particular attention to emotional challenges when they engage in critical thinking. This theoretical paper explores the potential of transformative learning theory by examining informal learning environments where people do not explicitly intend to learn but learning happens en passant or incidentally. It shows the ability of transformative learning theory to explain what can happen on the level of individual learning, organizational learning, learning in multi-professional networks, and learning in transdisciplinary or transformative research cooperation processes. Based on this analysis, recommendations can be derived to stimulate, enable, and accompany transformative learning processes for sustainability.

Análise do nível de ansiedade na gestação de alto risco com base na escala Beck Anxiety Inventory

Abstract Objectives: to analyze the level of anxiety in high risk pregnant women admitted in the maternity ward of the Hospital Universitário Lauro Wanderley (HULW) of the Federal University of Paraíba. Methods: an observational, descriptive, cross-sectional study of quantitative character, with a sample composed of 100 pregnant women diagnosed as high risk interned at HULW. Data collection was performed using the Beck Anxiety Inventory (BAI), used to assess the level of anxiety the patient is in and the existing symptoms. For the statistical analysis, the Mann Whitney, Kruskal Wallis and Spearman correlation tests were used, considering p<0.05. Results: it was observed that 68% of pregnant women have moderate to high anxiety, with heat, fear of the worst happening, faster heartbeat, emotional instability and nervousness listed as the most common symptoms. The presence of an anxious condition was independent of maternal age, marital status or parity, however the gestational trimester, history of abortions and length of hospital stay were identified as risk factors for anxiety. Conclusion: pregnant women with a high risk diagnosis hospitalized at HULW presented anxiety, thus identifying the need for a multiprofessional support network, such as family assistance.

Fathers in Early Parenting Programs. Impulses from the European and International Fatherhood Research

Prevention and intervention programs (early parenting programs) which are provided by regional multi-professional networks for families with infants are still addressed to mothers, primarily. The question is whether the European and international fatherhood research can supply valuable suggestions for a better involvement of fathers. We discuss determinants of lived fatherhoods that range from educated fathers of national middle class over fathers with migrant backgrounds up to educationally and economically disadvantaged fathers. We elucidate barriers which stand in the way of father involvement in the current parenting programs, and exemplary describe how the resistance could be successfully overcome.

CORRIGENDUM to “Trust in cross-sector alliances: Towards a theory of relational trust in multi-professional education networks”

CORRIGENDUM to “Trust in cross-sector alliances: Towards a theory of relational trust in multi-professional education networks”

Amyotrophe Lateralsklerose (ALS) – Diagnose, Verlauf und neue Behandlungsoptionen

Amyotrophic lateral sclerosis (ALS) is an adult-onset motor neuron disorder which is characterized by progressive motor symptoms, such as muscle weakness, muscle atrophy and spasticity. In Germany, 6000-8000 people are affected by ALS. Between 1200 and 1600 newly diagnosed patients are expected each year. Protein deposits in the cytoplasm of motor neurons are a molecular feature of ALS. The most common protein aggregates result from excessive deposition of TDP-43. Familial ALS is present in 5 to 10 % of all ALS patients. Common causal genes include C9orf72, SOD1, FUS, and TARDBP. Genetic factors may be involved even without a family history of ALS and may be underestimated. The disease course and progression are highly variable. Symptom severity and rate of progression are determined by the ALS Functional Scale (ALSFRS-R). Beyond clinical symptoms and the patient's perception of disease burden, measurement of slow vital capacity (SVC), peak cough flow (PCF), and body mass index (BMI) are used to underscore the indications for ventilatory and nutritional interventions, as well as palliative care. The validity of the biomarker neurofilament light chain (NF-L) for estimating prognosis is currently being investigated. ALS is not curable - however, various individual treatment options have to be considered for improving survival, symptom control and social participation. The care in specialized ALS centers is recommended to ensure optimal treatment regarding symptomatic medication, assistive devices, nutrition support and ventilation therapy. Optimal care is achieved by interdisciplinary collaboration of general practitioners, specialized physicians, neurologists and ALS experts being integrated in multiprofessional care networks.

Trust in cross-sector alliances: Towards a theory of relational trust in multi-professional education networks

In recent years, partnerships between schools and non-system actors, that is, cross-sector alliances, have become increasingly important in education systems around the world, raising concerns and doubts regarding the influence of non-school actors in educational management and leadership. In these debates, trust is regarded as a key element for the success of cross-sector alliances. Although both trust and cross-sector alliances have been increasingly studied in education research in recent years, an investigation of the role of trust in such relationships is still missing. This article analyzes relational trust in cross-sector alliances in education in order to contribute to further theory building. To this end, it implements a qualitative design based on semi-standardized interviews with 21 individuals responsible for managing an illustrative cross-sector alliance. Interviews are analyzed with the help of an approach based on Grounded Theory. The analyses result in a five-dimensional theory of trust in cross-sector alliances, comprising (1) individual attitude, (2) time, (3) professional affiliation, (4) power, and (5) multiplexity. The theoretical approach developed in this article has practical implications for networked leadership and school principals’ work and training as it provides information regarding the skills and knowledge needed for managing cross-sector alliances.

Os NAPNEs e o Plano Educacional Individualizado nos Institutos Federais de Educação

Conforme cresce o ingresso de estudantes Público-Alvo da Educação Especial (PAEE) em instituições educacionais comuns aumenta a demanda por ações que proporcionem participação e aprendizagem desses estudantes. No contexto da Rede Federal de Educação Profissional e Tecnológica há Núcleos de Atendimento/Apoio às Pessoas com Necessidades Educacionais Específicas (NAPNEs) e o objetivo desse artigo consistiu em analisar o papel dos núcleos em dois Institutos Federais de Educação Brasileiros, bem como refletir sobre a importância do Plano Educacional Individualizado (PEI). O estudo, de caráter documental, envolveu a análise das orientações para as ações dos NAPNEs e como é proposto o desenvolvimento do PEI. Evidenciou-se que os NAPNEs, apesar de envidarem esforços para assumir parte considerável do papel de ensino, pesquisa e extensão, têm apresentado diversas fragilidades. A ampliação do objetivo do Núcleo para ações que propõem medidas individuais demanda uma rede multiprofissional capacitada. O PEI, por sua vez, responde a uma necessidade de construção colaborativa da instituição, visando traçar objetivos e orientações focalizados na acessibilidade curricular para esses estudantes. O maior obstáculo, entretanto, tem sido a insuficiência de profissionais capacitados e uma demanda latente identificada é a contratação de professores de educação especial. Nesse contexto, os NAPNEs, embora assumam um papel relevante nos Institutos estudados, da forma como são constituídos não são suficientes para efetivar o direito dos discentes PAEE, sendo necessário lutar pela implantação de políticas públicas para remoção das barreiras no processo de escolarização nessas instituições.

Let us integrate sexual health\u2014do psychiatrists integrate sexual health in patient management?

The high prevalence of sexual dysfunction and the importance of sexual health issues in general stress the need for a physician to integrate sexual health issues in patient management. In this study, we evaluate the frequency of psychiatrists addressing sexual health issues as well as their attitude towards sexual health. Plus, we want to evaluate the multi-professional network for patient treatment that is needed by physicians for collaboration with other medical specialists and health care professionals. At total 100 psychiatrists (age range 30–60 years), participating at the annual meeting of the Austrian Society of Psychiatry, Psychotherapy, and Psychosomatics, were invited to self-assess their caring for patients’ sexual health issues and answer a self-report questionnaire. The return rate was 74%. A third of the participating psychiatrists and psychotherapists stated to address sexual health in patients in daily routine. Twenty-five percent of the physicians suspected sexual health problems in 60–100% of their patients but did not ask the patients about this topic. Mentioned reasons why patients would not actively address sexual problems were rated by the survey participants “a different problem was more important”, “lack of time”, and “embarrassment”. Only few of the participating psychiatrists stated to offer a consultation in sexual health to the patients, none to offer sexual therapy. A mentioned reason was “lack of competence regarding sexual health”. Twelve percent referred the patients with sexual issues to a physician with another medical specialization, especially to experts in gynaecology and obstetrics, to experts in urology, or to andrologists. However, a need for a network in the field of sexual medicine was stated and an unawareness of a sexual health care network: where to refer the patients in need. Our data showed an increased need in the routine treatment and management of sexual health care in psychiatrists and psychotherapists. Plus, the data stresses the need for professional sexual medicine qualification and for extended cooperation between different medical fields and health care professionals in order to integrate sexual health topics professionally in daily routine.

Study protocol for the COMET study: a cluster-randomised, prospective, parallel-group, superiority trial to compare the effectiveness of a collaborative and stepped care model versus treatment as usual in patients with mental disorders in primary care

IntroductionMental healthcare is one of the biggest challenges for healthcare systems. Comorbidities between different mental disorders are common, and patients suffer from a high burden of disease. While the effectiveness...

Implementation of complex perioperative intervention in older patients with cancer (IMPROVED program).

TPS11630 Background: Nearly 50% of patients are older than 70 years at diagnosis of digestive cancer. Surgical resection is the first line strategy of treatment. Despite improvement in surgical techniques and development of rehabilitation programs, the rate of postoperative complications remains high. Peri-operative involvement of geriatricians may improve care management older cancer patients. Methods: During a 6 months run-up period (emerging project), we structured a multi-professional network (digestive surgeons, anesthetists, geriatricians, digestive oncologists, epidemiologists), we elaborated a innovative peri-operative geriatric intervention (Improved program) in digestive surgery setting based on evidence-based data. We build a dedicated evaluation plan by determinate the best design for assessing geriatric intervention in this complex context and choose the more appropriate endpoints. Results: We will include 554 patients aged 75 or more with resectable digestive cancer in a stepped wedge cluster randomized trial. The intervention is based on 1/ a preoperative geriatric assessment, focusing on frailty parameters and developing a coordinated program of tailored geriatric interventions 2/ a postoperative shared care with an integrated care model where both surgeon and geriatrician share responsibility for the patient management in surgical ward. This geriatric postoperative management will be focus on prevention and correction of complications, early mobilization, optimal nutritional support. The main endpoint Is is Grade II or higher post-surgical complications rate according Clavien-Dindo classification within 30 days after the surgical procedure. Conclusion: We expected to demonstrate a benefit of a peri-operative shared management model to decrease the risk of post-surgical complications In older patients with digestive cancer.

Improving Treatment of Elderly Patients by Interprofessional Education in a Quality Network of Geriatric Medicine: Protocol for Evaluating an Educational Initiative.

BackgroundAll statistics on the development of demand for care for multimorbid elderly patients highlight the acute pressure to act to adequately respond to the expected increase in geriatric patient population in the next 15 years. Against this background, great importance must be attached to the improvement of cross-occupational group and cross-sector treatment of these patients. In addition, many professionals in the health care sector often have little knowledge about the special treatment and care needs of the elderly.ObjectiveThe Quality Network of Geriatric Medicine in north-west Germany is the body responsible for the project; with its member organizations, it provides care for over 400,000 inpatients and is thus one of the largest associations for geriatrics in Germany. The Quality Network conducts binding evaluated qualification measures for staff involved in the treatment and care of multimorbid elderly patients. The training offers are especially intended for staff who have not yet been trained in working with elderly patients. This approach is intended to improve the expertise of various occupational groups on different hierarchy levels, to include patients and their family members in the evaluation process, and to initiate changes within the organizations.MethodsVarious instruments are used in the evaluation of qualification measures: besides written surveys and questionnaires, structured work groups (consensus groups) and interviews are conducted. The evaluation starts before the qualification measures to determine the starting point and then continues during the measure and after its completion. This allows major findings to be integrated directly into the ongoing qualification program. At least 100 trainings on geriatric topics, 80 consensus groups, and 120 patients (and family members) are going to be included in the study.ResultsThe evaluation of the educational initiative is funded by the State of Northrhine-Westfalia (Germany; LZG TG 71 001 / 2015 and LZG TG 71 002 / 2015). The results of the study will be published after review and approval by the state authorities – presumably by the end of 2019. The before and after comparison of the treatment-related outcomes at the beginning and near the completion of the educational initiative gives insights into how transfer-oriented education can improve the treatment of elderly patients across sector lines for inpatients as well as outpatients. The evaluation of the implementation of educational content in day-to-day work and occupational groups is to facilitate recommendations about economically sensible use of educational resources and about further adjustments to the training content.ConclusionsThe evaluation develops the foundation for targeted and needs-oriented qualification measures as well as transfer in cross-sector, multiprofessional networks. Instruments and results will be published and provided to other health care networks and institutions. The Quality Network will implement the results of the evaluation process in its member institutions.International Registered Report Identifier (IRRID)DERR1-10.2196/11067

The establishment and functioning of the PRIMORE (European PRImary care MultiprOfessional REsearcher network) Project.

There is a need for multiprofessional comprehensive studies to better understand the relationship between design and provision of primary care and long-term care and health outcomes. The PRIMORE (PRImary care MultiprOfessional REsearcher network) project aims at bringing together researchers with different backgrounds and from a wide range of professional groups within the fields of primary care research and long-term care research to develop and share knowledge for the benefit of research on municipal health and care services, and eventually, the quality of municipal health and care in Europe. Main activities of the project will be network development, capacity building, providing a platform where multiprofessional primary care research activities can take place and publishing position papers.

The key challenges of discussing end-of-life stroke care with patients and families: a mixed-methods electronic survey of hospital and community healthcare professionals.

Communication between professionals, patients and families about palliative and end-of-life care after stroke is complex and there is a need for educational resources in this area. To explore the key learning needs of healthcare professionals, a multidisciplinary, expert group developed a short electronic survey with open and closed questions, and then distributed it to six UK multiprofessional networks and two groups of local clinicians. A total of 599 healthcare professionals responded. Educational topics that were either definitely or probably needed were: ensuring consistent messages to families and patients (88%); resolving conflicts among family members (83%); handling unrealistic expectations (88%); involving families in discussions without them feeling responsible for decisions (82%); discussion of prognostic uncertainties (79%); likely mode of death (72%); and oral feeding for 'comfort' in patients at risk of aspiration (71%). The free-text responses (n = 489) and 82 'memorable' cases identified similar themes. Key topics of unmet need for education in end-of-life care in stroke have been identified and these have influenced the content of an open access, web-based educational resource.

Clinical–insurer engagement to improve maternity safety in the UK, Ireland, Sweden and Australia

Objective To explore different models of clinical–insurer engagement around maternity safety and to understand how state insurers could and should engage with clinical staff to improve outcomes and reduce harm. Design Semi-structured interviews and focus groups were conducted with senior representatives from state insurers. Transcripts were analysed to identify different models of engagement. Themes were also elicited from the transcripts. A further one-day focus group allowed for clarification and elaboration of these themes. Participants Senior representatives from state insurers in England, Scotland, Wales, Republic of Ireland, Sweden and Victoria, Australia. Results A variety of clinical engagement activities were undertaken by the insurers. These included training on claims and risk management, hospital site visits, facilitating multi-professional network meetings and working with clinical experts to develop best practice recommendations. Some insurers engaged with frontline clinical staff through collaborative patient safety programmes. The themes (identity and size, data and research, incentivising improvement and system integration) were important for considering the role of state insurers within health systems and how insurers could engage with clinical teams. Conclusions This study identified different examples of clinical–insurer engagement. Whilst this was encouraging, the relationships between insurers and clinical teams could be developed further. Insurers and clinical staff could still collaborate more closely and work together in improving patient outcomes. Whilst not specifically their domain, insurers do have a role in patient safety. Closer clinical collaboration may strengthen this contribution.

Local emergency medical response after a terrorist attack in Norway: a qualitative study

IntroductionOn 22 July 2011, Norway suffered a devastating terrorist attack targeting a political youth camp on a remote island. Within a few hours, 35 injured terrorist victims were admitted to...