Support Team Research Articles

Good practice in sport science and medicine: perceptions of leaders on support and management of practitioners and teams

ABSTRACT The evaluation and delivery of good practice in the provision of Sport Science and Medicine (SSM) is clearly of interest and importance – with applied research, both anecdotal and empirical, that is burgeoning. However, no literature to date explores the role of the organisation and leader in supporting those striving to deliver good practice. The primary aim of this investigation is to explore the perceptions of experienced high-level leaders in the leadership, direction and operation of SSM practitioners and teams. A mixed methods modified Delphi technique, with three stages of investigation – a quantitative survey, individual interviews, and focus group discussions, was undertaken with 13 leaders of high-performance sport organisations in Europe and Australasia. This approach allowed expert consensus to be arrived at on a set of theoretically underpinned principles applicable to the pan regional support of good practice. A plethora of principles are offered relating to three core areas of support: organisational requirements; leadership; and practitioners´ skills and development. Importantly, a number of operational considerations for application are captured, including the impact of situational context in determining the focus and core elements of support required. Findings are particularly relevant for those leading SSM delivery – with a well led, organised and supported approach seemingly enabling good practice. In addition, results offer further empirical support to the importance of interdisciplinary teamwork, non-technical skill sets and relevant development opportunities for the practitioner. Overall, we hope the principles derived offer a practical starting point for those engaged in SSM provision.

“Having cancer is very expensive”: A qualitative study of patients with ovarian cancer and PARP inhibitor treatment

ObjectiveTo examine patient barriers and facilitators to PARP inhibitor (PARP-I) maintenance therapy in ovarian cancer. PARP-I improves survival in ovarian cancer, but these multi-year therapies cost around $100,000 annually and are under-prescribed. MethodsWe recruited patients with ovarian cancer treated with PARP-I maintenance therapy at an academic health system for a semi-structured interview. Patient demographics, including genetics and PARP-I cost, were self-reported. We assessed patient experiences with barriers and facilitators of PARP-I usage. Two team members used a thematic approach to analyze and identify key themes. ResultsIn May 2022, we interviewed 10 patients (mean age = 65 years; 80% White; 60% with a germline genetic mutation). Patients paid on average $227.50 monthly for PARP-I, straining resources for some participants. While sampled patients were insured, all patients identified having no or inadequate insurance as a major barrier to PARP-I. At the same time, all participants prioritized clinical effectiveness over costs of care. Patients identified PARP-I delivery from specialty pharmacies, separate and different from other medications, as a potential barrier, but each had been able to navigate delivery. Patients expressed significant initial side effects of PARP-I as a potential barrier yet reported clinician communication and prompt dose reduction as facilitating continuation. ConclusionsPatients identified cost, restrictive pharmacy benefits, and initial side effects as barriers to PARP-I usage. Having insurance and a supportive care team were identified as facilitators. Enhancing communication about PARP-I cost and side effects could improve patient experience and receipt of evidence-based maintenance therapy in ovarian cancer.

Medication strategies: enhancing symptom management and quality of life in palliative care

Background: Palliative care is integral to addressing suffering during advanced illnesses, and tailored medication is crucial. This study aims to explore medication patterns in palliative care, focusing on understanding their impact on symptom management and patient well-being. Methods: Data collection involves a retrospective approach with patients referred to the Community Support Team in Palliative Care of the Trás-os-Montes and Alto Douro Local Health Unit between April 2022 and March 2023. Data are recorded, including demographic information, medical history, and pain-related details. Medication is administered based on healthcare professionals’ judgment, following established pain management guidelines. Descriptive and cross-tabulation techniques are employed for the statistical analysis. Results: Key findings highlight Morphine and Paracetamol as primary analgesics, constituting 14.6% and 13.8%, respectively. Fentanyl, identified as a potent opioid, addresses severe pain at a rate of 10.0%. The study also reveals that 23.7% of cancer patients receive palliative sedation, emphasising its role in symptom control and dignified care. Conclusions: This research provides significant insights into the intricate relationship between medication administration and palliative care outcomes. The study reveals key findings, such as the prominence of Morphine, Paracetamol, and Fentanyl as essential analgesics in addressing pain and improving patient comfort. Additionally, the high prevalence of palliative sedation among cancer patients underscores its crucial role in symptom control and ensuring dignified care at the end of life. The complexity of medication choices within palliative care settings is emphasised, highlighting the need for careful consideration and tailored approaches.

Implementing Behavioral Optimization and Outcomes Support Team in a Medical/Surgical Telemetry Unit.

A community hospital reported 21 staff assaults with injuries and 242 emergency response code green (CG) calls for violent behaviors, resulting in a loss of time in the 2022 fiscal year. Evidence has shown that exposure to violent behavior can compromise effective patient care and lead to job dissatisfaction, high turnover, and higher healthcare costs. This quality improvement project aims to develop and implement behavioral optimization and outcome support team (BOOST) in a medical-surgical telemetry unit to reduce patient-to-staff assaults/injuries. BOOST was piloted for 15 weeks; process data included staff knowledge and satisfaction with BOOST; outcome data included the number of BOOST and CG calls and staff assaults/injuries. The team members included registered psychiatric nurses, nursing supervisors, and security officers. Data were collected and analyzed weekly using a run chart. The survey data demonstrated increased staff knowledge of the behavioral response team and staff satisfaction with the BOOST implementation. No staff injuries or assaults were reported during the BOOST implementation. Behavioral optimization and outcome support team was effective in de-escalating patients and the team provided support to nursing staff. BOOST utilization can effectively reduce assaults and injuries in the workplace.

Detection of Pancreatic Cancer and Nutritional Support in Chronic Pancreatitis

Chronic pancreatitis (CP) is a significant risk factor for pancreatic cancer and there had been a great deal of interest in surveillance and detection of pancreatic cancer. According to presence of genetic mutation, CP can be classified into hereditary CP and sporadic CP. CP with PRSS1 gene mutation showed a high incidence of pancreatic cancer justifying screening and surveillance for those older than 40 years. But CP with other mutations and sporadic CP have relatively low incidence of pancreatic cancer and surveillance is not recommended. While computed tomography or magnetic resonance imaging is widely used for screening, endoscopic ultrasound is not recommended because of parenchymal inflammation, fibrosis, and calcification associated with CP. However, when a patient with CP has multiple risk factors for pancreatic cancer, risk of pancreatic cancer increases significantly. Patients with CP have increased risk of pancreatic cancer at five years after diagnosis; individualized screening and surveillance based on symptoms and specific circumstances should be considered. Patients with CP have a high risk of malnutrition and malnutrition is quite common. Clinicians should assess nutritional status and implement nutritional support. Nutritional support must include both macronutrients and micronutrients. Given the high risk of osteoporosis and osteopathy in CP, clinicians should consider early diagnosis, prevention, and treatment. Consultation with nutritional support team is highly recommended.

Injury Risk and Prevention Strategies Among Saudi and Irish Amateur Women Soccer Players – A qualitative study

Abstract This qualitative study aimed to explore how Saudi and Irish women amateur soccer players perceive soccer-related injury risk and prevention, including barriers and facilitators to the implementation of prevention strategies. Online interviews were conducted with 36 amateur women soccer players (20 Saudi and 16 Irish) of 18 years and older. Findings were analysed using Reflexive Thematic Analysis. Three main themes were identified; (1) “we don’t have enough knowledge about injury prevention” (2) implementing injury prevention measures varies across players and teams, and (3) “we love the game…but we are undervalued”. The biopsychosocial characteristics of the players influenced their experiences on injury prevention in all three themes. Tailored educational programmes for women, their coaches, and parents of younger players, as well as provision of the required support for amateur teams are recommended to encourage participation and implementation of evidence-based injury prevention strategies, taking player’s biopsychosocial characteristics into account.

Effect of video-based education on percutaneous endoscopic gastrostomy tube use duration: A case report

Percutaneous endoscopic gastrostomy (PEG) is a safe, practical, and effective method for enteral nutrition. Minor and major complications may occur after the placement of a PEG tube. In the content of the education provided to caregivers, information should be given about the potential complications and the importance of communicating with the nutrition support team when these issues arise. In this case, we present a patient who was fed through a PEG tube and experienced infections and hypergranulation tissue processes during a thirty-seven-month follow-up, which included one tube replacement. Through this case, we aim to demonstrate that minor complications associated with the PEG tube can be addressed without hospitalization, through collaboration between the patient and the nutrition support team, allowing for an extended period of PEG tube usage.

E024 A pregnant woman with vasculitis and a new rash

Abstract Background/Aims A 41-year-old pregnant woman at 16 weeks of gestation was followed-up in the combined obstetric and rheumatology clinic as she had a history of eosinophilic granulomatosis with polyangiitis (EGPA) and two previous miscarriages at first trimester. Her vasculitis was well-controlled with a baseline daily dose of prednisolone 7.5mg. Methods During her pregnancy, she started on vaginal progesterone by the IVF (In Vitro Fertilization) team for pregnancy support following a vaginal bleed. During her second review in clinic, she complained about a widespread pruritic rash for the last 3 weeks. She had already been seen by her GP who prescribed her emollients without any improvement. On examination, the active lesions looked urticarial and were tender. There was also residual hyperpigmentation. The lesions persisted for more than 24 hours before spontaneous resolution. Cutaneous vasculitis was suspected based on the duration of the rash more than 24 hours, the hyperpigmentation, tenderness, and the history of EGPA. Otherwise, she was well in herself with no symptoms of active vasculitis and no recent infections. Therefore, prednisolone was increased to 15mg daily and loratadine was given for the pruritus. Her repeat blood tests were reassuring with negative ANCA, normal C3 and C4, CRP, and eGFR. Results During her early follow-up, the rash was the same despite the higher dose of steroids and she volunteered that the rash is worse in the morning and at night. Autoimmune progesterone dermatitis (AIPD) was considered then. AIPD is a rare autoimmune hypersensitivity reaction to endogenous or exogenous progesterone. AIPD varies greatly from patient to patient and can present as urticaria, eczema or vesiculobullous eruptions. Urticarial or EGPA vasculitis, and urticaria would have improved with steroids. Furthermore, she did not have any symptoms suggestive of systemic vasculitis and the relevant blood tests were also normal. Of note, the rash was worse in the morning and at night, which corresponded to the time of vaginal exposure to progesterone. The patient stopped the progesterone pessaries after discussion with the obstetrician. The rash improved gradually and resolved in five days, confirming the diagnosis of AIPD. Conclusion The rash could have been mistaken for urticaria or vasculitis. Consequently, the patient may have had unnecessarily antihistamines and steroids during pregnancy with all relevant side effects, such as gestational diabetes. In November 2021, NICE recommended vaginal progesterone in women who experience bleeding in early pregnancy and have a history of miscarriage as it slightly reduces the risk of a further miscarriage. The new guidelines suggest that more pregnant women will use topical progesterone during pregnancy who may develop AIPD. This means that we are going to see more pregnant women in the rheumatology clinic with AIPD and the rheumatology community should be aware of this entity. Disclosure A. Madenidou: Grants/research support; Janssen. H. Kither: None. I. Bruce: Consultancies; AstraZeneca, GSK, Eli Lilly, and UCB. Honoraria; AstraZeneca, GSK, and UCB. Grants/research support; AstraZeneca, GSK, and Janssen.

Challenges and opportunities in achieving secure hospital clinical mobility management: An illustrative use case

Objective: To qualitatively describe a use case at Yale New Haven Health System (YNHHS) illustrating the need for and effective deployment of innovative technologies to manage an enterprise-owned shared device (EOSD) management program. EOSD management provides clinicians with secure, rapid access to enterprise mobile devices and applications, maintains devices in functional, use ready condition for clinicians, and enables enterprise tracking and reduced loss of devices.Methods: Executive leaders in clinical information technology and informatics management at YNHHS were interviewed through written and telephonic communication. Qualitative data was gathered through communications between clinical and information technology executives and the implementation support team of a leading identity and access management (IAM) solutions and EOSD management solution provider. Use case information was gathered, integrated and shared with health system executives and health IT/informatics leaders to verify the description of unmet needs, solution objectives and impact/value delivered after implementation of the EOSD management solution.Results: Benefits realized from implementation of an enterprise-shared mobility management solution included establishment of a cohesive and comprehensive enterprise-owned, shared device management strategy. This included effective monitoring and dynamic management of the system’s mobile device fleet, and better IT resource management with reduced mobile device loss. The IT administrative burden was reduced. While not surveyed systematically, improved clinician experience and satisfaction were reported to IT leaders anecdotally. EOSD management solution deployment was rapid, as was the time to improved clinician mobile experience and clear demonstration of value.Conclusions: A leading US health system was able to rapidly deploy a shared mobile device management solution that enabled effective monitoring and dynamic management of the enterprise mobile device fleet, with easier and faster clinician device access and workflows, and reduced IT administrative demand and costs. While the complexities associated with increased clinical mobility in healthcare will likely continue to grow, issuing future device and mobile management challenges that require effective hospital system response, technologies have emerged that enable more effective, efficient and satisfactory organizational mobility performance.

Nutrition nurses’ status, practices, and routines: an online cross-sectional survey

Objectives: Nutrition is an integral component of care in the intensive care unit. However, no international comparison has been published about the status and practices of nutrition nurses, their legal titles, gained certificates, and routine duties. To describe the working conditions, educational background, nutrition-related practices, challenges, and future development needs of nutrition nurses in Türkiye, the European countries, and the USA. Methods: A cross-sectional design was used. A thirty-three-item online cross-sectional survey was sent to nutrition support nurses in collaboration with national nutrition societies. The data were collected between November 2020 and August 2021. One-way ANOVA and chi-squared test were used to compare the three countries. Results: Eighty-one nurses completed the survey: 44 (54.4%) from Türkiye, 27 (33.3%) from the European countries, and 10 (12.3%) from the USA. All nurses in Türkiye reported having a clinical nutrition support team, while 88.8% in the European countries and 80% of nurses in the USA had this team (p=0.040). Significant differences were found in terms of nurses’ age, length of service, estimated number of ambulant nutritional consultations per week, and time spent on nutritional practices during work (p<0.001). The type of first-line test for nasogastric tube placement was X-ray confirmation (70%) in the US, whereas it is auscultation (77.2%) in Türkiye and pH-testing of gastric aspirate (81.4%) in the European countries (p<0.001). The most frequently reported professional challenge among nurses in Türkiye (66%) and the European countries (22.5%) was having no legal job title. Conclusion: These findings reflect the broader picture of nutrition nurses’ status and point out the need to develop standardized strategies for education and evidence-based nutrition practices. This study has revealed important differences in the roles and responsibilities of nutrition nurses. The study guides the future development needs of nutrition nurses, highlighting the standardized guidelines and protocols for nutrition practices and calling for comprehensive training programs.

A pre-post study of pharmacist-led medication reviews within a hospital-based residential aged care support service.

Hospital-based residential aged-care support service teams typically consist of doctors and nurses who provide hospital substitutive care to aged-care residents. There is limited literature evaluating the pharmacist's role in such aged-care support teams. To analyse the effect of residential aged-care support service pharmacist-led medication reviews on polypharmacy, drug burden index, potentially inappropriate medications, and potential prescribing omissions for aged-care residents. Residents referred to a residential aged-care support service pharmacist for medication review over a 12-month period were included. The pharmacist communicated medication-related problems and recommendations to the resident's general practitioner and residential aged-care support service medical practitioner. Residents' medication histories were obtained at baseline and one-month postintervention. The number of medications and their associated drug burden indices were compared using paired t-tests; potentially inappropriate medications and potential prescribing omissions were compared using Wilcoxon's signed rank test. Of 175 residents (mean age 84 years) referred for pharmacist-led medication review, 146 had postintervention evaluation after one-month (median 29 days). Mean number of medications reduced from 12.47 at baseline to 11.84 postintervention (mean difference (95% CI): 0.63(0.33-0.93), P < .001). Mean drug burden index score reduced from 1.54 at baseline to 1.37 postintervention (mean difference (95% CI): 0.17(0.10-0.24), P < .001). More residents experienced a decrease in inappropriate medications (median (IQR) pre: 2(1-3), post: 1(0-2), P < .001) and prescribing omissions (median (IQR) pre: 0(0-1), post: 0(0-0), P = .003) compared with those that had an increase. Medication reviews performed by pharmacists embedded in hospital-based residential aged-care support services may improve medication prescribing. Further research into such preventative health service models is required.

An exploration of hybrid instruction intentions amongst higher education teachers in post-Covid-19 times

ABSTRACT This study used the Unified Theory of Acceptance and Use of Technology (UTAUT2) model to (i) predict factors influencing HE faculty members’ acceptance of hybrid instruction and (ii) identify factors influencing the faculty members’ behavioural intention to use hybrid instruction. Data were analysed using SPSS 22 and AMOS 23 software. Structural equation modelling techniques were used to analyse 114 data responses gathered online from faculty members. Results show that performance expectancy, social influence, hedonic motivation, regulators’ support and project team capability affected the behavioural intention of faculty members to use online teaching, whereas effort expectancy, facilitating conditions, price value and facilitating leadership did not. The results confirmed the direct impact of behavioural intention of faculty members on the use of online teaching. This research further extends the unified theory of acceptance and use of technology by introducing and validating three new constructs: facilitative leadership, regulatory support, and project team capability. The findings of the study add significant value to the acceptance of hybrid teaching among teachers, and informs how faculty members might be trained and supported.

Role of family medicine physicians in providing nutrition support to older patients admitted to orthopedics departments: a grounded theory approach.

Care of older adults requires comprehensive management and control of systemic diseases, which can be effectively managed by family physicians. Complicated medical conditions in older patients admitted to orthopedic departments (orthopedic patients) necessitate interprofessional collaboration. Nutrition is one of the essential components of management involved in improving the systemic condition of older patients. Nutrition support teams play an important role in nutrition management and can be supported by family physicians. However, the role of family physicians in nutrition support teams is not well documented. This study aimed to investigate the role of family physicians in supporting nutrition management in orthopedic patients. This qualitative study was conducted between January and June 2023 using constructivist grounded theory methodology. Eight family medicine physicians, three orthopedic surgeons, two nurses, two pharmacists, four rehabilitation therapists, four nutritionists, and one laboratory technician working in Japanese rural hospitals participated in the research. Data collection was performed through ethnography and semi-structured interviews. The analysis was performed iteratively during the study. Using a grounded theory approach, four theories were developed regarding family physicians' role in providing nutrition support to orthopedic patients: hierarchical and relational limitation, delay of onset and detection of the need for geriatric care in orthopedic patients, providing effective family medicine in hospitals, and comprehensive management through the nutrition support team. The inclusion of family physicians in nutrition support teams can help with early detection of the rapid deterioration of orthopedic patients' conditions, and comprehensive management can be provided by nutrition support teams. In rural primary care settings, family physicians play a vital role in providing geriatric care in community hospitals in collaboration with specialists. Family medicine in hospitals should be investigated in other settings for better geriatric care and to drive mutual learning among healthcare professionals.

A Model for Providing Psychological Support to Healthcare Leaders and Teams in Times of Crisis.

Pre-pandemic, the healthcare workforce was already at risk for higher burnout than the general population and, in some roles (e.g., physicians, nurses), at higher risk for clinical distress and suicide. Studies of healthcare workforce well-being during and after past pandemics reflect that distress can persist after a pandemic subsides, if adequate support within the workplace is not forthcoming and accessible. The current report presents the rationale for and development of a wellness consult service to provide support to leaders and teams in an academic medical center during the COVID-19 pandemic and now as teams work to recover and rebuild after years of significant pandemic and other stressors. Healthcare workers who participated in supportive Listening Sessions or Interactive Workshops facilitated by the wellness consult service were invited to complete an anonymous post-session survey. Between March 2020 and November 2022, 185 leaders and teams participated in 342 supportive Listening Sessions and Interactive Workshops. Of the respondents to the post-session survey (N = 701), 89% rated the intervention as "good to excellent" and 84% were likely or very likely to recommend this service. Leaders rated the experience more highly than non-leaders (F (1,307) = 13.99, p < 0.001) and were more likely to report feeling emotionally supported (F (1,304) = 19.836, p < 0.001). Supporting leader and team well-being may be critical to post-pandemic recovery of the healthcare workforce. The current report presents a feasible, theory-driven model for doing so, which was rated as highly satisfactory by participants.

Pregnancy in the shadow of psychosis: Navigating first-time motherhood with increased likelihood of postpartum psychosis and postnatal depression.

WHAT IS KNOWN ON THE SUBJECT?: New parents who have previously experienced psychosis outside and/or following childbirth have an increased likelihood of experiencing an episode during the postpartum period. The decision to try to conceive can be agonising. Receiving care from a specialist perinatal community mental health team can improve outcomes. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This article offers a first-person insight into the steps the author took to minimise the impact of an episode of postpartum psychosis and/or postnatal depression whilst navigating new motherhood. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This lived experience narrative aligns with the evidence base that demonstrates specialist perinatal community mental health services improve outcomes. It highlights the importance of maternity care providers asking about mental health history to identify any previous episodes or family history and offering referral to a specialist perinatal mental health service if available. ABSTRACT: Introduction Postpartum psychosis is a life-changing but treatable condition that usually occurs in the first few days to weeks after childbirth affecting 1-2 in 1000 pregnancies. Those who have experienced psychosis before, either as a single episode, related or unrelated to childbirth or as part of a long-term mental health condition have a higher likelihood of experiencing an episode in the postnatal period. Aim In this lived experience narrative the author shares personal experience of planning and navigating pregnancy with a higher likelihood of experiencing postpartum psychosis and postnatal depression around this major life transition due to previous episodes. Methods The author utilises a first-person approach to share and reflect on her lived experience. Findings The author shares her experience of receiving care and some of the steps she took to try to manage the impact of pregnancy and birth on her mental health during this major life transition. She describes how care from a specialist perinatal community mental health team and peer support contributed significantly to her family's well-being. Discussion Specialist perinatal community mental health services can improve outcomes for those with a higher likelihood of experiencing postpartum psychosis and postnatal depression by facilitating planning and mitigating some of the risks that could lead to relapse in the perinatal period.

A short-term “behavioural support” service for autistic adults without an intellectual disability: a pilot evaluation

Purpose A region’s transforming care partnership identified that autistic adults without an intellectual disability (ID) may be falling through gaps in services when presenting with a significant emotional and/or behavioural need in the absence of a mental health diagnosis. The region’s intensive support teams (ISTs) for adults with ID therefore piloted a short-term “behavioural support service” for this population. The purpose of this paper is to evaluate this pilot. Design/methodology/approach This study represents a mixed-methods service evaluation over a four year pilot period. The quantitative component examined referral rates and demographic data of accepted and declined referrals; and length of referral episodes and Health of The Nation Outcomes Scores (HoNOS) for accepted referrals. The qualitative component used thematic analysis to identify key themes relating to reasons for referral, clinical/therapeutic needs, and the models of support that most informed assessments and interventions at individual and systems levels. Findings The ISTs accepted 30 referrals and declined 53. Most accepted referrals were male (83%), and under 24 years old (57%). Average HoNOS scores were above the thresholds generally associated with hospital admission. Key qualitative themes were: transitional support; sexual risks/vulnerabilities; physical aggression; domestic violence; and attachment, trauma and personality difficulties. Support mostly followed psychotherapeutic modalities couched in trauma, attachment and second- and third-wave cognitive behavioural therapies. Positive Behaviour Support (PBS) did not emerge as a model of preference for service users or professionals. Originality/value This project represents one of the first of this type for autistic adults without an ID in the UK. It provides recommendations for future service development and research, with implications for Transforming Care policy and guidance.

Pancreatic surgery and tertiary pancreatitis services warrant provision for support from a specialist diabetes team

Pancreatic surgery units undertake several complex operations, albeit with considerable morbidity and mortality, as is the case for the management of complicated acute pancreatitis or chronic pancreatitis. The centralisation of pancreatic surgery services, with the development of designated large-volume centres, has contributed to significantly improved outcomes. In this editorial, we discuss the complex associations between diabetes mellitus (DM) and pancreatic/periampullary disease in the context of pancreatic surgery and overall management of complex pancreatitis, highlighting the consequential needs and the indispensable role of specialist diabetes teams in support of tertiary pancreatic services. Type 3c pancreatogenic DM, refers to DM developing in the setting of exocrine pancreatic disease, and its identification and management can be challenging, while the glycaemic control of such patients may affect their course of treatment and outcome. Adequate preoperative diabetes assessment is warranted to aid identification of patients who are likely to need commencement or escalation of glucose lowering therapy in the postoperative period. The incidence of new onset diabetes after pancreatic resection is widely variable in the literature, and depends on the type and extent of pancreatic resection, as is the case with pancreatic parenchymal loss in the context of severe pancreatitis. Early involvement of a specialist diabetes team is essential to ensure a holistic management. In the current era, large volume pancreatic surgery services commonly abide by the principles of enhanced recovery after surgery, with inclusion of provisions for optimisation of the perioperative glycaemic control, to improve outcomes. While various guidelines are available to aid perioperative management of DM, auditing and quality improvement platforms have highlighted deficiencies in the perioperative management of diabetic patients and areas of required improvement. The need for perioperative support of diabetic patients by specialist diabetes teams is uniformly underlined, a fact that becomes clearly more prominent at all different stages in the setting of pancreatic surgery and the management of complex pancreatitis. Therefore, pancreatic surgery and tertiary pancreatitis services must be designed with a provision for support from specialist diabetes teams. With the ongoing accumulation of evidence, it would be reasonable to consider the design of specific guidelines for the glycaemic management of these patients.

Connecting Students With Significant Support Needs to Employment: A Tool to Structure Employment Planning Meetings

One powerful way to prepare students with significant support needs for employment in adulthood is to ensure they experience employment during high school. To assist students with significant support needs in developing their employment goals and connecting to and sustaining a job, we developed a person-centered planning meeting focused centrally on employment—the Employment Planning Meeting. During the meeting, an Employment Planning Meeting Tool (The Tool) is used to guide and provide structure and organization for a team supporting a student. It serves as a living document of the student’s interests, needs, and goals as they relate to employment during and after high school. This article describes each step of the meeting and how to use the Tool with students and their support team members. In addition, we share the experiences of professionals who organized and facilitated Employment Planning Meetings with a student with significant support needs and their families.

Implementatie van de Infectierisicoscan in een ziekenhuisnetwerk door het Hospital Outbreak Support Team

Implementation of the Infection Risk Scan in a hospital network by the Hospital Outbreak Support Team The Infection Risk Scan (IRIS) assesses the quality of infection prevention and control (IPC) and antimicrobial stewardship (AMS) in a hospital ward by the standardized measurement of a broad range of quality indicators. IRIS was implemented in the geriatric wards of the 4 hospitals of the Plexus healthcare network ‘Oost-Vlaams-Brabant’ (Belgium). The goal was to compare the IPC and AMS policies of the hospitals in order to define common improvement strategies within the Hospital Outbreak Support Team (HOST), a federal project concerning IPC and AMS. In the first part of IRIS, the risk profile of the patient population is determined by a point prevalence measurement of 4 variables. In the second part, the improvement plot is created based on the measurement of 7 quality indicators. Improvement actions can be deduced from quality indicators with higher improvement potentials. The risk profiles of the 4 hospitals were highly comparable and the improvement plots showed an intermediate to high improvement potential for the use of AMT and hand hygiene compliance. There were important differences in the appropriate use of transurethral and intravascular catheters, with 2 hospitals having a low and 2 hospitals having a high improvement potential. IRIS was a useful tool in the early phase of the HOST project to benchmark the IPC and AMT policies between the Plexus hospitals and to decide what future projects could be collaborated on. As a result of IRIS, it was decided to define common care bundles for the prevention of catheter-associated urinary tract and blood stream infections and to determine hospital-specific actions with regard to the optimisation of AMS.

Cartes conceptuelles des facteurs critiques à la transition vers des espaces ouverts et flexibles sur la performance et le bien-être

&lt;p&gt;Many organizations are considering reconfiguring their workspaces to optimize them. While studies (Brunia et al., 2016; Dunford et al., 2013; Hoendenvanger et al., 2016) on open and flexible spaces tend to show mixed results, it is important to consider experimenting and transitioning to these new spaces so that they best meet the needs of the change recipients and the organization. A pilot project was built for recipients to experiment with new spaces. A support team followed 15 cohorts of about 15 people for two to three months each, over three years. Exploratory action research in a university setting made it possible to collect qualitative data from weekly follow-up meetings, a survey, and videotaped statements. Concept maps created (Davies, 2011) from 260 verbatim excerpts illustrate the hierarchical relationships between critical factors and their psychosocial effects. The results show three critical factors. The diversity and flexibility of the layouts facilitated adaptation and created a sense of increased performance by meeting the needs for focus, privacy, and teamwork. Physical proximity contributed to increased social interaction and accessibility to colleagues and managers, leading to collaboration and a sense of well-being. Change management fostered the perception of organizational support and spatial appropriation. Change management practitioners and leaders might consider a transition period of a few months for learning and monitoring of recipient groups before final decisions are made. The results obtained need to be contextualized and could vary by type of position. The effects of these spaces in the long term and consideration of tasks performed during the days spent in the office would be interesting leads for future studies.&lt;/p&gt;