Training Of Multidisciplinary Team Research Articles

Impact of multidisciplinary foot care team on outcome of diabetic foot ulcer in term of lower extremity amputation at a tertiary care unit in Karachi, Pakistan

To compare the outcomes of diabetic foot ulcers (DFU) in terms of healing and lower extremity amputation (LEA) rate before and after training of multidisciplinary foot care team (MDFCT). Subjects were categorised into two groups; Group-A cases seen between 1997 and 2006 (before upgrading of training and services of MDFCT) and Group-B cases seen between 2007 and 2016 (after upgrading of training and services of MDFCT). Baseline demographic characteristics, biochemical results, and outcomes of DFU in terms of healing or amputation were analysed by using statistical package social science (SPSS) version 20. Total 7994 DFU cases seen, 888 in group A and 7106 in group B. Mean age of patients was 53.80 ± 10.40 years and mean haemoglobin (HbA1c) was 10.12 ± 2.44. Overall, decreasing trends of amputations were observed from baseline 27.5% to 3.92% during the period of 20 years. In group A, 479 (78.8%) subjects healed completely compared with 3806 (89.1%) in group B. Significant reduction in toe amputations ([13.81%] vs [8.11%]) and below knee amputations [(5.26%) vs (1.82%)] were seen. Similarly, rates of above knee amputation ([1.80%] vs [0.35%] P-value 0.008) in two groups was also significant. Significant improvement was observed in outcomes of DFU in terms of amputation through multidisciplinary team approach.

Mothers and Premature Infants’ Emotional Interactions in a Neonatal Infant Care Unit: Case Studies

The aim of this study was to describe the ways premature infants and their mothers emotionally interact in the first weeks of their lives. In order to understand the intersubjective dyadic interaction between mother and premature infant, a qualitative and descriptive approach to research has been adopted. Four dyads comprised of primiparae women and their newly-born premature infants took part in the study. The babies were born prematurely after 28 to 35 weeks of gestation and admitted to the neonatal intensive care unit (NICU). Data was collected filming the first dyadic interaction with infant in the mother’s arms, lasting between 15 to 30 minutes. After that first registry, dyadic behaviors between mother and baby were described and categorized following the intersubjective categories suggested by Fiamenghi (1999) and Fiamenghi et al. (2010). Results showed that dyads display positive emotions, with infants’ behaviors falling into the categories of negotiation, interaction and emotional curiosity; as well as a low frequency of negative behaviors. The outcome of this research reinforces the need to adopt a humanizing approach to prematurely born infants and their mothers in NICU, as well as training and awareness of the whole multidisciplinary team that deals with them.

EGFR testing scenario across 111 centres in India: A questionnaire-based survey.

e13111 Background: Lung cancer diagnosis now involves routine use of biomarker testing to identify the driver mutations. We conducted a survey of 111 medical oncologists across India to understand the current pattern of EGFR mutation testing at their respective centres. Methods: Medical oncologists from 111 institutes across India were interviewed face to face using a structured questionnaire. They were divided into two groups - Group 1 with in-house EGFR testing and Group 2 who send samples to central/commercial labs. Answers of the two groups were analysed to see the prevailing patterns of EGFR mutation testing and differences between the groups if any. Results: In India, 95% of medical oncologists recommend testing for EGFR mutations in patients with adenocarcinoma histology. 40% would also recommend testing in squamous histology. 80% of medical oncologists request for biomarker testing at the time of primary biopsy. From the time of biopsy, the average time duration to get EGFR test results is 18 days. In centres with in-house testing (Group 1), results are available in 10 days. 96% of the medical oncologists from Group 1 centres request for factoring additional sample for biomarker testing compared to only 69% from Group 2. 69% of medical oncologists in Group 1 centres would prefer to wait for the test results before initiating treatment compared to 46% in Group 2. EGFR TKIs are used in 60% of patients with diagnosed EGFR mutation in the first line. For patients in whom chemotherapy is initiated while waiting for test results, 50% of medical oncologists prefer completing 4-6 cycles before switching to targeted therapy. At the time of progression, rebiopsy is possible in 25% of the patients. Rapid disease progression and poor PS were the two most common reasons given for the low rebiopsy rates. Conclusions: Application of molecular testing is ‎improving. Yield can be improved by training of multidisciplinary team involved in tumor biopsy. There is scope and need to reduce the turnaround time. This will reduce the current scenario of commencing chemotherapy while waiting for test results. Increasing application of liquid biopsy will help in initial diagnosis as well as at relapse, especially for patients with poor PS or difficult access to tumor site.

The speech-language pathologist's role in multidisciplinary burn care: An international perspective

PurposeTo explore international practices of speech-language pathology (SLP) within burn care in order to provide direction for education, training and clinical practice of the burns multidisciplinary team (MDT). Method(s)A 17-item online survey was designed by two SLPs experienced in burn care with a range of dichotomous, multiple choice and open-ended response questions investigating the availability and scope of practice for SLPs associated with burn units. The survey was distributed via professional burn association gatekeepers. All quantitative data gathered were analysed using descriptive statistics and qualitative data were analysed using content analysis. Result(s)A total of 240 health professionals, from 6 different continents (37 countries) participated within the study. All continents reported access to SLP services. Referral criteria for SLP were largely uniform across continents. The most dominant area of SLP practice was assessment and management of dysphagia, which was conducted in concert with other members of the MDT. ConclusionSLP has an international presence within burn care that is currently still emerging.

The One Minute Wonder Network.

The European Working Time Directive has had a well-documented impact on training, and therefore educational opportunities should be maximised. The clinical day has frequent short, routine pauses that could allow for brief bites of medical education. The One Minute Wonder Network was developed to take advantage of these pauses, and has created an additional educational opportunity within the normal working day. One Minute Wonders (OMW) are focused educational displays that contain information that can be read and absorbed in just 1minute. They are displayed on boards located where teams regularly briefly wait and experience dead time. The board topics change weekly and feature clinical topics related to the department. Written displays are shared between board hosts through the project website, enabling many departments to freely benefit from each OMW and the educational resource. The network of OMW boards has expanded across several specialties in addition to emergency medicine, and has been welcomed by trainees. There is now a large archive of OMWs available to share. One Minute Wonder boards are a novel opportunity for the education and training ofan entire multidisciplinary team.

Good practice recommendations on paediatric training programmes for health care professionals in the EU

Part of the SWEET Project: EU (European Union), Better Control in Paediatric and Adolescent Diabetes: Working to Create Centres of Reference, was specifically to examine the training of health care professionals (HCPs) across the EU. Several types of information were collected during 2009, and these included a literature search, workshops of the SWEET members, examination of the data collected by the Hvidøre Study Group and the Diabetes Attitudes, Wishes, and Needs (DAWN) Youth initiative, and a questionnaire distributed to SWEET members and professional colleagues who cared for children and young people (CYP) with diabetes. It was clear from the information collected that there was no European or global consensus either on a curriculum for the training of the paediatric diabetes multidisciplinary team (MDT) or individual professions in paediatric diabetes. A minority of countries had well-established training but, for the majority, there was little standardisation or accreditation. Moreover, most countries did not have available courses for training the diabetes MDT and training was not mandatory. Of the courses that were available more were accredited for doctors and nurses but fewer for the other professions. As a consequence, the majority of HCP posts in paediatric diabetes do not demand prior experience in the specialty. Standardised accredited training and continuous professional development (CPD) opportunities are severely limited. The SWEET Project supports a standardised, accredited approach to training and CPD of the MDT and for individual professions. As a consequence, a curriculum for the training of the MDT was developed, and this is now ready for implementation.