Implementation and Outcomes of Multidisciplinary Diabetes Management Program Among Type 2 Diabetic Patients: A Comparative Study.

BACKGROUND: Current guidelines recommend shifting physician-led care (PLC) for type 2 diabetes mellitus (T2DM) to more effective multidisciplinary health care (MHC). However, few researchers have studied its real-life implementation in Saudi Arabia. Therefore, we aimed to assess the implementation and compare the outcomes of an MDC diabetes management program (DMP) among T2DM patients to a PLC at a general hospital after one year of follow-up in a real-world practice setting. METHODS: We conducted this comparative patient files review study by analyzing medical records of all T2DM patients at two private care centers. Both were compared for their effectiveness in achieving two outcomes: the glycated hemoglobin (HbA1c) <7% and low-density lipoprotein-cholesterol (LDL-c) <70 mg/dl at the end of the first year. Additionally, we assessed the implementation of the DMP. RESULTS: Eight hundred thirty-four medical records were reviewed, 537 from DMP, and 279 from the PLC center. The personal health coordination was almost complete (97.8%) in the DMP, but the implementation was incomplete regarding nutrition (65.7%), dental exam (64.8%), and foot care (58.3%). Both care groups were matched for age (p = 0.056), gender (p = 0.085), duration of diabetes (p = 0.217), and basal glycemic control (p = 0.171). The DMP showed a significant net decrease in HbA1c (-0.5 [IQR 1.47%] vs -0.2 [IQR 3.05%], p = 0.0001) and LDL-c (-10 [IQR 50] vs -5 [IQR 60.5] mg/dl, p = 0.004) compared to PLC. A higher percentage of patients achieved glycemic control in the DMP than in the PLC (49.4% vs 38.7%, p = 0.038). However, both programs demonstrated similar outcomes in lipid control (28.7% vs. 30%, p = 0.695). CONCLUSION: Despite some gaps in implementation, one year of DMP showed better glycemic control among T2DM patients compared to PLC. Both programs were comparable in terms of lipid control. Further studies identifying the gaps in care implementation could improve sustainability, future replication, and generalizability of similar programs to other healthcare systems in Saudi Arabia.

Anaesthetic management of a child with Fontan heart undergoing laparoscopic cholecystectomy: A case report.

The Fontan procedure is a staged palliative surgery performed in children with congenital univentricular heart defects. These individuals are predisposed to a variety of issues due to their altered physiology. Through this article, we would like to describe the evaluation and anaesthetic management of a 14-year-old boy with Fontan circulation who underwent an uneventful laparoscopic cholecystectomy. The key to successful management was a multidisciplinary approach throughout the perioperative period as these patients pose a unique set of problems.

[The Hospice-Care Promotion Experiences of Multidisciplinary Care Providers in Residential Long-Term Care Facilities: A Qualitative Study].

BACKGROUND: In aging societies, residents of residential long-term care facilities (RLTCF) are a population that can significantly influence the success of efforts to promote hospice care and to achieve societal goals of domestic aging in place and good death. Multidisciplinary healthcare providers in RLTCF play vital roles in assessing, coordinating, and implementing the "five whole concepts" of hospice care. PURPOSE: To explore multidisciplinary healthcare providers' experiences with implementing hospice care in RLTCF. Study results may be referenced for future research into hospice care in RLTCF. METHODS: In this qualitative study, one-on-one interviews were conducted with 14 multidisciplinary healthcare providers working for three hospital-affiliated RLTCFs in Northern Taiwan from April to July 2019. Each interview lasted between 40 and 68 minutes. Data were transcribed and then analyzed using the content analysis technique. RESULTS: The emergent themes derived from participant experiences were "lack of hospice care literacy and multidisciplinary communication", "insufficient resources for hospice care implementation", "a dilemma between reasonability and sensibility", "quandary about and bearing from facing family dying", and "expectation of mental and physical well-being for family and residents". CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The experiences of the participants illuminate the importance of strengthening hospice care training for multidisciplinary RLTCF healthcare providers; establishing standard operating procedures; and increasing the manpower, environmental, and equipment resources available for implementing hospice care in RLTCF.

Application of Interprofessional Education Model to University Pre-Licensure Health Students in the Management of Chronic Care Conditions in Zambia.

Background: There is evidence that multidisciplinary healthcare teams can provide better quality of care and treatment outcomes compared to that delivered by individuals from a single health discipline. The project on which this article is based applied the interprofessional education model to university pre-licensure health students in the management of chronic care conditions in Zambia. Methods: Four distinct but interrelated approaches, namely desk review; module development workshops; review and validation of modules by experts; piloting and review of the training modules were employed. Results: Several models of interprofessional education currently in existence and used successfully by higher education institutions in other settings were identified. While several models of Interprofessional Education were identified, our project adapted the "didactic program, community-based experience, and interprofessional-simulation experience" models. To apply the models, modules of seven chronic care conditions were developed and piloted. The extent to which the module activities promoted interprofessional education were rated between 74 - 87% (agree or strongly agree) by the students. Conclusion: Three models of Interprofessional Education were identified and adapted in the project, and seven modules were developed and administered to the students. The process was effective for putting forth an interprofessional training program at the undergraduate level, with the potential to improve quality of care for patients.

'I think we're getting a bit clinical here': A qualitative study of professionals' experiences of providing mental healthcare to young people within an Australian rural service.

This paper contributes to scholarship on the medicalisation of mental health support for young people through a case study of a multidisciplinary mental health service in rural Australia. All staff (n = 13) working at the service participated in semi-structured, individual interviews. Transcripts of interview data were read and selectively coded and interpreted in relation to the overarching question of how participants view and experience mental health care provision to a diverse range of young people. Following analytical reflection, codes pertaining to engagement, accessibility and care provision were re-examined using the concept of medicalisation to understand the biomedical underpinning of mental healthcare and how this plays out in the experiences and perceived challenges participants talked about in responding to the mental health concerns of diverse young people. The resulting analysis is presented under five theme headings: (a) privileging clinical expertise and priorities within service provision, which was an important source of conflict for some participants; (b) 'multidisciplinary' teams-a 'difficult kind of culture at times'; (c) articulations of where cultural barriers lie; (d) the tracks along which young people are directed to 'engage' with 'mental health'; and (e) a clinical 'feel' to space. We suggest that service and system investment needs to be given to alternative ways of thinking about and approaching mental health and care provision that are cognisant of, and engage with, the inherent connections between individual circumstance and social, place, cultural, economic and political contexts. This is particularly relevant to the provision of care in rural contexts because of limited service options and the complexities of access and providing care to a diverse range of young people living in isolated environments. Interdisciplinary frameworks need to be enacted and services must acknowledge their own cultural positions for alternative ways of working to become possibilities.

Application of Interprofessional Education Model to University Pre-Licensure Health Students in the Management of Chronic Care Conditions in Zambia

Background:Thereisevidencethatmultidisciplinary healthcare teams can provide better quality of care and treatment outcomes compared to that delivered by individuals from a single health discipline. The project on which this article isbased applied the interprofessional education model to university pre-licensure health students in the management of chronic care conditions in Zambia. Methods:Four distinct but interrelated approaches, name ly desk review; module development workshops; review and validation of modules by experts; piloting and review of the training modules were employed. Results: Severalmodelsofinterprofessionaleducationcurrentlyinexistenceandusedsuccessfully by higher education institutions in other settings were identified. While several models of Interprofessional Education were identified, our project adapted the "didactic program, community-based experience, and interprofessional-simulation experience" models. To apply the models, modules of seven chronic care conditions were developed and piloted. The extent to which the module activities promoted interprofessional education were rated between 74 - 87% (agree or strongly agree) by the students. Conclusion: Three models of Interprofessional Education were identified and adapted in the project and seven modules were developed and administered to the students. The process was effective for putting forth an interprofessional training program at the undergraduate level, with the potential to improve quality of care for patients.

Health Concerns of Adolescents and Adults With Spina Bifida.

Due to advancements in medical care, people with spina bifida (SB) are surviving well into adulthood, resulting in a growing number of patients transitioning to an adult sector unequipped to care for people with chronic rehabilitative and medical needs. The Transitional and Lifelong Care (TLC) program is a multidisciplinary clinical service that compensates for this gap, providing comprehensive, coordinated care to adolescents, and adults with SB. As a relatively new clinical service, objective data about the patients using the service and their needs is scant. This study sought to identify the most common health concerns among TLC patients with SB at initial clinical consultation. A retrospective chart review of 94 patient charts was performed. Following data extraction, descriptive analyses were completed. The mean age of the sample was 29.04 ± 13.8 years. One hundred individual concerns and 18 concern categories were identified. On average, patients or care providers identified nine health concerns across various spheres of care, with care coordination being the most prevalent concern identified (86%). Patients also commonly had concerns regarding neurogenic bladder (70%), medications (66%), assistive devices (48%), and neurogenic bowel (42%). The numerous and wide-ranging health concerns identified support the need for individualised, coordinated care and a "medical home" for all adolescents and adults with SB during and following the transition to adult care. Health care providers caring for this population should continue to address well-documented health concerns and also consider raising discussion around topics such as sexual health, mental health, and bone health. Further research is required to understand how best to address the complex medical issues faced by adults with SB to maximise health and quality of life and improve access to healthcare.

Has "The Ceiling" Rendered the Readiness for Interprofessional Learning Scale (RIPLS) Outdated?

PURPOSE: The present study aimed to investigate the preliminary effects of collaborative learning and simulation on readiness to engage in and attitudes toward future interprofessional learning activities. We translated into Norwegian and validated the original Readiness for Interprofessional Learning Scale (RIPLS) (part 1) to measure the efficacy and feasibility of a structured collaborative learning activity (part 2). MATERIALS AND METHODS: Undergraduate social and health care professional students from five Norwegian universities (n = 307) participated in the validation stage of this study (part 1). A Norwegian version of the RIPLS was developed using forward and backward translation. An expert panel discussed discrepancies between the translations and professional concepts. We planned to conduct a principal component analysis to evaluate the structure, reliability, and internal consistency of the Norwegian version of the RIPLS, after investigating the skewness, kurtosis, and range of items included. One hundred fifty students participated in collaborative learning activities; 72 (48%) of these individuals answered the translated RIPLS questionnaire. RESULTS: We found a substantial ceiling effect in the majority of items in the RIPLS, making it difficult to use the instrument as a measure of change. We evaluated the efficacy and feasibility of the collaborative activities based on the changes in the single items that had sufficient univariate normality and ultimately confirmed positive changes in two of these items. CONCLUSION: Norwegian students appear ready for interprofessional learning; however, due to significant ceiling effects, the majority of items in the RIPLS no longer seem suitable for measuring and evaluating the effects of interprofessional learning (part 1). Single-item analysis revealed a potential effect of collaborative learning (part 2). A new questionnaire is needed where readiness is instead understood as self-efficacy in areas such as role awareness and interprofessional communication. Researchers should be aware that even previously validated questionnaires may lose their applicability over time and require revision. Demands for interprofessional learning and practice are continuously evolving, and evaluation methods should be adjusted accordingly.

Sialorrhoea Management Practices in Residential Older Adults Care Settings: A Qualitative Study.

AIM: The aim of this research was to explore both older adults' and health care professionals' experience and views of sialorrhoea management practices in older adult residential care settings. BACKGROUND: Sialorrhoea is quite a bothersome symptom among patients with certain neurological conditions. The complexity of sialorrhoea and its complications can be quite challenging for health care professionals. In the management of sialorrhoea, a multidisciplinary approach is proposed as an effective way of sialorrhoea management. METHODS: Thematic analysis of collected data via semi-structured qualitative interviews with five focus groups involving 28 multidisciplinary health care members and 1 patient. RESULTS: The older adult and multidisciplinary health care professionals' view of the management of sialorrhoea in residential care settings were established under three main themes: 1) 'Sialorrhoea compromising patient's dignity', 2) 'Ad hoc local management' and 3) 'Further integration of care required'. CONCLUSION: At present, there have been no comprehensive multidisciplinary sialorrhoea management strategies to meet the various needs of older adults with sialorrhoea. IMPLICATION FOR NURSING MANAGEMENT: It is important to minimize the negative impact of sialorrhoea on the patients. The recognition of issues associated with sialorrhoea provides constructive scope for the health care professionals to further investigate and develop more effective integrated sialorrhoea care protocols.

School nurses' perceptions of concussion management for secondary school student-athletes.

Background: School nurses play a vital role in concussion management at the secondary school level, often being the only on-site healthcare provider during school hours. However, little is known regarding how they perceive their role in the concussion management process. The purpose of this study was to explore school nurses' perceptions and satisfaction with concussion management in the secondary school setting using a qualitative approach.Methods: Twenty-two school nurses employed within a United States secondary school setting completed individual, semi-structured phone interviews. Data were analyzed using a consensual qualitative research approach.Results: Four overall themes emerged. This manuscript focuses on one specific theme: school nurse perceptions and satisfaction regarding concussion management. Subthemes included: school nurses' overall perception and satisfaction with current concussion management procedures, interactions with other involved personnel, concussion assessment tools, school nurses' perceived role, current concussion management policies, concussion education, and school nurse continuing education specific to concussion.Conclusions: School nurses were generally positive regarding concussion management within their setting and were satisfied with their roles overall. However, participants identified a number of areas that require further attention to ensure an evidence-based, consistent team approach to concussion management to support best student outcomes and continuity of care.

Care pathways in thrombosis management: the INNOVATE peer-to-peer educational initiative.

CONTEXT: Anticoagulant options for the management of venous thromboembolism (VTE) now include the non-vitamin K antagonist oral anticoagulants (NOACs). The safe and effective integration of these agents into routine clinical practice within different health care settings presents common challenges. Bayer AG created the INternational Network fOr Venous and Arterial Thrombosis Excellence in practice (INNOVATE) program as a professional education network to foster best practice in thrombosis management in the NOAC era. CONCEPT AND FORMAT: Since 2013, INNOVATE has been run as a series of educational 1.5-day global meetings at VTE centers of excellence. The format is based on expert-led discussion rather than lectures; all participants are encouraged to share their own expertise and experience. Through peer-to-peer exchange, less experienced professionals from an array of specialties learn from others in a small-group interactive setting. This format encourages positive engagement and discussion, and the establishment of relationships between health care professionals from different countries. EXPANSION AND LOCALIZATION: INNOVATE has successfully expanded to cover a broad spectrum of thromboembolic disorders in which anticoagulation with NOACs plays an important role; now including specific meetings focusing on the management of patients in the community. Local meetings are run in many countries in the local language, facilitating discussion and ensuring applicability to local or regional issues. IMPLEMENTING LEARNINGS: INNOVATE delegates have provided consistently positive feedback and have used their attendance to create and improve thrombosis management pathways in their own institutions. Overseen by a Steering Committee, the program responds to feedback, evolving to meet the needs of participants. CONCLUSION: By showcasing best practice in the care of patients requiring anticoagulation, INNOVATE provides a model for the non-promotional support of medical education by industry. The objectives are to encourage the responsible use of new drugs (specifically NOACs) and their integration into existing and new care pathways and to ensure that every patient receives the benefit of evidence-based clinical practice.

The complex patient: A concept clarification.

Over the last decade, the concept of the "complex patient" has not only been more widely used in multidisciplinary healthcare teams and across various healthcare disciplines, but it has also become more vacuous in meaning. The uptake of the concept of the "complex patient" spans across disciplines, such as medicine, nursing, and social work, with no consistent definition. We review the chronological evolution of this concept and its surrogate terms, namely "comorbidity," "multimorbidity," "polypathology," "dual diagnosis," and "multiple chronic conditions." Drawing on key principles of concept clarification, we highlight disciplinary usage in the literature published between 2005 and 2015 in health sciences, attending to overlaps and revealing nuances of the complex patient concept. Finally, we discuss the implications of this concept for practice, research, and theory.

The role of anatomy education in facilitating multidisciplinary collaboration in the treatment of musculoskeletal conditions ­ an example from Australia / El papel de la educación de la anatomía en la facilitación de la colaboración multidisciplinaria en el tratamiento de las afecciones musculoesqueléticas ­ un ejemplo de Australia

Emerging changes to the healthcare system are promoting the adoption of an integrative medicine and a more patient-centred approach to healthcare. A multidisciplinary approach to the management of musculoskeletal conditions has a potential to ease the pressure off the emergency public health care system. Interprofessional collaboration in health care is paramount for this synergism to occur. It is crucial that treatment options be consistent and transparent across different health professions in order for optimum patient centred care. Using the Australian educational and health setting as an example, it is argued in this paper that anatomy education could play an important role in facilitating this consistency and transparency. The first decisive step in this process would be to review the alignment of anatomy syllabi across the academic programs of different health professions. The review and comparison of anatomy content taught across the different health professional curricula should expedite the acceptance of one profession by another. This alignment of anatomy teaching would aid interprofessional relations and ultimately collaboration, beginning from education of students through to professional practice and encompassing accreditation guidelines.

Los cambios emergentes en el sistema de salud están promoviendo la adopción de una medicina integradora y un enfoque más centrado en el paciente en la atención sanitaria. Un enfoque multidisciplinario para el manejo de las afecciones musculoesqueléticas tiene el potencial para aliviar la presión del sistema de salud pública de emergencia. La colaboración interprofesional en el cuidado de la salud es primordial para que este sinergismo ocurra. Es crucial que las opciones de tratamiento sean coherentes y transparentes en las diferentes profesiones de la salud con el fin de que la atención centrada en el paciente sea óptima. Utilizando el marco educativo y de salud australiano como ejemplo, se argumenta en este trabajo que la educación en anatomía podría desempeñar un papel importante para facilitar esta consistencia y transparencia. El primer paso decisivo en este proceso sería revisar la alineación de los programas de anatomía a través de los programas académicos de diferentes profesiones de la salud. La revisión y comparación del contenido de la anatomía enseñada en los diferentes currículos de profesionales de la salud debería acelerar la aceptación de una profesión por otra. Esta alineación de la enseñanza de la anatomía ayudaría a las relaciones interprofesionales y, en última instancia, la colaboración, desde la educación de los estudiantes hasta la práctica profesional y las directrices de acreditación.

Improving perioperative care for adolescent idiopathic scoliosis patients: the impact of a multidisciplinary care approach.

The complex nature of the surgical treatment of adolescent idiopathic scoliosis (AIS) requires a wide variety of health care providers. A well-coordinated, multidisciplinary team approach to the care of these patients is essential for providing high-quality care. This review offers an up-to-date overview of the numerous interventions and safety measures for improving outcomes after AIS surgery throughout the perioperative phases of care. Reducing the risk of potentially devastating and costly complications after AIS surgery is the responsibility of every single member of the health care team. Specifically, this review will focus on the perioperative measures for preventing surgical site infections, reducing the risk of neurologic injury, minimizing surgical blood loss, and preventing postoperative complications. Also, the review will highlight the postoperative protocols that emphasize early mobilization and accelerated discharge.

Breaking down silos: engaging students to help fix the US health care system.

PROBLEM: The field of health care is becoming a team effort as patient care becomes increasingly complex and multifaceted. Despite the need for multidisciplinary education, there persists a lack of student engagement and collaboration among health care disciplines, which presents a growing concern as students join the workforce. APPROACH: In October 2013, the Emory-Georgia Tech Healthcare Innovation Program organized a student driven symposium entitled "US Healthcare: What's Broken and How to Fix It: The Student Perspective". The symposium engaged students from multiple disciplines to work together in addressing problems associated with US health care delivery. The symposium was organized and carried out by a diverse group of student leaders from local institutions who adopted a multidisciplinary approach throughout the planning process. OUTCOMES: The innovative planning process leading up to the symposium revealed that many of the student-discipline groups lacked an understanding of one another's role in health care, and that students were interested in learning how to work together to leverage each other's profession. The symposium was widely attended and positively received by students and faculty from the Atlanta metropolitan area, and has since helped to promote interdepartmental collaboration and multidisciplinary education across institutions. NEXT STEPS: The student symposium will become an annual event and incorporate broader discipline representation, as well as a patient perspective. Proposals for additional institution-wide, multidisciplinary educational offerings are being addressed with the help of faculty and health care providers across the network. Accordingly, the implementation of student-driven symposia to engage students and stimulate institution-wide changes may be a beneficial and cost-effective means for academic health centers looking to facilitate multidisciplinary health care education.