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[ES] El trabajo en equipos multidisciplinares es reconocido como el factor clave para el éxito en la mayoría de los proyectos, especialmente en aquellos asociados a nuevos desafíos e innovación. En el ámbito académico existe una clara tendencia en el interés por formar profesionales preparados y con experiencia en trabajo en equipos multidisciplinares. La formación de los estudiantes se organiza por especialidad y separada en diferentes titulaciones y escuelas, con lo cual, salvo contactos y colaboraciones puntuales, no hay mecanismos ni herramientas que faciliten la comunicación necesaria para la formación de equipos multidisciplinares para trabajar conjuntamente en proyectos. El objetivo de "TeamMaker" es ofrecer un espacio en el cual personas (profesores o estudiantes) interesadas en desarrollar un proyecto con un equipo multidisciplinar puedan publicar su iniciativa, y como contraparte otras personas que puedan estar interesadas puedan contactar para formar parte del equipo. Este TFG nace de la motivación asociada al desarrollo de TFG/TFM o proyectos de emprendimiento en el cual participen estudiantes de diferentes escuelas, lo cual es una necesidad actual de nuestra universidad, pero también aplicable a otras universidades, y en general podría ser útil en cualquier comunidad o institución de gran envergadura donde se quiera poner en contacto a personas para trabajar en un proyecto. Este TFG se desarrolla en el marco de una práctica de empresa en la UPV y asociada a la cátedra HP-UPV., [EN] Working in cross-functional teams is recognized as a key factor for success in most projects, especially those associated with new challenges and innovation. In the academic field there is a clear trend in the interest in training professionals prepared and experienced in working in multidisciplinary teams. The training of students is organized by specialty and separated in different degrees and schools, so that, except for contacts and occasional collaborations, there are no mechanisms or tools to facilitate the necessary communication for the formation of multidisciplinary teams to work together on projects. The objective of "TeamMaker" is to offer a space in which people (teachers or students) interested in developing a project with a multidisciplinary team can publish their initiative, and as a counterpart other people who may be interested can contact to be part of the team. This TFG is born from the motivation associated with the development of TFG/TFM or entrepreneurship projects in which students from different schools participate, which is a current need of our university, but also applicable to other universities, and in general could be useful in any community or large institution where you want to put people in contact to work on a project. This TFG is developed within the framework of an internship at the UPV and associated with the HP-UPV chair.

Funder: National Institute for Health Research; Id: http://dx.doi.org/10.13039/501100000272, BACKGROUND: It is not well understood the overall changes that multidisciplinary teams (MDTs) have had to make in response to the COVID-19 pandemic, nor the impact that such changes, in addition to the other challenges faced by MDTs, have had on decision-making, communication, or participation in the context of MDT meetings specifically. METHODS: This was a mixed method, prospective cross-sectional survey study taking place in the United Kingdom between September 2020 and August 2021. RESULTS: The participants were 423 MDT members. Qualitative findings revealed hybrid working and possibility of virtual attendance as the change introduced because of COVID-19 that MDTs would like to maintain. However, IT-related issues, slower meetings, longer lists and delays were identified as common with improving of the IT infrastructure necessary going forward. In contrast, virtual meetings and increased attendance/availability of clinicians were highlighted as the positive outcomes resulting from the change. Quantitative findings showed significant improvement from before COVID-19 for MDT meeting organisation and logistics (M = 45, SD = 20) compared to the access (M = 50, SD = 12, t(390) = 5.028, p = 0.001), case discussions (M = 50, SD = 14, t(373) = -5.104, p = 0.001), and patient representation (M = 50, SD = 12, t(382) = -4.537, p = 0.001) at MDT meetings. DISCUSSION: Our study explored the perception of change since COVID-19 among cancer MDTs using mixed methods. While hybrid working was preferred, challenges exist. Significant improvements in the meeting organisation and logistics were reported. Although we found no significant perceived worsening across the four domains investigated, there was an indication in this direction for the case discussions warranting further 'live' assessments of MDT meetings.

Contains fulltext : 293869.pdf (Publisher’s version ) (Open Access) Antimicrobial resistance (AMR) has been exacerbated by the inappropriate use of diagnostics, leading to excessive prescription of antimicrobials, and is an imminent threat to global health. Diagnostic stewardship (DS) is an auxiliary to antimicrobial stewardship (AMS) and comprises ordering the right tests, for the right patient, at the right time. It also promotes the judicious use of rapid and novel molecular diagnostic tools to enable the initiation of proper antibiotic therapy, while avoiding excessive use of broad-spectrum antibiotics. Proper interpretation of test results is crucial to avoid overdiagnosis and excessive healthcare costs. Although many rapid diagnostic tools have been developed with a high diagnostic yield, they are often limited by accessibility, cost, and lack of knowledge regarding their use. Careful consideration of clinical signs and symptoms with knowledge of the local epidemiology are essential for DS. This enables appropriate interpretation of microbiological results. Multidisciplinary teams that include well trained professionals should cooperate to promote DS. Challenges and barriers to the implementation of DS are mostly caused by scarcity of resources and lack of trained personnel and, most importantly, lack of knowledge. The lack of resources is often due to absence of awareness of the impact that good medical microbiology diagnostic facilities and expertise can have on the proper use of antibiotics. 01 juli 2023

Supinda Koonmee,1 Ongart Somintara,2 Piyapharom Intarawichian,1 Chaiwat Aphivatanasiri,1 Sakkarn Sangkhamanon,1 Suphawat Laohawiriyakamol,3 Rujira Panawattanakul,4 Phanchanut Mahantassanapong,5 Chayanoot Rattadilok,6 Piyarat Jeeravongpanich,7 Wilart Krongyute,8 Krisada Prachumrasee,9 Reza Alaghehbandan10 1Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 2Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 3Division of General Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand; 4Department of Surgery, Udonthani Hospital, Udonthani, Thailand; 5Department of Anatomical Pathology, Surin Hospital, Surin, Thailand; 6Department of Surgery, Nopparatrajathanee Hospital, Bangkok, Thailand; 7Anatomical Pathology Unit, Songkhla Hospital, Songkhla, Thailand; 8Department of Surgery, Fort Suranari Hospital, Nakhon Ratchasima, Thailand; 9The College of Local Administration, Khon Kaen University, Khon Kaen, Thailand; 10Department of Pathology, Faculty of Medicine, University of British Columbia, Royal Columbian Hospital, Vancouver, BC, CanadaCorrespondence: Chaiwat AphivatanasiriDepartment of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, ThailandEmail chaiap@kku.ac.thReza AlaghehbandanUniversity of British Columbia, Royal Columbian Hospital, Vancouver, BC, CanadaEmail reza.alagh@gmail.comPurpose: Breast cancer is a growing public health challenge in Thailand. Pathum Raksa project was launched in 2015, as a result of higher than expected rate of triple-negative breast cancers in Thai women. The purpose of this project was to identify the cause(s) and address the issue(s), hence improving the quality of breast cancer biomarker testing in Thailand.Materials and Methods: Nineteen hospitals across the country, with 902 breast cancer patients were enrolled in this study during 2015– 2020. The pre- and post-data from Pathum Raksa initiative was only available for Khon Kaen University (KKU) and Udonthani hospitals in Northeast Thailand. We developed a resource-stratified strategic plan that included designing a unique specimen container, forming multidisciplinary teams from the Surgery and Pathology Departments, and employing locally developed innovative technologies to optimize the entire process of breast cancer diagnostics and biomarker testing.Results: The rate of triple-negative breast cancers in KKU and Udonthani decreased 52.8% (p = 0.02) and 28.9% (p = 0.48), respectively. The rate of ER+ breast cancers in both hospitals increased 5% post-Pathum Raksa implementation. The rate of HER2-neu+ (score 3+) also increased in both hospitals (particularly an increased 65% rate in KKU). Luminal A/B cancers were the most common subtype in both KKU and Udonthani hospitals.Conclusion: Pathum Raksa project has significantly improved breast cancer biomarker testing in Thailand. As a result of this national innovation, false-negative rates of breast biomarkers have significantly decreased, resulting in improving prognosis, treatment, and survival of breast cancer women in Thailand.Keywords: breast cancer, biomarkers, Pathum Raksa, multidisciplinary teams, pre-analytical phase

Background: In order to tailor treatment to the individual patient, it is important to take the patients context and preferences into account, especially for older patients. We assessed the quality of information used in the decision-making process in different oncological MDTs and compared this for older (>70 years) and younger patients. Patients and methods: Cross-sectional observations of oncological MDTs were performed, using an observation tool in a University Hospital. Primary outcome measures were quality of input of information into the discussion for older and younger patients. Secondary outcomes were the contribution of different team members, discussion time for each case and whether or not a treatment decision was formulated. Results: Five-hundred and three cases were observed. The median patient age was 63 year, 32% were >70. In both age groups quality of patient-centered information (psychosocial information and patient's view) was poor. There was no difference in quality of information between older and younger patients, only for comorbidities the quality of information for older patients was better. There was no significant difference in the contributions by team members, discussion time (median 3.54 min) or number of decision reached (87.5%). Conclusion: For both age groups, we observed a lack of patient-centered information. The only difference between the age groups was for information on comorbidities. There were also no differences in contributions by different team members, case discussion time or number of decisions. Decision-making in the observed oncological MDTs was mostly based on medical technical information. (c) 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Learners in many schools inopportunely encounter a wide range of psychosocial ills, many of which have a detrimental effect not only on their academic performance but also on the learners’ overall growth and development. This paper explores and describes dilemmas that the learners experience in schools that necessitate school social work practice, particularly in South African high schools. The study is explorative and descriptive in nature. As such, phenomenology is a specific design employed in the study. A qualitative research approach was employed to interview 12 learners through in-depth interviews. More so, the 5 School Governing Body (SGB) members formed part of a focus group discussion. These participants were purposefully selected with the assistance of a school gatekeeper. The collected empirical data was analysed thematically. The ecological perspective is an inherent theory that underpins the study. The findings suggest that learners are regrettably confronted with inter alia; substance abuse, financial problems, bullying, depression, sexual abuse, and incest. The researcher recommends that the Department of Education (DoE) prioritise employing social workers in schools to meet the psychosocial needs of learners at risk.

Uvod: Sladkorna bolezen ali diabetes mellitus je najpogostejša presnovna kronična bolezen. Predstavlja glavni vzrok umrljivosti in zmanjšanje pričakovane življenjske dobe. Z naraščajočo razširjenostjo sladkorne bolezni potrebuje tekom svojega življenja operativni poseg približno 25 % ljudi s sladkorno boleznijo. Kirurško zdravljenje je eden izmed načinov zdravljenja, ki posega v celovitost bolnikovega organizma. Za bolnika predstavlja nenaden preobrat, na katerega se mora prilagoditi in zato potrebuje določen čas, moč in oporo. Pomembno je, da se za vsakega posameznega bolnika s sladkorno boleznijo pred operacijo pripravi individualen načrt obravnave. Dobro organizirana perioperativna zdravstvena nega in multidisciplinarni pristop olajšata izvedbo kirurškega posega na varen način brez akutnih in kroničnih zapletov. Namen: Namen diplomskega dela je predstaviti obravnavo bolnika s sladkorno boleznijo pri načrtovanem kirurškem posegu v splošni anesteziji. Metode dela: Diplomsko delo temelji na deskriptivni metodi. Opravljen je tematski pregled znanstvene in strokovne literature v slovenskim in angleškem jeziku, v spletnih podatkovnih bazah: COBISS, PubMed, CINAHL, Science Direct ter spletnem iskalniku Google Učenjak z uporabo izbranih ključnih besed. Rezultati: Kirurgija je pomembna možnost zdravljenja sladkorne bolezni. Pri bolnikih s sladkorno boleznijo, ki so napoteni na kirurški poseg, je treba ves čas spremljati raven glukoze v krvi z namenom dosega normoglikemije. Vse aktivnosti perioperativne zdravstvene oskrbe in kakovostna organizacija multidisciplinarnega tima so usmerjeni k uspešnem kirurškem zdravljenju, preprečevanju akutnih in kirurških zapletov in čimprejšnjemu okrevanju. Razprava in zaključek: Ključno orodje povezovanja strok in poenotenja pristopov so smernice za klinično obravnavo sladkorne bolezni, ki jih v Sloveniji stroka skladno s strokovnim napredkom in novimi pristopi redno posodablja. Izsledki diplomskega dela so pokazali pomembnost perioperativne zdravstvene nege za kakovostno obravnavo bolnika s sladkorno boleznijo in potek njegovega zdravljenja. Pot do kakovostne perioperativne oskrbe pa je v sodelovanju multidisciplinarnega tima z bolnikom in njegovimi svojci. Multidisciplinaren način obravnave izboljša oskrbo bolnikov, klinično se dosegajo boljši izidi, diagnostika bolezni je bolj natančna, izboljša se psihično in fizično stanje bolnika ter zmanjša umrljivost. Introduction: Diabetes or diabetes mellitus is the most widespread chronic metabolic disease. It is the main cause of death and reduced life expectancy. With the growing prevalence of diabetes, throughout their lives, approximately 25% of diabetes patients require surgical treatment. Surgical treatment is one of the ways of treatment that interfere with a patient’s entire organism. From their perspective, this is a sudden change that they have to adapt to, requiring a certain amount of time, strength and support. It is important that an individual treatment plan is prepared for each diabetes patient prior to the surgery. Well-organised perioperative medical care and a multidisciplinary approach ensure safe surgery, without acute and chronic complications. Aim: The aim of this paper is to present diabetes patient treatment before a planned surgery under general anaesthesia. Methods: This paper uses the descriptive work method. A thematic review of scientific and professional literature in Slovene and English was conducted, searching through COBISS, PubMed, CINAHL and Science Direct online databases and in the Google Scholar online search engine, using the selected keywords. Results: Surgery is an important diabetes treating option. The level of blood glucose should be monitored all the time in diabetes patients that are to undergo surgical treatment, in order to achieve normoglycaemia. All perioperative care activities and quality organisation of a multidisciplinary team ensure efficient surgical treatment, prevent acute and chronic complications and lead to rapid recovery. Discussion and conclusion: A key tool combining disciplines and harmonising approaches is guidelines for clinical treatment of diabetes, which Slovenian professionals regularly update in accordance with scientific progress and newly developed approaches. Findings of this research prove the importance of perioperative medical care for quality diabetes patient treatment and its course. Quality perioperative treatment can be achieved with the cooperation of a multidisciplinary team with the patient and their relatives. A multidisciplinary type of treatment improves patient care, achieves better clinical results, ensures a more accurate disease diagnosis, improves mental and physical state of the patient and reduces mortality rate.

Background Patients with drug resistant tuberculosis (DR-TB) with comorbidities and drug toxicities are difficult to treat. Guidelines recommend such patients to be managed in consultation with a multidisciplinary team of experts (the “TB consilium”) to optimise treatment regimens. We describe characteristics and treatment outcomes of DR-TB cases presented to the national DR-TB consilium in Uganda between 2013 and 2019. Methods We performed a secondary analysis of data from a nation-wide retrospective cohort of DR-TB patients with poor prognostic indicators in Uganda. Patients had a treatment outcome documented between 2013 and 2019. Characteristics and treatment outcomes were compared between cases reviewed by the consilium with those that were not reviewed. Results Of 1,122 DR-TB cases, 189 (16.8%) cases from 16 treatment sites were reviewed by the consilium, of whom 86 (45.5%) were reviewed more than once. The most frequent inquiries (N = 308) from DR-TB treatment sites were construction of a treatment regimen (38.6%) and management of side effects (24.0%) while the most frequent consilium recommendations (N = 408) were a DR-TB regimen (21.7%) and “observation while on current regimen” (16.6%). Among the cases reviewed, 152 (80.4%) were from facilities other than the national referral hospital, 113 (61.1%) were aged ≥ 35 years, 72 (40.9%) were unemployed, and 26 (31.0%) had defaulted antiretroviral therapy. Additionally, 141 (90.4%) had hepatic injury, 55 (91.7%) had bilateral hearing loss, 20 (4.8%) had psychiatric symptoms and 14 (17.7%) had abnormal baseline systolic blood pressure. Resistance to second-line drugs (SLDs) was observed among 9 (4.8%) cases while 13 (6.9%) cases had previous exposure to SLDs. Bedaquiline (13.2%, n = 25), clofazimine (28.6%, n = 54), high-dose isoniazid (22.8%, n = 43) and linezolid (6.7%, n = 13) were more frequently prescribed among cases reviewed by the consilium than those not reviewed. Treatment success was observed among 126 (66.7%) cases reviewed. Conclusion Cases reviewed by the consilium had several comorbidities, drug toxicities and a low treatment success rate. Consilia are important “gatekeepers” for new and repurposed drugs. There is need to build capacity of lower health facilities to construct DR-TB regimens and manage adverse effects.

Multidisciplinary teams (MDT) are groups of professionals from one or more clinical discipline who together make decisions regarding recommended treatment of individual patients. In the UK, the National Cancer Plan (2000) requires every cancer patient’s care to be reviewed by an MDT. The aim is to facilitate specialist input and reduce variation in access to, and decisions about, cancer care. However, since the introduction of these guidelines, MDTs have faced increasing demands, in terms of the number and complexity of cases they review. Further guidelines have since been released to help improve and streamline MDT working. More recently, the COVID-19 pandemic has presented MDTs with the challenge of running MDT meetings virtually rather than face-to-face. This has potential advantages and disadvantages. In this study, we aim to explore how the change from face-to-face to virtual MDT meetings during the COVID-19 pandemic may have impacted the effectiveness of decision-making in cancer MDT meetings. And use the findings to co-produce resource packs to improve future cancer MDT working.

While science and engineering students experience collaboration in multicultural teams, they frequently report improved understanding of how people from other disciplines think and act. Therefore, it is important to understand how students’ skills develop to function in multidisciplinary teams. This mixed-methods research explored the changes in students’ perceived multidisciplinary teamwork skills. Data was collected through a questionnaire and interviews. Findings collectively suggest perceived improvement in identifying one’s own disciplinary contributions to the design decisions. The qualitative analysis also showed growth in recognizing the contributions of other discipline.

While science and engineering students experience collaboration in multicultural teams, they frequently report improved understanding of how people from other disciplines think and act. Therefore, it is important to understand how students’ skills develop to function in multidisciplinary teams. This mixed-methods research explored the changes in students’ perceived multidisciplinary teamwork skills. Data was collected through a questionnaire and interviews. Findings collectively suggest perceived improvement in identifying one’s own disciplinary contributions to the design decisions. The qualitative analysis also showed growth in recognizing the contributions of other discipline.

While science and engineering students experience collaboration in multicultural teams, they frequently report improved understanding of how people from other disciplines think and act. Therefore, it is important to understand how students’ skills develop to function in multidisciplinary teams. This mixed-methods research explored the changes in students’ perceived multidisciplinary teamwork skills. Data was collected through a questionnaire and interviews. Findings collectively suggest perceived improvement in identifying one’s own disciplinary contributions to the design decisions. The qualitative analysis also showed growth in recognizing the contributions of other discipline.

Made available in DSpace on 2021-06-25T10:22:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Changes in animal population dynamics and community composition following species (re)introduction may have unanticipated consequences for a variety of downstream ecosystem processes, including infectious disease transmission. Due the lessons learned from ongoing projects, we present a novel approach on how to anticipate, monitor, and mitigate the vampire bats and rabies in rewilding projects. We pinpoint a series of precautions and the need for long-term monitoring of vampire bats and rabies responses to rewilding projects and highlighted the importance of multidisciplinary teams of scientist and managers focusing on prevention educational program of rabies risk transmitted by bats. In addition, monitoring the relative abundance of vampire bats, considering reproductive control by sterilization and oral vaccines that autonomously transfer among bats would reduce the probability, size and duration of rabies outbreaks. The rewilding assessment framework presented here responds to calls to better integrate the science and practice of rewilding and will help conservation practitioners and researchers to develop effective message framing strategies that minimize bats emerging infectious diseases and support biodiversity and its associated ecosystem services. Institute of Bioscience Department of Biodiversity Universidade Estadual Paulista (UNESP) Conservation Science Group Department of Zoology University of Cambridge Department of Biology University of Miami Institute of Biodiversity Animal Health and Comparative Medicine College of Medical Veterinary and Life Sciences University of Glasgow MRC–University of Glasgow Centre for Virus Research Institute of Bioscience Department of Biodiversity Universidade Estadual Paulista (UNESP)

Introduction: Multidisciplinary team (MDT) meetings could facilitate coordination of care for individuals living with multimorbidity, yet there is limited evidence on their effectiveness. We hence explored the common characteristics of MDT meetings in primary care and assessed the effectiveness of interventions that include such meetings, designed to improve outcomes for adults living with multimorbidity. Methods: A systematic review of literature was conducted using MEDLINE and EMBASE. A narrative synthesis was performed, extracting study and MDT meeting characteristics, in addition to any outcomes reported. Results: Four randomised controlled trials that were conducted in the United States of America were identified as eligible, recruiting a total of 3,509 adults living with multimorbidity. Common MDT meeting themes include regular frequency of discussion, the absence of patient involvement and the participation of three or four multiprofessionals. Significant improvements were observed in response to interventions with an MDT component across most measures, yet this trend did not extend to physical health outcomes. Discussion: It is unclear if the results in this review are sufficient to support the widespread implementation of MDT meetings in primary care, for adults living with multimorbidity. Due to the paucity of studies collated, further research is required to inform widespread implementation.

Background and purpose: Working collaboratively as a multidisciplinary team in the treatment and care of cancer patients is proven effective in increasing the quality of patient care. A multidisciplinary team (MDT) meeting (MDTM) is the main vehicle that facilitates this collaborative work between different healthcare specialities, and an appropriate meeting record is essential to communicate the meeting's outcomes. There is limited research to date regarding MDTM documentation, and here we report on a sample of healthcare professional's perspectives on current practices. Methodology: A survey, distributed to a purposive snowball sample, is used to collect the perceptions on record-keeping at MDTMs from involved healthcare workers. The survey is descriptive and exploratory in nature and uses closed and open-ended questions offered in both English and Swedish. Results: With a response of 37 healthcare workers, several commonly understood practices of MDTMs are confirmed, documentation is mostly electronic, encompasses suggested information, and the record is mostly acceptable in quality. The issues of responsibility, registering attendance, and verification of documentation can be improved. Conclusion: Electronic documentation is a laudable step that shows advancement in MDTM record-keeping. The highlighted quality of the records suggests that MDTM proceedings are reasonably well documented. There remain some important questions, with regard to standardization, centralization, and the responsibility for record-keeping at MDTMs.

Purpose The extent to which sustainability is integrated into conventional accounting practices, in the light of a more integrated thinking perspective, requires further exploration. This paper aims to investigate how management control systems (MCSs) and sustainability-specific control systems (SCSs) are mobilised and how they interact to support the environmental sustainability strategy of a small- and medium-sized entity (SME). Design/methodology/approach Through a case study in a waste disposal firm, this paper examines the influence of cognitive, organisational and technical factors on the interaction and integration of MCSs and SCSs to bolster an environmental sustainability strategy. Findings The MCSs that are mobilised vary according to the type of strategy that is pursued. Even though the technical integration of MCSs with SCSs was not achieved, interaction between them supported strategic decision-making and the pursuit of environmental performance in the light of a more integrated thinking perspective. The role of multidisciplinary teams formed by accountants and environmental scientists to support sustainability management control at the SME also enabled interaction and provided steps for integrated thinking. Practical implications Although based on single case study, this research offers practitioners useful knowledge about the potential levers and obstacles relating to the mobilisation of MCSs when a sustainability strategy is conceived and its impact on the development of integrated thinking. Originality/value The paper provides insight into how SMEs can mobilise their MCSs to support an environmental sustainability strategy, shedding light on the factors that enhance interaction among MCSs and SCSs.

Despite growing interest in the emergence of technologies in journalistic practices, especially from the production perspective, there is still very little research on organizational structures and professional culture in relation to the deployment of these technologies. Drawing on six interviews and observation in staff meetings, this study aims to explore the nuances behind the professional roles of data journalists and how these relate to structural aspects of news organizations. The study focuses on the case of ProPublica, a news organization internationally renowned for its global excellence in data stories. This work considers boundary‐making in the context of journalism and focuses on new professional roles in the news industry to produce a hybrid ethnography study based on qualitative data collected immediately before the Covid‐19 pandemic hit the United States. The findings reveal the importance of hybrid profiles at ProPublica. While some journalists have had to expand their knowledge to learn more about new areas, such as coding and design, some non‐journalistic professionals have had to develop writing skills, and this blurring of traditional boundaries forms an important aspect of ProPublica’s professional culture. The structure of the organization, divided into two teams engaged in cross‐sector activities, helps to promote data skills and collaboration with other journalists, which also serves to mitigate any individual lack of experience on certain topics. The article concludes by suggesting that the growing importance of these new professional roles has broader implications for the development of data skills in the newsroom, and also discusses the limitations that can arise from the increasing overlap between journalistic and non‐journalistic roles.

The creation of Multidisciplinary Teams to monitor patients with COVID-19 and those infected with SARS-CoV-2 in a situation of home confinement was one of the measures established by the Portuguese government to help stop the spreading of the infection in the parishes of the Lisbon Metropolitan Area more affected by the pandemic. To know its way of functioning and acting, as well as the role of social workers in the context of crisis and public health emergency, a qualitative study was developed based on interviews by focus groups and document analysis. It was found that the Multidisciplinary Teams and the intervention model carried out were fundamental in helping to break the transmission chains and prevent the growth of new contamination, with social workers having a crucial role in supporting the most vulnerable households in a containment situation. A criação de Equipas Multidisciplinares de acompanhamento de doentes com COVID-19 e infetados com SARS-CoV-2 em situação de confinamento domiciliário foi uma das medidas estabelecidas pelo governo português para ajudar a interromper o aumento de contágios nas freguesias da Área Metropolitana de Lisboa mais atingidas pela pandemia. Com o objetivo de conhecer o seu modo de funcionamento e atuação, bem como o papel do serviço social em contexto de crise e emergência de saúde pública, foi desenvolvido um estudo qualitativo com base em entrevistas por focus group e análise documental. Verificou-se que as Equipas Multidisciplinares e o modelo de intervenção levado a cabo foram fundamentais para ajudar a quebrar as cadeias de transmissão e evitar o crescimento de novas contaminações, tendo os assistentes sociais tido um papel crucial no apoio aos agregados familiares mais vulneráveis em situação de confinamento.

User-based evaluation by end users is an essential step in designing useful interfaces. Inspection methods can offer an alternate approach when end-user recruitment is problematic. A Learning Designers’ usability scholarship could offer usability evaluation expertise adjunct to multidisciplinary teams in academic settings. The feasibility of Learning Designers as ‘expert evaluators’ is assessed within this study. Two groups, healthcare professionals and Learning Designers, applied a hybrid evaluation method to generate usability feedback from a palliative care toolkit prototype. Expert data were compared to end-user errors detected from usability testing. Interface errors were categorised, meta-aggregated and severity calculated. The analysis found that reviewers detected N = 333 errors, with N = 167 uniquely occurring within the interface. Learning Designers identified errors at greater frequencies (60.66% total interface errors, mean (M) = 28.86 per expert) than other evaluator groups (healthcare professionals 23.12%, M = 19.25 and end users 16.22%, M = 9.0). Patterns in severity and error types were also observed between reviewer groups. The findings suggest that Learning Designers are skilled in detecting interface errors, which benefits developers assessing usability when access to end users is limited. Whilst not offering rich narrative feedback generated by user-based evaluations, Learning Designers complement healthcare professionals’ content-specific knowledge as a ‘composite expert reviewer’ with the ability to generate meaningful feedback to shape digital health interfaces.

Resumo Introdução: a formação para o exercício profissional da Psicologia, como nas demais profissões, requer, como primeira aproximação, a experiência de estágios, quando situações que demandam intervenção profissional são vivenciadas pelo ainda estudante. Objetivo: compreender fatores que motivam ou inibem a expressão (voz) ou retenção (silêncio) de ideias, informações, opiniões ou preocupações relacionadas ao trabalho desenvolvido no estágio curricular. Método: foram realizadas entrevistas com 15 estudantes de Psicologia cujos estágios curriculares foram realizados em equipes multiprofissionais. Buscou-se compreender os sentidos que as experiências narradas tiveram para as entrevistadas. Resultados: foram identificadas tanto forças agindo na direção da fala, como na direção do permanecer em silêncio, relacionadas a cinco fatores: disposições individuais; atitudes e percepções; emoções e crenças; comportamento do supervisor; e fatores contextuais. Conclusão: destaca-se a importância do desenvolvimento de práticas, na formação em Psicologia, que priorizem a atuação em ambientes coletivos e interprofissionais. Abstract Introduction: training for the professional practice of Psychology, as in other professions, requires, as a first approximation, the experience of internships, when situations that demand professional intervention are experienced by the student. Objective: to understand factors that motivate or inhibit the expression (voice) or retention (silence) of ideas, information, opinions or concerns related to the work developed in the curricular internship. Method: interviews were conducted with 15 Psychology students whose curricular internships were carried out in multidisciplinary teams. We sought to understand the meanings that the narrated experiences had for the interviewees. Results: both forces acting in the direction of speech and in the direction of remaining silent were identified, related to five factors: individual dispositions; attitudes and perceptions; emotions and beliefs; supervisor behavior; and contextual factors. Conclusion: the importance of developing practices in Psychology training that prioritize work in collective and interprofessional environments is highlighted. Resumen Introducción: la formación para el ejercicio profesional de la Psicología, como en otras profesiones, requiere como primera aproximación la vivencia de las prácticas, que es cuando el estudiante vive situaciones que demandan la intervención profesional. Objetivo: comprender factores que motivan o inhiben la expresión (voz) o retención (silencio) de ideas, informaciones, opiniones o inquietudes relacionadas con el trabajo desarrollado en la pasantía curricular. Método: se realizaron entrevistas a 15 estudiantes de Psicología cuyas prácticas curriculares se llevaron a cabo en equipos multidisciplinarios. Buscamos comprender los significados que las experiencias narradas tenían para los entrevistados. Resultados: se identificaron fuerzas que actúan en la dirección del habla y en la dirección del silencio, relacionadas con cinco factores: disposiciones individuales; actitudes y percepciones; emociones y creencias; comportamiento del supervisor; y factores contextuales. Conclusión: se destaca la importancia de desarrollar prácticas en la formación en Psicología que prioricen el trabajo en ambientes colectivos e interprofesionales.

Purpose Breast cancer is a growing public health challenge in Thailand. Pathum Raksa project was launched in 2015, as a result of higher than expected rate of triple-negative breast cancers in Thai women. The purpose of this project was to identify the cause(s) and address the issue(s), hence improving the quality of breast cancer biomarker testing in Thailand. Materials and Methods Nineteen hospitals across the country, with 902 breast cancer patients were enrolled in this study during 2015–2020. The pre- and post-data from Pathum Raksa initiative was only available for Khon Kaen University (KKU) and Udonthani hospitals in Northeast Thailand. We developed a resource-stratified strategic plan that included designing a unique specimen container, forming multidisciplinary teams from the Surgery and Pathology Departments, and employing locally developed innovative technologies to optimize the entire process of breast cancer diagnostics and biomarker testing. Results The rate of triple-negative breast cancers in KKU and Udonthani decreased 52.8% (p = 0.02) and 28.9% (p = 0.48), respectively. The rate of ER+ breast cancers in both hospitals increased 5% post-Pathum Raksa implementation. The rate of HER2-neu+ (score 3+) also increased in both hospitals (particularly an increased 65% rate in KKU). Luminal A/B cancers were the most common subtype in both KKU and Udonthani hospitals. Conclusion Pathum Raksa project has significantly improved breast cancer biomarker testing in Thailand. As a result of this national innovation, false-negative rates of breast biomarkers have significantly decreased, resulting in improving prognosis, treatment, and survival of breast cancer women in Thailand., Video abstract Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/v37IVgjnRYE

Background: Community psychiatric rehabilitation has proven effective in supporting individuals and their families in recovering from mental illness. The delivery of evidence-based community rehabilitation services, however, requires health care workers to possess a set of specially trained knowledge and skills. Most developing countries, including China, do not have specially trained mental health personnel. The purpose of this study was to test the feasibility and efficacy of a community psychiatric rehabilitation program delivered by laypeople.Method: We conducted a randomized controlled study. Patients at two sites in Chengdu, China, were randomly assigned to either the laypeople-delivered (LPD) community psychiatric rehabilitation group (N = 49) or the drop-in center control group (N = 45). The outcomes were changes in symptoms, social functioning, and family functioning over 6 months, as measured by the Positive and Negative Syndrome Scale (PANSS), the Personal and Social Performance Scale (PSP), the Family Burden Scale of Disease (FBS), and the Family APGAR index.Results: The number of sessions received over the 12-week period of treatment ranged from 20 to 100%, with a mean completion rate of 77.32% for all 12 sessions. Statistically significant interactions between group and time were found for the total PANSS [F(2, 94) = 12.51, p < 0.001] and both the Negative PANSS [F(2, 94) = 5.89, p < 0.01] and Positive PANSS [F(2, 94) = 6.65, p < 0.01] as well as the PSP [F(2, 94) = 3.34, p < 0.05], FBS [F(2, 94) = 5.10, p < 0.01], and Family APGAR index [F(2, 94) = 4.58, p < 0.01]. The results showed that the experimental group outperformed their counterparts in symptom management, personal social functioning, family care burden, and coherence.Conclusion: These results support the feasibility and efficacy of having laypeople deliver psychiatric rehabilitation services. A discussion and limitations of the study have been included.

Background Multidisciplinary cancer care to facilitate the provision of patient centred and evidence-based care is considered best practice internationally. In 2016 multidisciplinary care measures were developed for all local health districts across NSW. The aim of this study was to identify system-level changes and quality improvement activities across the NSW cancer system linked to reporting on these measures. Methods Focus group discussions were used to generate a synergy of ideas from key stakeholders. An exploratory descriptive approach was used within the ontological position of Framework Analysis, the analysis method chosen for this research study, sitting most closely within pragmatism. The use of Framework Analysis in the analytic strategy is because it is well-suited to addressing policy issues and maintaining specific focus within a wider dataset. Results Two focus groups were held with a total of 18 purposively selected participants. Four primary themes emerged: value of electronic documentation; role clarity; relationships; and future development of measures. Key findings included that the reporting of performance measures has expedited the development of electronic documentation and data extraction from the multidisciplinary team meeting (MDT), identified barriers and facilitators to MDT data collection and supported MDT improvement activities across NSW. Conclusions The findings of this study have highlighted that MDTs and their meetings across NSW are harnessing technological advancements to support and further develop their MDTs, as well as the challenges of implementing new processes within the MDTM. This study adds a unique contribution to knowledge of how the reporting of measures can assist in understanding variation in the development and implementation of multidisciplinary teams, as well as highlighting future programs of work to decrease variation in multidisciplinary team meetings and quality improvement activities.

This paper focuses on empathy in the Ideation phase of the Design Thinking process. The bibliographical review on empathy, Design Thinking and multidisciplinary teams is the basis of experiments developed to meet the demands of a social business. Results corroborate the perception that empathy can be achieved through collaborative multidisciplinary teams to build a scope. Finally, the theoretical gap is described and the opportunities for future research are presented. Este artigo enfoca a empatia na fase de ideação do processo de design thinking. A revisão bibliográfica dos temas empatia, design thinking e equipes multidisciplinares embasam experimentos desenvolvidos para atender as demandas de um negócio social. Os resultados corroboram para a percepção de que a empatia pode ser conquistada com equipes multidisciplinares colaborativas para a construção de um escopo. Finalmente, a lacuna teórica é descrita e as oportunidades para pesquisas futuras são apresentadas.

Aims An integrated chronic care programme in terms of a specialized outpatient clinic for patients with atrial fibrillation (AF), has demonstrated improved clinical outcomes. The aim of this study is to assess all-cause mortality in patients in whom AF management was delivered through a specialized outpatient clinic offering an integrated chronic care programme. Methods and results Post hoc analysis of a Prospective Randomized Open Blinded Endpoint Clinical trial to assess all-cause mortality in AF patients. The study included 712 patients with newly diagnosed AF, who were referred for AF management to the outpatient service of a University hospital. In the specialized outpatient clinic (AF-Clinic), comprehensive, multidisciplinary, and patient-centred AF care was provided, i.e. nurse-driven, physician supervised AF treatment guided by software based on the latest guidelines. The control group received usual care by a cardiologist in the regular outpatient setting. After a mean follow-up of 22 months, all-cause mortality amounted 3.7% (13 patients) in the AF-Clinic arm and 8.1% (29 patients) in usual care [hazard ratio (HR) 0.44, 95% confidence interval (CI) 0.23–0.85; P = 0.014]. This included cardiovascular mortality in 4 AF-Clinic patients (1.1%) and 14 patients (3.9%) in usual care (HR 0.28; 95% CI 0.09–0.85; P = 0.025). Further, 9 patients (2.5%) died in the AF-Clinic arm due to a non-cardiovascular reason and 15 patients (4.2%) in the usual care arm (HR 0.59; 95% CI 0.26–1.34; P = 0.206). Conclusion An integrated specialized AF-Clinic reduces all-cause mortality compared with usual care. These findings provide compelling evidence that an integrated approach should be widely implemented in AF management.

Funder: Guy's and St Thomas' Charity; Id: http://dx.doi.org/10.13039/501100000380, Funder: National Institute for Health Research; Id: http://dx.doi.org/10.13039/501100000272, Funder: Guy's and St Thomas' NHS Foundation Trust; Id: http://dx.doi.org/10.13039/501100004941, Funder: Welcome Trust; Id: http://dx.doi.org/10.13039/501100004941, Funder: Diabetes UK; Id: http://dx.doi.org/10.13039/501100004941, Two decades since their inception, multidisciplinary teams (MDTs) are widely regarded as the 'gold standard' of cancer care delivery. Benefits of MDT working include improved patient outcomes, adherence to guidelines, and even economic benefits. Benefits to MDT members have also been demonstrated. An increasing body of evidence supports the use of MDTs and provides guidance on best practise. The system of MDTs in cancer care has come under increasing pressure of late, due to the increasing incidence of cancer, the popularity of MDT working, and financial pressures. This pressure has resulted in recommendations by national bodies to implement streamlining to reduce workload and improve efficiency. In the present review we examine the historical evidence for MDT working, and the scientific developments that dictate best practise. We also explore how streamlining can be safely and effectively undertaken. Finally, we discuss the future of MDT working including the integration of artificial intelligence and decision support systems and propose a new model for improving patient centredness.

Supplemental Digital Content is available in the text, Objective: The aim of this study was to assess the outcomes of tracheostomy in patients with COVID-19 respiratory failure. Summary Background Data: Tracheostomy has an essential role in managing COVID-19 patients with respiratory failure who require prolonged mechanical ventilation. However, limited data are available on how tracheostomy affects COVID-19 outcomes, and uncertainty surrounding risk of infectious transmission has led to divergent recommendations and practices. Methods: It is a multicenter, retrospective study; data were collected on all tracheostomies performed in COVID-19 patients at 7 hospitals in 5 tertiary academic medical systems from February 1, 2020 to September 4, 2020. Result: Tracheotomy was performed in 118 patients with median time from intubation to tracheostomy of 22 days (Q1–Q3: 18–25). All tracheostomies were performed employing measures to minimize aerosol generation, 78.0% by percutaneous technique, and 95.8% at bedside in negative pressure rooms. Seventy-eight (66.1%) patients were weaned from the ventilator and 18 (15.3%) patients died from causes unrelated to tracheostomy. No major procedural complications occurred. Early tracheostomy (≤14 days) was associated with decreased ventilator days; median ventilator days (Q1–Q3) among patients weaned from the ventilator in the early, middle and late groups were 21 (21–31), 34 (26.5–42), and 37 (32–41) days, respectively with P = 0.030. Compared to surgical tracheostomy, percutaneous technique was associated with faster weaning for patients weaned off the ventilator [median (Q1–Q3): 34 (29–39) vs 39 (34–51) days, P = 0.038]; decreased ventilator-associated pneumonia (58.7% vs 80.8%, P = 0.039); and among patients who were discharged, shorter intensive care unit duration [median (Q1–Q3): 33 (27–42) vs 47 (33–64) days, P = 0.009]; and shorter hospital length of stay [median (Q1–Q3): 46 (33–59) vs 59.5 (48–80) days, P = 0.001]. Conclusion: Early, percutaneous tracheostomy was associated with improved outcomes compared to surgical tracheostomy in a multi-institutional series of ventilated patients with COVID-19.

Uvod: Zdravstvena nega pacientov s presajenimi organi pomeni zagotavljanje specialne zdravstvene nege, usmerjene v zaščito, promocijo in optimizacijo zdravja. Zdravljenje s presaditvijo (transplantacijo) organov je multidisciplinarno in zahteva implementacijo in izvajanje terciarnih znanj in veščin, ki zagotovijo optimalne rezultate zdravljenja: pomembno zmanjšajo skupno število zapletov, pospešijo okrevanje, povečajo varnost in zadovoljstvo pacienta pri njegovi obravnavi in zmanjšujejo stroške zdravljenja. Presaditev jeter je edina učinkovita metoda za zdravljenje akutne in kronične jetrne odpovedi. Namen dela: Prikaz vloge dela medicinske sestre s specialnimi znanji v multidisciplinarnem timu: vloga rabe in izvajanja standardov specialne zdravstvene nege, ki vključujejo etične in konceptualne podlage zdravstvene nege presaditev organov. Specialni standardi zajemajo rabo naprednih znanj z naslednjih področij: prehransko zdravljenje, podpora v zgodnjem in poznem obdobju po presaditvi, spodbujanje k ustrezni telesni vadbi, učenje zgodnje samostojnosti po presaditvi, učenje za samostojno nego, odkrivanje in preprečevanje poslabšanja vedenjskih motenj, psihosocialnih bolezni in dejavnikov okolja, ki bi lahko vplivali na poslabšanje stanja pacienta po presaditvi organa. Metode dela: Uporabili smo deskriptivno metodo dela s pregledom literature slovenskih in tujih podatkovnih baz s področja transplantacije jeter, edukacije pacientov in vpliva pridobljenega znanja na kakovost življenja ter zapletov po presaditvi jeter. Pregledali in analizirali smo strokovno ter znanstveno literaturo v naslednjih bibliografskih bazah: PubMed, Google Učenjak (Scholar), COBISS in ResearchGate. Iskalna strategija je temeljila na rabi naslednjih izrazov: edukacija, presaditev jeter, medicinska sestra, pacient, rehabilitacija, telesna aktivnost, prehrana. Rezultati: Edukacija pacienta ne zajema izključno učenja, ki se nanaša na zdravstveno nego in oskrbo, temveč tudi napotke glede pravilnega prehranjevanja, redne telesne aktivnosti, vnovičnega vključevanja v družbo (družina, prijatelji, služba) in psihosocialna ter zaposlitvena prilagoditev na spremembe po presaditvi jeter. Pri tem je pomemben odnos medicinske sestre do pridobljenega znanja, saj lahko pacient, ki nima vseh potrebnih informacij, živi manj kakovostno življenje. Pri tem je pomembno učenje samodiscipline, ki je ključna pri okrevanju in zmanjšuje tveganje za zaplete. Vloga medicinske sestre v multidisciplinarnem timu je večnivojska. Poskrbeti mora za edukacijo pacienta po presaditvi jeter ter skrbeti za hitro in ustrezno komunikacijo med operaterjem in drugimi sodelavci v timu. Na tak način zagotovi takojšnje in ustrezno ukrepanje v primeru pojava zgodnjih in poznih zapletov po transplantaciji jeter, jih ustrezno zmanjšuje in preprečuje. Zaključek: V prihodnje bi bila smotrna proučitev razvoja aplikacije ali izobraževalnega portala (na primer spletne akademije), v katerih bi imeli zaposleni v zdravstveni negi priložnost svoje znanje kontinuirano nadgrajevati. S tem bi se vsekakor povečala kakovost edukacije in kakovost življenja pacientov po presaditvi jeter v Sloveniji. Introduction: Caring for patients with organ transplants means providing special care aimed at protecting, promoting, and optimizing health. Organ transplant treatment is multidisciplinary and requires the implementation of tertiary knowledge and skills that ensure optimal treatment outcomes: significantly reduce overall complications, speed recovery, increase patient safety, increase patient satisfaction, and reduce treatment costs. Liver transplantation is the only effective method for treating acute and chronic liver failure. Purpose: Demonstration of the role of the work of a nurse with special knowledge in a multidisciplinary team: the role of the use and implementation of special care standards that include the ethical and conceptual basis of organ transplant care. Special standards cover the use of advanced knowledge in the areas of: nutritional treatment in the early and late post-transplant period, promotion of appropriate physical exercise, learning of early independence after transplantation, self-care learning, detection and prevention of aggravation of behavioural disorders, psychosocial diseases and environmental factors. could affect the deterioration of the patient’s condition after organ transplantation. Methods: We used a descriptive method of work with a review of the literature of Slovenian and foreign databases, in the field of liver transplantation, patient education and the impact of acquired knowledge on quality of life and complications after liver transplantation. We reviewed and analyzed the professional and scientific literature in the following bibliographic databases: PubMed, Google Scholar, COBISS and ResearchGate. The search strategy was based on the use of the following terms: education, liver transplant, nurse, patient, rehabilitation, physical activity (PA), nutrition. Results: Patient education does not only require learning regarding care and nursing, but also guidance on proper nutrition (diet), regular physical activity, reintegration into society (family, friends, work) and psychosocial adaptation to changes after liver transplantation and working ability. The attitude of nurse towards acquired knowledge is important, as a patient, who does not have all the necessary information may have a poorer quality of life. It is important for patient to self-care, which is crucial in overall recovery and, above all, taking prescribed drug therapy according to medical plan. The role of the nurse in a multidisciplinary team is multi-level: educating the patient after a liver transplant and taking care of fast and appropriate communication between the operator and other team members. In this way, it provides immediate and appropriate action in the event of early complications after liver transplantation and reduces and prevents them accordingly. Conclusion: Development of an application or educational courses (e.g. online academy) where nurses may have an opportunity to continuously upgrade their knowledge could increase quality of education and patient’s quality of life after liver transplantation in Slovenia.

Digital, Introducción: Este trabajo a partir de la investigación documental pretende delimitar el rol específico que debe desempeñar el especialista en Medicina Familiar dentro de los equipos de disciplinas múltiples para el cuidado integral del paciente con dolor crónico y así propiciar el abordaje de este padecimiento de una manera adecuada y efectiva desde un enfoque centrado en la persona, su familia y comunidad; asimismo proyecta recomendaciones para el ajuste curricular requerido sobre este objeto de aprendizaje en el programa de formación del Especialista en Medicina Familiar de la Universidad de Santander UDES. Metodología: Para el logro de este objetivo se emplearon métodos basados en la revisión narrativa donde mediante el uso de una ecuación de búsqueda se pudo recopilar diferentes fuentes de información para posteriormente hacer la clasificación y análisis de la información que prestara relevancia dentro de la investigación. Realizado el proceso de búsqueda y la incorporación de los parámetros de inclusión y exclusión se obtuvo una muestra de 13 artículos científicos, los cuales arrojaron hallazgos y evidencias concretas referentes al rol del especialista en Medicina Familiar en los equipos de disciplinas múltiples para el cuidado integral del paciente con dolor crónico Resultados: A partir de la normatividad vigente en Colombia, la revisión documental y el análisis en el equipo de trabajo de este proyecto, ampliado en su fase final con profesores, graduados y residentes de Medicina Familiar UDES, se propone el rol específico del Especialista en Medicina Familiar dentro de los equipos multidisciplinarios e interprofesionales para el cuidado integral del paciente con dolor crónico y se estructura una propuesta de ajuste microcurricular al plan de estudios de la Especialización en Medicina Familiar de la Universidad de Santander UDES sobre este objeto formativo., Introduction: This work, based on documentary research, aims to define the specific role to be played by the specialist in Family Medicine in the multiple discipline teams for the comprehensive care of patients with chronic pain and this promotes the approach to condition in an appropriate and effective, from an approach focused on the person, his family and community, also projects recommendations for the curricular adjustment required on this object of learning in the training program of the Specialist in Family Medicine at the University of Santander UDES. Methodology: To achieve this objective, methods based on narrative review were used, where through the use of a search equation, different sources of information could be gathered to later make the classification and analysis of the information that was relevant within the research. Once the search process was carried out, and the inclusion and exclusion parameters were incorporated, a sample of 13 scientific articles was obtained, which yielded concrete findings and evidence regarding the role of the specialist in Family Medicine in the multiple discipline teams for the integral care of the patient with chronic pain. Results: Based on the regulations in force in Colombia, the document review and analysis in the work team of this project, expanded in its final phase with professors, graduates and residents of Family Medicine UDES, the specific role of the Family Medicine Specialist is proposed within the multidisciplinary and interprofessional teams for the comprehensive care of the patient with chronic pain and a proposal for microcurricular adjustment to the curriculum of the Specialization in Family Medicine of the University of Santander UDES is structured on this training object., Pregrado, Especialista en Medicina Familiar, 1 ed., INTRODUCCIÓN .................................................................................................. 13 1. PLANTEAMIENTO DEL PROBLEMA ............................................................. 15 2. JUSTIFICACIÓN ............................................................................................. 17 3. OBJETIVOS .................................................................................................... 19 4. MARCO REFERENCIAL ................................................................................ 20 4.1. Dolor Crónico ........................................................................................... 20 4.2. Contexto de la Prestación de Servicios de Salud en Colombia ............... 39 4.3. Perfiles, competencias y lex artis del Especialista en Medicina Familiar . 42 4.4. Roles y Equipos de Salud ........................................................................ 45 4.5. Cuidado Integral de la Salud .................................................................... 48 4.6. Fundamentos Curriculares ....................................................................... 49 5. METODOLOGÍA ............................................................................................. 51 5.1. Alcance de la Investigación ........................................................................ 51 5.2. Diseño de la Investigación .......................................................................... 52 5.3. Población y Muestra ................................................................................... 53 5.4. Estructura Metodológica ............................................................................. 53 5.5. Métodos ...................................................................................................... 53 5.5.1. Términos Clave ..................................................................................... 54 5.5.2. Términos Mesh ..................................................................................... 54 5.5.3. Selección de las fuentes: Ecuación de Búsqueda ................................ 55 5.5.4. Criterios de Inclusión: ........................................................................... 55 5.5.5. Criterios de Exclusión: .......................................................................... 55 5.6 Consideraciones Éticas ............................................................................... 56 6. RESULTADOS ............................................................................................... 59 6.1 Aplicación de la Búsqueda ........................................................................... 59 6.1.1. Ecuación de Búsqueda ...................................................................... 59 6.1.2. Resultados Búsqueda Inicial ............................................................. 59 6.1.3. Artículos seleccionados ..................................................................... 60 6.2 Metasíntesis y Productos ............................................................................. 60 7. DISCUSIÓN .................................................................................................... 80 8. CONCLUSIONES ........................................................................................... 82 9. RECOMENDACIONES ................................................................................... 84 Referentes Bibliográficos ...................................................................................... 85

DOI:10.1590/2179-8966/2020/57098.ResumoO presente artigo tem como objetivo entender o funcionamento das equipes multidisciplinares atuantes em Juizados (ou Varas) de Violência Doméstica e Familiar contra a Mulher. Buscamos identificar e compreender as possíveis modificações desenvolvidas nesses espaços especializados, inaugurados há mais de uma década, na direção de novas respostas, desafiadoras daquelas tradicionalmente oferecidas pelo Sistema de Justiça Criminal. Para tanto, e tendo por base pesquisa empírica realizada em sete capitais brasileiras, utilizaremos de falas e reflexões extraídas dos grupos focais realizados com as equipes multidisciplinares estudadas, bem como das percepções extraídas de entrevistas com magistrados que atuam na violência doméstica e vítimas desse tipo de conflito. Ao final, propomos o reconhecimento da importância das equipes multidisciplinares na busca de novas saídas à violência doméstica contra a mulher no Brasil, bem como a necessidade de enxergar/admitir as rígidas fronteiras do nosso “mundo jurídico”.Palavras-chave: Violência Doméstica contra a Mulher; Equipes Multidisciplinares; Lei Maria da Penha.AbstractThis article aims to understand the workings of multidisciplinary teams in Domestic Violence Courts in Brazil. We seek to identify and understand the possible changes developed in these specialised spaces, which now exist for over a decade, that are turned to new responses capable of challenging the traditional way of doing things in the country’s Criminal Justice System. For that purpose and based on empirical research carried out in seven Brazilian capital cities, we will highlight some of the reflections extracted from focus groups carried out with the aforementioned multidisciplinary teams, as well as draw on the perceptions extracted from interviews with magistrates who work with domestic violence and victims of this type of conflict. In the end, we highlight the need for recognition of the importance of multidisciplinary teams when searching for new “ways out” in the domestic violence against women arena, as well as the need to see/admit the rigid borders of our “legal world”.Keywords: Domestic Violence against Women; Multidisciplinary Teams; The Maria da Penha Act (Brazil’s Domestic Violence Law)

BackgroundWatson for Oncology (WFO) is a cognitive computing system that provides clinical decision support. This study examined the concordance between the treatment recommendations for colorectal cancer (CRC) proposed by WFO and those recommended by the multidisciplinary teams (MDTs), and evaluated the influence of concordance on the prognosis.MethodsWe retrospectively collected 175 patients with colorectal cancer who received treatment recommended by MDTs at a hospital in China, and evaluated them using WFO. Concordance between the two recommendations was analyzed. The overall survival was analyzed between concordant and non-concordant groups. Logistic regression analyses were performed and a concordance-predicting model was developed.ResultsConcordance between WFO’ and MDTs’ recommendations occurred in 66.9% (117/175) of cases. The overall survival (OS) was significantly better in concordant group and non-concordance was found to be an independent prognostic factor [hazard ratio (HR)=2.784 (95% CI 1.264–6.315)]. Logistic regression analyses determined that tumor type [odds ratio (OR)= 2.195 for left colon cancer and OR=2.502 for rectum cancer], and TNM stage (OR=0.545 for stage II, OR=0.187 for stage III, OR=0.127 for stage IV) were independently related with concordance, which were used to develop a concordance-predictive-nomogram.ConclusionsTreatment recommendations for patients with colorectal cancer determined by WFO and MDTs were mostly concordant. However, the survival was better among concordant patients and non-concordance was found to be an independent prognostic factor. This study presents a nomogram that can be conveniently used for predicting individualized concordance. However, our findings should be prospectively validated in multi-center trials.

Background Multidisciplinary teams (MDT) formulate expert informed treatment recommendations for people with cancer. We set out to examine how the factors proposed by the functional perspective of group decision making (DM), that is, interaction process, internal factors (factors emanating from within the group such as group size), external circumstances (factors coming from the outside of the team), and case‐complexity affect the quality of MDT decision making. Methods This was a cross‐sectional observational study. Three cancer MDTs were recruited with 44 members overall and 30 of their weekly meetings filmed. Validated observational instruments were used to measure quality of DM, interactions, and complexity of 822 case discussions. Results The full regression model with the variables proposed by the functional perspective was significant, R 2 = 0.52, F(20, 801) = 43.47, P, To the best of our knowledge, this is the first study to attempt to assess the factors proposed by the functional perspective in the context of cancer MDT meetings. Validated observational instruments were used to measure quality of decision making, interactions, and complexity of 822 case discussions across 3 cancer teams and 30 of their weekly meetings. One novel finding is unraveling the sociocognitive predictors of team DM quality, while another is the cognitive‐catch 22 effect

V diplomski nalogi sem raziskovala multidisciplinarno sodelovanje v primerih zaščite otrok. Za to temo sem se začela podrobneje zanimati med študijsko prakso na centru za socialno delo Brežice, kjer sem se podrobneje seznanila s področjem preprečevanja nasilja v družini in z ukrepi za zaščito otrok. Opazila sem, da je za obravnavo nasilja v družini potrebno sodelovanje različnih strokovnjakov, z različnih institucij in področij. Zanima me, na kakšen način različne institucije sodelujejo v primerih zaščite otrok pred nasiljem, kakšna je njihova vloga v teh postopkih, kako v obravnavo vključujejo otroke, ki so žrtve nasilja in kako ocenjujejo sodelovanje z drugimi. Še posebej sem se osredotočila na multidisciplinarne time in zanimalo me je, kakšna stališča imajo do njih strokovni delavci iz različnih institucij, ki sodelujejo v postopkih zaščite otrok. V teoretičnem delu opredelim pojem družine in nasilja. Zatem predstavim oblike nasilja, opišem odnos do nasilja v družbi, nato pa se osredotočim še na posledice izpostavljenosti nasilju. Sledi poglavje o zakonodaji na področju nasilja nad otroki v Sloveniji, zatem pa predstavim še vlogo multidisciplinarnih timov in centra za socialno delo ter predstavim pristojnost ostalih institucij, ki so ključne pri reševanju problema nasilja v družini. Na koncu pozornost namenim tudi položaju otroka v postopku zaščite. Empirični del vsebuje rezultate raziskave, ki sem jo izvedla med predstavniki institucij, ki sodelujejo v multidisciplinarnih timih. To so predstavniki centra za socialno delo, regijske službe za preprečevanje nasilja v družini, državnega tožilstva, policije in vzgojno-izobraževalnega zavoda. V intervjujih me je zanimalo, kdo po njihovih izkušnjah najpogosteje poda prijavo o nasilju, kako v obravnavo vključujejo otroke in kako jim zagotovijo varen in zaupen prostor, katere ukrepe za zaščito otrok izvedejo, kaj storijo v primerih, ko se nasilje ponovi, kakšno je njihovo mnenje o trenutnem sistemu obravnave žrtev nasilja in kakšne izkušnje imajo z multidisciplinarnimi timi. Ugotovila sem, da se predstavniki pristojnih institucij zavedajo svoje vloge v postopkih zaščite otrok in da so s trenutnim sistemom obravnave žrtev načeloma zadovoljni, si pa vseeno želijo določenih izboljšav, ki bi lahko pripomogle k še večji učinkovitosti sistema. V multidisciplinarnih timih vidijo predvsem prednosti, saj se vsi zavedajo, da sta hitro in usklajeno ukrepanje v primerih nasilja nad otrokom ključnega pomena. Še naprej si želijo krepiti sodelovanje z drugimi institucijami in ga še izboljšati, še posebej z zdravstvom, saj z njihove strani zaznavajo najslabšo udeležbo na multidisciplinarnih timih. Izpostavljajo še, da je vključenost otroka v postopke zaščite zelo pomembna, vendar je potrebno biti ob tem pozoren, da postopki zanj ne pomenijo dodatne travmatizacije. In my diploma thesis I researched multidisciplinary cooperation in child protection cases. I became interested in this topic in more detail during my internship at the Brežice Centre for Social Work, where I became more acquainted with the field of prevention of domestic violence and measures for the protection of children. I have noticed that dealing with domestic violence requires the cooperation of different professionals from different institutions and fields. I am interested in how different institutions work together in cases of protection of children from violence, what is their role in these processes, how they include the treatment of children who are victims of violence and how do they assess cooperation with other institutions. In particular, I focused on multidisciplinary teams and was interested in the views of professionals from various institutions involved in child protection proceedings. In the theoretical part I define the concept of family and violence. I then present the forms of violence, describe the attitude towards violence in society, and then focus on the consequences of exposure to violence. This is followed by a chapter on legislation in the field of violence against children in Slovenia, followed by the role of multidisciplinary teams and the Centre for Social Work and the competence of other institutions that are the key to solving the problem of domestic violence. Finally, I pay attention to the position of the child in the process of protection. The empirical part contains the results of a research I conducted among representatives of institutions participating in multidisciplinary teams. They are representatives of the Centre for Social Work, the regional service for the prevention of domestic violence, the state prosecutor's office, the police and an educational institution. In the interviews, I was interested in who, in their experience, most often reports violence, how they involve children in treatment and how they provide them with a safe and confidential space, what child protection measures they take, what they do in cases of repeated violence, what is their opinion on the current system of dealing with victims of violence and what is their experience with multidisciplinary teams. I found that the representatives of the competent institutions are aware of their role in child protection procedures and that they are generally satisfied with the current victim treatment system, but still want some improvements that could make the system even more effective. They see multidisciplinary teams as the main advantage, as they are all aware that prompt and coordinated action in cases of violence against children is crucial. They want to continue to strengthen cooperation with other institutions and improve it, especially in healthcare, as their participation in multidisciplinary teams is considered the lowest. They also point out that the involvement of the child in protection procedures is very important, but it is necessary to be careful that the procedures do not mean additional traumatization.

Severe/critical cases account for 18-20% of all novel coronavirus disease 2019 (COVID-19) patients, but their mortality rate can be up to 61.5%. Furthermore, all deceased patients were severe/critical cases. The main reasons for the high mortality of severe/critical patients are advanced age (>60 years old) and combined underlying diseases. Elderly patients with comorbidities show decreased organ function and low compensation for damage such as hypoxia and inflammation, which accelerates disease progression. The lung is the main target organ attacked by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) while immune organs, liver, blood vessels and other organs are damaged to varying degrees. Liver volume is increased, and mild active inflammation and focal necrosis are observed in the portal area. Virus particles have also been detected in liver cells. Therefore, multidisciplinary teams (MDTs) and individualized treatment plans, accurate prediction of disease progression and timely interventions are vital to effectively reduce mortality. Specifically, a "multidisciplinary three-dimensional management, individualized comprehensive plan" should be implemented. The treatment plan complies with three principles, namely, multidisciplinary management of patients, individualized diagnosis and treatment plans, and timely monitoring and intervention of disease. MDT members are mainly physicians from critical medicine, infection and respiratory disciplines, but also include cardiovascular, kidney, endocrine, digestion, nerve, nutrition, rehabilitation, psychology and specialty care. According to a patient's specific disease condition, an individualized diagnosis and treatment plan is formulated (one plan for one patient). While selecting individualized antiviral, anti-inflammatory and immunomodulatory treatment, we also strengthen nutritional support, psychological intervention, comprehensive rehabilitation and timely and full-course intervention to develop overall and special nursing plans. In response to the rapid progression of severe/critical patients, MDT members need to establish a three-dimensional management model with close observation and timely evaluation. The MDT should make rounds of the quarantine wards both morning and night, and of critical patient wards nightly, to implement "round-the-clock rounds management", to accurately predict disease progression, perform the quick intervention and prevent rapid deterioration of the patient. Our MDT has cumulatively treated 77 severe/critical COVID-19 cases, including 62 (80.5%) severe cases and 15 (19.5%) critical cases, with an average age of 63.8 years. Fifty-three (68.8%) cases presented with more than one underlying disease and 65 (84.4%) severe cases recovered from COVID-19. The average hospital stay of severe/critical cases was 22 days, and the mortality rate was 2.6%, both of which were significantly lower than the 30-40 days and 49.0-61.5%, respectively, reported in the literature. Therefore, a multidisciplinary, three-dimensional and individualized comprehensive treatment plan can effectively reduce the mortality rate of severe/critical COVID-19 and improve the cure rate.

From the article: Research through Design projects in the health domain often involve collaborations of design and healthcare researchers. All partners have their own ideas and expectations with regard to what they consider valid ways to support their work. The evidence-based approach that dominates healthcare research differs from the ways that are common in design research, in which more iterative approaches are applied with focus on developing solutions to fit to the users and their context. The question that we address is twofold: a) How do differences in grounding approaches manifest themselves in projects where design and healthcare researchers collaborate? And b) How do project teams deal with these differences? We analyzed the grounding practices within ten Dutch research projects that address the development of e-health applications to support people as they grow older. All projects are collaborations of design and healthcare researchers and practice partners. We applied a multiple case study research approach in two series of interviews, with a cross-case interpretation after the first series of interviews to direct the second series. Differences in grounding approaches in the projects manifest themselves on four themes, each representing a spectrum: time, structure, control and position. These differences provided challenges, but were also used to strengthen the project.

From the article: Research through Design projects in the health domain often involve collaborations of design and healthcare researchers. All partners have their own ideas and expectations with regard to what they consider valid ways to support their work. The evidence-based approach that dominates healthcare research differs from the ways that are common in design research, in which more iterative approaches are applied with focus on developing solutions to fit to the users and their context. The question that we address is twofold: a) How do differences in grounding approaches manifest themselves in projects where design and healthcare researchers collaborate? And b) How do project teams deal with these differences? We analyzed the grounding practices within ten Dutch research projects that address the development of e-health applications to support people as they grow older. All projects are collaborations of design and healthcare researchers and practice partners. We applied a multiple case study research approach in two series of interviews, with a cross-case interpretation after the first series of interviews to direct the second series. Differences in grounding approaches in the projects manifest themselves on four themes, each representing a spectrum: time, structure, control and position. These differences provided challenges, but were also used to strengthen the project.

Melissa Horlait,1 Saskia Baes,1 Sophie Dhaene,2 Simon Van Belle,3 Mark Leys1 1Vrije Universiteit Brussel (VUB), Department of Public Health, Research Group Organisation, Policy and Social Inequalities in Health Care (OPIH), 1090 Brussels, Belgium; 2AZ Sint-Elisabeth Ziekenhuis, Department of Oncology, 9620 Zottegem, Belgium; 3Ghent University Hospital, Department of Medical Oncology, 9000 Gent, Belgium Background: In current cancer care, multidisciplinary team meetings (MDTMs) aim at uniting care professionals from different disciplines to decide upon the best possible treatment plan for the patients based on the available scientific evidence. In Belgium, the multidisciplinary approach is mandatory and formally regulated since 2003. Current research indicates that MDTMs are not always truly multidisciplinary, ie, with a mix of medical as well as paramedical disciplines, and that the medical profession (physicians and medical specialists) tends to dominate the interaction in MDTMs. To ensure that MDTMs can benefit from their diverse membership to achieve their full potential, significant attention should be devoted to the multidisciplinary character of these meetings. The aim of this study is to explore and describe the multidisciplinary character in MDTMs and how it is actually shaped in practice in different Flemish medical oncology departments. Methods: For this study, we carried out an observational comparative case study. We studied 59 multidisciplinary team meetings at inpatient medical oncology departments in five different Belgian hospitals (academic as well as general) and explored multidisciplinarity and how it is actually shaped in practice.Results: The study is unique in identifying and analyzing three distinct types of MDTMs. The analysis of the three types revealed an inconsistent and, at times, contradictory picture of multidisciplinary team meetings. The findings also align with previous studies arguing that MDTMs in oncology are typically driven by doctors, with limited input of nurses and other nonmedical staff in which decisions are argued on biomedical information and far less consideration of psychosocial aspects.Conclusion: The concept of a MDTM should not merely be a group of care professionals who work essentially independently and occasionally liaise with one another. Yet, this study has shown a worryingly low awareness of the true character of multidisciplinarity, particularly among medical disciplines. Keywords: medical oncology, multidisciplinary teams, interprofessional care, qualitative research, health services research

Older surgical patients care demands for multidisciplinary research to deepen the understanding of the needs of the aged. This study aimed to develop a strategic plan for the Perioperative Geriatric Excellent Research Center. The World Café methodology was employed to facilitate constructive dialogue. Consensus meetings were subsequently held to formulate a strategic plan. Twenty participants attended the seminar focused on using multidisciplinary teams to improve the quality of life of the elderly after surgery. They resolved that the infrastructure should be modified to facilitate the production of quality publications and encourage research implementation. Moreover, the participants productively explored common misunderstandings and disputes regarding authorship and resource management within multidisciplinary research teams. A strategic plan and schematic organisational structure were drafted. In conclusion, world Café’s simple yet powerful format empowered participants to discuss critical issues. The development of the strategic plan through group collaboration greatly aided the team in moving forwards

Multidisciplinary crisis management teams consist of highly experienced professionals who combine their discipline-specific expertise in order to respond to critical situations characterized by high levels of uncertainty, complexity, and dynamism. Although the existing literatures on team information processing and decision-making are mature, research specifically investigating multidisciplinary teams facing crisis situations is limited; however, given increasingly turbulent external environments that produce complex crisis situations, increasing numbers of organizations are likely to call upon multidisciplinary teams to address such events. In this paper, we investigate information processing and decision-making behaviors in an exploratory study of 12 organizational multidisciplinary crisis management teams. We identify three types of information sharing and track the emergence of distinct communicative phases as well as differences between high- and low-performing teams in the occurrence of sequences of information sharing behaviors. We close by discussing implications for research in this area and for managers of crisis management teams.

The current literature on the enabling conditions of multidisciplinary teams focuses on the singular dimensions of the organizations (i.e., human resources, clinical pathways, objects) without shedding light on to the way in which these organizational factors interact and mutually influence one another. Drawing on a system perspective of organizations, the authors analyze the organizational patterns that promote and support multidisciplinary teams and how they interrelate and interact to enforce the organization work system. The authors develop a modified sociotechnical system (STS) model to understand how the two dimensions of technical (devices/tools, layout/organization of space, core process standardization) and social (organizational structure, management of human resources and operations) can facilitate the implementation of multidisciplinary teams in health care. The study conducts an empirical analysis based on a sample of hospital adopters of transcatheter aortic valve implantation using the revised STS model. The modified STS model applied to the case studies improves our understanding of the critical implementation factors of a multidisciplinary approach and the importance of coordinating radical changes in the technical and the social subsystems of health care organizations. The analysis informs that the multidisciplinary effort is not a sequential process and that the interplay between the two subsystems needs to be managed efficaciously as an integrated organizational whole to deliver the goals set. Hospital managers must place equal focus on the closely interrelated technical and social dimensions by investing in (a) shared layouts and spaces that cross the boundaries of the specialized health care units, (b) standardization of the core processes through the implementation of local clinical pathways, (c) structured knowledge management mechanisms, (d) the creation of clinical directorates, and (e) the design of a planning and budgeting system that integrates the multidisciplinary concept.

OBJECTIVES: The objectives of this study were to: (1) explore the proportion of HTx centers that have a multidisciplinary team and (2) assess the relationship between multidisciplinarity and the level of chronic illness management (CIM). BACKGROUND: The International Society for Heart and Lung Transplantation (ISHLT) recommends a multidisciplinary approach in heart transplant (HTx) follow-up care but little is known regarding the proportion of HTx centers that meet this recommendation and the impact on patient care. HTx centers with a multidisciplinary team may offer higher levels of CIM, a care model that has the potential to improve outcomes after HTx. METHODS: We conducted a secondary analysis of the BRIGHT study, a cross-sectional study in 11 countries. Multidisciplinarity in the 36 HTx centers was assessed through HTx director reports and was defined as having a team that was composed of physician(s), nurse(s), and another healthcare professional (either a social worker, psychiatrist, psychologist, pharmacist, dietician, physical therapist, or occupational therapist). CIM was assessed with the Patient Assessment of Chronic Illness Care (PACIC). Multiple linear regression assessed the relationship between multidisciplinarity and the level of CIM. RESULTS: Twenty-nine (80.6%) of the HTx centers had a multidisciplinary team. Furthermore, multidisciplinarity was significantly associated with higher levels of CIM (β = 5.2, P = 0.042). CONCLUSION: Majority of the HTx centers follows the ISHLT recommendation for a multidisciplinary approach. Multidisciplinarity was associated with CIM and point toward a structural factor that needs to be in place for moving toward CIM. ispartof: Heart & Lung vol:46 issue:5 pages:351-356 ispartof: location:United States status: published

Background: Frail older people living in the community require multidisciplinary care. Despite the fact that patient participation is high on the public agenda, studies into multidisciplinary care mainly focus on the viewpoints of professionals. Little is known about frail older patients’ experiences with care delivered by multidisciplinary teams and their perception of collaboration between professional and informal caregivers. Objective: To gain more insight into the experiences of frail older patients with integrated multidisciplinary care by mapping the care networks of this patient group and their perception of the interconnection between professional and informal caregivers. Methods: Survey study to facilitate a care network analysis. Due to the vulnerable health status of the respondents, questionnaires were completed during interviews. Analysis was performed using an iterative process, using both visual and metric techniques. Participants: 44 older persons, considered ‘frail’ by their general practitioner. Setting: Four general practices in The Netherlands. Results: The networks of the participants consisted of an average of 15 actors connected by 54 ties. General practitioners were the most common actors in the networks, and were well connected to medical specialists and in-home care providers. The participants did not always perceive a connection between their general practitioner and their informal caregiver. The network analyses resulted in the identification of three subtypes: simple star (n = 16), complex star (n = 16), and sub-group networks (n = 12). Conclusions: Our findings indicate that the elderly often do not experience the integration of multidisciplinary care as such. This is a real opportunity for MTs to improve their care and to make the patients’ experiences better in line with what they are aiming: allowing patients to live at home as healthy and independently as possible for as long as possible. We showed that informal caregivers often form communication bridges between patients and professionals. Having a better knowledge of the patient perspective enables the gaps in professional care networks of frail older people to be filled and facilitates the anticipation of crisis situations.

Sweden has a unique opportunity to identify and follow up women presenting with, or at risk for, perinatal mental health problems and disorders because universal screening programmes are provided by its primary healthcare system. Although they are implemented across almost the entire population, screening programmes are not necessarily leading to effective interventions because the multidisciplinary perinatal mental healthcare teams that provide for the assessment and treatment of moderate to severe disorders are very few in number and must be increased. In particular, efforts to reach immigrant parents must be intensified to achieve equal quality of care for all.

In Norway, new national guidelines for school service emphasize the importance of establishing structured collaboration with schools. Nevertheless, few studies have explored the characteristics of such collaboration. The purpose of the present study is to explore how principals, teachers, and school nurses collaborate and to identify barriers and facilitators of structured collaboration. The study is based on 46 qualitative interviews conducted in five Norwegian municipalities in 2018 and 2019. The results reveal that school nurses are highly valued among the school staff but collaborations between teachers and school nurses varied both within and between schools, often for arbitrary reasons such as personal relations and office locations at schools. Personal relationships built over time as well as regular meetings, seemed to foster stronger collaboration, while discontinuity in personnel, recruitment difficulties, and sick and maternity leaves were frequently reported factors that seemed to have negative impacts on collaboration.

Introduction: In Ireland, and internationally, healthcare errors and incidents are frequently under-reported(1-3), undermining the utility of reporting systems as a source of meaningful learning for policy formulation and behaviour change. Common barriers to reporting include fear, deferred responsibility, and a belief that reporting would not lead to improvement(2-4). To address this challenge to patient safety, it is necessary to build shared understanding that reporting improves service quality, and aids professional development. Description of policy context and objective: Ireland’s Health Service Executive and Health Information and Quality Authority emphasise supportive organisational cultures, and sustained commitment to improvement by all actors within the health and social care services(4,5). This is not yet fully realised across institutions, and under-reporting remains a challenge. Our objective was therefore to create a tool for healthcare teams to openly discuss patient safety and error reporting. We used an inclusive co-design process to adapt the PlayDecide “serious game”(6), which tasks players with exchanging and discussing perspectives and information, then working towards a shared group policy position. Targeted population: The game initially targeted junior doctors, and was then revised for multidisciplinary healthcare team members and management staff. Highlights (innovation, impact, and outcomes): Patient representatives, academic researchers, hospital staff, and state actors were involved throughout the co-design process. Anonymously-contributed personal accounts of patient safety issues were adapted into short case stories for use in the game. A major strength is the game’s embedded learning approach, using educational content that is contextual to the targeted population’s work. The game was initially played by over 100 junior doctors. 98% of participants supported the policy position that staff should report all concerns. However, it was felt that the current environment did not support this – only 32% of the participants who had recently witnessed an incident had reported it – and previous training around incident reporting was insufficient. We also tested the game among members of acute care teams, including nurses, speech and language therapists, and others, who also found the experience valuable, and emphasised the need for error reporting to become more normalised in hospitals. Comments on transferability: Game content is broadly transferable due to a focus on challenges that might occur in any healthcare setting – e.g. lack of standardised protocols, difficult senior colleagues, or systems failures. The game occasionally references features of the Irish health system, but this could easily be adapted to other country contexts. Conclusions: Participants’ reported value of discussions with colleagues outside their own cadre, and the educational utility of the reality-based content, suggest that PlayDecide: Patient Safety would be a valuable addition to training and professional development initiatives. The embedded learning approach, with a focus on building knowledge and encouraging change from the “ground-up”, may be a useful strategy for change within healthcare organisations. PlayDecide: Patient Safety represents a novel tool to build understanding and encourage productive dialogue around error reporting and patient safety. The co-design process is also a valuable means of creating contend that is highly authentic and relevant to key stakeholders.