Interprofessional Healthcare Collaboration on the Front Lines: A Qualitative Exploration of the Facilitators and Barriers to Effective Collaboration in Qatar.

Background:

Healthcare in Qatar is undergoing a period of major reform, driven by a strong economy and vision for a world-class healthcare system. One area identified as a potential contributor to developing a world-class healthcare system is interprofessional education (IPE), with the goal of facilitating healthcare workers to work together collaboratively. Several key steps have been taken towards developing IPE in Qatar, such as the formation of the Qatar Interprofessional Health Council (QIHC), the development of an IPE program for undergraduate healthcare students, the development of a set of shared core competencies, the receipt of substantial buy-in from leaders across the healthcare system, and recent approval of funding to develop a post-licensure healthcare IPE program. In order to improve IPE in Qatar, it is important to better understand the facilitators and barriers to interprofessional collaboration in Qatar. This study seeks to do so by qualitatively exploring facilitators and barriers to interprofessional collaboration for healthcare professional in Qatar from the perspective of health care professionals. By better understanding how health care workers give meaning to interprofessional education and collaboration, this research can assist in improving interprofessional activities in healthcare in Qatar.

Objectives

The purpose of this paper-presentation is to report on finding from a qualitative study that explored different facilitators and barriers of interprofessional practice in Qatar.

Method:

Ten healthcare professionals who work in Qatar were interviewed using semi-structured, open-ended interviews. Interview questions were organized by phenomenological (e.g. exploring the lived-experiences of healthcare workers) and ethnographic interviewing techniques (e.g. focusing on what people do). The questions explored the barriers, facilitators, and what is working well in terms of interprofessional practice for health care professional in Qatar.

Findings and Implications:

Different factors associated with interprofessional collaborations will be discussed. In doing so, this research adds to the literature on IPE by shedding light on interprofessional collaboration and education in the Middle East. Furthermore, this study identifies barriers for health care workers to work collaboratively in health care settings in Qatar. Addressing such barriers, and building off of what is working well, will facilitate Qatar in reaching one of the Vision 2030 goals of improving Qatar’s health and wellness.

What counts and what is being counted – The social organization of knowledge on the front lines of emergency medical services.

Paramedics are trained to use specialized medical knowledge and a variety of medical procedures and pharmaceutical interventions to “save patients and prevent further damage” in emergency situations, both as members of “health-care teams” in hospital emergency departments (Swanson, 2005: 96) and on the streets – unstandardized contexts “rife with chaotic, dangerous, and often uncontrollable elements” (Campeau, 2008: 3). The paramedic’s unique skill-set and ability to function in diverse situations have resulted in the occupation becoming ever more important to health care systems (Alberta Health and Wellness, 2008: 12).
Today, prehospital emergency services, while varying, exist in every major city and many rural areas throughout North America (Paramedics Association of Canada, 2008) and other countries around the world (Roudsari et al., 2007). Services in North America, for instance, treat and/or transport 2 million Canadians (over 250,000 in Alberta alone ) and between 25 and 30 million Americans annually (Emergency Medical Services Chiefs of Canada, 2006; National EMS Research Agenda, 2001). In Canada, paramedics make up one of the largest groups of health care professionals, with numbers exceeding 20,000 (Pike and Gibbons, 2008; Paramedics Association of Canada, 2008). However, there is little known about the work practices of paramedics, especially in light of recent changes to how their work is organized, making the profession “rich with unexplored opportunities for research on the full range of paramedic work” (Campeau, 2008: 2).

This presentation reports on findings from an institutional ethnography that explored the work of paramedics and different technologies of knowledge and governance that intersect with and organize their work practices. More specifically, my tentative focus of this presentation is on discussing some of the ruling discourses central to many of the technologies used on the front lines of EMS in Alberta and the consequences of such governance practices for both the front line workers and their patients. In doing so, I will demonstrate how IE can be used to answer Rankin and Campbell’s (2006) call for additional research into “the social organization of information in health care and attention to the (often unintended) ways ‘such textual products may accomplish…ruling purposes but otherwise fail people and, moreover, obscure that failure’ (p. 182)” (cited in McCoy, 2008: 709).

Technologies of Knowledge and Governance on the Front Lines of Emergency Services.

Using institutional ethnography, a sociology and critical method of inquiry used primarily in North America, this presentation discusses new forms and technologies of knowledge and governance – “forms of language, technologies of representation and communication, and text-based, objectified modes of knowledge through which local particularities are interpreted or rendered actionable in abstract, translocal terms” (McCoy, 2008: 701) on the front line of emergency medical services. I focus specifically on technologies central to health reforms that attempt to reshape how health care is delivered, experienced, and made accountable (Anantharaman, 2004; Ball, 2005; Alberta Health Services, 2008). In additional to exemplifying how institutional ethnography can be used to answer Rankin and Campbell’s (2006) call for additional research into “the social organization of information in health care and attention to the (often unintended) ways ‘such textual products may accomplish…ruling purposes but otherwise fail people and, moreover, obscure that failure’ (p. 182)” (cited in McCoy, 2008: 709), this presentation will introduce the audience to a critical approach to social inquiry that explores how knowledge is socially organized.

Assessment Work of Paramedics on the Front lines of Emergency Health Services

This article draws on an institutional ethnographic inquiry into the work of paramedics and the institutional setting that organizes and coordinates their work processes. Drawing on over 200 hours of observations and over 100 interviews with paramedics (average length of 18 minutes) and other emergency medical personnel, this article explores the standard and not so standard work of paramedics as they assess and care for their patients on the front lines of emergency health services. More specifically, I focus on the multiplicity of interfacing social, demographic, locational, situational, and institutional factors that shape and organize the work of paramedics. In doing so, this article provides insights into how paramedics orient to the social context in which their work occurs and contrasts this actual work with how their work is institutionally reported and made visible; what gets counted institutionally is not necessarily the same as what counts for the paramedics. This article problematizes this demarcation between what is known institutionally and “systematic practices of ‘not knowing’” (DeVault, 2008, p. 290).

Street Medicine – Assessment Work Strategies of Paramedics on the Front lines of Emergency Health Services

This article is based on an institutional ethnographic inquiry into the work of paramedics and the institutional setting that organizes and coordinates their work processes in a major City in Canada. Drawing on over 200 hours of observations and over 100 interviews with paramedics (average length of 18 minutes) and other emergency medical personnel, this article explores the standard and not so standard work of paramedics as they assess and care for their patients on the front lines of emergency health services. The multiplicity of interfacing social, demographic, locational, and situational factors that shape and organize the work of paramedics are analyzed. In doing so, this article provides insights into the complex work of an understudied yet ever-important profession in healthcare.

Night-to-night variation of pulse oximetry in children with sleep-disordered breathing

BACKGROUND: Sleep-disordered breathing is a common and serious feature of many paediatric conditions and is particularly a problem in children with Down syndrome. Overnight pulse oximetry is recommended as an initial screening test, but it is unclear how overnight oximetry results should be interpreted and how many nights should be recorded.

METHODS: This retrospective observational study evaluated night-to-night variation using statistical measures of repeatability for 214 children referred to a paediatric respiratory clinic, who required overnight oximetry measurements. This included 30 children with Down syndrome. We measured length of adequate trace, basal SpO2, number of desaturations (>4% SpO2 drop for >10 s) per hour ('adjusted index') and time with SpO2<90%. We classified oximetry traces into normal or abnormal based on physiology.

RESULTS: 132 out of 214 (62%) children had three technically adequate nights' oximetry, including 13 out of 30 (43%) children with Down syndrome. Intraclass correlation coefficient for adjusted index was 0.54 (95% CI 0.20 to 0.81) among children with Down syndrome and 0.88 (95% CI 0.84 to 0.91) for children with other diagnoses. Negative predictor value of a negative first night predicting two subsequent negative nights was 0.2 in children with Down syndrome and 0.55 in children with other diagnoses.

CONCLUSIONS: There is substantial night-to-night variation in overnight oximetry readings among children in all clinical groups undergoing overnight oximetry. This is a more pronounced problem in children with Down syndrome. Increasing the number of attempted nights' recording from one to three provides useful additional clinical information.

Rocking behaviour of multi-block columns subjected to pulse-type ground motion accelerations

Ancient columns, made with a variety of materials such as marble, granite, stone or masonry are an important part of the
European cultural heritage. In particular columns of ancient temples in Greece and Sicily which support only the architrave are
characterized by small axial load values. This feature together with the slenderness typical of these structural members clearly
highlights as the evaluation of the rocking behaviour is a key aspect of their safety assessment and maintenance. It has to be noted
that the rocking response of rectangular cross-sectional columns modelled as monolithic rigid elements, has been widely investigated
since the first theoretical study carried out by Housner (1963). However, the assumption of monolithic member, although being
widely used and accepted for practical engineering applications, is not valid for more complex systems such as multi-block columns
made of stacked stone blocks, with or without mortar beds. In these cases, in fact, a correct analysis of the system should consider
rocking and sliding phenomena between the individual blocks of the structure. Due to the high non-linearity of the problem, the
evaluation of the dynamic behaviour of multi-block columns has been mostly studied in the literature using a numerical approach
such as the Discrete Element Method (DEM). This paper presents an introductory study about a proposed analytical-numerical
approach for analysing the rocking behaviour of multi-block columns subjected to a sine-pulse type ground motion. Based on the
approach proposed by Spanos (2001) for a system made of two rigid blocks, the Eulero-Lagrange method to obtain the motion
equations of the system is discussed and numerical applications are performed with case studies reported in the literature and with a
real acceleration record. The rocking response of single block and multi-block columns is compared and considerations are made
about the overturning conditions and on the effect of forcing function’s frequency.
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Characterization and modelling of software defined radio front-ends

O presente trabalho tem por objectivo estudar a caracterização e modelação de arquitecturas de rádio frequência para aplicações em rádios definidos por software e rádios cognitivos. O constante aparecimento no mercado de novos padrões e tecnologias para comunicações sem fios têm levantado algumas limitações à implementação de transceptores rádio de banda larga. Para além disso, o uso de sistemas reconfiguráveis e adaptáveis baseados no conceito de rádio definido por software e rádio cognitivo assegurará a evolução para a próxima geração de comunicações sem fios. A ideia base desta tese passa por resolver alguns problemas em aberto e propor avanços relevantes, tirando para isso partido das capacidades providenciadas pelos processadores digitais de sinal de forma a melhorar o desempenho global dos sistemas propostos. Inicialmente, serão abordadas várias estratégias para a implementação e projecto de transceptores rádio, concentrando-se sempre na aplicabilidade específica a sistemas de rádio definido por software e rádio cognitivo. Serão também discutidas soluções actuais de instrumentação capaz de caracterizar um dispositivo que opere simultaneamente nos domínios analógico e digital, bem como, os próximos passos nesta área de caracterização e modelação. Além disso, iremos apresentar novos formatos de modelos comportamentais construídos especificamente para a descrição e caracterização não-linear de receptores de amostragem passa-banda, bem como, para sistemas nãolineares que utilizem sinais multi-portadora. Será apresentada uma nova arquitectura suportada na avaliação estatística dos sinais rádio que permite aumentar a gama dinâmica do receptor em situações de multi-portadora. Da mesma forma, será apresentada uma técnica de maximização da largura de banda de recepção baseada na utilização do receptor de amostragem passa-banda no formato complexo. Finalmente, importa referir que todas as arquitecturas propostas serão acompanhadas por uma introdução teórica e simulações, sempre que possível, sendo após isto validadas experimentalmente por protótipos laboratoriais.

Tissue temperature estimation with pulse-echo in blood flow presence

Aiming at time-spatial characterization of tissue temperature when ultrasound is applied for thermal therapeutic proposes two experiments were developed considering gel-based phantoms, one of them including an artificial blood vessel. The blood vessel was mimicking blood flow in a common carotid artery. For each experiment phantoms were heated by a therapeutic ultrasound (TU) device emitting different intensities (0.5, 1, 1.5, 1.8 W/cm2). Temperature was monitored by thermocouples and estimated through imaging ultrasound transducer's signals within specific special points inside the phantom. The temperature estimation procedure was based on temporal echo-shifts (TES), computed based on echo-shifts collected through image ultrasound (IU) transducer. Results show that TES is a reliable non-invasive method of temperature estimation, regardless the TU intensities applied. Presence of a pulsatile blood flow vessel in the focal point of TU transducer reduces thermal variation in more than 50%, also affecting the temperature variation in the surrounding area. In other words, vascularized tissues require longer ultrasound thermal therapeutic sessions or higher TU intensities and inclusion of IU in the therapeutic procedure enables non-invasive monitoring of temperature. © 2013 IEEE.

Adaptive digital receivers for analog front-end mismatch correction

Phase and gain mismatches between the I and Q analog signal processing paths of a quadrature receiver are responsible for the generation of image signals which limit the dynamic range of a practical receiver. In this paper we analyse the effects these mismatches and propose a low-complexity blind adaptive algorithm to minimize this problem. The proposed solution is based on two, 2-tap adaptive filters, arranged in Adaptive Noise Canceller (ANC) set-up. The algorithm lends itself to efficient real-time implementation with minimal increase in modulator complexity.