Up close and personal with those experiencing homelessness: Pharmacist involvement in a multidisciplinary healthcare team

Introduction. The Brisbane City Council holds a biannual Homeless Connect event which brings together business and community groups on one day to provide free services to people experiencing or at risk of homelessness. Pharmacists were involved in this initiative and provided health services in a multidisciplinary healthcare environment building on the lessons of previous Homeless Connect events (Chan et al, 2015) Aims. To explore pharmacists reflections on their role in a multidisciplinary healthcare team providing services at a community outreach event for those experiencing homelessness. Methods. The pharmacists (n=2) documented the types of services provided during the Homeless Connect event. A semi-structured interview was conducted post-event to investigate barriers, facilitators and changes that would be recommended for future events. Their perceptions of their role in the multidisciplinary healthcare team were also explored. Results. Primarily, the services provided included delivery of primary healthcare, advice on accessing cost effective pharmacy services and addressing medication enquiries. The pharmacists also provided moisturiser samples and health information leaflets. Interdisciplinary referrals were primarily between the pharmacists and podiatrists; no pharmacist-medical practitioner referrals occurred. The pharmacists did believe they had a positive role in this health initiative but improvements could be implemented to improve the delivery of these services in future events. Discussion. Pharmacists can play an important role in providing services to people experiencing or at risk of homelessness and the overall experience was positive for the pharmacists. They were able to integrate into a multidisciplinary healthcare team in this setting but strategies for further collaboration were identified. The possibility of involving pharmacy students in future events was identified.

Multidisciplinary review of teaching and assessing competency attainment by non-medical prescribers

Background Prescribing is a complex task, requiring specific knowledge and skills, and the execution of effective, context-specific clinical reasoning. Systematic reviews indicate medical prescribing errors have a median rate of 7% [IQR 2%-14%] of medication orders [1-3]. For podiatrists pursuing prescribing rights, a clear need exists to ensure practitioners develop a well-defined set of prescribing skills, which will contribute to competent, safe and appropriate practice. Aim To investigate the methods employed to teach and assess the principles of effective prescribing in the undergraduate podiatry program and compare and contrast these findings with four other non-medical professions who undertake prescribing after training at Queensland University of Technology. Method The NPS National Prescribing Competency Standards were employed as the prescribing standard. A curriculum mapping exercise was undertaken to determine whether the prescribing principles articulated in the competency standards were addressed by each profession. Results A range of methods are currently utilised to teach prescribing across disciplines. Application of prescribing competencies to the context of each profession appears to influence the teaching methods used. Most competencies were taught using a multimodal format, including interactive lectures, self-directed learning, tutorial sessions and clinical placement. In particular clinical training was identified as the most consistent form of educating safe prescribers across all five disciplines. Assessment of prescribing competency utilised multiple techniques including written and oral examinations and research tasks, case studies, objective structured clinical examination exercises and the assessment of clinical practice. Effective and reliable assessment of prescribing undertaken by students in diverse settings remains challenging e.g. that occurring in the clinical practice environment. Conclusion Recommendations were made to refine curricula and to promote efficient cross-discipline teaching by staff from the disciplines of podiatry, pharmacy, nurse practitioner, optometry and paramedic science. Students now experience a sophisticated level of multidisciplinary learning in the clinical setting which integrates the expertise and skills of experience prescribers combined with innovative information technology platforms (CCTV and live patient assessments). Further work is required to establish a practical, effective approach to the assessment of prescribing competence especially between the university and clinical settings.

Questions about multidisciplinary teams

Multidisciplinary care (MDC) involves health professionals from a range of disciplines working together as a team (a multidisciplinary team – MDT) to deliver comprehensive care that addresses as many of a patient's needs as possible. Writing in 2011, Wilcoxon and others concluded: ‘Multidisciplinary care is accepted as best practice in cancer treatment planning and care.’ Yet their report (of the national audit of multidisciplinary cancer care in Australia) indicated that two-thirds of the surveyed hospitals did not have a MDT. Further, they found that where teams did exist, one-third of patients were not told that their case would be discussed by the team; the MDT-recommended treatment plan was not included in the patient’s record one-quarter of the time; and less than 1 per cent of teams reported routine attendance by the tumour-specific minimum core team. There is sparse case authority as to the potential medico-legal consequences of MDC by MDTs. This article raises five questions about legal aspects of MDC for consideration. The questions are not limited to cancer care, as MDTs are increasingly used in other areas of medicine.

Primary brain tumor patients’ supportive care needs and multidisciplinary rehabilitation, community and psychosocial support services: Awareness, referral and utilization

Primary brain tumors are associated with significant physical, cognitive and psychosocial changes. Although treatment guidelines recommend offering multidisciplinary rehabilitation and support services to address patients’ residual deficits, the extent to which patients access such services is unclear. This study aimed to assess patients’ supportive care needs early after diagnosis, and quantify service awareness, referral and utilization. A population-based sample of 40 adults recently diagnosed with primary brain tumors was recruited through the Queensland Cancer Registry, representing 18.9% of the eligible population of 203 patients. Patients or carer proxies completed surveys of supportive care needs at baseline (approximately three months after diagnosis) and three months later. Descriptive statistics summarized needs and service utilization, and linear regression identified predictors of service use. Unmet supportive care needs were highest at baseline for all domains, and highest for the physical and psychological needs domains at each time point. At follow-up, participants reported awareness of, referral to, and use of 32 informational, support, health professional or practical services. All or almost all participants were aware of at least one informational (100%), health professional (100%), support (97%) or practical service (94%). Participants were most commonly aware of speech therapists (97%), physiotherapists (94%) and diagnostic information from the internet (88%). Clinician referrals were most commonly made to physiotherapists (53%), speech therapists (50%) and diagnostic information booklets (44%), and accordingly, participants most commonly used physiotherapists (56%), diagnostic information booklets (47%), diagnostic information from the internet (47%), and speech therapists (43%). Comparatively low referral to and use of psychosocial services may limit patients’ abilities to cope with their condition and the changes they experience.

IMPOSE (IMProving Outcomes after Sepsis)—the effect of a multidisciplinary follow-up service on health-related quality of life in patients postsepsis syndromes—a double-blinded randomised controlled trial: protocol

Introduction Patients post sepsis syndromes have a poor quality of life and a high rate of recurring illness or mortality. Follow-up clinics have been instituted for patients postgeneral intensive care but evidence is sparse, and there has been no clinic specifically for survivors of sepsis. The aim of this trial is to investigate if targeted screening and appropriate intervention to these patients can result in an improved quality of life (Short Form 36 health survey (SF36V.2)), decreased mortality in the first 12 months, decreased readmission to hospital and/or decreased use of health resources. Methods and analysis 204 patients postsepsis syndromes will be randomised to one of the two groups. The intervention group will attend an outpatient clinic two monthly for 6 months and receive screening and targeted intervention. The usual care group will remain under the care of their physician. To analyse the results, a baseline comparison will be carried out between each group. Generalised estimating equations will compare the SF36 domain scores between groups and across time points. Mortality will be compared between groups using a Cox proportional hazards (time until death) analysis. Time to first readmission will be compared between groups by a survival analysis. Healthcare costs will be compared between groups using a generalised linear model. Economic (health resource) evaluation will be a within-trial incremental cost utility analysis with a societal perspective. Ethics and dissemination Ethical approval has been granted by the Royal Brisbane and Women’s Hospital Human Research Ethics Committee (HREC; HREC/13/QRBW/17), The University of Queensland HREC (2013000543), Griffith University (RHS/08/14/HREC) and the Australian Government Department of Health (26/2013). The results of this study will be submitted to peer-reviewed intensive care journals and presented at national and international intensive care and/or rehabilitation conferences.

Developing a Multidisciplinary Process View of IFC Standardization

The industry foundation classes (IFC) file format is one of the most complex and ambitious IT standardization projects currently being undertaken in any industry, focusing on the development of an open and neutral standard for exchanging building model data. Scientific literature related to the IFC standard has dominantly been technical so far; research looking at the IFC standard from an industry standardization per- spective could offer valuable new knowledge for both theory and practice. This paper proposes the use of IT standardization and IT adoption theories, supported by studies done within construction IT, to lay a theoretical foundation for further empirical analysis of the standardization process of the IFC file format.

Charting multidisciplinary research and action priorities towards the conservation and sustainable management of sea turtles in the Pacific Ocean: a focus on Malaysia

The four sea turtle species found in Malaysia are the leatherback, olive ridley, green and hawksbill. The threats to these species are acute. Populations of leatherback, olive ridley and hawksbill turtles are on the brink of collapse – threatening a biodiversity crisis in Malaysia and the region. This proceedings contains 8 technical papers presented at a workshop convened in Kijal, Terengganu to chart new directions in the conservation of Malaysia's critically endangered sea turtles and to reverse population decline. They represent a wide range of issues from aspects of biology to a review of 40 years of sea turtle conservation. A paper on the socioeconomic linkages and impacts of fisheries was also included as the workshop adopted a multidisciplinary approach to address the issues. Two case studies, including successful restoration examples from international experiences and restoration efforts in Sabah, pave the way for enhancing turtle conservation in the country.

Long Bay hypoxia study: A collaborative and multidisciplinary approach

The nearshore waters along the Myrtle Beach area are oceanographically referred to as Long Bay. Long Bay is the last in a series of semi-circular indentations located along the South Atlantic seaboard. The Bay extends for approximately 150 km from the Cape Fear River in North Carolina to Winyah Bay in South Carolina and has a number of small inlets (Figure 1). This region of the S.C. coast, commonly referred to as the “Grand Strand,” has a significant tourism base that accounts for a substantial portion of the South Carolina economy (i.e., 40% of the state’s total in 2002) (TIAA 2003). In 2004, the Grand Strand had an estimated 13.2 million visitors of which 90% went to the beach (MBCC 2006). In addition, Long Bay supports a shore-based hook and line fishery comprised of anglers fishing from recreational fishing piers, the beach, and small recreational boats just offshore. (PDF contains 4 pages)

Online journalism: research methods. A multidisciplinary approach in comparative perspective

Journalism on digital networks, and specifically on Internet, is a relatively recent phenomenon, whose spread began in approximately 1994, in parallel to that of the World Wide Web. Study of this new communicative phenomenon began simultaneously in several countries. This, in its turn, was helped by the new possibilities for communication amongst academics - electronic mail, predating the WWW, was, and is, one of the most widely used tools of the university community. The spread of these new forms of global communication helped to raise mutual awareness between research groups, making it possible to form increasingly broad and cohesive networks.

Humanism after the Spanish Civil War: Gernika (1945-53), a Humanities and Social Sciencesbasque magazine

Espainiako Gerra Zibilaren eta II. Mundu Gerrarren ostean Gerra Hotza heldu zen. Testuinguru larri horretan humanismoan ikusi zuten hainbatek zibilizazio-krisiari irtenbidea topatzeko bidea. Gernika aldizkariak (1945-53) bere burua humanistatzat zeukan. Bertako idazleek gai horren inguruan zer adierazi zuten jasotzen saiatu gara, euskarazko zein erdarazko artikuluetan agertzen diren iritziak sailkatuz.

Multidisciplinary research and management: fisheries in the Central Delta of the Niger River (Mali)

This contribution gives an overview of the fisheries in the Central Delta of the Niger River (Mali) and highlights the results of a multidisciplinary research and management program conducted in the area to assess the status of the fisheries and improve their management. The importance of multidisciplinary approaches is emphasized to fully elaborate the problems impacting fisheries and the measures for their resolution. Directions for increased decentralization, participation of fishers and ecosystem preservation for improved management of the Central Delta fisheries are briefly discussed.