scholarly journals The Validation of Geriatric Cases for Interprofessional Education: A Consensus Method

2020 ◽  
Vol 7 ◽  
pp. 238212052095763
Author(s):  
Carolyn CJ Teuwen ◽  
Rashmi RA Kusurkar ◽  
Hermien WH Schreurs ◽  
Hester HEM Daelmans ◽  
Saskia SM Peerdeman
Keyword(s):  
Interprofessional Education ◽  
Treatment Plan ◽  
Consensus Method ◽  
Ageing Population ◽  
Consensus Methods ◽  
Educational Setting ◽  
Healthcare Facilities ◽  
Face To Face ◽  
Roles And Responsibilities ◽  
Treatment Plans

Background: Case-based Interprofessional Education (IPE) can help students practise their roles and responsibilities. To construct these cases, input from experts in clinical practice is essential. Consensus between these experts can be facilitated using consensus methods. In this study, a geriatric focus for the cases was chosen because of the interprofessional nature of geriatrics and the ageing population in healthcare facilities. Methods: By combining the 3 most commonly used consensus methods, we developed a 6-step approach to validate cases for IPE. The 6 steps include 3 expert rounds (Steps 1, 3 and 5) and 2 rounds in which discussion points were formulated by the researcher (Steps 2 and 4). The cases were piloted with students as Step 6. Four facets of a case were included: the patient description, the complemented treatment plan, the difficulty of the case and the scoring of the treatment plan. Our educational setting required constructing 4 cases with increasing difficulty. Results: Step 1: 5 typical geriatric cases were assembled. Step 2: Similar characteristics were defined; 5 cases were merged into 4. The 4 cases showed increasing difficulty levels. Step 3: The constructed cases were validated for patient description authenticity, treatment plan adequacy, difficulty and scoring of the treatment plan. Step 4: The items for further discussion were defined. Step 5: Consensus was reached for all 4 cases through a face-to-face discussion. Step 6: The student pilot for Case 1 showed no significant adjustments. Conclusion: We developed a 6-step consensus method to validate cases for IPE, and we constructed 4 geriatric cases based on this method. While consensus about the patient descriptions and difficulty levels was reached easily, consensus on the treatment plans was more difficult to achieve. Validation of the scoring of the treatment plan was unsuccessful. Further research on this will be conducted.

scholarly journals Exploring healthcare students’ interprofessional teamwork in primary care simulation scenarios: collaboration to create a shared treatment plan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lene Lunde ◽  
Anne Moen ◽  
Rune B. Jakobsen ◽  
Elin O. Rosvold ◽  
Anja M. Brænd
Keyword(s):  
Primary Care ◽  
Interprofessional Education ◽  
Interprofessional Collaboration ◽  
Interaction Analysis ◽  
Treatment Plan ◽  
Primary Care Providers ◽  
Comprehensive Treatment ◽  
Care Providers ◽  
Healthcare Students ◽  
Treatment Plans

Abstract Background Primary care providers assume responsibility for patients with increasingly complex problems requiring interprofessional collaboration. Introducing interprofessional education in healthcare curricula prepares healthcare students for this reality. Solving simulation scenarios as an educational strategy is promoted to support interprofessional education in health care, and is mostly used in acute clinical situations. This paper aims to explore how healthcare students’ actions influence interprofessional collaboration and treatment plan identification when they solve common, sub-acute patient scenarios in primary care situations. Methods Interaction analysis of video recordings from the simulation scenarios was performed with a focus on the students’ joint actions; specifically how these actions unfold and how productive the students were in terms of developing treatment plans. Results We found variation in the groups’ interactions, the paths they followed, and the quality of their knowledge output in their shared treatment plan. The groups with the capacity to collaborate and engage in sharing information, and explain and elaborate on concepts, were more successful in developing comprehensive treatment plans. Furthermore, these groups managed the duality of defining and solving the immediate problem and collaboratively preparing for future care. Conclusions Analysis of the activities in our scenarios showed the students’ potential to practice interprofessional collaboration. Our study illustrates that simulation of sub-acute scenarios in primary care is an underexplored but suitable arena to train communication and teamwork in complex situations. The simulation scenarios are also feasible for use on-site in an educational facility or in practice with minimal equipment and resources.

scholarly journals Observations from a small country: mental health policy, services and nursing in Wales

2021 ◽  
pp. 1-12
Author(s):  
Ben Hannigan
Keyword(s):  
Mental Health ◽  
Health Policy ◽  
Mental Health Policy ◽  
National Policy ◽  
Ageing Population ◽  
Small Country ◽  
Mental Health Nurses ◽  
Face To Face ◽  
Health Need ◽  
The Uk

Abstract Wales is a small country, with an ageing population, high levels of population health need and an economy with a significant reliance on public services. Its health system attracts little attention, with analyses tending to underplay the differences between the four countries of the UK. This paper helps redress this via a case study of Welsh mental health policy, services and nursing practice. Distinctively, successive devolved governments in Wales have emphasised public planning and provision. Wales also has primary legislation addressing sustainability and future generations, safe nurse staffing and rights of access to mental health services. However, in a context in which gaps always exist between national policy, local services and face-to-face care, evidence points to the existence of tension between Welsh policy aspirations and realities. Mental health nurses in Wales have produced a framework for action, which describes practice exemplars and looks forward to a secure future for the profession. With policy, however enlightened, lacking the singular potency to bring about intended change, nurses as the largest of the professional groups involved in mental health care have opportunities to make a difference in Wales through leadership, influence and collective action.

scholarly journals The effects of a preoperative multidisciplinary conference on outcomes for high-risk patients with challenging surgical treatment options: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masayoshi Koike ◽  
Mie Yoshimura ◽  
Yasushi Mio ◽  
Shoichi Uezono
Keyword(s):  
Patient Safety ◽  
Retrospective Study ◽  
High Risk ◽  
Treatment Plan ◽  
Treatment Options ◽  
High Risk Patients ◽  
Appropriate Treatment ◽  
Risk Patients ◽  
Treatment Plans ◽  
Multidisciplinary Conference

Abstract Background Surgical options for patients vary with age and comorbidities, advances in medical technology and patients’ wishes. This complexity can make it difficult for surgeons to determine appropriate treatment plans independently. At our institution, final decisions regarding treatment for patients are made at multidisciplinary meetings, termed High-Risk Conferences, led by the Patient Safety Committee. Methods In this retrospective study, we assessed the reasons for convening High-Risk Conferences, the final decisions made and treatment outcomes using conference records and patient medical records for conferences conducted at our institution from April 2010 to March 2018. Results A total of 410 High-Risk Conferences were conducted for 406 patients during the study period. The department with the most conferences was cardiovascular surgery (24%), and the reasons for convening conferences included the presence of severe comorbidities (51%), highly difficult surgeries (41%) and nonmedical/personal issues (8%). Treatment changes were made for 49 patients (12%), including surgical modifications for 20 patients and surgery cancellation for 29. The most common surgical modification was procedure reduction (16 patients); 4 deaths were reported. Follow-up was available for 21 patients for whom surgery was cancelled, with 11 deaths reported. Conclusions Given that some change to the treatment plan was made for 12% of the patients discussed at the High-Risk Conferences, we conclude that participants of these conferences did not always agree with the original surgical plan and that the multidisciplinary decision-making process of the conferences served to allow for modifications. Many of the modifications involved reductions in procedures to reflect a more conservative approach, which might have decreased perioperative mortality and the incidence of complications as well as unnecessary surgeries. High-risk patients have complex issues, and it is difficult to verify statistically whether outcomes are associated with changes in course of treatment. Nevertheless, these conferences might be useful from a patient safety perspective and minimize the potential for legal disputes.

scholarly journals Multicriterial CNN based beam generation for robotic radiosurgery of the prostate

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Stefan Gerlach ◽  
Christoph Fürweger ◽  
Theresa Hofmann ◽  
Alexander Schlaefer
Keyword(s):  
Deep Learning ◽  
Treatment Planning ◽  
Treatment Plan ◽  
Plan Quality ◽  
New Approach ◽  
Beam Generation ◽  
Radiological Features ◽  
Improve Treatment ◽  
Robotic Radiosurgery ◽  
Treatment Plans

AbstractAlthough robotic radiosurgery offers a flexible arrangement of treatment beams, generating treatment plans is computationally challenging and a time consuming process for the planner. Furthermore, different clinical goals have to be considered during planning and generally different sets of beams correspond to different clinical goals. Typically, candidate beams sampled from a randomized heuristic form the basis for treatment planning. We propose a new approach to generate candidate beams based on deep learning using radiological features as well as the desired constraints. We demonstrate that candidate beams generated for specific clinical goals can improve treatment plan quality. Furthermore, we compare two approaches to include information about constraints in the prediction. Our results show that CNN generated beams can improve treatment plan quality for different clinical goals, increasing coverage from 91.2 to 96.8% for 3,000 candidate beams on average. When including the clinical goal in the training, coverage is improved by 1.1% points.

scholarly journals Outcomes of Peer Review for Radiotherapy Treatment Plans With Palliative Intent

2018 ◽  
Vol 14 (12) ◽  
pp. e794-e800
Author(s):  
Dina Thompson ◽  
Kimberly Cox ◽  
James Loudon ◽  
Ivan Yeung ◽  
Woodrow Wells
Keyword(s):  
Peer Review ◽  
Treatment Plan ◽  
Palliative Radiotherapy ◽  
Cancer Center ◽  
Palliative Intent ◽  
Treatment Plans ◽  
Important Quality ◽  
Radiation Medicine ◽  
Radiotherapy Treatment

Purpose: Peer review of a proposed treatment plan is increasingly recognized as an important quality activity in radiation medicine. Although peer review has been emphasized in the curative setting, applying peer review for treatment plans that have palliative intent is receiving increased attention. This study reports peer review outcomes for a regional cancer center that applied routine interprofessional peer review as a standard practice for palliative radiotherapy. Methods and Materials: Peer review outcomes for palliative radiotherapy plans were recorded prospectively for patients who began radiotherapy between October 1, 2015, and September 30, 2017. Recommended and implemented changes were recorded. The content of detailed discussions was recorded to gain insight into the complexities of palliative treatment plans considered during peer review. Results: Peer review outcomes were reviewed for 1,413 treatment plans with palliative intent. The proportions of detailed discussions and changes recommended were found to be 139 (9.8%) and 29 (2.1%), respectively. The content of detailed discussions and changes recommended was categorized. Major changes represented 75.9% of recommended changes, of which 84.2% were implemented clinically. Conclusion: Many complexities exist that are specific to palliative radiotherapy. Interprofessional peer review provides a forum for these complexities to be openly discussed and is an important activity to optimize the quality of care for patients with treatment plans that have palliative intent.

scholarly journals Managing Older Adults With Cognitive Impairment: An Interprofessional, Standardized Patient Approach

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 10-10
Author(s):  
Shaun Varrecchia ◽  
Carol Maritz ◽  
Colleen Maher ◽  
Megan Strauss
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Occupational Therapy ◽  
Interprofessional Education ◽  
Professional Organizations ◽  
Standardized Patient ◽  
Geriatric Population ◽  
Roles And Responsibilities ◽  
Interprofessional Teams ◽  
Occupational Therapy Students

Abstract Several professional organizations have called for increased preparation of health professionals capable of working with older adults, including those with cognitive impairment. Standardized patients (SP) are often used in interprofessional education (IPE) in the health professions, but limited data exists to support their use when teaching about the care and management of older adults with cognitive impairment. The purposes of this project were to: 1) develop, implement, and assess an interprofessional standardized patient exercise involving physical and occupational therapy students and 2) to evaluate students’ perceptions of a SP encounter on relevance and utility to patients with cognitive impairment. 88 students representing physical therapy (DPT) and occupational therapy (DrOT) were assigned to interprofessional teams to evaluate an SP portraying an older adult with cognitive impairment. At the conclusion of the session the SP provided the group formative feedback. Student teams then completed an assignment to develop a collaborative intervention plan and addressed questions about roles and responsibilities and communication/teamwork. Pre-/post- surveys focusing on the knowledge of roles and responsibilities, communication, and teamwork were completed by all students. Students also completed an evaluation about the SP experience. Results demonstrated student agreement to understanding the role of the other’s profession improved 28.67%; being comfortable communicating with the geriatric population improved 27.31%; and working in interprofessional teams can improve geriatric patient care improved 32.11%. These findings demonstrate that use of SPs has several advantages in teaching students how to work and communicate with individuals with cognitive impairments as an interprofessional team.

Diagnostic accuracy and clinical management by realtime teledermatology. Results from the Northern Ireland arms of the UK Multicentre Teledermatology Trial

1998 ◽  
Vol 4 (2) ◽  
pp. 95-100 ◽  
Author(s):  
M A Loane ◽  
R Corbett ◽  
S E Bloomer ◽  
D J Eedy ◽  
H E Gore ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Management ◽  
Low Cost ◽  
Treatment Plan ◽  
Management Plan ◽  
Face To Face ◽  
Management Plans ◽  
Video Link ◽  
The Uk ◽  
Management Recommendations

Diagnostic accuracy and management recommendations of realtime teledermatology consultations using low-cost telemedicine equipment were evaluated. Patients were seen by a dermatologist over a video-link and a diagnosis and treatment plan were recorded. This was followed by a face-to-face consultation on the same day to confirm the earlier diagnosis and management plan. A total of 351 patients with 427 diagnoses participated. Sixty-seven per cent of the diagnoses made over the video-link agreed with the face-to-face diagnosis. Clinical management plans were recorded for 214 patients with 252 diagnoses. For this cohort, 44 of the patients were seen by the same dermatologist at both consultations, while 56 were seen by a different dermatologist. In 64 of cases the same management plan was recommended at both consultations; a sub-optimum treatment plan was recommended in 8 of cases; and in 9 of cases the video-link management plans were judged to be inappropriate. In 20 of cases the dermatologist was unable to recommend a suitable management plan by video-link. There were significant differences in the ability to recommend an optimum management plan by video-link when a different dermatologist made the reference management plan. The results indicate that a high proportion of dermatological conditions can be successfully managed by realtime teledermatology.

Willingness to Travel for Cellular Therapy: The Influence of Follow-Up Care Location, Oncologist Continuity, and Race

2021 ◽  
pp. OP.21.00312
Author(s):  
Zachary A. K. Frosch ◽  
Esin C. Namoglu ◽  
Nandita Mitra ◽  
Daniel J. Landsburg ◽  
Sunita D. Nasta ◽  
...  
Keyword(s):  
Travel Time ◽  
Cellular Therapy ◽  
Treatment Plan ◽  
Admission Rate ◽  
B Cell Lymphoma ◽  
Travel Times ◽  
Importance Weights ◽  
Follow Up Care ◽  
Treatment Plans

PURPOSE Patients weigh competing priorities when deciding whether to travel to a cellular therapy center for treatment. We conducted a choice-based conjoint analysis to determine the relative value they place on clinical factors, oncologist continuity, and travel time under different post-treatment follow-up arrangements. We also evaluated for differences in preferences by sociodemographic factors. METHODS We administered a survey in which patients with diffuse large B-cell lymphoma selected treatment plans between pairs of hypothetical options that varied in travel time, follow-up arrangement, oncologist continuity, 2-year overall survival, and intensive care unit admission rate. We determined importance weights (which represent attributes' value to participants) using generalized estimating equations. RESULTS Three hundred and two patients (62%) responded. When all follow-up care was at the center providing treatment, plans requiring longer travel times were less attractive ( v 30 minutes, importance weights [95% CI] of –0.54 [–0.80 to –0.27], –0.57 [–0.84 to –0.29], and –0.17 [–0.49 to 0.14] for 60, 90, and 120 minutes). However, the negative impact of travel on treatment plan choice was mitigated by offering shared follow-up (importance weights [95% CI] of 0.63 [0.33 to 0.93], 0.32 [0.08 to 0.57], and 0.26 [0.04 to 0.47] at 60, 90, and 120 minutes). Black participants were less likely to choose plans requiring longer travel, regardless of follow-up arrangement, as indicated by lower value importance weights for longer travel times. CONCLUSION Reducing travel burden through shared follow-up may increase patients' willingness to travel to receive cellular therapies, but additional measures are required to facilitate equitable access.

scholarly journals A Creature Called CIH: From a Quantum Explanation of Psychological Disorders to a Classical Limit of Behavior

2017 ◽  
Author(s):  
Saeideh Mohseni Nezhad
Keyword(s):  
Impulse Control ◽  
Classical Limit ◽  
Treatment Plan ◽  
Psychological Disorders ◽  
Conduct Disorders ◽  
Quantum Limit ◽  
Quantum Model ◽  
Quantum Field Theories ◽  
Treatment Plans ◽  
Suitable Treatment

The objective of this study is to present a Quantum Model for designing and predicting suitable treatment plans for different psychological disorders. The theory has been extracted from Quantum Field Theories and is modeled on a Conceptual Isolated Human (CIH), which is a totally abstract idea. The Quantum limit of the model explains the way disorders are formed, and its classical limit forecasts the observable CIH behavior. Then, a pattern has been presented for treatment plans based on the CIH Quantum Model, which is named ‘Systematic Balancing’. Finally, Systematic Balancing is presented in this article in order to explain and predict the treatment plan for the category of 'Disruptive, Impulse-Control, and Conduct Disorders in DSM-5'.

scholarly journals Assessment of the capacity of future Dentists to elaborate treatment plans for dental trauma

2020 ◽  
Vol 9 (8) ◽  
pp. e255985718
Author(s):  
Daniela Atili Brandini ◽  
Denise Pedrini ◽  
Caio Vinicius Lourenço Debortoli ◽  
Luiza Monzoli Côvre ◽  
Marina Fuzette Amaral
Keyword(s):  
Treatment Plan ◽  
Dental Trauma ◽  
Great Difficulty ◽  
Cross Sectional ◽  
Adequate Treatment ◽  
Root Fracture ◽  
Occlusal Adjustment ◽  
Treatment Plans ◽  
Dentoalveolar Trauma ◽  
Systemic Condition

The prognosis of dental trauma depends on professionals with solid and updated knowledge. The objective was to evaluate the ability of undergraduate dentistry students to develop treatment plans for dental trauma. This cross-sectional, observational, quantitative  study had a sample of 242 participants. A clinical case involving avulsion of tooth 11 and complex coronary root fracture of tooth 21 was selected. All data relating to the patient's exams were added to a clinical record, which was delivered to students in the final year of the undergraduate dentistry course for three years consecutive. The students were instructed to develop a treatment plan for this case. The factors most considered in avulsion treatment plans were: how, when and where the trauma occurred, the patient's age and systemic condition. Of the students, 39.7% developed an adequate treatment plan, the main mistake being the lack of occlusal adjustment. In addition, 9,9% of students had an adequate treatment plan for coronary artery fracture. The recovery of periodontal biological space and the indication of intraradicular retainers were the main difficulties. It is concluded that undergraduate dentistry students had great difficulty in formulating treatment plans suitable for more severe cases of dentoalveolar trauma involving several specialties.

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