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To explore emergency nurses' and physicians' experience of collaboration and collective decision-making when triaging older Emergency Department patients within the interprofessional team triage system.Qualitative.Semi-structured interviews were conducted with seven nurses and five physicians. Transcripts were analysed via Interpretive Description between September 2016-May 2017.'Negotiating collaboration' was developed as the main theme. Three subthemes influenced the negotiation process: Participants described divergent opinions on how an optimal triage system should work ('preferences for triage systems'); they had conflicting perceptions of each profession's role ('role perceptions'); and they expressed different coping strategies regarding 'perceived time pressure'. The compatibility of participants' views on these sub-themes determined whether the nurse and physician were able to successfully negotiate their collaboration. These themes became more evident when the team triaged older ED patients.Improving interprofessional team triage requires working with the involved nurses' and physicians' values and beliefs. The strengths of both professions need to be considered and a flexible approach to collaboration established according to the patients' situations.Emergency Department leaders need to consider nurses' and physicians' values and beliefs to promote interprofessional collaboration in team triage.目的: 探讨急诊护士和医师在跨专业团队分诊系统中对急诊科老年患者进行分流时的协作和集体决策经验。 设计: 质化设计 方法: 对七名护士和五名内科医生进行了半结构式访谈。在2016年9月至2017年5月期间, 通过解释性说明对记录进行分析。 结果: 将‘协商合作’的发展作为主要主题。三个分主题影响了谈判进程: 参与者表达了关于最佳分流制度应如何运作的不同意见 (‘对分流制度的偏好’) ; 对每个职业角色的认知存在分歧(‘角色认知’) ; 在时间压力感知上, 表现出不同的应对策略。参与者对这些分主题观点的兼容性决定了护士和医师是否能够成功与其进行协商合作。当研究小组对老年ED患者进行分类时, 这些主题变得更加明显。 结论: 提高跨专业团队间的分诊需要与相关护士和医师具有相同价值观和信念。需要考虑两个专业的优势, 并根据患者的情况建立灵活的协作方法。 影响: 急诊科领导需要考虑护士和医师的价值观和信念, 以促进团队分诊中的跨专业协作。.

Context Research in workplace learning has emphasised trainees' active role in their education. By focusing on how trainees fine-tune their strategic learning, theories of self-regulated learning (SRL) offer a unique lens to study workplace learning. To date, studies of SRL in the workplace tend to focus on listing the factors affecting learning, rather than on the specific mechanisms trainees use to regulate their goal-directed activities. To inform the design of workplace learning interventions that better support SRL, we asked: How do residents navigate their exposure to and experience performing invasive procedures in intensive care units? Methods In two academic hospitals, we conducted post-call debriefs with residents coming off shift and later sought their elaborated perspectives via semi-structured interviews. We used a constant comparative methodology to analyse the data, to iteratively refine data collection, and to inform abductive coding of the data, using SRL principles as sensitising concepts. Results We completed 29 debriefs and nine interviews with 24 trainees. Participants described specific mechanisms: identifying, creating, avoiding, missing and competing for opportunities to perform invasive procedures. While using these mechanisms to engage with procedures (or not), participants reported: distinguishing trajectories (i.e. becoming attuned to task-relevant factors), navigating trajectories (i.e. creating and interacting with opportunities to perform procedures), and co-constructing trajectories with their peers, supervisors and interprofessional team members. Conclusions We identified specific SRL mechanisms trainees used to distinguish and navigate possible learning trajectories. We also confirmed previous findings, including that trainees become attuned to interactions between personal, behavioural and environmental factors (SRL theory), and that their resulting learning behaviours are constrained and guided by interactions with peers, supervisors and colleagues (workplace learning theory). Making learning trajectories explicit for clinician teachers may help them support trainees in prioritising certain trajectories, in progressing along each trajectory, and in co-constructing their plans for navigating them.

Background/objectives Interprofessional trainees need geriatrics training to prepare them to care for our aging population. Team-based care will help them be ready to work in an Age-Friendly Health System. The Geriatrics 5Ms provides a framework to engage learners in five main domains of caring for older adults from an interprofessional perspective: Mobility, Mind, Medications, Multicomplexity, and what Matters Most. Design We created a half-day workshop for interprofessional trainees using the Geriatric 5Ms framework to increase their preparedness in caring for older adults as part of an interprofessional team. Setting The New England Geriatric Research Education and Clinical Center. Participants A total of 66 trainees from 10 professions. Intervention After introductory sessions on careers in aging, participants engaged in an interactive session to learn about the professions represented. They then formed interprofessional groups to discuss a patient case using the Geriatrics 5Ms framework with a modified jigsaw format. Measurements Trainees were surveyed before and after the workshop on their attitudes toward careers in aging, understanding of skills and training paths of other professions, and familiarity with the Geriatrics 5Ms framework. Results Overall, 97% of the trainees rated the workshop highly. Trainee ratings significantly increased in the areas of understanding of other professions, and familiarity and applicability of the Geriatrics 5Ms, particularly for nonphysicians. Conclusion A workshop for interprofessional trainees using the Geriatrics 5Ms framework increased the readiness of trainees to care for older adults as part of an interprofessional team. This workshop offers a promising model for needed interprofessional geriatrics education. J Am Geriatr Soc 68:1857-1863, 2020.

Interprofessional education (IPE) is based on collaborative practices that increase the occasions for communication among those in various health professions. However, there is a paucity of literature about the effectiveness of IPE programs in health professions education. The aim of this systematic review and meta-analysis was to objectively assess the literature on the effectiveness of IPE in improving health professions students' attitudes after training. The major scholarly databases were searched for relevant IPE studies involving predoctoral health professions students. Two independent researchers selected the studies, extracted the data, and assessed the quality of the studies. Meta-analyses of the outcomes were performed using random effects models. Sixteen articles were ultimately selected for detailed review and meta-analysis. The meta-analysis showed that IPE training had a significant influence on students' understanding of collaboration and resulted in better attitudes about interprofessional teamwork. Subscale analysis showed that one subscale score (roles and responsibilities) did not statistically significantly improve after IPE training (p=0.06), whereas the other four subscale items showed statistically significant improvements (p0.01). The test for overall effects showed that IPE training had a significantly positive influence on students' attitudes about IPE (Z=6.85, p0.01). Subgroup results showed that medical students had more positive attitudes about IPE than did dental students. Regardless of profession, women students responded with significantly more positive feedback than did men students (p=0.02). These results suggest that intervention through IPE training has had positive effects in health professions education. Gender was an important factor impacting the outcomes of IPE. However, further clinical practice interventions may be helpful to enhance the IPE competence of health professions students.

Perioperative nurses use aseptic and sterile technique along with standard cleaning and disinfection practices to prevent surgical site infections. At our hospital, OR team members identified a clinical problem: the lack of a systematic approach to determine the type of postprocedure cleaning required between procedures involving patients with multi-drug resistant organisms or Clostridium difficile. Facility leaders developed a project to design and implement an evidence-based decision-making algorithm to help perioperative nurses rapidly identify the appropriate environmental cleaning procedures for these ORs. After the perioperative nurses were taught how to use the algorithm, it was put into use. Nineteen months later, the nurses completed a postimplementation survey. The results of the survey were generally positive, and the cleaning process was more standardized. We found that a decision-making algorithm was an effective tool to determine the proper postprocedure environmental cleaning between surgical procedures for patients with multi-drug resistant organisms or C difficile.

Objectives Patients with dementia are at high risk for hip fractures and often have poor outcomes when a fracture is sustained. Despite this poor prognosis, little data are available on what factors should be prioritized to guide surgical decision making in these cases. We aimed to understand the decision-making process for older dementia patients hospitalized after hip fractures. Design We performed a qualitative analysis of in-depth elite interviews conducted with a clinical care team involved in management of patients with dementia after hospitalization for hip fractures. Setting Interviews were conducted with an interprofessional team involved in the care of patients with dementia after being hospitalized for hip fractures. Participants Interviewees included nine orthopaedic surgeons, three hospitalists, three geriatricians, five nurses, three occupational therapists, three physical therapists, and two clinical ethicists. Measurements Verbatim transcripts of the interviews were analyzed and coded using QSR International's NVivo 10 qualitative database management software. Results The three main themes that most interviewees discussed were pain control, functional status, and medical comorbidities. Interviewees brought up many factors related to restoring functional status including baseline functional status, rehabilitation potential, social support, and the importance of mobility. Dementia and its impact on rehabilitation potential were mentioned by all geriatricians. Conclusion Although frailty, prognosis, and life expectancy were largely absent from the responses, the emphasis on dementia, advanced directives, and involving family or caregivers by the three geriatricians indicates the importance of including geriatricians in the decision-making team for these patients.

BACKGROUND: A critical task of the inpatient interprofessional team is readying patients for discharge. Assessment of shared mental model (SMM) convergence can determine how much team members agree about patient discharge readiness and how their mental models align with the patient’s self-assessment. OBJECTIVE: Determine the convergence of interprofessional team SMMs of hospital discharge readiness and identify factors associated with these assessments. DESIGN: We surveyed interprofessional discharging teams and each team’s patient at time of hospital discharge using validated tools to capture their SMMs. PARTICIPANTS: Discharge events (n = 64) from a single hospital consisting of the patient and their team (nurse, coordinator, physician). MEASURES: Clinician and patient versions of the validated Readiness for Hospital Discharge Scales/Short Form (RHDS/SF). We measured team convergence by comparing the individual clinicians’ scores on the RHDS/SF, and we measured team-patient convergence as the absolute difference between the Patient-RHDS/SF score and the team average score on the Clinician-RHDS/SF. RESULTS: Discharging teams assessed patients as having high readiness for hospital discharge (mean score, 8.5 out of 10; SD, 0.91). The majority of teams had convergent SMMs with high to very high interrater agreement on discharge readiness (mean r*wg(J), 0.90; SD, 0.10). Yet team-patient SMM convergence was low: Teams overestimated the patient’s self-assessment of readiness for discharge in 48.4% of events. We found that teams reporting higher-quality teamwork (P = .004) and bachelor’s level–trained nurses (P < .001) had more convergent SMMs with the patient. CONCLUSION: Measuring discharge teams’ SMM of patient discharge readiness may represent an innovative assessment tool and potential lever to improve the quality of care transitions. Journal of Hospital Medicine 2020;15:XXX-XXX.

Aim To examine older people and their families’ perceptions about their experiences with interprofessional teams. Design Naturalistic inquiry using qualitative descriptive methods to provide a comprehensive summary of older people and their families’ experiences with interprofessional teams. Methods Interviews were conducted with 22 people from 11 families. The families had experiences with teams in a variety of settings, such as community, residential care and hospital. Data were analysed using inductive content analysis. NiVivo was used to record preliminary codes. Analysis included comparing and contrasting families’ experiences. Results Older people and their families wanted communication about what was going on, regardless of whether the news was good, bad or unknown. They also wanted care that took the concerns of the older person into consideration. Communication was a necessary ingredient to ensuring that the older person's unique concerns were known to the interprofessional team. These percepectives were discussed in the themes of communication and patient-centred care.

Medical errors involve different health care professionals, are multifaceted, and can occur at the individual practitioner or system level. The conditions for errors vary in the health care environment; some practice areas may be more vulnerable to errors than others. Limited research exists that explores perioperative nursing errors. The purpose of this study was to describe and interpret the experiences of perioperative nurses related to intraoperative errors. We used the hermeneutic phenomenological method. Ten perioperative RNs participated in focus group interviews that we audio-recorded and transcribed. We analyzed data using thematic analysis, and three themes emerged that represent the essence of the experience of nurses involved in intraoperative errors: environment, being human, and moving forward. The findings support efforts to improve quality care and foster a culture of safety in the OR through strategies such as perioperative staff training, interprofessional team building, and controlling environmental factors that are distracting.

Interprofessional and intraprofessional education (when students from two or more professions or within the same profession, respectively, learn about, from, and/or with each other) is crucial for effective interdisciplinary collaboration. The aims of this study were to assess the effectiveness of a clinical intraprofessional education program for dental and dental hygiene students, based on students' expectations and satisfaction with the program and patients' satisfaction with the team-based care. The pilot program was developed at the University of Tennessee Health Science Center College of Dentistry, where dental hygiene students were paired randomly with dental students scheduled for prophylaxis, scaling and root planing, or periodontal maintenance. Surveys with questions about the students' expectations and satisfaction were distributed to 89 senior dental students and 27 senior dental hygiene students before and after team-based procedures. Another survey was distributed to 17 patients asking about their satisfaction with the team-based care. All 27 dental hygiene students (100% response rate), 51 dental students (57.3% response rate), and all 17 patients (100% response rate) participated in the surveys. The results showed that both the dental and dental hygiene students had high expectations and were overall satisfied with the intraprofessional education. The students' expectations and perceived educational gap (difference between expectations and satisfaction) differed for the dental and dental hygiene students (p

The first nurse practitioners in surgical care were introduced into Swedish surgical wards in 2014. Internationally, organisations that have adopted nurse practitioners into care teams are reported to have maintained or improved the quality of care. However, close qualitative descriptions of teamwork practice may add to existing knowledge of interprofessional collaboration when introducing nurse practitioners into new clinical areas. The aim was to report on an empirical study describing how interprofessional teamwork practice was enacted by nurse practitioners when introduced into surgical ward teams.The study had a qualitative, ethnographic research design, drawing on a sociomaterial conceptual framework. The study was based on 170 hours of ward-based participant observations of interprofessional teamwork practice that included nurse practitioners. Data were gathered from 2014 to 2015 across four surgical sites in Sweden, including 60 interprofessional rounds. The data were analysed with an iterative reflexive procedure involving inductive and theory-led approaches. The study was approved by a Swedish regional ethics committee (Ref. No.: 2014/229-31). The interprofessional teamwork practice enacted by the nurse practitioners that emerged from the analysis comprised a combination of the following characteristic role components: clinical leader, bridging team colleague and ever-present tutor. These role components were enacted at all the sites and were prominent during interprofessional teamwork practice.The participant nurse practitioners utilised the interprofessional teamwork practice arrangements to enact a role that may be described in terms of a quality guarantee, thereby contributing to the overall quality and care flow offered by the entire surgical ward team.

Objectives To explore the quality of interprofessional teamwork in acute geriatric care and to build a model of team types. Design Cross-sectional multicenter study. Setting Acute geriatric units in Belgium. Participants Team members of different professional backgrounds. Measurements Perceptions of interprofessional teamwork among team members of 55 acute geriatric units in Belgium were measured using a survey covering collaborative practice and experience, managerial coaching and open team culture, shared reflection and decision-making, patient files facilitating teamwork, members’ belief in the power of teamwork, and members’ comfort in reporting incidents. Cluster analysis was used to determine types of interprofessional teamwork. Professions and clusters were compared using analysis of variance. Results The overall response rate was 60%. Of the 890 respondents, 71% were nursing professionals, 20% other allied health professionals, 5% physicians, and 4% logistic and administrative staff. More than 70% of respondents scored highly on interprofessional teamwork competencies, consultation, experiences, meetings, management, and results. Fewer than 55% scored highly on items about shared reflection and decision-making, reporting incidents from a colleague, and patient files facilitating interprofessional teamwork. Nurses in this study rated shared reflection and decision-making lower than physicians on the same acute geriatric units (P < .001). Using the mean score on each of the six areas, four clusters that differed significantly in all areas were identified using hierarchical cluster analysis and scree plot analysis (P < .001). Conclusion Interprofessional teamwork in acute geriatric units is satisfactory, but shared reflection and decision-making needs improvement. Four types of interprofessional teamwork are identified and can be used to benchmark the teamwork of individual teams.

Engaging other health care providers in oral health-related activities and interprofessional care (IPC) could increase access to oral health care for underserved populations in the U.S. The aims of this study were to assess dental hygiene, dental, and medical students' intra- and interprofessional and oral and maxillofacial surgery (OMFS)/hospital dentistry-related knowledge/skills, attitudes, and behavior; determine whether first and second year vs. third and fourth year cohorts' responses differed; and explore how intra- and interprofessional knowledge was related to interprofessional education (IPE) and interprofessional attitudes and behavior. Data were collected between April 2014 and May 2015 from 69 dental hygiene, 316 dental, and 187 medical students. Response rates across classes for the dental hygiene students ranged from 85% to 100%; 24% to 100% for the dental students; and 13% to 35% for the medical students. The results showed that the medical students had lower oral health-related and interprofessional knowledge and less positive attitudes about oral health-related behavior, IPE, and interprofessional teamwork than the dental hygiene and dental students. While third- and fourth-year medical students' interprofessional knowledge/skills and behavior were higher than those of first- and second-year students, the two groups' IPE-related and interprofessional attitudes did not differ. The students' knowledge correlated with their IPE and interprofessional communication-related skills and behavior, but not with their interprofessional attitudes. These dental hygiene, dental, and medical students' OMFS/hospital dentistry-related knowledge/skills and behavior increased over the course of their academic programs, while their IPE-related and intra- and interprofessional attitudes, especially for medical students, did not improve over time. OMFS and hospital dentistry units in medical centers offer distinctive opportunities for IPE and IPC. Utilizing these units may be one way to ensure that graduating providers are motivated to engage in IPC in their practice, thus contributing to reducing oral health disparities and increasing access to oral care for underserved populations.

Medical errors can involve multiple team members. Few curricula are being developed to provide instruction on disclosing medical errors that include simulation training with interprofessional team disclosure. To explore more objective evidence for the value of an educational activity on team disclosure of errors, faculty developed and assessed the effectiveness of a multimodal educational activity for learning team-based disclosure of a medical error. This study employed a methodological triangulation research design. Participants (N = 458) included students enrolled in academic programs at three separate institutions. The activity allowed students to practice team communication while: (1) discussing a medical error within the team; (2) planning for the disclosure of the error; and (3) conducting the disclosure. Faculty assessed individual student's change in knowledge and, using a rubric, rated the performance of the student teams during a simulation with a standardized family member (SFM). Students had a high level of preexisting knowledge and demonstrated the greatest knowledge gains in questions regarding the approach to disclosure (P

Children's participation has been a requirement in the Norwegian child welfare system for decades and children's effective participation has the potential to benefit children's outcomes. However, research suggests that effective user participation is still relatively rare and that user participation is seen as ‘difficult’ by both service users and professionals. One way to ensure children's rights to participation in Norway is to include adolescent service users in the interprofessional team formed around the child. Knowledge about experiences of adolescents in this kind of participation may provide important insights. This study explores five adolescents' perceptions about participating in such teams. Qualitative interviews and qualitative content analysis was used. We found that adolescents' participation in interprofessional teams may constitute one way to achieve effective participation. Both facilitating factors and impediments to effective user participation were found. The study suggests new ways to facilitate positive circles of participation and to increase the likelihood of improved child welfare outcomes from processes which secure more effective interprofessional help and support.

The aim of this study was to explore the obstacles to and the opportunities for achieving optimal interprofessional team collaboration with the introduction of the nurse practitioner (NP). A team approach can contribute importantly to sustainable and safe patient care, and NPs have been added to the healthcare team in many countries. Following the international trend towards the development of the acute care NP, the role has recently been initiated in surgical care in Sweden. The introduction of an advanced nursing role into existing organisations raises questions about how the role will be developed and what its effects will be on collaboration between the different professions. We conducted a systematic review of qualitative studies using the meta-ethnographic approach developed by Noblit and Hare. Literature in the field of nursing was searched on PubMed and CINAHL, and empirical qualitative studies from outpatient and inpatient care in seven countries were included. The studies were appraised according to national guidelines and templates and were analysed and synthesised according to the meta-ethnographic approach. A total of 26 studies were included in the synthesis. The analysis revealed four themes: (i) a threat to professional boundaries, (ii) a resource for the team, (iii) the quest for autonomy and control, and (iv) necessary properties of a developing interprofessional collaboration. Based on these themes, the synthesis was created and presented as a metaphorical journey. The implementation of a new nursing role in a traditional healthcare team is a complex process influenced by many factors and can be described as "a tortuous journey towards a partially unknown destination". The synthesised obstacles and opportunities drawn from international studies may help healthcare organisations and new NPs prepare for, and optimise, the implementation of a new nursing role.

Knowledge and expertise about safeguarding children and child protection are both essential skills for schoolteachers. Since 2004, specific learning about these topics has been included in the curricula for undergraduate and postgraduate trainee teachers. This article explores the development of child protection education and learning for trainee teachers at the University of the West of England, and reflects on some of our experiences, learning to date and student feedback. Child protection education is a feature of all undergraduate and postgraduate trainee teacher courses at this university. Our model differs from others as it is embedded in face-to-face learning which is led by four professionals from relevant disciplines: education, health, police and social work. Evaluations have been mostly positive, and it is intended that such reflections might be helpful to other higher education institutions, local authorities and schools in informing the development of their curricula. Copyright © 2013 John Wiley & Sons, Ltd. ‘Our model is embedded in face-to-face learning which is led by four professionals from relevant disciplines’ Key Practitioner Messages Safeguarding and child protection training is a vital aspect of education for trainee teachers. An interprofessional team including a teacher, children's nurse, police officer and social worker is able to model respectful collaboration and communication required for professional practice in this area. Trainee teachers appreciated meeting the range of professionals in the training context as it enabled them to discuss issues of concern in a safe environment.

OBJECTIVES: To describe nursing home (NH) staff perceptions of avoidability of hospital transfers of NH residents. DESIGN: Mixed methods qualitative and quantitative analysis of 1,347 quality improvement (QI) review tools completed by staff at 26 NHs and transcripts of conference calls. SETTING: Twenty-six NHs in three states participating in the Interventions to Reduce Acute Care Transfers (INTERACT II) QI project. PARTICIPANTS: Site coordinators and staff who participated in project orientation and conference calls and completed QI tools. MEASUREMENTS: NH and hospitalization data collected for the INTERACT II project. An interprofessional team coded and quantified reasons for hospital transfer on 1,347 QI review tools. RESULTS: Staff rated 76% of the transfers in the QI review tools as not avoidable. Common reasons for transfers rated as unavoidable were acute change in resident status, family insistence, and physician order for transfer. These same reasons were given for transfers rated as avoidable. Avoidable ratings were associated with a broader set of reasons and recommendations for improvement, including earlier identification and management of changes in clinical status, earlier discussion with family members about advance directives, and more-comprehensive communication with physicians. NHs that were more actively engaged in the INTERACT II interventions rated more transfers as avoidable. Percentage of transfers rated avoidable was not correlated with change in hospitalization rates. CONCLUSION: NH staff rated fewer hospital transfers as avoidable than published estimates. Greater attention to the complex array of reasons that staff provide for hospital transfer should be considered in strategies to reduce avoidable hospitalizations of NH residents.

At present, a team approach involving gynecologists, nurses, embryologists, and the other professionals is considered necessary to provide successful infertility treatment. First, we documented which professionals were in charge during various phases of infertility treatment. Second, clinical staff and patients were surveyed regarding their expectations regarding which of these professionals should contribute during examination, during treatment and after treatment for infertility.We surveyed the actual situation perceived by staff as well as the desired situation for staff and patients in relation to 21 procedures related to infertility treatment. We distributed 781 questionnaires to staff and patients at 86 facilities. Of 380 returned by mail, we analyzed 128 responses from staff who worked with four types of professionals or specialists, i.e., medical doctors, nurses, embryologists, and medical clerks, and 46 from patients who consulted these professionals during their treatment.Most staff recognized 5 of 15 procedures before and after treatment as being conducted by medical doctors alone. However, explanation and consultation regarding the methods and schedule were mainly performed with an interprofessional team approach. Expectations regarding professionals in charge differed between staff and patients. A team approach including infertility counselors and medical clerks was utilized and considered desirable during counseling.An effective team approach should be established for each step of infertility treatment.

Context Poor interprofessional relationships in maternity units have resulted in a number of suboptimal outcomes: students are reluctant to pursue careers in obstetrics and gynaecology (OG trainees feel bullied, and poor communication between professionals results in avoidable adverse events. Interprofessional learning has been advocated to improve interprofessional relationships, but recent interventions have not been successful at undergraduate level. This study aimed to address this issue locally and then to disseminate our lessons, successes and challenges. Methods A strategy for interprofessional team-working was developed in a large maternity unit in the UK, with a variety of interprofessional interventions spanning the attachment and opportunities to participate in specific task or research teams. These interventions were evaluated before the strategy proceeded to large-scale implementation, with a validated attitudes questionnaire (Pollard) and a reaction survey. Results Interprofessional relationships improved significantly (P

Relatively little is known about the specific attributes of health professional students which may influence their attitudes towards both interprofessional teamwork and interprofessional education. A survey was distributed to all pre-licensure health professional students from medicine, nursing, pharmacy and social work programmes at our institution. Respondents were asked to rate their attitudes towards interprofessional healthcare teams and interprofessional education using validated and reliable scales reported in the literature. Information on the respondents’ gender, profession, year of study and prior experience with interprofessional education was also collected. There was no significant difference between attitudes of medicine and nursing students towards interprofessional teamwork; however, both these student groups report significantly less positive attitudes towards interprofessional teams than pharmacy and social work students. Medicine students reported significantly less positive attitudes towards interprofessional education than nursing, pharmacy and social work students. Female students and senior undergraduate students reported significantly more positive attitudes towards interprofessional teamwork and interprofessional education, while students reporting prior experience with interprofessional education reported significantly more positive attitudes towards interprofessional teamwork. Profession, gender and year of study appear to be attributes which were related to more positive attitudes towards both interprofessional teamwork and education.

We conducted a review of websites in oral health to identify content areas of our target interest and design features that support content and interface design. An interprofessional team evaluated fifty-six oral health websites originating from nongovernmental organizations (NGOs) and associations (28.6 percent), regional/state agencies (21.4 percent), federal government (19.6 percent), academia (19.6 percent), and commercial (10.7 percent) sources. A fifty-two item evaluation instrument covered content and web design features, including interface design, site context, use of visual resources, procedural skills, and assessment. Commercial sites incorporated the highest number of content areas (58.3 percent) and web design features (47.1 percent). While the majority of the reviewed sites covered content areas in anticipatory guidance, caries, and fluorides, materials in risk assessment, oral screening, cultural issues, and dental/medical interface were lacking. Many sites incorporated features to help users navigate the content and understand the context of the sites. Our review highlights a major gap in the use of visual resources for posting didactic information, demonstrating procedural skills, and assessing user knowledge. Finally, we recommend web design principles to improve online interactions with visual resources.

BACKGROUND In pancreatic cancer, postoperative weight loss is associated with higher mortality. This study assessed preoperative factors associated with postoperative weight loss so that at-risk patients can be identified for intervention. METHOD A retrospective review of patients who underwent pancreatic surgery was completed. Demographics and routine blood work were analyzed to determine association with postoperative weight loss. RESULTS Of 74 patients, 85% lost weight after surgery. Weight loss was associated with time since surgery, preoperative weight, and preoperative albumin, making patients who appear best nourished the most at-risk. CONCLUSIONS Weight loss was prevalent. in contrast to conventional assessment, patients who weighed more and had higher serum albumin lost the most weight. An interprofessional team may help to address this disparity.

Evolving health care environments present opportunities and challenges for clinical pharmacists to become increasingly more pivotally integrated as critical members of interprofessional care teams. Optimal medication therapy prescribing and management is best characterized as a process that results in safe, effective, efficient, and culturally sensitive medication ordering, order fulfillment, administration, and monitoring, which achieves desired clinical outcomes for a specific patient. Bringing together the knowledge, skills, and perspectives of an interprofessional team of physicians, nurses, physician assistants, nurse practitioners, pharmacists, and others where appropriate provides the expertise and synergy to optimize medication therapy decisions, educate patients, implement and monitor medication therapy, enhance adherence, and achieve and measure quality clinical outcomes. Although there are well-defined barriers to overcome, we, the members of the 2009 American College of Clinical Pharmacy Presidential Task Force, envision optimal medication therapy prescribing and management functions ideally to occur in health care settings with adequate resources to deliver high-quality care. In the presence of financial pressure, safeguards should be developed between practice activities and economic and accounting procedures to mitigate conflicts of interest that could otherwise occur in drug selection and overuse. In the future, clinical pharmacists will participate prospectively as essential full-time members of interprofessional care teams. Although it is anticipated that pharmacists will be embraced in these roles in all managed care and government-based systems, virtual or remote participation in medication therapy management may remedy access to pharmacists in settings and locales where they cannot be physically present or where economic models necessitate virtual care delivery.