Advancing Translational Research by Enabling Collaborative Teamwork: The TRACT Approach

Background: The work of multidisciplinary research teams (MDRTs) is vital for translational research. The objectives of this study were 1) to understand the structure and function of MDRTs, and 2) to develop effective strategies to enhance collaboration among team members. Methods and Findings: Semi-structured interviews were conducted with 23 participants involved in multidisiplinary research work at two San Antonio, Texas, institutions. Interview materials were tape-recorded, transcribed, and content analyzed using qualitative methods.Themes that emerged from the content analysis were used to develop and refine strategies to enhance the work of MDRTs. The findings showed that MDRTs operate through multiple cycles of: 1) team formation, 2) team collaboration, 3) sustainable collaborative activities, and 4) team maturity. Content analysis identified four interrelated basic elements within the MDRT tract that facilitate team cycles: 1) shared interest/vision among agreeable team leader and members, 2) viable means of communication, 3) available resources, and 4) perceived gain/benefit of teamwork.Conclusions: Our findings highlighted several opportunities and challenges in the formation, dynamics, and growth of MDRTs. Effective strategies to enhance teamwork should levearge these opportunities and address challenges, taking into consideration the interdependent aspects of the basic elements within the MDRTs tract

Communicating about medications during primary care outpatient visits: the role of electronic medical records

Objectives To assess the role of electronic medical records (EMR) in facilitating the content and process of patient_provider exchanges about medications during outpatient primary care visits. Methods Fifty encounters with six physicians using The EMR were videotaped, transcribed and content-analysed by applying conversation analysis and ethno-methodology techniques. The analysis focused on three aspects of medication communication: (1) process of care: practices by patients and physicians to implement medication decisions; (2) themes: medication topics that consistently emerge; and (3) names: ways patients and physicians refer to medications. In-depth analysis of 20 encounters examined the extent to which either or both parties initiated, expanded and concluded medication discussions. Results On average 21.2 (range: 8_35; SD=7.4) distinct exchanges per encounter were observed. Of those, 33% were related to medication. Of the 350 medication-related exchanges throughout the encounters, 56% were categorised as routine medication discussion such as ordering and/or refilling medications. Mailing issues were the next most common medication-related exchanges (10.6%), followed by partial adherence (8.9%), self-regulation (7.4%), alternative therapy/over-the-counter medication (6.6%), side effects (6%) and formulary issues (4.6%). Patients and providers used three ways to name medications: generic/scientific name (42%); physical description (39.7%) and brand name (18.3%). Forty-one percent of exchanges included initiation by one or both parties but no further discussion of the issue; 42% included initiation and expansion by both parties but not conclusion; only 17% of exchanges contained complete medication exchanges (initiation, expansion and conclusion) by both parties. Conclusions EMR facilitated content and process of communication regarding medications during outpatient encounters, especially among patients taking multiple medications and patients who used physical descriptions to identify their medications. EMR use stimulated medication exchanges, leading to further expansion about the topic. However, fewer than one-fifth of exchanges ended with clear conclusions by both parties regarding prescribed medication regimens

Treatment of olive mill based wastewater by means of magnetic nanoparticles: Decolourization, dephenolization and COD removal

AbstractOlive mill wastewater (OMW) is an environmental concern that has been highlighted as a serious environmental problem in the Mediterranean basin countries because of its high organic load and phytotoxic and antibacterial phenolic compounds, which resist biological degradation. Consequently, this type of wastewater represents a huge challenge for the conventional wastewater treatment techniques as it can impact the lifetime of bacteria needed for the treatment. Iron-oxide nanoparticles are attractive for wastewater treatment for two important reasons. First, nanoparticles can remove pollutants from wastewater rapidly. Second, this magnetic type of nanoparticles could be separated easily using a magnet after finishing treatment process. In this study, we aimed at investigating the effectiveness of the magnetic iron oxide nanoparticles in the removal of large organic contaminants from OMW. Batch and continuous mode processes were applied on OMW treatment to determine the effect of contact time, solution pH, coexisting contaminants and the adsorption isotherm.The results showed that the adsorption was fast and the adsorption reached equilibrium within less than 30min. The adsorption equilibrium data fit very well to the Brunauer–Emmett–Teller (BET) Model, indicating multi-layers adsorption. The adsorption of major pollutants was associated to an efficient removal of coexisting contaminants such as heavy metals and free ions. The adsorption of OMW pollutants was dependent on pH of the solution. Finally, continuous-mode process was tested successfully using a packed bed column that combined sand filtration with magnetic nanoparticles to decolourize OMW effluent. This study will provide valuable insight on the effect of nanoparticles toward the treatment and recyclability of olive mill wastewater, which is crucial for the local olive mill industry. After seeing the successful achievement of integrating nanoparticles with fixed bed filtration, a preliminary process description and cost estimation of stand-alone plant (with a capacity of 4m3/h) for OMW treatment were considered in this study. Process capital and annual operating costs were estimated to be $12,306 and$476/year, respectively

A group randomized trial of a complexity-based organizational intervention to improve risk factors for diabetes complications in primary care settings: study protocol

<p>Abstract</p> <p>Background</p> <p>Most patients with type 2 diabetes have suboptimal control of their glucose, blood pressure (BP), and lipids – three risk factors for diabetes complications. Although the chronic care model (CCM) provides a roadmap for improving these outcomes, developing theoretically sound implementation strategies that will work across diverse primary care settings has been challenging. One explanation for this difficulty may be that most strategies do not account for the complex adaptive system (CAS) characteristics of the primary care setting. A CAS is comprised of individuals who can learn, interconnect, self-organize, and interact with their environment in a way that demonstrates non-linear dynamic behavior. One implementation strategy that may be used to leverage these properties is practice facilitation (PF). PF creates time for learning and reflection by members of the team in each clinic, improves their communication, and promotes an individualized approach to implement a strategy to improve patient outcomes.</p> <p>Specific objectives</p> <p>The specific objectives of this protocol are to: evaluate the effectiveness and sustainability of PF to improve risk factor control in patients with type 2 diabetes across a variety of primary care settings; assess the implementation of the CCM in response to the intervention; examine the relationship between communication within the practice team and the implementation of the CCM; and determine the cost of the intervention both from the perspective of the organization conducting the PF intervention and from the perspective of the primary care practice.</p> <p>Intervention</p> <p>The study will be a group randomized trial conducted in 40 primary care clinics. Data will be collected on all clinics, with 60 patients in each clinic, using a multi-method assessment process at baseline, 12, and 24 months. The intervention, PF, will consist of a series of practice improvement team meetings led by trained facilitators over 12 months. Primary hypotheses will be tested with 12-month outcome data. Sustainability of the intervention will be tested using 24 month data. Insights gained will be included in a delayed intervention conducted in control practices and evaluated in a pre-post design.</p> <p>Primary and secondary outcomes</p> <p>To test hypotheses, the unit of randomization will be the clinic. The unit of analysis will be the repeated measure of each risk factor for each patient, nested within the clinic. The repeated measure of glycosylated hemoglobin A1c will be the primary outcome, with BP and Low Density Lipoprotein (LDL) cholesterol as secondary outcomes. To study change in risk factor level, a hierarchical or random effect model will be used to account for the nesting of repeated measurement of risk factor within patients and patients within clinics.</p> <p>This protocol follows the CONSORT guidelines and is registered per ICMJE guidelines:</p> <p>Clinical Trial Registration Number</p> <p>NCT00482768</p