Aim To provide insight into the basic characteristics of decision making in the treatment of symptomatic severe aortic stenosis (SSAS) in Dutch heart centres with specific emphasis on the evaluation of frailty, cognition, nutritional status and physical functioning/functionality in (instrumental) activities of daily living [(I)ADL]. Methods A questionnaire was used that is based on the European and American guidelines for SSAS treatment. The survey was administered to physicians and non-physicians in Dutch heart centres involved in the decision-making pathway for SSAS treatment. Results All 16 Dutch heart centres participated. Before a patient case is discussed by the heart team, heart centres rarely request data from the referring hospital regarding patients’ functionality (n = 5), frailty scores (n = 0) and geriatric consultation (n = 1) as a standard procedure. Most heart centres ‘often to always’ do their own screening for frailty (n = 10), cognition/mood (n = 9), nutritional status (n = 10) and physical functioning/functionality in (I)ADL (n = 10). During heart team meetings data are ‘sometimes to regularly’ available regarding frailty (n = 5), cognition/mood (n = 11), nutritional status (n = 8) and physical functioning/functionality in (I)ADL (n = 10). After assessment in the outpatient clinic patient cases are re-discussed ‘sometimes to regularly’ in heart team meetings (n = 10). Conclusions Dutch heart centres make an effort to evaluate frailty, cognition, nutritional status and physical functioning/functionality in (I)ADL for decision making regarding SSAS treatment. However, these patient data are not routinely requested from the referring hospital and are not always available for heart team meetings. Incorporation of these important data in a structured manner early in the decision-making process may provide additional useful information for decision making in the heart team meeting.
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Background: Teamwork is essential in healthcare, but team performance tends to deteriorate in stressful situations. Further development of training and education for healthcare teams requires a more complete understanding of team performance in stressful situations. We wanted to learn from others, by looking beyond the field of medicine, aiming to learn about a) sources of stress, b) effects of stress on team performance and c) concepts on dealing with stress. Methods: A scoping literature review was undertaken. The three largest interdisciplinary databases outside of healthcare, Scopus, Web of Science and PsycINFO, were searched for articles published in English between 2008 and 2020. Eligible articles focused on team performance in stressful situations with outcome measures at a team level. Studies were selected, and data were extracted and analysed by at least two researchers. Results: In total, 15 articles were included in the review (4 non-comparative, 6 multi- or mixed methods, 5 experimental studies). Three sources of stress were identified: performance pressure, role pressure and time pressure. Potential effects of stress on the team were: a narrow focus on task execution, unclear responsibilities within the team and diminished understanding of the situation. Communication, shared knowledge and situational awareness were identified as potentially helpful team processes. Cross training was suggested as a promising intervention to develop a shared mental model within a team. Conclusion: Stress can have a significant impact on team performance. Developing strategies to prevent and manage stress and its impact has the potential to significantly increase performance of teams in stressful situations. Further research into the development and use of team cognition in stress in healthcare teams is needed, in order to be able to integrate this ‘team brain’ in training and education with the specific goal of preparing professionals for team performance in stressful situations.
MULTIFILE
University teacher teams can work toward educational change through the process of team learning behavior, which involves sharing and discussing practices to create new knowledge. However, teachers do not routinely engage in learning behavior when working in such teams and it is unclear how leadership support can overcome this problem. Therefore, this study examines when team leadership behavior supports teacher teams in engaging in learning behavior. We studied 52 university teacher teams (281 respondents) involved in educational change, resulting in two key findings. First, analyses of multiple leadership types showed that team learning behavior was best supported by a shared transformational leadership style that challenges the status quo and stimulates team members’ intellect. Mutual transformational encouragement supported team learning more than the vertical leadership source or empowering and initiating structure styles of leadership. Second, moderator analyses revealed that task complexity influenced the relationship between vertical empowering team leadership behavior and team learning behavior. Specifically, this finding suggests that formal team leaders who empower teamwork only affected team learning behavior when their teams perceived that their task was not complex. These findings indicate how team learning behavior can be supported in university teacher teams responsible for working toward educational change. Moreover, these findings are unique because they originate from relating multiple team leadership types to team learning behavior, examining the influence of task complexity, and studying this in an educational setting. https://www.scienceguide.nl/2021/06/leren-van-docentteams-vraagt-om-gezamenlijk-leiderschap/
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In summer 2020, part of a quay wall in Amsterdam collapsed, and in 2010, construction for a parking lot in Amsterdam was hindered by old sewage lines. New sustainable electric systems are being built on top of the foundations of old windmills, in places where industry thrived in the 19th century. All these examples have one point in common: They involve largely unknown and invisible historic underground structures in a densely built historic city. We argue that truly circular building practices in old cities require smart interfaces that allow the circular use of data from the past when planning the future. The continuous use and reuse of the same plots of land stands in stark contrast with the discontinuity and dispersed nature of project-oriented information. Construction and data technology improves, but information about the past is incomplete. We have to break through the lack of historic continuity of data to make building practices truly circular. Future-oriented construction in Amsterdam requires historic knowledge and continuous documentation of interventions and findings over time. A web portal will bring together a range of diverse public and private, professional and citizen stakeholders, each with their own interests and needs. Two creative industry stakeholders, Yume interactive (Yume) and publisher NAI010, come together to work with a major engineering office (Witteveen+Bos), the AMS Institute, the office of Engineering of the Municipality of Amsterdam, UNESCO NL and two faculties of Delft University of Technology (Architecture and Computer Science) to inventorize historic datasets on the Amsterdam underground. The team will connect all the relevant stakeholders to develop a pilot methodology and a web portal connecting historic data sets for use in contemporary and future design. A book publication will document the process and outcomes, highlighting the need for circular practices that tie past, present and future.
