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Health Technology Assessment international (HTAi) supports global collaboration and innovation in HTA through its dynamic network of Interest Groups (IGs). These thematic communities provide a dedicated platform for members to engage in focused, collaborative efforts that drive professional exchange, advance methodologies, and develop best practices in HTA. This commentary offers a panoramic overview of all IGs, their evolution, aim, and initiatives. By drawing on diverse stakeholder perspectives, spanning academia, clinical practice, industry, and patient communities, the IGs foster inclusiveness and extend HTAi’s influence to significantly contribute to the broader HTA community. Through activities such as workshops, conference sessions, webinars, publications, and research projects, they offer opportunities for professional development and thought leadership. The IGs’ cross-cutting contributions position them as engines of innovation to ensure HTAi remains at the forefront of shaping a globally relevant, responsive, and ethically grounded HTA ecosystem.
from
Section 4
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Walking the Walk (and Talking the Talk)
William Fawcett, Royal Surrey County Hospital, Guildford and University of Surrey,Olivia Dow, Guy's and St Thomas' NHS Foundation Trust, London,Judith Dinsmore, St George's Hospital, London
Chronic pain can be categorised as nociceptive, neuropathic or nociplastic based on the underlying pathophysiology. It is considered a disease in its own right and can be sub-classified to differentiate types of chronic pain syndromes. Chronic primary pain is defined as pain in one or more anatomical regions, persisting or recurring for more than 3 months, and associated with significant emotional distress or interference with activities of daily life e.g. fibromyalgia or complex regional pain syndrome. Chronic secondary pain includes six subgroups where pain has initially developed as a symptom of another disorder or disease process e.g. chronic cancer-related pain and chronic neuropathic pain.
The experience of pain is a consequence of a variety of biological, psychological, and social factors and a wide range of pharmacological and non-pharmacological interventions are available. Pharmacological management involves opioid agents and non-opioid medications including simple analgesics, topical lidocaine, and capsaicin, anti-epilepsy drugs and antidepressants. Tolerance to opioids can develop rapidly. Misuse and abuse are increasing concerns. Non-pharmacological interventions include psychological and physical therapies. Patient engagement in the process is key and an interdisciplinary approach is recommended which focusses on the individual patient and uses a shared-decision model.
The importance of mentoring for professional development in Science, Technology, Engineering, Mathematics and Medicine (STEMM) fields is well established. With the increasing prevalence of team science, mentoring that incorporates team science skills is essential. Here, we describe a novel mentoring program designed to develop technical and relational/interpersonal skills for working in multi-disciplinary team science environments and to develop networks to improve collaboration in multi-disciplinary team science. The Georgia Clinical and Translational Science Alliance Translational Education and Mentoring in Science program is a nine-month program consisting of one-on-one mentoring, peer mentoring groups, mentoring resources, and shared learning experiences. Mentees (fellows) are exposed to a wide range of learning opportunities related to the goals of the program. This multi-institutional effort, in its fifth year, has been well received by participants. To date, 95 faculty, post-doctoral fellows, and research scientists have participated in the program as mentees. Participants indicated that they enjoyed the program, identified new networking opportunities, and would recommend it to others. In addition, fellows reported improved relational, technical, and networking skills over the duration of the program. Mentor ratings were also quite favorable. The multi-institutional nature of the program enriched learning and its unique structure combining traditional one-on-one mentoring with peer learning communities has been beneficial to those participating.
Forcibly displaced persons (FDPs) exposed to torture and trauma require multidisciplinary therapies to address their complex needs in mental and physical health. In this systematic review and meta-analysis, we explored the efficacy of models of care that integrated psychological and physical interventions for PTSD outcomes. We searched the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PubMed, EMBASE, CINAHL, PsychINFO, and Web of Science databases. We performed the meta-analysis on studies with randomized controlled trials and non-randomized controlled trial designs, followed by a subgroup analysis of moderators. In all meta-analyses, a random-effects model was used with standardized mean differences to accommodate for the heterogeneity of studies and outcome measures. In a meta-analysis of a between-group analysis of 11 studies comprising 610 participants, integrated intervention showed a moderate effect size (Hedges’ g = −0.46 (95% CI −0.80 to −0.12) in reducing PTSD symptoms. The proportion of variation in observed effects reflects 82% of variation in true effects (I2 = 82%). The efficacy of transdisciplinary interventions was higher compared to multidisciplinary models. Moderator analysis found that the type of PTSD measure, format of intervention, and type of personnel providing the intervention were significant predictors of efficacy. Integrated interventions are efficacious in reducing PTSD outcomes for people with FDPs and those exposed to war trauma. Factors such as the type of integration of interventions and service delivery need to be further studied with high-quality designs and larger numbers in future studies.
Diabetes mellitus is one of the most common and important medical complications affecting pregnancy. It can predate the pregnancy ('pre-existing diabetes') or arise during pregnancy ('gestational diabetes', GDM). Typically, GDM resolves once the pregnancy has ended. However, about 3% of women with a diagnosis of GDM have type 2 diabetes diagnosed for the first time in pregnancy, which persists beyond pregnancy. The coexistence of diabetes of any type and pregnancy is associated with an increased risk of adverse outcomes for both the woman and baby. However, with appropriate management by a multidisciplinary team before, during and after delivery these risks can be minimised. Optimising blood glucose control, screening for maternal and fetal complications and a discussion about delivery are key strategies. During pregnancy, all women should be offered screening for GDM. After pregnancy, all women with GDM should be offered annual screening to identify the development of type 2 diabetes.
Multidisciplinary One Health (OH) collaboration coupled with information communication and technology provides an avenue for combating and avoiding emerging and reemerging diseases. In 2020, AFROHUN-Kenya organized a OH App development hackathon to build an application for frontline community health workers to respond to OH challenges. This article describes the purpose, process, benefits and challenges of this hackathon. Forty-nine participants, divided into eight groups took part in the hackathon. The teams ranged from four to eight members, with 55% female. A total of eight applications were developed during the hackathon all of which are in the process of patenting, before deployment as open-source applications. In the post-hackathon survey, 95% of participants indicated that they had a better grasp of the topic because of the team members’ diverse perspectives and that working in multidisciplinary teams had resulted in new friendships and partnerships. In total, 72% of respondents indicated they would be interested in participating in another hackathon. However, 65% of the respondents suggested that the training time be lengthened. This study demonstrates that multidisciplinary hackathons effectively enhance learning, significantly impact communities and improve students’ soft skills, including project and time management, interpersonal communication, motivational strategies and problem-solving.
From a Nordic and British perspective, the history of education is a vibrant field of knowledge production. It invites scholars from the humanities and social sciences to investigate the continuities and changes in education over time, as well as Bildung, nurturing, learning, and teaching. By underlining the breadth of the history of education and using Nordic and British examples, I argue that the field is not shrinking but growing. A broader definition of the field expands the field’s scope beyond historical studies of formal schooling. It also enhances the field’s significance and reveals how it has a meaningful role in research policy, and practice.
Human intervention studies are gaining traction and recognition in the Developmental Origins of Health and Disease (DOHaD) field. Since DOHaD intervention studies will most frequently use complex public health interventions, collaborations across science and social science disciplines are critical for obtaining and interpreting DOHaD evidence in ways that matter for policy recommendation. This chapter explores the application of biosocial collaboration in a DOHaD intervention trial, namely Bukhali, the Healthy Life Trajectories Initiative (HeLTI) South Africa randomised controlled trial. Bukhali evaluates a complex intervention initiated prior to conception, through pregnancy, and into early childhood, with the primary aim of addressing childhood obesity. As part of the first trials assessing the potential of preconception interventions to shape intergenerational health, the trial is significant to DOHaD science. Bukhali has adopted a pragmatic approach, allowing for ongoing adaptation to new knowledge as it arises and testing not only the primary hypothesis but also undertaking process evaluation analyses. This requires a multidisciplinary process that serves as a case study of how biosocial collaboration can enhance DOHaD-inspired intervention research.
Comprehensive geriatric assessment (CGA) has been one of the cornerstones of geriatric medicine since its introduction by Marjory Warren in 1936. This kind of assessment is defined as a multidimensional and multidisciplinary process related to identifying medical, social, and functional needs and developing an integrated care plan designed to meet the patien’st needs.The practice and applications of CGA have been used to various degrees in mainstream care for older people in the UK and internationally.
Some limitations still exist around the wider implementation of CGA, as its practice relies on members of the multidisciplinary team (MDT) and on an effective communication between them, the patients, and their families. This kind of assessment has been criticised for not adequately acknowledging frailty and for not using patient-reported outcome measures to test its efficacy.
Randomised controlled studies, systematic reviews, and meta-analyses provided considerable evidence for the clinical and financial effectiveness of CGA in various hospital specialties. However, there are still concerns about the generalisability of CGA in community settings. Further research to identify target populations for CGA-led interventions and a consensus on outcome measures are required to realise CGA benefits.
In this chapter we describe required skills and practical tips to deliver CGA across a variety of settings.
The book’s closing Chapter 9 on change in economics begins with an examination of the methodological problem of explaining what counts as change, and argues change in economics needs to be explained in terms of economics’ relationships to other disciplines. It argues that economics’ core–periphery structure works to insulate its core from other disciplines’ influences upon it, minimizing their influences. This raises the question: Can other disciplines influence economics’ core and potentially produce change in economics? To investigate this question, the chapter develops an open–closed systems model of disciplinary boundary crossings and argues that economics’ core is only incompletely closed and consequently its adopting other disciplines’ contents can change its interpretation. Using the different forms of relationships between disciplines distinguished in Chapter 7, mainstream economics’ relations to other disciplines are argued to currently be interdisciplinarity, but may also be unstable and can break down. When and under what circumstances? Moving from what happens within social science, two sets of external forces influencing change in economics – change in how research is done and historical changes in social values and social expectations regarding what economics is and should be about – are argued likely to increase boundary crossings between economics and other disciplines, undermine the insularity of its core, and move economics toward being a multidisciplinary, more pluralistic discipline. What would then be especially different about economics would be that individuals are seen as socially embedded and an objective economics is seen as a normative, value-entangled science.
Teenagers often present in crisis with risk issues, mainly risk to self but sometimes risk to others. Adolescent violence is commonplace and is not just the remit of adolescent forensic psychiatry. Clinicians may lack confidence assessing risk of violence and can neglect vital areas that are essential to reduce risk. Use of structured violence risk assessments enables the multi-agency professional network to formulate a young person's presentation and their violence in a holistic way and consequently develop targeted risk management plans addressing areas such as supervision, interventions and case management to reduce the risk of future violence. Of the several validated tools developed for young people, the Structured Assessment of Violence Risk – Youth (SAVRY™) is that most used by UK-based forensic adolescent clinicians. This article outlines the epidemiology, causes and purposes of violence among adolescents; discusses types of risk assessment tool; explores and deconstructs the SAVRY; and presents a fictitious risk formulation.
In the STAR*D study, the efficacy of treatments for major depression was examined. It was found that, while many responded to the initial antidepressant treatment, only 30% of participants achieved complete remission. Concerning treatment resistance in depression, there is a recent distinction emerging between treatment-resistant depression (TRD) and difficult-to-treat depression (DTD). Historically, TRD and DTD have been conflated, but it is essential to recognize them as separate entities. While TRD is characterized by a patient’s inadequate response to two or more consecutive antidepressant treatments given for an adequate duration and dosage without achieving acceptable therapeutic effects, DTD describes a clinical category where patients do not achieve full symptom control despite various therapeutic approaches. The recent shift in perspective proposes a more integrated approach for DTD, encompassing psychosocial, biological, and interactive factors. This multifactorial model calls for a multidisciplinary therapeutic intervention, not restricted to pharmacological treatments but also including psychotherapy, neurostimulation, and social interventions. Informing professionals and the general public about the significance of this new approach could mitigate the stigma associated with depression and enhance the quality of care. The future challenge will involve a deeper clinical understanding of DTD and its optimal management by refining available treatments.
Functional neurological disorders (FNDs), also known as “conversion disorder”, consist in the appearance of neurological symptoms that do not correspond to any medical condition and produces an impairment in social, occupational and other areas in the patient’s life. This disorder can represent up to 30% of neurologist’s consultation. We introduce the case of a 23-year-old man who attended the emergency services due to fainting and was finally diagnosed with FND.
Objectives
To summarize the difficulties of making a diagnosis of FND and the importance of a multidisciplinary approach.
Methods
A narrative review through the presentation of a case.
Results
The patient presented many absence seizures during his stay in the hospital. These episodes were characterized by non-reactivity, dysarthria, tremors, tachycardia and hyperventilation. The neurological examination and imaging tests didn’t show any pathological findings. During the psychiatric interview he revealed he had lived a severe conflict with his brothers the previous week and he was being excluded within his family. Furthermore he didn’t have any social support besides his mother in the city he was living, leading this situation to an incrementation of anxiety. Due to the absence of any abnormalities in the examination and recent psychological conflict that was affecting him, FND diagnose was made.
Conclusions
Very frequently the absence of a clear psychological trigger and the presence of neurological alterations can hinder the study of the patient. This makes necessary a multidisciplinary approach and the knowledge of signs that can help to carry out an accurate diagnosis.
Since last year there has been a lively ethical discussion in Poland about the influence of religion and new cultural currents on medical ethics. There are many ways to work towards increasing ethical sensitivity in education of mental health care professionals.
All texts dealing with issues described were collected and divided into three groups: promoting new currents of thought, faithful to tradition, others. Presented views were analyzed basing on Polish Code of Medical Ethics (nil.org.pl/uploaded_images/1574857770_kodeks-etyki-lekarskiej.pdf) and compared with dominating philosophical schools.
Results
A total of 33 articles were published: 20 presenting new approach to medical ethics, supported by the Editorial Board (72% of the total), 7 embedded in traditional values (22%), 6 without a clear stand or denying the discourse on ethical issues (6%). Articles presented philosophical views (personalism, virtue ethics, utilitarianism, constructionism), discussed ethical standards, actions contrary to the dignity of medical profession, value of human life, compliance of arguments with medical knowledge, principles of dealing with patients in terminal states, the duty of care for the pregnant woman and her child.
Conclusions
All texts show dilemmas in our environment, reflect views in Polish society and in ethical discourse around the world. Thanks to them, readers familiarize themselves with the contemporary ethical debate and form their own opinions; also they are encouraged to reach for the indicated sources and their own research.
Chapter 2 explains the multidisciplinary nature of prehistoric archeology, providing an overview of many of the disciplines and explaining their basic applications in the field. It describes how archeological data is amassed and interpreted in ever-more efficient ways thanks to constantly evolving modern technologies.
How does the Anthropocene change human stories? In a word, drastically. Many people don't want our altered planet to alter their stories. This group, in the spirit of "anything goes," ignores or attacks the science and sometimes the scientists as well. But more and more, writers, social scientists, and humanistic scholars are beginning to engage seriously with Anthropocene science and its radical vision. This engagement results in two new types of narrative. The first kind is the singular collective story of humans from our ancestral species moving out of Africa through all our evolutionary permutations until we became a global force, an Earth System agent, in the mid-twentieth century. The other way of telling human stories in response to Anthropocene science is to acknowledge our species as an Earth System agent, but to point to the many textured, contingent, and small-scale human stories. Some of these are congruent with the overall global narrative; others point to alternatives. This essay takes the reader on a tour of how humanists and social scientists are responding to the Anthropocene through three kinds of stories: those that deny scientific evidence; those highlighting humanity as a collective planetary force, and those focusing on diverse alternative histories within planetary limits.
Altered Earth aims to get the Anthropocene right in three senses. With essays by leading scientists, it highlights the growing consensus that our planet entered a dangerous new state in the mid-twentieth century. Second, it gets the Anthropocene right in human terms, bringing together a range of leading authors to explore, in fiction and non-fiction, our deep past, global conquest, inequality, nuclear disasters, and space travel. Finally, this landmark collection presents what hope might look like in this seemingly hopeless situation, proposing new political forms and mutualistic cities. 'Right' in this book means being as accurate as possible in describing the physical phenomenon of the Anthropocene; as balanced as possible in weighing the complex human developments, some willed and some unintended, that led to this predicament; and as just as possible in envisioning potential futures.
This chapter considers the meaning and role of interdisciplinary approaches to research and teaching in medical law and ethics, itself an inherently interdisciplinary field. It notes that formidable challenges persist, however, especially when navigating methodological and conceptual differences across disciplines, and operating outwith a disciplinary ‘home’. The chapter looks at how complementary strands of diverse specialisms can come together to create the constellation of critical tools needed to address contemporary legal, regulatory and ethical challenges in medicine, health care and the biosciences. In the three case studies, the authors examine the contribution of multi- and interdisciplinary approaches to pedagogy, critical scholarship and the production of practical research outputs, and how these have informed and influenced their own work, with and alongside that of Graeme Laurie. Throughout, the discussions highlight the myriad ways that his research and teaching exemplify the openness of spirit and the intellectual curiosity required to engage meaningfully in interdisciplinarity.