Multidisciplinary Organization Research Articles

Nurses' perception on violence against children and adolescents by their companion in pediatric ward.

to know the nurses' perception on violence against children by their companion in pediatric ward; describe the nurses' actions in this situation; analyze these actions in light of government policies; and know the organization and communication of the multidisciplinary team to face this phenomenon. a descriptive qualitative research conducted through semi-structured interviews with nurses. Thematic analysis identified three categories: "A perception of violence"; "Actions and interventions performed by nurses"; and "Multidisciplinary team organization and communication". nurses recognize the types of violence, but attaches greater severity to physical violence. The reported causes were children with difficult temperaments, transgenerational violence and hospitalization. The actions were dialogue, companion-child separation, registry and notification to the Guardianship Council. Poor communication from the multidisciplinary team and medical-centric organization have been reported.

Sixty-Day Mortality Among 520 Italian Hospitalized COVID-19 Patients According to the Adopted Ventilatory Strategy in the Context of an Integrated Multidisciplinary Clinical Organization: A Population-Based Cohort Study

Background: Among COVID-19 patients, the decision of which ventilation strategy to adopt is crucial and not guided by existing outcome evidence. We described the clinical characteristics and outcomes of hospitalized COVID-19 patients according to the adopted respiratory strategy. Methods: Observational study including all COVID-19 patients (26/02/2020–18/04/2020) within Rimini Italian province. Hospitalized patients were classified according to the maximum level of respiratory support: oxygen supplementation (group Oxygen), NIV (group NIV-only), IMV (group IMV-only), and IMV after a NIV trial (group IMV-after-NIV). Sixty-day mortality risk was estimated with a Cox proportional hazard analysis adjusted by age, sex, and administration of steroids, canakinumab, and tocilizumab. Findings: We identified 1,424 symptomatic patients: 520 (36·5%) were hospitalized, the remaining 904 (63·5%) were treated at home with no 60-days death. According to the respiratory support, 408 (78·5%) were assigned to Oxygen, 46 (8·8%) to NIV-only, 25 (4·8%) to IMV-after-NIV, and 41 (7·9%) to IMV-only groups. There was no significant difference in the P/F at IMV inception among IMV-after-NIV and IMV-only groups ( p =0·9). Overall 60-day mortality was 24·2% (Oxygen: 23·0%; NIV-only: 19·6%; IMV-after-NIV: 32·0%; IMV-only: 36·6%; p = 0·165). Compared with Oxygen group, the 60-day mortality risk significantly increased for IMV-after-NIV (HR 2·776; p =0·024) and IMV-only group (HR 2·966; p =0·001). Interpretation: This study provides a population-based figure of the impact of the COVID-19 epidemic. A similar 60-days mortality risk was found for patients undergoing immediate IMV and those intubated after a NIV trial. Many patients had a favorable outcome after prolonged IMV. Funding: None Declaration of Interests: The authors declare that they have no conflict of interest. Ethics Approval Statement: The investigation conforms with the principles outlined in the Declaration of Helsinki. The AUSL della Romagna Institutional Review Board approved the project (registration number NCT04348448) with a waiver of informed consent.

System Engineering and Dependability: Methodology of Model Synchronization between System Architecture Models and Risk Analysis

ABSTRACTModern industry faces new challenges making classical organization in “disciplinary silos” ill‐adapted to demands for complex and evolving systems. We advocate promoting inter‐team communication in a “Multidisciplinary Organization” can manage complexity better: it allows early problem discovery, offers solutions to more complex issues, and favors early solution emergence. Indeed the transition to such organization requires new collaborative processes and methods to integrate various engineering fields earlier and along the development cycle. In this paper, we propose a collaborative approach to set‐up adapted modeling and methodological practices in the enterprise. It leverages the rising interest for Model‐Based Systems Engineering and related modeling technologies to offer a new approach to different engineering discipline model synchronization to support their collaboration. This approach considers the studied system context (under several viewpoints), applied processes, applied methods, and viewpoints produced by engineers. We illustrate it by creating a collaboration framework between two particular engineering fields: system architecture design and avionics applicative safety analysis at different life cycle stages.

Halos and Egos: Rankings and Interspecialty Deference in Multispecialty U.S. Hospitals

This paper examines how media rankings shift patterns of collaboration and deference between professional groups within organizations. Diversified and multidisciplinary organizations such as universities and hospitals often face distinct subunit evaluations that can influence coordination on interdependent tasks. Using patient-level treatment data for more than five million in-patient stays, I find that changes in the “best hospitals” rankings do not meaningfully shift treatment patterns by physicians in hospitals. However, when specialties were ranked in the top echelons (i.e., top 10) or had high categorical prestige, they were less likely to involve other specialties (i.e., ego effect) and had a higher chance of performing procedures on patients admitted in other specialties (i.e., halo effect). These effects were mostly confined to minor (i.e., less invasive) procedures, implying that the impact of external rankings on patient outcomes is relatively benign. This paper was accepted by Olav Sorenson, organizations.

How to Interpret the Ultrasound Output Display Standard for Diagnostic Ultrasound Devices: Version 3.

How to Interpret the Ultrasound Output Display Standard for Diagnostic Ultrasound Devices: Version 3.

In July 2019 the Portuguese Society of Myology was officially born: the first message from the founders.

The amazing behaviour and adaptation capacity of the skeletal muscle system call the attention of several scientists, including us. Thus, we have the pleasure to announce that it was born in the city of Coimbra, Portugal, the Portuguese Society of Myology (SPMyo), a society which the main aim is to spread skeletal muscle knowledge in the areas of muscle physiology, physiopathology and pharmacology in a multidisciplinary organization that reflects the different areas of the skeletal muscle study. The commitment of SPMyo is the progress of skeletal muscle awareness as well as its investigation, encouraging interdisciplinary, national and international collaboration. These goals will be achieved by organization of scientific meetings, formation courses, publications of books and other scientific and didactic materials. It is also a goal of the SPMyo to organize public events allowing general public to understand skeletal muscle system.

The "Begin Exploring Fertility Options, Risks and Expectations" (BEFORE) decision aid: development and alpha testing of a fertility tool for premenopausal breast cancer patients

BackgroundPremenopausal breast cancer patients are at risk of treatment-related infertility. Many patients do not receive sufficient fertility information before treatment. As such, our team developed and alpha tested the Begin Exploring Fertility Options, Risks, and Expectations decision aid (BEFORE DA).MethodsThe BEFORE DA development process was guided by the International Patient Decision Aids Standards and the Ottawa Decision Support Framework. Our team used integrated knowledge translation by collaborating with multiple stakeholders throughout the development process including breast cancer survivors, multi-disciplinary health care providers (HCPs), advocates, and cancer organization representatives. Based on previously conducted literature reviews and a needs assessment by our team – we developed a paper prototype. The paper prototype was finalized at an engagement meeting with stakeholders and created into a graphically designed paper and mirrored online decision aid. Alpha testing was conducted with new and previously engaged stakeholders through a questionnaire, telephone interviews, or focus group. Iterative reviews followed each step in the development process to ensure a wide range of stakeholder input.ResultsOur team developed an 18-page paper prototype containing information deemed valuable by stakeholders for fertility decision-making. The engagement meeting brought together 28 stakeholders to finalize the prototype. Alpha testing of the paper and online BEFORE DA occurred with 17 participants. Participants found the BEFORE DA usable, acceptable, and most provided enthusiastic support for its use with premenopausal breast cancer patients facing a fertility decision. Participants also identified areas for improvement including clarifying content/messages and modifying the design/photos. The final BEFORE DA is a 32-page paper and mirrored online decision aid (https://fertilityaid.rethinkbreastcancer.com). The BEFORE DA includes information on fertility, fertility options before/after treatment, values clarification, question list, next steps, glossary and reference list, and tailored information on the cost of fertility preservation and additional resources by geographic location.ConclusionThe BEFORE DA, designed in collaboration with stakeholders, is a new tool for premenopausal breast cancer patients and HCPs to assist with fertility discussions and decision-making. The BEFORE DA helps to fill the information gap as it is a tool that HCPs can refer patients to for supplementary information surrounding fertility.

Clinical and epidemiological features of viral infections in the children's non-infectious multidisciplinary medical organization

The article presents generalized clinical and epidemiological features of viral infections in children's noninfectious multidisciplinary hospital based on the results of a multi-year comprehensive study. The study was conducted for 12 years (2006–2017), included 16615 patients, including those diagnosed with «Acute respiratory viral infection» – 6104 patients, with a diagnosis of «Acute intestinal viral infection» – 1934 patients. A total of 193017 microbiological studies were conducted, including molecular genetic studies. It was found that the overall incidence of viral infections in children's non-infectious multidisciplinary hospital was 21.1 [95% CI 20.3-21.9] per 1000 hospitalized patients (according to long-term average data). The main nosological groups of viral infections were respiratory infections, enteric infections, intrauterine infections and parenteral viral hepatitis. Viral infections in in children's non-infectious multidisciplinary hospital were characterized by the following clinical and epidemiological features: high incidence; age group at risk – children under 3 years; features of clinical picture with «masks» of noncommunicable pathology; presence of combined infections; high level of virus transmission; high frequency of infections, brought into the hospital; prevalence of healthcare-associated infections in the general structure of morbidity with outbreak and involvement in the epidemic process of children and adults; uneven distribution of morbidity and carriers in departments; presence of nosocomial circulation of viruses.

1460P - Survival outcome of non-small cell lung cancer (NSCLC) patients: Comparing results between the database of the Comprehensive Cancer Center Zürich (CCCZ) and the Epidemiological Cancer Registry Zurich and Zug (KKR)

BackgroundThe Thoracic Oncology Centre of the University Hospital Zürich, founded in 2011, is certified by the German Cancer Society, and is one of 17 multidisciplinary organ-based centres of the CCCZ. All treatment recommendations are made at a multidisciplinary tumor board. Since 1980, all new cancer cases among the population of both cantons Zurich and Zug, are registered in the KKR. MethodsThe aim of the current study is to quantify the mortality risk of patients with NSCLC and identify differences on survival time and other factors between patients receiving their primary treatment at the CCCZ and those treated elsewhere and registered by KKR. Association of sex, histology, stage and age at initial diagnosis to survival as well as differential effect on survival between CCCZ and KKR are also explored. Imputation of last follow-up date of KKR by the database cut-off date (7 August 2018) was used, to address possible underestimation of survival due to missingness in this centre. ResultsPatients included 848 primary cases from the CCCZ and 1761 cases from the KKR diagnosed between January 1, 2011 and December 31, 2015. A comparable median follow-up time of 57 months and 56 months for CCCZ and KKR patients, respectively, was calculated. OS is significantly superior for CCCZ patients as compared to KKR patients (median: 36.0m, 95%CI:[31.0, 45.0] versus 12.0m, 95%CI:[11.0, 13.0];HR=1.71 [95% CI 1.54, 1.90] p<0.001). This difference remained significant when examined in the subgroups of gender, age (≤65 and >65y), UICC stage (I/II, III, IV), and histology (squamous, adenocarcinoma). The effect of treatment outside or within the CCCZ on patients’ survival remained significant (HR=1.42 [95% CI 1.27, 1.57]; p<0.001) in multivariate analysis adjusting for sex, histology, UICC stage and age at diagnosis, all factors with a significant effect on OS. ConclusionsOur analysis provides further evidence of the importance of the volume of experience and the availability of a multidisciplinary organisation and research environment, as delivered by a comprehensive cancer centre, on the outcome of patients with all stages of NSCLC. Legal entity responsible for the studyComprehensive Cancer Center Zürich. FundingHas not received any funding. DisclosureR.A. Stahel: Advisory / Consultancy: I have received honoraria as a consultant at advisory boards from AbbVie, AstraZeneca, Boehringer Ingelheim, MSD, Pfizer, Roche and Takeda.; Speaker Bureau / Expert testimony: I have received honoraria as a speaker from AstraZeneca, Boehringer Ingelheim, MSD and Roche.; Honoraria (self): Roche and Takeda; Research grant / Funding (institution), ETOP trials (president and scientific chair): AstraZeneca, BMS, Boehringer Ingelheim, Genentech, MSD, Roche, and Pfizer. All other authors have declared no conflicts of interest.

THE POTENTIAL OF KNOWLEDGE MANAGEMENT ON CONSTRUCTION SITES

Knowledge management is the process of creating, sharing, using, and managing knowledge, one of the most valuable organizational resources. This approach is well-known in Austria's industrial sector, but applied only in major construction companies. It is mainly used to share knowledge between different departments, but it is not commonly found on construction sites. During the construction phase a variety of separate firms build a temporary multidisciplinary organization, to produce investment goods. To show the potential of knowledge management on building sites in Austria, 78 interviews were conducted. Construction sites of different types (new construction and refurbishment of buildings) were taken into account in order to guarantee a representative outcome. The highest cost-benefit ratio for knowledge management can be seen in knowledge intensive processes. The execution phase is characterized by craftwork which often includes many routine steps. But the survey shows that almost a quarter of the daily business is about knowledge intensive processes while the amount doesn't correlate with the working experience. Furthermore, on construction sites with many trades the lack of information and knowledge transfer is the cause of nearly a quarter of the problems faced. The findings indicate the need for knowledge management on construction sites and the potential grows with the number of trades. The teambuilding process can be seen as the most important step for an efficient knowledge management during the execution phase.

Fostering positive weight-related conversations between health care professionals, children, and families: Development of a knowledge translation Casebook and evaluation protocol.

Health care professionals (HCPs) must communicate with children and families about weight management in a sensitive and nonstigmatizing manner. However, HCPs receive little training in weight-related communication and have requested resources, but these are scarce. This article details the development process of a knowledge translation (KT) Casebook and outlines the proposed protocol for its implementation and evaluation. Guided by the knowledge-to-action cycle, a KT Casebook aimed at HCPs integrated findings from a comprehensive scoping review with experiential and contextual evidence gathered through stakeholder workshops to provide guidance to HCPs communicating with children and families around weight-related issues. It was structured around five questions: (a) Who should participate in weight-related discussions? (b) When and how should the topic of weight be broached? (c) What terminology should be used? (d) How can HCPs enhance family engagement in weight-related discussions? (e) What specific communication techniques have been recommended? Checklists, evidence summaries, case studies, sentence starters, simulations, and other resources were clustered under each question. A dissemination strategy was developed using KT best practices and a pilot evaluation protocol designed. The Casebook was launched in November 2017 and has been presented at pediatric rehabilitation and obesity conferences. A communication strategy targeted multidisciplinary experts and organizations with weight management within their scope of practice. These efforts have resulted in 2,497 downloads across five countries to date. A practical and engaging KT Casebook was created to help foster positive weight-related conversations between HCPs, children, and their families. A pilot implementation study examining the impact of the Casebook on clinical practice will provide critical information for embedding the Casebook in a range of health care settings.

The Contribution of Taiwan in International Liaison Committee on Resuscitation Consensus on Science and Treatment Recommendation 2015 (ILCOR CoSTR 2015).

Taiwan has begun its board certification of emergency medicine since 1998. The scholars have also devoted themselves to research in the related fi elds including resuscitation for decades. On the other hand, International Liaison Committee on Resuscitation (ILCOR) was established to build up international expert consensus on resuscitation science in 1992. The National Resuscitation Council of Taiwan (NRCT) is a multidisciplinary organization and becomes one of the founding members of the Resuscitation Council of Asia (RCA) in 2005, whereas the RCA has also become currently the final regional member of ILCOR. Under these international platforms, the experts from Taiwan have significant contributions in establishment of evidence review and clinical guidelines on resuscitation such as ILCOR Consensus on Science and Treatment Recommendation (CoSTR). This brief review will introduce explicitly these important Taiwan investigations cited in ILCOR CoSTR 2015.

Historic Odyssey: The Institute of Cardiovascular Sciences: Past, Present, and Future.

The Institute of Cardiovascular Sciences (ICS) at St. Boniface Hospital Albrechtsen Research Center is located in the heart of Winnipeg, Manitoba, Canada. This multidisciplinary organization has been a driving force of cardiovascular research, training, and education since its inception in 1987. The ICS has attained international recognition for its research on heart failure, oxidative stress, diabetes mellitus, cardio-oncology, women’s health, tissue engineering, vascular disease, and fibrosis. Our faculty members are dynamically engaged in both the local and international cardiovascular communities through our many public outreach programs. Thus, it is no surprise that the ICS is both the founding home and editorial office for many international journals and book series and the headquarters of the International Academy of Cardiovascular Sciences. The ICS proudly fosters innovation and excellence in research, education, and patient care. Cultural diversity, a rich heritage, and people unified by arts, sports, and history make Winnipeg one of the most vibrant cities in all of Canada. Winnipeg, whose name was adapted from the Cree word win-nipi meaning muddy water, was first settled by indigenous people at the junction of the Red and Assiniboine Rivers, where the ICS prominently stands today.1 Although the fourth largest city in Canada, Winnipeg is arguably one of the most dynamic. We have the largest French-speaking population outside of Quebec, which is celebrated annually at our winter Festival du Voyageur. The Winnipeg Art Gallery is home to the largest collection of contemporary Inuit art, and Rainbow Stage is Canada’s oldest outdoor theater. Our frozen rivers that comprise the longest skating trails in the world are warmly complimented by our love for winter sports. Winnipeg’s cultural mosaic society has played an instrumental role in its development since the founding of the city in the early 1870s.1 The Sisters of Charity of Montreal, also known …

Creating a Community of Data Champions

Research Data Management (RDM) presents an unusual challenge for service providers in Higher Education. There is increased awareness of the need for training in this area but the nature of the discipline-specific practices involved make it difficult to provide training across a multi-disciplinary organisation. Whilst most UK universities now have a research data team of some description, they are often small and rarely have the resources necessary to provide targeted training to the different disciplines and research career stages that they are increasingly expected to support. This practice paper describes the approach taken at the University of Cambridge to address this problem by creating a community of Data Champions. This collaborative initiative, working with researchers to provide training and advocacy for good RDM practice, allows for more discipline-specific training to be given, researchers to be credited for their expertise and creates an opportunity for those interested in RDM to exchange knowledge with others. The ‘community of practice’ model has been used in many sectors, including Higher Education, to facilitate collaboration across organisational units and this initiative will adopt some of the same principles to improve communication across a decentralised institution. The Data Champions initiative at Cambridge was launched in September 2016 and this paper reports on the early months, plans for building the community in the future and the possible risks associated with this approach to providing RDM services.

ADMINISTRATIVE AND ECONOMIC PROCESSES OF A LARGE MULTIDISCIPLINARY MEDICAL INSTITUTION

Article is devoted to the process approach principles use at the description of administrative processes of the large multidisciplinary medical organization. In article the structure (list) of the main administrative processes and their maintenance for the subsequent development of flow charts is identified.

Influence of Community Support Service Providers on Human Trafficking of Young People in Nigeria

Nigeria has been bedevilled with myriad of problem which has hampered the attainment of the development of our society. Community support service providers in Nigeria are multidisciplinary non-profitable organizations that were established to tackle mostly human trafficking. The paper examined the influence of community support service providers on human trafficking of young people. Descriptive survey design was used for the study while purposive random sampling technique was used to select 200 young people from the community support service providers. Multiple regression and Pearson product moment correlation statistical analysis were used to analyse the data at 0.05 level of significance. The study established that there was a significant contribution of the age, socio-cultural practice and economic status F=(3.196)=985.856, P<0.001 and community support service providers. The result revealed that there was significant relationship between socio-cultural practice (r=0.622**, N=200, P<0.001) and community support service providers. The finding also showed that there was significant relationship between economic status of trafficked young people (r=0.486**, N=200, P<0.001) and community support service providers. It was also established that there was significant relationship between age of human trafficking of young people (r=0.967**, N=200, P<0.001) and community support service providers. The study, therefore, recommended that, community support service providers should increase the ways of boosting the economic status of human trafficking of young people and their parents since poverty was the main reasons why the young people fell to the hands of the traffickers. This can be done through the awareness of entrepreneurship programmes where the trafficked young people will learn different types of vocational skills.

MODERN TRENDS IN THE DEVELOPMENT OF VESSELS FOR MEDICAL PURPOSES

Hospital vessels are considered as the mobile multidisciplinary medical organizations on the sea battlefield. At the same time hospital vessels are used in daily conditions: for medical support of staff of ship groups of forces of the fleet in distant sea and ocean zones; for medical support in the remote areas of the coast and island territories; for medical support of oil industry workers, field men, fishermen, etc. Forms and ways of use of hospital courts according to modern requirements, taking into account modernization and development of the fleet are analysed (11 figs, bibliography: 13 refs).

Building Community Partnerships: Using Social Network Analysis to Strengthen Service Networks Supporting a South Carolina Program for Pregnant and Parenting Teens

In 2013, South Carolina implemented a multi-year program providing support services for pregnant and parenting teens. Local lead sites were responsible for coordinating service delivery in partnership with other multidisciplinary community-based organizations. We used social network theory and analyses (SNA) to examine changes in partnerships over time. Using two-stage purposeful sampling, we identified three lead sites and their self-reported community partners. We administered two web-based surveys grounded in social network theory that included questions about partnership relationships and organizational characteristics. We calculated selected whole-network measures (size, cohesion, equity, diversity). Following the Year 1 surveys, we reviewed our findings with the lead sites and suggested opportunities to strengthen their respective partnerships. Following the Year 3 surveys, we observed changes across the networks. Survey response rates were 91.5% (43/47) in Year 1 and 68.2% (45/66) in Year 3. By Year 3, the average network size increased from 15.6 to 20.3 organizations. By Year 3, one lead site doubled its measure of network cohesion (connectedness); another lead site doubled in size (capacity). A third lead site, highly dense in Year 1, increased in size but decreased in cohesion by Year 3. Innovative use of SNA findings can help community partnerships identify gaps in capacity or services and organizations needed to fulfill program aims. SNA findings can also improve partnership function by identifying opportunities to improve connectedness or reduce redundancies in program work. The ability of lead sites to strategically reconfigure partnerships can be important to program success and sustainability.

ESR concept paper on value-based radiology

The European Society of Radiology (ESR) established a Working Group on Value-Based Imaging (VBI WG) in August 2016 in response to developments in European healthcare systems in general, and the trend within radiology to move from volume- to value-based practice in particular. The value-based healthcare (VBH) concept defines “value” as health outcomes achieved for patients relative to the costs of achieving them. Within this framework, value measurements start at the beginning of therapy; the whole diagnostic process is disregarded, and is considered only if it is the cause of errors or complications. Making the case for a new, multidisciplinary organisation of healthcare delivery centred on the patient, this paper establishes the diagnosis of disease as a first outcome in the interrelated activities of the healthcare chain. Metrics are proposed for measuring the quality of radiologists’ diagnoses and the various ways in which radiologists provide value to patients, other medical specialists and healthcare systems at large. The ESR strongly believes value-based radiology (VBR) is a necessary complement to existing VBH concepts. The Society is determined to establish a holistic VBR programme to help European radiologists deal with changes in the evolution from volume- to value-based evaluation of radiological activities.Main Messages• Value-based healthcare defines value as patient’s outcome over costs.• The VBH framework disregards the diagnosis as an outcome.• VBH considers diagnosis only if wrong or a cause of complications.• A correct diagnosis is the first outcome that matters to patients.• Metrics to measure radiologists’ impacts on patient outcomes are key.• The value provided by radiology is multifaceted, going beyond exam volumes.

Impacting Binational Health through Leadership Development: A Program Evaluation of the Leaders across Borders Program, 2010-2014.

Workforce and leadership development is imperative for the advancement of public health along the U.S./Mexico border. The Leaders across borders (LaB) program aims to train the public health and health-care workforce of the border region. The LaB is a 6-month intensive leadership development program, which offers training in various areas of public health. Program curriculum topics include: leadership, border health epidemiology, health diplomacy, border public policies, and conflict resolution. This article describes the LaB program evaluation outcomes across four LaB cohort graduates between 2010 and 2014. LaB graduates received an invitation to participate via email in an online questionnaire. Eighty-five percent (n = 34) of evaluation participants indicated an improvement in the level of binationality since participating in the LaB program. Identified themes in the evaluation results included increased binational collaborations and partnerships across multidisciplinary organizations that work towards improving the health status of border communities. Approximately 93% (n = 37) of the LaB samples were interested in participating in future binational projects while 80% (n = 32) indicated interest in the proposal of other binational initiatives. Participants expressed feelings of gratitude from employers who supported their participation and successful completion of LaB. Programs such as LaB are important in providing professional development and education to a health-care workforce along the U.S./Mexico border that is dedicated to positively impacting the health outcomes of vulnerable populations residing in this region.