Multidisciplinary Organization Research Articles

Partnership Moves Community Toward Complete Streets

The Partnership for Active Communities brought together multidisciplinary organizations to create a 5-year project to support increased walking and bicycling in the Sacramento CA area. Using a community action model, the partnership focused on programs and promotions to expand walk- and bike-to-school programs. The partnership focused on policy and physical projects in conducting systematic reviews of development projects to influence land use. A comprehensive communications plan united diverse partnership interests to advocate for Complete Streets policy change and improve transportation infrastructure. Walk- and bike-to-school programs grew, and community-design workshops helped leverage more than $12 million in additional support, including Safe Routes to School grants. The partnership delivered more than 150 project reviews to city planners, architects, and developers with recommendations for improved pedestrian and bicycle infrastructure, and many positive changes resulted. Complete Streets is now included as a policy in the region's transportation plan, in the mobility element of the city's updated general plan and the county's draft circulation plan, and in the regional transit master plan. The partnership's communications plan linked partners with diverse interests to produce a powerful advocacy network to influence adoption of Complete Streets policies. Project development reviews were most successful in communities that allowed comments at a conceptual stage in the process. The Partnership for Active Communities produced increased public and agency awareness of pedestrian and bicycle safety issues and influenced considerable changes to policies and the physical environment in the Sacramento area.

Proceedings of the 10th National Conference on Anticoagulant Therapy

The 10th National Conference on Anticoagulant Therapy sponsored by the Anticoagulation Forum was held in San Diego, CA on May 7–9, 2009. The Anticoagulation Forum’s conference provided a unique opportunity to network and learn with professional colleagues with expertise in the diagnosis and treatment of thrombotic disorders. The 3-day conference included an outstanding roster of international expert speakers, whose presentations are published in these proceedings. As in the past, members had an opportunity to present abstracts of original research and case reports. Over 50 abstracts were presented and are reprinted in this supplement. The Anticoagulation Forum was founded in 1991 by Dr. Jack Ansell in response to the need for a professional group to focus on the discipline of anticoagulation management and related therapies. The AC Forum is a multidisciplinary nonprofit organization that works to improve the quality of care for patients taking antithrombotic medications. The goals of the AC Forum are to provide education and networking opportunities for health care professionals, to promote the clinical application of evidence-based practices, to facilitate research aimed at improving health outcomes, and to inform healthcare policy, regulatory agencies, and industry about best practices. The AC Forum has been an advocate for improved anticoagulation care through the establishment of anticoagulation clinics, the hosting of web-based education sessions, and the development of clinical guidelines. In addition, the AC Forum has served the interest of patients taking anticoagulants by promoting increased availability of self-monitoring, and by advocating for appropriate reimbursement from third-party payers. Many members of the AC Forum are actively engaged in clinical trials testing new and exciting antithrombotic drugs for the treatment of venous and arterial thromboembolism. These new drugs may have a major impact on the traditional responsibilities of anticoagulation clinics, as highlighted by presentations at this year’s conference. The AC Forum has also been an active supporter and partner in the development of a national certification program for providers who manage oral anticoagulation. At this year’s meeting, approximately 60 individuals sat for the examination delivered by the National Certification Board for Anticoagulation Providers. The Anticoagulation Forum wished to express its gratitude to the pharmaceutical and device manufacturers’ industry for their generous support of the meeting: ARYx Therapeutics, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Bristol-Myers Squibb and Pfizer, CSL Behring, GlaxoSmithKline, Inverness Medical Innovations, ITC, Ortho-McNeil Janssen Scientifc Affairs, Philips Remote Cardiac Services, Roche Diagnostics, SanofiAventis, and Tapestry Medical.

The American Association of Birth Centers: History, Membership, and Current Initiatives

The American Association of Birth Centers (AABC) is a multidisciplinary membership organization dedicated to the birth center model of care. This article reviews the history, membership, and current policy initiatives of the AABC. The history of AABC includes the promotion of research, education, and national and state policies that are supportive of birth center care. Current AABC priorities address three main pressures to birth center sustainability: high malpractice insurance rates, the lack of a federally mandated birth center facility fee, and low rates of certified nurse-midwife/certified midwife reimbursement. The AABC is addressing these concerns through lobbying, collaborating with other national organizations, and the promotion of birth research.

Swiss Romande burn center: A model of multidisciplinary team work and network organization

Swiss Romande burn center: A model of multidisciplinary team work and network organization

Organisation des soins spécialisés et intégrés en ambulatoire pour la prise en charge de la maladie rénale chronique en pédiatrie : expérience du CHU Sainte-Justine

The management and optimal care for the pediatric patient with chronic kidney disease requires attention not only to medical management, but also special focus on the psychosocial and developmental factors of children which is complicated by the presence of other disease-related complications. In recent years, specialized chronic kidney disease and predialysis clinics have been set up to facilitate and improve the quality of care of these patients with a multidisciplinary organisation and coordinated management approaches of a renal team. We present our experience in establishing such a renal management clinic named "Prévoir" for children with chronic kidney disease at Sainte-Justine Hospital.

An Operational Perspective of Challenging Statistical Dogma While Establishing a Modern, Secure Distributed Data Management and Imaging Transport System: The Pediatric Brain Tumor Consortium Phase I Experience

The Pediatric Brain Tumor Consortium (PBTC) is a multidisciplinary cooperative research organization devoted to the study of correlative tumor biology and new therapies for primary central nervous system (CNS) tumors of childhood. The PBTC was created in 1999 to conduct early-phase studies in a rapid fashion in order to provide sound scientific foundation for the Children's Oncology Group to conduct definitive trials. The Operations and Biostatistics Center (OBC) of the PBTC is responsible for centrally administering study design and trial development, study conduct and monitoring, data collection and management as well as various regulatory and compliance processes. The phase I designs utilized for the consortium trials have accommodated challenges unique to pediatric trials such as body surface area (BSA)-based dosing in the absence of pediatric formulations of oral agents. Further during the past decade, the OBC has developed and implemented a state-of-the-art secure and efficient internet-based paperless distributed data management system. Additional web-based systems are also in place for tracking and distributing correlative study data as well as neuroimaging files. These systems enable effective communications among the members of the consortium and facilitate the conduct and timely reporting of multi-institutional early-phase clinical trials.

Overcoming the barriers to optimum continence care: the need for an expanded approach to implementation

In spite of a growing body of evidence to show that urinary incontinence is treatable or symptoms can be significantly improved in the majority of older people significant shortfalls in the quality of continence care are highlighted consistently in the international literature. The key barriers to providing optimal continence care for older people points to a need to address change not only from an individual practitioner perspective but also at the levels of the multidisciplinary team and organization. Examples of some emerging implementation frameworks that incorporate the broader context in which change occurs in 'real world' practice are introduced which may serve as useful guides. It is argued that if national and international standards of good practice for continence care are to be achieved, implementation methods have to take account of the complex interplay of patient, practitioner, social and organizational factors that mediate change.

Investigator-led clinical research consortia: The Canadian Critical Care Trials Group

Advances in the care of critically ill patients are dependent upon rigorous clinical research undertaken to characterize natural history and risk factors, and determine optimal approaches to the management of the diseases of the critically ill patient. The Canadian Critical Care Trials Group (CCCTG) was formed in 1989 to foster such research. It has grown to become a national, multidisciplinary organization with more than 100 members, and more than 3 dozen active research programs. Its members have been highly successful in obtaining funding for, completing, and publishing well-designed studies that have informed international practice in areas such as transfusion, stress ulcer prophylaxis, long term outcomes from acute respiratory distress syndrome, diagnosis and management of infection in the intensive care unit, and end-of-life care. In the process, the CCCTG has developed a highly effective culture of scientific mentoring, and has served as a model for investigator-led critical care research groups around the world. This review summarizes the history, activities, approaches, and challenges of the CCCTG, in the conviction that investigator-led groups such as ours represent the future of intensive care unit-based research.

American Academy of Cosmetic Surgery Guidelines for Clinical Fellowship Training in Cosmetic Surgery

Preface: Maintaining and improving the quality of advanced education in nationally recognized cosmetic surgery fellowships is a primary aim of the American Academy of Cosmetic Surgery (Academy). The Academy is an accredited council of professionals devoted to postgraduate medical education in the field of cosmetic surgery. It is the nation's largest multi-disciplinary medical organization that exclusively devotes its educational efforts to cosmetic surgery.

Strengthening clinical and research ethics in Nigeria—an agenda for change

Strengthening clinical and research ethics in Nigeria—an agenda for change

Effectiveness of accelerated perioperative care and rehabilitation intervention compared to current intervention after hip and knee arthroplasty. A before-after trial of 247 patients with a 3-month follow-up

BackgroundIn Denmark, approximately 12,000 hip and knee arthroplasties were performed in 2006, and the hospital costs were close to US$ 110,000,000. In a randomized clinical trial, we have recently demonstrated the efficacy of accelerated perioperative care and rehabilitation intervention after hip and knee arthroplasty compared to current intervention under ideal circumstances. We do not, however, know whether these results could be reached under usual circumstances of healthcare practice. We therefore investigated whether length of stay after implementation of accelerated perioperative care and rehabilitation after hip and knee arthroplasty could be reduced in a normal healthcare setting, and how the achieved results matched those observed during the randomized clinical trial.MethodsAn effectiveness study as a before-after trial was undertaken in which all elective primary total hip and total knee arthroplasty patients were divided into a before-implementation group receiving the current perioperative procedure, and an after-implementation group receiving the new accelerated perioperative care and rehabilitation procedures as provided by a new multi-disciplinary organization. We used the Breakthrough Series Collaborative Model for implementation. The primary outcome measure was in hospital length of stay (LOS), and the secondary outcome measure was adverse effects within 3 months postoperatively.ResultsWe included a total of 247 patients. Mean LOS was significantly (P < 0.001) reduced by 4.4 (95% CI 3.8–5.0) days after implementation of the accelerated intervention, from 8.8 (SD 3.0) days before implementation to 4.3 (SD 1.8) days after implementation. No significant differences in adverse effects were observed. LOS in this effectiveness study was significantly lower than LOS reported in the efficacy study.ConclusionAccelerated perioperative care and rehabilitation intervention after hip and knee arthroplasty was successfully and effectively implemented. Results obtained during usual hospital circumstances matched the results achieved under ideal circumstances in this group of patients.

Remembering FAB's past, anticipating our future

This essay reviews and evaluates the accomplishments of The International Network on Feminist Approaches to Bioethics (FAB) over its initial fifteen years. It focuses on the origins, development, and expanding influence of FAB as a multidisciplinary organization of feminist bioethicists. Also noted are areas of bioethics that as yet have not been adequately addressed from feminist perspectives, including intersections between health and human rights, gender disparities in the treatment of chronic disease, health research priorities that shortchange women, HIV/AIDS proliferation among women in the global South, the health needs of recent migrants, and the encroachment of corporate interests on bioethics.

Edmund Vincent Cowdry and the Making of Gerontology as a Multidisciplinary Scientific Field in the United States

The Canadian-American biologist Edmund Vincent Cowdry played an important role in the birth and development of the science of aging, gerontology. In particular, he contributed to the growth of gerontology as a multidisciplinary scientific field in the United States during the 1930s and 1940s. With the support of the Josiah Macy, Jr. Foundation, he organized the first scientific conference on aging at Woods Hole, Massachusetts, where scientists from various fields gathered to discuss aging as a scientific research topic. He also edited Problems of Ageing (1939), the first handbook on the current state of aging research, to which specialists from diverse disciplines contributed. The authors of this book eventually formed the Gerontological Society in 1945 as a multidisciplinary scientific organization, and some of its members, under Cowdry's leadership, formed the International Association of Gerontology in 1950. This article historically traces this development by focusing on Cowdry's ideas and activities. I argue that the social and economic turmoil during the Great Depression along with Cowdry's training and experience as a biologist--cytologist in particular--and as a textbook editor became an important basis of his efforts to construct gerontology in this direction.

Remembering FAB’s past, anticipating our future

This essay reviews and evaluates the accomplishments of The International Network on Feminist Approaches to Bioethics (FAB) over its initial fifteen years. It focuses on the origins, development, and expanding influence of FAB as a multidisciplinary organization of feminist bioethicists. Also noted are areas of bioethics that as yet have not been adequately addressed from feminist perspectives, including intersections between health and human rights, gender disparities in the treatment of chronic disease, health research priorities that shortchange women, HIV/AIDS proliferation among women in the global South, the health needs of recent migrants, and the encroachment of corporate interests on bioethics.

Improving Information and Best Practices for Public Health Emergency Legal Preparedness

This is one of four interrelated action agenda papers resulting from the National Summit on Public Health Legal Preparedness convened in June 2007 by the Centers for Disease Control and Prevention and nineteen multi-disciplinary partner organizations. Each of the action agenda papers deals with one of the four core elements of public health legal preparedness: laws and legal authorities; competency in using those laws; coordination of law-based public health actions; and information. Options presented in this paper are for consideration by policymakers and practitioners — in all jurisdictions and all relevant sectors and disciplines — with responsibilities for all-hazards emergency preparedness.This paper focuses on the fourth core element: information that can be used in shaping and applying law as a public health tool, specifically in the context of public health emergencies.

Danish Breast Cancer Cooperative Group – DBCG: History, organization, and status of scientific achievements at 30-year anniversary

DBCG (Danish Breast Cancer Cooperative Group) constitutes a multidisciplinary organization established in 1975 by the Danish Surgical Society. The purpose involves first and foremost a nation-wide standardization of breast cancer treatment based on novel therapeutic principles, collaboration between experts handling diagnostic work-up, surgery, radiotherapy, medical oncology, and basic research, and, further, complete registration of relevant clinical data in a national data base attached to DBCG. Data are processed by the Secretariat personnel composed of statisticians, data managers, and data secretaries making current analyses of outcome results feasible. DBCG is run by the Executive Committee consisting of expert members appointed by their respective society. From 1978 the DBCG project gained widely accession from participating units, and since then nearly all newly diagnosed breast cancer incident cases are reported and registered in the national data base. Today, the data base includes approximately 80 000 incidents of primary breast cancer. Annually, the Secretariat receives roughly 1.5 million parameters to be entered into the data base.Over time DBCG has generated seven treatment programmes including in situ lesions and primary invasive breast cancer. Probands are subdivided into risk groups based on a given risk pattern and allocated to various treatment programmes accordingly. The scientific initiatives are conducted in the form of register- and cohort analysis or randomized trials in national or international protocolized settings. Yearly, about 4 000 new incident cases of primary invasive breast cancer and about 200 in situ lesions enter the national programmes. Further, about 600 women with hereditary disposition of breast cancer are registered and evaluated on a risk scale.The main achievements resulted in a reduction of relative risk of death amounting up to 20% and increased 5-year overall survival ascending from 60% to roughly 80%.This article is partly based on a Danish paper to be published in the Centenary Jubilee book of the Danish Surgical Society, 2008.

Twentieth-century survival from osteosarcoma in childhood

We have reviewed the data from our regional Bone Tumour Registry on patients with osteosarcoma diagnosed between 1933 and 2004 in order to investigate the relationship between survival and changes in treatment. There were 184 patients with non-metastatic appendicular osteosarcoma diagnosed at the age of 18 or under. Survival was calculated using Kaplan-Meier curves, and multivariate analysis was performed using the Cox regression proportional hazards model. The five-year survival improved from 21% between 1933 and 1959, to 62% between 1990 and 1999. During this time, a multi-disciplinary organisation was gradually developed to manage treatment. The most significant variable affecting outcome was the date of diagnosis, with trends in improved survival mirroring the introduction of increasingly effective chemotherapy. Our experience suggests that the guidelines of the National Institute for Clinical Excellence on the minimum throughput of centres for treatment should be enforced flexibly in those that can demonstrate that their historical and contemporary results are comparable to those published nationally and internationally.

A Study of Occupational Noise and Hand-Arm Vibration Exposure to Employees in Multidisciplinary Organisation

A Study of Occupational Noise and Hand-Arm Vibration Exposure to Employees in Multidisciplinary Organisation

The International Psychogeriatric Association: building on 25 years of leadership and vision

The International Psychogeriatric Association (IPA) was founded 25 years ago as a multidisciplinary organization with the ambitious vision of improving the mental health of the elderly around the world. For a variety of reasons, some leaders were skeptical about the value of an international organization and it was the vision and energy of Dr. Sanford Finkel, together with a relatively small group of colleagues, who brought IPA to life and nurtured it through its infancy. Dr. Finkel, known to all as Sandy, has chronicled some of the history of IPA elsewhere and I won't repeat it here other than to emphasize the profound effect that IPA's first executive director, the dedicated and beloved Fern Finkel, had on IPA until her retirement in 2006. The importance of IPA as a leading professional organization is now well established, but beyond its many achievements in molding and guiding the profession, IPA is also a professional home for our members, a place of intellectual comfort where colleagues speak a common language and share common goals. Within IPA we can relax, share universal concerns for the ambivalently viewed population of elders that the world worries about but often avoids or ignores at the same time. We can share our challenges and they are many, our hopes, our successes and our uncertainties.

The Fate of Lower Extremities With Failed Free Flaps

Lower-extremity reconstruction with microvascular free flap coverage is often the only option for limb salvage. Flap failure rates, however, continue to have higher complication rates than those to other anatomic sites; a significant number of flaps that fail result in amputation. This study retrospectively analyzed patients treated at a single institution who underwent attempted lower-extremity limb salvage with microsurgical techniques over a 25-year period. Of particular interest are the outcome data for patients who had initial free flap failure. A prospectively maintained database was used to identify patients who satisfy criteria. Every patient who was treated with a microvascular free flap to their lower extremities was identified and included in this analysis. All records were reviewed from 1980 through 2004. Patients who had free flaps to the lower extremity fail after the initial operation were identified and selected for further analysis. Five hundred eighty-eight patients who underwent microsurgical reconstruction of lower extremity wounds had a failure rate of 8.5%. Trauma patients (83%) had a failure rate of 9%. On subset analysis, the failure rate for trauma patients decreased from 11% (1980-1992) to 3.7% (1993-2004). Of patients who had a failed free flap, 18% went on to limb amputation; the remainder was salvaged with secondary free flaps, local flaps, or skin grafting. This single institutional experience spanning 25 years represents the longest continual series of lower-extremity free flaps reported in the literature. The improved success rate seen in the second half of the study period is attributed to a more critical selection of free-flap candidates, improved understanding of the physiology surrounding acute trauma and a more sophisticated multidisciplinary team organization.