Multidisciplinary Organization Research Articles

Proceedings of the 12th national conference on anticoagulant therapy

The 12th National Conference of Anticoagulant Therapy sponsored by the Anticoagulation Forum (AC Forum) was held in Phoenix, Arizona on May 9–11, 2013. The AC Forum conference welcomed over 750 attendees allowing them an opportunity to network and learn among professional colleagues with expertise in the diagnosis and treatment of thrombotic disorders. With the ever-changing landscape of anticoagulant therapy in mind, this worthwhile conference allowed participants to get access to the most current evidence-based research on drug therapies and experience an outstanding roster of international expert speakers, whose presentations are published in these proceedings. Members were also given the opportunity to present abstracts of original research. In total, 54 abstracts were presented and they are also published in this issue of the Journal of Thrombosis and Thrombolysis. New this year, the AC Forum, in conjunction with Boston University School of Medicine Office of CME, is pleased the announce the opportunity for readers to earn. Continuing Education Credits (CME AMA PRA Category 1 Credits or ANCC Nursing Contact Hours) for those that chose to read the designated manuscripts and complete associated evaluations. The designated articles include ‘‘Assessing Bleeding Risk in Patients Taking Anticoagulants’’; ‘‘Impact of Target-Specific Oral Anticoagulants on Transitions of Care and Outpatient Care Models’’; and ‘‘Frequency of Monitoring, Non-Adherence, and Other Topics Dear to an Anticoagulation Clinic Provider’’. Please follow the instructions inside this journal for more information. Attendance at the 12th National Conference on Anticoagulant Therapy is not mandatory to participate and apply for these continuing education credits. The Anticoagulation 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, promote the clinical application of evidence-based practice, facilitate research aimed at improving health outcomes, and inform healthcare policy, regulatory agencies, and industry about best practices. The AC Forum has over 5,500 members and represents over 1,800 anticoagulation services. In an effort to advance our mission of providing education and improving patient care, the AC Forum is proud of its new web-based program, the Anticoagulation Centers of Excellence, found at excellence.acforum.org. The site provides anticoagulation services with an opportunity to compare their practice to a rigorous set of standards of excellence in five key areas of patient care. The site also includes an exceptional, comprehensive library of anticoagulation resources including policies, procedures, guidelines, and toolkits. In addition to the Anticoagulation Centers of Excellence program, the AC Forum offers free webinar programs, a newsletter, grand rounds programs, and other educational opportunities. Please visit www.acforum.org for more information. D. A. Garcia (&) Division of Hematology, University of Washington, Seattle, WA, USA e-mail: davidg99@uw.edu

Insights on Unconventional Natural Gas Development from Shale: An Interview with Anthony R. Ingraffea

Adam Law, M.D., interviewed Anthony R. Ingraffea, Ph.D., P.E., as part of a series of interviews funded by the Heinz Endowment. Dr. Ingraffea is the Dwight C. Baum Professor of Engineering at Cornell University, and has taught structural mechanics, finite element methods, and fracture mechanics at Cornell for 33 years. He discusses issues related to hydraulic fracturing, including inherent risks, spatial intensity, and the importance of a multi-disciplinary organization in establishing a chain of evidence.

SASH Policy Statement (Revised): The Future of Problematic Sexual Behaviors/Sexual Addiction

The Society for the Advancement of Sexual Health (SASH) is a nonprofit multidisciplinary organization of professionals dedicated to scholarship, training, and resources for promoting sexual health ...

The Identity Work of Professional Identity: Challenges Constructing “Who Am I?” and “Who are We?”

This symposium showcases recent research projects on professional identity in a wide variety of contexts. We will present fresh insights into the interaction between the two levels of professional identity – the individual “who am I in this profession?” and the collective “who are we as a profession?” We position these struggles within the burgeoning topic of identity work – the “range of activities that individuals engage in to create, present, and sustain personal identities that are congruent with and supportive of the self-concept” (Snow & Anderson, 1987: 1348). Topics addressed herein include how nascent professions struggle at the collective and individual levels to mutually shape identity; how scientists deal with threats to their long-held definitions of professional identity; how individuals respond to ambiguity in their professional identity; and how social relationships affect professional identity, especially in multidisciplinary environments. The contexts in which these phenomena are explored are also diverse and include the emerging profession of health coaches, NASA scientists, chief ethics and compliance officers, and knowledge workers in a multidisciplinary research organization. Overall, the symposium will address these goals: (1) highlighting new findings and theory on each of these topics, with the goal of contributing to richer understanding of the relationship between individual and collective professional identity; (2) comparing and contrasting the identity work challenges of nascent versus longstanding professions; and (3) providing a forum for discussion of the challenges and opportunities of conducting research on professional identity. Ambiguity of Professional Identity – Boon or Burden? The Case of Ethics & Compliance Officers Presenter: Glen E. Kreiner; Pennsylvania State U. Presenter: Niki A. den Nieuwenboer; Santa Clara U. Presenter: Derron Bishop; Pennsylvania State U.

Helping midwives in Ghana to reduce maternal mortality

This article describes work undertaken in Ghana with Kybele, a multidisciplinary humanitarian organisation. Kybele is dedicated to improving childbirth safety worldwide, by improving processes that will reduce maternal mortality. The role of the author, as the midwife team member, was to work alongside doctors and midwives in a busy maternity referral hospital in Accra, Ghana. Review of the history of maternal deaths, and observing and working alongside the midwives revealed a heavy workload, cramped and disorganised space, poor decision making and inadequate referral systems. This project provided opportunities for small group work, supported managers and targeted teaching to enable the Ghanaian midwives to share their beliefs about their role, understand the challenges and identify ways to improve standards of care for women. The midwives decided on four key areas for improvement: monitoring women using the partogram, improving professional accountability by introducing patient allocation, improving the labour ward environment and developing leadership skills. The partnership working style and ongoing support that are key features of the Kybele model will continue to assist the project and monitor progress.

Child Abuse and the Church: A Call for Prevention, Treatment, and Training

Child abuse is both a sin and a crime. In this article, we present a call to the global Christian church to prevent and treat child abuse, and to train professionals across disciplines to do so. Vieth discusses effective child protection policies in churches. Among other recommendations, he encourages consultation with child protection experts, thorough screening of child workers, and accountable supervision of children in church. Tchvidjian examines cultural aspects of missions organizations that contribute to the abuse of children in the mission field. He suggests that missions organizations who have failed to protect abused children in the past placed their reputation above child protection, failed to treasure children, and believed in God-sanctioned power and control of missions workers. Knodel reviews the efforts of Christian organizations to prevent the trafficking of children worldwide. She finds effective advocacy occurring across the globe but among Christian organizations that are rarely tied to any specific denominational support. Next, Walker reviews evidence-based treatment recommendations for children and adolescents. Trauma-focused CBT is a leading empirically supported treatment for child abuse. Recently, efforts have been made to sensitively integrate faith into TF-CBT. Vieth then discusses effective church responses to allegations of abuse. He suggests suspending the activities of a church worker when allegations are made against him or her in addition to informing the police. Tchivdjian concludes by discussing the mission and vision of the GRACE foundation—a multidisciplinary Christian nonprofit organization dedicated to protecting children from child abuse and treating children who have been abused.

Addressing Tobacco Use in Homeless Populations: A Survey of Health Care Professionals

Cigarette smoking is common among homeless individuals, but little is known about health care providers' practices and attitudes in addressing tobacco use in this vulnerable population. We surveyed members of the Health Care for the Homeless Clinicians' Network, a nationwide multidisciplinary organization, to assess their tobacco screening practices, attitudes toward addressing tobacco use, and experience providing tobacco products to homeless individuals. Of 231 clinicians who completed the survey, 86.5% reported routinely screening for tobacco use. Although 74.4% of respondents viewed tobacco use as one of the most important health issues among homeless people, rates of agreement with this and other attitudes toward tobacco use in the setting of homelessness varied significantly by clinical discipline. Overall, 15.3% of respondents reported having ever given patients tobacco to build trust or promote adherence to care. Addressing providers' attitudinal variations and tobacco distribution practices may foster a more consistent anti-smoking message for this population.

Report on ISSWSH Fellowship

C for female sexual wellness and the diagnosis and treatment of female sexual dysfunction has led to its becoming a subspecialty in medical care over the past several decades. The small multidisciplinary group of 355 who first convened in Boston in 1999 as “The Female Sexual Function Forum” has grown to become The International Society for the Study of Women’s Sexual Health (ISSWSH), a robust international society of over 725 active members from 29 countries. The members of the society are reflective of the diversity and complexity within the field of female sexual health, and include: physicians (from diverse backgrounds: gynecology, urology, endocrinology, oncology, internal medicine, family medicine, psychiatry), nurse practitioners in women’s health, psychologists, counselors, sex therapists, physical therapists. ISSWSH is a multidisciplinary academic and scientific organization whose purposes are:

A new concept of a multidisciplinary lymphoedema centre: established in connection to a department of dermatology and the Copenhagen Wound Healing Center

Lymphoedema is increasingly recognized as a significant problem in healthcare. The number of patients is growing, posing a future challenge to healthcare systems and economics. Over the past decade, specialized lymphoedema management has been established around the world to accommodate the growing demands. However, information on organization, experiences and outcome are scarce. To conduct a clinical perspective analysis describing the establishment, organization, function and results of a new, multidisciplinary lymphoedema centre functioning as a university hospital unit in connection to a department of dermatology and the Copenhagen Wound Healing Center and integrated as a national expert function in the public healthcare organization of Denmark. Data were collected following the establishment of a lymphoedema centre based on the structured, multidisciplinary organization of lymphoedema management. During the first 4·5 years a total of 8058 patient consultations were performed. The mean duration of symptoms at the first visit was 19 years (range 1-67) and 31% of patients had never received any diagnosis or treatment prior to referral. Complications were found in 48% of referred patients. All patients received appropriate diagnostic investigations and treatment according to best practice. Multidisciplinary assessment involving four or more different healthcare professions was needed in 86% of cases. Research opportunities and expert education of staff were enhanced. A multidisciplinary lymphoedema centre improves management, knowledge and awareness of lymphoedema. This model, with minor adjustments, may be applicable for other regions and countries.

Abstract LB-37: Cancer patient navigators of Georgia (CPNG) advocate for cancer survivors

Abstract The Georgia Cancer Coalition (GCC) is a not-for-profit organization that seeks to unite government agencies, academic institutions, civic groups, healthcare organizations and survivors to reduce the number of cancer deaths in Georgia and to move Georgia to the top ranks of cancer care in the nation. The Georgia Society for Clinical Oncology (GASCO) partnered with the GCC and was awarded a grant from the American Society for Clinical Oncology (ASCO) to determine the interest in formulating a statewide multi-disciplinary organization for people who help cancer patients navigate the healthcare system. A survey was conducted and results from eighty navigators representing 25 cities demonstrated an organizational need. The Cancer Patient Navigators of Georgia (CPNG) was founded as a unique statewide organization of individuals who serve people with all types of cancer, at all stages, in all types of settings, with a diversity of education and training (from lay navigators to nurse navigators and social work navigators). CPNG's mission is to connect, educate and share best practices among patient navigators in Georgia, so that together we can successfully reduce barriers and increase access to services specifically related to cancer. The steering team developed a logo, by-laws, officers, working committees, electronic newsletters and a website, with a members-only section for social networking. Membership currently tops 230. A recent social networking survey had 100 respondents. We have conducted three annual meetings with attendance of each meeting exceeding 100. The GCC received a private gift of $250,000 to expand the patient navigation efforts in Georgia. One component of the gift is sponsoring the first Integrative Oncology conference to be held in Georgia on January 20, 2012 for the members of Cancer Patient Navigators of Georgia. In conclusion, the initial survey indicating an organizational need to create a statewide multi-disciplinary organization for people who help cancer patients navigate the healthcare system was the beginning of the Cancer Patient Navigators of Georgia (CPNG). Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr LB-37. doi:1538-7445.AM2012-LB-37

Le vécu de l’algoneurodystrophie ou syndrome douloureux régional complexe de type 1 par le chirurgien

The complex regional pain syndrome type 1 from the surgeon's point of view: description of the symptoms, imaging (nuclear medicine, MRI) and of the associated psychological context. Importance of the need for a multi-disciplinary organization from the diagnostic to the therapeutic care.

Synthetic Biology: Does Re-Writing Nature Require Re-Writing Regulation?

Technological advancements in the life sciences are continually pressing forward despite frequent and vocal resistance. Examples of such advancements include reproductive technologies, genetics, stem cell research, nanotechnology, and now synthetic biology. In May 2010, the J. Craig Venter Institute, a multidisciplinary scientific organization led by one of the first scientists to sequence the human genome, announced in the journal Science the creation of the first synthetic cell — a man-made, single-celled organism with the ability to self-replicate. While hailed as a monumental step forward for science, the response from opponents was swift: stop the science from going forward, keep the products off the market, and protect society from the inherent and unknown risks. Recognizing that there are measurable and important differences among advancements in the life sciences in terms of the touchstone risk-benefit dichotomy, this article will examine some promising synthetic biology developments in the medical realm in order to assess the application and performance of the Food and Drug Administration (FDA) regulatory framework. It concludes that the FDA is well equipped to assess and implement protections for products that fit into the traditional clinical trial, review and approval, and post-market regime. However, unlike other developments in the life sciences, synthetic biology poses potential environmental problems not previously contemplated by the limited life-cycle inquiry undertaken by the FDA, suggesting that it may be necessary to reassess the regulation of medical products using synthetic biology techniques.

Semantic Web based innovative design knowledge modeling for collaborative design

This paper describes a study about how to use the Semantic Web technologies for innovative design knowledge modeling in a multi-agent distributed design environment. Semantic Web based knowledge modeling for innovative design is proposed as prelude to the meaningful agent communication and knowledge reuse for collaborative work among multidisciplinary organizations. A model for innovative design is proposed at first, based on which a knowledge schema is brought forward. For sharing the design knowledge among an internet-based or distributed work team, even globally, A RDF-based knowledge model is presented to realize its representation on Semantic Web. A Semantic Web based repository for innovative design and its API for topper Semantic Web applications have been also constructed. The proposed knowledge modeling extends traditional product modeling with capabilities of innovative design, knowledge sharing and distributed problem solving, and is employed as a content language within the messages in the proposed multi-agent system architecture. The proposed approach is viewed as a promising knowledge management method that facilitates the implementation of computer supported cooperative work in innovative design of Semantic Web applications.

Symposium on the Societal Impact of Pain (SIP) 2011: European Commissioner John Dalli Calls for a Better Understanding of ‘Pain’ in Europe

Pain is a topic that affects every one of us - either directly or via a person close to us. Since the beginning of May, the issue of pain and its impact to society has become a new topic on the agenda of the EU institutions in Brussels. On the 3rd and 4th May 2011 a very unique symposium on the 'Societal Impact of Pain' (SIP 2011) took place in the European parliament, bringing together more than 300 European healthcare stakeholders from over 30 countries. This exciting meeting concluded with a call for action for all countries involved to actively participate in the new 'Road Map for Action' in pain. The symposium 'Societal Impact of Pain' was supported by all three European institutions, the EU parliament, the EU commission and the EU council. The European Federation of International Association for the Study of Pain (IASP(®)) Chapters (EFIC(®)) was responsible for the scientific framework of the meeting. EFIC is a multidisciplinary professional organization in the field of pain science and medicine, made up of the 35 European Chapters of National Pain Societies of IASP. Due to the urgency of this matter with pain affecting a significant number of the European population the scientific program of the symposium was endorsed by more than 85 national and international organizations and institutions that support pain care in Europe. Therefore, it provided a multistakeholder platform for healthcare professionals and specialists, as well as representatives of health authorities, pain advocacy groups, politicians, regulators and budget holders for discussion and to share examples of best practice in pain care. The pharmaceutical company Grünenthal GmbH was responsible for organization, logistics and support.

Information Management in UK-Based Architecture and Engineering Organizations: Drivers, Constraining Factors, and Barriers

The need to improve collaborative working, knowledge sharing, and operational effectiveness has made effective Information Management a growing priority for Architecture and Engineering (A & E) organizations in the UK construction industry. While significant research has been carried out in the construction industry on project Information Management, limited work has been carried out to understand Information Management from an organisational paradigm. This paper presents the findings of an investigation into the nature of Information Management within A & E organizations in the UK construction industry. Interviews were conducted with experts across nine large architectural and multidisciplinary consultancies, the outputs of which were analysed using thematic analysis. From this, 26 themes across three core categories classed as drivers, constraining factors, and barriers which shape Information Management practices in construction organizations emerged. The findings show that Information Management is indeed of strategic significance to organizations and an organizational dimension is necessary to better align information needs with an organisation’s operational processes. They also show that context-dependent factors exist which shape the nature of Information Management in line with the specific needs of each organizations. Therefore, the effectiveness of an organisation’s Information Management practices is not absolute, but rather relative to its level of alignment to the organisation’s chosen mode of operation. The findings provide a much needed practical view of the complexities of Information Management, highlighting that particularly within multidisciplinary organizations; a unifying approach is much more practical and appropriate than a single approach to managing information.

Many Stories, Many Voices: Alberta Aboriginal Arts

Many Stories, Many Voices:Alberta Aboriginal Arts Scott Sharplin (bio) Rubaboo [Roo'-bǝ-boo]: A Métis stew consisting of anything you can get your hands on. Click for larger view View full resolution Alberta Aboriginal Arts co-founders/co-directors Ryan Cunningham and Christine Sokaymoh Frederick welcome the audience to the second annual Rubaboo Arts Festival in June 2010. Photo by Frieda Gladue Click for larger view View full resolution Christine Sokaymoh Frederick emceeing the second Annual Rubaboo Arts festival in June 2010. Photo by Marc Chalifoux When describing the 2nd Annual Rubaboo Arts Festival, Christine Sokaymoh Frederick doesn't dwell on the broad range of Aboriginal theatre, music, and dance artists whose diverse contributions justify the event's name. Instead, her recollections focus on the audience. "It was downtown [Edmonton], and we had people coming in off the street," says Frederick. "To have Aboriginal people see something Aboriginal-themed on their own block was exciting." One particular woman came all four nights, and finally approached Frederick to ask, "What is this all about?" When Frederick began to explain Alberta Aboriginal Arts's role in organizing the festival, the patron interrupted: "What do you mean, you're an Aboriginal theatre company?" (qtd. in Frederick). When they founded Alberta Aboriginal Arts (AAA) in summer 2009, Frederick and co-founder Ryan Cunningham were seeking the answers to similar questions. What can an Aboriginal-themed theatre company contribute to the cultural landscape? What audience(s) does it serve? And—perhaps most importantly—is there even such a thing as Aboriginal theatre? In the same year that AAA was founded, Floyd Favel wrote, in the pages of Canadian Theatre Review, that "there exists no Indigenous Canadian theatre" (32)—a declaration that seems to contradict, or undermine, Drew Hayden Taylor's optimism a decade earlier, when he wrote, "Native theatre is strong, popular and practically everywhere in terms of the Canadian theatrical community" (61). As AAA attempts to reconcile this paradox of Aboriginal Canadian theatre—a hearty, complex stew of narratives and disciplines that somehow still remains invisible—it has supplied its own, unique definition: a community-focused, multi-disciplinary arts organization devoted to presenting a wide range of Aboriginal stories. The apparent scarcity of Native theatre is egregious in Alberta; the province has an Aboriginal population density of 6%, and its two largest cities (Edmonton and Calgary, [End Page 110] respectively) have the second and third highest Aboriginal populations of all Canadian cities ("Edmonton"; "Calgary"). Yet Ryan Cunningham recalls "growing up in theatre, going to theatre school, and working in theatre in Edmonton" without ever seeing an Aboriginal play produced. "It wasn't until I moved to Toronto that I was actually aware of Aboriginal theatre" (Cunningham). Click for larger view View full resolution Christine Sokaymoh Frederick and Donald Morin in a reading of Arvus in Excelsus by Gordon A. Fox for the second annual Rubaboo Arts Festival in June 2010. Photo by Marc Chalifoux And one province's scarcity may well reflect a broader dearth. Obtaining a clear impression of the Aboriginal Canadian theatrical landscape is difficult because, according to Frederick, many companies are "alive on paper, but there's no pulse" (Frederick). No companies with specifically Aboriginal mandates appear to be in operation in Quebec or Atlantic Canada, and between Ontario (e.g. Native Earth, Debajehmujig, Red Sky, Chocolate Woman Collective, and Turtle Gals Performance Ensemble) and Vancouver (e.g. Full Circle) there lies an unlikely cultural desert, punctuated only rarely by oases like Saskatchewan Native Theatre. Cunningham says he owes much of his artistic success to many of these companies, established in the 1980s and 1990s; but he feels that "no one in our generation seems to be stepping up" to maintain a nationwide network of Aboriginal companies (Cunningham). In fact, while Cunningham was working as an actor "out east" with companies like Native Earth, two Aboriginal theatre initiatives arose in Alberta. In Edmonton, Old Earth Theatre arose when a group of actors, having met in 2005 in Walterdale Playhouse's production of The Rez Sisters, resolved to keep working together on original projects (Heather). In Calgary, Crazy Horse Theatre produced professional plays and festivals in Calgary from 2000 to...

WE‐C‐220‐03: Lessons Learned: Creating a Dedicated Focused Ultrasound Surgery Program

MR‐guided focused ultrasound surgery (MRgFUS) is an emerging technology with the potential to disrupt traditional treatment techniques across a wide variety of surgical and medical disciplines. Proposed applications for MRgFUS are multiplying quickly and include indications as diverse as tumor ablation, thrombolysis, hemostasis, reversible blood‐brain barrier disruption, targeted drug delivery, gene therapy, and neuromodulation. Interest in MRgFUS is quickly increasing, however the desire to find new potential treatment indications may be outpacing work on developing “best practices” for designing new centers, organizing clinical teams, and defining standards for treatment quality and reporting. The University of Virginia recently started up one of the first programs in the world designed from the ground up specifically for the purpose of MR‐guided focused ultrasound surgery. The lessons learned during this process, both positive and negative, may be valuable to the ongoing discussion of best practices. This lecture will provide an overview of the UVA experience, including center design, construction, and administrative organization, and funding /revenue, and program startup. A particular focus will be on the clinical startup experience, and how this might be improved with a more formal risk‐based process analysis.Learning objectives:1. To understand the rationale for a stand‐alone FUS center versus a center created out of existing resources in the medical center.2. To understand the design features of the center, as well as the challenges that had to be overcome in the design and construction of the center.3. To understand the multidisciplinary organization of the center and how inter‐department conflicts are managed.4. To understand the expectations vs. reality of the center regarding the distribution of treatment indications, the effort required to start clinical trials, and the ability to collect clinical revenue.5. To understand the centerˈs experience during clinical startup, and the successes and challenges faced by the center when trying to refine clinical processes and develop standards for quality assurance.Funding Support, Disclosures, and Conflict of Interest: The Focused Ultrasound Center at the University of Virginia has received funding for development and research from the following: The Focused Ultrasound Surgery Foundation, the Commonwealth of Virginia, InSightec Ltd., and the General Electric Co.

Impact of IT Techniques on Human Resource Management in Technical Institutes of India

The impact of Information Technology (IT) techniques on Human Resource Management (HRM) in Technical Institutions of India has been studied by conducting case study of T1 singular-discipline and T2 multi-disciplinary organizations. The respondents comprise of 82 faculty members, 35 officers and 72 support staff of two technical institutes through well developed and standardized questionnaire. The outcomes of perceptions of human resources of two institutes were also compared with views of external sources such as society, parents and digital media. The opinion for infrastructure facilities related to administration, academics, living complexes and others were rated excellent for the two institutes. The academic related major aspects were found best places in the opinion of respondents for the two institutes. Financial matters such as pay-packages, supporting provisions are some of the aspects found satisfactory of the two institutes. The T2 has excelled in a few parameters whereas T1 has better place in most of the aspects as opined by respondents, society & media. This is a generic study and may be applied to most of the educational institutions of India in general and for technical educational institutions in particular with minor customization for individual organization.

Health Equity and Adolescent Health: A Call to Action for the Society for Adolescent Health and Medicine

Health Equity and Adolescent Health: A Call to Action for the Society for Adolescent Health and Medicine

Selection of a Method to Rate the Strength of Scientific Evidence for AORN Recommendations

The use of scientific evidence to support national recommendations about clinical decisions has become an expectation of multidisciplinary health care organizations. The objectives of this project were to identify the most applicable evidence-rating method for perioperative nursing practice, evaluate the reliability of this method for perioperative nursing recommendations, and identify barriers and facilitators to adoption of this method for AORN recommendations. A panel of perioperative nurse experts evaluated 46 evidence-rating systems for quality, quantity, and consistency. We rated the methods that fully covered all three domains on five aspects of applicability to perioperative nursing practice recommendations. The Oncology Nursing Society's method was rated highest for all five aspects of applicability, and interrater reliability of this method for perioperative recommendations was 100%. Potential barriers to implementation of the rating method include knowledge deficit, staff resources, resistance to change, and fear of showing that lower levels of evidence support some recommendations. Facilitators included education, resource allocation, and starting small. Barriers and facilitators will be considered by the implementation team that will develop a plan to achieve integration of evidence rating into AORN documents. The AORN Board of Directors approved adoption of this method in June 2010.