Prevention, diagnosis, therapy and follow-up care of sepsis: 1st revision of S-2k guidelines of the German Sepsis Society (Deutsche Sepsis-Gesellschaft e.V. (DSG)) and the German Interdisciplinary Association of Intensive Care and Emergency Medicine (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI))

Practice guidelines are systematically developed statements and recommendations that assist the physicians and patients in making decisions about appropriate health care measures for specific clinical circumstances taking into account specific national health care structures. The 1(st) revision of the S-2k guideline of the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information (results of controlled clinical trials and expert knowledge) on the effective and appropriate medical care (prevention, diagnosis, therapy and follow-up care) of critically ill patients with severe sepsis or septic shock. The guideline had been developed according to the "German Instrument for Methodological Guideline Appraisal" of the Association of the Scientific Medical Societies (AWMF). In view of the inevitable advancements in scientific knowledge and technical expertise, revisions, updates and amendments must be periodically initiated. The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources.

Role of intra- and peritumoral budding in the interdisciplinary management of rectal cancer patients

The presence of tumor budding (TuB) at the invasive front of rectal cancers is a valuable indicator of tumor aggressiveness. Tumor buds, typically identified as single cells or small tumor cell clusters detached from the main tumor body, are characterized by loss of cell adhesion, increased migratory, and invasion potential and have been referred to as malignant stem cells. The adverse clinical outcome of patients with a high-grade TuB phenotype has consistently been demonstrated. TuB is a category IIB prognostic factor; it has yet to be investigated in the prospective setting. The value of TuB in oncological and pathological practice goes beyond its use as a simple histomorphological marker of tumor aggressiveness. In this paper, we outline three situations in which the assessment of TuB may have direct implications on treatment within the multidisciplinary management of patients with rectal cancer: (a) patients with TNM stage II (i.e., T3/T4, N0) disease potentially benefitting from adjuvant therapy, (b) patients with early submucosally invasive (T1, sm1-sm3) carcinomas at a high risk of nodal positivity and (c) the role of intratumoral budding assessed in preoperative biopsies as a marker for lymph node and distant metastasis thus potentially aiding the identification of patients suitable for neoadjuvant therapy.

Nursing Homes as a Setting for Psychological Practice: Public Policy Perspectives.

Recent federal legislation has provided renewed interest in improving the quality of nursing home care. The lack of both funding and personnel are significant barriers that may keep psychology's disciplinary expertise from being fully used in nursing homes. Nursing homes may be forced to undertake mandated activities (e.g., preadmission screening, nurses aides' training, and evaluation) without psychologists' expertise, relying either on medical practitioners with little knowledge of mental health interventions or on minimally qualified, entry-level mental health workers. Advocates for improved nursing home care must see the links among basic disciplinary skills, interdisciplinary collaboration, and improved care for mentally impaired elderly individuals.

Developing Dramatic Movies to Teach Interdisciplinary Collaboration to Allied Health, Medical and Nursing Students

Many times a Hollywood movie has scenes that are useful to illustrate aspects of health care practice. However, it is often impractical to use an entire two-hour movie in class, and a clip or two really does not convey the dramatic picture that the complete movie reveals. [See PDF for complete abstract]

From Theory to Practice: Improving the Impact of Health Services Research.

BACKGROUND: While significant strides have been made in health research, the incorporation of research evidence into healthcare decision-making has been marginal. The purpose of this paper is to provide an overview of how the utility of health services research can be improved through the use of theory. Integrating theory into health services research can improve research methodology and encourage stronger collaboration with decision-makers. DISCUSSION: Recognizing the importance of theory calls for new expectations in the practice of health services research. These include: the formation of interdisciplinary research teams; broadening the training for those who will practice health services research; and supportive organizational conditions that promote collaboration between researchers and decision makers. Further, funding bodies can provide a significant role in guiding and supporting the use of theory in the practice of health services research. SUMMARY: Institutions and researchers should incorporate the use of theory if health services research is to fulfill its potential for improving the delivery of health care.

Abortion and Clinical Practice. Abortion Review Papers from the bpas conference: London, 25 - 26 June 2008

The groundbreaking bpas conference The Future of Abortion: Controversies and Care brought together clinicians, academics, policymakers and advocates from the UK, Europe and the USA for a discussion about all aspects of abortion provision. Taking place during a critical Parliamentary debate about the UK abortion law, the conference generated great excitement and presented a number of important research findings and policy suggestions.In order to maximise the strides made by The Future of Abortion conference in taking forward an international, interdisciplinary discussion, Abortion Review is producing a series of special editions in which we have published edited transcripts of the presentations. In this third edition, Abortion and Clinical Practice, the presentations examine developments in abortion research and practice, and what these might indicate for the kind of abortion service that should be provided.

The challenge of interdisciplinary collaboration in addressing the social determinants

The importance of professional disciplines working together to address the critical social and health issues facing society today cannot be overstated. Policy makers, service providers and researchers have long been calling for greater interdisciplinary collaboration. Despite this there has been little systemic analysis of the constraints involved in such collaboration. Far too often disciplines continue to work in silos. This paper aims to analyse the barriers to interdisciplinary collaboration through a case study of the relationship between social work and public health. These two disciplines have a lot more in common than might first appear. There is real potential for social work and public health to work together and enhance each other's efforts to address their common goal of greater social equality. However, this will require a genuine commitment from both disciplines to develop a shared political analysis, common language and a framework for action, which utilises their respective strengths.

Technologizing inhumanity: A discursive practice

A political interview intended to justify refugee detention in Australia is analysed using an interdisciplinary critical discourse method. Barthesian semiotic theory in which the 'Other' is the foundation of national myth provides a context for a close textual analysis using Hallidayan linguistics. The lexico-grammatical analysis identifies features associated with processes (verbs), grammatical metaphors, and nominals. Essentially, the effect is to blunt agency and distance the speaker, but, more importantly, create a classificatory system that allows humans to be treated in certain ways according to bureaucratic procedures. The discursive strategy is labelled technologizing the inhumane because it objectifies the subjective, turning profound human issues into technical issues. Analysed discursively, the interview reveals how discursive control is established and how democracy is represented as impeding the orderly procedure of 'objective' procedures.

Developing interdisciplinary research graduates: educational opportunities and dilemmas

Attempting to solve the complex problems of the 21st century requires research graduates that have developed a sophisticated array of interdisciplinary teamwork and communication skills. Although universities, governments, industry and the professions have emphasised the need to break down disciplinary silos in order to produce graduates, who can respond more effectively to the needs of the knowledge economy, much of this work has centred on undergraduate programs. While there are some research higher degree students who choose to work on interdisciplinary research topics, very little has been done to develop interdisciplinary research education systematically. This paper explores the educational opportunities and dilemmas involved in developing systematic programs of interdisciplinary research activities in two research centres at the University of Queensland. Framed by Bruhn's (2000, p. 58) theoretical discourse about interdisciplinary research as 'a philosophy, an art form, an artifact, and an antidote', this paper emphasises the need for such programs to embed the development of students' interdisciplinary research skills and attitudes within their research projects. The two diverse programs also emphasise experiential, active and interactive learning techniques and are centred upon the development of students' reflective practice skills.

From words to action:visibility of management in supporting interdisciplinary team working in an acute rehabilitative geriatric hospital

Purpose: The following case study aims to explore management's, health professionals' and patients' experiences on the extent to which there is visibility of management support in achieving effective interdisciplinary team working, which is explicitly declared in the mission statement of a 60-bed acute rehabilitative geriatric hospital in Malta. Design/methodology/approach: A total of 21 semi-structured interviews were conducted with the above-mentioned key stakeholders. Findings: Three main distinct yet interdependent themes emerged as a result of thematic analysis: "managing a team-friendly hospital", "interdisciplinary team components", and "interdisciplinary team processes". The findings show that visibility of management support and its alignment with the process and content levels of interdisciplinary teamwork are key to integrated care for acute rehabilitative geriatric patients. Research limitations/implications: The emerging phenomena may not be reproducible in a different context; although many of the emerging themes could be comfortably matched with the existing literature. Practical implications: The implications are geared towards raising the consciousness and conscientiousness of good practice in interdisciplinary teamwork in hospitals, as well as in emphasizing organizational and management support as crucial factors for team-based organizations. Social implications: Interdisciplinary teamwork in acute rehabilitative geriatrics provides optimal quality and integrated health care delivery with the aim that the older persons are successfully discharged back to the community. Originality/value: The authors draw on solid theoretical frameworks - the complexity theory, team effectiveness model and the social identity theory - to support their major finding, namely the alignment of organizational and management support with intra-team factors at the process and content level. © Emerald Group Publishing Limited.

I Stood Up: Social Design in Practice

Through practice-based research, we explore how interdisciplinary design projects can function to address social issues concerning environmental and social problems. Using two case studies developed between London in the United Kingdom, and Delhi and Ahmedabad in India, we discuss the importance of engagement with the people who the design ultimately serves. Finally, we argue that design concerned with complex social problems require equally complex, multidimensional responses, informed by bodies of knowledge, practices and approaches that lie outside of traditional design approaches.

Sports coaching and the law of negligence: implications for coaching practice

The ordinary principles of the law of negligence are applicable in the context of sport, including claims brought against volunteer and professional coaches. Adopting the perspective of the coach, this article intends to raise awareness of the emerging intersection between the law of negligence and sports coaching, by utilising an interdisciplinary analysis designed to better safeguard and reassure coaches mindful of legal liability. Detailed scrutiny of two cases concerning alleged negligent coaching, with complementary discussion of some of the ethical dilemmas facing modern coaches, reinforces the legal duty and obligation of all coaches to adopt objectively reasonable and justifiable coaching practices when interacting with athletes. Problematically, since research suggests that some coaching practice may be underpinned by “entrenched legitimacy” and “uncritical inertia”, it is argued that coach education and training should place a greater emphasis on developing a coach’s awareness and understanding of the evolving legal context in which they discharge the duty of care incumbent upon them.