Abstract Background Cancer care is undergoing an important paradigm shift from a disease-focused management to a patient-centred approach, in which increasingly more attention is paid to psychosocial aspects, quality of life, patients’ rights and empowerment and survivorship. In this context, multidisciplinary teams emerge as a practical necessity for optimal coordination among health professionals and clear communication with patients. The European Partnership for Action Against Cancer (EPAAC), an initiative launched by the European Commission in 2009, addressed the multidisciplinary care from a policy perspective in order to define the core elements that all tumour-based multidisciplinary teams (MDTs) should include. To that effect, a working group conference was held in January 2013 within the EPAAC Work Package 7 (on Healthcare) framework. Methods The consensus group consisted of high-level representatives from the following European scientific societies, patient associations and stakeholders: European CanCer Organisation (ECCO), European SocieTy for Radiology & Oncology (ESTRO), European Society for Medical Oncology (ESMO), European Society of Surgical Oncology (ESSO), International Society of Geriatric Oncology (SIOG), European Association for Palliative Care (EAPC), European Oncology Nursing Society (EONS), International Psycho-Oncology Society (IPOS),European Cancer Patient Coalition (ECPC), EuropaColon, Europa Donna - The European Breast Cancer Coalition, Association of European Cancer Leagues (ECL), Organisation of European Cancer Institutes (OECI), EUSOMA - European Society of Breast Cancer Specialists, European Hospital and Healthcare Federation (HOPE) and EPAAC Work Packages 5 (Health promotion and prevention), 7, 8 (Research), 9 (Information systems) and 10 (Cancer plans). A background document with a list of 26 core issues drawn from a systematic review of the literature was used to guide the discussion. Five areas related to MDTs were covered: care objectives, organisation, clinical assessment, patients’ rights and empowerment and policy support. Preliminary drafts of the document were widely circulated for consultation and amendments by the working group before final approval. Results The working group unanimously formulated a Policy Statement on Multidisciplinary Cancer Care to define the core elements that should be implemented by all tumour-based MDTs. This document identifies MDTs as the core component in cancer care organisation and sets down the key elements to guide changes across all European health systems. Conclusion MDTs are an essential instrument of effective cancer care policy, and their continued development crucial to providing patients the care they need and deserve. While implementation must remain in local hands, European health systems can still benefit from having a basis for an effective multidisciplinary model of cooperation. This policy statement is intended to serve as a reference for policymakers and healthcare providers who wish to improve the services currently provided to the cancer patients whose lives and well-being depend on their action.
Multidisciplinary design optimization is a field of research that studies the application of numerical optimization techniques to the design of engineering systems involving multiple disciplines or components. Since the inception of multidisciplinary design optimization, various methods (architectures) have been developed and applied to solve multidisciplinary design-optimization problems. This paper provides a survey of all the architectures that have been presented in the literature so far. All architectures are explained in detail using a unified description that includes optimization problem statements, diagrams, and detailed algorithms. The diagrams show both data and process flow through the multidisciplinary system and computational elements, which facilitate the understanding of the various architectures, and how they relate to each other. A classification of the multidisciplinary design-optimization architectures based on their problem formulations and decomposition strategies is also provided, and the benefits and drawbacks of the architectures are discussed from both theoretical and experimental perspectives. For each architecture, several applications to the solution of engineering-design problems are cited. The result is a comprehensive but straightforward introduction to multidisciplinary design optimization for nonspecialists and a reference detailing all current multidisciplinary design-optimization architectures for specialists.
The major goal for prostate cancer imaging in the next decade is more accurate disease characterization through the synthesis of anatomic, functional, and molecular imaging information. No consensus exists regarding the use of imaging for evaluating primary prostate cancers. Ultrasonography is mainly used for biopsy guidance and brachytherapy seed placement. Endorectal magnetic resonance ( MR) imaging is helpful for evaluating local tumor extent, and MR spectroscopic imaging can improve this evaluation while providing information about tumor aggressiveness. MR imaging with superparamagnetic nanoparticles has high sensitivity and specificity in depicting lymph node metastases, but guidelines have not yet been developed for its use, which remains restricted to the research setting. Computed tomography (CT) is reserved for the evaluation of advanced disease. The use of combined positron emission tomography/ CT is limited in the assessment of primary disease but is gaining acceptance in prostate cancer treatment follow-up. Evidence-based guidelines for the use of imaging in assessing the risk of distant spread of prostate cancer are available. Radionuclide bone scanning and CT supplement clinical and biochemical evaluation (prostate-specific antigen [PSA], prostatic acid phosphate) for suspected metastasis to bones and lymph nodes. Guidelines for the use of bone scanning (in patients with PSA level > 10 ng/mL) and CT (in patients with PSA level > 20 ng/mL) have been published and are in clinical use. Nevertheless, changes in practice patterns have been slow. This review presents a multidisciplinary perspective on the optimal role of modern imaging in prostate cancer detection, staging, treatment planning, and follow-up.
Purpose - This paper aims to undertake a content analysis of extant definitions of "innovation" as a basis for proposing an integrative definition of organizational "innovation".Design methodology approach - A literature review was used to generate a representative pool of definitions of organizational innovation, including definitions from the different disciplinary literatures of economics, innovation and entrepreneurship, business and management, and technology, science and engineering. A content analysis of these definitions was conducted in order to surface the key attributes mentioned in the definitions, and to profile the descriptors used in relation to each attribute.Findings - The key attributes in the paper present in definitions were identified as: nature of innovation; type of innovation; stages of innovation, social context; means of innovation; and aim of innovation. These attributes are defined, descriptors assigned to them, and both a diagrammatic definition and a textual definition of organizational innovation are proposed.Originality value - As a concept that is owned and discussed by many business disciplines, "innovation" has many different definitions that align with the dominant paradigm of the respective disciplines. Building on these diverse definitions, this paper proposes a general and integrative definition of organizational "innovation" that encompasses the different perspectives on, and aspects of, innovation, and captures its essence.
The concept—and reality—of continuity of care crosses disciplinary and organisational boundaries. The common definitions provided here should help healthcare providers evaluate continuity more rigorously and improve communication
In response to healthcare reform, a necessary evolution of radiology has shifted from generating volume to demonstrating value. Multidisciplinary tumor boards provide a critical opportunity for radiologists to demonstrate their value to their clinical colleagues, their patients, administrations, and society.