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Research within ISOC

Jörg Goldhahn, MD, MAS

On behalf of the outcome working group

3rd ISOC Meeting in Bologna

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Outline

Challenges

Analysis of

member clinics

ISOC Facts

Possible

approaches

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International Society of Orthopaedic Centers (ISOC)

Mission• Facilitate exchange of ideas and best

practices among premier specialty orthopaedic institutions

• Collaborate on patient care, education and research-based programs

• Advance improvements in orthopaedic care on a global scale

Global Orthopaedic Think Tank

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Need for collaboration

Kolling C, Herren DB, Simmen BR, Goldhahn J. Changes in surgical intervention patterns in rheumatoid arthritis over 10 years in one centre. Ann Rheum Dis. 2009 Aug;68(8):1372-3

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Challenges

• More competition for funding

• Large numbers in clinical trials

• Interdisciplinary problems require multiple and different ressources

• Need for harmonization of measures, e.g. in outcome research

• Conflicts of interests with industry

• New research areas, e.g. socioeconomic investigations

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Challenges

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Analysis of member clinics

• To explore the research potential

• To find common research topics

• To identify potential for collaboration, synergies and added value

• To learn more about research organization

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Methods

• Visits

• Survey

• websites

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Findings

• Research in collaboration with teams of professionals of varying size

• Different percentage of third-party funding

• Similar main topics but different technologies and core competencies

• Organization of research differs• Independent research team, e.g. HSS• Embedded in core research facilities, e.g, Mayo• Affilliated with clinic, e.g. Schulthess

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ISOC facts

No. scientists No. articlesFunding(Million $)

Summe 387 1524 38.44

Mean 35 139 5.49

Range 1-156 4-300 0,1-21,8

Median 16 70.5 1.5 Mill. USD

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Role of academic partnersexample

• Access to extensive research platform

• Linked to further partners

• Enable academic environment

• Offer further possibilities for funding

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Common findings

• Discussions about the value of research in the clinical environmente.g. Endoklinik and Schulthess Klinik

• Restructuring programs in several centers e.g. Joint Academic Plan of RNOH

• Ideas to focus research, e.g. at Instituto Nacional De Rehabilitacion, Mexico

• Interdisciplinary collaborations, e.g. with rheumatology or engineering

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Questions for collaboration

• What are current trends in surgical practice?

• How do different centers tackle hygenic challenges?

• How do different rehabilitation protocols affect outcome?

• How do socio-economic boundary conditions, e.g. health care system, influence decision-making, clinical pathways and subsequent outcome after orthopaedic interventions, e.g. influence of DRG’s on length of stay?

• Are their significant differences in treatment strategies based on region-specific training programs or thought schools, e.g. perioperative use of DMARD’s?

• How do implants perform in different entities of patients all over the world, e.g. Caucasian vs. Asian?

• How does cultural background influence patient and surgeon expectations for orthopaedic interventions?

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Use of the network

• Multicenter studies• Common indications with large numbers• Rare indications with reasonable numbers

• Synchronized prospective data collection

• Technological synergies

• Knowledge exchange

• Joint applications, e.g. to NIH or EU

• Surveys, e.g. about surgical practice

• Position statements

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Next steps

Databases

• Identification of prospective data collections at different sites

• Indications including inclusion and exclusion criteria, Core data sets, Intervals and follow-up schemes, Technological basis

• Establishing of a steering committee that ensures

• Data quality at each participating site, legal aspects, scientific quality

• Implementation of a harmonization process

• Regarding data quality, e.g. according to FDA requirements, protocols

• Start of pilot projects within a core group of ISOC

Clinical studies• Identification of sites with

common interest and infrastructure

• E.g. Orthopaedics and Rheumatology

• Development of a joint study protocol

• Applicable to all sites

• Application for external funding• WHO, EU, NIH

• IRB approval at each site

• Establishement of joint infrastructure

• Internet-based, skype conferences etc.

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Next stepsIdentification of relevant questionDiscussion of appropriate methodologyIdentification of necessary technology/ressourcesFormation of an ad-hoc working group

Identification legal aspects Need for harmonization Establishing communication Research proposal

Approval from the ISOC boardJoint application for fundingReport at the next ISOC meeting (hopefully)

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Thank you