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Results for “multidisciplinary”

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PubMed2005

Prognostic factors in multidisciplinary rehabilitation treatment in multiple sclerosis: an outcome study.

The aim of this outcome study was to evaluate the effectiveness and prognostic factors of inpatient multidisciplinary rehabilitation treatment in patients with multiple sclerosis (MS). We analysed 230 consecutive inpatients with MS admitted to an MS rehabilitation ward who followed an individualized, goal-oriented, multidisciplinary rehabilitation program. Every patient was submitted to a neurological examination and evaluated by means of Kurtzke's Expanded Disability Status Scale (EDSS), with its functional systems (FS), Barthel Index (BI) and the Rivermead Mobility Index (RMI). We observed an effectiveness (percentage of potential improvement achieved during rehabilitation) of nearly 16% on BI and 8% on RMI, corresponding to an improvement in 124 patients (54%) on BI and 113 patients (49%) on RMI. Basal EDSS (beta = -0.32, P <0.001), cognitive status (beta = -0.15, P <0.05) and disease duration (beta = -0.13, P <0.05) were negatively associated with effectiveness of treatment on BI (adjusted R2 = 0.176), whereas effectiveness on RMI was correlated only with the EDSS score (beta = -0.34, P <0.001, adjusted R2 = 0.113). In the logistic regression analysis, the absence of severe sphincteric disturbances was correlated with the probability of improvement on BI that was nearly twice as high (OR =2.25, 95% CI 1.24-4.08) as that of other patients. Moreover, patients without severe cognitive deficits showed a similar probability (OR =2.37, 95% CI 1.05-5.33) of improvement on RMI. The results of this study provide further evidence that intensive multidisciplinary rehabilitation in MS is effective in the majority of MS patients and that early treatment may favour functional recovery.

Activities of Daily Living↗

PubMed2006

The efficacy of multidisciplinary rehabilitation in stable multiple sclerosis patients.

OBJECTIVE: To evaluate the short-term efficacy of multidisciplinary, inpatient rehabilitation of multiple sclerosis (MS) patients. METHODS: A double-blind, randomized, parallel group design was used. The intervention group were offered comprehensive, multidisciplinary inpatient rehabilitation at the Haslev MS Hospital for an average of 35.5 days, while the control group received no treatment related to the study. All patients were examined in their homes twice with a 10-week interval. The rehabilitation of the intervention group started 2-3 weeks after the first examination and ended 2-3 weeks before the second examination. Impairment was assessed by the Multiple Sclerosis Impairment Scale and the Expanded Disability Status Scale. Disability was assessed by means of Guy's Neurological Disability Scale. Two specific scales were used to assess upper limb function and ambulation: The Nine-Hole Peg Test and timed 10-metre walking. Patients' own perception of bodily pain, bladder symptoms, spasticity, fatigue, impaired walking and transfers were recorded using visual analogue scales. Finally, quality of life was assessed using the Life Appreciation and Satisfaction Questionnaire and the Functional Assessment in Multiple Sclerosis. PATIENTS: Two hundred and thirty-three patients were screened and of those 38 were included for treatment and 52 as controls. RESULTS: We found no statistically significant differences between the two groups in any of the outcome measures. CONCLUSION: Although the study was underpowered, the negative outcome exposes the difficulties in quantitative analyses of the efficacy of multidisciplinary rehabilitation, which is liable to confounding factors such as variation in the indication for treatment, in the placebo effect, and in the reliability and responsiveness of the outcome measures.

Adult↗

PubMed1995

Outcome findings from a multidisciplinary clinic for children with epilepsy.

Children with chronic or intractable epilepsy are at higher risk for medical and social difficulties. A multidisciplinary clinic was established to improve medical management and address psychosocial issues. The purposes of the present study were to describe the multidisciplinary clinic, retrospectively examine the referral patterns for children served by the clinic, and analyze factors significantly predictive of parental satisfaction with the multidisciplinary approach. The Epilepsy Clinic Satisfaction Questionnaire was sent to all patients seen in the clinic over a 2-year period. Outcome findings were based on 136 respondents. A stepwise regression analysis indicated that the best predictor of parental rating of clinic quality was the amount of information given concerning the diagnosis and treatment of epilepsy. Staff attitude was also significantly related to parental satisfaction.

Adolescent↗

PubMed2004

Benefits of multidisciplinary case conferencing using audiovisual compared with telephone communication: a randomized controlled trial.

Multidisciplinary case conferencing using a video-link was compared with multidisciplinary case conferencing by telephone. One hundred patients were randomized to either videoconferencing (intervention group, 50 patients) or audioconferencing (control group, 50 patients). The effectiveness of the intervention compared with the control was evaluated in terms of: the number of conferences per patient, average length of conference, length of treatment, number of occasions of service, degree of multidisciplinary team involvement, recorded level of communication, quality of the management plan (in terms of the number of points contained in it) and staff satisfaction. The intervention and control groups showed significant differences on only two of the outcome measures: the mean number of case conferences per patient was less for the intervention group, and the intervention group had a shorter length of treatment (6 days) than the control group (10 days). The study did not demonstrate any significant differences in occasions of service or time commitment, which might have resulted in lower costs. However, the introduction of case conferencing by video-link was accompanied by a high level of satisfaction on the part of the 14 team members who were interviewed.

Attitude of Health Personnel↗

PubMedDate not supplied

Contribution of multidisciplinary team to pain management.

A fundamental part of satisfactory acute pain management is the regular and objective assessment of the patient's pain. The responsibility for this ongoing assessment is generally incorporated into the nursing role. Given the multidisciplinary nature of modern health care it is contended that this assessment is not the sole obligation of nursing or medical staff and that any healthcare professional who is offering treatment of therapy to patients should incorporate pain assessment into their treatment plan. This article outlines a small research study that assesses the contribution that the multidisciplinary team (MDT) makes towards pain management and pain assessment in particular. It highlights the importance of pain assessment and the fact that management is a multidisciplinary issue.

Attitude of Health Personnel↗

PubMed2005

Evaluation of the quality of venous leg ulcer care given in a multidisciplinary specialist centre.

OBJECTIVE: To determine the quality of venous leg ulcer care given in a multidisciplinary, specialist wound-healing centre and to identify problem areas that might affect it. METHOD: The case records of 90 consecutive patients with venous leg ulcers, diagnosed and treated at the Copenhagen Wound Healing Centre, Denmark, were retrospectively audited by a Scandinavian cross-sectional and multidisciplinary expert panel. Quality of care was audited in each case using implicit criteria. The experts then formulated key recommendations for good clinical practice for patients with venous leg ulcers. RESULTS: Quality of care was satisfactory in 74 patients (82%). The one-year healing rate was 77% (69/90), with a three-month recurrence rate of 12% (11/90). Identified problem areas included the lack of systematic assessment of patients' suitability for surgery; lack of systematic, duplex-verified diagnoses of venous aetiology; and the lack of systematic examination of distal arterial pressure. The recommendations include the need for venous diagnosis, differential diagnosis, compression therapy, surgery, systemic treatment, access to venous leg ulcer care and better communication. CONCLUSION: The quality of venous leg ulcer care given in this multidisciplinary centre was satisfactory.

Adult↗

PubMed2000

Clinical mental health training within a multidisciplinary school-based health clinic.

A model is presented to illustrate a clinical mental health training program within a multidisciplinary School-Based Health Clinic (SBHC). In collaboration with schools of education, medicine, nursing, and social work, a multidisciplinary training and treatment program was established that provided unique opportunities for clinical training. An ecological/public health model was utilized as the conceptual framework for clinical mental health training, treatment, and research. Preliminary clinical outcome data suggest that out of a sample of 381 patients, 15% of those utilizing the SBHC's mental health services were being treated for substance abuse disorders. This finding supports current research that has demonstrated that the SBHCs are providing access to students who are in the most serious need to mental health services. Process data suggest that the SBHC is an effective site for multidisciplinary clinical mental health training.

Adolescent↗

PubMed2000

Bariatric surgery: early results with a multidisciplinary team.

BACKGROUND: Bariatric surgery depends on complete preoperative study of morbid obesity, in order to obtain the treatment of choice. A multidisciplinary group was founded in 1998 at the University of Siena. METHODS: During 1998, 16 patients, with median weight 121.8 +/- 31 kg and median body mass index (BMI) 43 +/- 6, underwent bariatric surgery. A multidisciplinary assessment was used in order to evaluate psychological status, food intake problems and patient compliance, and hemodynamic, respiratory, metabolic and arthritic functions. 13 patients were submitted to laparoscopic surgery: in 11 adjustable gastric banding was performed and 2 were submitted to a vertical gastroplasty plus adjustable gastric banding. Three patients were operated via traditional laparotomy, due to previous abdominal surgery in 2 cases (submitted to an adjustable gastric banding) and one woman was submitted to a bilio-intestinal bypass according to the Hallberg technique, for her psychiatric troubles and coexisting systolic hypertension and uncontrolled diabetes. Monthly follow-up for each patient continues after 6 months. RESULTS: No morbidity or mortality has occurred. The median weight loss at three months, was 19.5 kg. Two cases required injection of 1 ml more of fluid into the port, respectively at 4 and 9 months. Fifteen days after surgery, seven patients (46%) had vomiting episodes, due to rapid food intake. All patients have shown an improvement of their comorbidities after surgery. CONCLUSION: Early results via the multidisciplinary team and laparoscopic banding have been satisfactory thus far.

Adult↗

PubMed2004

Parental obesity and higher pre-intervention BMI reduce the likelihood of a multidisciplinary childhood obesity program to succeed--a clinical observation.

OBJECTIVE: To assess the effects and identify factors associated with success of a combined, structured multidisciplinary weight management program in obese children and adolescents. METHODS: Seventy-seven obese children (age 6-16 years) participated in a 12-month combined dietary-behavioral-exercise intervention. Thirty-seven (age and maturity comparable) obese children who did not participate in the structured program served as controls. Body weight, BMI, and BMI percentiles were measured at baseline, after 6 months, and at the end of the intervention. RESULTS: The combined intervention was associated with a significant decrease in BMI (from 25.9+/-0.4 to 24.5+/-0.4 kg/m2, p <0.0005) and BMI percentile (from 97.3+/-0.2% to 92.6+/-0.9%, p <0.0005). In contrast, obese children who did not participate in the structured program gained weight (from 51.4+/-3.6 to 57.7+/-3.7 kg, p <0.0005), increased their BMI (from 25.2+/-1.0 to 26.6+/-0.9 kg/m2, p <0.0005), and had a non-significant increase in BMI percentiles (from 94.9+/-0.8% to 95.4+/-0.9%, NS). Children with higher BMI percentiles and parental overweight tended to respond less favorably to the combined multidisciplinary program (p <0.01). CONCLUSIONS: A prolonged (12 mo), combined, structured multidisciplinary intervention for childhood obesity resulted in a significant decrease in BMI and BMI percentiles. Higher pre-intervention BMI percentiles and parental obesity were associated with less favorable responses to the combined intervention.

Adolescent↗

PubMed1997

Preoperative multidisciplinary treatment with hyperthermia for soft tissue sarcoma.

We report the results of phase I/II studies of preoperative multidisciplinary treatment of 14 patients with soft tissue sarcoma using hyperthermia from November 1990 to April 1995. The preoperative treatment was conducted with thermo-radio-chemotherapy in 11 cases of stage III, and with thermo-radiotherapy as well as thermo-chemotherapy in three cases of stages I and II. Hyperthermia was carried out twice a week with totals ranging from 4 to 14 times (average: 8.4 times); each session lasted 60 min. Radiotherapy was administered four or five times per week, and the dose was 1.8 2Gy/fraction, with a total of 30-40 Gy in a four week period. Chemotherapy was mainly in the form of MAID regimen (2-mercaptoethanesulphonic acid (mesna), adriamycin, ifosfamide and dacarbazine). The tumors were surgically resected in all patients after completing the preoperative treatment. The efficacy rate, as expressed by the percentage of either tumors in which reduction rate was 50% or more, or tumors for which post-treatment contrast enhanced CT image revealed low density volumes occupying 50% or more of the total mass, was 71% (ten of the 14 tumors). The mean tumor necrosis rate in the resected specimens was 78%. The tumor necrosis rate was significantly high (P < 0.05) in patients whose Time > or = 42 degrees C was of long duration. Postoperative complications were observed in six patients; among these, two patients developed wound infection that required surgical treatment as a complication of surgery performed in the early stage following the preoperative treatment. After a mean postoperative follow-up of 27 months, distant metastasis occurred in four patients resulting in three fatalities. The three-year cumulative survival rate was 64.3%. No local recurrence was observed in any patient during the follow-up, thus confirming our hypothesis that preoperative multidisciplinary treatment has an excellent local efficacy. We think that it would be valuable to conduct, at many facilities, phase III studies on the treatment of soft tissue sarcoma by a combination of surgery and preoperative multidisciplinary treatment using hyperthermia, paying close attention to the interval between these two modalities.

Adult↗

PubMed1999

Benefits of a multidisciplinary approach in the management of recurrent diabetic foot ulceration in Lithuania: a prospective study.

OBJECTIVE: To assess the ability of a multidisciplinary approach to diabetic foot care to reduce the incidence of recurrent ulceration and amputations compared with standard care in a 2-year prospective study. RESEARCH DESIGN AND METHODS: A total of 145 patients with a past history of neuropathic foot ulcers but no evidence of peripheral vascular disease entered the study. Subjects were screened for their neuropathic and vascular status at baseline, and all received identical foot care education. The intervention group (n = 56) was followed by the multidisciplinary team of physicians, nurses, and podiatrists with regular podiatry and reeducation every 3 months and the provision of specialty footwear as required. The standard treatment group was followed in local clinics on a trimonthly basis and received identical screening and education at baseline. RESULTS: There were no significant differences at baseline in age (intervention 59.2+/-13.4, standard treatment 58.5+/-11.5 years), duration of diabetes (14.0+/-7.1 vs. 15.6+/-7.8 years), or neuropathic status (vibration perception threshold [VPT]: 31.1+/-12.1 vs. 33.9+/-11.3 V, neuropathy disability score [NDS]: 8.1+/-1.4 vs. 7.9+/-1.7). All patients had an ankle brachial pressure index (ABPI) of >0.9 and at least one palpable foot pulse. Significantly fewer recurrent ulcers were seen in the intervention group than in the standard treatment group during the 2-year period (30.4 vs. 58.4%, P < 0.001). CONCLUSIONS: This prospective study has demonstrated the effectiveness of a multidisciplinary approach to diabetic foot care together with the provision of specialty footwear in the long-term management of high-risk patients with a history of neuropathic foot ulcers.

Diabetic Foot↗

PubMed1995

Leg ulcers: report on a multidisciplinary approach.

In a Swedish survey, leg ulcer disease has been found to have a prevalence of around 1%. The multifactorial etiology requires a multidisciplinary approach. Forty-three patients with leg ulcers have been examined clinically and by pathophysiological and roentgenological investigations. Proper conservative treatment was instituted in 25 of the patients, and the remaining were treated by venous surgery, arterial surgery and skin transplantation. The previously used therapy only achieved healing in 23% of these patients, but after multidisciplinary assessment and treatment the healing rate was improved to 83%. The ulcer-free period of the whole group was 62% during a follow-up of 24 (3-36) months. The healing of venous ulcers can be improved by a multidisciplinary assessment by a vascular surgeon and a dermatologist.

Adult↗

PubMed2005

Liver resection in metastatic colorectal cancer: a multidisciplinary approach.

AIM: To analyze qualitative short-time results of a new program for multidisciplinary liver evaluation in complex cases of liver metastasis from colorectal cancer. PATIENTS AND METHODS: 40 clinical consecutive evaluations with liver metastasis assessed for major liver resection by a multidisciplinary specialist committee. Complementary explorations performed included CT and ultrasounds, and MRI or PET for doubtful cases. Liver resection was made in a single operation or two-stage hepatectomy, or combined with other techniques. RESULTS: Postoperative mortality at 30 days was 4%. Complications occurred in 28%, with surgical wound infection being most frequent (20%); 16.6% of resections were transfused, with a mean volume of 1000 ml. Two patients needed reoperation -one for an intraperitoneal abscess and one for bile-duct stenosis. Percentage of global relapse was 36%, with 26% of relapses out of the liver. Actuarial survival at one year follow-up was 90%, and 82% at two years; 64% of patients remain free of disease two years after the operation. CONCLUSIONS: Programs for liver resection for colorectal cancer metastasis may be implemented by multidisciplinary teams of recent setup. There is a need to evaluate own results and then compare them with a standard of quality previously reported.

Adult↗

PubMed1996

Organ donor Care MAP: a multidisciplinary approach.

A Care Multidisciplinary Action Plan was developed at a 300-bed rural medical center in 1994. Once a potential organ donor is identified and referred to the organ procurement organization and the family has consented to donation, the ICU nurse initiates the Care Multidisciplinary Action Plan, which is based on an 8-hour time frame for ICU care that may be adjusted as needed. The first hour includes prompts for coroner notification, billing changes, and completion of hospital-specific death notice forms. The remaining hours are spent administering tests and preparing the donor for organ retrieval. Collaborative issues such as donor family support also are addressed. ICU nurses who used the donor care Multidisciplinary Action Plan were interviewed to determine its effectiveness.

Case Management↗

PubMed1991

Pharmacy's role within a multidisciplinary, patient-focused model for health care.

In establishing a good multidisciplinary practice plan at Moffitt, the most critical points have been identified as follows: The patient's primary nurse must coordinate the patient's care. Good communications and a shared medical record are absolutely crucial. A clear understanding of basic responsibility for each profession is established via credentialing, inservices, and multidisciplinary policies. Authority to create care plans and document progress and recommendations must be universal across all professions. Patients and students should be the common focus; therefore, it is the results or outcome, not who provided the service, that is important. Nursing tells pharmacy it is wonderful, because it helps them and shares a concern for the patient. Pharmacy tells nursing the same thing for the same reasons. Occurrence reports reflect a collaborative spirit, seeking to resolve patient-related problems rather than cast blame. The two groups have not become generic health care professionals, as each profession has inherent capabilities that should be used. Nor has there developed a defensiveness that will prevent a nurse from interceding in traditional pharmacy issues, or a pharmacist in nursing issues. Statistically, it is not known whether Moffitt's staff has become more effective in providing patient care; however, the members of the team believe it to be true, and the patients exhibit trust in them. The future will be uncertain in health care. A multidisciplinary approach appears essential for optimal patient care and for forecasting and managing the complex administrative and economic issues that will continue. The staff at Moffitt believe that team synergy is a necessary component of a strong future.

Cancer Care Facilities↗

PubMed1999

A multidisciplinary approach to the treatment of childhood obesity.

Childhood obesity is a chronic disease that is associated with significant co-morbidity. Successful treatment and prevention of childhood obesity requires a multidisciplinary approach, including diet, nutrition education, behavior modification, and exercise. We studied 87 children (39 males, 48 females; aged 7-17 years) enrolled in a one-year multidisciplinary weight reduction program. Subjects were placed on a very low calorie/high protein diet, a moderate-intensity progressive exercise program, and behavior modification sessions for 10 weeks. Measures were taken at baseline 10 weeks, and 1 year. Significant anthropometric changes in weight, percent of ideal body weight, and percent body-fat were observed in all patients. We conclude that a multidisciplinary weight reduction program including diet, behavior modification, and exercise is an effective instrument to achieve weight loss in obese children and adolescents.

Adolescent↗

PubMed1999

[Multidisciplinary team and coordination of treatment network].

Because of the adverse consequences of alcohol dependence on somatic, psychological and social functions, treatment of alcoholics always requires a multidisciplinary approach. It is a good example of a treatment network. Despite the numerous difficulties encountered in such a multidisciplinary approach, its beneficial effect, its efficacy and even its rewards are tremendously important. The alcohol treatment network of our region should permit such multidisciplinary therapies. Two clinical presentations are used to illustrate its virtues, but also some open questions.

Alcoholism↗

PubMed1999

[Results of a multidisciplinary rehabilitation concept in patients with chronic lumbar syndromes].

The aim of our pilot study was to evaluate the influence of a multidisciplinary rehabilitation programme on various parameters of pain and function in 88 patients suffering from chronic low back pain caused by disc herniation (46 patients) or after lumbar discectomy (42 patients). We used an exercise-based multidisciplinary programme during a four-week in-patient treatment: active physiotherapy, exercise training and back school, organized in group therapies combined with passive techniques of physiotherapy (heat, massage, electrotherapy, medicated bath) with a daily duration of treatment exceeding three hours. Symptoms and functions improved simultaneously with the reduction of pain. The results of the visual analogue scale improved significantly in both groups (conservatively treated group p < 0.0001, after lumbar discectomy p < 0.005). As for the McGill pain questionnaire, however, only the group with conservatively treated disc herniations changed significantly for the better. We found an improvement in Roland-Morris' disability questionnaire in both groups, which reached statistical significance only in the group after lumbar discectomy. Forward-backward bending (kyphometer measurement as described by Debrunner), ameliorated significantly in both groups. Our results indicate that an exercise based multidisciplinary rehabilitation programme can improve pain and function even in patients suffering from definitely chronic low back pain caused by disc herniation or after lumbar discectomy.

Adult↗