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PubMed2005

[Multidisciplinary treatment rheumatoid arthritis. Statistical and clinical change in pain experience].

INTRODUCTION: To date only few studies have been reported on the effect of multidisciplinary inpatient treatment on pain experience in patients with rheumatoid arthritis (RA). Aims of the present research were: to asses the development of different pain qualities at the beginning, at the end of treatment and at a follow-up three months later in a RA-patient sample as a whole, to determine statistically and clinically significant changes on individual base, and to study pain coping behaviors as predictive and pain-change associated variables. METHODS: Subjects were 66 patients with a diagnosis of RA. They were treated with non-steroidal antiphlogistic and disease modifying drugs as well as with physical therapy. Measurement instruments were the pain experience scale with 5 subtests, the four-dimensional questionnaire of pain behavior, the functional disability scale, and a joint-index. RESULTS: At follow-up the reduction was strongest in the quality of persistent pain experience (effect size d: 0.54). Among sensory components a marked reduction was found for the experience of thermal pain. A statistically and clinically reliable change was assessed in 18% of he RA-patients, further 26% indicated a statistical only change. 33% remained stable at a functional level of pain experience. 12% did not change a high level of pain, and 11% deteriorated. Change in the coping behaviors of avoidance and support were associated with success in pain reduction. CONCLUSION: In the assessment of patient improvement different qualities of pain experience should be taken into account. It was suggested that inpatient multidisciplinary treatment was beneficial with regard to pain reduction in nearly on half of the RA-patients. The coping behaviors of avoidance and social support deserve attention as pain change associated variables.

Adult↗
PubMed2001

Multidisciplinary symptom control clinic in a cancer center: a retrospective study.

Our objective in this study was to review the characteristics, symptom intensity and satisfaction of patients referred to a half-day symptom control clinic (SCC) for advanced cancer patients. This was a retrospective study. The setting was a multidisciplinary symptom control clinic in a cancer centre. Those taking part were 166 consecutive advanced cancer patients referred to the half-day multidisciplinary SCC because of symptom distress. Patients referred to the clinic were assessed in a private room by a physician, a nurse, a pharmacist, a psychologist, and social, rehabilitation, nutrition, respiratory and pastoral care workers. Symptom distress (multiple visual analogue scales), cognition, and CAGE (alcoholism) were determined. Recommendations were given to the patient and sent to the oncologist, family physician and home care nurse. For 110 patients a second assessment was carried out 1 week later, and 64 patients underwent a telephone assessment 2 weeks after the second visit. Symptom intensity was determined during initial and follow-up visits, as well as during two follow-up telephone assessments. In addition, demographics and patient satisfaction with the SCC were determined. Overall symptom distress, depression, anxiety and sensation of wellbeing improved significantly from the first (n = 166) to the second clinic visit (n = 110). Further significant improvement was observed in overall symptom distress, pain, anxiety, sense of wellbeing and depression at the 2- (n = 64) and 4-week (n = 38) telephone follow-up assessments. Mean satisfaction with the SCC (0-10) was 7.7 +/- 2. Our findings suggest that the work of the SCC results in long-term effectiveness in symptom control and high levels of patient satisfaction. The SCC allows for better integration of care between a cancer center and community-based physicians and nurses. It also allows patients access to multiple disciplines that are not available outside tertiary centers.

Adult↗
PubMed2000

A multidisciplinary approach to the treatment of malignant pelvic bone tumors: results with eight consecutive patients.

The prognosis for malignant pelvic bone tumors is worse than that for malignant bone tumors of the extremities because definitive surgery in the pelvis is often difficult to accomplish. The results for eight patients who were treated consecutively with a multidisciplinary approach, from 1990, were analyzed. The histologic diagnosis was osteosarcoma in five patients, chondrosarcoma in two, and Ewing's sarcoma in one. Five lesions arose in the ilium and three in the pubis. The extraosseous tumors decreased in size and/or were encapsulated as a result of preoperative chemotherapy in six patients, four of these achieving a wide surgical margin. With respect to tumor location and surgical margin, all five lesions in the ilium involved the sacrum, four of these being resected with an inadequate margin. The three lesions in the pubis were resected with an adequate margin. Local recurrence was observed in two patients who had been treated with an inappropriate margin. During the period between 18 and 57 months after the first operation, five patients were continuously free of disease and one was still alive but had lung metastases. Our results indicate that a patient's chances of definitive surgery may be enhanced by a multidisciplinary approach, although the management of sacroiliac involvement remains challenging.

Adult↗
PubMed2003

Multidisciplinary pediatric pathology rotations in a residency training program.

The pediatric pathology residency rotations described herein represent an innovative multidisciplinary approach to residency education that combines concepts from anatomic pathology and laboratory medicine, and utilizes faculty members from pathology, pediatrics, and obstetrics/gynecology to teach pathology residents the clinicopathological highlights of antenatal, perinatal, and postnatal pathology. Training is provided through a combination of didactic interactions, laboratory experiences, and current clinical cases. As such, it can be a model for other multidisciplinary residency rotations that could span graduate medical education in pathology to permit a more thorough, informative, and stimulating residency experience.

Education, Medical, Graduate↗
PubMed2005

Advanced chemoresistant breast cancer responding to multidisciplinary treatment with hyperthermia, radiotherapy, and intraarterial infusion.

We employed multidisciplinary therapy, consisting of hyperthermia, radiotherapy, and intraarterial infusion, for a patient with progressive advanced breast cancer that was resistant to epirubicin hydrochloride and cyclophosphamide (EC) therapy as well as being resistant to docetaxel hydrate, and obtained a good therapeutic response. Because estrogen and progesterone receptors were both negative and HER2 was 3(+), administration of trastuzumab was started, and this patient has shown no signs of recurrence at 33 months after our treatment. The results suggested that our multidisciplinary therapy can be an effective method for the treatment of progressive breast cancer showing resistance to major chemotherapy agents such as anthracyclines and taxanes.

Antibodies, Monoclonal↗
PubMed2005

Multidisciplinary vascular screening program modestly improves the medical treatment of vascular risk factors.

PURPOSE: This study investigated whether recommendations given to the treating vascular specialist and the GP by a multidisciplinary team of vascular specialists concerning the medical treatment of risk factors, based on international guidelines, led to an increased medication use in a high-risk population. METHODS: Data were obtained from 618 patients enrolled in the SMART study, an ongoing single-center prospective cohort study of patients referred to the University Medical Center Utrecht for atherosclerotic vascular diseases. All patients underwent a vascular screening and their physicians received recommendations concerning the medical treatment of newly detected or not yet sufficiently treated vascular risk factors. After a median follow-up of 29 months, questionnaires about medication use were sent to 618 patients; 534 (86%) questionnaires were returned. Actual use of medication was compared with medical treatment recommendation given at baseline. RESULTS: The proportion of patients on antihypertensive medication with hypertension (> or =140/90 mmHg) and not diagnosed with coronary heart disease increased from 56% to 68% (95% confidence interval (95% CI) 2 - 23). The frequency of lipid-lowering medication use increased substantially from 47% to 69% (95% CI 17 - 28). The frequency of glucose-lowering medication use increased slightly from 11% to 14% (95% CI 1 - 7). The use of folic acid increased from 2% to 14% (95% CI 9 - 15) in patients with hyperhomocysteinaemia. CONCLUSIONS: Medical treatment recommendations, formulated by a multidisciplinary team, led to a significant increase in medication use. The increase is marginal compared with trends in medication use without this intervention in usual care.

Adolescent↗
PubMed1978

Multidisciplinary treatment of chronic pain: long-term follow-up of low-back pain patients.

Thirty-six patients with low-back pain who had been treated in our multidisciplinary pain center returned for 80-week follow-up evaluations by the staff pscyhologist, physiatrist and physical therapist. Statistically significant gains were maintained in the reduction of prescription analgesics and on 4 measures of physical functioning: (a) long-sittimg-to-toe; (b) straight-leg-raise; (c) knee-to-chest; and (d) overall exercise performance. Despite verbal reports of continuing pain, most patients claimed they were coping much better with it, and they displayed a marked reduction in their utilization of medical resources for further pain treatment. These long-term results suggest that a multidisciplinary approach can offer an effective means of treating chronic low-back pain.

Adaptation, Psychological↗
PubMed1982

The response to treatment in a multidisciplinary pain clinic.

Reports of the results obtained by multidisciplinary pain clinics are reviewed. The outcome of management of a cohort of patients referred to the Royal Adelaide Hospital Pain Clinic is described. Thirty-seven percent of patients reported partial or complete relief. The problems of assessing outcome are discussed, as well as the difficulty of making meaningful comparisons between pain clinics. The evidence thus far available suggests that multidisciplinary pain clinics make a useful and important contribution to the management of pain syndromes.

Adult↗
PubMed1983

A review of follow-up studies of multidisciplinary pain units.

Chronic pain is a major public health problem in the United States. Estimates from the National Institutes of Health put the cost of chronic pain at 40 billion dollars a year. They estimate that as many as 15 million adults suffer from low back pain with a minimum cost of 5 billion dollars in direct medical costs and 93 million work days lost every year. In an attempt to cope with this massive problem, multidisciplinary pain units have arisen which attempt to address the complex, multi-faceted aspects of a chronic pain problem. The importance of this new treatment approach is made evident by the 1981 overview of multidisciplinary pain centers published by the National Institutes of Health. In this publication, the history and success of these units since their first development by Bonica are evidenced. The purpose of the present paper is to briefly, critically summarize one small aspect of these programs, specifically follow-up analysis of the patients after discharge.

Chronic Disease↗
PubMed1984

Multidisciplinary considerations in cancer treatment: origin and scope.

The Tumor Board constitutes the control area where multidisciplinary protocols are created and where each patient's circumstance is thoroughly reviewed from the perspective of all pertinent clinical disciplines. Such input is an essential component of quality control at all levels of management of the cancer patient. This pertains whether in a community hospital or in a specialized cancer center. Cooperative groups and other research organizations have recognized the essential nature of this input, especially for the integration of new measures with those therapeutic modalities that are already established. Thus treatment may show a logical evolution by continuously updating standard approaches through clinical trials posing the most relevant question from the point of view of all modalities, while maintaining stringent quality control. Examples of questions being posed by therapeutic advances in testicular and ovarian cancer are described. The key element in accomplishing these advances is multidisciplinary participation.

Combined Modality Therapy↗
PubMed1990

Results of multidisciplinary limb salvage in 240 consecutive bone sarcomas.

From 1979 to 1989, 240 bone sarcomas of limbs were treated by a multidisciplinary limb salvage protocol. The tumors included 112 osteosarcomas, 71 chondrosarcomas, 3 fibrosarcomas, 10 malignant histiocytofibromas, 40 Ewing's sarcomas and 4 other rarer sarcomas. Patients mean age was 28.6 yr (range 4-91 yr). The average tumor size was 13.5 cm (3-43 cm). There were 2 grade IA, 21 IB, 1 IIA, 188 IIB, and 28 III B according to Enneking's classification. Extratumoral en bloc resection was performed in all cases (large in 113, marginal in 121, intrafocal in 6) by the same surgeon. In poor responders to preoperative chemotherapy with Ewing's sarcomas or osteosarcomas, 35 Grays postoperative radiotherapy was administered. Ewing's sarcomas and osteosarcomas received short preoperative and long postoperative chemotherapy. At last follow-up (median 60 months, range 6-120 months), 150 patients were disease-free; 4 were under treatment and had visible disease; 86 had died. Actuarial disease-free survival rate for patients seen with localized previously untreated disease was 83% at 2 yr and 77% at 3 yr. Fifteen local recurrences were observed (6%). Statistical analysis confirmed the poor prognosis factors of visible metastasis, proximal location and large tumor size, and pointed out the major prognostic value of therapeutic factors: the effectiveness of chemotherapy in Ewing's sarcoma and osteosarcomas, and the adequacy of surgery in all cases. Limb salvage can be performed by a well experienced multidisciplinary team in 96% of limb sarcomas without major risk of local recurrence. However, amputation is safer if the surgeon lacks experience.

Adolescent↗
PubMed1994

Local control of soft tissue sarcoma of the extremity: the experience of a multidisciplinary sarcoma group with definitive surgery and radiotherapy.

Data gathered on 62 patients with soft tissue sarcoma of an extremity, treated in entirety by an experienced multidisciplinary sarcoma group, were analysed. With a philosophy of emphasising attainment of histologically negative margins at carefully planned limb sparing surgery, combined with either pre-operative or postoperative radiation therapy, a crude local control rate of 95% (59 of 62 patients) at a minimum of 24 months follow-up was obtained. Of 9 patients with microscopically positive margins after definitive surgery, 8 had undergone maximal resection compatible with preservation of function. One of these 9 failed locally, indicating that radiation therapy is effective in eradicating microscopic disease in this tumour. The excellent local control obtained with limb-sparing surgery in this series justifies early referral of patients with these uncommon cancers to an experienced multidisciplinary unit. 26 patients (42%) failed systemically at a minimum of 24 months follow-up, and 19 (30.6%) died of their disease, confirming the need for effective systemic therapy in soft tissue sarcoma. Tumours greater than 10 cm in diameter had a greater risk of systemic relapse.

Adolescent↗
PubMed1996

The importance of a multidisciplinary group in the treatment of soft tissue sarcomas.

In 1987, a multidisciplinary soft tissue sarcoma (STS) group was established and a treatment protocol was set up. By 1993, there were 193 patients with a diagnosis of STS of the superficial trunk or extremities. 134 patients were referred with primary (stage M0) tumours and treated with curative or palliative intention. Nine amputations were performed. 94 (70%) patients were treated with wide or compartment surgery (n = 62) or marginal surgery combined with postoperative radiotherapy (n = 32). According to the protocol, these patients had received adequate treatment. 18 patients have recurred locally (13%) (median follow-up: 36 months). 12 were salvaged. 33 had metastases. The estimated 3-year survival, local control and disease-free survival rates are 79, 87 and 69%, respectively. These results compare favourably with previously published results from this hospital and from a nationwide study. The improved results emphasise the importance of a multidisciplinary STS group.

Adolescent↗
PubMed2006

Reducing surgical site infections through a multidisciplinary computerized process for preoperative prophylactic antibiotic administration.

BACKGROUND: Surgical site infections (SSIs) result in significant postoperative morbidity and mortality. Although many of these infections can be prevented by timely administration of preoperative antibiotics, data suggest that many patients do not receive such therapy. METHODS: A multidisciplinary team was convened that reviewed published guidelines, made antibiotic recommendations, and addressed administration issues. Responsibility for antibiotic administration was shifted from preoperative nursing staff to the anesthetist. Electronic quick orders were developed to encourage appropriate antibiotic selection and simplify order creation. RESULTS: Timely administration of preoperative antibiotics improved from 51% to 98% from February 2005 to February 2006. Appropriate antibiotic administered improved from 78% to 94%. The clean wound infection rate decreased from 2.7% to 1.4% over the same time period. CONCLUSION: A multidisciplinary approach to prophylactic antibiotic use, including computer-guided decision support, facilitates appropriate preoperative antibiotic use, resulting in a significant decrease in surgical wound infections.

Anesthesia Department, Hospital↗
PubMed2006

A multidisciplinary clinical pathway decreases rib fracture-associated infectious morbidity and mortality in high-risk trauma patients.

BACKGROUND: We initiated a multidisciplinary clinical pathway targeting patients greater than 45 years of age with more than 4 rib fractures. The purpose of the current study was to evaluate the effect of this pathway on infectious morbidity and mortality. METHODS: This was a prospective cohort study. Data evaluated included patient demographics, injury characteristics, pain management details, lengths of stay, morbidity, and mortality. Univariate and multivariate analyses were performed using a significance level of P < .05. RESULTS: When adjusting for age, injury severity score, and number of rib fractures, the clinical pathway was associated with decreased intensive care unit length of stay by 2.4 days (95% confidence interval [CI] -4.3, -0.52 days, P = .01) hospital length of stay by 3.7 days (95% CI -7.1, -0.42 days, P = .02), pneumonias (odds ratio [OR] 0.12, 95% CI 0.04 to 0.34, P < .001), and mortality (OR 0.37, 95% CI 0.13 to 1.03, P = .06). CONCLUSIONS: Implementation of a rib fracture multidisciplinary clinical pathway decreased mechanical ventilator-dependent days, lengths of stay, infectious morbidity, and mortality.

Aged↗
PubMed2005

Psychosocial conditions do not affect short-term outcome of multidisciplinary rehabilitation in chronic obstructive pulmonary disease.

OBJECTIVES: To characterize patients referred for pulmonary rehabilitation on a large number of psychologic and sociodemographic variables and to determine the contribution of these variables on the response to rehabilitation. DESIGN: Cross-sectional, explorative. SETTING: University hospital and outpatient clinic. PARTICIPANTS: Eighty-one consecutive patients with chronic obstructive pulmonary disease (forced expiratory volume in 1 second, 40%+/-16% of predicted) were included in outpatient pulmonary rehabilitation. INTERVENTION: Multidisciplinary rehabilitation program. MAIN OUTCOME MEASURES: Pulmonary function, exercise capacity (Wmax, 6-minute walk test [6MWT]), Chronic Respiratory Disease Questionnaire (CRDQ), Modified Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ-M), anxiety and depression (Hospital Anxiety and Depression Scale [HADS]) were assessed before and after 3 months rehabilitation. In addition, psychosocial adjustment, social support, marital status, mode of transportation, education, employment, and smoking status were assessed at the start of the rehabilitation. RESULTS: Rehabilitation improved exercise performance (Wmax, 6+/-12W; P<.01; 6MWT, 41+/-72 m; P<.001), quality of life (CRDQ score, 12+/-13 points; P<.001), functional status (PFSDQ-M activity score, -8+/-11 points; PFSDQ-M dyspnea score, -6+/-12 points; PFSDQ-M fatigue score, -4+/-8 points; all P<.01), HADS anxiety score (-2+/-3 points, P<.01), and HADS depression score (-3+/-3 points, P<.001). In single regression analysis, only baseline depression was weakly negatively correlated with the change in maximal workload. No other relations of initial psychologic or sociodemographic variables with outcome were observed. CONCLUSIONS: The effects of rehabilitation are not affected by baseline psychosocial factors. Patients with less favorable psychologic or sociodemographic conditions can also benefit from pulmonary rehabilitation. The multidisciplinary approach of the rehabilitation program might have contributed to this improvement.

Aged↗
PubMed2007

Oligometastatic non-small cell lung cancer: a multidisciplinary approach in the positron emission tomographic scan era.

BACKGROUND: We have assessed the survival rate of patients with non-small cell lung cancer and synchronous hematogenous solitary metastasis identified with complete staging workup, including total body [18F]fluorodeoxyglucose positron emission tomography scan, and treated with a multidisciplinary approach. METHODS: We examined the database of all patients who underwent surgery for primary non-small cell lung cancer in our institute. The criteria required for inclusion in this analysis were diagnosis of non-small cell lung cancer with synchronous hematogenous solitary metastasis by staging workup with total body computed tomography scan and brain magnetic resonance if indicated, total body positron emission tomography scan, radical surgery for the primary tumors, local treatment of the solitary metastasis, and systemic chemotherapy administration. RESULTS: We analyzed the data from 1,509 patients treated from January 2000 to December 2005: 10 patients (0.7%) satisfied the selection criteria. The median overall survival was 26 months, and the median time to progression was 20 months; 6 patients were alive at the time of analysis, with a median follow-up of 30 months. Four patients were tumor progression-free after 9, 18, 23, and 32 months from the start of their treatment. CONCLUSIONS: The presentation of non-small cell lung cancer with a synchronous hematogenous solitary metastasis identified by [18F]fluorodeoxyglucose positron emission tomography containing complete staging workup is extremely rare. This subset of patients can achieve long-term survival after a multidisciplinary treatment approach.

Adult↗