SEARCH · PubMed Health

Results for “multidisciplinary”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 415 records · Page 23Linked to original sources

PubMed1989

Multidisciplinary assessment of applicants for sheltered housing.

Three hundred applicants for sheltered housing underwent multidisciplinary geriatric assessment for suitability as a part of a joint assessment scheme with Local Authority Housing and Social Services Departments. Ninety-four applicants sought a move for health reasons while 206 applicants quoted housing and social reasons and denied medical problems. The assessment showed no significant disability necessitating sheltered housing facilities for 41 (44%) of the 94 people applying on health grounds. Severe disability made sheltered housing placement inappropriate for ten (10%) of the applicants with health problems. In the 206 applicants denying medical problems, the assessment revealed significant unreported physical illness in 46 (22%) and undiagnosed dementia in a further 26 (13%). Allocation of sheltered housing was affected in 99 (33%) of the 300 applicants. Eighty-two applicants were considered unsuitable, whereas 17 applicants originally thought to be unsuitable were recommended for sheltered housing. Multidisciplinary geriatric assessment is of considerable benefit in determining suitability of applicants for sheltered housing and will help in achieving better placement by avoiding inappropriate moves.

Aged↗

PubMed2002

Antithrombotic prescribing in atrial fibrillation: application of a prescribing indicator and multidisciplinary feedback to improve prescribing.

BACKGROUND: Atrial fibrillation is common in older people, and is associated with an increased risk of ischaemic stroke. Antithrombotic therapy reduces stroke-risk, but is known to be under-prescribed. OBJECTIVES: To use an evidence-based indicator to audit antithrombotic prescribing for older hospital inpatients with atrial fibrillation, and to assess whether feedback of audit results to hospital staff increases antithrombotic use. DESIGN: Cross-sectional notes-based audits, before and after feedback. SETTING: Six Aged Care and three General Medicine units at nine Australian public teaching hospitals between September 1998 and May 1999. SUBJECTS: 1416 hospital inpatients aged 65 years and over (median age 81). METHODS: Medication charts were reviewed to identify patients prescribed digoxin or amiodarone. Presence of atrial fibrillation was confirmed by review of the patients' medical notes. To be considered appropriate, patients with atrial fibrillation had to be receiving either warfarin or aspirin (or both), or have documented contraindications to both agents. Feedback of audit results was provided to medical, pharmacy and nursing staff at multidisciplinary meetings. Changes in antithrombotic prescribing 4-8 weeks and 6 months after feedback were assessed. Prescribing 8 weeks prior to feedback was assessed retrospectively. RESULTS: Appropriateness of the decision to prescribe (or not prescribe) antithrombotic therapy increased from 81/112 (72%) immediately prior to feedback to 97/105 (92%) 4-8 weeks later (P<0.0001). Six months after feedback, appropriateness of prescribing declined slightly, to 85% (p=0.36). Over the 8 weeks prior to feedback, appropriateness of prescribing did not change (74% versus 77%, p=0.80). Increased aspirin prescribing accounted for most of the improvement in antithrombotic use after feedback, while warfarin continued to be under-used. CONCLUSIONS: Antithrombotics were under-prescribed for older patients with atrial fibrillation. Audit and multidisciplinary feedback resulted in increased antithrombotic prescribing. The intervention had a greater impact on aspirin prescribing compared with warfarin.

Aged↗

PubMed1997

The effect of aspartame as part of a multidisciplinary weight-control program on short- and long-term control of body weight.

This study investigated whether the addition of the high-intensity sweetener aspartame to a multidisciplinary weight-control program would improve weight loss and long-term control of body weight. One hundred sixty-three obese women were randomly assigned to consume or to abstain from aspartame-sweetened foods and beverages during 16 wk of a 19-wk weight-reduction program (active weight loss), a 1-y maintenance program, and a 2-y follow-up period. Women in both treatment groups lost approximately 10% of initial body weight (10 kg) during active weight loss. Among women assigned to the aspartame-treatment group, aspartame intake was positively correlated with percentage weight loss during active weight loss (r = 0.32, P < 0.01). During maintenance and follow-up, participants in the aspartame group experienced a 2.6% (2.6 kg) and 4.6% (4.6 kg) regain of initial body weight after 71 and 175 wk, respectively, whereas those in the no-aspartame group gained an average of 5.4% (5.4 kg) and 9.4% (9.4 kg), respectively. The aspartame group lost significantly more weight overall (P = 0.028) and regained significantly less weight during maintenance and follow-up (P = 0.046) than did the no-aspartame group. Percentage weight losses at 71 and 175 wk were also positively correlated with exercise (r = 0.32, P < 0.001; and r = 0.34, P < 0.01, respectively) and self-reported eating control (r = 0.37, P < 0.001; and r = 0.33, P < 0.01, respectively). These data suggest that participation in a multidisciplinary weight-control program that includes aspartame may facilitate the long-term maintenance of reduced body weight.

Adult↗

PubMed2003

Pharmacist involvement in a multidisciplinary inpatient medication education program.

The development of a multidisciplinary inpatient medication education program is described. A multidisciplinary group designed and implemented a medication education program with defined roles for both nurses and pharmacists. Nurses provided medication education to patients during each medication administration using specially designed assessment and teaching tools. The nursing staff submitted requests for pharmacist consultations for patients with complex medication regimens, who were admitted because of a drug-related problem or who required additional teaching as determined through the medication education assessment form. A complex medication regimen was defined as the administration of oral medication more than five different times per day, the start of at least 5 new medications that would be continued at discharge, or the prescribing of at least 10 medications to be taken daily that would be continued at discharge. Pharmacists provided education for 19% of admitted patients during a six-month period. As a result of pharmacists' interactions with prescribers and nurses, the number of medications was reduced in 12% of these patients, and the number of medication administrations each day was reduced in 19% of patients. In addition, for 33% of patients, pharmacists contacted the prescriber to make recommendations beyond the scope of the medication education program that optimized and simplified the patient's drug regimen. The development of a structured medication education program allowed patients to receive medication education throughout their hospitalization from both nurses and pharmacists. Pharmacists provided education for patients at highest risk for noncompliance or poor outcomes. Full implementation of a medication education program involving staff pharmacists is planned.

Administration, Oral↗

PubMed1996

A multidisciplinary approach to oral rehabilitation with osseointegrated implants in children and adolescents with multiple aplasia.

Oral rehabilitation of children with extensive aplasia includes a number of dental considerations as well as attention to psychological and physical development. The well-documented results of the use of implants in adults have raised the question of the use of implants and the timing of this procedure in children and adolescents with multiple aplasia. Eight-years' experience of a multidisciplinary approach to oral rehabilitation of children with extensive aplasia is described. Special emphasis is placed on early diagnosis, careful therapy planning, and co-ordination and timing of different parts of the therapy. The specific considerations from the point of view of paediatric dentists, orthodontists, oral surgeons, and prosthodontists are presented. A system for integrating all these aspects and knowledge will be a guarantee for high professional standards and a successful outcome. To exemplify the multidisciplinary approach, three treated cases are presented.

Adolescent↗

PubMed2005

Effects of a multidisciplinary, post-discharge continuance of care intervention on quality of life, discharge satisfaction, and hospital length of stay: a randomized controlled trial.

OBJECTIVE: To determine the impact of a hospital-coordinated discharge care plan, involving a multidisciplinary team of primary health care providers, on hospital length of stay, quality of life, and both patient and general practitioner inclusion in, and satisfaction with, discharge procedures. DESIGN: This investigation comprised a prospective, randomized, controlled, clinical trial. SETTING: This multicentre and cross-jurisdictional study focused on areas of tertiary and primary health care as well as community allied health in Western Australia. PARTICIPANTS: Patients (n = 189) with chronic cardiorespiratory diagnoses were recruited from respiratory, cardiovascular, and general medical wards at two tertiary hospitals. INTERVENTION: Subjects were randomly assigned to one of two groups. Intervention group patients received a discharge care plan in accordance with that outlined in the Australian Enhanced Primary Care Package, completed before discharge and sent to the patient's general practitioner and other community service providers for review. Control patients were discharged under existing hospital processes. Outcome measures. Patients and general practitioners were surveyed pre-discharge and 7 days post-discharge for quality of life and opinion of discharge procedures. Hospital length of stay was also determined. RESULTS: Significant improvements in discharge planning involvement, health service access, confidence with discharge procedures, and opinion of discharge based on previous experience were seen for patients who received the discharge care plan. Further, improved perceptions of mental quality of life were observed within the first week post-discharge for intervention patients. Length of stay showed no difference between groups. Extent and speed of hospital-general practitioner communication were significantly improved via the intervention. CONCLUSIONS: Our results indicate that a multidisciplinary discharge care plan, initiated before separation, improves quality of life, involvement, and satisfaction with discharge care, and hospital-general practitioner integration. As such, it possesses benefits over current Western Australian hospital discharge procedures for the care of chronically ill populations.

Adult↗

PubMed2001

Multidisciplinary team evaluation of upper extremity injuries in a single visit: the UPPER Program.

Musculoskeletal disorders are the leading cause of disability among people between 18 and 64 years of age. Patients with musculoskeletal injuries of the upper extremities are usually evaluated and treated by an individual physician and therapist. However, for patients who have problems, especially after being treated by a hand surgeon and a certified hand therapist, there are few other management options. A multidisciplinary assessment program for patients with chronic upper limb pain has not been described in the literature. As part of The University of Michigan RERC (Rehabilitation Engineering Research Center), the UPPER Program (UPper extremity Protocol Evaluation in Rehabilitation) was developed to evaluate patients who have disabling upper limb musculoskeletal disorders. At the center of the program is a multidisciplinary team composed of a physiatrist (physical medicine and rehabilitation specialist), occupational therapist, physical therapist, exercise physiologist, vocational counselor and pain psychologist. The UPPER Program elements include a pre-evaluation questionnaire, individual team member assessments and a team meeting. It is followed by a patient appointment with the team physician to review the results and recommendations. The essential details of the program are presented in this article so it can be reproduced elsewhere.

Adolescent↗

PubMed1997

The two-year follow-up of a randomized comparison of in-patient multidisciplinary team care and routine out-patient care for active rheumatoid arthritis.

The long-term effects of a period of 11 days of in-patient multidisciplinary team care were compared with routine out-patient care in 80 patients with active rheumatoid arthritis (RA). Endpoint measures included swollen and tender joint counts, the patient's assessment of pain, the patient's and the physician's assessments of disease activity, the ESR and the Health Assessment Questionnaire (HAQ). Two years after hospitalization, all 39 patients randomized to the in-patient group and 39 out of 41 patients randomized to the out-patient group were evaluable. At 2 yr, in the in-patient group the improvement according to mean changes from baseline was greater than that in the out-patient group for all endpoint measures except for the HAQ score, the differences not reaching statistical significance. Averaged over the time points 2, 52 and 104 weeks, the improvement was significantly greater in the in-patient group than in the out-patient group, except for the ESR and HAQ score. In conclusion, a short period of in-patient multidisciplinary team care has a beneficial effect on disease activity over a period of 2 yr and should be considered as a useful treatment modality in patients with active RA.

Adult↗

PubMed2003

360-degree assessment in a multidisciplinary team setting.

OBJECTIVES: To use the 360-degree assessment in the multidisciplinary setting of a rheumatology department and to evaluate its impact, recognizing that this process will become part of the revalidation process of NHS professionals in the future. METHODS: Seventeen team members completed an anonymous questionnaire to give confidential opinions about the clinical, humanistic and other skills of their colleagues. Results and comments were collated and given as feedback to each individual. Before feedback, participants were asked to predict their perceived strengths and weaknesses. After feedback they evaluated the process. RESULTS: A profile of abilities was established for each team member and discussed privately with the clinical director. Often team members had good insight into their perceived strengths and weaknesses. Some participants were hurt by negative comments made about them even if this was balanced by positive comments. There were mixed views on the relevance and usefulness of the process, and whether or not it should be repeated. Some team members found the process threatening. CONCLUSION: The 360-degree assessment can be used in a multidisciplinary setting, the questions being the same for all individuals. It is a very powerful tool that must be handled carefully so that it does not cause more harm than good.

Clinical Competence↗

PubMed2004

Sleep-related fatal vehicle accidents: characteristics of decisions made by multidisciplinary investigation teams.

OBJECTIVES: To analyze factors that explain the attribution of crash causes as sleep-related by accident investigators. DESIGN: Analysis of national database of fatal road accidents studied in depth. All nonprofessional nonintoxicated car drivers responsible for a fatal accident from 1991 to 2001 were included (N = 1464). SETTING: Finland, with approximately 5.1 million inhabitants and 2.3 million motor vehicles. PARTICIPANTS: N/A. INTERVENTIONS: N/A. MEASUREMENTS: Comprehensive database recorded by multidisciplinary investigation teams, with specific emphasis on the availability of sleep-related driver variables and sleep-related causal decisions by teams. RESULTS: Injury severity, age, and marital status of the responsible car driver were related to the proportion of missing data in fatigue-related variables in the database (sleeping time, time awake, lifetime mileage). While there were differences between investigation teams and their activities, a series of logistic regression models showed that the lack of relevant variables in the database did not affect the proportion of accidents attributed to falling asleep (10% of cases) or as having fatigue-related causal factors (an additional 5% of the cases). The accident type (head-on and running-off versus other) and road conditions (dry or wet versus icy or snowy pavement) predicted the investigation teams' attribution of sleep-related causes in all models. CONCLUSIONS: Multidisciplinary teams' attribution of sleep-related causal factors were rather stable, comprising 10% to 15% of the cases investigated, independent of the availability of specific sleep-related information.

Accidents, Traffic↗

PubMed1998

Emerging and reemerging infectious diseases: a multidisciplinary perspective.

Predictions that infectious diseases would be eliminated as a major threat to human health have been shattered by emerging and reemerging infections, among them acquired immunodeficiency syndrome (AIDS), hemorrhagic fevers, marked increases in infections caused by antimicrobial-resistant bacteria, and the resurgence of tuberculosis and malaria. Understanding the dynamics of emerging and reemerging infections is critical to efforts to reduce the morbidity and mortality of such infections, to establish policy related to preparedness for infectious threats, and for decisions on where to use limited resources in the fight against infections. In order to offer a multidisciplinary perspective, 23 infectious disease specialists, epidemiologists, geneticists, microbiologists, and population biologists participated in an open forum at Emory University on emerging and reemerging infectious diseases. As summarized below, the group addressed questions about the definition, the identification, the factors responsible for, and multidisciplinary approaches to emerging and reemerging infections.

Acquired Immunodeficiency Syndrome↗

PubMed2001

Evolution of a multidisciplinary clinical pathway for the management of unstable patients with pelvic fractures.

OBJECTIVE: To determine whether the evolution of the authors' clinical pathway for the treatment of hemodynamically compromised patients with pelvic fractures was associated with improved patient outcome. SUMMARY BACKGROUND DATA: Hemodynamically compromised patients with pelvic fractures present a complex challenge. The multidisciplinary trauma team must control hemorrhage, restore hemodynamics, and rapidly identify and treat associated life-threatening injuries. The authors developed a clinical pathway consisting of five primary elements: immediate trauma attending surgeon's presence in the emergency department, early simultaneous transfusion of blood and coagulation factors, prompt diagnosis and management of associated life-threatening injuries, stabilization of the pelvic girdle, and timely insinuation of pelvic angiography and embolization. The addition of two orthopedic pelvic fracture specialists led to a revision of the pathway, emphasizing immediate emergency department presence of the orthopedic trauma attending to provide joint decision making with the trauma surgeon, closing the pelvic volume in the emergency department, and using alternatives to traditional external fixation devices. METHODS: Using trauma registry and blood bank records, the authors identified pelvic fracture patients receiving blood transfusions in the emergency department. They analyzed patients treated before versus after the May 1998 revision of the clinical pathway. RESULTS: A higher proportion of patients in the late period had blood pressure less than 90 mmHg (52% vs. 35%). In the late period, diagnostic peritoneal lavage was phased out in favor of torso ultrasound as a primary triage tool, and pelvic binding and C-clamp application largely replaced traditional external fixation devices. The overall death rate decreased from 31% in the early period to 15% in the later period, as did the rate of deaths from exsanguination (9% to 1%), multiple organ failure (12% to 1%), and death within 24 hours (16% to 5%). CONCLUSIONS: The evolution of a multidisciplinary clinical pathway, coordinating the resources of a level 1 trauma center and directed by joint decision making between trauma surgeons and orthopedic traumatologists, has resulted in improved patient survival. The primary benefits appear to be in reducing early deaths from exsanguination and late deaths from multiple organ failure.

Adult↗

PubMed1994

A multidisciplinary approach to critical path development: a valuable CQI tool.

Many health care facilities are developing and implementing critical paths to streamline the provision of quality care. Critical paths are a compilation of multidisciplinary input driven by specific time oriented outcomes. The purpose of this article is to illustrate critical path development, utilizing a multidisciplinary approach in a community hospital setting. The creation of a critical path will be described, from the environment that stimulated interest, to development and implementation of the path. Advantages to the patient and members of the health care team are presented. Emphasis is placed on strategies that promoted and facilitated collaboration among team members.

Clinical Protocols↗

PubMed1997

A multidisciplinary approach to occipital pressure ulcers related to cervical collars.

Pressure ulcers related to cervical collars are a common difficult-to-manage complication of cervical immobilization in the trauma patient. After many cases of occipital pressure ulcers occurred at our institution, a multidisciplinary task force was formed to look at this issue. The group was to identify causes for this problem and develop a plan to decrease the occurrence of pressure ulcers related to cervical immobilization. The problem involved three areas that needed improvement. These were: nursing care, the type of collar used, and the lengthy process of clearing C-spines. The group developed objectives, goals, and interventions to resolve these concerns. The task force developed a protocol for nursing care, changed to a different type of cervical collar, and developed a protocol for clearing cervical spine films. Through the use of a multidisciplinary approach, the development of protocols and a new product, pressure ulcers related to cervical collars have been eliminated in our institution. In addition, patients are staying in cervical collars half the time as before the protocol was implemented.

Braces↗

PubMedDate not supplied

Developing an outcome-based multidisciplinary care planning tool: process and outcomes.

Multidisciplinary care planning is required for patients in acute care settings. A task force was charged by the Vice President of Patient Care to develop and implement a multidisciplinary care planning tool. This article outlines the process used and includes examples of the tool and outcomes to date. This major change project resulted in the development of a successful tool, a successful Joint Commission on Accreditation of Healthcare Organization survey, and new opportunities for outcome-based care planning.

Critical Pathways↗

PubMed1997

An international, multidisciplinary approach to the management of advanced colorectal cancer. International Working Group in Colorectal Cancer.

The International Working Group in Colorectal Cancer conducted a survey (the Colorectal Cancer Care Pathway Review) in the summer of 1995 to examine medical, surgical and oncology nursing perceptions of patient management throughout Europe and the United States. The sample included 319 oncologists (surgical, medical and radiation) and 103 oncology nurses from a variety of centres in France, Germany, Italy, the United Kingdom and the United States. In response to issues identified in the Colorectal Cancer Care Pathway Review, a model for the optimal management of patients has been developed by the Working Group. The objectives of the Patient Management Model are: to define current best practice in advanced colorectal cancer; and to identify areas for ongoing research and clinical trials. Due to the multicultural nature of the Working Group, the model incorporates the differences in treatment that occur between countries. The Patient Management Model gives recommendations on treatment issues such as diagnosis, staging of disease, management strategy and therapy considerations including surgery, radiotherapy, chemotherapy, palliative supportive care, therapy management, auxiliary management and patient support. A multidisciplinary team approach to patient management is recommended to ensure optimal treatment and care. The multidisciplinary team should include all those involved in the treatment of the patient including specialists such as the oncology nurse. A summary of the recommendations of the Patient Management Model is presented here.

Colorectal Neoplasms↗

PubMed1990

Teaching the multidisciplinary team approach in a geriatrics miniresidency.

The miniresidency program in geriatrics begun in 1985 at the University of California, San Diego, School of Medicine acquaints practicing health professionals with a multidisciplinary team approach to the care of geriatric patients. The two-week program features participation in a multidisciplinary outpatient clinic, home visits, social work and nutrition consultations, and conferences with patients and families. Miniresidency members also participate in neurologic and neuropsychological evaluations and attend day care for demented adults. The 71 health professionals who completed the program during its first 20 months showed significant improvement on their scores between the pre- and posttests: the mean of all scores in the pretest was 51 out of a possible 80 (SD 15); the mean of all scores in the posttest was 75 out of a possible 80 (SD 4); p less than .001. The 77% who returned post-program evaluation questionnaires found the program "useful" or "very useful."

Geriatrics↗

PubMed1993

The prediction of return to the workplace after Multidisciplinary Pain Center treatment.

The prediction of return to the workplace after Multidisciplinary Pain Center (MPC) treatment has become a major research area. To delineate the variables that predict this outcome, the authors reviewed 164 multidisciplinary variables studies. Of these, 79 addressed work as an outcome variable. Twenty-six studies attempted to identify patient variables predicting return to the workplace. These latter studies were critically inspected for eight methodological criteria: pain location, follow-up time interval, response percentage and follow-up method, return to work subcategorization, vocational movement, univariate vs. multivariate statistics, multi-colinearity and variance, and statistical treatment of dropouts. In addition, other disability studies besides those in the chronic pain area were reviewed for return to the workplace predictor variables. Of these 26 studies, only a few appeared to satisfy the criteria examined. In addition, many studies were in conflict with one another on whether a variable was predictive. The review of the nonchronic pain/disability prediction literature yielded a large number of potential predictors that related to the work area. It is unclear which variables or set of variables predict return to the workplace after MPC treatment. Chronic pain studies may be neglecting the work area as an important source of return to the workplace predictor variables.

Combined Modality Therapy↗