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Results for “multidisciplinary”

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PubMedDate not supplied

The effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia: a randomized controlled trial.

OBJECTIVES: To assess the effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia in comparison to standard medical care. METHODS: Seventy-nine men and women were randomly assigned to one of two groups. The intervention group consisted of a rheumatologist and physical therapist intake and discharge, 18 group supervised exercise therapy sessions, 2 group pain and stress management lectures, 1 group education lecture, 1 group dietary lecture, and 2 massage therapy sessions. The control group consisted of standard medical care with the patients' family physician. Outcome measures included self-perceived health status, pain-related disability, average pain intensity, depressed mood, days in pain, hours in pain, prescription and nonprescription medication usage, and work status. Outcomes were measured at the end of the 6-week intervention and at 15-month follow-up. RESULTS: Thirty-five out of 43 patients from the intervention group and 36 out of 36 patients from the control group completed the study. There were no statistically significant differences between the 2 groups prior to intervention. Intention-to-treat analysis revealed that the intervention group, in comparison to the control group, experienced statistically significant changes at intervention completion in self-perceived health status, average pain intensity, pain related disability, depressed mood, days in pain, and hours in pain, but no significant differences in nonprescription drug use, prescription drug use, or work status. At 15 months, all health outcomes retained their significance except health status. Nonprescription and prescription drug use demonstrated significant reductions at 15 months. Binary logistic regression indicated that long-term changes in Pain Disability Index were influenced by long-term exercise adherence and income status. CONCLUSIONS: Positive health-related outcomes in this mostly unresponsive condition can be obtained with a low-cost, group multidisciplinary intervention in a community-based, nonclinical setting.

Combined Modality Therapy↗
PubMedDate not supplied

The application of laparoscopic bariatric surgery for treatment of severe obesity in adolescents using a multidisciplinary adolescent bariatric program.

The evolution of laparoscopic surgery has made bariatric surgery acceptable for weight loss; however, much controversy exists about its appropriateness for adolescents. Despite the controversial issues, the growing epidemic in adolescent obesity has resulted in rising numbers of applications for bariatric surgery. There are few bariatric surgical programs designed for adolescents. Pediatric settings face high start-up costs and poor reimbursement and lack established bariatric surgeons. Even so, bariatric surgery is increasingly being performed on adolescents in alarming numbers. To avoid adverse physical and psychosocial outcomes, the application of the principles of growth and development is essential. The program should be established as a multidisciplinary approach to management of adolescents and should be in institutions capable of meeting the guidelines for surgical treatment outlined by the American Society of Bariatric Surgery. To prevent postoperative complication, a multidisciplinary team of experienced medical and surgical specialists is needed for optimal preoperative decision making and postoperative management and long-term follow-up. Laparoscopic Roux-en-Y gastric bypass is a safe procedure and an effective means to treat obesity-related morbidity in the adolescent. Results have been excellent and justify a clinical trial to confirm the safety and efficacy of bariatric surgery in the adolescent population.

Adolescent↗
PubMed1990

Nonsurgical management of chronic pelvic pain: a multidisciplinary approach.

Experience with multidisciplinary management of CPP has demonstrated the importance of ruling out and of treating nongynecologic conditions such as myofascial syndrome, irritable bowel syndrome, urethral syndrome, and psychogenic pain in women with CPP and normal laparoscopies. Moreover, current data suggest that availability of a multidisciplinary pelvic pain clinic can reduce the frequency of hysterectomy for this disorder.

Adnexal Diseases↗
PubMed2000

Multidisciplinary vocational rehabilitation focusing on work training and case management for unemployed sick-listed people.

Twenty-four unemployed sick-listed people were referred during 1996 and 1997 to a multidisciplinary vocational rehabilitation programme with additional work training and case management. Twelve months after the programme, 54.2% in the study group had lowered their benefit levels compared with those at the start while 26.1% in the control group - who underwent a conventional rehabilitation programme - had lowered their benefit levels (p = 0.050, Chi-squared test). There were no significant differences regarding fewer sick days three and 12 months after the programme between the study group and the control group. Regarding self-assessed quality of life, there were no significant differences within or between the groups. We conclude that this multidisciplinary vocational rehabilitation programme with work training and case-management affected the outcome positively regarding lowered level of benefits 12 months after termination of programme compared with level at start. Studies of the long-term effect of the programme should, however, be performed with more subjects in both study group and control group.

Adult↗
PubMed1997

Multidisciplinary collaboration: conceptual development as a foundation for patient-focused care.

A participatory action research design using a combination of qualitative methods was used to induce a conceptual definition of multidisciplinary collaboration and to develop a measure of the concept among health care workers. Conclusions from the study include strategies to foster multidisciplinary collaboration among health care workers when health care delivery systems are being reengineered.

Cooperative Behavior↗
PubMed1996

Geriatric patients with depression. Improving outcomes using a multidisciplinary clinical path model.

Clinical pathways define multidisciplinary staff members' responsibilities, time lines, and patient outcomes. Although medical and surgical care settings frequently use them to improve quality, clinical, and fiscal outcomes for specific patient populations, staff members of psychiatric care settings have been hesitant to use clinical pathways because psychiatry emphasizes patient individuality. The authors describe the development and implementation of a psychiatric clinical pathway for geriatric patients with depression and identify common multidisciplinary interventions and a pattern of outcomes over the course of treatment for these patients. They also delineate quality and fiscal outcomes and future directions. Implementation of the pathway has been successful, and the development and implementation processes have applicability to other patient populations and care settings.

Aged↗
PubMed2003

Management of childhood pancreatic disorders: a multidisciplinary approach.

INTRODUCTION: Data on therapeutic endoscopy and radiologic interventions for the management of childhood pancreatic disorders are relatively limited. This study focuses on the multidisciplinary approach to the management of pancreatitis in children. PATIENTS AND METHODS: Children with pancreatic disorders were studied from January 1992 to May 2001. Acute pancreatitis (AP) was diagnosed by clinical evaluation, serum amylase more than three times normal, and morphologic abnormalities of the pancreas on imaging. Children with recurrent abdominal pain, pancreatic calcification or ductal stones on imaging, and pancreatic ductal changes on endoscopic retrograde cholangiopancreatography (ERCP) were diagnosed with chronic pancreatitis (CP). Patients were treated by gastroenterologists, surgeons, and interventional radiologists. Pancreatic exocrine insufficiency was diagnosed in appropriate settings. RESULTS: Fifteen children--6 with AP (posttrauma, 3; gallstone disease, 1; and viral, 1), 7 with CP, and 2 with pancreatic exocrine insufficiency--were diagnosed. Local complications observed in children with AP included pseudocyst in three, and infected acute fluid collection, right-sided pleural effusion, and ascites in one patient each. Complications of AP were managed with percutaneous catheter drainage (n = 3; pseudocyst, 2; infected fluid collection, 1), additional pancreatic duct stenting (n = 2), surgical drainage (n = 1), and octreotide for pleural effusion (n = 1). Signs of CP included abdominal pain (n = 7), obstructive jaundice resulting from lower common bile duct stricture (n = 2), and bleeding from gastroduodenal artery pseudoaneurysm (n = 1). Pancreatic duct stenting relieved pain in one patient, and steel coil embolization arrested bleeding from the pseudoaneurysm. Common bile duct strictures were managed by surgical bypass (n = 2), one of which required preoperative endoscopic bile duct stenting for management of cholangitis. Two other patients with CP required no intervention. CONCLUSION: A multidisciplinary approach of radiologic and endoscopic interventions and surgery are complimentary to each other in achieving successful outcomes of complicated childhood pancreatitis.

Acute Disease↗
PubMed1994

A multidisciplinary approach to the management of pregnant patients with end-stage renal disease.

End-stage renal disease (ESRD) in pregnancy is a complex perinatal condition requiring a multidisciplinary approach to care. This article will summarize the literature, provide a brief overview of dialysis therapy, describe the inherent maternal and fetal complications, and present a case history of a pregnant patient with ESRD. The clinical management, using a multidisciplinary approach, is discussed in detail, with a major focus on the obstetric nursing plan of care.

Adult↗
PubMed1997

Roles of mental health professionals in multidisciplinary medically supervised treatment programs for obesity.

Excess weight is a major medical problem for more than one third of Americans and, after cigarette smoking, is the second largest cause of death. However, obesity treatments remain controversial, and only surgical therapies have patient volume and appropriate follow-up adequate to prove effectiveness. National Institutes of Health conferences on obesity treatments and the Institute of Medicine have suggested that all obesity treatment programs, including those which are medically supervised, should be multidisciplinary, involving professionals from the behavioral, nutritional, and exercise fields to facilitate delivery of a patient-treatment matching strategy. There are no models to suggest how these recommendations should be accomplished or whether they are financially feasible. We present a case management model that includes psychotherapists in a multidisciplinary obesity treatment program. More data are needed to show whether these suggestions improve cost-effectiveness of obesity treatments.

Behavior Therapy↗
PubMed1999

Inclusion of resistance exercise in a multidisciplinary outpatient treatment program for preadolescent obese children.

BACKGROUND: Safe and effective exercise programs are needed to prevent and treat chronic diseases in childhood. In particular, preadolescent obese children should participate in activities that are specific to their special needs. METHODS: We included a moderate intensity, progressive resistance training program in a multidisciplinary weight management program for obese preadolescent children. The program included diet, behavior modification, and aerobic and flexibility exercises. RESULTS: The subjects reported no accidents or injuries and 100% compliance with the minimum required exercise prescription. Weight, percent ideal body weight, body mass index, and percent fat were reduced significantly at 10 weeks and did not increase significantly at 1 year follow-up. Height and lean body mass increased significantly at 1 year. CONCLUSION: A resistance training program may be safely included in a multidisciplinary weight management program for obese preadolescent children.

Adolescent↗
PubMedDate not supplied

Effect of high- versus low-frequency exercise training in multidisciplinary cardiac rehabilitation on health-related quality of life.

BACKGROUND: The authors examined the importance of the frequency of aerobic exercise training in multidisciplinary rehabilitation in improving health-related quality of life in the short run in patients with documented coronary artery disease. METHODS: Patients (114 males and 16 females; age range, 32-70 years) were randomized into either a high-frequency or a low-frequency exercise training program (10 versus 2 sessions per week, respectively) as part of a 6-week multidisciplinary cardiac rehabilitation program. The General Health Questionnaire and the RAND-36 were used to assess changes in psychological distress and subjective health status. RESULTS: After 6 weeks, high-frequency patients reported significantly more positive, change in "psychological distress" (P < 0.05), "mental health" (P = 0.05), and "health change" (P < 0.01), than low-frequency patients. Apart from changes in mean scores, individual effect sizes indicated that a significantly greater percentage of high-frequency patients experienced substantial improvements in "psychological distress" (P < 0.01), "physical functioning" (P < 0.05), and "health change" (P < 0.05), compared with low-frequency patients. In addition, deterioration of quality of life was observed in a considerable number of high-frequency patients (ranging from 1.7% to 25.8% on the various measures). CONCLUSIONS: The frequency of aerobic exercise has a positive, independent effect on psychological outcomes after cardiac rehabilitation. However, this benefit after high-frequency rehabilitation appears to be limited to a subgroup of patients. Further investigation is required to identify these patients. Results provide input into recent controversies regarding the role of exercise training in cardiac rehabilitation.

Adult↗
PubMed1998

Multidisciplinary achievement: the collaborative approach to rapid cycle ICU and hospital change.

Multidisciplinary teams are different from the traditional team format in that representation and participation from various disciplines characterize the structure. In April 1996, a multidisciplinary group from Muhlenberg Regional Medical Center's intensive care unit learned methodology at the Institute for Health Care Improvement (IHI) Breakthrough Series in Adult Intensive Care. With the format learned, improvements in diverse areas such as ventilator management, intermediate care, clinical laboratory utilization, and others were accomplished. Continued support from an expert staff and utilization of on-line communication tools characterized this 15-month quality improvement endeavor. The end of the breakthrough series spurred the development of a hospital-wide collaborative cost containment team.

Clinical Protocols↗
PubMedDate not supplied

A multidisciplinary approach for improving outcomes.

The healthcare environment has been impacted tremendously by higher patient acuity, cost-cutting measures, an increase in litigation, and increased expectations by an educated generation of healthcare consumers. This has led to the need to continually measure, assess, and improve quality. These activities must consider not only patient clinical outcomes, but also customer service ratings and financial outcomes. Quality improvement requires a collaborative approach to succeed, and the need to build a cohesive and effective multidisciplinary team is critical for positive outcomes. Strategies to build a culture of teamwork include incorporating total quality management principles into every level of the organization, seeking participation from every discipline and level of the organization, and recognizing employees for their efforts. Infusion nurses have an excellent opportunity to contribute their expertise to any multidisciplinary team that impacts the outcomes of infusion patients. In addition, team-building and quality improvement may prove to be excellent career moves for infusion nurses looking to further specialize their practice.

Cooperative Behavior↗
PubMed2005

Ocular vasculitis: a multidisciplinary approach.

PURPOSE OF REVIEW: The ophthalmologist has direct visual access to inflamed vessels when examining the retina, and "vasculitis" in ophthalmology has so far mainly referred to retinal vasculitis. In the past few years the means to explore vasculitis in the ocular sphere have improved. Indocyanine green angiography now enables the analysis of choroidal inflammatory vasculopathy as well as vasculitis of the sclera (scleritis) and episclera (episcleritis) in addition to retinal vasculitis. Because vasculitis detected by the ophthalmologist can be the presenting sign of a systemic disease and has to be approached in a multidisciplinary fashion, the emerging term "ocular vasculitis," instead of retinal vasculitis, should be used in the future. The term covers vasculitis affecting all structures of the eye and the periocular tissues as detailed in this article. The ocular findings have to be integrated within the established and accepted classification of systemic vasculitis, which is divided into primary vasculitides, where the vessel itself is the target of the inflammatory reaction, and secondary vasculitides, caused by other inflammatory processes. This review will deal with recently published articles on ocular vasculitis, including its clinical aspects, its link with systemic diseases, and its investigation and management. The discussion will be conducted within the framework of the new classification put forward here. RECENT FINDINGS: Novel imaging techniques such as indocyanine green angiography have made it possible to explore inflammation of choroidal vessels and of scleral vasculitis in addition to retinal vasculitis, contributing to the global concept of ocular vasculitis. It has been shown, in particular, that the choriocapillaris, a vascular structure adjacent to the retina, can be the site of a primary inflammatory vasculopathy unrecognized so far. Most of the recent articles cited, however, deal not so much with new findings but with the integration of ocular pathologic changes into the systemic diseases they are part of. New knowledge about disease mechanisms and novel therapeutic modalities with biologic agents cited in this review are coming from other fields but have contributed to progress in the management of ocular vasculitis. SUMMARY: New investigational techniques of vasculitis in ocular structures other than the retina have contributed to the development of the global concept of ocular vasculitis. This review shows the importance of promoting a comprehensive and global classification of ocular vasculitis compatible with the concepts accepted for systemic vasculitis to contribute to its multidisciplinary approach.

Diagnostic Techniques, Ophthalmological↗
PubMed2005

Predicting timely recovery and recurrence following multidisciplinary rehabilitation in patients with compensated low back pain.

STUDY DESIGN: Historical cohort study. OBJECTIVES: We investigated factors predictive of timely and sustained recovery following multidisciplinary rehabilitation in Workers' Compensation claimants with low back pain. SUMMARY OF BACKGROUND DATA: It is still unknown which factors predict better outcomes among back pain patients enrolled in intensive rehabilitation programs. Previously, few consistent predictors have been reported. METHODS: We created and tested predictive models using data from clinical and administrative databases of the Alberta Workers' Compensation Board. Predictive models were built on a cohort of subjects admitted for multidisciplinary rehabilitation in 1999 and tested on subjects admitted in 2000. Cox regression was used to evaluate days to time-loss benefit suspension and days to claim closure following admission for rehabilitation. Logistic regression was used to evaluate risk of future recurrence as judged through time-loss benefit resumption, claim reopening, or new back-related claims filing. RESULTS: Prediction models were variable between exploratory and confirmatory stages, and few variables were found to predict consistently. The number of preadmission healthcare visits was the most robust predictor of all recovery outcomes. Recurrence rates were 18% in 1999 and 22% in 2000. A higher number of preadmission healthcare visits and more previous back-related claims were associated with higher risk of recurrence. CONCLUSIONS: The number of preadmission healthcare visits was the most robust prognostic indicator with more healthcare visits related to delayed recovery and higher risk of recurrence. Recurrence rates following successful functional restoration were consistent with the episodic and recurrent nature of low back pain.

Adult↗
PubMed2005

A systematic review of sociodemographic, physical, and psychological predictors of multidisciplinary rehabilitation-or, back school treatment outcome in patients with chronic low back pain.

STUDY DESIGN: A systematic review. OBJECTIVE: To determine predictors of outcome of multidisciplinary rehabilitation-or back school treatment for patients with chronic low back pain. SUMMARY OF BACKGROUND DATA: Numerous reviews have been performed to gain insight into which patients benefit from which treatment. However, no review has systematically focused on predictors from multiple domains (i.e., sociodemographic, physical, and psychological), or on treatment outcome measured as activity limitation or participation restriction. METHODS: Studies were found by searching medical and psychological databases, and screening references. Two reviewers independently assessed the methodological quality using standard criteria. Studies were only included if they met a predefined level of internal validity. A qualitative analysis was performed. RESULTS: Heterogeneity among studies in patient characteristics, predictors, treatment, and outcomes limited evidence. All reviewed studies were descriptive or exploratory in nature. Consistent evidence was found for the predictive value of pain intensity (more pain--> worse outcome), several work-related parameters (e.g., high satisfaction--> better outcome), and coping style (less active coping--> better outcome). Other sociodemographic and physical variables consistently lacked predictive value. No consistent evidence was found for other psychological variables. CONCLUSIONS: It is impossible to define a generic set of predictors of outcome of multidisciplinary rehabilitation and back schools for patients with chronic low back pain because the reviewed studies were descriptive or exploratory in nature, and most predictors were only studied once. Nevertheless, for several predictors, consistent evidence was found. Large confirmatory studies are needed to test the value of these predictors.

Chronic Disease↗
PubMed2004

The HD12 panel of the German Hodgkin Lymphoma Study Group (GHSG): a quality assurance program based on a multidisciplinary panel reviewing all patients' imaging.

The purpose of this report is to determine the value of a central specialist radiologic review and to determine the image quality of computed tomography (CT) in Hodgkin disease. The HD12 protocol is a multicenter prospective randomized trial of the GHSG for advanced stages of Hodgkin disease. The indication and effectiveness of additional radiotherapy (30 Gy), in the area of initial bulky disease and of residual disease, following intensive chemotherapy using the BEACOPP schema (bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisone), is to be investigated. A multidisciplinary panel of radiation oncologists, radiologists, and medical oncologists reviews, blinded to treatment arms, the diagnostic imaging with comparison to the documentation forms. For patients with poor response to chemotherapy, the panel recommends radiotherapy independent of the randomization. This procedure guarantees that patients with a poor response to chemotherapy receive additional radiotherapy. Furthermore, the panel evaluates the quality of CT examinations in this multicenter study. Since July 1999, a total of 2607 CT of 371 patients have been evaluated. Helical CT showed significantly higher contrast enhancement and imaging quality than conventional CT (P < 0.001). CT from university hospitals was assessed as superior to that from other institutions (P < 0.001). Compared with the written disease documentation by the study centers, the panel assessed different extensions of disease in 814 of 2607 CT (31%), resulting in a change of stage in 17 of 371 patients (5%). After chemotherapy, 167 of 371 patients (45%) showed residual disease (>1.5 cm), and for 53 of 371 patients (14%) the panel recommended additional radiotherapy independent of the randomization arm. Patients with Hodgkin disease receive high-quality CT imaging. A central independent multidisciplinary panel markedly improves quality assurance for these study patients.

Adolescent↗