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Results for “multidisciplinary”

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PubMed2006

Nonalcoholic fatty liver disease decrease in obese adolescents after multidisciplinary therapy.

BACKGROUND: Despite the increasing prevalence of nonalcoholic fatty liver disease, its pathogenesis and clinical significance remain poorly defined and there is no ideal treatment. OBJECTIVE: The aim of this study was to assess the short-term (12-week) multidisciplinary therapy on visceral adiposity and nonalcoholic fatty liver disease control. METHODS: We evaluated and compared the distribution of visceral adiposity and nonalcoholic fatty liver disease, by ultrasonography, in 73 post-puberty obese participants (17.01+/-1.6 years old; body mass index 36.54+/-2.86 kg/m), submitted to a multidisciplinary treatment without medications, at the beginning and after 12 weeks of intervention. Descriptive and one-way analysis of variance, and paired t-test were performed. RESULTS: The results indicated that after intervention the adolescents had a significant reduction in visceral adiposity (4.05+/-1.55 to 3.37+/-1.44) and nonalcoholic fatty liver disease prevalence (from 52 to 29% on the right side and from 48 to 29% on the left side). It is a positive result because nonalcoholic fatty liver disease can progress to cirrhosis, even in children and adolescents. CONCLUSIONS: The short-term treatment suggests a profound impact on the control of obesity-related co-morbidities in young people.

Adiposity↗

PubMed2005

Extraction of dental crowns from the airway: a multidisciplinary approach.

We describe two cases of airway foreign bodies (FB) consisting of a dental crown. The shape and composition of dental crowns complicate their extraction from the tracheobronchial tree, sometimes necessitating thoracotomy. We describe the use of a multidisciplinary approach involving rigid and flexible bronchoscopy in concert with the use of wire snares under fluoroscopic guidance for extraction of these challenging FB. These cases illustrate that this multidisciplinary approach can allow successful extraction of the difficult FB from much of the tracheobronchial tree and the avoidance of thoracotomy.

Aged↗

PubMed2005

Multidisciplinary management of surgical disorders of the pancreas in childhood.

OBJECTIVES: To describe the frequency and range of pancreatic disorders in children requiring surgical intervention and to highlight the importance of multidisciplinary management. METHODS: An audit of all children under 17 years of age referred with surgical disorders of the pancreas or pancreatitis to a regional pediatric gastroenterology unit in the United Kingdom during a 10-year period. A retrospective chart review of clinical features, pathology and outcome was undertaken. RESULTS: Surgical intervention was required for the following pancreatic disorders: persistent hyperinsulinemic hypoglycemia of infancy (n = 4), pancreatic tumors (n = 5), pancreaticobiliary malunion (n = 12), pancreatic trauma (n = 6) and pancreatitis (n = 10). The indications for surgery in acute pancreatitis were a persistent pseudocyst (n = 1) and treatment of an underlying cause of pancreatitis (n = 4); in chronic pancreatitis, surgery was used to treat symptomatic pancreatic duct strictures (n = 4). One child died of a progressive lymphoma but all others who underwent surgery are alive and well. All 33 children with acute pancreatitis, including four with pancreatic necrosis, survived. CONCLUSIONS: Surgery for pancreatic disorders in children is rarely required but may be necessary a) for definitive management of primary pancreatic pathology, b) to treat sequelae of acute or chronic pancreatitis and c) to treat an underlying cause of pancreatitis. There is a broad spectrum of potential pathologies. These patients are best managed by a multidisciplinary team approach.

Acute Disease↗

PubMed2003

Daily multidisciplinary rounds shorten length of stay for trauma patients.

PURPOSE: Efficient patient care depends on close communication between the trauma team, other surgical providers, nursing, physical therapy, and discharge planners. Communication is hampered by the number of services involved, the workload of each service, and the institution's training mission. We hypothesized that daily multidisciplinary "discharge rounds" would improve patient flow and increase readiness. METHODS: A senior trauma center physician leads discharge rounds, focusing on each patient's plan of care, including surgeries, diagnostic tests, and anticipated date of discharge or transfer. Present at rounds are the fellows leading each trauma team; an orthopedic surgeon; the hospital bed manager; the unit's discharge planner; the unit nursing staff; and physical, occupational, and speech therapists. RESULTS: Discharge rounds cover 90 inpatient trauma service beds in approximately 60 minutes each day. Discharge rounds have had a dramatic effect on patient flow. While maintaining the daily census, we have seen a 36% increase in patient volume and a 15% decrease in length of stay. "Bypass" status-inability to accept admissions-has been virtually eliminated. This effect has been sustained. CONCLUSION: By providing a forum for clear communications among all providers, discharge rounds have streamlined the care of complex trauma patients. As health care resources become ever more constrained, this sort of multidisciplinary effort is a viable option for senior physicians to directly impact hospital performance.

Humans↗

PubMed2005

Use of a refined operative strategy in combination with the multidisciplinary approach to manage blunt juxtahepatic venous injuries.

BACKGROUND: Despite continuous advances in traumatology, juxtahepatic venous injuries are still the most difficult and deadly form of liver trauma. Most deaths result from exsanguination, and reported mortality ranges from 50% to 80%. This is an evaluation on our experience with the management of this high mortality injury following a refined operative strategy. METHODS: This is a retrospective study of consecutive patients sustaining blunt juxtahepatic venous injuries. The management for these patients was mainly a refined operative strategy combined with a multidisciplinary approach. Preoperative conditions and the patient demographics were gathered. In addition, the number and type of interventional procedures, overall complications, and operative procedures were collected and analyzed. RESULTS: From January, 1996 to March, 2004, 19 patients (M:F = 13:6) with juxtahepatic venous injuries were included and all were managed operatively. The operative procedures included hepatectomy by finger fracture technique for direct repair (8), perihepatic packing (1), packing and hepatic artery embolization (1), packing and hepatic artery ligation (1), hepatorrhaphy and packing (5), packing followed by hepatectomy (2) and atriocaval shunt for direct repair (1). The survival rate for the packing group was higher than that of the direct repair group (75% versus 45%), but was not statistically significant (p = 0.352). Injury to the retrohepatic vena cava influenced the patient's survival significantly (p = 0.041). The overall survival was 58% (11/19). CONCLUSION: A well-defined operative strategy helps surgeons deal with the problem of blunt juxtahepatic venous injury, and its combination with multidisciplinary management will improve patient outcomes.

Adult↗

PubMed1989

Using a multidisciplinary follow-up program to assist patient adjustment following temporal lobectomy.

A follow-up program for patients following temporal lobectomy for seizure control was established in 1983 at the UCLA Neuropsychiatric Hospital in response to patients' requests for information and assistance. The purpose of this program was to identify changes requiring adaptation and to offer assistance. Forty patients were contacted monthly by telephone for one year after surgery. They were interviewed by either a nurse or occupational therapist about medical and psychosocial issues. The information, support or referral needed were provided by the nurse, occupational therapist or social worker in consultation with appropriate member(s) of the multidisciplinary team. Problems encountered when beginning a less disabled lifestyle might not have been detected or resolved without active intervention through a multidisciplinary follow-up program.

Adaptation, Psychological↗

PubMed1992

Multidisciplinary approaches to management of acute head injury.

The formation of a multidisciplinary head injury team at St. Michael's Hospital has served to improve the quality of care for acutely head-injured patients. The multidisciplinary team follows the patient from the neurosurgical intensive care unit to the early rehabilitation phase. Treatment for the patient and family focuses on physical, cognitive and psychosocial areas. Cooperation of the various medical and paramedical professionals facilitates earlier and more comprehensive treatment for patients and their families, while enhancing research.

Communication↗

PubMed1995

Multidisciplinary teams and childhood visual impairment: a study of two teams.

Multidisciplinary teams are generally viewed as beneficial in the management of the visually impaired child, yet little is known about them. Two teams were studied. Team A had well-defined functions relating to identification of visually impaired children, co-ordination of services and liaison. Team B had a more general aim of sharing information on a range of ophthalmic issues other than visual impairment. By comparing the two teams, we conclude that a multidisciplinary team is more likely to be effective if it draws its membership from a range of appropriate professions and its functions are focused. Benefits of teams include increased and earlier referral, improved interdisciplinary liaison and collaboration, and speedier and more appropriate implementation of services. Lack of time to participate, particularly by medical personnel, is a problem.

Child↗

PubMed2006

The role of the multidisciplinary team in recruiting to cancer clinical trials.

This research analyses factors affecting the accrual of women to two breast cancer trials, the British Association of Surgical Oncology (BASO) II trial (a treatment trial) and the International Breast cancer Intervention Study (IBIS) (a prevention trial). The research sought to identify the factors affecting the recruitment of women to breast cancer clinical trials from the multidisciplinary teams' and women's perspectives using multiple methods. This paper reports on the findings from research undertaken with multidisciplinary teams across the United Kingdom and highlights their role in recruiting people to cancer clinical trials. The findings contribute to the debate and knowledge on recruitment in a number of ways by including the views of key stakeholders concerned with these trials, by highlighting the factors affecting recruitment to these two trials, and finally, by making recommendations on methods to enhance recruitment.

Attitude of Health Personnel↗

PubMed2005

Using a multidisciplinary classification in nursing: the International Classification of Functioning Disability and Health.

AIM: This paper reports a study to explore systematically the usefulness of the International Classification of Functioning, Disability and Health to nurses giving patient care. BACKGROUND: The International Classification of Functioning, Disability and Health has a history of more than 20 years. Although this World Health Organization classification offers multidisciplinary use, nurses are not familiar with it. METHODS: Applications of the International Classification for nursing practice were developed and evaluated in a multi-centre project, composed of a series of 10 projects in a variety of settings. These applications were a variety of tools, such as assessment forms, care plans and transfer forms. The study used information from 653 patients, 469 nurses and 178 others (International Classification experts; other professionals with whom nurses communicate or discuss patient data). FINDINGS: Large sections of the International Classification were used in the 10 projects, revealing a predominant focus on body functions (53% of all three-digit codes and corresponding terms used). Although large sections of the Classification were useful in practice applications, some items were identified that could be added, improved or described with more detail. Positive remarks made by nurses referred to the scope of the International Classification, which encouraged assessing beyond a patient's functional impairments. CONCLUSIONS: The International Classification of Functioning, Disability and Health can be a useful tool in classifying and communicating aspects of patient functioning by nurses. A level of moderate detail within the Classification (three-digit level) seems appropriate for most nursing purposes. Our results on items that could be added or improved can serve as input in future revisions of the Classification. Future use of the International Classification should be encouraged, because of its relevance to nursing and its potential for multidisciplinary use in patient care.

Activities of Daily Living↗

PubMed2007

A multidisciplinary approach to the management of individuals with fragile X syndrome.

BACKGROUND: Fragile X syndrome (FXS) is the most common inherited form of intellectual disability. Since the identification of the responsible gene (FMR1) and its protein (FMRP), there has been enormous progress in both clinical and pathogenetic research on the neurobehavioural aspects of the condition. However, studies regarding other medical problems anticipated in individuals with FXS are limited. A multidisciplinary study evaluating various causes of morbidity in the same group has not been published yet. METHODS: Twenty-four boys with FXS full mutation were recruited out of a larger group of 103 diagnosed in one centre over the past 10 years. Ear nose and throat, eye and cardiac examinations were performed in addition to routine cognitive, behavioural, neurological and speech and language assessments. RESULTS: The average IQ score was 49.8 +/- 20 (range 25-90). There were four patients (18%) with IQ above 70. Using DSM-IV, attention deficit hyperactivity disorder was diagnosed in five boys out of 22 examined (23%), while 32% were diagnosed with pervasive developmental disorder. The seizure frequency was 17%. A psychiatric disorder was diagnosed in six out of eight boys with electroencephalogram abnormalities (75%). Minimal conductive hearing loss was found in five (5/22) patients. There was significant delay in both expressive and receptive language skills. Ocular findings were refractive errors (13%) and strabismus (4.4%). Mitral valve prolapsus (MVP) was observed in 3/22 (13.7%) patients and aortic annulus dilatation was present in 2/22 (9%) patients. CONCLUSIONS: Frequency of psychiatric diagnoses made with DSM-IV were in parallel to those reported in the literature. Comorbidity of seizures and psychiatric disorders was noteworthy. The percentage of 'high-functioning' full mutation males supports the previous observations. Ear nose and throat and eye examination revealed remarkably lower prevalence of abnormal findings than reported. MVP was slightly less frequent compared with the single study in the literature. Age at the time of examination had an effect on the outcome of cardiac evaluation. These findings will guide us in future management of the group of patients followed in our institution. The protocol applied provides an applicable outline for multidisciplinary institutional settings dealing with individuals with FXS.

Aortic Diseases↗

PubMed1995

The importance of a multidisciplinary approach to the assessment of patients with obstructive sleep apnoea.

Obstructive sleep apnoea may present with a wide range of symptoms resulting in a variety of referral pathways. A multidisciplinary approach to examination and diagnosis helps to determine the most appropriate treatment plan for each individual. The subject is seen by each member of the team, appropriate investigations undertaken and a further meeting arranged at which all opinions are discussed. A reasoned treatment regime is produced, taking into consideration the patient's wishes and overall medical condition. This paper describes the team approach currently employed in the Department of Thoracic Medicine at The Prince Charles Hospital, Brisbane, Australia. The thoracic physician and ENT surgeon work in close collaboration with their dental colleagues: an orthodontist, prosthodontist and a maxillofacial surgeon. An outline of the examination and investigations made by each is described and the multidisciplinary approach is illustrated by a description of the management of five subjects with suspected obstructive sleep apnoea.

Adult↗

PubMed1996

The importance of a multidisciplinary approach to the assessment of patients with obstructive sleep apnoea.

Adult↗

PubMed1997

A descriptive study of multidisciplinary mental health staff moving to the community: the demographic and educational issues.

Mental health care philosophy has moved from the containment of patients within institutions to the integration of clients within the community. 'Caring for People' (a Department of Health report) and the subsequent legislation enshrined the philosophical shift in law. Previous policy reports had indicated that staff required training to move from hospital-based service to a community-based service, but did not propose content, and no systematic study of the needs of mental health staff has been carried out. Therefore, this study aimed to identify the skill and information needs of a group of multidisciplinary staff in preparation for the movement from hospital to community settings. The study design was a descriptive survey sampling of a total multidisciplinary population in Scotland. Data were collected using questionnaires and semistructured interviews with a small volunteer subsample of respondents. This paper presents the first set of study findings related to the demographic and educational issues. Differences between hospital and community staff and between health care assistants and qualified staff are demonstrated for demographic and educational factors. Proposals are made for managers, professionals, educators and researchers.

Community Mental Health Services↗

PubMed2004

Development and piloting of a multidisciplinary training course for detecting and managing depression in the older person.

Depression is the most common psychiatric condition found in older people. It is associated with increased mortality and adversely affects quality of life. Although the majority of depressive episodes are seen and treated in primary care, studies suggest in primary care there is under-detection and inadequate management of depression in older people. In line with national policy in the UK this paper argues that training needs to be multidisciplinary and multiagency, and meet the requirements of local needs. It outlines a course that meets the expectation that specialist mental health workers such as mental health nurses should provide training and advice for those providing care and treatment in primary care. The paper reports upon the design and evaluation of a pilot multidisciplinary training course for health professionals and voluntary sector workers in the detection and management of depression in the older person. The course consisted of three 1-day workshops and four consecutive courses were offered, with a total of 40 health professionals and voluntary sector workers completing the training. The training was evaluated using a questionnaire examining knowledge and confidence and by a scenario using an older person whom was potentially depressed. Results found a significant difference between pre- and post-test for knowledge of depression in the older person and confidence in both detecting and managing depression. Results of the scenario revealed that there was a significant change from pre- to post-test training in the type of questions participants would ask the older person to detect and assess depression. There was also a significant increase in the ability to identify types of interventions and local services available, which would help an older person with depression. The implications, limitations and future directions for research are discussed.

Aged↗

PubMed1977

Verbal communication between students in multidisciplinary health teams.

The study reported here was connected with the influence of two variables--the context in which communication occurs, and the concept availability of various health professionals--upon the verbal interaction of various health professionals. Specifically, the verbal output of health professionals in groups consisting entirely of their own professional peers (i.e. all nurses, or all medical students) was compared with that of professionals in multidisciplinary health teams. The study, in attempting to delineate possible barriers to effective verbal interaction, has important implications for the functioning of multidisciplinary health teams.

Australia↗

PubMed1978

Multidisciplinary training in family planning.

A review of 3 years' experience with multidisciplinary training in Family Planning involving representatives from nursing, medical, social work and education professions is presented. The multidisciplinary principle has been shown to be of value in this field, particularly in respect of improved communication.

Curriculum↗

PubMed2006

Orbital rhabdomyosarcoma: multidisciplinary treatment experience.

Orbital rhabdomyosarcoma (RMS) accounts for 10% of childhood RMS and has a relatively good prognosis of up to 85% 5-year survival. Improved survival has led to increased interest in late effects of treatment. The objective of this study was to review the results of treating orbital RMS with multidisciplinary treatment at Women's and Children's Hospital and Royal Adelaide Hospital with emphasis on late effects of treatment. A retrospective review was carried out of all patients with orbital RMS treated with multidisciplinary treatment including radiation therapy and chemotherapy in the two institutions between 1982 and 2002. A total of five patients (age range 5.5-12 years) satisfied the eligibility requirements. Late effects were significant and included facial bone hypoplasia, cataract formation and growth hormone deficiency. Overall survival was 80% (4/5) with mean follow up of 8 years (range 3-13 years). Given the high cure rates achieved, future treatments must aim to maintain the good results but to reduce the high incidence of late effects of treatment. Standardised rating of late toxicity, long-term follow-up clinics, and implementation of modern radiation techniques (3-D conformal radiotherapy, intensity modulated radiotherapy, proton therapy) for patients with orbital RMS are important to improving outcome.

Child↗