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Results for “multidisciplinary team”

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PubMed2004

Cancer control after low-dose-rate prostate brachytherapy performed by a multidisciplinary team with no previous prostate brachytherapy experience.

OBJECTIVES: To describe the biochemical disease-free survival observed in the first cohort men treated by a multidisciplinary team of clinicians with no previous experience in low-dose-rate prostate brachytherapy (LDRPB). METHODS: The information in this report concerns the first 63 men treated with LDRPB alone at our institution between September 1997 and September 1998. All men had histologically confirmed, clinically localized prostate cancer. All men were treated with iodine 125 according to published methods. The prescription dose was 144 Gy according to the Task Group 43 formalism. LDRPB was performed jointly by a radiation oncologist and urologist. Three definitions of biochemical recurrence were used: the American Society for Therapeutic Radiology and Oncology consensus definition; prostate-specific antigen level greater than 0.4 ng/mL at last follow-up; and prostate-specific antigen level greater than 0.2 ng/mL at last follow-up. Biochemical relapse-free survival was estimated using the product-limit method. Putative covariates for biochemical relapse-free survival were examined using the proportional hazards regression model. All P values are two-sided. RESULTS: The median follow-up for the entire cohort was 62 months. Of the 63 men, 45 (71%) had more than 60 months of follow-up. The median pretreatment prostate-specific antigen level was 6.68 ng/mL (range 1.1 to 23), and most men (44 of 63; 70%) had nonpalpable disease. The institutionally assigned Gleason score was less than 7 in 54 men (86%). Nine men developed evidence of biochemical relapse at a median of 19 months (range 6 to 38). The 5-year estimate of biochemical relapse-free survival was 85% (95% confidence interval 80% to 90%), 80% (95% confidence interval 74% to 86%), and 70% (95% confidence interval 64% to 76%) according to the three definitions given above. CONCLUSIONS: The biochemical results achieved in the first cohort of men treated with LDRPB by a previously inexperienced multidisciplinary team of clinicians are similar to the results reported from centers with extensive LDRPB experience.

Aged↗

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↗

PubMed1995

Outpatient planning for persons with physical disabilities: a randomized prospective trial of physiatrist alone versus a multidisciplinary team.

The purposes of this study were to assess the effect of adding a physiatrist to the usual community management of persons with complex disabilities, and to determine whether there were differences in decision making and patient outcome between evaluations by a physiatrist alone or with a multidisciplinary team in this population. Consecutively referred patients with functional complaints in two of the following areas, mobility, activities of daily living, emotions and cognition, work, or social support, were randomly assigned to a multidisciplinary outpatient team evaluation or physiatrist evaluation in an office setting. Forty persons, 21 team and 19 office, served as subjects. For the entire group, functional assessment scores before and after evaluation were as follows: Barthel index 71.79 versus 76.47 (p < .008) and Frenchay Activities index 9.97 versus 11.32 (p < .05) Wilcoxon Signed Ranks test. Patients quality of life differences were significant (p < .03 or less by Wilcoxon). Most differences between team and physiatrist were not shown to be statistically significant in this small population. Physiatric evaluation, with or without a multidisciplinary team, can improve outpatient functional status and quality of life for persons living in the community with complex disabilities.

Adolescent↗

PubMedDate not supplied

[Economic assessment of the implementation of a parenteral nutrition protocol for patients undergoing intestinal resection by a multidisciplinary team].

OBJECTIVE: An economic assessment on the impact of total parenteral nutrition guidelines developed by the Hospital Nutrition Committee for patients undergoing intestinal resection and implemented by a nutritional support multidisciplinary team, was conducted. METHOD: A comparative retrospective study of two consecutive annual periods before and after the implementation of total parenteral nutrition guidelines for patients undergoing intestinal resection developed by the Nutrition Committee was carried out. Cost-effectiveness analysis from the hospital perspective was performed with the pharmacoeconomic program Pharma-Decision Hospital. Effectiveness was assessed as nutritional gain and safety profile; as well as determination of the costs of acquisition, preparation, administration, monitoring and nutritional complications. Sensitivity analysis (+/-20%) of effectiveness and hospital stay. RESULTS: Among 326 patients hospitalized for intestinal resection, 69 out of 172 (40%) received parenteral nutrition during the early period, versus 40 out of 154 (26%) after the surgery procedure (p < 0.01). In 79% of the patients with parenteral nutrition, the adequacy of the indication was assessed, being adequate in 51.7% and 56.7%, respectively (p = 0.66). Nutritional gain before and after surgery was similar (78.3 vs. 82.5%, p > 0.05), with patients having less episodes of hypophosphatemia postoperatively (60 vs. 38%). Mean total cost per patient before and after surgery was 9,180.81 and 7,871.96, respectively. The sensitivity analysis confirmed the above results. CONCLUSIONS: The development of total parenteral nutrition guidelines by the Nutrition Committee for surgical patients undergoing intestinal resection and their implementation by a multidisciplinary team improved the use of parenteral nutrition and reduced associated costs, with the same nutritional evolution.

Aged↗

PubMed2001

Care planning and case conferencing. Building effective multidisciplinary teams.

BACKGROUND: The new Medicare items that cover care plans and multidisciplinary case conferences for patients with complex and chronic medical conditions have introduced new challenges in primary health care. General practitioners may be required to develop new skills if they are to work effectively with other professionals and carers where health is not their only priority. OBJECTIVES: This paper reports briefly on findings from a particular research project into the key factors that contribute to effective multidisciplinary teams. Principles from this research that can be applied to GPs being involved in multidisciplinary care plans and case conferences will be examined. DISCUSSION: Key factors discussed include the importance of efficiency, flexibility, an holistic view of the patient, communication and personal and professional characteristics that contribute to a successful outcome in multidisciplinary patient care.

Australia↗

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↗

PubMed2003

The multidisciplinary team approach to the outpatient treatment of disordered eating.

The multidisciplinary team approach to the patient with disordered eating is widely recognized as the best practice. Team members include a physician, a nutritionist, and a mental health professional. All should be experienced in the care of individuals with disordered eating. Each member of the treatment team has unique skills and responsibilities with respect to patient care. However, there is considerable overlap in what each member of the treatment team does to promote recovery from disordered eating. It is important to remember that eating problems exist on a spectrum from disordered eating behaviors that do not meet the Diagnostic and Statistical Manual of Mental Disorders criteria, to anorexia nervosa, and bulimia nervosa. Prognosis is directly related to duration of illness, so early intervention, even when symptoms may be minimal, is preferable. Despite multi- disciplinary treatment efforts, overall prognosis is poor, with only 40% to 50% of patients with anorexia nervosa and bulimia nervosa progressing to complete recovery. Continued efforts and early, comprehensive intervention must be undertaken by all practitioners.

Ambulatory Care↗

PubMed2001

Successful prevention of hiv transmission from mother to infant in Brazil using a multidisciplinary team approach.

OBJECTIVES: To determine the HIV vertical transmission rate (VTR) and associated risk factors by use of zidovudine and infant care education in Brazil. METHODS: Since 1995, a prospective cohort of HIV infected pregnant women has been followed at the Federal University of Rio de Janeiro. A multidisciplinary team was established to implement the best available strategy to prevent maternal-infant HIV transmission. Patients with AIDS or low CD(4) and high viral load received anti-retroviral drugs in addition to zidovudine. Children were considered infected if they had 2 positive PCR-RNA tests between 1 and 4 months of age, or were HIV antibody positive after 18 months. Education regarding infant treatment and use of formula instead of breast feeding was provided. RESULTS: Between 1995 and August, 2000, HIV status was determined for 145 infants. Compliance with intra-partum treatment, infant treatment and use of formula was 88.2%. Intra-partum zidovudine treatment was completed in 134/145 (92.6%) of patients; 88.1% had rupture of membranes < 4 hours; 85.4% of mothers were asymptomatic. The mean CD(4) count was 428.4 cells and mean viral load 39,050 copies. HIV vertical transmission rate was 4/145 (2.75%; CI: 0.1%-5.4%). The only risk factor significantly associated with transmission was a failure to use zidovudine intra-partum in 2 of the 4 mothers (50% versus 6.4% in non-transmitting mothers). A trend toward low CD(4) and high viral load at entry, and rupture of membranes > 4 hours were associated with increased HIV transmission. CONCLUSION: HIV vertical transmission in Brazil was reduced to a level similar to other countries with the most effective prevention programs using a multidisciplinary team approach. A high level of compliance for use of anti-retroviral drugs, the provision of health education to mothers, and use of formula for all exposed infants.

Adolescent↗

PubMed1994

The healing process for the multidisciplinary team: recovering post-inpatient suicide.

1. With an inpatient suicide, the staff may experience grief for a variety of reasons. The staff member's perception of self as a competent mental health care provider may be destroyed. The caregiver may grieve the loss of an ideal. Some inpatient staff members mistakenly believe that suicide can always be prevented and that the multidisciplinary team can accurately assess all patients. 2. To successfully mourn a loss, Worden (1982) identified four tasks of grieving that must be completed: accept the reality of the loss; experience the pain of grief; adjust to an environment in which the deceased or lost object is missing; and withdraw emotional energy and reinvest it in another relationship. 3. Interventions to promote healing post-inpatient suicide must be aimed at individual caregivers and the multidisciplinary team. Individual caregivers will differ in their responses based on experiences, beliefs, values, and culture.

Attitude of Health Personnel↗

PubMed2002

Intensive diabetes education program and multidisciplinary team approach in management of newly diagnosed type 1 diabetes mellitus: a greater patient benefit, experience at Siriraj Hospital.

It is accepted worldwide that an effective multidisciplinary management team is essential for providing comprehensive self-management training to type I diabetics and their families. Therefore, the authors developed an intensive multidisciplinary education team that included pediatric endocrinologists, a dietitian, a psychologist, nurses, scientists and volunteers in the Department of Pediatrics, Siriraj Hospital in August 1996. This study aimed to analyze twenty-four newly diagnosed diabetics who underwent this specified program and multidisciplinary team approach in comparison to twenty-eight diabetic patients who were diagnosed before the program and team were established in order to see whether the length of hospitalization had been reduced and to compare the readmission rates of recurrent DKA with previous patients. The results demonstrated that by using the intensive program and multidisciplinary team the average length of admission was reduced from 36.04 days to 17.63 days (p value = 0.03). The readmission rate in the first year after diagnosis was also reduced from 17.8 per cent to 4 per cent. Concerning diabetes control, the average HbA1c level showed significantly better control. Therefore, this study demonstrated a successful team and program for newly diagnosed Thai childhood and adolescent diabetics and also emphasized that a multidisciplinary team approach with an effectively intensive education program is important in helping diabetics and families cope with their emerging problems and receive the long-term benefits of effective self-care.

Adolescent↗

PubMed1989

Prospective evaluation of weight gain in both nonorganic and organic failure-to-thrive children: an outpatient trial of a multidisciplinary team intervention strategy.

Failure-to-thrive (FTT) is categorized as organic (OFTT) or nonorganic (NFTT). Traditionally, it has been taught that children with OFTT are unable to grow well in spite of adequate care (calories, nurturance, medical supervision), whereas NFTT children will grow well when given adequate care. We undertook this study to determine whether NFTT and OFTT children could grow at similar rates when treated by a specialized multidisciplinary team that provided concrete, individualized therapies including psychosocial support, medical care, and hypercaloric diets. Eighty-six children were enrolled on referral to our outpatient FTT consultative clinic; 64 had NFTT and 22 had OFTT. Growth quotient analysis was used to determine growth outcomes over a 6-month follow-up period. Growth at a rate paralleling the growth curve produces a GQ equal to 1. Growth 2 times as rapid as expected gives a GQ = 2. Children in both groups grew extremely well. For NFTT, GQ = 1.67 +/- 0.56 (SD); for OFTT, GQ = 1.81 +/- 0.37 (SD), p = NS. OFTT children grew just as well as NFTT children when given adequate calories for catch-up growth. Our data indicate that weight gain alone cannot reliably differentiate OFTT from NFTT, as has been traditionally taught. They suggest that we make every attempt to maximize caloric intake in FTT children. They also suggest that a multidisciplinary team consisting of a pediatrician, child psychiatrist, nutritionist, nurse clinician, and social worker may be successful in managing FTT children.

Behavior Therapy↗

PubMed1987

Multidisciplinary teams in consultation-liaison psychiatry: the Yale model.

The consultation-liaison service at Yale features integrated teams of psychiatrists, social workers, and clinical nurse specialists working together in both consultation and outpatient settings. The model is based on the tenets that (1) comprehensive evaluation of patients is essential for effective treatment; (2) role definition is necessary for specific disciplines, including the definition of overlapping and separate areas of expertise and practice. The multidisciplinary teams are coordinated by a psychiatric resident, who is supervised by an attending psychiatrist. The role of the resident is that of a diagnostician and coordinating physician. The social worker functions as an expert in family evaluation and treatment, and the nurse specialist functions as supportive therapist and liaison with the nursing staff. The structure of the division of consultation-liaison and ambulatory services at Yale is described and the advantages and disadvantages of the multidisciplinary team concept are discussed in comparison with other models of consultation-liaison psychiatry.

Combined Modality Therapy↗

PubMed2002

A multidisciplinary team approach to reducing medication variance.

BACKGROUND: In March 2000 a multidisciplinary team was formed at Williamsburg Community Hospital (Williamsburg, Virginia) to address medication-related patient safety initiatives. MEDICATION SAFETY TEAM: The team focused on promoting a nonpunitive reporting environment, developing a collaborative medication administration policy, and designing an education and communication plan that promoted safe medication practices. In creating a nonpunitive environment, the first step was to revise the medication variance reporting policy. The team focused on process improvement and removed all references to corrective action from the policy. It launched an extensive educational effort throughout the hospital to raise awareness of the change in policy and to increase the focus on patient safety initiatives. The team also oversaw development of a comprehensive medication administration policy, which consolidated nursing, physician, and pharmacy practices. The team implemented a number of quick fixes that generated momentum and provided some immediate successes. RESULTS: Within a 9-month period (May 2001-January 2002), the number of reports doubled. As the number of variance reports increased, a subcommittee formed, with the specific responsibility of reviewing the reports on a weekly basis. DISCUSSION: The team sought to change the environment and attitudes related to medication variances and reporting. This was an organization wide change that required employees to change their perceptions regarding the purpose of reporting. Implementing the changes in small bites to realize immediate successes helped provide the impetus to keep the team focused and energized in tackling this huge endeavor. The team provided the ability to solve problems and recommend changes quickly and effectively from a variety of perspectives.

Attitude of Health Personnel↗

PubMed2001

Working with a multidisciplinary team in secure psychiatric environments.

1. Research on working with a multidisciplinary team in inpatient mental health care is underdeveloped. 2. Knowledge of how to work as part of a team is taken for granted within the realm of professional training. 3. In effective teams, members value the support, knowledge, and professional development that membership offers. 4. Training teams to be more effective requires diverse educational strategies.

Attitude of Health Personnel↗

PubMed1994

Management of ovarian cancer: referral to a multidisciplinary team matters.

Differences in survival outcome for patients with ovarian cancer in Scotland led to an investigation of whether these differences were due to variation in presenting prognostic features or to the organisation and delivery of cancer services. A retrospective study of all 533 cases of ovarian cancer registered in Scotland in 1987 was carried out. After adjustment for age, stage, pathology, degree of differentiation and presence of ascites, survival improved when patients (1) were first seen by a gynaecologist (P < 0.05); (2) were operated on by a gynaecologist (P < 0.05); (3) had residual disease of less than 2 cm post-operatively (P < 0.001); (4) were prescribed platinum chemotherapy (P < 0.05); and (5) were referred to a joint clinic (P < 0.001). When gynaecologists operated the likelihood of smaller residual disease increased (P < 0.001). The improved survival from management by a multidisciplinary team at a joint clinic was not solely due to the prescription of platinum chemotherapy. The results of this study support the contents of the 1991 Department of Health report on present acceptable practice in the management of ovarian cancer, circulated to gynaecologists and surgeons in Scotland in 1992. The new finding that in a common cancer management by a multidisciplinary team at a joint clinic directly affects survival requires urgent attention.

Aged↗

PubMed1995

Family involvement in multidisciplinary team evaluation: professional and parent perspectives.

For many children and families, a multidisciplinary team evaluation is their introduction to special education systems. Increasingly, federal guidelines mandating parent involvement in all aspects of service provision have meant that parents are being asked to participate as part of the evaluation team. If families and professionals are to serve as partners in the evaluation process, mutual respect and understanding of one another's perspectives will be crucial. This paper uses survey data from 39 parents and 81 professionals to examine the various expectations and perceptions brought by participants to the assessment process. Results indicated that there is substantial variability of perceptions among parents and professionals about the nature of child assessment and their respective roles in it. Implications for research and practice are discussed, along with techniques for involving families in the assessment process in more meaningful ways.

Adolescent↗

PubMed1975

A psychiatric POMR for use by a multidisciplinary team.

A psychiatric problem-oriented medical record designed for use by multidisciplinary teams was introduced at Fairfield Hills Hospital in Newtown, Connecticut, in 1972. The need for revision in the hospital's medical record system had been pointed up by the development of the teams, which shared more equally in responsibility for patient care, and by problems in meeting Medicare standards. The authors describe the various forms that make up the POMR. Most of the forms are completed by the teams in regularly scheduled conferences.

Connecticut↗

PubMed1980

Multidisciplinary team malfunctioning on a state hospital unit: a case study.

The use of multidisciplinary teams in the care of psychiatric patients can be countertherapeutic unless attention is paid to the dynamics of team functioning. The authors present a case study of team malfunctioning on an inpatient unit in a state hospital that resulted from staff's role confusion and insecurity. Patient care was relegated to second place as major interpersonal conflicts among the staff were played out along ethnic and cultural lines. Resolution of the conflicts required identifying their source, clarifying staff roles, and initiating a special inservice training program focused primarily on the needs of paraprofessional staff.

Aggression↗