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PubMed1982

A multidisciplinary audit of cardiorespiratory arrest response patterns.

If a cardiopulmonary arrest occurs in your institution, will the response pattern be organized and consistent? Will the Code Blue procedure flow smoothly, with each member of the resuscitation team knowing what his responsibilities are and how to perform them? Is confusion kept to a minimum? These are the questions which our multidisciplinary Code Blue Committee was charged with answering. The committee audited four broad areas: adequacy of equipment and medication, written policies and procedures, documentation of activities, and preparedness of team members for their specific responsibilities. The multidisciplinary approach to establishing standards of practice for "Code Blues" has been very successful. As a result of the audit, specific actions were taken to correct deficiencies. In addition, the meetings provided a caucus for interdepartmental exposure and communication which has served to augment interdepartmental relationships.

Hospital Bed Capacity, 500 and over↗

PubMed1999

Multidisciplinary approach for the management of post-herpetic neuralgia in elderly patients.

Post-herpetic neuralgia is associated with significant distress and morbidity. The management of acute neuritis and/or post-herpetic neuralgia can be particularly difficult. A multidisciplinary approach is required. A team consisting of the primary care physician, pain specialist, neurologist, geriatrician, pain psychologist, psychiatrist, and a physiatrist with an integrated approach will provide the best results. Early interventional therapy with sympathetic nerve blocks may significantly decrease the need for long-term opioid therapy, as well as long-term use of anticonvulsants, antidepressants, or membrane stabilizers. Early referral to a multidisciplinary pain center may furthermore decrease the behavioral trauma and family disruption associated with this painful condition.

Aged↗

PubMed1999

Multidisciplinary case notes: an audit.

Patient records must be comprehensive, clear, accurate and updated on a regular basis. A pilot study which introduced multidisciplinary case notes to a mental health-care unit found they fulfilled these requirements. Staff who used the multidisciplinary case notes preferred them to traditional methods of record-keeping.

Attitude of Health Personnel↗

PubMed1999

[Natural histories of disease: a pragmatic approach to multidisciplinary research on health care seeking behavior and therapeutic itineraries].

Public health is determined by the interaction of social, cultural and biological factors. Because of this complexity, a multidisciplinary approach is needed when doing research on public health problems. Medical anthropology and epidemiology share a common interest for human behavior and health, so it is especially appropriate for these two disciplines to work together in studying health seeking behavior and the use of health systems. In order to better understand social and cultural factors associated with health seeking behavior, a suitable qualitative research method was needed for use in association with a medical and epidemiological approach in the research program "Use and perception of health systems by children and their family", carried out in Algeria, the Congo (Brazzaville), Morocco, and Togo. Three factors were considered important: coordinating the qualitative and quantitative research methods within a single time frame, involving all members of the multidisciplinary research teams in each country, and producing data accessible and useful to health care professionals and others responsible for health system performance. A case study method based on "natural histories of illness" was adopted, using home interviews of families about a recent illness episode of an under-5 child. There are several advantages to this approach: 1) analysis of illness episodes reveals the totality of the health seeking process, including therapeutic itineraries; 2) families have little difficulty in describing an illness episode in the order events occurred; 3) these accounts are easily understood by health professionals, resembling as they do a "clinical case study" approach; 4) the content is readily available in the form of common discourse for use by health program planners and administrators. The method is thus able to provide information necessary for organizing health services which meet the perceived needs of the population.

Algeria↗

PubMed1999

An inventory of patients' response to treatment at a multidisciplinary breath odor clinic.

OBJECTIVE: This study was undertaken to assess patients' response to their treatment at a multidisciplinary oral malodor clinic. METHOD AND MATERIALS: In 4 years, a multidisciplinary breath odor clinic in Belgium examined 406 patients. The team consisted of an ear, nose, and throat specialist, a periodontologist, occasionally a specialist in internal medicine, and, more recently, a psychiatrist. After the initial visit, each patient was scheduled for a follow-up appointment 2 to 6 months later; however, only 143 patients (35%) showed up for this control visit. The remaining 65% of the patients answered a mailed questionnaire. RESULTS: About half of the patients who returned no longer had complaints, while 17% reported no improvement. This group was characterized by imaginary bad breath and manifest psychologic problems. There was also disbelief of their cure, although clinical examination (organoleptic evaluation and volatile sulfide measurement by means of a portable monitor) did not reveal any oral malodor. Some also insufficiently performed the recommended oral hygiene measures (tongue brushing and interdental cleaning). Most of the patients who returned the questionnaire were disappointed by the suggestion that their halitosis was the result of insufficient oral hygiene. CONCLUSION: Better education of both the public and dental professionals as to the most frequent cause of halitosis, insufficient oral hygiene, might elevate the level of compliance by patients.

Adolescent↗

PubMed1999

Malignant fibrous histiocytoma of the scalp. Multidisciplinary treatment.

BACKGROUND: Malignant fibrous histiocytomas (MFH) are uncommon in the skin, and even less frequent on the scalp. On the scalp they are often very difficult to excise and it is even more difficult to close the resulting wound. OBJECTIVE: To review all malignant fibrous histiocytomas diagnosed and treated in our Department during the past 6 years, and to describe the multidisciplinary procedure employed to treat one special case of aggressive malignant fibrous histiocytoma on the scalp that recurred twice. RESULT: Malignant fibrous histiocytomas represent 0.01% of malignant cutaneous tumors in our area. The immediate results after a multidisciplinary treatment performed on a recurrent malignant fibrous histiocytoma located on the scalp were excellent, but recurrence was observed 6 months later. Two years later we have also treated another case of MFH on the scalp. The same surgical technique was performed, but the patient received high-dose-methotrexate-based neoadjuvant chemotherapy (HD-MTX). One year later, this patient is still alive and no signs of recurrence have been detected. CONCLUSION: When malignant fibrous histiocytoma occurs on the scalp it must be treated immediately by means of an excision with a large peripheral edge of 2 cm from the visual or CAT limits of the lesion, since the first treatment must be definitive.

Adult↗

PubMed2000

[Good results from a multidisciplinary and behavioral program for chronic back pain].

OBJECTIVE: To evaluate the results of a multidisciplinary and behavioral program for chronic back pain. DESIGN: Prospective cohort study. METHOD: In 1996, a total of 143 patients with chronic back pain participated in a 4-week multidisciplinary and behavioral treatment program in an outpatient centre for work reintegration (Rug AdviesCentrum) in Zeist, Eindhoven and Noordwijk, the Netherlands. At the start and six months after termination, data were collected on trunk muscle performance, pain intensity, disability and stress related physical complaints, and after 6 months about return to work, analgesics use, and health care utilization. Score differences between the first and the second measurements were tested on statistical significance using paired t-tests and on clinical relevance using the reliable change-index. RESULTS: The study group comprised 99 males and 44 females with a mean age of 41.6 years (range: 23-58). After 6 months the outcome variables were significantly improved statistically: depending on the outcome variable used, the improvement was clinically relevant in 44-91% of patients. The obtained percentage of full return to work at 6-months follow-up was 87%, while 80% had used no pain killers and 91% had made no use of health care facilities. CONCLUSION: The program resulted in important improvements in patients with chronic back pain.

Adult↗

PubMed2000

[Telemedicine: perspectives and multidisciplinary approach].

BACKGROUND: Telemedicine is use of the new computer-based communication technologies for medical purposes. It augments the exchange of scientific information, while its applications in the fields of patient care and medical education cover remote diagnosis and therapy as well as remote education and training. METHOD: This article reviews the development of telemedicine and its application to specialties such as anaesthesiology, dermatology, medicine, surgery and pathology at the University Hospital of Basle, Switzerland. RESULTS: Since 1980 the Department of Medicine has held multidisciplinary teleconferences for expert consultation and medical education. Since 1992 the Institute of Pathology has been linked to remote hospitals for real-time biopsy, and, since 1997, remote dermato-histopathological diagnosis has been performed in conjunction with a number of centres and practitioners. International academic teleconferences have been held in the field of surgery since 1986 and there is an interactive education programme via telemedicine in the field of anaesthesiology. The technology in use must be adapted to needs: since few practitioners are currently connected to the Internet, teleconferencing will still be the rule in the Department of Medicine. Remote diagnosis in dermatology and pathology requires high-resolution images transmitted by self-developed software via 64 Kb/s ISDN connection, while surgery works with ISDN teleconferencing at 384 Kb/s to ensure live transmission of surgical procedures with high-quality images. CONCLUSION: Our practice, based on several hundred cases, suggests that telemedicine is useful in simplifying and expanding access to remote interdisciplinary expertise, as well as improving medical education in a number of specialties. Telemedicine's multidisciplinary approach is to be recommended.

Humans↗

PubMed2000

Critical care bug team: a multidisciplinary team approach to reducing ventilator-associated pneumonia.

BACKGROUND: Ventilator-associated pneumonia rates in the medical-surgical intensive care unit first exceeded the 90th percentile in September 1997 and were significantly (P <.05) higher than National Nosocomial Infections Surveillance System pooled mean data. In January 1998, a multidisciplinary "Critical Care Bug Team" was developed by the Infection Control Committee to review 1997 National Nosocomial Infections Surveillance System data for four adult intensive care units in a 583-bed tertiary care hospital. METHODS: Membership included clinical nurse specialists, a dietitian, a pharmacist, a respiratory therapist, an infection control professional, a research specialist, and a physician adviser. Having the team report directly to the hospital's Infection Control and Adult Critical Care Committees maximized support for recommendations and provided a direct link from patient care to hospital administration. By identifying issues, evaluating patient care processes, performing literature searches, and monitoring compliance, the team implemented numerous interventions, including policy and procedure changes, purchasing of equipment, and implementation of various education tools. RESULTS: Each member of the Critical Care Bug Team contributed to a synergized effort that may have produced the desired outcome of decreasing ventilator-associated pneumonia rates. Except for August 1998, ventilator-associated pneumonia rates have been below the 75th percentile since May 1998. CONCLUSION: This study illustrates the effectiveness of a multidisciplinary team approach devised to reduce and stabilize ventilator-associated pneumonia rates in a medical-surgical intensive care unit.

Adult↗

PubMed1999

[Multidisciplinary management of malignant hepatic tumors in children: a recent national experience].

BACKGROUND: Malignant hepatic tumors (Mht) are rare in children. Among them hepatoblastoma (HB) is the most common. AIM: To report the results of the multidisciplinary management in 6 consecutive children: five HB and one metastatic Wilms tumor (MWT). PATIENTS AND METHODS: The mean age of patients was 42 months. All HB patients had elevated serum alfafetoprotein (median 150,000 ng/ml). All patients received preoperative chemotherapy: HB patients received carboplatin/doxorubicin alternating with cisplatin, and the MWT patient, vincristine alone. Surgery included two formal right and two formal left hepatectomies, one extensive central resection with partial left segmentectomy, and one lateral segmentectomy. Extracorporeal circulation was used in the child with atrial involvement. All patients received postoperative chemotherapy. RESULTS: All tumors had variable regresion on preoperative chemotherapy. Complete resection with negative margins was achieved in all patients. The degree of tumor necrosis on histology ranged from 60% to 90%. Alfafetoprotein levels fell to under 10 ng/ml in all HB cases, one to three months after surgery. All patients survive free of disease at a median follow up of 19 months. CONCLUSION: A multidisciplinary approach including the well timed used of chemotherapy and surgery is highly effective in the management of pediatric malignant tumors.

Child↗

PubMed2000

The multidisciplinary clinic approach to prostate cancer counseling and treatment.

The optimum management for an individual patient with prostate cancer is not well defined. Patients with localized disease may be offered options ranging from observation, hormonal therapy, cryotherapy, radiation therapy, or surgery. Each option may have unique aspects to consider when counseling a patient often leading to multiple physician visits over an extended period of time. Since 1996, the Kimmel Cancer Center of Thomas Jefferson University has offered newly diagnosed urologic cancer patients the opportunity to be evaluated in a multidisciplinary clinic. Here, multiple physician consultative visits, including pathologic and radiologic evaluation and protocol evaluation, are provided during the session. Herein we report on our experience with this multidisciplinary approach for patients with prostate cancer.

Cancer Care Facilities↗

PubMed2000

[Up to date of multidisciplinary treatments centering around hepatectomy for advanced liver cancer in stage IV-A].

Patients with advanced Stage IV-A primary liver cancer, hepatocellular carcinoma (HCC) can be divided into subgroups: those with involvement of a major branch of the portal (Vp3) or hepatic (Vv2, Vv3) veins and those having multiple tumors in both lobes without Vp3 or Vv2, Vv3. The prognosis of Stage IV-A patients with Vv2 or Vv3 may be improved by extended hepatectomy with resection and reconstruction of hepatic veins or IVC. In those with Vp3, multidisciplinary treatments consisting of extended hepatectomy and adjuvant chemotherapy, i.e. intra-arterial injection or TACE, are thought to be feasible at the present, but the outcomes are still poor. On the other hand, there are some Stage IV-A patients with multi-centrical tumors who have multiple tumors in both lobes without major vascular invasion, and their prognoses are improved by partial resection of each tumor. However, when there are multiple tumors caused by intrahepatic metastases, multidisciplinary treatments consisting of reduction surgery, microwave ablation, ethanol injection, and intra-arterial chemotherapy might be useful at present.

Aged↗

PubMed2000

[Infective endocarditis: short and long-term results in 261 cases managed by a multidisciplinary approach].

BACKGROUND: Early diagnosis, an effective treatment and prompt recognition of complications are essential to improve the prognosis of infective endocarditis (IE). AIM: To report the results of a multidisciplinary approach to diagnosis and management of patients with IE at the Universidad Católica de Chile Hospital. PATIENTS AND METHODS: The clinical history, diagnosis, treatment and outcome of 261 episodes (Duke criteria) of IE admitted between January 1980 and January 1999 were analyzed. These included 185 episodes of native, 73 of prosthetic valve and 3 of nonvalvular IE. RESULTS: Sixty nine percent of patients were men and the mean age was 49 +/- 16 years. Seventy five percent had a definite diagnosis of IE (Duke). S. viridans, staphylococci and enterococci together constituted 85% of the isolated bacterial strains. Twenty seven had culture-negative IE, related to a high incidence of antibiotic therapy prior to diagnosis. Transesophageal echocardiography was performed in 102 cases and it detected vegetations in 91% of aortic and 96% of mitral IE, rupture or prosthesis dehiscence in 67% of aortic and 52% of mitral IE and abscesses in 51% of aortic and 15% of mitral IE. Fifty one percent developed heart failure and 34% had embolic events. S. aureus IE was associated to a higher incidence of embolic events, complications which contraindicated surgery and increased mortality rate (27%). Of all patients, 40% were treated exclusively with antibiotics, 52% were operated on and 8% had surgical indication but were nonoperable because of serious complications. The overall mortality was 16.3%: 13% in the medical, 9% in the surgical and 81% in the non-operable groups. The type of treatment and mortality rates did not differ between IE of native valves and prosthetic valves. Long term follow up showed survival rates of 73% at 5 years and 66% at 10 years. CONCLUSION: A multidisciplinary approach may be very helpful to improve the prognosis of IE.

Adolescent↗

PubMed2000

Preliminary evaluation of medical outcomes (including quality of life) and costs in incident RA cases receiving hospital-based multidisciplinary management.

A six-month, prospective descriptive study of medical outcomes (including quality of life) and costs was conducted in 20 incident cases of rheumatoid arthritis (RA). Multidisciplinary management was started during an inpatient stay at the beginning of the study. Patients were evaluated on a day-hospital basis three and six months later. The following parameters were studied: quality-of-life scores on a generic scale (the Nottingham Health Profile [NHP]) and two specific scales (Health Assessment Questionnaire [HAQ] and the short-form Arthritis Impact Measurement Scale [AIMS]), pain severity, disease activity assessed by the patient and physician, painful and swollen joint counts, erythrocyte sedimentation rate, and C-reactive protein level. The following costs were evaluated: laboratory tests, plain radiographs, other investigations, physician care (by rheumatologists or other specialists), second-line drug therapy and monitoring for its side effects, care by nurses, physical therapy, and occupational therapy. All patients showed significant improvement three months after initiation of multidisciplinary management. This effect was sustained through the sixth month. Quality-of-life scores improved, with the exceptions of the social isolation subscore on the NHP and the psychological impact, social activity, and occupational activity subscores on the short-form AIMS. Mean total cost for the six-month period was 3429 +/- 880 euros (1 euro = 6.6 FF). Laboratory tests contributed the largest portion of the total cost (39%), followed by rheumatologist care (16%); the other costs accounted for 7.6 to 9.2% of the total cost. This prospective medical and economic study is preliminary. Comparative studies are needed.

Arthritis, Rheumatoid↗

PubMed2000

Restorative dentistry using a multidisciplinary approach.

Multidisciplinary treatment was essential for this patient to optimally manage the occlusion and missing teeth. When the space distribution was completed, ridge management procedures for pontic site development were accomplished. The final restorative treatment required was actually minimized to a 7-unit fixed partial denture. It was apparent the multidisciplinary treatment was essential to predictably manage this patient by decreasing risk and ensuring a long-term strategy for enhanced patient satisfaction.

Adolescent↗

PubMed2000

A multidisciplinary renal osteoporosis clinic: a new role for the nephrology nurse.

Osteoporosis is one form of osteodystrophy that may be treated and/or prevented with a comprehensive approach. At the University of North Carolina at Chapel Hill, we created a multidisciplinary kidney osteoporosis clinic with a nephrology nurse at the center of patient care. This article will describe the development of our clinic, our multidisciplinary approach to patient care, and how the nephrology nurse is uniquely qualified for the central role in the care of these patients. Preliminary outcome data is described, demonstrating the positive effect our clinic has had on patient care. A description of the pathogenesis and treatment of osteoporosis in renal patients is also given to provide background for the reader.

Ambulatory Care Facilities↗

PubMed2001

[Necessary multidisciplinary management of diabetic foot].

The pathogenesis of diabetic foot is multifactorial and optimal management requires a multidisciplinary team. In most cases, the diabetic foot complication is seen as a wound subsequent to trauma, less often as an acute neuroarthropathy or cellulitis without any apparent skin lesion. Patients look for medical care more or less rapidly, depending on the information received previously concerning foot problems. The patient may consult a general practitioner or sometimes directly attend a diabetic foot clinic. The efficiency of treatment depends on early diagnosis, a specific etiology-guided approach to wound care and management of diabetes mellitus. A multidisciplinary team is needed to provide optimal care for foot wounds and neurological, vascular and infections complications, and to control blood glucose in a global approach to management of the diabetic patient. The team must coordinate the actions of its different members, the goal for all being to obtain not only foot healing but also optimal foot function. This requires experience in surgery of the diabetic foot. Creation of special diabetic foot units has been proposed to manage diabetic patients with foot pathologies as outpatients or inpatients when necessary.

Algorithms↗

PubMed2001

[Multidisciplinary investigation is best for children with learning disabilities. Too critical attitude to diagnoses can keep the disorders hidden].

This article presents evidence of the importance of multidisciplinary assessment of students with learning disabilities. Multidisciplinary collaboration between different professions provides a more complete picture of each person's unique requirements, thereby facilitating more appropriate teaching. A critical attitude toward diagnosing students with learning disabilities may result in exaggeration of psychosocial problems, thereby running the risk that genuine learning disabilities, neurological problems or other disorders are being overlooked.

Attitude of Health Personnel↗