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Results for “multidisciplinary”

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PubMed2001

Multidisciplinary care in head and neck cancer.

Head and neck cancer treatment is uniquely suited to multidisciplinary care. A comprehensive list of essential participants consists of a broad spectrum of health care professionals. A spirit of cooperation and mutual respect is the foundation for the synergy that results in the best possible patient care. Reconstructive surgery has emerged as a sophisticated subspecialty that fills a critical role restoring the head and neck patient to maximal health and well-being. The concept of multidisciplinary care, pioneered at the nation's comprehensive cancer centers, should be adopted universally by clinicians seeking to offer the patient with head and neck cancer the best care.

Head and Neck Neoplasms↗

PubMed2001

Multidisciplinary model of occupational health services. Medical and non-medical aspects of occupational health.

Since 1950, the International Labour Organization (ILO) and the World Health Organization (WHO) have had a common definition of occupational health. The definition was adopted by the Joint ILO/WHO Committee on Occupational Health at its First Session (1950) and revised at its 12th Session (Geneva, November 1995). Occupational health should aim to promote and maintain the highest degree of physical, mental and social well-being of workers in all occupations; to prevent amongst workers the departure from health caused by their working conditions; to protect workers in their employment from risk resulting from factors adverse to health; to place and maintain workers in an occupational environment adapted to their physiological and psychological capabilities; in summary, to adapt work to the workers and each worker to his or her job. According to the ILO Convention No. 161/1985 (1) and the 1996 WHO Global Strategy on Occupational Health for All, to protect the worker against sickness, disease and injury arising out of his or her employment, the establishing of occupational health services for all workers is recommended. The Convention as well as the Strategy emphasize the importance of multidisciplinary approach and multisectoral collaboration. It is evident that during the last decades of the 20th century, the concept of occupational medicine and occupational health has been changed. Occupational health services mean services entrusted with essentially preventive functions. Is there still a room for medical services provided by occupational physicians? The dominance of medical professionals seems to disappear in the modern multidisciplinary model of Occupational Health Services.

Europe↗

PubMedDate not supplied

[Multidisciplinary approach to the patient with oropharyngeal dysphagia].

The Dysphagia Study Group of the Regional Hospital of Treviso uses a multidisciplinary approach to assess patients with oro-pharyngeal dysphagia. From 1996 to 2000, 208 patients with functional dysphagia were studied by the Group. Dysphagia was due to neurological disease in more than 50% of patients, to surgery in 25% and to a functional disease in 17%. In patients less than 20 years old the aetiology was due to the aftermath of traumas; in patients aged from 20 to 45 years the cause was a functional disease or achalasia, while in the majority of the older patients, aged over 45, had cerebral ischaemic lesions. The majority of patients (78%) were submitted to rehabilitation, 9.5% to medical treatment and 2.8% to surgery. Oro-pharyngeal dysphagia calls for a multidisciplinary approach in qualified centers with specialized facilities.

Adult↗

PubMedDate not supplied

[Outcome after an intensive, holistic and multidisciplinary rehabilitation program after traumatic brain injury. Medico legal values].

INTRODUCTION: This paper was designed to evaluate the integral rehabilitation treatments for patients with traumatic brain injury; data about efficiency of the C.RE.CER. intensive, holistic and multidisciplinary rehabilitation program is given. PATIENTS AND METHODS: The study was done keeping in mind not only the clinical aspects of rehabilitation, but also setting it within the judicial realm in which a great number of brain injury cases are found, mainly when caused by traffic accidents. A sample of 10 severe traumatic brain injury patients was studied, aged between 19 and 39. All the patients were assessed at the beginning and the end of the treatment, using a neuropsychological test battery, meanwhile were treated with the C.RE.CER. intensive, holistic and multidisciplinary rehabilitation program. RESULTS AND CONCLUSIONS: The results show a high efficiency of treatments in the majority of the patients, with reductions of more than 70% in emotional deficits and more than 60% in the global recovery of the patients that carried out the programs. This paper also shows some limitations of the criteria for compensation in Spanish legislation.

Adult↗

PubMedDate not supplied

[Fournier syndrome: multidisciplinary approach].

Fournier's gangrene, a form of necrotizing fasciitis, is an uncommon, fulminant, rapidly progressing subcutaneous infection of the scrotum and genito-perineal region, and may occur in all age groups. Most cases involve a mixed synergistic infection of aerobic and anaerobic bacteria, and occur as a result of one of this mechanisms: local trauma, extension from a perineal, periurethral or ischiorectal infection. It is associated with a high mortality rate. Predisposing factors included diabetes mellitus, steroids or chemotherapy, alcohol abuse, malignancy and radiation therapy. This disease requires prompt treatment: early diagnosis, antibiotic therapy, nutritional support, immediate extensive surgical debridement and hyperbaric oxygen therapy. The use of etherologue serum is a valuable adjunct in the therapy of Fournier's gangrene. We report a case of Fournier's syndrome treated with etherologue serum immuno-therapy, together with the conventional multidisciplinary approach. The postoperative course was uneventful and the patient was discharged on day 50 post intervention in good general conditions. The 3 years follow-up showed no recurrence of the disease. In conclusion we remark that the survival can be improved in patients with Fournier's gangrene by multidisciplinary approach.

Combined Modality Therapy↗

PubMed2002

Osteoporosis prevention project: a model multidisciplinary educational intervention.

Osteoporosis is a systemic metabolic disease resulting in low bone mass, which increases the risk for fracture. Evidence suggests that lifestyle changes to prevent or delay development of osteoporosis should be implemented throughout the life span. The purpose of this study was to evaluate the effectiveness of a multidisciplinary primary osteoporosis prevention program for community-dwelling women aged 25 to 75 years to determine if osteoporosis prevention program participants (treatment group) increased their knowledge of osteoporosis, calcium intake, and exercise compared with a control group. Other outcomes included participants' willingness to adopt lifestyle changes and ability to view themselves as able to make behavioral changes. Subjects in the treatment group versus control subjects increased their knowledge of osteoporosis over time. At posttest, subjects in the treatment group were more likely to be planning to change calcium intake, and at follow-up, they were more likely to be changing their calcium intake. No other group differences were found between the two groups. These findings suggest that a multidisciplinary education program may have an impact on knowledge and behaviors that may help to delay the development of osteoporosis.

Adult↗

PubMedDate not supplied

Treatment of homebound mentally ill elderly patients: the multidisciplinary psychiatric mobile team.

Authors evaluated the general feasibility of using a multidisciplinary psychiatric mobile team model for homebound elderly patients. Information was collected with a semistructured interview on 235 homebound elderly patient referrals over a 2.5-year period. Ninety-three subjects were accepted into the program; 12.9% of those accepted required psychiatric hospitalization during the follow-up. Maintaining individuals in the community was achieved with intense case management and significant increases in home-care hours. The multidisciplinary team approach appeared to lessen psychiatric disability in homebound mentally ill elderly patients.

Aged↗

PubMed2002

[Multidisciplinary cooperation in surgical treatment of complex head and neck tumor].

OBJECTIVE: To study the multidisciplinary cooperation in surgical treatment of complex head and neck tumors. METHODS: The data from 22 patients with head and neck tumors who had been given neurosurgery, orthopaedic surgery, plastic and otological surgery were reviewed from April 1995 to June 2000. RESULTS: Eight of 14 cases of benign tumors had been resected radical; 5 of 8 malignant cases had been moval of macroscopic tumor and 3 received operation for symptom improvement. No surgical death and serious complications were observed. The recurrence rate benign tumors was 21.4% (3/14), all of which were operated on at other hospitals. Follow-up for a year showed that in 8 cases of malignant tumors, 3 were tumor free, 2 survived with tumor, and 3 died. CONCLUSIONS: To obtain good outcome in treatment for patients with complex tumors of head and neck, cooperative efforts between multidisciplinary surgery are necessary.

Adolescent↗

PubMed2002

A multidisciplinary approach to nonpharmacologic pain management.

The multidisciplinary pain management team is the optimal method for delivery of comprehensive treatment to patients in pain. The biopsychosocial model of pain considers multiple factors for assessment, diagnosis, and treatment of pain. A structured approach to nonpharmacologic pain management includes medical and psychological interventions to educate and to empower patients to manage pain. Relaxation training, biofeedback, hypnosis, imagery, and cognitive-behavioral therapy are nonpharmacologic treatment modalities recommended by multidisciplinary pain management teams for effective pain control.

Behavior Therapy↗

PubMed2002

Aesthetic design preservation in multidisciplinary therapy: philosophy and clinical execution.

Complex perio-prosthetic cases that require multidisciplinary therapy often result in compromised aesthetics. Traditional treatment planning philosophies, as well as existing interdisciplinary relational patterns, do not promote the achievement of predictable aesthetic results. Implementation of a restorative-driven approach requires the development of an aesthetic blueprint that will serve as a guide through treatment. This article illustrates the clinical techniques and sequence for an outcome-based protocol that enhances therapeutic cohesiveness and ensures the sequential transfer of design objectives for the preservation of aesthetics in multidisciplinary therapy.

Dental Impression Technique↗

PubMed2002

Systematic detection and multidisciplinary care of delirium in older medical inpatients: a randomized trial.

BACKGROUND: Delirium is common and often goes undetected in older patients admitted to medical services. It is associated with poor outcomes. We conducted a randomized clinical trial to determine whether systematic detection and multidisciplinary care of delirium in older patients admitted to a general medical service could reduce time to improvement in cognitive status. METHODS: Consecutive patients aged 65 or more who were newly admitted to 5 general medical units between Mar. 15, 1996, and Jan. 31, 1999, were screened with the Confusion Assessment Method within 24 hours after admission to detect prevalent delirium and rescreened within a week to detect incident cases. Patients with delirium were randomly allocated to receive the intervention or usual care. Subjects in the intervention group were seen by a geriatric specialist consultant and followed in hospital for up to 8 weeks by an intervention nurse who liaised with the consultant, attending physicians, family and the primary care nurses. Subjects in the usual care group received standard hospital services but could consult geriatric specialists as needed. A research assistant, blinded as to treatment allocation, administered within 24 hours after enrolment the MiniMental Status Exam (MMSE), Delirium Index (measuring the severity of the delirium) and Barthel Index (measuring independence of personal care). Improvement was defined as an increase in the MMSE score of 2 or more points, with no decrease below baseline plus 2 points, or no decrease below a baseline MMSE score of 27. A short form of the Informant Questionnaire on Cognitive Decline in the Elderly was completed to identify patients with possible dementia. Subjects were assessed 3 times during the first week and weekly thereafter for up to 8 weeks in hospital or until discharge. Data on clinical severity of illness, length of stay and living arrangements after discharge were also collected. The primary outcome measure was time to improvement in MMSE score. RESULTS: Of the 1925 patients who met the inclusion criteria and were screened, 227 had prevalent or incident delirium and consented to participate (113 in intervention group and 114 in usual care group). There were no clinically significant differences between the intervention and usual care groups except for sex (female 58.4% v. 50.0%) and marital status (married 34.8% v. 41.2%). Overall, 48% of the patients in the intervention group and 45% of those in the usual care group met the predetermined criteria for improvement. The Cox proportional hazards ratio (HR) for a shorter time to improvement with the intervention versus usual care, adjusted for age, sex and marital status, was 1.10 (95% confidence interval [CI] 0.74-1.63). There were no significant differences within 8 weeks after enrolment between the 2 groups in time to and rate of improvement of the Delirium Index, the Barthel Index, length of stay, rate of discharge to the community, living arrangements after discharge or survival. Outcomes between the 2 groups did not differ statistically significantly for patients without dementia (HR 1.54, 95% CI 0.80-2.97), for those who had less co-morbidity (HR 1.36, 95% CI 0.75-2.46) or for those with prevalent delirium (HR 1.15, 95% CI 0.48-2.79). INTERPRETATION: Systematic detection and multidisciplinary care of delirium does not appear to be more beneficial than usual care for older patients admitted to medical services.

Aged↗

PubMedDate not supplied

Reinterpretation of cross-sectional images in patients with head and neck cancer in the setting of a multidisciplinary cancer center.

BACKGROUND AND PURPOSE: Patients referred to tertiary care centers frequently arrive with images obtained at outside institutions; these images require reinterpretation. We assessed the clinical value of reinterpreting cross-sectional imaging studies of patients with head and neck cancer, in the setting of a multidisciplinary cancer center. METHODS: Outside CT and MR images of 136 patients with known or presumed head and neck cancer were reinterpreted by a neuroradiologist. Clinical history and findings on physical examination were available. Reinterpretation was performed before review of outside reports, which were subsequently compared with those generated at the cancer center. Changes in interpretation were noted, and their effects on TNM staging, patient care, and prognosis were assessed. Reliability and statistical significance of rates of change in diagnosis were analyzed with 95% confidence intervals (CIs) and the sign test, respectively. Verification of change in diagnosis was confirmed by pathologic analysis (75%), characteristic radiologic findings (18%), or clinical and imaging follow-up (7%). RESULTS: Change in interpretation occurred in 56 patients (41%) (95% CI: 33-49%, P <.001). Forty-six patients (34%) had a change in T, N, and/or M staging (26-42%, P <.001). Change in T stage occurred in 27 cases (20%) (13-27%, P <.001) (upstaged in 22, downstaged in five), and a change in N stage in 26 cases (19%) (12-26%, P <.001) (upstaged in 20, downstaged in six). Two patients (1.5%) had missed systemic metastases. Three patients with an initial diagnosis of cancer were found to be cancer-free, and six patients had a diagnosis of new second primary cancers that were missed at original interpretation. One patient had a missed middle cerebral artery aneurysm. Changes in image interpretation altered treatment in 55 (98%) of 56 patients and affected prognosis in 53 patients (95%) (P <.001). CONCLUSION: Reinterpretation of cross-sectional images in the setting of a multidisciplinary cancer center has a significant effect on staging, management, and prognosis in patients with head and neck cancer.

Academic Medical Centers↗

PubMedDate not supplied

[An epidemic risk of yellow fever in Burkina Faso despite a rapid immunisation riposte: role of a multidisciplinary investigation team].

UNLABELLED: On October 8, 1999, one yellow fever (YF) case is confirmed in the South West of Burkina Faso by the Centre Muraz' virology unit. Epidemic extension is suspected as large movements of population are occurring due to troubles in Côte d'Ivoire nearby and as the Aedes vector is endemic in the region. On October 23, the Gaoua's Health Regional Head immunizes 1,000 people around the detected YF case, i.e. 70% of the estimated population and requests an epidemiological investigation. A multidisciplinary team (epidemiologist, entomologist, virologist) from the Centre Muraz, a medical research centre based in Bobo Dioulasso investigate in order to answer the following questions: are there any other or asymptomatic cases of YF? How far is the epidemic risk? Is a paper filter a valuable method for collecting blood samples? What benefit can be gained from a multidisciplinary team? METHOD: An epidemiological analysis of the patient, a research of asymptomatic or ignored patient is performed (Health Centre registers, interview of the population). This includes the research of people missing the immunisation campaign. Blood samples are collected through 5 ml EDTA glass tubes or through filter paper in order to measure immunoglobuline M. A classical entomological prospecting completes the investigation. RESULTS: Two possible cases are suspected in the patient's home. History of the patient's is in agreement with a local contamination. In the village 110 people missed the immunisation campaign and samples were collected in 58 people including 26 children. Among them, four (15.3%) were positive with immunoglobuline M, while there were none in the adults. Aedes Luteocephalus, a potential vector is collected through night-captures but is absent of home-water collection. Paper filter assays shows a 100% concordance with classical method. CONCLUSION: The team could determine the persistency of a yellow fever epidemic risk in the region despite a rapid and adequate immunisation riposte. Due to iterative sporadic cases and due to population movement, a routine survey of YF has to be promoted as the immune status of the population, particularly in the youth, do not protect them. Collection of blood through paper filter will greatly help the routine survey and shall be confirmed during the following investigations.

Adult↗

PubMed2003

[Multidisciplinary therapy of Tourette syndrome].

The marked fluctuation in symptoms with a spectrum of behavioral problems contribute to misdiagnosis of Tourette syndrome. The authors review the recent progress in diagnosis and management with an emphasis on multidisciplinary approach. Possible associations with various genes have been found in etiology of Tourette syndrome. Development of the disease comes of dopaminerg neurotransmission disorder resulting in cortico-striato-thalamic system dysfunction. Tics are brief movements or sounds that occur intermittently and unpredictably mimicking fragments of normal behavior. Diagnostic criteria are based on the motor and vocal phenomena and their dynamics. The key concept in management are the tic severity scaling correlating with quality of life measurements. Therapeutic interventions indicated at severe alteration in patient's quality of life. Treatment plan combines various drug protocols, psychotherapy and behavioral therapy which should be optimalized for most disabling symptom. Social isolation and self injurious behavior complicates the treatment resistant, severe cases. In these subgroup of patient, an adequate selection of stereotactic intervention could provide an effective control of tic severity or behavioral disorder. Tourette syndrome, as a typical neuropsychiatric disorder, is a striking example for improved efficacy of multidisciplinary approach.

Behavior Therapy↗

PubMed2002

[A multidisciplinary approach to orthognathic surgery].

Orthodontists are precisely aware of their therapeutic limits in dealing with maxillofacial dysmorphia. Unstable results and iatrogenic lesions caused by alveolo-dental compensations for displacements of the skeletal base have convinced them of the importance of orthognathic surgery as a complement to their orthodontic treatments. Collaboration between the orthodontist and the maxillofacial surgeon begins as of the moment a displacement of the skeletal bases is established through clinical and cephalometric diagnosis. Due to factors related to their age and dental history, it is necessary to complement the therapeutic provision for adult patients with the provision of a multidisciplinary team. The dentist and the family doctor take part in the decision regarding the treatment to be administered, they provide advice to their patients and treat them according to the chosen therapeutic sequence. Other practitioners are involved, including the physiotherapist or speech therapist, depending on the clinical requirements. This multidisciplinary approach and collaboration are conducive to the quality of the results and patient satisfaction.

Adult↗

PubMed2003

A multidisciplinary team approach to increasing AV fistula creation.

Despite high patient comorbid factors, our Renal Care [table: see text] Group program was able to totally eliminate placement of AV grafts and to use only fistulae with an acceptable rate of catheter use--all within four years' time. This demonstrated the importance and value of a multidisciplinary vascular access team. Organization was the key element. All the team members were already in place prior to 1996, but they were not focused on vascular access and lacked education in this area. With the nephrologist not trained in fistula creation and not involved in that process, the absence of leadership led to a high number of dialysis grafts and catheters and frequent thrombotic and infectious complications. The nephrologist must assume the team leadership since he or she is the only provider who can interact with all other team members (see Table 3, p. 60). It is recommended that each nephrology group select a lead nephrologist to begin the team-building process (see Table 4, p. 60). A checklist (see Table 5) should be maintained for each pre-dialysis or dialysis patient as documentation for vein mapping and a surgical plan. This will make preoperative vein mapping mandatory for every patient. Education is important at all levels of the multidisciplinary team. This training effort should be started during nephrology fellowship, surgery and radiology residency, dialysis staff education programs, and renal networks. In 2002, the NW Renal Network led the way with fistula creation seminars, focusing on practicing nephrologists, surgeons, radiologists, and dialysis caregivers. The result of this Vascular Access Quality Improvement Program is pending.

Aged↗

PubMed1992

[Multidisciplinary study of cerebrovascular accidents: I. Definition, design, and general results].

Cerebrovascular accidents (CVA) constitute a major cause of adult cardiac cardiovascular mortality in Chile. From July 87 to August 89 we prospectively studied 300 patients with CVA utilizing a multidisciplinary approach. Besides clinical evaluation this included brain CT scan (48 hrs), glucidic and lipid profile. Occlusive CVA were additionally studied with 2D-Echocardiogram, 24 hr Holter, Cerebral Angiography and/or carotid Duplex Echotomograph, and a second brain CT scan was performed within the first week. We found a 62.3% incidence of cerebral infarcts, 28.3% of cerebral hemorrhages and 9.3% of transient ischemic attacks. Cerebral infarcts were found to be cardiac related in 33.5% of cases, whereas 13.2% were lacunar, 4.4% were atherothrombotic and 14% had no precise etiology. Hypertension was associated to cerebral hemorrhages in 76% of cases, 26% of which were intracranial. At 2 months of follow-up 16.3% of patients were severely handicapped and mortality was 19.3%. We have confirmed that cerebral infarcts constitute the most common cause of CVA and most of them are cardiac related. Hypertension appears to be the most important cause of cerebral hemorrhage. A multidisciplinary approach to cerebrovascular accidents allowed a more precise diagnosis and contributed to implement appropriate therapeutic and preventive strategies. Proper identification of high risk patients could contribute to decrease the high incidence and mortality of CVA in our community.

Aged↗

PubMed2003

[A case of unresectable liver metastases from rectosigmoid colon cancer with survival for over 3 years after multidisciplinary treatment].

A 61-year-old man underwent curative low anterior resection for rectosigmoid colon cancer. Follow-up ultrasonography revealed unresectable multiple liver metastases at 10 months after surgery. Arterial infusion therapy with 5-fluorouracil (5-FU) was given at 1,500 mg every 2 weeks up to a total dose of 37.5 g, resulting in complete remission (CR) of the liver metastases. However, recurrence was seen 4 months after CR. Following partial hepatectomy and local ablation therapy, he received multidisciplinary treatment including local ablation therapy, arterial infusion of 5-FU and mitomycin C, and systemic chemotherapy with 5-FU/Leucovorin/CPT-11. The patient died of liver failure at 3 years and 7 months after the detection of hepatic metastases. If arterial infusion therapy achieves CR of unresectable hepatic metastases from colorectal cancer, the patient may survive for several years with multidisciplinary treatment including surgery, local ablation therapy, and systemic chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗