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Results for “multidisciplinary”

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At least 613 records · Page 34Linked to original sources

PubMed2005

Effectiveness of a multidisciplinary chronic pain program for treatment of refractory patients with complicated chronic pain syndromes.

BACKGROUND: Interventional pain physicians commonly encounter patients with a treatment refractory "chronic pain syndrome". Such patients have a chronically painful medical disorder that is complicated by a number of psychosocial factors, including psychiatric and substance use disorders, physical deconditioning, dependency upon the healthcare system, and perceived impairments that are out of proportion to objective medical findings. OBJECTIVE: The objective of the following study was to determine the effectiveness of a multidisciplinary chronic pain program for adult patients with treatment refractory chronic pain syndromes. METHODS: The following sequential, prospective, observational case series presents treatment outcome data on a 4-week multidisciplinary chronic pain program for adult patients with complex chronic pain syndromes that were refractory to standard pain management. Prior to enrollment in the program, patients had been treated with pain medications, physical therapy, and interventional procedures. Data were collected and analyzed on variables including pain ratings, healthcare utilization, opioid medication use, and perceived physical functioning at program admission and discharge as well as at intervals of 3 months, 6 months and 12 months post-discharge. RESULTS: Analysis of the data reveal statistically significant improvements in the variables of interest across most time parameters. CONCLUSIONS: Results demonstrate that participation in a chronic pain program is an effective intervention for selected patients with refractory pain.

Journal Article↗

PubMed2003

A multidisciplinary approach to the management of hormone-refractory prostate cancer.

The patient with hormone-refractory prostate cancer (HRPC) presents unique management challenges for both the urologist and the medical oncologist. Because of a lack of effective treatment options, the management of patients with HRPC has historically been palliative. Over the past 10 years, the advent of relatively efficacious chemotherapeutic regimens, particularly taxane-based chemotherapy, has resulted in a desire to treat patients with HRPC more aggressively. The complex needs of these patients have made a multidisciplinary approach, inclusive of specialists with expertise in disease processes directly affecting the patient, the optimal means of treating HRPC. An understanding of the natural history and complications of HRPC, combined with a systemic evaluative process, can allow the multidisciplinary team to comprehensively address the needs of the individual patient with HRPC.

Journal Article↗

PubMed2003

A multidisciplinary approach to the management of hormone-refractory prostate cancer.

Journal Article↗

PubMed2006

[Ectopia cordis: multidisciplinary approach with successful result].

Ectopia cordis is a pathology in which the heart is complete or partially outside of the thoracic cavity. It represents a challenge for the diagnosis and handling because of its high perinatal mortality. We present the first case of thoracic ectopia cordis with prenatal diagnostic (27th week), its multidisciplinary handling at Hospital de Ginecopediatria núm. 71 of the Centro Medico Nacional Adolfo Ruiz Cortines, IMSS, in Veracruz, Mexico. We communicate the case of a 24 year-old woman referred by her correspondent medical unit with the diagnosis of 23.6 weeks pregnancy with suspicion of heart malformation by ultrasound. The pregnancy was followed-up until the 38th week, when it was programmed a caesarean section. The newborn had ectopia cordis, which was treated at the moment of birth. In this article, we present pictures of the heart defect as well as its evolution. The up-to-date bibliography is revised about the medical profile and treatment. The handling of the ectopia cordis includes an appropriate prenatal diagnosis through echocardiograph, a multidisciplinary perinatal team, to program the caesarean operation, aseptic handling of the newborn, immediate correction of the wall defect with skin torn piece without trying to correct the costal grill, specific hemodynamic cares, to reprogramme a correction of associated defects.

Adult↗

PubMed2006

A new programme of multidisciplinary care for patients with heart failure in Poznań: one-year follow-up.

INTRODUCTION: Recent trials have demonstrated the effectiveness of multidisciplinary care (MDC) for patients with chronic heart failure (CHF). However, results of the assessment of different programmes in individual countries could be different because of local specificities of health care systems. AIM: We sought to determine whether MDC for patients with CHF has an influence on mortality, rate of rehospitalisation, quality of life (QoL) and self-care (SC) during a one-year study period. METHODS: 160 patients with CHF treated in our unit were randomly assigned to receive either MDC or routine care (RC). Patients from the MDC group (n=80; mean age 67+/-10.2 years) attended follow-up visits at the heart failure clinic after 14 days and 3, 6, 9 and 12 months after discharge. They were cared for by a team which consisted of a cardiologist, a heart failure nurse (HF nurse), a psychologist and a physiotherapist. This group of patients received comprehensive education from the HF nurse and the cardiologist. Telephone counselling and home-based interventions by the HF nurse were also available daily. Patients from the RC group (n=80, mean age 69.5+/-10.7 years) were cared for by their primary care physician only. In both groups QoL and SC scores were calculated based on a 21 and 12-item questionnaire completed by the patients at discharge and after one year. RESULTS: After one-year follow-up the two groups did not differ in terms of either total and HF mortality or number of sudden deaths. In the MDC group when compared to the RC group we observed a significant decrease in the total number of hospital readmissions (by 37%, p <0.05), a decrease in hospital admissions due to HF (by 48%; p <0.05) and decreased length of stay during both all-cause readmissions and those due to HF (p <0.05). After one year of follow-up both QoL and SC scores were significantly lower in the MDC group than in the RC group (p <0.001), indicating improved QoL in the MDC group. CONCLUSIONS: The one-year multidisciplinary care programme for patients with chronic heart failure in Poznań demonstrated significant improvement of treatment results in terms of frequency of readmissions and length of hospital stay as well as improved Qol. A tendency to decreased total and heart failure related mortality and decreased number of sudden deaths was also observed.

Aged↗

PubMed2006

SNOMED CT in multidisciplinary clinical practice--evaluation of usefulness for classification and coding of care-planning procedures.

Studies of the usefulness of SNOMED CT in everyday clinical practice have received little attention. The purpose of this study was to evaluate the usefulness of SNOMED CT in a multidisciplinary clinical setting. Another aim was to examine how well the terminology of care-planning procedures in a local development project could be mapped to SNOMED CT, and to explore the terminological surroundings in terms of superordinate concepts, subordinate concepts and coordinate concepts. A term list of 66 non-analysed types of procedures, considered necessary in the documentation of care planning, had been compiled in a local development project. The Clue-browser, version 5.5, was used to browse for matching concepts in SNOMED CT, and the degree of correspondence was assessed for each item. Of the 66 procedures, 72% corresponded completely and 22% corresponded partly to concepts in SNOMED CT. No match was found for 6% of the procedures. More subordinate concepts) were lacking in 30% of the concepts. The study showed that SNOMED CT could be mapped fairly well to care-planning procedures in a multidisciplinary setting such as advanced home health care. The terminological surroundings were extensive and stable for superordinate concepts (stem concepts), but unstable regarding subordinate concepts. SNOMED CT and the Clue-browser were feasible for choosing terminology with machine-readable codes for a specific area where there is no terminology in Swedish.

Humans↗

PubMedDate not supplied

Multidisciplinary patient care in preventive dentistry: idiopathic dental pain reconsidered.

Pain is a complex phenomenon which challenges healthcare providers to develop multidisciplinary diagnostic and treatment competencies. This paper reviews literature on idiopathic odontalgia and tooth hypersensitivity without apparent cause, and considers the role bioelectric mechanisms may play in the onset and treatment of these moderately common disorders. The hypothesis considers that such pain may be associated with health disturbances in areas remote from the teeth and periodontium. A multidisciplinary approach to preventive dental health is discussed along with factors which may impact the outcome in the treatment of dental pain.

Acupuncture Analgesia↗

PubMed1991

Comprehensive multidisciplinary pain center approach to the treatment of low back pain.

The primary objective of our program is full function. Other objectives include relief or decrease in pain with the abolition of pain medication, elimination of assistive devices, low or zero disability rating, job satisfaction with return to work and leisure activities without limitations, independence from the health care system, prevention of reinjury, and optimum wellness. The intense, multidisciplinary program described involves a full-time multidisciplinary staff, complete patient involvement, weight control, physical restoration and conditioning, home program maintenance, pacing, body mechanics, energy-saving techniques, reinjury prevention education, pain control and elimination, drug detoxification, behavioral modification, biofeedback, relaxation, imagery, individual and group therapy, family therapy, assertiveness training, stress management, coping skills, vocational counseling, job planning/development/simulation, achievement of maximal function, immediate return to work at discharge, and follow-up care. It is possible to return 86% of these patients to full function and work; they may have some residual pain, which should eventually remit. The 14% who fail are hardcore patients with major behavioral problems, although, to be fair, there are still unanswered questions to resolve. These people have problems that cannot be eliminated within the limit of time with which we have to work with the patient. Lastly, these patients can be disturbed and dangerous, as evidenced by the headline of "A Former Patient Shoots, Kills, New York Neurosurgeon, Self, Wife."

Back Pain↗

PubMedDate not supplied

[Psychic changes in systemic lupus erythematosus: a multidisciplinary prospective study].

Despite the high prevalence of psychic symptoms in lupus patients, there are few systematic studies in this area. Through a multidisciplinary approach, the authors developed a prospective study to characterize and correlate psychopathological aspects with clinical and laboratory data concerning neural manifestations of the disease. Out of 23 patients studied, 12 showed psychic alterations, which were interpreted as primary manifestations of the disease. All of them presented organic mental syndromes (DSM-III-R) in which cognitive symptoms were the most prominent, followed by affective, catatonic and hallucinatory features. The neurologic findings (seizure, migraine and muscular atrophy), as well as the ophthalmologic alterations (hemorrhage and soft exudates) were frequent and concomitant with the psychic features. The laboratory findings were: LE cells 50%; anti-Sm: 16%; anti-U1 RNP: 50%; anti-Ro/SS-A: 50%; anti-nDNA: 58%; decreased CH50 or fractions (C3, C4): 67%; anti-P: 18%; antigangliosides IgG: 67%; antigangliosides IgM: 78%. The cerebrospinal fluid analysis showed: increased cellularity: 18%; elevated protein: 36%; antigangliosides IgG: 67%; antigangliosides IgM: 33%; immunocomplexes: 36%. In spite of the absence of an adequate control group and of the small number of patients, the multidisciplinary approach leads to a better characterization of the nervous system involvement in this disease.

Adolescent↗

PubMed1991

Evaluation of long-term weight changes after a multidisciplinary weight control program.

The American Medical Association Council on Scientific Affairs recently emphasized the importance of nutritionally sound weight reduction diets and changes in life-style to promote long-term weight control. The purpose of this study was to evaluate long-term effectiveness and to identify predictors of success of an intensive multidisciplinary program utilizing the time-calorie displacement diet, a low-fat, high-complex-carbohydrate diet, to promote and maintain reduced body weight. In 213 obese adults consecutively entering the program, including dropouts, weight loss averaged 6.3 kg (0.4 kg/week) and 16% of excess weight over 7 months of treatment. The 78 (37%) completing the recommended 15 visits lost a mean of 10.8 kg and 28% of their excess weight while under treatment. Weight loss was largely predicted by number of visits, which was more important than treatment duration. An increased number of visits was predicted by being married, being female, and reporting a usual diet low in snack foods. Of 147 patients contacted at posttreatment follow-up, 53% maintained their weight loss or continued to lose weight an average of 25 months later and 24% experienced weight rebound but were still below their pretreatment weight; only 23% regained their lost weight. Mean net weight loss from pretreatment to follow-up was 8.0 +/- 1.0 kg (mean +/- standard error of the mean). No factor significantly predicted posttreatment weight rebound. Results suggest that a nutritionally sound diet, prescribed in a multidisciplinary program and emphasizing life-style changes, can result in long-term weight control in a majority of patients treated.

Adult↗

PubMedDate not supplied

Women's health as a multidisciplinary specialty: an exploratory proposal.

The purpose of this paper is to encourage the development of women's health as a multidisciplinary specialty. The idea for such a specialty arose from the grass roots women's health movement of the 1960s, whose tenets were rapidly embraced by physicians sympathetic to its ideals, especially members of the American Medical Women's Association. Women's health would be a multidisciplinary specialty offering service to a specific patient population, analogous to geriatric medicine. It would blend primary care, ambulatory obstetrics-gynecology, and psychiatry with additional training in endocrinology, nutrition, sports medicine, and orthopaedics. Suggestions for residency training and specialty certification are included.

Education, Medical↗

PubMed1990

Education on breast disease in an obstetrics and gynecology training program: a multidisciplinary approach.

Breast cancer affects one in ten women during their lifetime. Recognizing the importance of early detection in the prognosis of this condition, the American Board of Obstetrics and Gynecology has stated guidelines encouraging breast disease education in obstetrics and gynecology training programs. To fulfill this academic responsibility, we have organized a multidisciplinary Breast Disease Detection and Treatment Clinic where patients with abnormal mammograms or any breast-related complaints are evaluated and managed. In cooperation with the radiology department and general surgery service, a mammogram review conference has been instituted. Abnormal mammograms are reviewed with a radiologist. Our activities have been coordinated such that a general surgery staff member and resident are present during the breast clinic hours to review mammograms and to examine the patients with the gynecologist, providing immediate consultation. Needle aspiration of breast cysts, repeat imaging studies, and general surgery referrals for breast biopsies are performed as indicated. The patient receives integrated care of her breast problem in one visit, and our residents gain the experience of diagnosing and managing breast problems which, before establishment of this clinic, were referred to the general surgery department. This multidisciplinary approach developed in our institution helps us provide the most efficient care to our patients, while providing our residents with integrated teaching and training concerning the diagnosis and management of breast disease.

Ambulatory Care Facilities↗

PubMed1990

[Curability of multidisciplinary treatment including combined hyperthermia, radiotherapy and chemotherapy].

Reported are the results in 311 patients who received a multidisciplinary treatment for their cancers, said treatment combining hyperthermia, radiotherapy, and chemtherapy. Of his number, 266 patients were in the advance stage of their disease while another 42 still had localized cancers. According to the criteria of Koyama and Saitoh for evaluating solid tumors that had received chemotherapy, of 298 evaluable patients, 64 showed a complete response (CR), 94 showed a partial response (PR), 89 showed no change (NC), and 57 showed a progressive disease (PD), for an overall response of 53.0% (158 cases). A multidisciplinary treatment combining radiotherapy and hyperthermochemotherapy was used for cases involving localized tumors of the vulva, the skin, the thyroid gland, the prostate gland, the uterus, the rectum, the soft tissue bone, and the ovary, though our treatment regimen could not be continued in cases of tumors involving the stomach, the esophagus, the lung, the mediastinum, the liver, and the pancreas. Our data has shown that a high overall rate of curability was achieved in cases involving the stomach, the bladder, the blood, the skin, the head, and neck, and the esophagus.

Adult↗

PubMed1990

[The rescue station--a multidisciplinary treatment unit in the hospital].

The creation of integrative organizational structures are seen as an objective requirement of medicine characterized by progress of knowledge and specialisation. For emergency cases the rescue station has stood the test as a multidisciplinary unit of the hospital. This thesis is confirmed by experiences obtained from practical work in the Frankfurt/Oder District Hospital and by discussions in the "Working Group Rescue Station" of the "Society of Emergency Medicine of the GDR." In order to realize the function of the rescue chain as well as the multidisciplinary motivation, intensive quantitative and qualitative promotion of rescue stations is required.

Emergency Service, Hospital↗

PubMed1990

Multidisciplinary adverse drug reaction surveillance program.

Initial experience with a multidisciplinary adverse drug reaction (ADR) surveillance program at a 350-bed community hospital center is described. The pharmacy and quality-review (QR) departments developed a program that was incrementally incorporated into the hospital's overall QR activity. After inservice training, nurses and QR personnel were asked to complete an "alert" card for every suspected ADR and send it to the pharmacy. In addition, medical records were reviewed retrospectively for disease classification codes related to drug toxicity and unspecified adverse effects. Laboratory and utilization-review personnel also conducted retrospective reviews. A pharmacist reviewed all ADR reports and categorized each according to the severity of the reaction and the probability that it was drug related. For each reaction classified as severe, the patient's chart underwent physician peer review for appropriateness of therapy, avoidability of the reaction, and adequate documentation; related patient-care issues were addressed by the medical staff as part of routine quality-review activities. When problems with prescribing were identified, the pharmacy and therapeutics committee intervened with the prescribers or recommended further medical staff review. Drugs repeatedly associated with ADRs became the focus of drug-use reviews. The number of ADR reports increased from 0 to 134 in the first 11 months of the program. A multidisciplinary approach to ADR reporting increased the number and quality of ADR reports.

Drug-Related Side Effects and Adverse Reactions↗

PubMed1985

[Multidisciplinary treatment of head and neck cancer].

A new multidisciplinary treatment for head and neck cancer was shown by focusing on the maxillary and oropharyngeal carcinoma. Neo-adjuvant chemotherapy which consists of cisplatin and peplomycin was incorporated into it. In terms of maxillary carcinoma, 2 courses of chemotherapy were given with an interval of 2 weeks, followed by radiotherapy (40 Gy) combined with intraarterial chemotherapy (5-FU). When no cancer cells were detected at the completion of this therapy, adjuvant chemoimmunotherapy was given. When an apparent tumor was still revealed by CT, radical surgery was performed. When cancer cells were detected only by histological examination, additional radiotherapy up to 60 Gy was given by Linac. The results obtained were analysed in 14 cases. We also presented another type of multidisciplinary treatment in oropharyngeal carcinoma.

Aged↗

PubMed1986

[Multidisciplinary treatment of carcinoma of the esophagus].

The recent amazing improvements in surgery for esophageal carcinoma which have been due largely to several factors such as pre- and postoperative management, surgical techniques, etc., have reduced the operative mortality. However, long term survival rates are not yet satisfactory. As more than 95% of patients with esophageal carcinoma are advanced carcinoma, multidisciplinary treatment is necessary. We have devised preoperative hyperthermo-chemo-radiotherapy, intraoperative local adjuvant chemotherapy, and postoperative long term cancer chemotherapy. Long term results of these combined therapy suggested the effectiveness of multidisciplinary treatment.

Bleomycin↗

PubMed1989

[Detection and prognosis of medullary cancer of the thyroid gland. Influence of national multidisciplinary cooperation].

Medullary thyroid carcinoma is a rare and sometimes hereditary disease. The tumour can be diagnosed and followed up by measuring the amounts of calcitonin it secretes. The prognosis of this cancer largely depends on an early diagnosis and treatment. From the clinical and laboratory (calcitonin assays) data recorded in our department, we have endeavoured to determine the influence of a national multidisciplinary co-operative group (GETC: French medullary study group) on the diagnosis and prognosis of this malignancy. We are able to show that the number of medullary thyroid carcinomas detected (principally in their familial forms) has increased by 141 per cent after the GETC was created. Calcitonin levels at the time of diagnosis are significantly lower (P less than 0.05) in familial cases, which reflects an early detection. The same applies to post-operative calcitonin levels (P less than 0.005), so that in the long run a better prognosis can be expected. It seems therefore that together with a better knowledge of this cancer and its detection, the setting up of a national multidisciplinary co-operative group results in a better clinical and therapeutic approach of these patients, and particularly of the familial cases of medullary thyroid carcinoma.

Calcitonin↗