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PubMed1989

[Two cases of advanced breast cancer with distant metastasis showing long-term survival with multidisciplinary treatment including intra-arterial infusion chemotherapy].

Two cases of advanced breast cancer are reported that have had no recurrence for more than five years after multidisciplinary treatment including intra-arterial infusion chemotherapy. The first case is a 62-year-old housewife who had brain metastases. The primary lesion and distant metastases were completely responsive to irradiation combined with chemoendocrine therapy. The other one is a 38-year-old housewife with ovarian metastasis that was revealed after oophorectomy. In this case chemoendocrine therapy was added without irradiation after intra-arterial infusion chemotherapy. These cases indicate that intra-arterial infusion chemotherapy can be recommended as a component of multidisciplinary treatment even in advanced breast cancer with distant metastasis.

Adenocarcinoma, Scirrhous↗

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↗

PubMedDate not supplied

Minnesota plan for nonsmoking and health: multidisciplinary approach to risk factor control.

In 1981, the Minnesota Department of Health began a long-term program to control risk factors for the major health problems of the State as determined by an expert committee. The methods chosen to initiate programs were social, economic, and epidemiologic background research and a multidisciplinary statewide planning process. Smoking was considered the most important problem. During 1983-84, department staff members analyzed the epidemiology and economics of smoking in Minnesota and reviewed the literature on methods of smoking control. They and a multidisciplinary technical committee prepared a coordinated plan to increase the prevalence of nonsmoking in Minnesota. The 39 recommendations address mass communication and marketing, educational programs in schools, public and private regulation, economic disincentives through taxation, and funding of programs and evaluation of results. The Minnesota Plan for Nonsmoking and Health was released in September 1984. During the first half year, the plan provided material for formation of a coalition of health organizations to promote nonsmoking. In June 1985, the Minnesota Legislature passed the Omnibus Nonsmoking and Disease Prevention Act, which provides $4 million over 2 years for promotion of nonsmoking through education, regulation, and public communications. These intervention activities will be funded by a portion of a 5-cent increase in cigarette excise tax. The foundations have been laid for what may be the most comprehensive statewide nonsmoking program in the United States.

Adolescent↗

PubMed1988

Psychologic factors in the multidisciplinary evaluation and treatment of erectile dysfunction.

The members of a multidisciplinary team treating sexual dysfunction must work together from different perspectives and training to determine an accurate diagnosis, choose an appropriate treatment, and evaluate those treatments systematically. Integrating data from both physical and psychologic evaluations is essential. Anxiety, depression, or other reactions to stress are seen as cognitive interferences that inhibit sexual arousal by distracting attention from erotic stimuli. The goals of sex therapy are to enhance attentional focus on sexual cues and to lessen distractions in the form of anxiety, conflict, or other stresses. Although there continue to be methodologic problems in outcome evaluation research of multidisciplinary treatment of sexual dysfunction, follow-up studies generally indicate improvements in sexual functioning, satisfaction, and self-esteem.

Ejaculation↗

PubMed1988

Multidisciplinary cost-containment program promoting oral metronidazole for treatment of antibiotic-associated colitis.

A multidisciplinary cost-containment program for promoting oral metronidazole in place of oral vancomycin as initial therapy of antibiotic-associated colitis (AAC) is described. The pharmacy department and the division of infectious diseases implemented the program in two phases. In the first phase, a one-year retrospective drug-use review in patients with AAC treated with oral vancomycin was conducted to determine the average cost of therapy per treatment course. In the second phase, the use of oral metronidazole instead of oral vancomycin for initial treatment of AAC was promoted using inservice-education programs and distribution of pocket-size brochures containing AAC treatment guidelines to medical staff. The pharmacy and therapeutics committee supported the program by endorsing metronidazole as the drug of choice for AAC and by distributing follow-up progress reports of the program to medical staff. Pharmacists on the nursing units were responsible for enforcing the program stipulations regarding vancomycin and metronidazole use and for collecting data on patient-specific drug use. Six months after implementation of the program, the average cost of drug therapy for AAC had decreased by 89%, from $343.24 per patient to $37.50 per patient. The projected annual savings resulting from the program was $38,829.02. All prescribing physicians and dispensing pharmacists complied 100% with the program stipulations regarding drug use. The multidisciplinary program described here was successful in promoting the use of oral metronidazole for initial therapy of AAC.

Administration, Oral↗

PubMed1988

Multidisciplinary cost-containment program promoting less frequent administration of injectable mezlocillin.

A multidisciplinary cost-containment program for promoting less frequent administration of mezlocillin injection is described. The pharmacy department and the division of infectious diseases at Hartford Hospital implemented a program through which regimens of mezlocillin 5 g every eight hours would automatically be substituted for the frequently prescribed regimen of mezlocillin 3 g every four hours. Patients with urinary-tract infections or renal insufficiency and febrile neutropenic cancer patients also received various modified regimens. Use of the modified regimens was promoted through inservice education programs and distribution of newsletters and pocket-size brochures describing the dose-dependent pharmacokinetics of mezlocillin to medical staff. The pharmacy and therapeutics committee supported the program by endorsing the use of the modified regimens and distributing periodic progress reports. Pharmacists on the nursing units were responsible for enforcing the program stipulations regarding modified dosage regimens and for reporting adverse reactions and unexpected therapeutic failures. Ten months after implementation of the program, there was better than 99% compliance with the appropriately modified mezlocillin dosage regimens. Theoretical annual cost savings based on less frequent administration of mezlocillin injection amount to more than $33,000. The multidisciplinary program described here was successful in promoting the use of modified mezlocillin dosage regimens.

Connecticut↗

PubMed1988

Multidisciplinary program for promoting single prophylactic doses of cefazolin in obstetrical and gynecological surgical procedures.

A multidisciplinary cost-containment program for promoting the use of single prophylactic doses of cefazolin for obstetrical and gynecological surgical procedures is described. Following a one-month review of patient charts to identify the antimicrobial regimens used most frequently for prophylaxis in obstetrical and gynecological surgical procedures, the department of pharmacy services, with the cooperation of the pharmacy and therapeutics (P&T) committee and the departments of obstetrics and gynecology and infectious diseases, implemented an educational program to promote the use of single doses of cefazolin for surgical prophylaxis. The program included inservice education and distribution of letters of support and a therapeutics newsletter. Drug stocking patterns in the operating and delivery rooms were changed to make cefazolin more accessible, and the P&T committee formally restricted the use of prophylactic antimicrobial agents in obstetrical and gynecological surgical procedures to single doses of cefazolin unless a consulting infectious-disease physician recommended otherwise. Compliance with the program increased as each step was implemented; data collected 16 months after the program was initiated demonstrated a compliance rate of 78.8%. Based on comparison of data collected before initiation and six months after initiation of the program, an actual cost savings of +7,125 was realized, which extrapolates to +14,250 annually. No apparent adverse effects on patient care were noted. The multidisciplinary approach to promoting the use of single doses of cefazolin was effective.

Cefazolin↗

PubMed1986

[Planned multidisciplinary approach in the treatment of advanced carcinoma of the tongue].

16 patients with advanced lingual carcinoma treated by planned multidisciplinary treatment and postoperative reconstruction in our hospital from 1970 to 1984 are reported. The treatment included: preoperative chemotherapy of high dose MTX; extensive resection of the tongue with radical neck dissection and postoperative radiation. The immediate reconstruction was performed by using pedicled major pectoralis myocutaneous flap in 12 patients and free tensor fascia lata myocutaneous flap in 4. The 5 and 3 year survival rates of stage IV lesions were 50% and 100%. The advantages of the planned multidisciplinary treatment of advanced lingual cancer are discussed.

Adult↗

PubMed1986

[An evaluation of the multidisciplinary treatment of carcinoma of the maxillary antrum in head and neck surgery].

Radiation therapy combined with surgery or regional chemotherapy was given to 114 cases of squamous cell carcinoma of the maxillary antrum from 1972 to 1983 at Gunma Cancer Center. The each treatment method was contributed to successful multidisciplinary treatment consists of partial maxillectomy, radiation therapy doses of 40 Gy and regional chemotherapy using 5 FU doses of over 2,000 mg. The 5 year cumulative survival rate was 34.7% in this study. The role of minor surgery of the antrum after radiation and chemotherapy was available for irradiated necrotizing tumor tissue, residual lesion or bone necrosis of the antrum. This additional surgery was very useful as a post radio-chemotherapeutic treatment in this study of multidisciplinary treatment.

Carcinoma, Squamous Cell↗

PubMed1986

[Results of the multidisciplinary treatment of invasive bladder cancer].

Of the 843 patients with bladder cancer treated at Kyoto University between 1965 and 1984, 156 patients (18.6%) received total cystectomy. Between 1980 and 1984, 60 patients underwent multidisciplinary treatment with 4,000 or 2,400 rad adjuvant preoperative radiation therapy to the whole pelvis followed by radical cystectomy with or without postoperative adjuvant chemotherapy. The 5-year survival rate for the 65 patients with pelvic lymphadenectomy was 66% and that for the 40 patients without lymphadenectomy or only biopsy was 35%. The 5-year survival rate after radical cystectomy for 20 bladder cancer patients with regional lymph node metastasis was 11% and 73% for 59 patients without lymph node metastasis (p less than 0.001). The survival rate of multidisciplinary treatment protocol for muscle invasive bladder cancer was 55% a significantly (p less than 0.05) improved survival compared to the historical control. For analysis, the patients were divided into 2 categories according to histological criteria for evaluation of therapeutic effects for preoperative radiation by Ohoshi and Shimosato. The two groups were non-responder: grade I and IIa changes and responder: grade IIb, III and IV. Survival for responders and non-responders revealed significant differences (p less than 0.05), 87% for 28 responders and 48% for 24 non-responders.

Adult↗

PubMed1986

Nutrient intake and obesity in a multidisciplinary assessment of osteoarthritis.

The nutritional composition of diets and prevalence of obesity in 77 osteoarthritis patients were assessed biweekly for 12 weeks as part of a multidisciplinary approach to the management of osteoarthritis. Height was measured at the first visit, and weight was measured at each of the seven biweekly follow-up visits. A body mass index was calculated, based on height and weight, to determine obesity. Nutrient information was obtained by use of a 24-hour dietary recall and a food frequency questionnaire. Seventy-nine percent of the patients were obese. Obesity was positively related to pain from osteoarthritis and was more prevalent among these osteoarthritis patients than it is among the general geriatric population. Dietary intakes of vitamin D, folacin, vitamin B6, zinc, and pantothenic acid were below 80% of the recommended dietary allowance. Osteoarthritis patients may benefit from weight loss if they are obese and from eating more foods that supply the nutrients in which they are deficient. In addition to providing nutritional recommendations to avoid dietary deficiencies, a registered dietitian can assist in the multidisciplinary treatment of osteoarthritis by providing weight-control counseling and follow-up.

Adult↗

PubMed1985

Multidisciplinary treatment of advanced squamous carcinoma of the head and neck.

Advanced squamous carcinoma of the upper aerodigestive tract continues to be a therapeutic challenge. With recent advances in chemotherapy, systemic treatment has been used in an attempt to improve treatment results produced by radiation therapy and/or surgery. Such multidisciplinary experimental approaches have given new hope for cure in stage III and stage IV disease, but have reopened old questions as to the natural history and underlying biology of this disease. Multidisciplinary treatment, whether synchronous or sequential, appears to improve survival for stage III and stage IV patients achieving a complete response to chemotherapy plus irradiation. The role of surgery or radiotherapy for control of primary or nodal disease remains unchanged and is an essential component of all curative treatment plans.

Carcinoma, Squamous Cell↗

PubMed1985

[The present status of the multidisciplinary treatment of malignant melanoma].

Malignant melanoma is one of the malignant tumors that prognosis is still gravest. Over the past years, a number of approaches have been used in treating this disease. And recently it has been said that multidisciplinary treatment should be needed for patients with stage 1 b and more advanced stage. At present, most frequently used combined chemotherapeutic regimens DAV (DTIC, ACNU and Vincristine) and PAV (Peplomycin, ACNU and Vincristine). With regard to radiotherapy, fast neutron and irradiation with hyperthermia has been recognized to be useful for malignant melanoma. Recently immunotherapy has been applied to the treatment of malignant melanoma. It is expected that multidisciplinary treatment will improve the prognosis of malignant melanoma.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1979

A multidisciplinary audit of diabetes mellitus.

A multidisciplinary audit evaluating the quality of care of patients with a primary diagnosis of diabetes mellitus was performed at St. Mary's Hospital in Grand Rapids, Michigan. The audit served to evaluate the treatment and care of diabetic patients, in both the inpatient and ambulatory care settings, and also to identify interaction problems involving patient care among physicians, nurses, dieticians, and social workers. Analysis of the data indicated that each discipline rendered adequate patient care. As other published audits have also indicated, this multidisciplinary audit revealed that documentation of services is frequently lacking and that communication between the involved disciplines was less than desirable. The audit disclosed a need to educate the hospital staff (medical and nursing) as to the role and function of the Social Services Department. As a result of this audit, definite measures have been instituted in each participating department in an attempt to further upgrade the quality of medical care and improve interdepartmental communication and cooperation.

Diabetes Mellitus↗

PubMed1984

[Cancer of the maxillary antrum--a new multidisciplinary treatment containing neo-adjuvant chemotherapy].

During the period 1957-1982, 227 patients with maxillary carcinoma were treated. These cases were divided into 4 groups according to periods and methods of treatment. Five-year determinate survival figures for each group are as follows: I (1957-1966) 22%, 20/91, II (1967-1973) 40%, 27/67, III (1974-1978) 37%, 13/35, IV (1979-1982) 56%, 9/16 (3-year survival). The incorporation of intraarterial chemotherapy into the treatment of maxillary carcinoma has much contributed to an improvement of 5-year survival. Since 1982, a new multidisciplinary treatment containing neo-adjuvant chemotherapy has been introduced into the treatment of this type of carcinoma. Neo-adjuvant chemotherapy: day 1, cisplatin ( CPDD ) 50 mg/m2 or 80 mg/body i.a. over 2 hr., day 2-6, peplomycin (PEP) 5 mg/day i.a. over 5 hr. Two courses of chemotherapy were given with an interval of 2 weeks. Radiotherapy combined with intraarterial chemotherapy: Linac. 40 Gy/4 wks., 5-FU i.a. 250 mg/day q.d. (for 10 days). 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 9 patients who completed this therapy. At the completion of CPDD and PEP treatment, complete response was achieved in 5 cases and partial response in 3 cases with a response rate of 89%. In 2 out of the 9 cases, no cancer cells were detected by histological examination after chemotherapy. No cancer cells were detected in 2 other cases after 40 Gy by Linac. combined with 5-FU i.a. infusion, and in 3 other cases after 60 Gy by Linac. combined with 5-FU. Two patients had radical surgery because of uncontrolled tumors. Periods of follow-up are too short, but it is expected that this new multidisciplinary treatment results in the higher survival.

Aged↗

PubMed1983

Multidisciplinary survey of erectile impotence.

A study was done of 220 men referred principally by family physicians to a multidisciplinary erectile dysfunction study group to determine the factors causing or contributing to impotence that had persisted for more than 2 months and for which no cause was apparent. The men were aged 21 to 79 (mean 50.3) years, and the duration of impotence was a few months to 15 years (mean 2.65 years). The men were to be assessed from general medical, endocrinologic/metabolic, psychiatric and urogenital viewpoints. The significance of the causal or contributory factors detected was scored by application of defined criteria and a four-point scale. The degree of loss of potency and of libido as well as level of concern were also scored by each specialist. Impotence was complete in 60%, and an associated decline in libido was reported by 38%. The level of concern was high--that is, normal--in 81% and slightly reduced in 9%. Full investigation by all the specialists was precluded by the severity of other conditions in 16 patients, by the return of potency following relief of anxiety/depression or genitourinary tract infection in 16 and for logistic or other reasons in 34. Although the cause of the impotence could be attributed in 186 of the patients, only 154 were fully assessed. Among these patients general medical factors were contributory in 46%, endocrinologic/metabolic factors in 44%, psychogenic factors (primary or secondary) in 60% and urogenital factors in 49%. Multiple contributing factors were identified in 65%, which underscores the importance of a multidisciplinary approach to assessing many cases of impotence.

Adult↗

PubMed1983

Multidisciplinary education in geriatric medicine. Continuing experience at the Middlesex Hospital.

The unique feature about the course in teaching geriatric medicine to undergraduates at the Middlesex Hospital is its multidisciplinary nature. The course lasts for three weeks during the first or second clinical year and involves medical students together with student physiotherapists, nurses and occupational therapists. All take part in seminars, ward rounds and multidisciplinary case presentations. A full-time course organizer funded by the School of Nursing manages the course. Assessment includes MCQ and course evaluation questionnaire and an essay.

Education, Medical, Undergraduate↗

PubMed1995

[Standardized multidisciplinary diagnosis of cow's milk protein allergy in children. Work Group Cow's Milk Protein Allergy of the Groningen Academic Hospital].

OBJECTIVE: Evaluation of standardized multidisciplinary diagnostic procedures for cow's milk allergy (CMA) in children. DESIGN: Prospective standardized study. SETTING: Beatrix Children's Hospital, Department of Allergology, Dermatology and Dietetics, University Hospital Groningen, the Netherlands. METHODS: From August 1991 until May 1993, 114 children suspected of CMA for the first time were investigated according to the protocol for diagnosis of CMA, together with 23 children, previously diagnosed as CMA, in whom CMA was re-evaluated. Of 114 children with first suspicion of CMA, 66 improved on a cow's milk-free diet. The remaining 48 were excluded from the study because of no improvement on a cow's milk free diet, no diet given, insufficient data or no follow-up. The protocol was evaluated by questionnaire sent to 10 representatives of the departments involved. RESULTS: In 26/66 (39%) children, the diagnosis of CMA was confirmed by cow's milk challenge. The eosinophilic granulocytes were higher (p = 0.04), both IgE RAST and Skin Prick Test (SPT) for cow's milk were more often positive (both p = 0.01) in CMA than in non-CMA. The sensitivity and specificity were 50%-82% for IgE RAST and 60%-84% for the SPT, respectively. Four of the 23 children still had CMA at re-evaluation. In three of them, a SPT was performed, which was positive in all. In 12 of the 19 children, without CMA at re-evaluation, a SPT was performed, which was negative in all. At 1, 2, 3 and 4 years of age 13%, 48%, 74% and 78%, respectively, of the re-evaluation CMA patients had developed tolerance for cow's milk. The use of the protocol was found important by the representatives involved, although some practical difficulties remain. CONCLUSION: A multidisciplinary approach of CMA is possible. Improvement on a cow's milk-free diet by itself is not sufficient to diagnose CMA. Cow's milk challenge is obligatory. Laboratory investigations are of limited value. Re-evaluation of CMA after one year of age is necessary in view of the temporary character of CMA. When the SPT for cow's milk is positive, postponement of re-evaluation may be considered.

Allergens↗