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PubMedDate not supplied

Implementing a multidisciplinary cancer pain education program.

Cancer pain remains problematic for many patients. No standardized guidelines were available for the management of cancer pain until the early 1990s. In addition, many healthcare personnel have not been trained adequately in pain management, despite the abundance of literature. As a result, clinicians often manage patient's pain poorly. This article provides an overview of the process of development and implementation of a 5-year multidisciplinary cancer pain education program, begun in 1989 by the University of Pennsylvania School of Nursing, School of Medicine, and Cancer Center. The program was comprised of a multidisciplinary cancer pain consultation panel that sought to educate healthcare personnel in community hospitals and nursing homes in southeastern Pennsylvania about cancer pain. This was accomplished by providing consultations for agencies with patients experiencing uncontrolled and/or progressive cancer pain. The panel also provided education through lectures, newsletters, and symposia. A total of 1949 healthcare personnel attended 92 consultations, lectures, and symposia during the 5 years that the program has operated. With the linkage approach to innovation diffusion framework used in this consultation program, and the implementation of the guidelines now available, many healthcare personnel may be able to increase their skills and manage pain more effectively, thus reducing and/or eliminating needless suffering for patients. Developing role models in the area of pain management at community hospitals may be the most effective means of incorporating pain control guidelines and fostering innovation.

Diffusion of Innovation↗

PubMed1994

Multidisciplinary assessment of patients with Alzheimer's disease.

The complexity of AD necessitates that multiple disciplines interface effectively in the assessment of patient, caregiver, and family. This multidisciplinary effort should not be focused on the mere exchange of data. As this article emphasized, just from the perspective of nursing, it is critical that the various disciplines involved know about the purpose, focus, and process of assessment approaches used by each in the convergent effort to comprehensively evaluate the disease and its possible changes, as well as its impact on function, cognition, behavior, and emotion. From this article, it should be apparent that effective multidisciplinary assessment is not exchange of data but rather purposive interchange of clinical information to achieve the clinical goals of assessment, diagnosis, explanation, intervention, prognosis, and evaluation.

Alzheimer Disease↗

PubMed1994

[Multidisciplinary preoperative treatment of esophageal cancer].

To obtain a better prognosis, multidisciplinary treatment is essential for esophageal cancer. We prescribed hyperthermia combined with irradiation and chemotherapy (HCR) preoperatively for patients with resectable esophageal squamous cell carcinoma. The local effect of the HCR therapy was better than that of chemotherapy and radiotherapy (CR), showing 19.3% of the complete response rate. The five-year survival rate of stage III and IV patients given preoperative HCR was 18.5%, compared with 10.4% in the CR therapy group and 10.5% in the preoperative no treatment group. Moreover, preoperative HCR therapy improved prognosis of cases with far advanced cancer which invades the neighboring organs, showing 20.1% of 3-year survival rate. To evaluate the effectiveness of hyperthermia more objectively, we started a prospective randomized trial from 1988, comparing HCR therapy and CR therapy. The local effect is better in HCR therapy. When treated with cisplatin, the rate of complete response (Grade 3) in HCR therapy was 35.3%, which is as high as for the multi-drug combined treatment reported from other institutes previously. More effective multidisciplinary treatment together with basic research are necessary for a better therapeutic outcome.

Adult↗

PubMed1993

Restoration of the resorbed maxilla: a multidisciplinary approach.

The need for a multidisciplinary approach in implant restorations is well recognized today. This presentation describes the aesthetic restoration of the inadequate maxilla, involving augmentation of the grafting site, implant placement in the posterior regions to support the anterior restorations, and crown-and-bridge preparation. The learning objective of this article is a better understanding and execution of the multidisciplinary approach.

Alveolar Bone Loss↗

PubMed1993

Organization and development of a university multidisciplinary wound care clinic.

BACKGROUND: A multidisciplinary wound care clinic was established to diagnose and treat patients with nonhealing ulcers of the lower extremity. METHODS: The clinic was organized under the direction of the departments of vascular surgery and dermatology with support by the departments of plastic surgery, hyperbaric medicine, orthopedic surgery, and podiatry, and a research nurse. RESULTS: In the first 4 years and 3 months, 683 patients were evaluated. One hundred seventy-one patients underwent outpatient testing in the noninvasive vascular laboratory and 30 patients underwent angiography. Causes of the ulcers were venous stasis, 280 patients (41%); diabetic neuropathy, 182 patients (27%); arterial insufficiency, 119 patients (17%); rheumatologic disorders, 38 patients (6%); trauma, 15 patients (2%); and in 49 patients (7%) a variety of other disorders. One hundred seventy-nine operations were performed including 86 operating room debridements, 48 amputations (43 toe, 4 below knee, 1 above knee), 23 arterial bypasses, 1 venous bypass, 14 skin grafts, 2 pedicle flaps, and 5 excisions of tumor. Fifty-six patients with cellulitis were admitted to the hospital for intravenous antibiotics and 12 patients were treated with hyperbaric oxygen therapy. One-hundred thirty-two patients were entered into randomized prospective trials of topical growth factors on Institutional Review Board approved protocols. CONCLUSIONS: We concluded that a multidisciplinary approach to wound care is beneficial to patients with chronic wounds and provides a mechanism for clinical investigation on the healing of problem wounds.

Academic Medical Centers↗

PubMed1993

[Multidisciplinary treatment of cancer of the esophagus].

Multidisciplinary treatment is necessary for esophageal carcinoma. Radio-chemo-immunotherapy and aggressive chemotherapy with large doses of 5-FU, CDDP, ADR and VDS, were performed postoperatively from 1975. From 1975 to 1990, operations were performed on 456 patients with thoracic esophageal carcinomas. Postoperative radio-chemo-immunotherapy improved the 5-year survival rate of patients without lymph-node metastasis to 74.6% compared with 55.3% for patients not receiving any postoperative therapy. In the case of n1(+) and n2(+), the five-year survival rate of patients treated with aggressive chemotherapy (32.7%) was similar to the rate (34.8%) for patients treated with radio-chemo-immunotherapy. In cases of n3(+) and n4(+), improvement of the two-year survival rate of patients who received aggressive chemotherapy (37.0%) was noted compared with the rate of patients who received radio-chemo-immunotherapy (20.9%). However, there was no difference in five-year survival rate between the two groups. More effective multidisciplinary treatment based on randomized study will improve the therapeutic outcome.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1993

[Multidisciplinary treatment of advanced invasive thymoma].

From February 1988 to September 1992, six patients with Stage III or IV invasive thymoma were enrolled onto our study of multidisciplinary treatment, which included chemotherapy, surgery, and radiotherapy. The chemotherapy consisted of cisplatin (20 mg/m2 continuous 24-hour infusion on days 1 through 4), doxorubicin (40 mg/m2 on day 1), and methylprednisolone (1,000 mg on days 1 through 4 and 500 mg days 5 and 6). Two patients received surgery (incomplete resection) and postoperative chemo/radiotherapy, and four patients received induction chemotherapy followed by surgery and chemo/radiotherapy. All patients with induction chemotherapy showed a partial response and underwent complete (n = 2) or partial (n = 2) resection. Four patients are alive with no evidence of disease for 31 to 55 months after the diagnoses. But two with partial resection after chemotherapy died of recurrent disease. Multidisciplinary treatment including chemotherapy may be a new therapeutic choice in management of advanced invasive thymoma.

Adult↗

PubMed1993

Resident training in a multidisciplinary breast clinic.

A multidisciplinary breast clinic was initiated at William Beaumont Army Medical Center involving resident and staff physicians from the Departments of Obstetrics and Gynecology, General Surgery, Radiology and Pathology. During the period August 1988 to May 1989, 2,186 mammograms (MOGs) were screened. For this report, 197 patients were evaluated. Of them, 187 patients had been referred to the breast clinic based on MOG findings. Pathologic specimen correlation with the mammograms was performed on a periodic basis. Thirty-four patients were biopsied based on either physical examination or MOG findings. Biopsy diagnoses included: normal tissue (1), fibrocystic disease (18), sclerosing adenosis (1), fibroadenoma (8), mastitis (1) and intraductal carcinoma (5). The Multidisciplinary Breast Clinic provided improved care through expedited patient management. Resident training was accomplished through refinement of examination and diagnostic skills, management of abnormal MOGs, needle aspiration of breast masses and improved communication between the different medical disciplines.

Breast Diseases↗

PubMed1993

A prototype multidisciplinary cancer screening clinic for the military medical facility.

Optimal treatment of cancer depends upon early diagnosis. With an aging retiree and dependent population, cancer diagnosis and management must be addressed by military medical treatment facilities (MTFs) in a coherent and cost-effective fashion. A prototype multidisciplinary cancer screening clinic is described which interdigitated MTF and local American Cancer Society resources. Sites screened included breast, prostate, skin, cervix, and oral cavity, with mammograms, prostate-specific antigens, PAP smears, and physical exams, as appropriate. Of 194 patient contacts over a 4-hour period, eight cancers were found and subsequently treated (five skin, three prostate). Patient selection criteria, screening results by site, lessons learned, and recommendations for future clinics are discussed. The multidisciplinary screening clinic is readily applicable to the MTF setting, cost-effective, and provides an invaluable service to eligible patients.

Ambulatory Care Facilities↗

PubMed1995

A controlled clinical trial of multidisciplinary team approach in the general medical wards of Chulalongkorn Hospital.

The benefits and acceptability of a strengthened physician-nurse collaboration and a multidisciplinary team approach are demonstrated in the medical wards of a Thai acute-care hospital (Chulalongkorn University Hospital). The strengthened physician-nurse collaboration should be introduced or strengthened in all medical wards. Because of the lack of appropriately trained personnel, concentrating resources into a small unit or ward may be the appropriate measure at present if a multidisciplinary team approach is to be integrated into the medical ward of acute-care hospitals in South East Asia.

Adult↗

PubMed1995

Participative decision making: multidisciplinary team involvement in unit design.

This article describes the multidisciplinary team's input into the design and construction of an Epilepsy Monitoring Unit. The unit construction was a collaborative effort of a multidisciplinary team based in part on patient input as well as economic and efficiency factors. The Unit has resulted in long term rewards for both patients and staff. Patients benefit from the friendly environment created and staff benefits are due to the increased efficiency of the unit--working smarter not harder and the knowledge that staff nurses were an integral part of the planning process of this highly successful project.

Decision Making, Organizational↗

PubMed1996

Multidisciplinary teamwork--myth or reality?

The provision and delivery of health care has become increasingly complex in recent years due to technological innovation in medicine and increasing client expectations. The challenge for health care workers is to meet the purchasers' demands, one option may be to shift working practices from a functionalist approach to one of multidisciplinary teamwork. This paper explores one example of multidisciplinary teamwork and examines the processes which enhance and those that limit collaboration.

Attitude of Health Personnel↗

PubMed1996

[Therapeutic risk in multidisciplinary approach of cerebral arteriovenous malformations].

PATIENTS AND TECHNIQUES: A series of 67 patients treated for cerebral AVMs using a multidisciplinary approach is reported, paying special attention to the complications due to treatment. The malformations were classified according to the Spetzler Grading Scale, with 67% low-grade and 33% high-grade AVMs. Three modes of treatment were used: surgical resection, endovascular embolization, and radiosurgery (linear accelerator technique). The actual treatment was: resection alone (25% of cases), embolization plus resection (24%), embolization alone (21%), and radiosurgery, (30%) either alone or after embolization or surgery. The following eradication rates were obtained: 80% overall, 91% after resection (with or without embolization), 13% after embolization alone, 87% after radiosurgery. CLINICAL OUTCOME: The outcome was evaluated in terms of deterioration due to treatment. Treatment-related deterioration occurred in 28% of cases and consisted of a minor deterioration (19%), a neurological deficit (4%), or death (4%). As far as the mode of treatment is concerned, surgical resection was followed by deterioration in 20% of all operated cases (minor 17%, deficit 3%). Radiosurgery was followed by a minor deterioration in 10% of irradiated cases. Embolization resulted in complication in 25% of all embolized cases (minor 12.5%, neurological deficit 5%, or death 7.5%). The mechanism of the complication was: resection on manipulation of a functional area and the haemorrhage for cases treated by surgery, radionecrosis for radiosurgery, ischemia and haemorrhage (50% each) for embolization. In 4 out of the 5 cases of haemorrhage due to embolization, an occlusion of the main venous drainage could be demonstrated. DISCUSSION: The haemodynamic disturbances relating to AVMs and to their treatment are reviewed in the literature. The main haemodynamic mechanisms at the origin of a complication after treatment of cerebral AVMs are the normal perfusion pressure breakthrough syndrome, venous drainage defects (venous overload or occlusive hyperemia), and retrograde thrombosis of the feeding arteries. CONCLUSIONS: Improved treatment of cerebral AVMs has been achieved through the multidisciplinary approach, and especially through the endovascular embolization technique. Such an improvement is especially visible in the field of high-grade malformations, which are the most difficult and the most dangerous to treat. As a consequence, the risk of the treatment has naturally shifted from surgical resection towards endovascular embolization which is the first procedure to be performed in difficult cases. Careful consultation between the various specialists is necessary in this pathology, particularly as some of these AVMs are a good indication for each of the three available methods of treatment.

Adult↗

PubMedDate not supplied

Multidisciplinary approach to chronic back pain: prognostic elements of the outcome.

OBJECTIVE: This study presents an evaluation of a multidisciplinary approach to patients with chronic back pain. METHODS: Sixty-seven patients with back pain of more than three months duration participated in a comprehensive 4 week program which included back schooling, psychological intervention, and treatment by acupuncture, chiropractic, the Alexander technique and a pain specialist. At admission to the study, patients were asked to complete a questionnaire concerning their socio-demographic background and disease history. Patients also underwent a psychological evaluation based on a questionnaire and an interview. On the basis of this evaluation, patients were graded on three criteria: (i) predominance of psychological factors; (ii) secondary gain; (iii) personality features. At the end of the treatment, patients were divided into three groups according to their degree of improvement. Patients were evaluated at the end of the four week program and after 6 months of follow up. RESULTS: Significant improvement in the pain rating, pain frequency and analgesic drug consumption was observed in the treatment group, and was maintained for a period of 6 months. Satisfactory outcome was correlated to a moderate predominance of psychological factors, good functioning, a high level of motivation, and family support. Poor outcome was associated with a divorced marital status and unemployment, diffuse complaints, post surgery status, a high predominance of psychological factors, and the presence of secondary gain and personality disorders. CONCLUSION: Patients with chronic back pain seem to benefit from this proposed multidisciplinary approach. The improvement was maintained for a period of 6 months. Outcome was clearly related to psychosocial factors.

Acupuncture Therapy↗

PubMed1996

Multidisciplinary pain clinics for older people. Do they have a role?

Chronic pain occurs frequently in older people but is rarely considered a problem which warrants specialized attention by physicians or specialists in pain management. However a small proportion of older people with significant psychologic and physical disability from pain fail to respond to conservative management strategies. In this article, the authors describe the operations of a successful multidisciplinary pain management center for older people and briefly outline outcomes according to measures of pain, mood, and activity. Other factors that are specific and important to the management of chronic pain in older patients are discussed also. Despite some disadvantages, it is concluded that there is a place for multidisciplinary pain clinics for older people.

Aged↗

PubMedDate not supplied

Multidisciplinary treatment with anthracyclines in inflammatory breast cancer.

Twenty-two patients with inflammatory breast cancer treated between 1962 and 1994 were analyzed. Before the introduction of multidisciplinary treatment with anthracycline agents between 1962 and 1981, 11 patients out of 14 were resected, however, a curative operation was performed for only 3 of these patients (29.3%). Ablative endocrine therapy, intraarterial infusion of anticancer drugs (mitomycin C or 5-fluorouracil), and radiation were carried out as the preoperative induction therapy for inflammatory breast cancer. All 14 patients died within 36 months. After the introduction of multi-disciplinary treatment with anthracycline agents between 1981 and 1994, preoperative induction chemotherapy or chemoendocrine therapy using anthracyclines was carried out on 7 out of 8 patients and the remaining patient received radiation. Of the former 7 patients, 6 (85.7%) underwent a curative operation. There was approximately a 35 percent cumulative survival rate observed 60 months after operation, and 3 patients out of the 7 lived for more than 5 years. To conclude, multidisciplinary treatment including systemic induction chemotherapy with anthracyclines was an effective treatment for inflammatory breast cancer.

Adenocarcinoma↗

PubMedDate not supplied

Multidisciplinary outcome indicators.

Health care has been given a mandate by an educated public, managed care reimbursement sources, and the need to constantly improve patient care: to measure the quality of the outcomes of care. Multidisciplinary outcome indicators are basic to that measurement. A tool to assist with that measurement is a multidisciplinary clinical pathway.

Critical Pathways↗

PubMed1996

Lung volume reduction surgery CareMap. A multidisciplinary approach to managing patient care.

The introduction of Lung Volume Reduction Surgery (LVRS) presented an exciting challenge to the author's institution. A motivated, multidisciplinary collaborative group practice created the successful reality of the surgery. This was accomplished by formulating a realistic budget, providing essential staff education, and creating an LVRS CareMap. The CareMap provides critical direction for daily management of the patient and emphasizes integration of the patient and family into the continuum of care. The LVRS CareMap illustrates the vital importance of a fiscally sound plan of care that focuses on timely multidisciplinary interventions based on expected patient outcomes.

Critical Care↗