SEARCH · PubMed Health

Results for “multidisciplinary”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 667 records · Page 37Linked to original sources

PubMed1997

Experiences of a Belgian multidisciplinary breath odour clinic.

Experiences of a Belgian multidisciplinary breath odour clinic. Oral malodour is a frequent problem, which can benefit from a multidisciplinary approach (periodontology, ENT, internal medicine, psychiatry). An objective measurement of the amount of volatile sulphur compounds in the patient is very useful and easy to perform. Tongue coating is the most frequent cause. Initial treatment strategy should focus on oral hygiene. In a few cases, tonsillectomy or endoscopic sinus surgery may be necessary.

Adolescent↗

PubMed1997

Multidisciplinary breast cancer clinics. Do they work?

BACKGROUND: In an attempt to improve the care they provide for their patients with breast cancer, the authors' institution developed a multidisciplinary breast cancer clinic (MDBCC) to offer "one-stop shopping" consultation and support for newly diagnosed breast cancer patients. METHODS: One hundred sixty-two patients, the control group for this study, were evaluated at Henry Ford Hospital during the year prior to the opening of the MDBCC. These patients, who were referred in the traditional sequential consultation manner, were compared with the first 177 patients seen during the first year of the clinic's operation. Retrospective chart reviews were conducted to assess treatment timeliness, and anonymous questionnaires were used to assess patient satisfaction. RESULTS: The authors found that the MDBCC increased patient satisfaction by encouraging involvement of patients' families and friends and by helping patients make treatment decisions (P < 0.001). The time between diagnosis and the initiation of treatment was also significantly decreased (42.2 days vs. 29.6 days; P < 0.0008). CONCLUSIONS: Although planning and operating a multidisciplinary clinic is not a new venture, to the best of the authors' knowledge, they have provided the first report demonstrating the benefits described above.

Breast Neoplasms↗

PubMed1997

Breaking down barriers: multidisciplinary education model.

A pilot project was implemented involving students from three disciplines: dental hygiene, physical therapy, and physician assistant. The purpose was to prepare students to work together in multidiscipline teams utilizing concepts of problem-based learning (PBL) on both simulated and real patients. The project was divided into three phases. Phase I introduced discipline specific information, team concepts, and PBL concepts. Phase II involved students working in multidisciplinary teams solving a simulated patient case in the PBL format. Phase III consisted of students working in small groups and on real patients, performing an extraoral/intraoral and periodontal examination, a problem oriented physical examination, and a neuromuscular assessment. Pre and posttest evaluation of Phase I revealed no difference in knowledge among the three disciplines. Of those students evaluating Phase II and III, 100% felt PBL was an effective means of presenting multidisciplinary material; 93% reported enhanced problem-solving; 98% indicated improvements in working in groups; and 98% felt they had learned more about each other's discipline. This model may provide a viable means to prepare interdisciplinary teams to work effectively together.

Adult↗

PubMedDate not supplied

Trauma multidisciplinary QI project: evaluation of cervical spine clearance, collar selection, and skin care.

PURPOSE: To evaluate data regarding cervical collars and develop guidelines related to product selection, cervical spine clearance, and skin care. METHODS: Production selection and skin care were evaluated by multidisciplinary teams review of QI data. RESULTS: The multidisciplinary teams identified a c-spine clearance algorithm, a methodology for continuous skin evaluation, and a new policy for skin care under the c-collar. CONCLUSIONS: Focused attention to problems surrounding cervical spine immobilization can decrease patient complications.

Algorithms↗

PubMed1997

[Sexual violence: necessity of multidisciplinary management].

In the 300,000 inhabitant city-area of Nancy (France), admission of women victims of sexual violence follows a special procedure. That has been jointly set by the Justice Department, Police and Emergency Rooms of both the Maternite Régionale and the University General Hospital. Nevertheless, we have recently conclude the management and follow-up of victims were generally not good enough. Early management of the psychological shock and formation of all intervening parties have to be improved. As both a gynecologist attached to the Maternite regionale and the Commission for the Fight of violence against women to take initiatives aimed at increasing public awareness (congresses ...). These initiatives have driven to the creation of a meeting place where a multidisciplinary team takes care of victims and leads talking groups including both victims and authors of violence. The organization of such a multidisciplinary management team is slow and difficult. Strong political will and compassion are needed to achieve that task. In the process, power and knowledge of every member of the team have continuously to be called into question.

Aftercare↗

PubMed1998

[Communication disorders in children; experiences with a multidisciplinary outpatient diagnosis].

Communication disorders in children can be caused by impaired hearing. However, also other factors can adversely influence speech and language development, such as mental retardation, lack of language stimulation and anatomical defects of speech organs. Speech and language development can be regarded as a symptom; therefore a multidisciplinary diagnostic procedure is essential to the planning of an adequate therapy programme. In the Netherlands a great variety in diagnosis and treatment exists. A child with a communication disorder is usually seen by five specialists, and the interval between recognition of the communication problem by the parents and the final diagnosis, after which therapy starts, sometimes lasts almost three years. Besides that, in a majority of cases speech and language therapy is offered. In order to change this process for the better a prospective research programme was started in the Academic Hospital Groningen, the Netherlands, with a protocolled multidisciplinary diagnostic approach. The first findings are encouraging: 89% of 209 children with supposed communication disorders were diagnosed after one visit to the outpatient clinic.

Adolescent↗

PubMedDate not supplied

Evolutionary adaptations of gene structure and expression in natural populations in relation to a changing environment: a multidisciplinary approach to address the million-year saga of a small fish.

We have used an experimentally based strategy to address molecular mechanisms underlying adaptation in Fundulus heteroclitus. In an attempt to falsify the hypothesis that selection is a major driving force in the maintenance of genetic diversity, we employed a multidisciplinary approach including allelic isozyme and mtDNA phylogeography, kinetic analyses of allelic isozymes, analysis of variation in coding and regulatory DNA sequences, metabolic biochemistry, organismal physiology, and selection experiments. Observed differences in gene structure and expression led us to make testable predictions about differences in metabolic flux, whole organism performance, and differential survival between allotypes. We have shown that variation in the lactate dehydrogenase-B (Ldh-B) protein results in differences in physiological function and is correlated with differences in survival at high temperatures. Recent work has investigated the role of variation in Ldh-B expression. There are differences in the levels of Ldh-B protein, mRNA, and transcription rate. We have addressed the mechanisms responsible for differences in transcription rate by a combination of sequence comparison, DNase I footprinting, and functional analyses both in vitro and in vivo. We have shown that variation in the regulatory sequence of Ldh-B is responsible for the differences in transcription rate between populations and that the patterns of variation are inconsistent with a neutral model of molecular evolution. This functional differentiation, coupled with departures from neutral expectations, suggests that natural selection has acted on the regulation of Ldh-B. This article illustrates the value of a multidisciplinary approach in addressing problems in gene structure, expression, and evolutionary adaptation.

Adaptation, Physiological↗

PubMed1998

[Approach to severe functional deficiencies: evaluating the efficacy of a special multidisciplinary consultation].

A global approach is required to evaluate severe functional deficits. We have developed a multidisciplinary consultation and assessed its usefulness after one year. A total of 62 patients were evaluated (mean age 35 years), usually for neurological functional deficit (50%). Among the 62 patients, surgery was proposed in 72.6% (operations performed in 66%). Others were managed with non-surgical procedures or abstention. The functional outcome as assessed by patients and physicians was poor (or no result) for 6%, fair for 15%, good or very good for 79%. These results suggest that such a multidisciplinary approach is worth being pursued. Some adjustments for psychological dysfunction may further improve outcomes.

Adolescent↗

PubMed2003

Dermatologist detection and skin self-examination are associated with thinner melanomas: results from a survey of the Italian Multidisciplinary Group on Melanoma.

OBJECTIVE: To investigate patterns of detection and variables associated with early diagnosis of melanoma in a population at intermediate melanoma risk. DESIGN: Survey. SETTING: Hospital and university centers belonging to the Italian Multidisciplinary Group on Melanoma. PATIENTS: Eight hundred sixteen patients who were consecutively diagnosed as having melanoma and treated at 11 participating centers. MAIN OUTCOME MEASURE: Relationship between patterns of detection and patient's and physician's delay with melanoma thickness, assessed by multivariate analysis. RESULTS: A statistically significant association with early diagnosis was found for female sex (odds ratio [OR] for a lesion >1 mm in thickness, 0.70; 95% confidence interval [CI], 0.50-0.97), higher educational level (OR, 0.44; 95% CI, 0.24-0.79), residence in northern and central Italy (compared with southern Italy) (OR, 0.44; 95% CI, 0.30-0.65 and OR, 0.24; 95% CI, 0.15-0.37, respectively), and the habit of performing a skin self-examination (OR, 0.65; 95% CI, 0.45-0.93). When adjusted for all the previously mentioned variables, only melanoma detection made by a dermatologist, maybe incidentally, was associated with a statistically significant additional effect on early diagnosis (OR, 0.45; 95% CI, 0.28-0.73). No significant effect of anatomical site (trunk compared with other sites: OR, 0.83; 95% CI, 0.59-1.17), presence of atypical nevi (OR, 0.78; 95% CI, 0.52-1.17), and patient's delay (>3 months compared with < or =3 months: OR, 1.12; 95% CI, 0.78-1.60) was found. CONCLUSION: Future melanoma early diagnosis strategies should adequately stress the role of skin self-examination among the adult population, and should recommend that dermatologists perform a total skin examination to identify suspect lesions (such an examination should also be performed during consultations for other reasons).

Adult↗

PubMed2005

Echocardiographic findings in patients meeting task force criteria for arrhythmogenic right ventricular dysplasia: new insights from the multidisciplinary study of right ventricular dysplasia.

OBJECTIVES: The purpose of this study was to quantify the echocardiographic abnormalities in probands who were newly diagnosed with arrhythmogenic right ventricular dysplasia (ARVD). BACKGROUND: The diagnosis of ARVD remains challenging. The Multidisciplinary Study of Right Ventricular Dysplasia was initiated to characterize the cardiac structural, clinical, and genetic aspects of ARVD. METHODS: Detailed echocardiograms were performed in 29 probands and compared with echoes from 29 normal control patients matched for age, gender, body size, and year of echo. Right atrial (RA) and right ventricular (RV) chamber dimensions, RV regional function, and the presence of morphologic abnormalities (hyper-reflective moderator band, trabecular derangement, and sacculations) were assessed. The RV systolic function was calculated as RV fractional area change (FAC). RESULTS: The RV dimensions were significantly increased, and RV FAC was significantly decreased in probands versus control patients (27.2 +/- 16 mm vs. 41.0 +/- 7.1 mm, p = 0.0003). The right ventricular outflow tract (RVOT) was the most commonly enlarged dimension in ARVD probands (37.9 +/- 6.6 mm) versus control patients (26.2 +/- 4.9 mm, p < 0.00001). A RVOT long-axis diastolic dimension >30 mm occurred in 89% of probands and 14% of controls. The RV morphologic abnormalities were present in many probands (trabecular derangement in 54%, hyper-reflective moderator band in 34% and sacculations in 17%) but not in controls. CONCLUSIONS: Probands with ARVD have significant RA and RV enlargement and decreased RV function, which can be easily assessed on standard echocardiographic imaging. These parameters should be measured when ARVD is suspected and compared with normal values.

Adolescent↗

PubMed2005

Guidelines for the use of recombinant activated factor VII (rFVIIa) in uncontrolled bleeding: a report by the Israeli Multidisciplinary rFVIIa Task Force.

BACKGROUND: Recombinant activated factor VII (rFVIIa) has been approved by the U.S. Food and Drug Administration (FDA) for almost a decade for hemophilic patients with inhibitors. Its off-label use as a hemostatic agent in massive bleeding caused by a wide array of clinical scenarios is rapidly expanding. While evidence-based guidelines exist for rFVIIa treatment in hemophilia, none are available for its off-label use. OBJECTIVES: The aim of this study is to develop expert recommendations for the use of rFVIIa in patients suffering from uncontrolled bleeding (with special emphasis on trauma) until randomized, controlled trials allow for the introduction of more established evidence-based guidelines. METHODS: A multidisciplinary task force comprising representatives of the relevant National Medical Associations, experts from the Medical Corps of the Army, Ministry of Health and the Israel National Trauma Advisory Board was established in Israel. Recommendations were construed based on the analysis of the first 36 multi-trauma patients accumulated in the prospective national registry of the use of rFVIIa in trauma, and an extensive literature search consisting of published and prepublished controlled animal trials, case reports and series. The final consensus guidelines, together with the data of the first 36 trauma patients treated in Israel, are presented in this article. RESULTS: Results of the first 36 trauma patients: The prolonged clotting assays [prothrombin time (PT) and partial thromboplastin time (PTT)] shortened significantly within minutes following administration of rFVIIa. Cessation of bleeding was achieved in 26 of 36 (72%) patients. Acidosis diminished the hemostatic effect of the drug, while hypothermia did not affect it. The survival rate of 61% (22/36) seems to be favorable compared with published series of similar, or less severe, trauma patients (range 30%-57%). CONCLUSIONS: As a result of the lack of controlled trials, our guidelines should be considered as suggestive rather than conclusive. However, they provide a valuable tool for physicians using rFVIIa for the expanding off-label clinical uses.

Adolescent↗

PubMed1987

Bulimia. An underlying behavioral disorder in hyperlipidemic pancreatitis: a prospective multidisciplinary approach.

Between 1978 and 1985, we conducted a prospective study of 21 patients who survived several attacks of pancreatitis and were diagnosed as having primary hyperlipidemia. None of the patients suffered from chronic alcoholism, primary diabetes, or cholelithiasis or was receiving prolonged steroid therapy. Lowering of plasma lipid values toward normal was achieved in all patients following a program of combined dietary and drug (bezafibrate) therapy. Five patients had recurrent episodes of pancreatitis during the treatment program. These patients were diagnosed subsequently as suffering from bulimia and were all given cognitive behavioral therapy. One patient died following an attack of pancreatitis. An underlying eating disorder should be suspected in patients who relapse after treatment for pancreatitis and hyperlipidemia. Multidisciplinary treatment should be used in these patients to improve therapeutic efficacy and uncover behavioral patterns that have a direct impact on their life expectancy.

Adult↗

PubMed1999

Guideline for the management of pediatric idiopathic constipation and soiling. Multidisciplinary team from the University of Michigan Medical Center in Ann Arbor.

OBJECTIVE: To develop an evidence-based guideline for the primary pediatric care of children (birth to 18 years old) with idiopathic constipation and soiling. DATA SOURCES: References were identified through a MEDLINE search from January 1975 through January 1998 to address 3 focus questions: (1) the best path to early, accurate diagnosis; (2) best methods for adequate clean-out; and (3) best approaches to promote patient and family compliance with management. DATA SELECTION: Twenty-five references were identified. DATA EXTRACTION: References were reviewed by a multidisciplinary team and graded according to the following criteria: randomized controlled trial; controlled trial, no randomization; observational study; and expert opinion. Evidence tables were developed for each focus question. DATA SYNTHESIS: An algorithm and clinical care guideline were developed by consultation and consensus among team members. Emphasis was placed on methods to promote early identification of pediatric idiopathic constipation and soiling, to recognize points of referral, and to increase patient and family compliance with treatment through use of education, developmentally based interventions, and variables for tracking success of management. CONCLUSION: An algorithm and guideline for pediatric idiopathic constipation and soiling are presented for use by primary care physicians.

Child↗

PubMed1996

The "Basqueness" of the Basques of Alava: a reappraisal from a multidisciplinary perspective.

The genetic and linguistic peculiarity of the Basque population is well known. Analysis of the studies published to date on the Basque population reveals that these studies refer basically to the provinces of Vizcaya and Labourd, both in the Northern part of the Basque Country. Multidisciplinary information indicates that the landscape differences of the Basque Country could have conditioned differential population biodynamics in the Atlantic and Mediterranean parts of the Basque area. In order to evaluate this possibility, this study focuses on the genetic constitution of the Basque population of Alava (in the South of the Basque Country) through the analysis of several red-cell systems. The data obtained in this genetic study and those from archaeology, linguistics, ethnography, and skeletal biology suggest that within the "Basque population" there may be at least two distinct groups: an "Atlantic" group and a "Mediterranean" one, divided mainly by the watershed. This geographical feature could have led to a greater genetic isolation of the Northern slopes, with the South more open to population contact. This is reflected nowadays in the different cline distribution detected for most systems in the Alava Basques in comparison with other Basque and Iberian Peninsula series studied to date.

ABO Blood-Group System↗

PubMed1975

Multidisciplinary treatment of embryonal rhabdomyosarcoma in children.

Twenty-nine children under 15 years of age with embryonal rhabdomyosarcoma were treated according to a multidisciplinary protocol (T-2). The protocol consisted of surgical removal of the tumor if possible, followed by chemotherapy, and also with radiation therapy in patients with gross or microscopic residual disease. Radiation therapy was given in the 4500-7000 rads range. The chemotherapy consisted of cycles of sequential administration of dactinomycin, Adriamycin, vincristine, and cyclophosphamide, with obligatory periods of rest. The drug therapy was continued for 2 years. Following surgery, clinicopathologic staging of the disease revealed 10 patients with no residual disease (I-A), 5 with microscopic residual disease (I-B), 5 with unresectable tumors (II), 6 with unresectable tumors plus regional lymph node involvement (III), and 3 with disseminated tumors (IV). Twenty-four (82%) of the patients (20 Stages I-II, 4 Stage III) are alive with no evidence of disease for 4 plus to 42 plus months. These results are superior to those achieved between 1960-1970 among 108 children treated at Memorial Sloan-Kettering Cancer Center.

Adolescent↗

PubMed1983

Multidisciplinary treatment of maxillary sinus carcinoma.

The history of treatment of maxillary sinus carcinoma is divided into four characteristic periods, with the corresponding 5-year cumulative survival rates of: 20% of 282 patients for 1957 to 1966; 25% of 191 patients for 1967 to 1971; 39% of 166 patients for 1972 to 1975; and 54% of 134 patients for 1976 to 1979. The best treatment at present consists of 60Co gamma ray (5000 rad/25 fractions/5 weeks), continuous intra-arterial 5-FU infusion (2000 mg during the radiotherapy), tumor reduction mainly by weekly cryosurgery, and immunotherapy with cell wall skeleton of Nocardia rubra in appropriate combination. Early antrostomy and final curettage are mandatory. Maxillectomy should be resorted to when recurrence is histologically confirmed. Multidisciplinary treatment of maxillary sinus carcinoma based on this conception has successfully increased the survival rates and reduced the need for maxillectomy.

Adult↗

PubMed1984

Limb salvage for skeletal and soft tissue sarcomas. Multidisciplinary preoperative therapy.

One hundred eighty-three patients with malignant skeletal (83) or soft tissue sarcoma (100) were entered into the multimodality preoperative limb salvage protocol. Local recurrences were observed in 5 of 183 (2.7%). Six patients required amputation because of complications, and 13 patients died within 1 year from metastatic disease. There was no statistical difference in survival rates between a series of patients who had amputation and adjuvant therapy and patients treated by limb salvage and adjuvant therapy. Overall survival rates for patients with soft tissue sarcoma were 76%. Although the exact reason for the improved local control is not known, it is our belief that it is the result of the multidisciplinary therapy that destroys microscopic disease at the periphery of the primary tumor.

Adolescent↗

PubMed1985

Lucy Wortham James lecture. Multidisciplinary clinical investigation of the cancers of children. A model for the management of adults with cancer.

Clinical research on cancers of children during the last two decades has led to spectacular improvements in treatment and cure rates. The demands of multi-institutional clinical trials required development of teams of specialists at each participating institution. Multidisciplinary teamwork in diagnosing, staging, and treating children with cancer has become the only acceptable mode in this country. These concepts now should be applied to the management of adults with cancer. The complete staging of cancer now involves many new disciplines. Accurate staging, including biologic as well as clinical staging, is becoming increasingly important in determining the most appropriate treatment plan. Although surgical removal provides the greatest opportunity for cure of patients with malignant tumors, the majority of patients having primary surgery cannot be cured by surgery alone. Multiple disciplines should be involved in the assessment of each patient, in developing and in carrying out the most appropriate plan of patient management, in order to achieve the best results.

Adult↗