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Results for “multidisciplinary”

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PubMed1985

Intra-arterial infusion chemotherapy as an induction therapy in multidisciplinary treatment for locally advanced breast cancer. A long-term follow-up study.

A multidisciplinary treatment including intra-arterial infusion chemotherapy as an induction therapy was administered to 55 patients with locally advanced breast cancer. Intra-arterial chemotherapy conducted preoperatively produced marked responses in primary and lymph node lesions with 78% complete + partial response (CR + PR), subsequently permitting extended radical mastectomy. Histologic examination of resected specimens also revealed that 33% of the patients had no viable cancer cells remaining in their lesions. Five-year and 10-year survival rates were 57% and 41%, respectively, compared with 24% and 18%, respectively for the 17 patients of historic control. Patients showing better local responses to intra-arterial chemotherapy had longer survival time with less frequent local recurrences. Intra-arterial chemotherapy is an effective modality for the treatment of locally advanced breast cancer.

Aclarubicin↗

PubMed1989

Multidisciplinary treatment planning. Tumor boards.

A brief review of the current status of cancer treatment based on hospital consultations, cancer treatment plans, and cancer management protocols is presented. Some potential for the development of clinical indicators around these various consultation activities are explored. The utilization of hospital tumor conference and tumor boards as a mechanism for multidisciplinary treatment planning and consultation is reviewed and possible utilization of a measure of such activities as potential clinical indicators is presented.

Female↗

PubMed1977

Some personality differences among the multidisciplinary team.

Professional and student psychologists, social workers, physiotherapists and occupational therapists were administered a demographic questionnaire, the Dogmatism Scale and the Personality Research Form. Significant and trend differences on each of these measures were obtained between the four professional groups, the professional and student groups and the professional groups and the norms for the measures. The possible role of these differences in the operation of the multidisciplinary team is discussed.

Authoritarianism↗

PubMed2005

High-dose-rate brachytherapy as part of a multidisciplinary treatment of nasopharyngeal lymphoepithelioma in childhood.

BACKGROUND: Nasopharyngeal carcinoma in childhood is rare. Radiochemotherapy is considered the standard treatment and yields increased survival and local control rates. In this article, the authors report on the results from the multidisciplinary treatment of pediatric patients who had nasopharyngeal lymphoepithelioma with radiochemotherapy, including high-dose-rate brachytherapy of the primary tumor site. METHODS: Between May 1992 and May 2000, 16 children with nasopharyngeal lymphoepithelioma received neoadjuvant chemotherapy, conventional external beam radiotherapy, high-dose-rate brachytherapy, and adjuvant chemotherapy. Patients ranged in age from 7 years to 18 years, and 9 patients were male. Patient distribution according to clinical disease stage was as follows: Stage III, 1 patient; Stage IVA, 5 patients; Stage IVB, 9 patients; and Stage IVC, 1 patient. Three cycles of neoadjuvant and adjuvant chemotherapy in 3-week intervals were administered with cyclophosphamide, vincristine, doxorubicin, and cisplatin. The median doses of external beam radiotherapy to the primary tumor, positive lymph nodes, and subclinical areas of disease were 55 grays (Gy), 55 Gy, and 45 Gy, respectively. Children received 2 insertions of high-dose-rate brachytherapy at 5 Gy per insertion: These were performed with metallic applicators inserted through the transnasal access under local anesthesia. RESULTS: The median of follow-up was 54 months. At the time of last follow-up, 13 patients were alive without disease, 2 patients had died of disease, and 1 patient had died of treatment-related cardiac failure. Local control was achieved in 15 of 16 patients. Chemotherapy-related and radiotherapy-related acute toxicity was relevant but tolerable. CONCLUSIONS: In the current study, it was shown that the treatment was effective in the control of both local and distant disease, although there was relevant acute and late toxicity. High-dose-rate brachytherapy was deliverable on an outpatient basis with local anesthesia. Close follow-up of these patients was necessary to evaluate the significance of treatment-related late effects and their impact on quality of life.

Adolescent↗

PubMed1993

Older women as the focus for research and treatment of ovarian cancer. An overview for the National Institute on Aging, National Cancer Institute, and American Cancer Society Multidisciplinary Working Conference.

Ovarian cancer disproportionately affects women 65 years of age and older who are likely to have concomitant changes in physical ability, physiological functioning, and other chronic conditions associated with advancing age. The National Institute on Aging, National Cancer Institute, and the American Cancer Society cosponsored a multidisciplinary working conference, "Perspectives on Ovarian Cancer in Older-Aged Women: Current Knowledge and Recommendations for Research," at the National Institutes of Health on November 20-21, 1991 to confront the age-related aspects of ovarian cancer in epidemiology, etiology, clinical investigations, and patient management. Conference participants devoted attention to such special topics as drug resistance, dose intensity, patterns of care, and screening potential for ovarian cancer. After exploring these areas with existing data, the task was then to generate recommendations for research and practice. The scope of the conference and an introduction to the proceedings are presented in this paper.

Aged↗

PubMedDate not supplied

Multidisciplinary treatment of head and neck cancer using BCG, OK-432, and GE-132 as biologic response modifiers.

Since 1979, we have performed multidisciplinary treatment using intensive immunotherapy with biologic response modifiers (BRM) in combination with surgical treatment of oral cancer. Chemotherapy and radiotherapy were also included as part of the therapy. A historic control study was performed. Adjuvant therapy was administered by standardized methods, and the distribution of patients at various stages was similar between groups. The immunotherapy group showed a shorter treatment period, lower rates of recurrence, metastases, and side effects, greater histologic effects at the end of the first treatment, and a higher survival rate than the nonimmunotherapy group. Immunologically, immunotherapy tended to promote positive immune reactions and inhibit negative immune reactions.

Antineoplastic Agents↗

PubMedDate not supplied

A multidisciplinary approach to chronic pain.

Chronic pain often is frustrating to nurses and patients, since many times it has not been responsive to traditional medical approaches. The purpose of this article is to discuss the chronic pain syndrome and the role of nursing within a multidisciplinary chronic pain rehabilitation program designed to return the patient to a functional lifestyle. The purpose and rationale for each treatment modality within the pain management program is described, although the treatment plans are individualized for every patient. Nurses play a crucial role, because they are the only professionals who are constantly available to the patient. Nurses collect data and continually assess the patient to develop comprehensive nursing care plans. In this intensive educational program, nurses also assist in teaching the patient positive health practices to control the pain. Further evaluations of these chronic pain rehabilitation programs are needed.

Analgesia↗

PubMedDate not supplied

Patient discharge planning documentation in an Australian multidisciplinary rehabilitation setting.

This article, drawing on data from 17 case studies, addresses problems in documentation of discharge planning in an Australian multidisciplinary rehabilitation center and the ways these were, or could be, overcome. The problems identified in the case studies were not specific to one discipline; they were due to inadequately defined guidelines and responsibility and poorly designed forms, and they possibly reflected the tendency for members of practice-oriented disciplines to see documentation as low on their list of priorities.

Forms and Records Control↗

PubMedDate not supplied

Results of a multidisciplinary pain management program: a 6- and 12-month follow-up study.

The aim of this study was to evaluate an 8-week multidisciplinary pain management program offered to patients suffering from chronic pain. The study initially included 88 participants, and 61 of the sample completed a follow-up program conducted at 6 and 12 months after the initial programs. The pain management program was based on a cognitive behavioral approach with active patient participation in learning new coping skills. The intervention consisted of supervised dialog, physical activity, and education. The main goals were change of focus from pain and disability to resources and functional coping strategies. It was hypothesized that the positive changes gained at posttest registration after an 8-week program on coping, health-related quality of life, and pain intensity would be maintained during follow-up sessions. The results indicated that these hypotheses were mainly supported and further pain reduction, decreased emotion-focused coping, better social functioning, and overall physical and mental health gains were observed. The participants who did not complete the follow-up program did not differ from the patients who completed the program on background variables investigated. The study also supported the claim that professional nurses are competent to lead such programs and to evaluate treatment results. Clinical and research implications are discussed.

Adaptation, Psychological↗

PubMed2004

Pharmaceutical impurity identification: a case study using a multidisciplinary approach.

A multidisciplinary team approach to identify pharmaceutical impurities is presented in this article. It includes a representative example of the methodology. The first step is to analyze the sample by LC-MS. If the structure of the unknown impurity cannot be conclusively determined by LC-MS, LC-NMR is employed. If the sample is unsuitable for LC-NMR, the impurity needs to be isolated for conventional NMR characterization. Although the technique of choice for isolation is preparative HPLC, enrichment is often necessary to improve preparative efficiency. One such technique is solid-phase extraction. For complete verification, synthesis may be necessary to compare spectroscopic characteristics to those observed in the original sample. Although not widely practiced, an effective means of getting valuable structural information is to conduct a degradation study on the purified impurity itself. This systematic strategy was successfully applied to the identification of an impurity in the active pharmaceutical ingredient 1-(1,2,3,5,6,7-hexahydro-s-indacen-4-yl)-3-[4-(1-hydroxy-1-methyl-ethyl)-furan-2-sulphonylurea. Identification required the use of all of the previously mentioned techniques. The instability of the impurity under acidic chromatographic conditions presented an additional challenge to purification and identification. However, we turned this acidic instability to an advantage, conducting a degradation study of the impurity, which provided extensive and useful information about its structure. The following discussion describes how the information gained from each analytical technique was brought together in a complementary fashion to elucidate a final structure.

Drug Contamination↗

PubMed2003

Significance of reduction surgery in multidisciplinary treatment of advanced hepatocellular carcinoma with multiple intrahepatic lesions.

BACKGROUND AND OBJECTIVES: By comparing the survival rates of patients treated with or without surgery, the significance of, and the indication for, reduction surgery in the multidisciplinary treatment of patients with HCC with multiple intrahepatic lesions were examined. METHODS: In patients with HCC with multiple intrahepatic lesions, cumulative survival rates were determined and compared for 28 patients (group S) who underwent reductive hepatic resection and 43 (group N) who were treated nonsurgically by transcatheter arterial infusion chemotherapy (TAI), transcatheter arterial chemoembolization (TACE), or percutaneous transhepatic ethanol injection therapy. In group S, 20 patients had adjuvant therapy, consisting of ethanol injection therapy or microwave coagulonecrotic therapy for the remaining satellite lesions during hepatectomy, and all patients in this group underwent TAI or TACE postoperatively. The influence of surgery on patient survival was examined by multiple regression analysis using the Cox's hazard model; then, for each prognostic factor, survival rates were obtained and compared between the groups. RESULTS: In group S, the 1-, 3-, and 5-year cumulative survival rates were 58.2%, 27.1%, and 21.7%, whereas the corresponding values in group N were 34.3%, 4.7%, and 4.7%, the difference being statistically significant (P = 0.0239). In group S, the 1-, 3-, and 5-year cumulative survival rates for patients without intraoperative adjuvant therapy were 25%, 0%, and 0%, whereas those for patients with intraoperative adjuvant therapy were 72.7%, 41.3%, and 33.0% (P = 0.001). Multiple regression analysis showed that hepatic resection, the Child-Pugh score, and the size of the main tumor affected survival independently. Univariate analysis of differences in the cumulative survival rates between the groups as a function of prognostic factor showed that group S had statistically significant better survival rates than group N in those subgroups of patients who were <60 years old, with HBV infection, with a Child-Pugh score of 5 or 6, with a main tumor of <5-cm diameter, with <5 tumors, or without portal thrombi. CONCLUSIONS: When combined with intraoperative adjuvant therapy for remaining satellite tumors, reduction surgery provided survival benefit for patients with HCC with multiple intrahepatic lesions in those groups of patients selected by criteria determined in this study.

Aged↗

PubMed1985

Multidisciplinary pretreatment cancer planning.

One can estimate that 60% or more of cancer patients stand to benefit from the multidisciplinary treatment of cancer. Different treatments given in sequence mean real benefit in terms of absolute cure or length of disease-free life for many. While the details of treatment techniques can usually be worked out for each patient in expert fashion, the process of planning to fit the three main modalities together into a single plan presents complex problems. To obtain optimum results someone must assemble and coordinate the opinions of the oncologists who are consulted in each case; and someone must do it before treatment begins. Benefit is significantly reduced if the planning process is delayed until recurrence occurs. Those who act as primary physicians in caring for cancer patients have a newly defined major role to play: they must select the oncology team, coordinate the various opinions, and continue to supervise the course of the cancer throughout in order that the patients receive the best care. When a physician prepares for, and accepts, this role of leader-coordinator, and outlines in broad general terms a properly integrated plan from the first, details of therapy fall easily into place.

Cancer Care Facilities↗

PubMed1995

Needle localization breast biopsy: a model for multidisciplinary quality assurance.

As part of the quality assurance role of the Cancer Committee at Barnes Hospital, an institutional audit of Needle Localization Breast Biopsy (NLBB) was performed. Mammographic, operative, and surgical pathology reports from 370 consecutive patients at our institution undergoing both mammography and needle localization biopsy over a 34-month interval were reviewed. Carcinoma was diagnosed pathologically in 103 patients (28%), and 27% of these proved to be noninvasive. Sixteen patients were found to have histologic or clinical involvement of the axillary nodes; no patients with Tis lesions were found to have axillary nodal involvement. Of the patients, 73% were found to have either Stage 0 or Stage I disease, and 61% with an established malignancy had mastectomy (67% of patients with invasive carcinoma, 44% of those with carcinoma-in-situ), whereas 39% had some form of conservation therapy (33% of patients with invasive lesions, 56% of those with carcinoma-in-situ). Our results have been compared with other published studies, and important clinical indicators for evaluating the results of individual centers performing NLBB are discussed. It is concluded that NLBB is a safe and effective method of biopsying nonpalpable breast lesions, which allows for the identification of early stage breast carcinomas. In the present environment of concerns about the quality of care and costs, it is the responsibility of each center performing NLBB periodically to evaluate their results with this multidisciplinary procedure and to bring about change in those areas found to be deficient.

Biopsy, Needle↗

PubMed1991

A model for multidisciplinary data collection for cervical metastasis.

A system for multidisciplinary data collection for metastatic neck disease is discussed. Information from 87 neck dissections and 3218 lymph nodes is reported to illustrate the strength of the model. Clinical (endoscopic) assessment under general anesthesia, surgical assessment during the neck dissection, and radiographic (computed tomographic scan) assessment were compared with the pathological evaluation. All disciplines stratified the necks by region and node size. This model provides an effective stratagem for multi-institutional studies.

Data Collection↗

PubMed2007

A prospective pilot study of a multidisciplinary home training programme for lateral epicondylitis.

OBJECTIVE: To evaluate a new multidisciplinary structured home training programme for patients with lateral epicondylitis compared to conventional attendance. DESIGN: This study utilized a prospective non-randomized design to compare the effect of a home exercise programme against a pragmatic approach to managing patients with lateral epicondylitis in a primary care setting in Sweden. SUBJECTS: A total of 78 patients, presenting to their general practitioner with lateral epicondylitis were recruited from two separate geographical areas. The patients were divided into two group, 51 entered the intervention group and 27 entered the control group. METHODS: The intervention group was treated with a specific home training programme, ergonomic advice and when necessary wrist and/or night bandages. The control group was treated with conventional treatment, e.g. corticosteroid injections, stretching or no intervention. Pain and function were evaluated by the PRFEQ. An electronic hand-power gauge measured strength and stamina. Sick-leave absence was collected via the regional Social Insurance Office. RESULTS: After four weeks the intervention group experienced less sick-leave, less pain, better function and returned to work earlier than the control group. After 16 weeks the intervention group still had significantly better function than the control group and were taking less sick-leave. Pain decreased more in the intervention group but this was not significant. There was no difference in grip strength between the two groups. CONCLUSION: A structured home training programme can improve function and reduce sick leave in patients with lateral epicondylitis.

Adult↗

PubMedDate not supplied

Patient care in multidisciplinary cancer clinics: does attention to psychosocial needs predict patient satisfaction?

Satisfaction with treatment is an important early indicator of medical outcome for cancer patients. This study examined patient satisfaction with treatment-planning and follow-up appointments among 58 recently diagnosed ENT and GI cancer patients seen at a multidisciplinary cancer clinic. Patients reported which medical specialties they saw, whether adjuvant treatment was planned, and whether they had a chance to discuss their feelings about the diagnosis. Patients also rated the attention paid by staff to several psychosocial issues considered relevant to cancer. These included how the patient was coping, support services available, and the issue of common emotional reactions to cancer. Patients then rated their overall satisfaction with their clinic visits. Overall satisfaction was predicted by younger age, female gender, and greater attention to how patients were coping with their illness. Having a chance to discuss one's feelings about the diagnosis, and staff attention to other psychosocial issues, also predicted patient satisfaction. The relationship of these psychosocial issues to patient satisfaction did not vary by gender. Results suggest that patient satisfaction may be enhanced when hospital staff attend to and provide for the psychosocial needs engendered by a diagnosis of cancer.

Adaptation, Psychological↗

PubMed2001

Impact of a multidisciplinary day program on disease and healthcare costs in children and adolescents with severe asthma: a two-year follow-up study.

For patients whose asthma remains in poor control necessitating high utilization of medical services, a referral to a specialized "center of excellence" is often considered. A decade ago, we evaluated our pediatric asthma program of long-term hospitalization (median stay of 75 days) and found significant decreases in subjects' medical utilization following this intervention. In an effort to contain treatment costs, the former program was markedly altered to one of abbreviated stay with emphasis on family management of asthma. The purpose of the present study was to determine the outcome of children treated in the revised program with regard to disease severity, quality of life, and subsequent utilization of medical resources. Children with severe asthma who were admitted to the program and fulfilled study criteria were consecutively enrolled. Data was obtained concerning disease characteristics, treatment, and quality of life at admission, and at 1 and 2 years following discharge. Medical records for the year prior to program admission and for the 2 years following discharge were coded for medical care encounters. Ninety-eight children, aged 9 months to 18 years (mean age, 10.9 years), were enrolled. They participated in the program for a mean of 15.6 ( +/- 8 SD), median of 15.0, and range of 2-51 treatment days. The group showed significant improvement (P < 0.0001) from admission to 1- and 2-year follow-up in median corticosteroid use, asthma functional severity, perceived competence in asthma management, and quality of life for both caregiver and child. Medical record data showed significant improvement (P < 0.0001) at both 1- and 2-year follow-up in median number of corticosteroid bursts, emergency department visits, hospital days, and overall utilization of medical care encounters. A median total medical encounter cost/patient of $16,250 ($6,972-$25,714 interquartile range (IQR)) for the year prior to program participation was reduced to $1,902 ($505-$6,524 IQR) at 1-year and $690 ($185-$3,550 IQR) at 2- year follow-up (P < 0.0001). We conclude that multidisciplinary care in a short-term, outpatient, day treatment program can significantly contribute to improvement in asthma severity, quality of life, and reduction in healthcare costs.

Adolescent↗

PubMed2005

Expectations and satisfaction of patients with low back pain attending a multidisciplinary rehabilitation service.

BACKGROUND AND PURPOSE: To identify the expectations of service, and degree of satisfaction, with a multidisciplinary service for patients with low back pain, and to examine the strength of association between patients' satisfaction and expectations. METHOD: A three-stage study design was used. concerns were identified by a focus group; priority issues were identified by ranking by use of a Delphi consensus questionnaire; satisfaction or expectation questionnaires were also used to rate patients' satisfaction and the degree to which expectations were met. SUBJECTS: Three convenience samples of patients with low back pain were recruited. Ten patients attended the focus group, 55 completed the Delphi consensus questionnaire and 40 completed the satisfaction or expectation questionnaires. RESULTS: Patients rated a clear diagnosis and effective treatment as important, and the ease with which they could access the service and post-discharge follow-up as important issues when judging satisfaction. Patients rated their overall satisfaction and meeting their expectations higher than specific service issues, and the strengths of the associations between the two constructs varied from concern to concern. CONCLUSION: Certain aspects of service provision are rated with greater importance than others when patients judge a service they have experienced. There are differences in the strength of associations between the constructs of patient satisfaction and meeting expectations of service, specific to the individual service concern that is being evaluated. The present study provides more evidence that specific concerns within service provision should be identified before evaluating patients' expectations and satisfaction with the service overall.

Adult↗