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PubMed2006

Factors predicting work ability following multidisciplinary rehabilitation for chronic musculoskeletal pain.

INTRODUCTION: This study aimed to investigate the outcome and outcome predictors of multidisciplinary rehabilitation in terms of working ability. METHODS: One hundred and forty three (n=143) patients with musculoskeletal pain (mean age=45.7, SD=8.9) were included. Work status, pain, functional health status and psychosocial factors were collected previous to treatment, after a 5 week intensive training and a 52 week follow-up period. Demographics and data on personal characteristics were also collected. RESULTS: Workability increased from 57.4 to 80% during treatment period. Stepwise multivariate logistic regression indicated that age, sleeplessness, cognitive function, overall health, pain experience, and anxiety were the strongest predictors of work ability. Pain severity and depression were not found to be significant predictors of work ability. CONCLUSIONS: These data suggest that emotional distress, cognitive function and overall health are important priority areas in rehabilitation programmes to improve work ability.

Adaptation, Psychological↗
PubMed2006

Characteristics of drug-related problems discussed by hospital pharmacists in multidisciplinary teams.

OBJECTIVE: To investigate pharmacist contribution in the therapeutic hospital team by studying drug-related problems (DRPs), pharmacist therapy advice and consequences of the advice. METHODS: From May to December 2002, 827 patients in five Norwegian hospitals were included in the study. Demographic data, drugs used, relevant medical history, laboratory data and clinical/pharmacological risk factors were recorded prospectively at the wards. MAIN OUTCOME MEASURE: DRPs, patients characteristics, pharmacist advice to physicians, nurses or patients, response to the pharmacist advice, and reasons (stated by the pharmacist) for not discussing an identified DRP, were reported. An independent quality assessment team retrospectively assessed the DRPs for a randomly selected number of the study population. RESULTS: On average 2.6 DRPs per patient were found. A total of 2128 DRPs were registered and of these 1583 (74%) DRPs were brought up for discussion. Physician immediate acceptance rates varied from 80% (for extremely important clinically significant DRPs) to 50% (for DRPs of minor clinical significance). High age, use of many drugs at admission, existence of many DRPs and many clinical/pharmacological risk factors for DRPs were associated with low immediate acceptance rate. Type of DRP influenced how the DRP was discussed; adverse drug reaction (ADR) and unnecessary drug were discussed with physicians while e.g. medical chart error and need for patient education were discussed with nurses/patients. Reasons for not discussing DRPs in the team were: not given priority (37%), no longer relevant (31%) and others (31%). DRPs of minor clinical significance were most often excluded from discussion (37%) as opposed to 14% and 22% of those of moderate and major clinical significance. CONCLUSIONS: The majority of patients had one or more DRPs. The problems identified as DRPs by the pharmacists were accepted as such by the physicians and to a high degree acted upon. Both clinical significance of the DRP and patient characteristics influenced physician immediate acceptance rate. Some DRPs could be solved by direct contact with nurses or the patients. Awareness of DRPs increases through participation of pharmacists in the multidisciplinary therapeutic hospital team.

Adolescent↗
PubMed1990

Analysis of indications for referral to a multidisciplinary medical genetics clinic: implications for training programs in obstetrics and gynecology.

Clinical genetics has become an integral component of obstetric training. Advances in prenatal screening (particularly maternal serum alpha-fetoprotein) and the clinical applications of molecular technologies have broadened the indications for referral to geneticists. During the study period, 1237 patients were referred for genetics consultation. A total of 596 (48%) were referred because of cytogenetic indications (576 for genetic amniocentesis); 252 (20%) because of multifactorial-developmental abnormalities; 204 (17%) because of risk of diseases attributable to single-gene mutations; 58 (5%) because of antenatal teratogen exposure(s); and 127 (10%) because of other reasons. Herein we summarize our experience as a multidisciplinary genetics unit and offer recommendations for broadening resident training curricula to meet current clinical needs. These data will be useful for enhancement of health care use and more effective direction of limited resources.

Ambulatory Care Facilities↗
PubMed1977

Multidisciplinary treatment for childhood sarcoma.

Surgical extirpation of the primary tumor has traditionally been utilized as initial treatment for sarcomas in children. The present report, however, demonstrates that sarcomas are optimally treated by means of a coordianted multidisciplinary approach. The latter offers the potential for achieving improved survival and preservation of organs and limbs, particularly for structures of the head and neck, for extremities, and in the genitourinary system.

Adolescent↗
PubMed1987

Surgical problems in the fetus: a multidisciplinary approach.

Over a 2 year period, 90 cases of potential fetal pathologic conditions were presented to a multidisciplinary fetal board. Members, including persons from perinatology, neonatology, genetics, radiology, pathology, pediatric surgery, neurosurgery, and urology, met monthly to discuss new referrals, follow-up ongoing cases, and present findings and treatment in delivered cases. Of 90 referred cases, 76 surgical diagnoses occurred in 71 fetuses (79 percent), with central nervous system and genitourinary anomalies predominating. A formal presentation during a single meeting with the variety of specialists necessary to manage surgical problems in the fetus facilitated perinatal management and allowed for the appropriate specialist to counsel the parents as early as possible.

Congenital Abnormalities↗
PubMed1975

Neurons from fetal rat brain in a new cell culture system: a multidisciplinary analysis.

A new culture system for cells from the mammalian brain was developed by a modification of a previously established technique. This modification involved the use of fluorodeoxyuridine and adult horse serum. The cultures contained large, easily visualized neurons both isolated from other neurons and in networks of varying complexity. These cells were large enough to permit reliable intracellular electrophysiologic recording and were often sufficiently dispersed to allow examination of membrane responses to iontophoretically applied neurotransmitter candidates. Many responses characteristic of central neurons in situ were seen, including evoked and spontaneous action potentials, complex patterns of inhibitory and excitatory post-synaptic potentials, and neurotransmitter-induced membrane responses. These preparations were examined by phase contrast microscopy, by light microscopy after silver impregnation and by Nomarski interference optics. Total choline acetyltransferase (CAT) activity was little changed and specific activity was increased in the new culture system as compared with the earilier system. Conditions which gave the highest specific activity of CAT also provided the best cultures from the standpoint of electrophysiologic and morphologic analysis. This new approach will allow, in culture, detailed multidisciplinary analyses of individual neurons and small networks of neurons from the mammalian brain.

Acetylcholine↗
PubMed1991

Comprehensive treatment of bilateral cleft lip by multidisciplinary team approach.

Repair of bilateral cleft lip presents numerous problems, and in our opinion, it is better to begin treatment at the earliest age possible. At Fujita Health University Hospital, we utilise a multidisciplinary team approach to cleft lip. Nonsurgical correction of the nasal deformity using a nose retainer and preoperative orthodontics using a Kuwahara-modified Hotz's palatal plate begins soon after birth. Surgical repair of the lip is done within the first 2 months of life, by the time the nose, alveolus and projecting prolabium are adequately reformed. A one-stage surgical procedure, including restoration of muscle union, labial sulcus construction and nasal correction is performed. After lip repair, lip and tongue pressure are well balanced by the plate, and a good alignment of the alveolus can be achieved. A total of 27 cases of bilateral cleft lip were treated from August 1986 to October 1990. In all cases, the postoperative course was uneventful, and no complications due to early surgery were encountered.

Cleft Lip↗
PubMed1995

Remote monitoring of health status of the elderly at home. A multidisciplinary project on aging at the University of New South Wales.

This paper discusses the design and implementation of a multidisciplinary research project and associated field trials to test the hypothesis that functional health status amongst the elderly can be accurately determined remotely by continuously monitoring relatively simple parameters that measure the interaction between participants and their environment. In this study we propose that changes in such simple measures as mobility, sleep patterns, and utilisation of cooking, washing and toilet facilities, can identify changes in functional health status. One of the primary end goals of the project will be to automatically prompt appropriate, timely and cost-effective intervention of medical and community based services to help reduce morbidity and maintain an independent high quality of life for the elderly. Targeted intervention will diminish the demand for high cost medical services. This will have large potential economic implications in helping to contain and reduce the increasing cost of providing health care services to the aged.

Activities of Daily Living↗
PubMed1986

Communication and decision-making in a study of a multidisciplinary team conference with the registered nurse as conference chairman.

It was decided that the medical and nursing staff had to communicate verbally concerning the patient's need for information and to make decisions concerning steps to be taken when satisfying the patient's need for information. The aim of this study was, accordingly, to investigate if a training programme for registered nurses as chairperson of the multidisciplinary team conference (MTC) changed the communication and decision pattern during the neurological ward conference. The training material provided instructions and a scheme for the chairperson of the MTC. The training was carried through with the help of patient case reports and role play. Data were collected through tape recordings of the communication at ten MTCs before the training and ten MTCs after the training. The strictly medical communication was less illuminated, while the patient's psychological needs, especially concerning the patient's need for information, were better illuminated than before the training. After the training 42 information problems were reported and two before. For half of them, decisions were made on the steps to be taken in order to fulfil the patient's need. For the other half, the discussion concerning the patient's need for information was communicated between the staff. Only the decision-making was missed.

Communication↗
PubMed1991

The PLAT Study: a multidisciplinary study of hemostatic function and conventional risk factors in vascular disease patients.

In this paper are reported the basal results of a multidisciplinary, multicenter study designed to explore in a population with ischemic disease the relation between hemostatic variables, conventional risk factors and atherothrombotic sequelae. 953 patients less than or equal to 69 yrs with documented coronary, cerebral or peripheral atherosclerotic disease were studied and followed-up for 24 months. Examinations included hemostatic and lipid laboratory assays, arterial Doppler examination, cerebral computerized tomography and nuclear magnetic resonance, exercise electrocardiogram and coronary angiography. Fibrinogen (301.4 +/- 71.52 mg/dl) correlated positively with antithrombin III (r = 0.27) and leukocytes (r = 0.25), negatively with HDL-cholesterol (r = 0.18) and tended to increase with smoking. Heavy smokers had higher leukocyte counts than non-smokers (8.0 +/- 2.0 vs. 7.2 +/- 2.1 x 10(3)/microliters), higher triglycerides (1.87 +/- 1.12 vs. 1.53 +/- 1.35 mmol/l) and lower HDL-cholesterol (0.93 +/- 0.27 vs. 1.00 +/- 0.25 mmol/l). FVII correlated positively with triglycerides (r = 0.16) and protein C (r = 0.45). vWF:Ag (145.4 +/- 70.58%) ad FVII:C (139.7 +/- 59.10%) were positively correlated (r = 0.44). FVIII:C correlated positively with fibrinogen (r = 0.21). Myocardial infarction survivors with associated cerebral and peripheral vascular lesions had higher FVIII:C, FVII, fibronogen and vWF:Ag. These findings suggest that hemostatic factors may enhance and/or mediate the effects of conventional risk factors in atherothrombotic ischemic events.

Aged↗
PubMed1986

Veterans Administration Cooperative Studies Project No. 147. Part I: A multidisciplinary, multicenter experimental design for the evaluation of alternative metal-ceramic alloys.

The factors necessary for a comprehensive multidisciplinary, multicenter clinical study have been incorporated into CSP No. 147. The experimental design provides the potential for multiple laboratory and clinical data comparisons of alternative alloys. The study incorporates clinical performance observations with dental and medical histories that permit many unique correlations. This potential demonstrates the comprehensiveness of the CSP No. 147 study design and its contributions to clinical dental research in the evaluation of restorative materials.

Chromium Alloys↗
PubMed1988

Biological trace element research: a multidisciplinary science.

The last decade may be regarded as a crucial turning point in new developments in many areas of biological trace element research. It is slowly being recognized as a multidisciplinary science which requires a combination of biological insight and analytical awareness in planning the studies. It is also acknowledged that the complexities involved in dealing with the requirements of trace element research studies in the life sciences demand comprehensive planning of the investigations and use of a variety of techniques, thus bringing together a variety of talents. It cannot be emphasized enough that accurate analytical measurements on biologically and analytically "valid" samples hold the key for success in future biological trace element research studies. These aspects are illustrated.

Food Analysis↗
PubMed1991

Rationale for the multidisciplinary approach in epidemiological research.

Science has demonstrated that most macro-world phenomena are explicable by means of mechanisms taking place on a smaller scale. Epidemiologists, who by themselves work only with countable phenomena of the macro-world, must collaborate with specialists in subjects below the macro-level if they wish to improve the explanatory power and validity of their results. Multidisciplinary collaboration is particularly necessary in four phases of epidemiological investigations: hypothesis generation, data production, methodological design improvement, and the validation of epidemiological results. Collaboration with other specialists on the validation of results is important because of the fundamental difficulties which hinder the valid repetition of epidemiological studies and the long time it takes to accomplish systematic, epidemiological validation studies. Simpler and quicker alternative ways of reassessing epidemiological results are tests involving the biophysical structures of organs, cells, organelles, macro-molecules and so on. This argument is illustrated by examples from the Norwegian Thyroid Cancer Project.

Epidemiologic Methods↗
PubMed1989

Snap-Gauge band vs multidisciplinary evaluation in impotence assessment.

This study compares the findings of multidisciplinary evaluation to the two-night use of the Snap-Gauge band in 100 impotent men. An organic etiology was diagnosed in 52 percent of those evaluated. The Snap-Gauge band proved accurate as a screening device for organic disease. If no elements were broken over the two-night period, this finding correlated with multisystemic diagnosis of organic etiology in 86 percent of cases. Among the 52 patients in whom an organic etiology was diagnosed, 32 broke no elements for a 62 percent sensitivity. When more than one element was broken, the predictive value as to etiology of the erectile dysfunction diminished.

Erectile Dysfunction↗
PubMed1979

Phobic symptoms in an elderly woman: a multidisciplinary case conference.

A 67-year-old woman, previously self-sufficient, became housebound by phobic symptoms. During the patient's hospitalization for treatment of these disabling symptoms, a multidisciplinary case conference served to identify the underlying psychodynamic issues, which were related to separation anxiety. Treatment included helping the patient understand her relationships with her daughter and her own mother, and behavior modification to reduce the secondary gains of her symptoms. After treatment, the patient successfully returned to self-care.

Activities of Daily Living↗
PubMed1980

Hospice consultation team: a new multidisciplinary model.

The term "hospice" refers not only to certain facilities, but also to a philosophy of comprehensive, humanistic treatment for the patient and his family. Because death will always be a part of the general hospital setting, hospice concepts provide a useful method for improved patient care. This paper describes the development of a multidisciplinary team that provides consultation-liaison services for terminally ill patients and their families, either while in hospital or while being followed in a home-care treatment service. Cases are presented that illustrate the benefits of such an approach to the care of the dying patient and his family.

Adult↗
PubMed1993

A multidisciplinary investigation of a cluster of deaths on a paediatric intensive care unit.

During late December 1989 and early January 1990, a cluster of six unexplained deaths occurred on a paediatric intensive care unit (PICU) among children with congenital heart disease who had undergone cardiac surgical procedures. The children were all aged three years or less. In each case death was preceded by an unexpected increase in ventilatory pressure requirement followed by the development of a similar pulmonary shadowing on chest radiography. The radiological abnormality was felt to be consistent with a pneumonitis associated with some small airway disease. The clustering of these deaths, occurring in a similar unusual manner, was felt to constitute an outbreak warranting investigation. An Incident Committee was established to plan and manage a large multidisciplinary investigation during which the unit was temporarily closed. Following extensive investigation no bacterium, virus, fungus or other pathogen, toxic agent, or any other explanation for the cluster of deaths could be found. The possibility that the cluster occurred by chance remains although this was felt to be unlikely.

Cause of Death↗