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Results for “multidisciplinary”

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PubMed2004

The Dallas Heart Study: a population-based probability sample for the multidisciplinary study of ethnic differences in cardiovascular health.

The decrease in cardiovascular death rates in the United States has been slower in blacks than whites, especially in patients <65 years of age. The Dallas Heart Study was designed as a single-site, multiethnic, population-based probability sample to (1) produce unbiased population estimates of biologic and social variables that pinpoint ethnic differences in cardiovascular health at the community level and (2) support hypothesis-driven research on the mechanisms causing these differences using genetics, advanced imaging modalities, social sciences, and clinical research center methods. A probability-based sample of Dallas County residents aged 18 to 65 years was surveyed with an extensive household health interview. The subset of participants 30 to 65 years of age provided in-home fasting blood and urine samples and underwent multiple imaging studies, including cardiac magnetic resonance imaging and electron beam computed tomography. Completed interviews were obtained for 6,101 subjects (54% black), phlebotomy visits for 3,398 (52% black), and clinic visits for 2,971 (50% black). Participation rates were 80.4% for interviews, 75.1% for phlebotomy visits, and 87.4% for clinic visits. Weighted population estimates of many measured variables agreed closely with those of the United States census and were relatively stable from the interview sample to the phlebotomy and clinic subsamples. Thus, the Dallas Heart Study provides a phenotypically well-characterized probability sample for multidisciplinary research that will be used to improve the mechanistic understanding and prevention of cardiovascular disease, especially in black Americans.

Adolescent↗

PubMed2006

[Evaluation of a multidisciplinary management by a health care network for patients with chronic heart failure].

OBJECTIVES: To evaluate the impact, at three months, of a multidisciplinary management by a health care network for patients with chronic heart failure, compared with a historic control group. METHODS: We carried out an exhaustive prospective investigation of 68 patients included in the network in 2001 (stage II to IV of NYHA classification). The historic control was 64 patients hospitalized in 2000 with the same inclusion criteria. RESULTS: Mean age (78 years) and the initial severity of heart failure (stage NYHA II: 43%, III: 55%, IV: 2%) did not differ between the two groups. Seven parameters significantly improved at three months in intervention group: systolic blood pressure, heart frequency, walking distance covered in six minutes, quality of life score, prescription of angiotensin converting enzyme inhibitor at maximal dose, prescription of beta-blocker and the patient's compliance with therapy. The three months survival without event (hospital readmission or death) did not significantly differ between the two groups: 45% [33-57] in 2000 versus 41% [29-53] in 2001. CONCLUSION: The functional status and treatments of the patients significantly improved three months after their inclusion in health care network. The impact of the health care network for chronic heart failure management should be studied by randomised trials.

Adrenergic beta-Antagonists↗

PubMed2006

[Importance of therapeutic education in the multidisciplinary management of heart failure].

Heart failure is a severe disease with high morbidity and mortality rates. The interest for multidisciplinary heart failure patient management is increasing in order to improve prescription of medical therapies and to allow a better quality of life. Proofs of reduction in morbi-mortality exist and some models of management have been assessed. The most important point remains the major role of therapeutic education. Training of health care professionals is needed. Tools for therapeutic education have been created and can be associated with complementary informative means. All these elements allow that a new approach of heart failure takes in place in France.

Delivery of Health Care, Integrated↗

PubMed2005

Standard setting for outpatient gynaecology procedures: a multidisciplinary framework for implementation.

This chapter describes the changing cultural background of health care from which any service is delivered. In particular, the authors hope to outline cultural, educational, technical and environmental changes that have been used as opportunities to develop a quality-assessed outpatient hysteroscopic service. Examined within the chapter will be the roles and limitations of evaluation and audit, research and the multidisciplinary team. The importance of process, relationships and collaborative working within organizations will be explored, and outpatient hysteroscopy will be used as a working example of how these inform a model of practice development.

Ambulatory Surgical Procedures↗

PubMed2006

Developing and piloting a nurse-led model of follow-up in the multidisciplinary management of colorectal cancer.

One of the main challenges of colorectal cancer follow-up is the detection of early disease in order to influence survival and improve outcome. Yet, the benefits of follow-up are not only related to survival. It is well documented that patients can experience an array of problems following colorectal cancer surgery which impact upon quality of life, therefore symptom management plays an important part in the overall spectrum of follow-up care. In addition, there is emerging evidence to suggest that clinical nurse specialists are well placed in the multidisciplinary team to co-ordinate such follow-up programmes. This paper reports on a pilot study designed to assess the feasibility of a follow-up programme led by nurse specialists for patients with colorectal cancer. Key outcome areas were adherence to an agreed follow-protocol, quality of life, patient and clinician satisfaction and a cost-analysis of the new model. The study was conducted over one year with 60 patients. This redesign resulted in a smoother pathway of follow-up care, improved quality of life and acceptance to both patients and clinicians alike. The introduction of a nurse-led follow-up model is expected to demonstrate cost savings over a 3 year rolling follow-up programme.

Adult↗

PubMed2004

Catastrophizing and internal pain control as mediators of outcome in the multidisciplinary treatment of chronic low back pain.

The aim of the present study was to examine (a) whether a cognitive-behavioral treatment (differentially) affects pain coping and cognition; and (b) whether changes in pain coping and cognition during treatment mediate treatment outcome. Participants in this randomized clinical trial were 148 patients with chronic low back pain attending a multidisciplinary treatment program consisting of operant-behavioral treatment plus cognitive coping skills training (N = 59) or group discussion (N = 58) or allocated to a waiting list control condition (N = 31). Patients improved with respect to level of depression, pain behavior and activity tolerance at posttreatment and 12-month follow-up. Treatment also resulted in a short- and long-term decrease in catastrophizing and an enhancement of internal pain control. Changes in catastrophizing and to a lesser degree in internal pain control mediated the reduction in level of depression and pain behavior following treatment. The use of behavioral and cognitive interventions aimed at decreasing catastrophizing thoughts about the consequences of pain and promoting internal expectations of pain control possibly constitute an important avenue of change irrespective of the type of treatment.

Adaptation, Psychological↗

PubMed2004

Neuropsychological assessment of chronic non-malignant pain patients treated in a multidisciplinary pain centre.

The aim of the study was to investigate the influence of pain, sedation, pain medications and socio-demographics on cognitive functioning in chronic non-malignant pain patients. Chronic non-malignant pain patients (N=91) treated in a multidisciplinary pain centre were compared with age and sex matched healthy volunteers (N=64). Furthermore four subgroups of patients were examined: Group 1 (N=21) received no pain medications, group 2 (N=19) were in long-term oral opioid treatment, group 3 (N=18) were treated with antidepressants and/or anticonvulsants and group 4 (N=33) were treated with a combination of long-term oral opioids and antidepressants and/or anticonvulsants. Assessments comprised pain (PVAS) and sedation (SVAS), Continuous Reaction Time (CRT) testing for sustained attention, Finger Tapping Test (FTT) testing for psychomotor speed, Paced Auditory Serial Addition Task (PASAT) testing for information processing and working memory and Mini Mental State Examination (MMSE). CRT and FTT were impaired in the total patient sample. Treatment with opioids was associated with poorer performance of PASAT. High scores of PVAS and SVAS were associated with poor performance of PASAT and CRT, respectively. MMSE seems to be too insensitive for detecting the milder forms of cognitive impairment found in chronic non-malignant patients.

Adult↗

PubMed2006

Advancing insights into methods for studying environment-health relationships: a multidisciplinary approach to understanding Legionnaires' disease.

Recent years have witnessed important advances in the analysis of spatially referenced health data. This paper uses GIS and point pattern modelling to address previously unanswered questions regarding the spatial epidemiology of Legionnaires' disease. We demonstrate a distance effect for proximity of residence to cooling towers; mixed support for a directional effect; and some evidence relating to multiple sources. In uncovering complex conceptual and technical problems in the spatial modelling of infection risk we also extended the limits of existing point pattern techniques. We advocate further multidisciplinary research to advance methodological developments for understanding spatial environment-health relationships.

Air Conditioning↗

PubMed2006

The effect of multifactorial, multidisciplinary educational interventions on appropriate use of teicoplanin.

The aim of this study was to determine the effect of multifactorial, multidisciplinary educational interventions over a 3-year period on the appropriate use of teicoplanin. Teicoplanin was considered a valid surrogate marker of good antibiotic use in clinical practice owing to its peculiar pharmacokinetics (i.e. necessity for an initial loading dose regardless of the patient's renal function for early achievement of optimal exposure, namely C(min) > or = 10 mg/L) and to the opportunity of comparing current routine therapeutic drug monitoring (TDM) results with those of a historical retrospective study. A significantly higher proportion of patients received appropriate loading doses of teicoplanin in the present prospective study than in the retrospective study, both when considered as a whole (66.6% versus 38.6%, respectively; P<0.001) or when stratified according to the degree of estimated renal function (78.4% versus 60.4% for creatinine clearance (CL(Cr)) > 50 mL/min; 59.8% versus 26.8% for CL(Cr) 20-50 mL/min; and 27.7% versus 5.5% for CL(Cr) <20 mL/min). The highest adherence was observed in haematological wards (97.7%). The percentages of patients with teicoplanin C(min) > or = 10 mg/L during the treatment period in the present and retrospective study, respectively, were: 61.4% versus 3.2% on Day 2; 88% versus 35% on Day 4; 94% versus 70% on Day 7; and 99% versus 90% on Day 11. Our findings suggest that continuous application of a multifactorial educational programme including active TDM may be efficacious in improving and maintaining over time the appropriate use in a hospital setting of a theoretically difficult-to-use drug such as teicoplanin.

Aged↗

PubMed2004

Recent experiences with a multidisciplinary approach to complex hepatic trauma.

BACKGROUND: The selection of an appropriate time to terminate damage control efforts when faced with haemorrhagic shock from severe hepatic trauma can be challenging. At our centre, trauma surgeons have increasingly been favouring an operative approach simply involving early perihepatic packing (without extensive use of intraoperative measures aimed at achieving definitive haemostasis) and temporary abdominal closure. This is often followed by hepatic arteriography with angioembolization, resuscitation, and early re-exploration under more optimal physiological conditions. This study describes the initial outcomes of this approach. MATERIALS AND METHODS: All patients with high-grade liver injury requiring operative intervention due to refractory haemodynamic instability, presenting to our trauma centre between 1995 and 2001 were reviewed. Two treatment groups: definitive laparotomy (DL), and early packing (EP) with angioembolization and re-exploration were compared, using a retrospective audit. RESULTS: Thirty-seven patients were identified with severe liver injuries requiring operative intervention (DL 30, EP 7). Patient demographics between groups were similar. The EP group was found to have lower mortality (0% versus 36.7%), but increased length of hospital stay, transfusion requirements, and complication rates. CONCLUSIONS: A multidisciplinary approach to complex hepatic trauma involving brief damage control laparotomy with perihepatic packing only, followed by angioembolization, and early re-exploration may confer a survival benefit over early operative attempts at definitive haemostasis but is associated with complications.

Adolescent↗

PubMed2005

A multidisciplinary youth violence-prevention initiative: impact on attitudes.

BACKGROUND: In a previous report, enhanced resource commitment at a Level I trauma center was associated with improved outcomes for most major categories of injured patients, except those with gunshot wounds, which disproportionately affected the young (ages 15 to 24 years). We hypothesized that a primary violence-prevention initiative geared toward changing attitudes about interpersonal conflict among at-risk youths can be effective. STUDY DESIGN: Between May 2002 and November 2003, 97 youths (mean age 12.6 years) were recruited from one of two Police Athletic League centers in the catchment area of our Level I trauma center. Participant attitudes about interpersonal conflicts were surveyed with six previously validated scales before and after a hospital tour with a video and slide presentation graphically depicting the results of gun violence. Mean differences in scores between pre- and postintervention surveys were assessed. RESULTS: Of the 97 participants, 48 (49.4%) completed the intervention program with both the pre- and postintervention tests, with a mean of 25.8 days between tests. There was a statistically significant reduction in the Beliefs Supporting Aggression scale (mean -0.38 U; 95% CI, -0.23 to -0.54; p < 0.01), and a trend toward reduced Likelihood of Violence (mean -0.17 U; 95% CI, 0.01 to -0.34; p = 0.06). CONCLUSIONS: A multidisciplinary violence-prevention outreach program can produce short-term improvement in beliefs supporting aggression among at-risk youth. Longterm impact of this attitude change needs to be examined in future studies.

Aggression↗

PubMedDate not supplied

The nature of multidisciplinary HIV care in the ambulatory setting: a synthesis of the literature.

The purpose of this article is to provide a critical appraisal and synthesis of the literature relating to the provision of multidisciplinary HIV care in the ambulatory setting. As more people are living with HIV infection, and living longer, the demand for chronic care is great. Knowing what optimal care and treatment for people living with HIV/AIDS is and how to provide that care is an ongoing challenge. The literature suggests that the provision of care for HIV-infected individuals varies across and within HIV/AIDS clinics. This variability in care practices may influence the health and well-being of patients, and negatively impact on access to such care by people with HIV/AIDS. The goal of reviewing the literature on HIV-ambulatory clinics was to provide a description of a typical clinic, its staffing components, the care practices carried out at such a clinic (and by whom), and some barriers to providing optimal care. The ultimate goal of this review is to establish what is currently known about the provision of these services so that this information may build on existing knowledge and thereby standards of care for HIV-ambulatory clinics can be developed that could be implemented on a wide-scale basis.

Ambulatory Care↗

PubMed2005

Multidisciplinary treatment of cavernous sinus dural arteriovenous fistulae with radiosurgery and embolization.

OBJECTIVE: With the advent of interventional neuroradiology and stereotactic radiosurgery, dural arteriovenous fistulae are less often managed with open surgery. We evaluated the outcome of dural arteriovenous fistulae of the cavernous sinus treated with a combination of radiosurgery and embolization. MATERIAL AND METHODS: Twenty dural arteriovenous fistulae located in the cavernous sinus were enrolled in our study. Fifteen patients received X-knife radiosurgery alone and 5 also required embolization, one before radiosurgery and 4 after radiosurgery. The mean volume of the lesions was 2.8 ml (range 0.2-12.6), the corresponding radiation volume was 6.5 ml (range 0.6-24.6), and the conformity index was 2.9 (range 1.8-5.3). The mean peripheral and maximum radiation dose was 17.8 Gy (range 17-20) and 28.3 Gy (range 19-37) Gy, respectively. The clinical and imaging data were analyzed. RESULTS: The mean follow up period was 29 months (23-39). Seventy-five percent (15/20) of patients receiving radiosurgery alone achieved a symptomatic cure and with additional embolization 90% (18/20) were cured. All patients achieved cure on imaging after radiosurgery alone or in combination with embolization. Abnormal imaging findings were observed in two patients after treatment, one had an intracerebral hemorrhage and the other radiation edema, but both were asymptomatic. CONCLUSION: With multidisciplinary treatment with combined radiosurgery and embolization, satisfactory results can be achieved for dural arteriovenous fistulae with a low complication rate. In patients with mild symptoms, radiosurgery is the initial treatment option. Embolization should be performed in patients with severe symptoms or who have failed radiosurgery.

Adult↗

PubMed2006

Multidisciplinary management of cancer pain: a longitudinal retrospective study on a cohort of end-stage cancer patients.

The epidemiology of cancer pain and the outcomes associated with pain treatments were investigated through a retrospective survey of 772 patients with advanced cancer. The cumulative prevalence of pain was 87%, including all types of cancer. Mean duration of pain was 6.9+/-8.1 months. The prevalence of pain was 28%, 46%, 67%, 75%, and 79% at 6 months, 3 months, 1 month, 1 week, and 1 day before the time of death, respectively. The so-called "strong" opioids had been used in 85% of the 669 patients with pain. Seventy-nine percent of patients with pain received nonsurgical antineoplastic treatment for pain control. No more than 11% of patients ultimately experienced substantial pain in the last 6 months of life (defined as pain score 5-10 on a 0-10 numeric rating scale). We conclude that the application of a multidisciplinary approach to pain management offers effective pain control for most patients with advanced cancer.

Adolescent↗

PubMed2004

A multidisciplinary approach to the focal form of congenital hyperinsulinism leads to successful treatment by partial pancreatectomy.

BACKGROUND/PURPOSE: Congenital hyperinsulinism (HI) causes severe hypoglycemia in neonates and infants. Recessive mutations of the beta-cell K(ATP) channel genes cause diffuse HI, whereas loss of heterozygosity together with inheritance of a paternal mutation cause focal adenomatous HI. Although these 2 forms of HI are clinically identical, focal HI can be cured surgically. The authors reviewed their experience with partial pancreatectomy for focal HI. METHODS: From December 1998 to January 2003, 38 patients (ages 2 weeks to 14 months; median age, 10 weeks) were treated with partial pancreatectomy for focal HI. Before surgery, patients had localization studies using selective arterial calcium stimulation with venous sampling or transhepatic portal venous sampling. At operation, the focal lesion was found using the preoperative localization data and multiple pancreatic biopsies with frozen section analysis, followed by partial pancreatectomy. A complete response at follow-up was defined as no requirement for glycemic medications, no continuous tube feedings, and no diabetes mellitus. RESULTS: Nineteen pancreatic focal lesions were in the head; 15 were in the neck, body, or tail; and 4 had more extensive involvement. Lesions that required substantial resection of the pancreatic head underwent Roux-en-Y pancreaticojejunostomy to preserve the normal body and tail. Lesions of the body or tail were usually treated with partial distal pancreatectomy. Ninety-two percent (35 of 38) of patients had a complete response to surgery. Three patients have required glycemic medications. No patient is diabetic. Surgical complications included additional resection for residual disease (3), small bowel obstruction requiring laparotomy and enterolysis (2), and chylous ascites (3) that resolved with medical management. CONCLUSIONS: A multidisciplinary approach to patients with the focal form of congenital hyperinsulinism can distinguish focal from diffuse disease, localize focal lesions, and permit partial pancreatectomy with cure in most patients.

Congenital Hyperinsulinism↗

PubMed2005

[Adherence to antiretroviral therapy during HIV infection, a multidisciplinary approach].

Since HIV infection has become a chronic disease, antiretroviral therapy is now used on a long-term basis. Response to treatment is conditioned by numerous inter-dependent factors, including non-compliance, which can result in failure of the therapeutic regimen. Although compliance is crucial for long-term efficacy of the treatment, it is a dynamic factor, and therefore difficult to evaluate. This literature review proposes a multidisciplinary approach to treatment adherence during HIV infection, and deals with the following questions: how should adherence and non-adherence be defined? How are they correlated to the treatment response? How is adherence measured in trials and cohorts, as well as in clinical practice? By what factors is it influenced? What tools can be implemented to improve adherence? The interaction between adherence and response to antiretroviral therapy requires communication between clinicians, healthcare providers, patients, virologists, pharmacologists, and the companies responsible for developing drugs. The pharmaceutical industry must sustain its efforts to ensure a balance between demands for efficacy and adherence when developing new drugs. And the methods implemented by numerous healthcare teams plead in favour of a dynamic approach to adherence, with the active participation of all.

Anti-HIV Agents↗

PubMed2004

Multidisciplinary approaches for investigating the mechanisms of hippocampus-dependent memory: a focus on inbred mouse strains.

Inbred mouse strains differ in genetic makeup and display diverse learning and memory phenotypes. Mouse models of memory impairment can be identified by examining hippocampus-dependent memory in multiple strains. These mouse models may be used to establish the genetic, molecular, and cellular correlates of deficits in learning or memory. In this article, we review research that has characterized hippocampal learning and memory in inbred mouse strains. We focus on two well-established behavioral tests, contextual fear conditioning and the Morris water maze (MWM). Selected cellular and molecular correlates of good and poor memory performance in inbred strains are highlighted. These include hippocampal long-term potentiation, a type of synaptic plasticity that can influence hippocampal learning and memory. Further methods that might help to pinpoint the anatomical loci, and genetic and cellular/molecular factors that contribute to memory impairments in inbred mice, are also discussed. Characterization of inbred mouse strains, using multidisciplinary approaches that combine cellular, genetic, and behavioral techniques, can complement directed mutagenesis to help identify molecular mechanisms for normal and abnormal memory functions.

Animals↗

PubMed2005

Need for multidisciplinary research towards a second green revolution.

Despite recent achievements in conventional plant breeding and genomics, the rate of increase of crop yields is declining and thus there is a need for a second green revolution. Advances within single disciplines, alone, cannot solve the challenges of increasing yield. As scientific disciplines have become increasingly diversified, a more complete understanding of the mechanisms by which genetic and environmental variation modify grain yield and composition is needed, so that specific quantitative and quality targets can be identified. To achieve this aim, the expertise of plant genomics, physiology and agronomy, as well as recently developed plant modelling techniques, must be combined. There has been recent progress in these individual disciplines, but multidisciplinary approaches must be implemented to tackle drought stress and salinity as major constraints to achieving sufficient grain yield in the future.

Agriculture↗