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PubMed2006

Multidisciplinary and interdisciplinary management of chronic pain.

Multidisciplinary and interdisciplinary pain management programs incorporate a biopsychosocial model in assessing and treating pain and result in pain reduction, improved quality of life, and psychosocial functioning. Additionally, return-to-work and vocational outcomes may be seen in selected patients. Treatment teams may include a physiatrist, a physical or occupational therapist,a pain psychologist, a relaxation (biofeedback) therapist, vocational and therapeutic recreational therapists, social workers, and nurses. The key component to program success is collaborative ongoing communication among team members, the patient, and the case manager.

Chronic Disease↗

PubMed2004

A multidisciplinary approach to restoring an acquired palatal defect using distraction osteogenesis: a clinical report.

Prosthetic and surgical procedures can be applied to rehabilitate acquired palatal defects. Distraction osteogenesis may be used to narrow the defect to facilitate bone and soft tissue closure. This clinical report describes a multidisciplinary approach to the closure of a palatal defect with distraction osteogenesis, comprehensive orthodontic treatment, surgical soft tissue flap reconstruction of the residual soft tissue defect, implant placement in the newly created edentulous ridge, and restoration with an implant-supported prosthesis.

Adult↗

PubMed2006

Changes in salivary cortisol and corticosteroid receptor-alpha mRNA expression following a 3-week multidisciplinary treatment program in patients with fibromyalgia.

The aim of the present study was to investigate the effects of a 3-week residential multidisciplinary non-pharmacological treatment program (including individually prescribed aerobic exercise and cognitive-behavioral therapy) on fibromyalgia symptoms and hypothalamic-pituitary-adrenal (HPA) axis function. Salivary and venous blood samples were collected from 12 female patients with fibromyalgia (age: 25-58) the day before and the day after the treatment period: saliva, eight times (every two hours from 0800 to 2200 h); venous blood, at 0800 h. Peripheral blood mononuclear cells (PBMC) were separated and analyzed for glucocorticoid receptor-alpha (GR-alpha) mRNA expression by semi-quantitative RT-PCR, while the salivary cortisol concentration was determined by RIA. At the same time, pain and aerobic capacity were evaluated. Aerobic capacity improved at the end of the treatment program. The slope of the regression of salivary cortisol values on sampling time was steeper in all patients after treatment, indicating that the cortisol decline was more rapid. Concomitantly, the area under the cortisol curve "with respect to increase" (AUC(i)) was higher and there was a significant increase in GR-alpha mRNA expression in PBMC. The number of positive tender points, present pain, pain area and CES-D score were significantly reduced after the treatment, while the pressure pain threshold increased at most of the tender points. Our findings suggest that one of the active mechanisms underlying the effects of our treatment is an improvement of HPA axis function, consisting in increased resiliency and sensitivity of the stress system probably related to stimulation of GR-alpha synthesis by the components of the treatment.

Adult↗

PubMed2005

The development and implementation of a multidisciplinary neonatal resuscitation team in a Canadian perinatal centre.

PURPOSE: To describe the implementation of a multidisciplinary neonatal resuscitation team (NRT) at a Canadian tertiary perinatal centre. METHODS: In February 2002, the primary role of neonatal resuscitation was transferred from attending physicians (on-call off-site) to a NRT (consisting of a neonatal intensive care nurse, a respiratory therapist, and, when available, a resident, clinical associate (supervised licensed physician), or nurse practitioner). The NRT attended moderate- and high-risk deliveries (in the latter case, accompanied by a neonatologist). Normal, low-risk deliveries remained the responsibility of caseroom (delivery room) staff, assisted by the NRT when concerns arose. A prospective assessment was performed of resuscitation requirements and outcomes. RESULTS: : Over 24 months, the NRT attended 2944 (64.5%) out of 4565 deliveries. The NRT attended 2497 moderate-risk deliveries, providing positive pressure ventilation (in 15.7% of cases), chest compressions (0.1%), and epinephrine (adrenaline) (0.08%). There were no neonatal deaths or morbidities related to resuscitation in this cohort. A small, but significant, proportion of babies with no identifiable risk factors required resuscitation by caseroom staff (in most cases with brief periods of positive pressure ventilation). CONCLUSION: Assignment of level of risk provides a safe means of delivering neonatal resuscitation services, facilitating NRT attendance at the majority of deliveries that required resuscitation. A NRT can perform safely and effectively in a tertiary perinatal centre with off-site support from experienced neonatal staff at high-risk deliveries only. Caseroom (delivery room) staff should continue to be trained in neonatal resuscitation.

Analysis of Variance↗

PubMed2005

Multidisciplinary management of advanced prostate cancer: changing perspectives on referring patients and enhancing collaboration between oncologists and urologists in clinical trials.

Prostate cancer traditionally was managed by monotherapy, and treatment was almost exclusively provided by the urologic surgeon. As ongoing clinical trials in advanced disease identify novel agents or combination therapies with good tolerability and potential survival benefits, multidisciplinary management may offer optimal care for men with high-risk prostate cancer, as it does for women with breast cancer. Patients with high-risk recurrent or metastatic disease should be informed of clinical trials for which they may be eligible.

Aged↗

PubMed2006

A multidisciplinary approach reveals cryptic diversity in Western Palearctic Tetramorium ants (Hymenoptera: Formicidae).

Diversity of ants of the Tetramorium caespitum/impurum complex was investigated in a multidisciplinary study. Focusing on morphologically hardly distinguishable Western Palearctic samples, we demonstrate the genetic and phenotypic diversity, demarcate phylogenetic entities, and discuss the clades in terms of biogeography. Sequences of 1113bp of the mitochondrial COI gene revealed 13 lineages. COII data, worker morphometry and male genitalia morphology corroborated the COI results for seven lineages; the remaining six were disregarded because of small sample size. A comparison with published data on cuticular hydrocarbons showed correspondence. The seven entities show different distribution patterns, though some ranges overlap in Central Europe. Since no major discrepancy between the results of the different disciplines became apparent, we conclude that the seven entities within the T. caespitum/impurum complex represent seven species. Geographical evidence allows the identification of T. caespitum and T. impurum, and we therefore designate neotypes and redescribe the two species in terms of morphology and mtDNA. As the revision of about 50 taxon names would go beyond the scope of this study, we refer to the remaining five species under code names. We discuss our findings in terms of plesiomorphy and convergent evolution by visualizing the mtDNA phylogeny in morphological space.

Animals↗

PubMed2005

UISESS scale for staging and classifying clinical-epidemiological risk in type 2 diabetes mellitus and for establishing multidisciplinary preventive actions.

PURPOSE: The goal of this study is the creation and use of a five-stage scale for the description of the health status of a type 2 diabetes mellitus patient population, as individuals and as a set. The scale, named UISESS, ranges from the pre-pathological to the sequelae stage, and can help orient multidisciplinary prevention actions. SETTING AND SAMPLING: A sample of nondiabetics (n = 404), together with a census of all type 2 diabetic patients (n = 2,702) over 30 years of age, were obtained from a family medicine clinic of the Mexican Federal Social Security System (IMSS) in Guadalajara, Mexico. DESIGN AND METHOD: A descriptive study in which the Natural History of the Disease and an epidemiological focus on risk were used to create the UISESS scale. Case histories of a total of 3,106 persons from a family practice clinic were used. The data was classified in five stages and three risk control levels were used for analysis. RESULTS: In the type 2 diabetic group, the average age was 57.6 years; 58% were women. In the nondiabetic group, the average age was 55.38 years; 63% were women. The UISESS scale was applied. A large majority (86%) of the studied type 2 diabetic patients were classified within unfavorable stages for controlling their illness, and 65% of the 3,106 people were at high or very high risk of increasing deterioration of their health status. CONCLUSIONS: The UISESS scale appears to be a useful tool to detect the distribution, evolution and control of type 2 diabetes in a population attended at the outpatient clinic of a family medicine unit, according to the Natural History of the Disease.

Adult↗

PubMed2005

Advanced practice nurse entrepreneurs in a multidisciplinary surgical-assisting partnership.

CHANGES IN THE HEALTH CARE environment and reimbursement practices are creating opportunities for nurse entrepreneurs to be partners with other professional nurses and physicians. Advanced practice nurses (APNs) who want to step into an entrepreneurial role must have strong clinical expertise, specific personal characteristics, interpersonal skills, and business acumen. ESTABLISHING A MULTIDISCIPLINARY partnership for providing surgical assisting services has many benefits and presents many challenges.

Entrepreneurship↗

PubMed1998

Changing behaviors to optimize women's health: a multidisciplinary seminar.

The purpose of this article is to summarize the multidisciplinary seminar, "Changing Behaviors to Optimize Women's Health," which was offered in June 1997. We describe each of the 5 seminar presentations and present a synopsis of their conclusions and implications for dietetics practice. The seminar presented evidence that women's health is a national issue of increasing economic, political, and medical importance; the treatment and prevention of many diseases common to women have special and unique nutritional considerations; and optimizing women's health will require more effective strategies for transforming information into health practices. We discuss salient points from the seminar regarding the leadership roles of dietitians as educators, advocates, and agents for behavior change in optimizing women's health and explore strategies that could help dietetics professionals enhance their effectiveness among women, including building partnerships with patients, developing an understanding of the patient's experience, starting where the patient is, and concentrating on small changes for success.

Dietetics↗

PubMed1998

Lipid lowering in a multidisciplinary clinic compared with primary physician management.

A multidisciplinary lipid reduction clinic achieved greater reduction of serum cholesterol when compared with primary physicians among patients with coronary heart disease. The lipid clinic was more likely than the primary physicians to prescribe lipid-lowering medication, to prescribe multiple medications, and to use drug doses in excess of the "starting dose."

Aged↗

PubMed1998

A multidisciplinary approach to Alzheimer's disease: who should be members of the team?

The treatment goal for persons with Alzheimer's disease (AD) is to maintain the highest level of function possible and to minimize behavioral disturbances. Since multiple factors have an impact on function, a multidisciplinary approach to treatment and care is most effective. Whereas the primary-care physician can diagnose AD in most patients, data collection and routine examinations can be conducted by a nurse practitioner/clinical nurse specialist, and nonprofessional staff can often do mental status testing. Nutritionists, pharmacists, geropsychiatrists, home-healthcare case managers, elder-law attorneys, support services, and caregivers all fill important roles as members of the "AD team." With two AD drugs currently available and several impending new introductions, pharmacotherapy is becoming an increasingly more critical treatment option.

Alzheimer Disease↗

PubMed2000

Proceedings of the American Urogynecologic Society Multidisciplinary Symposium on Defecatory Disorders.

The Multidisciplinary Symposium on Defecatory Disorders was created to delineate the breadth of defecatory disorders and propose investigations to address identified knowledge deficits. Seven experts in defecatory disorders and 24 members of the American Urogynecologic Society were invited. The experts provided brief summaries of the scope of defecatory disorders from the perspectives of their specialties. The group then divided into 3 subgroups that focused on pathophysiology, imaging, and evaluation and treatment. Defecatory disorders, including anal incontinence and constipation, are common among women of all ages. Determination of their prevalence is complicated by a lack of standardized definitions. Defecatory disorders carry lengthy differential diagnoses. Imaging studies and anorectal testing, although not standardized, can aid in distinguishing different causes of dysfunction. The lack of uniformity in diagnosis and evaluation compromises comparisons of different treatments. Standardization of diagnoses and diagnostic modalities is essential to the design of meaningful evaluations of treatments for defecatory disorders.

Aging↗

PubMed2004

A specialized wound-healing center concept: importance of a multidisciplinary department structure and surgical treatment facilities in the treatment of chronic wounds.

The optimal way to improve prophylaxis and treatment of patients with problem wounds is to create an independent multidisciplinary wound-healing center that focuses on all types of problem wounds and has an outpatient clinic, as well as an inpatient ward. An integrated wound-healing department concept should be a standard in wound healing. A department structure containing both an outpatient clinic and inpatient ward, employing full-time personnel, allows the development of all features vital for optimal wound treatment. These are standardized treatment plans, access to relevant objective investigative methods and surgical approaches, a higher degree of continuity in treatment, increased patient satisfaction, greater potential for education and training, and improved possibilities for basic and clinical research in healing and care. The Copenhagen Wound Healing Center, Copenhagen, Denmark, and the University Center of Wound Healing, Odense, Denmark, are examples of this type of department. Initial results have demonstrated that these concept centers have resulted in improved rates of healing in patients with leg ulcers and have decreased the necessity for major amputations. The structure of the centers also offers greater opportunities for both basic and clinical research and provides expert education for all types of health care personnel. The centers were created in an attempt to establish an expert function in wound healing that would be fully integrated into the Danish national health care system. This model may, with individual modifications, be applicable for both industrialized and developing countries. In case it is impossible to realize the model in its entirety, alternative center concepts should be considered.

Chronic Disease↗

PubMed1997

The multidisciplinary structured clinical instruction module as a vehicle for cancer education.

BACKGROUND: The Structured Clinical Instruction Module (SCIM) modifies the Objective Structured Clinical Examination (OSCE) for teaching purposes. This study determined the effectiveness of a breast cancer SCIM in enhancing residents' clinical skills. METHODS: Twenty-five residents, 15 faculty members, and 12 breast cancer patients (simulated and actual) participated in the multistation, multidisciplinary SCIM. Afterward, faculty members, residents, and patients evaluated the SCIM. Residents completed an 18-item self-assessment of their skills before and after the SCIM. RESULTS: All residents, faculty members, and patients rated the SCIM as either outstanding or above average as an educational experience. The residents' self-assessments of their skills were significantly higher after the SCIM than before. CONCLUSIONS: This study shows that residents are aware of their deficiencies in breast cancer management. The SCIM provides an excellent format for residents to improve their clinical skills.

Attitude of Health Personnel↗

PubMed1995

The role of gastric surgery in the multidisciplinary management of severe obesity.

Severe obesity affects the health and quality of life of 4 million Americans. The major cost of treating severe obesity and its associated comorbidities of hypertension, diabetes, cardiovascular disease, pulmonary insufficiency, cancer, and degenerative arthritis as well as the poor long-term results of medical, drug, and behavioral therapy has increased the numbers of patients being referred for surgical treatment. Gastric bypass and vertical banded gastroplasty are the two procedures recommended for severely obese patients. These operations currently have low morbidity and mortality. Surgery should be considered adjuvant therapy and must be part of a multidisciplinary approach. The significant long-term weight control resulting from the surgical therapy is associated with improvement and, often, resolution of comorbidities, including diabetes, hypertension, hyperlipidemia, and pulmonary insufficiency.

Combined Modality Therapy↗

PubMed1997

Primary cardiac angiosarcoma: 53 months' survival after multidisciplinary therapy.

An 8-year-old girl underwent surgical excision of a tumor arising from the right atrium immediately after admission. Because histologic and immunohistochemical examination confirmed the diagnosis of angiosarcoma, adjunctive multidisciplinary therapy was administered for the following 2 years. She is leading a normal school life 53 months after the operation. Therapeutic strategy for this highly malignant cardiac tumor is discussed.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1999

A multidisciplinary surgical approach to superior sulcus tumors with vertebral invasion.

BACKGROUND: Vertebral body invasion by superior sulcus tumor has traditionally been considered a contraindication to surgical resection. Attempts at definitive radiation or chemoradiation have not been successful. Recent advances in spinal instrumentation have allowed more complete resection of vertebral body tumors. We, therefore, reviewed our recent experience with vertebral resection of superior sulcus tumors. METHODS: All patients (n = 17) undergoing resection of superior sulcus tumors with T4 involvement of the vertebrae from October 18, 1990 to September 21, 1998 at the University of Texas M.D. Anderson Cancer Center (MDACC) were evaluated. Their clinical and pathologic data were reviewed and analyzed for short- and long-term outcomes. RESULTS: Total vertebrectomy was performed in 7 patients (42%), partial vertebrectomy in 7 (42%), and 3 (18%) underwent neural foramina or transverse process resection. The median hospital stay was 11 days. Postoperative complications occurred in 7 patients (42%) and included pneumonia (6, 36%), arrhythmia (2, 12%), cerebrospinal fluid leak (2, 12%), wound breakdown (1, 6%), and reoperation for bleeding (1, 6%). Sixteen out of 17 patients received preoperative or postoperative radiation therapy. No perioperative mortality occurred. All patients remained ambulatory after spinal reconstruction. Overall actuarial survival at 2 years was 54%, with 11 patients still alive 2 to 50 months after resection. Locoregional tumor recurrence was noted in all 6 patients who had positive surgical margins, as opposed to 1 out of 11 patients (9%) with negative margins (p < 0.006). Additionally, the 2-year actuarial survival of patients with negative microscopic margins was 80% versus 0% for positive margins (p < 0.0006). CONCLUSIONS: An aggressive multidisciplinary approach to superior sulcus tumors with vertebral invasion can lead to long-term survival with acceptable morbidity if negative margins can be obtained. Vertebral body invasion should no longer be considered a contraindication for resection of superior sulcus tumors.

Adult↗

PubMed2003

Outpatient cognitive behavioral pain management programs: a randomized comparison of a group-based multidisciplinary versus an individual therapy model.

OBJECTIVE: To compare the efficacy of 2 models of chronic pain management. DESIGN: Randomized comparative trial with 2 active treatment arms. SETTING: Outpatient pain management clinics. PARTICIPANTS: A total of 113 adults with chronic pain of 0.5 to 38 years duration in (mean, 8.8y). INTERVENTIONS: Cognitive behavioral therapy (including education, relaxation, use of cognitive coping strategies, pacing, exercise) delivered in group-based multidisciplinary program or in an individual therapy program. MAIN OUTCOME MEASURES: Self-report of interference with daily activities and sense of control over pain (West Haven-Yale Multidimensional Pain Inventory [WHYMPI]) and depression (Beck Depression Inventory). Secondary outcome measures were state anxiety (Spielberger State-Trait Anxiety conventory), analgesic medication consumption, general activity, and pain severity (WHYMPI). Measurement points were 0 (before treatment), 2 months (end of treatment), and 3, 6 and 12 months (follow-up). RESULTS: No significant differences were found between the 2 modes of treatment at any of the major time points (0, 2, 12mo). Both treatment conditions made significant and sustained improvements on all primary outcome measures, although sense of control over pain tended to decline by 1 year. Individually treated participants made slower gains in some areas, but showed a lesser tendency to rebound at the end of treatment. CONCLUSION: The 2 programs appear to be equally efficacious for pain management in adults with chronic pain. In practical terms, the choice of model for service provision may rest more on local issues such as the availability of space and staff time.

Activities of Daily Living↗