SEARCH · PubMed Health

Results for “multidisciplinary”

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

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

At least 847 records · Page 47Linked to original sources

PubMed1997

Continuity of information for breast cancer patients: the development, use and evaluation of a multidisciplinary care-protocol.

The multidisciplinary nature of much patient-care may lead to gaps in the continuity of information which they receive, as well as to different care-professionals giving them contradictory information. As a counter-measure, a protocol has been developed which integrates medical, nursing, and a variety of extramural events and activities into a comprehensive description of 15 'moments' in the care of breast cancer surgery-patients. Among innovations, the protocol includes information about psychosocial guidance following diagnosis, and about the discharge procedure and contact with fellow-sufferers. The protocol was implemented in Rotterdam in 1994, in two hospitals and in the community; and evaluated formatively on the basis of reactions from 53 patients and 81 care-professionals. Both groups found its form and content to be successful and informative.

Breast Neoplasms↗

PubMed1997

The need for a multidisciplinary approach in the treatment of advanced colorectal cancer: a critical review from a medical oncologist and surgeon.

Over the last 10 years important advances have been made in the treatment of patients with advanced colorectal cancer, particularly with surgery either alone or in combination with radiotherapy. Furthermore, despite early scepticism, several chemotherapy studies have now reported significant clinical benefits with 5-FU-based regimens and promising results have also been reported with newer agents such as raltitrexed and irinotecan. Taken together these advances now enable a significant proportion of patients to undergo treatment which will improve their quality of life, prolong survival and even result in cure in certain cases. Patients with advanced colorectal cancer can only benefit from these important advances, however, if a truly multidisciplinary approach to patient care is adopted which requires integration of the roles of the surgeon, medical oncologist and radiotherapist.

Adenocarcinoma↗

PubMed2002

Multidisciplinary care of the obese patient with chronic critical illness after surgery.

The surgical patient with prolonged critical illness usually has a higher severity of illness on ICU admission, and is destined for greater morbidity, debilitation, and poorer hospital and long-term survival. Care of those with obesity is particularly difficult. Only with meticulous attention to detail and refined, dedicated, multidisciplinary processes of care, preferably assisted by protocolization, can these patients sustain any hope of recovery to acceptable functionality.

Blood Pressure Determination↗

PubMed1998

[Early perioperative mortality in a multidisciplinary hospital].

OBJECTIVE: To evaluate the incidence and the causes of early intra- and postoperative deaths in a multidisciplinary hospital. STUDY DESIGN: Retrospective survey. PATIENTS: All patients receiving an anaesthetic between 1992 and 1995. METHODS: Analysis of all deaths occurring during anaesthesia and in the subsequent 24 hours. Demographic data (age, gender) and medical data (ASA physical class, type of surgery and degree of emergency) were recorded. The contribution of anaesthesia, surgery or patient disease to fatal outcome was analysed. RESULTS: The analysis included 52,654 patients who underwent either general anaesthesia or epidural analgesia. Perioperative mortality (n = 170) was 1/310 patients (0.32%). The risk factors for mortality (multivariate analysis) were: age > 64 years (odds-ratio [OR] 4.8), ASA class > or = 3 (OR 16.6), emergency surgery (OR 3.6), duration of surgery > 115 minutes (OR 37.4). Fifty percent of deaths (95% confidence interval [CI] = 42-58) were related to patient's underlying diseases and 29% to surgery (CI 95% = 22-36). The percentage of deaths linked to anaesthesia was 17.6% (CI 95% = 11.9-23.3, 1/1,755), consisting of 8.2% (CI 95% = 4.1-9.3, 1/3,761) totally due to anaesthesia and 9.4% (CI 95% = 5-13.8, 1/3,291) only partially. The main aetiologies of the deaths linked to anaesthesia were a mismanagement of severe haemorrhages (30%), respiratory complications (23%) or cardiac complications (23%). The mismanagement of an intraoperative critical situation (46%) and a mistake in the post-operative care (33%) were the main causes. DISCUSSION: In this survey, mortality due to anaesthesia was higher than the rates reported in other studies. Human error remained the main cause.

Adolescent↗

PubMed1987

[A multidisciplinary approach to algodystrophy of the hand].

A multidisciplinary approach for the management of reflex sympathetic dystrophy at SOS Main of Strasbourg has been progressively adopted due to the severe functional sequelae of this disease. The TC99 bone scan in three phases has allowed us after a one week duration of the symptoms to make an early diagnosis and to start dynamic splinting in flexion. Our study compares two groups of patients, one with an early treatment and the other with delayed treatment. It shows a correlation between the stiffness of the affected hand and the isotopic findings. The benefit from an early dynamic splinting in flexion as evidenced by a clinical improvement is corroborated by the bone scan.

Combined Modality Therapy↗

PubMed2004

[The elaboration of analgesic protocols for the elderly. The experience of a multidisciplinary group].

TAKING INTO CONSIDERATION THE PAIN: This has become a right for the patient, an ethical and deontological necessity for the physician, and a near-judicial obligation for care centres. The current regulations authorise nurses to apply analgesic treatments, within the framework of written protocols, signed and dated by the physician. A NEW METHOD: In order to determine the main acute pains of the elderly in institutions and to develop analgesic protocols permitting rapid and efficient relief, with priority given to non-medical treatments, a multidisciplinary group consisting of nurses and non-nursing care workers has been made up. Training tools have been created and distributed. CONCRETE RESULTS: After 14 months' work, the initial objective has been reached. Five analgesic protocols taking into account acute pain in the elderly have been drawn-up. All the care workers have been trained by their nursing colleagues. Following validation, the protocols have been applied for the past year in the department and are now being circulated to other care structures.

Acute Disease↗

PubMed2004

[Diffuse idiopathic interstitial pneumonias. International multidisciplinary consensus classification by the American Thoracic Society and the European Respiratory Society, principal clinico-pathological entities, and diagnosis].

INTRODUCTION: The classification of the idiopathic interstitial pneumonias includes seven clinico-pathologic entities. The diagnosis is based on a multidisciplinary approach, integrating the clinical evaluation, the high-resolution computerised tomography, and the pathological pattern. STATE OF THE ART: A definitive diagnosis of idiopathic pulmonary fibrosis relies on the association of a suggestive clinico-radiological profile and a pathological pattern of usual interstitial pneumonia. Nonspecific interstitial pneumonia is a recently described clinico-pathologic entity, with a better prognosis than that of idiopathic pulmonary fibrosis. Cryptogenic organising pneumonia has been included in the group of idiopathic interstitial pneumonias because of its idiopathic and multifocal characteristics, although it does not predominate in the lung interstitium. Desquamative interstitial pneumonia and respiratory bronchiolitis with interstitial lung disease are rare entities with predominance in young smoking adults. Lymphoid interstitial pneumonia, usually encountered in the context of Sjögren's syndrome, is very rare in its idiopathic form. Acute interstitial pneumonia is responsible for idiopathic acute respiratory distress syndrome. PERSPECTIVES: The current classification of idiopathic interstitial pneumonias better defines the diagnostic criterias of each clinico-pathologic entity, and is expected to facilitate clinical research. CONCLUSIONS: This classification has clinical implications, with prognostic and therapeutic significance.

Anti-Inflammatory Agents↗

PubMed2003

What are the initial perceptions of multidisciplinary personnel new to integrated care pathway development?

Initial perceptions of programmatic shifts are important to gauge if organizational change is to be successful. We used qualitative methods to understand the perceptions of multidisciplinary team members who were responsible for developing integrated care pathways for chronic heart disease in an attempt to improve continuity of care. Members viewed continuity of care as problematic and perceived ICPs as a template for increasing knowledge and enhancing communication. Numerous barriers to ICP use were noted. Information collected in this study may assist others who are developing integrated care pathways.

Canada↗

PubMed1988

Multidisciplinary teams in health care: lessons from oncology and renal teams.

An indepth study conducted on units treating renal disease and cancer clinics determined that multidisciplinary teams are relatively commonplace in these areas. Developing four team organizational structures--sequential, primary, nucleus and dynamic--the authors hypothesize that each varies on a continuum in terms of how highly structured they are. The framework suggests that the ideology of equal participation on the team is the most difficult to sustain, and that difficulties typically arise as organization requirements become more complex. More research seems to be indicated to develop a comprehensive organizational framework, and the probable effect of organizational form on team performance. One of the key issues addressed is team leadership.

Canada↗

PubMed1995

A critical reappraisal of a social form in psychiatric care settings: the multidisciplinary team meeting as a paradigm case.

Critical analysis can be used to examine potential inequalities and interferences with freedom in psychiatric nursing contexts. Multidisciplinary team meetings (MDTM) evoke a sense of egalitarian multiparty cooperation, when underlying philosophical, ideological assumptions and realities can operate to contradict consciously held beliefs. Traditional approaches toward structural aspects of organizations are built on several conventional and taken-for-granted assumptions. Deconstruction and critical analysis can create alternate ways of thinking about fixed aspects of practice. The MDTM can be analyzed through different images. Underlying realities about the disempowerment of nurses and patients in the team structure can be shown through such analysis.

Culture↗

PubMed1998

The Network Project: a multidisciplinary cancer education and training program in pain management, rehabilitation, and psychosocial issues.

Despite recent advances in cancer pain management and education, the undertreatment of cancer pain remains a national health problem. In response to the need for interdisciplinary education and training, we have developed "The Network Project" at Memorial Sloan-Kettering Cancer Center. This program includes a 2-week observership in cancer pain management, psychosocial oncology, and cancer rehabilitation. The efficacy of the Network Project Observership Program was evaluated with the use of a knowledge and attitude inventory which contains questions pertaining to cancer pain, psychosocial oncology, and cancer rehabilitation, and follow-up questionnaires completed one year after participation in the program. The knowledge and attitude inventory was completed by each participant both before and after the observership period. Analysis of the 152 observers who participated in the first 3 years of the Network Project's Observership Program demonstrated a significant improvement in knowledge of cancer pain, psychosocial issues, and rehabilitation issues (P < 0.0001). In addition, observers reported a significant increase in their local educational and training activities in the year following participation in the Network Project (P < 0.01). The Network Project, funded by the National Cancer Institute, is an interdisciplinary, multimodal training program which has been demonstrated to be an effective means for improving and disseminating knowledge regarding the multidisciplinary management of pain and psychological distress in cancer patients.

Community Networks↗

PubMed1998

Presenting symptoms in patients referred to a multidisciplinary clinic for bone metastases.

Symptom control is the goal of palliative irradiation. Approximately 1 month is required before symptomatic relief is accomplished with radiotherapy. However, many patients with cancer-related pain do not receive adequate analgesics, and opioids are often not prescribed until patients fail to respond to palliative irradiation. The presenting symptoms of 108 patients who were referred to a multidisciplinary clinic for bone metastases were evaluated with the Wisconsin Brief Pain Inventory (BPI). This validated instrument evaluates the severity of pain using a 0-10 scale; 10 represents the worst pain imaginable. The population comprised 65 men (60%) and 43 women whose ages ranged from 33 years to 81 years; median age was 55 years, and 69% of patients were less than 65 years of age. Despite the presence of metastatic disease, 21% of patients were working full-time outside the home, and 6% were employed part-time outside the home; 13% were homemakers. Only 17 patients (16%) were unemployed. The time since diagnosis ranged from 2 weeks to 23 years; the median time since diagnosis was 22 months, and 30% of patients had been diagnosed with the past 6 months. Pain was a presenting symptom in 74% (N = 80) of patients at diagnosis. At its worst, the pain was rated as severe (levels 7-10) by 78% and intolerable (level 10) in 22% of the patients in the 24 hr prior to the clinic appointment. On average, the pain was rated moderate to severe (levels 4-10) in 79% and severe in 23% of patients. Only 45% of patients experienced good relief from the prescribed analgesics, and 23% of patients indicated that the prescribed analgesics were ineffective. This survey demonstrates that bone metastases incur significant pain that is often undertreated with analgesics before antineoplastic therapy is administered.

Adult↗

PubMed1997

Orthodontic treatment of a patient with multidisciplinary problems.

This report reviews the orthodontic treatment of a patient suffering from a metabolic disease controlled by medication. The patient also had periodontal problems on both hard and soft tissue support. The results of involvement of general medicine, periodontal surgery, and proper biomechanics is shown and the problems of the multidisciplinary treatment discussed.

Adolescent↗

PubMed2002

[Optic pathway gliomas in neurofibromatosis type I. Longitudinal study of 30 cases in two multidisciplinary practices].

UNLABELLED: The aim of this study was to analyse the outcome of optic pathway gliomas in 30 children with neurofibromatosis type 1, the indications of treatment, and the follow-up and screening protocol. PATIENTS AND METHODS: All patients with a minimal two years follow-up (median six years, range two to 19 years), in two multidisciplinary consultations of Saint-Vincent-de-Paul (Paris) and Purpan (Toulouse) hospitals, were included in the study. In our series, we practiced systematic screening MRI in children under six years' of age or with neuropsychological deficiency that may imply an unreliable ophthalmological examination. RESULTS: Thirty-seven percent (11 patients) had progressive ophthalmological signs and were treated, and 63% (19 patients) were not progressive. Our study confirmed that most of optic pathway gliomas were stable during evolution, but rare cases may have bad prognosis. CONCLUSION: Our study supported the importance of close ophthalmological follow-up during childhood for which screening methods are discussed. There is a consensus to limit treatment for patients with progressive ophthalmological symptoms.

Adolescent↗

PubMed2000

Case study to illustrate a multidisciplinary approach to a case of critical limb ischaemia and the role of chemical lumbar sympathectomy.

This case study illustrates the role of the Podiatrist in the primary health care team and how a multidisciplinary approach to treatment promotes successful diagnosis and treatment regimes. It also outlines the role for chemical lumbar sympathectomies in treating critical lower limb ischaemia, a procedure regarded as having been superseded by more effective treatments but which proved to be the treatment of choice in this case. The subject of this case study presented at a community podiatry clinic exhibiting the signs of acute ischaemia, together with two recently developed ulcers on her right foot. After further vascular investigations, including angiograms and doppler studies, a blockage in the popliteal artery was revealed. Due to anatomically slender arteries, angioplasty and by-pass surgery were contra indicated. A chemical lumbar sympathectomy was performed in an attempt to increase blood flow to the tissues and to reduce the extreme pain being experienced by the patient. This proved successful, allowing the lesions to heal and also the collateral circulation to develop, resulting in a re-vascularized, viable foot.

Female↗

PubMed2003

Multidisciplinary intervention for control of diabetes in patients undergoing coronary artery bypass graft (CABG).

In Israel, as elsewhere, diabetes mellitus is highly prevalent among patients undergoing coronary artery bypass graft (CABG). The bulk of evidence, derived retrospectively, suggests that poor control of diabetes predisposes to complications of CABG and increases mortality; but the findings in a number of studies fail to support that impression. Anticipating a prospective investigation designed to resolve this issue, we have carried out a preliminary study of 147 consecutive patients with diabetes who were hospitalized for elective CABG during 1998. Our objective was to determine how well and how often diabetes could be controlled in accordance with selected metabolic goals in the brief interval between hospital admission and surgery and during the operation itself and in the postoperative period. The task was undertaken by a multidisciplinary team, in cooperation with the Department of Cardiac Surgery. The metabolic goals were: fasting blood glucose consistently between 65-140 mg/dl before and after surgery and 120-180 mg/dl at the time of surgery; and postprandial blood glucose consistently <180 mg/dl. These goals were achieved in 18.1% of fasting blood glucose measurements before and after surgery, 22.1% of preprandial and 14.6% of postprandial blood glucose levels consistently <180 mg/dl. There were no clinical episodes of hypoglycemia. Due to the low incidence of major infection related complications (deep sternal wound infection in only 3 patients (2.0%)) no significant statistical conclusions on the relations between glucose control and these complications could be drawn. The means of all values of FBG and of hemoglobin A1c were significantly higher among patients with complications (n=49) than in those without (P=0.01).

Aged↗

PubMed2003

Multidisciplinary management of giant malignant endo-thoracic nerve sheath tumor.

Malignant degeneration of neurogenic tumors has been reported to occur in 1-25% of patients with neurofibromatosis-I, and is the leading cause of cancer-related death in these patients. We report a case of multidisciplinary management of a giant malignant endothoracic nerve sheath tumor leading to histologically proven remission.

Adolescent↗

PubMed2003

Curative treatment of gastric cancer: towards a multidisciplinary approach?

Despite marked decreases in incidence over the last century, particularly in developed countries, gastric cancer is still the second-most common tumor worldwide. Surgery remains the gold standard for the cure of locoregional disease. However, in most countries, the diagnosis is made at an advanced stage, and the 5-year survival for surgically resectable disease stays far below 50%. The efficacy of chemotherapy and/or radiation therapy in addition to surgery has been actively studied over the last 30 years. Unfortunately, with few exceptions, most studies of adjuvant therapy in gastric cancer have given deceiving results. The purpose of this review is to address the reasons for our failure to objectivate an improvement in the cure of gastric cancer with adjuvant treatment in most trials, and to consider potential solutions. The low efficacy of chemotherapy regimens available up to now may have hampered our progress. In addition, many previous studies suffered limitations of design or methodology (e.g. low accrual, inadequate disease stage selection, inadequate surgical treatment) that may have obscured a treatment effect. Furthermore, the reduced treatment tolerance of post-gastrectomy patients, perhaps due to their poor nutritional status, results in decreased or delayed adjuvant systemic therapy, with potential adverse consequences in its efficacy. Among potential solutions, the arrival of new drugs, taxanes and topoisomerase I inhibitors in particular, which have shown encouraging results in metastatic disease, may increase the impact of chemotherapy in a multidisciplinary treatment approach. Pre-treatment with chemotherapy and/or radiation therapy prior to surgery may also be advantageous, averting the problems associated with post-surgical treatment. Such an approach has been shown to be feasible in phase II studies, and is relatively well tolerated by patients. Several carefully designed randomized phase III trials are underway to answer this question.

Combined Modality Therapy↗