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A multidisciplinary field hospital as a substitute for medical hospital care in the aftermath of an earthquake: the experience of the Israeli Defense Forces Field Hospital in Duzce, Turkey, 1999.

The damage created by an earthquake can overwhelm local health services, and damage to clinics and hospitals can render them useless. After an earthquake, even undamaged medical facilities cannot be used for a period of time if there is a risk of aftershocks and collapse. In such a situation, there may be calls for international health teams--but what constitutes the optimal medical aid a few days after the event? Does a military field hospital fill the "gap" in the local healthcare system? On 12 November 1999, a 7.2 magnitude earthquake struck Duzce, Turkey. All of the medical activities of the responding Israeli Defense Forces (IDF) mission team field hospital in Duzce, Turkey were recorded and evaluated. A total of 2,230 patient contacts occurred at the field hospital during the nine days it operated. Most of the patients who presented (90%) had non-traumatic medical, pediatric, or gynecological problems unrelated to the earthquake. The IDF hospital offered medical care provided by specialists, hospitalization, and surgical abilities, which Duzce's hospitals could not offer until two weeks after the earthquake. These results strengthen the importance of a multidisciplinary, versatile, field hospital as an aid to an earthquake-affected population during the first few weeks after an earthquake.

Disasters↗

Delivering multidisciplinary public health in action - the Cardiff food strategy case study.

BACKGROUND: There is an increasing awareness that the provision of healthy food relies on the co-ordinated efforts of a number of diverse disciplines, not merely those traditionally linked with food. This paper documents the development of a food and health strategy, commissioned by the health alliance for the city of Cardiff, and focuses on the areas of sustainability, education and training as well as nutrition, food provision and food safety. OBJECTIVE: The aim of the strategy was to increase the uptake of a healthy, safe and sustainable diet for all those living in Cardiff. METHOD: The methodology included a rapid appraisal of food initiatives operating within the city, establishing a food and health strategy working group and the production of strategy documentation. Multi-agency collaboration and consultation were key components of the approach. RESULTS: As the strategy developed, seven action areas became apparent, including education and training, public sector procurement and rewarding excellence. These action areas were incorporated into seven 'action tables', which constitute the core of the strategy. The food and health strategy document was ratified by the Local Health Alliance board in August 2004. But, far greater benefits were realised as a consequence of setting up the strategy working group. Long before the document was written, the strategy process was operating as 'multidisciplinary public health in action'. CONCLUSION: The network that comprised the food and health strategy working group was already able to commence delivery of a more integrated approach to food and health within Cardiff.

Consumer Product Safety↗

Elucidating amyloid beta-protein folding and assembly: A multidisciplinary approach.

Oligomeric, neurotoxic amyloid protein assemblies are thought to be causative agents in Alzheimer's and other neurodegenerative diseases. Development of oligomer-specific therapeutic agents requires a mechanistic understanding of the oligomerization process. This is a daunting task because amyloidogenic protein oligomers often are metastable and comprise structurally heterogeneous populations in equilibrium with monomers and fibrils. A single methodological approach cannot elucidate the entire protein assembly process. An integrated multidisciplinary program is required. We discuss here the synergistic application of in hydro, in vacuo, and in silico methods to the study of the amyloid beta-protein, the key pathogenetic agent in Alzheimer's disease.

Amino Acid Sequence↗

In search of a novel anti-HIV drug: multidisciplinary coordination in the discovery of 4-[[4-[[4-[(1E)-2-cyanoethenyl]-2,6-dimethylphenyl]amino]-2- pyrimidinyl]amino]benzonitrile (R278474, rilpivirine).

Ideally, an anti-HIV drug should (1) be highly active against wild-type and mutant HIV without allowing breakthrough; (2) have high oral bioavailability and long elimination half-life, allowing once-daily oral treatment at low doses; (3) have minimal adverse effects; and (4) be easy to synthesize and formulate. R278474, a new diarylpyrimidine (DAPY) non-nucleoside reverse transcriptase inhibitor (NNRTI), appears to meet these criteria and to be suitable for high compliance oral treatment of HIV-1 infection. The discovery of R278474 was the result of a coordinated multidisciplinary effort involving medicinal chemists, virologists, crystallographers, molecular modelers, toxicologists, analytical chemists, pharmacists, and many others.

Administration, Oral↗

Enantioselective nonsteroidal aromatase inhibitors identified through a multidisciplinary medicinal chemistry approach.

To identify enantioselective nonsteroidal aromatase inhibitors, a multidisciplinary medicinal chemistry approach was pursued. First, our earlier CoMFA model [Bioorg. Med. Chem. 1998,6, 377-388] was extended taking purposely into account previously discovered enantioselective aromatase inhibitors. The 3D QSAR model was then exploited to design chiral ligands, whose configurational assignment was obtained, after HPLC separation, by means of a combination of circular dichroism measurements and time dependent density functional calculations. Finally, the new enantiomeric inhibitors were separately tested to ascertain both their potency against the cytochrome P450 aromatase (CYP19; EC 1.14.14.1), and their selectivity relative to another enzyme of the P450 family. A satisfactory agreement between experimental and predicted data allowed us to assert that a properly built "enantioselective CoMFA model" might constitute a useful tool for addressing enantioselective ligands design.

Aromatase↗

Calcium channel antagonists discovered by a multidisciplinary approach.

A multidisciplinary project has led to the discovery of novel, structurally diverse, L-type calcium entry blockers (CEBs). The absolute configuration of a recently reported CEB has been determined by vibrational circular dichroism spectroscopy, to assign the stereospecificity of the ligand-channel interaction. Thereafter, a virtual screening procedure was performed with the aim of identifying novel chemotypes for CEBs, starting from a database of purchasable compounds; 340,000 molecules were screened in silico in order to prioritize structures of interest for bioscreening. As a result, 20 compounds were tested in vitro, and functional and binding assays revealed several hits with promising behavior as CEBs.

Animals↗

Multidisciplinary weight management in locoregional breast cancer: results of a phase II study.

Sixty-one women with newly diagnosed locoregional breast cancer (T1-3, N0-1, M0) having an initial Body Mass Index (BMI) between 20 and 35 kg/m2 who were receiving standard adjuvant treatment (chemotherapy, tamoxifen, and/or radiation) were asked to avoid weight gain (if initial BMI < or = 25 kg/m2) or to lose up to 10 kg (if initial BMI 25-35 kg/m2) over one year. Women participated in twenty group sessions (10 weekly, 10 monthly) which involved a psychological supportive-expressive group intervention supplemented by individual weight goals, and nutrition and exercise programs. Fifty-five non-censored women (5 developed recurrence, 1 died of a subarachnoid hemorrhage) lost a mean of 0.53 +/- 3.72 kg. Weight loss was greatest in initially overweight women (BMI > or = 25 kg/m2) who lost 1.63 +/- 4.11 kg (p = 0.01 compared to normal weight women) and in those not receiving chemotherapy who lost 2.15 +/- 2.83 kg (p = 0.0004 compared to those receiving chemotherapy). 70.9% met predefined criteria for success. Aerobic exercise increased significantly during the intervention (p = 0.00005) and was the strongest predictor of success (OR 1.73 for each additional 30 minutes of exercise weekly, p = 0.003). Changes in caloric intake were not significant, but fat intake decreased and carbohydrate and fibre intake increased significantly during the intervention. Eating behavior and psychological status improved significantly. Thus, this multidisciplinary weight management intervention successfully prevented weight gain in women with newly diagnosed locoregional breast cancer, and helped overweight women lose weight.

Adult↗

Modelling decisions of a multidisciplinary panel for admission to long-term care.

This paper describes a modelling study of a multidisciplinary review panel which is responsible for matching levels of long-term care to the needs of older people. The study aims to understand the decision making process of the review panel and to predict placement decisions based on an applicant's attributes. Data were collected from cases notes presented to the London Borough of Merton review panel. A model predicting placement of an individual to residential home, nursing home or long-stay nursing care was built using logistic regression. and correctly predicts 78% of placement decisions. The model can be used as a means of checking the consistency of the review panel's placement decisions.

Activities of Daily Living↗

The prognosis after multidisciplinary treatment for patients with postinfectious chronic fatigue syndrome and noninfectious chronic fatigue syndrome.

The prognosis after multidisciplinary treatment for patients with postinfectious chronic fatigue syndrome (CFS, n = 9) and noninfectious CFS (n = 9) was clarified. After treatment, natural killer (NK) cell activity increased in the postinfectious CFS group but did not recover to within normal range in the noninfectious CFS group. In the postinfectious CFS group, physical and mental symptoms improved, and 8 patients returned to work. In the noninfectious CFS group, symptoms did not improve, and only 3 patients returned to work. The prognosis of postinfectious CFS group was better than that of noninfectious CFS group. Classification of CFS patients into postinfectious and noninfectious groups is useful for choosing the appropriate treatment in order to obtain better prognosis.

Adult↗

Pain self-management in the process and outcome of multidisciplinary treatment of chronic pain: evaluation of a stage of change model.

For chronic pain patients, acceptance of a self-management approach for pain may influence success in treatment, and adopting such a perspective may be conceptualized as a stage of change model. For 65 chronic pain patients in multidisciplinary treatment programs, we examined whether pretreatment self-management stage, assessed with Pain Stage of Change Questionnaire subscales, affected improvements in outcomes, and whether changes in stage represented a therapeutic process factor. Results showed (a) low precontemplation, high contemplation, and high action attitudes at pretreatment predicted greater improvements in outcomes than the opposite pattern of attitudes; (b) pre- to midtreatment changes in precontemplation and contemplation attitudes predicted mid- to posttreatment changes in pain severity and interference, but not vice versa. Results support the usefulness of a stage model in conceptualizing patients' acquisition of a self-management approach to pain, and suggest that early-treatment progression across stages may lead to reductions in pain severity and lifestyle interference.

Adult↗

Making explicit the implicit knowledge assets in healthcare: the case of multidisciplinary teams in care and cure environments.

Research in Australia and the United States offers evidence of sophisticated, implicit, knowledge assets in two diverse healthcare environments, care and cure. Two case studies representing these two distinct archetypal environments are presented (a palliative care organization in Australia and a spinal care unit in the United States); both are based around multidisciplinary service delivery and demonstrate the existence of implicit knowledge assets. Yet the full potential of these knowledge assets is not being realized. A Knowledge Management Infrastructure model is proffered as a way of making explicit the elements of these knowledge assets in both case studies. In addition, this model provides a systematic and robust approach to structuring the conceptualization of knowledge assets across a range of healthcare environments.

Australia↗

Dental neglect and dental health among 26-year-olds in the Dunedin Multidisciplinary Health and Development Study.

OBJECTIVES: To test a modification of a previously-reported six-item dental neglect scale and examine its association with dental health and service-use among young adults. METHODS: Of the 980 26-year-old participants in the Dunedin Multidisciplinary Health and Development Study, 973 completed the scale and 930 underwent dental examination. Sociodemographic and dental service-use data were collected using a self-report questionnaire. RESULTS: Factor analysis showed that five of the original six items loaded on the scale, and responses to those items were summed to give a dental neglect scale score for each participant. Scale scores were normally distributed (mean=13.0; SD=3.6; range 5 to 25), and a median split created higher and lower dental neglect groups. A higher proportion of the higher neglect group group: (i) were male; (ii) rated their dental health and dental appearance as below average; (iii) brushed their teeth infrequently; (iv) had extensive plaque deposits; (v) used dental services only when they had a problem; (vi) had not recently seen a dentist; (vii) had lost at least one permanent tooth because of caries, and (viii) had a greater number of decayed tooth surfaces. CONCLUSIONS: Although further examination of its validity and reliability is indicated, the dental neglect scale appears to hold promise for use in dental health promotion, not only in highlighting population groups or individuals who would benefit from intensive health promotion efforts, but also in the evaluation of health promotion interventions.

Adult↗

Ventilation and health in non-industrial indoor environments: report from a European multidisciplinary scientific consensus meeting (EUROVEN).

Scientific literature on the effects of ventilation on health, comfort, and productivity in non-industrial indoor environments (offices, schools, homes, etc.) has been reviewed by a multidisciplinary group of European scientists, called EUROVEN, with expertise in medicine, epidemiology, toxicology, and engineering. The group reviewed 105 papers published in peer-reviewed scientific journals and judged 30 as conclusive, providing sufficient information on ventilation, health effects, data processing, and reporting, 14 as providing relevant background information on the issue, 43 as relevant but non-informative or inconclusive, and 18 as irrelevant for the issue discussed. Based on the data in papers judged conclusive, the group agreed that ventilation is strongly associated with comfort (perceived air quality) and health [Sick Building Syndrome (SBS) symptoms, inflammation, infections, asthma, allergy, short-term sick leave], and that an association between ventilation and productivity (performance of office work) is indicated. The group also concluded that increasing outdoor air supply rates in non-industrial environments improves perceived air quality; that outdoor air supply rates below 25 l/s per person increase the risk of SBS symptoms, increase short-term sick leave, and decrease productivity among occupants of office buildings; and that ventilation rates above 0.5 air changes per hour (h-1) in homes reduce infestation of house dust mites in Nordic countries. The group concluded additionally that the literature indicates that in buildings with air-conditioning systems there may be an increased risk of SBS symptoms compared with naturally or mechanically ventilated buildings, and that improper maintenance, design, and functioning of air-conditioning systems contributes to increased prevalence of SBS symptoms.

Air Pollution, Indoor↗

Correlates of improvement in multidisciplinary treatment of chronic pain.

Although multidisciplinary pain programs have been demonstrated to be effective, the processes of improvement have yet to be clarified. Cognitive-behavioral models posit that improvement is due, in part, to changes in patient pain beliefs and coping strategies. To test the relationships between treatment outcome and changes in beliefs and coping strategies, 94 chronic pain patients completed measures of physical and psychological functioning, health care utilization, pain beliefs, and use of pain coping strategies at admission and 3 to 6 months after inpatient pain treatment. Improved functioning and decreased health care use were associated with changes in both beliefs and cognitive coping strategies. However, changes in some coping strategies, such as exercise and use of rest, were not associated with improvement.

Adaptation, Psychological↗

Repression predicts outcome following multidisciplinary treatment of chronic pain.

This study examined whether repression predicts outcome following multidisciplinary treatment for chronic pain and whether links between anxiety and outcome are obscured by repressors. Ninety-three chronic pain patients completed a 4-week pain program. Lifting capacity, walking endurance, depression, pain severity, and activity were measured at pre- and posttreatment. Low-anxious, repressor, high-anxious, and defensive/high-anxious groups were formed from median splits of Anxiety Content (ACS) and Lie scales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). Significant ACS x Lie interactions were found for lifting capacity, depression, and pain severity changes. Planned comparisons showed that both repressors and high-anxious patients performed poorly on lifting capacity; repressors alone recovered poorly on depression and pain severity. Results imply that repression may interfere with the process and outcome of pain programs.

Adult↗

The impact of a multidisciplinary, integrated approach on improving the health and quality of care for individuals dealing with multiple chronic conditions.

This study examined the effects of using a multidisciplinary, integrated, whole-person, team advocate approach to educate and empower participants with multiple chronic illnesses and coordinate, monitor, and support their health care process. Individuals (N = 39) from Midwest hospitals participated and completed self-report instruments. Changes in participants' functioning were also measured with diagnostic measures completed by the team advocates. The results indicate that the participants' perceptions of physical functioning, physical well-being, control, self-efficacy, and life satisfaction increased. Additionally, health-related behavior changes were reported, and short-term costs were significantly lower than projected costs. Finally, the participants rated their health care services in the program as more effective than previous health care services.

Adolescent↗

Reducing overweight through a multidisciplinary school-based intervention.

OBJECTIVE: This study sought to evaluate the effectiveness of a multidisciplinary elementary school-based intervention entitled Wellness, Academics & You. The primary areas of impact examined were BMI, consumption of fruits and vegetables, and physical activity. RESEARCH METHODS AND PROCEDURES: The sample consisted of 1013 students in fourth and fifth grades from 69 classes in four states. Intervention and comparison classes were randomly selected at each school. Intervention teachers participated in workshops on the intervention and received program materials. BMI was calculated for baseline and post-data points based on measured height and weight collected by trained research teams. Baseline surveys were administered by the students' teacher in the presence of one of the research team members and collected. RESULTS: SPSS (SPSS, Inc., Chicago, IL) analysis of post-data shows significant positive shifts (p = 0.01) in BMI in the intervention group compared with the comparison group. Notable increases in the consumption of fruits and vegetables and increased physical activity levels were reported in the intervention group. DISCUSSION: Data from this study indicate that this school-based program may contribute to the reduction of overweight and obesity. The intervention was well received by the classroom teachers and shows promise for a school-based obesity prevention initiative. This program has shown the capacity to effect positive changes in BMI through consumption of fruits and vegetables and physical activity. The evaluation covered a limited time period and, therefore, warrants additional studies to determine whether long-term program fidelity will result in continued improvement.

Body Mass Index↗

MRI update: a pilot scheme for a multidisciplinary liaisons project.

This MRI update brings you details of two research projects that are currently underway. The first is a project by Mark Bowen researching into multidisciplinary liaisons and whether it can improve patient care. The second is about the influence of quality management on the success of dental practices by David Ward, a GDP working in Sheffield.

Dentists↗