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Results for “multidisciplinary”

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PubMed2006

A conservative multidisciplinary approach for improved aesthetic results with traumatised anterior teeth.

A subgingival crown-root fracture presents a restorative problem to the clinician because restoration is complicated by the need to maintain the health of the periodontal tissues. If the remaining portion of the root is thought to be enough to support a definitive restoration, the root may be extruded by orthodontic forced eruption after root canal treatment. Extrusion enables the remaining root portion to be elevated above the epithelial attachment. Endodontic posts may be useful in exerting vertical forces to the root for extrusion without buccal tipping. The following case shows multidisciplinary management of a case of dental trauma. Orthodontic forced eruption is incorporated using endodontic posts and restoration with porcelain fused to metal crowns--leading to successful restoration of the traumatised teeth.

Adult↗

PubMed2003

Rapid access multidisciplinary lymph node diagnostic clinic: analysis of 550 patients.

Lymphadenopathy is common, affecting patients of all ages. The current referral pattern for investigating patients with lymphadenopathy varies widely with no universally practised pathway. Our institution set up a lymph node diagnostic clinic (LNDC) accepting direct referrals from primary care physicians. Details of clinical presentation and investigations were recorded prospectively. Between December 1996 and July 2001, 550 patients were referred (M: 203; F:347). The median age was 40 years (range 14-90). The median time between initial referral and the first clinic visit was 6 days. Of 95 patients diagnosed to have malignant diseases, the median time from the first clinic visit to reaching malignant diagnosis was 15 days. Multivariate logistic regression analysis identified five significant predictors for malignant nodes: male gender (risk ratio (RR)=2.72; 95% confidence interval (CI): 1.63-4.56), increasing age (RR=1.05; 95% CI: 1.04-1.07), white ethnicity (RR=3.01; 95% CI: 1.19-7.6) and sites of lymph nodes: supraclavicular region (RR=3.72; 95% CI: 1.52-9.12) and > or = 2 regions of lymph nodes (RR=6.41; 95% CI: 2.82-14.58). Ultrasound and fine-needle aspiration cytology of palpable lymph nodes were performed in 154 and 289 patients, respectively. An accuracy of 97 and 84% was found, respectively. In conclusion, a multidisciplinary lymph node diagnostic clinic enables a rapid, concerted approach to a common medical problem and patients with malignant diseases were diagnosed in a timely fashion.

Adult↗

PubMed2005

An evaluation of the impact of a multidisciplinary team, in a single centre, on treatment and survival in patients with inoperable non-small-cell lung cancer.

Treatment and survival of patients with inoperable Non-small-cell lung cancer in 1997 (n=117) and 2001 (n=126), before and after the introduction of a multidisciplinary team, was examined in a single centre. There were no differences in age, sex and extent of deprivation between the two years. However, in 2001, 23% of patients received chemotherapy treatment compared with 7% in 1997 (P<0.001). Median survival in 2001 was 6.6 months compared with 3.2 months in 1997 (P<0.001).

Age Distribution↗

PubMed2006

MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins?

Histopathological audit of positive circumferential resection margins (CRMs) can be used as a surrogate measure of the success of rectal cancer treatment. We audited CRM involvement in rectal cancer patients and the impact of the multidisciplinary team (MDT) on implementing a magnetic resonance imaging (MRI)-based preoperative treatment strategy. Data were collected on all newly diagnosed rectal cancer patients treated in our network between January 1999 and December 2002. Data were analysed for MRI prediction and histopathological assessment of CRM together with the MDT meeting treatment decisions. The CRM+ve rate of those discussed at MDT vs those not discussed were compared. We re-audited the CRM+ve rates 1 year after introducing a policy of mandatory preoperative MRI-based MDT discussion. Of the 298 patients diagnosed with rectal cancer, 39 (13%) were deemed palliative, 178 underwent surgery alone and 81 underwent neoadjuvant therapy. Of these, 62 out of 178 patients underwent surgery alone without MRI-based MDT discussion resulting in positive CRM in 16 cases (26%) as compared to 1 out of 116 (1%) in those patients with MDT discussion of MRI. Overall CRM+ve rate in all nonpalliative patients with or without MDT discussion was 12.5% (32 out of 256), significantly lower than the <20% rate (P<0.001) quoted in national guidelines. Re-audit in 98 consecutive patients following a change of policy produced a lower CRM+ve rate of 3% (1 out of 37) for all surgery alone patients and an overall CRM+ve rate of 7% (5 out of 70). In conclusion, MDT discussion of MRI and implementation of a preoperative treatment strategy results in significantly reduced positive CRM in rectal cancer patients.

Adult↗

PubMed2000

Discovery, scoring and utilization of human single nucleotide polymorphisms: a multidisciplinary problem.

There are great hopes that the most common form of human genetic variation, single nucleotide polymorphisms (SNPs), can be used to improve radically biological understanding and to advance medicine. However, considerable controversy exists over just how SNPs can be applied to gain these insights. The second international SNP meeting, held at Schloss Hohenkammer, Munich, Germany, brought together leading international scientists from academia and industry to look at these issues from a multidisciplinary perspective. Topics that were covered spanned SNP discovery, scoring technologies, population genetics, disease studies, commercial dimensions, pharmacogenomics, bioinformatics, and legal considerations. SNP discovery is picking up speed; The SNP Consortium (TSC) is set to produce 300,000 publicly available SNPs within 2 years. Improved technologies for scoring SNPs are reducing hands-on time and cost, although truly high-throughput methods are still lacking for genome-wide population-based studies. Large numbers of SNPs have already been analysed in diverse populations. The results emphasise the importance of considering population history when using SNPs to search for genetic risk factors. Opinions on the feasibility of extensive SNP-based analysis of complex disease vary. However, combining expertise from several fields will be key to achieving optimal utilization of SNPs.

Humans↗

PubMed2005

A multidisciplinary approach to assess erectile dysfunction in high-risk cardiovascular patients.

Erectile dysfunction (ED) is increasingly considered as one manifestation of systemic vascular disease. Accordingly, ED and coronary artery disease share mutual risk factors and frequently coexist. Sexual health is an important aspect of our patients' lives, and ED is a common concern of the cardiovascular patient. Despite this, sexual function is under-addressed in the cardiac patient. Even when this topic is broached by the primary care physician or urologist, ED frequently remains untreated due to safety concerns involving cardiac disease and other comorbidities. This article describes our experience with this unique patient population, as well as our approach to building a multidisciplinary clinic designed to specifically address the important issue of ED in the cardiac patient.

Administration, Oral↗

PubMed1998

Outcomes of obese children and adolescents enrolled in a multidisciplinary health program.

OBJECTIVE: The study was designed to evaluate the impact of a multidisciplinary program on children and adolescents' weight control. DESIGN: Retrospective study regarding changes in relative weight of all patients treated regularly in an out-patient care public service between January 1992 and December 1993. SUBJECTS: 198 children and adolescents (108 girls and 90 boys; mean age: 9.25y; mean body mass index (BMI): 24.26 kg/m2, range 19.1-40.31). MEASUREMENTS: Anthropometric data collected at the visits were obtained until June 30 1994. BMI compared to reference data was used. Dual Photon X-ray Absorptiometry (DEXA) was used for 64 patients, to determine percent body fat. RESULTS: Relative weight at the last visit was significantly lower when compared with initial relative weight for the whole sample. Significantly better outcome of relative weight was obtained when six or more visits occurred for the whole sample, and for girls when the days' interval between visits was shorter than 52 d. Variables such as percent body fat, body shape at the first visit, family obesity pattern, length of obesity and pubertal stage, did not significantly influence the outcome of relative weight for the subjects during the treatment. CONCLUSION: Results obtained indicated that good outcomes can be obtained in a program using nutrition education focused on small modifications of eating habits in order to avoid excess energy intake. The best predictors of weight improvement for children and adolescents participating in the program were the higher frequency of visits and shorter intervals between them.

Adolescent↗

PubMed1999

A multidisciplinary approach to the treatment of obesity.

OBJECTIVE: The aim of this paper is: (1) To describe a long-term multidisciplinary group approach to the treatment of morbidly obese persons; and (2) to present, in a preliminary report, results at three months in 30 obese women. DESIGN: Prospective study with evaluation at the start of therapy and after three months of therapy. SUBJECTS: Thirty obese women, initial mean BMI 35.3 kg/m2, age 28-67 y. RESULTS: Body weight decreased significantly (-6 kg) with 74% of weight loss as fat mass. This moderate decrease in body weight resulted in a significant improvement of VO2max/kg body weight. Resting metabolic rate and metabolic parameters remained unchanged. Among psychological variables, participating in the therapy resulted in a more pronounced restrained eating behaviour, an improvement of body image and a higher expression of positive feelings and actions. CONCLUSION: Preliminary results of the program are encouraging. However, continuous evaluation and improvement of the program in the long-term (at least several years) are extremely important.

Adult↗

PubMed2004

Effects of a multidisciplinary weight loss intervention on body composition in obese adolescents.

OBJECTIVE: To investigate if a multidisciplinary weight loss program in adolescents suffering severe obesity allows adequate growth and development and avoid lean mass loss. DESIGN: A total of 55 adolescents (33 girls and 22 boys) suffering severe obesity were enrolled in an interdisciplinary weight reduction program lasting 6-12 months. Progressive submaximal physical activity was performed and national dietary allowances for adolescents with low levels of physical activity energy were provided. MEASUREMENTS: Total and segmental body composition was assessed by means of dual-energy X-ray absorptiometry. RESULTS: The mean height significantly increased (P<0.001). The mean body mass index (BMI) dropped in boys from 34.5+/-3.2 to 25.5+/-2.3 kg/m(2) and in girls from 38.4+/-4.1 to 28.4+/-4.1 kg/m(2). Height increased according to the expected pattern (P<0.001). Total lean mass (LM) did not vary and was positively correlated to pubertal development in both sexes before and after weight loss. Steepest drop in fat mass (FM) was observed in the trunk (-63.2+/-10.1% in boys and -51.5+/-11.4% in girls). Decrease in BMI and FM was tightly correlated in both sexes. However, slopes significantly differed (P<0.0005) so that a decrease of 1 kg/m(2) in BMI corresponded to a decrease of 3.92 kg in FM in girls and of 5.44 kg in boys. In each sex, FM at baseline and duration of the treatment were the main determinants of the decrease in FM. CONCLUSION: During adolescence, despite a major weight loss, adequate growth and preservation of LM can be achieved. Weight loss kinetics markedly differs between boys and girls. Low-calorie diets are unnecessary to achieve a marked reduction of severe obesity during puberty.

Absorptiometry, Photon↗

PubMed2006

Health Effects of Arsenic Longitudinal Study (HEALS): description of a multidisciplinary epidemiologic investigation.

Health Effects of Arsenic Longitudinal Study (HEALS), a multidisciplinary and large prospective cohort study in Araihazar, Bangladesh, was established to evaluate the effects of full-dose range arsenic (As) exposure on various health outcomes, including premalignant and malignant skin tumors, total mortality, pregnancy outcomes, and children's cognitive development. In this paper, we provide descriptions of the study methods including study design, study population, data collection, response rates, and exposure and outcome assessments. We also present characteristics of the study participants including the distribution of exposure and the prevalence of skin lesion at baseline recruitment. A total of 11,746 married men and women between 18 and 75 years of age participated in the study at baseline (a response rate of 98%) and completed a full questionnaire interview that included a food frequency questionnaire, with a response rate of 98%. Among the 98% of the participants who completed the clinical evaluation, over 90% provided blood samples and spot urine samples. Higher educational status, male gender, and presence of premalignant skin lesions were associated with an increased likelihood of providing blood and urine samples. Older participants were less likely to donate a blood sample. About one-third of the participants consumed water from a well with As concentration in each of three groups: >100 microg/l, 25-100 microg/l, and <25 microg/l. Average urinary As concentrations were 140 and 136 microg/l for males and females, respectively. HEALS has several unique features, including a prospective study design, comprehensive assessments of both past and future changes in As exposure at the individual level, a large repository of biological samples, and a full dose range of As exposures in the study population. HEALS is a valuable resource for examining novel research questions on the health effects of As exposure.

Adolescent↗

PubMed2006

The Charlson comorbidity score: a superior comorbidity assessment tool for the prostate cancer multidisciplinary meeting.

INTRODUCTION: Multidisciplinary team (MDT) meetings use precise prognostic factors to select treatment options for patients with prostate cancer. Comorbidity is judged subjectively. Recent publications favour the Charlson comorbidity score (CS) for the use in the management of prostate cancer. We assess the feasibility of using the CS by our MDT in planning the treatment of patients with prostate cancer. PATIENTS AND METHODS: Patients from the histopathology database aged less than 75 years and with a diagnosis of localized prostate cancer between 1993 and 1995 were included in a notes audit. A second group consisted of patients recommended for curative treatment for localized prostate cancer by the local MDT in 2004. Data on comorbidity, prostatic malignancy and survival up to 10 years was collected. The prognostic accuracy of the CS was assessed for those patients offered radical treatment between 1993 and 1995. RESULTS: Of 1043 patients initially assessed, 37 patients with localized prostate cancer were identified. Using Cox regression, we found the CS to be a statistically significant predictor of survival, following radical treatment for localized prostate cancer (P=0.005). Current practice in 2004 (56 patients) shows a mean (range) Charlson probability of 10-year survival for radical prostatectomy of 0.823 (0.592-0.923) and for radical radiotherapy of 0.653 (0.07-0.936). CONCLUSIONS: Our results support the findings of recent research. We also found the CS easy to calculate and therefore feasible to use in our MDT setting. We propose the introduction of the Charlson score by prostate cancer MDTs to assess age and comorbidity.

Acquired Immunodeficiency Syndrome↗

PubMed2002

Diagnosis of skeletal dysplasia by multidisciplinary assessment: a report of two cases of thanatophoric dysplasia.

Skeletal dysplasias, a heterogeneous group of bone growth disorders, can be detected by routine prenatal ultrasound examination. As it is difficult to make a specific diagnosis, prediction of prognosis is of importance for obstetric management. In order to specify diagnosis, radiological, pathological and molecular genetic examination are often required. Our report describes two cases of thanatophoric dysplasia with different fetal sonographic findings. The classical classification of type I and II seems to be ambiguous as, in both cases, the same mutation in the fibroblast growth factor receptor 3 gene was found. The importance of comprehensive multidisciplinary assessment is emphasized.

Adult↗

PubMed1997

Issues in multidisciplinary teamwork for children with disabilities.

This paper presents a review of key issues surrounding multidisciplinary work in relation to the care of children with disabilities and their families. The discussion is based on experience of working in a child development team and research visits to teams around Britain at the beginning of the 1990s. An outstanding feature of child disability services is their organizational diversity. The research found that district interagency planning groups were a rarity, as were multiagency management groups for teams. Thus it was rare for teams to have clear lines of external accountability. Similarly leadership and management structures within the teams had a profound influence on their effectiveness. Issues are highlighted for identifying good practice and for further development of services.

British Columbia↗

PubMed1999

Multidisciplinary assessment of children with deficits relating to attention, motor activity and perception: evaluation of the ANSER model.

This study describes a process for multidisciplinary assessment of children having deficits in attention, motor activity and perception (DAMP) with an evaluation of that process based on the opinions of parents, teachers and team members. The process named the 'ANSER model' consists of six steps (I to VI) conducted over a 2-month period and a follow-up 2 years later (step VII). Parents and teachers are fully involved early in the process and their participation is considered essential for a good result. Particular consideration is given to directly helping a child understand him/herself and become aware of his/her own difficulties. Strategies to overcome those difficulties are developed together with the child, the parents and the teacher. A specific aspect of the assessment is the aim to provide therapy through discussion of the questions, thoughts and feelings evoked during, and by the process. The expectations of parents and teachers regarding the assessment, and their completion of six steps of the process were ascertained from questionnaires. A large majority of both parents and teachers had high expectations of the assessment. Slightly more parents than teachers were convinced of its necessity. Their expectations were satisfied. Parents, teachers and team members emphasized the importance of the participation of parents and teachers in the process. The average time required for a complete assessment according to the process and including the work of all the specialists was 33 hours.

Adolescent↗

PubMed1997

Audit of 6 years' experience of breast fine needle aspiration (FNA) cytology using the cytospin method; improvement through multidisciplinary clinical audit.

A breast FNA cytology service for palpable breast lumps was commenced in 1989 using the cytospin method. Over the following 6 years 2314 aspirates were received. The results were audited in detail in 1990, 1991/1992 and 1994. Multidisciplinary clinical audit meetings followed each audit cycle. Practice change was agreed after each audit. Each audit cycle was followed by demonstrable improvement in the complete sensitivity of the technique, being respectively 79%, 88% and 96%. The cytospin method is a viable alternative to the conventional smear method.

Biopsy, Needle↗

PubMed1998

A multidisciplinary approach to head and neck cancer.

Head and neck cancer and its treatment can leave patients with impaired swallowing and ability to communicate. A multidisciplinary approach from the speech and language therapist and dietician can help the patient maximise their function and identify when additional methods of support are required.

Deglutition Disorders↗

PubMed2000

Blurred roles and permeable boundaries: the experience of multidisciplinary working in community mental health.

This paper reports on an investigation of three interdisciplinary mental health teams. The discussion of the responses highlights the boundaries that exist between different professional roles and areas of responsibility. Whereas there is some evidence of role blurring, which was welcomed by a few respondents, others sought to preserve their own professional identity within the multidisciplinary environment. In a paradoxical sense, the lack of managerial direction and the encouragement of generic working seemed to make some respondents all the more insistent on separate professional identities. We conclude that, far from being a relic of the past or a product of 'ingrained attitudes', boundaries between professions are actively encouraged by the experience of interdisciplinary modes of working.

Journal Article↗

PubMed1993

Reader activity in a multidisciplinary health sciences library: a case study at St George's Library.

This paper reports on a survey of user activity in a London teaching hospital with a multidisciplinary health sciences library. Library users were asked to complete a simple survey form on each visit to the library over a week long period. Information was required to help establish a formula for funding. The user survey examined reasons for visiting the library, frequency of visits, length of visit and also asked for comments and suggestions. Finally there is discussion regarding the effectiveness of the survey in terms of the practical framework utilized and of the gains obtained.

Budgets↗