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PubMed1996

Developing multidisciplinary library services in trust hospitals: a case study at the City Hospitals Sunderland NHS Trust.

The paper describes an example of good practice in the establishment of multidisciplinary library services at a Trust hospital. In 1995, City Hospitals Sunderland NHS Trust commissioned a survey to determine their needs for library services for all staff. The results of the survey and the recommendations are described. The Trust's further actions are briefly noted. This case study is set into the wider context of the need for well-resourced library and information services within the NHS. The constraints under which such developments operate are listed.

Accreditation↗

PubMed2003

Multidisciplinary nursing: re-thinking role boundaries.

The ambiguous role of nurses within the health care team has been a subject of much debate, evident in current practice and the study of the early development of nursing in Australia. Early nursing work was broad and uncontested. Debates about nursing and 'non-nursing' tasks are thought to have emerged after the establishment of 'Nightingale reforms' in the 1870s. Nursing role conflicts may be due in part to the rise in technology and medical intervention, the demise of 'generalist' doctors, nurses and patient-centred care, the creation of nursing specialists who moved to other community care positions and nursing's drive for professionalization. Nurses' role in mealtimes provides one example of the ambiguous and contentious issue of nursing and non-nursing work. Health services need a generic worker who is client-focused, possesses multidisciplinary skills, manages the care environment, humanizes the system at the point of contact and acts therapeutically. This broad and flexible role ascribed to nurses is threatened by cost containment and the scramble for new occupations within the broad field of health services, which is plagued with increasingly rigid role boundaries. The examination of nursing workforce planning arrangements is needed to ensure greater coherence and clearer lines of nurses' roles and responsibilities.

Australia↗

PubMed2000

The Phil Hearne course: an evaluation of a multidisciplinary mental health education programme for clinical practitioners.

A description and evaluation of the pilot of a 30-week multidisciplinary mental health education programme (The Phil Hearne Course) is presented. The course was based upon the expressed service needs of an NHS Trust and upon the needs of users consulted during the developmental phase of the project. The course was designed to provide core skills, relating to effective assessment, communication, intervention and networking. These skills were thought to be applicable to all mental health disciplines. The course was evaluated positively by students and staff and was found to be effective in improving practice by providing a range of core skills for mental health workers. It was also determined that students tended to over-estimate their skills in core areas, particularly care planning and record-keeping. It is intended to develop the course into a distance learning, skills-based package.

Education, Nursing, Continuing↗

PubMed1998

The use of multidisciplinary consensus groups in the planning phase of an integrated problem-based curriculum.

In response to the General Medical Council's initiative to reform UK medical undergraduate education only a minority of medical schools have developed entirely novel curricula. Although the experiences gained by these schools in curriculum design and planning have not been recorded in the literature they are likely to be of interest to other medical schools still contemplating course revision. The medical school at the University of Liverpool recently launched an integrated problem-based course differing radically from its predecessor. The General Medical Council considered integration of contributing disciplines one of the most important aims of reform, yet courses that integrate independent component disciplines may be perceived by staff as threatening due to the loss of structure and disciplinary autonomy. Strategies for early course development must take account of these concerns as well as dealing with the identification of course content. A multidisciplinary consensus group process, designed to combat some of these problems, was employed to identify the learning objectives and core content for the new course. The purpose of this paper is to describe, first, the processes employed to identify the core palliative care component for a new PBL curriculum and secondly, how these objectives were integrated horizontally and vertically throughout all course elements.

Curriculum↗

PubMed2001

Quality assurance in a multidisciplinary symptomatic breast assessment clinic.

BACKGROUND: Although quality assurance guidelines for surgeons have been issued and adopted for use in population-based breast screening programs in Australia, similar guidelines are unavailable for women referred with symptomatic breast problems. METHODS: Six hundred and ninety-six women who attended the Royal Adelaide Hospital Women's Health Centre between February and November 1998 for investigation and management of a new breast-related complaint were prospectively evaluated. Investigation strategies and outcomes of the initial consultation were determined and the results compared with the performance quality standards for symptomatic breast disease according to the British Association of Surgical Oncology (BASO) Breast Surgeons' Group. RESULTS: A breast lump was the presenting symptom in 45%, while breast pain was present in 26%. Ninety per cent of women referred with breast symptoms were given a definitive benign or malignant diagnosis at the initial clinic visit. Although the median time delay between the date of general practitioner referral and breast clinic appointments for all patients was < or =7 days, the time delay for 'urgent' cases was not met according to BASO performance indicators. All other Royal Adelaide Hospital Breast Clinic audit data were within the range suggested by BASO performance indicators for new consultations in a symptomatic breast assessment clinic. CONCLUSIONS: A multidisciplinary breast clinic in a public hospital setting is able to provide clinical services to symptomatic women, with the majority of patients obtaining a confident diagnosis at the first presentation. Performance indicators for symptomatic breast disease are useful in identifying inadequacies at the clerical or clinical level which, following the implementation of subsequent changes, may lead to improvement in patient outcomes.

Adolescent↗

PubMed2002

Effectiveness of an individualized multidisciplinary programme for managing unsettled infants.

OBJECTIVE: To ascertain the effectiveness of an individualized multidisciplinary residential programme for managing young unsettled infants and whether changes in unsettled behaviour were maintained. METHODS: One hundred and nine clients of a Tresillian residential unit with singleton infants aged less than 20 weeks were studied before, during and after intervention. Mothers completed a 24 h infant activity record prior to admission, during the stay and 1 month after discharge. Intervention consisted of settling techniques, parent education, support and counselling. RESULTS: By day 4 of admission, the mean duration of unsettled (fussing, crying) behaviour had decreased significantly and mean sleeping time and awake/content times both increased significantly (P < 0.001). These changes were maintained 1 month after discharge. Changes in behaviour were particularly marked for very unsettled infants. CONCLUSIONS: In the absence of formal controls, the individualized programme appears effective in managing the behaviour of unsettled infants.

Adult↗

PubMed1999

Multidisciplinary treatment, including laser hyperthermia, for extensive regional metastasis of a penile tumor.

BACKGROUND: There is no reliable treatment for penile tumor with lymph node metastasis. METHODS: We report on a patient with a penile tumor with extensive regional metastasis that was successfully managed with combined laser hyperthermia, radiation and chemotherapy. RESULTS: The patient has survived more than 7 years without evidence of disease. CONCLUSIONS: Multidisciplinary treatment, including laser hyperthermia, may be useful for the treatment of regional metastasis of penile tumor.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2003

Is there a rationale for the continuous infusion of cefepime? A multidisciplinary approach.

This review is the fruit of multidisciplinary discussions concerning the continuous administration of beta-lactams, with a special focus on cefepime. Pooling of the analyses and viewpoints of all members of the group, based on a review of the literature on this subject, has made it possible to test the hypothesis concerning the applicability of this method of administering cefepime. Cefepime is a cephalosporin for injection which exhibits a broader spectrum of activity than that of older, third-generation cephalosporins for injection (cefotaxime, ceftriaxone, ceftazidime). The specific activity of cefepime is based on its more rapid penetration (probably due to its zwitterionic structure, this molecule being both positively and negatively charged) through the outer membrane of Gram-negative bacteria, its greater affinity for penicillin-binding proteins, its weak affinity for beta-lactamases, and its stability versus certain beta-lactamases, particularly derepressed cephalosporinases. The stability of cefepime in various solutions intended for parenteral administration has been studied, and the results obtained demonstrated the good compatibility of cefepime with these different solutions. These results thus permit the administration of cefepime in a continuous infusion over a 24-h period, using two consecutive syringes.

Bacterial Infections↗

PubMed2002

Do multidisciplinary integrated care pathways improve interprofessional collaboration?

This paper reports on the evaluation stage of an action research project on interprofessional collaboration in discharge planning. Findings from interviews with health care professionals working in the acute sector had revealed concerns about discharge planning and multidisciplinary teamwork. In the United Kingdom the National Health Service (NHS) Plan has reinforced the need for an integrated approach to health care. Effective health care integration requires effective communication, teamwork and the commitment to deliver integrated care. Integrated documentation is a key strategy for enhancing interprofessional collaboration and reducing the isolation of professionals, and has been successfully implemented in a range of health care settings. Presented with the concerns about the collaborative process in discharge planning, an action research strategy was chosen to bring about change in an orthopaedic ward in one London teaching hospital. This paper will evaluate the implementation of an integrated care pathway with fractured neck of femurs in one London teaching hospital. Care pathways facilitate the management of defined patient groups using interdisciplinary plans of care. The emphasis will be on understanding whether integrated care pathways enhance and develop interprofessional collaboration and enable effective information access and flow across the professions and the organization. The criteria for evaluation, forming the hypotheses of the study, were that interprofessional nonverbal and verbal communication would be enhanced and that interprofesisonal collaboration would increase. Methods of evaluation used were: (i) stakeholder interviews, (ii) interprofessional audit and (iii) analysis of the variances from the integrated care pathway. The evaluation revealed that although integrated care pathways led to improved outcomes for the health care trust there was little evidence to suggest that interprofessional relationships and communication were enhanced. Furthermore, key factors in discharge delays appeared to be organizational rather than professional.

Attitude of Health Personnel↗

PubMed1999

Multidisciplinary Management of Locally Advanced Breast Cancer.

The treatment of locally advanced breast cancer is aimed at achieving long-term local control with local surgery and/or radiation therapy and at improving disease-free and overall survival through the application of systemic cytotoxic chemotherapy and hormonal therapy. Studies of local therapy alone with surgery or radiotherapy have demonstrated high rates of local recurrence and low rates of long-term survival. The application of anthracycline-based neoadjuvant chemotherapy has resulted in rates of response ranging from 72% to 97%, clinical complete responses of 12-52%, and pathologic complete responses of 4-33%. Multidisciplinary treatment with neoadjuvant therapy, followed by local surgery and/or radiation therapy, followed by additional chemotherapy, has resulted in rates of local control that exceed 80%, and 5-year survival rates exceeding 50% are not unusual. The use of anthracycline-based neoadjuvant chemotherapy in the treatment of locally advanced breast cancer is thus now firmly established. Research in the treatment of locally advanced breast cancer is needed to further define the optimal method of local therapy and the role of new agents such as the taxanes.

Journal Article↗

PubMed2003

Multidisciplinary antimicrobial management and the role of the infectious diseases pharmacist--a UK perspective.

Improved clinical outcome, patient safety, cost savings and a reduction in the burden of antimicrobial resistance are outcomes associated with optimizing antimicrobial use. Despite this, the misuse of antimicrobials in the hospital setting remains a huge problem. The development of antimicrobial management teams and the promotion of the role of the clinical pharmacist in antimicrobial prescribing are recommended strategies for improving prescribing practice. It is recognized that there is a lack of published evidence-based research looking at the effects of antimicrobial control programmes and there is a need for more data. In the UK, the role of the hospital pharmacist in promoting responsible antimicrobial prescribing has been largely undervalued and needs to be encouraged and formalized in line with current directives. Managerial structures within hospitals need to endorse multidisciplinary antimicrobial management schemes with appropriate authoritative, administrative and information technology support.

Drug Resistance↗

PubMed2003

A multidisciplinary approach to the development of a cervical spine clearance protocol: process, rationale, and initial results.

BACKGROUND/PURPOSE: Assessment of potential spine injuries is inconsistent and controversial. Subsequent morbidity includes prolonged immobilization and missed injuries. To address these issues, a multidisciplinary team was organized to design a cervical spine management/clearance pathway. The process, algorithm, and initial results are described. METHODS: Team members consisted of pediatric surgeons, orthopedic surgeons, neurosurgeons, emergency room physicians, and trauma nurse practitioners. Nationwide standards, guidelines, and experiences across disciplines were reviewed, and a consensus pathway evolved for cervical spine clearance in children 8 years and younger. A short-term retrospective review (5 months) was performed to assess initial performance. Time required for clearance, number and type of imaging studies, and number of missed injuries were compared between a group of patients before (n = 71) and after (n = 56) the implementation of the pathway. RESULTS: Strict guidelines for cervical spine immobilization and clearance criteria were defined. After implementation of this pathway, time required for cervical clearance in nonintubated children decreased (before, 12.3 +/- 1.5 v after, 7.5 +/- 0.9 hours; P =.014). A clear trend toward earlier clearance in intubated patients existed (before [n = 6], 40.0 +/- 16.8 v after [n = 6], 19.4 +/- 8.1 hours; P =.10); there need to be larger numbers to determine statistical significance. The 2 study groups were similar in age; mechanism of injury; Glasgow coma scale score; and number of plain x-rays, computed tomography scans, and magnetic resonance imaging studies obtained. Neither group had missed injuries. CONCLUSIONS: standards for cervical spine immobilization, assessment, and clearance. Implementation of such guidelines decreased time for cervical spine clearance, and ongoing analysis of sensitivity is encouraging.

Algorithms↗

PubMed2001

Multidisciplinary management of pediatric low-grade gliomas.

Low-grade gliomas comprise a heterogeneous group of tumors accounting for 30% to 40% of all primary central nervous system (CNS) neoplasms in the pediatric population. Management of these patients has evolved significantly over the past 2 decades, the present emphasis being on surgery. Adjuvant therapies, such as radiation and/or chemotherapy are generally withheld until symptomatic or radiographic progression is evident. The goal of surgery is gross total resection, while preserving maximal neurologic function. The goal of radiation and chemotherapy is to provide symptom and tumor control with minimal acute and late toxicities. Chemotherapy has the additional goal of deferring radiation to allow maximal development and maturation of the child's CNS. The incorporation of these 3 modalities into the overall care of the pediatric low-grade glioma patient involves the multidisciplinary input of the neurosurgeon, radiation oncologist, and pediatric neuro-oncologist both at time of diagnosis and throughout the course of their disease.

Brain Neoplasms↗

PubMed2001

Multidisciplinary management of adult anaplastic astrocytomas.

The management of patients with anaplastic astrocytoma (AA) requires multidisciplinary involvement. In this article, the literature on the treatment of patients with AA is reviewed, emphasizing randomized trials and key retrospective studies. The role of surgery, radiation therapy, and chemotherapy in newly diagnosed patients and those with recurrent disease is described. Basic science insights, advances in neuroimaging and neuropathology, and novel therapies targeting invasion, angiogenesis, and growth modulation will hopefully lead to improved outcome in this subset of patients with malignant glioma.

Adult↗

PubMed2002

Heart failure management: multidisciplinary care has intrinsic benefit above the optimization of medical care.

PURPOSE: This work addresses the unanswered question of whether multidisciplinary care (MDC) of heart failure (HF) can reduce readmissions when optimal medical care is applied in both intervention and control groups. METHODS: In a randomized, controlled study, 98 patients (mean age, 70.8 +/- 10.5 years) admitted to hospital with left ventricular failure (New York Heart Association Class IV) were assigned to routine care (RC, n = 47) or MDC (n = 51). All patients received the same components of inpatient, optimal medical care of HF: specialist-led inpatient care; titration to maximum tolerated dose of angiotensin-converting enzyme inhibitor before discharge; attainment of predetermined discharge criteria (weight stable, off all intravenous therapy, and no change in oral regimen for 2 days). Only those in the MDC group received inpatient and outpatient education and close telephone and clinic follow-up. The primary study endpoint was rehospitalization or death for a HF-related issue at 3 months. MAIN FINDINGS: At 3 months, four people had events in the MDC group (7.8% rate over 3 months) compared with 12 people (25.5% rate over 3 months) in the RC group (P = 0.04). CONCLUSION: These data demonstrate for the first time the intrinsic benefit of MDC in the setting of protocol-driven, optimal medical management of HF. Moreover, the event rate of 7.8% at 3 months, as the lowest reported rate for such a high-risk group, underlines the value of this approach to the management of heart failure.

Aged↗

PubMed2001

Multidisciplinary management of sedation and analgesia in critical care.

Management of sedation and analgesia in critical care medicine is a multidisciplinary process that involves physicians, nurses, pharmacists, and other healthcare providers. Optimal management of these common issues includes recognition of the importance of predisposing and causative conditions that contribute to the sensations of pain and discomfort, anxiety, and delirium. Treatment includes pharmacological intervention, correction of predisposing factors, and use of other preventative and nonpharmacological measures. It is increasingly clear that, although necessary for patient comfort, sedative and analgesic medications can have adverse consequences, including side-effects as well as prolonged mechanical ventilation and ICU length of stay. Optimal use of sedative and analgesic medications involves matching unique properties of specific medications with individual patient characteristics. Guidelines that minimize unnecessary variability in practice, prevent excessive medication, and emphasize management based on individual patient characteristics improve the effective utilization of these medications.

Journal Article↗

PubMedDate not supplied

[Prognosis of labour force participation after multidisciplinary outpatient and inpatient rehabilitation for chronic back pain].

UNLABELLED: In a one-year prospective study of patients participating in a multidisciplinary outpatient or inpatient rehabilitation program (OPR/IPR) for chronic back pain the following issues were investigated: (i) the frequency of low labour force participation (LFP), i. e., work loss due to the disease or total duration of sick leave (SL) of 6 weeks or more; (ii) prognostic indicators at the beginning of the rehabilitation program (T1) for low LFP after one year (T2); (iii) the significance of the type of rehabilitation IPR vs. OPR in relation to the identified prognostic indicators for LFP. A total of 413 patients participating in OPR (n = 299) or IPR (n = 114) for chronic back pain returned a postal questionnaire after one year. Low LFP was found in 30 % of all patients without significant differences between OPR (32 %) and IPR (25 %). Compared to the year before T1 the proportion of patients without SL between T1 and T2 increased from 12 % to 48 % after OPR, from 15 % to 47 % after IPR, respectively. In multivariate logistic regression analyses adjusted for type of rehabilitation the following prognostic indicators of T1 for low LFP were identified (p </= 0,05): SL of 6 weeks or more in the year before T1 with an odds ratio (OR) of 11.1; intended termination of employment (OR = 3.2), household income of less than 3300 DM per month (OR = 2.2); reduced social functioning (SF-36) (OR = 2.0). Regarding LFP no significance of the type of rehabilitation (IPR vs. OPR) was found in relation to the identified prognostic indicators or after adjustment for differences (i) in the characteristics of the patients at T1, and (ii) in the duration and number of single measures of the rehabilitation program. CONCLUSIONS: One year after IPR or OPR the rate of return to work is similar (about seven out of ten patients). The identified prognostic indicators may stimulate further research of the improvement of the rehabilitation processes. No evidence was found against the expansion of OPR.

Adult↗

PubMed2006

[Offering multidisciplinary medical rehabilitation to workers with work disability due to musculoskeletal disorders: results of randomized controlled trial].

AIMS: In Germany medical rehabilitation has to be initiated by members of statutory pension fund and health insurances. This often leads to delays in the application for and provision of rehabilitation services. Since January 2000 a regional statutory pension fund for blue collar workers (LVA Schleswig-Holstein), 4 statutory health insurances and their medical service MDK have been evaluating a pro-active system to offer rehabilitation to certain member groups. Its acceptance, performance and outcomes were evaluated within a randomized controlled study. METHODS: Over one year actively insured (i. e. working) members of the a. m. institutions were screened for longer work disability due to musculoskeletal disorders (ICD-10: M05 - 25, M40 - 54, M60 - 99). Based on further inclusion criteria eligible persons were randomized either to an intervention (invitation, counselling, application support) or control (usual care) group. At baseline and six and 12 months all participants completed a postal questionnaire enquiring about various health status aspects (secondary outcomes). Information on sick leave (cases, days), hospital treatment and disability pension was based on administrative data (primary outcomes). Analyses were run on an intention to treat-, per protocol-, as actual-, and matched pairs-basis. RESULTS: 230 persons gave written informed consent (IG: n = 134, KG: n = 96). Within 6 months after study entry 69% of the IG- and 20 % of the KG-members participated in a 3 week in-patient multidisciplinary rehabilitation program. Compared to 6 months prior to the study the occurrence of sick leave due to musculoskeletal disorders was clearly reduced during follow-up between month 6 and 12, however with no significant difference between the two groups. Additionally, IG and CG did not differ in any other primary and secondary outcomes. CONCLUSION: Contrary to our expectations the IG-members do not seem to benefit from the PETRA-programme including inpatient rehabilitation.

Adult↗