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PubMedDate not supplied

A multidisciplinary approach to carotid paragangliomas.

The surgical management of carotid paragangliomas can be problematic. A multidisciplinary approach was used to include vascular surgery, otolaryngology, and neuroradiology to treat these patients over 9 years. From January 1992 to July 2001, a multidisciplinary team evaluated patients with carotid paragangliomas. Analyzed patient data included age, gender, diagnostic evaluation, tumor size, preoperative tumor embolization, operative exposure, need for extracranial arterial sacrifice/reconstruction, postoperative morbidity including cranial nerve dysfunction, and long-term follow-up. Twenty-five carotid paragangliomas in 20 patients underwent multidisciplinary evaluation and management. Average age was 51 years (range, 28-83 years), and 52% were male. Diagnostic evaluation included computed tomography in 76%, magnetic resonance imaging/magnetic resonance angiography in 52%, catheter angiography in 60%, and duplex ultrasonography in 16%. An extended neck exposure was required in 11 cases (44%), mandibulotomy was used once (4%), and mandibular subluxation was never required. The external carotid artery (ECA) was sacrificed in 8 cases (32%). The carotid bifurcation was resected in 1 patient (4%) requiring interposition reconstruction of the internal carotid artery. Preoperative tumor embolization was performed for 13 tumors (52%). Operative blood loss for patients undergoing preoperative embolization (Group I) was comparable to the nonembolized group (group II): group I lost 365 +/-180 mL versus 360 +/- 101 mL for group II (P = .48). This occurred despite larger tumors (group I - 4.2 cm versus group II - 2.1 cm, P = .03) and a higher mean Shamblin class (group I - 2.5 versus group II - 1.45, P = .001) for group I. There were no perioperative mortalities. Transient cranial nerve dysfunction occurred in 13 CBTs (52%), 2 (8%) of which remained present after 4 months. Patients with carotid paragangliomas benefit from a multidisciplinary team approach. Neuroradiology has been used for selective preoperative embolization, which has decreased estimated blood loss during excision of larger complex tumors. A combined surgical team of otolaryngology and vascular surgery provides for exposure of the distal internal carotid artery as high as the skull base, limited permanent cranial nerve dysfunction, and selective early division and excision of the external carotid artery for complete tumor resection.

Adult↗

PubMed2006

Impacting quality of life for patients with advanced cancer with a structured multidisciplinary intervention: a randomized controlled trial.

PURPOSE: The primary goal of this study was to evaluate the feasibility and effectiveness of a structured, multidisciplinary intervention targeted to maintain the overall quality of life (QOL), which is more comprehensive than psychosocial distress, of patients undergoing radiation therapy for advanced-stage cancer. PATIENTS AND METHODS: Radiation therapy patients with advanced cancer and an estimated 5-year survival rate of 0% to 50% were randomly assigned to either an eight-session structured multidisciplinary intervention arm or a standard care arm. The eight 90-minute sessions addressed the five domains of QOL including cognitive, physical, emotional, spiritual, and social functioning. The primary end point of maintaining overall QOL was assessed by a single-item linear analog scale (Linear Analog Scale of Assessment or modified Spitzer Uniscale). QOL was assessed at baseline, week 4 (end of multidisciplinary intervention), week 8, and week 27. RESULTS: Of the 103 participants, overall QOL at week 4 was maintained by the patients in the intervention (n = 49), whereas QOL at week 4 significantly decreased for patients in the control group (n = 54). This change reflected a 3-point increase from baseline in the intervention group and a 9-point decrease from baseline in the control group (P = .009). Intervention participants maintained their QOL, and controls gradually returned to baseline by the end of the 6-month follow-up period. CONCLUSION: Although intervention participants maintained and actually improved their QOL during radiation therapy, control participants experienced a significant decrease in their QOL. Thus, a structured multidisciplinary intervention can help maintain or even improve QOL in patients with advanced cancer who are undergoing cancer treatment.

Activities of Daily Living↗

PubMed1993

Impact of resident participation in a multidisciplinary diabetes team.

OBJECTIVE: To determine the impact of participation in a multidisciplinary diabetes team on pediatric residents' perceptions of team members' roles. RESEARCH DESIGN AND METHODS: Pediatric residents were assigned to a traditional diabetes clinical rotation (n = 34) or to an ambulatory multidisciplinary diabetes team within their continuity clinic (n = 21). The residents and a small sample of practicing pediatricians (n = 46) completed a Likert-type instrument at the completion of the 18-mo study. RESULTS: Multidisciplinary diabetes team residents were significantly more positive about the roles for endocrinological evaluation in monitoring compliance, for the nurse educator/certified diabetes educator in assisting with sick-day management and school behavioral problems, and for the dietician in helping with cholesterol problems. They were significantly more like practicing pediatricians in their perceptions of pediatric roles in teaching sick-day management, implementing weight reduction, assisting with conflict resolution about diabetes, screening for microvascular complications, and developing behavioral strategies for metabolic control than residents in the traditional rotation. The groups did not differ in their beliefs about patient empowerment. CONCLUSIONS: Multidisciplinary diabetes team participation may be useful in modifying specific role perceptions of pediatric residents about diabetes care. It does not appear to alter perceptions favoring greater patient empowerment.

Attitude to Health↗

PubMed2003

Multidisciplinary guidelines in Dutch mental health care: plans, bottlenecks and possible solutions.

PURPOSE: This article describes the Dutch 'Multidisciplinary Guidelines in Mental Health Care' project and its first products (multidisciplinary guidelines on depressive and anxiety disorders). CONTEXT OF CASE: In the early 1990s, disciplines in Dutch mental health care formulated their first monodisciplinary guidelines, which disagreed on essential features. In 1998, the Dutch government invited representatives of the five core disciplines in mental health care (psychiatrists, general practitioners, psychotherapists (clinical), psychologists and psychiatric nurses) to start a joint project aimed at the development of new integrated multidisciplinary guidelines. DATA SOURCES: The vision document, presented in 2000 by the five core disciplines, describes the directions for the development of new guidelines. The guidelines on depressive and anxiety disorders will appear in 2004. CASE DESCRIPTION: The first draft guidelines were presented in May 2003, in line with the vision document (2000). However, it is still not certain whether they will be authorised by all professional groups. Some disciplines do not recognise themselves in these guidelines. It is argued that these problems can be attributed at least in part to the evidence-based method that was used in drafting the guidelines. Interventions are compared on the basis of their 'level of evidence', the consequence of which is that cognitive behavioural therapy and drug treatment are almost always seen as the only appropriate interventions. Other interventions are excluded because of their lower level of evidence. CONCLUSIONS AND DISCUSSION: The conclusion is that guidelines cannot be based on empirical evidence alone. It is argued that the collective sense of professions involved should also be integrated into the guideline, for example in relation to goal differentiation. It is finally argued that multidisciplinary guidelines must also offer a hierarchy between those goals, i.e. a vision of the appropriate type of care and the order in which the various care components should be administered.

Journal Article↗

PubMed1999

Training health professionals: a multidisciplinary team approach in a university-based weight-loss program.

In a university-based weight-loss program for preadolescent girls, a multidisciplinary team delivered the intervention. The team included a nurse/health educator, an exercise physiologist, a psychologist, five dietitians, and 17 dietetics, nursing, and medical students, The six-month program provided 12 educational sessions in nutrition, stress management, behavior modification, and exercise. Concurrent sessions for parents addressed comparable educational topics and parenting skills. Dietitians and student research assistants (n = 19) were surveyed regarding their participation on a multidisciplinary team and their acquisition of new knowledge/skills. The survey included both open-ended questions and Likert-type statements. Results indicate that participation enhanced knowledge of nutrition counseling/education (chi = 1.6) as well as appreciation for research (chi = 1.8) and for the multidisciplinary team approach (chi = 1.7). Qualitative data reinforce the benefits of the multidisciplinary experience and multiskill training. Exercise, stress management, parenting skills, and psychological techniques were perceived as important skills to develop for professional careers.

Attitude of Health Personnel↗

PubMed2001

Care planning and case conferencing. Building effective multidisciplinary teams.

BACKGROUND: The new Medicare items that cover care plans and multidisciplinary case conferences for patients with complex and chronic medical conditions have introduced new challenges in primary health care. General practitioners may be required to develop new skills if they are to work effectively with other professionals and carers where health is not their only priority. OBJECTIVES: This paper reports briefly on findings from a particular research project into the key factors that contribute to effective multidisciplinary teams. Principles from this research that can be applied to GPs being involved in multidisciplinary care plans and case conferences will be examined. DISCUSSION: Key factors discussed include the importance of efficiency, flexibility, an holistic view of the patient, communication and personal and professional characteristics that contribute to a successful outcome in multidisciplinary patient care.

Australia↗

PubMedDate not supplied

Multidisciplinary management: why me?

Laboratory professionals are being asked more and more frequently to spread their wings and take on additional responsibilities in the form of multidisciplinary management. Multidisciplinary management can be described as the management of multiple departments with one or more being outside of the traditional laboratory department, such as respiratory care, pharmacy, radiology, or cardiodiagnostics. Reasons behind the trend in multidisciplinary management and why laboratory professionals often are asked to assume these roles will be explored. This column will cover how laboratory managers can prepare for the challenges of multidisciplinary management, what skills are necessary for these new roles, and how to prepare yourself to be the candidate of choice for these positions when they develop. Challenges often encountered will be discussed, including suggestions on how to turn potential difficulties into positive growth experiences. Hopefully, at the conclusion, you will be able to answer the question "Why me?"--either in the form of "Why have I been asked to take on this role?" or "Why might I want to pursue such a role with enthusiasm?"

Accreditation↗

PubMed2003

[Multidisciplinary outpatient clinics for back pain patients--a new treatment program].

Chronic low back pain (LBP) represents a major health problem, especially in Western Europe and North America. The aim of this study is to give an account of why a multidisciplinary treatment program in an outpatient spine clinic is the best treatment for many sub-acute and chronic LBP patients on long-term sick leave. We present an overview of documented treatment effects from multidisciplinary treatment programmes, an outline of the treatment in an outpatient spine clinic, and an account of why multidisciplinary programs are beneficial. The treatment of this patient group is also shown to be cost-effective when one differentiates between light and extensive multidisciplinary programmes. A future challenge rests in the fact that even after optimal treatment, approximately 20 % of patients still do not return to work.

Cost-Benefit Analysis↗

PubMed2004

Multidisciplinary predialysis care and morbidity and mortality of patients on dialysis.

BACKGROUND: Multidisciplinary predialysis care results in fewer hospitalizations and more patients starting hemodialysis therapy with vascular access. Rigorous comparisons of the effect of different types of predialysis care on outcomes after the initiation of dialysis therapy are in their infancy. We hypothesized that outcomes after the initiation of dialysis therapy would be superior in patients receiving multidisciplinary predialysis care than in those receiving conventional care. METHODS: All incident dialysis patients at our center who had received at least 3 months of specialist predialysis care were categorized according to whether they had attended the multidisciplinary Progressive Renal Disease Clinic (PRDC). Patients with a failed transplant, acute renal failure, or previous renal replacement therapy were excluded. We compared these groups at initiation and during 3 years of dialysis therapy. RESULTS: At the start of dialysis therapy, patient demographics and residual renal function were similar. PRDC patients were more likely to have a functioning access and be administered angiotensin-converting enzyme inhibitors, iron supplements, and bicarbonate therapy and had greater serum albumin and serum calcium levels. PRDC patients had fewer hospitalizations at 1 year (7.0 versus 69.7 d/patient/y; P < 0.01) and during the study duration (10.8 versus 57.4 d/patient/y; P < 0.05). There were fewer deaths in the PRDC group at 1 year (2% versus 23%; P < 0.01) and during the study duration (21% versus 42%; P < 0.05). A history of cardiovascular disease, older age, and non-PRDC predialysis care independently predicted death on dialysis therapy. CONCLUSION: Multidisciplinary predialysis care is associated with superior clinical outcomes after the start of dialysis therapy.

Adult↗

PubMedDate not supplied

[Multidisciplinary educational health programme for type 2 diabetic patients in primary care].

Type 2 diabetic patients followed in primary care rarely benefit from a structured educational approach in spite of the fact that the intervention of a multidisciplinary team has proven its efficacy for improving metabolic control. We describe a pilot project, which aimed at implementing an ambulatory multidisciplinary programme and at evaluating the feasibility of an educational module in type 2 diabetic patients followed in primary care. Four general practitioners (GP) selected 25 type 2 diabetic patients, not well controlled or with poor knowledge of their disease. Fourteen health care providers developed an intervention module comprising, over 4 months, an initial interview with the GP, three interviews with a dietician, two with a nurse and three with a psychologist. Besides studying the feasibility of the project, the primary objective was to analyze the subjective feeling of both patients and heath care providers participating to the project. A secondary objective was to compare some parameters of control (HbA1c, body weight) before and after the intervention in these 25 patients, and in 10 control patients followed as usual in general practice. The multidisciplinary educational intervention was well appreciated by diabetic patients whose adhesion was excellent. Health care provider's mobilization was enthusiastic, and all emphasized the human positive aspects of such a multidisciplinary approach. Preliminary analysis demonstrates beneficial effects of the educational programme.

Aged↗

PubMed2006

[Prospective monitoring of vascular access in hemodialysis by means of a multidisciplinary team].

PURPOSE: Nowadays, expert guidelines recommend the monitoring programs of the vascular access (VA) by a multidisciplinary team. MATERIAL AND METHOD: We present the experience over the last five years, of a prospective VA surveillance by a multidisciplinary team. The quality indicators reached are described as the associated factors for survival of the new VA. RESULTS: Three hundred seventeen VA have been studied, 73% were arteriovenous fistulas(AVF) and the rest were polytetrafluoroethylene (PTFE) grafts at 282 patients. The main causes of dysfunctions were elevated dynamic venous pressure (42.5%) and the decreased blood flow (36.4%) with a 88% of positive predictive value. Over the 5 years there was 88 thrombosis (24 AVF and 64 PTFE grafts), that means a hazard thrombosis global rate of 0.15 access/year, which were distributed in 0.06 for AVF and 0.38 in PTFE grafts. Two hundred and one repairs of VA were done: 66.6% were elective repair after a proper review by the multidisciplinary team and the rest of them were done after the AV thrombosis happened. Urgent rescue surgeries were done in 76% of the thrombosis. 62.5% of the patients did not need a catheter after vascular access thrombosis. The complication relation with AVF and PTFE were 11.4% of the total patients hemodialysis hospitalizations. 65.2% of the VA were new access. 57% of patients were properly reviewed in the pre-dialysis unit at least once and 80% of them start haemodialysis with a mature access. The average survival (Kaplan Meier) of the new AVF was 1,575+/-55 days vs 1,087+/-102 of the PTFE grafts (p < 0.008). The survival after 1, 2 and 3 years for the AVF was 89%, 85% and 83% and for the PTFE graft 3% 67% and 51% respectively. The Cox regression has proved that the type of vascular access is the strongest factor associated to VA survival. The survival added of VA repaired due to dysfunction was 1,062 +/- 97 days vs 707 +/- 132 due to thrombosis, log rank 5.17 (p < 0,02). The increasing risk of those repaired after a thrombosis vs dysfunction is 4.2 p < 0,01. CONCLUSIONS: The monitoring of the vascular access by a multidisciplinary team has reached:low rate of thrombosis, high elective number of repairs of the VA, high urgent rescue surgery after a thrombosis and a few number catheter needed and hospitalizations. AVF are associated with greater survival than PTFE. The VA repair due to dysfunction vs thrombosis had a greater survival as well.

Adult↗

PubMed1989

[Multidisciplinary treatment of advanced testicular tumors].

Present status and problems of multidisciplinary treatment for advanced testicular tumors were reviewed. In this paper, we presented the treatment results of 69 patients with advanced testicular cancer treated by multidisciplinary treatment. The primary PVB therapy induced a CR in 39 patients (56.5%), and 8 patients of them relapsed. After primary chemotherapy 40 patients, incomplete responders and relapsed cases, underwent salvage therapy. Salvage chemotherapy with CDDP and VM-26 or VP-16 was performed in 19 patients, and induced a CR in 10 (58.5%). Salvage surgery was done in 29, and produced NED in 22 patients (75.9%). As overall results of salvage therapy, 25 of 40 patients are living with NED, 3 are alive with tumors, and 12 patients died of the disease. As final results of the multidisciplinary treatment, of 69 patients with advanced testicular tumors 48 patients are living with NED and 3 patients with tumors, and 18 patients died of the disease. A overall cure rate was 73.9%. The overall 8-year survival rates of the 69 patients was 70.5%. The survival rate of 39 CR-patients, 23 PRs and 7 NRs was 94.9%, 45.7% and 0% at 4 years, respectively. The 8-year survival rates according to clinical stage for the last 10 years were 100% in stage I, 74.0% in stage II, and 70% in stage III. The survival rates for 10 years from 1968 to 1978 were 88.3% in stage I. 60% in stage II, and 33.3% in stage III. The treatment results were so satisfactory. To reach the treatment goal for advanced testicular tumors, importance of aggressive multidisciplinary treatment was emphasized.

Adolescent↗

PubMed1989

[Multidisciplinary treatment of head and neck cancer].

UNLABELLED: This presentation deals with multidisciplinary treatment of head and neck cancer, especially focusing on maxillary sinus carcinoma (MSC) and nasopharyngeal carcinoma (NPC). Since 1982, a new multidisciplinary treatment incorporating neo-adjuvant chemotherapy has been introduced in the treatment of MSC. The Neo-adjuvant chemotherapy includes cisplatin (CDDP) + peplomycin (PEP), adriamycin (ADR) analogs + CDDP + PEP, and CDDP +5-FU. Two courses of chemotherapy were given intraarterially with the interval of 2 weeks. Routinely, radiotherapy of 40 Gy by Linac was given to the primary tumor site, concomitantly combined with 5-FU intraarterial injections only during the first 10 days, 2 weeks after the end of chemotherapy. Additional treatment was performed according to the extent of the residual tumors. The 5-year survival rate for the 28 patients treated with this therapy was 55%. The 5-year survival rate by T classification was 100% for T2, 76% for T3 and 0% for T4 cases. The preservation rate of maxillo-facial structures and functions was 82%. Concerning NPC, neo-adjuvant chemotherapy included CDDP + PEP, ADR + CDDP + PEP and ADR + cyclophosphamide + PEP. Two courses of chemotherapy were performed, followed by radiotherapy of 60 Gy by Linac. Then intracavitary 60Co therapy was performed, followed by adjuvant chemoimmunotherapy. The 5-year survival rate for 21 patients treated with this therapy was 44%. CONCLUSIONS: (1) The 5-year survival rate was better for patients with MSC who were treated with multidisciplinary treatment incorporating intraarterial neo-adjuvant chemotherapy than that for patients who received other treatment so far. Furthermore, the highest preservation rate of maxillo-facial structures and functions was achieved in the neo-adjuvant chemotherapy group. However, survival rates for T4 cases were very poor, so another approach should be taken. (2) The 5-year survival rate was also better for patients with NPC who were given multidisciplinary treatment than for patients who received other treatment to date. However, there was no decrease of distant metastases, which we aimed initially, despite the introduction of neo-adjuvant chemotherapy.

Adult↗

PubMed1981

A multidisciplinary approach to child abuse.

The multidisciplinary approach has been utilized extensively by health care professions working with child abuse and neglect families. The multidisciplinary approach has allowed nurses, physicians, social workers, and mental health workers to collaborate in resolving complex problems. Multidisciplinary teams have taken many forms, depending on the demonstrated needs of the clinical setting. The many functions of the team may be summarized as: information-sharing, decision-making, support, and planning. Additional advantages include role clarification and many benefits for patients and families. Despite a number of well-recognized disadvantages, the multidisciplinary approach appears to have become well established in the child abuse field. Its application to other health care problems may lead to further collaboration among members of the health care professions.

Child↗

PubMed1996

Benefits of a multidisciplinary predialysis program in maintaining employment among patients on home dialysis.

We evaluated the benefits of a multidisciplinary predialysis intervention to help home dialysis patients maintain employment. This program was shown to be successful with in-center hemodialysis patients in a case-controlled study published in the American Journal of Kidney Disease in September, 1993. We looked at 30 patients on home dialysis (28 on continuous ambulatory peritoneal dialysis and 2 on home hemodialysis) as of March, 1995. The age of the patients ranged from 28 to 63 years, with a mean of 46.8 years. Forty-three percent of the patients were diabetic. The patients went through a multidisciplinary predialysis program which consisted of: (1) psychosocial assessment, (2) education about dialysis and choice of modalities, (3) orientation to dialysis unit, and (4) counseling sessions with patient, significant family members, and others. During this time, patients were referred to the program approximately six months before beginning dialysis. There was continued collaboration among members of the multidisciplinary team. Of the 30 patients, 11 were already disabled when beginning dialysis. Of the 19 who were working once dialysis began, 14 maintained employment (3 diabetic), with 1 retiring and 4 becoming disabled. Therefore, 74% of patients maintained employment. In conclusion, employment was maintained by this predialysis multidisciplinary program.

Adult↗

PubMed1999

Indicator quality for multidisciplinary systems.

In January 1998, a project studying the Unification of Indicator Quality for Assessment of Impact of Multidisciplinary Systems (UNIQUAIMS) began at IACR-Rothamsted. This three year European Union-funded project will examine the choice of indicators for the assessment of the sustainability and impact of multidisciplinary systems. The project links 27 developing country and European partners to clarify methods and rationalize indicators for assessing impact and sustainability in three priority areas: farming systems, ecosystems converted to agricultural use and degraded ecosystems. The results will be disseminated to national and regional agricultural research institutes, extension agents, research planners and policymakers to promote improved interdisciplinary, multidisciplinary and cross-sectorial management of natural resources. A strong socioeconomic component is involved. This paper describes the scientific and policy issues which led to the project and focuses upon the need to: clarify current methods of impact and sustainability assessment; identify key qualitative and quantitative indicators for both baseline and on-going studies and their relevance at different scales, allowing for the balance between standardization and responsiveness to local conditions; and establish sound guidelines for indicator collection procedures at all stages of research, from project conception through to impact and sustainability assessment.

Data Interpretation, Statistical↗

PubMed1993

An organizational model for developing multidisciplinary clinical research in the academic medical center.

OBJECTIVE: To assess the impact of a new organizational model designed to stimulate multidisciplinary clinical research. METHODS: We conducted a prospective, 3 1/2-year followup of a research training program for residents, fellows, faculty, nurses, and allied health professionals in rheumatology and orthopedic surgery. Program components included a multidisciplinary clinical research conference, a clinical research methods curriculum, consultations, a patient registry, and regular meetings of a Research Methodology Core group. Measures included participation in each program component and the number of new investigators who developed funded clinical research projects. RESULTS: The multidisciplinary clinical research conference was attended by 369 new health professionals; 218 professionals participated in at least one of the courses; and 280 consultations were provided to 108 professionals. Thirteen new investigators developed 17 new grant proposals, of which 14 were externally funded. Investigators who successfully procured funding for new projects demonstrated significantly more participation in program components compared with those who did not (P < 0.001 overall). CONCLUSION: Participation in the program was significantly correlated with the development of new prospective patient-based studies. We conclude that our model has the potential to foster such research in other settings.

Academic Medical Centers↗

PubMed2005

Randomized comparison of a multidisciplinary job-retention vocational rehabilitation program with usual outpatient care in patients with chronic arthritis at risk for job loss.

OBJECTIVE: Work disability is a major consequence of inflammatory rheumatic conditions. Evidence regarding the effectiveness of interventions aimed at the prevention or reduction of work disability in rheumatic diseases is limited. We conducted a randomized controlled trial to investigate the effectiveness of a multidisciplinary job-retention vocational rehabilitation (VR) program in patients with a rheumatic condition who were at risk for job loss. METHODS: A total of 140 patients with a chronic rheumatic condition were randomly assigned to either a multidisciplinary job-retention VR program (n = 74) or usual outpatient care (UC) (n = 66). Patients in the VR group were assessed and guided by a multidisciplinary team, whereas patients in the UC group received care as initiated by their rheumatologist, supplemented with written information. The main outcome measure was the occurrence of job loss (complete work disability or unemployment); additional outcome measures included job satisfaction, pain, functional status, emotional status, and quality of life. RESULTS: There was no difference between the 2 groups regarding the proportion of patients having lost their job at any time point, with 24% and 23% of the patients in the VR and UC groups, respectively, having lost their job after 24 months. Over the total period of 24 months, patients in the VR group had a significantly greater improvement of the fatigue visual analog scale and of emotional status (all P values < 0.05). CONCLUSION: A job-retention VR program did not reduce the risk of job loss but improved fatigue and mental health in patients with chronic rheumatic diseases at risk for job loss.

Adolescent↗