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At least 19 recordsLinked to original sources
PubMed1991

[Interdisciplinary communication in breast-preserving therapy of early infiltrating ductal breast carcinoma].

The goal in breast-maintaining treatment of early mammary cancer means control of the tumor in a cosmetically acceptable breast worthy to be left in place. To this intent, a staged approach with agreement between therapists (surgeon, radiotherapist, oncologist) and pathologist should be used. Morphologic and histopathologic findings are relevant and are age-dependent indicators for risk of local recurrence. The cosmetic result as well as local tumor control depend on clinical findings and techniques of resection. The interdisciplinary communication weighs clinical and morphological criteria for counselling and selection of patients. In the presence of unfavourable prerequisites for cosmetically satisfactory results and increased probability of local recurrence (greater than 20%/5 years), breast-maintaining therapy should not be recommended; however, prognostic criteria do not depend on operative techniques.

Age Factors↗
PubMed1993

The missing voice in interdisciplinary communication.

The research problem investigated in this article emerged from a year-long ethnographic study of the interdisciplinary process of teams evaluating children for mental retardation/developmental disabilities. The researchers noticed that when a discipline was not present at team meetings, others attempted to speak for it. This article examines the team process and case consequences of such a "missing voice." Data collected through participant observation and videotaping were triangulated with transcripts, written and audiovisual records, and an interview with the missing team member. This process revealed a trail of ambiguous findings and uncertainty on the part of team members of disciplines related to that of the missing member. The "missing" member identified the knowledge, assessment skills, and theoretical perspective she could have contributed if consulted. The findings demonstrate that (a) team members bring differing knowledge and observational perspectives and (b) team deliberations appear to be a function of who is present and what is negotiated.

Child↗
PubMedDate not supplied

[Interdisciplinary communication in neonatology].

An efficient and rational neonatal intensive care should be regionalized. Interdepartmental communication among obstetricians, neonatologists, pediatricians, neurologists should be planned and stirred between the reference centre and the outside hospitals, as well as in the catchment area. In this way only, such important goals as in-utero and neonatal transfer, training of obstetric neonatal teams, regionalized epidemiology and care evaluation can be achieved. In the same way, communication inside the hospital among doctors, nurses and parents is basic to humanize medical care.

Communication↗
PubMed1991

[Computerized graphic techniques in the interdisciplinary information communication in geriatrics].

Geriatric research shows that multidimensional assessment (MA) is the best method of approaching the complex functional problems of elderly subjects which are characterized by a close interdependence of clinical, social and mental factors. A correct and standardized communication of the results and the indications deriving from this complex interdisciplinary system is essential to enable the operators, despite their different professional backgrounds, to become involved in ensuring the health and welfare of their patients using integration and coordination criteria which are appropriate to the patient's individual situation. In this context, a computerized MA programme, known as "Senior", has been designed. The programme provides two communication sheets of data with different professional orientations: I) geriatric assessment sheet for doctors and other medical staff; II) graphic geriatric assessment sheet for non-medical operators. In practice, these assessment sheets are a useful backup in providing continuity between in- and out-patient programmes.

Aged↗
PubMedDate not supplied

Factors influencing ethical decision making in the home setting.

The process of ethical decision making does not differ according to the patient care setting. However, various factors in home care affect the way in which decisions are made. The factors to consider are the amount of time needed to make a decision, the involvement of the patient and family, the need for support systems, the difficulties with interdisciplinary communication, and the lack of an ethics committee. Recognizing the ways in which these variables affect the decision making can help home healthcare nurses resolve the ethical dilemmas they face. In addition, staff education programs, the use of consultants, and the development of ethics committees are possible strategies to facilitate ethical decision making.

Aged↗
PubMed1982

Interdisciplinary consultation on the care of the critically ill and dying: the role of one hospital ethics committee.

Little is known about the structure and objectives of various hospital ethics committees due to their need to preserve confidentiality, their reluctance to reveal internal hospital problems, and their concern about becoming involved in the developing debate about the appropriate role and value of such committees. The evolution, functions, and goals of one distinctive hospital committee concerned with the care of the critically ill and dying are explained. Its membership and proceedings are described, and the medico-moral issues with which it has grappled are presented and discussed. An assessment is provided of the positive and negative impact of this committee within the Medical Center with which it is affiliated. The experience of this particular group illustrates that hospital ethics committees can play advisory and educational roles within a large medical center. They can provide support for patients, medical professionals, and families who face difficult dilemmas about terminal illness. They can function as forces to sensitize medical personnel to the challenges presented by medicine's growing power over death. They can serve as catalysts for interdisciplinary communication. Finally, they can promote the development of new programs for informed and humane care of the terminally ill.

Aged↗
PubMed1979

Training in developmental pediatrics. How practitioners perceive the gap.

Ninety-seven randomly selected, board-certified pediatricians in five New England states were interviewed by two physicians to explore attitudes toward previous training and current sources of knowledge in developmental pediatrics. Formal training in development was rated as inadequate by 79%, of residency experience was viewed as highly valuable by only 30%, and 47% rated medical school as having no value. Although clinical experience was reported as a valuable source of knowledge by 99% of the sample, almost two thirds did not regard it as an adequate substitute for formal training. Frequent interdisciplinary communication was reported, and professional contacts were described as a highly valuable ongoing source of knowledge. Social class and size of practice did not correlate with differences in consultation patterns. A part-time longitudinal clinical experience for further education was preferred by 97%. Improved training with greater interdisciplinary content is needed.

Child↗
PubMed1995

Thyroid cancer management.

OBJECTIVE: Thyroid cancer is the commonest endocrine malignancy, yet management remains controversial. Many endocrinologists advocate diagnosis by fine needle aspiration (FNA), treatment by thyroidectomy, ablative radioiodine (131I) and TSH suppression, together with follow-up with 131I scans or thyroglobulin (Tg) measurements. 131I (therapy or diagnosis) is given only when TSH is > 30 mIU/I. With this strategy in mind, the aim of the present study was to audit existing clinical practice in a large Edinburgh teaching hospital to establish whether a need existed for local guidelines for the management of thyroid cancer. DESIGN AND PATIENTS: Retrospective case-note audit of 46 patients, aged 55 (range 26-86) years, admitted between 1988 and 1993 with a diagnosis of thyroid cancer. RESULTS DIAGNOSIS: Our FNA false negative rate was high (13%), aspiration technique varied considerably, and cytological reporting was not standardized. TREATMENT: Three (11%) patients received 131I despite suboptimal TSH levels because of poorly developed mechanisms to prevent this, and 7 (25%) patients had inadequate suppression of TSH as a result of poor interspecialty communication. FOLLOW-UP: Three (11%) patients were scanned despite TSH levels < 30 mIU/I, and in 5 (18%) Tg checks were incomplete. CONCLUSIONS: This audit identifies several shortcomings from what might be considered optimum management of thyroid cancer; practice was far from uniform even among the endocrinologists within a single hospital and interdisciplinary communication was poor. A locally agreed and implemented protocol should address most of these problems and improve the care of thyroid cancer patients.

Adult↗
PubMed1975

The National Large Bowel Cancer Project. Its goals and objectives.

The National Large Bowel Cancer Project, therefore, through the combined efforts of the Directorate, Working Cadre, and Subcommittees, has planned and activated a multidisciplinary approach to large bowel cancer aimed at reducing the incidence, mortality, and morbidity of this disease. Every effort is being made to improve interdisciplinary communications among biomedical scientists and clinical investigators involved in studies related to large bowel cancer. Early application of well-established biologic concepts of large bowel cancer to the study and management of patients with this disease, or to individuals at risk for the development of this form of cancer, hopefully will result in improved methods of controlling large bowel cancer.

Colonic Neoplasms↗
PubMed1992

Preoperative combined chemotherapy and radiation therapy plus radical surgery in advanced head and neck cancer. Five-year results with impressive complete response rates and high survival.

Radiation therapy combined with cisplatin as a chemoradiation sensitizer (CT/RT) has been reported to enhance tumor response in squamous cell carcinoma of the head and neck. In the present study, CT/RT was used preoperatively in advanced Stage III and IV head and neck cancer. Fifty-three patients were entered prospectively into a Phase II study. Treatment consisted of 4500 cGy of radiation therapy in 5 weeks combined with cisplatin 20 mg/m2 for 4 days during weeks 1 and 4 of radiation therapy. This was followed 4 to 8 weeks later by curative surgery. Pretherapy dental care; long-term nutritional support; individualized skin, mouth, and wound care; and continuous interdisciplinary communication were integral parts of this regimen. In four patients, CT/RT toxicity was seen (8%); three episodes of skin reaction or stomatitis and three episodes of leukopenia (less than 2500/microliters), causing a delay in CT/RT treatment in one patient. Three patients died of other causes during the preoperative interval, without clinical evidence of toxicity. Fifty patients (94%) had a complete (CR) or partial response (PR) to CT/RT. Clinical CR was seen in 38 of 51 (75%) primary tumors and 21 of 27 (78%) cervical nodes. Forty-one patients (77%) underwent curative surgery. In 27 of 32 (84%) resected CR primary tumors and 16 of 18 (89%) CR metastatic nodes, the surgical specimen was microscopically free of tumor. Postoperative morbidity was 32%. Five patients (12%) required additional surgery for their complications. Perioperative mortality was 5%. Five patients had tumor recurrence: three postoperatively after clinical PR to CT/RT and two in clinical CR patients who refused further treatment after CT/RT, then had a recurrence and were salvaged surgically. No patient with a CR in both the tumor and nodes who underwent surgery had a tumor recurrence. With a follow-up of 8 years (median, 40 months), the median survival for all patients was 45 months. The 5-year actuarial survival rate was 43% for all patients and 55% for patients who had CT/RT and surgery. This multimodality treatment of advanced head and neck cancer has low toxicity and impressive survival. It renders a significant number of patients tumor-free before surgery. These patients may be candidates for additional study triaging additional CT/RT for complete CR only and surgery for PR and biopsy-proved residual disease.

Adult↗