Disease Multidisciplinary Team Research Articles

Current state of dietetic services for inflammatory bowel disease patients in New Zealand: an observational study.

Nutritional therapies for inflammatory bowel disease are increasingly recommended. This study aimed to gain insight from patients, dietitians and gastroenterologists into inflammatory bowel disease dietetic care in New Zealand. Mixed-methods surveys were developed and then distributed online to patients with inflammatory bowel disease and dietitians and gastroenterologists that care for patients with inflammatory bowel disease. Quantitative survey data were analysed using nonparametric statistical tests. Qualitative survey data were analysed using thematic analysis. Responses were received from 406 inflammatory bowel disease patients, 79 dietitians and 40 gastroenterologists. Half of the patients (52%) had seen a dietitian for nutrition advice. Patients more likely to have seen a dietitian were/had: Crohn's disease (p = 0.001), previous bowel surgery (p < 0.001), younger (p < 0.001) or receiving biologic therapy (p = 0.005). Two-thirds (66%) of patients found the dietitian advice at least moderately useful. A common theme from patient comments was that dietitians needed better knowledge of inflammatory bowel disease. Almost all (97%) gastroenterologists reported that their inflammatory bowel disease patients ask about nutrition; 57% reported that there were inadequate dietitians to meet patient needs. Over 50% of dietitians saw inflammatory bowel disease patients infrequently and 39% were not confident that their knowledge of the nutritional management of inflammatory bowel disease was current. Dietitians desired greater links with the inflammatory bowel disease multidisciplinary team. Current inflammatory bowel disease dietetic services in New Zealandare inadequate. Standardised care, increased resourcing, dietitian training in inflammatory bowel disease, and stronger links with the multidisciplinary team are suggested to improve services.

90P Virtual sarcoma disease multidisciplinary team: A jump into the future?

90P Virtual sarcoma disease multidisciplinary team: A jump into the future?

The Management of the Hospitalized Ulcerative Colitis Patient, the Medical-Surgical Conundrum.

In this study we present the evidence based management for patients hospitalized for UC with a special focus on the synergic approach of the two key actors of the inflammatory bowel disease multidisciplinary team (IBD-MDT): gastroenterologist and surgeon. Focused treatment by a specialized IBD-MDT and early involvement of the colorectal surgeon in the management of hospitalized ulcerative colitis patients is advocated. The colectomy rate has not changed over the years. Moreover delayed surgery after admission is burden by increase complication and mortality. Thus, it is pivotal to identify the patients who are likely to undergo surgery, by mean of predictors of outcome, and to not prolong ineffective medical treatment. The perfect timing based on clinical close monitoring is crucial. Up to 25% of patients with ulcerative colitis (UC) may require hospitalization. The aim of admission is to evaluate severity of the disease, exclude infections and establish proper treatment while monitoring the response. During admission, the patient has to be closely observed for the possible development of toxic megacolon or perforation, which should prompt emergency colectomy. Up to 30% of UC patients will fail to respond to initial intravenous corticosteroid. Non responder or partial responder to medical therapy should be evaluated for timely surgery or could be considered for rescue medical therapy.

MP34-06 IMPROVING THE AWARENESS OF RARE GENETIC DISEASE MULTIDISCIPLINARY TEAM (MDT) CLINICS

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety II (MP34)1 Sep 2021MP34-06 IMPROVING THE AWARENESS OF RARE GENETIC DISEASE MULTIDISCIPLINARY TEAM (MDT) CLINICS Wiktoria Milczynska, Amy de Wolf, Akhil Mohindra, and Tet Yap Wiktoria MilczynskaWiktoria Milczynska More articles by this author , Amy de WolfAmy de Wolf More articles by this author , Akhil MohindraAkhil Mohindra More articles by this author , and Tet YapTet Yap More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002043.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The recent guidelines from European Academy of Andrology recommend increasing knowledge of Klinefelter Syndrome and creating multidisciplinary teams to care for affected patients. However, raising awareness of rare genetic disease clinics represents a significant challenge, due to limited recognition amongst patients and clinicians as well as limited resources. Our aim was to look at cost-effective strategies to raise awareness of a national access Klinefelter Syndrome multidisciplinary (KSMDT) clinic among patients and healthcare professionals. METHODS: This longitudinal Quality Improvement Project was carried out over a 6-month period (2020 - 2021) at a tertiary hospital where the KSMDT clinic is located. Two Plan-Do-Study-Act (PDSA) cycles were carried out. The first intervention consisted of creating an informational video about the clinic which was disseminated through Facebook, Twitter and YouTube. The second intervention involved refining the user experience of the clinic’s website. Surveys were distributed amongst KS support group members (n=70) and local primary care practitioners (n=27) before and after intervention, and a focus group (n=6) was held for the second intervention. RESULTS: Awareness of the clinic in the community increased from 33% pre-intervention to 70%. Similarly, awareness of the clinic’s website increased by 31% with an increased retention rate of 61.2% for the multimedia resources accessed. A total of 81% of patients reported that the video helped them understand the aims of the KSMDT. The engagement associated with website use increased by 13% for the focus group post-intervention. The interventions were associated with no financial costs. CONCLUSIONS: Our results indicated that a multifactorial approach, working with both patient and clinician populations, is successful in increasing awareness of rare disease services like the KSMDT clinic. Future awareness strategies need to employ more effective ways of engaging clinician and patient alike, such as targeted programs on social media and virtual programmed sessions with the KSMDT team. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e618-e618 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wiktoria Milczynska More articles by this author Amy de Wolf More articles by this author Akhil Mohindra More articles by this author Tet Yap More articles by this author Expand All Advertisement Loading ...

“Concealed cardiomyopathy” as a cause of previously unexplained sudden cardiac arrest

Abstract Background Current genetic testing guidelines recommend against broad, multi-phenotype genetic testing in survivors of sudden cardiac arrest (SCA) where no cause is identified on clinical screening. Recent reports describe malignant arrhythmic events preceding detectable structural changes in patients with pathogenic variants in cardiomyopathy genes, who go on to demonstrate structural changes in follow up. Purpose We sought to investigate the utility of a broad genetic testing approach, sequencing genes implicated in both arrhythmia syndromes and cardiomyopathy, in SCA survivors where no cause was identified after thorough clinical evaluation. Methods We retrospectively reviewed the clinical and genetic profiles of SCA survivors referred to a specialised genetic heart disease multidisciplinary team in Australia. Multi-phenotype genetic testing included analysis of 174 cardiac genes associated with arrhythmia or cardiomyopathy. Results The cohort was comprised of 86 SCA survivors. A clinical diagnosis was made in 46 (53%) patients while 40 (47%) cases were considered idiopathic, with no cause of arrest identified despite thorough clinical investigation. Thirty-two survivors of idiopathic SCA (80%) underwent broad, multi-phenotype genetic testing through genome (n=1), exome (n=26) or extended panel (n=5) analysis. The majority of the cohort were male (62.5%, n=25) and ≤35 years of age at time of arrest (60%, n=24). Events in this group most commonly occurred at rest or sleep (65.8%, n=25) and 5 patients had a family history of sudden death (12.5%). Seven disease causing variants were identified with a testing yield of 21.9%. There was no difference in demographic or clinical factors between those with and without a disease-causing variant. Six (85.7%) of these clinically actionable variants were identified in genes associated with cardiomyopathy (PKP2, MYBPC3, DES, DSP and ACTN2) that would not have been analysed on a standard commercial cardiac arrhythmia panel. Cardiac magnetic resonance (CMR) imaging was performed prior to genetic testing in 4 of the 6 cases found to have disease-causing variants in cardiomyopathy genes (2 patients did not have CMR performed due to the presence of cardiac devices), with 2 (50%) showing sub-diagnostic changes while 2 (50%) revealed a structurally normal heart. Conclusion A broad approach to genetic testing in idiopathic SCA can improve care for patients and their families by identifying clinically actionable variants that would be missed by phenotype specific gene panels and thus significantly increase the rate of diagnosis. “Concealed cardiomyopathy” represents a clinical challenge in how to manage patients and their relatives who carry a pathogenic cardiomyopathy variant, have no overt signs of structural disease, yet have an important risk of sudden cardiac arrest. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Cardiac Society of Australia and New Zealand; National Health and Medical Research Council (Australia)

Report on the Adult Congenital Heart Disease Multidisciplinary Team Meeting Held During the COVID-19 Pandemic

Report on the Adult Congenital Heart Disease Multidisciplinary Team Meeting Held During the COVID-19 Pandemic

Palliative care for chronic respiratory disease: integrated care in outpatient settings.

Chronic respiratory diseases are progressive and often life-limiting illnesses. Patients experience debilitating and troubling symptoms that impact on their quality of life. Despite this, there is under-recognition of patients who may be entering the final year of their life and require palliative care services. The Royal Wolverhampton NHS Trust in partnership with Compton Care has established chronic respiratory disease multidisciplinary team meetings and a combined respiratory and palliative care outpatient clinic to address these issues. This article presents the impact of this service, now in to its fourth year, of delivering palliative care services to patients with chronic respiratory disease.

The Management of the Hospitalized Ulcerative Colitis Patient: the Medical-Surgical Conundrum.

In this study, we present the evidence-based management for patients hospitalized for ulcerative colitis (UC) with a special focus on the synergic approach of the two key actors of the inflammatory bowel disease multidisciplinary team (IBD-MDT): gastroenterologist and surgeon. Focused treatment by a specialized IBD-MDT and early involvement of the colorectal surgeon in the management of hospitalized UC patients is advocated. The colectomy rate has not changed over the years. Moreover, delayed surgery after admission is burden by increase complication and mortality rates. Thus, it is pivotal to identify the patients who are likely to undergo surgery, by mean of predictors of outcome, and not to prolong ineffective medical treatment. The perfect timing based on clinical close monitoring is crucial. Up to 25% of patients with ulcerative colitis (UC) may require hospitalization. The aim of admission is to evaluate severity of the disease, exclude infections and establish proper treatment while monitoring the response. During admission, the patient has to be closely observed for the possible development of toxic megacolon or perforation, which should prompt emergency colectomy. Up to 30% of UC patients will fail to respond to initial intravenous corticosteroid. Non-responder or partial responder to medical therapy should be evaluated for timely surgery or could be considered for rescue medical therapy.

Characteristics of hypersensitivity pneumonitis diagnosed by interstitial and occupational lung disease multi-disciplinary team consensus.

The causes of hypersensitivity pneumonitis (HP) in the UK are changing as working practices evolve, and metalworking fluid (MWF) is now a frequently reported causative exposure. We aimed to review and describe all cases of HP from our UK regional service, with respect to the causative exposure and diagnostic characteristics. In a retrospective, cross-sectional study, we collected patient data for all 206 cases of HP diagnosed within our UK-based regional NHS interstitial and occupational lung disease service, 2002-17. This included demographics, environmental and occupational exposures, clinical features, and diagnostic tests (CT imaging, bronchiolo-alveolar cell count, lung function, histology). We grouped the data by cause (occupational, non-occupational and unknown) and by presence or absence of fibrosis on CT, in order to undertake hypothesis testing. Cases were occupational (n = 50), non-occupational (n = 56) or cryptogenic (n = 100) in aetiology. The commonest causes were birds = 37 (18%) and MWF = 36 (17%). Other occupational causes included humidifiers and household or commercial waste, but only one case of farmers' lung. Cryptogenic cases were associated with significantly older age, female gender, lower lung function parameters, fewer alveolar lymphocyte counts >20%, and fibrosis on CT; exposure information was missing in 22-33% of cryptogenic cases. MWF is the commonest occupational cause of HP, where workers usually present with more acute/subacute features and less fibrosis on CT; refuse work is an emerging cause. Cryptogenic HP has a fibrotic phenotype, and a full occupational history should be taken, as historical workplace exposures may be relevant.

Idiopathic pulmonary fibrosis: current and future directions

Idiopathic pulmonary fibrosis (IPF) is the most common idiopathic interstitial pneumonia and is increasingly recognised. Prior to the advent of effective therapies, achieving an early diagnosis was arguably of little prognostic consequence given IPF was considered an untreatable and uniformly fatal disease. The advent of new drug treatments has given hope for the future and raised the profile of IPF. International management guidelines highlight the critical role of radiology as part of an interstitial lung disease multidisciplinary team approach in reaching an accurate and early diagnosis of IPF. The diagnostic criteria and levels of diagnostic confidence for the radio-pathological pattern associated with the clinical syndrome of IPF, usual interstitial pneumonia (UIP), appear seemingly straightforward; however, with increasing research and recognition of radiopathological interobserver variability, limitations of this classification model are becoming increasingly apparent. This review describes ancillary radiological features, comorbidities, and emerging new entities that potentially co-exist with IPF. Beyond diagnosis radiology is developing as a key prognostic tool to inform longitudinal patient evaluation. These diagnostic and prognostic clinical challenges and the future role of radiology in IPF are discussed.

P075 &lt;break /&gt; Interstitial lung disease multidisciplinary team: concordance between two tertiary referral centres

P075 &lt;break /&gt; Interstitial lung disease multidisciplinary team: concordance between two tertiary referral centres

Nutritional management of the patient with Crohn's disease

Active Crohn's disease (CD) often co-exists with malnutrition and requires input from the inflammatory bowel disease multidisciplinary team in order to assess, prevent and treat the complications of both malnutrition and active disease. Three forms of nutrition therapy are available: enteral nutrition, parental nutrition and diet modification. This article will discuss the arguments for and against the use of each form of nutritional management in CD patients in order to empower health professionals caring for this patient population to initiate early nutritional support upon admission to hospital.

Nutritional management of the patient with Crohn's disease.

Active Crohn's disease often co-exists with malnutrition and requires input from the inflammatory bowel disease multidisciplinary team in order to assess, prevent and treat the complications of both malnutrition and active disease.

Defining the optimal design of the inflammatory bowel disease multidisciplinary team: results from a multicentre qualitative expert-based study

ObjectiveTo elicit expert views to define the aims, optimal design, format and function of an inflammatory bowel disease (IBD) multidisciplinary team (MDT) with the overall purpose of enhancing the quality...

Evaluation of the introduction of a standardised protocol for the staging and follow-up of colorectal cancer on resection rates for liver metastases

In 2004, an audit in our unit demonstrated wide variation in liver resection rates for colorectal cancer (CRC) metastases within the cancer network. Subsequently, a network-wide CT-based follow-up and referral policy was introduced for all patients. A second audit was performed to assess the impact of the guidelines on liver resection rates. Analysis of prospective liver resection database between 1997 and 2004 and after the introduction of standardised guidelines between January 2005 and April 2008. A total of 362 patients underwent liver resection for CRC metastases between 1997 and 2008, 237 prior to the introduction of the referral guidelines and 125 after. Liver resection rates according to referring hospital varied from 0.92 to 2.32 per 100,000 population before guidelines were introduced. After 2005, resection rates from the four district hospitals standardised (1.68-1.84 per 100,000 population), but the central unit rate (Sheffield) remained significantly higher (2.67 per 100,000 population). No significant difference in 1-year disease-free survival between patients from Sheffield and the out-lying hospitals was found (P = 0.553). Introduction of a referral protocol standardised resection rates from the four district hospitals, but these remain lower compared to the specialist centre. The wide-spread adoption of a policy to discuss all patients with liver metastases at an advanced disease multidisciplinary team meeting, in the presence of hepatobiliary specialists, may further increase resection rates across the UK.

Alzheimer's disease: Visual system review

Background Ten million baby boomers in the United States will get Alzheimer's disease. Optometrists can benefit from understanding the impact the Alzheimer's disease process has on the visual system. This can result in more effective management of the condition and in more effective communication with members of the Alzheimer's disease multidisciplinary team. Methods This is a review of the literature but by no means a completely exhaustive review. Alzheimer's disease is a complex disease. A rapidly expanding body of knowledge covers multiple disciplines. Results The visual system shows deficits early in the degenerative process of Alzheimer's disease. Biomarkers through the visual system such as nerve fiber deficits, lens opacities, and functional losses in the magnocellular pathway, such as contrast sensitivity and temporal processing, may prove to not only help detect Alzheimer's disease early but also detect it before there are the classic cognitive and memory losses. Conclusions The effects of Alzheimer's disease are devastating. Optometrists, as primary care clinicians, can make critical contributions in the diagnosis, treatment, and management of this neurodegenerative disease.

Differential Diagnosis of Abdominal Pain

Cellular pathology is a key component of the breast disease multidisciplinary team, representing the ‘gold standard’ in the diagnosis of breast cancer and providing crucial information for determination of prognosis and management. Material may be obtained for pathological examination using fine needle aspiration (FNA) cytology, needle core biopsy or surgical excision (histopathology). Common benign conditions include fibrocystic change, fibroadenomas, intraduct papillomas and radial scars. Carcinoma is by far the most common malignant tumour and may exist as in situ or invasive forms. The use of mammography in the NHS Breast Screening Programme (NHS BSP) has resulted in the detection of breast cancers at an earlier stage of development (e.g. in situ carcinoma and small, low-grade invasive carcinomas) and a comprehensive independent review assessing the benefits and possible drawbacks of this approach is due to report during 2012. A cellular pathology report for a breast excision specimen should include comments on the factors most pertinent to prognosis and management, such as tumour type, size, grade, and presence of vascular invasion and lymph node metastases. Assessment of adequacy of excision will inform decisions regarding further surgical excision and radiotherapy while identification of lymph node metastases will prompt consideration for chemotherapy in suitable patients. Cellular pathology can also predict the likelihood of tumour response to hormonal manipulation and newer treatments such as trastuzumab. The application of increasingly sophisticated genomic technologies to breast cancer has enhanced the classification of the disease whilst highlighting new levels of complexity, and may lead to an improvement in both prognostication as well as the ability to better identify patients who may particularly benefit from chemotherapy and novel molecularly targeted therapies.