Establishment Of Multidisciplinary Teams Research Articles

Antimicrobial Stewardship in the Hospital Setting: A Narrative Review.

The increasing global threat of antibiotic resistance, which has resulted in countless fatalities due to untreatable infections, underscores the urgent need for a strategic action plan. The acknowledgment that humanity is perilously approaching the "End of the Miracle Drugs" due to the unjustifiable overuse and misuse of antibiotics has prompted a critical reassessment of their usage. In response, numerous relevant medical societies have initiated a concerted effort to combat resistance by implementing antibiotic stewardship programs within healthcare institutions, grounded in evidence-based guidelines and designed to guide antibiotic utilization. Crucial to this initiative is the establishment of multidisciplinary teams within each hospital, led by a dedicated Infectious Diseases physician. This team includes clinical pharmacists, clinical microbiologists, hospital epidemiologists, infection control experts, and specialized nurses who receive intensive training in the field. These teams have evidence-supported strategies aiming to mitigate resistance, such as conducting prospective audits and providing feedback, including the innovative 'Handshake Stewardship' approach, implementing formulary restrictions and preauthorization protocols, disseminating educational materials, promoting antibiotic de-escalation practices, employing rapid diagnostic techniques, and enhancing infection prevention and control measures. While initial outcomes have demonstrated success in reducing resistance rates, ongoing research is imperative to explore novel stewardship interventions.

Dysphagia therapy for head and neck cancer patients undergoing radiotherapy by speech-language pathologists in Malaysia

PurposeThis study aimed to identify the current practices and challenges faced by speech-language pathologists (SLPs) in managing dysphagia among head and neck cancer patients undergoing radiotherapy (RT) in Malaysia.MethodA sequential, mixed-method study design was utilized in this research. Quantitative data were collected using a survey among 65 SLPs from 34 government hospitals throughout Malaysia. Additionally, 10 SLPs were selected using maximum variation sampling and interviewed for this study.ResultsThe survey showed that only 7.8% of SLPs conducted therapy on all patients before RT. Moreover, the frequency of therapy during and after RT has significant relationships with the variable of time to provide intervention [χ2 (3, 63) = 13.93, p = 0.004; χ2 (3, 64) = 12.58, p = 0.007]. This study also revealed varying responses from SLPs regarding the frequency and intensity of performing home therapy programs for patients undergoing RT. Furthermore, SLP practices were divided based on the type of treatments for patients who did not experience dysphagia or mild dysphagia upon the completion of RT. Nevertheless, this study had a high agreement on the type of treatment given to patients who had completed the RT. Qualitative results showed that SLPs faced challenges in terms of a lack of awareness of their role, the establishment of multidisciplinary teams, insufficient SLPs, and inadequate equipment for assessment.ConclusionThe study findings indicated a low standard of care in managing dysphagia among head and neck cancer patients undergoing RT and urgently call for improvements toward evidence-based practices.

Service provision of genetics health care in Portugal.

In recent decades, genetics has undergone important technological advances. The rapid shift to genomics has made a strong impact on health systems around the world. In Portugal, this huge increase in consultations and typologies of genetic tests has joined the serious limitations of the few existing genetics services. The following study aims to characterize the current state of the network of genetics services in Portugal regarding its functioning, main challenges, and opportunities.Five semi-structured interviews were conducted, corresponding to 83.33% of the directors of the public genetics services of the National Health Service.Four thematic categories emerged from the analysis: (1) specialty and technical developments, (2) structural difficulties, (3) potentialities, and (4) future directions. The developments are due to the emergence of more comprehensive geneticapplications, specific protocols and patient referral standards, and accreditation of services. The main difficulties encountered in the functioning of the services were difficulty in obtaining funding, lack of human resources, service overload, and lack of exclusive time for training and research. The potentialities mentioned were the establishment of multidisciplinary teams and the best articulation with specialists from other areas. Among the various future directions pointed out, better management of patients' waiting lists, the importance of research, the simplification of test request procedures, and the creation of specialized units inside the genetic services,were reported.The results showed several gaps in the practice of medical genetics that should be addressed with the development of public policies for the recognition and restructuring of medical genetics in health care.

Head and neck cancer in Africa

Management is a combination of surgery, chemotherapy and radiotherapy. Published guidelines are available for the developed world, but there are no official guidelines for Africa. Aim: The aim of the survey was to describe diagnosis and management of head and neck cancer in Africa. Setting: This study was undertaken by a clinical oncologist employed by the state sector in South Africa. Methods: An online, cross-sectional electronic survey was mailed to oncologists and surgeons, working in the field of head and neck cancer in Africa. The survey was open from August 2016 to January 2017. Questions were posed about diagnosis and management. Results: Thirty-nine respondents from different locations in Africa responded. All the respondents practised in urban centres in their respective countries. Sixty-three per cent identified as oncologists. The remainder identified as surgeons. A third of the respondents see more than 200 head and neck patients per year. Access to diagnostic tools as well as therapy resources was limited. Forty per cent of the patients were assessed in a multidisciplinary clinic. Surgery and adjuvant radiotherapy are important modes of therapy, in the setting of locally advanced disease. Two-dimensional radiotherapy and clinical mark-up were utilised by 47% and 34% of respondents, respectively. A substantial proportion of patients with curative disease were treated palliatively. Conclusion: Trainers from well-established centres in Africa need to develop coordinated training programmes to facilitate the establishment of multidisciplinary teams. This will aid in the development of local, relevant protocols.

Transition from pediatric to adult health care services for adolescents with chronic diseases: Recommendations from the Adolescent Branch from Sociedad Chilena de Pediatría

The Adolescent Branch from Sociedad Chilena de Pediatría supports the implementation of planned programs for transition from child to adult health centers, oriented to adolescents with chronic diseases, in order to ensure an appropriate follow-up and a high-quality health care. Recommendations for care are set out in the FONIS and VRI PUC project carried out by the Division of Pediatrics of the Universidad Católica de Chile: “Transition process from pediatric to adult services: perspectives of adolescents with chronic diseases, caregivers and health professionals”, whose goal was to describe the experience, barriers, critical points, and facilitators in the transition process. Critical points detected in this study were: existence of a strong bond between adolescents, caregivers and the pediatric team, resistance to transition, difficulty developing autonomy and self-management among adolescents; invisibility of the process of adolescence; and lack of communication between pediatric and adult team during the transfer. According to these needs, barriers and critical points, and based on published international experiences, recommendations are made for implementation of gradual and planned transition processes, with emphasis on the design and implementation of transition policies, establishment of multidisciplinary teams and transition planning. We discuss aspects related to coordination of teams, transfer timing, self-care and autonomy, transition records, adolescent and family participation, need for emotional support, ethical aspects involved, importance of confidentiality, need for professional training, and the need for evaluation and further research on the subject.

Improved outcomes of colorectal cancer patients with liver metastases in the era of the multidisciplinary teams.

The use of multidisciplinary teams (MDTs), which address colorectal cancer treatment planning through weekly regular group meetings, was begun in October 2007. We analyzed and compared the outcomes of colorectal cancer patients with metastatic disease before and after the era of MDTs. From 2001 to 2010, 1075 patients who presented with stage IV disease and were treated in Taipei Veterans General Hospital were enrolled in the study. Among these patients, 439 (40.8%) were diagnosed after MDTs had been established. The percentage of patients receiving surgical treatment for metastatic disease was calculated and compared before and after MDTs were established, and the survival rate was compared using a log-rank test, with a significance of P < 0.05. A significantly improved survival rate in patients with stage IV disease was observed after establishment of MDTs, with the 3-year survival rate increasing from 25.6 to 38.2% (P < 0.001). Based on multivariate analysis, establishment of a MDT was an independent prognostic factor in patients with stage IV disease (hazard ratio = 0.74, 95% confidence interval = 0.624∼0.866, P < 0.001). The percentage of liver resection in patients with liver metastasis increased from 19.6 to 35.2% after the establishment of MDTs, whereas the percentage of lung resection in patients with lung metastasis remained stationary from 12.4 to 14.3%. In the era of MDTs, intensive cooperation between different specialists has increased the referral rate for metastasectomy, resulting in significantly improved outcomes of colorectal patients in initial stage IV disease.

MP57-15 MULTI-DISCIPLINARY MANAGEMENT OF RENAL CELL CARCINOMA WITH VENOUS TUMOR THROMBUS: ARE WE GETTING BETTER

You have accessJournal of UrologyKidney Cancer: Advanced1 Apr 2014MP57-15 MULTI-DISCIPLINARY MANAGEMENT OF RENAL CELL CARCINOMA WITH VENOUS TUMOR THROMBUS: ARE WE GETTING BETTER Ramy Youssef, Bishoy Gayed, Oussama Darwish, Payal Kapur, Ganesh Raj, Michael DiMaio, Arthur Sagalowsky, and Vitaly Margulis Ramy YoussefRamy Youssef More articles by this author , Bishoy GayedBishoy Gayed More articles by this author , Oussama DarwishOussama Darwish More articles by this author , Payal KapurPayal Kapur More articles by this author , Ganesh RajGanesh Raj More articles by this author , Michael DiMaioMichael DiMaio More articles by this author , Arthur SagalowskyArthur Sagalowsky More articles by this author , and Vitaly MargulisVitaly Margulis More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1790AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Surgical management of patients with renal cell carcinoma (RCC) and venous tumor thrombus (VTT) is challenging and can be associated with significant morbidity. Herein, we report temporal trends in surgical outcomes of RCC/VTT patients managed by a dedicated multi-specialty team at a single academic center (urology, cardio-thoracic surgery, cardiac anesthesia, medical oncology, interventional radiology). Methods Review of 146 consecutive patients who underwent radical nephrectomy with venous thrombectomy between 1998 and 2012 was performed. Clinical date, surgical techniques, morbidity, and mortality were reported. Results The study included 146 patients; 97 males (66%) and median age was 61 y (range, 24-83). The mean operative time was 5 hours and it was correlated to level of thrombus. Mean estimated blood loss was 1.5 L and blood loss was most significant in patients with level IV VTT. Mean hospital stay was 9 days (range, 1-63) and mean ICU stay was 3 days (range, 0-51). Overall and high grade (Clavien III or IV) complications occurred in 57% and 10% of patients, respectively. 30 day peri-operative mortality was 2.7%. There was a significant lower incidence of overall (45% vs. 67%, p = 0.008), and high grade (8% vs. 13%, p = 0.03) complications in the last 6 years of study. Conclusions Our data suggest that patients with RCC and VTT can be treated safely and effectively through a dedicated multi-specialty team approach. Establishment of multi-disciplinary teams may improve outcomes and reduce morbidity related to surgery. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e647 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Ramy Youssef More articles by this author Bishoy Gayed More articles by this author Oussama Darwish More articles by this author Payal Kapur More articles by this author Ganesh Raj More articles by this author Michael DiMaio More articles by this author Arthur Sagalowsky More articles by this author Vitaly Margulis More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Developments in the Management of Patients with Lung Cancer in the United Kingdom Have Improved Quality of Care

The management of patients with lung cancer has undergone significant improvement in the last decade in the United Kingdom. The 5-year survival for all patients diagnosed with lung cancer had remained unchanged at 5% over the previous decade, well behind Europe and the United States. Together, government and medical bodies produced guidelines based on best available evidence. The dissemination of these guidelines into clinical practice became the remit of Cancer Networks. The establishment of Multidisciplinary teams (MDTs) has streamlined care and allowed individual teams to discuss patients' management within a wider body of expertise. The Cancer Network quality assurance team assesses the MDTs to ensure that standards are maintained. Though the efficacy of the MDTs in improving quality and consistency of care for patients with lung cancer is irrefutable, the effects on overall survival rates are less certain. The majority of patients have advanced incurable disease at presentation. Changes in awareness of the general public and in the primary care setting are required to address this issue. Severe co-morbidities in patients with potentially curable disease can also preclude operative treatment. The delivery of specialized care for patients with lung cancer has improved dramatically in the United Kingdom with the advent of national guidelines and the local MDT. These measures may not be enough in remedying the poor long-term survival of patients with lung cancer in the United Kingdom without attention to underlying cause. A holistic attitude to the "Big Three" smoking-induced diseases offers hope of novel approach to this problem.

Developing community mental health services: an evaluation of Glasgow's mental health resource centres.

Greater Glasgow Health Board's strategy for the development of community mental health services includes the establishment, over a 7-year period, of multi-disciplinary community mental health resource centres throughout Glasgow. An evaluation of the first phase of the development was carried out in three resource centres. This focused on three key themes: the establishment of multi-disciplinary teams, targeting of those with the most severe illnesses and the participation of users in the care process. The evaluation exercise comprised five substantive elements: analysis of the clinical database; interviews with staff within each of those centres, interviews with representatives of key external agencies associated with each centre; a survey of general practitioners; and a survey of the views of clients, their carers, their key workers, and their general practitioners (GPs). Clients were generally very satisfied with the services and felt that the resource centres met all their mental health needs. Although the majority of current centre cases had severe mental illnesses and those with the more severe conditions had the highest contact rates there was evidence that in the absence of a clear framework for referral the centres were also providing services for those with less severe illnesses. Despite a wish by centre staff to move towards modes of working less dominated by health professionals and more inclusive of other resources and especially of clients themselves, these goals remained to be achieved: there was a lack of clarity in the definition of the appropriate target groups for the centres; access to crisis support was regarded as problematic; the concept of multi-disciplinary team working had yet to be fully realized with evidence suggesting that some psychiatrists working in the resource centres had not embraced many aspects of the new approach to service delivery including a focus on the severely ill; and progress towards the ideal of active client involvement had been slow.

Farming systems research: relevance to Australia

Summary. Farming systems research was introduced into many international and national agricultural research institutes in lower income countries in the 1970s and 1980s with the purpose of improving the relevance of research for small-scale farmers. This review outlines the origin, context, goals, principles and process of farming systems research in these countries, and aims to enable agricultural professionals to assess the relevance and value of farming systems research to their work in particular situations in Australia and overseas. The key elements of farming systems research include a holistic approach, orientation towards the needs of defined target groups, high levels of farmer participation and hence co-learning by farmers and specialists. There is guidance by facilitators, continuous evaluation and linkage to policy makers. The goal of farming systems research is to improve the well-being of farmers through development of farming systems. It involves application of methods from various disciplines, first to define the constraints and opportunities for development and then to overcome these in a research process involving farmers, with specialists and policy makers. A generalised farming systems research procedure and various research activities are described. Initially in lower income countries, a fairly standard farming systems research procedure was used, but farming systems research has evolved to encompass a range of activities commonly regarded as the realm of agricultural extension or rural development. Basic science, applied science and farming systems research are compared in terms of the roles and relationships of the people involved in the research process. The implications of selecting farming systems research as a model for rural research and development are discussed. Achieving adequate levels of farmer participation can be a major issue in farming systems research so it is important that the principal notions of participation are understood. Success of farming systems research in Australia will depend on developing innovative ways of achieving high levels of participation. Current trends in the philosophy, practice and funding of agricultural research and extension in Australia make it timely to consider the wider adoption of farming systems research principles and practices. Farming systems research could provide a valuable philosophical and practical basis for the trend towards greater participation by researchers with end-users and extension practitioners in agricultural development programs. However, it seems unwise to adhere strictly to any one particular model of research and development from other places: farming systems research concepts are being combined successfully with those from other models, such as systems learning and computer modelling, to suit the needs of particular situations. Implications of a wider adoption of farming systems research in Australia for agricultural research and development organisations and professional bodies include, the establishment of multidisciplinary teams with shared goals, and the sourcing of funding for periods long enough to achieve outcomes. There is also a need for training in systems concepts and facilitation, for reputable channels of publication of the results of farming systems research and for greater recognition of participatory activities as valid forms of agricultural research.