Interdisciplinary Management Approach Research Articles

Temporomandibular Joint Disorder: An Integrated Study of the Pathophysiology, Neural Mechanisms, and Therapeutic Strategies

ObjectiveThe study aims to investigate Temporomandibular Joint Disorder (TMJD) through a interdisciplinary lens, integrating insights from neuroscience, dentistry, and psychology to dissect its complex pathophysiology and neural mechanisms. It focuses on exploring the neurobiological underpinnings of TMJD, emphasizing the role of pain perception, modulation, and the impact of neurophysiological changes on the disorder. DesignThis is a comprehensive narrative review of the literature. ResultsResearch findings pinpoint altered pain perception and modulation processes as central neural mechanisms contributing to TMJD, highlighting the importance of personalized treatment approaches due to the disorder's complexity and patient variability. The study recognizes advances in neuroscience offering new treatment avenues, such as neuromodulation and biofeedback, which provide non-invasive and personalized options. However, it also addresses the challenges in TMJD research, such as the multifaceted nature of the disorder and the need for more comprehensive, interdisciplinary strategies in research and clinical practice. ConclusionsTMJD is a multifaceted disorder requiring an interdisciplinary approach for effective management. The study stresses the crucial role of neuroscience in understanding and treating TMJD, facilitating the development of innovative treatment strategies. It emphasizes the need for further research, advocating an integrated approach that combines neuroscience, dentistry, and psychology to address TMJD's complexities comprehensively and improve patient care, thereby enhancing the quality of life for affected individuals.

Dietary Management of Obesity

Obesity is defined as a condition characterized by the abnormal accumulation of fat cells, which results in increased body weight. Worldwide, obesity is progressively on the rise, leading to an increased prevalence of chronic conditions such as cardiovascular disease, type 2 diabetes, and hyperlipidemia. Obesity is a result of the interplay between genetic, metabolic, social, behavioral, and cultural factors, necessitating an interdisciplinary and multimodal management approach. Diet therapy, which includes dietary modifications and nutritional interventions, is a fundamental component of the multifaceted approach to managing obesity. The principle of diet therapy is based on achieving weight loss through a negative energy balance and maintaining weight through an equilibrium of energy intake and expenditure. Strategies for weight loss and control rely on caloric restriction, macronutrient distribution, and dietary patterns such as the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets. Recently, studies have been conducted on weight control using information and communication technology-based interventions, as well as interventions based on intestinal microorganisms which consider inter-individual variability and long-term adherence. In conclusion, diet therapy stands as a pivotal element in the management of obesity, providing a personalized and comprehensive approach to weight control. By combining evidence-based dietary strategies with behavioral modifications and consistent support, healthcare professionals can enable individuals to attain and sustain a healthier weight, thereby reducing related health risks.

System Thinking for Sustainable Water Management: The Use of System Tools in Sustainability Transitions

AbstractManaging water resources to meet current social, economic, and environmental needs without compromising the ability to meet those needs in the future, requires water managers to look beyond jurisdictional boundaries and their immediate supply operations, protect shared water and marine environments, resources and ecosystems from pollution and over-abstraction and deliver structural changes and resilient solutions to make the provision of water services sustainable. With a plethora of system tools increasingly available to support the sustainability transformation of water systems, sorting through their breadth and diversity to determine what is useful and what is not can be challenging. From a selection of 40 popular system tools grouped in terms of how they function, we review those most commonly used in water management through 35 water-related studies from the literature. Findings demonstrate that system tools are not a substitute for systems thinking and applying them alone does not qualify the development of systemic solutions. Systems thinking offers a powerful approach to first improving collective understanding of sustainability challenges related to water and then, in collaboration with a diverse group of stakeholders and the public, defining desired goals for water management and working together to make them a reality. System tools in that context can play an important role in facilitating the process and here we propose an overarching framework of how to select and apply available tools to facilitate a holistic, integrated, and interdisciplinary systems approach for water management and wider urban sustainability transitions.

Driving Hospital-Acquired Pressure Injuries to Zero: A Quality Improvement Project.

To implement a collaborative, interdisciplinary team approach to reducing hospital-acquired pressure injuries (HAPIs) through nurse empowerment and engagement. This quality improvement project was conducted at a 288-bed community hospital. The Donabedian model was used to design this intervention. The authors used a collaborative, interdisciplinary team approach for pressure injury prevention and management, utilizing nurse empowerment and engagement as driving forces to reduce HAPI rates. The incidence of HAPI decreased from a peak of 5.30% in April 2019 down to 0% from August 2019 to December 2020. Pressure injuries are key quality indicators for patient safety and avoidance of patient harm. Through nurse empowerment and engagement, HAPIs were avoided, resulting in improved quality care outcomes and maintenance of a safe patient environment.

Interim guidelines for the assessment and treatment of pain in children with multiple sclerosis.

Pain in multiple sclerosis (MS) is common, but literature on pain in children with MS remains scarce. Pain has physical, psychological, and social implications in MS, and both comprehensive assessment and interdisciplinary management approaches are needed. We sought to develop an interdisciplinary interim guideline for the assessment and management of pain in children with MS. We convened a modified Delphi panel composed of 13 experts in pediatric and adult MS neurology, physiotherapy, pain, patient lived-experience, advanced practice nursing, psychology, physiatry, and MS research. A survey was sent to panelists for anonymous completion. The panel discussed survey themes extracted by the panel chair. The process was repeated twice. Thirteen assessment and treatment recommendations were produced regarding pain in children with MS. Future studies will assess implementation of these pain assessment and treatment guidelines in the clinical setting.

Hidradenitis Suppurativa: An Interdisciplinary Problem in Dermatology, Gynecology, and Surgery-Pathogenesis, Comorbidities, and Current Treatments.

Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic inflammatory disease that manifests as painful nodules, abscesses, draining dermal tunnels, and scarring in intertriginous areas such as the axillae, groin, and breasts. The nature of the disease and its chronicity have a destructive impact on mental health and quality of life. HS has an estimated global prevalence of 0.00033-4.1% and it disproportionately affects females compared to males. HS involving the female anogenital regions is reported rarely in the gynecological literature, and it can often be mistaken for other vulvar diseases. The distinct phenotypes and HS rarity cause delayed diagnosis and the implementation of effective treatment. Acne inversa is associated with several comorbidities, including metabolic disease, diabetes mellitus, inflammatory bowel diseases, and spondyloarthropathies. Although HS etiology and pathogenesis remain unclear, studies have shown that lifestyle, immunological processes, genetics, and hormonal predispositions may promote follicular hyperkeratosis, dilatation, and rupture, leading to the development of chronic tissue inflammation. This article provides updated information on HS pathogenesis, comorbidities, and treatment methods. Furthermore, we share our experience in the surgical treatment of the disease, which often proves most effective, and highlight that an interdisciplinary management approach ensures optimal outcomes.

Comprehensive care of children with cleft lip and palate

Cleft lip and palate (CLP) is a common congenital abnormality that demands multidisciplinary treatment. It affects 1 in 1,000 live births on average, and isolated cleft palate affects 1 in 2,000 live births. According to several epidemiological studies, if one parent has a cleft, their kid has a 3.2% probability of developing CLP and a 6.8% chance of developing an isolated cleft palate. A child born with a cleft lip or palate, or other craniofacial anomaly has several challenges, such as early feeding and nutritional issues, middle ear illness, hearing loss, speech and resonance irregularities, etc. This article gives an overview of interdisciplinary approach in management of cleft lip and palate and explains the significant role of a Pediatric dentist in management of CLP.

Skin lesions in a man with end-stage renal disease.

Calciphylaxis is an uncommon condition most often seen in patients with end-stage renal disease. It is easily mistaken for other more common conditions and requires a high level of suspicion to make a timely diagnosis. Although various treatments such as IV sodium thiosulfate and bisphosphonates have been used for management, calciphylaxis remains a condition with a high mortality that requires an interdisciplinary approach for optimal management.

The Sonic Identity Model: one interdisciplinary approach for qualitative urban soundscape analysis, management and design

Urban soundscapes are predominantly understood through the use of quantitative environmental noise management and traditional acoustic design approaches. These approaches, while valuable, do not capture the subjective qualities of sonic environments as experienced by its users. The Sonic Identity Model, developed by Pascal Amphoux of the Centre for Research on Sonic Space and Urban Environment (CRESSON), offers one interdisciplinary approach for qualitative urban soundscape analysis, management and design. The interdisciplinary Model is intended to be used by large research teams to study a city's soundscape. Since its publication in 1993 it has received little attention in urban soundscape research and practice. In this paper I provide an introduction to, and overview of, the Sonic Identity Model. I review practitioner uses of the Model, with a focus on its demonstrated applicability in conjunction with traditional acoustic design approaches. I then present my contemporary adaptation of the methodology, developed for individual researchers to study indoor and outdoor urban soundscapes in situ, and describe its use in a limited urban study. This paper serves to position the Model as a guiding framework for future urban soundscape practice, offering practitioners a toolkit of qualitative methods for soundscape documentation and conceptual tools for soundscape analysis.

DMARD treatment and skin cancer : Recognition, state of knowledge and prevention

Epithelial tumors differ in cellular origin, risk factors, incidence, and treatment. This article discusses the extent to which the use of disease-modifying antirheumatic drugs (DMARD) is associated with an increased risk for the development of skin tumors and for which substances the risk may be increased. In addition, some practical dermatological recommendations for rheumatologists are presented. The most frequent tumors of the skin are classified according to their cellular origin into malignant melanoma (MM) and so-called keratinocyte cancer (KC). The clinical presentation of these tumors differs and also the risk for the development of these epithelial skin tumors under DMARD treatment varies depending on the drug and tumor entity. As rheumatologists frequently see these patients for follow-up, it is essential to know the clinical findings as well as the corresponding risk factors of the specific tumor entities. Agenerally valid and reliable estimation of the risk for the development of epithelial skin tumors under DMARD treatment can only be formulated in the form of tendencies at the present time due to the lack of data. The relevant literature shows that regular intensive dermatological screening is recommended. Patients undergoing immunosuppressive or immune-modulating treatment should be instructed in self-inspection of the skin, receive regular dermatological check-ups and be instructed in strict UV protection methods. Lesions that do not heal or recurrently bleed should be referred for apunch biopsy to rule out or diagnose an epithelial skin tumor, as should atypical inflammatory lesions that do not heal with the use of topical glucocorticoids. An interdisciplinary approach in patient management is the key to success in ensuring the maximum quality of life with the lowest possible risk of developing epithelial skin tumors for these patients.

Interdisciplinary approach for diagnosis and management of the tooth with type III palatogingival groove

Palatogingival grooves (PGGs) are developmental anomalies well known for causing endodontic and periodontal diseases to the teeth that have no evidence of caries or trauma. It is a rare developmental defect that frequently exhibits the palatal aspect of maxillary anterior teeth. The aim of this case report is to diagnose PGG using cone-beam computed tomography (CBCT) and manage it with an interdisciplinary approach by endodontic and periodontic intervention. A 20-year-old healthy female patient came with a chief complaint of foul smell and discharge of pus from the gum region. During clinical examination, a sinus opening and deep periodontal pocket were noticed with respect to the maxillary left lateral incisor. The tooth showed mild tenderness to percussion and a negative response to thermal and electric pulp testing. The intraoral periapical radiograph showed a vertical radiolucent line with periapical radiolucency, giving suspicion of PGG, which was confirmed by CBCT investigation. The diagnosis of pulp necrosis with chronic periapical abscess was made. After root canal treatment, surgical intervention was done and sealed the groove with Biodentine. This case report shows the successful outcome of a tooth associated with PGG after a 9-month follow-up. The tooth associated with this anomaly can be correctly diagnosed and planned with CBCT, and successfully treated using an interdisciplinary approach with a bioactive restorative material.

An interdisciplinary crisis management approach based on day-to-day business operations and project delivering for typical cruise companies

An interdisciplinary crisis management approach based on day-to-day business operations and project delivering for typical cruise companies

An Interdisciplinary Approach for Management of Missing Canines with Implant Supported Cantilevered Prosthesis

Missing tooth in the anterior region of the maxilla lies in aesthetic zone and create quite noticeable discrepancies. With a paradigmshift in the patient expectations towards functional as well as aesthetically appealing replacements for edentulism, the implant basedoral rehabilitation has emerged as a sole winner in fulfilling all aspects of patient needs. Interdisciplinary team treatment planning is aparamount approach for achieving optimal final aesthetics. This article aims to present a case report of replacement of bilaterally missing maxillary canine and lateral incisors with cantilever prosthesis using an interdisciplinary approach.

An unexpected case of non-uremic calciphylaxis in a patient with multiple risk factors.

A 58-year-old woman with a history of morbid obesity, asthma, and prior warfarin use presented to the hospital with shortness of breath and a three-month history of painful, ulcerated ulcers with retiform purpura of her bilateral distal extremities. A punch biopsy specimen demonstrated focal necrosis and hyalinization of the adipose tissue with subtle arteriolar calcium deposition, findings consistent with calciphylaxis. We discuss the presentation of non-uremic calciphylaxis and review the risk factors, pathophysiology, and interdisciplinary management approach of this rare disease.

Impact of STAR-VA on Staff Injury and Disruptive Behavior Reports in VA Nursing Homes.

Workplace disruptive behavior incidents can be costly for organizations, employees, and customers. Persons with dementia living in long-term care settings have a high risk of exhibiting distressed behaviors. We examined whether a resident-centered, behavioral intervention for residents with dementia led to a reduction in reported workplace disruptive behaviors and staff injury rate due to assault. Impactful interventions are important for quality of care. We examined whether a team-based behavioral program in community living centers (CLCs), where a nurse champion and behavioral coordinator were trained to work with the clinical team to understand and manage distressed behaviors commonly associated with dementia, was associated with reductions in behavior incidents. The setting was Veterans Health Administration CLCs. The sample consisted of 120 aggregated CLCs operating between 2012 and 2017 with 62 completing training. CLCs were distributed across the United States. Outcomes included CLC-level rates of staff injury and number of workplace disruptive behavior incidents. Outcomes were regressed on measures of intervention completion, time since intervention, and several CLC characteristics. The intervention was significantly associated with lower incidence of assault with staff injury rates overall, particularly following the first year of training, but not with other reported workplace disruptive behavior incident rates. A team-based behavioral intervention was associated with reduction of employee assaults, a critical repercussion of distressed behavior in dementia. Given rapid growth in patients with dementia in nursing homes, effective treatment practices, such as interdisciplinary behavioral management approaches may be impactful and valuable to implement.

Оценка степени ответственности государственного регулирования Арктического региона Российской Федерации в современных институциональных условиях.

The article analyzes the role of state regulation in harmonization of the socio-economic interest system in the Arctic Zone of Russian Federation (AZRF) in the current institutional environment. Research and development of new institutions, forms of economic behavior in AZRF are especially topical in the new economic reality. They play an important role in ensuring energy and national security, which leads to increased attention to the pace and quality of the region development. The interdisciplinary management approach is required for AZRF development, because it covers social, economic, and environmental factors. The study has proven that the regional industry and transport development leads to a complex system of contradictory socio-economic interests: business, state and local population, including indigenous peoples. AZRF development effects are ranked by the degree of economic relation participants’ interests. The socio- economic interest system is analyzed. According to the authors, the general trend of AZRF development in the near future will greatly depend on accountability that the state assumes for the results of the region development, which requires tightening the institutional conditions of economic management and developing a new economic model. The study results can be used to justify the public policy in the elaboration of strategies for AZRF development.

Common Pitfalls in the Management of Vaginismus in Couples With Subfertility in India

Vaginismus is described as an involuntary pelvic muscular spasm that occurs due to “fear of pain” associated with vaginal penetration which prevents a woman from experiencing penovaginal sexual intercourse despite her wish to do so. In the context of heterosexual couples with subfertility, untreated vaginismus may result in unconsummated marriage and/or reduced quality of sex life and/or can affect a woman’s perception about her potential of femininity and motherhood. Though vaginismus is an easily diagnosable and treatable condition in many instances, it often gets ignored or inadequately/inappropriately managed. There is paucity of practice-informed clinical data on management of vaginismus in couples with subfertility that is contextualized to the Indian setting. The present viewpoint is based on real-world clinical scenarios who presented as couples to a tertiary fertility center with unconsummated marriage as their chief complaint. The intent of this viewpoint is not only to highlight the common pitfalls in the management of vaginismus but also showcase a clinically proven interdisciplinary management approach for assessment and management of vaginismus and any associated sexual problems.

Characteristics of Post-ICU and Post-COVID Recovery Clinics in 29 U.S. Health Systems.

OBJECTIVES:The multifaceted long-term impairments resulting from critical illness and COVID-19 require interdisciplinary management approaches in the recovery phase of illness. Operational insights into the structure and process of recovery clinics (RCs) from heterogeneous health systems are needed. This study describes the structure and process characteristics of existing and newly implemented ICU-RCs and COVID-RCs in a subset of large health systems in the United States.DESIGN:Cross-sectional survey.SETTING:Thirty-nine RCs, representing a combined 156 hospitals within 29 health systems participated.PATIENTS:None.INTERVENTIONS:None.MEASUREMENT AND MAIN RESULTS:RC demographics, referral criteria, and operating characteristics were collected, including measures used to assess physical, psychologic, and cognitive recoveries. Thirty-nine RC surveys were completed (94% response rate). ICU-RC teams included physicians, pharmacists, social workers, physical therapists, and advanced practice providers. Funding sources for ICU-RCs included clinical billing (n = 20, 77%), volunteer staff support (n = 15, 58%), institutional staff/space support (n = 13, 46%), and grant or foundation funding (n = 3, 12%). Forty-six percent of RCs report patient visit durations of 1 hour or longer. ICU-RC teams reported use of validated scales to assess psychologic recovery (93%), physical recovery (89%), and cognitive recovery (86%) more often in standard visits compared with COVID-RC teams (psychologic, 54%; physical, 69%; and cognitive, 46%).CONCLUSIONS:Operating structures of RCs vary, though almost all describe modest capacity and reliance on volunteerism and discretionary institutional support. ICU- and COVID-RCs in the United States employ varied funding sources and endorse different assessment measures during visits to guide care coordination. Common features include integration of ICU clinicians, interdisciplinary approach, and focus on severe critical illness. The heterogeneity in RC structures and processes contributes to future research on the optimal structure and process to achieve the best postintensive care syndrome and postacute sequelae of COVID outcomes.

Depression in postmenopause: interdisciplinary approach in management and perspectives for rehabilitation

Surgical and natural menopause is often associated with depression symptoms. Along with the postpartum period, perimenopause is a “window of vulnerability” for depression development, because decline in estrogen level accounts for extinction of reproductive function, emotional disorders, genitourinary menopausal syndrome, which are combined with non-endocrine risk factors, such as decreasing income levels, low social support, and stress. Although a direct relationship between blood estrogens level and depression has not been demonstrated, the relation between menopause symptoms and depression has been proven, i.e., the symptoms of menopause can be considered as risk factors. Here, we summarizes the current view on the correct counseling and routing of menopausal women with depression symptoms in primary health care facilities, the principles of managing patients with risk factors, including genitourinary menopausal syndrome, as well as methods of rehabilitation and informational support. This will aid to improve the quality of medical care for such patients.

Burns in pregnancy: Five-year experience in a tertiary hospital in southeastern Nigeria.

Burns in pregnancy is often associated with high maternal and fetal morbidity and mortality especially when the total burn surface area (TBSA) involved is high. This study aims to review management outcome of cases of burns in pregnancy at Alex Ekwueme Federal University Teaching Hospital Abakaliki (AE-FUTHA). A five year retrospective study of all pregnant women that presented at AE-FUTHA with burn injury between April 2014 and March 2019. Information was collected from the medical records using a proforma and analyzed with IBM SPSS Statistics version 20.0 (IBM Corp., Armonk, NY, USA) using descriptive statistics. A total of 222 cases of burns were managed but only 8 were pregnant, giving an incidence of 3.6%. The commonest causes were flame (62.5%), scald (25%) and friction (12.5%) occurring mostly during the harmattan season. The median age of participants was 25-34 years. The burns affected 12.5% of the patients in the first trimester and 62.5% and 25% in the 2nd and 3rd trimesters respectively. Most patients (62.5%) had superficial burns while 25% had other associated injuries in addition to burns. About 87.5% had term spontaneous vaginal delivery. There was no maternal death but, there was an early neonatal death. The good outcome observed in this study with a 100% survival, could be explained by inter-disciplinary management approach given, even as most cases were minor degrees of burns. Early involvement of obstetricians in all burns affecting pregnant women is advised especially in burn centres where obstetricians are hardly in the employ.