Multidisciplinary Attitudes Research Articles

Diet in the prevention and treatment of depression - systematic review

Depression is one of the leading causes of disability worldwide. It affects, according to WHO, nearly 300 million people worldwide, a number close to 3,8 % of the world’s population. Depression is not exclusively a mental disorder limited to psychiatry, nowadays it is present in all medical fields. It has a significant association with many comorbidities, as an example cardiovascular diseases and metabolic disorders. Additionally, depression often is manifested with psychosomatic symptoms. Both aspects lead clinicians to major diagnostic and therapeutic challenges. Each one of dietary element: omega-3 fatty acids, zinc, selenium, iron, vitamin B12, vitamin D, folate, creatine was found to correspond with mental health in patients and the level of mentioned diet components is negatively correlated with depression risk of individuals. Each of the dietary aspect considered in the article has a significant correlation with depression disorder and might support the new multidisciplinary attitude toward it in mental health.

Factors influencing the delivery of nutritional care by nurses for hospitalised medical patients with malnutrition; a qualitative study.

To describe an insight into nursing nutritional care delivery in the hospital from the perspectives of observed nursing care and an exploration of multidisciplinary attitudes and experiences with patient participation in nutritional care. The prevalence of malnutrition in hospitalised patients continues to be high. Nurses' essential role in the identification and treatment of malnutrition is an important aspect of the fundamentals of care. Nurses have a key role in providing optimal nutritional care in the hospital. A systematic nursing approach, combined with an active role for patients, is required to effectively counteract malnutrition. A multicentre qualitative study using ethnographic observations and focus groups. Direct observation of nutritional care was conducted on two nursing wards; nurses and inpatients were observed; and data were thematically analysed based on the fundamentals of care framework. Subsequently, six focus groups were held on three nursing wards with nurses, dietitians and nutrition assistants (n= 34). Data were analysed using open, axial and selective coding. The COREQ guidelines were used for reporting the study. During 54 days, representing 183 h, 39 nurses were observed in two medical wards. Three activities in nutritional care delivery were identified from observing nurses and patients: (1) screening and assessment/at-risk determination, (2) nutritional care plans and (3) monitoring and evaluating outcomes and transition-of-care planning. In addition, the focus groups identified barriers, facilitators, needs and expectations for optimal nursing nutritional care delivery. This study provides an understanding of the difficulties in the delivery of nursing nutritional care. Patient participation in the nutritional care process is rare. Evidence-based strategies are required to improve the knowledge and skills of nurses and patients to participate in (mal)nutrition care. The findings of this study are used for the development of a nursing nutrition intervention to optimise patient participation in (mal)nutrition care. During the study, patients were not involved with the observations of care and/or with the interviews; the researchers observed the nutritional care delivery at medical wards acting as passive participants. Nurses, nutrition assistants and dietitians were after the focus groups asked for feedback on the transcripts of the interviews.

Zeolite in tissue engineering: Opportunities and challenges.

Tissue engineering and regenerative medicine follow a multidisciplinary attitude to the expansion and application of new materials for the treatment of different tissue defects. Typically, proper tissue regeneration is accomplished through concurrent biocompatibility and positive cellular activity. This can be resulted by the smart selection of platforms among bewildering arrays of structural possibilities with various porosity properties (ie, pore size, pore connectivity, etc). Among diverse porous structures, zeolite is known as a microporous tectosilicate that can potentially provide a biological microenvironment in tissue engineering applications. In addition, zeolite has been particularly appeared promising in wound dressing and bone‐ and tooth‐oriented scaffolds. The wide range of composition and hierarchical pore structure renders the zeolitic materials a unique character, particularly, for tissue engineering purposes. Despite such unique features, research on zeolitic platforms for tissue engineering has not been classically presented. In this review, we overview, classify, and categorize zeolitic platforms employed in biological and tissue engineering applications.

“Imagine Neuro-Oncology”- a one week course with medical and technical students: students’ reflections about multidisciplinarity and its practical relevance

ABSTRACTModern medicine requires tight multidisciplinary collaboration and communication among several technical disciplines. Nevertheless, multidisciplinary medical courses are rare and even less often scientifically evaluated. The aim was to evaluate an innovative neuro-oncology course for medical students (MED) and students of science, technology, engineering, and mathematics (STEM) so that they learn and practice mutual understanding, communication and cooperation. 10 MED and 9 STEM were trained together during a one-week-course on the topic of “brain tumor” in imaging, surgical planning, surgery, pathological diagnosis, and adjuvant therapy. Evaluation was undertaken via focus groups and accompanying questionnaires about motivation, course acceptance, and multidisciplinary attitude. Students evaluated course structure, content, and multidisciplinary setting positively and showed high intrinsic motivation. However, the students sensed an “artificial dividing line” between both groups, which was conceptually encouraged by the deliberate temporary subdivision into “monodisciplinary” seminars and during the preparation of presentations. Students’ opinion of the concept was generally positive as they learned about the challenges in finding a “common scientific language”. Nevertheless, some criticisms were raised concerning the dividing line between the disciplines, which in part led to organizational changes. Even though the current reality may be reflected here, the goal of future interprofessional courses should definitely be to dissolve this dividing line.

Understanding of historical masonry for conservation approaches: the contribution of Prof. Luigia Binda to research advancement

Prof. Luigia Binda was a Full Professor in Restoration at the School of Architecture of Politecnico di Milano. She began her career teaching building and construction techniques, then strengthening and reinforcement of masonry buildings and preservation of cultural heritage. L. Binda, in her long scientific activity, addressed her interest to historic masonry structures, with a strategic broad knowledge of the process and merging knowledge from different research fields. Thanks to her multidisciplinary attitude, a deep passion toward puzzling problems and a gentle approach, she was able to combine conservation and safety issues with a robust experimental knowledge of masonry behavior, giving an extraordinary impulse to the research into the experimental understanding, modelling, strengthening and preserving the cultural heritage. The paper shortly illustrates the main aspects of selected topics among the most outstanding contributions given by Prof. L. Binda in research, and describes the advancements made possible in many related fields, both academic and of professional practice. The title of each chapter starts with a typical sentence L. Binda used to remind people, which summarizes at a glance the importance of that specific aspect in the topic. In the authors view, it also implicitly indicates the innovative character of her insights and her extraordinary dedication to research.

Multidisciplinary attitudes to people with dementia; training and environmental factors play a role in caring for people with dementia in a Cardiac Catheterisation Laboratory

Purpose The purpose of this paper is to explore multidisciplinary attitudes and environmental factors affecting dementia care in the Cardiac Catheter Laboratory (CCL). Design/methodology/approach Questionnaires (n=87) were distributed in a hospital CCL in the North of England. The authors utilised the Dementia Attitudes Scale which incorporates two subscales: Social Comfort and Dementia Knowledge. In addition, a newly devised questionnaire asking about perceptions of how the CCL environment affected care of patients with dementia was added. Findings The response rate was 71 per cent (n=62). Years’ experience in the CCL was associated with lower Social Comfort scores (p=0.026). Dementia training was associated with higher mean Dementia Attitudes Scale and Social Comfort scores (p=0.021, p=0.007). Participants who had undertaken “Professional studies” had higher Dementia Attitudes Scale and Dementia Knowledge mean scores (p=0.038, p=0.046) but “On-the-job” training was perceived as most beneficial (32 per cent, n=20). Unit co-ordinators and nurses felt the CCL was an unfavourable environment for patients with dementia. Care was perceived to be impaired by environmental functionality, equipment and the presence of ionising radiation. Research limitations/implications The small sample limits generalisability. Although the Dementia Attitudes Scale is a validated questionnaire it has not been widely used so reliability of these results is unclear. Practical implications Caring for patients with dementia has unique challenges especially in areas like the CCL. These results suggest that practical experience and training can affect the perception of staff to patients with dementia hence there may be a need to assess what would be the most appropriate training to give health professionals in the future. Originality/value The authors believe this to be the first multi-professional research study into care of patients with dementia in a specialised acute unit. This was the most diverse sample known to have attitudes to dementia measured quantitatively in an acute hospital department and the results need to be replicated before practice should be changed.

Case Studies of Rising Damp Treatment in Historical Buildings

Salt damage can affect the service life of numerous building structures, both historical and contemporary, in a significant way. Therefore, various conservation methods have been developed for the consolidation and protection of porous building materials exposed to the salt attack. As any successful treatment of salt damage requires a multidisciplinary attitude, many different factors such as salt solution transport and crystallization, presence and origin of salts in masonry, and salt-induced deterioration are to be taken into account. The importance of pre-treatment investigations is discussed as well; in a combination with the knowledge of salt and moisture transport mechanisms they can give useful indications regarding treatment options.Another important cause of building pathologies in buildings is the rising damp and this phenomenon it is particularly more severe with the presence of salts in water. The treatment of rising damp in historic building walls is a very complex procedure. At Laboratory of Building Physics (LFC-FEUP) a wall base hygro-regulated ventilation system was developed. This system patented, HUMIVENT, has been submitted to laboratorial monitoring and to in situ validation and a numerical simplified model was developed to facilitate the practical application. Having in mind the practical application of scientific and technological knowledge from Building Physics to practice, this paper presents the design of the system (geometry, ventilation rate and hygrothermal device), the detailing and technical specification of its different components and information about the implementation in three types of buildings: a church, a museum and a residential building.

Change in attitude towards psychotherapy in the course of clinical practice: Qualitative analysis of experience of students from various health care fields

IntroductionA stigmatizing attitude towards psychiatry and psychotherapy still prevails in Lithuania. It is evidenced by a variety of patterns, especially by a controversial social opinion about a person suffering from mental disorders.ObjectivesTo investigate the experiences of students in Psychiatry and General Practitioner Residency studies and those in Bachelor's and Master's degree programs of Psychology who during their clinical psychiatric practice joined a multi-professional team at the Stress Related Disorders Department as temporary members; and to analyse how their attitude towards psychotherapy changed in the process.AimsTo analyse students’ feedback about their experiences and involvement into the activity of the multi-professional team at the Stress Related Disorders Department (day care) during their clinical psychiatric practice.MethodsQualitative research methods based on phenomenological sociology were employed in the study. Students responded to five questions in writing during interview. Collected qualitative research material was analysed while applying content analysis.ResultsEighteen subthemes were obtained and they were matched with the following nine main thematic codes: (1) past, present, future; (2) difficult beginning: “birth”; (3) childbirth pain; (4) childhood challenges; (5) birthing team; (6) adulthood; (7) mourning; (8) joining the team; and (9) future prospect.ConclusionsClinical psychiatric practice develops a multidisciplinary attitude towards psychiatry including both pharmaceutical and non-pharmaceutical treatment while using individual and group psychotherapy. Significant experience and attitude of health care students changed during clinical psychiatric practice as they acquired deeper understanding of the meaningfulness of psychotherapy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A Case of Partial DiGeorge Syndrome with Attention Deficit and Hyperactivity Disorder and Specific Learning Disorder

DiGeorge Syndrome (DGS) is the most seen microdeletion syndrome and its prevalance varies from 1/4000 to 1/6000. Over embriogenesis, a deletion of an approximately 3 Mb frame from 22q11.2 results in this syndrome and its clinical features varies from congenital heart and gross vessels anomalies, hypocalcemia, respiratory problems, leucomotor or urogenitale system anomalies, hearing loss, to developmental delay. Alongside different clinical features and phenotypes, these patients should be followed up on psychiatric symptoms and disorders such as speech delay, specific learning difficulties (SLD), mental retardation, attention deficit hyperactivity disorder (ADHD), autism, anxiety, depression and even schizophrenia and other pcychotic disorders. This case, diagnosed with partial DGS and followed by immunology, cardiology, endocrinology and neurology departments, admitted to our clinic on account of his difficulties in learning and inattention. The patient was diagnosed with ADHD and SLD, then pharmacotherapy and individual educational programme were planned. The insufficient expression of the catecolamine-O-methyltransferase (COMT) gene located in the 22q11.2 gene could very well play a role in both the etiology of ADHD and SLD. There is still no clear causative relation between these, so there is a need to clarify this with further studies. As seen in our case, the patients with DGS and having some inattention or learning difficulties are needed to be examined by the child psychiatrists. Treatment protocols related to these patients' symptoms would be evaluated with a multidisciplinary attitude.

Wolfram Syndrome: Report of Two New Cases

Wolfram Syndrome (WFS) is a rare autosomal recessive disease. It is a progressive neurodegenerative disorder in which patients present with diabetes mellitus, optic atrophy, diabetes insipidus, sensorineural deafness, urologic abnormalities and multiple neurological abnormalities. This study reports two sisters with late diagnosed wolfram syndrome with diabetes insipidus, diabetes mellitus, optic atrophy, deafness and urological abnormalities. The condition should be evaluated in a multidisciplinary attitude and specific tests are necessary to make a precise diagnosis of the syndrome.

Creating and establishing a recovery-oriented clinical psychology provision across an acute care mental health pathway. Ethical obligation and clinical reality

Purpose– The purpose of this paper is to summarise the development of a recovery-oriented and socially inclusive acute care clinical psychology service in one of the NHS Trusts based in East Anglia. It demonstrates the service's compliance with relevant national policies and guidelines, and addresses some of the criticisms directed at acute mental health care in recent years. Both achievements and difficulties are reflected on.Design/methodology/approach– The paper employs an organisational development case example related to applicable clinical practice model, based on national guidelines and policies, in order to demonstrate that it is possible to develop and implement a recovery-oriented clinical psychology practice in acute inpatient mental health care. This is based on the authors, experiences as a public sector clinical psychologists specialising in complex, severe, and enduring mental health needs.Findings– Clinical psychologists may effectively contribute to the development of psychosocially informed and recovery-based multidisciplinary attitudes towards emotional difficulties of individuals admitted to psychiatric wards.Research limitations/implications– Future service development project of similar nature ought to implement standardised measures (e.g. ward atmosphere scales) to increase validity of findings.Practical implications– Despite limited, and continuously decreasing, resources in the NHS it appears possible to develop and establish a successful and objectively replicable provision of recovery-based psychological services across an entire acute care mental health pathway.Social implications– Recovery-enhancing clinical psychology interventions should not be limited to those receiving care from community-based services only. Building psychologically informed understanding of mental health needs should be employed on inpatient wards too, in order to counterbalance the dominating biomedical models of mental illness.Originality\value– Dissemination of examples of effective psychosocial practice in acute mental health settings appears largely underrepresented.

UrbAging: When cities grow older

Our future is old and urban. In 2050, for the first time in human history, there will be on earth more people aged over 60 than children between 0 and 14. No continent is exempt from the urbanization process. ‘Old’ Europe is already particularly concerned by this phenomenon, but demographic and migratory predictions foretell an analogous evolution worldwide. A multidisciplinary attitude is necessary to implement sustainable urban policies. For almost two decades urban strategies have been addressing the well-being of citizens, along with the development of necessary infrastructures. Today, the older city dweller has become in focus. Quality of life is generally admitted to be the result of a fruitful interaction between citizens and their urban environment in its different forms, beyond a mere question of health conditions. A Swiss study is described directed at making this concrete.

Multidisciplinary attitudinal positions regarding clinical supervision: a cross-sectional study

The aim of this study was to describe multidisciplinary attitudes towards/about Clinical Supervision. Clinical Supervision continues to be a matter of high interest for nurses and other health care disciplines. Despite the existence of a body of a substantive literature, gaps in our knowledge base remain. Data was collected using a form composed of 17 statements. A total sample of 74 participants completed the form and rank-ordered the statements. The sample was comprised of a mix of eight different disciplines: Registered Nurses (hospital based), Chiropodists, Occupational Therapists, Learning Disability Nurses, Registered Nurses (community based), Registered Mental Health Nurses, Health Visitors and Physiotherapists. Data were analyzed by descriptive and non-parametric statistics. The respondents' agreement was high concerning the rankings of the item (11) ''Confidentiality is assured and agreed''. Almost all respondents ranked this item as the most important characteristic for group supervision. The respondents shared almost a total agreement concerning the item (17) ''The supervisor should be a manager''. This was ranked as the least important characteristic for group supervision. The importance of having a clinical supervisory relationship that remains separate from administrative/managerial supervision and one where confidentiality is assured was highlighted by this study. Furthermore, the attitudes were not restricted to one professional or disciplinary group. The effective support system of clinical supervision should therefore not be diluted by awkward and unnecessary amalgamations with administrative/managerial supervision.

Storia naturale dell’infiammazione allergica

Allergic pathologies are the most common immunologic diseases and their prevalence and severity show a constantly increasing trend in industrialized countries. The present article presents some recent epidemiological data, the natural development of the allergic inflammation and its pathophysiology, focusing on the recent concept of a “minimal persistent inflammation”, with particular regard to its long term treatment with antiallergic drugs. In fact, according to the most recent interpretations, allergy has to be considered as a complex phenomenon, characterized by a inflammatory response to allergenic stimuli. The complicated interrelation between cells, cytokines and affected structures is described. Very often allergic diseases of the upper airways are associated with and complicate asthma, and data that support the benefits of treating these diseases as a whole are presented. Long-term treatment of allergies with antiflogistic/antiallergic molecules is capable of reducing tissutal damage, besides improving the quality of life of the patient and lowering the frequency of acute episodes. The chronic treatment with antiallergic drugs appears to be favorable also from a pharmacoeconomical point of view, as it is associated with a reduction of overall pharmaceutical expenses and of lost working/school days, as well as determining an improved quality of life for the patient and its relatives, particularly in pediatric age. The management of the allergic patient has always to be approached with an integrated multidisciplinary attitude, in which the efforts tend to the identification of all concurrent diseases, because the optimal treatment may be achieved only with the recognition and the resolution of all underlying diseases.