Multidisciplinary Care Team Approach Research Articles

Knowledge Gaps in Placenta Accreta Spectrum.

Since its first description early in the 20th Century, placenta accreta and its variants have changed substantially in incidence, risk factor profile, clinical presentation, diagnosis and management. While systematic use of diagnostic tools and a multidisciplinary team care approach has begun to improve patient outcomes, the condition's pathophysiology, epidemiology, and best practices for diagnosis and management remain poorly understood. The use of large databases with broadly accepted terminology and diagnostic criteria should accelerate research in this area. Future work should focus on non-traditional phenotypes, such as those without placenta previa-preventive strategies, and long term medical and emotional support for patients facing this diagnosis. KEY POINTS: · Placenta accreta spectrum research may be improved with standardized terminology and use of large databases.. · Placenta accreta prediction should move beyond ultrasound with the addition of biomarkers, and needs to extend to those without traditional risk factors.. · Future research should identify practices that can prevent future accreta development..

Cardiovascular disease in the elderly: proceedings of the European Society of Cardiology-Cardiovascular Round Table.

The growing elderly population worldwide represents a major challenge for caregivers, healthcare providers, and society. Older patients have a higher prevalence of cardiovascular (CV) disease, high rates of CV risk factors, and multiple age-related comorbidities. Although prevention and management strategies have been shown to be effective in older people, they continue to be under-used, and under-studied. In addition to hard endpoints, frailty, cognitive impairments, and patients' re-assessment of important outcomes (e.g. quality of life vs. longevity) are important aspects for older patients and emphasize the need to include a substantial proportion of older patients in CV clinical trials. To complement the often skewed age distribution in clinical trials, greater emphasis should be placed on real-world studies to assess longer-term outcomes, especially safety and quality of life outcomes. In the complex environment of the older patient, a multidisciplinary care team approach with the involvement of the individual patient in the decision-making process can help optimize prevention and management strategies. This article aims to demonstrate the growing burden of ageing in real life and illustrates the need to continue primary prevention to address CV risk factors. It summarizes factors to consider when choosing pharmacological and interventional treatments for the elderly and the need to consider quality of life and patient priorities when making decisions.

The role of managed care professionals in improving care for patients with ALS.

Amyotrophic lateral sclerosis (ALS) is a debilitating disease of progressively worsening physical function. The direct medical, direct nonmedical, and indirect costs of care for these patients is significant, and annual costs can be around $70,000 on average. Major drivers of cost can include hospitalizations, in-home care, nutrition, physical and occupational therapy, and medication interventions. Beyond the monetary costs, patients also endure a decreased quality of life, which may also burden caregivers and family members. Appropriate utilization management by managed care organizations and support for the multidisciplinary care team approach can help to ensure appropriate care, with a goal of optimizing clinical outcomes and potentially delaying disease progression. Although ALS has no cure, progressive gene therapy is currently being investigated and may offer promise. Thus, gene therapy may necessitate the need for novel and creative approaches to cost-management strategies in the future.

1149: Contraception uptake among women with cardiovascular disease: The impact of a multidisciplinary team care approach

As unintended pregnancy may pose greater risks to women with cardiac disease, effective contraceptive counseling is vital for this population. We sought to determine whether women with cardiac disease cared for by a multidisciplinary team had greater uptake of reliable contraception compared to women without cardiac disease undergoing routine prenatal care. We performed a retrospective cohort study of women with cardiac disease delivering at a single academic center between 2012-2019 and compared them to women without cardiac disease who delivered at the same center in 2016 (control group). Women with cardiac disease received prenatal care by a multidisciplinary team including perinatologists, anesthesiologists and cardiologists with comprehensive contraception counseling as an area of focus. We investigated effective contraception (long-acting reversible contraception or bilateral tubal ligation) uptake by 8 weeks postpartum and contraception plan (at delivery, at discharge from delivery and at postpartum visit) between the two groups. Multivariate analyses with adjusted odds ratios were conducted to estimate association between the contraception outcomes and maternal cardiac condition. 164 pregnancies in women with cardiac disease were compared to 970 pregnancies in women without cardiac disease. Women with cardiac disease cared for by the multidisciplinary team were more likely to have a plan for reliable contraception at time of delivery (56% vs 49%, p=0.02), at discharge from delivery (56% vs 44%, p=0.04) and at postpartum visit (40% vs 28%, p=0.02) compared to the control group. Furthermore, even after adjustments, women with cardiac disease had higher odds of uptake of effective contraception by 8 weeks postpartum (40% vs 28%, p=0.02, aOR=15.2 (9.0-25.7)) compared to the control group (Table). Women with cardiac disease in pregnancy who received care by a multidisciplinary team were more likely to have a reliable form of contraception chosen antepartum and to have their preferred method of contraception in place by their 8 week postpartum visit.

ON THE SUBJECT OF MEDICAL/SOCIAL ASPECTS OF REHABILITATION FOR VERY-LOW-BIRTH WEIGHT INFANTS IN EARLY CHILDHOOD

Innovative technologies in the reanimation and intensive therapy permitted to improve the survival of premature infants, including those with extremely low birth weight infants. There are considered various issues of practical medical care for very-low-birth weight infants in the first three years of life. The special attention is given to patients with bronchopulmonary dysplasia (BPD). There is briefly presented the own authors’ experience of the observation for premature infants in conditions of a multidisciplinary team care approach. There were described such important aspects of the mentioned category of patients as neurodietology/nutritional rehabilitation, compliance with aseptic environmental conditions, the correction of visual and hearing impairment, treatment of neurological deficit, especially neuropharmacology, treatment of paroxysmal disorders and epilepsy.

Perceptions and Practices of Diabetes Educators in Providing Oral Health Care: A Qualitative Study.

Purpose The purpose of this study was to explore the current perceptions and practices of diabetes educators (DEs) in providing oral health care to people with diabetes. Methods A qualitative study design involving focus groups was used to gather data. Purposive sampling was used to recruit DEs working across 3 metropolitan hospitals in South Western Sydney, Australia. Results Fourteen DEs participated in 3 focus groups. Participants had a mean ± SD age of 44.4 ± 9.2 years and 5.2 ± 5.3 years of work experience in diabetes care. Four main themes were identified: perceptions about oral health care and diabetes current oral health care practices, perceptions on incorporating oral health, and suggested model of care. DEs agreed that promoting oral health in diabetes clinics is important, and they reported seeing patients frequently with oral health problems. However, the majority do not include oral health care in consultations, primarily because they have limited knowledge in this area and have not received any formal oral health education or training. Additional barriers were the lack of referral pathways and resources for patient education. DEs were receptive to incorporating oral health provided that the current barriers were addressed. DEs also suggested a multidisciplinary team care approach to promote oral health. Conclusions Current practices of DEs in oral health care are limited, but they are willing to address oral health. A suggested model of oral health care should include capacity building of diabetes care providers, appropriate dental referral pathways, and a team approach within multidisciplinary diabetes care.

Adherence in pediatric kidney transplant recipients: solutions for the system.

Non-adherence remains a significant problem among pediatric (and adult) renal transplant recipients. Non-adherence among solid organ transplant recipients results in US$15-100 million annual costs. Estimates of non-adherence range from 30 to 70% among pediatric patients. Research demonstrates that a 10% decrement in adherence is associated with 8% higher hazard of graft failure and mortality. Focus has begun to shift from patient factors that impact adherence to the contributing healthcare and systems factors. The purpose of this review is to describe problems within the systems implicated in non-adherence and potential solutions that may be related to positive adherence outcomes. Systems issues include insurance and legal regulations, provider and care team barriers to optimal care, and difficulties with transitioning to adult care. Potential solutions include recognition of how systems can work together to improve patient outcomes through improvements in insurance programs, a multi-disciplinary care team approach, evidence-based medical management, pharmacy-based applications and interventions to simplify medication regimens, improved transition protocols, and telehealth/technology-based multi-component interventions. However, there remains a significant lack of reliability in the application of these potential solutions to systems issues that impact patient adherence. Future efforts should accordingly focus on these efforts, likely by leveraging quality improvement and related principles, and on the investigation of the efficacy of these interventions to improve adherence and graft outcomes.

A multidisciplinary team care approach improves outcomes in high-risk pediatric neuroblastoma patients.

We assessed the impact of a multidisciplinary team care program on treatment outcomes in neuroblastoma patients. Newly diagnosed neuroblastoma patients received treatment under the Taiwan Pediatric Oncology Group (TPOG) N2002 protocol at the National Taiwan University Hospital beginning in 2002. A multidisciplinary team care approach that included nurse-led case management for patients treated under this protocol began in January 2010. Fifty-eight neuroblastoma patients, including 29 treated between 2002 and 2009 (Group 1) and 29 treated between 2010 and 2014 (Group 2), were enrolled in the study. The 5-year overall survival (OS) and event-free survival (EFS) rates for all 58 patients were 59% and 54.7%, respectively. Group 2 patients, who were treated after implementation of the multidisciplinary team care program, had better 3-year EFS (P = 0.046), but not OS (P = 0.16), rates than Group 1 patients. In a multivariate analysis, implementation of the multidisciplinary team approach was the only significant independent prognostic factor for neuroblastoma patients. In further subgroup analyses, the multidisciplinary team approach improved EFS, but not OS, in patients with stage 4 disease, those in the high-risk group, and those with non-MYCN amplified tumors. These data indicate a multidisciplinary team care approach improved survival outcomes in high-risk neuroblastoma patients. However, further investigation will be required to evaluate the long-term effects of this approach over longer follow-up periods.

Association between multidisciplinary team care approach and survival rates in patients with oral cavity squamous cell carcinoma.

The purpose of this study was to investigate whether multidisciplinary team care (MDTC) is associated with outcomes in oral cavity squamous cell carcinoma (SCC). We retrospectively examined 1616 patients with oral cavity SCC who underwent radical surgery between 1996 and 2011. The study participants were classified into 2 subgroups according to the use of MDTC. Five-year outcomes were significantly better in the MDTC group than in the no-MDTC group (neck control, 88% vs 84%, p = .0397; disease-specific survival [DSS], 83% vs 78%, p = .0114; and overall survival [OS], 70% vs 64%, p = .0002, respectively). Among patients who were scheduled to undergo adjuvant therapy, the number who completed their adjuvant treatment was significantly higher in the MDTC group than in the no-MDTC group (90% vs 60% to 70%, p < .001). The association of MDTC with improved outcomes may be potentially explained by a better therapeutic alliance between the patient and the tumor board, and/or a greater thoroughness in clinical management. © 2016 Wiley Periodicals, Inc. Head Neck 38: E1544-E1553, 2016.

Reducing diabetes-related major limb amputations: A plea for a multidisciplinary team approach

Background: Diabetic foot is a challenging complication of diabetes mellitus, affecting a significant number of diabetic patients and often resulting in amputations especially in resource-poor nations. Patients and Methods: A 4-year retrospective review of clinical records of patients with diabetic foot lesions (DFLs) treated at Ahmadu Bello University Teaching Hospital, Zaria. Results: One hundred and thirty-eight patients were admitted with DFLs, but only 109 patients had complete medical records available for review. Nine patients had bilateral lesions at presentation. Seventy-three (61.9%) were male and 45 (38.1%) were female. Three (2.6%) were young adults ( 65 years). Fifty-two (44.0%) of the lesions were admitted through the diabetic clinic while 66 (56.0%) presented to the emergency room. Wagner Grade IV and V lesions constitute the majority (68.7%). The mean duration of the lesions at presentation was 6 weeks while the mean interval between first review by an endocrinologist and first surgical review was 17 days for those admitted through the diabetic clinic. Seventy-seven had surgical interventions, 30 of which were major amputations. The mortality rate was 14.6%. Conclusion: Diabetes-related foot lesions pose a great challenge in developing countries, with a significant number of the patients undergoing major amputation, an incapacitating outcome largely contributed to by late presentation and poor quality of diabetic foot care. With the impact being made by public health enlightenment programs on diabetes complications, a multidisciplinary team care approach from the outset goes a long way in reducing major amputations in these patients.

Multidisciplinary Interventions in Motor Neuron Disease.

Motor neuron disease is a neurodegenerative disease characterized by loss of upper motor neuron in the motor cortex and lower motor neurons in the brain stem and spinal cord. Death occurs 2–4 years after the onset of the disease. A complex interplay of cellular processes such as mitochondrial dysfunction, oxidative stress, excitotoxicity, and impaired axonal transport are proposed pathogenetic processes underlying neuronal cell loss. Currently evidence exists for the use of riluzole as a disease modifying drug; multidisciplinary team care approach to patient management; noninvasive ventilation for respiratory management; botulinum toxin B for sialorrhoea treatment; palliative care throughout the course of the disease; and Modafinil use for fatigue treatment. Further research is needed in management of dysphagia, bronchial secretion, pseudobulbar affect, spasticity, cramps, insomnia, cognitive impairment, and communication in motor neuron disease.

Evaluation of the annual activity of a continuing medical and home care unit

This report presents the annual activity of a home care unit which operates as an extension of a regional hospital into the community. This ‘intermediate-care’ (between hospitalization and ambulatory care) was developed because of the demographic and health characteristics of the urban population served and in response to their specific health care needs (immediate availability and accessibility of care). During this period, 471 patients were under care, 85% of whom were 65 years old and over. Forty percent were referred with a diagnosis of a malignant disease, about 20% with a diagnosis of a cerebral event and 15% with cardiac and vascular problems. The average period of stay in the program was three months, with less than 10% remaining under supervision for more than a year. In about 50% of the patients involved the care goals were attained and in an additional 25% (terminal cases) the patients were cared for at home until death. The service was found to be an important factor in the interim phase between acute hospitalization and the continuation of care provided by the family physician. The multidisciplinary team care approach was found to be effective in providing services to that group of patients characterized by old age, multiple medical problems and being homebound. The concerned service is continuously developing in compliance with the changing and growing needs of particular groups of patients such as advanced malignant disease, complex cardiovascular problems and multiple (simultaneous) diseases.