Multidisciplinary Group Of Specialists Research Articles

The Role of Parenteral Nutrition in Cancer in Indian Settings

Background: Almost 50% of patients with cancer suffer from malnutrition during their first hospital visit. However, it is often overlooked and undiagnosed and is associated with morbidity, mortality, poor tolerance to treatment, and treatment outcomes. Guidelines recommend supportive nutrition from the early stages of cancer treatment. However, in clinical practice, nutritional support is often prescribed only as an end-of-life intervention or is not prescribed at all; moreover, the use of parenteral nutrition (PN) is not well-defined. There are limited practical guidelines on the use of PN in patients with cancer. Methods: A multidisciplinary group of specialists in India formulated this consensus to guide oncologists on the judicious use of PN in Indian settings. It includes general and cancer-specific recommendations on the use of PN, supplemental PN (SPN), composition of PN, and monitoring patients to prevent adverse events associated with PN. Recommendations: The risk of malnutrition should be assessed at the very first presentation of a patient with cancer. These patients’ nutritional requirements are largely like those of the healthy population. Nutritional assessment of all cancer patients should begin at diagnosis and repeated regularly to initiate and monitor early nutritional intervention, before the general status is severely compromised. Oncologists and nutritionists need to be educated about using the appropriate nutrition support options according to the guidelines. While EN should be the preferred form of nutritional support, in specific circumstances PN might be a better option. Early PN in specific settings provides additional benefits, and is particularly important in some types of cancers. SPN as an additional nutritional support to EN can improve treatment tolerability and quality-of-life of patients with cancer. Education is also necessary for awareness about preventing and managing adverse effects of PN, which is the major reason for poor adoption of PN.

Hereditary gluten enteropathy in irish setters: evaluation of external parameters, clinical symptoms and fatal risks

Aim. Determine the features of appearance, clinical signs and fatal risks in Irish setters with hereditary gluten enteropathy. Methods. The methods used were observation, eye examination, clinical examination, autopsy, histological. Results. It has been established that in hereditary gluten enteropathy in Irish setters there are violations of the parameters of appearance, weak ability to train, fulminant and chronic forms of damage to the intestinal wall by type of enteropathy, anaphylactic reactions and cerebral disorders. In the dead setters, the causes of death were hypovolemic shock due to intestinal bleeding and combined critical injuries of the brain, heart and lungs. Conclusions. Violations of the parameters of appearance in setters with hereditary gluten enteropathy led to their unsuitability for hunting. Dietary therapy with the exclusion of feed containing cereals was effective in stabilizing the condition of sick setters. Setters with hereditary gluten enteropathy are at risk of developing fatal cardiovascular, pulmonary, and cerebral insufficiency. The validity of the spread of hereditary gluten enteropathy in Irish setters depends on the accounting of the results of multi-year studies by a multidisciplinary group of specialists.

Multidisciplinary management of type 2 inflammation diseases using a screening tool.

Dysregulation of type 2 (T2) immune response leads to an aberrant inflammatory reaction that constitutes the pathophysiological basis of diseases involving various organs. For this reason, several disorders can coexist in a single patient; however, as different specialists often treat these pathologies, T2 dysregulation, particularly when mild, is not always the first diagnostic suspicion. A breakdown in interdisciplinary communication or the lack of adequate tools to detect these entities can delay diagnosis, and this, together with a lack of coordination, can lead to suboptimal care. In this context, a multidisciplinary group of specialists in pneumology, immunology, allergology, dermatology and otorhinolaryngology compiled a list of the cardinal symptoms reported by patients presenting with T2 inflammation-related diseases: asthma, chronic rhinosinusitis, allergic rhinitis, allergic conjunctivitis, IgE-mediated food allergy, atopic dermatitis, eosinophilic oesophagitis, and NSAID-exacerbated respiratory disease (NERD). Using this information, we propose a simple, patient-friendly questionnaire that can be administered at any level of care to initially screen patients for suspected coexisting T2 diseases and referral to the appropriate specialist.

Introduction to the PANLAR guidelines: axial spondyloarthritis

In this video blog, Dr. Wilson Bautista explains the guidelines presented at PANLAR 2022 after research processes with a multidisciplinary group of specialists, as well as an analysis of what follows in the treatment and diagnosis process of this disease.

The Eumelanin Human Skin Colour Scale: a proof-of-concept study.

At present there is no standard nomenclature for describing the diversity of human constitutive skin colour. To develop a standard nomenclature to describe human constitutive skin colour. Monthly focus group discussions were carried out among a multidisciplinary group of specialists over a 7-month period. Topics covered were (i) limitations and unmet needs of current nomenclature(s) pertaining to human cutaneous diversity, (ii) practical considerations about the function and role of any proposed nomenclature pertaining to human cutaneous diversity, (iii) review of the cellular basis and current molecular genetic understanding of variation in human skin pigmentation and (iv) in vivo methods to evaluate human skin pigmentation. In addition, a preliminary review of the published literature was undertaken to collate data on published skin reflectance measurements, notably melanin index values for well-referenced human populations. We developed a five-point scale to describe the full spectrum of human constitutive skin colour, termed the Eumelanin Human Skin Colour Scale. The nomenclature of the scale uses eumelanin, the dominant chromophore of human skin, as a central descriptive word. The categories of the scale (nomenclature and melanin index values) are eumelanin low (EML), < 25; eumelanin intermediate low (EMIL), 25 to < 50; eumelanin intermediate (EMI), 50 to < 75; eumelanin intermediate high (EMIH), 75 to < 100; and eumelanin high (EH), ≥ 100. The Eumelanin Human Skin Colour Scale enables the complete range of human constitutive skin colour to be described in an objective, equitable and understandable manner. In future, this scale can be used as the basis for developing other scales that address the specific functional aspects of human skin, such as response to ultraviolet radiation.

Clinical nutrition as part of the treatment pathway of pancreatic cancer patients: an expert consensus

PurposeMalnutrition is a common problem among pancreatic cancer (PC) patients that negatively impacts on their quality of life (QoL) and clinical outcomes. The main objective of this consensus is to address the role of Medical Nutrition Therapy (MNT) into the comprehensive therapeutic management of PC patients.MethodsA Spanish multidisciplinary group of specialists from the areas of Medical Oncology; Radiation Oncology; Endocrinology and Nutrition; and General Surgery agreed to assess the role of MNT as part of the best therapeutic management of PC patients.ResultsThe panel established different recommendations focused on nutritional screening and nutritional screening tools, MNT strategies according to PC status, and MNT in palliative treatment.ConclusionsThere is an unmet need to integrate nutritional therapy as a crucial part of the multimodal care process in PC patients. Health authorities, health care professionals, cancer patients, and their families should be aware of the relevance of nutritional status and MNT on clinical outcomes and QoL of PC patients.

National guidelines for management of cervical squamous intraepithelial lesion: A survey of European Federation for colposcopy members

ObjectivesThe management of women with cervical squamous intraepithelial lesions (SIL) is fundamental to prevention of cervical cancer in an organized cervical screening programme. Clinical guidance should improve quality of care and clinical effectiveness if developed and implemented appropriately. This survey provides an update on the current situation of national guidelines for management of cervical SIL amongst member countries of European Federation for Colposcopy (EFC). Study designA questionnaire was sent to representatives of each member country of EFC. The questionnaire contained questions on: guidelines for management of cervical SIL of the National Societies/Associations of Colposcopy or others national societies/associations including the development and the consultation processes, guidelines for management of lower genital tract diseases and the regulations in each country for colposcopy practice. ResultsWe received responses from all 34 member countries. Thirty countries reported a national guideline for management of cervical SIL that were developed by, or in conjunction with, their national societies or associations of colposcopy. In most cases there was adherence to the recommended steps for guideline development: they were developed by a multi-disciplinary group of specialists (29 countries) and society members were consulted before publication (21 countries). A small number of countries (8) reported to have guidelines for the management of lower genital tract dysplasia (e.g. vulval disease) developed by other national societies. In most countries (26) the colposcopists are obliged to follow the guidelines but this is regulated in only 6 and in 12 countries the colposcopists need to be certified by the national society of colposcopy in order to practice. ConclusionThere are advances in the development and provision of country specific guidance on the management of cervical SIL. Most EFC member countries have appropriate national guidelines that were developed using a clear methodology, are updated according to progresses in the field and are accessible online to current practitioners. These guidelines support colposcopists to follow evidence-based practice and provides understanding of best practice in guideline development and access.

MS02.04 The Role of Molecular Board

Lung Tumor Board is a multidisciplinary group of specialists who are responsible for diagnosing and deciding the best treatment for a patient with lung cancer. In cancers with little to no metastatic evidence, the case is handed over to surgeons or sometimes to radiotherapists for local and curative treatment. But in cases of locally advanced or metastatic stages, the patient visits the oncologist alone or in conjunction with the radiotherapists for a more systemic approach. A few years ago, the patient was presented to tumor board immediately, but now because we are in the age of precision medicine, the oncologist can gather more information about the tumour itself to initiate the best personalized treatment for each patient’s cancer. In fact, the oncologist requires 3 types of information: accurate histological diagnosis, molecular characteristics of the tumor, and PD-L1 expression. Prior to the creation of this molecular tumor board, this information could be given by mail, mobile phone messaging, phone call or in person, since all the information usually arrives a few days after the patient is presented at Lung Tumor Board. If all this information is presented in a room with all the specialists involved in obtaining it, the data can be better analysed and the therapeutic decision making will be much more precise. Hence the idea of creating a MTB with oncologists, pathologists, biologists, bioinformatics, technicians, palliative care, and residents to review the different results for a lung cancer patient. The type of patients to present in this type of Molecular Tumour Board is widely variable, but usually fall into one of these 6 categories: 1) Newly diagnosed patients with metastatic disease. The MTB would reaffirm that there is sufficient material and that all the molecular or immunohistochemical techniques are underway (EGFR, BRAF, ALK, ROS1, and PD-L1). Oncologists re-assign the patient for the next MTB to review final results. The pathologist also comments on the percentage of tumour cellularity, so that technicians and biologists can make optimized calculations of the cuts and the type of sample that the biologist has to work with (biopsy and/or cell block and/or cytological smears). 2) Patients with progressive disease with a known molecular marker. They can be patients where the oncologist repeats sampling. Usually the patient is more familiar to the biologist because he receives liquid biopsies to monitor the disease and the pathologist only knows the patient if he has a re-biopsy. 3) Patients with possible disease progression, pseudoprogression or hyperprogression after immunotherapy. 4) Patients with molecular results received from outside (FM, FOne, clinical trials) The patient is more familiar to the oncologist who treats him and who has decided to send a sample for a clinical trial or external platform. They are presented in the MTB in order to reaffirm the mutation or translocation found with technology available in the center or maybe it can be consulted outside. 5) Surgical patients with multiple adenocarcinomas that require definitive staging. The patient is most familiar to the pathologist who diagnosed the surgical tumor. They are presented in order to know molecular details of multiple synchronous tumours. 6) Patients that wish to utilize stored material for new diagnostic studies/techniques For reasons of disease progression, the patient may enter a clinical trial or has the option of systemic treatment, so some studies that were not previously performed in are required. Pathologist, biomarkers, Molecular Tumor Board

Diagnostic du syndrome d’apnée obstructive du sommeil chez l’enfant (2–18 ans) : place de la polysomnographie et de la polygraphie ventilatoire

The French Society of Research and Sleep Medicine (SFRMS) organized a meeting on obstructive sleep apnea syndrome (OSAS) in children. A multidisciplinary group of specialists (pulmonologists, ENT surgeons, pediatricians, neurophysiologists, sleep specialists) drew up a consensus document on the value of electrophysiological recordings in the diagnosis of OSAS in children. Technical considerations and recommended sensors, respiratory event definitions, and scoring criteria are presented according to the 2012 and 2014 recommendations of the American Academy of Sleep Medicine (AASM). Polysomnographic criteria for sleep-disordered breathing in children and the French National Authority for Health guidelines for indications of polysomnographic studies were reported. Relevance and limits of in-lab PSG, home PSG, and respiratory polygraphy were presented and guidelines were proposed to improve the diagnosis and follow-up of these children.

Diagnostic clinique du syndrome d’apnées obstructives du sommeil de l’enfant

The French Society of Research and Sleep Medicine (SFRMS) organized a meeting on obstructive sleep apnea syndrome (OSAS) in children. A multidisciplinary group of specialists (pulmonologist, ENT surgeons, pediatricians, orofacial myofunctional therapists, neurophysiologists, and sleep specialists) reached a consensus on the value of isolated or clustered clinical symptoms and of questionnaires completed by parents in the clinical diagnosis and in assessing the severity of OSAS. Are clinical history with validated questionnaires and a rigorous physical examination sufficient to suspect OSAS, to appreciate its severity, and finally to confirm the diagnosis? Usually, a sleep recording of respiratory parameters remains mandatory for the diagnosis of OSAS to be made. However, clinical symptoms are very useful for estimating the probability of the diagnosis and the severity of the disease, and therefore for classifying which children will benefit form polysomnography and for proposing an adapted follow-up after OSAS therapy. Even if they are not able to ascertain the diagnosis of OSAS in children, clinical history, questionnaires, and physical examination are very important. Finally, we propose a classification of the indications for polysomnography in children suspected of having OSAS.

Recommendations for the management of pancreatic cancer type adenocarcinoma: A consensus statement reached during the 2015 Latin American Symposium on Gastroenterological Oncology

Pancreatic cancer is a malignancy of great impact in developed countries and is having an increasing impact in Latin America. Incidence and mortality rates are similar for this cancer. This is an important reason to offer to the patients the best treatments available. During the Latin American Symposium of Gastroenterology Oncology (SLAGO) held in Viña del Mar, Chile, in April 2015, a multidisciplinary group of specialists in the field met to discuss about this disease. The main conclusions of this meeting, where practitioners from most of Latin American countries participated, are listed in this consensus that seek to serve as a guide for better decision making for patients with pancreatic cancer in Latin America.

Consensus Statement on Diagnostic Criteria for PHACE Syndrome

A subgroup of patients with infantile hemangiomas have associated structural anomalies of the brain, cerebral vasculature, eyes, sternum, and/or aorta in the neurocutaneous disorder known as PHACE syndrome. The diagnosis has been broadly inclusive by using a case definition of a facial hemangioma plus >or=1 extracutaneous features, leading to numerous reports of potential associated disease features, many of uncertain significance. This consensus statement was thus developed to establish diagnostic criteria for PHACE syndrome. A multidisciplinary group of specialists with expertise in PHACE syndrome drafted initial diagnostic criteria on the basis of review of published, peer-reviewed medical literature and clinical experience. The group then convened in both executive and general sessions during the PHACE Syndrome Research Conference held in November 2008 for discussion and used a consensus method. All conflicting recommendations were subsequently reconciled via electronic communication and teleconferencing. These criteria were stratified into 2 categories: (1) PHACE syndrome or (2) possible PHACE syndrome. Major and minor criteria were determined for the following organ systems: cerebrovascular, structural brain, cardiovascular, ocular, and ventral/midline. Definite PHACE requires the presence of a characteristic segmental hemangioma or hemangioma >5 cm on the face or scalp plus 1 major criterion or 2 minor criteria. Possible PHACE requires the presence of a hemangioma >5 cm on the face or scalp plus 1 minor criterion. The group recognized that it may be possible to have PHACE syndrome with a hemangioma affecting the neck, chest, or arm only or no cutaneous hemangioma at all. In such cases, fulfillment of additional required criteria would also lead to a possible PHACE diagnosis. These criteria represent current knowledge and are expected to enhance future assessments of PHACE syndrome. It is understood that modifications are to be expected over time to incorporate new research findings.

Mild Alzheimer's disease: a "position paper".

Under the auspices of the Societe Francaise de Geriatrie et Gerontologie, a multi-disciplinary group of specialists in geriatrics, neurology, epidemiology, psychiatry, neuroradiology and nuclear medicine met with the aim of drawing up references on the methods for diagnosing and treating mild Alzheimer's disease. The critical analysis of international literature, conducted by Professor Bruno Vellas for the scientific committee, has served to support study of the latest knowledge in 2008. The multi-disciplinary group met on 14 and 15 May 2008 in order to set out the questions that this study must answer and to allocate draft studies. Thus, it has been possible to conduct a study focused on mild Alzheimer's disease, giving particular attention to diagnostic procedure, specific methods of treatment and the benefits of making a diagnosis.

Dietary Reference Intakes for the Cuban Population, 2008

Recommended dietary reference intakes (DRI) for energy and nutrients for the Cuban population were first established by the Nutrition and Food Hygiene Institute (INHA, its Spanish acronym) in 1996.[1] International organizations and Cuban public health research subsequently generated a considerable volume of new information on food-based energy and nutrient requirements,[2-4] resulting in the need for a revision. Updated DRIs were therefore compiled by a multidisciplinary group of specialists and published in 2008 by INHA and the Cuban Ministry of Public Health.[5,6].

Self-Monitoring of Blood Glucose (SMBG) in Insulin- and Non–Insulin-Using Adults with Diabetes: Consensus Recommendations for Improving SMBG Accuracy, Utilization, and Research

Current clinical guidelines for diabetes care encourage self-monitoring of blood glucose (SMBG) to improve glycemic control. Specific protocols remain variable, however, particularly among non-insulin-using patients. This is due in part to efficacy studies that neglect to consider (1) the performance of monitoring equipment under real-world conditions, (2) whether or how patients have been taught to take action on test results, and (3) the physiological, behavioral, and social circumstances in which SMBG is carried out. As such, a multidisciplinary group of specialists, including several endocrinologists, a health psychologist, a diabetes nurse practitioner, and a patient advocate (the Panel), discuss within this review article how the potential of SMBG might be fully realized in today's healthcare environment. The resulting recommendations cover technological, clinical, behavioral, and research considerations with the aim of achieving short- and long-term benefits, ranging from fewer hypoglycemic episodes to lower complication-related costs. The panel also made suggestions for designing future studies that increase the ability to discern optimal models of SMBG utilization for individuals with diabetes who may, or may not, use insulin.

Patología del suelo pélvico

Fecal and urinary incontinence are frequently associated, together with pelvic organ prolapse. The most important risk factors for pelvic floor disorders are vaginal delivery and chronic constipation. Irrespective of the symptom prompting the patient to seek medical attention and the specialist consulted, symptoms in other compartments must be investigated because patients rarely report them spontaneously. Patients with pelvic floor disorders should be evaluated by a multidisciplinary group of specialists. Complete evaluation includes urodynamics, anal manometry, endoanal ultrasonography and neurophysiologic study of the pelvic floor and is recommended in most patients, given that pelvic floor disorders have a complex and multifactorial pathophysiology and that all anatomic and functional abnormalities must be detected to provide the most appropriate treatment. Conservative treatment resolves or improves the problem in a large proportion of patients with mild-to-moderate symptoms. Surgery should be indicated in selected patients with careful evaluation to identify preoperatively all anatomical and functional defects that can be surgically corrected. The identification of risk factors and better knowledge of the prevalence and pathophysiology of this health problem will allow preventive strategies to be established and improve therapeutic outcomes.

Combined fecal and urinary incontinence: an update

To review last year's literature on combined fecal and urinary incontinence, highlighting the most recent contributions on prevalence, physiopathology, evaluation, and treatment. Prevalence studies of double incontinence are rare but both conditions are frequently associated with pelvic organ prolapse. Vaginal delivery and chronic straining are risk factors for double incontinence, and pudendal neuropathy may be responsible for deterioration of continence. Electrophysiological studies in patients with combined fecal and urinary incontinence are necessary to confirm this hypothesis. Patients with double incontinence should be evaluated by a multidisciplinary group of specialists. A complete evaluation including urodynamics, anal manometry, anal ultrasound and electrophysiologic tests is recommended in most cases. Conservative therapy including pelvic floor exercises combined with bladder training and biofeedback has been demonstrated to be effective. Surgery is indicated in very few selected patients and may be performed simultaneously for both fecal and urinary incontinence. New studies are necessary that focus on identification of other risk factors and preventive strategies before deterioration of continence occurs. Combined fecal and urinary incontinence is not uncommon and its pathophysiology involves multiple factors. These patients should be evaluated by a multidisciplinary group of specialists and offered appropriate measures to improve their quality of life.

Clinical Diagnosis and Management of Alzheimer's Disease, Second Edition

Serge Gauthier, MD, and Martin Dunitz, MD, 386 pp., ill., Malden, MA, Blackwell Science, 1999, $129.95 The objective of the initial edition of this book was to improve the care of patients and families affected by AD by providing a useful source of information to health care professionals who may interact with those affected by this disease. Less than 3 years later, with the increase of data from recent clinical trials, this second edition of the book maintains the same purpose, but includes more up-to-date information on the treatment, stabilization, and prevention of AD. The book is divided into seven sections and includes information about all aspects of the diagnosis and care of patients with AD and their families, such as diagnostic procedures, etiology, case management, community and institutional management, and ethical and legal issues. The chapters are written by an international, multidisciplinary group of specialists, many of whom are leading experts in this field. The authors do a commendable job of presenting an array of information in a useful and practical way. The chapters are brief, but not lacking in essential details. Most chapters are well-referenced, including recent publications and at least brief mention of relevant research. In addition, most chapters contain useful tables for conceptualizing information in a practically oriented way. There is some redundancy across chapters, without cross-referencing in the text, however, the index is helpful in locating overlapping or complementary information contained in different chapters. Within each chapter, information is organized well, although the arrangement of chapters within the book under the specified section headings does not always follow a clearly logical sequence. Nonetheless, information is easy to find and need not be read in chronologic order. Overall, I highly recommend this text as a reference to health care providers, including physicians, nurses, psychologists, social workers, …

JOINT STIFFNESS OF THE UPPER LIMB. Edited by Stephen A. Copeland, Norbert Gschwend, Antonio Landi, and Philippe Saffar. London, Martin Dunitz, 1997. $75.00, 401 pp.

This book is an outgrowth of an instructional course lecture presented at the Fourth Congress of the Federation of European Societies for Surgery of the Hand in Bologna. Its central theme is that the upper limb is unique in its complexity because it provides dexterity and mobility, as opposed to the lower limb, which provides strength and stamina. The editors assembled a multidisciplinary group of specialists to present their experience with the diagnosis, treatment, and rehabilitation …

Canadians Generate Blissymbolic Communication Development

Blissymbolics, a comprehensive core communication system through which non-speaking people are able to communicate, has been developed and made available throughout Canada and the world by the Blissymbolics Communication Institute in Toronto, Canada. In addition, Canadian users of the system have become leaders in helping to increase universal awareness of the intellectual, social, emotional and communication needs of communicatively impaired and disadvantaged people.Charles K. Bliss who was born in Australia and now resides in Australia, originally developed Blissymbolics between 1942 and 1965 as an international communication system to promote better understanding among people. The system was first successfully applied during the early 1970’s by a multidisciplinary group of specialists at the Ontario Crippled Children’s Centre in Toronto to cerebral palsied, school-aged, non-speaking children. This graphic and meaning-based system provided them with a means of more grammatically complete communication than picture or word boards.Since its first application, Blissymbolics has been expanded to many other applications and populations. Today it is used as an augmentative communiation system with cognitive and language development programs to support reading and pre-reading activities. Its users include people who are retarded, multiply-handicapped, autistic, aphasic and stroke victims.As experimentation and the use of Blissymbolics increased during the 1970’s, the need for training programs and instructional materials, for information about ongoing programs, for more symbols and for a structure to maintain a standard form of Blissymbols also grew. In order to meet and co-ordinate these requirements the Blissymbolics Communication Foundation was established in Toronto in 1975. The Foundation, through a licensing agreement with Mr. Bliss, obtained the exclusive mandate to co-ordinate the applications of Blissymbolics with non-speaking people around the world. Its mandate was to maintain symbol standards and to provide training and material for the increasing number of people applying the system with non-speaking people. The Foundation was re-named the Blissymbolics Communication Institute in 1978 to better represent its role as a central, co-ordinating educational organization.