Multidisciplinary Management Model Research Articles

Pleural empyema due to Salmonella enterica in a patient affected by lung adenocarcinoma: A clinical case report

During last years, lung cancer treatment has rapidly changed thanks to novel drugs, such as immunotherapy and target therapy. Hence, an improvement of life expectancy, notwithstanding with a higher infectious risk. This is probably due to many factors, such as longer survival and immunosuppression; furthermore, novel drugs could increase infectious risk with different biologic mechanisms. However, correlation between infections and immunotherapy has not been completely clear, although lately has increasingly been described. Salmonella enterica spp is an intracellular facultative anaerobe gram-negative bacillus that can spread to different sites, such as lung and pleura; nevertheless, an association between lung cancer and pleural empyema due to salmonella infection is rarely highlighted in literature and its management is challenging. Hereby we outline the case of a 62-year-old woman affected by extended lung adenocarcinoma who developed salmonella-related pleural empyema during its active oncological treatment with chemo-immunotherapy by describing our multidisciplinary management model.

Diagnostic and therapeutic care pathways of cancer patients: a model of multidisciplinary management and patient-tailored healthcare at University Hospital in Italy

Diagnostic and therapeutic care pathways of cancer patients: a model of multidisciplinary management and patient-tailored healthcare at University Hospital in Italy

Application and effect evaluation of multidisciplinary team management model: On central venous access device associated skin impairment based on Delphi method.

To establish a multidisciplinary management model based on Delphi method to guide nursing practice and reduce the incidence of CVAD-associated Skin Impairment (CASI) in tumor patients. On the basis of literature review and focus group interview, the initial item pool of CASI management model for cancer patients was determined. The Delphi method was used to conduct two rounds of letter consultation with 36 authoritative and representative experts to determine the content and weight of indicators of CASI multidisciplinary management model for cancer patients. Most of the research group were experts with bachelor degree or above. More than 90% of experts have worked for more than 10 years; Areas of expertise include oncology care, venous therapy, wound stomatology, and dermatology. The recovery rate of the two rounds of expert correspondence questionnaire was 100%. The authority coefficient of experts was 0.898, indicating a good degree of authority. Kendall's harmony coefficients were 0.193 and 0.250, with statistically significant differences (p < 0.001). After two rounds of expert letter consultation, a multidisciplinary management model of CASI for cancer patients was initially formed, which included 15 first-level prevention indexes and 38 second-level prevention indexes of CASI for cancer patients. There were 9 first-level indexes and 16 second-level indexes of CASI treatment in tumor patients. Cancer patients based on Delphi method to construct CASI multidisciplinary management model has high reliability and scientificity, multidisciplinary management model in the management of patients with tumor CASI exploration will provide new methods for central venous catheter nursing and the new way of thinking, will also be intravenous fluids will provide a scientific basis for professional development and quality improvement and practical experience.

Prognostic factors and long-term outcomes of obstetric fistula care using the Tanguiéta model.

To identify factors influencing the long-term prognosis after surgical repair of obstetric fistula, establish a prognosis-based classification system, and examine changes in quality of life after surgery. A retrospective study of 308 women who underwent obstetric fistula repair at Saint Jean de Dieu Hospital, Tanguiéta, Benin, between 2008 and 2016, and were supported by a multidisciplinary management model. All participants were from rural areas of Burkina Faso. The women completed interviews before, immediately after, and 2, 4-6, and 12months after surgery to assess their clinical state and socioeconomic and psychologic status. Overall, the fistulae of 230/274 (83.9%) women were considered to be repaired after 12months. Factors associated with poor repair outcome included the presence of sclerotic tissue (odds ratio [OR], 0.25; 95% confidence interval [CI], 0.11-0.53) and intraoperative complications (OR, 0.16; 95% CI, 0.07-0.39). Women with successful surgery had a better quality of life as compared with women with an unrepaired fistula (Ditrovie score, 1.1 vs 3.9; P<0.001). The multidisciplinary Tanguiéta model for management of obstetric fistula allowed successful fistula closure, thereby facilitating the women's long-term social reintegration, and improved quality of life.

Current management of intestinal bowel disease: the role of surgery.

Inflammatory bowel disease (IBD) is a chronic affection, in which the two main phenotypical components are Crohn's disease and ulcerative colitis. In both diseases, medical treatment has the main role; in some phases of the natural history of IBD, surgery becomes an important therapeutic tool. The IBD represents a model of multidisciplinary management. Timing represents the key issue for proper management of IBD patients. For acute and severe IBD, the surgery can be a salvage procedure. Today, the laparoscopic approach plays an important role in armamentarium of the surgeon. Several articles compared the short- and long-term results between laparoscopic and open approaches in IBD. The aim of this review is to focus the role of surgery in IBD as well as the role of laparoscopic approach, and principally, the "state of the art" for surgical treatment, sometimes very challenging for surgeon, in all clinical features of IBD by a review of literature highlighted by the most recent international guidelines.

A multi-disciplinary approach to treating hepatitis C with interferon and ribavirin in alcohol-dependent patients with ongoing abuse

Guidelines recommend 6 months of alcohol abstinence before treating hepatitis C (HCV). Abstinence is difficult for alcohol-dependent patients to achieve. This study evaluated HCV treatment in alcoholic patients with ongoing consumption or less than 6 months of abstinence. A multidisciplinary management model was built by a liver unit and two centers involved in the care of addict patients. Patients were included in a prospective observational study of treatment with pegylated interferon and ribavirin if they presented alcohol dependence with ongoing intoxication or abstinence of less than 6 months. Pre-therapeutic evaluation and follow-up were multidisciplinary, and addiction care was personalized to patient condition and willingness. Alcohol abstinence or reduction was encouraged but not mandatory. The primary end point was sustained virological response (SVR). Results were compared to a control group of patients matched for genotype, viral load, fibrosis stage, sex, and age. A total of 73 patients treated between 2002 and 2008 were included in the study. Intent to treat analysis showed an SVR in 48% (35/73) of patients versus 49% (36/73) of controls. Low viral load and length of abstinence during treatment were independently associated with SVR. During treatment, 20 (27%) patients were abstinent, 23 (32%) had controlled consumption, and 24 (33%) had excessive consumption. At the end of the follow-up, 22 (30%) patients were durably abstinent. A multidisciplinary approach allowed HCV treatment in alcohol-dependent patients with a satisfactory SVR rate and positive effects on addiction behavior.

The Amyotrophic Lateral Sclerosis Center: A Model of Multidisciplinary Management

The Amyotrophic Lateral Sclerosis Center: A Model of Multidisciplinary Management

The role of the clinical psychologist in acute pain management

Psychological factors are associated with difficulties in the management of acute pain. Extension of the model of multidisciplinary management of chronic pain to the management of acute pain can enhance patient care. This article describes the role of the clinical psychologist on the Acute Pain Service (APS) team. The psychologist as a consultant to the anesthesiologist, rather than as a care provider, will be emphasized. It will address (1) the current knowledge of psychological issues that influence the measurement and management of acute pain, (2) types of patient care situations that are likely to benefit from psychological consultation, (3) specific psychological issues that create problems in acute pain management, (4) practical matters related to defining a consultation question, preparing the patient to meet the psychologist, choosing a psychologist, and (5) psychological consultation financial issues.