Multidisciplinary Medical Team Research Articles

My experience of person-centered and personalized care in early-stage primary progressive aphasia.

Primary progressive aphasia (PPA) is a neurodegenerative brain disorder characterized by declining language ability. It is a rare, often young-onset dementia with a devastating impact on the work and personal activities of those affected. At present there is no cure or disease-modifying therapy for PPA nor any way to arrest or slow the underlying progressive brain degeneration. Throughout the course of the condition any treatment must therefore be palliative-designed to manage symptoms and improve the quality of life of the affected person. The majority of those affected receive little or no follow-up care after diagnosis, particularly in the early stage of the disease. There is very little information in the medical literature about person-centered care designed to improve the quality of life of people with PPA written from the perspective of those living with this condition. I received an early and accurate clinical diagnosis of the nonfluent/agrammatic variant of PPA, supported by imaging. I am fortunate to have benefited from exemplary individualized care from a multidisciplinary medical team from the onset of my difficulties with language. In this paper, I discuss my lived experience of all aspects of this personalized and person-centered care, describing how it was founded on shared decision-making and a holistic, dementia-inclusive approach encompassing the physical, mental, emotional, psychosocial and spiritual dimensions of living with an incurable neurodegenerative disease.

Challenges for a perioperative physician – A choking thyroid planned for total thyroidectomy

A large retrosternal goiter is a nightmare for an anesthesiology and a surgeon. A comprehensive history, a thorough clinical examination, pre-operative planning and a close working relationship among multidisciplinary medical teams are prerequisites to prevent adverse events intra-operatively and postoperatively. This case report is about a geriatric patient who presented with progressively enlarged anterior neck swelling for past 30 years associated with orthopnea and dysphagia. Patient underwent awake fibreroptic intubation under topical anesthesia. Thyroidectomy combined with sternotomy was done. Intra-operative and postoperative was uneventful.This case report suggests the use of AFOI in anticipated difficult airway and it’s success.

Clinical Management of Postoperative Growth Hormone Deficiency in Hypothalamic-Pituitary Tumors.

The present review focuses on growth hormone (GH) deficiency in pediatric and adult patients following surgery for hypothalamic-pituitary tumors, with a special emphasis on hormone replacement therapy with recombinant human growth hormone (rhGH). The symptoms and metabolic changes associated with GH deficiency are reviewed, and the potential risks and therapeutic outcomes of rhGH treatment in these patients are discussed. This review emphasizes the importance of rhGH in the normalization of growth in children and the improvement of quality of life (QoL) and metabolic health in adults. Aspects related to efficacy, safety, dosage, duration of treatment, and QoL in this population are analyzed. The need for regular follow-up and dose adjustment to maintain the optimal IGF-I levels in these patients is emphasized, as is the importance of individualized assessment and collaboration with a specialized multidisciplinary medical team to make the appropriate therapeutic decisions. Furthermore, continuous follow-up are necessary to optimize the clinical outcomes in this patient population.

Diagnosis, treatment and management of lipodystrophy: the physician perspective on the patient journey

BackgroundLipodystrophy syndromes are a heterogeneous group of rare, life-limiting diseases characterized by a selective loss of adipose tissue and severe metabolic complications. There is a paucity of information describing the experiences and challenges faced by physicians who have seen and treated patients with lipodystrophy. This study aimed to provide a better understanding of the physician’s perspective regarding the patient journey in lipodystrophy, including diagnosis, the burden of disease, and treatment approaches.MethodsThirty-three physicians from six countries who had seen or treated patients with lipodystrophy were interviewed using a semi-structured questionnaire. Interviews were transcribed, anonymized, and analyzed for themes and trends. Four main themes were developed: (1) the diagnostic journey in lipodystrophy including the disease features or ‘triggers’ that result in the onward referral of patients to specialist medical centers with experience in managing lipodystrophy; (2) the impact of lipodystrophy on patient quality of life (QoL); (3) the use of standard therapies and leptin replacement therapy (metreleptin) in lipodystrophy, and (4) barriers to metreleptin use.ResultsParticipants reported that, due to their rarity and phenotypic heterogeneity, lipodystrophy cases are frequently unrecognized, leading to delays in diagnosis and medical intervention. Early consultation with multidisciplinary specialist medical teams was recommended for suspected lipodystrophy cases. The development and progression of metabolic complications were identified as key triggers for the referral of patients to specialist centers for follow-up care. Participants emphasized the impact of lipodystrophy on patient QoL, including effects on mental health and self-image. Although participants routinely used standard medical therapies to treat specific metabolic complications associated with lipodystrophy, it was acknowledged that metreleptin was typically required in patients with congenital generalized lipodystrophy and in some acquired generalized and partial lipodystrophy cases. A lack of experience among some participants and restrictions to access remained as barriers to metreleptin use.ConclusionsTo our knowledge, this is one of the first studies describing the qualitative experiences of physicians regarding the diagnosis and management of lipodystrophy. Other physician-centered studies may help increase the awareness of lipodystrophy among the wider medical community and support clinical approaches to this rare disease.

Transgender and Gender Diverse Health Care in the US Military: What Dermatologists Need to Know.

The US Military has made considerable strides in providing quality health care to transgender and gender diverse service members (TSMs). Current policies ensure continued military readiness and allow TSMs to receive gender-affirming care while continuing to serve. Dermatologists play an important role in the multidisciplinary medical team required for medical gender transition; however, there is considerable discord between medically necessary procedures for dermatologic gender-affirming care and insurance-covered benefits. Within the scope of dermatology, many of the available procedures currently are not covered by insurance. This article seeks to discuss how military and civilian dermatologists can contribute to gender-affirming care. We also review existing disparities in health care and identify potential areas of improvement.

A case report on rare co-occurrence of invasive ovarian mucinous adenocarcinoma, unilateral renal agenesis, and bicornuate uterus: is it a new triad?

BackgroundConcomitant invasive ovarian mucinous adenocarcinoma, unilateral renal agenesis and bicornuate uterus is a rare combination. Unilateral renal agenesis has been associated with genital anomalies, such as unicornuate and bicornuate uterus. Furthermore, a wealth of studies has reported the association between unicornuate uterus and ovarian anomalies, such as the absence of an ovary or ectopic ovaries, but rarely has there been a combination of the three to the best of our knowledge. The present case report is the first case presentation with a combination of the three syndromes: ovarian mucinous tumor, unilateral renal agenesis, and bicornuate uterus.Case presentationWe report the case of a 17-year-old who presented with abdominal distension. On examination, a CT scan revealed a large multicystic abdominal mass on the right side, with an absence of the right kidney while the left kidney was normal in size, appearance, and position. Intraoperatively, massive blood-stained ascitic fluid was evacuated. Additionally, a large whitish polycystic intra-abdominal mass with mucus-like materials and solid areas was attached to the midpoint of the colon and the right ovary, with visible metastasis to the omentum. The uterus was bicornuate. The mass and omentum were taken for histopathology and a diagnosis of invasive ovarian mucinous cystadenocarcinoma with metastasis to the colon and omentum was made after a pathological report.ConclusionsThe presence of these conditions in the same individual could potentially complicate medical management and fertility considerations. Thus, a need for a multidisciplinary medical team, including gynecologists, urologists, and oncologists, to address their unique needs and provide appropriate treatment and guidance. Further research and case studies are needed to better understand the possible association and implications of these rare co-occurring conditions.

A multidisciplinary obesity registry for Iranian adults: a protocol.

Obesity is a global health challenge due to its high prevalence and increased related morbidity and mortality. Accordingly, creating a platform to enter data on patients with obesity, treatment process and outcome is mandatory. The objective of this registry is to provide such a database regarding Iranian adults with obesity in order to facilitate future research designs and effective decision making to control this condition. After obtaining informed consent from eligible individuals, a practical questionnaire will be used to gather information about basic characteristics, family history, past medical history, regular medications, dietary intakes and other relevant information of adults with obesity. This data along with the results of laboratory tests, physical examination, and anthropometric measurements will be registered into the registry system by trained members of the team during an in-person visit. Patients will undergo a specific treatment plan based on the multidisciplinary medical team's decision. Then, changeable variables and the outcomes of their treatment process will be registered later in the follow-up sessions. This registry aims to provide a comprehensive dataset on the epidemiology, outcomes and management process of obesity to serve as a foundation for later research projects and improve medical approaches toward this condition.

Epidemiology of Musculoskeletal Injuries in Tennis Players During the French Open Grand Slam Tournament From 2011 to 2022.

The epidemiology of musculoskeletal injuries at the Australian Open, Wimbledon, and US Open tennis tournaments has been investigated in recent studies; however, there is no published literature on the incidence of musculoskeletal injuries at the French Open. To describe the incidence, location, and type of musculoskeletal injuries in tennis players during the French Open tournament from 2011 to 2022. Descriptive epidemiology study. A review was performed of all injuries documented by a multidisciplinary medical team during the French Open from 2011 to 2022. All musculoskeletal injuries that occurred during the main draw of the female and male singles or doubles matches were included. Descriptive statistics were used to summarize the data. Injury locations were grouped into regions as well as into upper limb, trunk, and lower limb. In total, there were 750 injuries in 687 tennis players, resulting in a mean of 62.5 injuries per tournament; however, there were no obvious trends in injury incidence over the time frame evaluated. The number of injuries in female and male players was similar (392 vs 358, respectively). The most common injury regions were the thigh/hip/pelvis (n = 156), ankle/foot (n = 114), and spine (n = 103). The most common injury types were muscle-related (n = 244), tendon-related (n = 207), and joint-related (n = 163), and the most affected muscles were the adductors (n = 45), rectus abdominis (n = 38), and lumbar muscles (n = 25). Over the 12-year period from 2011 to 2022 female and male players experienced similar numbers of musculoskeletal injuries, with most injuries occurring in the lower limbs compared with the upper limbs and trunk.

Guideline for cleft lip and palate team approach management

Cleft lip and palate team approach management refers to the goal of achieving good appearance, normal function and mental health for patients with cleft lip and palate, through multidisciplinary cooperation, jointly formulating treatment plans, using surgical reconstruction as the main method, and performing the most appropriate treatment at the best time point. The team is a multidisciplinary medical team, and at least it is recommended to include oral and maxillofacial surgeons, orthodontists, pathological phoneticians, and psychological counselors. This guideline was formally applied by the Society of Cleft Lip and Palate and approved by Chinese Stomatological Association in 2019, and was officially released in 2022. This guideline describes the cleft lip and palate team approach management for Chinese, covering the primary and secondary surgical repair for cleft lip, cleft palate, and cleft alveolar, and orthodontic treatment, speech therapy, nursing, psychology, etc.

Experience of multidisciplinary medical teams on humanistic palliative care in oncology wards: a descriptive qualitative study in Southern China

ObjectivesThis study aimed to explore the experiences of multidisciplinary medical teams in implementing humanistic palliative care within the oncology ward.DesignPurposive and snowball sampling methods were used in this qualitative study,...

Secondary Trimester Pregnancy in Systemic Lupus Erythematosus Patients with Pneumonia: A Case Report

Background. Systemic lupus erythematosus (SLE) is an autoimmune disease that can attack multiple organs and has a high prevalence in women. Due to its treatment and resulting pathological conditions, SLE makes the patient susceptible to infections. Furthermore, physiological changes in the body that occur during pregnancy renders pregnant women with SLE vulnerable to disease exacerbation. Therefore, the management of such cases necessitates the evaluation and intervention of a multidisciplinary medical team.
 Case Presentation. We present the case of a female patient in her second trimester of pregnancy who complained of shortness of breath. The patient has a history of SLE diagnosed five years ago. Within 7 days of treatment, the patient experienced an improvement in symptoms.
 Conclusion. This is a rare case, and we report on the outcomes of treatment and our limitations to ensure better future treatment for pregnant women with SLE to prevent maternal and fetal death.

Updates on the pathophysiology and therapies of chylous pleural effusion: A narrative review

Chylous pleural effusion (CPE) is a milky pleural fluid that contains high levels of proteins, cholesterol, triglycerides, or chylomicrons. The main cause of CPE is disruption of the thoracic duct caused by traumatic or non-traumatic causes. High triglyceride, cholesterol, and/or chylomicron levels confirm the diagnosis. Recognizing the chyle leak site and underlying etiology is critical to the management of this clinical condition. There is no specific consensus on chylothorax treatment. However, a multidisciplinary (medical, surgical, and oncological) team approach is recommended.

Safety of inter-facility transport strategies for patients referred for severe acute respiratory distress syndrome

BackgroundInter-facility transport of patients with acute respiratory distress syndrome (ARDS) in the prone position (PP) is a high-risk situation, compared to other strategies. We aimed to quantify the prevalence of complications during transport in PP, compared to transports with veno-venous extracorporeal membrane oxygenation (VV-ECMO) or in the supine position (SP).MethodsWe performed a retrospective, single center cohort study in Lyon university hospital, France. We included patients ≥ 16 years with ARDS (Berlin definition) transported to an ARDS referral center between 01/12/2016 and 31/12/2021. We compared patients transported in PP, to those transported in SP without VV-ECMO, and those transported with VV-ECMO (in SP), by a multidisciplinary and specialized medical transport team, including an emergency physician and an intensivist. The primary outcome was the rate of transport-related complications (hypoxemia, hypotension, cardiac arrest, cannula or tube dislodgement) in each study groups, compared using a Fisher test.ResultsOne hundred thirty-four patients were enrolled (median PaO2/FiO2 70 [58–82] mmHg), of which 11 (8%) were transported in PP, 44 (33%) with VV-ECMO, and 79 (59%) in SP. The most frequent risk factor for ARDS in the PP group was bacterial pneumonitis, and viral pneumonitis in the other 2 groups. Transport-related complications occurred in 36% (n = 4) of transports in PP, compared to 39% (n = 30) in SP and 14% (n = 6) with VV-ECMO, respectively (p = 0.33). VV-ECMO implantation after transport was not different between SP and PP patients (n = 7, 64% vs. n = 31, 39%, p = 0.19).ConclusionsIn the context of a specialized multi-disciplinary ARDS transport team, transport-related complication rates were similar between patients transported in PP and SP, while there was a trend of lower rates in patients transported with VV-ECMO.

Fourteen Deaths from Suspected Heparin Overdose in an Italian Primary-Level Hospital.

Healthcare-related homicidal cases are not novel within the medical-legal landscape, but investigations are often made difficult with the scarcity of material evidence related to the crime. For this reason, it is necessary to carefully analyze the clinical documentation and employ ancillary forensic resources such as radiology, histopathology, and toxicology. In the presented scenario, the observation of 14 deaths from abnormal bleeding in a First-Level Italian Hospital revealed the administration of massive doses of heparin by a nurse. On behalf of the Judicial Authority, a multidisciplinary medical team investigated the case through the following steps: a thorough review of the clinical documentation, exhumation of the bodies belonging to the deceased patients, performing PMCT and autopsy, and collecting tissue samples for histopathological, immunohistochemical, and toxicological investigations. All the analyzed cases have been characterized by the observation of fatal hemorrhagic episodes not explained with the clinical conditions of the patients, confirmed using autopsy observations and the histological demonstration of the vitality of the lesions. However, due to the limited availability of biological material for the toxicological analysis, the indirect evidence from hematological analyses in hospitalized patients was crucial in demonstrating heparin overdose and its link to the recorded deaths. The present scenario demonstrates the fundamental importance of a multidisciplinary approach to cases of judicial interest related to the healthcare context. Therefore, the illustrated methodologies can be interpreted as an operational framework for similar future cases.

Human Factors Engineering for the Pediatric Hospitalist.

As pediatrics hospitalists, we care for a diverse population of hospitalized children with increasing acuity and complexity in large, multidisciplinary medical teams. In this Method/ology paper, we summarize how human factors engineering (HFE) can provide a framework and tools to help us understand and improve our complex care processes and resulting outcomes. First, we define and discuss the 3 domains of HFE (ie, physical, cognitive, and organizational) and offer examples of HFE's application to pediatric hospital medicine. Next, we highlight an HFE-based framework, the Systems Engineering for Patient Safety model, which conceptualizes how our work system shapes health care processes and outcomes. We provide tools for leveraging this model to better understand the context in which our work is done, which, consequently, informs how we design our systems and processes to improve the quality and safety of care. Finally, we outline the basics of human-centered design and highlight a case study of a project completed in a pediatric hospital setting focused on making rounds more family-centered. In addition, we provide resources for those interested in learning more about HFE.

Вплив булінгу на стан здоров’я дітей та подолання його наслідків в умовах воєнного стану (огляд літератури)

Purpose - to analyze data from the literature on the characteristics of bullying, its impact on the mental and physical health of children, and ways to overcome and prevent the consequences of this condition during the military invasion of Ukraine. For this, a search in scientometric databases was carried out, and a review of modern domestic and foreign medical literature, periodical publications, and official electronic resources was made. A review of the literature was conducted, which showed that the problems of school bullying and the consequences associated with it worsen not only mental and physical health but also have a negative impact on the quality of education of the younger generation. Bullying statistics regarding the number of completed administrative protocols in Ukrainian schools from 2019 to 2023 are given and analyzed. At the same time, human rights organizations noted that bullying was modified and became latent under martial law. It is emphasized that cases of bullying have a causal relationship with mental and physical health in adulthood. It is noted that starting in 2020, our country and the whole world will be celebrating the International Day of Combating Violence and Bullying at School. Forms of bulling, types of aggression and styles of behavior are described. It was noted that one of the important reasons for the spread of bullying is, unfortunately, its ignoring by adults. It is emphasized that children who differ in some way from others suffer most often from bullying.It is noted that under martial law, school bullying occurs more often in relation to temporarily displaced persons. It is emphasized that solving the problem of school bullying is possible through compliance with the principle of comprehensiveness between the administration of the institution, its employees, and parents. The main actors in the field of violence prevention and countermeasures who provide assistance outside educational institutions are listed. It is noted that the help and prevention of bullying consists of teaching the child to resist victimization. The role of the school nurse in the multidisciplinary medical team in overcoming the problems of school bullying and its consequences is noted. Recommendations for searching for information on organizations dealing with bullying issues on the website of the Ministry of Education and Culture of Ukraine are highlighted. It is emphasized that the most effective actions that contribute to reducing the number of cases of violence in the educational environment are systematic educational activities on non-violent behavior, implementation of high-quality preventive programs, and the promotion of anti-bullying policies. No conflict of interests was declared by the authors.

Shared Decision-Making and Cardiovascular Health: A Scientific Statement From the American Heart Association.

Shared decision-making is increasingly embraced in health care and recommended in cardiovascular guidelines. Patient involvement in health care decisions, patient-clinician communication, and models of patient-centered care are critical to improve health outcomes and to promote equity, but formal models and evaluation in cardiovascular care are nascent. Shared decision-making promotes equity by involving clinicians and patients, sharing the best available evidence, and recognizing the needs, values, and experiences of individuals and their families when faced with the task of making decisions. Broad endorsement of shared decision-making as a critical component of high-quality, value-based care has raised our awareness, although uptake in clinical practice remains suboptimal for a range of patient, clinician, and system issues. Strategies effective in promoting shared decision-making include educating clinicians on communication techniques, engaging multidisciplinary medical teams, incorporating trained decision coaches, and using tools (ie, patient decision aids) at appropriate literacy and numeracy levels to support patients in their cardiovascular decisions. This scientific statement shines a light on the limited but growing body of evidence of the impact of shared decision-making on cardiovascular outcomes and the potential of shared decision-making as a driver of health equity so that everyone has just opportunities. Multilevel solutions must align to address challenges in policies and reimbursement, system-level leadership and infrastructure, clinician training, access to decision aids, and patient engagement to fully support patients and clinicians to engage in the shared decision-making process and to drive equity and improvement in cardiovascular outcomes.

May be dysfunction of cellular immunity considered a sign of post-COVID syndrome?

Our aim was to study association between proliferative activity of peripheral blood lymphocytes after COVID, and developing post-COVID syndrome, and to determine whether the cell immunity dysfunction may be regarded as its marker. The retrospective cohort study involved 242 patients (56 males, 186 females, 18 to 85 years old) who contracted new coronavirus infection. Of them, post-COVID syndrome was diagnosed in 180 cases (duration over 3 months). The patients were classified by severity of clinical course of COVID (i.e., presence of acute respiratory disease and pneumonias), and PHA-induced blast transformation of lymphocytes. Along with PHA-induced response, we studied cyclooxygenase (COG)-producing cells by morphological method. Control group consisted of 200 healthy people without any features of coronavirus infection. All patients were questioned and examined by multidisciplinary medical team, dependent on their complaints. We also registered incidence of comorbidities associated with cellular immune deficiency. The patients with post-COVID syndrome exhibited a decrease of PHA-induced lymphocyte proliferation as compared with control group (significant at p 0.01 in cases of acute respiratory infection, and p 0.05 in patients with pneumonia). Activity of COG-producing cells was similar in all groups, independently on presence of post-COVID syndrome. Classification of patients by presence of cellular immune dysfunction (PHA-induced blast transformation 50%) allowed to detect higher activity of COG-producing cells. This enzyme is known to participate in development of inflammation promoting immune deficiency, thus, probably, manifesting in clinical activation of herpesvirus infection following COVID-19. Activity of COG-synthesizing cells was found to be higher in post-COVID syndrome which evolves after middle-severe and severe forms of new coronavirus infection complicated by pneumonias. Chronic inflammation in post-COVID syndrome associated with high activity of COG-producing cells may promote dysfunction of cell immunity, thus being a cause of evolving syndrome, like as its biomarker. Absence of the immune cell dysfunction markers among other post-COVID features leads to decreased registration of post-COVID patients and misinterpretation of the results obtained.

Case report peripheral ulcerative keratitis with nodular scleritis, presents as the primary manifestation of granulomatosis with polyangiitis.

A 38-year-old female complaining of recurrent deep boring pain with redness in her left eye for many years, which was diagnosed as nodular scleritis with peripheral ulcerative keratitis. The patient also has recurrent bouts of epistaxis and in suspicion of GPA laboratory investigations were carried out and later diagnosed. She was started on cyclophosphamide and is currently under maintenance with rituximab. Ocular involvement has been shown to occur in 20-50% of the population in several studies. It causes conjunctivitis, episcleritis, scleritis, necrotizing keratitis, corneoscleral perforation, posterior uveitis, and optic neuritis. The positive C-ANCA and high PR3 autoantibody have high sensitivity and association with GPA. Cyclophosphamide has been shown to be an effective treatment in multiple studies whereas rituximab has been emerging as a new treatment modality for maintenance, which in turn helps in the remission and relapse of GPA cases. Scleritis and peripheral ulcerative keratitis can be the manifestation of a GPA. Careful evaluation, diagnosis, and management with a multidisciplinary medical team, early start of cyclophosphamide, and rituximab have a huge role in decreasing the disease activity and is life-saving.

Complications of Diverticular Disease – a Quick Overview

Diverticulosis is a chronic acquired disease defined by the presence of diverticular protrusions throughout the wall layers of the digestive tract. Colonic diverticular disease is defined as clinically manifest or symptomatic diverticulosis, either by inflammation, diverticular bleeding or segmental colitis. It is a frequent cause of hospitalization in industrialized countries and also makes a major contribution to health care costs. Due to the spread of the Western-style diet, low in fibre and high in processed foods, the prevalence of diverticulosis is now increasing globally. Obesity is a significant risk factor contributing to the increased prevalence of both diverticular disease and diverticulitis and its complications, particularly in the younger population, previously considered to be at much lower risk than the geriatric population. Diverticulitis occurs when one or more diverticula, together with adjacent colonic tissue, undergo an inflammatory process. Approximately 15% of patients who suffer an episode of acute diverticulitis will experience complications, the most common of which is peridiverticular abscess, which can be complicated by peritonitis. Less common complications are colonic lumen stenosis and fistulae. Being a relatively common disease in the general population, with a constantly increasing prevalence, and also a disease with potentially reducible complications, especially in the case of frail patients with multiple comorbidities, it is necessary not only to update the therapeutic strategies, but also to set up multidisciplinary medical teams in which communication between the specialists involved results in a personalised (personalized) approach to each case.