Multidisciplinary Treatment Of Patients Research Articles

The Landmark Series: Multimodal Management of Oligometastatic Sarcoma.

The concept of "oligometastatic" disease suggests the presence of intermediate states between localized disease and widespread metastases, which may be potentially treatable with curative therapeutic strategies. Metastases local therapy (MLT) can be accomplished through various techniques such as stereotactic ablative radiotherapy (SABR), radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation, or surgical metastasectomy. The incorporation of MLT in the multidisciplinary treatment of patients with metastatic sarcoma is complex. Retrospective studies support consideration of MLT for selected patients based on factors such as patient condition, disease biology, histologic type, and disease burden. Decisions regarding type and timing of MLT should be made after multidisciplinary discussion including radiation oncologists, surgical and orthopedic oncologists, medical oncologists, and interventional radiology to explore all options before treatment decsions. All MLT techniques have advantages and disadvantages and should be performed in centers specialized in the care of complex oncology patients where various options can be explored concurrently or sequentially for each patient. Future studies evaluating quality of life and patient-reported outcomes are necessary to adequately align patient goals and optimal outcomes. This article reviews the medical scenarios that may benefit the use of MLT, evaluates the distinct advantages and disadvantages associated with these various techniques, and analyzes the findings from pivotal series to provide a comprehensive understanding of its role in clinical practice.

Multidisciplinary treatment for patients with advanced hepatocellular carcinoma complicated by Vp4 portal vein tumor thrombosis: Combination of atezolizumab and bevacizumab after hepatic arterial infusion chemotherapy and radiotherapy: A case series

Rationale: Various treatments are available for treating hepatocellular carcinoma (HCC). Among HCC, Vp4 portal vein tumor thrombosis (PVTT) has a poor prognosis. There have been reports of treatment with molecularly targeted agents in combination with hepatic arterial infusion chemotherapy (HAIC) and radiotherapy (RT) in HCC patients with Vp4 PVTT, but none with atezolizumab, the immune checkpoint inhibitor. Here, we present cases of unresectable HCC with Vp4 PVTT that were treated with the combination atezolizumab and bevacizumab (Atezo + Bev) after HAIC and RT. The purpose and significance of this study are to research the usefulness to precede HAIC and RT in the treatment of HCC with immune checkpoint inhibitors. Patient concerns: Sixty-six-year-old man, 74-year-old man, 83-year-old man, 69-year-old man, 62-year-old man, and 85-year-old woman were diagnosed with HCC with Vp4 PVTT. Diagnosis: Cirrhosis was classified as Child-Pugh class A or B. HCC was diagnosed as TNM stage IVa or IVb. Interventions: RT for PVTT was performed the same day or the day after HAIC. Atezo + Bev was started at least 1 week after RT was completed. Outcomes: Death was confirmed in 4 of the 6 patients; the median overall survival time was not reached. The survival times of the 4 patients were 18.7, 12.5, 5.1, and 1.7 months. Based on the modified response evaluation criteria in solid tumors criteria, the objective response rate of patients with best tumor response to Atezo + Bev therapy was 66.7%, and that of patients with best response of PVVT to Atezo + Bev was 66.7%. Lessons: These cases showed that in HCC with Vp4 PVTT, HAIC, and RT before Atezo + Bev may be useful to prolong survival.

The role of cytoreductive surgery and HIPEC for the treatment of primary and secondary peritoneal malignancies-experience from a tertiary care center in Germany.

Peritoneal surface malignancies (PSM) are commonly known to have a dismal prognosis. Over the past decades, novel techniques such as cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), and pressurized intraperitoneal aerosol chemotherapy (PIPAC) have been introduced for the treatment of PSM which could improve the overall survival and quality of life of patients with PSM. The decision to proceed with CRS and HIPEC is often challenging due the complexity of the disease, the extent of the procedure, associated side effects, and potential risks. Here, we present our experience with CRS and HIPEC to add to the ongoing discussion about eligibility criteria, technical approach, and expected outcomes and contribute to the evolution of this powerful and promising tool in the multidisciplinary treatment of patients with primary and secondary PSM. A single-center retrospective chart review was conducted and included a total of 40 patients treated with CRS and HIPEC from April 2020 to September 2022 at the University Hospital Münster Department of Surgery. All patients had histologically confirmed primary or secondary peritoneal malignancies of various primary origins. Our study included 22 patients with peritoneal metastases from gastric cancer (55%), 8 with pseudomyxoma peritonei (20%), 4 with mesothelioma of the peritoneum (10%), and 6 patients with PSM originating from other primary tumor locations. Median PCI at time of cytoreduction was 4 (0-25). Completeness of cytoreduction score was 0 in 37 patients (92.5%), 1 in two patients (5%), and 2 in one patient (2.5%). Median overall survival across all patients was 3.69years. Complete cytoreduction during CRS and HIPEC can be achieved for patients with low PCI, for patients with high PCI in low-grade malignancies, and even for patients with initially high PCI in high-grade malignancies following a significant reduction of cancer burden due to extensive preoperative treatment with PIPAC and systemic chemotherapy.

The Effect of Family Nursing Conversations as an Add-on to Multidisciplinary Treatment in Patients with Chronic Non-Cancer Pain: A Quasi-Experimental Trial.

Chronic non-cancer pain (CNCP) is a lifelong condition with radical consequences, calling for management involving patients' families. Interventions based on the family systems nursing framework by Wright and Leahey have proved beneficial in other populations but require investigation in a CNCP population. This trial assumed that family nursing conversations (FNCs) based on the family systems nursing framework would increase patients' and family members' self-efficacy concerning CNCP management. To investigate whether an intervention with FNCs as an add-on to the usual multidisciplinary treatment of CNCP would have an effect on patients' and family members' self-efficacy. Additionally, to investigate any impact on family function, health-related quality of life, anxiety, and depression. The trial applied a prospective non-blinded quasi-experimental design with two comparable groups of patients and family members: a historical control group (HCG) and an intervention group (IG). The intervention was executed by nurses employed at a multidisciplinary pain center in the Capital Region of Denmark. HCG data were collected before the nurses' intervention training. The primary outcome was self-efficacy. Secondary outcomes were family function, health-related quality of life, anxiety, and depression. In total, 58 patients and 85 family members were included. The primary outcome, self-efficacy, detected no statistically significant between-group differences in mean change for patients, p = .990, or family members, p = .765. A statistically significant effect in favor of the IG was found in between-group differences in mean change in patients' behavioral family function, p = .034, and anxiety, p = .031. No statistically significant between-group differences were detected in family members' secondary outcomes. The intervention had no effect on patients' or family members' self-efficacy but a positive effect on patients' behavioral family function and anxiety. The intervention was deeply affected by the COVID-19 pandemic. Hence, any results should be interpreted with caution.

A Retrospective Chart Review Suggests That Coordinated, Multidisciplinary Treatment for Patients with Anorexia Nervosa Improves Odds of Weight Restoration.

The objective of this study was to conduct a secondary data analysis of clinical information documented in the electronic medical record to assess the clinical outcomes of patients who received three different treatment approaches on clinical outcomes for treatment of patients with anorexia nervosa (AN). Historical electronic medical record (EMR) data on patients aged 6 to 80 years diagnosed with AN seen in a healthcare system between 2007 and 2017 were stratified, according to services received, into three groups: Group A (n = 48) received hospital-based services; Group B (n = 290) saw one or two provider types; Group C (n = 26) received outpatient coordinated multidisciplinary care from three provider types. Clinical outcomes [body mass index for adults (BMI), body mass index percentile (BMI%ile) for pediatric patients] defined AN severity and weight restoration. EMR data were analyzed using a generalized mixed-effects model and a Markov Transition model to examine the odds of weight restoration and the change in odds of weight restoration across the number of provider visits, respectively. Patients receiving coordinated multidisciplinary care had significantly higher odds of weight restoration compared with patients receiving hospital-based services only (OR = 3.76, 95% CI [1.04, 13.54], p = 0.042). In addition, patients receiving care from 1 to 2 providers (OR = 1.006, 95% CI [1.003, 1.010], p = 0.001) or receiving coordinated multidisciplinary care (OR = 1.005, 95% CI [1.001, 1.011], p = 0.021) had significantly higher odds of weight restoration per provider visit day compared with patients receiving hospital-based services only. This retrospective chart review supports the coordinated, multidisciplinary care model for the weight restoration in patients with AN in an outpatient setting.

Perceptions regarding the multidisciplinary treatment of patients with severe trauma in Korea: a survey of trauma specialists.

Patients with multiple trauma necessitate assistance from a wide range of departments and professions for their successful reintegration into society. Historically, the primary focus of trauma treatment in Korea has been on reducing mortality rates. This study was conducted with the objective of evaluating the current state of multidisciplinary treatment for patients with severe trauma in Korea. Based on the insights of trauma specialists (i.e., medical professionals), we aim to suggest potential improvements. An online questionnaire was conducted among 871 surgical specialists who were members of the Korean Society of Traumatology. The questionnaire covered participant demographics, current multidisciplinary practices, perceived challenges in collaboration with rehabilitation, psychiatry, and anesthesiology departments, and the perceived necessity for multidisciplinary treatment. Out of the 41 hospitals with which participants were affiliated, only nine conducted multidisciplinary meetings or rounds with nonsurgical departments. The process of transferring patients to rehabilitation facilities was not widespread, and delays in these transfers were frequently observed. Financial constraints were identified by the respondents as a significant barrier to multidisciplinary collaboration. Despite these hurdles, the majority of respondents acknowledged the importance of multidisciplinary treatment, especially in relation to rehabilitation, psychiatry, and anesthesiology involvement. This survey showed that medical staff specializing in trauma care perceive several issues stemming from the absence of a multidisciplinary system for patient-centered care in Korea. There is a need to develop an effective multidisciplinary treatment system to facilitate the recovery of trauma patients.

Relationship between type 2 diabetes and periodontitis

Diabetes and periodontitis are two different chronic diseases that share a bidirectional relationship, with periodontitis being named the sixth complication of diabetes. These two entities have a very high prevalence worldwide becoming a public health problem. Studies have revealed the interaction proposing a multidisciplinary treatment in patients with diabetes and periodontitis, since in both situations there are exacerbated inflammatory processes becoming a powerful set for tooth loss if both or one of them is not controlled and does not receive treatment. More severe periodontitis has been observed in subjects who do not have controlled levels of glycosylated hemoglobin (hAb1c) and this is increased in subjects who do not receive periodontal treatment.

A Systematic Review of Interventions Based on Judeo-Christian Principles for Patients with Substance Dependence.

Substance use disorders have significant consequences for patients and those around them. A qualitative systematic review was conducted to examine the effectiveness of religiosity and spirituality (R/S) interventions based on Judeo-Christian principles during the multidisciplinary treatment of patients with substance dependence disorder. Studies of patients of both sexes, at any age, of any nationality, and from any geographic location who were participating in treatment programs with religious elements explicitly tied to Christianity or Judaism were eligible for inclusion. Other religious interventions were excluded. Seven electronic databases were searched to identify eligible intervention studies published inEnglish until August 2021. Two reviewers independently screened studies and extracted data. JBI tools were used to assess risk of bias. Of 146 articles retrieved for full text reading, fivewere ultimately included in this review published from July 2008 to August 2021. The R/S interventions used in the included studies were music therapy in a religious context, reading of the Bible or Torah, reflexive readings, personal prayer and reflection, and religiously integrated cognitive behavioral psychotherapy with or without a comparison group. Despite the broad search, there were found only a small number of studies and little homogeneity in the data of patients that reported positive impacts of treatments. Well-designed controlled studies are needed to truly investigate the efficacy of Judeo-Christian religious interventions for helping people with substance use problems, so as to strengthen the evidence of the benefits of these type of approaches in the treatment of drug addicts.

Multidisciplinary Treatment of Patients with Progressive Biliary Tract Cancer after First-Line Gemcitabine and Cisplatin: A Single-Center Experience.

Patients with unresectable biliary tract cancer (uBTC) who progress despite first-line gemcitabine plus cisplatin (GC) treatment have limited systemic options with a modest survival benefit. Data are lacking on the clinical effectiveness and safety of personalized treatment based on multidisciplinary discussion for patients with progressing uBTC. This retrospective single-center study included patients with progressive uBTC who received either best supportive care or personalized treatment based on multidisciplinary discussion, including minimally invasive, image-guided procedures (MIT); FOLFIRI; or both (MIT and FOLFIRI), between 2011 and 2021. Ninety-seven patients with progressive uBTC were identified. Patients received best supportive care (n = 50, 52%), MIT (n = 14, 14%), FOLFIRI (n = 19, 20%), or both (n = 14, 14%). Survival after disease progression was better in patients who received MIT (8.8 months; 95% CI: 2.60-15.08), FOLFIRI (6 months; 95% CI: 3.30-8.72), or both (15.1 months; 95% CI: 3.66-26.50) than in patients receiving BSC (0.36 months; 95% CI: 0.00-1.24, p < 0.001). The most common (>10%) grade 3-5 adverse events were anemia (25%) and thrombocytopenia (11%). Multidisciplinary discussion is critical for identifying patients with progressive uBTC who might benefit the most from MIT, FOLFIRI, or both. The safety profile was consistent with previous reports.

SEVERE MUCOSITIS AND ORAL COMPLICATIONS IN A LEUKEMIC PEDIATRIC PATIENT

The aim of this study is to report a case of a pediatric patient with severe oral mucositis, toothache, and gingivitis as a consequence of chemotherapy (CTX) treatment. An 11-year-old female patient diagnosed with acute lymphocytic leukemia was referred to the dentistry service because of suspension of CTX due to oral lesions. The patient reported oral pain and toothache and was not performing oral hygiene tasks. On intraoral examination, there were erythematous, atrophic, desquamative, and ulcerated lesions with pseudomembrane on the tongue and buccal and labial mucosa. There was also gingival bleeding, decayed teeth, and pulp exposure in the upper left first molar. Oral hygiene instructions, prescription of salivary substitute, topical antifungal, and low-level laser therapy were performed. The complete adequacy of oral cavity was assessed. The introduction of dentistry in the multidisciplinary treatment of patients with cancer is extremely important for the prevention, control, and treatment of oral complications from CTX.

Circulating tumour cell gene expression and chemosensitivity analyses: predictive accuracy for response to multidisciplinary treatment of patients with unresectable refractory recurrent rectal cancer or unresectable refractory colorectal cancer liver metastases

BackgroundPatients with unresectable recurrent rectal cancer (RRC) or colorectal cancer (CRC) with liver metastases, refractory to at least two lines of traditional systemic therapy, may receive third line intraarterial chemotherapy (IC) and targeted therapy (TT) using drugs selected by chemosensitivity and tumor gene expression analyses of liquid biopsy-derived circulating tumor cells (CTCs).MethodsIn this retrospective study, 36 patients with refractory unresectable RRC or refractory unresectable CRC liver metastases were submitted for IC and TT with agents selected by precision oncotherapy chemosensitivity assays performed on liquid biopsy-derived CTCs, transiently cultured in vitro, and by tumor gene expression in the same CTC population, as a ratio to tumor gene expression in peripheral mononuclear blood cells (PMBCs) from the same individual. The endpoint was to evaluate the predictive accuracy of a specific liquid biopsy precision oncotherapy CTC purification and in vitro culture methodology for a positive RECIST 1.1 response to the therapy selected.ResultsOur analyses resulted in evaluations of 94.12% (95% CI 0.71–0.99) for sensitivity, 5.26% (95% CI 0.01–0.26) for specificity, a predictive value of 47.06% (95% CI 0.29–0.65) for a positive response, a predictive value of 50% (95% CI 0.01–0.98) for a negative response, with an overall calculated predictive accuracy of 47.22% (95% CI 0.30–0.64).ConclusionsThis is the first reported estimation of predictive accuracy derived from combining chemosensitivity and tumor gene expression analyses on liquid biopsy-derived CTCs, transiently cultured in vitro which, despite limitations, represents a baseline and benchmark which we envisage will be improve upon by methodological and technological advances and future clinical trials.

Combined interdisciplinary treatment of metastatic bone lesions – embolization, biopsy, ablation, and surgery in one operative sitting

Abstract Objective As a result of modern cancer treatment and thereby improved survival, many cancers spread to bone. Bone metastases may cause immobilizing pain and increase the risk of fracture even by inadequate or no trauma. Treatment of these patients should promptly address confirmation of the tumor entity, local control as well as adequate and lasting surgical stabilisation of the affected bone or joint. We present a setup to perform all the above in a single operative sitting. Methods Required imaging is completed before initial consultation. The treatment plan is discussed in an interdisciplinary team according to the primary tumor and thereof resulting survival estimation, the imaging evaluation and patient's expectations and needs. In a single operative setup, the patients are treated by an interventional radiologist and an orthopaedic surgeon in a hybrid operating room. Thus, in one single setup the patient may undergo arteriogram to diagnose hypervascularity of the tumor followed by embolization if needed, CT-guided biopsy, percutaneous radiofrequency or cryotherapy ablation of the metastases for local tumor control and eventually surgical treatment with resection of the tumor, joint replacement or minimally-invasive stabilization as needed. Biopsy results may be discussed at inhouse tumor boards and adjuvant radio- or chemotherapy may be planned for the postoperative course. Results Five combined procedures were performed in 5 patients (3 female, 2 male patients; median age 65 years (range 61–77)) each in one single operative sitting since October 2021. Three patients suffered from metastases of renal cell carcinoma, one each from thyroid carcinoma and breast cancer respectively. Metastases were located in the femoral meta- and diaphysis in 3 cases and in the acetabulum in 2 cases. Median duration of this multidisciplinary intervention was 375 min (251–426). Median length of hospital stay was 5 days (3–10). Median time from referral to definitive treatment was 24 days (17–32). All patients were able to walk with crutches immediately after treatment. No complications occurred. Conclusion Combined multidisciplinary treatment of patients with metastatic bone disease is possible and may be favourable in respect of minimising the number of consultations, anaesthesias and interventions. This should lead to accelerated and pain-free mobilisation, thus maximising the patients’ quality of life.

Long COVID: systemic inflammation and obesity as therapeutic targets

Long COVID: systemic inflammation and obesity as therapeutic targets

210 SALVAGE SURGERY AFTER DEFINITIVE CHEMORADIOTHERAPY FOR CT4 THORACIC ESOPHAGEAL CANCER

Abstract Salvage surgery after curative chemoradiotherapy for cT4 thoracic esophageal cancer is the only treatment that can be expected to cure, but the incidence of postoperative complications is also high, and its indication and timing should be carefully considered. In our hospital, radical chemoradiotherapy was positively performed for cT4 chest esophageal cancer, and salvage surgery was positively performed. Methods We examined 24 salvage surgery cases after chemo radiotherapy for cT4 esophageal cancer, which was conducted at our hospital from April 2012 to June 2018. The effect of treatment is determined after radical chemoradiotherapy. In the case of PR/SD, salvage surgery or salvage surgery is performed after additional chemotherapy. Salvage surgery was actively considered when it was considered resectable and resistant. In cases where CR was obtained, salvage surgery was performed in cases where relapse was observed during the course. Invasion organs were 9 cases of aorta, 11 cases of tracheobronchial, and 4 cases of others. Results No hospital deaths.Postoperative complications were 50%. Pneumonia 21%, anastomotic leak 13%. The period from the start of radical chemoradiotherapy to salvage surgery was 2.2 to 17.0 months (median 3.8 months). Grade 3 was observed in 4 cases. The 3-year OS was 80%, and the 3-year PFS was 43%. The recurrence rate of cT4b (Ao) was 75%, and that of cT4b (tracheobronchial) was 57%. In addition, the recurrence rate was high in the cases that were cN (+) and all the cases had postoperative recurrence in the cases that were pN (+) in the histopathological examination after salvage surgery. Conclusion Since cT4 was down-staged and enabled for radical surgery, dCRT could eventually be a powerful preoperative treatment. There was no death at the hospital, and postoperative complications are considered acceptable.Consideration of multidisciplinary treatment for patients with positive lymph node metastasis is needed. There are not a few cases of pCR, and surgical indications and informed consent are more important.

Combined Surgical/Interventional-Radiological Cytoreduction in a Patient with Disseminated Highly Differentiated Neuroendocrine Ileal Tumor

A combined approach to cytoreduction in a patient with a neuroendocrine tumor G1 the ileum with multiple bilobar metastases G2 in the liver, originally considered as a candidate only for drug therapy, has been demonstrated. The first stage was laparoscopic resection of the ileocecal segment of the intestine, followed by interventional radiological intervention — a two-stage selective transarterial oil chemoembolization of the liver with bleomycin. As a result, 90 % cytoreduction, suppression of clinical manifestations, normalization of chromogranin A and serotonin were achieved. The patient continues to be observed without signs of progression for more than 4 years from the moment of diagnosis. It is shown that multidisciplinary treatment of patient with timely inclusion of interventional-radiological interventions allows achieving long-term favorable results in patients with advanced stage of disease.

Multidisciplinary treatment for patients with chronic kidney disease in pre-dialysis minimizes costs: a four-year retrospective cohort analysis.

Introduction:Chronic kidney disease (CKD) can progress to end-stage renal disease (ESRD), and clinical studies show that this progression can be slowed. The objective of this study was to estimate the costs to Brazil’s public health system (SUS) throughout the course of CKD in the pre-dialysis stage compared to the costs to the SUS of dialysis treatment (DT). Methods:A retrospective cohort study was conducted to analyze clinical and laboratory variables; the outcome analyzed was need for DT. To assess cost, a microcosting survey was conducted according to the Methodological Guidelines for Economic Evaluations in Healthcare and the National Program for Cost Management, both recommended by the Brazilian Ministry of Health for economic studies. Results:A total of 5,689 patients were followed between 2011 and 2014, and 537 met the inclusion criteria. Average costs increased substantially as the disease progressed. The average cost incurred in stage G1 in Brazilian reals was R$ 7,110.78, (US$1,832.06) and in stage G5, it was R$ 26,814.08 (US$6,908.53), accumulated over the four years. Conclusion:A pre-dialysis care program may reduce by R$ 33,023.12 ± 1,676.80 (US$ 8,508.26 ± 432.02) the average cost for each year of DT avoided, which is sufficient to cover the program’s operation, minimizing cost. These results signal to public health policy makers the real possibility of achieving significant cost reduction in the medium term for CKD care (4 years), to a program that disbursed R$ 24 billion (US$ 6.8 billion) for DT in Brazil between 2009 and 2018.

Anesteziolozi u COVID-19 pandemiji - heroji prve linije fronta ili kolateralna šteta? - anesteziolozi u COVID-19 pandemiji

Anesthesiologists are ranked among health professionals that are most often affected by burnout syndrome. A critical view is needed to interpret data published about burnout syndrome among anesthesiologists, keeping in mind differences in methodology. This also causes difficulty to estimate the prevalence of overall burnout, no matter which professional group is studied. Safe anesthesia and surgical care are not available when needed for 5 billion of the world's 7 billion people. During the COVID-19 pandemic, even the countries with the highest numbers of Anesthesia Providers faced anesthesia shortages due to significant workload increases. The highly specialized, multidisciplinary treatment of patients during the pandemic, an increased risk of coronavirus infection, staff shortages, and a lack of equipment imposes a significant physical and cognitive burden on anesthesiologists. Burnout syndrome among healthcare workers during the COVID-19 pandemic is a critical topic. Health care workers and anesthesiologists worldwide reported relevant, work-related psychological pressure, burnout, and somatic symptoms. This fact requires attention as previous studies showed that emotional distress is associated with a long-lasting effect on professionals' health. Increasing the number of anesthesiologists, harmonizing regional, international, and world standards in education and patient safety while addressing the quality of life of anesthesiologists should be our goal, set by The World Federation of Societies of Anaesthesiologists (WFSA), so that by 2030, safe anesthesia will be available to all the people in the world.

Evidence-based nipple-sparing mastectomy in patients with higher body mass index: Recommendations for a successful standardized surgery

Nipple-sparing mastectomy is used with increasing frequency in the multidisciplinary treatment of patients with operable breast cancer. This technique allows to remove the entire glandular tissue preserving the skin envelope and the nipple-areola complex. Common indications to nipple-sparing mastectomy include extensive or multicentric disease, inability to obtain clear surgical margins with breast conserving-surgery, large tumor size with respect to the breast size, as well as cases with contraindications for radiotherapy as well as patient preference. Higher body mass index may cause longer operative times and increased risk of complications such as nipple-areola complex and skin flap ischemia. Repetitive performance of standardized tasks could optimize oncological and aesthetic outcomes and increase the chance of success.

Saúde bucal e doença de Alzheimer

A etiologia da doença de Alzheimer é desconhecida e pode haver influência de alguns fatores, tais como sexo, histórico familiar, idade avançada, grau de escolaridade, doença cerebrovascular, traumas cerebrais decorrentes de quedas, tumores e ocupação profissional. A doença apresenta três fases: inicial, moderada e avançada. O objetivo do presente artigo foi evidenciar as repercussões no âmbito bucal, que ocorrem em decorrência da doença de Alzheimer e de sua evolução. Foi realizado levantamento bibliográfico de estudos acerca da saúde bucal em indivíduos portadores da doença de Alzheimer. Na literatura tem sido evidenciado que a higienização bucal nesses pacientes é precária, uma vez que eles perdem a capacidade de desenvolver o autocuidado, à medida que a patologia avança. Nesse contexto, o papel desempenhado pelos familiares e pelos cuidadores é de extrema importância. Além disso, entre os recursos disponíveis para tratamento multidisciplinar nos pacientes com doença de Alzheimer, o tratamento odontológico figura com papel de destaque, em razão, principalmente, dos possíveis episódios de sintomatologia dolorosa de origem dentária, que podem ocorrer e podem passar despercebidos, tornando bastante dificultoso o tratamento a posteriori.

Relationship between Continuity of Care in the Multidisciplinary Treatment of Patients with Diabetes and Their Clinical Results

Multidisciplinary treatment and continuity of care throughout treatment are important for ensuring metabolic control and avoiding complications in diabetic patients. This study examines the relationship between continuity of care of the treating disciplines and clinical evolution of patients. Data from 1836 adult patients experiencing type 2 diabetes mellitus were analyzed, in a period between 12 and 24 months. Continuity was measured by using four well known indices: Usual Provider Continuity (UPC), Continuity of Care Index (COCI), Herfindahl Index (HI), and Sequential Continuity (SECON). Patients were divided into five segments according to metabolic control: well-controlled, worsened, moderately decompensated, highly decompensated, and improved. Well-controlled patients had higher continuity by physicians according to UPC and HI indices (p-values 0.029 and &lt;0.003), whereas highly decompensated patients had less continuity in HI (p-value 0.020). Continuity for nurses was similar, with a greater continuity among well-controlled patients (p-values 0.015 and 0.001 for UPC and HI indices), and less among highly decompensated patients (p-values 0.004 and &lt;0.001 for UPC and HI indices). Improved patients had greater adherence to the protocol than those who worsened. The SECON index showed no significant differences across the disciplines. This study identified a relationship between physicians and nurse’s continuity of care and metabolic control in patients with diabetes, consistent with qualitative findings that highlight the role of nurses in treatment.