Role Of Multidisciplinary Team Research Articles

The UK consensus supporting effective introduction of novel treatments for multiple myeloma in the National Health Service

AbstractIntroductionMultiple myeloma (MM) is a relapsing, debilitating blood cancer which remains incurable despite advances in treatments. Patients typically receive multiple lines of treatment, to which they become refractory, thereby limiting treatment options. B‐cell maturation antigen (BCMA) bispecific antibodies (BsAbs) represent a novel modality of treatment that has significant efficacy for relapsed or refractory patients.The objective was to develop consensus statements for the effective implementation of BCMA BsAbs for relapsed or refractory MM patients within the National Health Service (NHS).MethodsThe process employed a modified Delphi methodology. In March 2023, a literature review on the topic of novel treatments for MM was performed using the PubMed database.The process employed a modified Delphi methodology. Following a literature review, a steering group of eight expert clinicians identified and agreed on five main topics of focus and 44 statements. These were then developed into an online survey which was distributed to healthcare professionals working in Levels 1, 2 and 3 haematology centres in the United Kingdom. Results were then shared with the expert panel to determine conclusions. The threshold for consensus agreement was set at 75%.ResultsA total of 60 responses were received from all three centre levels. There was representation from all targeted centres. Consensus was achieved in 42 statements (95%) across three broad areas: the patient profile, initiation and step‐up dosing, monitoring and ongoing care, the role of multidisciplinary team and service designs for optimal management, consensus was not achieved for two statements. Given the level of agreement and that the stopping criteria were met, it was decided not to undertake further Delphi rounds.ConclusionThis consensus provides a framework to support the effective introduction of novel treatments for MM in the NHS. The results were used to inform a checklist for use within haematology services when considering the provision of MM care specific to BCMA BsAbs.

Preventing and Treating Diabetic Foot Infections

Diabetic foot infections (DFIs) represent a significant complication of diabetes mellitus, contributing to morbidity, prolonged hospital stays, and increased healthcare costs. This paper explores the epidemiology, pathophysiology, and clinical presentation of DFIs, while emphasizing strategies for prevention and treatment. Comprehensive care, including glycemic control, patient education, proper footwear, regular foot examinations, and early intervention, is critical. Treatment options span from conservative measures like antibiotics to surgical interventions. Emerging therapies and the role of multidisciplinary teams in managing DFIs are also discussed.

Nutrition's Role in Quality Healthcare in the United States: Opportunities and Education for Pharmacists to Take a Bite of the Apple and Strengthen Their Skills.

With global chronic disease rates on the rise, diet and nutrition remain pivotal yet under-appreciated aspects of healthcare, including in pharmacy practice. This perspective paper delves into how current United States health policies support nutrition's role in healthcare and its integration into pharmacy practice. The paper also reviews the landscape of nutrition education and training for pharmacists, pharmacy roles in multidisciplinary teams and interprofessional nutrition care, and the opportunities for post-graduate nutrition-focused certification, training, and continuing education. It advocates for a paradigm shift towards greater emphasis on nutrition within pharmacy practice, to improve skills and benefit quality patient nutrition care.

Nurture clinic: Promoting mental health of children and adolescents.

Nurses play an important role in multidisciplinary teams while treating children and adolescents with mental health issues. Nurses should recognize and capitalize on the client's and family's strengths as they develop interventions, provide education, and refer to resources as appropriate. It is a mixed-method research, with an initial qualitative phase of obtaining data by in-depth interviews of parents on caring for children and adolescents with mental illness followed by quantitative assessment of the level of care dependency and implementation of need-based nursing interventions to the children and adolescents with mental illness. A total of 235 boys and 123 girls received the interventions. The majority of them (51.4%) were boys aged between 6 and 12 years and the highest diagnosis was attention deficit and hyperactivity disorder (ADHD) (34%). The need-based interventions required were nutrition (90%), prevention of injury and infection (83%), and positive and productive engagement (80%). Other interventions included self-care, physical activity, and medication. Need-based nursing interventions help in promoting the mental health of children and adolescents. This approach may be extended to primary care facilities and community mental healthcare by nurses.

Left Atrial Appendage Occlusion: British Cardiovascular Intervention Society and British Heart Rhythm Society Position Statement.

Percutaneous left atrial appendage occlusion aims to reduce the risk of stroke in patients with AF, particularly those who are not good candidates for systemic anticoagulation. The procedure has been studied in large international randomised trials and registries and was approved by the National Institute for Health and Care Excellence in 2014 and by NHS England in 2018. This position statement summarises the evidence for left atrial appendage occlusion and presents the current indications. The options and consensus on best practice for pre-procedure planning, undertaking a safe and effective implant and appropriate post-procedure management and follow-up are described. Standards regarding procedure volume for implant centres and physicians, the role of multidisciplinary teams and audits are highlighted.

Left Atrial Appendage Occlusion: British Cardiovascular Intervention Society and British Heart Rhythm Society Position Statement.

Percutaneous left atrial appendage occlusion aims to reduce the risk of stroke in patients with AF, particularly those who are not good candidates for systemic anticoagulation. The procedure has been studied in large international randomised trials and registries and was approved by the National Institute for Health and Care Excellence in 2014 and by NHS England in 2018. This position statement summarises the evidence for left atrial appendage occlusion and presents the current indications. The options and consensus on best practice for pre-procedure planning, undertaking a safe and effective implant and appropriate post-procedure management and follow-up are described. Standards regarding procedure volume for implant centres and physicians, the role of multidisciplinary teams and audits are highlighted.

The national profile of the prosthetic and orthotic workforce in the UK: Sociodemographics and employment characteristics.

Prosthetists and orthotists (POs) are essential members of the health care workforce and one of the United Kingdom's (UK's) allied health professions. There is a paucity of information on their demographics, which is essential for the development of the profession. To fill this void, this study has attempted to comprehensively explore the sociodemographics and work-related characteristics of the entire workforce. Data were collected in 2022 through multiple sources, including surveys of POs, private companies employing POs, and freedom of information requests to National Health Service Trusts/Health Boards and higher education institutes offering programs leading to registration as a prosthetist/orthotist. The workforce survey had 641 respondents (74% response rate). The estimated national ratio of POs per million population was 13, with all bar of the 12 regions below the World Health Organization minimum recommendation of 15 POs per million population. Most of the survey respondents were female (47.6%) and younger than male respondents, were British (75.8%), and in the White ethnic group (74.3%). Most of them were employed by private companies (59.9% vs. 31.4% employed by the National Health Service) and had clinical duties (94%), permanent contracts (90%), worked full-time (75%), and treated a wide range of clinical conditions. The national UK prosthetist and orthotist ratio falls below the recommended international standards. The versatility and broad skill set of POs highlight their crucial role in multidisciplinary teams. Establishing a centralized prosthetist and orthotist workforce database system is recommended for data-driven strategic planning.

Impact of the Multidisciplinary Cancer Team on the Diagnostic and Therapeutic Care Pathway of Early Breast Cancer Patients and Perception of Team Members: The Experience of a Cancer Centre in Italy

Literature on the role of multidisciplinary team (MDT) in cancer is still controversial. We aimed to investigate MDT impact on a panel of indicators in breast cancer care in a single-center retrospective study performed in a Cancer Reference Center in Italy. We analysed the diagnostic and therapeutic care pathway (DTCP) of 266 early breast cancer patients managed by our MDT during 2019-2020. Process indicators reflecting the change of the diagnostic and therapeutic care pathways occurred after the MDT discussion were computed. Further, the performance of some quality care indicators in breast cancer care since the establishment of the MDT activity and the breast cancer MDT members’ perceptions were also investigated. According to our study, the MDT approach improves breast cancer management by increasing the completion of staging and by encouraging neo-adjuvant treatment and an appropriate and faster surgery. In MDT members’ perspective it also improves decision-making and training and creates a positive work environment. Globally, our study encourages MDT rollout in breast cancer care. However, to enhance the reliability and comparability of the results of studies investigating MDT effectiveness in clinical practice, shared guidelines on its operationalisation are strongly desirable.

Multidisciplinary perspectives on roles of hospital pharmacists in tertiary settings: a qualitative study.

In today's complex healthcare landscape, exacerbated by resource constraints at various levels, optimization of health professionals' roles is becoming increasingly paramount. Interprofessional collaboration, underpinned by role recognition and teamwork, leads to improved patient and organizational outcomes. Hospital pharmacists play a pivotal role in multidisciplinary teams, and it is imperative to understand multidisciplinary viewpoints on hospital pharmacists' roles to guide role prioritization and organizational efficiency. However, no study extensively investigated multidisciplinary views on values of diverse pharmacist roles in tertiary settings. This study aims to address this gap by examining non-pharmacist health professionals' views on hospital pharmacists' roles, recognizing their specialized niches as a crucial step towards optimizing their roles and services in Australia and internationally. Multiple focus group discussions and interviews were held via a virtual conferencing platform. Study participants were recruited using the study investigators' professional networks who were non-pharmacist health professionals with experience working with pharmacists in hospital settings. Data were collected from transcripts of the focus group recordings, which were later summarized using descriptive statistics and thematic analysis. Overarching themes were categorized and mapped against work system models to conceptualize organizational implications of multidisciplinary feedback, linking them to patient and organizational outcomes. Twenty-seven health professionals participated across focus groups and interviews, with the majority of professions being doctors and nurses. Three major themes were identified as follows: (i) overarching perceptions regarding hospital pharmacists; (ii) professional niches of hospital pharmacists; and (iii) future opportunities to optimize hospital pharmacy services. Valued professional niches included patient and health professional educators, transition-of-care facilitators, and quality use of medicines analysts. The study highlights critical insights into hospital pharmacists' roles in Australia, identifying their niche expertise as vital to healthcare efficiency and success. Based on multidisciplinary feedback, the study advocates for strategic role optimization and targeted research for enhanced clinical, economic, and organizational outcomes.

Social work scope of practice with Parkinson's disease: A qualitative study

Summary The field of social work has seen increased recognition across many sectors in recent years. Evolving racial, political, and medical paradigms and the COVID-19 pandemic have shown the importance of a person-centered approach to health and mental health. One such area of practice is neurology, specifically work with people with Parkinson's disease (PD), which is the second most common neurodegenerative disease, currently impacting more than 10 million people worldwide. While social workers have long played key roles in multidisciplinary teams in PD care settings, research and literature offering assessment and evidence in this area remain limited. This research study used a mixed-methods approach with additional in-depth qualitative interviews conducted with 11 social workers. This article presents findings from the 11 interviewees who are presently working with people with PD using thematic analysis. Findings Themes emerging were an in-depth detailed role of the social worker, the importance of strong relationships working with people with PD and their families, multidisciplinary teams, and the community. Institutional challenges were highlighted concerning supporting social work positions and encouraging social work intervention from the beginning of diagnosis to the end stages of the disease. COVID-19 proved very challenging for social workers, multidisciplinary teams, and families, and yet positive practices were identified as well. Applications The impact of this study reinforces the essential role specialized PD social workers play in multidisciplinary PD teams and recognition needed to increase their role through early intervention reflected in increasing social work positions in neurology.

Comprehensive Review of Anesthetic Evaluation and Management in Obese Female Patients Undergoing In Vitro Fertilization.

Obesity has become a global health epidemic with profound implications for various medical specialties, including reproductive medicine. This comprehensive review focuses on the anesthetic evaluation and management of obese patients undergoing in vitro fertilization (IVF) procedures. Obesity, as defined by BMI, is associated with infertility and poses unique challenges for anesthetic care. The review also addresses the timing of anesthesia concerning IVF procedures, the impact of obesity on IVF success rates, and the importance of emotional and psychological support for obese patients undergoing IVF. Challenges and future directions in the field are highlighted, focusing on ongoing research, emerging technologies, and the role of multidisciplinary teams in managing these complex cases. In conclusion, this review underscores the critical role of tailored anesthesia and perioperative care in optimizing outcomes for obese patients undergoing IVF. It provides valuable insights for anesthetic providers, reproductive specialists, and healthcare teams, emphasizing the need for a patient-centered approach to address the unique challenges posed by obesity in the context of assisted reproductive technology.

Role of multidisciplinary team in management of unresectable HCC: Opportunities that exist today

Hepatocellular cancer (HCC) is one of the most common and, at the same time, little-known gastrointestinal oncopathologies in wide clinical practice. HCC ranks 5th in the world in the structure of oncological morbidity and 3rd in cancer mortality. HCC accounts for 70–85 % of all primary liver tumors. The involvement of doctors from various specialties is considered the most effective approach to cancer treatment in today’s dynamic and complex healthcare system. One of the nosologies where the introduction and application of a multidisciplinary consultation system is extremely important is HCC, because a large number of clinicians of various specialties are involved in the treatment of these patients. The effectiveness of an interdisciplinary approach in patients with HCC has been confirmed by clinical studies. However, the creation of such multidisciplinary consultations for patients with HCC has quite objective difficulties: A low percentage of curable patients at the time of detection of this disease and diagnosis, either due to the initially disseminated tumor process, or due to the initially low functional status of these patients. Overcoming these obstacles and creating such teams, their wide replication and integration into clinical practice will increase the number of patients detected at earlier stages and naturally improve the immediate and long-term results of treatment of such patients

The Fifth United Arab Emirates Obesity Conference, November 4–5, 2023, Abu Dhabi, UAE

AbstractThe Fifth United Arab Emirates Obesity Conference was held from November 4 to 5, 2023, in Dusit Thani, Abu Dhabi, UAE. The theme of the conference was “What can we do better in obesity management?” The program included several didactic lectures and a question-and-answer time separately or grouped thematically. Over 2 days, the speakers covered the burden, definitions, and evaluation of obesity, including uncommon chromosomal and genetic syndromes associated with obesity in appropriate cases. It highlighted the importance of policy changes for public health improvement and prevention of obesity, the role of multidisciplinary teams in managing persons with obesity holistically, and present and future therapies, including personalized precision medicine backed up by science.

What’s New in Prevention of Invasive Fungal Diseases during Hospital Construction and Renovation Work: An Overview

The goal of the overview was to give insight into the recent data of invasive fungal diseases (IFDs) associated with construction and renovation in healthcare settings as well as the recent evidence about available prevention and infection control measures. The number of studies describing IFD outbreaks associated with construction or renovation is on the rise again. Applying adequate prevention measures is still a challenge not just for healthcare workers but also for architects and construction workers as well. The role of multidisciplinary teams in the planning and monitoring of prevention measures cannot be overemphasized. Dust control is an inevitable part of every prevention plan. HEPA filters are helpful in the prevention of fungal outbreaks in hematologic patients, but further studies are needed to clarify the extent in which they contribute as specific control measures. The cut-off value for a "threating" level of fungal spore contamination still remains to be defined. The value of antifungal prophylaxis is difficult to assess because other preventive measures are simultaneously applied. Recommendations are still based on few meta-analyses, a large number of descriptive reports, and the opinion of respective authorities. Outbreak reports in the literature are a valuable resource and should be used for education as well as for preparing outbreak investigations.

Exploring Failure Orientation : Its Mediating Role in Multidisciplinary Teams of the Petroleum Industry

Several factors that affect team effectiveness are listed in the literature on teams. This paper identified a new construct, failure orientation, which measured the collective capacity of a team to cope, learn, and develop from team failures. Qualitative research identified some interesting features of the failure orientation concept and its mediating role in teams input-mediator-output-input (I-M-O-I) model. The context was set in the Indian upstream petroleum industry, where failures are quite normal in oil-field operations. Learnings from such failures helped teams move forward to success in finding and producing crude oil and natural gas. The research methodology of conducting in-depth interviews of senior team leads and team members in two Indian public sector petroleum exploration companies was 80% of the industry activity. The findings enabled the development of a conceptual framework of failure orientation, which is a vital determinant of team effectiveness. The paper identified three categories (factors) of failure orientation for operationalizing this new construct: failure orientation in such multidisciplinary teams, that is, escapism, blame game, and collective analysis. The paper also positioned these as mediators in the I-M-O-I model of teams. Operationalization of the new construct would help practicing managers deal with teams encountering failures, which are frequent in this economically-vital petroleum industry. Further research with factor analysis could enrich the team literature significantly.

Critical Care Nurses' Knowledge, Attitudes, and Practices Regarding Pressure Injury Treatment: A Nationwide Cross-Sectional Survey.

Pressure injury is a common problem in intensive care units. Critical care nurses play an important role in multidisciplinary teams performing pressure injury treatment. Identifying the clinical status of pressure injury treatment may contribute to improving care quality. To identify the knowledge, attitudes, and practices regarding pressure injury treatment in critical care nurses. A cross-sectional survey. Secondary data were extracted from a multicenter clinical trial. Knowledge and attitudes toward pressure injury treatment were assessed through a self-administered eight-item questionnaire. The observed practices were recorded using a case report form. The report was in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement. A total of 950 critical care nurses in 15 hospitals from six provinces/municipalities of China were investigated. The mean knowledge score was 2.89 ± 1.16 (95% confidence interval: 2.82-2.97) out of a possible total of 5 points. The correct rates of selecting wound dressings and pain management were 34.4% and 45.6%, respectively. The mean attitude score was 9.07 ± 1.09 (95% confidence interval: 9.00-9.13) out of a possible total of 12 points. A total of 2092 patient days of pressure injury treatment practices were observed and recorded. Repositioning was the most commonly employed treatment measure (98.8%). Foam dressing was the common dressing for stage I (53.6%), stage II (47.5%), and more severe pressure injury (67.9%), including stage III, IV, unstageable, and suspected deep tissue injury. Critical care nurses exhibited a generally low level of knowledge and moderate attitudes regarding pressure injury treatment. Practices of pressure injury treatment were generally acceptable.

Continence management in children with severe caudal regression syndrome: role of multidisciplinary team and long-term follow-up.

Caudal regression syndrome (CRS) is a rare congenital abnormality including orthopedic deformities, urological, anorectal, and cardiac malformations. The clinical spectrum of CRS varies in severity, therefore multiple surgeries and complex medical care may be required with the efforts and support of a multidisciplinary team to ensure the most accurate treatment and the best outcome. The aim of our retrospective study was to evaluate the role of a multidisciplinary treatment and the long-term outcome in patients with severe CRS. Clinical, surgical and psychological data were collected for all patients with diagnosis of CRS, treated at our Pediatric Hospital from January 1995 to December 2020. Patients with a severe form of CRS according to Pang's classification were included in the study. All patients have been followed by a multidisciplinary team composed by urologists, neurosurgeons, neonatal and digestive surgeons, orthopedic surgeon, physiatrists and psychologists. On admission, patients were screened for CRS with sacrum, spine and legs X-ray, spine MRI, renal ultrasound, voiding cystography and urodynamic, and renography. Clinical data about bowel function were evaluated. During the study period, 55 patients with CRS were treated at our Institution. Six out of 55 (10.9%), presented with severe form of CRS (5 pts with type 1; 1 pt, with type 2) and represent our study group. Diagnosis of severe CRS was made at birth because of the typical deformities of the pelvis (fusion of the iliac wings), and of the lower extremities (undeveloped legs with flexion of the knees, clubfoot). All patients presented with neurogenic bladder, 4/6 (66.6%) with vesicoureteral reflux (VUR) and 2/6 (33.3%) with renal agenesia and contralateral ectopic hypoplastic kidney. Bowel symptoms occurred in 5/6 pts (83.3%). All patients were started with an earlier clean intermittent catheterization (CIC) regimen. In 3 patients oxybutynin has been effective or well tolerated, while in other 3 onabotulinumtoxin A has been used. Vesicoureteral reimplantation has been performed in 1 patient, 2 required endoscopic treatment of VUR. On long-term, 2 patients required bladder augmentation with ileum and appendicostomy (Mitrofanoff). Low adherences in CIC have been observed in three patients, mainly at puberty. Two patients presented with chronic renal failure. One patient reported suicide proposal. Regarding social life, only one is regularly performing sport activity. CRS is characterized by maldevelopment of the caudal half of the body with variable involvement of the gastrointestinal, genitourinary, skeletal, and nervous systems. Management of CRS includes a wide variety of interventions to address the full spectrum of possible anatomical abnormalities. Hence, a multidisciplinary team is also mandatory for a correct bladder and bowel management, in order to maintain continence and preserve renal function, improve quality of life and increase self-esteem.

Diagnostic and treatment of secondary chondrosarcoma of the femur with multiple recurrences. Case report

Chondrosarcoma is one of the most common tumors in adults. Resectable chondrosarcomas requires surgical treatment, and tend to local recurrence, often repeatedly.A case report of a 38 years old female patient with secondary chondrosarcoma of femur is presented. The role of multidisciplinary team in tactic choice of primary treatment and recurrence treatment is shown.

The Role of the Multidisciplinary Health Care Team in the Management of Patients with Systemic Sclerosis.

Systemic sclerosis (SSc) is a rare connective tissue disease characterised by immune dysfunction, vascular damage and fibrosis affecting the skin and multiple internal organs. The clinical spectrum of SSc is wide and its manifestations may lead to severe morbidity and mortality, in addition to a great impact on patients’ quality of life. Due to the multifaceted clinical manifestations of SSc, its management requires a combined expertise of different medical specialists to guarantee an adequate disease control and prevent organ complications. Multi-disciplinary teams (MDT), which are composed by physicians and other specialized health professionals, represent therefore a key element for the comprehensive management of SSc patients. Moreover, MTD can improve communication and patients’ empowerment while the presence of dedicated nurses can help patients to ask questions about their condition. The scope of this narrative review is to analyse the available evidences regarding the role of MDT in the management of SSc patients, and how this holistic approach may improve different disease domains and the overall prognosis. MDT regarding the cardiovascular and lung complication are the more represented in literature, given the great impact in prognosis. Nonetheless, MDT have been shown to be fundamental also in other disease domains as they can intercept early manifestations, thus stratifying patients based on the individual risks in order to personalize patients’ follow-up. MDTs may also minimize the treatment delay, enabling fast-track specialist referral. On the other hand, there are few trials specifically studying MDT in SSc and several authors have highlight the lack of standardization.

The role of multidisciplinary team in breast cancer patients

Breast cancer has become a significant health problem worldwide being one of the most commonly diagnosed malignancies especially due to the wild implementation of screening tests and genetic counselling. Therefore attention was focused on improving the therapeutic strategies in such cases and to offer for each patient the chance of a personalized treatment. In this respect specialized teams have been organized in which each case is discussed and the final decision is transmitted to the patient. That is how the concept of multidisciplinary team developed. The aim of the current paper is to discuss about the concept and benefits of the multidisciplinary meetings in breast cancer patients.