Strong Multidisciplinary Approach Research Articles

A Review of the Current Approach and Treatment Landscape for Stage III Non-Small Cell Lung Cancer.

The therapeutic landscape of the management of stage III non-small cell lung cancer (NSCLC) has drastically evolved with the incorporation of immunotherapy and targeted therapy. Stage III NSCLC accounts for one-third of the cases and the treatment strategy of these locally advanced presentations are diverse, ranging from surgical to non-surgical options; with the incorporation of chemo-immunotherapy, radiation, and targeted therapies wherever applicable. The staging of this disease has also changed, and it is essential to have a strong multidisciplinary approach to do justice to patient care. In this article, we aim to navigate the nuanced approaches in the diagnosis and treatment of stage III NSCLC and expand on the evolution of the management of this disease.

A MULTIDIMENSIONAL MODEL FOR PLACE-BASED EDUCATION THROUGH A CROSS-MEDIA APPROACH AND NEW TECHNOLOGIES. THE T-PLACE PROJECT

Abstract. In the world, Italy, and Tuscany in particular, is the country with the highest number and concentration of UNESCO Heritage sites. To fully understand, preserve and promote the richness of these areas, different research perspectives must be kept together and a proper educational approach to the places is needed to fully valorise this asset, which also has the highest economic value in the tourism industry. The T-PLACE project, funded by the PNR 2021-2027 and currently running at the University of Florence, aims at creating an inclusive and participatory model of cultural education focused on place and its assets, also exploiting new technologies such as the X-Reality and 3D modelling. T-PLACE is grounded on a strong multidisciplinary approach, ranging from Educational Technology to Historical Geography to Geomatics, that will be implemented with a full-range pilot in the surrounding of Florence, in the area of Sesto Fiorentino, of particular interest for its diffused cultural heritage and social testimonies. T-PLACE will actively involve the citizenship in training, documenting, and exploring activities with the objective of encouraging the digital transition in the interpretation of tangible and intangible cultural heritage and contributing to the formation of resilient, inclusive and cohesive societies.

A Family Affair: Addressing the Challenges of Factor H and the Related Proteins.

Inflammation is a common denominator of diseases. The complement system, an intrinsic part of the innate immune system, is a key driver of inflammation in numerous disorders. Recently, a family of proteins has been suggested to be of vital importance in conditions characterized by complement dysregulation: the human Factor H (FH) family. This group of proteins consists of FH, Factor H-like protein 1 and five Factor H-related proteins. The FH family has been linked to infectious, vascular, eye, kidney and autoimmune diseases. In contrast to FH, the functions of the other highly homologous proteins are largely unknown and, hence, their role in the different disease-specific pathogenic mechanisms remains elusive. In this perspective review, we address the major challenges ahead in this emerging area, including 1) the controversies about the functional roles of the FH protein family, 2) the discrepancies in quantification of the FH protein family, 3) the unmet needs for validated tools and 4) limitations of animal models. Next, we also discuss the opportunities that exist for the immunology community. A strong multidisciplinary approach is required to solve these obstacles and is only possible through interdisciplinary collaboration between biologists, chemists, geneticists and physicians. We position this review in light of our own perspective, as principal investigators of the SciFiMed Consortium, a consortium aiming to create a comprehensive analytical system for the quantitative and functional assessment of the entire FH protein family.

Between progress and obstacles in urban climate interdisciplinary studies and knowledge transfer to society.

Cities modify their local climate, and at the same time they suffer from the local impacts of climate change. Our paper discusses the progress and obstacles in three active research topics that contribute to increasing the capability within the urban climate research community for transferring local climate knowledge to society. The first is linked to the production of urban surface descriptions useful for urban climate studies. The concept of local climate zones is now widely used to represent urban climate variability at the neighborhood scale. Land-use, morphological, architectural, and social data are also needed, and those are being gathered using different approaches. The second is linked to the necessity for producing information directly connected to their effects on society. This requires a strong multidisciplinary approach, and nowadays impact studies are not limited to one dimension but instead cover multiple dimensions. The third is to transfer all this information to city practitioners, so that urban climate features are considered, among many other aspects, in city management. For urban planning, cartographic tools have been introduced to include urban climate diagnosis as well as recommendations for future urbanization.

“In Safe Hands” – A costly integrated care program with limited benefits in stroke unit care

Given reported favourable outcomes of accountable care unit models of health care delivery (Taylor et al., 2017; Stein et al., 2015; Kara et al., 2015), the Clinical Excellence Commission of NSW has embraced “In Safe Hands” (ISH) to enhance coordination of care. ISH embraces the structured interdisciplinary bedside round (SIBR) component, for which reported outcomes include reduced length of stay (Taylor et al., 2017; Stein et al., 2015; Kara et al., 2015), possible reduction in overall costs of care (Kara et al., 2015), and enhanced patient and staff satisfaction (O’Leary et al., 2011). It is not yet clear whether the benefits of such a model are translatable to the Australian Health Care System (Hunyh et al., 2016) and/or established units with an already strong multi-disciplinary approach to patient care. The purpose of this prospective cohort study of 200 participants was to assess the effect(s) of implementation of ISH in a stroke unit of a tertiary hospital in Sydney, Australia.Data on length of stay, re-admission rates, adverse events, as well as patient and nursing satisfaction, were collected pre and post implementation.There was no significant difference in length of stay in median days (5 (IQR 2–7) versus 4 (IQR 2–6), P = 0.55) or incidence of adverse events (10% versus 12%, P = 0.82). Stroke outcome disability scores were not affected by the intervention. There were no significant differences overall in reported patient and nursing satisfaction. Implementation of the ISH program cost approximately AUD$ 1805/week (USD$ 1365) in wages.The ISH program was a costly intervention of limited benefit in a well-established acute stroke unit. We here discuss potential reasons for the failure of this intervention to achieve its primary aim in this setting.

Ichthyosis Vulgaris

Ichthyosis Vulgaris

Sickle cell disease: an update on management

Abstract Sickle cell disease (SCD) is a common inherited disease affecting 12–15,000 individuals in the UK with approximately 250 new births per annum. Life expectancy has improved with the majority of those affected now surviving to adulthood, but it is associated with acute and chronic complications including haemolytic anaemia and intermittent episodes of severe bony pain, which may need hospital admission for management. Other acute complications include acute chest syndrome, stroke, priapism, splenic sequestration and red cell aplasia. Individuals with SCD also have an increased risk of infection and may develop renal dysfunction, respiratory complications and bony complications including avascular necrosis. Newborn screening will identify affected individuals and ensures early entrance into comprehensive care, which should include infection prophylaxis and primary stroke prevention by trans-cranial doppler screening. In addition annual review by a specialist team should continue throughout life. Optimal care provision comes from a strong multidisciplinary approach, with easy access to psychological services and an active community support team. With these measures, patients and their families can be educated to manage the minor complications of SCD with minimal impact to their daily lives and to recognize the more serious complications early, allowing quick and effective intervention to reverse the sickling process. Current treatments options are hydroxycarbamide (hydroxyurea), blood transfusion and haematopoietic stem cell transplant.

Ekkehart Krippendorf: una conciencia crítica y despierta

Ekkehart Krippendorff es un politólogo alemán comprometido con la Investigación para la paz, a la que se dedica desde los años sesenta. Su trabajo se basa en un enfoque extremadamente multidisciplinar: Literatura, Filosofía, Música, Historia, Sociología y demás ciencias humanas que enriquecen su discurso crítico y constructivo. Con respecto a la dimensión crítica, ésta se dirige particularmente hacia el Estado y el ejército, a las que considera instituciones basadas en la violencia y desinteresadas del bienestar de los ciudadanos. Su propuesta constructiva se centra en la cultura y en la ética, que nunca pueden estar separadas de la política, como enseñan los filósofos clásicos, desde Sócrates hasta Kant. Por lo tanto, este artículo pretende realizar un aporte al conocimiento social y al campo de reflexiones e investigaciones sobre la paz, teniendo en cuenta que Krippendorff podría considerarse un sobresaliente inspirador para todos quienes quieren entender de qué forma la cultura puede tener un rol importante en la política. Su trabajo resulta, entonces, de enorme pertinencia para comprender y generar acciones en el contexto contemporáneo.

A Review of the Management of Dysphagia

Dysphagia is an impairment of swallowing associated with neurological diseases, including stroke. Identification is vitally important but can be difficult because stroke patients with dysphagia rarely perceive that they have a swallowing problem. Assessments of swallowing are not consistently carried out by medical or nursing staff, and often, there are unclear lines of responsibility as to which patients should be referred to a speech-language pathologist. This study measured the prevalence, assessment, and management of dysphagia in three private rehabilitation clinics in South Africa. Findings indicated a prevalence of dysphagia in 56% of patients following stroke, a number far exceeding previously reported statistics. This number may have been inflated due to conservative swallowing assessments given the subjective measures commonly utilized in South Africa, a product of the often-limited availability of imaging technology. All three clinics evidenced a strong multidisciplinary approach in the care and management of dysphagia patients. These findings highlight the need for increased education of collaboration between speech-language pathologists and nursing staff and support the need for future research in the field of poststroke dysphagia.

The Oxford Handbook of Clinical Pharmacy

In the preface of their 656 pages Oxford Handbook of Clinical Pharmacy, the authors (three clinical pharmacists and a Director of Training at UK Cochrane Centre from Oxford, UK) describe the ancedote of an internationally renowned surgeon (most likely provided by his capable clinical pharmacist) stating that clinical pharmacy was one of the best things anyone had provided him with in his professional career. This illustrates that clinical pharmacy services are only as good as the pharmacists who provide them. Since pharmacotherapy is the most frequently applied medical intervention in current medical practice, many (if not all) physicians are aware of the possibilities and strengths but also of the limitations and risks of prescribing and using drugs. Indeed, clinical pharmacy, aiming at promoting the correct, safe, and appropriate use of drugs, is of great value to both healthcare professionals and patients. In this quick-reference guide meant for practising and student clinical pharmacists and also useful for industrial pharmacists, pharmacy technicians, and community pharmacists, the authors share their long years of experience and they express the wish that the book will contribute to assist clinical pharmacists in fulfilling their potential. Especially during recent years there has been a strong multidisciplinary approach to patient care and the involvement of clinical pharmacists has changed accordingly. Indeed, good collaboration between physicians and pharmacists is essential and of increasing importance. There is no doubt, therefore, that this book should be included in all medical libraries and it will be of particular interest to those physicians involved in multidisciplinary pharmaceutical care, and most certainly to clinical pharmacologists. In 16 chapters topics are organized alphabetically, covering practical information useful for practicing pharmacists on a day-to-day basis. Information on adherence, adverse drug reactions and drug interactions, anaphylaxis, clinial pharmacy skills, clinical trials, controlled drugs, evidence based medicine, herbal medicine, medical gases, patient management, patient specific issues such as drug therapy in children and elderly, pharmaceutical calculations, pharmaceutical care, medicines management and research. The final chapter includes therapy-related issues. It is disease related and includes the management of more than 70 common medical conditions but also gives important background information such as the intrinsic and extrinsic pathways of blood coagulation and basic microbiology. The first 15 chapters are an introduction to clinical pharmacy and give definitions, background information and general reference and methodological (e.g. with regard to clinical pharmacy skills) information. The field is widely covered from medication review to ward and patient etiquette and assertiveness. These chapters will be useful especially for pharmacists starting clinical pharmacy services and pharmacy students. For main topics such as dosing drugs in renal impairment and drugs in pregnancy and lactation, references of standard publications such as The Renal Drug Handbook by Ashley et al. and Drugs in Pregnancy and Lactation by Briggs et al. listing guidelines for specific drugs are included. An introductory chapter on contra-indications and on pharmacogenetics is lacking. Also the chapter on research is limited. Unfortunately, it does not make a strong appeal to clinical pharmacists to practice scientific drug and outcome research and herewith innovate the discipline. In the appendix, tables are presented with normal and pathological laboratory values, drug interference with laboratory tests, therapeutic drug monitoring values in adults and a list of useful websites. A comprehensive index makes it easy to find information throughout the book. In conclusion, this book is an important and well written contribution in the Oxford Handbook series and will prove useful especially for those pharmacists and students developing skills and knowledge in patient orientated pharmacy.

Defining remote health

To develop a definition of the discipline of Remote Health. A broad literature search using key words and an Internet search of industry-recognised web sites were carried out. Fifty-five relevant citations and nine web sites were reviewed, covering Australia, Canada, New Zealand, the United Kingdom and United States. The papers offered a variety of definitions of geographical and practice-based approaches to 'remoteness', and definitions of 'remote and rural health'. None of the single current definitions in the literature adequately reflect all of the characteristics of Remote Health in Australia. A definition is offered: Remote Health is an emerging discipline with distinct sociological, historical and practice characteristics. Its practice in Australia is characterised by geographical, professional and, often, social isolation of practitioners; a strong multidisciplinary approach; overlapping and changing roles of team members; a relatively high degree of GP substitution; and practitioners requiring public health, emergency and extended clinical skills. These skills and remote health systems, need to be suited to working in a cross-cultural context; serving small, dispersed and often highly mobile populations; serving populations with relatively high health needs; and a physical environment of climatic extremes.

Eden chairs AGU Meetings

The earth‐related sciences are in a time of great excitement, and, moreover, we are seeing the advent of a strong multidisciplinary approach to the underlying themes in these sciences, according to H. Frank Eden, the recently appointed AGU Meetings Chairman for 1983 and 1984. He succeeds Martin Walt, who completes his term as Meetings Chairman with the upcoming meeting. Eden and Walt have been working closely on the 1982 Fall MeetingAs senior science associate of the National Science Foundation's Directorate for Astronomical, Atmospheric, Earth, and Ocean Sciences (AAEO), Eden brings to the chairmanship a multidisciplinary approach from AAEO that is akin to AGU's longtime approach to its annual meetings. ‘The broad spectrum of disciplines genuinely interests me. I think the fact that scientists from all these disciplines get together twice each year is unique’ and is one of AGU's major strengths, he said. ‘I don't know any other broad branch of science where this happens.’ The best evidence of this approach at work is the increasing number of papers presented at the AGU meetings; this year's Fall Meeting is the largest AGU meeting ever, necessitating 8 full days of sessions.