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Multidisciplinary Interventions (multidisciplinary + intervention)
Selected AbstractsA Randomized, Controlled Trial of Comprehensive Geriatric Assessment and Multidisciplinary Intervention After Discharge of Elderly from the Emergency Department,The DEED II StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2004FRACP, Gideon A. Caplan MBBS Objectives: To study the effects of comprehensive geriatric assessment (CGA) and multidisciplinary intervention on elderly patients sent home from the emergency department (ED). Design: Prospective, randomized, controlled trial with 18 months of follow-up. Setting: Large medical school,affiliated public hospital in an urban setting in Sydney, Australia. Participants: A total of 739 patients aged 75 and older discharged home from the ED were randomized into two groups. Intervention: Patients randomized to the treatment group underwent initial CGA and were followed at home for up to 28 days by a hospital-based multidisciplinary outreach team. The team implemented or coordinated recommendations. The control group received usual care. Measurements: The primary outcome measure was all admissions, to the hospital within 30 days of the initial ED visit. Secondary outcome measures were elective and emergency admissions, and nursing home admissions and mortality. Additional outcomes included physical function (Barthel Index (total possible score=20) and instrumental activities of daily living (/12) and cognitive function (mental status questionnaire (/10)). Results: Intervention patients had a lower rate of all admissions to the hospital during the first 30 days after the initial ED visit (16.5% vs 22.2%; P=.048), a lower rate of emergency admissions during the 18-month follow-up (44.4% vs 54.3%; P=.007), and longer time to first emergency admission (382 vs 348 days; P=.011). There was no difference in admission to nursing homes or mortality. Patients randomized to the intervention group maintained a greater degree of physical and mental function (Barthel Index change from baseline at 6 months: ,0.25 vs ,0.75; P<.001; mental status questionnaire change from baseline at 12 months: ,0.21 vs ,0.64; P<.001). Conclusion: CGA and multidisciplinary intervention can improve health outcomes of older people at risk of deteriorating health and admission to hospital. Patients aged 75 and older should be referred for CGA after an ED visit. [source] Dermatitis Artefacta in a ChildPEDIATRIC DERMATOLOGY, Issue 5 2007Enzo D. Finore Ph.D. Self-harm tendencies can frequently be expressed through dermatologic lesions, and dermatitis artefacta falls within this clinical frame. The occurrence of this cutaneous manifestation in children is very rare, with a peak of greater frequency in adolescence. We describe the characteristics of a multidisciplinary intervention,dermatologic and psychologic. Our pediatric patient displays a dermatologic picture that has no etiologic confirmation. The source of this disorder must therefore be found in socio-relational difficulties within the family and school environments, which lead the patient to self-harm behaviors that have a high communication value. [source] Caregiver Depressive Symptoms and Observed Family Interaction in Low-Income Children with Persistent AsthmaFAMILY PROCESS, Issue 1 2008MARIANNE CELANO PH.D. This study examined the relationship between caregiver depressive symptoms and observed parenting behaviors and family processes during interactions among 101 urban, low-income Africtan American families with children with persistent asthma. Caregivers (primarily female) were assessed on four dimensions (i.e., warmth/involvement, hostility, consistent discipline, relationship quality) in three videotaped interaction tasks (loss, conflict, cohesion). The results indicated that increased depressive symptoms were significantly associated with lower warmth/involvement and synchrony scores and greater hostility scores during the loss and conflict tasks. In the total sample, the highest levels of hostility and the lowest levels of warmth/involvement were found for the conflict task; nevertheless, caregivers with moderate/severe depressive symptoms showed a significantly greater increase in hostility from the loss to the conflict task than caregivers with minimal/mild depressive symptoms. The findings highlight the salience of considering task content in family observational process research to expand our understanding of depressed and nondepressed caregivers' abilities to modulate appropriately their behaviors and affect across various family interactions. Implications for improving asthma management for low-income children with persistent asthma are discussed, including the utility of multidisciplinary interventions that combine asthma education with family therapy. RESUMEN Síntomas de depresión en los responsables de los niños e interacción familiar observada en niños de familias de bajos ingresos que padecen asma crónica Este estudio examinó la relación entre los síntomas de depresión de los responsables de los niños y los comportamientos paternos y dinámicas familiares observados durante interacciones entre 101 familias afronorteamericanas, urbanas y de bajos recursos, con niños que padecen asma crónica. Los responsables de los niños (la mayoría mujeres) fueron evaluados en base a cuatro criterios: calidez/implicación, hostilidad, disciplina constante, y calidad de la relación) en tres tareas de interacción grabadas en cinta de video (pérdida, conflicto y cohesión). Los resultados demostraron que el aumento de los síntomas de depresión estaban relacionados de forma significativa con una menor puntuación en calidez/implicación y comprensión mutua, y una mayor puntuación en hostilidad durante las tareas de pérdida y conflicto. En la muestra total, los mayores niveles de hostilidad y menores niveles de calidez/implicación se encontraron en la tarea de conflicto; sin embargo, los responsables con síntomas de depresión de moderados a severos mostraron un aumento mucho mayor de la hostilidad, de la tarea de pérdida a la de conflicto, que los responsables con síntomas de mínimos a leves. Los resultados enfatizan la importancia de considerar el contenido de la tarea en la investigación observacional de familias para aumentar nuestra comprensión de las habilidades de los responsables de los niños, con o sin depresión, con el fin de modular de una manera apropiada su comportamiento y afecto en diferentes interacciones familiares. Las medidas para mejorar el control del asma en niños que padecen asma crónica y provienen de familias de bajos ingresos están en debate, incluida la utilidad de intervenciones multidisciplinarias que combinen formación sobre el asma con terapia familiar. [source] Challenging behaviours in nursing home residents with dementia: a randomized controlled trial of multidisciplinary interventionsINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 1 2002Janet Opie Abstract Objectives To test the premise that individually tailored psychosocial, nursing and medical interventions to nursing home residents with dementia will reduce the frequency and severity of behavioural symptoms. Methods A four-member team comprising a psychiatrist, psychologist and nurses conducted detailed assessments of 99 nursing home residents with advanced dementia who were rated by staff as having frequent, severe behavioural disturbances. Residents were then randomly assigned to an ,early' or ,late' intervention group and observed for four weeks. Interventions encompassed psychosocial strategies, nursing approaches, psychotropic medications and management of pain. Outcome measures included the frequency and severity of disruptive behaviours and assessments of change by senior nursing home staff. Results While improvements in behaviour were noted in both groups from the outset of observations, pointing to a powerful Hawthorne effect, consultancies were associated with a modest but statistically significant decrease in challenging behaviours. Staff assessments of the interventions were highly favourable. Conclusions The consultancies were effective and well received by staff. The change-inducing nature of any new endeavour is an integral part of research in a long-term setting. Copyright © 2002 John Wiley & Sons, Ltd. [source] An examination of frequent nursing interventions and outcomes in an adolescent psychiatric inpatient unitINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 5 2009Candace Bobier ABSTRACT:, Little is known about which nursing interventions used in adolescent psychiatric inpatient treatment demonstrate improvements in outcome in the ,real world' setting, despite an increase in external outcomes reporting requirements. This paper examines nursing and other multidisciplinary interventions commonly used at the Youth Inpatient Unit, Christchurch, New Zealand, in relation to improvements in outcomes as measured by the Health of the Nation Outcome Scales for Children and Adolescents, utilizing data gathered prospectively as part of an ongoing quality assurance and outcomes project. We found the majority of interventions investigated were utilized equally across diagnostic groups, although stress management and problem-solving education was used more for patients with mixed affective disorders. Further, the results contribute to growing evidence toward the value of providing medication and problem-solving education to this population. Mental health nurses working with children and adolescents should be supported to utilize and develop their unique skill set to offer targeted interventions and to examine their practice to identify the most valuable interventions for their patients within this developmental context. [source] Pediatric renal transplantation in a South African teaching hospital: A 20-year perspectivePEDIATRIC TRANSPLANTATION, Issue 4 2006G. J. Pitcher Abstract:, Introduction:, Renal transplantation is established as the standard of care for end-stage renal failure (ESRF) in the developed world. In emerging nations, the appropriateness of such costly interventions has been questioned. We undertook an analysis of all renal transplants undertaken under the care of the pediatric nephrology service at the Johannesburg Hospital, South Africa, in order to establish the outcomes of a transplantation service in a resource-constrained environment in a developing country. Methods:, This was a retrospective review of renal transplantation undertaken at a single teaching hospital in Johannesburg, part of the University of the Witwatersrand. Two hundred and eighty-two transplants were performed between 1984 and 2003. Demographic characteristics of the transplanted population, diagnosis, morbidity, graft survival, and mortality were recorded. Results:, Overall 1-, 5-, and 10-yr graft survival was 82, 44, and 23%. Overall 1-, 5-, and 10-yr patient survival was 97, 84, and 68%. The median graft survival for all transplantation episodes was 4.38 yr; 70% of patients survive 10 yr and 54% survive 20 yr or more. Although early graft survival was good, there was a more rapid rate of graft loss than when compared to results from developed centers with much poorer results at 5 and 10 yr. Causes of ESRF show marked variation between the races, and black patients have significantly worse outcomes than others. Compared with white patients, black recipients received fewer living donor kidneys (26 vs. 10%, p = 0.0019), a greater proportion of totally mismatched organs (56 vs. 36%, p = 0.015), less pre-emptive transplantation (7 vs. 35%, p = 0.0001) and experienced a higher rate of primary non-function (13 vs. 3%, p = 0.004). Surgical complications of transplantation occurred in 9% of recipients, but rarely led to graft loss. Conclusion:, Pediatric renal transplantation in Johannesburg can be accomplished with low complication rates, but medium and long-term graft survival is poor when compared with contemporary results achieved in developed countries. The difficulties of undertaking such complex, multidisciplinary interventions in a developing nation are daunting, but we believe that renal transplantation should still be the treatment of choice for all children with ESRF. The poorer outcomes in black recipients can be addressed by increasing education in our communities and expanding the pool of appropriate donors. Better institutional support would allow for improved long-term patient care. [source] | ||||||||||