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Multidisciplinary Approach (multidisciplinary + approach)
Selected AbstractsNew Evidence of Early Holocene Agriculture from the Coast of Ecuador: A Multidisciplinary ApproachCULTURE, AGRICULTURE, FOOD & ENVIRONMENT, Issue 2 2002Karen E. Stothert First page of article [source] Book Reviews: Ancient Human Migrations: A Multidisciplinary Approach edited by Peter N. Peregrine, Ilia Peiros, and Marcus FeldmanAMERICAN ANTHROPOLOGIST, Issue 3 2010David J. Meltzer No abstract is available for this article. [source] Foodborne Infections and Intoxications: Need of a Multidisciplinary Approach for ControlMOLECULAR NUTRITION & FOOD RESEARCH (FORMERLY NAHRUNG/FOOD), Issue 7 2004Helge KarchArticle first published online: 19 NOV 200 [source] The National Accreditation Program for Breast Centers: A Multidisciplinary Approach to Improve the Quality of Care for Patients with Diseases of the BreastTHE BREAST JOURNAL, Issue 5 2008David P. Winchester MD No abstract is available for this article. [source] Head Injury: A Multidisciplinary ApproachACADEMIC EMERGENCY MEDICINE, Issue 9 2010Michael D. Burg MD No abstract is available for this article. [source] A Multidisciplinary Approach to Describe Protists: Redescriptions of Novistrombidium testaceum Anigstein 1914 and Strombidium inclinatumMontagnes, Taylor, and Lynn 1990 (Ciliophora, Oligotrichia)THE JOURNAL OF EUKARYOTIC MICROBIOLOGY, Issue 3 2003LETIZIA MODEO ABSTRACT. We combined behavioral, morphological (live, stained, scanning and transmission electron-microscope), and molecular data to redescribe two common, intertidal oligotrich ciliates, Novistrombidium testaceum and Strombidium inclinatum. Both species were collected from a rocky shore near Leghorn, Ligurian Sea. A literature review revealed four morphotypes of Novistrombidium testaceum that differ in subtle ways, including oral morphology. These differences may be diagnostic, but we do not consider them sufficient to distinguish different taxa. Although other studies have synonymised Strombidium inclinatum and S. sulcatum, based on oral structures, size, and nuclear structure, there are morphological distinctions between them. In particular, the present study supports a lack of anterior protuberance in both live and preserved S. inclinatum, while S. sulcatum possesses a protuberance. The 18S rDNA molecular data, in accordance with morphological and ultrastructural observations, indicate that the Strombidiida (Oligotrichia) constitute a well-supported clade. The separation of the genera within this clade, even between Novistrombidium and Strombidium, remains unresolved, and the analysis of more species is required. Finally, we recommend that when possible, ecologists, morphological taxon-omists, and molecular biologists combine their expertise to provide comprehensive taxonomic descriptions. [source] Family Caregiver Research: Multidisciplinary Approaches to Reduce Family StressNURSING & HEALTH SCIENCES, Issue 2 2000Sharon K. Ostwald 28,29 March 2000 Yamaguchi University School of Medicine, Ube, Japan (Local Organizers: Junko Yoneda and Susumu Tomonaga, Yamaguchi University) [source] Multidisciplinary approach to the treatment of an oblique crown,root fractureDENTAL TRAUMATOLOGY, Issue 1 2010Anna-Louise Bate After removal of the fractured cusp, a provisional restorative build-up in this area was carried out, in order to carry out an endodontic treatment in a sterile environment. A glass fibre post and core were then constructed and over a 90-day period the tooth was extruded orthodontically by 4 mm. The periodontal fibres associated with this tooth were cut with a tiny surgical blade to help to prevent reintrusion of the tooth and achieve fine contouring of the gingival margins. The new tooth position was maintained with a retainer for a further 60 days and after a period with a provisional acrylic crown, a porcelain bonded crown was fitted. This case report demonstrates that such a multidisciplinary treatment approach to an oblique subgingival fracture is a reliable and predictable manner in which to save a tooth that would have otherwise been difficult, if not impossible, to restore with a resultant good long-term prognosis. [source] Multidisciplinary approach of complicated crown fractures of both superior central incisors: a case reportDENTAL TRAUMATOLOGY, Issue 4 2008Anca Silvia Vâlceanu Since the development of the adhesive dentistry, many case reports of crown fractures restored using adhesive reattachment techniques were published. Complex cases, in which more than one tooth are involved, with fractures differing from each other, require specific treatment of each fracture, taking different advantages of the different remaining tooth structures. This case report describes a patient with dissimilar crown fractures of both superior central incisors. After the endodontic treatment, the patient was treated using the combination of several techniques: periodontal surgery (crown lengthening with apically repositioned flap and osseous resective surgery), adhesive technique and cast restoration plus esthetic crown. The periodontal procedure re-created the biologic width and proved to be a reliable adjunctive procedure to the adhesive and the prosthetic techniques used. [source] Reputation Formalization for an Information,Sharing Multi,Agent SystemCOMPUTATIONAL INTELLIGENCE, Issue 4 2002Jonathan Carter We propose that through the formalization of concepts related to trust, a more accurate model of trust can be implemented. This paper presents a new model of trust that is based on the formalization of reputation. A multidisciplinary approach is taken to understanding the nature of trust and its relation to reputation. Through this approach, a practical definition of reputation is adopted from sociological contexts and a model of reputation is designed and presented. Reputation is defined as role fulfillment. To formalize reputation, it is necessary to formalize the expectations placed upon an agent within a particular multi,agent system (MAS). In this case, the agents are part of an information,sharing society. Five roles are defined along with the ways in which these roles are objectively fulfilled. Through the measurement of role fulfillment, a vector representing reputation can be developed. This vector embodies the magnitude of the reputation and describes the patterns of behavior associated with the direction of the vector. Experiments are conducted to verify the sensibility of the proposed models for role fulfillment and overall reputation. The simulation results show that the roles, defined for building reputation in an information,sharing MAS environment, react to different agent and user actions in a manner consistent with the formal definitions. [source] Multidisciplinary treatment approach for crown fracture and crown-root fracture , a case reportDENTAL TRAUMATOLOGY, Issue 1 2007Wilson Roberto Poi Abstract,,, The increased incidence of traumatic injuries to anterior teeth is a consequence of leisure activities, where the most common injuries are crown fractures. Treatment of the dental trauma is complex and requires a comprehensive and accurate diagnostic and treatment plan. It is also important to consider the biological, functional, esthetic and economic aspects, as well as the patient's desire. The purpose of this article is to report a case that shows the multidisciplinary approach required to successfully manage the rehabilitation of a maxillary central incisor with a complex crown fracture and a maxillary lateral incisor, that at first presented an oblique crown-root fracture, and after the orthodontic extrusion, suffered a more apical new crown-root fracture. [source] Odontoma-like malformation in a permanent maxillary central incisor subsequent to trauma to the incisor predecessorDENTAL TRAUMATOLOGY, Issue 5 2005Paulo Nelson-Filho Abstract,,, This report describes a case of a patient (1 year and 8 months old) with traumatic avulsion of the maxillary right primary central incisor and morphological changes in the germ of the permanent successor. One year after the trauma, an odontoma-like malformation developed. This malformation was removed 6 years after trauma and orthodontic treatment was started. Clinical follow-up and periodic radiographs are necessary after traumatic avulsion of primary teeth to monitor possible sequelae in the permanent successor. An odontoma-like malformation requires a multidisciplinary approach. [source] Orthodontic extrusion of subgingivally fractured incisor before restoration.DENTAL TRAUMATOLOGY, Issue 3 2005A case report: 3-years follow-up Abstract,,, Orthodontic forced eruption may be a suitable approach without risking the esthetic appearance in tooth fracture below the gingival attachment or alveolar bone crest. Extrusion of such teeth allows elevating the fracture line above the epithelial attachment and so the proper finishing margins can be prepared. Restoration after orthodontic eruption may present a more conservative treatment choice in young patients compared with the prosthetic restoration after extraction. This case describes a multidisciplinary approach using the orthodontic forced eruption facilitating the composite restoration of a fractured upper permanent central incisor. [source] Management of skin cancer in solid organ transplant recipientsDERMATOLOGIC THERAPY, Issue 1 2005Carmen Traywick ABSTRACT:, The incidence of catastrophic skin cancer in the solid organ transplant population continues to rise. As transplant patients are living longer, it is likely that dermatologists will be looking after an increasing number of organ transplant recipients. The key to managing this patient population lies in a multidisciplinary approach encompassing patient education, skin screening in the immediate post-transplant period, regular follow-up, and rapid referral to a dermatologist once skin lesions suspicious for skin cancer are diagnosed. Of paramount importance is discussion with transplant physicians to negotiate reduction of immunosuppression in the setting of catastrophic skin cancer. This article defines the scope of the problem of skin cancer in the solid organ transplant population, defines the nature of the lesions commonly presented, and reinforces the benefit of a multidisciplinary approach in the management of these patients. [source] The advantages and disadvantages of non-surgical management of the diabetic footDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue S1 2008Fran Game Abstract It is frequently stated that diabetic foot ulcers should be managed by a multidisciplinary team, comprising individuals who can deliver all the necessary and wide-ranging skills: medical and surgical, podiatric, nursing and orthotic. Whilst there are some data to support this multidisciplinary approach there is little to guide us in ensuring the patient is seen by the right professional for the right treatment at the right time. This article will examine the evidence supporting the most effective use of the multidisciplinary team. It will look at medical managements of ulcers including dressings, offloading and the treatment of infection, either cellulitis or osteomyelitis. By contrast, the role of surgery in offloading, and the treatment of osteomyelitis will be examined, as well as the role of vascular surgery. The most important aspect of management choice, however, is the need to focus on the needs of the person with a diabetic foot ulcer rather than simply on the treatment of the ulcer in isolation. Other complications of diabetes, which may have an effect on wound healing such as glycaemic control, renal failure and visual disturbance will be explored. Finally, there will be discussion of the relevance of outcome measure, both of ulcers as well as those more patient-centred. The ways in which these can be used to monitor individual clinical responses to treatment will be described, as well as their potential use as an aid to comparison of the effectiveness of treatment protocols adopted in different centres. Copyright © 2008 John Wiley & Sons, Ltd. [source] Economic aspects of diabetic foot care in a multidisciplinary setting: a reviewDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 5 2007Giovanni A. Matricali Abstract Background To evaluate the economic aspects of diabetic foot care in a multidisciplinary setting. Method A review of the English language literature, published from 1966 to November 2005. Results The results of available studies on the cost-of-illness of diabetic foot problems are difficult to compare. Nevertheless trends concerning excess of costs, protraction in time of costs, positive correlation to severity of ulcer and/or peripheral vascular disease, contribution of in-hospital stay and length of stay, and the patient's own contribution to total costs, are obvious. Only a few cost-effectiveness and cost-utility studies are available. Most use a Markov based model to predict outcome and show an acceptable result on long-term. Conclusions Diabetic foot problems are frequent and are associated with high costs. A multidisciplinary approach to diabetic foot problems has proved to be cost saving with regard to cost of treatment itself. Nevertheless, it remained unclear if these savings could offset the overall costs involved in implementing this kind of approach. The few studies that address this issue specifically all show an acceptable cost-effectiveness, but often the profit will be evident after some years only, because long-term costs are involved. Based on these data, policymakers should foresee sufficient reimbursement for preventive and early curative measures, and not only for ,salvage manoeuvres'. Copyright © 2007 John Wiley & Sons, Ltd. [source] Consequences of misdiagnosis of lymphomatoid papulosisEUROPEAN JOURNAL OF CANCER CARE, Issue 2 2006S. LAUBE mrcp We report two patients with lymphomatoid papulosis (LyP), who were initially diagnosed as systemic T-cell lymphoma. The patients presented with recurrent self-healing cutaneous lesions and skin biopsies showed a lymphocytic infiltrate with malignant features. Clinico-pathological correlation of findings was not performed and results of staging investigations were misinterpreted. Consequently, both patients were unnecessarily treated with multi-agent chemotherapy, radiotherapy and stem cell/bone marrow transplants and sustained long-term adverse effects. The clinical and histological features of LyP are described and appropriate management discussed in detail. Factors leading to the unnecessary treatment of both patients are examined and several learning points highlighted such as the importance of a multidisciplinary approach. [source] Liver transplantation for alcoholic liver diseaseADDICTION BIOLOGY, Issue 4 2001Georges-Philippe Pageaux Although increasing numbers of alcoholic patients are being referred to liver transplant centres, liver transplantation for alcoholic liver disease still remains controversial, essentially because we are in an era of organ shortage. In fact, the main issue is the likelihood of relapse and its influence on outcome, because it is the possibility of returning to alcohol use that separates patients with alcoholic liver disease from those with other forms of chronic liver disease. In all proposed clinical guidelines of indications for referral and assessment for liver transplantation for alcoholic liver disease, the authors emphasize the risk of alcoholism recurrence and, thus, a multidisciplinary approach is required to select patients who are likely to comply with follow-up and not return to a damaging pattern of alcohol consumption after transplantation. It emerges from all clinical studies that when we take into account the usual criteria of success for liver transplantation, i.e. patient and graft survival, rejection rate and infection rate, alcoholic liver disease is a good indication for liver transplantation. Predictive factors for alcoholic relapse after liver transplantation have been assessed in numerous studies, often with contradictory results making these difficult to analyse and compare. Several predictive factors for alcoholic relapse have been studied: length of abstinence before transplantation, associated psychiatric problems, social conditions, associated drug addiction, age. Abstinence after transplantation is the goal, but the necessary treatment for alcoholic disease can result in considerable improvement, even when complete abstinence is not achieved. Finally, the good results obtained with liver transplantation for alcoholic liver disease should help us to educate the general population about alcoholic disease. [source] Seascape genetics and the spatial ecology of marine populationsFISH AND FISHERIES, Issue 4 2008Kimberly A Selkoe Abstract Molecular tools perform at their best when integrated with other data and approaches. The value of integrating approaches is especially high when the underlying genetic signal is relatively weak, as occurs in many marine species. Recently, studies combining genetic, oceanographic, behavioural and modelling approaches have provided new insights into the spatial ecology of marine populations, in particular regarding larval migration, barriers to dispersal and source-sink population dynamics. In this perspectives piece, we explore the advantages of a multidisciplinary approach to marine population genetics by (i) providing a synthesis of what has been learned about connectivity from studies that combine genetic data with other tools, (ii) discussing how incorporation of ecological and oceanographic information into alternative hypotheses can boost inference when genetic power is low, and (iii) summarizing recent innovations in statistical population genetics that enable seamless integration of ecological, environmental and genetic data. These topics are covered in the context of how genetic inferences of connectivity and dispersal can contribute to pressing questions facing marine conservation and management. [source] Further characterization of the first seminoma cell line TCam-2GENES, CHROMOSOMES AND CANCER, Issue 3 2008Jeroen de Jong Testicular germ cell tumors of adolescents and adults (TGCTs) can be classified into seminomatous and nonseminomatous tumors. Various nonseminomatous cell lines, predominantly embryonal carcinoma, have been established and proven to be valuable for pathobiological and clinical studies. So far, no cell lines have been derived from seminoma which constitutes more than 50% of invasive TGCTs. Such a cell line is essential for experimental investigation of biological characteristics of the cell of origin of TGCTs, i.e., carcinoma in situ of the testis, which shows characteristics of a seminoma cell. Before a cell line can be used as model, it must be verified regarding its origin and characteristics. Therefore, a multidisciplinary approach was undertaken on TCam-2 cells, supposedly the first seminoma cell line. Fluorescence in situ hybridization, array comparative genomic hybridization, and spectral karyotyping demonstrated an aneuploid DNA content, with gain of 12p, characteristic for TGCTs. Genome wide mRNA and microRNA expression profiling supported the seminoma origin, in line with the biallelic expression of imprinted genes IGF2/H19 and associated demethylation of the imprinting control region. Moreover, the presence of specific markers, demonstrated by immunohistochemistry, including (wild type) KIT, stem cell factor, placental alkaline phosphatase, OCT3/4 (also demonstrated by a specific Q-PCR) and NANOG, and the absence of CD30, SSX2-4, and SOX2, confirms that TCam-2 is a seminoma cell line. Although mutations in oncogenes and tumor suppressor genes are rather rare in TGCTs, TCam-2 had a mutated BRAF gene (V600E), which likely explains the fact that these cells could be propagated in vitro. In conclusion, TCam-2 is the first well-characterized seminoma-derived cell line, with an exceptional mutation, rarely found in TGCTs. © 2007 Wiley-Liss, Inc. [source] Single-stage surgical repair of benign laryngotracheal stenosis in adultsHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2004Jolanda van den Boogert PhD Abstract Background. Benign laryngotracheal stenosis causes considerable morbidity. In a retrospective study, we describe the results of our surgical treatment. Methods. Between June 1999 and June 2002, 14 adults with laryngotracheal stenosis were referred to our hospital. Stenosis resulted from mechanical ventilation in 11 patients, from Wegener's granulomatosis in 2 patients, and from strangulation in 1 patient. Eleven patients had a tracheotomy. One patient was found unfit for surgery. Nine patients underwent cricotracheal resection (CTR) with end-to-end anastomosis, and four patients underwent single-stage laryngotracheoplasty (SS-LTP) without stenting. Results. There were no perioperative deaths. Patients were extubated after mean of 3 days (range, 0,10 days; CTR 2.3 days vs SS-LTP 3.5 days, p = .45). There were in-hospital complications in five patients. Mean hospital stay was 19 days (range, 8,53 days; after CTR 24 days vs SS-LTP 9 days, p = .015). With regard to airway patency and voice recovery, 10 patients (77%) had good results, including 1 patient with two readmissions, and 3 (23%) had satisfactory results, including 1 patient with 11 additional nonsurgical interventions. Conclusions . Benign laryngotracheal stenosis in the adult patient can be repaired successfully using a strategy of two single-stage surgical procedures. All patients had good or satisfactory functional results. A multidisciplinary approach was essential to achieve these good results. © 2004 Wiley Periodicals, Inc. Head Neck26: 111,117, 2004 [source] Interstitial lung disease,the new synergy between radiology and pathologyHISTOPATHOLOGY, Issue 4 2006M Quigley In the last 30 years, high-resolution computed tomography (HRCT) has been the major advance in diagnosis of diffuse parenchymal lung disease (DPLD). We review the diagnostic accuracy of HRCT and discuss how the gold standard in diagnosis of DPLD has shifted from histopathological diagnosis in isolation to a multidisciplinary approach. This latter process is now accepted as providing the highest levels of diagnostic accuracy in patients with DPLD and lung biopsy is primarily reserved for cases with atypical clinical or radiological presentations. [source] Multimodal management of neuroendocrine liver metastasesHPB, Issue 6 2010Andrea Frilling Abstract Background:, The incidence of neuroendocrine tumours (NET) has increased over the past three decades. Hepatic metastases which occur in up to 75% of NET patients significantly worsen their prognosis. New imaging techniques with increasing sensitivity enabling tumour detection at an early stage have been developed. The treatment encompasses a panel of surgical and non-surgical modalities. Methods:, This article reviews the published literature related to management of hepatic neuroendocrine metastases. Results:, Abdominal computer tomography, magnetic resonance tomography and somatostatin receptor scintigraphy are widely accepted imaging modalities. Hepatic resection is the only potentially curative treatment. Liver transplantation is justified in highly selected patients. Liver-directed interventional techniques and locally ablative measures offer effective palliation. Promising novel therapeutic options offering targeted approaches are under evaluation. Conclusions:, The treatment of neuroendocrine liver metastases still needs to be standardized. Management in centres of expertise should be strongly encouraged in order to enable a multidisciplinary approach and personalized treatment. Development of molecular prognostic factors to select treatment according to patient risk should be attempted. [source] A judicial,mental health partnership to heal young children in juvenile courtINFANT MENTAL HEALTH JOURNAL, Issue 1 2008Judge Cindy Lederman In this article, we describe the background and issues to be addressed related to dependent children in juvenile court. In an important effort to systematically examine developmental functioning and treatment needs in maltreated and violence-exposed young children, the Prevention and Evaluation of Early Neglect and Trauma (PREVENT) initiative of the Dependency Court Intervention Program for Family Violence, a national demonstration project in the Miami-Dade Juvenile Court, developed a program to evaluate all infants, toddlers, and preschoolers who are adjudicated dependent by the court. The goal of the intervention is to raise awareness of the needs of infants and toddlers in juvenile court and to work toward healing the child. The PREVENT program involved the evolution of a judicial,mental health partnership designed to assist the court in making more informed decisions about the best interest of the child by adding scientific knowledge about development, prevention, intervention, evaluation, and treatment. The outcome of the partnership and multidisciplinary approach is illustrated through presenting a case vignette of a mother and baby showing the challenges and strengths of intervention. Finally, we consider overall outcomes of the intervention and directions for the future. [source] Hepatopancreatobiliary manifestations and complications associated with inflammatory bowel diseaseINFLAMMATORY BOWEL DISEASES, Issue 9 2010Udayakumar Navaneethan MD Abstract Abstract: Diseases involving the hepatopancreatobiliary (HPB) system are frequently encountered in patients with inflammatory bowel disease (IBD). Hepatobiliary manifestations constitute some of the most common extraintestinal manifestations of IBD. They appear to occur with similar frequency in patients with Crohn's disease or ulcerative colitis. HPB manifestations may occur in following settings: 1) disease possibly associated with a shared pathogenetic mechanism with IBD including primary sclerosing cholangitis (PSC), small-duct PSC/pericholangitis and PSC/autoimmune hepatitis overlap, acute and chronic pancreatitis related to IBD; 2) diseases which parallel structural and physiological changes seen with IBD, including cholelithiasis, portal vein thrombosis, and hepatic abscess; and 3) diseases related to adverse effects associated with treatment of IBD, including drug-induced hepatitis, pancreatitis (purine-based agents), or liver cirrhosis (methotrexate), and reactivation of hepatitis B, and biologic agent-associated hepatosplenic lymphoma. Less common HPB manifestations that have been described in association with IBD include autoimmune pancreatitis (AIP), IgG4-associated cholangitis (IAC), primary biliary cirrhosis (PBC), fatty liver, granulomatous hepatitis, and amyloidosis. PSC is the most significant hepatobiliary manifestation associated with IBD and poses substantial challenges in management requiring a multidisciplinary approach. The natural disease course of PSC may progress to cirrhosis and ultimately require liver transplantation in spite of total proctocolectomy with ileal-pouch anal anastomosis. The association between AIP, IAC, and elevated serum IgG4 in patients with PSC is intriguing. The recently reported association between IAC and IBD may open the door to investigate these complex disorders. Further studies are warranted to help understand the pathogenesis of HPB manifestations associated with IBD, which would help clinicians better manage these patients. An interdisciplinary approach, involving gastroenterologists, hepatologists, and, in advanced cases, general, colorectal, and transplant surgeons is advocated. (Inflamm Bowel Dis 2010) [source] The implementation of intravenous tissue plasminogen activator in acute ischaemic stroke , a scientific position statement from the National Stroke Foundation and the Stroke Society of AustralasiaINTERNAL MEDICINE JOURNAL, Issue 5 2009Ad Hoc Committee representing the National Stroke Foundation, the Stroke Society of Australasia Abstract Intravenous tissue plasminogen activator (tPA) has been licensed in Australia for thrombolysis in selected patients with acute ischaemic stroke since 2003. The use of tPA is low but is increasing across Australia and national audits indicate efficacy and safety outcomes equivalent to international benchmarks. Implementing tPA therapy in clinical practice is, however, challenging and requires a coordinated multidisciplinary approach to acute stroke care across prehospital, emergency department and inpatient care sectors. Stroke care units are an essential ingredient underpinning safe implementation of stroke thrombolysis. Support systems such as care pathways, therapy delivery protocols, and thrombolysis-experienced multidisciplinary care teams are also important enablers. Where delivery of stroke thrombolysis is being planned, health systems need to be re-configured to provide these important elements. This consensus statement provides a review of the evidence for, and implementation of, tPA in acute ischaemic stroke with specific reference to the Australian health-care system. [source] Management of brain metastasesINTERNAL MEDICINE JOURNAL, Issue 5 2004L. C. Lim Abstract Solid tumour brain metastases are a frequent clinical dilemma for oncologists and general physicians. The sound management of brain metastases requires a multidisciplinary approach. In this review we discuss the diagnosis and management of brain metastases including the role of surgery, radiotherapy, and chemotherapy. The standard approaches of surgical excision and primary radiotherapy have evolved from randomised studies. However, controversies remain regarding post-surgery irradiation in the setting of a solitary metastasis and the role of palliative chemotherapy. (Intern Med J 2004; 34: 270,278) [source] An integrated care pathway to save the critically ischaemic diabetic footINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 6 2006K. El Sakka Summary This prospective study describes and evaluates the efficacy of an integrated care pathway for the management of the critically ischaemic diabetic foot patients by a multidisciplinary team. A weekly joint diabetes/vascular/podiatry ward round and outpatient clinic was established where patients were assessed within 7 days of referral by clinical examination, ankle-brachial-index-pressures, duplex angiogram and transcutaneous oxygen pressures. An angiogram ± angioplasty or alternatively a magnetic resonance angiography prior to surgical revascularisation was performed in patients deemed not suitable for angioplasty based on the above vascular assessment. Between January 2002 and June 2003(18 months), 128 diabetic patients with lower limb ischaemia were seen. Thirty-four (26.6%) patients received medical treatment alone, and 18 (14.1%) were deemed ,palliative' due to their significant co-morbidities. The remaining 76 (59.4%) patients underwent either angioplasty (n = 56), surgical reconstruction (n = 18), primary major amputation (n = 2) or secondary amputation after surgical revascularisation (n = 1). Minor toe amputations were required in 35 patients. The mortality in the intervention group was 14% (11/76). This integrated multidisciplinary approach offers a consistent and equitable service to diabetic patients with critically ischaemic feet and appears to have a beneficial major/minor amputation ratio. [source] The Swiss Federal Dairy Research StationINTERNATIONAL JOURNAL OF DAIRY TECHNOLOGY, Issue 1 2003Max Rüegg The Federal Dairy Research Station (FAM) was established at the beginning of the last century. It is one of six agricultural research stations of the Swiss Department of Agriculture and the leading national research institute in dairy technology and consulting. It is part of the Swiss Centre of Competence for Animal Production and Foods of Animal Origin. Its mission is to improve the competitive position of the Swiss milk producers and dairy industry. The institute is organized into three functional areas corresponding to its well-established core competencies: (1) production of raw milk cheese and microorganisms for fermentation, (2) knowledge transfer and consultation for the dairy industry and beekeeping, and (3) testing of, and providing expertise on dairy and bee products. Research work is carried out using a multidisciplinary approach in a matrix organization. Two product- and customer-orientated technology units and one unit for consulting, contractual work and other services for the dairy industry are supported in their projects by three scientific and technical units (microbiology; chemistry, physics and sensory analysis; engineering and production) as well as by a unit offering central services. The 4-year research programmes are based on the strategic goals of the agricultural policy as well as on the current needs of the dairy industry. An advisory board oversees the preparation and execution of the projects. FAM is connected to an international network for both scientific work and supervisory tasks. Work is carried out within the background of the political strategy of a sustainable development including economic, ecological and social aspects. A primary research focus is therefore the avoidance of excessive processing of milk and dairy products, and keeping products natural and free of residues by applying only minimal, unavoidable treatments and additives. [source] Towards a multidisciplinary approach to structuring in reduced saturated fat-based systems , a reviewINTERNATIONAL JOURNAL OF FOOD SCIENCE & TECHNOLOGY, Issue 4 2010Paul Wassell Summary Although many food products are essentially emulsions, interest in the structuring of oil-continuous emulsions (and in specific cases water-continuous emulsions) is intense, particularly to meet the continuing challenge of reducing the degree of saturates in food systems. Consequently, it is necessary to observe the effects of structurants and to examine their impacts on current food systems. This is especially the case where novel structuring materials are used to wholly or partially replace traditional structurants. A multidisciplinary approach is discussed encompassing traditional and novel mechanisms considered able to structure within low saturated fat-based systems and which in themselves could also have emulsification properties. The presence of interfacial compositions as in emulsions requires a crucial understanding of the interactions within these compositions for the creation of building blocks in oil or fat structuring. Where a co-surfactant structure may be used, together with novel structurants, for example, wax esters, phytosterols, it is necessary to understand how these may influence interfacial film thickness, strength and flexibility. Understanding how to measure mechanical visco-elastic properties of structurant interactions both in model and real time dynamic measurements will be necessary to account for diffusion, orientation and self-assembly mechanisms. This review discusses combining traditional techniques with novel structurant technology; developing and validating dynamic measurement techniques; and investigation of real systems as opposed to purely model systems. [source] | ||||||||||||||||||||||||||||||||||||||||||||||