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Multidisciplinary Program (multidisciplinary + program)
Selected AbstractsA Multidisciplinary Program for Delivering Primary Care to the Underserved Urban Homebound: Looking Back, Moving ForwardJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2006Kristofer L. Smith BA The coming decades will see a dramatic rise in the number of homebound adults. These individuals will have multiple medical conditions requiring a team of caregivers to provide adequate care. Home-based primary care (HBPC) programs can coordinate and provide such multidisciplinary care. Traditionally, though, HBPC programs have been small because there has been little institutional support for growth. Three residents developed the Mount Sinai Visiting Doctors (MSVD) program in 1995 to provide multidisciplinary care to homebound patients in East Harlem, New York. Over the past 10 years, the program has grown substantially to 12 primary care providers serving more than 1,000 patients per year. The program has met many of its original goals, such as helping patients to live and die at home, decreasing caregiver burden, creating a home-based primary care training experience, and becoming a research leader. These successes and growth have been the result of careful attention to providing high-quality care, obtaining hospital support through the demonstration of an overall positive cost,benefit profile, and securing departmental and medical school support by shouldering significant teaching responsibilities. The following article will detail the development of the program and the current provision of services. The MSVD experience offers a model of growth for faculty and institutions interested in starting or expanding a HBPC program. [source] Setting Up a Multidisciplinary Program for Management of Patent Foramen Ovale-Mediated SyndromesJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2006GIANLUCA RIGATELLI M.D. Background: These days no codified multidisciplinary protocol has been reported to manage all the different patent foramen ovale (PFO)-mediated syndromes. We sought to propose a multidisciplinary program of diagnosis, treatment, and follow-up of all PFO-mediated syndromes based on an in-hospital multidisciplinary task force and to review the activities during the first year. Methods: From September 2004, we organized in our hospital, a 600-bed tertiary hospital, a management program for PFO-mediated syndromes based on a task force composed of cardiologists, neurologists, and internists. Different levels of protocols were created in order to cover diagnosis, treatment, and follow-up of PFO-mediated syndromes. We reviewed the activity of our program in the first year up to September 2005. Results: Thirty-five patients (23 female, mean age 65 ± 24 years) were evaluated for suspected PFO-mediated syndromes: 20 for cryptogenic stroke, 2 for peripheral and coronary embolisms, 3 for platypnea-orthodeoxia, 9 for emicrania with aura, and 1 with hypoxiemia during neurosurgical intervention in the posterior cranial fossa. Diagnosis of PFO was confirmed in 25 patients. According to the multidisciplinary protocols, 15 patients failed to meet the requirements for transcatheter closure and were left in medical therapy whereas 11 patients (7 patients with PFO, 2 with multiperforated ASD, and 2 with a secundum ASD) underwent transcatheter closure. After a mean follow-up of 10.8 ± 4.9 months, no recurrent PFO syndromes were noted in patients treated with devices. Conclusion: The first year of our multidisciplinary program allowed a reasonable and potentially successful approach for correctly identifying patients with PFO-mediated syndromes until randomized studies are completed. [source] Congenital hyperinsulinism , a review of the disorder and a discussion of the anesthesia managementPEDIATRIC ANESTHESIA, Issue 7 2007OLGA T. HARDY MD Summary Congenital hyperinsulinism (CHI) is the most common cause of persistent hypoglycemia in infants and children. In most affected infants, CHI is caused by a specific genetic defect that results in the altered expression of pancreatic beta cells causing unregulated oversecretion of insulin. Infants with CHI may have either focal or diffuse abnormalities of the pancreatic , -cells. Both forms of CHI manifest as hypoglycemia, usually in the early newborn period. Focal disease can be treated effectively with surgical resection of the affected area, resulting in a total cure or rendering the patient amenable to medical management. Most children with diffuse disease are unresponsive to medical therapy, and require near-total pancreatectomy. At The Children's Hospital of Philadelphia, we have developed a multidisciplinary program for diagnosis and treatment of CHI. Anesthesiologists have played an integral role in the perioperative care of these infants, which includes diagnostic procedures, partial or near-total pancreatectomy, and postoperative pain management. In this review, we describe the clinical features, diagnostic methods and anesthetic concerns in children with CHI. [source] The frontline and the ivory tower: A case study of service and professional-driven curriculumAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 3 2009Sue Lenthall Abstract Objective:,To describe the development of a postgraduate, multidisciplinary program designed to meet the needs of remote health professionals, present formative evaluation findings and to offer an analysis of the difficulties and lessons learnt. Design:,Case study. Setting:,University Department of Rural Health in a remote region. Participants:, University staff, students and stakeholders involved in the development of the remote health practice program. Results:,Formative evaluation suggests that a curriculum driven by service and professional groups, such as the Flinders University Remote Health Practice program, is able to better prepare remote health practitioners and improve their effectiveness. Difficulties in development included a lack of recognition by some university academics of the value of practitioner knowledge and a reluctance to accept a clinical component in a masters program. Lessons learnt included the importance of: (i) respect for practitioner knowledge; (ii) explicit and appropriate values; (iii) high-quality academics with strong service links; (iv) appropriate length of lead time; (v) institutional links between university and both relevant professional organisations and health services; (vi) a receptive university; (vii) location; and (viii) ongoing engagement with services and professional responsive development. Conclusion:,The success of the program was due in large part to the relationship with professional bodies and close links with remote health services. We have described a number of lessons learnt from this experience that can be useful to other educational groups developing or revising their educational programs. [source] Adherence to Oral Therapy for Type 2 Diabetes: Opportunities for Enhancing Glycemic ControlJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 1 2004CDEArticle first published online: 24 MAY 200, David Bartels PharmD Purpose Although diet and exercise are important parts of type 2 diabetes treatment, most patients require pharmacological intervention with multiple agents to maintain adequate glycemic control. This article addresses the numerous patient-related, disease-related, and demographic variables affecting medication adherence in this patient population. Data Sources Extensive review of scientific literature, clinical practice guidelines, and Internet sources. Conclusions Studies have demonstrated that treatments including multiple medications or frequent dosing had a negative impact on adherence. Practitioners have used several approaches in an effort to improve adherence to oral antidiabetic medical therapy, including increased communication between health care providers and patients, implementation of multidisciplinary programs, and use of treatment regimens with easier dosing (i.e., reduced number of drugs or doses taken per day). Implications for Practice Options for type 2 diabetes treatments that combine effective medications into a simpler oral-dosage form may motivate and improve patient adherence. Ultimately, simplifying dosing may lead to better glycemic control, thereby reducing the risks associated with long-term consequences of the disease. [source] A break-even analysis of a community rehabilitation falls prevention serviceAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2009Tracy Comans Abstract Objective: To identify and compare the minimum number of clients that a multidisciplinary falls prevention service delivered through domiciliary or centre-based care needs to treat to allow the service to reach a ,break-even' point. Method: A break-even analysis was undertaken for each of two models of care for a multidisciplinary community rehabilitation falls prevention service. The two models comprised either a centre-based group exercise and education program or a similar program delivered individually in the client's home. The service consisted of a physiotherapist, occupational therapist and therapy assistant. The participants were adults aged over 65 years who had experienced previous falls. Costs were based on the actual cost of running a community rehabilitation team located in Brisbane. Benefits were obtained by estimating the savings gained to society from the number of falls prevented by the program on the basis of the falls reduction rates obtained in similar multidisciplinary programs. Results: It is estimated that a multi-disciplinary community falls prevention team would need to see 57 clients per year to make the service break-even using a centre-based model of care and 78 clients for a domiciliary-based model. Conclusions and Implications: The service this study was based on has the capability to see around 300 clients per year in a centre-based service or 200-250 clients per year in a home-based service. Based on the best available estimates of costs of falls, multidisciplinary falls prevention teams in the community targeting people at high risk of falls are worthwhile funding from a societal viewpoint. [source] | ||||||||||