Is a Multidisciplinary Aerodigestive Clinic More Effective at Treating Recalcitrant Aerodigestive Complaints Than a Single Specialist?

2017 ◽  
Vol 126 (7) ◽  
pp. 537-543 ◽  
Author(s):  
Janine M. Rotsides ◽  
Gina M. Krakovsky ◽  
Dinesh K. Pillai ◽  
Sona Sehgal ◽  
Maura E. Collins ◽  
...  
Keyword(s):  
Nurse Practitioner ◽  
Pulmonary Infection ◽  
Diagnostic Yield ◽  
Operative Procedure ◽  
Vocal Cord Dysfunction ◽  
Speech Pathology ◽  
Team Approach ◽  
Longitudinal Observational Study ◽  
Duodenal Web ◽  
Function Testing

Objective: To determine the utility of a pediatric multidisciplinary aerodigestive clinic (ADC) in treating recalcitrant aerodigestive conditions. Methods: Longitudinal observational study of presenting complaints, evaluation, management, and outcome of patients seen during 12 monthly ADCs beginning August 2013. Results: Fifty-five patients were seen by the ADC team (otolaryngology/gastroenterology/pulmonology/speech pathology/nurse practitioner) and followed for a mean 17.6 months (range, 12-26 months). Mean age was 4.3 years (range, 0.5-19 years). All were seen by at least 1 specialist before ADC referral but without significant improvement. Chronic cough was the most common primary symptom (44%). Clinic evaluation included flexible nasopharyngolaryngoscopy (FFL, 53%) and pulmonary function testing (36%.) FFL influenced management in 79%. An operative procedure usually combined endoscopy was warranted in 58%. Endoscopy provided high diagnostic yield, detecting laryngeal cleft (8), adenoid hypertrophy (8), vocal cord dysfunction (4), pulmonary infection (4), reflux disease (3), laryngomalacia (3), tracheomalacia (2), cilia abnormality (2), celiac disease (1), Helicobacter pylori (1), duodenal web (1), and eosinophilic esophagitis (1). Outcome was available for 48 of 55 patients, with 73% reporting resolved to markedly improved symptoms and 27% minimal to no improvement. Conclusions: The ADC team approach resulted in resolved to markedly improved symptoms in 73% of patients whose symptoms persisted despite seeing a single specialist prior to referral.

Dysphagia Management in Military Service Members With Polytrauma: Overview and Case Report

2021 ◽  
pp. 1-14
Author(s):  
Laura L. Cord ◽  
Veena Rajpal ◽  
Nancy Pearl Solomon
Keyword(s):  
Case Report ◽  
Multidisciplinary Team ◽  
Military Service ◽  
Medical Center ◽  
Service Members ◽  
Complex Case ◽  
Speech Pathology ◽  
Team Approach ◽  
Swallowing Function ◽  
Swallowing Evaluation

Purpose At Walter Reed National Military Medical Center, service members (SMs) with polytraumatic injuries, usually resulting from blast explosions, are routinely referred to the Speech Pathology Clinic for evaluation of swallowing function. The purpose of this clinical focus article is to advance the speech-language pathologist's (SLP) knowledge of polytrauma and to improve the care of individuals with traumatic injuries, especially related to nutrition and swallowing within a larger multidisciplinary team approach. Case Report Previous research within our center identified common demographic and injury characteristics of SMs with combat-related injuries that led to referrals for swallowing evaluation. An SM with polytraumatic injuries was selected for this case report to illustrate the relevance of the research findings and also the importance of multidisciplinary team support to appropriately manage such complex cases. Evaluations and relevant treatments are described across a 3-month acute care hospitalization, including swallowing and nutritional recommendations at the time of each swallowing evaluation. Discussion Comparisons of polytrauma cases at Walter Reed National Military Medical Center with literature from civilian trauma centers revealed somewhat longer hospitalizations and the particular influence of maxillofacial trauma on dysphagia outcomes. The complex case reported in this article illustrates the importance of multidisciplinary care and coordination, with particular emphasis on the intersecting roles of the SLP and registered dietitian. This report can serve as a guide for SLPs working in trauma settings for developing prognostic statements, treatment plans, and multidisciplinary interaction.

The Role of the NNP in Facilitating Family-Centered Care

2007 ◽  
Vol 26 (4) ◽  
pp. 271-272 ◽  
Author(s):  
Nicole Bowen
Keyword(s):  
Health Care ◽  
Nurse Practitioner ◽  
Health Care Team ◽  
Team Approach ◽  
Certificate Programs ◽  
Centered Care ◽  
Effective Part ◽  
Family Centered ◽  
Limited Scope

THE NEONATAL NURSE practitioner (NNP) has come a long way since the 1970s. A profession that was once educated in certificate programs is now one in which each nurse practitioner is master’s prepared. The practitioner role has evolved from one of limited scope to its form as originally intended—an effective part of the collaborative team. The neonatal nurse practitioner collaborates not only with a physician, but with the entire NICU staff and family members. NNPs are excellent examples of the health care team approach that combines educated, research-based care with compassionate family-centered objectives.

scholarly journals The speech pathology treatment with alterations of the stomatognathic system

2000 ◽  
Vol 26 (1) ◽  
pp. 5-12
Author(s):  
Irene Marchesan
Keyword(s):  
Class Ii ◽  
Mouth Breathing ◽  
Speech Pathology ◽  
Team Approach ◽  
Class Iii ◽  
Myofunctional Therapy ◽  
Speech Language Pathologist ◽  
Stomatognathic System ◽  
Tongue Position

This article analyzes differences in orthodontic and craniofacial classifications and the role of the speech-language pathologist in adequately treating those patients with varying Class II and Class III malocclusions. Other symptoms, such as those of mouth breathing and tongue position, are compared and contrasted in order to identify characteristics and treatment issues pertaining to each area. The author emphasizes a team approach to myofunctional therapy and stresses the importance of collaborative treatment.

scholarly journals Utility of Bronchoscopy with Bronchoalveolar Lavage in Diagnosing Pulmonary Infection in Hospitalized Patients with Underlying Malignancy

1998 ◽  
Vol 9 (2) ◽  
pp. 87-93 ◽  
Author(s):  
CW Chow ◽  
A McGeer ◽  
G Kasupski ◽  
N Senathiragah ◽  
P Gallant ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Pulmonary Infection ◽  
Diagnostic Yield ◽  
Retrospective Chart Review ◽  
Marrow Transplant ◽  
Allogenic Bone ◽  
Underlying Malignancy ◽  
Antimicrobial Management ◽  
Simplex Virus ◽  
The Impact

Objectives: To evaluate the clinical utility of bronchoscopy with bronchoalveolar lavage (BAL) for diagnosing pulmonary infection in patients with underlying malignancy and to evaluate the impact of positive microbiology results on antimicrobial therapy.Design: Retrospective chart review.Setting: University-affiliated downtown teaching hospital in Toronto.Patient population: All patients who underwent bronchoscopy with BAL from November 1990 to September 1992.Results: One hundred and thirty-nine BALs were performed, of which 82 (59%) were positive for microorganisms. These 82 charts were reviewed. The main underlying diagnosis was hemotogenous malignancy (70 of 82). Primary indiction for bronchoscopy was the presence of pulmonary symptoms with or without radiographic abnormality. Common organisms identified were fungi (n=50), primarilyCandida albicansand cytomegalovirus (CMV) (27), and 16 ‘usual’ pathogens. Less common were herpes simplex virus (six),Pneumoncystis cariniipneumonia (PCP) (four),Legionella pneumoniaeandMycoplasma pneumoniae(one each). Eighty-seven per cent of patients were on broad spectrum antibiotics at the time of bronchoscopy. Although antiibiotic therapy was altered postbronchoscopy in 47 of the 82 cases, only 26 instances could be directly attributed to the results of BAL. Pathogens that commonly initiated specific therapy were CMV (16 of 27) and PCP (three of four). Diagnostic yield was highest in allogenic bone marrow transplant recipients (BMT). They comprised only 49% (40 of 82) of the cases but accounted for 85% (22 of 26) of those whose therapy was directly altered by the results of BAL. Of these 22 cases, 20 were attributed to the isolation of CMV.Conclusions: The overall raw diagnostic yield from bronchoscopy with BAL was high at 59%. Of those with positive BAL cultures, a change in antimicrobial management occurred in 32% of cases. In a patient poulation with underlying hematogenous malignancy, particularly BMT recipients, bronchoscopy with BAL is useful for a specfic diagnosis of pulmonary infection.

scholarly journals ORGANIZATION OF PSYCHOLOGICAL AND PEDAGOGICAL SUPPORT FOR JUNIOR SCHOOLCHILDREN IN AUTISTIC SPECTRUM DISORDERS

2021 ◽  
pp. 6-19
Author(s):  
Valentyna Bilan
Keyword(s):  
Behavioral Problems ◽  
Basic Education ◽  
Autism Spectrum ◽  
Assessment System ◽  
Speech Pathology ◽  
Team Approach ◽  
Special Schools ◽  
Education Development ◽  
Children With Asd ◽  
Spectrum Disorders

The article reveals the stages of psychological and pedagogical support for primary schoolchildren with autism spectrum disorders (ASD) and their organization. It is established that not every child with ASD can continue their education in an inclusive class even after studying in a correctional class. Often the main reasons are serious intellectual or behavioral problems, the solution of which is impossible in school. Such students should continue their education in the system of special schools (special correctional schools for children with intellectual disabilities, for children with severe speech pathology, etc.). Those students, who, after the correctional stage, can study in the mode of full inclusion, should move to regular classes and study according to the general schedule together with normally developed children under the obligatory support of a tutor. One of the proposals was the use of a specialized monitoring system, which allowed to adapt the assessment system, so that, on the one hand, children with ASD could achieve results and demonstrate knowledge of the subjects they studied, and on the other hand, allow timely action to address gaps. Also during the educational experiment it turned out that the team approach is one of the main requirements for the organization of training students with ASD in school. Only using such a method makes it possible to develop a single strategy for a comprehensive impact on children with ASD both in lessons and in frontal and individual correctional and developmental classes. It is important that the team includes a sufficient number of specialists to ensure a comprehensive and systematic correctional and developmental impact. The study is promising and allows to continue working in the following areas: development of specialized methods, technologies and forms of teaching students with ASD at the level of primary and basic education; development of the content of psychological and pedagogical correctional work for different groups of children with ASD, differentiated depending on the manifestation of disorders of the emotional-volitional and cognitive sphere of students.

scholarly journals The Diagnostic and prognostic value of CXCL12 (SDF-1α) level in Mycobacterium tuberculosis infection and disease

2021 ◽  
Vol 15 (01) ◽  
pp. 81-88
Author(s):  
Ilkay Koca Kalkan ◽  
Ayse Gozu ◽  
Ebru Tansel ◽  
Serife Nilgun Kalac ◽  
Belgin Samurkasoglu ◽  
...  
Keyword(s):  
Pulmonary Infection ◽  
Diagnostic Yield ◽  
Bacterial Load ◽  
Diagnostic Tools ◽  
Chronic Obstructive ◽  
Mycobacterium Tuberculosis Infection ◽  
Obstructive Pulmonary Disease ◽  
Significant Difference ◽  
Chemokine Cxcl12 ◽  
Severity Of The Disease

Introduction: New diagnostic tools are being investigated for rapid and accurate TB detection. We aimed to find out the diagnostic yield and accuracy of chemokine CXCL12 (SDF-1a) levels in diagnosing active TB (aTB) and making a differential diagnosis from other several infectious/non-infectious pulmonary conditions. Methodology: We collected demographic, clinic features and studied plasma CXCL12 levels using ELISA kit of the participants, classified into five categories: aTB (n = 30); cured TB (cTB, n = 15); close contacts of aTB (CC, n = 15); chronic obstructive pulmonary disease (COPD) with active nonspecific pulmonary infection (infCOPD, n = 15); and healthy controls (HC, n = 15). Results: CXCL12 levels were highest in aTB, but no significant difference was seen between other groups. When a cut-off level for CXCL12 was determined as 2835 pg/mL, the increased CXCL12 rate was significantly more in aTB than CC and HC (p = 0.02, p = 0.05). Also, participants with an active infection (aTB and infCOPD) had significantly higher increased CXCL12 rates (p = 0.01). The sensitivity and specificity of CXCL12 for diagnosing aTB were found to be 0.56 and 0.63, respectively. We found that bacterial load, the radiological severity and the extent of chest x-ray involvement were independent factors for increased CXCL12 levels. Conclusions: Our study demonstrates that CXCL12 may be a representative of active pulmonary infection regardless of the cause but correlated with the severity of the disease; enabling this test to be used as a prognostic factor rather than a diagnostic test for aTB.

scholarly journals Outcome of OMG Urethroplasty by Asopa, Barbagli and Kulkarni Technique for Management of Anterior Urethral Stricture : Are Results Affected by the Surgical Technique?

2020 ◽  
Vol 19 (1) ◽  
pp. 23-27
Author(s):  
Md Shariful Islam ◽  
Md Asaduzzamman ◽  
Md Ruhul Quddus ◽  
Waliul Islam ◽  
Pranashis Saha
Keyword(s):  
Surgical Technique ◽  
Success Rate ◽  
Urethral Stricture ◽  
Significant Variation ◽  
Operative Procedure ◽  
Lichen Sclerosus ◽  
Team Approach ◽  
Anastomotic Site ◽  
Stricture Recurrence

Objective: To determine outcome of OMG urethroplasty by different surgical technique comparing ASOPA, BARBAGLI and KULKARNI TECHNIQUE in the management of anterior urethral stricture. Materials and Methods: A total of 62 patients with an average age of 42 yr(21-55) underwent OMG urethroplasty between 2008 to 2015 for anterior urethral stricture of different etiology. 2 patient lost durig follow up patient with lichen sclerosus and failed hypospadias were not included. OMG was always harvested from cheek using 2 team approach graft were placed using surgical technique of ASOPA, BARBAGLI and KULKARNI technique in 21,27 and 12 patients respectively clinical outcome was considered success or failure at the time any post operative procedure needed mean follow up was 45 month (6-95) Results: Out of 60 cases 51(85%) considered success and 9(15%) were considered failure. success rate were 85.7%,85%,and 83.5% in ASOPA, BARBAGLI and KULKARNI Technique and failure rate were 14.3%,15% and 16.7% respectively. Failure involve in the anastomotic site (2 in distal and 3 in proximal) were managed by OIU and involving whole length in 3 patient managed with staged urethropllasty. Conclusion: In our series, success rate of ASOPA, BARBAGLI and KULKARNI technique has no statistically significant variation. more over stricture recurrence was uniformly distributed in all group. so the outcome is not significantly affected by different technique used in OMG urethroplasty for anterior urethral stricture. Bangladesh Journal of Urology, Vol. 19, No. 1, Jan 2016 p.23-27

Importance of an Interprofessional Team Approach in Achieving Improved Management of the Dizzy Patient

2017 ◽  
Vol 28 (03) ◽  
pp. 177-186 ◽  
Author(s):  
Amanda I. Rodriguez ◽  
Steven Zupancic ◽  
Michael M. Song ◽  
Joehassin Cordero ◽  
Tam Q. Nguyen ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Clinical Decision Making ◽  
Management Approach ◽  
Team Approach ◽  
Balance Function ◽  
Interprofessional Team ◽  
Diagnosis And Management ◽  
Number Of Patients ◽  
Function Testing ◽  
Dizzy Patient

AbstractBecause of its multifaceted nature, dizziness is difficult for clinicians to diagnose and manage independently. Current treatment trends suggest that patients are often referred to the otolaryngologist for intervention despite having a nonotologic disorder. Additionally, many individuals with atypical presentations are often misdiagnosed and spend a significant amount of time waiting for consultation by the otolaryngologist. Few studies have alluded that implementation of an interprofessional team approach in the diagnosis and management of the dizzy patient can improve clinical decision-making. However, to the authors’ knowledge, there is no information specifically quantifying the outcomes and potential benefits of using an interprofessional balance care team approach.To compare dizziness diagnoses trends and referral practices with and without the use of an interprofessional management approach within a university healthcare system.Over the course of a 3-yr period, a retrospective review of the diagnosis and management of dizziness was performed with and without implementation of an interprofessional team. To observe potential differences, year 3 incorporated the interprofessional management approach while years 1–2 did not. The two periods were then compared to each other.A total of 134 patients referred to a university hearing clinic for a vestibular and balance function evaluation.Diagnoses and management trends were examined with descriptive statistics (percentages and frequencies). Fisher’s exact tests, analysis of contingency tables, were conducted to evaluate the influence of interprofessional management on dizziness diagnoses and treatment patterns.Results demonstrated that before implementation of an interprofessional team approach, (1) referring clinicians used unspecific dizziness diagnosis codes (e.g., dizziness and giddiness), (2) a low number of patients with dizziness were referred for balance function testing, (3) diagnoses remained unspecific following the balance function assessment, and (4) the most frequently occurring vestibular diagnoses were unilateral vestibular hypofunction and benign paroxysmal positional vertigo. Following the use of an interprofessional management approach, it was determined that (1) disease-specific diagnoses increased, (2) patients with dizziness were referred for balance function testing mainly by otolaryngologists, (3) dizziness was considered to be multifaceted for a greater number of patients, (4) a larger percentage of patients were referred to a specialist other than the otolaryngologist as a result of their diagnosis, and (5) patients reported reduction or resolution of their symptoms.An interprofessional management approach for the dizzy patient can lead to more specific diagnoses and provide alternative referral pathways to other health-care professionals (e.g., audiologists, physical therapists, and pharmacists) in an effort to reduce over-referral to one specialist. Future studies should address the utility of an interprofessional team approach in the overall management of patients with dizziness.

Sign in / Sign up

Export Citation Format

Share Document