Multidisciplinary Team
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2021 ◽  
Vol 16 (1) ◽  
Sailan Li ◽  
Haoruo Zhang ◽  
Meihua Chen ◽  
Zhenzhen Wang ◽  
Yanjuan Lin

Abstract Background As a new surgical method for older adults with cardiac insufficiency, transapical mitral valve clamp surgery requires the cooperation of practitioners across multiple disciplines to ensure appropriate treatment and nursing care. This study aimed to explore the utility of a multidisciplinary team nursing model in the clinical treatment and nursing care of patients undergoing transapical mitral valve clamping. Methods Our sample of ten patients included four men (40%) and six women (60%), with a mean age of 71.4 ± 5.2 years. The multidisciplinary team comprised nurses that specialized in severe illness, cardiac health, rehabilitation, psychology, nutrition, and pain. The team engaged in comprehensive discussions regarding problems specific to the patients undergoing transapical mitral valve surgery, allowing them to formulate individualized nursing measures and implement precise policies. Results No serious postoperative complications occurred in any of the ten patients included in this study, and a significant improvement was noted in the cardiac status of all the patients. Color ultrasound findings at discharge indicated that the degree of reflux of all the patients was ≤2+. Among the ten patients, the Activity of Daily Living Scale scores at discharge were significantly higher than before the operation (69.0 ± 4.6 vs. 55.0 ± 5.8). In addition, the 6-min walking test results at discharge were significantly better than those observed before the operation (318.0 ± 21.7 m vs. 295.2 ± 18.4 m). Conclusions Utilization of a multidisciplinary team allows nurses across various specialties to provide more comprehensive and systematic care for patients undergoing a mitral valve clamping operation, thus promoting patient recovery.

Vascular ◽  
2021 ◽  
pp. 170853812110352
Helena Smith ◽  
Chung Sim Lim ◽  
Nicholas Evans ◽  
Anthie Papadopoulou ◽  
Mohamed Khalifa ◽  

Objective Current data on the nature and rate of major complications for embolo-sclerotherapy (EST) of vascular malformations are scarce. However, even fewer studies focus on vascular malformations specific to the head and neck, which confer an increased specific risk of airway compromise, neurologic and ophthalmologic injury. More understanding is required surrounding the type and incidence of complications to improve treatment planning and informed consent. Therefore, this study aimed to review major complications secondary to EST of head and neck vascular malformations over a 5-year period in a single specialized multidisciplinary centre for vascular anomalies. Methods All interventions were decided by the multidisciplinary team. Demographic, procedural and complication data between 1st January 2013 and 31st December 2017 were prospectively documented in a dedicated database and analysed. EST of high-flow vascular malformations (HFVMs) was performed by selective catheter angiography or direct injection, and by direct injection only for low-flow vascular malformations (LFVMs). Major complications were defined as any tissue or functional damage caused by direct injection, distal embolization or tissue reaction and were decided by the multidisciplinary team. Results Forty-eight patients (median age of 35 years; range of 14–70 years; 18 men and 30 women) had 100 EST procedures for head and neck vascular malformation. Of these, 14 patients had EST for HFVM and 34 patients for LFVM, total 43 and 57 procedures, respectively. Overall, five patients with HFVM developed major complications from EST when compared with two patients with LFVM ( p = 0.0167). Two patients required pre-emptive tracheostomy due to risk of post-operative airway compromise. Overall, seven (14.6%) patients experienced major complication from EST. In the HFVM group, major complications from EST occurred in five patients; four cases of tissue ulceration and necrosis (two needed debridement, one healed with resultant fibrosis that impeded speech and one resolved spontaneously) and one post-procedural airway compromise requiring tracheostomy. Meanwhile, in the LFVM group, major complications occurred in two patients; one case of severe necrosis involving the alar cartilage, lip and cheek requiring debridement and reconstruction under plastics and one simple cellulitis. No patients sustained stroke or vision impairment. Conclusions EST is relatively safe for head and neck vascular malformations in a high-volume experienced centre. Our major complication rate of 14.6% per patient (35.7% for HFVM; 5.9% for LFVM) or 7% per procedure (11.6% for HFVM; 3.5% LFVM) compares favourably with published data from other centres. These data will improve treatment planning and informed consent for EST for both HFVM and LFVM of the head and neck.

2021 ◽  
Vol 5 (1) ◽  
pp. 40
Carolina Fernandes ◽  
Inês Allen ◽  
Leonor Sá Pinto ◽  
André Júdice ◽  
Filipa Vicente ◽  

The sports dentistry consultation at the Clínica Universitária Egas Moniz is guaranteed by a multidisciplinary team of health professionals that provide a customized service to high performance athletes. Over the last year, 99 athletes were evaluated in terms of their oral health through extraoral, intraoral and radiographic exams. In this population a high prevalence of dry mouth, erosive wear, gingivitis, periodontitis and DMF index was observed, which may have a profound and negative impact on sports performance. Of the athletes, 40.4% attended follow up consultations, where restoration and scaling were the majority of the clinical procedures performed. This data highlights the importance of a dedicated sports dentistry consultations.

2021 ◽  
Vol Publish Ahead of Print ◽  
Jason W. Stoneback ◽  
Nathan Donaldson ◽  
Ashley Ignatiuk ◽  
Matthew L. Iorio

Abdurrahman Sani ◽  
Ismaila Mungadi ◽  
Ismi Ismail ◽  
Mohd Arshad ◽  
Kim Soh

Disorders of sex development is a complex interaction between biological, psychological, social, and cultural factors, making it necessary for the multidisciplinary team to decide on the individualized patient basis. The characteristics of the individual patient, family and the social background are taken into consideration in order to derive maximum benefit. In developing countries, many people living with disorders of sex development faced serious psychological and social traumas such as marginalization, rejection, isolation, feeling of sadness, feeling of uncertainty, and feeling of shame. Therefore, this study explores the social wellbeing and quality of life of people with disorders of sex development in Nigeria. We used qualitative phenomenological approach to explore the social wellbeing and quality of people with disorders of sex development in Nigeria. We recruited thirteen participants using purposive sampling technique from Usmanu Danfodiyo Teaching Hospital Sokoto, Nigeria. We conducted data collection exercise using face to face interviews, transcribed, and analysed using interpretative phenomenological analysis technique with the aid of NVivo software. Four themes emerged from the data that describe the social wellbeing and quality of life of people with disorders of sex development in Nigeria. These themes are socialization and social isolation, intimate relationships, sexuality, and relationships with people. Participants experienced social isolation, marital problems, poor sexual experience, absence of sexual pleasure and stigmatization. People with disorders of sex development had poor social wellbeing which negatively affects their quality of life. Findings would inform the multidisciplinary team the need to incorporate social wellbeing of people with disorders of sex development in their treatment and the need to explore public perception on people living with disorders of sex development in Nigeria.

Panipak Katawethiwong ◽  
Anucha Apisarnthanarak ◽  
Kittiya Jantarathaneewat ◽  
David J. Weber ◽  
David K. Warren ◽  

Abstract Background: Limited data are available on the implementation of an area under the concentration-time curve (AUC)–based dosing protocol with multidisciplinary team (MT) support to improve adherence with vancomycin dosing protocol. Objective: To evaluate the effectiveness of an AUC-based dosing protocol with MT support intervention with adherence to a hospital-wide vancomycin dosing protocol at Thammasat University Hospital. Method: We conducted a quasi-experimental study in patients who were prescribed intravenous vancomycin. The study was divided into 2 periods; (1) the preintervention period when the vancomycin dosing protocol was already applied in routine practice and (2) the post-intervention period when the implementation of an AUC-based dosing protocol with MT support was added to the existing vancomycin dosing protocol. The primary outcome was the rate of adherence, and the secondary outcomes included acute kidney injury events, vancomycin-related adverse events, and 30-day mortality rate. Results: In total, 240 patients were enrolled. The most common infections were skin and soft-tissue infections (24.6%) and bacteremia (24.6%). The most common pathogens were coagulase-negative staphylococci (19.6%) and Enterococcus spp (15.4%). Adherence with the vancomycin dosing protocol was significantly higher in the postintervention period (90.8% vs 55%; P ≤ .001). By multivariate analysis, an AUC-based dosing protocol with MT support was the sole predictor for adherence with the vancomycin dosing protocol (adjusted odds ratio, 10.31; 95% confidence interval, 4.54–23.45; P ≤ .001). The 30-day mortality rate was significantly lower during the postintervention period (8.3% vs 20%; P = .015). Conclusions: AUC-based dosing protocol with MT support significantly improved adherence with vancomycin dosing protocol and was associated with a lower 30-day mortality rate.

Maria Luisa Granada ◽  
Laura Audí

Abstract Objectives The development of female or male sex characteristics occurs during fetal life, when the genetic, gonadal, and internal and external genital sex is determined (female or male). Any discordance among sex determination and differentiation stages results in differences/disorders of sex development (DSD), which are classified based on the sex chromosomes found on the karyotype. Content This chapter addresses the physiological mechanisms that determine the development of female or male sex characteristics during fetal life, provides a general classification of DSD, and offers guidance for clinical, biochemical, and genetic diagnosis, which must be established by a multidisciplinary team. Biochemical studies should include general biochemistry, steroid and peptide hormone testing either at baseline or by stimulation testing. The genetic study should start with the determination of the karyotype, followed by a molecular study of the 46,XX or 46,XY karyotypes for the identification of candidate genes. Summary 46,XX DSD include an abnormal gonadal development (dysgenesis, ovotestes, or testes), an androgen excess (the most frequent) of fetal, fetoplacental, or maternal origin and an abnormal development of the internal genitalia. Biochemical and genetic markers are specific for each group. Outlook Diagnosis of DSD requires the involvement of a multidisciplinary team coordinated by a clinician, including a service of biochemistry, clinical, and molecular genetic testing, radiology and imaging, and a service of pathological anatomy.

2021 ◽  
Vol 9 (20) ◽  
pp. 5737-5743
Zheng Zhou ◽  
Hong-Mei Luo ◽  
Jian Tang ◽  
Wu-Jun Xu ◽  
Bin-Hui Wang ◽  

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