scholarly journals Multidisciplinary Management of Neuroendocrine Neoplasia: A Real-World Experience from a Referral Center

2019 ◽  
Vol 8 (6) ◽  
pp. 910 ◽  
Author(s):  
Ludovica Magi ◽  
Federica Mazzuca ◽  
Maria Rinzivillo ◽  
Giulia Arrivi ◽  
Emanuela Pilozzi ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Multidisciplinary Approach ◽  
Prospective Observational Study ◽  
Significant Proportion ◽  
Multidisciplinary Management ◽  
Neuroendocrine Neoplasia ◽  
Effective Care ◽  
Data Revision ◽  
Histological Data ◽  
Dedicated Team

Purpose: Multidisciplinary approach is widely advised for an effective care of patients with neuroendocrine neoplasia (NEN). Since data on efficacy of multidisciplinary management of NENs patients in referral centers are scanty, this study aimed at analyzing the modality of presentation and clinical outcome of patients with NENs managed by a dedicated multidisciplinary team. Methods. In this prospective observational study, we included all consecutive new patients visiting the Sant’Andrea Hospital in Rome (ENETS—Center of Excellence) between January 2014 and June 2018. Results. A total of 195 patients were evaluated. The most frequent sites were pancreas (38.5%), small bowel (22%), and lung (9.7%). Median Ki67 was 3%. After the first visit at the center, additional radiological and/or nuclear medicine procedures were requested in 163 patients (83.6%), whereas histological data revision was advised in 84 patients (43.1%) (revision of histological slides: 27.7%, new bioptic sampling: 15.4%). After that, disease imaging staging and grading was modified in 30.7% and 17.9% of patients, respectively. Overall, a change in therapeutic management was proposed in 98 patients (50.3%). Conclusions. Multidisciplinary approach in a dedicated team may lead to change of disease imaging staging and grading in a significant proportion of patients. Enhancing referral routes to dedicated-NEN center should be promoted, since it may improve patients’ clinical outcome.

scholarly journals Multidisciplinary Management of Pituitary Apoplexy

2016 ◽  
Vol 2016 ◽  
pp. 1-11 ◽  
Author(s):  
Adriana Albani ◽  
Francesco Ferraù ◽  
Filippo Flavio Angileri ◽  
Felice Esposito ◽  
Francesca Granata ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Pituitary Gland ◽  
Multidisciplinary Approach ◽  
Pituitary Apoplexy ◽  
Clinical Syndrome ◽  
Surgical Decompression ◽  
Medical Emergency ◽  
Multidisciplinary Management ◽  
Pituitary Tumours ◽  
Haemorrhagic Necrosis

Pituitary apoplexy is a rare clinical syndrome due to ischemic or haemorrhagic necrosis of the pituitary gland which complicates 2–12% of pituitary tumours, especially nonfunctioning adenomas. In many cases, it results in severe neurological, ophthalmological, and endocrinological consequences and may require prompt surgical decompression. Pituitary apoplexy represents a rare medical emergency that necessitates a multidisciplinary approach. Modalities of treatment and times of intervention are still largely debated. Therefore, the management of patients with pituitary apoplexy is often empirically individualized and clinical outcome is inevitably related to the multidisciplinary team’s skills and experience. This review aims to highlight the importance of a multidisciplinary approach in the management of pituitary apoplexy and to discuss modalities of presentation, treatment, and times of intervention.

Implication of Medical Treatment for Surgical Strategies in IBD

2019 ◽  
Vol 20 (13) ◽  
pp. 1363-1368
Author(s):  
Krisztina B. Gecse ◽  
Christianne J. Buskens
Keyword(s):  
Nutritional Status ◽  
Medical Treatment ◽  
Significant Proportion ◽  
Timing Of Surgery ◽  
Multidisciplinary Management ◽  
Key Factors ◽  
Surgical Strategies ◽  
Immunosuppressive Medications ◽  
Medical Paradigm ◽  
The Impact

Despite changing medical paradigm, still a significant proportion of patients with IBD require surgery. The patient's general condition, including nutritional status and the use of immunosuppressive medications is of great importance with regard to surgical complications, as well as the choice of optimal surgical strategy. The indication and the timing of surgery are key factors for the multidisciplinary management of IBD patients. The purpose of this review is to provide an overview on the impact of medical treatment on surgical strategies in IBD.

Multidisciplinary Management of Postoperative Pancreatic Fistula

2021 ◽  
Author(s):  
Alexa Glencer ◽  
Kim Kirkwood ◽  
Adam Schwertner ◽  
Cody Keller ◽  
Mustafa Arain ◽  
...  
Keyword(s):  
Interventional Radiology ◽  
Pancreatic Fistula ◽  
Multidisciplinary Approach ◽  
Postoperative Morbidity ◽  
Postoperative Pancreatic Fistula ◽  
Significant Source ◽  
Successful Outcome ◽  
Multidisciplinary Management ◽  
Economic Strain ◽  
Pancreatic Fistulas

AbstractPostoperative pancreatic fistulas are complex, challenging problems that often take weeks, months, or longer to resolve. Multiple interventions may be required to achieve a successful outcome. As such, resolution typically involves a multidisciplinary approach by a team whose skills include abdominal imaging, specialized surgery, advanced endoscopy, and interventional radiology. Intensive resources and time are often required, which impacts both patients and their caregivers. While treatment(s) continue to improve, a primary goal of research efforts in this area is the prevention of this significant source of postoperative morbidity, mortality, and economic strain.

Association between plasma transfusions and clinical outcome in critically ill children: a prospective observational study

Vox Sanguinis ◽  
2013 ◽  
Vol 104 (4) ◽  
pp. 342-349 ◽  
Author(s):  
O. Karam ◽  
J. Lacroix ◽  
N. Robitaille ◽  
P. C. Rimensberger ◽  
M. Tucci
Keyword(s):  
Clinical Outcome ◽  
Observational Study ◽  
Critically Ill ◽  
Prospective Observational Study ◽  
Critically Ill Children

Assessing Surgical Teamwork Competencies During Moments of Uncertainty Using OR Black Box

2021 ◽  
Vol 10 (1) ◽  
pp. 267-271
Author(s):  
Taylor Incze ◽  
Sonia Pinkney ◽  
Mark Fan ◽  
Patricia Trbovich
Keyword(s):  
Prospective Observational Study ◽  
Visual Analysis ◽  
Team Leadership ◽  
Black Box ◽  
Collaborative Problem Solving ◽  
Evidence Based ◽  
Team Members ◽  
Quality Healthcare ◽  
Collaborative Problem ◽  
Effective Care

Teamwork is an essential aspect to maintaining high-quality healthcare. This is especially true during times of uncertainty, when collaborative problem solving is necessary for clinical teams to adapt and deliver safe and effective care. We conducted a prospective observational study using audio/visual analysis captured by OR Black Box. Human factors experts transcribed and coded the videos using an evidence-based teamwork framework, specific to healthcare. We identified teamwork competencies that were either present or absent during moments of uncertainty in the operating room. Four main team roles (nurses, anesthesiologists, surgeons and trainees) were studied. We identified 3539 instances of teamwork, during 180 hours of surgical observation, and categorized them into 7 competencies. Team leadership was expressed significantly more often by surgeons compared to other team members whereas backup behaviour was expressed significantly more by nurses. Understanding how each team role uniquely contributes to teamwork can help develop specific and actionable teamwork interventions, which could ultimately lead to increased safety in the OR.

Multidisciplinary Management of a ‘Double Tooth’

Dental Update ◽  
2021 ◽  
Vol 48 (4) ◽  
pp. 266-270
Author(s):  
Niraj Halai ◽  
Shash Bhakta
Keyword(s):  
Clinical Diagnosis ◽  
Clinical Relevance ◽  
Multidisciplinary Approach ◽  
Case Reports ◽  
Multidisciplinary Management ◽  
Neutral Term

The term double tooth has often replaced the clinical diagnosis of gemination or fusion. If teeth have been extracted or exfoliated, the use of the neutral term ‘double tooth’ avoids the need to arbitrarily decide if it was gemination or fusion in origin. This case reports on a 16-year-old male who presented with an UL2 ‘double tooth’ and his combined restorative, surgical and orthodontic intervention to achieve his ideal result. CPD/Clinical Relevance: A multidisciplinary approach should be adopted when treating patients with a double tooth and an appropriate protocol as cited can be used.

Procalcitonin levels in sepsis and its association with clinical outcome in southern India

2017 ◽  
Vol 47 (4) ◽  
pp. 331-336
Author(s):  
Alex Rebello ◽  
Molly Mary Thabah ◽  
Tarun Kumar Dutta ◽  
Zachariah Bobby ◽  
BN Harish ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Prospective Observational Study ◽  
Medical Intensive Care Unit ◽  
Tertiary Care ◽  
Antibiotic Administration ◽  
Mean Values ◽  
Good Marker ◽  
Significant Difference ◽  
Medical Intensive Care ◽  
Medical Wards

Procalcitonin has been found to be a good marker for the diagnosis of sepsis. However, data on procalcitonin levels to predict the clinical outcome in patients with sepsis are limited. The aim of our study was to estimate serum procalcitonin levels in patients with sepsis and to identify its relationship with the clinical outcome. This was a prospective observational study conducted on 112 patients with sepsis admitted to the medical wards and medical intensive care unit of a tertiary care teaching hospital. Serum procalcitonin was measured at baseline before antibiotic administration and on day 5. The clinical outcome studied was death or survival on day 28. Baseline mean serum procalcitonin was highest in patients with septic shock and lowest in patients having sepsis without organ dysfunction. Mean values of procalcitonin at baseline and on day 5 were significantly higher in non-survivors when compared with survivors. There was a significant difference in the change in procalcitonin levels from baseline to day 5 between survivors and non-survivors, with survivors having declining values on day 5 while non-survivors had increasing values from baseline. The baseline APACHE II and SOFA scores also showed a significant correlation with the baseline procalcitonin level. Declining values of procalcitonin therefore indicate a favourable clinical outcome in patients with sepsis.

A multidisciplinary management approach for patients with Klippel-Trenaunay syndrome and multifetal gestation with successful outcomes

2018 ◽  
Vol 7 (2) ◽  
Author(s):  
James Hogg ◽  
Rebecca Pollack ◽  
Courtney Stephenson ◽  
Lorene Temming
Keyword(s):  
Multidisciplinary Approach ◽  
Congenital Disorder ◽  
Neonatal Outcomes ◽  
Management Approach ◽  
Multidisciplinary Management ◽  
Lymphatic Malformations ◽  
Multiple Gestations ◽  
Adverse Neonatal Outcomes ◽  
Maternal And Neonatal Outcomes ◽  
Klippel Trenaunay Syndrome

Abstract Background Klippel-Trenaunay syndrome (KTS) is a complex congenital disorder characterized by the classic triad of capillary malformation, venous and lymphatic malformations and limb overgrowth. The incidence of pregnancies affected by KTS is unknown. There is a paucity of literature regarding management and outcomes of affected pregnancies, particularly in multifetal gestations. Case We present two cases of pregnancies affected by KTS and multiple gestations. A multidisciplinary approach with hematology, radiology and anesthesia resulted in two successful pregnancies with no adverse neonatal outcomes. Conclusion Management of pregnancies affected by KTS and multiple gestations should be personalized with a multi-disciplinary approach to avoid morbidity and improve maternal and neonatal outcomes.

scholarly journals Usefulness of the prostate health index in predicting the presence and aggressiveness of prostate cancer among Korean men: a prospective observational study

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jae Yoon Kim ◽  
Ji Hyeong Yu ◽  
Luck Hee Sung ◽  
Dae Yeon Cho ◽  
Hyun-Jung Kim ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Specific Antigen ◽  
Significant Proportion ◽  
Health Index ◽  
Free Psa ◽  
Prostate Health Index ◽  
Total Psa ◽  
Prostate Health

Abstract Background We aimed to evaluate the usefulness of the Beckman Coulter prostate health index (PHI) and to compare it with total prostate-specific antigen (PSA) levels and related derivatives in predicting the presence and aggressiveness of prostate cancer (PCa) in the Korean population. Methods A total of 140 men who underwent their first prostate biopsy for suspected PCa were included in this prospective observational study. The diagnostic performance of total PSA, free PSA, %free PSA, [–2] proPSA (p2PSA), %p2PSA, and PHI in detecting and predicting the aggressiveness of PCa was estimated using the receiver operating characteristic curve (ROC) and logistic multivariate regression analyses. Results Of 140 patients, PCa was detected in 63 (45%) of participants, and 48 (76.2%) of them had significant cancer with a Gleason score (GS) ≥ 7. In the whole group, the area under the curve (AUC) for ROC analysis of tPSA, free PSA, %fPSA, p2PSA, %p2PSA, and PHI were 0.63, 0.57, 0.69, 0.69, 0.72, and 0.76, respectively, and the AUC was significantly greater in the PHI group than in the tPSA group (p = 0.005). For PCa with GS ≥ 7, the AUCs for tPSA, free PSA, %fPSA, p2PSA, %p2PSA, and PHI were 0.62, 0.58, 0.41, 0.79, 0.86, and 0.87, respectively, and the AUC was significantly greater in the PHI group than in the tPSA group (p < 0.001). In the subgroup with tPSA 4–10 ng/mL, both %p2PSA and PHI were strong independent predictors for PCa (p = 0.007, p = 0.006) and significantly improved the predictive accuracy of a base multivariable model, including age, tPSA, fPSA and %fPSA, using multivariate logistic regression analysis. (p = 0.054, p = 0.048). Additionally, at a cutoff PHI value > 33.4, 22.9% (32/140) of biopsies could be avoided without missing any cases of aggressive cancer. Conclusions This study shows that %p2PSA and PHI are superior to total PSA and %fPSA in predicting the presence and aggressiveness (GS ≥ 7) of PCa among Korean men. Using PHI, a significant proportion of unnecessary biopsies can be avoided.

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