• Title, Summary, Keyword: multidisciplinary therapy

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Multidisciplinary team approach for the management of patients with locally advanced non-small cell lung cancer: searching the evidence to guide the decision

  • Oh, In-Jae;Ahn, Sung-Ja
    • Radiation Oncology Journal
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    • v.35 no.1
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    • pp.16-24
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    • 2017
  • Locally advanced non-small cell lung cancer (LA-NSCLC) is composed of heterogeneous subgroups that require a multidisciplinary team approach in order to ensure optimal therapy for each patient. Since 2010, the National Comprehensive Cancer Network has recommended chemoradiation therapy (CRT) for bulky mediastinal disease and surgical combination for those patients with single-station N2 involvement who respond to neoadjuvant therapy. According to lung cancer tumor boards, thoracic surgeons make a decision on the resectability of the tumor, if it is determined to be unresectable, concurrent CRT (CCRT) is considered the next choice. However, the survival benefit of CCRT over sequential CRT or radiotherapy alone carries the risk of additional toxicity. Considering severe adverse events that may lead to death, fit patients who are able to tolerate CCRT must be identified by multidisciplinary tumor board. Decelerated approaches, such as sequential CRT or high-dose radiation alone may be a valuable alternative for patients who are not eligible for CCRT. As a new treatment strategy, investigators are interested in the application of the innovative radiation techniques, trimodality therapy combining surgery after high-dose definitive CCRT, and the combination of radiation with targeted or immunotherapy agents. The updated results and on-going studies are thoroughly reviewed in this article.

Interim palatal lift prosthesis as a constituent of multidisciplinary approach in the treatment of velopharyngeal incompetence

  • Raj, Neerja;Raj, Vineet;Aeran, Himanshu
    • The Journal of Advanced Prosthodontics
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    • v.4 no.4
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    • pp.243-247
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    • 2012
  • The velopharynx is a tridimensional muscular valve located between the oral and nasal cavities, consisting of the lateral and posterior pharyngeal walls and the soft palate, and controls the passage of air. Velopharyngeal insufficiency may take place when the velopharyngeal valve is unable to perform its own closing, due to a lack of tissue or lack of proper movement. Treatment options include surgical correction, prosthetic rehabilitation, and speech therapy; though optimal results often require a multidisciplinary approach for the restoration of both anatomical and physiological defect. We report a case of 56 year old male patient presenting with hypernasal speech pattern and velopharyngeal insufficiency secondary to cleft palate which had been surgically corrected 18 years ago. The patient was treated with a combination of speech therapy and palatal lift prosthesis employing interim prostheses in various phases before the insertion of definitive appliance. This phase-wise treatment plan helped to improve patient's compliance and final outcome.

Cleft Palate Speech - Language Management based on the Multidisciplinary Approach (다학문적 접근법의 구개열 말-언어 관리)

  • Yang, Ji-Hyung
    • Korean Journal of Cleft Lip And Palate
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    • v.8 no.2
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    • pp.95-105
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    • 2005
  • Cleft lip and palate is a congenital deformity which needs a professional and consistent management from the birth and along with the physical growth of patients. The patients with cleft lip and palate can have general speech problems with resonance disorders, voice disorders and articulation disorders after the successful primary surgical management and the physical growth. Speech problems of Cleft lip and palate are characterized hypernasality, nasal air emission, increased nasal air flow, and aberrant speech marks which decrease intelligibility. These speech problems of cleft lip and palate can be treated with the secondary surgical procedure, the application of temporary prosthesis and the effective and well-timed speech therapy. The speech and language problems of cleft lip and palate, the general procedures and schedules of the speech assessment and therapy based on the multidisciplinary approach are introduced for the patients with cleft lip and palate, their family and the other members of the cleft palate treatment team.

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Music Therapy Research Trends in KCI Journals (등재학술지 내 음악치료 연구 게재 동향)

  • Kim, Ha Young
    • Journal of Music and Human Behavior
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    • v.15 no.2
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    • pp.1-22
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    • 2018
  • The purpose of this analysis was to classify music therapy studies published in KCI journals to understand the type of research being conducted and trends in the research. This study analyzed 472 music therapy articles published in KCI journals from 2005 to October 31, 2017. The study analyzed the overall characteristics of the included studies, trends in each research field, study subjects, research types, and commonalities and differences between research fields. It was confirmed that the number of music therapy studies published in KCI journals steadily increased from 2005. The results also confirmed that the research subjects and types of music therapy research became more diverse. For example, earlier studies focused on participants with disabilities, but populations without disabilities were increasingly the focus of more recent studies. Similarly, earlier studies were mostly experimental or descriptive, but more recent research included historical, philosophical, and program development studies. The results of analysis confirm that music therapy research is evolving and being conducted in cooperation with many other fields. This article provides a snapshot of the current state of music therapy research and offers implications for the future of music therapy research with multidisciplinary characteristics.

Impact of Multidisciplinary Spine Conferences on Surgical Planning and Perioperative Care in Elective Lumbar Spine Surgeries

  • Namiranian, Khodadad;Norris, Edward John;Jolissaint, James Gregory;Patel, Jigar Bharat;Lombardi, Celeste Marie
    • Asian Spine Journal
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    • v.12 no.5
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    • pp.854-861
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    • 2018
  • Study Design: Pre- and post-implementation analysis. Purpose: We examined the impact of implementing multidisciplinary spine conferences-"spine board" reviews-on the general utilization of elective lumbar spine surgeries in a tertiary medical institute. Overview of Literature: A multidisciplinary approach to spine care reportedly improves the appropriate utilization of surgical spine procedures. Methods: A multidisciplinary spine board was established to review candidates selected for elective lumbar spine surgery. The board comprised representatives from orthopedic spine surgery, neurosurgery, psychology, physical therapy, radiology, pharmacy, primary care, pain management, anesthesiology, and veteran advocacy. Two similar 6-month periods were selected to study the impact of this implementation: pre-implementing (June 1, 2015 to November 30, 2015) and post-implementation (June 1, 2016 to November 30, 2016) periods. Results: Between March 1, 2016 and December 30, 2016, the spine board discussed 11 patients. All patients underwent clinical examinations and radiological assessments findings that warranted elective lumbar surgery. The board recommended non-surgical interventions before proceeding with the planned surgeries in all cases. In the pre-implementation period, a total of 101 elective lumbar spine surgeries were performed. In the post-implementation period, a total of 51 elective lumbar spine surgeries were performed (p<0.05). The surgical plan for elective lumbar spine surgery in the post-implementation period was not directly influenced by the review of spine board because none of the cases were discussed in the conferences; however, the care occurred at a hospital where the spine board was implemented. There was no significant change in the number of cervical spine surgeries performed (66 preimplementation vs. 56 post-implementation). The average surgery duration was 52 minutes shorter in the post-implementation period compared with that in the pre-implementation period (p<0.05). Conclusions: Implementation of a multidisciplinary spine board was concurrent with an overall decrease in the utilization of lumbar spine surgeries for elective cases of low back pain in a tertiary medical center.

Role of Catheter's Position for Final Results in Intrathecal Drug Delivery. Analysis Based on CSF Dynamics and Specific Drugs Profiles

  • De Andres, Jose;Perotti, Luciano;Villanueva, Vicente;Asensio Samper, Juan Marcos;Fabregat-Cid, Gustavo
    • The Korean Journal of Pain
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    • v.26 no.4
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    • pp.336-346
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    • 2013
  • Intrathecal drug delivery is an effective and safe option for the treatment of chronic pathology refractory to conventional pain therapies. Typical intrathecal administered drugs are opioids, baclofen, local anesthetics and adjuvant medications. Although knowledge about mechanisms of action of intrathecal drugs are every day more clear many doubt remain respect the correct location of intrathecal catheter in order to achieve the best therapeutic result. We analyze the factors that can affect drug distribution within the cerebrospinal fluid. Three categories of variables were identified: drug features, cerebrospinal fluid (CSF) dynamics and patients features. First category includes physicochemical properties and pharmacological features of intrathecal administered drugs with special attention to drug lipophilicity. In the second category, the variables in CSF flow, are considered that can modify the drug distribution within the CSF with special attention to the new theories of liquoral circulation. Last category try to explain inter-individual difference in baclofen response with difference that are specific for each patients such as the anatomical area to treat, patient posture or reaction to inflammatory stimulus. We conclude that a comprehensive evaluation of the patients, including imaging techniques to study the anatomy and physiology of intrathecal environment and CSF dynamics, could become essential in the future to the purpose of optimize the clinical outcome of intrathecal therapy.

Efficacy of Voice Therapy for Children with Vocal Nodules (소아 성대 결절에 대한 음성 치료의 효과)

  • So, Yoon Kyoung
    • Journal of Clinical Otolaryngology
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    • v.29 no.2
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    • pp.229-234
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    • 2018
  • Background and Objectives : Vocal nodules occur with a 12-22% prevalence in pediatric populations. Most otolaryngologists recommend voice therapy as the primary treatment. The aim of this study is to evaluate patient compliance with voice therapy and its effect on vocal nodules in children. Materials and Methods : We retrospectively reviewed 44 pediatric patients between 3 and 11 years old diagnosed with vocal nodules between March 2015 and December 2017. We evaluated the treatment adoption rate, dropout rate during voice therapy, and reasons for dropout. For patients who completed voice therapy, we measured the changes in nodule size, perceptual parameters, and acoustic parameters. We evaluated patient satisfaction using the pediatric voice handicap index (P-VHI). Results : Of the 44 pediatric patients diagnosed with vocal nodules, 22 (50%) agreed to voice therapy. Of the 22 patients who started voice therapy, 5 (22.7%) dropped out during therapy because they were unsatisfied with their treatment. Another 4 patients discontinued therapy for reasons unrelated to treatment effectiveness. Vocal nodule disappeared or decreased in all 13 patients who completed voice therapy. All voice parameters were improved and statistically significant changes were observed in perceptual, acoustic, and P-VHI parameters. Conclusions : Although compliance to voice therapy among the pediatric patients with vocal nodules was low, there were significant improvements in voice parameters for those who completed voice therapy. A change toward a positive perception of voice therapy is necessary and a multidisciplinary approach is needed to improve the effect of voice therapy on pediatric patients with vocal nodules.

Multidisciplinary Collaborative Therapy for 30 Children with Orbital Rhabdomyosarcoma

  • Ge, Xin;Huang, Dong-Sheng;Shi, Ji-Tong;Ma, Jian-Min
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.8
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    • pp.4641-4646
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    • 2013
  • Objective: To explore clinical experience and propose new ideas for treating children diagnosed with orbital rhabdomyosarcoma (RMS). Methods: We retrospectively analyzed the clinical data for30 patients (16 males and 14 females, with a median age of 6.2 years) with primary orbital RMS who were enrolled in the Department of Eye Oncology and Pediatrics of our hospital from November 2004 to December 2012. International Rhabdomyosarcoma Organization Staging Standards indicated that among the 30 patients, 4 cases were in phase II, 20 were in phase III, and 6 were in phase IV. All patients underwent a multidisciplinary collaborative model of comprehensive treatment (surgery, chemotherapy, external radiotherapy, $^{125}I$ radioactive particle implantation, and autologous peripheral blood stem-cell transplantation). Results: Follow-up was conducted until March 2013, with a median follow-up time of 47.2 months (5 to 95 months), and 7 deaths occurred. The 2-year estimated survival rate reached 86.1%, the ${\geq}3$-year estimated survival rate was 77%, and the 5-year estimated survival rate was 70.6%. Conclusions: The multidisciplinary collaborative model can be a safe and effective approach to the comprehensive treatment of children with orbital RMS. It has clinical significance in improving the tumor remission rate.

Intra Operative Radiation Therapy (IORT) (위암환자의 수술중 전자선을 이용한 방사선 치료방법에 대한 고찰)

  • Kim, Dong-Wook;Suh, Myong-Won
    • The Journal of Korean Society for Radiation Therapy
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    • v.2 no.1
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    • pp.75-80
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    • 1987
  • Intraoperative Radiation therapy (IORT) is a cancer treatment modality in which resectable masses or organs are removed surgically and residual cancer calls are sterilized by irradiation with a single massive dose during while patient is still anesthetized. Because it is possible that the turner mass can be visualized directly at the time of surgical exploration, tumor volume can be determined more precisely and at the same tin e sensitive adjacent structures can be pulled aside from the irradiation. With these theoretical advantages as compare to conventional external irradiation, IORT can improve the therapeutic ratio of tumor control to normal tissue injury. Yonsei cancer center initiated a pilot study of multidisciplinary IORT program in february of 1986 for the fist attempt in Korea. IORT Was performed in 7 patients with stomach cancer by using existing NELAC-1018 Linear Accelerator treatment room as a surgical suite. IOTR team included department of surgery, Department of Anethesiology, Department of Clinical pathology, operating room nursing personal and Department of radiation oncology.

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