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@#Joint hypermobility (JH) refers to the ability of joints to move beyond the 'normal' limits, which can be either physiologic or pathologic. Hypermobility spectrum disorders (HSDs) are a group of joint hypermobility-related clinical conditions. HSDs primarily affects the musculoskeletal system, predisposing the joints to subluxations or dislocations, and chronic pain. HSDs, however, may also manifest with symptoms such as fatigue, gastrointestinal disorders, and autonomic nervous system dysfunction, indicating multisystemic involvement that may impact psychological well-being. Although HSDs is usually not life-threatening, it is associated with poor quality of life. Currently, the molecular basis of HSDs remains unclear. The diagnosis of HSDs requires comprehensive medical evaluation and assessment. The main differential conditions/diagnoses include asymptomatic joint hypermobility, hypermobile Ehlers-Danlos syndrome (hEDS), and various musculoskeletal inflammatory or degenerative diseases. Asymptomatic joint hypermobility, HSDs, and hEDS are now viewed as a continuous spectrum. Due to limited awareness of the condition, individuals with asymptomatic joint hypermobility may experience overdiagnosis and overtreatment, while patients with HSDs may encounter prolonged misdiagnoses or underdiagnoses. Furthermore, individuals presenting with psychological symptoms may have all their somatic complaints erroneously attributed to psychological factors. These factors collectively impose unnecessary psychological and economic burdens on patients and their families. The multi-systemic and heterogeneous nature of HSDs necessitates a multi-disciplinary team (MDT) approach with a case manager in both the diagnosis and management processes. Additionally, patient education and self-management play pivotal roles in optimizing chronic disease management. This review aims to summarize the current state of diagnosis and management of HSDs and raise awareness of HSDs, providing a basis for the establishment and refinement of a multi-disciplinary diagnostic and management framework for HSDs in China.
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A 70-year-old woman with rheumatoid arthritis underwent above-knee amputation due to osteomyelitis after right total knee arthroplasty. After the surgery, the patient started rehabilitation for wearing a prosthetic leg. However, the patient could not wear the prosthesis by herself because of severe upper limb impairment due to bilateral finger joint deformity and muscle weakness associated with the rheumatoid arthritis. Therefore, physical therapists and prosthetists/orthotists collaborated to determine movements that could be performed, even with muscle weakness, using assistive devices such as a Velcro strip handle with the prosthesis and a prosthetic liner stand. Subsequently, repetitive training was performed in an environment similar to the setting of the patient's prosthesis use at home. Consequently, although no change in upper limb function was observed, the patient had increased independence during prosthesis attachment. As she had difficulty wearing and removing her trousers/underwear while wearing the prosthesis, she performed movements using assistive devices and made changes to the order of movements. Six months after the surgery, she could wear the prosthesis and perform self-care correctly by herself and return home. Therefore, to maximize function that enables independence after amputation, helping patients learn how to put on the prosthesis using a team approach is important.
ABSTRACT
A 70-year-old woman with rheumatoid arthritis underwent above-knee amputation due to osteomyelitis after right total knee arthroplasty. After the surgery, the patient started rehabilitation for wearing a prosthetic leg. However, the patient could not wear the prosthesis by herself because of severe upper limb impairment due to bilateral finger joint deformity and muscle weakness associated with the rheumatoid arthritis. Therefore, physical therapists and prosthetists/orthotists collaborated to determine movements that could be performed, even with muscle weakness, using assistive devices such as a Velcro strip handle with the prosthesis and a prosthetic liner stand. Subsequently, repetitive training was performed in an environment similar to the setting of the patient's prosthesis use at home. Consequently, although no change in upper limb function was observed, the patient had increased independence during prosthesis attachment. As she had difficulty wearing and removing her trousers/underwear while wearing the prosthesis, she performed movements using assistive devices and made changes to the order of movements. Six months after the surgery, she could wear the prosthesis and perform self-care correctly by herself and return home. Therefore, to maximize function that enables independence after amputation, helping patients learn how to put on the prosthesis using a team approach is important.
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@#Orthodontic treatment for dentofacial deformity is fundamental throughout the entire management process of cleft lip and palate. Orthodontist is one of those who are indispensable in the comprehensive multidisciplinary cleft team. Cleft lip and palate patients have unique dentofacial characteristics which makes the treatment goals and strategies different from those of other patients in different stages. For newborns with cleft lip and palate, the main treatment includes presurgical orthopedics. For patients in their primary dentition stage, the treatment mainly focuses on the prevention of bad oral habits and severe malocclusion. For those in their mixed dentition stage, the treatment mainly consists of dentition preparation for alveolar bone grafting and skeletal growth modification. For patients in their permanent dentition stage, treatment strategies include orthodontic camaflouge treatment, combined orthodontic-orthognathic approach and segmental alveolar distraction osteogenesis. In addition to routine orthodontic treatment, orthodontists should pay special attention to managing the compliance of cleft lip and palate patients with unique psychological characteristics. By summarizing the state-of-art cleft lip and palate orthodontic care in the multidisciplinary team, this review aims to involve more orthodontic clinicians to join in the modern biopsychosocial medical practice of cleft lip and palate team approach and to improve the standard of care for cleft lip and palate patients.
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Background: Cancer may have impacts on parents for child rearing. There has been few reports regarding what support is needed for them. The aim of this study is to investigate the needs of support system for cancer patients who have young children. Methods: First, we retrospectively studied records of specialized support for patients who had young children by palliative care team in National Cancer Center Hospital (NCCH) from April 2013 to September 2015. The data was collected from the NCCH electronic medical records. Next, we qualitatively classified the concerns about child-rearing of patients and their family. Results: A total of 131 (Male/Female: 41/90) cases received specialized support for patients who had young children during study period. The average age of patients was 43.3. Top three of primary sites of the patients were gastrointestinal tract, lung and breast. Approximately eighty percent of the patients were in the state of the recurrence and/or progressive cancer. The average age of their young children (n=239) was 9.6 (ages 0-17). The parents’ perceptions of child-related stressors were classified into three subcategories: 1. How to tell children about illness and treatment, 2. How to manage children’s reaction and emotion after having told them about illness, and 3. How to keep the parents’ role of child-rearing. Discussion: We found that patients who have children (age 0-17) have various types of concerns depending on their condition or age of children. Therefore, multi-disciplinary team approach for improving an effective support system was needed.
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Ludwig’s angina is an aggressive, rapidly spreading cellulitis of the floor of mouth and neck. It is less frequently seen in children as compared to adults. Successful management of Ludwig’s angina requires proper understanding of the anatomy, appropriate antibiotic therapy and surgical drainage whenever needed. Airway management is of prime concern and should be done with prior planning and cooperation of surgeon and anaesthesiologist. We hereby describe the successful management of Ludwig’s angina in a 3 year old child.
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The development of an expert consensus based on specific domestic situations will provide practical guidance to the efforts aiming at improving cleft care in China. The team approach of twenty-one cleft centers were pooled together, covering pre-surgical orthopedics, primary surgical repair, orthodontic treatment, alveolar bone graft, secondary deformity correction, palatal fistulae repair, the diagnosis and treatment of velopharyngeal incompetence, speech therapy, otitis media management, and skeletal deformity correction. Agreement was achieved among the authors concerning the application of critical surgical and non-surgical techniques. The ambition of this consensus is to introduce more clinicians to the revolution of sequential treatment of clefts, and form the basis for a more comprehensive cleft care manual in the future.
Subject(s)
Humans , Alveolar Bone Grafting , Cleft Lip , Velopharyngeal InsufficiencyABSTRACT
A refractory pressure ulcer should be treated not only by surgery but also with team medical care in order to avoid recurrence after the initial treatment. At our hospital, plastic surgeons are responsible for organizing the team care. As part of the team care strategy, physical therapists (PTs) and occupational therapists (OTs) provide education to improve the mobility of spinal-cord-injury patients, e.g., improving muscle strength of the upper extremities for adequate transfer and ability to perform wheelchair push ups. For elderly patients, nurses assess the risk of pressure ulcer development using the Braden's scale and set up a nutrition support team. Additionally, if patients have difficulty swallowing, a speech therapist treats the dysphagia. And PTs and OTs treat their impaired activities of daily living. Finally, medical social workers arrange home-health-care services when the patient returns to their home. The management of chronic wounds has progressed from merely assessing the status of the wound to understanding the underlying molecular and cellular abnormalities that prevent the wound from healing. The concept of wound bed preparation, TIME, has simultaneously evolved to provide a systematic approach to removing the barriers to natural healing and enhancing the effectiveness of advanced therapies. Wound bed preparation and the TIME framework are most likely to be successful when used alongside the wound bed preparation care cycle.
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PURPOSE: Intestinal failure (IF) is a complex clinical condition requiring a multi-disciplinary team approach. Our objective was to set up the treatment protocols and education documents for IF patients for development of intestinal rehabilitation programs in our hospital. METHODS: We compared the number of inpatients, length of hospital stay, mode of nutrition and calorie supply at discharge, and the frequency of blood transfusions before and after quality improvement of multidisciplinary activities, in order to evaluate the indirect effects of new protocols and training materials and for development of the intestinal rehabilitation system. RESULTS: We integrated eleven protocols for treatment and monitoring and seven educational materials for patients and caregivers. We compared indirect effects before and after the quality improvement activities. The number of IF patients hospitalized was reduced from 12 to 9. The mean days of hospital stay was decreased from 322 days to 73 days, the average number of monthly blood transfusions was also reduced from 1.8 to 0.3. In addition, the percentage of patients administered enteral nutrition and calories supplied was increased at discharge. CONCLUSION: By integrating IF protocols and education materials for IF patients, we found possible indirect effects of intestinal rehabilitation using a multidisciplinary team approach.
Subject(s)
Humans , Blood Transfusion , Caregivers , Clinical Protocols , Education , Enteral Nutrition , Inpatients , Length of Stay , Quality Improvement , RehabilitationABSTRACT
Background: In medical practice, a team approach becomes more important, so a shared awareness of the ethical viewpoint is demanded. Aims & Objective: The present study was conducted to clarify problem points in the evaluation of ethical awareness of medical specialists via the national exams. Material and Methods: This study focused on national board exams for physicians, pharmacists, and speech therapists (STs), specifically targeting the problems posed to exam takers by the 2007 national exams in Japan. Seven researchers first extracted from the exams what were referred to as “ethical problems,” and then they categorized these problems by forms and contents. Results: The percentages of ethical problems were 5.8% for the physicians’ exam, 3.8% for the pharmacists’ exam, and 1.0% for the STs’ exam. The results showed that the exams for physicians, compared to other specialists, contained a greater number of ethical problems and the proportion of ethical problems is also relatively large for the physicians’ exam. Moreover, in terms of taxonomy, problems posed to physicians not only elicited acquired knowledge but also required the exam taker to make decisions about specific cases. These ethical problems vary in forms and contents among the three exams. Conclusion: The results suggest that standardized criteria are necessary for national exams to raise a shared awareness of the ethical viewpoint among medical specialists.
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<b>Introduction</b> : As one of the strategies for the introduction of collaborative drug therapy management (CDTM) into a community healthcare system in Japan, we constructed a ‘positive list’ which was agreed by a family physician in advance, and subsequently validated the effects on healthcare insurance fees, the number of prescription question and the changes of utilization rate for generic drugs.<br><b>Methods</b> : The items that replaced prescription questions with regard to ex post facto approval were defined as ‘Resolved Questions’ in our constructed positive list. By adopting the ‘Resolved Questions’, we then examined the effect on healthcare insurance fees, prescription questions and the changes of utilization rates for generic drugs.<br><b>Results</b> : Among all prescription questions accepted from January through May 2012 inclusive, 178 (22.7%) were ‘Resolved Questions’, without there being change in the therapeutic strategies by the prescribing physicians. During this period, 17,455 healthcare insurance fees were reduced. In addition, the utilization rate for generic drugs were increased up to 46.6%.<br><b>Conclusion</b> : The reduction of healthcare insurance fees, prescription questions and the increased utilization rates of generic drugs were facilitated by prudent pharmacist judgements based on ‘Resolved Questions’.
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There are many problems in traditional medical personnel training model. The artificial division of specialities and subspecialities could make the trainees informed within the specialty/subspecialty but not beyond.This consequently results in biases and narrowed vision in their diagnosis and treatment of some illness. And what is even worse,this could be passed on from clinicians to medical students.In this paper,we introduce a novel model of medical teaching at Chinese PLA General Hospital,in which multidisciplinary team (MDT) work is involved.We found the MDT model beneficial not only to the patients but also the medical students.
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OBJECTIVE: The present paper highlights a case where the patients presented with spacing in the upper anterior region due to missing right lateral and peg shaped left lateral incisor. METHOD AND RESULTS: The initial treatment was standard edgewise fixed orthodontic appliance to distalize the canine, correct the bite and create space for the lateral incisors and correct the midline. CONCLUSION: After the active phase of fixed orthodontic treatment, an implant was placed and the peg shaped lateral incisor was built up with composite.
OBJETIVOS: O presente artigo refere-se a um caso em que o paciente apresentava espaços na região anterior da maxila devido à ausência de incisivo lateral direito e incisivo lateral esquerdo com coroa deformada. MÉTODO E RESULTADO: O tratamento inicial foi ortodontia fixa (edgewise) para distalizar o canino, corrigir a mordida e criar espaço para o incisivo lateral e corrigir a linha média. CONCLUSÃO: Após a fase ativa da ortodontia, utilizou-se um implante adequado na região do lateral direito e reconstruiu-se a coroa deformada do incisivo lateral esquerdo com compósito.
Subject(s)
Humans , Male , Young Adult , Anodontia/rehabilitation , Orthodontic Space Closure/methods , Dental Implants , Dental Prosthesis , Treatment OutcomeABSTRACT
Liver metastases in colorectal cancer are a frequent and lethal complication. Although hepatic resection is an effective treatment for patients with liver metastases in colorectal cancer, only 10-20% of the patients with liver metastases in colorectal cancer are indicated on hepatic resection. However, over the past several decades, liver resection has evolved as a safe and potentially curative treatment for liver metastases in colorectal cancer. Currently the absolute number of patients amenable to resection is large and is growing with better imaging, better surgery, and improvements in systemic therapies to reduce the risk of both intrahepatic and extrahepatic recurrences. The development of active chemotherapy and molecular targeted therapies, together with newer modalities like radiofrequency ablation, have expanded the indications for hepatic resection and improved survival. Also, although initially unresectable, a hepatic resection of colorectal liver metastases after down-sizing by using the above mentioned treatment modalities and chemotherapy can provide a hope for long-term survival that is similar to that of primarily resectable patients. To achieve this objective, for patients with liver metastases, a multidisciplinary team approach has become mandatory, with routine re-evaluation of patients and with adequate timing for each treatment.
Subject(s)
Humans , Colorectal Neoplasms , Liver , Molecular Targeted Therapy , Neoplasm Metastasis , RecurrenceABSTRACT
Developmental language disorder is the most common developmental disability in childhood, occurring in 5-8% of preschool children. Children learn language in early childhood, and later they use language to learn. Children with language disorders are at increased risk for difficulties with reading and written language when they enter school. These problems often persist through adolescence or adulthood. Early intervention may prevent the more serious consequences of later academic problems, including learning disabilities. A child's performance in specific speech and language areas, such as phonological ability, vocabulary comprehension, and grammatical usage, is measured objectively using the most recently standardized, norm-referenced tests for a particular age group. Observation and qualitative analysis of a child's performance supplement objective test results are essential for making a diagnosis and devising a treatment plan. Emphasis on the team approach system in the evaluation of children with speech and language impairments has been increasing. Evidence-based therapeutic interventions with short-term, long-term, and functional outcome goals should be applied, because there are many examples of controversial practices that have not been validated in large, controlled trials. Following treatment intervention, periodic follow-up monitoring by a doctor is also important. In addition, a systematized national health policy for children with speech and language disorders should be provided.
Subject(s)
Adolescent , Child , Child, Preschool , Humans , Comprehension , Developmental Disabilities , Early Intervention, Educational , Health Policy , Language Development Disorders , Language Disorders , Learning Disabilities , VocabularyABSTRACT
Developmental language disorder is the most common developmental disability in childhood, occurring in 5-8% of preschool children. Children learn language in early childhood, and later they use language to learn. Children with language disorders are at increased risk for difficulties with reading and written language when they enter school. These problems often persist through adolescence or adulthood. Early intervention may prevent the more serious consequences of later academic problems, including learning disabilities. A child's performance in specific speech and language areas, such as phonological ability, vocabulary comprehension, and grammatical usage, is measured objectively using the most recently standardized, norm-referenced tests for a particular age group. Observation and qualitative analysis of a child's performance supplement objective test results are essential for making a diagnosis and devising a treatment plan. Emphasis on the team approach system in the evaluation of children with speech and language impairments has been increasing. Evidence-based therapeutic interventions with short-term, long-term, and functional outcome goals should be applied, because there are many examples of controversial practices that have not been validated in large, controlled trials. Following treatment intervention, periodic follow-up monitoring by a doctor is also important. In addition, a systematized national health policy for children with speech and language disorders should be provided.
Subject(s)
Adolescent , Child , Child, Preschool , Humans , Comprehension , Developmental Disabilities , Early Intervention, Educational , Health Policy , Language Development Disorders , Language Disorders , Learning Disabilities , VocabularyABSTRACT
Sex identification may be described in terms of some characteristics. Any individual with testicular formation and contraindiction of any of the anatomical criteria of sex may be considered as a male pseudohermaphrodite. Most of them have genitalia that are more feminine than masculine, are best raised as females. We report a 26-year-old male pseudohermaphrodite who was phenotypically female with amenorrhea, little breast development and little sexual hair. For treatment, multidisciplinary team approach including pubic hair transplantation is needed to enhance self-image and confidence in intersexuality.
Subject(s)
Adult , Female , Humans , Male , Disorder of Sex Development, 46,XY , Amenorrhea , Breast , Disorders of Sex Development , Genitalia , HairABSTRACT
Endovascular technologies have intrinsic appeal to patients and physicians, they may, if proved safe and effective, replace a substantial proportion of current vascular surgical procedures. Because the developement and the use of these technologies require the skills and the talents of the vascular surgeons and interventional radiologists, a collaborative, multispecialty approach to the use of endovascular technologies is recommended as the most reasonable and optimal treatment for patient care. The purpose of this article is to review our experiences with cooperative endovascular treatments in vascular disease and to stress the key role of vascular surgeon on these technologies. From July, 1995 to March, 1998, 7 cooperative endovascular treatments were done in six patients. Male to female ratio was 4:2 and median age was 58.0 yrs (40~71 yrs). All procedures were done in angiography suite under the local anesthesia. Indications for treatments were 3 pseudoaneurysms in Behcet's disease, 2 abdominal aortic aneurysms (AAAs), 2 acute arterial occlusions with ASO. Six stent graftings were done for aneurysmal diseases. Recurred pseudoaneurysm was occurred in one patient with Behcet's disease, and stent graft was reinserted. Postoperative leak was seen in one patient with AAA, but sealed up spontaneously on following angiography. Simultaneous endovascular balloon angioplasty with open thrombectomy were done in 2 acute arterial occlusions with ASO. Vascular surgeons and interventional radiologists executed cooperative, team approaches in all procedures with success. Although this approach may not be applicable for every vascular disease, vascular surgeons must represent the leadership of the this cooperative treatment. For this, sufficient knowledge and training program with active participation in these technologies are necessary.