Interdisciplinary care in orbital complications of acute rhinosinusitis in children

Purpose: Orbital cellulitis is a serious condition with potentially severe complications. Treatment requires interdisciplinary care and early introduction of antimicrobial therapy. In our tertiary center, a team of pediatricians, pediatric ophthalmologists, and otorhinolaryngologists successfully participated in the management of pediatric periorbital/orbital cellulitis. This study aimed to demonstrate our interdisciplinary approach and to investigate clinical profile and management of pediatric periorbital/ orbital cellulitis. Methods: A retrospective chart review was performed of all pediatric patients hospitalized for periorbital and orbital cellulitis in a tertiary hospital center from September 15, 2016, to March 15, 2020. Results: A total of 26 children—median age 2.7 years (range 0.5–12)—were treated during the study period. Disease presentation was unilateral, mainly during winter (n = 12) and autumn (n = 12), without ophthalmoplegia/proptosis. Seven patients had orbital cellulitis (Chandler classification of ??) and were older (6.5 years, P = 0.011) with sinusitis (P < 0.001), required surgery (P = 0.004), underwent longer antimicrobial treatment (13 days, P < 0.001), and had a longer length of hospital stay (13.43 days, P = 0.001). Orbital cellulitis occurred in a median of three days (range 1–12) of acute rhinosinusitis. Radiological survey was performed in 11 patients, whereas six patients were treated surgically. All intraoperatively collected cultures (sinus swabs) were positive, whereas Streptococcus pyogenes and Peptostreptococcus were isolated in five cases. All patients fully recovered. No recurrence was documented. Conclusion: Sinusitis is associated with severe orbital cellulitis and surgical management. Orbital cellulitis occurred early in the course of acute rhinosinusitis, as a distinctive presentation of rhinosinusitis. Interdisciplinary care and early management are crucial in treatment of pediatric periorbital/orbital cellulitis

Do abandono à criação: o atendimento interdisciplinar de uma adolescente no CAPSij / From abandonment to creation: the interdisciplinary care of a teenager in CAPSij / Del abandono a la creación: la atención interdisciplinaria de un adolescente en CAPSij

O CAPSij é um equipamento do Sistema Único de Saúde (SUS) de Saúde Mental, destinado ao atendimento de situações de sofrimento psíquico grave e/ou persistente e de vulnerabilidade social, na Infância e Adolescência. O acompanhamento dos casos é conduzido pela equipe do serviço, composta por profissionais provenientes de diversas áreas, tais como: Psicologia, Serviço Social, Terapia Ocupacional, Enfermagem e Psiquiatria. O presente trabalho foi realizado em um Capsij, localizado na região sudeste da cidade de São Paulo e atendido por: uma psicóloga, uma terapeuta ocupacional e uma enfermeira da equipe. Trata-se de uma adolescente e sua família, que ao longo de dois anos, foram inseridas em diversos dispositivos terapêuticos do serviço. Sua história de vida é marcada pelo abandono e adoção por figuras parentais ambivalentes. As principais queixas se referiram a tentativas de suicídio, uso de drogas e fugas de casa. Ao longo do acompanhamento, foi observado um reposicionamento subjetivo da adolescente, que passou a se utilizar de suas habilidades artísticas, como novas possibilidades de laço social. Além de uma maior disponibilidade materna para acolher e cuidar da filha adotiva.

CAPSij is a piece of equipment of the Unified Health System (SUS) of Mental Health, intended to attend to situations of severe and / or persistent psychological distress and social vulnerability in childhood and adolescence. The follow-up of cases is conducted by the service team, composed of professionals from various areas, such as: Psychology, Social Work, Occupational Therapy, Nursing and Psychiatry. The present work was carried out in a Capsij, located in the southeastern region of São Paulo city and attended by: a psychologist, an occupational therapist and a team nurse. This is a teenager and her family, who over two years, were inserted in various therapeutic devices of the service. Her life story is marked by abandonment and adoption by ambivalent parental figures. The main complaints referred to suicide attempts, drug use and homelessness. During the follow-up, a subjective repositioning of the adolescent was observed, which started to use her artistic skills as new possibilities for social bonding. In addition to greater maternal availability to welcome and care for the adopted daughter.

CAPSij es un equipo del Sistema Unificado de Salud (SUS) de Salud Mental, destinado a atender situaciones de angustia psicológica grave y / o persistente y vulnerabilidad social en la infancia y la adolescencia. El seguimiento de los casos es realizado por el equipo de servicio, compuesto por profesionales de diversas áreas, tales como: psicología, trabajo social, terapia ocupacional, enfermería y psiquiatria. El presente trabajo se llevó a cabo en un Capsij, ubicado en la región sureste de la ciudad de São Paulo y contó con la asistencia de: un psicólogo, un terapeuta ocupacional y una enfermera del equipo. Esta es una adolescente y su familia, que durante más de dos anos, se insertaron en varios dispositivos terapêuticos del servicio. La historia de su vida está marcada por el abandono y la adopción de figuras parentales ambivalentes. Las principales quejas se referían a intentos de suicidio, uso de drogas y personas sin hogar. Durante el seguimiento, se observó un reposicionamiento subjetivo de la adolescente, que comenzó a utilizar sus habilidades artísticas como nuevas posibilidades de vinculación social. Además de una mayor disponibilidad materna para acoger y cuidar a la hija adoptada.

Clinical Implications of the Interdisciplinary Psychosocial Approach and Integrative Care for Patients with Advanced Cancer and Family Members in the Nutritional Support and Cancer Cachexia Clinic

Food and eating are of great significance to humans, as we are the only creatures that establish relationships and sustain a social network through food and eating. Recent studies revealed that patients with advanced cancer and their family members often experience complicated eating-related distress due to tumors themselves, side effects of cancer treatments, and negative impacts of cancer cachexia. Therefore, we suggested the importance of the integration of palliative, supportive, and nutritional care to alleviate eating-related distress among patients and family members, and the significance of the development of tools to measure their distress in supportive and palliative care settings. No care strategies for eating-related distress experienced by patients and family members have been established, and the development of an interdisciplinary psychosocial approach and integrative care is required. As such, we are planning to start a nutritional support and cancer cachexia clinic in the National Cancer Center, and disseminate a newly developed care program across Japan.

Effect of interdisciplinary nursing model on postoperative physical condition, mood and satisfaction of patients with thyroid cancer / 中国实用护理杂志

Objective To study the effects of interdisciplinary nursing model on physical condition, mood and satisfaction of postoperative patients with thyroid cancer. Methods A total of 296 patients who underwent thyroid surgery at the First Affiliated Hospital of China Medical University and were diagnosed with thyroid cancer were randomly selected from March 2016 to March 2017. The general situation of all patients was recorded, the above patients were divided into the intervention group and the control group according to whether they were willing to accept the interdisciplinary care model. The intervention group received an interdisciplinary care model and the control group chose a general care model. The symptom score and satisfaction score of the intervention group and the control group were evaluated 1 month after surgery. Results Postoperative symptom scores in the two groups were statistically different between happiness, fatigue, anxiety, depression, pain, lethargy, loss of appetite, and shortness of breath (t=1.18-3.18, P<0.05). Satisfaction rating reminder: After feeling the medical staff to solve their own concerns, trust the medical staff, feel the respect of the medical staff, feel the teamwork of the medical staff, and recommend other patients to our hospital for treatment (t=3.83-8.13, P<0.05). Conclusions Interdisciplinary care can significantly alleviate the symptoms of postoperative patients with thyroid cancer, relieve anxiety and depression, and improve patient satisfaction.

Tratamento interdisciplinar das hepatites virais no Hospital Estadual Bauru: relato de experiência / Interdisciplinary treatment of viral hepatitis at Bauru State Hospital: experience report

Este trabalho apresenta a experiência de uma abordagem interdisciplinar, desenvolvida na modalidade de pesquisa-ação, no atendimento ambulatorial a um grupo de 20 pacientes em tratamento da hepatite C. As especialidades envolvidas no projeto foram: assistência social, enfermagem, gastroenterologia, infectologia, nutrição e psicologia. Os objetivos do atendimento interdisciplinar foram manter a qualidade de vida do portador da doença, diante dos efeitos colaterais das medicações prescritas, reduzir os índices de abandono do tratamento, promover a participação do paciente no processo saúde-doença e na intervenção desse processo. Os métodos utilizados foram atendimentos individuais e grupo de apoio para os pacientes, com a integração cooperativa da equipe interdisciplinar. Como resultado dessa abordagem no primeiro ano de implantação obteve-se 100% de adesão dos pacientes ao tratamento, com relatos de experiências incentivadoras à continuidade de ações interdisciplinares. Ressalta-se a constatação de alto índice de cura dos pacientes, superior aos obtidos em outros centros de referência

This paper presents the experience of a interdisciplinary approach, developed under the action research approach, in a hepatitis C treatment clinic with 20 individuals. The multidisciplinary group was composed by: a social assistant, a nurse, ID and GI physicians, nutritionist and a psychologist. Used actions were individualized and support-group meetings for the patients and cooperative meetings of the interdisciplinary group. The main goals were to preserve the patient's quality of life regardless of the adverse events inherent to the used medications, to reduce the dropout rate, promote the patient understanding of the health-disease process and its participation in this intervention strategy. During the first year, the program showed 100% adherence rate, with reports that encourage the continuous use of the multidisciplinary actions. Among these treated patients, higher cure rates were observed, when compared to other treatment centers in Brazil

Doença renal crônica: importância do diagnóstico precoce, encaminhamento imediato e abordagem interdisciplinar estruturada para melhora do desfecho em pacientes ainda não submetidos à diálise / Chronic kidney disease: importance of early diagnosis, immediate referral and structured interdisciplinary approach to improve outcomes in patients not yet on dialysis

Atualmente, é amplamente aceita a definição da doença renal crônica (DRC) que se baseia em alterações na taxa de filtração glomerular e/ou presença de lesão parenquimatosa mantidas por pelo menos três meses. Embora os critérios para diagnóstico de DRC estejam agora bem mais claros, a proporção de pacientes com DRC em estágio avançado vista pela primeira vez por nefrologista imediatamente antes do início de tratamento dialítico ainda é inaceitável. O diagnóstico precoce e o encaminhamento imediato para o nefrologista são etapas essenciais no manuseio desses pacientes, pois possibilitam a educação pré-diálise e a implementação de medidas preventivas que retardam ou mesmo interrompem a progressão para os estágios mais avançados da DRC, assim como diminuem morbidade e mortalidade iniciais. Nesta revisão, discutimos a complexidade da DRC, a multiplicidade de intervenções atualmente recomendadas na sua prevenção secundária e diferentes modelos de prestação de cuidados à saúde, além de examinarmos o racional do atendimento interdisciplinar e a evolução dos pacientes seguidos em clínicas que já adotaram esse modelo.

At present, chronic kidney disease (CKD) is broadly defined on the basis of changes in the glomerular filtration rate and/or the presence of parenchymal damage present for at least 3 months. Although the diagnosis of CKD is now quite straightforward, the proportion of patients with end-stage renal disease seen by a nephrologist for the first time immediately before the initiation of dialysis is still unacceptable. Early diagnosis and immediate nephrology referral are key steps in management because enable predialysis education, allow implementation of preventive measures that delay or even halt progression of CKD to end stage renal disease, as well as decrease initial morbidity and mortality. In this review, we discuss the complexity of CKD and the multiplicity of interventions currently recommended in its secondary prevention, different models of healthcare delivery, and examine the rational and outcomes of patients followed in interdisciplinary care clinics.

Satisfação do paciente com o atendimento interdisciplinar numambulatório de prevenção da doença renal crônica / Patient’s satisfaction with interdisciplinary care in a clinic of prevention of chronic kidney disease

Introdução: Semelhantemente ao observado em outras doenças, a satisfação do paciente com o seu tratamento pode determinar melhor evolução da doença renal crônica (DRC). Objetivo: Avaliar a satisfação dos pacientes com o atendimento interdisciplinar recebido num ambulatório de prevenção da DRC. Métodos: A pesquisa de satisfação foi aplicada a pacientes do PREVENRIM – Programa Interdisciplinar de Prevenção da DRC. O diagnóstico e o estagiamento da DRC se fundamentaram nas diretrizes do KDOQI da NKF americana. A pesquisa de satisfação baseou-se em perguntas relativas à logística do atendimento, à importância dos membros da equipe no manejo da doença, à dinâmica do atendimento e à compreensão das informações sobrea DRC. Resultados: Foram avaliados 101 pacientes, 52,6% eram do sexo masculino, com idade média de 56±13,9 anos acompanhados em média por 32,66±18,17 meses. Do total de pacientes, 43,8% possuíam ensino fundamental incompleto. A principal causa de DRC foi nefroesclerose hipertensiva. A média da FG estimada foi de 31,59±15,02mL/min/1,73m2. A maioria absoluta (95,6%) dos pacientes relatou estar satisfeita com as explicações sobre as suas doenças. O atendimento foi considerado importante ou muito importante pelos pacientes com relação à atuação do nefrologista e da nutricionista (100%), assistente social e enfermeiro (98,8%), bem como da psicóloga (97,7%). Todos recomendariam o PREVENRIM a outros pacientes com DRC. Conclusão: Nesta amostra de pacientes com DRC pré-dialítica acompanhados por uma equipe interdisciplinar, observamos um alto nível de satisfação com os cuidados de saúde ofertados. Estudos futuros avaliarão se a satisfação do paciente com o seu tratamento determinará melhores desfechos biopsicossociais na evolução da DRC.

Introduction: Similarly to the observed in other diseases, the patient’s satisfaction with his or her treatment may determine better outcomes of the chronic kidney disease (CKD). Aim: To assess the satisfaction of patients with the interdisciplinary care delivered in a Clinic of secondary prevention of CKD. Methods: The satisfaction assessment was applied to patients of the PREVENRIM – Interdisciplinary Program of Prevention of CKD. The diagnosis and staging of CKD were done as proposed by the KDOQI of the American NKF. The satisfaction assessment was made through questions covering the logistic of the Clinic, the importance of each members of the team in the management of the disease, the dynamic of the interdisciplinary care, and the understanding of the information on CKD. Results: The questionnaire were applied to 101 patients, followed for 32,66 ± 18,17 months, 52,6% were male and the mean age was 56±13,9 years. Incomplete basic education was observed in 43,8% of the patients. The main cause of CKD was hypertensive nephroesclerosis. The mean estimated GFR was 31,59±15,02mL/min/1,73m2. The great majority (95,6%) of the patients reported to be satisfied with theexplanation given about their disease. Regarding the management of their disease, the patients considered important or very important the role played by nephrologists and dietician (100%), social worker and nurse (95,6%), and psychologist (97,7%). All the patients would refer patients with CKD to the PREVENRIM. Conclusion: In this group of patients with CKD not yet on dialysis, followed by an interdisciplinary team, we observed a high satisfaction level with the health care received. Future studies should assess if the level of patients’ satisfaction with their treatment will determine better outcomes in CKD.