Developing a decision-making model based on an interdisciplinary oncological care group for the management of colorectal cancer.

AIM: To report our experience on implementation and preliminary results of a decision-making model based on the recommendations of an Interdisciplinary Oncological Care Group developed for the management of colorectal cancer. PATIENTS AND METHODS: The multidisciplinary team identified a reference guideline using appraisal of guidelines for research and evaluation (AGREE) tool based on a sequential assessment of the guideline quality. Thereafter, internal guidelines with diagnostic and therapeutic management for early, locally advanced and metastatic colonic and rectal cancer were drafted; organizational aspects, responsibility matrices, protocol actions for each area of specialty involved and indicators for performing audits were also defined. RESULTS: The National Institute for Health and Care Excellence (NICE) UK guideline was the reference for drafting the internal guideline document; from February to November 2013, 125 patients with colorectal cancer were discussed by and taken under the care of the Interdisciplinary Oncological Care Group. The first audit performed in December 2013 revealed optimal adherence to the internal guideline, mainly in terms of uniformity and accuracy of perioperative staging, coordination and timing of multi-modal therapies. To date, all patients under observation are within the diagnostic and therapeutic course, no patient came out from the multidisciplinary "path" and only in 14% of cases have the first recommendations proposed been changed. The selected indicators appear effective and reliable, while at the moment, it is not yet possible to assess the impact of the multidisciplinary team on clinical outcome. CONCLUSION: Although having a short observation period, our model seems capable of determining optimal uniformity of diagnostic and therapeutic management, to a high degree of patient satisfaction. A longer observation period is necessary in order to confirm these observations and for assessing the impact on clinical outcome.

RBone volume reconstruction in atrophic edentulous ridges: placement method of graft-implant unity in single step together with endogenous growth factors.

AIM: The methods of inserting osseointegrated implants in atrophic edentulous ridges need first bone tissue graft and subsequently the insertion of fixtures. These methods need a long period of time before a prosthesis can be made: for this reason the researchers experimented different techniques to reduce times of prosthetic loading. Our experimented method makes it possible to shorten the prosthetic period notably. METHODS: During surgery an implant is inserted in the symphysis area and then it is removed by trephine bur having a diameter greater than 1 mm compared to the receiving site and by using irrigation with 4 degrees C physiological solution. After 75 days, the implant is loaded by temporary prosthesis and subsequently a final restoration is applied after 4-6 months, depending on bone quality. RESULTS: Our surgical method, in spite of being conditioned by the anatomical conformation of the edentulous ridge and anatomical limits, proved to be predictable and with the same success percentages as other surgical techniques used for morphological reconstruction of atrophic edentulous ridges, shortening prosthetic loading times notably. CONCLUSIONS: Despite the small number of patients treated and the short control period do not give enough elements to consider this new method applicable in all types of atrophies, our results confirm the validity of this technique if well used. In the future further studies and experimentations on greater number of patients and for at least 5 year follow-up are needed.