Effect of Multidisciplinary Assessment on Paediatric Patients with Monosymptomatic Nocturnal Enuresis.

OBJECTIVE: This study aimed to investigate the effect of multidisciplinary assessment in paediatric patients with monosymptomatic nocturnal enuresis (MNE). METHODS: From July 2018 to June 2021, 242 patients with enuresis who received diagnosis and treatment in our hospital were retrospectively enrolled. They were divided into the multidisciplinary assessment group (n = 130) and routine assessment group (n = 112). Multidisciplinary assessments were completed by a multidisciplinary team, and the data included structured medical history, physical and neurological examinations, bladder and bowel diaries, sleep diaries, questionnaires, psychological assessments, urinary ultrasonography, blood and urine laboratory tests, polysomnography and balance assessments. RESULTS: A higher proportion of patients with enuresis associated with other conditions was identified in the multidisciplinary assessment group than in the routine assessment group (27.7% vs 15.2%, p = 0.019). With regard to treatment response to the enuresis alarm, the treatment response rate was 52.9% (17/33) in the conventional assessment group, whereas such a response was significantly higher in the multidisciplinary assessment group (82.1%, 32/39; p = 0.028). Compared with the routine assessment group, the multidisciplinary assessment group had a significantly higher treatment response rate for desmopressin (83.3% vs 52.0%; p = 0.022) and alarms combined with desmopressin (74.2% vs 44.4%; p = 0.045). After treatment, the Pediatric Quality of Life Inventory version 4.0 (PedsQL 4.0) score in the multidisciplinary assessment group was significantly higher than that in the routine assessment group (91.9 ± 6.3 vs 87.1 ± 7.3; p < 0.001). CONCLUSIONS: Multidisciplinary evaluation can identify more children with enuresis caused by other diseases, which promotes the differential diagnosis of MNE. In addition, multidisciplinary assessment can determine the appropriate treatment response in children with MNE.

Effect of Multidisciplinary Assessment on Paediatric Patients with Monosymptomatic Nocturnal Enuresis

Objective: This study aimed to investigate the effect of multidisciplinary assessment in paediatric patients with monosymptomatic nocturnal enuresis (MNE). Methods: From July 2018 to June 2021, 242 patients with enuresis who received diagnosis and treatment in our hospital were retrospectively enrolled. They were divided into the multidisciplinary assessment group (n = 130) and routine assessment group (n = 112). Multidisciplinary assessments were completed by a multidisciplinary team, and the data included structured medical history, physical and neurological examinations, bladder and bowel diaries, sleep diaries, questionnaires, psychological assessments, urinary ultrasonography, blood and urine laboratory tests, polysomnography and balance assessments. Results: A higher proportion of patients with enuresis associated with other conditions was identified in the multidisciplinary assessment group than in the routine assessment group (27.7% vs 15.2%, p = 0.019). With regard to treatment response to the enuresis alarm, the treatment response rate was 52.9% (17/33) in the conventional assessment group, whereas such a response was significantly higher in the multidisciplinary assessment group (82.1%, 32/39; p = 0.028). Compared with the routine assessment group, the multidisciplinary assessment group had a significantly higher treatment response rate for desmopressin (83.3% vs 52.0%; p = 0.022) and alarms combined with desmopressin (74.2% vs 44.4%; p = 0.045). After treatment, the Pediatric Quality of Life Inventory version 4.0 (PedsQL 4.0) score in the multidisciplinary assessment group was significantly higher than that in the routine assessment group (91.9 ± 6.3 vs 87.1 ± 7.3; p < 0.001). Conclusions: Multidisciplinary evaluation can identify more children with enuresis caused by other diseases, which promotes the differential diagnosis of MNE. In addition, multidisciplinary assessment can determine the appropriate treatment response in children with MNE (AU)

Digital health technologies supporting the application of comprehensive geriatric assessments in long-term care settings or community care: A systematic review.

Objective: To provide high-quality elderly care, digital health technologies (DHTs) can potentially assist in reaching the full capacity of comprehensive geriatric assessments (CGAs) to improve communication and data transfer on patients' medical and treatment plan information and health decision-making. This systematic review aimed to describe the evidence on the feasibility and usability, efficacy and effectiveness, and implementation outcomes of DHTs developed to facilitate the administration of CGAs for long-term care settings or community care and to describe their technical features and components. Methods: A search strategy was conducted in three databases, targeting studies evaluating the DHTs facilitating the administration of CGAs used in long-term care settings or community care. Studies in English and Spanish published up to 5 April 2023 were considered. Results: Four DHTs supporting the administration of the CGAs were identified. Limited information was found on the technical features and required hardware. Some of the barriers identified regarding usability can be overcome with novel technologies; however, training of health professionals on the assessments and staff knowledge regarding the purpose of the data collected are not technology related and need to be addressed. Conclusions: Barriers regarding usability were related to experienced difficulties navigating the software, unstable network connectivity, and length of the assessment. Feasibility obstacles were associated with the lack of training to use the DHT, availability and accessibility to hardware (e.g. laptops), and lack of insight into the clinical benefits of collected data. Further research must focus on these areas to improve the implementation and usefulness of these DHTs.

Estimation of Late Postmortem Interval: Where Do We Stand? A Literature Review.

Estimating time since death can be challenging for forensic experts, and is one of the most challenging activities concerning the forensic world. Various methods have been assessed to calculate the postmortem interval on dead bodies in different stages of decomposition and are currently widely used. Nowadays, the only well-recognized dating technique is carbon-14 radioisotope measurement, whereas other methods have been tested throughout the years involving different disciplines with different and sometimes not univocal results. Today, there is no precise and secure method to precisely determine time since death, and late postmortem interval estimation remains one of the most debated topics in forensic pathology. Many proposed methods have shown promising results, and it is desirable that with further studies some of them might become acknowledged techniques to resolve such a difficult and important challenge. The present review aims at presenting studies about the different techniques that have been tested in order to find a valuable method for estimating time since death for skeletal remains. By providing a comprehensive overview, the purpose of this work is to offer readers new perspectives on postmortem interval estimation and to improve current practice in the management of skeletal remains and decomposed bodies.

Multidisciplinary management of posterior fossa dural arteriovenous fistula: A single-center experience.

PURPOSE: The management of posterior fossa dural arteriovenous fistulas (pfDAVFs) is challenging. Here, we show how multidisciplinarity leads to their successful management, even in complex cases. METHODS: All pfDAVFs managed from 2010 to 2019 at our center were reviewed. The preoperative clinical and radiological characteristics, their management and the occlusion rate were retrieved. The radiological and functional outcomes were retrieved at discharge and last follow-up (FU). RESULTS: n=27 patients were included (6 females, mean age: 61-years-old, mean FU: 22.5 months). n=8 patients presented with cerebral hemorrhage. Among patients with ruptured pfDAVFs, n=7 had headache, n=4 had ataxia, and n=2 had impaired level of consciousness. In the unruptured group N (n=19), n=7 patients had headache, n=6 patients had focal neurological deficit, n=4 patients had tinnitus, n=3 (had ataxia, and one presented with seizure. n=24 patients were treated by endovascular therapy (EVT), n=2 patients were treated by microsurgery (MS) and n=1 patient was managed with a combined approach. Re-treatment was necessary in n=6 patients. n=24 patients showed total exclusion at last FU. n=2 patients died during the first 30 days; n=1 patient died during FU. CONCLUSIONS: While EVT should be advocated as the first line therapy whenever possible, MS should not be banned from the treatment armamentarium. Neurosurgeons must be able to achieve direct surgical occlusion when the angioarchitecture speaks against EVT.

[Child abuse within a migratory process: pediatric management and assessment]. / Maltraitance des enfants migrants : éléments de prise en charge et évaluation pédiatrique.

When child abuse occurs within a family, it is necessary during a medico-psycho-social assessment to analyze which vulnerability factors have led to a systemic imbalance. The migratory process, like any major modification of family homeostasis, can cause parental difficulties without, however, embodying the cause of the abuse. However, it represents a major event in the life of the child and his parents who, in a situation of child abuse, should neither be trivialized nor be reduced to the sole cause of the abuse inflicted.

Lorsque la maltraitance infantile survient au sein d'une famille, il est nécessaire, au cours d'une évaluation médico-psycho-sociale, d'analyser les facteurs de vulnérabilité qui, au sein du système familial, ont conduit à un déséquilibre systémique. Le processus migratoire, comme toute modification majeure de l'homéostasie familiale, peut engendrer des difficultés parentales, sans toutefois incarner la cause du passage à l'acte. Pour autant, il représente un événement majeur dans la vie de l'enfant et de ses parents qui, en situation de maltraitance infantile, ne doit ni être banalisé ni se voir réduit à la seule cause des mauvais traitements infligés.

Multimodality treatment for brain arteriovenous malformation in Mainland China: design, rationale, and baseline patient characteristics of a nationwide multicenter prospective registry.

BACKGROUND: Brain arteriovenous malformation (AVM) is an important cause of hemorrhagic stroke in young adults, which can lead to severe neurological impairment. The registry of Multimodality treatment for brain ArTeriovenous malformation in mainland CHina (MATCH) is a national prospective registry to identify the natural history of AVMs in Asian population; to investigate traditional and emerging hemorrhagic predictors; and to explore the superiority of the multidisciplinary assessment in improving the long-term outcomes.  METHODS: Consecutive AVM patients will be enrolled from 52 participating hospitals in mainland China. Baseline demographic, clinical and imaging data will be collected prospectively. Conservation, microsurgery, embolization, stereotactic radiosurgery (SRS), and multimodal strategies are all included in this study. Patients will be divided into experimental and control group according to whether the treatment protocols are formulated by multidisciplinary team. Neurofunctional status, subsequent hemorrhage, seizure, and novel neurofunctional deficit will be queried at 3 months, annually (1 and 2 years), 3 years, and 10 years follow-up. RESULTS: Between August 2011 and April 2021, 3241 AVMs were enrolled in 11 participating sites. Among them, 59.0% were male with an average age of 28.4 ± 14.6 years, 61.2% had rupture history and 2268 hemorrhagic events occurred before admission. The median Spetzler-Martin grade and Lawton-Young grade was 3 and 5, respectively. Microsurgery is the dominant strategy (35.7%), with a similar proportion of embolization, SRS, and a combination of both (12.7%; 14.8%; 11.8%; respectively). Among them, 15.43% underwent multidisciplinary assessment and received standardized treatment. At the most recent follow-up, 7.8% were lost and the median follow-up duration was 5.6 years. CONCLUSIONS: The MATCH study is a large-sample nationwide prospective registry to investigate multimodality management strategy for AVMs. Data from this registry may also provide the opportunity for individualized risk assessment and the development of optimal individual management strategies. TRIAL REGISTRATION: ClinicalTrials.gov Registry ( NCT04572568 ).

Impact of head-and-neck radiation oncology clinical fellowship on multidisciplinary assessment, radiation workflow, and survival of adult patients with nasopharyngeal carcinoma.

Purpose: The purpose of the study wast to evaluate the influence of head-and-neck clinical fellowship training on multidisciplinary assessment, radiation workflow, and clinical outcomes of patients with nasopharyngeal carcinoma (NPC). Materials and Methods: This was a retrospective review of patients with NPC treated between 2010 and 2017. The study cohort was allocated into prefellowship cohort (pre-FSC) (January 2010-September 2014) and postfellowship cohort (post-FSC) (October 2014-December 2017). Patient demographics, tumor characteristics, multidisciplinary assessment, radiation workflow, and treatment were reviewed. Univariable, multivariable, and relapse-free survival (RFS) and overall survival (OS) were performed. Results: One hundred and forty-three patients were included, 68 in the pre-FSC and 75 in the post-FSC. For the post-FSC versus pre-FSC, there were increased multidisciplinary referrals to dental (100% vs. 79.4%, P = 0.001), nutritional (94.7% vs. 70.6%, P = 0.0001), peg-tube insertion (84% vs. 64.7%, P = 0.0001), speech and swallow (94.7% vs. 13.2%, P = 0.0001), psychosocial (100% vs. 26.5%, P = 0.0001), and smoking cessation clinic (33.3% vs. 5.9%, P = 0.0001). For the post-FSC versus pre-FSC, there were statistically significant differences in the elements of radiation workflow; mean time required for contouring was 3.2 vs. 8.8 days (P = 0.0001), radiotherapy plan implementation: 1.9 vs. 4.8 days (P = 0.0001), and plan approval: 0.4 vs. 0.9 day (P = 0.00012). On multivariable analysis, smoking was associated with poor RFS (P = 0.04). There were no statistically significant differences in OS (94.7% vs. 87.2% at 3 years; P = 0.126) and RFS (88.4% vs. 84.4% at 3 years; P = 0.281) between post and pre-FSCs, respectively. Conclusions: Clinical fellowship training results in increase multidisciplinary referrals to supportive services, improves radiotherapy workflow, but had no significant impact on survival outcomes.

El llamado síndrome de alienación parental y sus derivaciones / The so-called parental alienation syndrome and its derivations

La denigración de un progenitor por el otro es uno de los efectos más dañinos para el menor en situaciones de ruptura familiar, si bien el llamado síndrome de alienación parental (Gardner) como supuesto trastorno mental infantil, no ha obtenido la aceptación en las clasificaciones psiquiátricas internacionales, ni la necesaria validez y soporte científico, por lo que profesionales de la salud mental, peritos y juristas deberían evitar su empleo. En su lugar, cabe valerse de los criterios diagnósticos contemplados por las clasificaciones psiquiátricas diagnósticas internacionales que describimos. Es esencial establecer el diagnóstico diferencial a partir del síntoma del rechazo hacia un progenitor, cuestión que entraña dificultad y que puede requerir el concurso de un equipo multidisciplinar para valorar adecuadamente todos los aspectos evaluables. Los profesionales han de obrar con conocimiento de los límites de su ciencia, aportando aquellos datos y conclusiones que sean legítimos y válidos según tal premisa. (AU)

The denigration of one parent by the other would be one of the most damaging effects for the child in situations of family breakdown, although the so-called parental alienation syndrome (Gardner) as a supposed childhood mental disorder, has not obtained acceptance in psychiatric classifications nor the necessary validity and scientific support, so its use by mental health professionals, experts and lawyers should be avoided. Instead, one can use the diagnostic criteria contemplated by the international diagnostic psychiatric classifications that we describe. It is essential to establish the differential diagnosis based on the symptom of rejection of a parent, an issue that involves difficulty and may require the assistance of a multidisciplinary team to adequately evaluate all the evaluable aspects. Professionals must act with knowledge of the limits of their science, providing those data and conclusions that are legitimate and valid according to this premise. (AU)

Accentuated aging associated with HIV in a Mediterranean setting occurs mainly in persons aged>70 years: a comparative cohort study (Over50 cohort).

In an ongoing Mediterranean cohort, we compared age-related conditions between 208 HIV-infected persons and 104 matched controls. ≥3 comorbidities were found in 31.0% of HIV-infected patients and 8.7% of controls. Conditions significantly more frequent among the HIV-infected population were: lipid abnormalities, cancer, osteopenia/osteoporosis, liver disease, sexual dysfunction, hearing deficit, sleep disorders, falls, cognitive complaints, being single, living alone, and being elderly at risk. HIV-infected patients aged >70 years had a significantly higher number of cardiovascular risk factors (CVRF) and comorbidities than controls. HIV-infected persons who had never smoked had a higher prevalence of CVRFs, ≥3 comorbidities, liver disease, cancer, and cognitive complaints compared to controls. Factors associated with frailty were being a man who has sex with men, ≥3 CVRFs, nadir CD470 years. The multidisciplinary assessment also revealed concerning findings in social, cognitive, and functional variables among HIV-infected individuals, with a higher prevalence of elderly at risk than among controls.

[What is the place in pediatric hospitalization for child abuse ? Criteria and guidance]. / Quelle place en hospitalisation pédiatrique pour la maltraitance infantile ? Critères et orientations.

Child abuse situations are increasingly common clinical situations in pediatrics and, in extenso, in hospital wards. While it remains obvious that the hospital is a place of care and not of life for a child, the fact remains that in a number of cases, it is necessary to offer the child a multidisciplinary assessment in a neutral and secure environment in order to assess the abuse, its impact on the child, the systemic family disorders that underlie it and the orientation towards the most adequate life environment for the child. The hospital and specialized pediatric services then fulfill this mission, which meets strict admission criteria so that the hospital stay guarantees effective therapeutic action. The purpose of this article is to describe the management of situations of child abuse by using multidisciplinary hospital assessments as they are carried out in the Maltraitance Unit of the Pediatric Department of CHU Liège. We will briefly review the admission criteria, the modalities of care and the clinical interest of such hospitalisations.

Les situations de maltraitance infantile relèvent de situations cliniques de plus en plus fréquentes en pédiatrie et, in extenso, au sein même des services d'hospitalisation. S'il reste évident que l'hôpital est un lieu de soins et non de vie pour un enfant, il n'en demeure pas moins que, dans un certain nombre de cas, il est nécessaire d'offrir à l'enfant un bilan pluridisciplinaire en milieu neutre et sécurisant afin d'évaluer la maltraitance, ses impacts sur l'enfant, les troubles systémiques familiaux qui la sous-tendent et l'orientation vers le milieu de vie le plus adéquat pour l'enfant. L'hôpital et des services pédiatriques spécialisés remplissent alors cette mission qui répond à des critères stricts d'admission afin que le temps d'hospitalisation garantisse une action thérapeutique efficace. Cet article a pour objet de décrire les prises en charge de situations de maltraitance infantile sous forme de bilans hospitaliers pluridisciplinaires tels qu'ils sont réalisés dans le service Cellule Maltraitance du service de Pédiatrie du CHU Liège. Nous passerons rapidement en revue les critères d'admission, les modalités de prise en charge et les intérêts cliniques qui ressortent de telles hospitalisations.

The value of a dedicated multidisciplinary expert panel to assess treatment strategy in patients suffering from colorectal cancer liver metastases.

BACKGROUND: For patients with colorectal cancer liver metastases (CRLM), local treatment is the only treatment with curative intent. The majority of patients with CRLM are however evaluated in multidisciplinary teams of colorectal cancer specialists often lacking expertise in local treatment of liver tumors. The aim of this study was therefore to assess the value of a dedicated multidisciplinary panel consisting of hepatobiliary surgeons and interventional radiologists for patients suffering from liver-only CRLM. METHODS: Patients diagnosed with liver-only CRLM in 2016 were identified in a tertiary referral hospital, and two of the referring hospitals in the Netherlands. Diagnostic imaging was independently reviewed by a panel of four hepatobiliary surgeons and two interventional radiologists to re-evaluate treatment strategy retrospectively. If two or more panelists assessed all lesions eligible for resection and/or ablation, patients were deemed eligible for local treatment with curative intent. Interrater reliability between hepatobiliary surgeons was assessed through intraclass correlation coefficient (ICC) and weighted Cohen's kappa. RESULTS: Diagnostic imaging of 61 patients with liver-only metastases were reviewed. Local treatment strategies appeared feasible in 40/61 (65.6%) patients. Five out of 25 patients (20.0%) initially assigned to systemic therapy were deemed eligible for upfront local treatment with curative intent (p = 0.015). In this subgroup, interrater reliability between hepatobiliary surgeons was substantial (ICC: 0.704, 95% CI: 0.536-0.838, n = 25). CONCLUSION: Assessment of treatment strategy by a dedicated multidisciplinary panel including liver experts may result in an increased number of patients eligible for potentially curative treatment and reduce undertreatment of patients suffering from liver-only CRLM.

A multidisciplinary assessment of the impact of spilled acids on geoecosystems: an overview.

We developed and applied a multidisciplinary approach to the impact of an accidentally spilled acid on the underlying geomedia and subsurface environment, based on the concept of geoecosystem. We used mineralogical, geochemical, microbiological, and ecotoxicological techniques to identify and assess the multiple aspects involved. First, we constructed a conceptual model for the acid interactions with the underlying subsurface environment by introducing the concept of a geoecosystem-a multicomponent system composed of inorganic, organic, and biological components to describe the subsurface environment. Second, we designed and manufactured a two dimensional cell to visualize acid transport through geomedia. Third, we hypothesized that the acids are neutralized through dissolution of minerals and protonation of functional groups on the surfaces of minerals and organic matter. We tested this hypothesis by conducting batch-type geomedia-acid reaction and surface titration experiments. Fourth, we observed changes in soil microbial communities before and after the acid exposure and neutralization treatment. Fifth, we performed flow-through experiments using columns packed with soil samples pre-contaminated with arsenic to investigate potential longer term, secondary effects of remnant acids on geoecosystems. Finally, we conducted ecotoxicological investigations using various geomedia and observed that suitability of the geoecosystem as a habitat deteriorated to different degrees depending on the respective systems' acid neutralizing power. We conclude that a holistic understanding of the interactions among the multiple components of geoecosystems and subsequent estimation of the influenced area requires a multidisciplinary approach such as those used in this study. Based on the findings of this study, we propose geoecosystems' vulnerability defined as the reciprocal of their acid-neutralizing capacity against the moving acid fronts and present this concept as central to a quantitative assessment of the impact of acid spills on geoecosystems. We also inventoried the essential components, factors, and parameters necessary in developing geoecosystems' acid vulnerability assessment system.

Impact of Adherence to Multidisciplinary Recommendations for Adjuvant Treatment in Radical Prostatectomy Patients With High Risk of Recurrence.

INTRODUCTION: The purpose of this study was to investigate adherence to recommended adjuvant radiotherapy (aRT) in radical prostatectomy (RP) patients with adverse pathologic features and to analyse the outcome of patients who followed or denied this recommendation. PATIENTS AND METHODS: We included 1140 consecutive RP patients (2006-2015) with non-organ confined (pT3) prostate cancer and either positive surgical margins (R1) and/or lymph node involvement (pN1) and non-detectable postoperative prostate-specific antigen who received multidisciplinary aRT recommendations. Patients were stratified into adherence versus non-adherence to recommendations. Additionally, subgroups within pathologic criteria (pT3R1N0, pT3R0N1, pT3R1N1) were analyzed. Kaplan-Meier, as well as multivariable Cox regression analyses were used to assess biochemical recurrence (BCR)-free survival, metastasis-free survival, cancer-specific survival, and overall survival. RESULTS: Overall, 508 (44.6%) patients were non-adherent. Of those, 273 (53.6%) did not receive any RT, and 235 (46.4%) received salvage RT. At 8 years, BCR-free survival was 57.7 versus 20.1%, metastasis-free survival was 76.5 versus 75.4%, cancer-specific survival was 91.7 versus 87.4%, and overall survival was 80.4 versus 75.8% in adherent versus non-adherent patients, respectively (P < .001). In multivariable Cox regression predicting BCR, metastatic progression, cancer-specific mortality, and overall mortality, non-adherence to aRT recommendation represented an independent predictor (hazard ratio [HR], 3.8; 95% confidence interval [CI], 3.1-4.5; HR, 1.6; 95% CI, 1.2-2.2; HR, 2.8; 95% CI, 1.5-5.3; and HR, 1.8; 95% CI, 1.2-2.8, respectively). CONCLUSIONS: Only about 55% of patients followed our multidisciplinary recommendations. Adherent patients were significantly less likely to experience BCR, metastatic progression, cancer-specific mortality, and overall mortality. Thus, patients with high risk of recurrence may be advised about the possibility of improved oncologic outcomes in case of adherence to aRT recommendations.

In-situ biochar application conserves nutrients while simultaneously mitigating runoff and erosion of an Fe-oxide-enriched tropical soil.

Climate change gives rise to rapid degradation of rural soils in sloping subtropical and tropical areas and might further threaten environmental sustainability. In this study, we conducted an integrated evaluation of the effects of wood biochar (WB) application mixed with a green waste dreg compost (GWC) on runoff quality, soil losses, and agricultural productivity for a highly weathered tropical soil. A conventional agriculture method, in which soils are treated with anionic polyacrylamide (PAM), was also conducted for comparison. The amounts of runoff and soil loss, and nutrient retention were evaluated a year after WB application. Soil fertility was also investigated through a year pot experiment with rape (Brassica campestris L.) cultivation. Our results showed that the WB application not only effectively increased soil pH, soil organic carbon (SOC) and exchangeable K+ but also increased the production of rape plants. Significant reduction of runoff and the increases of inorganic nitrogen (IN) and total phosphorus (TP) were found in the WB-treated soil. Compared to the control, the co-application of WB and GWC, particularly for the WB at 4%, decreased runoff by 16.8%, soil loss by 25%, and IN loss (via runoff) by 41.8%. Meanwhile, compared to the control and PAM treatments, the co-application of WB and GWC improved soil acidity and the contents of SOC, IN, TP, and exchangeable K+. The co-application of WB and GWC could be an alternative agricultural strategy to obtain benefits to agricultural productivity and environmental sustainability.

From patients' needs to treatment outcomes in psoriasis: Results from the 'pSORRIDI' experience.

OBJECTIVE: To evaluate results of the 'pSORRIDI' experience (which is a prevention campaign to evaluate the prevalence of comorbidities, multidisciplinary needs and appropriateness of the therapeutic approach for comorbidities) in patients already being treated for psoriasis. METHODS: Telephone interviews were conducted in patients with psoriasis, who then underwent comprehensive evaluation and investigation of comorbidities. If necessary, patients were referred to specialist cardiology, endocrinology and/or rheumatology services. RESULTS: Overall, 72.0% (54/75) of patients required a multidisciplinary consultation. Among patients referred to cardiology, therapeutic adjustment was needed in 33.3% (five of 15) patients and a redefined diagnosis in 26.7% (four of 15) cases. Among patients undergoing endocrinology evaluations, therapeutic adjustment and a redefined diagnosis were needed in 61.1% (11/18) and 33.3% (six of 18) patients, respectively; for rheumatology evaluations, therapeutic adjustment and a redefined diagnosis were needed in 76.2% (16/21) and 19.0% (four of 21) of patients, respectively. CONCLUSIONS: Among patients with psoriasis, there may be a need for an improvement in the diagnosis of underlying comorbid conditions, and in disease management of both psoriasis and any comorbid conditions.

Children referred for evaluation for ADHD: comorbidity profiles and characteristics associated with a positive diagnosis.

BACKGROUND: The symptoms of attention-deficit/hyperactivity disorder (ADHD) are non-specific, and a range of possible causes and comorbidities need to be considered in children referred for assessment. OBJECTIVE: To examine the factors associated with ADHD diagnosis following multidisciplinary assessment. METHODS: Children underwent multidisciplinary evaluation including parent and teacher questionnaires; semi-structured interview to screen for internalizing and externalizing diagnoses; paediatric, psychology and special education assessments; and case conference. Predictors of ADHD diagnosis were examined in univariable and multivariable logistic regression models. RESULTS: Data from 190 assessments (82% male, mean age 6.8 years) were included. ADHD was diagnosed in 132 (70%) cases, of which 77% had one or more comorbidities. In children not diagnosed with ADHD, 60% had one or more alternate diagnosis made. Teacher-reported ADHD symptom severity and learning difficulties were the strongest predictors of ADHD diagnosis. The pattern of comorbid/alternative diagnoses was similar between those diagnosed with ADHD and those not diagnosed with ADHD. CONCLUSIONS: Direct report from teachers is the most critical element of the clinical dataset for the evaluation for ADHD. These findings emphasize the importance of cross-situational impairment to ADHD diagnosis. The frequency and similarity of diagnoses in both groups highlight the overlapping nature of childhood developmental disorders, and the importance of evaluating for comorbid disorders regardless of the primary diagnosis.

Impact of a multidisciplinary evaluation in pediatric patients with nocturnal monosymptomatic enuresis.

BACKGROUND: Enuresis (NE) is a clinical condition of multifactorial etiology that leads to difficulties in child/adolescent social interaction. METHODS: This was a prospective study on the impact of multidisciplinary assessment of 6- to 17-year-old patients with monosymptomatic nocturnal enuresis (MNE), including a structured history, clinical/neurological examination, bladder and bowel diaries, sleep diary and questionnaires, psychological evaluation [Child Behavior Checklist (CBCL) and PedsQL 4.0 questionnaires], urinary sonography, blood and urine laboratory tests, polysonography (PSG), and balance evaluation. RESULTS: A total of 140 enuretic participants were evaluated, of whom 27 were diagnosed with NE complicated by urinary disorder, four with hypercalciuria, three with nephropathy and one with attention-deficit hyperactivity disorder. Among the 87 participants who underwent PSG, six were diagnosed with severe apnea. Of the 82 MNE patients who underwent full assessment, 62 were male (75.6 %), and the mean age was 9.5 (±2.6) years. A family history of NE was diagnosed in 91.1 % of first- and second-degree relatives, constipation in 89.3 % and mild/moderate apnea in 40.7 %. Balance control alteration was identified by physical therapy evaluation of MNE patients. Participants' quality of life evaluation scores were significantly lower than those of their parents. CONCLUSION: Enuresis is a multifactorial disorder that requires a structured diagnostic approach.

Improvements to Rapfish: a rapid evaluation technique for fisheries integrating ecological and human dimensions.

This paper reports recent developments in Rapfish, a normative, scalable and flexible rapid appraisal technique that integrates both ecological and human dimensions to evaluate the status of fisheries in reference to a norm or goal. Appraisal status targets may be sustainability, compliance with a standard (such as the UN code of conduct for responsible fisheries) or the degree of progress in meeting some other goal or target. The method combines semi-quantitative (e.g. ecological) and qualitative (e.g. social) data via multiple evaluation fields, each of which is assessed through scores assigned to six to 12 attributes or indicators: the scoring method allows user flexibility to adopt a wide range of utility relationships. For assessing sustainability, six evaluation fields have been developed: ecological, technological, economic, social, ethical and institutional. Each field can be assessed directly with a set of scored attributes, or several of the fields can be dealt with in greater detail using nested subfields that themselves comprise multidimensional Rapfish assessments (e.g. the hierarchical institutional field encompasses both governance and management, including a detailed analysis of legality). The user has the choice of including all or only some of the available sustainability fields. For the attributes themselves, there will rarely be quantitative data, but scoring allows these items to be estimated. Indeed, within a normative framework, one important advantage with Rapfish is transparency of the rigour, quality and replicability of the scores. The Rapfish technique employs a constrained multidimensional ordination that is scaled to situate data points within evaluation space. Within each evaluation field, results may be presented as a two-dimensional plot or in a one-dimensional rank order. Uncertainty is expressed through the probability distribution of Monte-Carlo simulations that use the C.L. on each original observation. Overall results of the multidisciplinary analysis may be shown using kite diagrams that compare different locations, time periods (including future projections) and management scenarios, which make policy trade-offs explicit. These enhancements are now available in the R programming language and on an open website, where users can run Rapfish analyses by downloading the software or uploading their data to a user interface.