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PubMed2002

Palliative care and the hospitalist: an opportunity for cross-fertilization.

Most US citizens die in acute care hospitals, often in physical pain, without attention to emotional and spiritual suffering. This represents an ethical failure of our current health-care system. The field of palliative medicine aims to address the physical, emotional, and spiritual needs of patients with advanced disease. At the same time, a new specialty of hospitalists is emerging, providing care for acutely ill hospitalized patients, many of whom will die. Thus, the hospitalist may become the primary deliverer of palliative care. This presents many potential opportunities for dying patients and their families, including increased time and attention from a physician; enhanced knowledge and skills around the physical symptoms, and emotional and spiritual distress; perhaps more detached and therefore more accurate prognostication; and increased efficiency, leading to a more rapid discharge to home. Hospitalists could enhance the quality of care for the dying by emphasizing interdisciplinary communication and involvement of hospital-based health professionals to address emotional and spiritual distress and bereavement issues, as well as through specific quality-improvement efforts. Finally, hospitalists can provide strong role modeling of optimal care for dying patients and their families. When hospitalists are not selected and trained effectively around palliative care issues, the risks are great. Discontinuity of physicians can lead to miscommunication and misunderstanding (by professionals, patient, and family); disagreement about treatment focus (especially as it relates to a shift from curative to palliative); inappropriate deferring of advance care planning to the hospital setting; and, most worrisome, a lack of expertise in symptom control, communication skills, and attention to patient and family distress and the provision of emotional and spiritual support. This article evaluates the convergence of the 2 fields of palliative medicine and hospitalist medicine and reviews the opportunities for mutual education and improved patient care.

Communication↗
PubMed2001

Animation of in vitro biomechanical tests.

Interdisciplinary communication of three-dimensional kinematic data arising from in vitro biomechanical tests is challenging. Complex kinematic representations such as the helical axes of motion (HAM) add to the challenge. The difficulty increases further when other quantities (i.e. load or tissue strain data) are combined with the kinematic data. The objectives of this study were to develop a method to graphically replay and animate in vitro biomechanical tests including HAM data. This will allow intuitive interpretation of kinematic and other data independent of the viewer's area of expertise. The value of this method was verified with a biomechanical test investigating load-sharing of the cervical spine. Three 3.0 mm aluminium spheres were glued to each of the two vertebrae from a C2-3 segment of a human cervical spine. Before the biomechanical tests, CT scans were made of the specimen (slice thickness=1.0 mm and slice spacing=1.5 mm). The specimens were subjected to right axial torsion moments (2.0 Nm). Strain rosettes mounted to the anterior surface of the C3 vertebral body and bilaterally beneath the facet joints on C3 were used to estimate the force flow through the specimen. The locations of the aluminium spheres were digitised using a space pointer and the motion analysis system. Kinematics were measured using an optoelectronic motion analysis system. HAMs were calculated to describe the specimen kinematics. The digitised aluminium sphere locations were used to match the CT and biomechanical test data (RMS errors between the CT and experimental points were less than 1.0 mm). The biomechanical tests were "replayed" by animating reconstructed CT models in accordance with the recorded experimental kinematics, using custom software. The animated test replays allowed intuitive analysis of the kinematic data in relation to the strain data. This technique improves the ability of experts from disparate backgrounds to interpret and discuss this type of biomechanical data.

Biomechanical Phenomena↗
PubMed1991

Otolaryngologic aspects of acquired immunodeficiency syndrome.

Currently, most patients with AIDS present with a manifestation involving the head, neck, or respiratory tract. The otolaryngologist may be the first physician to evaluate the patient with HIV infection and, therefore, must be aware of the various manifestations. The otolaryngologist may also be involved in diagnosing and managing the disease through modalities such as biopsy, endoscopy, tracheotomy, and other surgical procedures. In all phases of care, it is important to retain a medically appropriate and psychologically supportive environment. Although universal precautions should be followed in all phases of care, there is no need to avoid the supportive gestures such as handshaking and shoulder patting. These contacts can be most comforting to patients. Physicians should also be aware of all sources of information and medical assistance within the community that might be of further assistance to patients. The AIDS epidemic presents an enormous challenge to all health care providers. Good interdisciplinary communication among the various specialists involved in the AIDS epidemic will promote increased standards of patient care. Such communication will also provide information and support for physicians who are uncomfortable with the challenges of this epidemic.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

"INTERMED": a method to assess health service needs. I. Development and reliability.

The purpose of this paper is to describe the development and to test the reliability of a new method called INTERMED, for health service needs assessment. The INTERMED integrates the biopsychosocial aspects of disease and the relationship between patient and health care system in a comprehensive scheme and reflects an operationalized conceptual approach to case mix or case complexity. The method is developed to enhance interdisciplinary communication between (para-) medical specialists and to provide a method to describe case complexity for clinical, scientific, and educational purposes. First, a feasibility study (N = 21 patients) was conducted which included double scoring and discussion of the results. This led to a version of the instrument on which two interrater reliability studies were performed. In study 1, the INTERMED was double scored for 14 patients admitted to an internal ward by a psychiatrist and an internist on the basis of a joint interview conducted by both. In study 2, on the basis of medical charts, two clinicians separately double scored the INTERMED in 16 patients referred to the outpatient psychiatric consultation service. Averaged over both studies, in 94.2% of all ratings there was no important difference between the raters (more than 1 point difference). As a research interview, it takes about 20 minutes; as part of the whole process of history taking it takes about 15 minutes. In both studies, improvements were suggested by the results. Analyses of study 1 revealed that on most items there was considerable agreement; some items were improved. Also, the reference point for the prognoses was changed so that it reflected both short- and long-term prognoses. Analyses of study 2 showed that in this setting, less agreement between the raters was obtained due to the fact that the raters were less experienced and the scoring procedure was more susceptible to differences. Some improvements--mainly of the anchor points--were specified which may further enhance interrater reliability. The INTERMED proves to be a reliable method for classifying patients' care needs, especially when used by experienced raters scoring by patient interview. It can be a useful tool in assessing patients' care needs, as well as the level of needed adjustment between general and mental health service delivery. The INTERMED is easily applicable in the clinical setting at low time-costs.

Humans↗
PubMed2003

[Cutaneous manifestations of internal diseases: purpura, livedo, pyoderma gangrenosum].

Dermatology and internal medicine have in common that many systemic diseases manifest with skin symptoms that are easily accessible for both diagnostic and investigative procedures. Even if modern practice of medicine tends towards organ specific particularity of specialists, dermatology traditionally strives for interdisciplinary communication. Cutaneous manifestations of internal diseases present in various forms. In a syndrome, a number of symptoms present in an identical pattern, and pattern recognition is diagnostic. Vice versa, a distinct skin sign can be a clue to various internal disorders, that have to be considered in the differential diagnosis. Purpura and livedo due to either inflammatory (immune complex mediated or associated with ANCA) or vasoocclusive microthrombotic vascular disease are presented as examples. Finally, subtile variations in key symptoms of the skin, such as of pyoderma gangrenosum, may give a clue to a specific underlying disease, such as rheumatoid arthritis, inflammatory bowel disease, monoclonal gammopathy, or hematologic disease, as exemplified by the variants of pyoderma gangrenosum.

Adult↗
PubMed2002

[Nursing personnel in inpatient rehabilitation--work satisfaction, motivation for interdisciplinary cooperation and for achieving psychosocial competence].

106 nurses from eleven rehabilitation clinics were questioned by means of an anonymous clinical questionnaire on the issues of job satisfaction, interdisciplinary cooperation, and expectations towards future psychosocial staff training (main fields of the participants: orthopaedics, cardiology, dermatology and neurology). Two thirds were altogether satisfied with their jobs, primarily with regard to their relationships with the patients and the colleague nurses (76%), to some extent less so, however, with the doctors (63%). More than 90% expected psychosocial service to deliver feedback for the team and close interdisciplinary communication. Main expectations of psychosocial staff focused on the improvement of communication skills with strained patients, on improved psychological and especially psychodiagnostic knowledge as well as more functional coping with conflicts with patients and team-members (60% expressed marked expectations with regard to each issue). More than half of the staff indicated that they would prefer regular training sessions of one to two hours' duration, and more than 20% favoured each one-day- or weekend-workshops. The most popular ways of working in staff training were "discussion of team conflicts", "exchange of experience", "seeking emotional release", "discussing cases" and "training of communication skills" (approx. 60% each). Nearly 90% found "coping with aggressive patients" as well as "depression and suicide" to be the most important issues, followed by "ways of self-protection", "dealing with anxious patients", "coping with illness", "improvement of team-atmosphere" and "coping with death and dying". The findings of the study recommend an integration of psychosocial issues into education--and training--curricula for the various professions in rehabilitation.

Adaptation, Psychological↗
PubMed2002

[Quality and quantitative comparison of health status during nursing care before and after basic kinesthesis training in a nuclear and radiotherapy clinic].

UNLABELLED: Immediately before and half a year after an introductory course into the principles of kinesthetic nursing the nursing team of the Clinic for Nuclear Medicine and Radiotherapy, City Hospital Triemli (Zurich, Switzerland), was asked to attend a semi-structured interview and nonverbal rating of a selection of important aspects of their physical and mental state during nursing. Eighteen persons had two interviews. The main differences in the second interview compared to the first one are the following: With respect to personal aims at work caring for the patients' well-being had fewer mentions; instead nursing was more often considered a process to which both sides do contribute significantly. Considerable improvements were found regarding to the physical contact to patients while caring, the team, and the nurses' general mental well-being. Physical benefits from the new nursing method were experienced only by part of the team, probably due to unplanned cancelling of kinesthetic supervision. Pressure due to the nurses' compassion for their patients' suffering and dying also was much less mentioned in the second interview, when pressure from outside, and lack of interdisciplinary communication and cooperation weighted more heavily. INTERPRETATION: Competence was already high in the team at the time of the first interview, but even improved by the time of the second interview. This is expressed by the resource-oriented patient-nurse partnership in the process of nursing, by team communication, as well as the heavily weighing discrepancy between knowledge and limited authorisation.

Attitude of Health Personnel↗
PubMed1992

Case histories in the great power of steady misrepresentation.

The widespread misrepresentation of behaviorism in the scientific and popular literature has caused its contributions to the understanding of behavior to be systematically ignored or denied. This misrepresentation is manifested, in large part, as a form of academic folklore that codifies erroneous accounts of behaviorism's assumptions, findings, and goals. This article examines three representative "case histories" of the academic folklore about behaviorism: its alleged environmentalism, totalitarian aims, and intellectual intolerance. Because academic folklore has been highly resistant to the corrective efforts of behaviorists, explicit strategies are suggested for identifying and correcting folklore and for promoting more effective interdisciplinary communication.

Behaviorism↗
PubMed1998

Working with team midwifery: health visitors' views of one team midwifery scheme.

The fragmented nature of maternity services in the UK has led to the introduction of various forms of team midwifery scheme. The aim of such schemes is usually to increase continuity through the provision of antenatal, intrapartum and postnatal care to women by a small team of midwives. Few published studies of this organization of midwifery care exist, and even fewer consider the impact of such schemes on related health professionals. This paper presents the results of an independent survey of health visitors working alongside one team midwifery scheme in the south-east of England. Eighty per cent of the health visitors thought that team midwifery was a good idea in theory; however, just 27% thought it was working well locally and 70% reported that they would like to go back to working in the way they did before the introduction of team midwifery. The survey highlighted the health visitors' concerns in relation to team midwifery locally. Two issues were paramount: firstly a reported deterioration in interdisciplinary communications, and secondly a perceived loss of continuity for the women. Thus team midwifery, as implemented in this locality, may not attain the goals aimed at by the organization of care in this way.

Continuity of Patient Care↗
PubMed1998

Preventable trauma deaths in Singapore.

BACKGROUND: This study was undertaken to determine the incidence of preventable trauma death at a non-designated trauma centre in Singapore. METHODS: A retrospective audit was carried out on all trauma deaths that occurred between January 1993 and December 1994 at the National University Hospital, Singapore. Of the 138 deaths, 38.4% (53/138) of patients were dead on arrival and were omitted from the study. Data from the remaining 85 deaths were summarized and presented before a multidisciplinary review board and injuries were scored according to the Abbreviated Injury Scale (AIS). RESULTS: Except for one patient, all deaths had an AIS score of 16 or greater. Sixty-one per cent (52/85) of deaths were the result of severe head injuries, and the rest had severe injuries in more than one body region. Following the guidelines of the Trauma Research and Education Foundation of San Diego, the incidence of 'not preventable', 'potentially preventable' and 'frankly preventable' deaths were 77.6, 15.3 and 7.1%, respectively. The most common errors in management were caused by delays in inter-departmental transfer (25.9%) and missed initial diagnosis (16.5%). After assessment by the Coroner's Office, autopsies were carried out in 60% of the cases and yielded information that altered the assessment of preventable deaths, particularly in the group with multiple injuries. CONCLUSIONS: The present study concludes that the preventable death rates in the National University Hospital are comparable to those in non-trauma designated centres elsewhere. There can only be a decrease in the preventable death rate if an improved system of pre-hospital trauma care, improved interdisciplinary communication, closer supervision of the initial attending physicians and stricter protocols on clinical monitoring are established.

Abbreviated Injury Scale↗
PubMed1981

Decision for alcohol detoxication: a method to standardize patient evaluation.

We have presented a tested method of evaluation of the patient with acute alcohol intoxication and/or abstinence syndromes, which we recognize needs further modification and refinement. However, we wish to encourage continued development and standardization of an evaluation instrument that ultimately can become widely accepted. This should reduce the current confusion concerning the diagnosis, extent, and severity of the acute phase of alcohol dependence. If this can be accomplished, the questions (and the controversy) of drug vs non-drug and medical vs nonmedical treatment become moot; rather, a continuum of care will exist which is based on meaningful use and interdisciplinary communication of symptom severity as a foundation for rational treatment approaches.

Adult↗
PubMed2001

The Ising model in physics and statistical genetics.

Interdisciplinary communication is becoming a crucial component of the present scientific environment. Theoretical models developed in diverse disciplines often may be successfully employed in solving seemingly unrelated problems that can be reduced to similar mathematical formulation. The Ising model has been proposed in statistical physics as a simplified model for analysis of magnetic interactions and structures of ferromagnetic substances. Here, we present an application of the one-dimensional, linear Ising model to affected-sib-pair (ASP) analysis in genetics. By analyzing simulated genetics data, we show that the simplified Ising model with only nearest-neighbor interactions between genetic markers has statistical properties comparable to much more complex algorithms from genetics analysis, such as those implemented in the Allegro and Mapmaker-Sibs programs. We also adapt the model to include epistatic interactions and to demonstrate its usefulness in detecting modifier loci with weak individual genetic contributions. A reanalysis of data on type 1 diabetes detects several susceptibility loci not previously found by other methods of analysis.

Algorithms↗
PubMed2002

Herb-drug, food-drug, nutrient-drug, and drug-drug interactions: mechanisms involved and their medical implications.

Adverse drug reactions (ADRs) and iatrogenic diseases have been identified as significant factors responsible for patient morbidity and mortality. Significant studies on drug metabolism in humans have been published during the last few years, offering a deeper comprehension of the mechanisms underlying adverse drug reactions and interactions. More understanding of these mechanisms, and of recent advances in laboratory technology, can help to evaluate potential drug interactions when drugs are prescribed concurrently. Increasing knowledge of interindividual variation in drug breakdown capacity and recent findings concerning the influence of environment, diet, nutrients, and herbal products can be used to reduce ADRs and iatrogenic diseases. Reviewed data suggest that drug treatment should be increasingly custom tailored to suit the individual patient and that appropriately co-prescribed diet and herbal remedies, could increase drug efficacy and lessen drug toxicity. This review focuses mainly on recently published research material. The cytochrome p450 enzymes, their role in metabolism, and their mechanisms of action are reviewed, and their role in drug-drug interactions are discussed. Drug-food and drug-herb interactions have garnered attention. Interdisciplinary communication among medical herbalists, medical doctors, and dietetic experts needs to be improved and encouraged. Internet resources for obtaining current information regarding drug-drug, drug-herb, and drug-nutrient interactions are provided.

Adverse Drug Reaction Reporting Systems↗
PubMed2026

Application of qualifying variants for genomic analysis.

MOTIVATION: Qualifying variants (QVs) are genomic alterations selected by defined criteria within analysis pipelines. Although crucial for both research and clinical diagnostics, QVs are often seen as simple filters rather than dynamic elements that influence the entire workflow. In practice these rules are embedded within pipelines, which hinders transparency, audit, and reuse across tools. A unified, portable specification for QV criteria is needed. RESULTS: Our aim is to embed the concept of a "QV" into the genomic analysis vernacular, moving beyond its treatment as a single filtering step. By decoupling QV criteria from pipeline variables and code, the framework enables clearer discussion, application, and reuse. It provides a flexible reference model for integrating QVs into analysis pipelines, improving reproducibility, interpretability, and interdisciplinary communication. Validation across diverse applications confirmed that QV based workflows match conventional methods while offering greater clarity and scalability. AVAILABILITY AND IMPLEMENTATION: The source code and data are accessible at the Zenodo repository https://doi.org/10.5281/zenodo.17414191. Manuscript files are available at https://github.com/DylanLawless/qvApp2025lawless. The QV framework is available under the MIT licence, and the dataset will be maintained for at least two years following publication.

Genomics↗
PubMedDate not supplied

Using information technology to assist in redesign of a fall prevention program.

This article presents the redesign of an adult inpatient falls program using a computerized information system. Named the ADAPT Fall Tool, the tool provides an accurate assessment of the fall risk of each patient. Indicators are embedded into routine assessment documentation, eliminating added charting time. The program allows tailored interventions for specific patient risks, and the fall risk information is integrated into the care plan, report sheets, and care conferences, producing an interdisciplinary communication network.

Accident Prevention↗
PubMed1977

Interdisciplinary education in child abuse and neglect.

The increased need for professionals working with children and their families to understand, identify, and in some cases treat and follow up situations of child abuse and neglect has led to the offering of a structured graduate interdisciplinary course to students in various types of professional training. This initial effort represents an attempt not only to aid students in gaining insight into the dynamics of child abuse but also to encourage interdisciplinary communication among students from law, medicine, social work, education, and other fields which will hopefully continue into their professional life. Based on the experience accumulated from two offerings, a description is presented of the objectives, content, methodology, problems, and short-term evaluation of this course.

Child↗
PubMedDate not supplied

The diversity of case management models.

Case management is experiencing rapid growth and evolutionary transition. This article explores the diversity and richness of case management models found in practice. Interdisciplinary communication in case management programs can be facilitated by an awareness of discipline-specific definitions and models. A categorization of models is described as a device to stimulate multidisciplinary case management collaboration.

Case Management↗
PubMedDate not supplied

The diversity of case management models.

Case management is experiencing rapid growth and evolutionary transition. This article explores the diversity and richness of case management models found in practice. Interdisciplinary communication in case management programs can be facilitated by an awareness of discipline-specific definitions and models. A categorization of models is described as a device to stimulate multidisciplinary case management collaboration.

Case Management↗