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Aim: To evaluate the effect of multidisciplinary treatment (MDT) on the survival outcomes of Chinese lung cancer patients. Methods: Data from a Chinese tertiary cancer hospital of lung cancer patients were collected and divided into two groups (MDT+/−) according to whether the patients had received an MDT. The survival analysis was performed after propensity score matching (PSM). Results: Before PSM, more patients in the MDT+ group had documented information on clinical characteristics and showed more unfavorable clinical characteristics than patients in the MDT− group. After PSM, there was no imbalance in the first‐line treatment strategies between the two groups. When the patients were analyzed separately, for patients in the MDT− group, age at diagnosis, Eastern Cooperative Oncology Group (ECOG) score, stage, smoking history, and epidermal growth factor receptor (EGFR) gene status were all significant factors for survival (p < 0.05). For patients in the MDT+ group, only age at diagnosis, stage, and comorbidities were significant factors for survival (p < 0.05). Moreover, age at diagnosis, ECOG score, stage, EGFR gene status, and MDT were all significant factors for survival for all patients (p < 0.001). The results indicate that MDT was a significant prognostic factor independent of clinical characteristics (HR: 2.095, 95% CI: 1.568–2.800, p < 0.001), with a significantly improved median survival (58.0 vs. 29.0 months, p < 0.001). Conclusion: Based on PSM, MDT itself did have a real favorable prognostic significance for Chinese lung cancer patients in the study. [ABSTRACT FROM AUTHOR]

Background: Surgical resection is standard treatment for invasive intraductal papillary mucinous carcinoma (IPMC); however, impact of multidisciplinary treatment on survival including postoperative adjuvant therapy (AT), neoadjuvant therapy (NAT), and treatment for recurrent lesions is unclear. We investigated the effectiveness of multidisciplinary treatment in prolonging survival of patients with invasive IPMC. Methods: This retrospective multi‐institutional study included 1183 patients with invasive IPMC undergoing surgery at 40 academic institutions. We analyzed the effects of AT, NAT, and treatment for recurrence on survival of patients with invasive IPMC. Results: Completion of the planned postoperative AT for 6 months improved the overall survival (OS), disease‐specific survival (DSS), and recurrence‐free survival (RFS) of patients with stage IIB and stage III resected invasive IPMC, elevated preoperative carbohydrate antigen 19–9 level, lymphovascular invasion, perineural invasion, serosal invasion, and lymph node metastasis on un‐matched and matched analyses. Of the patients with borderline resectable (BR) invasive IPMC, the OS (p = 0.001), DSS (p = 0.001), and RFS (p = 0.001) of patients undergoing NAT was longer than that of those without on the matched analysis. Of the 484 invasive IPMC patients (40.9%) who developed recurrence after surgery, the OS of 365 patients who received any treatment for recurrence was longer than that of those without treatment (40.6 vs. 22.4 months, p < 0.001). Conclusion: Postoperative AT might benefit selected patients with invasive IPMC, especially those at high risk of poor survival. NAT might improve the survivability of BR invasive IPMC. Any treatment for recurrence after surgery for invasive IPMC might improve survival. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Maxillary canines are often impacted, which can result in tooth disorders and adversely affect occlusal and facial development. The case report describes complete bilateral impaction of maxillary canines and significant root resorption of a central incisor. The multidisciplinary approach is the optimal strategy for addressing impacted maxillary canines. [ABSTRACT FROM AUTHOR]

Background: Treatment of functional movement disorder (FMD) should be individualized, yet factors determining rehabilitation engagement have not been evaluated. Subspecialty FMD clinics are uniquely poised to explore factors influencing treatment suitability and triage. Objectives: To describe our approach and explore factors associated with triage to FMD rehabilitation. Methods: We conducted a retrospective chart review of 158 consecutive patients with FMD seen for integrated assessment by movement disorders neurology and psychiatry, with the purpose of triage to rehabilitation. Demographic and clinical variables were compared between patients triaged to therapy versus no therapy, and logistic regression was used to explore factors predictive of triage outcome. Change in primary outcome scores were analyzed. Results: Sixty‐six patients (42%) were triaged to FMD therapy from July 2019 to December 2021. Patients triaged to therapy were more likely to have a constant movement disorder, gait disorder and/or tremor, hyperarousal, readiness for change, and people pleasing traits. Patients triaged to no therapy demonstrated persistent diagnostic disagreement, an inability to appreciate motor symptom inconsistency, low self‐agency, a propensity to dissociate, and cluster B traits. 90% of patients triaged to rehabilitation had improved outcomes. Conclusions: The ability to "opt‐in" to FMD rehabilitation relies on different factors than those relevant to establishing a diagnosis. Unlike many other neurological disorders, a triage and treatment planning step is recommended to identify those likely to meaningfully engage at that time. Holistic assessment through a transdisciplinary lens, and working collaboratively with the patient is essential to prioritize symptoms, determine engagement, and identify treatment targets. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Maintaining a disease‐free status for a long time in cases of renal cell carcinoma with multiple bone metastases and repeated recurrences is challenging. What matters most in the multidisciplinary approach is the treatment strategy. Although this is a case where multidisciplinary treatment resulted in long‐term CR during the TKI era, the treatment strategy is still relevant now that treatment options have increased. Recent advances in medications, such as immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs), have improved metastatic renal cell carcinoma (mRCC) outcomes. We report a case of mRCC with bone metastasis that was successfully treated using a multidisciplinary approach. Here, we present a case of a 56‐year‐old man with left renal cancer and large and painful bone metastases at the 11th thoracic vertebrae (Th11). Therefore, a metastasectomy of Th11 was performed. Systemic treatment with TKI, robot‐assisted partial nephrectomy, and metastasectomy were then administered. No recurrence was observed in >2 years. Long‐term disease‐free survival with the TKI‐era multidisciplinary approach in a patient with mRCC remains significant when considering treatment sequences, especially now that drug treatment options—including ICIs—have increased. Treatment strategy and indication and timing of resection of the primary lesion and metastasectomy should be carefully considered in each case. [ABSTRACT FROM AUTHOR]

Background: Haemophilia is a haematological disease, although most haemorrhages occur in the locomotor system. Patients are physically disabled from an early age and have a poorer perception of quality of life. In the day‐to‐day lives of patients and their families, psychosocial well‐being, the disease's physical, personal, and social impact, as well as work‐related problems are the most complicated aspects of the disease that need to be addressed. Objective: To identify the role of occupational therapy in managing patients with haemophilia and to analyse the therapeutic potential of occupational therapy in treating these patients. Methods: A scoping review was conducted to identify the role of occupational therapy in managing patients with haemophilia and to analyse the therapeutic potential of occupational therapy in treating these patients. The review was registered in the international registry PROSPERO (Id: CRD42022319637). The databases consulted were SCOPUS, PubMed, PsycINFO, Web of Science and Science Direct, including all studies published until 14 August 2023. Results: No single study was found that specifically developed an occupational therapy intervention for patients with haemophilia. Measurement instruments have been identified, specific for patients with haemophilia and generic, that can be useful for the functional evaluation of these patients in the occupational therapy approach. Different studies showed the importance of multidisciplinary treatment, including occupational therapy. Conclusions: The use of occupational therapy could be effective in improving autonomy and quality of life in haemophilia patients. Therefore, it is of paramount importance to conduct research studies within the field of occupational therapy. [ABSTRACT FROM AUTHOR]

Summary: Paediatric weight management (PWM) programs in the United States (US) face challenges in providing sustainable multidisciplinary care for patients. The aim of this study was to report PWM program approaches to sustaining program delivery. A survey of 39 PWM programs was administered to identify challenges and solutions to program sustainability. Common and useful strategies for optimizing reimbursement for services included the use of applicable reimbursable diagnostic codes and management, billing for assessments and non‐medical personnel services, and the use of hospital outpatient department clinic billing. Increasing clinical breadth and capacity was achieved by offering telemedicine and other services, such as psychotherapy, pharmacotherapy, and metabolic and bariatric surgery, as well as active management of schedules. Securing institutional and extramural funding was also reported. One of the positive changes during the pandemic was the fast adoption of telemedicine services. Although delivering sustainable evidence‐based multidisciplinary PWM under the current US payment models has its challenges, PWM programs implement practical operational strategies to support this work. [ABSTRACT FROM AUTHOR]

Background and Objective: Comprehensive headache care involves numerous specialties and components that have not been well documented or standardized. This study aimed to elicit best practices and characterize important elements of care to be provided in multidisciplinary headache centers. Methods: Qualitative, semi‐structured telephone interviews with a purposive sample of headache neurology specialists from across the US, using open‐ended questions. Interviews were recorded, transcribed, and coded. Coded data were further analyzed using immersion/crystallization techniques for final interpretation. Results: Mean years providing headache care was 17.7 (SD = 10.6). Twelve of the 13 participants held United Council for Neurologic Subspecialties headache certification. Six described their practice site as providing multidisciplinary headache care. Participants explained most of their patients had seen multiple doctors over many years, and had tried numerous unsuccessful treatments. They noted patients with chronic headache frequently present with comorbidities and become stigmatized. All participants asserted successful care depends on taking time to talk with and listen to patients, gain understanding, and earn trust. All participants believed multidisciplinary care is essential within a comprehensive headache center, along with staffing enough headache specialists, implementing detailed headache intake and follow‐up protocols, and providing the newest medications, neuromodulation devices, botulinum toxin injections, monoclonal antibodies, nerve blocks and infusions, and treatment from a health psychologist. Other essential services for a headache center are other behavioral health practitioners providing cognitive behavioral therapy, mindfulness, biofeedback and pain management; and autonomic neurology, neuropsychology, vestibular audiology, sleep medicine, physical therapy, occupational therapy, exercise physiology, speech therapy, nutrition, complementary integrative health modalities, and highly trained support staff. Conclusion: While headache neurology specialists form the backbone of headache care, experts interviewed for this study maintained their specialty is just one of many types of care needed to adequately treat patients with chronic headache, and this is best provided in a comprehensive, multidisciplinary center. [ABSTRACT FROM AUTHOR]

Background: Treatment of malignant pleural mesothelioma (MPM) represents a major challenge for oncologists. Multimodality treatment, which generally involves induction chemotherapy, surgery and radiotherapy have recently shown promising results. The aim of this study was to evaluate the locoregional control and toxicity of intensity modulated radiotherapy (IMRT) after pleurectomy and decortication (P/D) as part of trimodality therapy for patients with locally advanced MPM. Methods: We prospectively analyzed data from 20 patients with MPM treated at a single tertiary‐care institution. Initially every patient received induction chemotherapy with platinum‐based chemotherapy. After chemotherapy, patients without progression underwent P/D, and if feasible, hemi‐thoracic IMRT was administered at a planned dose of 50.4–54 Gy in 28–30 fractions and treated with 9–11 noncoplanar fields. Results: A total of 15 of the 20 enrolled patients underwent P/D followed by IMRT to the hemi‐thoracic cavity. The median total radiotherapy dose was 48.7 Gy (23.4–54 Gy). Radiation pneumonitis (RP) developed in nine patients (60%), and of these, two patients (13.3%) experienced G3 or G4 RP. The estimated locoregional‐relapse‐free survival at two years was 75.9%, and the main pattern of recurrence was distant (72.7%). For the entire cohort median follow‐up was 22.7 months, median progression‐free survival was 18.9 months and median overall survival 23.6 months. Conclusions: Platinum‐based chemotherapy followed by lung‐sparing surgery (P/D) and IMRT is a feasible and safe treatment modality that yields acceptable locoregional control in patients with locally advanced MPM; however, these results should be corroborated in larger studies. [ABSTRACT FROM AUTHOR]

The number of newly diagnosed cancers per year is predicted to almost double in the next two decades worldwide, and it remains unclear if and when this alarming trend will level off or even reverse. As such, cancer is very likely to continue to pose a major threat to human health. Radiation oncology is an indispensable pillar of cancer treatment and a well‐developed discipline. Nevertheless, key trends in cancer research and care, including improved primary prevention, early detection, integrated multidisciplinary approaches, personalized strategies at all levels of care, value‐based assessments of healthcare systems, and global health perspectives, will all shape the future of radiation oncology. Broader scientific advances, such as rapid progress in digitization, automation, and in our biological understanding of cancer, as well as the wider societal view of healthcare systems will also influence radiation oncology and how it is practiced. To stimulate a proactive discussion on how to adapt and reshape our discipline, this review provides some predictions on what the role and practice of radiation oncology might look like in 30 years' time. [ABSTRACT FROM AUTHOR]

Purpose: (1) To investigate the prevalence of poor sleep quality and (2) to explore the associations between clinical, cognitive, and emotional factors and quality of sleep in patients with chronic widespread pain (CWP) receiving multidisciplinary treatment. Method: Baseline data were used from 163 patients with CWP referred for multidisciplinary treatment. Linear regression models were used to assess the relationship of clinical (pain, fatigue, pain interference, and disability), emotional (anxiety, depression, and psychological distress), and cognitive factors (catastrophizing, acceptance, self‐efficacy, kinesiophobia and illness beliefs) with sleep quality, as measured using the Pittsburgh Sleep Quality Index. Results: Poor sleep quality was found in 92% of the patients. The multivariable model showed that a higher level of fatigue (b = 1.77, standard error [SE] = 0.62, β = 0.21, t = 2.87, P < 0.01), psychological distress (b = 0.02, SE = 0.01, β = 0.27, t = 3.50, P < 0.01), and more concerns about the illness (b = 0.46, SE = 0.18, β = 0.20, t = 2.57, P = 0.01) were independently associated with poorer quality of sleep. The overall linear regression model explains 27.9% of sleep quality. Conclusions: The high prevalence of poor sleep quality in patients with CWP referred for multidisciplinary treatment emphasizes the need to target sleep during treatment. Further research is needed to disentangle the cause–effect relationship between fatigue, psychological distress, and concerns about the illness and poor sleep (note: this abstract has been published before [Ann Rheum Dis. 2018;77:A1788]). [ABSTRACT FROM AUTHOR]

Background: Neuroendocrine carcinoma (NEC) arising from the esophagus (EsoNEC) is extreme rare, accounting for approximately 1% of esophageal cancer. Even for localized NEC, multidisciplinary approach including chemotherapy is recommended in treatment guidelines because of its high rates of systemic recurrence. However, it is controversial whether adding surgery or radiotherapy is appropriate local treatment for EsoNEC. There have been few reports regarding the clinical outcomes of definitive chemoradiotherapy (dCRT) for EsoNEC. The purpose of this study was to clarify the survival outcome of patients with locally advanced EsoNEC treated with dCRT. Methods: Clinical outcomes, feasibility, and prognostic factors of patients with locally advanced EsoNEC treated with radiotherapy (60 Gy/30 fraction) in combination with platinum plus etoposide (CE‐RT) or cisplatin plus 5‐fluorouracil (CF‐RT) at the National Cancer Center Hospital from 2001 to 2017 were retrospectively analyzed. Results: A total of 22 patients were identified as the subjects of this study. The overall response rate and clinical complete remission rate in all patients were 86.4% and 77.3%, respectively. The median progression‐free survival and median survival time in all patients were 12.7 and 37.5 months, associated with a 5‐year survival rate of 45.4%. Patients treated with CE‐RT experienced more hematological adverse events, especially in neutropenia (≥grade 3) and febrile neutropenia(≥grade 3), but achieved more long‐term progression‐free survival than with CF‐RT. Conclusions: Definitive chemoradiotherapy can be considered as an important treatment option for locally advanced esophageal neuroendocrine carcinoma. [ABSTRACT FROM AUTHOR]

Aim: Long-term evaluations of childhood obesity treatments are needed. We examined changes in weight and cardiometabolic risk 1 year after children completed individual family or group-based weight management interventions.Methods: In 2009-2010, 6- to 12-year-old children with overweight or obesity from Finnmark and Troms (Norway) were recruited after media coverage and randomised to 24 months of individual family (n = 49) or group intervention (n = 48). Individual family intervention included counselling by a paediatric hospital team and a public health nurse in the local community. Group intervention included meetings with other families and a multidisciplinary hospital team, weekly physical activity sessions and a family camp. The primary outcome body mass index (BMI) and cardiometabolic risk factors were analysed 12 months after intervention.Results: From baseline to 36 months, children's BMI increased 3.0 kg/m2 in individual family and 2.1 kg/m2 in group intervention (between-group -0.9kg/m2 , P = 0.096). Data were available from 62 children (64%). Between-group differences in C peptide (P = 0.01) were detected in favour of group intervention. Pooled data from both treatment groups showed continued decrease in BMI standard deviation score (P < 0.001).Conclusion: No between-group difference in BMI was observed 12 months after intervention. Both groups combined showed sustained decrease in BMI standard deviation score. [ABSTRACT FROM AUTHOR]

Background and Aim: Effective multidisciplinary approaches for unresectable pancreatic cancer (UR‐PC) that include modern chemotherapeutic regimens and subsequent conversion surgery (CS) are being developed. The aim of this study was to evaluate outcomes of patients clinically diagnosed with UR‐PC, focusing on the efficacy of CS. Methods: Patients ineligible for two multicenter phase II studies conducted by the Hokkaido Pancreatic Cancer Study Group (HOPS) were recruited. Sequential treatment regimens, conversion to radical surgery, and overall survival (OS) were analyzed by multidetector computed tomography (MDCT)‐based UR factors. Univariate and multivariate analyses were performed to identify predictors of OS. Results: Sixty‐six of 247 intended recruits for HOPS studies from October 2013 to April 2016 were included. Unresectability was due to locally advanced (LA) disease and metastasis (M) in 42 and 24 patients, respectively. Induction therapy began with chemotherapy (CT) and chemoradiotherapy (CRT) in 44 and 17 patients, respectively, of whom 23 received modern CT regimens. Radical surgery was completed in 12 (LA, 10; M, two) with a median treatment interval of 10.3 months (range, 2‐32). Eleven patients (91.6%) achieved pathological R0 resection. Median OS was significantly longer in patients who underwent CS than those who did not (44.1 vs 14.5 months, P < 0.0001). CS was an independent predictor of OS (hazard ratio, 0.078; 95% confident interval, 0.017‐0.348; P = 0.001). Conclusion: Conversion surgery after a favorable response to sequential treatment might prolong survival in patients with UR‐PC. Precise diagnosis on MDCT followed by sequential multimodal anticancer treatment is essential. [ABSTRACT FROM AUTHOR]

Abstract: Background: Conversion surgery (CS) is expected as a new therapeutic strategy for patients with unresectable pancreatic cancer (UR‐PC). We analyzed outcomes of CS for patients with UR‐PC and evaluated the survival benefit of CS. Methods: Thirty‐four patients diagnosed with UR‐PC according to the National Comprehensive Cancer Network guideline underwent CS in our hospital. Resectability was considered by multimodal images in patients who underwent nonsurgical treatment (NST) for more than 6 months. CS was performed only in patients who were judged to be able to undergo R0 resection. Results: Twenty‐six patients had locally advanced PC, and eight had distant metastases. The median duration of NST was 9 (range 5–44) months. R0 resection was achieved in 30 patients (88.2%). Six patients (17.6%) showed Evans grade ≥III. Three‐ and 5‐year overall survival (OS) rates from initial treatment were 74% and 56.9%, respectively, with median survival time (MST) of 5.3 years. The actual 5‐year OS rate in 19 patients was 47.4% with an MST of 4.0 years. Patients with Evans grade ≥III had a better prognosis than those with Evans grade

Abstract: Background: The aim of this study is to investigate the effects of the extended 30‐month follow‐up of an original trial (NCT00600197) which has been published in the Clinical Journal of Pain. Methods: Seventy‐four percent (146/197) of the participants who had taken part in the original study, including 69 patients in the intervention group and 77 patients in the control group, were followed up to 30 months after intervention. The intervention group continued receiving monthly motivational consultation and booster classes plus oral medication but the other group received just medication. Data on measures from the Short Form 36 (SF‐36), Quebec Disability Scale (QDS) and Ronald Morris Disability Questionnaire (RDQ) were collected at 3‐, 6‐, 12‐, 18‐, 24‐ and 30‐month follow‐ups and analyzed through repeated measures analysis of variance. Results: The two groups were comparable regarding all baseline characteristics (P > 0.05) except for education level and mental health, which were better in the intervention group (P < 0.05). The two groups improved regarding all studied variables over time up to 30 months (P < 0.001). Moreover, the intervention group in comparison with the control group had consistently better outcomes regarding all variables. There were significant differences within each group by time in terms of mental health (P = 0.01) and disability measured through QDS (P = 0.005) and RDQ (P = 0.014). Conclusion: The proposed multidisciplinary program could improve mental health and disability up to 30 months in chronic low back pain patients. [ABSTRACT FROM AUTHOR]

Abstract: Background: This study aimed to examine the effects of the extended follow‐up of an original trial (NCT00600197) which has been published in The Clinical Journal of Pain. Methods: Eighty‐three percent (165 of 197) of the original study, including 82 patients in intervention and 83 patients in the control group, provided extended 24‐month follow‐up data. The intervention was a group‐based multidisciplinary rehabilitation program which was continued by monthly motivational consultation. Data on measures of Short Form 36 (SF‐36), Quebec Disability Scale (QDS) and Ronald Morris Disability (RDQ) were collected at 12‐, 18‐ and 24‐month follow‐ups and analyzed through repeated measures analysis of variance. Results: The patients who responded (n = 165) and who did not respond (n = 32) to the questionnaires were the same in terms of all baseline data except for physical function which was better for respondents (P < 0.05). Among the respondents, both intervention and control groups were the same at baseline except for education level and mental health which was better in the intervention group (P < 0.05). As a result, the intervention group had consistently better outcomes regarding all variables except for social function at all follow‐up times. Furthermore, in the intervention group only for mental health the interaction between time and group was significant (P = 0.01). Discussion: The designed multidisciplinary program could improve health‐related quality of life and disability up to 24 months in chronic low back pain patients. [ABSTRACT FROM AUTHOR]

Objective In this review, we focus on nonmedication treatment approaches to chronic daily headaches and chronic migraine. We review the current scientific data on studies using multimodal treatments, especially physical therapy and occupational therapy, and provide recommendations on the formation of interdisciplinary headache teams. Background Chronic daily headache, which includes chronic migraine, is a particularly challenging clinical entity which often involves multiple headache types and comorbidities. A team approach in treating these patients may be particularly useful. Design/Methods We review all current studies performed with at least one or more other modality in addition to usual medical treatment, with a focus on physical and occupational therapy. Emphasis on physical and occupational therapy with an explanation of their methods and role in multidisciplinary treatment is a pivotal part of this review. We also suggest approaches to setting up a multimodality clinic for the busy headache clinician. Conclusion Setting up a collaborative, multidisciplinary team of specialists in headache practices with the goal of modifying physical, environmental, and psychological triggers for chronic daily headaches may facilitate treatment of these refractory patients. [ABSTRACT FROM AUTHOR]

Achieving continence of one's bowel movements is a key step in development and failure to do so leads to many negative consequences. Treatments for encopresis appearing in the literature have employed behavioral strategies; medications such as suppositories, laxatives, or enemas; and in some studies a combination of these approaches. To date, attempts to extend successful treatments for encopresis in typically developing children to those with developmental disabilities have been limited. The current study included three participants diagnosed with developmental disabilities who had a history of encopresis. None of the participants had a continent bowel movement under baseline conditions. Continent bowel movements increased during treatment that included the addition of suppositories to elicit continent bowel movements. Two participants began having independent continent bowel movements (i.e., without requiring suppositories) and medication was successfully faded out for the remaining participant. Treatment took between 13 and 21 days. [ABSTRACT FROM AUTHOR]

Introduction: Low back pain (LBP) is characterized with enormous costs originating from e.g. work absenteeism1. This study examined the effectiveness of a multidisciplinary intervention, with or without additional workplace intervention (WPI), in improving pain, functionality and return to work in employed (sub)acute LBP sufferers. Methods: A comprehensive search in six electronic databases was performed. The risk of bias (RoB) was assessed using the Cochrane RoB 2-tool and the ROBIS-tool. A level of evidence (LoE) and conclusion was determined according to the Dutch EBRO checklist. Results: Twelve studies were included (one A1, seven A2, four B LoE studies). A multidisciplinary intervention has beneficial effects on pain intensity and functionality compared to usual care. Contradictory results exist when compared with another intervention or an additional WPI. Regarding work-related outcomes conflicting results were found when a multidisciplinary intervention was compared to usual care, and no superior effects were found in comparison to other types of interventions. Adding a WPI to usual care might result in earlier work resumption. Discussion: A multidisciplinary intervention has favorable effects compared with usual care on pain and functionality. An additional WPI on top of usual care might be beneficial for RTW. Process evaluation: Most important limitations: 3 articles with coherent samples, the lack of articles containing an additional WPI and difficulty to compare results due to heterogeneity. [ABSTRACT FROM AUTHOR]

Background Many patients with cancer suffer from pain, which is often not optimally treated. In 2008, the evidence-based, multidisciplinary Dutch guideline on the diagnosis and treatment of pain in this patient group was published. We assessed knowledge about and adherence to the guideline by pain specialists. Methods A cross-sectional case vignette survey describing a palliative patient with intractable pancreatic cancer and pain was sent to all 350 Dutch anesthesiologists registered as pain specialists at the Netherlands Association of Anesthesiology. Descriptive statistics were conducted. Results Ninety-three pain specialists completed the questionnaire (27%). The majority appeared to follow the guideline recommendations on pharmacological (99%) and invasive treatment (95%) in the diverse stages of the disease. However, the recommendation to use a one-dimensional pain scale to evaluate the effect of pain treatment and the recommendation to perform a multidimensional pain assessment if the patient in pain is in a deteriorating stage were only followed by a minority of the respondents (23% and 15%, respectively). Conclusions Regarding most recommendations, Dutch pain specialists know and intend to follow the national multidisciplinary cancer pain guideline. Yet, only a minority of them perform structural pain assessment of the patient with cancer pain. However, as the response rate was low (27%), the results should be interpreted with caution and cannot be generalized to the entire population of pain specialists in the Netherlands. We recommend that, in the guideline update and implementation programs, more attention be given to thorough assessment of the patient with pain and cancer. [ABSTRACT FROM AUTHOR]

Objectives Evidence for the effectiveness of multidisciplinary rehabilitation for chronic musculoskeletal pain (CMP) has been reported but its outcomes in the longer term and in mixed groups of chronic pain patients are largely unknown. The aim of the present study was to describe the two-year outcomes of a 15-week multidisciplinary pain rehabilitation programme in patients with mixed CMP in terms of pain, activities, participation and healthcare usage. Methods Data were recorded routinely at admission, discharge, and at three, 12 and 24 months' follow-up for all consecutive patients with CMP referred to a rehabilitation programme over a 21-month period. The 15-week multidisciplinary rehabilitation programme consisted of cognitive behavioural therapy and exercise, as well as individual and group sessions with additional treatment modalities. Assessments included the Pain Disability Index (PDI), the Pain Catastrophizing Scale (PCS), the Multidimensional Pain Inventory (MPI) and numerical scales for pain and fatigue. Moreover, the RAND-36-Item Health Survey ('RAND-36') and questions on healthcare usage and work status were administered at admission, and at 12 and/or 24 months. Paired t-tests, Wilcoxon signed-rank tests, McNemar tests and mixed-model analyses were used to analyse changes over time. Results A total of 165 patients were included initially [mean age 44.1 (standard deviation 12.9) years], 143 of whom (87%) were women, with data from 125 (76%) and 120 (73%) patients being available at 12 and 24 months' follow-up, respectively. All outcomes showed statistically significant improvements between admission and discharge, and at three, 12 and 24 months' follow-up ( p < 0.05). At 24 months, the median number of different healthcare providers visited in the previous year had decreased significantly compared with that at admission [from a median of 4 (range 1-13) to a median of 2 (range 0-9)], and within the group of patients working at admission (50%), the proportion of those working 25 hours or more per week had increased significantly from 16% to 48%. Conclusions Improvements in pain and functioning seen directly after a 15-week multidisciplinary treatment programme for patients with CMP were maintained, health care usage decreased and the number of working hours among working patients increased at 24 months' follow-up. Future studies are needed to examine if additional interventions after discharge can enhance further the favourable results. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: There is extensive evidence that patients with cancer and cancer survivors have a strong need for expert support in relation to the psychological and social consequences of the disease. The requirements set out in the German Cancer Society's cancer center certification system include the routine provision of psycho-oncologic care (POC) and social service counseling for every patient. The current study investigated which organizational and structural characteristics in hospitals account for variations in psychosocial care provision in these centers.Methods: Data routinely collected during the certification process regarding the percentages of psychosocial care provision and characteristics of center sites and hospitals were matched with data with regard to size of the municipality, teaching hospital status, and institutional ownership. Linear multilevel regression analyses were performed to identify the characteristics of hospitals and center sites that were related to psychosocial care provision.Results: Substantial differences were found for different types of cancer (eg, a greater provision of psychosocial care in centers specializing in breast rather than prostate cancer). There was more POC provision in longer-certified centers and less in rural areas and university hospitals. Much of the variation between hospitals remains unexplained.Conclusions: Although the implementation of mandatory psychosocial services generally provides patients with access to POC and social service counseling, the wide differences in the provision of counseling indicate that additional measures are needed to avoid inequalities resulting from the center at which a patient receives cancer treatment. Cancer 2016;122:3538-3545. © 2016 American Cancer Society. [ABSTRACT FROM AUTHOR]

Introduction Evidence for the efficacy of a multi-component approach for chronic widespread musculoskeletal pain (CWP) has been reported, although the effects are overall moderate and this approach has rarely been investigated in real life. Aim The aim of the study was to describe the effects of a 15-week multidisciplinary pain rehabilitation programme on pain, activities and participation in patients with CWP. Methods The current retrospective study used data which were routinely gathered on all consecutive patients with CWP referred to a rehabilitation programme over a 21-month period. The 15-week multidisciplinary rehabilitation programme consisted of cognitive behavioural therapy and exercise, as well as individual and group sessions with additional treatment modalities. Assessments included the Pain Disability Index (PDI), the Pain Catastrophizing Scale (PCS), the Multidimensional Pain Inventory (MPI), numerical scales for pain and fatigue, the Canadian Occupational Performance Measure (COPM), the one-minute stair-climb test and the RAND-36. Paired t-tests and Wilcoxon signed-rank tests were carried out to analyse changes over time. Results A total of 165 patients were included [mean age 44.1 (standard deviation 12.9) years], 143 (87%) women). Discharge data were available for 154 patients (93%). All outcomes showed statistically significant improvements between admission and discharge ( p < 0.05), with the largest effect sizes (>1.0) observed for the COPM. A longer duration of complaints was associated with less improvement in the PDI. Discussion and conclusion In daily rehabilitation practice, a 15-week multidisciplinary treatment programme for patients with CWP showed statistically significant improvements in pain, activities and participation over time. Future studies are needed further to substantiate the long-term cost-effectiveness, and to identify the patients who benefit the most. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aim To examine and compare the presenting characteristics and the change in the physical and psychosocial functioning of adolescents with chronic fatigue syndrome ( CFS) or somatoform disorders who have received an adaptable multidisciplinary intervention over a 12-month period. Methods Fifty adolescents presenting to the Complex Adolescent Clinic at The Children's Hospital at Westmead, Sydney, Australia were assessed. Their physical and psychosocial functioning was rated by the adolescents and their parents using the Child Health Questionnaire. Participants were assessed at baseline, 4 months and 12 months after initiating treatment. Analyses examined whether diagnosis and/or illness precipitants were related to treatment outcome. Results Adolescents with both CFS and somatoform disorders demonstrated improvement in physical and psychosocial functioning over the first 4 months of treatment, sustained at 12-month follow-up. A diagnosis of CFS was associated with poorer physical functioning over time and a trend towards a longer illness time course compared with somatoform disorder. Adjustment for a physical precipitant reduced the association between diagnosis and physical functioning. Those who had a physical precipitant to their illness had significantly poorer physical functioning over time than those who did not, regardless of diagnostic category. Diagnosis and physical precipitant were not associated with psychosocial functioning. Conclusions Improvement in adolescent physical and psychosocial functioning over time suggests that a multidisciplinary treatment model may be effective for varied complex medico-psychosocial presentations, irrespective of diagnosis and illness precipitant. Illness precipitant may have a greater influence on treatment outcome than diagnostic category. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to identify ethnic differences in interdisciplinary pain treatment outcome and whether these differences occur while controlling for the effects of demographics, psychosocial, and secondary gain. Methods We assessed a sample of 116 (Caucasian, African American, and Latino/a) chronic pain patients who participated a 4-week interdisciplinary pain treatment program. Outcome measure included pretreatment, post-treatment, and change scores on the Multidimensional Pain Inventory, Pain Anxiety Symptom Scale 20, Chronic Pain Acceptance Questionnaire, Coping Strategies Questionnaire-revised, and the Center for Epidemiologic Studies Depression Scale-short form. Results Analysis of covariances revealed that after accounting for educational and sex differences, ethnic minorities differed from Caucasians on a number of treatment outcome measures at pre- and post-treatment [ F's ≥ 5.38; P's < 0.01]. At pretreatment, Latino/a's endorsed greater levels of pain-related anxiety, pain severity, and pain catastrophizing than Caucasians. Both Latino/a's and African Americans reported greater use of prayer at pre- and post-treatment, with Caucasians showing the greatest decrease in the use of prayer in response to treatment. At post-treatment, African Americans had higher level of depression and lower levels of reported activity than Caucasians. Conclusions Results support the notion that ethnic differences in pain treatment outcome exist. Further, ethnic minority groups appear to have greater levels of distress compared to Caucasians. However, African Americans, Latino/a's and Caucasians demonstrated similar improvements on all outcome measures, with exception of the use of prayer. Future studies should begin to explore the mechanisms to explain why ethnic group differences in pain treatment outcome occur. [ABSTRACT FROM AUTHOR]

Background This study aimed to examine the effects of a multidisciplinary treatment program on health-related quality of life of Iranian patients living with chronic low back, at 12 months follow-up. Methods This study is an extended follow-up of an original randomized, controlled trial with registration number NCT00600197. In the present study 87 patients in an intervention group and 91 patients in a control group were assessed at 12 months follow-up. The intervention was a group-based multidisciplinary rehabilitation program which continued by monthly motivational consultation by telephone from 6 to 12 months after intervention. Data from three standard measures, Short Form 36 ( SF-36), QDS and RDQ were collected at 3, 6 and 12 months follow-up and analyzed through repeated measures analysis of variance. Results Despite the similarity between the two groups who completed the 6 month follow-up in terms of all baseline variables, there were significant differences between the two groups in all domains of the SF-36 scale, as well as QDS and RDQ scales ( P < 0.05). Also, there were differences within each group over time in the SF-36 domains and disability measurements ( P < 0.05). The physical function mean score differed significantly when the interaction between groups and time points was examined ( P = 0.02). Conclusion This study indicates that the multidisciplinary program could improve the domains of health related quality of life and disability in chronic low back pain patients up to 12 months. [ABSTRACT FROM AUTHOR]

Objective.- To evaluate the long-term efficacy of a structured, multidisciplinary treatment program in patients who had been treated unsuccessfully for medication overuse headache by specialists in an open-label design. Background.- Medication overuse headache is a common and disabling disease. Management is complicated by substantial treatment failure and relapse, and those who relapse and nonresponders to treatment are often excluded from studies on medication overuse headache. Methods.- Patients with medication overuse headache who had previously been unsuccessfully treated by specialists and referred to a specialized, tertiary headache centre were recruited. They underwent a structured 2-month detoxification program and were subsequently closely followed up for 10 months by a multidisciplinary team of physicians, nurses, physiotherapists, and psychologists. Results.- Eighty-six of 98 patients completed the study. Primary Outcome.- At 12-month follow-up, headache frequency was reduced by 39.3% ( P < .001), 71 patients (82.6%) remained cured of medication overuse, reduction in headache frequency of more than 50% occurred in 42 patients (48.8%), and 52 (60.5%) reverted to episodic headache. Both of these figures had increased significantly from month 2 to month 12 ( P < .001). Medication use was reduced by 62.8% ( P < .001). Conclusion.- Patients with medication overuse headache previously regarded treatment-resistant benefit considerably from multidisciplinary treatment in a structured detoxification program with close follow-up. [ABSTRACT FROM AUTHOR]

Abstract: Background: Musculoskeletal pain represents a continuous process ranging from single-site to multiple-site pain, with an increase in pain sites accompanied by an increasing risk of chronification and the development of further comorbidities. Within this context, the impact of pain spread on therapy outcome is still unknown. Aims: This prospective clinical study aimed to evaluate whether and to what extent patients with pain at multiple sites would also benefit from multidisciplinary therapy or whether therapy success is limited by pain spread. Methods: Patients’ characteristics were assessed, including socio-demographic variables, occupational and workplace characteristics, pain intensity and dimensions of pain, psychological aspects and functional back capacity, as well as the generic health status. Data were prospectively collected at day 1 (baseline) and at 6-month follow-up from a sample of 389 patients undergoing multidisciplinary treatment. Patients were distributed into three groups based on the number of pain sites (single-site, dual-site and multiple-site) and the outcome parameters were compared. Results: All three groups improved significantly from baseline to the 6-month follow-up. Compared to patients with multiple-site pain, patients with single-site and dual-site pain displayed significantly better outcome on almost all measures. Only the subcategory mental health of the SF-36 did not show any statistically significant differences among the three groups. Conclusions: Our results display that patients with two or more pain sites also improve significantly in the outcome measures. Therefore, treatment should be offered independent of the extent of pain spread. However, therapy is significantly less successful in patients with pain at multiple sites. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the implementation of macroscopic assessment of mesorectal excision in patients with rectal cancer. It also investigates the factors that influenced surgical quality of mesorectal excision and disease recurrence. The results of the study indicate that good proficiency of mesorectal excision is associated with lower tumor recurrences after curative surgery.

Abstract: Interdisciplinary pain management programs have an established record of significantly improving the functioning of persons disabled with chronic pain. There is a group of pain sufferers, however, who have difficulty accessing these programs and for whom the effectiveness of these treatments in unknown, these are patients whose mobility and self-care deficits leave them unable to meet the practical demands of many treatment environments. The purpose of this study was to examine the results of a treatment program designed to meet the needs of these highly disabled individuals (n =53) in comparison to results obtained from a standard less-disabled group attending treatment at the same facility (n =234). Results from the highly disabled patients showed statistically significant change after treatment in eight of nine outcome variables, including improvements in pain-related distress, disability, depression, pain-related anxiety, daytime rest, and performance during an activity tolerance test. Effect size calculations showed a number of large treatment effects, for psychosocial disability, depression, and acceptance of pain. Analysis of reliable change and clinical significance demonstrated that results were not merely statistically significant but clinically meaningful. Results appeared stable at three months following treatment. This research plays an important part in establishing an evidence base to inform service development, ensuring that chronic pain services do not exclude people on the basis of the severity of their disability. [Copyright &y& Elsevier]

Abstract: Former studies have questioned the quality and effectiveness of multidisciplinary rehabilitation for working-age adults with fibromyalgia and chronic widespread pain (CWP). High-quality trials are needed, and return to work should also be included as an outcome variable. This randomized study evaluated the return-to-work outcome of an extensive and a light multidisciplinary treatment program combining cognitive strategies and exercise versus treatment-as-usual initiated by a general practitioner, for CWP patients. The patients (n =208), on sick leave for 3 months on average, were randomized to the extensive program including group sessions, a light and more individual program, and to treatment-as-usual. The number of days absent from work and full return to work were used as an outcome, and follow-up lasted 54 months after the programs ended. The regression analysis showed that the extensive program was associated with significantly fewer days absent from work among women. For women, the mean effect of extensive treatment versus treatment-as-usual on total number of days absent from work was estimated to −206.95 days. Among men, the light program was associated with significantly more days absent from work compared to treatment-as-usual. Both among men and women, independent of type of treatment, patients with poorer health (poor prognosis) were absent from work more days than patients with good prognosis. In our sample, higher age significantly increased the number of days absent from work, but only for women. The extensive outpatient multidisciplinary treatment program was effective in returning women to work. [Copyright &y& Elsevier]

Unlabelled: Constipation, faecal incontinence, soiling and difficult toilet training remain significant problems in children with Hirschsprung's disease after corrective surgery. Chronic defecation problems can have various negative implications. At the University Medical Centre Nijmegen, a multidisciplinary behavioural treatment was developed to treat defecation problems. In this paper, a prospective controlled study is presented concerning the effect of this treatment upon children suffering from chronic defecation problems following corrective surgery for Hirschsprung's disease. The effect of treatment was studied in 27 children (21M, 6F, mean age 5.2y, range 2-11 y). Fourteen children were allocated to the experimental treatment group. The 13 children allocated to the waiting-list control group were also treated following a waiting period of 6 mo. On all outcome variables, children in the experimental treatment group had significantly better results after treatment than children in the waiting-list control group after the waiting period. No effect of age upon treatment was found. The effect of treatment remained significant on all outcome variables at a mean follow-up of 7 mo after the end of treatment.Conclusion: Multidisciplinary behavioural treatment is successful in decreasing chronic defecation problems in children with Hirschsprung's disease. [ABSTRACT FROM AUTHOR]