Multidisciplinary Team

Background: The development of multidisciplinary team meetings (MDTMs) for radiology and pathology is a burgeoning area that increasingly impacts on work processes in both of these departments. The aim of this study was to examine work processes and quantify the time demands on radiologists and pathologists associated with MDTM practices at a large teaching hospital. The observations reported in this paper reflect a general trend affecting hospitals and our conclusions will have relevance for others implementing clinical practice guidelines.
Methods: For one month, all work related to clinical meetings between pathology and radiology with clinical staff was documented and later analysed.
Results: The number of meetings to which pathology and radiology contribute at a large university teaching hospital, ranges from two to eight per day, excluding grand rounds, and amounts to approximately 50 meetings per month for each department. For one month, over 300 h were spent by pathologists and radiologists on 81 meetings, where almost 1000 patients were discussed. For each meeting hour, there were, on average, 2.4 pathology hours and 2 radiology hours spent in preparation. Two to three meetings per week are conducted over a teleconferencing link. Average meeting time is 1 h. Preparation time per meeting ranges from 0.3 to 6 h for pathology, and 0.5 to 4 for radiology. The review process in preparation for meetings improves internal quality standards. Materials produced externally (for example imaging) can amount to almost 50% of the material to be reviewed on a single patient. The number of meetings per month has increased by 50% over the past two years. Further increase is expected in both the numbers and duration of meetings when scheduling issues are resolved. A changing trend in the management of referred patients with the development of MDTMs and the introduction of teleconferencing was noted.
Conclusion: Difficulties are being experienced by pathology and radiology departments participating fully in several multidisciplinary teams. Time spent at meetings, and in preparation for MDTMs is significant. Issues of timing and the coordination of materials to be reviewed are sometimes irreconcilable. The exchange of patient materials with outside institutions is a cause for concern when full data are not made available in a timely fashion. The process of preparation for meetings is having a positive influence on quality, but more resources are needed in pathology and radiology to realise the full benefits of multidisciplinary team working.

It  is  only  in  the  last  two  or  three  decades  that  the  link  between  substance abuse  and  mental  disorders  have  began  to  be  addressed.  (Hryb, 2007). This has  brought  about  the  difficulty  in  establishing  a  straightforward  causality,  generating  many  hypotheses  as  to  the  origin  of  the  dual  condition,  while linking  environmental  and  genetic  factors.  This,  in  turn,  has  prompted a search  for  new  more  effective  treatment  options  which  would  take  into account  this  disparity  in  empirical  studies,  to  bridge  various  conflicting theories.  This  paper  includes  a  brief  overview  of  competing  theories, followed  by  a  look  into  a  number of studies of mental conditions in relation to  substance  abuse  and,  finally,  a  brief  look  into  available  choice  of interventions.

Adherence to treatment is a key to improve cure rates in patients with chronic hepatitis C on interferon-based therapies. We aimed to determine the main reasons for telephone consultations and unscheduled visits in hepatitis C patients under antiviral treatment. Methods: We included all patients with hepatitis C treated with pegylated interferon plus ribavirin who consulted our department by telephone or unscheduled visits. Results: A total of 176 patients (mean age, 48 years; 67.6% male) were under treatment in the inclusion period. We registered 264 phone consultations and 193 unscheduled visits by 109 patients (53% women). The most common reason for telephone consultation was adverse effects (40.2%). The most common actions in response to telephone consultation were providing information (58.3%) and arranging or advancing appointments (22%). Reasons for unscheduled visits included adverse effects (59.1%), errors or administrative queries (13.4%), questions or doubts related to treatment (10.4%), and problems with medication devices (7.7%). Actions in response to unscheduled visits included medical visits (33.7%), training by nurses (24.9%), referral to other specialties (10%), laboratory tests (8.8%), prescription of medication (7.8%), administrative procedures (6.8%), discontinuation of treatment (2.6%), and transfusion (2.1%). Conclusion: Most telephone consultations or unscheduled visits of patients on chronic hepatitis C treatment are related to adverse events.

Performance on an information gathering task is shown to be superior in teleconference. Analysis of errors in an exercise revealed the data sources used in co-located and teleconference scenarios. The use of a visual display for text data, in addition to the audio source, is demonstrated in both co-located and teleconference discussions. Audio was used as a source of information more frequently in teleconference which resulted in an overall improvement in task performance.
The lesson learned from the higher performance in tele conference, can be applied to improve performance at co- located meetings. Providing appropriate visual data together within audio enhanced spaces can be expected to improve the communication event and reduce medical errors. Results support proposals for the incorporation of physical spaces to improve communication in everyday work in co-operative workplaces, such as hospitals.

The background of the Ethics Committee on Animal Use of the Faculdade de Medicina de São José do Rio Preto is a relevant reason of advocacy. It is an indirect institutional effort in favour of improving the conditions offered by the undergraduate medical course. It also hoists the flag of Animal Bioethics, putting into context the teaching-learning process and research. Furthermore, it provides technical and conceptual skills, among others. The real breakthrough has occurred over the course of 14 years. It is a frame of time when we can speak with more property about this voluntary service, which is being constantly improved. We can also vouch the commitment of the members of the Ethics Committee on Animal Use in compliance with the current legislation. However, above all, we can perceive the awareness that the development of education and research will never minimize the respect, consideration, and ethics that are due to the animals, as well as the collective effort in the hope of lowering their use for such activities aiming at the change to alternative methods. The background of the Ethics Committee on Animal Use of the Faculdade de Medicina de São José do Rio Preto travels all over the course already performed with data and information, which illustrate the work and progress done so far. On its own merits, it justifies its existence and the place it occupies in the state of São Paulo.