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<ul><li> 1. The Integrated Multidisciplinary <br />Approach-Team in Bariatric Surgery: An Overview <br />William Gourash, CRNP, MSN<br /></li></ul> <p> 2. The Integrated Multidisciplinary Approach-Team in Bariatric Surgery: An Overview <br />Presenter Name: William Gourash, CRNP, MSN<br />As previously disclosed, these are the companies with which I have a financial or other relationship(s):<br />Company Name(s)Nature of Relationship(s)<br />Infosurge Inc.Non-paid member of advisory board<br /> 3. Famous Multidisciplinary Team .<br /> 4. Multidisciplinary Approach (MDS) &amp; Teams (MTDs) in Surgical Specialties<br />Considered standard of care<br />Cancer<br />Trauma <br />Transplant<br />Joint replacement<br /> 5. Reports of MDTs in Surgical Literature<br /> evidence that influences current practices in the multidisciplinary treatment and shapes future directions in the treatment of resectable rectal cancer. <br />Diandra N Ayala, Suzanne M Russo and A William Blackstock Expert Review of Gastroenterology &amp; Hepatology, 2009<br />A multidisciplinary approach to breast cancer care is essential to the successful integration of available therapies.<br />Hulvat MC, Hansen NM &amp; Jeruss JS Surg Clin North Am, 2009<br />Interdisciplinary approach to the rehabilitation of open-heart surgical patients<br /> Interdisciplinary team reduces fragmentation of care, improves patients outcomes, and enhances patient, family, staff and physician satisfactions. <br />Carbone LM, Rehabil Nurse, 1999<br />Multidisciplinary approach to esophageal and gastric cancer<br />Quiros RM &amp; Bui CL<br />Surg Clin North Am. 2009<br />Effectiveness of a multidisciplinary team approach to hip fracture management.<br />Khasraghi et al., J Surg Orthop Adv. 2005<br />Multidisciplinary rehabilitation programs following joint replacement at the hip and know in chronic arthropathy.<br /> assess the evidence for effectiveness of multidisciplinary rehabilitation on activity and participation in adults following hip or know joint replacement for chronic arthropathy. <br />Khan F, Gonzalez S, Hale T, &amp; Turner-Stokes L.<br />Cochrane Database Syst Rev. 2008 <br />Multidisciplinary teams achieve the best results. This paper discusses the surgical management of rectal cancer ...<br />Glynne-Jones R, Mathur P, Elton C, &amp; Train ML<br />Best Pract Res Clin Gastroenterol,2007<br /> 6. Multidisciplinary Approach &amp; Teamin The Care Of Bariatric Surgical Patient<br />First advocated in bariatric surgery in the late 1970s at the Iowa meetings by Dr Edward Mason<br />Anti-obesity surgery is behavioral surgery, outcome is independent of the technical performance of the operation. <br />Kral, JG<br /> Selection of patients for anti-obesity surgery<br />International Journal of Obesity (2001) 25, S107-112<br />The NIH in the 1991 Consensus Statement advocated the use of the multidisciplinary approach and the "multidisciplinaryteam to optimize patient care.<br />and <br /> 7. Recommendations for MDTs &amp; MDAs <br />This study emphasizes that obesity surgery requires a significant experience of the surgical team and a multidisciplinary approach to improve behavioral changes.<br />Chevallier et al.<br />Ann Surg. 2007 Dec;246(6):1034-9.<br />Preoperative assessment and selection should be performed by a multidisciplinary team to obtain optimal results<br />YurcisinBM, GaddorMM &amp; DeMariaEJ, 2009<br />Clin Chest Med. 2009 sep;30(3):539-53, ix<br />Optimal care o the bariatric surgical patient requires a multi-disciplinary team to address the medical complications, nutritional management, and psychological and behavioral implications of obesity.<br />Kaplan, LM<br />Gastroenterol Clin North Am. 2005 Mar;34(1): 105-25<br />With this increased popularity, comes a responsibility for health-care professionals to guard against patients' perception of surgical treatment as a panacea. To counter this possibility, three recommendations are presented as components of a treatment paradigm by a multidisciplinary team of health professionals, which incorporate surgical and non-surgical treatment components, increase patient responsibility, promote lifelong health behavior change and effect permanent weight loss.<br />Bond et al. Obes Surg. 2004 Jun-Jul;14(6):849-56.<br /> 8. Bariatric surgery patients undergo many dramatic lifestyle changes, and comprehensive presurgical screening conducted by a multidisciplinary team is important to prepare patients for the numerous changes necessary for successful outcome.<br />Elder, KA and Wolfe, BM, 2007, Gastroenterology, 132:2253-2271<br />Candidates for bariatric procedures should be selected carefully after evaluation by an interdisciplinary team with access to medical, surgical, psychiatric, and nutritional expertise.<br />Kuruba, R, Koche, LS &amp; Murr MM, The Medical Clinics of North America, 2007, 91: 339-351.<br />Bariatric care should be delivered within credentialed multidisciplinary systems.<br />Clinical application of laparoscopic bariatric surgery: an evidence-based review.<br />Farrell, TM et al., 2009, Surgical Endoscopy, 23:930-949<br />The best results are available to the well-informed patients under the care of a dedicated multidisciplinary team that includes professional from a wide range of health-related disciplines (medicine, nursing, health promotion, psychology, exercise physiology and dietetic sciences.<br />Saltzman, E, 2005Obesity Research, 13(5) 2005,234-243<br />Follow-up in the bariatric clinic should be a multidisciplinary effort, and patients should have easy access to the nurse practitioner and surgeon as well as to the dietician and support-group staff. In addition, as exercise physiologist and psychotherapist familiar with the problem experienced by bariatric surgery patients should be available.<br />DiRocco, JD, Halverson, JD, Planer, J., Walser, M. &amp; Cunningham, PR., <br /> 9. Rosenthal &amp; Jones 2008<br /> 10. Is there Evidence? for Efficacy &amp; Positive Outcomes?<br />Betsy Lehman Center for Patient Safety and Medical Error Reduction:Expert Panel on Weight Loss Surgery (12-12-2007)<br />Evidence for MDTs in Bariatric Surgery<br />CATEGORY AEvidence obtained from at least one well-conducted randomized clinical trial of a systematic review of all relevant RCTs<br />CATEGORY BEvidence from well-conducted prospective cohort studies, registry or meta-analysis of cohort studies, or population-based case-control studies<br />CATEGORY CEvidence obtained from uncontrolled or poorly controlled clinical trials, or retrospective case-control analyses, cross-sectional studies, case series or case reports<br />CATEGORY DEvidence consisting of opinion from expert panels or the clinical experience of acknowledged authorities<br />Adapted from criteria used by the U.S. Preventive Services Task Force (USPSTF) and the American Diabetes Association<br /> 11. Definitions: Multidisciplinary Approach (MDA)&amp; Multidisciplinary Team (MDT)<br />Involves drawing appropriately from multiple disciplines to redefine problems outside of normal boundaries and reach solutions based on a new understanding of complex situations. Wikipedia2009<br />A group of health care workers of different disciplines, each providing different services to the patient<br />Mosby's Medical Dictionary 8th edition. 2009, Elsevier<br /> is composed of members from different healthcare professions with specialized skills and expertise. The memberscoordinate and communicate with each other to provide quality patient care. <br />Journal of HealthCare Quality2004<br /> 12. The use of multidisciplinary teams to evaluate bariatric surgery patients:Results from a national survey in the U.S.A.Santry, H.P., Chin, M.H., Cagney, K.A., Alverdy, J.C., &amp; Lauderdale, D.S. Obesity Surgery, 16 (2006), 59-66.<br /></p> <ul><li>NIH Consensus Statementrecommended candidates should be selected carefully after evaluation by a multidisciplinary team with access to medical, surgical, psychiatric, and nutritional expertise. </li></ul> <p> 13. Others recommended Teams that included different groupings of the following: surgeon,PCP/internist/OMP, behavioral health professionals,dietician, exercise specialist, nurses, &amp; NP/PA 14. Variety of team compositions and execution models &amp; practices </p>