It is widely accepted that a multidisciplinary approach is necessary to ensure the optimal care of patients with cancer, a complex disease that frequently requires a combination of treatments (e.g., surgery, chemotherapy, radiation therapy) to offer patients a chance at long-term survival. However, little has been written on how such multidisciplinary care should best be organized and/or delivered to patients suffering from sarcoma, a rare family of bone and soft tissue cancers. The purpose of this book is to explore the rationale and specifc methods for providing multidisciplinary care for these challenging patients. As with most complex issues, there is no single solution that will ft into every community or organization dealing with this disease. Therefore, we have invited a variety of authors from sarcoma centers and practices in the United States and from around the world, emphasizing best practices that can be translated into local and regional groups seeking to improve access and care delivery for these patients. At its core, a multidisciplinary approach is simply the application and coordination of individuals and/or teams representing different specialties working together and applying their knowledge and skills in their respective felds in order to solve or overcome a challenging problem.
Although intravenous recombinant tissue-type plasminogen activator therapy was approved for treating acute ischemic stroke within 3 h of symptom onset in 1996, less than 5% of patients with acute stroke were receiving this treatment. To facilitate adequate care for acute stroke patients, the Brain Attack Coalition (BAC) discussed the need to establish primary stroke centers (PSCs) where patients can receive emergency stroke care from qualifed teams and developed recommendations with criteria for PSCs in 2000. A consensus statement from the BAC with extensive recommendations for comprehensive stroke centers (CSCs), a facility for stroke patients who require high-intensity medical and surgical care, was published in 2005. The Joint Commission began to certify PSCs in 2003 and CSCs in 2012. The “Get With The Guidelines®-Stroke” program, a popular database tool to record and track performance measures, was developed by the American Heart Association as a national quality improvement program. A third type of facility, the acute stroke-ready hospital (ASRH), is currently under development. An ASRH would have fewer capabilities than a PSC, but would be able to provide initial diagnostic services, stabilization, emergent care, and therapies to patients with acute stroke. This chapter introduces literature about stroke centers from the United States, Europe, and Japan and discusses the effectiveness and future challenges of stroke centers.
Keratoconus is today a classic topic in ophthalmology . Its history is associated to a background of a corneal disease with a blinding potential and no hope for treatment. It is only since the late 1950s that contact lenses have become a partial solution for the visual loss for some cases of keratoconus while other approaches were nonexisting. Those patients diagnosed with keratoconus had the same category as any corneal dystrophy with no potential treatment and no therapeutic recommendations to perform. The patients had no hope for the future and could not do anything about preventing its progress or being informed about the potential long-term complications or any consistent and reliable therapeutic approach. Since those historical and recent “black days” until now there has been a tremendous evolution. At this moment in 2016, there is a completely different approach for the diagnosis and treatment of keratoconus. The study and diagnosis of keratoconus has radically changed since the early seventeenth century when the Jesuit Priest Christoph Scheiner experienced and reported that glasses of different shapes reflect light in different ways, until nowadays, corneal diagnostic technology has taken a huge step forward. Scheiner used the optical phenomenon he described to assess the curvature of the human cornea. In doing it, he was able to compare the light reflections of different shapes and he even described some pathologies that were evident cases of keratoconus.
Chronic Obstructive Pulmonary Disease (COPD) is a common disease and prevalence is increasing worldwide. It is characterized by persistent airway obstruction that is partially reversible but it is considered preventable and treatable disease now. Airﬂow limitation is associated with chronic and abnormal inﬂammatory response in the airways and the lung to noxious stimuli . Airway obstruction is defned by a reduction of expiratory airﬂow. Generally, forced expiratory volume in 1 s/forced volume capacity (FEV1/FVC) ratio of less than 70% after bronchodilator has been used to identify COPD patient. The use of lower limit of normal (LLN) values has been proposed to defne airﬂow limitation by spirometry, but current Global initiative for chronic Obstructive Lung Disease (GOLD) and American Thoracic Society/European Respiratory Society guidelines continue to recommend the fxed ratio criteria instead of an LLN for the diagnosis of COPD . Patients with COPD have shown a great deal of heterogeneity and can be classifed according to their clinical and radiologic parameters, biomarkers, lung function impairment and prognosis . Traditionally, COPD has been classifed as
chronic bronchitis (CB) and emphysema. CB is defned as the presence of a chronic productive cough for 3 months in each of two consecutive years. Emphysema is defned as the destruction of alveolar walls and permanent enlargement of the airspaces distal to the terminal bronchioles. Current GOLD guidelines do not include the use of these terms in the defnition of COPD.
This chapter discusses common dysphagia terminology. A common understanding of important terms relevant to dysphagia enables healthcare professionals to communicate clearly and rapidly. The basic knowledge of anatomical structures associated with swallowing is fundamental to understanding the whole swallow process including the evaluation and treatment of dysphagia.
Chronic pain is a term that defnes a set of specifc medical conditions in which a patient suffers from pain for extended periods of time. While many interventional treatment options exist depending on the nature of the complaint and the patient’s overall well-being, otherwise, many patients are given opioid therapy by primary care and ER physicians. This chapter addresses several key national factors that are currently tied to chronic pain: a growing epidemic of opioid use in the United States which is partially attributable to the lack of physicians who were effectively trained to treat pain, and the result is a signifcant economic burden on the country.
This book outlines our unique conceptualization of perfectionism, as well as assessment and treatment approaches for it. It represents the culmination of over two decades of research and clinical work on this topic. Our primary purpose for writing this book is to offer insight into the complex construct of perfectionism—not only as a personality style involving traits and relational elements, but also as a clinically relevant personality vulnerability factor that predisposes individuals to myriad problems. We also provide information on appropriate assessment and treatment of those people who are paying a signifcant personal price for their perfectionism.
Making an accurate diagnosis is essential for optimal male infertility management. Until recently, the assessment of the male had been largelymanaged by the gynecologist, principally because in vitro fertilization (IVF)is capable of overcoming many male-related semen abnormalities. With the current advancements that are being witnessed in the study of men’s health, such a practice, ortunately, is diminishing. The male is responsible for roughly about 50% of the etiology of nfertility in couples and thusreceiving adequate evaluation and management is as important as female counterpart management. Moreover, a specialized male fertility service would identify and treat a number of conditions that can avoid or ultimately improve assisted reproduction outcomes as well as identify issues that can negatively impact a man’s health. Microsurgical reconstructive surgery andsperm retrieval are other examples of the unequivocal need of a specialized male fertility service.
The pathological features of inﬂammatory bowel diseases (IBD) are characterized by an infltration of the lamina propria with lymphocytes, macrophages, and neutrophils . The cytokines released by these cells trigger a process of local cell death and matrix damage, leading to the endoscopic appearance of ulcers, friability, and exudates. The biologic agents approved, or in development, for IBD target specifc steps in this process. These mechanisms of action not only resolve local inﬂammation but also account for some of the adverse events associated with the use of biologics. In this chapter we will review the pharmacodynamics (physiological effects of drugs and their mechanisms of their actions) and the pharmacokinetics (the fate of a drug within the body) of currently approved biologics. Since the anti-TNFs were been the only biologic class for 15 years, most of the independent laboratory data has tested these agents, whereas published data on vedolizumab and ustekinumab is more limited.
Background While oral psoralen plus ultraviolet A (PUVA) remains the most popular therapeutic modality for vitiligo, recent reports have shown that narrowband ultraviolet B (UVB) also induces significant repigmentation. In this study we evaluated the efficacy of broadband UVB on actively spreading, progressive vitiligo in patients who had been followed for many months (12 or more) in our practice, who continued to depigment despite treatment