Is a Multidisciplinary Aerodigestive Clinic More Effective at Treating Recalcitrant Aerodigestive Complaints Than a Single Specialist?

Rotsides, Janine M.; Krakovsky, Gina M.; Pillai, Dinesh K.; Sehgal, Sona; Collins, Maura E.; Noelke, Carolyn; Bauman, Nancy M.

doi:10.1177/0003489417708579

Cited by 46 publications

(44 citation statements)

References 39 publications

(42 reference statements)

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“…2 Rotsides et al also reported a male preponderance (64%) with a mean age of 4.6 years. 13 Children with previous OA-TOF formed the largest proportion of children in our ADC. This is different from previously reported ADCs 2,13 from North America which reported only 0-4% of OA-TOF children.…”

Section: Discussionmentioning

confidence: 99%

“…Other ADC's led by otolaryngologists/gastroenterologists have a different patient base of CSHCN and ongoing aerodigestive symptomatology. 2,13 Rotsides et al 13 reported laryngeal cleft (15%) and adenoidal hypertrophy as the most common underlying aetiology of recalcitrant aerodigestive conditions presenting to their ADC, but this is an otolaryngologists led programme. We also noted a high proportion (37%) of syndromic association (VACTERL/VATER) in this group compared to other studies which have reported a lower number of syndromic association (5%) and higher association with cerebral palsy (28%) and extreme prematurity (17%).…”

Section: Discussionmentioning

confidence: 99%

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Multidisciplinary approach to paediatric aerodigestive disorders: A single‐centre longitudinal observational study

Fuladi

Suresh

Thomas

et al. 2020

J Paediatrics Child Health

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Aim: Aerodigestive clinics (ADCs) are multidisciplinary programmes for the care of children with complex congenital or acquired conditions affecting breathing, swallowing and growth. Our objective was to describe the demographic, clinical, etiological and investigational profile of children attending the inaugural ADC at a tertiary paediatric centre in Queensland. Methods: Children referred to the ADC at Queensland Children's Hospital from August 2018 to December 2019 were included. Data on clinical, growth and lung function parameters, bronchoscopy and upper gastrointestinal endoscopy findings, thoracic imaging and comorbidities were retrospectively analysed. Results: Fifty-six children (median (range) age 4 years (3 months-15 years); 18 female) attended the ADC during this 17-month period. Forty-six (82%) children had previous oesophageal atresia with tracheo-oesophageal fistula; 43 of these were type C. Previous isolated oesophageal atresia, congenital diaphragmatic hernia and congenital pulmonary malformation were the underlying disorder in three (5%) children each, with one child having a repaired laryngeal cleft. Vertebral Anal Tracheo Esophageal Renal Limb anomalies (VACTERL)/Vertebral Anal Tracheo Esophageal renal anomalies (VATER) association was seen in 21 (38%) children. Growth was adequate (median weight and body mass index z-score −0.63 and −0.48, respectively). Thirty-four (61%) children reported ongoing wet cough, with 12 (21%) requiring previous hospital admission for lower respiratory tract infection. Fourteen (25%) had bronchiectasis on computed tomography chest and 33 (59%) had clinical tracheomalacia, apparent on bronchoscopic examination in 21 patients. Dysphagia was reported in 15 (27%) children, 11 (20%) were gastrostomy feed-dependent and 5 (9%) had biopsy-proven eosinophilic oesophagitis. Conclusion: High proportion of children attending the ADC have ongoing respiratory symptoms resulting in chronic pulmonary suppuration and bronchiectasis. Potential benefits of this model of care need to be studied prospectively to better understand the outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Multidisciplinary approach to paediatric aerodigestive disorders: A single‐centre longitudinal observational study

Fuladi

Suresh

Thomas

et al. 2020

J Paediatrics Child Health

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“…Unfortunately, little data are published with regard to pertinent multisystemic rare diseases, perhaps due to the barriers noted. However, improved patient outcomes due to a multidisciplinary approach have been observed in pediatric chronic kidney disease, sickle cell disease, recalcitrant aerodigestive complaints, and diabetes management, among others (Ajarmeh, Er, Brin, Djurdjev, & Dionne, ; Asare et al, ; Chung et al, ; Rotsides et al, ). Compared to a control group, a group of pediatric chronic kidney disease patients in British Columbia, Canada, showed improved outcomes, particularly in anemia management, bone mineral metabolism, nutrition, and renal disease progression.…”

Section: A Multidisciplinary Approachmentioning

confidence: 99%

A multidisciplinary approach to the clinical management of Prader–Willi syndrome

Duis

Wattum

Scheimann

et al. 2019

Molec Gen & Gen Med

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Background Prader–Willi syndrome (PWS) is a complex neuroendocrine disorder affecting approximately 1/15,000–1/30,000 people. Unmet medical needs of individuals with PWS make it a rare disease that models the importance of multidisciplinary approaches to care with collaboration between academic centers, medical homes, industry, and parent organizations. Multidisciplinary clinics support comprehensive, patient‐centered care for individuals with complex genetic disorders and their families. Value comes from improved communication and focuses on quality family‐centered care. Methods Interviews with medical professionals, scientists, managed care experts, parents, and individuals with PWS were conducted from July 1 to December 1, 2016. Review of the literature was used to provide support. Results Data are presented based on consensus from these interviews by specialty focusing on unique aspects of care, research, and management. We have also defined the Center of Excellence beyond the multidisciplinary clinic. Conclusion Establishment of clinics motivates collaboration to provide evidence‐based new standards of care, increases the knowledge base including through randomized controlled trials, and offers an additional resource for the community. They have a role in global telemedicine, including to rural areas with few resources, and create opportunities for clinical work to inform basic and translational research. As a care team, we are currently charged with understanding the molecular basis of PWS beyond the known genetic cause; developing appropriate clinical outcome measures and biomarkers; bringing new therapies to change the natural history of disease; improving daily patient struggles, access to care, and caregiver burden; and decreasing healthcare load. Based on experience to date with a PWS multidisciplinary clinic, we propose a design for this approach and emphasize the development of “Centers of Excellence.” We highlight the dearth of evidence for management approaches creating huge gaps in care practices as a means to illustrate the importance of the collaborative environment and translational approaches.

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“…In a recent review of the presenting symptoms of this cohort of patients, we found chronic cough to be the most common complaint. 12…”

Section: Discussionmentioning

confidence: 99%

Cost Analysis of a Multidisciplinary Aerodigestive Clinic: Are Such Clinics Financially Feasible?

Mudd

Silva

Callicott

et al. 2017

Ann Otol Rhinol Laryngol

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Is a Multidisciplinary Aerodigestive Clinic More Effective at Treating Recalcitrant Aerodigestive Complaints Than a Single Specialist?

Abstract: The ADC team approach resulted in resolved to markedly improved symptoms in 73% of patients whose symptoms persisted despite seeing a single specialist prior to referral.

Cited by 46 publications

References 39 publications

Multidisciplinary approach to paediatric aerodigestive disorders: A single‐centre longitudinal observational study

Multidisciplinary approach to paediatric aerodigestive disorders: A single‐centre longitudinal observational study

A multidisciplinary approach to the clinical management of Prader–Willi syndrome

Cost Analysis of a Multidisciplinary Aerodigestive Clinic: Are Such Clinics Financially Feasible?

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