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Objective:To analyze the changes in service efficiency and cost structure before and after implementing multidisci-plinary treatment in the GD19(appendectomy with perforation,suppuration,gangrene,etc.)and GD29(appendectomy)groups of pedi-atric specialty medical institutions.Methods:The case data of GD19 and GD29 groups of medical insurance patients in sample hospi-tals in Beijing from 2021 to 2022 were collected.Mann Whitney U test was used to analyze the changes of medical expenses and effi-ciency indicators,and intermittent time series model was established to analyze the change trend.Results:Compared to 2021,the av-erage hospitalization expenses of GD19 group in 2022 decreased by 2 462.00 yuan year-on-year,and that of GD29 group decreased by 2 042.60 yuan year-on-year(P＜0.05).Among them,the cost of medicines,consumables,examinations and tests and treatment have all decreased.In the month when the management measures were implemented,the average consumption cost of GD19 group de-creased by 920.00 yuan(P＜0.05),and the average consumption cost of GD29 group decreased by 632.50 yuan.The average length of stay in GD29 group decreased from 3.74 days to 2.78 days(P＜0.05).Conclusion:After the implementation of management mea-sures,the cost of drug consumables in GD19 group and GD29 group was controlled,the cost level was reduced,and the operation effi-ciency was improved.It is suggested to adhere to the management measures of selection of key DRG groups and multidisciplinary con-sultation,mobilize the management enthusiasm of clinical departments,and strengthen the demonstration and optimization of pediatric DRG grouping and payment scheme.
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With the popularization of low-dose lung CT screening and the renewal of people's concept of physical examination, more and more pulmonary nodules are detected. This paper discusses some hot issues in the multidisciplinary diagnosis and treatment of pulmonary nodules from five perspectives: the concept and causes of pulmonary nodules, how to improve the diagnostic level of pulmonary nodules, the understanding of pulmonary nodules management in different specialties, the follow-up diagnosis of pulmonary nodules and the multidisciplinary diagnosis and treatment of pulmonary nodules.
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<b>Objective</b> To evaluate the effectiveness of multi-disciplinary team (MDT) mode in the prevention and control of multidrug resistant organism (MDRO) infection in lung transplant recipients. <b>Methods</b> Lung transplant recipients admitted to the hospital from 2019 to 2022 were enrolled. MDT expert group was established in January, 2020. A series of prevention and control measures were conducted. The implementation rate of MDRO prevention and control measures and the detection rate of MDRO on the environmental surface from 2020 to 2022, and the detection rate of MDRO in lung transplant recipients from 2019 to 2022 were analyzed. <b>Results</b> The overall implementation rate of MDRO prevention and control measures for medical staff was increased from 64.9% in 2020 to 91.6% in 2022, showing an increasing trend year by year (<i>P</i><0.05). The detection rate of MDRO on the environmental surface was decreased from 28% in 2020 to 9% in 2022, showing a downward trend year by year (<i>P</i><0.05). The detection rate of MDRO in lung transplant recipients was decreased from 66.7% in 2019 to 44.3% in 2022, showing a decreasing trend year by year (<i>P</i><0.001). <b>Conclusions</b> MDT mode management may enhance the implementation of MDRO prevention and control measures for medical staff, effectively reduce the infection rate of MDRO in lung transplant recipients and the detection rate of MDRO on the environmental surface, which is worthy of widespread application.
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Objective To summarize the experience of multi-disciplinary team(MDT)in the pediatric department of Qujing Maternal and Child Health Hospital,and to evaluate the effectiveness of MDT on neonatal brain injury.Methods The clinical data of children with brain injury and treated in the pediatrics department of Qujing Maternal and Child Health Hospital from November 2019 to April 2023 were collected.The children with brain injury and treated from October 2019 to June 2020 were regarded as the non-MDT group,and the children with brain injury and treated from July 2020 to April 2023 were regarded as the MDT group for comparative analysis.Chi-square test/t-test was used to compare and analyze the clinical data of the two groups.Results Among the 890 cases of pediatric brain injury,there were 519 males and 371 females.The median and quartiles of the age distribution for the two groups were as follows:MDT group 2.00(0.82,5.00)years and non-MDT group 1.00(1.00,4.00)years.Craniocerebral injury was the main type of brain injury in both groups,in addition,among children with craniocerebral injury and intracranial hemorrhage,the cure rate of MDT group was higher than that of non-MDT group,and the difference was statistically significant(P<0.05).Among the 405 children in MDT group,154(38.0%)underwent the surgery,while among the 485 children in non-MDT group,121(24.9%)underwent the surgery.The difference was statistically significant(P<0.05).23.2% of children in MDT group were in critical condition during the hospitalization,which was significantly lower than that in non-MDT group(30.5%),and the difference was statistically significant(P<0.05).The unhealed rate of MDT group(2.0%)was also significantly lower than that of non-MDT group(5.6%),the cure rate of MDT group(40.5%)was significantly higher than that of non-MDT group(34.4%),and there was a statistically significant difference(P<0.05).The expense of treatment,medicine and sanitary materials in MDT group were lower than those in non-MDT group,and the differences were statistically significant(P<0.05).The multivariate Logistic regression model analysis of the cure rate of children with brain injury showed that the MDT model could effectively improve the cure rate of children with brain injury(RR = 1.513,95% CI = 1.134-2.020).The results of multiple linear regression model analysis showed that there was no statistical difference in the effect of MDT on the actual hospitalization days of children(P>0.05).Conclusion Using MDT model to diagnose and treat children with brain injury is helpful to improve the cure rate,reduce the risk of children's disease aggravation,and achieve the significant therapeutic effects in children with brain injury.MDT model is worth popularizing and applying in children with brain injury.
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Primary hyperparathyroidism is a disease with a large potential population. Some cases of primary hyperparathyroidism are non-primary, preventable and curable at early stage, requiring long-term follow-up after surgery. Therefore, all-round and full-cycle management are necessary for primary hyperparathyroidism, which involves an enhancing focus on etiological prevention, early detection, prompt diagnosis, timely intervention, multi-disciplinary standardized diagnosis and treatment, and postoperative scientific management. Meanwhile, implementing a "12+5+1" multidisciplinary joint diagnosis and treatment model, along with a two-way referral model, to achieve the transition from a disease-oriented diagnostic and treatment model to a patient-oriented, all-round and full-cycle interdisciplinary management model. This management can reduce the incidence and recurrence rate of primary hyperparathyroidism, and related osteoporosis or osteopenia, fractures, nephrolithiasis, metastatic vascular calcification, and systemic abnormal migratory calcium deposits, improve the overall quality of life and prognosis of patients.
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Medical quality and safety are the foundation for the high-quality development of public hospitals.The concept of Multi-disciplinary Treatment(MDT)is of great value for functional departments of hospitals to collaborate in carrying out medi-cal quality management practices.Children's Hospital,Zhejiang University School of Medicine explored a new quality manage-ment model,constructed the MDT practice path for medical quality in administration,and formed a closed-loop management process where clinical departments actively initiate consultations,various administrative functional departments collaborate and in-teract in a two-way manner,accurately identify and solve clinical problems,and continuously track and feedback outcomes.After the inception of this path,the overall level of medical quality and safety in the hospital has been comprehensively improved,mainly manifested in the enhancement of quality control capabilities of clinical departments,optimization of core performance e-valuation indicators,and remarkable improvement in patient satisfaction,thereby holding profound significance for high-quality development of the hospital.
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The proper clinical application of antibiotics is of great significance to guarantee medical quality and safety.However,with the widespread clinical use,the phenomenon of non-standard use is becoming increasingly obvious,and the bacteri-al drug resistance caused by it has seriously jeopardized human health.Based on the performance appraisal in a Class A tertiary public hospitals,this paper analyzed the current clinical application of antibiotics in a cancer hospital,and suggested multi-discipli-nary cooperative management be adpoted and multi =measures be taken simultaneously to significantly improve proper drug use.
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Surgical treatment is the primary curative approach for hepatocellular carcinoma (HCC). In China, the proportion of advanced HCC is high, with a low rate of surgical removal at initial diagnosis and a high rate of postoperative recurrence, posing a serious threat to public health. With the advent of new therapeutic drugs and updated treatment concepts, the comprehensive treatment of HCC has entered a new era. Systemic treatments represented by targeted therapy and immuno-therapy, non-surgical local treatments such as interventional and radiotherapy, and the combination of systemic and local treatments, have significantly improved the treatment efficacy, bringing hope to patients. The authors review past studies, summarize diagnostic and treatment experience, and discuss the comprehensive treatment strategy for HCC in the era of targeted and immunotherapy, with surgery as the main approach.
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Due to long-term use of immunosuppressive agents, solid organ transplant recipients (SOTR) belong to high-risk populations of multiple pathogenic infection, including SARS-CoV-2. In addition, SOTR are constantly complicated by chronic diseases, such as hypertension and diabetes mellitus, etc. After infected with SARS-CoV-2, the critically ill rate and fatality of SOTR are higher than those of the general population, which captivates widespread attention from experts in the field of organ transplantation. Omicrone variant is currently the significant pandemic strain worldwide, rapidly spreading to more than 100 countries worldwide and causing broad concern. According to the latest international guidelines on the diagnosis and treatment of SARS-CoV-2 infection and relevant expert consensus in China combined with current domestic situation of SARS-CoV-2 pandemic and China's "diagnosis and treatment regimen for SARS-CoV-2 infection (Trial Version 10)", the epidemiology, clinical manifestations and prognosis, diagnosis, clinical classification and treatment of SARS-CoV-2 infection were briefly reviewed.
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Immune checkpoint inhibitors (ICIs)-based immunotherapy combined with other treatment for hepatocellular carcinoma (HCC) has achieved significant efficacy in clinical research and practice, and has become the most commonly used and mainstay therapy for the treatment of unresectable HCC. In order to help clinicians administrating immunotherapy drugs and regimens rationally, effectively and safely, we organized a multidisciplinary expert team to adopt the "Delphi" consensus formation method, and finally revised and completed the "Multidisciplinary Expert Consensus on Combination Therapy Based on the Immunotherapy for Hepatocellular Carcinoma (2023 Edition)" on the basis of the 2021 version. This consensus mainly focuses on the principles and methods of clinical application of combination therapy based on the Immunotherapy, aiming to summarize the recommendations for clinical application based on the latest research and expert experience, and provide application guidance for clinicians.
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Humans , Carcinoma, Hepatocellular/therapy , Consensus , Immunotherapy , Liver Neoplasms/therapyABSTRACT
@#Objective To analyze the clinical intervention effect of multi-disciplinary team (MDT) nursing mode on patients after transcatheter aortic valve implantation (TAVI). Methods A total of 89 patients who were admitted to our hospital and underwent TAVI surgery from April to December 2021 were selected, including 64 males and 25 females, with an average age of 64.7±11.8 years. The subjects were divided into a MDT intervention group (n=42) and a control group (n=47) according to different postoperative nursing intervention methods. Clinical effectivenesses were compared between the two groups. Results The left ventricular ejection fraction in the two groups significantly increased on the 7th day after the operation, and the increase in the MDT intervention group was more obvious, with no statistical difference between the two groups (P=0.14). On the 7th day after surgery, forced vital capacity/predicated value and forced expiratory volume in one second/predicated value significantly decreased, and decreased more significantly in the control group than those in the MDT intervention group with statistical differences (P=0.01). The ICU stay time (P=0.01), hospital stay time (P<0.01) and total postoperative pulmonary complications rate (P=0.03) in the MDT intervention group were significantly shorter or lower than those in the control group The evaluation results of the anxiety and depression status of the patients before and after nursing intervention showed that the scores of anxiety and depression in the two groups were significantly lower than before, and the scores of each scale in the MDT intervention group were lower. The score of quality of life of the two groups significantly improved at the end of 6 months after surgery, and in the MDT intervention group it was significantly higher than that in the control group (P=0.02). Conclusion MDT intervention mode can promote the rapid recovery of patients after TAVI, effectively reduce the risk of postoperative pulmonary complications, and improve the postoperative quality of life.
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OBJECTIVE To evaluate the mode of pharmacists’ participation in multi-disciplinary diagnosis and treatment （MDT）， as well as the effects of pharmacists’ participation. METHODS Retrieved from Cochrane Library， PubMed， Embase， CNKI， CBM and Wanfang database， experimental studies and observational studies on the effects of MDT with pharmacists on clinical outcomes of patients were collected. After data extraction and quality evaluation， the results of included studies were analyzed descriptively. RESULTS A total of 10 studies were included， among which 3 were randomized controlled trials （RCT）， 2 were non-RCT， 4 were cohort and 1 was case-control study； there were 2 422 patients in total. In terms of effectiveness， tumor progression-free survival， glycosylated hemoglobin， re-admission rate and length of stay and other indexes were all improved significantly after pharmacists participated in MDT. In terms of safety， the incidence of major bleeding events was significantly decreased after pharmacists participated in MDT. In terms of economy， hospitalization costs and total outpatient expenses were improved significantly after pharmacists participated in MDT， but medical cost was not improved significantly. In terms of humanistic outcomes， there was controversy over the conclusion of patient compliance after pharmacists participated in MDT. CONCLUSIONS Pharmacists， based on their own pharmaceutical care skills and methods， actively participate in MDT throughout the process， improving the clinical outcomes of patients and enhancing the safety of medication. There are still controversies regarding economic and humanistic outcomes.
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OBJECTIVE To make up the research gap of the concept of collaboration between clinical pharmacists and physicians in China， and to provide a theoretical basis for further improving the collaboration. METHODS Literature analysis was used to sort out the existing concepts of collaboration. Combined with the current practice and development trend of the collaboration between clinical pharmacists and physicians in China， the basic elements of the concept were deconstructed and the connotation of each component of the concept was explained in detail. RESULTS & CONCLUSIONS Based on the above theoretical research and practical analysis， the concept of collaboration between clinical pharmacists and physicians in the context of China was defined， that is， clinical pharmacists and physicians adhere to the patient-centered and rational drug use as the core in clinical drug therapy， and make joint decisions on drug management and drug therapy on the basis of communication， respect， trust and sharing， so as to ensure the effectiveness， safety and economy of clinical pharmaceutical care， and improve the coordination and cooperation process of comprehensive disease treatment system.
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Given the important position and function of the hypopharynx, the preservation of organ function and survival improvement are equally important. The optimal role of multi-disciplinary combined treatment modality becoming increasingly important. The optimal laryngeal preservation strategy for hypopharyngeal cancer is under continuous exploration. With the constant research of surgery, radiotherapy, chemotherapy, and molecular targeted therapy, new laryngeal preservation strategies continue to emerge. Herein, we primarily summarize the advances in multi-disciplinary combined treatment and the future direction in the treatment of hypopharyngeal carcinoma.
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The treatment strategy for colon cancer with liver metastasis has always been a great challenge for clinical surgeons.Single treatment method such as surgical resection or systemic chemotherapy can no longer meet the treatment needs of such patients.With the extensive development of the multi-disciplinary team(MDT)for colorectal cancer based on surgery,more and more patients with advanced colorectal cancer have obtained better treatment effects and survival benefits.A case of descending colon cancer with huge hepatic metastasis diagnosed and treated by a multi-disciplinary team was reported,aiming to provide reference for clinical practice.
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@#The Ehlers-Danlos syndromes (EDS) are a group of rare hereditary connective tissue disorders. EDS is clinically and genetically heterogeneous and usually involves multiple systems. EDS has 14 subtypes, the common features of which include joint hypermobility, skin hyperextensibility, tissue fragility, and etc. The clinical manifestations and their severity differ between the subtypes, involving recurrent joint dislocations, scoliosis, arterial aneurysm and dissection, organ rupture, and others. The complexity of the disease poses challenges to the diagnosis and management of EDS, together with the rareness of the disease. The development of clinical guidelines and implementation of coordinated multi-disciplinary team (MDT) approaches to the EDS is in priority in the world.Therefore, we formed the Multi-Disciplinary Working Group on the Ehlers-Danlos Syndromes in China. Based on GRADE methodology, the MDT group developed the Guidelines. The Group highly recommends a coordinated MDT approach to the diagnosis and management of EDS. The first drafted guidelines on EDS will facilitate the shortening of the diagnostic odyssey and meeting the unmet medical needs of the patients.
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Light chain amyloidosis (AL) is a kind of rare disease. The misfolding of the light chain of monoclonal immunoglobulin forms amyloid substances and deposit in different tissues and organs, resulting in organ dysfunction. The heart involvement is represented as light chain cardiac amyloidosis (AL-CA), leading to heart failure, arrhythmia, myocardial infarction, valvular and pericardial diseases. Cardiac involvement is crucial for the risk stratification and prognosis prediction of patients with AL. The median survival time of AL-CA patients is 24 months and only 6 months for the heart failure patients. In recent years, the prognosis of patients with AL-CA has been significantly improved, thanks to the advancement in diagnosis & treatment strategies of cardiac amyloidosis, the milestone in the breakthroughs in targeted therapy of AL, and the improvement of coordinated multidisciplinary treatment. This paper focuses on the cardiovascular involvement of AL and briefly illustrates the pathogenesis, clinical manifestations, and the diagnosis and treatment of AL-CA.
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Objective To investigate the safety and efficiency of multiple-discipline cooperated diagnosis and treatment on esophageal foreign body and to discover the risk factors of patients who need surgical treatment compared with medical treatment.Methods The information of 108 patients who was diagnosed with esophageal foreign body from January 2014 to June 2021 and accepted multiple-discipline cooperated diagnosis and treatment consisted of cardiothoracic surgery department,digestive system department,emergency department,imaging department and anesthesiology department was collected.Then,we compared the difference of clinic time,foreign body type,endoscopic findings,position of incarnation,complications,postoperative hospital stay between surgical treatment and medical treatment.Results Patients in medical treatment were older than surgical treatment[(59.21±13.12)years VS.(52.65±12.66)years,P＜0.05].Clinic time shew a skewed distribution,clinic time was longer in surgical treatment compared with medical treatment by rank sum test(P＜0.05).There were statistical differences in foreign body type,esophageal injury and complications between the two groups(P＜0.05).The white blood cell count of endoscopic treatment group and surgical treatment group was(7.89±3.08)× 109/L and(11.69±6.98)× 109/L,respectively(P＜0.05),neutrophil counts were(6.16±2.96)× 109/L and(9.97±6.97)× 109/L,respectively(P＜0.05),proportion of neutrophils were(76.11± 8.75)％ and(81.52±12.52)％,respectively(P＜0.05),and C-reactive protein level were(43.26± 56.87)mg/L and(111.37±102.86)mg/L,respectively(P＜0.05).Conclusion Multiple-discipline cooperated diagnosis and treatment is safe,rapid and effective in the diagnosis and treatment of esophageal foreign bodies.Patients with longer clinic time,higher white blood cell counts,higher neutrophil counts,higher proportion of neutrophils,and higher C-reactive protein level were more likely to require surgical treatment.
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In order to give full play to the important role of multi-disciplinary treatment (MDT) in oncology teaching in talent training and discipline development, an oncology teaching and research section has been established, the textbook Clinical Oncology has been compiled, excellent teaching workers in affiliated hospitals have been selected to form an MDT teaching team, and a multi-tutorial system has been established for the discipline related to specific tumor types. The multi-tutorial system of disciplines combines lecture-based learning (LBL) with case-based learning (CBL) and problem-based learning (PBL). Students are arranged to observe and participate in clinical MDT consultation during the inter-class practice, and compared with the traditional assessment form, MDT case discussion questions, review writing, classroom simulation of the MDT process and real participation in clinical MDT discussions are added. The questionnaire for students who participated in MDT teaching showed that more than 93% of the students believed that the MDT teaching model was helpful for systematically mastering the knowledge of the chapters they had learned and understanding the cutting-edge progress, improving learning initiative, thinking and problem-solving ability, clinical comprehensive analysis ability and teamwork spirit. The majority of students' expression skills [89%(169/190)] and literature review skills [79%(150/190)] were improved; 94%(178/190) of students expressed their willingness to accept this teaching method. The teaching practice experience of the Department of Oncology of Jilin University based on the MDT model helps to improve the teaching level of oncology.
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Objective:To evaluate the teaching effect of multi-disciplinary integrated training program on the open comprehensive training room to improve the post competency of medical imaging students.Methods:A total of 122 residential students of five-year medical imaging from Batch 2014 of The First Affiliated Hospital of Chengdu Medical College were divided into experimental group and control group. The experimental group carried out the multi-disciplinary open comprehensive training program, and the control group carried out open-ended exercises. The comprehensive discipline theory examination, assessment of clinical thinking and comprehensive skill appraisal, and satisfaction questionnaire results were compared between the two groups. SPSS 23.0 was used for t test. Results:①Comprehensive discipline theory examination scores were higher in experimental group than the control group [(80.33±3.70) vs. (74.56±5.09)], with statistical differences ( P<0.05). ②Experimental group scored higher in clinical thinking and comprehensive skills than the control group did, and the difference was statistically significant [(87.58±3.15) vs. (74.52±3.66), P<0.05]. ③The questionnaire investigation showed that the experimental group students did better in improving autonomous learning ability, expression ability, the team cooperation ability, the ability to find and fix problems and the degree of self-esteem than control group, with statistically significant differences ( P<0.05). Conclusion:The multi-disciplinary open comprehensive training program has a good effect on optimizing the open-ended exercises. Students' knowledge of multi-disciplinary comprehensive theoretical knowledge and imaging skills have been improved, and the ability of teamwork, problem-solving ability, self-learning ability and innovation ability required by the core competence of the profession have been developed and improved, which meets the modern medical treatment of education "to create an educational platform of medical education collaboration and multi-disciplinary integration, and to cultivate students' innovative and autonomous learning."