Demanda de cuidado nutricional de crianças com transtorno do espectro autista em uma região de acesso remoto / Demandas de atención nutricional de niños con trastorno del espectro autista en una región de acceso remoto / Nutritional care demands of children with autism spectrum disorder in a remote access region

Introdução: O transtorno do espectro autista é uma condição neuropsiquiátrica que demanda atenção interdisciplinar e multiprofissional. A abordagem nutricional é necessária frente aos possíveis sintomas associados, como seletividade alimentar e alterações do hábito intestinal. Famílias residentes em locais de acesso limitado à serviços de saúde podem possuir dificuldades para o adequado acompanhamento. Objetivo: Relatar a experiência de atendimentos em nutrição realizados pela Liga Acadêmica de Nutrição e Saúde Coletiva a crianças com transtorno do espectro autista explorando as principais demandas identificadas e enfrentadas em uma região de acesso remoto. Metodologia: Abordagem descritiva, do tipo relato de experiência, de atendimentos realizados no município de Coari, interior do Amazonas. Os encontros foram realizados com vista a identificar demandas e refletir sobre a melhor maneira de auxiliar as crianças com essas comorbidades. Resultados: Foram atendidas 9 crianças, nem todas com o diagnóstico fechado. Seletividade alimentar, distúrbios gastrointestinais e excesso de peso foram desafios recorrentes. Nota-se a carência da percepção da importância do acompanhamento nutricional, em um cenário de relatos importantes sobre as dificuldades no acesso a medicações, por falta no município ou por ausência de recursos para aquisição, assim como terapias especializadas. Aspectos que se tornam ainda mais desafiadores frente à distância geográfica e carência de profissionais especializados e que realizem uma atenção multiprofissional. Conclusões: O acompanhamento nutricional adequado é essencial para atender às necessidades específicas e melhorar a qualidade de vida dessas crianças. Diante das limitações identificadas na região, são necessários esforços contínuos para desenvolver soluções que garantam uma assistência inclusiva e eficaz às crianças com transtorno do espectro autista no interior do Amazonas. A colaboração entre instituições, a conscientização da comunidade e o fortalecimento da rede de saúde local são cruciais para promover uma abordagem abrangente e de alta qualidade para essas crianças e suas famílias (AU).

Introduction: Autism spectrum disorder is a neuropsychiatric condition that demands interdisciplinary and multidisciplinary attention. Nutritional intervention is necessary in the face of possible associated symptoms, such as food selectivity and changes in bowel habits. Families living in places with limited access to health services may have difficulties in obtaining adequate support and follow-up.Objective: Reporting the experience of nutrition services provided by the Academic League of Nutrition and Public Health to children with autism spectrum disorder, exploring the main identified demands and challengesfaced in a remote access region. Methodology:Descriptive approach, experience of an report, of services provided in the municipality of Coari, in the interiorof Amazonas. The meetings were held with the aim identifying demands and reflecting on the best way to assistchildren with these comorbidities. Results: Ninechildren attended to, not all with a confirmed diagnosis. Food selectivity, gastrointestinal disorders and overweight were recurring challenges. There is a lack of perception of the importance of nutritional monitoring, in a scenario where there areimportant reportsofdifficulties in accessing medications, either due to lack of availability in the municipality or lack of resources for acquisition, as well as specialized therapies. Theseaspects become even more challenging given the geographical distance and scarcity of specialized professionals whocanprovide multidisciplinary care. Conclusions: Adequate nutritional monitoring is essential to meet the specific needs and improve the quality of life of these children. Given the limitations identified in the region, continuous efforts are needed to develop solutions that guarantee inclusive and effective assistance for children with autism spectrum disorder in the interior of Amazonas. Collaboration between institutions, community awareness, and strengthening the local health network are crucial to promoting a comprehensive, high-quality approach for these children and their families (AU).

Introducción: El trastorno del espectro autista es una condiciónneuropsiquiátrica que requiere atención interdisciplinaria y multidisciplinaria. El enfoque nutricionales frente a losposibles síntomas, como selectividad alimentaria y alteraciones delhábitosintestinales. Las familias que viven en lugares con accesolimitado a los servicios de salud pueden tener dificultades para recibir un seguimiento adecuado. Objetivo: Reportar la experiencia de los servicios de nutrición brindados por la Liga Académica de Nutrición y Salud Pública a niños con trastorno del espectro autista, explorando las principales demandas identificadas y enfrentadas en una región de acceso remoto.Metodología: Enfoque descriptivo, relato de experiencia, de los servicios prestados en Coari, en el interior de Amazonas. Los encuentros se realizaron con el objetivo de identificar demandas y reflexionar sobre la mejor manera de ayudar. Resultados:Se atendieron 9 niños, no todos con diagnóstico confirmado. Selectividad alimentaria, trastornos gastrointestinales y exceso de peso fueron desafíos recurrentes. Se observa una falta percepción de la importancia del seguimiento nutricional, en un escenario de informes importantes sobre las dificultades en el acceso a medicamentos, debido a lafaltade suministro en el municipio o a la falta de recursos para su adquisición, así como terapias especializadas. Estosaspectos que se vuelven aún más desafiantes dada la distancia geográfica y falta de profesionales especializados que brinden una atención multidisciplinaria.Conclusiones: Un adecuado seguimiento nutricional es fundamental para satisfacerlas necesidades específicas y mejorar la calidad de vida de estos niños. Antelas limitaciones identificadas, se necesitan esfuerzos continuos para desarrollar soluciones que garanticen una atención inclusiva y efectiva estosniños en el interior de Amazonas. Colaboración entre instituciones, concientización comunitaria y fortalecimiento de la red de salud local son cruciales para promover un enfoque integral y de alta calidad para estos niños com trastorno del espectro autista y sus familias (AU).

Expert Consensus on Clinical Diseases Responding Specifically to Traditional Chinese Medicine：Fibromyalgia Syndrome / 中国实验方剂学杂志

Fibromyalgia syndrome （FMS） is a refractory， chronic non-articular rheumatic disease characterized by widespread pain throughout the body， for which there are no satisfactory therapeutic drugs or options. There are rich Chinese medical therapies， and some non-drug therapies， such as acupuncture， Tai Chi， and Ba-Duan-Jin， have shown satisfactory efficacy and safety and definite advantages of simultaneously adjusting mind and body. FMS is taken as a disease responding specifically to traditional Chinese medicine （TCM） by the National Administration of Traditional Chinese Medicine in 2018. In order to clarify the research progress in FMS and the clinical advantages of TCM/integrated Chinese and Western medicine， the China Academy of Chinese Medicine organized a seminar for nearly 20 experts in Chinese and Western medicine， including rheumatology， psychology， acupuncture and moxibustion， and encephalopathy， with the topic of difficulties in clinical diagnosis and treatment of FMS and advantages of TCM and Western medicine. The recommendations were reached on the difficulties in early diagnosis and solutions of FMS， mitigation of common non-specific symptoms， preferential analgesic therapy， TCM pathogenesis and treatment advantages， and direction of treatment with integrated Chinese and Western medicine. FMS is currently facing the triple dilemma of low early correct diagnosis， poor patient participation， and unsatisfactory benefit from pure Western medicine treatment. To solve the above problems， this paper suggests that rheumatologists should serve as the main diagnostic force of this disease， and they should improve patient participation in treatment decision-making， implement exercise therapy， and fully utilize the holistic and multidimensional features of TCM， which is effective in alleviating pain， improving mood， and decreasing adverse events. In addition， it is suggested that FMS treatment should rely on both TCM and Western medicine and adopt multidisciplinary joint treatment， which is expected to improve the standard of diagnosis and treatment of FMS in China.

Research progress on the diagnosis and treatment of pediatric malocclusion combined with obstructive sleep apnea-hypopnea syndrome / 口腔疾病防治

@#Pediatric malocclusion is common in dentistry. Some children with malocclusion combined with obstructive sleep apnea-hypopnea syndrome (OSAHS) often fail to receive appropriate treatment due to a lack of multidisciplinary diagnosis and treatment. It can cause abnormal ventilation during sleep, affecting the central nervous system and cardiovascular development and even causing neurological and behavioral problems. Pediatric OSAHS is caused by the narrowing of the upper respiratory tract, characterized by specific facial bone characteristics and neuromuscular factors and correlated with malocclusion. Due to its diverse clinical manifestations and etiology, the diagnosis and treatment of pediatric OSAHS require an interdisciplinary, personalized, and specialized approach. Questionnaires and physical examinations can be used for preliminary screening. Moreover, children's stomatology and otorhinolaryngology examinations are the basis for disease diagnosis. Polysomnography (PSG) is currently the direct diagnostic method. There are various treatment methods for OSAHS in children, and for OSAHS caused by adenoid tonsil hypertrophy, adenoidectomy and tonsillectomy are the main treatments. Othodontic treatment including mandibular advancement and rapid maxillary expansion et al is also effective for OSAHS in children with malocclusion. Currently, there is limited research on the correlation between childhood malocclusion and OSAHS, and multidisciplinary combination therapy may improve the cure rate, but there is a lack of sufficient evidence. In the future, the pathogenesis of OSAHS should be further elucidated, and research on multidisciplinary combination therapy should be promoted to achieve early intervention and treatment for potential and existing patients.

Application status of risk assessment models for periodontal disease / 口腔疾病防治

@#Risk assessment models for periodontal disease provide dentists with a precise and consolidated evaluation of the prognosis of periodontitis, enabling the formulation of personalized treatment plans. Periodontal risk assessment systems have been widely applied in clinical practice and research. The application fields of periodontal risk assessment systems vary based on the distinctions between clinical periodontal parameters and risk factors. The assessment models listed below are commonly used in clinical practice, including the periodontal risk calculator (PRC), which is an individual-based periodontal risk assessment tool that collects both periodontal and systemic information for prediction; the periodontal assessment tool (PAT), which allows for quantitative differentiation of stages of periodontal disease; the periodontal risk assessment (PRA) and modified periodontal risk assessment (mPRA), which are easy to use; and the classification and regression trees (CART), which assess the periodontal prognosis based on a single affected tooth. Additionally, there are orthodontic-periodontal combined risk assessment systems and implant periapical risk assessment systems tailored for patients needing multidisciplinary treatment. This review focuses on the current application status of periodontal risk assessment systems.

Application of multidisciplinary in situ simulation training in the treatment of acute ischemic stroke: a quality improvement project / 世界急诊医学杂志（英文）

@#BACKGROUND: Ischemic stroke refers to a disorder in the blood supply to a local area of brain tissue for various reasons and is characterized by high morbidity, mortality, and disability. Early reperfusion of brain tissue at risk of injury is crucial for the treatment of acute ischemic stroke. The purpose of this study was to evaluate comfort levels in managing acute stroke patients with hypoxemia who required endotracheal intubation after multidisciplinary in situ simulation training and to shorten the door-to-image time. METHODS: This quality improvement project utilized a comprehensive multidisciplinary in situ simulation exercise. A total of 53 participants completed the two-day in situ simulation training. The main outcome was the self-reported comfort levels of participants in managing acute stroke patients with hypoxemia requiring endotracheal intubation before and after simulation training. A 5-point Likert scale was used to measure participant comfort. A paired-sample t-test was used to compare the mean self-reported comfort scores of participants, as well as the endotracheal intubation time and door-to-image time on the first and second days of in situ simulation training. The door-to-image time before and after the training was also recorded. RESULTS: The findings indicated that in situ simulation training could enhance participant comfort when managing acute stroke patients with hypoxemia who required endotracheal intubation and shorten door-to-image time. For the emergency management of hypoxemia or tracheal intubation, the mean post-training self-reported comfort score was significantly higher than the mean pre-training comfort score (hypoxemia: 4.53±0.64 vs. 3.62±0.69, t= -11.046, P<0.001; tracheal intubation: 3.98±0.72 vs. 3.43±0.72, t= -6.940, P<0.001). We also observed a decrease in the tracheal intubation and door-to-image time and a decreasing trend in the door-to-image time, which continued after the training. CONCLUSION: Our study demonstrates that the implementation of in situ simulation training in a clinical environment with a multidisciplinary approach may improve the ability and confidence of stroke team members, optimize the first-aid process, and effectively shorten the door-to-image time of stroke patients with emergency complications.

Multidisciplinary treatment program for improvement in pain and disability associated with nonspecific chronic low back pain / Programa de tratamento multidisciplinar para melhora da dor e incapacidade associada a dor crônica lombar inespecífica

ABSTRACT BACKGROUND AND OBJECTIVES: Lumbar disorders, which contribute to significant workplace absenteeism and chronic disability, are associated with a considerable financial and social burden. Although a conservative approach provides satisfactory pain relief, biomechanical improvement and is associated with a low risk of adverse effects, there is lack of consensus in the literature regarding the best therapeutic strategy in such cases. METHODS: This retrospective longitudinal study used secondary data from the institutional medical records of patients who completed a multidisciplinary program for the treatment of low back pain between 2019 and 2021. Data regarding pain levels and motor skills were obtained from patients who completed the care program at a private hospital in Bento Gonçalves, RS. The following step-wise treatment algorithm was used: evaluation by a specialist physician for the etiological diagnosis of pain, pharmacological management and dry needling, followed by standard rehabilitation intervention performed by the physiotherapy team and exercises by the physical education team. The visual analogue scale (VAS) was used to measure pain at the start and at the completion of the intervention, and the Oswestry Disability Index (ODI) was used to measure motor skills at the start and at 6 and 12 months following the multiprofessional intervention for rehabilitation. RESULTS: A reduction in pain and motor disability in patients who completed all stages of the treatment program was observed. Pain by the VAS presented the following scores: baseline 7 [5-8] and after treatment 2 [0-4]; and the scores of the ODI were: at baseline 0.34 [0.26 - 0.40], at 6 months 0.16 [0.08 - 0.26] and after treatment 0.12 [0.04 - 0.21]. CONCLUSION: The treatment program reduced the pain and disability associated with low back pain and can serve as the basis for further studies carried out to confirm the effectiveness of this intervention.

RESUMO JUSTIFICATIVA E OBJETIVOS: As doenças lombares, que contribuem para um absenteísmo significativo no local de trabalho e para a incapacidade crônica, estão associadas a um encargo financeiro e social considerável. Embora a abordagem conservadora proporcione alívio satisfatório da dor, melhore a biomecânica e esteja associada a baixo risco de efeitos adversos, não há consenso na literatura sobre a melhor estratégia terapêutica nesses casos. MÉTODOS: Neste estudo longitudinal retrospectivo, foram utilizados dados secundários dos prontuários médicos institucionais de pacientes que completaram um programa multidisciplinar para tratamento de dor lombar entre 2019 e 2021. Dados sobre níveis de dor e habilidades motoras foram obtidos de pacientes que completaram o programa assistencial de um hospital privado de Bento Gonçalves, RS. Foi utilizado o seguinte tratamento passo a passo: avaliação por médico especialista para diagnóstico etiológico da dor, manejo farmacológico e agulhamento a seco, seguido de intervenção de reabilitação padrão realizada pela equipe de fisioterapia e exercícios pela equipe de educação física. A escala analógica visual (EAV) foi utilizada para medir a dor no início e após a conclusão da intervenção, e o Índice de Incapacidade de Oswestry (ODI) foi usado para medir as habilidades motoras no início e aos 6 e 12 meses após a intervenção multiprofissional para reabilitação. RESULTADOS: Observou-se redução na dor e na incapacidade motora em pacientes que completaram todas as etapas do programa de tratamento. A intensidade da dor medida pela EAV apresentou as seguintes pontuações: basal 7 [5-8] e após tratamento 2 [0-4]; enquanto o ODI apresentou as pontuações: basal 0,34 [0,26 - 0,40], até 6 meses 0,16 [0,08 - 0,26] e após o tratamento 0,12 [0,04 - 0,21]. CONCLUSÃO: O programa de tratamento reduziu a dor e a incapacidade associadas à dor lombar e pode servir de base para novos estudos realizados para confirmar a eficácia desta intervenção.

A mudança de paradigma no tratamento do tromboembolismo venoso grave / The paradigm shift in treatment of severe venous thromboembolism

Resumo A embolia pulmonar (EP) é a terceira maior causa de morte cardiovascular e a principal de morte evitável intra-hospitalar no mundo. O conceito PERT® (do inglês, pulmonary embolism response team) envolve seu diagnóstico e tratamento precoce e multidisciplinar. A trombose venosa profunda (TVP) é a sua causa inicial na maioria dos casos e é responsável por complicações como a recidiva tromboembólica, a síndrome pós-trombótica e a hipertensão pulmonar tromboembólica crônica. Uma abordagem inicial semelhante ao PERT nos casos de TVP ilíaco-femoral grave pode reduzir não apenas o risco imediato de EP e morte, mas também suas sequelas tardias. Novas técnicas percutâneas e aparatos de trombectomia mecânica para o tromboembolismo venoso (TEV) vêm demonstrando resultados clínicos encorajadores. Propomos o desenvolvimento de um conceito ampliado de resposta rápida ao TEV, que envolve não apenas a EP (PERT®) mas também os casos graves de TVP: o time de resposta rápida para o TEV (TRETEV®), ou do inglês Venous Thromboembolism Response Team (VTERT®).

Abstract Pulmonary embolism (PE) is the third leading cause of cardiovascular death and the main cause of preventable in-hospital death in the world. The PERT® (Pulmonary Embolism Response Team) concept involves multidisciplinary diagnosis and immediate treatment. Deep venous thrombosis (DVT) is the initial cause of most cases of PE and is responsible for complications such as chronic thromboembolic recurrence, postthrombotic syndrome, and chronic thromboembolic pulmonary hypertension. An aggressive approach to severe cases of iliofemoral DVT similar to the PERT® system can not only reduce the immediate risk of PE and death but can also reduce later sequelae. New percutaneous techniques and mechanical thrombectomy devices for venous thromboembolism (VTE) have shown encouraging clinical results. We propose the development of an expanded concept of rapid response to VTE, which involves not only PE (PERT®) but also severe cases of DVT: the Venous Thromboembolism Response Team (VTERT®).

Manejo multidisciplinario en un caso refractario de obstrucción intestinal maligna / Multidisciplinary management in a refractory case of malignant intestinal obstruction

Se denomina obstrucción intestinal maligna (OIM) a aquella alteración del tránsito intestinal por obstrucción mecánica o funcional, que genera alteración de la motilidad y acumulación de secreciones, causada por tumores malignos. Es una urgencia oncológica y paliativa de difícil manejo, esta entidad representa un reto para el equipo de salud, debido al gran impacto sobre la calidad de vida del paciente y su familia. Se presenta el caso de una paciente femenina de 73 años, con características clínicas de obstrucción intestinal maligna, evaluada inicialmente por oncología médica quienes diagnostican carcinoma seroso de alto grado de ovario y carcinomatosis peritoneal, se solicita manejo conjunto con un equipo multidisciplinario para tratar la obstrucción intestinal maligna refractaria a medicación convencional, donde se opta por sedación superficial intermitente; así mismo se aborda preferencias y cuidados de final de vida en domicilio con la paciente y su familia. Este caso es un ejemplo del manejo integral de casos refractarios a la obstrucción intestinal maligna, donde se logra aliviar el sufrimiento del paciente y su familia, cuando la cirugía no es una opción

Malignant intestinal obstruction (MIO) is defined as that alteration of intestinal transit due to mechanical or functional obstruction, which generates impaired motility and accumulation of secretions, caused by malignant tumors. It is an oncological and palliative emergency that is difficult to manage, this entity represents a challenge for the health team, due to the great impact on the quality of life of the patient and his family. The case of a 73-year-old female patient is presented, with clinical characteristics of malignant intestinal obstruction, initially evaluated by medical oncology who diagnosed high-grade serous ovarian carcinoma and peritoneal carcinomatosis, joint management with a multidisciplinary team is requested to treat malignant intestinal obstruction refractory to conventional medication, where intermittent superficial sedation is chosen; Likewise, preferences and end-of-life care at home are addressed with the patient and her family This case is an example of the comprehensive management of cases refractory to malignant intestinal obstruction, where it is possible to alleviate the suffering of the patient and her family, when surgery is not an option

Feridas complexas: abordagem por equipa multidisciplinar. Uma scoping review. / Complex wounds: approach by a multidisciplinary team. A scoping review

Objetivos: - reconhecer a importância da equipa multidisciplinar na abordagem à pessoa com ferida complexa na cicatrização de feridas; - mapear a evidência/conhecimento sobre a temática em estudo. Método: Scoping review realizada entre 04 de janeiro e 01 de fevereiro de 2020, nas bases de dados Repositório Científico de Acesso Aberto de Portugal (RCAAP), EBSCO host (CINAHL e Medline) e Web of Science, utilizando estratégias de pesquisa adaptadas a cada base de dados. Resultados e discussão: A evidência científica demonstra a importância das equipas multidisciplinares na abordagem à pessoa com ferida complexa. Conclusão: Tratando-se de um processo complexo, é fundamental ter em consideração todos os elementos que influenciam e atrasam a cicatrização, para se conseguir melhorar os resultados no tratamento e nos custos associados.(AU)

Objectives: - to recognize the importance of the multidisciplinary team in the approach to the person with a complex wound in wound healing; - to map the evidence/knowledge on the subject under study. Method: Scoping review carried out between January 4 and February 1, 2020, in the databases Repositório Científico de Acesso Aberto de Portugal (RCAAP), EBSCO host (CINAHL and Medline) and Web of Science, using search strategies adapted to each database. Results and discussion: The scientific evidence demonstrates the importance of multidisciplinary teams in dealing with people with complex wounds. Conclusion: As this is a complex process, it is essential to take into account all the elements that influence and delay healing, in order to improve treatment results and associated costs. (AU)

Objetivos: - reconocer la importancia del equipo multidisciplinar en el abordaje de la persona con herida compleja en la cicatrización de heridas; - mapear la evidencia/conocimiento sobre el tema objeto de estudio. Método: Revisión de alcance realizada entre el 04 de enero y el 01 de febrero de 2020, en las bases de datos Repositório Científico de Acesso Aberto de Portugal (RCAAP), EBSCO host (CINAHL y Medline) y Web of Science, utilizando estrategias de búsqueda adaptadas a cada base de datos. Resultados y discusión: La evidencia científica demuestra la importancia de los equipos multidisciplinares en el abordaje de las personas con heridas complejas. Conclusión: Al tratarse de un proceso complejo, es fundamental tener en cuenta todos los elementos que influyen y retrasan la cicatrización para mejorar los resultados del tratamiento y los costes asociados.(AU)

Placenta Accreta Spectrum Disorders - The Impact of the Creation of a Multidisciplinary Team on Maternal Outcomes in Portugal / Patologia do espectro do acretismo placentário - O impacto da criação de uma equipa multidisciplinar nos desfechos maternos em Portugal

Abstract Objective To describe a cohort of placenta accreta spectrum (PAS) cases from a tertiary care institution and compare the maternal outcomes before and after the creation of a multidisciplinary team (MDT). Methods Retrospective study using hospital databases. Identification of PAS cases with pathological confirmation between 2010 and 2021. Division in two groups: standard care (SC) group - 2010-2014; and MDT group - 2015-2021. Descriptive analysis of their characteristics and maternal outcomes. Results During the study period, there were 53 cases of PAS (24 - SC group; 29 - MDT group). Standard care group: 1 placenta increta and 3 percreta; 12.5% (3/24) had antenatal suspicion; 4 cases had a peripartum hysterectomy - one planned due to antenatal suspicion of PAS; 3 due to postpartum hemorrhage. Mean estimated blood loss (EBL) was 2,469 mL; transfusion of packed red blood cells (PRBC) in 25% (6/24) - median 7.5 units. Multidisciplinary team group: 4 cases of placenta increta and 3 percreta. The rate of antenatal suspicion was 24.1% (7/29); 9 hysterectomies were performed, 7 planned due to antenatal suspicion of PAS, 1 after intrapartum diagnosis of PAS and 1 after uterine rupture following a second trimester termination of pregnancy. The mean EBL was 1,250 mL, with transfusion of PRBC in 37.9% (11/29) - median 2 units. Conclusion After the creation of the MDT, there was a reduction in the mean EBL and in the median number of PRBC units transfused, despite the higher number of invasive PAS disorders.

Resumo Objetivo Descrever uma coorte de casos do espectro do acretismo placentário (PAS) de uma instituição terciária e comparar os resultados maternos antes e depois da criação de uma equipa multidisciplinar (MDT). Métodos Estudo retrospectivo utilizando bancos de dados hospitalares. Identificação de casos de PAS com confirmação patológica entre 2010 e 2021. Divisão em dois grupos: grupo Standard Care (SC) - 2010-2014; e grupo MDT - 2015-2021. Análise descritiva de suas características e desfechos maternos. Resultados Durante o período do estudo, houve 53 casos de PAS (24 - grupo SC; 29 - grupo MDT). Grupo Standard Care: 1 placenta increta e 3 percretas; 12,5% (3/24) tiveram suspeita anteparto; 4 casos tiveram histerectomia periparto - uma eletiva devido à suspeita anteparto de PAS; 3 devido a hemorragia pós-parto. A média de perda hemática estimada (EBL) foi de 2.469 mL; transfusão de concentrado eritrocitário (PRBC) em 25% (6/24) - mediana 7,5 unidades. Equipa multidisciplinar: 4 casos de placenta increta e 3 percretas. A taxa de suspeita anteparto foi de 24,1% (7/29); foram realizadas 9 histerectomias, 7 eletivas por suspeita anteparto de PAS, 1 após diagnóstico intraparto de PAS e 1 após rotura uterina após interrupção da gravidez no segundo trimestre. A EBL média foi de 1.250 mL, com transfusão de PRBC em 37,9% (11/29) - mediana de 2 unidades. Conclusão Após a criação da MDT, houve redução na média de EBL e na mediana do número de unidades de PRBC transfundidas, apesar do maior número de PAS invasivos.

Analysis of the impact of a diabetes education program on glycemic control and prevalence of chronic complications

ABSTRACT Objective: Diabetes mellitus (DM) is a chronic disease of increasing importance in public health, associated with chronic complications including retinopathy, neuropathy, and kidney, cardiovascular and cerebrovascular disease. This study assessed the impact of strategic DM education actions on glycemic control and prevalence of chronic complications in patients with DM. Subjects and methods: Retrospective, quantitative, cohort study at a diabetes patients association comprised of a multidisciplinary team. In all, 533 individuals with DM were included. Sociodemographic and clinical data were collected using questionnaire and medical records. Of these, 333 patients evaluated for 12 to 24 months, with type 2 DM (T2DM, n = 317) and other types of DM (n = 16), were selected to collect data on retinopathy and diabetes kidney disease (DKD). Results: There was a predominance of elderly individuals, low education level, women, high rate of overweight and obesity, physical inactivity, dietary errors, dyslipidemia, and T2DM. More patients with T2DM versus type 1 DM had optimal glycemic control (46.3% vs. 12.2%, respectively; p < 0.001). The impact of the educational processes was demonstrated by the analysis of the initial and final glycated hemoglobin (HBA1c) levels. There was an increased prevalence of individuals with well-controlled DM during follow-up (prevalence ratio [PR] 2.76, 95%, p = 0.001), along with a significant reduction in retinopathy (PR: 0.679, p = 0.001) and albuminuria (PR: 0.637, 95%, p = 0.002) when these variables were evaluated in well-controlled versus uncontrolled HbA1c groups. Conclusions: A multidisciplinary approach with integration and quality was associated with improvements in DM control and reduced occurrence of chronic DM complications.

ARDS with septic shock managed successfully using a multidisciplinary approach: A case report

Acute respiratory distress syndrome (ARDS) is an inflammatory process in the lungs that results in hypoxemia and decreased lung compliance. Invasive mechanical ventilation and prone positioning have proven benefits in the management of patients with severe ARDS. Post-extubation rehabilitation programs are equally important for the recovery of these patients. We are reporting the case of a 30-year-old male with severe ARDS where lung protective ventilation, timely intubation, early prone positioning, multidisciplinary communication, and post-discharge follow-up with teleconsultation were used under expert supervision in the successful management of the case

Rol del protesista en el equipo multidisciplinario para el manejo del paciente con cáncer de cabeza y cuello

La denominación de carcinomas de cabeza y cuello o tracto aerodigestivo superior, supone un agrupamiento de neoplasias que comparten elementos comunes como etiología, epidemiología, histología, evolución clínica, procedimientos diagnósticos, enfoques terapéuticos y medidas de seguimiento. El objetivo del presente trabajo es identificar la evidencia científica respecto al tratamiento multidisciplinario del paciente con cáncer de cabeza y cuello y el rol que desempeña el protesista. Para ello, se realizó una búsqueda de literatura disponible en las bases de datos electrónicas PubMed, Medline, Cochrane, Hinari y SciELO. Se encontró que el tratamiento de estas lesiones malignas requiere de un equipo conformado por diferentes especialistas, como otorrinolaringólogo, cirujano de cabeza y cuello, cirujano maxilofacial, odontólogo oncológico, protesista, psiquiatra y psicólogo, nutricionista y rehabilitador, para optimizar el tratamiento de estos pacientes mediante la decisión colectiva.

The designation of carcinomas of head and neck or high aero-digestive tract, supposes a grouping of neoplasia that share common elements like etiology, epidemiology, histology, clinical evolution, diagnostic procedures, therapeutic approaches and follow-up measures. The aim of this paper is to identify the scientific evidence regarding the multidisciplinary treatment of the patient with cancer of head and neck and the role played by the prosthodontist. To this end a literature search was conducted in the electronic databases PubMed, Medline, Cochrane, Hinari and SciELO. It was found that the treatment of these malignant lesions requires a team consisting of different specialists, such as otolaryngologist, head and neck surgeon, maxillofacial surgeon, oncologic dentist, prosthodontist, psychiatrist and psychologist, nutritionist and rehabilitator, to optimize the treatment of these patients through a collective decision.

Interpretation of Expert Consensus on Diagnosis and Treatment of Cutaneous Basal Cell Carcinoma (2021) by A Multidisciplinary Team / 肿瘤防治研究

Basal cell carcinoma (BCC) is the most common malignant tumor in dermatology with incidence rising rapidly. Expert consensus on diagnosis and treatment of cutaneous basal cell carcinoma (2021) was published in September 2021 by Skin Tumor Research Center, Chinese Society of Dermatology and Subcommittee on Skin Tumor, China Dermatologist Association. This consensus comprehensively describes the epidemiology, pathogenesis, clinical manifestations, auxiliary examination, pathology, pretreatment assessment, treatment, prognosis, and follow-up education. It offers an important guideline for promoting the standardized diagnosis and treatment of skin BCC in China. In this work, multidisciplinary experts interpreted the main contents of the consensus, including clinicopathological findings, pretreatment assessment, and treatment advance.

Progress on Multi-disciplinary Combined Therapy for Locally Advanced Hypopharyngeal Carcinoma / 肿瘤防治研究

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.

The Position of Oriental Medicine in COVID-19 / 全日本鍼灸学会雑誌

The number of patients with novel coronavirus infections (COVID-19) continues to increase with Omicron now the predominant strain, even amidst the three-dense (close-in, dense, and close-out) avoidance and vaccination strategies. In collaboration with the local government, Tohoku University Hospital has provided a large-scale vaccination center, drive-through outpatient PCR testing clinic, outpatient assessment, support for management of residential care facilities for the mildly ill, support for elderly care facilities, and an antibody cocktail center, to minimize deaths due to COVID-19. In residential care facilities for the mildly ill and others in need of medical support, we established an information sharing and house call system. Furthermore, we developed DX in cooperation with a wide-area IT system and have so far continued to achieve zero fatalities in residential care facilities. In addition, the Japanese Society for Oriental Medicine has conducted clinical research using Kampo medicine for the prevention of disease onset, treatment in the acute stage, and treatment of prolonged symptoms, with results suggesting that Kampo medicine has some effect in reducing disease severity in the acute stage. The COVID-19 response is a long-term effort to update the knowledge and techniques in Western, traditional, and Future Medicine. The response and updating of combined knowledge and skills will continue over the longterm. It is also necessary to continue to disseminate and share information among various professions, and give back information in the field and make steady and continuous efforts among multiple professions.

Thinking and Practice of Skilled Home Health Care Nurses to Determine Necessity of Multidisciplinary Collaboration for Users with Complex Issues / 日本プライマリ・ケア連合学会誌

Introduction: The purpose of this study was to identify the thinking and practice of skilled home health care nurses to determine the necessity of multidisciplinary collaboration for users with complex issues.Methods: Semi-structured interviews were conducted with 7 home health care nurses who met the following criteria: years of home health care nursing experience, affiliation, etc. Data on the thoughts and practices of the home-visit nurses were extracted from the interview records and analyzed qualitatively.Results: Seven categories were extracted as thoughts of skilled home health care nurses when judging the need for multidisciplinary collaboration to support users with complex issues, such as: "intending to foster a common understanding among related organizations and professions". Eight categories were extracted for practices of related organizations and professions, such as: "Establish a system appropriate for the conditions of the user and his/her family", and 4 categories were extracted regarding practices for users and their families, such as: "Involvement to reduce the burden of caregiving on the family".Conclusion: The study revealed that skilled home health care nurses promote multidisciplinary collaboration by utilizing various means while emphasizing a common understanding with related organizations and professionals. In collaboration with other professions, it was necessary to utilize the expertise of nursing professionals for assessment and management.

Multidisciplinary experts consensus on diagnosis and treatment of precancerous lesions of hepatocellular carcinoma (2023 version) / 中华肝脏病杂志

According to the latest statistical data, the incidence and mortality rate of hepatocellular carcinoma in China are still on the rise, posing a major threat to the health of the Chinese population. The occurrence is closely related to the formation of precancerous lesions in the liver. The clinical and basic research on precancerous lesions of hepatocellular carcinoma has developed rapidly, and the concepts and specific techniques for diagnosis and treatment have also undergone new changes and advancements. Therefore, based on the first version in 2020, this consensus has organized multidisciplinary experts to compile and improve a new version by integrating the latest progress in their respective professional fields at home and abroad. It aims to enhance clinicians' understanding of precancerous lesions of hepatocellular carcinoma standardize the pathology, imaging, and molecular diagnostic criteria, broaden early screening methods, formulate scientifically rational treatment plans, and help promote the advancement of diagnosis and treatment strategies and to enhance the overall 5-year survival rate of patients with hepatocellular carcinoma.

Commentary on relevant issues in surgical treatment of spinal metastatic tumors / 中国骨伤

The multidisciplinary treatment model led by surgery has become a comprehensive strategy and overall concept for the treatment of spinal metastatic tumors. But the surgical treatment of spinal metastatic tumors is different from primary malignant tumors of the spine. Surgery is only a part of the multidisciplinary comprehensive treatment. Therefore, the following aspects need to be evaluated comprehensively based on the survival assessment, evaluation of spinal stability damage, nerve dysfunction, and oncological characteristics of the metastatic tumors with a reasonable surgical intervention. The attention should be paid to the minimally invasive treatment of spinal metastases, progress of new radiotherapy technology, neoadjuvant chemotherapy, targeted drug therapy and other medical treatment to make a comprehensive and individualization decision which is benefit to relieve patients ' pain, reconstruct spinal stability and avoid paralysis. While improving patient survival, increasing local tumor control rate and possibly prolonging survival time, avoiding excessive surgery as much as possible.

Investigation of the mode of pharmacist participating in multi-disciplinary diagnosis and treatment and effect evaluation / 中国药房

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.