The concept of enhanced recovery after surgery(ERAS) has been well accepted by medical providers, which can be realized by a multidisciplinary team approach and minimally invasive surgical technology performed during perioperative periods. As the outcomes of the ERAS protocols, well effects are anticipated, and consistent outcomes are actually obtained. At the same time, there are some aspects which are not consistent including ① the evolution and challenge of ERAS concept:connotation and extension, ② consensus and arguments on the evaluation standard of ERAS protocol, ③ the cause of poorly compliance in medical providers and patient, ④ the function of multimodal programme and multidisciplinary team approach in ERAS protocol, which one is better? ⑤ methods and barriers of implementing enhanced recovery in clinic application.
Transcatheter aortic valve replacement (TAVR) has been a crucial treatment for elder patients with aortic stenosis in developed countries, which is still at its beginning in China. TAVR is a risky and complicated technic; and to promise the long-term development of it, we need to build a multiple disciplinary heart team consisted of doctors from different specialties and guided by various disciplines, also to guarantee the team operates well. In order to help Chinese doctors understand heart team well, this article describes component parts and requirement for each member of the team, in aspect of cardiologist, cardiac surgeon, echocardiologist, radiologist, anesthesiologist and nursing team; and discuss team operation mechanism through pre-procedural evaluation, procedural cooperation, peri-procedural management and post-procedural follow-up.
ObjectiveTo explore the application effect of standardized management on video-electroencephalogram (VEEG) monitoring.MethodsIn January 2018, a multidisciplinary standardized management team composed with doctors, technicians, and nurses was established. The standardized management plan for VEEG monitoring from outpatient, pre-hospital appointment, hospitalization and post-discharge follow-up was developed; the special quilt for epilepsy patients was designed and customized, braided for the patient instead of shaving head, standardized the work flow of the staff, standardized the health education of the patients and their families, and standardized the quality control of the implementation process. The standardized managemen effect carried out from January to December 2018 (after standardized managemen) was compared with the management effect from January to December 2017 (before standardized managemen).ResultsAfter standardized management, the average waiting time of patients decreased from (2.08±1.13) hours to (0.53±0.21) hours, and the average hospitalization days decreased from (6.63±2.54) days to (6.14±2.17) days. The pass rate of patient preparation increased from 63.14% to 90.09%. The capture rate of seizure onset increased from 73.37% to 97.08%. The accuracy of the record increased from 33.12% to 94.10%, the doctor’s satisfaction increased from 76.34±29.53 to 97.99±9.27, and the patient’s satisfaction increased from 90.04±18.97 to 99.03±6.51. The difference was statistically significant (P<0.05).ConclusionStandardization management is conducive to ensuring the homogeneity of clinical medical care, reducing the average waiting time and the average hospitalization days, improving the capture rate and accuracy of seizures, ensuring the quality of medical care and improving patient’s satisfaction.
The deep integration of modern technology and medical development promotes the change of medical and health management environment. As an important part of hospital medical and health decision-making process, the evaluation and access of medical equipment and consumables need scientific evidence-based evaluation system. This paper introduces a new-equipment evaluation model created by the multi-disciplinary evaluation team of West China Hospital of Sichuan University under the guidance of evidence-based ideas and methods. This model is suitable for the Chinese national conditions and easy to operate.
ObjectiveTo investigate the effectiveness of multidisciplinary doctor-nurse collaboration team on the perioperation management of geriatric patients with hip fractures.MethodsThe clinical data of 489 geriatric patients with hip fractures (femoral neck fracture and intertrochanteric fracture) between January 1st 2016 and January 1st 2018 was retrospectively analyzed. Among them, 279 patients were treated with the multidisciplinary doctor-nurse collaboration care (observation group) and 210 patients were treated with the conventional therapeutics and nursing care (control group). There was no significant difference in gender, age, cause of injury, type and classification of fracture, the interval between injury and admission, and Charlson index between the two groups (P>0.05). The surgery rates, time from hospitalization to operation, length of stay, and the incidences of perioperative complications were compared between the two groups.ResultsThe surgery rate was 90.32% (252/279) in observation group and 80.48% (169/210) in control group, showing significant difference between the two groups (χ2=9.703, P=0.002). The time from hospitalization to operation and length of stay in observation group [(5.39±2.47), (10.56±3.76) days] were significant shorter than those in control group [(6.13±2.79), (12.27±3.11) days] (t=−3.075, P=0.002; t=−5.330, P=0.000). The incidence of respiratory complications was 46.15% in control group and 30.56% in observation group; the incidence of cardiovascular system complications was 69.23% in control group and 51.19% in observation group; the incidence of cerebrovascular system complications was 20.12% in control group and 11.11% in observation group; the incidence of deep venous thrombosis was 40.24% in control group and 25.40% in observation group. The incidences of perioperative complications were significantly lower in observation group than in control group (P<0.05).ConclusionMultidisciplinary doctor-nurse collaboration team is conducive not only to improve the surgery rates, but also to reduce perioperative complications as well as shorten the length of stay and preoperative waiting time.
ObjectiveTo summarize the experience of diagnosis and treatment of 2 cases of intrathyroid thymic carcinoma(ITTC).MethodThe clinical data of 2 patients with ITTC treated in West China Hospital of Sichuan University since July 2019 were analyzed retrospectively.ResultsAfter the discussion of the multidisciplinary team (MDT), the diagnosis and treatment of 2 cases of ITTC were discussed together, and the prognosis of the patients was actively improved through multidisciplinary cooperation.ConclusionMDT cooperative therapy mode should be adopted in the clinical diagnosis and treatment of patients with ITTC in order to provide a better treatment plan.
In recent years, with the improvement of CT resolution, the reduction of radiation dose, the popularization of lung cancer screening and the enhancement of people's health awareness, the detection rate of lung nodules is higher and higher. Due to the close relationship between lung nodules and lung cancer, more and more attention has been paid to them. Although patients with early and middle stage lung cancer receive complete resection, all postoperative patients are at risk of recurrence and metastasis. Adjuvant or neoadjuvant therapy can improve the survival and reduce the recurrence and metastasis. Therefore, the multidisciplinary team, as the best model, provides a standardized and individualized plan for the diagnosis and treatment of lung nodules and lung cancer patients. However, in the clinical practice, the work efficiency of the multidisciplinary team is not high, and the participation rate of patients is low; therefore the multidisciplinary doctor model with thoracic surgeons as the mainstay is a reasonable alternative.
Tracheotomy is a commonly used measure in clinical rescue of critically ill patients, and it has an important impact on the survival outcome of patients. The time of extubation directly affects the recovery process of the patient. This article reviews the research progress of extubation management of tracheotomy patients at home and abroad, and mainly summarizes and elaborates from four aspects, including the role of the multidisciplinary team in tracheostomy management, where tracheostomy patients are extubated, conditions for extubation in tracheotomy patients, and wound care after extubation in tracheotomy patients. The purpose is to provide a reference for the selection of extubation timing and extubation management for patients with tracheotomy, to improve the success rate of extubation and improve the quality of life of patients.
Objective To investigate the value of multidisciplinary team (MDT) diagnosis and treatment model in the conversion therapy of liver cancer. Method The clinical data of a patient with high-risk giant liver cancer of the right liver who was admitted to People’s Hospital of Leshan in April 2019, and who was successfully conversion therapy and safely underwent hepatectomy after MDT discussion was retrospectively analyzed. Results A 62 years old male patient was admitted to our hospital with “abdominal distension for more than 1 month, and liver mass was found for 10 days”. The relevant auxiliary examinations were perfected. The patient was diagnosed as huge primary hepatocellular carcinoma in the right liver. One-stage surgical resection cannot be performed safely due to the huge tumor. After MDT discussion, transcatheter arterial chemoembolization (TACE) combined with sorafenib targeted therapy was decided to reduce the lesions, and two-stage surgical resection was performed safely after conversion therapy. After two cycles of TACE combined with sorafenib targeted drug therapy, MDT discussed the feasibility of safe surgical resection, and underwent fluorescence-guided laparoscopic right posterior lobectomy. The postoperative pathological examination revealed moderately differentiated hepatocellular carcinoma. The patient recovered and was discharged from the hospital one week later. Outpatient followed-up for 32 months showed no obvious abnormality. Conclusions MDT discussion can formulate a more individualized treatment plan, improve the conversion rate and resectable rate of advanced liver cancer, and has important value in the diagnosis and treatment of advanced liver cancer.
ObjectiveTo evaluate the role and value of multidisciplinary team (MDT) in the decision-making for the treatment of elderly patients with large hepatocellular carcinoma (HCC) with multiple organ dysfunction. MethodThe clinicopathologic data of an elderly patient with large HCC with multiple organ dysfunction admitted to Dongguan Hospital of Southern Medical University were analyzed retrospectively. ResultsThe patient was an 82 years old male patient with asthmatic bronchitis, long-term hormone use, severe pulmonary ventilation dysfunction, moderate pericardial effusion, hypertension, and poor liver function compensation. After MDT discussion including 10 departments and full communication with the patient and his families, the open hepatectomy for hepatic S5 and S4b and cholecystectomy were proposed to perform. The operation process was smooth, and the patient was discharged on the 15th day after the operation without any complications. After discharge, lenvatinib was taken and thymosin alpha for injection was injected. At present, the patient’s quality of life was better, and there was no tumor recurrence or metastasis. ConclusionsFor the elderly patients with large HCC with severe cardiopulmonary dysfunction, the risk of treatment is higher. By MDT mode, the optimum treatment scheme for patient could be formulated to ensure efficient and accurate diagnosis and ensure high-quality treatment process, so as to maximally benefit patient.