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 investige the effects of multidisciplinary perioperative nutrition management on nutrition and postoperative complications of patients with esophageal cancer.MethodsA total of 239 patients with esophageal cancer who received elective surgical treatment were included in the study. They were divided into a trial group (120 patients) and a control group (119 patients) according to the random number table method. There were 97 males and 23 females in the trial group with an average age of 63.78±9.13 years, and 94 males and 25 females in the control group with an average age of 64.12±7.91 years. The control group received routine diet management, and the trial group received multidisciplinary perioperative nutrition management. The differences of nutrition and postoperative complications between the two groups were compared.ResultsThe total protein and albumin levels on postoperative days 3 and 7 in the trial group were higher than those in the control group (P<0.05), patients' postoperative anal exhaust time was shorter than that in the control group (P<0.05), the incidence of postoperative gastrointestinal adverse reactions, lung infection, postoperative anastomotic fistula, hypoproteinemia on postoperative days 3 and 7 was lower than that in the control group (P<0.05), and hospitalization cost was lower than that in the control group (P<0.05).ConclusionMultidisciplinary nutrition management can effectively improve the nutrition of patients, promote the rapid recovery of postoperative gastrointestinal function, reduce postoperative complications, and reduce hospitalization costs. It has high clinical reference and promotion value.
Objective To explore the clinical effect of multidisciplinary team (MDT) in elderly patients with hip fracture under the model of close-type medical alliance. Methods The elderly patients with hip fracture treated in the Department of Orthopedics of Deyang People’s Hospital between January 2015 and December 2020 were included retrospectively. According to different treatment modes, the patients were divided into traditional mode treatment group (traditional group) and MDT mode treatment group (MDT group). The waiting time for operation, hospitalization time after operation, total hospitalization time, total hospitalization cost, and death and loss of follow-up were analyzed. Results A total of 661 patients were enrolled, including 275 in the traditional group and 386 in the MDT group. There was no significant difference between the two groups in terms of gender, age, Charlson comorbidity index, types of fracture or surgical methods (P>0.05). The waiting time for operation [5.50 (3.50, 7.50) vs. 6.00 (4.00, 6.00) d; Z=−3.473, P=0.001], hospitalization time after operation [7.44 (6.27, 8.67) vs. 8.34 (6.72, 13.70) d; Z=−4.996, P<0.001] and total hospitalization time [12.95 (10.46, 16.30) vs. 15.49 (11.77, 19.91) d; Z=−5.718, P<0.001] in the MDT group were shorter than those in the traditional group. The total hospitalization cost of the MDT group was higher than that of the traditional group, but the difference was not statistically significant [39 300 (33 400, 46 400) vs. 38 000 (31 800, 44 000) Yuan; Z=1.524, P=0.128]. There was no significant difference in the lost follow-up rate between the traditional group and the MDT group (9.82% vs. 6.48%; χ2=2.474, P=0.116). Except in-hospital mortality and 30-day postoperative mortality (P>0.05), there was significant difference between the traditional group and the MDT group in 6-month (6.45% vs. 2.77%; χ2=4.875, P=0.027) and 1-year (11.29% vs. 6.37%; χ2=4.636, P=0.031) postoperative mortality. Conclusion Under the model of close-type medical alliance, MDT can reduce the waiting time for operation, hospitalization time after operation, total hospitalization time, as well as 6-month and 1-year postoperative mortality.
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.
Objective To develop a multidisciplinary nursing program for Prader-Willi syndrome with spinal deformity and evaluate its effectiveness in clinical practice. Methods In July 2016, a multidisciplinary collaborative team was established before the treatment of children with Prader-Willi syndrome complicated with spinal deformity. For the nursing difficulties in the perioperative period, relevant literature was consulted, and a multidisciplinary collaborative nursing plan was formulated, which included nutrition management and blood glucose control, management of obstructive sleep apnea hypopnea syndrome, behavioral intervention related to mental change, and early identification and management of complications. The developed multidisciplinary collaborative nursing program was applied to three children with Prader-Willi syndrome complicated with spinal deformity in Peking Union Medical College Hospital from July 2016 to October 2018, and their postoperative recovery was evaluated. Results One child had inguinal skin ulceration when admitted to hospital, which was significantly improved after active treatment. The perioperative blood glucose level control of the three children was satisfactory, and there was no postoperative gastrointestinal dysfunction, deep wound infection, respiratory complications, internal fixation failure or other complications, and no asphyxia, fall, loss, or other adverse events. The follow-up compliance after discharge was 100%. Conclusions Multidisciplinary collaboration programs can escort patient’ safety and promote their recovery, improve the professional level of nursing staff, and reflect the nursing value. As a working mode, it can be further popularized and used for reference in the nursing of other difficult diseases.
The diagnosis and treatment of gastric cancer is a systematic and frameworking medical task in a multidisciplinary manner. New models, new technologies, new regimens, and new drugs have been developed to explore the best strategies to improve the survival of patients with gastric cancer. Here we discussed the research progress and guideline updates in four aspects, including the accurate staging-classification-based treatment strategy, the quality control in the surgery, the rational perioperative neoadjuvant-adjuvant therapies, and molecular classification joint with precision medicine. The purpose is to further promote the standardized gastric cancer management in China and emphasize its importance. From the updates of knowledge and the transformation of understanding and recognition, to the quality improvement, it’s critical to reduce the heterogeneity of the quality of gastric cancer management in China, as well as enhance adherence to guidelines and consensuses.
Traditional Chinese medicine (TCM) is a treasure of the Chinese nation. Presence of clinical effects represents a fundamental issue for TCM development. Nevertheless, the complexities of TCM interventions often result in presented effects deviating from expected ones, a phenomenon so called as "effect off-target"; this issue has become a major challenge for the development and use of TCM interventions. In continuing efforts, we have proposed an innovative evidence-based medicine model for studying the effects of TCM interventions, termed "systems evidence-based medicine (sysEBM)". Essentially, the sysEBM model integrates clinical and non-clinical evaluation to develop a systematic pathway for studying effects of TCM interventions, and the methodological steps typically include the development of PICO framework for a putative effect, exploration of the effect and confirmation of the effect by using animal models, observational studies and clinical trials. As an additional step, multidisciplinary technologies including pharmaceutical, pharmacological, information and biological technologies will be used to provide multidimensional analyses of potential action networks and mechanisms of TCM interventions. Building on this concept, we have developed a sysEBM model ("6R" model) for acupuncture and marketed Chinese patent medicines by integrating real-world evidence, clinical trials, evidence syntheses, and rapid recommendation methodologies, as well as information technology and biomedical technologies. We also applied this model for developing TCM interventions for maternal health, critical care, and knee osteoarthritis.
Objective To explore the efficacy of multidisciplinary nutritional support model in the perioperative management of elderly patients with nutritional risks undergoing joint replacement. Methods Between March 1, 2014 and May 31, 2015, 342 elderly patients who underwent joint replacement due to osteoarthritis were screened with nutritional risk screening 2002 (NRS2002). For patients who got a NRS2002 score of equal to 3 points or higher, nutritional treatment and intervention was carried out by doctor-nurse-rehabilitation therapist-dietitian collaboration and hospital departments related to patients’ complications. Results Among all the 342 patients, 225 (65.79%) had a NRS2002 score of equal to 3 points or higher on the admission day, in which 117 (52.00%) were male and 108 (48.00%) were female, 168 (74.67%) were at the age between 60 and 70 years old and 57 (25.33%) were at the age between 71 and 87. One day before surgery, the number of patients with a NRS2002 score equal to 3 points or higher decreased to 10 (2.92%), and the number became 68 (19.88%) after surgery. The difference was statistically significant (P<0.05). In those 68 elderly patients, 10 had a preoperative NRS2002 score equal to 3 points or higher, and 58 had newly developed nutritional risks after surgery; there were 23 patients with an age over 75, and 7 over 80. The NRS2002 score of all the 342 patients was below 3 points before discharge. For patients with nutritional risks at different periods before and after surgery, their serum albumin and hemoglobin levels were both improved after the treatment of nutritional support (P<0.05). Conclusion Multidis- ciplinary nutritional support for elderly perioperative patients undergoing joint replacement can reduce the incidence of postoperative complications, providing favorable conditions for the patients to undergo joint replacement surgery.
ObjectiveTo explore the effect of early graded respiratory severe rehabilitation training for patients with mechanical ventilation under a multidisciplinary model.MethodsTwo hundred and thirty-six patients were surveyed, who were hospitalized in the intensive care unit of the First Affiliated Hospital of Anhui Medical University from June 3, 2019 to March 31, 2020. They were randomly divided into an observation group and a control group, with 118 patients in each group. The observation group received rehabilitation training using early graded rehabilitation training under the mode of multidisciplinary cooperation, while the control group received routine respiratory rehabilitation training. Diaphragmatic excursion (DE) and diaphragmatic thickening fraction (DTF) of the patients before ventilator weaning were measured by ultrasound. The differences of DE, DTF, peak expiratory flow (PEF), maximal inspiratory pressure (MIP), success rate of withdrawal, duration of mechanical ventilation and intensive care unit (ICU) stay between the two groups were recorded and compared.ResultsAll evaluation indexes were statistically significant between the observation group and the control group (all P<0.05). There were interaction between oxygenation index, PEF, MIP, Acute Physiology and Chronic Health Score, Clinical Pulmonary Infection Score and recovery time.ConclusionRehabilitation training on early graded severe respiratory diseases under a multidisciplinary model can improve the respiratory function of patients on mechanical ventilation and shorten the duration of mechanical ventilation and ICU stay.
With the increasing number of chronic kidney disease (CKD) population globally, establishing an optimal model of CKD care has become an important issue. The major contents of CKD care include patient education, control of CKD risk factors (such as increased blood pressure and glucose), management of CKD complications, and preparation process of renal replacement therapy in pre-dialysis patients. Compared with other non-communicable diseases management, evidence-based evidence related to CKD care is limited. Based on the related studies worldwide, combined with the characteristics of CKD population and previous experiences in China, this paper discusses the management mode of non-dialysis CKD population.