The outpatient multi-disciplinary team (MDT) model is an important measure to improve the quality of medical services and enhance patients’ medical experience. The Second Affiliated Hospital of Zhejiang University School of Medicine has explored three types of outpatient MDT models, namely specialized disease model, self-service model, and professor team model, in order to improve the accessibility and coverage of outpatient MDT. Through practice, it has been found that the implementation of multi-type outpatient MDT models can further leverage the advantages of MDT in society, hospitals, and patients. This article will share the experience of building multi-type outpatient multi-disciplinary team models mentioned above.
This article is based on the work practice of Medical-lnsurance-Medicine Linkage carried out by the Nanping First Hospital Affiliated to Fujian Medical University under the reform of payment based on diagnosis related group (DRG). It outlines the connotation and extension of Medical-lnsurance-Medicine Linkage in the hospital, including concept definition, organizational structure, the relationship between DRG payment and Medical-lnsurance-Medicine Linkage, and summarizes the specific measures and positive results of the Medical-lnsurance-Medicine Linkage work mechanism from four aspects: medical quality management, medical insurance management, medical drugs/consumables management, and performance evaluation. These experiences are of great significance for improving the quality and efficiency of medical care, actively responding to the reform of medical insurance payment methods, enhancing the level of medical services in public hospitals, and achieving a win situation among the medical insurance management departments, hospitals, and patients.
ObjectiveTo investigate treatment of severe acute pancreatitis (SAP) concurrent peripancreatic walled-off necrosis.MethodsThe clinical data and treatment of a patient with SAP from the Second Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. The results of discussion of multidisciplinary team (MDT) were summarized.ResultsThe patient was admitted for the SAP with high fever, abdominal pain, and dyspnea for 2 weeks. The enhanced CT scan of the upper abdomen presented severe acute necrotizing pancreatitis with massive peripancreatic walled-off necrosis and pleural effusion. After the full discussion of SAP MDT, the percutaneous sinus tract necrosectomy (PSTN) was performed to relieved the symptom. After the two-stage PSTN treatment, the peripancreatic necrotic tissue was obviously reduced, the drainage was unobstructed, the clinical symptoms and biochemical indicators were obviously improved, and the patient was discharged on day 6 after the surgery.ConclusionsSAP is a critical situation with rapid progression and high mortality, and timing and approach of intervention for complications are very difficult to handle. PSTN could treat SAP with early appearance of infection or walled-off necrosis, which has advantages of less trauma, higher efficiency, and faster recovery as compared with traditional method and is of valuable in clinical practice.
Rare diseases are a kind of diseases with very low incidence and prevalence. They are difficult to diagnose, treat and use drugs. Multi-disciplinary team (MDT) has become the main mode of modern medical diagnosis and treatment. Many hospitals at home and abroad have begun to apply MDT in the diagnosis and treatment of rare diseases. This paper introduces the MDT mode of rare diseases at home and abroad, focusing on the mode, work flow and content of the MDT service system for rare diseases in West China Hospital of Sichuan University, and discusses the problems and optimization suggestions of the current construction of the MDT service system for rare diseases. The purpose is to provide some reference for the establishment of MDT model of rare diseases in China.
Objective To explore the value of multi-disciplinary team (MDT) for fertility preservation in patients with borderline ovarian tumor (BOT). Methods BOT patients who underwent MDT at West China Second University Hospital of Sichuan University between January 2020 and December 2022 were selected as the MDT group, while BOT patients who underwent surgery but did not undergo MDT during the same period were selected as the control group in a 1∶2 histological ratio. The clinical case data of two groups were retrospectively analyzed. The fertility assessment, implementation of fertility protection measures, and reproductive outcomes of two groups of patients were compared. Results A total of 24 patients were included in the MDT group, while 48 patients were included in the control group. There was no statistically significant difference in age of onset, marital status, preoperative carbohydrate antigen 199, carbohydrate antigen 125, surgical pathway, and International Federation of Gynecology and Obstetrics staging between the two groups of patients (P>0.05). The proportion of bilateral tumor involvement in the MDT group during the first surgery was higher than that in the control group (50.0% vs. 22.9%, P<0.05). In terms of fertility assessment, there was no statistically significant difference in the proportion of patients who underwent preoperative measurement of anti-Müllerian hormone between the two groups (P>0.05). The proportion of patients who underwent postoperative measurement of anti-Müllerian hormone in the MDT group was higher than that in the control group (100.0% vs. 37.5%, P<0.05). The proportion of patients in the MDT group who took fertility protection measures was higher than that in the control group (62.5% vs. 29.2%, P<0.05). There was no statistically significant difference in the proportion of successful pregnancies between the two groups of patients who were married (28.6% vs. 25.9%, P>0.05). Conclusion MDT is beneficial for improving the fertility assessment rate of BOT patients of childbearing age, providing personalized treatment plans, and taking timely measures to protect their fertility.
Objective To explore application value of multi-disciplinary team (MDT) model in patient underwent associating liver partition and portal vein occlusion for staged hepatectomy (ALPPS). Methods A huge mass of liver right lobe about 90.9 mm×75.5 mm×77.5 mm was found by the preoperative abdominal CT examination, which was considered as the primary liver cancer. The ALPPS was decided to perform through the discussion by the Departments of Radiology, Anesthesiology, Infectious disease, Oncology, and Hepatobiliary surgery. The first step operation included the exploratory laparotomy, associating ligation of the right branch of portal vein and disconnection of left and right hemi liver, radiofrequency ablation, and cholecystectomy. The second step operation was performed at 45 d after the first step operation, which included the release of the abdominal adhesion and the resection of the right lobe of liver. Results During the period of the two steps surgeries, though the patient had the liver failure, hepatic encephalopathy, and poor proliferation of the left lobe of liver, and so on, the ALPPS was finished smoothly and the R0 resection was achieved through the collboration of MDT. After the surgery, the related complications were treated by the MDT, the patient got great recovery and no recurrence or metastasis occurred during the following-up. Conclusion It is feasible to use ALPPS in treatment of primary giant liver cancer under MDT model, it will be more conducive to clinical brainstorming for the best treatment and better income of patient.
ObjectiveThe present study was to investigate the value of multi-disciplinary team (MDT) model in patient with primary giant liver cancer.MethodsThe MDT model was carried out for a BCLC B stage patient who admitted in the Second Affiliated Hospital of Chongqing Medical University in July 2018. The associated references were reviewed and the treatment methods were discussed about primary giant liver cancer.ResultsAn elder man who was diagnosed as primary hepatocellular carcinoma (minor cancer) in right lobe of the liver in three years ago and took Chinese medicine orally. When the patient subsequent visited this time, the liver cancer increased about 10 cm. After discussed by MDT, the treatment method was draw up to transarterial chemoembolization (TACE) plus surgery. After received twice TACE therapies in the later 14 weeks, the tumor in right lobe had significantly shrinked and left lobe enlarged. The patient underwent laparoscopic right liver hepatectomy after the second MDT discussion in 5 months later. The patient underwent operation successfully. The operation lasted for 270 minutes, and the intraoperative blood loss was about 500 mL. The suspended red blood cells (400 mL) was infused. The patient underwent transient liver failure and recovered through hepatoprotective and symptomatic supportive treatment, and discharged on 12 days after operation. A retrospective examination of abdominal CT at 4 months postoperatively revealed a significant hyperplasia of the left lobe of the liver, and there was no sign of recurrent tumor. The patient was continue to followed up.ConclusionsThepatient with primary giant hepatocellular carcinoma who cannot underwent surgery at the first time can received TACE, and a few patients could be underwent radical operation later. MDT should be applied flexibly in the treatment of patients with huge hepatocellular carcinoma from beginning to end, so the best treatment plan should be carried out for patients.
Objective To explore the clinical practice effects of multi-disciplinary team (MDT) model led by enterostomal therapist in the diagnosis and treatment of chronic wounds. Methods Three types of subspecialty patients diagnosed and treated by the MDT team for chronic wounds in the Wound Care Center of West China Hospital of Sichuan University between January 2020 and December 2022, including MDT for diabetes feet, MDT for immune ulcer and MDT for other refractory wounds, were retrospectively included. The clinical data, healing rate, healing time, and satisfaction rate of patients were analyzed. Results A total of 176 patients were included, including 103 cases of diabetes foot, 31 cases of immune ulcer, and 42 cases of other refractory wounds. The healing rate was 71.84% in patients with MDT of diabetes foot, 74.19% in patients with MDT of immune ulcer and 78.57% in patients with MDT of other refractory wound. The average healing time was 18.10 weeks for patients with diabetes foot, 19.69 weeks for patients with immune ulcer, and 20.53 weeks for patients with other refractory wounds. The satisfaction rates of patients in the three groups were relatively high (>95%). Conclusion The MDT model led by enterostomal therapist can provide comprehensive treatment plans for difficult and complex chronic wound patients, improve the treatment outcomes of chronic wounds, and is worthy of further promotion and application in the clinical diagnosis and treatment of chronic wounds.
Objective To diagnose and treat a patient with obstructive jaundice and hepatic bile duct tumor by multi-disciplinary team (MDT) and to provide individualized treatment. Methods By MDT model, a patient with obstructive jaundice and hepatic bile duct tumor, who was ever misdiagnosed as hilar cholangiocarcinoma, was discussed. The diagnosis, perioperative period management, and operation scheme were carried out by the MDT. Results After discussion of MDT, the patient was diagnosed as " hepatocellular carcinoma with bile duct tumor thrombi”, not " hilar cholangiocarcinoma”. Although hepatocellular carcinoma with bile duct tumor thrombi was end-stage disease, radical treatment was still considered. A plan of treatment was carried out by the MDT. Firstly, the percutaneous transhepatic cholangial drainage was operated for the predicted reserved half liver to relieve biliary obstruction. Secondly, hemihepatectomy combined with bile duct resection was carried out by the surgery team. The patient had nice postoperative recovery and there was no tumor recurrence after 6-month follow-up after surgery up to now. Conclusions MDT model do not only reduce misdiagnose, but also can provide the best therapeutic regimen and individualized treatment for patient presented with obstructive jaundice and hepatic bile duct tumor.
ObjectiveTo investigate the value of multi-disciplinary team (MDT) for the diagnosis and treatment of postoperative recurrence of hepatocellular carcinoma (HCC). MethodThe clinicopathologic data of a patient with giant HCC (66 mm×60 mm×102 mm) who was multiple intrahepatic metastases with portal vein tumor thrombus after radical resection, admitted to the Department of Hepatobiliary Surgery of Sichuan Provincial People’s Hospital, were gathered. ResultsThe patient was a middle-aged male. The multiple recurrent intrahepatic metastases combined with portal vein right branch thrombosis was found at 1 month after radical hepatectomy. After MDT discussion and evaluation, the hepatic arterial infusion chemotherapy combined with immunotherapy and targeted therapy (chemical drugs regimen was FOLFOX, immunotherapy drug was sindilizumab, targeted therapy drug was lenvatinib) was administered. After 3 times conversion therapy, and most of the intrahepatic lesions liquefied and necrotic and shrunk markedly or disappeared. After further discussion and evaluation by MDT, radical surgical resection was performed. The postoperative pathological examination results showed granulomatous inflammation with necrosis, and no exact liver cancer cells were detected. At 6 months after surgery, no tumor recurrence was observed.ConclusionsFor early recurrence combined with portal vein thrombosis after radical resection for HCC, hepatic arterial infusion chemotherapy combined with immunotherapy and targeted therapy may still be effective and even has an opporunity of surgical therapy. MDT discussion can provide the best treatment plan for patient with recurrent liver cancer, leading to a better clinical outcome for them.