The prevalence, incidence, and medical expenses of end-stage renal disease (ESRD) is extremely high in Taiwan, China; so decreasing the incidence of ESRD is a major work for kidney disease prevention in Taiwan, China. Current chronic kidney disease (CKD) guideline suggests multidisciplinary team (MDT) care for CKD patient with estimated glomerular filtration rate (eGFR) less than 30 mL/(min·1.73 m2). MDT includes not only nephrologist but also nursing specialty, dietitian, social worker, psychologist, and other professional personnel. The aim of the MDT care is to preserve renal function, decrease complications, provide nutrient support and nephrotoxic drug consultation, establish the concept of renal replacement therapy and preparation for dialysis access, provide the renal transplantation information, and give the psychosocial support. These cares should provide to CKD patients one year before starting renal replacement therapy. The MDT care for CKD could delay the progression from CKD to ESRD, lower the mortality and hospitalization of CKD, slow the renal function decline, provide better medical care and quality of life for patients, and decrease the medical expenditures. Besides, advanced CKD patients receiving MDT care have higher arteriovenous access preparation rate that prevent the additional intervention and hospitalization while starting dialysis. MDT care also decreases the hospitalization costs and medical expenditures, and decrease 3-year mortality rate after dialysis initiation. The further developing MDT care includes: (1) providing personalized renal care and treatment model, and intergraded care by cardiology-nephrology-diabetes-neurology model; (2) new iCKD care with health management platform and care mode combined with communication technology; (3) shared decision making for choice of renal replacement therapy; (4) advance care planning clinic for palliative treatment of ESRD. All MDT care hopes to establish a person-oriented care policy, provides a better quality care model, not only for the patient’s personalized medical care, but also hopes to improve the overall kidney disease care and prevention work. In addition, we can extend the CKD prevention and treatment experience to other countries worldwide.
Objective To explore the application of fast track surgery (FTS) mode through multidisciplinary cooperation for the perioperative period of liver cancer. Methods A total of 188 patients with liver cancer treated between April and December 2014 were randomly divided into two groups: FTS group (n=94) and control group (n=94). The FTS group was treated with multidisciplinary cooperative FTS mode, while the control group was treated with traditional perioperative treatment. The self-care ability of daily life, pain, ambulation time and frequency, anal exhaust time, defecation time, hospital stay, hospitalization expenses and readmission rate were compared between the two groups. Results Compared with the control group, patients in the FTS group had a better ability of self-care one to three days after surgery, more reduced pain 8, 24 and 48 hours after surgery, more frequent ambulation and longer ambulation time three days after surgery, shorter time of defecation and exhaust, shorter hospital stay and lower hospitalization expenses. All the above differences were statistically significant (P<0.05). The readmission rate, self-care ability four to seven days after surgery, pain scores 72 and 96 hours after surgery were not significantly different (P>0.05). Conclusion Multidisciplinary cooperative FTS mode for liver cancer perioperative rehabilitation can improve patients’ self-care ability, promote a speedy recovery, reduce hospitalization costs, save medical resources and improve disciplinary teamwork ability.
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.
ObjectiveTo provide the referencefor the guideline development and revision in China, we analyzed the composition of personnel who participated in developing Chinese clinical practice guidelines (CPGs)published in 2017. MethodsCNKI, WanFang Data, CBM and Google scholar were electronically searched to collect Chinese CPGs published from January 1st to December 31st, 2017. Two researchers independently screened literatures, extracted data of interest, such as composition and distribution of personnel, and analyzed the composition of personnel with Microsoft excel 2013. ResultsA total of 54 guidelines were included, and the majority of which are for treatment. Among which, 49 were developed by the associations accounting for 90.7%. Twenty-four (44.4%) guidelines reported the geographical distribution and unit ownership of the guideline developers, such as hospitals, schools, institutions (academies, institutes, laboratories, nursing homes, etc.). Almost all of the guidelines were developed by the cooperative work of experts from multidisciplinary clinical setting, 15 (27.8%) of which mentioned the participation of the methodologist. Among which, 13 (24.1%) of them involved literature retrieval experts, 2 (3.7%) of them involved epidemiologists, 2 (3.7%) of them involved evidence-based medicine experts, 1 (1.9%) of them involved statistical expert. Three of which mentioned external peer review. None of them has systematic review team. ConclusionIn China, the CPG formulation/revision organization is still not considering the importance of multidisciplinary collaboration, methodology researchers, and patients’ participation and external evaluation teams, which will affect the quality, practicability and maneuverability of CPG. We propose that multidisciplinary cooperation should be strengthened in the future while developing CPG, giving full consideration to the importance of medical personnel and the values of patients, and promoting the application of methodology.
ObjectiveTo investigate the clinical efficacy of multidisciplinary team (MDT) model combined with Da Vinci robot-assisted thoracic surgery in the treatment of early non-small cell lung cancer (NSCLC). MethodsFrom July 2020 to December 2021, the patients with NSCLC who received Da Vinci robot-assisted thoracic surgery in the Department of Thoracic Surgery, General Hospital of Northern Theater Command were collected. According to whether MDT were performed before hospitalization, the patients were divided into an MDT group and a common group. The recovery and clinical efficacy were compared between the two groups. ResultsA total of 187 patients were enrolled, including 81 males and 106 females, aged 63 (56, 67) years. There were 85 patients in the MDT group, and 102 patients in the common group. Compared with the common group, the MDT group had lower incidence of postoperative complications (9.4% vs. 29.4%, P=0.017), shorter intraoperative operation time [55 (45, 61) min vs. 79 (65, 90) min, P<0.001], and less intraoperative blood loss [25 (20, 30) mL vs. 30 (20, 50) mL, P=0.029] in the same operation mode. In addition, the drainage volume on the second postoperative day [270 (200, 350) mL vs. 215 (190, 300) mL, P=0.004], the number of dissected lymph nodes groups [6 (5, 6) groups vs. 5 (3, 6) groups, P=0.004] and the number of dissected lymph nodes [16 (13, 21) vs. 13 (9, 20), P=0.005] in the MDT group were significantly better than those in the common group. The differences in the postoperative intubation time and postoperative hospital stay between the two groups were not statistically significant (P>0.05). ConclusionMDT combined with Da Vinci robot-assisted thoracic surgery can further reduce the risk of surgery, improve the clinical treatment effect, reduce the incidence of postoperative complications, and accelerate the rehabilitation of patients.
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.
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.
ObjectiveTo break through the key problem in the process of ambulatory surgery operation and management, improve the operational efficiency of hospital, and ensure the quality and safety of medical care through new established ambulatory surgery informative platform.MethodsThrough the analysis of medical requirements and process optimization in ambulatory surgery in Xiangya Hospital, Central South University from March to April, 2020, we constructed an ambulatory surgery informative platform centered on patient behavior tracking.ResultsThere wasa significant difference in the reception time of different appointment modes before and after the launch of information platform [(290.45±50.35) vs. (158.58±40.27) s; t=16.040, P<0.001]. After the platform system went online, patients’ satisfaction with the treatment process, appointment waiting time, and overall satisfaction were higher than before (P<0.05); there was no significant difference in patients’ attitude towards medical staff before and after the system went online (P>0.05). The results of medical staff’s work experience after the system went online showed that the use of information platform could make the work more efficient (91.09%), the process more reasonable (91.09%), accurately and timely grasp the patient’s information (95.05%), guarantee the medical quality and safety (96.04%), and reduce the medical cost (88.12%).ConclusionThe ambulatory surgery informative platform improved our work efficiency and patients’ satisfaction, assured the quality and safety of medical care, and strengthen the multi-disciplinary synergy at the same time.
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.
Brain-computer interface (BCI) is a revolutionizing technology that disrupts traditional human-computer interaction by establishing direct communication and control between the brain and computer, bypassing the peripheral nervous and muscular systems. With the rapid advancement of BCI technology, growing application demands, and an increasing need for specialized BCI professionals, a new academic major—BCI major—has gradually emerged. However, few studies to date have discussed the interdisciplinary nature and training framework of this emerging major. To address this gap, this paper first introduced the application demands of BCI, including the demand for BCI technology in both medical and non-medical fields. The paper also described the interdisciplinary nature of the BCI major and the urgent need for specialized professionals in this field. Subsequently, a training program of the BCI major was presented, with careful consideration of the multidisciplinary nature of BCI research and development, along with recommendations for curriculum structure and credit distribution. Additionally, the facing challenges of the construction of the BCI major were analyzed, and suggested strategies for addressing these challenges were offered. Finally, the future of the BCI major was envisioned. It is hoped that this paper will provide valuable reference for the development and construction of the BCI major.