ObjectiveTo investigate the diagnosis and treatment value of multi-disciplinary team (MDT) model in patient with gastric perforation combined with hyperthyroidism crisis.MethodWe summarized the experiences of MDT model in treating one case of gastric perforation with hyperthyroidism crisis in the Fuling Central Hospital of Chongqing City on February 2019.ResultsThis patient had a history of hyperthyroidism and didn’t receive systemic treatment, diagnosing as acute diffuse peritonitis and perforation of hollow organs. After MDT discussions and a series of treatments, including anti-infection, control of heart rate and hyperthyroidism, this patient underwent surgical treatment of gastric peptic ulcer perforation, during and after the surgery, this patient suffered from hyperthyroid crisis. The surgery was successful, with the operation time was about 110 min, and the blood loss was about 50 mL. There was no side injury occurred without blood transfusion, and the patient was cured and discharged on 20 days after operation. The patient was followed up for about 1 year, and the general condition and life returned to normal.ConclusionMDT discussion is a very helpful way in the treatment of gastric perforation combined with hyperthyroidism crisis and can give a better outcome.
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.
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.
Objective To study the effect of multi-disciplinary treatment (MDT) on the surgical efficacy and satisfaction of patients undergoing total knee arthroplasty (TKA) for the first time. Methods The clinical data of patients who underwent unilateral TKA for single-compartment osteoarthritis of the knee in the General Hospital of Ningxia Medical University between January and September 2022 were retrospectively collected and analyzed. According to whether MDT was performed on patients during the perioperative period, they were divided into MDT group and traditional group. Perioperative nutrition-related indicators, perioperative complications, total hospitalization time, Visual Analogue Scale (VAS), and Hospital for Special Surgery Knee Score (HSS) before and after surgery were detected and recorded. Results A total of 95 patients were included. Among them, there were 42 cases in the MDT group and 53 cases in the traditional group. The postoperative complications and total hospital stay of patients in the MDT group were lower than those in the traditional group, and their satisfaction scores were higher than those in the traditional group (P<0.05). The perioperative serum total protein (TP), hemoglobin (Hb), serum albumin (ALB) levels, VAS score, and HSS score of both groups of patients changed over time. The intra group comparison results showed that compared with preoperative, the levels of TP, Hb, and ALB in both groups decreased on the 1st and 3rd postoperative days (P<0.05). On the 3rd day after surgery, the levels of TP, Hb, ALB in the MDT group and Hb, ALB in the traditional group were lower than on the 1st day after surgery (P<0.05). There was no statistically significant difference in TP levels between the traditional group on the 3rd day after surgery and the 1st day after surgery (P>0.05). The results of intra group comparison at different time points showed that there were statistically significant differences in VAS score and HSS score between the two groups (P<0.05). Conclusion The application of MDT in elderly patients undergoing unilateral TKA for the first time can shorten the total hospitalization time, reduce the incidence of perioperative complications, and improve the surgical efficacy and patient satisfaction.
Objective To summarize clinical diagnosis and treatment of 1 case of hypothyroidism complicated with postoperative gastroparesis syndrome (PGS) after radical resection of right colon cancer. Method The multi-disciplinary (MDT) mechanism was used to discuss the MDT consultations of the departments of general surgery, endocrinology, nutrition, radiology, and pathology in a patient with hypothyroidism and right colon cancer after the radical resection. Results The MDT discussion concluded that the patient had a clear diagnosis of right colon cancer before the surgery, and the PGS occurred after the radical resection of right colon cancer. The patient had the hypothyroidism before the operation, and the occurrence of PGS might be related to the hypothyroidism. The experts of MDT recommended to treat with the thyroxine sodium and nutritional support treatment after the surgery. According to the results of the MDT discussion, the patient’s PGS was gradually cured and discharged smoothly after the thyroxine supplementation and nutritional support. Conclusions Hypothyroidism may be a risk factor for occurrence of PGS after radical resection of right colon cancer. MDT mechanism can provide an individualized optimal treatment for patients with hypothyroidism complicated with PGS after radical resection of right colon cancer and benefit these patients.
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.
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.
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.
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.
ObjectiveTo investigate clinical features and treatment of pancreatic metastasis from cardiac carcinoma.MethodsThe clinicopathological data of a patient with pancreatic metastasis from cardiac carcinoma in the General Hospital of Western Theater Command were retrospectively analyzed. The results of multi-disciplinary treatment (MDT) of this case were summarized.ResultsThe imaging findings of abdomen CT of this patient were that the solid occupying position of the head of pancreas was considered as a new organism. After discussing by the MDT and exclusing operative contraindications, the radical resection of cardiac cancer with pancreaticoduodenectomy and enlarged intraperitoneal lymph node dissection was performed under the general anesthesia. The operation was smooth and the bleeding was about 600 mL. The patient recovered well after the operation and had no serious complications. The patient was discharged on day 10 after the operation. The results of postoperative pathological diagnosis were the cardiac carcinoma with pancreatic head implantation metastasis (stage Ⅱ A, T3M0N0); obstructive jaundice, liver damage, extrahepatic and extrahepatic biliary dilatation. The patient received the intravenous infusion of the oxaliplatin pluse tigualone for 4 courses. The patient was generally in a good condition and had survived 5 months free tumor. The CA19-9 level was 45.6 U/mL (it was 449.60 U/mL before the operation).ConclusionsPancreatic metastasis from cardiac carcinoma is rare and need to be distinguished from primary pancreatic cancer. Survival time is short and prognosis is poor. Clinical symptoms are improved and survival time is prolonged after operation with postoperative chemotherapy.