多学科协作的I-PDCA模式在结直肠癌学科建设中的实践与思考

目的 探讨北京大学肿瘤医院结直肠癌学科建设中多学科协作模式及实施情况,为医院学科建设和创新管理提供借鉴。方法 本中心7年来将创新设计与传统PDCA管理方法相融合,针对医疗、科研、人才培养开展了五阶段I-PDCA新模式的多学科协作。结果 该模式弥补了传统PDCA四阶段模式缺乏创造力的弊端,促进了本院结直肠癌学科相关资源在多个维度的高效配置,在结直肠癌学科建设中发挥了重要作用。结论 结直肠癌多学科协作的I-PDCA模式有利于提升医疗服务、科研成果产出和人才培养水平,为学科未来发展提供助力。

Value of multi-disciplinary input into laparoscopic management of rectal cancer-An observational study

AIM To assess the impact of multi-disciplinary teams(MDTs)management in optimising the outcome for rectal cancers.METHODS We undertook a retrospective review of a prospectively maintained database of patients with rectal cancers(defined as tumours≤15 cm from anal verge)discussed at our MDT between Jan 2008 and Jan 2011.The data was validated against the national database to ensure completeness of dataset.The clinical course and follow-up data was validated using the institution’s electronic patient records.The data was analysed in terms of frequencies and percentages.Significance of any differences were analysed usingχ2 test.A Kaplan-Meier analysis was performed for overall survival and disease free survival.RESULTS Following appropriate staging,one hundred and thirtythree patients were suitable for potentially curative resections.Seventy two(54%)were upper rectal cancer(URC)-tumour was>6 cm from the anal verge and 61(46%)were lower rectal cancers(LRC)-lower extent of the tumour was palpable≤6 cm.Circumferential resection margin(CRM)appeared threatened on preoperative MRI in 19/61(31%)patients with LRC requiring neo-adjuvant therapy(NAT).Of the 133 resections,118(89%)were attempted laparoscopically(5%conversion rate).CRM was positive in 9(6.7%)patients;Median lymph node harvest was 12(2-37).Major complications occurred in 8(6%)patients.Median follow-up was 53 mo(0-82).The 90-d mortality was 2(1.5%).Over the followup period,disease related mortality was 11(8.2%)and overall mortality was 39(29.3%).Four(3%)patients had local recurrence and 22(16.5%)patients had distant metastases.CONCLUSION Management of rectal cancers can be optimized with multidisciplinary input to attain acceptable long-term oncological outcomes even when incorporating a laparoscopic approach to rectal cancer resection.

Application of single balloon enteroscopy-assisted therapeutic endoscopic retrograde cholangiopancreatography in patients after bilioenteric Roux-en-Y anastomosis: Experience of multi-disciplinary collaboration

BACKGROUND Bilioenteric Roux-en-Y anastomosis is one of the most complicated approaches for reconstructing the gastrointestinal tract, and endoscopic retrograde cholangiopancreatography (ERCP) is technically challenging in patients after bilioenteric Roux-en-Y anastomosis. The optimal endoscopic strategies for such cases remain unknown. AIM To explore the feasibility and effectiveness of single balloon enteroscopy-assisted (SBE-assisted) therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis based on multi-disciplinary collaboration between endoscopists and surgeons as well as report the experience from China. METHODS This is a single center retrospective study. All of the SBE-assisted therapeutic ERCP procedures were performed by the collaboration between endoscopists and surgeons. The operation time, success rate, and complication rate were calculated. RESULTS Forty-six patients received a total of 64 SBE-assisted therapeutic ERCP procedures, with successful scope intubation in 60 (93.8%) cases and successful diagnosis in 59 (92.2%). All successfully diagnosed cases received successful therapy. None of the cases had perforation or bleeding during or after operation, and no post-ERCP pancreatitis occurred. CONCLUSION Based on multi-disciplinary collaboration, SBE-assisted therapeutic ERCP in patients after bilioenteric Roux-en-Y anastomosis is relatively safe and effective and has a high success rate.

基于加速康复外科-多学科团队构架下建立的All in One病房工作模式探索

基于多学科团队(multi-disciplinary team,MDT)参与的加速康复外科(enhanced recovery after surgery,ERAS)(ERAS-MDT)构架下建立的All in One(AO)病房,通过外科联合具有综合属性的内科协助外科治疗作为AO病房的主体病房,纳入在专业治疗上需要进行深度介入干预的相应专业组成的辅助病房以及协助外科完成治疗工作的相关专业组成的支持治疗病房,组成综合性独立单元体,其目标是探索多学科协同促进外科患者围手术期加速康复的策略。通过在加速康复AO病房实施LEER模式工作流程(即“少痛”“早动”“早食”“安心”)来实现患者术后加速康复这一共同目标。通过AO病房的治疗,期望增加老年、危重症患者的手术率,减少术后并发症的发生率,缩短外科患者平均住院时间,加快外科病房周转,节约有限的医疗资源,并拓展ERAS的应用领域。从形式和内容上创新了MDT,不仅有利于医院通过内部资源整合为外科纾困解难,也为进一步探索和深化慢病管理和临床专业协同工作模式提供了一种有益借鉴。

MDT与PBL-CBL联合教学模式用于淋巴瘤临床带教的价值研究

目的分析多学科协作诊疗(multi-disciplinary treatment,MDT)与以问题为基础的教学法-案例教学法(problem based learning-case based teaching,PBL-CBL)联合教学模式用于淋巴瘤临床带教的效果及对教学质量的影响。方法选取2021年2月—2022年2月在广州医科大学附属第一医院血液内科接受淋巴瘤临床带教的66名实习生为研究对象,依据不同带教模式分成两组。对照组33名采取常规带教模式,观察组33名采取MDT与PBL-CBL联合教学模式,对比两组实习生的考核成绩、岗位胜任能力、综合能力及对教学质量的评价。结果观察组实习生考核成绩总分(92.69±6.19)分,高于对照组的(83.80±8.21)分,差异有统计学意义(P<0.05)。带教前,两组实习生的岗位胜任能力比较,差异无统计学意义(P>0.05);带教后,两组的岗位胜任能力明显提高,且观察组高于对照组,差异有统计学意义(P<0.05)。带教前,两组实习生的综合能力比较,差异无统计学意义(P>0.05);带教后,两组的综合能力明显更高,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组实习生对于教学质量的评价高于对照组,差异有统计学意义(P<0.05)。结论MDT与PBL-CBL联合教学模式用于淋巴瘤临床带教的效果显著,有助提升其考核成绩、岗位胜任能力及综合能力,促进教学质量进一步提高。

Transforming Multidisciplinary Customer Requirements to Product Design Specifications

With the increasing of complexity of complex mechatronic products, it is necessary to involve multidis- ciplinary design teams, thus, the traditional customer requirements modeling for a single discipline team becomes difficult to be applied in a multidisciplinary team and project since team members with various disciplinary backgrounds may have different interpretations of the customers＇ requirements. A new synthesized multidisci- plinary customer requirements modeling method is pro- vided for obtaining and describing the common understanding of customer requirements （CRs） and more importantly transferring them into a detailed and accurate product design specifications （PDS） to interact with dif- ferent team members effectively. A case study of designing a high speed train verifies the rationality and feasibility of the proposed multidisciplinary requirement modeling method for complex mechatronic product development. This proposed research offersthe instruction to realize the customer-driven personalized customization of complex mechatronic product.

基于MDT的CHS-DRG付费下的管理持续改进

国家医疗保障局于2019年正式启动CHS-DRG付费改革。武汉大学中南医院作为CHS-DRG付费试点医院之一,通过组建DRG管理MDT团队,围绕CHS-DRG付费核心环节,联合开展CHS-DRG付费下的临床路径管理、药品和耗材治理、成本核算与绩效考核、监管病案首页质量、鼓励开展医疗新技术等,优化管理方案。经实践,医院CMI、平均住院日等指标持续改善,医疗新技术开展数量明显增加,改革取得较好成效。但仍需从医保部门合理补偿方面不断完善CHS-DRG付费方案,并积极关注支付方式改革对医疗质量和医院发展的长期影响。

Selection Method of Multi-Objective Problems Using Genetic Algorithm in Motion Plan of AUV

To research the effect of the selection method of multi-objects genetic algorithm problem on optimizing result, thismethod is analyzed theoretically and discussed by using an autonomous underwater vehicle(AUV) as an object. A changingweight vtlue method is put forward and a selection formula is modified. Some experiments were implemented on an AUV.TwinBurger. The results shows that this method is effective and feasible.

Multi-features Based Approach for Moving Shadow Detection

In the video-based surveillance application, moving shadows can affect the correct localization and detection of moving objects. This paper aims to present a method for shadow detection and suppression used for moving visual object detection. The major novelty of the shadow suppression is the integration of several features including photometric invariant color feature, motion edge feature, and spatial feature etc. By modifying process for false shadow detected, the averaging detection rate of moving object reaches above 90% in the test of Hall-Monitor sequence.

The Large Sky Area Multi-Object Fiber Spectroscopic Telescope (LAMOST)

The Large Sky Area Multi-Object Fiber Spectroscopic Telescope (LAMOST, also called the Guo Shou Jing Telescope) is a special reflecting Schmidt telescope. LAMOST’s special design allows both a large aperture (effective aperture of 3.6 m–4.9 m) and a wide field of view (FOV) (5°). It has an innovative active reflecting Schmidt configuration which continuously changes the mirror’s surface that adjusts during the observation process and combines thin deformable mirror active optics with segmented active optics. Its primary mirror (6.67m×6.05 m) and active Schmidt mirror (5.74m×4.40 m) are both segmented, and composed of 37 and 24 hexagonal sub-mirrors respectively. By using a parallel controllable fiber positioning technique, the focal surface of 1.75 m in diameter can accommodate 4000 optical fibers. Also, LAMOST has 16 spectrographs with 32 CCD cameras. LAMOST will be the telescope with the highest rate of spectral acquisition. As a national large scientific project, the LAMOST project was formally proposed in 1996, and approved by the Chinese government in 1997. The construction started in 2001, was completed in 2008 and passed the official acceptance in June 2009. The LAMOST pilot survey was started in October 2011 and the spectroscopic survey will launch in September 2012. Up to now, LAMOST has released more than 480 000 spectra of objects. LAMOST will make an important contribution to the study of the large-scale structure of the Universe, structure and evolution of the Galaxy, and cross-identification of multiwaveband properties in celestial objects.

美国2021版《妊娠期肾结石诊治-单中心多学科指南》解读--提高临床诊断能力,加强多学科协作管理

妊娠期肾结石是妊娠期患者非产科因素住院的常见病因,容易出现疼痛、恶心、呕吐、肾功能下降、泌尿道感染等并发症,处理不当会导致流产、早产等不良妊娠结局。美国医学中心多学科联合发布《妊娠期肾结石诊治-单中心多学科指南》,以规范妊娠期肾结石的诊治。本指南共形成10个指南推荐意见,其中4个用于指导诊断和影像学检查,6个用于指导临床治疗。值得关注的是,与国内指南相比,该指南提供了循证依据,证实了妊娠期使用低剂量CT平扫的安全性、有效性,并可以在患者病情变化且诊断不明确时优先使用,本文就以上内容对该指南展开深度解读。

A Comparative Study of Acute Hemodynamic Effects of Multi -site Cardiac Pacing in patients with cardiac function NYHA class ⅠtoⅡ without bundle branch block

Objective To compare the acute hemodynamic effects of five different pacing modes in patients with cardiac function NYHA class Ⅰ to Ⅱ without bundle branch block (BBB). Methods This study included 12 patients (SSS 7, Ⅲ°AVB 5) undergoing pacemaker implantation. Right ventricular apex (RVA), right ventricular outflow tract (RVOT), right ventricular bifocal (RV-Bi), left ventricular base (LVB) and bi -ventricular (Bi-Ⅴ) pacing at 60 -80 ppm were done in VVI mode prior to implantation of DDD pacemaker. The cardiac index (CI), mean pulmonary artery pressure (mPAP) and pulmonary capillary wedge pressure (PCWP) were measured with Swan - Ganz thermodilution catheter after 5 minutes of each pacing mode. Results (1) Comparing to pacing at RVA (CI: 2. 41± 0. 38 L/min per m2, PCWP: 16. 7 ±3.3 mmHg), the CI increased and the PCWP decreased significantly in pacing at RVOT(CI: 2. 63 ± 0.46, PCWP: 13. 8±2. 3), LVB(CI: 2. 78±0.52, PCWP: 14. 4±3.1), RV-Bi(CI: 2. 83±0.57, PCWP: 12. 8± 2. 5) and Bi -Ⅴ pacing (CI: 2. 94± 0.60, PCWP: 12. 7±2. 5), P < 0. 01, respectively. (2) The CI of RV-Bi and Bi-Ⅴ pacing was higher than that of RVOT and LVB pacing, the PCWP was lower, P < 0. 05, respectively. (3) There was no significant difference between RV - Bi pacing and Bi-Ⅴ pacing in CI and PCWP. Conclusion There is no significant difference between RV - Bi pacing and Bi -V pacing in the acute hemodynamic effects; however,dual - site pacing is much better than single site pacing in that aspect for patients with cardiac function NYHA class Ⅰ to Ⅱ without BBB. Among single site pacing, the RVOT and LVB pacing is better than RVA pacing in cardiac function.

Research on A Master - slave Multi - microcomputers Control System for Hollow Spindle Fancy Yarn Spinning Machine

In this paper, a successfully studied and developed master - slave muld - microcomputers control system based on PC - BUS for hollow spindle fancy yarn spinning machine, mainly Its overall scheme, software and hardware construction, is introduced. Spinning experiments show that the system achieves satisfactory result. This system can solve the diftkultles of mechatronical fusion between domestic hollow splndk fancy yarn spuming muchine and its microcomputer control technology.

On the Representation of Multi-layer Woven Structure

A quantitative method is developed to identify the structures of multi-layer woven fabric in this study. Six structural parameters are selected to represent the fabric structure. With some design criteria for the reinforcement of textile composites, the relationships among the structural parameters are derived for different binding patterns of the fabric structure. The conditions, which meet the requirements of structural cell stability,are also discussed.

Computer-aided Pattern Design of Multi-bar Warp Knitted Fabrics

To meet the development trend of multi-bar warp knit-ting machine towards high-speed,advanced technologyand computer control and the requirements of variousproducts with small quantity,there are many researcheson the computer-aided pattern design of multi-barwarp knitted fabrics.In terms of the special propertiesof the computer-aided pattern design of multi-barwarp knitted fabrics,the Object Oriented Program(OOP)programming-Object Windows class Library(OWL)programming is selected.According to thecharacters of the OWL programming,various functionsare defined.Pattern design and technical parameters canbe output,which offers a great convenience for the fac-tory.

Reducing Paediatric Outpatient Waitlists—A Proposed Allied Health Multidisciplinary Approach

Extremely long Australian paediatric outpatient waiting lists have resulted in large numbers of children waiting to see a paediatrician. Analyses of the patient referrals suggest that a large proportion of children may benefit from allied health input, in addition to being seen by the paediatrician. This paper provides an organisational strategy that involves streamlining Allied Health clinical services in an effort to assist with bringing down a Paediatric Out-patient waitlist. The paper describes principles to guide the formation of a Paediatric Allied Health Multi-Disciplinary team that proposes assessment and brief interventions. The service would focus on supporting the paediatricians through the use of structured procedures, telephone intakes, multidisciplinary triage, shared and standardised assessments, collaborative formulations and reports, brief interventions, clinical-community linkages, and allied health student support. A variety of additional important organisational principles are proposed to facilitate patient flow from the perspective of streamlining administrative processes, having adequate administrative support, shared responsibilities, teamwork, flexibility, carrying out intake assessments, determining which referrals were appropriate for allied health, and working closely with medical staff.

Multidisciplinary Approach to Breast Cancer:A New Outlook on Nursing Care

The treatment and general care for womendiagnosed with breast cancer has made a tremendous change andadvance in the last decades. Better methods for early detectionand screening of the disease, higher compliance of women to gofor screening, an open social and political discourse of women andthe health care team and others, are just a few that both enabledand are a result of this change. Nurses have been highly involvedin these changes, which resulted in the specialization of nursingin the field of breast cancer. This article will focus on the mainfour points that influence the nursing specialist care, that is, thetailoring of treatment and the ability to offer women treatmentwhich is more specific to their own cancer; the importance of themultidisciplinary team as providing a State of the Art care; theinvolvement of women in the decision-making regarding theirtreatment and the specific developing role of the specialist breastcare nurse.

多学科模式下ICU机械通气患者早期活动协作现状与影响因素分析

目的:了解在国内多学科模式下,ICU机械通气患者早期活动的协作现状,分析其影响因素。方法:2022年10月—11月,便利抽取国内18个省、自治区、直辖市的31家三级综合医院参与ICU机械通气患者早期活动实施的多学科医务人员,采用自设的ICU机械通气患者早期活动多学科协作现状调查问卷调查。结果:在554名医务人员中,有76.9%完全不了解或不太了解ICU机械通气患者早期活动多学科协作的规范流程,有69.0%不清楚自己在多学科协作中的职责,有51.4%所在的ICU没有成立明确的早期活动多学科团队。回归分析显示,管理危重患者数量、有无早期活动规范和流程、周围同事态度、是否成立多学科团队、成员沟通方式、活动主导者为早期活动多学科医务人员协作水平的影响因素(P<0.05)。结论:多学科模式下,ICU机械通气患者早期活动的协作方式尚不清晰,需要综合考虑我国医护人力资源现状、各地区经济水平等,构建并完善早期活动的多学科协作策略。

中国Ehlers-Danlos综合征诊疗指南

Ehlers-Danlos综合征(EDS)是一组具有临床和遗传异质性的结缔组织疾病,通常累及全身多系统,属于罕见病的一种。EDS共14个亚型,所有亚型共同特征是关节过度活动、皮肤过度伸展和组织脆弱等,不同亚型的临床特征和严重程度各不相同,包括反复关节脱位、脊柱侧凸、动脉夹层、内脏器官破裂等。EDS患者的诊断、治疗、随访、管理等多方面均面临诸多挑战,多学科团队的协同诊疗指南及流程尚未建立,因此中国Ehlers-Danlos综合征多学科诊疗协作组联合国内相关专业人士,共同制定本指南,旨在提高EDS诊疗水平,为患者提供同质化医疗服务。