Impact of extended nursing model after multi-disciplinary treatment on young patient with post-stroke

BACKGROUND Stroke has become one of the most serious life-threatening diseases due to its high morbidity,disability,recurrence and mortality rates.AIM To explore the intervention effect of multi-disciplinary treatment(MDT)extended nursing model on negative emotions and quality of life of young patients with post-stroke.METHODS A total of 60 young stroke patients who were hospitalized in the neurology department of our hospital from January 2020 to December 2021 were selected and randomly divided into a control group and an experimental group,with 30 patients in each group.The control group used the conventional care model and the experimental group used the MDT extended nursing model.After the inhospital and 3-mo post-discharge interventions,the differences in negative emotions and quality of life scores between the two groups were evaluated and analyzed at the time of admission,at the time of discharge and after discharge,respectively.RESULTS There are no statistically significant differences in the negative emotions scores between the two groups at admission,while there are statistically significant differences in the negative emotions scores within each group at admission and discharge,at discharge and post-discharge,and at discharge and post-discharge.In addition,the negative emotions scores were all statistically significant at discharge and after discharge when compared between the two groups.There was no statistically significant difference in quality of life scores at the time of admission between the two groups,and the difference between quality of life scores at the time of admission and discharge,at the time of discharge and post-discharge,and at the time of admission and post-discharge for each group of patients was statistically significant.CONCLUSION The MDT extended nursing mode can improve the negative emotion of patients and improve their quality of life.Therefore,it can be applied in future clinical practice and is worthy of promotion.

Multi-disciplinary treatment for hepatocellular carcinoma in primary hospitals in China during the COVID-19 epidemic

Hepatocellular carcinoma(HCC)is a common malignant tumor in the Chinese population.Due to its high degree of malignancy,rapid progression,and poor prognosis,it mainly requires multi-disciplinary treatment(MDT)in the clinic.In December 2019,COVID-19,a novel coronavirus pneumonia,broke out in Wuhan,China.It has rapidly spread across the country,with various places launching a level I response to major public health emergencies and traffic being restricted.Most patients with HCC were only able to attend primary hospitals,while the MDT model for HCC in provincial hospitals was restricted.Therefore,it was a huge task for clinicians in primary hospitals to ensure MDT was given to patients with HCC during the level I response to major public health emergencies.How to formulate a reasonable MDT mode for patients with HCC according to local conditions was worthy of consideration by hepatobiliary surgeons in primary hospitals.

Experiences and challenges in the health protection of medical teams in the Chinese Ebola treatment center,Liberia:a qualitative study

Background:Health care workers are at the frontline in the fight against infectious disease,and as a result are at a high risk of infection.During the 2014-2015 Ebola outbreak in West Africa,many health care workers contracted Ebola,some fatally.However,no members of the Chinese Anti-Ebola medical team,deployed to provide vital medical care in Liberia were infected.This study aims to understand how this zero infection rate was achieved.Methods:Data was collected through 15 in-depth interviews with participants from the People’s Liberation Army of China medical team which operated the Chinese Ebola Treatment Center from October 2014 to January 2015 in Liberia.Data were analysed using systematic framework analysis.Results:This study found numerous bio-psycho-socio-behavioural risk factors that directly or indirectly threatened the health of the medical team working in the Chinese Ebola Treatment Center.These factors included social and emotional stress caused by:(1)the disruption of family and social networks;(2)adapting to a different culture;(3)and anxiety over social and political unrest in Liberia.Exposure to Ebola from patients and local co-workers,and the incorrect use of personal protective equipment due to fatigue was another major risk factor.Other risk factors identified were:(1)shortage of supplies;(2)lack of trained health personnel;(3)exposure to contaminated food and water;(4)and long working hours.Comprehensive efforts were taken throughout the mission to mitigate these factors.Every measure was taken to prevent the medical team’s exposure to the Ebola virus,and to provide the medical team with safe,comfortable working and living environments.There were many challenges in maintaining the health safety of the team,such as the limited capability of the emergency command system(the standardized approach to the command,control,and coordination of an emergency response),and the lack of comprehensive international protocols for dealing with emerging infectious disease pandemics.Conclusions:The comprehensive and multidisciplinary measures employed to protect the health of the medical team proved successful even in Liberia’s resource-limited setting.The global health community can learn valuable lessons from this experience which could improve the safety of health care workers in future emergencies.These lessons include:establishing capable command systems;implementing effective coordination mechanisms;providing adequate equipment;providing training for medical teams;investing in the development of global health professionals;and improving research on ways to protect health care workers.

Active case-finding for tuberculosis by mobile teams in Myanmar:yield and treatment outcomes

Background:Since 2005,the Myanmar National Tuberculosis Programme(NTP)has been implementing active case finding(ACF)activities involving mobile teams in hard-to-reach areas.This study revealed the contribution of mobile team activities to total tuberculosis(TB)case detection,characteristics of TB patients detected by mobile teams and their treatment outcomes.Methods:This was a descriptive study using routine programme data between October 2014 and December 2014.Mobile team activities were a one-stop service and included portable digital chest radiography(CXR)and microscopy of two sputum samples.The algorithm of the case detection included screening patients by symptoms,then by CXR followed by sputum microscopy for confirmation.Diagnosed patients were started on treatment and followed until a final outcome was ascertained.Results:A total of 9349 people with symptoms suggestive of TB were screened by CXR,with an uptake of 96.6%.Of those who were meant to undergo sputum smear microscopy,51.4%had sputum examinations.Finally,504 TB patients were identified by the mobile teams and the overall contribution to total TB case detection in the respective townships was 25.3%.Among total cases examined by microscopy,6.4%were sputum smear positive TB.Treatment success rate was high as 91.8%in study townships compared to national rate 85%(2014 cohort).Conclusions:This study confirmed the feasibility and acceptability of ACF by mobile teams in hard-to-reach contexts,especially when equipped with portable,digital CXR machines that provided immediate results.However,the follow-up process of sputum examination created a significant barrier to confirmation of the diagnosis.In order to optimize the ACF through mobile team activity,future ACF activities were needed to be strengthened one stop service including molecular diagnostics or provision of sputum cups to all presumptive TB cases prior to CXR and testing if CXR suggestive of TB.

Ductal adenocarcinoma of the prostate or seminal vesicle adenocarcinoma:An multi-disciplinary team(MDT)case report and literature review

We introduced a 61-year-old male with ductal adenocarcinoma of the prostate who underwent a tortuous diagnosis and treatment.Multi-disciplinary team meetings organized by our hospital have shown great value in the whole process.The patient presented with gross hematuria accompanied by frequent urination initially,and was diagnosed with ductal adenocarcinoma of the prostate involving right seminal vesicle gland and urethra by urethroscopy biopsy.The clinical stage of tumor was T3bN0M0.After 4 cycles of neoadjuvant chemotherapy,the tumor shrank significantly and the patient underwent a laparoscopic radical prostatectomy.But the patient declined to continue chemotherapy postoperatively.After 10 months,the serum prostatic specific antigen increased to 0.05 ng/mL,and multiple metastases were found in the patient's bilateral lungs.However,an unexpected diagnosis of seminal vesicle adenocarcinoma was put forward from another hospital after supplementary pathologic immunohistochemical examination.Then,after careful discussion and demonstration by our multi-disciplinary team experts,we insisted on the diagnosis of ductal adenocarcinoma of the prostate and suggested that the original regimen of chemotherapy should be continued.Up-to-date,14 months after the operation,the patient continues to survive while undergoing ongoing active treatment as recommended.

肺癌多学科综合诊治现状及未来方向

尽管肺癌多学科诊疗(multidisciplinary team,MDT)模式能够提高患者的生活质量和生存预后,为何没有达到MDT诊疗模式所预期的目标呢?主要原因是肺癌MDT诊治模式相对滞后于各种治疗手段的进步。分析国内外肺癌MDT诊治最新研究成果,结合四川大学华西医院肺癌中心肺癌MDT诊治经验,本文将从以下几个方面对肺癌MDT的进展及未来发展方向进行讨论和总结:(1)肺癌MDT诊治模式的内涵和外延需要转变并适应新的诊治手段;(2)肺癌MDT诊治临床决策应当从“多学科会诊(multidisciplinary consultation,MDC)”向“MDT”转变;(3)肺癌MDT诊治过程要从“消防队模式”转向“防火墙模式”,并最终实行“个体化全程管理模式”;(4)肺癌MDT诊治路径要从“临时召集模式”向“肺癌单病种中心制模式”转变。

多学科协作诊疗模式对前置胎盘伴胎盘植入产妇妊娠结局的影响

目的探讨多学科协作(MDT)诊疗模式在改善前置胎盘伴胎盘植入母儿结局中的临床价值。方法回顾性分析2017年1月至2022年12月于江西省妇幼保健院分娩的281例前置胎盘伴胎盘植入产妇的临床资料,根据剖宫产术前是否进行MDT诊疗进行分组,其中MDT组152例,非MDT组129例。比较两组的剖宫产术前胎盘植入部位诊断准确性、术前预处理情况及母儿妊娠结局。结果MDT组术前胎盘植入部位的诊断符合率高于非MDT组,MDT组的腹主动脉球囊阻断率及输尿管置管率均高于非MDT组,且MDT组的术中出血量、出血>2000 ml率、输红细胞量及子宫切除率均低于非MDT组,差异有统计学意义(P<0.05)。结论MDT诊疗模式可以提高前置胎盘伴胎盘植入部位的术前诊断准确性,利于术者制定个体化的精准治疗方案,能有效减少胎盘植入患者术中出血量、输血量,降低子宫切除率,在改善母儿妊娠结局中具有一定临床价值。

快速反应团队工作模式对重症孕产妇抢救效率及救治结局的影响

目的:观察对重症孕产妇实施快速反应团队(RRT)工作模式的干预效果。方法:回顾性收集2021年10月-2022年10月开展常规护理模式的148例重症孕产妇临床资料纳入对照组,2022年11月-2023年11月开展RRT工作模式的152例重症孕产妇临床资料纳入观察组。比较两组抢救效率、救治结局、新生儿情况、重症孕产妇并发症。结果:观察组处理时间(22.6±4.0min)、抢救情况(10.5%)、剖宫产率(35.5%)、新生儿死亡率(0)、ICU入住率(2.0%)、住院时间(7.56±1.34d)、并发症总发生率(2.6%)均少于对照组(33.0±4.5min、18.9%、52.0%、4.1%、27.7%、10.86±3.33d、12.2%),预警情况(40.1%)、有效处理率(98.0%)、5minApagar评分(8.74±0.58分)、脐带血pH值(7.64±1.96)高于对照组(27.7%、81.8%、8.46±0.64分、4.96±1.34)(均P<0.05),两组孕产妇死亡率、新生儿1minApagar评分无差异(P>0.05)。结论:RRT工作模式可提高重症孕产妇的抢救效率,改善救治结局、新生儿情况。

基于价值医疗的某医院精细化诊疗组服务现状分析

目的描述某医院4个同类型科室诊疗组现状并展开分析,为“最高性价比医疗”建设提供依据。方法采用CN-DRG比较诊疗组的医疗能力和住院服务效率,纳入DRG病组原位癌和非恶性病损子宫手术、单病种子宫肌瘤,采用Kruskal-Wallis H检验,比较住院日和费用差异。结果研究纳入22630例患者,诊疗组1总权重最高,为3948.62;诊疗组11最低,为133.55。诊疗组5费用消耗指数最低,为0.89;诊疗组2最高,为1.04。诊疗组11时间消耗指数最低,为0.48;诊疗组5最高,为0.81。在诊疗组对比中,住院日、总费用、诊断费、治疗费和耗材费差异均有统计学意义(P<0.05);在科室内部诊疗组对比中,科室1和2的住院日和费用差异均有统计学意义(P<0.05),科室3的诊断费、治疗费和耗材费差异均有统计学意义(P<0.05)。结论各诊疗组的服务能力对医院的贡献有明显差别且费用有差异,需合理评估患者住院时长和医疗成本,以实现最高性价比医疗。

重症急性胰腺炎评分量表及诊疗进展

重症急性胰腺炎死亡率高、病情变化快且常伴有一种甚至多种并发症。此文通过对各种胰腺炎评分量表的适用范围及优缺点的学习有助于临床医师评估病情及判断预后,同时文章对于重症急性胰腺炎的诊断、治疗进行了综述,以期为临床医生对于重症急性胰腺炎的诊疗提供参考。

Does in-house availability of multidisciplinary teams increase survival in upper gastrointestinal-cancer?

AIM: To investigate the effect of the establishment of in-house multidisciplinary team (MDT) availability (iMDTa) on survival in upper gastrointestinal cancer (UGI) patients. METHODS: In 2001, a cancer centre with irradiation and chemotherapy facilities was established in the Norwegian county of West Agder with a change of iMDTa (WA/MDT-Change). "iMDTa"-status was defined according to the availability of the necessary specialists within one institution on one campus, serving the population of one county. We compared survival rates during 2000-2008 for UGI patients living in counties with (MDT-Yes), without (MDT-No), with a mix (MDT-Mix) and WA/MDT-Change. Survival was calculated with Kaplan-Meier method. Cox model was used to uncover differences between counties with different MDT status when adjusted for age, sex and stage. RESULTS: We analyzed 395 patients from WA/MDT-Change and compared their survival to 12 135 UGIpatients from four other Norwegian regions. Median overall survival for UGI patients in WA/MDT-Change increased from 129 to 300 d from 2000-2008, P = 0.001. The regions with the highest level of iMDTa achieved the largest decrease in risk of death for UGI cancers (compared to the county with MDT-Mix: MDT-Yes 11%, P <0.05 and WA/MDT-Change 15%, P < 0.05). Analyzing the different tumour entities separately, patients living in the WA/MDT-Change county reached a statisti-cally significant reduction in the risk of death [hazard ratios (HR)] compared to patients in the county with MDT-Mix for oesophageal and gastric, but not for pan-creatic cancer. HR for the study period 2000-2004 are given first and then for the period 2005-2008: The HR for oesophageal cancers was reduced from [HR = 1.12; 95%CI: 0.75-1.68 to HR = 0.60, 95%CI: 0.38-0.95] and for gastric cancers from [HR = 0.87, 95%CI: 0.66-1.15 to HR = 0.63, 95%CI: 0.43-0.93], but not for pancreatic cancer [HR = 1.04-, 95%CI: 0.83-1.3 for 2000-2004 and HR = 1.01, 95%CI: 0.78-1.3 for 2005-2008]. UGI patients treated during the second study period in the county of WA/MDT-Change had a higher probability of receiving chemotherapy. In the first study period, only one out of 43 patients (2.4%, 95%CI: 0-6.9) received chemotherapy, compared to 18 of 42 patients diagnosed during 2005-2008 (42.9%, 95%CI: 28.0-57.8). CONCLUSION: Introduction of iMDTa led to a two-fold increase of UGI patients, whereas no increase in survival was found in the MDT-No or MDT-Mix counties.

线上线下融合的多学科诊疗服务模式实践

推进多学科诊疗(MDT)服务模式,促进线上线下MDT融合发展是公立医院高质量发展的要求。通过采取明确会诊患者准入条件,优化门诊申请流程,设定团队专家和联络员资质等措施,促进线上线下MDT业务融合。认为,线上线下MDT服务融合发展需要加强医疗质量同质化监管,以及业务流程一体化管理等。

Benefits of multidisciplinary collaborative care team-based nursing services in treating pressure injury wounds in cerebral infarction patients

BACKGROUND Cerebral infarction patients need to be bedridden for long periods of time often resulting in pressure injuries,which may represent a serious threat to patients'life and health.An effective nursing program should be adopted for timely intervention in patients with pressure wounds.AIM To explore the value of nursing services based on a multidisciplinary collaborative treatment team in patients with pressure injury wounds following cerebral infarction.METHODS Patients with cerebral infarction pressure injury wounds in our hospital from December 2016 to January 2021 were selected and divided into one study group and one control group based on the simple random number table method.The control group was treated with conventional nursing care(CNC),and the study group was treated with care services based on multidisciplinary collaborative care(MDCC).The Pressure Ulcer Scale for Healing(PUSH),healing effect,Self-Perceived Burden Score(SPBS),and satisfaction with the intervention were calculated before and after 2 and 4 wk of intervention in both groups.RESULTS Sixty-two patients were enrolled,and 31 patients were assigned to each group.The results of the interventions were as follows:(1)There was no significant difference between the PUSH scores of the MDCC group(11.19±2.46)and CNC group(12.01±2.79)before the intervention(P>0.05),and the PUSH scores were lower after 2 and 4 wk of intervention in the MDCC group(6.63±1.97 and 3.11±1.04)than in the CNC group(8.78±2.13 and 4.96±1.35 points)(P<0.05);(2)The rate of wound healing in the MDCC group(96.77%)was higher than that in the CNC group(80.65%)(P<0.05);(3)There was no significant difference between the SPBS scores of emotional factors(21.15±3.11),economic factors(9.88±2.15),and physical factors(8.19±2.23)in the two groups before the intervention.The scores of emotional factors(13.51±1.88),economic factors(6.38±1.44),and physical factors(5.37±1.08)were lower in the MDCC group than in the CNC group(16.89±2.05,7.99±1.68 and 7.06±1.19)after 4 wk of intervention(P<0.05);and(4)Satisfaction with the intervention was higher in the MDCC group(93.55%)than in the CNC group(74.19%)(P<0.05).CONCLUSION Interventions for patients with cerebral infarction pressure wounds based on an MDCC treatment team can effectively reduce patients'self-perceived burden,improve pressure wound conditions,facilitate wound healing,and increase patient satisfaction with the intervention.

Guidelines for the diagnosis and treatment of pancreatic cancer in China (2021)

The incidence of pancreatic cancer has been rising worldwide,and its clinical diagnosis and treatment remain a great challenge.To present the update and improvements in the clinical diagnosis and treatment of pancreatic cancer in recent years,Chinese Pancreatic Association,the Chinese Society of Surgery,Chinese Medical Association revised the Guidelines for the Diagnosis and Treatment of Pancreatic Cancer in China(2014)after reviewing evidence-based and problem-oriented literature published during 2015-2021,mainly focusing on highlight issues regarding diagnosis and surgical treatment of pancreatic cancer,conversion strategies for locally advanced pancreatic cancer,treatment of pancreatic cancer with oligo metastasis,adjuvant and neoadjuvant therapy,standardized processing of surgical specimens and evaluation of surgical margin status,systemic treatment for unresectable pancreatic cancer,genetic testing,as well as postoperative follow up of patients with pancreatic cancer.Forty recommendation items were finally proposed based on the above issues,and the quality of evidence and strength of recommendations were graded using the Grades of Recommendation,Assessment,Development,and Evaluation system.This guideline aims to standardize the clinical diagnosis and therapy,especially surgical treatment of pancreatic cancer in China,and further improve the prognosis of patients with pancreatic cancer.

基于专科团队指导的家庭康复治疗在孤独症谱系障碍患儿中的应用效果

目的:观察基于专科团队指导的家庭康复治疗在孤独症谱系障碍(ASD)患儿中的应用效果。方法:选取2019年12月至2021年5月该院收治的82例ASD患儿进行前瞻性研究,按照随机数字表法将其分为观察组与对照组各41例。对照组采用常规家庭康复治疗,观察组采用基于专科团队指导的家庭康复治疗。比较两组治疗前后临床症状[孤独症治疗评估量表(ATEC)]、强弱项及发展/适应程度[孤独症儿童心理教育评核第3版(PEP-3)]和运动能力[大肌肉动作发展测试第3版(TGMD-3)]评分。结果:治疗后,两组健康/生理/行为、感知/认知能力、表达/语言沟通、社交能力等ATEC评分均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05);治疗后,两组沟通合成分数、体能合成分数等PEP-3评分均高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05);治疗后,两组移动性动作、物体控制性动作等TGMD-3评分均高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。结论:基于专科团队指导的家庭康复治疗应用于ASD患儿可提高PEP-3和TGMD-3评分,降低ATEC评分,其效果优于常规家庭康复治疗。

Multidisciplinary,three-dimensional and individualized comprehensive treatment for severe/critical COVID-19

Severe/critical cases account for 18e20% of all novel coronavirus disease 2019(COVID-19)patients,but their mortality rate can be up to 61.5%.Furthermore,all deceased patients were severe/critical cases.The main reasons for the high mortality of severe/critical patients are advanced age(>60 years old)and combined underlying diseases.Elderly patients with comorbidities show decreased organ function and low compensation for damage such as hypoxia and inflammation,which accelerates disease progression.The lung is the main target organ attacked by severe acute respiratory syndrome coronavirus 2(SARSCoV-2)while immune organs,liver,blood vessels and other organs are damaged to varying degrees.Liver volume is increased,and mild active inflammation and focal necrosis are observed in the portal area.Virus particles have also been detected in liver cells.Therefore,multidisciplinary teams(MDTs)and individualized treatment plans,accurate prediction of disease progression and timely interventions are vital to effectively reduce mortality.Specifically,a“multidisciplinary three-dimensional management,individualized comprehensive plan”should be implemented.The treatment plan complies with three principles,namely,multidisciplinary management of patients,individualized diagnosis and treatment plans,and timely monitoring and intervention of disease.MDT members are mainly physicians from critical medicine,infection and respiratory disciplines,but also include cardiovascular,kidney,endocrine,digestion,nerve,nutrition,rehabilitation,psychology and specialty care.According to a patient's specific disease condition,an individualized diagnosis and treatment plan is formulated(one plan for one patient).While selecting individualized antiviral,anti-inflammatory and immunomodulatory treatment,we also strengthen nutritional support,psychological intervention,comprehensive rehabilitation and timely and full-course intervention to develop overall and special nursing plans.In response to the rapid progression of severe/critical patients,MDT members need to establish a three-dimensional management model with close observation and timely evaluation.The MDT should make rounds of the quarantine wards both morning and night,and of critical patient wards nightly,to implement“round-theclock rounds management”,to accurately predict disease progression,perform the quick intervention and prevent rapid deterioration of the patient.Our MDT has cumulatively treated 77 severe/critical COVID-19 cases,including 62(80.5%)severe cases and 15(19.5%)critical cases,with an average age of 63.8 years.Fifty-three(68.8%)cases presented with more than one underlying disease and 65(84.4%)severe cases recovered from COVID-19.The average hospital stay of severe/critical cases was 22 days,and the mortality rate was 2.6%,both of which were significantly lower than the 30e40 days and 49.0e61.5%,respectively,reported in the literature.Therefore,a multidisciplinary,three-dimensional and individualized comprehensive treatment plan can effectively reduce the mortality rate of severe/critical COVID-19 and improve the cure rate.

Survey on the current status of the diagnosis and treatment of pancreatic cancer in public tertiary hospitals in China:a cross-sectional questionnaire-based,observational study

Objective:Pancreatic cancer is one of the most aggressive digestive system malignant tumors,and its clinical diagnosis and treatment are still challenging.To further understand the current status and improve the multidisciplinary collaboration for diagnosis and treatment of pancreatic cancer in China,we conducted an online questionnaire survey on the diagnosis and treatment status of pancreatic cancer in public tertiary hospitals of China in 2021.Methods:In this cross-sectional questionnaire-based,observational study,online questionnaires with real-name authentication were used to gather data from 500 clinicians,50 pharmacists,and 1000 pancreatic cancer patients in tertiary general hospitals or cancer hospitals nationwide.Results:A total of 485 valid questionnaires were obtained from the clinicians,majority of whom were from economically better developed regions or cities of China.There were multi-disciplinary team treatment(MDT)clinics for pancreatic cancer patients in 60%of the hospitals.Minimally invasive surgeries could be performed in all the surveyed hospitals.However,open surgery was still the mainstream choice in most cases.Gemcitabine-based chemotherapy was the most popular first-line adjuvant regimen for pancreatic cancer.A total of 50 valid questionnaires were collected from pharmacists,48%of them are not satisfactory with the efficacy of the chemotherapeutic drugs,and myelosuppression,liver,and renal damage were the most concerning side effects.In total,1011 valid questionnaires were collected from the patients.Approximately,48.4%of the patients did not know about pancreatic cancer before becoming ill.Over 80%of pancreatic cancer patients reported poor to very poor health-related quality of life,and the estimated overall medical expenses were within<400,000($58823.53)in 80%of the patients.Clinicians,pharmacists,and patients believe that popularizing scientific knowledge of pancreatic cancer,constructing MDT clinics and fast-lane system,and conducting clinical research will help further improve the diagnosis and treatment of pancreatic cancer.Conclusions:The MDT clinics for pancreatic cancer have been well developed in most of the public tertiary hospitals.Minimally invasive pancreatic surgery has developed rapidly in China;however,open surgery is still the mainstream choice for pancreatic cancer.The proportion of adjuvant treatment has been significantly improved,and the gemcitabine-based regimen is the most commonly used first-line regimen.Most of the public still lacks the general knowledge of pancreatic cancer,needing further popularization.The construction of a fast-lane treatment system and conducting of high-level clinical studies are the warm expectations of the clinicians and patients.The real-world situation of the diagnosis and treatment of pancreatic cancer in the other types of hospitals of China needs further exploration.

脑损伤患儿的多学科协作诊疗模式效果评估

目的 总结曲靖市妇幼保健院儿科对脑损伤患儿实施多学科协作诊疗模式(multi-disciplinary team,MDT)的诊疗经验,评估多学科诊疗模式对新生儿脑损伤的诊疗效果。方法 收集2019年11月至2023年4月在曲靖市妇幼保健院儿科诊治的脑损伤患儿的临床资料,将2019年10月至2020年6月收治的脑损伤患儿485例作为非MDT组,2020年7月至2023年4月收治的脑损伤患儿405例作为MDT组,采用统计学方法对2组患儿的临床资料进行对比分析。结果 890例脑损伤患儿中有男519例,女371例。2组患儿年龄中位数及四分位数分别为MDT组2.00(0.82,5.00)岁,非MDT组1.00(1.00,4.00)岁。2组患儿脑损伤类型均以颅脑损伤为主,且在颅脑损伤及颅内出血患儿中,MDT组的治愈率均高于非MDT组,差异均有统计学意义(P<0.05)。MDT组的405例患儿中有154(38.0%)例行手术治疗,非MDT组的485例患儿中有121(24.9%)例行手术治疗,差异有统计学意义(P <0.05)。MDT组23.2%的患儿在住院期间出现危重情况,显著低于非MDT组的30.5%,差异均具有统计学意义(P <0.05);MDT组的未愈率(2.0%)也显著低于非MDT组(5.6%),且MDT组的治愈率(40.5%)显著高于非MDT组(34.4%),差异均有统计学意义(P <0.05);MDT组患儿的治疗费、药品费、卫生材料费均低于非MDT组,差异均具有统计学意义(P <0.05)。脑损伤患儿治愈率的多因素Logistic回归模型分析结果显示,利用MDT模式诊治脑损伤能有效提高脑损伤患儿的治愈率(RR=1.513,95%CI=1.134~2.020)。实际住院天数的多重线性回归模型分析结果显示:MDT对患儿的实际住院天数的影响无统计学意义(P> 0.05)。结论 利用MDT模式诊治脑损伤患儿有利于提高治愈率,降低患儿疾病加重的风险,使脑损伤患儿获得明显疗效,MDT模式值得在脑损伤患儿中推广应用。

肺癌脊柱转移瘤治疗模式及治疗方式的临床研究进展

脊柱是肺癌远处转移的常见部位,严重影响患者的生活质量。随着医疗水平的提高,肺癌脊柱转移瘤的发病率逐年增加。在多学科治疗模式的推进下,针对肺癌脊柱转移瘤的放疗、化疗、手术治疗等方式取得新的研究进展,同时其治疗模式和决策模式也不断发生新的变化,取得了较为满意的临床效果。目前,多学科模式下根据新型决策模式制订最合适的综合治疗方案,使患者获得更高的生活质量和更长的生存期是治疗的大趋势。现本文对肺癌脊柱转移瘤治疗模式及治疗方式的研究进展进行综述总结,为临床治疗脊柱转移瘤提供参考。

以创伤医师为主导的多学科协作模式对血流动力学不稳定骨盆骨折的早期救治效果评估

目的探讨以创伤医师为主导的多学科协作(MDT)模式对血流动力学不稳定骨盆骨折的早期救治效果。方法选取2020年7月至2023年7月北京积水潭医院贵州医院收治的280例血流动力学不稳定骨盆骨折患者作为研究对象,根据救治模式分为观察组(140例)和对照组(140例)。观察组实施创伤医师为指导的MDT救治模式,对照组实施传统救治模式。比较两组死亡率、入院时及入院后生命体征、实验室指标、治疗情况及诊疗时间。结果两组入院后24 h内死亡率比较,差异无统计学意义(P>0.05);两组入院时收缩压、心率、血红蛋白、血小板计数、血乳酸比较,差异无统计学意义(P>0.05);入院后6、24 h,观察组收缩压高于对照组,观察组心率低于对照组,差异有统计学意义(P<0.05);入院后24 h,观察组血红蛋白、血小板计数高于对照组,观察组血乳酸低于对照组,差异有统计学意义(P<0.05);观察组输血量低于对照组,ICU住院时间、急诊通过时间、早期救治时间短于对照组,差异有统计学意义(P<0.05)。结论创伤医师为主导的MDT模式在血流动力学不稳定骨盆骨折的早期救治中,可有效提高患者生命体征的稳定性,缩短治疗相关时间。