Objective To explore the efficacy of multidisciplinary nutritional support model in the perioperative management of elderly patients with nutritional risks undergoing joint replacement. Methods Between March 1, 2014 and May 31, 2015, 342 elderly patients who underwent joint replacement due to osteoarthritis were screened with nutritional risk screening 2002 (NRS2002). For patients who got a NRS2002 score of equal to 3 points or higher, nutritional treatment and intervention was carried out by doctor-nurse-rehabilitation therapist-dietitian collaboration and hospital departments related to patients’ complications. Results Among all the 342 patients, 225 (65.79%) had a NRS2002 score of equal to 3 points or higher on the admission day, in which 117 (52.00%) were male and 108 (48.00%) were female, 168 (74.67%) were at the age between 60 and 70 years old and 57 (25.33%) were at the age between 71 and 87. One day before surgery, the number of patients with a NRS2002 score equal to 3 points or higher decreased to 10 (2.92%), and the number became 68 (19.88%) after surgery. The difference was statistically significant (P<0.05). In those 68 elderly patients, 10 had a preoperative NRS2002 score equal to 3 points or higher, and 58 had newly developed nutritional risks after surgery; there were 23 patients with an age over 75, and 7 over 80. The NRS2002 score of all the 342 patients was below 3 points before discharge. For patients with nutritional risks at different periods before and after surgery, their serum albumin and hemoglobin levels were both improved after the treatment of nutritional support (P<0.05). Conclusion Multidis- ciplinary nutritional support for elderly perioperative patients undergoing joint replacement can reduce the incidence of postoperative complications, providing favorable conditions for the patients to undergo joint replacement surgery.
ObjectiveTo investigate the effectiveness of multidisciplinary doctor-nurse collaboration team on the perioperation management of geriatric patients with hip fractures.MethodsThe clinical data of 489 geriatric patients with hip fractures (femoral neck fracture and intertrochanteric fracture) between January 1st 2016 and January 1st 2018 was retrospectively analyzed. Among them, 279 patients were treated with the multidisciplinary doctor-nurse collaboration care (observation group) and 210 patients were treated with the conventional therapeutics and nursing care (control group). There was no significant difference in gender, age, cause of injury, type and classification of fracture, the interval between injury and admission, and Charlson index between the two groups (P>0.05). The surgery rates, time from hospitalization to operation, length of stay, and the incidences of perioperative complications were compared between the two groups.ResultsThe surgery rate was 90.32% (252/279) in observation group and 80.48% (169/210) in control group, showing significant difference between the two groups (χ2=9.703, P=0.002). The time from hospitalization to operation and length of stay in observation group [(5.39±2.47), (10.56±3.76) days] were significant shorter than those in control group [(6.13±2.79), (12.27±3.11) days] (t=−3.075, P=0.002; t=−5.330, P=0.000). The incidence of respiratory complications was 46.15% in control group and 30.56% in observation group; the incidence of cardiovascular system complications was 69.23% in control group and 51.19% in observation group; the incidence of cerebrovascular system complications was 20.12% in control group and 11.11% in observation group; the incidence of deep venous thrombosis was 40.24% in control group and 25.40% in observation group. The incidences of perioperative complications were significantly lower in observation group than in control group (P<0.05).ConclusionMultidisciplinary doctor-nurse collaboration team is conducive not only to improve the surgery rates, but also to reduce perioperative complications as well as shorten the length of stay and preoperative waiting time.
ObjectiveTo investigate multidisciplinary collaborative role in the treatment of patients with lower extremity degloving injury. MethodsThe wound therapy group and the Department of Orthopedics, Nutrition, and Psychology, and the Pain Clinic and Rehabilitation team collaboratively carried out the comprehensive intervention for a patient with lower extremity degloving injury in March 2013 in our hospital. The wound therapist was responsible for correct evaluation, debridement, infection control, maintaining moisture balance, and protecting wound edges of the skin; The wound team members were responsible for the entire treatment and healing process in the form of text and photos; Department of Orthopedics was responsible for secondary skin graft; Nutrition division was responsible for the correction of anemia in patients with hypoalbuminemia; Psychological service was responsible for psychological counseling as treatment accident sometimes brought psychological trauma; Pain outpatient service was responsible for consultation, formulating specific plans to control and relieve the patient's pain, and promote the patient's physical and mental rehabilitation process; Rehabilitation division was responsible for the guidance of patients on lower limb function exercise, prevention of knee joint rigidity, muscle stiffness, to promote the functional recovery of lower limbs. ResultsThe patient's wound was healed completely without scar or joint contracture. Function of lower limbs recovered to normal. Patients was very satisfied to the treatment, and had a total full recovery of body and mind, and returned to the family and society. ConclusionMultidisciplinary collaboration treatment for patients with lower extremity degloving injury can ease pain, eliminate psychological barriers, promote wound healing, and maintain the limb function.
With the increasing number of chronic kidney disease (CKD) population globally, establishing an optimal model of CKD care has become an important issue. The major contents of CKD care include patient education, control of CKD risk factors (such as increased blood pressure and glucose), management of CKD complications, and preparation process of renal replacement therapy in pre-dialysis patients. Compared with other non-communicable diseases management, evidence-based evidence related to CKD care is limited. Based on the related studies worldwide, combined with the characteristics of CKD population and previous experiences in China, this paper discusses the management mode of non-dialysis CKD population.
Diabetic foot infection (DFI) is one of the main causes of hospitalized patients with diabetic foot. DFI should be diagnosed according to the clinical manifestations, and the severity of infection should be graded in time. Diabetic foot wounds are mostly chronic wounds, and there are many kinds of bacterial infections. The bacteria and antibiotics resistance will change with the progress of the disease. Bacterial biofilm is also one of the important causes of antibiotic resistance. Reasonable and timely surgical treatment combined with effective antibiotic treatment is an effective measure to deal with the challenge of DFI. On this basis, multidisciplinary cooperation will achieve the best clinical outcome.
Objective To investigate the application effect of ndividualized dietary care based on a multidisciplinary collaboration model on glycemic control, neurological recovery, dietary self-management, and satisfaction in stroke patients with abnormal blood glucose. Methods Patients with stroke and abnormal blood glucose admitted to the Department of Neurology, Shangjin Hospital, West China Hospital, Sichuan University between March and October 2024 were enrolled. Using SPSS 26.0 software, a random allocation sequence was generated to divide participants into an observation group and a control group. The control group received comprehensive nursing interventions, while the observation group received additional multidisciplinary collaboration model based individualized dietary care. Both groups were intervened until discharge. Glycemic indicators [glycated albumin (GA), fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hPG)], neurological recovery, dietary adherence, and patient satisfaction were compared pre-intervention and post-intervention (at discharge). Results A total of 112 patients were included, with 56 patients in each group. At the post-intervention stage, GA, FBG and 2hPG in the observation group were lower than those in the control group (P<0.05), and the scores of the Dietary Compliance Scale for Type 2 Diabetes were higher than those in the control group (P<0.05). Except for admission (3.27±0.86 vs. 3.25±0.90, P＞0.05), the modified Rankin Scale scores of the observation group were lower than those of the control group at discharge (3.14±0.86 vs. 3.17±0.86), 30-days follow-up (2.93±0.76 vs. 3.02±0.84), and 90-days follow-up (1.05±0.80 vs.1.43±1.01) (P<0.05). The comparison results within the group showed that, there were significant differences in GA, FBG, 2hPG, modified Rankin Scale scores and Dietary Compliance Scale for Type 2 Diabetes between admission and discharge (P<0.05). The satisfaction rate of the observation group was higher than that of the control group (97.78% vs. 86.76%; χ2=3.877, P=0.049). Conclusion Multidisciplinary collaboration model based individualized dietary care improves short-term glycemic control, promotes long-term neurological recovery, enhances dietary adherence, and increases patient satisfaction in stroke patients with abnormal blood glucose, demonstrating clinical value for widespread application.
ObjectiveTo investigate the effect of multidisciplinary team (MDT) on perioperative complications and clinical efficacy of patients who were receiver radical operation to treat lung cancer by video-assisted thoracoscopic surgery (VATS). MethodsEighty patients in the Thoracic Surgery Department of First Hospital of Lanzhou University from December 2017 to February 2019 who were diagnosed lung cancer were divided into two groups. Forty patients in the MDT group were treated with MDT discussion. The control group consisted of 40 patients who were treated without MDT discussion. The incidence of postoperative complications and clinical efficacy were compared between the two groups . ResultsThere was no statistical difference in incision infection, atelectasis, pleural effusion and pulmonary leakage between the two groups. However, the incidence of postoperative pulmonary infection (5% vs. 20%, P=0.043) and the overall postoperative complications (17.5% vs. 42.5%, P=0.015) in the MDT group was lower than that in the control group with a statistical difference. In the MDT group, the operative time (140.3±8.0 min vs. 148.8±6.8 min, P<0.001), intraoperative bleeding ( 207.8±19.4 mL vs. 222.0±28.3 mL, P=0.010), lymph node dissection number (25.1±6.2 vs. 20.1±7.0, P=0.001), postoperative drainage (273.0±33.5 mL vs. 24.0±52.5 mL, P<0.001), drainage duration (81.9±6.1 h vs. 85.3±8.1 h, P=0.039), pain on the first day after surgery (4.6±0.7 vs. 5.4±0.7), P<0.001), pain on the second day (2.5±0.7 vs. 3.0±0.8, P=0.002), pain on the third day (1.1±0.8 vs. 1.5±0.6, P=0.014), postoperative activity time (40.7±6.7 h vs. 35.3±7.1 h, P<0.001), postoperative recovery time (6.8±0.9 d vs. 7.4±0.7 d, P=0.003), patient satisfaction (8.1±1.4 vs. 7.2±2.0, P=0.020) were significantly better than those of the control group with statistical differences. But there was no statistical difference in the conversion to thoracotomy between the two group. ConclusionMDT discussion can reduce the surgical risk and postoperative complications, improve the clinical efficacy and accelerate the postoperative rehabilitation of patients, which has a good clinical significance.
Objective To develop a multidisciplinary nursing program for Prader-Willi syndrome with spinal deformity and evaluate its effectiveness in clinical practice. Methods In July 2016, a multidisciplinary collaborative team was established before the treatment of children with Prader-Willi syndrome complicated with spinal deformity. For the nursing difficulties in the perioperative period, relevant literature was consulted, and a multidisciplinary collaborative nursing plan was formulated, which included nutrition management and blood glucose control, management of obstructive sleep apnea hypopnea syndrome, behavioral intervention related to mental change, and early identification and management of complications. The developed multidisciplinary collaborative nursing program was applied to three children with Prader-Willi syndrome complicated with spinal deformity in Peking Union Medical College Hospital from July 2016 to October 2018, and their postoperative recovery was evaluated. Results One child had inguinal skin ulceration when admitted to hospital, which was significantly improved after active treatment. The perioperative blood glucose level control of the three children was satisfactory, and there was no postoperative gastrointestinal dysfunction, deep wound infection, respiratory complications, internal fixation failure or other complications, and no asphyxia, fall, loss, or other adverse events. The follow-up compliance after discharge was 100%. Conclusions Multidisciplinary collaboration programs can escort patient’ safety and promote their recovery, improve the professional level of nursing staff, and reflect the nursing value. As a working mode, it can be further popularized and used for reference in the nursing of other difficult diseases.
Traditional Chinese medicine (TCM) is a treasure of the Chinese nation. Presence of clinical effects represents a fundamental issue for TCM development. Nevertheless, the complexities of TCM interventions often result in presented effects deviating from expected ones, a phenomenon so called as "effect off-target"; this issue has become a major challenge for the development and use of TCM interventions. In continuing efforts, we have proposed an innovative evidence-based medicine model for studying the effects of TCM interventions, termed "systems evidence-based medicine (sysEBM)". Essentially, the sysEBM model integrates clinical and non-clinical evaluation to develop a systematic pathway for studying effects of TCM interventions, and the methodological steps typically include the development of PICO framework for a putative effect, exploration of the effect and confirmation of the effect by using animal models, observational studies and clinical trials. As an additional step, multidisciplinary technologies including pharmaceutical, pharmacological, information and biological technologies will be used to provide multidimensional analyses of potential action networks and mechanisms of TCM interventions. Building on this concept, we have developed a sysEBM model ("6R" model) for acupuncture and marketed Chinese patent medicines by integrating real-world evidence, clinical trials, evidence syntheses, and rapid recommendation methodologies, as well as information technology and biomedical technologies. We also applied this model for developing TCM interventions for maternal health, critical care, and knee osteoarthritis.
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.