Objective:To explore the experiences of palliative care multidisciplinary teams from the perspective of pluralistic synergy theory,aiming to enhance team collaboration.Method:Utilizing a qualitative research methodolo...Objective:To explore the experiences of palliative care multidisciplinary teams from the perspective of pluralistic synergy theory,aiming to enhance team collaboration.Method:Utilizing a qualitative research methodology,we conducted in-depth interviews with 15 palliative care team members to collect data.Results:The operational framework of palliative care multidisciplinary teams under pluralistic synergy theory involves:enhancing collaboration among team members;developing a comprehensive management model for the team;rationalizing the allocation of work tasks and durations;improving team communication and interaction through effective communication mechanisms and platforms;cultivating skilled professionals;and establishing a robust health record management system.Conclusion:The operational mechanism,informed by pluralistic synergy theory,advances the development of palliative care.展开更多
BACKGROUND Arthroscopic rotator cuff repair is a common surgical treatment for rotator cuff injuries(RCIs).Although this procedure has certain clinical advantages,it requires rehabilitation management interventions to...BACKGROUND Arthroscopic rotator cuff repair is a common surgical treatment for rotator cuff injuries(RCIs).Although this procedure has certain clinical advantages,it requires rehabilitation management interventions to ensure therapeutic efficacy.AIM To investigate the effect of integrated traditional Chinese medicine and Western medicine(TCM-WM)under the multidisciplinary team(MDT)model on the postoperative recovery of patients undergoing arthroscopic surgery for RCIs.METHODS This study enrolled 100 patients who underwent arthroscopic rotator cuff repair for RCIs at the Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine between June 2021 and May 2024.They were divided into a control group(n=48)that received routine rehabilitation treatment and an experimental group(n=52)that received TCM-WM under the MDT model(e.g.,acupuncture,TCM traumatology and orthopedics,and rehabilitation).The results of the Constant–Murley Shoulder Score(CMS),Visual Analogue Scale(VAS),Shoulder Pain and Disability Index(SPADI),muscular strength evaluation,and shoulder range of motion(ROM)assessments were analyzed.RESULTS After treatment,the experimental group showed significantly higher CMS scores in terms of pain,functional activity,shoulder joint mobility,and muscular strength than the baseline and those of the control group.The experimental group also exhibited significantly lower VAS and SPADI scores than the baseline and those of the control group.In addition,the experimental group showed significantly enhanced muscular strength(forward flexor and external and internal rotator muscles)and shoulder ROM(forward flexion,abduction,and lateral abduction)after treatment compared with the control group.CONCLUSION TCM-WM under the MDT model improved shoulder joint function,relieved postoperative pain,promoted postoperative functional recovery,and facilitated the recovery of muscular strength and shoulder ROM in patients with RCIs who underwent arthroscopic rotator cuff repair.展开更多
AIM: To evaluate the effect of multidisciplinary team (MDT) treatment modality on outcomes of patients with gastrointestinal malignancy in China. METHODS: Data about patients with gastric and colorectal cancer treated...AIM: To evaluate the effect of multidisciplinary team (MDT) treatment modality on outcomes of patients with gastrointestinal malignancy in China. METHODS: Data about patients with gastric and colorectal cancer treated in our center during the past 10 years were collected and divided into two parts. Part 1 consisted of the data collected from 516 consecutive complicated cases discussed at MDT meetings in Peking University School of Oncology (PKUSO) from December 2005 to July 2009. Part 2 consisted of the data collected from 263 consecutive cases of resect-able locally advanced rectal cancer from January 2001 to January 2005. These 263 patients were divided into neoadjuvant therapy (NT) group and control group. Patients in NT group received MDT treatment, namely neoadjuvant therapy + surgery + postoperative adjuvant therapy. Patients in control group underwent direct surgery + postoperative adjuvant therapy. The outcomes in two groups were compared. RESULTS: The treatment strategy was altered after discussed at MDT meeting in 76.81% of gastric cancer patients and in 58.33% of colorectal cancer patients before operation. The sphincter-preservation and local control of tumor were better in NT group than in control group. The 5-year overall survival rate was also higher in NT group than in control group (77.23% vs 69.75%, P = 0.049). CONCLUSION: MDT treatment modality can significantly improve the outcomes of patients with gastrointestinal malignancy in China.展开更多
Multidisciplinary team （MDT） model is a diagnostic and treatment model characterized by interdisciplinarity, integration, centralism, individualization, and precision and is becoming more common in the management of...Multidisciplinary team （MDT） model is a diagnostic and treatment model characterized by interdisciplinarity, integration, centralism, individualization, and precision and is becoming more common in the management of complex malignancies. MDT emphasizes team spirit and a personalized treatment strategy according to the actual condition of each patient. A cooperative and effective multidisciplinary team is an important guarantee for delivering high-quality services to patients. Under the guidance of a medical humanistic concept, MDT provides reasonable, effective, convenient, and a full range of excellent quality medical service to patients. The MDT maximizes patient benefits, and it is the developmental direction for large-scale general hospitals. At the same time, the MDT is also an important measure to strengthen the core competitiveness of hospitals. Here, we introduce the clinical application of the model in tumor therapy as well as the current state and development in our hospital.展开更多
The multidisciplinary approach is beneficial to the treatment of gastrointestinal stromal tumors(GISTs).However,pharmacists are seldom incorporated into a multidisciplinary team(MDT)of GIST.In the present study,we eva...The multidisciplinary approach is beneficial to the treatment of gastrointestinal stromal tumors(GISTs).However,pharmacists are seldom incorporated into a multidisciplinary team(MDT)of GIST.In the present study,we evaluated the clinical and economic benefits of a pharmacist in an MDT of GIST.This was a retrospective study that included 240 GIST patients receiving imatinib therapy.The GIST MDT pharmacist developed and validated an HPLC method to monitor the trough concentrations of imatinib in GIST patients.Besides,the pharmacist also provided patient education and pharmaceutical care services and collected the data for analysis.The 240 GIST patients received the services provided by the pharmacist.The trough concentrations in 25.42%of the 240 patients were less than 1100 ng/m L.The main genotypes of 121 in the 240 patients were KIT exon 11 mutations,wild type,and KIT exon 9 mutations.Moreover,13 GIST patients with trough concentrations less than 1100 ng/m L were confirmed to have low compliance.The adverse reactions were primarily mild and tolerable,except that 13 GIST patients were adjusted to lower doses because of the intolerable adverse reactions.The daily cost could be lowered by monitoring the trough concentrations and dose reductions.Collectively,a pharmacist included in a GIST MDT could increase the compliance of Chinese GIST patients to imatinib therapy and improve the efficacy,safety,and economy of imatinib therapy.展开更多
BACKGROUND Perioperative hypothermia(PH)negatively affects the physical and mental health of patients to varying degrees.Currently,there is no effective multidisciplinary team(MDT)intervention for gynecological patien...BACKGROUND Perioperative hypothermia(PH)negatively affects the physical and mental health of patients to varying degrees.Currently,there is no effective multidisciplinary team(MDT)intervention for gynecological patients with PH.AIM To apply the best evidence on the prevention and management of PH in gynecological patients,improve the quality of perioperative evidence-based care based on treatment by an MDT for gynecological patients and analyze the effect of MDT-and evidence-based practice(EBP)projects on the psychological status and cognitive function of gynecological patients with PH.METHODS Under the guidance of knowledge translation and combined with the opinions of involved stakeholders and clinical experts,the best evidence for PH prevention and management in gynecological patients was selected and adjusted to suit the practice setting.Based on the evidence,the practice plan was developed,and the MDT intervention was carried out in the preoperative ward,the preoperative preparation room,the intraoperative operating room,the postanesthesia care unit,and the 24-hour postoperative gynecological ward through the EBP program.The incidence of hypothermia,the nurses’awareness,the implementation rate of examination indicators,and the thermal comfort level,psychological status and cognitive function of patients were compared before and after the implementation of the program.RESULTS The incidence of PH in gynecological patients decreased from 43.33%to 13.33%after the implementation of the scheme.The implementation rate of examination indicators 6-10,12,14,16-18,21,and 22 reached 100%,and that of other indicators was above 90%,except for examination indicators 5 and 13,which was 66.67%;the indices were significantly improved compared with the baseline(before evidence application)(P<0.05).The score of nurses'awareness of PH prevention and management in gynecological patients increased from 60.96±9.70 to 88.08±8.96,and the difference was statistically significant(P<0.001).The total score of the perioperative thermal comfort level of patients undergoing gynecological surgery was 27.97±2.04,which was significantly increased compared with the score of 21.27±1.57 observed by researchers at baseline(P<0.001).The perioperative Hamilton Depression Scale and Hamilton Anxiety Scale scores of patients undergoing gynecological surgery decreased from 15.03±3.16 and 13.93±2.64 to 4.30±1.15 and 3.53±0.78,respectively,with statistically significant differences(P<0.001).The perioperative Montreal Cognitive Assessment Scale score of the gynecological surgery patients increased from 23.17±1.68 to 26.93±1.11,also with statistical significance(P<0.001).CONCLUSION MDT-based EBP for PH prevention and management in gynecological patients during the perioperative period can standardize nursing operations,improve nurses'awareness and behavioral compliance with gynecological hypothermia management,and reduce the occurrence of PH in gynecological patients while playing a positive role in reducing patients’negative emotions and enhancing their cognitive function.展开更多
BACKGROUND Adrenocortical carcinoma(ACC)is a rare malignant epithelial tumor originating from adrenocortical cells that carries a very poor prognosis.Metastatic or inoperable diseases are often considered incurable,an...BACKGROUND Adrenocortical carcinoma(ACC)is a rare malignant epithelial tumor originating from adrenocortical cells that carries a very poor prognosis.Metastatic or inoperable diseases are often considered incurable,and treatment remains a challenge.Especially for advanced cases such as ACC complicated with renal venous cancer thrombus,there are few cumulative cases in the literature.CASE SUMMARY The patient in this case was a 39-year-old middle-aged male who was admitted to the hospital for more than half a month due to dizziness and chest tightness.Computed tomography(CT)findings after admission revealed a left retroperitoneal malignant space-occupying lesion,but the origin of the formation of the left renal vein cancer thrombus remained to be determined.It was speculated that it originated from the left adrenal gland,perhaps a retroperitoneal source,and left adrenal mass+left nephrectomy+left renal vein tumor thrombus removal+angioplasty were performed under general anesthesia.Postoperative pathology results indicated a diagnosis of ACC.Postoperative steroid therapy was administered.At 3 mo after surgery,abdominal CT reexamination revealed multiple enlarged retroperitoneal lymph nodes and multiple low-density shadows in the liver,and palliative radiotherapy and mitotane were administered,considering the possibility of metastasis.The patient is currently being followed up.CONCLUSION ACC is a highly malignant tumor.Even if the tumor is removed surgically,there is still the possibility of recurrence.Postoperative mitotane and adjuvant chemoradiotherapy have certain benefits for patients,but they cannot fully offset the poor prognosis of this disease.展开更多
Current Status of Diagnosis and Treatment of Colorectal Liver Metastases Colorectal cancer(CRC)is one of the most common malignant tumors of the digestive tract.According to the tumor registration data collected by th...Current Status of Diagnosis and Treatment of Colorectal Liver Metastases Colorectal cancer(CRC)is one of the most common malignant tumors of the digestive tract.According to the tumor registration data collected by the National Cancer Registry Center,the number of new cases of malignant tumors in 2022 was estimated to be 4.83 million(2.53 million in males and 2.30 million in females).Of these,approximately 517,100 were CRC,which ranks second among malignant tumors in incidence.展开更多
[Objective]To evaluate the efficacy of adding multidisciplinary team(MDT)-led meridian-acupointmassage toconventional treatment forinfants with community-acquired pneumonia(CAP).[Methods]In this randomized trial,100 i...[Objective]To evaluate the efficacy of adding multidisciplinary team(MDT)-led meridian-acupointmassage toconventional treatment forinfants with community-acquired pneumonia(CAP).[Methods]In this randomized trial,100 infants with CAP were assigned to a control group(n=50)receiving conventional therapy or an intervention group(n=50)receiving conventional therapy plusMDT-led meridian-acupoint massage.Clinical efficacy,symptom resolution time,hospital stay,and family satisfaction were compared.[Results]Compared to the control group,the interventiongroup showed a significantly higher total effective rate(94.0% vs.78.0%),faster resolution of fever,cough,and pulmonary rales,a shorter hospital stay,and higher family satisfaction(96.0% vs.80.0%)(all P<0.05).[Conclusion]Adding MDT-led meridian-acupoint massage to conventional therapyimproves clinical outcomes,shortens recovery time,and increases family satisfaction for infants withCAP,demonstrating its strong potential for clinical application.展开更多
BACKGROUND Postoperative patients with gastrointestinal tumors are at high risk for poor wound healing and psychological distress,such as anxiety and depression,which can negatively impact recovery and quality of life...BACKGROUND Postoperative patients with gastrointestinal tumors are at high risk for poor wound healing and psychological distress,such as anxiety and depression,which can negatively impact recovery and quality of life.Multidisciplinary team(MDT)collaborative nursing has emerged as a comprehensive care approach that may address both physical and psychological needs.AIM To explored the impact of MDT collaborative nursing on wound healing and anxiety/depression symptoms in postoperative patients with gastrointestinal tumors.METHODS A retrospective analysis was conducted on 364 patients with gastrointestinal tumours admitted to our hospital between January 2022 and December 2024.Based on differing postoperative nursing approaches,two groups were established:the MDT group(n=196)and the control group(n=168).The control group received conventional nursing interventions,while the MDT group received MDT collaborative nursing.The study compared wound healing outcomes,pre-intervention and one-month post-intervention Hospital Anxiety and Depression Scale(HADS)scores,Functional Assessment of Cancer Therapy-General(FACT-G)quality of life scores,and complication rates between the two groups.RESULTS The MDT group demonstrated a Grade A wound healing rate of 88.27%and total treatment compliance of 99.49%,both significantly higher than the control group(75.00%and 95.83%,respectively).The complication incidence rate was 3.06%in the MDT group,lower than the control group(8.93%),with all differences statistically significant(P<0.05).After one month of intervention,patients in the MDT group demonstrated lower Anxiety Self-Rating Scale and Depression Self-Rating Scale scores on the HADS scale compared to the control group.Conversely,their scores on the FACT-G scale for physical,social/family,emotional,and functional domains were higher than those in the control group,with all differences being statistically significant(P<0.05).CONCLUSION MDT collaborative care promotes wound healing in patients undergoing gastrointestinal tumour surgery,alleviates anxiety and depressive symptoms,enhances treatment adherence and quality of life,and reduces the incidence of complications.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)present a significant healthcare challenge attributable to their high rates of disability and the limitations of applied traditional nursing approaches.Effective management is crit...BACKGROUND Diabetic foot ulcers(DFUs)present a significant healthcare challenge attributable to their high rates of disability and the limitations of applied traditional nursing approaches.Effective management is critical for uneventful health outcomes.AIM To investigate the effects of multidisciplinary team(MDT)nursing interventions and blood glucose control on the negative emotions and satisfaction of DFUhealing patients.METHODS This retrospective cohort study included 115 patients with DFUs,divided into MDT and blood glucose control intervention group(n=60)and standard care control group(n=55).The comparison factors were wound area,new granulation tissue coverage area,wound healing rate,2-hour postprandial blood glucose level,fasting plasma glucose level,Hamilton Anxiety Scale score,Hamilton Depression Scale score,and nursing satisfaction.RESULTS After 4 weeks,the average wound area reduced from 22.04±6.48 cm^(2)to 11.96±3.63 cm^(2)(P<0.05).New granulation tissue coverage area reached 52.85±18.39 cm^(2) for the intervention group and 28.39±9.94 cm^(2)(P<0.05)in the control group,respectively.The healing rate was significantly higher in the intervention group than in the control group(91.7%vs 76.4%,P<0.05).Fasting plasma glucose decreased more sharply in the intervention group(from 8.36±0.98 mmol/L to 6.91±1.23 mmol/L)than in the control group(8.41±1.05 mmol/L to 7.81±1.27 mmol/L),with the intervention group maintaining significantly lower levels(P<0.05).The intervention group demonstrated a significantly greater reduction in 2-hour postprandial blood glucose levels(11.35±2.67 mmol/L to 7.52±1.38 mmol/L)compared to the control group(11.61±3.01 mmol/L to 8.72±1.63 mmol/L;P<0.05).Hamilton Anxiety Scale and Hamilton Depression Scale scores were significantly lower in the intervention group(P<0.05).Patient satisfaction with nursing was 93.33%and 74.55%in the intervention and control groups,respectively(P<0.05).CONCLUSION MDT combined with blood glucose control enhanced healing rates and positively influenced emotional well-being and satisfaction among patients.This strategy holds potential for application in clinical practice.展开更多
This article comments on the research by Zhang et al on the role of advanced heart failure and transplant teams in extracorporeal membrane oxygenation(ECMO)management.The study by Zhang et al indicates that direct adv...This article comments on the research by Zhang et al on the role of advanced heart failure and transplant teams in extracorporeal membrane oxygenation(ECMO)management.The study by Zhang et al indicates that direct advanced heart failure and transplant involvement improves survival in ECMO patients,especially those on veno-arterial ECMO.However,the optimal approach varies due to multiple factors.This article discusses the clinical implications,research design limitations,and future directions to enhance ECMO care.展开更多
Background The continual and rapid development of techniques which are used for diagnosis and treatment makes management of colorectal cancer more difficult depending on single discipline.Colorectal cancer multidiscip...Background The continual and rapid development of techniques which are used for diagnosis and treatment makes management of colorectal cancer more difficult depending on single discipline.Colorectal cancer multidisciplinary team （MDT） working model is recommended by UK and other countries,but there is little information on the impact of MDT working on management of colorectal cancer in China.The aim of this study was to assess the effect on management of colorectal cancer after the inception of an MDT.Methods A total of 595 consecutive colorectal cancer patients were referred to the Department of Gastroenterological Surgery,the pre-MDT cohort include 297 patients,recruited from January 1999 to November 2002,and the MDT cohort had 298 patients enrolled from December 2002 to September 2006.Information recorded included：TNM stage from histological reports,degree of differentiation,the number of examined lymph nodes and CT TNM staging performed or not,and its accuracy,including local and distant recurrence.Results The number of examined lymph nodes and the accuracy of TNM staging by CT in the MDT group were significantly more than those in pre-MDT group.CT TNM staging was more accurate in the MDT group compared to the pre-MDT group （P=-0.044）.The rate of tumor recurrence in the MDT group was lower than pre-MDT group （log-rank test,P 〈0.001）.Multivariate analysis revealed that age （P=0.001）,management after inception of the MDT （P=0.002）,degree of differentiation （P=0.003）,number of examined lymph nodes （P=0.002）,and TNM stage （P=0.000） were important factors that independently influence overall survival.Conclusions The inception of MDT working improved the diagnostic accuracy and overall survival of colorectal cancer patients.MDT working promoted communication and cooperation between disciplines and ensured high-quality diagnosis,evidence-based decision making,and optimal treatment planning.展开更多
The treatment of severe trauma,especially multiple injuries,requires multidisciplinary collaboration.The current study aims to highlight the challenges of consultation mode for severe trauma in general hospitals and e...The treatment of severe trauma,especially multiple injuries,requires multidisciplinary collaboration.The current study aims to highlight the challenges of consultation mode for severe trauma in general hospitals and emphasizes the need to create a new temporary-sustainable team.It suggests developing an information consultation mode and enforcing the fine management to improve the quality and safety of the medical treatment.The management mode of a temporary-sustainable team will reduce the cost and improve the treatment efficiency.Overall,a temporary-sustainable team has significant advantages over a traditional multidisciplinary team for severe trauma treatment.展开更多
BACKGROUND Hepatocellular carcinoma(HCC),a major contributor to cancer-related deaths,is particularly prevalent in Asia,largely due to hepatitis B virus infection.Its prognosis is generally poor.This case report contr...BACKGROUND Hepatocellular carcinoma(HCC),a major contributor to cancer-related deaths,is particularly prevalent in Asia,largely due to hepatitis B virus infection.Its prognosis is generally poor.This case report contributes to the medical literature by detailing a unique approach in treating a large HCC through multidisciplinary collaboration,particularly in patients with massive HCC complicated by ruptured bleeding,a scenario not extensively documented previously.CASE SUMMARY The patient presented with large HCC complicated by intratumoral bleeding.Treatment involved a multidisciplinary approach,providing individualized care.The strategy included drug-eluting bead transarterial chemoembolization,sorafenib-targeted therapy,laparoscopic partial hepatectomy,and standardized sintilimab monoclonal antibody therapy.Six months after treatment,the patient achieved complete radiological remission,with significant symptom relief.Imaging studies showed no lesions or recurrence,and clinical assessments confirmed complete remission.This report is notable as possibly the first docu-mented case of successfully treating such complex HCC conditions through integrated multidisciplinary efforts,offering new insights and a reference for future similar cases.CONCLUSION This study demonstrated effective multidisciplinary treatment for massive HCC with intratumoral bleeding,providing insights for future similar cases.展开更多
In this study,we have summarized the coordination of operating room nurses participating in the multidisciplinary team in diagnosing and treating a patient with a large abdominal tumor and multiple pelvic fractures.To...In this study,we have summarized the coordination of operating room nurses participating in the multidisciplinary team in diagnosing and treating a patient with a large abdominal tumor and multiple pelvic fractures.To perform surgical treatment on patients with various conditions,it is crucial to consider the patients from a holistic perspective.Thus,the existing medical model has shifted from a“disease-centered”approach focusing on single-disciplinary diagnosis and treatment,to a“patient-centered”approach that involves multiple disciplines in diagnosis and therapy.Operating room nurses,as crucial collaborators of surgeons,should make necessary adjustments to enhance their comprehension of patients,improving the overall quality of surgical coordination.展开更多
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 prog...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.展开更多
Colorectal cancer(CRC)is the third most prevalent malignancy worldwide and the second leading cause of cancer-related mortality.Its global incidence increases annually,with most patients diagnosed at advanced stages.D...Colorectal cancer(CRC)is the third most prevalent malignancy worldwide and the second leading cause of cancer-related mortality.Its global incidence increases annually,with most patients diagnosed at advanced stages.Despite substantial advancements in chemotherapy,radiotherapy,immune therapy,and targeted therapy,surgical treatment remains the mainstay for CRC management.Particularly,surgery is most effective for managing early-stage and locally advanced cancers.CRC surgery has evolved from conventional subtractive surgery to modern minimally invasive and precision-based techniques.Additionally,CRC treatment strategies have expanded from a single surgical therapy to a multimodal integrated system encompassing endoscopic therapy,perioperative therapy,molecular targeted therapy,and immunotherapy.This review elucidates the evolution of CRC surgical treatment,describing its transition from early palliative surgery to radical surgery,and,finally,to functional surgery,minimally invasive surgical techniques,and personalized treatment.It reflects the transformation in CRC treatment from simplistic to complex,from generalized to precise,and from singular to comprehensive techniques,providing a holistic perspective on advancements in CRC surgical treatment.展开更多
BACKGROUND Tracheoesophageal fistula(TEF)is a life-threatening complication of advanced esophageal squamous cell carcinoma(ESCC).Cervical ESCC is rare and frequently diagnosed at an advanced stage.Managing cervical es...BACKGROUND Tracheoesophageal fistula(TEF)is a life-threatening complication of advanced esophageal squamous cell carcinoma(ESCC).Cervical ESCC is rare and frequently diagnosed at an advanced stage.Managing cervical esophageal cancer(CEC)is challenging,requiring intervention by a multidisciplinary team(MDT)and innovative surgical management.CASE SUMMARY Here,we present a 59-year-old male patient with a 5-month history of CEC and difficulty eating for over 20 days,who developed TEF secondary to recurrent ESCC after chemoradiotherapy.He underwent total pharyngolaryngoesophagectomy,left thyroidectomy,and lymphadenectomy.Gastric pull-up was performed to restore gastrointestinal continuity,and a 7 cm×5 cm supraclavicular artery island flap(SCAIF)was used to reconstruct the lower tracheal defect.Despite severe postoperative complications,he recovered by successful management by a MDT.A 7 cm×6 cm pectoralis major myocutaneous flap was successfully used to repair the necrotic gastric conduit defect.The patient recovered,regaining the ability to eat and breathe effectively.At the 27-month follow-up,he was alive without recurrence or metastasis.CONCLUSION This study highlights the efficacy of gastric pull-up and SCAIF reconstruction in managing TEF secondary to recurrent ESCC.展开更多
BACKGROUND Portal hypertension(PH)is a major complication of chronic liver disease and a leading cause of mortality and morbidity in patients with cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS)is an est...BACKGROUND Portal hypertension(PH)is a major complication of chronic liver disease and a leading cause of mortality and morbidity in patients with cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS)is an established treatment for PH-related complications,including refractory ascites,variceal bleeding,hepatic hydrothorax and Budd-Chiari syndrome.However,post-TIPS cardiac decompensation has been reported in up to 25%of patients,often due to haemodynamic shifts revealing occult cardiac dysfunction.Current approaches to pre-procedural cardiac assessment and risk stratification remain inconsistent.This systematic review examines current recommendations and emerging strategies for cardiovascular evaluation in patients with cirrhosis prior to a TIPS.AIM To identify the key predictive factors for cardiac decompensation following a TIPS in patients with cirrhosis.METHODS A systematic review of available literature,using PubMed(including MEDLINE),Embase and Cochrane databases.Results were searched comprehensively,without exclusion criteria,from inception to May 2025.Given the predominance of retrospective cohort studies,risk of bias assessment was primarily performed using the ROBINS-E tool.RESULTS Thirteen studies were included(n=1674 patients),with a pulled mean decompensation rate of 8.8%.Due to the variability in TIPS timing,study quality and heterogeneity,a meta-analysis was not feasible,therefore results were synthesised narratively.Multiple diastolic dysfunction parameters independently and integrated through the American Society of Echocardiography guidelines demonstrated predictive value.Newly validated risk score,heart failure with preserved ejection fraction,and biomarkers such as N-terminal pro-B-type natriuretic peptide≥125 pg/mL consistently highlight cardiac dysfunction amongst the literature.Our review also explored left-atrial strain imaging as well as recent advances in cardiac magnetic resonance imaging and potential genetic contributors.CONCLUSION Multiple predictors of cardiac decompensation following TIPS exist,however studies are of limited quality.Implementing reliable markers may enable early risk stratification,candidate selection and guide pre-procedural optimisation.展开更多
文摘Objective:To explore the experiences of palliative care multidisciplinary teams from the perspective of pluralistic synergy theory,aiming to enhance team collaboration.Method:Utilizing a qualitative research methodology,we conducted in-depth interviews with 15 palliative care team members to collect data.Results:The operational framework of palliative care multidisciplinary teams under pluralistic synergy theory involves:enhancing collaboration among team members;developing a comprehensive management model for the team;rationalizing the allocation of work tasks and durations;improving team communication and interaction through effective communication mechanisms and platforms;cultivating skilled professionals;and establishing a robust health record management system.Conclusion:The operational mechanism,informed by pluralistic synergy theory,advances the development of palliative care.
基金General Project of Health and Family Planning Scientific Research of Pudong New Area Health Commission:Evaluation of the Clinical Effectiveness of the Integrated Traditional Chinese and Western Medicine Clinical Program for Accelerating Postoperative Recovery of Patients with Rotator cuff Injury under the Multidisciplinary Team Mode,No.PW2021A-66Shanghai Municipal Health Commission Key Department of Integrated Traditional Chinese and Western MedicinePeak Discipline of Traditional Chinese Medicine(Orthopedics and Traumatology Department of Integrated Traditional Chinese and Western Medicine),Shanghai Pudong New Area Health Commission,No.YC-2023-0601.
文摘BACKGROUND Arthroscopic rotator cuff repair is a common surgical treatment for rotator cuff injuries(RCIs).Although this procedure has certain clinical advantages,it requires rehabilitation management interventions to ensure therapeutic efficacy.AIM To investigate the effect of integrated traditional Chinese medicine and Western medicine(TCM-WM)under the multidisciplinary team(MDT)model on the postoperative recovery of patients undergoing arthroscopic surgery for RCIs.METHODS This study enrolled 100 patients who underwent arthroscopic rotator cuff repair for RCIs at the Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine between June 2021 and May 2024.They were divided into a control group(n=48)that received routine rehabilitation treatment and an experimental group(n=52)that received TCM-WM under the MDT model(e.g.,acupuncture,TCM traumatology and orthopedics,and rehabilitation).The results of the Constant–Murley Shoulder Score(CMS),Visual Analogue Scale(VAS),Shoulder Pain and Disability Index(SPADI),muscular strength evaluation,and shoulder range of motion(ROM)assessments were analyzed.RESULTS After treatment,the experimental group showed significantly higher CMS scores in terms of pain,functional activity,shoulder joint mobility,and muscular strength than the baseline and those of the control group.The experimental group also exhibited significantly lower VAS and SPADI scores than the baseline and those of the control group.In addition,the experimental group showed significantly enhanced muscular strength(forward flexor and external and internal rotator muscles)and shoulder ROM(forward flexion,abduction,and lateral abduction)after treatment compared with the control group.CONCLUSION TCM-WM under the MDT model improved shoulder joint function,relieved postoperative pain,promoted postoperative functional recovery,and facilitated the recovery of muscular strength and shoulder ROM in patients with RCIs who underwent arthroscopic rotator cuff repair.
文摘AIM: To evaluate the effect of multidisciplinary team (MDT) treatment modality on outcomes of patients with gastrointestinal malignancy in China. METHODS: Data about patients with gastric and colorectal cancer treated in our center during the past 10 years were collected and divided into two parts. Part 1 consisted of the data collected from 516 consecutive complicated cases discussed at MDT meetings in Peking University School of Oncology (PKUSO) from December 2005 to July 2009. Part 2 consisted of the data collected from 263 consecutive cases of resect-able locally advanced rectal cancer from January 2001 to January 2005. These 263 patients were divided into neoadjuvant therapy (NT) group and control group. Patients in NT group received MDT treatment, namely neoadjuvant therapy + surgery + postoperative adjuvant therapy. Patients in control group underwent direct surgery + postoperative adjuvant therapy. The outcomes in two groups were compared. RESULTS: The treatment strategy was altered after discussed at MDT meeting in 76.81% of gastric cancer patients and in 58.33% of colorectal cancer patients before operation. The sphincter-preservation and local control of tumor were better in NT group than in control group. The 5-year overall survival rate was also higher in NT group than in control group (77.23% vs 69.75%, P = 0.049). CONCLUSION: MDT treatment modality can significantly improve the outcomes of patients with gastrointestinal malignancy in China.
基金supported by a grant (No. Z151100002615031) from the Project of Science and Technology in Beijing, China
文摘Multidisciplinary team （MDT） model is a diagnostic and treatment model characterized by interdisciplinarity, integration, centralism, individualization, and precision and is becoming more common in the management of complex malignancies. MDT emphasizes team spirit and a personalized treatment strategy according to the actual condition of each patient. A cooperative and effective multidisciplinary team is an important guarantee for delivering high-quality services to patients. Under the guidance of a medical humanistic concept, MDT provides reasonable, effective, convenient, and a full range of excellent quality medical service to patients. The MDT maximizes patient benefits, and it is the developmental direction for large-scale general hospitals. At the same time, the MDT is also an important measure to strengthen the core competitiveness of hospitals. Here, we introduce the clinical application of the model in tumor therapy as well as the current state and development in our hospital.
基金Chongqing Science and Technology Bureau and Chongqing Health Commission(Grant No.2021-MSXM335 and 2020GDRC009)。
文摘The multidisciplinary approach is beneficial to the treatment of gastrointestinal stromal tumors(GISTs).However,pharmacists are seldom incorporated into a multidisciplinary team(MDT)of GIST.In the present study,we evaluated the clinical and economic benefits of a pharmacist in an MDT of GIST.This was a retrospective study that included 240 GIST patients receiving imatinib therapy.The GIST MDT pharmacist developed and validated an HPLC method to monitor the trough concentrations of imatinib in GIST patients.Besides,the pharmacist also provided patient education and pharmaceutical care services and collected the data for analysis.The 240 GIST patients received the services provided by the pharmacist.The trough concentrations in 25.42%of the 240 patients were less than 1100 ng/m L.The main genotypes of 121 in the 240 patients were KIT exon 11 mutations,wild type,and KIT exon 9 mutations.Moreover,13 GIST patients with trough concentrations less than 1100 ng/m L were confirmed to have low compliance.The adverse reactions were primarily mild and tolerable,except that 13 GIST patients were adjusted to lower doses because of the intolerable adverse reactions.The daily cost could be lowered by monitoring the trough concentrations and dose reductions.Collectively,a pharmacist included in a GIST MDT could increase the compliance of Chinese GIST patients to imatinib therapy and improve the efficacy,safety,and economy of imatinib therapy.
基金The study was approved by the Institutional review board of The Affiliated Hospital of Southwest Medical University,No.KY2023184.
文摘BACKGROUND Perioperative hypothermia(PH)negatively affects the physical and mental health of patients to varying degrees.Currently,there is no effective multidisciplinary team(MDT)intervention for gynecological patients with PH.AIM To apply the best evidence on the prevention and management of PH in gynecological patients,improve the quality of perioperative evidence-based care based on treatment by an MDT for gynecological patients and analyze the effect of MDT-and evidence-based practice(EBP)projects on the psychological status and cognitive function of gynecological patients with PH.METHODS Under the guidance of knowledge translation and combined with the opinions of involved stakeholders and clinical experts,the best evidence for PH prevention and management in gynecological patients was selected and adjusted to suit the practice setting.Based on the evidence,the practice plan was developed,and the MDT intervention was carried out in the preoperative ward,the preoperative preparation room,the intraoperative operating room,the postanesthesia care unit,and the 24-hour postoperative gynecological ward through the EBP program.The incidence of hypothermia,the nurses’awareness,the implementation rate of examination indicators,and the thermal comfort level,psychological status and cognitive function of patients were compared before and after the implementation of the program.RESULTS The incidence of PH in gynecological patients decreased from 43.33%to 13.33%after the implementation of the scheme.The implementation rate of examination indicators 6-10,12,14,16-18,21,and 22 reached 100%,and that of other indicators was above 90%,except for examination indicators 5 and 13,which was 66.67%;the indices were significantly improved compared with the baseline(before evidence application)(P<0.05).The score of nurses'awareness of PH prevention and management in gynecological patients increased from 60.96±9.70 to 88.08±8.96,and the difference was statistically significant(P<0.001).The total score of the perioperative thermal comfort level of patients undergoing gynecological surgery was 27.97±2.04,which was significantly increased compared with the score of 21.27±1.57 observed by researchers at baseline(P<0.001).The perioperative Hamilton Depression Scale and Hamilton Anxiety Scale scores of patients undergoing gynecological surgery decreased from 15.03±3.16 and 13.93±2.64 to 4.30±1.15 and 3.53±0.78,respectively,with statistically significant differences(P<0.001).The perioperative Montreal Cognitive Assessment Scale score of the gynecological surgery patients increased from 23.17±1.68 to 26.93±1.11,also with statistical significance(P<0.001).CONCLUSION MDT-based EBP for PH prevention and management in gynecological patients during the perioperative period can standardize nursing operations,improve nurses'awareness and behavioral compliance with gynecological hypothermia management,and reduce the occurrence of PH in gynecological patients while playing a positive role in reducing patients’negative emotions and enhancing their cognitive function.
基金Supported by Foundation of Hunan Educational Committee,No.16A188Foundation of Hengyang Science and Technology Committee,No.2018KJ135.
文摘BACKGROUND Adrenocortical carcinoma(ACC)is a rare malignant epithelial tumor originating from adrenocortical cells that carries a very poor prognosis.Metastatic or inoperable diseases are often considered incurable,and treatment remains a challenge.Especially for advanced cases such as ACC complicated with renal venous cancer thrombus,there are few cumulative cases in the literature.CASE SUMMARY The patient in this case was a 39-year-old middle-aged male who was admitted to the hospital for more than half a month due to dizziness and chest tightness.Computed tomography(CT)findings after admission revealed a left retroperitoneal malignant space-occupying lesion,but the origin of the formation of the left renal vein cancer thrombus remained to be determined.It was speculated that it originated from the left adrenal gland,perhaps a retroperitoneal source,and left adrenal mass+left nephrectomy+left renal vein tumor thrombus removal+angioplasty were performed under general anesthesia.Postoperative pathology results indicated a diagnosis of ACC.Postoperative steroid therapy was administered.At 3 mo after surgery,abdominal CT reexamination revealed multiple enlarged retroperitoneal lymph nodes and multiple low-density shadows in the liver,and palliative radiotherapy and mitotane were administered,considering the possibility of metastasis.The patient is currently being followed up.CONCLUSION ACC is a highly malignant tumor.Even if the tumor is removed surgically,there is still the possibility of recurrence.Postoperative mitotane and adjuvant chemoradiotherapy have certain benefits for patients,but they cannot fully offset the poor prognosis of this disease.
文摘Current Status of Diagnosis and Treatment of Colorectal Liver Metastases Colorectal cancer(CRC)is one of the most common malignant tumors of the digestive tract.According to the tumor registration data collected by the National Cancer Registry Center,the number of new cases of malignant tumors in 2022 was estimated to be 4.83 million(2.53 million in males and 2.30 million in females).Of these,approximately 517,100 were CRC,which ranks second among malignant tumors in incidence.
基金Selffunded Scientific Research Project of Guangxi Zhuang Autonomous Region Administrationof Traditional Chinese Medicine(GXZYL20220605).
文摘[Objective]To evaluate the efficacy of adding multidisciplinary team(MDT)-led meridian-acupointmassage toconventional treatment forinfants with community-acquired pneumonia(CAP).[Methods]In this randomized trial,100 infants with CAP were assigned to a control group(n=50)receiving conventional therapy or an intervention group(n=50)receiving conventional therapy plusMDT-led meridian-acupoint massage.Clinical efficacy,symptom resolution time,hospital stay,and family satisfaction were compared.[Results]Compared to the control group,the interventiongroup showed a significantly higher total effective rate(94.0% vs.78.0%),faster resolution of fever,cough,and pulmonary rales,a shorter hospital stay,and higher family satisfaction(96.0% vs.80.0%)(all P<0.05).[Conclusion]Adding MDT-led meridian-acupoint massage to conventional therapyimproves clinical outcomes,shortens recovery time,and increases family satisfaction for infants withCAP,demonstrating its strong potential for clinical application.
文摘BACKGROUND Postoperative patients with gastrointestinal tumors are at high risk for poor wound healing and psychological distress,such as anxiety and depression,which can negatively impact recovery and quality of life.Multidisciplinary team(MDT)collaborative nursing has emerged as a comprehensive care approach that may address both physical and psychological needs.AIM To explored the impact of MDT collaborative nursing on wound healing and anxiety/depression symptoms in postoperative patients with gastrointestinal tumors.METHODS A retrospective analysis was conducted on 364 patients with gastrointestinal tumours admitted to our hospital between January 2022 and December 2024.Based on differing postoperative nursing approaches,two groups were established:the MDT group(n=196)and the control group(n=168).The control group received conventional nursing interventions,while the MDT group received MDT collaborative nursing.The study compared wound healing outcomes,pre-intervention and one-month post-intervention Hospital Anxiety and Depression Scale(HADS)scores,Functional Assessment of Cancer Therapy-General(FACT-G)quality of life scores,and complication rates between the two groups.RESULTS The MDT group demonstrated a Grade A wound healing rate of 88.27%and total treatment compliance of 99.49%,both significantly higher than the control group(75.00%and 95.83%,respectively).The complication incidence rate was 3.06%in the MDT group,lower than the control group(8.93%),with all differences statistically significant(P<0.05).After one month of intervention,patients in the MDT group demonstrated lower Anxiety Self-Rating Scale and Depression Self-Rating Scale scores on the HADS scale compared to the control group.Conversely,their scores on the FACT-G scale for physical,social/family,emotional,and functional domains were higher than those in the control group,with all differences being statistically significant(P<0.05).CONCLUSION MDT collaborative care promotes wound healing in patients undergoing gastrointestinal tumour surgery,alleviates anxiety and depressive symptoms,enhances treatment adherence and quality of life,and reduces the incidence of complications.
基金Supported by the Zhejiang Provincial Science and Technology Plan for Traditional Chinese Medicine,No.2025ZL594Municipal-Level Science and Technology Plan Project of Zhejiang Province,No.2023ZD039.
文摘BACKGROUND Diabetic foot ulcers(DFUs)present a significant healthcare challenge attributable to their high rates of disability and the limitations of applied traditional nursing approaches.Effective management is critical for uneventful health outcomes.AIM To investigate the effects of multidisciplinary team(MDT)nursing interventions and blood glucose control on the negative emotions and satisfaction of DFUhealing patients.METHODS This retrospective cohort study included 115 patients with DFUs,divided into MDT and blood glucose control intervention group(n=60)and standard care control group(n=55).The comparison factors were wound area,new granulation tissue coverage area,wound healing rate,2-hour postprandial blood glucose level,fasting plasma glucose level,Hamilton Anxiety Scale score,Hamilton Depression Scale score,and nursing satisfaction.RESULTS After 4 weeks,the average wound area reduced from 22.04±6.48 cm^(2)to 11.96±3.63 cm^(2)(P<0.05).New granulation tissue coverage area reached 52.85±18.39 cm^(2) for the intervention group and 28.39±9.94 cm^(2)(P<0.05)in the control group,respectively.The healing rate was significantly higher in the intervention group than in the control group(91.7%vs 76.4%,P<0.05).Fasting plasma glucose decreased more sharply in the intervention group(from 8.36±0.98 mmol/L to 6.91±1.23 mmol/L)than in the control group(8.41±1.05 mmol/L to 7.81±1.27 mmol/L),with the intervention group maintaining significantly lower levels(P<0.05).The intervention group demonstrated a significantly greater reduction in 2-hour postprandial blood glucose levels(11.35±2.67 mmol/L to 7.52±1.38 mmol/L)compared to the control group(11.61±3.01 mmol/L to 8.72±1.63 mmol/L;P<0.05).Hamilton Anxiety Scale and Hamilton Depression Scale scores were significantly lower in the intervention group(P<0.05).Patient satisfaction with nursing was 93.33%and 74.55%in the intervention and control groups,respectively(P<0.05).CONCLUSION MDT combined with blood glucose control enhanced healing rates and positively influenced emotional well-being and satisfaction among patients.This strategy holds potential for application in clinical practice.
基金Supported by National Natural Science Foundation of China,No.82200353Jiangsu Province Double Innovation Doctoral Program,No.JSSCBS20221948+3 种基金Suzhou Gusu Health Talent Program,No.(2022)043Suzhou Gusu Health Talent Plan Talent Research Project,No.GSWS2022014Jiangsu Province College Students’Innovation and Entrepreneurship Training Program Project,No.202410285087Zand“Boxi”Talent Casting Plan of the First Affiliated Hospital of Soochow University。
文摘This article comments on the research by Zhang et al on the role of advanced heart failure and transplant teams in extracorporeal membrane oxygenation(ECMO)management.The study by Zhang et al indicates that direct advanced heart failure and transplant involvement improves survival in ECMO patients,especially those on veno-arterial ECMO.However,the optimal approach varies due to multiple factors.This article discusses the clinical implications,research design limitations,and future directions to enhance ECMO care.
文摘Background The continual and rapid development of techniques which are used for diagnosis and treatment makes management of colorectal cancer more difficult depending on single discipline.Colorectal cancer multidisciplinary team （MDT） working model is recommended by UK and other countries,but there is little information on the impact of MDT working on management of colorectal cancer in China.The aim of this study was to assess the effect on management of colorectal cancer after the inception of an MDT.Methods A total of 595 consecutive colorectal cancer patients were referred to the Department of Gastroenterological Surgery,the pre-MDT cohort include 297 patients,recruited from January 1999 to November 2002,and the MDT cohort had 298 patients enrolled from December 2002 to September 2006.Information recorded included：TNM stage from histological reports,degree of differentiation,the number of examined lymph nodes and CT TNM staging performed or not,and its accuracy,including local and distant recurrence.Results The number of examined lymph nodes and the accuracy of TNM staging by CT in the MDT group were significantly more than those in pre-MDT group.CT TNM staging was more accurate in the MDT group compared to the pre-MDT group （P=-0.044）.The rate of tumor recurrence in the MDT group was lower than pre-MDT group （log-rank test,P 〈0.001）.Multivariate analysis revealed that age （P=0.001）,management after inception of the MDT （P=0.002）,degree of differentiation （P=0.003）,number of examined lymph nodes （P=0.002）,and TNM stage （P=0.000） were important factors that independently influence overall survival.Conclusions The inception of MDT working improved the diagnostic accuracy and overall survival of colorectal cancer patients.MDT working promoted communication and cooperation between disciplines and ensured high-quality diagnosis,evidence-based decision making,and optimal treatment planning.
文摘The treatment of severe trauma,especially multiple injuries,requires multidisciplinary collaboration.The current study aims to highlight the challenges of consultation mode for severe trauma in general hospitals and emphasizes the need to create a new temporary-sustainable team.It suggests developing an information consultation mode and enforcing the fine management to improve the quality and safety of the medical treatment.The management mode of a temporary-sustainable team will reduce the cost and improve the treatment efficiency.Overall,a temporary-sustainable team has significant advantages over a traditional multidisciplinary team for severe trauma treatment.
基金Supported by Gansu Provincial Hospital Internal Medicine Research Fund Project,No.22GSSYD-47"Innovation Star"Project for Graduate Students of Gansu University of Chinese Medicine,No.2023CXZX-756the Natural Science Foundation of Gansu Province,No.21JR11RA187.
文摘BACKGROUND Hepatocellular carcinoma(HCC),a major contributor to cancer-related deaths,is particularly prevalent in Asia,largely due to hepatitis B virus infection.Its prognosis is generally poor.This case report contributes to the medical literature by detailing a unique approach in treating a large HCC through multidisciplinary collaboration,particularly in patients with massive HCC complicated by ruptured bleeding,a scenario not extensively documented previously.CASE SUMMARY The patient presented with large HCC complicated by intratumoral bleeding.Treatment involved a multidisciplinary approach,providing individualized care.The strategy included drug-eluting bead transarterial chemoembolization,sorafenib-targeted therapy,laparoscopic partial hepatectomy,and standardized sintilimab monoclonal antibody therapy.Six months after treatment,the patient achieved complete radiological remission,with significant symptom relief.Imaging studies showed no lesions or recurrence,and clinical assessments confirmed complete remission.This report is notable as possibly the first docu-mented case of successfully treating such complex HCC conditions through integrated multidisciplinary efforts,offering new insights and a reference for future similar cases.CONCLUSION This study demonstrated effective multidisciplinary treatment for massive HCC with intratumoral bleeding,providing insights for future similar cases.
文摘In this study,we have summarized the coordination of operating room nurses participating in the multidisciplinary team in diagnosing and treating a patient with a large abdominal tumor and multiple pelvic fractures.To perform surgical treatment on patients with various conditions,it is crucial to consider the patients from a holistic perspective.Thus,the existing medical model has shifted from a“disease-centered”approach focusing on single-disciplinary diagnosis and treatment,to a“patient-centered”approach that involves multiple disciplines in diagnosis and therapy.Operating room nurses,as crucial collaborators of surgeons,should make necessary adjustments to enhance their comprehension of patients,improving the overall quality of surgical coordination.
文摘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.
基金Supported by Postgraduate Practice Innovation Program of Jiangsu Province,No.KYCX23_3621.
文摘Colorectal cancer(CRC)is the third most prevalent malignancy worldwide and the second leading cause of cancer-related mortality.Its global incidence increases annually,with most patients diagnosed at advanced stages.Despite substantial advancements in chemotherapy,radiotherapy,immune therapy,and targeted therapy,surgical treatment remains the mainstay for CRC management.Particularly,surgery is most effective for managing early-stage and locally advanced cancers.CRC surgery has evolved from conventional subtractive surgery to modern minimally invasive and precision-based techniques.Additionally,CRC treatment strategies have expanded from a single surgical therapy to a multimodal integrated system encompassing endoscopic therapy,perioperative therapy,molecular targeted therapy,and immunotherapy.This review elucidates the evolution of CRC surgical treatment,describing its transition from early palliative surgery to radical surgery,and,finally,to functional surgery,minimally invasive surgical techniques,and personalized treatment.It reflects the transformation in CRC treatment from simplistic to complex,from generalized to precise,and from singular to comprehensive techniques,providing a holistic perspective on advancements in CRC surgical treatment.
基金Supported by the Key R&D Program of Zhejiang,No.2023C03066and National natural science foundation of China,No.82471148.
文摘BACKGROUND Tracheoesophageal fistula(TEF)is a life-threatening complication of advanced esophageal squamous cell carcinoma(ESCC).Cervical ESCC is rare and frequently diagnosed at an advanced stage.Managing cervical esophageal cancer(CEC)is challenging,requiring intervention by a multidisciplinary team(MDT)and innovative surgical management.CASE SUMMARY Here,we present a 59-year-old male patient with a 5-month history of CEC and difficulty eating for over 20 days,who developed TEF secondary to recurrent ESCC after chemoradiotherapy.He underwent total pharyngolaryngoesophagectomy,left thyroidectomy,and lymphadenectomy.Gastric pull-up was performed to restore gastrointestinal continuity,and a 7 cm×5 cm supraclavicular artery island flap(SCAIF)was used to reconstruct the lower tracheal defect.Despite severe postoperative complications,he recovered by successful management by a MDT.A 7 cm×6 cm pectoralis major myocutaneous flap was successfully used to repair the necrotic gastric conduit defect.The patient recovered,regaining the ability to eat and breathe effectively.At the 27-month follow-up,he was alive without recurrence or metastasis.CONCLUSION This study highlights the efficacy of gastric pull-up and SCAIF reconstruction in managing TEF secondary to recurrent ESCC.
文摘BACKGROUND Portal hypertension(PH)is a major complication of chronic liver disease and a leading cause of mortality and morbidity in patients with cirrhosis.Transjugular intrahepatic portosystemic shunt(TIPS)is an established treatment for PH-related complications,including refractory ascites,variceal bleeding,hepatic hydrothorax and Budd-Chiari syndrome.However,post-TIPS cardiac decompensation has been reported in up to 25%of patients,often due to haemodynamic shifts revealing occult cardiac dysfunction.Current approaches to pre-procedural cardiac assessment and risk stratification remain inconsistent.This systematic review examines current recommendations and emerging strategies for cardiovascular evaluation in patients with cirrhosis prior to a TIPS.AIM To identify the key predictive factors for cardiac decompensation following a TIPS in patients with cirrhosis.METHODS A systematic review of available literature,using PubMed(including MEDLINE),Embase and Cochrane databases.Results were searched comprehensively,without exclusion criteria,from inception to May 2025.Given the predominance of retrospective cohort studies,risk of bias assessment was primarily performed using the ROBINS-E tool.RESULTS Thirteen studies were included(n=1674 patients),with a pulled mean decompensation rate of 8.8%.Due to the variability in TIPS timing,study quality and heterogeneity,a meta-analysis was not feasible,therefore results were synthesised narratively.Multiple diastolic dysfunction parameters independently and integrated through the American Society of Echocardiography guidelines demonstrated predictive value.Newly validated risk score,heart failure with preserved ejection fraction,and biomarkers such as N-terminal pro-B-type natriuretic peptide≥125 pg/mL consistently highlight cardiac dysfunction amongst the literature.Our review also explored left-atrial strain imaging as well as recent advances in cardiac magnetic resonance imaging and potential genetic contributors.CONCLUSION Multiple predictors of cardiac decompensation following TIPS exist,however studies are of limited quality.Implementing reliable markers may enable early risk stratification,candidate selection and guide pre-procedural optimisation.
