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Clinical application of Multidisciplinary Team-and evidence-based practice project in gynecological patients with perioperative hypothermia

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World Journal of Psychiatry 2023年第11期13卷 848-861页

作者： Qing-Yan Liu Tong-Yang You Dai-Ying Zhang Juan Wang The Operating Room The Affiliated Hospital of Southwest Medical UniversityLuzhou 646000Sichuan ProvinceChina

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 co

关键词： Hypothermia Gynecology Evidence-based care Knowledge translation Multidisciplinary Team

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A temporary-sustainable team:A new Multidisciplinary Team model for severe trauma

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Chinese Journal of Traumatology 2020年第6期23卷 363-366页

作者： Xing-Ming Zhong Xiao-Hong Wen Chao-Hui Ji Xing-Zhen Fei Xiao-Gang Zhao Department of Emergency and Department of Neurosurgery The First People's Hospital of HuzhouFirst Affiliated Hospital of Huzhou Normal UniversityHuzhou 313000Zhejiang ProvinceChina Department of Emergency The Second Affiliated Hospital of Zhejiang University School of MedicineHangzhou 310009Zhejiang ProvinceChina

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.

关键词： Trauma Temporary-sustainable team Multidisciplinary Team

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Impact of Multidisciplinary Team working on the management of colorectal cancer

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Chinese Medical Journal 2012年第2期125卷 172-177页

作者： Ye Ying-jiang Shen Zhan-long Sun Xian-tao Wang Zhi-feng Shen Dan-hua Liu Hui-jun Zhang Wan-lei Chen Ya-lin Zhou Jing Poston, G. J. Wang Shan Peking Univ Peoples Hosp Dept Surg Gastroenterol Beijing 100044 Peoples R China Peking Univ Peoples Hosp Dept Surg Oncol Beijing 100044 Peoples R China Peking Univ Peoples Hosp Dept Gastroenterol Beijing 100044 Peoples R China Peking Univ Peoples Hosp Dept Pathol Beijing 100044 Peoples R China Peking Univ Peoples Hosp Dept Radiol Beijing 100044 Peoples R China Peking Univ Peoples Hosp Dept Ultrason Beijing 100044 Peoples R China Peking Univ Peoples Hosp Dept Radiotherapy Beijing 100044 Peoples R China Peking Univ Peoples Hosp Dept Med Oncol Beijing 100044 Peoples R China Aintree Univ Hosp NHS Fdn Trust Dept Surg Liverpool L9 7AL Merseyside England

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.

关键词： colorectal cancer TNM stages computed tomography overall survival liver metastases Multidisciplinary Team chemotherapy surgery

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Multidisciplinary Team therapy for left giant adrenocortical carcinoma: A case report

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World Journal of Clinical Cases 2021年第20期9卷 5737-5743页

作者： Zheng Zhou Hong-Mei Luo Jian Tang Wu-Jun Xu Bin-Hui Wang Xu-Hui Peng Heng Tan Li Liu Xiang-Yang Long Yu-De Hong Xiao-Bin Wu Jian-Ping Wang Bai-Qi Wang Hai-Hui Xie Yong Fang Yong Luo Rong Li Yi Wang Department of Urology The Second Affiliated HospitalUniversity of South ChinaHengyang 421001Hunan ProvinceChina Department of Histology and Embryology Clinical Anatomy and Reproductive Medicine Application InstituteUniversity of South ChinaHengyang 421001Hunan ProvinceChina Department of Endocrinology The Second Affiliated Hospital of University of South ChinaHengyang 421001Hunan ProvinceChina Department of Oncology The Second Affiliated HospitalUniversity of South ChinaHengyang 421001Hunan ProvinceChina Department of Radiotherapy The Second Affiliated HospitalUniversity of South ChinaHengyang 421001Hunan ProvinceChina Department of Pathology The Second Affiliated HospitalUniversity of South ChinaHengyang 421001Hunan ProvinceChina Department of ICU The Second Affiliated HospitalUniversity of South ChinaHengyang 421001Hunan ProvinceChina Department of Clinical Pharmacy The Second Affiliated HospitalUniversity of South ChinaHengyang 421001Hunan ProvinceChina

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.

关键词： Adrenocortical carcinoma Ki-67 Multidisciplinary Team Cancer thrombus Mitotane Case report

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Current status and perspectives of conversion therapy for advanced gastric cancer

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Chinese Journal of Cancer Research 2022年第2期34卷 109-114页

作者： Heli Yang Ke Ji Jiafu Ji Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing) Center of Gastrointestinal CancerPeking University Cancer Hospital&InstituteBeijing 100142China

The concept and strategy of advanced gastric cancer treatment have gradually undergone profound changes with the in-depth understanding of the biology and heterogeneous characteristics of gastric cancer.Moreover,the development and application of new anticancer drugs,including chemotherapy drugs,molecularly targeted drugs and immunotherapy drugs for advanced gastric cancer are reported.The connotation of conversion therapy refers to the unresectable or borderline resectable tumors for surgical technical and/or oncological reasons,after active and effective chemotherapy and other comprehensive treatment,the primary gastric lesions can be reduced to a lower stage,while the metastatic lesions can be effectively controlled,to achieve R0 resection and improve the long-term survival rate.Current promising research results of conversion therapy are mostly from single-arm phase II clinical studies with small samples or retrospective studies.Conversion therapy still faces many challenges,including limited diagnostic and assessment methods,insufficient evidence of highly effective treatment regimens,difficulty in clarifying surgical indications,etc.Therefore,the integrated conversion therapy for advanced gastric cancer needs to be carried out with the close cooperation of a Multidisciplinary Team.Prospective,multi-center randomized controlled trial studies should be conducted in the future,and precision medicine such as molecular biology should be combined to provide better anticancer drug regimens and higher-level clinical evidence for conversion therapy of advanced gastric cancer.

关键词： Gastric cancer advanced conversion therapy Multidisciplinary Team

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Clinical application of Multidisciplinary Teams in tumor therapy

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Chinese Journal of Cancer Research 2017年第2期29卷 168-170页

作者： Cong Wang Dongjian Song Zhili Xu Jiaxiang Wang School of Humanities and Social Sciences Beihang University Department of Pediatric Surgery the First Affiliated Hospital of Zhengzhou University

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.

关键词： Multidisciplinary Team tumor therapy clinical application

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multidisciplinary discussion and management of synchronous colorectal liver metastases: A single center study in China

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World Journal of Gastrointestinal Oncology 2023年第9期15卷 1616-1625页

作者： Hao Li Guo-Li Gu Song-Yan Li Yang Yan Shi-Dong Hu Ze Fu Xiao-Hui Du Graduate School Medical School of Chinese People’s Liberation ArmyBeijing 100039China Department of General Surgery Air Force Medical CenterAir Force Medical UniversityBeijing 100142China Department of General Surgery Chinese People’s Liberation Army General HospitalBeijing 100039China

BACKGROUND The Multidisciplinary Team(MDT)has been carried out in many large hospitals now.However,given the costs of time and money and with little strong evidence of MDT effectiveness being reported,critiques of MDTs persist.AIM To evaluate the effects of MDTs on patients with synchronous colorectal liver metastases and share our opinion on management of synchronous colorectal liver metastases.METHODS In this study we collected clinical data of patients with synchronous colorectal liver metastases from February 2014 to February 2017 in the Chinese People’s Liberation Army General Hospital and subsequently divided them into an MDT+group and an MDT-group.In total,93 patients in MDT+group and 169 patients in MDT-group were included totally.RESULTS Statistical increases in the rate of chest computed tomography examination(P=0.001),abdomen magnetic resonance imaging examination(P=0.000),and preoperative image staging(P=0.0000)were observed in patients in MDT+group.Additionally,the proportion of patients receiving chemotherapy(P=0.019)and curative resection(P=0.042)was also higher in MDT+group.Multivariable analysis showed that the population of patients assessed by MDT meetings had higher 1-year[hazard ratio(HR)=0.608,95%confidence interval(CI):0.398-0.931,P=0.022]and 5-year(HR=0.694,95%CI:0.515-0.937,P=0.017)overall survival.CONCLUSION These results proved that MDT management did bring patients with synchronous colorectal liver metastases more opportunities for comprehensive examination and treatment,resulting in better outcomes.

关键词： Synchronous colorectal liver metastases Multidisciplinary Team Imaging examination Treatment strategy Oncological outcome

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

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Journal of Pancreatology 2021年第2期4卷 49-66页

作者： Yinmo Yang Xueli Bai Dapeng Bian Shouwang Cai Rufu Chen Feng Cao Menghua Dai Chihua Fang Deliang Fu Chunlin Ge Xiaochao Guo Chunyi Hao Jihui Hao Heguang Huang Zhixiang Jian Gang Jin Fei Li Haimin Li Shengping Li Weiqin Li Yixiong Li Hongzhen Li Tingbo Liang Xubao Liu Wenhui Lou Yi Miao Yiping Mou Chenghong Peng Renyi Qin Chenghao Shao Bei Sun Guang Tan Xiaodong Tian Huaizhi Wang Lei Wang Wei Wang Weilin Wang Junmin Wei Heshui Wu Wenming Wu Zheng Wu Jingyong Xu Changqing Yan Xiaoyu Yin Xianjun Yu Chunhui Yuan Taiping Zhang Jixin Zhang Jun Zhou Yupei Zhao on behalf of the Chinese Pancreatic Surgery Association Department of General Surgery Peking University First HospitalBeijing Department of Hepatobiliary and Pancreatic Surgery the First Affiliated Hospital of Medical CollegeZhejiang UniversityHangzhouZhejiang Province Departments of Endoscopy Peking University First HospitalBeijing Institute of Hepatobiliary Surgery of PLA Chinese PLA General HospitalBeijing Department of Pancreatobiliary Surgery Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouGuangdong Province Department of General Surgery Xuanwu HospitalCapital Medical UniversityBeijing Department of General Surgery Peking Union Medical College HospitalChinese Academy of Medical Science&Peking Union Medical CollegeBeijing Department of Hepatobiliary Surgery Zhujiang HospitalSouthern Medical UniversityGuangzhouGuangdong Province Department of Pancreatic Surgery Huashan Hospital Fudan UniversityShanghai Department of General Surgery The First Affiliated Hospital of China Medical UniversityShenyangLiaoning Province Department of Imaging Peking University First HospitalBeijing Department of Hepato-Pancreato-Biliary Surgery Peking University Cancer Hospital&InstituteBeijing Department of Pancreatic Cancer Tianjin Medical University Cancer Institute and HospitalTianjin Department of General Surgery Fujian Medical University Union HospitalFuzhouFujian Province Department of General Surgery Guangdong Provincial People’s HospitalGuangzhouGuangdong Province Department of Hepatobiliary Pancreatic Surgery Changhai Hospital Affiliated to Navy Medical UniversityShanghai Department of Hepatobiliary Surgery Xijing HospitalFourth Military Medical UniversityXi’anShaanxi Province Department of Pancreatobiliary Surgery Sun Yat-sen University Cancer CenterGuangzhouGuangdong Province Department of General Surgery Jinling HospitalMedical School of Nanjing UniversityNanjingJiangsu Province Department of General Surgery Xiangya HospitalCentral South UniversityChangshaHunan Province Department of Radiation Oncology Peking University First H

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.

关键词： Diagnosis Guideline Multidisciplinary Team Pancreatic cancer Treatment

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multidisciplinary comprehensive treatment of massive hepatocellular carcinoma with hemorrhage:A case report and review of literature

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World Journal of Gastrointestinal Oncology 2024年第5期16卷 2225-2232页

作者： Xian-Shuai Kou Fan-Fan Li Yun Meng Jian-Ming Zhao Sheng-Fen Liu Lan Zhang The First Clinical Medical College Gansu University of Chinese MedicineLanzhou 730000Gansu ProvinceChina Department of Thoracic Surgery The First Hospital of Lanzhou UniversityLanzhou 730000Gansu ProvinceChina Department of Surgery Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina Department of Orthopedics Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina

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.

关键词： Hepatocellular carcinoma Transarterial chemoembolization Sintilimab Sorafenib Translational therapy Multidisciplinary Team Case report

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Comprehensive treatment of a functional pancreatic neuroendocrine tumor with multifocal liver metastases

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Chinese Journal of Cancer Research 2014年第4期26卷 501-506页

作者： Wei Wang Sharvesh Raj Seeruttun Cheng Fang Zhiwei Zhou Department of Gastric and Pancreatic Surgery Sun Yat-sen University Cancer Center State Key Laboratory of Oncology in South China Collaborative Innovation Center for Cancer Medicine

A 64-year-old man was admitted to the Sun Yat-Sen University Cancer Center with chief complaints of recurrent abdominal pain and diarrhea for about 3 years and with a history of surgical repair for intestinal perforation owing to stress ulcer. Positron emission tomography （PET）/computed tomography （CT） demonstrated a primary tumor on the pancreatic tail with multifocal liver metastases. Pathological and immunohistochemistry staining revealed the lesion to be a pancreatic neuroendocrine tumor （pNET）. According to the latest World Health Organization （WHO, 2013） classification, the tumor was classified as stage IV fimctional G1 pNET. After referral to the multidisciplinary treatment board （MDT）, the patient was started on periodic dose of omeprazole, somatostatin analogues and Interferon α （IFNα） and had scanning follow-ups. Based upon the imaging results, CT-guided radioactive iodine-125 （1251） seeds implantation therapy, radiofrequency ablation therapy （RFA） or microwave ablation technique were chosen for the treatment of the primary tumor. Transarterial chemoembolization （TACE）, RFA and microwave ablation techniques were decided upon for liver metastases. The patient showed beneficial response to the treatment with clinically manageable low-grade side effects and attained partial remission （RECIST criteria） with a good quality of life.

关键词： Pancreatic neuroendocrine tumor （pNET） functional liver metastases Multidisciplinary Team prognosis

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