Objective To discuss the strategies for building the framework of team culture of multi-disciplinary team (MDT) for colorectal cancer. Methods By comprehending the traditional concept of volunteer and probing into the value of traditional team culture, combining the needs of MDT for colorectal cancer, build appropriate team culture and core idea of MDT for colorectal cancer. Results Confirm that building of volunteers groups and the volunteers culture is the core of the team culture of MDT for colorectal cancer. Analyze characters of volunteers groups and the operation strategies, and find the way of maintaining the volunteers culture. Conclusion With the development of volunteers groups and increased participants, the team culture of MDT for colorectal cancer will show more sociality and extent. And it is also the important idea and direction for development in future. As team culture, organization structure and personnel structure supplements each other, adjusting and perfecting the team culture in practice continually is a long-term work for MDT.
Objective To explore the application of multi-disciplinary team (MDT) clinics in fetal developmental abnormalities. Methods A retrospective analysis method was used to collect case data of fetal developmental abnormalities and completion of prenatal MDT clinics diagnosis and treatment in pregnant women who were registered in the Department of Obstetrics of West China Second Hospital, Sichuan University between December 2021 and November 2022. The situation of pregnant women and fetuses was summarized and analyzed. Results There were 19362 registered pregnant women, of which 1125 (5.8%) had abnormal fetal development. Among them, 272 (24.2%) received prenatal MDT clinics diagnosis and treatment. Fetal developmental abnormalities were mainly characterized by structural abnormalities (208 cases, 76.5%), with the top three being central nervous system abnormalities, circulatory system abnormalities, and multiple malformations. There were 202 pregnant women who continue to conceive, and 70 cases had undergone induced labor, with an induced labor rate of 25.7%. The top three main causes of induced abortion were multiple malformations, central nervous system abnormalities, and circulatory system abnormalities. After prenatal MDT clinics diagnosis and treatment, the diagnosis of fetal developmental abnormalities in 46 pregnant women were corrected. Conclusion Prenatal MDT clinics are helpful for the early comprehensive evaluation of fetal developmental abnormalities and the determination of diagnosis and treatment plans.
Objective To explore the clinical effect of different strategies for surgical treatment of cancer of rectum combined with neo-adjuvant chemotherapy under multi-disciplinary team. Methods From January 2007 to December 2007, the patients diagnosed definitely as rectal cancer were analyzed retrospectively, of whom accept surgery combined with neo-adjuvant chemotherapy were included. The clinical effects were studied and observed, the differences among the strategies for different surgical treatment 〔high anterior resection (HAR), low anterior resection (LAR), out-pouching with colo-anal anastomosis (OCAA), radical resection with non-saving anus (RNSA), and palliation colostomy (PCO)〕 in the multi modality therapy were compared. Results Comparing the constituent ratio of gross type of tumor in five groups, the difference between PCO group and the other 4 groups had mainly statistical significance （P＜0.05）. The difference of constituent ratio of Dukes staging had statistical significance between HAR group and OCAA group, HAR group and PCO group, LAR group and PCO group （P＜0.05）. According to the duration of operation, the persisting time of PCO group was obviously shorter than that of the other 4 groups （P＜0.05）, meanwhile, the persisting time of LAR group was shorter than that of OCAA group and RNSA group （P＜0.05）. According to the volume of ascites discovered in operation, mainly between HAR group and LAR group, between HAR group and RNSA group, the incidence of a seroperitoneum more than 200 ml in the former was less than the latter （P＜0.05）. Regarding to indexes of laboratory, CEA value in PCO group was higher than the other 4 groups, serum amyloid A value in RNSA group was higher than the other 4 groups, and the differences had statistical significances （P＜0.05）. Conclusion Mini-invasive surgery may have certain significance in clinical effect of the comprehensive treatment for advanced rectal cancer when different operative methods were combined with neo-adjuvant chemotherapy. And by the way, better clinical effect will take place when the anus-retained operation is possibly performed.
ObjectiveTo explore the practical effects of multi-disciplinary team (MDT) management model in the management of multidrug-resistant organisms (MDROs).MethodsIn 2015, the multi-drug resistant MDT was established, and MDT meetings were held regularly to focus on the problems in the management of MDROs and related measures to prevent and control nosocomial infections of MDROs.ResultsThe detection rate of MDROs from 2014 to 2017 was 9.20% (304/3 303), 7.11% (334/4 699), 8.01% (406/5 072), and 7.81% (354/4 533), respectively. The difference was statistically significant (χ2=11.803, P=0.008), in which the detection rates of carbapenem-resistant Acinetobacter baumannii (CRABA), carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Enterobacteriaceae (CRE) changed significantly (χ2=39.022, 17.052, 12.211; P<0.05). From 2014 to 2017, the proportion of multi-drug resistant infections decreased year by year, from 84.54% to 52.82%, and the proportion of multi-drug resistant hospital infections also declined, from 46.05% to 23.16%; the nosocomial infection case-time rate decreased from 0.24% to 0.13% year-on-year; the proportion of multi-drug resistant hospital infections in total hospital infections was 9.07%, 11.17%, 10.47%, and 6.16%, respectively; in the distribution of multi-drug resistant nosocomial infection bacteria, the proportion of methicillin-resistant Staphylococcus aureus, CRABA, CRE hospital infections accounted for the number of MDROs detected decreased year by year. The use rate of antibiotics decreased from 46.58% in 2014 to 42.93% in 2017, and the rate of pathogens increased from 64.83% in 2014 to 84.59% in 2017.ConclusionThe MDT management mode is effective for the management and control of MDROs, which can reduce the detection rate, infection rate, hospital infection rate, and antibacterial drug use rate, increase the pathogen detection rate, and make the prevention and control of MDROs more scientific and standardized.
Objective To build a systematic, comprehensive, high efficient and maneuverable follow-up system in multi-disciplinary team (MDT). Methods Comparing with abroad follow-up practical management, the advantages and disadvantages were analyzed by using multiple follow-up forms and the construct of staffs to guide and evaluate the postoperative patients in colorectal carcinoma at the beginning of follow up system. Results Follow-up system was made rationalized, and an effective follow-up model was built up to extend in MDT. Conclusion Following up the present situation with patients of colorectal cancer in this country, the correct direction which is based on current follow-up system would be put out. That would be the important study to improve the medical treatment in next stage.
Objective To deeply explore the consultation model of multi-disciplinary team (MDT) for colorectal cancer (CRC) reconstruction. Methods After analyzing early consultation model of CRC-MDT, some unreasonable factors were discovered and more suitable model was found. Results With analyzing the problems of members, time and management in early consultation model, reconstructing consultative joints and links, and optimizing flow-sheet were choosed. Finally, the MDT project was set up inter-project clinical round and network consultation. Conclusion The feedback from patients after consultation model reconstruction shows good results. Total consultative system in CRC-MDT will be completely finished step by step. However, advanced researches are still needed.
Objective To summarize recent advances on preoperative staging strategies in rectal cancer. Methods Relevant references about preoperative staging strategies were collected and reviewed. The multimodal preoperative evaluation (MPE) system recently documented was focused on. Results The comparably accurate T and M stage could be achieved preoperatively by following an appropriate available method; however, the N stage’s accuracy was still not satisfying. The MPE system， incorporating with the advantages of transrectal ultrasound， computerized tomography and serum amyloid A protein in a multi-disciplinary mode could display the most accurate preoperative staging for rectal cancer currently. Conclusion The MPE has potential prospects in preoperative staging of rectal cancer， and can provide the most accurate preoperative staging for rectal cancer at present.
The deep integration of modern technology and medical development promotes the change of medical and health management environment. As an important part of hospital medical and health decision-making process, the evaluation and access of medical equipment and consumables need scientific evidence-based evaluation system. This paper introduces a new-equipment evaluation model created by the multi-disciplinary evaluation team of West China Hospital of Sichuan University under the guidance of evidence-based ideas and methods. This model is suitable for the Chinese national conditions and easy to operate.
Objective To explore the clinical effect of neo-adjuvant/adjuvant chemotherapy combined with operation on colorectal cancer patients in the multi-disciplinary team (MDT). Methods The data were collected retrospectively from January to December in 2007. The patients were classified as non-adjuvant chemotherapy group and adjuvant chemotherapy group according to the treatment strategy. Non-adjuvant chemotherapy group had accepted only surgery followed by preoperative neo-adjuvant chemotherapy, and adjuvant chemotherapy group had taken postoperative adjuvant chemotherapy after preoperative neo-adjuvant chemotherapy and operation. The clinical effect of two groups were compared. Results Totally 789 patients were treated among 2007, and 195 patients who were firstly diagnosed as colorectal cancer were included, and there were 109 males and 86 females, 59 colonic cancers and 136 rectal cancers. Average age was 59.98 years old. All of the included patients were followed up for 5-17 months. Three cases missed, no recurrence and no death happened. The baseline between non-adjuvant chemotherapy and adjuvant chemotherapy group was nearly same. There were no differences between two groups about the internal medicine complications, the cancer related obstruction, preoperative transfusion or not (P＞0.05). Whether the patients were transfused or not during the procedure and Dukes stage were significantly different between two groups(P＜0.05), while the other surgical and pathological index didnt show any statistical significance (P＞0.05). After operation, more patients in non-adjuvant chemotherapy group had accepted transfusion (P＜0.05). However, the postoperative rehabilitative indexes during hospitalization were not different between two groups. And the differences about the postoperative complications and defecation were not significant (P＞0.05). The values of CEA and CA19-9 were greatly different between two groups in the 1st and 3rd month follow-up. Conclusion The strategy of neo-adjuvant chemotherapy/operation/adjuvant chemotherapy didnt affect the rehabilitation and increase the risk of complications, however, more researches were necessary to prove whether the clinical effect were improved or not.
Objective To determine the influence and significance of combinative assessment of 64 multi-slice spiral computed tomography (MSCT) with serum amyloid A protein (SAA) or C-reactive protein (CRP) on the selection of operative procedures of rectal cancer under the multi-disciplinary team. Methods Prospectively enrolled patients diagnosed definitely as rectal cancer at West China Hospital of Sichuan University from February to August 2009 were randomly assigned into two groups. In one group named MSCT+SAA group, both 64 MSCT and SAA combinative assessment were made for the preoperative evaluation. In another group named MSCT+CRP group, both MSCT and CRP combinative assessment were made for preoperative evaluation. Furthermore, the preoperative staging and predicted operation procedures were compared with postoperative pathologic staging and practical operation procedures, respectively, and the relationship between the choice of operation procedures and clinicopathologic factors was analyzed. Results All 165 patients were randomly assigned into MSCT+SAA group (n=83) and MSCT+CRP group (n=82). The baseline characteristics of two groups were statistically similar (Pgt;0.05). For MSCT+SAA group, the accuracies of preoperative staging T, N, M and TNM were 74.7%， 68.7%, 100% and 66.3%, respectively. For MSCT+CRP group, the accuracies of preoperative staging T, N, M and TNM were 72.0%, 86.6%, 100% and 81.7%, respectively. There were statistically significant differences in the accuracies of N staging and TNM staging between two groups (P＜0.05). However, there was no statistically significant difference of the accuracy of prediction to operative procedures between two groups (90.4% vs. 95.1%, Pgt;0.05). The pathological T staging (P＜0.001), N staging (P＜0.001), TNM staging (P＜0.001), preoperative serum level of SAA (P=0.010), serum level of CRP (P=0.042), and distance of tumor to the dentate line (P=0.011) were associated with the operative procedures. Conclusion Combinative assessment of MSCT+CRP could improve the accuracy of preoperative staging and operative procedures prediction, which may be superior to MSCT+SAA.