Trends in management and outcomes of pulmonary embolism with a multidisciplinary response team

Journal of Thrombosis and Thrombolysis - Multidisciplinary pulmonary embolism (PE) response teams have garnered widespread adoption given the complexities of managing acute PE and provide a...     

Randomized comparison of a multidisciplinary team care program with usual care in patients with systemic sclerosis

Objective

To compare the effectiveness of a multidisciplinary team care program with usual outpatient care in patients with systemic sclerosis (SSc; scleroderma).

Methods

We performed a randomized controlled trial comparing a 12‐week multidisciplinary team care program (1 day per week; individual treatments, group exercises, and group education) with outpatient clinic care. Outcome measures included the Hand Mobility in Scleroderma (HAMIS) test, grip strength, maximal mouth opening (MMO), 6‐minute walk distance (6MWD), maximum aerobic capacity (VO _2max), Checklist Individual Strength 20 (CIS‐20), SSc Health Assessment Questionnaire (HAQ), and Short Form 36 (SF‐36), assessed at 0, 12, and 24 weeks. Statistical comparisons of change scores were done by analysis of covariance.

Results

Twenty‐eight patients were assigned to the intervention group (mean age 53.9 years, 15 of 28 with diffuse SSc) and 25 were assigned to the control group (mean age 51.7 years, 15 of 25 with diffuse SSc). Twenty‐five patients (89%) in the intervention group completed the treatment program. At 12 weeks, there was a significantly greater improvement in grip strength (2.2 versus ?1.8 kg; P = 0.001), MMO (1.4 versus ?0.9 mm; P = 0.011), 6MWD (42.8 versus 3.9 meters; P = 0.021), and HAQ score (?0.18 versus 0.13; P = 0.025) in the intervention group, whereas differences for the other outcome measures did not reach significance. At 24 weeks, the effect on grip strength persisted.

Conclusion

In patients with SSc, a 12‐week multidisciplinary day patient treatment program was more effective than regular outpatient care with respect to 6MWD, grip strength, MMO, and HAQ score, but not for VO _2max, HAMIS test, CIS‐20, SF‐36, and visual analog scale for pain. This study provides a first step in quantifying the effect of a multidisciplinary team care program and warrants the conduct of further intervention studies.

     

Critical care bug team: a multidisciplinary team approach to reducing ventilator-associated pneumonia

BACKGROUND: Ventilator-associated pneumonia rates in the medical-surgical intensive care unit first exceeded the 90th percentile in September 1997 and were significantly (P <.05) higher than National Nosocomial Infections Surveillance System pooled mean data. In January 1998, a multidisciplinary "Critical Care Bug Team" was developed by the Infection Control Committee to review 1997 National Nosocomial Infections Surveillance System data for four adult intensive care units in a 583-bed tertiary care hospital. METHODS: Membership included clinical nurse specialists, a dietitian, a pharmacist, a respiratory therapist, an infection control professional, a research specialist, and a physician adviser. Having the team report directly to the hospital's Infection Control and Adult Critical Care Committees maximized support for recommendations and provided a direct link from patient care to hospital administration. By identifying issues, evaluating patient care processes, performing literature searches, and monitoring compliance, the team implemented numerous interventions, including policy and procedure changes, purchasing of equipment, and implementation of various education tools. RESULTS: Each member of the Critical Care Bug Team contributed to a synergized effort that may have produced the desired outcome of decreasing ventilator-associated pneumonia rates. Except for August 1998, ventilator-associated pneumonia rates have been below the 75th percentile since May 1998. CONCLUSION: This study illustrates the effectiveness of a multidisciplinary team approach devised to reduce and stabilize ventilator-associated pneumonia rates in a medical-surgical intensive care unit.     

Effect of multidisciplinary team treatment on outcomes of patients with gastrointestinal malignancy

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 dat...     

Diabetes foot complication: assessing primary and secondary outcomes of multidisciplinary team versus standard care (a systematic review)

About 15 % of all diabetes patients experience foot complication at some stage in their life. The goal of this review is to systematically assess on effectiveness of multidisciplinary teamwork compared to the standard care in risk reduction of diabetes-related foot complications with a primary and secondary outcome. Literatures of only English language were analyzed under strict inclusion criteria from electronic databases search. Result from overall pooled estimate up to 0.65 % reduction, with 95 % CI (p?<?0. 005) in foot ulceration and amputation using a multidisciplinary team care as a tool compared to the standard care in primary outcome. Evidence also supports program benefits in overall cost (0.6 % reduction, p?<?0.005), rate of hospitalization (80 % dropped, p?<?0.003), and patient quality of life as secondary outcomes. Study’s characteristic differed substantially in term of health care setting, nature of interventions, and outcomes measured reported. Evidently, multidisciplinary team efforts from specialists in diabetes, vascular and infectious disease, along with podiatry expertise and patient educators result in a significant reduction in diabetes-related foot complications compared to the standard care.     

A comparison of short-term outcomes between Ivor-Lewis and McKeown minimally invasive esophagectomy

Background

Only few comparative studies have been reported on the outcomes of minimally invasive esophagectomy (MIE) with intrathoracic anastomosis (MIE Ivor-Lewis) and MIE with cervical anastomosis (MIE McKeown) for patients with mid and lower esophageal cancer. The objective of this study is to compare the safety, feasibility, and short-term outcomes between two groups.

Methods

Clinical and surgical data of patients with esophageal cancer who underwent either MIE Ivor-Lewis or MIE McKeown between January 2013 and October 2014 were retrospectively analyzed. Demographic characteristics, pathological data, operative procedures, and perioperative outcomes and survival in patients were compared between both groups.

Results

Of the 72 patients included in this retrospective analysis, 32 underwent MIE Ivor-Lewis and 40 underwent MIE McKeown. Demographics, pathologic data, inpatient mortality, and surgical morbidity in both cohorts were almost identical. A significant difference was observed in Pulmonary complication (18.8% vs. 42.5%, P=0.032), Anastomotic leakage (9.4% vs. 30%, P=0.032), Anastomotic stenosis (12.5% vs. 35%, P=0.028), recurrent laryngeal nerve (RLN) injury (6.3% vs. 22.5%, P=0.034) between MIE Ivor-Lewis and MIE McKeown groups; however, no difference in operative time (312.6±82.0 vs. 339.4±80.0, P=0.249), blood loss (246.3±82.4 vs. 272.9±136.3, P=0.443), lymph nodes harvested (19.3±8.1 vs. 20.2±7.2, P=0.655) and 90-day mortality (3.1% vs. 5%, P=0.692) was observed between two groups.

Conclusions

The procedure of MIE Ivor-Lewis for esophageal cancer possesses advantages in perioperative outcomes and less complications compared with MIE McKeown.     

Comparison of short-term clinical outcomes between robot-assisted minimally invasive esophagectomy and video-assisted minimally invasive esophagectomy: a systematic review and meta-analysis

BackgroundThough robot-assisted minimally invasive esophagectomy (RAMIE) is demonstrated to offer a better visualization and provide a fine dissection of the mediastinal structures to facilitate the complex thoracoscopic operation, the superiorities of RAMIE over MIE have not been well verified. The aim of this study was to explore the actual superiorities through comparing short-term results of RAMIE with that of MIE.MethodsPubMed, EMBASE and web of science databases were systematically searched up to September 1, 2020 for case-controlled studies that compared RAMIE with TLMIE.ResultsFourteen studies were identified, with a total of 2,887 patients diagnosed with esophageal cancer, including 1,435 patients subjected to RAMIE group and 1,452 patients subjected to MIE group. The operative time in RAMIE was still significantly longer than that in MIE group (OR =0.785; 95% CI, 0.618–0.952; P<0.001). The incidence of pneumonia was significantly lower in RAMIE group compared with MIE group (OR =0.677; 95% CI, 0.468–0.979; P=0.038).ConclusionsRAMIE has the superiorities over MIE in short-term outcomes in terms of pneumonia and vocal cord palsy. Therefore, RAMIE could be considered as a standard treatment for patients with esophageal cancer.     

360-degree assessment in a multidisciplinary team setting

OBJECTIVES: To use the 360-degree assessment in the multidisciplinary setting of a rheumatology department and to evaluate its impact, recognizing that this process will become part of the revalidation process of NHS professionals in the future. METHODS: Seventeen team members completed an anonymous questionnaire to give confidential opinions about the clinical, humanistic and other skills of their colleagues. Results and comments were collated and given as feedback to each individual. Before feedback, participants were asked to predict their perceived strengths and weaknesses. After feedback they evaluated the process. RESULTS: A profile of abilities was established for each team member and discussed privately with the clinical director. Often team members had good insight into their perceived strengths and weaknesses. Some participants were hurt by negative comments made about them even if this was balanced by positive comments. There were mixed views on the relevance and usefulness of the process, and whether or not it should be repeated. Some team members found the process threatening. CONCLUSION: The 360-degree assessment can be used in a multidisciplinary setting, the questions being the same for all individuals. It is a very powerful tool that must be handled carefully so that it does not cause more harm than good.     

Impact of a multidisciplinary team meeting on patient-reported outcomes at 2 years after lumbar surgery: A prospective comparative exploratory study

Failed back surgery syndrome is a challenge. We hypothesized that a multidisciplinary team meeting (MTM) may be useful to select patients who are the most likely to benefit from lumbar surgery. We conducted an observational, prospective, comparative, exploratory study. We aimed to compare core clinical patient-reported outcomes at 2 years after lumbar surgery between patients who attended a MTM and those who did not. Patients who underwent lumbar surgery for a degenerative disease, in a single academic orthopedic department, between January and September 2018, were consecutively screened. Eligible patients were surveyed between April and June 2020. Patient-reported outcomes included lumbar and radicular pain, spine-specific activity limitations and health-related quality of life assessed via self-administered questionnaires. Outcomes were compared between respondents who attended the MTM and those who did not. Overall, 211 patients underwent lumbar surgery, 108 were eligible and 44 included: 11 attended the MTM and 33 did not. Mean participants’ age was 57.4 (15.4) years, symptom duration was 14.8 (15.3) months, lumbar pain was 51.3 (18.2) and radicular pain was 53.4 (18.6). At 2 years, we found no evidence that lumbar and radicular pain, activity limitations and health-related quality of life differed between the 2 groups. The decrease was −26.8 (41.1) versus −20.8 (30.4) in lumbar pain and −25.5 (43.0) versus −19.5 (27.5) in radicular pain, in participants who attended the MTM versus those who did not, respectively. We found no evidence that core clinical patient-reported outcomes at 2 years after lumbar surgery differed between participants who attended the MTM and those who did not. However, the exploratory design of our study does not allow concluding that MTMs do not have an impact.     

Survival impact of perioperative changes in prognostic nutritional index levels after esophagectomy

Esophagus - The correlation between perioperative changes in nutritional status during esophagectomy and prognosis remains unclear. This study aimed to evaluate the impact of changes in prognostic...     

Cost effectiveness and cost utility analysis of multidisciplinary care in patients with rheumatoid arthritis: a randomised comparison of clinical nurse specialist care,inpatient team care,and day patient team care

OBJECTIVE: To assess the relative cost effectiveness of clinical nurse specialist care, inpatient team care, and day patient team care. METHODS: Incremental cost effectiveness analysis and cost utility analysis, alongside a prospective randomised controlled trial with two year follow up. Included were patients with rheumatoid arthritis (RA) with increasing difficulty in performing activities of daily living over the previous six weeks. Quality of life and utility were assessed by the Rheumatoid Arthritis Quality of Life questionnaire, the Short Form-6D, a transformed rating scale, and the time tradeoff. A cost-price analysis was conducted to estimate the costs of inpatient and day patient hospitalisations. Other healthcare and non-healthcare costs were estimated from cost questionnaires. RESULTS: 210 patients with RA (75% female, median age 59 years) were included. Aggregated over the two year follow up period, no significant differences were found on the quality of life and utility instruments. The costs of the initial treatment were estimated at euro 200 for clinical nurse specialist care, euro 5000 for inpatient team care, and euro 4100 for day patient team care. Other healthcare costs and non-healthcare costs were not significantly different. The total societal costs did not differ significantly between inpatients and day patients, but were significantly lower for the clinical nurse specialist patients by at least euro 5400. CONCLUSIONS: Compared with inpatient and day patient team care, clinical nurse specialist care was shown to provide equivalent quality of life and utility, at lower costs. Therefore, for patients with health conditions that allow for any of the three types of care, the preferred treatment from a health-economic perspective is the care provided by the clinical nurse specialist.     

多学科团队协作模式在养老机构老年慢性病患者长期护理服务中的应用

目的探讨多学科团队协作护理模式在养老机构老年慢性病患者长期护理服务中的应用效果。方法选取泸州社会福利院老年慢性病患者120例为研究对象。组建多维度、多机构、跨专业的多学科团队,采用多学科团队协作模式进行3个月的长期护理服务。分别在实施多学科团队协作模式前后,采用问卷调查评估患者满意度,采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评定患者心理状态,采用日常生活能力Barthe指数评估量表评估患者日常生活能力,采用美国医学结局研究组健康状问卷(MOSSF-36)评估患者生活质量情况。结果多学科团队协作模式实施后,老年慢性病患者的满意度评分、日常生活能力评分和生活质量评分均高于实施前(P均<0.05),患者心理状态评分均低于实施前(P均<0.05)。结论多学科团队协作模式可以提高养老机构老年慢性病患者的满意度,改善患者的心理状态,提高患者的日常生活能力和生活质量,值得推广应用。     

Influence of splenectomy on perioperative morbidity and long-term survival after esophagectomy in patients with esophageal carcinoma

The aim of this study was to determine the influence of splenectomy on perioperative morbidity and mortality, as well as on the long-term survival after esophageal resection for carcinoma of the esophagus. From September 1985 to July 2003, 404 patients underwent surgery for esophageal carcinoma in our institution. Splenectomy was performed in 34 (8.4%) patients. Perioperative morbidity and long-term survival were compared in patients with and without concomitant splenectomy. Splenectomy was associated with an increase in intraoperative blood loss and the need for transfusions of blood preserves (P < 0.0001). However, there were no significant differences in pulmonary, general, or surgical complications between patients with and without (P > 0.05) splenectomy. While the survival rate of 13.9 months recorded in patients without splenectomy was longer compared with a survival rate of 8.9 months for patients after splenectomy, it did not reach statistical significance (P = 0.315). The analysis of survival time (log-rank) did not yield any differences between squamous cell and adenocarcinoma, distal tumor location and adenocarcinoma in combination with distal location for patients with and without concomitant splenectomy (P > 0.05). Incidental splenectomy in esophageal resection for esophageal carcinoma is not associated with an increase in perioperative morbidity. Both effective intraoperative management and postoperative intensive care therapy are essential measures in the avoidance of fatal complications after splenectomy. Although it is not yet proven, that splenectomy may have an adverse effect on long-term prognosis, operative procedure should avoid removing the spleen.     

Clinical pain management by a multidisciplinary palliative care team: Experience from a tertiary cancer center in China

To investigate the effect of multidisciplinary interventions on pain management in cancer inpatients.Four hundred thirty eight patients with cancer pain, who performed the multidisciplinary intervention were recruited. Before and after intervention, the Brief Pain Inventory (BPI) and the MD Anderson Symptom Inventory (MDASI) score as the primary endpoints and QOL scores as the secondary endpoint were all evaluated. To investigate the factors that led to different responses to multidisciplinary interventions, patients were classified as non-responders or responders.Finally, 92 patients (63 male and 29 female) scheduled for cancer pain management by inter-professional team were studied. After individualized multidisciplinary therapy, both pain and symptom severity was improved, as demonstrated by lowered BPI worst and average pain scores, as well as symptom severity score measured by MDASI (P = .017, P = .003, and P = .011, respectively). The proportion of patients with mild pain increased regarding the BPI worst and average pain at baseline and after treatment (P < .05). The QOL analyses showed multidisciplinary interventions could significantly improve the function and symptom scores (P < .001). More patients in responder group received chemotherapy (58, 70.7%, P = .003), while fewer received mini-invasive therapy (6, 7.32%, P = .011).Multidisciplinary interventions had certain beneficial effect on cancer pain management, especially in patients with moderate or severe pain.