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1.
Organ Transplantation ; (6): 183-2023.
Article in Chinese | WPRIM | ID: wpr-965040

ABSTRACT

Due to long-term use of immunosuppressive agents, solid organ transplant recipients (SOTR) belong to high-risk populations of multiple pathogenic infection, including SARS-CoV-2. In addition, SOTR are constantly complicated by chronic diseases, such as hypertension and diabetes mellitus, etc. After infected with SARS-CoV-2, the critically ill rate and fatality of SOTR are higher than those of the general population, which captivates widespread attention from experts in the field of organ transplantation. Omicrone variant is currently the significant pandemic strain worldwide, rapidly spreading to more than 100 countries worldwide and causing broad concern. According to the latest international guidelines on the diagnosis and treatment of SARS-CoV-2 infection and relevant expert consensus in China combined with current domestic situation of SARS-CoV-2 pandemic and China's "diagnosis and treatment regimen for SARS-CoV-2 infection (Trial Version 10)", the epidemiology, clinical manifestations and prognosis, diagnosis, clinical classification and treatment of SARS-CoV-2 infection were briefly reviewed.

2.
Chinese Journal of Hepatology ; (12): 16-34, 2023.
Article in Chinese | WPRIM | ID: wpr-970948

ABSTRACT

Immune checkpoint inhibitors (ICIs)-based immunotherapy combined with other treatment for hepatocellular carcinoma (HCC) has achieved significant efficacy in clinical research and practice, and has become the most commonly used and mainstay therapy for the treatment of unresectable HCC. In order to help clinicians administrating immunotherapy drugs and regimens rationally, effectively and safely, we organized a multidisciplinary expert team to adopt the "Delphi" consensus formation method, and finally revised and completed the "Multidisciplinary Expert Consensus on Combination Therapy Based on the Immunotherapy for Hepatocellular Carcinoma (2023 Edition)" on the basis of the 2021 version. This consensus mainly focuses on the principles and methods of clinical application of combination therapy based on the Immunotherapy, aiming to summarize the recommendations for clinical application based on the latest research and expert experience, and provide application guidance for clinicians.


Subject(s)
Humans , Carcinoma, Hepatocellular/therapy , Consensus , Immunotherapy , Liver Neoplasms/therapy
3.
JOURNAL OF RARE DISEASES ; (4): 554-588, 2023.
Article in English | WPRIM | ID: wpr-1004932

ABSTRACT

@#The Ehlers-Danlos syndromes (EDS) are a group of rare hereditary connective tissue disorders. EDS is clinically and genetically heterogeneous and usually involves multiple systems. EDS has 14 subtypes, the common features of which include joint hypermobility, skin hyperextensibility, tissue fragility, and etc. The clinical manifestations and their severity differ between the subtypes, involving recurrent joint dislocations, scoliosis, arterial aneurysm and dissection, organ rupture, and others. The complexity of the disease poses challenges to the diagnosis and management of EDS, together with the rareness of the disease. The development of clinical guidelines and implementation of coordinated multi-disciplinary team (MDT) approaches to the EDS is in priority in the world.Therefore, we formed the Multi-Disciplinary Working Group on the Ehlers-Danlos Syndromes in China. Based on GRADE methodology, the MDT group developed the Guidelines. The Group highly recommends a coordinated MDT approach to the diagnosis and management of EDS. The first drafted guidelines on EDS will facilitate the shortening of the diagnostic odyssey and meeting the unmet medical needs of the patients.

4.
Chinese Journal of Endemiology ; (12): 663-667, 2023.
Article in Chinese | WPRIM | ID: wpr-991690

ABSTRACT

Objective:To study the remote multi-disciplinary team (MDT) model in diagnosis and treatment of plague, in order to provide scientific basis for clinical treatment of plague.Methods:A retrospective analysis was made on the diagnosis and treatment process of a case of bubonic plague, a sudden imported Class A infectious disease, which was secondary to septicemic plague, involving a remote MDT team consisting of the Infectious Diseases Department, Intensive Care Unit, Respiratory and Critical Care Department, Cardiology Department, Pharmacy Department, and Nosocomial Infection Department of the General Hospital of Ningxia Medical University.Results:The patient was a middle-aged female who was engaged in herding work on the grassland. The first symptom was a sudden pain in the left lower abdomen for three days, accompanied by chest tightness and shortness of breath. After hospitalization, blood culture indicated Yersinia, abdominal CT indicated left lower abdominal lymph node enlargement, and lymph node puncture fluid was positive for Yersinia pestis nucleic acid. Combined with clinical symptoms and signs, the patient was diagnosed as bubonic plague secondary to septicemic plague, and was isolated for treatment. After remote MDT consultation, comprehensive treatment was given, including anti-infection treatment of streptomycin and ciprofloxacin, short-term application of hormones, nutritional support, and local application of chloramphenicol ointment, etc. Secondary acute pancreatitis occurred during the course of the disease, which improved after symptomatic treatment. Finally, after 20 days of treatment, MDT expert group assessed that it met the discharge criteria. No abnormalities were found in follow-up visits outside the hospital. Conclusion:The remote MDT is effective in the treatment of bubonic plague secondary to septicemic plague, which is worth popularizing.

5.
Chinese Journal of Medical Education Research ; (12): 1517-1520, 2022.
Article in Chinese | WPRIM | ID: wpr-955703

ABSTRACT

Objective:To study the effect of knowledge tree combined with problem-based learning (PBL) in the practice teaching of anesthesiology under the concept of multi-disciplinary team (MDT).Methods:A total of 60 students who practiced in the Department of Anesthesiology in Jiangsu Province Hospital from January 2019 to June 2019 were taken as the control group, and the traditional teaching was adopted; another 60 students who practiced from July 2019 to December 2019 were taken as the research group, and the knowledge tree combined with PBL under the MDT concept was conducted for the teaching. The two groups' test scores, clinical abilities and teaching satisfaction were compared between the two groups. SPSS 26.0 was used for t-test, Chi-square test and rank-sum test. Results:After the internship, the test scores of the students in the research group were higher than those in the control group ( P < 0.05); the clinical ability of the two groups were both improved compared to before the training, and the research group was superior to the control group ( P < 0.05); the satisfaction rate of internship students in the research group was 93.33% (56/60), which was higher than 75.00% (45/60) in the control group. Conclusion:The application of knowledge tree and PBL under the MDT concept in the practice teaching of anesthesiology can improve the performance of the intern students, and effectively improve the self-learning ability, communication and expression ability and teamwork ability of the interns, with obvious practice effect.

6.
Chinese Journal of Hospital Administration ; (12): 362-366, 2022.
Article in Chinese | WPRIM | ID: wpr-958790

ABSTRACT

Objective:To analyze the progress and promotion effect of the national multidisciplinary team(MDT) pilot project of digestive system tumor diagnosis and treatment, for the reference in promoting the popularition of tumor MDT model.Methods:The data of MDT project evaluation forms of 231 digestive system tumor MDT pilot hospitals in 2018(July 2017 to June 2018), 2019(July 2018 to June 2019)and 2020(July 2018 to June 2019)were obtained. The MDT of digestive system tumors, the development of outpatient and inpatient MDT, the distribution of cases, and the management, charging and regional radiation of MDT in the pilot hospital were analyzed. Descriptive analysis and frequency analysis were used for all the data.Results:With pilot hospitals of missing data excluded, the number of pilot hospitals included in the analysis from 2018 to 2020 was 227, 224 and 224, respectively.The number of pilot hospitals carrying out digestive system tumor MDT increased from 174 in 2018 to 222 in 2020, the number of outpatient and inpatient MDT cases increased from 48 332 and 61 823 to 72 493 and 106 899 respectively, and the proportion of pilot hospitals implementing the MDT management system increased from 159 to 214. In 2020, the average expenses of outpatient and inpatient MDT were mainly 200-500 yuan, and 135(60.3%) pilot hospitals became the leading MDT hospitals in the region.Conclusions:The MDT pilot project of digestive system tumors in China has achieved remarkable results.For example, the number of pilot hospitals carrying out MDT keeps increasing year by year, and the pilot hospitals have played a leading role in the region. In order to accelerate the coverage of the tumor MDT model, the authors suggested that the hospitals should optimize MDT in terms of patient accessibility, optimize management mode, promote the medical insurance reimbursement, and strengthen regional influence.

7.
Chinese Journal of Hospital Administration ; (12): 505-508, 2021.
Article in Chinese | WPRIM | ID: wpr-912789

ABSTRACT

Objective:To analyze the practice and experience of " patient-centered, popularizing multi-disciplinary team(MDT) mode" in medical institutions, and to put forward reasonable suggestions and opinions for medical institutions to further improve and popularize MDT mode.Methods:Based on the evaluation of China Healthcare Improvement Initiative, 40 typical cases of MDT in medical institutions were collected, and descriptive analysis and textual analysis were carried out on the cases.Results:There were more specialized hospitals carrying out MDT, the application scope of MDT services was constantly expanding, and the management system and diagnosis and treatment process were constantly optimized.Conclusions:The mode of MDT in China is in the stage of exploration and development. In the promotion process, it is necessary to give full play to the role of information means, establish scientific and reasonable cost measurement and charge standard, and improve the enthusiasm of medical institutions and medical personnel to participate in MDT.

8.
Chinese Journal of Hospital Administration ; (12): 385-388, 2021.
Article in Chinese | WPRIM | ID: wpr-912764

ABSTRACT

Multi-disciplinary team(MDT)mode is regarded as the key to standardized diagnosis and treatment of malignant tumors. The model, however, encounters such roadblocks in the current form of MDT organization, as costly clinical resources and time consumption, low efficiency, poor management of participating experts in MDT, and lack of enforceability of the therapeutic decisions made. This paper summarized the practical MDT experiences of the Affiliated Cancer Hospital of Shandong First Medical University. It introduced the construction of an intranet-based MDT system covering a large proportion of newly diagnosed malignant tumor patients, and the practices and achievements of such MDT management system under hospital administrative guidance. The authors proposed to use reporting ratio as the main assessment indicator in promoting MDT, and that to define the performance, responsibilities and rights in MDT practice. These measures aim at to upgrading individual behaviors of doctors to organizational behaviors of hospitals, and providing cancer patients with more standardized, comprehensive and personalized diagnosis and treatment decisions.

9.
Chinese Journal of Clinical Nutrition ; (6): 135-141, 2021.
Article in Chinese | WPRIM | ID: wpr-909334

ABSTRACT

Objective:To explore the effect of nurse-led multi-disciplinary team management on postoperative gastrointestinal function and nutritional status in elderly colon cancer inpatients.Methods:A total of 75 elderly inpatients after colon cancer operation who met eligibility criteria and signed informed consent form were randomized into study (n=37) or control group (n=38), receiving nurse-led multi-disciplinary team management or routine nursing for 6 months, respectively. The gastrointestinal function, days of postoperative hospital stay, body weight, body composition and dietary intake were compared between the two groups.Result:Compared to the control group, time to defecation (t=14.79, P<0.01), time to initiation of liquid diet intake (t=6.80, P<0.01), time to initiation of semi-liquid diet intake (t=10.78, P<0.01) and days of postoperative hospital stay (t=8.76, P<0.01) in the study group were significantly shortened; and body weight [(59.44±6.12)kg vs. (62.54±6.41)kg, P=0.004], BMI [(19.02±4.13)kg/m 2 vs. (19.98±3.98)kg/m 2, P=0.025], body fat percentage [(20.03±3.55)% vs. (21.34±3.68)%, P<0.01], lean body mass [(19.63±3.44)kg vs. (21.45±3.16)kg, P<0.01], grip strength [(21.65 ± 3.56) kg vs. (22.48 ± 3.81) kg, P=0.011], attainment rate of 75% target energy intake (65.8% vs. 86.5%, P=0.036) and attainment rate of 75% target protein intake (57.9% vs. 83.8%, P=0.014) were significantly improved in study group 6 months after operation. Conclusion:The nurse-led multi-disciplinary team management can effectively improve the postoperative recovery of gastrointestinal function and the long-term nutritional status in elderly patients with colon cancer.

10.
Chinese Journal of Endocrine Surgery ; (6): 283-287, 2021.
Article in Chinese | WPRIM | ID: wpr-907793

ABSTRACT

Objective:To observe the application effect of the multi-disciplinary team (MDT) process and program supported by WeChat group in the perioperative period of secondary hyperparathyroidism (SHPT) .Methods:A total of 80 SHPT patients who were hospitalized in Hunan Provincial People’s Hospital and Qidong County People’s Hospital from Jul. 2017 to Oct. 2019 were selected and divided into MDT group (40 cases) and control group (40 cases) according to the principle of complete randomization. In MDT group, there were 21 females and 19 males, aged (48.80±9.08) years old, ranging from 26 to 74 years; in the control group, there were 23 females and 17 males, aged (47.90±8.89) years old, ranging from 24 to 74 years. The control group were given a conventional treatment plan, and the MDT group were implemented with the WeChat MDT process on this basis. The perioperative preparation time, operation time, intraoperative blood loss, postoperative extubation time, and continuous full parathyroid were compared between the two groups. The levels of intact parathyroid hormone (iPTH) and blood calcium and phosphorus were compared with the postoperative complications and patient satisfaction in the two groups. The data in this study were analyzed using SPSS 23.0 statistical software.Results:The preoperative preparation time (4.35±1.12) d, operation time (130.00±32.58) min, intraoperative blood loss (15.75±7.89) ml, and postoperative extubation time (3.80±0.82) d in the MDT group were significantly lower than the preoperative preparation time of the control group (6.86±1.85) d, operation time (162.57±41.65) min, intraoperative blood loss (60.75±11.5) ml, postoperative extubation time (5.97±1.25) d ( P<0.05) 1 week after operation, the iPTH (20.86±1.52) pg/ml and blood calcium level (2.23±0.24) mmol/L of the MDT group were significantly lower than those of the control group (103.47±8.27) pg/ml and blood calcium level (2.87±0.21) mmol/L ( P<0.05) , meanwhile the blood phosphorus level of the MDT group (1.52±0.56) mmol/L was significantly higher than the blood phosphorus level of the control group (1.18±0.25) mmol/L ( P<0.05) . The number of complications in the MDT group (20 cases) was significantly lower than the number of complications in the control group (48 cases) ( P<0.05) ; and the satisfaction of treatment in the MDT group (100.00%) was significantly better than that of the control group (80.00%) ( P<0.05) . Conclusion:The WeChat MDT diagnosis and treatment process and treatment plan are safe and effective, which can effectively shorten the operation time, reduce the operation risk, reduce postoperative complications, and increase patient satisfaction. It can be further promoted in the clinic.

11.
Organ Transplantation ; (6): 77-2021.
Article in Chinese | WPRIM | ID: wpr-862779

ABSTRACT

Objective To investigate the clinical characteristics and the experience of multi-disciplinary team (MDT) on recurrence of primary hyperoxaluria (PH) type I after renal transplantation. Methods One case presenting with unexplained rapid decline of renal allograft function after allogeneic renal transplantation was discussed by MDT. The role of MDT in diagnosing rare hereditary diseases and improving the long-term survival of renal transplant recipients was summarized. Results After MDT consultation, the patient was diagnosed with recurrence of PH type I. Routine immunosuppressive regimen was initiated after the exclusion of rejection. The patient was instructed to drink a large quantity of water, and given with high-quality protein and low-phosphorus diet, vitamin B6, calcium and other conservative therapies to actively prevent and treat postoperative complications. The deterioration of renal graft function was delayed. Nevertheless, regular hemodialysis was resumed at 5 months after renal transplantation until the submission date of this manuscript. Conclusions Recurrence of PH type I after renal transplantation is relatively rare. The main clinical manifestations are recurrent kidney stones and decreased renal function with multiple complications and poor prognosis. The condition of the patient is consulted by MDT for confirming the diagnosis, determining the optimal treatment scheme, delaying the progression and improving the clinical prognosis.

12.
Organ Transplantation ; (6): 70-2021.
Article in Chinese | WPRIM | ID: wpr-862778

ABSTRACT

Objective To evaluate the effect of multi-disciplinary team (MDT) on acute heart failure (AHF) complicated with respiratory failure after allograft nephrectomy. Methods MDT discussion was performed on a patient with hemorrhagic shock caused by sudden renal graft hemorrhage, who developed acute myocardial infarction (AMI) with AHF, acute pulmonary congestion, pulmonary infection and acute respiratory failure 2 weeks after allograft nephrectomy. And treatment plan was formulated and effect evaluation was conducted. Results Based on the opinions of MDT discussion, the patient was given nasal high-flow oxygen therapy, continuous veno-venous hemodiafiltration (CVVHDF) to reduce cardiac load, anticoagulant, dilating blood vessels, reducing myocardial oxygen consumption, improving myocardial remodeling, lipid regulation, anti-infection, nutritional support, and other comprehensive treatment. The clinical outcome of the patient was good and regular hemodialysis treatment was resumed. Conclusions Application of MDT pattern helps to formulate a comprehensive and effective individualized treatment plan for patients with AHF and respiratory failure after allograft nephrectomy, which can enhance clinical treatment effects and improve prognosis of patient.

13.
Organ Transplantation ; (6): 64-2021.
Article in Chinese | WPRIM | ID: wpr-862777

ABSTRACT

Objective To improve the understanding of Danon disease and the efficacy of heart transplantation by multi-disciplinary team (MDT) pattern. Methods Prior to heart transplantation, MDT consultation was performed on one case of Danon disease, an extremely rare X-chromosome dominant genetic disease. The content of consultation included surgical indication, preoperative preparation and postoperative precaution, as well as the role of MDT in the treatment of Danon disease was summarized. Results Preoperative echocardiography showed that the patient presented withdilated-phase of hypertrophic cardiomyopathy complicated with heart failure, which was considered as Danon disease with end-stage heart failure. After MDT consultation, the patient received the preoperative treatment including anti-heart failure, reduction of pulmonary artery pressure, intra-aortic balloon pump (IABP) assistance, liver protection, strengthening nutritional support, etc. The patient underwent orthotopic heart transplantation after a suitable donor was matched. The patient developed muscle weakness in the limbs 5 days after operation, which was gradually mitigated after reducing the dose of glucocorticoid. At postoperative 48 days, the patient was discharged in good condition and continually treated with triple immunosuppressive regimen after discharge. Reexamination at postoperative 6 months revealed that the patient was in good health without any abnormality in electrocardiogram and echocardiography images. Conclusions Danon disease is extremely rare and MDT pattern may enhance the efficacy and safety of treatment by heart transplantation.

14.
Chinese Journal of Hospital Administration ; (12): 831-837, 2021.
Article in Chinese | WPRIM | ID: wpr-934514

ABSTRACT

Based on the GAPS(goal, analyze, problem, solution) management model, the authors analyzed the problems existing in the practice of prescription audit and the strategies of continuous optimization. Multi-disciplinary team(MDT) and evidence-based practice were applied to help the continuous optimization of prescription audit practice and promote the rational drug use management of medical institutions. Through the establishment of accurate control process, the personalized management of prescription dosage of chronic diseases, perioperative drugs, special grade antibiotics and auxiliary drugs was realized. The practice of prescription audit based on the GAPS management model, on the one hand, could improve the quality and efficiency of prescription audit, gradually improve the qualified rate of prescription, strengthen clinical use intervention and promote rational drug use; On the other hand, it could reflect the value of pharmacists′ professional technicians, provide patients with more high-quality pharmaceutical care, and gradually realize the prescription audit mode of " improving quality, controlling cost and increasing efficiency" .

15.
Journal of Chinese Physician ; (12): 1616-1618,1622, 2021.
Article in Chinese | WPRIM | ID: wpr-931970

ABSTRACT

The role of multidisciplinary collaborative diagnosis and treatment (MDT) in improving the prognosis of colorectal cancer, lung cancer, breast cancer and other tumors has been proven, but the research of oral cancer MDT is still in the exploratory stage and has not formed a complete conceptual system and operating mode. Oral squamous cell carcinoma (OSCC) is one of the main malignant tumors of the head and neck, with a 5-year survival rate of less than 50%. This article mainly elaborates on the difficulties of oral cancer treatment, the advantages of MDT, and the progress of oral cancer MDT.

16.
Journal of Prevention and Treatment for Stomatological Diseases ; (12): 848-853, 2021.
Article in Chinese | WPRIM | ID: wpr-886569

ABSTRACT

Objective @#To investigate the multi-disciplinary team (MDT) management in the treatment of giant neurofibroma in maxillofacial and neck region, to provide reference for clinical practice.@*Methods@#Retrospective analysis was conducted on the perioperative whole-process management process of 2 cases of giant neurofibroma in maxillofacial and neck region jointly formulated treatment plan by oral and maxillofacial surgery department with the assistance of the department of anesthesiology, ICU, vascular surgery, thoracic surgery, etc.@*Results@#MDT treatment process (anesthesia-embolization-collaborative surgery-ICU-post-operative management) of the two patients was smoothly conducted according to the pre-operative plan. There were no adverse events or accidents that were not predicted by the risk assessment from multiple teams during the operation, and no serious complications occurred after the operation. The post-operative pathological report of both cases was "neurofibroma". Wounds in both patients healed in stage I. The course of treatment was smooth, and the surgical treatment was completed without serious complications. @*Conclusion@# MDT management can play a positive role in the diagnosis and treatment of giant maxillofacial and neck neurofibroma so that patients can obtain safer and more effective diagnosis and treatment.

17.
Organ Transplantation ; (6): 184-2021.
Article in Chinese | WPRIM | ID: wpr-873728

ABSTRACT

Objective To improve the surgical efficacy of bilateral lung transplantation for pediatric cystic fibrosis through multi-disciplinary team (MDT). Methods Preoperative MDT consultation was delivered for a 10-year-old child with rare end-stage cystic fibrosis to establish the corresponding treatment protocol. Results The child was diagnosed with cystic fibrosis for 5 years, and the indication of lung transplantation were confirmed. After preoperative MDT consultation, bilateral lung transplantation via a Clam-shell incision was determined. The vital signs were maintained stable during operation. Postoperatively, ventilator-assisted ventilation, anti-infection, immunosuppression, acid suppression, prevention of stress ulceration and other treatments were delivered. Individualized treatment was given according to the characteristics of the child, and the child was well recovered. Conclusions Through preoperative MDT consultation, lung transplantation yields satisfactory surgical efficacy in treating pediatric cystic fibrosis and lowers the risk of postoperative complications, which deserves application in clinical practice.

18.
China Pharmacy ; (12): 364-369, 2021.
Article in Chinese | WPRIM | ID: wpr-872691

ABSTRACT

OBJECTIVE:To provide reference for the ra tional use of carbap enems in tuberculosis patients. METHODS :Totally 12 576 tuberculosis inpatients were collected from our hospital. Multi-disciplinary team (MDT) model was adopted for carbapenems management in aspects of policy intervention ,technical support and staff training. Average hospitalization duration , mortality,nosocomial infective rate ,use and drug resistance of carbapenems were compared before (Mar. 2016-Mar. 2017)and after management (Apr. 2017 to Mar. 2019). Interrupted time series (ITS)analysis was used to analyze the utilization rate of carbapenems,DDDs,the proportion of carbapenems ’DDDs in the total antibiotics ’DDDs,the proportion of carbapenems ’cost in the total antibiotics ’cost before and after management. Pearson correlation analysis was conducted for DDDs of carbapenems with medical quality indicators and detection rate of carbapenems-resistant bacteria. RESULTS :After the management ,average hospitalization stay ,the cost of antibiotics ,DDDs of carbapenems ,the proportion of carbapenems ’DDDs in the total antibiotics ’ DDDs,the proportion of carbapenems ’cost in the total antibiotics ’cost,the utilization rate of carbapenems ’,and the drug resistance rate of some bacteria to carbapenems were significantly lower than those before the management (P<0.05). ITS analysis results showed that after management ,the utilization rate of carbapenems ,DDDs,the proportion of com carbapenems’DDDs in the total antibiotics ’DDDs and the proportion of carbapenems ’cost in the total antibiotics ’cost hhyyzj@126.com were decrease d by 4.491% ,220.276,6.535% ,11.747% , with statistical significance (P<0.05). Co mpared with before management ,above indexes were decreased by 0.330%,17.625, 0.308%,0.304% monthly,among which the utilization rate and DDDs of carbapenems were decreased significantly (P<0.05). Before management ,drug resistance rate of Pseudomonas aeruginosa to carbapenems was 21.80%,and those of Acinetobacter baumannii to meropenem and imipenem were both 4.60%;after management ,drug resistance rate of P. aeruginosa to imipenem was 13.00%,and those of A. baumannii to meropenem and imipenem were both 16.30%,with statistical significance before and after management (P<0.05). There was no statistical significance in drug resistance rate of Enterobacteriaceae (P>0.05). Pearson correlation analysis showed that carbapenems ’DDDs was significantly positively correlated with average hospitalization duration and antibiotics ’cost(P<0.05);imipenem’s DDDs was positively correlated with drug resistance rate of P. aeruginosa (P<0.05). CONCLUSIONS: MDT management can effectively standardize the use of carbapenem in tuberculosis patients , shorten hospitalization duration ,and reduce drug cost ,DDDs and drug resistance rate of some bacteria.

19.
Organ Transplantation ; (6): 720-2021.
Article in Chinese | WPRIM | ID: wpr-904556

ABSTRACT

Objective To investigate the role of multi-disciplinary team (MDT) in the treatment of complex cholestatic liver injury after liver transplantation. Methods MDT consultation was conducted to clarify the causes and therapeutic strategies for one case of complex cholestatic liver injury after liver transplantation admitted to Liver Transplantation Center of the First Hospital of Jilin University on June 23, 2020. And the role of MDT in the treatment of complex cholestatic liver injury after liver transplantation was summarized. Results The patient presented with abnormal liver function after liver transplantation. The diagnosis of biliary stricture, rejection and biliary tract infection was confirmed successively. Endoscopic retrograde cholangiopancreatography (ERCP) stent internal and external double drainage, glucocorticoid shock and anti-infection therapy yielded low clinical efficacy. After MDT consultation, complex cholestatic liver injury after liver transplantation was confirmed. It was suggested to optimize the immunosuppressive regimen based on the exclusion of rejections by pathological examination, deliver targeted anti-infection interventions and prevent the potential risk of concomitant drug-induced liver injury. The patient was discharged after proper recovery. Conclusions The causes of complex cholestatic liver injury after liver transplantation are diverse, and the condition changes dynamically. MDT consultation are performed to deepen the understanding of this disease, strengthen the classification of diagnosis and treatment ideas and enhance the precision and efficacy of corresponding treatment.

20.
Organ Transplantation ; (6): 465-2021.
Article in Chinese | WPRIM | ID: wpr-881532

ABSTRACT

Objective To evaluate the role of multi-disciplinary team (MDT) in improving the diagnosis and treatment of human herpes virus-6B (HHV-6B) encephalitis after liver transplantation. Methods MDT consultation was delivered for one rare case of HHV-6B encephalitis after liver transplantation to establish an effective individualized treatment regime. Results On the 16 d after liver transplantation, the patient developed headache, and suddenly presented with unresponsiveness, unconsciousness, coma complicated with involuntary limb twitching on the 18 d. Blood ammonia level was increased. Brain CT scan showed cerebral ischemic changes. Electroencephalography prompted the epileptic seizure. After MDT consultation, the possibility of nervous system infection after liver transplantation was considered, and medication therapy was given to control the epileptic seizure. Cerebrospinal fluid examination via lumbar puncture hinted increased intracranial pressure. Real-time fluorescent quantitative polymerase chain reaction (RT-qPCR) of the cerebrospinal fluid demonstrated that the patient was tested positive for HHV-6B nucleic acid, which confirmed the diagnosis of HHV-6B encephalitis. The immunosuppressant regime was adjusted, intravenous ganciclovir was given for antiviral treatment, and active interventions were delivered to prevent and treat relevant complications. Epileptic seizure disappeared after 4 d, and neurological symptoms were significantly alleviated after 2 weeks. After 4-week antiviral treatment, the patient was tested negative for virology testing, and the neurological function was restored to normal. Conclusions HHV-6B encephalitis rarely occurs after adult liver transplantation, which is primarily associated with the virus reactivation after use of immunosuppressant. MDT pattern may be employed to deepen the understanding of the patient's condition, formulate more effective individualized treatment regime, and enhance the clinical efficacy and safety.

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