Multidisciplinary Collaborative Model Research Articles

Study on Drug Optimization for Patients with Comorbid Hypertension and Coronary Heart Disease

Comorbidity of hypertension and coronary heart disease (CHD) is a common and complex clinical condition, making drug treatment optimization crucial. Hypertension accelerates the development of CHD by promoting atherosclerosis and cardiac structural changes. Current pharmacological treatments include diuretics, ACE inhibitors, calcium channel blockers, and β-adrenergic antagonists for hypertension, as well as antiplatelet agents, statins, β-adrenergic antagonists, and ACE inhibitors for CHD. Drug optimization strategies involve individualized treatment, optimization of polypharmacy, and dynamic adjustment. Future directions focus on the development of innovative drugs and treatment methods, data-driven drug optimization techniques, and multidisciplinary collaboration models. These advancements will enhance the precision and effectiveness of drug therapy, thereby improving the overall health and quality of life of patients.

The Effect of Multidisciplinary Collaborative Model on Knowledge, Self-Care, and Glycemic Control in Type 2 Diabetes Mellitus Patients at Assuyuthiyyah Hospital, Pati

The Effect of Multidisciplinary Collaborative Model on Knowledge, Self-Care, and Glycemic Control in Type 2 Diabetes Mellitus Patients at Assuyuthiyyah Hospital, Pati

Management of PICC rupture in a multidisciplinary collaborative model: A case report.

A peripherally inserted central catheter (PICC) is commonly used for fluid infusion in patients. However, rupture is one of the most serious complications associated with PICC placement. We investigated an 81-year-old patient who experienced a catheter break nearly 11 months after the placement of PICC, followed by a catheter break during catheter capture that was removed after accessing the superior vena cava with a catcher. This case suggests that silicone-based PICCs are fragile and have a high risk of spontaneous dislocation. Therefore, they should be replaced with polyurethane-based PICCs.

A multidisciplinary collaborative diagnosis and rehabilitation program for dysphagia in general hospitals.

Dysphagia is a common complication of various clinical conditions, with an increased incidence as age advances. Complications such as aspiration, malnutrition, and aspiration pneumonia caused by dysphagia significantly affect the overall treatment outcomes of patients. Scholars both domestically and internationally are increasingly focusing on early rehabilitation for dysphagia. This article summarizes common conditions causing dysphagia, clinical manifestations, complications, screening assessment, diagnosis, rehabilitation, and nutritional support related to dysphagia. It emphasizes the arrival at a multidisciplinary collaborative diagnosis and formulation of a rehabilitation management plan for dysphagia in general hospitals in order to provide strategic suggestions for establishing a multidisciplinary collaborative model for swallowing disorder management in general hospitals.

Application of an Outpatient Multidisciplinary Collaborative Diagnosis and Treatment Model in the Management of Critically Ill Obstetric Patients

Application of an Outpatient Multidisciplinary Collaborative Diagnosis and Treatment Model in the Management of Critically Ill Obstetric Patients

Effectiveness of multidisciplinary interventions to improve blood culture efficiency and optimize antimicrobial utilization.

The low positive rate of blood cultures often leads to downstream consequences. We present a summary of multidisciplinary interventions implemented by a tertiary referral hospital to improve blood culture efficiency and optimize antimicrobial usage. We evaluated the knowledge, attitude, and practice (KAP) of healthcare workers in a tertiary care hospital before and after intervention using a questionnaire. A multidisciplinary team was formed to implement the intervention, defining roles, standardizing procedures, continually improving education and feedback, and establishing incentive mechanisms. Regular quality control assessments are conducted on the responsible departments. Following the intervention, the median submission time for blood culture specimens was reduced from 2.2 h to 1.3 h (p < 0.001). Additionally, the intervention group showed significant (p < 0.05) increases in rates of positivity (9.9% vs. 8.6%), correct timing (98.7% vs. 89.6%), correct processing (98.1% vs. 92.3%), reduced contamination rates (0.9% vs. 1.4%), and disqualification rates (1.3% vs. 1.7%). The delivery rate of therapeutic antibacterial increased (16.1% vs. 15.2%), and the consumption of restrictive grade antimicrobial also significantly increased (26.7% vs. 22.9%). The intervention measures led to a substantial improvement in awareness and compliance with KAP of blood culture collection in the hospital. Hospital-wide antimicrobial usage deceased by 10.7% after intervention. A multidisciplinary collaborative model proves effective in improving blood culture efficiency and optimizing antimicrobial usage.

Clusters of medical specialities around patients with multimorbidity – employing fuzzy c-means clustering to explore multidisciplinary collaboration.

Background: The increasing prevalence of multimorbidity challenges hospital care organization. Hospital care is structured around medical specialties and focused on separate treatment of individual organ systems. Consequently, patients with multimorbidity visit multiple healthcare professionals and have high healthcare utilization with a risk of interactions and contradictory treatments if multidisciplinary coordination is absent. Organizational structures for multidisciplinary collaboration between medical specialists in case of multimorbidity are, however, limited. To facilitate multidisciplinary, coordinated care and to prevent or minimize adverse health outcomes, it might be useful to organize hospital care around specific patterns of multimorbidity or medical specialties. Therefore, we hypothesized that the use of cluster analysis and real clinical data could be helpful to unravel groups of medical specialties who are simultaneously involved in hospital care for patients with multimorbidity. &#x0D; Method: We performed a cross-sectional cohort study and used retrospectively collected electronic health record (EHR) from a Dutch hospital in 2017. We extracted EHR data of 22,133 patients with multimorbidity aged ≥18 years who had received outpatient clinical care for two or more chronic and/ or oncological diagnosis. We used a fuzzy c-means clustering algorithm and explored the patients’ membership degree factors to each cluster to distinguish subgroups of patients with a specific pattern of involved medical specialties.&#x0D; Results: The mean age was 67.9 years (interquartile range (IQR):20.9), and 56.0% was female. We identified six clusters and 22 subgroups. The clusters were: 1. dermatology/ plastic surgery, 2. six specialties, 3. pulmonology, 4. internal medicine/ cardiology/ geriatrics, 5. neurology/ rehabilitation/ anesthesiology, and 6. internal medicine. Most patients had a full or dominant membership to one cluster only (11 subgroups) and the remaining subgroups were combinations of two clusters. The prevalence of specific diagnosis groups, patient characteristics and healthcare utilization seemed to differ between subgroups. For instance, patients of the subgroup with high involvement of internal medicine, cardiology and geriatrics; was characterized by cardiometabolic diseases. These patients had the highest average age (median:73 years, IQR:16.2), number of diagnoses (median:5, IQR:3), and number of outpatient visits (median:7, IQR:6). Patients of the subgroup with involvement of both the cardiologist and pulmonologist had lower number of diagnoses (median:3, IQR:1) and outpatient visits (median: 5:, IQR:4). This subgroup was mostly characterized by pulmonary and heart diseases, which can both represent with symptoms as dyspnea. Thus, the subgroups and their characteristics can provide clues about potential target populations that might benefit from (more) multidisciplinary collaboration, such as a formalization of a cardiometabolic or dyspnea outpatient clinic. &#x0D; Conclusion: Our study shows that it is possible to use fuzzy c-means cluster analysis and real clinical data to identify clinically relevant clusters and subgroups of medical specialties simultaneously involved in hospital care for patients with multimorbidity. With this strategy hospitals, healthcare professionals, and data scientists can further analyze which of these subgroups are target populations with multimorbidity that might benefit from improved multidisciplinary collaboration or new models of care.

The perceptions and attitudes of obstetric staff and midwives towards perinatal mental health disorders screening: a qualitative exploratory study in Shenzhen, China

BackgroundThe perinatal period is a crucial time for women, as they experience various biological, psychological, and social stressors. Due to the complexity of this vulnerable time, there is a high prevalence of depressive and anxiety disorders among pregnant women. In 2019, the Health Commission of Shenzhen initiated perinatal mental health screening programme in China. However, attitudes and perceptions of medical staff towards implementing mental health screening programme during pregnancy remain unclear. The aim of this study was to explore the perceptions and attitudes of obstetric staff and midwives towards screening for perinatal mental disorders in pregnant women, and identify their perceived needs and motivations for undertaking this task.MethodsThis is a qualitative exploratory study. Data were collected through in-depth, semi-structured, face-to-face interviews. The dataset was analysed using inductive content analysis. Purposive sampling method was used to recruit 13 participants at a tertiary maternal hospital in Shenzhen from September to November, 2019.ResultsA total of 13 obstetric staff was interviewed, including two obstetricians, three midwives, and eight nurses. Four themes were identified from this study: views on perinatal mental health disorders screening, competency in identifying and supporting high-risk groups, barriers to dealing with psychological problems during pregnancy, and the support needs of medical staff in undertaking the tasks of mental health disorders screening.ConclusionMedical staff lacked sufficient knowledge and skills in perinatal psychological health and were not well prepared for the task of screening pregnant women for mental health disorders. To address this issue, medical organisations and relevant government sectors should provide training to medical staff on perinatal mental health disorders, enhance public awareness of perinatal mental health disorders, establish a model of multidisciplinary collaboration for the screening of women’s perinatal mental disorders, and provide continuous and holistic care for pregnant women.

Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network Consortium (PPACMAN) 2021 Annual Meeting Proceedings.

The Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network (PPACMAN) is a nonprofit organization whose mission is to optimize the clinical care of patients with psoriatic disease through multidisciplinary collaboration models. The PPACMAN 2021 Annual Meeting was held virtually on December 11, 2021. In all, 50 stakeholders participated in the meeting including dermatologists, rheumatologists, cardiologists, clinical researchers, patient advocacy representatives, and industry representatives. During the opening session of the meeting, presenters provided an update of several research projects dedicated to predicting and preventing psoriatic arthritis (PsA) such as the Psorcast, PAMPA, HIPPOCRATES, and the ELLIPSS studies. The second session centered around novel approaches to deliver multidisciplinary care in psoriatic disease. PPACMAN leadership introduced its wellness program and invited speakers to discuss new advances in cardiovascular disease, sleep disturbance, mental health problems, and dietary interventions in psoriatic disease. The final session of the meeting focused on how to improve patient engagement in their disease and care.

Clinical value of multidisciplinary collaborative nursing model for breast cancer and its preventive effects on postoperative lymphedema

This study aimed to investigate the clinical effects of a multidisciplinary collaborative nursing model and its influence on postoperative complications in breast cancer patients. A total of 100 breast cancer patients were divided into a control and a research group, depending on the nursing plan. The former received usual care, while the latter was given multidisciplinary collaborative nursing. The mental state, quality of life, nursing satisfaction and the occurrence of postoperative complications were compared between the groups. After the intervention, the Self-Rating Anxiety Scale (SAS) and Self-Rated Depression Scale (SDS) scores and the scores of five other parameters for assessing the quality of life of the patients were found to be significantly increased in the research group compared with the control group. The nursing satisfaction was significantly higher (92.00% vs. 74.00%) and the occurrence of postoperative complications was significantly lower (10.00% vs. 44.00%) in the research group than in the control group, respectively. The developed multidisciplinary collaborative nursing model was a safe and effective nursing regimen with high nursing satisfaction and good compliance, which improved the mental state and quality of life and reduced the risk of postoperative complications for patients with breast cancer.

Enhancing a Willingness to Respond to Disasters and Public Health Emergencies Among Health Care Workers, Using mHealth Intervention: A Multidisciplinary Approach.

Health care workers (HCWs) are increasingly faced with the continuous threat of confronting acute disasters, extreme weather-related events, and protracted public health emergencies. One of the major factors that determines emergency-department-based HCWs' willingness to respond during public health emergencies and disasters is self-efficacy. Despite increased public awareness of the threat of disasters and heightened possibility of future public health emergencies, the emphasis on preparing the health care workforce for such disasters is inadequate in low-and-middle-income countries (LMICs). Interventions for boosting self-efficacy and response willingness in public health emergencies and disasters have yet to be implemented or examined among emergency HCWs in LMICs. Mobile health (mHealth) technology seems to be a promising platform for such interventions, especially in a resource-constrained setting. This paper introduces an mHealth-focused project that demonstrates a model of multi-institutional and multidisciplinary collaboration for research and training to enhance disaster response willingness among emergency department workers in Pakistan.

The Effectiveness of a Multidisciplinary Collaborative Model for the Diagnosis and Treatment of Vertigo

Objective: To investigate the effectiveness of applying a multidisciplinary collaborative model for the diagnosis and treatment of patients with vertigo. Methods: The study was carried out in Xianyang Hospital of Yan’an University, in which 100 patients with vertigo were selected from April 2021 to April 2022 and were divided into two groups: the control group was under the single diagnosis and treatment model, whereas the experimental group was under the multidisciplinary collaborative diagnosis and treatment model, with 50 cases in each group. The diagnostic effects of the two groups were compared. Results: The diagnostic and therapeutic efficiency of the patients in the experimental group were 94% and 98%, respectively, while those of the patients in the control group were 78% and 82%, respectively, with a significant difference between the two groups (p &lt; 0.05). The balance scores of the patients in both groups were low before the treatment, in which the difference was not significant (p &gt; 0.05); after the treatment, the scores improved, with those of the patients in the experimental group being significantly higher than those in the control group (p &lt; 0.05). Moreover, the satisfaction rate of patients in the experimental group (98%) was significantly higher than that of the control group (80%) (p &lt; 0.05). Conclusion: The application of the multidisciplinary collaborative diagnosis and treatment model in the diagnosis of patients with vertigo is effective. The multidisciplinary model can improve clinical diagnosis, enhance the treatment effect, improve the clinical symptoms of patients, and increase the satisfaction of patient care. Hence, it is of high clinical application value.

Construction of Pulmonary Embolism Prediction, Early Warning, and Precontrol MDT Collaborative Nursing Model Based on the Smith Model.

The purpose of this study was to construct a multidisciplinary collaborative nursing model for pulmonary embolism risk prediction, early warning, and precontrol based on the Smith model and evaluate the application effect and hospitalization satisfaction. 2,037 patients hospitalized in the thoracic surgery department from June 1, 2019, to May 31, 2021, were selected as the research subjects. The control group received routine pulmonary embolism prevention management, while the experimental group received safe, case-based, and programmatic multidisciplinary intervention management based on the Smith policy management model. The data were analyzed statistically. The experimental group's extubation and hospitalization time, D-dimer value, incidence of deep vein thrombosis, and pulmonary embolism on the seventh day after surgery were lower than those in the control group, and the satisfaction of hospitalization in the experimental group was higher than that in the control group. The implementation of the multidisciplinary collaborative nursing model of pulmonary embolism risk prediction, early warning, and precontrol based on the Smith model can promote the preventive effect of pulmonary embolism risk of surgical patients in our department and effectively improve the satisfaction of hospitalization, which is worthy for further promotion.

A Systematic Approach for the Interview of the Application to Psychiatry Specialty Training: The “I AM” Approach

AimsJob interviews are the platform for employers to identify suitable candidates for vacant posts, i.e. those who are able to demonstrate a certain set of competencies specified in the job description. In the recent psychiatry specialty training (ST) application process, candidates are required to propose a management plan for two complex scenarios. This interview can be stressful given the high-stakes nature of the outcome, i.e. the successful enrolment into a training programme of a preferred deanery. Candidates who are unable to have an organised approach to problem-solving will likely have an unfavourable result. To overcome this difficulty, a simplified “I AM” approach is being proposed to assist applicants to organise their thoughts during their ST application interview.MethodsThe “I AM” approach stands for “Issues, Assessments, and Management”, which is adapted from the “Handbook of Psychiatry: Surviving Consultation Viva Examination of Malaysian Conjoint Board”. The “Issues” are the problems identified in a scenario, “Assessments” are the investigation required to get a clearer picture of the problems, and “Management” is the action plan to solve the problems. This approach was piloted with five applicants of ST in psychiatry prior to their interview practices.ResultsFor a complex clinical case scenario, the “I AM” approach can be put into the matrix of 3 × 3 tables together with a biopsychosocial model to ensure the issues in different domains are explored thoroughly. Further sub-classification into necessary subheadings, including ideas, concerns, and expectations from different parties, can be included in the assessment matrix. Lastly, a management plan using a multidisciplinary team and collaborative decision-making model with the patient and family can be proposed. For a complex managerial scenario, the seven pillars of the National Health Service's clinical governance model involving different stakeholders can be incorporated into the “I AM” approach to explore problem-solving strategies from different angles. Positive reactions had been received from all five trainees (Kirkpatrick's Evaluation Model Level One).ConclusionThe “I AM” approach can be flexibly applied in different problem-solving scenarios and it works well with other models. The approach may be limited by inadequate information and a failure to prioritise. Further systematic evaluation of the effectiveness and generalisability of the “I AM” approach to other disciplines is required.

A digital twin-based multidisciplinary collaborative design approach for complex engineering product development

With the ever-increasing demand for personalized product functions, product structure becomes more and more complex. To design a complex engineering product, it involves mechanical, electrical, automation and other relevant fields, which requires a closer multidisciplinary collaborative design (MCD) and integration. However, the traditional design method lacks multidisciplinary coordination, which leads to interaction barriers between design stages and disconnection between product design and prototype manufacturing. To bridge the gap, a novel digital twin-enabled MCD approach is proposed. Firstly, the paper explores how to converge the MCD into the digital design process of complex engineering products in a cyber-physical system manner. The multidisciplinary collaborative design is divided into three parts: multidisciplinary knowledge collaboration, multidisciplinary collaborative modeling and multidisciplinary collaborative simulation, and the realization methods are proposed for each part. To be able to describe the complex product in a virtual environment, a systematic MCD framework based on the digital twin is further constructed. Integrate multidisciplinary collaboration into three stages: conceptual design, detailed design and virtual verification. The ability to verify and revise problems arising from multidisciplinary fusions in real-time minimizes the number of iterations and costs in the design process. Meanwhile, it provides a reference value for complex product design. Finally, a design case of an automatic cutting machine is conducted to reveal the feasibility and effectiveness of the proposed approach.

Design education in transition: A multidisciplinary design classroom with non-allied disciplines

The complex inter-relationships in the world, driven by technological breakthroughs, are prompting design educators to look for new ways to structure their courses to embrace expanding skill sets. Four critical areas to advance design education are highlighted: keeping up with technological advancements; teaching design as a participatory process; using a systems view to analyse problems; and facilitating student learning in a multidisciplinary collaborative environment. One of the key requirements of the design profession is collaboration among a wide variety of stakeholders who may reside well outside the scope of the designer’s sphere of influence. If one accepts the premise that today’s design student can no longer be confined by a narrow problem solving skill set, then academic institutional barriers have to be crossed in a collaborative way between seemingly incongruous academic disciplines. A sustainable model of multidisciplinary collaboration at the undergraduate level is reviewed and the potential of expanding that collaboration is explored through detailed interviews with five non-design academics at an Australian university. The research presents opportunities and challenges perceived by academic staff to connect fields such as law, business, tourism and design as a testing ground to educate designers to better understand the complexities of today’s design problems.

Focusing the role of surgery in the treatment of liver cirrhotic portal hypertension

Portal hypertension treatment has always been regarded as complex and diverse. With the innovation of concepts and technologies, its treatment model has been transformed from a single-disciplinary diagnosis and treatment model to a multidisciplinary collaborative diagnosis and treatment model. In the multidisciplinary diagnosis and treatment model, the surgical treatment of portal hypertension is not a treatment that is about to disappear soon, but one of the indispensable treatment methods under the multidisciplinary diagnosis and treatment model, and it will play an increasingly important role. Surgeons should formulate individualized, standardized, and minimally invasive treatment methods under the input of new concepts, master the surgical indications and individualized surgical methods for different populations, and maximize the optimization surgical treatment methods for portal hypertension. Therefore, it is necessary to re-examine the role of surgical treatment in the diagnosis and treatment of liver cirrhotic portal hypertension.

Modeling the developmental origins of pediatric cancer to improve patient outcomes.

ABSTRACTIn the treatment of children and adolescents with cancer, multimodal approaches combining surgery, chemotherapy and radiation can cure most patients, but may cause lifelong health problems in survivors. Current therapies only modestly reflect increased knowledge about the molecular mechanisms of these cancers. Advances in next-generation sequencing have provided unprecedented cataloging of genetic aberrations in tumors, but understanding how these genetic changes drive cellular transformation, and how they can be effectively targeted, will require multidisciplinary collaboration and preclinical models that are truly representative of the in vivo environment. Here, I discuss some of the key challenges in pediatric cancer from my perspective as a physician-scientist, and touch on some promising new approaches that have the potential to transform our understanding of these diseases.

Health Care Costs at the End of Life for Patients with Idiopathic Pulmonary Fibrosis. Evaluation of a Pilot Multidisciplinary Collaborative Interstitial Lung Disease Clinic.

Rationale: Even though idiopathic pulmonary fibrosis (IPF) is a disease with high morbidity and mortality and no cure, palliative care is rarely implemented, leading to high symptom burden and unmet care needs. In 2012, we implemented a multidisciplinary collaborative (MDC) care model linking clinic and community multidisciplinary teams to provide an early integrated palliative approach, focusing on early symptom management and advance care planning.Objectives: To evaluate the differences in resource use and associated costs of end-of-life care between patients with IPF who received early integrated palliative care and patients with IPF who received conventional treatment.Methods: Using administrative health data, we identified all patients in the Province of Alberta, Canada, who presented to a hospital with an IPF diagnosis between January 1, 2012, and December 31, 2018, and died within this time frame. We compared three groups of patients: those who received MDC care (our clinic patients), specialist care (SC; respirologist), or non-specialist care (NSC; no contact with a respiratory clinic). The primary outcomes were healthcare resource use and costs in the year before death.Results: Of 2,768 patients across the three study groups, in the last year of life, MDC patients were more than three times as likely as SC patients to have received antifibrotic therapies (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.8-5.2), almost twice as likely to have received pulmonary rehabilitation (OR, 1.9; 95% CI, 1.1-3.4), and 36% more likely to have received opiates (OR, 1.4; 95% CI, 0.8-2.3). The median total healthcare costs in the last 3 months of life were approximately C$7,700 lower for MDC patients than for those receiving SC, driven primarily by fewer hospitalizations and emergency department visits. MDC patients were also less likely to die in the hospital (44.9% MDC vs. 64.9% SC vs. 66.8% NSC; P < 0.001) and had the highest rates of no hospitalization in the last year of life.Conclusions: An integrated palliative approach in IPF is associated with improvements in the quality of end-of-life care and reduction in costs. Transformation of care models is required to deliver palliative care for patients with IPF. MDC teams within such models can address the high burden of unmet needs for symptom management, advance care planning, and community support in this complex population.

P1164INTERVENTIONAL NEPHROLOGY SERVICE ENHANCES PERITONEAL DIALYSIS UTILISATION AND UPTAKE: EXPERIENCE FROM A SINGLE CENTRE IN SINGAPORE

Abstract Background and Aims Interventional nephrology (IN) is not having a well-defined role in peritoneal dialysis (PD) service provision. Impact to PD catheter outcomes, PD utilisation and uptake on integrated care approach under IN service was not known. Here we report the experience and outcomes of IN practice in PD service from a single centre in Singapore. Method We postulated an IN-led, multidisciplinary collaborative model of care for end stage renal failure patients, who transited through a seamless care pathway from pre-dialysis counselling to insertion of PD catheter, could improve utilisation and increase uptake of PD as dialysis modality of choice. This approach was based on: 1. Interventional nephrologist-led PD catheter insertion service, 2. coordination of care (figure 1) and 3. early start of PD. Outcomes of IN involvement in PD access management and coordination of care were included in this study. Results From January 2015 to May 2019, a total of 140 PD catheter insertions were performed by interventional nephrologist (table 1). The prevalence of PD patients in our program was increased by 217% after initiation of IN service (figure 2). Annually, incident ESRF patients who chose PD as dialysis modality increased from 10% to 28% (figure 3). We had a very low PD catheter-related complication rate in reference to international standards (table 2). Catheter adjustment-free survival was 94% and 83% at 12 months and 36 months respectively (figure 4). Conclusion The multifaceted and holistic role of IN in PD translated into remarkable outcomes on PD utilisation and uptake. It also confirms the safety and efficacy of IN procedures in PD when performed by appropriately trained nephrologists.