With the extension of survival period and the improvement of imaging technology, the incidence of bone metastasis from colorectal cancer gradually increases. Therefore, the early diagnosis and treatment of bone metastasis should not be neglected while the primary lesion was controlled.Currently, the available evidence for bone metastasis from colorectal cancer is very limited. In this article, the Chinese Society of Colorectal Cancer organized multi-disciplinary experts to integrate the relevant studies worldwide and combine with clinical practice, focused on the issues and controversies about clinical characteristics, diagnosis and treatment, and follow-up of bone metastatic patients with colorectal cancer.After discussion and voting, Chinese expert consensus on multidisciplinary treatment of bone metastasis from colorectal cancer (2020 version) was formed. This consensus could provide clinicians with more detailed multidisciplinary treatment strategies for bone metastasis from colorectal cancer.
Asian Continental Ancestry Group ; Bone Neoplasms ; pathology ; secondary ; therapy ; China ; Colonic Neoplasms ; diagnosis ; therapy ; Colorectal Neoplasms ; diagnosis ; therapy ; Consensus ; Humans ; Interdisciplinary Communication ; Patient Care Team ; Practice Guidelines as Topic ; Treatment Outcome

OBJECTIVE: To analyze the roles of multidisciplinary team (MDT) in the diagnosis and treatment of suspected cases of coronavirus disease 2019 (COVID-19). METHODS: The clinical data of 48 patients with suspected COVID-19 admitted in Jinhua Municipal Central Hospital from January 21, 2020 to March 20, 2020 were retrospectively analyzed. RESULTS: In the 48 suspected cases, 18 were diagnosed with COVID-19, and 30 were excluded. Each of the confirmed cases were discussed among MDT for 2 to 12 times with an average of (4.7±3.2) times; while for non-COVID-19 patients were discussed for 2 to 4 times with an average of (2.3±0.6) times. With the guidance of MDT, one COVID-19 patient was transferred to designated provincial hospital after effective treatment; one patient complicated with acute cholecystitis underwent gallbladder puncture and drainage; and COVID-19 was excluded in a highly suspected patient after alveolar lavage fluid examination. Except one transferred patient, all 17 confirmed COVID-19 patients were cured and discharged. There was no cross-infection occurred in suspected patients during the hospitalization. There were no deaths and no medical staff infections. CONCLUSIONS The efficiency of diagnosis and treatment for suspected COVID-19 patients can be improved with MDT, particularly for complicated cases.
Betacoronavirus ; isolation & purification ; China ; Coronavirus Infections ; diagnosis ; therapy ; Humans ; Interdisciplinary Communication ; Pandemics ; Patient Care Team ; standards ; Pneumonia, Viral ; diagnosis ; therapy ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: To analyze the roles of multidisciplinary team (MDT) in the diagnosis and treatment of suspected cases of corona virus disease 2019 (COVID-19). METHODS: The clinical data of 48 patients with suspected COVID-19 admitted in Jinhua Central Hospital from January 21, 2020 to March 20, 2020 were retrospectively analyzed. RESULTS: Of the 48 suspected cases, 18 were diagnosed with COVID-19, and 30 were excluded. Each of the confirmed cases were discussed among MDT for 2 to 12 times with an average of (4.7±3.2) times; while for non-COVID-19 patients were discussed for 2 to 4 times with an average of (2.3±0.6) times per case. With the guidance of MDT, one COVID-19 patient was transferred to designated provincial hospital after effective treatment; one patient complicated with acute cholecystitis underwent gallbladder puncture and drainage; and COVID-19 was excluded in a highly suspected patient after alveolar lavage fluid examination. Except one transferred patient, all 17 confirmed COVID-19 patients were cured and discharged; there was no cross-infection occurred in suspected patients during the hospitalization; there were no deaths and no medical staff infections. CONCLUSIONS The efficiency of diagnosis and treatment for suspected COVID-19 patients can be improved under MDT mode, particularly for complicated and refractory cases.
Betacoronavirus ; Coronavirus Infections ; complications ; diagnosis ; therapy ; Disease Management ; Humans ; Interdisciplinary Communication ; Pandemics ; Patient Care Team ; standards ; Pneumonia, Viral ; complications ; diagnosis ; therapy ; Retrospective Studies ; Treatment Outcome

Computer Simulation ; Curriculum ; Education, Medical ; organization & administration ; trends ; Electronic Health Records ; Health Services Research ; Humans ; Interdisciplinary Communication ; Leadership ; Patient Care Team ; Public Health ; Schools, Medical ; Singapore

INTRODUCTION: Singapore has a rapidly ageing population and an increasing prevalence of Alzheimer's disease (AD). Compliance to AD medications is associated with treatment effectiveness. We investigated compliance to acetylcholinesterase inhibitors (AChEIs) and N-methyl-D-aspartate (NMDA) receptor antagonist and treatment persistence among patients seen at the General Memory Clinic of National University Hospital, Singapore. We also identified the reasons for non-compliance. METHODS: Patients seen at the General Memory Clinic between 1 January 2013 and 31 December 2014, who were prescribed AChEIs and NMDA receptor antagonist, were included in this retrospective cohort study. Non-compliance to medications was indirectly measured by failure to renew prescription within 60 days of the last day of medication supplied by the previous prescription. The reasons for non-compliance were identified. RESULTS: A total of 144 patients were included. At one year, 107 patients were compliant to AD medications, while 37 patients were non-compliant. Around 60% of the non-compliant patients discontinued the use of AD medications within the first six months, and the mean persistent treatment period among this group of patients was 10.3 ± 3.5 months. The main reason for non-compliance was patients' and caregivers' perception that memory loss was of lower priority than other coexisting illnesses. Other reasons for non-compliance included side effects of medications (18.9%), perceived ineffectiveness of treatment (16.2%), inability to attend clinic (5.4%) and high cost of medications (2.7%). CONCLUSION Our findings suggest that the reasons for medication non-compliance can be identified early. Better compliance may be achieved through a multidisciplinary approach to patient education.
Aged ; Aged, 80 and over ; Alzheimer Disease ; drug therapy ; epidemiology ; psychology ; Caregivers ; Cholinesterase Inhibitors ; therapeutic use ; Drug Costs ; Female ; Humans ; Interdisciplinary Communication ; Male ; Medication Adherence ; Middle Aged ; Patient Compliance ; Quality of Life ; Receptors, N-Methyl-D-Aspartate ; antagonists & inhibitors ; Retrospective Studies ; Singapore ; epidemiology ; Treatment Outcome

Rotational thromboelastometry (ROTEM) is a point-of-care viscoelastic method and enables to assess viscoelastic profiles of whole blood in various clinical settings. ROTEM-guided bleeding management has become an essential part of patient blood management (PBM) which is an important concept in improving patient safety. Here, ROTEM testing and hemostatic interventions should be linked by evidence-based, setting-specific algorithms adapted to the specific patient population of the hospitals and the local availability of hemostatic interventions. Accordingly, ROTEM-guided algorithms implement the concept of personalized or precision medicine in perioperative bleeding management (‘theranostic’ approach). ROTEM-guided PBM has been shown to be effective in reducing bleeding, transfusion requirements, complication rates, and health care costs. Accordingly, several randomized-controlled trials, meta-analyses, and health technology assessments provided evidence that using ROTEM-guided algorithms in bleeding patients resulted in improved patient's safety and outcomes including perioperative morbidity and mortality. However, the implementation of ROTEM in the PBM concept requires adequate technical and interpretation training, education and logistics, as well as interdisciplinary communication and collaboration.
Cooperative Behavior ; Education ; Health Care Costs ; Hemorrhage ; Humans ; Interdisciplinary Communication ; Methods ; Mortality ; Organization and Administration ; Patient Safety ; Point-of-Care Systems ; Precision Medicine ; Technology Assessment, Biomedical ; Thrombelastography

Caregivers ; Humans ; Interdisciplinary Communication ; Medical Oncology ; trends ; Neoplasms ; diagnosis ; psychology ; therapy ; Treatment Outcome

Singapore has an ageing population with a projected 53,000 people aged ≥ 60 years living with dementia by 2020. Primary care doctors have the opportunity to initiate early work-up for reversible causes of cognitive dysfunction, allowing identification of comorbidities and discussion of medical therapy options. Early diagnosis confers the sick role on the patient, which allays frustration and explains events and behaviour that may have strained relationships with family and friends. The patient can be encouraged to plan for future health and personal care options with a Lasting Power of Attorney and/or Advance Care Planning. Objective cognitive tests (e.g. abbreviated mental test and Mini-Mental State Examination) and brain imaging are adjuncts that help in formulating the diagnosis. Referral to a hospital memory clinic activates a multidisciplinary team approach to dementia, including clinical consultation, dementia counselling, physiotherapy sessions on gait/fall prevention, occupational therapy sessions on cognitive stimulation and caregiver training.
Advance Care Planning ; Aged ; Aged, 80 and over ; Brain ; physiopathology ; Caregivers ; Cognition ; Cognitive Dysfunction ; diagnosis ; epidemiology ; therapy ; Cognitive Therapy ; Dementia ; diagnosis ; epidemiology ; therapy ; Geriatrics ; methods ; Home Nursing ; Humans ; Interdisciplinary Communication ; Memory ; Middle Aged ; Neuropsychological Tests ; Referral and Consultation ; Singapore

BACKGROUND: Presently, a multidisciplinary team of doctors, pharmacists, nurses, and dietitians provides patient education to impart information on chemotherapy. However, studies on multidisciplinary education satisfaction are inadequate. In this study, we aimed to contribute to the improvement of quality of multidisciplinary education counseling for patients with cancer by developing a satisfaction questionnaire and analyzing the satisfaction survey. METHODS: A questionnaire was developed by an expert group, and the responses were recorded using the 5-point Likert scale. After conducting a pre-test, factor analysis was performed to evaluate validity. The reliability of the questionnaire was measured by Cronbach's alpha coefficient. A satisfaction survey was conducted by self-administration method. RESULTS: Based on the results of factor analysis, factors can be divided into two parts: “overall education” and “each team member's education” (total 14 questions). The construct validity and reliability of the questionnaire are sufficiently high. Fifty-one patients took the survey between January 2, 2018 and January 20, 2018. Twenty-six (51%) patients responded that they were “very satisfied” and 22 (43.1%) patients responded that they were “satisfied”. CONCLUSION: By developing a questionnaire on multidisciplinary education counseling for patients with cancer, it is possible to perform evaluation and research of cancer patient education. This study will contribute to the management and improvement of quality of multidisciplinary education.
Counseling ; Drug Therapy ; Education ; Humans ; Interdisciplinary Communication ; Methods ; Nutritionists ; Patient Education as Topic ; Pharmacists ; Reproducibility of Results

Polycystic ovary syndrome (PCOS) is the most common metabolic and endocrine disorder in women, leading to infertility. However, there is no general agreement concerning how to diagnose and treat PCOS. The Rotterdam consensus statement from the European Society of Human Reproduction and Embryology/American Society for Reproductive Medicine, the Chinese diagnostic criteria and consensus statement, and the clinical practice guideline from the Endocrine Society in the USA are widely recognized. Guidance has been provided for clinical practice based on a comparative analysis of the above three practice guidelines or consensus statements (Wang et al., 2018a). High body mass index (BMI) has no negative effect on the outcome of in vitro fertilization (IVF) in Chinese patients with PCOS; however, the conclusion may be limited by the retrospective design and potential bias (Pan et al., 2018). Neonatal birth weight is positively affected by both maternal pre-pregnancy body mass index (pre-BMI) and gestational weight gain (Du et al., 2017). Normal body weight is very important for conception. Women with PCOS are almost 3 times more likely to be obese than those without PCOS; however, no specific interventions are available to induce weight loss, and drugs are used to treat other symptoms of the syndrome or obesity in the general population. A network meta-analysis found that the amount of weight loss differed significantly according to the choice of drugs (in descending order): liraglutide, orlistat, and metformin. Liraglutide alone, liraglutide/metformin, and metformin alone significantly reduced waist circumference, but no change was found with orlistat, indicating liraglutide appears superior to the other drugs in reducing weight and waist circumference (Wang et al., 2018b). IVF, as a choice for more than 1 000 000 infertile couples each year, gives rise to the birth of over 3 000 000 babies worldwide.
Acupuncture Therapy ; Adolescent ; Adult ; Body Mass Index ; Body Weight ; China ; Clinical Trials as Topic ; Female ; Fertilization in Vitro ; Humans ; Infertility, Female/therapy* ; Interdisciplinary Communication ; Medicine, Chinese Traditional ; Polycystic Ovary Syndrome/therapy* ; Reproductive Medicine/methods* ; Research Design ; Young Adult