Outcomes of eosinophilic esophagitis in patients managed in a multidisciplinary clinic

Background: Eosinophilic esophagitis is a complex disease with an increasing prevalence. Multidisciplinary teams are often needed to manage this difficult-to-treat condition. Objective: To observe the clinical and histologic outcomes of patients with eosinophilic esophagitis after management in a multidisciplinary clinic. Methods: An observational, retrospective chart review was conducted to include all patients referred to the Walter Reed National Military Medical Center multidisciplinary eosinophilic esophagitis clinic between August 2012 and February 2021. Only patients who had at least one esophagogastroduodenoscopy before referral, one or more visits and endoscopy after multidisciplinary management, and documented clinical symptoms were included. Statistical analysis was performed by using McNemar and Wilcoxon tests. Results: A total of 103 patients were included in the study, with a mean age at diagnosis of 17.9 years. Management in the multidisciplinary clinic was associated with a reduction in solid-food dysphagia by 70.9%, poor growth by 70.8%, and emesis or regurgitation by 87.5%. We observed that 48.5% and 62.1% had histologic remission (<15 eosinophils/hpf) on the initial and any post-multidisciplinary endoscopy, respectively. Only seven patients (5.8%) with two or more visits and endoscopies did not achieve histologic remission. More than two-thirds of the patients (68.9%) required combination therapy to achieve remission. Conclusion: Although an observational study, these findings may suggest that the management of patients with eosinophilic esophagitis in a multidisciplinary clinic may improve the likelihood of clinical and histologic remission. Targeted management with a multidisciplinary approach may reduce overall morbidity and slow disease progression; however, more research is needed.

Diagnosis and treatment of hygroma of the wrist joint in the practice of an outpatient surgeon

Introduction. Synovial cyst or hygroma is a common disease that occurs in both children and adults, but it is most often observed in people 20–45 years old. More than 60% of patients who go to the polyclinic with complaints about the presence of tumor-like formations have hygroma.Goal. Analysis of the results of treatment of synovial cysts of the hand and wrist joint according to our own observations and literature data.Material and methods. We observed 54 patients suffering from hygroma of the hand and wrist joint, who were treated in polyclinic No. 2 and MEDEL multidisciplinary clinic in Kazan from 2005 to 2020. The treatment of hygrom was carried out using conservative (puncture) and surgical methods. Results. Our experience showed that after a single puncture of the hygroma with the evacuation of its contents (10 patients), relapse developed in all cases. After repeated puncture of the hygroma in 10 patients with evacuation of the contents and subsequent administration of 0.5 ml of betaspan solution, 6 of them did not relapse within 5–6 months, but 4 patients had a relapse in the nearest period (1–2 months). Of the 23 patients who underwent surgery to remove the hygroma, 15 of them had no relapses. In 8 patients in the postoperative period, recurrent hygroma occurred, which could be explained by the ineffectiveness of eliminating the communication zone between the hygroma and the joint.Conclusions. For the successful treatment of this disease, it is important to understand that for the occurrence and development of hygroma, its communication with the joint cavity or tendon vagina is of great importance. In the absence of a message, the successful use of puncture methods of treatment is possible. In the presence of such a message and its detection during preoperative examination, surgical treatment should be planned with mandatory ligation of the leg of the hygroma.

Survival Associated With Consolidated Multidisciplinary Care in Head and Neck Cancer: A Retrospective Cohort Study

Objective To compare survival among patients with head and neck cancer before and after implementing a weekly multidisciplinary clinic and case conference. Methods A retrospective cohort study with chart review was conducted of 3081 patients (1431 preimplementation, 1650 postimplementation) diagnosed with stage I-IVB tumors in the oral cavity, oropharynx, hypopharynx, nasopharynx, or larynx. Pre- and postimplementation differences in overall and disease-specific survival 1, 2, and 3 years after diagnosis were assessed with unadjusted Kaplan-Meier curves and multivariable Cox proportional hazard regression models adjusted for demographic characteristics, comorbidity burden, smoking status, tumor site and stage, p16 status for oropharyngeal squamous cell cancer, and initial treatment modality. Results Patients less commonly presented with oropharyngeal squamous cell cancer and advanced tumors (III-IVB) and received primary treatment with surgery alone or with adjuvant therapy preimplementation than postimplementation. Overall survival at 3 years was 77.1% and 79.9% ( P = .07) and disease-specific survival was 84.9% and 87.5% ( P = .05) among pre- and postimplementation patients, respectively. At 3 years, preimplementation patients had slightly poorer overall (hazard ratio, 1.20; 95% CI, 1.02-1.40) and disease-specific (hazard ratio, 1.26; 95% CI, 1.03-1.54) adjusted survival than postimplementation patients. In unadjusted and adjusted analyses, survival improvements were more pronounced among patients with advanced disease. Discussion A multidisciplinary clinic and case conference were associated with improved outcomes among patients with head and neck cancer, especially those with advanced tumors. Implications for Practice All patients with head and neck cancer should receive multidisciplinary team management, especially those with advanced tumors.

P.204 Integration of patient directed approach in pituitary tumor management – The Ottawa Hospital experience

Background: Pituitary adenomas are common and often require complex multidisciplinary care with multiple specialists. This may result in a health care system that is challenging for patients to navigate. Audits of care at our institution revealed opportunities for improvement to better align care with patients’ needs. Methods: A quality improvement initiative that incorporated a patient advisory committee of patients who had received treatment for pituitary adenoma at our center and their family members was used to help identify opportunities for improvement. The patient-identified gaps in care included the need to coordinate and minimize appointments and the desire for better communication and education. Based on this information, changes were implemented to the pituitary program, including increasing access to the multidisciplinary clinic and developing a standardized and centralized triage process. Results: A pre and post-intervention analysis consisting of retrospective chart reviews revealed that these changes had an impact on wait times for first assessment, and a significant shift in location of this first visit – with a larger proportion of patients being seen in the multidisciplinary clinic after intervention. Conclusions: We demonstrate that patient involvement, beyond individual patient-physician interactions, can lead to meaningful and observable changes, and can improve the quality of care for pituitary adenoma.

Paralytic stenosis of the larynx

The aim of the study was to evaluate the effectiveness of various types of surgical treatment of patients with bilateral paralytic stenosis of the larynx. Study involved 28 patients aged 18 to 75 years, suffering from paralytic stenosis of the larynx, who was treated at the ENT department of the multidisciplinary clinic of the Tashkent Medical Academy in the period from 2015 to 2020. The results of treatment with the use of laterofixation of the vocal fold, partial excision of the vocal fold in the posterior third and the vocal process of the arytenoid cartilage showed that after the above methods of surgical intervention, recurrence of stenosis occurs in 20-25% of cases, therefore it is necessary to develop tactics of surgical treatment and postoperative management of this category patients.

Simulation Training for the Formation of Practical Competence of Nurses

The publication is devoted to the experience of organizing and conducting simulation training for nurses and pharmacists on the basis of a high-tech multidisciplinary clinic. The authors provide information on training courses for nurses in the dental, procedural, endoscopic rooms, as well as for paramedics, midwives, ambulatory physician assistant and pharmacists.

Simulation Education of Healthcare Professionals in a High-Tech Multidisciplinary Clinic

The publication is devoted to the experience of organizing and applying simulation training in medicine on the basis of a multidisciplinary clinic. The authors noted modern approaches and rates of development of technologies in medicine, which require medical personnel to quickly and efficiently acquire manual skills and develop clinical thinking with minimization of diagnostic and treatment errors and safety for the patient. Simulation training is the educational stage that allows you to go through the required training path in a minimum time with maximum effect.

Dramatic Impact of Centralization and a Multidisciplinary Bladder Cancer Program in Reducing Mortality: The CABEM Project

PURPOSE Muscle-invasive bladder cancer (MIBC) is an aggressive disease with a complex treatment. In Brazil, as in most developing countries, data are scarce, but mortality seems exceedingly high. We have created a centralization program involving a multidisciplinary clinic in a region comprising seven municipalities. The aim of this study is to evaluate the impact of a multidisciplinary clinic and a centralization-of-care program (CABEM program) on MIBC treatment in Brazil. PATIENTS AND METHODS A total of 116 consecutive patients were evaluated. In group 1, 58 patients treated for MIBC before establishing a bladder cancer program from 2011 to 2017 were retrospectively evaluated. Group 2 represented 58 patients treated for MIBC after the implementation of the CABEM centralization program. Age, sex, staging, comorbidity indexes, mortality rates, type of treatment, and perioperative outcomes were compared. RESULTS Patients from group 2 versus 1 were older (68 v 64.2 years, P = .02) with a higher body mass index (25.5 v 22.6 kg/m2, P = .017) and had more comorbidities according to both age-adjusted Charlson Comorbidity Index (4.2 v 2.8, P = .0007) and Isbarn index (60.6 v 43.9, P = .0027). Radical cystectomy (RC) was the only treatment modality for patients in group 1, whereas in group 2, there were 31 (53%) RC; three (5%) partial cystectomies; seven (12%) trimodal therapies; 13 (22%) palliative chemotherapies; and three (5%) exclusive transurethral resections of the bladder tumor. No patient in group 1 received neoadjuvant chemotherapy, whereas it was offered to 69% of patients treated with RC. Ninety-day mortality rates were 34.5% versus 5% for groups 1 versus 2 ( P < .002). One-year mortality was also lower in group 2. CONCLUSION Our data support that a centralization program, a structured bladder clinic associated with protocols, a multidisciplinary team, and inclusion of chemotherapy and radiotherapy treatments can pleasingly improve outcomes for patients with MIBC.