Multidisciplinary collaboration in gallbladder carcinoma treatment: A case report and literature review

Effects of multidisciplinary model of damage control on acute cervical spinal cord injury in winter Olympic sports

PURPOSE

To investigate the feasibility of multidisciplinary model of damage control (MMDC) in patients with acute cervical spinal cord injury (ACSCI) in winter Olympic sports.

METHODS

A total of 110 patients with ACSCI who participated in winter Olympic sports were selected as the study subjects, and were divided into the study group (SG, n=60, MMDC) and the control group (CG, n=50, conventional intervention) according to the intervention mode. The clinical effects of intervention, changes in neurological function and muscle tone before and after intervention, the changes in motor function and activity of daily living during intervention, and patient satisfaction towards intervention were compared between the two groups.

RESULTS

The effective rate of intervention in the SG was 98.33%, higher than 88.00% in the CG (P < 0.05), and the percentage of patients with Grade E injuries in the SG after intervention was 30.00%, significantly higher than 12.00% in the CG (P < 0.05). The scores of all dimensions of Ashworth scale in the SG were lower than those in the CG (P < 0.05). The patients in the SG exhibited higher FMA scale and modified Barthel index (MBI) scores than the CG from 1 to 6 months of intervention (P < 0.05).

CONCLUSION

MMDC showed better efficacy, the patients' neurological function, muscle tone and motor function could be better restored, and patients' abilities of daily activities were improved after intervention.

Travel to a high volume hospital to undergo resection of gallbladder cancer: does it impact quality of care and long-term outcomes?

BACKGROUND

The relationship of volume and travel distance to patient outcomes after resection of gallbladder cancer (GBC) remains poorly defined.

METHODS

The 2004-2015 National Cancer Database was used to identify GBC resection patients and examine the impact of travel distance, hospital volume and both on overall survival (OS) and quality of care indicators.

RESULTS

Among 10,174 patients undergoing surgery for GBC, the majority of patients were Caucasian (N = 8,175, 80%) and had a Charlson-Deyo comorbidity score of 0 (N = 6,785, 67%). On unadjusted survival analysis increasing travel distance and hospital volume were associated with improved OS (both p < 0.001). After controlling for competing risk factors, the 4th quartile of hospital volume was associated with a decreased hazard of death (HR 0.831, 95% CI 0.751-0.920, p < 0.001). When both hospital volume and travel distance were included, the association with improved OS persisted only for hospital volume (4th quartile HR 0.835, 95% CI 0.753-0.925, p < 0.001), whereas there was no independent association of increasing travel distance with OS.

CONCLUSIONS

Both increasing travel distance and hospital volume were associated with improved OS; however, adjusted models demonstrated that the impact of travel distance was mediated through hospital volume.