多学科协作mdt演示教学

多学科协作（MDT）——通向医学未来的必经阶段CentralGovernmentForbiddenCityWomen&ChildrenInternalMed&SurgeryOutpatient&ERStatecouncilCPCheadquarter1915Megatrends现代医学诊疗模式大趋势传统模式：单学科诊疗（看人生的病）必经阶段：多学科协作（看生病的人）MDT是国际顶尖综合医院和专科医院的共识Cambridge(1766):Atleast2or3roundsofMDTdisscusionforeachcancerpatient.Mass.General(1811):Unitespecialistsacrossthehospitaltoofferpatientscomprehensive,state-of-the-artmedicalcare.MayoClinic(1863):Providingthebestcaretoeverypatientthroughintegratedclinicalpractice,educationandresearch.JohnsHopkins(1879):Providingpatient-centeredmedicinetoprevent,diagnoseandtreathumanillness.MDAnderson(1941):Multidisciplinary,research-drivenpatientcarethroughouteachphaseofthecancercarecycle.MDT的核心理念以病人为中心针对特定疾病，依托多学科团队，制定 规范 编程规范下载gsp规范下载钢格栅规范下载警徽规范下载建设厅规范下载 化、个体化、连续性的综合治疗 方案 气瓶 现场处置方案 .pdf气瓶 现场处置方案 .doc见习基地管理方案.doc关于群访事件的化解方案建筑工地扬尘治理专项方案下载 。MDT的核心目标为患者设计最佳诊疗方案，确保最佳疗效。提升学科的诊疗能力和学术水平。医教研健康管理真正融合，推动医学科学进步。MDT适用于各个学科例如：我院内分泌科：以多学科协作为特色的理念甲状腺疾病会诊中心（内分泌、外科、眼科、妇产科、核医学）糖尿病足防治中心（内分泌、整形、血管外科、骨科、社区医院）妊娠糖尿病产后随访门诊（内分泌、产科）糖尿病并发症筛查和治疗随访门诊（内分泌、肾内、心内、眼科）肥胖和糖尿病前期管理门诊（内分泌、营养）内分泌高血压专业门诊（内分泌、泌尿外科、影像、神外、介入）MDT适用于各个学科MDT适用于各个学科肿瘤治疗是典型的例证今年80岁，有严重的冠心病、肺气肿，刚刚被确诊前列腺癌，我该怎么办？假如我是患者传统医疗模式下，医患双方的共同困惑关于医院的选择：综合医院能治好我的肿瘤吗？专科医院能保证我的医疗安全吗？关于前列腺癌：就诊科室或医生不同，治疗方案差异巨大多种治疗方法可选：手术、放疗、介入、冷冻、化疗、内分泌治疗、靶向治疗、生物治疗等不同治疗方法各有优缺点对单一学科/医生的治疗效果有所担忧关于高龄及心肺疾病：如何平稳控制，耐受各项治疗 措施 《全国民用建筑工程设计技术措施》规划•建筑•景观全国民用建筑工程设计技术措施》规划•建筑•景观软件质量保证措施下载工地伤害及预防措施下载关于贯彻落实的具体措施 ？MDT是医患双方的必然选择通过MDT，与患者充分沟通，为患者找到最适合病情的科学合理的综合诊疗方案，在保证医疗安全的前提下使患者获得最佳疗效。综合医院案例：MDTatMass.GeneralCentersandservicesMultidisciplinaryCareCentersCancerCenter就诊途径一CriticalCareCenterDigestiveHealthcareCenterHeartCenterMassGeneralHospitalforChildrenTransplantCenterVascularCenterAlldepartmentsDepartmentofUrology就诊途径二就诊途径一：TheCancerCenterTheCancerCenter:Offersacoordinatedteamapproachtailoredtotheindividualneedsofeachpatient。Totally39treatmentprograms.ProstateCancerProstateCancer：MultidisciplinaryPatientCareNewpatientsaregenerallyseenwithintwoweeksofreferral.Atyourfirstappointment,youwillmeetthegenitourinarycancerspecialistswhowillbeinvolvedinyourcare.Thesespecialistsmayinclude:Urologistsandsurgicaloncologistsexperiencedinthelatestprostatecancersurgeryapproaches,includinglaparoscopicandroboticsurgeryRadiationOncologistswhospecializeindeliveringtheoptimaltherapeuticdosewhileprotectinghealthytissueMedicalOncologiststoprescribethemosteffectivetreatments,includinghormonetherapy,chemotherapyandimmunotherapyInaddition,youmayalsosee:PathologistsspecializinginurologiccancersRadiologistsspecializingingenitourinarycancerimagingOncologynursesandnursepractitionerswhospecializeincancercareOncologypsychiatristsandsocialworkersexperiencedinhelpingwiththecognitivesideeffectsofcancerandtreatment,aswelltheemotionalandspiritualsideofthecancerexperienceAnutritionisttohelpyouwithquestionsaboutdietandnutritionduringtreatmentPalliativecareproviderstoimprovequalityoflifeThisteamwillworkwithyoutodevelopatreatmentplanthatbalancespotentialsideeffectsandbenefitsoftreatment.Theywillcontinuetomonitoryourcareandcommunicateregularlywithyouandyourreferringphysicianaboutyourprogress.就诊途径二：DepartmentofUrologyTreatments&ServicesCancer:Bladder,Kidney,Penile,ProstateandTesticularCancerProgramErectileDysfunctionServiceFemaleUrologyProgramGeriatricUrologyProgramKidneyStoneProgramCompassionate&PersonalizedCareOururologistsworkcloselywithallofthecliniciansoneachpatient'streatmentteam,acomprehensiveandhighlycoordinatedapproachmanagedthroughtheworld-renownedMassGeneralCancerCenter.Dependingonyourillnessanddiagnosis,yourtreatmentteamincludesyoururologistalongwithmedicaloncologists,radiationoncologists,radiologistsandpathologists.YoualsohaveaccesstothewidevarietyofresourcesandsupportservicesavailablethroughtheCancerCenter.UnitespecialistsacrossthehospitaltogiveConsultationsandsupportservicestoensurewedeliverthehighestqualityandsafestcarepossible.如何为高龄及心肺疾患保驾护航专科医院案例：MDTatMDAndersonBrain&SpineCenterBreastCenterColorectalCenterEndocrineCenterGastrointestinalCenterGenitourinaryCenter就诊途径GynecologicOncologyCenterHead&NeckCenterLeukemiaCenterLymphoma&MyelomaCenterMelanoma&SkinCenterSarcomaCenterThoracicCenterMultidisciplinaryCancerCareCenters：MostofthenewpatientswhocometoMDAndersoneveryyeararetreatedinoneofourspecializedCancerCareCentersorclinics,whichembodytheteamapproachtocancercarethathasbecomeanMDAndersontrademark就诊途径：GenitourinaryCancerCenterMDAnderson’sGenitourinary(GU)CancerCenterprovidespersonalizedcareforcancersoftheurinarytractandmalegenitaltract.ThecenterisoneofthemostactiveprogramsinthecountryforGUcancers.Ourgoalistocontrolthecancerandpreservethebestqualityoflifeaftertreatmentfor:Prostatecancer BladdercancerKidneycancerTesticularcancerPenilecancerNonmalignanttumorsoftheurinarytractandmalereproductivesystemVonHippelLindaudisease(VHL)WhyChooseMDAnderson'sGenitourinaryCenter?Most-advancedgenitourinarycancertreatmentsincludingprotontherapy,genetherapyandtargetedtherapiesAdvancedsurgicaltechniquesincludinglaser,cryosurgeryandroboticlaparoscopicproceduresHighlyspecializedteamofexpertsDedicationtomaintainingoptimumfunctionandqualityoflifeRangeofclinicaltrialsofnewtreatmentsforgenitourinarycancerWetakeateamapproachtoGUcancer,andourexpertmedicaloncologists,surgicaloncologistsandradiationoncologists--eachhighlyspecializedinaparticulartypeofGUcancer—collaboratecloselytocustomizeyourtreatment.Specialty&TreatmentCentersCancerPreventionCenterCardiopulmonaryCenterIntegrativeMedicineCenterInternalMedicineCenterMohs/DermasurgeryUnitOrthopaedicCenterJulieKyteCenterforReconstructiveSurgeryPainManagementCenterProtonTherapyCenterRadiationTreatmentCenterStemCellTransplantation&CellularTherapyCenterSupportiveCareCenter如何为高龄及心肺疾患保驾护航CardiopulmonaryCenterTheCardiopulmonaryCenterbringstogetherexpertswhoperformdiagnosticsandtreatcancerpatientsfordiseasesoftheheart,vasculature,airwayandlungs.MDAnderson'smultidisciplinaryteamincludescardiologists,pulmonologists,nuclearmedicinepersonnel,mid-levelprovidersandtechnicalstaffwhoprovidediagnostics,aswellascomprehensivetreatmentandmanagementofpatientswithcardiacand/orpulmonaryconditions. Ourphysiciansprovidethelatestdiagnosticsandtreatments,including:Three-dimensionalechocardiographywithspeckleandstraintestingCardiaccatheterizationlaboratoryWorld-classinterventionalpulmonarylabPulmonaryfunctiontestingCardiacandpulmonarystresstestingPolysomnographystudies以该患者为中心的MDT团队构成前列腺癌核心团队前列腺癌支持团队心血管、呼吸、老年内科等协作学科我院前列腺癌MDT诊治现状MDT改善前列腺癌等预后的循证医学证据JeffersonKimmelCancerCenter的研究显示：采用MDT管理前列腺癌患者，10年生存率显著高于NCISEER登记系统内的没有采用MDT管理患者的生存率。原因：个体化综合治疗方案更为及时、合理、有效。MDT组织结构MDT普遍模式针对特定疾病/器官/系统联合接诊/查房/讨论/会议等多学科固定医生参与核心团队支持团队协作诊治学科（更广义MDT）固定时间，固定周期，固定地点形成诊治决议由MDT团队科室执行追踪MDT基本条件有一定的病例数（可多病种联合）确定的召集人，固定团队及专家替代 制度 关于办公室下班关闭电源制度矿山事故隐患举报和奖励制度制度下载人事管理制度doc盘点制度下载 诊治决议可执行团队人员志同道合，沟通无障碍MDT最关键标志让患者体验到！国内现阶段开展MDT的挑战宏观：待合理的医疗服务价格体系医院：模糊的医院及学科 发展规划 小学教师专业发展规划教师个人发展规划三年劳动实践场所建设地理教师发展规划教师三年成长专业规划 学科：传统的学科管理话语权模式医生：个体的诊疗行为主观随意性MDT的可操作性可操作性：结合具体情况，寻求突破点，以点带面Blinddates/Matchmaking有人推动，走到一起是开始，保持下去是进步，形成团队是成功。从大家感兴趣的事做起，从最容易的事做起，从对方最需要的事做起协作始于自觉，完善需要制度“行胜于言”，“说一尺不如干一寸”MDT模式下医院的发展综合医院、专科医院：殊途同归MDT模式下：肿瘤治疗等将不再有综合医院和专科医院的界限。NewsonCambridgeUniversityHospitalwebsite(13September2013):CUHwillbethefirstgeneralhospitaltobeaccreditedbyOrganizationofEuropeanCancerInstitutes(OECI)asacomprehensivecancercenter.CommentfromDr.KeithMcNeil:“Itisfantasticnewsthatwehavebeenrecognizedasoneofthebestcancercentersintheworld.……cancerwillbeoneofthetopprioritiesforusinthefuture.”综合医院、专科医院：殊途同归综合医院：依托综合实力，发展特色专业专科医院：做精特色专业，兼顾综合发展MDT是通向医学未来的必经阶段没有协作的竞争是低水平的竞争医学未来在于医学本质的回归传统模式：单学科诊疗（看人生的病）必经阶段：多学科协作（看生病的人）医学本质：人文之关爱（看生病的人）Tocuresometimes,torelieveoften,tocomfortalways.----E.L.Trudeau(1848-1915)谢谢