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  1. Article ; Online: Preoperative multidisciplinary team decisions for high-risk patients scheduled for noncardiac surgery-a retrospective observational study.

    Vernooij, Jacqueline E M / Smulders, Pascal S H / Geurts, José W / Kalkman, Cor J / Koning, Nick J

    Canadian journal of anaesthesia = Journal canadien d'anesthesie

    2021  Volume 68, Issue 12, Page(s) 1769–1778

    Abstract: Purpose: Preoperative multidisciplinary team (MDT) meetings are recommended for patients at high risk for perioperative complications and mortality, although the underlying evidence is scarce. We aimed to investigate the effect of MDT decisions on ... ...

    Title translation Décisions préopératoires par équipe multidisciplinaire pour les patients à haut risque devant bénéficier d’une chirurgie non cardiaque—une étude observationnelle rétrospective.
    Abstract Purpose: Preoperative multidisciplinary team (MDT) meetings are recommended for patients at high risk for perioperative complications and mortality, although the underlying evidence is scarce. We aimed to investigate the effect of MDT decisions on patient management and patient outcome.
    Methods: We conducted a single-centre retrospective cohort study including all noncardiac surgical patients selected for discussion at preoperative MDT meetings from January 2017 to December 2019 (N = 120). We abstracted preoperative data, MDT decisions, and patient outcomes from the electronic health records for analysis.
    Results: Of the 120 patients registered for an MDT meeting, 43% did not undergo their initially planned surgery. Only 27% of patients received perioperative management as planned before the MDT meeting. Most surgery cancellations were the MDT's decision (22%) or the patient's decision before or after the MDT discussion (10%). Postoperative complications occurred in 28% of operated patients, and postoperative mortality was 4% at 30 days and 10% at three months, most of which was attributable to postoperative complications. Non-operated patients had a 7% mortality rate at 30 days and 9% at three months. Alterations of perioperative management following MDT discussion were associated with fewer cases of extended length of hospital stay (> ten days).
    Conclusion: This study shows that preoperative MDT meetings for high-risk noncardiac surgical patients altered the management of most patients. Management alterations were associated with fewer hospital admissions of long duration. These results should be interpreted with appropriate caution given the methodological limitations inherent to this small study.
    MeSH term(s) Electronic Health Records ; Humans ; Length of Stay ; Patient Care Team ; Postoperative Complications/epidemiology ; Postoperative Complications/prevention & control ; Retrospective Studies
    Language English
    Publishing date 2021-09-22
    Publishing country United States
    Document type Journal Article ; Observational Study
    ZDB-ID 91002-8
    ISSN 1496-8975 ; 0832-610X
    ISSN (online) 1496-8975
    ISSN 0832-610X
    DOI 10.1007/s12630-021-02114-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: In pursuit of a better transition to selected residencies: a quasi-experimental evaluation of a final year of medical school dedicated to the acute care domain.

    Jonker, Gersten / Booij, Eveline / Vernooij, Jacqueline E M / Kalkman, Cor J / Ten Cate, Olle / Hoff, Reinier G

    BMC medical education

    2022  Volume 22, Issue 1, Page(s) 807

    Abstract: Background: Medical schools seek the best curricular designs for the transition to postgraduate education, such as the Dutch elective-based final, 'transitional' year. Most Dutch graduates work a mean of three years as a physician-not-in-training (PNIT) ...

    Abstract Background: Medical schools seek the best curricular designs for the transition to postgraduate education, such as the Dutch elective-based final, 'transitional' year. Most Dutch graduates work a mean of three years as a physician-not-in-training (PNIT) before entering residency training. To ease the transition to selected specialties and to decrease the duration of the PNIT period, UMC Utrecht introduced an optional, thematic variant of the usual transitional year, that enables the development of theme-specific competencies, in addition to physicians' general competencies.
    Methods: We introduced an optional transitional year for interested students around the theme of acute care, called the Acute Care Transitional Year (ACTY). This study aimed to evaluate the ACTY by judging whether graduates meet postgraduate acute care expectations, indicating enhanced learning and preparation for practice. In a comprehensive assessment of acute care knowledge, clinical reasoning, skills, and performance in simulations, we collected data from ACTY students, non-ACTY students interested in acute care, and PNITs with approximately six months of acute care experience.
    Results: ACTY graduates outperformed non-ACTY graduates on skills and simulations, and had higher odds of coming up to the expectations faculty have of a PNIT, as determined by global ratings. PNITs did better on simulations than ACTY graduates.
    Discussion: ACTY graduates show better resemblance to PNITs than non-ACTY graduates, suggesting better preparation for postgraduate acute care challenges.
    Conclusion: Transitional years, offering multidisciplinary perspectives on a certain theme, can enhance learning and preparedness for entering residency.
    MeSH term(s) Humans ; Schools, Medical ; Internship and Residency ; Critical Care ; Physicians ; Medicine
    Language English
    Publishing date 2022-11-23
    Publishing country England
    Document type Journal Article
    ZDB-ID 2044473-4
    ISSN 1472-6920 ; 1472-6920
    ISSN (online) 1472-6920
    ISSN 1472-6920
    DOI 10.1186/s12909-022-03871-0
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Is a preoperative multidisciplinary team meeting (cost)effective to improve outcome for high-risk adult patients undergoing noncardiac surgery: the PREPARATION study-a multicenter stepped-wedge cluster randomized trial.

    Vernooij, Jacqueline E M / Boerlage, Romijn M / Doggen, Carine J M / Preckel, Benedikt / Dirksen, Carmen D / van Leeuwen, Barbara L / Spruit, Rutger J / Festen, Suzanne / van der Wal-Huisman, Hanneke / van Basten, Jean P / Kalkman, Cor J / Koning, Nick J

    Trials

    2023  Volume 24, Issue 1, Page(s) 660

    Abstract: Background: As a result of increased life expectancy and improved care for patients suffering from chronic disease, the number of patients with multimorbidity requiring surgical intervention is increasing. For complex surgical patients, it is essential ... ...

    Abstract Background: As a result of increased life expectancy and improved care for patients suffering from chronic disease, the number of patients with multimorbidity requiring surgical intervention is increasing. For complex surgical patients, it is essential to balance the potential benefits of surgical treatment against the risk of permanent loss of functional capacity and quality of life due to complications. European and US guidelines on perioperative care recommend preoperative multidisciplinary team (MDT) discussions for high-risk noncardiac surgical patients. However, the evidence underlying benefits from preoperative MDT meetings with all relevant perioperative specialties present is limited. The current study aims to investigate the effect of implementation of preoperative MDT discussions for high-risk patients undergoing noncardiac surgery on serious adverse events.
    Methods/design: PREPARATION is a stepped-wedge cluster randomized trial in 14 Dutch hospitals without currently established preoperative MDT meeting. The intervention, preoperative MDT meetings, will be implemented sequentially with seven blocks of 2 hospitals switching from control (preoperative screening as usual) to the intervention every 3 months. Each hospital will be randomized to one of seven blocks. We aim to include 1200 patients. The primary outcome is the incidence of serious adverse events at 6 months. Secondary outcomes include (cost)effectiveness, functional outcome, and quality of life for up to 12 months.
    Discussion: PREPARATION is the first study to assess the effectiveness of a preoperative MDT meeting for high-risk noncardiac surgical patients in the presence of an anesthesiologist. If the results suggest that preoperative MDT discussions for high-risk patients are (cost)-effective, the current study facilitates implementation of preoperative MDT meetings in clinical practice.
    Trial registration: ClinicalTrials.gov NCT05703230. Registered on 11/09/2022.
    MeSH term(s) Humans ; Adult ; Quality of Life ; Medicine ; Perioperative Care ; Hospitals ; Patient Care Team
    Language English
    Publishing date 2023-10-11
    Publishing country England
    Document type Randomized Controlled Trial ; Multicenter Study ; Journal Article
    ZDB-ID 2040523-6
    ISSN 1745-6215 ; 1468-6694 ; 1745-6215
    ISSN (online) 1745-6215
    ISSN 1468-6694 ; 1745-6215
    DOI 10.1186/s13063-023-07685-3
    Database MEDical Literature Analysis and Retrieval System OnLINE

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