Multidisciplinary Team Managements and Clinical Outcomes in Patients With Pulmonary Arterial Hypertension During the Perinatal Period

Effects of multidisciplinary team continuous care model on psychological behavior and quality of life in children with β-thalassemia major

OBJECTIVE

To explore the effects of a multidisciplinary team (MDT) continuous care model on psychological behavior and quality of life in children with β-thalassemia major (β-TM).

METHODS

A retrospective study was conducted on 90 children with β-TM who were hospitalized in the Department of Pediatrics, Affiliated Hospital of Youjiang Medical University for Nationalities from October 2021 to May 2022. According to nursing methods, the children were divided into a routine group and an experimental group, with 45 cases in each group. The routine group was intervened with routine nursing approaches, and the experimental group was intervened with the MDT continuous nursing mode on the basis of the control group. The psychological behavior [Positive and Negative Affect Scale for Children (PANAS-C)], quality of life (QoL) [Pediatric Quality of Life Inventory TM (PedsQLTM)] and satisfaction were compared between the two groups before and 6 months after intervention. The hemoglobin level and ferritin level of children after 3 months and 6 months of intervention were measured. The occurrence of complications and nursing satisfaction were recorded. The prognostic factors were further analyzed.

RESULTS

After the intervention, the positive emotion score, QoL score, hemoglobin level, satisfaction score in the experimental group were all higher than those in the conventional group, and the negative emotion score and ferritin level in the experimental group were all lower than those in the conventional group (all P < 0.05). The results of Cox analysis showed that the use of iron-removing drugs and arrhythmia/heart rate failure were risk factors affecting the prognosis of children with β-TM, while the MDT continuous nursing mode was a protective factor (all P < 0.05).

CONCLUSION

The MDT continuous care model can effectively promote mental health in children with β-TM, improve their quality of life, medical satisfaction, ameliorate the degree of anemia in children, reduce the incidence of complications and improve the prognosis; thus, it is worthy of wide clinical application.

Multidisciplinary team discussion: the emerging gold standard for management of cardiopulmonary complications of connective tissue disease

Cardiopulmonary complications of connective tissue diseases (CTDs), particularly pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD), are major determinants of morbidity and mortality. Multidisciplinary meetings may improve diagnostic accuracy and optimise treatment. We review the literature regarding multidisciplinary meetings in CTD-ILD and PAH and describe our tertiary centre experience of the role of the multidisciplinary meeting in managing CTD-PAH.

Maternal and Fetal Outcomes in Pregnant Women with Pulmonary Arterial Hypertension: A Single-Center Experience and Review of Current Literature

BACKGROUND

Although pregnancy in women with pulmonary arterial hypertension has been considered a high-risk condition, current data regarding pregnancy with pulmonary arterial hypertension are scarce. In this study, we aimed to evaluate our single-center data on maternal and fetal outcomes in pregnant women with PAH and review currently available risk-based management strategies.

METHODS

Our single-center study group comprised 35 women who became pregnant after the diagnosis of pulmonary arterial hypertension or in whom pulmonary arterial hypertension was diagnosed within early post-partum period. Clinical, laboratory, echocardiographic, and hemodynamic characteristics of pregnant and non-pregnant productive women with pulmonary arterial hypertension were compared, and similar comparison was also repeated for survivors and non-survivors in pregnant patient group.

RESULTS

Pregnancy was noted in 15% of the 228 females with pulmonary arterial hypertension who were of hormonally productive ages, generally well-tolerated until delivery. Elective abortion and pre-term delivery were documented in 1 (2.8%) and 12 (35.3%) pregnant women, respectively. Switching to sildenafil was the standard medication during pregnancy. Cesarian section was the preferred method of delivery in all pregnant women with pulmonary arterial hypertension and was performed without any complication. Clinic deteoriation within the first week of delivery was observed in 5 (41.6%) patients. Maternal mortality was noted in 13 (37.1%) patients and was documented to cumulate within the first month of delivery. However, any sign predicting post-partum clinical deterioration was not found. No fetal mortality was observed.

CONCLUSION

Despite the development of advanced therapies, pregnancy in pulmonary arterial hypertension still carries a high mortality risk and requires multi-disciplinary expert center care with more proactive management strategies.

Pregnancy Considerations in the Multidisciplinary Care of Patients with Pulmonary Arterial Hypertension

Pulmonary arterial hypertension (PAH) is a vasoconstrictive disease of the distal pulmonary vasculature resulting in adverse right heart remodeling. Pregnancy in PAH patients is associated with high maternal morbidity and mortality as well as neonatal and fetal complications. Pregnancy-associated changes in the cardiovascular, pulmonary, hormonal, and thrombotic systems challenge the complex PAH physiology. Due to the high risks, patients with PAH are currently counseled against pregnancy based on international consensus guidelines, but there are promising signs of improving outcomes, particularly for patients with mild disease. For patients who become pregnant, multidisciplinary care at a PAH specialist center is needed for peripartum monitoring, medication management, delivery, postpartum care, and complication management. Patients with PAH also require disease-specific counseling on contraception and breastfeeding. In this review, we detail the considerations for reproductive planning, pregnancy, and delivery for the multidisciplinary care of a patient with PAH.