|Year : 2020 | Volume
| Issue : 1 | Page : 10-14
Development ideas for the multidisciplinary integrative diagnosis and treatment system of pelvic floor medicine
Capital College of Traditional Chinese Medicine, Australia
|Date of Submission||20-Oct-2019|
|Date of Acceptance||10-Jan-2020|
|Date of Web Publication||27-Mar-2020|
Prof. Haidong Wang
Capital College of Traditional Chinese Medicine
Source of Support: None, Conflict of Interest: None
With the rapid growth of the aging population, pelvic floor dysfunction (PFD) has become a new type of high-incidence disorder. This disorder can be caused by injury, functional deterioration, or coordination disorders of pelvic support structures, such as pelvic floor muscles, connective tissues, and pelvic floor muscle fiber. The symptoms can include dyssynergic defecation, fecal incontinence, overactive bladder, urinary incontinence, pelvic organ prolapse, hemorrhoids, sexual dysfunction, chronic urinary retention, and chronic pelvic pain. PFD often presents itself as a combination of symptoms involving urological, gynecological, anorectal, and psychological aspects. Under such circumstances, the development of multidisciplinary integrative diagnosis for PFD has become a trend.
Keywords: Construction of diagnostic and treatment system, multidisciplinary integration, pelvic floor
|How to cite this article:|
Wang H. Development ideas for the multidisciplinary integrative diagnosis and treatment system of pelvic floor medicine. Chin Med Cult 2020;3:10-4
|How to cite this URL:|
Wang H. Development ideas for the multidisciplinary integrative diagnosis and treatment system of pelvic floor medicine. Chin Med Cult [serial online] 2020 [cited 2020 Jun 1];3:10-4. Available from: http://www.cmaconweb.org/text.asp?2020/3/1/10/281479
The great development stages of traditional Chinese medicine (TCM) and and Western medicine are in the era of agricultural economy and industrial economy, respectively, consistent with the support provided by the relevant disciplines and industries of the two periods. The relationship between technology and economy is shown in [Figure 1].
The rapid development of modern life science and technology has led to a trend of convergence among the medical and pharmaceutical systems. Modern medicine is gradually taking shape due to the changing trends in the outlook on world development, consumption, and healthcare concept, as shown in [Figure 2].
|Figure 2: Outlook on the world development, consumption, and healthcare concept|
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The trends of the concepts of world development, consumption, and medical care (called “three concepts” for short in the rest of the article) reflect the trend of humans returning to the nature all over the world, that is, human beings are now pursuing people-oriented sustainable development and good quality of life characterized by individuality and diversity, and have started to pay attention to the human immunity and holistic health care.
The driving forces of the change in medical care concept are the limitations of the existing healthcare models, demographic changes, new disease challenges to humanity, development of the world economy, and especially the demand for innovation in the human society. Such forces have also led to the worldwide rise of traditional and herbal medicines, among which is the Chinese medicine, in particular. The changes of these three concepts have brought about the change in medical model, as well as the change in perceptions about diseases and their etiology. Gradually, people are putting more emphasis on maintaining or boosting their immunity and have begun to accept and appreciate “good quality of life” as the ultimate medical goal. In addition, the impact of these concepts has been felt in every aspect of human life. Social, economic, technological, and cultural activities have all been affected by these changes. Thus, the gradual convergence of modern medicine will become a better way to solve health problems in the future society.
Currently, the medical model has been changing from the traditional biomedical model to a modern bio- psychological-social medical model, which was proposed in 1977 by O. L. Engel, Professor of Psychiatry and Internal Medicine of the Medicine School of the University of Rochester.
The biomedical model is based on the biological science from the late 18th century to the early 19th century, and it reflects the medical and methodological aspects of the pathogenesis, host, and natural environment. The main defect of this model is that it only focuses on the biological property of the human body but ignores its social property; it only focuses on the physiological activities of human beings but neglects the role of psychological activities in the development of diseases and their prevention, treatment, and rehabilitation. In other words, this medical model only analyzes people from a biological and reductive perspective, abandoning the psychological and social factors of people; it focuses on diseases instead of patients; its goal mainly is to cure a disease but not necessarily to restore the wellbeing. Therefore, the use of this medical model for disease treatment has resulted in incomplete clinical diagnosis, inappropriate diagnostic measures, ineffective treatments, unnecessary hospitalizations, rising medical costs, and longer time for treatment in practice.
In contrast, the bio-psychological-social medical model focuses not only on human biology but also on the sociality of human beings, fully recognizing the comprehensive effect of social and psychological factors on health. It serves as a correction and supplement to the biomedical model because it not only looks into the biological individuals but also takes into consideration the social factors that influence the health of individuals and groups, as well as their psychological and mental state. The clinical diagnosis and treatment in this model value integrity and people-oriented principles.
In fact, “people-oriented” is the very core value of multidisciplinary integrative diagnostic and treatment services. This mode of diagnosis and treatment is different from the traditional medical service model in that it aims to provide efficient, convenient, and comprehensive services for patients with “treatment centering on diseases,” “doctors centering on patients,” “hospitals centering on curative effects” principles in mind.
| Reasons for the Establishment of a Multidisciplinary and Integrative Diagnosis and Treatment System for Pelvic Floor Medicine|| |
The establishment of the patient-oriented model, the “pelvic floor center,” in the same clinical system for patients, medical practitioners (many specialties), researchers, etc., has become a consensus
Mac Lennanet al. found that the incidence of urinary incontinence was 4.4% in males and 35.3% in females; the anal incontinence rate was 6.8% in males and 10.9% in females; the incidence of hemorrhoids was 19.9% in males and 30.2% in females, which are proportional to age and number of women giving birth. Hampel et al. found that the incidence of overactive bladder in men was 15.6% and in women was 17.4%, which is proportional to the age. The incidence of defecation disorders is 15%–20%, with 2.2 times more women than men over the age of 65. The American Health Survey found about 40% of women aged 50–79 years have varying degrees of organ prolapse. Chronic pelvic pain affects 15% of women aged 18–50 years, with pelvic floor pain affecting about 9 million women in the United States. Pelvic floor dysfunction has high clinical incidence, complicated etiology, long course and overlap of symptoms, causing physical pain, mental depression, adverse drug reactions, and financial burdens; and the patients' quality of life is seriously affected, which has attracted increasing attention in China.
Based on the clinical pathway concept, a multidisciplinary approach to the diagnosis and treatment of these diseases has been adopted. The idea of establishing the “pelvic floor center” model centering on patients, with patients, multidisciplinary healers, and researchers in the same system [Figure 3], has become a consensus, which is one of the most active research fields all around the world in recent years. Since 2000, many “pelvic floor centers” have been established, mainly in colorectal surgery, gynecology, urology, or rehabilitation [Figure 4]. Lots of research, standardization, training, and dissemination of a series of diagnostic and treatment techniques had been conducted.
Multidimensional diagnostic model and personalized comprehensive treatment need to be standardized and deepened on a multidisciplinary and integrated platform
Multidimensional diagnostic and assessment techniques have evolved over the past two decades. Morphological diagnosis techniques include defecography, barium enema, dynamic pelvic magnetic resonance imaging, and three-dimensional dynamic ultrasound; functional diagnostic techniques include colonic transmission test, anorectal manometry, urodynamics, pelvic electromyography, and evoked potentials (pelvic nerve electrophysiology). PFD often presents itself as a combination of symptoms; some of the patients may abuse various drugs; some may have upper digestive and psychiatric symptoms; therefore, each case should be evaluated comprehensively based on the patient's medical history and symptoms to complete detailed diagnosis and assessment of physical and mental health. These assessment techniques need to be standardized and deepened in a standard way [Figure 5].
Treatment techniques, in particular, need to be standardized. Every treatment technique is a research direction and needs to be refined [Figure 6]. Take the case of treating chronic constipation with acupuncture and moxibustion, for example, the studies to be carried about include,,,,, treatment advantage type, treatment scheme design (acupuncture depth, stimulation quantity, moxibustion, acupoint, electroacupuncture parameters, and other aspects of the task), implementation (technical standards or specifications), and evaluation of efficacy (patient-reported outcome/doctor reported outcome), which can eventually help to showcase the advantages of each treatment method.
The multidisciplinary integrative platform can realize a virtuous circle of optimization, training, and promotion of diagnosis and treatment systems
To achieve a relatively stable diagnostic system on the multidisciplinary integration platform, a multicentered approach needs to be taken to acquire more evidence-based medical evidences, and regional or national clinical guidelines need to be established to enrich specialist and disciplinary development and to optimize clinical practice to form a virtuous circle.
After realizing the relatively stable system of diagnosis and treatment technology, training and popularization of high technology should be carried out among the medical staff and the patients. Medical personnel having been trained in a professional system can accomplish many interdisciplinary tasks and can increase their work efficiency. For patients, patient cooperation and family support are also essential to improving long-term outcomes. Some noninvasive and safe diagnostic techniques, such as pelvic biofeedback therapy, can also be implemented remotely to gradually achieve chronic disease management.
Medicine of the 21st century will develop from the “disease medicine” to “health medicine,” from emphasizing treatment to emphasizing prevention, and from group study and treatment to that of individuals. The new medical reform introduced in 2009 regards disease prevention as the highest goal of medical treatment. In the new century, the advantages of informatization, networking, and wireless will be fully exploited by means of computer network technology to achieve premedical (prevention and monitoring), follow-up and service of medical and health process in medical treatment, and postmedical treatment (follow-up, customized service), thus extending the medical services outside of the hospital, improving the level of medical service, and eventually forming the national network of medical centers for pelvic floor disease diagnosis and treatment [Figure 7] and [Figure 8].
|Figure 7: Follow-up visit and long-distance care of patients after treatment|
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| Contents of the Multidisciplinary Integrative Medical Platform|| |
The integrative multidisciplinary treatment platform includes clinical pathway, regional medicine, and chronic disease management [Figure 9]. Based on a series of high-tech diagnosis and treatment techniques, this model takes on a patient-oriented approach, combines TCM syndrome differentiation with disease differentiation systems to improve the therapeutic effect, with the aim to establish disciplines ranging from prevention to treatment and from nonsurgical to minimally invasive treatment. It integrates TCM, acupuncture, spleen and stomach, preventive treatment, rehabilitation, related disciplines (gynecology, psychology, imaging, and pelvic physiology), nursing, and other divisions and disciplines
|Figure 9: Contents for multidisciplinary integrative diagnosis and treatment platform|
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Clinical pathways: Standardized workflows
A clinical pathway is a written and standardized workflow. All essential inspections, treatments, and care procedures are standardized in accordance with the principles of evidence-based medicine by professionals from all disciplines. These standards are tabulated according to expected treatment and length of stay so as to optimize the sequencing and timing of treatments, inspections, and care activities. These standards make it possible for all patients to be treated and cared by following the standardized workflow. A clinical pathway is characterized by comprehensiveness, timeliness, professional cooperation, and measurable results.,
The implementation of clinical pathways can promote multidisciplinary cooperation in the pelvic floor treatment community, guarantee the continuity of treatment and nursing, provide best services for patients, ensure rational and effective use of resources, and reduce waste of medical resources.
Regional medicine: Achieving a high degree of sharing and circulation
With the development of medical service, the regionalization of medical care is inevitable, and it also aligns with the mission of the medical service. The regional medical informatization is the most direct and effective embodiment of regional medical treatment, that is, by achieving a high degree of information sharing and circulation among regional residents, access to medical services will be facilitated and medical costs reduced.
Regionalization of PFD treatment mainly benefits three groups of people: (1) it provides convenience for patients as the online medical information system can enable remote registration bookings, remote medical consultation, or even remote medical group consultation; (2) it provides convenience for healthcare workers, for example, through the remote system, a doctor can have access to a patient's testing results and medical records taken at anytime and anywhere, which can help improve the accuracy of diagnosis and the effects of treatment, and can also guarantee the continuity of treatment in “two-way referral;” (3) it provides convenience for medical service managers; the integration of regional medical data centers must also be based on a stable and efficient telemedicine network, enabling the health administration department to coordinate health resources better and reduce redundant construction and waste, bringing into full play the economic benefits, management benefits, and decision-making benefits of the regional medical information system.
Chronic disease management: Comprehensive and multiangle health services for patients with chronic diseases
Chronic disease management refers to the organization of chronic disease professionals and nursing staff who will provide comprehensive, continuous, and proactive management for people with chronic diseases, to improve health conditions, slow down disease progression, reduce complications, reduce disability rates, prolong life span, and improve quality of life. It is also a scientific management mode to reduce medical expenses.
Chronic disease management in PFD is a comprehensive intervention model based on the bio-psycho-social medicine model. It looks into the whole process of disease occurrence and development based on groups (management of high-risk people, clinical treatment for illness, health rehabilitation, prevention, and treatment of complications), emphasizing the importance of multidisciplinary cooperation to highlight evidence-based medical guidance and health education, prevent disease exacerbation, and promote a continuous process of monitoring and continuous assessment of improvement.
| Thoughts and Outlook|| |
The multidisciplinary model of pelvic floor medicine at present has optimized efficiency for patients, doctors, researchers, and managers. It also provides a good idea for improving patient satisfaction, chronic disease management, regional medicine, and development of TCM. Although in practice many problems still remain unsolved, such as controversies over medical expenses, treatment time, optimal staffing, and public welfare, the holistic approach, the “people-oriented” direction, and the “multi-disciplinary integrative model” of pelvic floor medicine are bound to attract more professional integration and bring more fresh vitality.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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