BACKGROUND： Laparoscopic cholecystectomy（LC） is one of the most frequent abdominal surgical procedures. The present meta-analysis aimed to estimate the clinical effects of implementing a clinical pathway for LC com...BACKGROUND： Laparoscopic cholecystectomy（LC） is one of the most frequent abdominal surgical procedures. The present meta-analysis aimed to estimate the clinical effects of implementing a clinical pathway for LC compared with standard medical care by evaluating the length of hospital stay,costs, and the outcomes of patients undergoing LC.DATA SOURCES： Data were extracted from the following databases： PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Chinese Medical Citation Index（CMCI）,Chinese Medical Current Contents（CMCC）, and China BioMedical Literature Database（CBM）. We also searched the reference lists of the relevant articles and conference articles.Only randomized controlled trials and controlled clinical trials published from 1980 to 2013 were included. We did not set restrictions on language and country of publications. All of the data were evaluated and analyzed by two reviewers independently with RevMan software（version 5.0）.RESULTS： A total of 7 trials with 1187 patients were included.The patients who underwent LC with clinical pathway had shorter hospital stay [weighted mean difference=-1.90, 95%CI：-2.65 to-1.16, P〈0.00001], lower cost [standard mean difference=-0.69, 95% CI：-0.82 to-0.56, P〈0.00001], and better questionnaires based satisfaction with the medical services.CONCLUSIONS： The applications of the clinical pathway for LC effectively reduced hospital stay and total costs. However,there was insufficient evidence for proving the differences in postoperative complications. Future research should focus on patient outcomes and identify the mechanisms underlying the effect of the clinical pathway.展开更多
BACKGROUND Clinical pathways(CPs)are structured guidelines introduced to improve healthcare quality and efficiency.In South Korea,CPs for Korean medicine have been developed since 2016 under the 3rd Comprehensive Plan...BACKGROUND Clinical pathways(CPs)are structured guidelines introduced to improve healthcare quality and efficiency.In South Korea,CPs for Korean medicine have been developed since 2016 under the 3rd Comprehensive Plan for Korean Medicine Promotion,with limited studies on their clinical application.Neck and shoulder pain are common conditions frequently treated at Korean medicine clinics,often by patients dissatisfied with conventional treatments.The demand for Korean medicine treatments for neck and shoulder pain is on the rise.AIM To evaluate the clinical applicability and effectiveness of Korean medicine CPs for neck pain and shoulder pain in public healthcare institutions in South Korea.METHODS We collected and analyzed data from patients aged 19 years and older who visited the outpatient clinic of the Department of Korean Medicine at the National Medical Center in Korea from March 1,2023 to August 31,2023.CP completion rates,along with patient satisfaction,clinical outcomes,and economic outcomes between the CP-implemented and non-CP groups were assessed.RESULTS The CP completion rates were 93.3%for neck pain and 96.8%for shoulder pain.Patient satisfaction scores showed an improvement of 17.7%for neck pain and 18.0%for shoulder pain in the CP-implemented group compared to the non-CP group.For neck pain,significant improvements were observed in the numerical rating scale(NRS)and the neck disability index,while for shoulder pain,only the University of California-Los Angeles shoulder rating scale showed notable progress,with no substantial change in NRS scores.CONCLUSION This study partially confirms the clinical applicability and effectiveness of the Korean medicine CPs for neck pain and shoulder pain.Further research is required to enhance and validate these findings.展开更多
Objective:Aiming at the problems of clinical pathway optimization and medical cost control for stroke patients,this study proposes a clinical pathway discrimination model based on the XGBoost integrated learning algor...Objective:Aiming at the problems of clinical pathway optimization and medical cost control for stroke patients,this study proposes a clinical pathway discrimination model based on the XGBoost integrated learning algorithm.Combined with the multi-objective programming(MOP)method,this study explores its application value under the Diagnosis-Intervention Packet(DIP)payment model.Methods:The data of stroke patients(ICD codes I60-I63)from 2018 to 2024 were obtained through the medical record statistical management system of medical institutions in Guangdong Province.Efficiency indicators(average length of hospital stay),health economics indicators(total cost),effectiveness indicators(mortality rate),and specific indicators(NIHSS score)were extracted.The XGBoost algorithm was used to construct the clinical pathway discrimination model,and the hyperparameters were optimized through grid search.Based on the DIP payment rules,the prediction results of the model were used as inputs to establish a dynamic programming model,aiming to minimize costs and maximize curative effects to obtain the optimal clinical pathway plan.Results:The goodness-of-fit(R 2)of the XGBoost model on the test set reached 0.768,which was significantly better than that of the random forest(0.691)and the BP neural network(0.343).The total cost of the clinical pathway optimized by the dynamic programming model decreased by 12.7%(95%CI:10.2-15.1%),the average length of hospital stay was shortened by 1.8 days,and the NIHSS improvement rate increased by 8.3%.Conclusion:The integrated model proposed in this study has high accuracy and robustness in clinical pathway discrimination.Combined with the MOP method,it can provide a scientific basis for the optimization of medical resources under the DIP model,helping medical institutions achieve the dual goals of precise cost control and curative effect improvement.展开更多
Objective:To observe the intervention effect of clinical nursing pathway on patients receiving intravenous therapy via peripheral mid-long catheters.Methods:Ninety patients receiving intravenous therapy via mid-long c...Objective:To observe the intervention effect of clinical nursing pathway on patients receiving intravenous therapy via peripheral mid-long catheters.Methods:Ninety patients receiving intravenous therapy via mid-long catheters in the hospital from March 2024 to March 2025 were selected and randomly divided into a control group and an observation group,with 45 patients in each group.The control group received routine nursing intervention,while the observation group received clinical nursing pathway intervention.The nursing risk events,catheter indwelling time,and nursing satisfaction were evaluated in both groups.Results:The observation group had a shorter catheter indwelling time,fewer risk events during intravenous therapy(total incidence rate of 2.22%),and higher nursing satisfaction.Additionally,negative emotional feedback was reduced,and the SAS score(31.02±1.12)was lower in the observation group compared to the control group.There were significant differences between the two groups in all indicators(P<0.05).Conclusion:Applying the clinical nursing pathway during intravenous therapy via peripheral mid-long catheters can help ensure infusion safety,improve unstable emotional states,and promote high-quality service standards.展开更多
Objective:This study investigates the effect of orthopedic nursing in patients with ankle fractures.Methods:A total of 84 patients with ankle fractures treated in our hospital from September 2022 to September 2023 wer...Objective:This study investigates the effect of orthopedic nursing in patients with ankle fractures.Methods:A total of 84 patients with ankle fractures treated in our hospital from September 2022 to September 2023 were selected and randomly divided into a control group and an observation group using a random number table,with 42 cases in each group.The control group received routine nursing,while the observation group received orthopedic nursing clinical pathway on the basis of traditional nursing.We analyzed and scored the nursing satisfaction and nursing effect of the two groups.Results:Compared with the control group,the observation group had a higher total nursing satisfaction rate,shorter time to get out of bed,shorter hospital stay,and lower hospitalization cost.The Barid score and AOFAS score of the observation group were higher than those of the control group,while the NRS score was lower.Conclusion:The application of orthopedic nursing clinical pathway in patients with ankle fractures significantly improves their quality of life,promotes better recovery of ankle function,and shortens the rehabilitation time.展开更多
Objective: To evaluate the effect of endoscopic high-frequency electrocoagulation electrodesiccation (HFEE) of intestinal polyps in the clinical nursing pathway. Method: A total of 120 patients who underwent HFEE of i...Objective: To evaluate the effect of endoscopic high-frequency electrocoagulation electrodesiccation (HFEE) of intestinal polyps in the clinical nursing pathway. Method: A total of 120 patients who underwent HFEE of intestinal polyps were randomly divided into two groups of 60 cases. The control group received conventional nursing care while the observation group received the clinical nursing pathway of HFEE. Results: The average length of hospitalization, hospitalization costs, and mastery of the three health education of the observation group was lower than that of the control group (P < 0.01). The satisfaction of care in the observation group was significantly better than the control group (P <0.01). Conclusion: The clinical care path was suitable for HFEE of intestinal polyps, which shortened the patient’s length of hospitalization, improved their awareness of health education, improved their satisfaction with care, reduced medical disputes, and promoted the good development of nurse-patient relationships .展开更多
To study on the effect of clinical pathway （CP） on controlling pharmaceutical costs, we selected complex, chronic, non-communicable diseases, including cerebral infarction, cerebral hemorrhage, transient ischemic at...To study on the effect of clinical pathway （CP） on controlling pharmaceutical costs, we selected complex, chronic, non-communicable diseases, including cerebral infarction, cerebral hemorrhage, transient ischemic attack, and chronic obstructive pulmonary disease, as diseases to implement clinical pathways at a tertiary hospital in Qingdao. We then conducted intermittent time series analysis on pharmaceutical costs. After the implementation of clinical pathway, overall pharmaceutical costs of patients with transient ischemic attack reduced significantly. The effect was not significant for cerebral hemorrhage patients. The implementation of clinical pathway has a desirable outcome on controlling pharmaceutical costs.展开更多
For patients receiving chemotherapy, drugs represent the largest cost. Clinical chemotherapy Pathways have become a critical strategy to identify unnecessary drug costs and to implement mechanisms to deliver lower cos...For patients receiving chemotherapy, drugs represent the largest cost. Clinical chemotherapy Pathways have become a critical strategy to identify unnecessary drug costs and to implement mechanisms to deliver lower cost alternatives without sacrificing outcomes or quality of care. This paper describes the steps of development of a functioning pathways program beginning in an environment of full-risk capitation, including drugs. The next steps involved quantitating the potential impact of such a program and then collaborating with a payer to test the concept. When these studies showed promise, the practices adopting pathways used them as a backbone for drug management in the Oncology Care Model. These experiences very likely represent steps in a continuum towards placing more of the drug delivery costs at risk. The potential for again considering capitated payments is discussed.展开更多
AIM: To determine the effective hospitalization period as the clinical pathway to prepare patients for endoscopic submucosal dissection (ESD). METHODS: This is a retrospective observational study which included 189 pa...AIM: To determine the effective hospitalization period as the clinical pathway to prepare patients for endoscopic submucosal dissection (ESD). METHODS: This is a retrospective observational study which included 189 patients consecutively treated by ESD at the National Cancer Center Hospital from May 2007 to March 2009. Patients were divided into 2 groups; patients in group A were discharged in 5 d and patients in group B included those who stayed longer than 5 d. The following data were collected for both groups: mean hospitalization period, tumor site, median tumor size, post-ESD rectal bleeding requiring urgent endoscopy, perforation during or after ESD, abdominal pain, fever above 38 ℃, and blood test results positive for inflammatory markers before and after ESD. Each parameter was compared after data collection. RESULTS: A total of 83% (156/189) of all patients could be discharged from the hospital on day 3 postESD. Complications were observed in 12.1% (23/189) of patients. Perforation occurred in 3.7% (7/189) of patients. All the perforations occurred during the ESD procedure and they were managed with endoscopic clipping. The incidence of post-operative bleeding was 2.6% (5/189); all the cases involved rectal bleeding. We divided the subjects into 2 groups: tumor diameter ≥ 4 cm and < 4 cm; there was no significant difference between the 2 groups (P = 0.93, χ 2 test with Yates correction). The incidence of abdominal pain was 3.7% (7/189). All the cases occurred on the day of the procedure or the next day. The median white blood cell count was 6800 ± 2280 (cells/μL; ± SD) for group A, and 7700 ± 2775 (cells/μL; ± SD) for group B, showing a statistically significant difference (P = 0.023, t-test). The mean C-reactive protein values the day after ESD were 0.4 ± 1.3 mg/dL and 0.5 ± 1.3 mg/dL for groups A and B, respectively, with no significant difference between the 2 groups (P = 0.54, t -test). CONCLUSION: One-day admission is sufficient in the absence of complications during ESD or early postoperative bleeding.展开更多
1 Introduction Early detection and diagnosis of stable coronary artery disease （SCAD） is essential for proactive secondary prevention of myocardial infarction （MI）, control of disease progress, and reduction of mo...1 Introduction Early detection and diagnosis of stable coronary artery disease （SCAD） is essential for proactive secondary prevention of myocardial infarction （MI）, control of disease progress, and reduction of mortality. Clinical decision-making in modem medicine is increasingly dependent on cardiovascular imaging techniques. 2012 ACCF/AHA/ACP/AATS/ PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease has been issued by American Heart Association （AHA）. European Society of Cardiology （ESC） has issued 2013 ESC guidelines on the management of stable coronary artery disease.展开更多
Objective:Functional constipation(FC)is a common intestinal disease worldwide.Despite the presence of criteria such as Roman IV,there is no standardized diagnosis and treatment algorithm in Hong Kong that combines bot...Objective:Functional constipation(FC)is a common intestinal disease worldwide.Despite the presence of criteria such as Roman IV,there is no standardized diagnosis and treatment algorithm in Hong Kong that combines both Western and Chinese medicine approaches.This study integrates current effective and safe diagnosis and treatment methods for FC and provides a clear and scientific pathway for clinical professionals and patients.Methods:A systematic search of the PubMed,Cochrane Library,and China National Knowledge Infrastructure databases was performed from their inception to June 30th,2022,collecting the current evidence about the efficacious integrative management for FC.We organized a meeting of professionals in fields relevant to treatment and management of FC to develop a consensus agreement on clinical pathway process.Results:We developed a clinical pathway for the treatment of FC based on the most recent published guidelines and consultation with experts.This pathway includes a hierarchy of recommendations for every step of the clinical process,including clinical intake,diagnostic examination,recommended labs,diagnostic flowchart,and guidance for selection of therapeutic drugs.Conclusion:This pathway establishes clinical standards for the diagnosis and treatment of FC using Chinese medicine and Western medicine;it will help to provide high-quality medical services in Hong Kong for patients with FC.展开更多
BACKGROUND Over the past decades,clinical pathways(CPs)for hip and knee arthroplasty have been strongly and continuously evolved based on scientific evidence and innovation.AIM The present systematic review,including ...BACKGROUND Over the past decades,clinical pathways(CPs)for hip and knee arthroplasty have been strongly and continuously evolved based on scientific evidence and innovation.AIM The present systematic review,including meta-analysis,aimed to compare the safety and efficacy of enhanced recovery pathways(ERP)with regular pathways for patients with hip and/or knee arthroplasty.METHODS A literature search in healthcare databases(Embase,PubMed,Cochrane Library,CINAHL,and Web of Science)was conducted from inception up to June 2018.Relevant randomized controlled trials as well as observational studies comparing ERP,based on novel evidence,with regular or standard pathways,prescribing care as usual for hip and/or knee arthroplasty,were included.The effect of both CPs was assessed for(serious)adverse events[(S)AEs],readmission rate,length of hospital stay(LoS),clinician-derived clinical outcomes,patient reported outcome measures(PROMs),and financial benefits.If possible,a meta-analysis was performed.In case of considerable heterogeneity among studies,a qualitative analysis was performed.RESULTS Forty studies were eligible for data extraction,34 in meta-analysis and 40 in qualitative analysis.The total sample size consisted of more than 2 million patients undergoing hip or knee arthroplasty,with a mean age of 66 years and with 60%of females.The methodological quality of the included studies ranged from average to good.The ERP had lower(S)AEs[relative risk(RR):0.9,95%confidence interval(CI):0.8-1]and readmission rates(RR:0.8,95%CI:0.7-1),and reduced LoS[median days 6.5(0.3-9.5)],and showed similar or improved outcomes for functional recovery and PROMs compared to regular pathways.The analyses for readmission presented a statistically significant difference in the enhanced recovery pathway in favor of knee arthroplasties(P=0.01).ERP were reported to be cost effective,and the cost reduction varied largely between studies(€109 and$20573).The overall outcomes of all studies reported using Grading of Recommendation,Assessment,Development and Evaluation,presented moderate or high quality of evidence.CONCLUSION This study showed that implementation of ERP resulted in improved clinical and patient related outcomes compared to regular pathways in hip and knee arthroplasty,with a potential reduction of costs.展开更多
Clinical pathway (CP) is a medical management tool made by a group of medical specialists and specialized for certain diseases. It has been proved that CP was an efficient way to optimize the hospitalization managemen...Clinical pathway (CP) is a medical management tool made by a group of medical specialists and specialized for certain diseases. It has been proved that CP was an efficient way to optimize the hospitalization management and control medical cost. In this paper, we focused on the effect of CP in the patients with acute complicated appendicitis via total duration of hospitalization, hospitalization time before operation, total cost of hospitalization and drug expenditure. From March 2014 to March 2015, the patients with conditions of appendicitis in Three Gorges Central Hospital of Wanzhou, Chongqing, were divided into CP group and non path control group to analyze the effect of the application of CP. Our data showed that there were no significant differences between two groups of patients in total duration of hospitalization, hospitalization time before operation, total cost of hospitalization and drug expenditure. The implementation of CP neither decreased the time of patients in hospital nor the total hospitalization cost. Besides, application of CP for acute appendicitis patients should distinguish between simple appendicitis and complicated appendicitis, simple appendectomy patients implement CP is beneficial, and patients with complicated appendicitis did not come from the benefit.展开更多
Objective:To study the clinical effect of applying clinical pathway teaching method in clinica1 teaching of cardiology.Methods:This paper verifies and calculates that 50 interns working in cardiology department in our...Objective:To study the clinical effect of applying clinical pathway teaching method in clinica1 teaching of cardiology.Methods:This paper verifies and calculates that 50 interns working in cardiology department in our hospita1 from October 2016 to October 2019 are divided into groups and comparea in the form of double-blind method.1he rererence group(n=25)uses traditional teachingmethods,and the experimental group(n=25)uses clinical pathway teaching method.The satisfaction degree,teaching quality,theoretical assessment results,operation assessment and comprehensive assessment results of interns in the experimental group and the reference group are compared.Results:The satisfaction degree,theoretical examination result,operation examinationt comprehensive examination result,improvement of team spirit,professiona1 quality,improvemen of professional ethics,standardized diagnosis and treatment,improvement of clinical problem handling ability,stimulation of learning interest and cultivation of clinical thinking of the interns in the experimental group were compared with those of the reference group(P<0.05),showing the value of statistica1 comparison and demonstration between data indexes.Conclusion:The application of clinical path-teaching method in clinical teaching of cardiology can improve the clinical teaching effect and teaching quality.展开更多
Objective:To explore the safety and effectiveness nursing of 12 h discharged daytime laparoscopic cholecystectomy guided by enhanced recovery after surgery(ERAS)concept.Methods:Included 180 cases from the 12 h dischar...Objective:To explore the safety and effectiveness nursing of 12 h discharged daytime laparoscopic cholecystectomy guided by enhanced recovery after surgery(ERAS)concept.Methods:Included 180 cases from the 12 h discharged daytime laparoscopic cholecystectomy patients which assessmended and guided by ERAS,with the 180 case of routine cholecystectomy patients as control group at the same time.To quantitatively analyze the related indexes of perioperative period and ERAS concept,and evaluate the clinical safety,and effectiveness.Results:It displayed no significant differences in average age,gender distribution,duration of gallbladder related disease and distribution of clinical symptoms between the two groups(P>0.05).There were also no significant differences in preoperative smoking history,hypertension history,cardio-cerebrovascular history,abdominal operation history and disease composition ratio between the two groups(P>0.05).None of the patients had conversion to laparotomy.Compared with the conventional surgery group,there were no significant differences in the average amount of intraoperative blood loss,operation time and muscle strength before returning to the ward in patients with ERAS guided day surgery(P>0.05).When compared with the conventional surgery group,ERAS guided day surgery group had no significant difference in muscle strength between the two groups when going under the ground(t=1.64,P=0.082).Also,the level of peripheral white blood cells in patients with ERAS guided day surgery group was not significantly increased at 6 h after surgery.Meanwhile,liver function related indexes,transaminase,total bilirubin,indirect bilirubin were not significantly abnormal(P>0.05).Conclusion:12 h daytime laparoscopic cholecystectomy guided by ERAS concept can improve the clinical efficacy of patients with cholecystolithiasis,which is safe and feasible.展开更多
Background:To investigate and analyze the hospitalization costs of inpatients with primary acute angle closure glaucoma(PACG),and to explores the influencing factors of hospitalization cost and to provide reference fo...Background:To investigate and analyze the hospitalization costs of inpatients with primary acute angle closure glaucoma(PACG),and to explores the influencing factors of hospitalization cost and to provide reference for specialized hospitals to carry out clinical pathways.Methods:The first page diagnostic data of PACG patients’medical records were collected,and an Excel database was established according to the International Classification of Diseases(ICD-10)code.Statistical analysis of hospitalization data was performed using SPSS 17.0 software.Results:Hospitalization days and clinical pathway which affect the change of the hospitalization cost(P<0.001).Conclusions:Hospitalization day is an important factor affecting the hospitalization cost,reducing unnecessary hospitalization time can control the increase of hospitalization cost.展开更多
Background Nursing internship is the terminal course in nursing education. However, the long-standing nursing teaching evolves with obvious disadvantages： boring methods, lack of live Demo and unstandardized contents...Background Nursing internship is the terminal course in nursing education. However, the long-standing nursing teaching evolves with obvious disadvantages： boring methods, lack of live Demo and unstandardized contents. Therefore, a novel method is urgently in need. Methods In this study, a total of 74 nursing interns rotating in Cardiac Surgery ward of Large Vessel, Cardiac Surgery Department, were included. Of them, 37 included from July 2016 to March 2017 were distributed to the control group trained by the traditional method; while the rest 37 included from July 2017 to March 2018 were distributed to the study group receiving a novel teaching method characteristic of using clinical pathway and drawing. Baseline characteristics such as gender, age, graduation school were matched. Both groups had an internship for 4 weeks and each subject was taught by experienced instructors like nurse practitioner or nurse-in-charge. Comprehensive assessment,including growth assessment of specialty knowledge and examinations of both theory and operation,were applied both in the beginning and by the end of the internship. Results In the growth assessment of specialty knowledge, the study group performed significantly better than the control group in both total score and sub-section score（specialty pharmacy and specialty operation）. In the final examination, the study group had a higher score in specialty operation than the control group, which was statistically significant. Conclusions Application of clinical pathway combined with drawing method significantly improves the quality of cardiac surgery nursing teaching.展开更多
Objective: to explore the specific application effect of clinical pathway teaching method in clinical teaching of endocrinology department, improve the clinical teaching mode of endocrinology department, improve the c...Objective: to explore the specific application effect of clinical pathway teaching method in clinical teaching of endocrinology department, improve the clinical teaching mode of endocrinology department, improve the clinical teaching effect, cultivate a large number of high-quality clinical medical talents of endocrinology department, and make contributions to the development of endocrinology nursing industry in China. Methods: from June 2018 to June 2021, a total of 86 interns who practiced in the department of endocrinology in our hospital were taken as observation objects, and 86 interns were divided into two groups with the same number. The interns who received routine clinical teaching methods were divided into the control group, and the interns who received clinical pathway teaching methods were divided into the observation group. During clinical teaching in the department of endocrinology, the theoretical knowledge and professional skills of interns were regularly examined. The clinical level of the two groups of interns was compared, and the satisfaction of the two groups of interns to the teaching teachers was investigated by questionnaire. Then, the clinical teaching mode and method of endocrinology department were innovated and optimized to improve the professional level of clinical interns and the clinical teaching level of medical teachers. Results: by comparing the theoretical knowledge, case handling ability and basic operation of the two groups of interns at different stages, it can be seen that the clinical interns in endocrinology department who received clinical pathway teaching method have more solid theoretical knowledge, and their case handling ability and basic operation skills have been obviously improved, which is higher than that of the control group interns who received routine teaching. From the results of the questionnaire survey, it can be seen that the scores of the interns in the observation group to the teachers in the control group are much higher, and the satisfaction of the teachers in the observation group to the interns in the observation group is higher than that in the control group. The satisfaction score of interns in the observation group was higher than that in the control group. Conclusion: there is a huge talent gap in endocrinology department. In order to improve the medical and nursing quality of endocrinology department, it is necessary to speed up the training of interns. The clinical teaching method can effectively improve the professional level of medical interns in endocrinology department, and the clinical pathway teaching method can promote the balanced improvement of theoretical knowledge and professional skills of interns, strengthen the interns' case handling ability and basic operation skills, and effectively meet the demand of medical talents in endocrinology department of hospitals. It is suggested that clinical pathway teaching method should be used reasonably in future clinical teaching.展开更多
Objective: to explore the application value of clinical pathway combined with case introduction teaching method in clinical teaching of neurology. Methods: 24 medical students in neurology department of our hospital w...Objective: to explore the application value of clinical pathway combined with case introduction teaching method in clinical teaching of neurology. Methods: 24 medical students in neurology department of our hospital were studied. During the clinical training period from March 2020 to March 2021, the students were randomly divided into two groups, 12 cases in each group. The control group was the traditional teaching mode. The observation group chose the clinical route combined with case teaching to observe the students' theoretical knowledge, clinical practice and operation assessment scores, as well as the teaching satisfaction of the medical students. Results: the scores of theoretical knowledge and practical evaluation of the medical students in the observation group were (89.55±2.26) and (92.36±1.75) respectively, while the scores of theoretical knowledge and practical operation of the medical students in the control group were (80.66±2.23) and (85.16±1.46) respectively. The scores of the medical students in the observation group were significantly higher than those in the control group, with differences in scores (P < 0.05). The satisfactory rate of clinical teaching in the observation group was 100%, and that in the control group was 75%, with statistical significance (P < 0.05). Conclusion: the application effect of clinical pathway combined with case introduction teaching method in clinical teaching of neurology department is more obvious. Compared with the traditional teaching mode, the clinical pathway combined with case introduction teaching method has more advantages, can stimulate the interest of medical students, improve their own theoretical assessment results and clinical practice assessment results, improve the satisfaction of teaching, and has good promotional significance.展开更多
Objective: to analyze the clinical effect of clinical nursing pathway applied in tension-free repair of indirect inguinal hernia during perioperative period. Methods: 68 patients with indirect inguinal hernia were sel...Objective: to analyze the clinical effect of clinical nursing pathway applied in tension-free repair of indirect inguinal hernia during perioperative period. Methods: 68 patients with indirect inguinal hernia were selected from November 2020 to November 2021. All the patients were treated with tension-free hernia repair. The 68 patients were randomly divided into the control group (34 cases, perioperative routine care) and the observation group (34 cases, perioperative clinical care path). The rehabilitation progress, pain occurrence probability, total treatment cost, complications, total hospitalization time and nursing satisfaction of the patients after the operation were compared between the two groups after different nursing methods were implemented. Results: in terms of drug cost, hospitalization time and hospitalization expenses, the observation group was lower/shorter than the control group (P < 0.05). In terms of the occurrence of complications, the complication rate of the observation group was calculated to be 5.88%, and that of the control group was calculated to be 23.53%, P < 0.05;The incidence of postoperative pain was 52.94% in the observation group and 76.47% in the control group (P < 0.05). The time of anal exhaust, defecation and ambulation in the observation group was shorter than that in the control group (P < 0.05). In the aspect of nursing satisfaction, the satisfaction rate of the observation group was 100.00%, while that of the control group was 88.24%, P < 0.05. Conclusion: tension-free hernioplasty for patients with indirect inguinal hernia, and the application of clinical nursing pathway to carry out nursing work during the perioperative period of these patients, can enable these patients to recover more quickly after operation, avoid too many complications, reduce their treatment costs, relieve postoperative pain, and is conducive to improving the satisfaction of nursing service.展开更多
基金supported by a grant from the National Key Technology ResearchDevelopment Program of China(2008BAH27B06)
文摘BACKGROUND： Laparoscopic cholecystectomy（LC） is one of the most frequent abdominal surgical procedures. The present meta-analysis aimed to estimate the clinical effects of implementing a clinical pathway for LC compared with standard medical care by evaluating the length of hospital stay,costs, and the outcomes of patients undergoing LC.DATA SOURCES： Data were extracted from the following databases： PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Chinese Medical Citation Index（CMCI）,Chinese Medical Current Contents（CMCC）, and China BioMedical Literature Database（CBM）. We also searched the reference lists of the relevant articles and conference articles.Only randomized controlled trials and controlled clinical trials published from 1980 to 2013 were included. We did not set restrictions on language and country of publications. All of the data were evaluated and analyzed by two reviewers independently with RevMan software（version 5.0）.RESULTS： A total of 7 trials with 1187 patients were included.The patients who underwent LC with clinical pathway had shorter hospital stay [weighted mean difference=-1.90, 95%CI：-2.65 to-1.16, P〈0.00001], lower cost [standard mean difference=-0.69, 95% CI：-0.82 to-0.56, P〈0.00001], and better questionnaires based satisfaction with the medical services.CONCLUSIONS： The applications of the clinical pathway for LC effectively reduced hospital stay and total costs. However,there was insufficient evidence for proving the differences in postoperative complications. Future research should focus on patient outcomes and identify the mechanisms underlying the effect of the clinical pathway.
基金approved by the National Medical Center Institutional Review Board(approval No.NRC-2023-10-109).
文摘BACKGROUND Clinical pathways(CPs)are structured guidelines introduced to improve healthcare quality and efficiency.In South Korea,CPs for Korean medicine have been developed since 2016 under the 3rd Comprehensive Plan for Korean Medicine Promotion,with limited studies on their clinical application.Neck and shoulder pain are common conditions frequently treated at Korean medicine clinics,often by patients dissatisfied with conventional treatments.The demand for Korean medicine treatments for neck and shoulder pain is on the rise.AIM To evaluate the clinical applicability and effectiveness of Korean medicine CPs for neck pain and shoulder pain in public healthcare institutions in South Korea.METHODS We collected and analyzed data from patients aged 19 years and older who visited the outpatient clinic of the Department of Korean Medicine at the National Medical Center in Korea from March 1,2023 to August 31,2023.CP completion rates,along with patient satisfaction,clinical outcomes,and economic outcomes between the CP-implemented and non-CP groups were assessed.RESULTS The CP completion rates were 93.3%for neck pain and 96.8%for shoulder pain.Patient satisfaction scores showed an improvement of 17.7%for neck pain and 18.0%for shoulder pain in the CP-implemented group compared to the non-CP group.For neck pain,significant improvements were observed in the numerical rating scale(NRS)and the neck disability index,while for shoulder pain,only the University of California-Los Angeles shoulder rating scale showed notable progress,with no substantial change in NRS scores.CONCLUSION This study partially confirms the clinical applicability and effectiveness of the Korean medicine CPs for neck pain and shoulder pain.Further research is required to enhance and validate these findings.
基金Guangdong Medical Science and Technology Research Fund,Research on the Construction of a Clinical Path Discrimination Model for Stroke Patients Based on the XGBoost Integrated Learning Algorithm and Its Application in MOP under the DIP Payment Model,(Project No.:B2023177)Guangdong Health Economics Association,Research on the Prediction of Hospitalization Costs of Stroke Patients under the DRG/DIP Reform Based on Machine Learning Algorithms,(Project No.:2022-WJMF-13)。
文摘Objective:Aiming at the problems of clinical pathway optimization and medical cost control for stroke patients,this study proposes a clinical pathway discrimination model based on the XGBoost integrated learning algorithm.Combined with the multi-objective programming(MOP)method,this study explores its application value under the Diagnosis-Intervention Packet(DIP)payment model.Methods:The data of stroke patients(ICD codes I60-I63)from 2018 to 2024 were obtained through the medical record statistical management system of medical institutions in Guangdong Province.Efficiency indicators(average length of hospital stay),health economics indicators(total cost),effectiveness indicators(mortality rate),and specific indicators(NIHSS score)were extracted.The XGBoost algorithm was used to construct the clinical pathway discrimination model,and the hyperparameters were optimized through grid search.Based on the DIP payment rules,the prediction results of the model were used as inputs to establish a dynamic programming model,aiming to minimize costs and maximize curative effects to obtain the optimal clinical pathway plan.Results:The goodness-of-fit(R 2)of the XGBoost model on the test set reached 0.768,which was significantly better than that of the random forest(0.691)and the BP neural network(0.343).The total cost of the clinical pathway optimized by the dynamic programming model decreased by 12.7%(95%CI:10.2-15.1%),the average length of hospital stay was shortened by 1.8 days,and the NIHSS improvement rate increased by 8.3%.Conclusion:The integrated model proposed in this study has high accuracy and robustness in clinical pathway discrimination.Combined with the MOP method,it can provide a scientific basis for the optimization of medical resources under the DIP model,helping medical institutions achieve the dual goals of precise cost control and curative effect improvement.
文摘Objective:To observe the intervention effect of clinical nursing pathway on patients receiving intravenous therapy via peripheral mid-long catheters.Methods:Ninety patients receiving intravenous therapy via mid-long catheters in the hospital from March 2024 to March 2025 were selected and randomly divided into a control group and an observation group,with 45 patients in each group.The control group received routine nursing intervention,while the observation group received clinical nursing pathway intervention.The nursing risk events,catheter indwelling time,and nursing satisfaction were evaluated in both groups.Results:The observation group had a shorter catheter indwelling time,fewer risk events during intravenous therapy(total incidence rate of 2.22%),and higher nursing satisfaction.Additionally,negative emotional feedback was reduced,and the SAS score(31.02±1.12)was lower in the observation group compared to the control group.There were significant differences between the two groups in all indicators(P<0.05).Conclusion:Applying the clinical nursing pathway during intravenous therapy via peripheral mid-long catheters can help ensure infusion safety,improve unstable emotional states,and promote high-quality service standards.
文摘Objective:This study investigates the effect of orthopedic nursing in patients with ankle fractures.Methods:A total of 84 patients with ankle fractures treated in our hospital from September 2022 to September 2023 were selected and randomly divided into a control group and an observation group using a random number table,with 42 cases in each group.The control group received routine nursing,while the observation group received orthopedic nursing clinical pathway on the basis of traditional nursing.We analyzed and scored the nursing satisfaction and nursing effect of the two groups.Results:Compared with the control group,the observation group had a higher total nursing satisfaction rate,shorter time to get out of bed,shorter hospital stay,and lower hospitalization cost.The Barid score and AOFAS score of the observation group were higher than those of the control group,while the NRS score was lower.Conclusion:The application of orthopedic nursing clinical pathway in patients with ankle fractures significantly improves their quality of life,promotes better recovery of ankle function,and shortens the rehabilitation time.
文摘Objective: To evaluate the effect of endoscopic high-frequency electrocoagulation electrodesiccation (HFEE) of intestinal polyps in the clinical nursing pathway. Method: A total of 120 patients who underwent HFEE of intestinal polyps were randomly divided into two groups of 60 cases. The control group received conventional nursing care while the observation group received the clinical nursing pathway of HFEE. Results: The average length of hospitalization, hospitalization costs, and mastery of the three health education of the observation group was lower than that of the control group (P < 0.01). The satisfaction of care in the observation group was significantly better than the control group (P <0.01). Conclusion: The clinical care path was suitable for HFEE of intestinal polyps, which shortened the patient’s length of hospitalization, improved their awareness of health education, improved their satisfaction with care, reduced medical disputes, and promoted the good development of nurse-patient relationships .
文摘To study on the effect of clinical pathway （CP） on controlling pharmaceutical costs, we selected complex, chronic, non-communicable diseases, including cerebral infarction, cerebral hemorrhage, transient ischemic attack, and chronic obstructive pulmonary disease, as diseases to implement clinical pathways at a tertiary hospital in Qingdao. We then conducted intermittent time series analysis on pharmaceutical costs. After the implementation of clinical pathway, overall pharmaceutical costs of patients with transient ischemic attack reduced significantly. The effect was not significant for cerebral hemorrhage patients. The implementation of clinical pathway has a desirable outcome on controlling pharmaceutical costs.
文摘For patients receiving chemotherapy, drugs represent the largest cost. Clinical chemotherapy Pathways have become a critical strategy to identify unnecessary drug costs and to implement mechanisms to deliver lower cost alternatives without sacrificing outcomes or quality of care. This paper describes the steps of development of a functioning pathways program beginning in an environment of full-risk capitation, including drugs. The next steps involved quantitating the potential impact of such a program and then collaborating with a payer to test the concept. When these studies showed promise, the practices adopting pathways used them as a backbone for drug management in the Oncology Care Model. These experiences very likely represent steps in a continuum towards placing more of the drug delivery costs at risk. The potential for again considering capitated payments is discussed.
基金Supported by Grant-in-Aid for Cancer Research, No. 18S-2 from the Japanese Ministry of Health, Labor and Welfare to Saito Y
文摘AIM: To determine the effective hospitalization period as the clinical pathway to prepare patients for endoscopic submucosal dissection (ESD). METHODS: This is a retrospective observational study which included 189 patients consecutively treated by ESD at the National Cancer Center Hospital from May 2007 to March 2009. Patients were divided into 2 groups; patients in group A were discharged in 5 d and patients in group B included those who stayed longer than 5 d. The following data were collected for both groups: mean hospitalization period, tumor site, median tumor size, post-ESD rectal bleeding requiring urgent endoscopy, perforation during or after ESD, abdominal pain, fever above 38 ℃, and blood test results positive for inflammatory markers before and after ESD. Each parameter was compared after data collection. RESULTS: A total of 83% (156/189) of all patients could be discharged from the hospital on day 3 postESD. Complications were observed in 12.1% (23/189) of patients. Perforation occurred in 3.7% (7/189) of patients. All the perforations occurred during the ESD procedure and they were managed with endoscopic clipping. The incidence of post-operative bleeding was 2.6% (5/189); all the cases involved rectal bleeding. We divided the subjects into 2 groups: tumor diameter ≥ 4 cm and < 4 cm; there was no significant difference between the 2 groups (P = 0.93, χ 2 test with Yates correction). The incidence of abdominal pain was 3.7% (7/189). All the cases occurred on the day of the procedure or the next day. The median white blood cell count was 6800 ± 2280 (cells/μL; ± SD) for group A, and 7700 ± 2775 (cells/μL; ± SD) for group B, showing a statistically significant difference (P = 0.023, t-test). The mean C-reactive protein values the day after ESD were 0.4 ± 1.3 mg/dL and 0.5 ± 1.3 mg/dL for groups A and B, respectively, with no significant difference between the 2 groups (P = 0.54, t -test). CONCLUSION: One-day admission is sufficient in the absence of complications during ESD or early postoperative bleeding.
文摘1 Introduction Early detection and diagnosis of stable coronary artery disease （SCAD） is essential for proactive secondary prevention of myocardial infarction （MI）, control of disease progress, and reduction of mortality. Clinical decision-making in modem medicine is increasingly dependent on cardiovascular imaging techniques. 2012 ACCF/AHA/ACP/AATS/ PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease has been issued by American Heart Association （AHA）. European Society of Cardiology （ESC） has issued 2013 ESC guidelines on the management of stable coronary artery disease.
基金supported by the Strategic Development Fund of Hong Kong Baptist University (Ref No.20–0318-P01)Chinese Medicine Development Fund (No.19B2/057A)
文摘Objective:Functional constipation(FC)is a common intestinal disease worldwide.Despite the presence of criteria such as Roman IV,there is no standardized diagnosis and treatment algorithm in Hong Kong that combines both Western and Chinese medicine approaches.This study integrates current effective and safe diagnosis and treatment methods for FC and provides a clear and scientific pathway for clinical professionals and patients.Methods:A systematic search of the PubMed,Cochrane Library,and China National Knowledge Infrastructure databases was performed from their inception to June 30th,2022,collecting the current evidence about the efficacious integrative management for FC.We organized a meeting of professionals in fields relevant to treatment and management of FC to develop a consensus agreement on clinical pathway process.Results:We developed a clinical pathway for the treatment of FC based on the most recent published guidelines and consultation with experts.This pathway includes a hierarchy of recommendations for every step of the clinical process,including clinical intake,diagnostic examination,recommended labs,diagnostic flowchart,and guidance for selection of therapeutic drugs.Conclusion:This pathway establishes clinical standards for the diagnosis and treatment of FC using Chinese medicine and Western medicine;it will help to provide high-quality medical services in Hong Kong for patients with FC.
文摘BACKGROUND Over the past decades,clinical pathways(CPs)for hip and knee arthroplasty have been strongly and continuously evolved based on scientific evidence and innovation.AIM The present systematic review,including meta-analysis,aimed to compare the safety and efficacy of enhanced recovery pathways(ERP)with regular pathways for patients with hip and/or knee arthroplasty.METHODS A literature search in healthcare databases(Embase,PubMed,Cochrane Library,CINAHL,and Web of Science)was conducted from inception up to June 2018.Relevant randomized controlled trials as well as observational studies comparing ERP,based on novel evidence,with regular or standard pathways,prescribing care as usual for hip and/or knee arthroplasty,were included.The effect of both CPs was assessed for(serious)adverse events[(S)AEs],readmission rate,length of hospital stay(LoS),clinician-derived clinical outcomes,patient reported outcome measures(PROMs),and financial benefits.If possible,a meta-analysis was performed.In case of considerable heterogeneity among studies,a qualitative analysis was performed.RESULTS Forty studies were eligible for data extraction,34 in meta-analysis and 40 in qualitative analysis.The total sample size consisted of more than 2 million patients undergoing hip or knee arthroplasty,with a mean age of 66 years and with 60%of females.The methodological quality of the included studies ranged from average to good.The ERP had lower(S)AEs[relative risk(RR):0.9,95%confidence interval(CI):0.8-1]and readmission rates(RR:0.8,95%CI:0.7-1),and reduced LoS[median days 6.5(0.3-9.5)],and showed similar or improved outcomes for functional recovery and PROMs compared to regular pathways.The analyses for readmission presented a statistically significant difference in the enhanced recovery pathway in favor of knee arthroplasties(P=0.01).ERP were reported to be cost effective,and the cost reduction varied largely between studies(€109 and$20573).The overall outcomes of all studies reported using Grading of Recommendation,Assessment,Development and Evaluation,presented moderate or high quality of evidence.CONCLUSION This study showed that implementation of ERP resulted in improved clinical and patient related outcomes compared to regular pathways in hip and knee arthroplasty,with a potential reduction of costs.
文摘Clinical pathway (CP) is a medical management tool made by a group of medical specialists and specialized for certain diseases. It has been proved that CP was an efficient way to optimize the hospitalization management and control medical cost. In this paper, we focused on the effect of CP in the patients with acute complicated appendicitis via total duration of hospitalization, hospitalization time before operation, total cost of hospitalization and drug expenditure. From March 2014 to March 2015, the patients with conditions of appendicitis in Three Gorges Central Hospital of Wanzhou, Chongqing, were divided into CP group and non path control group to analyze the effect of the application of CP. Our data showed that there were no significant differences between two groups of patients in total duration of hospitalization, hospitalization time before operation, total cost of hospitalization and drug expenditure. The implementation of CP neither decreased the time of patients in hospital nor the total hospitalization cost. Besides, application of CP for acute appendicitis patients should distinguish between simple appendicitis and complicated appendicitis, simple appendectomy patients implement CP is beneficial, and patients with complicated appendicitis did not come from the benefit.
文摘Objective:To study the clinical effect of applying clinical pathway teaching method in clinica1 teaching of cardiology.Methods:This paper verifies and calculates that 50 interns working in cardiology department in our hospita1 from October 2016 to October 2019 are divided into groups and comparea in the form of double-blind method.1he rererence group(n=25)uses traditional teachingmethods,and the experimental group(n=25)uses clinical pathway teaching method.The satisfaction degree,teaching quality,theoretical assessment results,operation assessment and comprehensive assessment results of interns in the experimental group and the reference group are compared.Results:The satisfaction degree,theoretical examination result,operation examinationt comprehensive examination result,improvement of team spirit,professiona1 quality,improvemen of professional ethics,standardized diagnosis and treatment,improvement of clinical problem handling ability,stimulation of learning interest and cultivation of clinical thinking of the interns in the experimental group were compared with those of the reference group(P<0.05),showing the value of statistica1 comparison and demonstration between data indexes.Conclusion:The application of clinical path-teaching method in clinical teaching of cardiology can improve the clinical teaching effect and teaching quality.
基金Research and Application of Clinical Diagnosis and Treatment Technology in Capital(Z211100002921025)。
文摘Objective:To explore the safety and effectiveness nursing of 12 h discharged daytime laparoscopic cholecystectomy guided by enhanced recovery after surgery(ERAS)concept.Methods:Included 180 cases from the 12 h discharged daytime laparoscopic cholecystectomy patients which assessmended and guided by ERAS,with the 180 case of routine cholecystectomy patients as control group at the same time.To quantitatively analyze the related indexes of perioperative period and ERAS concept,and evaluate the clinical safety,and effectiveness.Results:It displayed no significant differences in average age,gender distribution,duration of gallbladder related disease and distribution of clinical symptoms between the two groups(P>0.05).There were also no significant differences in preoperative smoking history,hypertension history,cardio-cerebrovascular history,abdominal operation history and disease composition ratio between the two groups(P>0.05).None of the patients had conversion to laparotomy.Compared with the conventional surgery group,there were no significant differences in the average amount of intraoperative blood loss,operation time and muscle strength before returning to the ward in patients with ERAS guided day surgery(P>0.05).When compared with the conventional surgery group,ERAS guided day surgery group had no significant difference in muscle strength between the two groups when going under the ground(t=1.64,P=0.082).Also,the level of peripheral white blood cells in patients with ERAS guided day surgery group was not significantly increased at 6 h after surgery.Meanwhile,liver function related indexes,transaminase,total bilirubin,indirect bilirubin were not significantly abnormal(P>0.05).Conclusion:12 h daytime laparoscopic cholecystectomy guided by ERAS concept can improve the clinical efficacy of patients with cholecystolithiasis,which is safe and feasible.
基金Guangdong Editorial Society of Science and Technology Periodicals fund project funding(No.201820).
文摘Background:To investigate and analyze the hospitalization costs of inpatients with primary acute angle closure glaucoma(PACG),and to explores the influencing factors of hospitalization cost and to provide reference for specialized hospitals to carry out clinical pathways.Methods:The first page diagnostic data of PACG patients’medical records were collected,and an Excel database was established according to the International Classification of Diseases(ICD-10)code.Statistical analysis of hospitalization data was performed using SPSS 17.0 software.Results:Hospitalization days and clinical pathway which affect the change of the hospitalization cost(P<0.001).Conclusions:Hospitalization day is an important factor affecting the hospitalization cost,reducing unnecessary hospitalization time can control the increase of hospitalization cost.
文摘Background Nursing internship is the terminal course in nursing education. However, the long-standing nursing teaching evolves with obvious disadvantages： boring methods, lack of live Demo and unstandardized contents. Therefore, a novel method is urgently in need. Methods In this study, a total of 74 nursing interns rotating in Cardiac Surgery ward of Large Vessel, Cardiac Surgery Department, were included. Of them, 37 included from July 2016 to March 2017 were distributed to the control group trained by the traditional method; while the rest 37 included from July 2017 to March 2018 were distributed to the study group receiving a novel teaching method characteristic of using clinical pathway and drawing. Baseline characteristics such as gender, age, graduation school were matched. Both groups had an internship for 4 weeks and each subject was taught by experienced instructors like nurse practitioner or nurse-in-charge. Comprehensive assessment,including growth assessment of specialty knowledge and examinations of both theory and operation,were applied both in the beginning and by the end of the internship. Results In the growth assessment of specialty knowledge, the study group performed significantly better than the control group in both total score and sub-section score（specialty pharmacy and specialty operation）. In the final examination, the study group had a higher score in specialty operation than the control group, which was statistically significant. Conclusions Application of clinical pathway combined with drawing method significantly improves the quality of cardiac surgery nursing teaching.
文摘Objective: to explore the specific application effect of clinical pathway teaching method in clinical teaching of endocrinology department, improve the clinical teaching mode of endocrinology department, improve the clinical teaching effect, cultivate a large number of high-quality clinical medical talents of endocrinology department, and make contributions to the development of endocrinology nursing industry in China. Methods: from June 2018 to June 2021, a total of 86 interns who practiced in the department of endocrinology in our hospital were taken as observation objects, and 86 interns were divided into two groups with the same number. The interns who received routine clinical teaching methods were divided into the control group, and the interns who received clinical pathway teaching methods were divided into the observation group. During clinical teaching in the department of endocrinology, the theoretical knowledge and professional skills of interns were regularly examined. The clinical level of the two groups of interns was compared, and the satisfaction of the two groups of interns to the teaching teachers was investigated by questionnaire. Then, the clinical teaching mode and method of endocrinology department were innovated and optimized to improve the professional level of clinical interns and the clinical teaching level of medical teachers. Results: by comparing the theoretical knowledge, case handling ability and basic operation of the two groups of interns at different stages, it can be seen that the clinical interns in endocrinology department who received clinical pathway teaching method have more solid theoretical knowledge, and their case handling ability and basic operation skills have been obviously improved, which is higher than that of the control group interns who received routine teaching. From the results of the questionnaire survey, it can be seen that the scores of the interns in the observation group to the teachers in the control group are much higher, and the satisfaction of the teachers in the observation group to the interns in the observation group is higher than that in the control group. The satisfaction score of interns in the observation group was higher than that in the control group. Conclusion: there is a huge talent gap in endocrinology department. In order to improve the medical and nursing quality of endocrinology department, it is necessary to speed up the training of interns. The clinical teaching method can effectively improve the professional level of medical interns in endocrinology department, and the clinical pathway teaching method can promote the balanced improvement of theoretical knowledge and professional skills of interns, strengthen the interns' case handling ability and basic operation skills, and effectively meet the demand of medical talents in endocrinology department of hospitals. It is suggested that clinical pathway teaching method should be used reasonably in future clinical teaching.
文摘Objective: to explore the application value of clinical pathway combined with case introduction teaching method in clinical teaching of neurology. Methods: 24 medical students in neurology department of our hospital were studied. During the clinical training period from March 2020 to March 2021, the students were randomly divided into two groups, 12 cases in each group. The control group was the traditional teaching mode. The observation group chose the clinical route combined with case teaching to observe the students' theoretical knowledge, clinical practice and operation assessment scores, as well as the teaching satisfaction of the medical students. Results: the scores of theoretical knowledge and practical evaluation of the medical students in the observation group were (89.55±2.26) and (92.36±1.75) respectively, while the scores of theoretical knowledge and practical operation of the medical students in the control group were (80.66±2.23) and (85.16±1.46) respectively. The scores of the medical students in the observation group were significantly higher than those in the control group, with differences in scores (P < 0.05). The satisfactory rate of clinical teaching in the observation group was 100%, and that in the control group was 75%, with statistical significance (P < 0.05). Conclusion: the application effect of clinical pathway combined with case introduction teaching method in clinical teaching of neurology department is more obvious. Compared with the traditional teaching mode, the clinical pathway combined with case introduction teaching method has more advantages, can stimulate the interest of medical students, improve their own theoretical assessment results and clinical practice assessment results, improve the satisfaction of teaching, and has good promotional significance.
文摘Objective: to analyze the clinical effect of clinical nursing pathway applied in tension-free repair of indirect inguinal hernia during perioperative period. Methods: 68 patients with indirect inguinal hernia were selected from November 2020 to November 2021. All the patients were treated with tension-free hernia repair. The 68 patients were randomly divided into the control group (34 cases, perioperative routine care) and the observation group (34 cases, perioperative clinical care path). The rehabilitation progress, pain occurrence probability, total treatment cost, complications, total hospitalization time and nursing satisfaction of the patients after the operation were compared between the two groups after different nursing methods were implemented. Results: in terms of drug cost, hospitalization time and hospitalization expenses, the observation group was lower/shorter than the control group (P < 0.05). In terms of the occurrence of complications, the complication rate of the observation group was calculated to be 5.88%, and that of the control group was calculated to be 23.53%, P < 0.05;The incidence of postoperative pain was 52.94% in the observation group and 76.47% in the control group (P < 0.05). The time of anal exhaust, defecation and ambulation in the observation group was shorter than that in the control group (P < 0.05). In the aspect of nursing satisfaction, the satisfaction rate of the observation group was 100.00%, while that of the control group was 88.24%, P < 0.05. Conclusion: tension-free hernioplasty for patients with indirect inguinal hernia, and the application of clinical nursing pathway to carry out nursing work during the perioperative period of these patients, can enable these patients to recover more quickly after operation, avoid too many complications, reduce their treatment costs, relieve postoperative pain, and is conducive to improving the satisfaction of nursing service.
