Objective To evaluate the effect of clinical pathway (CP) teaching methods versus traditional methods in nursing clinical teaching. Methods The following electronic databases as PubMed, EMBASE, The Cochrane Library, CBM and CNKI were retrieved on computer from their establishment to April 2011 to search for randomized controlled trials (RCTs) of comparing CP with traditional methods in nursing clinical teaching. The methodological quality of the included RCTs was assessed by two reviewers independently according to the scale of criteria for methodological quality developed by Smits PB, and the meta-analysis was conducted by using the Cochrane Collaboration’s RevMan5.1 software. Results A total of 12 RCTs involving 1 269 participants were included, and nine of them were of high quality. The meta-analyses showed that compared with the traditional teaching method, the CP teaching tended to be superior (Plt;0.05) in improving nursing students’ objective knowledge, nursing operating skills, professional ability and satisfaction with teaching methods, and in improving patients’ satisfaction as well. Conclusion The clinical pathway teaching method is a scientific teaching model in nursing clinical teaching; it standardizes the teaching procedure, promotes students’ active learning and further enhances the teaching effect. But it is necessary to unify the method of assessment with more researches. In addition, researchers should pay more attention to improving the comprehensive quality of nursing students.
ObjectiveTo analyze the clinical manifestations and pathological patterns of renal diseases requiring percutaneous renopuncture, evaluate the clinical significance of renal biopsy and the value of clinical pathway for renal biopsy. MethodsWe retrospectively summarized and analyzed the clinical and pathological data, and the clinical pathway implementation of 224 patients who underwent renal biopsy between October 2009 and September 2014. ResultsIn the 224 patients, there were 62 cases of IgA nephropathy (27.68%), 50 cases of minimal change nephropathy (22.32%), 28 cases of lupus nephritis (12.5%), 26 cases of membrane nephropathy (11.6%), 26 cases of mesangial proliferative glomerulonephritis (11.6%), 6 cases of purpura nephritis (2.68%), 4 cases of focal segmental glomerular sclerosis (1.79%), 4 cases of hepatitis B virus-associated membrane nephropathy (1.79%), 4 cases of nodular diabetic glomerulosclerosis (1.79%), 4 cases of acute tubulointerstitial nephropathy (1.79%), 2 cases of hypertensive renal damage (0.89%), 2 cases of membrano-proliferative glomerulonephritis (0.89%), 1 case of lipoprotein kidney disease (0.45%), and 1 case of fibrillary glomerulopathy (0.45%). A total of 220 specimens in the 224 cases were qualified, accounting for 98.21%. Diagnosis of 70 patients in the qualified 220 cases were re-corrected according to their renal pathology reports, accounting for 31.81%. In the 224 cases, there were 16 cases of gross hematuria (7.14%) and 24 of peri-renal hematoma (10.71%) after renal biopsy. Patients who met the requirement of clinical pathway were divided into clinical pathway group and control group randomly. Average hospitalization time of the clinical pathway group was (7.6±1.2) days, and the average cost was (5 860±237) yuan, both lower than the control group [(11.8±2.3) days, (7 658±360) yuan)]. The difference was statistically significant. ConclusionsIgA nephropathy is the most common pathological type of primary glomerular diseases, and minimal change nephropathy the second. Lupus nephritis, membranous nephropathy, mesangial proliferative glomerulonephritis are still the most common types of glomerular diseases. Lupus nephritis becomes the first secondary glomerular disease. Ultrasound guided percutaneous renal biopsy is safe and has high success rate and high clinical application value. The implementation of clinical pathway can shorten the average length of hospital stay and reduce the average hospital cost.
Objective To evaluate the feasibility of the clinical pathway based on the medical data information integration system to guide the treatment of palmar hyperhidrosis (PHH). Methods We retrospectively analyzed the clinical data of 106 PHH patients in the Fourth Affiliated Hospital of Harbin Medical University from March 2012 through June 2015. The patients were divided into two groups including a day surgery group (52 patients) and a traditional group (54 patients). The patients in the day surgery group underwent day surgery guided by clinical pathway of PHH based on medical data information integration system. The patients in the traditional group stayed in hospital for 2-3 days. The pre-surgical situation, post-surgical effect of patients and cost of hospitalization were compared between the two groups. Results Only one patient of PPH suffered from insufficient relief of symptoms. The other patients’ symptom of PPH disappeared. No serious complication occurred. The postoperative visual analogue scale (VAS) pain score of patients was lower than 2 points. The hospitalization expense of the day surgery group was significantly lower than that of the traditional operation group. The average follow-up time was 2.5 months (0.5 to 4 months). The symptoms of the whole group had no recurrence. All of the patients were not found with compensatory hyperhidrosis. Conclusion Day-surgery clinical pathway of PHH based on medical data information integration system is safe and feasible. Day-surgery clinical pathway of PPH can accelerate the recovery of patients and save the cost of hospitalization.
Objective To analyze and evaluate the present status of application of clinical pathway evaluation indexes in China, in order to provide references to establish an evaluation system on clinical pathway. Methods Such databases as CBM (2004-2009), VIP (2004-2009), CNKI (2004-2009) and WanFang Data (2004-2009), and some relevant websites were searched systematically for collecting Chinese literature about domestic clinical pathway evaluation indexes. Results Among the 1 175 articles included, 135 (11%) were published in the core periodicals, 19 (2%) were masterate theses, and 1 021 were other kinds of articles. As to 135 core periodical literature and 19 masterate theses, most of which were graded into the second level of evidence, accounting for 96%. The analysis on the appearance of indexes showed that 87% of inconsistency could be identified between the contents and terms of indexes. Common indexes were summarized as the following four aspects: cost index, clinical index, serving index and quality evaluation index. There were 78% of all the 1 175 articles focusing on the application of nursing and medical education, in which only one masterate thesis used social research methods such as Delphi, focus group, experts scoring (percentile), etc. Conclusion Currently, there are some issues existing in the evaluation indexes of clinical pathway in China, such as low methodological quality of literature, irregularly and randomly using statistical terms, and lack of studies on system construction of clinical pathway evaluation indexes.
Objective To explore a scientific disease cost accounting. Method Disease cost accounting = disease cost accounting of clinic pathway + disease basis cost accounting. Conclusions It is the tendency with the medical reform for the social security department to pay by disease for the hospitals, as a result, both social security department and hospitals have to resort to the scientific way in terms of cost accounting of disease. And it is practical and effective by means of cost accounting for clinic pathway.
Exercise prescription is an effective tool for the prevention and control of hypertension, diabetes and dyslipidemia. However, a full set of exercise prescription is difficult to be implemented in China's primary medical institutions and community public health service centers. Therefore, under the support of the theoretical system of exercise prescription and the standard development norms, this clinical pathway of exercise prescription is developed according to the characteristics of national physical fitness and the status quo of primary healthcare institutions in China, aiming at simplifying the process of exercise prescription development, reducing the professional threshold, empowering primary healthcare, and providing a scientific and feasible solution for the promotion of exercise prescription in primary healthcare institutions.
ObjectivesTo analyze the citation of evidence in traditional Chinese medicine (TCM) clinical pathways in China, and to provide suggestions for future development and revision of TCM clinical pathways.MethodsTCM clinical pathways released on the websites of national administration of TCM and China association of Chinese medicine were obtained, with the retrieval time limit to June 2019. Two researchers separately utilized the Excel to extract data and performed a descriptive analysis.ResultsA total of 405 TCM clinical pathways were included, involving internal medicine, surgery, gynecology and pediatrics. Internal medicine accounted for the largest proportion of the TCM clinical pathways (133). All the 405 pathways cited references as evidence, among which the maximum and minimum quantities of cited references were 11 and 1, respectively, and the median was 3. More than 90% of the TCM clinical pathways cited the evidence in the parts of diagnosis and efficacy evaluation. For parts of TCM and western medicine treatment, the proportion of TCM clinical pathways which cited evidence was less than 75%; for parts of rehabilitation and nursing, the proportion of TCM clinical pathways which cited evidence was less than 2%. The types of evidence being cited were standard indicators (683), clinical practice guidelines (488), textbooks (236), consensus opinions, ancient books and clinical surveys. The released time was reported in 89.25% of the cited evidence; the largest time interval was between the release time of the standard indicators (evidence) and that of the TCM pathways. Among the evidence released more than 15 years before the release of the TCM pathways, the proportion of standard indicators was the highest (57.12%).ConclusionsThe published TCM clinical pathways are all developed based on evidence, however, the evidence citation ratio in different parts varies greatly. In some TCM clinical pathways, the cited evidences are not reported normatively, and some evidence are poor in timeliness.
ObjectiveTo explore the effect of clinical pathway in peri-operative nursing management of patients with esophageal carcinoma. MethodsA total of 120 patients with esophageal cancer who underwent the operation between January 2010 and April 2012 were divided into control group and trial group. the patients in control group was given conventional esophageal carcinoma peri-operative management; while the ones in the trial group received clinical pathway standardized management. The hospitalization days, costs of hospitalization, complications, satisfaction of the patients and families were compared between the two groups. ResultsThe length of hospitalization days and costs in the trial group were lower than those in the control group (P<0.01); the patients and families satisfaction in the trial group was superior to the control group (P<0.05); the difference in complications occurrence between the two groups was not significant (P>0.05). ConclusionThe clinical pathway of peri-operative nursing management for patients with esophageal cancer could effectively decrease the costs, improve satisfaction of the patients and families, and ensure the quality of care and improve the nursing efficiency.
The two factors that affect enrollment of participants and the process of intervention in randomizedcontrolled pragmatic trials are similar to the situation of clinical practice, thus its effects are similar to the situation ofclinical practice. Therefore, when one estimates an intervention’s effect on a patient, it will be more similar to a real clinicalsituation than results taken from an explanatory trial. Due to the introduction of interventions and process variables usedin a pragmatic trial that conform to traditional Chinese medicine and acupuncture practices, more and more interest isgrowing among researchers in the traditional Chinese medicine field. This article introduces the principles and conceptsof the pragmatic trial, and the key points of design via some samples.
Strengthening the management and evaluation of clinical pathways is one of the most important strategies of "Healthy China 2030" Strategic Plan. Evidence-based assessment and clinical guidelines can provide the best relevant evidence to develop clinical pathways. We planned to analyze the current situation of clinical pathways in China and explore how to apply evidence-based assessment on clinical pathway management. We searched PubMed, EMbase, ISI, CNKI, WanFang Data, VIP and the The Cochrane Library using "critical pathways" and "clinical guidelines" as key words or subject terms. And we conducted a comparison of their published volume, definitions, differences and connections. The management system of clinical pathway in China is fundamentally flawed, it is still a challenge to implement the clinical pathways effectively without scientific methodologies and standardized evidence-based evaluation system. In order to improve the management quality of clinical pathway in China, we should develop clinical pathways based on national situation and innovate the evaluation system to standardize the clinical pathway management according to WHO recommendations of clinical guideline and appraisal.