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.
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.
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.
In combination with the national health informatization construction in UK during the past ten years, this article introduced the resource construction of decision making knowledge library like British Electronic Medicine Library Clinical Pathway Database and NHS Evidence, as well as the function and application of clinical decision support system (CDSS) like PRODIGY, medical knowledge map and so on, discussed the development characteristics and construction experiences of British health decision support system (HDSS). And aiming directly at Chinese specific circumstances, this article offered some suggestions on promoting China HDSS development, for instance, dynamically integrating CDSS with patients’ diagnosis and treatment procedure through the electronic medical record system, strengthening the resources construction of knowledge library, establishing localized clinical pathway, and so on.
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.
Objective To analyze the significance of operation date in clinical path designing of cleft lip-palate. Methods The case records of cleft lip-palate patients from 8 hospitals in Gansu province were collected from 2005 to 2008. By means of comprehensive analysis of case records and frequencies of hospitalization duration, analyzed the influence of operation date selection on hospitalization duration in clinical path designing. Result In Gansu province, the average hospitalization duration of cleft lip-palate was 11 days, and the operation was usually done at the sixth day. The main preparations for operation were kinds of examinations. Within five days after operation, most treatments were postoperative care, diet and antibiotic therapy. Conclusion The strategy of operation date selection is much important to ascertain the real hospitalization duration in clinical path designing.
Objective To investigate differential points of clinical symptoms and pathology of solid-pseudopapillary tumor of the pancreas (SPTP) and islet cell tumor (ICT). Methods Fifteen cases of SPTP and twelve cases of ICT were studied in this retrospective research. Clinical symptom, pathologic feature and computed tomography (CT) image of patients with both tumors were analyzed, and the imaging features were compared with pathological results. Results The mean age of SPTP patients was 22.4 year-old. Twelve patients with SPTP presented a palpable abdominal mass as the initial symptom. It was observed that the tumor cells were located in a pseudopapillary pattern with a fibro-vascular core histologically. On the CT images, a mixture of solid and cystic structures could be seen in all the tumors. After taking enhanced CT scan, the solid portion was slightly enhanced in the arterial phase and the contrast intensity increased in the portal venous phase. On the other hand, the mean age of ICT patients was 39.3 year-old. The major symptom was due to the function of islet cell tumor, which was typical in 8 patients, presenting as Whipple triad. Histologically, cells demonstrated in trabecular, massive, acinar or solid patterns, and the blood supply of the tumor was abundant. On the CT images, most small tumors were difficulty to be detected. ICT could be markedly enhanced in the arterial phase and slightly enhanced in the portal venous phase on post-contrast CT scan. Conclusion Clinical symptom, pathologic feature and CT scanning are helpful to differentiate SPTP from ICT.
ObjectiveTo explore the correlation of clinicopathologic factors with the expression of estrogen receptor (ER) and progesterone receptor (PR) in patients with primary breast cancer. MethodsThe data of 105 patients with primary breast cancer were collected from September 2011 to September 2012. The expression of ER, PR and C-erbB-2 in breast cancer tissues was detected by immunohistochemistry. The correlation between the expression of ER, PR and C-erbB-2 and the clinicopathologic factors was evaluated. ResultsThe positive rates of expression of ER, PR and C-erbB-2 in breast cancer tissues reached 58.1%, 49.5% and 59.0%, respectively. The expression of ER had a positive correlation with the expression of PR. The concordance expression of ER and PR had a negative correlation with the expression of C-erbB-2. The positive rate of expression of ER had a correlation with the lymph node metastasis and histological grading, while it was not correlated with patients' age, the age of menarche, tumor size, tumor position, clinical stages, pathological type, or pathologic morphology of tissue adjacent to cancer (P>0.05). The positive rate of expression of PR and the different positive strength rate of expression of ER were not correlated with clinical and pathological factors (P>0.05). The positive rate of expression of C-erbB-2 in the group with lymph node metastasis was higher than that in non-lymph node metastasis group (P<0.05). ConclusionThe expression of ER and PR plays an important role in the occurrence and development of the breast cancer. Joint detection of ER and PR is very important for the evaluation of endocrine therapy effect and prognosis.
ObjectiveTo investigate the rule of lymph node metastasis in early gastric cancer (EGC) so as to provide a reasonable treatment. MethodsWe retrospectively analyzed the clinical data of 118 EGC patients who had been treated from January 2006 to December 2012,and a total of 8 potential factors associated with occurrence of EGC were evaluated by univariate analysis and multivariate logistic regression analysis. ResultsThe univariate analysis showed that ulcer,tumor size,depth of invasion and lymphatic involvement were correlated with lymph node metastasis (P<0.05).Multivariate logistic regression analysis showed that presence of an ulcer (OR=2.872),tumor of 3.0 cm or larger than that (OR=2.351),tumor invasion into the submucous layer (OR=3.461) and invasion into the lymphatic tubes (OR=1.784) were found to be independent risk factors. ConclusionLymph node metastasis of EGC is correlated with many factors,so EGC treatment choice should be made reasonably based on strict screening to exclude various risk factors before taking surgery.
ObjectiveTo introduce the clinical pathway for geriatric hip fracture regulated by our hospital and report the five-year outcomes after the implementation of the pathway. MethodsThe geriatric hip fracture patients treated between September 2003 and August 2012 were followed up. We did not implement the clinical pathway until January 2007. Statistical analysis was done to evaluate the effect of the clinical pathway on patient outcomes by comparing rate of complication, mortality, and length of hospital stay before and after the implementation of the clinical pathway. ResultsAfter the implementation of the pathway, the in-hospital mortality, one-year mortality and the rate of complication were significantly lower. Besides, the time from admission to operation and the total length of stay in hospital were obviously shortened. ConclusionThe use of clinical pathway for geriatric hip fracture can reduce the rate of complication and mortality, and shorten hospital stay, and the five-year outcomes after the implementation of the pathway are satisfying.