ObjectiveTo acquaint the development process and item composition of the appraisal tools and reporting standards of clinical pathways worldwide, in order to improve the development and evaluation of clinical pathways. MethodsWe searched databases including PubMed, EMbase, Web of Science, CBM, CNKI and WanFang Data for articles about the appraisal tools and reporting standards of clinical pathways from inception to Jan, 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and compared the difference in development process and item composition among included appraisal tools and reporting standards of clinical pathways. ResultsA total of 7 appraisal tools and reporting standards were included. Among them, 3 were from UK, 1 from China, 1 from Australia, 1 from Belgium, and 1 from Saudi Arabia. All included appraisal tools contained 4 to 15 domains and 14 to 99 items. Based on the comparison of different domains and items of included appraisal tools, "Clinical Pathway Management Guidelines" published by the National Health and Family Planning Commission of the People's Republic of China and the research of Vannhaecht, we identified 17 key elements of clinical pathway as follows:organizational commitment, pathway project management, format of doc, content of pathway, multidisciplinary involvement, variance management, EBM/guidelines, maintenance of pathway, accountability, patient involvement, development of pathway, additional support systems & documents, operational arrangement, implementation, outcome management, safety and organization of the care process. ConclusionCurrently, the appraisal tools and reporting standards of clinical pathways are rudimentary, so we desperately needs to establish mature appraisal tool and reporting standard of clinical pathways to guide the development and implementation of clinical pathway, so as to improve their application effects in clinical practice and medical quality.
With silk fibroin and vancomycin (VCM) as carrier and drug model, respectively, we prepared silk fibroin microspheres (SFM) with different concentration using the water-in-oil emulsion solvent diffusion method. We further developed VCM loaded calcium sulfate hemihydrates (CSH)/SFM artificial bone composites. In this study, surface morphology of the materials was observed using scanning electron microscope (SEM). Structure of the materials was studied with Fourier transform infrared spectroscopy (FTIR). Antibacterial activity of the materials was validated with the inhibition zone test. Drug release property of materials was evaluated using ultraviolet/visible spectrophotometry. Mechanical property of the materials was tested using computer-controlled electronic universal testing machine. The results showed that silk fibroin concentration had no significant effect on molecular conformation and antibacterial property of the SFM. The average diameter of SFM increased and the release rate decreased gradually as the silk fibroin concentration increased. The release rate decreased and the compressive fracture work increased as the silk fibroin concentration increased when adding SFM to CSH. This composite had partly corrected the disadvantages of CSH including the high brittleness and initial burst release. The research would have a good application foreground in the clinical treatment of infectious bone defect.