The application of clinical pathways in laparoscopic cholecystectomy

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.

Evaluation of the Effect of Endoscopic High- Frequency Electrocoagulation Electrodesiccation of Intestinal Polyps in the Clinical Nursing Pathway

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 .

Explore the clinical nursing path of daytime laparoscopic cholecystectomy under the guidance of enhanced recovery after surgery

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.

Application of Clinical Nursing Pathway in the Peri-Treatment Period of Immunoadsorption Therapy for Rheumatic Immune Diseases

Objective: The paper aims to investigate the clinical nursing pathway (CNP) in the application of immunosorption therapy in patients with rheumatic immune disease. Methods: Convenience sampling method was used to select inpatients who received immunoadsorption therapy from January 2020 to December 2022 in the rheumatology and Immunology department of a 3A hospital in Jingzhou City. 30 patients from January 2020 to June 2021 were selected as control group, and 30 patients from July 2021 to December 2022 were selected as observation group. The control group was given routine nursing. On the basis of the control group, the observation group used a clinical nursing pathway for intervention during the perioperative period of immunosorbent therapy. The incidence of adverse reactions, patient satisfaction, and nurse satisfaction during immunosorbent therapy between the control group and the observation group were compared. Results: After intervention, the incidence of adverse reactions in the observation group was significantly lower than that in the control group, while patient satisfaction and nurse satisfaction in the observation group were significantly higher than those in the control group. The results are all statistically significant (P Conclusion: Clinical nursing pathway is beneficial to reduce the incidence of adverse reactions in patients with immunoadsorption during peri-treatment and improve the satisfaction of patients and nurses.

Utilization Management:Walking the Line Between Patient Needs and Healthcare Economics-Short Communication

Utilization management plays a crucial role in healthcare by optimizing resource allocation,improving patient outcomes,and effectively controlling costs.By balancing patient needs with economic considerations,healthcare institutions can ensure efficient and sustainable service delivery.Utilization management encompasses various strategies,including prior authorization,concurrent review,and clinical pathways,to enhance care quality,manage expenses,and streamline resource use.The benefits of utilization management include cost containment,improved care standards,and the implementation of consistent treatment guidelines,thereby increasing the overall efficiency and effectiveness of healthcare delivery.

25 Years of Cancer Chemotherapy Pathways: A Brief History with a Look to the Future

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.

Assessment of the validity of the clinical pathway for colon endoscopic submucosal dissection

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.

Chinese expert consensus on the non-invasive imaging examination pathways of stable coronary artery disease

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.

The Effect of Clinical Pathway in Patients with Acute Complicated Appendicitis

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.

Application Effect of Clinical Pathway Teaching Method in Clinical Teaching of Cardiology

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.

Impact of enhanced recovery pathways on safety and efficacy of hip and knee arthroplasty:A systematic review and meta-analysis

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.

Influencing factors of hospitalization costs for glaucoma patients under clinical pathway management

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.

Application of Clinical Nursing Pathway Combined with Cluster Nursing Mode in Biologic Treatment of Rheumatoid Immune Disease Patients

Objective: To investigate the effect of clinical nursing pathway (CNP) combined with cluster nursing mode in intravenous biologic treatment of rheumatoid immune disease patients. Methods: Convenience sampling method was used to select inpatients receiving biologics treatment in Rheumatology and Immunology Department of a grade A hospital in Jingzhou city from May 2020 to April 2022. 75 patients from May 2020 to April 2021 were selected as the control group, and 75 patients from May 2021 to April 2022 were selected as the observation group. The control group was given routine care. The observation group was treated with CNP combined with cluster nursing mode on the basis of the control group, and the incidences of adverse infusion reactions, total treatment time, patient satisfaction and nurse satisfaction were compared between the two groups. Results: There were statistically significant differences between the two groups after intervention (P Conclusion: Using CNP combined with cluster nursing mode is beneficial to reduce the incidence of adverse infusion reactions in patients, shorten the total treatment time, and improve the satisfaction of patients and nurses.

Methodology for Developing a Nursing Administration Analysis System

Nursing administration requires a large volume of wide-ranging information, and nurse administrators are limited in their ability to compile and analyze information for nursing administration. The purpose of this study is to create methodology for developing a nursing administration analysis system to aid nurse administrators in performing outcome analysis. In this methodology, information required for nursing administration in the PSYCHOMS? (Psychiatric Outcome Management System, registered trademark) database is analyzed according to the individual needs of nurse administrators. It features a combination of a classification method and an extraction method for obtaining quantitative and qualitative data as information required for nursing administration, and enables nurse administrators to easily obtain analysis results that they directly need. This methodology converts the time required nurse administrators to collect and organize information into time for making considerations in order to devise strategies for improving the quality of nursing care services, and can improve the quality and efficiency of nursing administration. This may lead to an increase of the quality of nursing care services at psychiatric hospitals. This methodology is highly versatile as it can be applied in information management, not only for nursing, but for the entire psychiatric hospital.

临床护理路径应用于冠状动脉粥样硬化性心脏病患者介入治疗效果的meta分析

目的通过meta分析来评价临床护理路径对冠心病患者介入治疗后的效果。方法利用计算机检索Cochrane Library、Web of Science、PubMed、Embase、Medline、中国期刊全文数据库、中国生物医学服务系统、维普中文期刊全文数据库以及万方数据库中关于临床护理路径对冠状动脉粥样硬化性心脏病(以下简称“冠心病”)介入治疗效果的随机对照试验,根据纳入标准筛选出符合质量的文献,严格评价后提取数据,采用RevMan 5.2进行meta分析。结果共纳入12篇文献,均为随机对照试验,共1237例患者,meta分析结果证明:观察组住院天数少于对照组(加权均数差为-2.62,95%置信区间为-3.52~-1.72,P<0.0001);观察组住院费用少于对照组(加权均数差为-4214.30,95%置信区间为-7266.91~-1161.69,P=0.007);观察组满意率高于对照组(相对危险度(relative risk,RR)为1.17,95%置信区间为1.09~1.26,P<0.0001),(标准均数差为1.31,95%置信区间为0.43~2.18,P=0.0030);观察组尿潴留的发生率低于对照组(RR=0.41,95%置信区间为0.26~0.65,P=0.0001);观察组出血和血肿的发生率低于对照组(RR=0.37,95%置信区间为0.22~0.62,P=0.0002);观察组迷走反射的发生率低于对照组(RR=0.33,95%置信区间为0.16~0.68,P=0.0030);观察组心律失常的发生率低于对照组(RR=0.43,95%置信区间为0.32~0.58,P<0.0001);观察组心源性休克的发生率低于对照组(RR=0.52,95%置信区间为0.31~0.89,P=0.0200)。结论临床护理路径能够缩短冠心病介入治疗后患者的住院天数,减少其住院费用,提高满意度,降低相关并发症(出血和血肿、迷走反射、心律失常、心源性休克)的发生率,然而由于纳入的文献存在偏倚的风险较高,其确切效果仍需更多临床高质量随机对照试验来证实。

Effects of Integrated Case Payment on Medical Expenditure and Readmission of Inpatients with Chronic Obstructive Pulmonary Disease： A Nonrandomized, Comparative Study in Xi County, China

In the past few decades, Chinese government attempted to reduce the economic burden of chronic diseases and lower family financial risk of patients by establishing a nationwide coverage of Social Health Insurance system. However, the payment mode of Social Health Insurance varies across Chinese healthcare settings, and the effectiveness of each mode differs. This study aimed to evaluate the effects of integrated case payment on medical expenditure and readmission of inpatients with chronic obstructive pulmonary disease （COPD）, a complex, multicomponent, chronic condition. A nonrandomized, comparative method was used in this study. Inpatients with COPD before （n=1569） and after the integrated case payment reform （n=4764） were selected from the inpatient information database of the New Cooperative Medical Scheme Agency of Xi County. The integrated case payment comprises the case payment （including price-cap case payment and fixed-reimbursement case payment） and clinical pathway （including clinical pathway A, clinical pathway B and clinical pathway C）. Effects of integrated case payment were evaluated with indicators of per capita total medical expense and readmission within 30 days. A multivariate linear regression and a binary logistic regression were used to conduct statistical analysis. The results showed that case payment, comprising price-cap case payment （β=2382.988, P〈0.001） and fixed-reimbursement case payment β=2613.564, P〈0.001）, and clinical pathway C （β=1996.467, P〈0.001） were risk factors of per capita total medical expenses. Clinical pathway A （β=-1443.409, P〈0.001） and clinical pathway B （β=-1583.791, P〈0.001） were protective factors. The interactive effects of case payment with hospital level （β=0.710, P〈0.001） lowered the readmission rate within 30 days. Meanwhile, clinical pathways A （β=18.949, P〈0.001）, B （β=-19.752, P〈0.001） and C （β=-1.882, P〈0.1） were associated with the rate increase. The findings revealed that integrated case payment ensured the quality of care for inpatients with COPD to some extent. However, this payment mode increased the per capita total medical expense. Further, policy-makers should set reasonable reimbursement standards of case payment, unify the type of case payment, and strengthen the supervision of the reform to enhance its function on medical cost control.

运用临床路径对子宫内膜癌患者实施健康教育

目的:评估临床路径应用对子宫内膜癌患者健康教育的影响。方法:将60例子宫内膜癌患者随机分为两组,实验组30例按临床路径进行健康教育方式宣教,对照组30例按传统健康教育方式宣教。出院前采用自制设计的调查表进行调查,测评两组患者对子宫内膜癌健康知识、健康技能掌握情况及对健康教育的满意度。结果:实验组患者对健康知识和健康技能的掌握以及健康教育的满意度明显高于对照组(P>0.05)。结论:应用临床路径对子宫内膜癌患者实施健康教育,满足了患者和家属对健康教育的需求,提高了健康教育的效果,促进患者更好地掌握健康教育知识,提高了患者满意度。

A clinical pathway for integrative medicine in the treatment of functional constipation in Hong Kong,China

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.

Delayed healing is common in in-situ urethroplasty patients after artificial sphincter cuff erosion

Introduction:Urethral erosion is a known complication of artificial urinary sphincter(AUS)surgery.We performed an in-situ urethroplasty(ISU)to reduce the healing time and time to reimplantation of the AUS.We sought to assess urethral integrity one month after ISU and to identify factors associated with delayed healing in our high-volume tertiary referral center experience. Methods:A retrospective review of our AUS database from 2009 to 2023 was conducted to identify all ISU cases.Patients were stratified as healed or non-healed based on the absence of extravasation on voiding cystourethrogram(VCUG)obtained 4 weeks postoperatively.Background characteristics were evaluated including age,body mass index,diabetes,hypogonadism and smoking history.Operative variables included degree of erosion,location of defect,and the number of stitches required for repair. Results:Among 98 patients undergoing an ISU,61 underwent VCUG at one month.Of these,34.4%(21/61)had evidence of delayed healing on VCUG requiring prolonged catheterization.Although a higher average number of repair sutures were used in ISU,this was not significant(p=0.381).The most common complication in both groups was urinary tract infection(UTI).Non-healed patients had a higher rate of UTI,without significant predilection towards fistula,stricture or diverticulum.No other patient or operative characteristic was significantly different between groups. Conclusion:Despite an aggressive approach to management via ISU,many patients still require prolonged catheterization after AUS erosion to ensure complete healing of the defect.

Implications of clinical pathway reform on pharmaceutical costs at a hospital in Qingdao city

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.