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.

Clinical features and genetic variations of severe neonatal hyperbilirubinemia:Five case reports

BACKGROUND Neonatal hyperbilirubinemia is a common problem faced by pediatricians.The role of genetic factors in neonatal jaundice has been gradually recognized.This study aims to identify genetic variants that influence the bilirubin level in five patients using next-generation sequencing(NGS).CASE SUMMARY Five neonates with severe hyperbilirubinemia were retrospectively studied.They exhibited bilirubin encephalopathy,hypothyroidism,ABO blood type incompatibility hemolysis,glucose-6-phosphate dehydrogenase(G6PD)deficiency and premature birth,respectively.A customized 22-gene panel was designed,and NGS was carried out for these neonates.Eight variations(G6PD c.G1388A,HBA2 c.C369G,ABCC2 c.C3825G,UGT1A1 c.G211A,SPTB c.A1729G,EPB41 c.G520A,c.1213-4T>G and c.A1474G)were identified in these five neonates.Genetic mutations of these genes are associated with G6PD deficiency,thalassemia,Dubin-Johnson syndrome,Gilbert syndrome,hereditary spherocytosis,and hereditary elliptocytosis.One of the neonates was found to have compound variants of the EPB41 splice site c.1213-4T>G and c.G520A(p.E174K),but no elliptocyte was seen on his blood smear of 4 years old.CONCLUSION Pathological factors of severe neonatal hyperbilirubinemia are complicated.Genetic variants may play an important role in an increased risk of neonatal hyperbilirubinemia,and severe jaundice in neonates may be related to a cumulative effect of genetic variants.

Seasonal variation of transport pathways and potential source areas at high inorganic nitrogen wet deposition sites in southern China

This study attempts to identify the dominant transport pathways,potential source areas,and their seasonal variation at sites with high inorganic nitrogen(IN)wet deposition flux in southern China.This is a long-term study(2010-2017)based on continuous deposition measurements at the Guangzhou urban site(GZ)and the Dinghushan Natural Reserve site(DHS)located in the Pearl River Delta(PRD)region.A dataset on monthly IN concentration in precipitation and wet deposition flux were provided.The average annual fluxes measured at both sites(GZ:33.04±9.52,DHS:20.52±10.22 kg N/(ha·year))were higher,while the ratios of reduced to oxidized N(GZ:1.19±0.77,DHS:1.25±0.84)were lower compared with the national mean level and the previous reported level throughout the PRD region.The dominant pathways were not always consistent with the highest proportional trajectory clusters.The transport pathways contributing most of deposition were identified in the north and northnortheast in the dry season and in the east-southeast,east,and south-southwest in the wet season.A weighted potential source contribution function(WPSCF)value>0.3 was determined reasonably to define the potential source area.Emission within the PRD region contributed the majority(≥95%at both sites)of the IN deposition in the wet season,while the contribution outside the region increased significantly in the dry season(GZ:27.86%,DHS:95.26%).Our results could help create more effective policy to control precursor emissions for IN fluxes,enabling reduction of the ecological risks due to excessive nitrogen.

Visual pathways involvement in clinically isolated syndrome in children

AIM: To investigate extent and nature of visual pathways involvement in children with clinically isolated syndrome(CIS).METHODS: Forty-seven patients(age 11-17y) with CIS, which later proved to be multiple sclerosis(MS)onset, and 30 controls underwent visual evoked potentials(VEP) investigation within 12 d from the appearance of the first signs of disease. Latency and amplitude of P100 peak were compared with normative data and between groups.RESULTS: In 58% patients, including those without signs of retrobulbar neuritis, significant slowing of conduction along the central visual pathways(P100latency lengthening) is seen. P100 amplitudes drop(signs of axonal damage) are registered less frequently(29% cases).CONCLUSION: The results indicate that visual pathways are often affected in the MS onset; mostly demyelination signs are seen. Despite MRI significance for MS diagnostic, VEPs proved to be still effective in early diagnosis of MS in children.

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 .

Improving the accuracy and consistency of clinical target volume delineation for rectal cancer by an education program

BACKGROUND Accurate target volume delineation is the premise for the implementation of precise radiotherapy.Inadequate target volume delineation may diminish tumor control or increase toxicity.Although several clinical target volume(CTV)delineation guidelines for rectal cancer have been published in recent years,significant interobserver variation(IOV)in CTV delineation still exists among radiation oncologists.However,proper education may serve as a bridge that connects complex guidelines with clinical practice.AIM To examine whether an education program could improve the accuracy and consistency of preoperative radiotherapy CTV delineation for rectal cancer.METHODS The study consisted of a baseline target volume delineation,a 150-min education intervention,and a follow-up evaluation.A 42-year-old man diagnosed with stage IIIC(T3N2bM0)rectal adenocarcinoma was selected for target volume delineation.CTVs obtained before and after the program were compared.Dice similarity coefficient(DSC),inclusiveness index(IncI),conformal index(CI),and relative volume difference[ΔV(%)]were analyzed to quantitatively evaluate the disparities between the participants’delineation and the standard CTV.Maximum volume ratio(MVR)and coefficient of variation(CV)were calculated to assess the IOV.Qualitative analysis included four common controversies in CTV delineation concerning the upper boundary of the target volume,external iliac area,groin area,and ischiorectal fossa.RESULTS Of the 18 radiation oncologists from 10 provinces in China,13 completed two sets of CTVs.In quantitative analysis,the average CTV volume decreased from 809.82 cm3 to 705.21 cm3(P=0.001)after the education program.Regarding the indices for geometric comparison,the mean DSC,IncI,and CI increased significantly,whileΔV(%)decreased remarkably,indicating improved agreement between participants’delineation and the standard CTV.Moreover,an 11.80%reduction in MVR and 18.19%reduction in CV were noted,demonstrating a smaller IOV in delineation after the education program.Regarding qualitative analysis,the greatest variations in baseline were observed at the external iliac area and ischiorectal fossa;61.54%(8/13)and 53.85%(7/13)of the participants unnecessarily delineated the external iliac area and the ischiorectal fossa,respectively.However,the education program reduced these variations.CONCLUSION Wide variations in CTV delineation for rectal cancer are present among radiation oncologists in China's Mainland.A well-structured education program could improve delineation accuracy and reduce IOVs.

Copy number variation profile-based genomic typing of premenstrual dysphoric disorder in Chinese

Premenstrual dysphoric disorder(PMDD) affects nearly 5% of women of reproductive age. Symptomatic heterogeneity, together with largely unknown genetics, has greatly hindered its effective treatment. In the present study, analysis of genomic sequencing-based copy number variations(CNVs) called from 100 kb white blood cell DNA sequence windows by means of semisupervized clustering led to the segregation of patient genomes into the D and V groups, which correlated with the depression and invasion clinical types,respectively, with 89.0% consistency. Application of diagnostic CNV features selected using the correlation-based machine learning method enabled the classification of the CNVs obtained into the D group, V group, total patient group, and control group with an average accuracy of 83.0%. The power of the diagnostic CNV features was 0.98 on average, suggesting that these CNV features could be used for the molecular diagnosis of the major clinical types of PMDD. This demonstrated concordance between the CNV profiles and clinical types of PMDD supported the validity of symptom-based diagnosis of PMDD for differentiating between its two major clinical types, as well as the predominantly genetic nature of PMDD with a host of overlaps between multiple susceptibility genes/pathways and the diagnostic CNV features as indicators of involvement in PMDD etiology.

Genome-wide characterization of copy number variations in diffuse large B-cell lymphoma with implications in targeted therapy

Diffuse large B-cell lymphoma(DLBCL)is the aggressive form of haematological malignancies with relapse/refractory in∼40%of cases.It mostly develops due to accumulation of various genetic and epigenetic variations that contribute to its aggressiveness.Though large-scale structural alterations have been reported in DLBCL,their functional role in pathogenesis and as potential targets for therapy is not yet well understood.In this study we performed detection and analysis of copy number variations(CNVs)in 11 human DLBCL cell lines(4 activated B-cell–like[ABC]and 7 germinal-centre B-cell–like[GCB]),that serve as model systems for DLBCL cancer cell biology.Significant heterogeneity observed in CNV profiles of these cell lines and poor prognosis associated with ABC subtype indicates the importance of individualized screening for diagnostic and prognostic targets.Functional analysis of key cancer genes exhibiting copy alterations across the cell lines revealed activation/disruption of ten potentially targetable immuno-oncogenic pathways.Genome guided in silico therapy that putatively target these pathways is elucidated.Based on our analysis,five CNV-genes associated with worst survival prognosis are proposed as potential prognostic markers of DLBCL.

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.

Use of a clinical pathway in laparoscopic gastrectomy for gastric cancer

AIM: To evaluate the implementation of a clinical pathway and identify clinical factors affecting the clinical pathway for laparoscopic gastrectomy.METHODS: A standardized clinical pathway for gastric cancer(GC) patients was developed in 2001 by the GC surgery team at the Asan Medical Center. We reviewed the collected data of 4800 consecutive patients treated using the clinical pathway following laparoscopic gastrectomy with lymph node dissection for GC involving intracorporeal and extracorporeal anastomosis. The patients were treated between August 2004 and October 2013 in a single institution. To evaluate the rate of completion and risk factors affecting dropout from the clinical pathway, we used a multivariate logistic regression analysis.RESULTS: The overall completion rate of the clinical pathway for laparoscopic gastrectomy was 84.1%(n = 4038). In the comparison between groups of intracorporeal anastomosis and extracorporeal anastomosis patients, the completion rates were 8 3. 8 8 %(n = 1 7 4 0) a n d 8 4. 3 6 %(n = 2 0 7 1), respectively, showing no statistically significant difference. The main reasons for dropping out were postoperative complications(n = 463, 9.7%) and the need for patient observation(n = 299, 6.2%). Among the discharged patients treated using the clinical pathway, the number of patients who were readmitted within 30 d due to postoperative complications was 54(1.1%). In a multivariate analysis, the intraoperative events(OR = 2.558) were the most predictable risk factors for dropping out of the clinical pathway. Additionally, being male(OR = 1.459), advanced age(OR = 1.727), total gastrectomy(OR = 2.444), combined operation(OR = 1.731), and ASA score(OR = 1.889) were significant risk factors affecting the dropout rate from the clinical pathway.CONCLUSION: Laparoscopic gastrectomy appears to be a good indication for the application of a clinical pathway. For successful application, patients with risk factors should be managed carefully.

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.

Big-data analysis: A clinical pathway on endoscopic retrograde cholangiopancreatography for common bile duct stones

BACKGROUND A clinical pathway(CP)is a standardized approach for disease management.However,big data-based evidence is rarely involved in CP for related common bile duct(CBD)stones,let alone outcome comparisons before and after CP implementation.AIM To investigate the value of CP implementation in patients with CBD stones undergoing endoscopic retrograde cholangiopancreatography(ERCP).METHODS This retrospective study was conducted at Nanjing Drum Tower Hospital in patients with CBD stones undergoing ERCP from January 2007 to December 2017.The data and outcomes were compared by using univariate and multivariable regression/linear models between the patients who received conventional care(non-pathway group,n=467)and CP care(pathway group,n=2196).RESULTS At baseline,the main differences observed between the two groups were the percentage of patients with multiple stones(P<0.001)and incidence of cholangitis complication(P<0.05).The percentage of antibiotic use and complications in the CP group were significantly less than those in the nonpathway group[adjusted odds ratio(OR)=0.72,95%confidence interval(CI):0.55-0.93,P=0.012,adjusted OR=0.44,95%CI:0.33-0.59,P<0.001,respectively].Patients spent lower costs on hospitalization,operation,nursing,medication,and medical consumable materials(P<0.001 for all),and even experienced shorter length of hospital stay(LOHS)(P<0.001)after the CP implementation.No significant differences in clinical outcomes,readmission rate,or secondary surgery rate were presented between the patients in the non-pathway and CP groups.CONCLUSION Implementing a CP for patients with CBD stones is a safe mode to reduce the LOHS,hospital costs,antibiotic use,and complication rate.

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 Impact of a Structured Clinical Pathway on the Application of Management Standards in Patients with Diabetic Ketoacidosis and Its Acceptability by Medical Residents

Diabetic Ketoacidosis (DKA) is a serious and potentially a fatal complication of diabetes mellitus. Tools to guarantee proper, evidence-based, guideline implementation are of paramount importance and an essential element for quality patient care. Clinical pathways represent one such tool that clearly promotes the implementation of guidelines and research evidence into clinical practice. The aims of this study were to measure quantitatively and qualitatively the impact of a specially structured Resident-friendly, DKA clinical pathway on the application of evidence-based management standards and its acceptability by the treating resident physicians. A retrospective chart review of patients who were admitted prior to and after the launching of the clinical pathway and a questionnaire assessment of resident’s acceptance of the pathway format were undertaken. Eighty one episodes of DKA in a total of 58 patients fulfilled the criteria for inclusion in the study. Thirty seven admissions were on the pathway (45.7%) and 44 were not (54.3%). Documentation of severity indices of patients who were admitted under the pathway were significantly improved with a trend for a shorter hospital stay. The duration of intravenous insulin therapy, intensive care unit consultation and diabetes educator involvement in patient care were not different between the two groups. Residents found the pathway user-friendly, educationally very valuable, reduced their workload and had a positive effect on their DKA management skills.?Conclusions: Use of specially structured, resident-friendly pathway led to significant improvement in documentation of DKA severity indices and empowered our residents with evidence-based knowledge and skills to deal with this serious diabetic complication.

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.

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.

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.

Clinical metabolic analysis combined with traceability of biosynthetic pathway:a new approach to quality marker of Chinese materia medica

Quality marker(Q-marker)of Chinese materia medica(CMM)plays an important role in quality control of CMM products.However,its research strategy and technique remain unclear.Based on the fact that quality standard of CMM should be associated with clinical efficacy,taking Jinqi Jiangtang tablet treating type 2 diabetes as an example,the Q-marker related to activity via the reverse analysis of drug metabolism in clinic and traceability of botanic biosynthetic pathways is discovered and validated.Therefore,we proposed a new research strategy of Q-marker of CMM with"Discovery of clinical active constituents as guidance,Reverse analysis of metabolic transformations as link,and Traceability of biosynthesis pathways as key",to improve quality control of CMM products.