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 .

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.

莫斯顿互惠式CP教学法对神经外科护理实习生的带教效果观察

目的:研究莫斯顿互惠式CP教学法在神经外科护理实习生带教中的应用效果。方法:选取神经外科护理实习生92人作为研究对象,随机抽取46人为对照组,46人为试验组,分别应用传统教学法与莫斯顿互惠式CP教学法进行带教。对两组护理实习生进行出科考试和核心胜任力评价,数据进行统计学分析。结果:试验组护理实习生的出科考试成绩、核心胜任力评分和素质水平评分均明显高于对照组,P<0.05。结论:莫斯顿互惠式CP教学法不仅可提高神经外科护理实习生的出科考试成绩,还能增强护理实习生的核心胜任力与素质水平。

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.

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.

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.

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.

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.

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.

CP结合TBL教学在妇产科学临床实习教学中的应用分析

目的探讨临床路径(Clinical Pathway,CP)结合以团队为基础的教学(Team Based Learning,TBL)在妇产科学临床实习教学中的应用效果。方法分别选取2022年1—6月、2023年1—6月浠水县妇幼保健院产科实习的两批实习医生作为对照组、研究组,各30名。对照组应用传统教学法,研究组应用CP结合TBL教学法,比较两组学习态度评分、考核成绩及综合能力评分。结果研究组学习态度评分、考核成绩及综合能力评分均高于对照组,差异有统计学意义(P均<0.05)。结论在妇产科实习中,应用CP结合TBL的教学法可调整实习医生的学习态度,使其熟练掌握理论知识及操作技能,并可培养其综合能力。

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.

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.

儿科学临床见习中运用TBL加CP教学模式的效果

目的研究分析儿科学临床见习中运用团队教学法(team-based learning,TBL)加临床路径(clinical pathway,CP)教学模式的效果。方法选取2021年5月—2022年5月期间来常德市妇幼保健院儿科进行见习的12名临床医学生。采取随机数表法分为两组,其中6名纳入常规教学组,其余6名纳入联合教学组。比较两组临床技能成绩、基础理论知识成绩以及对教学模式的满意率。结果联合教学组学生在出科时的临床技能成绩、基础理论知识成绩均明显优于常规教学组,差异有统计学意义(P<0.05)。联合教学组学生对教学模式的满意率与常规教学组学生相比,差异无统计学意义(P>0.05)。结论在儿科学临床见习工作中运用TBL加CP教学模式能够有效提高学生的临床技能水平以及对基础理论知识的掌握程度,且学生对于该种教学模式的满意度更高,有利于提高学生学习和工作的主动性和积极性。

CP教学在医学临床带教中应用效果的Meta分析

目的评价CP教学在医学临床带教中的应用效果。方法检索中国期刊全文数据库,收集近五年(2012～2017)CP教学在医学临床带教中应用的随机对照试验(RCTs)38篇,按照纳入和排除标准独立筛选文献、提取资料,用Rev Man 5.3软件进行数据分析。结果共纳入29篇RCTs,共计1000余名学生,分析显示,CP教学对学生理论测试成绩[SMD=1.82,95%CI(1.70～1.94),P<0.01]、实践技能操作成绩[SMD=1.57,95%CI(1.45～1.69),P<0.01]及病例分析能力测试成绩[SMD=1.51,95%CI(1.30～1.73),P<0.01]均优于普通临床带教。结论 CP教学是一种较为科学的带教法,可用于医学临床带教。

PBL联合CP教学模式在骨科学临床实习教学中的应用研究

为提高学生的自主学习能力及评判性思维能力,本研究将以问题为导向的教学方法(problem-based learning,PBL)和临床路径(clinical pathway,CP)相结合的教学模式应用到脊柱骨科临床实习教学中,并与传统带教方法进行对比研究。研究结果表明:PBL联合CP教学模式在脊柱骨科实习带教中具有十分重要的价值,该方法不仅使实习生了解并掌握脊柱骨科重点的单病种疾病,同时能够使学生系统学习脊柱骨科重点专科知识,培养临床思维及批判性思维,对于学生自主学习能力的提高也具有促进作用。

Targeting RAS-RAF-MEK-ERK signaling pathway in human cancer:Current status in clinical trials

Molecular target inhibitors have been regularly approved by Food and Drug Administration(FDA)for tumor treatment,and most of them intervene in tumor cell proliferation and metabolism.The RAS-RAF-MEK-ERK pathway is a conserved signaling pathway that plays vital roles in cell proliferation,survival,and differentiation.The aberrant activation of the RAS-RAF-MEK-ERK signaling pathway induces tumors.About 33%of tumors harbor RAS mutations,while 8%of tumors are driven by RAF mutations.Great efforts have been dedicated to targeting the signaling pathway for cancer treatment in the past decades.In this review,we summarized the development of inhibitors targeting the RAS-RAF-MEK-ERK pathway with an emphasis on those used in clinical treatment.Moreover,we discussed the potential combinations of inhibitors that target the RAS-RAF-MEK-ERK signaling pathway and other signaling pathways.The inhibitors targeting the RAS-RAF-MEK-ERK pathway have essentially modified the therapeutic strategy against various cancers and deserve more attention in the current cancerresearchandtreatment.