影响临床路径实施因素概述

临床路径(clinical pathway,CP)是近年来逐渐发展起来的一种标准化诊疗及医疗管理模式.它是一种多学科共同协作、医院综合管理的整体医疗工作模式,是由医疗、护理、医技等多个相关专业人员对某一特定的疾病做最恰当的有序性诊疗计划,从而缩短患者康复时间、控制医疗经费、减少资源浪费、提高医疗质量[1]. 1临床路径的起源及发展 "临床路径"的概念最早起源于20世纪70年代早期.当时,美国医疗费用急速上涨,政府医疗系统和国家财政承受巨大压力.在这种背景下,政府对医院实施了"预先支付系统(prospective payment,PPS)".实施"预先支付系统"后,控制成本成为医院长期生存的关键,临床路径应运而生[2].     

I期临床试验研究概述

人体试验伴随着医学的发展而发展。在中国从神农尝百草的传说到唐宋年间(约公元1000年前后)种人痘的记载:在西方从18世纪前叶,Edward Jenner在人群中接种天花疫苗,到1907年Ehrlich的胂凡钠明开创了第一例特异性的药理学疗法,人体试验的重要性逐渐为人们所认识,实验的数量和范围也不断增加。     

骨关节炎的临床治疗研究概述

骨关节炎（OA）又称为骨关节病、退行性关节病和增生性关节炎等,是常见的关节软骨退变而引发的非炎症病变,其主要病理改变为关节软骨退变、缺损、软骨为深度硬化及关节缘骨质增生等。无症状性OA最早可发生于20～30岁年龄。OA的发病率随着年龄的增加而增高。     

Ⅰ期临床试验研究概述

人体试验伴随着医学的发展而发展.在中国从神农尝百草的传说到唐宋年间(约公元1000年前后)种人痘的记载[1]:在西方从18世纪前叶,edward jenner 在人群中接种天花疫苗,到1907年ehrlich的刖凡钠明开创了第一例特异性的药理学疗法,人体试验的重要性逐渐为人们所认识,实验的数量和范围也不断增加.     

临床药效学概述

药物的最终价值取决于其药效动力学作用,评价药物治疗效果最直接的方法是监测药理效应和临床效果,并且,临床治疗中所关心的真正内容是药物的疗效而不是药物的浓度,这就说明为了提高合理用药水平,仅测定血药浓度是不够的。因此,在疾病的发展和用药     

仙茅药理作用和临床应用研究概述

仙茅为石蒜科多年生草本植物仙茅（Curculligo or—chioides Gaertn）的干燥根茎^[1]。其味辛,性热、有毒。具有消散痈肿、补肾阳、强筋骨、祛寒湿、益精血等功效。常用于痈疽肿痛、肾阳不足、阳痿精冷、筋骨痿软、腰膝冷痹、阳虚冷泻等症^[2]。其化学成分主要包括酚性化合物及酚苷,环菠萝蜜烷型三萜皂苷,木脂素及木脂素苷类,黄酮类化合物,苯环取代物、桉烷类衍生物和甜味蛋白以及挥发油等^[3]。     

复方丹参滴丸国内临床应用研究概述

本文对国内近年来复方丹参滴丸在冠心病、心绞痛、糖尿病、高血压等方面的临床应用进行了概述,以期为临床医生用药提供参考。     

左布比卡因临床应用研究概述

左布比卡因是新型长效酰胺类局部麻醉药,是布比卡因的左旋异构体。其神经毒性和心脏毒性均低于布比卡因,因而具有更广泛的临床用途。本文主要针对近几年来左布比卡因的临床应用作简要综述。     

利奈唑胺临床应用研究概述

自20世纪70年代以来,由革兰阳性(G+)菌引起的感染在全球范围内迅速蔓延,同时,病原菌对抗菌药物的耐药性也在迅速增加。目前,多药耐药性(MDR)已经对人类的健康与生命构成重大威胁,临床上在治疗多重耐药菌感染时,可供选择的药物十分有限。许多制药公司都在积极研发     

盐酸阿罗洛尔临床应用研究概述

盐酸阿罗洛尔是具有β受体阻滞和适度α受体阻滞作用的降压药,降压效果明显,被广泛地应用于高血压、慢性肾功能不全合并高血压、心绞痛、原发性震颤等疾病的治疗。本文主要针对阿罗洛尔近几年的临床应用做简要综述。     

ICU护理临床路径在急症抢救中与常规路径的对比研究

目的:对比在急症抢救中ICU护理临床路径与常规路径的抢救价值,为急症抢救工作的开展提供参考。方法:选择某院2016年5月～2017年5月收治的110例急症抢救患者,按照随机数字表进行实验分组。对照组(n=55)采取常规路径,实验组(n=55)采取临床路径,对比两组急症抢救患者的抢救成功率以及有效抢救、执行医嘱时间。结果:组间抢救成功率对比,实验组高于对照组(P<0.05);组间有效抢救时间、执行医嘱时间对比,实验组所需时间均明显短于对照组(P<0.05)。结论:ICU护理临床路径干预可以提高急症抢救患者的抢救成功率,缩短抢救以及执行医嘱时间,具有实施价值。     

临床药师参与癫痫临床路径实施效果的对照研究

目的：探讨临床药师参与实施临床路径、确保临床合理用药的方法。方法：我院实施癫痫临床路径前、后,临床药师通过参与临床路径合理用药方案的本地化调整及监测内容制订,对干预临床路径合理用药指标的结果进行对照分析。结果：实施临床路径后,我院患者的平均住院时间减少了0.7d,平均住院费用降低了324.5元,临床路径组总费用比对照组多收入了70311.50元。主要合理用药指标,即等间隔用药比例及血药浓度监测比例分别由36.04%和72.07%上升至97.66%和93.75%。结论：临床药师可以参与临床路径实施的全过程,在确保临床路径实施和规范临床合理用药方面发挥作用。     

躁狂抑郁症患者应用临床路径的护理分析

目的:分析临床路径在躁狂抑郁症患者护理中的应用效果。方法:选取某院在2013年11月~2014年11月收治的84例躁狂抑郁症患者为研究对象,随机分成对照组和实验组,每组各42例。对照组患者予以常规护理,实验组患者予以临床路径护理,对比两组患者的护理效果。结果:(1)实验组患者的住院时间、住院费用和SDS评分均明显低于对照组(P0.05);(2)实验组患者的护理总满意度(95.24%)显著高于对照组(80.95%)(P0.05)。结论:对躁狂抑郁症患者实施临床路径护理,效果明显优于常规护理,具有较高的临床应用和推广价值。     

An Overview of Statistical Planning to Address Subgroups in Confirmatory Clinical Trials

The effects of treatments within demographic and clinical subgroups of patients are of major interest in most confirmatory clinical trials. Potential factors for defining subgroups include gender, age, disease severity, and geographic region. A major statistical issue for the interpretation of treatment comparisons for subgroups is whether the role of a subgroup is inferential, supportive, or exploratory through respectively corresponding to a primary, key secondary, or hypothesis-generating assessment. This article discusses statistical planning to control type 1 error for the multiple comparisons that correspond to the scope of prespecified inferential subgroups, and it provides some suggestions for addressing the type 2 error that can pertain to prespecified supportive subgroups. Treatment comparisons for exploratory subgroups without a priori specification should always have a very cautious interpretation that accounts for how random variation can influence their pattern of results, although the suggested methods for supportive subgroups can be helpful in this light.     

临床路径：药师作用不可或缺

目的：对实施临床路径过程中临床药师所起的作用进行综述。方法：检索参阅相关文献并进行总结归纳。结果：在临床路径的制定、实施、改进过程中,药师的参与都有重要的意义。结论：临床路径正在我国日益推广开来．然而．临床药师在临床路径中应发挥的作用还亟待进一步重视和肯定。     

Trovafloxacin: An Overview

Trovafloxacin, a new synthetic naphthyridine fluoroquinolone antibiotic, is a broad-spectrum agent available orally and intravenously. It was recently approved by the Food and Drug Administration for the treatment of selected pulmonary, surgical, intraabdominal, gynecologic, pelvic, skin, and urinary tract infections. Its spectrum of activity includes aerobic gram-positive and gram-negative organisms as well as anaerobic pathogens. It is rapidly absorbed after oral administration, achieves good tissue and cerebrospinal fluid penetration, and has a half-life that allows once-daily dosing. It is hepatically metabolized, and dosage adjustments are necessary for patients with severe hepatic dysfunction but not for those with mild or moderate dysfunction or renal dysfunction. The drug has a favorable safety profile, and a high tendency for transient first-dose dizziness and/or lightheadedness in young women. Similar to other quinolones, trovafloxacin should not be taken with antacids that contain aluminum or magnesium, sucralfate, or ferrous sulfate. Trovafloxacin may prove beneficial as it allows for oral or intravenous monotherapy against indicated infections that normally require multidrug, broad-spectrum antibiotic coverage.     

病例组合与临床路径

随着不断的应用与扩展,临床路径已成为一种医院质量管理的有效工具和疾病诊疗的评估标准。     

临床药师参与制订临床路径病种预防用抗菌药物作用探讨

目的:探讨临床药师在临床路径执行中的作用。方法:对本院临床药师参与制订临床路径病种预防用抗菌药物的工作方法及效果进行总结。结果:临床药师通过查阅资料及与临床医师面对面进行沟通,使其推荐的围术期抗菌药物用药方案得到了临床的认可和执行。结论:临床药师在临床路径执行中发挥着重要的作用。     

Ceftibuten: An Overview

Ceftibuten is an orally active third-generation cephalosporin that exhibits good microbiologic activity against many gram-negative and select gram-positive organisms. It is stable against plasmid-mediated β-lactamases, including extended-spectrum β-lactamases. Ceftibuten has been shown to be effective in the treatment of upper and lower respiratory tract infections and, although not approved indications, complicated and uncomplicated urinary tract infections in both adults and children. It is readily absorbed (75–90%) after oral administration, with peak serum levels of 17 μg/ml in healthy volunteers. Its half-life is 2.5 hours in healthy volunteers and is increased in elderly patients to approximately 3.2 hours. Elimination occurs primarily through the kidneys, requiring dosage adjustments to be made when creatinine clearance falls below 50 ml/minute. The drug's safety profile is favorable and similar to that of most other cephalosporins. Based on pharmacokinetic information and clinical trial data, ceftibuten can be dosed once/day for most infections. It is an alternative to other currently available antimicrobial agents in the treatment of indicated upper and lower respiratory tract infections.