临床路径管理在外科手术中的实施效果观察

目的观察临床路径管理在外科手术中的实施效果。方法随机抽取2014-09~2016-09的5个外科病种,其中实施临床路径管理的358例(计划性剖宫产92例、输尿管结石71例、子宫平滑肌瘤64例、腹股沟疝53例、急性阑尾炎78例)为观察组,未实施临床路径管理的217例(计划性剖宫产56例、输尿管结石43例、子宫平滑肌瘤39例、腹股沟疝32例、急性阑尾炎47例)为对照组,对各病种两组病例的次均住院费用、次均药品住院费用、平均住院日、患者满意度进行观察比较。结果两组比较显示,次均住院费用急性阑尾炎差异不大,其余4个病种差异有统计学意义(P0.05);次均药品费用急性阑尾炎差异不大,其余4个病种差异有统计学意义(P0.05);平均住院日5个病种观察组均低于对照组,差异有统计学意义(P0.05);患者满意度腹股沟疝差异不大,其余4个病种差异有统计学意义(P0.05)。结论临床路径管理不仅能降低次均费用和次均药物费用,而且还能缩短平均住院日以及提升患者满意度。     

临床路径在新型农村合作医疗单病种管理中的应用效果

目的 探讨临床路径在新型农村合作医疗(新农合)单病种管理中的应用价值.方法 将同期于我院行阑尾炎、腹股沟疝手术的患者各60例随机分为观察组和对照组各60例,其中观察组制定临床路径并据此实施诊疗计划,对照组则依照常规医疗护理模式进行各项诊疗护理工作.观察两组住院时间、等待手术时间、住院费用,并调查患者满意度.结果 观察组两个病种患者的住院费用及住院时间均显著低于对照组,观察组腹股沟疝手术者等待手术时间亦显著低于对照组,P均＜0.05.结论 临床路径用于单病种管理有利于使新农合参保人员以低廉的费用享受优质的医疗卫生服务.     

临床路径在择期剖宫产手术中的应用

目的 探讨临床路径在择期剖宫产术产妇中的应用效果.方法 将100例择期剖宫产术产妇随机分为试验组和对照组,每组各50例.试验组按制定好的医、护、患临床路径实施每日诊疗、护理、康复工作,对照组采用传统医疗护理方法.结果 试验组平均住院日、平均住院费用明显低于对照组(P＜0.05);产妇满意度和健康知识评分明显高于对照组(P＜0.05).结论 按临床路径实施诊疗、护理及产妇的自理康复,可以减少平均住院日,降低住院费用,有利于产妇主动参与诊疗和护理,促进了产妇术后生活自理能力的恢复,提高了产妇满意度.     

临床护理路径在晚期血吸虫病巨脾型患者标准化管理中的应用

目的 目的 研究晚期血吸虫病巨脾型患者临床护理路径标准化管理的可行性及实施效果。方法 方法 将64例晚期血吸虫病巨脾型患者随机分为常规护理组 （对照组） 和临床护理路径组 （CNP组）, 分析比较2组患者术后情况、 平均住院日、 住院费用及满意率的区别。结果 结果 实施临床护理路径后, 晚期血吸虫病巨脾型患者的术后并发症、 平均住院日、 住院费用较对照组明显减少, 患者满意度从81.25%上升至100%。结论 结论 在晚期血吸虫病巨脾型患者治疗中实施CNP标准化管理有效降低了患者住院天数、 费用和并发症的发生, 提高了患者满意率。     

脑出血患者实施临床护理路径的效果研究

目的探讨脑出血患者实施临床护理路径的效果。方法选取2012年4月—2013年5月我科收治的脑出血患者50例,将其随机分为试验组和对照组,各25例。对照组采用传统的护理模式,试验组采用临床护理路径对患者实施有针对性、连续性的优质护理服务。比较两组患者对护理服务满意率、住院费用满意率、疾病相关知识认知率及住院天数满意率。结果试验组患者对护理服务满意率、住院费用满意率、疾病相关知识认知率、住院天数满意率均高于对照组(P0.05)。结论对脑出血患者应用临床护理路径,可降低患者医疗成本,缩短住院天数,增加患者满意率,提高医疗护理质量。     

临床路径在前列腺汽化电切术中的应用探讨

目的探讨临床路径在前列腺增生症行经尿道前列腺汽化电切术患者中的应用成效。方法将60例经尿道前列腺汽化电切术的患者随机分为观察组和对照组,每组各30例。观察组按制定好的临床路径进行诊疗护理。对照组采用传统的医疗护理模式。结果观察组患者的住院天数、住院费用明显低于对照组(P<0.01),患者满意度增高(P<0.05)。观察组护理人员在工作自主性、满足感和成就感上优于对照组的护理人员(P<0.01)。结论临床路径应用于前列腺汽化电切术患者,可减少无效住院日,降低医疗费用,减少术后并发症。不仅提高了患者满意度,还增强了护理人员的工作自主性、满足感和成就感,规范了护理行为,提高了护理质量,有良好的应用前景。     

自发性气胸患者实施临床护理路径的效果评价

目的探讨临床护理路径在自发性气胸患者中的应用效果。方法选取我院呼吸内科2010年4月—2012年12月收治的96例自发性气胸住院患者,将其随机分为观察组和对照组,各48例。在整体护理的基础上,给予对照组患者常规护理,给予观察组患者临床护理路径护理。结果和对照组相比,观察组患者的住院天数短、住院费用低、健康知识评分和满意度高,并发症发生率低,对护理服务满意度高,差异均有统计学意义(P<0.05)。结论在自发性气胸患者护理中应用临床护理路径可缩短患者的住院时间,降低住院费用,减少并发症,提高护理质量。     

临床护理路径对轻症胰腺炎实施优质护理的效果探讨

目的探讨临床护理路径对轻症胰腺炎患者实施优质护理的效果。方法选取2011年5月—2012年5月我院收治的轻症胰腺炎患者80例,将其随机分为试验组和对照组,各40例。对照组采用传统的护理模式,试验组利用临床护理路径对患者实施针对性、时间性、连续性的优质护理服务。比较两组患者护理服务满意率、疾病相关知识认知率、住院费用满意率、技术操作水平满意率等。结果试验组患者护理服务满意度、疾病相关知识认知率、住院费用满意率均高于对照组(P0.05)。两组操作技术水平满意率比较,差异无统计学意义(P0.05)。结论在轻症胰腺炎患者中应用临床护理路径,可降低医疗成本,增加患者满意率,提高医疗护理质量。     

要重视获得性免疫缺陷综合征临床路径的推广应用

临床路径是指针对一个病种制定出医院内医务人员必须遵循的诊疗模式,使患者从入院到出院依照该模式接受检查、手术、治疗、护理等医疗服务。近年来,临床路径管理成为提高医疗质量的一种新兴的临床诊疗规范化管理方式。     

临床路径在糖尿病肾病患者中的应用临床价值探究

目的探讨临床路径在糖尿病肾病患者中的应用临床价值。方法选取2012年12月—2013年12月来该院治疗的糖尿病肾病患者80例随机分为观察组和对照组。对照组接受常规治疗,观察组在常规治疗的基础上接受临床路径治疗。对两组患者的治疗效果、住院时间、住院及医疗总费用等进行比较分析。结果观察组的平均住院时间、平均住院费用明显少于对照组;而观察组患者的满意率也明显高于对照组,以上三项的差异均具有统计学意义(P<0.05)。结论采用临床路径的方法治疗,较常规的诊疗方法和模式具有明显的优势,能够产生良好的经济和社会效益,值得在临床上推广应用。     

Immunization of healthy children with measles-mumps-rubella trivalent vaccine simultaneously given with varicella vaccine]

Trivalent vaccine, containing measles TD97, rubella TCRB-19 and mumps NK-M46 strains (MMR vaccine) was administered to a total of 116 healthy children of which 50 subjects were simultaneously injected with varicella vaccine in the opposite arm. The seroconversion rates for measles, mumps, rubella, and varicella in those who received both MMR and varicella vaccines (MMR + V group) were 100% (44/44), 91% (39/43), 100% (46/46) and 95% (39/41), respectively. And these rates were comparable to those in subjects receiving only MMR vaccine, namely 100% (64/64) for measles, 95% (57/62) for mumps, and 97% (58/60) for rubella. Fifty-eight children receiving MMR vaccine were seronegative to measles, mumps and rubella before vaccination, and 51 (88%) of them were found to be seropositive against all three viruses at 6 to 8 weeks after vaccination. Among the children injected with MMR and varicella vaccines, 36 subjects had no pre-antibodies to measles, mumps, rubella and varicella. Seroconversion in post-serum to all four viruses were found in 31 cases (86%). Clinical reactions observed in some vaccines were mild fever (17%) and exanthem (5%). There were no complications of lymphadenopathy, swelling in parotid regions, or meningitis. Our results indicate that simultaneous administration of MMR vaccine and varicella vaccine is a safe and effective method for immunizing children against these four infectious diseases.     

Progress toward measles and rubella elimination in Egypt

Measles and rubella were common infectious diseases in Egypt during the prevaccine era. Monovalent measles vaccine was introduced in 1977, and measles vaccination coverage increased from <50% to >90% from 1980 to 1999; however, measles outbreaks continued to occur at 2- to 4-year intervals during this period. After the introduction of a second routine dose of measles vaccine as a combined measles-mumps-rubella (MMR) vaccine in 1999 and the implementation of measles immunization campaigns targeting 6- to 16-year-old children during 2000-2003, reported measles cases dramatically decreased by 2003. In 2002, Egypt established a goal to eliminate measles and rubella and to prevent congenital rubella syndrome (CRS) by 2010. Large-scale rubella and measles outbreaks in 2005-2007, however, led to a revision of the plan of action to achieve the 2010 goals. A nation-wide measles-rubella immunization campaign, targeting children, adolescents, and young adults 2-20 years old, was conducted in 2 phases during 2008-2009 and achieved coverage >95%. With the decrease to record low levels of cases of measles and rubella in 2009 and 2010, Egypt should achieve measles and rubella elimination in the near future, but high coverage(>95%) with 2 doses of measles-rubella vaccine needs to be maintained, measles-rubella surveillance strengthened, and CRS surveillance developed.     

Impact of a clinical pathway for total knee arthroplasty

The purpose of this study is to evaluate the effect of a clinical pathway for total knee arthroplasty in terms of length of stay, hospital costs, and quality of care. One hundred and twenty-two patients who underwent primary total knee arthroplasty for degenerative osteoarthritis in Kaohsiung Medical University hospital were included in the study. The pre-clinical pathway group included 53 patients before clinical pathway implementation (October 1996 approximately September 1997). The clinical pathway group included 69 patients after implementation of the clinical pathway (October 1997 approximately September 1998). All patients were followed up for at least 2 years after surgery. Data collection, including length of stay, hospital costs, comorbidity, and complications, was done by chart review, and Knee Society Clinical Rating System scores were used for assessment of preoperative and postoperative knee function for each group. Statistical analysis included Student's t-test to test the impact of the clinical pathway on resource consumption and medical care processes, and multiple linear regression to control for characteristics such as age and comorbidity. The implementation of the clinical pathway reduced the length of stay by 24%. Hospital costs were reduced by 16%. The implementation of the clinical pathway also reduced the number of unnecessary medical procedures. There was no statistically significant difference between the preoperative or the postoperative knee scores of the pre-clinical pathway group and clinical pathway group. The application of clinical pathway did not affect clinical outcomes and complication rates. In conclusion, the clinical pathway is an effective medical management tool to decrease the length of stay, decrease resource consumption and control medical care expenditure, and this is accomplished without a long-term adverse effect on quality of care.     

Pediatric admission for vaccine preventable diseases: a 5-year survey from 1994 to 1998 in Aichi Prefecture

Several infectious childhood diseases can be prevented by vaccination. A survey of hospital admissions for such diseases was conducted in Aichi Prefecture over 5 years beginning in 1994. A questionnaire was sent annually to hospitals with 100 or more beds to obtain information on pediatric patients requiring hospitalization for 10 vaccine preventable diseases. Information was obtained on 3,953 patients. Most admissions were for measles (49%), followed by mumps, chickenpox, pertussis, rubella, and tuberculosis. Over half of the patients were under 3 years old, with 20% aged under 12 months, 25% aged from 12 months to 2 years, and 10% aged from 2 to 3 years. The average hospital stay was longest for tuberculosis and pertussis, and was around 1 week for the other diseases. Familial transmission was the most common source of infection identified. The only death was an unvaccinated patient with measles pneumonia. Sequelae were reported at the time of discharge in 15 patients (0.4%), and were permanent in some cases. Some 96% of the patients surveyed were unvaccinated against the disease causing hospitalization. The fact that there were 14 patients with sequelae and the one patient who died were unvaccinated, emphasizes the need to promote vaccination.     

输入性疟疾临床路径的管理及其应用效果分析

 目的  探讨根据临床路径对输入性疟疾治疗的管理及其应用效果。 方法  收集首都医科大学附属北京友谊医院2011年1月至2012年12月期间疟疾住院患者的资料,分为临床路径组（43例,年龄25~56岁）和对照组（37例,年龄16~61岁）,评价两组患者住院天数、住院费用、临床疗效以及对疾病知识掌握程度、对医疗护理满意度情况。 结果  临床路径组疟疾患者平均住院天数为（6.1±1.5）d,对照组为（8±2.1）d,两组住院天数比较差异有统计学意义（P=0.000）;临床路径组和对照组总费用分别为（2 766±721）元、（4 393±1 392）元;西药费（576±291）元、（1 145±597）元;检验费（1 355±504）元、（1 939±645）元;检查费（109±16）元、（445±73）元;治疗费（73±22）元、（104±43）元;临床路径组均低于对照组（P＜0.05）。出院时,临床路径组患者对疟疾知识掌握程度、对医疗护理满意度与对照组比较差异有统计学意义（P＜0.05）。两组间临床疗效及30d内同一疾病非计划再入院无差异。 结论  临床路径管理在规范医疗行为的同时降低了本病的医疗成本,避免了过度用药、检查及治疗,临床路径的健康教育模式更有利于输入性疟疾患者的护理与康复。     

Immunization of healthy children with mumps-rubella bivalent live vaccine and simultaneous vaccination with mumps-rubella and varicella vaccines]

Bivalent virus vaccine, containing rubella TCRB-19 strain and mumps NK-M46 strain (MR vaccine), was administered to a total of 95 healthy children who had already received measles vaccine or had been infected with wild measles virus. The seroconversion rates for rubella and mumps viruses in subjects having no antibody to rubella or to mumps virus were 99% (75/76) and 97% (63/65), respectively, at 6-8 weeks after vaccination. The seroconversion rates for both rubella and mumps in vaccinees initially seronegative to both viruses were 95% (56/59). Immune responses after MR vaccine injection were comparable to those after administration of monovalent rubella or mumps vaccine. Clinical reactions observed in some subjects who received MR vaccine were mild fever (3.6%), exanthem (8%), lymphadenopathy (1.8%), and swelling of the parotis region (1.8%). MR vaccine could be simultaneously injected with varicella vaccine at the opposite site producing no adverse effect on immune response. Our results indicate that MR vaccine is a safe and effective vaccine, especially for children who have had wild measles or who have received measles vaccine.     

Management of infections in hospital employees

Hospital employees are often exposed to infectious diseases, both within and outside of the hospital. Susceptible personnel are at risk of acquiring infection and are a possible source of infection for patients, other employees and members of their households. In recent years epidemics in hospitals due to rubella, pertussis, hepatitis B and Legionnaires' disease have included infection transmitted to and from personnel. A comprehensive plan for management of hospital personnel exposed to communicable diseases should include the following: (1) protocols for the management of each of the common infectious diseases; (2) protocols for employees who are at special risk (pregnant women) and employees who work in areas of risk for certain infectious diseases (newborn nursery, clinical and pathology laboratories, hemodialysis unit); (3) assessment of infectious disease experience of new employees by history, skin test (tuberculosis) and serology (rubella, hepatitis B), and a plan for subsequent tests during employment; (4) continuous program of education of employees in infection control; and (5) coordination of policies among administration, employee health service and infection control officer and committee.     

Seroprevalence survey of measles,rubella, varicella,and mumps antibodies in health care workers and evaluation of a vaccination program in a tertiary care hospital in Japan

Vaccine-preventable viral infections in health care workers (HCWs) have been on the rise for the past 10 years in Japan. To reduce the viral infections and the burden of exposure follow-up surveys at a tertiary care hospital in Osaka, Japan, a seroprevalence survey was conducted, and free vaccinations for measles, rubella, varicella, and mumps were offered to newly hired HCWs (199 physicians and 72 nurses and nursing assistants) who had negative serologic results for antibodies against these viruses. Negative antibody titers were obtained from 7.4% of the newly hired HCWs for measles, 12.5% for rubella, 4.1% for varicella, and 15.9% for mumps. The vaccination program for HCWs improved the vaccine-preventable infection rates and resulted in fewer exposure follow-up surveys, fewer lost work days, and fewer HCWs requiring hospitalization for these viral infections compared with those counted for the previous year. These data indicate that all HCWs should be strongly recommended to be vaccinated against (or have documented immunity to) these viruses in Japan, as is the case in the United States.     

Immunity to vaccine-preventable diseases among paediatric healthcare workers in Denmark, 2019

BackgroundHealthcare workers (HCW) have been identified as index cases in disease outbreaks of vaccine-preventable diseases (VPD) in hospitals.AimWe investigated whether Danish paediatric HCW were protected against selected serious VPD.MethodsWe included 90% of staff members from two paediatric departments. All 555 HCW (496 women) supplied a blood sample for serology and filled in a questionnaire. Antibodies were measured with enzyme immunoassay against measles, mumps, rubella (MMR), varicella zoster, pertussis toxin and diphtheria toxin.ResultsProtective levels of IgG were found for measles (90.3%), mumps (86.5%), rubella (92.3%), varicella (98.6%) and diphtheria (80.5%). We found seropositivity for all three MMR components in 421 (75.9%) HCW, lowest in those younger than 36 years (63.3%). Only 28 (5%) HCW had measurable IgG to pertussis. HCW with self-reported immunity defined as previous infection or vaccination, had protective levels of IgG against measles, mumps, rubella and varicella in 87.4–98.8% of cases, not significantly higher than in those not reporting immunity. Previous history of disease had a high positive predictive value (PPV) of 96.8–98.8%. The PPV for previous vaccination ranged from 82.5% to 90.3%. In contrast, negative predictive values of self-reported history of disease and vaccination were remarkably low for all diseases.ConclusionThe immunity gaps found primarily in young HCW indicate a need for a screening and vaccination strategy for this group. Considering the poor correlation between self-reported immunity and seropositivity, efforts should be made to check HCW’s immune status in order to identify those who would benefit from vaccination.     

社区获得性肺炎临床路径实施效果的评价与分析

目的 了解社区获得性肺炎临床路径的实施情况,分析我院临床路径实施的效果.方法 回顾性分析我院2011年11月～2012年8月收治的253例成人社区获得性肺炎患者的临床资料,了解入径率、路径组与非路径组平均住院日、路径组抗生素使用、CURB-65评分对临床路径的价值以及未进入临床路径的原因.结果 入径率为81.0％;路径组平均住院日为（10.46±4.36）天,非路径组平均住院日为（22.31±12.53）天;路径组抗生素使用基本符合指南要求;CURB-65评分越低,越有可能进入临床路径;未能进入临床路径的原因有病情加重转入ICU,合并肺癌、肾功能衰竭、泌尿系感染、脑血管病等基础疾病、住院时间过长、使用了指南之外的抗生素、因经费问题要求出院等.结论 实施社区获得性肺炎临床路径能缩短平均住院日,促进抗生素使用规范,减少平均住院费用,有利于促进医院整体医疗安全、质量、效率及费用控制等综合管理水平的提高.