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Objective To explore the effective strategies of clinical pathway construction in intensive care unit (ICU).Methods From January 2016 to July 2018,1 488 patients were discharged from ICU of Liuzhou Worker's Hospital of Guangxi Zhuang Autonomous Region.The pilot project of "postoperative monitoring of heart disease" with simpler route and less variation was selected first,and then the pilot project was promoted to "post-operative monitoring" after its success.The implementation of the clinical pathway was divided into three stages:the first stage,January 2016 to May 2017,for the pilot phase,a total of 87 patients were enrolled in the clinical pathway trial;the second stage,June 2017 to December 2017,surgical ICU "postoperative monitoring of heart disease" was put into the pathway 111 times;the third stage,January 2018 to July 2018,surgical ICU "postoperative monitoring of heart disease" was entered in the path 116 times;comprehensive ICU "postoperative care" was put into the path 96 times.After carefully analyzed the reasons and sum up the experience,internet+medical treatment (Liuzhou Worker's Hospital became the fifih deep partner of Tencent Inc in the internct+medical field,and carried out the plan and practice of "WeChat wisdom hospital 3.0" in 2017) was used,four aspects of connection,payment,security and ecological cooperation were upgraded,and the construction of 6 level of electronic medical record (EMR) was accelerated.At the same time,through diagnosis related groups system (DRGs),the concept of evidence-based medicine,quality management and continuous improvement as the leading factor,and combined with the construction status of hospital information system (HIS) and EMR system,step by step implementation and design of information management platform for clinical pathway were formulated.The completion rate of clinical pathway,average length of hospital stay,average cost,cure rate and improvement rate were the main observation parameters.Results In the first stage,none of the 87 patients who entered the clinical pathway completed the clinical pathway.In the second stage,the completion rate of surgical ICU clinical pathway was increased from 33.33％ in June 2017 to 94.44％ in December 2017,and up to 100％ in October 2017,and the average completion rate from January to July 2018 was 94.00％.The completion rate of ICU clinical pathway was increased from 81.82％ in January 2008 to 92.86％ in July 2008.There was a significant difference in the overall clinical pathway completion rate from 2016 to 2018 (x2 =204.300,P =0.000).After the effective implementation of clinical pathway in June 2017,the length of hospital stay of patients was significantly shortened as compared with that before implementation (days:2.96 ± 0.43 vs.6.66 ± 0.75,P ＜ 0.01),and the daily cost was significantly reduced (Yuan:3 550.92 ± 755.51 vs.6 171.48 ± 377.29,P ＜ 0.01).The average length of hospital stay was shortened by about 3.84 days (P ＜ 0.01),and the average daily cost was reduced by about 2 108.39 Yuan (P ＜ 0.01) after the implementation of clinical pathway by surgical ICU "postoperative monitoring of heart disease" as compared with those before implementation.The average length of hospital stay was shortened by about 2.98 days (P ＜ 0.01) and the average daily cost was reduced by 5 094.13 Yuan (P ＜ 0.01) after the implementation of clinical pathway by comprehensive ICU "post-operative monitoring" as compared with those before implementation.At the same time,the cure rate was increased from 1.16％ (7/603) to 42.26％ (105/227),and the improvement rate was decreased from 94.36％ (569/603) to 52.86％ (120/227,both P ＜ 0.01) after the implementation of surgical ICU clinical pathway,but there was no significant difference in the cure rate or the improvement rate after the implementation of comprehensive ICU [2.77％ (33/1 193) vs.2.22％ (2/90),79.21％ (945/1 193) vs.97.78％ (88/90),both P ＞ 0.05].Conclusions Application of clinical pathway to control ICU quality and guide diagnosis and treatment,more refined diagnosis and treatment schemes including clinical guidelines,average length of stay,average cost of hospitalization,cost-efficiency ratio and so on were completed,which confirmed that the improvement of clinical pathway management strategy originated from clinical were needed.Informatization,intellectualization,standardization and effective control of medical cost of clinical pathway could improve medical quality and accurate management.The integration of ICU clinical pathway construction and HIS could promote the development of digital hospitals.
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Objective To explore the impact of diagnosis related groups (DRGs) payment and drug zero plus on the management of intensive care medicine department. Methods The clinical data of patients in one year from 2016 to 2017 admitted into the Department of ICU in Liuzhou Worker's Hospital concerning their numbers of discharged patients, transferred patients, bed utilization rate, number of bed turnover, average length of stay of discharged patients, cure and improvement rates, admission and discharge diagnostic coincidence rate, 3-day definite diagnosis rate, clinicopathological diagnosis coincidence rate, rescue success rate, total income, drug proportion, consumable proportion, DRGs payment and settlement data, etc were retrospectively analyzed to explore the dual challenges, DRGs payment and drug zero plus, facing the department and how to respond and deal with them. Results In 2016 and 2017, the total incomes of the department of critical care medicine in our hospital were 42.107 0 million yuan and 41.371 3 million yuan respectively, and the medical insurance incomes were 15.03 million yuan and 16.69 million yuan respectively;in 2016 and 2017, 2 693 patients and 2 922 patients were admitted and treated respectively; 595 patients and 577 patients were discharged respectively, with 2 071 patients and 2 334 patients transferred respectively; the balances of the department were 15.48 million yuan and 29.11 million yuan, respectively. From July to December 2017, the medical insurance DRGs payment data suggested that the proportion of loss of the department be 7.02%. Accelerating the Grade 6 electronic medical records and informationization construction, adopting the severe disease information solution program and fine quality control management in the department of critical care medicine can reduce the cost of manpower. Conclusion Our future development direction in the Department of Intensive Care Medicine includes the following aspects: Open source and reduce expenditure, strictly control the proportions of drugs and consumables, improve the balance of the department, and actively respond and deal with the medical insurance DRGs payment.
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Objective To observe the clinical effects of fresh amniotic membrane transplantation combined soft corneal contact lens and immunomodulatory therapy on epithelial herpes simplex keratitis (HSK),Methods Together 56 participants with recrudesced epithelial type HSK were incorporated from January of 2012 to January of 2014,and randomly divided into control group and treatment group according to random number table.The treatment group was performed complete removal of corneal lesions with microscope,and then the whole cornea was covered with double fresh amniotic membrane;after the whole limbus was fixed with continuous suturing,the soft contact lenses were worn at the end of the operation.After the operation,Chinese formula,including Yupingfeng particles,ganciclovir ophthalmic gel and oral valacyclovir hydrochloride tablets,was administrated.The control group was treated only with ganciclovir ophthalmic gel and oral valaciclovir hydrochloride tablets,Results In control group,15 patients (53.6％) were cured,6 (21.4％) were markedly improved,2 (7.1％) were effective,5 (17.9％) was invalid,and the overall effective rate was 82.1％,but 6 patients (21.4％) were recrudesced;while in the treatment group,22 patients (78.6％)were cured,6 (21.4％) were markedly improved,and the total effective rate was 100.0％,but 3 patients were recurred.Moreover,the visual acuity were improved about 0.43 visual lines in the control group,and about 2.14 lines in treatment group.Therefore,the curative rate,effective rate and visual improvement of the treatment group was significantly better than those of the control group (all P ＜ 0.05),but the recurrence rate was lower than that of the control group (P ＜ 0.05).Conclusion The comprehensive treatment including fresh anniotic membrane transplantation combined corneal contact lens with Chinese formula were effective for quickly and effectively controlling inflammation,promoting ulcer repair and shortening the course of disease as well as reducing the recurrence.
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AIM: To evaluate the clinical feature of 9 patients harboring mitochondrial DNA ( mtDNA ) G11778A mutation with Leber hereditary optic neuropathy ( LHON) . ●METHODS: Nine LHON patients were enrolled and followed- up between 2012 to 2015 in Shenzhen Eye Hospital, clinical data were collected and analyzed. ●RESULTS: Six cases had maternal inheritance history ( 67%) . Three were sporadic cases. The patients aged from 9 to 43 years old, with average age of (22. 00±9. 42) years. Simultaneous onset with both eyes was in 5 cases (56%). Successively onset was in other 4 cases (44%). The ratio between male and female was 2:1. In the last follow-up, the visual acuity was finger counted in 2 eyes (11%), 0. 01-0. 1 in 12 eyes (67%), 0. 12-0. 4 in 2 eyes (11%),≥0. 4 in 2 eyes (11%). All patients had pale disc and clear boundary. ln the Humphrey visual field examination, 10 eyes had typically cecocentral or paracentral scotoma, 8 eyes had diffuse visual field defect. ●CONCLUSION: ln the 9 LHON patients with mtDNA G11778A mutation, simultaneous onset cases were more than successively onset cases within 1y cases. In most cases, LHON patients kept stable visual acuity. Rare cases had a raise in visual acuity within 1y. Majority patients had typically cecocentral or paracentral visual field scotoma. In the last stage of LHON, visual field present diffused defect. The secondary affected eye was similar performed defect as the former one.
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PURPOSE: We studied the voiding dysfunction after surgical treatment of female stress urinary incontinence and diagnosis and treatment. MATERIALS AND METHODS: Three hundred women with stress urinary incontinence underwent surgical procedure between January 1998 and December 2004. Ninety two patients(30.6%) experienced the postoperative voiding dysfunction. As the primary procedure for the management of postoperative voiding dysfunction alpha-blockers medication and clean intermittent catheterization(CIC) were performed. Then, hegar dilation and urethral pull-down procedure were performed as a secondary measure. For the patients who showed persistent obstructed symptoms, cutting of mesh or sling materials were performed. RESULTS: In 57 patients, symptoms improved by alpha-blockers medication and CIC. The others were received hegar dilation and urethral pull-down procedure, and 29 patients were improved. 6 patients were not controlled by conservative treatment, of which 3 patients underwent cutting of mesh or sling. De novo urgency was developed in 12 patients. Anticholinergics were taken, symptoms were diminished in 10 patients after 5 months of medication. CONCLUSION: Most voiding dysfunction after surgery may be effectively managed by conservative treatment. In cases of failure, hegar dilation and urethral pull-down procedure may be useful within postoperative first weak. Finally, cutting of mesh or sling must be considered in patient whose the secondary measure is failed.
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Female , Humans , Cholinergic Antagonists , Diagnosis , Urinary IncontinenceABSTRACT
PROPOSE: A specific criterion or comprehensive criteria for the condition of nocturnal erection, which can be considered as an abnormal erection mechanism or organic erectile dysfunction(ED), remain to be established. Thus, it was decided to verify the tenability of the currently referred criteria by performing nocturnal erection tests on volunteers with normal sexual cravings and erection capabilities. MATERIALS AND METHODS: This study was performed on 58 volunteers aged 20 years or older, with a normal sexual life and without past perversion. An IIEF questionnaire was used for verification of normalcy. Only the results from the volunteers who had had more than 4 sexual intercourses during the past 4 weeks, and had attained satisfaction, were reflected in the final report. All subjects completed three sessions of 3 nights of recording using the RigiScan device during the 3 day period. The volunteers were excluded if they woke due to the pressure of the ring or when they had less than 6 hours sleep during the test. RESULTS: The average number and period of erections were 3.7+/-1.7 times and 91+/-53.3 minutes and the average hardness of the distal part and base of the penis were 61+/-25.1 and 73.7+/-22.1% respectively. The average number of erections and maintained duration were 3.7 and 91 minutes, respectively. With more than 40% hardness, the distal part and base of the penis stayed erect for 62.3+/-37.0 and 74.1+/-46.5 minutes, while these figures for an erection were 57.7+/-35.7 and 72.8+/-46.3 minutes, respectively, as confirmed by greater than 60% hardness. Therefore, 56 of the 58(96.5%) failed to satisfy more than one of the criteria and 44(75.8%) did not meet the Brandley's nocturnal erection criterion standard. CONCLUSIONS: Our results were below the criteria for the existing erection test, which means there is the likelihood that these standards are overly high for Korean adult males. Apparently not all cases failing to reach the existing standard level of the nocturnal erection test should be considered as ED, with greater discretion required in the diagnosis for patients with ED.