ABSTRACT
Objective To explore the effect of clinical evidence management program based on evidence-based concept in the implementation of hospital bronchial pneumonia management. Methods Fifty-six patients diagnosed with bronchial pneumonia and admitted to the First Affiliated Hospital of Chongqing Medical University from January 2016 to January 2018 were enrolled. Patients were divided into study group (28 cases) and control group (28 cases). The control group was implemented routine medical management programs, including establishing cases, health education, and routine examinations; the research team was implemented the clinical pathway management scheme based on the concept of evidence-based medicine, that is, to set up a bronchopneumonia management team to manage and monitor the patient's care and treatment based on evidence-based theory, conduct regular spot checks, find problems and correct them in time, and establish a unified standardized process according to the contents specified in the clinical pathway form. The clinical efficacy, the length of hospital stay, hospitalization costs, and life quality of the patients were compared between two groups. Results The gender, age, and degree of disease of the two groups were highly balanced. Compared with the control group, the total clinical effective rate of the study group was significantly increased (92.9% vs. 71.4%, χ2= 10.746, P = 0.002), the length of hospital stay was significantly shortened (days: 9.6±1.8 vs. 13.8±2.4, t = 5.927, P = 0.001), the hospitalization costs were significantly reduced (yuan: 4 855.0±822.8 vs. 6 452.0±845.5, t = 6.210, P = 0.000). In addition, the scores of somatic pain, somatic function, physiological function, social function, vitality, psychological function, emotional function and overall health in the SF-36 scale in the study group were significantly higher than those in the control group [somatic pain: 80.71±2.23 vs. 72.87±1.77, somatic function:81.44±5.02 vs. 70.43±4.46, physiological function: 82.11±3.12 vs. 71.86±3.65, social function: 62.51±1.60 vs. 51.33±1.58, vitality: 87.40±1.65 vs. 70.11±1.90, psychological function: 82.30±1.32 vs. 75.52±1.62, emotional function: 73.66±2.81 vs. 66.54±2.60, overall health: 78.32±1.93 vs. 58.90±1.00, all P < 0.01]. Conclusion The evidence-based clinical path management program can significantly improve the clinical outcomes of patients with bronchial pneumonia, shorten the length of hospital stay, reduce hospitalization costs, and have higher patient life quality.
ABSTRACT
Objective To study the safety,efficacy and advantages of enhanced recovery after surgery (ERAS) combined with clinical pathway management in laparoscopic common bile duct exploration and lithotomy (Laparoscopic common bile duct exploration,LCBDE).Methods 78 patients who underwent LCBDE in the Department of Hepatobiliary and Pancreatic Surgery in the First Hospital of Fuyang District in Hangzhou were selected as the non-ERAS group (the control group).76 patients who underwent LCBDE treated with fast track surgery and ERAS clinical pathway management were selected as the ERAS group.The data between the two groups which included the postoperative insulin resistance index,changes in C-reactive protein,duration of postoperative analgesic use and analgesia,timing of first passage of postoperative flatus,postoperative abdominal tube removal,postoperative bile leakage,recurrence of biliary stones,intestinal ileus and other complications.Results All the two groups were discharged home successfully.On preoperative 7 day,the differences on the postoperative insulin resistance index and the levels of C reactive protein were significantly different (P＜0.05).The time to first get out of bed after operation,the postoperative analgesic use,the time to first passage of flatus,the time to postoperative abdominal drainage tube removal,and the time to clamping of the T tube after operation were significantly different (all P＜0.05).The postoperative complications of pulmonary infection,abdominal infection and the incidence of prolonged intestinal ileus were significantly different (all P＜0.05).Conclusions ERAS combined with clinical pathway management reduced postoperative stress reaction and complication rate.The treatment accelerated recovery and shortened hospital stay for patients who underwent LCBDE,which led to good social and economic benefits.