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@#At present, implant surgery robots have basically achieved "surgical intelligence", but "brain-inspired intelligence" of robots is still in the stage of theory and exploration. The formulation of a clinical implantation plan depends on the timing of implantation, implantation area, bone condition, surgical procedure, patient factors, etc., which need to evaluate the corresponding clinical decision indicators and clinical pathways. Inspired by evidence-based medicine and the potential of big data and deep learning, combined with the data characteristics of clinical decision indicators and clinical pathways that can be quantitatively or qualitatively analyzed, this review simulates the cognitive behavior and neural mechanisms of the human brain and proposes a feasible brain-inspired intelligence scheme by predicting the decision indices and executing clinical pathways intelligently, that is, "select clinical indicators and clarify clinical pathways -- construct database -- use deep learning to intelligently predict decision indicators -- intelligent execution of clinical pathways -- brain-inspired intelligence of implant decision-making". Combined with the previous research results of our team, this review also describes the process of realization of brain-inspired intelligence for immediate implant timing decisions, providing an example of the comprehensive realization of brain-inspired intelligence of implant surgery robots in the future. In the future, how to excavate and summarize other clinical decision factors and select the best way to realize the automatic prediction of evidence-based clinical indicators and pathways and finally realize the complete intellectualization of clinical diagnosis and treatment processes will be one of the directions that dental clinicians need to strive for.
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Objective:To optimize the clinical nursing pathway, service program and evaluation parameters of percutaneous coronary intervention(PCI), for references for the cost accounting and compensation mechanism of nursing program in public hospitals.Methods:After literature analysis and group discussion, the initial templates were constructed for the PCI clinical nursing pathway, nursing service projects, and their evaluation parameters. 15 experts were consulted by two rounds of Delphi method to optimize PCI nursing path, nursing service items and their evaluation parameters (basic labor consumption, basic time consumption, technical difficulty and risk degree).Results:Two rounds of Delphi method finally determined the PCI clinical nursing path and 27 nursing service items, and adjusted the evaluation parameters of 10 nursing service items. The new projects for PCI clinical nursing services included adjustment and review of dual antiplatelet therapy plans, postoperative rehabilitation nursing, and key project verification. The three nursing service projects with the highest level of technical difficulty and risk were intravenous blood transfusion, gastric catheterization, and gastrointestinal decompression. The two items with the highest importance assigned were high pump assisted arterial/venous infusion (blood) and invasive continuous arterial blood pressure monitoring.Conclusions:The PCI clinical nursing pathway and nursing service project constructed in this study could closely integrate with clinical practice, highlight the integrated nursing service model, and reflect the labor value of nurses.
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The standardized treatment of malignant tumor has always been the direction of continuous improvement of major medical institutions. In recent years, the basic research, prevention, screening and diagnosis and treatment level of gastric, gastroesophageal junction and esophageal cancer have been greatly improved, resulting in a significant improvement in the 5 years′ survival rate of patients, but there are still great differences in the diagnosis and treatment level among different regions. Chinese gastric cancer, gastroesophageal junction cancer and esophageal cancer differ greatly from European and American countries in etiology, pathological types, high incidence sites, etc. Therefore, the relevant guidelines of European and American countries cannot fully meet Chinese clinical practice. In 2021, Elsevier Publishing Group launched the Chinese edition of Elsevier clinical pathway for gastric, gastroesophageal junction and esophageal cancer, and the first update edition was made in 2022, which aims to promote the quality control of tumor diagnosis and treatment, standardize tumor diagnosis and treatment behaviors, promote the homogenization and standardization of tumor diagnosis and treatment, and ultimately improve the survival rate and quality of life of patients with malignant tumor. This pathway refers to the National Comprehensive Cancer Network clinical practice guidelines, the Chinese Society of Clinical Oncology guidelines, combines evidence-based medicine and clinical experience, and follows the scientific, universal, standardized and operable principles. It has been promoted and applied in clinical practice, and is constantly updated according to the latest research results.
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Intra-abdominal infections (IAI) is common surgical emergencies and have been reported as major contributors to non-trauma deaths in hospitals worldwide. The principles of IAI management included early diagnosis, adequate source control, appropriate antimicrobial therapy, and prompt physiologic stabilization using critical care resources, combined with an optimal surgical approach. In order to facilitate clinical management, establish a global standard and provide guidance for clinicians, the World Society of Emergency Surgery (WSES), the Global Alliance for Infection in Surgery (GAIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), and the American Association for the Surgery of Trauma (AAST) worked together to complete an international multi-society document, which provided the evidence-based clinical pathways. Herein, we made a comprehensive interpretation for the clinical pathways combined with the latest domestic and international research developments, aiming to provide evidence for domestic doctors on the diagnosis and treatment of IAI, and ultimately benefit patients.
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Objective:To analyze the effect of problem-based learning (PBL) combined with case-based learning (CBL) and clinical pathway (CP) teaching methods in standardized residency training in department of hepatobiliary surgery.Methods:A total of 64 residents who received the standardized residency training in the Department of Hepatobiliary Surgery in Shaanxi Provincial People's Hospital from July 2018 to July 2019 were selected and divided into the observation group and the control group. The control group used PBL + CBL teaching methods, while the observation group adopted PBL + CBL + CP teaching methods. The after-department examination scores and the teaching cognition scores of the two groups were compared. SPSS 15.0 was used for t-test and Chi-square test. Results:The after-department examination scores of the two groups were compared. Compared with the control group, the examination scores of professional theories, case analysis and operation skills in the observation group were significantly higher, and the difference was statistically significant ( t = 6.98, 7.85, 7.01, P < 0.05). In terms of recognition of teaching, the observation group was significantly higher than the control group, and the difference was statistically significant ( t = 9.14, P < 0.05). Conclusion:The PBL + CBL + CP teaching is conducive to the comprehensive and systematic mastery of knowledge and the rapid establishment of scientific clinical thinking. It has a strong scientific and systematic nature and is worthy of promotion.
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Objective:To explore the feasibility and application value of case-based learning (CBL) combined with clinical pathway in thoracic surgery practice teaching.Methods:A total of 30 clinical undergraduate students who practiced from January 2018 to August 2018 were selected and randomly divided into the traditional group and the research group. The traditional group used traditional teaching mode, while the research group adopted the CBL combined with clinical pathway teaching. The scores of theoretical examination and practice skills assessment and the case analysis ability of the two groups were compared at the time of department. In addition, the evaluation of the teaching effect of the two groups of teachers and students was observed through anonymous questionnaires. SPSS 21.0 was used for t-test and Chi-square test. Results:The scores of the students in the research group were better than those in the traditional group, including score of theoretical examination [(88.20±4.02) vs. (80.76±4.62), P<0.001], score of practice skills assessment [(90.80±2.16) vs. (84.80±3.07), P<0.001] and case analysis ability [(89.80±3.34) vs. (81.86±4.31), P<0.001]. The differences were statistically significant. At the same time, the questionnaire showed that the research group was superior to the traditional group in improving students' learning interest, clinical skills, case analysis ability, clinical communication ability, theoretical knowledge understanding and clinical thinking ability, with a statistically significant difference ( P<0.05). While the two groups had no statistically significant difference in students' satisfaction with teachers ( P=0.083). Conclusion:The CBL method combined with clinical pathway teaching method can improve the teaching effect of thoracic surgery practice, which is worth popularizing.
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Objective:To explore the application of OTD (observation, teaching and discussion) teaching combined with clinical pathway in nursing standardized training in operating room.Methods:A total of 50 nurses who were trained in the Operating Room of The First Affiliated Hospital of Air Force Medical University from August 2017 to June 2020 were selected and divided into control group and study group according to the rotation order, with 25 nurses in each group. Traditional teaching was used in the control group, and OTD teaching combined with clinical pathway was used in the study group. After the rotation training, the teaching effect was evaluated through the assessment of theoretical knowledge and clinical practice comprehensive ability, teaching satisfaction, and the satisfaction scores of participating surgeons and patients. SPSS 22.0 was used for t-test and chi-square test. Results:The results of theoretical assessment, clinical skill assessment and comprehensive ability assessment of operating room of the rotating nurses in the study group were higher than those in the control group, with significant difference ( P < 0.05). The study group was significantly better than the control group in 8 aspects, including learning initiative, stimulating learning interest, problem-solving ability, communication ability, clinical thinking ability, teamwork ability, critical thinking ability and teaching satisfaction ( P<0.05). The satisfaction scores of doctors [(94.06±2.67) vs. (92.17±2.75)] and patients [(94.90±3.22) vs. (91.25±3.10)] in the study group were significantly higher than those in the control group ( P<0.05). Conclusion:OTD teaching combined with clinical pathway can help to improve the theoretical knowledge, clinical practice comprehensive skills and teaching satisfaction of nursing students in operating room, and then improve the teaching quality.
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Objective:To examine the effect of applying clinical pathway model in the cultivation of humanistic care ability of nursing college students in clinical practical teaching.Methods:The study collected 52 nursing students who practiced in the department of gynecology of a tertiary first-class hospital in Xi’an from July to October, 2017 as the control group, and 52 nursing students who practiced in the same unit from July to October, 2018 were selected as the experimental group. The control group adopted the teaching method of infiltrating humanistic care education into the training process of operational skills, while the experimental group adopted the teaching method of cultivating humanistic care ability of nursing college students through clinical pathway. The differences of humanistic care ability scores between the two groups were compared. SPSS 19.0 was used for t test. Results:Before the internship, there was no statistically significant difference in humanistic care scores between the two groups ( P>0.05). After the internship, the total scores of nursing students in the experimental group were significantly higher than those in the control group ( P<0.05). Conclusion:Applying the clinical pathway model to the cultivation of humanistic care ability of nursing students in clinical practice teaching is a new cultivation model of humanistic care ability, which is helpful to improve the humanistic care ability of nursing students.
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Objective:To explore the effectiveness of clinical pathway (CP) and team-based learning (TBL) teaching method in standardized residency training of gynecology.Methods:The research included 40 residents as objects who took standardized training in gynecological rotation in Luohe Central Hospital from July 2017 to July 2019, and they were randomized into experimental group and control group. The combination of CP and TBL teaching method was used in the experimental group ( n=20), while the traditional teaching method was applied in the control group ( n=20). All residents were tested for the professional theory and clinical skill after training. After the training, a survey about the teaching satisfaction and the effectiveness of teaching methods was conducted for both groups. Statistical analysis was performed by SPSS 23.0 software. Results:The average scores of professional theory and clinical practice skills in the experimental group were (85.55±5.96) points and (89.90±6.40) points respectively, which were better than the average scores of the control group [(76.36±6.68) points and (75.50±4.81) points, respectively], and there were significant differences between two groups ( P<0.05). The results of the questionnaire survey showed that the experimental group residents had a higher degree of satisfaction and a higher evaluation of the teaching method than the control group. Conclusion:CP and TBL teaching is beneficial to improve the quality of standardized residency training of gynecology, and it is suggested to make wide popularization and application in the training.
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Objective:To investigate the efficacy of clinical pathway teaching method in standardized training of general practitioners in gastroenterology.Methods:From 2018 to 2019, 40 residents who participated in the standardized training of general practitioners in the Department of Gastroenterology, Zhongshan Hospital Qingpu Branch, Fudan University Medical College were randomized into the experimental group and the control group. The residents of the experimental group were trained by clinical pathway teaching method, while the control group were trained by traditional methods. After 6 weeks' teaching, theoretical examination, operation skills and case analysis test were assessed and satisfaction surveys were conducted.Results:The operation skills and case analysis scores of the experimental group were significantly better than those of the control group [operation test (91.50±2.77) vs. (89.80±3.74), P<0.01; case analysis (92.10±1.98) vs. (86.40±2.87), P<0.01]. The teaching satisfaction of the experimental group was significantly higher than that of the control group, and the difference was statistically significant ( P<0.01). Conclusion:The teaching model of clinical pathway can improve the teaching quality of the residents in the department of gastroenterology, improve the satisfaction of the doctors in the training, and broaden clinical thinking, which is worthy of promotion in clinical teaching.
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ObjectiveTo evaluate the efficacy and safety of a perioperative rehabilitation clinical pathway of acetabular fracture in light of orthopedics rehabilitation team approach. MethodsA prospective randomized control trial was conducted in 82 patients with acetabular fractures who had been admitted from the Emergency Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from June, 2019 to January, 2021. The patients were randomly divided into control group (n = 41) and intervention group (n = 41). The control group was managed routinely, while the intervention group received the rehabilitation clinical pathway, for 24 weeks. The Visual Analogue Score (VAS) of pain, the Barthel Index (BI) and Majeed Pelvic Score were compared. ResultsFinally, 76 patients completed the trial. There was no statistical difference in VAS score between two groups in all periods (|Z| < 1.926, P > 0.05). The BI score was higher in the intervention group than in the control group at discharge, two weeks, six weeks and twelve weeks after operation (|Z| > 2.121, P < 0.05); and no significant difference was found before operation and 24 weeks after operation (|Z| < 1.862, P > 0.05). Majeed Pelvic Score was higher in the intervention group than in the control group two weeks, six weeks, twelve weeks and 24 weeks after operation (|Z| > 2.428, P < 0.05). Six, twelve and 24 weeks after operation, the excellent rate of Majeed Pelvic Score was higher in the intervention group than in the control group (χ2 > 6.136, P < 0.05). ConclusionIn comparison with traditional protocol in acetabular fracture, the perioperative rehabilitation clinical pathway was proved effective and of great safety in the light of the integration of orthopedics and rehabilitation mode for improving the function and activities of daily living of patients.
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Objective:To explore the effect and significance of clinical pathway (CP) teaching method in the standardized residency training of gynecology.Methods:The study included in 60 residents having standardized residency training of gynecology from June 2016 to June 2019 as research subjects, and they were randomized into control group and experimental group. The traditional teaching method was applied in the control group ( n=30), while CP teaching method were used in the experimental group ( n=30). All residents in the two groups were tested for the basic theory, case analysis and clinical skill after training. At the same time, they all had a teaching satisfaction survey, and the effectiveness of CP teaching was investigated among residents of the experimental group. Descriptive statistics, t test and chi-square analysis were performed by SPSS 23.0 software. Results:The results of examination about the basic theory [(86.30±7.04) vs. (75.30±5.27)], case analysis [(84.97±6.49) vs. (78.60±4.78)] and clinical skill [(83.90±6.32) vs. (77.40±8.29)] in the experimental group were higher than those in the control group, with statistical differences ( P<0.05). And residents in the experimental group believed that CP teaching was helpful to improve their self-learning ability, clinical thinking ability, operation ability, communication ability and scientific research ability, and they supported the continuous promotion of CP teaching. Conclusion:CP teaching is beneficial to improve the quality of standardized residency training of gynecology, and it is expected to be further promoted and applied in the standardized residency training of gynecology.
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The electronic nursing clinical pathway was fully applied, and the evidence-based practice achievements of cancer patient symptom management was integrated into the electronic nursing clinical pathway in Fudan University Shanghai Cancer Center. Taking " comprehensive evaluation before chemotherapy" , " chemotherapy-related nausea and vomiting" , " chemotherapy-related diarrhea" as examples, the authors introduced the application of evidence-based practice project in nursing clinical pathway. Through the implementation of the project, a standardized operation flow of electronic nursing clinical pathway was formed; The nurses introduced new nursing tools, new processes and new technologies in the process of project implementation; Meanwhile, the project reduced the incidence of adverse symptoms and shortened the hospitalization time of patients. The project achieved the goal of " win-win" to reduce the burden of patients′ disease and improve the efficiency of tumor care.
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Objective:To evaluate the effect of CBL combined with clinical pathway teaching in the teaching of general practitioner job-transfer training of cardiology department.Methods:From May 2018 to March 2019, a total of 63 students taking the general practitioner job-transfer training in our hospital were enrolled in this study, and randomized into control group ( n=30) and test group ( n=33). The control group used traditional teaching mode, the test group adopted CBL combined with clinical pathway teaching method. At the end of the training, the scores of theoretical and operational examination were compared between the two groups, and the satisfaction of the training was evaluated by questionnaire survey. Results:The scores of theory test and practical skills in the test group were all higher than those in the control group [(83.57±4.32) vs. (77.10±4.72), t=-5.678, P<0.001; (78.24±5.28) vs. (70.83±5.86), t=-5.279, P<0.001], and the test group was also better than the control group in the satisfaction survey of standardizing diagnosis and treatment, and improving learning interest, doctor-patient communication and physical examination skills ( P<0.05). Conclusion:In the teaching of general practitioner job-transfer training of cardiology department, CBL combined with clinical pathway teaching has shown better performance than the traditional teaching mode, which is worth promoting in general practitioner job-transfer training.
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@#The traditional view is that breast reconstruction is not an option for day surgery center. As a result, few hospitals in the world conduct this operation in day surgery center. Endoscopic breast reconstruction with liposuction and robot-assisted breast reconstruction are minimally invasive surgeries for breast cancer patients, but they cannot be carried out in the day surgery center due to long operation time. The novel endoscopic-assisted immediate implant-based breast reconstruction after nipple sparing mastectomy through a single axillary incision for breast cancer patients has been successfully conducted in the day surgery center in our hospital due to short operation time and small trauma. Standardized management of the complete process from the patient selection to follow-up after discharge brings rapid recovery and few complications. At the same time, the development of endoscopic surgery makes the breast almost scarless and improves aesthetic results. Therefore, the mode of endoscopic-assisted reconstruction in the day surgery center of our hospital is expected to be popularized in the whole country.
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OBJECTIVE@#This study determined the mean overall adherence to the clinical pathway formulated by the Section of Pulmonology together with the Division of Burns for adult burn patients at high risk for inhalation injury admitted at the UP-PGH ATR Burn Center in a two-year period@*METHODOLOGY@#A retrospective cohort study regarding adherence to the clinical pathway of acutely burned adult patients at high risk for inhalation injury admitted at the UP-PGH ATR Burn Center between August 2016 to July 2018 was conducted. Medical records were reviewed and an adherence checklist was used to assess each item in the clinical pathway. For the adherence and patient profile, descriptive statistics were used.@*RESULTS@#This pilot assessment study showed acceptable rates of adherence and implementation of the clinical pathway. Overall, 60% of the cases followed the clinical pathway completely. While 26.67% had acceptable rates of compliance (more than half of items adhered), while 13% of the cases scored adhered to less than half of the items.@*CONCLUSION@#The pathway has been shown to be a feasible clinical pathway that can be implemented in a tertiary hospital setting.
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BurnsABSTRACT
Peritoneal cancer originates from a wide range of tumor sources and is associated with poor prognosis. Standardized therapy is of great significance in the treatment for patients with peritoneal cancer. The Peritoneal Surface Oncology Group International (PSOGI) instituted guidelines for peritoneal metastases. This article uses the Chinese version, which is divided into four parts: preoperative evaluation, surgery, chemotherapy, and clinical pathway. The preoperative evaluation consists of preoperative computed tomography, prognostic evaluation model, diagnostic laparoscopic exploration, the peritoneal cancer index, and the cytoreduction score. Peritoneal cancer treatment primarily consists of comprehensive treatment with cytoreductive surgery (CRS) and intraperitoneal hyperthermic chemotherapy. However, complete CRS is the key to the long-term survival of patients. Peritoneal cancer chemotherapy generally includes perioperative chemotherapy and regional chemotherapy. Finally, this guide outlines the clinical pathways. The Chinese version of the guidelines was published under the permission of the Secretary-General of the PSOGI Executive Committee.
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BACKGROUND: Hip and knee arthroplasty has been widely carried out in various levels of hospitals. The amount of hip and knee joint surgery has increased year by year. The surgical methods and techniques have reached a difficult time. Promoting the clinical pathway is an effective method to improve the treatment effect. OBJECTIVE: To systemically evaluate the difference between the clinical pathways and conventional pathways in total hip arthroplasty and total knee arthroplasty. METHODS: Clinical trials about the comparison of conventional and clinical pathways in total hip arthroplasty and total knee arthroplasty were searched in MEDLINE, Cochrane Library, EMbase, and CNKI. Study selection, data collection and evaluation of methodological quality were undertaken by two reviewers independently. The Cochrane Collaboration’s RevMan 5.0 was used for data analyses. RESULTS AND CONCLUSION: (1) Totally 17 clinical trials meeting research design criteria were included in this analysis, including 13 semi-randomized controlled trials and 4 randomized controlled trials. (2) The incidence of complications in the traditional method group was higher than that in the clinical pathway group [OR=0.63, 95%C/(0.53, 0.74), P < 0.000 01]. (3) Pain visual analogue scale score [MD=1.49, 95%C/(0.69, 2.85), P=0.001], postoperative Harris hip score [MD=19.31, 95%C/(-13.98, -4.92), P< 0.000 1], and 5-year prosthesis survival rate [OR=0.59, 95% Cl (0.36, 0.98), P=0.04] were better in the clinical pathway group than in the traditional method group. (4) There was no significant difference in postoperative mean deviation of mechanical axes of lower limbs after total knee arthroplasty in both groups [MD-0.0Q, 95%C/(-0.14, 0.14), P=0.99]. (5) Results showed that compared with traditional technique, hip and knee arthroplasty patients who entered the clinical pathway had better clinical efficacy, fewer complications and better joint function after operation.
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A clear shoulder platform that can be easily identified by doctors and technicians or machines (mouth scan and warehouse scan) is important to obtaining a good long-term and stable fixed prosthesis treatment effect. At present, the pre-paration of the shoulder platform is usually based on free hands, and the practical operation is mainly guided by experience. Moreover, no comprehensive and objective preoperative design, intraoperative verification, and final test are available. Thus, the accuracy of shoulder platform preparation needs to be improved. In this study, the clinical pathway of "three determination, three selection, and three steps" with high accuracy of preparation and the precise shoulder preparation method of "bur-tip guidance" are proposed in detail.
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Critical Pathways , Shoulder , Tooth , Tooth Preparation , Tooth Preparation, ProsthodonticABSTRACT
Objective@#To investigate the application and effect of clinical pathway in practice teaching of hepatic surgery.@*Methods@#The 64 clinical interns who had an internship in our department between February 2018 and May 2019 were divided randomly into two groups: the experimental group (n=32) and the control group (n=32). The clinical pathway teaching method was used in the experimental group and the traditional teaching method was used in the control group. At the end of their internship, the examination and the satisfaction survey were requested to finish in the both groups. The statistical software SPSS 17.0 was used. Continuous variables were analyzed through the t-test. Categorical data were compared through Pearson chi-square.@*Results@#The examination results included theoretical knowledge (P=0.033), operating skill (P=0.021), case analysis (P=0.006) and medical record writing (P=0.017), which were significantly better in the experimental group than in the control group, and the satisfaction of interns was also significantly better in the experimental than in the control group (P<0.05).@*Conclusion@#The clinical pathway teaching method is effective in practice teaching of hepatic surgery, and can improve the results of practice teaching quality obviously.