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Objective@#To systematically review the barriers and facilitators affecting the implementation of clinical pathways for the clinical pathways.@*Methods@#PubMed, Embase, CNKI, CBM, Wanfang, Cvip databases were searched to collect articles about clinical pathways implementation barriers and facilitators from inception to January 4th, 2019. The tool of confidence in the evidence from reviews of qualitative research(CERQual)was used to grade the confidence of each study.@*Results@#A total of 43 articles from 12 countries were included.There were 8 main categories and 31 subcategories of the barriers about clinical pathways, including content of the clinical pathways, negative outcomes of clinical pathways, physicians knowledge, physicians attitude, resource availability, implementation of activities, patients factors and social factors. The first three barriers of high confidence were lacking of time, capital, equipment, staff and other resources(15 articles, 34.9%), increasing workload(14 articles, 32.6%), unrecognizing pathways(12 articles, 27.9%). There were 6 main categories and 28 subcategories of the facilitators about clinical pathways, including pathways content related, physician related, resource factor and implementation activity. The first three facilitators of high confidence were communication, education and training(25 articles, 58.1%), supporting from managers and colleagues(21 articles, 48.8%)and establishing a clinical pathway facilitation committee(17 articles, 39.5%).@*Conclusions@#The successful implementation of clinical pathways connects with its development process, aftereffect evaluation and feedback. It will be implemented effectively only by the completely and environmentally acceptable pathways design, adequate resources, effective organizational activities, continuous audit, evaluation and feedback and physicians active cooperation.
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Objective To systematically review the barriers and facilitators affecting the implementation of clinical pathways for the clinical pathways.Methods PubMed, Embase, CNKI, CBM, Wanfang, Cvip databases were searched to collect articles about clinical pathways implementation barriers and facilitators from inception to January 4th, 2019. The tool of confidence in the evidence from reviews of qualitative research ( CERQual) was used to grade the confidence of each study. Results A total of 43 articles from 12 countries were included.There were 8 main categories and 31 subcategories of the barriers about clinical pathways, including content of the clinical pathways, negative outcomes of clinical pathways, physicians knowledge, physicians attitude, resource availability, implementation of activities, patients factors and social factors. The first three barriers of high confidence were lacking of time, capital, equipment, staff and other resources (15 articles, 34.9% ), increasing workload (14 articles, 32.6% ), unrecognizing pathways(12 articles, 27.9% ). There were 6 main categories and 28 subcategories of the facilitators about clinical pathways, including pathways content related, physician related, resource factor and implementation activity. The first three facilitators of high confidence were communication, education and training(25 articles, 58.1% ), supporting from managers and colleagues ( 21 articles, 48.8% ) and establishing a clinical pathway facilitation committee(17 articles, 39.5% ).Conclusions The successful implementation of clinical pathways connects with its development process, aftereffect evaluation and feedback. It will be implemented effectively only by the completely and environmentally acceptable pathways design, adequate resources, effective organizational activities, continuous audit, evaluation and feedback and physicians active cooperation.
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Objective To observe the effect of transcranial direct current stimulation (tDCS) with mirror neuronal rehabilitation training system (MNST-V1.0) in post-traumatic unconscious patients after severe craniocerebral injury. Methods A prospective, self controlled and open-label method was used. Thirty-six post-traumatic unconscious patients with severe craniocerebral injury from January 2016 to July 2017 were selected. Four cases of the patients did not complete the treatment and the last 32 cases completed the study. All patients were given routine wake-up therapy, and tDCS combined with MNST-V1.0 (20 min/time, 1 time/d, 6 times/week, a total of 8 weeks) was given at the same time. The Glasgow coma scale (GCS), JFK coma recovery scale and Four coma rating scale before treatment and 2, 4, 8 weeks after treatment were recorded. Results The scores of open reaction, language and motor response score of GCS 2, 4, 8 weeks after treatment were significantly higher than those before treatment:(1.56 ± 0.82), (2.06 ± 1.01) and (3.11 ± 1.45) scores vs. (1.00 ± 0.45) scores, (2.23 ± 1.06), (2.56 ± 1.08) and (3.02 ± 1.04) scores vs. (1.00 ± 0.61) scores, (2.79 ± 1.12), (3.22 ± 1.33) and (4.44 ± 1.07) scores vs. (1.00 ± 0.54) scores, and there were statistical differences (P ＜ 0.01 or ＜0.05). The scores of hearing, vision, movement, speech response, communication and arousal of JFK coma recovery scale 2, 4, 8 weeks after treatment were significantly higher than those before treatment, and there were statistical differences (P＜0.01). The scores of open reaction, sport reaction, brainstem response of Four coma rating scale 2, 4, 8 weeks after treatment were significantly higher than those before treatment, and there were statistical differences (P＜0.05); there was no statistical difference in respiratory score of Four coma rating scale before and after treatment (P＞0.05). Conclusions The tDCS combined with MNST-V1.0 can improve the consciousness level in post-traumatic unconscious patients with severe craniocerebral injury, and have the effect of promoting awakening.
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<p><b>OBJECTIVE</b>To assess the quality of integrative medicine clinical practice guidelines (CPGs) published before 2014.</p><p><b>METHODS</b>A systematic search of the scientific literature published before 2014 was conducted to select integrative medicine CPGs. Four major Chinese integrated databases and one guideline database were searched: the Chinese Biomedical Literature Database (CBM), the China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Data, and the China Guideline Clearinghouse (CGC). Four reviewers independently assessed the quality of the included guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument. Overall consensus among the reviewers was assessed using the intra-class correlation coefficient (ICC).</p><p><b>RESULTS</b>A total of 41 guidelines published from 2003 to 2014 were included. The overall consensus among the reviewers was good [ICC: 0.928; 95% confifi dence interval (CI): 0.920 to 0.935]. The scores on the 6 AGREE domains were: 17% for scope and purpose (range: 6% to 32%), 11% for stakeholder involvement (range: 0 to 24%), 10% for rigor of development (range: 3% to 22%), 39% for clarity and presentation (range: 25% to 64%), 11% for applicability (range: 4% to 24%), and 1% for editorial independence (range: 0 to 15%).</p><p><b>CONCLUSIONS</b>The quality of integrative medicine CPGs was low, the development of integrative medicine CPGs should be guided by systematic methodology. More emphasis should be placed on multi-disciplinary guideline development groups, quality of evidence, management of funding and conflfl icts of interest, and guideline updates in the process of developing integrative medicine CPGs in China.</p>
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Objective To evaluate the clinical efficacy of endoscopic transnasal palatal nerve block for persistent allergic rhinitis.Methods 123 patients with heavy persistent allergic rhinitis who aged over 17 years old in Longhua central hospital affiliated to Guangdong medical university from October 2013 to February 2015 were divided into observation group and control group.The patients in the observation group(72 cases) were blocked with endoscopic sphenopalatine,the control group (51 cases) treated with medicine.The rhinoconjunctivitis quality of life questionnaire (RQLQ) and VAS were assessed before and after treatment for 6 months,1 year and 2 year survival.Results 106 patients were followed up for 2 years.In observation group,the average score of RQLQ and VAS before treatment were (2.39 ± 0.43),(7.45 ±1.24) respectively;6 months after treatment,the average scores of RQLQ and VAS were (0.82 ± 0.38),(2.47 ± 1.42) respectively;1 years (0.93 ± 0.41) and (2.53 ± 1.54);2 years (1.05 ± 0.47) and (2.67 ± 1.69);the differences were statistically significant (P ＜ 0.05).The control group showed no obvious difference in RQLQ and VAS before and after treatment.Conclusion Endoscopic sphenopalatine nerve block can effectively improve the quality of life of patients with persistent rhinitis allergic,which is safe and effective in the treatment of severe persistent allergic rhinitis.
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To study the chemical constituents of Artemisia lactiflora. The compounds were isolated by column chromatography with silica gel, C18 reverse-phase silica gel, semi-preparative HPLC, and their structures were elucidated on the basis of spectral analysis. Twelve compounds were isolated from alcohol extracts of A. lactiflora and identified as 7-hydroxycoumarin (1), 7-methoxycoumarin (2), balanophonin (3), aurantiamide (4), aurantiamide acetate (5), isovitexin (6), kaempferol-3-O-beta-D-rutinoside (7), rutin (8), caffeic acid ethyl ester (9), quercetin (10), methyl 3, 5-di-O-caffeoyl quinate (11) and methyl 3, 4-di-O-caffeoyl quinate (12), respectively. Compounds 3-12 were obtained from this plant for the first time.
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Artemisia , Medicamentos de Ervas Chinesas , Química , Estrutura Molecular , Espectrometria de Massas por Ionização por ElectrosprayRESUMO
Objective To evaluate the effect of carbon fiber couch on dose distribution of radiotherapy planning and verification pass rate.Methods Establishing the carbon fiber treatment couch model in Pinnacle8.0m Treatment Planning system (TPS),and then this model was used to correct dose calculations of oblique fields in the treatment plans of 10 cases of nasopharyngeal carcinoma,10 cases of breast cancer and 10 cases of lung cancer and evaluate the effect of carbon fiber couch on the whole dose distribution of the plans.Then these plans were measured by three-dimensional dose verification equipment Delta4 to confirm the improvement extent of Gamma pass rate after considering the carbon fiber treatment couch.Results For the majority of plans,when the carbon fiber couch was taken into consideration,the target doses was significantly reduced (4772 cGy-7266 cGy vs.4859 cGy-7347 cGy,P=0.000-0.002) and the relative deviation of D95 was 1％ to 3％.Measurement results of Delta4 showed that Gamma pass rate (3 mm/3％ criteria) increased in all plans (96.4％-98.8％ vs.93.4％-97.3％,P =0.000),some of that were up to 5 percentage when the couch model was applied.Conclusions Target doses will be overestimated if the treatment couch is ignored in TPS measurement.,However it should arouse enough attention when the disease with smaller doses corresponding gradient.