Process quality of medical care for inpatients with cholecystectomy:a clinical pathway based study / 中华医院管理杂志

Objective To study the compliance of medical care with corresponding national clinical pathways for inpatients of cholecystectomy for cholecystolithiasis with acute cholecystitis at public hospitals of China. Methods Thirty medical records of the inpatients with cholecystectomy admitted in 2014 were randomly sampled from 18 public hospitals in Shanghai, Hubei province and Gansu province, for assessment on their compliance with corresponding national clinical pathways. Results The average compliance rate of inpatient care of cholecystectomy at public hospitals was 67. 7%. The study found low compliance rates in both severity assessment and timely examinations/diagnosis within two days after admission ( 5. 8% and 35. 3%, respectively) . Conclusions Public hospitals in China should strengthen their supervision over the medical care process for inpatients of cholecystectomy with acute cholecystitis, and the clinical pathways in question should be updated and improved in time.

Process quality of medical care for inpatients with community acquired pneumonia: a clinical pathway based study / 中华医院管理杂志

Objective To study the compliance of medical care at public hospitals in China with corresponding clinical pathway for inpatients of community acquired pneumonia ( CAP) . Methods Thirty medical records of inpatients with CAP admitted in 2014 were randomly sampled from 18 public hospitals in Shanghai, Hubei province and Gansu province, for assessment on their compliance with corresponding clinical pathways. Results The average compliance rate of inpatient care of CAP at public hospitals was 65. 1%. The study the lowest compliance rates in both timely examinations/diagnosis and severity assessment within three days after admission (0. 7% and 26. 6%, respectively). The compliance rate of reasonable initial antibiotic use was 48. 5%. Conclusions The compliance rate of inpatient care of CAP is low in China. Thus admission examinations, patient severity assessment and antibiotic utilization should be enhanced accordingly for their compliance.

Process quality of medical care for inpatients with cholecystectomy:a clinical pathway based study / 中华医院管理杂志

Objective To study the compliance of medical care with corresponding national clinical pathways for inpatients of cholecystectomy for cholecystolithiasis with acute cholecystitis at public hospitals of China. Methods Thirty medical records of the inpatients with cholecystectomy admitted in 2014 were randomly sampled from 18 public hospitals in Shanghai, Hubei province and Gansu province, for assessment on their compliance with corresponding national clinical pathways. Results The average compliance rate of inpatient care of cholecystectomy at public hospitals was 67. 7%. The study found low compliance rates in both severity assessment and timely examinations/diagnosis within two days after admission ( 5. 8% and 35. 3%, respectively) . Conclusions Public hospitals in China should strengthen their supervision over the medical care process for inpatients of cholecystectomy with acute cholecystitis, and the clinical pathways in question should be updated and improved in time.

Process quality of medical care for inpatients with community acquired pneumonia: a clinical pathway based study / 中华医院管理杂志

Objective To study the compliance of medical care at public hospitals in China with corresponding clinical pathway for inpatients of community acquired pneumonia ( CAP) . Methods Thirty medical records of inpatients with CAP admitted in 2014 were randomly sampled from 18 public hospitals in Shanghai, Hubei province and Gansu province, for assessment on their compliance with corresponding clinical pathways. Results The average compliance rate of inpatient care of CAP at public hospitals was 65. 1%. The study the lowest compliance rates in both timely examinations/diagnosis and severity assessment within three days after admission (0. 7% and 26. 6%, respectively). The compliance rate of reasonable initial antibiotic use was 48. 5%. Conclusions The compliance rate of inpatient care of CAP is low in China. Thus admission examinations, patient severity assessment and antibiotic utilization should be enhanced accordingly for their compliance.

Analysis on the implementation of clinical pathways at public hospitals in China / 中华医院管理杂志

Objective To analyze the implementation of clinical pathways ( CP) at public hospitals at different levels and in different regions in China. Methods The status of CPs′ implementation at 54 public hospitals in Shanghai, Hubei province and Gansu province was surveyed by questionnaires from March to May of 2015. Results 51 (94. 4%) of the surveyed public hospitals put in place clinical pathway(s), where the average CPs implemented were 45 and the average percentage of the cases using CPs was 52. 7%. There were great variations among these hospitals. In addition, the common diseases with definite diagnostic and treatment options were found with the highest implementation rates of CPs at such hospitals. Conclusions CPs are implemented widely at public hospitals of China, yet enhanced implementation strategies are expected to further CPs′adoption.

Analysis on clinical pathway management at public hospitals in China / 中华医院管理杂志

Objective To analyze the management of clinical pathways ( CP) in China. Methods Cross-sectional questionnaire surveys of 51 public hospitals with CPs in place in Shanghai, Hubei province and Gansu province were conducted from March to May of 2015. Results Among the 51 public hospitals with CPs, 48 ( 94. 1%) of them organized training on CPs, 48 ( 94. 1%) of them monitored CPs′implementation, and 40 (78. 4%) applied incentives for CPs′ implementation. But there were some issues and difficulties encountered in CPs′ implementation. Conclusions Comprehensive measures are necessary to improve the management of CPs at public hospitals of China.

Sinusoidal stimulation trains suppress epileptiform spikes induced by 4-AP in the rat hippocampal CA1 region in-vivo.

Deep brain stimulation (DBS) shows promises in the treatment of refractory epilepsy. Due to the complex causes of epilepsy, the mechanisms of DBS are still unclear. Depolarization block caused by the persistent excitation of neurons may be one of the possible mechanisms. To test the hypothesis, 4-aminopyridine (4-AP) was injected in rat hippocampal CA1 region in-vivo to induce epileptiform activity. Sinusoidal stimulation trains were applied to the afferent pathway (Schaffer collaterals) of CA1 region to suppress the epileptiform spikes. Results show that 2-min long trains of sinusoidal stimulation (50 Hz) decreased the firing rate of population spikes (PS) and decreased the PS amplitudes significantly. In addition, small positive sharp waves replaced PS activity during the periods of stimulation. A lower frequency sinusoidal stimulation (10 Hz) failed to decrease the firing rate of PS, but decreased the PS amplitudes significantly. These results suggest that stimulation trains of sinusoidal waves could suppress epileptiform spikes. Presumably, the stimulation with a high enough frequency might excite the downstream neurons persistently and elevate the membrane potentials continuously, thereby cause depolarization blocks in the neurons. The findings of the study provide insights in revealing the mechanisms of DBS, and have important implications to the clinical treatment of epilepsy.

Clinical study of 40 cases with chronic hydrocephalus after traumatic subarachnoid hemorrhage / 中国医师进修杂志

Objective To discuss the clinical features and treatment methods of chronic hydrocephalus after traumatic subarachnoid hemorrhage.Methods A total of 40 cases of chronic hydrocephalus after traumatic subarachnoid hemorrhage were analyzed retrospectively.Results Eight cases improved after treatment of non-operation,the lateral ventricle external drainage was done in 32 cases of chronic hydrocephalus.Shunt tube obstruction occurred in 3 patients,with abdominal,subcutaneous and intracranial infection.The shunting operation device was pulled out and the 3 patients received operation for the second time.Two cases appeared intracranial hemorrhage,and the hemorrhage was absorbed after conservative treatment.Total Glasgow prognosis score was good in 32 cases,with mild disability in 5 cases,moderate disability in 2 cases and severe disability in 1 case.Conclusions Traumatic subarachnoid hemorrhage after chronic hydrocephalus should be early diagnosed and early treated,CT and MRI scan is the effective means to the diagnosis and differentiaion.The lateral ventricle external drainage is good method in treatment.