衛生部下發《臨床路徑管理指導原則(試行)》(衛醫管發〔2009〕99號)的通知, 希望建立一套既能貫徹醫院質量管理標準, 又能節約資源的醫療標準化模式。為適應現代醫學和康復醫學發展的需要, 采用康復臨床路徑對康復治療進行規范, 是非常重要的。四川大學華西醫院康復醫學科根據臨床路徑要求, 于2011年制定了康復醫學科膝骨關節病康復臨床路徑, 希望通過臨床試用, 對路徑的臨床實用性、可行性進行探討, 并逐漸完善。
目前，國內尚未制定出較為完整的康復醫學專業常見骨關節疾病的康復臨床路徑，為適應現代康復醫學發展的需要，四川大學華西醫院康復醫學科根據衛生部《臨床路徑管理指導原則》要求，結合康復醫學科住院患者的疾病、康復評定、康復治療、康復護理、康復教育等，于2011年制定了康復醫學科常見疾病的康復臨床路徑，希望通過臨床試用，對路徑的臨床實用性、可行性進行探討，并逐漸完善。
目前，國內尚未制定出較為完整的康復醫學專業常見骨關節疾病的康復臨床路徑，為適應現代康復醫學發展的需要，四川大學華西醫院康復醫學科根據衛生部《臨床路徑管理指導原則》要求，結合康復醫學科住院患者的疾病、康復評定、康復治療、康復護理、康復教育等，于2011年制定了康復醫學科常見疾病的康復臨床路徑，希望通過臨床試用，對路徑的臨床實用性、可行性進行探討，并逐漸完善。
Objective To explore the referral patterns for rehabilitation of patients with spinal cord injury (SCI) in community hospitals and establish green channel for SCI rehabilitation between community hospitals and large comprehensive hospitals. Methods Thirty SCI patients who were referred from the Center of Rehabilitation Medicine, West China Hospital to community hospitals between February 2013 and June 2014 were selected for this study. All the patients were assessed with American Spinal Injury Association (ASIA 2011), activities of daily living (ADL), and instrumental activities of daily living (IADL). Based on the assessment results, rehabilitation plan was made and the patients underwent community rehabilitation treatment. Results After rehabilitation treatment in community hospitals, the scores of ASIA, ADL and IADL in all the SCI patients were significantly higher than those at the time of referral (P<0.001). Conclusions SCI patients can accept rehabilitation treatment in community hospitals with good conditions. This practice can provide a new type of seamless referral pattern between large comprehensive hospitals and community hospitals for rehabilitation of SCI patients.
Objective To investigate inter-observer reproducibility in the pathologic diagnosis of breast intraductal proliferative lesions (BDPL). Methods Forty three BDPL patients were diagnosed by criterion of Page. Every specimen from each case was sorted randomly. All slides were classified as mild usual hyperplasia, moderate-severe usual hyperplasia, mild atypical hyperplasia, moderate-severe atypical hyperplasia, ductal carcinoma in situ, or ductal carcinoma in situ with invasion. Inter-observer agreement of the two groups was statistically analyzed using Kappa test. Then we compared all the diagnoses of individual pathologist with the consensus opinion confirmed by two breast pathologists to analyze the diagnostic accuracy and undue diagnosis. Results Inter-observer reproducibility of the trial group was higher than that of the control group (The total K value of 6, 3, and 2 diagnoses in the two groups were 0.289 3, 0.337 1, 0.492 8, 0.100 3, 0.150 3 and 0.340 3, respectively). When the categories were simplified, inter-observer reproducibility increased. There were still undue diagnoses of different degrees among pathologists of the trial group. Conclusion Using the same criteria is an important method to increase the diagnostic reproducibility and accuracy. More practice is needed to familiarize with these criteria.
ObjectiveTo summarize the clinical experience of surgical resection of synchronous multiple ground-glass nodules (SMGN), and explore the individualized diagnosis and treatment strategy of SMGN.MethodsClinical data of 84 patients with SMGN who underwent thoracic surgery in Anhui Chest Hospital from July 2016 to August 2018 were analyzed retrospectively, including 18 males (21.4%) and 66 females (78.6%), aged 32-80 (55.6±10.3) years. The results of operation and the information of GGNs were analyzed.ResultsExcept for 1 patient who was converted to thoracotomy due to extensive dense adhesion of thoracic, other patients underwent video-assisted thoracoscopic surgery successfully. All patients recuperated successfully after operation, without severe perioperative complications or death. Finally, 79 patients were diagnosed as malignant tumors (94.0%), and 5 patients of benign lesions (6.0%). A total of 240 GGNs were removed, among which there were 168 pGGNs, including 68 benign lesions (40.5%) and 100 malignant tumors (59.5%), and 72 mGGNs, including 2 benign nodules (2.8%) and 70 malignant tumors (97.2%). Nodules diameter (P<0.001), consolidation/maximum diameter of nodule ratio (P<0.001), vacuole sign (P<0.001), air bronchograms sign (P=0.001), spine-like process (P=0.001), pleural indentation sign (P<0.001), lobulation sign (P<0.001), and vascular convergence (P=0.002) were correlated with malignant tumor.ConclusionAnalysis of the imaging features of GGNs by thin-section CT scan and three-dimensional reconstruction is of great value in predicting the benign and malignant nodules, which can guide the surgical decision-making and preoperative planning. Through reasonable preoperative planning and following certain principles, simultaneous surgical treatment for SMGN is safe and feasible.