Study of new clinical pathway in patients with senile cataract treated by operation / 实用医学杂志

Objective To explore the standard clinical pathway and stratified cost insurance in patients with senile cataract operation. Methods Patients treatment by senile cataract phacoemulsification combined with IOL implantation were selected as research subjects by cluster sample from two hospitals from 2013 to 2014 . Patients were divided into different groups according to the year, chronic diseases, preoperative waiting time. The difference of hospitalization expenses and hospitalization time were compared. Different levels of hospital costs were established by CHAID decision tree used hospitalization cost as target variable. Results The waiting time for operation was 2 days, the total hospitalized time was 5 days and these can be used as reference time in clinical pathway. Patients uninsured or with long waiting time for operation had longer hospitalized time. Chronic disease, terms of payment and waiting time before operation were point factors that effect the hierarchical of decision tree. Conclusion The new standard of clinical path need to adjust constantly. Distinguish different patients condition and pay different clinical path costs.

Investigation about efficacy of periarticular drug injection in total knee arthroplasty / 中国矫形外科杂志

[Objective]Postoperative analgesia with the use of parenteral opoids or epidural analgesia can be associated with troublesome side effects.Good perioperative analgesia facilitates rehabilitation,improves patient satisfaction,and may reduce the hospital stay.We investigated the analgesic effect of locally injected drugs around a total knee prosthesis.[Method]Thirty-eight patients undergoing total knee arthroplasty were randomized either to reveive a periarticuiar intraoperative injection containing bupicaine,morphine,epinephrine,hydrocordisone or to reveive no injection.We compared the PCA consumption at the some time point after tatal knee arthroplasty.Visual analog scores for pain,preoperation and postoperation,6 weeks after operation were collected.[Result]The patients who had received the injection used significantly less patient-controlled analgesia over the first 24 hours after the surgery.They had lower visual analog scores for pain 24 hours and 48 hours after operation.No cardiac or central nervous system toxicity was observed.[Conclusion]The perioperative analgesia protocol improved patient satisfaction,pain control and minimizes side effects after total kneearthroplasty.