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71.
目的探讨循证护理对原发性胆汁性肝硬化患者术后并发症和康复进程的影响。方法抽取入院行手术治疗的原发性胆汁性肝硬化患者50例作为研究对象,采用抽签法分为2组,对照组行常规护理,观察组行循证护理,观察2组康复进程并记录并发症发生情况。结果观察组并发症发生率为24.0%,低于对照组的60.0%,差异有统计学意义(P0.05)。观察组瘙痒好转时间、水肿消失时间、腹水消失时间、出院时间均显著短于对照组(P0.05)。结论原发性胆汁性肝硬化患者术后接受循证护理,可降低并发症发生率,改善康复效果。 相似文献
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Charles D. Qin Mia M. Helfrich David W. Fitz Mark A. Oyer Kevin D. Hardt David W. Manning 《The Journal of arthroplasty》2018,33(5):1477-1480
Background
The demand for conversion of prior hip surgery to total hip arthroplasty (conversion THA) is likely to increase as a function of increasing US hip fracture burden in addition to its application in managing other conditions. Thus, outcome analysis is warranted to better inform value-based reimbursement schemes in the era of bundled payments.Methods
Via Current Procedural Terminology codes, the National Surgical Quality Improvement Project data files were queried for all patients who underwent primary THA and conversion of previous hip surgery to THA from 2005 to 2014. To better understand the isolated effect of procedure type on adverse outcomes, primary and conversion cohorts were then propensity-score matched via logistic regression modeling. Comparisons of the study's primary outcomes were drawn between matched cohorts. Statistical significance was defined by a P-value less than or equal to .05.Results
Relative to the primary THA group, the conversion THA group had statistically greater rates of Center Medicare and Medicaid Services (CMS) complications (7.5% vs 4.5%), non-home bound discharge (19.6% vs 14.7%), and longer length of hospital stay. Conversion THA was associated with increased likelihood of CMS complications (odds ratio 1.68, confidence interval 1.39-2.02) and non-home bound discharge (odds ratio 1.41, confidence interval 1.25-1.58). No statistically significant differences in mortality and readmission were detected.Conclusion
The elevated risk for CMS-reported complications, increased length of hospital stay, and non-home bound discharge seen in our study of conversion THA indicates that it is dissimilar to elective primary THA and likely warrants consideration for modified treatment within the Comprehensive Care for Joint Replacement structure in a manner similar to THA for fracture. 相似文献79.
Steven M. Kurtz Edmund C. Lau Doruk Baykal Susan M. Odum Bryan D. Springer Thomas K. Fehring 《The Journal of arthroplasty》2018,33(5):1352-1358
Background
The purpose of this study is to analyze whether the cost for ceramic-on-polyethylene (C-PE) and ceramic-on-ceramic (COC) bearings used in primary total hip arthroplasty (THA) was changing over time, and if the cost differential between ceramic bearings and metal-on-polyethylene (M-PE) bearings was approaching the previously published tipping point for cost-effectiveness of $325.Methods
A total of 245,077 elderly Medicare patients (65+) who underwent primary THA between 2010 and 2015 were identified from the United States Medicare 100% national administrative hospital claims database. The inpatient hospital cost, calculated using cost-to-charge ratios, and hospital payment were analyzed. The differential cost of C-PE and COC bearings, compared to M-PE, were evaluated using parametric and nonparametric models.Results
After adjustment for patient and clinical factors, and the year of surgery, the mean hospital cost and payments for primary THA with a C-PE or COC was within ±1% of the cost for primary THA with M-PE bearings (P < .001). From the nonparametric analysis, the median hospital cost was $318-$360 more for C-PE and COC than M-PE. The differential in median Medicare payment for THA with ceramic bearings compared to M-PE was <$100. Cost differentials were found to decrease significantly over time (P < .001).Conclusion
Patient and clinical factors had a far greater impact on the cost of inpatient THA surgery than bearing selection. Because we found that costs and cost differentials for ceramic bearings were decreasing over time, and approaching the tipping point, it is likely that the cost-effectiveness thresholds relative to M-PE are likewise changing over time and should be revisited in light of this study. 相似文献80.
Moritz M. Innmann Katrin Spier Marcus R. Streit Peter R. Aldinger Thomas Bruckner Tobias Gotterbarm Christian Merle 《The Journal of arthroplasty》2018,33(4):1126-1132