Effectiveness,Patient Satisfaction,and Cost Reduction of Virtual Joint Replacement Clinic Follow-Up of Hip and Knee Arthroplasty

BackgroundTotal hip and knee arthroplasties are increasingly performed operations, and routine follow-up places huge demands on orthopedic services. This study investigates the effectiveness, patients’ satisfaction, and cost reduction of Virtual Joint Replacement Clinic (VJRC) follow-up of total hip arthroplasty and total knee arthroplasty patients in a university hospital. VJRC is especially valuable when in-person appointments are not advised or feasible such as during the COVID-19 pandemic.MethodsA total of 1749 patients who were invited for VJRC follow-up for knee or hip arthroplasty from January 2017 to December 2018 were included in this retrospective study. Patients were referred to VJRC after their 6-week postoperative review. Routine VJRC postoperative review was undertaken at 1 and 7 years and then 3-yearly thereafter. We evaluated the VJRC patient response rate, acceptability, and outcome. Patient satisfaction was measured in a subgroup of patients using a satisfaction survey. VJRC costs were calculated compared to face-to-face follow-up.ResultsThe VJRC had a 92.05% overall response rate. Only 7.22% required further in-person appointments with only 3% being reviewed by an orthopedic consultant. VJRC resulted in an estimated saving of £42,644 per year at our institution. The patients’ satisfaction survey showed that 89.29% of the patients were either satisfied or very satisfied with VJRC follow-up.ConclusionVJRC follow-up for hip and knee arthroplasty patients is an effective alternative to in-person clinic assessment which is accepted by patients, has high patient satisfaction, and can reduce the cost to both health services and patients.     

内听动脉闭塞综合征的临床与发病机理

目的：探讨内听动脉闭塞综合征的临床与发病机理。方法：分析24例患者年龄、性别及所伴发疾病如高血压病、糖尿病、冠心痛及椎-基底动脉供血不足等。结果：50岁以上，有高血压病、冠心病、糖尿病、椎-基底动脉供血不足者内听动脉闭塞发病明显增加。结论：高血压病、冠心病、糖尿病、椎基底动脉供血不足是内听动脉闭塞综合征的主要危险因素。     

成人水痘20例临床分析

目的探讨成人水痘的临床特点。方法分析20例成人水痘的临床特点，并与30例儿童水痘比较。结果患者出疹时间、皮疹分布区域、发热时间和并发症等，成人水痘都与儿童水痘不同。结论与儿童水痘相比较，成人水痘有自己的临床特点。     

TEN YEARS' EXPERIENCE IN LOW VISION PRACTICE

The Low Vision Clinic at the Palmerston North Hospital has now been oerating for 70 years. Over the course of these ten years a number of factors have emerged which can be as readily applied to general ophthalmological practice as to low vision practice. The philosophy of low vision care is one of which all ophthalmologists should be aware and includes factors to be taken into account when dealing with children, people in the workplace, and everyday factors involved in daily living activities, all of which are equally relevant in routine ophthalmological practice. This paper endeavours to share some thoughts on these factors and also discusses means by which the visually handicapped can be helped in areas where specialist low vision services are not readily available.     

Are Continuity Clinic Patients Less Satisfied When the Resident Is Postcall?

Due to recent public debate and newly imposed resident work hour restrictions, we decided to investigate the relationship of resident call status to their ambulatory patients' satisfaction. Resident continuity clinic patients were asked to rate their level of satisfaction on a 10-point Likert-type scale. Using multiple regression approaches, these data were then assessed as a function of resident call status. We found that in 646 patient encounters, patient satisfaction scores were significantly less when the resident was postcall, 8.99 ± 1.8, than when not postcall, 9.31 ± 1.3. We herein discuss etiologies and implications of these findings for both patient care and medical education.     

静脉药物配置中心的建立在临床中的应用

静脉输液药物集中配置、管理是我国医院管理的一项新举措.长期以来,临床静脉输液中的加药工作一直是由护士在治疗室独立完成,这种方式存在着很多不足之处.在这种环境污染下,职业健康安全管理越来越受到各国政府的重视.为了提高服务质量,预防和控制可能存在的环境污染及职业健康安全风险,国家颁布 GB/T24001～ 1996<环境管理体系规范和使用指南>, GB/T28001-2001<职业健康安全管理体系规范>标准,引进国外的先进管理模式,此项工作由药师和护士共同完成,以期达到合理用药减少药物的流失和浪费,科学配置、降低输液反应.静脉药物配置中心把静脉药物配置从普通环境的治疗室转为在具有洁净条件的配置中心进行集中管理配置,保证配置出来的药品安全无菌、有效.需要输液的患者在舒适、整洁和安静的环境下进行输液,减少临床护理工作量的目的,把更多的时间还给病人.这为顺利实施静脉配置中心的项目提供了保障,确保了输液中心正常运行.     

眼外伤临床统计规范探讨

眼外伤是我国眼科住院三大主要疾病之一，占眼科住院病人总数的１６￣３２％。每年发表临床统计文章百余篇，但由于统计资料不全面，标准不统一，降低了这部分劳动的价值。本文就眼外伤临床统计规范及某些问题进行讨论，强调规范化的重要意义。     

无痛麻醉在拔牙术中的临床应用

目的：评价无痛麻醉技术的临床麻醉效果，寻求一种更有利于手术进行的局麻技术。方法：选择120例就诊于齿槽外科门诊需要拔牙的患者，将其随机分为对照组和实验组，每组60例。对照组施常规局麻，实施组施无痛麻醉技术，观察每组麻醉结束、术中及术后的血压、心率变化。结果：对照组与实验组对比，术中、术后观测指标的变化无显著性差异，麻醉结束后的观测指标15以下者无显著性差异，15岁以上者有显著性差异。结论：无痛麻醉技术与常规的局麻技术一样可以达到麻醉的目的，无痛麻醉可减少麻醉注射中因疼痛所引起的血压、心率的变化。     

腮腺导管癌的临床病理特征分析--附1例报告及文献复习

目的:结合文献探讨腮腺导管癌的临床病理特征。方法:报道1例腮腺导管癌，就本病的临床生物学特征、病理、治疗及预后进行总结分析。结果:经手术及放疗后3个月复查，出现同侧颈部淋巴结转移。结论:腮腺导管癌是一类恶性度很高的恶性肿瘤，诊断主要依靠术后病理学及免疫组织化学检查，以局部广泛切除加颈廓清术为主，术后给予放疗。     

原发性胃肠道粘膜相关淋巴组织淋巴瘤47例临床病理分析

目的 探讨原发性胃肠道粘膜相关淋巴组织淋巴瘤(GIL-MALT)的临床病理特点。方法 回顾性分析1990～2000年我院经手术及病理证实的47例胃肠道MALT患者临床病理资料。结果 47例患者平均年龄57．2岁，男女比例2．1：1。以腹痛和发热为主。病变分布为胃32例，小肠4例，回盲部及盲肠5例，大肠6例。内窥镜下息内型15例，溃疡型25例，弥漫型7例。除1例为T细胞淋巴瘤，其余均为B细胞淋巴瘤。结论 胃肠道粘膜相关淋巴瘤以中老年为主，男性居多，临床误诊率较高。内窥镜下多次多点活检、深凿活检可提高本病的确诊率。