Systems-based integrated course is a advanced and mainstream educational mode in western medical education, and also it is a hotspot of current medical education reform in China. In this article, we introduce our practice and the students' feedback of the orthopedic module of 8-year clinical medicine systems-based integrated course. During practice, we follow the integral curriculum design of Sichuan University, establish a team of teachers, integrate the curriculum of relevant disciplines, and improve teaching methods, ameliorate evaluation forms, etc. Through the implementation of this course, we recognize that this new course system aims to cultivate excellent clinical doctors, which focuses on the bilateral permeation and reconstruction among disciplines, especially between basic curriculums and clinical curriculums, changes traditional teaching methods, and strengthens the ability of practice and lifelong learning.
Mixed reality technology is new digital holographic imaging technology that generates three-dimensional simulation images through computers and anchors the virtual images to the real world. Compared with traditional imaging diagnosis and treatment methods, mixed reality technology is more conducive to the advantages of precision medicine, helps to promote the development of medical clinical application, teaching and scientific research in the field of orthopedics, and will further promote the progress of clinical orthopedics toward standardization, digitization and precision. This article briefly introduces the mixed reality technology, reviews its application in the perioperative period, teaching and diagnosis and treatment standardization and dataization in the field of orthopedics, and discusses its technical advantages, aiming to provide a reference for the better use of mixed reality technology in orthopedics.
Enhanced recovery after surgery (ERAS) has been carried out in many surgical fields such as orthopedics, galactophore, cardiothoracic surgery, gastrointestinal surgery, and obstetrics due to its standardized perioperative management process to reduce surgical stress and reduce surgical complications. After more than a decade of development, ERAS has achieved initial results. However, in China, the development of ERAS in orthopedic is still in its infancy. Most of the researches focus on the multidisciplinary management path of perioperative period. How to break through the existing bottlenecks is the key to accelerate the further development of rehabilitation. Therefore, this paper introduces the origin and development of ERAS, analyzes the challenges and opportunities of orthopedic ERAS in clinical advancement, proposes the important measures to promote the accelerated development of orthopedics, and provides new ideas for promoting the in-depth development of orthopedics accelerated rehabilitation.
Objective To analyze current research status of enhanced recovery after surgery of orthopedics in China, and to provide reference for further development of enhanced recovery after surgery in orthopedics department. Methods We searched Wanfang database and China National Knowledge Infrastructure (CNKI) database for articles about enhanced recovery after surgery of orthopedics department which were included by the Chinese Science and Technology Core Journal (2018 version) or Chinese Core Journal criterion of Peking University (2017 version), and bibliometric analysis was performed. Results A total of 135 articles were included in this study, 49 of which were collected in Chinese Core Journal criterion of Peking University. The amount of articles showed a rising trend in general over last decade. The main research topic was joint diseases (69 articles, 51.11%), followed by traumatic diseases (23 articles, 17.04%) and spinal diseases (21 articles, 15.56%); 35.56% (48 articles) of the articles were supported by different funds; Sichuan Province had the largest number of publications (36 articles) and the largest number of funds so far (8 items); clinical studies accounted for 37.78% (51 articles) with 78.43% (40 articles) randomized controlled trials, in which evaluation indicators focused on function scores, pain, length of hospital stay, complications or adverse reactions, patient satisfaction, and hospitalization costs. Conclusions The research on enhanced recovery after surgery of orthopedics in China was in a rising stage, and joint replacement was one of the hotspots. The funds are insufficient, and a series of guidelines should be developed according to the evidence-based study to accelerate the enhanced recovery after surgery of orthopedics.
To introduce the current situation of platelet-rich plasma (PRP) and its appl ication in orthopedics field. Methods The latest l iterature was reviewed, concerning the preparations of PRP, physiological mechanism and the latest appl ications in orthopedics field. Results PRP represent a new biotechnology for the stimulation and acceleration of tissue heal ing and bone regeneration. To succeed, some of the challenges need to be addressed including standardization and definition of the different PRP preparations, the complete characterization of the platelet released factors and proteins. Furthermore, well-designed studies and cl inical trials are needed to evaluate the potential therapeutic impact ofPRP. Conclusion PRP provides a novel appl ication for orthopedics field.
Objective To investigate the inpatient’s disease and cost constitution of the Third People’s Hospital of Chengdu in 2009, so as to provide baseline data for further research. Methods The case records of inpatients in the Third People’s Hospital of Chengdu in 2009 were collected, and based on the first diagnose, the diseases were classified according to the International Classification of Diseases (ICD-10). The data including general information of the inpatients, discharge diagnosis and hospitalization expense etc. were rearranged and analyzed using Excel software. Results a) The total number of inpatients was 1 220, and male was more than female. The disease spectrum included 12 categories. b) A total of 1 093 inpatients suffered from the top 3 systematic diseases as follows: trauma and toxicosis, musculoskeletal system and connective tissue disorders, and the factors affecting health and resulting from contact with health care institutions. Except the musculoskeletal system and connective tissue disorders, the other 2 systematic diseases were mostly seen in male rather than in female. c) According to ICD-10, the top 9 diseases of trauma and toxicosis were injuries to the wrist and hand, injuries to the hip and thigh, injuries to the knee and lower leg, injuries to the shoulder and upper arm, injuries to the lower back, lumbar spine and pelvis, injuries to the elbow and forearm, injuries to the thorax, injuries to the neck and injuries to the ankle and foot; the top 4 diseases in musculoskeletal system and connective tissue disorders were dorsopathies, soft tissue disorders, arthrosis, and osteopathies and chondropathies; among the factors affecting health and resulting from contact with health care institutions, removal of fracture fixation device. d) According to ICD-10 (list of three-digit catalogue and four-digit sub-catalogue), the top 5 single diseases in trauma and toxicosis were muscle and tendon injuries of the wrist and hand, intertrochanteric frature, fracture of the femoral neck, fracture of the tibia and fibula, and fracture of the lumbar spine; the top 5 single diseases in musculoskeletal system and connective tissue disorders were lumbar disc herniation, spondylosis, arthrosis of the knee, osteoporosis with pathological fracture, and osteonecrosis. e) The average hospital stay were 23.55 days, and the average cost per capita were 13 073.73 yuan which were constituted by material cost, drug cost including western and Chinese medicines, treatment expenses including blood transfusion fee, operation expenses including anesthetic fee, examination expenses including radiation fee and laboratory fee, bed fee and others. The inpatient costs were mainly at patient’s own expense, nearly a half of those expenses were paid by social security, and public medical care only accounted for less than 3% of the total payment. Conclusion In 2009: a) The male inpatients were mainly the young and middle-aged, and the female were the elderly. The main 3 systematic diseases were trauma and toxicosis, musculoskeletal system and connective tissue disorders, and the factors affecting health and resulting from contact with health care institutions. Except the musculoskeletal system and connective tissue disorders, the other 2 systematic diseases were mostly seen in male rather than in female. b) The top 3 single diseases were lumbar disc herniation, muscle and tendon injuries of the wrist and hand, and intertrochanteric fracture. Except lumbar disc herniation, the other 2 single diseases were mostly seen in male rather than in female. c) The average hospital stay was 23.55 days. The overall costs were mainly constituted by material and drug cost (59.25%), with rationality worthy of attention. d) Inpatient costs were mainly at patient’s own expense or paid by social security, and the proportion of public medical care was low in the payment.
The full-cycle rehabilitation management for orthopedic patients can solve the problems of standardization, systematization, and whole process of orthopaedic rehabilitation management, and prevent short-term and long-term complications. The First Affiliated Hospital of Sun Yat-sen University has constructed a full-cycle rehabilitation management platform for orthopedic patients based on multi-source data since 2023, including six modules: multi-source data collection and integration module, intelligent individualized rehabilitation program setting module, and visual rehabilitation training module, and has explored a digitally-driven full-cycle rehabilitation management mode for orthopedic patients. This article elaborates on the platform’s functional design and implementation, full-cycle rehabilitation management mode, and application effectiveness, in order to provide a reference for promoting the integration of mobile health and orthopedic patient rehabilitation practice.
Objective To investigate the mental status of medical staffs in the orthopedics department during the earthquake, providing evidence for psychological intervention. Methods Choosing 104 staffs in the orthopedics department as eligible subject with convenient sampling; the research tool was Symptom Checklist-90. The questionnaire was done by the participants with the same instruction from psychological professionals; analyze the results. Results The score in somatization, anxiety and phobic anxiety of staffs in the orthopedics department was significantly higher than the national norm. Conclusion There exists disorder in mental health of medical staffs in orthopedics department, it is necessary to implement mental intervention.
Objective To evaluate the feasibility and significance of problem-based learning (PBL) in orthopedic internship. Methods A total of 315 students in grade 2002 were involved in PBL during their internship in the Department of Orthopedics at the First Affiliated Hospital of China Medical University, Shenyang, China. Teaching effectiveness was evaluated with a questionnaire and an ability examination. The results of PBL teaching during different semesters were compared, and the feasibil ity and significance of PBL were analyzed. Results Students who participated in PBL were in a dominant position and were more active in the learning process. The PBL pattern could improve students’ ability to identify, analyze and solve problems, and also contribute to fostering and enhancing their clinical thinking. This could help them solve the problems that emerged from the theory curriculum.Conclusions The PBL pattern used in the orthopedics internship has advantages and practical significance, which are applicable in modern medical teaching practice.
Objective To investigate the orthopaedic inpatients’ disease and cost constitution of the Third People’s Hospital of Chengdu during 2008-2010, so as to provide detailed baseline data for further research on the factorial analysis of disease burden and effective intervention. Methods The medical records of inpatients in orthopaedic department of the hospital during 2008-2010 were collected, and the diseases based on the first diagnosis on discharge records were classified according to the International Classification of Diseases (ICD-10). Results During 2008 to 2010, the total number of inpatients increased year by year. Most of the male inpatients were the young and middle-aged, while the female were the old. The rank order of top 5 systematic diseases didn’t change, while there were 6 single diseases kept ranking as top 10 in those 3 years. The average cost per capita averagely grew by 8.97%. The top 3 constitution of hospitalization cost remained the same, which were material cost, drug cost, and treatment cost; while the top 3 payment modes of hospitalization cost were patient’s own expense, social security, and public expense. Among those payment modes, social security rose obviously, and patient’s own expense reduced generally. Conclusion a) The total number of inpatients increases yearly during 2008-2010, and the gender and age distribution of inpatients are tending towards stability. b) The spectrum of disease and single diseases classified according to the one-level code of ICD-10 are relatively stable in those 3 years; of which the top ranked disease is lumbar disc herniation, and the disease with most obviously rising trend is intertrochanteric fracturethe. c) The hospitalization cost per capita rises year by year, of which the constituent ratio of both material and examination costs grow obviously, but the operation, treatment and bed costs are still lower. It requires a multi-pronged approach to control the increase of hospitalization cost as well as the rationalization of cost constitution. d) Among all payment modes of hospitalization cost, the constituent ratio of patient’s own expense reduces year by year, while social security rises, indicating the medical security in national social security has been further expanded.
