In recent years, the rapid development of information and communication technology, big data, and artificial intelligence has provided technical support for exploring new medical methods, leading to the emergence of digital therapeutics (DTx). At present, the application of DTx in orthopedics is still in the preliminary exploration stage. Therefore, based on the authors’ experience of applying DTx, this article summarizes the definition and formation process of DTx, as well as the relationship among digital health, digital medicine, and DTx, evaluates the working principles and application effects of existing orthopedic related DTx products, analyzes their shortcomings in the application process, and looks forward to their future development trends, aiming to lay a foundation for the comprehensive development and application of DTx in orthopedics.
Objective To summarize the application progress of surface electromyography (sEMG) and surface electromygraphic biofeedback (sEMGBF) in low back pain (LBP). Methods The related literature about the application of sEMG and sEMGBF in diagnosis and therapy of LBP was summarized and analyzed. Results As a auxiliary diagnostic technique, lumbar muscle fatigue, lumbar muscle activity disorder, flexion-relaxation phenomenon, and asymmetry of the paravertebral muscle electromygraphic activity were found in patients with LBP by sEMG. For treatment, sEMG combined with sEMGBF technology to form sEMGBF training. sEMGBF training include sEMGBF training and sEMGBF stretching exercise. sEMGBF training can improve lumbar muscle activity disorder, recover muscle function, and relieve back pain. Conclusion sEMG can monitor the electromyographic signal and sEMGBF biofeedback information can relax or strengthen the muscle. It is very meaningful for diagnosis and therapy of LBP.
Objective To investigate the current status of fear of disease progression and sleep quality among laryngeal cancer patients, and analyze the correlation between them. Methods Laryngeal cancer patients who were hospitalized in West China Hospital of Sichuan University between March 2021 and February 2022 were selected for this cross-sectional survey. Sociodemographic and disease-related data questionnaires, Chinese version of Fear of Progression Questionaire Short Form, and Pittsburgh Sleep Quality Index (PSQI) Scale were used to investigate the laryngeal cancer patients who met the inclusion criteria, and the correlation between fear of disease progression and PSQI score in laryngeal cancer patients was analyzed by Spearman correlation analysis. Multiple linear stepwise regression analysis was used to analyze the effects of sociodemographic and disease-related characteristics on the total score of fear of disease progression in laryngeal cancer patients, and the effects of sociodemographic, disease-related characteristics and total score of fear of disease progression on the total score of PSQI of laryngeal cancer patients. Scores were expressed as median (lower quartile, upper quartile). Results A total of 312 copies of questionnaires were distributed and 309 valid copies were recovered, with an effective recovery rate of 99.0%. The total score of fear of disease progression in the laryngeal cancer patients was 22.00 (16.00, 30.00), including 12.00 (8.00, 17.00) in physiological health dimension, and 10.00 (7.00, 14.00) in social and family dimension. The total score of PSQI was 5.00 (3.00, 8.50). The correlations of the physiological health dimension score, the social and family dimension score, and the total score of fear of disease progression with the total score of PSQI in laryngeal cancer patients were positive with statistical significance (rs=0.294, P<0.001; rs=0.234, P<0.001; rs=0.287, P<0.001). Multiple linear stepwise regression analyses showed that the total score of fear of disease progression in laryngeal cancer patients was affected by the stage of disease, occupation, primary caregiver and treatment plan (P<0.05), and the total score of PSQI of laryngeal cancer patients was affected by level of education, treatment plan and the total score of fear of disease progression (P<0.05). Conclusions The fear of disease progression in laryngeal cancer patients has a significant negative correlation with the sleep quality. Meanwhile, alleviating the level of fear of disease progression may improve sleep quality.
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 summarize the optimal evidence for improving the management of chronic wounds exudate, so as to provide evidence-based references for medical professionals, therapists, patients, and their caregivers. Methods PubMed, Wanfang, CNKI, Medlive, UpToDate, etc., were searched by computer for literature about chronic trauma exudate management. The retrieval time limit was from 1998 to 2023. Two researchers trained in evidence-based practice evaluated the quality of the included literature and finally extracted evidence from the literature that met the quality evaluation criteria. Results A total of 11 articles were included, including 2 expert consensuses, 7 systematic reviews, 1 randomized controlled trial, and 1 guideline, covering 7 aspects of the assessment of the nature of chronic wounds exudate, selection of exudate assessment tools, management of antimicrobial concerns, selection and application of wound dressings, negative pressure wound drainage therapy, wound drainage bags, and affected limb elevation or compression therapy for patients with venous leg ulcers. A total of 13 best evidences were extracted. Conclusions When applying evidence, medical professionals should fully evaluate and combine the individual circumstances of the patient, make full use of existing resources, new treatment concepts and technologies, and carry out comprehensive integrated management. This can optimize the management of chronic wounds exudate and improve the quality of life of patients.
In recent years, the widespread use of medical devices has led to the increasing frequency of device related pressure injuries (DRPI), which seriously affects the quality of life of patients and increases the burden on the healthcare system. The management model of DRPI has become an effective means of coping. This article reviews the application status of the care bundles model, SSKIN clinical management model, SECURE clinical management model in the prevention of DRPI. According to the characteristics of different management models, the key steps of implementation are given, aiming to provide a reference for exploring the prevention and management model of DRPI suitable for China’s national conditions.
Objective To explore the postoperative satisfaction of patients with lumbar disc herniation after enhanced recovery after surgery and its related factors. Methods A total of 102 patients with lumbar disc herniation were selected and analyzed by convenient sampling method from September 2016 to June 2017. The patients’ general information, functional status [using the Oswestry Disability Index (ODI) to investigate the preoperative, postoperative and post-discharge ODI] and patients’ satisfaction (1 month after the discharge) were collected. Results A total of 102 patients, including 62 males and 40 females, aged from 14 to 82 years with an average of (43.8±14.4) years were included in the study.The mean length of hospital stay was (6.61±2.49) days. The total score of patients’ satisfaction was 62.43±6.37, and the satisfaction degree was at the middle and high level. Postoperative and post-discharge ODIs were associated with patients’ satisfaction (rs=0.328, 0.452; P<0.05). Conclusions The postoperative satisfaction of patients with lumbar disc herniation after enhanced recovery after surgery should be further improved. The medical staff should pay attention to the recovery of postoperative function in order to improve the patients’ satisfaction.
ObjectiveTo investigate and analyze comorbidities of elderly patients with total hip/knee arthroplasty, so as to provide a basis for the management of comorbidities.MethodsConvenience sampling was used to select elderly patients who underwent total hip/knee arthroplasty in the Department of Orthopedics in West China Hospital of Sichuan University from June to December 2019 as the research objects. We collected general data and comorbidity data of patients, and statistically analyzed the comorbidities of elderly patients undergoing total hip/knee arthroplasty, and the characteristics of perioperative psychology, sleep, postoperative complications, and length of hospital stay in elderly patients undergoing total hip/knee arthroplasty with comorbidities.ResultsA total of 263 patients were included, of whom 64.6% had comorbidities. The number of comorbidities in elderly patients undergoing total hip/knee arthroplasty ranged from 2 to 12. The most common comorbidity was hypertension. Between patients with comorbidities and non-comorbidities, there were statistically significant differences in age (Z=−2.225, P=0.026), preoperative Huaxi Emotion Index scores (9.6±4.6 vs. 6.4±5.0; t=5.126, P<0.001), preoperative Pittsburgh Sleep Quality Index scores (13.3±3.1 vs. 12.3±2.5; t=−2.972, P=0.003), hospital stay [(5.2±0.8) vs. (4.8±0.4) d; t=4.243, P<0.001], and incidence of postoperative complications (13.5% vs. 5.4%; χ2=4.201, P=0.040).ConclusionsComorbidities are common in elderly patients with total hip/knee arthroplasty, which may aggravate negative emotions, reduce sleep quality, increase postoperative complications and prolong length of stay. Medical staff should strengthen the management of comorbidity in elderly patients with total hip/knee arthroplasty, so as to reduce its influence on perioperative period and promote the rehabilitation of patients.
ObjectivesTo explore the status quo of the readiness for hospital discharge and the quality of discharge guidance in patients after total hip/knee arthroplasty, and analyze their correlations.MethodsA cross-sectional survey was conducted to investigate patients who underwent total hip/knee arthroplasty in a tertiary hospital in Chengdu between January and November 2017. The survey included basic patient information questionnaire, Readiness for Hospital Discharge Scale, and the Quality of Discharge Teaching Scale.ResultsThe average age of 352 patients undergoing total hip/knee arthroplasty was (59.56±12.69) years. The total score of readiness for hospital discharge was 177.08±19.41, the average score was 7.82±0.88, and the average quality of discharge teaching was 145.87±14.87. There was a statistically significant difference between the patients’ access and the required discharge teaching (t=28.742, P<0.001). The score of readiness for hospital discharge was positively correlated with the score of the quality of discharge guidance (r=0.645, P<0.001), the obtained content dimension (r=0.542, P<0.001), and the teaching skill dimension (r=0.522, P<0.001).ConclusionsThe readiness for hospital discharge in patients after total hip/knee arthroplasty is in a medium level, and the quality of discharge teaching is higher overall and it is positively correlated with the readiness for hospital discharge. Medical staff should pay attention to the discharge guidance for patients. In the course of health education, not only the content and quantity of guidance should be emphasized, but also the guiding skills should be paid attention to, so as to improve the quality of discharge teaching, thereby improving the patient’s discharge readiness and promoting the patient’s later rehabilitation.
Objectives To explore the application effect of orthopedic psychological sleep management mode based on enhanced recovery after surgery (ERAS) in orthopedic patients. Methods A non-synchronous clinical controlled study was conducted. The intervention group enrolled 118 orthopedic patients who admitted to our hospital between April and June 2017, and the control group enrolled 111 orthopedic patients who admitted to our hospital between January and March 2017. The control group used routine nursing measures during hospitalization, while the intervention group implemented an ERAS-based orthopedic psychological sleep management mode based on routine nursing measures, which included carrying out a new mode of multidisciplinary collaborative management, implementing the normative path of orthopedic psychological sleep management, and implementing the comprehensive psychological sleep management. The mood, sleep quality and satisfaction of the two groups within 24 hours after admission and before discharge were compared. Results Before the intervention, there was no statistically significant difference in general data, mood or sleep quality between the two groups (P>0.05). After the intervention, the median score (the lower and upper quartiles) of the Huaxi Emotional Index of the intervention group was 1 (0, 5), while the score of the control group was 2 (0, 6); the median score (the lower and upper quartiles) of the Pittsburgh Sleep Quality Index was 4 (3, 7) in the intervention group and 6 (4, 9) in the control group; the satisfaction score in the intervention group was better than that in the control group (96.47±2.72vs. 95.52±2.79); the differences between the two groups were statistically significant (P<0.05). Conclusions The ERAS-based orthopedic psychological sleep management mode is beneficial to improve the patients’ emotional disorder, sleep quality and satisfaction. It facilitates the patients’ accelerated recovery.