Objective To explore the effective strategies of clinical pathway construction in intensive care unit (ICU).Methods From January 2016 to July 2018,1 488 patients were discharged from ICU of Liuzhou Worker's Hospital of Guangxi Zhuang Autonomous Region.The pilot project of "postoperative monitoring of heart disease" with simpler route and less variation was selected first,and then the pilot project was promoted to "post-operative monitoring" after its success.The implementation of the clinical pathway was divided into three stages:the first stage,January 2016 to May 2017,for the pilot phase,a total of 87 patients were enrolled in the clinical pathway trial;the second stage,June 2017 to December 2017,surgical ICU "postoperative monitoring of heart disease" was put into the pathway 111 times;the third stage,January 2018 to July 2018,surgical ICU "postoperative monitoring of heart disease" was entered in the path 116 times;comprehensive ICU "postoperative care" was put into the path 96 times.After carefully analyzed the reasons and sum up the experience,internet+medical treatment (Liuzhou Worker's Hospital became the fifih deep partner of Tencent Inc in the internct+medical field,and carried out the plan and practice of "WeChat wisdom hospital 3.0" in 2017) was used,four aspects of connection,payment,security and ecological cooperation were upgraded,and the construction of 6 level of electronic medical record (EMR) was accelerated.At the same time,through diagnosis related groups system (DRGs),the concept of evidence-based medicine,quality management and continuous improvement as the leading factor,and combined with the construction status of hospital information system (HIS) and EMR system,step by step implementation and design of information management platform for clinical pathway were formulated.The completion rate of clinical pathway,average length of hospital stay,average cost,cure rate and improvement rate were the main observation parameters.Results In the first stage,none of the 87 patients who entered the clinical pathway completed the clinical pathway.In the second stage,the completion rate of surgical ICU clinical pathway was increased from 33.33％ in June 2017 to 94.44％ in December 2017,and up to 100％ in October 2017,and the average completion rate from January to July 2018 was 94.00％.The completion rate of ICU clinical pathway was increased from 81.82％ in January 2008 to 92.86％ in July 2008.There was a significant difference in the overall clinical pathway completion rate from 2016 to 2018 (x2 =204.300,P =0.000).After the effective implementation of clinical pathway in June 2017,the length of hospital stay of patients was significantly shortened as compared with that before implementation (days:2.96 ± 0.43 vs.6.66 ± 0.75,P ＜ 0.01),and the daily cost was significantly reduced (Yuan:3 550.92 ± 755.51 vs.6 171.48 ± 377.29,P ＜ 0.01).The average length of hospital stay was shortened by about 3.84 days (P ＜ 0.01),and the average daily cost was reduced by about 2 108.39 Yuan (P ＜ 0.01) after the implementation of clinical pathway by surgical ICU "postoperative monitoring of heart disease" as compared with those before implementation.The average length of hospital stay was shortened by about 2.98 days (P ＜ 0.01) and the average daily cost was reduced by 5 094.13 Yuan (P ＜ 0.01) after the implementation of clinical pathway by comprehensive ICU "post-operative monitoring" as compared with those before implementation.At the same time,the cure rate was increased from 1.16％ (7/603) to 42.26％ (105/227),and the improvement rate was decreased from 94.36％ (569/603) to 52.86％ (120/227,both P ＜ 0.01) after the implementation of surgical ICU clinical pathway,but there was no significant difference in the cure rate or the improvement rate after the implementation of comprehensive ICU [2.77％ (33/1 193) vs.2.22％ (2/90),79.21％ (945/1 193) vs.97.78％ (88/90),both P ＞ 0.05].Conclusions Application of clinical pathway to control ICU quality and guide diagnosis and treatment,more refined diagnosis and treatment schemes including clinical guidelines,average length of stay,average cost of hospitalization,cost-efficiency ratio and so on were completed,which confirmed that the improvement of clinical pathway management strategy originated from clinical were needed.Informatization,intellectualization,standardization and effective control of medical cost of clinical pathway could improve medical quality and accurate management.The integration of ICU clinical pathway construction and HIS could promote the development of digital hospitals.

Objective To observe the gene mutation and clinical phenotype of patients with retinitis pigmentosa (RP) and cone rod dystrophy (CORD).Methods Thirty-seven patients with RP and 6 patients with CORD and 95 family members were enrolled in the study.The patient's medical history and family history were collected.All the patients and family members received complete ophthalmic examinations to determine the phenotype,including best corrected visual acuity,slit lamp microscope,indirect ophthalmoscopy,color fundus photography,optical coherence tomography,full-field electroretinogram,and fluorescein fundus angiography.DNA was abstracted from patients and family members.Using target region capture sequencing combined with next-generation sequencing to screen the 232 candidate pathogenic mutations.Polymerase chain reaction and direct sequencing were used to confirm the pathogenic pathogenic mutations and Co-segregation is performed among members in the family to determine pathogenic mutation sites.The relationship between genotype and clinical phenotype of RP and CORD was analyzed.Results Of the 37 patients with RP,13 were from 6 families,including 4 families with autosomal dominant inheritance,2 families with autosomal recessive inheritance,and 3 in 6 families were detected pathogenic gene mutations.24 cases were scattered RP.Six patients with CORD were from four families,all of which were autosomal recessive.Of the 43 patients,21 patients were detected the pathogenic gene mutation,and the positive rate was 48.8％.Among them,15 patients with RP were detected 10 pathogenic gene mutations including USH2A,RP1,MYO7A,C8orf37,RPGR,SNRNP200,CRX,PRPF31,C2orf71,IMPDH1,and the clinical phenotype included 10 typical RP,2 cases of RPSP,3 cases of Usher syndrome type 2 and 6 cases of CORD patients were all detected pathogenic gene mutations,including 2 cases of ABCA4,2 mutations of RIMS 1 gene,1 case of CLN3 gene mutation,and 1 case of CRB 1 and RPGR double gene mutation.Conclusions RP and CORD are clinically diverse in genotype and clinically phenotypically similar.For patients with early RP and CORD,clinical phenotype combined with genetic analysis is required to determine the diagnosis of RP and CORD.

Objective:To analyze the risk factors associated with retinal detachment in patients with myopia, and to establish and validate the predictive column-line diagram model.Methods:A cross-sectional clinical study. From January 2020 to November 2021, 90 patients with myopia combined with retinal detachment who were diagnosed by ophthalmologic examination in the People's Hospital of Ningxia Hui Autonomous Region were included in the study (observation group). Ninety myopic patients with age- and gender-matched myopia who underwent ophthalmologic examination for myopia during the same period were selected as the control group. The clinical data of the two groups were analyzed, and the indicators with differences were subjected to univariate and multivariate logistic regression analyses. The results of the regression analyses were visualized by using R software to obtain the column charts, and the accuracy of the column charts was verified by the ROC curves of the subjects' work characteristics; the clinical efficacy of the column chart model was verified by the internal data.Results:Compared with the control group, patients in the observation group were older, had higher myopic refraction, had more visual fatigue, ocular trauma, and cataracts, had lower choroidal and retinal thickness, and had more history of ophthalmic surgery, and the differences were statistically significant ( P<0.05). The area under the ROC curve (AUC) for age, myopic refraction, retinal thickness, and choroidal thickness were 0.612, 0.613, 0.720, and 0.704, respectively; the optimal cutoff values were 43 years old, -3.5 D, 225 μm, and 144 μm. the ROC values were 0.612, 0.613, 0.720, and 0.704 for age (>43 years old), myopic refraction (>-3.5 D), visual fatigue (yes), ocular trauma (yes), cataracts (yes), retinal thickness (≤225 μm), and choroidal thickness (≤144 μm) were the risk factors affecting the development of retinal detachment in myopic patients ( P<0.05). The consistency index of the column chart model for predicting the risk of retinal detachment in patients with myopia was 0.731 (95% confidence interval 0.665-0.824); the risk threshold for predicting the development of retinal detachment in patients was >0.07. Conclusions:Age >43 years, myopic refraction >-3.5 D, presence of visual fatigue, ocular trauma, cataract, retinal thickness ≤225 μm, choroidal thickness ≤144 μm are the risk factors affecting the development of retinal detachment in myopic patients. The column-line diagram model constructed on the basis of the risk factors has good accuracy.