"军字一号"工程检验科信息管理系统初步应用及体会

“军字一号”医院信息管理系统是医院由经验管理模式向科学管理模式转变的标志。随着现代检验医学的发展,临床及科研部门对临床实验室的要求进一步提高,许多以往靠人工进行检验的项目逐渐被自动仪器代替,人工方法进行检验结果的登录、计算及报告已不能适应实验的正常运作。目前,我科使用“军字一号”工程检验信息管理系统,实现了检验报告的规范化、检验数据的存档、检验结果的查询以及检验收费的统一管理,收益颇多。1主要应用经验(1)检验信息管理系统包括了检验申请项目录入,检验结果数据自动采集或录入,以及检验费用的管理,产生检验科管理…     

浅谈现代临床实验室管理新模式

21世纪是一个知识更新飞速发展的时代,在基础医学和临床医学快速发展的推动下,临床实验室的工作范畴、性质和程序也发生了变化,主要体现在各种大型自动化仪器的使用,检测项目的快速增加等方面,为临床疾病的诊断、治疗、病情观察及预后判断提供更直接更快捷的实验数据。检验专业的内涵也由医学检验向检验医学转变。因此,在新时     

临床生化检验结果异常的临床指导探讨

目的 对临床生化检验结果异常的临床指导进行探讨.方法 随机抽取治疗的94例需要生化检验的患者,分为两组:对照组与观察组,对照组患者使用常规临床生化检验方法进行检验,而观察组患者使用质量严格控制的生化检验方法进行检验,对两组患者的检验结果进行对比与分析.结果 观察组患者的检测结果异常明显为8.5％,对照组为51.1％,存在较大差异,具备统计学意义(P＜0.05).观察组患者的重现性、时效性明显高于对照组,存在较大差异,具备统计学意义(P＜0.05).结论 在临床生化检验的过程中,通过科学、严格的质量控制,能够有效降低临床生化检验结果的异常率,提高生化检验结果的准确性与可靠性,为医生的诊断治疗提供科学的数据支持,具有非常重要的意义.     

临床生化检验数据库管理系统的研究和应用

目的：建立一种临床生化检验数据库管理系统。方法：在Ｆｏｘｐｒｏ２．５ＢｆｏｒＭＳ－ＤＯＳ高级关系型数据开发软件环境下，应用计算机信息处理技术，研制临床生化检验信息数据库管理系统。结果：本系统具有通用性和广泛的兼容性，能够在ＵＣＤＯＳ６．０中文环境下运行，可以在８０３８６ＣＰＵ以上档次的任何微机中使用，对内存和硬盘均没有严格要求。结论：本系统设计功能强大，运行速度快，具有一定的容错性，是一种较为理想的临床生化检验数据库管理系统     

溶血对部分生化检验项目结果的影响

溶血是指在采集、运送、分离或保存血液的过程中,由于各种原因,尤其是操作不当引起的红细胞在体外的破裂,使红细胞内的许多化学成分外溢到血清中,又是临床生化检验中影响检验结果准确性的最常见的一种干扰因素。为了探索不同程度溶血对常规生化检验项目结果的影响,本研究对标本在不同程度溶血的情况下做常规生化项目的对照检测与分析,为临床医师正确判断溶血标本的测定结果提供参考。     

对野战医疗队快速检验的改进建议

新疆伊宁解放军11医院叶兴德、靳西勇、孙广伟、张强来稿：对野战医疗队快速检验的改进建议。文章说，基层野战医院都在强化野战医疗队的日常演练，而战地快速检验是战地早期救治的重要内容。目前的训练项目主要包括血常规检验、尿液检验、生化检查、配血检验、核化生武器致病医学检验、食品卫生检验等。这些项目虽然可基本满足战时需要，但考虑到战时随时可能发生特殊情况，他们认为应该具备一些更实用、更适合野战医疗队应用的检验试剂和方法。一是应增加快速凝血功能检验的手段，如手工检验方法（波片法和试管法）快速可靠，携带器械简易轻便。     

溶血现象对临床生化检验项目的影响及对策分析

目的 分析溶血现象对临床生化检验项目的不良影响及相关对策.方法 选择2019年4月～2021年3月接诊的100例健康体检者当做研究对象.于次日清晨抽取研究对象的空腹静脉血6 mL,并将其平均分为两份.对其中一份血液样本进行溶血处理,并将其纳入研究组;另一份血液样本不进行任何处理,并将其纳入对照组.详细记录两组血液样本的生化检验结果 ,并分析溶血现象对临床生化检验项目的不良影响及干扰作用.结果 对比研究组与对照组的ALB、TG、UA、BUN、Cr等指标水平,组间无显著统计学意义(P＞0.05);对比研究组与对照组的ALT、AST、TBIL、TP、LDH、K+、CK、GLU、DBIL、TC、ALP等指标水平,组间存在显著统计学意义(P＜0.05).结论 溶血现象会对临床生化检验项目产生较多的不良影响及干扰,不仅会降低酶类指标的血液检测真实性,还会严重降低其准确性,为了确保临床生化检验项目的真实和可靠,还应该加强临床生化免疫检验质量管理,预防溶血现象的出现.     

列车运行对半自动生化分析仪测定血糖结果的影响

目的：探讨列车运行状态对血糖测定结果的影响。方法：列车运动状态下，采用葡萄糖氧化酶法，科华K-HB3280半自动生化分析仪测定20份样本的血糖水平，与静止状态下的血糖结果进行对比分析。结果：列车运行状态下血糖检验结果与静止状态下相比无显著差异（P〉0．05）。结论：列车运行对应用科华K-HB3280半自动生化分析仪测定血糖无明显影响。     

组合分析的临床应用

组合分析是检验科根据临床的实际需要以及普查工作时的具体情况而设定的检验项目的组合。近三十多年来，由于临床生化工作内容的迅速扩大以及机、光、电新技术不断应用到检验领域，特别是生化自动分析仪的不断发展，经历了连续流动式、分立式、离心式及袋式几种主要类型，加上计算机的应用，使临床化学工作大大改进了分析的质和量，提供了检测大批标本的工作程序，并设计出各种组合分析，为临床疾病的诊断与治疗提供了更为详尽的资料，组合分析在临床医疗和保健工作中起着越来越重要的作用。1组合分析用于器官功能检查当某一器官组织发生损…     

临床生化超微量检验设备的研制和应用

超微量、准确、快速是平战时最为理想的检验方法,但关键有两个问题没有解决,即超微量加样和比色,我们对此作了改进,生化超微量检验只需取末梢血50～100μl,即能完成大部分生化检验项目。以白蛋白测定为例:分别用半自动加样器吸取测定血清、标准血清、生理盐水各1μl于相应的55孔板的测定、标准和空白孔内,各孔加溴甲酚绿试剂320μl,混匀,放     

慢性肝病血性腹水38例临床分析

目的：研究38例慢性肝病合并外观血性腹水的病因诊断与预后。方法：选择慢性肝病并有外观血性腹水病例38例，总结临床资料，以临床症状、腹水常规、肝功能、肝脏病理、B超诊断结果分别对38例病人进行分析。结果：该组病人全部有乏力，腹胀、腹水及不同程序纳差、肝痛；总胆红素异常升高率94．7％，AFP阳性率78．9％，ALT异常升高率为84．2％；活动进展期各型肝炎18例，肝癌20例；治疗好转4例，无变化8例，死亡26例。结论：慢性肝病并有自发性血性腹水的病人预后不良。     

“科研训练信息管理系统”在军队医院研究生管理中应用

目的探讨"科研训练信息管理系统"在军队医院研究生管理中应用的方法和效果。方法军队医院研究生管理工作存在的主要问题包括人员构成复杂、难以统一管理及管理力量薄弱,为此,沈阳军区总医院研发建立了"科研训练信息管理系统",将其应用于学员入院信息注册、数据共享、成绩录入、考试报名、毕业信息保存。结果 "科研训练信息管理系统"可简化研究生管理人员工作程序,提高管理工作效率,实现院内多部门信息共享,并与医院信息系统(HIS)融合,实现对研究生学员的高效动态管理。结论 "科研训练信息管理系统"已广泛应用于我院包括研究生管理工作在内的多项医院管理工作中,成为我院管理工作改革创新的重要环节。     

Procedural Impact of a Dedicated Interventional Oncology Service Line in a National Cancer Institute Comprehensive Cancer Center

PurposeWe tested the hypothesis that establishing a dedicated interventional oncology (IO) clinical service line would increase clinic visits and procedural volumes at a single quaternary care academic medical center.MethodsTwo time periods were defined: July 2012 to June 2013 (pre-IO clinic) and July 2013 to June 2014 (first year of dedicated IO service). Staff was recruited, and clinic space was provided in the institution’s comprehensive cancer center. Clinic visits and procedure numbers were documented using the institution’s electronic medical record and billing forms. IO procedures included were transarterial chemoembolization, Y-90 radioembolization, perfusion mapping for Y-90, portal vein embolization, and bland embolization. We compared changes in clinic visit and procedure numbers using paired t tests. Changes after IO initiation were compared to 1-year changes in the Medicare 5% Limited Data Set by cross-referencing Current Procedure Terminology and International Classification of Diseases codes in 2012 and 2013.ResultsClinic visits increased from 9 to 204 (P = .003, t = 8.89, df = 3). Procedures increased from 60 to 239 (P = .018, t = 3.85, df = 4). Procedural volumes increased at least 150% for each subtype. The volumes in the 5% Limited Data Set did not change significantly over the 2-year period (443 to 385, P > .05).ConclusionsThe establishment of a dedicated IO service significantly increased clinic visits and procedural volumes. National trends were unchanged, suggesting that the impact of our program was not part of a sudden increase of IO procedures.     

Sexually transmitted disease screening and reporting practices in a military medical center

Sexually transmitted diseases (STDs) and their sequelae are responsible for significant human and economic costs. Military personnel are one of many core populations at increased risk for acquiring STDs. This study was designed to assess primary care physician/practitioner compliance with secondary screening recommendations and reporting practices of STDs in a military setting. Data from approximately 27,000 covered lives from the Naval Hospital and the Naval Air Station Branch Medical Clinic in Jacksonville, Florida, were used in this analysis. Because chlamydia is the most prevalent STD, laboratory results indicative of infection with chlamydia from July 1 to December 31, 1996, were used as a marker of a patient population requiring additional (secondary) STD screening. Patients with laboratory-confirmed chlamydia infection were identified using the Composite Health Care System. The medical records of these index cases were then analyzed for the presence of laboratory test results of human immunodeficiency virus (HIV), rapid plasma reagin, and hepatitis B virus (HBV) within 6 months of a positive chlamydia test. To assess compliance with mandated reporting of particular STDs, total laboratory-confirmed cases of chlamydia, syphilis, and HBV were compared with total cases reported to the Office of Preventive Medicine at the Bureau of Medicine and Surgery, U.S. Navy, during a 1-year period from July 1, 1996, to June 30, 1997. In 32% of chlamydia cases, no additional laboratory tests for HIV, syphilis, or HBV were obtained within 6 months. Fourteen percent of chlamydia cases were reported to the Office of preventive Medicine. Compliance with screening for multiple STDs after the identification of a single STD should be improved. In addition, better methods for reporting cases of STDs should be implemented.     

联合国驻黎巴嫩临时部队中国二级医院皮肤科就诊患者疾病谱及不同时段变化情况分析

目的 探讨联合国驻黎巴嫩临时部队(UNIFIL)中国二级医院皮肤科就诊患者皮肤病谱及不同时段的变化规律,为后续维和医疗分队皮肤专科训练、药品采购以及进一步的维和卫勤保障工作提供参考.方法 查阅UNIFIL 中国二级医院信息管理系统,收集2009年11月-2011年7月就诊患者的临床资料,分别计算皮肤专科门诊就诊人次占全院门诊就诊总人次的构成比以及前10位皮肤病各病种就诊人次占皮肤专科门诊就诊总人次的构成比,并分析不同时段上述指标的变化,采用SPSS软件x2检验模块进行统计学分析.结果 7905人次门诊病例中,皮肤病专科门诊占8.2％(648/7905),其中时段A(2009年11月1日-2010年6月30日)、时段B(2010年7月1日-2011年2月28日)和时段C(2011年3月1日-2011年7月 31日)专科门诊构成比分别为6.2％、6.8％、11.9％(x2=66.37,P=0.000).皮肤癣菌病(16.05％)、湿疹(10.65％)、疣(7.72％)、慢性单纯性苔藓(5.71％)等前10位的病种占皮肤病患者的54.17％.常见病多发病、感染性皮肤病、心身性皮肤病多见是其疾病潜的重要特征;不同时段皮肤病谱不同,时段A、B病种相对集中,时段C则相对分散(x2=13.12,P=0.001).结论 UNIFIL中国二级医院皮肤科就诊患者疾病谱以常见病多发病、感染性皮肤病、心身性皮肤病为主,不同时段有一定变动.     

Prediction of perceptibility curves of direct digital intraoral radiographic systems.

OBJECTIVES: To derive and test a method to predict Perceptibility Curves (PCs) for direct digital intraoral radiographic systems. METHODS: A test object was used to determine the performance of an average observer with respect to the threshold contrast and internal noise of the human visual system. These data were combined with system parameters to predict PCs mathematically. RESULTS: Data on the performance of an average observer could be defined to obtain values of the effective threshold contrast as a function of background gray level. This function combined with the gamma-value of the system predicted PCs that agreed well with PCs obtained in the conventional way. CONCLUSION: It is possible to predict PCs from a limited number of system parameters together with predetermined data on an average observer.     

基于PLC控制的蠕动泵式核素药物自动稀释分装仪的研制

目的:本文旨在为目前PET/CT中心回旋加速器制备的放射性核素药物,开发一种新型的自动分装稀释装置。方法:结合临床实际操作流程,设计装置的机械驱动模块,同时自主开发软件系统,实现对硬件模块的控制及满足临床需求。结果:研制成功了一台可以应用于临床的设备,该设备以工业可编程控制器(programmable logical controller,PLC)为控制核心,辅以触摸屏、蠕动泵、专门设计的管路系统、剂量仪、打印机等组成,触摸屏提供输入输出界面,完成各种核素各种不同剂量的分装的设置。结论:该仪器经过临床测试,达到了实际需求,减少了工作人员95%的辐射水平。该仪器已申请实用新型与国家发明技术专利,专利号分别为:200620079934.X,200710016915。     

Patients, diagnoses, and procedures in a military internal medicine clinic: comparison with civilian practices

BACKGROUND: Our goal was to compare the demographic features, diagnoses, and procedures in civilian and military ambulatory internal medicine clinics. METHODS: One year (September 1996 to August 1997) of data from the Ambulatory Data System of the Adult Primary Care Clinic at Madigan Army Medical Center was extracted and compared with the most recent (1995) National Ambulatory Medical Care Survey. RESULTS: A total of 41,374 Madigan patient encounters were compared with civilian data from the National Ambulatory Medical Care Survey. The age distribution was similar, with military patients averaging 53.5 years of age and civilian patients averaging 54.5 years. Military patients were more likely to be female (71 vs. 60%) and were more ethnically diverse (military: 68% white, 17% African American, 7% Hispanic, 7% Asian American, and 1% Native American; civilian: 78% white, 10% African American, 6% Hispanic, 5.9% Asian American, and 0.3% Native American). There were similar rank orderings of the top 189 diagnostic groups seen in each setting (Spearman's rho = 0.87). There were also no differences in the type or rank order of procedures performed between military and civilian internists (p = 0.53). CONCLUSION: The practice content of military and civilian practices appears to be more similar than different.     

肺结核咯血患者非支气管动脉出血的介入治疗

目的:分析34例肺结核咯血患者支气管动脉及非支气管动脉栓塞的临床资料,探讨非支气管动脉栓塞在肺结核咯血患者临床止血中的意义。方法:经皮穿刺行支气管动脉造影,同时对相关的非支气管动脉进行造影,发现病变一并进行栓塞。结果:34例血管造影显示支气管动脉合并肋间动脉出血8例,支气管动脉合并肋间动脉和胸廓内动脉出血10例,支气管动脉合并胸廓内动脉和胸外侧动脉出血6例,支气管动脉合并胸廓内动脉和甲状颈干分支出血7例,支气管动脉合并肋间动脉和肺动脉出血3例。对所有破损的血管逐一进行栓塞。结论:在肺结核咯血的患者行支气管动脉栓塞过程中,应常规对相关的非支气管动脉造影,对提高栓塞在肺结核中量及大量咯血治疗中的效果、减少复发有重要的临床意义。     

Irritable bowel syndrome: is a barium enema necessary?

A retrospective analysis was made of 114 new patients attending a gastroenterology clinic, in whom the initial clinical diagnosis was irritable bowel syndrome. Barium enemas were performed in 84 patients (74%), 15 of whom were found to have significant other disease. In each case this would have been suspected from the routine haematological and biochemical screening tests. It is suggested that, in the investigation of patients under 50 years of age presenting to a gastroenterology clinic with a typical history of irritable bowel syndrome, a barium enema should only be performed if the clinical examination, sigmoidoscopy, rectal biopsy or routine blood tests are abnormal. This policy would reduce substantially the number of normal barium enemas performed.