电子病历质控系统研发与应用

以信息技术为手段,在新版电子病历系统应用基础上,开发电子病历质控系统.该系统可在线实时检查病历质量及反馈质控信息,并对检查结果作出进一步统计分析,明显提高了电子病历的完整性和及时性,使病历内涵质量得到保证,病历质控效能全面提升,提高了医疗管理水平.     

电子病历质控体系的重要手段及质控点设置的探讨

通过对电子病历系统的研究,介绍了电子病历质量控制方法及质控点的设置.电子病历系统可通过设置病历质控点,全程对病历质量进行实时监控,达到提高病历质量、规范医疗行为的目的.同时,提出了电子病历现阶段运用存在的问题,并对电子病历质控点的合理设置和电子病历质控体系进行探讨.     

基于电子病历的医疗质量控制与安全管理策略

电子病历是临床信息的集成平台,可以提供完整、安全、可交换、可挖掘的临床信息源,同时也可以改变传统的医疗质量监控与安全管理方式,提高质量和安全管理水平.介绍了基于电子病历的医疗质量控制与安全管理的一系列策略,主要包括数字化医疗质量监控管理平台、单病种临床路径管理系统、合理用药监测与处方点评系统、医疗过程控制与任务管理、危急值提醒与医疗安全警示、院内感染管理系统、重症病人监护管理系统、基于电子病历的无线移动技术和物联网技术的应用等.     

神经内科急诊电子病历的设计与实现

目的设计与开发神经内科急诊电子病历,以实现对神经内科急诊病人信息的采集、加工、存储和传输。方法以Oracle为后台数据库、Powerbuilder 6.5为前台开发工具,通过建立神经内科结构化病历,实现神经内科电子病历系统。结果该病历系统已在神经内科急诊使用,系统运行良好,达到了存储和传输病人信息、快速查询的目的。结论该系统能对医疗过程实施科学管理和智能化控制,有效提高临床医疗质量,提高医生书写病历的效率与质量,积累大量病历资料,方便临床、科研工作,为将来实现决策支持、规范和辅助治疗打下基础。     

电子病历质量监控系统的功能与应用

目的：加强病历质控,提高病历质量,保障医疗安全。方法有效运用电子病历质控系统,对在院病历进行系统检查、环节实时分级控制、持续质量改进,对出院病历进行终末控制。结果病历及时性提高,雷同率降低,医院病历质量明显提高。结论利用电子病历质控系统,病历质量得到持续改进,病历完整性、正确性有了明显提高,保证病案医疗、教学、科研等服务水平。     

新版电子病历系统应用效果分析

目的探讨新版电子病历系统的实施方案及应用效果。方法从管理层面设计系统的实施细则,从技术角度分析系统的特征优势,从应用需求阐述系统需完善的内容。结果新版电子病历系统实现了医疗过程的全面信息化及实时、标准化的病历质量控制,并为医护人员提供满足临床诊疗的信息需求。结论新版电子病历系统的应用,可有效提高医护质量和效率,实现医疗事务的科学管理。     

基于B/S结构电子病历系统的院内会诊流程再造

通过借鉴企业业务流程再造管理理论,对某院院内会诊现状进行分析,利用B/S结构电子病历系统对院内会诊进行流程再造.基于B/S结构电子病历系统的应用,优化了会诊业务流程,完善了会诊监管手段,提高了医疗质量和效率.也探讨了以电子病历为核心的医疗信息化技术在加强医疗质量和安全管理方面的作用.     

临床路径与电子病历集成的研究与设计

临床路径在提升医疗质量、控制医疗成本、优化医疗服务流程中起到重要作用,但很少有医院能将路径过程中的文档形成电子病历。本研究建立临床路径系统与电子病历接口实现数据交互,通过电子病历中的医嘱、病史、医疗质量评价等功能将临床路径贯穿到整个医疗活动中。从而提高医疗管理质量,提升医院服务水平。     

基于电子病历的临床医疗质量评价

随着信息技术的日趋成熟,电子病历系统逐步进入知识型、学习型时代,并在临床医疗质量评价体系中发挥着关键性和基础性的作用。综述了电子病历与临床医疗质量评价体系进展情况,阐述了建立基于电子病历的临床医疗质量评价体系的必要性及意义,并分析了存在问题,提出了改进对策。     

电子病历系统的研究与开发

目的研究与开发电子病历(CPR)系统,以实现病人信息的采集、加工、存储、传输和服务。方法通过建立结构化病历,开发文体编辑器,建立数据库安全性技术、在线帮助知识、实时监控技术、打印控制技术以及功能扩展技术来实现CPR系统。结果通过上述技术建立起来的CPR系统已在两所三级医院使用。实践证实,该系统运行良好、安全稳定、易维护、通用性好,提高了医疗质量和临床工作效率。结论①建立结构化病历是实现CPR的基础;②开发专用编辑器是实现CPR的关键;③拥有完备的数据库安全性技术是启动CPR的保障;④构建在线帮助“知识库”是辅助医生提高临床决策水平的有效途径;⑤CPR系统是提高病历质量的有效措施;⑥CPR是提高病历书写效率的有效方法。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.