我国中毒事件卫生应急能力建设与提升

目的回顾我国21世纪以来中毒事件卫生应急的能力建设情况。方法从体系建设、中毒处置技术、培训与交流等多方面分析我国中毒卫生应急能力所取得的进步。结果我国在体系建设、中毒咨询服务与信息技术、中毒监测与风险评估、毒物检测技术与装备、中毒事件现场急救与诊疗、科学研究与技术标准等多方面加强建设,中毒事件卫生应急能力得到了较大的提升,可有效应对中毒事件发生,降低病死率,保护居民健康。结论当前我国中毒卫生事件卫生应急工作仍面临诸多挑战,亟须继续加强建设。     

高尿酸血症患者QQ群随访模式的建立与评价

目的 探讨QQ群随访模式应用于高尿酸血症患者的可行性及有效性。 方 法将120例在我院健康体检中发现高尿酸血症的患者随机分为干预组和对照组,每组60例。两组随访前均接受相同的健康宣教,之后对照组采用电话随访,干预组采用QQ群随访。 结果两组干预后在饮食、运动及控制体质量等方面的遵医行为比较,差异均有统计学意义（P＜0.01）,干预组优于对照组。两组干预3个月、6个月后的血尿酸水平均较干预前明显降低（P＜0.01）,但干预组降低更明显,且与对照组比较有显著的统计学意义（P＜0.01）。 结论QQ群随访模式能明显改善高尿酸血症患者的遵医行为,降低血尿酸水平及随访的成本,值得临床推广。      

基于SaaS 云平台的延续护理在2型糖尿病患者出院后的应用研究

[目的] 探讨基于 SaaS 云平台的延续护理模式对 T2DM 患者出院后的干预效果。[方法] 将选取从我院内分泌科出院的67例T2DM 患者按随机数字表法分为对照组和实验组,实验组33例,对照组34例。对照组给予常规糖尿病教育管理(常规出院指导,包括饮食和用药指导、症状观察、血糖监测方法与注意事项及随访时间和内容 );实验组：基于SaaS 云平台的延续护理模式干预追踪管理患者;观察两组患者出院6个月后的空腹血糖、餐后2小时血糖、糖化血红蛋白等变化,并使用幸福感指数量表(WHO-5)对患者进行分析。[结果]干预后,实验组的空腹血糖为(6.60±0.62)mmol/L,低于对照组的(7.98±1.34)mmol/L、餐后2小时血糖为(8.41±1.12)mmol/L低于对照组(10.92±2.31)mmol/L、糖化血红蛋白(6.26±0.69)%低于对照组(7.83±1.60)%、幸福感指数(88.49±5.40)分高于对照组(78.41±9.2)。以上差异均有统计学意义(P<0.05)。[结论]基于 SaaS 云平台的延续护理模式可以有效的降低出院后的2型糖尿病患者的血糖水平,提高糖化血红蛋白的达标率,提高患者的幸福指数。     

医护合作型责任制护理模式在妇科病区的实践

目的探讨医护合作型责任制护理模式对医疗护理质量和病区相关满意度的影响。方法选取该院妇科2014年1月~6月收治的患者为对照组（实施医护合作型责任制护理模式前）,2014年7月~12月收治的患者为实验组。对照组采用传统的查房模式,实验组采用医护合作型责任制护理模式,比较医护合作型责任制护理模式实施前后医疗护理质量和病区相关满意度的情况。结果实施医护合作型责任制护理模式后, 患者的住院天数、甲级病历病案率、患者满意度均优于实施前（P < 0.01）。结论医护合作型责任制护理模式改善了医护患沟通,提高了工作效率,改进医疗护理质量,有利于深化优质护理服务,强化专科护理内涵。      

贵州省传染病疫情预警与应用实践

目的通过传染病早期预警及时发现传染病聚集性疫情，使其得到及时有效处置。方法2006 — 2016年，用VB＋VC 语言编写传染病聚集性疫情筛查辅助软件，参照贵州省传染病流行规律和流行特征制定的各种传染病预警阈值，建立以乡镇、集体单位为层级的传染病聚集性病例预警模式；2017 — 2019年，建立省级传染病大数据中心，搭建“贵州省传染病监测数据分析和辅助决策系统”，基于人工智能技术，通过机器自主学习历史上所有的传染病个案数据，建立智能化的传染病监测预警模式。结果贵州省传染病监测数据分析和辅助决策系统较VB＋VC 语言编写传染病聚集性疫情筛查辅助软件更易及时发现医疗机构报告病例异常增多和传染病聚集性疫情，实现了对各级疾控机构全程监管预警信息的处置，聚集性疫情发展得到有效控制，预警及时响应率由61.17%提高到97.59%，预警及时处置率由63.67%提高到98.51%，暴发疫情和突发公共卫生事件报告数由343起降低到83起。结论大数据分析和人工智能技术在传染病监测系统中的应用，可大大提高传染病监测准确性和敏感性，充分发挥传染病早期预警的作用，降低传染病暴发的风险。     

基于CT影像的COVID-19智能辅助诊断方法

目的结合COVID-19患者肺部CT影像学特征,探讨深度学习技术在COVID-19辅助诊断上的价值。方法搜集武汉大学中南医院和华中科技大学同济医学院确诊为COVID-19患者的部分CT影像资料构建小样本COVID-19数据集,将VGG-16具有提取高层抽象特征部分与设计的全连接层共同构成初步的基于迁移学习的COVID-19智能辅助诊断模型,使用COVID-19训练集迭代训练诊断模型,不断优化全连接层网络参数,最后训练出一个基于VGG-16卷积神经网络迁移学习的COVID-19智能辅助诊断模型。结果在COVID-19测试集中早期、进展期和重症期3个类别的样本上,COVID-19智能辅助诊断模型测试的敏感度分别为0.95、0.93和0.96,F1 Score分别为0.98、0.95和0.92,综合的诊断准确率达到94.59%。结论小样本数据集上采用迁移学习技术训练的COVID-19辅助诊断模型具有较高的可靠性,在防控疫情的关键时期,能快速地为医生提供诊断的参考意见,提高医生的工作效率。      

3D打印技术在髋臼骨折个性化导航模块设计中的应用

目的探讨3D打印技术结合虚拟手术设计为髋臼骨折患者制定个性化导航模块的可行性方案。方法采集20例临床髋臼骨折薄层CT扫描数据,导入Mimic17.0中进行三维重建、虚拟骨折复位、内固定植入、导航模块设计。将复位骨折模型和导航模块3D打印出实物模型进行手术模拟并进行X线照片和CT扫描,比较虚拟手术与模拟手术导航螺钉长度、方向,是否进入髋关节。结果所有病例均按照虚拟手术设计完成模拟手术,3D模拟手术螺钉进针位置和螺钉长度、方向与数字化设计高度一致,通过导航模块辅助植入螺钉107颗,螺钉长度进行配对t检验P=0.476（P < 0.05）,螺钉方向偏差1°~5°的7颗,偏差大于5°的0颗,没有螺钉进入关节腔。结论3D打印结合虚拟手术设计能为髋臼骨折患者制定个性化导航模块,能有效提高内固定植入精确性。3D打印技术结合虚拟手术技术能为髋臼骨折患者制定个性化手术方案。      

肺癌肿瘤标志物神经元特异性烯醇化酶抗原适配子的筛选及其应用

目的提出一种基于适配子快速检测肺癌肿瘤标志物的方法。 方法利用指数级富集配体的系统进化技术筛选其高特异性适配子,通过流式细胞术检测亲和力,最终选出一条高亲和力、强特异性的适配子。枸橼酸钠还原法制备纳米金颗粒。建立基于免标记纳米金和适配子的分析方法,并对其方法进行考察。 结果通过 6 轮筛选得到三条 NSE 的高特异性、强亲和力的适配子,其中,a 适配子特异性最高。同时利用筛选得到的肺癌肿瘤标志物 a 适配子和纳米金颗粒建立一种快速检测 NSE 抗原的方法。 结论该方法具有较好的准确度,为肺癌的早期检测提供了一种新的手段。      

PACS系统架构在数字化医院建设中的作用

图像归档和通讯系统(Picture Archiving and Communication System,PACS)能够在医院内部实现各种影像设备的互连、各种模态医学图像的统一存储和管理、便捷的图像检索、分析和丰富的后处理功能以及节省运作成本和提高工作效率等。PACS已经成为了国内医疗机构建设的热点。然而从国内PACS应用的现况来看,真正能够充分发挥PACS优势、实现无胶片化运作的医疗机构并不多,其中的原因是多方面的,但PACS系统架构对构建无胶片化运作的数字化医院起着关键的作用。本文结合本院数字化建设过程,探讨一种行之有效的PACS系统架构的设计和实现方法。     

脊柱外科术中合理安置体位与压疮预防的护理体会

目的探讨脊柱手术病人术中正确安置体位与体位保护对机体的影响及防护措施。方法对我院115例不同年龄段脊柱外科手术病人手术体位正确摆放,加强受压部位的护理及保护。结果115例患者全部顺利完成手术,术后未发生压疮。结论合理的体位安置和体位保护可以减少病人的不适,有效预防压疮的发生。      

DICOM relay over the cloud

Purpose

Healthcare institutions worldwide have adopted picture archiving and communication system (PACS) for enterprise access to images, relying on Digital Imaging Communication in Medicine (DICOM) standards for data exchange. However, communication over a wider domain of independent medical institutions is not well standardized. A DICOM-compliant bridge was developed for extending and sharing DICOM services across healthcare institutions without requiring complex network setups or dedicated communication channels.

Methods

A set of DICOM routers interconnected through a public cloud infrastructure was implemented to support medical image exchange among institutions. Despite the advantages of cloud computing, new challenges were encountered regarding data privacy, particularly when medical data are transmitted over different domains. To address this issue, a solution was introduced by creating a ciphered data channel between the entities sharing DICOM services.

Results

Two main DICOM services were implemented in the bridge: Storage and Query/Retrieve. The performance measures demonstrated it is quite simple to exchange information and processes between several institutions. The solution can be integrated with any currently installed PACS-DICOM infrastructure. This method works transparently with well-known cloud service providers.

Conclusions

Cloud computing was introduced to augment enterprise PACS by providing standard medical imaging services across different institutions, offering communication privacy and enabling creation of wider PACS scenarios with suitable technical solutions.     

An improved cloud masking algorithm for MODIS ocean colour data processing

Cloud cover is one major obstacle to obtaining an accurate ocean colour signal by satellite remote sensing methods. Identifying the cloud pixels correctly is of great importance for satellite ocean colour data processing. Several cloud masking algorithms currently exist: near infrared threshold, shortwave infrared threshold, spatial variability threshold, and spectral variability threshold. Any of these algorithms can identify nearly all of the real cloud pixels. However, the influence of turbid waters, turbidity fronts, aerosols, and sunglint causes some amount of non-cloud pixels to be mistaken as clouds. This situation inevitably leads to the loss of valuable data. After reviewing these current approaches, this study proposes an improved cloud masking algorithm for the Moderate Resolution Imaging Spectroradiometer, which is based on the high spatial variability characteristic of clouds, as well as the small contribution from water reflection at shortwave bands. The new cloud masking algorithm reduces the influence of turbid waters, turbidity fronts, aerosols, and sunglint, although some high-gradient glint pixels are still misclassified as clouds.     

数字影像—PACS—远程影像学及其在我国的发展前景

数字影像有别于模拟影像在于可以毫不费力地相互混合,同时或分别地被重复使用,并且可以以光速传输,通过数据压缩和纠正错误的功能,能够在非常昂贵或杂音充斥的信道上准确、快速地传递,这是进行PACS建设所必须的。PACS则是医院管理系统的一部分,包括医学影像的获取、数据库与数据库管理、在线存储、离线归档、图像显示与处理、RIS／HIS的接口、胶片打印,通过PACS的建立能够达到异地访问、图像复制、同步显示、快速传送,并且易于病变的观察和诊断。远程影像学作为一种高科技手段正在蓬勃发展,它将充分发挥专家优势,能够使异地的患者同样享受高水平的影像诊断,并且有利于大样本的医学影像研究和各种教育的需要。目前数字影像除一些大医院正在完成或努力建设中以外,中小型医院还需相当长的一段时间才能够完成。PACS由于技术含量高、各种设备缺乏统一标准,所需费用巨大,造成开发与建设的困难,真正达到HIS系统下使用的PACS尚未见到。对于地域广泛、医疗水平差别较大的我国,远程医学影像是非常有意义,也是非常需要的。但是现有国情下,如果需要建立和完善远程医学影像学则需要国家或公司的大量投入,才能够完成远程医学影像学和远程医学的建设,才能真正提高农村医疗水平。而单纯依靠基层医院,则需要数年,以至10数年才能够完成。     

Outcomes and Costs of Residential Services for Adults with Intellectual Disabilities in Taiwan: A Comparative Evaluation

Background The disability policy in Taiwan has traditionally emphasized residential care in large institutions and, more recently, medium‐sized group homes. This paper compares the relative costs, services provided and outcomes between the traditional institutions, medium‐sized group homes and new small‐scale community living units that were launched in 2004 in Taiwan. Materials and Methods Cross‐sectional analysis was used to investigate the three current residential service models. A total of 248 participants with intellectual disabilities were interviewed, including all residents from the existing 25 small residential units and purposively sampled respondents from the other two residential models. Results Outcomes for the Taiwanese participants were consistent with the existing literature on deinstitutionalization from Western societies. Small homes provided better subjective and objective quality of life than both medium‐sized community‐based units and traditional institutions. Conclusion Participants living in small residential homes experienced better outcomes at lower cost than persons living in medium‐sized group homes or institutions.     

提高中小医院冷冻切片病理诊断质量的方法(附300例分析)

目的：探讨提高中小医院冷冻切片病理诊断准确率的方法。方法：分析300例冷冻切片快速病理诊断结果的确诊率、误诊率,并分析误诊及不能确诊的原因。结果：本组确定性诊断285例,占95％,其中误诊9例,误诊率3％,全部为假阴性诊断;不能确诊者15例,占5％。误诊的主要原因系取材不当,不能确诊的主要原因为诊断人员对误诊过度担心,保留性意见表达过度。结论：影响中小医院冷冻切片诊断确诊率的因素,除读片水平外,标本取材、临床资料的采集、对疾病的总体分析和估计、诊断中对疑难病例准确适当的表达等也都是十分重要;另外,如冷冻切片在手术室进行有利于提高诊断的准确率及确诊率。     

全球疫情数据分析和风险评估平台设计与应用

目的 针对当下全球新型冠状病毒感染疫情数据难采集、难整理、难分析、难应用等问题,顺应疫情风险评估和防控需求,构建全球疫情数据分析和风险评估平台。方法 从业务需求、架构设计、功能建设等方面,阐述全球疫情数据分析和风险评估平台的设计与实现,并分析平台应用效果。结果 通过充分运用大数据、云计算、人工智能、机器学习、模型算法、地理信息等先进技术方法,实现标准化、可视化、关联化和模型化等综合利用,集成疫情信息一站式浏览平台。结论 平台的建立填补了我国在全球疫情监测系统化方面的空白,为常态化开展全球新型冠状病毒感染监测提供技术支撑,为开展科学研究和循证决策提供数据保障。     

Introduction to Picture Archive and Communication Systems

Picture Archive and Communication Systems (PACS) are comprehensive management systems for diagnostic imaging studies that are increasingly used in hospitals and health care systems. It is essential for PACS to be an integrated part of the total hospital electronic information system in order to be maximally effective. The main objective of any new information system in health care is to improve the effectiveness and efficiency of health care. Although the initial implementation of PACS is costly, the ability for care providers to have faster access to diagnostic imaging information allows care to be delivered more expediently, which improves the overall quality of care patients receive. Nurses will have the ability to see images, rather than just reports about imaging studies. An electronic system for diagnostic imaging procedures and management provides nurses with unique opportunities to improve their involvement in clinical discussions, their ability to provide quality patient care, and potential to further nursing research.     

核医学科Mini-PACS的设计思路与实现

PACS是医院用于采集、管理、传输和综合使用医学图像信息的系统.本文在介绍PACS在当今世界发展现状的基础上,重点介绍用于医院核医学科的mini-PACS,因为在科室一级核医学科更需要PACS.跨入21世纪之后的医学影像领域中,发展最快的是诸如分子影像和反义核酸成像的领域,因为这是弄清基因和生物大分子功能的关键.该领域的发展不仅是临床诊疗,也是新药开发和满足人体科学基础研究的需要.PET/SPECT是目前开展分子水平成像最合适的成像模态.在核医学科建立mini-PACS有助于发扬核医学的优点,克服核医学的缺点,使得病人、医院都能从mini-PACS的建立中受益.把发展中国的PACS技术放在科室内部,需要建立医生、医学物理工作者和工程技术人员的合作机制,需要解决当前核医学科诊疗中迫切希望解决的问题,而让IT行业的人完成科室之间的、基于web的信息整合,就有可能找到一个发展中国PACS的新路.基于这个思想,本文介绍了建立核医学mini-PACS的技术路线和关键技术.希望从这个例子得到启发,使得我国PACS技术得到更快的发展.     

Small arteries can be accurately studied in vivo, using high frequency ultrasound

We have validated measurements of diameters of the superficial temporal artery and other small arteries in man with a newly developed 20 MHz ultrasound scanner with A, B and M-mode imaging. The diameter of a reference object was 1.202 mm vs. 1.205 mm as measured by stereomicroscopy (nonsignificant). In vitro measurements of porcine carotid arteries could be reproduced with a mean interobserver difference of 0.008 mm, and the repeatability coefficient was 0.04 mm (1.4%). The frontal branch of the human superficial temporal artery (mean 1.24 mm) was measured with intraobserver repeatability coefficients of 0.18 mm (13.8%) to 0.31 mm (23.4%). The interobserver mean difference was 0.01 mm (0.69%) and the interobserver repeatability coefficient was 0.16 mm (11.1%). Pulsatile changes of the cross sectional area of the radial plus the ulnar artery averaged 0.93 mm² compared to 0.63 mm² by strain-gauge plethysmography (nonsignificant). Pulsations were 4.6% in the radial artery. We conclude that high frequency ultrasound provides an accurate and reproducible measure of the diameter of small and medium sized human arteries in vivo.     

Evolutionistic or revolutionary paths? A PACS maturity model for strategic situational planning

Purpose  

While many hospitals are re-evaluating their current Picture Archiving and Communication System (PACS), few have a mature strategy for PACS deployment. Furthermore, strategies for implementation, strategic and situational planning methods for the evolution of PACS maturity are scarce in the scientific literature. Consequently, in this paper we propose a strategic planning method for PACS deployment. This method builds upon a PACS maturity model (PMM), based on the elaboration of the strategic alignment concept and the maturity growth path concept previously developed in the PACS domain.