基于TTS技术的“人声语音定时提醒”系统设计及应用

目的:针对临床护理工作中医嘱执行容易遗漏或错过的问题,设计一种应用于临床护理的“人声语音定时提 醒”系统.方法:利用计算机TTS技术合成人声语音,拟人化地用人声语音进行定时提醒,使各种提示报警音易于辨识,且准确及时地提醒护士某时该做某项护理或治疗.结果:该系统的应用有效地减少和避免了临床护理工作的差错和遗漏.结论:该系统根据不同的患者和需求可按时提醒医护人员完成各项医疗护理操作,避免了护理工作中的差错和遗漏发生,得到了医患人员的一致好评.     

基于蓝牙的医嘱执行自动提醒系统设计

医嘱执行的实时性和准确性直接关系患者的健康。为提高医嘱执行的实时性与准确性,本文提出基于无线通信技术的医嘱执行实时自动提醒系统。通过设计内嵌数据处理、定时灯光报警的时间自动提醒装置,研制具有医嘱数据的提取与传送、定时灯光提醒、病患信息查询和医嘱执行数据查询功能的智能药盒,实时提醒护士应对病患进行护理与护理的内容,保证了医嘱执行的准确性和实时性。     

智能输液监视装置

一种智能输液监视装置，可达到减轻劳动强度和节省时间的目的。该装置以8031单片机为核心，配以传感器电路、报警电路、键盘和显示电路。系统性能稳定，效果较好。     

电脑药瓶

由美国科技人员开发出的这种电脑药瓶,在瓶盖上装有“服药监视装置”。它能提醒患者按时按量及时服药,尚能自动记录下服药者开瓶时间、取药数量等数据。这种药瓶对懒于服药者、浪费者和服药失误者都大有好处。     

护理全过程无纸化研发与实践

整合医嘱执行过程中多个系统产生的数据,全面取消纸质执行单,通过色标管理、核对执行与提醒拦截等完成在线患者身份确认与医嘱核对,实现重要护理执行过程同步写入护理病案。实施后,医护人员使用电子执行单体验得分高于使用纸质执行单得分（P＜0.05）,医嘱执行内容同步写入护理病案得分高于医嘱执行后手工录入得分（P＜0.05）,交班报告智能写入总用时较手工书写节约了55.13%。护理全过程无纸化是大数据再利用的有益尝试,提高了护理工作效率与质量。     

一体化临床护理管理信息系统的研究与实现

目的：减少目前护理临床及管理工作中大量的手工记录和事后录入工作,实现临床护理的信息化和医嘱执行的实时监控和闭环管理。方法：结合移动查房推车终端、手持式护理记录终端、PDA等多种形式的移动护理工作站技术,构建涵盖护理电子排班、医嘱执行情况的实时记录、患者体征的实时记录等功能的一体化临床护理管理信息系统。结果：实现了护理工作量管理,护理质量全程监控,护理质量考核,护理记录及护士绩效考核等临床护理和护理管理的全程信息化。结论：该系统的建立和完善改变了传统护理工作模式,提高了护理质量和护理管理水平。     

一款人性化输液器的研制

目的：设计一款人性化输液器,以增加患者输液过程中的活动自由,改善输液的医疗质量,彰显输液过程中的人性化服务。方法：利用电动机提供输液动力、传感装置反馈提醒、红外装置加热输液、液晶面板便捷操作和精确控制、过滤装置精细过滤等设备,将精确控速、避光加热、精细过滤、及时提醒等不同功能整合为一体,研制成该款人性化的输液器。结果：该输液器便于携带,能够实现精确控速、避光加热、精细过滤、及时提醒等不同输液功能。结论：此款输液器适用于不同的人群,便于携带,提高了患者自由活动的能力和范围,增加了患者输液过程中的舒适性和安全感。     

新型多功能治疗车的研制及使用效果评价

目的：研制一种新型多功能治疗车,便于护士及时有效地为患者治疗护理,提高工作效率。方法：采用轻型防水的塑钢材料制作新型多功能治疗车,将治疗护理所用的物品、敷料和药物等集中放置,既便于实际操作,又能增强护患沟通,提高护理质量。结果：使用该治疗车后减少了工作耗时,提高了录入工作效率,提高了患者满意度和护士满意度。结论：该治疗车提高了护理人员的工作质量,有效降低了劳动强度,深受医护人员、患者及家属的好评,值得临床推广应用。     

多功能护理车的研制和应用

目的：通过改进临床上原有护理车的结构，提高其实用性，避免医护人员在护理过程中带来院内交叉感染的危险。方法：遵循护理管理新理念和临床工作实际需要，研制了多功能护理车。结果：“多功能护理车”获得国家实用新型专利，尤其是医用垃圾可直接分类装袋，减少了院内交叉感染机会，且有警示语时时提醒医护人员进行“三查七对”，提高了医疗安全性。结论：“多功能护理车”结构合理，操作方便、实用，经临床应用，效果满意。     

危急值提醒医疗安全警示系统的创新研究与应用实践

目的：应用现代信息技术管理临床检验危急值,提高患者的安全管理水平,降低医疗风险。方法：研发和应用危急值提醒医疗安全警示系统,系统核心是仪器结果的警示提醒和检验危急值的短信警示提醒。结果：通过使用该系统,保证临床及时、准确、全面地获得检验危急值信息,缩短了临床检验危急值的通知时间,扩大了通知范围,实现了危急值分级管理。结论：该系统的应用加强了危急值的管理,保障了患者的安全,提高了临床医疗质量．提升了医院的管理水平,成为信息化创造价值的又一例证。     

Impact of a postcard versus a questionnaire as a first reminder in a postal lifestyle survey.

STUDY OBJECTIVE--The study aimed to consider the impact of two different types of reminder on response rates and costs in a postal survey. DESIGN--The study was a cross sectional survey. A self-completion lifestyle questionnaire was used. Those who did not respond after the initial mailing were randomly allocated to receive either a postcard or questionnaire as a first reminder. All outstanding non-responders received a questionnaire as a second reminder. SUBJECTS--A representative sample of 698 adults aged 16-70 was used, drawn from a family health services authority register. MAIN RESULTS--Postcard reminders were as effective as questionnaire reminders in increasing response whether one or two reminders are sent. The costs per response were calculated. Two questionnaires as reminders were found to be 1.7 times more expensive than a postcard plus questionnaire. Including the initial mailing, the cost per response using all questionnaires was 1.3 times the cost when a postcard was used for the first reminder. CONCLUSIONS--To increase the response to a postal survey effectively and economically, two reminders should be sent--first a postcard and then a questionnaire.     

The use of patient and physician reminders for preventive services: results from a National Study of Physician Organizations

BACKGROUND: Clinical preventive services improve patient health, and reminder systems can increase the use of such services. However, physician organizations often underutilize clinical preventive service reminders. Little is known about the incentives, capabilities, and organizational characteristics associated with the use of reminders by physician organizations. METHODS: The predictors of patient and physician reminder system use were examined in a sample of 1,104 US physician organizations. The cross-sectional sample was obtained through a telephone survey with a 70% response rate. RESULTS: Fifty-one percent of physician organizations used mammogram reminders, 41% used influenza immunization reminders, and 26% used eye exam reminders for patients. Eighteen percent of physician organizations used computer-generated reminders to physicians. Required reporting of data (P = 0.0006), public recognition for quality (P = 0.0002), and IT capabilities (P < 0.0001) were strongly associated with patient reminder use. Medical groups were more likely to use patient-level reminders than independent practice associations (IPAs) (P < 0.0001). Physician reminder use was related to required reporting of data (P < 0.0001) and IT capabilities (P < 0.0001). CONCLUSIONS: Physician organizations have relatively low use of preventive service reminders to patients and physicians. Offering quality incentives to physician organizations and improving their IT capabilities may increase the use of preventive service reminders and improve the delivery of preventive care.     

The effect of microcomputer-generated reminders on influenza vaccination rates in a university-based family practice center

Less than 20 percent of elderly and other high-risk persons targeted for annual influenza vaccination are immunized each year. In most busy practice settings, it is difficult for primary care physicians to identify every patient in need of preventive health interventions. The purpose of this study was to assess the effect of microcomputer-generated reminders on influenza vaccination rates in a university-based family practice center. The practice uses an interactive encounter form system from which updated clinical information is routinely entered into a cumulative database. During a 2-month period, 686 patients were identified in the database as eligible to receive influenza vaccine according to accepted criteria. Practice physicians (n = 32) were stratified by level of training and randomized to one of three groups, thereby receiving printed reminders on the encounter forms of all, none, or half of their eligible patients. Patients of physicians who always received reminders were more likely to receive influenza vaccine during the study period than patients of the never-reminded physicians (51 percent versus 30 percent, P less than 0.001). Patients whose physicians received reminders for only half their patients had an intermediate likelihood of receiving a vaccination if a reminder was printed (38 percent) but were less likely than the patients of never-reminded physicians to receive the vaccine if no reminder was printed (20 percent, P less than 0.001). This study suggests that physicians learn to depend on reminders for preventive health activities and that reminders are most effective when they are provided at every patient encounter.     

Suitability of an electronic reminder device for measuring drug adherence in elderly patients with complex medication

We evaluated an electronic reminder device for detecting non-adherence in elderly patients with complex medication regimens. Randomly selected, home-living elderly patients were studied. The patients were aged over 65 years and were taking more than four drugs. Patients received an electronic reminder device which contained a GSM communications module. They were visited three times over a one-year period by a nurse who counted their medicine supply. We compared the adherence measured by the electronic device with the actual adherence measured by the pill count. Almost half of the 315 patients dropped out of the study for various reasons, so the calculations were performed on 168 patients. The adherence measured by the electronic reminder system was 79% and was 92% measured by pill count (P<0.0001). The limits of agreement estimated by a Bland-Altman analysis were -57 to +30. We also compared electronically measured adherence at morning/evening intake times with pill count adherence in the morning/evening only. For the pill count, there was almost no difference between morning and evening adherence rates (93%). For electronic measurement, adherence rates were lower in the evening (75%) than in the morning (81%). Electronic reminders were less reliable than the pill count in measuring adherence. However, the electronic system may be a useful supplement to other, more time consuming methods for measuring adherence.     

Comparative Cost Analysis of Clinical Reminder for HIV Testing at the Veterans Affairs Healthcare System

ObjectiveTo estimate the cost and health outcomes associated with a new HIV testing strategy that utilizes routine-based clinical reminders.MethodsWe conducted an economic analysis of 1) traditional pretest/post-test counseling; 2) counseling and a new clinical reminders system; and 3) only clinical reminder in the veterans’ health care system. A payer-perspective decision model was conducted to calculate the 1-year budget impact of three HIV testing strategies. Parameter values were obtained from the literature, including patients’ probability of accepting test, and costs associated with HIV testing procedures. Deidentified patient data, including total population screened and number of new HIV cases, were collected from one clinic in Los Angeles, California, from August 2004 to December 2011. Annual total costs and costs per new case were calculated on the basis of parameter values and patient data. Sensitivity analyses were conducted to evaluate the robustness of the critical variable on costs.ResultsThe total cost of the clinical reminder system with pretest counseling was $81,726 over 1 year compared with $109,208 for traditional HIV testing. Under a clinical reminder system with no pretest counseling, the number of HIV tests performed and the number of new diagnoses increased for that year. In addition, cost per new diagnoses was the lowest.ConclusionsThe clinical reminder system can reduce the cost per cases identified and promote better performance of HIV testing compared with traditional HIV testing. The fundamental decision model can be used for hospital facilities outside the Veteran Affairs adopting a similar program for improving the HIV testing rate.     

Delivering Preventive Health Services for Breast Cancer Control: A Longitudinal View of a Randomized Controlled Trial

Objective. To develop a longitudinal model to characterize the delivery of mammography services using repeated observations of mammography referral rates during a randomized controlled trial (RCT) of physician mammography reminders. Data Sources/Study Setting . Administrative records of a health department and observational data on mammography appointment scheduling. Study Design. The design was a longitudinal study of month‐specific referral rates during a 1‐year RCT. A retrospective case‐control study was used to investigate differences between women with timely and delayed (or absent) mammography referral assessed at the end of the intervention year. Data Collection/Extraction Methods. Month‐specific indicators for referrals and missed clinical opportunities, that is, months when clinic visitors were due for a mammogram and not referred, were constructed using administrative and observational data. Findings. In the unadjusted analysis, the effectiveness of the reminder declined over time. However, in a multivariate analysis that controlled for the number of missed opportunities, the effectiveness was constant over time. On a monthly basis, physician reminders were significantly associated with higher referral rates among clinic visitors newly due for mammography (adjusted OR=2.8, 95 percent CI=1.3, 5.8) or who had one previously missed clinical opportunity (adjusted OR=3.0, 95 percent CI=1.6, 5.3) but were not for those with two or more missed clinical opportunities (adjusted OR=1.2, 95 percent CI=0.7, 2.3). Factors independently associated with delayed referral were age over 65, presence of more than one chronic illness, and the absence of a physician mammography reminder. Conclusions. Longitudinal models that examine rates of referral over time and include information about outcomes on previous visits can enhance our understanding of how intervention strategies work in practice.     

Improving influenza vaccination performance in an HMO setting: the use of computer-generated reminders and peer comparison feedback.

We evaluated a program for improving influenza immunization performance in a health maintenance organization (HMO). The HMO implemented several interventions successively from 1984-87: a postcard reminder to members at high risk for complications of influenza, a computer-generated reminder to the physician at the time of any primary care visit by high-risk patients, performance feedback to chiefs of service, and, finally, retrospective feedback to each physician comparing his/her performance with that of the other physicians. We examined immunization rates for a group of members older than age 65, a high-risk group under age 65, and a group of diabetic members who had not been subject to the reminders (vs a group who had been covered by the program). Vaccination rates were increased in those diabetic members who received reminders. Nevertheless, among members younger and older than age 65 whose experience was observed over three flu seasons, a significant increase in vaccination rates was not achieved until physician feedback was added to the program. We conclude that each element of the reminder and feedback program has contributed to the overall increase in vaccination rates at the HMO and that effective ongoing influenza immunization programs can be implemented in practice settings with appropriate systems support.     

Not 2 old 2 TXT: there is potential to use email and SMS text message healthcare reminders for rheumatology patients up to 65 years old

Short message service (SMS) and email reminders have the potential to improve adherence to appointments and medication taking. Within the UK, information and communication technology (ICT) is widely used with a very high proportion of people having access to the internet and mobile phones. Little is known about ICT use by older adults and those with chronic illness. A feasibility survey was carried out with 112 rheumatology patients in Hertfordshire, UK to determine their current use of the internet, email and SMS and their willingness to receive electronic reminders in the future. A high proportion of patients up to age 65 are successfully using ICT despite older age or functional disability caused by rheumatic disease. Forty-four percent would be willing to receive an electronic appointment reminder and 25% a medication reminder. The results suggest that reminders would be welcomed by some patients and extensive patient training would not be needed before implementation.     

Computer-generated physician and patient reminders. Tools to improve population adherence to selected preventive services

Despite an emerging consensus on appropriate preventive services, a minority of patients receive them. A study was undertaken to assess the impact of computer-generated reminders to adult patients, their physicians, or both patients and physicians on adherence to five recommended preventive services: cholesterol measurements, fecal occult blood testing, mammography, Papanicolaou smears, and tetanus immunization. During the academic year 1988-1989, all 7397 adult patients and their 49 physicians in a university family medicine clinical practice were randomized by practice group into one of four study groups: control, physician reminders, patient reminders, and both physician and patient reminders. Adherence was defined in community-oriented terms: the percentage of patients within each group who had received the preventive service in the recommended interval. During the study period, adherence to four of the five preventive services increased significantly, with the largest increases in the physician and patient reminder group: cholesterol measurements increased from 19.5% to 38.1%, fecal occult blood testing 9.3% to 27.0%, mammography 11.4% to 27.1%, and tetanus immunization 23.4% to 35.4% (for each increase, P less than .0001, McNemar's chi-square test). In general, increases were greater in blacks and in patients with any form of insurance coverage. Computer-based physician and patient reminder systems have great promise of improving adherence to preventive services in primary care settings.     

Association between patient reminders and influenza vaccination status among children

BackgroundPatient reminders are recommended to increase vaccination rates. The objectives of this study were to estimate the percentage of children 6 months–17 years for whom a patient reminder for influenza vaccination was received by a child’s parent or guardian, estimate influenza vaccination coverage by receipt of a patient reminder, and identify factors associated with receipt of a patient reminder.MethodsNational Immunization Survey-Flu (NIS-Flu) data for the 2013–14 influenza season were analyzed. Tests of association between patient reminders and demographic characteristics were conducted using Wald chi-square tests and pairwise comparison t-tests. Multivariable logistic regression was used to determine variables independently associated with receiving a patient reminder.ResultsApproximately 22% of children had a parent or guardian report receiving a patient reminder for influenza vaccination for their child, ranging from 12.9% in Idaho to 41.2% in Mississippi. Children with a patient reminder were more likely to be vaccinated compared with children without a patient reminder (73.7% versus 55.5%). In the multivariable model, reminder receipt was higher for children 6–23 months compared with children 13–17 years, black children compared with white children, and children whose parent completed the survey in English compared with children whose parent completed the survey in a language other than English or Spanish.ConclusionsAlthough patient reminders are associated with a higher likelihood of influenza vaccination, nationally, less than one-fourth of children had a parent report receiving one. Despite being based on parental report, with its limitations, this study suggests that increasing the number of parents who receive patient reminders for their children may improve vaccination coverage among children.