基于省级平台的远程医疗系统设计

提出了一种基于省级平台的远程医疗系统的设计方案,主要从系统整体架构设计、网络结构设计、功能规划以及系统的业务流程设计几个方面进行了分析.通过建立省级远程医疗服务平台,可完成省内各医院之间远程医疗服务的统一调度和费用结算,各医院所建立的远程医疗业务平台完成医院间的各种远程医疗服务,系统可实现省内其他医院和省外医院的无缝接入.     

基于HIE信息平台的手术麻醉信息平台设计与应用

目的探讨手术麻醉信息平台的设计和建设,解决现有数据采集不完整、电子化程度低、无法为医院管理和临床科研提供全手术过程数据等问题,提高围术期管理水平。方法详细介绍了医院HIE信息平台功能以及基于HIE信息平台的手术麻醉平台的整体技术架构,主要功能模块,术前、术中、术后的业务流程,以及平台应用后取得的效果。结果通过该平台的实施,解决了系统间的互联互通问题,能够实现数据的高度集成和共享,为建立临床数据中心和智慧医院建设打下坚实的基础。结论基于HIE信息平台的手术麻醉信息平台有助于提高医院手术麻醉管理水平,可进一步完善平台数据采集能力和术中监控、报警功能,为病人的手术麻醉安全提供保障。     

智能自适应临床路径系统模型建设方法研究

临床路径知识库是实现病人诊疗流程中个性化诊疗与标准化路径有机结合的有效技术手段。为满足医院医疗质量提升与病人个性化诊治的需要,文章提出了智能自适应临床路径系统的信息技术建设方案,系统框架由语义层、中间层以及临床路径执行层3层架构组成,重点讨论了基于临床路径本体的知识库模型及建设方法,对下一阶段临床路径电子化应用工作进行了规划和展望。     

基于医院信息平台患者主索引的建立与应用

目的研究基于医院信息平台的患者主索引的建设方法,从而实现应用系统间患者信息共享。方法应用IHEPIX和PDQ的集成规范,在集成平台上建设患者主索引服务端,并对相关应用系统的患者登记环节进行改造。结果实现了交叉索引信息生成及共享查询,为临床文档交换与共享奠定基础。结论结合医院实际建成的患者主索引注册和查询机制可以满足医院患者信息共享的需求。     

医疗信息数字平台对我院科研工作的促进作用

我院于2003年全面建成了医疗信息数字平台,为科研资源的共享提供了便捷的服务平台,为临床科研选题、设计提供了新的技术手段,促进了临床科研工作的开展.科研管理办公自动化系统应用后,实现了项目管理的全域网络化和自动化,增强了科研论文管理的科学性,使科技绩效考评更科学、准确.医院数字化不仅促进了临床医疗水平的提高,同时还对医院科技创新能力和水平的提高起到了重要的推动作用.     

临床路径知识库及诊疗决策支持系统研究

1临床路径知识库及诊疗决策支持系统提出背景及现况在临床路径执行过程中,病人的个体和动态信息的处理需要更加专业、强劲的知识功能来进行支持[1]。基于临床路径知识库的智能决策系统能够满足这样的需求,这就使临床知识库信息化建设平台和诊疗决策支持系统的建设显得尤为重要。它是临床路径能否被广大医务人员全面、广泛、积极使     

构建远程医学信息平台的数据整合

目的：探讨远程医学信息网信息共享平台的架构与使用，用来整合远程医学信息网和HIS、PACS等系统的资源。方法：通过整合医院内部数据资源、搭建信息平台以及规范会诊流程等凡方面进行研究。结果：能够实现基于远程医学信息网信息的信息共享平台，实现信息最大限度的共享。结论：提高了远程医疗会诊的质量和水平。     

上海市级医院临床信息共享项目的系统架构

旨在研究设计上海市级医院临床信息共享项目的系统架构,探讨系统设计中的关键问题,为区域医疗信息共享系统的设计提供借鉴.上海医疗信息共享系统包括通用共享的就医卡、医院内部系统、联结各医院的网络、临床信息交换共享平台、数据中心、辅助决策支持系统和公众服务门户.系统设计中的关键问题包括个人身份认证、标准和规范的建立、信息共享模式、信息存储模式、与医院相关系统关系和个人隐私保护.     

大型仪器设备共享平台的设计与实现

目的:设计并实现一个基于Web的大型仪器设备共享服务平台,提高大型仪器设备的使用和管理效率.方法:以SQL Server为后台数据库,使用ASP.NET和Ajax技术进行系统平台的构建和实现.结果:该平台已成功应用到大型仪器设备的管理和使用当中,取得了良好的实践效果.结论:大型仪器设备共享平台的投入使用,既提高了仪器设备的管理效率和使用效率,同时也为广大科研人员提供了一个高效的仪器预约使用平台.     

区域化健康管理协同系统的研制

目的:开发基于个人标准化健康数据库的医院间健康管理协同系统,实现数据设备共享、统一标准、双向转诊和远程技术指导.方法:系统采用浏览器/服务器(B/S)架构,以Python作为开发工具,以Linux操作系统作为服务器运行平台,通过ADSL网络实现数据共享,具有健康管理标准化流程、个人网络化健康数据库共享、个人健康提醒、个人健康评估和个性化健康处方等功能.结果:系统以成都军区总医院为大型医院、四川省3家地市级医院为中心医院、5家社区服务中心或县级基层医院为试点进行试用,实现了省级大型医院、中心医院、基层医院三级区域化健康管理协同,可以进行数据共享、标准统一、双向转诊和远程教学指导.结论:系统的普及使用不仅为健康管理提供了标准化的数据接口和标准化的流程,也为健康体检数据的流行病学分析提供了数据平台.     

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.     

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.     

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.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.     

Stress in the Norwegian police service

BACKGROUND: High levels of stress have been attributed to the conditions of police work, but there is little empirical evidence for this. AIMS: To develop a new instrument to measure job stress in the police; to assess the most severe and frequent police stressors; to compare levels of stress according to the demographic and organizational factors; and to study stress in relation to personality traits, work locus of control and coping strategies. METHODS: A comprehensive nationwide questionnaire survey of 3272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey (NPSS), the Job Stress Survey, the Basic Character Inventory, the Work Locus of Control Scale, and the Coping Strategies Scale. RESULTS: Work injuries were appraised as the most stressful but least frequent stressor and job pressure was reported the least severe but most frequent stressor. Females experienced job stressors less frequently, but appraised them as more severe than men did. Older police officers reported more job pressure severity and fewer work injuries. The police in districts where peer support was planned but not implemented, and who worked in districts with more than 50,000 inhabitants, perceived the lack of support more severely than others. The correlations between stress and personality traits, work locus of control, and coping were moderate. CONCLUSIONS: The NPSS captures police-specific stressors that are not adequately measured by global stress instruments. The study of stress in police work should preferably involve a nationwide use of police-specific stress instruments.