湖南某三甲综合医院85例PICU儿童意外伤害临床分析

目的探讨儿童意外伤害的防范措施,为永州地区儿童意外伤害的有效干预提供一定的理论依据。方法回顾性研究2017年1月至2019年12月在本院PICU救治的85例儿童意外伤害病例,统计分析儿童意外伤害的不同影响因素及分布特点。结果儿童意外伤害病例中男童多于女童,农村多于城市;年龄分组中以幼儿期组最多见;种类分布以中毒(43.53%),尤其是以药物中毒最常见(28.24%);不同年龄组意外伤害种类分布不同。因意外伤害死亡的病例占同期死亡病例的41.38%。结论重症监护室意外伤害儿童死亡率高,具有性别、年龄及分布特点,对不同区域、不同年龄段儿童,尤其是男童,要有侧重地采取防范措施、加强监护、提高安全意识,可有效预防儿童意外伤害事件的发生。     

心肺联合超声检测COVID-19心血管系统损伤

基础和临床研究已经证实,新型冠状病毒肺炎（COVID-19）不仅会造成患者呼吸系统的严重病变,同时也对心血管系统产生不同程度的损伤。这些损伤通常同时具有炎症和非炎症损伤的特点,部分患者临床表现与疾病严重程度并不平行,病情变化急剧。充分采用简便、可靠的心肺联合超声检测技术方法,既有助于COVID-19患者的分型、分类管理,又有助于及时有效的现场病情监控和治疗疗效判别。     

加拿大电子健康档案建设新进展及其启示

阐述电子健康档案建设意义及加拿大电子健康档案建设最新进展，分析建设经验并提出对我国的启示，包括注重统筹规划设计、加强相关法律法规建设、引入认证机制等方面，以期为我国电子健康档案建设提供借鉴。     

The natural language processing of medical databases

The consideration of natural language as a domain for computer processing has has been one of the long-term projects in the history of data processing. Computers were developed in the late 40's and early 50's in the United States and from the very beginning there was a desire and intent that someday the computer would handle speech and be able to understand normal English literature and text with the coherency of a student or perhaps even an expert. Such breakthroughs have also been anticipated in the medical area. This paper will present a series of design specifications that facilitate the processing of natural language medical databases. Using these techniques it will be possible to expand the use of our traditional tools and exploit the effort that has been invested in these literary creations.     

Managing urethral injuries in suburban India—general surgeon's perspective

Although, urethral injuries are relatively uncommon, their incidence has been increasing due to increasing incidence of road traffic accidents. Initial management of urethral injury depends upon the degree and location of the injury, patients'' haemodynamic status, and any associated injuries. Besides these factors, availability of clinical infrastructure and clinical expertise also play a significant role in making appropriate management decisions at the time of injury.Key Words: haematuria, pelvic injury, urethral disruption, urethral injury, urethral stricture, urethral trauma     

Penetrating wounds caused by needle-fish in Oceania

Needle-fish are slender silvery fish with long pointed beaks. They are commonly seen swimming beneath the surface near fringing reefs in the Indo-Pacific area. Such areas are also frequented by Melanesian villagers. The speed of needle-fish, together with their tendency to leap out of the water when bright lights are used for fishing and at other times, occasionally result in deep, penetrating injuries to swimmers, waders, and, in particular, to fishermen who are working at night from small canoes. Injuries from needle-fish are a relatively common occupational hazard of subsistence village life in Oceania, and probably also for some fishermen in other coastal environments, such as those in Japan and Malaysia.     

Clinician beliefs underlying autopsy requests.

The aim of the study was to use psychological theory to identify and evaluate factors influencing clinical autopsy requests. A series of pilot interviews were conducted with 20 clinicians to identify beliefs about the benefits and drawbacks, social groups and circumstances influential in the decision to make an autopsy request. The most common beliefs, together with measures of intention to request autopsies, were incorporated into a questionnaire which was distributed among all appropriate clinicians in four hospitals. Statistical analyses identified which beliefs had the most influence on clinicians'' intentions to request autopsies. A total of 145 clinicians returned the questionnaire, a response rate of 42%. Clinicians were significantly more likely to request autopsy the more they thought that the outcome of requesting would be of educational value, would confirm clinical diagnoses, would not distress relatives, would not be time-consuming and that the request itself would receive support from their consultant. An autopsy request was unlikely in circumstances where clinicians felt uncomfortable when requesting relatives'' permission and when the patients were elderly. The fear of causing distress to relatives and the degree of support from the clinician''s consultant were found to be the strongest predictors of intention to request autopsies. These are two areas in which intervention could help to increase autopsy request rates.     

试论“风者,百病之长也”与儿科疾病的相关性

风为百病之长,百病之始也,致病广泛,历代医家对"风"的认识有所不同,但始终不离外风与内风之说。随着现今外界环境的变化,风邪伤人较前更甚,临床上对风邪的认识亦逐渐深入。"风"邪可有狭义与广义之分,狭义之"风"单指六淫中的风邪,广义之"风"除了六淫中的风邪外,还包括了其他具有轻扬开泄、善动不居等特点的一切"外风"以及因体内阳气亢逆变动而产生的"内风"。文章从广义之"风"入手,结合小儿生理病理特点,阐述"风邪致病"在儿科疾病发病中的重要性,以期为儿科临床辨证提供参考。     

Three Decades of Research on Computer Applications in Health Care: Medical Informatics Support at the Agency for Healthcare Research and Quality

The Agency for Healthcare Research and Quality and its predecessor organizations—collectively referred to here as AHRQ—have a productive history of funding research and development in the field of medical informatics, with grant investments since 1968 totaling $107 million. Many computerized interventions that are commonplace today, such as drug interaction alerts, had their genesis in early AHRQ initiatives.This review provides a historical perspective on AHRQ investment in medical informatics research. It shows that grants provided by AHRQ resulted in achievements that include advancing automation in the clinical laboratory and radiology, assisting in technology development (computer languages, software, and hardware), evaluating the effectiveness of computer-based medical information systems, facilitating the evolution of computer-aided decision making, promoting computer-initiated quality assurance programs, backing the formation and application of comprehensive data banks, enhancing the management of specific conditions such as HIV infection, and supporting health data coding and standards initiatives.Other federal agencies and private organizations have also supported research in medical informatics, some earlier and to a greater degree than AHRQ. The results and relative roles of these related efforts are beyond the scope of this review.Three decades ago, when the federal government''s National Center for Health Services Research and Development began to support research on computer applications in health care, few imagined the impact that information systems and sciences would have on medical care today. For most, the idea of a national clearinghouse of guidelines, available through a computer that sits on a home office desktop, seemed like science fiction. For a few researchers and those supporting their work, however, visions of what could become possible in the management of health care information called for development of computerized systems and the evaluation of their effects on quality, cost, and access to care.The Agency for Healthcare Research and Quality (AHRQ, from 1999) and its predecessor agencies—the National Center for Health Services Research and Development (beginning in 1968) and the Agency for Health Care Policy and Research (from 1989 to 1999)—have a rich history of funding research, development, and evaluation in medical informatics. Although the grant investments since 1968 total only $107 million ($246 million in 2000 dollars), they supported initiatives that have established a research framework for many of the computer applications now being used today.The focus of AHRQ''s early research funding in medical informatics was on acquiring patient care data and communicating patient care management information. The goal was not only to improve the quality of care, but also to achieve reductions in costs and medical personnel resource use by processing data more efficiently. Research aimed at improving communication of information was targeted at what we would call today “getting the right information to the right place at the right time.” The promise of this research was its ability to provide findings that would guide reorganization of care delivery, take advantage of the more rapid communication of necessary information, and reduce manpower needs.¹ Over time, AHRQ''s funding has emphasized the application of health services research methods to evaluations of information technology used in community health settings. This article highlights key accomplishments emerging from AHRQ''s funding that have improved the quality of patient care in studied sites and have the potential to improve health care in all settings.Other federal agencies (such as the National Library of Medicine, the Veterans Health Administration, and the Department of Defense) and private organizations (such as The John A. Hartford Foundation, The Robert Wood Johnson Foundation, and the American Hospital Association) have supported developments in medical informatics, with some having greater research expenditures and earlier histories than AHRQ. Nevertheless, it is the Agency''s contributions to medical informatics that are the focus of this study. The purpose of this article is to provide a historical perspective for understanding the benefits of past research funded by AHRQ that supports health care applications of information technology today and that foreshadows AHRQ''s medical informatics initiatives for the future.     

温州市高校无偿献血志愿者管理研究

目的研究高校无偿献血志愿者管理。方法对我市高校2015年5~11月在校的500名大学生进行调查,对其对无偿献血的认知情况、目的及动机进行分析。结果 500名高校学生中,知道固定献血者、《献血法》的学生分别占总数的32.6%、55.4%;是无偿献血志愿者、愿意参加无偿献血、想成为固定献血者的学生分别占总数的64.2%、86.6%、51.2%;知晓无偿献血的方式主要为广告宣传,占总数的69.2%;认为无偿献血最能反映的精神为奉献精神、最能体现的作用为社会辐射、最能造就的能力为开展公益活动、最能培养的品德为社会责任感及爱心,分别占总数的70.2%、45.2%、90.4%、37.6%、33.6%。对无偿献血的目的及动机主要为无私奉献,占总数的65.6%;其次为给自己查体,占总数的13.0%;再次为将来回报、好奇试一试、返血费,分别占总数的4.6%、4.4%、4.0%;最后为完成指派任务、亲友劝说,分别占总数的1.4%、0.8%。结论高校学生中具有较多的无偿献血志愿者,加强对其的管理力度能够将学生的服务意识及奉献精神培养起来,推进校园文化建设及无偿献血事业。     

The nurse under physician authority.

A medical centre is an institution established for a specific purpose: to facilitate the health and health-related welfare of the medical centre''s patients. Within this institution, there are a variety of professionals who act and interact to serve this purpose. Of particular interest is the interaction between physician and nurse. Generally, the nurse is thought to be under a certain obligation to implement a physician''s orders unless there is good reason not to do so. This qualifier places a conflicting obligation upon the nurse not to implement some physician orders. How should a judgement about which orders there is ''good reason'' not to implement be made? I propose to approach this question through an analysis of the obligation the nurse has to implement the order of a physician, and the conditions under which the order does not pose such obligations. This analysis will consist of an examination of the obligation in terms of the purposive authority of the physician. For example, in the context of the medical centre, the physician''s medical training qualifies her as best able to make determinations of what treatment would promote the patient''s health. However, this purpose not only serves as the basis of the physician''s authority, but also serves as a limitation upon the physician''s authority (for example, an order which would harm the patient would not reflect the purpose for which the physician has been given authority). Thus, a philosophical investigation into the nature of the obligation to implement a physician''s orders can help to clarify those occasions when a nurse should not implement an order.     

合理用药驾照式记分管理系统构建

介绍实施合理用药驾照式管理的背景,阐述合理用药驾照式记分管理系统架构及功能,包括后台管理维护,医生个人级、科室级及医院级记分查询,记分主动推送和预警功能,分析系统应用流程和效果,指出该系统有助于提高医师合理用药水平。     

基于虚拟仿真平台的物联网专业RFID课程实践教学探索

针对物联网工程专业射频识别课程实践存在的实验条件受限、成本过高问题,提出采用开源虚拟仿真平台进行实践教学,介绍平台基本情况、环境搭建步骤、应用案例开发等方面,指出该平台有助于培养学生自学、工程实践、发现和解决问题的能力。     

基于信息技术基础架构库的IT运维服务体系构建

以四川省人民医院为例,分析其信息技术运维现状和存在的问题,从规范运维制度、构建运维流程、完善运维记录等方面介绍基于信息技术基础架构库的运维体系及其应用效果,为大型医院信息技术运维管理工作提供参考。     

False belief and the refusal of medical treatment.

May a doctor treat a patient, despite that patient''s refusal, when in his professional opinion treatment is necessary? This is the dilemma which must from time to time confront most physicians. An examination of the validity of such a refusal is provided by the present authors who use the case history of a patient refusing treatment, for cancer as well as for a fractured hip, to evaluate the grounds for intervention in such circumstances. In such a situation the patient is said to have a ''false belief'' and it is the doctor''s duty to try to change that belief in the patient''s interest. The false belief is considered here in terms of the liberty principle, the patient''s mental competence and on what is called the ''harm principle'' (harm to other individuals or to society). Finally the concept of paternalism is examined. The authors conclude that the doctor must attempt to change a false belief, and if this fails he must examine the patient''s mental competence to make the decision to refuse treatment. But in the last analysis the doctor may be under an obligation to respect the patient''s refusal. Readers might like to look at (or read again) the papers on ''Liberty'' and ''Conscience'' published in this Journal under the heading Analysis.     

PDCA在高职护理教师顶岗锻炼中的应用研究

目的利用PDCA管理理论,形成一套教师顶岗锻炼过程管理机制。方法根据PDCA管理理论步骤,监测教师顶岗锻炼的过程与效果,并利用教师顶岗锻炼评价指标考核教师顶岗锻炼的效果。结果本次实践锻炼取得了较为满意的效果,如自我评价、锻炼单位评价、同行教师评价、学生评价的得分都较之前有所提高,但动态跟踪评价得分差异不显著。结论通过使用PDCA循环,教师顶岗锻炼效果有了很大提高,并找出问题为下一次顶岗锻炼提供依据。     

Sideswipe injuries to the elbow in Western Australia

OBJECTIVE: To examine the conditions leading to sideswipe injury of the upper limb in motor vehicle accidents and to highlight the severity of these injuries. DESIGN AND SETTING: Prospective study of upper-limb sideswipe injuries in patients admitted to Royal Perth Hospital, Western Australia, between August 2003 and January 2005. PARTICIPANTS: Eleven patients sustaining sideswipe injuries to the upper limb. MAIN OUTCOME MEASURES: Accident pattern, type of injury, surgical management, complications, and functional and employment implications. RESULTS: Ten patients required open reduction and internal fixation for open fractures of the humerus, ulna and radius, and nine underwent additional surgical procedures including nerve, artery and tendon repair, and free flaps and split-skin grafting. The injury severity scores ranged from 9 to 25. The severity of injuries led to extensive functional deficits in eight patients, affecting employment prospects in seven. CONCLUSION: Appropriate educational programs, legislation and improvements in traffic conditions, especially in rural areas, as well as changes in current car design, could contribute to preventing these devastating and complex injuries.     

Corticosteroid therapy in Riedel's thyroiditis.

We report a case of Riedel''s thyroiditis presenting with a systemic illness, life-threatening stridor and a stony hard goitre. Diagnosis was confirmed by open thyroid biopsy. Treatment with corticosteroid resulted in a dramatic improvement. A possible autoimmune mechanism in the pathogenesis of Riedel''s thyroiditis is discussed.     

Pregnancy in a severely mentally handicapped adult.

What happens when we discover that a severely mentally handicapped girl, resident under our care, is heavily pregnant? What options are open to us in her management? What are the legal and ethical issues involved? How do we ensure that she receives the best possible care and protection and will the involvement of the police actually make the situation worse? Few of us have had the experience of working through such dilemmas, and little help can be found in consulting ''experts'' who are awaiting the result of ''test cases'' in the High Courts. This article highlights some of the problems we encountered with such a case.     

Laryngeal Trauma

Laryngeal trauma may be obscured by associated injuries of the face and chest. An early assessment of these injuries should be made. Many cases may require observation only. In patients with severe laryngeal fractures, preservation of the airway and control of hemorrhage must first be assured. Following this, splinting by external or internal means should be carried out. Three severe laryngeal injuries were splinted with open and closed plastic moulds, with satisfactory results. It is proposed that early recognition and proper management of severe cases of this nature would shorten the treatment and achieve the best results.