百尺竿头再进一步

在本期杂志与您见面的时候,我们刚刚迎来2011年元旦,也即将迎来2011年春节,值此辞旧迎新之际,我谨代表<中华肝脏病杂志>编辑委员会,向一直以来关心、支持本刊的人们致以最崇高的敬意和最诚挚的祝福!也衷心希望在新的一年里,广大肝病界的工作者们能给予本刊更多的关心和支持!     

医学影像存储与传输系统的流程优化

目的：集成医学影像存储与传输系统（PACS）与医院信息系统（HIS）,提高PACS的效率,提升用户的使用体验。方法：对系统应用中存在的问题进行深入分析,采用流程优化、软件优化和硬件升级的方式对PACS进行优化。结果：实现了PACS与HIS的互联,提高了PACS的整体性能,提升了用户的使用体验,扩展了PACS的应用范围。结论：确定优化方案前应深入分析现有问题,以系统流程、软件环境的优化为主,硬件设备的升级更换为辅。     

Pinnacle计划系统静态调强治疗计划导入方法的探讨

目的:探讨Pinnacle计划系统导入静态调强治疗计划的方法。材料和方法:在Matlab软件中读取XiO计划系统通过Dicom传输到Pinnacle7.6c计划系统上的调强计划DicomRT文件,利用现有公开的Pinnacle脚本语言资料,用Matlab程序生成Pinnacle计划系统静态调强治疗计划导入脚本,在Pinnacle系统中运行脚本,验证脚本是否正确导入静态调强治疗计划。结果:解决了诸如控制点的安排,治疗计划系统间坐标系的转换,加速器MLC叶片附值次序等等问题后,成功将XiO计划系统产生的静态调强计划导入Pinnacle治疗计划系统。结论:本研究显示,通过Matlab编程生成脚本的方法方法,将其他治疗计划系统产生的调强计划导入Pinnacle系统是完全可行的。     

医学院校物联网工程专业应用型人才培养的探索与实践

医学院校物联网工程专业作为新兴战略产业中的一个分支,既具有普通高校该专业的普遍性,又具有一定的特殊性,本文从实施卓越计划、智慧医疗、“211质量工程”三个方面探索了培养方案的制定策略,在实际教育过程中,从更新教育观念、改革课程教学、强化实践能力、重视科技创新四个方面进行了实践。     

应用层次分析法和德尔菲法构建医学图像存档与传输系统评估指标体系

目的 应用层次分析法（AHP）和德尔菲法建立医学图像存档与传输系统（PACS）评估指标体系。方法 回溯性检索2003年 ～ 2012年PubMed、Embase、Science Citation Index、Cochrane Library、万方数据、中国知网等6种电子数据库的PACS文献,在文献分析的基础上,邀请医学影像、计算机应用、生物医学工程、PACS项目管理、临床医疗等专业的9名专家咨询,采用德尔菲法建立评估体系的指标框架,采用AHP确定评估体系各级指标权重,并计算下级指标相对于上级指标的组合权重。结果 构建的评估体系包括一级指标5个、二级指标23个。5个一级指标供应商综合能力、产品成熟性与先进性、系统安全性与可靠性、系统准确性和系统性能的权重分别为0.091 7、0.224 7、0.232 6、0.181 0、0.270 0;各级指标权重均满足一致性检验,所得权重是可以接受的;二级指标组合权重按权重大小排序,权重最大的前5位分别是“工作站性能”、“系统存储与影像存档性能”、“影像质量及显示性能”、“数据的完整性”和“数据安全策略”。结论 德尔菲法和APH相结合是建立评估体系的有效方法,同时,这种构建评估体系的方法也为大型设备的招标评估指标的制定提供新思路。     

Pneumonia in Nigeria: The way forward

Pneumonia is the leading cause of child deaths in Nigeria. Interventions to combat pneumonia are known and globally available, but not yet deployed effectively in Nigeria. While the under‐five pneumonia deaths dropped globally by 51% during the Millennium Development Goals (MDG) years (2000 to 2015), the rate declined by a mere 8% in Nigeria. In this commentary, we focus on three factors that may have stalled Nigeria's progress on pneumonia control. First, a chronically weak health system failed to deliver the needed services at scale. Second, strong coordination of a multipronged and well‐funded push against pneumonia was absent. Third, sound and timely data on pneumonia intervention coverage were lacking, thus blunting the accountability mechanisms that could have driven quick, targeted action. In response, the Federal Ministry of Health recently developed a National Pneumonia Control Strategy with the support of the “Every Breath Counts Coalition” (EBCC). This strategy, a first of its kind, articulates a common vision for reducing pneumonia‐led morbidity and mortality and provides a unified approach to respond comprehensively to pneumonia within and outside the health sector. Strong political will and sustainable financing are now needed to effectively implement this strategy and accelerate progress on pneumonia control. This will contribute hugely to achieving the government's health goals, the Sustainable Development Goal (SDG) 3.2 and the Global Action Plan on Pneumonia and Diarrhoea (GAPPD) targets.     

2017年-2018年某三甲综合医院病案归档措施实施前后的效果分析

目的分析广东省惠州市某三甲综合医院病案归档措施实施前后的效果,探讨病案归档管理的有效实施方法和效果,为医院病案管理质量持续改进与提升提供依据。方法对2017年1月1日-2018年12月31日期间某院的172606份归档病案资料进行回顾性研究。将实施改进措施前的2017年的84459份归档病案,与实施一系列行之有效的改进措施后的2018年的87147份归档病案相互比较,对比结果进行整理、归类与统计分析。结果实施后的2日、3日、7日病案归档率为50.3%、67.0%、95.6%,实施前的病案归档率分别为31.9%、45.1%、86.8%,二者相比,差异具有统计学意义。其中实施后的第4季度7日病案归档率达到最高值97.4%。某院的病案归档管理的改进措施成效明显。结论某院在实施一系列整改措施后,优化病案归档全流程闭环管理,明显改善病案延迟归档现状,有效促进医院2日、3日、7日病案归档率明显提升,持续改进医院病案管理质量和水平。     

Executive summary. Consensus document of GESIDA and SPNS (Spanish Secretariat for the National Plan on AIDS) regarding combined antiretroviral treatment in adults infected by the human immunodeficiency virus (January 2012)

In the present update of the guidelines, starting antiretroviral treatment is recommended in symptomatic patients, in pregnant women, in sero-discordant couples with high transmission risk, in patients co-infected with hepatitis B requiring treatment and in patients with HIV-related nephropathy. Guidelines on combined antiretroviral treatment (cART) are included in the event of concurrent HIV infection diagnosis with an AIDS-defining event. In asymptomatic naïve patients, cART will be based on CD4 lymphocyte count, plasma viral load (VL), patient age and patient comorbidity: (i) cART is recommended if CD4 count is lower than 350 cells/μL; (ii) cART is equally recommended if CD4 count is between 350 and 500 cells/μL and may only be deferred in the event of patient refusal with stable CD4 count and low VL; (iii) if CD4 count is higher than 500 cells/μL cART can be delayed, but it may be considered in patients with liver cirrhosis, chronic virus C hepatitis, high cardiovascular risk, VL >10⁵ copies/mL, CD4 proportion lower than 14% and age over 55 years. cART in naïve patients requires a combination of three drugs and its aim is to achieve undetectable VL. Treatment adherence plays a basic role in sustaining good response. cART could and should be changed if virologic failure occurs in order to achieve undetectable VL again. Approaches to cART in HIV acute infection, in women and pregnancy and post exposure prophylaxis are also commented on.     

胶片集中打印中提高信息识别率的分析与策略

目的 探寻医学影像存储与传输系统(PACS)集中打印中提升胶片信息识别率的有效方法.方法 分析各成像设备胶片布局中四角信息布局对识别率的影响因素;针对不同的影响因素,通过修改设备的四角信息格式、调整胶片格式、优化选片布局、修改放射信息系统存取号(RIS ACCESSION NUMBER)、引入正则表达式的正确性校验以及多次识别等优化方法识别胶片信息.结果 应用此方法对普放检查集中打印系统进行测试,在信息识别的准确性和有效性方面得到了显著的改进.结论 信息识别优化方法提高了胶片的信息识别率,为数字影像和通信标准(DICOM)电子胶片集中打印模式的实施提供了关键技术保障.