医护综合通讯服务系统的发展趋势

利用医院内部完善的程控交换机、计算机局域网优势，结合现代无线通讯技术，组成医护综合通讯服务系统。本文介绍了该系统在实践中的具体应用，为医疗护理行业实现患者与医护人员、管理者与医护人员及时进行有线通话、无线寻呼、短信息交流，以及院务管理、特色服务等提供了有效手段。展望了医护综合通讯服务系统在未来医疗系统应用中的发展趋势。     

Therapeutic strategies in the management of endocrine GEP tumours

Abstract. The therapeutic principles in the management of endocrine gastroenteropancreatic (GEP) tumours include surgical extirpation of the primary tumour in the absence of metastases and medical control of symptoms in the preoperative phase. In the presence of metastases only palliative procedures are available. Tumour growth might be controlled by surgical procedures as debulking of tumour masses, medically by chemotherapy and more recently by new developments as a long-acting somatostatin analogue (SMS 201–995) and α-interferon. Their efficacy is currently evaluated in prospective studies. In contrast to inhibition of growth symptoms derived from excessive hormone production by GEP tumours can be well controlled. SMS 201–995 effectively prevents or at least improves flush and diarrhoea in the carcinoid syndrome, disabling diarrhoea in the Verner-Morrison syndrome and migratory erythema in the glucago-noma syndrome. SMS acts by inhibition of hormone release from the tumour and by a direct mechanism at the site of the target cell via SMS receptors present on tumour and target cells. For control of acid hypersec-retion in gastrinoma patients omeprazole is superior to all former and present alternatives and replaced total gastrectomy completely. A similarly effective drug to prevent hypoglycaemia due to uncontrolled insulin release from insulinomas is not available since neither SMS nor diazoxide are effective in every insulinoma patient.     

Content guidance for mobile phones short message service (SMS)-based antiretroviral therapy adherence and appointment reminders: a review of the literature

Mobile phones are increasingly being used to support health activities, including the care and management of people living with HIV/AIDS. Short message service (SMS) has been explored as a means to optimize and support behaviour change. However, there is minimal guidance on messaging content development. The purpose of this review was to inform the content of SMS messages for mobile health (mHealth) initiatives designed to support anti-retroviral therapy adherence and clinic appointment keeping in resource-limited settings. PubMed, OvidMedline, Google Scholar, K4Health’s mHealth Evidence database, the mHealth Working Group project resource, and Health COMpass were searched. A request to online communities for recommendations on message content was also made. 1010 unique sources were identified, of which 51 were included. The information was organized into three categories: pre-message development, message development, and security and privacy. Fifteen of the publications explicitly provided their message content. Important lessons when developing the content of SMS were: (1) conducting formative research; (2) grounding content in behaviour change theory; and (3) reviewing proposed content with experts. Best practices exist for developing message content for behaviour change. Efforts should be continued to apply lessons learned from the existing literature to inform mHealth initiatives supporting HIV/AIDS care and treatment.     

Development and psychometric properties of a self report measure to assess clinicians' practices in self management support for patients with long term conditions

Objective

This paper presents a process of developing practices in self management support (PSMS) - a measure assessing clinicians’ self reported use of self management support practices in clinical consultations for patients with long term conditions (LTCs).

Methods

The development process comprised the following steps: literature review to define what skills clinicians need to effectively support patients to self manage, review of existing measures of SMS practices, construction of an initial pool of items, E Delphi study pilot survey to select items for final measure, data collection to confirm the factor structure and internal consistency of the final measure.

Results

The PSMS comprises three subscales: Clinical SMS (14 items), Patient Centeredness (4 items) and Organizational SMS (7 items). All subscales have very good internal reliability (Cronbach α: 0.94, 0.78 and 0.85; all item-total correlations above 0.50).

Conclusions and practice implications

We believe PSMS measure is suitable for both research and programme evaluation in UK clinical settings. To complete the process of measure development we are now planning to conduct further analyses to establish the validity of PSMS measure in UK and non UK healthcare settings and test the validity of PSMS measure on a wider range of other LTC groups.     

基于SMSMODEM实现对医院数据库异常的自动监测

介绍一种基于sMsMODEM模式建立短信平台的设计方法,利用短信平台实现对医院信息系统数据库异常进行监测,如作业运行失败、数据库阻塞及死锁、CPU占用时间超长等,为数据库管理员及时获取数据库异常开辟了一条新途径,保证了对数据库异常的及时发现和处理,从而保障了医院信息系统的正常运行。     

Prevention trials in Alzheimer's disease: an EU-US task force report

Despite enormous financial and scientific efforts, still no approved disease-modifying therapies exist for Alzheimer's disease (AD). During the last decade all Phase III clinical trials on disease modifiers in AD have failed. The dementia stage of AD being probably too late in order to allow for successful disease modification has been identified as a possible culprit that could explain the failure of so many clinical trials. In parallel, a major development in the diagnostic research field of AD was achieved by the recent proposal of new diagnostic criteria for AD, which also specifically incorporate the use of biomarkers as defining criteria for preclinical stages of AD, thus extending the traditional definition of disease to very early stages that may be a more feasible target for various disease modifying therapeutic interventions. This ongoing paradigm shift in AD definition and diagnosis represents a fundamental basis for redefinition of interventional trials in AD, allowing to specifically focus on preventative measures during very early pathophysiologically confirmed stages of disease. This consensus paper reflects the outcome from a European Union and North American Task Force meeting comprised of experts from academia, industry, private foundations, and regulatory agencies that was convened in Toulouse, France on November 5, 2010 and that focused on prevention trials in AD. This position paper thoroughly analyzes prerequisites for successful preventative trials in AD and concludes with concrete recommendations on biomarkers, statistical tools and other variables important for improved study designs suitable for preventative as well as for early therapeutic interventional trials in AD.     

手机戒烟干预和网络戒烟干预的国际进展研究

提供戒烟帮助是控烟工作的重点之一。该文对国际上新显现的手机戒烟干预和网络戒烟干预的发展进行了总结,以期为我国的控烟工作提供借鉴支持。手机和网络戒烟干预方式的共同优势在于：无时间和地域性的限制,范围更广;规避了有些人不愿意面对面交流的忧虑,保护了咨询者的隐私;成本相对较低。二者在可及性、沟通效果、成本效益等方面则各有利弊。     

Digital Divide: Variation in Internet and Cellular Phone Use among Women Attending an Urban Sexually Transmitted Infections Clinic

We sought to describe: (1) the prevalence of internet, cellular phone, and text message use among women attending an urban sexually transmitted infections (STI) clinic, (2) the acceptability of health advice by each mode of information and communication technology (ICT), and (3) demographic characteristics associated with ICT use. This study is a cross-sectional survey of 200 English-speaking women presenting to a Baltimore City STI clinic with STI complaints. Participants completed a self-administered survey querying ICT use and demographic characteristics. Three separate questions asked about interest in receiving health advice delivered by the three modalities: internet, cellular phone, and text message. We performed logistic regression to examine how demographic factors (age, race, and education) are associated with likelihood of using each modality. The median age of respondents was 27 years; 87% were African American, and 71% had a high school diploma. The rate of any internet use was 80%; 31% reported daily use; 16% reported weekly use; and 32% reported less frequent use. Almost all respondents (93%) reported cellular phone use, and 79% used text messaging. Acceptability of health advice by each of the three modalities was about 60%. In multivariate analysis, higher education and younger age were associated with internet use, text messaging, and cellular phone use. Overall rate of internet use was high, but there was an educational disparity in internet use. Cellular phone use was almost universal in this sample. All three modalities were equally acceptable forms of health communication. Describing baseline ICT access and the acceptability of health advice via ICT, as we have done, is one step toward determining the feasibility of ICT-delivered health interventions in urban populations.     

Enhancement of care through self-monitoring and tailored feedback via text messaging and their use in the treatment of childhood overweight

Objective

This paper first illustrates the general potential of the short message service (SMS) for symptom and behavior monitoring and the provision of tailored feedback. Second, an SMS-based maintenance treatment (SMSMT) is introduced aimed at enhancing the treatment of childhood overweight.

Methods

After a 12-week cognitive behavioral group treatment (CBGT), 40 children were assigned to the SMSMT for a period of 36 weeks. Children were asked to send weekly self-monitoring data on eating behavior, exercise behavior, and emotions and received tailored feedback. The adherence to SMSMT and changes in Body Mass Index Standard Deviation Scores (BMI-SDS) during the first and second treatment phase were analysed.

Results

Children (mean age = 10.05, SD = 1.28) submitted 67% of the weekly SMS that they were expected to send in. During CBGT a significant reduction by 0.20 BMI-SDS was observed. The reduction by 0.07 BMI-SDS during the SMSMT did not reach statistical significance.

Conclusion

The results support the feasibility of SMSMT in the treatment of childhood overweight. The efficacy of the intervention needs to be demonstrated in an RCT.

Practice implications

SMSMT is a promising intervention that may extend the reach of treatment centers for childhood overweight at reasonable cost and effort.