个体化下肢小腿假肢接受腔设计的生物力学评价技术研究

作为传递体重、固定假肢的部件 ,接受腔对于小腿假肢使用的舒适性和方便程度有决定性的作用。本研究建立了基于有限元应力分析的小腿假肢生物力学评价技术平台 ,实现了小腿残端 /接受腔 3D几何建模与信息交互、三维有限元自动建模及应力分析。 3D模型与信息交互的实现基于得到广泛支持的OpenGL技术 ,有限元模型的构建采用了专门针对小腿残端 /接受腔结构特点的自动建模方法 ,通过构建档案数据库系统作为整个系统的操作平台。该技术平台可与现有的CAD/CAM系统相结合 ,为接受腔的个体化设计提供生物力学定量化依据。其临床应用将改善传统的设计流程 ,提高设计效率。同时 ,它也是未来构建接受腔设计专家 /智能系统的基础。     

Development of multielectrode impedance plethysmography

The feasibility of simultaneous independent measurements of impedance variations in the right and left apex and base of the lungs using the technique of multielectrode impedance plethysmography (MIPG) was investigated. To obtain independent impedance measurements in each region, high impedance sensitivity areas must be localised by weighting the impedance sensitivity distribution. 12 planar coaxial-type electrodes were attached on the right and left upper, middle and lower sites of the anterior and posterior chest walls. Currents of identical absolute values and differing polarities were simultaneously applied to neightbouring electrodes and voltage measurements were carried out sagittally at the right and left upper and lower sites of the chest walls. The effect of weighting the impedance sensitivity distribution was verified through experimental studies on mongrel dogs. The methods utilised for the induction of regional physiological conductivity changes were selective ventilation and selective indicator infusion into the pulmonary vasculature. The detected impedance variation showed reasonably indenpendent responses which were consistent with our expectations from the results of the computer simulation.     

失眠的评估

失眠是困扰许多人的最常见的睡眠问题。失眠引起白天困倦、疲劳、情绪烦恼、工作效率下降，甚至可造成致命性的结果。虽然失眠发病率很高，但大多数失眠者并未被临床医生所识别。对失眠恰当的评估对患者非常重要。本文将回顾近年来对失眠评定方面的研究，内容包括睡眠史、自评方法、心理评估，心理生理评估、医学评估、多导睡眠图及其它睡眠评估方法。     

Assessing graduate programs for healthcare information management/technology (HIM/T) executives

This paper describes a methodology to assess health/medical informatics graduate-level education curricula. The authors used the Certified Professional in Healthcare Information Management Systems (CPHIMS) exam objectives published by the Healthcare Information and Management Systems Society (HIMSS) as the basis for their assessment. The authors compared the 69 CPHIMS exam objectives against four health/medical informatics program course objectives as stated in the selected program's online graduate catalog. Results showed that the two programs with management as a focus addressed the majority (67 and 59%) of the CPHIMS objectives within core and elective courses combined. Overall, the other two programs addressed closer to a third of the CPHIMS objectives (36 and 32%). This methodology could prove to be useful in assisting students interested in graduate-level training programs with a tool by which to measure the congruence of the curricula of different programs with the mission of the programs and with their own professional interests.     

血常规参数RDW在肝纤维化诊断中的价值

目的初步探讨病毒性肝炎患者的红细胞分布宽度（RDW）、平均红细胞体积（MCV）、平均血小板体积（MPV）、血小板分布宽度（PDW）等四项血常规参数在肝纤维化诊断中的意义。方法303例病毒性肝炎患者分为急性肝炎（AH）组、慢性肝炎（CH）组、肝炎肝硬化（LC）组和重型肝炎（SH）组，对照组由16名健康人组成。采用全自动血细胞计麴仪检测所有被测试者的血常规参数，并同期对其中179例患者采用放射免疫法检测其血清透明质酸（HA）和层粘蛋白（LN）水平、采用彩色多普勒超声仪测量其脾脏的长径（SPL）及厚度（SPT），研究上述指标之间的相互关系。结果CH组、LC组和SH组患者的RDW均显著高于对照组，CH组、LC组的MCV显著高于对照组，MPV和PDW在各病毒性肝炎组与对照组之间无显著性差异：病毒性肝炎患者的RDW与其HA、LN、SPT、SPL成显著直线正相关。结论RDW对慢性肝炎肝纤维化的诊断有一定的临床价值。     

临床医师绩效评价系统应用体会

目的介绍我院自主研发的临床医师绩效评价系统在现代医院管理中的应用经验。方法基于医院信息系统的数据资源库，应用临床医师绩效评价系统促进病人选医生工作、开展临床医师绩效评价工作、辅助医院医疗管理工作。结果通过临床医师绩效评价系统的应用，促进了医院社会效益、经济效益和管理效益的全面提高。结论临床医师绩效评价系统的应用能够促进医患关系、提高医疗质量和加强科学管理。     

Kinetics of hepatic transport of 4-methylumbelliferone in rats. Analysis by multiple indicator dilution method

Hepatic elimination of 4-methylumbelliferone (4MU), which has been used as a model compound for conjugative metabolism, was studied by means of a multiple indicator dilution (MID) method in the isolated perfused rat liver. Using this method, three intrinsic hepatic clearances, CL _int,inf , CL _{int,eff, and} CL _{int,seq, which represent the influx, efflux, and sequestration processes, respectively, were obtained. When the dose was increased from a low dose (50 g/rat liver) to a high dose (3000 g/rat liver), the hepatic availability of 4MU increased from 0.11 to 0.73. With increasing dose, the} CL _{int,eff value increased approximately two times, while the} CL _{int,seq value decreased to approximately one-third. The remarkable dose dependence of hepatic availability was due to nonlinearity in both} CL _{int,eff and} CL _{int,seq values. However, the} CL_int,inf value was almost independent of dose. The dose-dependent change in CL_int,seq might be explained by the saturation of conjugative metabolism of 4-MU, while the increase in the CL _{int,eff value with increasing dose might be partly explained by the nonlinear tissue binding of 4-MU, since the tissue unbound fraction determined by an ultrafiltration method using liver homogenate increased approximately 1.5 times at higher concentration of 4-MU compared to that at lower concentrations. In addition, based on a comparison of the individual intrinsic clearances, i.e.}, CL _int,inf , CL _{int,eff, and} CL _{int,seq, the major determining process of the apparent hepatic intrinsic clearance of 4MU is thought to be the sequestration process at the high dose. However, at the low dose, the membrane transport process (influx and efflux processes) as well as the sequestration process also determine the apparent hepatic intrinsic clearance}.     

家庭医生签约服务模式下全科团队年度考核指标体系构建

目的建立一套家庭医生签约服务模式下的全科团队年度考核指标体系。方法通过文献回顾法和半结构访谈法初步拟定指标初稿;邀请15名专家开展专家函询,评价全科团队年度考核指标体系重要性和可行性,并采用界值法对指标进行筛选,采用层次分析法确定各级指标权重。结果两轮函询专家积极系数均为100%,权威系数分别为0.83和0.75。最终确定家庭医生签约服务模式下全科团队年度考核指标体系包括服务数量、服务质量和服务效果3个维度共19项指标。结论 构建的家庭医生签约服务模式下的全科团队年度考核指标体系具有一定科学性和实用性,下一步有待结合实证结果对指标体系进行优化。     

北京市13家中医综合医院住院医疗服务评价研究

目的建立中医综合医院住院医疗服务评价指标体系,对之进行评价,以明确优势与短板并针对性改进。方法通过文献分析法确定评价指标体系,运用层次分析法对指标权重进行赋值,利用改良TOPSIS法对北京市13家中医综合医院进行排名。结果综合排名前3的分别是E、B、D 三家中医综合医院。服务能力最强的为M医院,服务效率、医疗安全和数据质量最好的均为D医院,运营效益最优的为F医院,中医特色最强的为E医院。结论建立的指标体系能够对中医综合医院住院医疗服务进行客观评价,有利于医院持续改进,从而全面提高服务能力。