基于中医传承辅助系统治疗失眠经方组方规律分析

目的:基于中医传承辅助系统(V1.1)分析治疗失眠经方的组方规律。方法:收集自1955年以来文献中治疗失眠的仲景经方,应用中医传承辅助系统(V1.1)软件,录入方剂信息,构建数据库,使用软件的数据挖掘方法,分析治疗失眠经方中常用的药物、核心组合及发现新方。结果:根据73首方剂的分析,明确治疗失眠经方中药物出现的频次,常用药对27个,核心组合29个,及演化新处方4个。结论:初步揭示了治疗失眠经方的组方用药规律,中医传承辅助系统(V1.1)可应用于分析方剂组方规律和新方发现。     

Use of different comorbidity scores for risk-adjustment in the evaluation of quality of colorectal cancer surgery: Does it matter?

Aims

Comorbidity affects outcomes after colorectal cancer surgery. However, it's importance in risk adjustment is unclear and different measures are being used. This study aims to assess its impact on post-operative outcomes.

Methods

All 2204 patients who were operated on for stage I–III colorectal cancer in the Midwestern region of the Netherlands between January 1, 2006 and December 31, 2008 were analyzed. A multivariate two-step enter-model was used to evaluate the effect of the American Society of Anaesthesiologists Physical Status classification (ASA) score, the sum of diseased organ systems (SDOS), the Charlson Comorbidity Index (CCI) and a combination of specific comorbidities on 30-day mortality, surgical complications and a prolonged length of stay (LOS). For each retrieved model, and for a model without comorbidity, a ROC curve was made.

Results

High ASA score, SDOS, CCI, pulmonary disease and previous malignancy were all strongly associated with 30-day mortality and a prolonged LOS. High ASA score and gastro-intestinal comorbidity were risk factors for surgical complications. Predictive values for all comorbidity measures were similar with regard to all adverse post-operative outcomes. Omitting comorbidity only had a marginal effect on the predictive value of the model.

Conclusion

Irrespective of the measure used, comorbidity is an independent risk factor for adverse outcome after colorectal surgery. However, the importance of comorbidity in risk-adjustment models is limited. Probably the work and costs of data collection for auditing can be reduced, without compromising risk-adjustment.     

The changing face of dermatological practice: 25 years' experience

Background In order to plan appropriate delivery of dermatology services we need periodically to assess the type of work we undertake and to examine changing trends in the numbers and type of referrals and the workload these referrals generate. Objectives To quantify outpatient workload in hospital‐based and private practice; to assess reasons for referral to secondary care and to examine the changes over 25 years in the diagnostic spectrum of conditions referred. Methods During November 2005, all outpatient dermatological consultations in the south‐east of Scotland were recorded. Demographic data, source of and reason for referral, diagnoses, investigations performed, treatment administered and disposal were recorded, and comparisons made with four previous studies. Results During the 1‐month study, attendances were recorded for 2118 new and 2796 review patients (new/review 1 : 1·3, female/male 1·3 : 1, age range 0–106 years). Eighty‐nine per cent of new referrals came from primary care and 11% from secondary care. Fifty‐seven per cent of referrals were for diagnosis and 38% for management advice. Benign tumours accounted for 33·4%, malignant tumours 11·6%, eczema 16% and psoriasis 7·4% of new cases. For return patients, 20% had skin cancer, 16·5% eczema, 13·4% psoriasis and 9% acne. The referral rate has risen over 25 years from 12·6 per 1000 population in 1980 to 21 per 1000 in 2005, with secondary care referrals increasing from 61 in November 1980 to 230 in November 2005. Conclusions Attendances for benign and malignant skin tumours have increased sixfold since 1980. Patients with eczema and psoriasis account for one third of clinic visits. New referrals have risen by 67%, with those from other hospital specialties almost quadrupling since 1980 to 11% of the total in 2005. These results confirm the demand from both primary and secondary care for a specialist dermatology service.     

门诊预交金系统流程优化及账户安全

本文阐述我院门诊预交金系统流程,以及如何确保预交金账户安全。     

实施基本药物制度对社区卫生服务供需双方的影响及对策研究

目的:分析社区卫生服务机构开展基本药物制度试点对供需双方的影响及其原因,为完善政策提供依据。方法:对机构开展问卷调查,对相关人员进行半结构式访谈。结果:基本药物制度试点对不同地区社区卫生服务机构的影响存在差异,部分机构的服务量和收入有所下降,由于补偿不到位影响了医务人员积极性;基本药物价格水平总体上大幅度下降,但次均门诊费用的变化存在地区差异;由于基本药物目录不完善等原因,影响到患者用药。结论:需要根据实际情况对基本药物目录进行调整;完善基本药物招标和配送机制,保障基本药物的生产供应;采取综合措施提高基本药物使用率,控制医疗费用;进一步建立健全社区卫生服务机构的补偿机制。     

基于HIS、RIS的排队叫号系统的设计与实现

目的：设计实施了一套基于HIS、RIS的排队叫号系统。方法：分析就诊、取药、检查各环节的数据流和事务处理过程,在优化门诊流程的基础上,配套开发了与HIS、RIS紧密耦合的排队叫号系统。结果：实现了就诊、取药和检查的排队叫号功能。结论：排队叫号系统的应用,有效解决了患者排长队的问题,减少了患者的等待时间,提高了患者的满意度。     

门诊临时输液单生成算法的研究和应用

目的：研究门诊处方向输液医嘱序列转换的算法。方法：基于医院信息系统对电子处方的药品进行数据预处理,使用PB9实现门诊临时输液单生成算法。结果：完成了门诊临时输液单生成算法的设计,能够较好地解决门诊医生处方医嘱到输液单治疗医嘱的转换问题。结论：电子化门诊输液单的应用显著地减轻了医护人员的工作压力,提高了门诊临时输液的执行和管理水平。     

Characteristics and Pattern of Mortality in Cancer Patients at a Tertiary Care Oncology Center: Report of 259 Cases

Background: Little is known about mortality statistics of hospitalised cancer patients from developingcountries. This paper describes the distribution of causes of death in various malignancies, status of malignancy atthe time of death, type and intent of therapy received by the cancer patient prior to death and nature of infectionsin terminal cancer patients who died in hospital. We also aimed to study discrepancies in mortality reporting interms of death certificate at our center and tried to analyse possible causes. Results : Data for 259 consecutivedeaths in hospitalized cancer patients in a calendar year were analysed. Of all these, 147 (57%) were cases ofsolid tumors, 107 (41%) were cases of hematological malignancies and 5 (2%) were other or undiagnosed cases.Median duration of hospital stay prior to death was 7 (1-106) days. Sepsis/multi organ dysfunction syndrome(MODS) was commonest immediate cause of death 118/259 (45.2%) followed by progressive malignancy in64/259 (24.7%) cases. Only 13/267 (5%) patients died with controlled cancer. Some 184 (71.3%) deaths occurredwithin 90 days of any form of anticancer treatment of which more than three fourths (77.2%) occurred afterchemotherapy. Among these chemotherapy related deaths, 63 were febrile neutropenic deaths, with the commonestsite of infection in the lungs, and positive blood culture was found in 18 (28%) cases. There were discrepanciesin information derived from death certificates and from case records in 84 (32%) cases. Most of these weredue to the use of ambiguous terms like cardio-respiratory arrest as a cause of death in the death certificate.Conclusion: It is important to audit mortality data on a regular basis as this can provide valuable insight intohospital practice and may help to identify preventable causes of mortality. Mortality record keeping is anotherimportant aspect as variable practices in this area may have implications for cancer mortality reporting andthis may ultimately lead to erroneous cancer epidemiology.