LCT及HR-HPV诊断宫颈病变的临床价值

目的探讨LCT和HR-HPV对宫颈病变的诊断价值。方法对20479例患者行LCT检查,LCT阳性者行HR-HPV检测及电子阴道镜下宫颈活检组织病理检查,以组织病理学结果作为诊断的金标准,比较LCT阳性结果、HR-HPV检测结果与阴道镜下宫颈活检病理结果的符合率。结果1)LCT结果为ASCUS、LSIL、ASCH、HSIL与阴道镜下宫颈活检病理结果的符合率分别为54.55%、62.65%)、88.24%、92.99%。其HR-HPV阳性率分别为71.64%、80.56%、88.24%、92.86%。差异有显著性(P<0.001)。2)HR-HPV阳性组与阴性组比较,高级别宫颈病变的检出率分别为48.14%、17.39%,经卡方检验,P<0.001,差异有显著性。结论高危型人乳头瘤病毒检测对于细胞学诊断为非典型鳞状细胞的患者有重要的分流价值。     

建立“全院共享、流程自动”的人力资源信息系统

信息化是医院人力资源管理发展的一种趋势。本文以某县级医院人力资源管理信息化实践为基础,提出借助商品化软件、内外网结合、全院共享的信息化思路,通过细致筛选软件产品、医院主导软件实施、运行中持续改进等具体做法,实现实施技术向医院的成功转移,捋顺薪酬管理流程,建立全院共享的人力资源信息系统。人事信息系统的建立提高人事信息的利用效率,为医院的管理决策提供有效支撑。本文总结建设思路和做法,为其他县级医院人力资源信息化建设提供借鉴。     

Innovative information visualization of electronic health record data: a systematic review

Objective This study investigates the use of visualization techniques reported between 1996 and 2013 and evaluates innovative approaches to information visualization of electronic health record (EHR) data for knowledge discovery.Methods An electronic literature search was conducted May–July 2013 using MEDLINE and Web of Knowledge, supplemented by citation searching, gray literature searching, and reference list reviews. General search terms were used to assure a comprehensive document search.Results Beginning with 891 articles, the number of articles was reduced by eliminating 191 duplicates. A matrix was developed for categorizing all abstracts and to assist with determining those to be excluded for review. Eighteen articles were included in the final analysis.Discussion Several visualization techniques have been extensively researched. The most mature system is LifeLines and its applications as LifeLines2, EventFlow, and LifeFlow. Initially, research focused on records from a single patient and visualization of the complex data related to one patient. Since 2010, the techniques under investigation are for use with large numbers of patient records and events. Most are linear and allow interaction through scaling and zooming to resize. Color, density, and filter techniques are commonly used for visualization.Conclusions With the burgeoning increase in the amount of electronic healthcare data, the potential for knowledge discovery is significant if data are managed in innovative and effective ways. We identify challenges discovered by previous EHR visualization research, which will help researchers who seek to design and improve visualization techniques.     

Turning Data Into Information: Opportunities to Advance Rehabilitation Quality,Research, and Policy

Attention to health care quality and safety has increased dramatically. The internal focus of an organization is not without influence from external policy and research findings. Compared with other specialties, efforts to align and advance rehabilitation research, practice, and policy using electronic health record data are in the early stages. This special communication defines quality, applies the dimensions of quality to rehabilitation, and illustrates the feasibility and utility of electronic health record data for research on rehabilitation care quality and outcomes. Using data generated at the point of care provides the greatest opportunity for improving the quality of health care, producing generalizable evidence to inform policy and practice, and ultimately benefiting the health of the populations served.     

口腔科患者电子病历程序的建立

目的通过系统结构设计、专家指标论证等方式,建立起有循证医学意义的口腔疾病病案管理系统框架图和口腔科患者病案管理系统的电子程序。方法使用模拟退火模型收录可能的诊断指标、治疗指标、复查指标,使用9分度专家打分法分别建立三个指标的层次分析模型,对于三个指标进行分层,并运用ACCESS+ASP技术构建网络框架体系。结果设计出的口腔科电子病历管理网站可包涵四大业务模块:面向患者模块;面向医生模块;费用管理;数据模块。结论口腔门诊电子病历管理网站的建立能很好地保证病案的完整性,系统地进行口腔疾病统计,促进口腔医患互动和圈内病例的交流学习。     

Clinical decision support in the neonatal ICU

Clinical Decision Support (CDS) tools help the healthcare team diagnose, monitor, and treat patients more efficiently and consistently by executing clinical practice guidelines and recommendations. As a result, CDS has a direct impact on the delivery and healthcare outcomes. This review covers the fundamental concepts, as well as the infrastructure needed to create a CDS tool and examples of its use in the neonatal setting. This article also serves as a primer on what to think about when proposing the development of a new CDS tool, or when upgrading an existing one. We also highlight important elements that influence CDS development, such as informatics methodologies, data and device interoperability, and regulation.     

Cigarette électronique chez les patients fumeurs présentant une pathologie psychotique. Revue de la littérature

ObjectivesThis systematic literature review focused on patients suffering from schizophrenia (SZ), psychotic disorders or mental illness (MI) including SZ. It was interested in data on prevalence of electronic cigarette (EC) use, patient perceptions and expectations, as well as caregivers’ attitudes towards the EC and its benefit in helping to stop or reduce smoking.MethodThe research was carried out on Medline for the period 2000–2020. Cross-sectional, case-control, prospective, randomized controlled studies and preliminary studies were included in this review.ResultsEC is widely used by MI patients with current and lifetime use from 7.4% to 28.6%. More specifically, patients with SZ and schizoaffective disorders observe current and lifetime use from 7% to 36%, respectively. Many reasons are given by patients for its use including the possibility of using it in places where smoking is prohibited, its lower toxicity compared to cigarettes for oneself and those around, its lower cost, and the help provided to reduce consumption.ConclusionEC is used by smokers with MI; several studies confirm the possibility for these smokers to reduce tobacco consumption through EC and without disturbing their mental state. However, its value in helping to quit smoking remains uncertain.     

Benchmarking failure mode and effects analysis of electronic brachytherapy with data from incident learning systems

PurposeFailure modes and effects analysis (FMEA) is a prospective risk assessment tool for identifying failure modes in equipment or processes and informing the design of quality control systems. This work aims to benchmark the performance of FMEAs for electronic brachytherapy (eBT) of the skin and for breast by comparing predicted versus actual failure modes reported in multiple incident learning systems (ILS).Methods and MaterialsTwo public and our institution's internal ILS were queried for Xoft Axxent eBT-related events over 9 years. The failure modes and Risk Priority Numbers (RPNs) were taken from FMEAs previously performed for Xoft eBT of nonmelanoma skin cancer and breast intraoperative radiation therapy (IORT). For each event, the treatment site and primary failure mode was compared with the failure modes and RPNs from that site's FMEA.Results49 events involving Xoft eBT were identified. Thirty-one (63.3%) involved breast IORT, and 18 (36.7%) involved the skin. Three events could not be linked to an FMEA failure mode. In 87.7% of events, the primary failure mode ranked in the FMEA top 10 by RPNs. In 83.3% of skin events, the failure modes ranked in the top 10 by RPN or severity. In 90.3% of IORT events, the failure modes ranked within the top 10 by RPN or severity.ConclusionsEvaluating FMEA failure modes against ILS data demonstrates that FMEA is effective at predicting failure modes but can be dependent on user experience. ILS data can improve FMEA by identifying potential failure modes and suggesting realistic occurrence, detectability, and severity values.