病历知识库的构建探索与实践

以循环系统心外科疾病作为研究范围,讨论如何根据临床医学的特点、病历书写规范和病历管理的要求,选择大量的规范病历,经过归纳、提炼和分类,运用模糊数学方法,借助计算机建立病历知识库软件。     

Results from a multicenter,randomized, double‐blind,placebo‐controlled study of repository corticotropin injection for multiple sclerosis relapse that did not adequately respond to corticosteroids

IntroductionAbout 20%–35% of multiple sclerosis (MS) patients fail to respond to high‐dose corticosteroids during a relapse. Repository corticotropin injection (RCI, Acthar^® Gel) is a naturally sourced complex mixture of adrenocorticotropic hormone analogs and pituitary peptides that has anti‐inflammatory and immunomodulatory effects.AimsThe study objective was to determine the efficacy and safety of RCI in patients with MS relapse that inadequately responded to corticosteroids. This was a multicenter, double‐blind, placebo‐controlled study. Nonresponders to high‐dose corticosteroids were randomized to receive RCI (80 U) or placebo daily for 14 days. Assessments included improvements on the Expanded Disability Status Scale (EDSS), Multiple Sclerosis Impact Scale (MSIS‐29), Clinical Global Impression of Improvement (CGI‐I), and adverse events (AEs).ResultsEighteen patients received RCI, and 17 received placebo. A greater proportion of EDSS responders was observed in the RCI group at Day 7, 21, and 42 compared with the placebo group. Qualitative CGI‐I showed that more patients receiving RCI were much improved or very much improved than with placebo. No meaningful differences were observed between treatment groups for MSIS‐29. No serious AEs or deaths were reported.ConclusionRCI is safe and effective for MS relapse patients who do not respond to high‐dose corticosteroids.     

从服务视角看医学智慧图书馆建设

分析医学智慧图书馆的内涵和服务定位,从自助借还、数字参考咨询、资源发现服务等论述基础服务的提升,从学科服务、数据管理、机构知识库阐述新型服务深化,以期为各医学院校建设智慧图书馆提供参考。     

大数据时代网络舆情研究的前沿演进和发展趋势

大数据时代，依托大数据科学推进网络舆情研究新发展是一项重要任务。基于国内近10年网络舆情研究文献，运用科学知识图谱，分析了网络舆情研究的热点和趋势。结合大数据环境下涉军网络舆情的实际特点，从精确采集、舆情知识库、科学研判、有效管控等4方面对如何做好大数据环境下涉军网络舆情工作进行了探讨。     

学科化服务平台建设

为提升学科化服务的水平和层次,提出了基于机构仓储和社交网络的学科化服务平台的设计框架。该平台具有科研知识管理和在线学术交流的功能,旨在为学科馆员向用户提供知识化、个性化的学科化服务提供有效保障。     

Multilingual Medical Data Models in ODM Format: A Novel Form-based Approach to Semantic Interoperability between Routine Healthcare and Clinical Research

Background

Semantic interoperability between routine healthcare and clinical research is an unsolved issue, as information systems in the healthcare domain still use proprietary and site-specific data models. However, information exchange and data harmonization are essential for physicians and scientists if they want to collect and analyze data from different hospitals in order to build up registries and perform multicenter clinical trials. Consequently, there is a need for a standardized metadata exchange based on common data models. Currently this is mainly done by informatics experts instead of medical experts.

Objectives

We propose to enable physicians to exchange, rate, comment and discuss their own medical data models in a collaborative web-based repository of medical forms in a standardized format.

Methods

Based on a comprehensive requirement analysis, a web-based portal for medical data models was specified. In this context, a data model is the technical specification (attributes, data types, value lists) of a medical form without any layout information. The CDISC Operational Data Model (ODM) was chosen as the appropriate format for the standardized representation of data models. The system was implemented with Ruby on Rails and applies web 2.0 technologies to provide a community based solution. Forms from different source systems – both routine care and clinical research – were converted into ODM format and uploaded into the portal.

Results

A portal for medical data models based on ODM-files was implemented (http://www.medical-data-models.org). Physicians are able to upload, comment, rate and download medical data models. More than 250 forms with approximately 8000 items are provided in different views (overview and detailed presentation) and in multiple languages. For instance, the portal contains forms from clinical and research information systems.

Conclusion

The portal provides a system-independent repository for multilingual data models in ODM format which can be used by physicians. It serves as a platform for discussion and enables the exchange of multilingual medical data models in a standardized way.     

Building a diabetes screening population data repository using electronic medical records

There has been a rapid advancement of information technology in the area of clinical and population health data management since 2000. However, with the fast growth of electronic medical records (EMRs) and the increasing complexity of information systems, it has become challenging for researchers to effectively access, locate, extract, and analyze information critical to their research. This article introduces an outpatient encounter data framework designed to construct an EMR-based population data repository for diabetes screening research. The outpatient encounter data framework is developed on a hybrid data structure of entity-attribute-value models, dimensional models, and relational models. This design preserves a small number of subject-specific tables essential to key clinical constructs in the data repository. It enables atomic information to be maintained in a transparent and meaningful way to researchers and health care practitioners who need to access data and still achieve the same performance level as conventional data warehouse models. A six-layer information processing strategy is developed to extract and transform EMRs to the research data repository. The data structure also complies with both Health Insurance Portability and Accountability Act regulations and the institutional review board's requirements. Although developed for diabetes screening research, the design of the outpatient encounter data framework is suitable for other types of health service research. It may also provide organizations a tool to improve health care quality and efficiency, consistent with the "meaningful use" objectives of the Health Information Technology for Economic and Clinical Health Act.     

医学术语仓储管理系统构建

介绍医学术语仓储管理系统（Medical Terminology Repository Architecture,MTRA）建设目标与原则、建设路线、系统功能和体系结构,探讨其服务现状并对后续发展进行思考。     

新形势下高校机构知识库的功能设计与实现

系统梳理了我国高校机构知识库的演变和发展，指出了机构知识库在“双一流”“双万计划”等高等教育发展新形势下存在的问题，介绍了黑龙江中医药大学机构知识库的设计与实现，以期为高校机构知识库建设提供借鉴和参考。     

CDR及其特征

CDR已经成为国内医院电子病历发展的一个重点。研究综述了CDR的定义,提出CDR八个方面的特征,并讨论了CDR实现和应用的两个模式。