关于医学生外科临床实习质量的探讨

外科是一门实践性很强的学科，如何培养实用型医学人才是摆在我们面前的首要问题。本文分析了外科临床实习中存在的问题，并提出一些应对措施。     

数据库技术新进展及其在医疗系统中的应用

论述了关系型数据库的革命性贡献与发展中的矛盾,实现医疗系统中的数据管理功能需要解决的问题,以及对临床数据输入系统的需求。     

Enhancing laboratory report contents to improve outpatient management of test results

In today''s environment, providers are extremely time-constrained. Assembling relevant contextual data to make decisions on laboratory results can take a significant amount of time from the day. The Regenstrief Institute has created a system which leverages data within Indiana Health Information Exchange''s (IHIE''s) repository, the Indiana Network for Patient Care (INPC), to provide well-organized and contextual information on returning laboratory results to outpatient providers. The system described here uses data extracted from INPC to add historical test results, medication-dispensing events, visit information, and clinical reminders to traditional laboratory result reports. These “Enhanced Laboratory Reports” (ELRs) are seamlessly delivered to outpatient practices connected through IHIE via the DOCS4DOCS clinical messaging service. All practices, including those without electronic medical record systems, can receive ELRs. In this paper, the design and implementation issues in creating this system are discussed, and generally favorable preliminary results of attitudes by providers towards ELRs are reported.     

区域性大型医疗设备预防性维护规范探讨

目的：大型医疗设备是医院医教研工作的重要保障,也是医院体现诊疗水平的主要手段和工具。因此,保持医院中大型医疗设备安全有效的运行是一项十分重要的工作,研究做好大型医疗设备的预防性维护是保证设备良好运行状态的一项重要措施。方法：分析探讨CT、MR和DSA设备各部件及外围环境要求。结果：建立了CT、MRI和DSA等区域性大型医疗设备的预防性维护规范。结论：给出预防性维护计划表格制定方案,为医院开展这项工作提供了参考。     

Fisher information matrix for nonlinear mixed effects multiple response models: Evaluation of the appropriateness of the first order linearization using a pharmacokinetic/pharmacodynamic model

We focus on the Fisher information matrix used for design evaluation and optimization in nonlinear mixed effects multiple response models. We evaluate the appropriateness of its expression computed by linearization as proposed for a single response model. Using a pharmacokinetic–pharmacodynamic (PKPD) example, we first compare the computation of the Fisher information matrix with approximation to one derived from the observed matrix on a large simulation using the stochastic approximation expectation–maximization algorithm (SAEM). The expression of the Fisher information matrix for multiple responses is also evaluated by comparison with the empirical information obtained through a replicated simulation study using the first‐order linearization estimation methods implemented in the NONMEM software (first‐order (FO), first‐order conditional estimate (FOCE)) and the SAEM algorithm in the MONOLIX software. The predicted errors given by the approximated information matrix are close to those given by the information matrix obtained without linearization using SAEM and to the empirical ones obtained with FOCE and SAEM. The simulation study also illustrates the accuracy of both FOCE and SAEM estimation algorithms when jointly modelling multiple responses and the major limitations of the FO method. This study highlights the appropriateness of the approximated Fisher information matrix for multiple responses, which is implemented in PFIM 3.0, an extension of the R function PFIM dedicated to design evaluation and optimization. It also emphasizes the use of this computing tool for designing population multiple response studies, as for instance in PKPD studies or in PK studies including the modelling of the PK of a drug and its active metabolite. Copyright © 2009 John Wiley & Sons, Ltd.     

Working‐correlation‐structure identification in generalized estimating equations

Selecting an appropriate working correlation structure is pertinent to clustered data analysis using generalized estimating equations (GEE) because an inappropriate choice will lead to inefficient parameter estimation. We investigate the well‐known criterion of QIC for selecting a working correlation structure, and have found that performance of the QIC is deteriorated by a term that is theoretically independent of the correlation structures but has to be estimated with an error. This leads us to propose a correlation information criterion (CIC) that substantially improves the QIC performance. Extensive simulation studies indicate that the CIC has remarkable improvement in selecting the correct correlation structures. We also illustrate our findings using a data set from the Madras Longitudinal Schizophrenia Study. Copyright © 2008 John Wiley & Sons, Ltd.     

日本新型急救医疗救援体系的分析与借鉴

日本急救医疗体系比较发达，一般把急救患者分检为I级、II级和III级，再送到相应的医疗机构进行救治。急救医疗从业人员都是专业的人员，能够及时有效地对急救患者进行诊治。现在日本正在进行急救医疗体系的改革，成立了相关委员会并形成一些基础改革，主要是增加急救医疗的投入及专业急救医生的提高。这些对我国急救医疗体系现存的一些问题有一定借鉴意义。     

探究医院电子信息交换标准HL7

医药信息学在医学应用中的最大领域就是医院信息系统(Hospital Infornation System,HIS),随着HIS的快速发展,需要我们有一个开放的,统一的HIS开发和交换的标准.HL7是1987年开始发展起来的一个专门规范医疗机构用于临床信息,财务信息和管理信息电子信息交换的标准.它特别适合于解决不同厂商开发的医院信息系统、临床实验室系统及药学信息系统之间的互连问题.HL7在国内的发展刚刚起步,但是我国医疗卫生信息化发展很快,尤其是医疗保险、社区医疗和区域卫生信息系统等,都十分需要标准化的支持,HL7将成为建设这些系统的重要基础和关键技术.     

市场机制下政府调节与医疗管制制度框架的构建

医疗机构分类管理的政策确定了我国医疗服务的市场取向.我国医疗市场服务因其特殊的技术经济特点也存在一般意义上的市场失灵,使政府管制这一非市场治理机制的产生与存在成为必要,以弥补与矫正市场缺陷,保证医疗服务市场的规范运行和卫生改革的顺利推进.     

医学遗传学教学中计算机辅助教学的应用

目的:探讨计算机辅助教学在医学遗传学教学中的作用.方法:将180名护理中专生按学年分为对照组和观察组,分别采用传统的教学方法和计算机辅助教学进行医学遗传学教学,并在学期末对两组学生进行理论与综合考试,并调查两组学生对各组教学方法的作用及满意度.结果:两组学生考试成绩比较,观察组明显好于对照组(P＜0.05);两组学生对各自所在组教学方法的作用及满意度比较,观察组好于对照组(P＜0.05),差异有显著性意义.结论:计算机辅助教学有利于增强学生的学习兴趣,提高学生的学习效果,是一种较好的医学遗传学教学方法.