Integrating computerized anesthesia charting into a hospital information system

Background: Systems for computerization of anesthesia records have typically been stand-alone computers many times connected to monitoring devices in the operating theater. A system was developed and tested at LDS Hospital in Salt Lake City, Utah, USA that was an integral part of the Health Evaluation through Logical Processing (HELP) hospiial information system.Methods: The system was evaluated using time and motion studies to assess impact of the system on the anesthesiologists use of time, an assessment for completeness of the anesthesia record was conducted, and a questionnaire was used to assess anesthesiologists attitudes. Timing studies were performed on 44 surgical cases before computerization and 41 surgical cases after computerization. For both before and after computerization, about 80% of procedures were D&C, vaginal hysterectomy, laparoscopy, tubal ligation, or A&P repair.Results: The study showed a major reduction in time required for charting from 20.4% to 13.4% which was statistically significant (p=0.0001). Other significant factors were a reduction in the time spent scanning the entire area which dropped from 10.5% to 5.6% (p=0.001), patient preparation time increased from 10.1% to 13.1% (p=0.02), the time spent arranging equipment increased from 6.4% to 8.1%, and the average time spent on non-anesthesia activities increased from 6.3% to 11.3%. The computerized anesthesia record was more legible, and complete than the manual record. The overall assessment of computer charting by anesthesiologists questionnaire was positive. The computerized anesthesia charting was preferred by the anesthesiologists, who, after one or two training sessions, used the system on their own.Conclusions: It appears that having a computerized anesthesia charting system that is an integral part of a hospital information system not only saves anesthesiologists charting time, but also improves the quality of the record and was well accepted by busy private practive anesthesiologists.     

补阳还五汤、针灸拔罐联合甲钴胺穴位注射治疗面神经炎的近、远期临床观察

目的探讨补阳还五汤、针灸拔罐联合甲钴胺穴位注射治疗面神经炎的临床疗效。方法选取2019年2月—2020年2月收治的46例发生面神经炎的患者为本研究对象,采用随机数字表法将其分为观察组和对照组各23例,对照组采用针灸拔罐联合甲钴胺穴位注射治疗,观察组在对照组基础上给予补阳还五汤治疗,比较2组患者治疗后近期、远期患部功能恢复情况及临床疗效。结果治疗前,2组患者的临床症状评分及面部神经功能等级评估结果差异均不显著(P>0.05);治疗后1个月(近期)及治疗后3个月(远期),观察组患者的临床症状评分均显著低于对照组(P<0.05)。治疗后(远期)观察组患者中Ⅰ级患者比例显著高于对照组(P<0.05),2组中Ⅱ级和Ⅲ级患者占比差异均不显著(P>0.05),观察组显效患者占比显著高于对照组(P<0.05)。2组治疗总有效率差异不显著。结论补阳还五汤、针灸拔罐联合甲钴胺穴位注射治疗可显著缓解患者面神经炎的近、远期临床症状,有效促进患者面部神经功能恢复,具有重要临床价值。     

移植肝硬度及背向散射积分测定的临床诊断价值

目的应用组织硬度及超声背向散射积分方法对移植肝进行检测,以探讨该技术在肝移植术后的临床诊断价值。方法应用HP Sonos5500型彩超仪对60例健康成年人及60例肝移植患者进行检测,对左肝膈面压缩幅度及背向散射积分值进行定量分析。结果有术后并发症的肝移植患者移植肝的背向散射积分值高于正常对照组及无术后并发症的肝移植组,其差异有显著性意义（P〈0.05）。有术后并发症的肝移植患者移植肝左肝膈面压缩幅度低于正常对照组及无术后并发症的肝移植组,其差异有显著性意义（P〈0.05）。正常对照组与无术后并发症的肝移植组的肝背向散射积分值或左肝膈面压缩幅度之间的差异没有显著性意义（P〉0.05）。结论肝硬度及超声背向散射积分测定能够较客观、准确地评价移植肝的病理状况。     

从元整体发生学观点探讨“天人相应”的本质内涵

中医"天人相应"理论包括天人相副、人天依存、天人相合等不同认识。西医学整体观包含着"人的可分解性",即合整体观;中医学整体观的核心是人与环境、人体自身的"不可分割性",即元整体观。从元整体观探讨天人相应的理论内涵可知,天人相应包含天人本一、以人应天、天人合一在内的逻辑递进的多层次概念。其具体表现在:从宇宙本体论来看,天人相应首先是天人本一;从宇宙发生的过程看,人的健康疾病与自然环境息息相关;从宇宙生态平衡角度看,养生防病上需要天人合一。阐明"天人相应"理论深层次内涵,有助于从根本上理解健康与疾病及其防治,有益于中医"天人相应"理论的继承和发展。     

MDT理念下知识树联合PBL在麻醉科实习教学中的效果观察

目的　研究多学科诊疗模式（multi-disciplinary team,MDT）理念下知识树联合以问题为基础的学习（PBL）在麻醉科实习教学中的效果。方法　选取2019年1月至2019年6月在江苏省人民医院麻醉科实习的60名学生作为对照组,采用传统教学;选取2019年7月至2019年12月实习的60名学生作为研究组,采用MDT理念下知识树联合PBL教学。对比两组出科考试成绩、临床能力及教学满意度。采用SPSS 26.0进行t检验、卡方检验和秩和检验。结果　实习后研究组学生的各项考试成绩均高于对照组（P<0.05）;实习后两组学生临床能力均较实习前提升,且研究组各项临床能力均优于对照组（P<0.05）;研究组实习生满意度达93.33%（56/60）,高于对照组的75.00%（45/60）。结论　MDT理念下知识树联合PBL运用于麻醉科实习带教,更能提高实习生的成绩,有效提升实习生的自主学习能力、沟通表达能力和团队协作能力,实习效果明显。     

Integrated care for autism assessment,diagnosis and intervention

Autism spectrum disorder is one of a group of conditions considered to be a neurodevelopmental disorder. These conditions, including ADHD, language disorders and intellectual disability frequently co-occur. Diagnostic pathways often focus on assessment of a named condition (e.g. autism spectrum disorder) in isolation, resulting in inefficiencies in service delivery; other services look holistically at the child's strengths and needs, and provide a neurodevelopmental diagnostic formulation. However, there is growing support for a change to this neurodevelopmental approach that informs recommendations for ongoing multiagency support and intervention for the child and their family. Whilst there may be different ways to deliver a successful neurodevelopmental pathway, the move to integrated commissioning offers an opportunity to redesign services to bring together teams; for example, CAMHS and child development services could deliver an integrated neurodevelopmental pathway, instead of separate single condition pathways. This paper presents the research and reasoning, as well as potential pitfalls, for services to deliver a neurodevelopmental approach, and what this means for clinical practice.     

痰热清注射液治疗慢性支气管炎急性发作90例

目的:观察痰热清注射液治疗慢性支气管炎急性发作(AECB)的临床疗效.方法:将慢性支气管炎急性发作患者90例按入院编号随机分为两组.治疗组45例,在常规西医治疗基础上加用痰热清注射液;对照组45例,采用单纯西医治疗.观察两组治疗前后主要临床症状及体征改善情况,动脉血氧分压(PaO2)、二氧化碳分压(PaCO2),第1秒用力呼气肺容量(FEV1)的变化.均7 d为1疗程.结果:治疗组总有效率91.11%,对照组66.67%,两组比较差异有显著性(P＜0.05).两组治疗后主要临床症状及体征改善情况比较,差异有显著性意义(P＜0.05),治疗组明显优于对照组.两组PaO2,PaCO2,FEV1治疗前后组内比较,差异有显著性意义(P＜0.05);治疗后两组PaO2,PaCO2,FEV1比较,差异均有显著性意义(P＜0.05).结论:痰热清注射液治疗慢性支气管炎急性发作有较好的临床疗效.