基于5G的危重母婴急救转运平台设计及应用

目的：依托5G,整合院内院外危重母婴急救诊疗中的所有信息资源,打造一套一体化的危重母婴急救转运的整体解决方案。方法：集成智能救护车、创新型车载医疗设备、院前急救智慧系统、院内数字化业务管理系统等,优化业务流程,实现院前急救、院内急诊、多学科会诊、多业务全流程的闭环可追溯管理。结果：通过区域母婴急救转运,实现了下级医院和上级医院转诊、转运、会诊、任务管理、急救车管理等信息共享。结论：基于5G的危重母婴急救转运平台提升了急诊工作效率,可为危重母婴提供差异化服务保障。     

基于3G/4G无线网络的区域急救系统的设计

本文阐述了一套基于3G/4G无线网络的区域性急救系统的设计过程。该系统以医院急诊科为救治中心,依托专网专线和3G/4G通信网络建立,集成了数字化智能救护车系统、急救现场手提箱系统和区域性急救医疗信息系统。该系统的应用可以有效地提高院前医疗急救水平,提升应急突发事件的紧急救援处置能力,缩短院前急救时间,提高抢救成功率。     

基于5G和人工智能技术的院前院内急救管理平台建设

目的：解决院前与院内急救数据的传输稳定性问题,提高急救信息互联互通水平。方法：基于5G和人工智能技术,在院内集成平台的基础上,对院前院内急诊系统进行标准化数据传输、医联体院前急救模式改造和统一调度平台建设,打通院前和院内急救系统。结果：院内医生可提前查看院前危重患者的生命体征、心电图等诊疗信息,并通过5G网络与患者或医生进行实时视频沟通或指导。结论：5G的高速率、低时延、大连接特性,可大大缩短抢救响应时间,提高患者救治效率,实现院前院内信息资源共享、院前院内急救系统信息互联互通,为院前急救、智慧医疗提供强大的技术支撑。     

基于医疗大数据的市级医院急诊急救一体化平台建设研究

上海申康医院发展中心以急诊医疗救治一线需求为导向,依托医联工程,加快推进市级医院急诊急救一体化建设,运用大数据、5G、人工智能等数字技术,建设基于医疗大数据的市级医院急诊急救一体化平台,形成院前急救、院内急诊互联互通和无缝联动的一体化救治网络,提高急诊急救效率,实现了急诊可视化管理、规范化诊疗、精细化质控。     

北京市智慧院前医疗急救信息平台顶层设计

目的/意义 制定与北京市院前医疗急救体系发展相适应的智慧急救平台顶层设计,为院前急救信息化建设提供参考。方法/过程 调研组走访院前急救中心、分中心、急救站及院内急诊,通过访谈深入了解北京地区急救信息化现状及问题,分析用户需求,构建智慧院前医疗急救信息平台顶层设计。结果/结论 顶层设计包括总体架构、数据架构和支撑平台,围绕调度指挥、医疗服务、应急保障、决策管理、公众服务等7大急救职能提出系统功能规划,为院前医疗急救体系建设高质量发展提供坚实的信息化支撑。     

五常法在院前急救车管理中的运用

目的运用五常法对急救车内环境、设备、物品、药品进行规范管理,提高院前急救效率.方法建立急救车五常法管理标准,进行全员培训,按五常法管理标准,根据急救车上物品的种类、用途、使用频率等采用分层、分类管理.结果一年来,急救物品完好率,应急合格率及急救物品的“四定”管理达标率均明显提高;护士抢救准备物品时间明显缩短.结论将五常法巧妙运用于急救车管理管理中,使工作更科学、便捷及有效,提高院前急救成功率,确保护理安全.     

急救医疗中心院前急救信息化建设与管理

介绍南宁急救医疗中心院前急救发展现状及信息化建设需求,阐述其院前急救信息化建设与管理,分析院前急救信息化建设后的效果,包括提升院前急救能力、统筹指挥调度能力、急救反应能力等方面。     

院前急救仿真模拟教学方案的构建与实践

院前急救是急危重症护理学的一个重要组成部分,进行院前急救单项和综合训练,目的是增强学生的急救意识,培养学生在紧急情况下迅速评估、正确决策和果断实施的综合急救能力[1].但基于院前急救的特点和医疗服务性质的特殊性,很难在真实场景中实践护生对急救知识的实际应用能力.因此,依托校内仿真实训平台,应用院前急救综合训练系统开展院前急救仿真模拟教学,成为了解决护理能力需求与实训困惑的教改切入点.     

上海市级医院“便捷就医服务”数字化转型实践探讨

目的：总结上海市35家市级医院“便捷就医服务”数字化转型工作实践经验,为医疗机构开展就医服务数字化转型提供借鉴与参考。方法：依托申康医联服务总平台,充分发挥市便民服务移动总入口和各市级医院移动门户功效,统一开展7项就医服务场景数字化转型,通过多数据融合,创新优化医疗服务场景,实现便捷就医效果。结果：总体上提高了所有市级医院门诊预约精度,减少了候诊时间,优化了医患沟通效率和核酸检测便捷度,深化了医疗付费“一件事”和检查检验结果互认场景成效,强化了急诊急救协同能力,在全市发挥了示范作用。结论：就医服务数字化转型场景建设可有效改善市级医院就医服务效果,该模式具备可复制性,具有良好的推广价值。     

医院院前院内急救一体化模式探讨

对国内外医院急救模式进行对比,分析院前院内一体化急救的实现路径和内涵,具体介绍郑州大学第一附属医院实践情况。在原有急救系统基础上,通过多种通讯手段的集成将医疗信息无缝连接,建立数字化急救平台,从院前急救现场、院内急救平台、院前急救平台、院外急救平台4个方面着手,实现院前院内急救一体化。     

Guidelines for a palliative approach for aged care in the community setting: A suite of resources

In Australia, many people ageing in their own homes are becoming increasingly frail and unwell, approaching the end of life. A palliative approach, which adheres to palliative care principles, is often appropriate. These principles provide a framework for proactive and holistic care in which quality of life and of dying is prioritised, as is support for families. A palliative approach can be delivered by the general practitioner working with the community aged care team, in collaboration with family carers. Support from specialist palliative care services is available if necessary.The Guidelines for a Palliative Approach for Aged Care in the Community Setting were published by the Australian Government Department of Health and Ageing to inform practice in this area. There are three resource documents. The main document provides practical evidence based guidelines, good practice points, tools, and links to resources. This document is written for general practitioners, nurses, social workers, therapists, pastoral care workers, and other health professionals and responded to needs identified during national consultation. Evidence based guidelines were underpinned by systematic reviews of the research literature. Good practice points were developed from literature reviews and expert opinion. Two ‘plain English’ booklets were developed in a process involving consumer consultation; one is for older people and their families, the other for care workers.The resources are intended to facilitate home care that acknowledges and plans for the client’s deteriorating functional trajectory and inevitable death. At a time when hospitals and residential aged care facilities are under enormous pressure as the population ages, such a planned approach makes sense for the health system as a whole. The approach also makes sense for older people who wish to die in their own homes. Family needs are recognised and addressed. Unnecessary hospitalisations or residential placements and clinically futile interventions are also minimised.     

上海市中心城区居家临终患者生活状况及护理指导需求调查

选择2011年1月至2013年12月本社区诊断明确的恶性肿瘤患者、诊断明确的慢性病晚期生活失能患者及照护者各150例,采用自制定量问卷进行面对面调查.112例（74.7％）的照护者认为相对医院而言,患者本人更希望在家里接受护理;95例（63.3％）的照护者护理技术认知水平欠缺,照护技术能力较弱;97例（64.7％）照护者表示希望得到临终患者护理技术指导.说明居家临终关怀可以满足患者的身心需求,但需要社区医疗服务和资源的支持,借助居委会平台集中培训,提供居家照护的技能指导或疾病管理的相关信息支持;需要建立临终关怀互助小组,尽早建立护理规范.     

护理团队在手术室护理质量管理中的应用效果

目的：探讨护理团队对提高手术护理管理质量的效果。方法：将2013年1月至2013年12月在本院实施护理团队管理的80例手术患者设为观察组,将2012年1月至2012年12月实施常规性护理管理的80例手术患者设为对照组,分别于护理团队实施前后采用自行设计的护理质量调查问卷及患者满意度问卷了解患者对护理人员服务意识、工作责任心、解决问题能力、专科知识学习能力、专科操作能力、文书管理能力的评分及满意度,并记录两阶段护理错差率。结果：与未实施护理团队相比,实施后患者对护理人员服务意识、工作责任心、解决问题能力、专科知识学习能力、专科操作能力、文书管理能力的评分显著提高,差异有统计学意义（P〈0.05）。与未实施前相比,实施后配错药、文书归档错误、遵错医嘱、术后压疮发生率显著下降,患者满意度显著提高,差异有统计学意义（P〈0.05）。结论：对手术室实施护理团队管理模式能有效提高护理人员护理质量,降低护理风险,提高患者满意度,有利于建立和谐的护患关系。     

Value Driven Outcomes (VDO): a pragmatic,modular, and extensible software framework for understanding and improving health care costs and outcomes

Objective To develop expeditiously a pragmatic, modular, and extensible software framework for understanding and improving healthcare value (costs relative to outcomes).Materials and methods In 2012, a multidisciplinary team was assembled by the leadership of the University of Utah Health Sciences Center and charged with rapidly developing a pragmatic and actionable analytics framework for understanding and enhancing healthcare value. Based on an analysis of relevant prior work, a value analytics framework known as Value Driven Outcomes (VDO) was developed using an agile methodology. Evaluation consisted of measurement against project objectives, including implementation timeliness, system performance, completeness, accuracy, extensibility, adoption, satisfaction, and the ability to support value improvement.Results A modular, extensible framework was developed to allocate clinical care costs to individual patient encounters. For example, labor costs in a hospital unit are allocated to patients based on the hours they spent in the unit; actual medication acquisition costs are allocated to patients based on utilization; and radiology costs are allocated based on the minutes required for study performance. Relevant process and outcome measures are also available. A visualization layer facilitates the identification of value improvement opportunities, such as high-volume, high-cost case types with high variability in costs across providers. Initial implementation was completed within 6 months, and all project objectives were fulfilled. The framework has been improved iteratively and is now a foundational tool for delivering high-value care.Conclusions The framework described can be expeditiously implemented to provide a pragmatic, modular, and extensible approach to understanding and improving healthcare value.     

糖尿病的护理

随着生活水平的提高,糖尿病的发病率越来越高。然而,糖尿病患者心理压力大,缺乏糖尿病的基本知识,导致自我护理能力差。需要对糖尿病患者进行自我护理指导,帮助患者制定治疗和护理计划,做好终生护理工作;维持血糖的稳定,控制并发症,提高糖尿病患者的生活质量。     

安宁缓和医疗志愿者培训平台建设

为了让全社会的普通大众,不论性别、年龄、职业、受教育程度,都能够了解安宁缓和医疗的核心理念,并运用在自己的生活当中,甚至传播并服务给更多人,北京协和医院安宁缓和医疗组于2021年成立了面向全社会的专业安宁缓和医疗志愿者培训平台。本文对安宁缓和医疗志愿者培训平台的培训设计、内容、方式和结果进行回顾性的梳理和总结,发现平台的培训设计有理论依据,培训内容逻辑完整,培训方法适宜志愿者,培训结果优异。安宁缓和医疗志愿者培训平台建设具有极好的可行性,需要进一步深入探索培训平台的有效性并拓展长期发展策略。     

An overview of neurocritical care in China: a nationwide survey

Background Little quantitative evidence was available regarding the development of NICUs in China. The purpose of this survey was to evaluate the current situation of neurointensive care units （NICUs） across China. Methods The directors of NICUs from 100 tertiary care hospitals across China were contacted and asked to complete a closed response questionnaire regarding their NICUs. Basic information, equipment, and technology information available in the units, as well as staffing information were investigated. Results Seventy-six questionnaires were returned （a 68% response rate）. Of 76 NICUs, 43 units constituted the majority. The number of each NICU bed varied from 4 to 45, occupying 2%-30% of the total department beds. Over 70% of NICUs were equipped with many emergency treatment equipments as well as physiological and biochemical monitoring equipments, while 34%-70% of NICUs still lacked some kinds of equipments such as defibrillators. Some specialist equipments were still partially lacking in 62%-95% of NICUs. A vast majority of the NICUs were equipped with neurocritical care directors, full-time attending physicians, and head nurses, but full-time NICU residents and neurocritical care nurses were still lacking in nearly half （53%） and one-third （33%-37%） of NICUs, respectively. In 76 NICUs, full-time neurointensivists and nurses added up to 359 and 852, respectively. In addition, 78%-97% of all the surveyed NICUs were severely short of non-neurological professional staffs. Conclusion In China, neurocritical care has developed rapidly, but there is still a shortage of well-equipped and well- staffed NICUs across the nation currently.     

美国医疗保健经济演变历程及对我国启示

美国作为以市场配置资源著称的发达国家,其医疗保健演化和变革的探索历程,为人类积累了经验和教训,为国内着力优化配置医疗资源相关制度体系的深化设计提供了有益的启发和可贵的警示。本文旨在借"他山之石",结合国内医疗保健经济发展的现实,提取出对"健康中国"国家战略下未来相关制度发展的有益借鉴。     

伤口护理中的营养护理实践

现代伤口护理理论认为，营养护理应贯穿伤口护理的始终。实践证明，动态估计患者的营养状况，并区分营养不良的危险性和程度，是制订和实施个体化营养计划的基础；动态监测与评价营养状况是确保营养护理安全有效的重要环节。本文重点介绍有关伤口护理中营养护理的方法、内容、判断标准、监测指标及并发症预防。     

细节护理在儿科静脉穿刺中的应用

目的:探讨细节护理在儿科静脉穿刺中的应用效果。方法:将683例儿科住院患儿,按照治疗先后随机分为对照组和试验组。对照组给予常规护理,实验组实施细节护理,并对两组患儿输液结束后情况(静脉穿刺成功率、护理差错率及患者满意度等)进行比较分析。结果:试验组实施细节护理后,提高了护士静脉穿刺成功率和患者满意度,护理差错率明显降低,与对照组比较,差异有统计学意义(P<0.05)。结论:细节护理在儿科静脉穿刺中应用价值较高,可以提升患者满意度和护理质量,值得在临床中进一步推广与使用。