临床路径电子化应用与临床知识库建设实践

目的 通过临床路径概念发展,描述临床路径管理定义及关键特征,分析临床路径电子应用趋势,总结医学本体临床路径知识库建模方法及应用.方法 (1)查阅相关文献,追溯临床路径的起源及特点,分析临床路径关键特征要素,总结临床路径应用的11个关键特征;(2)对临床路径电子化应用分析,研究国内外临床路径知识库的建设方法;(3)通过临...     

智能自适应临床路径系统模型建设方法研究

临床路径知识库是实现病人诊疗流程中个性化诊疗与标准化路径有机结合的有效技术手段。为满足医院医疗质量提升与病人个性化诊治的需要,文章提出了智能自适应临床路径系统的信息技术建设方案,系统框架由语义层、中间层以及临床路径执行层3层架构组成,重点讨论了基于临床路径本体的知识库模型及建设方法,对下一阶段临床路径电子化应用工作进行了规划和展望。     

高原知识库管理系统的建立方法与应用

目的：通过建立一套高原知识库管理系统,提高高原知识的检索、查新效率,为医院科研服务。方法：采用ACCESS 2003创建高原知识库管理系统。结果：实现了高原文献资源和信息的快捷检索查询。结论：应用ACCESS2003建立的高原知识库管理系统具有结构简单、易于操作、检索速度快,查找文献方便、便携等特点,经实际应用,收到了良好效果。     

卫生系统中一种简单有效的决策方法——知识库结构模型的建立及其应用

本文介绍了知识库结构模型的一种简单建立方法和在卫生系统中的应用，利用图论中弱连通等概念直观地建立知识库模型，无需求邻接矩阵和可达性矩阵。卫生系统的知识领域有许多问题不明确，知识间的逻辑关系错综复杂，需要决策者有共同认识，这就要有一种行之有效的决策方法，建立知识库模型的方法就是一种较好的方法。它具有简单、直观、实用等特点。     

临床路径知识库及诊疗决策支持系统研究

1临床路径知识库及诊疗决策支持系统提出背景及现况在临床路径执行过程中,病人的个体和动态信息的处理需要更加专业、强劲的知识功能来进行支持[1]。基于临床路径知识库的智能决策系统能够满足这样的需求,这就使临床知识库信息化建设平台和诊疗决策支持系统的建设显得尤为重要。它是临床路径能否被广大医务人员全面、广泛、积极使     

临床决策支持知识库研究

目的 运用知识管理的理念和方法,探讨切合实际应用的临床决策支持知识库概念模型,使医院能够通过知识管理提升其核心竞争力.方法收集国内外相关资料,系统化研究及分析具有人工智能的临床决策支持知识库的框架.结果实施医院知识管理的关键就是必须建立一个动态的,并具有自我学习能力的临床决策支持知识库,该知识库不仅需要通过医院信息系统收集传统的医学知识,而且需要建立用于临床指南等的标准医学知识收集的引擎和隐性知识转化模型,并嵌入智能化工具,通过知识库的自我学习功能,保证其动态更新和智能化的临床决策支持能力.结论医院知识库创建过程实质也是医院价值的创造过程,智能化的临床决策支持知识库开发不仅涉及知识的收集和处理,还包括知识的表达,人工智能技术的嵌入和各种规则、条件及分类方法等的应用,有待进一步研究.     

基于医学本体的电子病历系统研究

尽管电子病历在临床医学中已广泛应用,但传统模版生成方式的病历与临床思维逻辑存在吻合度问题,因此笔者提出基于医学本体的电子病历系统,系统地探讨了电子病历较纸质病历的优势并对本体相关知识内容进行介绍,探索建立基于医学本体的电子病历系统。在电子病历本体构建过程中,将大量的临床医学知识有机地组织并重用。系统实际应用过程表明,基于医学本体的电子病历系统能够有效缓解临床病历描述主观性强、模糊引争议等现象的发生,提高临床数据质量。     

基于医学本体的电子病历结构化数据采集研究

目的：对临床描述性信息结构化录入程序（SDE）进行再开发，建立基于医学本体的临床信息结构化采集模型和应用框架。方法：使用0penSDE建立临床医学信息域本体模型，主要是患者病程病史、检查检验等医学术语概念及它们的内容描述，并建立树型结构框架。结果：建立了基于医学本体模型的可扩展临床电子数据采集系统。结论：其结构化可选式数据录入对基于电子病历的临床决策有重要意义。     

临床实验室检验知识的数据挖掘和表达

目的探索基于自组织映射（SOM）的数据挖掘方法从历史积累的临床实验室检验数据中发现知识的能力,并尝试利用本体方法将该领域相关知识进行标准化表达。方法本研究的基本思想是采用自组织映射神经网络技术,从过去积累的数据中挖掘出专家经验基础上的临床检验项目的应用规律（知识）。以2009--2011年西安市两所综合医院的内科门诊患者就诊资料为训练样本,采用自组织映射方法建立门诊患者的聚类模型。采用通用的本体构建原则和方法,提取领域内相关概念及相互关系,建立临床实验室检验领域本体框架。结果SOM网络将就诊患者聚为8个类别,每个类别都具有较明显的临床意义,即每个类别中的患者具有相似的临床实验室检验项目的应用规律。聚类结果可以涵盖69．73％的患者。患者性别、年龄、3年累计临床检验项目数、疾病特征对聚类模型的贡献较大。构建了临床实验室检验领域本体框架,该框架的构建过程符合本体的建立准则,本体中的概念及其关系相对完整。结论自组织映射方法对门诊患者聚类效果较好,说明采用数据挖掘方法从历史数据中发现临床实验室检验项目的应用规律是可行的。采用本体方法将该领域知识进行标准化表达是一种有益的尝试。     

支持临床路径过程的诊疗知识库处理设计分析

现代医院中医疗流程设计起着非常重要的作用,由于医疗成本和提高医疗服务质量的双重压力,医院需要重新设计其医疗服务流程,评价医疗服务效率与结果。临床路径是基于特定诊断结论的多学科循证医疗临床流程,在其执行过程中,产生了大量的临床文档,这些文档包含了今后临床医疗可重用的知识信息。本文提出了使用临床路径模型规则语义标引技术进行面向知识库的建设方法,对医院临床路径信息系统建设有重要意义。     

基于本体的临床案例知识库研究与实践

基于本体论的思想,给出了临床案例知识表示方法和知识库的结构,介绍了临床案例知识的获取流程,设计了临床案例相似度计算方法,并用医院的临床数据进行了案例相似度的计算验证。     

A Review of Nutrition Support Guidelines for Individuals with or Recovering from COVID-19 in the Community

COVID-19 negatively impacts nutritional status and as such identification of nutritional risk and consideration of the need for nutrition support should be fundamental in this patient group. In recent months, clinical nutrition professional organisations across the world have published nutrition support recommendations for health care professionals. This review summarises key themes of those publications linked to nutrition support of adults with or recovering from COVID-19 outside of hospital. Using our search criteria, 15 publications were identified from electronic databases and websites of clinical nutrition professional organisations, worldwide up to 19th June 2020. The key themes across these publications included the importance in the community setting of: (i) screening for malnutrition, which can be achieved by remote consultation; (ii) care plans with appropriate nutrition support, which may include food based strategies, oral nutritional supplements and referral to a dietitian; (iii) continuity of nutritional care between settings including rapid communication at discharge of malnutrition risk and requirements for ongoing nutrition support. These themes, and indeed the importance of nutritional care, are fundamental and should be integrated into pathways for the rehabilitation of patients recovering from COVID-19.     

标准化临床路径与地域间协同医疗

临床路径是医院一组人员，针对某病种的检查、治疗、护理和康复指导等，以及所制定的一个有严格工作顺序、有准确时间要求的照顾计划，而标准化的临床路径则是跨地区、跨医疗机构医务人员共同执行的规范医疗护理计划。标准化电子临床路径主要包括两部分：一是治疗计划的标准化；二是数据交换的标准化。标准化的临床路径在地域间协同医疗中起着重要的作用。     

嵌入式临床路径管理软件功能标准研究

目的：确定嵌入式临床路径电子化系统功能标准,满足临床电子病历系统应用的相关要求。方法：对病区医生进行访谈,从纸张临床路径应用中得到电子化临床路径的基本功能,从临床路径电子化软件切换应用中得到其附加功能,比较相关软件得到适合大型医院使用的能嵌入电子病历系统的临床路径软件的功能标准。结果：嵌入式临床路径的功能标准,其重要功能是患者临床处置列表、变异管理、评估与统计分析。结论：该研究对嵌入电子病历系统的临床路径电子化开发具有帮助作用。     

Development and implementation of a clinical pathway programme in an acute care general hospital in Singapore.

A critical or clinical pathway defines the optimal care process, sequencing and timing of interventions by doctors, nurses and other health care professionals for a particular diagnosis or procedure. Clinical pathways are developed through collaborative efforts of clinicians, case managers, nurses, pharmacists, physiotherapists and other allied health care professionals with the aim of improving the quality of patient care, while minimizing cost to the patient. The use of clinical pathways has increased over the past decade in the USA, the UK, Australia, and many other developed countries. However, its use in the developing nations and Asia has been sporadic. To the author's knowledge, there is to date, no published literature on the use and impact of clinical pathways on the quality and cost of patient care in the Asian health care setting. This paper provides a qualitative account of the development and implementation of a clinical pathway programme (using the example of patients with uncomplicated acute myocardial infarction) in an acute care general hospital in Singapore. The paper concludes that clinical pathways, when implemented in the context of an acute care hospital, can result in improvements in the care delivery process.     

脂肪细胞分化相关miRNA-hsa-miR-378生物信息学分析

【目的】 利用各种生物信息学工具分析hsa-miR-378转录调控、靶基因功能,以期为研究hsa-miR-378在人脂肪细胞分化过程中的功能与调控机制提供线索。 【方法】 应用UCSC Genome Browser、Promoter scan等在线工具,分析hsa-miR-378在基因组上下游10 kb 以内的CpG 岛分布情况、转录起始位置(TSS)、转录因子结合位置(TFBS)等;选择TargetScan、PicTar、MiRanda三种计算方法预测hsa-miR-378的靶基因,取三个预测结果的交集,并合并DIANA LAB-TarBase 6.0数据库的已验证靶标,对所得靶基因集分别进行GO注释描述、GO富集分析和pathway富集分析。 【结果】 hsa-miR-378可能具有独立的启动子,可能受C/EBPβ转录因子的调控;其预测靶基因集合富集于转录调控、蛋白质修饰、细胞分化等生物学过程和功能(P<0.01);并显著富集于TGF-β信号通路、Wnt信号通路等4个信号通路,以及甲状腺癌、系统性红斑狼疮等8个疾病通路中 (P<0.05)。 【结论】 通过对hsa-miR-378转录调控元件、靶基因的分析,为hsa-miR-378在人脂肪细胞中的功能与调控机制研究提供了线索和理论依据。     

Bayesian semiparametric regression models for evaluating pathway effects on continuous and binary clinical outcomes

Many statistical methods for microarray data analysis consider one gene at a time, and they may miss subtle changes at the single gene level. This limitation may be overcome by considering a set of genes simultaneously where the gene sets are derived from prior biological knowledge. Limited work has been carried out in the regression setting to study the effects of clinical covariates and expression levels of genes in a pathway either on a continuous or on a binary clinical outcome. Hence, we propose a Bayesian approach for identifying pathways related to both types of outcomes. We compare our Bayesian approaches with a likelihood‐based approach that was developed by relating a least squares kernel machine for nonparametric pathway effect with a restricted maximum likelihood for variance components. Unlike the likelihood‐based approach, the Bayesian approach allows us to directly estimate all parameters and pathway effects. It can incorporate prior knowledge into Bayesian hierarchical model formulation and makes inference by using the posterior samples without asymptotic theory. We consider several kernels (Gaussian, polynomial, and neural network kernels) to characterize gene expression effects in a pathway on clinical outcomes. Our simulation results suggest that the Bayesian approach has more accurate coverage probability than the likelihood‐based approach, and this is especially so when the sample size is small compared with the number of genes being studied in a pathway. We demonstrate the usefulness of our approaches through its applications to a type II diabetes mellitus data set. Our approaches can also be applied to other settings where a large number of strongly correlated predictors are present. Copyright © 2012 John Wiley & Sons, Ltd.     

From boundary concept to boundary object: The practice and politics of care pathway development

Care pathways are multidisciplinary care management technologies which map out chronologically activities in a healthcare process. In the UK, they are advanced as a mechanism for enacting the changes called for under clinical governance. The terminological imprecision of care pathway methodology has enabled it to align clinical, management and service user interests and helps to explain the growing popularity of care pathways as quality improvement tools. Whilst it is possible to identify a ‘zone of agreement’ between these social worlds, there exists a fuzzy periphery characterised by conflicting agendas, which presents challenges for those charged with inscribing these interests into the pathway artefact. Drawing on a qualitative case study of a mental health safety care pathway in the UK, this paper examines the processes by which originators negotiated and settled upon a given design. The data reveal inherent tensions within pathway technology and the knowledge developers draw upon in devising strategies to overcome these challenges.     

Identification of Potential Target Genes of Butyrate in Dimethylhydrazine-Induced Colorectal Cancer in Mice

The mechanism by which butyrate prevents colorectal cancer (CRC) is unclear. The objective of this study was to identify potential target genes of butyrate in 1,2-dimethylhydrazine (DMH)-induced CRC in mice. Nontumor colorectal tissues of mice from DMH + butyrate, DMH, and control groups were hybridized on Agilent Mouse Whole Genome 44K Oligo Microarrays. Selected genes were validated by qRT-PCR. Data was further analyzed by KEGG, gene ontology (GO), and pathway studio software. The tumor incidence in the DMH + butyrate and DMH groups was 30% and 90%, respectively (P < 0.05). There were 355 genes downregulated due to DMH treatment while upregulated by butyrate, and 475 genes upregulated by DMH while downregulated by butyrate. The results revealed that most of the tumor-related signaling pathways (e.g., MAPK pathway, Wnt pathway, insulin pathway, and VEGF pathway) were downregulated by butyrate. The GO terms related to cell differentiation, cell cycle, cell proliferation, cell death, cell adhesion, and cell migration were significantly affected. The chemopreventive effects of butyrate were confirmed in the DMH-induced CRC mice model. And mechanisms encompassing multiple pathways and GO terms are involved in the regulation of gene expression.