社区医疗信息管理系统的设计与实现

研究设计并实现了一种医疗信息管理系统,对信息管理系统的结构进行了分析、设计,建立了以家庭为单位的个人健康档案,以提供常见疾病检索、流行病预防常识、重大疾病的预警信息、健康保健及营养卫生常识等医学信息服务,并实现了对心脑血管疾病患者的日常监护。     

基于数字化医院与数字家庭的社区医疗服务

数字家庭为数字化医院业务流程在社区内的延伸,为群众的医疗服务无疑提供了先进技术支持下的最为便捷的途径和全新的服务体验.本文介绍具有独特"岭南模式"的广东数字家庭推广计划和广东省内数字化最为全面的中山市人民医院的技术与业务整合之下的数字化社区医疗服务原型.     

社区疾病防治的全科医疗服务模式分析

近年来兴起的以全科医学为基础的社区全科医疗服务正逐渐成为社区医疗服务体系的主体。针对我国城市社区全科医疗系统处于初步阶段,探讨社区疾病防治的全科医疗服务模式建设的侧重点与存在的问题。提出以健康管理为理念,发展全科医学,规范化培养全科医生以保障医学服务质量,更好的发挥基层医疗优势。     

基于ADuC845的多功能便携式医疗监护系统的设计

本文设计一个适用于家庭应用的多功能便携式医疗监护系统.该系统通过嵌入式采集端与PC存储端的协作,实现了对人体体温、血压、心率等重要生理参数的采集和存储.同时系统采集端还具有显示及报警功能.多功能便携式医疗监护系统为医疗监护仪器的微型化和家用化提供了便捷的解决方案,可以方便将病人更多有用的生理信息提供给医生,帮助医生诊断和治疗.     

药师在社区医疗服务中的作用

随着我国医疗体制改革的全面推行,社区卫生服务将成为基层医院的基本功能之一。它以城市或农村社区为基本单位,为群众提供基本医疗、预防、保健、康复、健康教育和计划生育技术指导等卫生服务的综合服务。发展社区卫生服务,符合人口老龄化和疾病谱的变化,有利于降低医疗卫生服务成本,向居民提供便捷的服务。同时,也有利于卫生资源的合理配置和有效利用,控制医疗费用的过快增长。社区服务的推行,医院药剂科中的药师将面临较大的挑战:一部分医院药师将走出医院,面向社区为病人提供服务。由于药师对药     

一种老年人移动健康监护系统的研究

目的:设计一种老年人移动监护系统,实现移动心率检测,跌倒检测,紧急情况自动电话呼叫与GPS定位,减少突发事件对老年人的健康威胁。方法:采用分层的体系结构,第一层为传感器层,用于采集并实时分析ECG信号以及加速度数据,第二层为手持终端,用于汇集各传感器数据,综合判断并实现数据远程传输、呼叫以及定位,第三层位于远程服务器,实现数据库管理,数据显示等。结果:分层的体系结构有利于系统功能的扩展,有利于传感器单元的可穿戴性。结论:基于无线传感器网络与GPRS网络的移动健康监护系统能够有效实时地对老年人的健康与安全状况进行监护,对老年人生命安全保障具有重要意义。     

一种基于全仿真的医疗设备故障预测与健康管理系统开发平台的研究

医疗设备故障预测与健康管理(prognostics and health management,PHM)系统具有提高医疗设备运行安全性、降低维修成本等功能,因此其开发越来越受到重视.本研究提出一种基于全仿真的医疗设备PHM系统开发平台,该平台基于Proteus仿真实现数据采集及传输,基于MATLAB/Simulink完...     

基于GPS和GPRS远程医疗监护报警系统的设计*

背景：远程医疗监护系统可以传输医疗信息,实现动态生理监护。 目的：设计一种基于GPS和GPRS的远程医疗监护报警系统。 方法：系统由中心站和多个用户机组成。运用医疗信息监测技术、移动通信技术、嵌入式技术以及GPS技术,由定位传输模块把采集终端实时采集的患者生理信息,连同患者的位置信息一起发送到GSM移动通讯网,供医生进行及时诊断和处理,实现生理参数的远程实时监测与报警。 结果与结论：该系统构建了家庭、社区、医院的三位一体远程医疗信息传输、医疗救治平台,第一时间将患者的医疗信息和位置信息传送到医疗中心,由专家协助诊断并提供救治指导和援助。该系统可用于院前急救、院外监护以及远程医疗与紧急救助,不仅适用于医院、装配在救护车里,也可以用于家庭,对慢性病患者进行有效的院外监测和跟踪。 关键词：远程医疗;移动监护;GPS定位;GPRS通信; Google地球 doi:10.3969/j.issn.1673-8225.2012.13.011     

一种面向医疗安全的智能清单系统

安全清单是一种规范化诊疗行为的有效工具,在临床上日益受到重视。安全清单要求医务工作者在诊疗流程中的关键环节对任务的准备情况或完成情况按临床规范进行核对,从而保证医疗安全。但传统的安全清单难与临床工作流程集成,对病人缺乏针对性,并且缺乏信息系统支持,因而临床应用效果不佳。通过研究清单的计算机化表达方法,将安全清单分解为诊疗流程、清单表格、医学算法和辅助信息等4个层次的知识;设计一套执行机制,利用工作流引擎和规则引擎对这些知识进行执行,并在此基础上开发一套智能清单系统来实现此机制。通过一个心内科经皮冠状动脉介入治疗清单案例,对系统进行评估。该系统将清单细化成11个对应于流程中关键场景的清单,在恰当时机将清单推送给预定义的医护人员,从而使清单融入他们的诊疗工作。每个场景的清单都是由预定义的医学算法结合病人实际情况动态生成,从而确保清单的针对性。结果表明,这种方法可以有效支持智能清单的表达和执行,提供能够与诊疗流程集成的病人个体化清单,方便医护人员的使用。     

便携式医疗检测掌上系统设计

目的:以单片机技术为核心设计一个低功耗、小型化的人体信号检测系统,为家庭监护设备提供一种可行的方案。方法:系统以MSP430F149为控制核心,能够实现数据实时采集与处理、数据存储、液晶显示和报警,以及键盘输入、USB通讯、上位机回放、处理等功能。结果:系统可实现生理、生化参数监测并上传到上位机。结论:该设计可为动态心电、血压等多参数人体信号的便携式检测建立一个软硬件的系统平台,实用性好。     

Psychology in primary health care: effects of brief targeted therapy on children's medical care utilization

Evaluated the impact of psychological treatment for 93 children (ages 1-15) with common behavior, toilet, school, and psychosomatic problems. Children and parents, who were members of a health maintenance organization, had 1-6 visits to a primary care-based psychological consultation service. Individualized treatment was guided by problem-specific behavioral protocols. Parent outcome and behavior checklist ratings indicated improvement or resolution for 74% of children and high satisfaction with the psychological service. Children's use of medical services, especially acute primary care visits, was reduced during the year after treatment; a matched comparison group's use was unchanged. Addressing children's unmet mental health needs reduces medical care utilization. A primary health care model of psychological services provides an integrated system for serving the health and mental health needs of children.     

A methodology for the analysis of rural primary health care delivery systems

A methodology for the analysis of rural primary health care delivery systems is presented. The basic approach is that the dynamics of rural primary health care delivery systems can be understood as an interaction between consumer and provider models. Computer modelling techniques can be used to analyze the efficiency of particular rural health care systems based on site-specific geographical data and economic data regarding the cost of gasoline and other costs to the consumer and provider. The methodology is relevant in developing countries as well as in the United States.     

Children's primary health care services: social-cognitive factors related to utilization

OBJECTIVE: To test social-cognitive influences on parent decision-making processes related to children's health care use. METHODS: Eighty-seven primary caretakers of children ages 4 to 9 years completed measures of child health and behavior, parent functioning, and social-cognitive factors related to parenting and health care use. Primary care use was obtained from the children's primary care physician(s) for the 2 years prior to recruitment. RESULTS: Social-cognitive variables accounted for 13.2% of the variance in primary health care use, above and beyond the influence of child health status and psychosocial variables. The best predictive model, accounting for 29.8% of the variance in primary care use, included the interaction between parental stress and self-efficacy to cope with parenting demands, child behavior problems, self-efficacy for accessing physician assistance, medication use, and parent health care use. CONCLUSIONS: Results documented the relationship between self-efficacy and parent stress in decision making about pediatric primary care use. Social-cognitive theory provides a new perspective for evaluating factors that influence health care use.     

Practice size and service provision in primary care: an observational study

Background

In 2004, primary care payments for basic services and enhanced services were separated. This change has greatly facilitated the evaluation of the breadth and volume of services.

Aim

To determine whether larger practices produce a higher volume and greater diversity of enhanced services.

Design of study

Cross-sectional observational study using practice data obtained under the Freedom of Information Act 2000.

Setting

A total of 384 practices in 14 English primary care trusts.

Method

Practice data for all practices were collated for enhanced services, practice size, and deprivation. Diversity and volume of enhanced services were used as dependent variables in a series of multiple regression models to ascertain the effect of practice size, and any relationship with deprivation.

Results

Larger practices provided a greater diversity of services (P = 0.002), although this effect was not present in practices with more than 6330 patients. Practice size seems to influence the volume of enhanced services in general medical services, but this effect disappeared when deprivation was taken into account. Deprivation had a negative influence on the volume of enhanced services provided (P = 0.019). The effect of deprivation on volume persisted in practices with more than 6330 patients.

Conclusion

Current average-sized practices provide similar volume and diversity of enhanced services as those in the largest quartile; therefore, there seems to be little merit in creating ‘supersurgeries’ if the aim is to transfer work from secondary to primary care. There does not seem to be an upper threshold above which practice size creates spare capacity and expertise to deliver a significantly greater volume or more diversity of extra services.     

The benefits and costs of a master's programme in primary health care: a cross-sectional postal survey

Background

Master''s programmes can provide continuing professional development, equipping GPs to teach, research, and lead general practice. A previous evaluation of the MSc in primary health care found that graduates were contributing significantly to the discipline of general practice. Given the changes in general practice over the last 10 years, it was considered useful to investigate longer-term outcomes.

Aim

To assess the benefits GPs have derived from the MSc in terms of the intended learning outcomes and their own plans for involvement in research and teaching.

Design of study

A cross-sectional survey using a postal questionnaire.

Setting

Department of Primary Care and Public Health Sciences, King''s College London.

Method

A postal questionnaire was sent to the graduates of MSc in primary health care from 1997 until 2008.

Results

A total of 50 completed questionnaires were returned (response rate 76%). After graduation, 22 GPs had completed another degree or diploma and 21 had work accepted for publication, resulting in 74 papers. Nine held academic posts at lecturer or senior lecturer level, 21 were GP trainers, and 21 undergraduate teachers. Twenty-five GPs held more than one teaching-related post. The majority of the graduates confirmed the attainment of the MSc''s intended outcomes. Positive influences of the MSc were identified, including career development, personal development, and job satisfaction.

Conclusion

Graduates reported a number of benefits to themselves, their practices, and their patients. As the requirements for continuing professional development of GPs become more stringent, and with the advent of revalidation, the current ad hoc approach to career development in general practice is becoming unsustainable. To enhance its credibility as an academic discipline, general practice must continue to develop its capacity for research and scholarship. Master''s programmes are likely to have an important role in supporting professional development in general practice in the future.     

A simple risk score using routine data for predicting cardiovascular disease in primary care

Background

Population-based screening for cardiovascular disease (CVD) risk, incorporating blood tests, is proposed in several countries.

Aim

The aim of this study was to evaluate whether a simple approach to identifying individuals at high risk of CVD using routine data might be effective.

Design of study

Prospective cohort study (EPIC-Norfolk).

Setting

Norfolk area, UK.

Method

A total of 21 867 men and women aged 40–74 years, who were free from CVD and diabetes at baseline, participated in the study. The discrimination (the area under the receiver operating characteristic curve [aROC]), calibration, sensitivity/specificity, and positive/negative predictive value were evaluated for different risk thresholds of the Framingham risk equations and the Cambridge diabetes risk score (as an example of a simple risk score using routine data from electronic general practice records).

Results

During 203 664 person-years of follow-up, 2213 participants developed a first CVD event (10.9 per 1000 person-years). The Cambridge diabetes risk score predicted CVD events reasonably well (aROC 0.72; 95% confidence interval [CI] = 0.71 to 0.73), while the Framingham risk score had the best predictive ability (aROC 0.77; 95% CI = 0.76 to 0.78). The Framingham risk score overestimated risk of developing CVD in this representative British population by 60%.

Conclusion

A risk score incorporating routinely available data from GP records performed reasonably well at predicting CVD events. This suggests that it might be more efficient to use routine data as the first stage in a stepwise population screening programme to identify people at high risk of developing CVD before more time- and resource-consuming tests are used.     

Clinical features of kidney cancer in primary care: a case-control study using primary care records

Background

Kidney cancer accounts for over 4000 UK deaths annually, and is one of the cancer sites with a poor mortality record compared with Europe.

Aim

To identify and quantify all clinical features of kidney cancer in primary care.

Design

Case-control study, using General Practice Research Database records.

Method

A total of 3149 patients aged ≥40 years, diagnosed with kidney cancer between 2000 and 2009, and 14 091 age, sex and practice-matched controls, were selected. Clinical features associated with kidney cancer were identified, and analysed using conditional logistic regression. Positive predictive values for features of kidney cancer were estimated.

Results

Cases consulted more frequently than controls in the year before diagnosis: median 16 consultations (interquartile range 10–25) versus 8 (4–15): P<0.001. Fifteen features were independently associated with kidney cancer: visible haematuria, odds ratio 37 (95% confidence interval [CI] = 28 to 49), abdominal pain 2.8 (95% CI = 2.4 to 3.4), microcytosis 2.6 (95% CI = 1.9 to 3.4), raised inflammatory markers 2.4 (95% CI = 2.1 to 2.8), thrombocytosis 2.2 (95% CI = 1.7 to 2.7), low haemoglobin 1.9 (95% CI = 1.6 to 2.2), urinary tract infection 1.8 (95% CI = 1.5 to 2.1), nausea 1.8 (95% CI = 1.4 to 2.3), raised creatinine 1.7 (95% CI = 1.5 to 2.0), leukocytosis 1.5 (95% CI = 1.2 to 1.9), fatigue 1.5 (95% CI = 1.2 to 1.9), constipation 1.4 (95% CI = 1.1 to 1.7), back pain 1.4 (95% CI = 1.2 to 1.7), abnormal liver function 1.3 (95% CI = 1.2 to 1.5), and raised blood sugar 1.2 (95% CI = 1.1 to 1.4). The positive predictive value for visible haematuria in patients aged ≥60 years was 1.0% (95% CI = 0.8 to 1.3).

Conclusion

Visible haematuria is the commonest and most powerful single predictor of kidney cancer, and the risk rises when additional symptoms are present. When considered alongside the risk of bladder cancer, the overall risk of urinary tract cancer from haematuria warrants referral.     

Implementing the role of the primary care mental health worker: a qualitative study

BACKGROUND: Primary care mental health workers are a new role recently introduced into primary care in England to help manage patients with common mental health problems. AIM: To explore the views of GPs, primary care teams and patients on the value and development of the new role of primary care mental health workers in practice. DESIGN OF STUDY: Qualitative study. SETTING: The Heart of Birmingham Primary Care Teaching Trust in the West Midlands, UK. METHOD: Thirty-seven semi-structured interviews involving seven primary care mental health workers, 21 patients and 11 focus groups involving 38 members of primary care teams were held with six teams with a worker. Two teams asked for the worker to be removed. Six practice managers also took part in the study. RESULTS: A number of different approaches were used to implement this new role. Strategies that incorporated the views of primary care trust senior management, primary care teams and workers' views appeared most successful. Rapid access to a healthcare professional at times of stress and the befriending role of the worker were also highly valued. Workers felt that their role left them professionally isolated at times. A number of workers described tension around ownership of the role. CONCLUSION: Primary care mental health workers appear to provide a range of skills valued by patients and the primary care teams and can increase patient access and choice in this area of health care. Successful implementation strategies highlighted in this study may be generalisable to other new roles in primary care.