Automated Production of an On-line Laboratory Reference Manual from a Laboratory Information System

Laboratories provide information beyond test results, including information related to patient preparation, specimen collection and handling, test methodology, test availability, and interpretation of results. Most laboratories publish reference manuals to distribute this information to clients, while relying on the laboratory information system to provide this information to laboratory staff. Maintaining duplicate sources of information is expensive and error-prone, and printed materials become rapidly outdated. We developed a process to automate the production of a web-based reference manual directly from the laboratory information system, using a combination of MUMPS programs and HTML templates. We now focus our resources to assure that the laboratory information system database is accurate and complete, and then with minimal additional effort or expense produce an up-to-date on-line reference manual. We are therefore able to provide better sources of information in a sustainable manner.     

Challenges of a negative work load and implications on morale,productivity and quality of service delivered in NHS laboratories in England

The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the “engine room” of modern medicine with 70% of diagnosis based on the laboratory results generated by them.This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England.Laboratory service delivery in the NHS in England faces numerous daunting challenges; staffing levels in the last few years have become dangerously low, less remunerated, relatively less experienced and predominantly band 5's, multidisciplinary rather than specialty based, associated with working more unsocial hours without adequate recovery time, de-banding of staff, high staff turnaround, profit and cost driven rather than quality. These factors has resulted in burn out, low morale, high sickness absences, increased error rate, poor team spirit, diminished productivity and suboptimal laboratory service delivery.There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix, ensuring adequate remuneration of laboratory staff, implementing evidenced-based specialty oriented service, determining the root cause/s for the high staff turnover and implementing corrective action, identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness.     

Estimating supply requirements for implementing a laboratory information system

The implementation of a new laboratory information system requires the total commitment of all laboratory personnel. Difficulties both within and external to the lab are to be expected as the lab and the hospital staff learn to use the system. Proper planning prior to implementation will avert additional problems that can arise due to an inadequate supply inventory. The purpose of this paper is to discuss methods of estimating supply requirements, as well as to point out other operational considerations related to system start-up.     

基于C/S结构的放疗信息系统研发

目的:随着广东医科大学附属医院放疗技术的进步,设备及工作人员增加,急需一个放疗信息系统对医院目前的放疗流程进行优化。方法:以病人在整个放疗过程产生的数据为中心,结合广东医科大学附属医院实际放疗工作流程,利用跨平台C++图形用户界面应用程序开发框架Qt和关系型数据库管理系统MySQL开发的放疗信息系统。结果:放疗信息系统在开发过程中不断完善,已在本院正式上线运行接近一年。目前该系统已涵盖本院放疗整个流程。除流程管理外,系统也开发了条形码生成、预约、数据统计与分析等功能。结论:放疗信息管理系统数据安全可靠,系统运行稳定,使用、维护简单方便。该系统投入使用后,优化了放疗流程,缩小了数据统计误差,降低了人为的操作错误,缩短了工作人员的工作时间。在医院的信息化建设中收到良好的效果。     

提升继续教育标准 建立科学的检验人员岗位培训体系

医院检验科继续教育的目标,应是让全体检验人员通过不断的学习以满足临床、患者和医学发展的需求。但由于其起步较晚,目前多数医院均袭用临床医生的培训管理模式,很不规范。临床实验室应如何建立科学的继续教育培训体系,如何针对不同教育背景和不同级别的工作人员进行岗位培训,笔者依据我们在实验室认可过程中对ISO15189认可准则的理解和工作经验提出建议,供大家参考。     

县级工作人员健康体检实验室检测结果分析

目的了解本县健康人群的主要实验室检查指标的异常率,为提高国民身体素质提供依据。方法收集2007年至2008年在华容县人民医院体检中心体检人员的资料10825例,按年龄分组对肝功能,血脂,血糖,乙型肝炎表面原,甲胎蛋白,癌胚抗原,EB病毒,血常规的实验室结果进行分析。结果血脂,血糖,血常规检测结果异常率随着年龄的增大而不断升高,各年龄组之间检测结果相比差异有显著性(P<0.01),谷丙转氨酶,甘油三脂,胆固醇,血糖检测结果的异常率分别为11.0%,18.9%,9.2%,6.4%,乙肝病毒,甲胎蛋白,癌胚抗原,EB病毒检测结果的阳性率分别为9.71%,0.08%,0.02%,1.1%,白细胞,血红蛋白,血小板的异常率分别为7.07%,7.26%,10.1%。结论血脂,血糖检测结果的异常率高于全国平均水平,阳性率与全国平均水平接近,乙肝病毒,甲胎蛋白,癌胚抗原,EB病毒检测结果的阳性率还处于较低水平。     

湖北省结防专业机构实验室人力资源变化分析

目的了解湖北省地市、县区级结核病防治专业机构实验室人力资源变化情况,为加强实验室能力建设提供参考。方法通过制定调查表,收集湖北省2008～2010年三年间地市、县区级结核病实验室人员资料,包括学历、职称、专业、专兼职、工作量等信息进行收集和分析。结果从2008～2010年三年间,湖北省结核病实验室人员绝对数逐年下降,实验室人员队伍极不稳定,三年间人员变动率地市和县级分别为60.0%和65.4%,熟练的实验室人员流失率为38.0%和54.6%。人员兼职比例较高,实验室人员学历低于同级其他结防专业人员的学历,综合素质有待进一步提高。结论随着结核病实验室工作量的增加,新检测项目逐步推广和开展,必须加强人力资源的建设,稳定实验室队伍,建立培养、使用和留住人才的机制。     

Rapid measurement of creatine kinase activity in a coronary care unit using a portable benchtop reflectance photometer

Rapid measurements of plasma creatine kinase activity using an inexpensive benchtop reflectance photometer (Ames Seralyzer) and disposable reagent strips were evaluated in the laboratory and coronary care unit. The system proved simple to use and capable of yielding rapid (four minutes per analysis), precise (coefficient of variation less than 9%), and accurate results (correlation with routine method 0.995) when used by medical staff. Creatine kinase values were available 6.5-102 hours earlier than routine laboratory data, depending on the time and day of sampling, thereby facilitating appropriate and economic patient management. This instrument might be used to supplement the routine enzyme service for selected admissions, resulting in greatly improved availability of results and hence contributing to the early discharge of patients from intensive care facilities.     

临床检验信息系统的建立及初步应用

目的建立临床信息网络系统(lanoratoryinformationsystem,LIS)对检验科检验数据的采集、检测结果的保存、报告输送及日常科务工作的管理实现自动化。方法医学检验中心计算机局域网拟采用以太网结构，配置一台服务器。网络操作系统采用windowsNTserver4.0中文版，数据库管理系统采用SQLserver7.0，各工作站操作系统采用windows9x。医学检验系统软件选用PowerBuilder6.0。结果①使用本信息系统可实现检验科日常工作管理计算机化；使检验科检测项目及数据的采用、检测结果的保存与输送实现自动化；②可打印统一的中文报告单，彻底避免手工填写引起的差错；③提高工作效率，缩短了检验报告单的发出时间；④减少了因报告单传递而引起的交叉感染；⑤保证检验结果的准确性和可比性；⑥杜绝了漏费现象。结论使用临床检验信息系统，可提高检验科的检验质量和管理水平。     

Initial impact of a clinical laboratory computer system

A longitudinal study is being conducted of a clinical laboratory computer information system's impact. This paper reports on effects that laboratory directors anticipated prior to installation, and effects reported by laboratory technologists 7 months postimplementation. Primary changes caused by the computer system were increases in the amount of paper work performed by technologists, and improvements in laboratory results reporting. The system generally was well accepted, but laboratory technologists differed in their responses to it. Technologists in some laboratories focused on work increases, whereas in other laboratories they emphasized improved information flow. The paper considers how changes in processes and outcomes of work might affect responses to a computer system. It also considers the implementation process, and suggests some areas where management could benefit from an improved understanding of responses to a computer information system.     

病案信息管理人员应持证上岗

医院的病案信息管理是一种涉及多门学科知识的新兴学科,医院的病案信息工作涉及到全院的临科室、医技科室、行政管理部门。病案的建立、收集、整理、储存、管理、信息开发应用等活动,都需要具有较强的专业知识和技能。目的建立岗位证书制,确认病案信息管理人员掌握专业技术的能力,持证上岗以满足医疗改革对病案信息管理越来越高的要求。方法加强人员培训,进行专业技能认证考试,建立病案信息人员持证上岗制,替换不能完成专业工作的冗员。结果具有岗位证书的病案信息人员持证上岗,适应信息时代对病案信息工作的要求。     

Creation of a RFID Based Real Time Tracking (R-RTT) System for Small Healthcare Clinics

A well-managed healthcare system improves the quality of the patient experience. However, many small healthcare clinics have suboptimal systems for scheduling and locating patients and medical staff, delaying the relay of information and creating poor resource and room utilization. This paper proposes a Radio Frequency Identification (RFID)-based Real-Time Tracking (R-RTT) System for optimizing small healthcare facility operations, enabling further optimization of throughput time, room utilization, and patient flow. In the proposed scenario, RFID readers were equipped in strategic locations throughout the facility. Patients and medical staff were issued personalized RFID tags. When they pass through the reader's interrogation zone, it reads their RFID tag and sends the information to a central computer equipped with software capable of filtering the RFID data into useable information. A Visual Basic Application (VBA) program uses the information received from the ID tags to display the location of the patients and staff as they move throughout the facility. This increases their visibility within the facility by allowing medical staff to determine where their colleagues and patients are at all times. The VBA program was also able to record the data in order to track the time each stage of the appointment process takes to complete. The recorded time data can be broken into processes, making it easier to determine if it adds value. This data can then be transformed into a value stream map for further analysis and improvement.     

基于Web日志的医务人员网络信息行为研究

目的:了解医务人员网络信息行为特征,以促进医院图书馆改善信息服务,提高服务质量。方法:使用Piwik开源分析工具对医院图书馆网站的Web日志文件进行处理,从网络流量、离站链接数量、页面访问次数、用户信息行为时间偏好、浏览器及访问设备等角度分析医务人员网络信息行为。结果:医务人员的信息行为频繁,主要目的是使用电子资源,信息行为发生的时间主要集中于工作时间。结论:医院图书馆应该加强图书馆网站内容建设,优化网站设计,根据信息行为的时间偏好更新信息,加大图书馆宣传力度,提升服务质量。     

部分脾动脉栓塞术对比脾切除术治疗肝硬化脾功能亢进的Meta分析

目的 系统评价部分脾动脉栓塞术(partial splenic artery embolization,PSE)与脾切除术治疗肝硬化脾功能亢进的疗效。方法 通过检索PubMed、Cochrane Library、Embase、中国知网、万方数据知识服务平台等数据库,收集自建库以来至2021年10月30日关于PSE与脾切除术治疗肝硬化脾功能亢进的随机对照试验和队列研究,由两位研究员分别独立筛选文献、提取资料和评价偏倚风险后进行统计分析。结果 共纳入14篇文献,1092例患者,Meta分析结果显示,两组术后1周、1个月、1年白细胞计数水平比较,差异均无统计学意义(P＞0.05),术后6个月(MD= -2.03,95%CI:-3.03~-1.04,P＜0.001)脾切除术组明显高于PSE组;两组术后1个月、1年血小板计数比较,差异无统计学意义(P＞0.05);术后1周(MD=-65.46,95%CI:-116.39~-14.52,P=0.01)和术后6个月(MD= -117.99,95%CI:-229.71~-6.27,P=0.04)脾切除术组均高于PSE组;两组术后1周、1个月和1年红细胞计数水平比较,差异均无统计学意义;两组患者NK细胞计数水平比较,术后1个月(MD= 6.02,95%CI:4.27~7.77,P<0.001)、术后1年(MD=3.53,95%CI:1.68~5.37,P=0.0002),均提示PSE组的术后自然杀伤细胞计数水平明显高于脾切组;与脾切除术组比较,PSE组术中出血量更少(MD=-73.92,95%CI:-89.39~-58.45,P<0.001)、住院费用更少(MD=-0.80,95%CI:-1.27~-0.34,P=0.0008)、住院时间也更短(MD=-4.08,95%CI:-5.22~-2.95,P<0.001)。结论 现有证据表明,PSE治疗肝硬化脾功能亢进短期与远期均有一定的疗效,相较于脾切除术,其手术创伤小,住院时间和费用少,并发症易控制,且可保留一定的免疫功能,更值得在临床应用推广。受纳入文献数量以及质量的限制,上述结论仍需开展更多高质量研究予以验证。     

临床决策支持在检验结果自动审核和解释中的应用评价

目的：利用临床决策支持实现检验后的自动化过程。方法：研发自动审核和智能解释的临床决策支持系统,建立高质量、专业化的规则库和知识库。结果：临床决策支持包括自动审核、结果解释和全面知识支持。自动审核符合ISO 15189、CAP Checklist、CLSI AUTO-10等标准要求。应用效果包括：实验室可减少80%的审核工作量,缩短40%的结果报告时间;可优化工作流程,减少差错率;可均衡员工技术差异,降低审核工作压力。结论：临床决策支持显著提高检验后过程的质量和效率。     

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.     

基于UML技术的医院检验信息管理系统的设计

根据医院实际需求,采用对象建模语言（UML）开发了医院检验信息管理系统。本文详细介绍了该系统各模块的功能及其应用效果。该系统的应用提高了检验科设备的利用率,缩短了标本控制时间及故障响应时间,提高了医院检验设备的工作效率。     

Training appropriate laboratory workers for rural health centres in Papua New Guinea

Many rural health centres in developing countries continue to treat patients without the help of any laboratory tests. The result is often inaccurate diagnosis, wasteful use of multiple drugs, and increasing drug resistance of pathogens. It is unlikely that there will ever be sufficient funds to employ a full-time laboratory worker at each of the many small remote health centres in Papua New Guinea. It is also doubtful whether staff and health extension officers who run such centres have the appropriate knowledge to adequately utilize full-time laboratory personnel. It is feasible, however, to train selected health workers in courses of three to four months' duration to perform a few simple laboratory tests part-time, in addition to their clinical duties. Suitable tests are those where the result does not require skilled interpretation. For most such tests, the result is the diagnosis. After the clinical staff have received the laboratory diagnosis, they are free to decide whether it fits the clinical picture. If so, they can then find the appropriate treatment to prescribe in standard treatment books. The present paper describes the experience in setting up and operating laboratory training for health centre staff in Milne Bay Province, Papua New Guinea. Costs and initial results of the program are discussed.     

临床化学检验结果自动审核系统的建立与评价

目的 随着医学科学技术的发展,实验室检测结果对大部分临床决策的影响越来越显著。因此,在保证检验结果准确性、可靠性的前提下,缩短周转时间(TAT)是当前临床实验室的工作重点之一。本研究的目的是建立一套适合本实验室的临床化学检验结果自动审核系统并进行应用效果评价。 方法 研究以雅培C16000生化分析仪以及中间体软件IM、实验室信息系统(LIS)为基础,参考美国临床实验室标准化协会(CLSI)AUTO-10A文件、美国病理学会(CAP)清单和ISO15189文件,从自动审核范围确认规则、危急值审核规则、历史比对值审核规则、逻辑条件审核规则和质量控制审核规则五个层面建立相应的自动审核规则,构建自动审核流程图,并比较了采用自动审核系统前后样本周转时间(TAT)的变化情况,分析报警状况分布以及人工审核与自动审核的一致性。 结果 共产生了435条自动审核条目,并根据这些审核条目构建了自动审核流程图。采用自动审核系统后,325 000例样本的通过率为52.3%,门诊和住院标本的TAT在自动审核前后的差异具有统计学意义(均P<0.05),门诊和住院标本的平均TAT分别缩短了43 min和60 min、自动审核和人工审核的符合率为99.98%。 结论 本研究建立了符合本实验室的临床化学检验结果自动审核系统,该系统可以显著缩短TAT,具有很高的安全性,值得在实验室推广和应用。      

农村基层医疗人员信息化管理平台系统设计

介绍了农村基层医疗人员信息化管理平台系统设计。针对农村基层医疗人员学习培训和资格审核管理工作中存在的问题,新疆医科大学通过构建省区、地州和县市三级管理模式,完成对培训人员信息注册、学习培训和资格审核等信息化管理。详细地讨论了信息化平台建设系统设计、功能等方面内容。