医学生临床实践能力评价途径和方法的研究

分析了西方发达国家临床医学生实践能力的评价方法 ,结合我国临床实践能力评价的现状 ,对如何建立一套既比较规范又客观公正、切实可行的医学生临床实践能力评价方法 ,就其内容、范围、途径、形式与方法及应注意的几个问题谈了一些看法     

基层医院加强临床药师用药管理对临床合理用药的价值

目的探讨基层医院临床药师用药管理对促进临床合理用药的价值。方法选取2011年3月～2013年4月入我院治疗的1108例住院患者,按照1：1比例随机分为两组各554例。对照组给予常规用药管理,观察组由临床药师对患者用药全过程进行适时管理,比较两组患者不安全事件的发生情况。结果对照组不安全用药事件发生率（3．07％）显著高于观察组（0．90％）,差异有统计学意义（P〈0．05）。对照组总体满意度（72.38％）低于观察组（89．89％）,观察组患者总体满意率显著优于对照组（P〈0．05）。结论临床药师在临床治疗过程中具有重要的价值。     

A sequence labeling approach to link medications and their attributes in clinical notes and clinical trial announcements for information extraction

Objective

The goal of this work was to evaluate machine learning methods, binary classification and sequence labeling, for medication–attribute linkage detection in two clinical corpora.

Data and methods

We double annotated 3000 clinical trial announcements (CTA) and 1655 clinical notes (CN) for medication named entities and their attributes. A binary support vector machine (SVM) classification method with parsimonious feature sets, and a conditional random fields (CRF)-based multi-layered sequence labeling (MLSL) model were proposed to identify the linkages between the entities and their corresponding attributes. We evaluated the system''s performance against the human-generated gold standard.

Results

The experiments showed that the two machine learning approaches performed statistically significantly better than the baseline rule-based approach. The binary SVM classification achieved 0.94 F-measure with individual tokens as features. The SVM model trained on a parsimonious feature set achieved 0.81 F-measure for CN and 0.87 for CTA. The CRF MLSL method achieved 0.80 F-measure on both corpora.

Discussion and conclusions

We compared the novel MLSL method with a binary classification and a rule-based method. The MLSL method performed statistically significantly better than the rule-based method. However, the SVM-based binary classification method was statistically significantly better than the MLSL method for both the CTA and CN corpora. Using parsimonious feature sets both the SVM-based binary classification and CRF-based MLSL methods achieved high performance in detecting medication name and attribute linkages in CTA and CN.     

Combining rules and machine learning for extraction of temporal expressions and events from clinical narratives

Objective

Identification of clinical events (eg, problems, tests, treatments) and associated temporal expressions (eg, dates and times) are key tasks in extracting and managing data from electronic health records. As part of the i2b2 2012 Natural Language Processing for Clinical Data challenge, we developed and evaluated a system to automatically extract temporal expressions and events from clinical narratives. The extracted temporal expressions were additionally normalized by assigning type, value, and modifier.

Materials and methods

The system combines rule-based and machine learning approaches that rely on morphological, lexical, syntactic, semantic, and domain-specific features. Rule-based components were designed to handle the recognition and normalization of temporal expressions, while conditional random fields models were trained for event and temporal recognition.

Results

The system achieved micro F scores of 90% for the extraction of temporal expressions and 87% for clinical event extraction. The normalization component for temporal expressions achieved accuracies of 84.73% (expression''s type), 70.44% (value), and 82.75% (modifier).

Discussion

Compared to the initial agreement between human annotators (87–89%), the system provided comparable performance for both event and temporal expression mining. While (lenient) identification of such mentions is achievable, finding the exact boundaries proved challenging.

Conclusions

The system provides a state-of-the-art method that can be used to support automated identification of mentions of clinical events and temporal expressions in narratives either to support the manual review process or as a part of a large-scale processing of electronic health databases.     

苏州市居民安全用药常识和用药行为调查

目的了解市民安全用药常识和用药行为现状,为进行有效的药学服务提供依据。方法采用自行设计的问卷,随机对294名苏州市居民进行调查。结果用药常识正确率为55.9%,用药行为正确率为53.7%,自备药保管方式正确率为32.4%。结论相关部门应一方面在市民健康教育中加强经常性用药知识教育,另一方面提供通俗易懂的用药指南,以改变市民的不良用药习惯,确保疗效和降低用药风险。     

临床护理安全用药管理的探索与思考

护理人员作为药物治疗的直接执行者和观察者,在整个过程中始终处于第一线,从执行医嘱到实施治疗的任一环节,如果出现工作缺陷或失误,均可能引起不良事件发生。如何保证临床护士用药安全,加强药物不良反应的监测,避免差错事故的发生一直是护理管理的研究课题．本文作者参阅国内外文献资料,结合临床护理实践,就用药安全管理问题进行探讨．     

38例自诉青霉素过敏患者再用药体会

目的：探讨自诉有青霉素过敏史患者再次应用青霉素治疗的可行性。方法：对38例自诉青霉素过敏患者再次应用青霉素治疗。结果：38例自诉青霉素过敏患者再用药,35例未出现青霉素过敏反应。结论：有青霉素过敏史的患者可以酌情皮试,阴性后可以应用青霉素。     

临床药师干预对高血压患者用药依从性及血压达标率的影响

目的探讨临床药师干预对高血压患者用药依从性和血压达标率的影响。方法选取我院2010年3月至2012年3月收治的142例高血压患者,随机分为对照组与观察组,分别采取常规药物治疗和临床药师干预用药,比较两组患者用药依从性和血压达标情况。结果观察组依从性良好、依从性较差和依从性差发生率与对照组比较差异均具有统计学意义(P<0.01);观察组治疗后血压达标率明显高于对照组(P<0.01)。结论临床药师对高血压患者用药具有较好的指导作用,可明显提高患者用药依从性和血压达标率,有利于维持患者血压平稳。     

Computerized clinical decision support for medication prescribing and utilization in pediatrics

Background and objective

Accurate and informed prescribing is essential to ensure the safe and effective use of medications in pediatric patients. Computerized clinical decision support (CCDS) functionalities have been embedded into computerized physician order entry systems with the aim of ensuring accurate and informed medication prescribing. Owing to a lack of comprehensive analysis of the existing literature, this review was undertaken to analyze the effect of CCDS implementation on medication prescribing and use in pediatrics.

Materials and methods

A literature search was performed using keywords in PubMed to identify research studies with outcomes related to the implementation of medication-related CCDS functionalities.

Results and discussion

Various CCDS functionalities have been implemented in pediatric patients leading to different results. Medication dosing calculators have decreased calculation errors. Alert-based CCDS functionalities, such as duplicate therapy and medication allergy checking, may generate excessive alerts. Medication interaction CCDS has been minimally studied in pediatrics. Medication dosing support has decreased adverse drug events, but has also been associated with high override rates. Use of medication order sets have improved guideline adherence. Guideline-based treatment recommendations generated by CCDS functionalities have had variable influence on appropriate medication use, with few studies available demonstrating improved patient outcomes due to CCDS use.

Conclusion

Although certain medication-related CCDS functionalities have shown benefit in medication prescribing for pediatric patients, others have resulted in high override rates and inconsistent or unknown impact on patient care. Further studies analyzing the effect of individual CCDS functionalities on safe and effective prescribing and medication use are required.     

整体护理教学法在临床教学中的应用

目的:探讨整体护理在临床教学中的应用。方法:将实习护生200名分为试验组和对照组。试验组采用护理程序的教学方法,对照组采用传统的功能制护理教学方法教学。以护生考核成绩,问卷调查作为评估依据。结果:试验组护生的理论和操作成绩、职业情感、教学满意度明显优于对照组。结论:护理程序的教学法激发了护生学习的兴趣和积极性,理论知识和操作水平都有明显提高,培养护生热爱护理专业,提升护生的整体素质,和谐师生关系,促进护理人才的培养。     

Pharmacists’ perceptions of a machine learning model for the identification of atypical medication orders

ObjectivesThe study sought to assess the clinical performance of a machine learning model aiming to identify unusual medication orders.Materials and MethodsThis prospective study was conducted at CHU Sainte-Justine, Canada, from April to August 2020. An unsupervised machine learning model based on GANomaly and 2 baselines were trained to learn medication order patterns from 10 years of data. Clinical pharmacists dichotomously (typical or atypical) labeled orders and pharmacological profiles (patients’ medication lists). Confusion matrices, areas under the precision-recall curve (AUPRs), and F1 scores were calculated.ResultsA total of 12 471 medication orders and 1356 profiles were labeled by 25 pharmacists. Medication order predictions showed a precision of 35%, recall (sensitivity) of 26%, and specificity of 97% as compared with pharmacist labels, with an AUPR of 0.25 and an F1 score of 0.30. Profile predictions showed a precision of 49%, recall of 75%, and specificity of 82%, with an AUPR of 0.60, and an F1 score of 0.59. The model performed better than the baselines. According to the pharmacists, the model was a useful screening tool, and 9 of 15 participants preferred predictions by medication, rather than by profile.DiscussionPredictions for profiles had higher F1 scores and recall compared with medication order predictions. Although the performance was much better for profile predictions, pharmacists generally preferred medication order predictions.ConclusionsBased on the AUPR, this model showed better performance for the identification of atypical pharmacological profiles than for medication orders. Pharmacists considered the model a useful screening tool. Improving these predictions should be prioritized in future research to maximize clinical impact.     

不同入路夹闭前循环动脉瘤的临床疗效分析

目的 对比经眶上外侧入路和经眶上锁孔入路夹闭前循环动脉瘤的治疗效果,以指导前循环动脉瘤手术入路的选择.方法 回顾性分析2011年1月至2016年1月因自发性蛛网膜下腔出血确诊为前循环动脉瘤80例患者的临床资料,分为经眶上锁孔入路(A组)和眶上外侧入路(B组).分析两组患者的手术时间、开颅时间、关颅时间、估计术中出血量、手术前后红细胞压积(HCT)改变、术后早期下床活动时间、术后住院时间、入院和出院时格拉斯哥昏迷评分(GCS评分)、出院时格拉斯哥预后评分(GOS评分)的差异并进行文献回顾.结果 经眶上外侧入路的手术时间和开颅时间少于经眶上锁孔入路,差异有统计学意义(P＜0.05).两组关颅时间、估计术中出血量、手术前后HCT改变、术后早期下床活动时间、术后住院时间、入院和出院时GCS评分、出院时GOS评分差异无统计学意义(P＞0.05).结论 经眶上外侧入路具有手术时间和关颅时间短,术中能提供更好的手术视野,术中牵拉较少和术后并发症少等优点,在行颅内前循环动脉瘤夹闭术时可作为眶上锁孔入路的替代方案.     

哮喘患者用药依从性的影响因素分析及干预措施探讨

目的探讨哮喘患者用药依从性的影响因素,并针对影响因素提出干预措施。方法收集本院2017年5月～2019年5月收治的80例哮喘患者作为研究对象,依据CPAT评价标准进行分组,分别为依从性良好组(n=38)与依从性差组(n=42)。对两组患者进行问卷调查,并对用药依从性的影响因素进行多因素分析。结果单因素分析结果显示,年龄、文化程度、用药用法、哮喘知识掌握程度与用药依从性有关(P0.05)。多因素分析结果显示,年龄、文化程度、用药用法是否正确、哮喘知识掌握程度为影响哮喘患者用药依从性的独立危险因素。结论影响哮喘患者用药依从性的危险因素为年龄、用药用法、文化程度、哮喘知识掌握程度,应采取针对性措施,以保证患者良好的用药依从性。     

麻风病院患者用药情况及合理性分析

目的 分析麻风病患者的用药情况及趋势。方法 选取我院麻风病院药房2015年1月～2017年1月用于治疗麻风病患者药物处方单1278份,共涉及826例次患者。分析研究对象并发症相关疾病的诊断情况、抗菌(单一使用和联合用药)和抗炎药物(非甾体抗炎药)使用情况以及不合理用药情况。结果 临床诊断发病较多的为麻风溃疡、上呼吸道感染及神经痛,使用抗菌药物患者共826例次,其中使用单一药物治疗占抗菌药物治疗的79.30%,联合用药占20.70%;使用抗炎镇痛药物较多的为麻风溃疡(55.21%)、关节损伤(32.43%)及麻风眼病(12.36%);共有92例次患者出现用药不合理情况,占总数的11.13%,其中用药剂量不合理情况最多。结论 麻风病院患者的用药主要集中于麻风溃疡、上呼吸道感染和疼痛等疾病,应根据患者病情发展,合理调整药物的剂量,增强用药的合理性,减少不良反应的发生,提高麻风病患者的生活质量。     

腋下纵切口15例应用体会

报道腋下纵切口的改进及临床应用体会，儿童１０例，成人５例，其中，动脉导管未闭结扎术６例，慢性脓胸清除术３例，各种肺切除术３例，贲门失弛症Ｈｅｌｌｅｒ术１例，纵隔畸胎瘤摘除术１例及急性心包炎心包部分切除术１例。手术顺利，切口甲级愈合，随访无并发症，与后外侧切口相比，可能有美容好，创伤轻、出血少、恢复快及不影响女性乳房发育等优点。     

骨质疏松症患者用药依从性调查及影响因素的分析与对策

目的:调查骨质疏松症患者用药依从性,分析可能的影响因素,提出相应的对策。方法:采用问卷调查方式对门诊及住院的86例骨质疏松症患者进行用药依从性调查。结果:用药依从性与患者对疾病的认知、对医务人员的信任度、治疗方案的复杂度、患者的经济状况有显著性差异(P<0.05)。结论:建议实施有效的个体化健康教育、建立良好的医患关系、简化治疗方案、减轻患者的经济负担等方面提高患者用药依从性。     

信息技术在医院临床教学及其管理中的应用

运用信息技术,实现教育的多媒体化、教学的网络化和管理的标准化是现代教育技术的标志。本文结合所在医院临床教学实际,介绍了信息技术在医院临床教学与管理中的应用。     

角色转换教学法在临床见习中的实践与效果

目的：探讨角色转换教学法在临床见习中的效果。方法：采用随机分组的方法分为实验班（采取角色转换教学法）和对照班（采用传统教学法）,比较两班的理论考试成绩,问卷调查学生对两种教学方法的反馈。结果：实验班的理论考试平均成绩与对照班有显著性意义（P〈0．05）;实验班在提高自主学习能力、开拓临床思维、增加学习兴趣、提高临床问题技能以及提高沟通能力方面均明显提高（P〈0．01）,对教学方法的接受能力、对知识的接受能力以及喜爱的授课方式方面也明显高于对照班（P〈0．01）。结论：在临床见习中应用角色转换教学法是一种有效的教学尝试。     

采供血及临床输血管理网络信息系统建设

河北省2004年提出并实施了全省采供血和临床输血管理信息系统建设,实现了全省采血、供血、临床输血等血液信息的共享、控制、交换和统计分析等,使全省的血液采集、检验、成份制备、血液储存运输、临床用血等实现了全封闭的网络化管理。