基于HIS的健康体检信息系统的设计与应用

通过介绍HIS的应用现状,对健康体检系统开发的必要性和应用前景进行了描述。通过临床应用,总结了该系统的工作流程特点、开发技术、系统内容及应用情况和应用效果,对系统的改进和发展方向提出了具体要求。     

鼻内窥镜外科技术的临床应用

本文回顾了鼻内窥镜临床应用的历程,简要阐述了该技术临床应用的范围以及在鼻部相邻领域的延伸应用,对该技术在中国的应用现状和目前存在的问题进行了评价,介绍了内窥镜技术在耳鼻咽喉--头颈微创伤外科领域的应用前景.     

公共卫生大数据应用

本文从公共卫生的数据需求出发,分析了公共卫生大数据特征,提出了公共卫生大数据应用架构。并通过对传染病预警预报大数据应用和基于互联网大数据舆情监测预警应用的案例分析,阐述了大数据对公共卫生的应用愿景与应用模式,并以政府主导和社会参与为技术路径,提出了应用策略与关键技术。     

ETM技术及其在医疗装备中的应用

通过介绍IETM技术的起源与发展、特点及发展趋势等,回顾了国内外IETM技术的发展状况及其应用情况,并简述了其应用前景。分析了IETM技术在医疗装备中应用的必要性、可行性,并阐述了应用的重要意义,最后得出IETM在医疗装备中的应用是可行的,且具有重要的现实意义。     

基于网络的考勤系统开发及应用

对考勤系统设计思路、功能实现及应用做了介绍,并对应用的过程进行了分析和研究.该系统目前已在医院工作中应用,运行结果表明达到了医院人力资源部门对人事考勤管理和应用的需要.     

数字减影造影设备的新技术发展及其应用

概述了目前国内外数字减影造影(DSA)设备的新技术发展及其应用的新进展,重点介绍了平板探测器(FPD) 在DSA设备的应用、消除运动伪影技术的应用和三维血管信息采集技术的应用原理及特点,及其在医学临床应用中的技术优势。     

中医教学医院计算机应用系统整体规划的构想

本文根据中医教学医院信息化建设所处的阶段,阐述了中医教学医院应用计算机系统规划和建设的重要性,提出了应用系统规划和建设的原则,对中医医院应用系统作了整体规划,介绍了相关的技术。     

移动式术中放疗系统的工作原理及临床应用

本文介绍了移动式术中放疗系统的工作原理及临床应用;从基本结构、主要功能、工作原理和临床应用等4个方面进行了阐述;探讨了移动式术中放疗系统与传统的术中放疗相比在临床应用中的技术优势;介绍了该系统在临床工作中的应用方法和应用范围,以及其广泛的发展前景。     

谈医院物流安全解决方案的发展

随着信息流的高速发展,医院物流的安全解决方案亟待解决。文章概括了当前医院物流应用的需求,描述了各种物流解决方案的应用特点,对各种物流应用方案进行了对比分析,介绍并推荐了符合国际发展潮流的医院物流解决方案,为医院建设尤其是物流系统的发展应用提供参考。     

妇科腹腔镜手术临床应用进展

本文对妇科腹腔镜手术临床应用进展进行综述,主要包括腹腔镜在妇科附件肿物手术的应用、在妇科急腹症手术中的应用、在妇科不孕症手术中的应用以及在子宫手术中的应用。其中在妇科附件肿物手术的应用中,回顾了附件肿物早期的症状以及诊疗方式,重点阐述了通过腹腔镜手术对良性成熟性的附件肿物进行诊疗的方法 ,并强调了一些禁忌情况,如肿块具有恶变的可能性则推荐开腹手术等;在妇科急腹症手术中的应用中,回顾了通过腹腔镜来治疗输卵管妊娠的类别以及保守手术的方式,通过统计数据证实了：在患者希望拥有生育功能的情况之下,基于腹腔镜的手术效果显著超过传统手术方式;在妇科不孕症手术中的应用以及在子宫手术中的应用中,重点回顾了腹腔镜子宫切除术以及基于腹腔镜的子宫肌瘤剥除术。     

腹腔镜胆囊切除术转开腹手术22例原因分析

目的分析腹腔镜胆囊切除术中转开腹的原因,探讨安全降低LC中转开腹率的措施。方法对2008年01月至2014年01月收治的512例接受LC患者中中转开腹手术22例的临床资料、中转开腹原因进行回顾性分析。结果中转开腹的原因为：胆囊三角及周围致密纤维化或炎症明显,解剖关系不清11例;胆囊动脉及分支、胆囊床出血难止6例;胆道损伤1例;腹腔粘连,无法建立气腹1例;胆囊严重萎缩1例;Mirizzi综合征1例;膈肌损伤1例。结论严格掌握腹腔镜手术指征,正确解剖胆囊三角和减少胆囊动脉出血,可以降低中转开腹手术率。     

知情选择对苏州市已婚育龄妇女避孕节育状况的影响调查

目的分析实施避孕节育知情选择对苏州市已婚育龄妇女避孕节育和人工流产发生状况的影响。方法根据实施知情选择前后的常规统计年报资料,对避孕措施现用率和避孕失败的人工流产率进行统计分析。结果实施知情选择后,已婚育龄妇女综合避孕率从1998年的91.39%下降至2005年的88.38%,其中,长效避孕措施现用率从82.70%下降到71.27%,短效避孕措施现用率从8.69%上升至17.11%;避孕失败的人工流产率从9.06‰下降到8.11‰,其中,长效措施避孕失败的人工流产率下降了2.41‰,短效措施避孕失败的人工流产率上升了4.55‰,前后比较均有统计学意义(P<0.01)。结论开展避孕节育方法的知情选择,使已婚育龄妇女的避孕节育方法多样化,降低了避孕失败的人工流产率;但短效措施避孕失败人工流产率有所上升,提示需进一步提高咨询和随访质量、提供满足个性化需求的指导和服务。     

医院感染增加医疗费用不同统计方法的比较

本文采用病例对照配对法研究医院感染患者医疗费用的变化,19例下呼吸道医院感染患者增加的医疗费用频数呈正偏态分布,使用对数转换后再按正态分布规律分别计算算术均数和几何均数,结果可见同一资料医疗费用的算术均数值均大于几何均数值,说明使用对数转换后以几何均数计算医院感染增加的医疗费用均数,供评价医院感染对医疗费用影响的强度比较确切。     

Measuring the burden of premature death due to smoking in Korea from 1990 to 1999

This study estimated the burden of premature death due to smoking in Korea between 1990 and 1999 using the years of life lost (YLL) due to premature death method. To implement this study, age-group-specific YLL due to premature death were calculated by employing the standard expected years of life lost method. YLL due to smoking were calculated based on assumptions and methods developed by the Global Burden of Disease Study Group. The burden of premature death due to smoking was estimated by multiplying the population attributable risk by the YLL of smoking-related diseases. In 1999, the burden of premature death due to smoking was 57.7% in males and 11.4% in females in Korea. The burden of premature death due to smoking increased from 1643 person years per 100,000 in 1990 to 1888 person years in 1999 for males, and increased from 151 person years in 1990 to 225 person years in 1999 for females in Korea. Our results suggest that the method employed in this study, generated in quantified terms, enabled the burden of premature death due to smoking to be obtained comparably with methods used by other international studies in this field, and thus can provide a rational basis for national health policy planning regarding premature death from smoking and the related risk factors in Korea.     

High physical work load and low job satisfaction increase the risk of sickness absence due to low back pain: results of a prospective cohort study

Objective: To determine whether physical and psychosocial load at work influence sickness absence due to low back pain.

Methods: The research was a part of the study on musculoskeletal disorders, absenteeism, stress, and health (SMASH), a 3 year prospective cohort study on risk factors for musculoskeletal disorders. Workers from 21 companies located throughout The Netherlands participated in the part of this study on sickness absence due to low back pain. The study population consisted of 732 workers with no sickness absences of 3 days or longer due to low back pain in the 3 months before the baseline survey and complete data on the reasons for absences during the follow up period. The mean (range) period of follow up in this group was 37 (7–44) months. Physical load at work was assessed by analyses of video recordings. Baseline information on psychosocial work characteristics was obtained by a questionnaire. Data on sickness absence were collected from company records. The main outcome measure was the rate of sickness absences of 3 days or longer due to low back pain during the follow up period.

Results: After adjustment of the work related physical and psychosocial factors for each other and for other potential determinants, significant rate ratios ranging from 2.0 to 3.2 were found for trunk flexion, trunk rotation, lifting, and low job satisfaction. A dose-response relation was found for trunk flexion, but not for trunk rotation or lifting. Non-significant rate ratios of about 1.4 were found for low supervisor support and low coworker support. Quantitative job demands, conflicting demands, decision authority, and skill discretion showed no relation with sickness absence due to low back pain.

Conclusions: Flexion and rotation of the trunk, lifting, and low job satisfaction are risk factors for sickness absence due to low back pain. Some indications of a relation between low social support, either from supervisors or coworkers, and sickness absence due to low back pain are also present.

     

Mediation analysis of time-to-event endpoints accounting for repeatedly measured mediators subject to time-varying confounding

In this article, we will present statistical methods to assess to what extent the effect of a randomised treatment (versus control) on a time-to-event endpoint might be explained by the effect of treatment on a mediator of interest, a variable that is measured longitudinally at planned visits throughout the trial. In particular, we will show how to identify and infer the path-specific effect of treatment on the event time via the repeatedly measured mediator levels. The considered proposal addresses complications due to patients dying before the mediator is assessed, due to the mediator being repeatedly measured, and due to posttreatment confounding of the effect of the mediator by other mediators. We illustrate the method by an application to data from the LEADER cardiovascular outcomes trial.     

Evaluation of economic effectiveness of the complex measures related to mass screening of the population in a rural region

Socioeconomic appraisal of efficacy of a complex of measures on overall dispensarization in a rural district is presented. A prognostic medicosocial potential of the capacity for work is recommended as an integral indicator. Cost analysis of socioeconomic effect achieved due to the complex programme realization comprises the volume of national income received by virtue of additional participation in the process of social production of those with preserved capacity for work; resources from social insurance funds saved due to the decline in temporary and permanent disability rates; budget funds of public health bodies saved due to the decrease in the number of patients in need of treatment. The study demonstrated that the total annual economic effect of the complex programme on overall dispensarization in the rural district was equal to 674100 roubles.     

An estimate of the cost of acute health effects from food- and water-borne marine pathogens and toxins in the USA

Large and growing segments of the United States population consume seafood or engage in marine recreation. These activities provide significant benefits but also bring risk of exposure to marine-borne illness. To manage these risks, it is important to understand the incidence and cost of marine-borne disease. We review the literature and surveillance/monitoring data to determine the annual incidence of disease and health consequences due to marine-borne pathogens from seafood consumption and beach recreation in the USA. Using this data, we employ a cost-of-illness model to estimate economic impacts. Our results suggest that health consequences due to marine-borne pathogens in the USA have annual costs on the order of US$900 million. This includes US$350 million due to pathogens and marine toxins specifically identified as causing food-borne disease, an estimated US$300 million due to seafood-borne disease with unknown etiology, US$30 million from direct exposure to the Vibrio species, and US$300 million due to gastrointestinal illness from beach recreation. Although there is considerable uncertainty about the degree of underreporting of certain pathogen-specific acute marine-related illnesses, the conservative assumptions we have used in constructing our estimate suggest that it should be considered a lower bound on true costs.     

Deaths due to disease of seafarers on board Singapore ships

Based on records kept in the Singapore Mercantile Marine Office, the paper presents the results of a study on deaths due to disease of seafarers on board Singapore ships. Out of a total of 373 deaths, altogether 69 fatalities were attributed to diseases. More than 65% (n=45) of theses deaths were due to circulatory diseases commonly associated with life-style factors, but only 24 cases had a specific and 9 cases had an unspecific diagnosis confirmed by a medical, practitioner. A total of 32 seafarers (46.4%) died of a sudden death and were found dead by their shipmates whereas 17 seafarers (24.6%) died on board after a short illness. In only two cases was it reported that Radio Medical advice had been sought indicating either a lack of interest of the ship's management or a lack of knowledge or information on the availability of such services. Eight of the fatalities who died on board had seen a doctor and been declared fit to stay on board, pointing to deficiencies in the port medical services or pressures on port doctors to avoid a costly repatriation. The mean annual mortality rate for deaths due to all causes was 26.5 per 10,000 seafarers and due to disease was 4.9 per 10,000 seafarers.     

Further definition of the role of COX-2 inhibitors and NSAIDs in patients with nociceptive pain

New information has been reported regarding the effects of cyclo-oxygenase(COX)-2 inhibitors on renal function and cardiac arrhythmia, indicating that the incidence of peripheral oedema, hypertension and renal failure is different for the different selective COX-2 inhibitors. The estimated renal risk due to valdecoxib/parecoxib, etoricoxib and lumiracoxib is essentially unchanged, the risk due to rofecoxib is increased, while the risk due to celecoxib in low dosage is decreased. New data have also been reported on the cardiovascular risk due to cyclo-oxygenase inhibition, indicating that the relative risk due to naproxen, piroxicam, ibuprofen, celecoxib and meloxicam is essentially unchanged while the risk due to indomethacin, diclofenac and rofecoxib is increased. Recent studies show that the cardiovascular risk of etoricoxib is comparable to that ofdiclofenac. For daily practice, the following actions should be taken: (a) determine whether a prostaglandin synthetase inhibitor is needed; (b) consider the gastrointestinal as well as the cardiovascular risk profile ofthe patient; (c) if the gastrointestinal risk is above normal, a selective COX-2 inhibitor or a classical NSAID with a proton-pump inhibitor may be used; (d) in patients with renal disease, heart failure or hypertension without arteriosclerosis, the choice is between a classical NSAID, notably naproxen and ibuprofen, and low-dose celecoxib (200 mg per day); (e) in patients with arteriosclerosis in whom secondary cardiovascular prophylaxis with low-dose aspirin is indicated, celecoxib has no added value.