基于UML的国家卫生信息系统评估框架体系构建研究

国家卫生信息系统是在国家层面运行的结构复杂,功能强大的信息系统,它集成了卫生领域大量信息资源,主要用于支持决策,目的在于改善当前我国卫生状况。对国家卫生信息系统的评估需要建立完善的评估框架和体系,确保综合全面的反映卫生领域的信息。本文通过比较研究发展中国家卫生信息系统评估框架,提出了基于UML的国家卫生信息系统评估框架体系,以期为卫生政策制定者提供决策支持和依据。     

基于标准建模语言的国家卫生信息系统评估框架体系构建

国家卫生信息系统是在国家层面运行的结构复杂、功能强大的信息系统,主要用于支持决策,改善当前国家卫生状况。分析了国家卫生信息系统对综合全面反映卫生领域运行情况的重要性以及目前发展中国家卫生信息系统建设存在的问题,指出了需要建立完善的评估框架和体系。通过比较研究发展中国家卫生信息系统评估框架,提出了基于标准化建设语言（UML）的国家卫生信息系统评估框架体系,以期为卫生政策制定者提供决策支持和依据。     

WHO国家卫生信息系统框架和标准对加强我国疾病监测信息化工作的启示

随着国家深化医改和人口健康信息化的推进,研究卫生信息系统的评估办法,发现现行疾病监测信息化的不足及差距,进一步加强我国疾病监测信息系统建设质量将十分必要。重点介绍《国家卫生信息系统框架和标准》,结合我国疾病监测信息化工作,阐述对我国疾病监测信息系统规划和实施的思考,并提出一些工作建议。     

泛美国家卫生健康信息系统成熟度评估模型研究及启示

在数字健康策略大力发展的背景下,通过研究泛美国家卫生健康信息系统成熟度评估模型的内容与特点,提取总结其中可借鉴的内容,结合我国卫生健康领域信息化发展现状,提出我国卫生健康信息系统建设框架与建设原则,旨在一定程度上为卫生领域信息化发展提供参考.     

DeLone&McLean信息系统成功模型及其对卫生信息系统的启示

阐述DeLone&McLean信息系统成功模型的演化、国内外实证研究及其对卫生信息系统设计、实施和评价的启示,指出更新版D&M模型有待完善之处,以期为我国卫生信息系统评估理论和体系构建提供参考。     

卫生监督信息系统需求工程建模方法研究

阐述了随着卫生监督信息系统需求的持续增长,从不同角度建立其需求模型时所存在的局限性。重点介绍了实施Zachman框架的信息系统需求工程建模方法的结果,包括实际信息系统顺应国家《卫生监督基本数据集标准》不断优化和完善的过程,以及当食品安全预瞽机制新需求产生时相应功能的平滑接入。实践证明,Zachman框架的使用,在杜绝系统需求分析歧义、隐性需求显性化和系统功能事件有序化方面,起到了很好的作用。     

2003年医疗卫生领域信息化进展

介绍了国际国内医疗卫生领域信息化的进展情况:SARS刺激了医院信息系统的发展,医学信息标准化2003年开始有了实质性进展;卫生部制定了国家公共卫生信息系统建设现阶段的主要任务;美国国家疾病控制中心传染病监控系统的建设;我国区域卫生信息系统及其需进一步研究的难点是标准化问题、医院信息系统、门诊信息系统、医学图象处理系统以及医院信息系统中间件研究.     

西部卫生行动医改评估与信息系统支持研讨会在京召开

受国家卫生和计划生育委员会国际合作司和世界卫生组织（WHO）委托，统计信息中心于2013年6月21日在北京召开西部卫生行动医改评估与信息系统支持研讨会。来自国家卫生和计划生育委员会体改司、法制司、国际司的领导，     

部分国家卫生信息体系建设经验与启示

我国卫生信息体系建设在卫生服务体系中的地位和作用日益重要,正经历以信息系统建设为主向系统与制度建设并重、从技术导向向需求导向、从粗放式建设向集约式发展转变的过程。借鉴部分发达国家卫生信息体系建设的经验,总结其发展规律,对我国卫生信息体系建设具有积极意义。从建设目标、规划制定、组织管理、建设方式、实施路径、信息系统等方面归纳了部分发达国家卫生信息体系建设的经验,并分析了其特点,提出完善我国卫生信息体系的启示与建议。     

苏州市感知健康区域卫生信息服务系统研究

在中国电子健康档案的研究,起步较晚,伴随着卫生信息系统与社区卫生信息化的发展,医院信息系统的研究与建设在中国逐步展开。该文对卫生信息系统存的问题、卫生信息系统研究的必要性、苏州市感知健康区域卫生信息服务系统研究的主要思路、卫生信息服务系统的主要内容进行了初步探讨。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.