北京某区医院急诊医护人员突发事件监测意识的调查

目的:调查医院急诊医护人员对实施突发事件监测的意识,为寻找合理的监测指标、建立突发事件监测系统提供科学依据.方法:选取北京某区医院为研究现场,对该区所有二、三级医院的部分急诊医护人员进行问卷调查.结果:97.3%(291/299)的医护人员认为有必要监测,其中81.4%(237/291)认为有在门急诊同时建立监测的必要性.Kruskal-Wallis H检验显示在北京该区所有二、三级医院医护人员关于发热等9项症状的日常监测预警例数均有显著差异(P<0.000 1);三级医院及二级医院范围内各院医护人员对于上述问题的回答均有显著差异(P<0.000 1).结论:SARS暴发后,医院急诊医护人员普遍存在对突发事件的监测意识.症状监测要根据各地区各医院的实际情况,结合病例数、病情严重程度及其他伴随症状判定和实施.     

Standards for reporting randomized controlled trials in medical informatics: a systematic review of CONSORT adherence in RCTs on clinical decision support

Introduction

The Consolidated Standards for Reporting Trials (CONSORT) were published to standardize reporting and improve the quality of clinical trials. The objective of this study is to assess CONSORT adherence in randomized clinical trials (RCT) of disease specific clinical decision support (CDS).

Methods

A systematic search was conducted of the Medline, EMBASE, and Cochrane databases. RCTs on CDS were assessed against CONSORT guidelines and the Jadad score.

Result

32 of 3784 papers identified in the primary search were included in the final review. 181 702 patients and 7315 physicians participated in the selected trials. Most trials were performed in primary care (22), including 897 general practitioner offices. RCTs assessing CDS for asthma (4), diabetes (4), and hyperlipidemia (3) were the most common. Thirteen CDS systems (40%) were implemented in electronic medical records, and 14 (43%) provided automatic alerts. CONSORT and Jadad scores were generally low; the mean CONSORT score was 30.75 (95% CI 27.0 to 34.5), median score 32, range 21–38. Fourteen trials (43%) did not clearly define the study objective, and 11 studies (34%) did not include a sample size calculation. Outcome measures were adequately identified and defined in 23 (71%) trials; adverse events or side effects were not reported in 20 trials (62%). Thirteen trials (40%) were of superior quality according to the Jadad score (≥3 points). Six trials (18%) reported on long-term implementation of CDS.

Conclusion

The overall quality of reporting RCTs was low. There is a need to develop standards for reporting RCTs in medical informatics.     

Post-marketing safety surveillance and reevaluation of Motherwort injection: A clinical study of 10 094 cases

OBJECTIVE

To investigate the safety profiles of Motherwort injection (MI).

构建和谐的医患关系:医务社会工作的专业使命

中国正处于社会结构转型时期,社会环境、社会价值观、社会关系和社会结构发生翻天覆地的变化,整个社会处于结构性紧张状态,医患关系同样处于结构性紧张的状态.在微观医患关系层次上,医疗纠纷、医疗事故和医患关系结构性紧张的主要原因是沟通问题.在宏观层次上,医患关系结构性紧张主要成因是结构性、体制性和制度性因素.制度性问题必须用制度化方法才能解决.医务社会工作是解决医患关系结构性紧张问题的制度化途径.医务社会工作泛指在健康照顾处境中提供的社会工作专业服务实践,主要职责是解决病人及其家属因疾病所带来的个人、家庭和心理问题.中国医务社会工作历史悠久,积累宝贵经验.改革开放以来,医务社会工作蓬勃发展,目前迫切需要国家相关政策支持与制度化保障措施.     

医学生应对方式与人格、社会支持的关系

目的:探讨医学生应对方式与人格、社会支持的关系。方法:采用应付方式问卷、艾森克人格问卷简式量表(中国版)和社会支持评定量表对472名医学生进行测试,分析医学生人格、社会支持对应对方式的影响。结果:应对方式中男生合理化得分高于女生(P0.01),而女生自责和幻想分均高于男生(P0.01和P0.05);农村生源学生合理化和幻想得分均高于城镇生源学生(P0.01);应对方式与人格、社会支持密切相关。结构模型拟合指数χ2/df=4.164,P0.01,拟合优度指数=0.967,调整拟合优度指数=0.935,常规拟合指数=0.949,比较拟合指数=0.930,近似误差均方根=0.069。结论:医学生人格、社会支持对应对方式有直接的影响,多因素理论假设得到结构模型的有力支持。     

Feasibility of capturing real-world data from health information technology systems at multiple centers to assess cardiac ablation device outcomes: A fit-for-purpose informatics analysis report

ObjectiveThe study sought to conduct an informatics analysis on the National Evaluation System for Health Technology Coordinating Center test case of cardiac ablation catheters and to demonstrate the role of informatics approaches in the feasibility assessment of capturing real-world data using unique device identifiers (UDIs) that are fit for purpose for label extensions for 2 cardiac ablation catheters from the electronic health records and other health information technology systems in a multicenter evaluation.Materials and MethodsWe focused on data capture and transformation and data quality maturity model specified in the National Evaluation System for Health Technology Coordinating Center data quality framework. The informatics analysis included 4 elements: the use of UDIs for identifying device exposure data, the use of standardized codes for defining computable phenotypes, the use of natural language processing for capturing unstructured data elements from clinical data systems, and the use of common data models for standardizing data collection and analyses.ResultsWe found that, with the UDI implementation at 3 health systems, the target device exposure data could be effectively identified, particularly for brand-specific devices. Computable phenotypes for study outcomes could be defined using codes; however, ablation registries, natural language processing tools, and chart reviews were required for validating data quality of the phenotypes. The common data model implementation status varied across sites. The maturity level of the key informatics technologies was highly aligned with the data quality maturity model.ConclusionsWe demonstrated that the informatics approaches can be feasibly used to capture safety and effectiveness outcomes in real-world data for use in medical device studies supporting label extensions.     

Hospital-acquired infections in a Nigerian tertiary health facility: An audit of surveillance reports

Background:

Hitherto efforts to implement data driven prevention guidelines for hospital-acquired infections (HAI) in Nigeria have been limited by the inadequate knowledge of the risks of these infections. This study evaluated the occurrence of HAI in a foremost tertiary health facility over a 5-year period for the purpose of reinforcing control efforts.

Materials and Methods:

A retrospective survey of records from the infection control unit of the University College Hospital, Ibadan, Nigeria, was done for the years 2005-09. For the 5 years studied 22,941 in-patients were reviewed and the data of those who developed infections during admission were retrieved and analyzed. The prevalence, types, and causative organisms of HAI were determined. The chi-square test was used to evaluate associations.

Results:

The prevalence of HAI over the 5-year period was 2.6% (95% CI: 2.4–2.8). Surgical and medical wards had the most infections (48.3%) and (20.5%) respectively. Urinary tract infection (UTI) and surgical site infection (30.7%) were the most prevalent (43.9%) HAI. UTIs were significantly higher in surgical and medical wards, surgical site infections in obstetrics and gynecology wards, and soft tissue infections and bacteremia in pediatric wards (P<0.05). Gram-negative infections occurred about four times as often as gram-positive infections with Klebsiella sp. and staphylococcus aureus being the predominant isolates (34.3%) and (20.1%) respectively.

Conclusion:

Efforts to limit HAI should be guided by local surveillance data if progress is to be made in improving the quality of patient care in Nigeria.     

Formulation of a model for automating infection surveillance: algorithmic detection of central-line associated bloodstream infection

Objective

To formulate a model for translating manual infection control surveillance methods to automated, algorithmic approaches.

Design

We propose a model for creating electronic surveillance algorithms by translating existing manual surveillance practices into automated electronic methods. Our model suggests that three dimensions of expert knowledge be consulted: clinical, surveillance, and informatics. Once collected, knowledge should be applied through a process of conceptualization, synthesis, programming, and testing.

Results

We applied our framework to central vascular catheter associated bloodstream infection surveillance, a major healthcare performance outcome measure. We found that despite major barriers such as differences in availability of structured data, in types of databases used and in semantic representation of clinical terms, bloodstream infection detection algorithms could be deployed at four very diverse medical centers.

Conclusions

We present a framework that translates existing practice—manual infection detection—to an automated process for surveillance. Our experience details barriers and solutions discovered during development of electronic surveillance for central vascular catheter associated bloodstream infections at four hospitals in a variety of data environments. Moving electronic surveillance to the next level—availability at a majority of acute care hospitals nationwide—would be hastened by the incorporation of necessary data elements, vocabularies and standards into commercially available electronic health records.     

Validation of a common data model for active safety surveillance research

OBJECTIVE: Systematic analysis of observational medical databases for active safety surveillance is hindered by the variation in data models and coding systems. Data analysts often find robust clinical data models difficult to understand and ill suited to support their analytic approaches. Further, some models do not facilitate the computations required for systematic analysis across many interventions and outcomes for large datasets. Translating the data from these idiosyncratic data models to a common data model (CDM) could facilitate both the analysts' understanding and the suitability for large-scale systematic analysis. In addition to facilitating analysis, a suitable CDM has to faithfully represent the source observational database. Before beginning to use the Observational Medical Outcomes Partnership (OMOP) CDM and a related dictionary of standardized terminologies for a study of large-scale systematic active safety surveillance, the authors validated the model's suitability for this use by example. VALIDATION BY EXAMPLE: To validate the OMOP CDM, the model was instantiated into a relational database, data from 10 different observational healthcare databases were loaded into separate instances, a comprehensive array of analytic methods that operate on the data model was created, and these methods were executed against the databases to measure performance. CONCLUSION: There was acceptable representation of the data from 10 observational databases in the OMOP CDM using the standardized terminologies selected, and a range of analytic methods was developed and executed with sufficient performance to be useful for active safety surveillance.     

从抗击"非典"中的北京120系统看社会医疗紧急救助体系的改进与完善

在总结北京120医疗急救网络系统在“抗非”斗争中的作用及其新的应急机制形成过程,分析北京120医疗急救服务系统在应对突发性公共卫生事件中的相对优势及其存在的问题的基础上,提出了完善紧急医疗救助体系的建议:建立社会公共医疗紧急救助体系和社会公众医疗紧急救助体系(日常医疗急救服务),建立和完善北京市公共卫生应急系统的互联网络,尽快完善相应的法律法规。     

Fracture of a cerebral protection device wire in carotid artery stenting: an unexpected complication

There are very few reports concerning the failure of devices used in carotid artery stenting. Here we report a fracture of the distal part of the guiding wire of a cerebral protection device during carotid artery stenting for management of a restenotic lesion after carotid endarterectomy.     

人工流产后口服屈螺酮炔雌醇片、放置宫内节育环、依托孕烯皮下埋植剂的避孕效果及安全性对比研究

目的 对比人工流产后口服屈螺酮炔雌醇片(优思明)、放置宫内节育环、依托孕烯皮下埋植剂的避孕效果及安全性.方法 对比分析人工流产术即口服短效避孕药优思明患者980例(优思明组)、放置宫内节育环患者120例(宫内节育环组)、行依托孕烯皮下埋植剂患者38例(依托孕烯组)的避孕效果及不良反应.结果 3组人工流产术后1年均无患者再次妊娠,避孕有效率均为100.0％,优思明组主要不良反应为月经改变(43.3％),宫内节育环组主要不良反应为月经改变(15.8％)及腰腹胀痛(10.0％),依托孕烯组主要不良反应为月经改变(52.7％).人工流产后1个月、3个月、6个月、12个月时3组不良反应总发生率比较,差异均有统计学意义(P＜0.05),其中1个月时依托孕烯组不良反应最低,宫内节育器组最高;3个月时,优思明组最低,宫内节育器组亦最高;6个月时,优思明组最低,依托孕烯组最高;12个月时,依托孕烯组最低,优思明组最高.结论 人工流产术后口服优思明、放置宫内节育环、依托孕烯皮下埋植剂的避孕效果均良好,均可作为流产后高效的避孕方法;人工流产后1个月、12个月时,依托孕烯皮下埋植剂不良反应总发生率最低,而在人工流产后3个月、6个月,优思明不良反应总发生率最低.     

三种止血方法在股动脉穿刺部位止血中有效性和安全性的比较

目的:评价冠状动脉造影(CAG)和经皮冠状动脉介入治疗(PCI)后人工压迫止血法和两种动脉穿刺闭合器(Angi-oseal和Perclose)在股动脉径路止血中的安全性和有效性及其影响因素.方法:366例经股动脉行选择性冠状动脉造影或介入治疗的患者,分为人工压迫止血组128例、Angioseal组128例和Perclose组110例,观察3种止血方法的有效性、安全性,并分析其影响因素.结果:止血成功率各组间无明显差异;即刻止血率Angioseal组明显高于Perclose组(P＜0.01).下肢制动时间和止血时间Angioseal组和Perclose组均明显短于人工压迫组(P＜0.01).血管迷走神经反射和严重并发症仅发生在人工压迫组;局部并发症Angioseal组和人工压迫组均明显低于Perclose组(P＜0.01).影响因素:术后使用肝素者血肿发生率高(OR=4.382,P＜0.05);男性、PCI及术后使用氯吡格雷者渗血发生率高(P＜0.05或P＜0.01);年龄大及PCI者成功率低;术后使用低分子肝素和肝素者止血时间延长.结论:Angioseal、Perclose与人工压迫止血法均可有效用于心导管术后股动脉穿刺部位的止血.与Perclose相比,Angioseal止血时间更短、即刻止血率更高且局部并发症更少.     

在全国艾滋病防治综合示范区建立医学生社会实践基地的实践与探索

医学生社会实践基地是医学生开展社会实践活动的载体和依托，为了在全国艾滋病防治综合示范区建立稳固、长效、合适的医学生社会实践基地，我们进行了不懈地实践与探索。实践证明基地建设工作前期准备是基础，当地政府支持是关键，领导重视、资金充足、多部门配合是保障，形式多样、行之有效的社会实践活动是推进基地建设的根本途径。     

Dulaglutide治疗2型糖尿病有效性和安全性的Meta分析

目的 评价Dulaglutide治疗2型糖尿病的有效性和安全性.方法 计算机检索Cochrane图书馆、PubMed、OVID、Medline、Embase、知网、万方、维普等数据库,按Cochrane系统评价的方法评价纳入研究的质量,并使用RevMan 5.2软件进行Meta分析.结果 共纳入10项研究,6 699例患者.Meta分析结果显示,Dulaglutide在降低糖化血红蛋白(HbA1c)[阳性对照组:均数差(MD) =-0.32,95％CI(-0.42,-0.22),P＜0.01;安慰剂:MD=-1.07,95％CI(-1.16,-0.99),P＜0.01]、空腹血糖(FPG)[阳性对照组:MD=-0.60,95％CI(-0.84,-0.36),P＜0.01;安慰剂:MD=-1.86,95％CI(-1.88,-1.84),P＜0.01]、体质量方面[阳性对照组:MD=-0.95,95％CI(-1.69,-0.21),P=0.010;安慰剂:MD=-1.31,95％CI(-2.13,-0.49),P=0.002]优于阳性对照组或安慰剂.安全性方面,Dulaglutide与阳性对照组及安慰剂相比,低血糖发生风险和总不良反应发生率差异无统计学意义(P＞0.05).结论 Dulaglutide治疗2型糖尿病安全有效.     

Adoption of a wiki within a large internal medicine residency program: a 3-year experience

Objective

To describe the creation and evaluate the use of a wiki by medical residents, and to determine if a wiki would be a useful tool for improving the experience, efficiency, and education of housestaff.

Materials and methods

In 2008, a team of medical residents built a wiki containing institutional knowledge and reference information using Microsoft SharePoint. We tracked visit data for 3 years, and performed an audit of page views and updates in the second year. We evaluated the attitudes of medical residents toward the wiki using a survey.

Results

Users accessed the wiki 23 218, 35 094, and 40 545 times in each of three successive academic years from 2008 to 2011. In the year two audit, 85 users made a total of 1082 updates to 176 pages and of these, 91 were new page creations by 17 users. Forty-eight percent of residents edited a page. All housestaff felt the wiki improved their ability to complete tasks, and 90%, 89%, and 57% reported that the wiki improved their experience, efficiency, and education, respectively, when surveyed in academic year 2009–2010.

Discussion

A wiki is a useful and popular tool for organizing administrative and educational content for residents. Housestaff felt strongly that the wiki improved their workflow, but a smaller educational impact was observed. Nearly half of the housestaff edited the wiki, suggesting broad buy-in among the residents.

Conclusion

A wiki is a feasible and useful tool for improving information retrieval for house officers.     

Biomechanical comparison of interspinous distraction device and facet screw fixation system on the motion of lumbar spine: a finite element analysis

Background A large amount of biomechanical and clinical evidence from previous studies suggest the efficiency of the two different posterior lumber non-fusion methods,interspinous distraction device （ISDD） and facet screw fixation system （FSS）,but the biomechanical comparison of ISDD and FSS has not been thoroughly clarified.Methods In the current study,finite element methods were used to investigate the biomechanical comparison of ISDD and FSS.The range of motion （ROM）,intradiscal pressure （IDP） and the protective effects gained by maintaining disc heights were evaluated.Results The ROM was similar between the two non-fusion methods under static standing,flexion and lateral bending.The FSS appeared to be more effective in resisting extension.At the implanted level L3/4,FSS displayed better results for maintaining and increasing posterior disc heights.At the L4/5 level in extension and lateral bending,FSS was better than ISDD,with comparable results observed in other motions.Comparing the posterior and lateral disc heights,FSS appeared to be more effective than ISDD.FSS also had a minor effect on the inferior adjacent segment than ISDD.FSS was more effective in reducing IDP than ISDD in extension.Conclusion Through the finite element analysis study,it can be seen that FSS demonstrates more beneficial biomechanical outcomes than does ISDD,such as being more effective in resisting extension,maintaining and increasing lumbar disc heights and reducing the inferior adjacent IDP in extension.     

基于实证研究的健康人社会功能性衰老量表的应用

目的：以自制社会功能性衰老量表为根据,在现场人群实证基础上探析该量表判断健康人衰老的可行性 和实用性。方法：按9个年龄组分层随机抽样,运用自制量表获取反映研究对象社会功能衰老的现况资料;统计分析 个体社会功能衰老得分分布情况及其与年龄、端粒长度的相关性。结果：现场调查人数共2 297,男女比0.8:1;社会 功能性衰老总分为3.00~12.90分,个人能力、社会参与、组织交往得分分别为1.00~4.45,1.00~4.52,1.00~5.00分;年龄 与衰老分值的相关性较高(r=0.696,P<0.001);调查对象相对端粒长度为1.056±0.261,不同年龄间相对端粒长度差异 具有统计学意义(F=35.803,P<0.001);端粒长度与年龄呈负相关(r=-0.964,P<0.001),与社会功能性衰老得分呈负相 关(r=–0.857,P<0.001)。结论：社会功能衰老总分及各维度得分随年龄增大而升高,并与端粒长度呈负相关;量表适 用于社会功能性衰老测评,为衰老综合性评估提供参考。     

Extracting social determinants of health from electronic health records using natural language processing: a systematic review

ObjectiveSocial determinants of health (SDoH) are nonclinical dispositions that impact patient health risks and clinical outcomes. Leveraging SDoH in clinical decision-making can potentially improve diagnosis, treatment planning, and patient outcomes. Despite increased interest in capturing SDoH in electronic health records (EHRs), such information is typically locked in unstructured clinical notes. Natural language processing (NLP) is the key technology to extract SDoH information from clinical text and expand its utility in patient care and research. This article presents a systematic review of the state-of-the-art NLP approaches and tools that focus on identifying and extracting SDoH data from unstructured clinical text in EHRs.Materials and MethodsA broad literature search was conducted in February 2021 using 3 scholarly databases (ACL Anthology, PubMed, and Scopus) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 6402 publications were initially identified, and after applying the study inclusion criteria, 82 publications were selected for the final review.ResultsSmoking status (n = 27), substance use (n = 21), homelessness (n = 20), and alcohol use (n = 15) are the most frequently studied SDoH categories. Homelessness (n = 7) and other less-studied SDoH (eg, education, financial problems, social isolation and support, family problems) are mostly identified using rule-based approaches. In contrast, machine learning approaches are popular for identifying smoking status (n = 13), substance use (n = 9), and alcohol use (n = 9).ConclusionNLP offers significant potential to extract SDoH data from narrative clinical notes, which in turn can aid in the development of screening tools, risk prediction models, and clinical decision support systems.