关于村卫生机构合作医疗信息系统B/S和C/S架构的探析

当今世界科学技术飞速发展,尤其以通信、计算机、网络为代表的互联网技术更是日新月异,令人眼花燎乱,目不暇接.HIS(医院信息管理系统)已经成为医院信息化建设中的基本组成部分,是医院现代化的重要标志之一,是保证医院顺利开展医疗、教育、科研必不少的现代化工具之一,随着新型农村合作医疗在全国遍地开花,基层卫生院的HIS系统已经基本构架起来,现在我们面对的是如何更好的构建村卫生机构合作医疗信息系统.     

我院网络升级改造的经验总结

我院是一所三等甲级中医院,2002年初我院建筑面积为3.6万m~2的新住院大楼落成,原有的17个旧病区扩充至23个病区搬迁至新大楼。结合这次搬迁过程,我院信息科对网络进行了重新规划,实现了医院主干网由100兆到1000兆的升级,采用三层交换以及Vlan技术对我院原有网络进行了改造,并注重了与原有网络的兼容,同时完成了中心机房的搬迁,服务器操作系统的升级,保证了病区搬迁当日电脑系统的正常运作,得到了医院领导的充分肯定。下面将这次我院网络升级改造作一次经验总结,以供同行在网络改造,系统升级,机房搬迁中参考。1 新网络设计目标 对于新的网络,首先要能够充分满足HIS系统的高效稳定地运行,还要能够提供丰富的网络应用。具体的讲,应达到以下目标:1.1 实现全院的网络物理联通,并为将来的发展做出规划。1.2 达到千兆主干,百兆桌面的网络性能。1.3 增强网络的冗余性能,保证故障的及时排除。1.4 增强网络的安全性能,保证关键数据的安全,比如说财     

我院预防HIS系统故障的整体解决方案

我院作为全国性肿瘤专科医院，目前已经全面实施HIS系统，在网络建设和网络改造同时，对系统的安全和故障预防，确立了一套完整的系统故障预防方案，此方案的主要方法是由多台服务器组成的服务器集群来预防服务器和数据库故障，由院内千兆快速以太网和FDDI光纤环网组成的两套物理独立的网络相互备份，来预防网络的故障发生。     

简论《中国医院知识仓库》(CHKD)在医院科研、临床、教学工作中的应用

二十一世纪是信息技术飞速发展的时代,数字化资料逐渐取代印刷品已成为必然趋势。在这个信息时代,医院的网络信息化建设刻不容缓。结合我院目前的实际情况,以科研、     

医院信息化发展中多系统共存的现状与对策

随着计算机技术、网络通信技术、多媒体技术的迅速发展,国际互联网引入各行各业并得到有效利用,医院同样面临着信息化和网络化的巨大挑战。在网络进入医院的同时,医院的各部门也利用网络环境纷纷建立起自己的信息和业务系统。医院的信息化发展已经不再局限于孤立的H IS系统,Internet的接入、省市医保网络的建设、各科室小型科研子网的建立等,使医院中多个系统同时存在成为事实,如何使资源更好的共享,如何使系统的安全性得到更有效的保障,是医院信息系统管理中迫切需要解决的重大课题。医院的信息化实际上是相互关联的多个管理信息子系统的…     

医院数据和网络安全的思考

随着医院业务不断发展,规模越来越大,其信息系统(HIS、PACS)应用范围也日渐扩大.信息化进程迅猛发展,网络技术已经给医院管理和医教研等各方面带来重大影响.     

充分发挥计算机在现代化医院管理中所起的作用

随着计算机网络技术不断的提高,计算机网络技术已经成为现代化医院管理的一个重要手段,本文就我院网络信息系统近几年来的管理和使用谈几点体会,以便能更加充分地发挥计算机在现代化医院管理中所起的作用。     

城域医疗信息联网方案

随着信息技术的不断发展和人们对医疗保健水平要求的不断提高以及国家医疗制度改革的深化 ,加强信息化建设成为医疗系统的重要目标。当前信息技术应用已在医疗服务、卫生管理医学教育和医学科研等领域全面展开。济南市的许多医院已经相继建立了自己医院内的信息系统。但是大部分医院的信息系统是以经济管理为主线 ,主要面向医院内部资金流和物流管理。国际发展趋势表明 ,医院信息系统已经从重在费用信息管理的阶段逐渐发展到面向临床医疗信息管理的阶段 ,它包括临床信息管理、电子病历系统、医学影像系统和远程医疗会诊等交互式网络信息服务…     

加强信息化建设,促进医院全面发展

在信息时代的今天 ,加强医院信息化建设 ,实现医院管理数字化 ,已成为医院全面发展的需要。我院大力加强信息化建设 ,先后开通运行了军卫 1、 2号工程 ,建立并开通了全球卫生信息检索系统、光盘文献检索系统及全军医学信息资源共享网络系统三大信息检索系统 ,建立了院区多媒体电化教学系统和实时监控系统 ,从根本上彻底改变了多年的传统手工管理模式和知识信息获取方式 ,形成了初具规模的集综合管理、科研教学和辅助决策为一体的网络信息系统 ,实现了对医疗、护理、政治工作、财务等方面的全面自动化管理 ,以信息化建设促医院发展 ,向现代化…     

新一代医院管理信息系统的组织与开发

1　引言随着计算机技术的发展,医疗系统的信息化相继在80年代中、90年代初,实现了以财务收费管理为主的单机信息化管理。1995年为了进一步促进医疗卫生系统的信息化进程,卫生部开始了“金卫工程”,加上“中国医院信息系统”(HIS)的研制与应用,使得医院信息系统建设得到了进一步发展。但是进入90年代末,随着计算机网络技术的迅猛发展和社会对医院信息服务需求的发展,以“财务管理信息系统”为主的医院管理信息系统已经远远不能满足社会对医疗信息化服务的需求,医院管理信息急切需要有新的模式来为社会公众提供全方位的服务。面对我国21世纪…     

胃大部切除术后残胃功能性排空障碍10例临床分析

目的:探讨胃大部切除术后残胃功能性排空障碍发生原因,诊断及治疗。方法:对1996年至2008年收治的108例胃大部切除术患者的临床资料进行回顾性分析。结果:本组共发生功能性胃排空障碍10例,发生9.2%,均发生于术后3～12天。所有患者均经保守治疗出院,均于35天内治愈。结论:术后残胃和远端空肠正常的运动功能破坏是发生功能性胃排空障碍的主要原因,上消化道造影及胃镜检查是诊断本病、鉴别机械性梗阻的重要方法。采取非手术治疗一般均可治愈,针对胃排空动力学机制的改变采用促胃肠动力药可能收到较好的疗效。     

Thrombotic Microangiopathy Following Pediatric Autologous Hematopoietic Cell Transplantation: A Report of Significant End-Organ Dysfunction in Eculizumab-Treated Survivors

Transplantation-associated thrombotic microangiopathy (TA-TMA) is a known complication of autologous hematopoietic cell transplantation (aHCT), particularly in children with neuroblastoma. We describe a pediatric single-institution experience of TA-TMA after aHCT. Data were abstracted from the medical record of patients who underwent aHCT between January 1, 2008, and July 1, 2018, at Boston Children's Hospital. TA-TMA was diagnosed using either the International Working Group criteria or the “probable TA-TMA criteria” of Cho et al. Overall, 318 aHCTs were performed in 243 patients. Nine patients (3.7%) were diagnosed with TA-TMA. TA-TMA occurred most frequently in children with neuroblastoma (n = 7; 78%), all of whom were conditioned with carboplatin, etoposide, and melphalan. The median age at aHCT in children who developed TA-TMA was 3 years, 5 months (range, 18 months to 25 years). TMA was diagnosed at a median of 35 days (range, 8 to 106 days) after stem cell infusion. On a retrospective chart review using the same criteria used by the provider, patients met criteria a median of 5 days before the clinical diagnosis (range, 0 to 58 days). Eight patients had renal involvement at presentation, including nephrotic range proteinuria and severe hypertension, requiring from 2 to 6 antihypertensive medications. Two patients presented with multiorgan failure. Six patients were treated with eculizumab a median of 0 days after TA-TMA diagnosis (range, 0 to 11 days). On retrospective review, patients were treated a median of 18 days (range, 0 to 58 days) after meeting criteria for TA-TMA. Before initiation of therapy, 4 of 6 patients checked for serum complement levels had normal values, 1 had elevated CH50 and 1 had elevated sC59-b and CH50. All patients had CH50 levels within the target range (≤3 CAE) after induction therapy. Two patients (33%) had no response to eculizumab and died of multiorgan failure. The other 4 had both a hematologic response with transfusion independence (median, 6.5 weeks; range, 4 to 9 weeks) and renal response, defined as resolution of nephrotic range proteinuria (median, 21 weeks; range, 13 to 25 weeks). Among the eculizumab-treated survivors, 2 patients remained on prolonged eculizumab therapy, and one had recurrence of TA-TMA after discontinuation of eculizumab. All 4 eculizumab treated survivors have persistent organ dysfunction. Three children were treated with supportive care only; 2 died of relapsed cancer, and the third is alive with stage 2 chronic kidney disease. The median duration of follow-up after TA-TMA diagnosis was 2.5 years (range, 9 months to 4 years). The 1-year overall survival was 78% (SE = 14%). However, regardless of treatment, no survivors had complete normalization of function in all organs. Three children with normal serum CH50 and sc5b-9 levels responded to eculizumab. This report highlights the importance of maintaining a high suspicion for TA-TMA after aHCT. Further study is warranted to identify individual risk factors for TMA after aHCT, predict the response to eculizumab, and capture long-term sequelae in survivors.     

^99mTc-MAA肺灌注显像对下肢创伤及手术后肺栓塞患者的疗效评价

目的利用Tc-大颗粒聚合白蛋白（MAA）肺灌注显像（PPI）监测下肢创伤及手术后（LEPP）肺99m栓塞（PE）患者疗效并对其评价。方法19例临床确诊的LEPP合并PE患者分别于溶栓治疗前、治疗2～4周后进行PPI;PPI图像上显示一个肺段灌注完全缺损记3分,缺损25%～75%记2分,〈25%记1分,无异常记0分,根据记分变化分析溶栓治疗前后临床改善情况。结果19例患者溶栓治疗2～4周后临床症状完全消失10例、明显改善6例、有改善3例,治疗前（10.2±3.8）后（2.8±1.4）PPI记分有明显差异（t=7.75,P〈0.01）。结论PPI为一种准确、可靠的无创性评价肺血流改善的手段,对LEPP合并PE患者疗效观察具有重要的临床价值。     

Comparison of preservation media for storage of stool samples.

Transportation of clinical samples and long-term recoverability of pathogens are critical to epidemiological studies, particularly when conditions do not permit immediate processing. This study confirms that Cary-Blair medium (CB) is suitable for the preservation of Salmonella and Shigella isolates for more than 2 weeks at 25, 4, or -70 degrees C. Campylobacter jejuni was not recovered after 2 days of storage in CB at 25 degrees C when an inoculum of 12 x 10(8) cells per ml was used. Lower temperatures supported the recovery of this organism for 6 days. When individual pathogens were preserved with stools in CB and incubated at 25, 4, or -70 degrees C, the Salmonella and Shigella concentrations dropped from 12 x 10(8) cells to 1 x 10(3) or 1 x 10(4) cells per ml within 2 days and then remained stable for the rest of the observation period (15 days). C. jejuni survived preservation with stools for 5 to 9 days. The addition of blood and glycerol to CB improved the recoverability of all enteropathogens, particularly C. jejuni, which was consistently detected for 7 to 9 days at the different preservation temperatures used. When trypticase soy broth-glycerol (freezing medium), with or without blood, was used, there was little or no decrease in the Salmonella and Shigella concentrations during 2 weeks of preservation with stools at -70 degrees C. C. jejuni demonstrated a relatively sustained high concentration in Trypticase soy broth-glycerol with 5% blood.(ABSTRACT TRUNCATED AT 250 WORDS)     

Use of etoposide, ifosfamide and cisplatin (EIP) for treatment of inoperable non-small cell lung cancer

Recent studies have pointed out that chemotherapy can prolong life in advanced inoperable cancer patients. A clinical study to evaluate response and toxicity of the combination of etoposide, ifosfamide and cisplatin (EIP) in the treatment of inoperable non-small cell lung cancer was performed. 25 patients entered the study. Treatment consisted of etoposide 120 mg/m2 given i.v. on days 1-3, ifosfamide 1.5 g/m2 given i.v. on days 1-5 with mesna protection and cisplatin 20 mg/m2 given i.v. on days 1-5. Cycles were repeated every 4 weeks for a maximum of 6 in responders. 16 (64%) patients responded to treatment, 13 (52%) reached partial and 3 (12%) complete remission. In two recurrent cases second remission was achieved after reinstitution of the EIP regimen. Median survival time was 13 months (range 7-48 months) for responders and 5 months (range 2-11 months) for non-responders. Overall treatment was well tolerated with granulocytopenia being the most frequent toxicity. The results are encouraging for further investigations. Application of higher doses of ifosfamide with colony stimulating factors protection is planned.     

Three vs. 10 days of amoxycillin–clavulanic acid for type 1 acute exacerbations of chronic obstructive pulmonary disease: a randomised, double-blind study

The optimal duration of antibiotic treatment for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is unknown. This study compared the outcome of treatment for 3 vs. 10 days with amoxycillin-clavulanic acid of hospitalised patients with AECOPD who had improved substantially after initial therapy for 3 days. Between November 2000 and December 2003, 56 patients with AECOPD were enrolled in the study. Unfortunately, because of the low inclusion rate, the trial was discontinued prematurely. Patients were treated with oral or intravenous amoxycillin-clavulanic acid. Patients who showed improvement after 72 h were randomised to receive oral amoxycillin-clavulanic acid 625 mg or placebo, four times daily for 7 days. The primary outcome measure of the study was clinical cure after 3 weeks and 3 months. Of 46 patients included in the final analysis, 21 were in the 3-day treatment group and 25 were in the 10-day treatment group. After 3 weeks, 16 (76%) of 21 patients in the 3-day treatment group were cured, compared with 20 (80%) of 25 in the 10-day treatment group (difference -3.8%; 95% CI -28 to 20). After 3 months, 13 (62%) of 21 patients were cured, compared with 14 (56%) of 25 (difference 5.9%; 95% CI -23 to 34). Microbiological success, symptom recovery, the use of corticosteroids, the duration of oxygen therapy and the length of hospital stay were comparable for both treatment groups. It was concluded that 3-day treatment with amoxycillin-clavulanic acid can be a safe and effective alternative to the standard 10-day treatment for hospitalised patients with AECOPD who have improved after initial therapy for 3 days.     

Serial right ventricular endomyocardial biopsy in rapid-onset severe heart failure due to giant cell myocarditis.

Giant cell myocarditis (GCM) is a serious condition that warrants immediate diagnosis and treatment. It often presents as rapidly progressive heart failure and/or malignant ventricular arrhythmias. Here, we describe a 34-year-old patient with myasthenia gravis who presented with GCM 2 weeks after resection of a thymoma. A cardiac biopsy confirming the diagnosis was done within 3 days after admission. After institution of an aggressive immunosuppressive drug regimen, implantation of an implantable cardioverter defibrillator, and intensive cardiac rehabilitation, the patient recovered dramatically. In control biopsies after 4 weeks and 6 months, no more giant cells were found. We conclude that, in the case of nonischemic acute heart failure in young patients, a biopsy should be performed as soon as possible to prevent an unfavourable outcome of this often fatal disease.     

Kinetics of antibody responses in Rickettsia africae and Rickettsia conorii infections

African tick-bite fever, caused by Rickettsia africae, is the most common tick-borne rickettsiosis in sub-Saharan Africa. Mediterranean spotted fever due to Rickettsia conorii also occurs in the region but is more prevalent in Mediterranean countries. Using microimmunofluorescence, we compared the development of immunoglobulin G (IgG) and IgM titers in 48 patients with African tick-bite fever and 48 patients with Mediterranean spotted fever. Doxycycline treatment within 7 days from the onset of disease significantly prevented the development of antibodies to R. africae. In patients with African tick-bite fever, the median times to seroconversion with IgG and IgM were 28 and 25 days, respectively, after the onset of symptoms. These were significantly longer by a median of 6 days for IgG and 9 days for IgM than the times for seroconversion in patients with Mediterranean spotted fever (P < 10(-2)). We recommend that sera collected 4 weeks after the onset of signs of patients with suspected African tick-bite fever should be used for the definitive serological diagnosis of R. africae infections.     

Early skin testing is effective for diagnosis of hypersensitivity reactions occurring during anesthesia

Allergic skin tests have to be performed 4–6 weeks after an allergic anesthetic reaction. Patients with allergic reactions during anesthesia were prospectively included (n = 44). Skin tests were performed in two stages: (i) Stage 1 (S1), 0–4 days after the reaction; and (ii) Stage 2 (S2), 4–8 weeks after. Five (11.5%) surgical procedures were suspended due to the reaction. Positive skin tests were obtained in 25/44 patients (57%). Allergic diagnosis was carried out at S1 in 15/25 (60%) and at S2 in 10/25 (40%). Three patients resulted positive only in S1. Overall agreement among S1 and S2 skin tests was 70.45%. The kappa statistic was 0.41 (P‐value = 0.002). Odds ratio of obtaining a false negative in S1 (compared with S2) was 3.33. Early allergological study is useful, could minimize false negatives, but should be considered as a complement to late skin tests.     

肩锁关节劳损的诊断与注射治疗

目的 探讨肩锁关节轻度损伤的诊断与强的松龙局部注射疗法。方法选择门诊确诊为肩锁关节扭伤或劳损的患者15例，采取强的松龙混悬液25mg加1％普鲁卡因或2％利多卡因5ml注射关节腔及肩锁韧带的方法，未用其他治疗。结果多数病例在注射后1周左右痊愈。少数病例经2—3次注射，每次间隔1周，而后痊愈。个别病例数月或数年后复发，以相同方法治愈。结论对诊断正确的轻度肩锁关节损伤(劳损或扭伤)，采取局部注射强的松龙的方法，可以获得满意的效果。