医学信息学的发展

医学信息学是一门集医学、信息科学和管理学于一身的新兴交叉学科。国外医学信息学研究涉及领域较广。发展较快。国内研究的领域比较少，但取得了一定的成绩，医学信息学教育取得了一定成绩，也出现了一些有待解决的问题。为了促进我国医学信息学的研究和教学，本文提出了重视高层次医学信息学人才培养、支持医学信息学研究课题、在临床研究生教学中开设课程、师资培训和教材建设、发挥医学信息学会领导作用等对策。     

Education review: applied medical informatics--informatics in medical education

The importance of informatics training within a health sciences program is well recognized and is being implemented on an increasing scale. At Chicago Medical School (CMS), the Informatics program incorporates information technology at every stage of medical education. First-year students are offered an elective in computer topics that concentrate on basic computer literacy. Second-year students learn information management such as entry and information retrieval skills. For example, during the Introduction to Clinical Medicine course, the student is exposed to the Intelligent Medical Record-Entry (IMR-E), allowing the student to enter and organize information gathered from patient encounters. In the third year, students in the Internal Medicine rotation at Norwalk Hospital use Macintosh power books to enter and manage their patients. Patient data gathered by the student are stored in a local server in Norwalk Hospital. In the final year, we teach students the role of informatics in clinical decision making. The present senior class at CMS has been exposed to the power of medical informatics tools for several years. The use of these informatics tools at the point of care is stressed.     

临床医学专业学生对循证医学双语教学的认知与需求调查分析

目的了解安徽省某医科大学临床医学专业学生对循证医学双语教学的认知与需求状况,探讨双语教学方法在高等医学院校应用的前景。方法采取方便抽样的方法,选取临床医学专业的本科生为研究对象,采用自制调查问卷,调查学生对循证医学双语教学的认知和需求。结果共调查323名临床医学专业学生,仅有1.9%的学生深入了解双语教学模式,一般或不了解双语教学的学生占64.1%;54.8%的学生认为循证医学课程很有必要或有必要开展双语教学;40.6%的学生希望双语教学的学时数占该课程总学时的60%～80%;16.4%的学生希望双语教学的重点在系统评价和meta分析;不同年级的学生和既往参与双语教学的经历是循证医学双语教学的认知程度和需求情况的影响因素。结论临床医学专业大学生对循证医学双语教学的认知程度相对较低,但具有较高的需求。采取灵活多变的教学方式、提高教师双语教学的水平、选编难度适宜的教材对双语教学的推广至关重要。     

On geography and medical journalology: a study of the geographical distribution of articles published in a leading medical informatics journal between 1999 and 2004

Background  

Studying the contribution of individual countries to leading journals in a given discipline can highlight which countries have the most impact on that discipline, and also give some idea about the geographical outreach of those journals. This paper examines the number of countries that contributed articles to one leading medical informatics journal, Medical Informatics & the Internet in Medicine, and the amount of their contributions between 1999 and the first half of 2004.     

Self-instructional teaching of biostatistics for medical students

A growing body of literature deals with the use of self-instructional methods for teaching biostatistics to medical students. The University of Tennessee Department of Community Medicine tested the hypothesis that, in controlled, randomized situations, learning of statistical material by self-instruction is equivalent to learning identical material by the lecture method. An analysis of student performance, in terms of the grades obtained on two separate examinations, showed that students learning by self-instruction did as well or better than their colleagues taking lectures. On the basis of these results, self-instructional biostatistics for medical students at the University of Tennessee has been selected as the major teaching method of that subject.Dr. Robinson is Professor and Chief of Biostatistics in the Department of Community Medicine, University of Tennessee College of Medicine, 800 Madison Avenue, Memphis, Tennessee 38163. Mr. Burke is Instructor in the Department of Community Medicine, University of Tennessee, and Director of Statistical Services in the Memphis and Shelby County Health Department. Dr. Stahl was Assistant Professor of Community Health and Medical Practice, Section of Health Care Studies, University of Missouri, Columbia, Missouri, during this study. He is currently Assistant Professor of Sociology, Purdue University, School of Humanities, Social Science and Education, Lafayette, Indiana. Requests for reprints should be addressed to Dr. Robinson. John W. Runyan, Jr., M.D., and Stephen T. Miller, M.D., of the Department of Community Medicine, University of Tennessee, made valuable suggestions during the preparation of this paper.     

The discipline of epidemiology: engaging in the full breadth of population health science

This address was delivered by Harold I. Feldman, MD, MSCE, at the Annual Meeting of the American College of Epidemiology in New Orleans, Louisiana, on September 26, 2017. Dr. Feldman is George S. Pepper Professor of Public Health and Preventive Medicine, Professor of Epidemiology and Medicine, and Chair, Department of Biostatistics, Epidemiology, and Informatics at the Perelman School of Medicine at the University of Pennsylvania. He is recognized nationally and internationally for his expertise in kidney disease epidemiology. Dr. Feldman pioneered the integration of epidemiology and renal medicine with his first studies of dialyzer reuse and hemodialysis vascular access morbidity. He is internationally renowned in nephrology and clinical epidemiology and an architect of one of the largest and most successful epidemiological research programs in chronic kidney disease. For over 15 years, he has led NIH's Chronic Renal Insufficiency Cohort Study, placing him at the helm of the “Framingham Study of Renal Disease”. It has elucidated the chronic kidney disease–specific relationships of mineral dysmetabolism and cardiovascular complications; dietary sodium and heart failure; novel vascular stiffness metrics and renal disease progression; cardiovascular biomarkers and heart failure; and cognitive decline and renal dysfunction, among others. He has also led the nation's largest trials targeting hemodialysis vascular access morbidity, discovered the benefits of transplantation before dialysis dependence, elucidated racial disparities and the role of genetics in kidney failure, and shaped our understanding of the toxicity from unregulated reuse of medical devices. He is the past President of the American College of Epidemiology and directs one of the nation's largest clinical epidemiology and biostatistics programs. Dr. Feldman has an MD from Boston University and an MSCE from the University of Pennsylvania. He is an elected member of the American Society of Clinical Investigation, the Association of American Physicians, and the American Epidemiological Society.     

Data standards, terminology and classification systems for caring in health and nursing

Information is essential for nursing care because nurses in subsidizing clinical decision making for the resolution and reduction of health problems. This review integrative study identified publications in national and international journals the major data standards, terminologies and classification systems used in health care and nursing. The research was conducted on MEDLINE, CINAHL and SCIELO using the keywords: Information Systems, Nursing Informatics, Medical Informatics, Computerized Medical Records Systems, Terminology and Nomenclature of Medicine Systematized. It was selected 91 articles which were analyzed in two empirical categories: "data standards for health care and nursing" and "terminologies and classification systems in nursing" From the various data standards, terminologies and classification systems, it is important that nursing take ownership of them aiming to improve and renew the quality of care.     

Importance of community size in practice location decisions of final year residents

Final year residents in training in Louisiana were surveyed regarding plans for medical practice and their perceptions of the importance of various factors in choosing practice locations. Most specialty groups selected smaller communities at similar rates. Growing up in small towns is associated with wanting to practice in small towns while concerns about opportunities for the family and income of the region are associated with wanting to practice in a larger city.This study was supported by the Louisiana Council for Statewide Planning for Physician Manpower through Contract No. 23058, Louisiana Department of Health and Human Resources.Ms. Samaha is a data analyst for the Louisiana Council for Statewide Planning for Physician Manpower; Robert R. Franklin, M.D. is Executive Secretary of the Council and Assistant Professor, Department of Biostatistics and Epidemiolgy, Tulane University School of Public Health and Tropical Medicine; Janet C. Rice is Assistant Pofessor, Department of Biostatistics and Epidemiology at the Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana 70112.     

Health care provider and family acceptance of a rural community-based nursing service for chronically ill children

Health care providers' and families' overall acceptance of a community-based nursing program was assessed in relationship to their perceptions of the program nurses' (1) accessibility, (2) professional competence, and (3) personal qualities. Perceptions were measured by questionnaires completed by 139 health care providers and 140 families. Overall, providers indicated that the program has been of benefit to both the children it serves and the medical community. The majority of families felt that the nurses were helpful to them despite a few complaints related to poor availability.Barbara A. Cook, M.S., is an Assistant in the Department of Pediatrics, University of Florida, Gainesville, FL. Jeffrey P. Krischer, Ph.D., is Professor and Chief of the Division of Epidemiology and Biostatistics, Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL. Randy Kraft, B.A.E., is Health Educator, Florida Association of Pediatric Tumor Programs, Inc., Gainesville, FL. Address requests for reprints to Barbara Cook, M.S., Department of Pediatrics, 1105 West University Avenue, Suite 200, Gainesville, FL 32601. This research was supported in part by Children's Medical Services, Florida State Department of Health and Rehabilitative Services and in part by the Robert Wood Johnson Foundation.     

北京中医医院医疗联盟模式探讨

在新医改背景下,北京中医医院积极探索＂医疗联盟＂的新模式,在全国范围内相继与30多家医院建立了协作与对口支援、院际合作、托管等合作关系,并制定了具体措施来深化和落实合作,取得一定成效。对医疗联盟的模式和成果作出总结,为完善工作模式提供参考。     

Book Reviews

Book reviewed in this article:
Class and Health: Research and Longitudinal Data . Edited by Richard G. Wilkinson .
Vaccinating Against Brain Syndromes: The Campaign Against Measles and Rubella . Edited by Ernest M. Gruenberg, C. Lewis & S. E. Goldston . Monographs in Epidemiology and Biostatistics, Volume 9.
Labour and Delivery: Impact on Offspring . By E.A. Friedman & R.K. Neff .
The Developing Human Brain: Growth and Epidemiologic Neuropathology . By F.H. Giles, A. Leviton & E. Dooling .
Epidemiology in Medicine . By C.H. Hennekens & J.E. Buring; Editor S.L. Mayrent .
People Count, a History of the General Register Office . By Muriel Nissel .
An Introduction to Medical Statistics . By M. Bland .     

江苏省气象因素对猩红热发病影响

目的探讨江苏省气象因素对猩红热发病的影响,为猩红热的防制工作提供理论依据。方法以江苏省2010年1月1日—2015年12月31日猩红热日发病数据及同期气象数据为基础,采用分布滞后非线性模型(DLNM)分析气象因素对猩红热发病的影响。结果江苏省2010—2015年共报告猩红热新发病例10 886例,年均发病率为2.29/10万;其中男性新发病例6 748例,女性4 138例,男女性别比为1.63:1。相关分析结果显示,平均气温和相对湿度与猩红热发病均呈负相关(r_s=–0.140、–0.132,均P<0.05);平均气压和温差与猩红热发病均呈正相关(r_s=0.051、0.172,均P<0.05)。DLNM结果显示,温度较低时猩红热发病增多,且对猩红热发病的影响时间较长,其效应在滞后10 d时依然呈正效应,而后随着温度升高,猩红热发病风险降低;气温变化较小时猩红热发病风险相对较小,呈持续时间较长的保护效应,随着气温变化加大,猩红热的发病人数不断增加,且温差越大,猩红热发病风险持续时间越长;干燥气象条件下猩红热发病风险较高且影响时间较长,当相对湿度较为舒适时猩红热的发病数减少,在环境非常潮湿时相对湿度对猩红热发病呈保护效应,且在滞后5 d时仍存在。结论气象因素对猩红热流行的影响呈非线性关系,且具有一定的滞后作用。     

Worksite and communications-based promotion of a local walking path

Current research has shown relationships between the environment (eg, parks and trails) and levels of physical activity participation. This study was designed to implement and evaluate a communications based worksite campaign to promote awareness of an existing local walking path and to increase walking. Promotional materials were distributed for 1 month via flyers, email, website postings, and during bi-weekly information booths. Evaluations were conducted at baseline, during, and following the promotional campaign. Borderline statistically significant increases in walking activity from baseline were observed midway through the campaign (p = 0.069) and following the campaign (p = 0.075). Counts observed during the intervention were almost triple those at baseline and increased in the post-campaign phase to approximately three and a half times those at baseline. Sign recognition surveys revealed at baseline, 51% of the participants correctly identified the walking path signs, which increased to 65% during the campaign (p = .0674). Familiarity with physical activity messages around the workplace increased from 64.6% at baseline to 75.5% during the campaign (p = .097). This study shows initial promise of a theoretically based communications intervention to increase knowledge of physical activity and to promote walking.Melissa A. Napolitano is Assistant Professor of Psychiatry and Human Behavior and Staff Psychologist, Centers for Behavioral and Preventive Medicine, Brown Medical School and The Miriam Hospital, Providence, Rhode Island, Heather Lerch is a Health Promotion Specialist at MassMutual Benefits Management, Inc., Springfield, Massachusetts, George Papandonatos is Assistant Professor of Biostatistics, Brown University, Providence, Rhode Island, and Bess H. Marcus is Professor of Psychiatry and Human Behavior and Director, Centers for Behavioral and Preventive Medicine, Brown Medical School and The Miriam Hospital, Providence, Rhode Island     

Issues and opportunities in public health informatics: a panel discussion.

A panel was convened at the American Medical Informatics Association Spring Congress to discuss issues and opportunities that arise when informatics methods, theories, and applications are applied to public health functions. Panelists provided examples of applications that connect efforts between public health and clinical care, emphasizing the need for integration of clinical data with public health data and the analysis of those data to support surveillance and informed decision making. Benefits to be gained by both medical informatics and public health at the interface were evident; both encounter the same major issues including privacy, systems integration, standards, and many more.     

Community service as an integral component of undergraduate medical education: facilitating student involvement.

Urban poverty, of which New York City has the highest incidence, is associated with unmet needs and inappropriate use of emergency rooms and hospitals. Community-based medical practitioners can ameliorate these situations. Medical students from New York City-area schools often are willing to help. The New York Academy of Medicine instituted an Urban Health Initiative to coordinate student and faculty involvement in community service and to emphasize the social responsibilities of medicine. The experience may provide a model for integrating community service into medical school curricula.     

Characteristics of health data: structure and relationships

The characteristics of health data are diverse and vary by discipline. Health data can be viewed from three perspectives. They can be examined at a basic level of different variable types and database constructions. At an intermediate level, the way data are structured in a facility is a model of how an organization works. A computerized information system is a model of how work is performed. An understanding of facility data architecture and data structure is essential for adapting both manual and computerized systems to the rapid changes occurring in health care today. Lastly from the highest-level perspective, for communication and exchange of health data to be possible across all components of the health care delivery system, standards for data must be adopted by all institutions and individuals involved in the development of health data information systems. To expedite such exchange, the American Medical Informatics Association (AMIA) has recommended standards for patient, provider, and site-of-care identifiers; computerized message exchanges; and medical record content and structure. AMIA has also recommended the use of the universal medical language system as the basis for future developments in a universal medical language.     

Toward understanding elders' health service utilization

Providing appropriate health services to the elderly is emerging as one of the major challenges of this decade. Using the theoretical framework developed by Andersen and Aday, this study attempts to improve our understanding of those factors which inhibit or facilitate elders' use of health services. The data come from a 1974 statewide random probability sample of 1,625 noninstitutionalized elders 65 years of age or older living in Massachusetts. Regression analysis is used to study the effects of predisposing, enabling, and need characteristics on the use of five health services: hospitals, physicians, dentists, home care, and ambulatory care. The model explains from 5% to 27% of the variance in health service utilization. Need characteristics, in general, account for most of the explained variance.Drs. Branch and Jette and Ms. Polansky are with the Department of Social Medicine and Health Policy, Division on Aging, Harvard Medical School, 643 Huntington Avenue, Boston, Massachusetts 02115; Dr. Jette is also with the Massachusetts General Hospital's Institute of Health Professions; Dr. Evashwick and Ms. Rowe are with the Department of Health Services and Long Term Care Gerontology Center, School of Public Health and Community Medicine, University of Washington; and Dr. Diehr is with the Department of Biostatistics, School of Public Health and Community Medicine, University of Washington. Work for this project was supported in part by a grant from the Massachusetts Department of Public Health while the first author was with the Center for Survey Research, a facility of the University of Massachusetts and the Joint Center for Urban Studies of M.I.T. and Harvard University; in part by Grant 90-A-1350/2 from the Administration on Aging of H.E.W. to the Harvard School of Public Health; and in part by Grant 90-AT-2159 from the Administration on Aging of H.E.W. to the Harvard Medical School.     

An outcomes research perspective on medical education: the predominance of trainee assessment and satisfaction

CONTEXT: A fundamental premise of medical education is that faculty should educate trainees, that is, students and residents, to provide high quality patient care. Yet, there is little research on the effect of medical education on patient outcomes. OBJECTIVE: A content analysis of leading medical education journals was performed to determine the primary foci of medical education research, using a three- dimensional outcomes research framework based on the paradigm of health services outcomes research. DATA SOURCES: All articles in three medical education journals (Academic Medicine, Medical Education, and Teaching and Learning in Medicine) from 1996 to 1998 were reviewed. Papers presented at the Research in Medical Education conference at the Association of American Medical Colleges annual meeting during the same period, and published as Academic Medicine supplements, were also analysed. STUDY SELECTION: Only data-driven articles were selected for analysis; thus editorials and abstracts were excluded. DATA EXTRACTION: Each article was categorized according to primary participant (i.e. trainee, faculty, provider and patient), outcome (performance, satisfaction, professionalism and cost), and level of analysis (geographic, system, institution and individual(s)). DATA SYNTHESIS: A total of 599 articles were analysed. Trainees were the most frequent participants studied (68.9%), followed by faculty (19.4%), providers (8.1%) and patients (3.5%). Performance was the most common outcome measured (49.4%), followed by satisfaction (34.1%). Cost was the focus of only 2.3% of articles and patient outcomes accounted for only 0.7% of articles. CONCLUSIONS: Medical education research is dominated by assessment of trainee performance followed by trainee satisfaction. Leading journals in medical education contain little information concerning the cost and products of medical education, that is, provider performance and patient outcomes. The study of these medical education outcomes represents an important challenge to medical education researchers.     

Reform and innovation: a repeating pattern during a half century of medical education in the USA

INTRODUCTION: Medical education in the USA today is remarkably varied despite the shared mission of training doctors. SIX MEDICAL SCHOOLS: A brief introduction to 6 institutions illustrates the variety of education available, while providing some specific details of how schools differ and how the mandate of any particular school may differ from that of another. Private schools include Dartmouth Medical School, Duke University School of Medicine, and Mount Sinai School of Medicine. State-supported schools include the University of Arizona College of Medicine, Oregon Health and Science University School of Medicine, and Southern Illinois University School of Medicine. CHANGE: General remarks are made about changes over recent years in three separate areas of influence. NEW SCHOOLS: Forty new medical schools were established between 1960 and 1980; a brief explanation is provided of the reasons for this and how it was achieved. NEW DISCIPLINARY EMPHASES IN TRAINING DOCTORS: A few of the numerous new emphases that have been introduced into the medical school curriculum are discussed briefly. CURRICULUM REFORM: A small sample is given of ways in which particular medical schools have reformed their curricula over the years. What went into the most influential curricular reform is presented, along with mention of what are perhaps the most unusual curricular paths today. CONCLUSION: The paper concludes with an assessment of where reforms have brought US medical education by the beginning of the 21st century and what needs yet to be accomplished.     

Risk of Mortality during Four Years after Substance Detoxification in Urban Adults

The objective of this analysis was to assess the mortality rate and risk factors in adults, with substance dependence, who are not receiving primary medical care (PC). Date and cause of death were identified using the National Death Index data and death certificates for 470 adults without PC over a period of almost 4 years after detailed clinical assessment after detoxification. Factors associated with risk of mortality were determined using stepwise Cox proportional hazards models. Subjects were 76% male, 47% homeless, and 47% with chronic medical illness; 40% reported alcohol, 27% heroin, and 33% cocaine as substance of choice. Median age was 35. During a period of up to 4 years, 27 (6%) subjects died. Median age at death was 39. Causes included: poisoning by any substance (40.9% of deaths), trauma (13%), cardiovascular disease (13.6%), and exposure to cold (9.1%). The age adjusted mortality rate was 4.4 times that of the general population in the same city. Among these individuals without PC in a detoxification unit, risk factors associated with death were the following: drug of choice [heroin: hazard ratio (HR) 6.9 (95% confidence interval (CI) 1.6–31.1]; alcohol: HR 3.7 (95% CI 0.79–16.9) compared to cocaine); past suicide attempt (HR 2.1, 95% CI 0.96–4.5); persistent homelessness (HR 2.4, 95% CI 1.1–5.3); and history of any chronic medical illness (HR 2.1, 95% CI 0.93–4.7). Receipt of primary care was not significantly associated with death (HR 0.85, 95% CI 0.34–2.1). Risk of mortality is high in patients with addictions and risk factors identifiable when these patients seek help from the health care system (i.e., for detoxification) may help identify those at highest risk for whom interventions could be targeted. Saitz, Cheng, Richardson, and Samet are with the Clinical Addiction Research and Education Unit, Department of Medicine, Boston Medical Center, Boston, MA, USA; Saitz, Gaeta, Cheng, Richardson, and Samet are with the Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA; Saitz and Richardson are with the Youth Alcohol Prevention Center, Boston University School of Public Health, Boston, MA, USA; Gaeta is with the Boston Health Care for the Homeless Program, Boston, MA, USA; Cheng is with the Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA; Larson is with the New England Research Institutes, Watertown, MA, USA; Samet is with the Department of Social & Behavioral Sciences, Boston University School of Public Health, Boston, MA, USA.