基于卫生信息平台的电子病历信息共享研究和实现

研究信息共享的关键技术,通过电子病历的标准化和结构化处理、传输和交换,实现电子病历信息的共享。在卫生部电子病历数据标准的基础上,结合采用情景分析法和层次分析法,通过Delphi法专家咨询确定电子病历可以结构化的数据项,实现电子病历的标准化和结构化处理;然后运用SWOT分析法,结合应用可扩展标记语言（XML）和临床文档结构标准（CDA）两项技术,实现电子病历的标准化传输和交换,使得电子病历信息在传输和交换过程中能够被机器自动识别,实现数据的自动化传输和交换;最后,研发电子病历完整性测试系统,实现电子病历完整性的自动测试。完成电子病历信息标准化和结构化处理、传输和交换全流程的技术研究,形成技术规范。有123家医院实现电子病历标准化上传省级卫生信息平台,有16家电子病历提供商具备了电子病历标准化和结构化处理、传输和交换能力。初步实现了电子病历的信息共享,电子病历数据传输技术规范作为浙江省地方标准正式颁布实施。     

电子病历系统临床文档的语义表示的建构研究

本文论述了电子病历系统的目标和边界范围,从分析临床文档语义框架的层次结构入手,引入临床文档体系结构(CDA)来描述电子病历的临床信息,为设计、实施标准化、结构化的电子病历系统奠定了语义建构的基础.     

手外科电子病历的设计与实现

目的 设计开发手外科电子病历系统.方法 以SQL Server 2005为后台数据库、以Delphi 7.0为前台开发工具,建立结构化手外科电子病历.结果 系统运行良好,实现了用计算机技术管理手外科病人医疗信息.结论 该系统能有效提高医生书写病历的效率与质量,减轻医生的工作量,为将来全面实现电子病历打下基础.     

基于DICOM结构化报告模型和可扩展标记语言的放疗计划电子病历*

背景：如何建立DICOM标准与医院信息系统间的互联和共享成为新的研究方向。 目的：通过对DICOM结构化报告标准的研究,结合可扩展标记语言结构的特点,设计出适合放射治疗计划的电子病历。 方法：根据DICOM结构化报告标准,设计放射治疗计划电子病历的专业模板,使用可扩展标记语言模式对DICOM数据格式进行重定义,以面向对象的方法生成符合结构化报告标准的可扩展标记语言文件,然后进行可扩展样式表语言的转换或者生成符合DICOM结构化报告标准的DICOM文件。 结果与结论：针对放射治疗计划对象的特点,设计了放疗计划结构化报告模板,包含36个模板标识符。在Visual C++ 2008平台编写的软件上可以生成3种格式的电子病历文件,可以很好的与医院信息系统互连,最终实现以电子化的方式管理放疗计划信息,减少人工误差,实现真正的无纸化。     

基于多特征融合的中文电子病历命名实体识别

目的针对某三级甲等医院电子病历中的非结构化部分(诊断和病情),建立多特征融合的条件随机场模型,自动化识别用自然语言描述的电子病历(electronic medical records,EMR)中的疾病和症状,从而实现电子病历信息的结构化存储,以利于电子病历的信息挖掘和统计分析。方法将手动标注的语料库分为训练集和测试集,借助NLPIR工具分割文本,选择CRF++工具进行实验。针对中文电子病历的数据特点,先选取基本特征和相应的特征模板,通过不同上下文窗口的对比实验确定其大小;再分别添加引导词特征和构词结构特征,对比两种高级特征对实验结果的影响。结果仅选取基本特征,上下文窗口为7时,识别效果最好;添加高级特征后,最终疾病实体F值为92.80%,症状实体F值为94.17%。结论条件随机场模型融合多种有效的特征,可以很好地识别出电子病历中的疾病和症状实体。本研究对电子病历的命名实体识别有重要的意义。     

鼻专科电子病历的设计与实现

目的设计与开发鼻专科电子病历，以实现对鼻专科病人信息的采集、加工、存储和传输。方法以SQL SERVER 2000为后台数据库、MS Visual Foxoro 6．0为前台开发工具，通过建立鼻专科结构化病历，实现鼻专科电子病历系统。结果该专科病历系统已在耳鼻喉科使用，实践证明，该系统运行艮好，达到了存储和传输病人信息、实现快速查询的目的。结论该系统能够有效提高医生书写病历的效率与质量，为将来全面实现电子病历打下了基础。     

眼眶病科电子病历系统的建立和应用

目的设计与开发眼眶病科电子病历，以实现对眼眶病科病人信息的采集、加工、存储和传输。方法以Microsoft SQL Server2005为后台数据库、Microsoft Visual Studio2005为前台开发工具，通过建立一个以医学图像存储为主的结构化病历，实现了眼眶病科电子病历系统。结果该病历系统已在眼眶病科使用，实践证明，其运行稳定、查询快捷、操作简明、信息显示丰富、打印详尽。结论该系统能够有效提高医生的工作效率及医疗质量，为眼眶病科病例数据的收集及将来全面实现电子病历积累了宝贵经验。     

基于电子病历的医院信息化建设

电子病历在医院信息化发展中发挥了非常重要的作用.该文阐述了电子病历启用的背景,电子病历发展过程中的三个阶段,新一代电子病历的功能技术,电子病历今后的发展趋势以及电子病历推进与发展的重大意义.     

基于Skip-gram词嵌入算法的结构化患者特征表示方法研究

目的基于表示学习中的Skip-gram词嵌入算法,寻找能够克服电子病历中结构化特征的高维性并在语义层次上表示特征的方法。方法本文的数据来源于北京市某三甲医院的电子病历系统,从中提取患者的结构化特征,包括疾病、药物和实验室指标,其中实验室指标通过正常值范围离散化;利用Skip-gram算法,将电子病历中离散型患者特征(疾病和药物)和离散后的连续型患者特征(实验室指标)嵌入到同一个低维实数向量空间中。通过t-SNE降维可视化方法显示低维实数空间中特征向量的关系,并与特征向量间的余弦距离计算结果相互印证,从而评价特征表示的有效性和揭示特征向量间的潜在联系。结果患者特征的低维实数向量既降低了患者特征的维度,又很好地表征了特征间的潜在联系,临床含义相关的特征表示成的低维实数向量也很相近。结论基于Skip-gram算法将患者结构化特征表示成低维实数向量取得了较好的效果,为解决EMR数据表示的高维性以及结构化特征间潜在关系分析提供一种思路。     

中文电子病历中否定术语检出方法研究

对中文电子病历中的否定术语进行检测,可以为非结构化的电子病历文本的概念索引的建立提供依据。对于电子病历中术语的提取,在经典的正向最大匹配算法的基础上,结合互信息,可以有效地避免覆盖性歧义对提取结果的影响;对于否定语义的确定,在基于规则算法的基础上,结合词共现率模型,有效地降低了由于标点录入错误而出现假阳性术语的概率。通过实验表明,本文提出的方法相对于传统的基于规则的算法,阴性结果的预测值提高了6.85%。     

肝外胆管梗阻病变MSCT曲面重建胆管成像与MRCP的比较研究

目的比较多层螺旋CT（MSCT）曲面重建（CPR）胆管成像与磁共振胰胆管成像（MRCP）对肝外胆管梗阻病变的诊断价值。方法66例经B超检查提示有肝外胆管梗阻病变的患者，采用单次激发快速自旋回波（SSFSE）序列，行MRCP检查，同期采用10mm层厚层距，使用血管对比剂，行MSCT增强扫描，将门静脉期图像采用2．5mm层厚、1．25mm层距重建，获得轴面源像（ASI），数据传输至图像工作站，作CPR胆管成像。比较CPR胆管成像、MRCP对肝外胆管梗阻病变的定位、定性诊断价值。结果CPR胆管成像、MRCP成功率为100％；CPR胆管成像、MRCP均对肝外胆管梗阻部位做出明确诊断，定位诊断率为100％；CPR胆管成像、MRCP定性诊断率分别为95．5％和80．9％。结论CPR胆管成像、MRCP对肝外胆管梗阻病变均能明确定位，CPR胆管成像定性诊断率明显高于MRCP，CPR胆管成像显示胆管及其周围病变与扩张胆管的关系更直观。     

A comparison of standard cardiopulmonary resuscitation and active compression-decompression resuscitation for out-of-hospital cardiac arrest. French Active Compression-Decompression Cardiopulmonary Resuscitation Study Group.

BACKGROUND: We previously observed that short-term survival after out-of-hospital cardiac arrest was greater with active compression-decompression cardiopulmonary resuscitation (CPR) than with standard CPR. In the current study, we assessed the effects of the active compression-decompression method on one-year survival. METHODS: Patients who had cardiac arrest in the Paris metropolitan area or in Thionville, France, more than 80 percent of whom had asystole, were assigned to receive either standard CPR (377 patients) or active compression-decompression CPR (373 patients) according to whether their arrest occurred on an even or odd day of the month, respectively. The primary end point was survival at one year. The rate of survival to hospital discharge without neurologic impairment and the neurologic outcome were secondary end points. RESULTS: Both the rate of hospital discharge without neurologic impairment (6 percent vs. 2 percent, P=0.01) and the one-year survival rate (5 percent vs. 2 percent, P=0.03) were significantly higher among patients who received active compression-decompression CPR than among those who received standard CPR. All patients who survived to one year had cardiac arrests that were witnessed. Nine of 17 one-year survivors in the active compression-decompression group and 2 of 7 in the standard group, respectively, initially had asystole or pulseless electrical activity. In 12 of the 17 survivors who had received active compression-decompression CPR, neurologic status returned to base line, as compared with 3 of 7 survivors who had received standard CPR (P=0.34). CONCLUSIONS: Active compression-decompression CPR performed during advanced life support significantly improved long-term survival rates among patients who had cardiac arrest outside the hospital.     

The effect of PGF2 alpha on human and rat oral mucosa

PGF2 alpha exerts a cytoprotective effect on the oral mucous membrane against the caustics, trichloroacetic acid and silver nitrate. The prophlogistic effect of PGF2 alpha and a caustic agent acting synergistically is an exaggerated inflammatory reaction (caustic-prostaglandin reaction or CPR). Intraperitoneal pretreatment with PGF2 alpha can prevent this CPR in rats. Probably the prostaglandin pretreatment depresses the PG receptors. Intraperitoneal pretreatment with indomethacin evokes a more marked CPR in rats. Probably the indomethacine pretreatment activates the PG receptors. Histological sections of the rat oral mucosa show a much less marked reaction after PGF2 alpha pretreatment. They also show signs of more marked swelling after indomethacin pretreatment.     

自噬水平变化对心脏骤停心肺复苏后大鼠海马神经元凋亡的影响

目的探讨自噬水平变化对心脏骤停心肺复苏(CA/CPR)后大鼠海马神经元凋亡的影响。方法将40只大鼠随机分为假手术组(sham)、CA/CPR模型组(model)、雷帕霉素(Rapa)组(CA/CPR+Rapa)及3-甲基腺嘌呤(3-MA)组(CA/CPR+3-MA)。采用呼气末夹闭气管窒息法复制大鼠CA/CPR动物模型,分别给予自噬激动剂Rapa 0.2 mg/kg及自噬抑制剂3-MA 10 mg/kg进行干预。采用神经功能缺陷评分(NDS)评价CA/CPR大鼠神经功能;用TUNEL染色法检测大鼠海马神经元的凋亡变化;用RT-PCR和Western blotting法检测大鼠海马内微管蛋白轻链3(LC3)、Beclin-1、Bax、Bcl-2及Caspase-3 mRNA和蛋白的表达水平。结果与假手术组比较,CA/CPR模型组大鼠NDS评分明显降低;海马神经元TUNEL染色阳性细胞数明显增多,凋亡率显著升高;海马内LC3、Beclin-1、Caspase-3、Bax表达上调,Bcl-2表达下调(P<0.05,P<0.01)。与模型组比较,CA/CPR+Rapa大鼠NDS评分明显降低,而海马神经元凋亡率明显有所增加,海马内LC3、Beclin-1、Caspase-3、Bax表达明显上调,而Bcl-2表达则明显有所下降;CA/CPR+3-MA大鼠NDS评分明显升高,而海马神经元凋亡率下降,海马内LC3、Beclin-1、Caspase-3、Bax表达明显下调,而Bcl-2表达则有所升高(P<0.05,P<0.01)。结论 CA/CPR后自噬水平升高促进海马神经元凋亡,自噬水平降低抑制海马神经凋亡,两者相互作用共同参与CA/CPR的病理过程。     

CPR in medical schools: learning by teaching BLS to sudden cardiac death survivors – a promising strategy for medical students?

Background  

Cardiopulmonary resuscitation (CPR) training is gaining more importance for medical students. There were many attempts to improve the basic life support (BLS) skills in medical students, some being rather successful, some less. We developed a new problem based learning curriculum, where students had to teach CPR to cardiac arrest survivors in order to improve the knowledge about life support skills of trainers and trainees.     

Cumulative pregnancy rate following in-vitro fertilization: the significance of age and infertility aetiology

During the years 1984–1992, 951 couples completed 2252in-vitro fertilization (TVF) treatment cycles at the In-VitroFertilization Unit of The Chaim Sheba Medical Centre. This studywas conducted to evaluate the success of IVF using the cumulativepregnancy rate (CPR), with special emphasis on the optimal numberof treatment cycles, the age of the patients and female infertilityfactors. It was found that the CPR showed a constant rise duringthe six initial IVF treatments (56% CPR), and plateaued in thesubsequent three cycles (63% CPR). Various female infertilityfactors did not influence this rate. Women >40 years of agehave a significantly lower CPR. Thus, it was concluded thatthe CPR in IVF declined after the sixth initial treatment cycle,and in women >40 years of age. The infertility factor didnot significantly influence CPR.     

基于ADuC812电动心肺复苏装置的研制

电动式心肺复苏装置用于克服当前气动心肺复苏器对瓶装气体消耗大而无法多次对伤病员施救的缺陷。电动式心肺复苏机控制系统以单片机ADuC812为核心实现胸外按压的电控电动式控制和呼吸通气的电控气动式控制;按压组件由电机、驱动连杆和按压头组成,并实施按压;呼吸管路采用加鱼嘴阀的设计方案。电动式心肺复苏装置有效地节约了氧气,实现了对伤病员的多次救助,尤其适用于突发性群伤事件。     

Survival after cardiopulmonary resuscitation in babies of very low birth weight. Is CPR futile therapy?

We conducted a retrospective study of outcome after cardiopulmonary resuscitation (CPR) in babies of very low birth weight. Of 158 such babies (birth weight, less than 1500 g) admitted to a neonatal intensive care unit in 1985, 49 (31 percent) underwent CPR. Low birth weight, low Apgar scores, birth asphyxia, pulmonary interstitial emphysema, hyaline membrane disease, and severe intraventricular hemorrhage were associated with the need for CPR. None of the 38 babies who received CPR in the first three days of life survived. Four of the 11 babies who received CPR after the first 72 hours survived. Three of the four survivors had residual neurologic deficits. Survival rates after CPR in infants of very low birth weight are lower than those in older children or adults. CPR may therefore be considered a nonvalidated therapy in this population. If the results of our study are confirmed, CPR should not be instituted automatically in very-low-birth-weight babies as though it were a validated treatment. Instead, it should be administered upon parents' advance informed consent to experimental treatment.