医院经营数据每日发布系统设计与应用

介绍医院经营数据每日发布系统的设计思路、采用的技术方法、数据库设计、系统架构及程序运行环境,阐述系统功能设计、功能实现,对系统的数据发布对象、发布内容、发布形式及未来发展进行讨论。经营数据每日发布系统的建立使数据仓库的内容更丰富,医院管理人员掌握信息更灵活。     

Research and applications: Formative evaluation of the accuracy of a clinical decision support system for cervical cancer screening

Objectives

We previously developed and reported on a prototype clinical decision support system (CDSS) for cervical cancer screening. However, the system is complex as it is based on multiple guidelines and free-text processing. Therefore, the system is susceptible to failures. This report describes a formative evaluation of the system, which is a necessary step to ensure deployment readiness of the system.

Materials and methods

Care providers who are potential end-users of the CDSS were invited to provide their recommendations for a random set of patients that represented diverse decision scenarios. The recommendations of the care providers and those generated by the CDSS were compared. Mismatched recommendations were reviewed by two independent experts.

Results

A total of 25 users participated in this study and provided recommendations for 175 cases. The CDSS had an accuracy of 87% and 12 types of CDSS errors were identified, which were mainly due to deficiencies in the system''s guideline rules. When the deficiencies were rectified, the CDSS generated optimal recommendations for all failure cases, except one with incomplete documentation.

Discussion and conclusions

The crowd-sourcing approach for construction of the reference set, coupled with the expert review of mismatched recommendations, facilitated an effective evaluation and enhancement of the system, by identifying decision scenarios that were missed by the system''s developers. The described methodology will be useful for other researchers who seek rapidly to evaluate and enhance the deployment readiness of complex decision support systems.     

面向区域医疗协同的可扩展远程医学教育系统设计与实现

在分析远程医学教育系统需求的基础上,提出构建可扩展远程医学教育系统和具体的系统架构;详细分析系统在前端、应用层、数据库层的可扩展性;以分层方式分析系统的部署模型;解释课件点播和实时交互两种培训模式的网络选型。最后说明可扩展远程医学教育系统的使用情况及社会效益。     

基于B/S模式的体检信息系统开发与应用

按照体检中心的业务流程和信息化管理需求,提出基于B/S架构的体检信息系统。详细介绍系统的架构设计、开发环境和功能应用,实现体检业务全流程信息化管理。结果表明系统设计和应用满足体检中心数字化、自动化、规范化的需求,同时提高体检中心的工作效率和管理质量。     

The acquisition of a Laboratory Information System

The Hinsdale Sanitarium and Hospital Pathology Department installed a Pathlab (The MEDLAB Company) Laboratory Information System (LIS) in October of 1977. Acquisition of the system was based upon a study, “Justification for a Laboratory Information System”, prepared in October 1976. This report presents findings on the evaluation of this system after 21/2 years of operation in relationship to the initial objectives developed in the justification study. The impact of the system on personnel (intra- and extradepartmental) as it relates to daily activities was also considered. The effectiveness of the system in contributing to the goals of improving the operation and management of the laboratory by enhancing communication of our services toward quality patient care was carefully studied through users' opinion surveys evaluation. The evaluation plan is developed by first describing the initial basic system, initial costs, and the impact of continuing costs to the institution (service, software modification, etc.). The department's problem areas were identified along with deviations from the justification expectations of the LIS. The conditions existing currently and attitudes of user personnel toward the system were surveyed at all levels of the institution. The survey revealed that 20 (87%) of 23 specific goals or expectations stated in the original justification report were satisfied. There was a partial achievement of 2 objectives (8.7%), and 1 (4.3%) was not achieved. The survey also revealed a net annual cost reduction of $128,756 as a result of the LIS. Payback period to recover the entire system's cost is estimated at 4.0 years. This includes all purchased hardware and software to date.     

Extending the capabilities of a laboratory computer system through cooperative processing

The concept of cooperative processing within the context of a hospital or laboratory computer systems environment is introduced. Two examples that produce graphical display of laboratory data are described to illustrate cooperative processing's ability to enhance a system's functionality without placing significant additional burden on system resources.     

A comprehensive cardiac exercise stress processor for environmental health effects studies

We have shown that an interactive microcomputer system using noninvasive cardiovascular measurements during exercise is both possible and practical. Experimental use of the system has verified our choice of variables as appropriate for automatic generation of a cardiovascular data base, but additional studies are required to determine the system's sensitivity for assessing health-effect decrements.     

直流伺服系统摩擦力及死区补偿的鲁棒自适应控制器

直流伺服系统的死区和摩擦力参数往往是不可知的,而且速度估计也存在误差,如果不能较好地处理这些因素将会严重影响系统的性能。针对这些问题,提出了一种鲁棒自适应控制方法,并运用Lyapunov稳定性原理证明了其稳定性;提出了使用差分器来估计速度值的方法,以减少实际系统中因速度估计误差引起的控制性能的降低。仿真结果表明：该控制方法在提高系统速度估计精度、改善摩擦力和死区补偿效果等方面具有很好的效果,为直流伺服的系统设计提供了一种较好的方法。     

远程心电系统在病区的应用

对西南医院病区心电图检查的应用需求进行分析,描述远程心电系统在病区中的应用。介绍系统的组成、功能模块、业务流程、关键技术及应用效果。远程心电系统在病区应用既可减少病人的等待时间,又能实现床旁心电检查,受到病人和临床科室欢迎。     

基于BPM的住院医师管理系统开发与实现

对医院住院医师管理系统进行开发,介绍系统组织架构、核心业务流程、总体框架、主要功能,结果表明住院医师管理信息系统各功能模块符合预期目标。     

The current systems assessment and the clinical care process

A side benefit of a current systems assessment carried out prior to automation was the development of a systematic picture of the clinical care system as captured in the system flow chart. The results of this assessment provided clinical administrators with ablueprint identifying the current system's strengths and weaknesses, which could be used both to introduce improvements and to measure the effect of such changes totally apart from the initial question of automation.     

电子病历辅助临床诊断系统研究

为共享医生诊疗经验,从相似电子病历检索的角度探讨辅助诊断系统的建设,介绍系统功能模块组成和理论算法,包括主诉相似度、诊疗模式相似度、图像相似度、综合相似度计算算法。此方法能够较为全面地根据电子病历的内容计算相似度,检索出的电子病历为医生制订诊疗计划提供参考。     

Understanding the acceptability of a computer decision support system in pediatric primary care

Objective

Individual users’ attitudes and opinions help predict successful adoption of health information technology (HIT) into practice; however, little is known about pediatric users’ acceptance of HIT for medical decision-making at the point of care.

Materials and methods

We wished to examine the attitudes and opinions of pediatric users’ toward the Child Health Improvement through Computer Automation (CHICA) system, a computer decision support system linked to an electronic health record in four community pediatric clinics. Surveys were administered in 2011 and 2012 to all users to measure CHICA''s acceptability and users’ satisfaction with it. Free text comments were analyzed for themes to understand areas of potential technical refinement.

Results

70 participants completed the survey in 2011 (100% response rate) and 64 of 66 (97% response rate) in 2012. Initially, satisfaction with CHICA was mixed. In general, users felt the system held promise; however various critiques reflected difficulties understanding integrated technical aspects of how CHICA worked, as well as concern with the format and wording on generated forms for families and users. In the subsequent year, users’ ratings reflected improved satisfaction and acceptance. Comments also reflected a deeper understanding of the system''s logic, often accompanied by suggestions on potential refinements to make CHICA more useful at the point of care.

Conclusions

Pediatric users appreciate the system''s automation and enhancements that allow relevant and meaningful clinical data to be accessible at point of care. Understanding users’ acceptability and satisfaction is critical for ongoing refinement of HIT to ensure successful adoption into practice.     

DMSS—A computer-based diabetes monitoring system

This paper describes a microcomputer-based decision support system (DSS) for diabetes monitoring. The system's basic functions include a patient management subsystem, an electronic logbook, a nutrition and exercise module, a dictionary for diabetes-related terminology, a diabetic-physician data transfer module and an on-line help capability. DMSS (Diabetes Monitoring Support System) provides a data capturing capability, trend analysis, and nutrition/exercise decision support to improve the monitoring and maintenance of diabetes. It was designed to be used by both a physician and a patient and can also serve as a useful teaching aid for a new diabetic. Its basic advantages lie in its comprehensiveness and flexibility. It is also user-friendly, easy to operate, and does not require any previous computer experience.     

A dynamic family practice information system for enhanced financial management

Problems in data management for family practice arise when family structures change frequently. The authors define a solution for a family medicine information system, which allows for the representation of both simple and complex family structures. Design criteria are presented, along with illustrations of the system's operation.     

区域产科门诊电子病历系统建设实践

构建杭州市区域产科门诊电子病历系统,介绍系统功能模块,包括高危孕产妇和危机值、产检一览表、孕妇档案等,阐述系统互联互通要求、数据交换标准并提出具体措施,指出该系统有助于提高围产期保健数据质量,实现区域妇幼信息互通共享。     

分布式实时嵌入式系统的能耗建模与分析

为支持分布式实时嵌入式（DRE）系统的能耗分析,提出了一种能耗时延Petri网（ECTPN）对系统的模块、任务、任务间关系、通信协议等进行建模。基于所建DRE的ECTPN模型,分析系统的可调度性和能耗约束,并给出启发式算法来计算满足时间约束和能耗约束的可行调度。最后应用一个实例模拟系统的建模和分析过程,从而直观地展示了该方法的可行性。     

Using a symbiotic man/machine approach to evaluating visual clinical research data

Some candidate medical expert system applications have a significant visual component. Knowledge engineers usually dismiss such task domains as potential expert systems applications. Our success in developing ESCA, a system forevaluatingserialangiograms, shows that such task domains should not be dismissed so quickly. We used a symbiotic approach between man and machine, where technologists provide the visual skills with an expert system imitating the conceptual skills of the expert, to produce a partially automated system that is more consistent and cost effective than one that is fully manual. The agreement between the system's conclusions and that of a panel of experts is good. The expert system actually has a slightly higher agreement rate with the expert panel than the agreement rate between two expert panel teams evaluating the same film pair.     

Initial impact of a clinical laboratory computer system

A longitudinal study is being conducted of a clinical laboratory computer information system's impact. This paper reports on effects that laboratory directors anticipated prior to installation, and effects reported by laboratory technologists 7 months postimplementation. Primary changes caused by the computer system were increases in the amount of paper work performed by technologists, and improvements in laboratory results reporting. The system generally was well accepted, but laboratory technologists differed in their responses to it. Technologists in some laboratories focused on work increases, whereas in other laboratories they emphasized improved information flow. The paper considers how changes in processes and outcomes of work might affect responses to a computer system. It also considers the implementation process, and suggests some areas where management could benefit from an improved understanding of responses to a computer information system.     

中医药防治阿尔茨海默病与Wnt/β-catenin信号通路作用研究述评

阿尔茨海默病(Alzheimer's disease,AD)是一种中枢神经系统退行性疾病,以记忆力减退和认知障碍为主要表现。经典Wnt信号通路是重要的信号转导通路之一,调节多种靶基因的转录、翻译,参与中枢神经系统发育的过程。Wnt/β-catenin信号通路参与多种神经系统发育过程的调节,包括突触发生及功能形态变化,神经细胞的增值分化等。Wnt/β-catenin信号通路在AD发生机制中起到非常重要的作用。近年来研究发现,中医药对Wnt/β-catenin信号通路具有调节作用,中医药具有多成分、多靶点的优势,多种中药及复方、单体具有保护神经血管单元的作用,主要是通过调节Wnt/β-catenin信号通路中的关键信号分子Wnt3a、Axin2、GSK-3β、Wnt7b、β-catenin、TCF4、Fiz9等蛋白的表达发挥作用。这对探讨AD的发病机制及中医药防治的作用机制提供理论基础。