卫生信息交换标准在检验信息系统中的应用研究

目的 探讨卫生信息交换标准(HL7)在检验信息系统中的应用.方法 分析HL7标准协议以及消息的结构并通过编写程序实现检验仪器在以与检验信息系统(LIS)之间的通信接口.结果 运行后实现结果 数据和测试项目申请信息双向通信,结合LIS的标本条码化管理,可以显著提高工作效率.结论 数据交换的标准化是未来检验信息系统发展的必然趋势,使用HL7节约了LIS开发维护成本,节省了信息交换时间,保证了数据的可靠性,提高了工作效率.     

Classification of cardiac pacemakers: the pacemaker code

Pacemaker codes were developed to describe cardiac pacemaker function. Familiarity with these codes is essential for nurses caring for the patient with a permanent pacemaker. The article addresses the classification code of the North American Society of Pacing and Electrophysiology and the British Pacing and Electrophysiology Group and its relationship to pacemaker characteristics.     

Pacemaker Diagnostic Diagrams

Dual-chamber pacemakers interact with cardiac rhythms in complex ways. The resultant surface electrocardiograms (ECGs) are often very difficult to interpret. A simple and automatic diagnostic diagram is described that graphically illustrates pacemaker-heart interactions. Pacemaker operation is explained by a continuous series of lines and symbols that interconnect any sequence of paced and sensed events in both chambers. Fixed, programmable, and adaptive pacemaker timing intervals are all shown in a simple format. The pacemaker diagnostic diagram is plotted directly below the ECG to help users interpret the paced cardiac rhythm. The pacemaker diagnostic diagram is generated by software in a pacemaker programmer from: (1) telemetered real-time event markers; (2) fixed and programmable timing parameters (lower rate, AV interval, etc.); (3) pacemaker conditional logic. If this computer analysis of the telemetered event markers is not consistent with normal pacemaker operation, a specific error-message is printed. The pacemaker diagnostic diagram should be useful for instruction, pacemaker follow-up, and troubleshooting.     

Pulse Width Dependent Increase in the Pacemaker Automatic Interval

From a total of 51 patients equipped with rate and pulse width adjustable pulse gen erators (Microlith-P 0505, Microthin-PI 0522) implanted over the last 3 years, 10 (19.6%) showed an un expected drop in pacemaker pulse rate during pulse width programming. For one of the pulse gen erators used (Microthin-PI 0522), unexpected rate decrease occurred in 7/13 cases (53.8%). For all ex cept one patient, decrease in pacemaker pulse rate corresponded with the total refractory period of the pulse generator (320 ms), at a certain pulse width when rate drop first occurred. In seven of the patients the pulse generator automatic interval was extended from 13 ms to 171 ms beyond the re fractory period. In two patients it was necessary to replace the pulse generators. Our study strongly proves that this abnormal pacemaker functioning is a result of sensing of the polarization voltage at the pacemaker electrode/tissue interface and/or the T-wave. The polarization voltage is highly dependent on the total pacemaker electrode/tissue interface impedance. Using typical values for pulse genera tor output and input resistance and output capacitance, Faraday resistance, Helmholtz capacitance and tissue resistance at the electrode/tissue interface it was shown mathematically that in some cases the polarization voltage alone would be of sufficient amplitude and slew rate for pacemaker inhibi tion. The study demonstrates an urgent need for change in the filter characteristics by making the pulse generators less sensitive in the low frequency region and reducing the polarization voltage by reducing the output circuit capacitance. (PACE, Vol. 5, May-June, 1982)     

A standard clinical instrument interface for robotic applications

Many clinical laboratory instruments are not designed for robotic compatibility, hence the need for standardization of data communications and analyzer interface hardware. We developed an interface with supporting software that simplifies communication between a microcomputer and clinical instruments. Our interface establishes a standardized bidirectional communications protocol, which is useful in many clinical laboratory robotic projects. Instruments targeted for interfacing require no prior on-board communications capabilities. Additionally, modifications to the clinical instrument are minimized. Once installed, the interface translates input commands to codes or actions recognizable by the analyzer. Features not normally available to the user, such as electrode real-time response and full instrument status, are also reported by the interface, thereby establishing a remote monitor and control mechanism for the interfaced instrument. We have written an operating system to control the interface microcomputer, which in turn commands and monitors the clinical analyzer. A host computer controls the information flow to the interface and provides (a) requests to the interface for instrument operation and status and (b) commands to the interface to initiate the desired instrument operation. This arrangement maintains complete instrument functionality as designed by the manufacturer while allowing remote monitoring and operation of the instrument.     

Enhancing presentation skills for the advanced practice nurse: strategies for success

Professional speaking is a component of the professional practice role of the advanced practice nurse (APN). The skills to communicate effectively to one person or an audience of 100 provide the APN with the essential tools for implementing change, collaborating effectively, presenting information at professional meetings, or communicating the impact of clinical outcomes in the boardroom. Public speaking skills, a professional image, and improved communication can facilitate advancement along any career ladder. The greater your fear, the more self-confidence you will gain by stepping up to a challenge and conquering it. This article describes strategies for organizing and presenting your message in a clear and concise format. Techniques to manage the anxiety produced when attempting to articulate your thoughts is essential for effective communication. Skills for enhancing the delivery of your message through effective body language, professional image, voice modulation, and use of audiovisual aids are addressed. Creative techniques for fielding questions are key in promoting a dynamic closure and provide consistent reinforcement of the key message content.     

Computerized ordering of ultrasound examinations

A uniform format for requesting ultrasound examinations was developed in response to the installation of a computerized communication system within the hospital. This format consists of a sequence of eight question-lists (screens), which are presented to the referring physicians on a computer video terminal and from which he selects appropriate information with a light pen. With computerized ordering, it is now possible for the ultrasonographer to be assured of always receiving study indications and relevant patient clinical information while knowing that the referring physician has been advised of study contraindications, scheduling advice, and the proper patient preparation.     

Investigation on the thermo-electric-electrochemical characteristics of retired LFP batteries for echelon applications

Electric vehicles (EVs) have been developed to alleviate environmental pollution and climate change, but they leave behind a large amount of retired lithium-ion batteries (LIBs). Since the replacement of LIBs from EVs will lead to considerable waste generation, improving the echelon utilization of retired LIBs is becoming increasingly critical. In this paper, we studied the thermo-electric-electrochemical performance of retired LiFePO₄ (LFP) batteries using traditional methods, and found that the remaining capacity of retired LFP batteries has a strong correlation with their internal resistance. This result helped us to propose a rapid and elementary classification method for the calibration of the remaining capacity, and to then formulate a test protocol seeking to balance the time spent and the test cost. Besides, the cut-off voltage and charge–discharge current density have a significant impact on the calibration of the remaining capacity, especially for retired LFP batteries with low residual capacity. In the cycle life test and temperature reliability evaluation process, the results demonstrate that the retired LFP batteries have a good service life when under a lower current of charge/discharge, and the capacity reductions were 2.3%, 11.2% and 4.8% for retired LFP batteries with 80% state of health (SOH), 70% SOH and 60% SOH, respectively, after 500 cycles. Finally, considering the temperature reliability, voltage consistency and large current cycling performance of retired LFP batteries, there are still many challenges in their future echelon utilization.

Electric vehicles (EVs) have been developed to alleviate environmental pollution and climate change, but they leave behind a large amount of retired lithium-ion batteries (LIBs).     

Understanding barriers to basing nursing practice upon research: a communication model approach

It is suggested in this paper that the potential barriers to facilitating research-based practice can be comprehensively understood using a communication model approach Barriers can thus be explored related to the research findings' message, to the ways in which this message is encoded and transmitted by nurse researchers and to the ways in which the message is received, interpreted and accepted by nurse practitioners The role of research-based practice as a communication feedback mechanism is also described The paper concludes by proposing that strategies for increasing the research base of our profession are more likely to be successful if all of these potential barriers are taken into account     

The impact of the millennium problem on implantable pacemakers and defibrillators

The unpredictable behavior of computer systems on January 1, 2000, known as the millennium problem or millennium'bug,'also affects medical establishments and, due to the large use of computers in all kind of applications, cardiological clinics in particular. This review discusses the effect of the millennium computer problem on the implantation procedures and follow-up registries of implantable pacemakers and defibrillators. The review concludes that the transition in the next millennium will not influence the proper functioning of implanted pacemakers and defibrillators. The function of pacemaker/defibrillator programmers seems to be safe and no major difficulties are anticipated. Pacemaker databases and the logistics linked to the implantation and follow-up of patients and their pacemaker may and probably will be affected by the millennium transition. Using the FDA database on biomedical equipment, the actual status of all biomedical devices can be assessed.     

Communication and the terminally ILL: A theoretical model

This paper presents a conceptual theory and path model of communication involving terminally ill individuals. The theory considers three types of variables: factors that inhibit communication; a critical context variable, communication apprehension caused by the knowledge that one participant in the interaction is dying; and message variables that influence the quality of the death experience. Fifteen hypotheses predict relationships between thirteen variables; the hypotheses represent both extant research findings and original ideas that provide new directions for research.     

基于健康信息交换第七层协议的心电图仪信息化研究

背景：医疗仪器种类繁多且数据结构各异,缺乏统一的交互标准,严重阻碍了医疗仪器的信息化共享。目的：以心电图仪为研究对象,应用健康信息交换第七层协议（Health Level Seven,HL7）信息化标准实现其信息化交互,探讨基于HL7的医疗仪器信息化交互的可行性和优越性。方法：分析比较现有的数据交换标准,以HL7注释心电图作为心电图仪的交互标准,以消息引擎方式在WINCE嵌入式平台下采用.Net和可扩展标记语言关键技术实现心电图仪的标准心电数据交换协议消息解释和HL7信息化编码,并验证其有效性。结果与结论：对信息化编码后的数据成功通过HL7结构的有效性验证,心电图数据能解析并正确显示。研究结果验证了心电图仪HL7信息化的可行性,且实现方法具有较好的可扩展性和通用性。     

Learning retention in patients receiving midazolam during permanent pacemaker implantation.

This pilot study (N = 20) tested the effects of intravenous midazolam administration on learning retention after pacemaker implantation. Patients were randomized to receive teaching at 1 or 3 hours after the last dose of midazolam. Using a standardized teaching format, one of two study nurses performed the teaching that included incision care, activity restrictions, environmental factors potentially affecting pacemaker function, and follow-up requirements. Learning was evaluated by one of the investigators blinded to teaching time. Subjects in the 1-hour group retained significantly less information than those taught at 3 hours after drug administration. Patients taught later answered similar numbers of questions correctly, whereas there was much more variability in correct responses for the group taught earlier. This article reviews the effects of midazolam on memory and learning as well as provides suggestions for alterations in patient education protocols for patients receiving midazolam for pacemaker implantation. The effect of shortened length of stay on care practices is also discussed.     

Interpretation of Dual Chamber Pacemaker Electrocardiograms

A diagramming system has been developed to assist in interpreting dual chamber pacemaker electrocardiograms. The system is based on the ladder diagram principle but uses two separate ladders, one for the ECG allowing proper representation of atrial A-V and ventricular activation, and a second ladder diagram below it for pacemaker events. The system is applicable to all current single and dual chamber pacing modes and is easy to draw. The ladder diagram allows the logical sequence of timing events to be easily illustrated, and pacemaker malfunction becomes clearly recognizable as a conflict between the ECG events ladder and the pacemaker timing ladder. The system is easy to apply and may eventually prove suitable for automatic generation by computer utilizing sophisticated pacemaker telemetry.     

A clinical screening protocol for the RSVP Keyboard brain–computer interface

Purpose: To propose a screening protocol that identifies requisite sensory, motor, cognitive and communication skills for people with locked-in syndrome (PLIS) to use the RSVP Keyboard? brain–computer interface (BCI). Method: A multidisciplinary clinical team of seven individuals representing five disciplines identified requisite skills for the BCI RSVP Keyboard?. They chose questions and subtests from existing standardized instruments for auditory comprehension, reading and spelling, modified them to accommodate nonverbal response modalities, and developed novel tasks to screen visual perception, sustained visual attention and working memory. Questions were included about sensory skills, positioning, pain interference and medications. The result is a compilation of questions, adapted subtests and original tasks designed for this new BCI system. It was administered to 12 PLIS and 6 healthy controls. Results: Administration required 1?h or less. Yes/no choices and eye gaze were adequate response modes for PLIS. Healthy controls and 9 PLIS were 100% accurate on all tasks; 3 PLIS missed single items. Conclusions: The RSVP BCI screening protocol is a brief, repeatable technique for patients with different levels of LIS to identify the presence/absence of skills for BCI use. Widespread adoption of screening methods should be a clinical goal and will help standardize BCI implementation for research and intervention.

• Implications for Rehabilitation

• People with locked-in syndrome must have certain sensory, motor, cognitive and communication skills to successfully use a brain–computer interface (BCI) for communication.

• A screening profile would be useful in identifying potentially suitable candidates for BCI.

     

Computer-Assisted Measurements in Pacemaker Follow-Up

The application of increasingly sophisticated engineering techniques to cardiac pacemaker design has resulted in substantially greater complexity of follow-up which requires that more complicated measurements be made and interpreted. A feasibility study was conducted in which microcomputer software was designed to permit direct electronic communication between the computer and a commercial follow-up measurement device. This technique eliminates human error in reading or copying measurement data, and facilitates the application of computerized error-trapping, predictive interpretation of measurements, and database-management methods to pacemaker follow-up.     

Communication and the terminally ILL: A theoretical model

Abstract

This paper presents a conceptual theory and path model of communication involving terminally ill individuals. The theory considers three types of variables: factors that inhibit communication; a critical context variable, communication apprehension caused by the knowledge that one participant in the interaction is dying; and message variables that influence the quality of the death experience. Fifteen hypotheses predict relationships between thirteen variables; the hypotheses represent both extant research findings and original ideas that provide new directions for research.     

Computer Modeling of Cardiac Rhythm Disturbances and Heart-Pacemaker Interaction

Different computer models have been developed in order to study various aspects of cardiac electrophysiological processes. These models can be classified according to many parameters and also in respect to their application areas. One group of the models is devoted to computer simulation of cardiac rhythm disturbances and to reproduction of interactions between the heart and an artificial pulse generator. This report overviews the recent models of arrhythmias and heart-pacemaker interaction. Special attention is paid to (1) functioning of fundamental model elements, (2) structure of the heart model, (3) pacemaker models, and (4) forms of results offered by simulation experiments. Existing models are classified and compared. To illustrate the medical capability of rhythm and pacemaker models, three computational experiments are presented with model atrioventricular reentry tachycardia and reentry tachycardia mediated by a DDD pacemaker. Future development and utilization of arrhythmia and pacemaker models are briefly discussed.     

计算机信息系统在区域性消毒供应中心管理中的应用

目的:加强区域性消毒供应中心计算机信息系统功能,提高管理中消毒灭菌产品和相关服务的质量。方法:采用Windows操作界面和HIS系统的部分数据进行软件设计,输入设备为无线条码扫描器,输出设备为条码标签机、HP打印机,进行消毒供应中心各项工作的计算机信息化管理。结果:通过计算机信息化管理系统,优化了区域性消毒供应中心的工作流程,提高了消毒灭菌产品及相关服务的质量,节约了运营成本,获得了良好的社会效益与经济效益。结论:区域性消毒供应中心实施计算机信息化管理,是提升核心竞争力的直接手段,为高质量服务提供了保障。