大数据分析在智慧医疗辅助诊断中的应用与发展趋势

智慧医疗以临床大数据为基础,以物联网、云计算、人工智能等技术为手段,是一种以患者数据为中心的医疗服务模式。该文介绍了当前智慧医疗和大数据概况,分析总结了当前大数据分析在智慧医疗辅助诊断中的应用,包括在医学检验、医学图像分析、临床决策支持系统以及远程诊疗中的应用,并对大数据分析在智慧医疗诊断中的挑战及未来发展趋势进行了展望。     

远程ICU的国内外实施现状

远程重症监护(tele-intensive care unit,Tele-ICU),简称远程 ICU,是一种基于信息化技术的重症护理模式,能够通过各种形式的信息化技术对重症监护病房提供远程实时监护,与异地患者和医疗护理人员进行实时视频交流,促进优质重症监护服务资源的共享且保障患者安全[1].近年来,在人口老龄化、慢性病...     

远程医疗系统与数字化技术的发展及应用

远程医疗是随着现代通信技术和信息技术的发展而出现的一种医疗模式，其主要目标是为医疗条件差的地区提供基于专家的健康护理或紧急情况下的危重患者救护。它是远程通信技术、医疗保健技术和信息学技术的结合，反过来，这三大技术便构成了远程医疗的支撑技术。远程医疗系统的发展经历了基于有线电话的第1代远程医疗系统、基于微波和卫星通信的第2代远程医疗系统到今天基于移动通信和互联网的第3代远程医疗系统。远程医疗应用广泛，如远程诊治、远程咨询、远程手术、远程监护及远程战地救护等。远程医疗目前已成为国际上一门发展十分迅速的跨学科高新技术，成为医疗保健服务和军队卫勤医疗救护保障的一种新模式。     

失能老人智慧化远程照护的最佳证据总结

目的 通过检索、总结,系统评价智慧化养老背景下失能老人居家接受远程照护的最佳证据,为有效实施医养结合远程智慧化照护提供参考。方法 计算机检索Up To Date（中文版）、BMJ Best Practice、JBI Evidence Summary、苏格兰学院间指南网、美国远程医疗协会、Cochrane Library、Ovid、PubMed、Elsevier Science Direct、中国生物医学文献数据库、CNKI、万方数据知识服务平台等关于失能老人远程智慧化照护的相关证据,包括指南、专家共识、证据总结、系统评价、原始研究等。检索时限为建库至2022年4月30日。由两名研究员对文献质量进行独立评价,并结合专业判断,提取符合标准的文献。结果 共纳入文献14篇,其中指南3篇,系统评价9篇,随机对照试验2篇,提取了6个方面共37条证据。结论 失能老人智慧化养老远程照护须基于评估开展,由多专业照护团队借助远程医疗设备从营养、药物、活动等多方面提供专业照护,提倡全程、连续照护,以确保失能老人居家期间照护服务质量。     

失能老人智慧化远程照护发展的态势分析

智慧化远程照护是社会老龄化进程中养老服务多元化发展的新方向,本研究运用SWOT态势分析法,对失能老人智慧化远程照护策略的优势、劣势、机遇和威胁进行分析,提出健全智慧居家养老系统,完善智慧居家服务内容,优化技术、培养人才,科学评估预测失能等发展策略,达到失能老人照护服务供需动态匹配、适老化能力提高的目标。     

基于5G互联网时代智慧病房患者满意度调查研究

目的 探讨基于5G互联网时代智慧病房对住院患者满意度的影响。方法 应用以互联网、人工智能、物联网为主的5G技术及相关智能硬件设备,构建以5G技术为基础的移动护理、体征监测、无线输液监控、移动查房、远程会诊等一体化5G智慧病房,回顾性选取某三甲医院内科病房于2021年1~6月与2022年1~6月共123例患者满意度资料,对照组是5G智慧病房管理前随机抽样调查2021年1月至6月54例出院患者资料,观察组是5G智慧病房管理后随机抽样调查2022年1月至6月69例出院患者资料,比较两组应用智慧病房的住院患者满意度、健康教育满意度、健康教育效果满意度评价。结果 观察组住院患者满意度、健康教育满意度、健康教育效果评价均高于对照组,差异有统计学意义（P＜0.05）。 结论 应用智慧病房系统管理可以提高患者住院满意度、提高健康教育满意度,提升住院患者的健康教育效果。     

数字医生与平行医疗:从医疗知识自动化到系统化智能医学

针对数字转型和智慧医疗面临的诸多问题，本文讨论如何利用人工智能和数字医生，包括各种数字孪生和元宇宙方法及设想，特别是平行智能技术，集复杂性医学、跨学科医学、系统智能医学为一体，从医疗保健服务的专业分工、人机分工、虚实分工角度，构造新一代医学智能平台与设施，发展主动、精准、个性化、虚实平行互动的低成本、高效益智慧医疗服务事业。     

远程医疗会诊车的应用与管理

目的探索远程医疗会诊车的应用与管理。方法采取配备专业技术人员、定期开展野战医疗训练、建立健全管理制度等手段,保证远程医疗会诊车设备处于良好状态,随时随地提供远程医学信息服务。结果实现了远程医疗会诊车、野战医疗所与远程医学中心音视频的实时双向传输、数据互联,对伤病员进行远程诊疗等。结论应用远程医疗会诊车可以提高战时及突发事件卫勤保障功能,改革野战医疗训练演习模式,拓展远程会诊技术应用范围。     

中国远程医疗研究现状分析

目的 定性分析以中文发表的中国远程医疗研究文献。 方法 计算机检索CBM、VIP、CNKI和中国社会科学引文数据库（CSSCI）等,全面收集与远程医疗有关的临床研究,检索时限均为建库至2012年3月,并追溯纳入研究的参考文献。由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,对纳入研究的应用领域、范围、效果等方面进行定性分析。 结果 最终纳入19篇文献,包括16个半随机对照试验和3个观察性研究。按照JBI质量评价标准,16个半随机对照试验中有12个为中等质量,4个为低质量;3个观察性研究均为低质量。定性分析结果显示：远程医疗的文献报道从1995年起逐年增加, 但研究类文献在2002年才开始发表,文献数量保持均匀态势发展,发表杂志比较分散。按照远程医疗技术的应用范围分类,15个（80%）应用在远程监护方面,尤其是远程胎儿监护,4个（21%）用于远程会诊,3个（16%）用于远程治疗,19个研究结果均提示远程医疗效果优于传统医疗。 结论 我国远程医疗研究文献数量逐年增多但研究质量不高,需要进一步开展高质量研究;远程医疗技术的应用范围分布不均衡,多集中在远程监护方面;远程医疗的治疗效果良好,监测数据准确,为患者带来便利。     

国内外超声远程医疗的现状与展望

远程医疗(Telemedicine)是指医护人员利用现代通信技术，电子技术和计算机技术来实现对各种医学信息的远程采集、存储、处理、传输和查询等，从而跨越时空障碍，向更广泛的人群提供医疗保健服务、远程治疗、远程会诊、远程教育、远程咨询等。狭义的远程医疗是指研究怎样利用多媒体计算机技术，通讯技术进行医疗活动的一门学科。最早的远程医疗雏形可追     

医联体智能化采集影像质量控制专家共识

目的 随着分级诊疗制度的推行,我国已成立诸多医联体,并通过云技术实现影像互通与协同诊断,但各医院影像质量控制标准和实现程度不一,导致在医联体内推行影像互通互认存在一定问题。为基于人工智能技术于5G影像云平台项目建设中形成医联体内影像质量控制,特达成此共识,旨在为建立医联体质量控制体系提供参考。     

军队智慧疗养综合管理信息化平台的构建与研发

目的探索提升新形势下军队疗养机构卫勤保障能力和疗养服务水平。方法通过三层结构的设计构建智慧疗养综合管理信息化平台,其中引入穿戴式智能设备并结合人工智能技术研制新式智能手环,采用Java、Android、Vue、Idea Webstorm等开发语言和工具,以nodejs+vue+jquery+Spring boot+spring cloud+mybatis的技术架构为基础,结合数据分析技术开发智慧疗养APP与配套的智慧疗养管理平台。结果实现疗养保障的院前工作前移、院后服务拓展及疗养官兵健康管理的全程化、持续化与个性化,形成疗养、保障、质控、安防全方位、全过程动态管理的智慧化疗养管理模式。结论该系统的应用为探索疗养服务新模式提供了信息化支持,提高了管理效能与工作效率,有效提高疗养保障能力,促使疗养院真正成为提高官兵身心健康、再生战斗力的保健基地。     

Effect of a multiple-site intensive care unit telemedicine program on clinical and economic outcomes: an alternative paradigm for intensivist staffing

OBJECTIVE: To examine whether a supplemental remote intensive care unit (ICU) care program, implemented by an integrated delivery network using a commercial telemedicine and information technology system, can improve clinical and economic performance across multiple ICUs. DESIGN: Before-and-after trial to assess the effect of adding the supplemental remote ICU telemedicine program. SETTING: Two adult ICUs of a large tertiary care hospital. PATIENTS: A total of 2,140 patients receiving ICU care between 1999 and 2001. INTERVENTIONS: The remote care program used intensivists and physician extenders to provide supplemental monitoring and management of ICU patients for 19 hrs/day (noon to 7 am) from a centralized, off-site facility (eICU). Supporting software, including electronic data display, physician note- and order-writing applications, and a computer-based decision-support tool, were available both in the ICU and at the remote site. Clinical and economic performance during 6 months of the remote intensivist program was compared with performance before the intervention. MEASUREMENTS AND MAIN RESULTS: Hospital mortality for ICU patients was lower during the period of remote ICU care (9.4% vs. 12.9%; relative risk, 0.73; 95% confidence interval [CI], 0.55-0.95), and ICU length of stay was shorter (3.63 days [95% CI, 3.21-4.04] vs. 4.35 days [95% CI, 3.93-4.78]). Lower variable costs per case and higher hospital revenues (from increased case volumes) generated financial benefits in excess of program costs. CONCLUSIONS: The addition of a supplemental, telemedicine-based, remote intensivist program was associated with improved clinical outcomes and hospital financial performance. The magnitude of the improvements was similar to those reported in studies examining the impact of implementing on-site dedicated intensivist staffing models; however, factors other than the introduction of off-site intensivist staffing may have contributed to the observed results, including the introduction of computer-based tools and the increased focus on ICU performance. Although further studies are needed, the apparent success of this on-going multiple-site program, implemented with commercially available equipment, suggests that telemedicine may provide a means for hospitals to achieve quality improvements associated with intensivist care using fewer intensivists.     

骨科ICU的护理服务文化建设

目的分析护理服务文化在骨科ICU的创建与运用。方法用先进的服务理念,衍生出优秀的服务行为。ICU的设置是根据病人需求配备高素质的护士;采取弹性探视制度;对病人适时进行健康教育;重视ICU病人的访视工作;护士长采用“双向沟通,耐心指导”的科学管理方法,计划排班与按需排班相结合,运用经济杠杆,提高护士工作的积极性与主动性。结果优秀的护理服务文化满足了病人的需求,使病人真正得到了人性化服务,以人为本的管理促使全体护理人员自觉把个人命运和医院整体联系起来,对医院的未来产生强有力的使命感和责任感。结论护理服务文化是医院生存与发展的重要组成部分。     

Automatic quality improvement reports in the intensive care unit: One step closer toward meaningful use

AIM: To examine the feasibility and validity of electronic generation of quality metrics in the intensive care unit (ICU). METHODS: This minimal risk observational study was performed at an academic tertiary hospital. The Critical Care Independent Multidisciplinary Program at Mayo Clinic identified and defined 11 key quality metrics. These metrics were automatically calculated using ICU DataMart, a near-real time copy of all ICU electronic medical record (EMR) data. The automatic report was compared with data from a comprehensive EMR review by a trained investigator. Data was collected for 93 randomly selected patients admitted to the ICU during April 2012 (10% of admitted adult population). This study was approved by the Mayo Clinic Institution Review Board. RESULTS: All types of variables needed for metric calculations were found to be available for manual and electronic abstraction, except information for availability of free beds for patient-specific time-frames. There was 100% agreement between electronic and manual data abstraction for ICU admission source, admission service, and discharge disposition. The agreement between electronic and manual data abstraction of the time of ICU admission and discharge were 99% and 89%. The time of hospital admission and discharge were similar for both the electronically and manually abstracted datasets. The specificity of the electronically-generated report was 93% and 94% for invasive and non-invasive ventilation use in the ICU. One false-positive result for each type of ventilation was present. The specificity for ICU and in-hospital mortality was 100%. Sensitivity was 100% for all metrics. CONCLUSION: Our study demonstrates excellent accuracy of electronically-generated key ICU quality metrics. This validates the feasibility of automatic metric generation.     

比利时Sint-Jan医院ICU护理见闻及启示

文章介绍了比利时西弗兰德省Sint-Jan医院ICU的护理特点,包括以人为本的护理理念、良好的多学科团队、先进的护理仪器设备、智能化的资讯系统、人性化的护理管理、注重职业防护和重视院内感染预防等,并根据国内情况提出借鉴比利时医院的先进做法,更新我国护理一些陈旧的观念和设备,改进临床工作中的不足,提升护理服务质量。     

Descriptive analysis of critical care units in the United States.

OBJECTIVE: To gather data about available technology, staffing, administrative policies, and bed capacities of ICUs in the United States. DESIGN AND SETTING: On January 15, 1991, survey instruments were mailed to the administrators of 4,233 hospitals to gather information from the medical director of the institutions' respective ICUs for the purpose of developing a database on ICUs in the United States. The sampling frame for this study was based on all American Hospital Association (AHA) hospitals that stated they have ICUs. MEASUREMENTS: Census questionnaires solicited information on types of hospitals, types of ICUs, number of ICU beds open and closed, technology available to the unit, organizational structure and management of the ICU, as well as the staffing and certification of unit personnel. MAIN RESULTS: Data were obtained on 32,850 ICU beds with 25,871 patients from 2,876 separate ICUs in 1,706 hospitals in the United States. Census responses came from units in all sizes of hospitals within all ten census regions in the country, all states, and all types of hospital sponsorship (federal, state, and local government, private nonprofit and private for profit). The census response rate was 40% of the AHA hospitals that stated that they have ICUs, with specific ICU data on 38.7% of the nation's ICUs. The number of ICUs per hospital increases with overall hospital size. The smallest hospitals (less than 100 beds) usually had only one ICU. As hospital size increased, the single, all inclusive medical/surgical/coronary care units diminished, and in hospitals with greater than 300 beds, specialization of units became prevalent. In absolute terms, hospitals had the following number of ICUs: 1.04 +/- 0.20 (less than or equal to 100 beds); 1.30 +/- 0.65 (101 to 300 beds); 2.37 +/- 1.58 (301 to 500 beds); and 3.34 +/- 2.21 (greater than 500 beds). ICU beds averaged, nationally, 8.09% of hospital-licensed beds with a median of 6.98%. Generally, medical units, pediatric units, coronary care units (CCUs), and medical/surgical/CCUs reported an average of 10 beds per unit. Neonatal units averaged 21 beds, and surgical units averaged 12 beds. The average ICU size, nationally, was 11.7 +/- 7.8 beds per unit. Available technology within hospitals and individual units was increased as hospital size increased; surgical units tended to have more available technology than other unit types. A wide range of organizational arrangements within hospitals determines where the ICU appears in an organizational chart and to whom unit management is accountable. Thirty-six percent of the units were located organizationally within the hospital's department of medicine, while 23% were considered "free standing," having no departmental affiliation. Although units must have a medical director, the perception as to whether this director supervises the day-to-day operation was different in larger vs. smaller hospitals. In hospitals with less than or equal to 100 beds, 72% of the units were perceived to be supervised by the medical director, whereas in larger hospitals (greater than 500 beds), 81% of units were supervised. Study results indicated that medical directors in pediatric, neonatal, and burn units most often were perceived to supervise the unit. Presently, 63% of all ICUs responding are directed by an internist. The next largest group to direct ICUs were surgeons, followed by pediatricians. Pediatrician involvement tended to be exclusive in pediatric and neonatal units. Surgeons directed most surgical and neurologic units and were involved in 21% of mixed medical/surgical units. Internists predominated in medical units and in CCUs, as well as in combined medical/surgical/CCUs. Direction by anesthesiologists, although relatively infrequent, predominated in the surgical unit. Critical care medicine certification of the medical director and attending staff of the ICU increased as hospital size increased, although only 44% of all units stated that thei     

数字化重症监护病房的管理

目的：总结数字化条件下重症监护病房的管理经验。方法：以危重症临床监护信息系统为核心,通过与众多软件的链接,实现患者数据的高效管理;通过办公自动化系统、一体化护士工作站等实现ICU的人员和业务管理;通过成本核算系统、绩效系统、科室物资管理系统实现ICU的经济管理。结论：依托数字化平台,能够实现ICU的现代化、规范化的高效管理。     

人工智能在医疗彩超检查中的应用及发展趋势研究

人工智能推动了医疗领域的进步。基于此,本文以医疗彩超检查为切入点,从问题分类处理、检测问题处理以及分割问题处理三方面说明了人工智能在医疗彩超检查中的应用,并对基于人工智能的彩超检查的发展趋势进行了展望。