国家卫生信息概念数据模型与HL7 RIM的映射研究

目的:确定国家卫生信息概念数据模型与HL7 RIM之间的关系,检验概念数据模型的范围. 方法:在深刻理解RIM中每一个类或概念的基本定义及其在RIM中的角色的基础上,使它们与国家卫生信息概念数据模型中的实体一一对应. 结果:在所选取用于映射的211个不同层次的RIM类或概念中,共有165个有相应的概念数据模型实体与之映射,占全部的78.20%. 结论:国家卫生信息概念数据模型与HL7 RIM有着很强的映射关系,国家卫生信息概念数据模型在概念水平上是与国际卫生信息模型保持一致的.     

The Clinical Document Architecture and the Continuity of Care Record: A Critical Analysis

Health care provides many opportunities in which the sharing of data between independent sites is highly desirable. Several standards are required to produce the functional and semantic interoperability necessary to support the exchange of such data: a common reference information model, a common set of data elements, a common terminology, common data structures, and a common transport standard. This paper addresses one component of that set of standards: the ability to create a document that supports the exchange of structured data components. Unfortunately, two different standards development organizations have produced similar standards for that purpose based on different information models: Health Level 7 (HL7)'s Clinical Document Architecture (CDA) and The American Society for Testing and Materials (ASTM International) Continuity of Care Record (CCR). The coexistence of both standards might require mapping from one standard to the other, which could be accompanied by a loss of information and functionality. This paper examines and compares the two standards, emphasizes the strengths and weaknesses of each, and proposes a strategy of harmonization to enhance future progress. While some of the authors are members of HL7 and/or ASTM International, the authors stress that the viewpoints represented in this paper are those of the authors and do not represent the official viewpoints of either HL7 or of ASTM International.     

基于HL7 V3模型建立应用系统自身数据模型的探讨

HL7 V3是采用模型驱动开发,RIM是HL7 V3模型的基础,DMIM和RMIM是建立在RIM基础上并用于直接生成接口消息定义的消息信息模型。由于HL7标准在医疗卫生信息领域的重要性,很多厂商试图基于HL7 V3的模型作为自身系统架构设计的基础,开发中间件平台产品或独立的应用系统。但RIM的模式完全是针对系统接口设计,并不适合应用系统设计。因此,基于HL7 V3的模型作为自身系统架构设计的基础。应抛开RIM和完全仿照RIM的DMIM、RMIM,而直接从更具体的HMD反推出未套用RIM之前的DIM,再按照适合自身系统的设计模式,建立系统自身的数据模型。     

追踪检查模式下构建四心护理管理体系的探讨

目的：探讨追踪检查模式下构建护理管理新体系，以保证患者安全，提高护理服务满意度。方法建立四心护理管理体系（“以患者为中心”的临床护理、“以管理为核心“的护理管理、“以护士为重心”的护士行为督导管理、“以护士长为向心”的护士长管理），将“以单项质量为中心”的管理模式创新为“以整体质量”为核心的管理模式，比较新管理体系实施前后住院患者满意度、分级护理质量、护理组织收到感谢资讯及亮点。结果新体系实施后出院患者满意度、分级护理质量分别由实施前的（91．52±1．62）、（90．12±1．38）上升为（97．34±2．12）、（95．42±2．36），均有统计学意义；收到感谢资讯及工作亮点分别由实施前的64、8例增加到实施后的107、20例。结论实施“以整体质量”为核心的四心护理管理体系能有效树立“以患者安全和满意”的护理管理理念，完善护理管理内涵，提高护理服务水平，密切护患关系。     

Evaluation of family history information within clinical documents and adequacy of HL7 clinical statement and clinical genomics family history models for its representation: a case report

Family history information has emerged as an increasingly important tool for clinical care and research. While recent standards provide for structured entry of family history, many clinicians record family history data in text. The authors sought to characterize family history information within clinical documents to assess the adequacy of existing models and create a more comprehensive model for its representation. Models were evaluated on 100 documents containing 238 sentences and 410 statements relevant to family history. Most statements were of family member plus disease or of disease only. Statement coverage was 91%, 77%, and 95% for HL7 Clinical Genomics Family History Model, HL7 Clinical Statement Model, and the newly created Merged Family History Model, respectively. Negation (18%) and inexact family member specification (9.5%) occurred commonly. Overall, both HL7 models could represent most family history statements in clinical reports; however, refinements are needed to represent the full breadth of family history data.     

临床数据中心的设计与实现

描述临床数据中心设计,主要包括两大部分：一是临床数据中心信息模型的设计;二是临床数据中心提供的信息服务.信息模型的设计参照HL7标准组织提供的RIM.然后根据数据库理论,设计了医疗信息按照信息模型的组织形式存储在数据库中;存储在数据库中的数据只有对外提供了需要的信息服务才具有价值,因此根据医疗行业的业务特点设计了所需要的信息服务.     

An investigation into the occupational protection status of clinical nursing staff exposed to anti-tumor drugs

ObjectiveTo investigate the occupational protection status of clinical nursing staff vocationally exposed to anti-tumor drugs.MethodsA self-designed questionnaire was used to survey 180 clinical nursing staff vocationally exposed to anti-tumor drugs.ResultsRecognition of the need for protection and dependent occupational protection behaviors were very poor in clinical nursing staff vocationally exposed to anti-tumor drugs. The management of the occupational protection of clinical nursing staff vocationally exposed to anti-tumor drugs was also seriously underdeveloped.ConclusionThere is deficiency in the understanding and related protection practices of clinical nursing staff vocationally exposed to anti-tumor drugs in our hospital. The protection measures currently employed in medical practice are inadequate in virtually every aspect considered. It is recommended that all clinical nursing staff should receive full occupational protection training in these matters. The training must raise nursing staff's awareness of the need for occupational protection and standardize their occupational protection behaviors to conform to “best practice” models. These “best practice” models should be quickly established and all staff made cognizant of them forthwith. In addition, where occupational protection systems are already in place, they should be improved to come into line with the new “best practice” models instigated.     

HL7 Clinical Document Architecture,Release 2

Clinical Document Architecture, Release One (CDA R1), became an American National Standards Institute (ANSI)–approved HL7 Standard in November 2000, representing the first specification derived from the Health Level 7 (HL7) Reference Information Model (RIM). CDA, Release Two (CDA R2), became an ANSI-approved HL7 Standard in May 2005 and is the subject of this article, where the focus is primarily on how the standard has evolved since CDA R1, particularly in the area of semantic representation of clinical events. CDA is a document markup standard that specifies the structure and semantics of a clinical document (such as a discharge summary or progress note) for the purpose of exchange. A CDA document is a defined and complete information object that can include text, images, sounds, and other multimedia content. It can be transferred within a message and can exist independently, outside the transferring message. CDA documents are encoded in Extensible Markup Language (XML), and they derive their machine processable meaning from the RIM, coupled with terminology. The CDA R2 model is richly expressive, enabling the formal representation of clinical statements (such as observations, medication administrations, and adverse events) such that they can be interpreted and acted upon by a computer. On the other hand, CDA R2 offers a low bar for adoption, providing a mechanism for simply wrapping a non-XML document with the CDA header or for creating a document with a structured header and sections containing only narrative content. The intent is to facilitate widespread adoption, while providing a mechanism for incremental semantic interoperability.     

家庭健康档案概念数据模型及其应用研究

目的构建家庭健康档案概念数据模型和数据模板,为家庭健康档案的数据采集、信息共享和信息系统建设提供标准支持。方法概念框架以居民健康档案相关业务规范为依据,数据模型参照HL7参考信息模型(RIM)和HL7数据类型,数据模板参照IHE PCC已发布的标准模板,将现行的武威市居民新型电子健康档案系统中家庭电子健康档案模块的数据项与模型和模板进行对照。建模方法采用统一建模语言(UML)。结果家庭健康档案概念数据模型包含家庭标识信息和家庭健康及其影响因素2个维度,家族性疾病等14个子维度。数据模板包含标识类、一般记录项目、家族性疾病,共产生72个数据元,现有系统中尚缺30个数据元。结论家庭健康档案概念数据模型和数据模板有助于实现健康档案内容的完整性,保证信息表达的规范化和标准化。     

HL7 V3在区域医疗交换平台中的应用研究

区域医疗交换平台是所有医疗信息系统中覆盖数据量最大、涉及信息系统种类最多的系统之一。HL7（HealthLevelSeven）标准的出现为异构医疗信息系统之间的信息数据交换与共享提供了基础条件和重要的应用价值。针对区域交换平台在国内外的研究现状以及HL7发展,概述了HL7 V2．x版本与HL7 V3版本,结合HL7 V2在区域交换平台的应用,借助HL7 V3的RIM模型及V3消息,设计了基于HL7 V3标准的区域医疗交换平台,实现了医院之间、医院与卫生机构之间的信息交换与共享。     

论基于信息标准的临床数据中心构建

结合国内外医疗信息化的现状，介绍了临床数据中心的发展历程和构建框架，该框架基于HL7RIM模型表达，同时通过各种医学信息标准和HIT技术的实现，构建基于信息标准的临床数据中心体系结构和基础架构，用以实现具备统一和开放性的系统集成框架，推动医院内异构医疗信息系统的交互，并对临床数据中心在医疗信息化过程中发挥的作用和未来发展趋势进行了展望。     

7 E教学模式联合SP在普外科护理实习教学中的应用研究

目的 探讨7E教学模式[激发（elicit）、参与（engage）、探索（explore）、解释（explain）、精制（elaborate）、评价（evaluate）、延伸（extend）]联合标准化病人（standardized patients,SP）在普外科护理实习教学中的应用。方法 将分配到解放军总医院普外科实习的80名护生作为研究对象,按进科先后顺序分为对照组和观察组,每组40人。对照组采用传统教学,观察组运用7E教学模式联合SP开展教学。考核两组实习护生理论和实践操作成绩,比较组间非技术性技能评分。采用SPSS 22.0进行t检验。结果 观察组实习护生理论成绩[（89.36±2.13） vs. （87.64±2.07）]和实践操作考核成绩[（92.07±4.33） vs. （85.19±3.46）]均优于对照组,差异有统计学意义（P<0.05）。观察组护生的非技术性技能评分（人文关怀能力、能激发学习兴趣、与患者沟通交流能力、对疾病的理解深度和护理能力、知识延伸能力、团队协作能力、临床思维能力、临床问题决策能力）均高于对照组,差异有统计学意义（P<0.05）。结论 7E教学模式联合SP应用于普外科护理实习带教,能更好地提升实习护生的理论知识和实践操作能力,有利于提高护生非技术性技能水平。     

手术室护理教学模式研究

手术室护理教学是临床护理实习的重要组成部分,本文从以问题为基础的教学模式、以“个性化”为重点的教学模式、以“情境模拟”为核心的教学模式、以“信息技术”为载体的教学模式几方面进行综述,以期探索激发护生学习兴趣、缓解焦虑情绪、巩固理论知识以及提高临床实践能力的手术室临床教学新方法,为今后手术室人才培养提供依据。     

卫生数据的集成整合研究

重点研究卫生数据的整合思路、方法和技术实现。在数据中心建设的同时进行数据规划,研究数据的采集、交换与存储问题,通过信息资源规划建立数据模型和主题数据库,基于HL7RIM模型进行数据整合与存储,最终达到消除冗余、数据共享和提供信息服务的目的。     

Implementing Single Source: The STARBRITE Proof-of-Concept Study

ObjectiveInefficiencies in clinical trial data collection cause delays, increase costs, and may reduce clinician participation in medical research. In this proof-of-concept study, we examine the feasibility of using point-of-care data capture for both the medical record and clinical research in the setting of a working clinical trial. We hypothesized that by doing so, we could increase reuse of patient data, eliminate redundant data entry, and minimize disruption to clinic workflow.DesignWe developed and used a point-of-care electronic data capture system to record data during patient visits. The standards-based system was used for clinical research and to generate the clinic note for the medical record. The system worked in parallel with data collection procedures already in place for an ongoing multicenter clinical trial. Our system was iteratively designed after analyzing case report forms and clinic notes, and observing clinic workflow patterns and business procedures. Existing data standards from CDISC and HL7 were used for database insertion and clinical document exchange.ResultsOur system was successfully integrated into the clinic environment and used in two live test cases without disrupting existing workflow. Analyses performed during system design yielded detailed information on practical issues affecting implementation of systems that automatically extract, store, and reuse healthcare data.ConclusionAlthough subject to the limitations of a small feasibility study, our study demonstrates that electronic patient data can be reused for prospective multicenter clinical research and patient care, and demonstrates a need for further development of therapeutic area standards that can facilitate researcher use of healthcare data.     

基于工作过程导向的护理学基础实训课程设计——以本科老年护理专业为例

基于工作过程导向的护理学基础实训课程以真实的临床护理工作过程为主线,设计了紧密衔接的工作情境和工作任务,采用教、学、做、评一体化的教学模式,一主多元的教学方法和多维度的评价标准,体现了护理工作的整体性、学生的主体性,遵循学生的认知发展规律,是学生进入临床实习之前必要的过渡.     

高血压合并高脂血症大鼠模型的实验研究

目的利用高脂饲料饲喂自发性高血压大鼠(SHR),构建高血压合并高脂血症大鼠模型,并对其心肾损伤进行评价,为高血压合并高脂血症治疗药物的评价提供药效学动物模型及相关方法参考。方法选取3周龄SHR随机分为空白对照组、模型组;同时选用同周龄正常血压的Wistar-Kyoto(WKY)大鼠作为模型对照组。空白对照组和模型对照组饲喂普通维持饲料,模型组饲喂高脂饲料,诱导SHR产生高血压合并高脂血症。造模期间定时测定各组大鼠的血压、体重,造模终点测定大鼠血压、血脂及体重后处死,收集心脏及肾脏组织并检测其纤维化损伤。结果 SHR高脂饲料饲喂23周后,血脂水平紊乱明显;心肾器官呈现明显的病理学改变:心肌细胞肥厚明显,肾组织小叶间动脉血管壁显著性重构,且心、肾组织严重纤维化。结论 SHR饲喂高脂饲料23周后可成功获得高血压合并高脂血症大鼠模型,其心脏及肾脏靶器官均呈现出明显的病理学改变,与人类高血压合并高脂血症临床表现较相似,有望广泛用作治疗高血压合并高脂血症的药物、或改善该类合并症心肾系统损伤的治疗药物的药效学评价模型。     

Use of intrathecal midazolam or fentanyl as an adjunct to spinal anaesthesia with bupivacaine for lower limb surgery: A randomised controlled study

BackgroundIntrathecal adjuncts have been used to prolong the quality and duration of subarachnoid anaesthesia. Midazolam given intrathecally is reported to have antinociceptive properties. The purpose of this study was to compare intrathecal midazolam with fentanyl for pain relief and patient comfort.MethodsIn this prospective, double-blind, randomised controlled trial, 90 patients for lower limb surgeries were randomly allocated to three groups: “control group” (3 ml 0.5% heavy bupivacaine), “fentanyl group” (3 ml 0.5% bupivacaine + 10 mcg fentanyl) and “midazolam group” (3 ml 0.5% bupivacaine + 1 mg midazolam). Level, duration, and quality of blocks were compared along with the duration and quality of postoperative analgesia. Haemodynamic stability and any associated complications were also noted.ResultsOnset of block was fastest in Group C (28.5 ± 13.48 min) vis-a-vis other groups (35.5 ± 26.05 min for Group “F” and 28.5 ± 23.68 min for Group “M”; P = 0.51). Duration of block was comparable in all groups (130.5 ± 39.3 min Group “C”; 126.5 ± 44.0 min Group “F” and 129.5 ± 45.7 min Group “M”; P > 0.5).Addition of adjuncts did not significantly defer the appearance of pain. Intensity of pain was lower in Group “M”. Average VAS scores were lower for Group “M” (3–4) than those for Group “C” (4–5) and Group “F” (4–6).Majority of patients required at least one dose of rescue analgesic; however, those receiving fentanyl reported better quality of postoperative analgesia than those in midazolam group.ConclusionAdjuvants improve quality of postoperative analgesia (fentanyl better than midazolam).