Clinical informatics during the COVID-19 pandemic: Lessons learned and implications for emergency department and inpatient operations

In response to a pandemic, hospital leaders can use clinical informatics to aid clinical decision making, virtualizing medical care, coordinating communication, and defining workflow and compliance. Clinical informatics procedures need to be implemented nimbly, with governance measures in place to properly oversee and guide novel patient care pathways, diagnostic and treatment workflows, and provider education and communication. The authors’ experience recommends (1) creating flexible order sets that adapt to evolving guidelines that meet needs across specialties, (2) enhancing and supporting inherent telemedicine capability, (3) electronically enabling novel workflows quickly and suspending noncritical administrative or billing functions in the electronic health record, and (4) using communication platforms based on tiered urgency that do not compromise security and privacy.     

蒲公英的促进胃肠动力活性有效部位及化学成分研究

[目的]研究蒲公英促进胃肠动力的有效部位及化学成分.[方法]采用小鼠胃肠推进运动实验确定蒲公英的有效部位,并采用NMR及MS等方法确定有效成分的结构.[结果]蒲公英中溶解于乙酸乙酯和正丁醇的部分具有促进胃肠动力的活性,分别为阿魏酸和齐墩果酸.[结论]蒲公英中溶解于乙酸乙酯和正丁醇的部分中含有促进胃肠动力的有效成份,而溶解于正丁醇部分即齐墩果酸的促进胃肠动力活性更高.     

广西桑寄生科药用植物资源的开发与应用研究

目的调查广西桑寄生科药用植物的种类、地理分布、药效功能及民间使用情况,为广西桑寄生科药用植物开发与应用提供依据。方法野外调查、市场调查、收集标本、查看资料,进行分类学对照。结果作为药材的桑寄生科药用植物共有9个属共28个种（含变种）,占广西桑寄生科植物种数的84．85％。桑寄生科药用植物全区各地均有分布,种属与寄主不同其寄生功效各异。结论广西桑寄生科药用植物具有极大的开发价值。     

药用植物生物技术与药材质量标准研究方法

根据作者多年的研究经历及近年来国内外的研究进展,结合我国中医药的优势,从现代生物技术的产生与广泛应用、中药有效成分及药材质量控制研究的重要性出发,系统地阐述了现代生物技术应用于药用植物研究的重要性及其发展趋势。着重从药用植物无性繁殖系的建立与快速繁殖、细胞次生代谢调控、药材质量标准体系的构建等方面,详细介绍了药用植物生物技术及药材质量标准研究的具体方法,以期为实现中药的安全、有效、稳定、可控和中药走向世界提供参考。     

三尖杉碱类化合物的来源、药理作用及临床应用研究进展

三尖杉属植物是主要的抗癌药用植物,三尖杉碱类化合物是其主要活性成分,主要来源于植物组织培养、化学合成、内生真菌等手段。这些生物碱有很强的抗肿瘤作用,其机制主要有抑制蛋白基因的表达、诱导细胞分化和凋亡等;因药理作用比较明显,临床上用于急、慢性白血病以及红斑狼疮等疾病的治疗。对三尖杉碱类化合物的来源和药理作用及临床应用方面的研究进展进行综述。     

Research and applications: Automatic glaucoma diagnosis through medical imaging informatics

Background

Computer-aided diagnosis for screening utilizes computer-based analytical methodologies to process patient information. Glaucoma is the leading irreversible cause of blindness. Due to the lack of an effective and standard screening practice, more than 50% of the cases are undiagnosed, which prevents the early treatment of the disease.

Objective

To design an automatic glaucoma diagnosis architecture automatic glaucoma diagnosis through medical imaging informatics (AGLAIA-MII) that combines patient personal data, medical retinal fundus image, and patient''s genome information for screening.

Materials and methods

2258 cases from a population study were used to evaluate the screening software. These cases were attributed with patient personal data, retinal images and quality controlled genome data. Utilizing the multiple kernel learning-based classifier, AGLAIA-MII, combined patient personal data, major image features, and important genome single nucleotide polymorphism (SNP) features.

Results and discussion

Receiver operating characteristic curves were plotted to compare AGLAIA-MII''s performance with classifiers using patient personal data, images, and genome SNP separately. AGLAIA-MII was able to achieve an area under curve value of 0.866, better than 0.551, 0.722 and 0.810 by the individual personal data, image and genome information components, respectively. AGLAIA-MII also demonstrated a substantial improvement over the current glaucoma screening approach based on intraocular pressure.

Conclusions

AGLAIA-MII demonstrates for the first time the capability of integrating patients’ personal data, medical retinal image and genome information for automatic glaucoma diagnosis and screening in a large dataset from a population study. It paves the way for a holistic approach for automatic objective glaucoma diagnosis and screening.     

安眠颗粒治疗失眠的中药筛选及临床研究

目的:观察纯中药医院制剂安眠颗粒对失眠的疗效。方法:将140例患者分为试验组30例;对照组50例、60例,疗效进行统计学分析。结果:试验组总有效率、睡眠最长持续时间、睡眠总量优于对照组。结论:安眠颗粒治疗失眠(不寐)一般症状的疗效确切。     

国内外临床数据管理系统发展现状

临床数据管理是临床试验的关键性工作,对研究结果的准确可靠性起着决定性作用,本文论述了临床数据的质量标准,介绍了临床数据管理规范化发展中的重要法规和原则,回顾了国内外临床数据管理系统的发展及其现状,并提出了积极借鉴国际先进管理模式和引入国外规范化临床数据管理软件系统,以提高国内临床数据管理水平的建议.     

新疆维吾尔族常用药食兼用植物对果蝇寿命影响的实验研究

本文观察了新疆南部长寿区１５种维吾尔族药食兼用植物对果蝇寿命的影响。实验结果表明：喂饲芜菁、石榴、香豆子、黑草种子、玫瑰花、无花果干、马奶子葡萄干、甜巴旦杏仁、阿月浑子、蔷薇红景天水浸物的果蝇成虫平均寿命显著高于空白对照组。提示这些药食兼用植物具有延长果蝇寿命的作用。     

随机对照试验及统计学分析在临床医学应用中存在的问题

随机对照试验(RCT)研究被认为是临床治疗试验中论证强度最高的试验方法,可为临床实践提供真实的科学依据,引导临床医师在实践中做出正确的决策.本文介绍了RCT的方法及设计原则,分析了在临床实际应用中存在的问题,并对RCT中统计学方法应用的常见错误进行了分析,阐述了应用RCT及采用正确的统计学分析方法的重要性.     

Pivotal Factors Concerned in Design of Acupuncture Clinical Research: From Two Articles in JAMA

Two randomized controlled trials of acupuncture concerning polycystic ovary syndrome (PCOS) and stress urinary incontinence (SUI) were published simultaneously in the 24th issue, 2017 of The Journal of the American Medical Association (JAMA). A trial involving PCOS indicated that active acupuncture did not increase live birth compared with sham acupuncture; meanwhile, another trial referring to SUI showed that electroacupuncture resulted in less urine leakage compared with sham electroacupuncture. With an eye to the negative and positive results of acupuncture, three pivotal factors should be contemplated: (1) proper illness for acupuncture, that is, a problem need to be solved in current medical science, and acupuncture may really work for it; (2) proper pre-studied primary outcome, which is better be objective and repeatedly measurable to reveal the therapeutic effect of acupuncture truly and objectively; (3) proper sham control, which can blind the patients to the upmost extent with minimal biological effects. Through the publication of clinical trials of acupuncture in high-impact journals in recent years, researchers should have confidence in their clinical trials by pondering over these three pivotal factors.     

中国临床试验注册和发表机制及实施说明

2006年4月16～17日在成都召开第四届亚太地区循证医学研讨会期间,中国48家医(药)学期刊和中国临床试验注册中心(Chinese Clinical Trial Register,ChiCTR)、卫生部中国循证医学中心、循证医学教育部网上合作研究中心和Chinese Cochrane Centre的代表经过充分讨论达成共识,决定共同发起创建中国临床试验注册和发表机制,并成立"中国临床试验注册和发表协作网(Chinese Clinical Trial Registration and Publishing Collaboration,ChiCTRPC)".这种临床医学研究管理新模式的创建和应用,将对提高中国临床试验信息透明度和质量、提高医学研究公信度发挥极其重要的作用.本文介绍其结构特点和运作方式.     

Research and applications: A question of trust: user-centered design requirements for an informatics intervention to promote the sexual health of African-American youth

Objective

We investigated the user requirements of African-American youth (aged 14–24 years) to inform the design of a culturally appropriate, network-based informatics intervention for the prevention of HIV and other sexually transmitted infections (STI).

Materials and Methods

We conducted 10 focus groups with 75 African-American youth from a city with high HIV/STI prevalence. Data analyses involved coding using qualitative content analysis procedures and memo writing.

Results

Unexpectedly, the majority of participants’ design recommendations concerned trust. Youth expressed distrust towards people and groups, which was amplified within the context of information technology-mediated interactions about HIV/STI. Participants expressed distrust in the reliability of condoms and the accuracy of HIV tests. They questioned the benevolence of many institutions, and some rejected authoritative HIV/STI information. Therefore, reputational information, including rumor, influenced HIV/STI-related decision making. Participants’ design requirements also focused on trust-related concerns. Accordingly, we developed a novel trust-centered design framework to guide intervention design.

Discussion

Current approaches to online trust for health informatics do not consider group-level trusting patterns. Yet, trust was the central intervention-relevant issue among African-American youth, suggesting an important focus for culturally informed design. Our design framework incorporates: intervention objectives (eg, network embeddedness, participation); functional specifications (eg, decision support, collective action, credible question and answer services); and interaction design (eg, member control, offline network linkages, optional anonymity).

Conclusions

Trust is a critical focus for HIV/STI informatics interventions for young African Americans. Our design framework offers practical, culturally relevant, and systematic guidance to designers to reach this underserved group better.     

Enhancing the use of EHR systems for pragmatic embedded research: lessons from the NIH Health Care Systems Research Collaboratory

ObjectiveWe identified challenges and solutions to using electronic health record (EHR) systems for the design and conduct of pragmatic research.Materials and MethodsSince 2012, the Health Care Systems Research Collaboratory has served as the resource coordinating center for 21 pragmatic clinical trial demonstration projects. The EHR Core working group invited these demonstration projects to complete a written semistructured survey and used an inductive approach to review responses and identify EHR-related challenges and suggested EHR enhancements.ResultsWe received survey responses from 20 projects and identified 21 challenges that fell into 6 broad themes: (1) inadequate collection of patient-reported outcome data, (2) lack of structured data collection, (3) data standardization, (4) resources to support customization of EHRs, (5) difficulties aggregating data across sites, and (6) accessing EHR data.DiscussionBased on these findings, we formulated 6 prerequisites for PCTs that would enable the conduct of pragmatic research: (1) integrate the collection of patient-centered data into EHR systems, (2) facilitate structured research data collection by leveraging standard EHR functions, usable interfaces, and standard workflows, (3) support the creation of high-quality research data by using standards, (4) ensure adequate IT staff to support embedded research, (5) create aggregate, multidata type resources for multisite trials, and (6) create re-usable and automated queries.ConclusionWe are hopeful our collection of specific EHR challenges and research needs will drive health system leaders, policymakers, and EHR designers to support these suggestions to improve our national capacity for generating real-world evidence.     

中医临床信息标准体系框架与体系表的构建方法及研究路径

本研究基于目的性原则、系统性原则、科学性原则和实用性原则,创造性地提出了中医临床信息标准体系框架与体系表的构建方法：“自上而下”管理驱动的方法建立信息标准体系框架;“自下而上”业务驱动的方法建立中医临床信息概念模型;基于HL7CDAHD信息模型对中医临床信息特征数据元素进行表示;基于中医临床特征信息元素的值域分析中医临床信息标准的需求,从而构建中医临床信息标准体系表。同时,描绘了中医临床信息标准体系框架与体系表的研究路径,可供其他健康信息领域编制信息标准体系框架与体系表时参考。     

Healthcare Process Modeling to Phenotype Clinician Behaviors for Exploiting the Signal Gain of Clinical Expertise (HPM-ExpertSignals): Development and evaluation of a conceptual framework

ObjectiveThere are signals of clinicians’ expert and knowledge-driven behaviors within clinical information systems (CIS) that can be exploited to support clinical prediction. Describe development of the Healthcare Process Modeling Framework to Phenotype Clinician Behaviors for Exploiting the Signal Gain of Clinical Expertise (HPM-ExpertSignals).Materials and MethodsWe employed an iterative framework development approach that combined data-driven modeling and simulation testing to define and refine a process for phenotyping clinician behaviors. Our framework was developed and evaluated based on the Communicating Narrative Concerns Entered by Registered Nurses (CONCERN) predictive model to detect and leverage signals of clinician expertise for prediction of patient trajectories.ResultsSeven themes—identified during development and simulation testing of the CONCERN model—informed framework development. The HPM-ExpertSignals conceptual framework includes a 3-step modeling technique: (1) identify patterns of clinical behaviors from user interaction with CIS; (2) interpret patterns as proxies of an individual’s decisions, knowledge, and expertise; and (3) use patterns in predictive models for associations with outcomes. The CONCERN model differentiated at risk patients earlier than other early warning scores, lending confidence to the HPM-ExpertSignals framework.DiscussionThe HPM-ExpertSignals framework moves beyond transactional data analytics to model clinical knowledge, decision making, and CIS interactions, which can support predictive modeling with a focus on the rapid and frequent patient surveillance cycle.ConclusionsWe propose this framework as an approach to embed clinicians’ knowledge-driven behaviors in predictions and inferences to facilitate capture of healthcare processes that are activated independently, and sometimes well before, physiological changes are apparent.     

中国临床试验注册和发表机制及实施说明

2006年4月16~17日在成都召开第四届亚太地区循证医学研讨会期间,中国48家医(药)学期刊和中国临床试验注册中心(Chinese Clinical TrialRegister,ChiCTR)、卫生部中国循证医学中心、循证医学教育部网上合作研究中心和ChineseCochrane Centre的代表经过充分讨论达成共识,决定共同发起创建中国临床试验注册和发表机制,并成立“中国临床试验注册和发表协作网(ChineseClinical Trial Registration and Publishing Collabo-ration,ChiCTRPC)”。这种临床医学研究管理新模式的创建和应用,将对提高中国临床试验信息透明度和质量、提高医学…     

气血立论治疗家兔实验性肾炎的研究

以尿蛋白、尿管型、尿红细胞、血清 Cr、BUN、双肾病理活检的 GD、GC、GP、GM 共九项客观指标,采用抗原抗体复合物免疫学方法诱发成年健康家兔形成实验性肾炎的疾病模型。并按照中医气血立论,组成肾康(黄芪、当归等)、肾通(大黄、红花等)和康通(两组药物合用)三组中药配方,分别治疗家兔实验性肾炎,外设环强组(环磷酰胺+强的松)、康强组(肾康组药物+强的松)、空白组比较观察其药效。结果九项客观指标同步地反映药效大小顺序是:康通≥肾通≥肾康>康强≥环强>空白,且具有统计学意义,证明气血立论治疗实验性肾炎具有一定意义.