Building capacity of community health centers to overcome data challenges with the development of an agile COVID-19 public health registry: a multistate quality improvement effort

ObjectiveDuring the coronavirus disease 2019 (COVID-19) pandemic, federally qualified health centers rapidly mobilized to provide SARS-CoV-2 testing, COVID-19 care, and vaccination to populations at increased risk for COVID-19 morbidity and mortality. We describe the development of a reusable public health data analytics system for reuse of clinical data to evaluate the health burden, disparities, and impact of COVID-19 on populations served by health centers.Materials and MethodsThe Multistate Data Strategy engaged project partners to assess public health readiness and COVID-19 data challenges. An infrastructure for data capture and sharing procedures between health centers and public health agencies was developed to support existing capabilities and data capacities to respond to the pandemic.ResultsBetween August 2020 and March 2021, project partners evaluated their data capture and sharing capabilities and reported challenges and preliminary data. Major interoperability challenges included poorly aligned federal, state, and local reporting requirements, lack of unique patient identifiers, lack of access to pharmacy, claims and laboratory data, missing data, and proprietary data standards and extraction methods.DiscussionEfforts to access and align project partners’ existing health systems data infrastructure in the context of the pandemic highlighted complex interoperability challenges. These challenges remain significant barriers to real-time data analytics and efforts to improve health outcomes and mitigate inequities through data-driven responses.ConclusionThe reusable public health data analytics system created in the Multistate Data Strategy can be adapted and scaled for other health center networks to facilitate data aggregation and dashboards for public health, organizational planning, and quality improvement and can inform local, state, and national COVID-19 response efforts.     

白内障手术引起房水闪光值变化的相关因素

白内障手术后早期或多或少会引起眼球的炎症反应,导致房水闪光值增加,主要与手术方式、切口的大小、术中应用灌注液和黏弹剂的性质、人工晶状体的光学设计及植入位置、患者病史等因素有关.     

原发性肝细胞癌术后早期转移复发的相关因素分析

目的 分析原发性肝细胞癌术后早期转移复发的相关因素.方法 对2006年1月至2015年1月行肝癌切除术且术后病理确诊为肝细胞癌的93例患者进行回顾性研究.将手术后1年内出现转移复发者纳入复发组,1年内未出现转移复发者纳入未复发组.分析性别、年龄、乙肝表面抗原、甲胎蛋白(AFP)、糖类蛋白肿瘤标志物19-9(CA19-9)、血糖、谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰胺转肽酶(GGT)、总胆红素、白蛋白、国际标准化值(INR)、凝血酶原时间(PT)、是否合并肝硬化、肝功能Child-Pugh分级、肿瘤大小、位置、数目、是否侵犯血管、包膜是否完整、病理分化程度、肝癌CLIP评分、肝癌TNM分期等23个因素对原发性肝癌术后早期转移复发的影响.结果 年龄、AFP、CA19-9、ALT、AST、GGT、总胆红素、白蛋白、INR、肿瘤大小、肿瘤包膜是否完整、肝癌CLIP评分、肝癌TNM分期等13个因素经单因素生存分析,差异均有统计学意义(P<0.05),而年龄、AFP、CA19-9、ALT、AST、GGT、总胆红素、肝癌CLIP评分、肝癌TNM分期等9个因素,差异均有显著统计学意义(P<0.01);AFP、肿瘤大小、肝癌的CLIP评分经多因素生存分析,差异均有统计学意义(P值分别为0.048、0.006和0.003).结论 年龄、CA19-9、ALT、AST、GGT、总胆红素、白蛋白、INR、肿瘤包膜是否完整、肝癌TNM分期等因素是肝癌术后早期转移复发的危险因素;AFP、肿瘤大小、肝癌的CLIP评分是肝癌切除术后早期转移复发的独立危险因素.     

腹腔镜下剥除卵巢巧克力囊肿后复发的相关因素研究

目的 探讨卵巢巧克力囊肿行腹腔镜下剥除手术治疗病例术后复发情况及相关因素.方法 选择我院2010年5月～2012年4月收治的卵巢巧克力囊肿行腹腔镜下剥除手术治疗病例96例进行随访及回顾性分析,记录患者卵巢巧克力囊肿复发情况,并进行相关因素的比较分析.结果 96例患者中复发12例,复发率12.5％.在各类因素中,ASF-r分期和组织粘连是影响卵巢巧克力囊肿术后复发的重要因素,轻度患者复发率7.89％,显著低于重度患者（30％）,囊肿壁与卵巢皮质组织粘连者复发率19.23％,显著高于无组织粘连者（4.55％）,差异具有统计学意义（P＜0.05）.患者婚姻状况、囊肿范围及囊肿最大径大小比较无统计学差异（P＞0.05）.结论 囊壁与卵巢皮质组织粘连是造成复发的重要因素,重度患者术后复发率高,建议腹腔镜手术应重视组织粘连和ASF-r分期的重度患者.     

Factors Influencing Pleural Effusion after Fontan Operation：an Analysis with 95 Patients

Objective To investigate the association between preoperative,operative,and postoperative factors and persistent pleural effusion after the extracardiac Fontan procedure. Methods Ninety-five consecutive patients diagnosed with univentricular heart underwent extracardiac connection using Gore-Tax conduits at the Department of Children’s Heart Centre,Justus-Liebig-University Giessen in Germany from June 1996 to July 2007. The outcome measures were duration and volume of chest tube drainage after surgical intervention. The investigated factors included age and weight at the time of operation,anatomical diagnosis,preoperative oxygen saturation,mean pulmonary artery pressure,ventricular end-diastolic pressure,fenestration,cardiopulmonary bypass time,conduit size,postoperative pulmonary artery pressure,administration of angiotensin-converting enzyme inhibitors,and postoperative infection. Associations between these factors and persistent pleural effusion after the extracardiac Fontan procedure were analyzed. Results Every patient suffered postoperative effusion. The median duration of postoperative chest tube drainage was 9 days （range,3-69 days）,and the median volume was 12 mL·kg-1·d-1 （range,2.0-37.5 mL·kg-1·d-1）. Thirty-seven （38.9%） patients had pleural drainage for more than 15 days,and the volume in 35 （36.8%） patients exceeded 25 mL·kg-1·d-1. Nineteen （20%） patients required placement of additional chest tubes for re-accumulation of pleural effusion after removal of previous chest tubes. Fifteen （17.8%） patients were hospitalized again due to pleural effusion after discharge. The median length of hospital stay after the operation was 14 days （range,4-78 days）. Multivariate analysis results showed that non-fenestration,low preoperative oxygen saturation,and postoperative infections were independent risk factors for prolonged duration of pleural drainage （P0.05）. Long cardiopulmonary bypass time,non-fenestration,small conduit size,and low preoperative oxygen saturation were independent risk factors for excessive volume of pleural drainage （P0.05）.Conclusions For reduing postoperative duration and volume of pleural drainage following Fontan procedure,it seems to be important to improve the preoperative oxygen saturation,use large size of conduit,shorten cardiopulmonary bypass time,and make fenestration during the operation,as well as avoid postoperative infections.     

胃癌根治术后复发死亡的相关因素分析

目的探讨相关因素对胃癌术后复发死亡的影响,为改善个体化综合治疗、提高术后生存率提供依据。方法回顾性分析2000年8月-2006年9月间胃癌根治术后复发者138例,其中死亡112例,对可能影响术后复发死亡的14项临床、病理和治疗措施,采用Logistic进行单因素和多因素回归分析。结果138例平均复发时间为术后19.8个月,2年内复发率76.8%,2-5年内复发率21.7%,5年后复发率1.4%;单一复发占81.9%,多种复发类型占18.1%;其中腹膜复发占49.3%,血行转移复发占34.8%,区域局部复发占15.4%;logistic单因素、多因素回归分析显示：病程分期、TNM分期、术后腹腔化疗、术前介入化疗是影响术后复发死亡的独立因素,其中腹腔化疗、介入化疗是保护因素。结论胃癌根治术后复发大部分发生在术后2年内,影响术后复发死亡的原因由多方面促成,独立因素起主要作用。     

中国和英国子宫内膜异位症患者的发病相关因素分析

目的 研究子宫内膜异位症发病的相关因素及其在中国和英国患者之间可能的差异。方法 采用病例对照研究方法,选取英国牛津John Radcliffe Hospital收治的子宫内膜异位症患者387例和非子宫内膜异位症患者199例、广州中医药大学第一附属医院收治的子宫内膜异位症患者101例和非子宫内膜异位症患者50例分别为病例组和对照组。通过标准化的WERF EPHect调查问卷,收集4组人群的身高、体质量、体质量指数、婚姻状况、工作状况、月经情况、生育情况、手术原因等临床资料并进行统计分析。结果 多因素Logistic回归分析结果显示,英国患者中体质量指数、因痛经进行手术、怀孕史、既往子宫内膜异位症手术次数、工作情况等均与子宫内膜异位症的发生相关（P<0.05）,而中国患者中痛经史与子宫内膜异位症的发生相关（P<0.05）。结论 痛经可能是中国和英国子宫内膜异位症患者最主要的相关因素;同时,子宫内膜异位症发生的相关因素在中国和英国患者之间可能存在差异。     

A review of human factors principles for the design and implementation of medication safety alerts in clinical information systems

The objective of this review is to describe the implementation of human factors principles for the design of alerts in clinical information systems. First, we conduct a review of alarm systems to identify human factors principles that are employed in the design and implementation of alerts. Second, we review the medical informatics literature to provide examples of the implementation of human factors principles in current clinical information systems using alerts to provide medication decision support. Last, we suggest actionable recommendations for delivering effective clinical decision support using alerts. A review of studies from the medical informatics literature suggests that many basic human factors principles are not followed, possibly contributing to the lack of acceptance of alerts in clinical information systems. We evaluate the limitations of current alerting philosophies and provide recommendations for improving acceptance of alerts by incorporating human factors principles in their design.     

新疆乌鲁木齐地区1150例支气管哮喘患者危险因素分析

目的对新疆乌鲁木齐地区1150例支气管哮喘患者就诊情况进行调查研究,总结分析该地区哮喘患者发病危险因素的规律,为哮喘防治提供有效依据。方法针对1150例患者进行问卷调查,包括患者一般情况、首次发作原因、经常发病原因、发作季节进行分析。结果①环境因素:上呼吸道感染的914例,占79.5%;冷空气刺激的885例,占77.0%;刺激性气味的885例,占77.0%,其中油烟刺激的578例(50.3%);发作季节以冬季为主的578例,占50.3%;②宿主因素:不同年龄组的不同性别哮喘患者分布不同,差异有统计学意义(χ2=45.095,P0.05);有明确过敏史的750例,占65.2%,其中有过敏性鼻炎的632例(55.0%);有明确的哮喘家族史的488例,占42.4%。结论新疆乌鲁木齐地区哮喘发生和(或)加重的主要危险因素以上呼吸道感染、冷空气刺激、刺激性气味、过敏史为主。在预防过程中要重视以上主要危险因素对患者的影响,以减少哮喘发作。     

Development of a tool within the electronic medical record to facilitate medication reconciliation after hospital discharge

Serious medication errors occur commonly in the period after hospital discharge. Medication reconciliation in the postdischarge ambulatory setting may be one way to reduce the frequency of these errors. The authors describe the design and implementation of a novel tool built into an ambulatory electronic medical record (EMR) to facilitate postdischarge medication reconciliation. The tool compares the preadmission medication list within the ambulatory EMR to the hospital discharge medication list, highlights all changes, and allows the EMR medication list to be easily updated. As might be expected for a novel tool intended for use in a minority of visits, use of the tool was low at first: 20% of applicable patient visits within 30 days of discharge. Clinician outreach, education, and a pop-up reminder succeeded in increasing use to 41% of applicable visits. Review of feedback identified several usability issues that will inform subsequent versions of the tool and provide generalizable lessons for how best to design medication reconciliation tools for this setting.     

内镜治疗胆总管结石术后复发的危险因素分析

目的分析内镜治疗胆总管结石术后复发的危险因素。方法回顾分析187例行经内镜乳头括约肌切开术（EST）治疗胆总管结石患者的临床资料。结果6例（3．21％）出现近期并发症,28例（14．97％）出现远期并发症,其中胆总管结石复发26例（13．90％）;体重指数高、胆管炎史、胆总管直径增大及血清胆固醇含量升高是结石复发的危险因素（P〈0．05）;乳头切口小（约1．0cm）是结石复发的保护因素（P〈0．05）。结论体重指数、胆管炎史、胆总管直径、乳头切口大小及血清胆固醇含量与EST术后结石复发相关。     

Cognitive work analysis to evaluate the problem of patient falls in an inpatient setting

Objective

To identify factors in the nursing work domain that contribute to the problem of inpatient falls, aside from patient risk, using cognitive work analysis.

Design

A mix of qualitative and quantitative methods were used to identify work constraints imposed on nurses, which may underlie patient falls.

Measurements

Data collection was done on a neurology unit staffed by 27 registered nurses and utilized field observations, focus groups, time–motion studies and written surveys (AHRQ Hospital Survey on Patient Culture, NASA-TLX, and custom Nursing Knowledge of Fall Prevention Subscale).

Results

Four major constraints were identified that inhibit nurses'' ability to prevent patient falls. All constraints relate to work processes and the physical work environment, opposed to safety culture or nursing knowledge, as currently emphasized. The constraints were: cognitive ‘head data’, temporal workload, inconsistencies in written and verbal transfer of patient data, and limitations in the physical environment. To deal with these constraints, the nurses tend to employ four workarounds: written and mental chunking schemas, bed alarms, informal querying of the previous care nurse, and informal video and audio surveillance. These workarounds reflect systemic design flaws and may only be minimally effective in decreasing risk to patients.

Conclusion

Cognitive engineering techniques helped identify seemingly hidden constraints in the work domain that impact the problem of patient falls. System redesign strategies aimed at improving work processes and environmental limitations hold promise for decreasing the incidence of falls in inpatient nursing units.     

小儿支原体肺炎病情轻重的相关因素研究

目的探讨影响小儿支原体肺炎(MPP)病情轻重的相关因素。方法选取2005—2009年广元市中心医院儿科住院的诊断为MPP患儿186例,分别在入院和出院时进行血清颗粒凝集法(MAA)和冷凝集试验(CAT)检查,根据年龄分为:≤2岁组(28例),3～5岁组(79例),≥6岁组(79例)。根据肺炎类型分为:支气管肺炎组(94例),节段性/大叶性肺炎组(92例)。≥6岁患儿按肺炎轻重程度分为支气管肺炎组(25例),中度节段性/大叶性肺炎组(31例),重度节段性/大叶性肺炎组(23例)。回顾性分析患儿的发病年龄、临床症状、肺损伤程度、实验室检查指标及血清转化率。结果≤2岁组、3～5岁组、≥6岁组患儿发热持续时间>7 d、支气管肺炎、节段性/大叶性肺炎、白细胞计数、中性粒细胞、淋巴细胞、血小板计数、C反应蛋白(CRP)水平比较,差异均有统计学意义(P<0.05)。支气管肺炎组和节段性/大叶性肺炎组患儿年龄、发热持续时间、住院时间、白细胞计数、中性粒细胞、淋巴细胞、淋巴细胞绝对计数、血小板计数、CRP、红细胞沉降率(ESR)及血清转化率比较,差异均有统计学意义(P<0.05)。≥6岁患儿支气管肺炎组、中度节段性/大叶性肺炎组、重度节段性/大叶性肺炎组住院时间、CRP水平及血清转化率比较,差异均有统计学意义(P<0.05)。结论年龄较大的MPP患儿,其发热持续时间较长,且肺损伤症状较重。肺损伤程度与当时诊断性IgM抗体是否缺失及淋巴细胞计数是否降低有关。因此,快速配对血清IgM抗体检测对小儿支原体肺炎的早期确诊非常重要。     

神经外科术后患者颅内感染相关因素分析与预防对策

目的探讨神经外科术后患者颅内感染相关因素,并提出行之有效的预防措施。方法对在该院自2011年12月-2013年1月接受治疗的100例开颅手术治疗患者资料进行回顾性分析,将这些患者根据是否发生感染分为两组,一组为实验组（感染）,另一组为对照组（未感染）,每组有患者50例。比较两组患者手术前GCS评分、手术时间、是否伴有切口脑脊液漏、手术次数、术后白蛋白水平等指标,分析神经外科开颅手术后颅内感染相关因素。结果实验组患者术前GCS评分〈8分、患者切口脑脊液漏、患者手术后白蛋白〈35g/L的例数明显高于对照组患者,且两组差异有统计这意义（P〈0．05）。结论临床上,GCS评分、患者的手术次数、手术时间等都是影响神经外科开颅手术后发生颅内感染的危险因素,医护人员应采取有效办法防止患者颅内发生感染。     

IVF/ICSI治疗后早期自然流产的相关因素分析

目的探讨不孕症患者接受体外受精/卵细胞质内单精子注射(IVF/ICSI)-胚胎移植治疗获得妊娠后发生早期流产的相关因素。方法回顾性分析笔者医院生殖中心2008年6月～2009年12月间经IVF/ICSI治疗获得临床妊娠的331例患者,按妊娠结局分为早期流产组及继续妊娠组;分析受精方式、年龄、既往自然流产史、移植后12天血β-HCG值、孕囊数及不孕原因与早期流产率的关系。结果 IVF、ICSI两种受精方式的早期流产率无显著差异,早期流产组的年龄显著高于继续妊娠组,多胎妊娠率、移植后12天血β-HCG值显著低于继续妊娠组。众多导致不孕的病因中,排卵障碍的流产率最高,差异具有统计学意义。结论高龄、单胎妊娠、多囊卵巢为IVF/ICSI治疗后早期自然流产的危险因素,移植后12天低β-HCG水平可高度预测早期自然流产的发生。