基于药物论坛中潜在不良反应与适应症的知识发现体系构建

目的：基于用户反馈信息,构建药物论坛中潜在不良反应与适应症的知识发现体系。方法：利用BIO序列标注方法和BiLSTM-CRF命名实体识别方法,从药物论坛的评论数据中识别不良反应与适应症的实体。结果：对不良反应与适应症进行过滤,得到26种药物共180种不良反应和26种适应症,并以此构建模型。结论：基于药物论坛构建的知识发现体系为挖掘中文领域内基于评论信息药物潜在不良反应与适应症可提供一种新的研究思路方案。     

2004-2013年国内图情领域网络舆情研究综述

采用主题分析的方式,梳理了近10年国内图情领域的网络舆情研究,发现使用文献计量、知识图谱等方法对网络舆情研究热点进行分析已比较成熟,而从内容层面探讨图情学科如何应用网络舆情提供服务方面的理论支撑薄弱,图情领域针对网络舆情的研究目的、理论支撑、技术方法乃至应用价值尚存诸多问题,有待进一步深入研究。     

Influence of clinical knowledge, organizational context, and practice style on transfusion decision making. Implications for practice change strategies

Evidence shows that blood products, like other health care resources, are often used inappropriately, but the reasons for this have not been well studied. We conducted a face-to-face survey of 122 general surgeons, orthopedic surgeons, and anesthesiologists in three hospitals to evaluate the influence of several clinical and nonclinical factors on transfusion decision making. We found widespread deficiencies in physicians' knowledge of transfusion risks and indications. Each transfusion risk was estimated correctly by fewer than half of the physicians surveyed, and only 31% responded correctly to a set of four questions regarding transfusion indications. Attending physicians routinely had lower knowledge scores than did residents, yet they exhibited more confidence in their knowledge. Residents' transfusion decisions, however, were strongly influenced by the desires of their attending physicians, resulting in their ordering potentially inappropriate transfusions. Of the residents surveyed, 61% indicated that they ordered transfusions that they judged unnecessary at least once a month because a more senior physician suggested that they do so. These findings provide insights for the development of strategies to improve transfusion practices, which would address the dual concerns of quality of care and cost containment.     

公共图书馆健康信息服务现状及提升策略

“健康中国”战略对健康信息服务提出新的要求，公共图书馆有必要开展健康信息服务。对31个省级公共图书馆的官网和微信公众号进行调研，了解其健康信息服务的形式、内容等，以此提出公共图书馆开展健康信息服务的策略：应将健康信息纳入常规性服务范畴，在现有服务基础上进一步拓宽服务内容、细分用户人群，并与医院等官方机构积极开展合作，以全面提升健康信息服务质量。     

基于数字人文技术的中国历代医家传记专题知识库构建

论述了中医人物研究的特点,探讨了数字技术时代中医历史人物的标引方式,按照"确定人物范围—获取资料-确定知识点-建立关联-构建知识地图"的步骤,利用知识图谱、地理信息系统等数字人文的方法构建了中国历代中医医家知识库,实现了中医历史人物信息整合、关联知识分析、地理位置标注等功能,丰富了中医人物的资源建设,为中医人物研究、医...     

突发公共卫生事件下生物医学电子预印本资源的作用及其启示

以medRxiv和bioRxiv预印本平台上COVID-19专题收录的论文为研究对象,采用文献计量学的方法,分析论文的发文时间、关注量、作者以及出版期刊。在数据分析结果的基础上进一步探究突发公共卫生事件下电子预印本资源所发挥的作用,包括迅速公布最新科研进展;促进学术交流,加速知识传播;降低费用,促进知识共享;占据科研成果首发权,并为图书馆建设提出相关的建议,如加大对电子预印本资源的宣传、做好电子预印本资源服务的支持工作、将电子预印本纳入数字图书馆资源建设体系、协助相关部门建立科学的评价体系。     

公众健康科普知识阅读素养测评方法初探

健康科普知识宣传是各国进行健康教育,提高公众健康素养,进而促进公众健康的重要措施之一。健康科普知识能被吸收的前提是公众能够阅读并正确理解健康信息。该文设计了一个基于网络的中国公众健康科普知识阅读素养测评方法,以了解我国公众阅读并理解健康科普知识的能力及其影响因素,为更好地开展健康教育与健康科普工作提供参考。     

A survey of Papua New Guinean private medical practitioners

A postal survey of all Papua New Guinean private medical practitioners was conducted to ascertain their practice characteristics, how well they kept up with current medical knowledge and whether they were interested in contributing to public sector medicine. Replies were received from 44% of the doctors, who mostly represented the younger age group of graduates. The majority of the responders had entered private practice since 1981, were self-employed and made little use of existing opportunities for keeping up to date with medical knowledge. The average number of patients seen in a day showed a normal distribution with a peak at 20-29 patients per day. Over 75% of the responders stated that they would be willing to work for the government health services on a sessional basis at an average minimum hourly rate of K40. Financial reasons were given as the main justification for leaving government service. When asked whether they would return to full-time public service if doctors' terms and conditions improved, the private practitioners were evenly divided. Those interested in returning would expect an average annual salary of approximately K30,000 per annum. In this paper we argue that private medical care has so far been allowed to develop without guidance and controls, and little use has been made of it to support government health services. Escalating shortages of financial and human resources have now made it imperative to find innovative ways of developing both services in harmony with each other so that private medical services for the mostly urban minority will not grow to the detriment of public medical services for the rural majority.     

Development and evaluation of an ensemble resource linking medications to their indications

Objective

To create a computable MEDication Indication resource (MEDI) to support primary and secondary use of electronic medical records (EMRs).

Materials and methods

We processed four public medication resources, RxNorm, Side Effect Resource (SIDER) 2, MedlinePlus, and Wikipedia, to create MEDI. We applied natural language processing and ontology relationships to extract indications for prescribable, single-ingredient medication concepts and all ingredient concepts as defined by RxNorm. Indications were coded as Unified Medical Language System (UMLS) concepts and International Classification of Diseases, 9th edition (ICD9) codes. A total of 689 extracted indications were randomly selected for manual review for accuracy using dual-physician review. We identified a subset of medication–indication pairs that optimizes recall while maintaining high precision.

Results

MEDI contains 3112 medications and 63 343 medication–indication pairs. Wikipedia was the largest resource, with 2608 medications and 34 911 pairs. For each resource, estimated precision and recall, respectively, were 94% and 20% for RxNorm, 75% and 33% for MedlinePlus, 67% and 31% for SIDER 2, and 56% and 51% for Wikipedia. The MEDI high-precision subset (MEDI-HPS) includes indications found within either RxNorm or at least two of the three other resources. MEDI-HPS contains 13 304 unique indication pairs regarding 2136 medications. The mean±SD number of indications for each medication in MEDI-HPS is 6.22±6.09. The estimated precision of MEDI-HPS is 92%.

Conclusions

MEDI is a publicly available, computable resource that links medications with their indications as represented by concepts and billing codes. MEDI may benefit clinical EMR applications and reuse of EMR data for research.     

医联体内知识共享的范畴研究

目的　探讨医联体内知识共享的范畴,为医联体内各级医疗机构间知识共享机制的建立奠定基础。方法　于2016-07-26至2016-08-22在“周康航新”医联体内选取社区卫生服务中心管理人员、全科医生及上海市浦东新区周浦医院（周浦医院）管理人员、专科医生共39名进行半结构化访谈,主要内容为在临床、科研及其他方面需要上/下级医疗机构提供的支持、可以向上/下级医疗机构提供的支持。对访谈结果进行提炼和汇总,得出社区卫生服务中心需求导向、周浦医院需求导向的医联体内知识共享范畴。将社区卫生服务中心需求导向的医联体内知识共享范畴设计成问卷,于2016-11-15至2016-12-06选取90名社区卫生服务中心人员进行调查,以了解其对各项内容的重要性评分。结果　访谈结果显示：周浦医院基本可以满足社区卫生服务中心在临床、科研方面以及在协助培养青年医生、专业发展指导方面的需求,但在临床检验中心建立、行政和卫生管理、信息化建设方面未予回答;社区卫生服务中心尚不能完全满足周浦医院的需求。最终形成的社区卫生服务中心需求导向的医联体内知识共享范畴包括临床支持（92类疾病规范诊治/相关知识、医患沟通4项、辅助资源11项）、科研支持（10项）、其他支持（5项）3个部分,重要性评分分别为4.16~4.96、4.58~4.62、4.66~4.76分。根据重要性评分,排在前6位的病种分别为高血压（4.96分）、冠状动脉粥样硬化性心脏病（4.94分）、慢性阻塞性肺疾病（4.94分）、糖尿病（4.94分）、脑梗死/脑栓塞（4.94分）、脑卒中（4.94分）,排在第1位的医患沟通技巧为急性病或危急情况下沟通处理指导（4.91分）,排在第1位的辅助资源为辅助检查的适应证、禁忌证、检查前准备工作及辅助检查指导（4.89分）;排在第1位的科研支持为论文撰写指导或专项培训（4.62分）;排在第1位的其他支持为协助培养青年医生（4.76分）。结论　目前医联体内知识共享需以满足社区卫生服务中心需求为主,且以社区常见慢性病的规范诊疗为重。建议从社区常见慢性病的联合管理方案入手,以知识共享为契机,不断提升社区卫生服务机构的临床技能。     

Effectiveness of Clinician-selected Electronic Information Resources for Answering Primary Care Physicians’ Information Needs

ObjectiveTo determine if clinician-selected electronic information resources improve primary care physicians’ abilities to answer simulated clinical questions.DesignObservational study using hour-long interviews in physician offices and think-aloud protocols. Participants answered 23 multiple-choice questions and chose 2 to obtain further information using their own information resources. We established which resources physicians chose, processes used, and results obtained when looking for information to support their answers.MeasurementsCorrectness of answers before and after searching, resources used, and searching techniques.Results23 physicians sought answers to 46 questions using their own information resources. They spent a mean of 13.0 (SD 5.5) minutes searching for information for the two questions using an average of 1.8 resources per question and a wide variety of searching techniques. On average 43.5% of the answers to the original 23 questions were correct. For the questions that were searched, 18 (39.1%) of the 46 answers were correct before searching. After searching, the number of correct answers was 19 (42.1%). This difference of 1 correct answer was attributed to 6 questions (13.0%) going from an incorrect to correct answer and 5 (10.9%) questions going from a correct to incorrect answer. We found differences in the ability of various resources to provide correct answers.ConclusionFor the primary care physicians studied, electronic information resources of choice did not always provide support for finding correct answers to simulated clinical questions and in some instances, individual resources may have contributed to an initially correct answer becoming incorrect.     

Practice nurses in Australia: current issues and future directions

Almost 60% of general practices now employ at least one practice nurse. Australian Government initiatives to support the expansion of practice nursing are not consistently based on strong evidence about effectiveness, outcomes or efficiencies. Reviews from other countries suggest that practice nurses can achieve good health outcomes, but there is little information about the Australian practice-nurse workforce, funding models to support their work, scope of their practice, or its outcomes. Australian practice nursing lacks a career structure and an education framework to advance nurses' skills and knowledge. To maximise the contribution of nurses in primary care, a more systematic approach is needed, with a stronger evidence base for policy to support effective outcomes.     

基于互联网的院前急救转运与风险评估信息平台构建

从双向转诊的角度来讲,国家已经开始探索利用信息化手段建设院前急救转运平台,但是从规模、区域、建设标准来讲,目前都没有明确的准则出台.基于可用性、实用性和科研需要,儿童医院采用信息技术与临床医学知识相结合的方式,建立一个以优质医院为中心,辐射到周边地区的区域转诊和危重症评估体系,解决当前各地区、各医疗单位之间医疗资源分配不均衡,危重症患者转运高风险的问题,合理优化资源配置,实现区域范围内医疗资源的共享和转运分流,有效降低患者转运风险.     

泛在知识视角下疾控中心医学图书馆的转型

以泛在知识环境为研究视角,从目标和策略两方面探讨了疾控中心（CDC）医学图书馆如何根据泛在知识环境的内涵和特征向智慧型图书馆转型,提出了在泛在知识环境下,CDC医学图书馆应拓宽信息资源采集领域、丰富特色专题建设、挖掘隐性知识、实现多元信息资源整合、构建馆际联盟、构建海量数据信息模型、推送个性化疾控信息和为公共卫生突发事件应急决策提供知识管理。     

罕见病智能知识服务体系设计

为使罕见病患者及其家属和医务人员等更加精准便捷地获取罕见病知识、熟悉罕见病的临床特点及了解罕见病专家和药物资源分布,并缓解罕见病诊疗难题、促进医患交流及提高公众对罕见病的认知水平,本文对罕见病智能知识服务体系的设计进行了探讨。罕见病智能知识服务体系的设计思路为：根据罕见病知识受众的特点,设计罕见病知识服务模式;通过对罕见病诊疗指南、经典病例、专业文献、专业书籍和临床诊断标准等资料进行整理和分析以广泛采集罕见病领域的权威知识,在由罕见病领域专家对其进行审核的基础上,基于人工智能、数据挖掘、大数据处理和软件工程等技术形成多样化的罕见病知识体系、知识库和模型库,最终构建罕见病智能知识服务平台。借助信息化平台和“互联网+医疗”远程、智能、便捷和高效的独特优势为患者及其家属、医务人员和管理者等提供10类智能化服务的同时,提升罕见病的识别、筛查和诊断水平,促进罕见病注册和疾病地图绘制,并助力罕见病防治。     

Finding the evidence: resources and skills for locating information on clinical effectiveness

Limited time and lack of knowledge about where and how to search for information often present barriers to practitioners who want to locate current best evidence for treating their patients. There is as yet no single place they can go to get an answer to all their questions. High quality clinical studies are difficult to filter out from the mass of information on large databases, and secondary resources of evaluated information are dispersed over hundreds of Internet sites worldwide. This overview presents a practical guide for the busy practitioner who searches only occasionally and needs to maximise the time spent. Major collections of secondary resources are identified and their individual features described briefly. Following this, several services using PubMed are outlined that automatically apply filters for studies with high quality research design. Further sources of information and assistance are listed for those who wish to learn more.     

AMIA Advocates National Health Information System in Fight Against National Health Threats

To protect public health and national safety, AMIA recommends that the federal government dedicate technologic resources and medical informatics expertise to create a national health information infrastructure (NHII). An NHII provides the underlying information utility that connects local health providers and health officials through high-speed networks to national data systems necessary to detect and track global threats to public health. AMIA strongly recommends the accelerated development and wide-scale deployment of electronic public health surveillance systems, computer-based patient records, and disaster-response information technologies. Such efforts hold the greatest potential to protect our citizens from disaster and to deliver the best health care if disaster strikes.To protect public health and national safety, AMIA recommends that the federal government dedicate technologic resources and medical informatics expertise to create a national health information infrastructure (NHII). An NHII provides the underlying information utility that connects local health providers and health officials through high-speed networks to national data systems (e.g., Centers for Disease Control and Prevention) necessary to detect and track global threats to public health.In the short term, this means adapting existing information systems to facilitate public health surveillance and emergency response. To establish a permanent infrastructure, AMIA strongly recommends the accelerated development and wide-scale deployment of electronic public health surveillance systems, computer-based patient records, and disaster-response information technologies. Such efforts hold the greatest potential to protect our citizens from disaster, and to deliver the best health care if disaster strikes.While meeting the acute needs of today, this initiative will begin laying the groundwork for a NHII that will continue to serve the health needs of the nation—a lasting endowment for future generations. Establishing an NHII requires thoughtful strategic planning and strong inter-agency leadership. Work on key components of the NHII must begin immediately. These key components include:

• Strategic planning and coordination. There must be a central coordinating entity that can quickly inventory existing public- and personal-health initiatives and develop a strategy to fashion a national system to protect Americans against health threats of various types, including biological, chemical, nuclear, and physical. The short-term strategy must be part of a framework for a permanent infrastructure that serves public health, patient care, and research.
• Connectivity and communications. Local, regional, and national coordination cannot exist without efficient, instantaneous communication. Public health services must be linked using secure connections to the Internet as an immediate top priority. AMIA recommends federal government funding to guarantee high-speed, dedicated access to the Internet for all public and private health care facilities and related organizations. Minimum-level workstations should be required, and adequate tools and training should be provided.
• Standards. Effective communication among local, community, state, and federal facilities require the use of standards. Health care messaging standards should be used for data interchange. A common vocabulary standard and required data elements for public health surveillance databases are required to enable effective sharing of data. Without a common vocabulary, data from local systems cannot be analyzed to detect emerging health threats. Government coordination and support for consensus standardization and low-cost distribution of common vocabularies for health event detection, prevention, and intervention are a fundamental aspect of an NHII.
• Resource databases. An up-to-date, central, Internet-based health resources directory containing information about available resources—knowledge, physical, and human—is vital to providing the timely information needed to manage any public health crisis. The national health resource directory would include information about physical resources, such as health care organizations, safety facilities, and environmental agencies; human resources, including physicians, nurses, and public health and support personnel; organizational resources, such as emergency medical services, county and city law enforcement agencies, and other emergency-response groups; and knowledge resources ranging from clinical guidelines to extensive clinical decision support algorithms related to threat vectors. Local health authorities must be trained in use of the directory to effectively derive maximal benefit when responding to national health threats.
• Public health surveillance systems. Effective public health practice and decision making depend on timely information, much of which is not readily available. Information about patients with clinical conditions of public health importance, symptoms compatible with prodromes of serious infection or exposure, health behaviors, and environmental risk factors must be collected, transmitted, aggregated, analyzed, and utilized for prompt decision making. Whether the health threat is biological, chemical, or nuclear, early detection and rapid response are essential. Existing public health systems in place and under development should be adapted to meet the current needs. Implementation of public health system initiatives such as the National Electronic Disease Surveillance System and Health Alert Network must be accelerated to meet the acute threat posed by bioterrorism.
• National identifiers. National identifiers for providers, insurers, businesses, and individuals are required by the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The privacy provision of HIPAA that protects confidential health information has been finalized. In the face of the acute crisis, the work on identifiers should be accelerated so that effective epidemiologic data can be gathered and analyzed and appropriate health care services delivered where needed.

AMIA is an organization of professionals who operate at the interface between health care and computer and information science. Our leadership and members are capable and willing to contribute to solving the acute situation while laying the foundation for a lasting infrastructure to manage health information for the benefit of patients and the public.TANG, National Health Information System Proposal     

Perspective: Imaging-based observational databases for clinical problem solving: the role of informatics

Imaging has become a prevalent tool in the diagnosis and treatment of many diseases, providing a unique in vivo, multi-scale view of anatomic and physiologic processes. With the increased use of imaging and its progressive technical advances, the role of imaging informatics is now evolving—from one of managing images, to one of integrating the full scope of clinical information needed to contextualize and link observations across phenotypic and genotypic scales. Several challenges exist for imaging informatics, including the need for methods to transform clinical imaging studies and associated data into structured information that can be organized and analyzed. We examine some of these challenges in establishing imaging-based observational databases that can support the creation of comprehensive disease models. The development of these databases and ensuing models can aid in medical decision making and knowledge discovery and ultimately, transform the use of imaging to support individually-tailored patient care.     

Improving hospital doctors' working lives: online questionnaire survey of all grades

Background: In 2001, the Department of Health produced the Improving Working Lives (IWL) for Doctors document. This is the first national survey which asks hospital doctors what changes are needed to improve their working lives. Methods: An online questionnaire was run over a period of six weeks and was open to all doctors of all grades. Doctors were asked to choose their top five factors from a list of 35 diverse choices or to provide alternatives in free text. Demographic data were also collected. Results: 1603 hospital doctors working in the UK completed the online questionnaire. Improved secretarial or managerial support was the first IWL choice for consultants, with different aspects of clinical and non-clinical support representing their top four choices. Junior hospital doctors and staff and associate specialist grades (staff grades, associate specialists, and clinical assistants) identified improved support for education and training as their first choice, while among the female specialist registrars, it was improved support for childcare. Greater opportunities to develop new skills was an important issue for doctors in the surgical specialties and improved access to mentoring was important for all junior doctors, staff and associate specialist grades, and doctors from black and ethnic minority groups. Conclusions: Hospital doctors in the UK need more support to improve their working lives. The principle needs are better secretarial and managerial support for consultants; education, training, and mentoring for junior doctors and staff and associate specialist grades; and improved opportunities to develop new skills for those in surgical specialties. Support with childcare is an important issue for female specialist registrars. The Department of Health, NHS trusts, deaneries, and Royal Colleges need to endorse policies that promote a training and working environment that will improve working lives for all hospital doctors, ensuring that appropriate and continuing support is available from the time doctors enter the new foundation programmes and proposed run-through grades, to their time spent as consultants in today''s NHS.     

医院图书馆资源利用现状及新媒体服务

对北京大学人民医院不同类别人员利用其图书馆资源进行问卷调查,利用Excel2010和SPSS22.0软件分析院图书馆资源利用现状以及微信公众平台建设情况,发现医院读者对图书馆的资源与服务需求呈现个性化,传统的服务模式已经无法有效地为读者提供信息保障。因此,提出了在新媒体背景下,医院图书馆可针对读者个性化的需求提供精准服务,基于智库理念进行深层次知识服务,借助微信公众平台开展移动式服务等改进措施。