手机二维码在医疗设备信息管理中的应用探索

杭州市红十字会医院将手机二维码技术应用于医院医疗设备的验收、核查、巡检、维修、防伪、技术培训以及设备库房管理、个人名片识别等领域,取得了很好的实践效果;分析了手机二维码在医疗设备管理领域的应用前景和面临的问题。     

Analyzing security issues of android mobile health and medical applications

ObjectiveWe conduct a first large-scale analysis of mobile health (mHealth) apps available on Google Play with the goal of providing a comprehensive view of mHealth apps’ security features and gauging the associated risks for mHealth users and their data.Materials and MethodsWe designed an app collection platform that discovered and downloaded more than 20 000 mHealth apps from the Medical and Health & Fitness categories on Google Play. We performed a suite of app code and traffic measurements to highlight a range of app security flaws: certificate security, sensitive or unnecessary permission requests, malware presence, communication security, and security-related concerns raised in user reviews.ResultsCompared to baseline non-mHealth apps, mHealth apps generally adopt more reliable signing mechanisms and request fewer dangerous permissions. However, significant fractions of mHealth apps expose users to serious security risks. Specifically, 1.8% of mHealth apps package suspicious codes (eg, trojans), 45.0% rely on unencrypted communication, and as much as 23.0% of personal data (eg, location information and passwords) is sent on unsecured traffic. An analysis of the app reviews reveals that mHealth app users are largely unaware of the surfaced security issues.ConclusionDespite being better aligned with security best practices than non-mHealth apps, mHealth apps are still far from ensuring robust security guarantees. App users, clinicians, technology developers, and policy makers alike should be cognizant of the uncovered security issues and weigh them carefully against the benefits of mHealth apps.     

医学图书馆嵌入临床循证医学信息服务模式构建

以前的循证医学信息服务采用"主动参与参考咨询"模式,视角不够科学、内容不够系统。以临床医师循证决策需求为逻辑起点,引入"信息-知识-智能"转化律后,通过比较循证过程及"信息-知识-智能"转化过程,构建了循证医学信息服务新型模式,为临床医学馆员和临床医师思考"需要做什么"以及"如何科学地做"提供了统一理论,有效指导临床医学馆员开展循证医学信息服务工作,辅助临床医师科学地进行临床决策。     

决策树在居民就诊影响因素研究中的应用

目的了解影响重庆地区居民就诊服务的主要影响因素,满足更多居民卫生服务需求,提高卫生服务利用率.方法 针对重庆地区不同人群的影响因素,采取不同的卫生政策,构建影响居民就诊率的决策树模型.结果 调查的11 570名居民中,合计就诊人次为2 447人次,平均就诊次数2.1次,两周就诊率为21.15%(城市为12.58%、农村为29.19%),高于全国平均水平,而各年龄段的就诊率呈现中间低两端高的趋势,各年龄段就诊率差异有统计学意义(P<0.05);从决策树模型来看,此决策树共有17个节点,对应17条分类规则,树的根节点为职业类型,此变量对就诊率的影响最大,职业类型、年龄、居民类型、参保情况以及家庭年收入对居民就诊影响较大,且所选出的影响因素对不同人群的影响不同.结论 重庆地区居民就诊卫生服务利用相对较高,且不同人群的影响因素不同,因此,在制订卫生服务规划时应针对不同人群提出相应的卫生政策.     

军队医院机动卫勤分队保障能力评估研究

目的: 建立军队医院机动卫勤分队卫勤保障能力评估体系,对医院机动卫勤分队卫勤保障能力进行科学评估. 方法: 本研究采用的是德尔菲专家咨询法,以分发问题表的方式,征求、汇集并统计专家个人的意见或判断,并经过二至三轮咨询使专家对某问题的意见趋于一致的方法. 结果: 通过对保障能力构成的要素进行分解,明确保障能力的构成,包括组织指挥能力、应急机动能力、医疗后送能力、野战环境适应能力,应用德尔菲法,构建医院机动卫勤分队卫勤保障能力评估体系及权重. 结论: 我们提出了一套军队医院机动卫勤分队保障能力评价标准,评估机动卫勤分队的保障能力,提出工作对策建议.     

The personal digital assistant, a new medical instrument for the exchange of clinical information at the point of care

Personal digital assistants can provide a portable, integrated platform for point-of-care clinical reference, patient management and data communication. Clinical reference programs allow the user to access information from the Internet and guidelines. Patient management programs allow doctors to access and store clinical information. Wireless technologies have potential for rapid exchange of clinical laboratory results and efficient "electronic patient handovers". Thus, these devices provide the potential for true continuity of care across the healthcare system.     

信息化条件下军队医院机动卫勤分队战备训练存在的问题分析

在信息化条件下,军队医院机动卫勤分队战备训练在意识理念、训练人才、训练内容和训练方法等方面仍存在诸多问题,降低了战备训练的针对性和有效性,也对战备训练效果造成影响。本文从上述4个方面进行系统剖析,为有效解决战备训练的瓶颈问题提供新思路,使信息化条件下军队医院机动卫勤分队战备训练真正落到实处,从而有效提高军队医院机动卫勤分队的保障能力。     

Health innovations in patient decision support: Bridging the gaps and challenges

Patient decision aids (PDAs) help to support patients in making an informed and value-based decision. Despite advancement in decision support technologies over the past 30 years, most PDAs are still inaccessible and few address individual needs. Health innovation may provide a solution to bridge these gaps. Information and computer technology provide a platform to incorporate individual profiles and needs into PDAs, making the decision support more personalised. Health innovation may enhance accessibility by using mobile, tablet and Internet technologies; make risk communication more interactive; and identify patient values more effectively. In addition, using databases to capture patient data and the usage of PDAs can help: developers to improve PDAs’ design; clinicians to facilitate the decisionmaking process more effectively; and policy makers to make shared decision making more feasible and cost-effective. Health innovation may hold the key to advancing PDAs by creating a more personalised and effective decision support tool for patients making healthcare decisions.     

论信息时代医药卫生信息质量

从信息质量的概念出发探讨了医药卫生信息存在的质量问题、医药卫生信息质量评价的指标及提高医药卫生信息质量的策略.     

Understanding the mobile internet to develop the next generation of online medical teaching tools

Healthcare providers (HCPs) use online medical information for self-directed learning and patient care. Recently, the mobile internet has emerged as a new platform for accessing medical information as it allows mobile devices to access online information in a manner compatible with their restricted storage. We investigated mobile internet usage parameters to direct the future development of mobile internet teaching websites. Nephrology On-Demand Mobile (NOD^M) (http://www.nephrologyondemand.org) was made accessible to all mobile devices. From February 1 to December 31, 2010, HCP use of NOD^M was tracked using code inserted into the root files. Nephrology On-Demand received 15 258 visits, of which approximately 10% were made to NOD^M, with the majority coming from the USA. Most access to NOD^M was through the Apple iOS family of devices and cellular connections were the most frequently used. These findings provide a basis for the future development of mobile nephrology and medical teaching tools.     

肾病门诊患者健康教育移动平台的构建与应用探讨

介绍了基于智能手机或iPad等移动终端的肾脏专科健康教育移动平台。该系统适用于患者在医院门诊候诊时或在家里进行实时健康教育。系统的功能有对医院、科室、医师的介绍性内容;有健康教育视频;有专科健康教育的必修内容;有自助挂号、检验报告查询等服务性内容;有影视片、游戏等娱乐内容。该平台构架由医院、患者家庭、服务公司三方面组成,软件通过建立专科APP,硬件通过智能手机、无线路由器、服务器、互联网等实现,并有云计算和大数据功能。该系统适合健康教育,并有利于提高医疗服务。     

国内外医患共享决策评估工具的系统综述

背景　医患共享决策（SDM）是基于最佳临床证据,结合患者的个人偏好、价值观联合进行决策的过程。SDM评估工具的开发和应用对促进临床SDM的实践具有重要意义,目前SDM评估工具在国外已有成熟发展,国内相关研究尚处于起步阶段。目的　在已有系统综述基础上,对国内外有关SDM评估工具进行系统梳理及更新,为我国有关人员在不同临床条件下选用及开发SDM评估工具提供参考。方法　于2019年1月系统检查PubMed（2017年9月-2018年12月）及中国知网、万方数据知识服务平台、维普网（建库至2019年1月）中与SDM评估工具相关的文献,获取与SDM评估工具的基本特征及信效度相关心理测量特性等信息。结果　检索到符合标准文献12篇,包括15个评估工具,结合之前SDM相关评估工具的系统综述总结的50个工具和1个观察患者参与医疗决策量表（OPTION）工具网站发现的工具,共66个SDM评估工具,根据工具应用对象不同,可分为患者视角（46个）、医生视角（4个）、观察者视角（13个）及多视角（3个）的评估工具。其中患者视角的SDM评估工具的内容维度包括患者参与决策前、患者参与决策过程、患者参与决策后,医生视角的SDM评估工具包括医生评价患者参与决策和医生在医疗决策中的满意度,观察者视角的SDM评估工具是第三方对医生决策和患者参与决策的评价,多视角评估工具是从医生、患者或观察者中至少两方的视角对同一个决策过程的患者参与决策程度进行评价。结论　随着患者参与临床决策不断受到关注和重视,我国学者引进或构建SDM评估工具的研究呈上升趋势,立足于多个视角的SDM评估工具构建及汉化需进一步受到重视。     

某高校临床医学"5+3"一体化学生手机依赖与心理健康关系的现况研究

目的:了解某高校临床医学"5+3"一体化学生手机依赖的现状,分析其与心理健康的关系,为手机依赖行为的干预提供科学依据.方法:采用方便抽样的方法对812名临床医学"5+3"一体化学生进行手机依赖量表和焦虑、抑郁、孤独的自评量表以及自编问卷调查.结果:临床医学"5+3"一体化学生手机中度、高度手机依赖率分别为48.2%和27.2%;单因素分析显示,女生手机依赖程度高于男生(P<0.01);手机依赖程度与手机使用年限、平均每月消费金额、每天使用时间、孤独程度呈正相关(C=0.13、0.18、0.20、0.13,P<0.05);手机使用功能为打电话和看电视听音乐者手机依赖程度低于其他使用功能者(P<0.01),手机使用动机为工作学习者依赖程度低于其他使用动机者(P<0.01),谈恋爱者、有焦虑者、有抑郁者手机依赖程度分别高于不谈恋爱者、无焦虑、无抑郁者(P<0.01);焦虑和孤独分数在手机依赖不同程度间表现为高度>中度>低度(P<0.01),抑郁分数为中、高度高于低度(P<0.01);多元回归分析结果显示女性、恋爱、平均每天手机使用时间长、平均每月消费高、手机使用功能玩游戏、焦虑和孤独是学生手机依赖的独立危险因素.结论:临床医学"5+3"一体化学生手机依赖行为比较普遍,有焦虑、孤独感的学生可作为手机依赖干预的重点人群,应给予高度重视和关注.     

The baby MB case: medical decision making in the context of uncertain infant suffering

The recent MB case involved a dispute between an infant's parents and his medical team about the appropriateness of continued life support. The dispute reflected uncertainty about two key factors that inform medical decision making for seriously ill infants: both the amount of pain MB experiences and the extent of his cognitive capacities are uncertain. Uncertainty of this order makes decision making in accordance with the best-interests principle very problematic. This article addresses two of the problems that cases such as that of MB pose for those charged with making medical decisions for infants. First, the question of the moral significance of the interest in avoiding pain is considered. It is claimed that this interest can be outweighed by higher-order interests such as those related to autonomy but that where such higher-order interests do not exist, the interest in avoiding pain should be prioritised. Second, the question of how to proceed in cases in which the level of pain or the extent of an infant's higher-order interests cannot be decisively established is considered. It is suggested that when genuine uncertainty over the interests of an infant exists, parental views about treatment should prevail.     

郑州市金水区医疗资源整合效果评价

目的:对郑州市金水区医疗资源整合的效果进行评价.方法:采用问卷调查及文献研究的方法比较金水区4所乡镇卫生院医疗资源整合前后门诊与住院人次、业务收入、设备、医护人员职称与学历及参合农村居民就诊情况的变化.结果:医疗资源整合后,乡镇卫生院门诊与住院人次均增加,业务收入提高,万元以上设备增加了34台,其中50万元以下设备20台,一100万元设备8台,100万元以上设备6台.医护人员职称比例下降(Z=4.672,P＜0.001),学历水平提高(Z=3.417,P=0.001);参合农村居民的门诊人次及住院人次均增加.结论:区镇医疗资源整合可增加门诊与住院人次及业务收入,提高乡镇卫生院医护人员学历水平,并较好地支持了新农合制度的实施,但仍需做进一步的探讨与改进.     

Presence of key findings in the medical record prior to a documented high-risk diagnosis

Background

Failure or delay in diagnosis is a common preventable source of error. The authors sought to determine the frequency with which high-information clinical findings (HIFs) suggestive of a high-risk diagnosis (HRD) appear in the medical record before HRD documentation.

Methods

A knowledge base from a diagnostic decision support system was used to identify HIFs for selected HRDs: lumbar disc disease, myocardial infarction, appendicitis, and colon, breast, lung, ovarian and bladder carcinomas. Two physicians reviewed at least 20 patient records retrieved from a research patient data registry for each of these eight HRDs and for age- and gender-compatible controls. Records were searched for HIFs in visit notes that were created before the HRD was established in the electronic record and in general medical visit notes for controls.

Results

25% of records reviewed (61/243) contained HIFs in notes before the HRD was established. The mean duration between HIFs first occurring in the record and time of diagnosis ranged from 19 days for breast cancer to 2 years for bladder cancer. In three of the eight HRDs, HIFs were much less likely in control patients without the HRD.

Conclusions

In many records of patients with an HRD, HIFs were present before the HRD was established. Reasons for delay include non-compliance with recommended follow-up, unusual presentation of a disease, and system errors (eg, lack of laboratory follow-up). The presence of HIFs in clinical records suggests a potential role for the integration of diagnostic decision support into the clinical workflow to provide reminder alerts to improve the diagnostic focus.     

医疗服务信息连续性对分级医疗的影响

医疗服务信息不连续影响着我国分级医疗格局的形成,本文通过对影响医疗服务信息连续性的＂信息孤岛＂、机构沟通障碍等问题的探讨,以期解决部分医疗服务信息不连续问题,从而促进分级医疗体系的推进.     

Evaluating health information technology in community-based settings: lessons learned

Implementing health information technology (IT) at the community level is a national priority to help improve healthcare quality, safety, and efficiency. However, community-based organizations implementing health IT may not have expertise in evaluation. This study describes lessons learned from experience as a multi-institutional academic collaborative established to provide independent evaluation of community-based health IT initiatives. The authors'' experience derived from adapting the principles of community-based participatory research to the field of health IT. To assist other researchers, the lessons learned under four themes are presented: (A) the structure of the partnership between academic investigators and the community; (B) communication issues; (C) the relationship between implementation timing and evaluation studies; and (D) study methodology. These lessons represent practical recommendations for researchers interested in pursuing similar collaborations.