以三级综合性医院为主体的“互联网+护理服务”信息平台的构建与运行

目的构建以三级综合性医院为主体的"互联网+护理服务"信息平台并运行,为"互联网+护理服务"试点工作的推进提供参考。方法成立跨部门、多学科的研发小组,依托院内信息化建设集成平台,以互联网为载体,以O2O模式为实施路径,基于J2EE平台,采用Java编程语言和服务器端Java技术开发。21例患者端用户和4名护理人员使用平台,通过量性与质性数据评价平台运行效果。结果 21例患者注册平均时间为(3.21±0.78)min,服务满意度为100%。半结构式访谈患者及护理人员的使用体验,对信息平台操作的便捷性、界面的专业性与设计感、流程的可操作性等感到满意。结论以三级综合性医院为主体的"互联网+护理服务"信息平台的构建基于政策导向与患者需求,以服务安全为核心,具有较好的适用性与易用性。     

老年乳腺癌患者围术期信息需求特点的调查

目的 了解老年乳腺癌患者围术期的信息需求特点。方法 采用多伦多乳腺癌信息需求问卷,对144例老年（老年组）及118例非老年（非老年组）即将接受手术的乳腺癌患者进行调查。结果 老年组信息需求总分（201.74±28.83）分,与非老年组比较,差异无统计学意义（P>0.05）;老年患者关注的信息需求内容主要体现在癌症复发征象、伤口护理、治疗不良反应的应对及身体其他部位是否会有癌细胞等治疗或疾病维度信息,其中老年患者对伤口护理及治疗不良反应的重视程度远远高于非老年组（均P<0.05）,而对检验检查信息、社会心理相关信息需求显著低于非老年患者,尤其体现在寻求社会帮助或支持、检查意义及结果解释、疾病发生发展及相关医学名词等方面。结论 老年乳腺癌患者围术期信息需求水平较高,较为关注辅助治疗及自我护理等信息,对疾病形成、检验检查等专业信息需求相对偏低。需根据其特点调整围术期信息支持方案,提高老年乳腺癌患者疾病适应性,减轻围术期负性心理情绪。     

医院信息系统的数据挖掘与实施医院客户关系管理的思考

目的对医院信息系统大型数据库中积累的病人资料进行挖掘和利用，为医院的经营管理服务。方法引入客户关系管理的概念，构建了3类医院客户分析系统。结果对病人的一般信息、就诊信息、消费水平、付费方式等内容的多重分类分析可产生医院不同的客户群体；对病人就诊、治疗情况的分类分析，可发现某种疾病的发病和潜在发病情况；对体检结果、手术情况的单项分析，可对病人提出随诊建议。结论医院客户关系管理拓展了医院信息系统的功能，有助于病人资源的管理，对不同的客户群体针对性地采取差异性服务，有利于保持和增加病人资源，提高医院效益。     

3～12岁儿童眼轴长度、晶状体屈光力与屈光不正的关系

目的：探讨3～12岁儿童屈光参数发育特点,分析其与屈光不正的相关性。方法：描述性研究。共纳入2017年12月至2018年12月在重庆医科大学附属儿童医院眼科门诊就诊的3～12岁儿童600例 （1 200眼）,通过睫状肌麻痹检影验光及光学生物量仪（IOL-Master）获得等效球镜度（SE）、眼轴长度、角膜屈光力、前房深度,并计算晶状体屈光力。按年龄分成3组,分别为3～6岁组,7～9岁组和10～12岁组。按SE分成5组,分别为远视组、正视组、轻度近视组、中度近视组和高度近视组。 采用独立样本t检验、单因素方差分析及线性回归分析年龄、屈光与各屈光参数的关系。结果：3～6岁组,7～9岁组和10～12岁组SE（F=131.5,P<0.001）及晶状体屈光力（F=276.4,P<0.001）随年龄增长逐渐变小,眼轴长度（F=235.02,P<0.001）、前房深度（F=228.7,P<0.001）随年龄增长逐渐增大,角膜曲率（F=0.01,P=0.66）变化稳定。3组SE与眼轴长度呈负相关（r=-0.80、-0.85、-0.81,均P<0.001）,与晶状体屈光力呈正相关（r=0.98、0.92、0.91,均P<0.001）。轻度近视组,眼轴长度及晶状体屈光力与SE呈正相关性（r=0.545、0.601,P<0.001）;高度近视组眼轴长度及晶状体屈光力与SE呈正相关性（r=0.675、0.784,P<0.001[1]）。矫正年龄和性别后,眼轴长度解释SE 73.6%的变异,晶状体屈光力可解释SE 86.5%的变异。结论：眼轴长度与晶状体屈光力是影响屈光发育和近视发展的主要因素。     

Accuracy of biometric formulae for intraocular lens power calculation in a teaching hospital

AIM: To evaluate the accuracy of three commonly used biometric formulae across different axial lengths (ALs) at one United States Veterans Affairs teaching hospital. METHODS: A retrospective chart review was conducted from November 2013 to May 2018. One eye of each patient who underwent cataract surgery with a monofocal intraocular lens (IOL) was included. The range of postoperative follow-up period was from 3wk to 4mo. The Holladay 2, Barrett Universal II, and Hill-Radial Basis Function (Hill-RBF) formulae were used to predict the postoperative refraction for all cataract surgeries. For each formula, we calculated the prediction errors [including mean absolute prediction error (MAE)] and the percentage of eyes within ±0.25 diopter (D) and ±0.5 D of predicted refraction. We performed subgroup analyses for short (AL<22.0 mm), medium (AL 22.0-25.0 mm), and long eyes (AL>25.0 mm). RESULTS: A total of 1131 patients were screened, and 909 met the inclusion criteria. Resident ophthalmologists were the primary surgeons in 710 (78.1%) cases. We found no statistically significant difference in predictive accuracy among the three formulae over the entire AL range or in the short, medium, and long eye subgroups. Across the entire AL range, the Hill-RBF formula resulted in the lowest MAE (0.384 D) and the highest percentage of eyes with postoperative refraction within ±0.25 D (42.7%) and ±0.5 D (75.5%) of predicted. All three formulae had the highest MAEs (>0.5 D) and lowest percentage within ±0.5 D of predicted refraction (<55%) in short eyes. CONCLUSION: In cataract surgery patients at our teaching hospital, three commonly used biometric formulae demonstrate similar refractive accuracy across all ALs. Short eyes pose the greatest challenge to predicting postoperative refractive error.     

Midwives' attitudes to and knowledge about a newly introduced foetal screening method

A number of screening procedures are offered by midwives during pregnancy and the number is increasing rapidly. The measurement of nuchal translucency is a fairly new ultrasound method for antenatal screening, primarily for Down syndrome. The results give a better risk calculation than maternal age alone and can mean a decrease in the number of invasive procedures needed to identify this syndrome prenatally. The aim of this study was to gain insight into the midwives' point of view concerning the introduction of the method in two different hospitals. In one hospital it had been introduced as part of a research project while in the other it had been integrated as an offer in the antenatal care programme. A questionnaire was sent to the 80 midwives working in the antenatal clinics serving these two hospitals. A total of 79% of the questionnaires were answered. The results indicate that in both districts, the similarities are greater than the differences with regard to the midwives' education, knowledge and their own opinions of their ability to inform pregnant women about the method. Although most of the respondents were positive to it, a number of midwives felt that, in general, information about foetal diagnosis was a difficult part of their work, mentioning both ethical and practical aspects. This highlights the need for continuing education, standardized policy and an ongoing ethical debate.     

cTnT、NT-proBNP及心肌酶谱联合检测在诊治急性冠脉综合征中的临床意义

目的：探究cTnT、NT-proBNP及心肌酶谱联合检测诊治急性冠脉综合征（ ACS）中的临床意义。方法选取该院2012年1月至2013年5月所收治的收治并确诊急性冠脉综合征患者24例,作为观察组,同时,针对该院在同期间入住的24例主要临床表现为“胸闷,难受,呼吸困难,胸痛”的患者为对照组,对患者的血样进行肌钙蛋白（ cTnT ）、N-端脑钠肽前体（ NT-proBNP ）、天门冬氨酸转移酶（ AST）、肌酸激酶（ CK）、乳酸脱氢酶（ LDH）及肌酸激酶同工酶（ CK-MB）的含量进行测定。结果治疗前,观察组在急性冠脉综合征患者各个指标均高于对照组,并且数据间差别存在显著性,即P＜0．05。治疗后,观察组中急性冠脉综合征患者在CTnT、NT-proBNP均高于对照组,并且数据间差别存在显著性,即P＜0．05,而两组在CK、CK-MB、LDH和AST上与对照组相比,无统计学差异（ P＞0．05）。结论 cTnT、NT-proBNP及心肌酶谱的检测对急性冠脉综合征患者的应用价值较高,可以有效反映ACS的具体情况,对ACS 的早期诊断及治疗具有非常重要的价值。     

Use,attitudes and knowledge of medications among pregnant women: A Saudi study

Objective

Medication use during pregnancy is a major concern for most women. The aim of the present study was to assess medication use, knowledge and beliefs about medications among pregnant women in Saudi Arabia.

Methods

More than 760 pregnant women, attending the obstetric clinic, filled a semi-structured questionnaire. Data were collected about their sociodemographic background, medication use during pregnancy, medication/pregnancy risk awareness, sources of drug information and beliefs about medications.

Results

Most women had a positive attitude toward medications in general but they believed pregnant women should be more cautious regarding drug-use during pregnancy. A significant association was found between participants’ education and occupation, and beliefs about medications. In this context, well educated women and those working in a health-related career demonstrated more correct beliefs about medications. Women with health-related occupations were more knowledgeable about the life saving effect of drugs on unborn children. Women indicated inadequate provision of drug-related information from physician and pharmacist; they rely on medication pamphlet to get such information. The most frequently used drugs were paracetamol and vitamins (13.2%). Most pregnant women (59.2%) were able to identify drugs to-be avoided in pregnancy that agreed roughly with FDA categories with 23 hits out of 32. They indicated that newborn anomalies (6.5%) were not attributed to drug-use during pregnancy.

Conclusion

During pregnancy, women were more conservative and skeptic toward medication, health-care professionals should be aware of such attitudes when advising pregnant women to take medication.