国内外医疗机构患者安全文化测评工具的系统综述

目的了解国内外医疗机构患者安全文化测评工具的特征、优劣点及研究趋势,为后续研究及医院管理提供借鉴与参考。方法在Pub Med和CNKI上,对2000—2016年间国内外公开发表的患者安全测评工具进行系统文献综述。结果最终检索并纳入68篇文献,涉及20个患者安全文化测评工具;在调查方法上,除Ma PSAF采用访谈法之外,另外19个测评工具均采用问卷法;在调查对象上,除Parental-reported hospital safety climate是服务对象之外,另外19个测评工具均是医务人员;PSCHO、Ma PSAF、SAQ、HSOPSC和SCOPE 5个测评工具针对不同机构或国家和地区提供了修订版本,其中HSOPSC的修订版本最多达23个。结论国内外医疗机构患者安全文化测评工具研究日趋成熟,针对不同机构或文化背景的测评工具研究已成为研究热点及趋势之一,建议将患者安全文化测评纳入医疗机构的评审指标或规范化管理流程之中,以更好地促进患者安全和医疗服务质量。     

Composite score for prediction of 30-day orthopedic surgery outcomes

The LACE+ (Length of stay, Acuity of admission, Charlson Comorbidity Index score, and Emergency department visits in the past 6 months) risk-prediction tool has never been tested in an orthopedic surgery population. LACE+ may help physicians more effectively identify and support high-risk orthopedics patients after hospital discharge. LACE+ scores were retrospectively calculated for all consecutive orthopedic surgery patients (n = 18 893) at a multi-center health system over 3 years (2016-2018). Coarsened exact matching was employed to create “matched” study groups with different LACE+ score quartiles (Q1, Q2, Q3, Q4). Outcomes were compared between quartiles. In all, 1444 patients were matched between Q1 and Q4 (n = 2888); 2079 patients between Q2 and Q4 (n = 4158); 3032 patients between Q3 and Q4 (n = 6064). Higher LACE+ scores significantly predicted 30D readmission risk for Q4 vs Q1 and Q4 vs Q3 (P < .001). Larger LACE+ scores also significantly predicted 30D risk of ED visits for Q4 vs Q1, Q4 vs Q2, and Q4 vs Q3 (P < .001). Increased LACE+ score also significantly predicted 30D risk of reoperation for Q4 vs Q1 (P = .018), Q4 vs Q2 (P < .001), and Q4 vs Q3 (P < .001).     

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。     

FBG Strain Monitoring of a Road Structure Reinforced with a Geosynthetic Mattress in Cases of Subsoil Deformation in Mining Activity Areas

This paper presents implementation of purpose-designed optical fibre Bragg grating (FBG) sensors intended for the monitoring of real values of strain in reinforced road structures in areas of mining activity. Two field test stations are described. The first enables analysis of the geogrid on concrete and ground subgrades. The second models the situation of subsoil deformation due to mining activity at different external loads. The paper presents a system of optical fibre sensors of strain and temperature dedicated for the investigated mattress. Laboratory tests were performed to determine the strain characteristic of the FBG sensor-geogrid system with respect to standard load. As a result, it was possible to establish the dependence of the geogrid strain on the forces occurring in it. This may be the basis for the analysis of the mining activity effect on right-of-way structures during precise strain measurements of a geogrid using FBG sensors embedded in it. The analysis of the results of measurements in the aspect of forecasted and actual static and dynamic effects of mining on the stability of a reinforced road structure is of key importance for detailed management of the road investment and for appropriate repair and modernization management of the road structure.     

The expression patterns and prognostic significance of pleckstrin homology-like domain family A (PHLDA) in lung cancer and malignant mesothelioma

BackgroundPleckstrin homology domain family A (PHLDA) genes play important roles in cancer cellular processes, including inhibiting Akt activation, repressing growth factor signaling, inhibiting the negative feedback of EGFR/ErbB2 signaling cells, and inducing apoptosis. However, the prognostic significance of PHLDA in non-small cell lung cancer (NSCLC) and malignant pleural mesothelioma (MM) remains unclear. The present study investigates the associations between PHLDA expression patterns and their prognostic value in lung adenocarcinoma (LUAD) and MM.MethodsWe analyzed PHLDA family members at the genomic level in silico to explore their mRNA expression pattern and predictive significance in LUAD and MM. We then created a PHLDA–drug interaction network and a protein-protein interaction (PPI) network using different databases. Finally, we immunohistochemically assessed the protein expression of each PHLDA family member on tissue microarrays (TMAs) in both LUAD and MM cohorts with long-term follow-up.ResultsWhile PHLDA1 mRNA expression in both LUAD and MM was lower than that of normal tissue, PHLDA2 mRNA was significantly overexpressed in LUAD, and PHLDA3 mRNA was overexpressed in MM. In NSCLC, both low PHLDA1 mRNA expression and high PHLDA3 mRNA expression correlated with worse overall survival (OS) (P<0.01), whereas high PHLDA2 mRNA expression was associated with better OS (P<0.01). In MM, patients presenting high PHLDA1 and PHLDA2 mRNA expression had poor OS (P=0.01 and P<0.01, respectively). In addition, the PHLDA-drug interaction network indicated that several common drugs could potentially modulate PHLDA expression, and the PPI network suggested that PHLDA1 interacts with Notch family members, whereas PHLDA3 interacts with TP53. Our results also showed that the expression of PHLDA2 and PHLDA3 was significantly higher in LUAD and MM than that of PHLDA1 (P<0.05) and was associated with the risk of death. While patients with PHLDA2 >85.09 cells/mm² had a low risk of death (P=0.01) and a median survival time of 48 months, those with PHLDA3 <70.38 cells/mm² had a high risk of death (P=0.03) and a median survival time of 34 months.ConclusionsWe shed light on the role of the PHLDA family as promising predictive biomarkers and potential therapeutic targets in LUAD and MM.