“Am I OK?” using human centered design to empower rheumatoid arthritis patients through patient reported outcomes

Objective

Use of patient reported outcomes (PROs) in the routine care of rheumatoid arthritis (RA) has been shown to improve health outcomes, However, integration of PROs into the clinical visit is inconsistent. We aimed to develop a “dashboard” for RA patients to display relevant PRO measures for discussion during a routine RA clinical visit.

Validity of using UK primary care electronic health records to study migration and health: a population-based cohort study

BackgroundDespite international migrants comprising 15·6% of the English population, there are no large-scale studies of migrant health in UK primary care electronic health records (EHRs). Developing and validating a migration phenotype (a transparent reproducible algorithm based on EHRs to identify migrants) is necessary to determine the feasibility of using EHRs for migration health research. This study aims to develop and validate a migrant phenotype in Clinical Practice Research Datalink (CPRD), the largest UK primary care EHR.MethodsThis is a population-based cohort study of individuals of any age in CPRD between Jan 1, 2007, and Feb 29, 2016, with a diagnostic Read term indicating international migration. We describe completeness of recording of migration: percentage of individuals recorded as migrants over time. We also describe representativeness of the cohort (age, sex, and geographical origin) compared with data from the Office of National Statistics (ONS; country of birth and the 2011 English Census).Findings325 391 (3·4%) of 9,448,898 individuals in CPRD had at least one of 440 terms indicating international migration. The cohort was mostly female (53·7% [174 883/325 391] overall; 52·4% [55 734/106 462] in 2011), which is similar to ONS 2011 census data (51·7 [3 791 375/7 337 139]). The percentage of migrants per year increased from 1·2% (69 046/5 716 075) in 2007 to 2·8 (154 525/5 427 745) in 2013, following a similar trend to ONS migration data (11·7% [5 927 000/50 714 000] in 2007; 13·7% [7 285 000/53 164 000] in 2013). Proportions were significantly lower in CPRD (χ² test; p<0·0001). The highest percentages of migrants were in the 25–34-year-old band (4·6% [30 549/668 864] in CPRD; 25·9% [1 851 952/7 160 102] in ONS). Migrants were mostly born in Europe (35·4% [10 316/29 113] in CPRD; 36·5% [2 675 003/7 337 042] in ONS) or the Middle East and Asia (34·5% [10 037/29 113] in CPRD; 34·5% [2 529 137/7 337 042] in ONS).InterpretationWe created a cohort of international migrants in England that is broadly representative in terms of age, sex, and geographical region of origin. Future validation work should explore representativeness by ethnicity and deprivation. Potential reasons for undersampling compared with ONS data include insufficient recording and poor health-care access. Nonetheless, the large cohort size provides sufficient power to study a range of health-care analyses in this potentially underserved population.FundingWellcome Trust (approvals [CPRD ISAC 19_062R]; REC 09/H0810/16).     

用户健康信息学学科建设与发展设想

介绍用户健康信息学发展背景、起源及发展机遇,阐述学科发展历程和应用技术体系,提出学科教育建设设想,包括课程设置、教学方式及人才培养方向几方面,为加快推进用户健康信息学学科建设提供有益参考。     

医学院校非信息类专业医学信息学选修课的教学实践研究

以移动互联网、物联网、云计算、大数据等为代表的新一代信息技术与健康医疗行业紧密融合,对医学院校面向非信息类专业的医学信息学选修课提出了更高的教学目标和内容要求。本文结合实际教学需求和临床医学生培养目标,对医学信息学选修课的教学内容进行了科学地优化和配置。选择医学信息学教育中的“小数据集,电子病历/电子健康档案的基本应用”为主要内容,模块化医学信息处理中的数值型数据、文本型数据和图像数据,以案例驱动和翻转课堂变革教学方式,将机器学习中常见的方法（如回归、分类和聚类方法）根植于案例的解决方案中,以综合的算法实例报告作为课程考核评价方式。实践表明,以上探索既激发了学生对医学信息学选修课的兴趣,又有效贯彻了医学生培养早预测、早调整、早发现、早诊断和早治疗的“五早”模式。     

卫生信息标准化中的数据类型

目的：分析国际及国内数据类型规范之间的区别和联系,为今后卫生信息标准研制过程中数据类型的应用提供参考。方法：收集、对比涉及数据类型的国际标准和规范,包括IS011404、ISO21090、ISO／IEC11179、HL7v3DataTypes以及openEHRDataTypesInformationModel,并与我国的WS／T3032009、WS363—2011进行对照。结果：从标准的背景和目的、基本内容、规范维度、基本数据类型与分类等5方面分析比较。数据类型的国际标准之间相互借鉴并保持协调,其中的数据类型具有语义,约束数据格式和内容。国内标准定义的数据元值的表示类型规范数据元值的格式,数据元值的数据类型则是数据元值表示类型的一个维度。结论：数据类型、数据元值的表示类型及值域之间既有区别又有联系。随着我国数据标准化方法体系的完善,需要从语义的角度规范和定义数据类型,正确应用数据类型和数据元值的表示类型。     

PUBLIC HEALTH AND EPIDEMIOLOGICAL DATABASES FOR THE ENHANCEMENT OF MEDICAL EDUCATION

The collaboration of public health education and information technology has made patient care safer and more reliable than before. Nurses and doctors use handheld computers to record a patient''s medical history and check that they are administering the correct treatment. Fortunately Public Health Informatics (PHI) is the intersecting point of technology and public health. Therefore, the inclusion of online medical and epidemiology databases in the course curriculum of budding medical professionals and postgraduate students would be beneficial in enhancing the quality of health care, extensive epidemiological research, health education, health policies, health planning and consumer satisfaction as well. The purpose of this article is to discuss and provide introduction of various databases which have huge information and it could be used to enhance the public health education.     

临床照护分类系统在综合ICU护理实践中的应用分析与展望

目的 探索临床照护分类系统（Clinical Care Classification System,CCC）在综合ICU护理实践中的应用情况。方法 使用CCC全智能护理信息系统（以下简称CCC系统）对研究期间的护理记录进行分析,研究数据包括2019年3月—7月的所有护理记录,共计301 358项护理文件条目。结果 从CCC系统中提取的数据显示,患者出现的护理诊断中,生理性要素占45.14%,功能性要素占41.62%,健康行为要素占12.33%,心理性要素占0.91%;照护要素分类中皮肤完整性方面涉及的护理措施最多（24.67%）,其次是活动类（21.55%）、安全类（15.09%）、身体调节类（13.72%）,其中评估监测类的护理措施占总护理措施的一半以上（52.39%）,护理执行类的护理措施占26.56%,而教导指导、管理转介类的措施分别占11.68%和9.36%;护理实际结局与预期护理目标比较,差异有统计学意义（P<0.05）。结论 CCC能够在为重症监护病房的患者提供个性化的临床护理实践中用于记录护理数据和书写护理电子病历,也能分析每项护理措施的频率和次数,有利于护理大数据的分析与应用;应用CCC可以促进综合ICU开展临床护理实践和护理科研。     

普通病区护理信息化看板的设计及应用

目的 研发供普通病区临床护士使用的双维度护理信息化看板,解决手工标识患者重要信息不便和跨空间沟通问题,为护士提供准确、直观的信息显示方式和沟通渠道。方法 采用现状调查法、文献查询法、专家会议法对双维度护理信息化看板进行信息项确认,从医院信息平台自动获取数据并进行解析、分类、呈现,在全院普通病区应用看板,通过访谈护士,评价看板应用效果。结果 护理信息化看板从双维度（全病区和单患者）抽取关键信息,共4大类62项,即患者资料15项、护理评估37项、护理任务9项、备注信息1项,实现了数据的直接读取和实时更新,提高了护士的工作效率,给护理人员带来正性心理感受。结论 双维度护理信息化看板实现信息传递自动化和资源共享,改变固有的临床护理工作模式,具有实用性和创新性。