医院信息系统与医保联网的问题与对策

医疗保险是国家医疗保险体制改革的重要举措,具有极其重要的意义,建立医保中心与医院信息系统（hospital information system,HIS）的联网,对于提高医保患者的结算效率与医保中心的管理能力,有着重要作用。但各医院在联网与实施过程中会有一些共性的问题,本文就这些问题,提出了对应的解决措施。     

基于PACS的以数字化影像征象分类为模块的教学系统的研究与应用

目的研究基于PACS的以数字化影像征象分类为模块的教学系统及临床应用。方法在PACS系统中，允许每一权限医生对典型病例图像注释后按影像征象进行归类，然后存储于SQLSERVER2000服务器中，采用模块化管理方式，归类的影像征象按临床实践要求分析其病理过程、可能的疾病及其鉴别诊断方法。在专业的显示器（或个人计算机）上，通过用户界面输入解剖部位／影像征象即可调阅相关图像进行教学，弘要时通过Intrartet或Interilet实现网络教学。结果 系统开放性、稳定性好，影像数据和信息能安全、无损的存储，传输速度快，操作互动性好。结论基于PACS的以数字化影像征象分类为模块的教学系统符合临床实践过程要求，具有直观、实用性强，操作简便，图像安全可靠等优点，便于临床影像教学工作的开展。     

Effect of Jieze No.1(洁泽Ⅰ号)on Cervicitis Caused by Ureaplasma Urealyticum and on Ureaplasma Urealyticum in vitro

Objective:To observe the clinical therapeutic effect of Jieze No.1(洁泽Ⅰ号)on cervicitis caused by ureaplasma urealyticum and its inhibitory effect on ureaplasma urealyticum (Uu)in vitro.Methods:A total of 393 patients suffering from cervicitis induced by ureaplasma urealyticum without other complications were randomly assigned to 3 groups,the combined treatment group:140 patients treated with Chinese herbs Jieze No.1 by vaginal lavage,30 min each time,once a day for 10 consecutive days and oral administration of Azithromycin,1.0 g once every 72 h for three times;Jieze group:115 patients were treated with Jieze No.1 alone by vaginal lavage,30 min each time,once a day for 10 consecutive days;and the Azithromycin group:138 patients were treated with oral administration of Azithromycin,1.0 g once in 72 h for three times.All the patients were treated for 1 therapeutic course and condom were used for contraception during the treatment course.The Uu patients were examined again after 21 days of treatment.The therapeutic effect on cervicitis was observed.The experimental study of Jieze No.1 on the Uu strain separated from the secretion of the urogenital tract was also observed.The minimum inhibitory concentration(MIC)and minimum bactericidal concentration(MBC)of the Uu were investigated.Results:The total effective rate of the combined group was 85.3%,showing a significant difference compared with the Jieze group(67.8%)and the Azithromycin group(60.3%,both P＜0.01).There was no statistical significance between the latter two groups(P＞0.05).The clearing rate of Uu in the combined group was 78.4%,that of the Jieze group was 60.9%and the Azithromycin group was 47.9%.The combined group also showed a significant difference in comparison with the other two groups(all P＜0.01).Especially for the drugresistant strain,the clearing rate of Uu reached 48.1%in the combined group,42.1%in the Jieze group,and 16.1%in the Azithromycin group,respectively.The clearing rate of Uu for the drugresistant strain in the former two groups had significant differences in comparison with the latter (P＜0.01,P＜0.05),while there was no significant difference between the former two(P＞0.05).The range of MIC and MBC of Jieze No.1 to the drug-resistant strain of Uu was 15.62-250.00 mg/mL.To the non-drug-resistant MIC and MBC strain,it was 15.62-125.00 mg/mL.For the drug-resistant strain,MIC50 was≤31.25 mg/mL,MBC50 was≤62.50 mg/mL,MIC90 was≤1 25.00 mg/mL and MBC90 was≤250.00 mg/mL.For the non-drug-resistant strain,MICso was≤31.25 mg/mL,MBC50 was≤62.50 mg/mL,MIC90 was≤62.50 mg/mL and MBC90 was≤1 25.00 mg/mL.Conclusion:Jieze No.1 combined with Azithromycin can effectively treat cervicitis caused by Uu.The laboratory study confirms that Jieze No.1 has an inhibitory effect on ureaplasma uraalyticum strain.It has a remarkably effective therapeutic effects on drug-resistant strains,which is worthy of further research.     

Automatic Computation of Left Ventricular Volume Changes Over a Cardiac Cycle from Echocardiography Images by Nonlinear Dimensionality Reduction

Curve of left ventricular (LV) volume changes throughout the cardiac cycle is a fundamental parameter for clinical evaluation of various cardiovascular diseases. Currently, this evaluation is often performed manually which is tedious and time consuming and suffers from significant interobserver and intraobserver variability. This paper introduces a new automatic method, based on nonlinear dimensionality reduction (NLDR) for extracting the curve of the LV volume changes over a cardiac cycle from two-dimensional (2-D) echocardiography images. Isometric feature mapping (Isomap) is one of the most popular NLDR algorithms. In this study, a modified version of Isomap algorithm, where image to image distance metric is computed using nonrigid registration, is applied on 2-D echocardiography images of one cycle of heart. Using this approach, the nonlinear information of these images is embedded in a 2-D manifold and each image is characterized by a symbol on the constructed manifold. This new representation visualizes the relationship between these images based on LV volume changes and allows extracting the curve of the LV volume changes automatically. Our method in comparison to the traditional segmentation algorithms does not need any LV myocardial segmentation and tracking, particularly difficult in the echocardiography images. Moreover, a large data set under various diseases for training is not required. The results obtained by our method are quantitatively evaluated to those obtained manually by the highly experienced echocardiographer on ten healthy volunteers and six patients which depict the usefulness of the presented method.     

Computer-Aided Methodology for Syndromic Strabismus Diagnosis

Strabismus is a pathology that affects approximately 4 % of the population, causing aesthetic problems reversible at any age and irreversible sensory alterations that modify the vision mechanism. The Hirschberg test is one type of examination for detecting this pathology. Computer-aided detection/diagnosis is being used with relative success to aid health professionals. Nevertheless, the routine use of high-tech devices for aiding ophthalmological diagnosis and therapy is not a reality within the subspecialty of strabismus. Thus, this work presents a methodology to aid in diagnosis of syndromic strabismus through digital imaging. Two hundred images belonging to 40 patients previously diagnosed by an specialist were tested. The method was demonstrated to be 88 % accurate in esotropias identification (ET), 100 % for exotropias (XT), 80.33 % for hypertropias (HT), and 83.33 % for hypotropias (HoT). The overall average error was 5.6Δ and 3.83Δ for horizontal and vertical deviations, respectively, against the measures presented by the specialist.     

Evaluation of an automated superimposition method for computer-aided cephalometrics

ObjectivesTo evaluate a new superimposition method compatible with computer-aided cephalometrics and to compare superimposition error to that of the conventional Sella-Nasion (SN) superimposition method.Materials and MethodsA total of 283 lateral cephalometric radiographs were collected and cephalometric landmark identification was performed twice by the same examiner at a 3-month interval. The second tracing was superimposed on the first tracing by both the SN superimposition method and the new, proposed method. The proposed method not only relied on SN landmarks but also minimized the differences between four additional landmarks: Porion, Orbitale, Basion, and Pterygoid. The errors between the landmarks of the duplicate tracings oriented by the two superimposition methods were calculated at Anterior Nasal Spine, Point A, Point B, Pogonion, and Gonion. The paired t-test was used to find any statistical difference in the superimposition errors by the two superimposition methods and to investigate whether there existed clinically significant differences between the two methods.ResultsThe proposed method demonstrated smaller superimposition errors than did the conventional SN superimposition method. When comparisons between the two superimposition methods were made with a 1-mm error range, there were clinically significant differences between them.ConclusionsThe proposed method that was compatible with computer-aided cephalometrics might be a reliable superimposition method for superimposing serial cephalometric images.     

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目的探讨偏振数码照相结合计算机辅助图像分析法评价邻面去釉后釉质脱矿程度的准确性。方法于2010年3月选取青岛大学医学院附属医院口腔外科门诊因正畸需要拔除的上颌第一前磨牙40颗,沿牙冠颊舌向磨切得到80个标本,随机分为A（空白对照,未进行任何去釉处理）、B（邻面去釉）、C（邻面去釉后使用氟化泡沫）、D（邻面去釉后使用护牙素）4组。体外pH循环60d后,用偏振数码照相结合计算机辅助图像分析法定量测量各组标本邻面去釉及再矿化后的灰度值,以此来评价其釉质脱矿程度。同时用显微硬度仪定量测量各组标本的硬度值作为对照。结果（1）灰度值：A组灰度值最低,B组灰度值最高,C组和D组经过再矿化处理后灰度值较B组降低,差异有统计学意义（P〈0．05）。c组和A、D组之间灰度值差异无统计学意义（P〉0．05）。（2）硬度值：A组硬度值最高,B组硬度值最低,c组和D组经过再矿化处理后硬度值升高,但均较A组低。B组硬度值和其他3组之间比较,差异均有统计学意义（P〈0．05）,而A组与c组、c组与D组之间硬度值比较,差异均无统计学意义（P〉0．05）。结论偏振数码照相结合计算机辅助图像分析法得出的结果与显微硬度仪的定量检测结果相符合,表明了其是一种有效的定量评价釉质脱矿及再矿化效果的方法,值得临床推广。