Where's the Beef? The Promise and the Reality of Clinical Documentation

Physician-generated emergency department clinical documentation (information obtained from clinician observations and summarized decision processes inclusive of all manner of electronic systems capturing, storing, and presenting clinical documentation) serves four purposes: recording of medical care and communication among providers; payment for hospital and physician; legal defense from medical negligence allegations; and symptom/disease surveillance, public health, and research functions. In the consensus development process described by Handler, these objectives were balanced with the consideration of efficiency, often evaluated as physician time and clinical documentation system costs, in recording the information necessary for their accomplishment. The consensus panel session participants and authors recommend that 1) clinical documentation be electronically retrievable; 2) selection and implementation be evidence-based and grounded on valid metrics (research is needed to identify these metrics); 3) the user interface be crafted to promote clinical excellence through high-quality information collection and efficient charting techniques; 4) the priorities for integration of clinical information be standardized and implemented within enterprises and across health and information systems; 5) systems use accepted standards for bidirectional, real-time clinical data exchange, without limiting the location or number of simultaneous users; 6) systems fully utilize existing electronic sources of specific patient information and general medical knowledge; 7) systems automatically and reliably capture appropriate data that support electronic billing for emergency department services; and 8) systems promote bedside documentation and mobile access.     

NEWLY DEVELOPED ULTRASOUND ENDOSCOPE WITH AN ELECTRONIC RADIAL ARRAY TRANSDUCER

A prototype electronic radial scan ultrasound endoscope has been developed by Olympus (Tokyo, Japan) for endoscopic ultrasound (EUS) study. The ultrasound view‐angle of this model is 360° vertical to the scope. Though the diameter of the scanner and the shaft of the scope is bigger than those of the present mechanical radial scan model, clinical manipulation of the new scope is the same as that of the present model. Image quality of the ultrasound picture demonstrated by the electronic radial model was as clear as those provided by the mechanical radial scan model. Ultrasound penetration was better and satisfactory because of less echoic reduction compared to the mechanical radial model. The newly developed electronic radial model can be evaluated as an ultrasound endoscope for the next generation. The advantage of this system is to facilitate the clinical use of color Doppler function and tissue harmonic imaging, and this system can be operated by the same monitor unit as a convex model of ultrasound endoscope.     

新一代低频电治疗仪的研制

本文介绍一种新型低频电脉冲治疗仪，采用新型单片机、程序控制和OTL功率放大器，产生变化有序的多种治疗脉冲波形模拟针灸治疗。电脉冲刺激器治疗仪可以用作减轻疼痛、放松肌肉、预防和减缓肌肉萎缩、增加局部血液循环等。     

头颈部肿瘤射野摆位误差的差异性研究

目的：研究采用电子射野系统评价头颈部肿瘤患者摆位误差时的观察者间变异和观察者自身变异。方法：两队研究小组，分别由四名医师和四名技师组成，两组分别对6名头颈部肿瘤的患者，采用电子射野影像仪（electronic portal imaging device，EPID）拍摄验证片（electronic portal images，EPIs），在EPIs上勾画骨性标志，以放疗计划生成的数字重建图像（digitally reconstructed radiographs，DRRs）做为参考图像，定量分析不同观察研究人员之间和研究人员自身采用EPID确定头颈部肿瘤患者的射野摆位误差（field placement errors，FPEs）的差异性。结果：在前／后位射野图像上．不同医师之间、医师自身及技师自身对摆位误差的判断无明显差异，但在技师之间出现了明显的自身差异性．医师组和技师组在前／后射野图像上的均方根（root-mean—square，RMS）分别为2．52±0．46和3．43±0．43，两者具有明显差异；在侧位野图像上，医师自身对摆位误差的判断有较好的稳定性，但部分不同医师之间在腹背、头足方向上部分患者中出现差异，而不同的技师之间存在明显差异性，医师组和技师组在侧位射野图像上的RMS分别为2．72±0．16和2．62±0．22．两者无明显差异。结论：医师和技师组在采用电子射野系统对头颈部摆位误差进行判断时存在人员之间的误差，应对所有人员进行统一训练才能减少射野摆位误差，从而提高IMRT治疗效果。     

免疫电镜技术运用过程中电子染色方法的选用

目的探究免疫电镜不同染色方法对免疫组化阳性实验结果影响的关系。方法组织切片经常规免疫组化（雌激素受体GPR30）并行DAB-硫酸镍铵显色后进行电镜切片，然后分为双氧铀-柠檬酸铅双染、双氧铀单染与未染色3组，以便对不同电子染色结果进行比较。结果GPR30免疫阳性产物位于细胞核外的膜性结构上，在铀-铅双染组显示很高的电子密度，但是背景染色也很深，在铀单染组的反差比较好，而未染色组的反差更好。结论免疫电镜技术中针对不同的免疫阳性反应选用不同的电子染色方法，有利于阳性结果的判断与鉴别。     

Springer Link及其收录的医学期刊分析

目的：向图书馆员和用户介绍Springer Link，对其收录的医学期刊进行深入分析，使该数据库得到更好的利用。方法利用《外国报刊目录》和美国《医学索引》(IM)的《引用期刊一览表》等对Springer Link收录的英文医学期刊从权威性、出版地分布、学科分布和收藏年限等方面进行考查。结果86％的期刊被IM引用，欧洲——尤其是德国的期刊较多，医学各学科都有相应的期刊被收录，但数量分布不均，有所偏重，72．7％的期刊可以保证至少近5年或自创刊以来的文献。结论Springer Link所提供的全文医学期刊服务质量较上乘，并有自己的特色。     

Electronic data processing in the Danish Cytogenetic Central Register and EDP problems of registers in general

A brief introduction to the Danish Cytogenetic Central Register (DCCR) is given, and possibilities, principles and problems concerning the establishment and maintenance of a national cytogenetic register are presented.
Various data carrier media for registers in general are discussed, of which the magnetic disc is considered most appropriate. General principles for programs capable of performing insertions, deletions and other modifications in the data base are outlined as well as the principles for the programs in the DCCR.
The individual records should preferably be identified by aid of a central person registration number (CPR) rather than by name. The data should be stored and sorted by this identification in order to facilitate retrieval of a desired record. The structure of the records is discussed with regard to prevention of the occurrence of certain errors as well as the optimization of processing.
Flexibility and economy of space are achieved by using programs able to handle records of unequal length, and problems occurring in connection with this are discussed. The question of how to protect sensitive data is dealt with, and two different methods used in the DCCR are outlined. Programs capable of analyzing karyotypes with the purpose of recognizing various cytogenetic syndromes have been developed for use in the DCCR. Various examples of computing times of typical program runs are presented.     

Simulation of cardiovascular physiology: the diastolic function(s) of the heart

The cardiovascular system was simulated by using an equivalent electronic circuit. Four sets of simulations were performed. The basic variables investigated were cardiac output and stroke volume. They were studied as functions (i) of right ventricular capacitance and negative intrathoracic pressure; (ii) of left ventricular relaxation and of heart rate; and (iii) of left ventricle failure. It seems that a satisfactory simulation of systolic and diastolic functions of the heart is possible. Presented simulations improve our understanding of the role of the capacitance of both ventricles and of the diastolic relaxation in cardiovascular physiology.