Executing medical logic modules expressed in ArdenML using Drools

The Arden Syntax is an HL7 standard language for representing medical knowledge as logic statements. Despite nearly 2 decades of availability, Arden Syntax has not been widely used. This has been attributed to the lack of a generally available compiler to implement the logic, to Arden's complex syntax, to the challenges of mapping local data to data references in the Medical Logic Modules (MLMs), or, more globally, to the general absence of decision support in healthcare computing. An XML representation (ArdenML) may partially address the technical challenges. MLMs created in ArdenML can be converted into executable files using standard transforms written in the Extensible Stylesheet Language Transformation (XSLT) language. As an example, we have demonstrated an approach to executing MLMs written in ArdenML using the Drools business rule management system. Extensions to ArdenML make it possible to generate a user interface through which an MLM developer can test for logical errors.     

The Triangle Model for evaluating the effect of health information technology on healthcare quality and safety

With the proliferation of relatively mature health information technology (IT) systems with large numbers of users, it becomes increasingly important to evaluate the effect of these systems on the quality and safety of healthcare. Previous research on the effectiveness of health IT has had mixed results, which may be in part attributable to the evaluation frameworks used. The authors propose a model for evaluation, the Triangle Model, developed for designing studies of quality and safety outcomes of health IT. This model identifies structure-level predictors, including characteristics of: (1) the technology itself; (2) the provider using the technology; (3) the organizational setting; and (4) the patient population. In addition, the model outlines process predictors, including (1) usage of the technology, (2) organizational support for and customization of the technology, and (3) organizational policies and procedures about quality and safety. The Triangle Model specifies the variables to be measured, but is flexible enough to accommodate both qualitative and quantitative approaches to capturing them. The authors illustrate this model, which integrates perspectives from both health services research and biomedical informatics, with examples from evaluations of electronic prescribing, but it is also applicable to a variety of types of health IT systems.     

针灸治疗理论建设探讨——以针灸治痹为例

对体表具体病位/症状的局部针灸治疗,方法丰富,临床运用普遍,但其自身理论化程度较低,目前针灸治疗理论也未予恰当表述和应有的体现。通过分析《内经》等有关痹证针灸治疗较集中反映的诊治过程、方法及经验认识,探讨此类具体针灸治法的形成、要素及特点,指出在辨证、刺法、经络、腧穴等方面与临床难合的认识误区,提出"身形辨证"概念等,以期促进针灸治疗理论的研究。     

有毒中药在抗肿瘤治疗中的应用及思考

目的:探讨有毒中药在肿瘤治疗中的应用.方法:收集历代中医文献论述、国家药典规定、名家理论经验及实验结果,阐述有毒中药在肿瘤治疗中的应用现状,并思考临床应用存在的问题.结果:有毒中药从理论、实验及临床经验均有广泛应用,解毒扶正培本理论从理论与现代研究上均取得一定的成就,解毒法从外治到内治亦取得一定疗效.结论:抗肿瘤治疗可以应用有毒中药,但需要进一步的规范.     

Factor structure and dimensionality of the two depression scales in STAR*D using level 1 datasets

Background

The factor structure and dimensionality of the HAM-D₁₇ and the IDS-C₃₀ are as yet uncertain, because psychometric analyses of these scales have been performed without a clear separation between factor structure profile and dimensionality (total scores being a sufficient statistic).

Methods

The first treatment step (Level 1) in the STAR*D study provided a dataset of 4041 outpatients with DSM-IV nonpsychotic major depression. The HAM-D₁₇ and IDS-C₃₀ were evaluated by principal component analysis (PCA) without rotation. Mokken analysis tested the unidimensionality of the IDS-C₆, which corresponds to the unidimensional HAM-D_6.

Results

For both the HAM-D₁₇ and IDS-C₃₀, PCA identified a bi-directional factor contrasting the depressive symptoms versus the neurovegetative symptoms. The HAM-D₆ and the corresponding IDS-C₆ symptoms all emerged in the depression factor. Both the HAM-D₆ and IDS-C₆ were found to be unidimensional scales, i.e., their total scores are each a sufficient statistic for the measurement of depressive states.

Limitations

STAR*D used only one medication in Level 1.

Conclusions

The unidimensional HAM-D₆ and IDS-C₆ should be used when evaluating the pure clinical effect of antidepressive treatment, whereas the multidimensional HAM-D₁₇ and IDS-C₃₀ should be considered when selecting antidepressant treatment.     

Predicting university undergraduates' binge-drinking behavior: a comparative test of the one- and two-component theories of planned behavior

This study provides a comparative test of the one- and two-component theories of planned behavior (TPB) in the context of university undergraduates' binge-drinking. Participants (N = 120) self-completed questionnaire measures of all TPB constructs at time 1 and subsequent binge-drinking at time 2 (two-weeks later). The data were analyzed using a combination of path analyses and bootstrapping procedures. Both models accounted for a substantial proportion of the variation in behavior. However, the two-component TPB provided a significantly better fit to the data, with the total direct and indirect effects accounting for 90% of the variance. Intention was the only direct predictor of behavior. Instrumental attitude, affective attitude and self-efficacy had indirect effects. Although health interventions could usefully target these cognitive antecedents, simulation analyses, modeling the effects of cognition change on behavior, showed that only large-sized (0.8 SD) changes to affective attitude, or moderate-sized changes to all of these cognitions in combination were sufficient to reduce binge-drinking.     

仲景调和肝脾学术思想初探

文章从《伤寒论》、《金匮要略》二书中,探讨总结了张仲景调和肝脾的学术思想及其体系,其总的精神为"平调阴阳",恢复机体生理平衡;其治疗方法,则按照标本关系,或治肝为主,或治脾为主,或肝脾同治,或先用一法,后用一法。其治疗手段则有方药、针刺等。文章试图总结归纳其方法及精神,以期对临床有所裨益。     

论何广贤顾护小儿脾胃理论思想

何广贤名中医顾护小儿脾胃的思想体现于小儿保健及疾病的防与治。主张小儿保健由零岁做起,此为保证小儿健康成长的第一步;而小儿脾常不足,无论饮食、外感、内伤,还是药之不慎,均可伤及小儿原本不足之脾胃,故脾胃失调是小儿发病的重要因素,强壮和顾护脾胃应贯穿于治病防病全过程。     

“中医标准化病人”建设思路探讨

目的:探讨"中医标准化病人"的建设思路。方法:从标准化病人的应用概况入手,探讨"中医标准化病人"的建设目的、方法,及其存在的意义和价值。结论:"中医标准化病人"建设是我国高等中医药院校教学改革的重要环节,有其自身的价值,应在实践中不断发展和完善。     

行为转变理论在糖尿病合并脑梗塞患者血糖控制中的疗效观察

目的探讨行为转变理论在糖尿病合并脑梗塞患者血糖控制中的应用效果。方法将98例糖尿病合并脑梗塞患者随机分为两组,观察组49例实施以行为转变理论为基础的干预模式,对照组49例实施常规健康教育,并比较两组的效果。结果观察组患者空腹血糖（FPG）、餐后2h血糖（2hPG）、糖化血红蛋白（HbA1c）明显优于对照组,两组差异有统计学意义（P〈0.05）,观察组的知晓水平、熟悉水平、顾问水平、满意度均明显高于对照组（P〈0.05）。结论行为转变理论模式对糖尿病合并脑梗塞患者的血糖控制有积极的促进作用。