基于真实世界数据特点构建中医临床信息采集模式的对策

医学信息化的快速发展带来了医疗健康数据的井喷式增长,虽然其创造了丰富的临床数据资源,但也存在着管理不当和应用不足的问题,其核心在于现有采集模式不能适用真实世界数据采集的需要。通过梳理目前临床研究信息采集的现状,发现其存在着采集场景较局限,采集角色较单一,数据采集的丰富性和客观性较欠缺,跨场景医疗健康数据之间的连贯性和共享性较差以及个体健康数据采集的时间范围较短的问题,针对这些问题从扩展数据场景和采集角色,丰富数据采集的工具及建立个体健康信息的全生命周期采集4个方向探讨了中医多场景、多角色、全时空的临床信息采集模式的构建,以期为中医临床研究提供一些参考和借鉴。     

政策工具视角下国内护理卫生政策的文本分析

目的 研究1978年—2020年护理卫生政策中政策工具使用情况,探讨现有政策工具的分布情况及框架结构,为后续政策的制定及落实提供参考。方法 基于Rothwell&Zegveld构建的政策工具分析框架,采用内容分析法,构建X维度（基本政策工具）及Y维度（政策发展阶段）的二维分析框架,对现有护理卫生政策文本进行编码整理和量化分析。结果 最终纳入24篇政策文件,共整理378条政策分析条目。X维度中,供给型、需求型、环境型政策工具所占比例分别为24.60%、14.02%、61.38%。Y维度中,萌芽探索期、补充完善期、成熟提升期政策工具占比分别为23.02%、31.75%、45.24%。结论 目前国内护理卫生政策工具总体使用不协调,供给型政策工具较关注人才培养,科技研究和信息化建设有待增加;需求型政策工具应用较少,缺乏有效拉动作用;环境型政策工具使用过于频繁,内部工具比例有待调整。建议可进一步把握护理卫生政策演化的规律性,提升政策实施的实效性,强化政策组合的整体性。     

运用质量管理工具降低护理不良事件发生率

目的通过分析我院护理不良事件发生的种类及引发因素,制定相应护理对策,从而降低护理不良事件的发生率。方法针对我院2014年非惩罚性上报护理部的42例护理不良事件,运用质量管理工具进行分析,提出整改措施并实施。结果通过实施改进措施后,护理不良事件发生率明显下降,差异具有统计学意义(P0.05)。结论质量管理工具使护理管理者抓住重点,有针对性地实施改进措施,有效降低护理不良事件发生率。     

3种衰弱评估工具对老年腹部手术患者术后并发症预测效能的比较分析

目的：比较衰弱表型(Frailty Phenotype,FP)、衰弱量表(Frail scale,FS)、埃德蒙特衰弱量表(The Edmonton Frail Scale,EFS)3种衰弱评估工具对老年腹部手术患者术后并发症的预测效能,以期为衰弱评估工具的选择提供参考。方法：便利选取某三级甲等医院年龄≥60岁的老年腹部手术患者184例,采用FP、FS、EFS评估患者的衰弱状态,收集患者的一般资料、手术类型、手术方式以及术后并发症的资料。应用χ²检验,通过受试者工作特征(receiver operating characteristic,ROC)曲线分析FP、FS和EFS对老年腹部手术患者术后并发症的预测作用。结果：184例老年腹部手术患者FP、FS、EFS衰弱的检出率分别为22.3%、16.8%、22.2%, 3种评估工具的衰弱检出率比较差异无统计学意义(P>0.05)。FP预测老年腹部手术患者术后并发症发生的ROC面积为0.798,高于FS、EFS的0.681和0.670(P<0.05)。结论：3种衰弱评估工具对老年腹部手术患者的衰弱检出率具有一致...     

Data mining and clinical data repositories: Insights from a 667,000 patient data set

Clinical repositories containing large amounts of biological, clinical, and administrative data are increasingly becoming available as health care systems integrate patient information for research and utilization objectives. To investigate the potential value of searching these databases for novel insights, we applied a new data mining approach, HealthMiner, to a large cohort of 667,000 inpatient and outpatient digital records from an academic medical system. HealthMiner approaches knowledge discovery using three unsupervised methods: CliniMiner, Predictive Analysis, and Pattern Discovery. The initial results from this study suggest that these approaches have the potential to expand research capabilities through identification of potentially novel clinical disease associations.     

Determinants of and changes in catastrophic health expenditure in the occupied Palestinian territory: an analysis of ten rounds of the Palestinian Households Expenditure and Consumptions Survey (1996–2011)

Background

Catastrophic health expenditure (CHE) is measured to assess the financial protection from the risk of health-related conditions, which is considered a principle performance goal of any health system. The incidence and intensity of CHE in the occupied Palestinian territory between 1998 and 2007 was assessed in previous research; however, no research has assessed the occurrence of CHE in different population groups in the occupied Palestinian territory. The objective of this study was to examine the changes in the occurrence of CHE in different groups of Palestinians from 1996 to 2011, which was a period of increasing political turmoil, transformation of the national health system, and economic hardship faced by the population.

Prevention of hypertension in patients with prehypertension in the rural areas of China: a community-based quasi-experiment

Background

People with prehypertension are highly likely to develop hypertension and other cardiovascular diseases. Lifestyle modifications may prevent hypertension in patients with prehypertension, but evidence remains scarce in developing countries. This study aimed to investigate whether a community-based intervention could prevent hypertension through lifestyle modifications in people with prehypertension in the rural areas of China.

Violence prediction in the Emergency Department

The purpose of this study was to examine whether the SAGE assessment survey could predict, within the Emergency Department setting, those youth at risk for engaging in violent behavior. It also examined whether those who test positive for engaging in high-risk violent behavior during the initial baseline SAGE survey were prone to continue this behavior 1 month later. This was an observation, convenience sample of young male and female patients, half of whom had injuries related to violence and half of whom had injuries unrelated to violence, who presented when a research fellow was available. They were given the SAGE aggression assessment survey and questioned about their risk behavior in the past 6 months to 1 year. Those youths were contacted 1 month after enrollment to determine the incidence of continued at-risk behavior. Demographic information was used to contact the patient on follow-up but not for identification purposes. The study was IRB-approved. The setting was a Level I pediatric and adult trauma center in an inner city with 45,000 annual visits. The inclusion criteria were: age 10-24 years, consenting patient or guardian, medically stable, and able to communicate. The exclusion criteria were: those youths who were uncooperative or refused to participate. The comparison between the SAGE overall scores of the 182 subjects with 46% who had injuries related to violence vs. 54% who presented with injuries not related to violence did not show a significant difference. Those who presented with non-violent injuries had an overall score range of 7-8 with a mean of 7.4 and those who presented with violent injuries had an overall scale of 10-11 with a mean of 10.1 out of a possible 12 total. There were, however, significant differences at the .05 or less level when looking at specific questions asking about certain behaviors such as physical fighting, shoving, needing medical attention, and kicking, in the initial survey. At the 1-month follow-up, with 118 subjects, the SAGE tool also showed differences in the areas of physical fighting, shoving, and kicking between the 56% who had injuries not related to violence vs. the 44% who did have violence-related injuries. It identified 18-50% of those who presented with violence-related injuries and who continued to engage in high-risk behavior at the 1-month follow-up. These results indicate that the SAGE survey scores based on the responses to all 12 questions is not effective in identifying those youths at risk for general violent behavior, especially with a high-risk population. A set of four questions from the 12-question SAGE survey, however, was successful at tracking specific types of at-risk behaviors. This indicates that certain questions within the SAGE survey may be effective at tracking those who engage in high-risk violent behavior. These same questions were able to track those who continued to engage in high-risk violent behaviors 1 month later.     

应用Braden量表构建压疮二维防控体系的探讨

目的探讨应用Braden量表构建压疮防控体系的作用。方法应用Braden量表对住院病人实施压疮风险评估,依据Braden评分值,划分发生压疮的高、中、低危险,同时,建立护理部一科护士长～病区三级监控体系,形成以压疮发生的危险分层为横轴,三级护理管理体系为纵轴的压疮二维防控体系。根据压疮风险预报的不同风险,采取对应的管理办法。结果通过规范管理,树立压疮风险预报概念,压疮上报率明显增加,压疮的治疗效果明显提高。结论应用Braden量表构建压疮二维防控体系可以有效预防住院病人压疮的发生,保障病人安全。