智慧医院规划设计及应用实践

以泸州市中医医院为例,从基础业务系统、基础硬件工程、数据仓库和数据交换中心、数据挖掘与为管理层提供决策支持几方面阐述医院智慧医疗架构设计及其应用,实践表明该系统应用能够提高医院智能化水平,为相关研究提供参考。     

湖南省郴州市一起新型冠状病毒肺炎聚集性疫情流行病学调查

目的 通过分析郴州市一起新冠肺炎聚集性疫情相关病例发病确诊过程,探讨新冠病例早发现、早报告以及病例诊断和隔离观察解除的策略依据。 方法 对该起新冠肺炎聚集性疫情的病例和密切接触者进行现场流行病学调查,描述性分析流行病学史、临床和实验室资料。 结果 利用大数据比对监测,在转送监测对象至集中场所隔离医学观察时发现了新冠肺炎确诊病例何某华,由此发现一起新冠肺炎家庭聚集性疫情,何某的5名密切接触者中有3人发病确诊（包含1名重症病例）,其中重症病例黄某第7次新型冠状病毒核酸检测阳性进而确诊,密切接触者中胡某有流行病学史、血常规白细胞下降和肺炎影像学改变,但是5次咽拭子核酸检测阴性,未确诊。 结论 大数据比对监测对发现传染病有积极作用;早期对有流行病学史人员单独隔离医学观察对防止聚集性疫情发生有重要意义;将2次核酸检测阴性作为新冠肺炎病例的排除标准和将核酸检测阳性作为确诊新冠肺炎病例的必备条件,值得探讨,这都可能放走传染源,导致新冠肺炎传播。     

2型糖尿病病人锻炼行为及其相关因素研究

目的 了解2型糖尿病病人的锻炼状况并探索其相关因素。方法 采用个人基本资料问卷、相关知识量表、自我效能量表和锻炼行为量表对门诊130例2型糖 病病人进行调查。结果 2型糖尿病病人总体的锻炼行为不够理想；在职人员锻炼行为明显不如非在职人员；病人的相关知识的自我效能均与锻炼行为呈正相关；多元回归分析显示，自我效能对锻炼行为具有决定作用，其可解释锻炼行为72.4%的变异量。结论 护理人员应致力于改善糖尿病病人的锻炼行为，在传授知识的同时，结合Bandura自我效能理论采取一定措施，提高病人的自我交通。     

护士压力状况的调查分析

目的：了解当前护士的压力状况，设法调整其工作方式方法，以便最大限度地调动护士的工作积极性和创造性。方法：采用随机抽样的方法对506名护士进行问卷调查.结果：40．5％护士工作压力感较强，有44．9％的压力来源于工作任务繁重，19．6％源于知识不够用和技能不熟练。中级技术职务护士的压力48．7％是源于工作任务繁重，初级技术职务的护士压力21．6％源于知识和技能不适应工作；正在接受继续教育的护士压力感强于未接受教育者（x^2=9.72,P＜0．05）。结论：应适当增加护士编制，调整科室人员配备，为护士继续教育提供条件，以缓解护士压力。     

Presentation, treatment, and outcome of oral cavity cancer: a National Cancer Data Base report

BACKGROUND: Oral cancer has been identified as a significant public health threat. Systematic evaluation of the impact of this disease on the US population is of great importance to health care providers and policy makers. METHODS: This study used the National Cancer Data Base (NCDB) to evaluate associations between demographic and disease characteristics, treatment, and survival for patients with oral cavity cancer in the United States. Of patients diagnosed between 1985 and 1996, 58,976 were extracted from the NCDB. ANOVAs were performed on selected cross-tabulations, and relative survival was used to calculate outcome. RESULTS: Median age of patients was 64.0 years. Men made up 60.2% of patients. Pathologic diagnosis was squamous cell carcinoma (SCC) in 86.3% of cases. Younger patients had a much higher frequency of non-SCC, and this was related to survival in these patients. African-Americans (independent of income), lower income patients, and patients with higher grade disease were seen more frequently with advanced-stage SCC. Five-year relative survival for SCC cases was lower for older patients, men, and African-Americans. CONCLUSIONS: This study addressed many issues related to oral cancer that have been previously discussed in the literature. The demographic, site, stage, histologic, and survival data available for this large number of cases in the NCDB allowed an accurate characterization of the contemporary status of oral cancer in the United States.     

副神经移接肩胛上神经术后肌电恢复规律的初步探讨

目的　探索副神经移位于肩胛上神经后冈下肌肌电恢复的规律。方法　对 46例副神经移接肩胛上神经者 ,于术后不同时期测定冈下肌复合运动动作电位 (CMAP)的波幅及潜伏期 ,并用SPSS统计软件进行KaplanMeier生存率的分析及数据、方程式的拟合。结果　 (1)术后冈下肌出现新生电位的平均时间为 3 11.98± 3 5 .87d ;(2 )不同随访时间的复合运动动作电位潜伏期 (L)、波幅 (A)及术后时间 (x)的关系 ,即经验方程式为L =13 .8764 + 2 10 7.3 2 /x(Rsq =0 .3 78) ;A =0 .710 6+ (-0 .0 171)x + (2E-0 6)x 2 + (-1E -7)x 3 (Rsq =0 .64 8)。结论　副神经移位于肩胛上神经术后不同时期复合运动动作电位的波幅及潜伏期的预测可提供经验方程式 ,并为临床早期判断手术疗效提供量化依据。     

Open mesh versus non-mesh repair of groin hernia meta-analysis of randomized trials leased on individual patient data

Abstract Background. The EU Hernia Trialists Collaboration was established to provide reliable evaluation of newer methods of groin hernia repair. It involved 70 investigators in 20 countries. Materials and methods. Twenty eligible trials (5016 participants) of open mesh vs. non-mesh groin hernia repair were identified. Meta-analysis was performed using raw individual patient data where possible. Results. Fewer hernia recurrences were reported after mesh repair. There were no clear differences between mesh and non-mesh groups in complications. Overall, those in the mesh groups had a shorter hospital stay, quicker return to usual activities and less frequent persisting pain, but individual trial results varied. Conclusions. The review provides strong evidence that open mesh repair is associated with a reduction in the risk of recurrence of between 50% and 75%. There is also some evidence of quicker recovery and of lower rates of persisting pain following open mesh repair. Electronic Publication     

多模态医学影像数据融合三维构建肢体肿瘤及其周围解剖整体结构

目的利用多模态医学影像数据三维重建和配准融合的方法构建肢体肿瘤及瘤周解剖整体结构,明确肿瘤的局部特征和三维空间关系,为肿瘤外科治疗术前评估和计划提供客观的空间可视化信息。方法采集4例肢体肿瘤患者盆部和大腿上段CT、MRI和MRA影像数据,分别导入三维重建软件,基于CT和MRI对人体不同组织结构成像敏感度的差异,从各模态影像数据中分别提取肿瘤及其周围目标结构进行三维重建。依据体内解剖参照点对各个组织的三维结构进行配准融合,构建肢体肿瘤及瘤周解剖整体结构。结果通过CT、MRI和MRA影像数据构建出包括肿瘤及周围骨骼、肌肉、神经、血管、盆腔脏器等组织的三维整体结构,显示了肿瘤的大小、形状、部位等局部特征以及肿瘤与其周围结构的三维空间关系。结论以多模态影像数据通过三维重建和配准融合的方法可以构建肿瘤区域多种组织的三维整体结构,清楚而直观地显示肿瘤的局部特征以及与周围结构的空间解剖关系,具有个体化肿瘤术前评估和计划的应用价值。     

甲状腺影像报告和数据系统在超声检查甲状腺结节中的应用

目的 探讨甲状腺影像报告和数据系统(thyroid imaging reporting and data system,TI-RADS)在超声检查甲状腺结节中的诊断价值.方法 收集292例(423个)甲状腺结节患者的超声资料,以组织病理学结果为参照标准,采用TI-RADS分级诊断标准进行回顾性评价.结果 423个甲状腺结节中,TI-RADS分级为1～5级者其恶性结节所占百分率分别为0(0/129)、6.3%(11/176)、33.3%(10/30)、86.8%(46/53)和100%(35/35).对甲状腺良性结节超声检查TI-RADS分级的灵敏度、特异度、正确率、阳性预测值和阴性预测值分别为96.3%(309/321)、83.3%(85/102)、93.1%(394/423)、94.8%(309/326)和87.6%(85/97),阳性似然比、阴性似然比及Youden指数分别为5.77、0.04和79.6%.TI-RADS分级的良、恶性结节在形态、边界、内部回声、回声质地、内部构成和钙化灶方面所占比例的差异均有统计学意义(P<0.001).结论 在甲状腺结节的超声检查中,应用TI-RADS分级诊断标准对临床诊断和治疗具有重要的指导价值.     

Complications and revision amputation following trauma-related lower limb loss

IntroductionTrauma-related amputations are a common cause of limb loss in the United States. Despite the military and public health impact of trauma-related amputations, distributions of various lower limb amputations and the relative frequency of complications and revision amputations have not been well described. We used the National Trauma Data Bank (NTDB) in order to investigate the epidemiology of trauma-related lower extremity amputations among civilians in U.S. trauma centers.Materials and methodsWe conducted a secondary data analysis of the 2011–2012 NTDB research data sets, using means and frequencies to characterize the patient population and describe the distribution of major lower extremity amputations. Multivariable regression models were fit to identify predictors of major post-surgical complications, revision amputation, length of hospitalization, and in-hospital mortality.ResultsA total of 2879 patients underwent a major lower extremity amputation secondary to a trauma-related lower limb injury, representing 0.18% of all NTDB trauma admissions from 2011 to 2012. 80.4% were male and 67.6% were white. The three most frequent definitive amputations preformed included trans-tibial (46%), trans-femoral (37.5%), and through foot (7.6%). The average length of hospitalization for all amputees was 22.7 days. Patients with at least one revision amputation stayed in the hospital approximately 5.5 days longer than patients not needing a revision amputation. 1204 patients (41.8%) required at least one revision amputation. 27.5% of amputees experienced at least one major post-surgical complication. African Americans experienced a 49% higher major post-surgical complication incidence and stayed, on average, 2.5 days longer in the hospital compared to whites. Injury severity score, age, hospital teaching status, presence of a crush injury, fracture location, presence of compartment syndrome, and experiencing a major post-surgical complication were all significant predictors of revision amputation.ConclusionWe report a high rate of complications and revision amputations among trauma-related lower limb amputees, and identify predictors of surgical outcomes that have not been described in the literature including African American race. Compartment syndrome is a significant predictor of major post-surgical complications, revision amputation, and length of hospitalization.