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991.
《The Journal of arthroplasty》2019,34(10):2204-2209
BackgroundDriven by the recent ubiquity of big data and computing power, we established the Machine Learning Arthroplasty Laboratory (MLAL) to examine and apply artificial intelligence (AI) to musculoskeletal medicine.MethodsIn this review, we discuss the 2 core objectives of the MLAL as they relate to the practice and progress of orthopedic surgery: (1) patient-specific, value-based care and (2) human movement.ResultsWe developed and validated several machine learning-based models for primary lower extremity arthroplasty that preoperatively predict patient-specific, risk-adjusted value metrics, including cost, length of stay, and discharge disposition, to provide improved expectation management, preoperative planning, and potential financial arbitration. Additionally, we leveraged passive, ubiquitous mobile technologies to build a small data registry of human movement surrounding TKA that permits remote patient monitoring to evaluate therapy compliance, outcomes, opioid intake, mobility, and joint range of motion.ConclusionThe rapid rate with which we in arthroplasty are acquiring and storing continuous data, whether passively or actively, demands an advanced processing approach: AI. By carefully studying AI techniques with the MLAL, we have applied this evolving technique as a first step that may directly improve patient outcomes and practice of orthopedics. 相似文献
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The use of cell salvage during caesarean section has been increasing steadily, although there are concerns relating to cost, a perceived risk of amniotic fluid embolism, and fetal red cell sensitisation. We present observational data from almost a decade of use of intra-operative cell salvage in obstetrics. By the end of this period, we set up cell salvage collection for > 98% of all caesarean sections. From 2008 to 2017, 1170 women have had a re-infusion of cell salvaged blood with no clinical safety concerns; the median (IQR [range]) volume was 231 (154–306 [80–1690]) ml. During this time there has been a marked reduction in the number of women who were transfused allogeneic blood, as well as the amount of blood transfused. In total, 647 (55%) women have had alloimmunisation testing, with two positive cases. Quality control data indicate that the quality of blood processed from partial first bowls is no worse than that from full bowls. We discuss the costs of providing this service with regard to: staffing costs; single suction; leucodepletion filters; selectivity in the processing of collected blood; and the use of partial first bowls. 相似文献
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目的调查分析外科ICU(SICU)患者身体功能现状及活动能力水平,为开展早期活动以促进患者快速康复提供参考。方法采用方便抽样法选取SICU符合条件患者100例,应用切尔西危重患者身体功能评估工具(CPAx)和佩尔梅危重患者活动评分量表进行评估。结果 SICU患者身体功能评分3～29(14.83±1.91)分,活动能力评分3～15(8.30±1.62)分;是否使用血管活性药物及机械通气的患者身体功能评分比较,差异有统计学意义(均P0.01);不同年龄段、是否使用身体约束及机械通气、有无引流管的患者活动能力评分比较,差异有统计学意义(P0.05,P0.01)。结论 SICU患者的身体功能和活动能力评分较低,需积极开展重症患者群体中早期活动相关评估,实施适宜的干预措施,改善重症患者的预后和生存质量。 相似文献
996.
目的调查老年心力衰竭患者出院过渡期心衰相关症状,分析其变化趋势及影响因素。方法采用Memorial心力衰竭症状评估量表、心脏病患者抑郁量表、照护负担问卷和家属照护者照护能力问卷,对219例老年心衰患者及主要家庭照护者,于患者出院前1～2 d、出院后1个月和3个月进行调查。结果患者的心衰相关症状随着出院过渡期的延长呈恶化趋势,与出院前1～2 d相比,出院后1个月和3个月患者的心衰症状总分及各维度得分显著提高(P<0.01)。抑郁症状在出院后1个月得分最高(90.31±3.27),随着过渡时间的延长得分逐渐下降(P<0.01)。回归分析显示,出院过渡期患者心衰相关症状受患者服药种类、心功能分级和照护能力的影响;抑郁受患者年龄、病程和住院次数的影响(P<0.05,P<0.01)。结论老年心衰患者出院过渡期心衰相关症状较差且呈动态变化,受多种因素影响。护理人员应该制定针对性的过渡期护理计划,减轻患者症状负担。 相似文献
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Amy L. Seybert Pharm.D. FCCP Pamela L. Smithburger Pharm.D. M.S. FCCP Neal J. Benedict Pharm.D. Lawrence R. Kobulinsky Sandra L. Kane-Gill Pharm.D. M.S. FCCP James C. Coons Pharm.D. FCCP 《JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY》2019,2(6):686-692
Innovations in clinical pharmacy education have advanced patient-centered care knowledge in skills of pharmacy graduates through the use of simulation, virtual reality, and gaming. Pharmacy schools and colleges, as well as health care institutions, have adopted simulation education in various clinical education formats for all levels of learners and practitioners. Over the past 15 years, the University of Pittsburgh School of Pharmacy has embraced innovative approaches to learning and documented advancement of clinical pharmacy education. This brief report will discuss advances in national and international pharmacy education, as well as the PittPharmacy experience with simulation education. A particular emphasis is on human patient simulation, computer-based simulation, virtual patient, and gaming in the settings of direct patient care-related education and assessment. The available literature and the experience at PittPharmacy shows improvement in learner satisfaction, knowledge enhancement, critical thinking skills, and problem solving in patient care topics. The evidence included provides support for the use of simulation to advance clinical pharmacy education and can serve to encourage further scholarship in this area. 相似文献