云南省县域医院消化内镜诊疗现状调查及建议

目的　综合分析云南省县域医院消化内镜中心（室）的基本情况、诊疗现状等信息,为提高与规范云南省消化内镜诊疗水平提供依据。方法　采用网络调查方式开展,对2019年1月—2020年1月期间云南省县域医院消化内镜中心（室）的医疗质量相关数据信息,包括内镜中心（室）设置、人员配置、诊疗技术及诊疗量、质量控制指标等进行统计分析。结果　共有143家县域医院参加调查统计,消化内镜中心（室）平均仅1.74个操作间,内镜主机平均1.42台,胃肠镜数量平均4条,143家县域医院内镜中心（室）的超声内镜主机共10台,小肠镜主机仅2台,经内镜逆行胰胆管造影术仅4家县域医院在开展。省内县域医院专职消化内镜医师共392名,能够完成四级手术的医师仅占医师总人数的18.62%（73/392）,其中掌握内镜黏膜下剥离术的医师比例仅6.12%（24/392）。省内县域医院消化道癌早期诊断率仅19.48%（1 133/5 817）,其中食管癌早期诊断率21.04%（276/1 312）、胃癌早期诊断率19.53%（397/2 033）、结直肠癌早期诊断率18.61%（460/2 472）。结直肠腺瘤检出率12.83%（12 207/95 148）,盲肠插管成功率70.49%（67 067/95 148）,内镜黏膜下剥离术完整切除率为12.54%（221/1 763）。结论　云南省县域医院消化内镜中心（室）配置、诊疗技术水平、质量控制指标整体水平较低下,仍需要在完善消化内镜质量控制体系的基础上,提升县域医疗机构消化内镜服务能力、诊疗技术水平。     

试从《内经·素问疏五过论》论“疑难杂病”新治疗观

《内经·素问疏五过论》阐述五个医者常见的过错,强调社会生活事件、负性情绪、生活环境等对疾病发生、发展的影响,并重视心理支持及干预疗法的运用,这种理念与生物-心理-社会医学模式的核心内容形神皆似;目前由于生物医学模式影响,疑难杂病在中西医各级医院的诊疗不容乐观;提出在生物-心理-社会医学模式下推进疑难杂病的新治疗观。     

Constructing language: evidence from a French-English bilingual child

This paper presents evidence from a French-English bilingual child between the ages of two years three months and three years five months, growing up bilingually from birth, with a French mother and English father in an English speaking environment. In focussing upon questions in the child's two languages, and charting in some detail the emergence of particular structures, it is argued that the data support a growing body of evidence that young children learn language in a piecemeal, item-by-item fashion. Furthermore, analysis of the questions in the parents' two languages suggests that the input also has an important role to play. The implications of these findings are considered with regard to the training of professionals working in early years settings.     

西北军队医院开展整体护理的难点及对策

按照医院分级管理标准对西北军队１０所医院２８个责任制护理病区进行检查，发现存在以下问题：床、护比例不合理；病房无中、高级技术职称的护理人员进行专科业务指导；医院领导对责任制护理认识不足；缺乏信息交流。以上问题均影响了新的护理制度的开展，并提出了针对性的对策。     

SimQ: Real-Time Retrieval of Similar Consumer Health Questions

Background

There has been a significant increase in the popularity of Web-based question-and-answer (Q&A) services that provide health care information for consumers. Large amounts of Q&As have been archived in these online communities, which form a valuable knowledge base for consumers who seek answers to their health care concerns. However, due to consumers’ possible lack of professional knowledge, it is still very challenging for them to find Q&As that are closely relevant to their own health problems. Consumers often repeatedly ask similar questions that have already been answered previously by other users.

Objective

In this study, we aim to develop efficient informatics methods that can retrieve similar Web-based consumer health questions using syntactic and semantic analysis.

Methods

We propose the “SimQ” to achieve this objective. SimQ is an informatics framework that compares the similarity of archived health questions and retrieves answers to satisfy consumers’ information needs. Statistical syntactic parsing was used to analyze each question’s syntactic structure. Standardized Unified Medical Language System (UMLS) was employed to annotate semantic types and extract medical concepts. Finally, the similarity between sentences was calculated using both semantic and syntactic features.

Results

We used 2000 randomly selected consumer questions to evaluate the system’s performance. The results show that SimQ reached the highest precision of 72.2%, recall of 78.0%, and F-score of 75.0% when using compositional feature representations.

Conclusions

We demonstrated that SimQ complements the existing Q&A services of Netwellness, a not-for-profit community-based consumer health information service that consists of nearly 70,000 Q&As and serves over 3 million users each year. SimQ not only reduces response delay by instantly providing closely related questions and answers, but also helps consumers to improve the understanding of their health concerns.     

基于Delphi7.0实现试题库编辑管理系统

探讨了在试题库管理系统中如何应用Delphi7.0和Word2003编程实现对含有图表、公式等图形的图文混合试题进行录入编辑、存储、浏览、维护及Word文档的数据库存储。通过Delphi7.0的TImage元件将Word编辑的图文试题内容以图形方式进行显示,实现了试题基本信息与图文内容的同窗口同步显示。在文中给出了在Delphi7.0和Micorsoft Word2003环境下的具体编程实现方法。     

全静脉营养制剂配制中常见问题及措施

全静脉营养制剂在配制中容易出现药物配伍不当、药物配比浓度不当、配制顺序混淆等多种问题。因此,应做好配液前的充分准备、严格执行规范操作、加强对营养液的审核与核对、药剂师提供合理用药技术支持、加强配制的无菌环境等。     

Expanding the reach of decision and communication aids in a breast care center: A quality improvement study

Objective

One academically based breast cancer clinic implements decision and communication aids as part of routine clinical care. This quality improvement study aimed to expand reach of these supportive materials and services with budget-neutral program changes.

Methods

We used program theory and continuous quality improvement to design changes to our program. We calculated reach as the number of new patient visits for which we administered decision and communication aids. We compared reach before and after the program changes.

Results

Program changes included: reassigning program outreach tasks from over-committed to under-utilized personnel; deploying personnel in floating rather than fixed schedules; and creating a waitlist so service delivery was dynamically reallocated from overbooked to underbooked personnel. Before these changes, we reached 208 visitors with decision aids, and 142 visitors with communication aids. Changes were associated with expanded reach, culminating in program year 2008 with the delivery of 936 decision aids and 285 communication aids.

Conclusions

We observed over a fourfold increase in decision aid reach and a twofold increase in communication aid reach. We attribute increases to recent program changes.

Practice implications

This study illustrates how program theory and quality improvement methods can contribute to expanded reach of decision and communication aids.     

《黄帝内经·素问》中虚词英译规律探析

有关中医古典文献英译,研究实词者多,研究虚词者少。然古医籍行文中虚词的比重不小,其语法与词法远比实词复杂,所以中医古典文献中虚词的英译,应该予以充分的重视。本研究从翻译《黄帝内经.素问》入手,分析其虚词的分类、句子成分及其上下语境,总结出必译、不译、半译、多译四种对应的英译规律,同时归纳出虚词句法标记作用(句式、时态、语态与语气)对英译的影响。     

朝鲜《医林撮要》所载中朝医学交流史料研究

由丧鲜内医郑正先撰、杨礼寿校正,成书于16－17世纪时期的《医林撮要》一书,共13卷128门,它引用了大量李朝前期的朝鲜医书及当时已成书的中国医书资料,是一部非常切合临床应用的综合性方书。特别是书中所收载的“中朝质问方”和中朝传习方”中的方剂,若干处与中国宋代医书《仁斋直指方论》等有诸多联系,是中国和朝鲜医学交流过程中的重要记录。但它与记载中朝两国政府官员之间医学质问的傅懋光《医学疑问》毫不相关。