整体护理模式病房建设计算机管理系统的应用及效能

阐述了整体护理模式病房建设计算机管理系统的应用及效能：①促进了整体护理工作的开展。②高效率地体现了护理程序的全程。③使各种护理文件及护理表格达到清晰、美观、格式规范。④有利于科研、教学工作的完善。⑤推动了护理学科计算机技术的应用     

DicomWorks: Software for Reviewing DICOM Studies and Promoting Low-cost Teleradiology

DicomWorks is freeware software for reading and working on medical images [digital imaging and communication in medicine (DICOM)]. It was jointly developed by two research laboratories, with the feedback of more than 35,000 registered users throughout the world who provided information to guide its development. We detail their occupations (50% radiologists, 20% engineers, 9% medical physicists, 7% cardiologists, 6% neurologists, and 8% others), geographic origins, and main interests in the software. The viewer’s interface is similar to that of a picture archiving and communication system viewing station. It provides basic but efficient tools for opening DICOM images and reviewing and exporting them to teaching files or digital presentations. E-mail, FTP, or DICOM protocols are supported for transmitting images through a local network or the Internet. Thanks to its wide compatibility, a localized (15 languages) and user-friendly interface, and its opened architecture, DicomWorks helps quick development of non proprietary, low-cost image review or teleradiology solutions in developed and emerging countries.     

Good design practice for medical devices and equipment,Part II: design for validation

Medical devices and their associated process equipment must be reliable and fit for purpose. In light of the recent changes to the medical device regulations, manufacturers must now take an integrated approach to design, development and validation. Good design practice encourages this integrated approach while ensuring fitness for purpose within commercial reality. A review of current literature related to good design practice carried out in Part I of this paper showed that there is inadequate guidance regarding the integration of validation with design. This paper proposes a practical approach to design for validation aimed at making devices easier and more economic to validate. The approach comes in the form of a model of design for validation that illustrates the basic relationship between design, development and validation and a series of design tactics that were formulated in order to help designers take a more proactive approach to validation during design.     

Effects of movement impairment based treatment in the management of mechanical neck pain

Background

Neck pain is a common musculoskeletal complaint in computer users due to prolonged static or awkward work postures. It has been shown that pathogenesis of neck pain is associated with scapular movement impairment syndromes. However, there is a dearth of literature in treatment based on these syndromes.

三维运动捕捉技术在颈椎整复手法中肢体运动轨迹的在体研究

目的:通过三维运动捕捉与分析系统,采集与分析手法运动数据,归纳肩、肘、膝和踝关节运动特点。方法:由1位施术者在头部、躯干、左右肩峰、肘关节内外侧、腕关节内外侧、前臂外侧、上臂外侧、髂前上棘、髂后上棘、股骨大转子、胫骨结节、内外侧膝、腓骨小头、内外侧踝、足跟、双侧大腿、小腿胫骨外侧以及第1、2、5跖骨头、粘贴光标,对1位受试者完成1次颈椎“骨错缝、筋出槽”治疗的右手手法操作周期,重复5次,对施术者右侧肩、肘、膝和踝关节运动轨迹进行捕捉、记录、计算和分析。结果:手法操作过程中4个关节运动轨迹的趋势一致,其中肘关节的离散度最为明显。肩关节和肘关节的三维活动度明显,而膝关节和踝关节相对较小,然而膝关节的屈伸活动明显大于旋转和侧弯活动。结论:石氏伤科颈椎整复手法的上肢关节灵活性较高,而下肢关节的稳定性是重要保证,其中同侧膝关节通过屈伸活动来辅助上肢发力;红外线三维运动捕捉与分析系统建立的手法模型可以为教学和基础研究提供新的研究思路。     

Building bridges across electronic health record systems through inferred phenotypic topics

ObjectiveData in electronic health records (EHRs) is being increasingly leveraged for secondary uses, ranging from biomedical association studies to comparative effectiveness. To perform studies at scale and transfer knowledge from one institution to another in a meaningful way, we need to harmonize the phenotypes in such systems. Traditionally, this has been accomplished through expert specification of phenotypes via standardized terminologies, such as billing codes. However, this approach may be biased by the experience and expectations of the experts, as well as the vocabulary used to describe such patients. The goal of this work is to develop a data-driven strategy to (1) infer phenotypic topics within patient populations and (2) assess the degree to which such topics facilitate a mapping across populations in disparate healthcare systems.MethodsWe adapt a generative topic modeling strategy, based on latent Dirichlet allocation, to infer phenotypic topics. We utilize a variance analysis to assess the projection of a patient population from one healthcare system onto the topics learned from another system. The consistency of learned phenotypic topics was evaluated using (1) the similarity of topics, (2) the stability of a patient population across topics, and (3) the transferability of a topic across sites. We evaluated our approaches using four months of inpatient data from two geographically distinct healthcare systems: (1) Northwestern Memorial Hospital (NMH) and (2) Vanderbilt University Medical Center (VUMC).ResultsThe method learned 25 phenotypic topics from each healthcare system. The average cosine similarity between matched topics across the two sites was 0.39, a remarkably high value given the very high dimensionality of the feature space. The average stability of VUMC and NMH patients across the topics of two sites was 0.988 and 0.812, respectively, as measured by the Pearson correlation coefficient. Also the VUMC and NMH topics have smaller variance of characterizing patient population of two sites than standard clinical terminologies (e.g., ICD9), suggesting they may be more reliably transferred across hospital systems.ConclusionsPhenotypic topics learned from EHR data can be more stable and transferable than billing codes for characterizing the general status of a patient population. This suggests that EHR-based research may be able to leverage such phenotypic topics as variables when pooling patient populations in predictive models.     

基于数字化技术建立距骨颈骨折螺钉固定安全通道的研究

 目的 探讨距骨颈骨折螺钉自距骨内侧壁安全固定时螺钉安全通道的建立。方法 限定志愿者年龄20~60岁,男性身高165~185 cm,女性身高155~175 cm,体质指数(BMI)< 25,既往踝、足部无骨折病史,非重体力劳动及长期站立工作者,X线片证实无关节退行性改变等。共获得男性33名,年龄21~59岁,平均43.7岁,身高168~184 cm,平均176.0 cm;女性22名,年龄22~60岁,平均43.2岁,身高158~172 cm,平均165.4 cm。对所有志愿者的踝部及足部进行CT扫描,将重建层厚为0.75 mm的图像数据以DICOM格式存入光盘,使用SuperImage^TM Orthopedics Edition1.1软件对图像进行显示和三维重建。测量距骨颈和跗骨管的高度,建立螺钉进入跗骨管的模型;模拟螺钉自距骨内侧壁远端中1/3和下1/3两点置入,并沿两条不同的方向走行,测量螺钉的最大长度及角度;最后使用SPSS 13.0软件对以上数据进行比较分析。 结果 获得距骨颈和跗骨管的高度值,同性别左右侧的差异无统计学意义;男性距骨颈和跗骨管高度均大于女性;获得螺钉自距骨颈穿出进入跗骨管的模型;获得以距骨内侧壁远端中1/3和下1/3为入点、自不同方向置入时螺钉的长度值和角度值;以距骨内侧壁远端中1/3为入点时螺钉固定的夹角较以距骨内侧壁远端下1/3为入点时明显更大;;计算出螺钉不同固定方向的长度、角度的安全范围。 结论 螺钉固定时应避免对距骨血运造成进一步破坏;距骨内侧壁中1/3是螺钉固定的良好入点;计算机数字化技术与距骨颈骨折内固定方式相结合可以提高手术安全性和可行性。     

听骨链CT仿真内窥镜成像技术的临床应用价值

目的　探讨听骨链CT仿真内窥镜 (CTVE)成像技术的初步临床应用价值。方法　使用HiSpeedCT/i扫描机 ,层厚 1 0mm、螺距 1 0、骨算法、视野 9 6cm× 9.6cm、间隔 0 1mm重建 ,对 10例正常中耳和 2 1例临床怀疑中耳病变 (14例手术 )的患者进行CTVE成像。正常及异常中耳的观察阈值分别为 - 6 0 0～ - 2 0 0HU和 5 0～ 30 0HU。结果　CTVE能清楚显示正常听骨链的形态、大小及相互关系 ,锤骨、砧骨及锤砧关节的显示率为 10 0 % (38/38) ,镫骨底板的显示率为 32 % (12 /38) ,只有 2 1%(8/38)可以分辨镫骨的前、后脚 ;18例中耳炎患者中 12例胆脂瘤形成 ,CTVE上有不同程度的听小骨破坏。 1例中耳畸形显示听骨链发育异常。结论　CTVE是一种新的、非侵袭性的方法 ,能显示听骨链的立体影像 ,有利于听骨链病变的显示和诊断     

Computer-based cognitive retraining: a controlled study

Microcomputers have gained popularity as treatment tools after severe head injury but there have been no controlled studies to show it the programmes used can modify behaviour or cognitive improvement. This paper describes a controlled study of such a training programme using three groups of subjects of ten each, one head-injured group using the computer, one head-injured group not using the computer, and a non-head-injured group. The study lasted 4 weeks. The only differences found were in the behavioural aspects of attention. Psychomotor and vigilance were not improved. The reasons for this are discussed.     

Relative value of analog and digital teaching files

RATIONALE AND OBJECTIVES: This study was performed to determine if it is financially reasonable for radiology residency programs that create and maintain their own teaching files to switch from analog teaching files (ATFs) to digital teaching files (DTFs). MATERIALS AND METHODS: Radiology residency program directors were surveyed electronically about the monetary value and importance of conventional ATFs and DTFs. The costs for maintaining each type of file were calculated at the authors' institution. RESULTS: Surveys were sent to the program directors of all 197 accredited radiology residencies. Responses were received from 48 (24%). DTFs were scored as more important than ATFs, but the difference was not significant (P = .22). DTFs were rated as less complete (P = .01) but more current (P < .001) than ATFs. DTFs included the American College of Radiology Learning File (85%), in-house productions (77%), and other commercially available products (63%). Thirty percent of respondents had a DTF integrated into a picture archiving and communication system, and 28% reported having a technician dedicated to the teaching file. Program directors ascribed total median dollar values of $250 and $3,000 per year to their ATFs and DTFs, respectively. The annual costs at the authors' institution were much higher than these ascribed values: $44,720 ($91 per case) for maintaining a DTF produced in house and $24,601 ($50 per case) for maintaining an ATF, excluding physician time. CONCLUSION: Program directors are more willing to pay for a DTF than an ATF. For both, the costs of maintenance are great and the relative monetary value is low.