医院信息化系统在武汉新冠肺炎防疫救治过程中暴露出的问题及其引发的思考

目的针对武汉地区医院信息化系统在新型冠状病毒肺炎(简称新冠肺炎)防疫救治过程中暴露出的问题,提出应对突发公共卫生事件时医院信息化的完善方法。方法充分分析医院信息化系统在新冠肺炎防疫救治中所暴露出的各个医院信息化系统结构不同、各个医院之间无法实施信息共享、门诊病房之间系统相互独立、数据信息更新不及时等九大问题,并提出医院信息化基础布局的建立、区域链及大数据临床中的应用等多项措施。结果医院信息化能力的提高有助于降低医护人员工作强度,提高患者的安全。结论新冠肺炎疫情的发生给我国医院信息化系统带来了严峻的挑战,但同时也给我们带来了更大的机遇。我国在未来针对突发公共卫生事件时,医院信息化将为医护人员、患者提供更有利的支持。     

三级公立医院行政总值班管理现状分析与研究*

探索一套符合现代化医院的行政总值班管理体系，确保医院管理工作安全、稳定运行。分析国内外医院总值班现状和问题，运用系统性、科学性、规范性等综合干预措施，进一步提高值班人员责任意识、分析问题和解决问题能力等综合管理能力，使总值班管理从粗放式向精细化转变，实现目标标准化、过程规范化、结果同质化的服务格局。     

Registries,Databases and Repositories for Developing Artificial Intelligence in Cancer Care

Modern artificial intelligence techniques have solved some previously intractable problems and produced impressive results in selected medical domains. One of their drawbacks is that they often need very large amounts of data. Pre-existing datasets in the form of national cancer registries, image/genetic depositories and clinical datasets already exist and have been used for research. In theory, the combination of healthcare Big Data with modern, data-hungry artificial intelligence techniques should offer significant opportunities for artificial intelligence development, but this has not yet happened. Here we discuss some of the structural reasons for this, barriers preventing artificial intelligence from making full use of existing datasets, and make suggestions as to enable progress. To do this, we use the framework of the 6Vs of Big Data and the FAIR criteria for data sharing and availability (Findability, Accessibility, Interoperability, and Reuse). We share our experience in navigating these barriers through The Brain Tumour Data Accelerator, a Brain Tumour Charity-supported initiative to integrate fragmented patient data into an enriched dataset. We conclude with some comments as to the limits of such approaches.     

一种面向中医药数据的高效脱敏算法＊

目的 针对中医药大数据平台传统的加密方案效率不高的问题，提出一种高效的基于属性的内积加密的数据脱敏算法。方法 Hash（哈希）算法是应用广泛的高效的数据加密方法，但传统的哈希算法基于单一的控制策略，效率不高。本文提出一种基于属性的内积加密的数据脱敏算法，把批量的敏感数据分割为不同长度数据颗粒度，与特定密文的哈希进行内积处理。结果 在面对中医药大数据平台的海量数据加密的场景，与传统的哈希加密算法相比，本文提供的加密算法具有很好的性能。结论 为了保障个人隐私数据不被泄露，中医药大数据平台中的个人医疗数据需要加密脱敏后，才能进行分析处理或对外发布。本文提出的算法具备灵活的数据颗粒度、策略和高效的性能表现，适用于海量的中医药数据脱敏。     

中药大蜜丸中活螨快速分离方法

本文对极易污染活螨的中药大蜜丸,在应用分离法的基础上,根据螨怕光、怕热的习性,适当调整光照,周围严格避光,达到分离活螨的目的.     

Reclaiming 'Big Nurse': a feminist critique of Ken Kesey's portrayal of Nurse Ratched in One Flew Over the Cuckoo's Nest

Reclaiming 'Big Nurse': a feminist critique of Ken Kesey's portrayal of Nurse Ratched in One Flew Over the Cuckoo's Nest Nurse Ratched or 'Big Nurse' in Ken Kesey's counter-culture novel One Flew Over the Cuckoo's Nest is one of popular culture's most arresting and memorable images of the nurse. She is, however, deemed to be remarkable primarily for her malice and authoritarianism. This paper argues that such a purely realist reading fails to fully appreciate the significance of the character of Nurse Ratched. A feminist critique of the novel contends that die importance of 'Big Nurse' is less related to how realistic/unrealistic or good/bad she is as a nurse. Nurse Ratched is important because she exemplifies all diat traditional masculinity abhors in women, and particularly in strong women in positions of power and influence. This paper explores the stereotype of 'Big Nurse' and argues that Kesey's vision of her ultimate 'conquest' is not a progressive allegory of 'individual freedom', but a reactionary misogyny which would deny women any function other than that of sexual trophy.     

病例组合指数的内涵及应用探讨

国内普遍认为病例组合指数(CMI)属于医疗服务能力维度,体现收治疾病的疑难复杂程度和医疗服务的整体技术难度。通过结构方程模型分析发现,CMI与时间消耗指数、费用消耗指数等服务效率维度指标联系更紧密,与DRG组数、入组病例数及总权重等服务能力维度指标联系相对较弱,故应归属医疗服务效率维度。CMI的直接应用主要是对平均住院费用的预测控制及对科室绩效的评价;CMI的间接应用主要是对管理指标的调整/校正。医院管理者应准确把握CMI内涵,恰当应用CMI对不同层级及不同类别住院费用进行预测、评价与控制,并对其他管理指标进行调整后再评价。     

大五人格因素与企业职工工作倦怠的关系

目的:探讨大五人格因素与企业职工工作倦怠的关系。方法:采用工作倦怠问卷(MBI-GS)与大五人格问卷调查了506名某企业职工。结果:分层回归分析的结果显示,在控制了人口统计学变量之后,大五人格因素所解释的工作倦怠的方差变异量,在情绪衰竭、玩世不恭和职业效能三个维度分别为28%、24%和17%。具体而言,宜人性是情绪衰竭、玩世不恭和职业效能的有效预测因子;责任感是玩世不恭和职业效能的有效预测因子;情绪稳定性是情绪衰竭和玩世不恭的有效预测因子;而外向性和开放性两个维度对工作倦怠的预测作用均未达到显著水平。结论:大五人格因素能够有效预测企业职工的工作倦怠。     

Endogenous estrogen status, but not genistein supplementation, modulates 7,12-dimethylbenz[a]anthracene-induced mutation in the liver cII gene of transgenic big blue rats

A growing number of studies suggest that isoflavones found in soybeans have estrogenic activity and may safely alleviate the symptoms of menopause. One of these isoflavones, genistein, is commonly used by postmenopausal women as an alternative to hormone replacement therapy. Although sex hormones have been implicated as an important risk factor for the development of hepatocellular carcinoma, there are limited data on the potential effects of the estrogens, including phytoestrogens, on chemical mutagenesis in liver. Because of the association between mutation induction and the carcinogenesis process, we investigated whether endogenous estrogen and supplemental genistein affect 7,12-dimethylbenz[a]anthracene (DMBA)-induced mutagenesis in rat liver. Intact and ovariectomized female Big Blue rats were treated with 80 mg DMBA/kg body weight. Some of the rats also received a supplement of 1,000 ppm genistein. Sixteen weeks after the carcinogen treatment, the rats were sacrificed, their livers were removed, and mutant frequencies (MFs) and types of mutations were determined in the liver cII gene. DMBA significantly increased the MFs in liver for both the intact and ovariectomized rats. While there was no significant difference in MF between the ovariectomized and intact control animals, the mutation induction by DMBA in the ovariectomized groups was significantly higher than that in the intact groups. Dietary genistein did not alter these responses. Molecular analysis of the mutants showed that DMBA induced chemical-specific types of mutations in the liver cII gene. These results suggest that endogenous ovarian hormones have an inhibitory effect on liver mutagenesis by DMBA, whereas dietary genistein does not modulate spontaneous or DMBA-induced mutagenesis in either intact or ovariectomized rats.     

The effect of big endothelin-1 in the proximal tubule of the rat kidney

1. An obligatory step in the biosynthesis of endothelin-1 (ET-1) is the conversion of its inactive precursor, big ET-1, into the mature form by the action of specific, phosphoramidon-sensitive, endothelin converting enzyme(s) (ECE). Disparate effects of big ET-1 and ET-1 on renal tubule function suggest that big ET-1 might directly influence renal tubule function. Therefore, the role of the enzymatic conversion of big ET-1 into ET-1 in eliciting the functional response (generation of 1,2-diacylglycerol) to big ET-1 was studied in the rat proximal tubules.
2. In renal cortical slices incubated with big ET-1, pretreatment with phosphoramidon (an ECE inhibitor) reduced tissue immunoreactive ET-1 to a level similar to that of cortical tissue not exposed to big ET-1. This confirms the presence and effectiveness of ECE inhibition by phosphoramidon.
3. In freshly isolated proximal tubule cells, big ET-1 stimulated the generation of 1,2-diacylglycerol (DAG) in a time- and dose-dependent manner. Neither phosphoramidon nor chymostatin, a chymase inhibitor, influenced the generation of DAG evoked by big ET-1.
4. Big ET-1-dependent synthesis of DAG was found in the brush-border membrane. It was unaffected by BQ123, an ET_A receptor antagonist, but was blocked by bosentan, an ET_A,B-nonselective endothelin receptor antagonist.
5. These results suggest that the proximal tubule is a site for the direct effect of big ET-1 in the rat kidney. The effect of big ET-1 is confined to the brush-border membrane of the proximal tubule, which may be the site of big ET-1-sensitive receptors.