抓住电子病历应用共享核心 推进数字化医院建设

国家卫生部对电子病历应用水平验收主要是对医院、区域电子病历共享进行验收,意在促进区域协同医疗和全民健康管理。长安医院紧紧抓住全国电子病历试点医院这一契机,努力建设数字化医院,获得国家卫生部“电子病历系统应用水平”考核全国第一,医院建设获得全面推进。     

由传统病历向电子病历平稳过渡的探讨

随着现代化科学技术的飞跃发展,计算机及网络广泛地应用于社会各个领域,医院管理的信息化不断加强,传统病历已不能满足医学发展的需要。从传统病历向电子病历过渡是否顺利,将影响到很长一段时间内的医疗质量和医疗安全。结合北京天坛医院电子病历的使用情况,从电子病历使用者的角度探讨了如何实现由传统病历向电子病历的平稳过渡。     

云计算环境下电子病历一体化管理初探

在文件生命周期理论和文件连续体理论的基础上提出了电子病历一体化管理思想,分析电子病历一体化管理存在的障碍,阐述利用云计算技术进行电子病历一体化管理的必要性,从顶层设计、云服务模式选择、云平台构建、标准化建设、业务流程重组等方面加强电子病历一体化管理,使电子病历数据保持云端同步,从而提高电子病历的管理水平,方便数据提取和数据共享。     

临床医师对电子病历相关知识认知的调查研究

目的:了解临床医师对电子病历书写的态度和行为现状以及电子病历管理和对医疗质量的认知等情况,为制定科学的电子病历管理方案提供借鉴。方法:选取两所2所三级甲等和2所三级乙等医院临床医师共计450名进行调查,采用问卷调查医师对电子病例相关知识(如临床医师对电子病例相关法规认知、电子病例监控对电子病历影响及电子病历优点等)的认知和需求。结果:临床医师电子病历总体书写现状调查显示,对于书写电子病历中相似的部分,48.7%(219例)的医师直接复制粘贴再修改;复制粘贴使用比率≥40%占76.7%(345例);电子病历书写出错原因主要为认为责任心不强(38.2%)和病历系统掌握不到位(29.6%);促进临床医师按要求写好病历的主要动力为法律证据(32.9%)和培养临床思维(49.1%);54.9%(247例)医师能对自己的病历进行经常检查;科室负责人对电子病历经常检查的占33.1%(149例);50%左右人员对电子病历系统操作掌握情况一般;79.33%的临床医师认为电子病历的使用有助于提高医疗质量;临床医师认为电子病历对医疗质量的影响主要是提高病历书写速率、病历完成及时性、管理系统性、病历安全性和患者满意度。结论:临床医师在电子病历书写中复制粘贴比例较高,且对相关的法律法规认识一般,对医院电子病历系统掌握不熟悉,应加大相关内容的培训,更有利于医院电子病历的管理。     

电子病历系统在医院信息管理系统中应用初探

电子病历系统是通过计算机等电子设备为载体,对医院患者的诊疗活动进行数字化记录的软件。电子病历中详细记录了医嘱、病程、过敏史、影像检查结果、出院记录等多项医疗数据。电子病历完整、系统、科学地记录了患者身体健康情况以及历次就诊记录,通过一个维度将患者内部不同层次的信息有机的联系在一起。与传统的纸张病历相比,电子病历可以迅速实现不同时间、不同医院医疗信息的高效整合以及信息共享,为临床诊疗提供大量科学准确的信息,大大提高医院的服务效率。本文通过电子病历系统在医院信息管理系统中的应用情况进行简要分析,以期提高电子病历系统在临床中解决实际医疗问题的能力。     

北京市属三级医院单病种质量管理现况研究

目的 调查北京市市属22家三级医院在单病种质量管理工作的开展现况,评估单病种质量管理水平。方法 采用调查问卷和深入访谈法对22家北京市市属三级医院单病种质量管理的开展数量、管理模式进行调查。结果 北京市市属22家三级医院开展单病种质量管理的占54.5%,单病种开展率为57.5%。实现实时监测单病种质控管理模式的仅4家医院。结论 单病种质控管理需要提升电子病历系统建设水平,结构化的电子病历对于质控数据的提取至关重要。     

电子信息工程在医院护理管理体系中的应用性研究

目的 利用电子信息工程,创建一种新型、安全、高效的护理工作模式。方法 在医院未实现护理无线移动系统的状态下,研制在电子病历中实现护理电子病历、护理管理等7项综合功能,使医院电子病历“无纸化”办公得以施行。结果 简化医嘱查对制度和流程,杜绝执行转抄医嘱方面的护理差错,保证患者用药安全,缩短护士的非护理时间,减轻护士的工作量,推进护理工作信息改革进程。结论 对患者、护理人员、医生、护理管理和医院节省资金等方面均带来不同程序的收益,降低管理成本,提高管理效能,为护理科学化管理提供正确的方法和途径。     

住院电子病历常见问题及解决方案

在医院住院电子病历使用过程中,问题主要出现在电子病历模板、与其他系统接口程序、系统管理3个方面。列举这3方面具有典型意义的案例并提出了解决方法,供系统使用、维护人员参考。     

卫生部发布“电子病历试点工作方案”

2010年10月14日,卫生部发布“电子病历试点工作方案”（以下简称“试点方案”）,决定在北京等22个省区市的部分区域和医院开展电子病历试点工作。试点方案指出,按照统筹兼顾东、中、西部地区分布的原则,以及当地医院前期基于电子病历的医院信息化管理工作开展情况,选定北京市、河北市省、辽宁省、黑龙江省、上海市、江苏省等22个省市作为试点省份。并指定29家医院和3个区域作为卫生部电子病历试点单位和试点区域。     

医院临床数据中心建设与应用

为解决医疗记录报告单的管理混乱问题,文章提出了医院临床数据中心体系架构,主要从系统整体架构、层次结构以及关键技术实现等方面进行了阐述,实现了基于Ensemble集成平台的医疗记录报告单数字化集中归档,生成PDF格式的报告单,为医护人员及病人提供各类应用服务。医生借助电子病历里调阅PDF格式的医疗记录报告单,解决了电子病历与各临床信息系统之间的信息集成,提高了医院的服务质量。     

Antibiotics in the treatment of wounds in the victims of the earthquake in the Armenian SSR

Purulent wounds in 88 victims of the Armenian earthquake with the syndrome of long-term squeezing were examined microbiologically and the experience with using antimicrobial drugs for their treatment was analyzed. In all the cases microbial associations were detected, coliform and nonfermenting gram-negative bacilli, enterococci, anaerobes and yeast-like fungi being isolated from 80, 20, 15 and 25 per cent of the patients respectively. 130 bacterial strains were studied in detail. 80 to 100 per cent of the bacterial isolates were resistant to the antibiotics routinely used in surgical practice, i.e. benzylpenicillin, tetracycline, levomycetin, kanamycin, cephalothin and cefazolin and highly sensitive to new antimicrobial drugs belonging to ureidopenicillins (mezlocillin), quinolones (ciprofloxacin) and cephalosporins of the 3rd generation (cefoperazone and ceftazidime). Retrospective estimation of the antibiotic therapy revealed its inadequacy in 55.7 per cent of the patients for the most part because of the isolates resistance. The 19 variants of the antibiotic use prescribed by the physicians mainly included penicillins, aminoglycosides and their combinations (in 67.2 per cent of the cases). The use of the highly efficient drugs of the groups of ureidopenicillins and quinolones was extremely rare which was likely due to lacking of information on the drugs.     

Histogenesis of the taste buds of the vallate papilla in the in the rat in the postnatal stages of development

The developing taste buds of vallate papillae were studied with electron microscope in rats during the first 7 days after birth. Two types of cells--light and dark--are identified in the taste buds of a one day old animal. The apical parts of dark cells are characterized by numerous dark granules. A distinguishing feature of light cells is the presence of synaptic contacts with afferent intragemmal nerves. On the 4th day of development on the top of the apical parts of the cell, a microvillar apparatus is seen to form, which does not yet communicate with the oral cavity. On the 7th day, basal cells appear in the taste buds. Some of these cells are seen mitotically dividing. The differentiated microvillar apparatus now communicates with oral cavity. The structure of the taste buds is getting similar to that in the adults. The structural and functional peculiarities of the developing taste buds are discussed in association with the period of ontogenesis under consideration.     

Changes in the size of the nucleoli of the Purkinje cells in the canine cerebellum in the postresuscitation period

The changes in the size of Purkinje cell (PC) nucleolus in the lateral and medial cerebellum zones were studied in dogs with different degree of neurologic status recovery after clinical death of various etiology and duration. PC always possess one nucleolus in the control and experimental groups. In the case of complete neurologic status recovery of animals the area of PC nucleolus increases in both zones studied, irrespective of the cause of clinical death. In the case of neurologic disorders the increase in PC nucleolus area is clearly expressed only in the medial zone of the cerebellum, being insignificant in the lateral zone. It is suggested that adaptive characteristics of PC are distinct in the two compared zones, which leads to greater PC vulnerability in the lateral zone during deep hypoxia.     

Frequency of the stages in the cycle of the seminiferous epithelium in the rat

This study determined the optimum number of tubules to be counted per testis cross section, and the number of animals per treatment group, when changes in stage frequencies in the cycle of the seminiferous epithelium are criteria for assessing effects of treatment on spermatogenesis. A data base of 9,672 observed and staged tubules was collected from testicular cross sections of 15 Sprague-Dawley rats. A significant variation between animals was found for the frequencies of Stages I, II, IV, VI, VIII, and XIII. Computer simulation was used to randomly select different combinations of animal and tubule numbers from the observed data. Stage frequency means from each simulation experiment were compared statistically to observed mean frequencies. A model that used data from all 14 stages was analyzed. The following conclusions were made: a) a minimum of 200 tubule cross sections/testis is recommended for estimating stage frequencies; b) for a fixed number of tubules scored, the number of animals sampled is more important than the number of tubules per animal in reducing variance; c) to detect a difference of 2 standard deviations from the mean with a 2% error rate and examining 200 tubules/testis, at least 12 animals must be used per group when assessing all 14 stages; d) when individual stages are examined using 10 animals per group, only Stage VII has 80% or greater power of test (alpha = 0.05) to detect a frequency difference; e) pooling stages into 3-4 groups is recommended to improve the power of detecting a treatment difference.     

Self-organization in the determination of the size of the axial structures in the embryogenesis of the clawed toad

Experiments were performed using X. laevis embryos during gastrulation and neurulation (stages 10, 11 1/2, 12 1/2, 13 1/2, 15 and 18). Part of presumptive epidermis and lateral plate mesoderm was removed, and embryos raised until stage 25. The size of axial structures (notochord, somite mesoderm, central nervous system) was determined using serial histological sections and compared with that of control embryos. In experimental embryos, the size of axial structures was decreased. Until a specific stage of development, close correlation was found between the volume of embryonic compartment corresponding to a particular, structure and the volume of presumptive epidermis and lateral plate mesoderm. This stage is individual for each axial organ: middle gastrula (stage 11 1/2) for notochord, late gastrula (stage 12 1/2) for somite mesoderm, and late neurula (stage 18) for central nervous system. This data suggest that differentiation pattern of ecto-mesodermal rudiment is subject to regulation during gastrulation-neurulation, and subdivision of ectoderm and mesoderm into axial and non-axial tissues is a self-organizing process.     

Role of the mediodorsal nucleus of the thalamus in the function of generalization in the cat

In chronic experiments on cats contribution of the thalamic mediodorsal nucleus to the organization of the processes of generalization and abstraction was studied by means of alternation method. Electrolytic ablation of the nucleus retarded the learning and impeded the initial stages of formation of the generalization function. Mechanisms of thalamic dementia are discussed.