医生工作站电子申请检验项目时附加费用的智能收取

目的:探讨医生工作站电子申请检验项目时附加费用的智能收取的实现及应用价值。方法:检验单项和检验组套进行分组;每组内先根据标本类型收取采血费和一次卫材费,然后将标本类型同组内样本类型进行比较,不同则加收一次。有多个分组时,每组先加收一次卫材费,然后组内判断循环同上。特殊情况设置特殊的处理方案。结果:临床医生选中检验项目时,采样所需要收取的卫材费及采血费,自动添加到医嘱中。当去掉某一项目时只需删除项目,卫材费及采血费由收费程序判断保留,多余的自动删除。特殊情况实现了按需收取。结论:电子申请检验项目时实现附加费用的智能收取,表明在HIS建设中在注重功能大而全的同时,也需要注重小而精的细节,以求方便日常工作。     

条形码自助取单系统的临床应用

目的：通过创建条形码自助取单系统,实现检验报告单发放的自动化、科学化和人性化管理,实现无纸化验室。方法：在检验信息管理系统与医院信息系统实现无缝连接的基础上,门诊患者在医生申请检验项目收费处确认收费后,由门诊抽血护士站采集标本时生成条形码和条形码取单凭证,患者用条形码取单凭证上的条形码在自动取单机上扫描打印所有检验报告单,住院患者由医生根据申请在医生工作站自行打印检验报告单。结果：条形码自助取单系统代替了传统人工分发检验报告单的繁琐、遗失和重复打印等问题,节省人力,使用方便。结论：利用条形码自助取单系统实现了检验报告单管理的自动化、规范化和实验室管理的科学化,杜绝了交叉污染,保护了病人隐私。     

小儿表浅静脉采集血标本成功率影响因素

目的：研究小儿表浅静脉采集血标本成功率影响因素,探讨提高表浅静脉采集血标本成功率的有效护理对策。方法：对每种影响因素进行分组研究,每组按随机分组原则设试验组和对照组,采取所需血量为成功,未采取所需血量为不成功。结果：常见几种影响因素试验组与对照组差异有统计学意义（p〈0.01）。结论：小儿表浅静脉采集血标本影响因素是多方面的,采血前必须对患儿进行综合评估,选择恰当的采血方法。     

降钙素原指导AECOPD抗菌药物使用与停用的临床研究

目的:通过对照研究探讨血清降钙素原(Procalcitonin,PCT)水平用于判断慢性阻塞性肺疾病急性加重期(Acute exacerbations of chronic obetructive pulmonarydisease,AECOPD)使用和终止抗菌药物治疗时机的可行性。方法:120例AECOPD住院患者随机分为实验组和对照组,每组60例。实验组在入院后24小时内采血进行血清PCT检查,当实验组患者血清PCT0.5 ng/m L时使用抗菌药物治疗,且PCT0.5 ng/m L的患者使用抗菌药物后予以隔日采血检查血清PCT水平,如果PCT0.5 ng/m L或者下降超过峰值的80%时就停止使用抗菌药物;对照组则根据患者的临床症状、体征及医生临床判断决定使用和停用抗菌药物时机。结果:共118例患者完成临床试验。实验组患者的抗菌药物使用天数和住院天数明显低于对照组;实验组患者的住院总费用显著低于对照组(P0.01);两组AECOPD复发率无差异(P0.05)。结论:PCT可能是判断AECOPD抗菌药物治疗使用与终止时机的良好指征,此方法不仅可以提高疗效,还可以减少抗菌药物的滥用,降低患者医疗费用减轻经济负担,具有临床可行性。     

全国按疾病诊断相关分组收付费在医院的应用探讨

受国家卫生计生委财务司委托,国家卫生计生委卫生发展研究中心自按项目收付费规范、按病种收付费规范之后,从2010年开始研制《全国按疾病诊断相关分组收付费规范》,目前已经全部完成,将于2017年进入DRG改革试点。C-DRG收付费改革是一项系统工程,从医院的应用目标来看包括支付目标和管理目标。实现支付目标时涉及临床医师应用、诊疗信息收集、费用生成结算、质量监督控制、信息系统支持等多个环节的必要改造与调整。实现C-DRG收付费机制下的运营管理目标是通过C-DRG本身的分类属性与分组原理,对医疗服务的范畴、收治疾病的难易程度、运营效率及成本等实现精细化的横向、纵向对比。     

临床标本采集量对凝血系统检测结果的影响

目的：探讨临床标本采血量的准确性对凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）测定的影响。方法：用BE-RockRotor全自动血凝仪和配套试剂分别对15例临床患者不同抽血量标本进行检测,观察不同的采血量对PT、APTT检测结果的影响,并将所得检测结果采用统计方法处理。结果：与标准采血量为1．8mL相比,采血量大于或小于1．8mL时测得的PTT、APTT结果有显著性差异。结论：临床标本采集量对凝血系统检测结果的准确性有直接影响;必须严格按照标准采血量规定采集标本,才能确保凝血系统检测结果的准确,为病人疾病的诊断提供可靠的实验室依据。     

两种方法检测血糖的差异

目的:探讨罗氏ADVANTAGE优越血糖仪与迈瑞-820全自动生化分析仪检测血糖的可比性,为临床提供可靠数据。方法:随机选取本院就诊血糖测定患者,血糖仪标本为静脉血全血,采血后立即测试,血糖仪试条为随机附带,仪器用质控液校正,生化仪为同一标本,采血后2 h内测试,血清是静脉血抽取后离心分离。结果:通过对127例血糖仪与全自动生化分析仪的血糖检测结果进行对比分析,表明两种检测方法在检测血糖中差异无显著(P0.05)。结论:在血糖仪的测定范围内,两种方法都是可靠的,但血糖仪测定范围受限,过高或过低时无数据显示,生化仪会补血糖仪之不足。     

一种智能营养筛查系统用于住院肿瘤患者营养风险的预测性分析

目的：比较一种智能营养自动筛查系统与NRS 2002在肿瘤患者中的适用性,从而为营养筛查工作的落实提供一种新的方法和选择。方法：采取连续取样的方法,对205名住院成年肿瘤患者进行观察性的横断面研究。在入院后24h内营养师利用NRS 2002对患者进行营养风险筛查,同时智能营养筛查系统从医院信息系统（HIS）和实验室信息系统（LIS）中提取智能营养相关数据指标,如BMI、体重下降、进食减少、ALB、膳食医嘱等,对患者进行营养风险识别。χ2 检验比较两种营养筛查与评估工具结果差异,用灵敏度、特异度、约登指数及Kappa 值分析比较两种营养筛查与评估工具的评定效果。结果：采用NRS 2002筛查发现59人（28.8%）存在营养风险,同时智能营养筛选系统检测出78名患者（38%）存在营养风险。与NRS 2002相比,智能营养筛选系统的灵敏度为83%、特异性为80.1%、约登指数为0.63、Kappa为0.58。NRS 2002和智能筛查系统均与体重、体重下降、BMI、影响进食的症状存在明显相关性（P＜0.01）,但智能筛查系统在影响进食症状、体重下降、BMI的相关性明显优于NRS 2002。NRS 2002与智能筛查系统也存在明显的相关性（r=0.349,P＜0.000）。NRS 2002＜3分组较NRS 2002≥3分组的体重、BMI、TP、ALB、LY、HGB、RBC存在统计学差异（P＜0.05）;智能筛查系统无营养风险组与营养风险组在体重、BMI、ALB、HGB、RBC存在统计学差异（P＜0.05）。结论：智能营养筛查系统的敏感性和特异性用于住院肿瘤患者尚可以被接受,可用于筛查和早期识别存在营养风险的住院肿瘤患者,但需要在更多的病种和患者中进行验证。     

苹果属花粉形态特征及其分类学和进化意义

本文用扫描电镜观察了苹果属Malus 26种及5个杂种的花粉形态,描述了外壁纹饰形态特征的 变化类型,并对其进化趋势作了推论,指出外壁纹饰类型具属内分组意义。苹果属花粉在形状。大小、沟孔位置及数量、外壁纹饰等方面都十分相似。外壁纹饰的主要演化趋势可能是：由密的细条纹型到具有穿孔的、较少条纹型。杂种的外壁纹饰对于判断亲本种的关系有一定意义,属内种间的杂合导致了多倍体种、新变种、栽培种的大量出现,甚至是新种产生的方式。     

北京市老年人肝肾功能参数的参考值范围调查

目的：观察北京市60岁以上不同年龄段健康老年人肝肾功能检验项目水平的差异,建立各自的参考值范围。方法：随机挑选600例60岁以上的北京市健康老人,按照不同年龄段分为三组,空腹采血,采用Modular仪器及原装试剂测定血清ALT（丙氨酸氨基转移酶）、AST（天冬氨酸氨基转移酶）、TP（总蛋白）、ALB（白蛋白）、Bun（尿素氮）、Crea（肌酐）、UA（尿酸）水平,结果利用SPSS11.0进行统计分析,根据统计学结果,判断参考值范围,并比较不同组间水平的差异。同时随机选择371例健康青年,与老年组进行这些项目水平的比较。结果：统计学结果显示,AST、TP、UA组间无显著差异;ALT、ALB随年龄增加而下降;Bun、Crea随年龄增加而升高。结论：通过上述实验,对老年人群的ALT、AST、TP、ALB、Bun、Crea、UA等项目的参考区间进行初步分析,对现行参考区间的设定提供建议与参考。各实验室应建立自己的参考值范围。     

Continuing Medical Education Tuition: A Survey of Charges

A survey was carried out on the tuition charged for continuing medical education (CME) programs offered by a variety of providers. These included schools of medicine throughout the United States, national organizations and societies, state-wide organizations and societies located in California, and a small group of hospitals in or near Sacramento, California.The fees charged for continuing medical education (expressed in this article as the amount in dollars that a physician must pay for one hour of approved Category I credit) may vary from nothing to more than $20 an hour. The average charge per hour for CME courses sponsored by medical colleges in the United States ranged from none to $11.19 during 1976 and 1977. Recent data indicate that most schools have increased tuition for CME courses because of inflation. Many schools of medicine provide CME through grand rounds, conferences and special lectures at no cost to participants. Similarly, in a small sample of hospitals in California, CME was found to be available at a minimal charge to physicians.Some CME programs are more costly because fees may include the expenses of honored visiting faculty, and costs of food or social activities. There may be further expense if travel is required, although these additional costs may be offset by the benefits of study in a relaxed atmosphere away from practice and office pressures.     

基于结构变动度的不同付费方式住院医疗费用控制研究

目的 探讨住院医疗费用的结构构成,分析不同付费方式下影响费用结构变动的趋势与特征,为控制住院医疗费用不合理增长提供循证依据。方法 采用结构变动度、结构变动值和结构变动贡献率等指标进行统计分析。结果 住院医疗费用结构变动度达7.84%,以2012—2013年变动振幅较大;药品费、治疗费、化验费是引起结构变动的主要项目,三者累计贡献率为78.38%;其中化验费和治疗费呈持续正向变动,药品费呈持续负向变动。结论 控制住院医疗费用应结合不同付费方式分类制宜,药品费和检查化验费比重过高,而体现医护人员医疗服务价值的诊疗手术费等过低,费用结构有待优化,医疗服务价格与支付制度改革势在必行。     

Prevention of Rh(D) alloimmunization: a cost-benefit analysis.

The Rh Programme of Nova Scotia was established in 1964 for the prevention and treatment of Rh(D) alloimmunization. The program''s effectiveness in preventing the condition has been established previously. Because of increasing budget restraint in health care we decided to examine the cost-effectiveness of the program by comparing the cost of prevention (office administration fees, program staff salaries and the price of Rh immune globulin) with the cost of health care services required in addition to standard obstetric procedures and neonatal care in 80 cases of Rh(D) alloimmunization treated from 1982 to 1986. Neonatal intensive care accounted for 80.1% of the additional health care expenses; an extra 512 hospital days for such care constituted 65.7% of the total treatment expense. The cost per case prevented ($1495) was 2.7 times less than the cost per case treated ($3986).     

Kidney Transplantation Is Associated with Catastrophic Out of Pocket Expenditure in India

Kidney transplantation (KT) is only viable renal replacement option for most patients in India. Most patients do not have health insurance and meet treatment expenditure from their own resources. We prospectively evaluated the expenses associated with KT and its impact on the socioeconomic status of families in a public hospital. All direct and indirect expenses incurred by the patients from the time of diagnosis of chronic kidney disease to KT were recorded. Direct expenses included physician fees, cost of drugs and disposables, dialysis, and expenses on investigations and hospitalization. Indirect expenses included travel, food, stay, and loss of income suffered by the family. Educational dropout and financial loss were also recorded. There were 43 males and 7 females between the ages of 12 and 57 years. Direct expenses ranged from US$ 2,151–23,792 and accounted for two-thirds of the total expenses. Pre-referral hospitalization, dialysis and medication accounted for majority of direct expense. Indirect expenses ranged from US$ 226–15,283. Travel expenses and loss of income accounted for most of indirect expense. About 54%, 8%, and 10% of families suffered from severe, moderate, and some financial crisis respectively. A total of 38 families had job losses, and 1 patient and 12 caregivers dropped out of studies. To conclude, KT is associated with catastrophic out-of-pocket expenditure and pushes a majority of the patients who come for treatment to public hospitals into severe financial crisis. Educational dropout and loss of jobs are other major concerns. Systematic efforts are required to address these issues.     

Laboratory voice data entry system

We have assembled a system using a personal computer workstation equipped with standard office software, an audio system, speech recognition software and an inexpensive radio-based wireless microphone that permits laboratory workers to enter or modify data while performing other work. Speech recognition permits users to enter data while their hands are holding equipment or they are otherwise unable to operate a keyboard. The wireless microphone allows unencumbered movement around the laboratory without a "tether" that might interfere with equipment or experimental procedures. To evaluate the potential of voice data entry in a laboratory environment, we developed a prototype relational database that records the disposal of radionuclides and/or hazardous chemicals. Current regulations in our laboratory require that each such item being discarded must be inventoried and documents must be prepared that summarize the contents of each container used for disposal. Using voice commands, the user enters items into the database as each is discarded. Subsequently, the program prepares the required documentation.     

When Less Is More: Evolutionary Origins of the Affect Heuristic

The human mind is built for approximations. When considering the value of a large aggregate of different items, for example, we typically do not summate the many individual values. Instead, we appear to form an immediate impression of the likeability of the option based on the average quality of the full collection, which is easier to evaluate and remember. While useful in many situations, this affect heuristic can lead to apparently irrational decision-making. For example, studies have shown that people are willing to pay more for a small set of high-quality goods than for the same set of high-quality goods with lower-quality items added [e.g. 1]. We explored whether this kind of choice behavior could be seen in other primates. In two experiments, one in the laboratory and one in the field, using two different sets of food items, we found that rhesus monkeys preferred a highly-valued food item alone to the identical item paired with a food of positive but lower value. This finding provides experimental evidence that, under certain conditions, macaque monkeys follow an affect heuristic that can cause them to prefer less food. Conservation of this affect heuristic could account for similar ‘irrational’ biases in humans, and may reflect a more general complexity reduction strategy in which averages, prototypes, or stereotypes represent a set or group.     

Neurology: Use of Antiepileptic Drugs in Pregnancy

The Scientific Board of the California Medical Association presents the following inventory of items of progress in neurology. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, or scholars to stay abreast of these items of progress in neurology that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another.The items of progress listed below were selected by the Advisory Panel to the Section on Neurology of California Medical Association, and the summaries were prepared under its direction.     

Urology: continent urinary diversions-are appliances necessary?

The Scientific Board of the California Medical Association presents the following inventory of items of progress in urology. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established both as to scientific fact and important clinical significance. The items are presented in simple epitome and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, research workers, or scholars to stay abreast of these items of progress in urology that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another.The items of progress listed below were selected by the Advisory Panel to the Section on Urology of the California Medical Association, and the summaries were prepared under its direction.     

Anesthesiology-important advances in clinical medicine: outpatient anesthesia techniques: continuous intravenous infusion of anesthetic agents

The Scientific Board of the California Medical Association presents the following inventory of items of progress in anesthesiology. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist practitioners, students, research workers or scholars to stay abreast of these items of progress in anesthesiology that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another.The items of progress listed below were selected by the Advisory Panel to the Section on Anesthesiology of the California Medical Association and the summaries were prepared under its direction.