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。     

《侵权责任法》第六十条抗辩事由立法技术若干问题

《中华人民共和国侵权责任法》在解决医疗损害侵权案件中起了非常关键的作用,考虑到医疗行为是一个高风险行为,在有些情况下,即便医疗机构和医务人员不存在违法违规的过失行为,进行医疗活动也有可能发生患者人身损害的后果,立法者为了保护医生的合法权益,在《侵权责任法》第六十条规定了三种抗辩事由。但是在其立法技术上,第六十条却错误的使用了封闭列举免责事由,导致其在实践中的运用的非常困难,保护医生合法权益的立法目的的实现受到很大的限制。     

Regulation of vascular function by RCAN1 (ADAPT78)

RCAN1 (Adapt78) functions mainly, if not exclusively, as a regulator of calcineurin, a phosphatase that mediates many cellular responses to calcium. Identification of this regulatory activity has led to a surge of interest in RCAN1, since calcineurin is involved in many cellular and tissue functions, and its abnormal expression is associated with multiple pathologies. Recent studies have implicated RCAN1 as a regulator of angiogenesis. To more fully investigate the role of RCAN1 in vascular function, we first extended previous studies by assessing RCAN1 response in cultured endothelial cells to various vascular agonists. Strong induction of isoform 4 but not isoform 1 was observed in human umbilical vein- and bovine pulmonary aortic-endothelial cells in response to VEGF, thrombin, and ATP but not other agonists. Inductions were both calcium and calcineurin dependent, with the relative effect of each agonist cell-type dependent. Ectopic RCAN1 expression also inhibited calcineurin signaling in the HUVEC cells. Based on these strong RCAN1 responses and a lack of RCAN1-associated vascular studies beyond angiogenesis, we investigated the potential role of RCAN1 in vascular tone using whole mounted mesenteric artery. RCAN1 knockout mice exhibited an attenuated mesenteric vasoconstriction to phenylephrine as compared with wild-type. Overall contractility was unaffected, suggesting that this component of smooth muscle action is similar in the two mouse strains. Constriction in the knockout artery appeared to be potentiated by the addition of the nitric oxide synthase (NOS) inhibitor l-NAME, suggesting that elevated nitric oxide (NO) production occurs in the knockout vasculature and contributes to the weakened vasoconstriction. Our results reveal a newly identified vascular role for RCAN1, and a potential new target for treating vascular- and calcineurin-related disorders.     

Evaluation of Electronic Medical Record (EMR) at Large Urban Primary Care Sexual Health Centre

Objective

Despite substantial investment in Electronic Medical Record (EMR) systems there has been little research to evaluate them. Our aim was to evaluate changes in efficiency and quality of services after the introduction of a purpose built EMR system, and to assess its acceptability by the doctors, nurses and patients using it.

Methods

We compared a nine month period before and after the introduction of an EMR system in a large sexual health service, audited a sample of records in both periods and undertook anonymous surveys of both staff and patients.

Results

There were 9,752 doctor consultations (in 5,512 consulting hours) in the Paper Medical Record (PMR) period and 9,145 doctor consultations (in 5,176 consulting hours in the EMR period eligible for inclusion in the analysis. There were 5% more consultations per hour seen by doctors in the EMR period compared to the PMR period (rate ratio = 1.05; 95% confidence interval, 1.02, 1.08) after adjusting for type of consultation. The qualitative evaluation of 300 records for each period showed no difference in quality (P>0.17). A survey of clinicians demonstrated that doctors and nurses preferred the EMR system (P<0.01) and a patient survey in each period showed no difference in satisfaction of their care (97% for PMR, 95% for EMR, P = 0.61).

Conclusion

The introduction of an integrated EMR improved efficiency while maintaining the quality of the patient record. The EMR was popular with staff and was not associated with a decline in patient satisfaction in the clinical care provided.     

陕西省翼手类新纪录——大菊头蝠

2010年4月16日,在陕西省安康市镇坪县的一无名岩洞获得1号蝙蝠标本.该标本为雄性,体型较大.马蹄叶发达、覆盖上唇且两侧无小附叶.鞍状叶呈三角形,向两侧明显扩张成翼状.体毛细长柔软而稍卷曲.经鉴定为大菊头蝠(Rhinolophus luctus),属陕西省翼手类新纪录.标本保存于陕西省动物研究所标本室.本文报道了这种...     

尾突角蟾Megophryscaudoprocta(两栖纲,角蟾科)的进一步记述

尾突角蟾(Megophrys caudoprocta Shen,1994)具有非常特殊的特征,它们的尾杆骨(urostyle)长,超过坐骨(ischium)后缘,支持着尾突(caudal projection);泄殖孔(cloacal pore)在股间后缘向腹面开口;上眼睑(upper eyelid)前部大,有一三角形突起向侧后突出.这些特征有别于角蟾属其他物种,有重要研究价值.近年来在模式标本产地又采到1雌2雄,先后共4号成体标本,本文对其形态特征,生物学资料和分布作了进一步记述,并拍摄到原色生态照片.     

The roles of JK-1 (FAM134B) expressions in colorectal cancer

The aims of the present study are to investigate the clinicopathological correlations of JK-1(FAM134B) expression and its relationship to carcinogenesis in a colorectal adenoma–adenocarcinoma model. JK-1(FAM134B) protein expression was studied in a colon cancer cell line by Western blot and immunocytochemistry. JK-1(FAM134B) expression profiles at mRNA and protein levels were investigated in cancer tissues from 236 patients with colorectal adenocarcinoma and 32 patients with colorectal adenoma using real-time polymerase chain reaction and immunohistochemistry. The findings were then correlated with the clinicopathological features of these tumours. JK-1(FAM134B) protein was demonstrated in the colon cancer cells by Western blot. The protein was located in the nuclei of the tumour cells at both cellular and tissue levels. In colorectal adenocarcinomas, lower levels of JK-1(FAM134B) protein expression were associated with younger age (p=0.032), larger tumour size (p=0.004), advanced cancer stages (p=0.016) and higher rates of cancer recurrence (p=0.04). Also, lower levels of JK-1(FAM134B) mRNA expression were associated with advanced cancer stages (p=0.02) and presence of lymphovascular invasion (p=0.014). Higher JK-1(FAM134B) mRNA and protein expression levels were identified in adenomas and non-neoplastic mucosae, compared to carcinomas (p=0.005). To conclude, JK-1(FAM134B) mRNA expression and JK1 (FAM134B) protein levels varied with the different stages of progression of colorectal tumours. The expression levels of the gene were associated with clinicopathological features in patients with colorectal adenocarcinoma suggesting that JK-1(FAM134B) gene has roles in controlling some steps in the development of the invasive phenotypes from colorectal adenoma to early staged as well as advanced staged colorectal adenocarcinomas.     

Regulation of the adrenoleukodystrophy-related gene (ABCD2): Focus on oxysterols and LXR antagonists

The regulation of the ABCD2 gene is recognized as a possible therapeutic target for X-linked adrenoleukodystrophy, a rare neurodegenerative disease caused by mutations in the ABCD1 gene. Up-regulation of ABCD2 expression has indeed been demonstrated to compensate for ABCD1 deficiency, restoring peroxisomal β-oxidation of very-long-chain fatty acids. Besides the known inducers of the ABCD2 gene (phenylbutyrate and histone deacetylase inhibitors, fibrates, dehydroepiandrosterone, thyroid hormone and thyromimetics), this review will focus on LXR antagonists and 22S-hydroxycholesterol, recently described as inducers of ABCD2 expression. Several LXR antagonists have been identified and their possible indication for neurodegenerative disorders will be discussed.