基于视联网的远程门诊系统应用探讨

远程门诊可拓展远程医疗服务范围和服务内容,将成为未来远程医疗发展的一种新型服务模式。文章介绍了远程门诊的概念和发展现状,分析了基于视联网技术的远程门诊系统框架和业务流程,探讨了基于视联网的远程门诊系统在远程门诊诊疗、门诊检查和门诊咨询等方面的应用及未来发展前景。     

标准操作流程模型在医疗设备管理流程中的应用

依据标准操作流程模型,将医疗设备管理细分为物流采购控制、应用核算控制和质量技术控制3个方面,实施了医院医疗设备管理的标准化和一些有效的做法, 阐述了加强医疗设备标准化管理的必要性, 提出了建立医疗设备质量管理体系的理念,使医疗设备管理逐步进入质量—效率—效益良性循环的发展轨道。

     

国内临床医师绩效分配模式的现状、不足与对策

科学构建和优化医师绩效分配模式,着力体现医务人员技术劳务价值,关注医疗服务内涵,对有效调动医务人员工作积极性、提高公立医院运营效率和精细化管理水平有着重要意义。通过广泛文献研究,系统分析了我国目前公立医院绩效分配模式现状及存在的不足,同时针对存在的主要问题提出了相应的对策建议。     

医疗联合体绩效评估理论框架的构建

目前,国内公开发表的文献中尚未见到对医疗联体体绩效进行定量评估的报道。经由利益相关者分析,并借鉴经典的“结构—过程—结果”模型,在文献阅读和分析的基础之上,进一步发现和分析医疗联合体工作推进的关键点。研究初步形成医疗联合体绩效评估的理论框架包含治理结构、卫生资源投入等方面,涉及到人员协作机制、资源共享机制等要素。可为开展类似的评估项目提供参考。

     

皮肤病专科医院电子病历的设计与应用

???????目的 研究与开发具有皮肤病专科特色的电子病历系统,以实现皮肤科病人医疗信息的采集、加工、存储、传输和服务。方法 以windows sqlserver2005为后台数据库,以XML、C#为开发语言,建立皮肤病结构化病历。结果 该系统运行良好,安全稳定、易维护、通用性好。有效地提高了医生书写病历的速度和质量,并具有皮疹数码照片嵌入等功能。结论 本研究实现了具有皮肤病专科特色的电子病历系统,值得皮肤病医院推荐使用。     

基于信息技术平台的医院会诊模式重建

????? 临床会诊是综合性医院的一项经常性医疗活动,会诊制度也是一项基本的医疗制度。利用信息技术的平台,改变原有的传统会诊模式,再造新型的电子会诊模式,对于加强医疗会诊管理,控制医疗质量,确保医疗安全可起到重要的作用。

     

我国医疗联合体发展的动态分析

目的 对我国医疗联合体各阶段发展进行动态分析。方法 运用文献荟萃分析的方法,针对医疗联合体产生发展的各时期特征进行阶段划分。结果 我国医疗联合体自产生时起可分为3个发展时期,分别为1980—1989年萌芽期,医联体萌芽产生;1990—2009年形成期,医联体缓慢发展、典型类型形成;2010年至今发展期,医联体快速发展。结论 随着医改的深化,我国医疗联合体将不断改革发展,概念不断完善、类别更为丰富、紧密程度更受重视。

     

Early signatures of bleeding and mortality in patients on left ventricular assist device support: novel methods for personalized risk-stratification

Background: Left ventricular assist devices (LVADs) provide support for patients with end-stage heart failure. The aims of this study were to determine whether baseline analysis and early trends in routine laboratory data, platelet activity, and thromboinflammatory biomarkers following LVAD implantation reveal trends that predict personalized risks of one-year gastrointestinal (GI) bleeding, stroke, pump thrombosis, drive-line infections and mortality in patients on LVAD support.

Methods: We performed an observational study at the University of Kentucky with 61 participants who underwent first-time LVAD implantation. Blood was collected at baseline and post-op days 0, 1, 3 and 6 as well as clinical follow-up. Demographics, clinical characteristics, one-year adverse events and routine laboratory data were collected from electronic medical records. Platelet function and plasma biomarkers were profiled.

Results: Evaluation of routine laboratory results revealed that sustained thrombocytopenia and increased mean platelet volume (MPV) were associated with development of GI bleeding and mortality. Platelet function at follow-up visit predicted one-year bleeding events. Thrombotic biomarker sCD40L strongly predicted one-year GI bleeding at baseline before implantation and within the first week following LVAD implant.

Conclusions: Early trends in routine bloodwork and platelet function may serve as novel signatures of patients at risk to experience adverse events.     

Determination of air pollution-related biomarkers of exposure in urine of travellers between Germany and China using liquid chromatographic and liquid chromatographic-mass spectrometric methods: a pilot study

Objective: The influence of different exposures to PM_2.5 (particulate matter with an aerodynamic diameter below 2.5?μm) on the concentrations of biomarkers of exposure and oxidative stress should be investigated. For this purpose, urine samples from individuals travelling from Germany to China were collected and analysed.

Materials: Robust LC and LC-MS/MS methods were established for the determination of biomarkers including 8-hydroxy-2′-deoxyguanosine, malondialdehyde, F_2α-isoprostanes and hydroxylated polycyclic aromatic hydrocarbons. As a pilot study, nine volunteers travelled from Germany (mean daily concentration of PM_2.5: 21?μg/m³) to China (mean daily concentration of PM_2.5: 108?μg/m³). Urine samples were collected before and after the trip.

Results: In samples collected after return to Germany, the median concentrations of oxidative stress biomarkers were observed to be higher than in samples collected before leaving Germany. Decreasing trends were observed in the sequences of samples collected after return in the following weeks. Correlations were found between exposure and oxidative stress biomarkers.

Conclusion: Travellers are ideal models for PM pollution-induced acute health effects study. Exposure to PM pollution can cause oxidative stress and damage.     

农村高血压患者协调性和连续性服务的利用现状研究

目的 分析高血压患者在农村医疗服务网络接受协调性和连续性服务的提供状况,为改进患者的整合服务利用提供决策参考。方法 根据国内外文献,以自行编制服务协调性和连续性提供的问卷为工具,调查数据采用描述性统计分析。结果 49.6%的患者伴有1种及以上疾病,约73.0%在乡镇卫生院有就医经历,到过2家及以上机构就医的占51.3%;在乡村两级治疗效果不佳的患者,能够获取村医和乡镇医生推荐转诊机构的比重最大,分别为28.4%和68.7%;上级医生能够根据下级机构相关诊疗信息连续诊疗的不到43.0%,下级医生能够根据前期诊疗信息继续诊疗的比例刚超4成;“上转容易、下转难”现象同样存在。 结论 农村慢性病患者的患病特点增加了在农村纵向医疗机构就诊的几率,但该网络提供连续性和协调性服务的程度却不高,应加强农村三级医疗机构间的全面整合。     

Soluble TREM-1 as a diagnostic and prognostic biomarker in patients with septic shock: an observational clinical study

Objectives: The impact of TREM-1-mediated inflammation was investigated in different inflammatory settings.

Methods: Secondary analyses of an observational clinical pilot study, including 60 patients with septic shock, 30 postoperative controls and 30 healthy volunteers.

Results: Plasma levels of sTREM-1 were found to identify patients with septic shock more effectively than procalcitonin and C-reactive protein. Moreover, sTREM-1 was identified to be an early predictor for survival in patients with septic shock.

Conclusion: Due to its diagnostic as well as prognostic value in sepsis syndrome, implementation of sTREM-1 measurements in routine diagnostics should be taken into account.     

我国ICD-10疾病分类编码质量的系统评价

目的 基于文献,系统评价我国出院疾病诊断分类的编码质量。方法 计算机检索SINOMED(CBMdisc)、中国知网（CNKI）、维普数据库（VIP）、万方数据库,并辅以文献追溯的方法,收集2000-2014年间在国内公开发表的所有住院病历出院疾病编码错误率的文章。按纳入和排除标准筛选文献并评价其质量,采用描述性分析方法对编码质量进行定性系统评价。结果 纳入30篇文献中,19篇报道了总体编码错误率,研究对象为全部或大部分疾病10篇,仅针对特定种类或某专科疾病的文献9篇,编码错误率中位数分别是12.99%和20.41%,两者间差异无统计学意义,P＝0.121。编码错误率与时间无关但与研究样本量存在负相关关系,r_s＝-0.702,P＝0.001。16篇报道主要诊断编码错误率的文献中,8篇报道了主要诊断总错误率,11篇文献报道了主要诊断选择的错误率,错误率中位数分别为24.77%和5.17%。结论 我国编码质量水平总体上与现有标准仍存较大差距,政策制定者、医院管理者及病案编码人员应采取更有效措施来缩小差距,提高编码质量。

     

The prognostic value of MR-proadrenomedullin in patients with acute coronary syndrome complicated by cardiogenic shock

Context: Cardiogenic shock (CS) still remains one of the main causes of death in acute myocardial infarction (AMI).

Objective: The aim of this study was to evaluate the prognostic value of midregional (MR)-proadrenomedullin in AMI complicated by CS.

Methods: Forty-seven consecutive patients were included in our prospective observational study. All patients underwent coronarography and successful percutaneous coronary intervention (PCI). Plasma levels of MR-proADM were measured by a immunofluorescence method. The primary endpoint of the study, defined as cardiovascular death, occurred in 17 patients (36%).

Results and conclusion: Elevated plasma level of MR-proADM, determined 24?h after diagnosis of CS could be a predictor of in-hospital mortality in patients with AMI complicated by CS.     

Prediction of Alzheimer’s disease with serum lipid levels in Asian individuals: a meta-analysis

Background: The serum lipid profile has become a routine clinical test and used as an important predictor for Alzheimer’s disease (AD), although its predictive value remains undetermined.

Objective: To evaluate the role of serum lipid levels in predicting the risk of AD.

Methods: Meta-analyses were conducted using Comprehensive Meta-analyses (CMA) software to investigate the association between four conventional serum lipid profile parameters and the risk of AD, focused on samples from Asian.

Results: In total, 3423 AD patients and 6127 healthy participants were involved. The results demonstrated that AD patients showed higher LDL-C and TC levels (SMD?=?0.27, 95% CI: 0.04–0.51, p?=?0.02 for LDL-C; SMD?=?0.25, 95% CI: 0.05–0.46, p?=?0.02 for TC) compared with those of healthy controls. People with higher LDL-C and/or TC levels had an increased risk of AD (OR?=?1.64, 95% CI: 1.07–2.51 for LDL-C and OR?=?1.58, 95% CI: 1.10–2.92 for TC).

Conclusions: This study provided evidence that serum LDL-C and TC levels were associated with the risk of AD in Asian individuals. The routine lipid profile may be useful for AD diagnosis, monitoring and treatment.     

Platelet proteomics: from discovery to diagnosis

Introduction: Platelets are the smallest cells within the circulating blood with key roles in physiological hemostasis and pathological thrombosis regulated by the onset of activating/inhibiting processes via receptor responses and signaling cascades.

Areas covered: Proteomics as well as genomic approaches have been fundamental in identifying and quantifying potential targets for future diagnostic strategies in the prevention of bleeding and thrombosis, and uncovering the complexity of platelet functions in health and disease. In this article, we provide a critical overview on current functional tests used in diagnostics and the future perspectives for platelet proteomics in clinical applications.

Expert commentary: Proteomics represents a valuable tool for the identification of patients with diverse platelet associated defects. In-depth validation of identified biomarkers, e.g. receptors, signaling proteins, post-translational modifications, in large cohorts is decisive for translation into routine clinical diagnostics.