目的 探究患者对智能预问诊的持续使用意愿及其影响因素,为系统的管理优化提供参考.方法 基于期望确认理论构建模型并提出假设,对172位使用智能预问诊的用户进行代填式问卷调查.数据利用偏最小二乘法结构方程模型进行分析.结果 模型中各因素对患者持续使用意愿的解释程度为75.5％.满意度(P<0.001)、感知有用性(P<0.01)对患者的持续使用意愿有正向影响,期望确认度对满意度(P<0.001)和感知有用性(P<0.001)均有正向影响.结论 在建设和推进智能预问诊的过程中,患者的持续使用意愿是系统有效实施和可持续发展的重要保障.关注患者的用户体验、完善优化系统功能、适度宣传有助于提升患者的感知有用性和满意度,从而使其愿意持续使用智能预问诊.

介绍复旦大学附属眼耳鼻喉科医院互联网医院建设历程和运营管理模式.该院互联网医院通过手机即可在线预约、挂号、支付,查看电子病历、检查检验结果、电子发票和药品配送情况等,实现就诊服务全流程移动化,大幅提升患者在线就诊体验.运营3年来,该院互联网医疗数据始终领先于上海各类医院,单科接诊量、周互联网服务量、年互联网服务量、周互联网处方量均保持全市第一.并从患者、医生和医院层面提出未来公立医院互联网医院持续稳定发展的建议和思考.

Background: Conversational agents (CAs) have been developed in outpatient departments to improve physician-patient communication efficiency. As end users, patients' continuance intention is essential for the sustainable development of CAs. Objective: The aim of this study was to facilitate the successful usage of CAs by identifying key factors influencing patients' continuance intention and proposing corresponding managerial implications. Methods: This study proposed an extended expectation-confirmation model and empirically tested the model via a cross-sectional field survey. The questionnaire included demographic characteristics, multiple-item scales, and an optional open-ended question on patients' specific expectations for CAs. Partial least squares structural equation modeling was applied to assess the model and hypotheses. The qualitative data were analyzed via thematic analysis. Results: A total of 172 completed questionaries were received, with a 100% (172/172) response rate. The proposed model explained 75.5% of the variance in continuance intention. Both satisfaction (beta=.68; P<.001) and perceived usefulness (beta=.221; P=.004) were significant predictors of continuance intention. Patients' extent of confirmation significantly and positively affected both perceived usefulness (beta=.817; P<.001) and satisfaction (beta=.61; P<.001). Contrary to expectations, perceived ease of use had no significant impact on perceived usefulness (beta=.048; P=.37), satisfaction (beta=-.004; P=.63), and continuance intention (beta=.026; P=.91). The following three themes were extracted from the 74 answers to the open-ended question: personalized interaction, effective utilization, and clear illustrations. Conclusions: This study identified key factors influencing patients' continuance intention toward CAs. Satisfaction and perceived usefulness were significant predictors of continuance intention (P<.001 and P<.004, respectively) and were significantly affected by patients' extent of confirmation (P<.001 and P<.001, respectively). Developing a better understanding of patients' continuance intention can help administrators figure out how to facilitate the effective implementation of CAs. Efforts should be made toward improving the aspects that patients reasonably expect CAs to have, which include personalized interactions, effective utilization, and clear illustrations.

目的 引入"互联网+"理念,优化医院门诊管理模式,缩短门诊全流程就医时间,提升患者满意度.方法 运用简单线性回归,预测样本医院未来门诊患者人数;分析2015-2018年样本医院门诊投诉相关数据,发现门诊就医环节中焦点问题,为优化管理流程提供依据;将互联网技术优势运用于门诊诊疗全流程环节.结果 就诊时间冗长是医院门诊亟待解决的重要问题,就诊期间窗口服务是投诉的焦点,与此同时,样本医院面临年均增长就诊患者13 248人的压力,因此,样本医院正式启动"智慧化门诊"建设项目.2019年建设以来,9月份门诊窗口工作量较2018年同期相比下降14.11％,窗口投诉人数较2018年同期相比下降15.06％,患者均次就医时间由90分钟缩短至58分钟.结论 建立"门诊无人值守"就医新流程,通过网上就诊数据实时分析,动态调整门诊医务人员初诊人数,能有效地减少患者候诊时间;通过医院线下电子设备部署改造,实现线下患者的线上引流,大幅度地提升患者就医便携性,进一步优化就医流程,提升患者满意度.

本文介绍了通过信息化技术建立新的医院质控体系在某医院门诊管理中的应用.该体系分为"大数据"信息管理平台和"数据采集整合——分析报告"联动流程两部分,阐述了质控体系的运作方法和应用成效,总结了信息化在医院门诊质量管理中所发挥的重要作用.

To demonstrate the identification of corneal diseases using a novel deep learning algorithm. A novel hierarchical deep learning network, which is composed of a family of multi-task multi-label learning classifiers representing different levels of eye diseases derived from a predefined hierarchical eye disease taxonomy was designed. Next, we proposed a multi-level eye disease-guided loss function to learn the fine-grained variability of eye diseases features. The proposed algorithm was trained end-to-end directly using 5,325 ocular surface images from a retrospective dataset. Finally, the algorithm’s performance was tested against 10 ophthalmologists in a prospective clinic-based dataset with 510 outpatients newly enrolled with diseases of infectious keratitis, non-infectious keratitis, corneal dystrophy or degeneration, and corneal neoplasm. The area under the ROC curve of the algorithm for each corneal disease type was over 0.910 and in general it had sensitivity and specificity similar to or better than the average values of all ophthalmologists. Confusion matrices revealed similarities in misclassification between human experts and the algorithm. In addition, our algorithm outperformed over all four previous reported methods in identified corneal diseases. The proposed algorithm may be useful for computer-assisted corneal disease diagnosis.

笔者介绍了复旦大学附属眼耳鼻喉科医院在推动区域医联体进程的基础上,借助医联体的平台创立了“近视防控康联体”,旨在对儿童青少年眼科疾病进行早期筛查,推动建设相关数据库连续跟踪、数据挖掘并进行分析反馈,实现预警预防早治,推进医防融合,提供全面全程有效的视觉健康管理,构建学校(包括幼儿园)、社区、家庭及医院等多方联动形成合力的近视防控干预体系,以期为国内其他区域的近视防控提供模式参考.

区域医联体发展是实现分级诊疗的重要举措,专科医院如何利用专科优势推动区域医联体发展是当下议题.以上海市某三级甲等公立专科医院为例,分析其在区域医联体中存在的过程协同、管理协同、资源协同、制度协同等困境.思考基于医联体内部信任,建立基于病种管理的解决策略.

疼痛是一种令人不快的主观感受和情绪体验,是临床上最常见的症状之一.鼻部术后疼痛集中在术后24～48 h[1],主要是因麻醉药物效果的消失及填塞物对周围组织的压迫和刺激所致,常伴有头痛、头晕等其他不适,直接影响患者的睡眠、饮食、呼吸及情绪[2].

目的寻找最适合临床鼻内手术备皮的电动鼻毛修剪器的消毒剂。方法分别用75%乙醇、10%聚维酮碘和2%戊二醛作为3组消毒剂消毒鼻毛修剪器的刀头,观察细菌培养结果及机器刀头腐蚀情况。结果75%乙醇消毒组出现2次培养结果阳性;2%戊二醛消毒刀头组刀头使用寿命最长。结论2%戊二醛是电动鼻毛修剪器刀头最适合的消毒剂,且消毒效果最好,腐蚀性最低。

甲状腺癌是高发的颈部恶性肿瘤,约占全身恶性肿瘤的1%[1],常发生颈部淋巴结转移.手术切除是甲状腺癌的有效手段之一.因甲状腺解剖复杂、血运丰富、重要血管神经密布,且甲状腺癌手术范围大,术后病情多变,并发症发生率高.影响患者的康复,甚至危急生命,所以围手术期的护理非常重要,现将甲状腺癌围手术期护理现状及进展综述如下.