目的:分析恶性肿瘤术后化疗患者住院费用的影响因素,设计DRG分组方案并制定支付标准,为DRG支付方式改革提供参考.方法:以四川省成都市某三甲综合医院2021年7月至2022年6月出院的恶性肿瘤术后化疗患者为研究对象,采用非参数检验及多元线性回归筛选出住院费用的主要影响因素,利用E-CHAID算法构建DRG分组方案,利用变异系数及非参数检验评价分组合理性,制定各DRG分组参考费用.结果:住院天数、是否有手术操作及是否有合并症或并发症被纳入决策树模型,最终生成9个DRG分组;各DRG分组的组内同质性高,组间异质性强,分组效果良好.结论:基于E-CHAID算法的恶性肿瘤术后化疗住院患者DRG分组方案科学合理,能够为医疗机构规范诊疗行为、控制资源消耗提供依据.

医院医疗健康大数据中心的建设是一项系统工程,如何分步骤、科学、有效实施是亟需解决的现实问题.本文初步提出了综合医院多源异构健康体检数据平台建设方案,将包含有绝大多数临床诊疗数据类型的健康体检资料作为研究对象,探讨了健康体检数据平台建设目的 、整体框架,以及卫生信息标准、数据治理、数据质控、数据建模、数据应用等关键技术,可为建设医疗信息互联互通的医院"医疗健康大数据中心"提供技术储备.

2018年初,世界卫生组织(World Health Organization, WHO)开始使用首个全球烧伤注册平台(global burn registry,GBR)[1],目的 是使公共卫生和医疗管理机构全面了解烧伤影响因素,合理制订和高效实施烧伤预防措施.全球烧伤每年约造成18万人死亡,其中大部分发生于低收入和中等收入国家.高收入国家得益于使用安全厨房灶具、安装烟雾探测器和消防花洒、设置儿童警示,甚至制定热水温度相关法规等一系列措施,在降低烧伤死亡方面取得了显著进展.而低收入和中等收入国家由于缺乏烧伤相关数据,无法准确制定和实施预防措施.为此,从2013年开始,WHO、全球清洁炉灶联盟(Global Alliance for Clean Cookstoves,GACC)、疾病预防控制中心(Centers for Disease Control and Prevention,CDC)和国际烧伤学会(International Society for Burn Injuries,ISBI)联合开发了一种简易的烧伤数据采集表格,并基于WHO DataCol(Data Collector)建立了用于验证该表格有效性的研究平台[2].2016年,Peck等 [3]报道:经过8个月来自30个国家52家医院的验证,完成该烧伤数据采集表约需5 min,85％的医院反映GBR数据采集表格对于制定、评估和监测烧伤预防措施非常有价值.经系统检索国内文献,尚未发现GBR数据采集表格中文翻译版及应用研究相关报道.为便于国内推广应用,笔者翻译该数据采集表格,并展望其应用.

目的:实现医院各级医保接口统一管理.方法:建立医保统一管理平台对医保接口进行管理.结果:将省、市医保,异地、新农合等医保业务接口进行平台化整合.结论:规范了医保接口调整信息化流程,提高了医院业务系统升级改造的效率,节约了拓展医保业务功能相关的人力及时间成本.

Primary, objective: To investigate the epidemiological characteristics of paediatric inpatients, with traumatic brain injury (TBI) in China. Research design: The Chinese Trauma Database (CTD), a nationwide register system based on hospital admission data; contains diagnosis and treatment information for trauma inpatients in over 200 military-managed public-service hospitals in China. Using the ICD-9 coding, the data for Children with TBI aged 0-17 years between 2001 and 2007 were retrieved'. Methods and procedures: The demographic characteristics, admission time, injury cause, severity and treatment outcomes of paediatric inpatients with TBI were analysed. Main outcomes and results: A total of 26,028 paediatric inpatients with TBI (69.52% male, 30.48% female) were included in the CTD. Motor vehicle traffic (MVT) accidents, falls and assaults were the primary causes of injury. Falls were, the leading cause of TBI in children aged 0-4 years, and MVT was the leading cause of TBI in children aged 5-17 years. According to the abbreviated injury scale, 37.20% of the TBI cases were mild, 25.15% were moderate, 24.81% were severe and 12.84% were critically severe. Conclusion: Chinese authorities, should develop targeted measures to reduce children injuries based on the leading causes of TBI in the different age groups, particularly MVT, falls and assaults.

由于人口密度增高、工业和交通发展等因素,自然灾害或人为引起的灾害(如恐怖活动、化学与核事故、建筑物倒塌、大型交通事故等)对人类的危害程度不断增加.因此,医院作为医疗系统的重要组成部分,精确筹备应急计划,确保医疗工作从初期混乱恢复到有序至关重要.灾害具有不可预判性和突然性,但它不是完全随机发生的,一定程度上可以被预见[1].在特定区域,灾害类型(如龙卷风、火灾、地震、核灾害事件)甚至是恐怖主义可以被预见,成功的应对策略则可以减轻灾害程度.作为一所综合性三甲医院,本院参与了"5.12汶川地震""芦山地震""赴尼国外地震救援"等重大应急救援行动,通过不断完善医院层面应急计划,成功完成了各类应急事件的救援任务.本文就灾害事件的特点、制约因素及应对策略进行分析.

Objective:To realize the digital management of hospital scientific research work and speed up the development process of hospital digital.Methods:According to the characteristics of the hospital itself,the resources needed for the scientific research work were integrated,and the information management platform was built with the goal of information sharing.Results:The advanced scientific research management system was introduced into the information management process,which changed the traditional way of scientific research management and laid the digital foundation for the scientific research management of the hospital.Conclusion:The scientific research information management platform standardizes the scientific research management system,straighten out the management process and improve the management efficiency.

介绍了铁路后送、卫生列车和高速铁路的相关概念,总结了铁路后送的优缺点.综述了外军和我军卫生列车在战时医疗后送、国内抢险救灾的应用情况,阐述了中国和印度健康快车项目在平时医疗服务中的应用及国内手术急救列车研制情况.结合近年来国内高铁发展和动车组列车技术特点,提出了高速动车组列车是研制未来高水平卫生列车的良好平台.

目的:探讨未来高铁卫生列车编组方式及模块功能.方法:以中国标准动车组为设计平台,借鉴既往卫生列车编组方式,参照机动卫勤分队分组及救治流程,并咨询相关领域专家.结果:确定了基于中国标准动车组的卫生列车编组,从头车开始依次为指挥及分类车、药材及物资储藏车、检验检查车、手术车、重症监护车、轻伤员车①、轻伤员车②、餐车及工作人员寝车.提出了卫生列车的八大模块和具体功能定位.结论:新提出的卫生列车编组方式和模块功能具备一定的科学性和可行性,可用于指导下一步卫生列车具体模块设计工作,但仍需在未来研究过程中进一步修正.

药物性肝损害是最常见的药品不良反应之一,重者会导致黄疸、急性肝功能衰竭甚至死亡.其发病率逐年上升,已越来越受到人们的关注.影响因素包括患者因素(如年龄、性别、妊娠、营养不良和基础疾病等)、药物因素和环境因素.有效利用医院信息系统开展监测预警药物性肝损害的发生至关重要,因此建议国家和政府尽快建立药物性肝损害的监测系统.

结合我院门诊处方量大、原配药发药模式效率低、出错率高的实际情况，我们利用计算机技术建立了一套高效智能的配药发药系统。现将系统需求分析、系统结构设计、系统开发、系统功能参数、系统应用效果介绍如下。

近年来，国内自然灾害频发，卫生系统担负的国家级应急救援任务日趋繁重。为了进一步发挥医院国家应急救援分队的应急救援反应效益，提高医院医疗应急救援保障水平，本文结合我院正在开展的数字化医疗、数字化管理、数字化服务的信息化建设，采用成熟的智能物联网技术、数据挖掘技术和国家及军队卫生信息标准，依托“军卫一号”医院管理信息系统的基础数据和业务流程，从卫生物资管理、应急救援、决策支持三个方面研究和设计军队三甲医院的国家应急救援分队综合管理平台新模式［1］。

Although significant effort has been made to diagnose and treat patients with acute pancreatitis (AP), knowledge of the risk factors and their relationship with patient outcomes is still lacking. Little is known about whether clinical outcomes, such as mortality or being cured of AP, may be influenced by certain factors, including season of admission; place of residence; time of admission; insurance status; lifestyle habits, such as smoking; pretreatment methods and durations; and other clinical conditions at admission. This study aimed to investigate the association between potential risk factors and clinical outcomes in patients with AP. A retrospective cohort study of adult patients at the initial onset of AP was carried out. The patients were identified using a pancreatitis database in the tertiary referral hospital. Information on place of residence, season of admission, insurance status, lifestyle habits and plasma biochemical indexes were retrieved from clinical profiles and reviewed by two independent researchers. Recovery, partially recovery and death were considered to be the categorical primary outcomes and group classification evidence. One-way ANOVA and the chi-square test were performed to compare the differences of all characteristics between the three groups. Adjusted odds ratios and 95% confidence intervals were calculated using multinomial logistic regression. Data of 684 (365 M, 319 F) patients from 2008 to 2012 were retrieved. There were 518, 147 and 19 patients in the recovery, partially recovery and dead groups, respectively, with an overall death rate of 2.7% and a rate of 9.4% among sever acute pancreatitis (SAP) patients. Risk factors for death compared to the recovery group were hypertriglyceridemic acute pancreatitis (HTAP) (OR: 3.364; 95% CI=1.237-9.144; P=0.017); classification of AP (OR: 7.023; 95% CI=2.317-21.288; P=0.001); blood creatinine level (OR: 7.259; 95% CI=2.442-21.575; P<0.001); blood AST level (OR: 11.345; 95% CI=2.355-54.651; P<0.001); and blood albumin level (OR: 3.389; 95% CI=1.032-11.130; P=0.044). Being over 61 years of age was also a risk factor for mortality. Alcoholic AP, severity diagnosis and Alb level were risk factors for poor improvement. None of the hospital-based factors were risk factors for the outcomes. Patients older than 61 years had a higher risk of mortality than those of other ages. Patients who were diagnosed with HTAP or SAP were also at greater risk for mortality. Moreover, blood creatinine, AST and Alb levels, which may be indicative of mild organ dysfunction and malnutrition, could also be considered predictors for mortality.

背景2013年中国四川省芦山地震的应急救援动员效率相比汶川地震有着较大提升,然而,面对同样的道路受阻和地震次生灾害频发的困难,仍未建立起统一的伤员转运管理中心,空运后送的优势未得到有效的利用.方法通过“军卫一号”医院信息系统调取地震伤病员诊疗信息,采用SPSS16.0进行平均住院日的非参检验,比较陆路后送和直升机后送伤员的预后转归情况,评价后送方式对地震伤病员的影响.结果两种后送方式对伤员总就诊天数的影响虽然没有统计学差异,但在检验水平上下降较为明显,表明了后运方式发挥了积极的影响,因此,应急救援中发挥出直升机空运后送的优越性,提高获得医院专科治疗的及时性,这对于伤病员的后续医疗救援是至关重要的.结论在目前中国的灾害应急救援体系建设中,完善空中救护体系的人员、设备和指挥协调机制,应尽快建立日常运行的伤员转运管理中心,有效的协调各方救援力量,这是下一步应急救援建设的重要方向.

目的 编制符合我国卫生行业标准的健康风险评估问卷,为健康管理提供标准风险评估工具.方法 参考国际公认健康测量量表建立健康风险评估问卷条目池,采用自定的筛选条目标准和我国卫生行业数据标准对问卷及选项进行筛选和标准化,形成健康风险评估问卷.结果 构建了包含298个条目的健康风险评估问卷条目池;按照条目筛选原则,并咨询健康管理领域专家,最终筛选60个条目作为健康风险评估问卷的正式条目,包含10个维度:性别、年龄、婚姻状况等个人一般情况,身高、体重、腰围、胸围、臀围等体格测量情况,饮酒、吸烟、运动等生活方式情况,荤食、素食、嗜盐、嗜糖等饮食习惯情况,家族健康史及个人患病史情况,社会家庭支持,精神心理压力,自我健康意识,自评健康和工作情况.采用我国卫生行业数据标准对问卷及选项进行筛选和标准化后,形成符合我国卫生行业标准的健康风险评估问卷.结论 编制的健康风险评估问卷既包括了健康风险评估所需个体信息,又符合国家卫生行业数据标准,在健康管理及相关软件系统研发领域具有较好的应用前景.

目的:在应急状态下,利用现有的通信装置和通畅的信息管路,快速构建一套相对完备的应急医疗救治信息平台.方法:借助微信的相关功能构建应急临床救治指挥信息平台,并与医院现有的医院信息系统(hospital information system,HIS)平台的数据信息相对接,将院前地震灾区接诊、后送及入院办理、院内救治融为一体,实现信息的即时互动与共享.结果:该信息平台能使后方医院快速、准确、全面地了解应急状态下的医疗救治相关信息,为伤病员的有序接收、协调管理、科学救治提供强有力的信息技术手段.结论:该信息平台的快速构建与应用,切实解决了应急状态下后方医院医疗救治信息化管理的实际需求,并取得了良好的效果.

等级医院评审是2012年解放军各师以上医院工作重点之一,也是各级医院管理者普遍关注的焦点[1-3].接到上级评审检查通知后,为全力做好等级评审工作,我院成立了等级医院评审办公室,具体负责等级评审工作的组织与实施.经过近一年的准备,我院于2012年10月中旬迎接了总后卫生部等级医院评审现场检查.结合等级医院评审办公室具体工作职能,本文从评审标准解读、任务分工、资料准备、应知应会学习、医院自查等5个方面,浅谈军队三级综合医院迎接等级评审工作组织与管理.

本文重点介绍和分析了美国、欧盟、日本等发达国家及地区电子病历的发展、应用历程及作法.针对我国当前试点推行的电子病历及区域医疗信息系统建设,我们可以从中借鉴其科学合理的建设经验,结合我国的实际情况,以电子病历建设为基础,实现数字化医疗信息建设的跨越式发展.

Objective To construct the health risk model of fatty liver, and to evaluate the model reliability, and to provide tool to fatty liver health management and health education. Methods The data were collected using Chinese Health Risk Appraisal Questionnaire(CHRAQ). The health risk model of fatty liver was constructed with reference to the relevant literature. The reliability was evaluated using Cronbach's alpha coefficient, Spearman-Brown coefficient, test-retest reliability. Results The health risk model of fatty liver was constructed using 17 items selected from CHRAQ. The model scores followed the normal distribution(Z=1.126, P = 0.158). The Cronbach's alpha coefficient, Spearman-Brown coefficient, test-retest reliability were 0.679,0.819,0.883(P<0.001). Conclusion According to the mainstream scoring method of health risk model and the classical reliability evaluation methods, the health risk model of fatty liver was constructed. The reliability of the constructed model were good, and the model has a certain application prospects in the field of health management and health education.

In this paper,a new relaxation algorithm based on Pentland's linear SFS model is presented,for which a weak necessary condition is also proposed and proved.Some experiments on shape recovery from a single terrain model image,by the methods of Pentland,Tsai-Shah,Ulich and ours respectively,show that:(1)the relaxation based algorithm could really obtain the corresponding surface of the image to some extent without the boundary conditions;(2)the relaxation factor could control and reflect the roughness of the surface to some extent and might remove the noises in a meaning way.