The establishment of healthcare-associated infection（HAI） prevention and control emergency system for respiratory infectious diseases is the basis for large general hospitals to start emergency mechanisms smoothly and quickly in response to the outbreaks of respiratory infectious diseases, and achieve the “transformation of epidemic prevention” mode, thus can greatly reduce the risk of HAI in general hospitals during the outbreaks of respira-tory infectious diseases. Based on the practical experience of the prevention and control of severe acute respiratory syndrome coronavirus 2（SARS-CoV-2） infection, relevant standards, norms, guidelines, documents, and combined with risk assessment, this study preliminarily explores and establishes a four-level emergency management system for general hospitals to respond to HAI of respiratory infectious diseases. The emergency system consists of four-level organizational system: the emergency command center, HAI management and collaborative departments, joint inspection teams, department leaders and grid administrators. The hospital leadership is responsible for the overall deployment. The emergency command center is responsible for unified coordination. Responsibilities of each department are clearly defined, and the hospital-wide grid mechanism of the prevention and control is activated. The joint inspection team supervises the implementation of various prevention and control measures, and the hospital quickly converts to the “epidemic prevention and control” emergency status, while ensuring the orderly conduct of daily diagnosis and treatment work.

目的:探索基于血管超声报告进行自然语言处理并智能生成诊断提示的方法.方法:对血管超声报告采用Bi-LSTM-CRF模型进行分词及命名实体识别,根据专家指南构建知识图谱,通过查询实体及关系属性,实现超声诊断的智能建议.结果:Bi-LSTM-CRF模型识别了4类实体,其识别准确度均在90％以上,单个报告的处理速度在毫秒量级,同时构建包括4类关系的知识图谱.结论:自然语言处理结合知识图谱可以用于血管超声报告的智能诊断提示生成.

目的 建立覆盖医保付费管理和医疗评价的疾病诊断相关分组(D R G s)信息管理平台,促进实现医疗费用管控、医疗服务质量和效率的提升,解决医政、医保DRGs融合管理的难点.方法 建立药品、诊疗、医保规则知识库和规则引擎,使用大数据分析及一体化平台接口技术,将规则引擎嵌入各业务系统中,进行事前、事中、事后全流程实时监控.结果 建立了涵盖事前、事中、事后全流程的DRGs管理监测一体化平台,实现了DRGs的综合管理.结论 医保付费和医疗评价一体化DRGs信息管理平台的建立,对医院医政、医保管理起到了重要的支持作用.

目的 借助水囊法超声生物显微镜检查探讨儿童先天性角膜混浊的影像学特点.方法 回顾性分析先天性角膜混浊患儿142例(181眼),观察先天性角膜混浊的眼前节发育情况,根据发育异常的表型分为A、B、C、D四型.结果 181眼中有A型43眼(23.8％),仅前部角膜混浊不伴有其他结构异常.B型11眼(6.1％)为后部或全层角膜混浊,伴角膜后部局部缺损,而虹膜晶状体正常.C型88眼(48.6％)为虹膜或房角发育异常,但晶状体未见异常,其中房角发育异常范围小于4个方位的C1型共35眼(19.3％);房角发育异常范围大于等于4个方位的C2型共53眼(29.3％).D型39眼(21.5％)为角膜虹膜与晶状体粘连,或存在混浊、膜样、缺如等晶状体异常.双眼混浊患者两眼表现可不对称;同时伴有晶状体和虹膜异常的比例,双眼混浊(32.1％)显著多于单眼(13.6％)(x2=8.947,P=0.003).结论 采用水囊包裹探头的超声生物显微镜是适合于儿童的眼前节检查方法,可用于分析先天性角膜混浊角膜、虹膜、房角和晶状体的影像学特点并分型,对明确其诊断和预后具有指导意义.

目的 通过对某三甲医院住院病案首页数据的统计,分析影响老年住院择期手术患者并发症的因素,为医政管理提供线索.方法 抽取某院2017年1月1日-2019年12月31日 的老年住院择期手术患者信息,进行手术并发症描述与推断分析,采用例数、比率等指标,使用卡方检验、秩和检验等方法进行描述.结果 男性、高龄、四级手术并发症发生率高,P＜0.05,男性0.86％大于女性0.62％,70岁以上0.84％大于60岁～69岁0.68％,四级1.42％大于非四级0.40％;所调查32301例择期手术中,感染178例、出血或血肿23例等例数较多.结论 性别、年龄、手术级别对部分手术并发症发生率有影响.对男性、高龄、四级手术患者要加强医疗质量与安全管理,利用好信息化平台,不断完善预警监测体系,探索多学科协作模式,加强手术分级授权管理,严格遵循医疗质量管理制度.

目的 探讨肿瘤免疫营养指标预测胰腺癌可切除性的价值.方法 回顾性分析2015年1月至2018年12期间就诊于首都医科大学宣武医院、经病理学检查确诊的55例胰腺癌患者的临床资料,收集指标包括:中性粒细胞计数、淋巴细胞计数、单核细胞计数、血小板计数、血红蛋白、白蛋白、前白蛋白、胆固醇和血清肿瘤标志物(CEA和CA19-9),计算中性粒细胞计数/淋巴细胞计数比(NLR)、血小板计数/淋巴细胞计数比(PLR)、淋巴细胞计数/单核细胞计数比(LMR)、预后营养指数(PNI)、老年营养风险评分(GNIR)和控制营养状况评分(COUNT),采用受试者工作特征曲线(ROC曲线)评价各种指标对胰腺癌根治性切除的预测价值.结果 55例胰腺癌患者中,22例接受了根治性手术,33例未接受根治性手术.根治性手术组与非根治性手术组患者的性别、BMI、中性粒细胞计数、单核细胞计数、血小板计数、血红蛋白水平、白蛋白水平、前白蛋白水平、胆固醇水平和肿瘤部位比较差异均无统计学意义(P＞0.05),但2组患者的年龄、淋巴细胞计数、CEA和CA19-9水平比较差异均有统计学意义(P＜0.05).中性粒细胞计数、淋巴细胞计数、单核细胞计数、血小板计数、血红蛋白、白蛋白、前白蛋白、胆固醇、NLR、PLR、LMR、PNI和GNIR预测胰腺癌可切除性的曲线下面积(AUC)均无统计学意义(P＞0.05),而COUNT、CEA和CA19-9的AUC值均有统计学意义,具有一定的诊断效能.COUNT、CEA水平和CA19-9水平的AUC值分别为0.700、0.705和0.739,最佳临界点对应的灵敏度分别为59.09％、80.00％和100％,特异度分别为87.88％、66.67％和42.42％.COUNT的特异度比较高,而灵敏度差;血清肿瘤标志物CEA水平和CA19-9水平的灵敏度比较高,但特异度差.结论 COUNT可以作为预测胰腺癌可切除性的一项临床参考指标.COUNT、CEA及CA19-9的综合应用,可以帮助临床更好地判断胰腺癌的手术指征.

目的:探讨陕西省自1月23日以来确诊患者接触史的变化趋势,以及不同时期应关注的重点场所.验证自然语言处理和大数据分析技术在流行病学史分析中应用的可行性.方法:收集陕西省2020年1月23日至2月20日卫健委公布的疫情数据,应用自然语言处理技术对确诊患者情况进行分词处理,计算每日的热点词语出现频率并排序.通过对词频和共词频率的统计,分析确诊患者的流行病学史变化趋势.结果:陕西省自1月23日起,前8日确诊患者描述中,标志着输入性疫情的"返回"等词频较高;自第9日起,标志以家庭为主要场所的聚集性疫情的各类"亲属关系"词频显著提高;第14日开始,体现其他场所的聚集性疫情的词汇频率明显提升.发病地区词频较高的为:西安市、安康市等;与陕西确诊病例相关的外省市地区词频较高为武汉/湖北、孝感市和杭州市.结论:通过词频分析可以发现陕西省疫情由输入性转向聚集性的转折点大致发生在2月1日.家庭作为聚集场所的传播方式为主要传播方式,后期有其他传播场所值得关注.本研究也验证了使用自然语言处理和词频分析等大数据分析技术可以在经典的流行病学史分析基础上,拓展新的思路,呈现新的表达方式.

目的 研究因视网膜母细胞瘤(Rb)而行眼球摘除手术,术后健眼新发肿瘤的位置和时间特点.方法 收集自2014年1月至2017年1月因单眼视网膜母细胞瘤在北京儿童医院就诊和治疗并最终行患眼眼球摘除手术的281例(281眼)患儿的临床资料,从中选取随访过程中健眼出现新发肿瘤的患儿进一步分析研究.结果 有31例(11.03％)患儿在随访过程中出现健眼的新发肿瘤.其中,患眼初次诊断年龄小于1周岁的患儿有24例(18.46％)发现健眼新发肿瘤,而初次诊断年龄大于1周岁的患儿有7例健眼发生肿瘤(4.64％),两者之间存在统计学差异(P＜0.05).在25例存在阳性家族史的患者中,有10例(40％)健眼出现新发肿瘤,与无阳性家族史患者相比具有统计学差异(P＜0.05).新发肿瘤大多发生在健眼的周边部视网膜.结论 对于因视网膜母细胞瘤而行眼球摘除手术的患者,在没有准确基因检测结果的情况下,健眼也需要密切的随访观察.

目的 研究建立康复医疗资源统计指标体系,为评价和掌握区域康复医疗资源提供参考依据.方法 采用专家咨询法,对北京市相关机构的关键人员进行深度访谈,遴选20余名专家对拟选用的指标进行筛选,构建康复医疗资源统计指标体系.结果 构建的统计指标体系从医疗机构基本情况、康复医学科基本情况、人力资源、医疗设备、服务能力5个方面综合反映康复医疗资源的发展和分布情况,其中包括5个一级指标,41个二级指标及55个三级指标.结论 应尽快研究制定康复医疗资源信息收集的有效机制,建立康复医疗资源数据上报的便捷渠道,为管理者提供准确、及时的康复医疗资源状态信息.

整合医嘱执行过程中多个系统产生的数据,全面取消纸质执行单,通过色标管理、核对执行与提醒拦截等完成在线患者身份确认与医嘱核对,实现重要护理执行过程同步写入护理病案.实施后,医护人员使用电子执行单体验得分高于使用纸质执行单得分(P＜0.05),医嘱执行内容同步写入护理病案得分高于医嘱执行后手工录入得分(P＜0.05),交班报告智能写入总用时较手工书写节约了55.13％.护理全过程无纸化是大数据再利用的有益尝试,提高了护理工作效率与质量.

目的 观察自体富血小板血浆(PRP)皮内微针注射联合308 nm准分子激光治疗稳定期白癜风的临床效果.方法 选取2017年2月至2018年2月首都医科大学附属北京友谊医院及白癜风专科医院接诊和募集的稳定期白癜风患者40例进行前瞻性自身对照研究.40例患者的对称部位或相近部位有2片单独的稳定皮损,共得80片皮损,左侧或上部为观察组,右侧或下部为对照组,每组各40片皮损.所有患者皮损均予他克莫司软膏每日1次外用,308 nm准分子激光照射治疗,每周2次,观察组另外给予自体PRP 3周1次皮内微针注射,对照组另外给予安慰剂注射,每次注射前测量皮损面积,连续治疗3个月后评价皮损复色面积、显效率和皮损治疗中的不良反应.结果 ①40例患者均完成了治疗周期,观察组患者白斑面积治疗前为(14.18±1.88)cm2,治疗后为(5.00±2.43)cm2,差异具有统计学意义(P<0.05).对照组患者白斑面积治疗前为(13.27±1.57)cm2,治疗后为(6.36±2.83)cm2,差异具有统计学意义(P<0.05).观察组平均复色面积为(19.19±2.70)cm2,对照组平均复色面积为(6.92±2.94)cm2,两组平均复色面积比较,观察组患者白斑面积变化较对照组显著,差异具有统计学意义(t=3.606,P<0.05).②观察组患者显效率为77.50％;对照组患者显效率为52.50％.观察组显效率明显高于对照组,差异具有统计学意义(χ2=5.49,P<0.05).③观察组面颈部显效率为84.61％(11/13),躯干部显效率为86.67％(13/15),四肢部显效率为71.43％(5/7),肢端部显效率为40.00％(2/5).结论 自体PRP皮内微针注射治疗白癜风是一种安全、有效的疗法,与308 nm准分子激光联合治疗可有效提高白斑复色率,缩短治疗时间,避免长期308 nm准分子激光照射的不良反应.

白癜风是一种常见的自身免疫性疾病,其对患者面容的损坏严重伤害了患者的自尊心,影响患者的生活质量[1,2].综合来说,白癜风的发生是遗传因素和环境因素相互作用引起皮肤黑素细胞被自身免疫系统攻击损伤造成的结果 .目前白癜风的治疗方法 虽然较多,但其疗效常常欠佳,且很多治疗方法 缺乏循证医学的证据.近年来随着对白癜风发病机制的探索不断深入,一些新的治疗靶位的发现,使得白癜风的治疗方向与方法 得到发展.

临床用血信息化管理对临床输血安全具有重要作用.基于HIMSS EMRAM 7标准的临床用血管理系统中输血申请、相容性检测、血液库存、输血反应、病历检查、统计功能模块的信息化流程再造,实现了用血全过程闭环管理以及关键节点的实时监控,保证了输血安全.

注射治疗是面部年轻化的重要手段,根据注射目的和要求不同,可选择的注射药品和注射方法多种多样,注射疗效的观察和判定也各有不同.面部皱纹年轻化注射治疗可以通过皱纹形态变化和WSRS量表等来观察和评价,面部轮廓年轻化注射治疗可以直接观察或通过3D测量方法对注射前后面部轮廓变化进行比较,面部皮肤年轻化注射可以直接观察,也可借助VISIA等仪器检测皮肤纹理、皱纹、毛孔、色素等的变化来评价,病人的满意程度也是重要的疗效判定内容.

Objective To study the utilization of data in hospital information system for clinical research by taking a large general hospital as an example. Methods We collected the data of application for clinical research and research score in 2016, and used SAS3.0 to do statistical analysis. Results The application for research purpose accounted for 28.8% and 44.7% of the departments never applied. The utilization frequency per capita was 0.06. The correlation coefficients were 0.43 and 0.55(P<0.05) between the frequency of application and paper score, and research score, respectively. Conclusion The data utilization activities of hospital information system for research are few. There is a positive relationship between application frequency and research score.

在推动信息化建设和数据利用的过程中,提出了应用"数据治理"的理念,在医院层面定义数据获取和使用中的"正向"行为,进行医疗卫生数据治理,并对相关行为进行评价、监督.通过探索、实践、扩充数据治理策略,并结合流程治理,在主数据管理、数据安全与共享、数据整合与数据质量、数据内容管理等方面都取得了显著的改善,同时配合数据的分析和反馈,促进医院数据获取、分析和利用工作的持续改进.

目的:建立基于信息化辅助的药师实时处方审核模式,并评价该模式的实施效果,为药学服务转型提供支撑.方法:以临床用药决策支持系统为审核规则智库建立信息化审核系统,在医师开具处方/医嘱时进行实时预审.医师对系统审出的问题处方/医嘱进行主动修改,也可以发给专职审核药师进行人工审核.对新模式实施效果进行评价,如处方合格率、医师对系统审核提示的主动修改率和药师审核意见的接受率;医保拒报销费用;医师满意度和患者满意度等指标.结果:该系统上线运行1年内,共审核处方245.49万张,审核医嘱413.19万条.医师对问题处方主动修改率平均为86.48％.经药师实时审核后,处方合格率由95.60％提升到99.67％.医嘱合格率由84.27％提升到97.53％.医师修改前后平均每张处方费用减少(146.25±13.49)元;降脂药拒付金额2017年9月份与2016同期分别为9216.24元和20 540.20元,同比下降55.13％.医师满意度为98.00％;患者对药学服务满意度达到97.30％,比去年同期提高5.70％.结论:基于信息化辅助的药师实时处方审核药学服务模式,可有效提高处方合格率,保证患者用药安全,节省医疗费用.

Objective The present study examined the effects of surgical and conservative treatment on the cura⁃ tive effect of patients with condylar fracture to determine the best treatment scheme and indication. Methods A total of 339 clinical cases of condylar fracture were selected, and pain severity, degree of mouth opening, angle of condylar fracture (calculated as the difference in the angle of the condylar between the fractured side and uninjured side) and the height of the mandibular ramus (calculated as the difference in the height of the mandibular ramus between the frac⁃ tured side and uninjured side) of patients at admission were measured and analyzed. The effects of surgical treatment (rigid internal fixation) and conservative treatment (functional therapy) were evaluated and compared 6 months after treatment. Results Among the patients with a condylar fracture displacement angle ≥ 11.50°, Significantly more (c2 = 26.38, P < 0.05) patients exhibited good recovery 6 months after surgical treatment [69.4% (118/170)] than those after conservative treatment [35.4% (29/82)]. Among the patients with a condylar fracture displacement angle < 11.50°, there was not a significant difference (c2 = 0.55, P > 0.05) between the numbers of patients who exhibited good recovery 6 months after surgical treatment [52.4% (22/42)] and conservative treatment [44.4% (20/45)]. Among the patients with mandibular ramus height ≥ 4.19 mm, significantly more (c2 = 20.35, P < 0.05) patients exhibited good recovery 6 months after surgical treatment [64.7% (112/173)] compared with those after conservative treatment [35.6% (32/90)]. Among the patients with mandibular ramus height < 4.19 mm, there was not a significant difference (c2 = 0.21, P > 0.05) between the numbers of patients who exhibited good recovery 6 months after surgical treatment [46.7% (14/30)] and conservative treatment [41.3% (19/46)]. Conclusion Patients with a displacement angle of condyle fracture great⁃ er than 11.50° and a mandibular ramus height less than 4.19 mm exhibit the greatest pain and a better effect from surgi⁃ cal treatment than those from conservative treatment.

Objective To observe the clinical effect of external use of imiquimod combined with ozone oil after laser operation of condylo-ma acuminatum. Methods Sixty condyloma acuminatum patients were retrospectively analyzed from Feb 2017 to May 2018 and were randomly di-vided into two groups with 30 patients in each group. The treatment group was treated with CO2laser for external use of imiquimod combined with ozone oil and the control group was treated by CO2laser therapy with imiquimod combined with ciprofloxacin gel. They were followed up at 2 weeks and 4 weeks after operation,and the wound healing and condyloma acuminatum recurrence circumstance were recorded. Results The wound healing rate was 86.7% in treatment group,which was higher than that of the control group 60.0%,the difference was statistically significant (P ＜0.05);and the recurrence rate 30.0% in treatment group was lower than that of the control group 56.7% with statistically significant difference (P ＜0.05). Conclusion External use of imiquimod combined with ozone oil after laser operation of condyloma acuminatum is effec-tive. It was good for mucosal wound healing and can reduce recurrence rate. Therefore,it is worth for clinical practice.

Objective Through the external using chemokine- like factor 1 (CKLF1) antagonism peptides C19 topical administration, to investigate its function in the mouse model with atopic dermatitis. And to analyze the relationship between C19 concentration and the therapeutic effect of atopic dermatitis in mice. Methods The mouse models of atopic dermatitis were established by sensitizating with ovalbumin (OVA) through the skin.55 BALB/c mice were randomly divided into atopic dermatitis (AD) group, control group, prevention group and treatment group a, b and c, 11 mice in each group. The control group and dermatitis group were treated with topical 0.9％ sodium chloride treatment. The treatment groups (a, b and c) were treated with C19 topical application of 0.1 μg/ml, 1.0 μg/ml and 10.0 μg/ml, respectively. At the end of treatment, the lesions of mice in each group were observed and recorded. The lesions and serum of mice were collected and the histopathological changes, the related inflammatory factors and the serum total IgE level were observed. Results ①Compared with the blank control group,dermatitis group and the treatment group showed obvious edema, erythema, exudation, dander, scab and other skin rash on the local skin of the mice. The modeling was successful.②After treatment, local skin appearance and histopathological inflammation of AD mice were alleviated after local topical treatment with C19. Compared with dermatitis group, inflammatory factors IL-4 and IL-5 in tissue homogenate were significantly decreased in treatment group c (P ＜0.05), while there was no significant difference between the treated group and the dermatitis group (P ＞0.05). Compared with the dermatitis group, the levels of inflammatory cytokines IL (P ＜0.05), while IL- 13 and Eotaxin decreased significantly in treatment group a, b and c, and the difference was statistically significant. There was no significant difference in a, b and c groups (P ＞0.05). Conclusion CKLF1 antagonist peptide C19 can play a therapeutic role in skin- specific absorption in mouse- specific dermatitis model. The effect of high concentration C19 in serum IgE and tissue homogenate IL-4 and IL-5 is better than that of low concentration C19. In Eotaxin and IL- 13, its therapeutic effect has no concentration dependence.