Basis of seventy-seven case records of twenty-six diseases in Linzheng Zhinan Yi'an(Guide to Clinical Practice),analyze and distinguish them into four types.They are disorder of the mother-organ affecting the chil...Basis of seventy-seven case records of twenty-six diseases in Linzheng Zhinan Yi'an(Guide to Clinical Practice),analyze and distinguish them into four types.They are disorder of the mother-organ affecting the child-organ,disorder of the child-organ affecting the mother-organ,over restraint and reverse restraint.The essence of this article is to recognize the pathological transmission among the Zang-fu organs according to the theory of five elements.展开更多
Recorded stories of the clinical encounter stretch back to ancient times.Throughout their history,these narratives have been called by different names,reflecting changes in format,function,and audience.This paper exam...Recorded stories of the clinical encounter stretch back to ancient times.Throughout their history,these narratives have been called by different names,reflecting changes in format,function,and audience.This paper examines and explains the differences in two related forms of clinical writing as practiced by East Asian Medicine clinicians in the United States today-the case study and the case report.Each has its strengths and weaknesses;each is suited to different roles.The case study is ideal for education and the practice of narrative medicine,whereas the case report has played a vital role in propelling East Asian Medicine into the arena of modern scientific research.展开更多
<strong>Background:</strong> Zimbabwe started HIV case-based surveillance in April 2017. Rapid testing for HIV recent infection was introduced into routine HIV and testing services in 2019 along with the I...<strong>Background:</strong> Zimbabwe started HIV case-based surveillance in April 2017. Rapid testing for HIV recent infection was introduced into routine HIV and testing services in 2019 along with the Impilo Electronic Health Record System. For the period January-June 2020, only 1 out of 13 health facilities in Mutare district reported seven newly diagnosed HIV patients through the electronic health record system compared to 483 in the District Health Information System (DHIS-2) recorded from paper-based registers. We evaluated the case-based surveillance system attributes, usefulness and reasons for under-reporting from January-December 2020. <strong>Methods:</strong> We conducted a descriptive cross-sectional study using updated Centres for Disease Control guidelines for evaluating public health surveillance systems. Questionnaires were administered to 36 health workers involved in HIV testing services. Facility checklists were used to collect data on knowledge, system attributes and usefulness of the system. Completed HIV case-based surveillance forms were assessed for completeness. Epi Info Version 7 was used to generate frequencies, means and proportions. <strong>Results:</strong> The reasons for under-reporting of patients in the electronic health record system were lack of reporting guidelines 26/36 (72%), limited coordination between technical staff and health facilities 24/36 (67%) and limited competency on the Electronic health record system 22/36 (61%). Timeliness, completeness, and validity were 88%, 82% and 100% respectively. The stability of the system was affected by the lack of standard operating procedures during system interruptions. Overall representativeness was 45% despite increasing from 3/226 (1%) to 224/303 (73%) between Quarter-1 and Quarter-4 of 2020. Acceptability was 100% due to reduced paperwork and the ability to generate simple reports. The information generated was used to identify new infection hotspots 28/36 (78%). <strong>Conclusion:</strong> The HIV cases based surveillance system was timely, acceptable with good data quality. Representativeness was poor due to limited competency on the electronic health record system. As a result, health workers received further training.展开更多
目的分析某专科医院在疾病诊断相关组(diagnosis related groups,DRGs)结算模式下存在的未入组病例问题,并提出相应的改进措施。方法通过回顾性分析和专家讨论,选取并总结某专科医院2021年1月—2022年6月上传至市医保平台病例信息管理...目的分析某专科医院在疾病诊断相关组(diagnosis related groups,DRGs)结算模式下存在的未入组病例问题,并提出相应的改进措施。方法通过回顾性分析和专家讨论,选取并总结某专科医院2021年1月—2022年6月上传至市医保平台病例信息管理系统中病例33935例中未入组病例300例,并对所有的未入组病例进行深入分析。结果未入组病例原因主要为主要诊断编码或者手术编码为灰码、医保版本切换导致原本入组的有效主诊断变成无效主诊断、主要诊断编码国家临床版医保版没有做好对照和临床医师主要诊断选择错误等方面。结论通过对医院DRGs结算模式下未入组病例的全面分析,找到改进措施,不断加强对临床医师和编码员的培训、加强病案首页质控、加强信息系统建设,从而提高DRGs入组率。展开更多
Objective:To analyze misdiagnosis features in clinical cases of“Classified Medical Cases of Famous Physicians”and“Supplement to Classified Case Records of Celebrated Physicians.”Materials and Methods:Two hundred a...Objective:To analyze misdiagnosis features in clinical cases of“Classified Medical Cases of Famous Physicians”and“Supplement to Classified Case Records of Celebrated Physicians.”Materials and Methods:Two hundred and five ancient misdiagnosed cases were analyzed in aspects of locations(exterior-interior type,qi-blood type and Zang‑Fu organs type)and patterns(heat-cold type and deficiency-excess type)by Apriori Algorithm Method.Results:The main types of misdiagnosis in those medical casesare as follows::Zang‑Fu location misjudgment,misjudging the interior as the exterior,misjudging deficiency pattern as excess pattern,and misjudging cold pattern as heat pattern.Among them,the most outstanding type is the misjudgment of deficiency–cold pattern as excess–heat pattern.Conclusions:(1)Accurate judgment of location and differentiation of deficiency and excess patterns are the key points in diagnosing the diseases correctly.The confusion of true deficiency–cold and pseudo‑excess–heat pattern should be taken seriously.(2)Data mining on ancient clinical cases offers a new methodology for assisting clinical diagnosis of traditional Chinese medicine.展开更多
Regional healthcare platforms collect clinical data from hospitals in specific areas for the purpose of healthcare management.It is a common requirement to reuse the data for clinical research.However,we have to face ...Regional healthcare platforms collect clinical data from hospitals in specific areas for the purpose of healthcare management.It is a common requirement to reuse the data for clinical research.However,we have to face challenges like the inconsistence of terminology in electronic health records (EHR) and the complexities in data quality and data formats in regional healthcare platform.In this paper,we propose methodology and process on constructing large scale cohorts which forms the basis of causality and comparative effectiveness relationship in epidemiology.We firstly constructed a Chinese terminology knowledge graph to deal with the diversity of vocabularies on regional platform.Secondly,we built special disease case repositories (i.e.,heart failure repository) that utilize the graph to search the related patients and to normalize the data.Based on the requirements of the clinical research which aimed to explore the effectiveness of taking statin on 180-days readmission in patients with heart failure,we built a large-scale retrospective cohort with 29647 cases of heart failure patients from the heart failure repository.After the propensity score matching,the study group (n=6346) and the control group (n=6346) with parallel clinical characteristics were acquired.Logistic regression analysis showed that taking statins had a negative correlation with 180-days readmission in heart failure patients.This paper presents the workflow and application example of big data mining based on regional EHR data.展开更多
文摘Basis of seventy-seven case records of twenty-six diseases in Linzheng Zhinan Yi'an(Guide to Clinical Practice),analyze and distinguish them into four types.They are disorder of the mother-organ affecting the child-organ,disorder of the child-organ affecting the mother-organ,over restraint and reverse restraint.The essence of this article is to recognize the pathological transmission among the Zang-fu organs according to the theory of five elements.
文摘Recorded stories of the clinical encounter stretch back to ancient times.Throughout their history,these narratives have been called by different names,reflecting changes in format,function,and audience.This paper examines and explains the differences in two related forms of clinical writing as practiced by East Asian Medicine clinicians in the United States today-the case study and the case report.Each has its strengths and weaknesses;each is suited to different roles.The case study is ideal for education and the practice of narrative medicine,whereas the case report has played a vital role in propelling East Asian Medicine into the arena of modern scientific research.
文摘<strong>Background:</strong> Zimbabwe started HIV case-based surveillance in April 2017. Rapid testing for HIV recent infection was introduced into routine HIV and testing services in 2019 along with the Impilo Electronic Health Record System. For the period January-June 2020, only 1 out of 13 health facilities in Mutare district reported seven newly diagnosed HIV patients through the electronic health record system compared to 483 in the District Health Information System (DHIS-2) recorded from paper-based registers. We evaluated the case-based surveillance system attributes, usefulness and reasons for under-reporting from January-December 2020. <strong>Methods:</strong> We conducted a descriptive cross-sectional study using updated Centres for Disease Control guidelines for evaluating public health surveillance systems. Questionnaires were administered to 36 health workers involved in HIV testing services. Facility checklists were used to collect data on knowledge, system attributes and usefulness of the system. Completed HIV case-based surveillance forms were assessed for completeness. Epi Info Version 7 was used to generate frequencies, means and proportions. <strong>Results:</strong> The reasons for under-reporting of patients in the electronic health record system were lack of reporting guidelines 26/36 (72%), limited coordination between technical staff and health facilities 24/36 (67%) and limited competency on the Electronic health record system 22/36 (61%). Timeliness, completeness, and validity were 88%, 82% and 100% respectively. The stability of the system was affected by the lack of standard operating procedures during system interruptions. Overall representativeness was 45% despite increasing from 3/226 (1%) to 224/303 (73%) between Quarter-1 and Quarter-4 of 2020. Acceptability was 100% due to reduced paperwork and the ability to generate simple reports. The information generated was used to identify new infection hotspots 28/36 (78%). <strong>Conclusion:</strong> The HIV cases based surveillance system was timely, acceptable with good data quality. Representativeness was poor due to limited competency on the electronic health record system. As a result, health workers received further training.
文摘目的分析某专科医院在疾病诊断相关组(diagnosis related groups,DRGs)结算模式下存在的未入组病例问题,并提出相应的改进措施。方法通过回顾性分析和专家讨论,选取并总结某专科医院2021年1月—2022年6月上传至市医保平台病例信息管理系统中病例33935例中未入组病例300例,并对所有的未入组病例进行深入分析。结果未入组病例原因主要为主要诊断编码或者手术编码为灰码、医保版本切换导致原本入组的有效主诊断变成无效主诊断、主要诊断编码国家临床版医保版没有做好对照和临床医师主要诊断选择错误等方面。结论通过对医院DRGs结算模式下未入组病例的全面分析,找到改进措施,不断加强对临床医师和编码员的培训、加强病案首页质控、加强信息系统建设,从而提高DRGs入组率。
基金Budget Foundation of Shanghai University of TCM(A1-GY010130)Philosophy and Social Science Foundation of Shanghai(2019BTQ005)。
文摘Objective:To analyze misdiagnosis features in clinical cases of“Classified Medical Cases of Famous Physicians”and“Supplement to Classified Case Records of Celebrated Physicians.”Materials and Methods:Two hundred and five ancient misdiagnosed cases were analyzed in aspects of locations(exterior-interior type,qi-blood type and Zang‑Fu organs type)and patterns(heat-cold type and deficiency-excess type)by Apriori Algorithm Method.Results:The main types of misdiagnosis in those medical casesare as follows::Zang‑Fu location misjudgment,misjudging the interior as the exterior,misjudging deficiency pattern as excess pattern,and misjudging cold pattern as heat pattern.Among them,the most outstanding type is the misjudgment of deficiency–cold pattern as excess–heat pattern.Conclusions:(1)Accurate judgment of location and differentiation of deficiency and excess patterns are the key points in diagnosing the diseases correctly.The confusion of true deficiency–cold and pseudo‑excess–heat pattern should be taken seriously.(2)Data mining on ancient clinical cases offers a new methodology for assisting clinical diagnosis of traditional Chinese medicine.
基金Supported by the National Major Scientific and Technological Special Project for"Significant New Drugs Development’’(No.2018ZX09201008)Special Fund Project for Information Development from Shanghai Municipal Commission of Economy and Information(No.201701013)
文摘Regional healthcare platforms collect clinical data from hospitals in specific areas for the purpose of healthcare management.It is a common requirement to reuse the data for clinical research.However,we have to face challenges like the inconsistence of terminology in electronic health records (EHR) and the complexities in data quality and data formats in regional healthcare platform.In this paper,we propose methodology and process on constructing large scale cohorts which forms the basis of causality and comparative effectiveness relationship in epidemiology.We firstly constructed a Chinese terminology knowledge graph to deal with the diversity of vocabularies on regional platform.Secondly,we built special disease case repositories (i.e.,heart failure repository) that utilize the graph to search the related patients and to normalize the data.Based on the requirements of the clinical research which aimed to explore the effectiveness of taking statin on 180-days readmission in patients with heart failure,we built a large-scale retrospective cohort with 29647 cases of heart failure patients from the heart failure repository.After the propensity score matching,the study group (n=6346) and the control group (n=6346) with parallel clinical characteristics were acquired.Logistic regression analysis showed that taking statins had a negative correlation with 180-days readmission in heart failure patients.This paper presents the workflow and application example of big data mining based on regional EHR data.
