The trusted sharing of Electronic Health Records(EHRs)can realize the efficient use of medical data resources.Generally speaking,EHRs are widely used in blockchain-based medical data platforms.EHRs are valuable privat...The trusted sharing of Electronic Health Records(EHRs)can realize the efficient use of medical data resources.Generally speaking,EHRs are widely used in blockchain-based medical data platforms.EHRs are valuable private assets of patients,and the ownership belongs to patients.While recent research has shown that patients can freely and effectively delete the EHRs stored in hospitals,it does not address the challenge of record sharing when patients revisit doctors.In order to solve this problem,this paper proposes a deletion and recovery scheme of EHRs based on Medical Certificate Blockchain.This paper uses cross-chain technology to connect the Medical Certificate Blockchain and the Hospital Blockchain to real-ize the recovery of deleted EHRs.At the same time,this paper uses the Medical Certificate Blockchain and the InterPlanetary File System(IPFS)to store Personal Health Records,which are generated by patients visiting different medical institutions.In addition,this paper also combines digital watermarking technology to ensure the authenticity of the restored electronic medical records.Under the combined effect of blockchain technology and digital watermarking,our proposal will not be affected by any other rights throughout the process.System analysis and security analysis illustrate the completeness and feasibility of the scheme.展开更多
The purpose of this paper is to discuss the development of medical informatization in the era of big data.Through literature review and theoretical analysis,the development of medical informatization in the era of big...The purpose of this paper is to discuss the development of medical informatization in the era of big data.Through literature review and theoretical analysis,the development of medical informatization in the era of big data is deeply discussed.The results show that medical informatization has developed rapidly in the era of big data,and its role in clinical decision-making,scientific research,teaching,and management has become increasingly prominent.The development of medical informatization in the era of big data has important purposes and methods,which can produce important results and conclusions and provide strong support for the development of the medical field.展开更多
Objective:To explore the core drug of Tian-shi Ye(1666 C.E.–1745 C.E.,a famous medical experts in Qing Dynasty)for treating exogenous cough and its mechanism of action.Methods:The database of prescriptions for treati...Objective:To explore the core drug of Tian-shi Ye(1666 C.E.–1745 C.E.,a famous medical experts in Qing Dynasty)for treating exogenous cough and its mechanism of action.Methods:The database of prescriptions for treating exogenous cough was established in Clinical Guide to Medical Records,and the complex network was constructed with frequency analysis and Gephi 0.9.2 software to obtain the core drug for exogenous cough,and the network of traditional Chinese medicine-component-disease-target regulation was constructed through network pharmacology to reveal the potential mechanism.Results:Xingren(Amygdalus Communis Vas)is the core drug for the treatment of exogenous cough in the“Clinical Guidelines and Medical Records”.It contains 19 active ingredients and forms 27 traditional Chinese medicine-disease targets for the treatment of acute bronchitis.Kyoto Encyclopedia of Genes and Genomes analysis involving 114 pathways,including arachidonic acid metabolism pathways,peroxidase pathways,estrogen metabolism pathways,and tryptophan metabolism pathways are the main signal pathways involved.Conclusion:Xingren(Amygdalus Communis Vas)-acute bronchitis has a multi-molecule,multi-target,and multi-pathway,and may be regulating the arachidonic acid metabolism pathway,peroxidase pathway,estrogen metabolism pathway,and tryptophan metabolism pathway.Such interventions as various biological processes in the body play a role in the treatment of acute bronchitis.展开更多
Sodium homeostasis disorder is one of the most common abnormal symptoms of elderly patients in intensive care unit(ICU),which may lead to physiological disorders of many organs.The current prediction of serum sodium i...Sodium homeostasis disorder is one of the most common abnormal symptoms of elderly patients in intensive care unit(ICU),which may lead to physiological disorders of many organs.The current prediction of serum sodium in ICU is mainly based on the subjective judgment of doctors’experience.This study aims at this problem by studying the clinical retrospective electronic medical record data of ICU to establish a machine learning model to predict the short-term serum sodium value of ICU patients.The data set used in this study is the open-source intensive care medical information set Medical Information Mart for Intensive Care(MIMIC)-IV.The time point of serum sodium detection was selected from the ICU clinical records,and the ICU records of 25risk factors related to serum sodium were extracted from the patients within the first 12 h for statistical analysis.A prediction model of serum sodium value within 48 h was established using a feedforward neural network,and compared with previous methods.Our research results show that the neural network learning model can predict the development of serum sodium in patients using physiological indicators recorded in clinical electronic medical records within 12 h,and has better prediction effect than the serum sodium formula and other machine learning models.展开更多
With the rapid development of information technology,the electronifi-cation of medical records has gradually become a trend.In China,the population base is huge and the supporting medical institutions are numerous,so ...With the rapid development of information technology,the electronifi-cation of medical records has gradually become a trend.In China,the population base is huge and the supporting medical institutions are numerous,so this reality drives the conversion of paper medical records to electronic medical records.Electronic medical records are the basis for establishing a smart hospital and an important guarantee for achieving medical intelligence,and the massive amount of electronic medical record data is also an important data set for conducting research in the medical field.However,electronic medical records contain a large amount of private patient information,which must be desensitized before they are used as open resources.Therefore,to solve the above problems,data masking for Chinese electronic medical records with named entity recognition is proposed in this paper.Firstly,the text is vectorized to satisfy the required format of the model input.Secondly,since the input sentences may have a long or short length and the relationship between sentences in context is not negligible.To this end,a neural network model for named entity recognition based on bidirectional long short-term memory(BiLSTM)with conditional random fields(CRF)is constructed.Finally,the data masking operation is performed based on the named entity recog-nition results,mainly using regular expression filtering encryption and principal component analysis(PCA)word vector compression and replacement.In addi-tion,comparison experiments with the hidden markov model(HMM)model,LSTM-CRF model,and BiLSTM model are conducted in this paper.The experi-mental results show that the method used in this paper achieves 92.72%Accuracy,92.30%Recall,and 92.51%F1_score,which has higher accuracy compared with other models.展开更多
Introduction: Today, information technology is considered as an important national development principle in each country which is applied in different fields. Health care as a whole and the hospitals could be regarded...Introduction: Today, information technology is considered as an important national development principle in each country which is applied in different fields. Health care as a whole and the hospitals could be regarded as a field and organizations with most remarkable IT applications respectively. Although different benchmarks and frameworks have been developed to assess different aspects of Hospital Information Systems (HISs) by various researchers, there is not any suitable reference model yet to benchmark HIS in the world. Electronic Medical Record Adoption Model (EMRAM) has been currently presented and is globally well-known to benchmark the rate of HIS utilization in the hospitals. Notwithstanding, this model has not been introduced in Iran so far. Methods: This research was carried out based on an applied descriptive method in three private hospitals of Isfahan—one of the most important provinces of Iran—in the year 2015. The purpose of this study was to investigate IT utilization stage in three selected private hospitals. Conclusion: The findings revealed that HIS is not at the center of concern in studied hospitals and is in the first maturity stage in accordance with EMRAM. However, hospital managers are enforced and under the pressure of different beneficiaries including insurance companies to improve their HIS. Therefore, it could be concluded that these types of hospitals are still far away from desirable conditions and need to enhance their IT utilization stage significantly.展开更多
BACKGROUND: Inaccurate and incomplete documentation can lead to poor treatment and medicolegal consequences. Studies indicate that teaching programs in this field can improve the documentation of medical records. The ...BACKGROUND: Inaccurate and incomplete documentation can lead to poor treatment and medicolegal consequences. Studies indicate that teaching programs in this field can improve the documentation of medical records. The study aimed to evaluate the effect of an educational workshop on medical record documentation by emergency medicine residents in the emergency department.METHODS: An interventional study was performed on 30 residents in their first year of training emergency medicine(PGY1), in three tertiary referral hospitals of Tehran University of Medical Sciences. The essential information that should be documented in a medical record was taught in a 3-day-workshop. The medical records completed by these residents before the training workshop were randomly selected and scored(300 records), as was a random selection of the records they completed one(300 records) and six months(300 records) after the workshop.RESULTS: Documentation of the majority of the essential items of information was improved significantly after the workshop. In particular documentation of the patients' date and time of admission, past medical and social history. Documentation of patient identity, requests for consultations by other specialties, first and final diagnoses were 100% complete and accurate up to 6 months of the workshop.CONCLUSION: This study confirms that an educational workshop improves medical record documentation by physicians in training.展开更多
Concern is expressed that electronic medical records may actually compromise care.Reports are electronically collated with patient charts, but when are they examined? Current electronic transmission of results to pati...Concern is expressed that electronic medical records may actually compromise care.Reports are electronically collated with patient charts, but when are they examined? Current electronic transmission of results to patients' electronic medical records do not seem to notify of new information.The unknown time from prescription to patient action and the variable time required for individual test performance seem to mandate that a physician attempting to be conscientious would have to examine all sections of every patient medical record in their practice, every day.That is quite inefficient and error-prone.Electronic medical record still contains what appear to be dangerous "bugs" which compromise our ability to provide the care we believe our patients deserve? I remain unsure that outpatient electronic medical records are "ready for prime time."展开更多
The electronic medical record is an essential technology tool to improve the quality of care. In present study we reported on the design and feasibility of electronic medical records in Female Pelvic Floor Dysfunction...The electronic medical record is an essential technology tool to improve the quality of care. In present study we reported on the design and feasibility of electronic medical records in Female Pelvic Floor Dysfunction Ward. Our main goal was documentation with the least possible missed data, evidence-based decision making, documented active patient follow up and increasing patient’s satisfaction. The Electronic Registry System of Female Pelvic Floor Dysfunction (Vali e Asr Hospital, Tehran, Iran) was designed in mid 2014 and tested till March 2015. The software description was designed based on previous paper questionnaire used in this ward. The electronic questionnaires were filled in upon hospitalization and thereafter including follow ups. The questionnaire included 10 demographic and 15 main questions. A digital analog scale (1 - 10) in each part quantified the effects of problem on patient’s quality of life and also the effects of interventions as well. Entered information in each step was available for those with defined access. Reporting design was dependent on the needed data. Our supervised data entry was a guarantee to the quality of information with the least errors. Access to all para clinical data made rapid and evidence-based decision making. Patient satisfaction was achieved because of unified approach. The most interesting part was access to evidence-based results and data to be used in research projects. This study showed that EMRs in Female Pelvic Floor Dysfunction Wards could provide valuable information, improve the quality of care and increase patient’s satisfaction.展开更多
Medical record coding plays an important role in hospital management and the improvement of medical record coding quality is quite important to hospital management.The professional qualities of medical record coders s...Medical record coding plays an important role in hospital management and the improvement of medical record coding quality is quite important to hospital management.The professional qualities of medical record coders significantly affect the improvement of coding quality.At present,Medical record coders lack in professional knowledge,clinical knowledge and disease classification knowledge.In order to improve the quality of medical record coding,medical record coders should receive regular professional training,and hospital management departments should strengthen the monitoring of the quality of medical record coding.When encountering problems in the process of coding,medical record coders should take the initiative to consult and learn from clinicians.At the same time,medical record coders should cultivate a sense of responsibility,which can continuously improve their professional qualities and achieve the objective of improving the quality of medical record coding.展开更多
Objective:During the prevention and control of the outbreak of the new coronavirus,an upsurge of online teaching was set off in various teaching institutions.There is a relatively new online teaching method that has s...Objective:During the prevention and control of the outbreak of the new coronavirus,an upsurge of online teaching was set off in various teaching institutions.There is a relatively new online teaching method that has stood out,namely the screen sharing method.The purpose of this study was to compare the effectiveness of live broadcasting and PowerPoint recorded lectures in terms of medical students' mastery of knowledge.Methods:The study was carried out among medical students of class 1806 from the First Affiliated Hospital of Xi'an Medical University who were in their clinical years.The students were randomly divided into two groups,in which 15 students were enrolled in the live broadcast lecture group,while 13 were in the PowerPoint recorded lecture group.Each group underwent two weeks of teaching in obstetrics and gynecology.After the second week of the course,a knowledge post-test and satisfaction survey were carried out,and the same test paper was used again 14 days after the previous test.The knowledge post-test and satisfaction survey were carried out using the Dingding intelligent form.Results:With regard to the post-test knowledge,the scores of the students under the two teaching methods were high,indicating that the learning effects from the two methods are similar(p>0.05).In terms of satisfaction,students showed more acceptance to screen sharing lectures(p<0.01).Conclusion:In small-scale online teaching,live lecture with screen sharing is a better and more effective teaching method,and students are more likely to accept this teaching method.展开更多
Background:The impact of sleep disorders on active-duty soldiers’medical readiness is not currently quantified.Patient data generated at military treatment facilities can be accessed to create research reports and th...Background:The impact of sleep disorders on active-duty soldiers’medical readiness is not currently quantified.Patient data generated at military treatment facilities can be accessed to create research reports and thus can be used to estimate the prevalence of sleep disturbances and the role of sleep on overall health in service members.The current study aimed to quantify sleep-related health issues and their impact on health and nondeployability through the analysis of U.S.military healthcare records from fiscal year 2018(FY2018).Methods:Medical diagnosis information and deployability profiles(e-Profiles)were queried for all active-duty U.S.Army patients with a concurrent sleep disorder diagnosis receiving medical care within FY2018.Nondeployability was predicted from medical reasons for having an e-Profile(categorized as sleep,behavioral health,musculoskeletal,cardiometabolic,injury,or accident)using binomial logistic regression.Sleep e-Profiles were investigated as a moderator between other e-Profile categories and nondeployability.Results:Out of 582,031 soldiers,48.4%(n=281,738)had a sleep-related diagnosis in their healthcare records,9.7%(n=56,247)of soldiers had e-Profiles,and 1.9%(n=10,885)had a sleep e-Profile.Soldiers with sleep e-Profiles were more likely to have had a motor vehicle accident(p OR(prevalence odds ratio)=4.7,95%CI 2.63–8.39,P≤0.001)or work/duty-related injury(p OR=1.6,95%CI 1.32–1.94,P≤0.001).The likelihood of nondeployability was greater in soldiers with a sleep e-Profile and a musculoskeletal e-Profile(p OR=4.25,95%CI 3.75–4.81,P≤0.001)or work/dutyrelated injury(p OR=2.62,95%CI 1.63–4.21,P≤0.001).Conclusion:Nearly half of soldiers had a sleep disorder or sleep-related medical diagnosis in 2018,but their sleep problems are largely not profiled as limitations to medical readiness.Musculoskeletal issues and physical injury predict nondeployability,and nondeployability is more likely to occur in soldiers who have sleep e-Profiles in addition to these issues.Addressing sleep problems may prevent accidents and injuries that could render a soldier nondeployable.展开更多
Mobile health apps (MHAs) and medical apps (MAs) are becoming increasinglypopular as digital interventions in a wide range of health-related applications inalmost all sectors of healthcare. The surge in demand for dig...Mobile health apps (MHAs) and medical apps (MAs) are becoming increasinglypopular as digital interventions in a wide range of health-related applications inalmost all sectors of healthcare. The surge in demand for digital medical solutionshas been accelerated by the need for new diagnostic and therapeutic methods inthe current coronavirus disease 2019 pandemic. This also applies to clinicalpractice in gastroenterology, which has, in many respects, undergone a recentdigital transformation with numerous consequences that will impact patients andhealth care professionals in the near future. MHAs and MAs are considered tohave great potential, especially for chronic diseases, as they can support the selfmanagementof patients in many ways. Despite the great potential associated withthe application of MHAs and MAs in gastroenterology and health care in general,there are numerous challenges to be met in the future, including both the ethicaland legal aspects of applying this technology. The aim of this article is to providean overview of the current status of MHA and MA use in the field ofgastroenterology, describe the future perspectives in this field and point out someof the challenges that need to be addressed.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
Clinical innovations are ideations resulting from collective experiences that enhance the “norm” and embrace an avenue for change with an invention. As such, collective data that were suggestive of increased medicat...Clinical innovations are ideations resulting from collective experiences that enhance the “norm” and embrace an avenue for change with an invention. As such, collective data that were suggestive of increased medication errors that compromised patient safety initiated the exploration of methods that could reduce multifactorial human errors. The pursuit for an appropriate system followed with the discovery of barcode medication administration system (BCMA) and electronic medication administration system (e-MAR). Prior to the adoption of BCMA and e-MAR, it was crucial to assess the impact of the new medication administration system and the rate of medication administration errors recorded, specifically those that resulted in harm. The purpose of the study was to evaluate BCMA and e-MAR usage outcomes, clinical practices, policies, and processes impacting nurses administering medications in the clinical environment using BCMA and e-MAR system. Thus, an annotated literature review was conducted prior to the implementation of the innovation which analyzed various studies that elaborated on their study methods, data collection and analysis that deliberated on the advantages and disadvantages of barcode medication administration system. It is evident in the researched journals that increased compliance was observed with appropriate guidance, processes and policies in place. There was also a significant reduction in reported errors. The incorporation of barcode technology with electronic medication administration record (e-MAR) had greatly improved the efficiency of the BCMA system. BCMAs method was one of the proposed solutions to medication administration errors and to enhance patient safety measures. As such, the innovation could significantly reduce medication error resulting from intrinsic and extrinsic factors. This paper will further elaborate on the advantages and disadvantages of BCMA and e-MAR, the strategies assumed in the development of BCMA and e-MAR system and its implementation process by identifying and overcoming potential challenges that may arise.展开更多
Patients with colorectal cancer (CRC) can have chemotherapy with oxaliplatin postoperatively. Oxaliplatin can cause acute and chronic neurotoxicity. It is important to be aware of neurotoxic side effects so they can b...Patients with colorectal cancer (CRC) can have chemotherapy with oxaliplatin postoperatively. Oxaliplatin can cause acute and chronic neurotoxicity. It is important to be aware of neurotoxic side effects so they can be documented and action taken at an early stage. The study aimed to identify and explore neurotoxic side effects documented in the medical records of patients with colorectal cancer treated with oxaliplatin-based adjuvant chemotherapy. Data in this study were medical records;presenting documentation about patients treated at the University Hospital in the south of Sweden between 2009 and 2010. A summative content analysis approach was used to explore the neurotoxic side effects. Identification and quantification of the content of medical records were carried out by using a study-specific protocol. “Cold sensitivity” and “tingling in the hands” were the most frequently documented neurotoxicity-related terms in the medical records. This identification was followed by interpretation. Three categories were identified in the interpretive part of the study: acute, chronic, and degree of neurotoxicity. The results show the importance of awareness of neurotoxic side effects so that they can be documented and action taken at an early stage. The documentation could be more reliable if patient-reported structured measurements were used, combined with free descriptions in the medical records. Being able to follow the progression of the symptoms during and after treatment would improve patient’s safety and also quality of life. The protocol that we developed and used in this review of medical records may be helpful to structure the documentation in the electronic system for documentation of neurotoxicity side effects.展开更多
Securing large amounts of electronic medical records stored in different forms and in many locations, while making availability to authorized users is considered as a great challenge. Maintaining protection and privac...Securing large amounts of electronic medical records stored in different forms and in many locations, while making availability to authorized users is considered as a great challenge. Maintaining protection and privacy of personal information is a strong motivation in the development of security policies. It is critical for health care organizations to access, analyze, and ensure security policies to meet the challenge and to develop the necessary policies to ensure the security of medical information. The problem, then, is how we can maintain the availability of the electronic medical records and at the same time maintain the privacy of patients’ information. This paper will propose a novel architecture model for the Electronic Medical Record (EMR), in which useful statistical medical records will be available to the interested parties while maintaining the privacy of patients’ information.展开更多
基金supported by the National Natural Science Foundation of China under grant 61972207,U1836208,U1836110,61672290the Major Program of the National Social Science Fund of China under Grant No.17ZDA092+2 种基金by the National Key R&D Program of China under grant 2018YFB1003205by the Collaborative Innovation Center of Atmospheric Environment and Equipment Technology(CICAEET)fundby the Priority Academic Program Development of Jiangsu Higher Education Institutions(PAPD)fund.
文摘The trusted sharing of Electronic Health Records(EHRs)can realize the efficient use of medical data resources.Generally speaking,EHRs are widely used in blockchain-based medical data platforms.EHRs are valuable private assets of patients,and the ownership belongs to patients.While recent research has shown that patients can freely and effectively delete the EHRs stored in hospitals,it does not address the challenge of record sharing when patients revisit doctors.In order to solve this problem,this paper proposes a deletion and recovery scheme of EHRs based on Medical Certificate Blockchain.This paper uses cross-chain technology to connect the Medical Certificate Blockchain and the Hospital Blockchain to real-ize the recovery of deleted EHRs.At the same time,this paper uses the Medical Certificate Blockchain and the InterPlanetary File System(IPFS)to store Personal Health Records,which are generated by patients visiting different medical institutions.In addition,this paper also combines digital watermarking technology to ensure the authenticity of the restored electronic medical records.Under the combined effect of blockchain technology and digital watermarking,our proposal will not be affected by any other rights throughout the process.System analysis and security analysis illustrate the completeness and feasibility of the scheme.
文摘The purpose of this paper is to discuss the development of medical informatization in the era of big data.Through literature review and theoretical analysis,the development of medical informatization in the era of big data is deeply discussed.The results show that medical informatization has developed rapidly in the era of big data,and its role in clinical decision-making,scientific research,teaching,and management has become increasingly prominent.The development of medical informatization in the era of big data has important purposes and methods,which can produce important results and conclusions and provide strong support for the development of the medical field.
文摘Objective:To explore the core drug of Tian-shi Ye(1666 C.E.–1745 C.E.,a famous medical experts in Qing Dynasty)for treating exogenous cough and its mechanism of action.Methods:The database of prescriptions for treating exogenous cough was established in Clinical Guide to Medical Records,and the complex network was constructed with frequency analysis and Gephi 0.9.2 software to obtain the core drug for exogenous cough,and the network of traditional Chinese medicine-component-disease-target regulation was constructed through network pharmacology to reveal the potential mechanism.Results:Xingren(Amygdalus Communis Vas)is the core drug for the treatment of exogenous cough in the“Clinical Guidelines and Medical Records”.It contains 19 active ingredients and forms 27 traditional Chinese medicine-disease targets for the treatment of acute bronchitis.Kyoto Encyclopedia of Genes and Genomes analysis involving 114 pathways,including arachidonic acid metabolism pathways,peroxidase pathways,estrogen metabolism pathways,and tryptophan metabolism pathways are the main signal pathways involved.Conclusion:Xingren(Amygdalus Communis Vas)-acute bronchitis has a multi-molecule,multi-target,and multi-pathway,and may be regulating the arachidonic acid metabolism pathway,peroxidase pathway,estrogen metabolism pathway,and tryptophan metabolism pathway.Such interventions as various biological processes in the body play a role in the treatment of acute bronchitis.
基金supported by the National Natural Science Foundation of China(No.12345678)。
文摘Sodium homeostasis disorder is one of the most common abnormal symptoms of elderly patients in intensive care unit(ICU),which may lead to physiological disorders of many organs.The current prediction of serum sodium in ICU is mainly based on the subjective judgment of doctors’experience.This study aims at this problem by studying the clinical retrospective electronic medical record data of ICU to establish a machine learning model to predict the short-term serum sodium value of ICU patients.The data set used in this study is the open-source intensive care medical information set Medical Information Mart for Intensive Care(MIMIC)-IV.The time point of serum sodium detection was selected from the ICU clinical records,and the ICU records of 25risk factors related to serum sodium were extracted from the patients within the first 12 h for statistical analysis.A prediction model of serum sodium value within 48 h was established using a feedforward neural network,and compared with previous methods.Our research results show that the neural network learning model can predict the development of serum sodium in patients using physiological indicators recorded in clinical electronic medical records within 12 h,and has better prediction effect than the serum sodium formula and other machine learning models.
基金This research was supported by the National Natural Science Foundation of China under Grant(No.42050102)the Postgraduate Education Reform Project of Jiangsu Province under Grant(No.SJCX22_0343)Also,this research was supported by Dou Wanchun Expert Workstation of Yunnan Province(No.202205AF150013).
文摘With the rapid development of information technology,the electronifi-cation of medical records has gradually become a trend.In China,the population base is huge and the supporting medical institutions are numerous,so this reality drives the conversion of paper medical records to electronic medical records.Electronic medical records are the basis for establishing a smart hospital and an important guarantee for achieving medical intelligence,and the massive amount of electronic medical record data is also an important data set for conducting research in the medical field.However,electronic medical records contain a large amount of private patient information,which must be desensitized before they are used as open resources.Therefore,to solve the above problems,data masking for Chinese electronic medical records with named entity recognition is proposed in this paper.Firstly,the text is vectorized to satisfy the required format of the model input.Secondly,since the input sentences may have a long or short length and the relationship between sentences in context is not negligible.To this end,a neural network model for named entity recognition based on bidirectional long short-term memory(BiLSTM)with conditional random fields(CRF)is constructed.Finally,the data masking operation is performed based on the named entity recog-nition results,mainly using regular expression filtering encryption and principal component analysis(PCA)word vector compression and replacement.In addi-tion,comparison experiments with the hidden markov model(HMM)model,LSTM-CRF model,and BiLSTM model are conducted in this paper.The experi-mental results show that the method used in this paper achieves 92.72%Accuracy,92.30%Recall,and 92.51%F1_score,which has higher accuracy compared with other models.
文摘Introduction: Today, information technology is considered as an important national development principle in each country which is applied in different fields. Health care as a whole and the hospitals could be regarded as a field and organizations with most remarkable IT applications respectively. Although different benchmarks and frameworks have been developed to assess different aspects of Hospital Information Systems (HISs) by various researchers, there is not any suitable reference model yet to benchmark HIS in the world. Electronic Medical Record Adoption Model (EMRAM) has been currently presented and is globally well-known to benchmark the rate of HIS utilization in the hospitals. Notwithstanding, this model has not been introduced in Iran so far. Methods: This research was carried out based on an applied descriptive method in three private hospitals of Isfahan—one of the most important provinces of Iran—in the year 2015. The purpose of this study was to investigate IT utilization stage in three selected private hospitals. Conclusion: The findings revealed that HIS is not at the center of concern in studied hospitals and is in the first maturity stage in accordance with EMRAM. However, hospital managers are enforced and under the pressure of different beneficiaries including insurance companies to improve their HIS. Therefore, it could be concluded that these types of hospitals are still far away from desirable conditions and need to enhance their IT utilization stage significantly.
文摘BACKGROUND: Inaccurate and incomplete documentation can lead to poor treatment and medicolegal consequences. Studies indicate that teaching programs in this field can improve the documentation of medical records. The study aimed to evaluate the effect of an educational workshop on medical record documentation by emergency medicine residents in the emergency department.METHODS: An interventional study was performed on 30 residents in their first year of training emergency medicine(PGY1), in three tertiary referral hospitals of Tehran University of Medical Sciences. The essential information that should be documented in a medical record was taught in a 3-day-workshop. The medical records completed by these residents before the training workshop were randomly selected and scored(300 records), as was a random selection of the records they completed one(300 records) and six months(300 records) after the workshop.RESULTS: Documentation of the majority of the essential items of information was improved significantly after the workshop. In particular documentation of the patients' date and time of admission, past medical and social history. Documentation of patient identity, requests for consultations by other specialties, first and final diagnoses were 100% complete and accurate up to 6 months of the workshop.CONCLUSION: This study confirms that an educational workshop improves medical record documentation by physicians in training.
文摘Concern is expressed that electronic medical records may actually compromise care.Reports are electronically collated with patient charts, but when are they examined? Current electronic transmission of results to patients' electronic medical records do not seem to notify of new information.The unknown time from prescription to patient action and the variable time required for individual test performance seem to mandate that a physician attempting to be conscientious would have to examine all sections of every patient medical record in their practice, every day.That is quite inefficient and error-prone.Electronic medical record still contains what appear to be dangerous "bugs" which compromise our ability to provide the care we believe our patients deserve? I remain unsure that outpatient electronic medical records are "ready for prime time."
文摘The electronic medical record is an essential technology tool to improve the quality of care. In present study we reported on the design and feasibility of electronic medical records in Female Pelvic Floor Dysfunction Ward. Our main goal was documentation with the least possible missed data, evidence-based decision making, documented active patient follow up and increasing patient’s satisfaction. The Electronic Registry System of Female Pelvic Floor Dysfunction (Vali e Asr Hospital, Tehran, Iran) was designed in mid 2014 and tested till March 2015. The software description was designed based on previous paper questionnaire used in this ward. The electronic questionnaires were filled in upon hospitalization and thereafter including follow ups. The questionnaire included 10 demographic and 15 main questions. A digital analog scale (1 - 10) in each part quantified the effects of problem on patient’s quality of life and also the effects of interventions as well. Entered information in each step was available for those with defined access. Reporting design was dependent on the needed data. Our supervised data entry was a guarantee to the quality of information with the least errors. Access to all para clinical data made rapid and evidence-based decision making. Patient satisfaction was achieved because of unified approach. The most interesting part was access to evidence-based results and data to be used in research projects. This study showed that EMRs in Female Pelvic Floor Dysfunction Wards could provide valuable information, improve the quality of care and increase patient’s satisfaction.
文摘Medical record coding plays an important role in hospital management and the improvement of medical record coding quality is quite important to hospital management.The professional qualities of medical record coders significantly affect the improvement of coding quality.At present,Medical record coders lack in professional knowledge,clinical knowledge and disease classification knowledge.In order to improve the quality of medical record coding,medical record coders should receive regular professional training,and hospital management departments should strengthen the monitoring of the quality of medical record coding.When encountering problems in the process of coding,medical record coders should take the initiative to consult and learn from clinicians.At the same time,medical record coders should cultivate a sense of responsibility,which can continuously improve their professional qualities and achieve the objective of improving the quality of medical record coding.
基金Shaanxi Undergraduate and Higher Continuing Education Teaching Reform Research Project in 2021 by Shaanxi Education Department“Construction and Practice of Faculty Construction and Quality Assurance System Based on Online Learning Platform for Clinical Faculty of Western Medical College”(Grant Number:21BZ066)Education and Teaching Reform Research Project in 2020 by Xi'an Medical University“Construction and Practice of‘Double-Qualified’Teaching Staff Construction and Quality Assurance System in Affiliated Hospitals Based on‘Clinical Teachers Online Learning Platform’”(Grant Number:2020JG-02)。
文摘Objective:During the prevention and control of the outbreak of the new coronavirus,an upsurge of online teaching was set off in various teaching institutions.There is a relatively new online teaching method that has stood out,namely the screen sharing method.The purpose of this study was to compare the effectiveness of live broadcasting and PowerPoint recorded lectures in terms of medical students' mastery of knowledge.Methods:The study was carried out among medical students of class 1806 from the First Affiliated Hospital of Xi'an Medical University who were in their clinical years.The students were randomly divided into two groups,in which 15 students were enrolled in the live broadcast lecture group,while 13 were in the PowerPoint recorded lecture group.Each group underwent two weeks of teaching in obstetrics and gynecology.After the second week of the course,a knowledge post-test and satisfaction survey were carried out,and the same test paper was used again 14 days after the previous test.The knowledge post-test and satisfaction survey were carried out using the Dingding intelligent form.Results:With regard to the post-test knowledge,the scores of the students under the two teaching methods were high,indicating that the learning effects from the two methods are similar(p>0.05).In terms of satisfaction,students showed more acceptance to screen sharing lectures(p<0.01).Conclusion:In small-scale online teaching,live lecture with screen sharing is a better and more effective teaching method,and students are more likely to accept this teaching method.
基金The Department of Defense Military Operational Medicine Research Program(MOMRP)supported this study。
文摘Background:The impact of sleep disorders on active-duty soldiers’medical readiness is not currently quantified.Patient data generated at military treatment facilities can be accessed to create research reports and thus can be used to estimate the prevalence of sleep disturbances and the role of sleep on overall health in service members.The current study aimed to quantify sleep-related health issues and their impact on health and nondeployability through the analysis of U.S.military healthcare records from fiscal year 2018(FY2018).Methods:Medical diagnosis information and deployability profiles(e-Profiles)were queried for all active-duty U.S.Army patients with a concurrent sleep disorder diagnosis receiving medical care within FY2018.Nondeployability was predicted from medical reasons for having an e-Profile(categorized as sleep,behavioral health,musculoskeletal,cardiometabolic,injury,or accident)using binomial logistic regression.Sleep e-Profiles were investigated as a moderator between other e-Profile categories and nondeployability.Results:Out of 582,031 soldiers,48.4%(n=281,738)had a sleep-related diagnosis in their healthcare records,9.7%(n=56,247)of soldiers had e-Profiles,and 1.9%(n=10,885)had a sleep e-Profile.Soldiers with sleep e-Profiles were more likely to have had a motor vehicle accident(p OR(prevalence odds ratio)=4.7,95%CI 2.63–8.39,P≤0.001)or work/duty-related injury(p OR=1.6,95%CI 1.32–1.94,P≤0.001).The likelihood of nondeployability was greater in soldiers with a sleep e-Profile and a musculoskeletal e-Profile(p OR=4.25,95%CI 3.75–4.81,P≤0.001)or work/dutyrelated injury(p OR=2.62,95%CI 1.63–4.21,P≤0.001).Conclusion:Nearly half of soldiers had a sleep disorder or sleep-related medical diagnosis in 2018,but their sleep problems are largely not profiled as limitations to medical readiness.Musculoskeletal issues and physical injury predict nondeployability,and nondeployability is more likely to occur in soldiers who have sleep e-Profiles in addition to these issues.Addressing sleep problems may prevent accidents and injuries that could render a soldier nondeployable.
文摘Mobile health apps (MHAs) and medical apps (MAs) are becoming increasinglypopular as digital interventions in a wide range of health-related applications inalmost all sectors of healthcare. The surge in demand for digital medical solutionshas been accelerated by the need for new diagnostic and therapeutic methods inthe current coronavirus disease 2019 pandemic. This also applies to clinicalpractice in gastroenterology, which has, in many respects, undergone a recentdigital transformation with numerous consequences that will impact patients andhealth care professionals in the near future. MHAs and MAs are considered tohave great potential, especially for chronic diseases, as they can support the selfmanagementof patients in many ways. Despite the great potential associated withthe application of MHAs and MAs in gastroenterology and health care in general,there are numerous challenges to be met in the future, including both the ethicaland legal aspects of applying this technology. The aim of this article is to providean overview of the current status of MHA and MA use in the field ofgastroenterology, describe the future perspectives in this field and point out someof the challenges that need to be addressed.
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.
文摘Clinical innovations are ideations resulting from collective experiences that enhance the “norm” and embrace an avenue for change with an invention. As such, collective data that were suggestive of increased medication errors that compromised patient safety initiated the exploration of methods that could reduce multifactorial human errors. The pursuit for an appropriate system followed with the discovery of barcode medication administration system (BCMA) and electronic medication administration system (e-MAR). Prior to the adoption of BCMA and e-MAR, it was crucial to assess the impact of the new medication administration system and the rate of medication administration errors recorded, specifically those that resulted in harm. The purpose of the study was to evaluate BCMA and e-MAR usage outcomes, clinical practices, policies, and processes impacting nurses administering medications in the clinical environment using BCMA and e-MAR system. Thus, an annotated literature review was conducted prior to the implementation of the innovation which analyzed various studies that elaborated on their study methods, data collection and analysis that deliberated on the advantages and disadvantages of barcode medication administration system. It is evident in the researched journals that increased compliance was observed with appropriate guidance, processes and policies in place. There was also a significant reduction in reported errors. The incorporation of barcode technology with electronic medication administration record (e-MAR) had greatly improved the efficiency of the BCMA system. BCMAs method was one of the proposed solutions to medication administration errors and to enhance patient safety measures. As such, the innovation could significantly reduce medication error resulting from intrinsic and extrinsic factors. This paper will further elaborate on the advantages and disadvantages of BCMA and e-MAR, the strategies assumed in the development of BCMA and e-MAR system and its implementation process by identifying and overcoming potential challenges that may arise.
基金Linköping University Hospital Swedish Society of Nursing
文摘Patients with colorectal cancer (CRC) can have chemotherapy with oxaliplatin postoperatively. Oxaliplatin can cause acute and chronic neurotoxicity. It is important to be aware of neurotoxic side effects so they can be documented and action taken at an early stage. The study aimed to identify and explore neurotoxic side effects documented in the medical records of patients with colorectal cancer treated with oxaliplatin-based adjuvant chemotherapy. Data in this study were medical records;presenting documentation about patients treated at the University Hospital in the south of Sweden between 2009 and 2010. A summative content analysis approach was used to explore the neurotoxic side effects. Identification and quantification of the content of medical records were carried out by using a study-specific protocol. “Cold sensitivity” and “tingling in the hands” were the most frequently documented neurotoxicity-related terms in the medical records. This identification was followed by interpretation. Three categories were identified in the interpretive part of the study: acute, chronic, and degree of neurotoxicity. The results show the importance of awareness of neurotoxic side effects so that they can be documented and action taken at an early stage. The documentation could be more reliable if patient-reported structured measurements were used, combined with free descriptions in the medical records. Being able to follow the progression of the symptoms during and after treatment would improve patient’s safety and also quality of life. The protocol that we developed and used in this review of medical records may be helpful to structure the documentation in the electronic system for documentation of neurotoxicity side effects.
文摘Securing large amounts of electronic medical records stored in different forms and in many locations, while making availability to authorized users is considered as a great challenge. Maintaining protection and privacy of personal information is a strong motivation in the development of security policies. It is critical for health care organizations to access, analyze, and ensure security policies to meet the challenge and to develop the necessary policies to ensure the security of medical information. The problem, then, is how we can maintain the availability of the electronic medical records and at the same time maintain the privacy of patients’ information. This paper will propose a novel architecture model for the Electronic Medical Record (EMR), in which useful statistical medical records will be available to the interested parties while maintaining the privacy of patients’ information.