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124 Development of a system for clinical-disorder detection in the ICU

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Development of a system for clinical-disorder detection in the ICUJyrki Ojaniemi1, Mark van Gils1, Ilkka Korhonen1,Arno Heikelä2, Aarno Kari31VTT Information Technology, Tampere, Finland2Datex-Ohmeda Division, Instrumentarium Corp., Kuopio, Finland,3Kuopio University Hospital, Dept. of Anaesthesiology and Intensive Care, Kuopio, FinlandAbstract: A system was developed that assesses the presence of defined clinical disorders occurring in the ICU. The system uses a range of variables obtained by querying the ICU’s patient database management system. After processing the obtained data, an estimation is given in how far a certain disorder is likely to be present. This is communicated back in a variable to the patient database management system (which can, if necessary, used as a trigger for an alarm). The set-up allows for integration of new algorithms to a system that is in routine use through a standard interface. In this way it allows clinical experimentation with new biosignal interpretation methods and hence can speed up the dissemination of research methods into products.INTRODUCTIONToday’s intensive care unit (ICU) is equipped with a wide range of measurement systems that provide a wealth of data to the clinician. This large set of information, that contains such diverse components as numerical values obtained from patient monitors, laboratory-generated values, and nurse observations, in principle provides the means to assess the patient’s physiological state. Although modern equipment, can present all this information, the step to, combine information and extract the required relevant parts from it and present the right results in time in an easily comprehensible manner proves to be difficult. Alarming systems, often operating as single-signal limit alarms, generating many false-positives are still a too common phenomenon in the ICU (e.g., [1-2]).The first step to obtaining better results would be to process changes in one variable in the context of values of other variables; a very natural step every clinician will take when interpreting any information obtained from the patient. Other fundamental issues that play a role in the less-than-ideal performance of current alarming systems are [3]:1. how to deal with noisy and unreliable patient data;2. a need for new ideas in knowledge representation;3. investigated techniques are not mature enough to find them in real clinical use;4. lack of architectures that provide a generic platform on which domain-specific applications can easily be installed; and5. lack of an infrastructure (from a system’s point of view as well as from a protocol point of view) for easy clinical evaluation of the developed systems.In recent years many new approaches have been tried that deal with issue 2. These include the use of Artificial Neural Networks (ANNs), Fuzzy Logic, or combinations of such techniques with rule-based systems. Despite the efforts, the uptake of advanced techniques into a real clinical setting is poor [4]. This is typically caused by issues 4 and 5 (and, as a result, issue 3) and values for false-alarm rates and low positive prediction values remain a problem.This article reports on a first step in addressing the problems mentioned above. Next to taking into account the use of multiple data sources in building the system, the foundation is laid for an environment that allows on-line as well as off-line testing of biosignal interpretation (BSI) algorithms that can be altered easily for experimentation with new insights.METHODSThe first installation of the Intelligent Alarm System (IAS) has been done at the Intensive Care Unit of Kuopio University Hospital (KUH), Kuopio, Finland.The system is closely attached to the Patient Database Management System (CIMS, Datex-Ohmeda Div., Instrumentarium Corp., Helsinki, Finland) system in use at KUH. A schematic representation of the overall architecture of the measurement system in which the IAS is incorporated is depicted in Figure 1.Signals from the patient are recorded using standard monitoring equipment (Datex-Ohmeda AS/3 monitors, Datex-Ohmeda Div., Instrumentarium Corp., Helsinki, Finland). Information present in those signals is transferred to CIMS work stations (CIMS WS). The CIMS has as its main function the support of the patient care: it records all trend data from the patient monitors, laboratory results, and information on medication and nursing actions. This information is stored in a database on the CIMS database server.The IAS runs on a dedicated PC – running under MS-Windows NT4 (Microsoft Corp., Redmond, USA). The IAS communicates with the CIMS data base (Sybase Inc., Emeryville USA) via ODBC drivers. Data is obtained by polling the CIMS database by means of SQL queries. The system provides possibilities to use any variable that is present in the CIMS database.The IAS polls the database for the most recent data every two minutes. Subsequently, the data is processed by BSI algorithms developed to detect possible presence of patient disorders. The outputs of the algorithms, in the formMedical & Biological Engineering & Computing Vol.37, Supplement 1, 1999 124of an index indicating the probability of the presence of a disorder, is written back to the CIMS, again using ODBC. The CIMS work stations can read this information from the database and e.g., display it as graphical information in trend charts.The IAS system can operate in two modes: an on-line mode and an off-line mode. During the on-line mode the system retrieves data, processes it, and sends disorder indices back to the database. In off-line mode, parameters that are used in the disorder detection algorithms (such as scaling factors, limit variables, the set of recorded variables to be used) as well as configuration parameters (e.g., identification of patients to be measured, files to be used) may be changed. Changing the first group of parameters allows the user to experiment with different algorithms by tuning their parameters.The algorithms rely on domain knowledge provided by an international group of clinicians as well as on robust signal processing methods. Alarms have structures containing: 1) artifact detection blocks (that operate e.g., on the basis of statistical distributions of artifact-free measurements); 2) filtering blocks; 3) blocks that apply scaling functions to map all different signals onto a normalized range; and 4) methods that generate estimations of current values for those variables that are sampled at a very low frequency. Outputs of ‘chains’ of processing blocks for each variable are combined and presented as input to the clinical rules to come to sub-state indexes. These provide information on ‘attributes’ that make up a patient disorder (e.g., ‘presence of metabolic signs of tissue hypoxia’ or ‘presence of inadequate flow’). Indexes for sub states in their turn are combined to generate an index reflecting the presence of a disorder.RESULTSThe first version of the system is installed at the ICU of KUH. Data that it uses includes trend variables and laboratory test results as defined in the ‘Clinical definitions of Disorders’ for the EU/BIOMED1 Improve project (PL921768) [5]. The disorders that are concentrated upon here are ‘cardiac failure’ and ‘sepsis evolved into high blood flow state’. BSI methods to detect these disorders were developed and validated in an earlier study [6].In an initial test phase the technical reliability was evaluated over a recording time of over 6000 patient hours. The clinical performance was tested on 5 patients with long ICU stay (total 162 monitoring hours) and 10 post-operative cardiac patients for 200 hours. The current network-IAS combination allows for concurrent processing of data from 3 patients. The system was found to be suitable for use in an elaborate evaluation of the BSI algorithms.A first assessment of the clinical performance of the BSI methods used in the IAS system was evaluated daily by two to three experienced intensivists. Trend curves of the probability estimations of the IAS were compared to original patient data. The episodes of all three disorders could be detected during the test period. All three experts agreed that the system could detect the disorders with high specificity and with reasonable sensitivity.CONCLUSIONSA multi-signal based alarming system has been developed that allows for assessing the presence of patient disorders in the ICU using BSI algorithms that can be altered easily. It provides a means to on-line run BSI methods, thus providing a testbed for trying out new ideas.First validation of the algorithms shows that the system detects the disorders cardiac failure and sepsis evolved into high blood flow with high specificity and with acceptable sensitivity. To thoroughly asses the value of the algorithms the system is currently running in a clinical evaluation set-up recording 100 cardiac patients and 200 patients with TISS score > 40 or that have a pulmonary catheter.REFERENCES1. C.L. Tsien, J.C. Fackler, "Poor prognosis for existingmonitors in the intensive care unit." Crit. Care Med., vol. 25, pp. 614-6199, 1997.2.T. Lawless, "Crying wolf: false alarms in a pediatricintensive care unit," Crit. Care Med., vol. 22, pp. 81-85, 1994.3. F.A. Mora, G. Passariello, G. Carrault, J-P Le Pichon,"Intelligent Patient Monitoring and Management Systems: A review," IEEE EMB Mag., vol. 12 pp. 23-33, 1993.4.N. Saranummi, I. Korhonen, M. van Gils M, A. Kari,"Framework for Biosignal Interpretation in Intensive care and Anesthesia," Meth. Inf. Med., vol. 36, pp. 340-344, 1997.5.K. Nieminen, R.M. Langford, C.J. Morgan, J. Takala,A. Kari, "A Clinical Description of the IMPROVELibrary," IEEE EMB Mag.,vol. 16, pp. 21-24,40, 1997.6.J. Ojaniemi, M. van Gils, I. Korhonen, K. Nieminen,"Intelligent Alarms for Efficient Detection of Patient Disorders in the ICU," Med. Biol. Eng. Comp., vol. 35, Supp. Pt 1, p. 619, 1997.Figure 1: Schematic overview of the place of the IAS in theexisting system set-up.Medical & Biological Engineering & Computing Vol.37, Supplement 1, 1999125。

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国内外药学门诊发展现状

国内外药学门诊发展现状

56智慧健康Smart Healthcare2021年1月第7卷第1期No.7 roll up No. 1 Issue, January, 2021智戆慝疗-前沿综逑D01:10.19335/ki.2096-1219.2021.01.019国内外药学门诊发展现状谭涵梦\魏理(1.广州医科大学药学院，广东广州510120; 2.广州医科大学附属第一医院药学部，广东广州510120)摘要：随着医疗改革的不断深化和药师职能的快速转变，开展药学门诊已逐步成为一种趋势。

国外实践证明，药师加入到门诊患者的慢病管理中，能够使得患者在用药合理性、安全性、有效性和经济性等方面获益。

因此在政策鼓励下，我国各省份已有多家医院开展药学门诊，但由于起步较晚，大多还是照搬国外经验，离国外成熟完整的体系模式还有一定差距。

本文通过阐述药学门诊在国内外的发展背景，对比、综述药学门诊在国内外的工作内容与模式及评价标准方面的差异，旨在为建立符合我国国情的药学门诊体系提供一定参考。

关键词：药学门诊；工作内容与模式；评价标准本文引用格式：谭涵梦，魏理.国内外药学门诊发展现状U].智慧健康,2021,7(1):56-58,61. Development Status of Pharmacist-managed Clinic at Home and AbroadTAN Han-meng1, WEI Li2*(1.Pharmaceutical Sciences, Guangzhou Medical University, Guangzhou, Guangdong 510120; 2.Department of Pharmacy,the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120) ABSTRACT: With the continuous deepening of medical reform and the rapid transformation of pharmacists' functions, the development of pharmacist-managed clinic has gradually become a trend. Foreign practice has proved that the participation of pharmacists in the management of chronic diseases in outpatients can make patients benefit from the rationality, safety, effectiveness and economy of drug use. Therefore, under the encouragement of the policy, there are many hospitals in various provinces in my country to carry out pharmacist-managed clinics. However, due to the late start, most of them still copy foreign experience, and there is still a certain gap from the mature and complete system model abroad. This article aims to provide a reference for the establishment of a pharmacist-managed clinic system that conforms to my country's national conditions by describing the development background of pharmacist- managed clinic at home and abroad, comparing and summarizing the differences in the content and modes and evaluation criteria of pharmacist-managed clinic at home and abroad.KEY WORDS: Pharmacist-managed clinic; Work content and mode; Evaluation criteria〇引言药学门诊（Pharmacist-Managed Clinic,PMC)是指由具有药学专业技术优势的药师对门诊患者提 供用药评估、用药调整、用药计划、用药教育及随 访管理的一种服务模式[1]。

医院咳喘药学服务门诊药师培训质量评价标准指标体系构建

医院咳喘药学服务门诊药师培训质量评价标准指标体系构建

医院咳喘药学服务门诊药师培训质量评价标准指标体系构建Δ葛艳慧＊，陈晓莉，赵晓玉，陈哲，关克磊，杜书章 #（郑州大学第一附属医院药学部，郑州　450052）中图分类号 R 952 文献标志码 A 文章编号 1001-0408（2023）21-2649-05DOI 10.6039/j.issn.1001-0408.2023.21.14摘要 目的 构建医院咳喘药学服务门诊（CWPC ）药师培训质量评价标准指标体系，为CWPC 药师培训师资的选择以及培训方案的改善提供依据。

方法 以柯氏模型为基础，采用德尔菲法对国内10个省份的13家三级甲等医院的15名专家进行函询，建立CWPC 药师培训质量评价标准指标体系。

采用层次分析法确定各级指标权重，并根据各级指标权重量化CWPC 药师培训质量评价标准指标体系。

结果 专家权威系数为0.810，判断系数为0.727，熟悉系数为0.893。

各级指标的肯德尔协调系数为0.308～0.687，χ2检验P 均小于0.05，说明专家函询结果的一致性高。

经过2轮专家函询后，确定了以柯氏模型为基础的CWPC 药师培训质量评价标准指标体系，包括4个一级指标（学员反应层、学习收获层、行为改善层、培训成果层）、12个二级指标（培训需求、教学方法、理论知识、实践技能、岗位能力、患者受益等）和44个三级指标（培训目标明确、CWPC 核心制度、特殊装置的操作和评价、咳喘患者治疗相关专业知识、推进CWPC 的建设、患者依从性提高等）。

结论 构建的医院CWPC 药师培训质量评价标准指标体系具有一定权威性和科学性，为医院CWPC 药师培训质量评价提供了科学的理论依据。

关键词 咳喘药学服务门诊；药师；培训质量；评价标准；指标体系；柯氏模型Development of the index system of the quality evaluation standard for pharmacist training in cough and wheeze pharmaceutical care outpatient departmentGE Yanhui ，CHEN Xiaoli ，ZHAO Xiaoyu ，CHEN Zhe ，GUAN Kelei ，DU Shuzhang （Dept. of Pharmacy ， the First Affiliated Hospital of Zhengzhou University ， Zhengzhou 450052， China ）ABSTRACTOBJECTIVE To establish the index system of quality evaluation standard for pharmacist training in cough andwheeze pharmaceutical care （CWPC ） outpatient department ， and to provide a basis for the selection of CWPC pharmacist training teachers and the improvement of training plans. METHODS Based on Kirkpatrick model ， using the Delphi method ， a total of 15 experts from 13 tertiary hospitals in 10 provinces in China were consulted to establish the standard index system of the quality evaluation for CWPC pharmacists training. Analytic hierarchy process （AHP ） was adopted to determine the weights of each indicator and quantify the index system according to the weights of indicators at all levels. RESULTS The coefficient of expert authority was 0.810， the judgment coefficient was 0.727， and the familiarity coefficient was 0.893. The Kendall coordination coefficient of each index was 0.308-0.687. The P values of χ2 test were all less than 0.05， which indicated that the degree of coordination of the experts was high. After two rounds of correspondence ， Kirkpatrick model-based index system of quality evaluation standard for CWPC pharmacist training was determined. The index system included 4 first-level indexes （participants ’ reaction layer ， learning gain layer ， behavior improvement layer ， training outcome layer ）， 12 second-level indexes （such as training needs ， teaching methods ， theoretical knowledge ， practical skills ， job abilities ， patient benefits ， etc.） and 44 third-level indexes （such as clear training objectives ， core system of CWPC ， special device operation and evaluation ， professional knowledge related to the treatment of cough and wheeze patients ， promoting the construction of CWPC ， improving patient compliance ）. CONCLUSIONS The constructed index system of quality evaluation standard for CWPC pharmacist training has a certain level of authority and scientificity ， and provides a scientific theoretical basis for quality evaluation of CWPC pharmacist training.KEYWORDScough and wheeze pharmaceutical care outpatient department ； pharmacist ； training quality ； evaluation standard ；index system ； Kirkpatrick model2020年1月，中华医学会呼吸病学分会、中国医师协会呼吸医师分会、中国药学会药学服务专业委员会启动了“呼吸与危重医学（PCCM ）咳喘药学服务项目——咳喘药学服务门诊（cough and wheezepharmaceuticalΔ 基金项目河南省医学科技攻关计划（联合共建）项目（No.LHGJ 20190271）＊第一作者主管药师，硕士。

我爱我院,我与医院共成长英语演讲稿

我爱我院,我与医院共成长英语演讲稿

我爱我院,我与医院共成长英语演讲稿Because of love, we are all here today, because of love, we are constantly changing, and change, always around.In November of 20XX, I came to our hospital for a job with a longing heart. Due to the early reasons, our hospital is small and crowded, and it is located at the X-shaped intersection of the national road, so traffic is a big pain for out-patient medical treatment. I still remember the scene when I first came to our hospital. At that time, the hospital was like a maze, and I always felt that every time I went there, I would circle back to the origin. But even small place can we serve patients with enthusiasm heart, at that time, I found that even so, our hospital is not a lack of patient, clinic examination of patients is still an endless stream, I think, is what reason, let us at a disadvantage conditions, have created such a medical phenomenon?After joining the company, I found that all the staff in the hospital are in an atmosphere full of "love", and even the superior leaders often communicate with their subordinates. Suchatmosphere and environment is a kind of harmony that cannot be seen in other work units. Less than a year after I was admitted to the hospital, I basically knew all my colleagues. At that time, I joked that every colleague was our dear, because this kind of life in a large group and a small environment made all my colleagues get closer and closer.Remember just admitted to hospital, we have not yet the use of electronic medical records, then we don't have a CT machine, under the care of the superior leadership and the institute of leadership, we continue to progress, constantly innovation, in order to help doctors and patients to create better working conditions and treatment environment, and under the supervision institute leader personally, hospital environment every year will have great changes, Not only the walls and signs of the hospital have become beautiful and warm, but also the support of the new electronic medical record system and the CT machine of the general hospital, not to mention the new instruments invested in the development of each department have made our hospital more beautiful, efficient and powerful.With all the care for our hospital in spring and autumn, with the continuous rise of new buildings, we are bound to move towards a new tomorrow. As a member of this collective, I would like to give more care to every colleague around me. Because there is love, I hope we can walk together with the growth of the hospital and move towards glory!。

对医务室工作建议的英语作文

对医务室工作建议的英语作文

对医务室工作建议的英语作文The development and construction of the infirmary is inseparable from the wisdom of the leading cadres and workers at all levels, especially from the consistent style of gathering the wisdom of the people and valuing the public opinion.Therefore, the good practice of the staff correctly reflecting their personal wishes and contributing their suggestions for the development of the infirmary has been continued, and has become a good tradition of the infirmary.To this end, according to the call of the infirmary, a little immature advice to the leadership.First, we should strengthen the ideological education of the medical staff, form a conscious maintenance of the honor of the infirmary, and cultivate the work style of consciously working hard for the infirmary conscientiously.Consciously complete work tasks with high quality and efficiency, carry forward the spirit of cooperation, and consciously do a good job in work cohesion.Second, we should form a mechanism to complete the system, ideological education and management guidance.To further clarify the functions, tasks and post responsibilities, we need to learn the post responsibility system generally, establish and improve the post responsibility system of scientific coordination and reasonable support of the management functions of the whole hospital, so that everyone is responsible and fulfill their responsibilities.Third, we should strengthen the professional learning of medical personnel and personnel in various management positions, and do a good job in education and training and guide their own learning in accordance with a scientific plan and a complete system.To often carry out the supervision and inspection, assessment and summary of the study situation, to promote the gradual formation of the learning atmosphere.Fourth, we should strengthen medical ethics to provide guarantee for the medical work of the infirmary.Strengthen ideological education and punishment, and put an end to accepting "red envelopes" and other behaviors that harm theinterests of patients.Receiving "red envelopes" increases the burden of the masses, opens the emotional distance with patients, damages the reputation of the infirmary, odes the nature of medical staff, and also lays hidden dangers for the development of the infirmary.Supervision and supervision, patient return visits and social evaluation should be carried out to plug loopholes and curb bad behavior.Recently, the party branch of the clinic received a letter signed "a worker of the hospital", to the clinic middle-level cadres to compete for the post work talked about some feelings, put forward a few suggestions.Because it is an anonymous letter, I cannot reply to me, so I reply through the infirmary website:First of all, the medical reform work itself needs the participation and supervision of the majority of cadres and workers. We are very grateful for the care and support for the reform of the personnel distribution system in the clinic and the overall development of the clinic.Second, the purpose of the reform is to abolish the lifelong system, through theimplementation of middle-level cadres competition for this form, make the incompetent on the mediocre, so that outstanding talents stand out, truly select a group of good quality, high level, strong ability of the management team.Third, the current problems existing in the middle-level cadres of the clinic analyzed in the letter of the worker are more objective, and some problems do exist in our individual middle-level cadres to different degrees With, although only an individual phenomenon, but affected the overall image of middle-level cadres.Fourth, the clinic will carefully study and timely adopt the rationalization suggestions for workers, try to plug the loopholes in the system, such as in the evaluation of middle cadres, fully listen to the advice of the front-line people; By introduce the competitive mechanism, implement the system of tenure of middle cadres, especially in the performance of morality, ability, ability, performance, and select the staff of middle cadres In the reform and development of the infirmary.The competition for middle-level cadres is an importantpart of the personnel distribution system reform of the clinic, and also an important task of the new medical reform.In the specific implementation process, the infirmary will strictly follow the procedures and standardize the operation to ensure that the expected goals and results are achieved.At the same time, I also hope that the majority of workers actively supervise and put forward valuable opinions, to benefit our continuous improvement, really the middle-level cadres to compete for the post work to do a good job.。