Analysis on the Current Situation,Influencing Factors and Strategies of Data Sharing in Cross-regional Specialty Medical Alliances / 医学信息学杂志

Purpose/Significance To clarify the construction mode and key factors of data sharing in Chinese medical alliances,and to provide references for promoting data sharing in medical alliances.Method/Process Taking children's medical alliance of Yangtze River Delta as an example,Delphi method and qualitative interview method are used to explore the key contents and effect evaluation of specialty alliance construction,and the key factors of specialty alliance data sharing are defined based on the technology-organization-environment framework;SWOT analysis model is used to propose development strategies.Result/Conclusion Member hospitals are less satisfied with the construction effect of information interconnection.Key factors for realizing data sharing in specialty alliances include:support from government administrative departments,uniform and systematic compatibility of information standards,information security emergency response,patient privacy protection and informed consent,willingness of department directors to share,and internal communi-cation and compensation mechanism of alliances.

Emotional and behavioral effects of after-school tutoring on school-age children in a district in Shanghai / 上海预防医学

ObjectiveTo explore the effects of after-school tutoring for school-age children on their emotions and behaviors， and to provide a basis for developing after-school tutoring and psychological support strategies for school-age children. MethodsFour elementary schools in a district of Shanghai were selected by simple random sampling method. Whole group sampling was conducted by class， and parents of students were surveyed by general questionnaire and the scale of strengths and difficulties. Information was collected on the basic conditions of children and families and the results were compared and analyzed. ResultsThis study showed that 88.26% of children attended extracurricular classes， of which 26.16% attended 3 or more classes， 42.5% attended cultural classes， 28.3% attended sports classes， and 59.8% attended art classes. Children who did not attend classes had higher pro-social scores. Children who attended reading class had lower scores for emotional problems that was a protective factor for emotional problems. Children who chose extracurricular programs in sports and reading also had lower overall scores for difficulties. Excessive use of electronic devices by school-age children on weekdays or weekends had a negative effect on emotional and conduct problem scores regardless of whether they chose extracurricular programs. It appeared that the choice of cultural programs， art programs and different levels of exercise intensity had no effect on children's emotions and behaviors. ConclusionFor children with low pro-social level， extracurricular classes should be carefully selected. For extracurricular classes， more reading and sports-related courses can be considered， which have positive effects on school-age children’s emotions and behaviors. Regardless of the choice of extracurricular classes， try to avoid excessive online classes.

Discussion on critical issues in the construction of management and supporting system of Investigator-Initiated Trials in pediatrics / 中华医学科研管理杂志

Objective:To explore the critical issues in the construction of management and supporting system of Investigator-Initiated trials (IIT) in pediatrics.Methods:Through summarizing related literature and considering the current status of pediatric clinical research, the critical issues in the construction of management and support system, for instance, the responsibility, training model, and performance evaluation in Europe and U. S. were evaluated, decision-making suggestions were put forward based on domestic pediatric IIT management system.Results:Besides IIT, clinical trials on children′s drugs are also supported by the pediatric clinical research management system in Europe and U. S.. The supporting service covers research consultation, ethical review, research design, trial implementation, patient education, risk control, and investigator training. The organizational structure and management system are relatively mature. Clinical trials are the majority of clinical research in children′s hospitals in China. Main issues identified in the construction of the management and supporting system include ethical review for pediatric clinical research, professional investigator training, multicenter cooperation scheme, performance assessment, and incentive strategies.Conclusions:Taking account into the current status of pediatric IIT in China, it is urgent to accelerate the training of pediatric investigators, set up standard IIT project management team, build the professional project management platform and Electronic Data Capture System, and promote the transformation of research outcomes. Finally, the whole process management of pediatric IIT will be developed to facilitate the development of pediatric medicine.

Technical Realization of Integrating Bone Age Artificial Intelligence Assessment System with Hospital RIS-PACS Network / 中国医疗器械杂志

OBJECTIVE@#To explore the integration method and technical realization of artificial intelligence bone age assessment system with the hospital RIS-PACS network and workflow.@*METHODS@#Two sets of artificial intelligence based on bone age assessment systems (CHBoneAI 1.0/2.0) were developed. The intelligent system was further integrated with RIS-PACS based on the http protocol in Python flask web framework.@*RESULTS@#The two sets of systems were successfully integrated into the local network and RIS-PACS in hospital. The deployment has been smoothly running for nearly 3 years. Within the current network setting, it takes less than 3 s to complete bone age assessment for a single patient.@*CONCLUSIONS@#The artificial intelligence based bone age assessment system has been deployed in clinical RIS-PACS platform and the "running in parallel", which is marking a success of Stage-I and paving the way to Stage-II where the intelligent systems can evolve to become more powerful in particular of the system self-evolution and the "running alternatively".

Investigation on the situation and patients′ demand of medical information privacy protection / 中华医院管理杂志

Objective To learn the situation of medical information privacy protection of a hospital and patient′s privacy demand for different medical information .Methods A 300-questionnaire survey was conducted at a tertiary hospital in Shanghai in April 2017 .The data were subject to descriptive analysis .Results The patients were generally satisfied with the hospital′s medical information privacy protection ,as 71％ of them (213/300)were satisfied ,and 13％ (39/300)of them experienced privacy exposure.Patients were most concerned with medical information from which others could identify them .Conclusions The State should promulgate rules and regulations for the protection of medical information privacy as soon as possible ;information technology need to be adopted to encrypt identifiable information ;a system of norms that can be followed need to be developed for the use of medical information ;hospitals should build a patient′s privacy protection system to comprehensively protect the privacy of patients .

Status analysis and practical experiments of regional medical big data sharing and open access / 中华医院管理杂志

Following an overview of the present big medical data sharing abroad, the paper identified the problems of the regional health information platform in data sharing and utilization as follows. Namely, poor data integration, low data availability, poor data security and privacy, unclear data sharing model, and poor data management accountability. On such basis, the authors made thoughtful studies in data quality management, information security and privacy protection and data sharing model. These efforts provide useful references for big health data integration sharing and open access.

Analysis of influence factors on anemia in preterm infants / 临床儿科杂志

Objective To study the influencing factors on anemia in preterm infants at the corrected age of 6-month-old based on gestational age (GA),birth weight (BW) and feeding pattems.Method Preterm infants with GA＜37 weeks (n=124)were followed up to 6 months of corrected age (CA) between June 2014 and November 2015.The incidence of anemia in preterm infants among different groups according to GA,BW and feeding pattem was statistically analyzed.Results Preterm infants included are of 70 males and 54 females.Median age of GA was 33.7 weeks with an average BW of 1910g.The incidences of anemia was 30.6％ (95％ CI:23％,38％) in preterm infants at 6 months of CA,66％ in breast-fed preterm infants.which is significantly higher than 19％ in those receiving mixed feeding and 13％ in those receiving formula feeding (P=0.000).No significant differences in anemia incidence were found among preterm infants of different GA and BW.Conclusions Anemia incidence in 6-month-old preterm infants is associated with feeding pattern,which conferrs greatest risk.It is necessary to undergo further analysis and treatments for preterm infants with anemia.

Design of Huge Data Repository Platform Based on Children Infectious Diseases / 中国医疗器械杂志

Taking children respiratory infectious diseases as the research object, CDSS transform from isolated clinical data to an integration Model. With integrating pharmacy and laboratory knowledge, the system establishes children typical characterization data of common infectious diseases and medical efficacy data repository to providing treatment recommendations for doctor. Based on the clinical characteristics of children infectious diseases, this paper proposes knowledge inference engine and an information integration model. decision-making inference engine, medical information integration model.

Progress and proposal of reforming medical insurance payment system at public hospitals in China / 中华医院管理杂志

This article elaborated the connotation of public hospital medical insurance payment system and the importance of reform,summarizing and analyzing the practical exploration of promoting medical insurance payment system reform in the localities.Then it moved on to introduce new progress of medical insurance payment system reform abroad and the emerging mode of medical insurance payment, such as pay for performance,payment by results,and bundled payment.In the end,the authors put forward policy suggestions to improve medical insurance payment system at public hospitals in China, namely to build a modern healthcare payment system in line with the needs of medical service system.Such a system should be guided by comprehensive performance,restrained by cost budgeting, based on a diversified payment mode,and supported by information technology.In addition,it should have scientific payment standard and modern governance mechanism,and keep interactive development with commercial health insurance.

Development and application of information sharing platform of municipal public hospitals / 中华医院管理杂志

This paper introduced the design ideas and general information of Shanghai in building theHospital-Link Project.Thanks to innovative information technology and service model,it achieved real-time connectivity and clinical information sharing between the 38 municipal hospitals,which enables the general reform of such hospitals citywide.

Practice of SHDC in strengthening disciplines development of public hospitals / 中华医院管理杂志

By means of joint research of new advanced technology project,joint development and application of appropriate health technology project,comprehensive prevention and control of chronic diseases between municipal hospitals and community clinics project and research supporting platform project,Shanghai Hospital Development Center has effectively improved the clinical science and technology innovation capability, promoted the development of medical disciplines and talents and improved the discipline influence of such hospitals.

Early intervention programs in improving development outcome of premature infants / 国际儿科学杂志

Preterm birth is the main factor affecting the lives and quality of life for premature infants,which is also the main cause for a large economic burden on family,society and medical system.It has been confirmed that the bad neurodevelopment outcome can be effectively prevented by early intervention programs,which are including therapeutic developmental interventions targeting the infants,as well as psychosocial support and education for parents.This review summarizes early intervention programs for improving developmenr outcome in recent years.

Evaluation of probiotics effectiveness in hospitalized pneumonia children by elec-tronic medical records / 药学实践杂志

Objective To describe the profile of probiotics utilization in hospitalized pneumonia children and evaluate the ef -fectiveness of probiotics in the treatment of pneumonia in hospitalized children combined with antibiotics. Methods Descriptive data a-nalysis was obtained from the medical records in one children′s hospital in one year period. The clinical data including patient charac-teristics, drug prescribed time, drug use duration, and length of stay was reviewed. Ridit analysis was used to compare the data. Re-sults Data of 2 974 children hospitalized for pneumonia was accessed. Antibiotics were prescribed to 99.1 % ( n=2 948) of pa-tients, probiotics were prescribed to 42.1%(n=1 252) of patients, and both antibiotics and probiotics were prescribed to 41.9%(n=1 246 ). The median of the time to start administration of probiotics was the second day of hospitalization and the mode was the first day of hospitalization. For those patients who were prescribed antibiotics combined with probiotics, the median of the duration of ad-ministration of antibiotics before accepting probiotics was 3 days and the mode was 1 day.After administrating probiotics, the median of the duration of accepting of antibiotics was 5 days, the mode was 4 days, and the median and the mode of the duration of administration of probiotics were 4 days.21%(n=626) of all hospitalized patients were administrated anti-diarrheals.The most common age group of them were neonates and infants (82.3%, n=515).The patients with anti-diarrheal who was administrated antibiotics with or with-out probiotics were 585(47.0%), 34(2.0%), respectively (P<0.05).The median of duration of anti-diarrheals in those adminis-trated antibiotics with probiotics was 4 days, the mode was 3 days and the interquartile range was 2-6 days.For those administrated an-tibiotics without probiotics, the median of duration of anti-diarrheals was 3 days, the mode was 1 day and the interquartile range was 1-6 days (P>0.05).The median of the length of stay in those administrated antibiotics with probiotics was 7 days, the mode was 6 days and the interquartile range was 6-9 days.For those administrated antibiotics without probiotics, the median and the mode of the length of stay were 7 days and the interquartile range was 6-9 days(P>0.05).Conclusion The time of starting to administrate probiotics was mainly within 2 days combined with antibiotics. The aim of prescribed probiotics was prevention of antibiotic-associated diarrhea. There was no significant difference in the duration of the following antibiotic therapy, the duration of anti-diarrhea therapy, the length of stay between those administrated antibiotics combination with or without probiotics.

A new model for diabetes care based on GPs-specialists cooperation through internet in community: Shanghai Wuliqiao study / 中华内分泌代谢杂志

ObjectiveTo assess the effectiveness of tele-medicine and self-management goal(SMG) setting technique used in the diabetes management in the community setting.Methods It is a control-group study.415 type 2 diabetic residents were recruited from the Shanghai Wuliqiao community based on existing medical records.The subjects were divided into two groups,the study group was cared by general practitioners (GPs) specialists cooperation through the tele-medicine mechanism,the other was a control group.For the study group,a cooperation pathway between community health care centers and general hospitals were established.Standardized training and guidelines were provided to community health workers,regarding the setting of management goals of blood glucose and blood pressure,treatment plan,patient education,and SMG techniques.Fasting blood glucose ( FBG ) and 2 h postprandial blood glucose (2hBG) in the study group were monitored,followed by community health workers visiting monthly with seminars for diabetes education.At the baseline and the 12tb month,FBG,2hBG,HbA1C,blood pressure,triglyceride,total cholesterol,body mass index,waist-hip ratio were determined in each group.A survey was conducted to evaluate the costs of diabetes treatments,the knowledge base related to their disease,lifestyle,and the awareness of the new care model.The rates of achieving the goal of blood glucose,blood pressure,and HbA1Ccontrol were calculated.Internet case discussion between GPs-Specialists and referral to certain specialists were implemented when some patients did not reach the control goal.ResultsBy the 12 month follow up,FBG,2hBG,HbAIc,blood pressure of the study group were lower than the baseline,and as well as the control group with statical significance (P＜0.05).There are other improvcments:diabetes knowledge (29.1％ vs 5.5％ ),healthy diet (9.6％ vs -10.4％ ),blood glucose monitoring (30.3％ vs 10.8％ ),support for diabetes care in community (35.7％ vs 9.4％ ),and the preference of the new model (63.8％ vs 17.9％ ) with statistical significauce (P＜0.01 ).As for the medical costs,the study group's monthly costs were consistently lower than the control's.( -3.39Yuan vs 32.26 Yuan,P＜0.05).ConclusionsThe new diabetes care model based on GPs-Specialists tele-medicine and SMG in community opens the door to the community based care model formulation in regard to the health quality and costs control.The deployment of more technologies and management techniques could be explored further to improve the outcomes of community based chronic disease care model.

System architecture of the clinical information-sharing project for Shanghai's municipal-level hospitals / 中华医院管理杂志

The article analyzed the system architecture design of the Shanghai municipal hospital clinical information sharing project, aiming to provide reference for system design of a regional medical information sharing system. This project is composed of the following: A universal medical card,hospital's internal information system, an inter-hospital network, a clinical information exchange and sharing platform, a data center, a decision support system and a public service portal. Key issues involved in the system design include the personal identity, the establishment of standards and specifications, the information sharing model, the information storage model, systems related to hospitals and personal privacy protection.

A randomized control trial on interruption of HBV transmission in uterus / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To study the interruptive effect of hepatitis B virus (HBV) specific immunolobulin (HBIG) before delivery in attempt to prevent intrauterine transmission of HBV.</p><p><b>METHODS</b>Nine hundred and eighty HBsAg carrier pregnant women were randomly divided into HBIG group and control group. Each subject in the HBIG group received 200 IU or 400 IU of HBIG intramuscularly at 3, 2 and 1 month before delivery. The subjects in the control group did not receive any specific treatment. All newborn infants received 100 IU of HBIG intramascularly after venous blood samples were taken at birth and 2 weeks after birth, followed by 30 micro g plasma-derived HB vaccine or 5 micro g recombinant yeast-derived hepatitis B vaccine at 1, 2 and 7 months of age. Blood tests were performed for all the lying-in women and their neonates. Blood specimens were tested for HBsAg and HBeAg by enzyme immunoassay. All infants were followed up for 1 year.</p><p><b>RESULTS</b>In the HBIG group, 491 neonates were born to 487 HBV carrier mothers; and in the control group, 496 neonates were born to 493 HBV carrier mothers. The rates of intrauterine transmission in the two groups were 14.3% and 5.7% respectively (chi(2) = 20.280, P < 0.001), and the rates of chronic hepatitis B in the two groups were 2.2% and 7.3% respectively (chi(2) = 13.696, P < 0.001). The high risk factors of intrauterine HBV infection included HBsAg HBeAg double positive and HBV DNA positive in the peripheral blood of pregnant women.</p><p><b>CONCLUSION</b>HBV infection in the uterus may be interrupted by injecting multiple intramuscular HBIG injections before delivery without causing any side-effects.</p>