1,721,004 research outputs found
A Study on the Benefit of Implementing Clinical Information System for Intensive Care Unit in Hospital
No full text有鑑於目前全球人口老化的趨勢，對於醫療資源的需求以及如何有效運用日趨迫切，而在所有醫療資領域中，又以急重症單位所面臨之挑戰最為嚴峻。其中牽涉到醫療資源的不足、醫護素質的參差不齊、醫病關係的不對等以及醫療網絡的整合不完全等等，都使得急重症醫療領域面臨挑戰，亟需導入臨床資訊系統來加以改善目前醫療環境所面臨之問題。
本研究希望探討臨床資訊系統之內涵以及導入臨床資訊系統於加護病房所帶來之效益。利用波特價值鏈模型為架構，探討目前急診流程所面臨之挑戰，以及在系統導入後，可以因流程改善而帶來之效益加以分析，並以針對相關人員做專案訪談，提供護理人員、病人、醫師之專業意見回饋。以質化及量化之數據，證實在臨床資訊系統導入後，分別在人力資源效能、醫療品質，病人滿意度以及流程簡化四部分，都有得到實質的效益提升。
最後，在本研究後續討論中，我們希望不管是在持續追蹤系統導入對流程改善與組織效益的發展狀況，或是未來將資訊系統擴大運用至所有臨床單位，甚至是結合資訊與通訊科技，將醫療服務延伸至居家照護等願景，都能達到打造超越國界與時空之雲端醫療環境的終極目標。Due to global trend of aging population, the demand for medical resources and how to effectively use it is getting increasingly urgent. Among all health care fields, critical care and ICU are two units facing the greatest challenges, including insufficiency of healthcare resources, uneven healthcare quality, unequal relationships between physicians and patients, and incomplete integration of the healthcare network and so on,. It therefore becomes urgent to evaluate the costs and benefits of implementing a clinical information system to improve and solve the problems in the healthcare environment.
The purposes of this research are to discuss the concept and reality of a clinical information system and to analyze the benefits of implementing clinical information systems in ICU. Guided by Porter''s value chain model, this research is able to explore the current challenges in emergency procedures of ICU, and the differential benefits of ICU procedures after implementation. Moreover, for project-related members such as nurses, patients and physicians, their professional opinions and feedbacks are interviewed as well. Based on the qualitative and quantitative data, for parts respectively in the human resources efficiency, quality of healthcare, patient satisfaction, as well as procedure streamlined are found to be improved.
Future endeavor based on our initial findings can be made on examining the benefits of system implementation and the improvement of the organization, or expansion of the implementation of clinical information systems to other clinic units, even more applications of combination of informatics and telecommunication techniques in healthcare fields to extend the services to homecare, among others. We hope that an ultimate goal of being a cloud environment without boundary for healthcare can be realized soon.目錄
口試委員審定書 iii
誌謝 iv
中文摘要 v
英文摘要 vi
目錄 vii
圖目錄 ix
表目錄 xi
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究問題與目的 3
第三節 研究方法與流程 4
第四節 章節架構 7
第二章 文獻探討 9
第一節 波特價值鏈分析模型 9
第二節 資訊管理系統 13
第三節 醫療資訊管理系統 20
第四節 小結 20
第三章 醫療資訊系統產品與應用 22
第一節 醫療資訊系統產業 22
第二節 臨床資訊系統之範疇與趨勢 25
第三節 臨床資訊系統的應用 28
第四節 急重症臨床資訊系統產業 34
第五節 小結 42
第四章 急重症臨床資訊系統之效益分析 44
第一節 急重症臨床資訊系統之現況與問題分析 44
第二節 急重症臨床資訊系統之建構 49
第三節 實施之價值鏈與成效分析 57
第四節 小結 71
第五章 結論與建議 73
第一節 研究結論 73
第二節 後續發展與建議 75
參考文獻 .. 77
附錄 80
圖目錄
圖1-1全國急診病床數 2
圖1-2研究架構 5
圖1-3研究流程 7
圖2-1波特價值鏈分析模型 10
圖2-2產業價值鏈分析 13
圖2-3資訊管理系統的組成 15
圖2-4資訊系統的架構及功能 16
圖2-5資訊管理的活動層級與其主要工作內容 18
圖2-6企業資訊系統的發展 18
圖2-7資訊管理的實施變革模式 19
圖3-1醫學資訊學定義 23
圖3-2醫學資訊產業的發展沿革 24
圖3-3建構臨床的三個層次 29
圖3-4電子病例(EMR)系統為臨床資訊的核心 32
圖3-5急診流程 35
圖3-6數位健康應用技術發展歷程 39
圖3-7多生理參數即時同步收集系統功能架構 40
圖3-8遠距醫療諮詢系統的整體佈署圖 40
圖3-9 Philips e-ICU platform 42
圖4-1臨床單位床旁設備整合示意圖 46
圖4-2醫療資訊系統整合示意圖 50
圖4-3臨床資訊系統之建置 51
圖4-4臨床護理表單 53
圖4-5 Bundle綜合評分表單 54
圖4-6呼吸器(VAP)紀錄表單 55
圖4-7 ICU住院統計表單 55
圖4-8臨床決策支持表單(含建議事項) 56
圖4-9波特價值鏈模型探討醫療流程 58
圖4-10醫院急診流程&波特價值鏈基本活動比對 59
圖4-11 ICU VAP Bundle Compliance 64
圖4-12 UTI Bundle Data 66
圖4-13 Scoring Report 67
附圖1-1 Philips生理監視器演進歷程 81
附圖1-2 ICCA標準化15床配置圖 82
附圖1-3 ICCA Patient Administration 83
附圖1-4 Flowsheet 83
附圖1-5 Lab Overview 84
附圖1-6 Order Management 84
附圖1-7 Order Overview 85
附圖1-8 Worklist 85
附圖1-9 Infusion Management 86
附圖1-10 Event Documentation 87
附圖1-11 Printout 88
附圖1-12 Data filter 89
附圖1-13 Clinical Advisor 89
附圖1-14 Application Bundle 90
表目錄
表1-1 IT實施七個階段 6
表4-1呼吸器相關肺炎(VAP)照護不正確原因分析 61
表4-2 VAP bundle 稽核遵從率 62
表4-3加護病房VAP bundle 施行前、後各三年相關數據之統計資料 63
表4-4 ICCA系統功能成效分析 6
Corrosion Resistance of Epoxy Phosphate/Waterborne Epoxy Coatings on Steel
No full textThe preparation of an inhibitor used for waterborne epoxy coating and its corrosion resistance were investiga- ted in this research.Waterborne epoxy phosphate was synthesized by the reaction of bisphenol A epoxy resin and phosphoric acid and then neutralization using N,N -dimethyl ethanolamine.Three different coatings(E44,0.2% P-E44 and 0.5% P-E44)were obtained by adding epoxy phosphate into the two-component waterborne epoxy resin.The protective performance of epoxy phosphate/waterborne epoxy coatings based on Q235 steel immersed in 3.5% NaCl solution was investigated by polarization curves and electrochemical impedance spectroscopy(EIS).The results show that the corrosion current density of the 0.2% P-E44/Q235 carbon steel system (0.431muA/cm~2) is lower than that of the E44/Q235 carbon steel system (0.928 muA/cm~2)and 0.5% P-E44/Q235 carbon steel system (0.553 muA/cm~2) after 24 hours.During the immersion of 24 hours,the coating capacitances Q_c of the three coatings gradually increase,and the coating resistances R_c and charge transfer resistances R_(ct) gradually decrease.Epoxy phosphates can significantly improve the corrosion resistance of waterborne epoxy coatings on Q235 steel.The epoxy phosphate content of 0.2% achieves high corrosion protection performance
Water isolation and protective performance of waterborne graphene-doped epoxy coating
No full textA graphene-epoxy resin was prepared by physical blending home-made aqueous dispersion of graphene and two-component waterborne epoxy resin. The dispersed graphene in aqueous solution was analyzed by scanning electron microscopy. The water isolation and corrosion resistance of the waterborne epoxy coating doped with 0.5% graphene (0.5%G-E44) in simulated seawater were studied by polarization curve measurement, electrochemical impedance spectroscopy (EIS), and neutral salt spray (NSS) test, and compared with that of untreated E44 epoxy coating. The results indicated that graphene is dispersed well in the solution and presents good water-isolating performance, which is overlapped layer by layer in the waterborne epoxy resin, forming a dense physical isolation layer and thus slowing down the diffusion rate of water molecules in the coating. Fick diffusion coefficients of E44 and 0.5%G-E44 immersed in simulated seawater at early stage are 5.56 * 10~(-9) cm~2/s and 1.61 * 10~(-11) cm~2/s, respectively. The protection performance of waterborne epoxy coating is obviously improved by adding grapheme, as shown by the decreasing of self-corrosion current density and the increasing of coating resistance and charge transfer resistance. The coating features a level and smooth surface after 200 h NSS test without distinct corrosion
Corrosion Inhibition Performance of 2,3-dimercaptosuccinic Acid on Copper
No full textObjective 2,3-dimercaptosuccinic acid(DMSA) was synthesized with maleic acid as raw material, to study the corrosion inhibition performance of DMSA on copper in 0.5 mol/L NaOH solution. Methods DMSA was prepared by methods of addition, elimination, addition and hydrolysis with maleic acid as raw material, the structure of which was then characterized by Fourier infrared spectroscopy (IR) and mass spectrometry (MS). The corrosion rates of copper in 0.5 mol/L NaOH supplemented with different concentrations of DMSA were investigated by static weight loss tests, the corrosion inhibition performance was investigated by polarization curves and electrochemical impendence spectroscopy (EIS), respectively. Copper surface corrosion morphology was observed by scanning electronmicroscopy (SEM). Results IR and mass spectrometry jointly confirmed that the target product was DMSA. The corrosion rates of Cu in 0.5 mol/L NaOH were 7.60, 3.25, 2.13 mug/(cm~2·h) with supplementation of 0, 2.5, 5.0 g/L DMSA, respectively. When the DMSA concentration in NaOH solution was 5.0 g/L, the inhibition efficiency reached 94.92%. Conclusion DMSA could absorb on the copper surface, decrease water erosion and increase the corrosion product film resistance and the charge transfer resistance. DMSA was an anodic inhibitor
Corrosion Resistance of Galvalume Coated Steel in Qingdao Seawater
No full textThe corrosion resistance of Galvalume coated steel in Qingdao seawater was investigated by polarization curves and EIS methods. The morphology of corrosion products absorbed on the coating was analyzed by scanning electron microscopy (SEM), the effects of temperature and dissolved O_2 concentration on electrochemical corrosion behavior of Galvalume coated steel were studied in details. The results show that the protective corrosion product film absorbed on the coating is damaged and the anodic reaction is activated with the increase of temperature. The cathodic reaction is inhibited under low concentration of dissolved O_2 and the corrosion resistance of the galvalume coating is improved
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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