目的:基于真实世界研究,提取医院信息管理系统(Hospital Information System,HIS)医疗电子病历,按照脑梗死临床路径探索神经内科医师药物开嘱习惯和模式,按照疾病诊断相关分组DRGs付费要求,优化子群网络中的药物经济性、用药合理性,为...目的:基于真实世界研究,提取医院信息管理系统(Hospital Information System,HIS)医疗电子病历,按照脑梗死临床路径探索神经内科医师药物开嘱习惯和模式,按照疾病诊断相关分组DRGs付费要求,优化子群网络中的药物经济性、用药合理性,为脑梗死疾病在DRGs付费下的合理用药提供依据。方法:从南昌大学第一附属医院2017年1月至2021年4月HIS医疗电子病历数据中,提取脑梗死患者医疗电子病历13588例,其中入组了脑梗死临床路径的为12501例,对脑梗死患者的合并用药进行复杂网络分析,并根据树形图提取子群网络进行用药优化分析。结果:复杂网络分析共纳入100种入组临床路径后常用药物,对药物复杂关系网络进行划分,得到3个主要的用药子群。对其中药物连接度占比较高的子群2进行优化分析,其中包括阿司匹林肠溶片、氢氯吡格雷片、阿托伐他汀钙片、瑞舒伐他汀钙片、依达拉奉注射液、单唾液酸四己糖神经节苷脂等16种药物,初始用药费用为8846元。从医保和药物经济学角度考虑将盐酸罂粟碱氯化钠注射液替换为盐酸罂粟碱注射液,并同种适应证的药物选择一种,天麻素注射液需要有头晕的诊断才可以使用。经过与医师沟通,预计子群2中的16种药物可组成多个治疗方案,其中最优化的用药方案10日费用约为1642元,达到用药优化目的,且用药合理性提高。结论:用药子群是代表医师的用药习惯,通过用药合理性、药物经济性评价、医保支付角度,优化脑梗临床路径的经济方案,降低路径治疗费用并提高合理性。继续对其他子群的优化,可以降低脑梗死临床路径费用,使得医疗机构和医师可以享受到药师参与的临床路径下DRGs付费的改革成果。展开更多
The coverability of Wireless Sensor Networks （WSNs） is essentially a Quality of Service （QoS） problem that measures how well the monitored area is covered by one or more sensor nodes. The coverability of WSNs was ...The coverability of Wireless Sensor Networks （WSNs） is essentially a Quality of Service （QoS） problem that measures how well the monitored area is covered by one or more sensor nodes. The coverability of WSNs was examined by combining existing computational geometry techniques such as the Voronoi diagram and Delaunay triangulation with graph theoretical algorithmic techniques. Three new evaluation algorithms, known as CRM （Comprehensive Risk Minimization）, TWS （Threshold Weight Shortest path） and CSM （Comprehensive Support Maximization）, were introduced to better measure the coverability. The experimental results show that the CRM and CSM algorithms perform better than the MAM （MAximize Minimum weight） and MIM （Minimize Maximum weight） algorithms, respectively. In addition, the TWS algorithm can provide a lower bound detection possibility that accurately reflects the coverability of the wireless sensor nodes. Both theoretical and experimental analyses show that the proposed CRM, TWS, and CSM algorithms have O（n2） complexity.展开更多
文摘目的:基于真实世界研究,提取医院信息管理系统(Hospital Information System,HIS)医疗电子病历,按照脑梗死临床路径探索神经内科医师药物开嘱习惯和模式,按照疾病诊断相关分组DRGs付费要求,优化子群网络中的药物经济性、用药合理性,为脑梗死疾病在DRGs付费下的合理用药提供依据。方法:从南昌大学第一附属医院2017年1月至2021年4月HIS医疗电子病历数据中,提取脑梗死患者医疗电子病历13588例,其中入组了脑梗死临床路径的为12501例,对脑梗死患者的合并用药进行复杂网络分析,并根据树形图提取子群网络进行用药优化分析。结果:复杂网络分析共纳入100种入组临床路径后常用药物,对药物复杂关系网络进行划分,得到3个主要的用药子群。对其中药物连接度占比较高的子群2进行优化分析,其中包括阿司匹林肠溶片、氢氯吡格雷片、阿托伐他汀钙片、瑞舒伐他汀钙片、依达拉奉注射液、单唾液酸四己糖神经节苷脂等16种药物,初始用药费用为8846元。从医保和药物经济学角度考虑将盐酸罂粟碱氯化钠注射液替换为盐酸罂粟碱注射液,并同种适应证的药物选择一种,天麻素注射液需要有头晕的诊断才可以使用。经过与医师沟通,预计子群2中的16种药物可组成多个治疗方案,其中最优化的用药方案10日费用约为1642元,达到用药优化目的,且用药合理性提高。结论:用药子群是代表医师的用药习惯,通过用药合理性、药物经济性评价、医保支付角度,优化脑梗临床路径的经济方案,降低路径治疗费用并提高合理性。继续对其他子群的优化,可以降低脑梗死临床路径费用,使得医疗机构和医师可以享受到药师参与的临床路径下DRGs付费的改革成果。
文摘The coverability of Wireless Sensor Networks （WSNs） is essentially a Quality of Service （QoS） problem that measures how well the monitored area is covered by one or more sensor nodes. The coverability of WSNs was examined by combining existing computational geometry techniques such as the Voronoi diagram and Delaunay triangulation with graph theoretical algorithmic techniques. Three new evaluation algorithms, known as CRM （Comprehensive Risk Minimization）, TWS （Threshold Weight Shortest path） and CSM （Comprehensive Support Maximization）, were introduced to better measure the coverability. The experimental results show that the CRM and CSM algorithms perform better than the MAM （MAximize Minimum weight） and MIM （Minimize Maximum weight） algorithms, respectively. In addition, the TWS algorithm can provide a lower bound detection possibility that accurately reflects the coverability of the wireless sensor nodes. Both theoretical and experimental analyses show that the proposed CRM, TWS, and CSM algorithms have O（n2） complexity.
