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Clinical Knowledge Management:Opportunities and Challenges
临床医学知识管理：时机和挑战

Rajeev K. Bali

Foreword
序
Preface
前言
Section I: Key Opportunities and Challenges in Clinical Knowledge Management
临床知识管理的关键时机和挑战
Chapter I
Issues in Clinical Knowledge Management: Revisiting Healthcare Management
临床知识管理的议题：重访医疗管理
Chapter II
It’s High Time for Application Frameworks for Healthcare
医疗应用框架的最佳时机
Chapter III
Management and Analysis of Time-Related Data in Internet-Based Healthcare Delivery
基于互联网的医疗递送下时间相关数据的管理和分析
Chapter IV
Interactive Information Retrieval as a Step Towards Effective Knowledge Management in Healthcare
互动信息恢复：朝向有效的

PNHP Mission Statement
使命

Physicians for a National Health Program (PNHP) believes that access to high-quality health care is a right of all people and should be provided equitably as a public service rather than bought and sold as a commodity.
PNHP相信，获得高品质的医疗是全民的权利，并且以公共服务方式提供比买卖日用品更能够体现公正。

The mission of PNHP is therefore to educate physicians, other health workers, and the general public on the need for a comprehensive, high-quality, publicly-funded health care program, equitably-accessible to all residents of the United States.
因此，PNHP的使命是教育医师、其他健康从业人员以及大众对一个全面广泛的、高品质的、公共基金的医疗保健计划的需要。这个计划公平惠及美国的每一个居民。

Equitable accessibility requires, in t

Risk Management Services   'A Benefit of Membership'
风险管理服务 （仅限会员服务）

The Cooperative of American Physicians, Inc. (CAP) Risk Management program provides a unique blend of services designed to help member physicians control the risks inherent in today's practice of medicine and, thus, mitigate potential claims. These services educate and support physician members in the following areas:
美国医师合作公司（CAP)风险管理项目提供独特的为会员医师设计的控制当今医疗执业固有风险也因此降低潜在诉讼的系列服务。这些服务为医师会员在下列领域里提供教育和支持：

Management of High-Risk Areas
高危领域的管理

These common activities are frequent elements of litigation:
这些常见活动是诉讼的频发因素：

Medical record documentation
病历记录

National Breast Cancer Awareness Month, 2007
2007年国家乳腺癌宣传月
A Proclamation by the President of the United States of America
美国总统公告

Breast cancer is the second leading cause of cancer-related deaths among American women. During National Breast Cancer Awareness Month, we renew our commitment to fighting this disease, raising awareness, and supporting those affected by breast cancer.
乳腺癌是美国妇女癌症相关死因中列于第二位。在国家乳腺癌宣传月期间，我们重申对抗击乳腺癌这种疾病、提高认知度以及支持那些受到乳腺癌侵袭人群的承诺。
Research has shown that several factors may increase the risk of developing breast cancer, including family history, age, genetics, and obesity. By making healthy lifestyle choices and exercising regularly, individuals can help reduce the risk of developing breast cancer. Mammograms, regular self-

Attitude Doesn't Affect Cancer Survival
态度不影响癌症生存率
Study Shows Positive Thinking by Patient Has No Impact on Surviving Cancer
研究显示患者的积极心态并不能影响癌症生存
By Salynn Boyles
WebMD Medical NewsReviewed by Louise Chang, MDOct. 22, 2007 -- Having a positive attitude may help cancer patients deal with their disease, but it doesn't directly affect survival, according to one of the largest and most rigorously designed investigations ever to examine the issue.
根据一项最大宗和最严格的调查方案设计得出的研究结论认为：积极心态可能有助于癌症患者面对他们的疾病，但并不直接影响生存率。

The study included more than 1,000 people treated for head and neck cancer; the emotional state of patients was found to have no influence on survival.
这项研究包括超过1000名头颈癌症患者，研究发现他们的情绪状态对生存率并无影响。

About PNHP

Physicians for a National Health Program is a single issue organization advocating a universal, comprehensive single-payer national health program. PNHP has more than 14,000 members and chapters across the United States.
国家健康计划医生联盟是一个单一议题的组织，它主张统一的全面覆盖的单一付费形式的国家健康计划。PNHP有超过14000成员和分会遍布美国。

Since 1987, we've advocated for reform in the U.S. health care system. A large part of our work involves educating health professionals about the benefits of a single-payer system--including fewer administrative costs and affording health insurance for the 46 million Americans who have none.
自1987年以来，PNHP倡导美国医疗体系改革。我们工作的大部分是就单一付费系统益处对健康从业人员的教育－－包括降低管理成本和为四千六百万没有保险的美国

AVERY COMAROW

U.S. News's Avery Comarow has been editor of the America''s Best Hospitals annual rankings since their debut in 1990. In his reporting on all aspects of clinical medicine from the latest cholesterol guidelines to robotic surgery, he has kept one question in the front of his mind: What does this mean to patients? That perspective uniquely qualifies him to observe and comment on the efforts by hospitals and other healthcare providers to improve care and patient safety.
美国新闻的Avery Comarow是全美最佳医院年度排行榜1990年开办以来的编辑。在他的报告中囊括临床医学的所有方面，从最新的胆固醇治疗指南到机器人手术等，他的思想始终将一个问题放在首位，那就是对于患者意味着什么？这样独特的观念使得他致力于对医院以及其它保健提供者改善照顾和患者安全的观察和评论。

Memo to Hospitals: Bad Care Will

Best Hospitals Survey /summary
最佳医院调查/概述

The main purpose of the 'America's Best Hospitals' survey has been to annually rank hospitals across the United States in several medical specialties. NORC has contributed to all aspects of the survey since 1991, including design of the instrument (questionnaire), sampling, data collection, data analysis and report writing. NORC has selected physician respondents from a stratified random sample of the American Medical Association's Physician Masterfile. Data has been collected by mailed self-administered questionnaires, supplemented in early years by telephone follow-up and, in recent years, by a web-based questionnaire. The sample size was 1,500 and 1,600 for 1991 and 1992 respectively, and approximately 2,500 since 1993. Response rate has traditionally been around 50%.

全美最佳医

Giving Bad News
告知坏消息

·Learning objectives
学习目标
·List the 6 steps in giving bad news
列举告知坏消息的六个步骤
·Adapt the bad news protocol to your work setting
调整工作中告知坏消息的方式
·Explain how the manner in which bad news is given can impact patient outcome and patient care
解释告知坏消息的方式对患者结果和照顾的影响
·Explain how culture impacts patient information needs and decision-making
解释患者信息需求和决策的文化影响
·Consider a case
讨论案例
24-year-old F; HIV+ for 3 years; current IVDU
24岁女性，HIV三年，静脉吸毒
Unstable living situation
Estranged from family
家庭疏远
On HAART, but questionable adherence
高效抗逆转录病毒治疗，但依从性可疑
Recent abnormal L