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鹰骐温
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2 Visual Evaluation Summary Sheet,,, VESS (visual evaluation summary sheet)., (Diagnosis S 16,,,,,,,, A4,. (Clinical treatment summary) 14,,,,,,,,, A4. Visual Evaluation Summary Sheet,, (Diagnosis Summary),,

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8 In order to construct a visual evaluation summary sheet (VESS), information required include written descriptive information concerning the present illness of the patient, pertinent laboratory data, also image studies which can be acquired by imaging with a digital camera, or through a PACS system, which is not universally available in most hospitals, pathology images can also be acquired through a digital camera attached to a microscope. Motion pictures in the MPG file format can be acquired through an image acqusition card converting analog signals obtained through a video tape recorder. Images acquired through PACS or a digital camera usually take up kilobyte of memory at an image resolution of 1 million pixels. Motion picture files in the MPG format take up a great deal of memory space, averaging 450MB per hour of recording. To process the acquired data, we need a computer with a central processing speed >500MHz, random access memory (RAM) >64MHz, a digital camera with image resolution >1,000,000 pixels, and relay lens to connect to a microscope. Image editing and optimization can be done through the software included with the digital camera, images are subsequently inserted into any word processing, presentation, or spreadsheet software to formulate a VESS. Motion picture files can be played using the windows media player.

9 After construction, the incomplete VESS can be stored and updated anytime when new information becomes available. The VESS constructed for each patient can take up anywhere from 1 megabyte to over 10 megabytes of memory, and should preferably be stored on a removable memory storage facility, which could be a read/writable CD-ROM, a magneto optical disk, or zip disk. Once information collection is complete, and patient follow-up adequate for analysis, the patient can receive a print out copy of the VESS or a CD. A printer capable of producing photographic images with a minimum 720dpi resolution should be used for VESS printout on photo quality inkjet paper for best results. Junior medical staff, or nursing staff would be the most appropriate personnel to construct a VESS, but non-medical personnel can be trained to do the task if the physician in charge pre-selects the information to be entered into the VESS. Skills required in constructing a VESS include computer processing ability, and the ability to manipulate a digital camera. Form and layout of the VESS can be tailored to suit the patient. This study includes two major sections, a surgical diagnosis summary was created for 17 colorectal cancer patients undergoing surgical resection, and includes their preoperative workup, documentation during operation, and also postoperative pathology and staging; a clinical trial treatment summary was constructed for a

10 group of 14 cancer patients undergoing chemotherapy in a clinical trial setting, it is a longitudinal study to evaluate endpoints of efficacy, toxicity, pharmacokintics and survival.

12 A total of 14 complete VESS were created for patients entered on the phase II and pharmacokinetic study of GL331 in refractory gastric cancer patients. VESS data collection started when the first patient was entered on protocol study on 1998/2/13, and the final information was completed on 2000/4/30, all patients were followed till demise, longitudinal data collection spanned 17 to 421 days, with a mean of 162days, median of 99days. Heading the VESS page is basic patient demographic data, with a short relevant history concerning the present illness and past history, study treatment and date of initiation and completion are also included, this is followed by a short summary of the study treatment, including drug dose intensity, response to therapy, and toxicity data incurred by the designated therapy. There were 3-13 images inserted per page, with a median of 7 images, the image files are in jpeg format, each about kb. These images include pathology study to confirm histological proof of disease, and associated special immunohistochemical stains to ascertain relevant tumor biology. Patients were evaluated after every course of treatment, and a text box containing relevant laboratory and response data has been inserted next to the relevant images. A pharmacokinetic graph and final text box was inserted at the end of the study with survival data. The completed VESS on the 14 patients take up 1-5MB of memory size, 14 VESS take up just under 30MB of memory, and all the information has been transferred onto a read/writable CD-ROM to be distributed to all personnel involved in the study.

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16 1. Sackett DL, Rosenberg WMC, Gray JAM, et al. Evidence based medicine: what it is and what it isn t: it s about integrating individual clinical expertise and the best external evidence. BMJ 312:71-72, Barnett GO, Winickoff R, Dorsey JL, et al. Quality assurance through automated monitoring and concurrent feedback using a computer based medical information system. Med Care 16:962-70, Hunt DL, Haynes RB, Hanna SE, et al. Effects of computer based clinical decision support systems on physician performance and patient outcomes. JAMA 280: , Hammond P, Harris AL, Das SK, et al. Safety and decision support in oncology. Meth Information Med 33:371-81, Sless D: What is information design? In: Penman R, Sless D, eds. Designing information for people. Sydney: Communications Research Press, 1-16, Wyatt JC, Wright P. Design should help use of patients data. Lancet 352: , Nygren E, Wyatt JC, Wright P. Helping clinicians to find data and

17 avoid delays. Lancet 352: , Weed LL. Medical records that guide and teach. N Engl J Med 278:593-99, , Fries JF. Alternatives in medical record formats. Med Care 12:871-81, Wright P. Research in brief: understanding tabular displays. Visible Language 7:351-59, Tufte ER. Visual explanations. Cheshire, CT: Graphics Press, Powsner SM, Tufte ER. Graphical summary of patient status. Lancet 344:386-89, Staggers N, Mills ME. Nurse-computer interaction: staff performance outcomes. Nursing Res 43:144-50, Wright P, Jansen C, Wyatt JC. How to limit clinical errors in interpretation of data. Lancet 1352: , Poulton EC. Letter differentiation and rate of comprehension in reading. J Appl Psychol 49:358-62, Maylor EA. Older peoples memory for the past and future. Psychologist 9:456-59, Bransford JD, Johnson MK. Contextual prerequisites for

18 understanding: some investigations of comprehension and recall. J Verbal Learning Verbal Behav 11:717-26, Powsner SM, Wyatt JC, Wright P. Opportunities for challenges of computerization. Lancet 352: , Wyatt JC. Clinical data systems, part 2: components and techniques. Lancet 344:609-14, Wyatt JC. Clinical data systems Part III: developing and evaluating clinical data systems. Lancet 344: , Sullivan F, Mitchell E. Has general practitioner computing made a difference to patient care? A systematic review of published reports. BMJ 311:848-52, Massaro TA. Introducing physician order entry at a major academic medical center: II, impact on organizational culture and behavior. Acad Med 68:20-25, 1993.

19 89shu20 1. Visual Evaluation Summary Sheet 2. VESS 3. a b c,

東莞工商總會劉百樂中學

東莞工商總會劉百樂中學 /2015/ 頁 (2015 年版 ) 目錄 : 中文 1 English Language 2-3 數學 4-5 通識教育 6 物理 7 化學 8 生物 9 組合科學 ( 化學 ) 10 組合科學 ( 生物 ) 11 企業會計及財務概論 12 中國歷史 13 歷史 14 地理 15 經濟 16 資訊及通訊科技 17 視覺