docs: salvage zh-CN health security skill translations

2026-05-19 23:33:07 +08:00 · 2026-05-11 15:02:07 -04:00
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+---
+name: healthcare-cdss-patterns
+description: 临床决策支持系统（CDSS）开发模式。药物相互作用检查、剂量验证、临床评分（NEWS2、qSOFA）、警报严重性分类以及集成到电子病历工作流程中。
+origin: Health1 Super Speciality Hospitals — contributed by Dr. Keyur Patel
+version: "1.0.0"
+---
+
+# 医疗CDSS开发模式
+
+构建可集成至EMR工作流的临床决策支持系统的模式。CDSS模块关乎患者安全——对假阴性零容忍。
+
+## 适用场景
+
+* 实现药物相互作用检查
+* 构建剂量验证引擎
+* 实现临床评分系统（NEWS2、qSOFA、APACHE、GCS）
+* 设计异常临床值警报系统
+* 构建带安全校验的用药医嘱录入
+* 结合临床上下文解读检验结果
+
+## 工作原理
+
+CDSS引擎是一个**无副作用的纯函数库**。输入临床数据，输出警报。这使得它完全可测试。
+
+三个核心模块：
+
+1. **`checkInteractions(newDrug, currentMeds, allergies)`** — 检查新药物与现有用药及已知过敏的冲突。返回按严重程度排序的`InteractionAlert[]`。使用`DrugInteractionPair`数据模型。
+2. **`validateDose(drug, dose, route, weight, age, renalFunction)`** — 根据体重、年龄和肾功能调整规则验证处方剂量。返回`DoseValidationResult`。
+3. **`calculateNEWS2(vitals)`** — 基于`NEWS2Input`计算国家早期预警评分2。返回包含总分、风险等级和升级指导的`NEWS2Result`。
+
+```
+EMR UI
+  ↓ (用户输入数据)
+CDSS 引擎（纯函数，无副作用）
+  ├── 药物相互作用检查器
+  ├── 剂量验证器
+  ├── 临床评分（NEWS2、qSOFA 等）
+  └── 警报分类器
+  ↓ (返回警报)
+EMR UI（内联显示警报，严重时阻止操作）
+```
+
+### 药物相互作用检查
+
+```typescript
+interface DrugInteractionPair {
+  drugA: string;           // generic name
+  drugB: string;           // generic name
+  severity: 'critical' | 'major' | 'minor';
+  mechanism: string;
+  clinicalEffect: string;
+  recommendation: string;
+}
+
+function checkInteractions(
+  newDrug: string,
+  currentMedications: string[],
+  allergyList: string[]
+): InteractionAlert[] {
+  if (!newDrug) return [];
+  const alerts: InteractionAlert[] = [];
+  for (const current of currentMedications) {
+    const interaction = findInteraction(newDrug, current);
+    if (interaction) {
+      alerts.push({ severity: interaction.severity, pair: [newDrug, current],
+        message: interaction.clinicalEffect, recommendation: interaction.recommendation });
+    }
+  }
+  for (const allergy of allergyList) {
+    if (isCrossReactive(newDrug, allergy)) {
+      alerts.push({ severity: 'critical', pair: [newDrug, allergy],
+        message: `Cross-reactivity with documented allergy: ${allergy}`,
+        recommendation: 'Do not prescribe without allergy consultation' });
+    }
+  }
+  return alerts.sort((a, b) => severityOrder(a.severity) - severityOrder(b.severity));
+}
+```
+
+相互作用对必须**双向**：若药物A与药物B相互作用，则药物B与药物A相互作用。
+
+### 剂量验证
+
+```typescript
+interface DoseValidationResult {
+  valid: boolean;
+  message: string;
+  suggestedRange: { min: number; max: number; unit: string } | null;
+  factors: string[];
+}
+
+function validateDose(
+  drug: string,
+  dose: number,
+  route: 'oral' | 'iv' | 'im' | 'sc' | 'topical',
+  patientWeight?: number,
+  patientAge?: number,
+  renalFunction?: number
+): DoseValidationResult {
+  const rules = getDoseRules(drug, route);
+  if (!rules) return { valid: true, message: 'No validation rules available', suggestedRange: null, factors: [] };
+  const factors: string[] = [];
+
+  // SAFETY: if rules require weight but weight missing, BLOCK (not pass)
+  if (rules.weightBased) {
+    if (!patientWeight || patientWeight <= 0) {
+      return { valid: false, message: `Weight required for ${drug} (mg/kg drug)`,
+        suggestedRange: null, factors: ['weight_missing'] };
+    }
+    factors.push('weight');
+    const maxDose = rules.maxPerKg * patientWeight;
+    if (dose > maxDose) {
+      return { valid: false, message: `Dose exceeds max for ${patientWeight}kg`,
+        suggestedRange: { min: rules.minPerKg * patientWeight, max: maxDose, unit: rules.unit }, factors };
+    }
+  }
+
+  // Age-based adjustment (when rules define age brackets and age is provided)
+  if (rules.ageAdjusted && patientAge !== undefined) {
+    factors.push('age');
+    const ageMax = rules.getAgeAdjustedMax(patientAge);
+    if (dose > ageMax) {
+      return { valid: false, message: `Exceeds age-adjusted max for ${patientAge}yr`,
+        suggestedRange: { min: rules.typicalMin, max: ageMax, unit: rules.unit }, factors };
+    }
+  }
+
+  // Renal adjustment (when rules define eGFR brackets and eGFR is provided)
+  if (rules.renalAdjusted && renalFunction !== undefined) {
+    factors.push('renal');
+    const renalMax = rules.getRenalAdjustedMax(renalFunction);
+    if (dose > renalMax) {
+      return { valid: false, message: `Exceeds renal-adjusted max for eGFR ${renalFunction}`,
+        suggestedRange: { min: rules.typicalMin, max: renalMax, unit: rules.unit }, factors };
+    }
+  }
+
+  // Absolute max
+  if (dose > rules.absoluteMax) {
+    return { valid: false, message: `Exceeds absolute max ${rules.absoluteMax}${rules.unit}`,
+      suggestedRange: { min: rules.typicalMin, max: rules.absoluteMax, unit: rules.unit },
+      factors: [...factors, 'absolute_max'] };
+  }
+  return { valid: true, message: 'Within range',
+    suggestedRange: { min: rules.typicalMin, max: rules.typicalMax, unit: rules.unit }, factors };
+}
+```
+
+### 临床评分：NEWS2
+
+```typescript
+interface NEWS2Input {
+  respiratoryRate: number; oxygenSaturation: number; supplementalOxygen: boolean;
+  temperature: number; systolicBP: number; heartRate: number;
+  consciousness: 'alert' | 'voice' | 'pain' | 'unresponsive';
+}
+interface NEWS2Result {
+  total: number;           // 0-20
+  risk: 'low' | 'low-medium' | 'medium' | 'high';
+  components: Record<string, number>;
+  escalation: string;
+}
+```
+
+评分表必须严格符合皇家内科医师学会规范。
+
+### 警报严重程度与UI行为
+
+| 严重程度 | UI行为 | 临床医生操作要求 |
+|----------|--------|------------------|
+| 危急 | 阻止操作。不可关闭的模态框。红色。 | 必须记录覆盖原因才能继续 |
+| 主要 | 行内警告横幅。橙色。 | 必须确认后才能继续 |
+| 次要 | 行内信息提示。黄色。 | 仅需知晓，无需操作 |
+
+危急警报**绝不能**自动关闭或实现为Toast通知。覆盖原因必须存储在审计追踪中。
+
+### 测试CDSS（对假阴性零容忍）
+
+```typescript
+describe('CDSS — Patient Safety', () => {
+  INTERACTION_PAIRS.forEach(({ drugA, drugB, severity }) => {
+    it(`detects ${drugA} + ${drugB} (${severity})`, () => {
+      const alerts = checkInteractions(drugA, [drugB], []);
+      expect(alerts.length).toBeGreaterThan(0);
+      expect(alerts[0].severity).toBe(severity);
+    });
+    it(`detects ${drugB} + ${drugA} (reverse)`, () => {
+      const alerts = checkInteractions(drugB, [drugA], []);
+      expect(alerts.length).toBeGreaterThan(0);
+    });
+  });
+  it('blocks mg/kg drug when weight is missing', () => {
+    const result = validateDose('gentamicin', 300, 'iv');
+    expect(result.valid).toBe(false);
+    expect(result.factors).toContain('weight_missing');
+  });
+  it('handles malformed drug data gracefully', () => {
+    expect(() => checkInteractions('', [], [])).not.toThrow();
+  });
+});
+```
+
+通过标准：100%。一次遗漏的相互作用即构成患者安全事件。
+
+### 反模式
+
+* 使CDSS检查变为可选或可跳过且无记录原因
+* 将相互作用检查实现为Toast通知
+* 使用`any`类型处理药物或临床数据
+* 硬编码相互作用对而非使用可维护的数据结构
+* 静默捕获CDSS引擎错误（必须大声暴露失败）
+* 在体重数据缺失时跳过基于体重的验证（必须阻止，而非通过）
+
+## 示例
+
+### 示例1：药物相互作用检查
+
+```typescript
+const alerts = checkInteractions('warfarin', ['aspirin', 'metformin'], ['penicillin']);
+// [{ severity: 'critical', pair: ['warfarin', 'aspirin'],
+//    message: 'Increased bleeding risk', recommendation: 'Avoid combination' }]
+```
+
+### 示例2：剂量验证
+
+```typescript
+const ok = validateDose('paracetamol', 1000, 'oral', 70, 45);
+// { valid: true, suggestedRange: { min: 500, max: 4000, unit: 'mg' } }
+
+const bad = validateDose('paracetamol', 5000, 'oral', 70, 45);
+// { valid: false, message: 'Exceeds absolute max 4000mg' }
+
+const noWeight = validateDose('gentamicin', 300, 'iv');
+// { valid: false, factors: ['weight_missing'] }
+```
+
+### 示例3：NEWS2评分
+
+```typescript
+const result = calculateNEWS2({
+  respiratoryRate: 24, oxygenSaturation: 93, supplementalOxygen: true,
+  temperature: 38.5, systolicBP: 100, heartRate: 110, consciousness: 'voice'
+});
+// { total: 13, risk: 'high', escalation: 'Urgent clinical review. Consider ICU.' }
+```