Perceptions of Home Dialysis Training and Experience Among US Nephrology Fellows

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Functional characterization of plantar pressure patterns in gait of typically developing children using dynamic pedobarography

BackgroundAbnormal foot posture is a common complaint presented in pediatric and pediatric orthopedic clinics. Functional, objective assessment of foot posture, with the potential for early identification of pathologic foot deformities, has, however, been lacking to date. While quantifying functional and regional impulses via dynamic pedobarography can improve the clinical assessment of children’s feet, normative values have not yet been reported or characterized.Research QuestionThe objectives of this study were to: (1) quantify and characterize the pattern and spectrum of foot impulses in walking-aged, typically developing children; and (2) compare these to impulses from non-disabled adults.MethodsFoot impulses of 102 participants (52 female) in five pre-determined age groups (2−3, 4–6, 7–10, 11−14, 15−17 years) were examined using dynamic pedobarography. Each pressure map (3 per foot per child) was divided according to anatomical foot regions: the hallux, heel, medial forefoot, lateral forefoot, lesser toes (D2 to D5), and midfoot. The impulse was calculated for each region and used to generate regional percent impulses and impulse ratios to assess anteroposterior and mediolateral balance within the foot.ResultsThe impulse through the midfoot was highest in the youngest age group, with a corresponding lower impulse through the medial forefoot. As age advanced, the midfoot impulse decreased (p = 0.001), and the forefoot balance shifted slightly more medially (%Medial Forefoot: p = 0.004; Medial-Lateral Forefoot Balance: p = 0.019). When compared to adults, there were no significant differences between 15−17 year old children and adults in any of the regional percent impulses and impulse ratios. This indicates that skeletal maturity of the foot by late adolescence results in functional characteristics seen in adults.SignificanceThe age-standardized norms of functional and regional impulse measures in children reported in this study can be used as a comparative benchmark in the clinical assessment of children presenting with various foot deformities.     

特殊疾病医疗保险对糖尿病患者治疗费用的影响及相关因素分析

目的比较重庆市已纳入慢病管理系统2型糖尿病患者中，有、无特殊疾病医疗保险（简称特病医保）者之间的治疗费用情况及可能影响申请该特病医保的因素。方法采用结构化问卷，调查患者的基本信息及与糖尿病有关的药房、门诊、住院治疗费用情况。使用SAS 9.1软件进行数据统计分析，计数资料分析采用 χ ²检验，有统计学差异的变量再纳入多因素逐步logistic回归模型。连续性变量用中位数（四分位数间距）[ M（ Q）]来表示，采用Wilcoxon秩和检验。 结果门诊组有特病医保的患者年人均总费用[2160（3081）元]较无特病医保的患者高[1000（2100）元， P < 0.01]，年次均自费比例（54.04%）低于无特病医保患者的自费比例（93.78%， P < 0.01）。就申请特病医保而言，中等收入水平（ OR=1.94）、高收入水平（ OR=2.11）、参加城镇职工医疗保险（ OR=4.19）、病程超过5年（ OR=2.04）都是其可能的影响因素，具有这些特征的患者相对更容易申请到特病医保。 结论为缓解2型糖尿病患者经济负担，政府应大力宣传特病医保的相关政策，鼓励患者主动了解，积极申报。同时，医保部门与医疗机构应加强监管，简化办理流程，建议增加特殊疾病定点零售药店的数量和覆盖面，提高特病医保利用的可及性。同时，应更加关注低收入人群和病程相对较短的患者，增强他们抵御疾病经济风险的能力，提高特病医保的利用及公平性。     

Clinical phenotyping in selected national networks: demonstrating the need for high-throughput,portable, and computational methods

ObjectiveThe combination of phenomic data from electronic health records (EHR) and clinical data repositories with dense biological data has enabled genomic and pharmacogenomic discovery, a first step toward precision medicine. Computational methods for the identification of clinical phenotypes from EHR data will advance our understanding of disease risk and drug response, and support the practice of precision medicine on a national scale.MethodsBased on our experience within three national research networks, we summarize the broad approaches to clinical phenotyping and highlight the important role of these networks in the progression of high-throughput phenotyping and precision medicine. We provide supporting literature in the form of a non-systematic review.ResultsThe practice of clinical phenotyping is evolving to meet the growing demand for scalable, portable, and data driven methods and tools. The resources required for traditional phenotyping algorithms from expert defined rules are significant. In contrast, machine learning approaches that rely on data patterns will require fewer clinical domain experts and resources.ConclusionsMachine learning approaches that generate phenotype definitions from patient features and clinical profiles will result in truly computational phenotypes, derived from data rather than experts. Research networks and phenotype developers should cooperate to develop methods, collaboration platforms, and data standards that will enable computational phenotyping and truly modernize biomedical research and precision medicine.     

产时电子胎心监护减速区面积在新生儿酸中毒预测中的价值

目的:探讨产时胎心监护减速区面积在新生儿酸中毒预测中的价值。方法:分析2011年2月至2013年10月在北京大学第三医院住院分娩足月单胎孕产妇204例的分娩前30分钟的胎心监护图形的减速区面积,根据p H7.20和(或)碱剩余-12.00 mmol/L分为酸中毒组(26例)和对照组(178例),探讨胎心监护图形的减速区面积与新生儿脐动脉血气的关系,并绘制受试者工作特性曲线(ROC曲线),计算曲线下面积(AUC),预测酸中毒的敏感性和特异性。结果:酸中毒组减速区面积(18.00 cm~2)明显大于对照组(10.50 cm~2),差异有统计学意义(P0.05)。分娩前30分钟图形的减速区面积的AUC为0.663(95%CI 0.541~0.785),预测酸中毒的敏感性为61.5%,特异性为72.5%。结论:产时胎心监护减速区面积对预测新生儿酸中毒有一定价值,特异性较高,而敏感性欠佳,建议结合更多图形指标解读图形对新生儿酸中毒的预测。     

医学物理界科研滞后原因探讨

研究目的在于推动医学物理界科研发展。通过对医学物理界历史和现实的科研状况回顾与分析，揭示影响医学物理界开展科研的主要原因：缺乏科研带头人的传帮带，缺乏科研设备，教师的科研要求太低动力不足，知识面太窄，没有明确的研究方向。强调指出科研能否开展起来，贡献大小关键在于主观能动性的发挥，在端正科研态度的基础上，应遵循“一综述、二对比、三确定”的三个步骤，认真选定有发展前景的研究方向，掌握研究该方向课题的相关理论和技能；最后部分阐明了选题常用的四种方法：（1）顺藤摸瓜找题，（2）到相关社会实践中找题，（3）阅读文献找题，（4）学术交流找题。     

A closer look at nursing documentation on paper forms: Preparation for computerizing a nursing documentation system

A small scale documentation analysis was conducted to explore the medical and surgical nursing content of the patient record at a large teaching hospital affiliated with Partners Healthcare System (PHS), in preparation for a computerized documentation system. Through this study, we identified a number of problems associated with the paper record that require resolution in the new computerized system, including elimination of documentation redundancy, areas where more structure is needed to properly capture data on nursing practice, and various design considerations to support a more complete and accurate documentation of nursing care.     

人工智能在病理学教学中的应用

病理学属于基础医学学科,它着重研究疾病的起因、形态结构改变以及由这些变化引起的机体功能改变,为临床诊断提供依据,是基础医学与临床医学之间的重要纽带和过渡,其教学质量对后续临床实践起到举足轻重的作用,病理学教学也从传统的教学模式发展出混合式教学、虚拟病理实验室、互联网+等多种教学模式。近年来随着人工智能在医疗医学行业的飞速发展,其技术已广泛应用到医疗领域的各个方面,培养适应智能化医疗时代的新型病理人才刻不容缓。文章研究从病理学科教学工作的特点和性质入手,结合我国病理学人工智能应用现状,分析了中国目前病理专业技能培养的现状,为人工智能在病理人才专业技能与素质培养的应用中提供启发。