American Society for Bone and Mineral Research

 【网址】 http://www.asbmr.org
【类型】 专业机构 

美国骨矿研究学会（American Society for Bone and Mineral Research，ASBMR）创建于1977年，是骨矿研究领域首个专、科学的医学学 会，旨在鼓励临床和科研学者参与到骨骼和矿物质代谢的研究中，促进骨矿研究的发展，加快将基础研究成果转化为临床实践应用。该学会成员包括基础研究学者、骨矿物质代谢及相关领域临床研究者，同时还包括医生和其他健康医疗从业人员。目前全球会员人数约4000 名，覆盖研究领域有生物力学、细胞生物学、分子生物学、口腔医学、发育生物学、内分泌学、流行病学、内科学、新陈代谢、分子遗传学 、肾脏学、妇产科学、骨科学、病理学、药理学、生理学、风湿病学以及其他基础或临床领域。
学会通过举办科学年会、创办杂志（Journal of Bone and Mineral Research）和原始读物、与政府机构和有关学会交流来鼓励并推动此领 域研究的不断扩大。
该学会主页提供了大量的信息资源，主要栏目如下：
（1）会议（Meetings）：主要包括年会和专题会议，以年会信息为主，提供已经举办过的年会报告下载、即将举行的以及将来举行的年会 信息等，具体信息包括大会注册、发言内容、专家介绍、各论坛时间安排等。
（2）出版物（Publications）：提供官方期刊和骨矿研究领域入门读物的相关介绍、编辑精选以及电子版链接，其中入门读物提供书籍每 章内容的幻灯片下载；另外该栏目下还有学会的电子新闻（eNews）专栏，主要为用户时时传达该领域内的重大事件、会议信息、会员福利 以及其他重要信息。“In The Field”子栏目还为用户提供本领域内发表的最新研究论文及相关链接。
（3）教育（Education）：包括骨骼基础课程、在线研讨会、网络广播、基本读物幻灯和教育资源5个子栏目，骨骼基础课程介绍骨的结构 、功能、生长、重塑、骨细胞等基础知识；在线研讨会提供每期会议的时间、频道和往期的内容；网络广播为用户提供往届年会和专题会议 的录像和幻灯下载，用户可在线观看会议的实况录像。
（4）基金资助（Grants）：提供该学会资助的基金项目的详细介绍，具体资助的国家，以及资助项目的相关网站链接。此外，网站的宣传中心提供了骨矿研究相关的最新消息、其他学会的网站链接和合作信息；同时职业规划中心还提供了工作岗位、职业规划 建议等大量的就业信息。     

American cancer society guidelines- are we truly improving all aspects of effectiveness?: American cancer society guidelines for screening and surveillance for early detection of colorectal polyps and cancer: Update 1997

This paper reports revised American Cancer Society guidelines for colorectal cancer screening and surveillance. Compared with the last revision in 1992, the current recommendations expand options for average risk screening to include colonoscopy and double contrast barium enema. The guideline introduces a concept called “total colon evaluation,” which appears to imply equivalency of colonoscopy and double contrast barium enema. Recommendations for high risk groups follow widely accepted protocols, but the postpolypectomy recommendations include unconventional features such as returning patients with a single, small tubular adenoma to general population screening after a negative follow-up colonoscopy.     

American Association for Respiratory Care

 【网址】 http://www.aarc.org 
【类型】 专业机构 
美国呼吸护理协会（American Association for Respiratory Care，AARC）创建于1947年，是一个国际领先的非营利性组织，会员逾52 000人，主要由呼吸治疗师和辅助内科医师的护理从业者组成。协会由美国胸腔学会（ATS）、美国胸科医师学会（ACCP）和美国麻醉医师学 会（ASA）资助。 
AARC主办两种期刊：Respiratory Care和AARC Times Magazine，前者主要发表原始研究论文和专题病例报告，如胸部X摄影术、肺功能检测 和血气分析；后者为新闻实事杂志。 
AARC每年举办国际呼吸年会，吸引世界各地6000多位呼吸治疗师和相关从业人员聚会研讨。AARC每年还举办其它学术会议、教学项目和专题讨论会。 
AARC网站上提供大量信息资源，主要栏目如下：
（1）社区交流（Community）：提供多种渠道的促进学会与会员、会员与会员之间交流的平台，如专业人员与社会交流网点AARConnect、 AARC电子邮件列表、微博等。
（2）资源（Resources）：提供相关新闻和杂志的文档、AARC基准系统（AARC Benchmarking System）、重要政府网站的链接、AARC资助项 目、临床实践指南、图片库、政府政策和声明等。AARC基准系统供各呼吸病诊疗单位在线报告和相互比较有关数据，以准确数据支持诊治决 策。
（3）职业（Career）：提供工作信息、求职建议、呼吸治疗师相关介绍以及呼吸护理领域研究者、治疗师、学生和内科医生的真实生活和 科研视频。
（4）教育（Education）：为专业人员和学生提供重要的教育资源链接，以及相关教育项目目前开展的状态，包括AARC继续教育课程、学术 会议等链接。网站还提供呼吸护理相关学会和政府机构、卫生保健相关学会、专业期刊等网络资源的链接。
（中国医科大学医学信息学系黄亚明潘现伟 整理）     

American College of Rheumatology

 【网址】 http://www.rheumatology.org 
【类型】 专业机构

美国风湿病学会（American College of Rheumatology，ACR）旨在利用教育、研究和实践支持项目为医生、健康专家和科学家们提供风湿 病学专业信息资源，最终实现推进风湿病学发展的目的。
 ACR通过举办风湿病学科学年会、专业会议和在线课程，为科研人员和临床医生提供继续深造的机会，每年秋季举办风湿病学领域最大规模 的科学年会，年会吸引成千上万名来自世界各地的风湿病学专家和关节炎健康专业人员参会。此外该学会举办的会议还有冬季的风湿病学专 题讨论会、春季的临床会议，以及其他专题会议等一系列以教育培训为目的的学术会议。
 ACR主办Arthritis and Rheumatism杂志，为风湿性疾病研究领域水平最高的学术期刊。风湿病健康专业协会（Association of Rheumatology Health Professionals，ARHP）作为ACR的一个子机构，主办Arthritis Care and Research，该机构是一个会员制协会，会 员包括风湿病学相关的专业医护人员，如高级护士、职业治疗师、理疗师等。
该学会主页提供了大量的信息资源，主要包括：
（1）实践管理（Practice Management）：包括临床实践管理、办公支持、实践管理快速链接等，其中以临床实践管理内容为主，信息主要 包括风湿病的临床支持信息，如参考书目、疾病分类和反应标准、患者健康状况评估、疾病活动度指数和损伤指数，实践指南等，同时还包 括风湿病专业人员实践标准、患者资源、质检及药品安全信息。
（2）出版物（Publications）：提供该学会主办的两种杂志的相关介绍、投稿指南、往期目录及网站链接；另外增加了学会的服务信息， 如药物安全性评价和最新消息、咨询热线；网站提供的会议资料和实践指南文件的下载只对其会员开放；值得一提的是该栏目中提供的风湿 病学图片库，收集了大量风湿病学相关图片，是风湿病学领域内容最全面的图片库，用户可以点击链接直接查看感兴趣的图片。
（3）教育和职业（Education &; Careers）：主要有年会和专业座谈会举办的时间、地点和主题等相关信息、课程大纲、上课时间及考试信 息等，除此之外，学会还提供了大量风湿病学相关资源和工具的链接，如图片库、医学知识自我评估模型、风湿病学编码手册等，方便用户 快速查阅所需内容；就业中心提供了工作岗位的信息介绍和应聘建议。
学会还为用户提供了大量风湿病学相关的法律知识、医改方案介绍、学会公开信等，设立了专门的立法行动中心，为用户提供全面的法律援 助；学会有自己的研究和教育基地，为临床医生、学生、健康专业人员、研究者和研究机构提供研究资金、培训和接受教育的机会。
（中国医科大学医学信息学系黄亚明潘现伟 整理）     

Are the American College of Cardiology/American Heart Association guidelines for exercise testing for suspected coronary artery disease correct?

BACKGROUND: Recently published American College of Cardiology (ACC)/American Heart Association (AHA) guidelines state that patients with suspected coronary disease and an intermediate pretest probability are appropriate candidates for exercise ECG, while those with low or high pretest probability are not. METHODS: From 5,103 consecutive patients with symptoms of suspected coronary disease, we evaluated 872 patients who underwent coronary angiography following exercise ECG. Differences in test performance were determined using receiver operating characteristic curve area analysis. A score using age, gender, symptoms, and risk factors was used to classify patients into low, intermediate, and high pretest probability groups. RESULTS: When patients with inadequate exercise tests were excluded, overall sensitivity and specificity were 70% and 66%, respectively. Only the intermediate pretest probability group demonstrated significant incremental value: pretest vs posttest intermediate, 70 +/- 3 vs 79 +/- 3 (p < 0.0001); low, 71 +/- 6 vs 76 +/- 7 (p = 0.39); and high, 69 +/- 8 vs 75 +/- 7 (p = 0.12). From the low- to the high-probability groups, there was a progressive increase in positive predictive value (21%, 62%, and 92%) and decrease in negative predictive value (94%, 72%, and 28%), respectively. The frequencies of abnormal exercise ECGs were lower in the unselected groups compared with the angiography groups (low, 13% vs 36%; intermediate, 22% vs 53%; high, 36% vs 63%). CONCLUSIONS: Based on the information added by exercise testing to clinical data, these results confirm the ACC/AHA guideline assignments for test selection. However, despite these guidelines, patients with a low pretest probability can be selected for exercise testing with the knowledge that a positive result is infrequent and a negative result carries a very high negative predictive value. Intermediate-probability patients on average carry a significant false-negative rate, suggesting that exercise ECG alone may not be a sufficient screening test in all intermediate-probability patients. Because of poor negative predictive value and a large percentage of negative tests, high-probability patients should undergo coronary angiography as the initial strategy, unless the goal of exercise testing is to assess prognosis.     

Comparison of the 1987 American College of Rheumatology and the 2010 American College of Rheumatology/European League against Rheumatism criteria for classification of rheumatoid arthritis in the Nurses’ Health Study cohorts

Performance of rheumatoid arthritis (RA) classification by the 2010 American College of Rheumatology (ACR)/European League against Rheumatism (EULAR) criteria, compared to the 1987 ACR criteria, has not been assessed in population-based cohorts in which disease identification is by mailed questionnaire. Women followed in the Nurses’ Health Study and Nurses’ Health Study II cohorts self-reported new doctor-diagnosed RA on biennial questionnaires. Two RA experts reviewed medical records of 128 new RA self-reports to obtain individual 1987 and 2010 criteria and arrived at a consensus opinion. We compared agreement in classification by the two criteria sets (kappa), and calculated sensitivity and specificity, with reviewers’ opinion as gold standard. Ninety-eight (77 %) participants were classified as RA by reviewers’ consensus opinion; 98 (77 %) fulfilled 1987 criteria, while 79 (63 %) fulfilled 2010 criteria. Seventy-two (56 %) were classified as RA by both sets, 21 (16 %) by neither, 26 (20 %) by only 1987 criteria, and 9 (7 %) by only 2010 criteria. Kappa for concordance was 0.36 (95 % CI 0.20–0.53). Compared to reviewer’s opinion, sensitivity and specificity were 0.93 and 0.77 for 1987 criteria, and 0.79 and 0.87 for 2010 criteria. Participants fulfilling 1987 criteria only were more likely to be seronegative. In these prospective population-based cohorts, significant discordance between 1987 ACR and 2010 ACR/EULAR criteria for classifying RA exists. Using the 2010 ACR/EULAR criteria alone had decreased sensitivity, and seronegative RA cases would be excluded in particular. Combined use of both will be necessary to maximize inclusion and allow sensitivity analyses.     

Appropriateness of indication and diagnostic yield of colonoscopy： First report based on the 2000 guidelines of the American Society for Gastrointestinal Endoscopy

AIM: To assess the appropriateness of referrals and to determine the diagnostic yield of colonoscopy according to the 2000 guidelines of the American Society for Gastrointestinal Endoscopy (ASGE). METHODS: A total of 736 consecutive patients (415 males, 321 females; mean age 43.6±16.6 years) undergoing colonoscopy during October 2001-March 2002 were prospectively enrolled in the study. The 2000 ASGE guidelines were used to assess the appropriateness of the indications for the procedure. Diagnostic yield was defined as the ratio between significant findings detected on colonoscopy and the total number of procedures performed for that indication. RESULTS: The large majority (64%) of patients had colonoscopy for an indication that was considered "generally indicated", it was "generally not indicated" for 20%, and it was "not listed" for 16% in the guidelines. The diagnostic yield of colonoscopy was highest for the "generally indicated" (38%) followed by "not listed" (13%) and "generally not indicated" (5%) categories. In the multivariable analysis, the diagnostic yield was independently associated with the appropriateness of indication that was "generally indicated" (odds ratio=12.3) and referrals by gastroenterologist (odds ratio =1.9). CONCLUSION: There is a high likelihood of inappropriate referrals for colonoscopy in an open-access endoscopy system. The diagnostic yield of the procedure is dependent on the appropriateness of indication and referring physician's specialty. Certain indications "not listed" in the guidelines have an intermediate diagnostic yield and further studies are required to evaluate whether they should be included in future revisions of the ASGE guidelines.     

Is the American Association for the Study of Liver Diseases recommendation for hepatocellular carcinoma screening a cul-de-sac?

The American Association for the Study of Liver Diseases just confirmed a grade Ⅰ recommendation for hepatocellular carcinoma (HCC) screening despite growing controversy. Why should HCC be an exception in the long list of other cancers where the feasibility and the efficacy of screening were investigated by randomized trials? Only 12.0% of United States patients are screened, a fact that precludes efficacy, and there are no relevant figures on the benefit-risk ratio. The ethics of belief is a treacherous reef. Screening is not just performing a test, but is a public health issue: a national program is needed to ensure minimal participation, quality controls and evaluation of the results to improve the process. There are also serious concerns regarding undisclosed potential conflicts of interest.     

The Psychosocial Functioning of HIV+ and HIV− African American Recent Mothers

African American HIV+ and HIV– recent mothers were compared on levels of psychosocial functioning. Participants included 82 HIV+ and 122 HIV– women. HIV risk behaviors, stressors, coping resources, close relationships, coping responses, and psychological distress were examined. There were fewer statistically significant differences than expected, indicating that psychosocial functioning was relatively well preserved for the HIV+ women. There were no statistically significant differences in social support, close relationships or psychological distress. Statistically significant differences indicated that HIV– women perceived greater control over present health and sexual behaviors than HIV+ women, although HIV+ women used more sexual protection than did the HIV– women. HIV+ women also used avoidant as well as support coping more than their HIV– counterparts. These differences were also apparent in a discriminant function analysis, implying that they are independent of each other. Implications of the findings for future efforts to address HIV/AIDS in this community are discussed.     

Guidelines for management of osteoarthritis published by the American College of Rheumatology and the European League Against Rheumatism: why are they so different?

Because of different methodology the ACR and EULAR guidelines differ significantly in their recommendations despite an identical evidence base. Guidelines that use a strictly evidence-based approach are less likely to incur bias than those that rely more on expert consensus. Although expert consensus is useful in areas in which there are little trial data, clear delineation should be made between evidence-based statements and expert opinion. Following the dissemination of guidelines for the management of OA, emphasis should now be placed on discussion and implementation of the recommendations and subsequent revision of guidelines as new evidence comes to light.     

Can we use a lower dose of liposomal amphotericin B for the treatment of mucosal American leishmaniasis?

Liposomal amphotericin B has been used as an alternative treatment of mucosal leishmaniasis, but the optimal dose is not established. We retrospectively reviewed the clinical outcome of eight patients with mucosal leishmaniasis treated with liposomal amphotericin B. The mean total dose was 35 mg/kg (range 24-50 mg/kg), which resulted in the healing of all the lesions in all patients and no recurrences were observed during the follow-up period (mean 25 months; range 7-40 months).