使用观察性数据评估治疗效果

随机临床试验（randomized clinical trial，RCT）是评估治疗效果的理想方法。临床试验的参试者被随机分配至治疗组或对照组。随机化可使治疗组与对照组除治疗方法以外的“所有特征都相同”，由此减少了偏倚。在正确随机化后，统计学比较发现的治疗结果问的差异便可以反映治疗组与对照组的区别。     

Using an Alternative Method to Estimate the Status of Iodine Nutrition in Pregnant Women

正Iodine is an element that is essential for the synthesis of thyroid hormones.Adequate intake of dietary iodine has been recognized as a critical factor for maintaining health[1].It is a well-known fact that iodine deficiency can impede the production of thyroid hormones in both the mother and fetus,which increases the risk of brain damage in the fetal stage.Excess iodine can also result in a series of thyroid dysfunction symptoms such as goiter and     

Using Citation Data to Improve Retrieval from MEDLINE

ObjectiveTo determine whether algorithms developed for the World Wide Web can be applied to the biomedical literature in order to identify articles that are important as well as relevant.Design and MeasurementsA direct comparison of eight algorithms: simple PubMed queries, clinical queries (sensitive and specific versions), vector cosine comparison, citation count, journal impact factor, PageRank, and machine learning based on polynomial support vector machines. The objective was to prioritize important articles, defined as being included in a pre-existing bibliography of important literature in surgical oncology.ResultsCitation-based algorithms were more effective than noncitation-based algorithms at identifying important articles. The most effective strategies were simple citation count and PageRank, which on average identified over six important articles in the first 100 results compared to 0.85 for the best noncitation-based algorithm (p < 0.001). The authors saw similar differences between citation-based and noncitation-based algorithms at 10, 20, 50, 200, 500, and 1,000 results (p < 0.001). Citation lag affects performance of PageRank more than simple citation count. However, in spite of citation lag, citation-based algorithms remain more effective than noncitation-based algorithms.ConclusionAlgorithms that have proved successful on the World Wide Web can be applied to biomedical information retrieval. Citation-based algorithms can help identify important articles within large sets of relevant results. Further studies are needed to determine whether citation-based algorithms can effectively meet actual user information needs.     

利用数据挖掘技术实现LIS数据共享的设计实践

介绍了如何利用数据挖掘技术对现有医院实验室信息管理系统（LIS）进行大数据分析,并利用Web或手机APP的方式呈现给客户诊断结果,为患者建立一个关于身体指标的数字账户,构建了一个以“智慧医疗”为理念的数据共享平台。经过半年的调试运行,大大缩减了病人的排队等待和就诊时间,减轻了医生的门诊工作压力,为医学专家提供了检验数据的查询分析工具。     

福辛普利治疗原发性高血压46例临床疗效观察

目的:观察福辛普利治疗原发性高血压临床疗效。方法:原发性高血压(轻、中度)46例服用福辛普利10mg/天,观察4周。服药2周降压不明显者,加服吲哒帕胺2.5mg/天。同期选择原发性高血压患者24例服用苯那普利10mg/天,作为对照组。结果:福辛普利组在治疗前、治疗第2周后、治疗第4周后的收缩压分别是(187±16)mmHg、(171±14)mmHg和(159±13)mmHg,舒张压分别是(95.2±5.1)mmHg、(90.6±4.9)mmHg和(84.3±6.3)mmHg;苯那普利组在治疗前、治疗第2周后、治疗第4周后的收缩压分别是(184±20)mmHg、(170±16)mmHg和(159±14)mmHg,舒张压分别是(93.9±7.2)mmHg、(89.2±5.9)mmHg和(83.4±4.8)mmHg,两组的收缩压和舒张压在治疗前后无统计学差异(P<0.05)。结论:轻、中度高血压患者,福辛普利是一安全的降压药物,与其他ACEI类制剂比较,可减少咳嗽的发生。     

A Software Tool for Determination of Breast Cancer Treatment Methods Using Data Mining Approach

In this work, breast cancer treatment methods are determined using data mining. For this purpose, software is developed to help to oncology doctor for the suggestion of application of the treatment methods about breast cancer patients. 462 breast cancer patient data, obtained from Ankara Oncology Hospital, are used to determine treatment methods for new patients. This dataset is processed with Weka data mining tool. Classification algorithms are applied one by one for this dataset and results are compared to find proper treatment method. Developed software program called as “Treatment Assistant” uses different algorithms (IB1, Multilayer Perception and Decision Table) to find out which one is giving better result for each attribute to predict and by using Java Net beans interface. Treatment methods are determined for the post surgical operation of breast cancer patients using this developed software tool. At modeling step of data mining process, different Weka algorithms are used for output attributes. For hormonotherapy output IB1, for tamoxifen and radiotherapy outputs Multilayer Perceptron and for the chemotherapy output decision table algorithm shows best accuracy performance compare to each other. In conclusion, this work shows that data mining approach can be a useful tool for medical applications particularly at the treatment decision step. Data mining helps to the doctor to decide in a short time.     

治疗选择偏倚的存在与观察性研究分析：使用倾向积分法和工具变量法评价心脏介入治疗对AMI存活的影响

背景：对观察性研究中治疗与未治疗患者的结果进行比较时，由于患者预后存在组间差异，因此可发生偏倚，后者常常是因为存在未予观察的治疗选择偏倚。 目的：对下列4种去除观察性研究选择偏倚的分析方法进行比较：多变量模型危险校正法（muhivariable model risk adjustment）、倾向积分危险校正法（propensity score risk adjustment）、倾向匹配法（propensity—based matching）以及工具变量分析法（instrumental variable analysis）。 设计、地点及患者：122124例因急性心肌梗死（AMI）而于1994～1995年住院的、接受医疗保险的老年（年龄65～84岁）患者全国队列。这些患者适合心脏导管检查。基线图表审查取自心血管协作项目并与医疗保险健康管理数据联合以便提供系列预后变量。患者随访7年（至2001年12月31日）以便评估长期存活与住院30天内心脏导管检查两者的关系。 主要观测指标：使用各种分析方法获得的危险校正后相对死亡率。 结果：与未接受心导管检查的患者相比，接受心导管检检查的患者较年轻而且急性心肌梗死的严重度较低。采用标准的统计学危险校正法校正预后因素后，心导管检查与死亡率相对下降50％相关（多变量模型危险矫正法：校正后相对危险度[relative risk，RR]，〉0．51；95％可信区间[confidence interval，CI]，0．50～0．52。倾向积分危险校正法：校正后RR，0．54；95％CI，0．53～0．55]。倾向配对法：校正后RR，0．54；95％CI，0．52～0．56）。使用局部插管作为一种工具，工具变量分析显示死亡率相对下降16％（校正后RR，0．84；95％CI，0．79～0．90）。随机临床试验中常规介入治疗的生存获益在8％和21％之间。 结论：心导管检查与急性心肌梗死长期死亡率的关系对分析方法高度敏感。对于去除未测量的治疗选择偏倚而言，各种标准危险校正方法具有同样的局限。与标准建模法比较，工具变量分析法可以减少治疗效果偏倚。但是相对于特殊的临床问题，该法更适合回答政策策略问题。     

A Hybrid Data Mining Model to Predict Coronary Artery Disease Cases Using Non-Invasive Clinical Data

Coronary artery disease (CAD) is caused by atherosclerosis in coronary arteries and results in cardiac arrest and heart attack. For diagnosis of CAD, angiography is used which is a costly time consuming and highly technical invasive method. Researchers are, therefore, prompted for alternative methods such as machine learning algorithms that could use noninvasive clinical data for the disease diagnosis and assessing its severity. In this study, we present a novel hybrid method for CAD diagnosis, including risk factor identification using correlation based feature subset (CFS) selection with particle swam optimization (PSO) search method and K-means clustering algorithms. Supervised learning algorithms such as multi-layer perceptron (MLP), multinomial logistic regression (MLR), fuzzy unordered rule induction algorithm (FURIA) and C4.5 are then used to model CAD cases. We tested this approach on clinical data consisting of 26 features and 335 instances collected at the Department of Cardiology, Indira Gandhi Medical College, Shimla, India. MLR achieves highest prediction accuracy of 88.4 %.We tested this approach on benchmarked Cleaveland heart disease data as well. In this case also, MLR, outperforms other techniques. Proposed hybridized model improves the accuracy of classification algorithms from 8.3 % to 11.4 % for the Cleaveland data. The proposed method is, therefore, a promising tool for identification of CAD patients with improved prediction accuracy.     

尘螨变应原疫苗治疗变应性鼻炎的临床动态观察

目的 观察并探讨尘螨变应原疫苗治疗变应性鼻炎的临床疗效及其安全性评价. 方法 纳入尘螨类过敏的变应性鼻炎患者300例,随机分为对照组和观察组（n=150）,对照组采取药物治疗法,观察组接受舌下含服变应性疫苗,比较两组患者在疗程结束时和停药几年后的药物评分、症状评分以及鼻炎相关生活质量评分,同时计算不良反应发生率,评价治疗效果和安全性. 结果 观察组药物评分由治疗结束时的1.07±0.54降至停药2年后0.21 ±0.45,具有极显著性差异（P＜0.01）.对照组停药2年后药物评分为0.98±0.37,与观察组比较具有显著性差异（P＜0.05）.同时,观察组症状评分和鼻炎相关生活质量评分均显著降低,与疗程结束时比较具有显著性差异（P＜0.01）,和对照组停药2年后比较也具有显著性差异（P＜0.05）.观察组中共计出现4例局部不良反应,5例全身不良反应,均为Ⅰ级,无Ⅱ级及以上不良反应. 结论 尘螨变应原疫苗治疗变应性鼻炎可显著改善患者症状和体征,疗效确切,是一种安全可靠的治疗方法,值得临床推广应用.     

改善微循环对老年骨质疏松症钙治疗作用研究

老年性骨质疏松症属退行性疾病,系因微循环障碍、血流变异常、氧代谢紊乱导致细胞功能低下,使骨需物质的吸收、运载及利用失衡而发病。为解决老年骨质疏松患者钙吸收困难的问题进行本项研究,对象共90例,年龄50～69岁,男女各占一半,均为微循环总分值6.0以上、骨密度值低于同年龄组正常参考值1.5个标准差以上、有骨痛症状的非继发性骨质疏松病人。分设两组,第1组为治疗组,60例,男女各30例;先用氦氖弱激光氧液治疗1个疗程,复检微循环明确改善程度后,每日口服钙尔奇D片600毫克,连续服用3个月,复检骨密度。第2组为对照组.30例,男女各15例;每日口服钙尔奇D片600毫克,连续服用3个月,复检骨密度。治疗组病例骨痛症状全部控制,治疗前后检测的徽循环、血流变及骨密度数据,经统计学t检验处理P<0.01,有显著意义;对照组仅部分病例骨痛症状减轻,治疗前后检测的骨密度数据,经统计学t检验处理P>尸>0.05,无意义。说明改善老年骨质疏松患者微循环障碍的程度,有促进机体对钙的吸收作用。     

The Feasibility of Using Automated Data to Assess Guideline-Concordant Care for Schizophrenia

This study examines the feasibility of using automated computer data versus written medical record data to identify patients receiving guideline concordant treatment for schizophrenia. Central elements of care derived from published practice guidelines for schizophrenia were examined for a convenience sample of 28 patients who received acute inpatient treatment. The results showed that automated data were superior to medical record data for identifying some elements of guideline-concordant treatment. Not only were the elements of care examined in this study clinically significant and within the current capabilities of the existing computer information system, but they are also likely related to patient outcomes. Implications for clinical care, future research, and health care quality improvement efforts are discussed.     

利用虚拟化技术构建医院数据中心

分析传统医院数据中心架构存在的问题,从虚拟化架构、服务器资源整合、网络配置优化等方面提出利用虚拟化技术构建新型医院数据中心.服务器虚拟化整合能够节省资源,提高利用率,简化硬件维护和升级,降低运营成本,提高维护效率.     

A Pragmatic Observational Feasibility Study on Integrated Treatment for Musculoskeletal Disorders: Design and Protocol

Background:Musculoskeletal disorders(MSD) comprise a wide range of conditions,associated with an enormous pain and impaired mobility,and are affecting people's lives and work.Management of musculoskeletal disorders typically involves a multidisciplinary team approach.Positive findings have been found in previous studies evaluating the effectiveness of complementary therapies,though little attention has been paid to evaluating of the effectiveness of integrated packages of care combining conventional and complementary approaches for musculoskeletal conditions in a National Health Service(NHS) setting.Objective:To determine the feasibility of all aspects of a pragmatic observational study designed:(1) to evaluate the effectiveness and cost effectiveness of integrated treatments for MSDs in an integrated NHS hospital in the UK;(2) to determine the acceptability of the study design and research process to patients;(3) to explore patients' expectation and experience of receiving integrated treatments.Methods:This is an observational feasibility study,with 1-year recruitment and 1-year follow-up,conducted in Royal London Hospital for Integrated Medicine,University College London Hospital Trust,UK.All eligible patients with MSDs newly referred to the hospital were included in the study.Interventions are integrated packages of care(conventional and complementary) as currently provided in the hospital.SF-36 Health Survey,short form Brief Pain Inventory,Visual Analogue Scale,and modified Client Service Receipt Inventory will be assessed at 4/5 time points.Semi-structured interview/focus group will be carried out before treatment,and 1 year after commence of treatment.Discussion:We intend to conduct a pragmatic observational study of integrated medical treatment of MSDs at a public sector hospital.It will inform the design of a future trial including recruitment,retention,suitability of the outcome measures and patients experiences.     

甲磺酸阿帕替尼治疗驱动基因未明的晚期非小细胞肺癌的观察性研究

目的：探讨非干预性观察甲磺酸阿帕替尼对表皮生长因子受体(EGFR)野生或未明的晚期非小细胞肺癌(NSCLC)的疗效及安全性。方法：选取2015年8月至2017年4月某院就诊化疗失败的34例EGFR野生或未明的晚期NSCLC患者,以口服甲磺酸阿帕替尼（425mg·d-1）为主要治疗,观察其无进展生存期（PFS）、客观缓解率（ORR）和疾病控制率（DCR）,随访相关不良事件。结果：34例患者中可评价疗效者30例,中位PFS（mPFS）为3.75个月（95%CI：0.648~6.852）,ORR为20%,其中部分缓解（PR）6例（20.00%）,疾病稳定（SD）16例（53.33%）,进展（PD）7例（23.33%）,DCR为73.33%。不良反应主要有高血压18例（52.94%）、手足综合征18例（52.94%）、蛋白尿15例（44.12%）和乏力14例（41.18%）,无药物相关性死亡。疗效相关性分析显示ECOG评分0~1分和联合化疗是延长PFS的因素,联合化疗为独立预后因子。结论：甲磺酸阿帕替尼治疗化疗失败的晚期NSCLC有良好疗效,不良反应可期可控,有进一步开展大规模临床研究的价值。     

消除摇瓶与罐发酵工程参数差异的一种方法

以所测得的摇瓶内分压（ｐｆ）数据，及冷模实验求出的瓶口过滤层氧通透率，求出了啤酒酵母摇瓶发酵真实氧传递系数（ＫＬａ）；以摇瓶周围大气压（Ｐａ）计算得出了表观氧传递系数（ＫＬａ）ａｐｐ，两者差异较大。此外，分析比较了考虑水分蒸发时求出的摇瓶内的菌体摄氧率（ＯＵＲ）、ＫＬａ与不计水分蒸发时所求的上述参数间差值的大小，得出：考虑水分蒸发并以摇瓶内分压数据来求算ＫＬａ和ＯＵＲ值，能有效地消除瓶与罐发酵的差     

利用VB实现全屏数据编辑功能数据表的方法

在临床和基础科研工作中,随着计算机应用水平不断提高,数据处理手段日趋先进,可选用的统计方法不断增加,利用已知数据所能得到的结论更加科学可靠。笔者在１９９７年１０月开发完成了“Ｄａｔａｗｉｎｄ—医学文献数据处理系统”,经多家医学院校、各类医院、各级医学...     

小剂量微波理疗婴幼儿手术切口疗效观察

目的:探讨小剂量微波理疗对治疗婴幼儿手术切口的疗效。方法:186例婴幼儿手术切口随机分为观察组和对照组各93例,观察组用微波理疗,对照组涂擦百多帮,其他治疗两组相同,5天后观察切口红、肿、渗出等情况。结果:观察组各项指标均低于对照组(P<0.05),差异有显著性。结论:小剂量微波理疗能促进切口愈合,提高疗效,缩短疗程,减轻医疗费用。     

从气象资料变异系数看六气主气时段划分合理性

一年划分为六气是中医运气学说的重要基础,运气学说用从大寒起始的六个主气代表一年六个时段的正常气候变化,但有观点认为六气应从立春起始,究竟哪种起始更合理?通过分析10地区30年气象资料变异系数,证实了六气以大寒为起始的划分更符合运气理论、更合理。     

Using Data Envelopment Analysis to Measure the Technical Efficiency of Public Health Centers in Kenya

Data Envelopment Analysis has been widely used to analyze the efficiency of health sector in developed countries, since 1978, while in Africa, only a few studies have attempted to apply DEA in the health organizations. In this paper we measure technical efficiency of public health centers in Kenya. Our finding suggests that 44% of public health centers are inefficient. Therefore, the objectives of this study are: to determine the degree of technical efficiency of individual primary health care facilities in Kenya; to recommend the performance targets for inefficient facilities; to estimate the magnitudes of excess inputs; and to recommend what should be done with those excess inputs. The authors believe that this kind of studies should be undertaken in the other countries in the World Health Organization (WHO) African Region with a view to empowering Ministries of Health to play their stewardship role more effectively.