大数据背景下观察性研究中对照选择的方法学进展

对照选择作为流行病学研究设计的核心,伴随健康医疗大数据研究的日益增多,其策略在不断丰富和完善,不同策略潜在影响的估计方法也在不断提出和推广.中国流行病学工.作者亟需紧跟国际对照选择相关的方法学趋势,发现并解决方法学本土化问题,以便更好地服务于健康医疗大数据的开发.     

我国医疗机构在大数据时代下的机遇与挑战

当前,大数据技术在互联网行业得到了广泛的应用。国家对大数据的应用也非常重视,并于2015年和2016年先后发布《国务院关于印发促进大数据发展行动纲要的通知》和《国务院办公厅关于促进和规范健康医疗大数据应用发展的指导意见》,从国家层面推动大数据在各行业的应用。笔者分析了我国医疗机构在当前情况下,在应用大数据方面所面临的机遇以及挑战。     

大数据时代构建“患者画像”的机遇与挑战△

作者介绍了以大数据时代为背景,构建“患者画像”的目的和具体应用,结合用户画像和互联网医疗的发展,探讨构建“患者画像”的机遇与挑战,展望构建“患者画像”相关应用发展的三个策略方向。     

大数据时代的流行病学研究：机遇、挑战与展望

近年来,高通量组学技术迅速发展,人群队列与样本资源逐渐累积,互联网和信息技术飞速进步,大数据开发工具不断涌现,健康医疗大数据为流行病学研究提供了丰富的数据资源和广阔的科研平台。本文将分析大数据时代流行病学研究的机遇和挑战,展望未来学科的发展方向。流行病学应抓住机遇,开辟新方向、发展新方法,推动医学基础研究成果向公共卫生...     

健康医疗大数据驱动下的流行病学研究:机遇与挑战

本文回顾健康医疗大数据国家战略的形成与发展,结合流行病学研究的视角,探讨健康医疗大数据的时代机遇和现实挑战,为未来健康医疗大数据驱动下的流行病学研究提出新思路。     

医疗大数据的应用与挑战

目的 :为更好地利用医疗大数据为医院的管理及诊疗服务,对医疗大数据的应用情况进行探讨。方法 :在剖析医疗大数据基本概念、来源及特征的基础上,对医疗大数据的处理流程及应用模型进行分析,并重点阐述医疗大数据的应用领域及面临的挑战。结果:提出规范电子病历数据的采集与存储、搭建数据云平台、建立医疗大数据人才队伍、构建数据驱动型组织、加强数据加密及匿名技术的发展等方法应对挑战。结论:医疗大数据的应用提高了医疗质量,是今后智能医疗的发展方向。     

大数据时代医学图书馆特色服务的机遇与挑战

随着社会的快速发展,大数据的应用范围正在不断扩大,不仅可以为企业带来巨大的经济效益,也可以推动企业的快速发展。目前,我国很多医学图书馆已经应用大数据技术建立数据平台,查询用户的借阅信息,也可以为用户提供信息查询服务。图书馆就为用户提供服务的,如果图书馆的服务无法让用户的满意,就会影响图书馆的社会地位,图书馆的功能也无法发挥出来。大数据时代给医学图书馆带来机遇的同时也带来了新的挑战。     

基于大数据的随机对照试验

我国医疗领域目前已积累了海量数据,如何利用大数据开展随机对照试验日益得到关注。本研究结合国外利用大数据实施随机对照试验的成功经验,从数据来源、研究对象和研究结局确定、干预措施、随机化方法、知情同意的实施等方面进行梳理总结,以期为国内未来开展相关研究提供借鉴。     

大数据时代我国高等医学教育挑战

随着计算机互联网信息技术的发展,社会进入大数据时代,传统的医学教育模式已经无法适应社会发展的需求.在大数据时代背景下,探讨我国高等医学教育面临的困境与矛盾,从改革理念、培养模式、课程设置、信息素养、人文素质等五个方面提出对策与建议.     

健康医疗大数据的应用及其挑战

在数据驱动的时代下,各领域产生的数据数量惊人,医疗行业正处于大数据时代的潮流中:医疗实践在产生数据的同时,数据也在改变着医疗实践,例如在模型预测、决策支持、疾病监测等方面[1]。与此同时,人们对健康医疗大数据重要性的认知也有所增加。与统计学知识在解释试验结果和探索未知研究中发挥的作用一样,大数据可以协助医疗行业从业者了解和推进所在领域的研究。为了实现这些收益,医疗行业从业者需要了解和掌握大数据在医疗领域中的基本概念内容和应用情况。然而,基于各类研究中不同的目的、领域及其他因素,关于健康医疗大数据从概念到应用仍存在争议。     

Vaxtracker: Active on-line surveillance for adverse events following inactivated influenza vaccine in children

Vaxtracker is a web based survey for active post marketing surveillance of Adverse Events Following Immunisation. It is designed to efficiently monitor vaccine safety of new vaccines by early signal detection of serious adverse events. The Vaxtracker system automates contact with the parents or carers of immunised children by email and/or sms message to their smart phone. A hyperlink on the email and text messages links to a web based survey exploring adverse events following the immunisation. The Vaxtracker concept was developed during 2011 (n = 21), and piloted during the 2012 (n = 200) and 2013 (n = 477) influenza seasons for children receiving inactivated influenza vaccine (IIV) in the Hunter New England Local Health District, New South Wales, Australia. Survey results were reviewed by surveillance staff to detect any safety signals and compare adverse event frequencies among the different influenza vaccines administered. In 2012, 57% (n = 113) of the 200 participants responded to the online survey and 61% (290/477) in 2013. Vaxtracker appears to be an effective method for actively monitoring adverse events following influenza vaccination in children.     

Active SMS-based surveillance of adverse events following immunisation with influenza and pertussis-containing vaccines in Australian pregnant women using AusVaxSafety

BackgroundMaternal immunisation is important to protect both mother and baby, but safety concerns can lead to low uptake. AusVaxSafety participant-based surveillance actively monitors adverse events following immunisation (AEFI) in Australia. We aimed to analyse AEFI in the days following vaccination with seasonal inactivated influenza vaccine (IIV) and/or reduced antigen diphtheria-tetanus-acellular pertussis vaccine (dTpa) in pregnant women in Australia.MethodsDe-identified AEFI reports were solicited from vaccine recipients via automated SMS survey (using SmartVax software) following routine vaccination with IIV and/or dTpa at 219 national sentinel surveillance sites from 2015 to 2018. AEFI rates were compared by vaccine group (IIV alone, dTpa alone, or IIV and dTpa together), vaccine brand, trimester (IIV only) and vaccination period (April to August 2016–2018; IIV only). Women who had two vaccination encounters during surveillance were identified and AEFI rates compared for each dose.ResultsAmong 13,758 participants, overall AEFI rates were lower following IIV (4.9%) than dTpa (6.4%) or IIV and dTpa given concomitantly (7.4%). The AEFI profile was similar for both vaccines, with injection site reactions, tiredness, and headache most commonly reported. Injection site pain and swelling/redness were significantly more common in women who received dTpa than IIV. Reports of medical attendance following immunisation were similar (0.3%) for each vaccine group. AEFI rates did not differ by IIV brand (FluQuadri®, Fluarix® Tetra), dTpa brand (Boostrix®, Adacel®), or by trimester. Among women with sequential dTpa vaccinations, 6.0% (7/116) had an AEFI following their second dTpa dose.ConclusionsSelf-reported AEFI rates did not differ by trimester (IIV), or by vaccine brand (IIV or dTpa). Concomitant influenza and pertussis vaccination was associated with more frequent, but low rates of minor, expected AEFI. These real world ‘citizen science-based’ data provide further reassuring evidence of the safety of maternal vaccination.     

我院医疗质量监控体系的构建

在分析数据挖掘技术的基础上,围绕医疗质量和患者安全管理的目标,结合医院管理需求,对医院信息系统中的数据进行梳理、挖掘,并在必要时对电子病历系统的数据表进行有效的改造,初步构建了一套基于电子病历系统的具有实时监测和预警功能的医疗质量监控体系.整套体系包括危重病例监控、手术及有创操作监控、整体情况监控、中医特色优势应用情况监控4个系统.     

Investigating adverse events following immunisation with pneumococcal polysaccharide vaccine using electronic General Practice data

BackgroundIn early 2011, following an increased number of reports of severe vaccine-related injection site reactions, Australian authorities recommended against administering repeat doses of the 23-valent pneumococcal polysaccharide vaccine (23vPPV) in otherwise healthy adults. The aim of this study was to assess a source of electronic medical record data from primary care providers (General Practitioners, GPs), for validity and ability to retrospectively detect this adverse event signal.MethodsThe General Practice Research Network (GPRN) holds data routinely collected from a representative sample of Australian GPs. Data were extracted on persons 18 years or older who had received at least one dose of 23vPPV or influenza vaccine (as comparator) between January 2002 and June 2012. Increases above background levels were assessed using 95% confidence intervals of reaction rates, calculated from the Poisson distribution of counts.ResultsThere was an average of 253 practices and 532 GPs contributing data per year. Over the study period there were 95,760 recorded 23vPPV administrations and 823 reactions, of which 233 were local. For influenza vaccine the numbers were 683,829 doses, 3001 and 387 respectively. Patterns of vaccinations and reactions were consistent with known safety profiles. There were 3 local reactions following 23vPPV in early 2011 (235/100,000 doses, 95% CI 49–717), which was not significantly different to the historical average (260, 225–298). We estimate that this system could have detected a 3-fold increase over background levels.ConclusionsUsing GP consultation data, we were unable to confirm an increase in local reactions detected by passive surveillance, suggesting that this apparent signal was artefactual. GP consultation data captures large numbers of vaccine recipients and medically attended adverse reactions at low cost. If available in a timely manner and expanded, this system has significant potential for use in validation of apparent signals from passive surveillance.     

2008年与2011年某综合医院外科ICU多药耐药菌主动监测培养结果分析

目的了解2008年和2011年上海中山医院外科ICU患者多药耐药菌(MDROs)的定植情况。方法患者进入ICU时(第1天)、第4天、每周和离开ICU时分别采集鼻拭和直肠拭子标本,使用生物梅里埃公司提供的耐药菌显色培养基,对鼻拭和直肠拭子标本分别进行耐甲氧西林金黄色葡萄球菌(MRSA)和产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌(ESBL+Eco/Klp)的筛查。结果 2008年和2011年鼻拭标本中MRSA检出率分别为5.0%和7.2%,直肠拭子中ESBL+Eco/Klp检出率分别为35.0%和42.0%;2008年入ICU时MRSA/ES-BL+Eco/Klp的定植率为39.7%,出ICU时为47.4%,2011年则分别上升至49.3%和58.9%,2008年入住ICU第3～4天,MRSA获得的定植率为9.7%,入住5～7 d后上升为22.7%;2011年分别为16.3%和22.2%,2008年在相应时间段获得ESBL+Eco/Klp定植率分别是13.0%和40.0%;2011年则为7.7%和40.0%。结论 2011年ICU的MRSA/ESBL+Eco/Klp的检出率和定植率比2008年明显上升;定植率随着入住ICU时间的延长显著增加。     

Detecting possible vaccine adverse events in clinical notes of the electronic medical record

The Vaccine Safety Datalink (VSD) is a collaboration between the CDC and eight large HMOs to investigate adverse events following immunization through analyses of clinical data. We modified an existing system, called MediClass, that uses natural language processing to identify clinical events recorded in electronic medical records (EMRs). We customized MediClass so it could detect possible vaccine adverse events (VAEs) generally, and gastrointestinal-related VAEs in particular, in the text clinical notes of encounters recorded in the EMR of a large HMO. Compared to methods that use diagnosis and utilization codes assigned to encounters by clinicians and administrators, the MediClass system can both find more adverse events and improve the positive predictive value for detecting possible VAEs.     

大数据时代临床数据库在肿瘤研究中的应用

2018年全球癌症统计数据显示，世界范围内癌症的发病率和病死率呈持续增高趋势，癌症已成为危害人类健康的重要杀手，也是当今医学研究的热点话题。随着生物信息技术的迅速发展和精准医学大数据的崛起，世界各地的研究人员构建了大量功能不同的癌症数据库，利用现代生物信息技术对大量临床医疗数据进行深度挖掘与分析，数据库的建立为癌症的机制学研究提供了丰富的数据来源和人群支持。本文主要对目前国内外癌症数据库的研究进展进行介绍，并结合我中心建立的肝癌临床数据库，探讨其在癌症研究方面的应用及意义，对我国乃至世界各癌症数据库的发展提出展望。     

2015-2016年南通市食源性疾病主动监测结果分析

目的 对南通市2015-2016年食源性疾病主动监测结果进行了分析,了解南通市食源性疾病流行特征,为预防和控制食源性疾病提供科学依据。方法 收集在哨点医院就诊的食源性疾病病例信息并采集病例标本进行病原学检测。结果 共监测3 438例食源性疾病病例信息,病例多集中于25~34岁,高发期为7~9月。可疑暴露食品中占比最高的是肉与肉制品,其次为水产动物及其制品。共采集标本830份,检出阳性病原体101株,总检出率为12.17%。副溶血性弧菌检出率最高,三季度病原体检出率最高。结论 南通市食源性疾病高发期为7~9月,主要以副溶血性弧菌感染为主。需要加强食源性疾病主动监测工作,不断完善监测体系,减少食源性疾病的发生。     

A statistical methodology for postmarketing surveillance of adverse drug reaction reports

This paper presents a statistically optimal exact hypothesis testing procedure for detecting changes in sales adjusted adverse drug reaction (ADR) rates between historical and current periods, with a computer program that implements this test appended. We provide discussions and illustrations on how to monitor ADR rates for product lines that consist of several pharmacologically equivalent dosage forms.