一种医学辅助诊疗系统的构造方法

一种医学辅助诊疗系统的构造方法范逢曦，李祥生（山西医学院计算机中心，太原）李茹香，刘卓敏，李运乾（山西医学院第一附属医院心血管科，太原）关键词：医学辅助诊疗，心肌梗塞，预后ＡＳＴＲＵＣＴＵＲＥＤＭＥＴＨＯＤＯＦＭＥＤＩＣＡＬＡＩＤＥＤＤＩＡＧＮＯＳＩ...     

从循证医学与转化医学谈中医药临床研究发展

中医药是中华文明的瑰宝,优势在于临床以整体观念和辨证论治为指导思想,强调以人为本的理念,具有科学和人文的双重属性。临床疗效体现了中医药的生命力,近年来,研究者聚焦中医临床优势病种和优势疗法,掌握循证医学方法,建立符合中医药特点的临床疗效评价新方法、新技术,与国际临床研究模式接轨,获得共识认可。运用转化医学思路和方法,从需求和疗效出发,构建临床与基础的转化平台,提高临床服务水平,促进新药物、新技术开发。总之,中医药临床研究发展应坚持国学原理,弘扬原创思维,兼容并蓄,文明互鉴,和合互动,多学科交叉协作,迎接大科学、大卫生背景下高概念、大数据、信息智能两化融合新纪元,把握中医药从中西医汇通到中西医并重来之不易的发展形势,实现我主人随,传承创新。     

美国国家科研资源中心(NCRR)战略计划及对发展我国转化医学的思考

较全面地了解美国国家科研资源中心(NCRR)的宗旨、研究项目及其发展计划,为加强我国与NCRR的合作及在国内开展转化医学研究提出若干建议.通过介绍NCRR的宗旨、资助项目及其在NIH长期蓝图中的地位,结合我国转化医学的进展状况,找出我国与美、英等发达国家在转化医学研究、发展中的差距,本文总结了从事转化医学研究的艺术.我国转化医学研究尚处于起步阶段,与国外发达国家还有较大差距.吸收发达国家转化医学研究与实践的先进成果,转换理念,以整合相关资源等方式促进我国转化医学研究的发展.     

转化生长因子β1和β3在前列腺癌的表达及意义

一、材料与方法１标本：选用我院１９８６～１９９６年间前列腺癌４６例，年龄５３～８４岁，平均６８２±９１岁。组织学分级（Ｇｌｅａｓｏｎ标准）：２～５分（高分化）２５例，６～８分（中分化）１９例，９～１０分（低分化）２例。临床分期（Ｊｅｗｅｔｗｈ...     

试述转化医学的发展与实践

转化医学是连接基础研究与临床应用的创新研究模式,发展转化医学,促进成果转化,可为临床疾病的防、 诊、治提供先进的理念和方法。本文围绕转化医学的发展和实践进行综述。     

肺癌分子标志物的研究进展及转化应用

转化医学促进了分子生物学等基础医学发展,改变了医学模式。其目的是将医学的基础研究成果快速有效的转化为用于临床的技术和药物,为医学知识服务临床铺平道路。随着肿瘤分子生物学的研究进展,越来越多的分子生物标志物被发现并用于肺癌的诊断、治疗、预后和疗效监测。本文将肺癌分子标志物的研究进展和在转化方面的应用进行综述。     

100例急诊肠梗阻患者的影像及临床诊疗

目的：对100例急诊肠梗阻患者的影像及临床诊疗情况进行分析。方法资料选自2011年7月~2013年7月在我院救治的急诊肠梗阻患者100例。将所有患者随机分为研究组和对照组,根据患者的具体情况予以手术治疗和保守治疗。在诊断方面,对照组患者予以X线检查,研究组患者在此基础上予以CT检查,分析临床诊断的准确率。结果分析急诊肠梗阻的主要病因,其主要为肿瘤性急性肠梗阻和粘连性肠梗阻,分别占总数的41%和44%;在梗阻原因诊断准确率的比较中,研究组的准确率高达100.00%,显著高于对照组的44.00%,两组数据的比较差异具有统计学意义(P<0.05)。结论急诊肠梗阻的主要病因为恶性肿瘤和粘连,且在疾病诊断中,予以患者X线检查后行CT检查,可显著提升病因方面的确诊率,值得在临床推广应用。     

导师培训项目提升临床和转化医学导师的自信心和技能

目的北京协和医院于2018年首次引入导师培训项目(MTP),以加强人才培养体系建设。本研究旨在对MTP培训的效果进行调查研究。方法研究纳入18位接受MTP培训的临床和转化医学导师,培训前、培训后1周、3个月对导师技能的自信程度进行问卷调查。采用非参数Kruskal-Wailis H检验评估培训前后的差异,使用开放编码分析开放性问题。结果经MTP培训后,全部导师认为培训提高导师技能、有助于成为优秀的导师,促进导师间的联络与合作,提高职业满意度。导师对具体技能的信心如沟通、制定长期职业规划、与学生制定统一的目标、时间管理、以身作则、获得课题基金、撰写发表研究结果等方面均有显著提高。导师的实践改变体现在将导师理念、沟通模式和技巧、利用MTP培训学习到的个人发展工具等应用到导师的实践过程。结论MTP培训有助于导师理念革新和技能提升,可考虑进一步开展并推广,培养具有胜任力的临床和转化医学导师。     

医学科研院所科技成果转化的问题及对策

为提高医学科研院所科技成果转化的效率,本文从科研管理的角度分析了医学科研院所科技成果转化存在的问题,即组织机构和功能设计不完善、转化相关专业人才缺乏、转化资金投入不足、转化平台不健全等。提出可从完善组织机构和功能设计、优化学科和人才培养体系、加大经费投入及优化经费结构、加强医学科技成果转化服务平台建设等方面探索解决问题的对策。     

肾癌转化生长因子β1表达及与预后的关系

目的 探讨转化生长因子β1(TGFβ1)肾癌发生、发展中的作用及与预后关系。方法 采用免疫组化ABC法对45例肾癌组织中TGFβ1表达进行了研究，对患者存活率进行回顾性随访。结果 癌旁肾组织中TGFβ1阳性表达率显著高于肾癌组织。TGFβ1阳性表达率随肾癌病理分级和临床分期的上升而下降，染色强度也减弱。TGFβ1阳性表达组3年及5年存活率高于阴性表达组。结论 TGFβ1为肾癌的负性调节因子，对抑制肾癌的恶性转化和进展可能有重要的意义。临床上检测TGFβ1可作为肾癌恶性度及预后评估的参考指标之一。     

基于双层建模的知识表达方法在医学知识库构建中的应用

医学知识库是临床决策支持系统(CDSS)的重要组成部分。目前部署在医院内部的CDSS通常针对特定的需求(如合理用药、辅助诊断),其知识库所涵盖的知识种类比较单一。构建一个整合多种不同医学知识种类的协同知识库,能够使得不同类型的知识内容作为一个有机整体提供更加全面和有效的决策支持应用。提出一种基于双层建模的知识表达方法,首先分析和归纳临床信息化环境下影响诊疗决策的各类医学知识,如诊断知识、治疗知识、药学知识等,并对它们之间的协同关系进行定义,形成认知模型,然后针对特定的知识推理和计算的需求,为每一种知识类型选取具体的知识表达形式,形成最终的计算模型。基于该双层建模方法所研发的临床决策支持系统在三甲医院已运行4年多,实践表明该系统有效解决不同知识类型的集成和推理的需要,为构建整合和全面的知识应用奠定基础。     

药物基因组学临床决策支持系统综述

近几年来精准医学成为生物医学的一个热门领域,世界各国都致力于率先在这一领域取得突破性的进展。药物基因组学(PGx),通过基因组学和其他“组学”知识来个性化药物选择和药物使用以避免药物不良反应和最大化药物疗效,是精准医学的重要组成部分,也是目前最有希望在临床上实现日常应用的精准医学领域之一。其中药物基因组学临床决策支持(PGx-CDS)系统,是实现PGx临床应用和知识转化必不可少的工具。目前很多临床医疗机构已经开展PGx服务并部署PGx-CDS系统,同时更多的临床医疗和研究机构正在筹备开展这类服务。对目前已出现并被报道的主要PGx-CDS系统和研究进行文献综述,共涉及11个PGx-CDS系统。通过对这些系统的临床应用场景、系统设计、知识表达、干预方式和应用评估等方面的综合回顾,总结目前PGx-CDS系统的研究进展和发展现状,然后对PGx-CDS系统目前面临的主要挑战和未来发展方向进行讨论,为在国内落地PGx服务和PGx-CDS系统提供借鉴。     

Credentialed Persons, Credentialed Knowledge

The vast experimental literature on human error agrees with history of medicine, folklore, and superstition In discrediting knowledge claims based solely on anecdotal impressions. Since clinical experience consists of anecdotal impressions by practitioners, tt Is unavoidably a mixture of truths, half-truths, and falsehoods. The scientific method is the only known way to distinguish these, and it is both unscholariy and unethical for psychologists who deal with other persons' health, careers, money, freedom, and even life itself to pretend that clinical experience suffices and that quantitative research on diagnostic and therapeutic procedures is not needed. Disputes about philosophy of science (e.g., logical positivism) are irrelevant to this issue, which is simply one of distinguishing knowledge claims that bring reliable credentials and others that do not.     

Engaging With a Wiki Related to Knowledge Translation: A Survey of WhatisKT Wiki Users

Background

In 2008, WhatisKT wiki was launched as a collaborative platform for knowledge translation (KT) researchers and stakeholders to debate the use and definitions of KT-related terms. The wiki has definitions for over 110 terms from disciplines including health care, information technology, education, accounting, and business. WhatisKT wiki has over 115 registered users. Approximately 73,000 unique visitors have visited the wiki since 2008. Despite annual increases in visitors and regular maintenance of the wiki, no visitors have contributed content or started a discussion.

Objective

We surveyed wiki users to gain an understanding of the perceived value of the website, reasons for not engaging in the wiki, and suggestions to facilitate collaboration and improve the usability of the wiki.

Methods

We surveyed three cohorts: KT Canada members who were previously invited to join the wiki, registered wiki members, and unregistered visitors. The first two cohorts completed a Web-based survey that included the System Usability Scale (SUS) questionnaire to assess usability; additionally 3 participants were interviewed. Unregistered wiki visitors were surveyed with polls posted on the wiki. The study received ethics approval from the McMaster University Faculty of Health Sciences Research Ethics Board.

Results

Twenty-three participants completed the Web-based and SUS surveys; 15 participants indicated that they would collaborate on the wiki. The mean SUS score of 67 (95% CI 56-77) indicated that the wiki could be considered for design improvements. Study participants indicated that the wiki could be improved by email notification regarding new terms, better grouping of terms, user friendly interface, and training for users interested in editing content.

Conclusions

The findings from this survey will be used to enhance the design and content of WhatisKT wiki. Further feedback from participants will be used to make the wiki an ideal collaboration platform for KT researchers interested in terminology.     

Grading quality of evidence and strength of recommendations in clinical practice guidelines

The GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach provides guidance to grading the quality of underlying evidence and the strength of recommendations in health care. The GRADE system's conceptual underpinnings allow for a detailed stepwise process that defines what role the quality of the available evidence plays in the development of health care recommendations. The merit of GRADE is not that it eliminates judgments or disagreements about evidence and recommendations, but rather that it makes them transparent. This first article in a three-part series describes the GRADE framework in relation to grading the quality of evidence about interventions based on examples from the field of allergy and asthma. In the GRADE system, the quality of evidence reflects the extent to which a guideline panel's confidence in an estimate of the effect is adequate to support a particular recommendation. The system classifies quality of evidence as high, moderate, low, or very low according to factors that include the study methodology, consistency and precision of the results, and directness of the evidence.     

Grading quality of evidence and strength of recommendations in clinical practice guidelines part 3 of 3. The GRADE approach to developing recommendations

This is the third and last article in the series about the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to grading the quality of evidence and the strength of recommendations in clinical practice guidelines and its application in the field of allergy. We describe the factors that influence the strength of recommendations about the use of diagnostic, preventive and therapeutic interventions: the balance of desirable and undesirable consequences, the quality of a body of evidence related to a decision, patients' values and preferences, and considerations of resource use. We provide examples from two recently developed guidelines in the field of allergy that applied the GRADE approach. The main advantages of this approach are the focus on patient important outcomes, explicit consideration of patients' values and preferences, the systematic approach to collecting the evidence, the clear separation of the concepts of quality of evidence and strength of recommendations, and transparent reporting of the decision process. The focus on transparency facilitates understanding and implementation and should empower patients, clinicians and other health care professionals to make informed choices.     

Perceived Criticism: A Research Update for Clinical Practitioners

Perceived criticism (PC), an easily obtained measure that can be assessed using a single item, predicts a range of negative clinical outcomes. Evidence suggests that PC is not a proxy for neuroticism or other variables that could be relevant for prognosis. PC also shows incremental predictive validity over related constructs. This may be because PC appears to moderate how the brain processes criticism and how people respond to negative stimuli more generally. Despite evidence supporting PC's concurrent and predictive validity, the measure is not currently used in clinical practice. In an effort to bridge this science–practice gap, we review the PC literature and highlight its clinical relevance. We also provide suggestions for using PC in clinical practice to improve outcomes.     

Grading quality of evidence and strength of recommendations in clinical practice guidelines: Part 2 of 3. The GRADE approach to grading quality of evidence about diagnostic tests and strategies

The GRADE approach to grading the quality of evidence and strength of recommendations provides a comprehensive and transparent approach for developing clinical recommendations about using diagnostic tests or diagnostic strategies. Although grading the quality of evidence and strength of recommendations about using tests shares the logic of grading recommendations for treatment, it presents unique challenges. Guideline panels and clinicians should be alert to these special challenges when using the evidence about the accuracy of tests as the basis for clinical decisions. In the GRADE system, valid diagnostic accuracy studies can provide high quality evidence of test accuracy. However, such studies often provide only low quality evidence for the development of recommendations about diagnostic testing, as test accuracy is a surrogate for patient-important outcomes at best. Inferring from data on accuracy that using a test improves outcomes that are important to patients requires availability of an effective treatment, improved patients' wellbeing through prognostic information, or – by excluding an ominous diagnosis – reduction of anxiety and the opportunity for earlier search for an alternative diagnosis for which beneficial treatment can be available. Assessing the directness of evidence supporting the use of a diagnostic test requires judgments about the relationship between test results and patient-important consequences. Well-designed and conducted studies of allergy tests in parallel with efforts to evaluate allergy treatments critically will encourage improved guideline development for allergic diseases.